Radiotherapy for melanotic freckles

Five patients who received radiotherapy (RT) for 7 melanotic freckles (MF, also known as Hutchinson's freckles, lentigo maligna) were reviewed 8 to 37 months after their treatment by RT. Local control and a favourable cosmetic result occurred in all patients. Treatment toxicity was minimal. Few reports about the use of RT for MF exist. Many other treatments including observation alone have been associated with high rates of recurrence, and in some cases conversion to invasive melanoma has occurred. RT appears to be a safe and effective treatment for this condition, providing that doses equivalent to 44 Gy in 11 fractions or more are given.     

新型强脉冲光治疗面部雀斑疗效观察

目的：采用自身对照观察具有完美脉冲技术（optimal pulse technology,OPT）的新型强脉冲光（intense pulsed light,IPL）治疗面部雀斑的疗效。方法：选取10例雀斑受试者,随机将每人左右面部分为治疗侧和未冶疗侧,治疗侧给予新型OPT—IPL治疗,未治疗侧不予治疗。治疗后对雀斑清除情况进行评价,受试者对疗效进行满意度评价。根据治疗前、后雀斑面积和严重程度指数（Freckles area and severity index,FASI）计算雀斑改善率。结果：治疗结束后随访时,70％以上的受试者皮损清除达50％以上、80％以上的受试者对治疗满意甚至非常满意。治疗侧治疗过程中、治疗后6个月随访时,FASI波动于7．9～9．4,明显低于首次治疗前的28．4;雀斑改善率维持在66％-70％,明显高于未治疗侧。结论：新型OPT—IPL可安全、有效地治疗面部雀斑。     

景天祛斑胶囊联合超声透入氢醌霜治疗黄褐斑的临床研究

目的：观察景天祛斑胶囊联合超声透入氢醌霜治疗黄褐斑的临床疗效。方法本研究为随机对照研究。将符合纳入标准的180例黄褐斑患者采用随机数字表法分为2组,对照组80例给予超声波透入2%氢醌乳膏;治疗组100例在对照组基础上加服景天祛斑胶囊,均连续治疗2个月。评价治疗结束时和2个月后随访时症状和皮肤损伤总积分。结果治疗结束时,治疗组治愈率为81.0%(81/100),对照组为67.5%(54/80),2组比较差异有统计学意义(χ2＝4.320,P＝0.038)。2个月后随访时,治疗组治愈率为92.0%(92/100),对照组为76.3%(61/80),2组比较差异有统计学意义(χ2＝5.538,P＝0.019)。治疗组治疗结束时、2个月后随访时皮损总积分[(1.61±0.84)分、(1.30±0.85)分比(3.48±1.02)分,t＝14.152、16.419]均较治疗前降低(P＜0.01);对照组治疗结束时、2个月后随访时皮损总积分[(2.04±0.61)分、(2.03±0.51)分比(3.45±1.09)分,t＝10.097、10.554]均较治疗前降低(P＜0.01)。治疗组治疗结束、2个月后随访时皮损总积分下降程度较对照组显著(t值分别为3.839、6.767,P＜0.01)。结论景天祛斑胶囊联合超声波透入氢醌乳膏可有效治疗黄褐斑。     

氨甲环酸联合谷胱甘肽治疗黄褐斑的临床观察

目的探讨氨甲环酸联合谷胱甘肽治疗黄褐斑的临床疗效。方法选择2016年1月~2017年4月期间本院收治的86例黄褐斑患者,根据治疗方式分为谷胱甘肽和联合组,各43例。对照组采用谷胱甘肽+维生素C注射液治疗,联合组在对照组基础上增加氨甲环酸治疗,对比两组治疗后黄褐斑面积及颜色改善情况,并采用共聚焦激光扫描显微镜检查观察患者黄褐斑改善情况,同时追踪随访两年,对比两组长期疗效。结果联合组黄褐斑(93.35%)治疗总有效率显著高于对照组(76.74%),差异具有统计学意义(P<0.05)。但联合组治疗后皮损面积(1.12±0.23)cm^2和皮损颜色评分(0.79±0.6)5分均显著低于对照组(2.38±0.75)cm^2、(1.54±0.38)分,差异具有统计学意义(P<0.05)。联合组治疗后共聚焦激光扫描显微镜检查显示:41例患者棘细胞层黑色素颗粒的亮度和密度较治疗前显著降低,1例偏真皮混合型和1例表皮型患者改善不显著;对照组治疗后共聚焦激光扫描显微镜检查显示:30例患者治疗后皮损区域皮肤色素显著降低,与正常皮肤区域相似,棘细胞层黑色素颗粒的亮度和密度显著降低,3例表皮型患者棘细胞层黑色素颗粒减少不显著,3例偏表皮混合型基底层黑色素细胞仍呈增生活跃状态,散在黑色素颗粒未减少;4例偏真皮混合型患者真皮浅层噬黑色素细胞及黑色素颗粒无改善。随访2年显示,观察组复发4例,对照组复发10例,观察组复发率(9.30%)显著低于对照组(23.30%),差异具有统计学意义(P<0.05)。结论谷胱甘肽治疗黄褐斑基础上联用氨甲环酸,可进一步提升祛斑效果,促进黄褐斑消退、淡化,治疗效果较为理想。     

A clinically invisible melanoma

We report a case of an amelanotic lentigo maligna incidentally found on a shave biopsy in an 87‐year‐old woman. Amelanotic lentigo maligna is a rare variant of lentigo maligna. It is often reported as presenting as erythematous scaly macules and is usually confused as benign dermatoses. Here were present a case of amelanotic lentigo maligna with no visible or palpable features.     

白茶、玫瑰花及玳玳花提取物对体外培养黑素细胞功能的影响

[目的]观察白茶、玫瑰花及玳玳花提取物（祛斑因子A、B）对体外培养的正常人表皮黑素细胞功能及角质形成细胞和黑素细胞共培养体系中黑素小体转运的影响。[方法]制备含药血清,建立正常人表皮黑素细胞体外培养体系,采用4-甲基偶氮唑蓝（MTT）法测定黑素细胞增殖,酪氨酸酶多巴速率氧化法测定酪氨酸酶活性,NaOH裂解法测定黑素生成量,逆转录-聚合酶链反应（RT-PCR）检测黑素细胞酪氨酸酶mRNA的表达,Pull-down法检测黑素细胞GTP-RhoA和GTP-Rac1蛋白的表达;建立正常人角质形成细胞和黑素细胞的体外共培养体系,流式细胞术检测共培养细胞体系中黑素转运的情况。[结果]与空白血清对照组相比,祛斑因子A、B可显著抑制酪氨酸酶活性;祛斑因子A可显著降低酪氨酸酶mRNA的表达。祛斑因子A中、低剂量可抑制树突结构蛋白的表达。祛斑因子A高、中、低剂量及祛斑因子B均可抑制黑素小体的转运。[结论]为祛斑因子用于色素性疾病的保健防治提供一定的实验依据。     

表面麻醉在化学剥脱术治疗雀斑中的应用

目的:研究表面麻醉能否有效地减轻化学剥脱术在治疗雀斑中的疼痛。方法:采用随机对照的方法,将60例雀斑患者随机分为A、B两组。B组术前用利多卡因及654-2的混合液纱布覆盖面部并用塑料薄膜封包30min,术中用改进的视觉模拟评分法进行疼痛评估,术后对皮肤过敏、色素沉着等情况进行比较。结果:疼痛评分,A组:良13例,可16例,差1例;B组优14例,良16例。疼痛值比较两组有显著差异(P<0.01)。术后过敏阳性对比两组无明显差异(P>0.05)。术后6个月色素沉着无可见差异。结论:利多卡因及654-2混合液进行表面麻醉能有效减轻化学剥脱术在治疗雀斑中的疼痛。     

4. Idiopathic Acquired Melanosis

Acquired melanosis is the clinical term used to describe a slowly enlarging, diffusely pigmented lesion of the conjunctiva which may also involve the lids, caruncle or cornea. The controversial histologic classifications are reviewed and suggestions made regarding useful and accurate terminology. In acquired melanosis, development of malignant melanoma may occur. Previous work indicates that the prognosis of the resulting melanoma may be assessed by histopathologic staging as is done in cutaneous melanoma. The suggested management of acquired melanosis is close observation with excisional biopsies of areas clinically suggestive of invasive melanomas. Examination of the entire biopsy by serial or staged sections is essential for accurate histopathologic diagnosis. Invasive melanomas have been conventionally treated by local excision or exenteration. Radiation therapy may be a beneficial adjunct.     

Treatment of lentigo maligna

Lentigo maligna (LM) is the in situ phase of lentigo maligna melanoma (LMM) and, if left untreated, 30-50% of cases will progress to LMM, which is now thought to behave as aggressively as any other melanoma. Literature on the of treatment of LM including conventional surgery, micrographic Mohs surgery, cryosurgery, radiotherapy, electrodesiccation and curettage, 5-fluorouracil (5-FU), azelaic acid, retinoic acid and lasers are reviewed. It is concluded that micro-graphic Mohs surgery has the lowest recurrence rates and that conventional surgery, cryosurgery and radiotherapy all have recurrence rates in the order of 7-10%. Therefore, on the basis of the current literature available, all three of these methods could be recommended as primary treatment of LM. It is extremely important when choosing one of the above treatments that the physician is adequately trained in the appropriate technique and understands the limitation of the method used and the need for close follow up of the patient