Popp C, Kligman A M, Stoudemayer T J
Foundation for Basic Cutaneous Research, Philadelphia, Pennsylvania, USA.
Br J Dermatol. 1995 Jan;132(1):46-53. doi: 10.1111/j.1365-2133.1995.tb08623.x.
Pretreatment of skin with all-trans retinoic acid (tretinoin) has been shown to enhance wound healing. Previous studies have mainly used animal models to demonstrate this effect. We wanted to determine whether pretreatment could promote wound healing in severely photoaged dorsal forearm skin. Four elderly men with severely actinically damaged forearms were treated daily for 16 weeks. One arm was treated with 0.05-0.1% tretinoin cream (Retin A, Ortho), and the other with Purpose cream (Ortho) as a vehicle control. Four-millimetre punch biopsies were taken from both dorsal forearms prior to treatment. After 16 weeks, full-thickness 2-mm punch biopsies were taken from both sides. Serial photographs were taken, and healing of the wounds quantitatively assessed by image analysis. On the 11th day, the wounds were excised using a 4-mm biopsy punch. Biopsies were processed for light microscopy. After 16 weeks, the tretinoin-treated forearms showed moderate erythema and scaling. Polarized light photographs revealed multiple, red, vascularized foci and/or a diffuse network of small vessels. The histological effects were typical for tretinoin, i.e. compaction of the stratum corneum, epidermal acanthosis with correction of atypia, an increase in small vessels, and increased cellularity in the upper dermis. Purpose cream had no effect, either clinically or histologically. On the tretinoin-treated side, the wound areas were 35-37% smaller on days 1 and 4, and 47-50% smaller on days 6, 8, 11, compared with the controls. Clinically and histologically, reepithelialization occurred more rapidly. Thus tretinoin dramatically accelerated wound healing in photodamaged skin.
已证明用全反式维甲酸（维甲酸）预处理皮肤可促进伤口愈合。以往研究主要使用动物模型来证明这种效果。我们想确定预处理是否能促进严重光老化的前臂背部皮肤的伤口愈合。四名前臂严重光损伤的老年男性接受了为期16周的每日治疗。一只手臂用0.05 - 0.1%的维甲酸乳膏（维甲酸，奥索）治疗，另一只手臂用赋形剂乳膏（奥索）作为载体对照。在治疗前，从双侧前臂背部取4毫米打孔活检组织。16周后，从两侧取2毫米全层打孔活检组织。拍摄系列照片，并通过图像分析对伤口愈合情况进行定量评估。在第11天，用4毫米活检打孔器切除伤口。将活检组织进行光镜检查。16周后，维甲酸治疗的前臂出现中度红斑和脱屑。偏振光照片显示有多个红色的血管化病灶和/或小血管的弥漫网络。组织学效应是维甲酸的典型表现，即角质层致密化、表皮棘皮症伴异型性矫正、小血管增多以及真皮上层细胞增多。赋形剂乳膏在临床和组织学上均无作用。与对照组相比，在维甲酸治疗侧，第1天和第4天伤口面积小35 - 37%，第6天、第8天、第11天小47 - 50%。在临床和组织学上，再上皮化发生得更快。因此，维甲酸显著加速了光损伤皮肤的伤口愈合。
