中药药浴联合卤米松乳膏对银屑病患者角质层神经酰胺及屏障功能的影响

摘要 目的：研究中药药浴联合卤米松乳膏对银屑病患者角质层神经酰胺及屏障功能的影响。方法：本研究招募2020年3月~2021年5月在我院皮肤门诊科就诊的80例银屑病患者,所有患者经临床病理确诊寻常型银屑病。其中男性患者52例,女性患者28例,患者年龄23~72岁,平均年龄48.29±6.33岁。实验分为两组：对照组（常规药物治疗）和观察组（中药药浴联合卤米松乳膏进行治疗）。观察患者病情康复情况,据PASI评分比较银屑病患者的总体严重程度,通过DLQI评分和VAS评估患者皮肤干燥和脱屑,通过电容检测和经表皮失水评估银屑病患者皮肤的水化程度和屏障功能,通过反相-液相色谱-质谱法分析患者角质层细胞中神经酰胺Cer和Cer（[NP]/[NS]）。通过蛋白印迹检测患者病变区域VEGFR-1和VEGFR-2的蛋白表达。结果：（1）根据PASI比较银屑病患者的总体严重程度,治疗前3周,两组患者PASI评分比较无差别（P>0.05）,第5周、8周和12周观察组较对照组的PASI评分降低（P<0.05）。（2）观察组较对照组DLQI和VAS评分降低（P<0.05）。（3）观察组较对照组病患者病变皮肤的电容增大,经表皮水分降低（P<0.05）。（4）观察组组较对照组Cer含量和Cer（[NP]/[NS]）升高（P<0.05）。（5）观察组较对照组VEGFR-1和VEGFR-2的蛋白表达降低。结论：中药药浴联合卤米松乳膏通过提高银屑病患者Cer的含量和Cer（[NP]/[NS]比率,维持角质层细胞的屏障功能,从而改善患者的皮肤干燥和瘙痒,角质层神经酰胺及屏障功能。     

5%环孢菌素霜对银屑病合并代谢综合征患者血清IL-17 及IL-18 水平的 影响

目的:探讨5%环孢菌素霜对银屑病合并代谢综合征患者外周血IL-17、IL-18水平及PASI评分的影响。方法:选择我院收治的寻常型银屑病合并代谢综合症患者68例,分为实验组和对照组。对照组予以复方甘草酸苷和卡泊三醇治疗,实验组在此基础上加用制备好的5%环孢菌素霜,观察并比较两组患者治疗前后外周血IL-17及IL-18水平的变化情况以及血压、空腹血糖、血脂及PASI评分结果。结果:与治疗前比较,两组患者治疗后IL-17及IL-18水平、血压、FPG、TG及PASI评分均显著降低,而HDL-C明显升高,差异均具有统计学意义(P0.05);与对照组比较,实验组治疗后IL-17及IL-18水平、血压、FPG、TG及PASI评分较低,而HDL-C较高,差异均具有统计学意义(P0.05)。结论:5%环孢菌素霜辅助治疗可调节银屑病合并代谢综合征患者外周血IL-17、IL-18水平,降低其PASI评分,改善患者机体代谢紊乱状态,对银屑病合并代谢综合症有显著临床疗效。     

误诊2年的左上臂难辨认体癣1例

报道1例由须癣毛癣菌引起的难辨认体癣。患者女,45岁,左臂伸侧多处红斑、丘疹伴脱屑、瘙痒2a余。曾多次就医诊断不明,患处皮损取活检做病理检查倾向于＂银屑病＂但疗效不佳。刮取皮屑镜检见真菌菌丝,小培养见葡萄串状小分生孢子及螺旋菌丝,尿素酶试验阳性,毛发穿孔试验阳性,鉴定为须癣毛癣菌。经内服特比萘芬和外用萘替芬酮康唑乳膏治疗28d后皮损消退,复查真菌阴性。     

复方壳聚糖消痤乳膏的制备和临床观察

目的制备复方壳聚糖乳膏并用于寻常痤疮的临床观察。方法研制以壳聚糖和苦杏仁酸等为主药的复方消痤乳膏。结果３４例寻常痤疮患者用上述消痤乳膏治疗３周总有效率为９４．１２％。结论消痤乳膏可作为治疗寻常痤疮的一种安全、稳定、有效的制剂。     

Successful treatment of herpes labialis with topical acyclovir.

A double blind, placebo controlled trial of 5% acyclovir cream, applied topically five times a day for five days, was carried out in 49 patients with recurrent herpes labialis. These patients had a total of 74 episodes, 34 of which were treated with the 5% acyclovir cream and 40 with matching placebo. First episodes and all episodes treated with acyclovir cream had significantly shorter times to formation of ulcer or crust and to complete healing (p less than 0.05 for all variables). The duration of all symptoms and proportion of patients developing itching was also reduced by acyclovir cream in first episodes, though the difference was not significant. When the patient started treatment early in the course of a first episode acyclovir cream significantly reduced the percentage of lesions progressing beyond the papular stage (p less than 0.05). Acyclovir cream is well tolerated and effective for the treatment of recurrent herpes labialis.     

Failure of acyclovir cream in treatment of recurrent herpes labialis.

A double blind, randomised, crossover placebo controlled trial of 5% acyclovir cream, applied topically five times a day for five days, was carried out in 45 patients with recurrent herpes labialis. These patients had a total of 72 episodes, 34 of which were treated with the 5% acyclovir cream and 38 with placebo cream. Treatment was begun by the patients as soon as possible after the onset of prodromal symptoms. There was no significant clinical benefit from treatment with acyclovir cream compared with placebo cream. The median healing times were nine days with acyclovir cream, 10 days with placebo cream, and 13 days when no treatment was given. The possibility that the 40% propylene glycol cream base alone has a therapeutic effect must therefore be considered.     

An hypothesis explaining the successful treatment of psoriasis with thermal biofeedback: A case report

This is a single case report of a 56-year-old Caucasian female referred for biofeedback by her dermatologist after seven years of failed standard medical treatment for psoriasis. Patient's presenting complaint was the embarrassing psoriasis lesions on her arms. Following 13 weekly one-hour finger/hand thermal biofeedback treatments, all 11 presenting psoriasis lesions (2–6 cm) had disappeared. Interestingly, any new psoriasis lesions that surfaced during our treatment disappeared without leaving palpable or visible scarring, unlike lesions that were present prior to biofeedback treatment. Patient was unmedicated for psoriasis during our treatment and continues to be unmedicated and asymptomatic at 12-month follow-up.     

Affinoleukin in combined treatment of psoriasis

Open randomized controlled clinical trials in which 161 patients were included showed that Affinoleukin (commercial drug which contains low molecular weight proteins obtained from extract of human leukocytes membranes) was effective in treatment of psoriasis. Affinoleukin, when added to regular treatment, accelerated the establishment of remission and its duration by restoration of impaired regulatory and defensive functions of T-lymphocytes, particularly, gamma deltaT- and NKT-cells as well as monocytes and NK-cells. Regular treatment led to marked positive effect in 45% of patients with severe psoriasis and psoriasis of intermediate severity. Addition of Affinoleukin in combined treatment increased proportion of patients with marked positive effect to 72%. Magnitude of Affinoleukin effect was directly related with its dose and severity of psoriasis. Course of Affinoleukin injections (up to 30 units in adults) is worthwhile to use as immunobiological component of combined treatment of exacerbations of severe psoriasis and psoriasis of intermediate severity.     

Comparison of terbinafine and clotrimazole in treating tinea pedis.

OBJECTIVE--To compare the efficacy and safety of terbinafine 1% cream and clotrimazole 1% cream in the treatment of tinea pedis. DESIGN--Multicentre, double blind parallel group study. SETTING--32 general practices and one hospital. PATIENTS--256 patients with mycologically confirmed tinea pedis. Of the 211 patients evaluable, 107 were randomised to terbinafine (75 male, 32 female; mean (range) age 40 (12-81) years) and 104 to clotrimazole (79 male, 25 female; mean (range) age 36 (12-71) years). INTERVENTIONS--Terbinafine 1% cream applied twice daily for one week and inert cream applied twice daily for the next three weeks. Clotrimazole 1% cream applied twice daily for four weeks. MAIN OUTCOME MEASURES--Mycological cure (negative results on microscopy and culture) and effective treatment (mycological cure plus no or minimal signs and symptoms) measured at weeks 1, 2, 3, 4, and 6. RESULTS--At week four rates of mycological cure were 93.5% for terbinafine and 73.1% for clotrimazole (p = 0.0001); and at week six 97.2% for terbinafine and 83.7% for clotrimazole (p = 0.001). Rates of effective treatment at week 4 were 89.7% for terbinafine and 58.7% for clotrimazole (p = 0.0001); and 89.7% for terbinafine and 73.1% for clotrimazole (p = 0.002) at week 6. CONCLUSION--These results indicate that a one week course of terbinafine 1% cream is more effective in the treatment of tinea pedis than a four week course of clotrimazole 1% cream, both in terms of mycological cure and effective treatment.     

复方黄柏液联合夫西地酸软膏及西替利嗪 治疗面部糖皮质激素依赖性皮炎疗效观察

目的观察复方黄柏液联合夫西地酸软膏及西替利嗪治疗面部糖皮质激素依赖性皮炎（以下简称为面部激素性皮炎）的疗效。方法采用随机对照观察方法对108例面部激素性皮炎患者分成治疗组和对照组。治疗组使用复方黄柏液（湿敷）联合夫西地酸软膏（外用）,对照组用3%的硼酸溶液湿敷及维生素B6软膏外用;两组均口服西替利嗪片。2周为1个疗程,治疗2个疗程。结果治疗组有效率为80.77%;对照组有效率为56.86%。两组有效率比较差异有统计学意义（χ^2=7.16,P〈0.05）。结论复方黄柏液联合夫西地酸软膏及西替利嗪治疗面部激素性皮炎疗效好,无明显不良反应。     

Ambulatory Goeckerman treatment of psoriasis: experience with 200 patients.

At a psoriasis day care centre 200 patients were treated with an ambulatory Goeckerman regimen, 25 of them twice, because of recurrence. This treatment consists of the application of a coal tar preparation at home at bedtime, followed the next day by exposure to high-intensity short wavelength ultraviolet radiation (UVB) at the centre. Treatment was given 5 days a week for 1 month. The psoriasis cleared in 86% of the patients after a mean of 21.6 UVB treatment sessions. The mean length of remission was 5.1 months, but at the time of follow-up 15 patients were still free of psoriasis. Compliance with the regimen was good to excellent in 94% of the patients. In our hands ambulatory treatment of psoriasis is much less expensive than hospital treatment and gives better results than photochemotherapy.     

Anti-photoaging effect of skin cream manufactured with ziyuglycoside I isolated from Sanguisorba officinalis on ultraviolet B-induced hairless mice

In this study, skin cream containing ziyuglycoside I isolated from Sanguisorba officinalis was manufactured and examined the protective effects of the skin cream against UVB-induced hairless mice. UVB-induced hairless mice were topically treated with the skin cream once a day for 5 weeks. Application of the skin cream did not exhibit side effect on body growth showing normal body weight and food efficiency in the mice. The skin cream treatment also was inhibited mRNA expression of interleukin (IL)-1β, matrix metalloproteinase (MMP)-2, MMP-9, and MMP-2 protein expression in the mice. Furthermore, the skin cream treatment inhibits epidermal wrinkle formation, wrinkle depth, wrinkle thickness, and collagen degradation in UVB-induced hairless mice. Therefore, the skin cream was able to play a role in the attenuation of photoaging caused by UVB irradiation via downregulation of mRNA expression of inflammatory cytokine IL-1β, MMP-2, MMP-9, and suppression of MMP-2 proteins expression.     

A NEW CORTICOID FOR TOPICAL THERAPY—Fluocinolone Acetonide

Sixty-seven patients with chronic and subacute cutaneous lesions of varying long duration that had previously been resistant to topical use of corticosteroid compounds were treated with a cream containing fluocinolone acetonide. To avoid subjective bias, only two classifications were used in appraising results: “complete clearing of treated lesions” and “not effective.”Forty-eight patients had complete clearing of the treated area. Results were best in atopic dermatitis, chronic eczematous dermatitis and nummular dermatitis. Granuloma annulare, dyshidrotic dermatitis of the palms and psoriasis were not affected.In some cases in which there were multiple lesions some of the lesions were treated with fluocinolone acetonide cream and some were treated concurrently with other corticoid ointments or with noncorticoid compounds, either bland or with active ingredients. Fluocinolone was effective in more than twice as many cases as the other agents.In some of the patients with chronic disease it was possible to greatly reduce or discontinue systemic steroid therapy after fluocinolone acetonide became available.No untoward effects were observed.     

The importance of patient selection for photochemotherapy in psoriasis.

Twenty-four patients with psoriasis were treated with orally administered 8-methoxypsoralen followed by exposure to high-intensity long-wavelength ultraviolet radiation (PUVA) at a psoriasis day care centre. Among the 20 with plaque type psoriasis the condition cleared in 13 (65%), after a mean of 20.7 treatment sessions, and improved but failed to clear in 4 (20%); the treatment failed in the other 3 (15%). The other four patients had erythrodermic, pustular or inflammatory psoriasis, and all failed to respond to PUVA therapy. Factors to be considered in patient selection for this form of therapy are the type of psoriasis, the patient''s skin type and th proportion of the body surface area involved.     

Expression of antimicrobial peptides and proteins in etanercept-treated psoriasis patients

Recent papers highlight the role of dysregulated expression of antimicrobial peptides and proteins (AMPs) in the pathogenesis of psoriasis. Etanercept, a blocker of the pro-inflammatory cytokine tumour necrosis factor-α (TNF-α), is effective in the treatment of psoriasis. We aimed to evaluate the expression profiles of AMPs in psoriatic skin before and after a 6-week course of etanercept therapy. We included 12 psoriasis patients who underwent medium-dose etanercept treatment for 6weeks. At baseline and at the end of therapy immunohistochemistry from lesional skin was performed for psoriasin, LL-37, and human ?-defensin 2 (hBD-2). After 6-week treatment, the modified psoriasis area and severity index significantly decreased from 37.5±5.9 to 14±13.4. Lesional immunoreactivity scores of psoriasin, LL-37, and hBD-2 also significantly decreased after a 6-week course of etanercept. We have demonstrated that etanercept-induced improvement of psoriasic lesions is associated with a significant decline of AMP protein expression.     

Long-term Effects of Hydroxyurea in Psoriasis

Hydroxyurea is an effective treatment for psoriasis but consistently produces macrocytosis in peripheral blood with a fall in haemoglobin levels and white cell counts. In this long-term study of 16 patients anaemia and leukopenia have proved frequent and troublesome side effects requiring discontinuance of treatment in many cases. In view of these findings hydroxyurea cannot be recommended as the drug of first choice even for treating severe and intractable psoriasis, and it is our opinion that methotrexate is safer and at least as effective in these circumstances. The clearest indications for the use of hydroxyurea appear to be in life-ruining psoriasis when methotrexate treatment has either failed or is contraindicated because of liver damage. A great deal more investigative work is required before these indications can be generally extended.     

硝酸舍他康唑乳膏每日1次疗法治疗股癣疗效观察

目的 观察舍他康唑乳膏1次/d疗法治疗股癣的效果与安全性.方法 将参与试验的股癣患者随机分组,试验组每晚1次外用舍他康唑乳膏,对照组早晚各1次外用舍他康唑乳膏,连续用药4周,于治疗前、用药2周、4周及停药后2周分别进行症状和体征评分.结果 治疗结束和停药2周时,两组的临床疗效无显著差异(P＞0.05).治疗2周时试验组和对照组的真菌清除率分别为82.6％和92.5％,有显著差异(P＜0.05);治疗结束和停药2周时试验组的真菌清除率分别为95.9％和97.3％,对照组分别为96.4％和98.6％,均无显著差异(P＞0.05).结论 舍他康唑乳膏1次/d疗法治疗股癣疗效好,简便易行,安全性高.     

Ustekinumab

Ustekinumab is an anti-IL12/23 IgG1 kappa human monoclonal antibody currently undergoing US Food and Drug Administration review for use as a psoriasis treatment. The candidate has also been evaluated in Phase 2 studies as a treatment for psoriatic arthritis, Crohn disease and multiple sclerosis. In large clinical trials, ustekinumab has proven effective for treating moderate to severe plaque psoriasis. Although long-term follow-up studies are needed to address safety concerns, the hopes are high for psoriasis treatment. Ustekinumab has recently been approved for marketing in Canada and Europe.Key words: ustekinumab, CNTO-1275, Stelara, psoriasis, psoriatic arthritis, Crohn disease, multiple sclerosis     

Dysbiosis of gut microbiota was closely associated with psoriasis

Psoriasis is an autoimmune disease and gut microbiota participate in the establishment of intestinal immunity. This study was performed to identify the fecal microbial composition of psoriasis patients, and investigated the influence of subgroup(type and severity) on the fecal microbial composition, and to define the key microbiota in the pathogenesis of psoriasis. Fecal samples from 35 psoriasis patients and 27 healthy controls were sequenced by 16 S rRNA and then analyzed by informatics methods. We found that the microbiota of the psoriasis group differed from that of the heathy group. The relative abundances of Firmicutes and Bacteroidetes were inverted at the phylum level, and 16 kinds of phylotype at the genus level were found with significant difference. No microbial diversity and composition alteration were observed among the four types of psoriasis. The microbiota of psoriasis patients in the severe state differs from those of psoriasis patients with more mild conditions and also the healthy controls. The veillonella in fecal microbiota showed a positive relationship with h-CRP in blood. This research proved that psoriasis patients have a significant disturbed microbiota profiles. Further study of psoriasis based on microbiota may provide novel insights into the pathogenesis of psoriasis and more evidence for the prevention and treatment of psoriasis.