【摘要】 【目的】观察热毒蕴肤型玫瑰痤疮患者应用中药面膜（由大黄、黄柏、薄荷、黄连、川芎、马齿苋、紫草、茜草、鱼腥草组成）联合变通炙甘草汤（由炙甘草汤去阿胶、麻仁、大枣，加生石膏、连翘、防己、黑顺片、姜炭、僵蚕、乌梅、五味子、山萸肉组成）内外同治法治疗的临床效果。【方法】选取2022年6月至2024年6月期间东莞市第六人民医院皮肤科收治的热毒蕴肤型玫瑰痤疮患者90例，采用随机抽签法将患者随机分为研究组和对照组，每组各45例。2组患者均给予重组牛碱性成纤维细胞生长因子外用治疗，在此基础上，对照组患者给予盐酸多西环素口服及红蓝光照射治疗，研究组患者给予中药面膜外敷联合变通炙甘草汤口服治疗，疗程均为6周并随访6个月。观察2组患者治疗前后中医证候积分、皮损评分及皮肤病生活质量量表（DLQI）评分的变化情况，评估2组患者的临床疗效、复发情况及不良反应发生情况。【结果】（1）疗效方面，治疗6周后，研究组的总有效率为93.33%(42/45)，对照组为77.78%(35/45)，组间比较（χ~2检验），研究组的疗效明显优于对照组（P<0.05）。（2）中医证候积分方面，治疗后，2组患者的持续性红斑、阵发性潮红、丘疹脓疱、灼热瘙痒、口干、便秘等中医证候积分均较治疗前降低（P<0.05），且研究组的降低幅度均明显优于对照组（P<0.01）。（3）皮损评分及毛囊蠕形螨数量方面，治疗后，2组患者的红斑评分、丘疹脓疱评分及毛囊蠕形螨数量均较治疗前降低（P<0.05），且研究组的降低幅度均明显优于对照组（P<0.01）。（4）生活质量方面，治疗后，2组患者的DLQI评分均较治疗前降低（P<0.05），且研究组的降低幅度明显优于对照组（P<0.01）。（5）复发情况方面，随访6个月，研究组的复发率为6.67%(3/45)，明显低于对照组的24.44%(11/45)，组间比较，差异有统计学意义（P<0.05）。（6）不良反应方面，研究组的不良反应发生率为4.44%(2/45)，对照组为6.67%(3/45)，组间比较，差异无统计学意义（P>0.05）。【结论】中药面膜外敷联合变通炙甘草汤口服方案治疗热毒蕴肤型玫瑰痤疮患者效果可靠，可显著改善患者临床症状与生活质量，降低皮肤毛囊蠕形螨数量及疾病复发风险，且不增加不良反应。更多还原

【Abstract】 Objective To observe the clinical efficacy of a combined internal-external treatment of Chinese herbal medicine facial mask(composed of Rhei Radix et Rhizoma, Phellodendri Chinensis Cortex, Menthae Haplocalycis Herba, Coptidis Rhizoma, Chuanxiong Rhizoma, Portulacae Herba, Arnebiae Radix, Rubiae Radix et Rhizoma,and Houttuyniae Herba)combined with adapted Zhigancao Decoction(composed of Zhigancao Decoction with Asini Corii Colla, Cannabis Fructus, and Jujubae Fructus removed, and with crude Gypsum Fibrosum, Forsythiae Fructus, Stephaniae Tetrandrae Radix, Aconiti Lateralis Radix Praeparata, Zingiberis Rhizoma Carbonisata,Bombyx Batryticatus,Mume Fructus,Schisandrae Chinensis Fructus,and Corni Fructus added) in patients with rose acne of heat-toxin accumulated in the skin type. Methods A total of 90 patients diagnosed with heat-toxin accumulated in the skin typed rose acne from the Department of Dermatology at Dongguan Sixth People’s Hospital between June 2022 and June 2024 were randomly divided into a treatment group(n = 45) and a control group(n = 45) using a random lot-drawing method. Both groups received topical recombinant bovine basic fibroblast growth factor. The control group additionally received oral use of doxycycline hydrochloride and red-blue light therapy, while the treatment group received topical Chinese herbal medicine facial mask combined with oral use of modified Zhigancao Decoction. The treatment duration was 6 weeks,with a 6-month follow-up. Changes in TCM syndrome scores,lesion scores,and Dermatology Life Quality Index(DLQI) scores were observed before and after treatment. Clinical efficacy,recurrence rates,and adverse events were evaluated. Results(1) After 6 weeks of treatment,the total effective rate was 93.33%(42/45) in the treatment group and 77.78%(35/45) in the control group. The intergroup comparison(by Chi-square test) showed that the treatment group showed significantly superior efficacy(P<0.05).(2) Both groups exhibited significant reductions in scores of persistent erythema,paroxysmal flushing,papules/pustules,burning/pruritus,dry mouth,and constipation after treatment(P<0.05),with the treatment group demonstrating significantly greater improvements(P<0.01).(3) Both groups showed significant reductions in erythema scores, papule/pustule scores, and Demodex folliculorum count after treatment(P<0.05),with the treatment group achieving significantly greater reductions(P<0.01).(4) Both groups had improved DLQI scores after treatment(P<0.05), with the treatment group showing significantly superior improvements(P<0.01).(5) At 6-month follow-up, the recurrence rate was 6.67%(3/45) in the treatment group and 24.44%(11/45) in the control group, with a statistically significant difference(P<0.05).(6) The incidence of adverse events was 4.44%(2/45) in the treatment group and 6.67%(3/45) in the control group, with no statistically significant difference(P>0.05). Conclusion The combined internal-external treatment of Chinese herbal medicine facial mask and modified Zhigancao Decoction is effective and reliable for heat-toxin accumulated in the skin typed rose acne. It improves clinical symptoms, enhances quality of life, reduces Demodex folliculorum counts, and lowers recurrence rates without increasing adverse events.更多还原