他克莫司软膏对成年中重度面部皮炎快速抗瘙痒机制分析

Rapid Antipruritic Mechanisms of Tacrolimus Ointment in Adult Patients with Moderate-to-Severe Facial Dermatitis

目的探讨他克莫司软膏对成年中重度面部皮炎快速抗瘙痒和抗炎症机制。方法采用研究者总体评估(IGA)、瘙痒程度(SP)评分及参照由温度敏感瞬时受体电位通道建立的痛痒觉基本规则和分子底物方法,评估外用0.1%他克莫司软膏治疗前、后成年患者面部皮炎临床体征、SP及皮肤感觉变化。结果所有患者治疗后第4天和第11天的IGA评分,治疗后第1天、第4天和第11天的SP评分均显著低于治疗前(P均<0.05)。60例患者中,有34例(56.7%)用药后出现辣椒素样效应,9例(15%)出现樟脑样效应,17例(28.3%)未出现辣椒素样效应或樟脑样效应。结论外用他克莫司软膏可以迅速缓解成年中重度面部皮炎的症状和体征。他克莫司软膏诱导辣椒素样效应或樟脑样效应可能是通过直接或间接激活皮肤感觉神经上的瞬时受体电位香草类受体1途径,最终通过使皮肤感觉神经脱敏或去功能化来达到快速抗瘙痒和抗神经源炎症效应。

Objective To investigate the rapid antipruritic and antiinflammatory mechanisms of tacrolimus ointment for moderate-to-severe facial dermatitis. Methods The investigators global ＆ssessment （IGA） score, severity of pruritus （SP） scores, and a basic syntax and molecular substrate （molecular psychophysics）of nociception and pruriception established by temperature-sensitive transient receptor potential （TRP） channels were used to evaluate the clinical sign, severity of pruritus and skin sensory phenomenon. Results The IGA score at day one and day four of treatment and the SP score at day one, four and eleven of treatment were significantly lower than the baseline scores before treatment （P〈0.05）. Among these 60 patients, 34 （56.7%） showed positive eapsaicin-like response （i.e.burning with consequent rapid amelioration of pruritus） on application sites, 9 （15%） showed camphor-like response （i.e.warming with consequent rapid amelioration of pruritus）, 17（28.3%） showed negative capsaicin-like response or negative camphor-like response. Conclusion Treatment with tacrolimus ointment 0.1% has a quick and marked improvement of signs and symptoms of facial dermatitis in adult patients. Tacrolimus ointment 0.1% may take effect on TRPV1 in the skin sensory which afferenting to induce capsaicin-like response（i.e.hot painful burning sensation） or camphor-like response （i.e.warm only sensation）, then desensitizes neurones and rapidly inhibits or alleviates itch and neurogenic inflammation.