他克莫司软膏联合三重修护特润霜治疗女性面部激素依赖性皮炎疗效观察
[摘要]目的：了解他克莫司软膏联合三重修护特润霜治疗女性面部激素依赖性皮炎的疗效及安全性。方法：采用随机对照开放试验，他克莫司组给予他克莫司软膏外用，2次/天，待皮疹痊愈后改为1次/天，连用3天后停药；特润霜组给予特润霜外用，2次/天，待皮疹痊愈后仍可维持；联合组给予他克莫司软膏外用每日两次，特润霜外用2次/天，错时使用，待皮疹痊愈后他克莫司软膏改为1次/天，连用3天后停药，特润霜2次/天维持。于就诊的当日，用药的第7、28天复诊，记录皮疹变化，对红斑、丘疹、鳞屑及瘙痒、刺痛的总积分进行评价。结果：治疗第7天，联合组的显效率与他克莫司组相当，优于特润霜组；联合组的痊愈率优于他克莫司组或特润霜组。治疗第28天，联合组的显效率和痊愈率均优于他克莫司组或特润霜组。结论：他克莫司软膏联合三重修护特润霜治疗女性面部激素依赖性皮炎具有较好的疗效，安全性较高，在临床有一定的推广价值。
[关键词]他克莫司；三重修护特润霜；激素依赖性皮炎；面部
[中图分类号]R758.2 [文献标识码]A [文章编号]1008-6455(2011)04-0627-03
Clinical observation of tacrolimus cream combined with triple selective emollient cream in treatment of female facial steroid dependence dermatitis
YANG Ting, YUAN Hui-ying, PU Jie, BI Ming-ye
(Department of Dermatology and Pharmacy, Wuxi People's Hospital Affiliated to Nanjing Medical University，Wuxi 214023，Jiangsu，China)
Abstract：ObjectiveTo evaluate the efficacy and safety of tacrolimus cream combined with triple selective emollient cream in treatment of female facial steroid dependence dermatitis.MethodsA randomized controlled open trial was performed. The group of tacrolimus was applied with tacrolimus cream twice per day only and the therapy was switched to once every day for three days after the rash cured. The group of emollient cream was applied with triple selective emollient cream twice per day and maintained after the rash cured. The combine group applied with tacrolimus cream and triple selective emollient cream twice per day alternately, and the later was maintained after the rash cured. The variations of the rash were recorded and the total scores of erythema, papule , scale, pruritus and twinge were evaluated in the return visit of the same day visiting , 7, 28 days after medication. ResultsThe cure rate of combine group was higher than tacrolimus and emollient cream group on 7,28 day of therapy. The obvious effective rate of combine group corresponded to tacrolimus group on 7 day of therapy, and was significantly higher than tacrolimus and emollient cream group on 28 day of therapy. Conclusions Tacrolimus cream combined with triple selective emollient cream may be an effective and safe treatment option for women with facial steroid dependence dermatitis. It was of a certain spreading value in clinical.
Key words: tacrolimus； triple selective emollient cream； steroid dependence dermatitis；face
糖皮质激素因其能抑制炎症反应、快速控制症状而受到医生和患者的青睐。近年来，随着糖皮质激素外用制剂及含糖皮质激素化妆品的不规范使用，且女性面部皮肤较男性薄，并有较多机会接触化妆品，导致女性面部激素依赖性皮炎的发病率上升，已成为皮肤科门诊常见病之一。笔者采用随机对照开放的研究方式对2009年10月～2010年9月就诊的女性面部激素依赖性皮炎患者应用他克莫司软膏联合三重修护特润霜(简称：特润霜)治疗，并观察其疗效及安全性，现报道如下。
1资料和方法
1.1入选标准：①女性，年龄≥14周岁；②皮损局限于颜面部，自觉有皮肤瘙痒、灼热、刺痛、干燥、紧张感、热敏感等；③皮损表现为红斑、丘疹、鳞屑，可伴有毛细血管扩张、色素沉着、皮肤萎缩；④外用含糖皮质激素制剂超过1个月，临床有依赖和反跳现象；⑤征得患者同意，并能坚持至随访结束。
1.2 排除标准：①皮疹局部合并明显的细菌、真菌等感染者；②合并有痤疮皮损者；③皮疹有苔藓样变者；④伴有特应性皮炎；⑤皮疹局部有破溃渗出者；⑥入组前4周内系统应用过糖皮质激素及免疫抑制剂；⑦已知对他克莫司软膏或特润霜所含成分及其化学结构类似药物有过敏史；⑧合并有发热、咳嗽、腹泻等内科疾病症状者。
1.3 入选病例：均为到我院皮肤科门诊就诊、根据典型病史及临床表现明确诊断为面部激素依赖性皮炎的患者，但排除激素副作用之痤疮样表现。共150例入选，年龄15～55岁，平均32.3岁。病程4月～3年，平均0.9年。按就诊日期分为三组：每组50例，因失访等原因退出/中止治疗13例，脱落率8.7%。纳入符合方案集共137例，其中他克莫司组45例，特润霜组44例，联合组48例。三组在年龄、治疗前病情等方面差异均无统计学意义。, http://www.100md.com(杨挺 袁惠英 浦洁 毕鸣晔)
[关键词]他克莫司；三重修护特润霜；激素依赖性皮炎；面部
[中图分类号]R758.2 [文献标识码]A [文章编号]1008-6455(2011)04-0627-03
Clinical observation of tacrolimus cream combined with triple selective emollient cream in treatment of female facial steroid dependence dermatitis
YANG Ting, YUAN Hui-ying, PU Jie, BI Ming-ye
(Department of Dermatology and Pharmacy, Wuxi People's Hospital Affiliated to Nanjing Medical University，Wuxi 214023，Jiangsu，China)
Abstract：ObjectiveTo evaluate the efficacy and safety of tacrolimus cream combined with triple selective emollient cream in treatment of female facial steroid dependence dermatitis.MethodsA randomized controlled open trial was performed. The group of tacrolimus was applied with tacrolimus cream twice per day only and the therapy was switched to once every day for three days after the rash cured. The group of emollient cream was applied with triple selective emollient cream twice per day and maintained after the rash cured. The combine group applied with tacrolimus cream and triple selective emollient cream twice per day alternately, and the later was maintained after the rash cured. The variations of the rash were recorded and the total scores of erythema, papule , scale, pruritus and twinge were evaluated in the return visit of the same day visiting , 7, 28 days after medication. ResultsThe cure rate of combine group was higher than tacrolimus and emollient cream group on 7,28 day of therapy. The obvious effective rate of combine group corresponded to tacrolimus group on 7 day of therapy, and was significantly higher than tacrolimus and emollient cream group on 28 day of therapy. Conclusions Tacrolimus cream combined with triple selective emollient cream may be an effective and safe treatment option for women with facial steroid dependence dermatitis. It was of a certain spreading value in clinical.
Key words: tacrolimus； triple selective emollient cream； steroid dependence dermatitis；face
糖皮质激素因其能抑制炎症反应、快速控制症状而受到医生和患者的青睐。近年来，随着糖皮质激素外用制剂及含糖皮质激素化妆品的不规范使用，且女性面部皮肤较男性薄，并有较多机会接触化妆品，导致女性面部激素依赖性皮炎的发病率上升，已成为皮肤科门诊常见病之一。笔者采用随机对照开放的研究方式对2009年10月～2010年9月就诊的女性面部激素依赖性皮炎患者应用他克莫司软膏联合三重修护特润霜(简称：特润霜)治疗，并观察其疗效及安全性，现报道如下。
1资料和方法
1.1入选标准：①女性，年龄≥14周岁；②皮损局限于颜面部，自觉有皮肤瘙痒、灼热、刺痛、干燥、紧张感、热敏感等；③皮损表现为红斑、丘疹、鳞屑，可伴有毛细血管扩张、色素沉着、皮肤萎缩；④外用含糖皮质激素制剂超过1个月，临床有依赖和反跳现象；⑤征得患者同意，并能坚持至随访结束。
1.2 排除标准：①皮疹局部合并明显的细菌、真菌等感染者；②合并有痤疮皮损者；③皮疹有苔藓样变者；④伴有特应性皮炎；⑤皮疹局部有破溃渗出者；⑥入组前4周内系统应用过糖皮质激素及免疫抑制剂；⑦已知对他克莫司软膏或特润霜所含成分及其化学结构类似药物有过敏史；⑧合并有发热、咳嗽、腹泻等内科疾病症状者。
1.3 入选病例：均为到我院皮肤科门诊就诊、根据典型病史及临床表现明确诊断为面部激素依赖性皮炎的患者，但排除激素副作用之痤疮样表现。共150例入选，年龄15～55岁，平均32.3岁。病程4月～3年，平均0.9年。按就诊日期分为三组：每组50例，因失访等原因退出/中止治疗13例，脱落率8.7%。纳入符合方案集共137例，其中他克莫司组45例，特润霜组44例，联合组48例。三组在年龄、治疗前病情等方面差异均无统计学意义。, http://www.100md.com(杨挺 袁惠英 浦洁 毕鸣晔)