皮脂腺及皮下脂肪疾病

20063209青春期后痤疮严重程度影响因素的调查分析/李亚娟(广东佛山市南海区松岗医院皮肤科),郭庆,曾凡钦∥中国中西医结合皮胜性病学杂志.-2006,5(2).-66~69对187例患者进行问卷调查,部分患者进行血清性激素水平的检测,肾上腺和卵巢的B超检查,细菌培养及耐药性试验。结果:男性、阳性家族史、油性皮肤、嗜食油腻者、经常便秘者、工作压力较大者、伴发脂溢性皮炎者的痤疮较严重;痤疮的严重程度随着年龄的增长而减轻(P<0·1)。62·5%(20/32)患者雄激素水平升高(P<0·05),6·49%(5/77)女患者合并了多囊卵巢。细菌培养的分离率由高到低依次为…     

寻常痤疮与正常人皮肤微生物的对比

目的探讨寻常痤疮与正常人皮肤表面微生物的差异及细菌耐药性问题,为痤疮的病原学研究及痤疮的抗生素治疗提供科学的理论依据。方法对寻常痤疮面部皮损内容物及正常人面部皮肤表面进行细菌培养、分离及鉴定。对培养出细菌分别进行体外抗生素药物敏感试验。结果 137例寻常痤疮面部皮损中细菌总检出率高于89例正常人面部皮肤。144例寻常痤疮中有137例面部皮损中分离出细菌306株(阳性率95.14%)。主要是痤疮丙酸杆菌102株(33.33%)、表皮葡萄球菌95株(31.05%)。96例正常人中有89例面部皮肤表面分离出223株细菌(阳性率92.71%)。主要是痤疮丙酸杆菌67株(30.04%)、表皮葡萄球菌44株(19.73%)。寻常痤疮及正常人皮肤表面均未分离出念珠菌;痤疮丙酸杆菌对抗生素的耐药率寻常痤疮患者高于正常人,耐药率前2位为:甲硝唑,克林霉素;表皮葡萄球菌对抗生素的耐药率寻常痤疮患者高于正常人。耐药率前5位依次为青霉素、红霉素、克林霉素、复方新诺明、苯唑西林。结论寻常痤疮皮损中主要细菌是以痤疮丙酸杆菌及表皮葡萄球菌混合感染常见。治疗寻常痤疮时应避免使用甲硝唑、青霉素、红霉素、克林霉素。可选择米诺环素、喹奴普汀、万古霉素、呋喃妥因。     

皮肤细菌感染440例患者的病原菌及药敏分析

目的:了解皮肤细菌感染的菌种分布特征及对常用抗菌药的敏感性,为指导临床用药提供依据。方法:收集2011—2012年天津市长征医院皮肤科住院患者常规细菌培养阳性结果共440例,记录其细菌培养及药敏结果。从而了解该院皮肤科患者的病种分布、细菌分布现状及耐药情况。结果:革兰阳性菌为主要致病菌且对红霉素、青霉素耐药率较高;革兰阴性球菌对左氧氟沙星和环丙沙星的耐药率较高;对亚胺培南和阿米卡星较敏感;金黄色葡萄球菌(SA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)二者的药敏结果存在差异,差异具有统计学意义(P0.05)。结论:皮肤科住院患者细菌培养的耐药问题较严重;通过药敏试验结果进一步了解患者病原菌的变化和耐药情况,并根据细菌的种类和耐药情况为进一步合理、准确地使用抗生素,指导临床个性化用药提供了一定的依据。     

痤疮患者痤疮丙酸杆菌对大环内酯类抗生素的敏感性分析

目的:了解广东省东莞地区痤疮患者痤疮丙酸杆菌对三种大环内酯类抗生素的敏感性情况。方法:采用质谱检测系统鉴定痤疮丙酸杆菌,琼脂稀释法测定痤疮丙酸杆菌对红霉素、阿奇霉素和克拉霉素的最小抑菌浓度(MIC)。结果:104例痤疮患者中分离出70株痤疮丙酸杆菌,对大环内酯类抗生素的耐药率从高到低依次为:阿奇霉素71.43%(50/70)、克拉霉素65.71%(46/70)、红霉素32.86%(23/70)。三种抗生素间存在交叉耐药。结论:东莞地区痤疮患者痤疮丙酸杆菌对大环内酯类抗生素有较高的耐药率并且存在交叉耐药,为该地区痤疮治疗的临床用药提供了借鉴。     

青春期前痤疮患者血清性激素水平测定及危险因素分析

目的分析青春期前痤疮患者血清性激素水平及发病因素。方法选取我院2016年4月~2018年3月收治的青春期前痤疮患者60例(男25例,女35例)作为研究对象,对血清性激素水平进行测定,另选取相应年龄段的正常青春前期群体50例(男21例,女29例)进行对照,比较血清性激素水平,分析青春前期痤疮患者发病因素。结果女性、男性青春期前痤疮患者游离睾酮、脱氢表雄酮同女性、男性对照者差异有统计学意义(P 0.05),睾酮、孕酮、黄体生成素、催乳素等指标差异无统计学意义(P0.05)。青春期前痤疮患者和正常青春期群体皮肤类型、遗传因素、睡眠习惯等方面差异有统计学意义(P 0.05);行Logistic多因素回归分析,家族遗传、睡眠不足、油性皮肤等是青春期前痤疮的独立危险因素。结论青春期前痤疮患者与正常青春期前群体血清性激素水平存在一定的差异。遗传、睡眠质量、皮肤类型等是影响青春期前痤疮发病的主要因素,因而需针对性地给予防治,减少青春期前痤疮的发生。     

痤疮患者的痤疮丙酸杆菌对大环内酯类和四环素类抗生素耐药性分析

目的了解痤疮患者的痤疮丙酸杆菌对三种大环内酯类抗生素和三种四环素类抗生素的药敏情况。方法采用MALDI-TOF MS鉴定痤疮丙酸杆菌,琼脂稀释法进行药敏试验。结果 212例痤疮患者中,分离出156株痤疮丙酸杆菌,对大环内酯类抗生素的耐药率从高到低依次为克拉霉素83.97%(131/156)、阿奇霉素48.72%(76/156)、红霉素30.13%(47/156),且三种抗生素间存在交叉耐药。156株痤疮丙酸杆菌对米诺环素、多西环素和四环素100%敏感。结论痤疮患者的痤疮丙酸杆菌对大环内酯类抗生素有较高的耐药率并且存在交叉耐药,对四环素类抗生素均敏感,这为本地区痤疮治疗临床用药提供了借鉴。     

寻常性痤疮严重度的影响因素分析

目的探讨寻常性痤疮严重度的影响因素。方法于2007年1～12月对本科门诊确诊为寻常性痤疮的1129例患者,由首诊医生向患者发放自制的流行病学调查问卷。调查内容包括13项:性别、年龄、皮肤类型、家族史、初发年龄、平时饮食喜好、每日洗脸次数、每日睡眠时间、平均每天使用电脑时间、有无便秘、哪些季节加重、女性患者月经初潮年龄、有无月经不规律。采用SAS Version8.1软件包进行χ2检验、单因素Logistic回归分析和多因素Logistic回归分析。结果单因素Logistic回归分析显示,与痤疮严重程度相关的5个因素依次为性别、痤疮初发年龄、每日洗脸次数、油性皮肤、季节。多因素Logistic回归分析结果显示与痤疮严重程度相关的依次是性别(P<0.0001)、初发年龄(P<0.05)、喜食咸味(P<0.05)、皮肤类型(P<0.05)。结论寻常性痤疮的严重程度与油性皮肤、喜食咸味明显相关;初发年龄越小,痤疮越严重;且男性患者皮损较女性患者更严重。     

女性痤疮患者卵泡期血清六项性激素水平的测定

目的探讨女性寻常痤疮患者体内性激素水平的改变。方法采用电化学发光免疫分析法对30例青春期女性痤疮患者及20例迟发性女性痤疮患者卵泡期血清六项性激素水平进行检测,并分别与相应年龄段的正常女性各15人作对照。结果女性青春期痤疮患者血清雌二醇水平明显低于同龄正常对照组(P<0.05);睾酮/雌二醇比值明显高于正常对照组(P<0.01);促卵泡素明显高于正常对照组(P<0.05);女性迟发性痤疮患者血清睾酮水平较相应年龄的正常对照组显著升高(P<0.05)。结论青春期女性痤疮发病的主要原因可能是由于雌激素分泌不足,使血清内睾酮水平相对增多所致。女性迟发性痤疮发病的主要原因则可能与雄激素分泌增多有关。     

524例青春期后女性痤疮患者的性激素和血脂分析

目的：检测青春期后女性痤疮患者血脂和性激素水平变化情况,探讨痤疮与性激素和血脂的关系。方法：收集青春期后女性寻常痤疮患者和健康对照者,检测BMI、甘油三酯、高密度脂蛋白、垂体泌乳素、促卵泡生成素、促黄体生成素、睾酮和硫酸脱氢表雄酮水平和盆腔超声。结果：共纳入524例青春期后女性痤疮患者（轻、中、重度痤疮分别为239例,207例和78例）及50名健康对照。轻、中、重度患者垂体泌乳素、雄烯二酮和硫酸脱氢表雄酮均显著高于健康对照者（P<0.05）。379例患者无多囊卵巢综合征（PCOS）,其中高雄烯二酮患者62例,雄烯二酮水平正常者317例。较雄烯二酮正常组,高雄烯二酮组垂体泌乳素、促黄体生成素、睾酮、硫酸脱氢表雄酮及高密度脂蛋白水平升高,甘油三酯水平降低（均P<0.05）。结论：青春期后女性痤疮患者易合并多种性激素异常,其中雄激素水平升高明显。     

双胎中遗传控制的皮脂分泌和痤疮的研究

有报道痤疮患者中82%至少有一个同胞有痤疮史,60%的患者其父母一方或双方患过痤疮。而同卵双胎者一方患痤疮则另一方几乎100%也患痤疮。作者对性别相同的20对同卵双胎(年龄14～16,年龄中位数15)和20对非同卵双胎的痤疮患者(年龄12～18岁,年龄中位数15)进行痤疮程度和皮脂分泌率的研究,并对结果进行了方差分析。发现同卵双胎者皮脂分泌率无显著差别,而痤疮的严重程度差别显著(P<0.01)。非同卵双胎者皮脂分泌率和痤疮程度的差别均很显著(P<0.01)。通过遗传学和种族的研究,提示遗传因素对痤疮易感性的重要性。同卵双胎者患痤疮的高度一致性也证实了这一观点。近来从皮脂成分的研究中     

女性青春期后痤疮临床分型与风险因素相关性研究

目的 探讨女性青春期后痤疮不同临床分型与相关风险因素之间的关联.方法 对2016年1-10月期间在我院皮肤科门诊就诊的25岁以上女性青春期后痤疮患者,通过问卷的方式调查相关风险因素,由皮肤科医生进行患者皮损评估、临床分型分级.采用SPSS21.0软件进行统计学处理.组间均数比较采用t检验,计数资料比较采用卡方检验.结果 312例女性青春期后痤疮患者参与调查,其中轻中度痤疮268例(85.9％),重度44例(14.1％);持续型241例(77.2％),迟发型71例(22.8％);粉刺型102例(32.7％),丘疹型210例(67.3％).相关风险因素调查发现,121例有季节加重因素,其中夏季加重者最多,有59例占18.9％;饮食加重因素中,辛辣刺激食物131例(42％),甜食93例(29.8％),油炸食物85例(27.2％);196例(62.8％)有经前期加重现象;心理因素加重者161例(51.6％);外源性化学物质接触加重者136例(43.6％).丘疹型患者饮食、月经前加重及便秘因素较粉刺型具有更高风险(x2值分别为4.523、4.068、3.910,均P＜0.05);而粉刺型较丘疹型以及迟发型较持续型患者与外源性化学物质接触如化妆品的使用、暴露于污染的空气中、职业相关有害物质接触等更加相关(x2值分别为6.579、9.057,均P＜0.05).此外,与迟发型相比,经前加重现象在持续型中更为显著(x2=4.512,P＜ 0.05).结论 女性青春期后痤疮发病风险因素复杂,月经前加重现象在丘疹型和持续型青春期后痤疮中较为明显,饮食、便秘在丘疹型中具有更高风险,但粉刺型及迟发型还应考虑外源性化学物质接触情况.在临床诊疗女性青春期后痤疮中应考虑其分型.     

Correlation between endocrinological parameters and acne severity in adult women

Many studies demonstrate increased androgen levels and high prevalence of polycystic ovaries in women affected by acne. We evaluated the relationship between clinical features, ultrasonographic data on polycystic ovaries and hormonal parameters in 129 women >17 years of age with acne. Serum levels of androgens of ovarian and adrenal origin were measured. Menstrual cycle regularity, hirsutism, body mass index and ultrasonographic evaluation of ovaries were recorded. Raised levels of at least one androgen were evident in a majority of our patients. Only 19% of them had polycystic ovary syndrome. Hirsutism and acne severity correlated negatively with serum sex hormone-binding globulin (SHBG) levels (p<0.05). No correlation between acne severity and hirsutism was found. In post-pubertal women, severity of acne seems to depend on peripheral hyperandrogenism, with a negative relationship between the acne severity and serum SHBG levels. We strongly recommend the evaluation of serum SHBG levels in women with acne in order to select patients who can have a better response to appropriate hormonal regimes.     

The role of androgens in determining acne severity in adult women

BACKGROUND: Although many arguments have been put forth supporting the role of androgens in the aetiology of acne, their part in determining the severity of the disease is not well established. OBJECTIVES: The aim of our study was to evaluate the relationship between acne severity and the clinical and laboratory markers of androgenicity in a large group of patients. METHODS: Ninety women over 17 years of age with acne were enrolled into the study. The levels of testosterone, androstenedione, dehydroepiandrosterone, dehydroepiandrosterone sulphate and sex hormone binding globulin (SHBG) were measured. Menstrual cycle regularity, hirsutism score, acne severity and ultrasound evaluation of polycystic ovaries were recorded. One-way analysis of variance, chi(2)-test and correlation analysis were used for data processing. RESULTS: Hirsutism was documented in 19 (21%) subjects, elevated levels of at least one androgen in 73 (81%) subjects, an irregular cycle was reported by 43 (48%) women, and polycystic ovaries were found in 45 (50%) women. The patients were divided into three groups according to acne severity. Acne was graded using the Leeds technique as minor in 43 (48%) cases, mild in 27 (30%) and moderate in 20 (22%). We did not demonstrate a positive correlation between the grade of acne severity and any of the clinical or laboratory markers of androgenicity assessed. On the contrary, women with a higher grade of acne severity showed lower values of the index of free testosterone, a lower hirsutism score and higher SHBG levels. CONCLUSIONS: Our study suggests that the severity of acne manifestation in adult women is not determined by androgen production.     

Post-adolescent acne: a review of clinical features

Acne is usually recognized as a disorder of adolescence. However, the referral of patients over the age of 25 years with acne has significantly increased over the past 10 years. The clinical features of 200 patients over the age of 25 years, referred to our department for treatment of acne. were evaluated with a view to establishing possible aetiological factors. There were 152 (76%) women and 48 (24%) men. The mean age of the patients was 35.5 years (range 25-55 years). The acne was mild or moderate in severity, consisting principlly of inflammatory lesion, with mean total acne grade (Leeds Grading Scale) of 1.125 for men and 0.75 for women. Most patients had persistent acne; but true late-onset acne (onset after the age of 25 years) was seen in 28 (18.4%) of women and four (8.3%) of men. Thirty-seven per cent of women had features of hyperandrogenicity. One hundred and sixty-four patients (82%) had failed to respond to multiple courses of antibiotics, and 64 (32%) had relapsed after treatment with one or more courses of isotretinoin. External factors, such as cosmetics. drugs and occupation, were not found to be significant aetiological factor. A family history revealed that 100 (50%) of patients had a first-degree relative with post-adolescent acne. Patients with post-adolescent acne appear to represent an increasingly important population of acne sufferers. External factors do not seem to have a significant aetiological role. Two main clinical groups were identified: those with persistent acne and those with late-onset acne. A minority of women also had features of hyperandrogenicity. These patients, and those with late-onset acne, may represent a subgroup who have underlying abnormalities of ovarian, adrenal or local androgen metabolism, and require separate investigation.     

Most women with acne have polycystic ovaries

Out of 98 female referrals with acne vulgaris it was possible to define ovarian morphology by high resolution ultrasound imaging of the pelvis in 82 (84%). Sixty-eight (83%) were shown to have polycystic ovaries, compared with 19% in a control group without acne. The presence of polycystic ovaries in the acne patients did not correlate with acne severity, infertility, menstrual disturbance, hirsutes, or biochemical endocrinological abnormalities.     

Clinical, ultrasound and hormonal markers of androgenicity in acne vulgaris

Androgenic stimulation of sebaceous glands is an important factor in the development of acne. We examined 36 females (aged 14-34 years), selected because none had received oral contraceptives, anti-androgen therapy, or systemic antibiotics during the previous year, or isotretinoin therapy, prior to their participation in the study. Subjects were divided into groups on the basis of acne severity, as follows: physiological, mild and moderate. Only two patients had polycystic ovaries on ultrasound examination. Seven patients had irregular menses; none had evidence of hirsutism. We found that the severity of acne, based on the acne grade, was highly correlated with the inflammatory lesion count, and less correlated with the sebum excretion rate. Either acne grade or inflammatory lesion count could be related to some of the five androgenic hormone determinants; free testosterone (TESTOS), δ4 androstenedione (DELTA 4), sex hormone binding globulin (SHBG), dehydroepiandrostenedione sulphate (DHEAS) and dihydrotestosterone (DHT). Multiple linear regression analysis determined the best model for predicting ACNE score as involving DELTA 4 and DHEAS (positive effects), and SHBG (negative effect), P < 0.005, R²= 0.36). In none of the patients were the levels of DHEAS or SHBG outside the normal range. The flndings in the two patients with polycystic ovaries did not differ signiflcantly from those in the remainder of the patients.     

Update and future of systemic acne treatment

Systemic treatment is required in patients with moderate-to-severe acne, especially when acne scars start to occur. Antibiotics with anti-inflammatory properties, such as tetracyclines (oxytetracycline, tetracycline chloride, doxycycline, minocycline and limecycline) and macrolide antibiotics (erythromycin and azithromycin) are the agents of choice for papulopustular acne, even though the emerging resistant bacterial strains are minimizing their effect, especially regarding erythromycin. Systemic antibiotics should be administered during a period of 8-12 weeks. In severe papulopustular and in nodulocystic/conglobate acne, oral isotretinoin is the treatment of choice. Hormonal treatment represents an alternative regimen in female acne, whereas it is mandatory in resistant, severe pubertal or post-adolescent forms of the disease. Compounds with anti-androgenic properties include estrogens combined with progestins, such as ethinyl estradiol with cyproterone acetate, chlormadinone acetate, desogestrel, drospirenone, levonogestrel, norethindrone acetate, norgestimate, and other anti-androgens directly blocking the androgen receptor (flutamide) or inhibiting androgen activity at various levels, corticosteroids, spironolactone, cimetidine, and ketoconazole. After 3 months of treatment control of seborrhea and acne can be obtained. Low-dose corticosteroids (prednisone, prednisolone, or dexamethasone) are indicated in patients with adrenal hyperandrogenism or acne fulminans. New developments and future trends represent low-dose long-term isotretinoin regimens, new isotretinoin formulations (micronized isotretinoin), isotretinoin metabolites, combination treatments to reduce toxicity, insulin-sensitizing agents, 5alpha-reductase type 1 inhibitors, antisense oligonucleotide molecules, and, especially, new anti-inflammatory agents, such as lipoxygenase inhibitors.     

Antibiotic resistance of microbial strains isolated from Korean acne patients

Over several decades, topical and systemic antibiotics have been the mainstay of treatment for acne vulgaris. The widespread and long‐term use of antibiotics in the treatment of acne has resulted in the spread of resistant bacterial strains and treatment failure. We aimed to examine the bacteriology of acne vulgaris and to evaluate its susceptibility to the antibiotics widely used for acne in Korea. We examined the species of bacteria aerobically and anaerobically isolated from 100 Korean acne patients. Among the bacteria isolated, Staphylococcus epidermidis (36 patients) was the most common, followed by Propionibacterium acnes (30 patients). Eleven strains of P. acnes (36.7%) and 25 strains of S. epidermidis (69.4%) were resistant to one or other of the antibiotics tested. A higher proportion of P. acnes isolates were resistant to clindamycin (30%) and erythromycin (26.7%), than to any other antibiotics tested (P = 0.0003). Some S. epidermidis isolates were resistant to tetracycline and doxycycline in addition to clindamycin and erythromycin. In the previous studies, few strains of P. acnes were found to be resistant to any of the antibiotics, but this study shows that antibiotic‐resistant strains have been increasing in Korea acne patients.     

Antibiotic-resistant acne: lessons from Europe

BACKGROUND: Propionibacterium acnes and P. granulosum are widely regarded as the aetiological agents of inflammatory acne. Their proliferation and metabolism are controlled using lengthy courses of oral and/or topical antibiotics. Despite numerous reports of skin colonization by antibiotic-resistant propionibacteria among acne patients, accurate prevalence data are available only for the U.K. OBJECTIVES: To determine the prevalence of skin colonization by antibiotic-resistant propionibacteria among acne patients and their contacts from six European centres. METHODS: Skin swabs were collected from 664 acne patients attending centres in the U.K., Spain, Italy, Greece, Sweden and Hungary. Phenotypes of antibiotic-resistant propionibacteria were determined by measuring the minimum inhibitory concentrations (MIC) of a panel of tetracycline and macrolide, lincosamide and streptogramin B (MLS) antibiotics. Resistance determinants were characterized by polymerase chain reaction (PCR) using primers specific for rRNA genes and erm(X), followed by nucleotide sequencing of the amplified DNA. RESULTS: Viable propionibacteria were recovered from 622 patients. A total of 515 representative antibiotic-resistant isolates and 71 susceptible isolates to act as control strains were characterized phenotypically. The prevalence of carriage of isolates resistant to at least one antibiotic was lowest in Hungary (51%) and highest in Spain (94%). Combined resistance to clindamycin and erythromycin was much more common (highest prevalence 91% in Spain) than resistance to the tetracyclines (highest prevalence 26.4% in the U.K.). No isolates resistant to tetracycline were detected in Italy, or in Hungary. Overall, there were strong correlations with prescribing patterns. Prevalence of resistant propionibacteria on the skin of untreated contacts of the patients varied from 41% in Hungary to 86% in Spain. Of the dermatologists, 25 of 39 were colonized with resistant propionibacteria, including all those who specialized in treating acne. None of 27 physicians working in other outpatient departments harboured resistant propionibacteria. CONCLUSIONS: The widespread use of topical formulations of erythromycin and clindamycin to treat acne has resulted in significant dissemination of cross-resistant strains of propionibacteria. Resistance rates to the orally administered tetracycline group of antibiotics were low, except in Sweden and the U.K. Resistant genotypes originally identified in the U.K. are distributed widely throughout Europe. Antibiotic-resistant propionibacteria should be considered transmissible between acne-prone individuals, and dermatologists should use stricter cross-infection control measures when assessing acne in the clinic.