光、激光及射频技术治疗寻常痤疮

痤疮是一种十分常见﹑累及皮脂腺、毛囊的多因素疾病。痤疮治疗中,光疗法具有起效快、疗程短、不良反应少等优点,但这些尚不能完全代替常规的传统治疗,对于那些不愿接受传统治疗、治疗无效或不能耐受的患者,光、激光和射频是其理想选择。     

Human Papillomavirus Infections: Epidemiology, Pathogenesis, and Therapy

BACKGROUND: Human papillomaviruses (HPV) are common human pathogens and are classified into more than 80 different types. These viruses produce benign warts in many cases and aggressive squamous cell carcinomas in other cases. OBJECTIVE: The goal of this review is to update the reader on the epidemiology, pathogenesis, and therapy of HPV infections. Nonanogenital warts are transmitted by skin-to-skin contact while anogenital warts are usually transmitted sexually. Both types of warts produce much morbidity but rarely undergo malignant transformation. They are commonly treated with surgical or cytodestructive therapy, but immunomodulatory agents, such as imiquimod, have been proven to be very effective in anogenital warts and are being evaluated in nonanogenital warts. Other types of HPV have marked oncogenic potential such that over 99% of all cervical cancers and over 50% of other anogenital cancers are due to infection with oncogenic HPV. Many cofactors, such as cigarette smoking, genetics, and helper viruses, have potential roles in HPV oncogenesis, but their relative contributions are poorly understood. Other control measures for warts and HPV-associated cancers are under study, but the greatest future potential may be from the development of prophylactic and therapeutic vaccines. CONCLUSIONS: Infection with HPV is very prevalent as are the clinical manifestations of this family of pathogens. Improved therapies for warts (e.g., imiquimod) have recently become available. Vaccines for HPV offer hope for future interventions for warts as well as for prevention of anogenital malignancies.     

Generalized Granuloma Annulare Treated with Monthly Rifampicin,Ofloxacin, and Minocycline Combination Therapy

Granuloma annulare (GA) is a disease characterized by granulomatous inflammation of the dermis. A variant form of the disease, generalized granuloma annulare (GGA), can be observed in 15% of affected patients. Localized GA is likely to resolve spontaneously within months or a few years, whereas GGA can persist for decades. There are various therapies for treating GGA. Monthly combination therapy of rifampicin 600 mg, ofloxacin 400 mg, and minocycline 100 mg (ROM) is used for treating paucibacillary leprosy which shares both clinical and histopathologic similarities with GA. Therefore, we decided to evaluate the possible efficacy of monthly ROM in a patient with GGA.     

Therapy of congenital melanocytic nevi. Excision, dermabrasion, laser

Congenital melanocytic nevi are rare lesions which depending on their size and location may cause major cosmetic and psychological problems. Large congenital melanocytic nevi may undergo malignant change and can also be associated with neurocutaneous melanosis. The different treatment approaches reach different levels of the skin. Complete excision is the treatment of choice, but is not always possible with giant nevi. Superficial treatment can reduce the pigmentation, but repigmentation is not uncommon. Incomplete removal of melanocytic nevi does not reduce the melanoma risk. Surgical intervention must be carefully planned; the advantages and disadvantages of the different modalities must be discussed with the parents. The risk of malignant transformation must be weighed up against the expected aesthetic and functional outcomes.     

Dermatoses of Pregnancy - Clues to Diagnosis, Fetal Risk and Therapy

The specific dermatoses of pregnancy represent a heterogeneous group of pruritic skin diseases that have been recently reclassified and include pemphigoid (herpes) gestationis, polymorphic eruption of pregnancy (syn. pruritic urticarial papules and plaques of pregnancy), intrahepatic cholestasis of pregnancy, and atopic eruption of pregnancy. They are associated with severe pruritus that should never be neglected in pregnancy but always lead to an exact work-up of the patient. Clinical characteristics, in particular timing of onset, morphology and localization of skin lesions are crucial for diagnosis which, in case of pemphigoid gestationis and intrahepatic cholestasis of pregnancy, will be confirmed by specific immunofluorescence and laboratory findings. While polymorphic and atopic eruptions of pregnancy are distressing only to the mother because of pruritus, pemphigoid gestationis may be associated with prematurity and small-for-date babies and intrahepatic cholestasis of pregnancy poses an increased risk for fetal distress, prematurity, and stillbirth. Corticosteroids and antihistamines control pemphigoid gestationis, polymorphic and atopic eruptions of pregnancy; intrahepatic cholestasis of pregnancy, in contrast, should be treated with ursodeoxycholic acid. This review will focus on the new classification of pregnancy dermatoses, discuss them in detail, and present a practical algorithm to facilitate the management of the pregnant patient with skin lesions.     

Variations in Serum Hemoglobin, Albumin, and Electrolytes in Patients Receiving Intravenous Immunoglobulin Therapy

Background and objective: Intravenous immunoglobulin (IVIg) is a solution of globulins containing antibodies derived from pooled human plasma of donors and used in the treatment of a number of immune deficiencies and autoimmune diseases. However, several investigators have reported biochemical alterations with use of IVIg. The objective of this study was to evaluate the effects of IVIg therapy on selected biochemical and hematologic parameters in patients with autoimmune mucocutaneous blistering diseases (AMBDs). Methods: In this preliminary clinical study, ten patients with AMBDs (seven with pemphigus vulgaris and three with mucous membrane pemphigoid) received 133 cycles of IVIg for a total of 399 infusions. We evaluated the effects of IVIg therapy on serum hemoglobin (Hb), albumin, and electrolyte levels, including sodium (Na⁺), potassium (K⁺), chloride (Cl^-) and calcium (Ca²⁺). Values of these parameters were measured 24 hours before, during, and 24 hours and 4 weeks after the 3-day infusion period. Results: The observed variations in serum electrolyte levels were physiologically and clinically negligible. Furthermore, 24 hours after the last infusion, mean electrolyte values had spontaneously returned to normal levels without the need for additional supplementation: Na⁺ 137.59 ± 1.42 mmol/L (p = 0.6091 vs baseline); K⁺ 3.97 ± 0.5 mmol/L (p = 0.2689); Cl^- 103.4 ± 2.69 mmol/L (p = 0.0388); and Ca²⁺ 9.07 ± 0.44 mg/dL (p = 0.5332). Conversely, significant variations in mean Hb and albumin levels were observed. When measured 24 hours after the last infusion, mild/moderate decreases in Hb (11.62 ± 2.12 g/dL; p = 0.009 vs baseline) and/or albumin (mean 3.14 ± 0.24 g/dL; p = 0.0016 vs baseline) were evident. Such changes may, albeit very rarely, be of sufficient clinical significance in individual patients as to necessitate additional treatment. Conclusion: In patients receiving intravenous IVIg for AMBDs, electrolyte values should be monitored but do not represent a real clinical threat. Hemoglobin and albumin values may be altered sufficiently to require additional treatment but this is a very rare occurrence. These findings confirm and extend previous reports of the safety of IVIg therapy.     

Therapy of pemphigus and pemphigoid

Severe cases of pemphigus vulgaris should be treated with prednisone in high dosage (180-360 mg daily). In milder cases, we prefer the combined therapy with prednisone 40 mg every other day and an immunosuppressive drug, i.e. azathioprin, cyclophosphamide, or methotrexate. For treatment of bullous pemphigoid, the combined therapy is usually sufficient.     

Therapy and etiology of sebopsoriasis

9 patients suffering from psoriasis vulgaris associated with sebopsoriasis lesions as well as 21 patients showing sebopsoriasis only were treated with 1% bifonazole cream and gel. We found good and excellent results in 86% of the sebopsoriatic, but only in 40% of the psoriasis vulgaris lesions. These results were achieved independently of the galenic preparation. In some of the sebopsoriasis patients, typical lesions were brought about by intracutaneous injection of bacterial antigens like steptococcus viridans and staphylococcus albus; my be, this is a hint on the etiology.