皮脂腺及皮下脂肪疾病

20 0 4 0 35 7　女性更年期痤疮的临床特征及睾酮和雌二醇水平的检测 /王建琴 (广州市一院皮肤科 )…∥中华皮肤科杂志 .- 2 0 0 3,36 (6 ) .- 338～ 339观察了 6 6例女性更年期痤疮患者的临床特征 ,并测定其中 35例患者血清睾酮和雌二醇水平。结果 :与正常对照组相比 ,患者血清睾酮和雌二醇水平无显著性差异 ,但睾酮 /雌二醇显著高于正常对照组。皮损以上唇及颏部最多 ,以粉刺、炎性丘疹或丘脓疱疹为主 ,绝大多数经一般治疗即可治愈。认为更年期妇女痤疮与其卵巢功能减退 ,致肾上腺源性雄激素相对过剩有关。表 1参 5　 (马勇 )2 0 0 4 0 35…     

珍菊降压片所致光敏性药疹的临床研究

目的 了解珍菊降压片所致光敏性药疹的临床特点,以引起人们对该药所致药疹的重视.方法 对38例服用珍菊降压片后发生皮疹患者的病史、皮损特点、光试验和治疗情况进行分析.结果 38例患者中服珍菊降压片时间最短为2周,最长为2年.皮损仅局限于暴光部位的36例,主要表现为水肿性红斑,少数患者有丘疹、丘疱疹;皮损同时累及非暴光部位的有2例,皮损表现为红斑、丘疹、丘疱疹、斑块、风团等多形性损害;16例患者在治疗前进行了光试验,其中有7例对中波紫外线敏感,3例对长波紫外线和中波紫外线均敏感,另6例则为正常反应.所有患者在停用珍菊降压片后,口服烟酰胺和抗组胺药,外用炉甘石洗剂或糖皮质激素乳膏.皮损于1～3周内基本消退,仅2例患者在2月后仍有皮损.结论 珍菊降压片导致的光敏性药疹主要为光毒反应,表现为水肿性红斑,也可能存在光变态反应,皮损表现为多形性,应引起临床医生的重视.     

滋阴清热药对系统性红斑狼疮患者性激素及临床疗效的影响

目的 探讨滋阴清热中药对系统性红斑狼疮(SLE)患者性激素及临床疗效的影响。方法 将54例伴有阴虚证的活动期SLE患者随机分为2组,治疗组(30例)给予滋阴清热中药知柏地黄丸加大补阴丸结合泼尼松(龙)治疗,对照组(24例)给予泼尼松(龙)治疗,共2个月。比较治疗前后两组患者血清黄体生成素、卵泡刺激素、雌二醇、孕酮、睾酮和泌乳素及临床表现。治疗前同时检测30例伴有非阴虚证的活动期SLE患者及25例正常人血清。结果 治疗前,活动期阴虚证SLE患者血清黄体生成素、卵泡刺激素、雌二醇较非阴虚证患者及正常人显着升高(P<0.05),睾酮显着降低(P<0.05).治疗后,治疗组黄体生成素、卵泡刺激素、雌二醇水平较治疗前明显降低(P<0.05),并低于同期治疗的对照组(P<0.05);睾酮值上升(P<0.05),治疗组高于对照组(P<0.05).治疗组病情SLAM评分的好转优于对照组,阴虚内热的症状明显改善。2个月使用的皮质类固醇总量治疗组少于对照组(P<0.05).结论 采用滋阴清热中药联合西药治疗活动期伴阴虚内热的SLE患者,疗效优于单用西药治疗。其作用机理可能与该类中药具有调节阴虚内热患者垂体、性腺轴的功能,下调雌激素、升高睾酮,从而间接改善患者的免疫功能有关。     

维胺酯和异维A酸治疗寻常痤疮随机双盲研究

目的 评价维胺酯胶囊和异维A酸胶丸治疗中重度寻常痤疮的疗效和安全性.方法 采用多中心、随机、双肓双模拟、对照临床研究,按痤疮综合分析系统(GAGS)评价痤疮的严重程度,将评分确定为中重度痤疮的患者随机分为维胺酯组(50mg,每日3次)和异维A酸组(10mg,每日2次),于服药前、服药后2、4、6周计数皮损,观察疗效和不良反应.结果 共入组227例,计入全分析集(FAS)分析213例,符合方案集(PPS)分析200例.PPS分析治疗后2、4、6周异维A酸组有效率分别为6.0%、29.0%、57.0%;维胺酯组分别为5.0%、20.0%、51.00%,两组比较差异无统计学意义(P>0.05).各随访期皮损数下降值比较,除异维A酸组炎性丘疹和脓疱数下降值高于维胺酯组(P<0.05)外,粉刺、结节类皮损数两组差异无统计学意义.FAS分析不良反应发生率异维A酸组(68.81%)显著高于维胺酯组(36.53%)(P<0.001),常见不良反应如口干、口唇脱屑异维A酸组发生率显著高于维胺酯组(P<0.001),不良反应的程度也明显重于维胺酯组(P<0.05).结论 异维A酸和维胺酯治疗中重度痤疮疗效较为一致,但异维A酸治疗炎性皮疹起效较快,同时其常见不良反应也多于维胺酯.     

增殖性脓皮病1例

1 病历摘要 患者男．30岁。因头颈部反复出现脓疱疹、疣状损害4个月．躯干,四肢出现脓疱疹20d．于2006年5月23日入院、患者于4个月前无诱因于头颈部出现毛囊性红色丘疹、丘脓疱疹．经抗生素治疗,皮损痊愈,3个月前额郜、枕部再次出现毛囊性丘疹及脓疱疹．予中药治疗10d后病情好转,遂给予抗生素治疗至脓疱干涸、结痂、脱落。20d前皮损再次复发。[第一段]     

光子治疗寻常性痤疮60例疗效观察

我们于2003年10月~2004年12月采用美国Radiancy公司生产的Clear-TouchTM光子痤疮治疗仪治疗中度寻常性痤疮,其疗效满意。现报道如下。临床资料病例均来自皮肤科门诊,皮损主要为累及颜面部的散在性黑头粉刺、炎性丘疹、脓疱或结节。体征按靳培英1标准分为轻(I级):主要皮损为粉刺     

中药痤疮冲剂对兔耳实验模型抗角化作用的研究

目的 建立痤疮实验动物模型,并用来观察中药的抗粉刺作用.方法 采用Kligman法煤焦油外涂于白色家兔耳管开口处,每日1次,连续2周,然后将白色家兔分为两组,第1组灌饲痤疮冲剂2周,第2组不做任何处理.结果 外涂煤焦油2周后,肉眼可见兔耳呈粉刺样发疹,光镜、电镜下观察其改变与人类粉刺相似.又经过 2周后,第1组粉刺样改变明显减轻,第2组未见明显改变.结论 兔耳粉刺实验动物模型具可重复性,并能用于观察药效;中药痤疮冲剂能减少粉刺动物模型的毛囊角栓和减轻真皮炎症.     

丹参酮联合阿达帕林凝胶治疗轻、中度痤疮的疗效观察

<正>痤疮为常见皮肤病,多发于青少年,临床表现为非炎性皮损(白头粉刺、黑头粉刺)及丘疹、脓疱、囊肿等炎性皮损。该病常迁延数年,除了对容貌的影响外,对患者心理也产生影响。我科采用口服丹参酮联合外用阿达帕林凝胶治疗轻、中度痤疮,现将结果报告如下。1资料与方法     

枇杷清肺饮加减联合维胺脂软膏治疗寻常性痤疮疗效观察

笔者从2006年2月至2007年5月采用中西医结合方法治疗寻常性痤疮，疗效肯定，现报告如下： 55例患者均来自本科门诊，符合寻常性痤疮中医辩证肺经风热症诊疗标准，表现为颜面潮红、粉刺掀热、舌红、苔薄黄，面部、前胸及后背散在或簇集性丘疹、丘疱疹、脓疱、炎性结节，部分可见萎缩性瘢痕。     

高强度窄谱蓝光对寻常痤疮表皮分离菌的抗菌作用研究

目的 评价高强度窄谱蓝光对寻常痤疮致病菌的抗菌作用.方法 取67例轻、中度痤疮患者皮损内容物进行细菌培养、分离并鉴定菌种.用高强度窄谱蓝光对培养所得的各种细菌进行照射,观察照光前后细菌数量、形态及超微结构的变化.结果 皮损处检出痤疮丙酸杆菌(32.4%)、颗粒丙酸杆菌(6.9%)、表皮葡萄球菌(35.3%)、金黄色葡萄球菌(4.9%)、溶血葡萄球菌(7.8%)、孔氏葡萄球菌(1.0%)、棒状杆菌(9.8%)及肺炎克雷伯菌(1.0%)和B群链球菌(1.0%).照光后痤疮丙酸杆菌和表皮葡萄球菌较未照光组菌量显著减少(P<0.05),菌落明显变小.结论 高强度窄谱蓝光有抗痤疮表皮分离菌作用.     

羊肠线穴位埋藏法治疗寻常痤疮临床观察与试验研究

目的观察羊肠线穴位埋藏法治疗痤疮临床疗效并探讨其作用机制。方法将107例病人随机分成痤疮治疗组与痤疮对照组,进行临床对比观察,治疗组取血清检测睾酮和雌二醇,与正常对照组比较,并做治疗前后比较。结果治疗组临床疗效优于对照组,差异显著(P<0.05),羊肠线穴位埋藏法可降低女性血清中升高的睾酮水平(P<0.05)。结论羊肠线穴位埋藏法治疗痤疮疗效显著,其作用机制可能与调节患者性激素水平有关。     

66例痤疮患者血清睾酮及雌二醇水平研究

对６６例痤疮患者和２０名正常人的血清睾酮及雌二醇水平进行检测。结果显示：伴有多毛现象女性患者的血清睾酮水平和男性患者的雌二醇水平明显高于正常对照组（Ｐ〈０．０５），提示痤疮发生与性激素水平改变有关。     

寻常型痤疮患者性激素水平与发病的相关性研究

目的探讨痤疮患者外周血雄激素(T)及雌二醇(E2)含量对寻常型痤疮发生发展的影响。方法双盲随机抽取2009年8月-2011年6月本科门诊病例131例痤疮患者和131名正常对照组,采用放射免疫法检测血清雄激素(T)和雌二醇(E2)水平。结果痤疮患者性激素(雄激素、雌二醇)水平与对照组相比无明显相关性(P>0.05)。结论痤疮患者性激素(雄激素、雌二醇)水平与痤疮发病无明显相关     

524例青春期后女性痤疮患者的性激素和血脂分析

目的：检测青春期后女性痤疮患者血脂和性激素水平变化情况,探讨痤疮与性激素和血脂的关系。方法：收集青春期后女性寻常痤疮患者和健康对照者,检测BMI、甘油三酯、高密度脂蛋白、垂体泌乳素、促卵泡生成素、促黄体生成素、睾酮和硫酸脱氢表雄酮水平和盆腔超声。结果：共纳入524例青春期后女性痤疮患者（轻、中、重度痤疮分别为239例,207例和78例）及50名健康对照。轻、中、重度患者垂体泌乳素、雄烯二酮和硫酸脱氢表雄酮均显著高于健康对照者（P<0.05）。379例患者无多囊卵巢综合征（PCOS）,其中高雄烯二酮患者62例,雄烯二酮水平正常者317例。较雄烯二酮正常组,高雄烯二酮组垂体泌乳素、促黄体生成素、睾酮、硫酸脱氢表雄酮及高密度脂蛋白水平升高,甘油三酯水平降低（均P<0.05）。结论：青春期后女性痤疮患者易合并多种性激素异常,其中雄激素水平升高明显。     

Serum hormone levels in men with severe acne.

In order to evaluate the hormonal milieu in young men with severe acne, we measured serum estradiol (E2), total testosterone (T), free testosterone (FT), dihydrotestosterone (DHT), dehydroepiandrosterone sulfate (DHEA-S), and sex hormone binding globulin (SHBG) levels in sixteen male patients aged 20-30 years with severe acne, including twelve cases of nodular-cystic acne, and in seventeen age-matched normal controls. There were no significant differences in the serum levels of T, FT, DHT, DHEA-S, or SHBG between the patients and the controls, but serum E2 was significantly higher in the patient population. Thus, the hemodynamics of serum androgens in male patients with acne do not seem to differ significantly from that of normal controls. Elevated E2 levels might affect the inflammatory response of acne vulgaris through the release of thymic hormones, as reported in the literature.     

女性痤疮与多囊卵巢综合征的相关性研究

目的 检测成年女性痤疮患者体内性激素水平的变化,探讨其与多囊卵巢综合征（PCOS）的相关性。方法 采用放射免疫分析法,对50例痤疮患者进行血清性激素水平测定和妇科经阴道超声检查。以30例正常成年女性为对照。结果 痤疮组睾酮、二氢睾酮、脱氢表雄酮及黄体生成素水平增高,与正常对照组比较差异有高度显著性（P＜0．001或P＜0．01）;雌二醇、卵泡刺激素、孕酮水平变化不明显（P均＞0．05）。50例中有28例患PCOS。对其中10例应用达英－35治疗,可降低血清雄激素水平。结论 高雄激素血症和PCOS与成年女性痤疮有关,且是其长期不愈的重要原因。达英－35对此类痤疮有较好疗效。     

Oral contraceptives in the treatment of acne

Oral contraceptives (OCs) can reduce acne by lowering the production of adrenal and ovarian androgens, by inhibiting 5-alpha-reductase, which in turn, reduces the levels of dihydrotestosterone, and by stimulating sex hormone binding globulin (SHBG), thus reducing the levels of free testosterone. In newer OCs, such as Tricyclen and Diane-35, the progestin component is minimally androgenic and anti-androgenic respectively, thereby enhancing the favorable profile of these products in the treatment of hyperandrogenic disorders, including acne. The efficacy of these agents and their long-term safety profile supports their use in various grades of acne in females: * As adjunctive therapy to topical agents for women with mild non-scarring acne desiring oral contraception * As primary therapy for patients with moderate non-scarring acne in combination with topical therapy and systemic antibiotics * As one of two preferred methods of contraception in patients with scarring and severe inflammatory acne being treated with systemic isotretinoin.     

Acne fulminans successfully treated with prednisone and dapsone

Acne fulminans is a rare condition and the most severe form of acne. It involves the sudden onset of febrile and multisystemic symptoms, with poor response to ordinary therapy in patients who previously had mild to moderate acne. It is characterized by hemorrhagic ulcerative crusting lesions on the face, chest and upper back. The authors report a case of acne fulminans that was successfully treated with oral prednisone and dapsone.     

Mild Insulin Resistance during Oral Glucose Tolerance Test (OGTT) in Women with Acne

The purpose of this study was to evaluate serum levels of basal insulin and glucose-stimulated insulin, and to evaluate their correlations with androgen levels in women with acne. Serum levels of total testosterone (T), free testosterone (FT), dihydrotestosterone (DHT), dehydroepiandrosterone sulfate (DHEA-S), sex hormone binding globulin (SHBG), insulin-like growth factor-1 (IGF-1), and immunoreactive insulin (IRI) were measured and compared in thirty women with moderate or severe acne and thirteen healthy controls. Serum FT, DHT and DHEA-S levels in the acne group were significantly higher than those in the control group. In the acne group, there were no significant correlations between insulin or IGF-1 levels and T, FT, DHT and SHBG, despite the positive correlation between insulin and IGF-1. In order to determine the effects of insulin secretion as a dynamic response to an oral glucose tolerance test (OGTT) on serum androgen levels in acne patients, we examined the responses of serum insulin and androgen levels to a 75 g, 2 hour OGTT in the acne group and in the control group. Basal insulin levels were not significantly higher than those in the control group, but the summed insulin levels during the OGTT in the acne group were significantly higher than those in the control group. Serum T and FT levels in the acne group decreased during the OGTT, but these changes were not so significant when compared to normal controls. In conclusion, we tried to demonstrate mild insulin resistance during the OGTT in acne patients. However, postmeal transient hyperinsulinemia does not seem to play an important role in determining hyperandrogenemia in acne patients.     

Adrenal androgen abnormalities in women with late onset and persistent acne

Androgens are an essential prerequisite for the development of acne. The present study was undertaken to characterize the androgen status of women with late onset and persistent acne only and, using the dexamethasone (dex) suppression test, to identify the source(s) of the androgen excess. We measured serum levels of total testosterone (T), free testosterone (FT), androstenedione ( ⁴A), dihydrotestosterone (DHT), dehydroepiandrosterone sulphate (DHEA-S) and sex hormone binding globulin (SHBG) in 34 healthy control subjects, in 34 women with mild acne and in 29 women with moderate or severe acne. Serum FT, DHT and DHEA-S levels in patients of both acne groups were significantly higher than those in the control subjects. The other hormone levels showed no significant differences between patients and control subjects, and there were no significant differences between the two acne groups in any of the androgen levels. In order to evaluate the ovarian and adrenal contributions to serum androgens in the acne patients, the serum levels of ⁴A, T, DHT and DHEA-S were measured prior to and following 2 weeks of dex therapy. Following the dex test, the DHT and T of adrenal origin were significantly higher in the acne patients than in the control subjects. These results suggest that, in acne patients, hyperandrogenaemia is likely to develop as a result of adrenal androgen excess. In addition, since abnormally high androgen levels are frequently seen in late onset and persistent acne, it seems that this condition is likely to be a sign of hyperandrogenism.