湿疹伴细菌感染定植的检测和治疗

目的： 分析湿疹皮损处的细菌定植情况并评价地奈德乳膏与夫西地酸乳膏联合外用治疗的疗效。 方法： 84例湿疹患者分两组：A组外用地奈德乳膏（2次/天）和夫西地酸乳膏（2次/天）,B组外用地奈德乳膏（2次/天）,分别于治疗后7天和14天观察疗效,治疗前皮损处取材做细菌培养和药敏。结果： 治疗7天和14天后,A组患者的有效率为71.43%和88.09% 明显高于B组的42.86%和69.05%（P=0.008和P=0.033）。84例湿疹患者中 45例患者皮损处培养鉴定细菌阳性,包括金葡菌32株（38.09%）,表皮葡萄球菌10株（11.9%）,大肠埃希菌2株（2.38%）,溶血性链球菌1株（1.19%）。结论：湿疹皮损易伴发微生物感染,地奈德联合夫西地酸外用治疗伴发细菌感染的湿疹可提高疗效。     

Pimecrolimus cream 1% is effective in asteatotic eczema: results of a randomized, double-blind, vehicle-controlled study in 40 patients

BACKGROUND AND OBJECTIVE: Pimecrolimus cream 1% is an effective treatment for atopic eczema. The aim was to investigate its efficacy in asteatotic eczema, a skin disease similar to atopic eczema and its associated dry skin and itching. METHODS: Single-centre, randomized, double-blind, vehicle controlled study in 40 patients with asteatotic eczema. Efficacy was assessed by eczema area and severity index (EASI), investigators global assessment (IGA), patient's self-assessment, and pruritus severity. RESULTS: After 4 weeks of treatment, EASI, the primary efficacy variable, was reduced by 62+/-7% from baseline in patients on pimecrolimus, compared to 21+/-14% in patients on vehicle (P=0.013). With pimecrolimus there was also a better control of pruritus (P=0.042) at week 4 whereas a better control of disease according to self-assessment could only be observed at weeks 2 (P=0.01) and week 3 (P=0.08). CONCLUSION: Pimecrolimus cream 1% is effective in patients with asteatotic eczema.     

曲安奈德益康唑乳膏长疗程间歇疗法治疗局限性慢性湿疹

目的 探讨外用糖皮质激素长疗程间歇疗法治疗局限性慢性湿疹的疗效、安全性及复发情况,以指导临床用药。方法 选取门诊局限性慢性湿疹患者,外用曲安奈德益康唑乳膏短程治疗。症状积分下降指数（SSRI）≥90％的患者进入长疗程,随机分两组,分别外用曲安奈德益康唑乳膏和润肤霜,间歇用药,共治疗8周。长疗程治疗4周、8周时及长疗程治疗停药12周时各随访1次。结果 长疗程治疗8周及停药12周时,曲安奈德益康唑组SCORAD评分均显著低于润肤霜组（t值分别为3.076和2.367,P值均 < 0.05）。长疗程治疗4周、8周及停药12周时,曲安奈德益康唑组复发率均显著低于润肤霜组（χ2值分别为4.426、7.683、8.199,P值均 < 0.05）。治疗期间不良反应发生率3.1％,无严重不良事件。结论外用糖皮质激素长疗程间歇治疗慢性湿疹,有防止症状加重、延缓湿疹复发的作用。     

曲安奈德益康唑乳膏长疗程间歇疗法治疗局限性慢性湿疹

目的 探讨外用糖皮质激素长疗程间歇疗法治疗局限性慢性湿疹的疗效、安全性及复发情况,以指导临床用药.方法 选取门诊局限性慢性湿疹患者,外用曲安奈德益康唑乳膏短程治疗.症状积分下降指数(SSRI)≥190%的患者进入长疗程,随机分两组,分别外用曲安奈德益康唑乳膏和润肤霜,间歇用药,共治疗8周.长疗程治疗4周、8周时及长疗程治疗停药12周时各随访1次.结果 长疗程治疗8周及停药12周时,曲安奈德益康唑组SCORAD评分均显著低于润肤霜组(t值分别为3.076和2.367,P值均<0.05).长疗程治疗4周、8周及停药12周时,曲安奈德益康唑组复发率均显著低于润肤霜组(x2值分别为4.426、7.683、8.199,P值均<0.05).治疗期间不良反应发生率3.1%,无严重不良事件.结论 外用糖皮质激素长疗程间歇治疗慢性湿疹,有防止症状加重、延缓湿疹复发的作用.     

曲安奈德益康唑乳膏长疗程间歇疗法治疗局限性慢性湿疹

目的 探讨外用糖皮质激素长疗程间歇疗法治疗局限性慢性湿疹的疗效、安全性及复发情况,以指导临床用药.方法 选取门诊局限性慢性湿疹患者,外用曲安奈德益康唑乳膏短程治疗.症状积分下降指数(SSRI)≥190%的患者进入长疗程,随机分两组,分别外用曲安奈德益康唑乳膏和润肤霜,间歇用药,共治疗8周.长疗程治疗4周、8周时及长疗程治疗停药12周时各随访1次.结果 长疗程治疗8周及停药12周时,曲安奈德益康唑组SCORAD评分均显著低于润肤霜组(t值分别为3.076和2.367,P值均<0.05).长疗程治疗4周、8周及停药12周时,曲安奈德益康唑组复发率均显著低于润肤霜组(x2值分别为4.426、7.683、8.199,P值均<0.05).治疗期间不良反应发生率3.1%,无严重不良事件.结论 外用糖皮质激素长疗程间歇治疗慢性湿疹,有防止症状加重、延缓湿疹复发的作用.     

Clocortolone pivalate cream 0.1% used concomitantly with tacrolimus ointment 0.1% in atopic dermatitis

This study was designed to evaluate the safety and efficacy of concomitant therapy with the corticosteroid clocortolone pivalate cream 0.1% (Cloderm Cream 0.1%) and the topical immunosuppressive agent tacrolimus ointment 0.1% (Protopic Ointment 0.1%) and to compare each drug alone for the treatment of atopic dermatitis in adolescents and adults. Concomitant therapy may minimize the potential adverse effects of both treatments taken alone and may potentially improve overall response. In this 21-day study with 57 patients with atopic dermatitis, groups of 19 patients were randomized to 1 of 3 treatments: concomitant treatment with clocortolone pivalate cream 0.1% and tacrolimus ointment 0.1% (CPC+ TO), monotherapy with clocortolone pivalate cream 0.1% (CPC), or monotherapy with tacrolimus ointment 0.1% (TO). CPC+ TO was statistically superior to TO alone in the percentage change for dermatologic sum score at days 14 (P = .024) and 21 (P = .033), excoriation at day 21 (P = .028), induration at day 21 (P = .033), and erythema at day 14 (P = .048). The dual therapy was also superior to CPC alone in excoriation at days 7 (P = .045) and 14 (P = .037), oozing or crusting at days 3 (P = .034) and 7 (P = .012), and lichenification at day 3 (P = .031). In addition, unlike the 2 single-therapy treatment groups, percentage reductions from baseline in scores for the sensation of transient pruritus and burning or stinging were statistically significant for the concomitant treatment at days 14 (P = .016) and 21 (P = .016).     

Control of the bioavailability of a topical steroid; comparison of desonide creams 0·05% and 0·1% by vasoconstrictor studies and clinical trials

Theoretically two corticosteroid preparations should show the same clinical activity even though they possess different medicament concentrations, provided that both preparations are at or above saturation e.g. they are suspensions. To test this theory, the non-fluorinated corticosteroid desonide prepared as two suspensions in the same cream formulation (Apolar Cream 0.1% and 0.05%) were evaluated for vasoconstriction using an occluded blanching test. Included in the vasoconstriction test were also another desonide 0.05% preparation (Tridesilon Cream®) and Betnovate Cream® (betamethasone 17-valerate 0.1%). The study was extended into patients by comparing the effects of Apolar Cream 0.1% and 0.05, in a double-blind, randomized, right-left comparative study including 40 patients with bilateral, non-infected hand eczemas, No significant difference could be demonstrated between the blanching responses of the four preparations tested in the vasoconstriction study. Betnovate Cream provided the lowest blanching response. Thirty-eight patients completed the clinical trial. All patients improved after 11 days of treatment with Apolar Cream 0.1%. With the 0.05% cream, 37 improved and, in one, the condition remained unchanged. No statistically significant difference could be demonstrated between treatments. It is concluded that, for practical therapeutic purposes, Apolar Cream 0.05% will equate with the corresponding 0.1% preparation.     

复方多粘菌素B软膏联合地奈德乳膏治疗亚急性/慢性湿疹的多中心、随机、双盲、平行对照临床研究

目的探讨复方多粘菌素B软膏联合地奈德乳膏治疗亚急性/慢性湿疹的临床疗效和安全性。方法采用多中心、随机、双盲、平行对照临床研究，入选亚急性湿疹患者144例（试验组72例，对照组72例），慢性湿疹患者144例（试验组72例，对照组72例）。试验组与对照组分别外用复方多粘菌素B软膏和复方多粘菌素B软膏基质，隔3h后两组均使用地奈德乳膏，每日交替使用各2次。记录患者的症状/体征（包括瘙痒程度、炎症程度、糜烂/渗出程度、浸润/肥厚程度及靶皮损面积）和时间指标（瘙痒减轻起效时间、瘙痒减轻缓解时间）。分析两组的疗效，评估安全性。结果试验组和对照组的症状/体征总分在用药7d（亚急性湿疹：试验组6.09±2.78，对照组8.26±3.17；慢性湿疹：试验组6.56±2.68，对照组8.84±2.90）和14 d（亚急性湿疹：试验组3.68±3.18，对照组5.28±4.05；慢性湿疹：试验组4.38±3.27，对照组6.25±3.78）均较基线水平（亚急性湿疹：试验组13.44±1.66，对照组13.60±1.75；慢性湿疹：试验组12.96±1.16，对照组12.64±1.18）有不同程度的下降。试验组亚急性、慢性湿疹患者在用药7、14 d后的症状/体征均较相应的对照组低，差异有统计学意义（均P<0.05）。亚急性湿疹患者中，试验组瘙痒和浸润肥厚评分的下降幅度均显著高于对照组（均P<0.01）；慢性湿疹患者中，试验组瘙痒、浸润肥厚和靶皮损面积评分的下降幅度均显著高于对照组（均P<0.05）。亚急性湿疹患者试验组瘙痒减轻起效时间短于对照组，但瘙痒减轻缓解时间长于对照组（均P<0.05）；慢性湿疹患者试验组瘙痒减轻起效时间短于对照组（P<0.0001），但瘙痒减轻缓解时间与对照组差异无统计学意义。试验组医生和患者对治疗效果的满意度均高于对照组（均P<0.05）。结论外用复方多粘菌素B软膏可增强外用地奈德乳膏治疗亚急性和慢性湿疹的疗效，且对亚急性湿疹的效果更为显著。复方多粘菌素B软膏还能较好地控制湿疹患者的瘙痒症状和浸润肥厚。     

地奈德乳膏联合薇诺娜柔润保湿霜治疗婴幼儿湿疹疗效观察

目的评价0.05%地奈德乳膏联合薇诺娜柔润保湿霜治疗婴幼儿湿疹的有效性及安全性。方法将门诊2014年1月—2014年12月诊治的婴幼儿湿疹100例随机分成试验组和对照组。试验组先给予薇诺娜柔润保湿霜外用,5 min后再外用地奈德乳膏;对照组仅外用地奈德乳膏,每日2次,7 d为1个疗程。在第1个疗程和第2个疗程后判定疗效。8周后随访,观察预后及复发情况。结果第1个疗程试验组有效率为70.2%,对照组为64%,两组有效率比较差异无统计学意义。第2个疗程试验组有效率为94%,对照组为82%,两组相比差异有统计学意义。8周后随访,试验组有效率为84%,对照组为60%,两组相比差异有统计学意义。结论地奈德乳膏联合薇诺娜柔润保湿霜治疗婴幼儿湿疹疗效好,并能减少皮损的反复。     

Optimized interval treatment of eczema with fluprednidene. A multicenter double-blind study

In a multicenter double-blind study, 44 patients suffering from eczema were bilaterally treated with 0.1% fluprednidene-21-acetate over 21 days. Continuous application twice a day was compared with intermittent therapy, i.e. 1 day intermission (15 patients), 2 days intermission (16 patients) and 3 days intermission (13 patients) using the cream base. Final evaluation was based on 11 criteria. All regimens, continuous and intermittent, proved effective (at least 90% reduction of the lesions). Treatment with 3 days intermission showed the same favorable results as continuous application, although the amount of glucocorticoids applied was 75% less. Measurements of the skin fold thickness (SFT) in healthy controls did not indicate any atrophy after treatment with fluprednidene under the same conditions as the eczema patients or under occlusion for up to 21 days. Clobetasol-17-propionate, in contrast, significantly reduced the SFT already after application of only 1 week.     

派瑞松霜治疗皮炎湿疹的疗效观察

目的观察派瑞松霜治疗皮炎湿疹的疗效、耐受性及不良反应。方法60例患者来自门诊和住院病人,男55例,女5例。年龄14～87岁,平均71.1±15.1岁;病程2天～20年,平均9.5±25.1月。每日2次外用派瑞松霜涂于患处,每周随访1次,共3周。结果治愈33例(55.0％),显效16例(26.7％),好转4例(6.6％),无效7例(11.7％)。总有效率为81.7％,未发现不良反应。结论派瑞松霜是治疗皮炎湿疹类皮肤病的安全、有效药物。     

1%吡美莫司乳膏治疗阴囊湿疹疗效观察

目的探讨1%吡美莫司乳膏治疗阴囊湿疹的疗效及安全性。方法通过随机数字表法将82例患者分为两组,对照组40例,采用百癣夏塔热片治疗,3片/次,3次/d;治疗组42例,在百癣夏塔热片治疗的基础上外用1%吡美莫司乳膏,2次/d,连用21天。结果治疗组第7天、第14天和第21天的有效率分别为45.23%,69.05%和76.19%,优于对照组的37.50%,45.00%和52.50%。两组第14天和第21天的有效率比较差异有统计学意义(P均<0.05)。患者均未出现严重的不良反应。结论 1%吡美莫司乳膏治疗阴囊湿疹有良好的效果,不良反应少。     

Low-dose triamcinolone acetonide in the phytocosmetic lichtena reduces inflammation in mild to moderate atopic dermatitis

BACKGROUND: Previously, we reported the efficacy of Lichtena--a phytocosmetic cream product--in atopic dermatitis (AD). Later, fraudulent triamcinolone acetonide (TACA) was detected at low doses (16-40 microg/g) in Lichtena. This suggested that TACA may be effective at much lower concentrations than used in commercial products (1,000 microg/g). OBJECTIVES: To investigate the efficacy in AD of low-dose TACA in Lichtena compared to plain Lichtena. METHODS: Fourteen patients presenting symmetrical lesions of AD were treated for 1 month with Lichtena plus 25 microg/g TACA (= verum) and plain Lichtena (= placebo). The severity of the lesions was assessed by the Severity Scoring of Atopic Dermatitis (SCORAD) on days 0 (= baseline), 7, 14 and 28. RESULTS: Already after 1 week of treatment, significant SCORAD differences to baseline were observed comparing verum- and placebo-treated areas. No improvement was observed using plain Lichtena. CONCLUSIONS: TACA displayed a significant improvement of AD at doses up to 40 times lower than in commercial products.     

湿疹和特应性皮炎皮损处细菌定植情况及药物联合治疗的分析

目的 探讨湿疹和特应性皮炎(AD)皮损处金黄色葡萄球菌(金葡菌)及其他细菌的定植情况,评价抗菌药物与糖皮质激素联合用药的疗效。方法 采用多中心、随机、双盲试验,在筛选日及治疗后第7、14和28天对皮损评分,并在皮损和非皮损处分离细菌。试验组外用抗菌药物和糖皮质激素,对照组外用基质和糖皮质激素。结果 共入选患者327例,湿疹208例,AD119例。湿疹皮损处细菌的阳性率为70.19%,金葡菌占47.26%;非皮损部位细菌阳性率为32.69%,金葡菌占27.94%。AD皮损处细菌阳性率为74.79%,金葡菌占79.78%;非皮损部位细菌阳性率为34.45%,金葡菌占80.49%。湿疹和AD皮损部位金葡菌的定植量均高于非皮损部位(P<0.01,P<0.05),细菌的定植量与皮损的严重程度呈正相关。两组患者治疗后总体疗效无明显差异(P>0.05),但湿疹临床症状评分指数>8分者及AD评分指数>7分者,在治疗的第7天,试验组与对照组的症状评分指数改善率存在显著差异(P<0.05),在治疗的第14天和第28天,两组差异均无显著性(P>0.05)。结论 湿疹和AD患者皮损部位细菌的检出率和金葡菌的带菌率均明显增高,说明金葡菌与湿疹皮炎的关系密切,早期联用抗菌药物可提高疗效。     

Efficacy and safety of PAC-14028 cream – a novel,topical, nonsteroidal,selective TRPV1 antagonist in patients with mild-to-moderate atopic dermatitis: a phase IIb randomized trial

This research, from Korea, showed that a non-steroid containing cream, called PAC-14028, can be as effective in treating eczema symptoms as current creams on the market but with fewer side-effects. Eczema is one of the most common skin diseases. Available topical (applied to the skin) treatments can be very effective in treating eczema symptoms. However, they can also cause negative side-effects such as itching and burning, which can result in patients discontinuing their treatment. The research was conducted with 194 adults with mild to moderate eczema. Participants were split into four groups and treated with either a control cream or the new treatment, PAC-14028 cream, at one of three different concentrations (0.1%, 0.3% or 1.0%). Participants applied the cream twice daily for eight weeks. The results were primarily measured using the Investigator's Global Assessment (IGA). This is a visual scale for assessing the severity of eczema in a patient based upon typical symptoms. After eight weeks, 57.5 percent of patients in the group who received the highest concentration PAC-14028 cream, had an IGA score indicating that their symptoms of eczema were completely eradicated or reduced to an almost-clear level. IGA success rates at week eight were 15 percent for the control cream, compared to 43 percent for PAC-14028 cream at 0.1%, 38 percent for 0.3% and 57 percent 1.0%. The efficacy of PAC-14028 cream was similar to a commonly used non-steroidal cream called pimecrolimus but with a far lower incidence of unwanted side-effects.     

糠酸莫米松乳膏治疗湿疹皮炎类皮肤病多中心临床研究

目的 评价0.1%糠酸莫米松乳膏治疗湿疹皮炎类皮肤病疗效和安全性。方法 本研究采用随机、双盲、平行对照的临床研究方法。受试者分别接受国产糠酸莫米松乳膏和艾洛松治疗。患者每日局部涂药1次,连续用药4周。在治疗始及治疗后第1～4周对各观察指标进行评估记录。结果 本研究共入选受试者284例(试验组和对照组各142例)中湿疹143例,神经性皮炎141例。治疗后1～4周,两组患者各项症状/体征指标计分及总计分均有明显下降。试验组和对照组组间比较差异无统计学意义。治疗结束时,湿疹患者试验组基愈率和总有效率分别为78.87%、97.18%;对照组基愈率和总有效率分别为84.51%、92.96%。神经性皮炎患者试验组基愈率和有效率分别为75.71%、100%;对照组基愈率和总有效率分别为80.28%、94.37%。两组患者总体评价试验组基愈率77.30%,有效率98.58%。对照组基愈率82.39%,有效率93.64%。两组间疗效比较差异无统计学意义。研究中两组均未发生不良反应。试验组发生接触性皮炎1例。结论 0.1%糠酸莫米松乳膏治疗湿疹、神经性皮炎使用方便,安全性好。     

二丙酸倍他米松乳膏治疗慢性湿疹临床观察

目的价二丙酸倍他米松乳膏治疗慢性湿疹的近期临床疗效和安全性。方法采用随机、开放、平行对照的方法将120例慢性湿疹患者分为两组,治疗组和对照组分别外用0.05%二丙酸倍他米松乳膏和卤米松乳膏,2次/d,疗程2周,治疗结束后观察两组患者的治疗结果。结果治疗组有效率98.31%,对照组69.49%,治疗组有效率明显高于对照组,差异有统计学意义(P<0.01),两组均无严重不良事件发生。结论 0.05%二丙酸倍他米松乳膏治疗慢性湿疹临床疗效可靠,安全性高。     

强力脉痔灵联合曲安奈德益康唑乳膏治疗肛周湿疹疗效观察

目的观察强力脉痔灵联合曲安奈德益康唑乳膏治疗肛周湿疹的临床疗效。方法采用随机法将99例患者分为两组,治疗组50例,予强力脉痔灵2片口服,同时外用曲安奈德益康唑乳膏,均2次/d,连用3周。对照组49例,仅外用曲安奈德益康唑乳膏,连用3周。两组均治疗结束时观察近期疗效,痊愈者随访3个月观察远期疗效。结果治疗组近期疗效有效率80.00%,对照组为71.43%,差异无显著性(P>0.05);痊愈病例随访3个月,治疗组复发率20.0%,对照组57.9%,差异有显著性(P<0.01)。结论强力脉痔灵联合曲安奈德益康唑乳膏治疗肛周湿疹疗效好。     

Topical idoxuridine for treatment of genital warts in males. A double-blind comparative study of 0.25% and 0.5% cream.

Fifty heterosexual male patients with histologically verified genital warts of short duration (less than 3 months) were randomly allocated to treatment with either 0.25% or 0.5% idoxuridine cream. The application of the cream to the warts was performed twice daily for an initial period of 14 days, whereafter patients with partial improvement or no response were retreated in the same way for another period of 14 days. Patients not completely healed after 28 days were regarded as treatment failures and withdrawn from the study. After the initial treatment period of 14 days, 19 of 25 patients (76%) treated with 0.5% idoxuridine cream, and 9 of 25 patients (36%) treated with 0.25% idoxuridine cream were completely healed. This difference is significant (p less than 0.01). The corresponding figures at the second follow-up examination (28 days after start of the study) were 19 of 25 (76%) and 13 of 25 (52%), respectively. At the last follow-up examination three months after start of treatment, four patients treated with 0.5% idoxuridine cream and five patients treated with 0.25% idoxuridine cream had a relapse. Thus, the overall rate of complete healing was 15 of 25 (60%) for the patients treated with 0.5% idoxuridine cream and 8 of 25 (32%) for those treated with 0.25% idoxuridine cream. The difference is significant (p less than 0.01). No adverse reactions were observed or reported by the patients.     

外用皮质类固醇激素皮肤病患者的斑贴试验研究

用含不同皮质类固醇激素外用药的斑试剂对１７２例有外用皮质类固醇激素史的皮肤病患者进行斑贴试验，结果１２例（７．０％）对多种皮质类固醇激素制剂有反应。其阳性率仅次于橡胶促进剂、香料、苯唑卡因及白降汞，是第５位常见的过敏原。皮质类固醇激素过敏多见于钱币状湿疹，瘀积性皮炎等慢性皮肤疾患。临床表现多为皮损迁延不愈，但也可发生急性接触性皮炎。过敏的发生与性别、年龄无关；交叉过敏与多价过敏现象常见；未见全身性反应。