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。     

Influence of narrow-band UVB phototherapy on cutaneous microbiota of children with atopic dermatitis

OBJECTIVE: In the present work, the effect of narrow-band ultraviolet B (UVB) phototherapy on a cutaneous microbial population was evaluated in patients with atopic dermatitis (AD) and compared with control patients (vitiligo). METHODS: Count, isolation and identification of cutaneous microbiota from anticubital fossa were performed in 10 controls and 10 AD patients, both submitted to similar levels (P > 0.05) of UVB phototherapy (4.3 +/- 0.9 and 4.3 +/- 0.8 accumulated joules, respectively). Additionally, Staphylococcus aureus isolates were screened for the production of exotoxins. RESULTS: The total and staphylococcal cutaneous microbial population levels were higher (P < 0.05) in AD patients than in the controls. All these population levels decreased (P < 0.05) for both AD and control patients after UVB phototherapy, which also decreased the SCORAD for AD patients. All patients with AD and 50% of controls were carriers of S. aureus, and harboured the bacteria simultaneously on skin and anterior nares. All of the S. aureus strains recovered from AD patient skin produced toxin and the B type was the most frequently detected (70%), followed by C (20%) and A (10%) toxins. Only 40% of the S. aureus isolates from control patients produced toxin. After UVB treatment, microbial population levels of AD patients were similar (P > 0.05) to the ones found in control patients before phototherapy, and toxin production ability of S. aureus isolates decreased drastically. CONCLUSION: The results of the present study show the beneficial effect of UVB phototherapy on AD and suggest that this may be attributable not only to reduction of skin surface bacteria but also to the suppression of superantigen production from S. aureus.     

窄谱中波紫外线治疗顽固性特应性皮炎临床研究

目的：观察窄谱中波紫外线治疗顽固性特应性皮炎的疗效、近期副作用及患者依从性。方法：对20例顽固性特应性皮炎患者进行窄谱中波紫外线全身照射治疗，每周3次，共8周；在治疗前及治疗8周后用EASI标准进行病情评分，计算病情改善率。结果：20例患者中19例均完成8周的治疗；治疗8周后3例患者基愈，9例显效，6例有效，1例无效，平均病情改善率为55．11％。3例患者出现全身轻度色素沉着，随访6个月3例基愈患者未见复发。结论：对顽固性特应性皮炎，窄谱中波紫外线显示出较好的治疗效果，且近期副作用少，患者依从性好，复发少。     

A UVB phototherapy protocol with very low dose increments as a treatment of atopic dermatitis

From 1991 to 1992, 15 patients with atopic dermatitis were treated with a new UVB treatment regimen guided by skin reflectance measurements. The new treatment was characterized by very low dose increments from start to end of therapy. The median cumulative dose increment during therapy was only 20%. The severity of the disease, the efficacy of the treatment, the occurence of adverse effects and the cumulative UVB dose were obtained from the case records. This data were compared in an open study with the data obtained from 17 patients with atopic dermatitis who were treated from 1988 to 1991 at the department with a standard UVB treatment regimen with stepwise dose increments. There was no difference in the severity of the disease at the beginning of the therapy between the two groups. The skin reflectance-guided low-dose UVB therapy was not significantly faster (3.5 weeks) than the regimen with stepwise dose increments (4.5 weeks). The cumulative UV exposure was four times lower with the new treatment regimen (34 standard erythema doses) compared with the old regimen (161 standard erythema doses), P <0.001. The healing score was significantly higher with the new treatment regimen compared with the old, P <0.05. This study indicates that skin reflectance-guided UVB phototherapy may enable the dermatologist to lower the cumulative UVB exposure significantly without losing effect.     

Staphylococcal septicemia in children with atopic dermatitis

Atopic dermatitis (AD) is frequently complicated by minor bacterial superinfections. Invasive infections such as osteomyelitis have rarely been reported. We describe two children with staphylococcal septicemia during an exacerbation of their AD. Cellulitis and underlying congenital heart disease, respectively, were considered predisposing factors for the development of bacteremia. Identical strains were isolated from the skin, and there was a significant increase in antibodies against Staphylococcus aureus capsular polysaccharide in one child. Our cases demonstrate the potential severity of bacterial skin infections in AD, especially when associated with an underlying condition that increases vulnerability to bacteremia. While their true incidence in children with AD is currently unknown, it is conceivable that systemic staphylococcal infections may be more common than previously thought. Staphylococcal bacteremia has to be considered in the differential diagnosis of fever in children with severe AD. Conversely, episodes of staphylococcal bacteremia should prompt a search for underlying predisposing factors.     

The treatment of severe atopic dermatitis in childhood with narrowband ultraviolet B phototherapy

BACKGROUND: There is a lack of data regarding the use of narrowband ultraviolet B (NB-UVB) phototherapy in children with atopic dermatitis (AD). Many centres use this mode of treatment for children with AD; however, there have only been two previous studies observing the effect of NB-UVB in children with AD. AIM: We undertook a retrospective review of children with severe eczema who had undergone NB-UVB consecutively in our department between 1999 and 2005. METHODS: All children with AD who had undergone NB-UVB consecutively in our department between 1999 and 2005 were identified from the phototherapy database. Their clinical notes were reviewed for information on age, sex, skin type, minimal erythema dose (MED), adjuvant therapy, previous therapy, adverse effects, number of exposures, cumulative dose, response to treatment and length of remission. RESULTS: In total, 50 children (83%) completed more than 10 exposures of NB-UVB. Complete clearance or minimal residual activity was achieved in 20 children (40%). A good improvement was achieved in a further 10 children (23%), and a moderate improvement in 13 (26%). Children with MEDs > 390 mJ/cm2 were more likely to clear, and this was found to be statistically significant (P = 0.02). Overall, the treatment was well tolerated and the median length of remission was 3 months. CONCLUSION: NB-UVB is an effective treatment for children with severe AD. Children with MEDs > 390 mJ/cm2 are more likely to clear. Further studies are needed to evaluate the efficacy of NB-UVB and long-term safety in treating children with severe AD.     

RAST and PRIST in children with atopic dermatitis

The study was carried out in 535 children. The frequency of positive RAST for food allergens decreased with age, whereas the frequency of positive RAST for inhalant allergens increased with age. Coexistence of asthma and/or rhinitis was not related to the results of RAST with food allergens. Positive RAST and multiple sensitivity for inhalant allergens were significantly greater in children with coexistence atopic respiratory disease. Total IgE was significantly higher in children with coexistent atopic respiratory disease in all age groups. This study provides information for the critical analysis of a RAST in atopic dermatitis.     

The use of alternative or complementary medicine for children with atopic dermatitis

Complementary or Alternative Medicine is defined as a form of therapy that has no scientific basis or proven effectiveness. The aim of this study was to investigate the prevalence of the use of such therapies for pediatric patients with atopic dermatitis at the University Hospital of Brasília, in the period between March 2007 and December 2008. A total number of 54 patients (63.5%) used some kind of alternative resource and phytotherapy and homeopathy were the most used ones.