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Modern approaches to treatment of chronic spontaneous urticaria in adult patients 成人慢性自发性荨麻疹的现代治疗方法
Pub Date : 2020-07-10 DOI: 10.30978/ujdvk2020-2-34
O. Denysenko
Objective — to study and analyze thematic publications on aspects of etiopathogenesis and modern approaches to the treatment of chronic spontaneous urticaria in adult patients. Materials and methods. A study and analysis of current domestic and foreign publications was conducted on aspects of the etiopathogenesis and treatment of chronic urticaria, including the recommendations of the National Health Service of the United Kingdom (NHS, 2020) for the treatment of chronic spontaneous urticaria in adult patients, based on principles of evidence­based medicine. Results and discussion. According to domestic and foreign publications, urticaria affects about 15—20 % of the population, while in recent years the number of chronic forms of dermatosis resistant to treatment (registered in about 2 % of the population) is increasing, which reduces the capability for work and quality of life of patients. In more than half of the patients the probable cause of chronic urticaria cannot be determined, which indicates the development of a spontaneous (idiopathic) form of dermatosis. First­line drugs for the treatment of chronic urticaria are non­sedative H1­antihistamines of the second generation, which, however, in many patients do not provide a positive clinical effect in standard doses. In the European recommendations, to increase the effectiveness of treatment of patients with torpid forms of chronic urticaria, it is proposed to increase the daily dose of antihistamines by 4 times. According to NHS recommendations (2020), created on evidence­based medicine, adult patients with chronic spontaneous urticaria are recommended to use a cost­ and clinically effective second­generation antihistamine cetirizine as first­line therapy which is prescribed step by step with increasing daily dose by 2—4 times. Conclusions. Chronic urticaria is a serious medical and social problem today. More than half of patients with chronic urticaria are those having spontaneous (idiopathic) form of dermatosis. H1­antihistamines of the second generation are the first­line therapy for chronic urticaria, but due to the lack of a positive effect in some patients when using their standard doses, it is recommended to increase their daily doses by 4 times. According to NHS recommendations (2020), adult patients with chronic spontaneous urticaria are recommended an efficient and cost­effective second­generation antihistamine cetirizine as first­line (dose­increasing) therapy.
目的:研究和分析关于成人慢性自发性荨麻疹发病机制和现代治疗方法的专题出版物。材料和方法。基于循证医学原则,对目前国内外关于慢性自发性荨麻疹发病和治疗方面的文献进行了研究和分析,包括英国国家卫生服务体系(NHS, 2020)关于成人慢性自发性荨麻疹治疗的建议。结果和讨论。根据国内外出版物,荨麻疹影响约15 - 20%的人口,而近年来,对治疗产生抗药性的慢性皮肤病(约占人口的2%)的数量正在增加,这降低了患者的工作能力和生活质量。在超过一半的患者慢性荨麻疹的可能原因不能确定,这表明自发性(特发性)形式的皮肤病的发展。治疗慢性荨麻疹的一线药物是非镇静的第二代h1 -抗组胺药,然而,在许多患者中,标准剂量不能提供积极的临床效果。在欧洲的建议中,为了提高治疗迟钝型慢性荨麻疹患者的有效性,建议将抗组胺药的日剂量增加4倍。根据基于循证医学的NHS建议(2020年),建议慢性自发性荨麻疹成年患者使用成本高且临床有效的第二代抗组胺药西替利嗪作为一线治疗方法,逐步处方,每日剂量增加2-4倍。结论。慢性荨麻疹是当今严重的医学和社会问题。超过一半的慢性荨麻疹患者患有自发性(特发性)皮肤病。第二代h1 -抗组胺药是慢性荨麻疹的一线治疗药物,但由于部分患者在使用标准剂量时缺乏积极作用,建议每日剂量增加4倍。根据NHS的建议(2020),慢性自发性荨麻疹的成年患者被推荐使用有效且具有成本效益的第二代抗组胺药西替利嗪作为一线(剂量递增)治疗。
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引用次数: 0
To compare the clinical effectiveness of azithromycin vs doxycycline on the first follow-up visit of acne vulgaris patients 比较阿奇霉素与多西环素在寻常痤疮患者首次随访中的临床疗效
Pub Date : 2020-06-30 DOI: 10.15406/jdc.2020.04.00155
G. Butt
Acne Vulgaris is a chronic inflammatory disorder of pilosebaceous unit which frequently affects the cosmetically important areas of the body like face, back, chest, neck, and upper arms. It is a multifactorial disease and its pathophysiology centres on the interplay of increased sebum production, follicular hyperkeratinisation, colonization with Propionibacterium Acnes and inflammation. There are many systemic modalities for the treatment of acne among which Azithromycin and Doxycycline are the commonly prescribed ones. With an aim to manage patients effectively a case-control study was conducted on 70 patients to compare the clinical effectiveness of both the drugs for the early symptomatic relief of moderate to severe inflammatory acne. Method This study was conducted at the outdoor of dermatology department at Punjab Rangers Teaching Hospital over a period of three months starting from August 2019 till the end of October. A total of 70 acne patients compatible with the inclusion criteria were enrolled and divided into two equal groups of cases and controls. The cases were prescribed Azithromycin 500mg once a day for first two weeks followed by 250mg once a day for the next two weeks, while the controls were prescribed Doxycycline 100 mg once a day. Both groups were treated for a period of four weeks and were assessed based on new lesion count and the settlement of older lesions to compare the clinical effectiveness of each drug. Results Based on the clinical assessment at the first follow-up after 4 weeks, it was observed that in the Azithromycin group 21 patients (60%) showed a good response with (more than 50%) clearance of the inflammatory pustules and nodules, 9 (26%) patients showed a moderate response between 30-50% and 5 (14%) patients showed a mild response between 20-30%. In Group B, 12 (34%) patients showed moderate response between 30- 50%, 12 (34%) patients showed mild response between 20-30%, while the remaining 11 (32%) patients were placed in the no response category with less than 20% improvement. Overall Azithromycin showed significantly better response, p-value < 0.001 than other group, p-value=0.014. Conclusion It was observed that Azithromycin has an earlier onset of action in the treatment of inflammatory acne as compared to Doxycycline. So, for patients where prompt results are desired Azithromycin has proven to be more effective as compared to Doxycycline.
寻常痤疮是一种毛囊皮脂腺单位的慢性炎症性疾病,经常影响身体的美容重要部位,如面部、背部、胸部、颈部和上臂。它是一种多因素疾病,其病理生理学中心是皮脂分泌增加、毛囊角化过度、痤疮丙酸杆菌定植和炎症的相互作用。痤疮的治疗有许多系统的方式,其中阿奇霉素和强力霉素是常用的处方。为了有效管理患者,我们对70例患者进行病例对照研究,比较两种药物对中重度炎性痤疮早期症状缓解的临床疗效。方法本研究于2019年8月至10月底在旁遮普省游骑兵教学医院皮肤科室外进行,为期3个月。符合纳入标准的痤疮患者共70例,分为病例组和对照组两组。前两周给予阿奇霉素500mg / d,后两周给予250mg / d,对照组给予强力霉素100mg / d。两组均治疗4周,根据新发病灶计数和老发病灶沉降情况进行评估,比较两种药物的临床疗效。结果根据4周后第一次随访的临床评估,观察到阿奇霉素组21例(60%)患者表现出良好的反应,炎症性脓疱和结节的清除率超过50%,9例(26%)患者表现出30-50%的中度反应,5例(14%)患者表现出20-30%的轻度反应。在B组中,12例(34%)患者表现为30- 50%的中度缓解,12例(34%)患者表现为20-30%的轻度缓解,而其余11例(32%)患者被置于无缓解类别,改善幅度小于20%。阿奇霉素整体疗效显著较好,p值<p值=0.014。结论与多西环素相比,阿奇霉素治疗炎性痤疮起效早。因此,对于那些希望得到即时结果的患者,阿奇霉素已被证明比强力霉素更有效。
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引用次数: 1
Differences between family doctors and dermatologists in the diagnosis of potentially transmissible skin diseases among pool swimmers 家庭医生和皮肤科医生在泳池游泳者中潜在传染性皮肤病诊断的差异
Pub Date : 2020-03-02 DOI: 10.15406/jdc.2020.04.00146
P. Iordanis
Introduction Due to the difficult financial conditions in Greece most of the prospective swimmers do not go to the dermatologist for their medical report regarding transmissible dermatological diseases They receive this report from their family doctors The purpose of this study was the evaluation of the ability of other specialties on recognizing and diagnosing transmissible dermatological diseases of swimmers nbsp Methods A total of people were examined The first group consisted of people who were examined for the first time in the medical office of the swimming pool and had no medical report about a transmissible dermatological disease The second group consisted of the remaining people who had a recent medical report from a family doctor certifying that they did not suffer from a transmissible dermatological disease nbsp Results The of the first group had some potentially transmissible dermatological disease while the corresponding percentage of the second group was Virtually one in two swimmers of the second group suffered from a potentially transmissible dermatological disease and had been diagnosed as healthy by a family doctor nbsp Conclusions There are issues with the diagnosis of dermatological diseases by non dermatologists since some lesions might not be recognized by General Practitioners or family doctors The reason for that might be the difficulty in the diagnoses of the dermatological diseases the training of other specialties in dermatological lesions and the financial status of the people examined nbsp nbsp Methods A total of people were examined The first group consisted of people who were examined for the first time in the medical office of the swimming pool and had no medical report about a transmissible dermatological disease The second group consisted of the remaining people who had a recent medical report from a family doctor certifying that they did not suffer from a transmissible dermatological disease nbsp Results The of the first group had some potentially transmissible dermatological disease while the corresponding percentage of the second group was Virtually one in two swimmers of the second group suffered from a potentially transmissible dermatological disease and had been diagnosed as healthy by a family doctor nbsp Conclusions There are issues with the diagnosis of dermatological diseases by non dermatologists since some lesions might not be recognized by General Practitioners or family doctors The reason for that might be the difficulty in the diagnoses of the dermatological diseases the training of other specialties in dermatological lesions and the financial status of the people examined nbsp
由于希腊的经济条件困难,大多数潜在的游泳者不会去皮肤科医生那里获得关于传染性皮肤病的医疗报告,他们从家庭医生那里得到这份报告。本研究的目的是评估其他专业对游泳者传染性皮肤病的识别和诊断能力首次在医学检查游泳池和办公室没有医学报告的第二组由传染性皮肤病其余人从家庭医生医疗最近的一份报告证明他们没有患有传染性皮肤病中结果第一组有一些潜在的传染性皮肤疾病,而第二组的相应比例实际上是一个在吗结论非皮肤科医生对皮肤病的诊断存在问题,部分病变可能未被全科医生或家庭医生发现,其原因可能与皮肤科疾病的诊断困难、其他专科对皮肤科病变的培训和临床经验等因素有关财务状况的人们检查方法共有人盼检查第一组由人首次检查诊所的游泳池和没有医学报告的第二组由传染性皮肤病其余人从家庭医生医疗最近的一份报告证明他们没有患有传染性皮肤病第一组的结果第二组游泳者中,几乎每两个游泳者中就有一个患有潜在传染性皮肤病,并被家庭医生诊断为健康。结论非皮肤科医生对皮肤病的诊断存在问题,因为一些病变可能未被全科医生或家庭医生发现皮肤科疾病诊断的困难、其他专业在皮肤科病变方面的培训以及被检查人员的经济状况
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引用次数: 1
Neutrophilic dermatoses: Sweet syndrome and gangrenous pyoderma. Literature review and own clinical observations 中性粒细胞性皮肤病:甜综合征和坏疽性脓皮病。文献回顾和自己的临床观察
Pub Date : 2020-02-06 DOI: 10.30978/ujdvk2020-1-103
Y. Yehudina, S. Trypilka, I. Golovach
Neutrophilic dermatoses are a heterogeneous group of inflammatory skin diseases that have unique clinical features, but are combined by the presence of a sterile, predominantly neutrophilic infiltrate at histopathological examination. Neutrophilic dermatoses include Sweet syndrome, gangrenous pyoderma, Behcet’s disease, neutrophilic urticaria, subcorneal pustular dermatosis, palmoplantaris pustulosis, acrodermatitis Allopo, acute generalized exentematous pustulosis, infant pustulosis, etc. The morphology of skin lesions associated with these diseases is heterogeneous, which makes diagnosis challenging. In addition, a thorough clinical evaluation of patients is necessary to exclude diseases that mimic these disorders and to diagnose potential concomitant infectious, inflammatory, and tumor processes. While some neutrophilic dermatoses may disappear spontaneously, most require treatment to achieve remission. A delay in diagnosis and treatment can lead to significant morbidity and even mortality in these patients. Glucocorticoids are the drugs of choice for the treatment of neutrophilic dermatoses. In case of their ineffectiveness, other biological disease-modifying antirheumatic drugs may be administered depending on the severity of the skin lesion, chronicity of the disease, the presence of systemic lesions, and refractory status. This work is devoted to epidemiology, etiopathogenesis, clinical features, diagnostic signs and modern methods of treating Sweet syndrome and gangrenous pyoderma based on a review of modern literature and our own clinical observations.
中性粒细胞性皮肤病是一种异质性的炎症性皮肤病,具有独特的临床特征,但在组织病理学检查中表现为无菌的,主要是中性粒细胞浸润。中性粒细胞性皮肤病包括甜综合征、坏疽性脓皮病、白塞病、中性粒细胞性荨麻疹、角膜下脓疱性皮肤病、掌跖性脓疱病、异位性肢端皮炎、急性广泛性脓疱病、婴儿脓疱病等。与这些疾病相关的皮肤病变形态是异质的,这使得诊断具有挑战性。此外,对患者进行彻底的临床评估是必要的,以排除类似这些疾病的疾病,并诊断潜在的伴随感染、炎症和肿瘤过程。虽然一些中性粒细胞性皮肤病可能会自发消失,但大多数需要治疗才能缓解。诊断和治疗的延误可能导致这些患者的严重发病率甚至死亡率。糖皮质激素是治疗中性粒细胞性皮肤病的首选药物。在它们无效的情况下,根据皮肤病变的严重程度、疾病的慢性、是否存在全身病变和难治性,可以使用其他生物疾病缓解抗风湿药物。本文在回顾现代文献和本人临床观察的基础上,对甜证和坏疽性脓皮病的流行病学、发病机制、临床特征、诊断征象和现代治疗方法进行了综述。
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引用次数: 0
Detrimental effects of perfumes, aroma & cosmetics 香水、香料和化妆品的有害影响
Pub Date : 2020-01-01 DOI: 10.15406/JDC.2020.04.00149
M. Athar
Perfumes have been historically used primarily for fragrance. Aroma or fragrance has also been added to the cosmetics to make it more attractive. These fragrance products emit a range of chemicals including hazardous pollutants but the ingredients do not fully disclosed on the product label. Hence, they are found to cause various detrimental effects ion human health. The detrimental effects associated with the use of perfumes are contact dermatitis, contact urticaria, and photo allergy and photo toxicity. Detrimental effects of cosmetics are lungs disease, damage to reproductive organs, skin allergies, excessive hair problems, headache and cancer. The present review summarizes some of the harmful effects caused by the use of fragrance products including perfumes, aroma and cosmetics. Moreover, the preventive measures which have to be taken care of have also been discussed.
历史上,香水主要用于制造香味。香气或香味也被添加到化妆品中,使其更具吸引力。这些香精产品会释放出包括有害污染物在内的一系列化学物质,但产品标签上并没有完全披露其成分。因此,它们被发现对人体健康造成各种有害影响。与使用香水有关的有害影响是接触性皮炎、接触性荨麻疹、光过敏和光毒性。化妆品的有害影响包括肺部疾病、生殖器官损伤、皮肤过敏、头发过多、头痛和癌症。本文综述了香精产品的使用对人体健康的危害,包括香水、香精和化妆品。此外,还讨论了必须注意的预防措施。
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引用次数: 1
A case series of dupilumab-treated atopic dermatitis resulting in new onset psoriasis 杜匹单抗治疗的特应性皮炎导致新发牛皮癣的病例系列
Pub Date : 2020-01-01 DOI: 10.15406/jdc.2020.04.00158
Lauren Boudreaux
Five male patients age ranged from 30-69 were each diagnosed with moderate-to-severe AD. They were initially treated with traditional topical and systemic therapies for atopic dermatitis such as topical steroids, calcineurin inhibitors, and oral immune suppressants. Ultimately, all patients required dupilumab with improvement noted in their first few months of treatment. Psoriaform dermatitis presented at varying timelines. In 4/5 cases, the diagnosis of presumed druginduced psoriasis was supported with biopsies and pathology consistent with the morphologic changes noted in clinic (Figure 1). In 4/5 cases patients were able to fully recover from psoriaform plaques when dupilumab was discontinued. In some cases, patients were able to restart Dupilumab without reoccurrence of psoriaform findings. However, in one case, the rash persisted despite several treatment attempts. (Table 2).
5名年龄在30-69岁之间的男性患者被诊断为中度至重度AD。他们最初接受传统的局部和全身治疗特应性皮炎,如局部类固醇、钙调磷酸酶抑制剂和口服免疫抑制剂。最终,所有患者都需要dupilumab,并在治疗的前几个月得到改善。银屑病性皮炎出现在不同的时间线。在4/5的病例中,推测为药物性银屑病的诊断得到了与临床形态学变化一致的活检和病理的支持(图1)。在4/5的病例中,停用杜匹单抗后,患者能够从银屑病斑块中完全恢复。在某些情况下,患者能够重新开始Dupilumab而不会出现银屑病症状。然而,在一个病例中,尽管多次治疗尝试,皮疹仍然存在。(表2)。
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引用次数: 1
Microneedling with radiofrequency for improvement in neck skin laxity and texture 微针射频改善颈部皮肤松弛和质地
Pub Date : 2020-01-01 DOI: 10.15406/JDC.2020.04.00145
Joely Kaufman
In recent years, the number of patients presenting with neck rhytides has been increasing. This increase is in part due to the availability of newer non-invasive technology to treat the normal aging process, but also due to the postural and behavioral changes of this generation where people adopt a head down posture in order to be able to use their computers or smartphones. We present the successful treatment of a case of anterior neck skin laxity and texture with microneedling and radiofrequency.
近年来,出现颈部心律失常的患者数量不断增加。这种增长部分是由于新的非侵入性技术的可用性来治疗正常的衰老过程,但也由于这一代人的姿势和行为的变化,人们采用头朝下的姿势,以便能够使用他们的电脑或智能手机。我们提出了一个成功的治疗病例的前颈部皮肤松弛和纹理微针和射频。
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引用次数: 0
Hyperimmunoglobulin E syndrome associated with nephrotic syndrome–case report 高免疫球蛋白E综合征伴肾病综合征1例报告
Pub Date : 2020-01-01 DOI: 10.15406/JDC.2020.04.00168
S. Elfaituri
A 3 years old child with coarse facial appearance was suffered from generalized eczema associated with secondary infections and recurrent multiple skin abscesses since he was 1 year old. The dermatitis and infections was present to some degree at all times. The patient had wheezy chest, food (cow milk) allergy and recurrent attacks of otitis media, candidiasis and herpes simplex virus infection with Kaposi varicelliform eruption. There was positive consanguinity between parents and positive family history with his older brother -5 years old, had similar disease. Routine blood counts revealed leukocytosis with persistent eosinophilia (40%).Blood chemistry was normal. The serum IgE level was11.000IU/ml with normal levels of other immunoglobulin classes.
一名面部粗糙的3岁儿童,自1岁起患有全身湿疹并继发感染和复发性多发性皮肤脓肿。皮炎和感染在任何时候都不同程度地存在。患者有胸鸣、食物(牛奶)过敏,中耳炎、念珠菌病、单纯疱疹病毒感染反复发作,伴卡波济水痘样疹。父母间有阳性血缘关系,与哥哥-5岁,有类似疾病,家族史阳性。常规血球计数显示白细胞增多伴持续性嗜酸性粒细胞增多(40%)。血液化学正常。血清IgE水平为11.000 iu /ml,其他免疫球蛋白类正常。
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引用次数: 0
Comparative study on the effect of solar radiation on workers’ skin at different altitudes 不同海拔高度太阳辐射对工人皮肤影响的比较研究
Pub Date : 2020-01-01 DOI: 10.15406/jdc.2020.04.00142
P. Iordanis
A great part of the Greek population works in the agriculture economy related to agriculture, livestock and fisheries. According to the Hellenic Statistical Authority, in 2013, the agriculture economy employed 1.218.000 people of which 939.000 were exclusively employed in this domain. A basic source of the Greek economy is tourism, especially in the summer months, with the number of workers in the sector reaching 400,000 in 2017. Therefore, it can be stated that approximately 1,600,000 Greek residents work either year-round or seasonal and especially in summer in outdoor work exposed to the sunlight radiation. The total number of sunny days in the country during a calendar year is large.
希腊人口的很大一部分从事与农业、畜牧业和渔业有关的农业经济。根据希腊统计局的数据,2013年,农业经济雇佣了121.8万人,其中93.9万人专门从事这一领域的工作。希腊经济的一个基本来源是旅游业,尤其是在夏季,2017年该行业的工人人数达到40万。因此,可以这样说,大约有160万希腊居民全年或季节性工作,特别是在夏季,他们从事暴露在阳光辐射下的户外工作。在一个日历年里,这个国家的晴天总数很大。
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引用次数: 2
Pasini-Pierini’s atrophoderma and frontal fibrosing alopecia: an unusual association in a young patient 帕西尼-皮里尼萎缩皮病和额部纤维化性脱发:一个不寻常的关联在一个年轻的病人
Pub Date : 2020-01-01 DOI: 10.15406/jdc.2020.04.00140
A. Rasso, Z. Douhi, M. Bennani, S. Elloudi
A young woman of 38 years old, followed for fibrosing frontal alopecia under topical coricide, she had presented hypo pigmented macules at the abdominal level, back and thigh, whose histology had concluded a Pasini-Pierini atrophodermia. The association between fibrosing frontal alopecia and Pasinipierini atrophodermia is to our knowledge never described, whose physiopathology is unknown need more studies to explain this association
一名38岁的年轻女性,在局部治疗下因前部纤维化性脱发而随访,她在腹部、背部和大腿表现出低色素斑,其组织学结论为帕西尼-皮里尼萎缩性皮肤病。据我们所知,纤维化性额部脱发和帕西尼皮里尼型萎缩症之间的联系从未被描述过,其生理病理尚不清楚,需要更多的研究来解释这种联系
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引用次数: 0
期刊
Ukrainian Journal of Dermatology, Venerology, Cosmetology
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