玫瑰痤疮神经源性炎症及肉毒毒素治疗相关机制的研究进展

【摘要】 局部血管神经功能失调是玫瑰痤疮发病的重要因素,已证实神经源性炎症是神经血管失调的重要环节,而皮内注射肉毒毒素可缓解面部潮红、灼热表现,可能与抑制神经末梢神经肽释放以及抑制肥大细胞脱颗粒有关。本文综述玫瑰痤疮发病机制中神经源性炎症以及肉毒毒素治疗玫瑰痤疮的相关研究进展,以期为玫瑰痤疮神经相关基础研究及临床治疗提供依据。     

A型肉毒毒素治疗玫瑰痤疮持久性红斑2例并文献复习

患者女性,50岁,面部红斑、丘疹、脓疱伴潮红、灼热、瘙痒3年。诊断：玫瑰痤疮。共给予2次20 U/mL浓度A型肉毒毒素治疗后明显好转（首次：两侧面颊各注射25 U,1周后第2次注射：每侧面颊各10 U）。病例2：患者女性,48岁,面部红斑、丘疹伴潮红、灼热、瘙痒感2年。诊断：玫瑰痤疮。给予1次注射20 U/mL浓度A型肉毒毒素治疗后明显好转（两侧面颊各注射20 U）。     

A型肉毒毒素皮内注射治疗多汗症

目的　介绍A型肉毒毒素皮内注射治疗多汗症。方法　重点介绍A型肉毒毒素注射治疗手掌多汗症和腋部多汗症。结果　A型肉毒毒素皮内注射治疗多汗症 ,注射后 2～ 3天即止汗 ,5～ 7天止汗明显 ,平均可维持 9～ 12个月。大剂量注射可维持更长时间。结论　A型肉毒毒素皮内注射是治疗手掌多汗症和腋部多汗症安全、有效的治疗方法。     

A型肉毒毒素微滴注射治疗玫瑰痤疮的研究进展

A型肉毒毒素是一种神经毒素,临床上广泛应用于皮肤美容.近年来研究证实其治疗玫瑰痤疮相关的面部红斑及毛细血管扩张安全、有效.本文对肉毒毒素治疗玫瑰痤疮的机制、临床应用、疗效及安全性等进行评价.     

A型肉毒毒素治疗多汗症研究进展

多汗症是临床上的一种常见病、多发病,虽然对患者的身体健康不产生致命的后果,但对患者的生活质量会产生较大影响。该病的治疗方法较多,疗效各异。A型肉毒毒素局部皮内注射治疗多汗症起效快、疗效稳定确切,无创伤,无显著不良反应,不影响日常生活,是目前临床上治疗多汗症的一个有前景的课题。本文对A型肉毒毒素局部注射治疗多汗症的研究进展作了综述。     

A型肉毒毒素联合Lux1540 nm非剥脱点阵激光治疗眶周皱纹的临床疗效

目的:探讨A型肉毒毒素联合Lux1540 nm非剥脱点阵激光治疗眶周皱纹的临床疗效。方法:选择年龄30~60岁有眶周皱纹患者60例,随机分为3组,A组给予A型肉毒毒素注射,B组给予Lux1540 nm非剥脱点阵激光治疗,C组给予A型肉毒毒素注射联合Lux1540 nm非剥脱点阵激光治疗。每例患者在治疗前,治疗后14 d、1、3、6个月随访并行疗效评估。结果治疗1个月后,三组患者眶周皱纹、纹理、弹性、水分均有所改善,与治疗前比较,差异均有统计学意义(P值均<0.05)。肉毒毒素注射联合Lux1540 nm非剥脱点阵激光的C组患者,其皱纹、纹理、弹性、水分的远期效果改善更加明显。结论 A型肉毒毒素联合Lux1540 nm非剥脱点阵激光治疗可同时改善眶周的皱纹和纹理,同时具有紧致眶周皮肤的作用,是眶周皮肤年轻化治疗的理想治疗方案。     

A型肉毒毒素在几种皮肤病的应用进展

近年来,随着A型肉毒毒素作用机制和临床研究的不断深入,其在皮肤病的应用范围日渐增多.A型肉毒毒素的植物神经系统效应可治疗腋部多汗症和手部多汗症,其镇痛效应可治疗带状疱疹后遗神经痛,因其抑制增生性瘢痕成纤维细胞增殖和胶原蛋白的合成,可治疗瘢痕疙瘩及瘢痕.A型肉毒毒素可短暂麻痹骨骼肌,达到延缓皱纹深化的作用.A型肉毒毒素注射的最大弊端就是只能暂时缓解或消除症状,若想长期控制就必须反复注射,许多报道表明,A型肉毒毒素注射最多只能维持12个月.     

A型肉毒毒素消除面部上三分之一皱纹的临床观察

目的通过局部注射A型肉毒毒素,观察其去除面部上三分之一皱纹的临床疗效。方法在产生额纹、鱼尾纹、眉间纹、鼻背纹的局部肌肉内,注射浓度为4 u/0.1m l的适量A型肉毒毒素。结果A型肉毒毒素治疗面部上三分之一皱纹有效率为100%,显效率90.32%,疗效维持时间3~10个月。副作用局限、轻微、短暂。结论A型肉毒毒素局部注射治疗面部上三分之一皱纹是安全、有效、简单非侵入性疗法。     

A型肉毒毒素在美容皮肤科的应用

介绍A型肉毒毒素在美容皮肤科除皱、止汗的功效和方法。A型肉毒毒素局部注射除皱、止汗疗效肯定,而且安全性好,注射1次A型肉毒毒素可维持除皱约4个月,止汗效果可维持12个月。A型肉毒毒素局部注射是美容皮肤科用于除皱、止汗的新方法。     

A型肉毒毒素除去老年人皱纹临床疗效观察

目的:了解肉毒毒素去除老年人头面部皱纹的临床效果。方法:对要求去皱纹部位注射A型肉毒毒素,每针剂量2.5～5.0U,两注射部位的间距不<1.5cm,注射A型肉毒毒素总量≤50U。结果:注射A型肉毒毒素后,去皱纹的起效时间在48h内,1周内达到稳定的疗效。所有接受去皱的老年患者均取得满意的效果,仅在注射A型肉毒毒素后局部有短暂、轻度的不适感,无全身不适。结论:老年人使用A型肉毒毒素除皱纹安全、有效。     

A Pilot Study to Evaluate the Efficacy and Safety of Treatment with Botulinum Toxin in Patients with Recalcitrant and Persistent Erythematotelangiectatic Rosacea

BackgroundThere are few pharmacologic options to reduce erythema and flushing in patients with recalcitrant erythematotelangiectatic rosacea (ETR). We previously reported two cases of refractory flushing and erythema of rosacea that were successfully treated with intradermal botulinum toxin injection, and additional research is needed to prove the efficacy and safety of this treatment.ObjectiveTo report the efficacy and safety of botulinum toxin injection as an aid in persistent erythema of rosacea patients.MethodsA total of 20 Korean patients with recalcitrant ETR were enrolled to receive treatment by injection of botulinum toxin. Patients received one treatment of intradermal botulinum toxin injection and were assessed 1, 2, 4, and 8 weeks after treatment. The severity of erythema and telangiectasia was investigated by a non-treating physician, and the Erythema Index (EI) was assessed by mexameter at each visit. Patient satisfaction and any adverse events were also assessed at each visit.Results17 patients completed all follow-up visits and were included in the analysis. Intradermal injection of botulinum toxin significantly reduced erythema severity and EI in ETR patients. Patients reported a satisfaction score of 2.94±0.56 at 8 weeks after treatment. Except for three patients who discontinued the study early due to inconvenience of facial muscle paralysis, 17 patients participating in the final analysis did not report side effects except injection pain at the time of the procedure.ConclusionIntradermal injection of botulinum toxin can be used as an effective and relatively safe adjuvant agent for recalcitrant and persistent erythema of ETR patients.     

Botulinum toxin blocks mast cells and prevents rosacea like inflammation

Background

Rosacea is a chronic inflammatory skin condition whose etiology has been linked to mast cells and the antimicrobial peptide cathelicidin LL-37. Individuals with refractory disease have demonstrated clinical benefit with periodic injections of onabotulinum toxin, but the mechanism of action is unknown.

玫瑰痤疮药物治疗进展

玫瑰痤疮是一种常见的慢性炎症性皮肤病,根据临床表现不同可分为红斑毛细血管扩张型、丘疹脓疱型、肥大型和眼型.美国国家玫瑰痤疮协会的诊疗指南认为,玫瑰痤疮应按照不同亚型给予相应的治疗.治疗方法包括一般护理、药物、激光、手术等.目前针对红斑毛细血管扩张型的α肾上腺素能受体激动剂、β受体阻滞剂、肉毒素A及针对丘疹脓疱型的亚抗生素剂量多西环素、伊维菌素等的出现,为治疗玫瑰痤疮提供了可能.由于酒石酸溴莫尼定、亚抗生素剂量多西环素、伊维菌素的使用时间较短,其安全性及功效性尚需更多的临床研究证据.     

An enhanced transcutaneous delivery of botulinum toxin for the treatment of Hailey–Hailey disease

Successful treatment of Hailey–Hailey disease with intradermal botulinum toxin injections has been previously reported. The main disadvantages of this treatment are the excruciating pain and the risk of infections due to the numerous injections. We sought to evaluate the clinical effectiveness and safety profile of a novel approach using an energy‐based device (Tixel, Novoxel, and Israel), followed by the topical application of botulinum toxin Type A for the treatment of Hailey–Hailey disease. A retrospective study of all cases of histologically diagnosed cases of Hailey‐Hailey disease treated with Tixel device followed by topical application of botulinum toxin between 2018 and 2019 was performed. Epidemiologic, clinical, and treatment data, including effectiveness score and safety, were reviewed. The study included eight patients, of whom seven patients (87.5%) showed good or partial response. No systemic or local adverse effects were reported. There was no difference in effectivity between different body areas. Response to treatment ranged between patients with an average duration of 7.125 months after the second treatment. Tixel treatment followed by topical application of botulinum toxin can be considered in the treatment of Hailey–Hailey disease. This approach is less invasive, less painful, and yet effective as well as safe.     

The successful use of botulinum toxin for the treatment of nasal hyperhidrosis

Background Patients with facial hyperhidrosis often experience occupational, social, and psychological problems. Botulinum toxin type A, which has been shown to be useful in the treatment of hyperhidrosis, can cause the paralysis of facial muscles if used in the skin overlying the facial muscles. It can, however, be used in the skin of the nose without significantly affecting the muscles of facial expression. Methods Two patients with severe nasal hyperhidrosis were treated with botulinum toxin. Results Two patients with severe nasal hyperhidrosis responded to a single session of treatment with intradermal injections of botulinum toxin. Conclusions This treatment method for nasal hyperhidrosis is simple, well tolerated, and effective, and significantly improves the quality of life of the affected individuals.     

中国玫瑰痤疮诊疗指南（2021版）

【摘要】 玫瑰痤疮是一种好发于面中部的慢性炎症性皮肤病,主要表现为面中部反复潮红、红斑。近年来,对本病的诊治有了新的认识,为此,组织部分专家在《中国玫瑰痤疮诊疗专家共识（2016）》的基础上制定本指南,新版指南提出了分部位诊断标准,希望能进一步规范我国玫瑰痤疮的诊断与治疗。     

Treatment of idiopathic palmar hyperhidrosis with botulinum toxin. Report of 23 cases and review of the literature.

BACKGROUND: Botulinum toxin represents a novel therapeutic option for idiopathic palmar hyperhidrosis. However, so far there is no consensus on the way to administer botulinum toxin in this indication. Moreover, its use is limited by severe pain during the injections, especially with subepidermal injections close to 'free nerve endings'. OBJECTIVES: To analyze the effectiveness and tolerability of intracutaneous injections of botulinum toxin after nerve blocks and to review the techniques of injections and the results reported by other groups. METHODS: Twenty-three adult patients with refractory palmar hyperhidrosis were treated with intracutaneous injections of botulinum toxin after ulnar and median nerve blocks. Patients were followed up on a monthly basis. RESULTS: In all patients botulinum toxin abolished sweating in the injected areas within 1 week. Anhidrosis lasted for 4-13 months. The intensity of pain was rated as absent (n = 13), mild (n = 8) or moderate (n = 2). Other side effects included hematoma (n = 2) and pain consecutive to nerve block (n = 1). DISCUSSION: Intracutaneous injections of botulinum toxin after median and ulnar nerve block represent an effective and mildly painful technique to treat palmar hyperhidrosis and may be as safe as subepidermal injections.     

Midface lifting with botulinum toxin: intradermal technique

Background An intradermal injection technique is a variation of the intramuscular or subcutaneous injection technique usually performed with botulinum toxin for facial rejuvenation. The technique applied to realign the imbalance of the facial muscles by weakening the downward pull of the depressors and allowing the levators to contract in a compensatory fashion results in midface lifting and rejuvenation. Aims To address the intradermal injection technique of botulinum toxin for midface lifting. Methods A restrospective review of the patients undergoing midface lifting during the year 2008, the procedure, the details of the injection technique, and outcomes are described. Results An intradermal injection technique of botulinum toxin successfully gives rise to midface lifting and rejuvenation. Conclusion An intradermal injection technique of botuinum toxin treatment is effective for aesthetic improvement in the midface.