Diet and dermatology
CUTANEOUS WOUND HEALING
皮肤创面愈合
英文原文
Because the healing of wounds involves regrowth and repair of tissues, a sound nutritional foundation is important so that the necessary building materials are available for reconstruction of the skin. As reviewed by Reed and Clark, one of the systemic factors that can retard wound healing is nutritional deficiency. Inadequate amounts of protein, vitamin A, vitamin C, vitamin K, and/or zinc can lead to a delay in wound healing. Levenson and Demetriou also noted that essential fatty acid deficiency can retard wound healing. These same authors consider other trace elements besides zinc, such as copper and iron, to playa role in some cases of impaired wound repair. Incontrasttothesespecificdeficiencies,there is evidence in laboratory animals that dietary supplementation with vitamin E may inhibit wound healing.
对应中文
由于伤口的愈合涉及组织的再生和修复，所以良好的营养基础很重要，可以为皮肤的重建提供必要的建筑材料。正如Reed和Clark所回顾的，营养缺乏是阻碍伤口愈合的系统因素之一。蛋白质、维生素A、维生素C、维生素K和/或锌的摄入量不足会导致伤口愈合的延迟。利文森和德梅特拉还指出，必需脂肪酸缺乏会阻碍伤口愈合。这些作者认为，除了锌以外，其他微量元素，如铜和铁，在一些受损的伤口修复案例中发挥作用。与这些明确的缺陷相反，有证据表明在实验动物中，饮食中补充维生素E可能会抑制伤口愈合。
英文原文
It is imperative that any deficiency be corrected as soon as possible so that wound healing may progress at an optimalrate. However, some patientsmay become nutritionally deficient acutely (e.g., after surgeryor other trauma) without demonstrating symptoms or signs of deficiency. Most often, these patients exhibit only a borderline deficiency that was asymptomaticbefore the systemic insult. Therefore, to maximize wound healing efficiency, somepatients may need nutritional supplementation although they do not appear to be nutritionally depleted.
对应中文
任何不足都应尽快纠正，以使伤口以最佳速度进行愈合。然而，一些患者可能会出现急性营养缺乏(例如在手术或其他创伤后)，但没有表现出营养缺乏的症状或体征。大多数情况下，这些患者在系统损伤前无症状，仅表现出临界性缺乏。因此，为了最大限度地提高伤口愈合的效率，尽管一些患者没有出现营养不足，他们也可能需要补充营养。
ATOPIC DERMATITIS
特应性皮炎
英文原文
Food allergen avoidance by patients with atopic dermatitis (AD) and by pregnant and lactating mothers is a well-recognized, albeit difficult and controversial, form of therapy in AD. Such dietary manipulation is particularly relevant in the 10% to 20% of patientsin whomfood allergyis suspected to be an important provocative trigger of disease. The rationaleandtechniques forsuchallergen avoidance have been well described both in original research papers and recent reviews.
对应中文
特应性皮炎(AD)患者、孕妇和哺乳期母亲避免食用食物过敏原是一种公认的治疗方法，尽管这种方法比较困难且存在争议。在10%~20%的AD患者中这种饮食控制尤其相关，他们的食物过敏被怀疑是一种疾病的重要的刺激触发因素。在最初的研究论文和最近的综述中，已经对避免过敏源的原理和技术进行了很好的描述。
英文原文
Less well-established dietary therapies for AD, including oral supplementation with fish oil, evening primroseoil, and Chinese tea, have received increasing interest. These unconventional treatments with low toxicity are worthy of attention particularly whenmoretraditionaltherapeuticadvancessuchas interferon and oral cyclosporine are replete with significant side effects.
对应中文
目前还不太成熟的AD饮食疗法，包括口服鱼油、月见草油和中国茶，已经受到越来越多的关注。特别是当更传统的治疗方法如干扰素和口服环孢素有明显的副作用时，这些低毒性的非常规治疗方法值得关注。
PSORIASIS
银屑病
英文原文
Psoriasis has been shown to be responsive to therapy with vitamin A and D analogues. Studies of the treatment of psoriasis with dietary fish oil alone,prompted by epidemiologic observations of a strikingly low incidence of psoriasis in Greenland Eskimos, have demonstrated only modest clinical improvement.Further studies have investigated whether dietary fish oil may enhance the efficacy of otber establishedtreatment modalities; modest benefits were demonstrated when fish oils were administered in combinationwith UVB,but fish oils did not augment the therapeutic effects of topical betamethasone dipropionate.Perhaps combination therapy is most relevant with respect to the role of fish oil in ameliorating significant deleterious systemic effects of retinoids and cyclosporine.
对应中文
银屑病用维生素A和D类似物治疗已证明是有效的。流行病学观察格陵兰爱斯基摩人银屑病发病率极低，进而引发只用膳食鱼油治疗银屑病的研究，这项研究表明，临床疗效只有轻微改善。进一步的研究调查了食用鱼油是否可以提高已有治疗模式的疗效；当鱼油与UVB联合使用时，显示了适度的疗效，但鱼油并不能增强局部二丙酸倍他米松的治疗效果。也许联合治疗最相关的可能是鱼油在改善维甲酸和环孢素有害系统显著效应方面的作用。
DERMATITIS HERPETIFORMIS
疱疹样皮炎
英文原文
Dermatitis herpetiformis (DH) is related to dietary gluten. A gluten-free diet (GFD) reverses the associated enteropathy,potentially protectspatients with DH from malignancy, particularlylymphoma of the gastrointestinal tract,and reduces dapsone requirements.In addition, the restriction of iodides and milk: and the prescription of an elemental diet may be important dietary interventions in patients with DH.
对应中文
疱疹样皮炎(DH)与饮食中的谷蛋白有关。无谷蛋白饮食(GFD)逆转了相关的肠病，潜在地保护DH患者免受恶性肿瘤，特别是胃肠道淋巴瘤的侵袭，并减少对二氨二苯砜的需求。此外，碘和牛奶的限制和要素饮食的处方可能对DH患者是重要的饮食干预。
Iodides
碘化物
英文原文
There is evidence that dietary iodides can be an exacerbating factor for some patients with DH. Topical and oral administration of potassiumiodide to patients with DH results in rapid worsening of DH symptoms.In addition, when iodides are applied topically to uninvolved skin of patients with DH, skin lesions appear that are histologically identical to DH papulovesicles.It is possible that iodides may exacerbate DH by affecting local chemotaxis so that neutrophilmigrationis stimulated.A few patients with DH have improved when iodides wereremovedfromtheir diet;however, there have not been any trials of an iodide-free diet in patients with DH. At present, restriction of iodides is not usually a part of dietary therapy, but it should be considered in patients who are not responding to a GFD or are consuming large amounts of iodides (in fish, kelp, iodized table salt, and some vitamin pills).
对应中文
有证据表明，饮食中的碘元素可能是某些DH患者病情恶化的一个因素。DH病人外用或口服碘化钾会导致DH症状迅速恶化。此外，当将碘化物局部应用于DH患者未受累性皮肤时，出现与DH丘疱疹组织学相同的皮肤病变。碘化物可能通过影响局部趋化作用刺激中性粒细胞迁移进而加重DH。当从饮食中去除碘化物后，一些DH患者的病情有所改善；然而，还没有对DH患者进行任何无碘饮食试验。目前，限制摄入碘化物通常不是饮食疗法的一部分，但对于那些对GFD无反应或摄入大量碘化物(鱼、海带、碘化食盐和一些维生素片)的患者，应该考虑限制碘化物的摄入。
Milk
牛奶
英文原文
There are two case reports in which milk: consumption influenced the severity of DH.One patient on a GFD did not improve until started on amilk-freediet,andwhenmilkandmilkproteins were reintroduced, skin lesions returned.It is possible that in these cases milk proteins may be the dietary antigens that enter the circulation and stimulate IgA formation. However, Shortridge suggested that iodide contamination of cow’s milk may accountforthe possiblebenefitofmilkrestrictionin patients with DH.
对应中文
有两个病例报告表明牛奶摄入量影响了DH的严重程度。直到开始无奶饮食后，一名接受GFD治疗的患者才有所改善，当再次引入牛奶和牛奶蛋白时，皮肤损伤再次出现。在这些情况下，乳蛋白可能是进入循环并刺激IgA形成的饮食抗原。然而，Shortridge认为，DH患者限制牛奶的好处可能是牛奶的碘离子污染。
Elemental diet
元素饮食
英文原文
It is possible that the IgA in DH skin lesions is formed in reaction to dietary protein antigens that gain access to the circulation because of gluten-induced damage to the gastrointestinal mucosa. This theory led van der Meer et a1.to test the efficacy of an elemental diet in treating DH. In an elemental diet, the presumablyantigenicproteins are replaced by amino acids; without antigenic stimulation, IgA antibodies would not be formed and skin lesions would improve. This is supported by a report that five patients with DH on an elemental diet were able to decrease dapsone requirements in only 2 weeks from a range of 250 to 300mg/day to up to 75 mg/day.Remarkably, one patient, while supplemented with 25 gm of gluten daily, was able to decrease his dapsone dose from 300 to 50 mg/day in 2 weeks. Another patient had a recurrence of skin lesions when changed from an elemental diet to a GFD. In a similar study, Kadunce et a1.concluded that an elemental diet was effective in patients with DH regardless of gluten intake. These findings support the idea that gluten may not be the antigen directly responsible for DH skin lesions. It could be that the GFD is effective because it repairs the damaged gastrointestinal tract, thereby restoringthe mucosalbarrier. Thisgradual mucosalrepair could account for the long delay before effects of GFD therapy are seen.
对应中文
DH皮损中的IgA有可能是由于谷蛋白诱导的胃肠道粘膜损伤而对进入循环的膳食蛋白抗原的反应形成的。这个理论引导范德米尔等人测试元素饮食治疗DH的效果。在元素饮食中，假定的抗原蛋白质被氨基酸所取代；没有抗原的刺激，IgA抗体不会形成，皮肤病变会改善。这得到了一份报告的支持，该报告称，5名采用元素饮食的DH患者仅在2周内就能够将氨苯砜需要量从250 – 300毫克/天降低到75毫克/天。值得注意的是，在每天补充25克谷蛋白的情况下，有位患者能够在两周内将氨苯砜的剂量从每天300毫克减少到50毫克。另一名患者从元素饮食改为GFD后皮肤病变复发。在一个类似的研究中，Kadunce等人得出结论，无论谷蛋白摄入量如何，元素饮食对DH患者都是有效的。这些发现支持了谷蛋白可能不是引起DH皮肤病变的直接抗原的观点。GFD之所以有效，可能是因为它修复了受损的胃肠道，从而恢复了粘膜屏障。这种逐渐的粘膜修复可以解释GFD治疗效果出现之前的长时间延迟。
CONCLUSION
结论
英文原文
Vitamin A precursors and derivatives (including beta carotene and retinoids), selenium, vitamin E, and vitamin D may be important in the prevention of skin cancer. Various elimination diets, fish oil, EPO, and Chinese herbal therapy have proved to be clinically effective in the treatment of some cases of AD. Fish oil, vitamin A derivatives, and vitamin D appear to have efficacy in treating patients with psoriasis.Dietary manipulation and avoidance(such as a GFD or an elemental diet for DH) have been well documented as potentially efficacious.
对应中文
维生素A前体和衍生物(包括β胡萝卜素和维甲酸)、硒、维生素E和维生素D可能对预防皮肤癌很重要。各种消除饮食、鱼油、促红细胞生成素和中草药疗法已被证明在临床上对某些AD病例有疗效。鱼油、维生素A衍生物和维生素D似乎对治疗牛皮癣有疗效。控制和避免饮食(如GFD或DH的元素饮食)已被证明是潜在有效的。
英文原文
Vitamin ingestion must be tempered with the knowledge that hypervitaminosis is a remote possibility if recommended doses are exceeded. The potential toxicities of the retinoids are well known; this medication is also expensive. Elimination diets are generally safe as long as the patient is receiving proper nutrition. Collaboration with nutritionists should ensure the patient’s general well-being and help patients comply with potentially egregious dietary restraints. The safety of herbal teas, fish oils, EPO, and trace elements will require further study.
对应中文
维生素摄入必须适量，如果超过推荐剂量，维生素过多症是一种很小的可能性。维甲酸的潜在毒性是众所周知的；这种药物也很昂贵。只要患者得到适当的营养，排除法饮食通常是安全的。与营养学家合作应确保患者的总体健康，并帮助患者遵守可能恶化的限制饮食。中草药茶、鱼油、促红细胞生成素和微量元素的安全性还需要进一步研究。
英文原文
The importance of controlled and supervised dietary manipulation has been underscored, particularly in reference to AD. Webber et al.found that neady three fourths of 73 consecutive patients with primarily mild flexural AD had had significant dietary manipulation before their initial dermatologic evaluation. Most of the dietary alterations were not based on the advice of a physician or a nutritionist and several patients were on diets deemed dangerous by a hospital dietician.
对应中文
饮食的重要性一直被强调控制和监督，特别是涉及AD。Webber等人发现，以轻度屈曲型AD为主的73名连续患者中，在进行最初的皮肤科评估前，有四分之三的患者有显著的饮食调整。大多数人的饮食改变并不是基于医生或营养学家的建议，医院的营养学家认为一些患者的饮食是危险的。
英文原文
What role should dietary therapy play in the treatmentof the cutaneousdiseases?A significantly malnourished patient would benefit from supplementation before minor excisional surgery or in an effort to heal acute or chronic ulcers. Patients with AD refractory to conventional therapy should be evaluated for possibledietary manipulation including an elimination diet or supplementation with EPO or fish oil. A GFD clearly is of value in the treatment of DR and other measures such as a milk-free diet may be consideredin treatment-resistant cases.
对应中文
在皮肤病的治疗中饮食疗法应该发挥什么作用？在小手术切除前或治愈急性或慢性溃疡时，严重营养不良的病人可以通过补充营养来获益。对常规治疗无效的AD患者，应评估饮食控制的可能性，包括消除或补充促红细胞生成素或鱼油的饮食。在DR的治疗中GFD显然是有价值的，在耐药病例中其他措施如无奶饮食应该被考虑。
英文原文
Additional study of dietary manipulation and the effect of nutritional supplementation on the skin and skin diseases is required. Nutritional deficiency states have given us some insight into the role of these nutrients in preventingcutaneous disease. The challenge is to apply this information to the treatment and prophylaxis of various cutaneous conditions.
对应中文
进一步研究饮食操作和营养补充剂对皮肤和皮肤病的影响是必要的。营养缺乏状态使我们对这些营养素在预防皮肤疾病中的作用有了一些了解。将这些信息应用于各种皮肤疾病的治疗和预防是很大的挑战。
REFERENCES
1.Rackett SC, Rothe MJ, Grant-Kels JM. Diet and dermatology. The role of dietary manipulation in the prevention and treatment of cutaneous disorders. J Am Acad Dermatol. 1993;29(3):447-461.