瘙痒研究国际论坛敏感性皮肤兴趣组《敏感性皮肤定义专家共识》解读

敏感性皮肤是近年来皮肤科临床工作中成年女性患者的常见问题,但长期以来国内外学者对其的确切定义及临床地位一直存在争议。瘙痒研究国际论坛敏感性皮肤兴趣组通过组织来自不同国家在瘙痒和(或)敏感性皮肤领域具有知名学术地位的皮肤病学、心理学以及生物学专家,应用Delp Hi方法,经过5轮讨论最终形成了对敏感性皮肤定义的专家共识,并在2016年发表,旨在推动对敏感性皮肤认识水平的进一步提升。该文对专家共识进行介绍并解读。     

Clinical classification of itch: a position paper of the International Forum for the Study of Itch

Chronic itch is a common and distressing symptom that arises from a variety of skin conditions and systemic diseases. Despite this, there is no clinically based classification of pruritic diseases to assist in the diagnosis and cost-effective medical care of patients with pruritus. The proposed classification focuses on clinical signs and distinguishes between diseases with and without primary or secondary skin lesions. Three groups of conditions are proposed: pruritus on diseased (inflamed) skin (group I), pruritus on non-diseased (non-inflamed) skin (group II), and pruritus presenting with severe chronic secondary scratch lesions, such as prurigo nodularis (group III). The next part classifies the underlying diseases according to different categories: dermatological diseases, systemic diseases including diseases of pregnancy and drug-induced pruritus, neurological and psychiatric diseases. In some patients more than one cause may account for pruritus (category "mixed") while in others no underlying disease can be identified (category "others"). This is the first version of a clinical classification worked out by the members of the International Forum for the Study of Itch. It is intended to serve as a diagnostic route for better evaluation of patients with chronic pruritus and aims to improve patients' care.     

Guidelines for the management of vitiligo: the European Dermatology Forum consensus

The aetiopathogenic mechanisms of vitiligo are still poorly understood, and this has held back progress in diagnosis and treatment. Up until now, treatment guidelines have existed at national levels, but no common European viewpoint has emerged. This guideline for the treatment of segmental and nonsegmental vitiligo has been developed by the members of the Vitiligo European Task Force and other colleagues. It summarizes evidence‐based and expert‐based recommendations (S1 level).     

Modulation of TRPV1 function by Citrus reticulata (tangerine) fruit extract for the treatment of sensitive skin

Background

Sensitive skin (SS) is a clinical syndrome defined by the occurrence of unpleasant sensations (such as stinging, burning, pain, pruritus, and tingling) in response to stimuli that normally should not provoke them. According to growing evidence, transient receptor potential vanilloid subtype 1 (TRPV1) has elevated expression in individuals with SS and is linked with the severity of SS symptoms. However, its pathogenesis is still unknown.

Objective

Herein, Citrus reticulata (Tangerine) fruit extract (CR) was obtained and examined for its effect on SS with a focus on TRPV1 stimulation and expression.

Methods

A recombinant hTRPV1 over-expression cell line (HaCaT-TRPV1-OE cell) was constructed to screen substances and extracts from several plants. Intracellular calcium mobilization was monitored by Flexstation 3 and a fluorescence microscope using Fluo 8 AM fluorophore. Next, immunofluorescence was used to detect the TRPV1 expression under different stimulants treated for 24 h. To investigate the relief and increased tolerance of CR to lactic acid-induced skin discomfort, clinical tests were carried out on the nasolabial folds or cheek areas.

Results

According to the obtained results, compared to HaCaT cells, HaCaT-TRPV1-OE cells showed a higher expression of TRPV1. Neuronal hyperresponsiveness in SS triggered by capsaicin (CAP), lactic acid, phenoxyethanol or nicotinamide may be through activation of TRPV1 and increased TRPV1 expression. CAP activates TRPV1 in HaCaT-TRPV1-OE cells, and more than 100 plants or chemicals were tested for their inhibitory effects before being screened for CR. CR (1%–4%) inhibited TRPV1 activation induced by CAP or phenoxyethanol or nicotinamide. Meanwhile, CR (0.25%) suppressed TRPV1 protein expression induced by phenoxyethanol or lactic acid. In vivo results showed that CR not only instantly relieved lactic acid-induced skin discomfort under 5 min but also enhanced skin tolerance to lactic acid after 7 days of continuous use.

Conclusions

Topical application of CR showed an instant and long-lasting improvement in SS by modulating the activation and expression of TRPV1. Moreover, it has been suggested that CR might act as a TRPV1 inhibitor to reduce skin irritation or sensitivity.     

First results from the multicentre study rehabilitation of occupational skin diseases--optimization and quality assurance of inpatient management (ROQ)

Background and objectives. The German stepwise procedure of handling occupational skin diseases (OSDs) offers interdisciplinary integrated (inpatient/outpatient) rehabilitation measures [tertiary individual prevention (TIP)] for severe OSD. In 2005, a prospective cohort multicentre study was started in order to evaluate TIP. Methods. One thousand seven hundred and eighty‐eight patients with severe OSD were treated and educated in five clinics with follow‐up before and 4 weeks after return to work. Results. During the inpatient phase, there was a significant improvement in the severity of OSD (Osnabrueck Hand Eczema Severity Index, p < 0.001) and in the quality of life (Dermatology Life Quality Index, p < 0.001). These effects were largely sustained during the outpatient follow‐up phase and in the 4 weeks after return to work. Among all patients, 89.4% used topical steroids before TIP, including 52.5% using high‐grade topical steroids; 93.2% of the patients were able to refrain from using topical steroids before returning to work. As a result of TIP, return to work was possible for 1587 patients (88.8%). Conclusions. The primary objectives of TIP (return to work, improvement of OSD, enhancement of quality of life, and reduction in the use of topical steroids) were successfully met. The long‐term follow‐up (1 and 3 years after TIP) will examine whether these favourable outcomes can be sustained.     

特种伤病防治信息管理系统结构及数据库设计研究

目的探讨特种伤病防治信息管理系统的需求分析和设计方案,为实现特种伤病资料信息化管理提供参考。方法系统结构设计采用浏览器／服务器（B/S）模式,便于用户远程使用和实现数据存储。以液体火箭推进剂致伤为例,设计符合特种伤病诊疗需求的数据库表单。结果该系统数据库设计采用B／S模式符合需求分析,液体火箭推进剂致伤数据库表单设计方案合理可行。结论本系统结构及数据库设计方案可以为构建特种伤病防治信息管理系统提供参考,提高特种伤病数据资料的信息化管理水平。     

含马齿苋及甘草提取物护肤品对敏感性皮肤辅助治疗作用的临床观察

目的:评价含马齿苋及水溶性甘草提取物护肤品(商品名:薇诺娜舒敏保湿修复霜及薇诺娜舒敏控油凝露)辅助治疗敏感性皮肤的有效性及安全性.方法:采用多中心、治疗前后对照的临床试验方法,对110例敏感性皮肤受试者(干、中性敏感性皮肤受试者80例,油性敏感性皮肤受试者30例)面部分别外用薇诺娜舒敏保湿修复霜及薇诺娜舒敏控油凝露,每日2次,连续使用1个月.在治疗前及治疗后7 d、15 d、30 d分别对受试者皮肤进行皮肤生理功能测试,同时对乳酸试验、皮损恢复情况、受试者对该产品的满意度及安全性进行评价.结果:治疗30d后,干性、中性敏感性皮肤组受试者角质层含水量由治疗前71.53%±3.34%增加至74.49%±2.87%,油脂含量由治疗前(74.30±29.19)μg/cm2增加至(90.01±11.45)μg/cm2.油性皮肤组受试者含水量由治疗前71.95%±2.34%增加至75.09%±1.67%,油脂含量由治疗前(247.13±41.90)μg/cm2下降至(223.23±40.19)μg/cm2,治疗前后比较(P<0.001),差异具有统计学意义,而皮肤弹性相比差异无统计学意义;乳酸试验分值由治疗前4.39±0.82降至2.58±0.40(P<0.001),差异具有统计学意义;皮肤改善者87例,占79.09%;与使用前相比(P<0.001),差异具有统计学意义;试验中未出现不良反应.结论:薇诺娜舒敏保湿修复霜及薇诺娜舒敏控油凝露对于、湿性敏感性皮肤有辅助治疗作用,有助于恢复皮肤屏障功能,安全性好.     

Human skin penetration of flufenamic acid: in vivo/in vitro correlation (deeper skin layers) for skin samples from the same subject

Previously, the interest in in vivo/in vitro correlations in the dermal field of research has increased steadily. Unfortunately, in most cases the skin from different human donors was taken for in vivo and in vitro experiments, which led to problems concerning the interindividual variability of the skin. Therefore, we established a methodology to utilize the same skin for both sets of data. In time dependency, drug amounts in the stratum corneum and the deeper skin layers were determined from eight donors using the same skin area for in vivo and the corresponding in vitro tests. Penetration experiments were carried out with the lipophilic drug flufenamic acid dissolved in wool alcohols ointment as the model formulation, which was administered to the skin under "infinite dose" conditions. At different time points prior to starting the surgery, the drug preparation was applied topically on the edges of the skin area, which was planned for excision using Finn chambers. After anesthetizing the patient and disinfecting the operation area, the incubated skin pieces were cut off first and immediately frozen to limit further drug diffusion. In vitro experiments were performed on the remaining skin flap, using two different test systems, a penetration and a permeation model. At the end of all experiments (in vivo and in vitro) the skin specimens were segmented horizontally and the drug was extracted and quantified. The in vivo and in vitro drug amounts in the stratum corneum and the deeper skin layers, respectively, were compared. The inevitable use of unknown volumes of disinfectant in vivo (medical reasons) might be the reason why a correlation failed for the stratum corneum. Nevertheless, for both in vitro test systems a direct linear correlation was found for the deeper skin layers, which showed slopes of a = 3.2272 +/- 0.3933 (penetration model vs in vivo) and a = 1.7776 +/- 0. 1926 (permeation model vs in vivo). This difference demonstrates the varying influence of the test systems and represents a factor about which in vivo and in vitro data are shifted against each other. As far as the model drug flufenamic acid is concerned, this methodology represents a tool to predict drug penetration into the deeper skin layers in vivo after carrying out corresponding in vitro experiments. Therefore, the potential is given to reduce the number of in vivo experiments, the risk for the volunteers, and the costs for the development of new drug preparations.