=) ldyl 1IOGNOULVG OOS WYHO Bran Avent zen VH) 10G NOUL vd 90S Wy3: pH da vi ing dung 4. Din thude qua da... 6. Caccich phan losi da. ss ois CHUONG I: CAC LOAI DUQC- MY PHAM TREN THI TRUONG... 7. Che buse chim sb da 8. Ria mit, ty trang. 18, Peptides, yéu 06 ting truding, tf bao géc trong chim sé 19. Thudc uéing lam d LOT CAM ON oe TAI LIEU THAM KBACyo HOANGVANT" ‘CHAMSOC DATRON 801-TAP1. TI 1.CAU TRUC DA = Da la co quan Ién hat, chiém —seycturn ts khodng 16% trong hugng co thé. + Dangubibinh thuimg o63 lop tir tuén xudng dudi: thugng bi, tring bivahabi = Thugng bi cé 46 day thay dGi tay me timg vi tr, tie < 0.1 mm 6 mi mit t6i Imm 6 vi tei ngoai vi nh tay chin. Trung bi 06 d6 day thay 461 tiy timg vite, Khoding tir 1 mim 6 rit d&a xp xi 4 mm 6 lung. He BL 6 dd day thay d6ilim nha (cb thé Da gm 3 1p: tug bi ram bi web. . CHAM SOc DA TRON DOI-TAPT 23 tc dung te ché 65% marker gly viém la IL-18, gm ngia qua tte chi PAR-2 va kich thich bio mign dich bi sinh dé sinh defensin ching Ie ‘ip prebiotics chinh xée sé ting cing phat tein vi Khun ma ehing ta ‘mong mun Uu dim cia phurong php Ta gy anh hung ti hg min ittécdung phy. Tuy nhiénhigu quécia phurong php nay Kinng, ng gin tip, 6 thé ich thich ng vi kun Khe phi ign, 5.1. Trong bénk tring cf + Cutibactrium acnes a mot trong 4 co ché bénh sinh trong tring cd. Tre ‘6 céctén gol Khée nha fa Bacillus acnes, sau 46 chuyéin sang 6 hinh dang gidng w6i tree Khun ‘Ki phan tich gen bidu hin 16S ERA thy vi Khun nay khée 0 véi chi Propionibacterium, tir 46 ngubi ta phin ra mot chi méi (Catibacterium. Chi ny of nha loi nur C. cones, C. avidumy C. gramulosum. Da theo eis tic vich té bio, C. acnes duge chia thin ofe dud Todi 1, 1 trong 46 dud Tot T chia thin JAI, 142, IB, IC. Na diya theo phiin36 HOANGYANTAM 5 thé chia than ribotypes (RTs) ich gen 165 RNA C. aes 05 thé : io te yon ning oH KT TE ‘man, M@t s6 quan dim choring vige phn chi Propionibactriom tha. ‘Cutibacterium acnes thinh Corynebacterium acres (cing viet a C. acnes) nhur hie ban dit. -- Trude day ching ta nim tung ring C. aos tng trong da bénh nin tring, Hin tg ngutta thy ring sv mit da dang cia Gi Pe Cao, Gi 9 ting cia TAI s0 vi dud type Kinde mét Ta nguyén nha chinh gy tring cf, Si mit da dang cia dud type C.aenes Jam hoat héa hé min dich themhién cia co thé, kichthich qua trinh viém nh sau: + Trong 1 thir nghiém nguti tai da chi v6 C. genes dud type LAL thy ting cic cit gay viém nb 1-6, TL, IL-0, L-17 ting len s0 vive dda véi ch IAL +I1+IIL Khi bé sung cfc dudi type d@ da dang lai C. acnes phan ing vim glam. «Kh ding extracellular vesicles Ia mgt si phim cia C. aoes the ng ‘vao da chudt thiy xuat hign cic tru ching gidng bénh trimg cé. Ma ink mink hoa ch C. oes te goo Wi i San pane tence aa cic receptors ttn ofc tbo dog tran tin ti 2 he NF chit ny kick hogt i thong mi _siy rating ch me em, CHAM SOC DA TRON BO!-TAP1. 25 «Tye da. epleriisc6 itm ng qua li vt C. anes. epidermidis Wich thich qué trnh ln men glycerol ti 46 sinh ra succinic acd, chit ny 38 ee thé hoot dng cia C. anes, Thém vio 46, tu ciu da ngin chén qué tink tech thich cia C.aenes vio tio simg d€ sin sin ra chat gly viém IATL YATNF-a Nguge lai C.aenes tic ch@hoat ng ca S. epidermidis bing cich sit moi tradng da 6 pH act... « Malassezia gin diy cing duge 4 cAp t6i nhing trxong hop tring éhing tri, Tuy nln, ca ché chin xéc van chua duoc xée din = Se thay Adi cia hé vi sinh daimg ru6t 6 anh huong dén co ché bn sinh cia ting, i thing qua truc dt ~ da. Trong tring, ch gidm Firmicates va ting Bacteroides & rut, chinh vi vy hing ta 05 th BS sung oe probiotics dada hod Ia soon my: se « Nghién cu 45 nit tring ch nhe, = trang Binh chia thinh 3 nhém: top = Lactobacillus acidophilus, Lactobacillus delbrueckii bulgaricus va B. bifidum; yin Acniover cia Marti Derm ia prebiotics i ec probiotics ne L, acidophilus, L. gasseri Lease, L plantarum, L. lactis, B. coagulans,uding nity 1 vién. shém ding minocycline don thin va rnhém phéi hyp 2 phuong phip cho ty o6 higu qua cia probiotics tong te minocycline giim 67% tin thugmg sau 12 tin trong Kh it tée dung phu. Két hop probiotics uéng vi minoeyelin cho higu qua t6t hon. ‘+ Mot nghién au khéc ding actoferin Ia 1 loat dam whey ten véi sia 1m men chia L bulgaricus va . thermophilus trong 12 tui thy gldm 30% 50 véinhém ding probiotics dom thin, Mite d6 it dau hit 50% 6 bénh nn wong probiotics. Mot thir nghigm gin dy sir dung L. rhamnosus SP1 trong, 12 tun o gin mute €6 mun lug eb 4 nghia so véi nhém gia duoc. - Vay vie b6i probiotics, prebiotics, postbiotics... 08 giip lam gidm tring cé va dw phng bénh tring cé hay Khong? Bay la céu hoi céc nha ‘khoa hc dang tim edu tra Io26 HOANGVAN TAM « Mot nghién cfu méi pha Mb/Il ding minh ring: béi Nitrosomonas ‘eutropha 2 Tin/ngay trong 12 tun ‘giim 2 dim vé bing IGA trong tring ‘cd s0 voi nhém chimg, gidm céc ton thurong viém. Tuy mhién, vi day Ia vi pravotin cia lactoferrin + hun ngoa al én ing, tn meno bin Seg thuong téi phat. is ‘8. epidermidis trong vilhé binh thurimg o6 thé te ch C, aenes. Mt hy, _nghiém diung gel ty ciu da béi 2Fan/tuin lim thay 46i hé vi 2 da va ting curing thm hg sinh vat. Vi vy dling S. epidermidis hit hgp thon $0 v6i c&e loai ngoai lai nhu N. eutropha & trén, ‘© Ghép ty cau da 6 ving khéc vio ving mat: trong nghién cifu ding ty cfu da béi 2 Tan/tun lam ting kha nang gitr nude cia ving mit, gidm ply ‘cia da tir 5.5 xuding 5. ‘+ Mot trong nhimg huéng méi trong digu tri bénh tring vie st «dung virus c6 khé nang thyc bio nhimg dudi type C.aenesc6 hai (LA1) ma Bi Iai ning of thé C.aenes I, tir dé ki soat bénh tring eé téthon, + AMPs nhur da trinh bay 6 trén 1a m@t trong nhimg chat kiém soit sy phat tin cia vi Khun eho 6 tha mot trong ning chit Kh sinh dung boi duge siz dung trong du tr tng cé trong tuong lai 5.2, Viem da co dja + Trong viém da co da, ri loan chit ning cia hang 1 Iho’ mién dich tai ci tao iu kign thus Ioicho vi Khun bénh nay, osu ting 36 lugmg tu eu ving, gldm cic vi Kkhudin ow tri Kc. _M@t nghién eta gin dy cho thy giim sv da dang hé vi sinh vét trong viém dda co dia, misc 49 glim ny é itn quan dén mie 46 nghiém trong cia bénh: sia doan ning thiy tf ty elu ving cao trong nhing truimg hgp ne hon thay ch yu la ty eb da. H vi khudin during rudt cing e6 lién quan dé vigm da co da, 6 nig, tré mic vém da coda é lin quan dén IgE cing Se ee oe, . sya sm Escherichia coli vio rug é i Se cook el 6t trong 2 thing dau dai én ~ Trong bénh viém da co dia tu cbu vang phat rin cd thé la do ant peptides (AMPs) thiéu hut. Mot trong nhiing vi. take es Sear ene enaanacaeten eee =a CHAM SOC DATRONDOI-TAPT. 27 dng ce vi khusin ny ca chinh co thé bénh nh (ving da Khéng bi viém da co dia) nhén bin len sau dé ghep lai cho chinh bn nin slam gid gg tu chu vag. - Nitrosomonas eutropha Ia 1 Toa vi Khuéin ngoa Iai eling dye ép dung trong viém da co dia va tring cd. = Cle loai probiotics nhur Lactobacl casei, Lactobacillus paracasel, Lacobadi shamnosus, Lactobacillus salivarius, Lactobacillus fermentum, Bifidobacterium animals, Bifidobacterium longum Bifidobacterium breve... va cic loai hin hop, 1 Vil leg Latopic 1 itn i 119 oi chi 50% Lactobas casei, 25% Lactobacillus igt ae dung 6 te vier da co dia kim theo dj img the dn. Thude an toin. cho phy nit o6 thal, cho con bi, té 0 sinh. = Using probiotics trong hic otha, cho con bi cho bé wing sngay sau sinh lim gi nguy co viém da co dia cho em bé. «= Nhitunghién ci chia ing: 1 Tour hv sin vat @ da c thé hich host con dmg Th17 trong viy nn, Vai thirnghitm ching minh o6 su khécbiét ‘he sinh vat o ving da 6 tin thuong vay nén (idm da dang ip Actinobacteria, nguge lait 8p + Cho dé nay, dit igu qua cia ché. M6t nghién citu diing Bifidobacterium infantis trong 8 tun 6 bénk shin gdm 06 ¥ nghia ing d@ CRP, TNF-alpha, nhung khong, cb si khdc bigtvé lim sing. Tuy nbién, 6 mé hinh vay néh 6 chudt, ding, Lactobacillus pentosus GMNL77 duimg uéng lam gidm TNF-alpha, 1L-23, 1L-17, gidm t6n thuong dat €é bong vay. 5.4 Hurong méi trong kim sat mit co thé “= Mit co thé Ih do vi Khuiin tt ra ce chit ob mii Kho chiu. M6t trong rig bin phap duge ép dung d6 la dling tu chu da ghép vio wing hoi dich o thé ci thign duge ink trang nay.28 GANG YANTAM: 5.5. Viém da diiu + Vim da du duge coi lA bu hign cia su dap tng viém da v6 do sin xustb6i nim Maassezi. Ning 46 MalasseziaKhng ins ic 46 ning cia ben nhung Kh gidm 88 lung nin, bénh vig sidm. Giam 46 da dang vi Khuda cing o6 lin quan dn 46 ning aa + Che nha Khoa hoe bit iu dint gi hitu qué cia probs vim da dau, Ding V.fliformis boi tei chd lim gidm ngtia dé, vj, 68 nghién cru mit ddi tn 60 bah nin, Vitreoscilaflformis lam ya xuit IL-10 bai té bao gai va ting hoat déng cia Tdiéu ho8. Bénh nhin os L. parncasei cing lam giam gau, dé da, Tuong ty v6i Vitreoscilla, L, i ich thich sin xultL-10 qua yu 6 phat trign trung gian~beta, din ncn ‘gid thuy&t vB ding probiotics udng va bai trong viém da du, = 5.6. Linh thuong ~ Phan ting viém kéo dai va ri loan he vi sinh 6 da lam chim lai thuong Probiotics o6 thé c6 tic déng tch ewe lén qué trinh lan thurong do diéu hot cic phan ting viém, te ché ef vi Khuain 6 hai. vv khong phai do dai théo duong thong qua dita ; guyén bio soi, Tuong ty, probiotics duimg wing cita Lactoba 6 higu qua trong du tj lost man tinh do dai théo dung. = ©6 niu nghign ciru ching minh vai tz cla probiotics 6 bénh nhin bong trong vige lanh thuong dng thbieé téc dung. hing, du ti nhiém hun thir phat, Probiotics boi chia L. plantarum lim gim nhiém tring Pseudomonas aeruginosa trén md hinh chudt bj bing, © ngudi, ding L. plantarum trong bong d6 2, 3.06 tc dung nhu bye sulfadiazine trong vie gid nguy co nhiém khufn,giém s8 lugng vi Kun, dng thi hich thich 1mé hat, lanh thuong tot hon. 5.7, Da nhay cam Co ché cia probiotic trong da nhay cim duge gai thich qua eo ch’ giim Khir hat t@ bao mast, gidn mach, phiin8, gi phng TNF-alpha, tir dé lam gif trigu chimg trong da mhay cim. CHAMSOCDATRON801-TAP1 29 = Neghién cru nim 2009 cia Audrey Gueniche ten 66 béih nn ni 6 da _thay cim sau ki nh id bing test acid lactic, chia thn 2 sm: 33 bénh nhan duge ding kem eb ca Bifidobacterium longum ap 10% vi 33 bah niin ding gid duoc. Két qua cho thay gidm trigu chimg ob ¥ nghia sau 29 ngly 6mhém bah nhn cing Bifidobacterium longum ap 10% = Mt trong nig huéng nghién eu méi v® probiotic fractions (ding probiotics bit host trong mi rung ln men) délam gidm viém giim d&: + Vitreoscilla fiiformis 1k mét vi Khun duge tin thiy & méi trubng rude Khoaing, Vi Khuin nly duge hing La Roche-Posay nghién ci tt liu, Khi tn v6i nude khodng cia hing thi iu qué ca né ting Jen. Loi Khun nay 5 tie dung ting cudmg hoat dng cia superoxide dismutase 2 nén ob tinh chit chéng oxy héa, ching Wo héa nh ‘bio vé co thé khdi oxidative stress ngi sinh vi ngoat sinh. Ngodi ra, Vitreoscila fliformis con Kich thich chit Khéng Khun ni sinh la 6 defensins c6 tinh cht ching him Khusin vit oval td trong chéng io ‘aa (tit xem bai peptides wa yu tng ting). Mot du thi vinta vi Khusn ny 6 tic dung a gidm IL-8 lat rong nhing chit tung gian say vem, + Lactobacilus pentosus cng duxge nghién cic tic dung tuong ti Vitreosil filiform. Trong mt thie nghiém ten 8 ngubi da ting ding cream dia 2% Lactobacillus pentosus thy ring: thude bi Tim glam mat rude qua thugng bi, gidm vim thing qua giim IL-8. Kt qua may goi Lactobacillus pentosus cb higu qua tren d6i tung da nhay chm. ‘Mineral 89 cia Viehy hia Vitreoscillafilformis, ngoai —pentosus 2% trong. ain pi 1m cdn iia HA, nncinamide 6 te dung giim mat mac qua tac bi, 4%, pt 6 dng din Ke. hing vem.50. HOANG VAN TAM 58, Ung tarda «Gj lon hf vi sn vat 6 da 06 thé gay rain toong ting gin tgo u. C6 sy lién quan git mhiém 5S, aureus va mite 46 Ring A) Iympho da, rng qua vai cba iu ing Bun vg! vige tou = Nuoe li, hé wisn vt Kho man 6 thé gldm 90 u do dita hy rnin dich, kiém sodt phin ing viém. Lactobacilli dung wong c they idm tic hai catia oye tim lén da, giim nguy co ung thu, 6. TINH AN TOAN CUA PROBIOTICS = Probiotics chiing Lactobacillus va Bifidobacteria da dye ching minh i 66 tinh an toan cao trén lim sing, Cho t6i nay, o6 trén 70 thir nghiém lim sang dénh gié tinh an toan cia sia hay thite n c6 b6 sung céc ching yi, ‘Khuain nay txén hoon 4000 tré (cdi théng va non thang) cho thay khéng cs tée dung phy nto duge ghinhén. T6 chic Y t€ Thé gidi (WHO) va TS chic ‘Thyc phim va ndng nghifp (FAO) cng bS ring: “M6ilién quan duge gh nn gitta cic nhiém tring hé théng va céc probiotics da durge chiimg minh ‘tit, chi yéu xy ra trén cdc bénh nhani 6 cfc van dy t€ tiém tang”. = Tré so sinh cé thé bi cdc bénh nhiém tring tir cfc ching vi Khun curt trong durimg tiéu héa, Tuy nhién, Bifidobacteria lA chiing vi Khuéin chiém ww thi mht (dj bgt tré bi me) trong hé vi sinh during rudt cia té, cho dé nay churao6 bing chimg nto vé Kha ning gay bénh cia Bifidobacteria due thdng béo. Bifidobacteria cing cé mit trong nhiéu loai thin dcbigt la sia chua dugc sir dung trong khau phan an cita tré Khi tré d cai sita va khong _ghinhén thay truong hop bénh ly nio o6lién quan dén nhigm Khun huyét. Bifidobacteria dugc bé sung trong sifa cing thire va duge sir dung tron 15 ndm tren toan thé gid, ng thoi klng ob trang hp beni Iy hay tie dung phy ndo duge béo cio. ~ Céenghién ciru hign c6 disa ra khuyén céo sit dung Bifidobacteria dic biét 1a B. lactis la probioties duy nhat c6 thé si dung cho tré so sinh va tré sinh zon, Lactobacillus dic biét Ia LGG lA mét probiotics cé tinh an todn ca0, thich hop dé sie dung cho tré nh, tré lon va ngudi én, “Tai ligu tham Kendo: xem tai trang 323, CHAM SOC DA TRON BO! rap) 312 HOANGVANTAM 1. KHALI NIEM pH = B} pH phan nh ning a mol Thepiseale ca céc ion hydro trong dung dich. @ 305 85g 5 [NO a thude do tile acid -kiém v6i me thang do logarit tr 0 (acid manh. hat) dn 14 (kiém nhit) véi 718 trung tinh, Nhu viy d pH phin 4nh tinh chat kiém hay acid cia bed bk ‘mgt mdi trudng. ~ Hinh anh bén thé hign pH cia m@t sé héa chat, hoa qué hay dé uéng. Véi pH tung tinh 17, pH acid cao, trong ki pl 14 thé hign tinh kitm cao nha. 2. pH SINH LYCUA DA ~ Olan da binh thutng, pH trung binh cita ton b6 co thé’ 6 tinh hoi acid thn minh va tay chan. Riéng 6 ving mt cing ed sy kde nha * 7 gitacicving cath lice S6ttinsacmimittinte Gene nhurndh, ben, KE chin iu mincé 9 pHlcaomtivenra en ~ Bo pH hoi acid ita da o6 vai trd quan trong eat ce w Kn tn BE mt cig nh nh hang ae henge on enzyme tham ga tng hop cfc thinh hn cia hing hobo ype ai CHAM SOC DATRON BOI-TAPT 33 3. CO CHE DUY TRi pH ACID CUA DA Vie duy ti 46 pH sinh ly néi chung dat duge nhd sy ein bing trong qué ‘einh chuyéin héa va trao d6i chat cia to da, trong dé lién quan trv tip 90% 5. areas 46 pH, rong Ki db ne 6 pH6S chit ny hid th i ch€> 60% ~ Nite dugctit rab tuyénemb sau 6 duge chuyéa thi itt bi ‘Rhu sou 6 nitite chuyéa thinh nitrogen oat inh inh cht King hun (iu ny chi xy ra trong moi trudmg acid) 8. pH VAMOT SOBENHLYODA 8.1. Viem da co dia + Trong t6n thuong ei viém da co dia pH cao hon so véi viang da thuring, Ching ta thay iém da co dja bidu hign Khée nhaw 6 trébii me36 HOANG VAN TAM ‘va tré om: tré bit me pH ving més mat dudi cing tay ca0 hon nay, eee a gray ong kw 1608Y BAP OVANENE ida, 8 hon. Vay ti S20 li ob se Khe ig gs, ay ath nyt think pin 90 tinh acid ne ca imino acid ty do,uroeanicaci...Ching ta bet trong viem daco diag, thes hytfilaggrin Ia chit to ra amino acid ty do vi urocanic ac «Thatta tay mb hit ra acd Tactic ting bi gidm trong ben vig da codia, _ «Cui cing li sy 18 trong vig Ht lamellar bodies (vi thé ny I nut, tao proton cho da). = Cie did tn Kin cho pH cia da ‘bénh nan viém da co dia cao hon ‘ihiéu so véi da binh thudng, tao dieu eign cho S. aureus ting c20 vi gay ‘nih. Mot vi nghién etn cut hi ding cream o6 tinh acid pH 28 so véipHt 74 thy ring kem cb tinh Ceradan adoanced cin I? dim Ze tem (74) lim ting ilbbiviém daco_actobionate e646 pi pi hp dja va hen phe quin & cut, tong, ot a bok da co dia, Ki Ble Lid ny git & due D6 Bing, 121 pHT oR sn hd Ht dt em o6 tinh aid (P1428) th duy tri ge dp pH nay trong 2 _ Hign tai 6 mét 6 ding thude dung dim o6 tinh acd (de bigt 6 pH ung {quanh ) gi cin bing la pH da cia bénh hin cing ob cc thuse ba chit than phn vi Khun coi hoe virus délim giim hog dng ca S. a tren da. 8.2. Bénk vy of enh vy cheb pH da co on trong ci thir nghiém ding ac atic bd df (a tr Bénh nay 43 ching minh duge hig eur 8.3 Viém ké do nin candida Candida albicans 1a m6t log nim hang hinh, 6 msi a acid cantina ee dda dang gay bea) Ovane KE V8 96 pH cS x hung cao han én bj viém ké do: ndim candida. ah. cuams6c DATRON ©! TAPT 7 acid 06 vai tb trong iu ti nf 4 moi truimg PH 5 acid cing gidp han ché Bi at 96 ding dn 6 moi trong PI san tt thong, Wo ha da, dat 50 i 4, Vai tra cia pH tromg hi git pH da 6 dang acid am iim nh ni i ‘eatnong tr hon. Vi vy, tude BO cin 5 PH acid va he dém t6t a6 gi ‘pH én dinh trong nhieu 1 hong thréng pH sinh If 655, ce sin phim 06 mu hung te0 pH @ natin 55 Nhung trong ofc trong hop da tré en | fag git hay mat 96 én nbs ie do ch te dia, pH da o8 xu huring ting en, vi BY va Sen thu bai cb pH acid hon (khosng 4) = 448 ching lal se ting pH lia cc tink trang, ddanci tn. MGt trong ning thud 66 Kha g vt pH Ann of Kh ning ts ‘in phi Clairial peel cia SVR ec acct ny dng vai 8 QUAN aid trie 0% PITS. ‘rong trong diéu tri lao héa da. oped lic cng 11 acid thuge nhémm AHA ah glycolic acid cling doe Jpddong ato moi tring pH acid cho da rong mot thiznghiém ding 4% art act (pH Whodng 4) boi mgay 2 fin lim gidm sx mst mde qua ca va him hay cam cia da vGiSLS. Ngodira acticacid alginic aid, acd crc WaHA cing ob Kha ning dém tot vi pK, @mguong gin 4 «tre em trong 6 thing du tién da ob pH cao hon, vi vay vige sit dung ‘ude boi ob pH Khoing 4 va cé a6 dém cao oé thé gid gidm trigu chiing, de phong bénh viém da co dia. 85. Vai tré cia pH trong tring of = C.aenes sng t6t 6 mot trudmg pH 6-65, MOt vai nghién cima chi ra ring, rahém dling ria mito tinh chét kiém th s6 rong mun viém cao hon nhém dng rra mit o6 tinh chat acid sau 4 tun si dung, «= Trong nghin cia gin nhat cia tdc gid Valle-Gonzélez Khi sir dung ning, 46 thip glycolic acid 0.1, 02, 0.4% c6 thé Kim ham C. aenes & pH13.0,3.5, 40. Ditu nay d&t ra mot hudng rt mdi trong céc sin phim bai tring of: ding,eee ‘38 HOANGVANTAM -aieu tri ben trig 4 ma it aga tp CA ong pH uP AES elegegir at hay sir dung x4 Phong cO PH kfén, ales trade diy nia ™ chain guy cn oa he vim chi s6c da pit a he no, the te ding cle che rdving ta thiy AHA, BHA tao pH ly «Che sin phim chim s6c da cb 40 7 Qua bing 6 audi pi cia Paula's Chole) " Khibi cic sin phim chim se da gn nhau, cing ta 59 cing sé bi mit tic dung cia nha: vi dy ba vitamin Co pH Khodng 3 qua gin duo dn ‘eb inh chit rung tinh sé lim mat téc dung ca nhau khéng? Nhu da tinh (6t 48 git urge pH Sn su thay d6i én vé pH. au khong vai phiit dé ching ta nén b6i sin phim chim sde da ob ch phim e6 pH cao lén trén? Thue tiga nay cn ching bing ching Kon hoe vin 8 ry. NE dp ore aun greg ap in bi vinminG BHA, AHA wong ci ae ‘dis ninth no? Bing 6 tin cho thy pH cia serum ‘amin ut dag LAA tp it nn bo tr, au db tip BHA én AHA (hug AHA ob pH cao hom BHA), “Tilia tham ko: xem trang 304 CHAM SOC DATRON 801° TAP 39yz HoANcvER™ 1. KHAI NIEM pH = BO pH phan anh niing 4 mol ‘cia céc ion hydro trong dung dich. @ ig: [NB ade do te acid - itm vét = thang do logarit ti 0 (acid man shat) dn 14 (kiém nit) vi 7 ‘rung tinh. Nhur vay d@ pH phin | q—————._—_ dnb tinh chit kim fay acid cia“? ae ndtmdi truing. ~ Hinh nh bn the hin pH cia msShéa cht hoa qua hay @ ing, Vk tong pastel gliadin 2.pH SINHLYCUA DA CHAM SOC DATRONBOI-TAPT 33 3. CO CHE DUY TRipH ACID CUA DA ‘Vig duy tri d6 pH sinh ly néi chung dat duge nhd sy cin bing trong qué trinh chuyéin h6a va tao 46 cht cia tbo da, trong dé lién quan trv tgp (46n sirhinh think va tiga thy proton. Co ché'ré ring cia qué trinh nay chura dug ching minh chinh xéc hug c6 m@t 8 con dung ién quan bao gm: = Con during filaggrin ~ histidine — urocanic acid con durong thy phn cia filaggrin cudi cing <8 tao ra urocanic acid, acid nay @6 18 06 vai tad trong vige duy te pH acid cia da. Tuy mhién, céc nha khoa hye cho ring vai rd duy te tinh acid 6 da cia urocanic King, cao bdi vi: cfc thi rnghiém trén chudtb biga d6i gen thé histadinase hoc tig flaggrin thi pH da ting len khong dng k& Hon nia, & nhém bah nhin viém da co ia o5+ khong cb dt bin gen flaggrin this khéc big v8 pH da Khdng cb {neha Trong vay ef bénh nin thigu hut filaggrin tm trong thi pH da tang len ~ Hoat dong eta céc bom proton tén mang cia cic melanosome duge xem 1a 6 val trd quan trong trong uy ti pH @ pin dui cia da. ~ Qué tinh thiy phan phospholipid hol ceramide to ra cic acid béo ty do cing la. co ché g6p phn duy ti tinh acid cia da. 4. CAC YEU T6 ANH HUONG DEN pH DA 5 yéu t6ndisinh bao gm: tsi, yéu 16 gen tinh trang bs nh, d6 dim cia da ‘va tinh trang tiét mi hoi. Céc ya t6 ngoai sinh bao gm: cht ty ria (trong 446 stata mst lam ting pH cia da, mét trong nig, iém th vila ngay ‘akhi ching ta ria mating nude thuimg pH da cing ting len Khosing 1 don ‘i), mg phim, cée sin phim chim sée da, tinh trang bing bit da va cfc thude bai trén da. 41.6 tudi ~ Ngay sau Khi sinh pH da cia tré sinh thing trung binh I 6 cao hon so ‘ving truémg thin vat Tin. pH gidm nha trong vi gay sau Ki sinh sau dé gidm ti tr va trv Binh thung trong vng 1 thing vé sau. ng én tui, th 46 pH cia da cing ting: + Trong,3 ngly dit sau sinh 6 pH cia da khéc bgt king nhitu gia ‘cc tei Khe nau tn co thé, Ki lin bit iu 6 sy phi ha din v8 DH da cic ving khdenhau. Trong thing du tin pH da caohon 6 vingPe ae. 34 HOANG VANTAM i thing tbl, pH da cao hon g, gap cing tay. thoi dim té due’ thang i aaa dag enh ita niyo EBA ek iad tb me hay gp 8 md mt dub cing ty). PH che ving yy a do ving ming bi it te vA ving mé Hep xe MhU, tye, i train, a +O ngudi trang think pH da thuing cs hon & oc ving nép he ny, nich, ben, ké chin. Chinh sting pH da 6 ofc ving ny tao diéu kigy, thusn lg ch vi kia, nm phat trign va diy cing IA noi big hign gig ‘bénh vidm daca ia. “ eusesaicta'ul Giibwolonsiih tree imashara = Ongui gi pH da ng tdi ging thoi so sinh, ig a ‘cia da gidm i. Bu ny duge gi thich Ia do sur tia hut ceramide sé Ly ting hoa inh cha me vi enzymes o tinh chat kim. 42. Sic t6da = Nauta quan st thy ngudi da ti mu (phi loaiFtzpatick IV, V) th 69 pH thip hon so voingudi da sing mau (pH14.6 0.03 s0v6i5.0 0.08) = Bing thi, che nha Khoa hoc thy hing rio bio vé da 8 nguid ton ven vA én wing hon. ‘mau 43. Vite trén co thé? + Khico thé truéng tanh ving nép ke va nép gap nur nh, ben, dust vi. Hof xu hutng cao hon so véi ving da thug. Chin i@u nay tao digu ‘i cho vi Rhu, im pt tri ~ Oving nich pH cao tao diéu kin cho vi khudn nher propionibacteria via staphylococci phit tin tao than mii khé chu, Céc sn phim Khir mi chia acid citi (A acid tao pH acid vad gm t6t 58 trinh bay & dud cb te dung lim gidm mii. Tong ty, ving nép ké cb xu uring bi nim niin candida nhigu hon. 5.pH DA VAHE DEM ic cin bing pH ca daft thay adi khi ta thém bazo dling stanza mit 6 tinh chit bazo, do ka ning mth gan ngin pH da lai chuyea v tinh acid. HE trungbinh trong mudi cia né CHAM SOc DA TRON DOI-TAP1_35, spliong ce sin phim chim sda, ching taking ch quan tim pila BE HS ma ch phi chs nh dm ca hing hay Lg, PH pK, Mot clu hd mei ngui hay d3t ra "en bi 2 Pn cb EAN bis ong cng a Smt the dung cha nha kg? Ci tr i rit bv mb hn hin eu xiy dug cho minh mt he dtm tt duy ti Gn din dupe pH ki bot thuse trén da 6.LIEN QUAN CUA pH DA VAHANG RAO BAO VEDA ~ Hing rio bio v6 da gm ceamie, acid bdo ty do vi cholesterol. tng hop cic cht ny ph tute vio cc enzymes mae enzymes my lo boat dng 66 pH ai. Pgcocerebrosdae acidic sphingomyelinase enzymes én quant sng hop ceramide ont ng tpt 36va45 + Gin dy, tana ding thu PHA 4 gt pH a in da gp ngin gia hinh thin vit da co ia 6 cht, Dyeing Ib mot rong nn, Jhung méi trong vie pt ten dng that chin PHA da i hing Binh vim da coda ting ch 7.pH VAHEKHUAN CHITREN DA ~ Hv an sg cg sinh vali nh tain da pH acd ty bu da Ssaphylococis epidermidis bi eh pH 85. Trong ki cic vi Khun iy inh nS euras sink rang 6 mdi tng pH rang tinh C aces biechéo pits. + Trong mi i lng igt> 9075 chicbthé techd> = Nitrate dupe titra tuyén mb isa A de chu thin ite bi i ku, sau dé nite chan think trogen hoo inh tn chit King nun (un ch xy a rong tng ac). st digt ain 614 dermetdin, chit ny c6 kh 4:49 pHSS, trong khid6 nda 6 d6 pH65 chit nay 8. pH VAMOT SO BENH LYODA 8.1. Viém da co dja «20 hom 80 v6i ving da ign khdenhau tee bi me = Trong tn hong cia bénhviém da co throng. Ching ta thy ing vim da co6 4 dubi cing ay c20 hon nd jy 6 ba me JH 6 ving ma, ol B mols ey ven Sy ng Ee a ie za dnc. rw mS EN ay th au: : : : an la sr thiu hut ofc than phn tao tinh acid ne cba da ny, ‘amino aci eda anoec ca cioinerebintonee AE, sa ht filoggrin Ta ino acid ty do va urocanic acid, «sTingehai a tuyn mid hoi tit a a dacodia. «Cui cing Is Ii trong vide ti tao proton cho da)- «= Che fu tén khin cho pH cia da ‘peak nin wiém da co dja co om rh so wi da binh thud, ta0 eu Ign cho S. aureus Hing ca0 v8 Bay ‘nh. Mot vi nghien cu ttn cht si dig cream ob tink acid pH 28 s0 wi pH 74 thy ring kem cf tinh stm (74) Tim ting ile bi viém da co dia va hen phé quin & chudt, trong nt 18 nay gidm 6 chu boi bing kem o$ tinh acd (pH128). «= Hign tai cb mts dg thc dung dim o6 tinh acid (Ae bigt 6 pH sung ‘quanh4) giip cin bing lai pH da cia bénh nbn, cing e6 cc thud bei chia thinh phn vi Khu o Igi hoe virus dé lam gidm oat dng ca S.eureas oteinda chit tgo ra ami cid lactic cing bi gidm trong Binh vig lamellar bodies (vi thé nay languid, Ceradan adoanced chia ie dim Zine Iactobionate,e6 pH pi hep 06d cia cla bj viém da co dia ‘he ko pa sin 1, nH i thé uy te ged pH ny trong 25. 8.2. Benh viy of Bah vy cb pH da cao hon tong ce thie nghifm dung acid lactic bi df diguti ben ny 43 ching minh duge higu qua. 83. Viém ké do ndin candida ~ Candida albicans la mt logi nam luéng oi ic 5 nim ludng hinh, & m6i truémg acid thudné nim ob xu Faas ames as hb pflcctenn eld 8 cHAMSOCDA TRON ©O!-TAP1 37 — ka a it 8m tng paid va rong, abo 1 T candida. Mot 38 dung &m & mot tru’mg pH acid cling gid han ché bi nim ke. 4, Vai trd cia pH trong lanh vét thuong, 1a0 «sé 1am gidm nhiém nim, vi Khun, gid lan thud bai din eb pH acid vi he dém t6t d& git héa da, da 6 tré so sink = Kh git pH da & dang ack téin thuong, t6t hon. Vi vay, pH én dinh trong nhieu gid- “Thong thudmg pH sinh ly 8 55, cic sin phim o6 xu hudng t90 pH é nguing 55. Nhung trong cée truimg hop da tré em, ngudi gid hay mt s6 bénh hue viém da co dia pH da ob xu hung ting lén, vi vay tin thade boi 05 pH acid hon (Khong 4) 4 chéing la su ing pH cia cfc tinh trang dda nei trén. Mot trong ning thud o6 Kha ing tao pH énguong 4 va c6 pK,3.8 (in ‘véi pH 4 nén cf kha niing dm t6t) 46 1a ny déng vai trd quan ao ha da. én phiim Clairial peel ciia SVR glycolic acid, ‘chitn acid citric 10%, pH3.8. 4p dung 46 tgo moi trubng pH acid cho da. Trong mot thirnghi¢m ding 4% ‘acid lactic (pH khoding 4) bai ngay 2 Tan lam gidm syz mat nuéc qua da va ‘gidm nhay cim cia da véi SLS. Ngodi ra, acetic acid, alginic acid, acid citric ‘AHA cing 6 kha nang dém tot vi pK, ongudng gin 4. ~ Tré em trong 6 thing dau tién da e6 pH cao hon, vi vay vige sie dung thud boi 06 pH khoding 4 va e6 40 dém cao cb thé gid fu che cao c6 thé gitip gidm trigu chin; dy phong bénh viém da co dia. Z 85. Vai tro cia pHT trong trig ef ~ C.acnes sng tét 6 méi trudng pH 6-65. Mot vai nghién au ; 5. Mat vai chi ra rin thn dingrndtb i ch Gm Oo loge cup vio cas hon en ding rita mito tinh chit acid sau 4 tulin sir dung. ~ Trong nghién ctu gn nhit cia tae gia lez khi ‘Tron at cia tac gid Valle-Gonzilez Khi sit dung ns eee Diu nay dat ra mot hudng rat méi trong eée san phim bai tring cé: dlinggo HOANGVANTAM S capcaog nt te eee 05 i is dung x4 phong ¢6 PH kit, trade diy ria mat ay sit ‘ ingnkeu hon. Ngby ay, fet Khoa hoe diy 8 H acid phia hop hon véi pH cla da. Theo tie pn hap da dng 45 Tam glam kich ng phim cham s6c da 6 dp pH nhu thé no, thé tu dling cle hy @ dudi ching ta thay AHA, BHA tao pH 86, pHa ef sin += Cée sin phim chim s6e da phim may ra sao? Qua bing, fut 3-4 (sin phim cia Paulas Choice) ~ Khibéi cde sin phim chim s6cda gin nhau, ching ta 59 chuing sbi mit tee dung ca nhau: vi dy boi vitamin C cb pH khodng 3 qué gn ducing fm btn cit trung tinh sé lim mt te dung cha nhau Khong? Nhu dé trinh iy & tr, thud bs Bu ct tao mothe dm t6t dE Bie doe pH inh nén hi bi cfc ch ph nay gin nha it gay ras thay At Kon an toan ching ta nén bi cic sin phim céch nhau Khoding vai phiit dé thude bai tnd thiim vio da, sau dé dig tiép cic thuBe bai tigp theo. = Méts6 quan diém cho ring chiing ta nén bai sin phim chim s6e da ¢6 pH thip tru, sau dé bai cde ehé phim o6 pH cao len tren? Thue t@ hin nay vin dura e6 nhimg bang chimg khoa hc vé vin d nay. Néu dp dung Sc tn trong trong hop cin béi vitamin C, BHA, AHA trong cing tri sé nhur thé ndo? Bang 6 trén cho thay pH cita serum vitamin C du6i dang LAA I tip nha én bot tru, sau a bot tp BHA 181 én AHA (thing AHA c6 pH ciohon BHA), “Ta liga tham Khdo: xem tl trang 324 CHAM SOC DATRON ©O1-TAP1. 3940 HOANG VAN TAM 1. CACH THUc THUGC QUA DA = Fring thr, a thud thm vio trong a mot cch Uni th yy 2 tinh chit trong luong phan ti <500 Daltons va khdng wa nage, yg Cach dng vit yg: hitb phitmhigt nh laser, RE; ding dng dién anu din dif chay ion; co hoc nu tiém, Lin kim; bigm php Khe nht ‘iu fm, méy tiém thud khing diing kim... ‘Uu diém cia phuong phépniy 1a din tude qua da nhanh hing, Tuy nha, day a phuong php xim li, hii iu te méy mb Cc pang pip ot fd had qua de te haying hi dfn the, xan), i hp, situ ing hi ing nit ase RE, ing dich wing Kind, ey (dng i ie a,x ing ng ki i ig Ki shd 3. DIEN DI ION GONTOPHORESIS) BAL Coch Digna sit dung dng dién ign tu, higu dign thé hip gidp din es] ce the 6 phén age am dong vio trong da. Hai thong 36 quan O-8-O trong tong dign i a6 1 exing 6 dng dién va tht gan dn a, “i Tring thuing, cuing a ding itn tong che may dign di te G15 mA. Cuimg dd dong itn pipe ting dng din inti dn cang cao én nhin cing cim thiy hy o62 gv an. bite = Din di cb 2 ce () vi (9,1 eye sé gin vio lim bth nin, 1 ove We ic wi ving da cn dit te, Nea tude mang din tch dn th eye cia ‘ang da cin ditt cing phi mang din tic Am eve cing din eh tf nhau th hase vio co thé a hon Vid L-ascobic acid (LAA) mang, Aig tc am vith dng eve im dy thud vio da, Céc chit gm dau, corticoid, salicylic mang dién fim, ldocsin v8 hyaluronidase mang ign dong> Trong dan vitamin C: * Trong nghién ciu eta Xu va cing st sit dung serum LAA 23.94, in rong + in ion Sutin 1620 nh hn gdm. 8 Hola da ngoa ra tac te dng gam mn nig Jam sing da. * Trong nghén ci cia Chang-Hun Huh si dung MAP Phi hyp ign i a tt bh rim mi sa 12 un im ng sk tS cia ng ditn di MAP gitm so véiném din di gid duoe.Tée dung phuhay gyn chim chich do dign (21%), Trongthirnghiém nly ta gi ding dng ge SmA trong 6 phit ~ Gay t@ lidocain tai ché: cdc tic gid thurimg ding Iiéu 4 mA trong 19 phy (40 mA/pht vét lidocain 2% gly te tre khi lam thi thugt. Chi 60-120 phit méi cb sir dung liéu thap hon ~ Ngoitra, din di con ding dé din thude fentanyl giip gidm dau chi dng cho bénh nan, 4. $180 AM DAN THUGC (SONOPHORESIS) 4.1. Co ché cia siéu am ~ Sigu dm c6 tin $620 ktiz-16 MHz, cumg d6 cao nit 14 Wiem?. Khi sia Am tao 2 higu img: nhigt va tao béng kh, ~ Hig img nhigt: Khi sng sidu m qua da s& bj hap thu va sinh nhige, Véi {in 6 thép 20 kliz 6 thé ting nhigt d9 cia da lén khoang 20 d6. Khi nit 40 da tang ln lam ting tinh thm cia da, vi thé hip thy thuée tt hon. Céc ‘m6 06 tif collagen cao hu gan, diy ching... tic dung hp thu song su 4m cao hon, Tin s6 cing cao cho higu tng nhigt cing cao: fin s6'3. MFlz cb dung sinh nhigt cao hon 1 MHz khong 3 Fin, dua vio de), ce bong ki an tat 5 taén mang t ia tbo. Khi ching tad r img siéu am che bing khi nay s8 déng ai (CHAM SOC DATRONDOI-TAPT 43 = Tan 6 sifu iy tn 56 thp 20-100 kf, trung bin tr 100-700 kHz, cao >07 Mite (hug ding nt 1-3 MHz). Tin s siéu im cang cao thi d6 dm ayn cing gidm, vi dy 1 MHz 6 thé dim shu 5 cm, trong khi 3 MHz cht, dim stu duge 1-2 am, Tin 6 sium cing cao thi Kh ning sinh ait cing én: vi dia kh ding fin 581 Miz cuing dao 15.25 Wham? 8 tg racim side dim sau 2-3 phist trong ki ding tin s6 3 MHz chi cin liu 05 Wiem? adi, ~ Curing sium: it tp: 01.0.5 Wien trung binh 05-15 Wiemt, cao 1525 Wham. ~ Thi gian di tr: ngin: 3.5 phi trung binh 5-15 phit, da: 15-20 phi. [Nét kich thuse ving diéu tr li e6 thé cng thoi gian di tj di, ving 0,8 ml sé dau hon. = Nguy ov gy kim: nguy co gay kim khi kim qué ngén, hod tié gitta chitu cao/dy thi ((hurong nhé hon 3). Khi kim bj gay 48 gay viém da do dj vat. ~ Dida sau digu tris khi kim ngfin hon 0,1 mm da khéng bj d6, kim cang dai guy co 45 cing cao, khi kim > 0,55 mm xuat hign diém chay mau tai vi ti ding. Thong thurdng, 46 da s® phuc hii tir 30 phiit dén 2 tiéng. + INhiém Khun: kim kim logi dé gy nhiém khuain hon. ~ Dé an toan cia kim hda tan phy thudc vao chit ligu lim kim: ‘ThE hé dau tién cia kim Jogi may thuimg ding polymer nh Rae (CMC) va polyvinylpyrrolidone (PVP). Kim s ‘ong bj phn hiyy sinh hoc vi thé thurdmg durgc dao thai qua than, rong lugng < 40 kDa la an toin. bia: sapatneFeyvnylpymoidone pw! waluronic acid (HA), Nhih Sa Vai ngly tai da, (1A). Nhiing ) polyethylene glycol aybi pha hy sinh hoe CHAM SOC DATRON©01-TAP1. 47 ‘+ Thing thug nhiing chit ligu cba kim hia tan sé gay dé da kéo dai thom so véi kim de. Tuy nhién, phuong phép nay kh6ng gay nhiém Khun va lay nhiém chéo. = Phin ing w hat sau tiém: méi diy Razich Soltani-Arabshahi béo cho 3 truimg hop ding bit tém Dermapen dé din serum vitamin C va durdng im qua da xuat hign phan dng what kém phan ting toin than nur daw kh6p, 8. Phin ng suit hign sau vi ngay (6 vi iin hi diing thudc. 2/3 dap tmg tot vi doxycydine, minocycline wing va corticoid bi lai nhe- Phin sng « hat sau ding bit tiém nko dt hada. 64, M6t s6'nghitm cu deg tgh han sit dung kim nd - Ji Yeon Hong iu tj 90 bf nhin nép nhin chan chim. Chia 3 nhém: ‘ihm I ir dung kim hba tan don thin, nhém 2st dung kim ha tan + bi em chéing nhiin chia adenosine, nhém 3 dling adenosine don thulin. Kim hnda tan chita HA 16.7% 46 di 0.35 mm, chia 125 kim ttn dign ich 38 em? ‘Kim hda tan sr dung migng dn 48 qua dém 2 Tiy/tuln, kem bot? findngay. Sau4tulin nhém 2 da cho higu qua cao, an ton, dung nap tt = Nghién cia khéc tgn hinh bei Kim tn 24 bénh nhin Hin Qu chia 2 nhém thanh 2 nika mat: str dung kim hoa tan chita chat din + thuBe LAA 6 mat bén nay vA kim hda tan cha chit din + retinyl retinoate 6 mit bén con lai, Ca 2 nhém du lim gidm nép nhiin chén chim sau 12tuin. = Cc te gid Hin Quée difu tr 24 bénh nhan stn ngrta bing cfch ding ‘ming dn kim hoa tan bing HA tun/ Tin 48 12 tgng qua dém sau a6 boi ‘mometasone 0.1% cream trong 4 tuin cho thay higu qua hon nhém diing thudic bi don thin Khoding 1.5 Tn = Dhurat difu tr] 100 bénh han rung téc hi chia 2 nhém sit dung rmicroneedles tun 1 fin + minoxidil 5% 2 lan/ngay s0 v6i nhiém minoxidil 5% 2 lin/ngay don thin, Sau 12 tun nm két hop thay 82% bénh nan cai thign tr 50% ten so véi chi 45% nhém ding minoxidil don thuin,