癫痫发作伴血管内压增高性紫癜1例

癫痫发作伴血管内压增高性紫癜１例张新桂林市第二人民医院皮肤科（邮政编码５４１００１）患者女，２７岁。因癫病发作伴面颈部皮下瘀点１天，于１９９４年９月１３日就诊，７年前患“病毒性脑炎”，约２年后出现癫痛，在京沪大医院确诊为“继发性癫痛”。近几次在夜间发...     

组织细胞样Sweet综合征1例

患者男,36岁,因面颈部及四肢皮肤反复起疹伴疼痛2年,加重4 d于2020年1月10日第3次入我院。患者2年前因“支原体感染”于当地医院应用抗炎药（具体不详）治疗,双小腿、双足出现红斑、结节伴疼痛（图1A）,于2018年1月25日第1次入我院,结合病理（图1B）诊断为“脂膜炎”……     

308 nm准分子激光联合他克莫司乳膏治疗儿童面颈部白癜风疗效观察

目的 评价308 nm准分子激光联合0.03%他克莫司乳膏治疗儿童面颈部白癜风的疗效及安全性。 方法 68例儿童面颈部白癜风（年龄 ≤ 14岁）,根据皮损部位分为皮损组（包括面颈部）;腔口组（包括口周、眼周）;均给予308 nm准分子激光照射,每周1 ～ 2次,20次1个疗程;联合外用0.03%他克莫司乳膏,每日2次,疗程结束后分别进行疗效评价,并观察红斑反应及照射累积量对疗效的影响。结果 20次治疗结束后,皮损组显效率78.4%,腔口组显效率54.8%,皮损组显效率优于腔口组（P < 0.05）。两组在治疗过程中红斑反应持续48 h以上的平均次数分别是皮损组5.84次、腔口组9.12次。腔口组红斑反应持续48 h以上的平均次数明显多于皮损组（P < 0.01）。两组在完成10次和20次治疗后的平均照射累积量分别是：皮损组4215 mJ/cm2（10次）、10 453 mJ/cm2（20次）;腔口组3364 mJ/cm2（10次）、7430 mJ/cm2（20次）,皮损组平均照射累积量均大于腔口组（P < 0.01）。结论 308 nm准分子激光联合0.03%他克莫司乳膏治疗儿童面颈部白癜风是安全、有效的,面颈部疗效好于面部腔口部位,且后者红斑反应重于前者。     

正红花油所致接触性皮炎后继发日光性皮炎1例

正红花油所致接触性皮炎后继发日光性皮炎１例邹德明江苏高淳县皮肤病防治所（邮政编码２１１３００）患者男，４６岁。因左颈部被蚊虫叮咬后，自行外用正红花油（永龙南洋集团产品）１２ｈ后，局部出现弥漫性潮红，次日泛发至面、颈、胸前“Ｖ”形区、四肢等暴露部位，剧...     

血管性水肿误诊为急性蜂窝织炎1例

患者男，60岁。因面颈部、上胸部肿胀伴呼吸闲难3d．于2003年10月12日以“急性血管性水肿”入住我院。患者于3d前饮酒、食海鲜后6h面颈部出现严重肿胀，表面皮肤紧张发亮，睁眼困难，皮损迅速累及上胸部，并伴有呼吸困难。在当地医院被诊断为“急性蜂窝织炎”，行气管切开、吸痰、吸氧、抗感染等治疗2d。治疗期间患者自觉耳后肿胀反复发作，多次间断出现不同程度的气急、呼吸困难，     

干扰素致荨麻疹型药疹1例

患者女性,２１岁,因外阴部起赘生物半月以“尖锐湿疣”行激光烧灼并给予γ－干扰素３００万U（商品名克隆伽玛,上海克隆生物制药厂生产）局部注射,隔日１次。第２次注射后约４小时（隔日１次）颈部、躯干出现散在红色风团伴瘙痒,持续约２小时自行消退,未再复发。２天后换用α－干扰素（商品名福康泰,卫生部长春生物制品研究所生产）１００万U肌注,约２小时后,患者再次出现同样反应。查体：咽无充血,双侧扁桃体不大。颈部、躯干、四肢散在指盖至铜钱大红色风团,压之退色。给予扑尔敏４mg、维生素C０．２口服后１小时皮疹完全消…     

丘疹鳞屑型亚急性皮肤型红斑狼疮

患者女，58岁。主诉：面颈部、上肢、肩背部鳞屑性斑丘疹2年。现病史：患者2年前无明显诱因面颈部出现散在三粒红色丘疹，逐渐扩大成大小不等形状不规则斑丘疹，上覆有细薄鳞屑，随后渐累及上肢、肩背部，伴有轻度瘙痒，偶日晒后加重。曾就诊于当地多家医院，拟“银屑病”、“多形性日光疹”予治疗（具体用药不详），无明显好转。起病以来无脱发、手足发冷、关节酸痛等不适。     

磺胺药过敏患者对三种抗组胺药过敏1例

患者男 ,50岁 ,因“右下肢湿疹两年加重半月” ,于1 998年 5月来我院就诊。给予口服赛庚啶 ,外搽蒽肤霜治疗。口服赛庚啶 1次 4ｍｇ约 8小时后患者突感面、颈部灼热、瘙痒 ,胸、腹、背部出现针尖大小红色丘疹伴剧痒。考虑药疹 (麻疹样发疹型 )。对其静脉推注葡萄糖酸钙 1ｇ,口服强的松 1 0ｍｇ,一日三次。两天后皮疹基本消退 ,痒感消失。因原湿疹未愈 ,予停服赛庚啶 ,改服扑尔敏。患者服用 1片4ｍｇ后约 1小时 ,突然感觉胸闷、气急 ,面、颈部出现片状风团块 ,胸、腹、背、腰、四肢近端出现弥漫性红色丘疹 ,同时伴有腹部隐痛 ,皮疹处灼热剧痒…     

阿维A、雷公藤多甙联合治疗聚合性痤疮1例

患者男，32岁，已婚。因面颈部、背部及双侧腋下反复起丘疹、脓疱（伴溢脓血、疼痛）及瘢痕形成15yr于2005年9月6日到我科门诊就诊。15yr前，患者无明显诱因面颈部、背部及双侧腋下出现大小不等的红丘疹、脓疱及囊肿，自行用手挤压囊肿后有脓血溢出，多方求治．诊断为“毛囊炎”、“痤疮”。前后口服过“维胺酯”、“磺胺”、“安体舒通”及多种治疗痤疮的中成药如“青春痤疮片”、“清热暗疮片”、“湿毒清”等，外用过“痤康王”、“必麦森”、“达芙文”、“白色洗剂”等药，均无明显好转。     

皮肌炎合并鼻咽癌1例

患者男，45岁。面颈部、背部红斑2年，鼻塞、鼻流血伴四肢乏力1年余。2年前患者无明显诱因出现面颈部红色斑疹，自觉瘙痒，未引起重视，后逐渐发展至整个面部、后背部及四肢伸侧，并出现皮肤红肿，颜色逐渐加深。查肌电图示：肌源性损害（活动期），肌酶谱：乳酸脱氢酶333U／L，羟丁酸脱氢酶263U／L，抗核抗体：1：160（H），诊断为皮肌炎。     

Comparative study of some treatment modalities of rosacea

Background   Rosacea is a disease of complex pathogenesis and variable response to various therapeutic methods.
Aim of the work   To evaluate and compare the efficacy, safety and side effects of some topical lines of treatment of rosacea.
Patients and methods   The study included 24 patients (23 females and 1 male) with rosacea on the face. They were classified into three groups – each including eight patients (16 face sides) – and treated with one of three topical agents (azelaic acid 20% cream, metronidazole 0.75% cream or permethrin 5% cream) on one side of the face and another one on the other side twice daily for 15 weeks.
Results   There was a significant improvement of lesions after 15 weeks of topical treatment with the three agents. Azelaic acid cream was significantly more effective on inflammatory lesions but not erythema than the other two creams. Side effects – mostly transient – were observed with topical creams with no significant difference. They included itching, burning sensation, oedema and scales. Patients who used azelaic acid 20% cream were more satisfied than with other modalities.
Conclusion   Azelaic acid 20% cream provides an effective and safe alternative to metronidazole 0.75% cream or permethrin 5% cream with the added benefit of increased patient satisfaction.     

2%夫西地酸乳膏联合小剂量盐酸米诺环素治疗玫瑰痤疮自身对照研究

目的:评价2%夫西地酸乳膏外用联合小剂量盐酸米诺环素口服治疗玫瑰痤疮的临床疗效。方法:选取门诊20例玫瑰痤疮患者,予盐酸米诺环素50 mg每晚口服,随机选择一侧面部外用2%夫西地酸乳膏,另外一侧作为对照,6周后评估临床疗效并测定皮肤红斑指数、经皮水分丢失和皮肤弹性,记录不良反应。结果:6周后外用夫西地酸侧总有效率和红斑指数分别为83.33%和982.94±8.09高于对照侧的22.22%和997.94±8.40(均P0.05);外用夫西地酸侧经皮水分丢失为16.17±3.79,低于对照侧的21.28±3.88(P0.05);治疗前后皮肤弹性无明显变化,组间无差异。结论:2%夫西地酸乳膏外用联合小剂量盐酸米诺环素口服治疗玫瑰痤疮较单用小剂量盐酸米诺环素口服更为有效。     

Randomized, placebo-controlled, double blind study on the clinical efficacy of a cream containing 5% alpha-lipoic acid related to photoageing of facial skin

BACKGROUND: alpha-lipoic acid (LA) or the reduced form dihydrolipoate (DHLA) is a potent scavenger with anti-inflammatory properties. Previous uncontrolled studies with topical treatment with 5% LA-containing creams indicate a beneficial effect on photoageing skin. OBJECTIVE: The purpose of this study was to investigate whether a cream containing 5% LA showed any advantages concerning a number of the criteria associated with ageing of the facial skin, compared with an identical cream lacking LA. MATERIAL AND METHODS: Thirty-three women, mean age 54.4 years, were included in this controlled study. After randomization half the face was treated twice daily for 12 weeks with the LA cream and the other half with the control cream. The following methods of assessment were used: self-evaluation by the test subjects, clinical evaluation, photographic evaluation and laser profilometry. Profilometry was performed before the start of treatment and at the end. RESULTS: All four methods of assessment showed a statistically significant improvement on the LA-treated half of the face. Laser profilometry, the most objective method used, showed an average decrease in skin roughness of 50.8% (44.9-54.0) on the LA-treated side, compared with 40.7% (32.4-48.7) on the placebo-treated half of the face P < 0.001 (Wilcoxon matched pairs test). CONCLUSIONS: It is indicated that 12 weeks of treatment with a cream containing 5% LA improves clinical characteristics related to photoageing of facial skin.     

In vitro evaluation of a novel topical cream for vitiligo and psoriasis that selectively delivers NB‐UVB therapy when exposed to sunlight

Ultraviolet‐B (UVB) phototherapy is a well‐established mode of treatment for several types of dermatological disease. For psoriasis and vitiligo, narrow band UVB (NB‐UVB) phototherapy is an effective therapy, demonstrating greater efficacy and safety compared to broadband UVB or psoralen plus UVA treatments. While the treatment efficacy of NB‐UVB artificial light sources is well documented, the long term time and cost commitment of the therapy remains a barrier to treatment adherence. Natural sunlight is an ideal source of accessible UVB radiation; however, exposure to natural sunlight generally results in erythema prior to the accumulation of sufficient dosage of therapeutic wavelengths of UVB. This communication describes a novel topical cream designed to selectively deliver NB‐UVB therapy when exposed to sunlight. The topical cream when combined with natural sunlight could offer patients a more convenient phototherapy option for psoriasis and vitiligo, potentially increasing patient compliance.     

萘替芬酮康唑乳膏治疗面部脂溢性皮炎疗效观察

目的 探讨萘替芬酮康唑乳膏和复方乳酸乳膏混合外涂治疗面部脂溢性皮炎的临床疗效和安全性。方法 将65例面部脂溢性皮炎患者随机分成两组,治疗组33例,将适量萘替芬酮康唑乳膏和复方乳酸乳膏1:1放于洗净的手掌,混合调匀,再均匀涂于面部皮损处;对照组32例,将适量曲安奈德尿素乳膏和复方乳酸乳膏以1:1按上法均匀涂于面部皮损处。疗程均为4周,每2周复诊1次,观察疗效和不良反应。结果 治疗第2,4周后,两组症状总积分均较治疗前显著下降,差异有统计学意义(P<0.05);治疗组有效率分别为72.73%和78.13%,对照组分别为81.82%和87.50%,差异均无统计学意义(P均>0.05)。结论 外涂萘替芬酮康唑乳膏与外涂曲安奈德尿素乳膏治疗面部脂溢性皮炎疗效均满意且相当,但外涂萘替芬酮康唑乳膏更安全,无糖皮质激素乳膏外用的不良反应。     

Four cases of sebopsoriasis or seborrheic dermatitis of the face and scalp successfully treated with 1a-24 (R)-dihydroxycholecalciferol (tacalcitol) cream

A 71-year-old woman visited our clinic due to the presence of widespread scaly erythema on her face, scalp, and lower extremities. She was tentatively diagnosed as having seborrheic dermatitis but the symptoms were difficult to distinguish from psoriasis vulgaris. As a result, she was diagnosed as having sebopsoriasis. She was treated topically with an active vitamin D3 compound, 1a-24 (R)-dihydroxycholecalciferol D3 (tacalcitol) cream. She applied tacalcitol cream twice daily for 4 weeks, and her facial eruptions thus cleared up completely. No recurrence was observed for 2 months thereafter, even though the use of tacalcitol cream was stopped. To investigate whether or not tacalcitol cream is generally effective for the treatment of such seborrheic dermatitis-like eruptions, three more patients were treated with tacalcitol cream. All patients exhibited scaly erythematous macules on the face and/or scalp, and their eruptions improved rapidly with tacalcitol cream. Tacalcitol cream was thus found to be effective and useful for the treatment of both sebopsoriasis and even seborrheic dermatitis of the face and scalp.     

New local treatments for different types of melasma: Vascular type vs nonvascular type. A randomized polycentric study

Melasma is an acquired circumscribed hyperpigmented disorder seen mainly on the malar area of face and other parts of body. We evaluated the safety and efficacy of two different creams for melasma. Sixty volunteers with melasma were evaluated in this study, divided in three groups: A, B, and C. Patients in groups A and B were treated with same creams with the exception of addition of Tranexamic acid in cream B. Patients in group C were treated with placebo cream containing petrolatum only, respectively, twice daily for 10 weeks. Melasma Areas and Severity Index (MASI) score, melanin index (MI) and adverse events were evaluated every 4 weeks. MASI scores declined significantly in groups A and B compared to group C (P < .05). Cream B, containing tranexamic acid, resulted superior to cream A in subjects with hypervascular melasma. No adverse reactions were observed in all groups. Both active creams are safe and effective for melasma and should be selected according to normal or hypervascular type of melasma. Cream B (containing tranexamic acid) should be prescribed instead of cream A (not containing tranexamic acid) to subjects with hypervascular melasma.     

Phototoxic effects of topical azelaic acid, benzoyl peroxide and adapalene were not detected when applied immediately before UVB to normal skin

The enhancing effects on UVB erythema of topical agents applied on sun exposed areas are important due to their increased sunburn risk. Since the lesions in acne vulgaris are seen primarily on the face, the effects of topical agents used in acne treatment on the erythemogenicity of UVB is important. The aim of the present study was to examine whether azelaic acid cream, benzoyl peroxide gel, adapalene gel have the enhancing effects on UVB erythema which are widely used in the topical treatment of acne vulgaris. The minimal erythema dose (MED) was determined with phototest in 30 volunteers and the test was repeated with thin (0.1 cc/25 cm(2)) and thick (0.3 cc/25 cm(2)) azelaic acid cream, benzoyl peroxide gel, adapalene gel. The effects of each agent on MED was determined after 24 hours. MEDs of UVB were unaffected by azelaic acid cream, benzoyl peroxide gel and adapalene gel when applied immediately before irradiation. According to our results azelaic acid, benzoyl peroxide and adapalene do not seem to have enhancing effects on UVB erythema and thus increased sunburn risk.     

Novel anti‐wrinkle effect of cosmeceutical product with new retinyl retinoate microsphere using biodegradable polymer

Background: The novel hybrid retinoid, retinyl retinoate, is a synthetic material that was designed to reduce the side effects of retinoic acid and to increase the stability of retinol. The formulation of the retinyl retinoate, however, is required to enhance skin permeation, and thus to increase the anti‐wrinkle effect. Aim: To identify the efficacy of retinyl retinoate microsphere using biodegradable polymer as an anti‐aging agent of cosmetics in treating females over 30 years old with periorbital wrinkles. Methods: The retinyl retinoate microsphere was prepared using the biodegradable polymer; polylactic acid (PLA). We also conducted two clinical studies with a total of 44 Korean women for 12 weeks. In the first clinical study, 20 patients completed a 12‐week trial of cream A [3% PLA‐retinyl retinoate (2%) microsphere] applied twice daily to the face. In the second clinical study, 24 patients completed a 12‐week trial of cream B (0.06% retinyl retinoate) applied twice daily to the face. Efficacy was based on a global photodamage score, photographs, and image analysis using replicas and Visiometers every 4 weeks. Results: The PLA‐retinyl retinoate microsphere was more effective for the permeation of retinyl retinoate than retinyl retinoate in itself. The cream A, which contains 3% PLA‐retinyl retinoate (2%) microsphere, showed a statistically significant improvement in facial wrinkles (P<0.05) in 20 volunteers after only 4 weeks of application in a clinical trial test. The visual wrinkle improvement and the maximum roughness improvement rate (R2) for cream A was 6.05%, 8.03% higher than that of cream B which contains 0.06% retinyl retinoate, after 4 weeks. Conclusion: Retinyl retinoate has a potent anti‐wrinkle activity, and the PLA‐retinyl retinoate microsphere could be a useful cosmeceutical product for anti‐aging purposes.     

A double-blind randomized trial of 5% ascorbic acid vs. 4% hydroquinone in melasma

BACKGROUND: Melasma is an acquired treatment-resistant hyperpigmentation of the skin. METHODS: Sixteen women with idiopathic melasma were included in our trial. After randomization by another clinician, they were instructed to use, at night, 5% ascorbic acid cream on one side of the face and 4% hydroquinone cream on the other side, for 16 weeks. Sunscreen was applied daily throughout the period of observation. They were evaluated every month by colorimetry, digital photography, and regular color slides. Subjective evaluation by each patient was also taken into account. RESULTS: The best subjective improvement was observed on the hydroquinone side with 93% good and excellent results, compared with 62.5% on the ascorbic acid side (P < 0.05); however, colorimetric measures showed no statistical differences. Side-effects were present in 68.7% (11/16) with hydroquinone vs. 6.2% (1/16) with ascorbic acid. CONCLUSION: Although hydroquinone showed a better response, ascorbic acid may play a role in the therapy of melasma as it is almost devoid of side-effects; it could be used alone or in combination therapy.