中西医结合联合强脉冲光治疗玫瑰痤疮的临床疗效

Clinical Effect:Combined Treatment of Rosacea with Traditional Chinese Medicines and Intense Pulsed Light

目的观察盐酸多西环素、中药外敷联合强脉冲光治疗玫瑰痤疮的临床疗效。方法选择2019年3月至2021年6月,玫瑰痤疮患者128例,采用随机数表法分为对照组和研究组,每组患者各64例。对照组口服盐酸多西环素并联合强脉冲光治疗;研究组在对照组基础上另给予中药外敷,两组均行强脉冲光治疗,先行波长590 nm治疗,脉宽25~40 ms,能量密度18~25 J/cm^(2);再行波长420 nm治疗,脉宽100~200 ms,能量密度8~10 J/cm^(2),共治疗3次,每次治疗间隔4周。口服盐酸多西环素、中药外敷治疗的疗程为3个月。治疗后3和6个月随访,记录两组中医症状积分、临床疗效,皮肤生理指标、蠕形螨虫率变化情况。治疗后6个月,比较两组患者的不良反应发生情况和复发率。结果两组治疗后3个月主症、次症中医证候评分均低于治疗前(P<0.05),研究组明显低于对照组(P<0.05)。治疗后3个月,研究组总有效率高于对照组(P<0.05),两组患者的角质层含水量均高于治疗前(P<0.05),研究组治疗后3个月的角质层含水量高于对照组(P<0.05);两组治疗后3个月的皮肤油脂、红斑指数均低于治疗前(P<0.05),研究组治疗后3个月的皮肤油脂、红斑指数低于对照组(P<0.05)。研究组治疗后3个月的蠕形螨虫阳性率低于对照组(P<0.05)。两组治疗期间总不良反应发生率比较,差异无统计学意义(P>0.05)。治疗后6个月研究组复发率低于对照组(P<0.05)。结论多西环素、中药外敷联合强脉冲光治疗玫瑰痤疮可增强治疗效果,改善皮肤生理功能,改善皮肤微生物环境,减小复发风险且安全性良好。

Objective To observe the effect to treat rosacea jointly with traditional Chinese medicines and intense pulsed light.Methods Totally 128 patients with rosacea treated during the period from Mar.2019 to Jun.2021 were selected and divided into a control group and study group,64 patients in each group.The patients in the control group were given oral doxycycline and intense pulsed light therapy,and those in the study group external application of traditional Chinese medicines in addition.The patients in both groups were treated with intense pulsed light twice at an interval of 4 weeks,and the course of treatment with oral doxycycline and external application lasted for 12 weeks.For both groups,the TCM symptom scores and clinical efficacy were recorded 3 months after the treatment,the skin physiological indexes,rate of Demodex,changes of inflammatory factors and recurrence during the follow-up period were also observed and recorded.Results After the treatment,the TCM syndrome scores of the main and secondary symptoms decreased(P<0.05)in both groups,which was more obvious in the research group(P<0.05).The total effective rate was higher in the study group than in the control group(P<0.05).The water content of stratum corneum after treatment in both groups was higher than that before the treatment(P<0.05),and the water content of the stratum corneum in the study group was higher than that in the control group after the treatment(P<0.05).The skin oil and erythema index after treatment in both groups were lower than those before the treatment(P<0.05),and the skin oil and erythema index in the study group were lower than the control group after the treatment(P<0.05).The positive rate of Demodex was lower in the study group than in the control group after the treatment(P<0.05).The Nod-like receptor protein 3(NLRP3),interleukin-37(IL-37)and cysteine protease-1(Caspase-1)after treatment in both groups were lower than those before the treatment(P<0.05).The levels of NLRP3,IL-37 and Caspase-1 were lower in the study group than in the control group(P<0.05).There was no significant difference in the incidence of total adverse reactions between the two groups(P>0.05).The recurrence rate of the study group was lower than that of the control group(P<0.05).Conclusions For the treatment of rosacea,the combination of traditional Chinese medicines and intense pulsed light will enhance the therapeutic effect,improve the physiological functions of skin,regulate the expression of inflammatory factors and reduce the risk of recurrence.