外用他克莫司与卤米松自身对照和联合治疗白癜风临床疗效分析

目的探讨外用他克莫司与卤米松自身对照、两者联合治疗白癜风的临床疗效及安全性。方法 35例选择对称或者相近部位皮损,分别给予他克莫司2次/d,卤米松1次/d,卤米松采用2周停1周的间歇疗法。8例给予他克莫司与卤米松联合治疗,他克莫司2次/d,卤米松1次/d,卤米松采用2周停1周的间歇疗法。治疗前后测量皮损面积并拍照,用于疗效对照。在共聚焦激光扫描显微镜下观察靶皮损改变。结果他克莫司和卤米松自身对照、联合治疗三者有效率差异无统计学意义。两药起效时间相近,且病程≤12个月的疗效高于病程12个月患者。两药治疗病程≤12个月疗效及病程12个月有效率差异无统计学意义。对于稳定期白癜风,卤米松有效率高于他克莫司。两药治疗进展期和稳定期白癜风有效率均差异无统计学意义。两药联合治疗对进展期白癜风皮损有较好的疗效。两种药物治疗有效的皮损在共聚焦激光扫描显微镜下可见皮损处基底层数量不一的高折光度树突状细胞,分布于毛囊或毛囊之间。结论他克莫司与卤米松、联合治疗均可以有效治疗白癜风,联合治疗并不能明显提高有效率。

Clinical Efficacy of External Use of Tacrolimus and Halometasone in Treatment of Vitiligo

Objective To evaluate the efficacy and safety of tacrolimus and halometasone in treatment of vitiligo.Methods Symmetrical or similar parts of the vitiligo lesions from 35 cases were selected.The lesions were given different treatment.One side was applied tacrolimus twice a day,and the other side was given halometasone once a day with intermittent therapy.Eight cases were given tacrolimus twice a day combination with halometasone once a day with intermittent therapy.Lesion area was measured before and after treatment,and it was photographed for the efficacy of control,and it was also observed by the confocal laser scanning microscopic.Results There were no significant differences among these three groups.The onset time of tacrolimus and halometasone was similar.The efficient rate of these two drugs in patients of the course which was shorter or equal to 12 months was higher than that of the course longer than 12 months.There was no significant difference of tacrolimus and halometasone in the treatment of the course which shorter or equal to 12 months group,as well as of the course longer than 12 months in efficacy.The effective rate of halometasone was higher than tacrolimus in the treatment of the stable vitiligo,but there was no significant difference in progressive and stable vitiligo between tacrolimus and halometasone.The combination therapy of these two drugs has a better effect in the progressive vitiligo.The number of high refractive index varying dendritic cells at the basal layer that located in hair follicles or between hair follicles were found in lesions which effectively treated by two drugs in the confocal laser scanning microscopic.Conclusion Tacrolimus and halometasone or combination therapy can be effective in treating vitiligo.But combination therapy can not improve efficiency significantly.