黄褐斑的治疗进展

黄褐斑是一种获得性色素增加性皮肤病,病因复杂,治疗困难。外用药是黄褐斑治疗的首选,单用4%氢醌乳膏和三联疗法（4%氢醌乳膏+0.01%氟轻松+0.05%维A酸乳膏）为一线治疗方案,目前外用氨甲环酸治疗黄褐斑被证实安全有效,苯丙氨酸、丁雷锁辛也有一定疗效。外用木质素过氧化物酶、锌、西酸模精华、二乙酰伯尔定碱及转化生长因子β1仿生寡肽68、氟他胺等是近年的新方法。联合口服氨甲环酸能增加疗效。Q开关激光治疗黄褐斑疗效明显,但易复发和色素沉着。强脉冲光、点阵激光尚缺乏大样本研究,CO2激光和铒激光疗效显著,但极易造成亚洲患者的炎症后色素沉着,故不适于亚洲人群。顽固性黄褐斑患者可考虑化学或物理剥脱治疗,皮肤磨削术使97%患者的黄褐斑获得了永久性清除。     

复方熊果苷制剂对中波紫外线照射所致豚鼠皮肤色素沉着的抑制作用

目的研究复方熊果苷制剂对皮肤色素沉着的抑制作用,为其治疗色素沉着性皮肤病提供实验依据。方法选用熊果苷、曲酸、维A酸、维生素E、地塞米松及氢醌6种成分制成不同组合的乳膏,制作棕黄色豚鼠经UVB照射诱导皮肤色素沉着的实验动物模型,采用苏木精一伊红、Schmorl、Imokawa等方法染色,观察外用复方制剂后黑素细胞数量和形态的改变。结果不同组合的复方制剂均使多巴阳性的黑素细胞及含黑素颗粒的细胞数较对照组明显减少（P〈0．05）,其中熊果苷3号、4号与阳性对照组3％氢醌外用差异无统计学意义（P〉0．05）。结论复方熊果苷制剂对UVB诱导的色素沉着具有一定的抑制作用。     

雪夫霜治疗黄褐斑、炎症后色素沉着斑疗效观察

应用雪夫霜治疗黄褐斑、炎症后色素沉着斑 10 8例 ,有效率为 83 .3 % ,说明全反式维A酸霜剂外搽对 2种病具有祛斑、增白的肯定疗效 ,且副作用小     

间歇应用维A酸、氢醌霜、氢化可的松复方制剂治疗亚洲黑斑病患者的临床和组织学观察

氢醌和维A酸治疗白种人和黑种人黄褐斑的疗效确切,然而在亚洲人的疗效尚不肯定。作者观察了0.1％维A酸,5％氢醌和1％氢化可的松组成的复方制剂(简称RHQ)治疗韩国人中黄褐斑的疗效,同时通过皮肤组织学检查     

黄褐斑的病因及治疗

黄褐斑是一种获得性面部皮肤浅褐至深褐色色素沉着斑，现将其病因及治疗综述如下。病因１．黑素细胞刺激激素（ＭＳＨ）　Ｍａｒｉｅ等报道用αＭＳＨ孵育正常黑素细胞１２ｍｉｎ后，细胞内ｃＡＭＰ增加７倍，但４８ｈ后酪氨酸酶活性增加反而较轻（＜２０％）。血清βＭＳＨ的水平在黄褐斑患者与对照组相同，故有作者认为ＭＳＨ与黄褐斑关系不大。２．性激素　Ｃｌａｕｄｙ等报道一组经皮注射雌二醇同时用中波紫外浅（ＵＶＢ）进行亚红斑量光疗的妇女，在局部产生无炎症的色素沉着。用β雌二醇孵化正常黑素细胞２４ｈ后即可产生剂量依…     

激光与脉冲强光治疗黄褐斑

黄褐斑是常见的面部色素沉着性疾病.外用药物仍然是目前治疗黄褐斑的首选方法,包括遮光剂、脱色剂、维A酸、化学剥脱剂、糖皮质激素等.激光治疗黄褐斑的机制大多基于选择性光热作用原理.表皮型黄褐斑对常规激光治疗有效,但是会迅速复发甚至诱发更严重的色素沉着.而真皮型和混合型的黄褐斑效果不佳,为提高疗效逐步发展新的治疗技术,包括CO2激光和Q开关翠绿宝石激光的联合治疗、Er:YAG激光、脉冲强光和点阵激光,但是仍需要进一步研究以确定其有效性及这些激光治疗的最佳参数.     

橙皮苷对中波紫外线诱导豚鼠色素沉着抑制作用的研究

目的：研究橙皮苷对皮肤色素沉着的抑制作用,为其治疗色素沉着性皮肤病提供实验依据。方法：选定橙皮苷、甘草提取物、甘草双胺盐及氢醌4种成分制成不同浓度的乳膏,制作棕黄色豚鼠经UVB照射诱导皮肤色素沉着的实验动物模型。采用苏木精—伊红、Schmorl、Imokawa等方法染色,观察外用中药后黑素细胞数量和形态的改变。结果：橙皮苷、甘草提取物、甘草双胺盐均使多巴阳性的黑素细胞及含黑素颗粒的细胞数较对照组明显减少（P〈0．05）,其中3％、4％橙皮苷与阳性对照组3％氢醌外用差异无统计学意义（P〉0．05）。结论：橙皮苷、甘草提取物和甘草双胺盐对UVB诱导的色素沉着均具有抑制作用。     

点阵激光治疗黄褐斑进展

点阵激光是皮肤激光美容领域的一种新技术,近年来在黄褐斑的治疗中显示出良好的前景.点阵激光的作用原理是局灶性光热作用,是选择性光热作用的一个重要拓展和延伸.点阵激光可分为非剥脱性点阵激光和剥脱性点阵激光,对黄褐斑有一定的疗效,改善程度不一,有的甚至加重,其疗效与治疗参数的选择、皮肤类型、术后护理、黄褐斑类型等有关.不良反应主要为短暂性红斑、水肿、灼热和疼痛感等,患者可耐受,但炎症后色素沉着发生率相对较高.     

复方壬二酸乳剂的研制及其治疗黄褐斑的临床对比观察

国外屡有壬二酸外用对某些色素沉着性皮肤病具有良效的报告[1,2],国内也有治疗黄褐斑[3]及油彩皮炎黑变病的报告[4]。但因所用浓度、原料来源、处方成分和制备工艺各异,而难以精确评价其疗效。我们自1993年3月～1994年10月,采用双盲对照法,对本所研制的复方壬二酸霜剂和氢醌霜治疗黄褐斑的疗效及副作用等作了对比观察,现将结果报告如下。资料和方法1.病例选择　共30例黄褐斑患者,均来自本所门诊。分为A霜组29例,B霜组28例。由于27例系自身左右对照,且单用A霜者和单用B霜者分别为2例和1例,故共计30例。其中男2例,女28例,年龄21～44岁,平均3…     

黄褐斑：表皮屏障与黑素屏障失衡

黄褐斑是一种面部获得性色素增加性皮肤病，发病机制尚不清，概述黄褐斑的表皮屏障及黑素屏障的变化，以及真皮血管的变化。在此基础上推测黄褐斑的可能发病机制为紫外线、化妆品、避孕药等不良刺激导致表皮屏障功能障碍，代偿性引起黑素细胞功能活跃，黑素屏障增强，形成临床上表现为色素沉着为主的皮肤病。进一步导致真皮毛细血管扩张，血管内皮生长因子表达增加，促进色素沉着发生。     

Retinoid therapy of pigmentary disorders

Topical retinoids such as all-trans-retinoic acid (RA), 13-cis-retinoic acid (isotretinoin), retinol, retinaldehyde, tazarotene, and adapalene have been shown to improve dyspigmentation of photodamaged skin including mottling and actinic lentigines. RA monotherapy has also been demonstrated to improve melasma and postinflammatory hypermelanosis. Furthermore, RA in combination with hydroquinone or 4-hydroxyanisole, or azelaic acid increases the potency of depigmenting agents for the treatment of melasma, actinic lentigines, and postinflammatory hypermelanosis. The basic mechanisms underlying these effects are not completely identified. Topical retinoids stimulate the cell turn-over of epidermal keratinocytes and promote a decrease in melanosome transfer and a rapid loss of melanins via epidermopoiesis. Topical retinoids are also involved in the control of cell differentiation. Retinoid-induced changes in the stratum corneum and the permeability barrier may also facilitate the penetration of depigmenting agents in the epidermis and increase their bioavailability, leading to increased depigmentation. In addition, several in vitro studies demonstrate that cis and trans-retinoic acid inhibit UV-B stimulated melanogenesis in term of tyrosinase activity and melanin synthesis. It is likely that topical retinoids modulate epidermal melanin count via a direct action on melanocytes and epidermal keratinocytes.     

The Role of Topical Retinoids in the Treatment of Pigmentary Disorders

Topical retinoids have been used in the treatment of pigmentary disorders such as melasma, actinic lentigines, and post-inflammatory hyperpigmentation. This article evaluates the clinical efficacy and tolerability of retinoid treatment for pigmentary disorders through an evidence-based approach.We searched the MEDLINE and The Cochrane Library databases using the keywords ‘retinoid’ combined with ‘melasma,’ ‘lentigines,’ or ‘postinflammatory hyperpigmentation.’ For each study, the methodology and outcomes were assessed according to specific criteria. There is fair evidence to support the use of topical tretinoin as a monotherapy in the treatment of melasma as well as in the treatment of lentigines (grade B). Adverse effects of topical retinoids are quite frequent, and include local skin irritation, erythema, and peeling, and their severity is mild to moderate. There is evidence to support the use of topical tretinoin in a fixed, triplecombination therapy (hydroquinone 4%/tretinoin 0.05%/fluocinolone acetonide 0.01%) for the treatment of melasma (grade B). There is poor evidence (grade C) to support the use of combination formulations for the treatment of lentigines, and large, randomized, double-blind, controlled trials are needed to further evaluate their use for this indication. In conclusion, there is evidence to support the use of topical retinoids as monotherapy or in combination with other topical agents in the treatment of pigmentary disorders.     

Skin lightening preparations and the hydroquinone controversy

ABSTRACT:  Skin lightening preparations are widely used in dermatology by persons of all Fitzpatrick skin types. Fitzpatrick skin types I–III require local pigment lightening for the treatment of hormonally induced melasma and postinflammatory hyperpigmentation caused by acne and trauma. Fitzpatrick skin types IV and darker have an even greater need for skin lightening for social reasons, as well as pigmentary changes that occur around the eyes, in the intertriginous areas, following dermatitis, or with acne and trauma. The gold standard dermatologic agent for skin lightening was hydroquinone, until regulatory agencies in Japan, Europe, and most recently in the United States questioned the safety of this substance. This has encouraged research into alternative agents to inhibit skin pigmentation such as retinoids, mequinol, azelaic acid, arbutin, kojic acid, aleosin, licorice extract, ascorbic acid, soy proteins, and N-acetyl glucosamine. The efficacy and safety of each of these ingredients is examined as possible topical alternatives to hydroquinone.     

Acne in ethnic skin: special considerations for therapy

Acne vulgaris occurs in people of all ethnicities and races. Although the pathophysiology and treatment options are similar in all skin phototypes, darker-skinned patients have higher incidence rates of two sequelae of acne: postinflammatory hyperpigmentation and keloidal scarring. Postinflammatory hyperpigmentation may also be triggered by skin irritation. In choosing therapies for patients of color, therefore, clinicians must find a balance between aggressive early intervention to target inflammatory acne lesions, and gentle treatments to increase tolerability and avoid skin irritation. For most patients, a combination of topical retinoids, and topical or oral antibiotics with hydroquinone (as needed) to control hyperpigmentation will be successful. For patients with sensitive skin, topical agents in lower concentrations and cream vehicles are preferred. If tolerated, the retinoid strength can be titrated upward after four to six weeks. Ethnic patients also need to be counseled on use of noncomedogenic and nonirritating skin and hair-care products. Individualized care and close monitoring is required.     

Lustra,Lustra-AF and Alustra

Hydroquinone has been successfully used to treat hyperpigmentation disorders for many years. Recently, new formulations containing hydroquinone have become available, including Lustra and Lustra-AF (Medicis). These products also contain glycolic acid 2%, an active antioxidant system (ascorbyl palmitate and tocopherol acetate), and moisturizers. Lustra-AF also contains a broad-spectrum sunscreen. Alustra contains a stabilized, high-concentration of retinol. The above formulations inhibit melanogenesis, stimulate epidermal desquamation, inhibit free radical-mediated photodamage and restore the antioxidant reservoir. The addition of retinoids may facilitate epidermal penetration of hydroquinone and prevent its oxidation. Comparative studies have shown that these agents can be effective in reducing blotchiness, mottled hyperpigmentation, post-inflammatory hyperpigmentation, and surface roughness. In addition, these formulations have been generally well tolerated with patients rarely reporting mild-to-moderate adverse events such as dryness, redness, or peeling of the skin.     

Management of Facial Hyperpigmentation

Facial and neck pigmentations are the most cosmetically important. They are common in middle-aged women, and are related to endogenous (hormones) and exogenous factors (such as use of cosmetics and perfumes, and exposure to sun radiation). Melasma (chloasma) is the most common cause of facial pigmentation, but there are many other forms such as Riehl’s melanosis, poikiloderma of Civatte, erythrose peribuccale pigmentaire of Brocq, erythromelanosis follicularis of the face and neck, linea fusca, and cosmetic hyperpigmentations. Treatment of melasma and other facial pigmentations has always been challenging and discouraging. It is important to avoid exposure to the sun or to ultraviolet lamps, and to use broad-spectrum sunscreens. Several hypopigmenting agents have been used with differing results. Topical hydroquinone 2 to 4% alone or in combination with tretinoin 0.05 to 0.1 % is an established treatment. Topical azelaic acid 15 to 20% can be as efficacious as hydroquinone, but is less of an irritant. Tretinoin is especially useful in treating hyperpigmentation of photoaged skin. Kojic acid, alone or in combination with glycolic acid or hydroquinone, has shown good results, due to its inhibitory action on tyrosinase. Chemical peels are useful to treat melasma: trichloroacetic acid, Jessner’s solution, Unna’s paste, α-hydroxy acid preparations, kojic acid, and salicylic acid, alone or in various combinations have shown good results. In contrast, laser therapies have not produced completely satisfactory results, because they can induce hyperpigmentation and recurrences can occur. New laser approaches could be successful at clearing facial hyperpigmentation in the future.     

皮肤炎症后色素沉着的研究进展

炎症后色素沉着是皮肤炎症后过量色素沉积导致的结果,是临床常见的症状之一,尤其好发于深色皮肤的人.它是一种获得性色素增加疾病,在黑素生成过程中,任何一步发生改变都能够导致其发生.国内外一直在进行其发病机制的研究,目前尚不完全清楚.外用维A酸、氢醌、壬二酸、曲酸和化学剥脱术可一定程度地改善病情.近来有报道证实,某些激光可以加速色素的去除,这或许是未来研究热点之一.     

An open-label study of the efficacy and tolerability of microencapsulated hydroquinone 4% and retinol 0.15% with antioxidants for the treatment of hyperpigmentation

Hyperpigmentation describes areas of the skin with increased melanin content, when the pigmentation is darker than the healthy surrounding skin. Disorders of hyperpigmentation, such as melasma, postinflammatory hyperpigmentation (PIH), and solar lentigines, are common and pose a treatment challenge for all patients, particularly those with darker skin types whose melanocytes are more reactive to various stimuli. Although distressing when affecting the face and areas of the body that are difficult to conceal, disorders of hyperpigmentation can affect individuals from head to toe. An innovative product containing microencapsulated hydroquinone 4% and retinol 0.15% with antioxidants has improved hyperpigmentation disorders of the face based on disease severity, pigmentation intensity, lesion area, and colorimetric measurements. The objective of the current open-label study was to evaluate the efficacy and tolerability of microencapsulated hydroquinone 4% and retinol 0.15% with antioxidants in individuals with Fitzpatrick skin types II through VI with hyperpigmentation of the face and/or body and to determine if this hydroquinone preparation was as effective on the body as it was on the face. Participants were treated twice daily for 12 weeks. Study evaluations were conducted at baseline and weeks 4, 8, and 12. Results from the efficacy assessments demonstrated that reductions in lesion size, darkness, and disease severity were significant as early as 4 weeks after treatment initiation and remained significantly reduced throughout the study (all P < .032). Furthermore, 63% of participants (12/19) had either marked improvement (defined as 75% overall improvement) or complete clearing (> or = 95% overall improvement) of their hyperpigmented lesions at the end of the 12-week treatment period. Reflectance spectrophotometer readings also were performed at each study visit and demonstrated a significant reduction in melanin content as early as week 4 (target A, P < or = .001; target B, P = .002).     

The mechanism of action and clinical benefits of soy for the treatment of hyperpigmentation

Background Hyperpigmentation disorders are common and diverse conditions that may require treatment for medical and/or cosmetic reasons. Hyperpigmented lesions can reduce patients’ quality of life, self‐perception, and social and vocational functioning. The most commonly used treatments for hyperpigmentation include topical agents, such as hydroquinone, retinoids and azelaic acid. Objectives Current topical treatments have significant limitations; they often do not produce adequate results and may be limited by adverse effects, such as dermatitis. Soy and soy‐based products have demonstrated a wide range of potential benefits for health and nutrition, including a range of dermatological effects. Methods Research from the last decade has identified multiple mechanisms by which soy‐derived products may affect skin pigmentation, as well as photodamage and photoaging, overall skin health, and even the risk for and progression of skin cancer. Results Preclinical evidence has demonstrated that soy‐derived serine protease inhibitors affect skin pigmentation by inhibiting protease‐activated receptor‐2‐mediated phagocytosis of melanosomes by keratinocytes. Conclusion Soy‐based products containing these serine protease inhibitors may represent a new therapeutic option for dermatological treatment. Indeed, recent evidence from randomized clinical studies supports the safe and effective use of soy products for the treatment of hyperpigmentation.     

Topical treatments for melasma and postinflammatory hyperpigmentation

Hyperpigmentation disorders of the skin are common and can be the source of significant psychosocial distress for patients. The most common of these disorders are melasma and postinflammatory hyperpigmentation. Sunscreen use and minimizing sun exposure are crucial in all cases. Topical applications are the mainstay of treatment and include phenols, retinoids, corticosteroids, and their combinations.