他克莫司软膏治疗白癜风的临床疗效观察

我科自2006年10月-2007年9月采用他克莫司软膏治疗白癜风,并进行临床疗效及安全性的观察,现报告如下.     

0.1％他克莫司软膏治疗白癜风疗效观察

单独使用0.1％他克莫司软膏治疗白癜风患者,并观察疗效.入选38例白癜风患者中有25例有不同程度的复色,其中1个月共复色8例,占21％;2个月内共复色17例,占44.7％;3个月内共复色21例,占55.2％;4个月内共复色25例,占65.8％.痊愈2例(痊愈率5％),显效12例(显效率36.8％),有效11例(有效率65.8％),仅1例有局部刺激的不良反应.他克莫司治疗白癜风安全有效,部分患者的起效时间较晚,疗效评估时间应延长.     

皮肤外用他克莫司治疗白癜风

他克莫司是一种强效大环内酯类免疫抑制剂,随着其外用制剂的产生,越来越广泛地用于皮肤病的治疗,其中治疗特应性皮炎已较为成熟。在白癜风的治疗中也取得了一定的成效,且由于其局部不良反应小,耐受性高,有较好的应用前景,由于缺乏随机、双盲、对照的临床试验,他克莫司在白癜风治疗中与疾病类型的关系,是否还存在尚未发现的不良反应及长期使用系统吸收是否导致全身不良反应,仍需做进一步的研究。     

他克莫司软膏治疗面颈部白癜风疗效观察

目的为了观察他克莫司软膏治疗面颈部白癜风的临床效果及安全性。方法采用自身对照的方法对40例白癜风患者的自身对称或相邻的皮损分别外用0．1％他克莫司软膏作为试验组和0．05％卤米松乳膏作为对照组，1个月观察1次，并拍照对比疗效。结果治疗组有效率52．5％，对照组有效率47．5％，两组疗效比较差异无统计学意义（P〉0．05）。对照组出现2例毛细血管扩张，1例轻度皮肤萎缩，5例毛囊性丘疹。结论外用0．1％他克莫司软膏治疗面颈部白癜风有效而且安全。     

他克莫司治疗白癜风的研究进展

白癜风是自身免疫异常引起的色素障碍性皮肤病,他克莫司是局部治疗白癜风的一种新药,可通过抑制T细胞的激活和各种细胞因子的产生等机制阻断免疫异常,进而有效治疗白癜风。     

他克莫司治疗白癜风疗效观察

观察0.1%他克莫司软膏治疗白癜风疗效和安全性.将87例白癜风患者随机分成两组,治疗组外用0.1%他克莫司软膏,对照组外用15%补骨脂醑.结果:治疗组治愈率51.2%,总有效率83.7%,对照组治愈率29.5%,总有效68.2%.两组疗效比较,有显著性差异,P＜0.01.他克莫司软膏治疗白癜风安全有效.     

他克莫司治疗白癜风的现状和机制

自2002年首次报道他克莫司软膏治疗白癜风以来，该药治疗白癜风的现状和疗效陆续见诸文献。为了全面了解该药．笔者对他克莫司软膏治疗白癜风的治疗现状、治疗机制及该药在治疗白癜风中存在的问题进行了综述。     

他克莫司联合补骨脂酊治疗白癜风临床疗效观察

目的观察他克莫司联合补骨脂酊治疗白癜风的临床疗效。方法采用他克莫司联合补骨脂酊外涂治疗白癜风78例(治疗组),并与单用补骨脂酊外涂治疗白癜风40例(对照1组)及单用他克莫司外涂治疗白癜风41例(对照2组)相比较。结果三组总有效率分别为73.1%、52.5%和60.9%,三组总有效率相比较差异有统计学意义(P0.05)。结论他克莫司联合补骨脂酊治疗白癜风较单用补骨脂酊外涂及单用他克莫司外涂治疗白癜风效果好,安全可靠。     

点阵式Er:YAG激光配合外用他克莫司软膏治疗局限型白癜风疗效观察

白癜风的治疗方法虽很多,但疗效不肯定。他克莫司是一种具有免疫活性的大环内酯类抗生素,有很强的免疫抑制作用,在各种自身免疫性疾病的治疗中取得了较好的疗效［１］。外用他克莫司治疗白癜风已广泛应用于临床,但其疗效仍有局限性［2］。为进一步加强其疗效,近年来,人们做了很多尝试。方芳等［3］运用他克莫司联合窄谱中波紫外线治疗白癜风,胡慧丽等［4］联合308 nm准分子激光治疗儿童面颈部白癜风,刘鸿伟等［5］联合高能紫外线治疗白癜风。我科于2010年7月,引进点阵式Er: YAG激光,联合外用他克莫司治疗白癜风,取得了较好的疗效,报道如下……     

他克莫司软膏治疗白癜风的临床疗效及长期随访观察

目的:对前期已完成的他克莫司软膏治疗白癜风临床观察的患者进行随访,以获得他克莫司治疗白癜风长期的疗效及不良反应等资料.方法:采用调查问卷方式,对已完成前期观察并可配合问卷调查的患者进行随访.随访间期为试验结束后6～30个月.结果:46例入选患者中,34例(73.9%)完成随访研究.前期观察结束时,13例复色面积达到50%或以上,显效率为38.24%,总有效率为73.53%.随访时,7例(20.6%)病情加重,12例(35.3%)病情减轻.13例(38.2%)选择继续使用他克莫司,8例(23.5%)采用其他方法治疗.继续单用他克莫司80%有效,他克莫司联合治疗62.5%有效.随访中8例出现-过性不良反应,2周内可自行消退.7例出现后期不良反应(毛囊炎、过度色素沉着),数月后消退.结论:白癜风患者对他克莫司有一定认同度.停药复发后继续使用该药仍然有效.他克莫司早期及后期不良反应较轻.     

他克莫司软膏联合308 nm准分子激光治疗白癜风临床疗效观察

目的：评价0．1％和0．03％他克莫司软膏联合308nm准分子激光治疗对紫外线治疗抵抗的白癜风皮损的疗效与安全性。方法：采用随机、自身对照的临床试验，每例患者选取紫外线治疗抵抗区域的皮损，随机选取躯体一侧皮损为治疗侧，采用他克莫司软膏联合308nm准分子激光治疗；另一侧为对照侧，仅用308nm准分子激光治疗。2个月后进行疗效判定。结果：联合治疗组有效率为89．0％，对照组为71．6％，两组间疗效比较差异有统计学意义（P〈0．05）。结论：他克莫司软膏联合308nm准分子激光治疗白癜风起效快，疗效好。     

The efficacy and safety of tacrolimus as mono- and adjunctive therapy for vitiligo: A systematic review of randomised clinical trials

There is currently no definitive treatment for vitiligo; various modalities include immune modulators phototherapy and skin camouflage. We investigated the efficacy and safety of topical tacrolimus either as monotherapy or combined therapy in the treatment of vitiligo. Electronic systematic search of the literature was carried out using four major databases. Randomised clinical trials (RCTs) that reported the use of topical tacrolimus in the treatment of human vitiligo have been included in a systematic review and meta-analysis. Meta-analysis was conducted via RevMan, and risk of bias was assessed through the Cochrane quality assessment tool. The protocol was published through PROSPERO (CRD42018112430). A total of 19 studies including 814 patients were included in our systematic review. The random-effects-model meta-analysis of two studies revealed that the tacrolimus and narrowband ultraviolet B (NB-UVB) combination therapy rates is better than NB-UVB alone in inducing >75% repigmentation [RR 1.34 (95% CI: 01.05–1.71), P = 0.02]. Tacrolimus and steroids had similar potency in acheiving >75% repigmentation [RR 1.02 (95% CI: 0.19–5.51), P = 0.98]. Meta-analysis of two studies revealed that the fractional laser and tacrolimus combination therapy is no better than tacrolimus alone in causing >75% repigmentation [RR 2.11 (95% CI: 0.87–5.09), P = 0.10]. Further investigating tacrolimus as mono- or adjuvant therapy for vitiligo is highly recommended. Combining tacrolimus to other treatment options such as steroids, phototherapy and laser may be superior to using tacrolimus alone.     

Topical tacrolimus therapy for pyoderma gangrenosum

Pyoderma gangrenosum (PG) is a type of neutrophilic disorder with a chronic clinical course. Immunosuppressive agents have been used for its management. Among them, corticosteroid is known as the most effective. However, other immunosuppressants including cyclosporine A have been selected for patients with PG who were refractory to systemic steroids. Herein we report a case of PG resistant to systemic steroids, who was successfully treated with topical tacrolimus. A fifty-four year-old male had a 14-year history of PG. In 2002, necrotic ulcers appeared on his right leg that were refractory to oral prednisolone (30 mg/day). The application of topical tacrolimus to the border of the ulcers hastened epithelization of the ulcers and allowed for reduction of the oral prednisolone. Topical tacrolimus therapy may be an effective alternative for PG when the lesion is poorly controlled by corticosteroid.     

外用他克莫司软膏治疗口周白癜风后腹泻一例

患者男,15岁,因口周(1.5 cm×1.5 cm)及躯干部白斑(约20 cm2)4年余来我院门诊就诊.检查:白斑区在Wood灯下可见白垩色荧光,边界清楚;皮肤共聚焦激光显微镜检查发现白斑区表皮棘层和基底层黑素颗粒消失,真皮乳头周围色素环消失.诊断:白癜风.     

Efficacy and safety of topical tacrolimus for the treatment of face and neck vitiligo

Vitiligo is a common acquired idiopathic hypomelanotic disorder characterized by circumscribed depigmented maculae. The conventional treatments are limited by their inconsistent and incomplete responses, relapse rate, inconvenience to apply, side-effects and especially long-term effects. The aim of the present study was to determine the efficacy and safety of topical tacrolimus as monotherapy for the treatment of face/neck vitiligo in Taiwan. This was a multicenter, open-label, non-comparative study. Patients were at least 16 years old and had vitiligo lesions with Vitiligo Index of Disease Activity score +1 or more on face or neck. Patients received a monotherapy with 0.1% of tacrolimus ointment twice daily for 12 weeks. The efficacy was measured by the percentage of repigmentation of target lesion, which was graded as minimal (1–25%), mild (26–50%), moderate (51–75%) or excellent (76–100%). Patients who had at least mild repigmentation were defined as responders. A total of 61 patients were enrolled in this investigation. Most of the patients showed repigmentation at week 4. At the end of treatment, all patients showed repigmentation and 45.9% of patients were responders. During the study, 15 adverse events related to the ointment were reported. All the reported adverse events were mild and similar to the well-known adverse effect of tacrolimus in the treatment of atopic dermatitis. Tacrolimus ointment is effective and well tolerated for the treatment of patients with vitiligo in Taiwan. It will be another drug of choice for persons with vitiligo who are unable to receive regular phototherapy and fear the side-effects of topical steroid in long-term use.     

Effectiveness of 0.1% topical tacrolimus in adult and children patients with vitiligo

Topical corticosteroids and phototherapy are the conventional treatments of vitiligo. However, the acrofacial and segmental types are often unresponsive to these treatments. Nowadays, a few studies have been conducted on efficacy of topical tacrolimus in treatment of vitiligo including vulgaris and segmental types. Nevertheless, the acrofacial type has never been investigated with this topical therapy. The aim of our study is to evaluate the effectiveness of 0.1% tacrolimus ointment in patients including all types of vitiligo. Forty-two patients with vitiligo (22 adults, 20 children) were enrolled in this study. They were treated with 0.1% tacrolimus ointment twice daily for 6 months. Of these 42 patients, 38 of them completed the treatment process. The mean age of the patients was 27.8 years. The response rate was 76.09%. The vulgaris and focalis had a maximum response rate of 94.12%. The response rates for segmentalis and acrofacialis were 76.92% and 56.25% respectively. Concerning the response, age groups, types and location of vitiligo, there was significant difference in all variables (P = 0.001, P = 0.001, P = 0.025, respectively). Children had approximately nine times higher odds (95% CI = 1.09, 81.88) of having better response to the treatment than adults. The disease duration of 5 years or less also showed a better response. In conclusion, topical tacrolimus can be used for the treatment of patients with vitiligo. We recommend that, other than in the vulgaris type, topical tacrolimus may be considered as a treatment for two difficult to treat types of vitiligo, acrofacialis and segmentalis, before considering other modalities.     

中波高能紫外线联合他克莫司软膏治疗白癜风疗效评价

目的:评价中波高能紫外线联合他克莫司软膏治疗白癜风的临床疗效。方法:120例白癜风患者随机分成3组,治疗组40例,采用304 nm中波高能紫外线联合他克莫司软膏治疗;对照1组40例,单纯予304nm中波高能紫外线治疗;对照2组40例,单纯给予他克莫司软膏治疗。治疗12周后评价疗效。结果:治疗组有效率87.50%,对照1组为67.50%,对照2组为42.50%,差异有统计学意义(P0.05)。结论:中波高能紫外线联合他克莫司软膏治疗白癜风临床疗效优于中波高能紫外线单独照射或他克莫司软膏单独外用。     

他克莫司软膏治疗白癜风的临床疗效及对患者T淋巴细胞水平的影响

目的:探讨他克莫司软膏治疗白癜风的临床疗效及对患者T淋巴细胞水平的影响。方法:将80例白癜风患者随机分为对照组和观察组,各40例。对照组给予窄谱中波紫外线照射治疗,观察组在对照组治疗基础上给予0.1%他克莫司软膏外涂。治疗1个月后评估疗效,均随访12个月。治疗后,采用酶联免疫吸附试验检测患者白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、趋化因子-9(CXCL-9)及细胞间黏附分子1(ICAM-1)水平;采用流式细胞仪检测患者T淋巴细胞CD3+、CD4+、CD8+、CD4+/CD8+水平。比较两组皮损面积、首次复色时间、色素积分、炎症因子水平、T淋巴细胞水平、不良反应发生率及复发率。结果:治疗1个月后,观察组皮损面积、色素积分及首次复色时间均小(短)于对照组(t值分别为11.49、16.89、19.30,P值均<0.05),治愈率高于对照组(2=25.07,P<0.05)。观察组与对照组治疗过程中瘙痒、水疱、瘢痕发生率比较,差异均无统计学意义(P值均>0.05)。观察组治疗后6个月、12个月复发率均低于对照组(2值分别为12.62、14.83,P值均<0.01)。治疗后1个月,观察组炎症因子IL-6、TNF-α、CXCL-9及ICAM-1水平均低于对照组(t值分别为48.69、12.83、18.42、35.52,P值均<0.05),T淋巴细胞CD3+、CD4+及CD4+/CD8+百分比高于对照组(t值分别为7.91、5.12、2.73,P值均<0.05),CD8+百分比低于对照组(t=3.96,P<0.05)。结论:他克莫司软膏治疗白癜风能减小皮损面积,缩短首次复色时间,降低复发率,有助于降低炎症因子水平,改善T淋巴细胞水平,且药物安全性较高,值得推广应用。