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.     

湿包裹疗法在中重度特应性皮炎患者护理中的效果评价

 目的:探讨中重度特应性皮炎患者应用湿包裹疗法护理的效果。方法:按照入院顺序号将2018年6月-2019年6月在本院诊断为中重度特应性皮炎的60例患者随机分为对照组和试验组,每组30例。两组患者均口服左西替利嗪口服液止痒,外用氢化可的松乳膏及尿囊素保湿,对照组予常规单纯外搽药物护理,试验组在对照组护理基础上加用湿包裹疗法护理。比较两组患者治疗前后全身的皮损改善情况及不良反应发生情况。结果:两组患者治疗后的皮损面积和临床特征评分均明显低于治疗前（P值均<0.01）,试验组治疗后的皮损面积和临床特征评分均明显低于对照组（t=3.17,P=0.002;t=4.07,P=0.001）,差异具有统计学意义。两组患者不良反应发生率差异无统计学意义（P>0.01）。结论:湿包裹疗法护理能有效改善中重度特应性皮炎患者的症状,且安全性较高,值得在临床推广应用。     

曲尼司特治疗特应性皮炎临床疗效观察

目的：观察曲尼司特治疗特应性皮炎的疗效与安全性。方法：采用随机双盲、安慰剂平行对照的方法，将入选患者随机分为试验组与对照组，分别接受曲尼司特和安慰剂的治疗，同时两组患者均外用丝塔芙保湿润肤霜。对皮肤病变范围、皮损严重程度、瘙痒和睡眠影响程度进行临床观察，用SCORAD评分系统进行评估。结果：治疗组23例基本痊愈6例，显效9例，有效4例，无效4例，总有效率为65．22％，对照组总有效率为22．73％，两组有显著性差异（P=0．0216）；治疗组患者治疗前后SCORAD评分有统计学差异（P〈0．05）。治疗过程中治疗组不良反应仅为4．35％，且症状轻。结论：曲尼司特治疗特应性皮炎安全、有效。     

特应性皮炎的治疗

<正>特应性皮炎(atopic dermatitis,AD)又名异位性湿疹,是一种较常见的慢性、复发性、炎症性皮肤病,主要表现为剧痒、湿疹样皮损和干皮病样症状等,常在婴幼儿期或青少年期起病,可伴有血清IgE水平升高及过敏性鼻炎或哮     

特应性皮炎的治疗

特应性皮炎（atopic dermatitis,AD）又名异位性湿疹,是一种较常见的慢性、复发性、炎症性皮肤病,主要表现为剧痒、湿疹样皮损和干皮病样症状等,常在婴幼儿期或青少年期起病,可伴有血清IgE水平升高及过敏性鼻炎或哮喘的个人史或家族史。流行病学调查显示,近年来AD的发病率逐渐上升,严重影响患者的生活质量,故正确治疗AD应是皮肤科医师熟知的内容。     

儿童特应性皮炎的长期治疗管理

特应性皮炎(Atopic dermatitis,简称AD)是世界范围内困扰儿童健康的常见慢性、复发性、炎症性皮肤疾病,发病机制目前尚不清楚.本文主要对AD的长期治疗管理进行综述.AD的长期治疗管理包括基本治疗和药物治疗:基本治疗主要包括对患儿及患儿家长进行健康教育,使其了解并避免AD的诱发或加重因素;药物治疗包括,积极使用保湿润肤剂维护皮肤屏障功能,合理使用抗炎症药物抑制皮肤炎症反应,从而使患儿皮肤状况处于长期缓解状态.     

加味启脾丸颗粒治疗儿童特应性皮炎疗效观察

目的观察加味启脾丸颗粒治疗儿童特应性皮炎疗效。方法治疗组27例予加味启脾丸颗粒治疗,对照组24例予赛庚啶治疗。结果治疗组有效率为62.96%,对照组为29.17%,两组有效率比较差异有显著性(P<0.05)。结论加味启脾丸颗粒冲服治疗儿童特应性皮炎有一定的疗效。     

复方松馏油糊治疗儿童特应性皮炎的疗效观察

目的观察复方松馏油糊治疗儿童特应性皮炎的疗效和安全性。方法治疗组予复方松馏油糊局部封包患处,对照组予益康唑曲安奈德霜外用治疗,疗程3周。结果治疗组有效率为91.11%,对照组有效率为74.44%,两组有效率差异有显著性(P<0.05);治疗组无任何不良反应。结论复方松馏油糊治疗儿童特应性皮炎疗效好,不良反应发生率低,是一种安全有效的外用药。     

大连市区学龄前儿童特应性皮炎流行病学调查

目的:了解大连市区学龄前儿童特应性皮炎(AD)的流行情况和相关因素。方法:对大连市内4区学龄前儿童进行问卷调查。结果:共收回8492份调查问卷,有效调查问卷为7872份,其中特应性皮炎患儿212例,男104例,女108例。总标化患病率为2.69%,其中男性标化患病率为2.769%,女性标化患病率为2.613%,两者之间无显著性差异。室内装修、经常玩毛绒玩具、家中有宠物、地毯、布艺沙发,家庭收入高、房屋居住位置接近主干道、4个月内添加辅食者AD发病率明显高于对照组。结论:大连市区3～6岁儿童特应性皮炎男女患病率无显著差别。     

儿童特应性皮炎急性发作期的血浆氨基酸代谢分析

目的 通过靶向代谢组学分析儿童特应性皮炎(atopic dermatitis,AD)急性发作期的血浆氨基酸代谢变化,从代谢通路方面探讨特应性皮炎发病机制;探讨特应性皮炎亚型外源型和内源型急性发作期血浆氨基酸代谢差异.方法 将收集的符合儿童特应性皮炎诊断标准的患者40例(其中22例为外源型AD组,18例为内源型AD组)和...     

The Efficacy and Safety of Long-term Oral Cyclosporine Treatment for Patients with Atopic Dermatitis

Background

Steroids are used in conventional treatment of atopic dermatitis (AD) and they are very effective for improving the symptoms, but they also have several complications. Many studies have reported that short-term use of cyclosporine (CsA) is effective for severe AD as a substitute for steroid. However, there are very few studies on the long-term use of CsA for AD in the Korean population.

Objective

The purpose of this study was to investigate whether long-term CsA therapy is effective and safe for treating AD.

Methods

We performed a retrospective study of the patients with AD and who were treated with CsA at Kyung Hee Medical Center between January 2001 and February 2008. Among 147 patients, 61 received CsA treatment for more than 6 months. To evaluate the efficacy of CsA treatment, the objective SCORAD was checked for all 61 patients at every visit. Extensive laboratory tests were performed every two months to assess the safety of treatment.

Results

The mean duration of CsA treatment was 13.5±8.4 months and the mean initial dose of CsA was 2.7±0.9 mg/kg/day. The mean objective SCORAD values significantly decreased from 34.1±11.2 at baseline to 11.4±10.7 after 6-month of CsA treatment (p<0.05). A significant decline of the SCORAD score was observed starting from 1-month of CsA treatment. The mean duration of remission was 4.5±2.9 months. A total of 13 adverse events in 10 patients were recorded during the study period. One patient dropped out due to renal dysfunction. Elevation of peripheral blood pressure was noted in 8 patients. Three patients complained of gastrointestinal troubles, and one patient had hypertrichosis, but the problems of these 4 patients were mild and easily treated.

Conclusion

We suggest that long-term, low-dose CsA treatment is safe and effective for patients who suffer from AD.     

Consensus Update for Systemic Treatment of Atopic Dermatitis

BackgroundIn 2015, the Korean Atopic Dermatitis Association (KADA) working group published consensus guidelines for treating atopic dermatitis (AD).ObjectiveWe aimed to provide updated consensus recommendations for systemic treatment of AD in South Korea based on recent evidence and experience.MethodsWe compiled a database of references from relevant systematic reviews and guidelines on the systemic management of AD. Evidence for each statement was graded and classified based on thestrength of the recommendation. Forty-two council members from the KADA participated in three rounds of voting to establish a consensus on expert recommendations.ResultsWe do not recommend long-term treatment with systemic steroids forpatients with moderate-to-severe AD due to the risk of adverse effects. We recommend treatment with cyclosporine or dupilumab and selective treatment with methotrexate or azathioprine for patients with moderate-to-severe AD. We suggest treatment with antihistamines as an option for alleviating clinical symptoms of AD. We recommend selective treatment with narrowband ultraviolet B for patients with chronic moderate-to-severe AD. We do not recommend treatment with oral antibiotics for patients with moderate-to-severe AD but who have no signs of infection. We did not reach a consensus on recommendations for treatment with allergen-specific immunotherapy, probiotics, evening primrose oil, orvitamin D for patients with moderate-to-severe AD. We also recommend educational interventions and counselling for patients with AD and caregivers to improve the treatment success rate.ConclusionWe look forward to implementing a new and updated consensus of systemic therapy in controlling patients with moderate-to-severe AD.     

他克莫司软膏治疗成人中重度特应性皮炎的疗效和安全性观察

目的观察0.1%和0.03%他克莫司软膏治疗成人中重度特应性皮炎的疗效和安全性。方法采用随机双盲、赋形剂平行对照的临床试验,共入组54例成人中重度特应性皮炎患者,年龄18~65岁,共用药3周,其中49例患者完成本试验。结果治疗结束时0.1%和0.03%他克莫司软膏痊愈率分别为46.7%(7/15)和23.5%(4/17),显效率分别为46.7%(7/15)和47.1%(8/17),与赋形剂组的痊愈率17.7%(3/17)和显效率11.8%(2/17)相比,差异有统计学意义;0.1%和0.03%他克莫司软膏治疗有效率分别为93.3%(14/15)和70.6%(12/17),均明显高于赋形剂对照组的29.4%(5/17),差异具有高度统计学意义。在0.1%和0.03%他克莫司软膏中,主要不良反应表现为用药部位出现瘙痒(38.9%和27.8%)、灼热感(33.3%和16.7%)、刺痛(16.7%和22.2%)等,严重程度多为轻到中度,并且均为一过性。治疗前后实验室检查也无明显异常改变。结论0.1%和0.03%他克莫司软膏是一种安全、有效的治疗成人中、重度特应性皮炎的药膏。     

The Clinical Efficacy, Safety and Functionality of Anion Textile in the Treatment of Atopic Dermatitis

Background

Several previous studies have suggested the improvement of atopic dermatitis (AD) in response to special fabrics. In particular, beneficial effects have been reported, following the use of anion textiles.

Objective

The purpose of this study is to evaluate the effectiveness and safety of an anion textile in patients suffering from AD.

Methods

We compared an anion textile with a pure cotton textile. Fifty-two atopic patients (n=52) were enrolled and divided into two groups. The patients in the test (n=25) and control (n=19) groups wore undergarments made of an anion textile or pure cotton over a period of 4 weeks. The overall severity of disease was evaluated using the SCORing atopic dermatitis (SCORAD) index, whereas, the treatment efficacy was measured using a Tewameter® (Courage & Khazaka, Cologne, Germany), Mexameter® (Courage & Khazaka) and Corneo meter® (Courage & Khazaka).

Results

At the end of the study, a significant decrease in the SCORAD index was observed among the patients with AD in the test group (mean SCORAD decreased from 47.2 to 36.1). Similarly, improvements in the mean transepidermal water loss, skin erythema and stratum corneum hydration were significantly greater among the patients with AD in the test group than in the control group.

Conclusion

Anion textiles may be used to significantly improve the objective and subjective symptoms of AD, and are similar in terms of comfort to cotton textiles. The use of anion textiles may be beneficial in the management of patients with AD.     

Atopic Dermatitis

Atopic dermatitis (AD) is a chronic and relapsing disease affecting an increasing number of patients. Usually starting in early childhood, AD can be the initial step of the so-called atopic march, i.e. followed by allergic rhinitis and allergic asthma. AD is a paradigmatic genetically complex disease involving gene-gene and gene-environment interactions. Genetic linkage analysis as well as association studies have identified several candidate genes linked to either the epidermal barrier function or to the immune system. Stress, bacterial or viral infections, the exposure to aero- or food-allergens as well as hygienic factors are discussed to aggravate symptoms of AD. Athough generalized Th2-deviated immune response is closely linked to the condition of AD, the skin disease itself is a biphasic inflammation with an initial Th2 phase and while chronic lesions harbour Th0/Th1 cells. Regulatory T cells have been shown to be altered in AD as well as the innate immune system in the skin. The main treatment-goals include the elimination of inflammation and infection, preserving and restoring the barrier function and controlling exacerbating factors. The overall future strategy in AD will be aimed to control skin inflammation by a more proactive management in order to potentially prevent the emergence of sensitization as well as to design customized management based on genetic and pathophysiologic information.     

中药药浴联合他克莫司软膏治疗儿童特应性皮炎的疗效及安全性观察

目的 评价中药药浴联合他克莫司软膏外用治疗儿童特应性皮炎的临床疗效及安全性.方法 本试验采用随机、单盲、阳性平行对照试验将45例儿童患者采用随机数字表分成治疗组和对照组.治疗组23例,对照组22例.治疗组采用中药药浴治疗联合外用0.03％他克莫司软膏外用,1次/d.对照组单用0.03％他克莫司软膏外用,1次/d,疗程均为4周.随访3个月.结果 4周疗程结束后,2组间有效率差异无统计学意义(x2=5.148,P＜0.05).2组初诊时SCORAD积分值比较差异无统计学意义(t=0.557,P＞0.05),治疗4周后SCORAD积分值比较差异具有统计学意义(x2=5.148,P＜0.05)).结论 中药药浴联合0.03％他克莫司软膏较单用0.03％他克莫司软膏治疗特应性皮炎疗效较优,复发率低,安全性好,值得临床推广.     

儿童特应性皮炎153例变应原皮试分析

目的探讨儿童特应性皮炎(AD)的病因。方法对153例AD患儿进行了变应原皮试。结果阳性率83.01%,其中吸入组阳性率80.1%,食物组74.6%,二组阳性率差异无显著性。常见的阳性变应原为室内尘土(73.5%)、粉尘螨(70.9%)、多价昆虫(56.9%)、虾(46.4%)、芝麻(40.0%)。年龄3岁以内组、3～7岁组和7岁以上组的吸入组皮试阳性率分别为46.7%,82.9%和85.0%,其差异有显著性(P<0.005)。结论吸入性和食物变应原是儿童特应性皮炎的主要病因之一,吸入性变应原过敏多发生在3岁以上。     

Intravenous Immunoglobulin Treatment in a Child with Resistant Atopic Dermatitis

In a subgroup of patients suffering from atopic dermatitis (AD), treatment is quite difficult even after taking oral immunosuppressants. High-dose intravenous immunoglobulin (IVIG) treatment has been reported to be beneficial for them in a few uncontrolled trials. Herein we report a case of intractable AD in a 5-year-old girl who had significant clinical improvement after receiving 3 cycles of IVIG treatment (2 g/kg) without notable side effects. Since the first infusion of IVIG, the patient''s skin lesions improved steadily and the improvement persisted until the 8-month follow-up. The eczema area and severity index score decreased remarkably, while immunologic parameters did not correlate with clinical improvement. This case suggests that IVIG therapy can be quite effective and safe for children with resistant AD.     

特应性皮炎与行为异常

特应性皮炎作为一种慢性炎症性皮肤病严重影响患者的身心健康,行为学方面的异常也影响着患者的生活质量,其严重时可表现为注意缺陷多动症。睡眠紊乱及感觉调制障碍是行为异常可能的原因,特应性皮炎、注意缺陷多动症以及伴随的睡眠紊乱的因果关系需要进一步研究,特应性皮炎仍然需要完整的医学诊断、预防及治疗的联合策略。