耿春杰　黄俊会　李增刚　刘乐　尹志辉

[摘要]目的：探討点阵激光联合小剂量异维A酸胶丸治疗寻常性痤疮的疗效及对皮肤屏障功能的影响。方法：选择2017年1月-2018年12月笔者科室收治的80例寻常性痤疮患者，随机分为两组。对照组：40例，仅给予口服小剂量异维A酸0.25mg/kg·d;观察组：40例，在对照组的基础上行CO2剥脱性点阵激光治疗，1次/月，两组疗程均为3个月。对比两组疗效、血清炎性因子及皮肤生理指标。结果：观察组总有效率为80.00%，对照组为62.50%，两组比较差异具有统计学意义（P<0.05）;治疗前，两组IL-1、TNF-α、pH、TEWL、a值、角质层含水量指标比较差异均无统计学意义（P>0.05），治疗后观察组IL-1、TNF-α、a值均低于对照组，差异具有统计学意义（P<0.05）;观察组不良反应发生率为75.00%，对照组为60.00%，组间差异具有统计学意义（P<0.05）。结论：点阵激光联合小剂量异维A酸治疗寻常性痤疮疗效良好，且不良反应轻微，对皮肤屏障无显著影响。

[关键词]点阵激光;异维A酸胶丸;寻常性痤疮;临床疗效;皮肤屏障

[中图分类号]R758.73+3    [文献标志码]A    [文章编号]1008-6455（2020）08-0052-04

Therapeutic Effect of Lattice Laser Combined with Low-dose Isotretinoin Capsules on Acne Vulgaris and Its Effect on Skin Barrier Function

GENG Chun-jie，HUANG Jun-hui，LI Zeng-gang，LIU Le，YIN Zhi-hui

（Department of Dermatology，Xingtai Third Hospital， Xingtai 054000， Hebei，China）

Abstract： Objective To investigate the efficacy of lattice laser combined with low-dose isotretinoin capsules in the treatment of acne and its effect on skin barrier function. Methods 80 patients with acne admitted to our department from January 2017 to December 2018 were enrolled. They were randomly divided into 2 groups， 40 patients in the control group were given oral low-dose isotretinoin 0.25 mg/kg·d， and 40 patients in the observation group were treated with CO2 exfoliative lattice laser treatment， 1 time/month， two groups of courses. All are 3 months. The efficacy of the two groups， serum inflammatory factors and skin physiological indicators were compared. Results The total effective rate was 80.00% in the observation group and 62.50% in the control group. The difference was statistically significant （P<0.05）. The IL-1， TNF-α， pH， TEWL， a value and stratum corneum were included in the two groups before treatment. There was no significant difference in water volume index （P>0.05）. The IL-1， TNF-α， and a values in the observation group were lower than those in the control group after treatment， the difference was statistically significant （P<0.05）. The adverse reactions occurred in the observation group. The rate was 75.00%， and the control group was 60.00%. The difference between the groups was statistically significant（P<0.05）. Conclusion The combination of lattice laser with low-dose isotretinoin in the treatment of acne has a good effect， and the adverse reactions are mild， and has no significant effect on the skin screen.

Key words： lattice laser; isotretinoin capsules; acne vulgaris; clinical efficacy; skin barrier

寻常性痤疮是一种损容性皮肤病，其发病机制较为复杂，可能和皮脂分泌、雄激素、毛囊口上皮角化过度、痤疮棒状杆菌感染及遗传等因素相关[1]。光疗、化学换肤术、针挑、口服药物及激光等常规治疗方法已广泛应用于临床。异维A酸又名13-顺维A酸，具有抑制皮脂腺分化和皮脂分泌、抑制痤疮丙酸杆菌繁殖等作用，是目前重度痤疮患者的一线推荐用药[2]。但临床研究显示，异维A酸用药后患者皮肤屏障功能受损，皮肤黏膜干燥、皮肤瘙痒、口唇干燥、唇炎等不良反应较为常见[3]，近年来，点阵激光技术取得了突破性进展，在治疗寻常性痤疮、瘢痕和嫩肤等方面具有良好的疗效。为了在保证疗效的基础上降低异维A酸的药物不良反应，本次研究对点阵激光联合小剂量异维A酸胶丸治疗寻常性痤疮的疗效及安全性进行了探讨，以期为寻常性痤疮的临床治疗提供参考。……