婴儿头面部脂溢性皮炎马拉色菌带菌情况分析

目的了解患头面部脂溢性皮炎的婴儿与正常婴儿头面部马拉色菌带菌情况及来源分析。方法采用胶带法粘取脂溢性皮炎患儿头面部皮损及其母亲胸前皮肤、正常婴儿额部皮肤及其母亲胸前皮肤等处鳞屑,接种于含菜籽油培养基进行真菌培养,分离马拉色菌,并用生理生化及形态学方法鉴定菌种。结果①4组150例标本中共分离出101株马拉色菌;②脂溢性皮炎患儿与正常婴儿马拉色菌培养阳性率以及菌种构成差异均无显著性意义;③脂溢性皮炎患儿与正常婴儿分别与其母亲的马拉色菌培养阳性率以及菌种构成比较差异均无显著性意义,菌种存在一致性,但一致性较差。结论马拉色菌是患儿皮肤的常驻菌;脂溢性皮炎患儿及正常婴儿皮肤马拉色菌可能部分来源于母亲。     

脂溢性皮炎研究进展

脂溢性皮炎(SD)或头皮屑临床常见,过去被认为是发病机制不同的两种疾病,目前多数学者认为二者是同一疾病的不同阶段,头皮屑属轻型脂溢性皮炎。其确切的发病机制至今不清,一般认为是众多因素综合作用的结果,研究发现,SD的发病与免疫功能紊乱及糠秕马拉色菌(M.furfur)感染密切相关。本病的治疗以去脂、消炎、杀菌、止痒为主,近几年有作者提出局部用免疫抑制剂及紫外线治疗取得较好效果。     

脂溢性皮炎致病因素中马拉色菌致病作用的系统评价

目的:明确脂溢性皮炎的致病因素以及马拉色菌在致病中是否起重要作用.方法:应用计算机和人工检索国内外与脂溢性皮炎研究有关的文献,按照循证医学非随机研究的系统评价方法,分析脂溢性皮炎病因学研究的证据,并进行综合评价.结果:自1950年以来有关病因学研究的49篇外文文献均认为其发病是多因素综合作用,基本集中在马拉色菌属酵母、脂质作用和个体易感性3个方面,其中以对马拉色菌致病性研究最多.5篇中文病因学研究文献中4篇不符合质量要求.结论:脂溢性皮炎的发病主要是在个体易感性基础上,机体对共生的马拉色菌菌体,及其脂酶分解皮脂产生游离脂肪酸的反应性增强,破坏皮肤屏障功能并引起皮肤炎症反应.抗真菌治疗可通过减少马拉色菌菌量而缓解皮肤炎症,提示马拉色菌在脂溢性皮炎的发病机制中起重要作用.     

脂溢性皮炎治疗进展

脂溢性皮炎的药物治疗主要集中在抗真菌药及钙调神经磷酸酶抑制剂,外用糖皮质激素、烟酰胺及透明质酸钠等也有报告。因长期外用糖皮质激素有诱发激素依赖性皮炎的风险,已经逐渐少用,烟酰胺及透明质酸钠治疗脂溢性皮炎还有待更多文献支持。脂溢性皮炎的物理治疗主要集中在强脉冲光及光动力治疗,这些治疗可以减少皮脂腺的分泌、减轻皮肤红斑,值得深入探索。窄谱中波紫外线治疗面部脂溢性皮炎因有色素再生风险受到一定限制。射频治疗脂溢性皮炎的疗效还处于试用阶段。     

花斑癣和脂溢性皮炎患者皮损中马拉色菌种的鉴定及其分布情况

马拉色菌属是人和温血动物皮肤的常驻菌群之一．与花斑癣、马拉色菌毛囊炎、脂溢性皮炎及某些银屑病有关,近年来还有引起甲癣和系统感染的报道。笔者以标准株作对照．用生理生化学和形态学方法对260株临床分离的马拉色菌进行分类和描述．并分析了各菌种在花斑癣和脂溢性皮炎中的分布情况。     

类人胶原蛋白敷料治疗面部脂溢性皮炎疗效观察及对皮肤屏障功能的影响

目的探讨类人胶原蛋白敷料治疗面部脂溢性皮炎的疗效、安全性及其对皮肤屏障功能的影响。方法将20~50岁女性面部脂溢性皮炎患者67例随机入组,试验组患者外用酮康唑乳膏加类人胶原蛋白敷料,对照组患者单独外用酮康唑乳膏,两组患者均用药10 d,观察皮损变化并测定皮肤屏障功能相关指标。结果第2次随访时,试验组症状积分[(1.06±1.06)分]、经皮水分丢失量(transepidermal water loss,TEWL)[(11.99±5.84)g/(m2?h)]均低于对照组[(1.94±1.17)分、(16.17±8.47)g/(m2?h)],角质层含水量(40.20±11.69)高于对照组(34.13±10.86),差异均有统计学意义(P=0.002,0.024,0.033)。两组患者均未出现明显不良反应。结论类人胶原蛋白敷料治疗成年女性面部脂溢性皮炎,能改善皮肤屏障功能,减轻皮损,可以作为面部脂溢性皮炎的一个安全有效的辅助治疗手段。     

脂溢性皮炎患者血清中抗马拉色菌抗体检测

为了探讨马拉色菌在脂溢性皮炎发病中的作用和意义,我们采用病例对照设计,以马拉色菌(原卵形糠秕孢子菌P.ovale)整菌(WPO)、胞外提取物(ECE)、胞壁提取物(CWE)、胞浆提取物(CPE)为抗原,用间接酶联免疫吸附试验(ELISA)方法检测37例脂溢性皮炎患者和正常人血清中的抗P.ovale抗体。脂溢性皮炎患者血清中抗WPO和抗CPEIgG抗体高于正常对照组(P<0.01),其平均OD值约为正常对照组的1.6～1.8倍,而抗ECE、CWEIgG抗体与正常对照组差异无显著性(P>0.05);4个抗原的IgASD均有不同程度上升,上升明显且具有统计学意义的是抗ECE、CPE的IgA(P<0.01,P<0.05);除抗WPOIgM升高外,余IgM抗体均有不同程度的下降。结果提示脂溢性皮炎的发病可能与马拉色菌相关,脂溢性皮炎患者可能存在某些分子水平上免疫调节方面的缺陷。     

以脂溢性皮炎为首发表现的艾滋病一例

患者,男,57岁.头面部、颈部、前胸及双下肢可见红斑、鳞屑伴瘙痒1年,加重10余天.真菌镜检马拉色菌阳性,人免疫缺陷病毒(HIV)抗体初筛及确证实验均为阳性.诊断:1.艾滋病;2.脂溢性皮炎.口服伊曲康唑胶囊、外用卢立康唑软膏治疗,同时患者转至吉林省疾控中心治疗艾滋病.     

糠秕马拉色菌所致荷兰男性脂溢性皮炎一例

糠秕马拉色菌是人体皮肤表面的常驻嗜脂性酵母,可引起皮肤浅部真菌感染如花斑糠疹和马拉色菌毛囊炎.脂溢性皮炎为发生在头皮、面部和躯干上半部的慢性红斑,常伴油性鳞屑,本病的病因尚不清楚,但近年研究提示,其发病机制与马拉色菌酵母有关.     

外用钙调磷酸酶抑制剂治疗面部脂溢性皮炎

脂溢性皮炎是一种常见的炎症性皮肤病,以红斑、鳞屑、不同程度瘙痒为特征,好发于皮脂腺分泌旺盛部位,给患者的生活、工作带来影响.由于其具有慢性、复发性的特点,更需要一种安全有效的、可以长期使用的治疗手段.过去,脂溢性皮炎的治疗主要为抗真菌药、角质剥脱剂和糖皮质激素.近年,外用免疫调节剂成为慢性炎症性皮肤病的新型治疗方法.多项脂溢性皮炎的临床研究表明,钙调磷酸酶抑制剂,如他克莫司、吡美莫司治疗面部脂溢性皮炎安全有效.     

0.1％他克莫司软膏治疗面部脂溢性皮炎疗效观察

目的：观察0.1%他克莫司软膏治疗面部脂溢性皮炎的疗效和安全性。方法44例面部脂溢性皮炎患者外用0.1%他克莫司软膏,每日2次,治疗4周后改为每周2次给药,于治疗后第4周和第8周复诊,观察疗效和不良反应。结果0.1%他克莫司软膏治疗第4周和第8周皮损平均积分与治疗前相比均明显下降（P＜0.05）,第4周和第8周皮损积分下降相比差异无统计学意义（P＞0.05）。结论他克莫司软膏治疗面部脂溢性皮炎疗效显著,不良反应少,每周2次给药维持治疗可以有效防止皮损复发。     

盐酸特比萘芬乳膏治疗面部脂溢性皮炎的临床疗效观察

目的评价盐酸特比萘芬乳膏外用治疗面部脂溢性皮炎的疗效与安全性。方法 78例面部脂溢性皮炎患者随机分成两组,试验组39例,接受盐酸特比萘芬乳膏外用治疗,每日2次;对照组39例,接受复方益康唑乳膏治疗,每日2次。两组患者疗程均为4周,每2周复诊1次,复诊时观察和记录疗效和不良反应,治疗结束1个月后对两组患者进行随访。结果治疗2、4周后,两组患者症状总积分均较治疗前明显下降,差异有统计学意义(P0.01)。治疗2周后,试验组和对照组总有效率分别为71.8%和76.9%;治疗4周后,试验组和对照组总有效率分别为79.5%和84.6%,组间差异均无统计学意义(P0.05)。此外,治疗4周后两组患者马拉色菌菌量均比治疗前明显减少,且试验组可检出马拉色菌菌量明显少于对照组。1个月后随访结果表明,试验组复发率为7.7%,显著低于对照组的43.8%。试验组和对照组不良反应发生率分别为10.3%和30.8%。结论外用盐酸特比萘芬乳膏与外用复方益康唑乳膏治疗面部脂溢性皮炎疗效均令人满意,但外用盐酸特比萘芬乳膏的复发率更低,且无糖皮质激素乳膏外用所致的不良反应。     

Malassezia spp carriage in patients with seborrheic dermatitis.

The role of Malassezia spp in seborrheic dermatitis (SD) is controversial. To compare the cutaneous density and the cultural characteristics of Malassezia in persons with or without SD, quantitative cultures were obtained by stripping the forehead with a tape placed on Leeming and Notman medium. Plates were incubated at 37 degrees C in a plastic bag, and colonies were counted after 14 days. High yeast density was defined as > 100 colony forming units (CFU)/tape. Volunteers were divided into four groups depending on their HIV serology [HIV (+) versus HIV (-) or unknown] and their clinical status (with or without SD). 126/129 cultures were positive (97.7%). Malassezia spp density was low on clinically normal skin in all HIV (-) persons (40/40) but was high in 8/34 (24%) HIV (+) persons without SD (p < 0.001). In SD patients, high densities were found in 10/22 (45%) HIV (+) and in 17/33 (52%) HIV (-) persons. The strains could be divided into three basic groups on the basis of their cultural characteristics. Colony morphology type A predominated on normal skin (72%), and morphology type C predominated on persons with SD (78%). High yeast density can be present without skin symptoms. The pathogenicity of Malassezia seems more likely to be determined by the subtype present on the skin rather than by its density.     

强脉冲光联合他克莫司软膏治疗面部脂溢性皮炎疗效观察

目的探讨强脉冲光联合他克莫司软膏治疗面部脂溢性皮炎的疗效.方法治疗组24例患者应用强脉冲光照射,每3周治疗1次,3次为1个疗程,同时外用0.03％他克莫司软膏,每日2次.对照组21例仅外用0.03％他克莫司乳膏,每日2次,共4周.两组均于治疗结束后半个月判定疗效.结果两组瘙痒、红斑、鳞屑均有明显改善,治疗组和对照组临床有效率分别为87.50％和57.14％,治疗组疗效优于对照组.外用他克莫司软膏的7例患者局部有一过性刺激反应.治疗组面部经表皮丢失水分、皮肤油脂、皮肤红斑指数、皮肤弹性较治疗前有明显改善,差异有统计学意义(P＜0.05).结论强脉冲光联合外用他克莫司软膏治疗面部脂溢性皮炎安全、有效.     

Demodex folliculorum infestations in common facial dermatoses: acne vulgaris,rosacea, seborrheic dermatitis

BackgroundDemodex mites are found on the skin of many healthy individuals. Demodex mites in high densities are considered to play a pathogenic role.ObjectiveTo investigate the association between Demodex infestation and the three most common facial dermatoses: acne vulgaris, rosacea and seborrheic dermatitis.MethodsThis prospective, observational case-control study included 127 patients (43 with acne vulgaris, 43 with rosacea and 41 with seborrheic dermatitis) and 77 healthy controls. The presence of demodicosis was evaluated by standardized skin surface biopsy in both the patient and control groups.ResultsIn terms of gender and age, no significant difference was found between the patients and controls (p > 0.05). Demodex infestation rates were significantly higher in patients than in controls (p = 0.001). Demodex infestation rates were significantly higher in the rosacea group than acne vulgaris and seborrheic dermatitis groups and controls (p = 0.001; p = 0.024; p = 0.001, respectively). Demodex infestation was found to be significantly higher in the acne vulgaris and seborrheic dermatitis groups than in controls (p = 0.001 and p = 0.001, respectively). No difference was observed between the acne vulgaris and seborrheic dermatitis groups in terms of demodicosis (p = 0.294).Study limitationsSmall sample size is a limitation of the study. The lack of an objective scoring system in the diagnosis of Demodex infestation is another limitation.ConclusionThe findings of the present study emphasize that acne vulgaris, rosacea and seborrheic dermatitis are significantly associated with Demodex infestation. Standardized skin surface biopsy is a practical tool in the determination of Demodex infestation.