润燥止痒胶囊在成人轻中度特应性皮炎治疗中的作用

目的探讨润燥止痒胶囊在成人轻中度特应性皮炎(Atopic Dermatitis,AD)治疗中的作用。方法将入选的AD患者随机分为治疗组32例,采用润燥止痒胶囊、凡士林乳膏和莫匹罗星软膏(百多邦)联合治疗;对照组21例,采用凡士林乳膏和莫匹罗星软膏治疗,均连续用药4周,采用SCORAD积分评价疗效。结果治疗组与对照组治疗前、后SCORAD积分均有所下降(P<0.01),治疗组的SCORAD积分下降明显大于对照组(P<0.05),治疗组的瘙痒积分明显下降(P<0.01),对照组的瘙痒积分无明显下降,治疗组有效率(62.50%)大于对照组(33.33%)。结论润燥止痒胶囊、凡士林乳膏和莫匹罗星软膏(百多邦)联合治疗成人轻中度AD可以改善病情,且润燥止痒胶囊可减轻瘙痒症状,并提高有效率。     

中药健脾止痒颗粒合铍宝消炎癣湿药膏治疗特应性皮炎疗效分析

目的观察中药健脾止痒颗粒合铍宝消炎癣湿药膏治疗特应性皮炎(AD)的临床疗效。方法将64患者随机分为治疗组(健脾止痒颗粒合铍宝消炎癣湿药膏)和对照组(氯雷他定合1%丁酸氢化可的松软膏)连续治疗4周进行疗效对比。采用AD评分标准进行临床评估,用酶联免疫测定法(ELISA)及伊红酚法对免疫球蛋白E(IgE)水平、嗜酸性粒细胞(EOS)计数进行检测对比。结果治疗组总有效率为84%,与对照组比较,差异有显著性(χ2=12,P<0.01)。治疗组SCORAD积分较对照组明显降低(t=4.82,P<0.01)、VAS积分也降低(t=2.64,P<0.05)。治疗组血清总IgE水平与对照组比较差异无显著性(P>0.05)、E0S计数降低(P<0.05)。结论健脾止痒颗粒合铍宝消炎癣湿药膏治疗特应性皮炎临床疗效满意,能明显降低患者SCORAD积分和VAS积分,降低E0S计数。血清IgE水平下降差异无显著性。     

44例特应性皮炎中医临床证候分析与辨证治疗

目的探讨特应性皮炎(atopicdermatitis,AD)中医证候特征与中药临床疗效。方法运用中医辨证理论与AD严重度评估方法———SCORAD相结合,对44例AD患者的证候、严重度和中药临床疗效进行分析研究。结果中医辨证无单一证型,均为多证相兼。证型机率由高到低依次为:脾虚证81.82%,血热血燥证70.45%,湿热证56.82%,肾虚证20.45%,肝郁证18.18%。中药治疗4周后,SCORAD积分和VAS积分均较治疗前明显下降(P<0.01);治疗8周后与治疗4周后比较,SCORAD积分明显下降(P<0.01),VAS积分下降(P<0.05)。治疗4周后总有效率54.55%,8周后总有效率70.45%。结论中医辨证治疗AD有较好临床疗效,其治疗机理有待进一步研究。     

308nm单频准分子光与311nm窄谱中波紫外线照射治疗特应性皮炎的临床疗效比较

目的观察308nm单频准分子光与311nm窄谱中波紫外线治疗特应性皮炎的临床疗效与不良反应。方法将入选的97例特应性皮炎患者随机分为两组,治疗组48例予308nm单频准分子光照射治疗,对照组49例予311nm窄谱中波紫外线进行照射治疗。两组患者均2次/周,连续治疗24次。治疗前、后采用欧洲AD评分标准(SCORAD)对AD的临床严重度进行评分,用视觉模拟尺度(VAS)评分法对瘙痒程度进行评分。疗程结束后,评价两组患者的临床疗效及安全性。结果治疗组与对照组的有效率分别为89.58%和71.43%,治疗组SCORAD积分和VAS积分下降情况优于对照组。以上差异均有统计学意义(P0.01)。两组患者中均未见严重不良反应。结论 308nm单频准分子光治疗特应性皮炎的临床疗效好,起效快,而且不良反应少。     

卡介菌多糖核酸注射液联合咪唑斯汀治疗特应性皮炎疗效评价

目的:评价卡介菌多糖核酸注射液联合咪唑斯汀治疗特应性皮炎(AD)的疗效。方法:治疗组AD患者70例,给予卡介菌多糖核酸注射液联合咪唑斯汀治疗;对照组50例给予咪唑斯汀治疗,治疗12周。通过治疗前后SCORAD积分和血清总IgE水平变化评价疗效。结果:治疗组有效率(61.4%)高于对照组(34.0%)。治疗组SCORAD积分和血清总IgE值下降水平明显大于对照组(P0.05)。结论:卡介菌多糖核酸联合咪唑斯汀治疗中轻度特应性皮炎疗效显著。     

窄谱中波紫外线治疗特应性皮炎疗效观察

目的：观察窄谱中波紫外线（NB—UVB）治疗特应性皮炎（AD）的疗效。方法：53例AD患者接受NB—UVB治疗仪照射治疗,每周治疗3次,连续治疗36次。采用欧洲AD评分标准（SCORAD）对AD的临床严重度进行评分,用视觉模拟尺度（VAS）评分法对瘙痒程度进行评分,同时记录SCORAD积分和VAS积分。疗程结束后评价疗效。结果：53例患者痊愈17例（32．08％）,显效28例（52．83％）,有效5例（9．43％）,有效率为84．91％,SCORAD积分和VAS积分较治疗前明显下降（P〈0．01）。结论：NB—UVB治疗AD安全性高,近期疗效好,操作简便,患者依从性好。     

窄谱中波紫外线治疗特应性皮炎疗效观察及血清总IgE和EOS变化

目的观察窄谱中波紫外线(NBUVB)治疗特应性皮炎(AD)的疗效及治疗前后血清总IgE和末梢血嗜酸性粒细胞(EOS)计数的变化,以探讨治疗机制。方法给予64例AD患者NBUVB照射,每周3次,共12周;采用SCORAD计分系统对AD临床严重度进行评估;采用视觉模拟尺度评分法(VAS)对瘙痒程度进行评估;采用ELISA法检测血清总IgE。结果64例患者NBUVB治疗后12例痊愈,临床有效率86.2%;64例患者治疗前SCORAD和VAS积分以及血清总IgE和EOS计数较正常对照组水平升高,照射后显著下降。结论NBUVB是治疗AD的一种有效治疗方法;NBUVB可能是通过降低T细胞,抑制机体免疫来降低IgE和EOS。     

健脾渗湿法治疗特应性皮炎患者血清总IgE、IgG、IgG4变化及疗效评价

目的通过检测血清中总IgE(TIgE)、IgG、IgG4浓度在特应性皮炎(AD)发病过程中的变化,探讨健脾渗湿法治疗有效率与指标间的联系。方法选择38例AD患者为研究对象,于治疗前后观察其主要症状(包括瘙痒、睡眠、皮损面积、皮损严重程度),记录SCORAD积分,及检测血清中TIgE、IgG、IgG4水平。并将各项血清学指标与治疗有效率进行相关分析。结果治疗前的SCORAD评分为55.46±15.05,治疗后为49.41±12.33,两者有显著性差异(P<0.01);AD患者血清治疗前、后TIgE、IgG、IgG4均高于正常对照组(P<0.05)。但治疗后TIgE相对于治疗前明显下降,而IgG、IgG4水平明显升高。治疗有效率与TIgE、TIgE/IgG4治疗前后变化差值成中等正相关,相关系数分别为0.541,0.793。结论 TIgE、TIgE/IgG4水平变化是反映AD病情变化的重要指标,在一定程度上可用于评价病情是否好转。使用健脾渗湿法治疗AD后,TIgE、TIgE/IgG4随症状改善变化明显。     

NB-UVB对特应性皮炎患者外周血CLA~+CD8~+T细胞的影响

目的观察窄谱中波紫外线(NB-UVB)治疗特应性皮炎(AD)患者的临床疗效,并分析其对外周血皮肤归巢的CD8~+T细胞数量及表达杀伤功能相关蛋白水平的影响,探讨NB-UVB治疗AD的作用机制。方法选取19例AD患者,予NB-UVB照射治疗8周,采用特应性皮炎积分指数(SCORAD)判断病情严重程度;并用流式细胞术检测外周血表达皮肤淋巴细胞相关抗原(cutaneous lymphocyte-associated antigen,CLA)的CD8~+T细胞(CLA~+CD8~+T细胞)的比例,分析其杀伤功能相关蛋白穿孔素、颗粒酶B的表达。另选15例健康体检者作为正常对照。结果 (1)SCORAD评分在AD治疗前组明显高于治疗后组,差异有统计学意义(P0.01);(2)CLA~+CD8~+T细胞的比例在AD治疗前组明显高于对照组,差异有统计学意义(P0.01),且AD治疗前组CLA~+CD8~+T细胞的比例与SCORAD评分正相关(Pearson相关,P0.01);穿孔素和颗粒酶B的表达在AD治疗前组均明显高于对照组,差异均有统计学意义(P均0.01);(3)NB-UVB治疗后,AD患者血清CLA~+CD8~+T细胞的比例较治疗前明显降低,差异有统计学意义(P0.05),且表达穿孔素和颗粒酶B水平也均较治疗前明显下降,差异均有统计学意义(P均0.05)。结论 NB-UVB照射可明显下调AD患者外周血CLA~+CD8~+T细胞的比例及杀伤功能相关蛋白的表达,这可能是NB-UVB治疗AD的机制之一。NB-UVB治疗AD安全有效。     

健脾除湿汤加减治疗手足湿疹疗效观察

目的观察健脾除湿汤加减治疗手足湿疹的临床疗效。方法 83例患者随机分为2组,治疗组41例,对照组42例,治疗组给予中药健脾除湿汤加减和除湿止痒软膏,对照组口服氯雷他定片和外用除湿止痒软膏,临床观察4周。结果 2组皆完成治疗,治疗前两组瘙痒症状及皮损程度评分差异无统计学意义(P0.05);治疗4周后2组评分均明显低于治疗前(P0.01),且治疗组评分低于对照组(P0.05)。治疗组的有效率显著高于对照组,差异有统计学意义(P0.05)。结论健脾除湿汤加味治疗手足湿疹的疗效优于对照组,值得临床推广。     

湿包裹治疗儿童重度特应性皮炎的疗效观察

目的 观察湿包裹(WWT)治疗儿童重度特应性皮炎(AD)的疗效和安全性.方法 2018年9月-2019年9月在南京儿童医院皮肤科门诊诊断为重度AD的患儿(符合Williams诊断标准,SCORAD ＞50分)40例,随机分为WWT组(n =20)和传统治疗组(n=20).WWT组采用0.1％糠酸莫米松乳膏联合2％莫匹罗...     

益生菌治疗成人特应性皮炎疗效评价

目的:评价益生菌治疗成人特应性皮炎(AD)的疗效。方法:40例AD患者随机分为A组和B组,A组给予抗组胺药、0.05%地奈德乳膏及益生菌制剂,B组仅给予抗组胺药和0.05%地奈德乳膏,两组均治疗12周。20名健康者作为对照。治疗前、后及治疗后2个月用SCORAD和VAS法进行病情评分,并用PCR荧光定量法检测受试者粪便中的细菌水平。结果:治疗结束时,A组、B组评分较治疗前均显著降低(P0.01);停药2个月时,A组评分仍低于治疗前(P0.01),而此时B组评分与治疗前相比无统计学差异。治疗前A、B组双歧杆菌及乳酸杆菌的数量明显低于健康对照组(P0.01)。治疗结束及停药2个月时,A组两种杆菌较治疗前均显著增加(P0.01),B组两种杆菌较治疗前均无显著差异。结论:益生菌可通过增加肠道双歧杆菌及乳酸杆菌菌群而改善病情并延缓复发。     

联合臭氧水治疗特应性皮炎患者的疗效及白细胞介素4、神经生长因子检测

目的：观察联合臭氧水治疗特应性皮炎（AD）患者的临床疗效和安全性。方法收集6~65岁中重度AD患者，分为试验组和对照组，每组30例。两组患者均口服左西替利嗪胶囊（5 mg每日1次），外涂他克莫司软膏，每日2次，同时外涂保湿润肤霜。试验组加用臭氧水疗，每周3~5次。共观察2周。观察两组患者治疗前后特应性皮炎严重度评分（SCORAD）评分、视觉模拟尺（VAS）瘙痒评分、皮肤病生活质量指数（DLQI）/儿童皮肤病生活质量指数（CDLQI）变化情况，ELISA法检测患者治疗前后外周血白细胞介素4、神经生长因子表达水平。结果试验组患者治疗前SCORAD评分、VAS评分、DLQI/CDLQI评分分别为42.13±16.03、7.14±2.12、14.92±5.94，治疗2周后分别为27.3±11.01、2.23±1.31、9.69±4.17；对照组治疗前SCORAD评分、VAS评分、DLQI/CDLQI评分分别为43.36±17.78、6.45±1.29、15.15±5.40，治疗2周后分别为39.65±16.67、3.32±0.87、12.84±5.37。两组3种评分治疗前后比较，差异均有统计学意义（均P<0.05），且治疗2周后两组之间3种评分差异亦有统计学意义（均P<0.05）。两组患者治疗后外周血白细胞介素4和神经生长因子水平均下降，与治疗前相比，差异有统计学意义（均P<0.05），其中试验组白细胞介素4下降幅度大于对照组（t=8.57，P<0.05），神经生长因子下降幅度两组间差异无统计学意义（t=9.51，P>0.05）。结论联合臭氧水能安全、有效地改善AD患者病情，可能与降低患者外周血白细胞介素4水平有关。     

湿包裹治疗13例儿童重度特应性皮炎临床效果观察

目的 观察湿包裹疗法(WWT)治疗儿童重度特应性皮炎(AD)的效果和安全性.方法 2016年9月至2017年3月在北京儿童医院皮肤科收集重度AD患儿(符合Williams诊断标准,SCORAD＞50分)13例,每日接受WWT,共治疗3～5d,评估治疗前后患儿SCORAD评分及VAS评分改善情况.选取其中3例患儿双侧肢体对称皮损进行WWT与传统治疗的对比观察,比较治疗3d后双侧局部皮损严重度评分.结果 13例患儿治疗前SCORAD评分及VAS评分分别为60.2±9.7和7.3±1.8,WWT治疗3～5d后,分别降至24.7±5.8和2.4±1.0,治疗前后差异均有统计学意义(t值分别为15.128、9.385,均P＜ 0.001);12例患儿SCORAD改善率达50％以上.3例患儿双侧皮损治疗3d后,WWT侧皮损严重度评分低于对照侧(t=7.0,P＜ 0.05).WWT不良反应轻微,3例患儿主诉治疗过程中潮湿引起不适感.结论 WWT治疗儿童重度AD起效快,不良反应少,效果优于传统单纯外用药物.     

儿童特应性皮炎严重程度与血清25-羟维生素D和总IgE水平的相关性

目的：明确儿童特应性皮炎患者特应性皮炎严重程度与血清25-羟维生素D和IgE水平的相关性。方法：参考SCORAD评分法评估60例特应性皮炎患者疾病严重程度，并检测特应性皮炎患者及55例对照组血清25-羟基维生素D3水平以及特应性皮炎患者总IgE水平。结果：特应性皮炎组患者血清25-羟维生素D水平(16.13±6.68)ng/mL低于对照组(19.81±8.24)ng/mL，差异有统计学意义（P<0.05）。根据SCORAD评分，特应性皮炎患者中33例为轻度、20例为中度，7例为重度。轻度组血清25-羟基维生素D3水平为(18.69±7.01)ng/mL，高于中度(12.81±4.35)ng/mL，差异有统计学意义（P<0.05）。血清25-羟维生素D与SCORAD评分之间有显著负相关（P<0.05）。IgE水平与SCORAD评分之间无相关性（P>0.05）。结论：AD患者血清25-羟基维生素D与AD严重程度呈负相关。     

The effect of dermatology consultations in secondary care on treatment outcome and quality of life in new adult patients with atopic dermatitis

BACKGROUND: The prevalence of atopic dermatitis (AD) is increasing worldwide, and many patients present to secondary care in adult life. This is a significant contribution to the workload of all dermatology departments. There are no studies investigating the impact of a dermatology consultation within secondary care. OBJECTIVES: To examine the effect of dermatology consultations in secondary care on treatment outcome and quality of life in new adult patients with AD. METHODS: This prospective observational study recruited new adult patients with AD referred from primary care. Eczema severity was assessed using the SCORAD (Severity Scoring of AD) index and subjective good or poor clinical outcome. The Dermatology Life Quality Index (DLQI) was used to quantify the impact of AD on adult patients. Patients were assessed at initial consultation (T1), 6 weeks (T2) and 3 months (T3). Statistical analysis was performed using independent t-tests, repeated-measures analysis of variance, correlation coefficients and Bonferroni post hoc comparisons. RESULTS: Sixty-three patients were recruited (37 women, 26 men) with a mean age of 34 years. Mean SCORAD at T1 was 48.2 and the majority (51%) had severe eczema (objective SCORAD>40). Mean SCORAD reduced by 52% from T1 to T2 (P<0.001) but there was no significant change in SCORAD from T2 to T3. A subjective good clinical outcome was validated by a decrease in SCORAD of >20 (P<0.001). Patients in the good clinical outcome group were significantly older than those in the poor clinical outcome group (38 vs. 27 years, P<0.05). The mean age at presentation of women was significantly younger than men (29 vs. 43 years, P<0.01). Women's mean SCORAD improved over all three visits, while men's mean SCORAD improved from T1 to T2 but worsened from T2 to T3 (P<0.001). The mean DLQI reduced over all three visits, from 9.5 at T1 to 8.8 at T2 and 7.0 at T3, and was significantly correlated with SCORAD at T1 and T2 (P<0.01). Patients accurately self-scored their eczema on a body map as shown by a significant correlation between these scores and SCORAD at T1 and T2 (P<0.001). CONCLUSIONS: We have shown that within the first 3 months of referral to secondary care, new adult patients with AD have the greatest improvement in AD, measured by SCORAD, after their initial appointment. Quality of life, as measured by DLQI, continued to improve over all three visits.     

Oral antihistamine therapy influences plasma tryptase levels in adult atopic dermatitis

BACKGROUND: Atopic dermatitis (AD) is an allergic skin disease that follows a clinical course of 'flare-up' and remission. Histamine and tryptase are inducers of pruritus and non-sedating second-generation antihistamines, including fexofenadine, are widely used for treatment of allergic skin disorders. OBJECTIVE: We assessed the efficacy of a second-generation antihistamine in AD patients and examined its pharmacological effects on chemical mediators. METHODS: The scoring atopic dermatitis (SCORAD) instrument and visual analogue scale (VAS) for pruritus were used to assess disease severity in 349 AD patients. Twenty patients with moderate AD symptoms, who had not received any treatment for 2 weeks, were randomly assigned into two groups. Ten patients underwent fexofenadine and emollient treatment (Group 1) and 10 received fexofenadine and steroid treatment (Group 2) for 1 week. SCORAD and VAS for pruritus, and blood histamine and tryptase levels were evaluated before and after treatment. RESULTS: SCORAD and VAS improved in both Group 1 (p=0.01 and p=0.006, respectively) and Group 2 (p<0.001 and p=0.001, respectively). The improvement in Group 1 showed a significant correlation with the diminution rate of blood tryptase levels (SCORAD: r=0.83 and p=0.013, respectively; VAS: r=0.81, p=0.015, respectively). End-point plasma tryptase levels were significantly lower than baseline levels in Group 2 (p=0.046). Histamine levels did not show any significant changes in either group. CONCLUSION: These results suggest that second-generation antihistamine therapy reduces AD pruritus, resulting in the effective clinical treatment for AD. In addition, monitoring tryptase levels during antihistamine therapy in moderate AD treatment may prove to be useful in establishing treatment effects.     

Efficacy and tolerability of a Chinese herbal medicine concoction for treatment of atopic dermatitis: a randomized, double-blind, placebo-controlled study

BACKGROUND: There has been considerable interest in traditional Chinese herbal medicine (TCHM) as a treatment for atopic dermatitis (AD). A twice-daily concoction of an ancestral formula containing five herbs has been found to be beneficial in an open study. OBJECTIVES:To assess the efficacy and tolerability of the concoction in children with AD. METHODS: Following a 2-week run-in period, children with long-standing moderate-to-severe AD were randomized to receive a 12-week treatment with twice-daily dosing of three capsules of either TCHM or placebo. The SCORing of Atopic Dermatitis (SCORAD) score, Children's Dermatology Life Quality Index (CDLQI), allergic rhinitis score, and requirement for topical corticosteroid and oral antihistamine were assessed before and at weeks 4, 8, 12 and 16 after treatment. Adverse events, tolerability, haematological and biochemical parameters were monitored during the study. RESULTS: Eighty-five children with AD were recruited. Over 12 weeks, the mean SCORAD score fell from 58.3 to 49.7 in the TCHM group (n = 42; P = 0.003) and from 56.9 to 46.9 in the placebo group (n = 43; P = 0.001). However, there was no significant difference in the scores at the corresponding time points between the two groups. The CDLQI in TCHM-treated patients was significantly improved compared with patients receiving placebo at the end of the 3-month treatment and 4 weeks after stopping therapy (P = 0.008 and 0.059, respectively). The total amount of topical corticosteroid used was also significantly reduced by one-third in the TCHM group (P = 0.024). No serious adverse effects were observed between the groups. CONCLUSIONS: The TCHM concoction is efficacious in improving quality of life and reducing topical corticosteroid use in children with moderate-to-severe AD. The formulation was palatable and well tolerated.     

Medium-dose UVA1 cold-light phototherapy in the treatment of severe atopic dermatitis

BACKGROUND: Recently, conventional high-dose UVA1 phototherapy (340-400 nm) has been shown to be more effective than combined UVA-UVB therapy in the treatment of severe atopic dermatitis (AD). However, there are limitations of this treatment, such as intense sweating caused by the immense heat load during therapy and the high cumulative UVA1 doses that are required. For this reason, lavish UVA1 equipment was developed containing an advanced filtering and cooling system resulting in almost complete absence of heat load and sweating during therapy. OBJECTIVE: In this study we compared the monotherapeutic efficacy of conventional medium-dose UVA1, medium-dose UVA1 cold-light, and combined UVA-UVB phototherapy in the treatment of severe AD. METHOD: The study involved 120 patients with severe AD. Fifty patients each received conventional UVA1 or UVA1 cold-light phototherapy (15 days, 50 J/cm(2)/day), and 20 patients were treated with combined UVA-UVB (15 days, minimal erythema dose dependent). Severity of AD was scored by means of the SCORAD score, and clinical improvement was additionally monitored by serologic cytokine markers. RESULTS: Six (12%) of 50 patients treated with UVA1, 2 (4%) of 50 patients treated with UVA1 cold-light therapy, and 4 (20%) of 20 patients treated with combined UVA-UVB therapy discontinued treatment prematurely because of an unsatisfactory clinical outcome or adverse reactions. Skin status improved or even cleared completely in 77.3% of the patients treated for 3 weeks with conventional UVA1 therapy and in 85.4% of the patients treated for 3 weeks with UVA1 cold-light therapy, resulting in a significant decrease in the SCORAD score in both UVA1 groups (P <.05 each). In the group treated with combined UVA-UVB, the SCORAD score also decreased but significantly less than in both groups treated with UVA1 photo-therapy (P <.05 each). At follow-up after 4 weeks, the patients treated with UVA1 displayed a more prolonged therapeutic benefit than the patients treated with UVA-UVB therapy. Plasma levels of soluble interleukin 2 receptors and soluble interleukin 4 receptors significantly decreased under both UVA1 and UVA1 cold-light phototherapy but not under combined UVA-UVB phototherapy. CONCLUSION: Our study demonstrates that medium-dose UVA1 cold-light phototherapy displays advantages compared with conventional UVA1 phototherapy caused by the almost complete absence of heat load and intense sweating and is more effective than UVA-UVB phototherapy in the treatment of severe AD.