痤疮的抗雄激素治疗

痤疮的发生与体内雄激素水平及其代谢密切相关。抗雄激素治疗通过抑制雄激素的产生或干扰雄激素在靶器官的活动而发挥作用,主要药物有雌性激素,抗雄激素药物和糖皮质激素三大类。治疗方法为口服给药和局部外用。本文就抗雄激素治疗痤疮的原理、治疗方法、不同治疗方案作一综述。     

痤疮治疗的临床研究进展

寻常性痤疮病因复杂，治疗上针对其主要发病机制采用抗感染、调节内分泌、抗雄激素、抑制皮脂腺功能及抗毛囊皮脂导管角化、抗炎等药物，近年来在治疗方法、药物选择和临床疗效上都有了较大的发展。     

皮脂腺及皮下脂肪疾病

雄激素受体基因CAG多态性与痤疮中医分型的相关性研究;妊娠期痤疮患雄激素和垂体激素水平研究;女性痤疮患卵泡期血清六项性激素水平的测定;寻常性痤疮局部药物治疗进展（综述）;自血疗法结合西药治疗寻常痤疮116例……[第一段]     

痤疮的抗雄激素治疗进展

痤疮是青少年常见的发生于毛囊皮脂腺单位的慢性复发性炎症性皮肤病,雄激素在痤疮发病中起到了关键的始动作用,临床上已经使用Clascoterone及口服避孕药等抗雄激素药物治疗痤疮,其他抗雄激素药物如ASC-J9霜、醋酸环丙孕酮洗剂、酮康唑霜剂、螺内酯、氟他胺等均显示出一定疗效,但仍需高质量的临床研究提供循证依据。本文对上述抗雄激素药物治疗痤疮进行了综述。     

痤疮的抗雄激素治疗

痤疮的发生与体内雄激素水平及其代谢密切相关。抗雄激素治疗通过抑制雄激素的产生或干扰雄激素在靶器官的活动而发挥作用，主要药物有雌性激素，抗雄激素药物和糖皮质激素三大类。治疗方法为口服给药和局部外用。本文就抗雄激素治疗痤疮的原因，治疗方法，不同治疗方案作一综述。     

抗痤疮药物与成纤维细胞生长因子受体2信号通路

研究发现,成纤维细胞生长因子受体2信号通路与痤疮发病机制有关,多种具有明确抗痤疮作用的药物均可通过同一机制,即下调雄激素依赖性成纤维细胞生长-成纤维细胞生长因子受体2信号通路发挥约效,这些药物包括抗雄激素类药物、过氧苯甲酰、壬二酸、四环素、维A酸类药物以及红霉素。因此,将为未来研究成纤维细胞生长因子受体对毛囊皮脂腺的作用和研究抗痤疮药物提出发展方向。     

痤疮的局部治疗

近年对痤疮的了解与治疗有显著进展,大多数病人单纯局部用药即可奏效,从而避免了全身应用可能有毒药剂.本文将药物按作用机制分为6类进行讨论.皮脂抑制剂皮脂是毛囊角化产物及皮脂腺分泌的混合物.因为在皮脂腺的厌氧深度,皮脂为痤疮丙酸菌提供底物,故曾被称为痤疮的"燃料".这些细菌与皮脂相互作用的结果,产生各种不同的刺激性、抗原性或化学吸引性物质.雄激素是皮脂产物的主要已知刺激剂.抗雄激素包括5—α—还原酶的抑制剂,现正在研究中.至今尚未发现局部应用后既有效又无全身毒性的药物.局部应用雌激素基本无局部作用,但通过吸收可有全身作用,降低内源性雄激素的产生,天然黄体酮不产生男性征,但某些合成黄体酮可产生男性征,某些避孕药可诱发或加重痤疮.     

女性青春期后痤疮研究进展

女性青春期后痤疮可分为迟发性痤疮及持续性痤疮,发病率有升高趋势.临床表现多为轻至中度痤疮,主要为炎性损害,多分布于下颏、口周等部位.女性青春期后痤疮可能的发病机制为皮肤雄激素增多,痤疮丙酸杆菌耐药菌株的存在及大然免疫的慢性刺激.各种原因引起的性激素水平改变、血清胰岛素样生长因子-1升高、精神压力、吸烟等为其诱发或加重因素,部分患者可有潜在内分泌疾病需注意排查.治疗方面可考虑加用抗生素类,低剂量异维A酸间歇治疗.对治疗较抵抗的患者抗雄激素治疗是重要手段之一,主要药物有螺内酯、氟他胺、醋酸环丙孕酮及口服避孕药.     

多囊卵巢综合征的皮肤表现及治疗

多囊卵巢综合征在临床上已有病例报告。多发性卵巢囊肿可导致高雄激素性血症，引起痤疮、多毛、皮脂溢出、女性型脱发等症状。采用传统方法治疗痤疮无效，需采用抗雄激素疗法，必要时采用根治疗法。     

寻常性痤疮局部药物治疗进展

寻常性痤疮是皮肤科常见病,治疗方法繁多,局部外用药物因对机体的影响较小,且多有良好的疗效和依从性,故临床应用较多。痤疮局部药物治疗主要有抗生素、维A酸类、羟基酸类、抗雄激素类及过氧化氢类等。针对发病因素选择合适的药物局部外用治疗痤疮,往往可取得良效。     

New fillers for the new man

ABSTRACT:  Two new collagen-based lidocaine-containing dermal fillers, ArteSense™/ArteFill™ (Artes Medical, San Diego, CA) and Evolence® (Colbar LifeScience Ltd., Herzliya, Israel), have proved to be of particular interest to men, many of whom seek a long-lasting or permanent correction. ArteFill™ has been available in the United States since 2006, and it is expected that Evolence® will reach the American market in 2008. The properties of the two products will be described, and experience based on the administration of many hundreds of syringes of both products by a Canadian dermatologist will be detailed here, with tips and precautions to optimize patient outcomes.     

Outcomes and adverse effects of ablative vs nonablative lasers for skin resurfacing: A systematic review of 1093 patients

It is generally believed that ablative laser therapies result in prolonged healing and greater adverse events when compared with nonablative lasers for skin resurfacing. To evaluate the efficacy of ablative laser use for skin resurfacing and adverse events as a consequence of treatment in comparison to other modalities, a PRISMA‐compliant systematic review (Systematic Review Registration Number: 204016) of twelve electronic databases was conducted for the terms “ablative laser” and “skin resurfacing” from March 2002 until July 2020. Studies included meta‐analyses, randomized control trials, cohort studies, and case reports to facilitate evaluation of the data. All articles were evaluated for bias. The search strategy produced 34 studies. Of 1093 patients included in the studies of interest, adverse events were reported in a total of 106 patients (9.7%). Higher rates of adverse events were described in nonablative therapies (12.2% ± 2.19%, 31 events) when compared with ablative therapy (8.28% ± 2.46%, 81 events). 147 patients (13.4%) reported no side effects, 68 (6.22%) reported expected, transient self‐resolving events, and five (0.046%) presented with hypertrophic scarring. Excluding transient events, ablative lasers had fewer complications overall when compared with nonablative lasers (2.56% ± 2.19% vs 7.48% ± 3.29%). This systematic review suggests ablative laser use for skin resurfacing is a safe and effective modality to treat a range of pathologies from photodamage and acne scars to hidradenitis suppurativa and posttraumatic scarring from basal cell carcinoma excision. Further studies are needed, but these results suggest that ablative lasers are a superior, safe, and effective modality to treat damaged skin.     

Genetic alterations in RAS‐regulated pathway in acral lentiginous melanoma

Studies integrating clinicopathological and genetic features have revealed distinct patterns of genomic aberrations in Melanoma. Distributions of BRAF or NRAS mutations and gains of several oncogenes differ among melanoma subgroups, while 9p21 deletions are found in all melanoma subtypes. In the study, status of genes involved in cell cycle progression and apoptosis was evaluated in a panel of 17 frozen primary acral melanomas. NRAS mutations were found in 17% of the tumors. In contrast, BRAF mutations were not found. Gains of AURKA gene (20q13.3) were detected in 37.5% of samples, gains of CCND1 gene (11q13) or TERT gene (5p15.33) in 31.2% and gains of NRAS gene (1p13.2) in 25%. Alterations in 9p21 were identified in 69% of tumors. Gains of 11q13 and 20q13 were mutually exclusive, and 1p13.2 gain was associated with 5p15.33. Our findings showed that alterations in RAS‐related pathways are present in 87.5% of acral lentiginous melanomas.     

Self‐resolving superficial primary cutaneous mucormycosis in a 7‐week‐old infant

A 7‐week‐old girl, born at 30 weeks' gestational age, presented to clinic for evaluation of a crop of vesicular lesions that were noted after removal of a bandage that had been in place for 4 days. A punch biopsy of the lesion revealed fungal elements that were later identified as Rhizopus spp. The lesion began to self‐resolve, and no further treatment was needed, with full resolution of the lesion by 1 month after presentation. Clinicians should be aware of the variable presentations of mucormycosis and consider fungal infection in the differential diagnosis when evaluating vulnerable patients with skin eruptions.     

Multiple New-Onset Subcutaneous Nodules of the Upper Extremity Digits: Giant Cell Tumor of Tendon Sheath and Lipoma

A black woman with the concurrent onset of two subcutaneous nodules located on the digits of her upper extremities is described. Initially, a single systemic disorder was considered; yet, the lesions differed in morphology and consistency. Microscopic examination of the nodules showed a giant cell tumor of tendon sheath and a lipoma. Although Occam's “razor” suggests that multiple lesions in the same person are more likely to represent variable manifestations of a single disorder than several different diseases in that individual, the simultaneously appearing lesions in this patient represented two different conditions.