【作者】 王娜；

【导师】 宋文英；

【作者基本信息】 广州中医药大学 ， 中医学， 2012， 硕士

【摘要】 背景：痤疮是一种毛囊、皮脂腺的慢性炎症性皮肤病,本病好发于颜面部、胸背部,以皮肤散在粉刺、丘疹、脓疱、结节及囊肿,伴皮脂溢出为临床特征,属中医学“肺风粉刺”、“酒刺”等范畴,是临床的常见病,多发病。根据国内外的研究报告,青春期痤疮的患病率高达70-80%,部分患者甚至由青春期持续到成年,而且治疗护理失当,会遗留疤痕等永久性皮肤损害,严重影响颜面美观,对青少年的身心健康都会带来不良影响。目前,西医治疗的药物主要有抗生素、抗角化药、抗雄性激素药、抑制皮脂腺分泌药、维生素等,疗效尚可,但都存在着一定的副作用。近年来,越来越多资料证明,中医药治疗痤疮具有疗效明显、副作用少等特点,外治法作为中医药一种重要方法,治疗痤疮有其独特作用。目的：观察中药熏蒸治疗寻常型痤疮的临床疗效,以探索一种经济、疗效可靠、副作用更小、适宜推广的外用治疗寻常型痤疮的方法。方法：所选80例患者均来源于广州中医药大学第一附属医院皮肤科门诊(2011年9月—2012年1月),符合寻常型痤疮诊断标准。患者年龄在15—45岁之间,男女不限。将80例患者随机分为两组：治疗组(痤疮方内服联合中药熏蒸),对照组(痤疮方内服联合阿达帕林凝胶外用),治疗组40例,对照组40例。两组均内服痤疮方,每次100ml,日两次,早晚饭后温服。另外,治疗组外用熏蒸方熏蒸每周2次,每次15分钟,对照组予阿达帕林凝胶日一次,每晚睡前外搽治疗。两组的总疗程均为6周。2、4、6周及完成治疗后2个月各随访一次,观察治疗前后两组皮损的变化,计算两组皮损评分疗效指数以及治疗中不良反应的发生率、复发率；检测两组患者治疗前后血清睾酮水平；从而作出疗效评价及安全性评价。结果：(1)经6周治疗后,治疗组有效率为85%；对照组有效率为82.5%,两组有效率比较差异无统计学意义(P>0.05)。提示熏蒸方熏蒸治疗对患者皮损的改善与阿达帕林凝胶相当。(2)两组间比较,治疗完成6周后,治疗组皮损评分与对照组相比,差异无统计学意义(P>0.05)。(3)测定治疗前后患者的血清睾酮(T)水平,经检验,两组患者治疗后血清T水平均较治疗前明显下降,有统计学差异(P<0.05)；对照组与治疗组治疗后血清T水平比较差异无统计学意义(P>0.05)。(4)对痊愈患者进行跟踪观察2个月,治疗组复发率为11.11%,对照组复发率为18.75%,差异无统计学意义(P>0.05)。(5)治疗组未见不良反应,对照组外用阿达帕林凝胶后有5例患者出现局部不良反应,发生率为12.5%,包括皮肤红斑干燥、脱屑、或灼烧感,多出现在用药的1-2周内,可耐受,不影响治疗。结论：中药熏蒸治疗寻常型痤疮的疗效与阿达帕林凝胶治疗寻常型痤疮的疗效相当,且尚未见不良反应。中药熏蒸治疗寻常型痤疮临床疗效确切,操作方法简单、安全,具有一定的可重复性和临床价值。更多还原

【Abstract】 Background:Aene vulgaris is a chronic and inflammatory skin disease involving in hair follice and sebaceous gland. It often occurs in the face, chest and back, The characteristic of Acne vulgaris is PaPules, pustule, node, cyst and seborrhea. In traditional chinese medicine, it is generally called as "lung-wind acne". It is common and frequently-occurring disease clinical. According to the research done in China and foreign countries, the prevalence of adolescent acne is80-90%. Some patients even suffer from adolescence to adulthood. The malpractice of acne will leave behind scarring and other permanent skin damage, seriously affecting the facial appearance. It affects both young people’s physical and mental health. The main drugs of treating acne include anti-androgen, drug which can restrict the secretion of sebaceous gland and anti-keratinization, antibiotics and vitamins etc, efficacy is acceptable but there are certain side effects. More and more information prove that chinese medicine treatment of acne has a curative effect and fewer side effects. External treatment as an important method of Chinese medicine has its own unique role in the treatment of acne.Objective:In order to explore a kind of economic, secure and equal to promotion treatment of traditional Chinese medicine, observing the curative effect of acne vulgaris treated by internal administration of herbal decoction.Methods:All of the80patients are selected from The Out-patient Department of Dermatology of Traditional Chinese Medicine Hospital which is the First Affiliated Hospital of Guangzhou University of TCM(from September,2011to January,2012). All the patients conform to the Diagnostic criteria of acne vulgaris. All Of the80patients who aged15to45and without limitation of sex were randomly assigned into two groups:the number of patients for experiment (Chinese medicine and modified suffocating with self-prescribed TCM drugs) and control group (Chinese medicine combined with Adapalene gel) were40and40. The cases were treated with Chinese medicine,100ml each time, twice e day, and taken warmly after breakfast and dinner. In observation group, was added self-prescribed TCM drugs, twice e week,15minutes each time. In control group, the cases combined with Adapalene gel used topically, once e day after dinner. The course of treatment are both6weeks. According to observing the variation of skin lesions on the2nd,4th,6th week,2months after completion of treatment and calculating the declined count, the evaluation index of skin, lesions as well as the incidence and recurrence rates of the adverse reaction during the treatmengt;Serum testosterone levels were detected before and after treatment;we evaluated the effect and security.Results:(1)After6weeks, the clinical efective rate of observation group was85%, compared with the clinical efective rate of control group was82.5%, The comparative differences between the observation group and the control group have no statistical significance (P>0.05). It prompt improvement of Chinese Medicine Steaming of skin lesions of patients with adapalene gel quite.(2) After been treated for6weeks, the evaluation indlx of skin is the same between in two groups, the observation group and the control group have no statistical significance (P>0.05).(3)Mesuring the serum testosterone leve of patients in two groups.The outcome revealed that setum T levels decreased dramatically than before, so there was statistical significance(P<0.05);and there was no statistical significance between the treatment group and the control group after treatment(P>0.05).(4) After2month of the stopping treatment, recall the crued patients of two groups, the reoccurrence rate of observation group was11.11%, and the control group was18.75%, comparative differences between the observation group and the control group have no statistical significance.(5) There was no adverse reaction in the treatment group, In control group,5patients had adverse reaction after using adapalene gel, the side-effect rate is12.5%. it was local adverse reaction including skin erythema, dry desquamation, or a burning sensation, and appearing in1to2weeks, but can be tolerated, does not affect the treatment. Conclusion:Chinese medicine steaming and Adapalene gel have the similar effect in treating acne vulgaris, and haven’t found side effect. It means that Chinese medicine steaming has certain curative effect in treating acne vulgaris, which is easy and safe to operate, and has certain repeatability and clinical value.更多还原