Areolar and periareolar pityriasis versicolor
Areolar and periareolar pityriasis versicolor
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乳晕和乳晕周围花斑癣
DOI：
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发表时间：
2004
影响因子：
9.2
通讯作者：
JM Weinberg
中科院分区：
文献类型：
--
作者：
BL Smith;EK Koestenblatt;JM Weinberg
本研究包括 23 名在 2000 年 5 月至 2002 年 3 月期间诊断出的连续 23 名红斑痤疮患者。接受口服和/或局部红斑痤疮治疗的患者被排除在外。从每位患者暴露的面部皮肤中获取 4 毫米病变穿刺活检标本。此外，对九名患者的耳后区域的非病变、未暴露的皮肤进行了活检。通过基于乙二胺四乙酸（EDTA）的抗原修复技术进行免疫组织化学分析。应用经典的抗生物素蛋白-生物素-过氧化物酶方法和二氨基bervzidine (DAB)色原来演示雄激素受体（M3562单克隆；稀释度1:40；DAKO，Glostrup，丹麦）。通过对每 1000 个细胞中阳性染色的细胞进行计数来评估雄激素受体状态。红斑痤疮患者包括 2 名男性和 21 名女性。年龄范围为 18-70 岁（平均 45.2 岁）。病程从 1 年到 25 年不等（平均 4.7 年；中位 3.00 年）。 7 名患者 (30.4%) 患有红斑毛细血管扩张症，15 名患者 (65.2%) 患有丘疹脓疱性，1 名患者 (4.3%) 患有肉芽肿性红斑痤疮。免疫组织化学检查显示，23 个病变活检标本中的 22 个（95.6%）和 9 个非病变活检标本中的 8 个（88.8%）表达雄激素受体。在病变皮肤和正常皮肤中，皮脂腺、毛囊和表皮基底层的细胞核内都发现了强烈的雄激素受体免疫反应性（图 1 和 2）。病变和正常皮肤的平均雄激素受体计数分别为293.7727±205.6483和248.8889±231.9183。 Mann–Whitney U 检验并未显示两组之间存在显着差异（U = 88 000；Z = − 0479；P = 0.632）。有大量临床证据表明红斑痤疮可能是一种激素紊乱。更年期期间血管舒缩不稳定会引起脸红，从而频繁引发或加剧红斑痤疮。 1,2,5,6 患有红斑痤疮 7 的女性有内分泌失调的记录，该疾病与雄激素过多异常有关，包括月经异常、寻常痤疮、多囊卵巢综合征和多毛症。 3,6 此外，据报道，抗雄激素治疗方式（雌激素和醋酸环丙孕酮）对女性红斑痤疮患者有效，可以减少潮红，甚至使丘疹脓疱性皮损完全恢复。 6,8 已知外源性雌激素可以减少过量的雄激素并抑制皮脂腺分泌。 9 它们对红斑痤疮的功效表明，较高的局部雄激素浓度可能至少在红斑痤疮滤泡性丘疹脓疱的形成中发挥作用。尽管红斑痤疮患者的血清雌激素和雄激素水平、皮脂分泌和皮脂脂质成分始终正常，5 局部皮肤内分泌环境的作用尚未阐明。大多数组织中的雄激素作用是通过雄激素受体介导的。 10 我们假设，病变皮肤内雄激素受体表达增强（与正常皮肤相比）可以为雄激素在红斑痤疮发病机制中的作用提供支持证据。据我们所知，红斑痤疮中雄激素受体的状态此前仅由 Schmidt 等人进行过研究。 5
The present study included 23 consecutive patients with rosacea diagnosed between May 2000 and March 2002. Patients receiving oral and/or topical therapy for rosacea were excluded. A 4-mm lesional punch biopsy specimen was obtained from exposed facial skin of each patient. In addition, nonlesional, unexposed skin from the postauricular area was biopsied in nine patients. Immunohistochemical analysis was performed by the ethylenediaminetetraacetic acid (EDTA)-based antigen retrieval technique. The classical avidin–biotin–peroxidase method and diaminobervzidine (DAB) chromogen were applied for demonstration of androgen receptors (M3562 monoclonal; dilution 1 : 40; DAKO, Glostrup, Denmark). Androgen receptor status was assessed by counting the positively stained cells per 1000 cells. The patients with rosacea comprised two males and 21 females. The age range was 18–70 years (mean 45.2 years). The duration of the disease varied from 1 to 25 years (mean 4.7 years; median 3.00 years). Seven (30.4%) patients had erythematotelangiectatic, 15 (65.2%) had papulopustular and one (4.3%) had granulomatous rosacea. Immunohistochemical examination showed that 22 (95.6%) of the 23 lesional and eight of nine (88.8%) nonlesional biopsy specimens expressed androgen receptors. In both lesional and normal skin, strong androgen receptor immunoreactivity was found within the nuclei of cells in sebaceous glands, hair follicles and the basal layer of the epidermis (figs 1 and 2). The mean androgen receptor counts in lesional and normal skin were 293.7727 ± 205.6483 and 248.8889 ± 231.9183, respectively. The Mann– Whitney U -test did not reveal a significant difference between the two groups ( U = 88 000; Z = − 0479; P = 0.632). There is a plenty of clinical evidence suggesting that rosacea may be a hormonal disorder. The vasomotor instability during menopause provokes flushing, when rosacea is frequently triggered or exacerbated. 1,2,5,6 Endocrine disorders have been documented in women with rosacea 7 and the disease is associated with abnormalities of androgen excess, including menstrual abnormalities, acne vulgaris, polycystic ovary syndrome and hirsuitismus. 3,6 Moreover, antiandrogenic treatment modalities (oestrogens and cyproterone acetate) are reported to be effective in female patients with rosacea, providing a decrease in flushing and even complete recovery of papulopustular lesions. 6,8 Exogenous oestrogens are known to decrease excessive androgens and depress sebaceous gland secretion. 9 Their efficacy in rosacea suggests that higher local androgen concentrations may play a role at least in the development of follicular papulopustules of rosacea. Although serum oestrogen and androgen levels, sebum secretion and sebum lipid composition have been consistently normal in rosacea, 5 the role of local cutaneous endocrine milieu has not been clarified. The androgen action in most tissues is mediated through the androgen receptor. 10 We hypothesized that demonstration of an enhanced expression of androgen receptors within lesional skin (as compared with the normal skin) could provide supportive evidence for a role of androgens in the pathogenesis of rosacea. To the best of our knowledge, androgen receptor status in rosacea has been previously investigated only by Schmidt et al . 5
雄激素作用的复杂性。
影响因子：
13.8
作者：
McPhaul,MJ;Young,M
通讯作者：
Young,M