Facial hormone dependence Hormone-dependent dermatitis is a kind of dermatosis caused by long-term external use of glucocorticoids, mainly manifested by facial skin flushing, edema and capillary dilation, and the patient feels uncomfortable and affects the aesthetics, which is very difficult to treat clinically. We used the triple therapy combined with Chinese and Western medicine to achieve more satisfactory results, which are reported as follows.
Data and methods: 40 patients with hormone-dependent dermatitis were outpatients of our hospital from May 2006 to July 2007, 13 males and 27 females, aged 17 – 60 years old, with an average age of 38.3 years, with a course of treatment from 2 months to 10 years. The diagnosis met the clinical diagnostic criteria for hormone-dependent lazy dermatitis. Exclusion criteria: 1. oral administration of glucocorticoids and antihistamines within 1 week before treatment. 2. combination of diabetes mellitus, hypertension, systemic lupus erythematosus and other connective tissue diseases. 3. patients with severe renal dysfunction. 4. pregnant and lactating women. The 80 patients were randomly and equally divided into two groups, and there was no significant difference in age, disease duration, and severity between the two groups. p>0.05 by x2 test, comparable. Song Qunxian, Department of Dermatology, The First Affiliated Hospital of Henan College of Traditional Chinese Medicine
Treatment methods and drugs
Experimental group: Oral cooling blood five flowers soup plus reduction (safflower 15, cocklebur 15, rose flower 15, chrysanthemum 15, loquat leaf 15, scutellaria 15, angelica 15, raw earth 20, raw gypsum 30, Zhi Mu 15, raw licorice 10, lingxiao flower 15) twice a day, 250 ml each time. The above drugs were soaked in twice as much water for half an hour into the Chinese herbal extract decoction twice, each time for 30 minutes, and the combined liquid was packed into bags, 160 per bag for four weeks, tacrolimus ointment was applied externally once a day.
Control group: oral imipramine 10mg, once a day. vitc200mg, three times a day, vitb610mg, three times a day, vite cream for external use. The application method and treatment time were the same as those of the experimental group.
Observation items: Before treatment and after the start of treatment, the patients’ papular erythema, lesion area, edema capillary dilatation, pruritus and adverse reactions after treatment were recorded in detail every week. The severity of the lesions was scored on a 4-grade scale: papular erythema, lesion area and edema capillary dilation were each classified into 4 grades according to their severity: 0=none, 1=mild, 2=moderate and 3=severe. The degree of pruritus was evaluated by visual analogue scale scoring (VAS), using the two ends of a 10-cm scale (10-0) to represent the most itchy_not itchy respectively. The reduction of total points >90 is considered as cured, the reduction of total points 70-89 is considered as effective, the reduction of total points 30-69 is considered as effective, and the reduction of total points <30% is considered as ineffective. At the end of the 4-week treatment period, the score decrease index was calculated and the efficacy was evaluated.
Statistical methods: t-test was used for measurement data, and t-test was used for efficiency comparison.
Results:
The degree of improvement of the indexes in the two groups at 4 weeks of treatment is shown in Table 1
Group
Papules
Erythema
Edema
Lesion area
Vascular dilatation
Pruritus degree
Control group
1.05+0.47
1.82+0.57
0.38+0.18
1.95+0.62
0.54+0.28
9.30+1.21
Experimental group
0.41+0.17
0.52+0.31
0.20+0.11
0.76+0.62
0.42+0.28
2.20+1.45
t-value
8.61
10.09
3.82
6.70
0.59
20.99
p
〈0.01
〈0.01
〈0.01
〈0.01
〉0.05
〈0.01
Table 2 Comparison of the efficacy of the two methods for the treatment of facial hormone dependent dermatitis
Group
Number of cases
Cured
Apparent effect
Effective
Ineffective
Total effective rate%
Treatment group
20
15
2
2
1
85%
Control group
20
6
4
5
5
50%
Treatment results: the total effective rate of facial hormone dependent
The total effective rate of dermatitis was 85% in the treatment group and 50% in the control group, with significant differences between the two groups (x2= P<0.05).
Side effects: In the treatment group, there were 3 cases of stomach discomfort and 3 cases of mild diarrhea, which were relieved after discontinuation without special treatment, and 4 cases of nausea and dizziness and 1 case of drowsiness in the control group.
Discussion
1 Hormone-dependent dermatitis is mostly due to long-term unreasonable external use of glucocorticoid preparations, such as skin relaxation, dermatoplanin, enzyme cream, etc., resulting in facial erythema, papules, desquamation, capillary dilation, pruritus and aggravation of hair dermatosis, and some patients have used cosmetics containing hormones for a long time, and after discontinuing use, facial swelling, pruritus and itching appear. For the treatment of this disease, there has been no better treatment method in clinical practice.
2 According to the theory of Chinese medicine, glucocorticoids are heat-producing drugs that help Yang, and their prolonged use can cause blood heat to flourish, forcing blood to move delicately and overflowing the skin, resulting in facial erythema, capillary dilation, blood heat injury to yin, and loss of skin nourishment, so flaking and dryness. This disease is mostly facial erythema, belongs to the upper jiao, and is classified as lung and stomach meridians, and is identified as heat in the lung and stomach and heat in the blood.
3 Treatment is to clear heat and drain fire, dry dampness and detoxify, cool blood and eliminate spots. In the formula, wild chrysanthemum, loquat leaf, scutellaria, gypsum and Zhi Mu have the function of clearing heat and fire, drying dampness and detoxifying, raw earth and lingxiaohua have the function of clearing heat and cooling blood to eliminate blemishes, safflower, cocklebur and rosebud have the function of activating blood to remove silt and eliminate blemishes, angelica nourishes blood and harmonizes blood, licorice contains glycyrrhizin, which has hormone-like effect without hormonal side effects. Vitamin E cream can be used externally to relieve dry and flaky skin. The combination of internal and external use can make the medicine reach the disease directly, and play the role of medicine to remove the disease.