玫瑰痤疮严重程度与血清睾酮、雌二醇水平及肠道菌群的关系研究

目的 探讨玫瑰痤疮严重程度与血清睾酮、雌二醇、肠道菌群的关系。方法 选取2021年3月—2022年9月诊治的102例玫瑰痤疮患者作为观察组,同期105例健康体检志愿者为对照组。根据临床症状严重程度不同,将患者分为轻度组64例、中度组17例、重度组21例。采用放射免疫法检测血清睾酮、雌二醇水平;荧光定量聚合酶链反应对肠道菌群中双歧杆菌、乳酸杆菌、大肠埃希杆菌、肠球菌的拷贝数进行检测;采用Pearson相关性分析对玫瑰痤疮患者血清睾酮、雌二醇水平与肠道菌群的相关性进行分析。结果 与对照组[(445.34±68.75) ng/L、(294.25±42.97) pmol/L]比较,观察组玫瑰痤疮患者血清睾酮水平[(547.06±75.13)ng/L]升高,雌二醇[(225.28±25.89) pmol/L]降低,差异有统计学意义(P<0.05);观察组玫瑰痤疮男性患者血清雌二醇水平低于对照组男性,女性患者血清睾酮水平高于对照组女性,差异有统计学意义(P<0.05)。与对照组比较,观察组玫瑰痤疮患者肠道双歧杆菌、乳酸杆菌菌群数量减少,大肠埃希杆菌、肠球菌菌群数量增多,B/E值降低,差...     

《中国儿童系统性红斑狼疮诊断与治疗指南》解读

鉴于儿童系统性红斑狼疮的诊断和治疗较成人更具复杂性,2021年中华医学会儿科学分会免疫学组联合指南方法学专家及《中华儿科杂志》编辑部制定了我国首部《中国儿童系统性红斑狼疮诊断与治疗指南》。该指南是对2011年我国《儿童系统性红斑狼疮诊疗建议》的延续,依据循证实践,结合中国具体国情,指南回答了12个儿童系统性红斑狼疮诊断、评估、治疗和预后管理等方面的关键临床问题,以期为各级医疗机构和参与儿童系统性红斑狼疮诊疗及管理的专业人员提供指导,规范系统性红斑狼疮患儿的诊断、合理用药及长期管理。本研究对该指南的重点内容进行解读,以期促进指南的临床应用。     

玫瑰痤疮分型再认识

玫瑰痤疮,又称酒渣鼻,是一种发生在面部尤其是面中部的慢性炎症性皮肤病。美国国家玫瑰痤疮协会专家委员会(NRSEC)将玫瑰痤疮分为红斑毛细血管扩张型、丘疹脓疱型、鼻赘型和眼型4型。但临床上发现,此种分型有其局限性,并不符合疾病发生发展的特点。笔者分析了玫瑰痤疮现有分型的缺点并结合收集的586例玫瑰痤疮患者的临床特点,提出了玫瑰痤疮新的分型的思考。     

探究精细化护理指导在女性玫瑰痤疮患者治疗中的应用效果

目的 探讨精细化护理指导在女性玫瑰痤疮患者治疗中的应用效果。方法 选取 2021 年 8 月至 2022 年 8 月在我院治疗的 女性玫瑰痤疮患者 60 例作为研究对象。依据随机数字表法随机分为研究组（n=30）和对照组（n=30）。对照组采取常规护理, 研究组采取精细化护理。分析比较两组患者的疗效、DLQI 评分、护理满意度。结果 研究组的疗效明显好于对照组（P<0.05）。 研究组的 DLQI 评分明显低于对照组（P<0.05）。研究组的护理满意度高于对照组（P<0.05）。结论 女性玫瑰痤疮患者实施精 细化护理,能够提高疗效,生活质量和护理满意度。     

《2021年AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR胸痛评估与诊断指南》解读

美国心脏协会等七大协会于2021年10月28日首次联合发布了《2021年AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR胸痛评估与诊断指南》.此次指南强调了急性胸痛风险分层和诊断流程,考虑了低风险胸痛诊断检查的成本经济效益,并建议与患者共享决策.该指南主要涉及胸痛初始评估、以患者为中心的急性胸痛诊治流程和稳定型胸痛患者的评估.该文通过文献查阅,对指南推荐要点进行详细解读.     

不容忽视的心肌炎——来自《2021年ESC急慢性心力衰竭诊断与治疗指南》的启示

2021年9月,Eur Heart J发布了《2021年ESC急慢性心力衰竭诊断与治疗指南》,该版指南对2016年版指南作出重要更新。其中,心肌炎作为心力衰竭的一种特定临床情况应给予重点关注。本文结合我国心肌炎临床诊疗实践,对新版指南中心肌炎部分进行全面解读,以加深临床医师对此类疾病的认识和理解。     

玫瑰痤疮患病的危险因素分析

目的 探讨玫瑰痤疮患病的危险因素,并根据危险因素分析相应的预防措施。方法 回顾性收集2020年7月至2021年7月河南省人民医院（郑州大学人民医院）皮肤科收治的75例玫瑰痤疮患者为观察组,另选取同期收治的未患玫瑰痤疮的75例患者为对照组,对两组临床资料予以单因素分析法分析,并将单因素分析结果显示差异有显著性的因素纳入多因素分析中,通过多因素logistic回归分析法分析玫瑰痤疮患病的危险因素。结果 观察组年龄大于对照组,且有家族史、每日阳光照射时间>60min、洗脸水温高、每周化妆次数>2次、每周情绪变化>5次、空调温度>24℃、有过敏史、喜欢甜食的患者占比均高于对照组,差异有显著性（P<0.05）;而两组性别、有无吸烟史、有无饮酒史、是否喜欢饮茶、是否喜欢辛辣食物等情况相比,差异均无显著性（P>0.05）。多因素logistic回归分析结果表明,玫瑰痤疮患病的独立危险因素包括有家族史、每日阳光照射时间>60 min、洗脸水温高、每周化妆次数>2次、每周情绪变化>5次、空调温度>24℃（OR=6.760、1.458、2.330...     

护理干预对提高玫瑰痤疮患者生活质量的影响

目的观察护理干预对提高玫瑰痤疮患者生活质量的影响。方法选择该院2016年7月至2017年7月收治的红斑毛细血管扩张型玫瑰痤疮患者80例,采用皮肤护理、心理护理以及健康教育进行干预,观察和比较患者干预前后生活质量的改善情况。结果玫瑰痤疮患者进行护理干预后,其生活质量指数评分[(5.12±2.45)分]显著低于干预前的生活质量指数评分[(9.85±4.23)分],差异有统计学意义(P0.05);心理抑郁程度评分[(4.41±4.56)分]亦显著低于干预前的心理抑郁程度评分[(10.85±7.23)分],差异有统计学意义(P0.05)。结论护理干预有助于提高玫瑰痤疮患者的生活质量,值得临床广泛应用及推广。     

黄金微针联合舒敏治疗仪治疗玫瑰痤疮的疗效观察

目的 探讨黄金微针联合舒敏治疗仪治疗玫瑰痤疮的疗效观察。方法 选取2021年6月-2022年6月于我院的玫瑰痤疮患者92例,随机分为两组。对照组应用舒敏治疗仪+异维A酸胶囊,研究组在此基础上应用黄金微针,观察比对两组治疗前后的皮肤生理指标、症状评分、角质层完整性、生活质量以及治疗效果。结果 研究组治疗后油脂、表皮含水评分均比对照组高,TEWL、毛细血管扩张、红斑、潮红评分比对照组低(P<0.05);研究组治疗后Acne-QOL评分比对照组高,粘脱蛋白含量、丝氨酸蛋白活性比对照组低;研究组治疗总有效率(95.66%)比对照组(76.09%)高(P<0.05)。结论玫瑰痤疮患者联合应用舒敏治疗仪+黄金微针效果理想,不仅可以修复角质层,同时可以改善患者的皮肤生理功能,加速皮肤屏障的修复和疾病症状的改善,值得推广应用。     

红斑毛细血管扩张型玫瑰痤疮的治疗进展

玫瑰痤疮是临床一种常见的面部的慢性炎症性皮肤病,病因复杂,容易复发,给患者的生活造成了巨大影响。临床上玫瑰痤疮可分为四型,红斑毛细血管扩张型玫瑰痤疮(erythematotelangiectatic rosacea,ETR)是其最常见的类型,目前治疗ETR的方法多种多样,包括外用药物治疗、口服药物治疗、光学治疗及注射治疗等,其有效性和安全性有待于临床进一步验证,本文将结合国内外研究对ETR的治疗进展进行综述。     

肉毒毒素联合强脉冲光治疗玫瑰痤疮难治性红斑和潮红

目的目前临床治疗以面部红斑和潮红为主要表现的玫瑰痤疮仍然比较棘手,本研究报道2例应用肉毒毒素联合强脉冲光治疗顽固性玫瑰痤疮患的案例,希望临床治疗提供方新思路.方法肉毒毒素总剂量为30-50U/次,注射点间隔1cm交错覆盖在面部红斑处,改善血管神经功能,减轻面部阵发性潮红.结果与治疗前相比,治疗部位临床症状明显缓解,VISIA皮肤图像分析仪显示红斑明显减轻,治疗后通过综合日常管理皮肤,随访时间未见症状复发.结论肉毒毒素联合强脉冲光可用于治疗玫瑰痤疮难治性红斑和面部潮红,对其疗效及安全性需在今后的临床中再进行进一步大样本量观察及探讨.     

Potential antioxidant mechanism of action for metronidazole: Implications for rosacea management

Chronic inflammation is believed to account for some symptoms of rosacea. The efficacy of topical metronidazole in the treatment of rosacea may be due to its antimicrobial as well as anti-inflammatory activity. Neutrophils release potent inflammatory mediators, including reactive oxygen species (ROS), and intrafollicular neutrophils have been observed in stage II disease. ROS and other free radicals may contribute to intrinsic and extrinsic aging, both of which accentuate clinical manifestations of rosacea. If, as in vitro data suggest, metronidazole has antioxidant activity, it may help subdue the oxidative tissue damage of intrinsic and extrinsic aging as well as prevent and treat rosacea symptoms.     

Topical Ivermectin 10 mg/g and Oral Doxycycline 40 mg Modified-Release: Current Evidence on the Complementary Use of Anti-Inflammatory Rosacea Treatments

Rosacea is a common, chronic inflammatory skin disease that can present with a variety of signs and symptoms. The potentially simultaneous occurrence of different signs and symptoms is due to different underlying inflammatory pathways, emphasizing the need for complementary treatment approaches. Topical ivermectin cream (10 mg/g) and systemic, oral anti-inflammatory doxycycline (40 mg modified-release) are both approved for the treatment of papulopustular rosacea (PPR). Whether or not a combined therapeutic approach may be more beneficial than monotherapy for patients with PPR remains to be tested. Here, we summarize underlying inflammatory pathways implicated in rosacea and clarify the impact of these two agents on selective pathways during inflammation, due to specific characteristics of their individual mechanisms of action (MoA). Based on the complementary MoA of doxycycline modified-release and ivermectin, a scientific rationale for a combined therapy targeting inflammatory lesions in rosacea is given. We propose that topical ivermectin cream is a promising new candidate as first-line treatment to target the inflammatory lesions of rosacea, which can be used in combination with systemic doxycycline modified-release to provide an optimal treatment approach considering all inflammatory pathways involved in PPR. Funding Galderma.     

Treatment options for rosacea with concomitant conditions

Patients with rosacea frequently present with coexisting skin conditions, such as seborrheic dermatitis, acne, perioral dermatitis, and melasma, which may complicate diagnosis and treatment. This article discusses the presentation, pathophysiology, and management of rosacea with common concomitant skin disorders.     

13-Cis-retinoic acid: a new form of treatment of rosacea (author's transl)

13-cis-retinoic acid was given with good results to 7 patients with exceptionally severe rosacea. Side effects were transitory and of minor consequence and subsided quickly on reduction of the dosage and topical application of mild cosmetics. The long-lasting remissions recorded to date indicate that 13-cis-retinoic acid may prove a new and successful approach to the treatment of rosacea.     

双波长脉冲染料激光联合绽妍透明质酸保湿乳治疗玫瑰痤疮的临床疗效观察

目的 分析对玫瑰痤疮患者采用双波长脉冲染料激光联合绽妍透明质酸保湿乳治疗的临床效果.方法 选择2018年3月至2020年9月收治的50例玫瑰痤疮患者作为研究对象,随机分为观察组(25例,采用双波长脉冲染料激光联合绽妍透明质酸保湿乳治疗)和对照组(25例,采用绽妍透明质酸保湿乳治疗).治疗前后分别对两组患者临床症状进行积...     

Management of rosacea with intense pulsed light (IPL) systems and laser

A combination of different clinical symptoms is represented under the broad rubric of rosacea. These consist of facial flushing, erythema with the appearance of telangiectatic vessels of the face, eruption of inflammatory papules and pustules, and hypertrophy of the sebaceous glands with fibrosis. The disease can be characterized by different phases. Classical topical and systemic medications lack sufficient reduction for the main parts of the disease, for flushing attacks and dilated vessels. The impressive results obtained by using intense pulsed light (IPL) and lasers in treating these symptoms indicate that they should finally be a part of standard treatment regimes for rosacea therapy.     

How We Treat Rosacea

The basic cause of rosacea is not known. General, topical, systemic and dietary factors must be considered in the successful management of this often recalcitrant and recurrent disorder. While principally of cosmetic importance, rosacea may cause serious ocular changes or it may develop into rhinophyma, which requires surgical treatment.     

Use of macrolides and tetracyclines for chronic inflammatory diseases

OBJECTIVE: To review the efficacy of macrolides and tetracyclines in several chronic inflammatory conditions. DATA SOURCES: Searches of MEDLINE (1966-March 2004) and an extensive bibliography search were undertaken. Key terms included acne, blepharitis, cardiovascular disease, cystic fibrosis, periodontitis, rosacea, and rheumatoid arthritis. STUDY SELECTION AND DATA EXTRACTION: Data were obtained primarily from randomized placebo-controlled trials upon which key recommendations are based. DATA SYNTHESIS: Antibiotics are often prescribed for months or even years for treatment of chronic inflammatory conditions such as acne, blepharitis, cardiovascular disease, cystic fibrosis, periodontitis, rosacea, and rheumatoid arthritis. Randomized controlled trials have shown that azithromycin is useful in the management of cystic fibrosis and the tetracyclines are beneficial in the management of rheumatoid arthritis, acne, blepharitis, and periodontitis. Several large, randomized controlled trials have failed to show any benefit of macrolides in the secondary prevention of cardiovascular disease. No randomized placebo-controlled clinical trials have been performed to assess the efficacy of macrolides or tetracyclines in patients with rosacea. CONCLUSIONS: The use of tetracyclines and macrolides for rosacea is based primarily on anecdotal reports or open-label trials. Limited clinical trials support the use of tetracyclines or macrolides in acne, blepharitis, periodontitis, rheumatoid arthritis, and cystic fibrosis. Trials to date do not support the use of antibiotics for secondary prevention of cardiovascular disease.