果酸治疗痤疮的临床疗效观察

发布时间：2019-06-19 09:44

【摘要】：背景:果酸(α-羟基酸,Alpha hydroxy acids,AHAs)是在α位含有羟基的羧酸,现今在美容皮肤科用其达到美容功效与治疗各种皮肤病,化妆品配方中亦经常应用。α-羟基酸可以提取自天然的纯植物如水果,亦可人工合成,现今使用的大多来自各种水果,如来自甘蔗的甘醇酸即羟基乙酸、扁桃中的扁桃酸等,故α-羟基酸又称之为果酸。如今含有果酸的产品相当流行,其作用从皮肤保湿、减轻皱纹到深部皮肤化学剥脱。化妆品类的有霜、保湿乳、爽肤水、面膜、洁面类、祛斑类等等。果酸产品根据浓度,消费者可以日常使用、可以由皮肤科专业医师操作使用、也可用于化妆品研究机构[1,2]。本研究中主要使用的甘醇酸(Glycolic acid GA)是果酸中分子质量最小的,其分子结构简单,同时因为分子构型式中含有羟基,因此与水能较好相容,透皮吸收较高,进而加速表皮及真皮细胞的更替及代谢。对于皮肤科多种疾病如痤疮、各种角化性疾病、玫瑰痤疮、光老化性皮肤病,黄褐斑等色素沉着性疾病均有效,也可作为鱼鳞病、皮肤淀粉样变性、黑变病、银屑病的辅助治疗,同时也是近年来医学及美容护肤领域发展的新趋势[3]。目的:本篇文章主要观察评价果酸(甘醇酸)治疗痤疮及痤疮后遗症(黑褐色色素沉着、凹陷性瘢痕,毛细血管扩张导致的红色印记)的临床有效性,明确果酸在临床上的适应症、方法及其安全性。方法:38例以面部皮损为主的痤疮患者,根据皮疹状况分别依次使用浓度为20%、35%、50%、70%的甘醇酸活肤液治疗4次,每次间隔2周,治疗前医生判断患者前次治疗时对果酸的耐受程度,决定是否提高果酸浓度。每次治疗前后对患者面部各类皮损进行计数、并对痤疮后遗症评分积分值做统计,同时在第3、6、9、12周通过比较治疗前后瘢痕大小及深浅度变化、色素沉着斑及红色印记减退程度,对果酸治疗面部痤疮及痤疮后遗症临床有效性做出客观评价。最后一次治疗结束后,医师对果酸治疗痤疮及痤疮后遗症客观满意程度与患者的主观满意程度(满意,良好,无效)的一致性做出评价。结果:本研究中38例患者均完成治疗,12例患者皮损完全消退达到痊愈,21例患者大部分皮损消退,2例患者仍有少量皮损,3例患者皮损以脓疱、结节、囊肿为主,治疗效果不明显。治疗总有效率达92.1%。将第3周与第12周治疗结束后比较,P0.005,差异有统计学意义;痤疮后瘢痕、色素沉着及红色印记积分与治疗前比较,明显降低,临床有效率显著,P0.005,差异有统计学意义。在治疗期间有8例患者分别表现出局部红肿、灼痛,治疗结束后部分患者有痂皮生成、脱屑等不良反应。结论:果酸治疗轻、中度面部痤疮及痤疮后遗症临床疗效显著,特别是非炎性皮损较炎性皮损对果酸反应性更好;临床应用比较安全,无严重副作用发生,患者客观评价满意。
[Abstract]:Background: fruit acid (伪-hydroxyacid, Alpha hydroxy acids,AHAs) is a carboxylic acid containing hydroxyl group in 伪 position. Nowadays, it is used in cosmetic dermatology to achieve cosmetic effect and treat all kinds of skin diseases. 伪-hydroxyacid can be extracted from natural pure plants such as fruit, and can also be synthesized artificially. Most of the fruits used today come from all kinds of fruits, such as glycolic acid from sugar cane, mandelic acid in almond and so on. Therefore, 伪-hydroxyacid is also called fruit acid. Nowadays, products containing fruit acid are quite popular, and their effects range from moisturizing, reducing wrinkles to chemical peeling of deep skin. Cosmetics include cream, moisturizing milk, toner, mask, cleanser, freckle and so on. According to the concentration of fruit acid products, consumers can use them on a daily basis, can be operated by dermatologists, or can be used in cosmetics research institutions [1, 2]. Glycolic acid (Glycolic acid GA), which is mainly used in this study, has the smallest molecular weight and simple molecular structure. At the same time, because the molecular structure contains hydroxyl groups, it is compatible with water and has high transdermal absorption, thus accelerating the replacement and metabolism of epidermis and dermis cells. It is effective for many dermatological diseases such as acne, keratosis, rose acne, photoaging dermatosis, chloasma and other pigmentation diseases. It can also be used as auxiliary treatment of ichthyosis, skin amyloidosis, melanosis and psoriasis. It is also a new trend in the field of medicine and cosmetic skin care in recent years. Objective: to observe and evaluate the clinical efficacy of fruit acid (glycolic acid) in the treatment of acne and acne sequelae (black brown pigmentation, concave scar, red imprinting caused by telangiectasia), and to clarify the clinical indication, method and safety of fruit acid. Methods: 38 patients with acne with facial lesions were treated with 20%, 35% and 50% respectively according to the condition of rash. 70% glycolic acid lotion was used for 4 times at intervals of 2 weeks. Before treatment, doctors judged the tolerance of patients to fruit acid during the previous treatment and decided whether to increase the concentration of fruit acid. All kinds of facial lesions were counted before and after each treatment, and the scores of acne sequelae were counted. At the same time, at the 3rd, 6th and 9th weeks, the changes of scar size and depth, pigmentation and red imprinting before and after treatment were compared to objectively evaluate the clinical effectiveness of fruit acid in the treatment of facial acne and acne sequelae. After the last treatment, doctors evaluated the consistency between the objective satisfaction of fruit acid in the treatment of acne and acne sequelae and the subjective satisfaction of the patients (satisfactory, good, ineffective). Results: in this study, 38 patients completed treatment, 12 patients recovered completely, 21 patients with most skin lesions disappeared, 2 patients still had a small amount of skin lesions, 3 patients with pustules, nodules and cysts, the therapeutic effect was not obvious. The total effective rate was 92.1%. At the end of the third week and the 12th week, the difference was statistically significant, and the scores of scar, pigmentation and red imprinting after acne were significantly lower than those before treatment, and the clinical effective rate was significantly higher than that before treatment, and the difference was statistically significant. During the treatment period, 8 patients showed local redness, swelling and burning pain, and some patients had adverse reactions such as scab formation and desquamation after treatment. Conclusion: the clinical effect of fruit acid in the treatment of mild to moderate facial acne and acne sequelae is remarkable, especially the responsiveness of non-inflammatory skin lesions to fruit acid is better than that of inflammatory skin lesions, and the clinical application is safe and no serious side effects occur, and the objective evaluation of the patients is satisfactory.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R758.733

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