日光性黑子的治疗进展

日光性黑子的治疗主要分为物理治疗和局部药物治疗。物理治疗包括冷冻、激光、强脉冲光和化学剥脱术,治疗成功率高,时间短,但也伴随着一定的不良反应和复发率。局部药物治疗包括氢醌、维甲酸、阿达帕林、对甲氧酚和维甲酸混合制剂。局部药物治疗的疗程比物理治疗时间长,但能取得更好的疗效。本文对其治疗进展进行了综述。     

复发性尖锐湿疣的评判与综合治疗

本文阐述了尖锐湿疣的相关概念,尝试提出复发性尖锐湿疣的标准,并对复发性尖锐湿疣的物理治疗、手术治疗、药物治疗等综合治疗措施作一综述.希望能为医务人员减少尖锐湿疣的复发,提高治愈率提供一定的参考.     

儿童尖锐湿疣的流行病学及治疗的研究进展

尖锐湿疣是人乳头瘤病毒所引起的性传播疾病.近年来,儿童患病的报道有所增加,其传播途径多样,不能忽略性虐待的可能,儿童感染人乳头瘤病毒类型及临床表现有别于成年人.儿童尖锐湿疣的治疗主要包括物理治疗、手术治疗、局部药物治疗等.选择治疗方案需要充分考虑安全性、有效性及耐受性,目前尚无美国食品药品监督管理局批准的可用于治疗＜ 12岁儿童尖锐湿疣的药物.     

硬化性萎缩性苔藓在某些研究方面的进展

硬化性萎缩性苔藓(LSA)临床上少见,多见于成年女性,皮损好发于外阴部。近年来报告儿童发生 LSA 并不少见,Chalmers 报告在100例因包皮疾病而作选择性环切的男孩中,有14例是 LSA。LSA 的病因和发病机理还不清楚,可能是多因素的,许多证据表明,遗传、性激素和自身免疫是 LSA 发病的三大因素。下面就近年来的此三个因素的研究及治疗进展作一综述。     

硬化萎缩性苔藓并发局限性硬皮病1例并文献复习

目的探讨硬化萎缩性苔藓(LSA)并发局限性硬皮病(LoS)的临床表现、组织病理学特点及诊断,提高对本病的认识,更好地理解硬皮病的疾病谱。方法分析1例LSA并发LoS的临床表现及组织病理特点,复习相关文献并进行讨论。结果患者全身皮损进行性增多无痛痒5年余。2年前初次就诊时明确诊断为LSA,治疗后皮损仍进行性增多,且硬化。此次就诊时皮肤科检查:躯干、四肢散在或密集粟粒至黄豆大瓷白色、略带光泽的扁平丘疹,部分萎缩、硬化;四肢、左手足片状或带状暗红色硬化性斑,部分皮损上有瓷白色扁平丘疹。初次就诊时背部皮损组织病理检查结果显示符合LSA。此次就诊时左小腿皮损组织病理检查结果符合LSA并发硬皮病。结合临床表现和组织病理检查结果,诊断为LSA并发LoS。结论该例LSA并发LoS的患者临床过程、临床表现和组织病理学改变表明,硬皮病可能是谱系性疾病,或许可以认为LSA是浅表性硬皮病。     

银屑病的长期治疗和管理

总结了现阶段银屑病治疗过程中所采用的相对适用的药物、剂量、时间等高效安全方案,强调了银屑病患者心理特质及治疗依从性的重要性,分析了长期使用某种药物或治疗手段的可行性及相关的管理措施。探讨新研制药物和治疗手段的有效性和安全性,利用药理遗传学及新的评估方法筛选合适某种药物使用的银屑病患者,达到有效治疗、经济安全的目的。展望在不远的将来成立包括疾病教育、患者自身行为管理、药物治疗、物理治疗和精神情绪疏导等一揽子方案的银屑病治疗中心。     

化脓性汗腺炎的治疗

化脓性汗腺炎虽少见,但病程慢性、治疗困难,往往给患者造成较大的痛苦。本文对本病的传统和最新的各种治疗方法,如长期应用抗菌药物、维甲酸、抗雄性激素药物、物理治疗、外科手术和生物制剂等作了介绍,以备临床医师参考。     

新书摘要

20062913皮肤病性病药物治疗指南/胡晓军,王士力.-北京:人民卫生出版社,2005.-406页;大32开:406千字系统地阐述了常见皮肤病、性病的药物治疗方案及用药进展,包括病毒性、细菌性、真菌性、动物性、物理性、鳞屑性、大疱性、血管性、色素性、角化性、代谢性皮肤病和性传播疾病等     

抗病毒药物联合黄柏液治疗带状疱疹疗效观察

目的比较抗病毒药物联合物理疗法与单纯抗病毒药物治疗带状疱疹的疗效。方法将64例患者按就诊顺序随机分为两组,治疗组32例,在抗病毒药物更昔洛韦治疗的同时配合复方黄柏液冷湿敷物理治疗;对照组32例仅给予抗病毒药物更昔洛韦治疗,疗程均为7天,进行疗效观察。结果联合用药组在止痛、结痴、缩短病程方面均优于单用更昔洛韦组（P〈0．01）。两组疗效比较,差异有显著性（P〈0．01）。结论联合用药组效果优于对照组,且临床症状、体征消失早,能缩短疗程,差异有显著性。抗病毒药物联合物理疗法治疗带状疱疹疗效好,值得临床推广应用.     

干扰素与尖锐湿疣的复发与防治

尖锐湿疣是我国最常见的性传播疾病之一.传统的治疗方式包括局部药物治疗、局部物理治疗、光动力,这些方法被用于消除疣体.这些疗法复发率高,因为其不能完全根除残留在邻近上皮黏膜中的潜伏的人乳头瘤病毒.干扰素属于免疫治疗,是一种新型抗病毒方式,前景广阔.干扰素联合传统疗法治疗尖锐湿疣有助于减少复发率.本文主要对干扰素的作用机制...     

Lichen sclerosus et atrophicus following radiation therapy

Several years after postmastectomy radiation therapy, lichen sclerosus et atrophicus (LSA) developed in two patients within the radiation fields. This sequence, to our knowledge, has not previously been described. The etiology of LSA is largely unknown, but trauma has been implicated as a provoking factor in some cases, and LSA might be an isomorphic response to the trauma of radiation therapy.     

Extragenital lichen sclerosus et atrophicus mimicking cutaneous T‐cell lymphoma: report of a case

Early lesions of lichen sclerosus et atrophicus (LSA) may present as a mild lichenoid tissue reaction, occasionally together with basilar epidermotropism, mimicking early cutaneous T‐cell lymphoma, mycosis fungoides (MF) variant. We report a case of extragenital LSA in which both histological patterns were present in the same clinically homogenous and stable lesion. A 27‐year‐old man presented with a history of white atrophic plaques on the trunk. A biopsy of an abdominal lesion revealed epidermal thinning, a superficial perivascular lymphoid cell infiltrate with focal epidermotropism, mild nuclear atypia and perinuclear halos. Immunophenotyping showed decreased CD5 and CD7, with a slight predominance of CD8‐positive T‐lymphocytes. All these changes were suggestive of MF. However, a repeat biopsy 3 months later from the same stable plaque revealed features diagnostic of LSA. LSA mimicking early MF histologically has been reported in genital skin. Conversely, MF may clinically and histopathologically resemble LSA. With gene rearrangement studies, clonal proliferation may not be detected in early MF but has been reported to occur in LSA. Awareness of the histopathologic spectrum of LSA within a stable plaque is important to avoid a potential diagnostic pitfall, and should prompt a repeat biopsy. Suchak R, Verdolini R, Robson A and Stefanato CM. Extragenital lichen sclerosus et atrophicus mimicking cutaneous T‐cell lymphoma: report of a case.     

Lichen sclerosus et atrophicus in a surgical scar treated with fractional laser

Lichen sclerosus et atrophicus (LSA) is a chronic inflammatory disease of unknown cause that typically affects the genital area (1). It has been reported in post-traumatic areas as a result of Koebner phenomenon. LSA responds poorly to treatment making it a therapeutic challenge (2). Laser therapy has been described for LSA with variable results (3,4).     

Penile lichen sclerosus et atrophicus treated with clobetasol dipropionate 0.05% cream: a retrospective clinical and histopathological study

BACKGROUND: Treatment with clobetasol propionate 0.05% cream is effective against lichen sclerosus et atrophicus (LSA) of the vulva. OBJECTIVE: The purpose of this study was to retrospectively evaluate whether clinical and histologic responses to topical clobetasol can be accomplished in penile LSA. METHODS: A self-assessment questionnaire was obtained from 22 men with LSA, and a clinical examination was performed in 21 of them. Biopsy specimens from 15 cases were compared before and after treatment. RESULTS: Itching, burning, pain, dyspareunia, phimosis, and dysuria decreased significantly (P < .001 to .05) after 1 to 2 daily applications, for a mean of 7.1 weeks (2-16 weeks). Additional operation for phimosis was required in 6 of the 22 men. All histologic LSA criteria were significantly (P < .01 to .05) reduced after treatment. CONCLUSION: Topical treatment of penile LSA with clobetasol propionate represents a safe and effective therapy with no risk of epidermal atrophy but with some potential for triggering latent infections, most importantly human papillomavirus.     

A Case of Generalized Lichen Sclerosus et Atrophicus

A 62-year-old female, with previous history of asthma and hypertension, presented with generalized hyperpigmented skin lesion, found a year ago. Physical examination revealed brown colored lichenified and sclerotic patches on the lower abdomen and flexural areas of extremities. Punch biopsy was performed and histopathological examination revealed hyperkeratosis, follicular plugging and thinning in epidermis. In dermoepidermal junction, cleft like space separating atrophic epidermis and dermis was seen. Also, lichenoid lymphocytic infiltration was observed in mid-dermis. Based on clinical and histopathological findings, a diagnosis of generlaized lichen sclerosus et atrophicus (LSA) was made. Other laboratory examinations were unremarkable. As there is no standard treatment for LSA, the patient received various treatments including topical steroid, tacrolimus and narrow-band ultraviolet B therapy. The skin lesion has softened and its color improved after treatment. LSA is defined as infrequent chronic inflammatory dermatosis with anogenital and extragenital manifestations. Generalized type is rare and genital involvement is the most frequent and often the only site of involvement. We report this case as it is an uncommon type of LSA with generalized hyperpigmented and sclerotic skin lesion in a postmenopausal female patient.     

The histologic spectrum of prepuces from patients with phimosis

Histologic examination of the prepuces removed from 78 consecutive patients with phimosis was performed during a 2-year period. In 15 cases (14.2%), the typical changes of lichen sclerosus et atrophicus (LSA) were found. A different, distinct histologic pattern of fibrosis was noticed in six patients (7.7%). Clinically, the two conditions were indistinguishable and presented as severe, nonretractable phimosis. The largest group of the patients (46.2%) had histologically normal prepuces, but clinically they too had severe phimosis. Since phimosis especially in young boys may regress spontaneously, and since on the other hand LSA may evolve into squamous cell carcinoma, we conclude that treatment of phimosis should be planned according to its histologic pattern and not according to its monotonous clinical appearance.     

Therapy of psoriasis in childhood and adolescence ‐ a German expert consensus

Psoriasis of childhood shows an annual prevalence of 0.71 % and accordingly has to be regarded as a frequent chronic inflammatory skin disorder of this age. The impact on the quality of life as well as development of the afflicted children and their parents is evident. On the other side, therapy is demanding with regard to the specific juvenile metabolism, physical development and skin penetration of topical drugs. Long‐term treatment at an early age has to be critically judged regarding the chronicity of the disease. Topical corticosteroids, alternatively dithranol may be used first‐line, followed by vitamin D derivatives. A combination with UV‐light, preferably UV‐B, has to be decided on an individual basis. Systemic treatment may be initiated in recalcitrant disease with methotrexate and cyclosporine where long‐term experience is available from juvenile rheumatology and transplantation medicine. Alternatively fumaric acid esters or retinoids are available. Rehabilitation procedures will help the children and their parents to cope with the disease and its treatment. The different treatment options are presented here as a German expert consensus, as clinical studies are hardly available and only a few therapeutics are licensed for this age. In any case the therapy has to be individually planned and decided together with the patients and their parents to gain maximal safety, comfort and success.     

Effects of low dose ultraviolet A-1 phototherapy on morphea

AIM: The effects of low dose ultraviolet A-1 (UVA-1) phototherapy on different clinical stages of morphea (localized scleroderma) were analyzed in this case study. Based on these data, the different types of phototherapy described in the literature and currently used for treatment of morphea are compared. METHODS: Three patients with severe plaque type morphea in different stages were studied: one patient with late-stage lesions having stable sclerotic plaques; another patient with active inflammatory lesions; and a third patient with late-stage lesions associated with overlying lichen sclerosus et atrophicus (LSA). The treatment given was low dose UVA-1 phototherapy with single doses of 20 J/cm2 administered four times a week for 6 weeks, and once a week for another 6 weeks. RESULTS: Following UVA-1 phototherapy, the sclerotic plaques resolved, leaving smooth and soft tanned skin with normal structure, consistency and folding capability. In morphea with overlying LSA the elastic fibers did not completely return to the superficial papillary dermis despite the clinical clearance of both morphea and LSA. These data suggest that low dose UVA-1 phototherapy may improve, but not completely reverse, the histopathological changes of LSA. No side effects were observed during or after treatment. CONCLUSION: Our observations show in three patients that low-dose UVA-1 phototherapy is highly effective for treatment of all stages of morphea, including early inflammatory and late sclerotic lesions, and morphea with overlying lichen sclerosus et atrophicus. Because of its safety and efficacy, low dose UVA-1 phototherapy appears to be the treatment modality of choice.     

着色芽生菌病的治疗进展

着色芽生菌病是暗色真菌引起的感染性疾病中最为常见的一种。患者多是通过外伤将病原菌接种于机体而导致皮肤及皮下感染。该病治疗困难且易复发,至今仍无治疗的金标准。目前多采用手术疗法、物理疗法(CO_2激光、冷冻治疗)、化学疗法及联合疗法等,光动力、免疫调节剂等新的治疗手段和方法也应用于临床。本文就目前该病的治疗进展进行综述。