30%浓过氧化氢溶液外涂治疗脂溢性角化病的半边皮损自身对照临床观察和机制研究

30%Concentrated Hydrogen Peroxide Solution Used Topically to Treat Seborrheic Keratosis in an Autologous Half-lesional Comparison

目的探索30%浓过氧化氢(HO)溶液外涂诱导脂溢性角化病(SK)皮损的清除机制与临床疗效。方法2020年9月—2021年5月自黄冈市中心医院皮肤科门诊招募62例病理确诊的SK患者,每例患者选取2个典型皮损。皮损一分为二,一半外涂医用白凡士林作自身阴性对照,另一半外涂30%HO溶液直至霜白色。2周涂药1次,共治疗3次。每次治疗前,数码相机摄像和皮肤镜观察皮损变化。依据皮损清除效率判定疗效。在接受第一次治疗后行皮肤活检切除一个完整SK皮损,进行HE染色和原位末端转移酶标记荧光染色(TUNEL)检测细胞凋亡。结果接受30%HO外涂SK皮损3次治疗,头皮、面颈部和躯干四肢皮损的清除率分别为83.3%、71.9%和45.8%;外涂药物时局部皮肤出现红斑水肿、刺痒或刺痛等可耐受的不良反应。30%HO处理皮损组织TUNEL法细胞凋亡染色结果显示治疗的皮损组织,凋亡细胞百分率为78%,而未治疗的皮损仅为5%。结论30%HO外涂可诱导SK增殖的表皮细胞发生凋亡,能在3周内清除SK皮损,是一种很有前途的替代传统有创治疗SK的方法。

Objective In order to investigate the effects and mechanism of 30%hydrogen peroxide solution(30%HO)in the treatment of seborrheic keratosis(SK)by an autologous half-lesional comparison.Methods Sixty-two patients with SK were recruited from the outpatient department of dermatology in Huanggang central hospital from Sept.2020 to May 2021.A typical lesion was selected for each patient,and the lesion was divided into two parts.Half of them was topically applied with medical-grade vaseline serving as self-negative control,and the other half was topically applied with 30%HOsolution,once every two weeks for three times.The changes of SK lesions were recorded using digital camera and dermatoscope at visit to estimate the clearance of skin lesions.The lesional skin was biopsied after the first topical administration with 30%HOsolution for hematoxylin-eosin staining(HE)and terminal-deoxynucleoitidyl transferase mediated nick end labeling(TUNEL)assay.Results The clearance rates of lesions on scalp,face and neck,as well as trunk and extremities were83.3%,71.9%and 45.8%,respectively after three treatments of 30%HO.Local skin side effects such as erythema,edema,itching,or mild pain were noted during topical administration and then disappeared spontaneously without any medical interventions.The percentage of apoptotic cells in 30%HO-treated lesional skin tissue was 78%,while that in untreated skin tissue was only 5%.Conclusion The complete removal of SK lesions is achieved with topically application of 30%HOsolution in three weeks,possibly by induction of keratinocyte apoptosis in SK lesions,which is a promising alternative to the traditional invasive treatments of SK.