田振国教授治疗肛门瘙痒症经验

文章主要介绍著名肛肠专家田振国教授在治疗肛门瘙瘁症这一疾病方面的独到见解，并具体阐述肛门瘙瘁症的病因病机及田教授的辨证施治理念，内服与外用相结合，双管齐下的独到之处。     

Long-term treatment with interferon-α2b for severe pruritus in patients with polycythaemia vera

Summary. Pruritus is a major clinical problem in patients with polycythaemia vera (PV). Conventional symptomatic treatment is unsatisfactory. Recently, a favourable effect of interferon-α on pruritus in patients with PV has been reported. Also, interferon-α suppresses the increased haemopoiesis in PV. However, long-term treatment with interferon-α may be hampered by side-effects and the inconvenience of chronic subcutaneous injection therapy.
We conducted a long-term study (median follow-up 13 months) of the efficacy and tolerability of interferon-α in 15 patients (mean age 68 years) with PV and severe pruritus. Six patients were evaluable after 1 year. Pruritus significantly improved in 12/15 patients. Haematological control improved, as evidenced by a decreased number of phlebotomies from a mean of 4.3 in the year before the study to 1.8 while on interferon-α. Leucocyte and platelet numbers also decreased significantly. Five patients (33%) did not tolerate interferon-α. The effects of interferon-α could not be ascribed to an inhibitive effect on histamine production or to the disappearance of the abnormal erythroid progenitor clone, because erythropoietin-independent erythroid colony formation persisted during interferon-α treatment. We conclude that long-term interferon-α treatment is feasible and effectively relieves pruritus in patients with PV, but side-effects are an important concern. The optimal dose regimen that is well tolerated, relieves pruritus, and offers satisfactory haematological control at the same time remains to be established.     

血液灌流串联血液透析治疗尿毒症皮肤瘙痒临床效果观察

目的探讨血液灌流（HP）串联血液透析（HD）治疗尿毒症皮肤瘙痒的疗效。方法将尿毒症血透患者分为实验组（n=17）与对照组（n=18），实验组采用HP串联HD，对照组采用HD，观察两组患者瘙痒缓解时间，测定治疗前后血B2-mG、iPTH、P^3-、Ca^2＋。结果实验组皮肤瘙痒症状6例完全消失，10例明显改善，1例症状改善不显著，有效率94．12％，起效时间：治疗后15—20天；对照组全身皮肤瘙痒无明显改善，3例皮肤瘙痒症状加重，两组比较P=0．000，差异有显著性意义。治疗组治疗前后生化指标比较差异有显著性意义，P〈0．01。结论HP串联HD治疗皮肤瘙痒效果好。     

Skin barrier structure and function and their relationship to pruritus in end-stage renal disease.

BACKGROUND: The relationship between dry skin and uraemic pruritus remains controversial. In addition, there is a lack of published data describing the structure and function of the stratum corneum (SC) in end-stage renal disease (ESRD). The purpose of the present study was to assess the function and structure of the skin barrier in patients with ESRD and to correlate any abnormalities with uraemic pruritus. METHODS: Thirty-eight subjects participated in the study; 20 with ESRD and 18 healthy controls. Subjects underwent evaluation of SC integrity and permeability barrier recovery, SC surface pH, pruritus and dry skin. The content of glycerol, an important endogenous humectant, was assessed in D-squame tape strips from seven patients with ESRD. Skin biopsies from six of these patients were examined by electron microscopy using ruthenium tetroxide (Ru04)-post-fixation. RESULTS: Although SC integrity was impaired in ESRD patients (P = 0.001), there were no significant differences in permeability barrier recovery rates between ESRD subjects and controls. However, there was a high significant negative correlation between SC glycerol content and dry skin in the arms of ESRD subjects (r = -0.866, P = 0.01). Yet, there was no consistent correlation between pruritus and either dry skin, SC integrity, glycerol content or surface pH. Electron microscopy revealed no significant ultra-structural abnormalities, with particular reference to the lipid bi-layer. CONCLUSIONS: SC integrity, but not permeability barrier recovery, is impaired in dialysis patients. Although dry skin in ESRD is associated with reduced SC glycerol levels, the ultra-structure appears to be unaffected.     

Oxytrex Minimizes Physical Dependence While Providing Effective Analgesia: A Randomized Controlled Trial in Low Back Pain

Physical dependence or withdrawal is an expected effect of prolonged opioid therapy. Oxytrex (oxycodone + ultralow-dose naltrexone) is an investigational drug shown here to minimize physical dependence while providing strong analgesia with twice-daily dosing. In this 719-patient, double-blind, placebo- and active-controlled Phase III clinical trial in chronic low back pain, patients were randomized to receive placebo, oxycodone qid, or oxytrex qid or bid. Each oxytrex tablet contains 1 microg naltrexone; oxytrex bid and qid treatments provide 2 and 4 microg naltrexone/day, respectively. Following a washout, patients with pain >or=5 on a 0-10 scale were dose-escalated weekly from 10 up to 80 mg/day until reaching adequate pain relief (pruritus (by 51%, P < .001). This is the first large well controlled study to show strong analgesia with minimal withdrawal symptoms and better safety compared with oxycodone. PERSPECTIVE: Previous clinical data have shown ultralow-dose naltrexone enhances and prolongs oxycodone analgesia, and preclinical data also show a suppression of opioid tolerance and dependence. A cellular mechanism of action has been demonstrated to be the prevention of aberrant G protein signaling by mu opioid receptors caused by chronic opioid administration.     

Relationship between pruritus, transepidermal water loss, and biochemical markers of renal itch in haemodialysis patients

The pathogenesis of pruritus in patients undergoing chronichaemodialysis is unknown. Dryness of the skin is common in uraemicpatients, and a correlation between xerosis and pruritus hasbeen reported. Transepidermal water loss (TEWL) is a measureof cutaneous barrier function and also reflects skin water content.In this study the transepidermal water loss was measured atfour sites pre- and postdialysis in 20 subjects undergoing chronichaemodialysis and in 16 healthy controls. Patients were weighedbefore and after dialysis and blood was taken for measurementof urea, creatinine, calcium, magnesium, phosphate and haemoglobin.All patients had parathyroid hormone measured within 3 monthsof the assessment. There was no significant difference in TEWL between patientsand controls, with control values in general being between pre-and postdialysis rates of TEWL, and no correlation between TEWLand the presence or absence of pruritus. There was no significantdifferences between the pruritic and non-pruritic patients forany of the biochemical markers measured. Finally there was nosignificant correlation between the percentage water loss andTEWL. These findings indicate that pruritus of chronic haemodialysisis not related to abnormalities of cutaneous permeability.     

青黛膏外涂治疗外阴白色病变临床疗效分析

目的：观察外用青黛膏治疗外阴白色病变的临床疗效。方法27例经外阴活检证实的外阴白色病变患者,鳞状细胞增生型12例,硬化性苔藓型8例,硬化性苔藓型伴鳞状细胞增生型（混合型）4例,不典型增生型3例,经青黛膏治疗1个疗程后,观察其外阴皮肤黏膜色素变化及临床症状改善情况。结果27例外阴白色病变患者经青黛膏治疗后的有效率为100％,治疗后鳞状细胞增生型、硬化苔藓型、混合型及不典型增生型病变外阴局部皮肤弹性评分与本证型治疗前比较差异均有统计学意义（P 均＜0．05）。结论外用青黛膏治疗外阴白色病变是一种无创、无毒副作用、经济、安全的治疗方法,值得临床推广应用。     

Dermatologic comorbidities of the patients with severe COVID‐19: A case‐control study

The current studies focus on the association between COVID‐19 and certain comorbidities. To the best of our knowledge, the association between severe COVID‐19 and dermatologic comorbidities has not been reported yet. In this study, we aimed to describe the dermatologic comorbidities of patients with severe COVID‐19 and compare it with the control group. Patients who have died at U?ak Training and Research Hospital due to COVID‐19 and other diseases in the COVID‐19 Intensive Care Units and Internal Medicine Intensive Care Units were recruited into the study. Two groups were compared with each other regarding the most common dermatologic comorbidities. A total of 198 patients including 111 patients with COVID‐19 and 87 age and sex‐matched patients with other diseases were enrolled in the study. The most common dermatologic comorbidities were pruritus (8.1%), eczema (6.3%), skin infections (3.6%), leukocytoclastic vasculitis (1.8%), and urticaria (0.9%) in the COVID‐19 group while they were skin infections (9.2%), eczema (3.4%), pruritus (2.3%), and urticaria (1.1%) in the control group. None of patients in the control group had leukocytoclastic vasculitis. There were no significant differences between COVID‐19 and control groups in terms of pruritus, eczema, skin infections, and urticaria (P values were .117, .517, .181, .505, and 1.000, respectively). In conclusion, although it is not statistically significant, it appears that pruritus and leukocytoclastic vasculitis are more common in severe COVID‐19 patients. These cytokines‐related diseases in the immuno‐cutaneous systems may give some clues on the COVID‐19 severity. Further studies are required to elucidate the relationship between the immuno‐cutaneous system and COVID‐19 severity.     

Fototerapia en el prurigo nodular. Experiencia propia y revisión de la literatura

Background and objectivePrurigo nodularis is a chronic inflammatory skin disease characterized by highly pruritic nodular lesions that cause constant itching and scratching and significant quality-of-life impairment. It has been described in a range of conditions, including skin diseases (mainly atopic dermatitis) and metabolic, neurological, and psychiatric disorders. The pathophysiological mechanisms are largely unknown. Various modalities of phototherapy have been described as appropriate and safe treatments for achieving clinical control and alleviating symptoms. In this article, we describe our experience with phototherapy in patients with prurigo nodularis.Material and methodsRetrospective observational study of patients who received their first cycle of phototherapy to treat prurigo nodularis between March 2011 and October 2019. Information was collected on epidemiological and clinical characteristics, concomitant treatments, type and duration of phototherapy, maximum dose reached, and response to treatment.ResultsWe studied 44 patients (30 women and 14 men) with a median age of 65.5 years. The most common form of phototherapy used was narrowband UV-B phototherapy (34 cycles, 77.27%) followed by a combination of UV-B and UV-A phototherapy (8 cycles). Response to treatment was considered satisfactory (clearance rate of ≥ 75%) in 24 patients (55.4%).ConclusionsPhototherapy is a suitable treatment for prurigo nodularis in a considerable proportion of patients. It can be used as monotherapy or combined with other treatments.