不同疗程5％咪喹莫特乳膏预防尖锐湿疣的复发

目的 探讨应用不同疗程5％咪喹莫特乳膏预防尖锐湿疣复发的疗效和安全性。方法 采用随机、对照的方法，将患者分成3组：A组单用CO2激光治疗；B组用CO2激光祛除疣体后外用5％咪喹莫特乳膏4周，每周3次；C组用CO2激光祛除疣体后外用5％咪喹莫特乳膏8周，每周3次。所有患者均随访6个月。结果 共有90例外生殖器及肛周尖锐湿疣患者完成临床研究．6个月后．3组的复发率分别为64．29％、50％及21．88％，3组复发率比较，差异有统计学意义（P=0．0033）。外用咪喹莫特乳膏8周组复发率低于前两组；外用4周组与8周组复发率比较，差异有统计学意义（P=0．0207）。激光治疗后外用5％咪喹莫特乳膏4周组与8周组出现的不良反应率分别为73．33％．84．38％。不良反应包括：红斑、瘙痒、疼痛、灼热、糜烂、溃疡，以及流感样症状，两组差异无统计学意义（P〉0．05）。结论 激光治疗后外用5％咪喹莫特乳膏8周．皮损的复发率比外用4周明显下降。两组安全性无明显差异。     

咪喹莫特乳膏预防尖锐湿疣复发随机对照临床观察

5％咪喹莫特乳膏（5％ Imiquimod cream）为非核苷类异环胺类药，是新型外用免疫调节剂。研究表明5％咪喹莫特乳膏用于治疗肛周及外生殖器疣疗效好，复发率低。为观察咪喹莫特预防外生殖器和肛周尖锐湿疣复发的临床疗效，笔者于2005年1～7月对41例患者进行观察，现将结果报道如下。     

清疣洗剂联合5%咪喹莫特乳膏治疗尖锐湿疣临床观察

目的观察清疣洗剂联合5%咪喹莫特乳膏治疗肛周和外生殖器尖锐湿疣的临床疗效。方法将120例患者随机分为两组,治疗组用清疣洗剂外泡后局部外用5%咪喹莫特乳膏,对照组单纯局部外用5%咪喹莫特乳膏,治疗8周后,观察两组临床疗效。结果治疗组有效率为89.47%,对照有效率为48.15%,两组间的差异具有统计学意义(P<0.05);两组均无系统不良反应,仅有给药部位的局部不良反应,以轻度和中度红斑为多见,两组间差异无统计学意义(P>0.05)。结论清疣洗剂联合5%咪喹莫特乳膏治疗肛周和外生殖器尖锐湿疣的临床疗效较好,不良反应少。     

吡美莫司乳膏治疗特应性皮炎多中心、随机双盲、平行对照研究

目的评价1％吡美莫司乳膏治疗特应性皮炎的安全性和有效性。方法采用多中心、随机双盲、赋形剂平行对照的临床研究。特应性皮炎患者被随机分配至治疗组和安慰剂组，分别外用1％吡美莫司乳膏或赋形剂，每日2次，疗程4周，于治疗前（基线）及治疗后第1、2、4周各访视1次。主要疗效指标为研究者总体评估（IGA）评分，次要疗效指标包括湿疹面积与严重度指数（EASI）、瘙痒程度评分及受试者胪理者主观评分等。结果7个中心共有336例儿童和成人轻、中度特应性皮炎患者纳入意向治疗分析（ITT）。治疗结束时，1％吡美莫司乳膏组总体评估的治疗成功率为31．55％，明显高于赋形剂组的18．45％（P=0．0046）。其他疗效指标在治疗后第1、2．4周1％吡美莫司乳膏组均明显优于赋形剂组（P〈0．05）。1％吡美莫司乳膏组药物相关不良反应发生率为19．64％，赋形剂组为24．40％，主要表现为红斑，红斑加重、疼痛、瘙痒，瘙痒加重、烧灼感和毛囊炎等。结论1％吡美莫司乳膏对治疗儿童和成人轻、中度特应性皮炎疗效确切。安全性较好。     

国产咪喹莫特乳膏治疗尖锐湿疣随机双盲对照临床研究

目的:观察国产5％咪喹莫特乳膏治疗外生殖器和肛周尖锐湿疣的临床疗效和安全性。方法:采用随机、双盲、平行对照的临床研究方法,入选病例外搽试验药物,并轻轻按摩,每周3次,疗程8周。结果:治疗组疗后4、6、8周的治愈率分别为28.57％,52.38％,71.43％;对照组分别为18.18％,22.73％,27.27％;治疗组疗后4、6、8周的有效率分别为66.67％,76.19％,80.95％。对照组分别为31.82％(P=0.0337),31.82％(P=0.0058),31.82％(P=0.0019)。结论:5％咪喹莫特乳膏治疗外生殖器和肛周尖锐湿疣疗效好,不良反应轻,使用方便。     

5%咪喹莫特乳膏外用治疗尖锐湿疣70例

目的观察5％咪喹莫特乳膏外用治疗外生殖器尖锐湿疣的临床疗效。方法治疗组采用5％咪喹莫特乳膏外擦尖锐湿疣，隔日一次，共三个月；对照组采用0．5％足叶草毒素酊外擦尖锐湿疣，早晚一次，共3d为一个疗程，最多不超过三个疗程。结果治疗组70例患者，治疗组治愈51例（72．86％），无效19例（27．14％）；对照组70例患者，治愈36例（51．43％），无效34例（48．57％）。两组治愈率比较差异有统计学意义（X^2=6．83，P〈0．01）。结论5％咪喹莫特乳膏外用治疗外生殖器尖锐湿疣疗效好，安全性高，是一种较理想的治疗方法。     

5％眯喹莫特乳膏外用治疗尖锐湿疣70例

目的观察5％咪喹莫特乳膏外用治疗外生殖器尖锐湿疣的临床疗效。方法治疗组采用5％咪喹莫特乳膏外擦尖锐湿疣，隔日一次，共三个月；对照组采用0．5％足叶草毒素酊外擦尖锐湿疣，早晚一次，共3d为一个疗程，最多不超过三个疗程。结果治疗组70例患者，治疗组治愈51例（72．86％），无效19例（27．14％）；对照组70例患者，治愈36例（51．43％），无效34例（48．57％）。两组治愈率比较差异有统计学意义（X^2=6．83，P〈0．01）。结论5％咪喹莫特乳膏外用治疗外生殖器尖锐湿疣疗效好，安全性高，是一种较理想的治疗方法。     

咪喹莫特治疗尖锐湿疣的临床疗效分析

 目的:分析咪喹莫特治疗尖锐湿疣的临床疗效。方法：将160例尖锐湿疣患者随机分为治疗组和对照组两组，每组各80例，其中治疗组采用咪喹莫特乳膏治疗，对照组采用二氧化碳激光治疗，比较两组治愈率和疣体清除率，并分别随访1、4、8、12和16周，观察并记录患者复发率和不良反应情况。治疗后12周，检测患者皮损中  CD4^＋、CD8^＋和TNF-α的含量，比较治疗前后变化。结果：治疗组患者治愈率、疣体清除率分别为８２.５0％、９８.７５％，对照组分别为６０.００％、８３.７５％，差异均有统计学意义（P值均<0.001）。两组不良反应发生率以及治疗后皮损中  CD4^＋、CD8^＋和TNF-α含量比较，差异均有统计学意义（P值均<0.05），第8周后，两组复发率差异有统计学意义（P值均<0.05）。结论：咪喹莫特治疗尖锐湿疣能明显提高临床治疗效果，减少复发率,且安全性高。     

5%咪喹莫特乳膏治疗尖锐湿疣多中心、随机、双盲研究

目的观察5%咪喹莫特乳膏治疗肛周和外生殖器尖锐湿疣的临床疗效和安全性。方法采用随机、双盲、平行对照的临床研究方法,受试者每周3次局部外搽研究药物,用药后6￣8h用清水清洗,疗程8周。疣体完全消退者继续随访1个月以观察复发率。结果共有231例肛周及外生殖器尖锐湿疣患者参加本次研究,其中5%咪喹莫特乳膏治疗组116例,安慰剂对照组115例。治疗后2、4、6、8周的痊愈率在治疗组分别为8.41%、30.84%、49.53%及61.68%,对照组分别为2.68%、7.14%、16.07%及24.11%,两组间差异有统计学意义(P<0.001);疗后2、4、6、8周的有效率在治疗组分别为34.58%、60.75%、68.22%及74.77%,对照组分别为10.72%、18.75%、28.57%及32.14%,两组间差异有统计学意义(P<0.001)。治疗组痊愈患者随访1个月后的复发率为10.61%,与对照组相比差异无统计学意义。治疗组无系统不良反应,仅有给药部位的局部不良反应,以轻度和中度红斑为多见,发生率为34.55%。结论5%咪喹莫特乳膏治疗肛周和外生殖器尖锐湿疣疗效好,安全性好,使用方便。     

5%咪喹莫特乳膏治疗尖锐湿疣随机双盲临床研究

为评价国产咪喹莫特乳膏治疗外生殖器和肛周尖锐湿疣的临床疗效和安全性，采用随机、双盲、安慰剂平行对照研究方法。入选患者随机分为A、B两组，A组用基质安慰剂治疗，B组用5％咪喹莫特乳膏治疗，结果A组23例，B组24例按方案完成疗程。两组在治疗后2、4、6、8周治愈率、有效率均有显著性差异。两组不良反应严重程度比较无统计学差异。     

Outcomes and adverse effects of ablative vs nonablative lasers for skin resurfacing: A systematic review of 1093 patients

It is generally believed that ablative laser therapies result in prolonged healing and greater adverse events when compared with nonablative lasers for skin resurfacing. To evaluate the efficacy of ablative laser use for skin resurfacing and adverse events as a consequence of treatment in comparison to other modalities, a PRISMA‐compliant systematic review (Systematic Review Registration Number: 204016) of twelve electronic databases was conducted for the terms “ablative laser” and “skin resurfacing” from March 2002 until July 2020. Studies included meta‐analyses, randomized control trials, cohort studies, and case reports to facilitate evaluation of the data. All articles were evaluated for bias. The search strategy produced 34 studies. Of 1093 patients included in the studies of interest, adverse events were reported in a total of 106 patients (9.7%). Higher rates of adverse events were described in nonablative therapies (12.2% ± 2.19%, 31 events) when compared with ablative therapy (8.28% ± 2.46%, 81 events). 147 patients (13.4%) reported no side effects, 68 (6.22%) reported expected, transient self‐resolving events, and five (0.046%) presented with hypertrophic scarring. Excluding transient events, ablative lasers had fewer complications overall when compared with nonablative lasers (2.56% ± 2.19% vs 7.48% ± 3.29%). This systematic review suggests ablative laser use for skin resurfacing is a safe and effective modality to treat a range of pathologies from photodamage and acne scars to hidradenitis suppurativa and posttraumatic scarring from basal cell carcinoma excision. Further studies are needed, but these results suggest that ablative lasers are a superior, safe, and effective modality to treat damaged skin.     

New fillers for the new man

ABSTRACT:  Two new collagen-based lidocaine-containing dermal fillers, ArteSense™/ArteFill™ (Artes Medical, San Diego, CA) and Evolence® (Colbar LifeScience Ltd., Herzliya, Israel), have proved to be of particular interest to men, many of whom seek a long-lasting or permanent correction. ArteFill™ has been available in the United States since 2006, and it is expected that Evolence® will reach the American market in 2008. The properties of the two products will be described, and experience based on the administration of many hundreds of syringes of both products by a Canadian dermatologist will be detailed here, with tips and precautions to optimize patient outcomes.     

Multiple New-Onset Subcutaneous Nodules of the Upper Extremity Digits: Giant Cell Tumor of Tendon Sheath and Lipoma

A black woman with the concurrent onset of two subcutaneous nodules located on the digits of her upper extremities is described. Initially, a single systemic disorder was considered; yet, the lesions differed in morphology and consistency. Microscopic examination of the nodules showed a giant cell tumor of tendon sheath and a lipoma. Although Occam's “razor” suggests that multiple lesions in the same person are more likely to represent variable manifestations of a single disorder than several different diseases in that individual, the simultaneously appearing lesions in this patient represented two different conditions.     

Deutliche Einschränkung der Lebensqualität bei Patienten mit Pemphigus vulgaris: Ergebnisse der deutschen Bullous Skin Disease (BSD)‐Studiengruppe

Background: Pemphigus vulgaris is a potentially life‐threatening autoimmune disorder of the skin and mucous membranes characterized by antibodies against epidermal adhesion molecules. Clinically characteristic are painful chronic blisters or erosions of mucous membranes and skin. There are no published studies on the impact o this disease on quality of life. Patients and methods: This registration was performed within the scope of the German BSD (Bullous Skin Disease) study group, from November 1997 until January 2002. A total of 36 patients with the first diagnosis of pemphigus vulgaris were registered at the university hospitals of Dresden, Erlangen, Kiel, Mannheim, München and Würzburg. Thirty of the 36 (83 %) patients participated in the quality of life questionnaire utilizing the German version of ‘Dermatology Life Quality Index’ (DLQI) provided by A. Y. Finlay. The DLQI varies from 0 to 30 with an increased DLQI score indicating a decrease in quality of quality. Results: The overall DLQI total score of 10 ± 6,7 in the investigated pemphigus patients was significantly increased in comparison to other skin diseases. Conclusions: These results suggest that the DLQI can be a very useful additional outcome criteria for clinical studies with pemphigus vulgaris and in the treatment of these patients.     

Genetic alterations in RAS‐regulated pathway in acral lentiginous melanoma

Studies integrating clinicopathological and genetic features have revealed distinct patterns of genomic aberrations in Melanoma. Distributions of BRAF or NRAS mutations and gains of several oncogenes differ among melanoma subgroups, while 9p21 deletions are found in all melanoma subtypes. In the study, status of genes involved in cell cycle progression and apoptosis was evaluated in a panel of 17 frozen primary acral melanomas. NRAS mutations were found in 17% of the tumors. In contrast, BRAF mutations were not found. Gains of AURKA gene (20q13.3) were detected in 37.5% of samples, gains of CCND1 gene (11q13) or TERT gene (5p15.33) in 31.2% and gains of NRAS gene (1p13.2) in 25%. Alterations in 9p21 were identified in 69% of tumors. Gains of 11q13 and 20q13 were mutually exclusive, and 1p13.2 gain was associated with 5p15.33. Our findings showed that alterations in RAS‐related pathways are present in 87.5% of acral lentiginous melanomas.     

Medición del impacto psicológico en pacientes con psoriasis en tratamiento sistémico

Background and objectives

The negative impact of psoriasis on patient quality of life can be as important as the physical consequences of the disease. We could assume that clearance of the disease would also lead to an improvement in its psychosocial impact. The present study assesses the psychological state of patients with psoriasis receiving systemic treatment in a psoriasis unit, especially those with mild or no disease involvement.