An Qian, Sun Meng, Qi Rui-Qun, Zhang Li, Zhai Jin-Long, Hong Yu-Xiao, Song Bing, Chen Hong-Duo, Gao Xing-Hua
Department of Dermatology, The First Hospital of China Medical University, Shenyang, Liaoning 110001, China.
Department of Dermatology, Shenyang Children's Hospital, Shenyang, Liaoning 110032, China.
Chin Med J (Engl). 2017 Jul 20;130(14):1662-1669. doi: 10.4103/0366-6999.209895.
Seborrheic dermatitis (SD) is a common inflammatory skin condition. The etiology is unclear, although overgrowth of Malassezia on the skin has been suggested to cause SD. This study investigated whether colonization with Staphylococcus plays a role in facial SD, which was not well addressed previously.
The study was conducted from September 1, 2011 to February 20, 2012 in the First Hospital of China Medical University. In the first phase, the study evaluated the level of transepidermal water loss (TEWL) and the number of colony-forming units (CFU) of Staphylococcus in defined skin areas of SD patients who were human immunodeficiency virus (HIV) seropositive (HIV [+] SD [+] group, n = 13), classical SD (HIV [-] SD [+] group, n = 24) patients, HIV seropositive-non-SD (HIV [+] SD [-] group, n = 16) patients, and healthy volunteers (HIV [-] SD [-] group, n = 16). In the second phase, we enrolled another cohort of HIV (-) SD (+) patients who applied topical fusidic acid (n = 15), tacrolimus (n = 16), or moisturizer (n = 12). Changes in the Seborrheic Dermatitis Area Severity Index (SDASI), TEWL, and Staphylococcus density were evaluated 2 weeks later. Comparisons of each index were performed using analysis of variance (ANOVA) and least significant difference method.
The level of TEWL was greater through lesional sites in the HIV (+) SD (+) group than that in HIV (+) SD (-) and HIV (-) SD (-) groups (95% confidence interval [CI]: 18.873-47.071, P < 0.001 and 95% CI: 28.755-55.936, P < 0.001, respectively). The number of CFU of Staphylococcus was greater in the HIV (+) SD (+) group than that in HIV (+) SD (-) and HIV (-) SD (-) groups (95% CI: 37.487-142.744, P = 0.001 and 95% CI: 54.936-156.400, P < 0.001, respectively). TEWL was significantly more improved in patients treated with tacrolimus and fusidic acid than that in those treated with moisturizers (95% CI: 7.560-38.987, P = 0.004 and 95% CI: 4.659-37.619, P = 0.011, respectively). Topical tacrolimus and fusidic acid were significantly associated with decreased SDASI as compared with moisturizer (95% CI: 0.03-0.432, P = 0.025 and 95% CI: 0.033-0.44, P = 0.024, respectively).
High colonization with Staphylococcus epidermidis, along with impaired skin permeability barrier function, contributes to the occurrence of SD.
脂溢性皮炎（SD）是一种常见的炎症性皮肤病。病因尚不清楚，尽管有研究表明皮肤表面马拉色菌过度生长会导致SD。本研究调查了金黄色葡萄球菌定植是否在面部SD中起作用，此前这方面研究较少。
本研究于2011年9月1日至2012年2月20日在中国医科大学附属第一医院进行。第一阶段，研究评估了人类免疫缺陷病毒（HIV）血清学阳性的SD患者（HIV[+]SD[+]组，n = 13）、典型SD患者（HIV[-]SD[+]组，n = 24）、HIV血清学阳性非SD患者（HIV[+]SD[-]组，n = 16）以及健康志愿者（HIV[-]SD[-]组，n = 16）在特定皮肤区域的经表皮水分流失（TEWL）水平和金黄色葡萄球菌的菌落形成单位（CFU）数量。第二阶段，我们招募了另一组HIV（-）SD（+）患者，分别外用夫西地酸（n = 15）、他克莫司（n = 16）或保湿剂（n = 12）。2周后评估脂溢性皮炎面积严重程度指数（SDASI）、TEWL和金黄色葡萄球菌密度的变化。各指标比较采用方差分析（ANOVA）和最小显著差异法。
HIV（+）SD（+）组皮损部位的TEWL水平高于HIV（+）SD（-）组和HIV（-）SD（-）组（95%置信区间[CI]：18.873 - 47.071，P < 0.001；95% CI：28.755 - 55.936，P < 0.001）。HIV（+）SD（+）组金黄色葡萄球菌的CFU数量高于HIV（+）SD（-）组和HIV（-）SD（-）组（95% CI：37.487 - 142.744，P = 0.001；95% CI：54.936 - 156.400，P < 0.001）。外用他克莫司和夫西地酸治疗的患者TEWL改善程度明显优于外用保湿剂的患者（95% CI：7.560 - 38.987，P = 0.004；95% CI：4.659 - 37.619，P = 0.011）。与保湿剂相比，外用他克莫司和夫西地酸与SDASI降低显著相关（95% CI：0.03 - 0.432，P = 0.025；95% CI：0.033 - 0.44，P = 0.024）。
表皮葡萄球菌的高定植率以及皮肤通透性屏障功能受损，共同导致了SD的发生。
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