强效糖皮质激素局部封包法治疗儿童斑秃疗效观察

Clinical efficacy of topical potent glucocorticoid with occlusion for the treatment of alopecia areata in child

目的:观察使用强效糖皮质激素封包治疗儿童斑秃的有效率、安全性及短期复发率。方法:采用回顾性分析,观察比较试验组(46例)与对照组(44例)对儿童斑秃治疗的有效率、不良反应及短期复发率的差异,并分析其原因。结果:试验组治疗有效率为82.6%,其中治愈率为69.6%;对照组有效率及治愈率均为36.4%,两组差异均有统计学意义(P均<0.05),且试验组有效率明显高于对照组,即封包法治疗有助于患儿的毛发再生。试验组平均起效时间为(1.8±1.0)个月,达到有效生发面积的平均时间为(3.0±1.5)个月,与对照组比较,差异无统计学意义(P>0.05)。随访发现,试验组短期内(3个月)复发率为44.7%,对照组为50.0%,差异无统计学意义(P>0.05)。发病年龄越小、脱发面积越大者有复发率越高的趋势。治疗过程中两组患儿均未出现明显全身及系统性不良反应,部分患儿仅出现轻度局部不良反应(如局部表皮变薄、头皮以外毳毛增多、毛囊炎等)。试验组不良反应发生率为60.9%,对照组为45.5%,两组差异无统计学意义(P>0.05)。结论:外用糖皮质激素封包治疗儿童斑秃可提高有效率,且不良反应轻微,安全性较高,但未改善复发率,复发率与发病年龄小、脱发面积大及病程长等相关。

Objective： To observe the efficacy, side effects and short-term relapse rate of child alopecia areata（AA） patients with topical potent corticosteroid with occlusion. Methods： In this retrospective analysis, the efficacy, adverse reaction and short-term recurrence rate of occlusion group（g6 cases） and non-occlusion group（44 cases） were analyzed. Results： The ef- fective rate（ER） was 82.6% and the curative rate（CR） was 69.6% in the occlusion group, while the ER and CR were both 36.4% in the non-occlusion group. The ER of occlusion group was higher than that of the non-occlusion group, and the dif- ference was significant between the two groups （P〈0.05）, which showed that the occlusion was helpful for the hair regenera- tion in child. The average time of starting to be effective in the occlusion group was （1.8＋1.0） months, the average time of effective area of hair generation was （3.0＋1.5） months, as compared with the non-occlusion group there was no significant difference（P〉0.05）. The short-term（3 months） relapse rate was 44.7% in the occlusion group, and 50.0% in the non-occlu- sion group. There was no difference between the two groups（P〉0.05）. The younger the age of onset of the disease, the larger the area of hair loss, and the higher the recurrence rate would be. There were no systemic side effects during the treatment, only topical side effects（mild scalp atrophy and telangiectasia, hypertrichosis, folliculitis, etc） were observed in some patients. The incidence of adverse reaction in the occlusion group was 60.9%, and the non-occlusion group was 45.5%, there was also no significant difference（P〉0.05）. Conclusion： Topical potent corticosteroid with occlusion is effective and safe for the treat- ment of AA in child, and adverse reaction is also mild. However, it cannot reduce the recurrence rate, which is related to the age of onset, area of alopecia and disease course.