避光教育对多形性日光疹患者病情和治疗的影响

Effects of sun protection education on the severity and treatment of polymorphous light eruption

目的探讨正规避光教育对多形性日光疹（PLE）患者病情和治疗的影响。方法采用随机数字表将PLE患者随机分为试验组（31例）与对照组（31例）。所有患者均接受常规治疗。试验组在初春及初夏接受两次以讲座形式辅以宣教手册开展的正规避光教育。采取当面询问方式，所有患者在基线时和人组1年后各完成一份病情调查问卷。采用SPSSl1．5软件对数据进行t检验、秩和检验或r检验。结果与避光教育前1年相比，试验组PLE患者避光教育1年中发病月数（t=4．611，P〈0．01）、年发病总次数（t=3．569，P〈0．01）、皮损累及面部频率（Z=2．369，P〈0．05）、日晒后皮损发作所需时间（Z=2．650，P〈0．01）均显著减少，与同期对照组相比，差异均有统计学意义。与避光教育前1年相比，试验组PLE患者避光教育1年中外用强效糖皮质激素软膏人数（誓：10．928，P〈0．01）、口服抗组胺药物人数（X2=18．723，P〈0．01）、口服抗组胺药物累计时间（Z=2．656，P〈0．01）均显著减少，与同期对照组相比，差异具有统计学意义。结论以讲座形式辅以宣教手册开展的正规避光教育能使PLE患者病情有所缓解，在1年中所需要的治疗药物减少，提示临床医生应该更重视对光过敏的患者进行完善的避光教育。

Objective To estimate the effect of sun protection education on the severity and treatment of polymorphous light eruption （PLE）. Methods Sixty-two patients with PLE were enrolled in this study, and randomly assigned into the control group （n = 31 ） and intervention group （n = 31 ） by using a random number table. Routine therapy was provided to all the subjects at their visits. The intervention group attended two lectures on sun protection at the beginning of spring and summer, and was given an education manual after each lecture. All the subjects completed a face to face interview and a questionnaire on the severity and therapy of PLE at the baseline and 12 months after enrollment. SPSS 11.5 software was used for data processing. Rank sum test, t test and chi-square test were carried out to assess the differences in the severity and treatment of PLE between the control group and intervention group as well as between pre- and post-intervention. Results The patients receiving sun protection education showed a significant decrease in the severity of PLE, including the number of months affected by PLE （t = 4.611, P 〈 0.01 ）, number of PLE episodes （t = 3.569, P 〈 0.01 ）, frequency of facial involvement （Z = 2.369, P 〈 0.05 ） and the time taken for lesions to appear after sun exposure （Z = 2.650, P 〈 0.01 ） in the year after enrollment compared with that before enrollment. Significant differences were also observed between the intervention group and control group in the number of months affected by PLE （t = 3.679, P 〈 0.01 ）, number of PLE episodes （t = 2.995, P 〈 0.05）, frequency of facial involvement （Z = 2.169, P 〈 0.05）, the time taken for lesions to appear after sun exposure （Z = 2.169, P 〈 0.05 ） in the year after enrollment. The percentage of patients applying highly potent topical glueocortieosteroids （X2 = 10.928, P 〈 0.O1）and administrating antihistamines （X2 = 18.723, P 〈 0.01 ） as well as the cumulative time of treatment with oral antihistamines （Z = 2.656,P 〈 0.01） were significantly reduced in the intervention group in the year after enrollment than in that before enrollment. Further more, a marked decrease was found in the percentage of patients applying topical highly potent ＇glucocorticosteroids （X2 = 4.521, P 〈 0.05） and administrating antihistamines （X2 = 10.949, P 〈 0.01 ） as well as the cumulative time of treatment with oral antihistamines （Z = 3.353, P 〈 0.01 ）. Conclusions Sun protection education through lectures and manuals appears to be an efficient adjuvant for the relief of PLE severity as well as for the reduction in the use of antihistamines and glucocorticosteroids, suggesting thatdermatologists should pay more attention to sun protection education in the treatment of photosensitive diseases.