308 nm准分子激光联合他克莫司乳膏治疗儿童面颈部白癜风疗效观察

目的 评价308 nm准分子激光联合0.03%他克莫司乳膏治疗儿童面颈部白癜风的疗效及安全性。 方法 68例儿童面颈部白癜风（年龄 ≤ 14岁），根据皮损部位分为皮损组（包括面颈部）；腔口组（包括口周、眼周）；均给予308 nm准分子激光照射，每周1 ～ 2次，20次1个疗程；联合外用0.03%他克莫司乳膏，每日2次，疗程结束后分别进行疗效评价，并观察红斑反应及照射累积量对疗效的影响。结果 20次治疗结束后，皮损组显效率78.4%，腔口组显效率54.8%，皮损组显效率优于腔口组（P < 0.05）。两组在治疗过程中红斑反应持续48 h以上的平均次数分别是皮损组5.84次、腔口组9.12次。腔口组红斑反应持续48 h以上的平均次数明显多于皮损组（P < 0.01）。两组在完成10次和20次治疗后的平均照射累积量分别是：皮损组4215 mJ/cm2（10次）、10 453 mJ/cm2（20次）；腔口组3364 mJ/cm2（10次）、7430 mJ/cm2（20次），皮损组平均照射累积量均大于腔口组（P < 0.01）。结论 308 nm准分子激光联合0.03%他克莫司乳膏治疗儿童面颈部白癜风是安全、有效的，面颈部疗效好于面部腔口部位，且后者红斑反应重于前者。

Efficacy of 308-nm excimer laser combined with topical tacrolimus cream for the treatment of childhood vitiligo on the face or neck

HU Hui-li, FAN Qi-min, CHEN Jun-fan, XU Ai-e. Department of Dermatology, Third People′s Hospital of Hangzhou, Hangzhou 310009, China Corresponding author : XU Ai-e , Email: xuaihz@msn.com 【Abstract】 Objective To assess the efficacy and safety of 308-nm excimer laser combined with topical tacrolimus 0.03% cream for the treatment of childhood vitiligo on the face or neck. Methods Sixty-eight children aged < or = 14 years with vitiligo on the face or neck were enrolled in this study, and divided into two groups based on lesional sites, i.e., skin group with lesions on the forehead, cheek, lower mandible, neck or in the periortic region and mucosa group with lesions in the perioral or periorbital region. All the patients received 308-nm excimer laser irradiation once or twice weekly and topical tacrolimus 0.03% cream twice daily. Twenty sessions of irradiation served as a treatment course. Efficacy was evaluated at the end of the treatment course. The effects of erythema reaction and cumulative irradiation dose on efficacy were assessed. Results After 20 times of laser therapy, an excellent response was achieved in 78.4% of the patients in the skin group, and 54.8% in the mucosa group （P < 0.05）. During the treatment, the average frequency of erythema reaction lasting 48 hours or longer was significantly lower in the skin group than in the mucosa group （5.84 vs. 9.12, P < 0.01）. After 10 and 20 times of laser therapy, the cumulative radiation dose was 4215 mJ/cm2 and 10 453 mJ/cm2 in the skin group, respectively, compared to 3364 mJ/cm2 and 7430 mJ/cm2 in the mucosa group, respectively （both P < 0.01）. Conclusions The 308-nm excimer laser combined with topical tacrolimus cream is effective and safe for the treatment of childhood vitiligo on the face or neck. Vitiligo on the forehead, cheek, lower mandible, neck and in the periortic region appears to respond better to this therapy with a weaker erythema reaction than that in the perioral or periorbital region.