面部痤疮、湿疹、黄褐斑及日光皮炎皮肤屏障功能评价及其临床意义

Evaluation of skin barrier function in patients with facial acne, eczema, melasma and solar dermatitis and its clinical significance

目的探讨痤疮、亚急性湿疹、黄褐斑及日光皮炎的皮肤屏障功能的差异。方法选损容性皮肤病300例，其中痤疮80例，亚急性湿疹80例；黄褐斑80例；日光皮炎60例。健康人60例为对照。运用德国Courage＋Khazaha公司的无创性皮肤生理功能测试仪，测量受试者面部皮肤的皮脂含量、角质层含水量和经表皮水分流失值（TWEL）。结果4种损容性皮肤病组与健康对照组相比，痤疮的皮脂含量及TWEL值较健康对照高，角质层含水量较健康对照低，差异有统计学意义（P〈0．01）。亚急性性湿疹、日光皮炎及黄褐斑的皮脂含量、角质层含水量均较健康对照组低，TWEL值均较健康对照高，差异有统计学意义（P〈0．01）。4种皮肤病组间进行比较，痤疮的皮脂含量比其他3组高，差异有统计学意义（P〈0．01），其余3组间皮脂含量差异无统计学意义（P〉0．05）；亚急性湿疹的角质层含水量比痤疮及黄褐斑低，差异有统计学意义（P〈0．01），与13光皮炎的角质层含水量相比，差异无统计学意义（P〉0．05）；日光皮炎的角质层含水量比痤疮及黄褐斑低，差异有统计学意义（P〈0．01）；痤疮的角质层含水量比黄褐斑低，差异有统计学意义（P〈0．01）；黄褐斑的TWEL值比其他3组低，差异有统计学意义（P〈0．01），其余3组TWEL值相比差异无统计学意义（P〉0.05）。结论4种损容性皮肤病皮肤屏障功能均存在损伤，提示恢复皮肤的屏障功能有助于治疗这4种损容性皮肤病。

Objective To compare skin barrier function among patients with facial acne, subacute eczema, melasma and solar dermatitis. Methods Three hundred patients, including 80 patients with facial acne, 60 subacute facial eczema, 80 facial melasma and 60 facial solar dermatitis, as well as 60 healthy controls were recruited in this study. Skin sebum content and transepidermal water loss （TEWL） were measured by a sebmeter and Tewameter TM 210 （Courage and Khazaka, Germany）, respectively. Stratum corneum hydration was measured with a Scalar Moisture Checker （Scalar Corporation, Japan）. Statistical analysis was carried out using analysis of variance and t test. Results Compared with the healthy controls, patients with facial ache showed increased skin sebum content and TEWL value but decreased stratum corneum hydration （all P 〈 0.01）, and patients with subaeute eczema, solar dermatitis and melasma displayed lower sebum content and stratum corneum hydration but higher TEWL value （all P 〈 0.01 ）. Skin sebum content was significantly higher in patients with facial acne than in patients with subacute eczema, solar dermatitis and melasma （（184.65 ± 83.07） vs. （21.86 ± 18.94）, （25.10 ±14.22） and （36.05±32.84） μg/cm2, all P 〈 0.01 ）, but was similar between the patients with subacute eczema, solar dermatitis and melasma （P〉 0.05）. In terms of stratum corneum hydration, patients with subacute eczema and solar dermatitis were statistically lower than those with acne and melasma （18.66% ± 7.85% and 20.91%±8.05% vs. 24.32%± 8.16% and 28.02%±4.67%, all P 〈 0.01 ）, patients with facial subacute eczema were similar to those with solar dermatitis （P 〉 0.05）, and patients with facial acne were statistically lower than those with melasma （P 〈 0.01 ）. TEWL value was significantly higher in patients with melasma than in patients with ache, solar dermatitis and subacute eczema （（13.80±4.13） vs. （20.86± 8.78）, （22.85 ± 9.84） and （22.48±10.37） μg/m2 h, all P 〈 0.01 ）, but similar between patients with acne, solar dermatitis and subacute eczema （P 〉 0.05）, Conclusions Skin barrier function is somewhat impaired in patients with facial acne, subacute eczema, melasma and solar dermatitis. Therefore, to recover skin barrier function may facilitate the treatment of these diseases.