异维A酸胶丸联合百癣夏塔热片治疗中重度寻常型痤疮临床疗效观察

目的：探讨异维A酸胶丸联合百癣夏塔热片治疗中重度寻常型痤疮的临床效果。方法：采用随机、平行、对照的临床试验,将78例受试对象随机分为对照组和治疗组;对照组30例常规使用异维A酸胶丸口服治疗,治疗组48例在上述治疗基础上联合百癣夏塔热片治疗,两组均外用克林霉素凝胶和0.025%迪维霜。疗程为6周,结束后观察疗效。结果：治疗组总有效率为89.58%,痊愈率为62.50%;对照组总有效率为66.67%,痊愈率为40.00%,两组疗效比较差异有统计学意义（P〈0.05）。结论：异维A酸胶丸联合百癣夏塔热片治疗中重度寻常型痤疮有较好的疗效,值得临床使用。     

异维A酸胶丸联合红霉素肠溶胶囊治疗难治性痤疮疗效观察

目的：观察异维A酸胶丸联合红霉素肠溶胶囊治疗难治性痤疮的效果。方法：将106例难治性痤疮患者随机均分成两组,治疗组给予异维A酸胶丸联合红霉素肠溶胶囊,对照组给予异维A酸胶丸治疗4周,观察用药后两组临床指标的改善情况。结果：治疗组与对照组总有效率分别为86.79%、67.92%（P<0.05）,临床疗效治疗组优于对照组。结论：异维A酸胶丸联合红霉素肠溶胶囊治疗难治性痤疮安全、有效。     

复方木尼孜其颗粒治疗寻常型痤疮的临床研究

目的：探讨复方木尼孜其颗粒治疗寻常型痤疮的临床疗效和安全性。方法：215例患者随机分为观察组114例和对照组101例,观察组采用复方木尼孜其颗粒和夫西地酸乳膏治疗,对照组采用异维A酸胶囊和夫西地酸乳膏,治疗结束后观察疗效。结果：观察组有效率为96.49%,治愈率为57.02%;对照组有效率为92.08%,治愈率为54.46%,两组患者的总有效率和治愈率比较无显著性差异（P〉0.05）;但是观察组患者的不良反应率为16.67%,明显低于对照组的91.09%（P〈0.01）。结论：复方木尼孜其颗粒治疗寻常型痤疮疗效与异维A酸胶囊相当,但不良反应发生率明显较低,值得临床推广应用。     

异维A酸胶丸治疗结节囊肿性痤疮196例的疗效

目的：观察异维A酸胶丸治疗结节囊肿性痤疮的临床疗效。方法：选择门诊痤疮患者326例进行治疗,随机分成试验组和对照组。试验组196例,口服异维A酸胶丸,剂量0.4mg.kg^-1.d^-1,bid;对照组130例,口服红霉素12mg.kg^-1.d^-1,bid。两组均给药12周后观察疗效。结果：试验组有效率显著高于对照组（73.47%vs48.46%,P〈0.05）。两组均无明显不良反应发生。结论：异维A酸胶丸治疗结节囊肿性痤疮疗效确切。     

异维A酸胶丸联合丹参酮胶囊治疗结节囊肿性痤疮的疗效评价

目的观察异维A酸胶丸联合丹参酮胶囊治疗结节囊肿性痤疮的疗效。方法将患者随机分为异维A酸组（A组）、丹参酮组（B组）和联合治疗组（C组）。A组口服异维A酸胶丸10mg,2次/d;B组口服丹参酮胶囊4粒,3次/d;C组口服异维A酸胶丸10mg,2次/d和丹参酮胶囊4粒,3次/d。连续观察8周。结果A、B、C组的痊愈率分别为53.75%,43.75%和77.50%,有效率分别为76.30%,67.50%和90.00%（P〈0.05）。结论异维A酸胶丸联合丹参酮胶囊治疗结节囊肿性痤疮能增强疗效、缩短起效时间和疗程,提高治愈率,减少复发和不良反应。     

红蓝光联合异维A酸治疗中重度痤疮30例临床观察

目的:探讨红蓝光照射联合异维A酸治疗中、重度痤疮的临床疗效和安全性。方法:将入选的60例中、重度痤疮患者随机分为两组,治疗组(30例)予红蓝光联合口服异维A酸治疗,对照组(30例)仅口服异维A酸治疗,比较两组的治疗效果。结果:有效率治疗组为86.7%,对照组为70.0%,差异有统计学意义(P<0.05)。两组均未出现导致治疗终止的严重不良反应。结论:红蓝光联合异维A酸治疗中、重度痤疮疗效好,安全性高。     

中西医结合治疗囊肿型痤疮的临床疗效观察

目的评价中药消痤合剂联合异维A酸胶丸治疗囊肿型痤疮疗效。方法对囊肿型痤疮患者86例,随机分为两组,治疗组患者给予中药消痤合剂及异维A酸胶丸口服,对照组单纯异维A酸胶丸口服,分别于4、8、12周观察疗效。结果疗程结束后治疗组与对照组总有效率分别为93.2%、78.5%。结论中药消痤合剂联合异维A酸胶丸治疗囊肿型痤疮效果显著,不良反应低。     

季德胜蛇药片对中重度痤疮患者的治疗效果观察

目的 探讨外用季德胜蛇药片联合口服异维A酸治疗中重度痤疮的临床疗效与安全性。方法 选择门诊80例中重度痤疮患者为观察对象,随机分为治疗组和对照组各40例。治疗组给予外用季德胜蛇药片联合口服异维A酸治疗,对照组口服异维A酸治疗,分别在治疗后2、4、6、8周比较两组临床疗效、GAGS评分,并对比患者Acne-QOL评分的变化。结果 两组患者皮损数量均明显减少(P<0.05);治疗组在不同时间点(第2、4、6、8周)疗效均明显优于对照组(P<0.05);针对不同类型的皮损,治疗组对丘疹、脓疱、结节、囊肿的疗效比对照组更具优势,在针对粉刺的疗效上两组差异不明显(P>0.05);对照组在2、4、6、8周GAGS评分较治疗组高(P<0.05);治疗8周后,治疗组的生活质量评分均高于对照组(P<0.05);两组不良反应发生率无显著改变(P>0.05)。结论 季德胜蛇药片外敷加口服异维A酸在中重度痤疮的疗效显著且安全,值得临床推广。     

异维A酸治疗跖疣的疗效观察

目的：观察口服异维A酸治疗跖疣的疗效。方法：将门诊确诊的50例患者分为两组。治疗组25例,口服异维A酸胶囊,每次口服10mg,一天3次,连续服用6wk,每周随访1次。治疗6wk后继续随访3个月。对照组25例,给予2．5％的5-FU＋2％普鲁卡因（5：1）混合液逐个注入跖疣中心,每周1次,连用6wk,治疗6wk后,继续随访3个月。观察两组疗效及不良反应。结果：治疗组治愈22例（88％）,其中复发3例（13．6％）;对照组治愈20例（80％）,其中复发10例（50％）。两组患者均无中途失访,且治愈率相近,但治疗组复发率较对照组低（P〈0．01）。结论：口服异维A酸胶囊对跖疣具有较好的治疗作用,近期复发率较5-FU＋普鲁卡因作局部注射组低。     

异维A酸红霉素凝胶联合过氧苯甲酰凝胶治疗中、重度痤疮

目的观察异维A酸红霉素凝胶联合过氧苯甲酰凝胶治疗中、重度痤疮的疗效。方法将201例Ⅱ～Ⅳ度寻常痤疮患者随机分为2组,治疗组106例,对照组95例。治疗组予异维A酸红霉素凝胶联合过氧苯甲酰凝胶,对照组给予异维A酸红霉素凝胶治疗。每2周随访1次,观察疗效及不良反应,8周后进行治疗评定。结果治疗组痊愈率和有效率(58.49%、96.23%)高于对照组(36.84%、88.42%)。结论异维A酸红霉素凝胶联合过氧苯甲酰凝胶治疗中、重度痤疮较单纯外用异维A酸红霉素凝胶疗效好。     

Long-pulsed dye laser-mediated photodynamic therapy combined with topical therapy for mild to severe comedonal, inflammatory, or cystic acne

BACKGROUND: Acne patients who fail to respond to conventional treatments have been treated with isotretinoin, an effective treatment coming under strict regulation due to the risk of significant side effects. Photodynamic therapy (PDT) may be a viable alternative treatment for recalcitrant acne of various types and levels of severity. OBJECTIVE: To determine the safety and efficacy of combination PDT with topical 5-aminolevulinic acid (ALA) and activation by long-pulsed, pulsed dye laser (LP PDL, 595 nm) energy with topical therapy in patients with mild to severe acne. METHODS: A prospective, controlled pilot, proof-of-principle study of 19 consecutive patients (aged 16-47 years, Fitzpatrick skin types I-VI) with mild to severe cystic, inflammatory, or comedonal acne of the face was conducted. All patients had failed conventional therapy, including oral antibiotics, topical treatments, hormonal therapy, laser procedures (without ALA), and/or oral isotretinoin. Fifteen patients were treated with ALA PDT and 4 patients served as controls; all were continued on topical medications. Patients undergoing PDT were initially randomized to receive either blue light or laser energy. Because recrudescence occurred in 1 patient while undergoing multiple treatments with ALA and blue light, all subsequent patients were treated with ALA and laser energy. The total number of patients treated with LP PDL-mediated ALA PDT was 14. ALA was applied for a short 45-minute incubation followed by 1 minimally overlapping pass with the LP PDL (595 nm, 7.0-7.5 J/cm2 fluence, 10-ms pulse duration, 10-mm spot size, and dynamic cooling spray of 30 ms with a 30-ms delay). Patients treated with conventional therapy (oral antibiotics, oral contraceptives, and topical medications) or laser energy without ALA PDT served as control groups. Patients were followed monthly for up to 13 months. RESULTS: Complete clearance was achieved in 100% (14 out of 14) patients in the LP PDL PDT-treated group. A mean of 2.9 treatments (range 1-6; 2.0-3.7, 95% CI; n=14) was required to achieve complete clearance for a mean follow-up time of 6.4 months (range 1-13; 3.8-8.9 95% CI; n=14). The patient mean percent lesional clearance rate per treatment was 77% (64%-90%, 95% CI; n=14). Improvement in acne lesions became apparent within 1 to 2 weeks after the first treatment. Clearance in the LP PDL PDT group was superior to control groups. In the LP PDL-only control group (n=2), the patient mean percent lesional clearance rate per treatment was 32% without complete clearance after 3 to 4 treatments. In the oral antibiotics, oral contraceptives, and topicals control group (n=2), the clearance rate per treatment was 20%, the mean clearance rate per month was 4%, and complete clearance was not achieved after 6 to 10 months. In the LP PDL-mediated PDT group, treatments were well-tolerated with minimal erythema lasting 1 to 2 days. No cases of crusting, blistering, purpura, scarring, or dyspigmentation occurred. A reduction in the erythema in erythematous acne scars was observed. CONCLUSION: For teenage to adult patients with recalcitrant comedonal, inflammatory, or cystic acne of various degrees of severity, ALA PDT with activation by LP PDL appears to be a safe and effective treatment with minimal side effects. LP PDL-mediated PDT may serve as an important alternative to isotretinoin. Cosmetically well-accepted, LP PDL PDT combined with topical therapy is the first PDT modality to achieve complete clearance with long-term follow-up as compared to controls.     

5-氨基酮戊酸光动力疗法治疗中重度痤疮的临床效果

目的研究中重度痤疮患者应用5-氨基酮戊酸光动力疗法的治疗效果。方法104例中重度痤疮患者,经随机数字编号后,52例奇数患者编入对照组,52例偶数患者纳入观察组。对照组采用红蓝光照射治疗,观察组采用5-氨基酮戊酸光动力疗法治疗。比较两组患者的治疗效果及不良反应发生情况。结果观察组患者治疗2、4、6周后的总有效率分别为28.85%、75.00%、86.54%,均高于对照组的9.62%、51.92%、69.23%,差异均具有统计学意义(χ²=6.1905、5.9713、4.5217,P=0.0128、0.0145、0.0335<0.05)。观察组患者的不良反应发生率为5.77%,低于对照组的32.69%,差异具有统计学意义(χ²=12.1333,P=0.0005<0.05)。两组患者的不良反应经对症处理后均缓解消退。结论中重度痤疮患者采用5-氨基酮戊酸光动力疗法治疗,效果理想,值得推行。     

异维A酸联合克林霉素凝胶治疗痤疮的疗效观察

目的：观察口服异维A酸与外用克林霉素磷酸酯凝胶联合治疗面部中度寻常痤疮的疗效。方法：将136例中度痤疮患者随机分为两组,治疗组70例采用口服异维A酸联合外用克林霉素磷酸酯凝胶治疗8wk;对照组单用克林霉素磷酸酯凝胶治疗8wk。结果：治疗组的总有效率为84．29％;对照组的总有效率为39．39％。经卡方检验,两组有极显著性差异（P〈0．01）。结论：口服异维A酸联合外用克林霉素磷酸酯凝胶是治疗中度寻常痤疮的有效方法。     

外涂 20％超分子水杨酸及口服盐酸米诺环素联合红蓝光治疗中重度痤疮 51例

目的 探讨外涂20％超分子水杨酸及口服盐酸米诺环素联合红蓝光治疗仪治疗中重度痤疮的临床效果及不良反应,为中重度痤疮治疗提供更加安全有效的方法.方法 选取2016年5月至2019年2月广西壮族自治区桂东人民医院收治的中重度痤疮病人102例,采用随机数字表法分成观察组与对照组,每组51例,对照组采取口服盐酸米诺环素+红蓝光治疗仪治疗,观察组在对照组治疗方法的基础上加用20％超分子水杨酸外涂治疗,对比两组临床疗效、治疗前后的痤疮综合分级系统(GAGS)评分以及不良反应发生情况.结果 观察组治疗总有效率90.20％,对照组为72.55％,组间对比差异有统计学意义(P=0.022);治疗前观察组与对照组GAGS评分差异无统计学意义[(46.56±3.47)分比(46.89±3.82)分,P>0.05];观察组治疗3周[(32.80±3.22)分比(44.10±3.67)分]、5周[(21.00±3.92)分比(33.60±3.74)分]和8周[(9.20±3.71)分比(20.40±3.75)分]后的GAGS评分均低于对照组,差异有统计学意义(P<0.05);观察组和对照的不良反应发生率分别是9.80％和13.72％,组间对比差异无统计学意义(P=0.539).两组治疗期间出现的不良反应较轻微,病人均可耐受,未对治疗产生明显影响.结论 相较于口服盐酸米诺环素联合红蓝光治疗仪治疗,加用20％超分子水杨酸外涂治疗中重度痤疮,能够获得更加显著的治疗效果,病人的症状能够更加迅速有效地改善,且治疗的安全性能够得到保证.     

Evaluation of ovarian reserve and function in female patients treated with oral isotretinoin for severe acne: an exploratory study

Background: Isotretinoin affects the levels of female hormones and ovaries in patients with severe acne.

Objective: This study evaluated the effects of isotretinoin on the ovarian reserve and levels of female hormones in patients with severe acne.

Methods: Thirty-two female patients with severe acne were enrolled. All the patients were treated with oral isotretinoin 0.5–2?mg/kg/d. The total cumulative dose for a full course was 120–135?mg/kg. The treatment duration ranged from 5 to 8 months. The serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol (E2) levels and antral follicle count (AFC) and ovarian volume (OV) were evaluated before and after treatment.

Results: After treatment, the mean FSH, LH, and E2 levels were significantly lower than before treatment. In addition, the mean AFC and OV decreased after treatment, although the difference was not significant.

Conclusion: The results of this exploratory study do not demonstrate that oral isotretinoin has an impact in ovarian function. In contrast, isotretinoin affects levels of female hormones in patients with severe acne.     

Low-dose schema of isotretinoin in acne vulgaris

In severe papulopustular and in nodulocystic/conglobate acne, oral isotretinoin is the treatment of choice. It is also required for patients with moderate to severe acne, especially when acne scars start to occur A new therapeutic approach consists of a low-dose regimen of isotretinoin. We performed a comparative study of high- and low-dose schemas of isotretinoin per os for the treatment of acne. The purpose of this study was to assess the therapeutic effect and tolerability of low doses of isotretinoin in the treatment of acne vulgaris and compare low-dose with high-dose regimens. Sixty-four patients (35 women and 29 men) with different types and grades of acne vulgaris were divided into two treatment groups of 32 patients, in a trial that compared a low dose of 0.15-0.40 mg/kg per day with a high dose of 0.5-1.0 mg/kg per day. These regimens were analyzed with reference to clinical history of acne, baseline investigations, dose and response to isotretinoin, clinical and laboratory adverse effects, relapses and cost of therapy. The mean success rate of the low-dose schema was 69%. The total dose up to 120 mg/kg should be followed for optimal results (success rate of 91%) and avoidance of relapses. The low-dose schema produced fewer adverse effects and offered a very beneficial effect on pre-existing scarring. Our results confirm the beneficial effect of the low-dose schema. We recommend a total dose > or = 120 mg/kg, as this therapeutic regimen of isotretinoin has proven to be the most successful in preventing relapses and scarring.     

Isotretinoin in acne vulgaris: a prospective analysis of 160 cases from Kuwait

A total of 160 patients (59 male and 101 female) ages varying from 13 to 28 years (mean age 20 years) with moderate to severe acne were treated with isotretinoin in the doses ranging from 0.5 mg/kg/day to 1 mg/kg/day. The drug was given for a period ranging from 6 to 28 weeks. The patients were followed up regularly for a period of 12 months after stoppage of isotretinoin for any evidence of relapse. In the event of a recurrence greater than mild acne after 8 weeks of stoppage of isotretinoin therapy, the patients were given another course of the drug. Patients were considered to be non-relapsing if they had no evidence of recurrence after 12 months of follow-up. Twenty seven patients were excluded from the study. Of the remaining 133 patients (51 male and 82 female) only 117 patients (36 male and 81 female) could follow up for at least 12 months after stopping therapy. Of the 133 patients, a total of 127 patients (95.5%) achieved complete or partial clearance. Forty two percent (total 49 patients: 20 male and 29 female) experienced relapse after stopping therapy. Of these, 21 (42.85%) were given a second course of the drug. None of the patients developed a rise in lipids levels significant enough to warrant stoppage of the drug.     

异维A酸红霉素凝胶联合强脉冲光治疗轻中度痤疮的临床研究

目的探讨轻中度痤疮患者采用异维A酸红霉素凝胶联合强脉冲光治疗的临床效果。方法将94例轻中度痤疮患者随机分为对照组与观察组,每组47例,两组患者均采用异维A酸红霉素凝胶,观察组患者在此基础上联合给予强脉冲光治疗,比较两组患者的临床治疗效果。结果观察组患者治疗后皮损数量、皮疹形态、皮疹类型及皮脂分泌率均明显好于对照组(P<0.05),且治疗4、8、12周后的总有效率高于对照组(P<0.05)。两组患者不良反应发生率比较差异无统计学意义(P>0.05)。结论异维A酸红霉素凝胶联合强脉冲光治疗轻中度痤疮的临床效果较好,且具有良好的安全性。