四物消风饮化裁联合他扎罗汀乳膏外擦对血热风燥证银屑病患者皮损改善、生活质量的影响

目的观察用四物消风饮化裁联合他扎罗汀乳膏外擦治疗血热风燥证银屑病患者的临床效果。方法将就诊于我院的136例血热风燥证银屑病患者随机分为对照组和观察组各68例。对照组患者给予他扎罗汀乳膏外擦;观察组患者则加用四物消风饮化裁而成的汤剂治之,连续用药1个月为1个疗程。比较2组患者的临床疗效,评价中医证候积分,用银屑病皮损面积及严重程度指数评分(PASI)、皮肤病生活质量指数(DLQI)量表分别评价皮损程度及生活质量。结果观察组的临床效果高达92.6%,明显高于对照组的76.5%(χ2=8.441,P0.05);治疗后观察组患者的中医证候积分较对照组显著下降(P0.05);皮损明显减轻,PASI、DLQI评分均显著低于治疗前及对照组患者(P0.05);且不良反应发生率2.9%显著低于对照组的17.6%(χ2=7.963,P=0.0090.05)。结论四物消风饮化裁联合他扎罗汀乳膏外擦协同作用突出,利于缩小患者的皮损面积,减轻患处瘙痒程度,提高患者生活质量,其机制可能与免疫调节、抑制表皮细胞增殖、抗炎等作用有关,值得临床推广运用。     

几种色素减退性皮肤病的共聚焦激光扫描显微镜图像特点

目的 观察白癜风、无色素痣、进行性斑状色素减少症、贫血痣的活体共聚焦激光扫描显微镜(CLSM)特征.方法 用CLSM观察同一层面(基底层真表皮交界处)皮损处、交界处及白斑周边正常皮肤的镜下特征.结果 进展期白癜风白斑区部分区域色素完全缺失,部分区域可见残存色素环,残存之色素环结构欠完整且色素含量降低;交界处界限模糊;白斑周边正常皮肤可见部分色素环失去完整性.稳定期白癜风白斑处色素完全消失;交界处界限清晰;白斑周边正常皮肤色素环完整,折光明亮;恢复期可见到树突状、折光明亮的黑素细胞.无色素痣和进行性斑状色素减少症的CLSM表现相似:白斑处色素环结构完整,色素含量降低,折光减弱.贫血痣白斑处色素环结构和色素含量与周边正常皮肤无明显差异.结论 结合临床表现,CLSM可以作为鉴别诊断白癜风、无色素痣、进行性斑状色素减少症、贫血痣的一种辅助方法.

Abstract：

Objective To investigate the confocal laser scanning microscopic (CLSM) features of several hypopigmented diseases, including vitiligo, nevus depigmentosus, progressive macular hypomelanosis and amelanotic nevus. Methods A total of 131 patients with hypopigmented diseases were recruited in this study. CLSM was performed on depigmented lesions, adjacent normal appearing skin and lesion borders at the dermoepidermal junction level in these patients. Results CLSM showed that in progressive vitiligo, melanin was completely absent from some areas in vitiliginous skin, while some areas were present with residual dermal papillary rings which were less intact with decreased melanin content; the border of lesions was obscure; some dermal papillary rings lost integrity in normal appearing skin adjacent to the vitiliginous skin. There was a complete disappearance of pigment in vitiliginous skin, clear border of lesions and intact dermal papillary rings with bright reflected light in adjacent normal appearing skin in stable vitiligo. Dendrite-like melanocytes with bright reflected light were noted in recovery-stage vitiligo. The CLSM imaging of nevus depigmentosus and progressive macular hypomelanosis was similar: dermal papillary rings were intact with decreased melanin content and weak reflected light in depigmented lesions. No significant difference was observed in the structure of dermal papillary rings or melanin content between vitiliginous skin and adjacent normal-appearing skin of nevus anemicus. Conclusion Combined with clinical manifestations, CLSM may serve as an auxiliary tool to discriminate vitiligo, nevus depigmentosus, progressive macular hypomelanosis and amelanotic nevus.     

活血祛疹汤治疗慢性荨麻疹疗效观察

目的:探讨活血祛疹汤对慢性荨麻疹患者的临床疗效。方法:将慢性荨麻疹患者72例随机分为2组各36例,观察组采用活血祛疹汤治疗,对照组采用枸地氯雷他定片治疗,观察2组治疗3月后的临床疗效及症状总积分变化;随访3月,观察比较复发情况。结果:总有效率观察组为75.00%,对照组为44.44%,2组比较,差异有统计学意义(P0.05)。治疗后,2组症状总积分均较治疗前降低(P0.05),且治疗组积分下降较对照组更显著(P0.05)。随访3月,观察组复发率为5.56%,对照组为25.00%,2组比较,差异有统计学意义(P0.05)。结论:活血祛疹汤治疗慢性荨麻疹疗效肯定,优于单纯枸地氯雷他定片治疗,值得临床合理选用。     

色素失禁症一例

患儿女,4岁,因口腔牙齿发育异常于2009年8月25日到我院口腔科就诊.患儿出生时躯干及左大腿出现红斑、条带状绿豆至黄豆大小不等水疱,疱液澄清,不易破溃,黏膜无异常.实验室检查:C反应蛋白正常,WBC 16.0×109/L,嗜酸粒细胞计数为1.20×109/L,血培养:阴性.水疱区皮肤组织活检:表皮内水疱伴海绵形成,疱内含少量嗜酸粒细胞,真皮浅层血管周围可见少量淋巴细胞及嗜酸粒细胞浸润.当时诊为新生儿湿疹?给予外用炉甘石洗剂以及"激素药膏(药名不详)"等抗过敏治疗.住院9 d,水疱未消退即出院,于出生后2个半月水疱自行消退结痂,在原水疱部位出现疣状增生,于10个月时出现带状色素沉着,无自觉症状.4岁就诊时躯干色素沉着大部分消退,仅躯干右侧及左股内侧的色素沉着斑仍存在.遂到我院皮肤科就诊.     

黑素小体代谢与相关皮肤病

黑素小体是皮肤、眼、内耳、脑膜等处色素细胞特有的、溶酶体样的膜性细胞器,是合成和储存黑色素的亚细胞结构,其代谢过程包括黑素小体的生成、转运和降解三个过程。其代谢过程的异常可导致一些皮肤病的发生。文中简要地综述了黑素小体的代谢过程以及与代谢异常有关的皮肤病。