荷兰治疗白癜风的指南

白癜风是一种常见的特发性色素代谢障碍性疾病。目前尚无明确可供选择的治愈方法。对其治疗 ,主要着重于使皮损处色素再沉着 ,并阻止色素减退。色素再沉着使外观好看 ,并改善皮肤对光照的耐受性。每年有许多关于促使色素沉着疗法的有效性及安全性的文章发表。人们对临床治疗指南有浓厚的兴趣。指南帮助医生在特定的条件下选择最合适的治疗方法 ,并且是避免不合理处理、控制治疗方案地区差异的工具。然而 ,现有的指南中介绍的有些治疗方法基于作者个人的经验 ,有的由正规的或不正规的学术会议所制定 ,因此科学依据不充分 ,可能引起误导。2 0…     

Guidelines for drug treatment of male infertility.

The prerequisite for rational therapy of male fertility disorders is an exact diagnosis. While the possibilities of influencing disturbances of spermiogenesis are limited, male adnexal diseases can be successfully treated in many cases. Drugs for the treatment of fertility disorders must be applied with this in mind, and empiric therapy is often performed in addition to causal treatment which, however, may be quite rationally determined. The therapeutic spectrum in andrology includes antibiotic and antiphlogistic agents, mast cell blockers, zinc, vitamins, and immunosuppressive drugs (corticosteroids). These agents are used for the treatment of inflammatory diseases of the testes and the accessory glands or for suppression of antispermatozoal antibodies. Hormonal disturbances are infrequently encountered by the andrologist, but they can be treated, with proven efficacy, with gonadotrophins, gonadotrophin-releasing hormone (GnRH) or androgens. In certain cases that are not hormonally related, the use of antiestrogens (clomifene, tamoxifen) as stimulating agents may be successful. Furthermore, tissue hormone releasing proteases (kallikrein) can be used both therapeutically (especially in motility disturbances that are not due to structural flagellar defects) and diagnostically (in order to distinguish between inflammatory and noninflammatory testicular damage). Anticholinergics and alpha-sympathomimetics are applied to ameliorate ejaculation or emission failure. In addition to a review of these treatment forms, the development of new concepts, e.g. angiotensin converting enzyme (ACE) inhibitors, is discussed.     

Calcipotriol in the treatment of childhood vitiligo

Eighteen patients with a clinical diagnosis of vitiligo, aged between three and 12 years (mean 8.9 years), were enrolled in this study in order to evaluate the efficacy and tolerability of topical calcipotriol in the treatment of childhood vitiligo. Six patients (33.3%) were males and 12 were females (66.7%). Fourteen patients (77.8%) had focal vitiligo, two (11.1%) had mucosal vitiligo and two (11.1%) had segmental vitiligo. The face was involved in 11 patients (61.1%). The treatment was applied twice daily as 50 microg/gm cream in nine patients and as ointment in the remaining patients. Treatment assessment was carried out clinically at 2 weeks, and then monthly for 4-6 months. Four patients (28.6%) were excluded from the study (one due to irritation and three due to lost contact in follow-up). Fourteen patients (71.4%) completed the treatment course (> 3 months). Of the treated patients, ten (77.8%) showed improvement and four patients (22.2%) had no response. Among responders, three patients (21.4%) showed complete resolution, four (28.6%) showed 50%-80% improvement and three patients (21.4%) showed 30% to < 50% improvement. Only one patient (5.5%) developed irritation. In conclusion, calcipotriol is an effective treatment in vitiligo. Better results are obtained with ointment than with cream. Calcipotriol can be helpful in children in whom potent steroids and PUVA are not advisable.     

Topical cream delivers NB-UVB from sunlight for the treatment of vitiligo

Ultraviolet-B (UVB) phototherapy for the treatment of vitiligo is an effective first-line choice. However, the cost of multiple doctor visits and the lengthy treatment regimen has resulted in low compliance, limiting access to this safe and effective mode of treatment. Topical Photocil represents an innovative solution to this problem. The drug selectively filters solar radiation to deliver narrow-band UVB to vitiligo lesions. Here, we discuss how this novel topical cream could provide a convenient alternative to artificial light phototherapy.     

白癜风治疗现状

白癜风是皮肤科常见的一种获得性色素脱失性疾病,世界范围内患病率为0.5％ ～ 2.0％,临床表现为局限性或泛发性的皮肤色素脱失斑.导致黑素细胞破坏的机制尚未完全阐明,学界主要的假说有自身免疫学说、遗传学说、黑素细胞自毁学说及神经化学因子学说等,其中越来越多的研究倾向于认为白癜风是一种自身免疫性疾病,此外,氧化应激在白癜风发病中的作用及机制也是皮肤科的研究热点.白癜风的治疗是皮肤科医师面临的一大难题,临床主要以控制皮损发展、促进白斑复色为治疗目的,但起效较慢,整体疗效不甚满意.选择治疗方案时需综合考虑患者的白斑面积、型别、病期等因素.白癜风的主要治疗方法有外用及系统应用药物、光疗及光化学疗法、外科手术疗法等,新型生物制剂在白癜风的治疗中亦初显成效.随着白癜风研究的不断深入和现代医疗技术的快速发展,新的治疗方法和治疗思路层出不穷.     

Advances in the treatment options for vitiligo: activated low-dose cytokines-based therapy

Introduction: Vitiligo is a skin disorder characterized by a progressive depigmentation, which is caused by the loss of melanocytes at the cutaneous level. A shift of the immune system with a prevalence of T helper (Th)1/Th17 response instead of a Tregs/Th2 one and may be part of etiology of 10 vitiligo.

Areas covered: This review describes the major points of vitiligo onset and shows the cutting-edge results in the field of low-dose medicine in the treatment of dermatologic diseases and, in particular. in vitiligo. In this review on advances in vitiligo pharmacotherapy, the most pertinent recent publications are reported. Electronic databases such as PubMed were searched for terms ‘low-dose medicine’ or ‘low dose and vitiligo’ or ‘low dose and psoriasis.’

Expert opinion: The availability of a systemic treatment for vitiligo, based on the oral administration of low-dose activated signaling molecules represents an opportunity for the dermatologists to overcome some specific pitfalls of currently available therapeutic protocols.     

New treatment modalities for vitiligo: focus on topical immunomodulators

The development of effective treatment modalities for vitiligo is dependent on an understanding of the events leading to depigmentation. However, the exact pathogenesis of vitiligo is still mostly unknown. Abnormalities in both humoral and cell-mediated immunity have been documented in vitiligo patients and they present a basis for using immunomodulating agents, such as corticosteroids and macrolide immunomodulators, in the treatment of vitiligo. Macrolide immunomodulators, such as tacrolimus and pimecrolimus, which can be used topically, are known as topical immunomodulators (TIMs). TIMs inhibit the action of calcineurin, and consequently inhibit T-cell activation and the production of various cytokines; this is considered the working mechanism of action of TIMs in vitiligo. Several small studies and case reports on the use of TIMs in vitiligo have been published so far. Tacrolimus achieves better results on the face and neck than on other body areas.Particular advantages of TIMs are safety in treating these areas because of lack of skin atrophy and good tolerability. The incidence of application site adverse events in vitiligo seems to be lower than in the treatment of atopic dermatitis. On the face and neck, TIMs may become a useful tool in the treatment of adults and children with vitiligo despite possibly lower efficacy than topical corticosteroids. Further, larger, controlled clinical studies are warranted to determine the definite role of TIMs as monotherapy or in combination with other modalities in the treatment of vitiligo.     

他克莫司软膏治疗白癜风临床疗效观察

目的观察外用他克莫司软膏治疗白癜风的临床疗效和安全性。方法对50例白癜风患者每日2次外用他克莫司软膏,每2～4周随访1次,对其临床疗效进行观察。结果50例白癜风患者52处皮损中,有47处出现不同程度的色素恢复,有效率达90%;其中26处皮损色素痊愈或恢复≥50%,显效率为50%。32例进展期白癜风中33处皮损全部有效,18例稳定期中19处皮损有14处有效。治疗过程中仅4例出现轻微的一过性局部反应,其中1例为局部瘙痒,3例为痤疮样皮疹。结论外用他克莫司软膏治疗白癜风安全、有效。     

Guidelines for the use of corticosteroids in the treatment of pulmonary sarcoidosis

Sarcoidosis is the most common diffuse parenchymal lung disease and occurs worldwide. Although it affects all ethnic groups, prevalence and severity varies between different races. This has complicated the interpretation of existing clinical studies and extrapolation of their findings to different populations. Sarcoidosis can affect any organ, but the lungs are involved in >90% of patients, and respiratory specialists are therefore frequently responsible for their care. Oral corticosteroids have been used to treat sarcoidosis since the 1950s, with evidence of short- to medium-term improvement in symptoms, respiratory function and radiology. More recently, there have been studies examining the role of inhaled corticosteroids. The long-term benefits of corticosteroid treatment are nevertheless uncertain. Current international guidelines (published in 1999) on sarcoidosis, including recommendations on treatment, represent a consensus statement endorsed by North American and European respiratory societies. British guidelines on diffuse parenchymal lung disease, including sarcoidosis, were published in the same year. There are clearly areas where there is agreement and others where uncertainty persists. This article outlines current guidance with particular reference to which patients should be treated, when treatment should be commenced, the possible role of inhaled corticosteroids, how long treatment should be continued, and what monitoring should be performed for adverse events.     

儿童白癜风及其治疗的研究进展

白癜风是一种常见多发的色素性皮肤病，发病率较高，且逐年增多，尤其是儿童白癜风的发病率近年有上升趋势。回顾分析我中心2001-01-2005-12接诊的507例白癜风患者，发现12岁以前发病的人数占32．15％。因此，儿童白癜风已成为儿童皮肤病中的一个重要疾病。白癜风的治疗目的是为了恢复皮损处黑素细胞，恢复皮肤的正常外观和功能，但目前对于白癜风的治疗还相当困难，特别是儿童白癜风的治疗。本文就儿童白癜风的近年研究作一综述。     

Retrospective analysis of pimecrolimus cream 1% for treatment of facial vitiligo

OBJECTIVE: To explore the effectiveness of pimecrolimus cream 1% used twice daily (BID) for the treatment of facial vitiligo. METHODS: Patients who had used pimecrolimus cream 1% monotherapy BID for at least 3 months and who had photographs taken at baseline and after initiation of therapy were analyzed in a retrospective study. The total affected surface area (cm2) of facial vitiligo in the baseline and follow-up photographs was compared. The extent of facial depigmentation was scored using a 7-point scale (0 = no disease to 6 = 100% involvement). RESULTS: Eight patients met study entry criteria. Mean time from initiation of treatment to the final follow-up visit was 11 months (SD +/- 7.5 months). Mean affected surface area at baseline and follow-up were 79.40 cm2 and 17.96 cm2, respectively, (P = .012) with a mean percent improvement 72.5% (SD +/- 20.4%). Mean depigmentation score decreased from 2.8 at baseline to 1.4 at follow-up. No adverse events were reported. CONCLUSION: Pimecrolimus cream 1% may be a viable alternative to current therapies for the treatment of facial vitiligo.     

天然药用产物治疗白癜风的研究进展

白癜风(vitiligo)是一种获得性慢性皮肤黏膜色素脱失性疾病,发病机制复杂,患者需接受长期治疗.天然药用产物(natural heallth products,NHPs)因其相对安全,并具有多种生物活性,近年来得到广泛关注.目前,草药、营养剂、氨基酸及脂肪酸类NHP在抗白癜风研究方面有一定新进展,并结合现代医学进行...