【摘要】：背景:果酸(α-羥基酸,Alpha hydroxy acids,AHAs)是在α位含有羥基的羧酸,現(xiàn)今在美容皮膚科用其達(dá)到美容功效與治療各種皮膚病,化妝品配方中亦經(jīng)常應(yīng)用。α-羥基酸可以提取自天然的純植物如水果,亦可人工合成,現(xiàn)今使用的大多來自各種水果,如來自甘蔗的甘醇酸即羥基乙酸、扁桃中的扁桃酸等,故α-羥基酸又稱之為果酸。如今含有果酸的產(chǎn)品相當(dāng)流行,其作用從皮膚保濕、減輕皺紋到深部皮膚化學(xué)剝脫�；瘖y品類的有霜、保濕乳、爽膚水、面膜、潔面類、祛斑類等等。果酸產(chǎn)品根據(jù)濃度,消費(fèi)者可以日常使用、可以由皮膚科專業(yè)醫(yī)師操作使用、也可用于化妝品研究機(jī)構(gòu)[1,2]。本研究中主要使用的甘醇酸(Glycolic acid GA)是果酸中分子質(zhì)量最小的,其分子結(jié)構(gòu)簡單,同時(shí)因?yàn)榉肿訕?gòu)型式中含有羥基,因此與水能較好相容,透皮吸收較高,進(jìn)而加速表皮及真皮細(xì)胞的更替及代謝。對(duì)于皮膚科多種疾病如痤瘡、各種角化性疾病、玫瑰痤瘡、光老化性皮膚病,黃褐斑等色素沉著性疾病均有效,也可作為魚鱗病、皮膚淀粉樣變性、黑變病、銀屑病的輔助治療,同時(shí)也是近年來醫(yī)學(xué)及美容護(hù)膚領(lǐng)域發(fā)展的新趨勢(shì)[3]。目的:本篇文章主要觀察評(píng)價(jià)果酸(甘醇酸)治療痤瘡及痤瘡后遺癥(黑褐色色素沉著、凹陷性瘢痕,毛細(xì)血管擴(kuò)張導(dǎo)致的紅色印記)的臨床有效性,明確果酸在臨床上的適應(yīng)癥、方法及其安全性。方法:38例以面部皮損為主的痤瘡患者,根據(jù)皮疹狀況分別依次使用濃度為20%、35%、50%、70%的甘醇酸活膚液治療4次,每次間隔2周,治療前醫(yī)生判斷患者前次治療時(shí)對(duì)果酸的耐受程度,決定是否提高果酸濃度。每次治療前后對(duì)患者面部各類皮損進(jìn)行計(jì)數(shù)、并對(duì)痤瘡后遺癥評(píng)分積分值做統(tǒng)計(jì),同時(shí)在第3、6、9、12周通過比較治療前后瘢痕大小及深淺度變化、色素沉著斑及紅色印記減退程度,對(duì)果酸治療面部痤瘡及痤瘡后遺癥臨床有效性做出客觀評(píng)價(jià)。最后一次治療結(jié)束后,醫(yī)師對(duì)果酸治療痤瘡及痤瘡后遺癥客觀滿意程度與患者的主觀滿意程度(滿意,良好,無效)的一致性做出評(píng)價(jià)。結(jié)果:本研究中38例患者均完成治療,12例患者皮損完全消退達(dá)到痊愈,21例患者大部分皮損消退,2例患者仍有少量皮損,3例患者皮損以膿皰、結(jié)節(jié)、囊腫為主,治療效果不明顯。治療總有效率達(dá)92.1%。將第3周與第12周治療結(jié)束后比較,P0.005,差異有統(tǒng)計(jì)學(xué)意義;痤瘡后瘢痕、色素沉著及紅色印記積分與治療前比較,明顯降低,臨床有效率顯著,P0.005,差異有統(tǒng)計(jì)學(xué)意義。在治療期間有8例患者分別表現(xiàn)出局部紅腫、灼痛,治療結(jié)束后部分患者有痂皮生成、脫屑等不良反應(yīng)。結(jié)論:果酸治療輕、中度面部痤瘡及痤瘡后遺癥臨床療效顯著,特別是非炎性皮損較炎性皮損對(duì)果酸反應(yīng)性更好;臨床應(yīng)用比較安全,無嚴(yán)重副作用發(fā)生,患者客觀評(píng)價(jià)滿意。
[Abstract]:Background: fruit acid (偽-hydroxyacid, Alpha hydroxy acids,AHAs) is a carboxylic acid containing hydroxyl group in 偽 position. Nowadays, it is used in cosmetic dermatology to achieve cosmetic effect and treat all kinds of skin diseases. 偽-hydroxyacid can be extracted from natural pure plants such as fruit, and can also be synthesized artificially. Most of the fruits used today come from all kinds of fruits, such as glycolic acid from sugar cane, mandelic acid in almond and so on. Therefore, 偽-hydroxyacid is also called fruit acid. Nowadays, products containing fruit acid are quite popular, and their effects range from moisturizing, reducing wrinkles to chemical peeling of deep skin. Cosmetics include cream, moisturizing milk, toner, mask, cleanser, freckle and so on. According to the concentration of fruit acid products, consumers can use them on a daily basis, can be operated by dermatologists, or can be used in cosmetics research institutions [1, 2]. Glycolic acid (Glycolic acid GA), which is mainly used in this study, has the smallest molecular weight and simple molecular structure. At the same time, because the molecular structure contains hydroxyl groups, it is compatible with water and has high transdermal absorption, thus accelerating the replacement and metabolism of epidermis and dermis cells. It is effective for many dermatological diseases such as acne, keratosis, rose acne, photoaging dermatosis, chloasma and other pigmentation diseases. It can also be used as auxiliary treatment of ichthyosis, skin amyloidosis, melanosis and psoriasis. It is also a new trend in the field of medicine and cosmetic skin care in recent years. Objective: to observe and evaluate the clinical efficacy of fruit acid (glycolic acid) in the treatment of acne and acne sequelae (black brown pigmentation, concave scar, red imprinting caused by telangiectasia), and to clarify the clinical indication, method and safety of fruit acid. Methods: 38 patients with acne with facial lesions were treated with 20%, 35% and 50% respectively according to the condition of rash. 70% glycolic acid lotion was used for 4 times at intervals of 2 weeks. Before treatment, doctors judged the tolerance of patients to fruit acid during the previous treatment and decided whether to increase the concentration of fruit acid. All kinds of facial lesions were counted before and after each treatment, and the scores of acne sequelae were counted. At the same time, at the 3rd, 6th and 9th weeks, the changes of scar size and depth, pigmentation and red imprinting before and after treatment were compared to objectively evaluate the clinical effectiveness of fruit acid in the treatment of facial acne and acne sequelae. After the last treatment, doctors evaluated the consistency between the objective satisfaction of fruit acid in the treatment of acne and acne sequelae and the subjective satisfaction of the patients (satisfactory, good, ineffective). Results: in this study, 38 patients completed treatment, 12 patients recovered completely, 21 patients with most skin lesions disappeared, 2 patients still had a small amount of skin lesions, 3 patients with pustules, nodules and cysts, the therapeutic effect was not obvious. The total effective rate was 92.1%. At the end of the third week and the 12th week, the difference was statistically significant, and the scores of scar, pigmentation and red imprinting after acne were significantly lower than those before treatment, and the clinical effective rate was significantly higher than that before treatment, and the difference was statistically significant. During the treatment period, 8 patients showed local redness, swelling and burning pain, and some patients had adverse reactions such as scab formation and desquamation after treatment. Conclusion: the clinical effect of fruit acid in the treatment of mild to moderate facial acne and acne sequelae is remarkable, especially the responsiveness of non-inflammatory skin lesions to fruit acid is better than that of inflammatory skin lesions, and the clinical application is safe and no serious side effects occur, and the objective evaluation of the patients is satisfactory.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R758.733

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