无创性皮肤测试在黄褐斑临床分型中的应用及意义

目的探讨黄褐斑不同临床类型及其皮肤生理功能,以指导疾病治疗。方法采用无创性皮肤测试仪分析黄褐斑不同临床类型的皮肤生理功能。用伍氏灯及玻片压诊法对84例黄褐斑患者进行分型;采用德国CK公司的无创性皮肤测试仪检测84例患者皮损部位及40例正常对照的油份、水分、经表皮水分流失、血色素及黑色素,并两两比较各型黄褐斑的血色素及黑色素水平。结果根据伍氏灯及玻片压诊法初步将84例黄褐斑分为四型:单纯色素型(M)23例,单纯血管型(V)17例、M>V型24例及V>M型20例。84例患者与对照组相比,面颊部皮肤水分显著降低(p<0.01),经表皮水流失(TEWL)、血色素、黑色素水平显著增高(p<0.01),皮脂含量无显著性改变(p>0.05);V型与V>M型之间血色素水平无明显差异(p>0.05),但均高于其他两型(p<0.01);M型及M>V型的黑色素水平之间无显著差异(p>0.05),但高于其他两型(p<0.05)。结论黄褐斑在临床上存在四种不同类型,即M型、V型、M>V型及V>M型;四型均存在皮肤屏障功能受损,保湿是四型黄褐斑治疗的基础;M型及M>V型以黑色素值增高为主,V型及V>M型以血红蛋白增高为主,提示黄褐斑的治疗应以其类型为依据。

The application of non-invasive physiometry in different clinical type of melasma and its clini-cal significance

Objective To study the new methods for classifying melasma and the physiometry of different clinical types, to provide the theory basis for treatment of melasma. Methods Eighty-six China female women with melasma were examined with Wood＇s light and glass compression examination and divided into four clinical types. The value of sebum content, stratum corneum water content, TEWL, melanin and hemoglobin of the patients with melasma and normal skin were measured. The level of melanin and hemoglobin were com- pared between different clinical types. Results Four types of melasma are described on the basis of Wood＇s light and glass compression examination： melanin type （M type, 23 cases）, vascular type （V type, 17 cases）, melanin dominant type （M〉V type, 24 cases） and vascular dominant type （V〉M type, 20 cases）. Compared with normal skin, the value of TEWL, melanin and hemoglobin increased （P 〈0. 001 ）, but the water content of stratum corneum decreased （ P〈0. 001 ） in patients with melasma, however, the sebum content be-tween normal skin and melasma has not statistical difference （ P〉0. 05 ）. The value of hemoglobin in the lesion of V and V〉M types was significant increased compare with other two types （P〈0.01）, and the value of melanin content in the lesion of M and M〉V types de-creased compare with V and V〉M types （P〈0.01）. Conclusion The clinical pattern of melasma can be divided into four types, melanin type, vascular type, melanin dominant type and vascular dominant type. The value of stratum corneum water content in all types of melas- ma was decreased, and Twl inreased,which suggest the epidermal barrier in melasma was damaged. The treatment of melasma should be based on its clinical types.