5-氨基酮戊酸光动力疗法联合CO_2激光治疗尖锐湿疣的临床观察

目的观察5-氨基酮戊酸光动力(ALA-PDT)疗法联合CO2激光与单纯使用ALA-PDT疗法和单纯使用CO2激光疗法治疗尖锐湿疣的临床疗效。方法将入选的120例尖锐湿疣患者随机分为3组,即ALA-PDT疗法联合CO2激光治疗组、单纯ALA-PDT疗法治疗组和单纯CO2激光治疗组,每组40例,均治疗结束3月后判定疗效。结果 ALA-PDT疗法联合CO2激光治疗组清除率为100%(40/40),痊愈率为90%(36/40),复发率为10.00%(4/40);单纯使用ALA-PDT疗法组痊愈率为42.50%(17/40),复发率为29.17%(7/24);单纯使用CO2激光治疗组一次性清除率为100%(40/40),痊愈率为37.50%(17/40),复发率为62.50%(25/40)。三组患者的痊愈率和复发率比较,ALA-PDT疗法联合CO2激光治疗组均优于单纯ALA-PDT疗法治疗组和单纯CO2激光治疗组,差异均有统计学意义(P均0.001)。结论 ALA-PDT疗法联合CO2激光疗法治疗尖锐湿疣的疗效确切,复发率较低,其疗效优于单纯使用ALA-PDT疗法组和单纯使用CO2激光治疗组,值得临床应用。     

CO2激光联合5-氨基酮戊酸光动力疗法治疗尖锐湿疣疗效观察

目的 评价CO2激光与5-氨基酮戊酸光动力疗法(ALA-PDT)联合治疗尖锐湿疣的疗效及复发性.方法 124例尖锐湿疣患者随机分为两组,每组62例.治疗组采用CO2激光与ALA-PDT联合治疗,对照组单用CO2激光治疗.结果 治疗组患者痊愈率为90.6%(58/62),复发率为9.4%(4/62);对照组痊愈率为76.7%(46/62),复发率为23.3%(16/62).两组在痊愈率及复发率上差异有统计学意义.结论 CO2激光联合5-氨基酮戊酸光动力疗法治疗尖锐湿疣在疗效及复发率方面均明显优于单用CO2激光治疗.     

5-氨基酮戊酸光动力疗法联合CO_2激光治疗复发性尖锐湿疣疗效观察

目的:比较外用药、CO_2激光及5-氨基酮戊酸光动力疗法(ALA-PDT)联合CO_2激光3种方法治疗复发性尖锐湿疣的疗效,探索一种能有效降低尖锐湿疣复发的方法.方法:分别采用外用药、CO_2激光、ALA-PDT联合CO_2激光治疗39例复发性尖锐湿疣患者,并进行回顾性分析.结果:对39例患者随访3～12个月,均先开始外用鬼臼毒素酊治疗,平均41 d在原皮损部位出现新的皮损.复发率为100%.再采用CO_2激光治疗,平均57 d复发,复发率为100%.最后经ALA-PDT联合CO_2激光治疗,复发率降至5.1%(2例),对复发患者再次采用联合疗法治疗1次达痊愈.结论:ALA-PDT联合CO_2激光治疗复发性尖锐湿疣可明显降低复发率(P＜0.01),且安全、耐受性好,无明显不良反应.     

二氧化碳点阵激光联合5-氨基酮戊酸光动力疗法治疗顽固性甲周疣的临床观察

目的:观察二氧化碳点阵激光联合5-氨基酮戊酸光动力疗法(ALA-PDT)治疗顽固性甲周疣的疗效及安全性。方法:将31例顽固性甲周疣患者(76个皮损)随机分为观察组和对照组,观察组16例(40个皮损)予CO2点阵激光联合ALA-PDT治疗,对照组15例(36个皮损)予ALA-PDT治疗,两组均治疗3次,每隔14天1次,第3次治疗结束2周后评价疗效和不良反应,3个月后随访观察复发率,并进行比较。结果:观察组治愈率为100%(40/40),未见复发;对照组治愈率为72.22%(26/36),复发率为15.38%(4/26)。两组治愈率和复发率差异均有统计学意义(P值均<0.01)。两组不良反应均轻微。结论:CO2点阵激光联合ALA-PDT治疗顽固性甲周疣具有良好的疗效和安全性。     

5-氨基酮戊酸光动力疗法联合CO_2激光治疗宫颈尖锐湿疣疗效观察

目的观察5-氨基酮戊酸光动力(ALA-PDT)疗法联合CO2激光治疗宫颈尖锐湿疣的疗效和复发率。方法将入选的38例患者随机分为两组,分别采用CO2激光及ALA-PDT联合CO2激光治疗,比较两组患者的疗效和复发率。结果治疗组的治愈率和治疗后3个月时复发率分别为84.20%和15.80%,对照组分别为36.80%和63.20%,其治愈率和治疗后3个月时的复发率比较,差异均有统计学意义(P均<0.05),两组患者均未发生不良反应。结论 ALA-PDT联合CO2激光治疗宫颈尖锐湿疣治愈率高,复发率低,患者依从性好。     

二氧化碳激光联合艾拉光动力疗法治疗肛管内尖锐湿疣72例疗效分析

目的 探讨二氧化碳（CO2）激光联合艾拉光动力疗法（ALA-PDT）与CO2激光单用治疗肛管内尖锐湿疣（CA）优化疗效.方法 将138例肛管多发性CA患者分为2组：CO2激光联合光动力疗法组72例,CO2激光66例,先采用CO2激光祛除疣体,CO2激光联合光动力疗法组再用20％5-ALA湿敷封包4h,用633 nm的红光以100 J/cm2能量照射,1次/周,共做3次ALA-PDT,对照组只进行CO2激光治疗.结果 在首次CO2激光治疗后4周、8周、12周及24周时分别判定其复发情况及不良反应,CO2激光联合光动力疗法组的复发率与对照组在各时间点比较均有统计学意义（P＜0.05）,观察组的复发率较对照组低,在24周时观察组均治愈,对照组有9例复发.结论 CO2激光联合ALA-PDT能快速去除疣体,复发率低,患者耐受性好,可作为治疗肛管内尖锐湿疣的首选方案。     

5-氨基酮戊酸光动力疗法与CO2激光治疗尖锐湿疣疗效观察

目的:观察5-氨基酮戊酸光动力疗法(ALA-PDT)与CO2激光治疗尖锐湿疣的疗效。方法:采用ALA-PDT与CO2激光治疗尖锐湿疣各30例。结果:光动力组患者痊愈率为63.3%(19/30),复发率为15.8%(3/19);CO2激光组痊愈率为100.0%(30/30),复发率为60.0%(18/30)。结论:CO2激光组痊愈率高于光动力组,特别是一次性去除疣体方面;光动力组在复发率及安全性方面明显优于CO2激光组。     

光动力疗法联合咪喹莫特对尖锐湿疣复发的影响

目的研究5-氨基酮戊酸光动力疗法联合咪喹莫特治疗尖锐湿疣的临床效果。方法选择2016年1月—2017年10月在我院皮肤科进行诊治的61例尖锐湿疣患者,随机分为2组。对照组单纯给予5-氨基酮戊酸光动力疗法,观察组联合于皮损部位涂抹5%咪喹莫特软膏。治疗3周后,比较2组的临床治愈率、复发率以及免疫功能。结果观察组的复发率为明显低于对照组(P0.05),观察组的治愈率明显高于对照组(P0.05);治疗后,2组的CD~+4、CD~+3以及CD~+4/CD~+8均明显升高,且观察组更为明显(P0.05)。结论 5-氨基酮戊酸光动力疗法联合咪喹莫特治疗尖锐湿疣的临床效果明显优于单纯使用5-氨基酮戊酸光动力疗法,可以有效降低复发率,改善免疫功能,并具有较高的安全性。     

二氧化碳激光联合咪喹莫特乳膏治疗尖锐湿疣疗效观察

目的探讨CO2激光联合咪喹莫特乳膏治疗尖锐湿疣(CA)的临床疗效。方法将60例CA患者随机分为2组,治疗组在CO2激光术后局部外用咪喹莫特乳膏8周,对照组单纯用CO2激光治疗,随访6个月,观察2组患者复发情况。结果治疗组与对照组的复发率分别为6.67%,63.33%(P<0.01)。结论CO2激光联合咪喹莫特乳膏治疗CA有较好的临床疗效。     

氨基酮戊酸光动力疗法与CO2激光治疗跖疣疗效观察

目的 观察氨基酮戊酸光动力疗法（ALA-PDT）与CO2激光治疗跖疣的疗效。方法 ALA-PDT 与CO2激光治疗跖疣各68例。结果 光动力组患者的痊愈率为 86.8%（59/68）,复发率为13.6%（8/59）;CO2激光组痊愈率为100%（68/68）,复发率为29.4%（20/68）。两组在痊愈率及复发率上差异有统计学意义（P ＜ 0.05）。结论 CO2激光组痊愈率高于ALA-PDT组,而ALA-PDT组具有安全、复发率低、痛苦轻的特点,但所需治疗次数较多,费用较高。     

High-dose intravenous immunoglobulin in the treatment of adult patients with bullous pemphigoid

High-dose intravenous immunoglobulin (IVIg) has only been sporadically used in the treatment of bullous pemphigoid (BP), as it is suggested as an adjuvant to systemic corticosteroids in progressive disease or when life-threatening complications are of concern with other therapeutic interventions. The aim of the present study was to report our observations in the treatment of adult BP patients with IVIg, in association with a focused literature review. In our Department we identified five patients (4 women, 1 man) who had received IVIg for BP relatively early in the course of their disease. These cases were added to the 36 adequately documented ones reported in the literature. Most of these patients (33/41) responded to treatment with IVIg and 7/33 responders remained clear one year after the onset of IVIg. However, the time for effective disease control after IVIg treatment depended positively on disease duration before treatment (P<0.01). In conclusion, despite the limited experience with its use, IVIg seems to be a useful therapeutic alternative to conventional modalities for selected BP patients, particularly if it is initiated promptly after BP diagnosis.     

Bullous Pemphigoid and Epidermolysis Bullosa Acquisita: Presentation,Prognosis, and Immunopathology in 11 Children

Abstract: The immunobullous diseases bullous pemphigoid (BP) and epidermolysis bullosa acquisita (EBA) are very rare in childhood. Although case studies have been detailed, there are no reports of a large series of patients documenting the effectiveness of treatment and long-term prognosis. We report the clinical presentation, immunopathologic features, disease course, and long-term prognosis of BP and EBA in a series of 11 children. The initial diagnoses based on clinical features were BP (5), EBA (3), and chronic bullous disease of childhood (CBDC) (3). These were subsequently revised from BP to EBA (2), CBDC to BP (2), and CBDC to BP or EBA (1) following the results of direct and indirect immunofluorescence and immunoblotting. Analysis of IgG subclasses in eight cases showed that the predominant subclasses were lgG1 (8) and lgG4 (6). The clinical features appeared to be highly variable, and in patients presenting with inflammatory blistering, laboratory studies were required in order to differentiate between BP and EBA. All patients improved on treatment with corticosteroids and/or sulfones, although treatment regimens showed wide variation. Their diseases tended to remit within 2 years, and their long-term prognosis was good.     

Clinical manifestations in 100 Japanese bullous pemphigoid cases in relation to autoantigen profiles

The relationship between clinical findings and antigen profiles in 100 bullous pemphigoid (BP) patients has been investigated. The patients were divided into four groups based upon the results of immunoblot analysis, namely patients whose sera detected the 230-kPa BP antigen (BP230) and the 180-kDa BP antigen (BP180), those recognizing either BP23Q or BP180 alone, and those recognizing neither antigen, analysis by the chi-squared test showed predominant occurrence of oral (P < 11(15) and facial lesions (P < 0.005) in patients whose sera detected BP180, and these patients also tended to have more extensive lesions (P < 0.005). Patients that were positive for UP 180 alone needed treatment with higher doses of steroids than the patients positive for BP230 alone (P < 0.05). Furthermore, all rue recalcitrant cases, which did not respond well to steroid treatment, were shown to possess auto antibodies against UP I NO in their sera. Patients with antibodies to BP230 had a tendency to have a high titre of anti-HMZ antibodies (P < 0 (105). These results suggest that anti-BPI80 antibodies nun be more related to the disease severity than anti-BP230 antibodies.     

Randomized clinical trials for psoriasis 1977-2000: the EDEN survey

This study aims to describe the range of treatment comparisons, study designs and quality of reporting of randomized clinical trials (RCTs) in psoriasis published in a variety of medical and dermatological journals, and to analyze time trends with quality items. Hand-searching of clinical trials of psoriasis published from 1977 to 2000 in 13 medical or dermatological journals, selected as relevant to a European readership, was performed. A total of 249 trials published in 226 papers were classified as RCTs. Of these, 139 (55.8%) employed a parallel control group design, 107 (43.0%) studies adopted a self-control design and 3 (1.2%) a cross-over design. The median number of patients recruited per study was 40 (range 6-699). Overall, 55 different treatment modalities, including topical, ultraviolet-based, systemic, and other miscellaneous therapies were assessed. Only 31 (12.5%) RCTs were comparative studies of treatment modalities in different therapeutic classes. Most of the studies were short-term with a median study duration of 7 weeks (range 1-104), with only 18 studies (7.2%) lasting for more than four months. A variety of outcome measures including 44 different score systems were employed. According to the conclusions of the authors, 196 (78.7%) studies were judged to provide striking or definite observations in favor of one of the treatments examined. No important variations over time were documented for quality items. Based on our survey we have identified an enormous range of treatments that have been evaluated for psoriasis over the examined period. Most studies were short-term, and only a handful compared treatment options in different therapeutic classes. Since we did not examine all the relevant journals, the number of treatment options may be even greater than we have documented. There is an urgent need to reset the research agenda focusing on long-term comparative RCTs. Editors of major medical and dermatological journals are urged to take a role in improving the quality of RCT reporting.     

Topical treatment of genital warts in men, an open study of podophyllotoxin cream compared with solution.

OBJECTIVE--To evaluate the clinical efficacy of a 0.15% and a 0.3% cream formulation of podophyllotoxin in comparison with the 0.5% solution in the treatment of condylomata acuminata and to compare the treatment modalities regarding side effects. DESIGN--The study was designed as an open randomised trial. Ninety male patients with signs of penile HPV infection, with either acuminate or papular lesions, were randomised into three parallel treatment groups. The study medication comprised 0.15% and 0.3% cream and 0.5% solution of podophyllotoxin. The patients treated themselves twice daily for three consecutive days and if total regression of the warts was not achieved after this first treatment cycle, further treatment cycles at 7-day intervals were to be repeated up to a maximum of four treatments. SETTING--The study was carried out in three outpatient clinics: two STD clinics, Department of Dermatology and Venereology, University Hospital (45 patients) and Institut Antoine Fournier, Paris (30 patients), and one military hospital, S1/FO 47/48, Sjukhusenheten, Enköping (15 patients). RESULTS--Statistical evaluation of the treatment effect was based on a "Response rate" calculation at each visit. The number of completely responding patients after the first, second, third and fourth cycle were 40 (44%), 61 (68%), 67 (74%) and 70 (78%), respectively. There was no statistically significant difference between the three treatments after four treatment cycles. However, the 0.15% cream had a significantly slower onset of efficacy as compared with the 0.3% cream and 0.5% solution. Adverse effects were less severe and less frequent with the 0.15% cream than with the other treatment modalities. Severe adverse effects were reported by 12 patients, of whom two were treated with 0.15% cream, five with 0.3% cream and five with 0.5% solution. Thirty-one patients were completely free from adverse effects. CONCLUSION--In this open randomised study with three parallel treatment groups, two cream formulations of 0.15% and 0.3% podophyllotoxin and a 0.5% solution of the same drug all showed an equally good response rate after four treatment cycles. Reported adverse effects were few and mild. The convenience of having different formulations to offer when prescribing treatment for condylomata must be considered.     

Therapie von Handekzemen

Hand eczema is a very common skin disease, which can be induced by different causes. Although many interventions ranging from topical corticosteroids and UV therapy to oral cyclosporine and retinoids are available, the treatment of hand eczema can be very difficult and frustrating. The objective of our study was to assess the external evidence of different treatment modalities for hand eczema. Electronic databases (Cochrane, MEDLINE, Embase, Pascal, Jicst-Eplus, Amed) were systematically searched for clinical trials on therapy for hand eczema. Additionally, four general medical journals (BMJ, JAMA, Lancet, NEJM) and 17 specialists dermatological journals were hand searched from 1977 to August 2004. A total of 100 studies were found and 31 identified as randomised clinical trials (RCTs) dealing with different interventions. Due to the poor quality of most of these RCTs, they are inadequate as a guide to clinical practice. There is a need for high-quality RCTs on therapy for hand eczema regarding established as well as new treatment options taking different subgroups of hand eczema into consideration.     

Rituximab and Omalizumab for the Treatment of Bullous Pemphigoid: A Systematic Review of the Literature

Background

Bullous pemphigoid (BP) is the most common autoimmune blistering skin disease worldwide. Systemic corticosteroids are considered the mainstay of therapy; however, they may cause significant adverse effects and treatment failures, so additional therapeutic modalities with better safety profiles are required. Rituximab and omalizumab are novel biologic agents administered in recent years for the treatment of BP, yet data regarding their use in the disease are limited.

Objective

Our objective was to systematically review the current literature regarding the use of rituximab and omalizumab for the treatment of BP to evaluate their safety and efficacy.

Methods

A systematic review of all publications evaluating patients with BP treated with rituximab or omalizumab was performed. The primary outcome was clinical response; secondary outcomes were adverse events and recurrence rate.

Results

The systematic review included 35 publications (84 patients: 62 receiving rituximab and 22 receiving omalizumab). In total, 61 of 63 patients had not experienced disease control with systemic corticosteroids before receiving the biologic treatment. Complete response rates were 85% and 84% for rituximab and omalizumab, respectively. The recurrence rate was considerably lower with rituximab (29%) than with omalizumab (80%). Mean time to recurrence was 10.2 and 3.4 months, and adverse effects occurred in 24% and 20% of the patients, respectively.

Conclusions

Available data, although potentially limited because of publication bias, suggest that rituximab and omalizumab have similar safety profiles and provide clinical benefit for patients with BP. The reviewed data indicated that rituximab resulted in lower recurrence rates and a longer time until recurrence than omalizumab.

     

The association of HLA-DQ7 with bullous pemphigoid is restricted to men

This study examines in detail the HLA associations of 74 patients (40 women and 34 men) with bullous pemphigoid (BP) and compares their immunogenetic profile with that of 604 unrelated control subjects (238 women and 366 men). Correlations were sought between HLA antigens and the various BP disease parameters investigated. The presence of milia was the only clinical or laboratory finding which was linked with a specific HLA antigen, HLA-DQ6, in both men and women with BP ( P  < 0.01). BP has previously been linked with the HLA-DQ7 antigen and this association was confirmed in 39 of our patients (14 women and 25 men). Twelve of these patients (four women and eight men) were homozygous for HLA-DQ7. The association of HLA-DQ7 with BP was gender-restricted and only significant for men ( P  < 0.01). No equivalent HLA disease susceptibility risk factor could be identified for our female BP patients. This difference in HLA association between men and women with BP has not been reported previously, and its significance for disease pathogenesis is not known. No specific link could be found between HLA-DQ7 and BP for any of the clinical, immunofluorescence, western blotting, treatment or prognostic disease factors studied.     

大疱性类天疱疮的临床路径与预后初探

目的观察外用糖皮质激素(glucocorticoids,GC)软膏或联合中、小剂量系统应用GC治疗大疱性类天疱疮(bullous pemphigoid,BP)的疗效,并与大剂量系统应用GC治疗的疗效作比较,观察其能否作为BP治疗的临床路径,达到既控制病情又减少不良反应和降低死亡率的目的。方法研究组14例BP患者,根据病情轻重,每天予外用卤米松或联合5～15mg泼尼松治疗的临床路径。对照组为本院2003-2006年住院的14例BP患者,予系统应用GC治疗相当于泼尼松0.5～1.2mg/(kg·d)。比较两组用药后不同时间点的全身水疱数、新发水疱数、外周血嗜酸性粒细胞绝对计数(EOS)、疾病控制率和不良反应等。结果研究组在疗效评定的各项指标中与对照组相当,治疗3周时12例病情得到控制(85.71%),而对照组为11例(78.57%);研究组EOS的变化和临床症状相平行(r=0.7331);研究组出现4例不良反应(28.57%),而对照组为11例(78.57%)。结论局部外用GC治疗BP的疗效显著,与高剂量系统应用GC疗效相当。且外周血嗜酸性粒细胞绝对计数(EOS)与临床症状密切相关,均可列入该病的临床路径。     

Asociación entre penfigoide ampolloso e inhibidores de la dipeptidilpeptidasa-4: estudio de cohortes retrospectivo

BackgroundThe association between dipeptidyl peptidase 4 inhibitors (DPP-4i) and bullous pemphigoid (BP) has been demonstrated in several studies. The main aim of this study was to estimate the use of DPP-4i treatment in patients diagnosed with BP in our setting.MethodsWe selected patients histologically diagnosed with BP in our department between October 2015 and October 2018 and performed a retrospective chart review to assess clinical and epidemiological data and direct immunofluorescence (DIF) patterns.ResultsOf the 70 patients diagnosed with BP during the study period, 50% were diabetic and 88.57% of these were being treated with a DPP-4i when diagnosed with BP. The most common DPP-4i was linagliptin (used in 18.6% of patients), followed by vildagliptin (17.1%). The median latency period between initiation of DPP-4i treatment and diagnosis of BP was 27.5 months for all treatments, 16 months for linagliptin, and 39 months for vildagliptin (log rank < 0.01). A negative DIF result was significantly more common in patients not being treated with a DPP-4i. The DIF pattern most strongly (and significantly) associated with DPP-4i treatment was linear immunoglobulin G deposits along the dermal-epidermal junction. DPP-4i treatment was withdrawn in 87% of patients and 96% of these achieved a complete response.ConclusionsDPP-4i treatment is very common in patients with BP in our setting. The latency period between start of treatment and onset of BP seems to be shorter with linagliptin than with other types of gliptins. Patients receiving DPP-4i treatment may show different DIF patterns to those not receiving treatment.