当归苦参丸联合小剂量多西环素治疗酒渣鼻疗效观察

目的探讨当归苦参丸联合小剂量多西环素治疗酒渣鼻的临床疗效及安全性。方法治疗组口服当归苦参丸5.5g,口服多西环素片20mg,同时外用甲硝唑凝胶,均2次/d。对照组口服多西环素片0.1g,(2~4)周症状控制后减为50mg,同时外用甲硝唑凝胶,均2次/d。两组疗程8周,于治疗后每2周复诊1次,记录皮损变化及不良反应情况,8周后判定疗效,对治愈病例随访3个月,并记录复发情况。结果治疗组痊愈率、有效率、痊愈患者复发率、不良反应发生率分别为54.3%、82.9%、10.5%、5.7%;对照组分别为26.7%、60.0%、37.5%、22.6%。两组间对比差异具有显著性(χ~2=5.074,P0.05;χ~2=4.215,P0.05;χ~2=3.715,P0.05;χ~2=3.971,P0.05)。结论当归苦参丸联合小剂量多西环素治疗酒渣鼻疗效好、复发率低、不良反应少,值得临床推广应用。     

阿奇霉素联合维生素B6软膏治疗酒渣鼻疗效观察

目的探讨阿奇霉素联合维生素B6软膏治疗酒渣鼻的疗效。方法将68例患者随机分为治疗组37例，口服阿奇霉素，1次／d，0．5g／次，每日早晚洁面后外用1．2％维生素B6软膏；对照组31例，口服阿奇霉素，外用5％硫磺软膏，用法同治疗组。两组疗程均为1月。结果两组有效率分别为81．08％和54．84％，两组有效率比较差异有显著性（P〈0．05）。结论阿奇霉素联合维生素B6软膏治疗酒渣鼻疗效较满意且未见局部不良反应。     

外用卡泊三醇倍他米松凝胶治疗头皮银屑病临床研究

目的观察卡泊三醇倍他米松凝胶治疗头皮银屑病的临床疗效。方法将2016年7月-2017年10月于我院皮肤科门诊就诊的97例头皮银屑病患者随机分为3组。治疗组34例,每晨1次卡泊三醇倍他米松凝胶外搽头皮;对照1组,31例,每晨1次卡泊三醇搽剂外搽头皮;对照2组,32例,每晨1次倍他米松搽剂外搽头皮。疗程4周,分别在治疗前和治疗2周、4周时对头皮银屑病患者银屑病皮损面积和严重程度指数(PASI)评分和疗效评估。结果治疗第2周时,治疗组患者的PASI评分为(9.12±2.54)分,低于对照1组的(12.26±2.23)分及对照2组的(10.11±2.02)分,差异有统计学意义(P<0.05);治疗第4周时,治疗组患者的PASI评分(4.02±2.78)分,明显低于对照1组的(8.26±2.23)分及对照2组的(6.11±2.02)分,差异有统计学意义(P<0.05);治疗第2周、4周时,治疗组患者的治疗有效率分别为38.24%、82.35%,均高于对照1组的25.81%、54.84%及对照2组的34.38%、65.63%,但仅治疗4周时的有效率比较差异有统计学意义(P<0.05)。结论外用卡泊三醇倍他米松凝胶治疗头皮银屑病疗效确切,使用方便,不良反应小,可广泛应用于临床。     

多西环素联合雷尼替丁治疗轻、中度痤疮的临床观察

目的通过探讨多西环素联合雷尼替丁治疗轻、中度痤疮的临床疗效及安全性。方法将入选的122例轻、中度痤疮患者随机分为3组。治疗组45例,予多西环素、雷尼替丁口服治疗;对照1组38例,予多西环素口服治疗;对照2组39例,予雷尼替丁治疗;3组患者均同时外用10%硫软膏外搽,疗程为8周。结果治疗8周以后,治疗组有效率93.33%,对照1组有效率57.89%,对照2组68.21%,差异有统计学意义(P0.05)。对照2组复发率33.33%,略低于对照1组39.47%,高于治疗组22.22%,差异有统计学意义(P0.05)。结论多西环素联合雷尼替丁治疗轻、中度痤疮疗效和安全性均较好。     

克拉霉素与强力霉素治疗男性非淋菌性尿道炎疗效对比观察

目的探讨克拉霉素与强力霉素治疗男性非淋菌性尿道炎的疗效。方法将门诊确诊为非淋菌性尿道炎的患者随机分为治疗组55例,应用克拉霉素口服;对照组53例,口服强力霉素。疗程14天,停药一周后随诊观察疗效。结果治疗组的治愈率为87.27%,有效率为94.55%;对照组的治愈率为60.38%,有效率为75.47%;两组的治愈率和有效率对比差异均有显著性(P<0.01)。结论克拉霉素组疗效明显高于强力霉素组,且不良反应较低。     

雅漾三重修护特润霜联合丁酸氢化可的松乳膏治疗婴幼儿湿疹/特应性皮炎临床观察

目的评价雅漾三重修护特润霜联合丁酸氢化可的松乳膏治疗婴幼儿湿疹和特应性皮炎的临床疗效和安全性。方法将入选的121例患者按就诊顺序编号后,采用随机数字表法入选将患者分为三组,治疗组(37例)予雅漾三重修护特润霜联合丁酸氢化可的松乳膏外搽,对照1组(41例)予雅漾三重修护特润霜外搽,对照2组(43例)予丁酸氢化可的松乳膏外搽,均2次/d,疗程2周,分别于治疗1周、2周后观察其疗效及不良反应。结果治疗2周后治疗组、对照1组和对照2组有效率依次为94.6%、63.41%和79.07%,治疗组有效率高于其他两组患儿的有效率,且差异均有统计学意义(P均0.05)。三组患儿均未出现明显不良反应。结论雅漾三重修护特润霜对治疗婴幼儿湿疹和异位性皮炎有良好的辅助治疗作用,联合应用丁酸氢化可的松软膏后可明显提高临床疗效,值的临床医生选用。     

甲硝唑凝胶治疗酒渣鼻疗效观察

为观察甲硝唑外用制剂治疗酒渣鼻的疗效和安全性,对法国高德美制药公司生产的0.75%甲硝唑凝胶治疗酒渣鼻进行了随机双盲、安慰剂对照、多中心临床试验。     

昆明山海棠片联合甲砜霉素治疗掌跖脓疱病34例临床观察

目的观察昆明山海棠片联合甲砜霉素治疗掌跖脓疱病的临床疗效。方法将入选的98例掌跖脓疱病患者随机分成三组。治疗组（34例）予口服昆明山海棠片0．72g和甲砜霉素0．25g,均3次／d,同时外搽氯倍他索乳膏2次／d;对照1组（32例）予昆明山海棠片口服联合氯倍他索乳膏外搽;对照2组（32例）予甲砜霉素口服联合氯倍他索乳膏外搽。三组患者均治疗6周后判定疗效。结果治疗组、对照1组和对照2组的有效率分别为72．73％,40．43％和34．38％,治疗组有效率显著高于其他两组（P均〈0．05）。三组均出现轻度不良反应,患者可耐受,未影响治疗,差异无统计学意义（P均〉0．05）。结论口服昆明山海棠片和甲砜霉素并同期外用氯倍他索乳膏治疗掌跖脓疱病的疗效好,安性高,值得临床选用。     

血塞通颗粒联合阿达帕林凝胶治疗痤疮临床观察

目的观察口服血塞通颗粒联合外用阿达帕林凝胶治疗痤疮的临床疗效及安全性。方法随机将81例痤疮患者分为两组,治疗组42例,予口服血塞通颗粒联合外用阿达帕林凝胶;对照组39例,仅予外用阿达帕林凝胶。疗程6周,分别于2周、4周、6周记录皮损评分及不良反应。结果 6周的疗程后,治疗组和对照组的有效率分别为80.95%和51.28%,两组痤疮患者治疗2周、4周、6周时有效率差异均有统计学意义(χ~2=4.58,χ~2=7.10和χ~2=8.01,P 0.05)。所有患者均未发生明显不良反应。结论口服血塞通颗粒联合阿达帕林凝胶外用治疗痤疮患者的临床疗效好,不良反应小,值得临床医生选择。     

微晶磨削联合药物治疗轻中度痤疮疗效观察

目的探讨微晶磨削联合药物治疗轻中度痤疮的临床疗效和安全性。方法将160例轻中度痤疮患者随机分成三组,其中治疗组70例,采用微晶磨削联合外用0.025%维A酸乳膏和口服甲硝唑-vitB6片;对照1组40例单独采用微晶磨削治疗;对照2组50例外用0.025%维A酸乳膏和口服甲硝唑-vitB6片。8周后观察治疗效果。结果治疗组有效率为100%,对照1组有效率85%,对照2组有效率86%,治疗组有效率明显高于两个对照组,差异分别有统计学意义(P<0.05)。未见明显不良反应。结论微晶磨削联合药物治疗轻中度痤疮较为安全、有效。     

Permethrin 5% cream versus metronidazole 0.75% gel for the treatment of papulopustular rosacea. A randomized double-blind placebo-controlled study

BACKGROUND: Permethrin 5% cream used against human ectoparasites suggests that it may be effective in papulopustular rosacea. METHODS: This study included 63 patients diagnosed as having papulopustular rosacea based on the clinical and histological findings. Patients were randomly assigned into permethrin (n = 23), metronidazole (n = 20) and placebo (n = 20) groups. Scores of erythema, telangiectasia, edema and rhinophyma and the numbers of papules, pustules, inflammatory nodules and Demodex folliculorum were determined. Twenty-three patients were given permethrin 5% cream (Zalvor 5% skin cream, 20 patients metronidazole 0.75% gel (Roza gel and 20 patients placebo cream (Basis cream, in packages looking identical to those of metronidazole and permethrin creams, and were recommended to apply them to their faces twice a day. All patients were also given SPF 20 cream for protection against sunlight. Two months of treatment were planned, and the patients were invited to the clinic for fortnightly controls. Scores of erythema, telangiectasia, edema and rhinophyma and the numbers of papules, pustules, inflammatory nodules and D. folliculorum were recorded at each visit. The mean scores of erythema and the mean numbers of papules, pustules and D. folliculorum were determined at baseline and on days 15, 30, 45 and 60. Side effects were also detected. RESULTS: The effect of permethrin 5% cream on D. folliculorum was superior to that of metronidazole 0.75% gel. The effect of permethrin 5% cream on erythema and papules was found to be more effective than placebo and as effective as metronidazole 0.75% gel. However, it had no effect on telangiectasia, rhinophyma and pustules. CONCLUSION: It can be concluded that the application of permethrin 5% cream twice daily for 2 months can be as effective and reliable as metronidazole in the treatment of rosacea and a greater benefit can be gained when it is combined with other systemic and/or topical treatments.     

Adapalene vs. metronidazole gel for the treatment of rosacea

BACKGROUND: Rosacea is a common, chronic dermatosis that requires long-term therapy. Oral isotretinoin and topical and/or oral antibiotics are effective, but their usage may be limited due to side-effects. OBJECTIVE: The goal of the study was to compare the efficacy of topical adapalene gel (0.1%) and topical metronidazole gel (0.75%) in the treatment of patients with papulopustular rosacea. METHODS: This study included 55 patients with papulopustular rosacea. Diagnostic efforts were focused on clinical and histological features. Patients were randomly assigned to the adapalene (n = 30) and metronidazole (n = 25) groups. Sunlight protection factor 20 cream was used to protect all patients from sunlight. The characteristics and numbers of inflammatory papules, pustules, erythema and telangiectasia were scored at baseline and after 2, 4, 8 and 12 weeks. Side-effects were recorded at each visit. RESULTS: Fifty patients, 27 in the adapalene group and 25 in the metronidzaole group, completed the study. Significant reductions in the total number of inflammatory lesions were found in the adapalene group compared with the metronidazole group. There was no significant difference in the scores of erythema and telangiectasia in the adapalene group. However, a significant reduction in erythema was seen in the metronidazole group. CONCLUSIONS: Adapalene gel is well tolerated and can be used as an alternative for topical treatment of papulopustular rosacea.     

Topical metronidazole for severe and recalcitrant rosacea: a prospective open trial

Nineteen patients with severe or recalcitrant rosacea were treated twice daily with 0.75 percent metronidazole topical gel in an open label study. Sixteen of the patients (84 percent) showed 50 percent or greater reduction in inflammatory lesions, while fifteen (79 percent) demonstrated a reduction in erythema severity and an improvement when evaluated by the investigator global assessment. No positive response was recorded for any patient prior to topical medication, whereas six of nine patients previously treated with tetracycline/minocycline demonstrated improvement. Seven of these nine patients responded to topical metronidazole treatment. One additional patient who did not respond to minocycline or desonide treatment showed a good response to topical metronidazole. Only one patient reported local irritation after using metronidazole. These results demonstrate that topical metronidazole gel is safe and effective for the treatment of severe or recalcitrant rosacea.     

A comparison of 15% azelaic acid gel and 0.75% metronidazole gel in the topical treatment of papulopustular rosacea: results of a randomized trial

OBJECTIVE: To compare the efficacy and safety of a novel formulation of 15% azelaic acid gel (Finacea; Berlex Laboratories, Inc, Montville, NJ) with 0.75% metronidazole gel (MetroGel; Galderma Laboratories LP, Fort Worth, Tex) as topical therapy for moderate, papulopustular facial rosacea. DESIGN: Multicenter, double-blind, randomized, parallel-group study. SETTING: Thirteen US centers. PATIENTS: A total of 251 patients with papulopustular rosacea with persistent erythema and telangiectasia. INTERVENTIONS: Patients were randomized to receive azelaic acid gel or metronidazole gel twice daily for 15 weeks. MAIN OUTCOME MEASURES: Nominal and percent change in inflammatory lesion count, change in erythema and telangiectasia severity ratings, investigator's global assessment of rosacea, and investigator's and patient's overall improvement ratings. RESULTS: Azelaic acid gel was superior to metronidazole gel in reduction of mean nominal lesion count (-12.9 vs -10.7, respectively) (P =.003) and mean percent decrease in inflammatory lesions (-72.7% vs -55.8%, respectively) (P<.001). With respect to erythema severity, 56% of azelaic acid gel-treated patients were rated improved vs 42% of metronidazole gel-treated patients (P =.02). The effectiveness of metronidazole gel on these variables seemed to plateau after week 8, whereas azelaic acid gel demonstrated progressive improvement through week 15. Neither treatment had a clinically appreciable effect on telangiectasia. Both the investigator's global assessment (P =.02) and overall assessment of improvement (P =.005) showed a significant therapeutic advantage for azelaic acid gel. Azelaic acid gel also scored higher on the patient's overall assessment of efficacy. Both treatments were rated as having high cosmetic acceptability. No serious or systemic treatment-related adverse events were reported in either group. CONCLUSION: Use of 15% azelaic acid gel twice daily for 15 weeks demonstrated significant superiority over using 0.75% metronidazole gel in improving principal signs of rosacea (inflammatory lesions and erythema).     

Once-daily topical metronidazole cream formulations in the treatment of the papules and pustules of rosacea

BACKGROUND: The papules and pustules of rosacea can be effectively treated with topical metronidazole. The optimal concentrations of metronidazole and optimum frequencies of application are uncertain. Traditionally, twice-daily applications have been advised, based on the pharmacokinetic profile of metronidazole. Once-daily applications may be safer and less expensive, and they may enhance patient compliance. OBJECTIVE: We compared the efficacy and safety of 2 commercially available topical metronidazole formulations (0.75% metronidazole cream formulation and 1.0% metronidazole cream formulation) when both were used in a once-daily regimen. METHODS: A multicenter, randomized, investigator-blind, parallel group trial was conducted at 3 separate clinical sites located in 3 US cities. The study enrolled 72 rosacea patients with at least 8 to 50 inflammatory facial lesions (pustules and papules) and moderately severe facial erythema. Patients were randomly assigned to receive either 0.75% metronidazole cream or 1.0% metronidazole cream and instructed to apply the medication once daily for 12 weeks. Patients' lesions were evaluated at baseline and at weeks 3, 6, 9, and 12. RESULTS: There were no significant differences between treatment groups for any of the efficacy parameters evaluated. The overall median percentage change in lesion count at end point for patients in the 0.75% metronidazole cream treatment group was -62% compared with -60% for the 1.0% metronidazole cream treatment group. The overall percentage change in erythema scores at endpoint for patients in the 0.75% metronidazole cream treatment group was -26% compared with -30% for patients in the 1.0% metronidazole cream treatment group. Regarding physician assessment of global severity, 57% of subjects (20/35) in the 0.75% metronidazole cream group compared with 37% of subjects (13/35) in the 1.0% metronidazole cream group were rated as having a clear to mild condition at end point. Both drugs were well tolerated; there was no significant difference in the number of drug-related adverse events between the two agents. CONCLUSION: This controlled trial demonstrates that both 0.75% metronidazole cream and 1.0% metronidazole cream, when used once daily, provide well-tolerated efficacy for moderate to severe rosacea.     

The management of rosacea

Rosacea is a multiphasic disease which is associated with flushing, erythrosis, papulopustular rosacea and phymas; each phase is likely to have its own treatment. Flushing is better prevented rather than treated, and its etiology investigated. Beta-blockers, atenolol in particular, are worthy of prophylactic trials examining their efficacy in treating the flushing associated with rosacea. Currently, clonidine is the only drug available for the treatment of flushing. Treatment for erythrosis includes topical and systemic therapies. Metronidazole 1% cream and azelaic acid 20% cream have been reported to reduce the severity score of erythema. The systemic treatment of erythrosis is based on the association of Helicobacter pylori with rosacea. However, this role is still being debated. Eradication of H. pylori can be achieved using a triple therapy regimen lasting 1 to 2 weeks [omeprazole and a combination of two antibacterials (a choice from clarithromycin, metronidazole or amoxicillin)]. Both the flashlamp-pumped long-pulse dye laser and the potassium-titanyl-phosphate laser may be used in the treatment of facial telangiectases. Both systemic and topical remedies may be used to treat the papulopustules of rosacea. Systemic treatment includes metronidazole, doxycycline, minocycline, clarithromycin and isotretinoin, while topical treatment is based on metronidazole cream and gel. The presence of Demodex folliculorum is important in the inflammatory reaction, whether it is pathogenetic or not. Crotamiton 10% cream or permethrin 5% cream may be useful medications for papulopustular rosacea, although they are rarely successful in eradicating D. folliculorum. Oral or topical ivermectin may also be useful in such cases. Ocular involvement is common in patients with cutaneous rosacea and can be treated with orally administered or topical antibacterials. Once rhinophyma starts to be evident, the only way to correct it is by aggressive dermatosurgical procedures. Decortication and various types of lasers can also be used. Associated conditions, such as seborrheic dermatitis and possible contact sensitizations, deserve attention.     

Acne and rosacea. New and emerging therapies

The goal of this article is to highlight recent developments in the treatment of acne and rosacea. An update on the use of isotretinoin, minocycline, topical retinoids, and hormones in the treatment of acne are presented. Highlights of research findings that may lead to future acne therapies are discussed. New in the management of rosacea are studies demonstrating the efficacy of 1% topical metronidazole in the treatment of rosacea, reports on the successful maintenance of remissions of rosacea with 0.75% metronidazole gel, and data regarding the controversial association of rosacea with Helicobacter pylori infection.     

Cumulative irritation potential among metronidazole gel 1%, metronidazole gel 0.75%, and azelaic acid gel 15%

Topical therapy for rosacea aims to reduce inflammatory lesions and decrease erythema but can carry side effects such as stinging, pruritus, and burning. Metronidazole and azelaic acid gel 15% are U.S. Food and Drug Administration-approved for the treatment of rosacea. The current study was conducted to assess the cumulative irritation potential of 2 formulations of metronidazole 0.75% gel and 1% gel--and azelaic acid gel 15% over 21 days (N=36). Results of this study demonstrated a significantly greater poten tial for irritation from azelaic acid compared with metronidazole gel 0.75% (P < .0001), which had significantly greater potential for irritation compared with metronidazole gel 1% (P = .0054). Metronidazole gel 1% had a similar profile to white petrolatum.     

Current topical and systemic approaches to treatment of rosacea

Rosacea is a common, often overlooked, chronic facial dermatosis characterized by intermittent periods of exacerbation and remission. Clinical subtypes and grading of the disease have been defined in the literature. On the basis of a genetic predisposition, there are several intrinsic and extrinsic factors possibly correlating with the phenotypic expression of the disease. Although rosacea cannot be cured, there are several recommended treatment strategies appropriate to control the corresponding symptoms/signs. In addition to adequate skin care, these include topical and systemic medications particularly suitable for the papulopustular subtype of rosacea with moderate to severe intensity. The most commonly used and most established therapeutic regimens are topical metronidazole and topical azelaic acid as well as oral doxycycline. Conventionally, 100–200 mg per day have been used. Today also a controlled release formulation is available, delivering 40 mg per day using non-antibiotic, anti-inflammatory activities of the drug. Anti-inflammatory dose doxycycline in particular allows for a safe and effective short- and long-term therapy of rosacea. Topical metronidazole and topical azelaic acid also appear to be safe and effective for short-term use. There are indications that a combined therapy of anti-inflammatory dose doxycycline and topical metronidazole could possibly have synergy effects. Further interesting therapy options for the short- and long-term therapy of rosacea could be low-dose minocycline and isotretinoin; however, too little data are available with regard to the effectiveness, safety, optimal dosage and appropriate length of treatment for these medications to draw final conclusions.

Conflicts of interest

None declared.     

Effective and evidence-based management strategies for rosacea: summary of a Cochrane systematic review

Rosacea is a common chronic skin disease affecting the face. There are numerous treatment options, but it is unclear which are the most effective. The aim of this review was to assess the evidence for the efficacy and safety of treatments for rosacea. Searches included the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials in The Cochrane Library, MEDLINE, EMBASE, Science Citation Index, and Ongoing Trials Registers (updated February 2011). Randomized controlled trials in people with moderate to severe rosacea were included. Fifty-eight trials, including 27 from the original review, comprising 6633 participants were included in this updated review. Interventions included topical metronidazole, oral antibiotics, topical azelaic cream or gel, topical benzoyl peroxide and/or combined with topical antibiotics, sulphacetamide/sulphur, and others. There was some evidence that topical metronidazole and azelaic acid were more effective than placebo. Two trials indicated that doxycycline 40mg was more effective than placebo. There was no statistically significant difference in effectiveness between doxycycline 40mg and 100mg but there were fewer adverse effects. One study reported that ciclosporin ophthalmic emulsion was significantly more effective than artificial tears for treating ocular rosacea. Although the majority of included studies were assessed as being at high or unclear risk of bias, there was some evidence to support the effectiveness of topical metronidazole, azelaic acid and doxycycline (40mg) in the treatment of moderate to severe rosacea, and ciclosporin 0·05% ophthalmic emulsion for ocular rosacea. Further well-designed, adequately powered randomized controlled trials are required.