中医温通方法结合308 nm准分子激光治疗斑秃的效果

目的 探究中医温通方法结合308 nm准分子激光治疗斑秃的效果。方法 收集2023年1月-2024年1月 齐齐哈尔市第一医院收治的斑秃患者69例,按照治疗方法不同分为火针联合3 0 8 nm准分子激光组 （A组）、火针组（B组）、308 nm准分子激光组（C组）,各23例,比较三组临床疗效、终毛密度、 脱发症状改善评分、皮肤病生活质量指数评分及不良反应发生率。结果 A组临床总有效率高于B组、 C组（P ＜0.05）;A组治疗后终毛密度高于B组、C组（P＜0.05）;A组脱发症状改善评分高于B组、C组,皮 肤病生活质量指数评分低于B组、C组（P＜0.05）;三组不良反应发生率比较,差异无统计学意义（P＞0.05）。 结论 中医温通治疗联合308 nm准分子激光治疗斑秃的疗效良好,可增加终毛密度,改善脱发症状,提升 患者生活质量,且具有较高的安全性。     

A 308-nm excimer laser for the treatment of scalp psoriasis

BACKGROUND AND OBJECTIVES: Scalp psoriasis is a frustrating disorder whose treatments can all too often be cumbersome and ineffective. Our objective was to test a combination device involving the 308-nm excimer laser in tandem with a hair blower for treating scalp psoriasis. STUDY DESIGN/MATERIALS AND METHODS: Adult subjects with scalp psoriasis unresponsive to class I topical steroids used in conjunction with medicated shampoos were treated with 308-nm excimer laser pulses in conjunction with a hair blower that parted the obstructing hair twice a week for up to 15 weeks. Half of the scalp served as a control. Starting doses were based on standard minimal erythema dose (MED)'s with subsequent increments of up to 20%. RESULTS: Thirteen subjects completed the study without adverse events. Two were dropped due to lack of compliance. At the end of the investigation, the difference in the mean modified PASI scores between the control and treated sites was 4.0 (<0.0001). CONCLUSIONS: The air blower device in conjunction with the 308-nm excimer laser can safely and effectively treat otherwise refractory scalp psoriasis.     

Treatment of alopecia areata with the 308-nm xenon chloride excimer laser: case report of two successful treatments with the excimer laser

BACKGROUND AND OBJECTIVES: Alopecia areata is a common disease of unknown etiology; it causes significant cosmetic and psycho-social distress for most of the people it affects. We report on an innovative form of treatment in two patients with typical alopecia areata on the capillitium. STUDY DESIGN/PATIENTS AND METHODS: We successfully treated two patients whose alopecia areata had worsened progressively for 3 and 14 weeks. The treatment involved the use of a 308 nm xenon chloride excimer laser (dosage 300-2,300 mJ/cm(2) per session). RESULTS: After 11 and 12 sessions within a 9-week and 11-week period, the entire affected focus showed homogenous and thick regrowth. No relapse was observed during the follow-up period of 5 and 18 months. CONCLUSIONS: The use of the excimer laser is an effective, elegant, and safe means of treatment and has good tolerability. Analogous to topical treatment of alopecia areata, the immunosuppressive mechanism of the excimer laser can be interpreted as an induction of T-cell apoptosis. This new means of treatment has yet to be discussed in medical literature. Further studies with greater numbers are needed to assess its potential more precisely and evaluate the excimer laser in treating alopecia areata.     

Optimal frequency of treatment with the 308-nm excimer laser for vitiligo on the face and neck

OBJECTIVES: This study was designed to determine the optimal treatment frequency with the 308-nm excimer laser for vitiligo and identify key clinical variable(s) associated with treatment efficacy at the optimal frequency. BACKGROUND DATA: Optimal clinical parameters for excimer laser treatment of vitiligo have not been fully determined. Data about the influence on treatment frequency of different clinical variables of vitiligo are needed to facilitate effective treatment regimens. METHODS: A total of 187 patients were treated with the 308-nm excimer laser for 20 sessions at different frequencies (0.5, 1.0, 2.0, and 3.0 per week). The repigmentation rate was graded on a six-point scale and was blindly evaluated by independent physicians. RESULTS: The final percentage of repigmentation for group 0.5 was statistically lower than those for group 1.0, 2.0, and 3.0, and percentages of final levels of repigmentation among these three groups were not statistically different. The clinical variables showed no statistical differences in the final repigmentation effect. Repigmentation occurred fastest with treatment frequencies of 2.0 and 3.0 and there was no statistically significant difference between them. The onset of repigmentation correlated with the area of vitiliginous patches treated, not with the other clinical variables. CONCLUSIONS: The 308-nm excimer laser is effective for therapy to treat vitiligo on the face and neck. The ultimate laser-induced repigmentation effect does not correlate with treatment frequency and repigmentation occurs faster with treatment frequencies of 2.0 and 3.0 than that of 1.0. It appears that the onset of repigmentation correlates with the total area of vitiliginous patches and the optimal treatment frequency. Monitored studies on a larger population with long-term follow-up would be needed to confirm and extend our findings.     

他克莫司软膏联合308nm准分子激光治疗儿童局限性白癜风

目的:本研究旨在评价0.03%他克莫司软膏和308 nm准分子激光治疗儿童局限性白癜风的安全性和有效性。同时研究308nm准分子激光联合外用0.03%他克莫司软膏对疗效的影响。方法:76个患者入组研究,研究采用随机单盲自身对照试验共15周。入组患者均具有两侧对称病变,进行左/右面部、躯干、手足的比较。按患者2至4个靶病变随机分为两组:A组患者外用0.03%他克莫司软膏,每天两次;B组患者外用0.03%他克莫司软膏每日两次,联合308nm准分子激光治疗,每周两次。研究期间对疗效和安全性因素进行评价。结果:76个患者完成了研究,A组91.3%和B组97.4%的皮损观察到复色。与治疗前相比,A组和B组皮损均明显改善。B组72.3%的皮损获得4级复色,与A组比较有显着性差异(P<0.05)。面颈部的复色率(复色75%以上)明显高于躯干、四肢、手足的复色率(P<0.05)。两组患者未见明显的副作用,两组之间的副作用发生率没有显著差异。结论:0.03%的他克莫司软膏和308 nm准分子激光对于治疗儿童局限性白癜风是安全、有效的,且耐受性良好。联合使用他克莫司软膏和308nm准分子激光显著提高疗效。     

Targeted phototherapy using 308 nm Xecl monochromatic excimer laser for psoriasis at difficult to treat sites

Psoriasis is a chronic inflammatory multisystem disease involving skin and joints affecting 1–3 % of the world population. The 308-nm excimer laser has been recently used in the treatment of psoriasis, especially localized psoriasis of scalp and palm and soles. The objective of the study is to evaluate the therapeutic efficacy and safety of a 308-nm excimer laser for the treatment of scalp and palmoplantar psoriasis. A total of 41 adult patients (25 males and 16 females) were enrolled in this study, of which 26 patients had lesions localized to scalp, and 15 patients had involvement of palm and soles. The mean age was 44.5 years (range 18–73). And, the mean duration of psoriasis in our patients was 15 years. They were treated with a 308-nm excimer laser. The initial dose was based on multiples of a predetermined minimal erythema dose, twice weekly for a maximum 12 weeks. Twenty-two of the 23 patients with scalp psoriasis showed improvement, while one patient showed no change; none experienced worsening of symptoms. The mean minimal erythema dose (MED) was found to be 383 mJ/cm² (range 180–650 mJ/cm²). The cumulative dose of irradiation was 1,841 mJ/cm² (range 600–2,500). The percentage improvement from baseline in PSSI score was 78.57 %. Side effects were seen in 20 patients (86.96 %) mainly in the form of erythema. Four patients developed mild relapse at the end of 6 months after the therapy. In 15 patients with palmoplantar psoriasis, the mean MED was found to be 415 mJ/cm² (range 200–950 mJ/cm²). The cumulative dose of irradiation was 28.4–115.5 J?cm² (mean 59.1 J?cm²). The mean number of treatments to achieve clearance (equal to 90 % reduction of PSI score) was 16. Two patients relapsed at the end of 6 months after the therapy. The 308-nm excimer laser is an effective, safe, easy, and relatively quicker method for the treatment of psoriasis at difficult to treat sites, with good results in a somewhat short time.     

应用抑制性消减杂交方法构建斑秃毛乳头差异表达基因文库

目的：构建斑秃区与正常毛囊毛乳头细胞（DPC）差异表达的cDNA正向和反向消减杂交文库，为从中克隆鉴定出斑秃特异性表达和生长期DPC特异性表达的基因奠定基础。方法：应用抑制性消减杂交技术，分别从斑秃区DPC及正常头皮DPC提取总mRNA；依次合成单链及双链cDNA，分别与2种不同的接头连接，再进行正向和反向的2次消减杂交及2次抑制性PCR，将产物与T／A载体连接构建cDNA消减文库。结论：构建成功具有高消减效率的斑秃区及正常头皮DPC cDNA消减文库，文库扩增后得到120个阳性克隆，其中90个克隆含有100－500bp插入片段，结论：应用抑制性消减杂交技术所构建的斑秃区及正常头皮DPC cDNA消减文库，为进一步批量筛选，克隆斑秃区及正常头皮DPC特异性表达的基因奠定了基础。     

308nm准分子激光联合0.1%他克莫司乳膏治疗白癜风的临床体会

目的:比较应用0.1%他克莫司软膏联合308nm准分子激光与单用308nm准分子激光治疗白癜风的效果。方法:64例白癜风患者,每个部位选择1～2处皮损将自身皮损分为A、B两组,分别108处皮损,A组予308nm准分子激光治疗,2次/周,共30次;B组在激光治疗的基础上外用0.1%他克莫司乳膏,2次/天。治疗过程中记录疗效及不良反应。结果:两组分别108处皮损,所有患者完成了治疗。总有效率:A组65.74%(71/108),B组89.81%(97/108),(χ2=18.10,P<0.05);其中面颈部有效率:A组88.10%(38/42),B组92.86%(39/42)(χ2=0.26,P>0.05);躯干部有效率:A组53.84%(28/52),B组94.23%(49/52)(χ2=22.06,P<0.05);四肢有效率A组50.00%(5/10),B组80.00%(8/10);手足有效率:A组0(0/4),B组25.00%(1/4);平均治疗次数:A组21.8次、B组19.4次,平均出现色素次数:A组7次、B组5.5次。结论:308nm准分子激光联合他克莫司乳膏治疗白癜风起效快、疗效好,副作用少;面颈部单用308nm准分子激光亦可获良效。     

Combined Excimer Laser and Topical Tacrolimus for the Treatment of Vitiligo: A Pilot Study

Background. Vitiligo is an acquired skin disorder that is characterized by well-defined, often symmetric white patches. Although current therapeutic modalities are directed toward increasing melanocyte melanin production, few treatment modalities address the immunologic nature of the disease.
Objective. To determine whether excimer laser, a known therapeutic modality, in combination with tacrolimus, a topical immunomodulator, accelerate response time and/or improve the degree of response in patients with this disorder.
Methods. Eight subjects diagnosed with vitiligo were recruited to participate in this institutional review board–approved double-blind, placebo-controlled study. Twenty-four symmetric vitiliginous patches (elbows, knees) from eight subjects received excimer laser treatment three times per week for 24 treatments or 10 weeks. Additionally, topical tacrolimus 0.1% ointment (Protopic) and placebo (Aquaphor) were applied to randomized patches (left or right) twice daily throughout the length of the trial. Vitiliginous patches were monitored with photographs at baseline, every 2 weeks, and 6 months after treatment. Biopsies were performed on subjects with significant results.
Results. Twenty vitiliginous patches from six subjects qualified for evaluation. Fifty percent of patches treated with combination excimer laser and tacrolimus achieved a successful response (75% repigmentation) compared with 20% for the placebo group. Subjects who responded successfully repigmented faster (19%) with combination therapy compared with excimer laser alone. Additionally, three subjects experienced transient hyperpigmentation in lesions treated with combination therapy.
Conclusion. Combining topical immunomodulators with known phototherapeutic modalities may represent a key advancement in the treatment of disease.     

The Use of the 308-nm Excimer Laser for the Treatment of Vitiligo

BACKGROUND: Recent reports show that 308-nm excimer laser may be an effective and safe method for the treatment of vitiligo, which is usually resistant to other available treatment methods. OBJECTIVE: The objective was to study the effectiveness of the new 308-nm excimer laser for the treatment of vitiligo. METHODS: A retrospective chart review of thirty-two patients with 55 spots of vitiligo were enrolled; a population-based sample was studied that included men and women, adults and children, with different ethnic backgrounds. The treatment was started with the lowest dose, which is 100 mJ/cm(2) (comparable to one minimal erythema dose value and one multiplier). Depending on Fitzpatrick skin type, the dose was raised gradually in a stepwise fashion. In skin types I to II, the same does was repeated twice before going up to avoid burns. Patients were treated for 30 sessions, or 75% repigmentation, whichever comes first. RESULTS: Overall 55 spots were treated: 29 (52.8%) had 75% pigmentation or greater, and 35 (63.7%) had 50% pigmentation or greater. The best results were on the face: of the 21 spots treated 15 (71.5%) had 75% pigmentation, and 16 (76.2%) had 50% pigmentation or greater. Other areas (neck, extremities, trunk, and genitals) had moderate response in comparison to the face. The least response was on the hands and feet; of the 5 spots treated only 20% showed 50% pigmentation or more. CONCLUSION: Slightly more than 50% of the patients tested showed 75% or more pigmentation of their lesions, after 30 treatments or less; most of the responders had Fitzpatrick skin type III and above. All the untreated patches (controls) remained unchanged. This demonstrates that the 308-nm excimer laser is an effective method of treatment for vitiligo.     

308-nm Excimer Laser Treatment of Mature Hypopigmented Striae

BACKGROUND: The 308-nm excimer laser has been shown to be effective in the treatment of disorders of hypopigmentation. OBJECTIVE: To evaluate the effectiveness of the 308-nm excimer laser in the treatment of mature hypopigmented striae. RESULTS: Seventy-five subjects were treated for a total of 615 treatments. All patients achieved a substantial increase in the darkening of their striae after an average of 8.4 treatments. Clinically evident improvement in cosmetic appearance of striae was noted by 80% of subjects. CONCLUSION: The 308-nm excimer laser is effective for increasing pigmentation in mature hypopigmented striae. This pigmentation is cosmetically significant. Future studies are required to determine the duration of clinical improvement.     

多层次颞部除皱术

目的 为在除皱术中尽可能减少斑状脱发、头发稀疏和头皮痂下愈合等并发症的发生，探讨一种新的除皱术式。方法 颞部采用多层次除皱，在保留颞浅知名血管对头皮的血供的同时，对头皮和皮肤区域采用不同的手术操作层次。结果 全部受术者均获得满意疗效。术区无斑状脱发、头发稀疏和痂下愈合等并发症发生。结论 多层次颞部除皱术最大限度地保留头发的血供，能明显地减少除皱术中斑状脱发、头皮痂下愈合的发生率，有利于获得较佳的美容效果。     

皮质类固醇激素治疗顽固性斑秃的疗效评价

目的　评价得宝松皮损内注射及甲基强的松龙静脉内冲击治疗顽固性多灶性斑秃的疗效。方法　对 2 3例病程在 13个月至 6年的斑秃患者 ,于皮损内注射得宝松 (0 .1ml/cm2 ) ,治疗结束 2个月后判定疗效 ,对得宝松治疗无效的病例 ,予甲基强的松龙冲击治疗 ,5 0 0mg/日 ,每月静滴 3天 ,连续治疗 3个月。结果　得宝松治疗组痊愈及显效病例为 11例 (4 7.83 % ) ,甲基强的松龙组痊愈及显效病例为 4例 (5 7.14% )。结论　皮损内注射得宝松及甲基强的松龙静脉内冲击治疗对病程至少是 13个月的顽固性多灶性斑秃患者 ,有较好的疗效 ,对其他治疗手段抵抗的病例 ,只要掌握好适应证 ,皮质类固醇激素冲击治疗也是一种有效的治疗方法     

多只扩张器超量扩张修复大面积瘢痕性秃发

目的 探讨应用多只扩张器超量扩张头皮修复大面积瘢痕性秃发的临床效果.方法 Ⅰ期手术：根据秃发区的形状、面积大小,选择多只扩张器,在肿胀麻醉下,置于头部有发区帽状腱膜下,注射壶外置.超量扩张3～6个月,以获得额外有发头皮.Ⅱ期手术：将扩张器取出,切除瘢痕,将扩张后的有发头皮,采用滑行推进皮瓣、旋转皮瓣与易位皮瓣联合运用的手术方式,修复头皮秃发区.结果 23例患者术后秃发区修复效果良好,外观满意.结论 多只扩张器超量扩张可获得大量额外扩张头皮.合理设计皮瓣转移术,最大限度地提高了扩张皮肤的利用率,可修复大面积瘢痕性秃发,修复效果良好.     

Treatment of oral lichen planus with the 308-nm UVB excimer laser--early preliminary results in eight patients

BACKGROUND AND OBJECTIVES: Oral lichen planus (OLP) is a chronic disease of uncertain origin. Many patients with OLP are refractory to all available therapies. The 308-nm excimer laser was used as a possible additional method in the treatment of OLP. STUDY DESIGN/MATERIALS AND METHODS: Eight patients with OLP were treated using the 308-nm UVB excimer laser. RESULTS: Clinical improvement was achieved in six patients. Two patients showed complete remission, of which one patient showed recurrence of the lesions after 4 weeks. CONCLUSION: The preliminary results in our opinion warrant further studies of this treatment.     

Surgical treatment of secondary cicatricial alopecia of scalp and eyebrow

Secondary cicatricial alopecia occurs as a result of destruction of hair follicles by scar tissue formed in the scalp and eyebrows. It is a permanent condition and regrowth of hairs in the area is not expected. The purpose of the study was to select the appropriate method for treating cicatricial alopecia. 24 patients were admitted to our hospital during the period from June 2006 to July 2007. They were suffering from acquired cicatricial alopecia affecting the scalp and the eyebrow. Their ages ranged from 6-48 years with mean age 26-25 years. They were treated surgically by total excision of the lesions with direct closure of the defect in ten cases, excision of alopecia with advancement flaps with the aid of scalp expanders in seven cases, scalp reduction through serial excision of alopecia in three cases and excision of alopecia and reconstruction of the defect by strip composite hair-bearing scalp grafts in four cases. Our results suggest there are three key factors that decide the surgical methods for treating alopecia: size, location and shape. We also discuss and evaluate the various techniques of reconstruction. Good results were obtained in 18 patients.     

Follow-up survey of 308-nm laser treatment of psoriasis

BACKGROUND AND OBJECTIVES: UVB treatment with a 308-nm excimer laser is a new treatment modality for localized psoriasis. The purpose of this study is to assess patients' impressions and satisfaction with 308-nm laser treatment of mild to moderate psoriasis. STUDY DESIGN/MATERIALS AND METHODS: Telephone survey data were obtained from patients after participation in a case series study of 124 patients with mild to moderate psoriasis treated with 308-nm UVB laser treatment for a target plaque and other lesions. The survey included information on changes in the target plaque, remission time, changes in other areas of psoriasis, satisfaction with the result, side effects of treatment, and efficacy relative to other treatments. RESULTS: Patients (55% of total) reported overall satisfaction with the treatments, and 63% of patients thought they needed additional laser treatments, including for maintenance. Subjects (25%) reported that the laser treatments were better than any other treatment they had tried. Adverse effects were mild and had either disappeared or were significantly decreased in 86% of patients. Self reported length of remission compared favorably to those for other therapies for localized disease. CONCLUSIONS: UVB laser treatments provide a well-tolerated means to clear psoriasis plaques. The treatment provides a high level of patient satisfaction.     

Recalcitrant Scarring Follicular Disorders Treated by Laser-Assisted Hair Removal: A Preliminary Report

Background. Recalcitrant scarring follicular disorders have been treated previously by removing hair follicles both surgically by scalp resection with skin grafting and with X-ray epilation. Laser-assisted hair removal may provide an alternate method of hair removal with less associated morbidity.
Objective. The goal is to determine whether laser-assisted hair removal can be used to treat follicular inflammatory disorders by destroying hair follicles.
Methods. Three patients with various scarring follicular disorders (dissecting cellulitis of the scalp, keratosis pilaris spinulosa decalvans, and pseudofolliculitis barbae) were treated with the long-pulse non-Q-switched ruby laser and followed clinically.
Results. The patients tolerated the treatments well without significant side effects and noted improvement of their condition along with decreased hair growth in the treated area.
Conclusion. Laser-assisted hair removal may provide a safe, effective means of treating recalcitrant follicular disorders.     

Failure of two TNF-alpha blockers to influence the course of alopecia areata

Alopecia areata is a form of hair loss believed to be due to an anti-hair-bulb autoimmune process in which CD4 and CD8 lymphocytes affect the peribulb area. Alopecia universalis is the most severe form of alopecia areata and manifests itself as a complete loss of all body hair. The authors present the case of a 44-year-old psoriasis patient with a 20-year history of alopecia universalis who failed to respond to etanercept in terms of skin psoriasis and alopecia universalis, while reporting improvement in arthropathy. While tumor necrosis factor-alpha inhibitors succeeded in the treatment of some autoimmune disorders, reports of alopecia areata failures and this one of alopecia universalis demonstrate resistance to such treatment. Tumor necrosis factor-alpha inhibitors seem to not represent an effective treatment modality for alopecia universalis. The understanding gained from this experience should redirect the aims of alopecia areata therapy toward alternate mechanistic interventions.     

Is there a therapeutic effect of botulinum toxin on scalp alopecia? Physiopathology and reported cases: A systematic review of the literature

Botulinum toxin is a treatment whose effectiveness has been widely demonstrated in the treatment of facial wrinkles. Its use in alopecia has been much less studied in the literature. Therefore, we carried out a systematic review of the literature in December 2019 in order to index published cases of alopecia patients treated with botulinum toxin. Pub Med, Embase, and Cochrane Library databases were explored. Six studies that included 94 patients were selected. Only one study was prospectively controlled against placebo.Of the 94 patients, 85 were affected by androgenetic alopecia, 8 by alopecia areata, and 1 by radiation-induced alopecia.The doses injected per session varied between 30 and 150 units and the number of sessions between 1 and 12. In the majority of the studies, the injections were carried out in all the muscles of the scalp (frontal, temporal, peri-auricular, occipital). Four studies showed a frank improvement in hair growth. Two of them showed improvement in hair density using an objective endpoint (hair count). The remaining reported studies showed inconclusive results.Patient satisfaction was high across all studies, but this systematic review did not clearly demonstrate the value of using the botulinum toxin in the treatment of alopecia. Subsequent prospective randomized controlled studies are required.