Clinical and Biochemical Evaluation of Facial Acanthosis Nigricans

Background: Acanthosis nigricans is a well known cause of facial melanosis in Iraqi males and usually it is a part of ordinary acanthosis nigricans. It is commonly associated with many metabolic derangements. Objectives: To evaluate cases of acanthosis nigricans of the face for all metabolic disturbances including fasting blood sugar, fasting serum insulin, total cholesterol, triglyceride, growth hormone and serum leptin. Patients and Methods: Twenty seven cases of acanthosis nigricans of the face were included in this case descriptive, clinical and biochemical study. This was conducted in Department of Dermatology-Baghdad Teaching Hospital and Department of Clinical Biochemistry, College of Medicine, Baghdad, Iraq during the period from November 2012-August 2014. It consisted of 26 males and one female, their ages ranged from 16 - 58 (39 ± 4.9) years. The diagnosis was established by clinical and histopathological evaluation. Sharquie’s ANSI scoring of acanthosis nigricans of face was carried out for all patients, also body mass index was assessed. Biochemical evaluation was carried out for all patients including total cholesterol, triglyceride, fasting blood sugar and insulin, insulin resistance, growth hormone and leptin enzyme immunoassay. Twenty seven healthy control non obese individuals with comparable ages and gender were assessed for all tests. Results: Biochemical results showed that fasting blood glucose, fasting serum insulin, insulin resistance, fasting serum triglyceride, total cholesterol, growth hormone and serum leptin were statistically significantly high in patients with acanthosis nigricans of the face in comparison with control individuals and all were positively correlated with the scoring of acanthosis nigricans of the face apart from high density lipoprotein was negatively correlated. Conclusion: Acanthosis nigricans of the face is a good marker for the associated metabolic diseases and these metabolic changes were statistically significantly correlated with the severity of acanthosis nigricans.

持久性色素异常性红斑合并瑞尔黑变病1例

患者,女,58岁,颈部发黑8年,背部暗红色斑4年。颈部皮疹反射式共聚焦显微镜:表皮基底层色素未见明显增加,真皮浅层少许炎细胞及噬色素细胞浸润。背部皮疹组织病理:表皮基底细胞液化变性,真皮浅层色素颗粒及淋巴样细胞浸润。诊断:持久性色素异常性红斑合并瑞尔黑变病。

颧部褐青色痣黑素细胞特性及来源的研究

目的为了进一步证实颧部褐青色痣的组织病理特点,并初步探讨颧部褐青色痣黑素细胞的来源。方法选取颧部褐青色痣、皮内痣、蓝痣及黑变病标本各10例,所有病理切片标本均进行HE染色和免疫组化法检测CD68、S-100、Melan-A、NSE、C-Kit(CD117)在黑素细胞上的表达。结果①颧部褐青色痣的HE染色:在真皮浅层有散在的含黑素颗粒的梭形细胞分布,其细胞长轴与表皮平行,主要分布于真皮浅层。真皮含黑素颗粒细胞分为散在或弥漫的分布。②免疫组化:颧部褐青色痣、皮内痣和蓝痣各组中银染色、S-100、Melan-A、NSE、CD68免疫组化均为阳性,其中Melan-A染色在颧部褐青色痣和皮内痣组显示有表皮基底层黑素细胞增加;黑变病组仅有CD68阳性。C-kit阳性在颧部褐青色痣组有9例、蓝痣组有8例、皮内痣组有5例。结论颧部褐青色痣的表皮基底黑素细胞增加,真皮内既有黑素细胞,也有噬黑素细胞。其黑素细胞是一种具有痣细胞、神经嵴来源细胞及早期胚胎细胞的特性。

机械磨削术治疗瑞尔黑变病的疗效观察

目的:探讨机械磨削术治疗Riehl’s黑变病的临床疗效。方法:2010年2月-2018年10月笔者科室收治瑞尔黑变病患者8例,所有患者采用机械磨削治疗,均随访1年以上。利用5分法对机械磨削治疗的临床疗效进行评价,患者对治疗满意度进行评价。结果:8例Riehl’s黑变病患者,经治疗皮损均较治疗前消退75%以上,未见复发,7例非常满意,1例满意。不良反应均能耐受,主要为红斑、结痂及短暂的色素沉着。结论:机械磨削术治疗Riehl’s黑变病安全、有效。

痤疮涂膜剂联合氢醌乳膏治疗女子颜面黑变病疗效观察

目的:观察痤疮涂膜剂联合氢醌乳膏治疗女子颜面黑变病的临床疗效。方法:观察组26例,口服维生素C和维生素E,痤疮涂膜剂和氢醌乳膏联合外用;对照组26例,口服维生素C和维生素E,氢醌乳膏单独外用。12周后停药,对比两组疗效并评定。结果:观察组有效率92.3%,对照组有效率57.7%,两组比较差异有统计学意义(P<0.01)。结论:内服维生素C和维生素E,痤疮涂膜剂、氢醌乳膏联合外用治疗女子颜面黑变病,疗效明显,方法简单、无明显不良反应,患者依从性好,值得基层医师临床使用。

贾敏教授对瑞尔黑变病的临床证治经验

瑞尔黑变病依其外观表现与中医病“面尘”“黛黑斑”相类,贾敏教授认为此病主要病因病机为气血不足、肝肾阴虚。气血不足,无以上荣于面,而变为黧黑色;肝“体阴而用阳”,肝阴不足则肝之疏泄功能失常,气机不畅,瘀血内停,筋脉失养;肾阴不足,则水亏不能制火,血弱不能华肉,以致火烁结成黑斑,色枯不泽。补益气血、滋养肝肾之阴是基本治法。常用女贞子、墨旱莲等补益肝肾,黄芪、白术等益气,当归、川芎等补血;从中医的黑色主病归于肾,以及久病及肾的理论,提出肾阳虚可生黧黑的观点,并强调补肾阳在黧黑斑治疗中的重要性,故治疗时既滋养肾阴,同时亦重视温补肾阳,加用淫羊藿、补骨脂、肉苁蓉、锁阳等温补肾阳。

里尔黑变病辨治验案3则

黑变病（melanosis）是一组发生在身体暴露部位的弥漫性色素沉着性皮肤病,由于病因不同,命名也不同。里尔黑变病（Riehl’s melanosis）多见于青壮年妇女,表现为面部网状色素沉着,与化妆品等因素有关。本病属中医学＂黧黑斑＂＂面尘＂范畴[1-3]。《外科大成》载：＂黧黑斑多生女子之面,由血弱不华,火燥结成,疑事不决所致。宜服肾气丸以滋化源,洗玉容散,