外用水杨酸在玫瑰痤疮治疗中的应用效果研究

The Study on Topical Salicylic Acid in Rosacea Therapy

目的:评价外用2%水杨酸联合30%水杨酸化学剥脱术对玫瑰痤疮患者皮肤炎症反应及皮肤屏障的作用。方法:采用自身左右脸对照研究方式,在23例丘疹脓疱型玫瑰痤疮患者治疗侧外用2%水杨酸产品,并于第1周和第4周进行2次30%水杨酸化学剥脱术;对照侧不予治疗。在第0、1、4、7周进行随访,通过炎症性皮损计数、临床医师红斑评估量表及MX18测定的皮肤红斑指数E值来判断皮肤炎症反应程度。通过测定皮肤角质层含水量、经皮失水量、皮肤pH值等皮肤屏障相关指标观察水杨酸对表皮通透屏障的影响。结果:水杨酸侧红斑E值在第0、4、7周分别为441±84、381±71、377±67,在4周及7周时下降程度均显著高于对照侧(第0、4、7周分别为436±83、416±73、403±77,P<0.05);水杨酸侧红斑程度评分在第0、4、7周分别为2.7±0.8、1.5±0.6、1.3±0.6,在7周时评分下降程度明显高于对照侧(第0、4、7周评分分别为2.6±1.1、1.9±0.7、1.9±0.7,P<0.05);水杨酸侧皮肤角质层含水量在第0、4、7周分别为(45.9±14.3、56±15.6、61.5±10.5)CU,4周和7周升高程度均显著高于对照侧(第0、4、7周分别为49.3±15.5CU、53.7±14.7CU、58.1±11.7CU,P<0.05)。治疗前后,炎症性皮损、经皮失水量、皮肤pH值等相关指标在治疗侧较对照侧改善更明显,但差异无统计学意义(P>0.05)。大部分患者对水杨酸化学剥脱术及外用含水杨酸产品耐受良好,化学剥脱术时有1例患者出现重度刺痛及烧灼感,缩短时间后缓解。结论:外用2%水杨酸联合30%水杨酸化学剥脱术具有良好耐受性,可改善丘疹脓疱型玫瑰痤疮患者皮肤炎症反应,缓解皮肤干燥症状,临床上可作为辅助治疗手段。

Objective To investigate the efficacy and safety of topical using 2% salicylic acid product and 30% salicylic acid peeling in rosacea patients. Methods 23 patients fulfilled the diagnostic criteria of papulo-pustular rosacea were included in the study. In this split face study, 2% topical salicylic acid product and 30% salicylic acid peeling were randomly applied on the treated side of the face. All the patients were followed up on week 0、1、4 and week 7. According to the number of inflammatory lesions, the subjective assessment of erythema severity by investigator and E value measured by MX18, we can evaluate the degree of inflammation. The water content in the stratum corneum, pH value and trans-epidermal water loss(TEWL) were measured to assess the barrier function. Results The treatment side erythema E index on week 0,4 and 7 were 441±84,381±71,377±67,the descent degree was significantly higher than that on the control side on week 4 and 7( on week 0,4,week 7 were 436±83,416±73,403±77, P <0.05);The clinical erythema assessment scores on treatment side were 2.7±0.8,1.5±0.6,1.3±0.6, the descent degree was significantly higher than that on the control side on week 7(on week 0,4 and week 7 were 2.6±1.1,1.9±0.7,1.9±0.7, P <0.05);The water content of the treatment side on week 0、4、7 were(45.9±14.3,56±15.6,61.5±10.5) CU, the rising degree was significantly higher than that on the control side on week 4 and week 7(water content on week 0,4,7 were(49.3±15.5,53.7±14.7,58.1±11.7) CU, P<0.05). The number of inflammatory lesions, TEWL and pH value on the treated side were better improved than those on the control side, but without significant differences(P>0.05). Most of the patients tolerated the treatment very well, only one patient felt severe pain and burning during the first peeling procedure, which remitted after cutting down the peeling duration. Conclusion The regimen of topical usage of 2% salicylic acid product and 30% salicylic acid peeling in this study were well tolerated in papulopustular rosacea patients, it can improve the inflammation and alleviate the dryness. Topical salicylic acid can be a useful conjunctive treatment in rosacea.