ATR-FTIR技术在面部敏感性皮肤角质层成分分析中的应用研究

【摘要】 目的 利用衰减全反射傅里叶变化红外光谱仪（ATR-FTIR）分析敏感性皮肤与正常皮肤角质层成分的差异,探讨该技术在敏感性皮肤发生机制研究中的应用价值。方法 自2018年12月至2019年2月,招募在上海市居住 ≥ 6年的148例志愿者,通过问卷调查、乳酸刺痛试验和辣椒素试验,将受试者分为正常皮肤组和敏感性皮肤组;同时,记录乳酸刺痛试验和辣椒素试验中受试者的总刺痛评分和总灼痛评分。应用ATR-FTIR检测角质层成分,包括天然保湿因子（NMF）、角质层脂质、游离脂肪酸（FFA）和β/α比值;同时应用其他无创技术测量经表皮失水率（TEWL）、角质层含水量、角质层脂质、皮肤pH值和3种周围感觉神经纤维的电流感觉阈值和浅表皮肤血流灌注量等皮肤生理参数。分析角质层成分与总刺痛评分和总灼痛评分的Spearman相关系数,以及与皮肤生理参数的Pearson相关系数。结果 73例志愿者完成全部试验,其中敏感性皮肤组34例,男15例,女19例,年龄（41.8 ± 8.9）岁;正常皮肤组39例,男19例,女20例,年龄（42.8 ± 9.4）岁。敏感性皮肤组和正常皮肤组角质层NMF分别为30.90 ± 7.38、37.01 ± 8.77（t = 3.193,P < 0.01）,FFA分别为14.90 ± 6.75和20.45 ± 11.76（t = 2.422,P < 0.05）,β/α值分别为3.17 ± 1.03和2.67 ± 0.56（t = -2.595,P < 0.05）,角质层脂质两组差异无统计学意义（t = 1.458,P > 0.05）。皮肤生理参数中,敏感性皮肤组TEWL显著高于正常皮肤组（t = -3.496,P < 0.001）,而5 Hz电流感觉阈值和表皮致密度显著低于正常皮肤组（P < 0.05）,角质层脂质差异无统计学意义（P > 0.05）。相关分析显示,NMF、FFA和β/α与TEWL（r值分别为-0.405、-0.562、0.503,均P < 0.01）和总刺痛评分（rs值分别为-0.401、-0.285、0.316,P < 0.01或0.05）均呈良好的相关性,同时,表皮致密度与NMF（r = 0.402,P < 0.01）和β/α比值（r = -0.369,P < 0.05）也呈良好的相关性。但NMF、FFA和β/α与角质层脂质、3种感觉神经纤维的电流感觉阈值、浅表皮肤血流灌注量及表皮厚度之间均无相关性（均P > 0.05）。结论 敏感性皮肤与正常皮肤角质层NMF、FFA和β/α存在显著差异,且NMF、FFA和β/α与部分角质层屏障功能生理参数之间具有良好的相关性。因此,ATR-FTIR是一种有效评价敏感性皮肤屏障功能的手段。     

Guidelines for management of androgenetic alopecia based on BASP classification–the Asian consensus committee guideline

Background Androgenetic alopecia (AGA), or pattern hair loss, is a common disorder in both Asian men and women. There are several guidelines for the treatment of AGA which are suitable for Caucasian patients; however, each of these has some limitations. Furthermore, in comparison with Caucasian patients, Asian patients with AGA have different types of hair loss and family histories which may alter the treatment response. There is currently no published AGA guideline for Asian patients. Objectives The Asian Consensus Committee for Androgenetic Alopecia aimed to develop an algorithmic guideline, based on the basic and specific (BASP) classification, for the treatment of AGA especially in Asian patients. Methods The committee collaborated extensively on reviewing available literature on AGA treatment in order to formulate an algorithmic guideline on AGA management. Results Previously published guidelines based on pre‐existing classifications of AGA cannot easily classify the patterns of AGA that are more frequently seen in Asians. The BASP classification not only facilitates the development of a unified and simplified algorithm, but also overcomes the disadvantages of previously reported classification systems. Conclusions The proposed treatment guideline for AGA based on the BASP classification may be useful for dermatologists in their approach to treating Asian patients with AGA in clinical practice. Ideally, clinicians should try to utilize this guideline consistently in their practice to monitor treatment response with the goal of enhancing successful outcomes. This will help boost patients' confidence and self‐esteem, thus improving patients compliance with the prescribed treatments.     

Double-blind,Placebo-controlled Study Assessing the Effect of Chocolate Consumption in Subjects with a History of Acne Vulgaris

Objective: To assess the effect of chocolate on acne exacerbation in males between the ages of 18 and 35 with a history of acne vulgaris. Design: Double-blind, placebo-controlled, randomized, controlled trial. Setting: Single-site, outpatient, research, clinical facility at an academic research institution. Participants: Fourteen men between the ages of 18 and 35 were assigned to swallow capsules filled with either unsweetened 100-percent cocoa, hydrolyzed gelatin powder, or a combination of the two, at baseline. Measurements: Lesions were assessed and photographs were taken at baseline, Day 4, and Day 7. Results: Of the 14 subjects, 13 completed this Institutional Review Board approved study. A statistically significant increase in the mean number of total acneiform lesions (comedones, papules, pustules, nodules) was detected on both Day 4 (p=0.006) and Day 7 (p=0.043) compared to baseline. A small-strength positive Pearson’s correlation coefficient existed between the amount of chocolate each subject consumed and the number of lesions each subject developed between baseline and Day 4 (r=0.250), while a medium-strength positive correlation existed between baseline and Day 7 (r=0.314). No serious adverse events occurred. Conclusion: It appears that in acne-prone, male individuals, the consumption of chocolate correlates to an increase in the exacerbation of acne.The effect that chocolate has on acne has been debated in the literature. Although it has been hypothesized that several factors, including body mass index (BMI), hormonal levels, glucose levels, emotional stress, and glycemic index, may have an effect on acne, the role of the diet in the generation and/or worsening of acne remains controversial.1 In 2002, Cordain et al2 demonstrated that Westerners have a higher percentage of the population suffering from acne vulgaris than two non-Westernized populations, including Kitavan Islanders of Papua New Guinea and Aché hunter-gatherers of Paraguay.2 Despite this, few studies have evaluated the effects of chocolate on acne.One study of note was conducted in 1969 by Fulton et al.3 Sixty five subjects were assigned to consume either a chocolate bar that contained 10 times the amount of bittersweet chocolate of a normal 45g chocolate bar or a chocolate-less placebo bar that contained 28 percent vegetable fat corresponding with the fat content in chocolate liqueur and cocoa butter. Both bars weighed between 112 and 114g, although the control bar had 592 more calories than the experimental bar. The results demonstrated no significant difference between the two groups, suggesting that chocolate had no effect on acne.3 However, Mackie and Mackie4 criticized the study for the ingredients in the placebo bar that attempted to mimic the lipid and sugar contents of the chocolate bar. In addition, they criticized that the xanthine content was not mentioned for either bar.4 Rasmussen5 criticized Fulton’s method for lesion quantification, as all types of lesions (comedones, papules, and pustules) were accounted equally, thus not assessing the severity of the acne.One other study that assessed the effect of chocolate on acne was conducted by Anderson. Twenty-seven medical students were administered six servings of 39g chocolate bars for seven days. Facial acneiform lesions were counted at baseline and then daily during the seven-day study. Although the methods used were not appropriately stated, the author did not observe a causal relationship between chocolate consumption and acne proliferation.6Review of the literature in 2009 showed that there were no studies assessing the effects of chocolate with 100-percent content of cocoa on acne. In turn, the authors’ study team felt that it was necessary to conduct a study assessing pure chocolate on acne. In a recent pilot study published in the Journal of the American Academy of Dermatology, Berman et al7 assessed the effect of 100-percent cocoa on the exacerbation of acne in men between the ages of 18 and 35 years. At baseline, the study team had 10 healthy male subjects consume up to six ounces of 100-percent chocolate (Ghirardelli baking bars). Lesions were counted, assessed, and documented appropriately at baseline, Day 4, and Day 7. Statistical significance was achieved when the total mean number of acneiform lesions, including comedones, papules, and pustules, on Days 4 and 7 were compared to baseline (P=0.031 and 0.050 for Days 4 and 7, respectively). Additionally, strong positive Pearson’s correlations were calculated analyzing the amount of chocolate each subject consumed and the number of lesions subjects developed on Days 4 (r=0.510) and 7 (r=0.608). This dose-dependent relationship that was found suggested that chocolate did exacerbate acne in men with a history of acne vulgaris.7 However, this study did have limitations as only 10 subjects were included, and the study was not double-blinded nor placebo controlled. Therefore, the authors decided to expand on this pilot study and created an Institutional Review Board (IRB)-approved protocol to analyze the effect of chocolate’s exacerbation on acne in a double-blind, placebo-controlled study.