皮脂腺及皮下脂肪疾病

20110251女性青春期后痤疮的发病因素分析/李金勇(山东潍坊市皮防所),王晓云,于维恒…∥中国麻风皮肤病杂志.-2010,26(2).-98~101选取133例女性青春期后痤疮患者进行问卷调查,对部分患者检测血清性激素水平,分析女性青春期后痤疮发病的危险因素。     

青春期痤疮患者血清六项性激素水平的测定

目的探讨青春期寻常型痤疮患者体内性激素水平的改变.方法采用电化学发光免疫分析法对30例青春期女性痤疮患者及18例青春期男性痤疮患者血清六项性激素水平进行检测,并以相应年龄段的15例正常女性及12例正常男性作对照.结果女性青春期痤疮患者血清雌二醇水平明显低于正常对照组(P＜0.05);睾酮/雌二醇比值明显高于正常对照组(P＜0.01);促卵泡素明显高于正常对照组(P＜0.05);男性青春期痤疮患者血清睾酮、雌二醇、孕酮、促卵泡素、黄体生成素、催乳素及睾酮/雌二醇与对照组相比均无显著性差异(P＞0.05).结论青春期女性痤疮患者发病的主要原因可能是由于雌激素分泌不足,使血清内睾酮水平相对增多所致.男性青春期痤疮患者的发病可能与血清六项性激素水平变化无直接关系.     

外用痤疮洗剂治疗寻常痤疮90例

寻常痤疮是毛囊皮脂腺的慢性疾病,具有自限性。主要发生于青春期,发病率高,病因复杂。1995年5月至1996年5月间,应用本所自制的痤疮洗剂治疗390例寻常痤疮,并与外用过氧苯甲酰洗液治疗40例寻常痤疮进行比较,临床观察显示,外用痤疮洗剂治疗痤疮有效,且副作用小。 治疗组90例,患者中女性31例(34.44％),男性59例(65.56％);对照组40例中女性13例(32.5％),男性27例(67.5％)。年龄最小16例,最大38岁,平均     

女性青春期后痤疮的发病因素分析

目的:分析女性青春期后痤疮发病的危险因素.方法:选取133例女性青春期后痤疮患者进行问卷调查,对部分患者检测血清性激素水平.结果:单因素分析年龄、家族史、油性皮肤、化妆品使用、精神紧张或工作压力、体重指数偏大、雄激素水平高是发病的危险因素(P＜0.05);多因素分析年龄、家族史、化妆品、皮肤类型、精神紧张为危险因素(P＜0.05).结论:女性青春期后痤疮发病涉及多方面,确切病因仍有待进一步研究.     

女性痤疮患者黄体期性激素水平与中医证型关系研究

目的 探讨性激素水平与不同年龄段、不同中医分型女性痤疮患者的关系.方法 118例女性痤疮分为青春期组(16～20岁)和青春期后组(21～45岁),根据中医理论分为肺胃积热型、脾胃湿热型、肝郁化火型和阴虚火旺型.应用化学发光法检测患者血清促卵泡激素(FSH)、促黄体激素(LH)、催乳素(PRL)、孕酮(P)、雌二醇(E2)和睾酮(T)水平,并以30例正常女性为对照.结果 青春期女性痤疮患者FSH,LH,T/E2增高,E2水平降低;青春期后女性T/E2,PRL增高,E2降低.青春期女性表现以肺胃积热型为主,FSH,LH水平升高,E2降低;青春期后女性以肺胃积热型、脾胃湿热型和肝郁化火型为主,其中肺胃积热型E2水平降低,脾胃湿热型T,T/E2明显增高,肝郁化火型PRL明显升高.结论 青春期和青春期后女性痤疮患者,以及不同中医证型患者在黄体期性激素水平存在明显差异.     

98例青春期后痤疮临床分析

为了探讨青春期后痤疮可能的病因因素,对98例25岁以上痤疮患者的临床特征进行了分析。女86例,男12例。多数患者为持续性痤疮,仅31例（31.63%)患迟发性痤疮（25岁后发病）,痤疮多为轻度或中度,外界因素似乎没有明显的致病作用。精神紧张可能量 种有意义的病因因素,87.5%女性患者月经前痤疮突发或加重。24例（24.49%)患者有青春期后痤疮阳性家族史,19例（22.09%)女性患者伴有多毛症或脱发等雄激素过多症的特征。     

温经汤加减治疗宫寒血瘀型青春期后痤疮的临床研究

目的评价温经汤加减治疗宫寒血瘀型青春期后痤疮的疗效。方法采用随机对照的方法,将符合纳入标准的64例研究对象按1∶1随机分入治疗组和对照组,治疗组予口服温经汤加减,对照组予口服达英-35。治疗2个疗程后观察临床症状、血清睾酮水平在治疗前后的改变。结果治疗后2组的丘疹、脓疱、脂溢评分均较治疗前降低,差异有统计学意义(P<0.05)。治疗后2组的血清睾酮水平均较治疗前明显下降,差异有统计学意义(P<0.05)。治疗组治疗后的粉刺、丘疹、脓疱、脂溢评分和血清睾酮水平与对照组治疗后比较,差异无统计学意义(P>0.05)。结论温经汤加减治疗宫寒血瘀型女性青春期后痤疮疗效确切,可降低血清睾酮水平,其作用机制可能与拮抗雄激素受体或是雄激素相关代谢途径等有关。     

痤疮的中西医治疗现状

痤疮是一种常见的毛囊、皮脂腺慢性炎症性疾病,好发于青春期。其病因很多,一般认为雄性激素分泌增多,皮脂腺分泌增多,皮脂淤积成脂栓,毛囊、皮脂腺导管角化栓塞,丙酸痤疮杆菌大量繁殖,毛囊壁损伤破裂,毛囊周围皮肤炎症反应;免疫反应、内分泌障碍、多脂多糖及刺激性饮食、环境高温及某些化学因素等等参与痤疮的整个病程;还与遗传及心理因素有关[1],这些因素间相互影响。临床表现为粉刺、丘疹、脓疱、结节以及囊肿,或各种皮疹并存。现将痤疮的中西医治疗现状综述如下。1痤疮的西医治疗1.1常用的外用西药适用于轻度和中度的痤疮,或和口服药物配合用于中到重度的患者,在病情控制后用于维持治疗、预防复发。1.1.1维甲酸用于痤疮治疗外用维甲酸主要有第一、三代维A酸类药物,它能选择性结合于对皮肤角质细胞增长与分化有调节作用的维A酸受体r,调节表皮细胞的有丝分裂和促进表皮细胞更新,使病变皮肤的增长和分化恢复正常。促进毛囊上皮更新,防止角质栓塞,抑制蛋白产生,抑制和减少粉刺的形成,清除成熟粉刺和炎性皮损使痤疮皮损消退。研究显示,13-顺维A酸可诱导皮脂腺细胞凋亡[3]。1.1.1.1第一代维A酸迪维霜,对于丘疹和粉刺效果较佳,具有逆转上皮异常角化、...     

乌鲁木齐市女性青春期后痤疮病因初探

为探讨乌鲁木齐市女性青春期后痤疮可能的发病因素,我们自2002年9月~2003年9月,对门诊就诊的85例年龄在25岁以上女性痤疮患者进行了有关病因方面的总结分析,现报道如下。资料方法与结果在我科门诊就诊的85例年龄25岁以上女性痤疮患者,由专人详细询问病史、发病相关因素,进行体检和记录。患者年龄25~47岁,平均34.2岁。其中25~35岁52例(61%),36~45岁28例(33%),46岁及以上5例(6%)。油性皮肤51例,干性皮肤12例,中性皮肤22例;室内工作者62例,室外工作者23例;已婚49例,未婚36例;月经规律者47例,不规律者30例,停经者8例;经前加重者41例;便秘者58例;…     

70例儿童痤疮临床分析

目的:探讨儿童痤疮的临床表现、实验室检查和治疗方法,了解其发病的主要因素。方法:对70例儿童痤疮的临床资料进行回顾性分析。结果:70例患儿中,男35例,女35例,男女之比为1∶1,年龄8～12岁,平均(9.12±1.46)岁;病程15天～18个月,平均(6.27±1.74)个月。临床表现为粉刺55例(78.57%),炎性丘疹30例(42.86%),脓疱10例(14.29%),结节2例(2.86%),囊肿1例(1.43%),瘢痕1例(1.43%)。患儿均有一定程度偏食汉堡包或薯条等高糖、高脂肪食物情况。结论:高糖、高脂肪和高能量饮食可能与儿童痤疮发病有一定关系。     

Post-adolescent acne: a review of clinical features

Acne is usually recognized as a disorder of adolescence. However, the referral of patients over the age of 25 years with acne has significantly increased over the past 10 years. The clinical features of 200 patients over the age of 25 years, referred to our department for treatment of acne. were evaluated with a view to establishing possible aetiological factors. There were 152 (76%) women and 48 (24%) men. The mean age of the patients was 35.5 years (range 25-55 years). The acne was mild or moderate in severity, consisting principlly of inflammatory lesion, with mean total acne grade (Leeds Grading Scale) of 1.125 for men and 0.75 for women. Most patients had persistent acne; but true late-onset acne (onset after the age of 25 years) was seen in 28 (18.4%) of women and four (8.3%) of men. Thirty-seven per cent of women had features of hyperandrogenicity. One hundred and sixty-four patients (82%) had failed to respond to multiple courses of antibiotics, and 64 (32%) had relapsed after treatment with one or more courses of isotretinoin. External factors, such as cosmetics. drugs and occupation, were not found to be significant aetiological factor. A family history revealed that 100 (50%) of patients had a first-degree relative with post-adolescent acne. Patients with post-adolescent acne appear to represent an increasingly important population of acne sufferers. External factors do not seem to have a significant aetiological role. Two main clinical groups were identified: those with persistent acne and those with late-onset acne. A minority of women also had features of hyperandrogenicity. These patients, and those with late-onset acne, may represent a subgroup who have underlying abnormalities of ovarian, adrenal or local androgen metabolism, and require separate investigation.     

Predictive factors for failure of isotretinoin treatment in acne patients: results from a cohort of 237 patients.

BACKGROUND: The efficacy of oral isotretinoin in acne has been established, though the role of the mean daily dose (MDD) is still unclear. OBJECTIVE: To determine the predictive factors of resistance to oral isotretinoin and the role of the MDD of isotretinoin on relapse of acne while taking into account patient characteristics and the total cumulative dose (TCD). METHODS: Two hundred and thirty-seven patients treated with oral isotretinoin for the first time were enrolled by a single dermatologist. Patients with closed comedonal acne and with hyperandrogenism received adequate therapy prior to isotretinoin. RESULTS: Closed comedonal acne was the only predictive factor of resistance to isotretinoin with an adjusted OR = 2.7 (95% CI: 1.0-7.3). The estimated rates of relapse at 1, 3 and 5 years were 14, 40 and 48%, respectively. Age and grade of facial acne were the only predictive factors for relapse with adjusted relative risks of 0.6 (95% CI: 0.4-0.8) for age >/= 20 and 1.5 (95% CI: 1.0-2.2) for grade > 3. CONCLUSION: MDD, TCD, closed comedonal acne and hyperandrogenism that have been adequately treated prior to isotretinoin treatment had no prognostic value for relapse.     

The cutaneous microflora of adolescent, persistent and late-onset acne patients does not differ

The cutaneous microbiology and antibody status to Propionibacterium acnes of patients with persistent (males, n = 32; females, n = 33) and late-onset (females, n = 25) acne were compared with individuals with adolescent acne (males, n = 22; females, n = 18) and normal control volunteers (persistent acne: males, n = 26; females, n = 30; late-onset: females, n = 20). Males had significantly higher grades of acne compared with females (P < 0.05). The microflora consisted in the main of propionibacteria, staphylococci and Malassezia; other bacteria represented less than 0.01% of the total microflora. At all sites for all samples there were significantly more propionibacteria than staphylococci or Malassezia (P < 0.05). There were significantly higher (P < 0.05) numbers of microorganisms in follicular casts from patients compared with their control volunteers for female facial skin and male back skin. Twenty-six papules and 48 normal follicles were analysed. A bimodal distribution of microbial colonization was noted, with about 90% of normal follicles and about 10% of acne follicles having no detectable viable microorganisms. Anti-P. acnes IgG antibody titres were measured using a secondary fluorescein isothiocyanate antibody technique, and no significant differences in titre were found between any groups of patients (P > 0.05). Correlation analysis showed no association between the population densities of P. acnes and anti-P. acnes IgG titres. There were no differences in the microbiology of skin of adolescent acne patients, persistent acne patients or late-onset acne patients which could account for these various forms of acne.     

Incidence of polycystic ovaries in patients with late-onset or persistent acne: hormonal reports

Forty-six women affected by late-onset or persistent acne were studied in order to investigate the frequency of hormonal abnormalities and polycystic ovaries. Hirsutism, perioral distribution of acne lesions and irregular menses were recorded. Hormonal measurements and ovarian echographies were performed. Twenty-four patients were affected with polycystic ovaries, detected by ultrasound scanning. Among the acne patients, the women with ovarian abnormalities had higher values of androstenedione, dehydroepiandrosterone, dehydroepiandrosterone sulfate and luteinizing hormone (LH), and a higher LHT/follicle-stimulating hormone ratio than those with acne and without ovarian abnormalities. This study indicates the prevalence of polycystic ovaries in women with late-onset or persistent acne. Moreover, hormonal abnormalities indicate a subgroup of acne patients defined by the presence of ovarian disorders.     

清热养阴、理气活血法治疗女性迟发性与持久性痤疮的临床与实验室研究

目的中医清热养阴、理气活血法治疗不同证型女性迟发性与持久性痤疮的临床与实验研究,并探讨其对痤疮患者神经生长因子、性激素与相关细胞因子水平的影响.方法随机分为治疗组与治疗对照组,38例治疗组给予中药芩参粉刺清口服液治疗,26例治疗对照组给予中药丹参酮胶囊治疗,并对其疗效进行了评价,同时运用放射免疫双抗法及双抗夹心ABC-ELISA法对治疗组、治疗对照组患者与30名正常对照者的血清睾酮(T)、雌二醇(E2)、神经生长因子(NGF)及白介素18(IL-18)水平进行检测并进行比较.结果两组患者皮损改善,但总有效率无统计学意义(P＞0.05).在三种不同证型的女性迟发性与持久性痤疮患者中,其血清NGF、T及IL-18水平明显高于正常对照组(P＜0.05).结论不同证型女性迟发性与持久性痤疮的发生与神经生长因子、性激素与细胞因子IL-18水平的影响有关.中医清热养阴、理气活血法是治疗女性迟发性与持久性痤疮的有效法则,它的治疗作用可能是通过调节患者血清神经生长因子、性激素与细胞因子IL-18水平实现的.     

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。     

青春期后痤疮严重程度影响因素的调查分析

目的了解青春期后痤疮严重程度的主要影响因素。方法对187例患者进行问卷调查,部分患者进行血清性激素水平的检测,肾上腺和卵巢的B超检查,细菌培养及耐药性试验。结果男性、阳性家族史、油性皮肤、嗜食油腻者、经常便秘者、工作压力较大者、伴发脂溢性皮炎者的痤疮较严重;痤疮的严重程度随着年龄的增长而减轻(P<0.1)。62.5%(20/32)患者雄激素水平升高(P<0.05),6.49%(5/77)女患者合并了多囊卵巢。细菌培养的分离率由高到低依次为耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)、表皮葡萄球菌、痤疮丙酸杆菌;需氧菌的耐药率由高到低依次为青霉素、红霉素、氯洁霉素……。结论多种因素影响着青春期后痤疮的严重程度;对于顽固难治的患者,尚需考虑多囊卵巢及多重耐药菌株存在的可能。     

Acne vulgaris

Acne vulgaris is worldwide the most common skin disease. Acne is an inflammatory disorder in whose emergence androgens, PPAR ligands, the IGF-1 signaling pathway, regulating neuropeptides and environmental factors are probably involved. These factors interrupt the natural cycling process in the sebaceous gland follicle and support the transition of microcomedones to comedones and inflammatory lesions. Proinflammatory lipids and cytokines are mediators for the development of acne lesions. Bacterial antigens can potentate the inflammatory phenomena. Acne is predominantly treated with combination therapy. Selecting a treatment regimen depends on the exact classification of acne type and severity. The development of scars is the main criterion for the choice of systemic therapy. Retinoids for mild comedonal acne and the combination of retinoids with antibiotics and/or benzoyl peroxide for mild to moderate papulopustular acne are the drugs of first choice for topical treatment. The use of topical antibiotics is not recommended any more because of the development of resistant bacterial strains. Systemic antibiotics, in combination with topical retinoids and/or benzoyl peroxide, for moderate papular/nodular acne and isotretinoin for severe nodular/conglobate acne are the columns of systemic acne treatment. Systemic anti-androgens are used in women against moderate papulopustular acne. Due to advances in the understanding of the underlying inflammatory mechanisms in recent years the development of new therapeutic agents with good efficacy and better side effect profile should be expected in the future.     

非梅毒螺旋体血清学试验持续阳性梅毒患者神经梅毒发生情况及影响因素分析

目的 探讨正规治疗后非梅毒螺旋体（Tp）血清学试验持续阳性梅毒患者的神经梅毒发生情况及相关危险因素。 方法 回顾性分析248例正规治疗后非Tp血清学试验持续阳性梅毒患者的临床资料。用单因素分析、多因素logistic回归分析及ROC曲线法检测可用于预测神经梅毒的临床指标。 结果 248例患者中25例（10.1%）诊断为神经梅毒。单因素分析显示,血甲苯胺红不加热血清试验（TRUST）下降程度（χ2 = 20.663,P < 0.05）、血TRUST持续阳性滴度（Z = -7.021,P < 0.05）与神经梅毒发生有关,而性别、年龄、梅毒分期、治疗方案、初次就诊时血TRUST滴度、有无神经系统症状与神经梅毒无显著相关性（均P > 0.05）。多因素logistic回归分析显示,血TRUST持续阳性滴度是神经梅毒的相关危险因素（OR = 4.685,95% CI = 2.552 ～ 8.601,P < 0.05）。绘制血TRUST持续阳性滴度的ROC曲线下面积为0.907,最佳临界滴度为1 ∶ 8。 结论 正规治疗后,血清TRUST滴度对于预测神经梅毒有一定意义。     

Anti-P. acnes antibody in comedonal extracts

Extracts of comedonal material obtained from patients with acne vulgaris were analyzed for albumin, IgG, IgM, IgA, and anti-Propionibacterium acnes antibodies using immunodiffusion and anti-immunoglobulin hemagglutination tests. Extracts were obtained from comedones of patients with (1) comedonal, (2) papulopustular, (3) nodular-cystic, (4) "burned out" acne, (5) patients under oral tetracycline treatment, and (6) with pustules. In all comedonal extracts analyzed, albumin and IgG (ratio approximately 1:2.5) could be detected. IgM, IgA, and C3 could not be found in noninflamed comedones by the techniques used; pustules, however, contained all immunoglobulin classes and albumin in ratios found in serum as well as C3. The anti-P. acnes antibody activity in the comedonal extracts was associated with the IgG class. Immunofluorescence microscopical examination of material from single comedones obtained by the cyano-acrylate technique showed IgG antibody on rod-shaped bacteria. The amount of IgG and albumin in comedonal extracts from the various patient groups was not different. It is concluded that IgG (and antibody of the IgG class) in comedones is derived from the serum and selectively accumulated in the follicle by an unknown mechanism.