Management of Steroid-Induced Acneiform Eruptions and Facial Telangiectasia: A 14-Month Case Study of TCM Herbal Treatment 类固醇诱发痤疮样皮疹及面部毛细血管扩张的中药管理
A 40-year-old woman presented with facial redness and rash. She reported using cosmetic dermal fillers over the past three years, during which she occasionally experienced episodes of erythematous papules that resolved after using topical medications prescribed by her doctor. However, over the past three months, the redness has persisted despite the application of steroid creams. Her facial skin appeared waxy and lacked elasticity, and exposure to sunlight and hot weather exacerbated the redness.
Upon examination, significant facial telangiectasia was observed, as shown in the baseline image. The patient was advised to discontinue the use of dermal fillers, all cosmetic products, and steroid creams, and her skin’s natural response was to be monitored for one month. At a follow-up four weeks later, her face exhibited uniformly distributed red raised papules, some filled with pus. Laboratory testing of the lesions and scales revealed findings consistent with allergic dermatitis and acneiform changes.
The preliminary clinical diagnosis included facial telangiectasia, possibly induced by dermal filler injections or exacerbated preexisting telangiectasia, and acneiform eruptions likely triggered by prolonged use of topical corticosteroids or unknown cosmetics products.
A customised traditional Chinese medicine (TCM) herbal treatment, along with supportive topical herbal creams, was prescribed. The first few months were challenging, as her acne-like eruptions worsened during the initial four months of treatment, with increased redness, oozing, and pain. Despite these challenges, the patient remained committed to the prescribed herbal regimen. Over time, her condition gradually improved: the redness diminished, oozing stopped, and her skin began to recover. By the end of the 14-month treatment, her previously waxy, rash-covered skin had undergone a remarkable transformation. Her face became smooth and free of visible acne and telangiectasia.
一名40岁的女性因面部红斑和皮疹前来就诊。她自述在过去三年中曾使用皮肤美容填充剂,其间偶尔会出现红斑丘疹,经医生开具的外用药膏治疗后能够消退。然而,在过去的三个月中,即使外用激素药膏,红斑也未能消退。其面部皮肤呈蜡样,无弹性,且在日光和炎热天气下红斑加重。
检查发现患者面部存在明显的毛细血管扩张,如图所示(基线图)。建议患者停止使用皮肤美容填充剂、所有美容产品以及激素药膏,观察一个月后皮肤的自然反应。在4周后的复诊中,患者面部出现了均匀分布的红色隆起丘疹,部分丘疹充满脓液。皮疹及皮屑的实验室检查结果显示为过敏性皮炎和痤疮样改变。
初步临床诊断包括面部毛细血管扩张,可能由美容填充剂注射引起或加重,或长期使用外用类固醇导致的毛细血管扩张和痤疮样皮疹。
为患者开具了定制的中药草本治疗方案,同时配合使用支持性草本外用膏剂。在治疗的最初几个月中,患者的痤疮样皮疹加重,出现了更严重的红斑、渗出和疼痛。尽管如此,患者严格遵循了中药治疗方案。随着治疗的推进,情况逐渐好转:红斑开始消退,渗出停止,皮肤开始愈合。在14个月的治疗结束时,曾经粗糙且发炎的皮肤发生了显著改善。患者的面部,曾被痛苦的病灶覆盖,现在变得光滑,并且不再有明显的痤疮和毛细血管扩张迹象。
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Reference:
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