张士卿教授应用葛根芩连汤治疗痤疮经验

张士卿教授认为痤疮是由湿热、痰瘀、热毒内蕴等诸多因素共同作用的结果,好发于颜面部,证型以湿热内蕴多见;葛根芩连汤是阳明经方,颜面部系阳明经循行部位,故选方以葛根芩连汤为主方,随证加减,同时注意饮食调摄,每获良效。     

丹参酮对女性迟发性痤疮患者血清性激素水平的影响及疗效观察

目的探讨丹参酮对女性迟发性痤疮患者血清性激素水平的影响及临床疗效。方法选择门诊女性迟发性痤疮患者115例,随机分为：治疗组（A组）60例,口服丹参酮胶囊4粒,4次/d;对照组（B组）55例,口服多西环素片0.1 g,2次/d,4周后减为0.1 g,1次/d。8周为一疗程,疗程结束后进行疗效评价。并对治疗组（A组）患者,于治疗前后分别采用电化学发光免疫分析法检测其卵泡期血清六项性激素水平,另选40例相应年龄段的健康女性作健康对照组（C组）。结果A组痊愈率为36.7%,有效率为78.4%;B组痊愈率为14.5%,有效率为45.4%,A组痊愈率及有效率均高于B组,差异有统计学意义（P〈0.05或〈0.01）。A组女性迟发性痤疮患者治疗前血清睾酮水平较C组明显升高（P〈0.05）,而治疗后血清睾酮水平与C组相比差异无统计学意义（P〉0.05）。结论女性迟发性痤疮发病的主要原因与雄激素分泌增多有关。丹参酮具有抗雄激素作用,对女性迟发性痤疮的疗效确切,且无耐药性及明显不良反应。     

一起职业性痤疮的诊断体会

职业性痤疮是指在生产劳动中接触矿物油类或某些卤代烃类引起的皮肤毛囊、皮脂腺系统的慢性炎症损害。由于用人单位和劳动者本人缺乏对该病足够的重视,可能导致职业性痤疮得不到及时的诊断和治疗,本院于2006年11月接诊3例职业性痤疮病人,现报道如下。     

Synovitis,acne, pustulosis,hyperostosis, osteitis syndrome with invisible organizing pneumonia: A case report

We report the case of a 59-year-old female patient, presenting with pustular rash on both hands and pain in the lumbosacral part and left lower limb. A magnetic resonance imaging examination of the left leg was undertaken and the result showed that a malignant lesion with bone destruction of the left femoral shaft could not be excluded. Subsequently, bone tumor was excluded by pathological examination. Lung computed tomography scan showed patchy consolidation and cord shadow in the middle left lung. Subsequently, lung cancer was excluded by pathological examination, and the histopathological changes of lung were consistent with those of organized pneumonia. Blood tests revealed elevated C-reactive protein and erythrocyte sedimentation rate. Antinuclear antibody, rheumatoid factor, and human leukocyte antigen-B27 were unremarkable. Whole body bone scintigraphy via technetium 99m-methyl diphosphonate showed increased radionuclide uptake in the left middle femur. Based on her clinical manifestations, imaging results and bone scintigraphy, the patient was diagnosed as having synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome. Loxoprofen and Tripterygium wilfordii Hook F led to impressive clinical and radiologic improvement.     

The cutaneous microflora of adolescent, persistent and late-onset acne patients does not differ

The cutaneous microbiology and antibody status to Propionibacterium acnes of patients with persistent (males, n = 32; females, n = 33) and late-onset (females, n = 25) acne were compared with individuals with adolescent acne (males, n = 22; females, n = 18) and normal control volunteers (persistent acne: males, n = 26; females, n = 30; late-onset: females, n = 20). Males had significantly higher grades of acne compared with females (P < 0.05). The microflora consisted in the main of propionibacteria, staphylococci and Malassezia; other bacteria represented less than 0.01% of the total microflora. At all sites for all samples there were significantly more propionibacteria than staphylococci or Malassezia (P < 0.05). There were significantly higher (P < 0.05) numbers of microorganisms in follicular casts from patients compared with their control volunteers for female facial skin and male back skin. Twenty-six papules and 48 normal follicles were analysed. A bimodal distribution of microbial colonization was noted, with about 90% of normal follicles and about 10% of acne follicles having no detectable viable microorganisms. Anti-P. acnes IgG antibody titres were measured using a secondary fluorescein isothiocyanate antibody technique, and no significant differences in titre were found between any groups of patients (P > 0.05). Correlation analysis showed no association between the population densities of P. acnes and anti-P. acnes IgG titres. There were no differences in the microbiology of skin of adolescent acne patients, persistent acne patients or late-onset acne patients which could account for these various forms of acne.     

Comparison of 2940 nm Er: YAG laser treatment in the microlaser peel,fractional ablative laser,or combined modes for the treatment of concave acne scars

Objective:To compare and analyze the effects of Er:YAG laser treatment in the microlaser peeling, fractional ablative laser, or combined modes for the treatment of concave acne scars.Method:Ninety patients of concavity acne scar were randomly assigned to three different groups:microlaserpeeling mode group (MM group), fractional ablative mode group (FM group) and combined mode group (CM group). MM group received microlaserpeeling mode with depth of 60 μm and a repetition rate of 20%, FM group received fractional ablative mode with depth of 300 μm and a fractional density of 8%, and CM group received a fractional depth of 200 μm, density of 8%, and a peeling depth of 30 μm, repetition rate of 20%. All patients were evaluated for their treatment effects and side effects 30 days after treatment, including the treatment satisfaction, the ECCA grading scale, pain score and pigmentation level.Results:According to the effect satisfaction of patients’ self-assessment, the difference among the three groups was statistically significant (P < .05), the CM group was better than the other two groups, but there was no significant difference between the FM group and the MM group (P > .05). About the ECCA grading scale 30 days after treatment, the statistical result among the three groups was significant (P < .05), the CM group is much lower than the FM group which is approximately equal to the MM group. There was statistical difference in pain score among the three groups and every two groups (P < .05), the CM group had the highest pain score, while FM group had the lowest. About the pigmentation level, there was statistical difference among the three groups (P < .05), FM group had the lightest pigmentation, while the CM group had the heaviest.Conclusions:Three treatment modes are all effective in treating the concavity acne scar. Among the three modes, CM group is best effective, also accompanied with the most severe side effect; FM group achieves the best balance between treatment effect and side effect. The treatment practices indicate that when the Er:YAG laser with a wavelength of 2940 nm is used to treat concavity acne scars, the right treatment mode should be subject to the severity of the scar.     

Treatment of acne scars using the plasma skin regeneration (PSR) system

BACKGROUND AND OBJECTIVES: Acne scarring is a common and difficult to treat condition. The plasma skin regeneration (PSR) system is a novel device that causes delayed ablation of the epidermis and controlled thermal modification to the underlying dermis. PSR has previously been shown to be a safe and effective treatment for facial rhytides and benign skin lesions. In this study, we investigated the safety and efficacy of single-treatment, high-energy, double-pass PSR for the treatment of acne scarring. STUDY DESIGN/MATERIALS AND METHODS: Ten patients with acne scarring and Fitzpatrick skin types I-III were included in the study. All patients underwent a single PSR treatment with two high-energy passes (3.5-4.0 J). Treatments were performed in an outpatient clinic setting. Nine patients completed 6 months of follow-up. Improvement was determined by patient questionnaires and physician evaluation of digital photographs taken prior to treatment and at 3 and 6 months post-treatment. RESULTS: On average, patients reported 34% improvement in their acne scarring at 3 months and 33% improvement at 6 months. Blinded physician ratings of patient photos demonstrated 19% improvement at 3 months and 34% at 6 months. Re-epithelialization was complete by 4-6 days after treatment, and no serious adverse events were encountered. CONCLUSION: PSR appears to provide a safe and effective single treatment, minimal downtime alternative for the treatment of acne scarring. Additional studies are warranted to further demonstrate the safety and efficacy of this device.     

Expression of human neutrophil proteins in acne vulgaris

Background In acne vulgaris patients, the presence of a dysregulation of the production of innate and specific antimicrobial peptides has been postulated. Objective This study aims to determine whether human neutrophil proteins (HNP) 1–3 are expressed in acne patients. Materials and methods HNP 1–3 expression was investigated in 35 acne patients treated with isotretinoin and in 25 healthy subjects. At the beginning of the study, two skin biopsies were taken from acne patients; one biopsy was taken from an established pustule and one from uninvolved skin, and the biopsies were repeated after treatment. Only one biopsy was obtained from controls. Results The statistical analysis showed that pustular lesions of acne patients had significantly higher levels of perivascular and interstitial HNP 1–3 expression when compared with the biopsy of uninvolved skin of these patients (P = 0.003, P = 0.001, respectively) and with that of healthy controls (P = 0.007, P = 0.014, respectively). Isotretinoin treatment achieved a decrease in the perivascular and interstitial HNP 1–3 expression of pustular lesions (P = 0.01, P = 0.001, respectively). Conclusion Our current study demonstrates the novel observation that a recently identified antimicrobial peptide, HNP 1–3, is expressed in neutrophils of acne inflammation but not in uninvolved skin of these patients. These results suggest that HNP 1–3 may contribute to the development of inflammatory lesions of acne.     

顽固性粉刺的针灸综合治疗

本病主要病机在于热、痰、瘀 ,辨证多属于气血壅滞或痰瘀蕴结型 ,因而主要选取耳垂、大椎、心俞 ,采用叩刺放血之法以泻热邪行瘀滞 ,再配合常规体针的辨证施针和耳穴埋压的辅助治法 ,收到了显著的效果。运用此法对 16例病程在 2～ 3年的顽固性粉刺患者施治 ,临床治愈率为75 %。