特应性皮炎皮损微生物与外用药对比治疗研究

目的 研究特应性皮炎(AD)皮损微生物感染、金黄色葡萄球菌(金葡菌)耐药与外用药的疗效.方法 2001年11月至2002年3月在北京中日友好医院及北京市儿童医院皮肤科门诊,按照Hanifin-Rajka诊断标准,共诊断AD患者71例.治疗前后于皮损处取材进行真菌直接镜检、真菌培养、细菌培养及药敏试验,以SCORAD方法计分,将其中66例患者随机分成两组,分别采用1%硝酸益康唑+0.1%曲安奈德霜与0.1%丁酸氢化可的松软膏外用对比治疗AD患者.结果 AD患者以婴幼儿、儿童为主(≤12岁者占73.24%);皮损细菌培养阳性率为53.51%(金葡菌阳性率为35.21%),真菌阳性率为1.41%;药敏结果显示金葡菌对利福平、万古霉素、丁胺卡那霉素、环丙沙星、头孢唑啉、头孢呋辛等敏感性好;1%硝酸益康唑+0.1%曲安奈德霜与0.1%丁酸氢化可的松软膏外用治疗AD4周时,前者疗效优于后者(P<0.05),细菌阴转率前者高于后者(P<0.01).两组外用药治疗的患者均未见不良反应.结论 具有抗感染与抗炎双重作用的1%硝酸益康唑+0.1%曲安奈德霜治疗AD的疗效优于0.1%丁酸氢化可的松软膏.     

Influence of local triamcinolone acetonide on patch test reactions to nickel sulfate.

The influence of local application of triamcinolone acetonide on patch test reactions was investigated in patients with a contact allergy to nickel sulfate. In 15 patients the reaction to patch tests with a mixture of 5% nickel sulfate and 0.1% triamcinolone acetonide in petrolatum was compared with the reaction to 5% nickel sulfate in petrolatum. In eight patients the test area on the skin was infiltrated with triamcinolone acetonide or saline solution after which test were performed with nickel sulfate. In eight patients the test area was pretreated with 0.1% triamcinolone acetonide cream or the cream base alone before the patch tests with nickel sulfate were done. In general, all three methods gave partial suppression of the size of the reaction.     

Mometasone furoate ointment and cream 0.1 percent in treatment of psoriasis: comparison with ointment and cream formulations of fluocinolone acetonide 0.025 percent and triamcinolone acetonide 0.1 percent

Mometasone furoate (Elocon) is a newly formulated and unique medium-potency synthetic 17-heterocyclic corticosteroid. The efficacy and safety of the ointment and cream formulations (0.1 percent) of the corticosteroid, administered once daily, were compared with those of the ointment and cream formulations of fluocinolone acetonide 0.025 percent administered three times daily and triamcinolone acetonide 0.1 percent administered twice daily in four multicenter clinical studies. They were conducted involving psoriasis patients with chronic and moderate to severe disease. Evaluation of change in disease sign scores indicated that mometasone ointment, applied once daily, was significantly more effective (P less than 0.01) than fluocinolone ointment, applied three times daily, and triamcinolone ointment, applied twice daily. The cream formulation of mometasone was significantly more effective (p less than 0.001) than fluocinolone cream, applied three times daily, and equivalent to triamcinolone cream, applied twice daily. The incidence of local adverse experiences following treatment with the ointment or cream formulations of mometasone was minimal. Mometasone ointment and cream provide a highly effective once-a-day treatment for moderate to severe psoriasis with minimal risk of side effects.     

Improved risk-benefit ratio for topical triamcinolone acetonide in Transfersome in comparison with equipotent cream and ointment: a randomized controlled trial

BACKGROUND: Transfersome is a drug delivery technology based on highly deformable, ultraflexible lipid vesicles which penetrate the skin when applied non-occlusively. OBJECTIVES: To assess the advantages of this carrier-based formulation in humans, the efficacy and the atrophogenic potential of triamcinolone acetonide (TAC) in Transfersome was compared with commercially available TAC-containing cream and ointment. METHODS: Healthy volunteers were enrolled in double-blind, placebo-controlled clinical trials with random study medication assignment to the test areas. RESULTS: A 10-fold lower dose of TAC in Transfersome(R) (2.5 micro g cm-2) was bioequivalent to 25 micro g cm-2 TAC in conventional formulations as measured by erythema suppression (cream: P = 0.01, ointment: P < 0.001). A skin blanching assay revealed different kinetics of the formulations, with a delayed onset of action of the Transfersome and ointment preparations. Ultrasonic measurements revealed a significantly reduced atrophogenic potential. There was a 12.1% reduction in skin thickness given by TAC in Transfersome compared with a 21.1% reduction given by a bioequivalent dose in TAC cream after a 6-week treatment period (P = 0.007). CONCLUSIONS: Transfersome may significantly improve the risk-benefit ratio of topically applied glucocorticosteroids.     

A randomized, double-blind study to assess the efficacy of addition of tetracycline to triamcinolone acetonide in the treatment of moderate to severe atopic dermatitis

Objective To assess the efficacy of tetracycline in triamcinolone acetonide ointment compared with triamcinolone acetonide ointment in patients with moderate to severe atopic dermatitis. Design Randomised, double‐blind parallel group study of 8 weeks’ duration. Setting Outpatient clinic in a university hospital. Participants Forty‐four adult patients with moderate to severe atopic dermatitis (objective SCORAD > 25). Interventions Initial phase (2 weeks): 3% tetracycline 0.1% triamcinolone acetonide vs. 0.1% triamcinolone acetonide twice daily all over the body. Maintenance phase (6 weeks) 0.1% triamcinolone acetonide once daily for 2 weeks, followed by every other day for 2 weeks. In the last 2 weeks, two applications a week were done. An emollient was used additionally once daily. Main outcome measures Primary outcomes were the disease severity scores assessed by objective SCORAD and SASSAD at week 2. Secondary outcomes were the objective SCORAD and SASSAD at weeks 4 and 8, and Staphylococcus aureus colonization at weeks 0 and 2. Results No significant differences in disease severity outcomes were found between the two groups. Both groups showed clinically relevant improvements in disease severity compared with baseline at weeks 2 and 4. At week 8, there was some worsening in disease severity in both groups, but the disease severity was still significantly lower than at the beginning of the study. Improvement of bacterial colonization was seen in 14 (63.6%) out of the 22 patients in the 3% tetracycline 0.1% triamcinolone acetonide group and in 5 (22.7%) out of the 22 patients in the 0.1% triamcinolone acetonide group. Conclusion The addition of tetracycline was effective on skin colonization by S. aureus but did in our patients with atopic dermatitis not result in a significantly different improvement compared with the group treated without tetracycline.     

A comparison of the potencies of several diluted and undiluted corticosteroid preparations using the vasoconstrictor assay

10 subjects were assessed using the vasoconstrictor assay technique in a double-blind study in order to evaluate the relative potencies of several diluted and undiluted proprietary corticosteroid preparations. Dermovate ointment achieved a significantly higher score than any other preparation but there was no significant difference between the scores for Betnovate ointment (betamethasone valerate 0.1%), Propaderm Forte cream (beclomethasone dipropionate 0.5%), Propaderm ointment (beclomethasone dipropionate 0.025%), Nerisone Forte ointment (diflucortolone valerate 0.3%), and Nerisone ointment (diflucortolone valerate 0.1%). Furthermore, no significant difference in scores could be demonstrated between Adcortyl ointment (triamcinolone acetonide 0.1%), Ledercort ointment (triamcinolone acetonide 0.1%) and extemporaneous dilutions of these ointments 1 part in 4 in their recommended diluents (triamcinolone acetonide 0.025%). The relevance of these findings to clinical practice is discussed.     

Differential rates of percutaneous absorption through the eczematous and normal skin of a monkey

A monkey (Macaca fascicularis), diagnosed as having eczematous dermatitis on the basis of histopathology of a skin biopsy, was used to study the percutaneous absorption of 2 anti-inflammatory steroids. Absorption was measured through involved and uninvolved skin by using in vitro diffusion cell techniques. Hydrocortisone (0.5%) and triamcinolone acetonide (0.1%) were applied to the skin in a petrolatum vehicle. After application for 24 h, the permeation of hydrocortisone was approximately doubled (from 2.6 to 5.5% of the applied dose) when diseased skin was used. The absorption of triamcinolone acetonide was enhanced through the eczematous skin during the initial 12 h. At 24 h, however, no significant difference in total absorption was obtained.     

Epidermal thinning: Evaluation of commercial corticosteroids

Summary Epidermal thinning of mouse tail skin was compared for commercial preparations of clobetasol propionate (Dermovate), clobetasone butyrate (Eumovate), fluocinonide (Metosyn), and hydrocortisone butyrate (Locoid). The thickness measurements were ranked with those for hydrocortisone (1%), betamethasone valerate (Betnovate), triamcinolone acetonide (Ledercort), fluocinolone acetonide (Synalar), and prednisolone stearoylglycolate (Sinistrone) obtained in a previous study (Spearman and Jarrett, 1975). All steroids caused epidermal thinning, except clobetasone butyrate. Some cream and ointment vehicles were also assayed. Epidermal thickening was caused by the cream and ointment vehicles used for Eumovate and also by the cream employed for Locoid formulation.     

A comparison of treatment of oral lichen planus with topical tacrolimus and triamcinolone acetonide ointment

Treatment of symptomatic oral lichen planus remains a challenging problem. This study compared the efficacy of topical tacrolimus ointment with triamcinolone acetonide ointment in patients with oral lichen planus. Twenty patients (group I) were treated with topical tacrolimus 0.1% ointment 4 times daily, and 20 (group II) were treated with triamcinolone acetonide 0.1% ointment 4 times daily. The clinical effect was graded after 6 weeks. In group I, 6 patients healed, 12 showed improvement and 2 showed no improvement. In group II, 2 patients healed, 7 improved and 11 showed no improvement. The most commonly reported side-effect in both groups was temporary burning or stinging at the site of application. Unfortunately, oral lesions recurred within 3-9 weeks of cessation of treatment in 13 of the 18 patients who had initially shown an improvement or were healed in group I and in 7 of the 9 patients in group II. Topical tacrolimus 0.1% ointment induced a better initial therapeutic response than triamcinolone acetonide 0.1% ointment. However, relapses occurred frequently within 3-9 weeks of the cessation of treatment.     

Cardiospermum--a new phytogenic drug in dermatology?

In a double blind study on persons with healthy skin, we tested the efficacy of cardiospermum ointment against the ointment base only. There were no significant differences between placebo and active substance regarding clinical evaluation, light reflection photometry, and transepidermal water loss. By means of doppler laser flowmetry, we found a decrease in corial blood supply after 16 hours' application of cardiospermum, which suggests a possible antiphlogistic effect.     

Irritant and allergic responses as influenced by triamcinolone in patch test materials

While the prior application of triamcinolone acetonide to skin does not strongly influence patch test reactions, the presence of triamcinolone in the materials used for patch testing has a profound effect. Both irritant and allergic reactions to thimerosal are consistently negated when triamcinolone acetonide is present in concentrations of 0.1% and 0.025%.     

曲安奈德结合利多卡因皮损内局部注射治疗疥疮结节疗效分析

目的：分析曲安奈德结合利多卡因皮损内局部注射对疥疮结节的治疗效果。方法：选择我院皮肤性病科门诊2011年6月至2013年6月收治的82例疥疮结节患者,随机分为观察组和对照组,观察组给予曲安奈德结合利多卡因（1∶2）皮损内局部注射治疗;对照组疥疮结节外涂肤轻松软膏,比较两组疗效。结果：观察组结节平均消退时间为（9.4±5.2）d,明显优于对照组结节消退时间（12.3±6.7）d,差异有显著性（t＝2.327,P＜0.05）;观察组在治疗7d、14d及21d时其总有效率明显高于对照组,差异有统计学意义（P＜0.05）;14d及21d时大结节治疗总有效率明显高于对照组,差异有统计学意义（P＜0.05）。结论：曲安奈德结合利多卡因皮损内局部注射疗效确切,是一种安全有效的治疗手段。     

Comparative evaluation of skin atrophy in man induced by topical corticoids

In this in-patient study, mild skin atrophy was observed clinically in 6 out of a total of 22 patients after fluocinolone acetonide and in one patient after flumethasone pivalate ointment applications (P less than 0,05). Investigations were discontinued prematurely on days 14 and 17 in 2 patients because they developed early atrophy due to fluocinolone acetonide applications. Histological findings indicating either moderate or marked skin atrophy were evident in 15 patients after flucinolone acetonide as against one patient after flumethasone pivalate ointment applications (P less than 0.001). In comparison with the controls the mean decrease in epidermal thickness was more marked after fluocinolone acetonide applications, namely 30.5% vs 21.3% after flumethasone pivalate applications. The ultrastructural tissue changes were less marked at the sites to which flumethasone pivalate was applied. In comparison with controls, the percentages of mean decrease in diameters of collagen fibrils measured in six volunteer patients ranged from 5.1% to 27.6% after fluocinolone acetonide and from 0% to 12.3% following flumethasone pivalate ointment applications, This difference was statistically significant (range P less than 0,01 to less than 0.001). This experimental study has demonstrated that flumethasone pivalate displays only a mild atrophogenic effect and it is clinically and histologically significantly less atrophogenic than fluocinolone acetonide. Flumethasone pivalate can therefore be reckoned as a suitable topical corticosteroid especially for the long-term treatment of corticoid-responsive dermatoses.     

Lichen striatus following solarium exposure

Two cases of lichen striatus occurring after solarium exposure are presented. Both patients were adult females who regularly attended a solarium prior to the development of their skin lesions. A 19-year-old woman attended the solarium twice weekly for 8 weeks prior to the appearance of lichen striatus on the chest and epigastrium. The condition resolved completely with the twice daily application of calcipotriol ointment for 6 months. The second patient, a 40-year-old woman, attended the solarium once weekly for 3 months before lichen striatus developed on the abdomen. She was treated with clobetasol propionate ointment, calcipotriol ointment and intralesional triamcinolone acetonide and the eruption cleared 7 months after onset. The histopathological picture in both patients supported a diagnosis of lichen striatus.     

养阴活血除湿法治疗慢性湿疹的临床观察

目的观察养阴活血除湿法治疗慢性湿疹的临床疗效和安全性。方法 70例慢性湿疹患者,随机分为试验组和对照组,试验组给予养阴活血除湿方和氯雷他定口服,醋酸曲安奈德尿素软膏外用,对照组给予氯雷他定口服,醋酸曲安奈德尿素软膏外用,4周后对2组患者临床疗效进行评估。结果试验组有效率89.47%,对照组有效率69.75%,2组有效率比较差异有统计学意义(P0.05)。试验组有4例患者出现轻微胃肠道不适,对照组有3例患者出现轻度嗜睡及心悸。结论养阴活血除湿法治疗慢性湿疹临床有辅助疗效,不良反应小。     

Die hemmung der glucose-6-phosphat-dehydrogenase-aktivität durch glucocorticoide

Zusammenfassung Als Beitrag zur Frage, ob die Bestimmung von Hemmeffekten auf die Glucose-6-phosphat-Dehydrogenase-Aktivität als Screening für antipsoriatische Wirkungen von Bedeutung is, wurden dermatologisch interessante Glucocorticoide in diesem Modell untersucht. Als Testsubstanzen dienten zwei wasserlösliche Glucocorticoidester (6-Fluor-16-methylprednisolon-21-dinatriumphosphat und 6-Methylprednisolon-hemisuccinat-Natrium) und die vier wasserunlöslichen Steroide Hydrocortison, Triamcinolonacetonid, Fluocinolonacetonid und-Methasonvalerat. Die Hemmung der G-6-PDH-Aktivität wurde am Reinenzym und am Hautenzym bestimmt, wobei sich gute Parallelen ergaben. Die stärksten Effekte zeigten sich beim Triamcinolonacetonid und beim Fluocinolonacetonid (Milieu Ringer mit 5% DMFA), Hydrocortison und Betamethasonvalerat hemmten die G-6-PDH-Aktivität weit geringer. Die Übereinstimmungen mit den klinischen Wirkungen werden kurz diskutiert. — Von den wasserlöslichen Steroiden erwies sich Methylprednisolon am Reinenzym stärker wirksam; am Hautenzym waren die beiden untersuchten wasserlöslichen Steroidester etwa gleich stark hemmend.

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Inhibitory action of glucocorticoids on glucose-6-phosphate dehydrogenase activityA Screening of Antipsoriatic Effects

Summary Inhibitory effects of glucocorticoids on glucose-6-phosphate dehydrogenase activity have been introduced for the screening of antipsoriatic actions. In this study, glucocorticoids which are used in dermatological therapy have been investigated. As test substances, two water soluble glucocorticoid esters (6-fluor-16-methylprednisolone 21-dinatriumphosphate and 6-methylprednisolone hemisuccinate-sodium) and four water insoluble steroids (hydrocortisone, triamcinolone acetonide, fluocinolone acetonide,-methasone valerate) were used. G-6-PDH-ac-tivity and its changes were measured on pure enzyme (from yeast) and on the skin enzyme (human skin homogenate). In both systems, good accordance was seen. Among the water insoluble steroids, triamcinolone acetonide and fluocinolone acetonide exhibited the strongest inhibitory action (medium Ringer with 5% dimethylformamide); hydrocortisone and-methasone valerate provoked a less pronounced inhibition. The significance of these observations are briefly discussed in respect to the clinical effectiveness. — Among the water soluble steroid esters, methylprednisolone was more active on the pure enzyme, whereas in the skin homogenate both esters revealed about the same inhibitory action on glucose-6-phosphate dehydrogenase activity.

     

Selection of the acceptor medium in in vitro measurements of drug release from dermatological ointments

Comparative measurements of in vitro agent release using hydrophilic, intermediate, and lipophilic acceptor phases and in vivo measurements of the blanching effect with triamcinolone acetonide are reported. White petrolatum, wool alcohols ointment, and polyethylene glycol ointment served as donator phases. The results demonstrate that the lipophilic acceptor phase (isopropyl palmitate) is most representative for the in vivo acceptor phase. Conclusions cannot be drawn regarding in vivo effectiveness from measurements of agent release to the hydrophilic (phosphate buffer, pH 6) and intermediate (n-octanol) acceptor phases. In vitro measurements of agent release have a screening character and must usually be supplemented by very elaborate penetration models of the human skin for a definitive evaluation of an ointment.     

Radiographic measurement of topical corticosteroid-induced atrophy.

Soft tissue x-ray techniques were used to measure skin thickness as influenced by the chronic usage of topical corticosteroids. In a double-blind study commercial preparations of 1% hydrocortisone (HC), 0.1% triamcinolone acetonide (TA), and a placebo cream were compared for their ability to produce atrophy in normal human forearm skin. After 8 weeks of topical application of the creams, only TA produced clinically apparent atrophy. The average percent decreases in skin thickness measured after 8 weeks of treatment with placebo, HC, or TA were 6.0%, 6.0%, and 17.1%, respectively. During the first week after cessation of treatment the clinical appearance of the skin began to improve and by 1 month all treated skin areas had essentially returned to pretreatment thickness.     

曲安奈德益康唑乳膏治疗脂溢性皮炎78例临床观察

目的观察曲安奈德益康唑乳膏治疗微生物相关皮肤病脂溢性皮炎的临床疗效及安全性。方法治疗组78例脂益性皮炎患者，予早、晚各1次外用曲安奈德益康唑乳膏，并轻揉搓片刻，疗程4周。对照组80例予外搽皮炎平，用药方法及疗程同前。每周复诊时观察皮损情况。结果治疗组有效率89．3％，对照组为66．6％；治疗组出现不良反应3例，占3．8％，均予对症处理，与对照组（8例）比较差异有统计学意义（P〈0．05）。结论曲安奈德益康唑乳膏治疗脂溢性皮炎疗效确切，不良反应少。     

Millimeter wave reflectivity used for measurement of skin hydration with different moisturizers

Background/aims: A new non‐invasive method for determining the free water content in human skin has been developed. The method analyzes the reflection of millimeter (mm) wavelength electromagnetic waves. The amount of reflection of mm waves depends on an electrical property (namely, the permittivity) of the skin, and this depends upon the free water content of the various skin layers. The aim of the present study was to use the mm wave reflectometry method for determination of free water content in healthy skin treated with different hydrating substances. Methods: Skin lotion, pure water, glycerol, and petroleum jelly (an occlusive substance) were used for hydration of skin. The amount of free water was calculated using the permittivity values of skin layers found from fitting a three layer skin model to measured reflection data. The skin model consisted of (1) the stratum corneum (SC), (2) the viable epidermis plus the dermis, and (3) fat layers. Results: Mm wave reflection was significantly affected by the water content of the thick SC of the palm but not by the very thin SC of the forearm. Treatment of the forearm and palm skin with different hydrating substances produced notable changes of the free water content in the SC, but not in the viable epidermis or dermis. The greatest hydration was produced by pure water and skin lotion, and the lowest by petroleum jelly. However, petroleum jelly produced prolonged retention of water in the SC following its hydration by other moisturizers. The content of free water was found to return to its baseline value after removal of moisturizers in as short a time as 8.3 min. Conclusion: The study shows that mm wave reflectometry can be used as a sensitive technique for the non‐invasive determination of water content in living skin.