黄褐斑病因及发病机制的研究进展

黄褐斑是一种以面部或浅或深的棕黑色斑片为特征的色素性疾病.近年来研究发现,黄褐斑的发病机制涉及多个方面,基底膜结构受损、血管功能亢进、氧化应激.蛋白基因水平方面发现,黄褐斑皮损中脂类代谢相关基因的表达下调,非编码RNA H19基因显著低表达.分子生物学研究发现,多个信号转导通路如WNT通路、一氧化氮合酶与核因子κB通路在黄褐斑发病中起关键作用.另外神经调节也涉及黄褐斑的病理生理过程.     

氨甲环酸治疗黄褐斑的研究进展

黄褐斑是一种常见的获得性色素增加性疾病,病因复杂,多种治疗方法均可改善黄褐斑,但疗效差及复发是临床常见的难题.氨甲环酸是一种抗纤溶药物,在临床上广泛用于治疗各种出血性疾病,近年来许多研究证实其治疗黄褐斑安全、有效.口服小剂量氨甲环酸治疗黄褐斑,可单独用药,或联合其他口服、外用药及激光治疗.用药时间的长短与疗效相关,一般用药1～2个月开始起效,治疗时间越长,疗效越好.静脉用药与口服药疗效无明显差别,但起效更快.氨甲环酸外用治疗黄褐斑与赋形剂无明显差异,局部微针和显微注射氨甲环酸有显著疗效,以前者疗效更佳.     

色素性扁平苔藓误诊为黄褐斑1例

患者男,60岁。口周出现深棕色斑点、斑片,无明显自觉症状3月。外院以"黄褐斑"予驱斑霜外用治疗,皮疹增多并融合成片。皮损组织病理诊断为口周色素性扁平苔藓。予相关治疗,在随访中。     

黄褐斑的中西医治疗进展

黄褐斑是临床常见的一种发病率高,病因复杂的色素代谢性疾病。祖国传统医学认为肝、脾、肾三脏及气血与黄褐斑的发病及治疗有着至关影响;现代医学认为,黄褐斑的发生与酪氨酸活性升高,黑素细胞及黑素体生成增多等相关。临床中本病易诊难治,中西医对黄褐斑的认识及治疗各有见谛。中医学将黄褐斑通过辨证论治进行口服中药及中医特色外治以及情志调节,临床取得较好的疗效,且不良反应较低;现代医学常用药物以及光点先进技术等治疗本病,起效较快,但易出现反复;现总结最近治疗进展,将中西医有效结合,各取所长,力求取得更加满意疗效。     

反射式共聚焦激光扫描显微镜在刮痧治疗黄褐斑中的疗效评估价值

目的探讨反射式共聚焦激光扫描显微镜(RCM)在黄褐斑诊断和监测治疗效果中的价值。方法选择2013年4月-2014年6月在天津市中医药研究院附属医院皮肤科门诊就诊的黄褐斑患者24例,均予面部刮痧治疗,1次/周,分别于治疗前和治疗2次、5次和10次时拍摄临床照片和进行RCM检查,并取其中1例典型皮损者进行组织病理学检查。结果黄褐斑患者RCM镜下所见与皮损组织病理检查结果相一致。面部刮痧治疗有效率为66.67%,均未见不良反应。RCM各项指标评分和MASI评分均显著下降(P0.05)。结论面部刮痧治疗黄褐斑安全有效,RCM可以为黄褐斑诊断和疗效评价提供有力的参考依据。     

基于痰饮浅析黄褐斑

黄褐斑是临床易诊难治的皮肤病,多从肝郁气滞、气滞血瘀、脾虚湿蕴或肝肾阴虚论治,而血瘀被认为是其重要病理因素而贯穿治疗的始终。笔者在临床中发现,痰饮亦为黄褐斑的重要病理因素。因此,本文从痰饮作为切入点,简述痰饮的概念和形成原因,并基于古文献和现代临床研究,从风邪犯表、脾虚湿蕴、肾阳亏虚、肝肾阴虚、肝郁气滞和痰瘀互结来探讨黄褐斑的病因病机和中医治疗,并附验案1则,以飨同道。     

银屑病微血管异常增生机制及治疗对策

银屑病发生的病理生理机制主要包括表皮细胞异常增生、炎细胞浸润、T细胞激活和真皮乳头微血管增生、扩张等,其中真皮乳头层微血管异常增生可能启动了整个病理变化过程。回顾与微血管异常增生相关的因素及其抗血管生成疗法的现状和潜在治疗靶位,以期为银屑病的临床治疗及新药研究寻找线索。     

女性黄褐斑患者血清性激素水平检测以及谷胱苷肽与维生素C治疗

目的探讨黄褐斑与血清性激素水平的关系,并观察谷胱苷肽合并维生素C治疗黄褐斑的疗效。方法随机选择60例黄褐斑患者采用放射免疫学方法检测其血清促卵泡刺激素,黄体生成素、雌二醇、孕酮、催乳素、睾酮的含量,同时设立随机对照对谷胱苷肽合并维生素C治疗黄褐斑的疗效进行比较。结果女性黄褐斑患者血清雌二醇、黄体生成素、促卵泡刺激素水平明显高于对照组(P<0.01),孕酮水平较高(P<0.05),睾酮、催乳素水平与对照组相比差异无显著性(P>0.05)。谷胱苷肽合并维生素C治疗黄褐斑,痊愈率44.45%,有效率81.49%,与对照组比较经统计学处理差异有显著性(P<0.01)。结论女性黄褐斑发病与下丘脑—垂体—性腺轴紊乱有关,谷胱苷肽合并维生素C治疗黄褐斑有明显疗效。     

黄褐斑的化学换肤及光电治疗进展

黄褐斑是一种好发于中青年女性的治疗周期长、容易复发的常见色素增加性皮肤病,严重影响患者生活质量。近年来,随着对黄褐斑发病机制研究的深入、新型化学剥脱剂的问世、光电治疗技术的革新,黄褐斑的化学剥脱及光电治疗领域也得以迅速发展。该文总结了国内外黄褐斑的化学换肤及光电治疗领域研究成果及新进展,以期为黄褐斑治疗方案的个体化选择提供参考依据。     

黄褐斑的研究进展

黄褐斑是以颜面部色素沉着为主的损容性皮肤病,以肤色深和经常日晒的女性多见,严重影响患者的生活质量。本文从中西医角度对黄褐斑的发病情况、病因、病理以及诊断治疗的最新进展进行归纳整理,以期为患者提供更好的医疗服务。     

Histopathological study of the treatment of melasma lesions using a low‐fluence Q‐switched 1064‐nm neodymium:yttrium–aluminium–garnet laser

The low‐fluence 1064‐nm Q‐switched neodymium:yttrium–aluminium–garnet (QSNY) laser is a widely used treatment for melasma in East Asia, although its mechanism of action is unclear. The aim of this study was to elucidate the mechanism of action of the QSNY laser. We performed a histopathological study on eight Korean women who had considerable improvement in their melasma lesions after a series of low‐fluence QSNY laser treatments. Compared with nonlesional skin, samples from melasma lesions showed increased reactivity in melanin (Fontana–Masson staining) and in melanogenesis‐associated proteins, including α‐melanocyte‐stimulating hormone, tyrosinase, tyrosinase‐related protein (TRP)‐1, TRP–2, nerve growth factor and stem cell factor. After laser treatment, the melasma skin showed a decrease in the number of melanosomes and reduced expression of melanogenesis‐associated proteins. Expression levels of the melanogenic proteins were reduced after laser treatment, although the number of melanocytes was unchanged even in hypopigmented areas. Based on these results, we believe that repeated application of low thermal energy via QSNY laser may result in damage to melanocytes and long‐lasting hypopigmentation.     

黄褐斑的药物治疗进展

黄褐斑是临床常见的获得性色素沉着性疾病，病因不明，尚元特效疗法，目前以药物治疗为主，抑制黑素生成是主要的作用机制，包括抑制酪氨酸酶合成、抑制黑素小体转运、加速表皮更新等，其中以酪氨酸酶抑制剂使用最为广泛；植物萃取物在治疗黄褐斑方面仍缺乏足够证据。应用明确有效的治疗及安全合适的维持治疗方案是主要治疗原则。随着对黄褐斑发病机制的进一步研究及基因工程药物的出现可能为本病的治疗带来新思路。     

氨甲环酸治疗黄褐斑的研究进展

氨甲环酸可以通过多个环节治疗黄褐斑,包括抑制真皮血管形成,减少肥大细胞数目并抑制其活性,减少基底膜带损伤,抑制表皮黑素合成和转运,促进皮肤屏障功能恢复等。本文综述氨甲环酸治疗黄褐斑的机制及疗效,为临床应用提供更多依据。     

强脉冲光单独或联合其他疗法治疗黄褐斑的研究进展

【摘要】 黄褐斑病因复杂,目前治疗手段较多,但均无确切、满意的疗效。近年来,强脉冲光治疗黄褐斑取得了良好的疗效。本文综述近年来单用强脉冲光及联合激光、外用药和系统用药治疗黄褐斑取得的进展。     

Induction of melasma by 1064‐nm Q‐switched neodymium:yttrium–aluminum–garnet laser therapy for acquired bilateral nevus of Ota‐like macules (Hori nevus): A study on related factors in the Chinese population

Laser treatment has emerged as a common treatment modality for acquired bilateral nevus of Ota‐like macules (ABNOM). To identify the ratio of melasma induction and exacerbation before and after laser therapy for ABNOM and to observe the risk factors related to the induction and exacerbation of melasma by laser therapy, we analyzed related factors of 1268 adult Chinese patients who underwent 1064‐nm Q‐switched neodymium:yttrium–aluminum–garnet (Nd:YAG) laser (QNYL) treatment using case series and case–control studies. Overall, 24.0% of the ABNOM patients had mixed melasma. Among the ABNOM patients without melasma, after laser therapy the development of melasma was more frequently noted in patients older than 35 years (P < 0.0001), as well in patients whose ABNOM was less than 10 cm² (P = 0.027), ABNOM were light (similar to yellow‐brown) in color (P = 0.021) and skin types were closer to type IV (P < 0.0001). New melasma lesions also appeared most frequently in the zygomatic region (P < 0.0001). Among the ABNOM patients with melasma, 89.5% experienced worsening of their melasma, irrespective of their related factors above. We concluded that the risk of inducing melasma is great after 1064‐nm QNYL treatment in ABNOM patients, and particularly in the patients with both ABNOM and melasma. ABNOM patients should be treated as early as possible and before the age of 35 years.     

Successful treatment of hydroquinone‐resistant melasma using topical methimazole

Melasma is an acquired hyperpigmentation skin disorder in sun‐exposed areas. It occurs almost exclusively over the face, and is most commonly seen in women. Several depigmenting agents have been used for the treatment of melasma among which hydroquinone has been the most widely used due to its efficacy and safety in short‐term use. However, hydroquinone is recently reported to be a cytotoxic and mutagenic compound in mammalian cells and is thus banned in several countries. Hydroquinone ban has caused investigators to search for alternative depigmenting agents for the treatment of melasma in recent years. Methimazole is an antithyroid agent orally used in humans since several decades and has been shown that when applied topically, it inhibits melanin synthesis and causes skin depigmentation in lab animals as well as human subjects. Herein, we report two hydroquinone‐resistant melasma patients who were successfully treated with methimazole cream. Application of 5% methimazole cream once daily resulted in significant improvement of melasma in both patients after 8 weeks. The efficacy of methimazole for melasma treatment as well as its advantages over other known depigmenting compounds (non‐mutagenicity, non‐cytotoxicity and high tolerability profile) suggests that topical methimazole should be added to the armamentarium of anti‐melasma treatment.     

A Face-Split Study to Evaluate the Effects of Microneedle Radiofrequency with Q-Switched Nd:YAG Laser for the Treatment of Melasma

BackgroundLaser toning using a low-fluence 1,064 nm Q-switched Nd:YAG laser is one of the most frequently used treatment modalities for melasma. However, this therapy is time consuming because it requires a lot of treatment sessions. Recently, it has been reported that transdermal radiofrequency (RF) is effective for the treatment of melasma.ObjectiveTo determine whether microneedle RF conduction could be an adjunct therapy for melasma, we have studied the effect of simultaneous treatments with laser toning and RF for melasma.MethodsFifteen patients with melasma underwent five sessions of laser toning and microneedle RF on the right side of the face, and only laser toning on the left side. Responses to treatments were evaluated using the Mexameter® (Courage Khazaka, Germany) score, the pigmentation and severity index (PSI) score, and the patient''s overall assessment. Additionally, an electron microscopic study of a skin biopsy was performed.ResultsBoth laser toning and combination therapy showed significant decreases in the Mexameter® and PSI score after five treatment sessions. Combination therapy showed a more significant improvement of melasma than laser toning. No remarkable side effects were reported. Electron microscopic analysis showed a greater number of vacuolar changes and increased loosening of melanocytes and adjacent epidermal cells after combination therapy.ConclusionThe combination treatment of laser toning and microneedle RF therapy showed a better therapeutic effect for melasma than laser toning alone. Therefore, the microneedle RF technique could be a new and safe adjunct therapy for the treatment of melasma.     

Mequinol 2%/tretinoin 0.01% topical solution for the treatment of melasma in men: a case series and review of the literature

Melasma is a common hyperpigmentation disorder that typically affects women, though up to 10% of white individuals seeking treatment for melasma are men. Melasma can be a source of embarrassment for men because of its association with women and pregnancy. We performed a case series assessing the use of mequinol 2%/ tretinoin 0.01% topical solution in 5 men with melasma. Four of 5 patients achieved complete clearance of melasma at 12 weeks, and 1 patient showed moderate improvement. Side effects were minimal and consisted of stinging in one patient. All patients maintained results at the 16-week follow-up visit. Mequinol 2%/tretinoin 0.01% topical solution was an effective and well-tolerated treatment of melasma in men. The vehicle resulted in good compliance and minimal adverse effects in patients. This is the first report describing the use of mequinol 2%/tretinoin 0.01% topical solution for the treatment of melasma in men; there are no reports in women.     

强脉冲光治疗黄褐斑的研究现状

近年来强脉冲光(intense pulsed light, IPL)在临床上应用广泛,也在黄褐斑的治疗上取得了很大的进展。由于多种机制参与黄褐斑的发病,现阶段,临床上常根据不同的病因采用IPL综合治疗的方法,其疗效显著,安全性高,患者依从性好。因此本文回顾了IPL在黄褐斑治疗方面的应用及不良反应等研究进展。     

Efficacy of beta-carotene topical application in melasma--an open clinical trial

Beta-carotene, a structural analogue of vitamin A, works as an agonist of this vitamin, by reversibly sticking the chemical mechanism of melanogenesis by saturating the nuclear receptors of melanocytes and/or binding protein. To study the safety and efficacy of Beta-carotene lotion on topical application in melasma, clinically diagnosed 31 adults (26F and 5M) with melasma were included in this trial. All of them applied Beta-carotene lotion daily, morning and evening to the affected areas. Twenty six of them, completed regular 8 weeks treatment. Nine of them continued same treatment for 16 more weeks. All cases were evaluated clinically using melasma intensity (MPI) index (Grade I, II, III) and size of the lesion. Clinical photograph was taken for each case at 0 week, 8th week and 24th week. Initial 8 weeks treatment revealed that the single case with grade-I pigmentation included in this study recovered completely. Two out of 13 cases with grade-II pigmentation, showed no change, in 10 cases, pigmentation became lighter to grade-I (76.9%) and one case recovered completely. Out of 12 grade-III cases, one did not show any change, 10 (83.3%) converted to grade-II and one to grade-I. At the end of 24 weeks, all the nine cases (2 grade-II and 7 grade-III) showed further clearing of the pigmentation to the next lower grade. Side effects like mild erythemo and local irritation were observed in two cases each, who were advised to discontinue treatment as per the protocol. In control group, out of 12 (two with grade-II, six in grade-II, and four in grade-III) cases 11 showed no improvement, only one case with grade-II melasma revealed reduction of pigmentation to grade-I. One case developed local irritation. In conclusion, topical application of Beta-carotene lotion appears to be an effective and safe for melasma. Longer duration of application is associated with better result.