透明质酸修护生物膜辅助治疗干燥性湿疹的多中心对照研究

目的 探讨透明质酸修护生物膜辅助治疗干燥性湿疹的结果.方法 5家医院82例干燥性湿疹分为试验组和对照组.试验组外搽糠酸莫米松乳膏和透明质酸修护生物膜,对照组仅外搽糠酸莫米松乳膏,每天2次,14 d后停用糠酸莫米松乳膏,试验组继续外搽透明质酸修护生物膜,分别于首诊、治疗后7、14、28、42、56 d随访.比较两组皮损SCORAD评分、总改善率、受试者自评、复发率、经皮水分丢失(TEWL)值及角质层含水量.结果 ①试验组比对照组皮损SCORAD评分显著改善,42 d时SCORAD评分,试验组(4.42±2.64)、对照组(6.03±4.02),56 d时试验组(3.49±2.78),对照组(6.06±4.28),两组比较,差异有统计学意义(P均＜ 0.05)；②试验组改善率高于对照组,停用糠酸莫米松乳膏后,试验观察56 d时,差异有统计学意义(均P＜ 0.05)；③停用糠酸莫米松乳膏后,观察28、42、56 d时试验组均无复发,对照组复发率分别为11.4％、11.4％、20％,两组比较,差异有统计学意义(均P＜0.05)；④试验组TEWL下降低于对照组,56 d时,试验组TEWL(10.35±2.02)与对照组TEWL(17.28±4.06)比较,差异有统计学意义(P＜0.05)；试验组角质层含水量高于对照组,42 d时试验组角质层含水量(29.10±5.39)、对照组(23.12±4.76),56 d时,试验组角质层含水量(31.79±4.09)、对照组(22.87±4.85),两组比较,差异有统计学意义(均P＜0.05).试验组未发生不良反应.结论 透明质酸修护生物膜可以辅助治疗干燥性湿疹,降低复发率,促进皮肤屏障功能的恢复,安全性高.     

透明质酸修护生物膜辅助治疗干燥性湿疹的多中心对照研究北大核心CSCD

目的探讨透明质酸修护生物膜辅助治疗干燥性湿疹的结果。方法5家医院82例干燥性湿疹分为试验组和对照组。试验组外搽糠酸莫米松乳膏和透明质酸修护生物膜,对照组仅外搽糠酸莫米松乳膏,每天2次,14d后停用糠酸莫米松乳膏,试验组继续外搽透明质酸修护生物膜,分别于首诊、治疗后7、14、28、42、56d随访。比较两组皮损SCORAD评分、总改善率、受试者自评、复发率、经皮水分丢失（TEwL）值及角质层含水量。结果①试验组比对照组皮损SCORAD评分显著改善,42d时SCORAD评分,试验组（4．42±2．64）、对照组（6．03±4．02）,56d时试验组（3．49±2．78）,对照组（6．06±4．28）,两组比较,差异有统计学意义（P均〈0．05）;②试验组改善率高于对照组,停用糠酸莫米松乳膏后,试验观察56d时,差异有统计学意义（均P〈0．05）;③停用糠酸莫米松乳膏后,观察28、42、56d时试验组均无复发,对照组复发率分别为11.4％、11．4％、20％,两组比较,差异有统计学意义（均P〈0．05）;④试验组TEWL下降低于对照组,56d时,试验组TEWL（10．35±2．02）与对照组TEWL（17．28±4．06）比较,差异有统计学意义（P〈0．05）;试验组角质层含水量高于对照组,42d时试验组角质层含水量（29．10±5．39）、对照组（23．12±4．76）,56d时,试验组角质层含水量（31．79±4．09）、对照组（22．87±4．85）,两组比较,差异有统计学意义（均P〈0．05）。试验组未发生不良反应。结论透明质酸修护生物膜可以辅助治疗干燥性湿疹,降低复发率,促进皮肤屏障功能的恢复,安全性高。     

复方苦参止痒软膏联合糠酸莫米松乳膏治疗慢性湿疹的效果观察

目的探讨复方苦参止痒软膏与糠酸莫米松乳膏联合治疗对慢性湿疹患者临床症状与皮肤生理功能的改善效果。方法回顾性分析2017年10月-2018年10月期间在本院治疗的116例慢性湿疹患者的临床资料,依据上述入选者临床药物治疗方式的不同,分为对照组(糠酸莫米松乳膏,58例)与观察组(复方苦参止痒软膏+糠酸莫米松乳膏,58例),比较2组患者治疗前与治疗4周后,皮损面积评分、皮损瘙痒评分、靶皮损面积、皮肤生理功能[皮肤油脂、角质层含水量(WCSC)、经表皮水分流失(TEWL)]以及湿疹病情缓解情况。结果治疗4周后,观察组患者皮损面积评分与皮损瘙痒评分均低于对照组患者,靶皮损面积少于对照组患者,差异有统计学意义(P<0.05);治疗4周后,观察组患者皮肤油脂、WCSC值高于对照组患者,TEWL值低于对照组患者,差异有统计学意义(P<0.05);治疗4周后,观察组患者湿疹面积及严重程度指数(EASI)低于对照组患者,差异有统计学意义(P<0.05)。结论慢性湿疹患者经复方苦参止痒软膏与糠酸莫米松乳膏联合治疗,可有效缩减皮损面积,利于缓解皮损瘙痒症状,提高皮肤生理功能,促使患者病情尽快好转。     

薇诺娜柔润保湿霜对慢性湿疹辅助治疗作用的观察

目的评价薇诺娜柔润保湿霜对慢性湿疹的辅助治疗作用。方法在根据病情酌情给予系统药物治疗的基础上,采用病例自身对照(左右两侧皮损分别外用薇诺娜柔润保湿霜联合糠酸莫米松乳膏和单用糠酸莫米松),比较两组在治疗1,2,3周后的EASI评分、痊愈率、有效率和皮肤生理功能[经皮水丢失(TEWL)、角质层含水量(WCSC)和油脂含量],以及停止治疗4,8周后EASI评分、复发率和皮肤生理功能。结果①纳入105例病例,97例完成3周治疗,停药4,8周后分别有88例和81例获得随访;②治疗1,2,3周后,两组EASI均值均较治疗前明显下降,治疗组明显低于对照组,前者痊愈及有效率明显高于后者(P均<0.05);两组TEWL逐渐下降,WCSC和皮脂含量增加,治疗组明显好于对照组(P<0.05);③治疗结束4,8周,治疗组EASI值及复发率明显低于对照组(P<0.05);TEWL,WCSC和皮脂含量治疗组也明显好于对照组。以上差异均有统计学意义。结论在酌情采用药物治疗基础上,薇诺娜柔润保湿霜联合糠酸莫米松在改善病情、减少复发方面优于单用糠酸莫米松,薇诺娜柔润保湿霜对于慢性湿疹的治疗具有一定的辅助作用。     

氟芬那酸丁酯软膏联合糠酸莫米松乳膏治疗慢性湿疹疗效观察

目的观察氟芬那酸丁酯软膏联合糠酸莫米松乳膏治疗慢性湿疹的疗效。方法氟芬那酸丁酯软膏与糠酸莫米松乳膏联用为治疗组,前者连用4周,后者连用2周,单用糠酸莫米松乳膏为对照组,连用4周。根据评分标准进行疗效比较。结果两组有效率无显著性差异(χ2=0.0071,P>0.05)。结论氟芬那酸丁酯软膏的应用可减少治疗慢性湿疹时对糖皮质激素的依赖。     

序贯外用糠酸莫米松乳膏与他克莫司软膏治疗儿童特应性皮炎的临床观察

目的:观察序贯外用0.1%糠酸莫米松乳膏与0.03%他克莫司软膏治疗儿童特应性皮炎的疗效、安全性及复发率。方法:收集该院门诊符合入选标准的儿童特应性皮炎患儿270例,随机分为3组。观察组外用0.1%糠酸莫米松乳膏,每晚1次,连续使用2周后,换用0.03%他克莫司软膏,早晚各1次,继续使用2周;对照A组外用0.1%糠酸莫米松乳膏,每晚1次,连续使用4周;对照B组外用0.03%他克莫司软膏,早晚各1次,连续使用4周。治疗结束后观察3组患者临床疗效和不良反应,随访4周,比较复发率。结果:(1)观察组的湿疹面积及严重指数(eczema area and severity index, EASI)评分[(2.70±1.74)分]、痊愈率(12.8%)及有效率(80.2%)与对照A组[(2.66±1.56)分、15.8%、88.2%]比较,差异无统计学意义,与对照B组[(5.51±2.96)分、3.8%、61.3%]比较,差异有统计学意义(P0.05);(2)观察组不良反应发生率(7.0%)低于对照A组(18.4%)和对照B组(15.0%);(3)观察组复发率(13.2%)与对照B组(10.6%)比较,差异无统计学意义,但低于对照A组(26.9%),差异有统计学意义(P0.05)。结论:序贯外用0.1%糠酸莫米松乳膏与0.03%他克莫司软膏治疗儿童特应性皮炎,临床疗效好,复发率低,安全性高,值得临床推广。     

外用川百止痒洗剂联合0.1%糠酸莫米松乳膏治疗湿疹临床研究

目的观察川百止痒洗剂联合0.1%糠酸莫米松乳膏治疗湿疹的有效性与安全性。方法采用随机、单盲、平行对照的方法对63例湿疹患者应用川百止痒洗剂联合0.1%糠酸莫米松乳膏外用治疗,同时设立对照组64例单独外用0.1%糠酸莫米松乳膏,治疗12天后评价疗效,并进行皮肤病生活质量指数(dermatology life quality index,DLQI)问卷调查。结果试验组总有效率为87.30%,与对照组70.31%相比有统计学差异(P<0.01);DLQI总分两组均下降,但无统计学差异(P=0.8775);试验组和对照组发生局部刺激反应分别为6.3%和7.8%,无统计学差异(Fisher校正χ2检验P=1.0000)。结论川百止痒洗剂联合0.1%糠酸莫米松乳膏治疗湿疹较为有效、安全。     

润燥止痒胶囊联合左西替利嗪治疗慢性湿疹疗效观察

目的观察润燥止痒胶囊联合左西替利嗪并外用糠酸莫米松乳膏治疗慢性湿疹的疗效。方法将84例患者随机分成2组,各42例。对照组口服左西替利嗪10mg,并外用糠酸莫米松乳膏,均1次/d。治疗组在对照组的基础上加用润燥止痒胶囊4粒口服,3次/d,,两组疗程均为4周。结果治疗组有效率为83.33%,对照组为57.14%,差异有显著性(χ2=6.891,P<0.01)。结论润燥止痒胶囊联合左西替利嗪,并外用糠酸莫米松乳膏治疗慢性湿疹疗效确切。     

复方甘草酸苷联合维A酸乳膏和糠酸莫米松乳膏治疗寻常性银屑病疗效观察

目的探讨复方甘草酸苷联合维A酸乳膏和糠酸莫米松乳膏治疗寻常性银屑病的临床疗效。方法165例患者随机分为两组,试验组81例,口服复方甘草酸苷联合维A酸乳膏和糠酸莫米松乳膏外用;对照组84例,仅外用维A酸乳膏和糠酸莫米松乳膏,疗程均为4周,随访3个月。结果试验组有效率为76．54％,明显高于对照组（48．81％）（P〈0．01）;试验组不良反应发生率为13．58％,比对照组低（20．24％）（P〈0．05）;试验组治愈患者复发率为24．00％,低于对照组（36．00％）（P〈O．05）。结论复方甘草酸苷联合维A酸乳膏和糠酸莫米松乳膏外用治疗寻常性银屑病疗效优于仅给予维A酸乳膏和糠酸莫米松乳膏外用,且患者不良反应和复发率明显降低。     

青鹏软膏治疗双下肢慢性对称性湿疹疗效及其对皮肤屏障功能的影响

目的评价青鹏软膏治疗慢性对称性湿疹的临床疗效和安全性,并观察患者皮肤屏障功能的改变情况。方法采用自身对照研究,对86例双下肢慢性对称性湿疹患者左下肢皮损外用青鹏软膏(治疗组),右下肢皮损外用糠酸莫米松乳膏(对照组),比较两组皮损治疗前和治疗4周时瘙痒、皮损严重程度和面积、湿疹病情指数(EASI)、皮肤生理功能,包括经表皮水分流失(TEWL)、角质层含水量(WCSC)和皮肤油脂(SC)及有效率。结果治疗4周后,两组皮损的瘙痒评分、皮损严重程度评分、皮损面积及EASI评分和TEWL均显著低于其治疗前,而WCSC和SC显著高于其治疗前,且治疗组靶皮损面积、皮损面积评分、皮损瘙痒评分、EASI评分和TEWL均显著低于对照组,但是治疗组靶皮损WCSC,SC和有效率均显著高于对照组,以上差异均有统计学意义(P均0.01)。结论青鹏软膏治疗慢性对称性湿疹安全有效,有利于皮肤屏障功能修复。     

Occupational allergic contact dermatitis caused by decorative plants

12 cases of occupational allergic contact dermatitis caused by decorative plants were diagnosed in a 14-year period. The patients were middle-aged, and their average exposure time was 13 years. The plant families and plants causing occupational contact dermatitis were Compositae (5 patients: chrysanthemum, elecampane, gerbera, feverfew), Alstroemeriaceae (5 patients, Alstroemeria ), Liliaceae (4 patients; tulip, hyacinth). Amaryllidaceae (2 patients: narcissus) and Caryophyllaceae (2 patients; carnation, cauzeflower). The known chemical allergens causing dermatitis were tuliposide-A and sesquiterepene lactones, such as alantolactones and parthenolide, in the Liliaceae and Compositae families. 7 of the 12 patients were able to continue their work; 5 were not because of severe relapses of skin symptoms. The plant allergen and extract series currently available are of great help in the diagnosis.     

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.     

Metástasis cutáneas de tumores sólidos. Estudio descriptivo retrospectivo

Introduction

Cutaneous metastases are a rare event compared with other metastases. Their incidence is estimated between 0.7% and 9% of patients with cancer. Their presence always indicates a disseminated malignant disease and could also be the first manifestation of a tumor, appearing simultaneously or after a diagnosis of cancer.

Objectives

To describe the epidemiological and clinical characteristics of cutaneous metastases in our hospital.

Material and method

We performed an observational retrospective study. We included all patients with cutaneous metastases diagnosed in the Dermatology Service of our hospital during a 7-year period. Patients with metastases from sarcomas, melanomas and hematologic malignances were excluded.

Results

We studied 102 patients with cutaneous metastases. The primary tumor was identified in 87 patients (85%). The most frequent tumors were breast cancer in women (48%) and lung cancer in men (11%). Cutaneous metastases were the first sign of malignancy in 12 patients (11%). The predominant clinical form was the nodular form. The most common localization of the metastases was the thoracic region. The most common histologic diagnosis was adenocarcinoma. The mean survival after the development of metastases was 22.1 months.

Conclusion

There is an association between the frequency of cutaneous metastases and the most frequent malignancies in each sex.Our results were similar to those of other studies regarding age, sex distribution, the predominant clinical form, location, and histological diagnosis of cutaneous metastases.     

Mutations in mevalonate pathway genes in patients with familial or sporadic porokeratosis

Porokeratosis comprises heterogeneous keratinization disorders that are characterized by one or more atrophic patches surrounded by a ridge‐like cornoid lamella. In this study, we evaluated seven families affected by porokeratosis and five sporadic patients of the disease in a Chinese population. We performed Sanger sequencing of exons and flanking intron–exon boundaries of mevalonate pathway genes (MVD, MVK, PMVK and FDPS) and of SLC17A9. In five familial and three sporadic patients, we detected six variations, including four novel mutations (MVD c.1A>G; p.Met1?, c.916G>A; p.Ala306Thr, c.1013+1G>A, and PMVK c.65A>G; p.Lys22Arg) and two recurrent mutations (MVD c.746T>C; p.Phe249Ser, and MVK c.1028T>C; p.Leu343Pro). We then applied I‐TASSER and iGEMDOCK to assess these variants for probable functional impacts. The findings of this study extend the mutation spectrum of porokeratosis and provide further evidence for the genetic basis of this disease.     

[Translated article] Pruritus in Dermatology: Part 1—General Concepts and Pruritogens

Pruritus is the most common symptom of dermatologic and systemic diseases. The diagnosis of pruritus is clinical, although additional tests may be necessary to identify or confirm the cause. Translational medicine has led to the discovery of new mediators of itch, or pruritogens, as well as new receptors. Knowing how to properly recognize the main pathway that mediates itch in each patient is the key to successful treatment. Although the histaminergic pathway predominates in conditions like urticaria or drug-induced pruritus, it is the nonhistaminergic pathway that predominates in nearly all other skin diseases covered in this review. Part 1 of this 2-part review discusses the classification of pruritus, additional testing, the pathophysiology of itch and the pruritogens implicated (including cytokines and other molecules), and central sensitization to itch.     

Anästhesieverfahren in der Dermatologie

Zusammenfassung Die Verfahren der Lokalanästhesie sind integraler Bestandteil der operativen Dermatologie. Sie gewährleisten eine effiziente und sichere Analgesie in umschriebenen Haut- und Weichteilregionen und ermöglichen, einen sonst schmerzhaften diagnostischen oder therapeutischen Eingriff bei erhaltenem Bewusstsein zu tolerieren. Einzelne Methoden der Applikation sind "konkurrenzlos", wie die topische Applikation von EMLA^® oder die Kryoanästhesie, andere bieten alternative Optionen zur Allgemeinanästhesie. Die Tumeszenzlokalanästhesie wurde—jenseits der kosmetischen Liposuktion—zu einer effizienten Anästhesieform für größere Operationen bei Tumoren der Haut, plastische Rekonstruktionen und in der Phlebochirurgie weiterentwickelt. Die Wahl des Verfahrens im Einzelfall wird vom Alter, der Kooperationsfähigkeit und der Komorbidität des Patienten bestimmt. Für Infiltrationsanästhesien werden heute vorwiegend Lokalanästhetika vom Amidtyp eingesetzt. Fundierte Kenntnisse über die Anatomie der sensiblen Nerven sind Voraussetzung für erfolgreiche operationsfeldnahe periphere Blockaden. Wenn die Wirkungsweise der Lokalanästhetika, ihre toxischen Effekte und potenzielle Arzneimittelinteraktionen bei ihrem Metabolismus in der Praxis beachtet werden, dann ist das Risiko von Komplikationen relativ gering. Es sollte dennoch nicht unterschätzt, und adäquate Notfallmaßnahmen im Operationsteam sollten regelmäßig trainiert werden.     

Skin microbiome and acne vulgaris: Staphylococcus,a new actor in acne

Propionibacterium acnes (P. acnes), the sebaceous gland and follicular keratinocytes are considered the three actors involved in the development of acne. This exploratory study investigated the characteristics of the skin microbiota in subjects with acne and determined microbiota changes after 28 days of application of erythromycin 4% or a dermocosmetic. Skin microbiota were collected under axenic conditions from comedones, papulo‐pustular lesions and non‐lesional skin areas from subjects with mild to moderate acne according to the GEA grading using swabs. Samples were characterized using a high‐throughput sequencing approach that targets a portion of the bacterial 16S rRNA gene. Overall, microbiota samples from 26 subjects showed an overabundance of Proteobacteria and Firmicutes and an under‐representation of Actinobacteria. Staphylococci were more abundant on the surface of comedones, papules and pustules (P=.004 and P=.003 respectively) than on non‐lesional skin. Their proportions increased significantly with acne severity (P<.05 between GEA‐2 and GEA‐3). Propionibacteria represented less than 2% of the bacteria on the skin surface. At Day 28, only the number of Actinobacteria had decreased with erythromycin while the dermocosmetic decreased also the number of Staphylococci. A significant reduction (P<.05) from Day 0 of comedones, papules and pustules with no significant difference between the products was observed. The bacterial diversity on all sampling areas was similar. The dermocosmetic decreased the number of Actinobacteria and Staphylococcus spp. after 28 days. Staphylococcus remained the predominant genus of the superficial skin microbiota. No significant reduction in Staphylococcus spp. was observed with the topical antibiotic.