低能量Q开关Nd:YAG激光对黄褐斑体表温度与黑素指数的影响

目的:观察Q开关Nd:YAG激光治疗黄褐斑时皮肤体表的温度变化,探讨体表温度的改变与黑素指数的关系。方法:对22例黄褐斑患者使用Q开关Nd:YAG1064nm激光治疗,光斑直径6mm或8mm,能量密度2.0～3.3J/cm2,每周1次,12次为1个疗程。单次激光治疗前、治疗中、治疗后即刻用红外测温仪测量黄褐斑部位皮肤体表温度,并在治疗前、治疗6次、12次后使用皮肤多功能测试仪检测相应固定部位黑素指数。结果:黄褐斑皮损区单次治疗后双面颊体表温度高于治疗前,但与正常皮肤相比无差异;激光治疗6次、12次后黑素指数均显著性减少。结论:低能量Q开关Nd:YAG激光治疗黄褐斑后皮肤温度有一定程度升高,但并不引起明显光斑反应,治疗后黑素指数降低,表明温度并非导致激光光斑反应的唯一及主要因素,可能与Q开关激光激活黑素细胞内部的反应原件相关。     

儿茶素治疗黄褐斑疗效观察及机理初探

目的为治疗黄褐斑寻找一种新的方法。方法口服及外用儿茶素，并检测治疗前后患者血中过氧化脂质（ＬＰＯ）、超氧化物歧化酶（ＳＯＤ）、还原型谷胱甘肽（ＧＳＨ）、谷胱甘肽过氧化物酶（ＧＳＨＰｘ）。结果儿茶素治疗效果与复方氢醌霜组接近（Ｐ＞０．０５），治疗前血浆ＬＰＯ较正常人显著增高（Ｐ＜０．０１），氧自由基清除剂水平相对降低，治疗后ＬＰＯ水平显著降低（Ｐ＜０．０５），氧自由基清除剂水平增高。结论儿茶素可通过调节氧自由基系统，提高机体抗氧化能力来减轻色素沉着。儿茶素为天然产物，无毒副作用，对皮肤无刺激，是治疗黄褐斑较有前景的一种物质。     

黄褐斑患者皮损区微生态改变的探讨

应用定量、定位和定性的方法对１０６例黄褐斑病人皮损区进行微生态学研究，将结果与５５例健康人面部菌群进行比较，并用不同温度培养其它产色素微球菌。结果显示：黄褐斑皮损区过路菌与正常人比较改变明显，产色素的微球菌及革兰氏阴性杆菌数量增加１８×１０３（ｃｍ２），分离率高（７９．２５％～９２．４５％），与健康人相比差异显著（Ｐ＜０．００１），适当的温度促进微球菌产生色素，并增加菌量。提示黄褐斑皮损处微生态改变与本病的发生有明显相关性。     

氨甲环酸在治疗黄褐斑领域中的应用进展

黄褐斑是一种常发于面部的难治性皮肤疾病,以不规则的色素沉着斑为特征。目前主要治疗药物有对苯二酚、维A酸等,但其副作用较大。氨甲环酸是一种人工合成的赖氨酸衍生物,属于抗纤维蛋白溶解剂,经FDA批准用于治疗月经过多和预防出血。另外,氨甲环酸具有治疗黄褐斑功效,它通过对纤溶酶原激活途径的抑制作用,从而减轻色素沉着症状。本文在PubMed、Web of Science、CNKI、ScienceDirect等数据库进行了广泛的文献检索,对氨甲环酸在治疗黄褐斑领域的制剂学研究和临床有效性研究进行了资料归纳与分析,为临床上应用氨甲环酸治疗黄褐斑提供参考。     

What Should Be Considered in Treatment of Melasma

Melasma is a common acquired hyperpigmentary skin disorder characterized by light to dark brown macules and patches occurring in the sun-exposed areas of the face. Melasma lesional skin is characterized by epidermal hyperpigmentation through increased melanogenesis in epidermal melanocytes. Some patients have dermal melanin but its amount is not significant and its distribution is very heterogeneous in the whole melasma lesional skin. Melasma is not homogeneous disease and there are personal characteristics of patients with melasma. The pathogenesis of melasma is not fully understood, but several hypotheses have been suggested. Increased vascularity in melasma lesions has suggested the role of increased number of enlarged vessels in the development of melasma. Endogeneous and exogeneous stimuli such as sex hormones and ultraviolet irradiation respectively may stimulate the microenvironment leading to the release of various mediators that cause activation of melanocytes and/or these stimuli may directly activate the melanocytes. Melasma patients may have specialized melanocytes with an intrinsic sensitivity to these stimuli.     

止血环酸对酪氨酸代谢影响的临床与实验研究

目的用实验证实口服止血环酸治疗黄褐斑有效的机理是该药能干扰酪氨酸代谢。方法采用氨基酸自动分析法和高压液相法。结果临床上口服止血环酸０．２５ｇ每日３次，６～８周后皮损明显消退，总有效率８２．０３％，与对照组有显著差别（Ｐ＜０．０５～０．００１），未见明显副反应。实验用氨基酸自动分析仪测试发现，当酪氨酸和酪氨酸酶均为等量时，止血环酸量达到或超过４０ｍｌ时，酪氨酸的消耗明显增加。高压液相证实，只有当有酪氨酸酶存在时，止血环酸才能干扰酪氨酸代谢。结论止血环酸除具有止血功能外，还有干扰酪氨酸代谢的功能，因而有破坏黑色素产生的功能     

Clinical & ultrastructural evaluation of the effect of fractional CO2 laser on facial melasma

ABSTRACT

Melasma represents the most obvious and disfiguring change of the face leading to psychological problems especially in females. Ablative lasers have also been used by many professionals to treat melasma, although there is few scientific data supporting this indication. The exact mechanism of action of ablative lasers in melasma is not yet clear enough. We aimed to evaluate the ultrastructural effect of fractional ablative CO2 (FrCo2) laser on facial melasma. Eleven melasma patients evaluated clinically by clinical modified area and severity index (MASI) score, treated by two sessions of fractional CO2 laser one month a part. Two punch biopsies of 2 mm diameter were obtained from all subjects one before and the other 3 months after treatment. All biopsies were analyzed by light and electron microscopy. Clinically, significant improvement of pigmentation and 48% reduction of (MASI) score were observed after two sessions of laser treatments. Light microscopic analysis of specimens revealed significant decrease in melanocyte count after treatment. Electron microscopic analysis of specimens after treatment revealed significant decrease in the number and size of melanocytes and significant decrease or complete absence of melanin granules in the surrounding keratinocytes compared to pre-treatment specimens. No scarring or post inflammatory hyper or hypopigmentation. We concluded that repeated application of Fractional CO2 laser on melasma skin may result in long lasting improvement due to its destructive effect on melanocytes.     

左旋维生素C导入联合外用烟酰胺凝胶治疗黄褐斑疗效观察

目的观察左旋维生素C超声波导入联合外用烟酰胺凝胶治疗黄褐斑的疗效。方法60例患者随机分成两组,连续治疗3个月,每两周随访1次。治疗组30例,左旋维生素C超声波导入,每周2次,外搽烟酰胺凝胶2次／d。对照组30例,外搽烟酰胺凝胶2次／d。观察两组的疗效差异,治疗组不同治疗次数与疗效之间的关系以及不良反应。结果治疗组疗效优于对照组,随着治疗次数的增加效果更明显。结论左旋维生素C超声波导入联合外用烟酰胺凝胶治疗黄褐斑疗效确切,不良反应较少,值得在临床应用。     

旁氏无暇透白日霜改善黄褐斑及其皮肤屏障功能的疗效观察

目的观察旁氏无暇透白日霜(SPF 15 PA++)改善黄褐斑临床症状及皮肤屏障功能的疗效。方法采用随机双盲、自身对照的临床研究方法。选取30例面部皮损较对称的黄褐斑患者,受试者每天用温水清洁面部,半脸使用约0.5g测试产品,另外半脸使用等量对照产品,早晚各1次,2次/d。分别于首诊、治疗后第28天、56天评估皮损情况。结果①主观比较:实验组基本治愈0例,显效4例,好转10例,无效16例,总有效率46.6%。对照组基本治愈0例,显效1例,好转5例,无效24例,总有效率20.0%。治疗组与对照组疗效经卡方检验差异有统计学意义(P0.05)。②TEWL值:试验组与对照组随时间延长TEWL值均值均有所降低,治疗组与对照组相比0、28、56天P值均0.05,差异无统计学意义。③皮肤角质层含水量:试验组与对照组随时间延长皮肤角质层含水量均值均有所升高,治疗组与对照组相比0、28天P值均0.05,差异无统计学意义,第56天时,试验组角质层含水量(41.14±5.94)与对照组角质层含水量(41.90±5.81)比较,差异有统计学意义(P0.05)。④LAB值检测:随时间延长实验组与对照组LabL值均值均有所升高、LabA值均值无明显变化、LabB值均值均有所下降。实验组与对照组相比,LabL值0、28天P值均0.05,差异无统计学意义;56天时,实验组LabL值(58.92±3.52)与对照组LabL值(56.86±3.11)相比,差异有统计学意义(P0.05)。LabA值0、28、56天P值均0.05,差异无统计学意义。LabB值0、28天P值均0.05,差异无统计学意义;56天时,实验组LabB值(15.21±1.90)与对照组LabB值(16.16±1.52)相比,差异有统计学意义(P0.05)。结论受试品"旁氏无暇透白日霜"和对照品市售"凡士林保湿露"均具有良好的美白、保湿、恢复皮肤屏障的效果,并且"旁氏无暇透白日霜"美白效果显著优于对照品市售"凡士林保湿露"。