高频电离子联合局部用药治疗扁平疣疗效观察

目的观察表面麻醉下,高频电离子联合利巴韦林注射液和重组人干扰素软膏治疗面部扁平疣的临床疗效。方法将100例扁平疣患者随机分成3组,A组(电离子联合外用药)34例,B组(电离子组)32例,C组(外用药组)34例,A组表面麻醉后以高频电离子局部去除皮损后,外涂利巴韦林注射液,待干燥后,用美宝湿润烧伤膏至结痂。痂皮脱落后改用利巴韦林注射液和重组人干扰素软膏交替外用,3次/d,共4周。B组单以高频电离子局部治疗。C组单用药物外用(即每天交替外用利巴韦林注射液和重组人干扰素软膏)。结果 A组治愈率88.23%、有效率94.11%、复发率11.76%,与B组治愈率62.5%、有效率75%复发率43.75%及C组治愈率35.25%、有效率52.94%复发率70.58%相比,差异均有统计学意义(P0.05)。结论高频电离子联合利巴韦林注射液和重组人干扰素软膏治疗面部扁平疣安全可靠,治愈率高,复发率低。     

5%咪喹莫特乳膏与重组人干扰素凝胶预防扁平疣冷冻后复发的疗效比较

目的对比液氮冷冻后局部外用5%咪喹莫特乳膏和重组人干扰素α-2b凝胶对预防扁平疣复发的作用。方法将66例扁平疣患者给予液氮冷冻去除肉眼可见的疣体后,随机分两组,治疗组外用5%咪喹莫特乳膏,1次/qod;对照组外用重组人干扰素α-2b凝胶,(3~4)次/d,疗程均为8周,随访3个月,比较两组患者治愈、复发情况及不良反应。结果治疗组和对照组的治愈率分别为90.9%和63.6%。差异具有统计学意义(P0.05)。结论扁平疣液氮冷冻后局部使用5%咪喹莫特乳膏比重组人干扰素α-2b凝胶更阻止扁平疣复发。     

斑蝥素联合a-2b干扰素治疗尖锐湿疣疗效观察

目的:观察斑蝥素联合a-2b干扰素治疗尖锐湿疣的疗效、安全性及复发情况。方法:将41例尖锐湿疣患者随机分为两组,其中对照组20例,治疗组21例。对照组应用斑蝥素软膏每日1次外用,治疗组在斑蝥素软膏治疗基础上辅以a-2b干扰素肌注100万U,隔日1次肌内注射,同时外用干扰素α-2b凝胶,每日4次外用。疗程3个月,治疗结束后随访8个月,观察复发情况。两组的治疗情况、安全性及复发情况均由专人记录。结果:(1)治疗组治愈率为90.48%,高于对照组(P0.05);(2)治疗组复发率为29.41%,低于对照组(P0.05);(3)对两组疣体完全脱落时间比较,差异无统计学意义(P0.05)。结论:应用斑蝥素联合a-2b干扰素治疗尖锐湿疣,能够获得满意疗效,可在临床推广应用。     

甲氰咪胍联合二种外用药物治疗扁平疣疗效观察

临床资料　 117例均为门诊病人 ,符合扁平疣诊断标准 ,治疗组 6 7例 ,男 2 8例 ,女 39例 ,年龄 16～ 40岁 ,病程 2周～ 8年 ,皮疹主要分布在面部、手背及前臂等处。对照组 5 0例 ,男 2 0例 ,女 30例。发病年龄、病程、皮疹分布及数量两组基本相同。近 1月内未行任何治疗。治疗方法　治疗组 6 7例 ,内服甲氰咪胍 0 .2ｇ,4次 /ｄ ,每日晚外用 0 .1%维甲酸软膏 1次 ,白天外用肽丁胺搽剂 4次 /ｄ ,外用时注意用牙签仔细蘸药涂于患处。对照组 5 0例 ,内服吗啉胍 0 .2ｇ,3次 /ｄ ;同时外用病毒唑注射液 4次 /ｄ ,两组疗程均为 1个月 ,治疗期间停用…     

脊髓灰质炎混合多价糖丸活疫苗治疗扁平疣120例疗效观察

一般资料　 15 0例扁平疣患者均为门诊病人 ,分治疗组和对照组。治疗组 12 0例 ,男 48例 ,女 72例 ,年龄 11～ 70岁 ,其中 17～ 2 9岁 112例 ,姐弟同患 2例 ,病程 2个月～ 9年。对照组3 0例 ,男 12例 ,女 18例 ,年龄 15～ 40岁。病程 3个月～ 4年。治疗方法　治疗组用中国医学科学院、医学生物学研究所出品 ( 87)卫药准字号第Ｓ昆 ( 2 ) 0 1号的脊髓灰质炎混合多价糖丸活疫苗治疗。用法 :11～ 17岁患者每周口服 1次 ,每次 4粒 ,连续 3周为 1疗程 ,18岁以上每周口服 1次 ,每次 5粒 ,连服 3周为 1疗程。凡发热、急性传染病、佝偻病、免疫缺陷…     

高频电灼术联合口服甘露聚糖肽外用干扰素凝胶治疗尖锐湿疣疗效观察

目的:观察高频电灼术联合甘露聚糖肽外用干扰素凝胶治疗尖锐湿疣的疗效。方法:将75例尖锐湿疣患者随机分为两组。两组病人均采用高频电灼术去除皮损。之后,治疗组口服甘露聚糖肽20ml/d,一个月为一疗程,对照组肌注干扰素100m一次/qod,15次为一个疗程。两组患者术后伤口愈合后外涂干扰素凝胶4次/d,共8周,术后观察3个月后评价疗效。结果:治疗组治愈率88.10%,复发率11.90%;对照组治愈率90.91%,复发率9.10%。经统计学处理无显著性差异(P0.05),治疗组和对照组不良反应分别为7.14%,51.5%。经统计学处理有非常显著性差异(P0.005)。结论:高频电灼术联合口服甘露聚糖肽外用干扰素凝胶治疗尖锐湿疣治愈率高,复发率低,不良反应少。     

肉芽肿性口周皮炎二例

报告2例肉芽肿性口周皮炎。例1男,6岁。面部红斑、丘疹5个月就诊。曾外用糖皮质激素软膏后皮疹渐增多。例2女,28岁。口周、鼻周红斑、小丘疹2个月余就诊。2例均表现为面部腔口周围直径1—3mm大小的淡红色坚实小丘疹,皮损组织病理检查：真皮毛囊周围上皮样细胞肉芽肿改变。结合临床表现及组织病理学检查,2例均确诊为肉芽肿性口周皮炎。例1口服琥乙红霉素颗粒200mg/次,每日4次、1％克林霉素凝胶和0．03％他克莫司软膏外用,治疗2个月后皮疹完全消退,1个月后口周皮疹又复发。例2在行组织病理活检后皮疹自行消退,提示本病具有临床自愈倾向。     

肉芽肿性口周皮炎二例

报告2例肉芽肿性口周皮炎.例1男,6岁.面部红斑、丘疹5个月就诊.曾外用糖皮质激素软膏后皮疹渐增多.例2女,28岁.口周、鼻周红斑、小丘疹2个月余就诊.2例均表现为面部腔口周围直径1 ～3mm大小的淡红色坚实小丘疹,皮损组织病理检查:真皮毛囊周围上皮样细胞肉芽肿改变.结合临床表现及组织病理学检查,2例均确诊为肉芽肿性口周皮炎.例1口服琥乙红霉素颗粒200 mg/次,每日4次、1％克林霉素凝胶和0.03％他克莫司软膏外用,治疗2个月后皮疹完全消退,1个月后口周皮疹又复发.例2在行组织病理活检后皮疹自行消退,提示本病具有临床自愈倾向.     

艾拉光动力疗法联合薏翘颗粒治疗手部多发寻常疣1例

报告1例双手指远端及甲周多发性寻常疣患者。该患者在院外反复多次行冷冻或外用腐蚀性药物等方法治疗,皮疹逐渐增多,由手指远端皮肤延及甲周。来我院就诊后采用艾拉光动力疗法(ALA-PDT)联合口服薏翘颗粒治疗,光动力治疗1次/周,共3次,口服薏翘颗粒1服/d,治疗1个月后,皮疹显著缩小,逐渐脱落至完全清除。治疗后随访3个月,皮疹未复发;于治疗前后行皮肤镜检查,结果显示治疗后疣体清除干净。提示对特殊部位及较为广泛的寻常疣,且常规治疗方法疗效不显著的患者,艾拉光动力治疗是比较有效的治疗手段,同时可以口服中药薏翘颗粒辅助治疗。     

火针、中药面膜联合外用咪喹莫特乳膏治疗扁平疣疗效观察

目的探讨火针、中药面膜联合咪喹莫特乳膏治疗扁平疣的临床疗效及安全性。方法 95例患者,采用序号随机分为2组,治疗组49例火针治疗后,第2天外敷中药面膜,3次/周,并隔日晚上外涂咪喹莫特乳膏;对照组46例外敷中药面膜,3次/周,并隔日晚上外涂咪喹莫特乳膏。结果治疗8周后,治疗组的痊愈率(49.0%)和有效率(85.7%)均高于对照组的17.4%和52.2%,(χ~2=10.6,12.58;P0.01);痊愈和显效患者随访3个月,治疗组和对照组复发率分别为7.7%和54.17%(χ~2=18.39,P0.01)。结论火针、中药面膜联合咪喹莫特乳膏治疗扁平疣疗效佳,不良反应少,复发率低,安全可靠。     

Reactional states and neuritis in multibacillary leprosy patients following MDT with/without immunotherapy with Mycobacterium w antileprosy vaccine

A vaccine based on autoclaved Mycobacterium w was administered, in addition to standard multidrug therapy (MDT), to 157 untreated, bacteriologically positive, lepromin negative multibacillary leprosy patients, supported by a well matched control group of 147 patients with similar type of disease, who received a placebo injection in addition to MDT. The MDT was given for a minimum period of 2 years and continued until skin smear negativity, while the vaccine/placebo was given at 3-monthly intervals up to a maximum of eight doses. The incidence of type 2 reaction and neuritis during treatment and follow-up showed no statistically significant difference in the vaccine and placebo groups. The incidence of type 1 reaction (mild in most cases), however, was higher in the vaccine group (P = 0.041, relative risk ratio 1.79), considering LL, BL and BB leprosy types together, and considerably higher (P = 0.009) in LL type, probably because of confounding due to higher number of patients with previous history of reaction in this group. The occurrence of reactions and neuritis in terms of single or multiple episodes was similar in the vaccine and placebo groups. The association of neuritis and reactions, as well as their timing of occurrence (during MDT or follow-up), was also similar in the two groups, with more than 90% of occurrences taking place during MDT. The incidence of reversal reaction was significantly higher among the males in the vaccine group (34.5% versus 8.3%, P = 0.019). Patients with high initial BI (4.1-6.0) showed higher incidence of reactions (70.3%) as compared to those with medium (2.1-4.0) and low (0.3-2.0) BI where the reactions were observed with a frequency of 56.1% and 38.8%, respectively. However, unlike reactions, neuritis incidence did not seem to be affected by initial BI to the same extent in the vaccine group, with frequencies of 35.3%, 36.3% and 25.9% in the three mentioned BI ranges. Overall, the vaccine did not precipitate reactional states and neuritis over and above that observed with MDT alone.     

Mycobacterium w vaccine, a useful adjuvant to multidrug therapy in multibacillary leprosy: a report on hospital based immunotherapeutic clinical trials with a follow-up of 1-7 years after treatment

A vaccine based on autoclaved Mycobacterium w was administered, in addition to standard multidrug therapy (MDT), to 156 bacteriologically positive, lepromin negative multibacillary leprosy patients compared to a well matched control group of 145 patients with a similar type of disease who received a placebo injection in addition to MDT. The MDT was given for a minimum period of 2 years and continued until skin smear negativity, while the vaccine was given at 3-month intervals up to a maximum of eight doses. The fall in clinical scores and bacteriological indices was significantly more rapid in vaccinated patients, from 6 months onward until years 2 or 3 of therapy. However, no difference was observed in the fall in bacteriological index in the two groups from year 4 onwards. The number of LL and BL patients released from therapy (RFT) following attainment of skin smear negativity, after 24-29 months of treatment was 84/133 (63.1%) in vaccinated and 30/120 (25.0%) in the placebo group; the difference was highly statistically significant (P < 0.0001). In all, 90.2% patients (146/162) converted from lepromin negativity to positivity in the vaccine group, as against 37.9% (56/148) in the placebo group. The average duration of lepromin positivity maintained following eight doses of vaccine administered over 2 years was 3.016 years in the vaccine and 0.920 years in the placebo group. Histological upgrading after 2 years of treatment in the LL type was observed in 34/84 (40.5%) cases in the vaccine and 5/85 (5.9%) cases in the placebo group, the difference being statistically significant (P < 0.001). The incidence of type 1 reactions was significantly higher (30.5%) in the vaccine group than (19.7%) in the placebo group (P = 0.0413); the difference was mainly observed in LL type (P = 0.009). The incidence of type 2 reactions was similar (31.8 and 34.6%) in vaccine and placebo groups. The vaccine did not precipitate neuritis or impairments over and above that encountered with MDT alone. After 5 years of follow-up following RFT, no incidence of bacteriological or clinical relapses was observed in both groups.     

生物反馈放松疗法治疗寻常型银屑病疗效评价

目的:评价生物反馈放松疗法治疗寻常型银屑病的临床疗效。方法:364例寻常型银屑病患者随机分为治疗组和对照组,各182例。对照组给予维A酸治疗,治疗组在对照组基础上进行生物反馈放松疗法。8周后比较两组患者的疗效及不良反应发生率。结果:两组治疗后相比,治疗组PASI和DLQI评分显著低于对照组(P<0.05);治疗组的有效率为67.05%明显高于对照组的37.36%(P<0.05);研究组不良反应发生率明显低于对照组。结论:生物反馈放松疗法对寻常型银屑病有显著疗效。     

Bacillus Calmette‐Guerin polysaccharide nucleic acid vs Bacillus Calmette‐Guerin vaccine in the treatment of warts: A comparative,double‐blind,controlled study

Bacillus Calmette‐Guerin polysaccharide nucleic acid (BCG‐PSN) is a relatively new generation, bacteria lipopolysaccharide fraction extracted from BCG vaccine. It has a strong immunomodulatory effect with higher efficacy and fewer side effects. To assess the clinical efficacy and safety of BCG‐PSN vs the viable BCG vaccine in treatment of multiple warts. One hundred twenty patients with warts were allocated into three groups each containing 40 patients. Each group received intralesionally 0.1 mL of BCG‐PSN, BCG vaccine, saline in group A, B, and C, respectively, for a maximum of five sessions, 3 weeks apart. Complete response occurred in 77.5% of group A vs 63.8% in group B. Partial response detected in 7.9% of control group (P < .0001). The distant warts showed 72.5% complete clearance in group A compared to 58.3% in group B (P = .19). Group A showed fewer number of sessions (P = .03) and earlier response than group B (P = .0003). A significant increase in the frequency of adverse effects was found among group B than group A (P < .0001). No recurrence was seen in both groups. BCG‐PSN immunotherapy has a higher therapeutic efficacy with almost no serious side effects compared to the BCG vaccine in warts therapy.     

Treatment of the depressed and dysmorphophobic acne patient

Sixteen patients with minimal facial acne but with symptoms of dysmorphophobia related to their acne were treated with isotretinoin, 0.5 mg/kg/day, (n = 5); 1 mg/kg/day (n = 11) for 16 weeks. All 16 had previously received long-term antibiotic therapy with no 'perceived' improvement in their acne. Formal psychiatric assessment was not possible through lack of cooperation. Fourteen of 16 patients derived benefit from isotretinoin therapy in that all 14 were subsequently satisfied with the cosmetic results achieved. However, the incidence of relapse was greater than that for a control group, 14 requiring additional therapy in the form of antibiotics or further isotretinoin (seven patients) within 20 months of completing the original course. Patients with acne and dysmorphophobia represent an important group of patients who benefit from treatment with isotretinoin; if possible this should be in conjunction with psychotherapy.     

Immunizations in immunocompromised patients: a guide for dermatologists

The increasingly frequent use of immunomodulatory agents in dermatology requires the observance of specific recommendations for immunization. These recommendations are developed and regularly updated by the German Standing Committee on Vaccination (STIKO), an independent advisory group at the Robert Koch Institute. Dermatological patients on immunosuppressive treatment should ideally receive all vaccinations included in the standard immunization schedule. Additionally, it is recommended that they also undergo vaccination against the seasonal flu, pneumococci, and herpes zoster (inactivated herpes zoster subunit vaccine for patients ≥ 50 years). Additional immunizations against Haemophilus influenzae type B, hepatitis B and meningococci may be indicated depending on individual comorbidities and exposure risk. Limitations of use, specific contraindications and intervals to be observed between vaccination and immunosuppression depend on the immunosuppressive agent used and its dosing. Only under certain conditions may live‐attenuated vaccines be administered in patients on immunosuppressive therapy. Given its strong suppressive effect on the humoral immune response, no vaccines – except for flu shots – should be given within six months after rituximab therapy. This CME article presents current recommendations on immunization in immunocompromised individuals, with a special focus on dermatological patients. Its goal is to enable readers to provide competent counseling and to initiate necessary immunizations in this vulnerable patient group.     

补中益气汤加味辅助电刺激生物反馈治疗气虚型盆底功能障碍性疾病的疗效分析

目的探讨补中益气汤加味辅助电刺激生物反馈治疗气虚型盆底功能障碍(PFD)性疾病的疗效和对其生活质量的影响。方法选取2017年2月至2018年8月达州市中西医结合医院治疗的256例气虚型PFD患者的临床资料作为研究对象,进行回顾性分析。根据治疗方案将患者分为研究组(n=131)和对照组(n=125)。对照组入院后均给予电刺激生物反馈治疗及凯格尔运动治疗法,研究组在对照组基础上加用补中益气汤辩证加减。对两组进行6个月的随访,比较两组疗效、盆底肌情况、生活质量、症状相关评分及阴道内细胞因子相关水平的差异,并采用多因素Logistic回归模型分析影响患者生活质量的相关因素。结果研究组治疗后与末次随访时治疗总有效率显著高于对照组,差异具有统计学意义(P<0.05);研究组治疗后及末次随访时UDI-7、PFDI-20及PFIQ-7评分较对照组均显著较低,差异具有统计学意义(P<0.05);研究组末次随访时TGF-β1及TIMP-2较对照组显著升高,MMP-2较对照组显著下降,差异具有统计学意义(P<0.05);多因素Logistic回归分析结果显示,1次分娩史是导致患者治疗后生活质量无显著改善的危险因素,而中药辅助治疗是保护因素。结论补中益气汤辅助电刺激生物反馈疗法治疗气虚型PFD患者,可以有效改善患者盆底功能,提升疗效,改善患者生活质量。     

Regular sweating activities for the treatment of cholinergic urticaria with or without acquired idiopathic generalized anhidrosis

Cholinergic urticaria (CholU) decreases affected individuals' quality of life because they must avoid stimuli including exercise and hot bathing. Although case reports have indicated that regular sweating activities are effective for CholU with hypohidrosis, little evidence is available. This retrospective medical record review examined CholU patients who received any form of treatment at our hospital. Twenty‐seven cases (78% men; median age 22 years, range 12‐70 years) were analyzed. Fourteen (52%) patients had acquired idiopathic generalized anhidrosis (AIGA). Among the 12 patients receiving sweating therapy (4 with, 8 without AIGA), improvement of symptoms was confirmed in 11 (92%; sweating therapy alone: n = 5, with H1 blocker: n = 5, with steroid pulse: n = 1) including 8 (67%) showing complete response (CR). In this sweating‐therapy group, CR was achieved by six of the eight (75%) patients without AIGA and two of the four (50%) patients with AIGA. Among the 15 patients without sweating therapy, symptom improvement was observed in 9 (60%; steroid pulse: n = 7, H1 blocker: n = 2) including 1 (7%) achieving CR. Sweating therapy was safely undertaken except in one case in which the patient showed angioedema and anaphylaxis. Regular sweating activities could be a potential therapeutic option for CholU patients.     

A comparison of the efficacy and safety of mupirocin cream and cephalexin in the treatment of secondarily infected eczema

The efficacy and safety of mupirocin calcium cream were compared with those of oral cephalexin in the treatment of secondarily infected eczema. In this multicentre, double-blind, double-dummy study, 159 patients with secondarily infected eczema (suitable for treatment with topical antimicrobials) and a total skin infection rating scale score of 8 or more were randomized to receive either topical mupirocin cream three times daily or oral cephalexin, 250 mg four times daily, for 10 days (intent-to-treat group). Clinical success (per-protocol group), defined in part as a patient with a response of improvement in the skin infection rating scale, was similar in the two groups: 89% for mupirocin (n = 44) and 82% for cephalexin (n = 38) [P = 0.29; 95% confidence interval (-8.4%, 22.5%)]. Bacteriological success (intent-to-treat group), defined as a patient with a response of eradication, improvement or colonization of bacteria at the end of therapy, however, was significantly higher for mupirocin [50% and 28% in the mupirocin (n = 48) and cephalexin (n = 47) groups, respectively; P=0.005]. Mupirocin cream was as well tolerated as cephalexin; 9% and 13% of patients reported adverse events related or possibly related to study medication in the mupirocin and cephalexin groups, respectively. The most common adverse events overall were diarrhoea and nausea. Mupirocin cream applied three times daily is as effective clinically and superior bacteriologically compared with oral cephalexin given four times daily in the treatment of secondarily infected eczema of limited depth and severity. Mupirocin cream is as well tolerated as oral cephalexin, and more patients prefer the topical regimen, which should improve patient compliance.     

咪唑斯汀两种服药方法治疗慢性荨麻疹疗效及控制复发临床观察

目的观察咪唑斯汀缓释片两种服药方法治疗慢性荨麻疹及控制复发的效果。方法107例慢性荨麻疹患者随机分为两组,A组48例,必要时口服咪唑斯汀,服药剂量24h不超过10mg;B组59例,连续服用咪唑斯汀,10mg／d,共观察8周。在治疗前、治疗后1、2、4、8周及停药后第3d、1周、2周对两组患者的症状和体症进行评分。结果两组患者在治疗期间,总体症状控制早期B组优于A组,但随着时间推移,差距逐渐缩小,且对控制瘙痒症状差异不显著。在控制复发方面,1周后两组无明显差异。结论治疗慢性荨麻疹以控制瘙瘁为主,必要时采取口服咪唑斯汀可减少用药次数、用量和不良反应的发生。