皮肤镜在治疗面部脂溢性皮炎疗效观察中的应用

The application of dermoscopy in the curative effect evaluation of facial seborrheic dermatitis

目的借助皮肤镜观察评估药物和光电治疗面部脂溢性皮炎的临床疗效。方法72例面部脂溢性皮炎患者采取随机单盲法分为药物组37例、光电组35例,分别接受他克莫司软膏和Q开关1064nm激光大光斑低能量治疗,疗程3个月。治疗前后均采集皮肤镜图像,比较治疗前、治疗后1个月和4个月临床表现及皮肤镜图像的改变。结果最终完成临床观察62例,药物组30例、光电组32例。药物组患者接受治疗后皮损好转明显,皮肤镜下观察结果与临床观察结果一致,且发现他克莫司软膏在血管、鳞屑方面疗效肯定,但对于脂溢改善疗效欠佳:光电组患者接受治疗后,皮损亦明显好转,皮肤镜下观察发现Q开关1064 nm Nd:YAG激光对脂溢改善疗效较好,但对脱屑改善不明显,虽对血管有损伤作用,但目前机制不明。结论皮肤镜作为一种无创、便捷的辅助检查和诊断手段,在面部脂溢性皮炎疗效判定和评估方面具有敏感、客观、准确作用。

Objective To explore the application value of dermoscopy in the evaluation of therapeutic effect of seborrheic dermatitis treated by tacrolimus ointment and laser. Methods A total of 72 patients who were diagnosed as seborrheic dermatitis were divided into the drug group(37 cases) and the laser group(35 cases) randomly. The drug group were treated with tacrolimus ointment and the laser group were given large spots low-energy Q-switch 1064 nm Nd:YAG laser treatment respectively for 3 months. The clinical manifestations and the dermoscopy images were collected and compared between the two groups before, 1 and 4 months after the treatment. Results A total of 62 patients, with 30 cases in drug group and 32 cases in laser group, finished the study. For the patients in the drug group, the skin lesion improved significantly. The results of dermoscopic observation were consistent with the clinical manifestations. It was found that tacrolimus ointment had a positive effect on blood vessels and scales, but it was not effective for seborrhoea. For the patients in the laser group, the conditions also improved significantly, and the Q-switch 1064 nm Nd:YAG laser was found to have a better effect on seborrheic conditions, but have no significant effect on improving desquamation, and although the laser treatment had a damaging effect on blood vessels, the mechanism is still unknown currently. Conclusion Dermoscopy, as a non-invasive and convenient auxiliary examination and diagnosis method, may help the clinicians make sensitive, objective and accurate assessments of the curative effect of facial seborrheic dermatitis.