硫酸羟氯喹联合他克莫司软膏治疗慢性光化性皮炎的疗效观察

目的评价硫酸羟氯喹联合他克莫司软膏治疗慢性光化性皮炎(CAD)的临床疗效及安全性。方法选择95例慢性光化性皮炎患者,按就诊顺序随机分为3组,联合治疗组、羟氯喹组和他克莫司组,联合治疗组患者口服硫酸羟氯喹片100 mg/次,2次/d,同时外用他克莫司软膏,2次/d;羟氯喹组单纯口服硫酸羟氯喹片100 mg/次,2次/d;他克莫司组单纯外用他克莫司软膏,2次/d;3组患者均连续用药8周。记录不良反应。结果治疗2周、4周和8周后,联合治疗组与单纯用药组症状体征积分均较治疗前下降;治疗2周后联合治疗组与单纯用药组症状积分相比差异无统计学意义(P0.05);治疗4周和8周后,联合治疗组与单纯用药组症状积分相比差异均有统计学意义(均P0.05)。在患者的皮肤病生活质量指数(DLQI)评分方面,治疗8周后联合治疗组与单纯用药组评分相比差异有统计学意义(均P0.05)。在治疗后疗效方面,治疗2周后,联合治疗组与单纯用药组有效率比较差异无统计学意义(P0.05),而治疗4周和8周后,联合治疗组和单纯用药组有效率差异均有统计学意义(均P0.05);3组治疗中均未出现严重不良反应。结论硫酸羟氯喹联合他克莫司软膏治疗CAD疗效确切,安全性好。     

DPL联合0.1%他克莫司软膏治疗红斑毛细血管扩张型玫瑰痤疮的临床观察

目的观察精准脉冲光(delicate pulse light,DPL)联合0.1%他克莫司软膏治疗红斑毛细血管扩张型玫瑰痤疮的临床疗效和安全性。方法将入选的115例红斑毛细血管扩张型玫瑰痤疮患者,按随机数字表随机分为两组,全部患者均外涂0.1%他克莫司软膏,2次/d,共12周。治疗组同时予DPL治疗,每4周1次,3次为1个疗程。结果 3次治疗后,在红斑、毛细血管扩张评分和VISIA评分上,治疗组和对照组皮损改善比较差异有统计学意义(P<0.05);在临床疗效上,治疗组有效率(66.67%)明显高于对照组(29.63%),差异有统计学意义(P<0.05)。两组均未发生明显不良反应。结论 DPL联合0.1%他克莫司软膏治疗红斑毛细血管扩张型玫瑰痤疮疗效优于单用0.1%他克莫司软膏,且安全性好。     

中西医结合治疗外阴硬化性苔藓临床观察

目的观察外用他克莫司软膏联合口服中药治疗外阴硬化性苔藓的临床疗效。方法将60例患者随机分为2组,其中治疗组30例采用口服中药加局部外用0.1%他克莫司软膏治疗,对照组30例单纯外用0.1%他克莫司软膏治疗。4周为1个疗程,连续应用3个疗程后观察疗效。结果外用他克莫司软膏联合口服中药组有效率为93.3%,单纯外用他克莫司软膏组有效率为73.3%,2组有效率比较差异有统计学意义(P0.05)。结论外用他克莫司软膏联合口服中药对外阴硬化性苔藓具有良好的疗效,且疗效明显优于单纯外用他克莫司软膏。     

阿维A联合他克莫司治疗扁平苔藓——红斑狼疮重叠综合征

报告阿维A联合他克莫司软膏封包治疗扁平苔藓-红斑狼疮重叠综合征1例.患者女,72岁.双足跟反复糜烂34年.皮肤科检查:双足跟水肿性红斑散在糜烂,皮损组织病理符合扁平苔藓组织病理表现.实验室检查:抗核抗体(ANA)(+),滴度1∶80,均质型,抗双链DNA抗体(+),抗SS-A抗体(+),滴度1∶4.诊断:扁平苔藓-红斑狼疮重叠综合征.给予口服阿维A30 mg/d,0.1％他克莫司软膏局部封包治疗,皮损好转明显.     

强脉冲光联合他克莫司软膏治疗面部脂溢性皮炎疗效观察

目的探讨强脉冲光联合他克莫司软膏治疗面部脂溢性皮炎的疗效.方法治疗组24例患者应用强脉冲光照射,每3周治疗1次,3次为1个疗程,同时外用0.03％他克莫司软膏,每日2次.对照组21例仅外用0.03％他克莫司乳膏,每日2次,共4周.两组均于治疗结束后半个月判定疗效.结果两组瘙痒、红斑、鳞屑均有明显改善,治疗组和对照组临床有效率分别为87.50％和57.14％,治疗组疗效优于对照组.外用他克莫司软膏的7例患者局部有一过性刺激反应.治疗组面部经表皮丢失水分、皮肤油脂、皮肤红斑指数、皮肤弹性较治疗前有明显改善,差异有统计学意义(P＜0.05).结论强脉冲光联合外用他克莫司软膏治疗面部脂溢性皮炎安全、有效.     

0.1%他克莫司软膏联合火针治疗稳定型白癜风临床观察

目的研究火针联合0.1%他克莫司软膏治疗白癜风的疗效及优越性。方法将入选的62例白癜风患者随机分为两组,对照组(31例),用0.1%他克莫司软膏外用2次/d治疗。治疗组(31例),采用0.1%他克莫司软膏外用2次/d,联合火针每2周治疗1次,治疗12周后评定临床疗效。结果治疗12周后,治疗组有效率为93.55%对照组有效率为83.87%。结论火针联合0.1%他克莫司软膏治疗安全有效,不良反应少,可明显改善患者临床症状,值得推广应用。     

小剂量羟氯喹联合他克莫司软膏治疗面部激素依赖性皮炎疗效观察

目的探究小剂量羟氯喹联合0.03%他克莫司软膏治疗面部激素依赖性皮炎的临床疗效。方法选取2015年5月至2017年2月皮肤科门诊就诊的面部激素依赖性皮炎患者100例,随机分为ABCD四组。A组患者口服盐酸左西替利嗪片,5mg/次,1次/d及外用氧化锌软膏于患处,2次/d;B组患者口服盐酸左西替利嗪片,5 mg/次,1次/d及外用0.03%他克莫司软膏于患处,2次/d;C组口服硫酸羟氯喹片,0.1g/次,2次/d及外用氧化锌软膏于患处,2次/d;D组口服硫酸羟氯喹片,0.1g/次,2次/d及外用0.03%他克莫司软膏于患处,2次/d。四组均连续治疗6周。观察四组的临床疗效,同时比较四组的反跳发生率。结果治疗后,ABCD组的总有效率分别为52%、72%、84%、96%,四组比较差异具有统计学意义(P0.05)。ABCD组反跳发生率分别为46.2%、22.2%、9.1%、4.2%,差异具有统计学意义(P0.05)。结论小剂量羟氯喹联合0.03%他克莫司软膏治疗面部激素依赖性皮炎具有较好的临床疗效,且反跳发生率低。     

中药联合他克莫司软膏治疗面部糖皮质激素依赖性皮炎临床观察

目的观察中药联合他克莫司软膏治疗面部糖皮质激素依赖性皮炎的疗效。方法治疗组40例患者口服自拟中药加味多皮饮,同时外用0.1%他克莫司软膏,1次/d,共4周。对照组38例患者外用0.1%他克莫司软膏,1次/d,共4周。结果有效率治疗组为92.5%,对照组为68.4%,两组比较差异有统计学意义（P〈0.05）。两组治疗后积分及治疗前后积分差值比较,差异均有统计学意义（P〈0.05）。结论中药联合他克莫司软膏治疗面部糖皮质激素依赖性皮炎疗效较好。     

面颈部线状皮肤型红斑狼疮10例

目的：分析面颈部线状皮肤型红斑狼疮的临床、组织病理及治疗预后。方法：采用回顾性分析方法 对10例面颈部线状皮肤型红斑狼疮患者的临床表现、组织病理、实验室检查以及治疗预后进行分析。结果：10例患者中男性6例，女性4例，年龄分布：7～67岁，平均年龄35.1岁。皮损分布及走向与Blaschko线一致，所有患者皮损局限，均无其他部位及系统受累表现；结合组织病理检查结果，符合皮肤红斑狼疮表现；口服硫酸羟氯喹配合外用他克莫司软膏或单用他克莫司软膏治疗反应良好。结论：面颈部线状皮肤型红斑狼疮可发生于各个年龄段，临床并非罕见，本病不引起系统受累，对口服硫酸羟氯喹及外用他克莫司反应好，预后良好。     

网状红斑黏蛋白病1例

患者女,28岁,双侧乳房境界清楚的网状红斑3年,月经期间发红加重.皮损组织病理示:真皮中上层血管周围淋巴细胞浸润,间质胶原纤维束间有阿辛兰染色阳性的黏蛋白沉积.诊断:网状红斑黏蛋白病.外用0.1％他克莫司软膏2次/d,治疗1.5个月后无明显改善,口服羟氯喹200 mg,2次/d,0.5个月后皮损显著改善,1.5个月后完...     

Effectiveness of topical calcineurin inhibitors as monotherapy or in combination with hydroxychloroquine in cutaneous lupus erythematosus

Background Calcineurin inhibitors show potent anti‐inflammatory effects and favorable safety profile when used in the treatment of cutaneous lupus erythematosus (CLE). Objective The present study investigates the change in clinical parameters of erythema, desquamation and edema, when calcineurin inhibitors are used as monotherapy or in combination with hydroxychloroquine in CLE for a period of 60 days. Methods 18 patients were treated with topical tacrolimus and 20 patients with topical pimecrolimus, as monotherapy or in combination with hydroxychloroquine. Clinical parameters of erythema, desquamation and edema were assessed on a scale from 0 to 3 for erythema and edema and 0 to 2 for desquamation. Results Statistically significant improvement in erythema, desquamation and edema was observed in patients on monotherapy with calcineurin inhibitor and combination treatment with hydroxychloroquine, regardless of disease type. Combination treatment resulted in improvement of edema in 100% of patients, while monotherapy did so in 75% of patients. Conclusions Topical calcineurin inhibitors enhance the therapeutic effect of systemic agents in cutaneous lupus erythematosus, and result in improvement of the clinical parameters studied.     

Vulvar vestibulitis syndrome.

VVS is currently recognized as one of the leading causes of vulvodynia or chronic vulvar pain. Its cause is unknown, and it is defined by a constellation of signs and symptoms confined to the vulvar vestibule. Hence, there is introital or entry dyspareunia, vestibular erythema of varying degrees, and localized tenderness confined to the vulvar vestibule. It has been found to be associated with subclinical HPV infection; chronic, recurrent candidiasis; and persistent alteration of vaginal pH secretion, and therapy for some of these conditions sometimes leads to amelioration of the symptoms associated with vulvar vestibulitis. The majority of cases, however, are still idiopathic. The more chronic and severe cases are frequently helped by a surgical procedure that results in excision of most of the vestibule and advancement of the vaginal epithelium. Some of the milder cases are known to remit spontaneously, so conservative, supportive management is of the utmost importance.     

儿童头皮深在性红斑狼疮五例

目的 探讨儿童头皮深在性红斑狼疮（LEP）临床及病理学特征。 方法 回顾性分析5例LEP患儿临床、组织病理特点及治疗和预后情况。 结果 5例儿童头皮LEP,男2例,女3例;中位发病年龄5个月（范围2 ～ 38个月）;中位病程15个月（范围4 ～ 72个月）。皮损为头部弧形或环形紫红色萎缩性斑块伴脱发,枕部及颞部最常受累。1例患儿抗核抗体（ANA）1 ∶ 100,4例患儿ANA抗Ro/SSA、La/SSB抗体检查均为阴性。组织病理学改变主要为脂肪透明变性,黏蛋白沉积及脂肪小叶淋巴细胞灶状聚集。2例口服泼尼松（1.5 ~ 2） mg·kg-1·d-1, 1例口服羟氯喹5 mg·kg-1·d-1,1例口服泼尼松1.5 mg·kg-1·d-1并联合羟氯喹5 mg·kg-1·d-1;1例患儿仅外用卤米松乳膏及0.03%他克莫司软膏。患儿皮损于治疗后2 ~ 3月均获得缓解,6个月消退,新发生长,随访1.5年未见病情反复。 结论 头皮LEP对泼尼松及羟氯喹治疗反应良好,患儿可选用强效糖皮质激素及钙调磷酸酶抑制剂外用治疗。     

慢性光化性皮炎2例

慢性光化性皮炎是一组以长期皮肤丘疹、红斑等皮炎样表现的慢性光敏感性皮肤病,临床易误诊。例1男,50岁。面、颈部弥漫性、浸润性红斑1个月,以夏季为重。皮损组织病理示皮炎湿疹样改变,诊断为慢性光化性皮炎,给予羟氯喹口服,外用维生素E霜,目前患者仍在随访中。例2男,55岁。鼻面部弥漫性、浸润性暗红色斑块4～5年,皮损组织病理示淋巴瘤样改变,诊断为慢性光化性皮炎,治疗瞩避光,给予羟氯喹、咪唑斯汀、氯苯那敏口服,外用维生素E霜、丁酸氢化可的松软膏,目前患者仍在随访中。     

Adapalene 0.1%/Benzoyl Peroxide 2.5% Gel

Adapalene 0.1%/benzoyl peroxide 2.5% gel (Epiduo?, Tactuo?) is the only fixed-dose combination product available that combines a topical retinoid with benzoyl peroxide; it targets three of the four main pathophysiologic factors in acne. This article reviews the therapeutic efficacy and tolerability of topical adapalene 0.1%/benzoyl peroxide 2.5% gel in the treatment of patients aged ≥ 12 years with acne vulgaris, as well as summarizing its pharmacologic properties. In three 12-week trials in patients aged ≥12 years with moderate acne, success rates were significantly higher with adapalene 0.1%/benzoyl peroxide 2.5% gel than with adapalene 0.1% gel or benzoyl peroxide 2.5% gel alone, and combination therapy had an earlier onset of action. In addition, significantly greater reductions in total, inflammatory, and noninflammatory lesion counts were seen in patients receiving adapalene 0.1%/benzoyl peroxide 2.5% gel than in those receiving adapalene 0.1% gel or benzoyl peroxide 2.5% gel alone. Adapalene 0.1%/benzoyl peroxide 2.5% gel did not significantly differ from clindamycin 1%/benzoyl peroxide 5% gel in terms of the reduction in the inflammatory, noninflammatory, or total lesion counts in patients with mild to moderate acne, according to the results of a 12-week trial. Twelve-week studies showed that topical adapalene 0.1%/benzoyl peroxide 2.5% gel in combination with oral lymecycline was more effective than oral lymecycline alone in patients with moderate to severe acne, and topical adapalene 0.1%/benzoyl peroxide 2.5% gel in combination with oral doxycycline hyclate was more effective than oral doxycycline hyclate alone in patients with severe acne. In patients with severe acne who responded to 12 weeks’ therapy with topical adapalene 0.1%/benzoyl peroxide 2.5% gel plus oral doxycycline hyclate or oral doxycycline hyclate alone, an additional 6 months’ therapy with adapalene 0.1%/benzoyl peroxide 2.5% gel was more effective than vehicle gel at maintaining response, with further improvement seen in adapalene 0.1%/benzoyl peroxide 2.5% gel recipients. A noncomparative study also demonstrated the efficacy of 12 months’ therapy with adapalene 0.1%/benzoyl peroxide 2.5% gel in patients with acne vulgaris. Topical adapalene 0.1%/benzoyl peroxide 2.5% gel was generally well tolerated in patients with acne. In 12-week trials, the most commonly occurring treatment-related adverse events included erythema, scaling, dryness, and stinging/burning; these dermatologic treatment-related adverse events were usually of mild to moderate severity, occurred early in the course of treatment, and resolved without residual effects. Topical adapalene 0.1%/benzoyl peroxide 2.5% gel was generally well tolerated in the longer term, with dry skin being the most commonly occurring treatment-related adverse event over 12 months of treatment. In conclusion, adapalene 0.1%/benzoyl peroxide 2.5% gel is a valuable agent for the first-line treatment of acne vulgaris.     

羟氯喹和氟芬那酸丁酯等联合治疗多形性日光疹的疗效观察

目的 探讨羟氯喹、氯雷他定联合氟芬那酸丁酯软膏治疗多形性日光疹的疗效和安全性。 方法 多形性日光疹患者48例,随机分为治疗1组和治疗2组,每组24例,用药时间共8周。两组患者均口服羟氯喹200 mg,每天2次,氯雷他定每天10 mg,4周后,均改为单独口服羟氯喹每次100 mg,每天2次,再服4周,同时辅以外用药。治疗1组患者辅以氟芬那酸丁酯软膏外搽患处,每天2次,共8周;治疗2组患者辅以糠酸莫米松乳膏外搽患处,每天2次,外用2周后,改为外用氟芬那酸丁酯软膏,每天2次,再使用6周。2周为1个疗程,共4个疗程,即8周。每个疗程结束时评价两组的有效率,治疗前后评价两组患者的皮肤病总评分和红斑评分。 结果 治疗1组第14、28、42、56天的总评分/红斑评分有效例数分别为0/1、3/5、12/13、19/18;治疗2组分别为1/0、4/5、12/11、20/17;两组患者各观测点有效率比较,差异无统计学意义（P > 0.05）。两组患者治疗后总评分及红斑评分均有明显降低,与治疗前相比,差异有统计学意义（P < 0.05）。两组均未出现严重的不良反应。结论 羟氯喹、氯雷他定联合氟芬那酸丁酯软膏治疗多形性日光疹疗效好,安全性高。外用氟芬那酸丁酯软膏治疗以红斑表现为主的多形性日光疹疗效较佳。     

Multicenter randomized controlled trial on combination therapy with 0.1% adapalene gel and oral antibiotics for acne vulgaris: comparison of the efficacy of adapalene gel alone and in combination with oral faropenem

We conducted a randomized controlled trial in patients with acne vulgaris with moderate to severe inflammatory lesions. The patients were assigned to the following three treatment groups: group A received monotherapy with 0.1% topical adapalene gel for 4 weeks; group B received combination therapy with 0.1% topical adapalene gel and 600 mg oral faropenem for 2 weeks followed by 0.1% topical adapalene gel alone for 2 weeks; and group C received combination therapy with 0.1% topical adapalene gel and 600 mg oral faropenem for 4 weeks. The result of the analysis indicated that the percentage reduction in inflammatory lesion counts after 2 weeks of treatment was significantly higher in groups B and C than in group A (P < 0.05). After 4 weeks of treatment, group C showed significantly higher percentage reduction in inflammatory lesion counts than in groups A and B (P < 0.05), whereas no significant difference was noted between the latter two groups. Adverse reactions included dryness and irritation at the adapalene application sites that were observed in 10.1% of cases (16/158 patients) and diarrhea and loose stool because of oral faropenem that were observed in 7.5% of cases (8/106 patients). Taken together, our results suggest that combination therapy with oral antibiotics and adapalene results in earlier improvement in patients with moderate to severe inflammatory acne compared to the application of adapalene alone, and that 4 weeks of the combination therapy is preferable to 2 weeks of treatment.     

Dramatic Response of Scarring Scalp Discoid Lupus Erythematosus (DLE) to Intravenous Methylprednisolone, Oral Corticosteroids, and Hydroxychloroquine in a 5-Year-Old Child

Abstract:  Discoid lupus erythematosus (DLE) is rare in childhood. We report the case of a 5-year-old girl who presented with erythematous scaly plaques, with scarring alopecia, involving approximately 40% of her scalp. Histopathology confirmed the diagnosis of DLE. Treatment with intravenous methylprednisolone, hydroxychloroquine, oral prednisone, topical corticosteroids, and sunscreen lead to reversal of scarring alopecia and re-growth of hair.     

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.     

进食藜导致植物日光性皮炎11例临床分析

【摘要】 目的 探讨进食藜导致的植物日光性皮炎的临床特点和治疗。方法 对2013—2017年在济宁医学院附属医院皮肤科诊治的11例进食藜引起的植物日光性皮炎患者的一般资料、临床表现、实验室检查、治疗及预后进行回顾性分析。结果 11例患者均为女性,年龄45 ~ 62岁,起病前1 ~ 2 d内均有进食藜史和日光暴露史。临床均表现为颜面部、双手背、前臂暴露处对称分布的非凹陷性肿胀性红斑,表面紧张光亮,伴痛痒。6例患者血白细胞计数升高,1例嗜酸性粒细胞计数升高,1例尿蛋白阳性,1例隐血阳性。均系统给予甲泼尼龙、氯雷他定、依巴斯汀、螺内酯、呋塞米、奥美拉唑治疗,2例同时应用人免疫球蛋白,3例口服洛芬待因,并予外用药物对症治疗。10例治疗7 ~ 10 d后好转出院,1年后随访均无色素沉着及瘢痕;1例出现双手背皮肤坏死,转入整形科继续治疗,半年后随访告知遗留皮肤瘢痕。结论 进食藜导致的植物日光性皮炎常表现为暴露部位肿胀性红斑,明确诊断后避免进食藜和日晒,并及时给予抗过敏治疗可有效控制病情。