他克莫司联合红光对脂溢性皮炎的疗效及其对皮肤生理参数和炎性因子的影响

Curative Effect of Combination of Tacrolimus and Red Light Irradiation on the Treatment of Seborrheic Dermatitis and Their Influences on the Skin Physiological Parameters and Inflammatory Factors

目的探讨他克莫司联合红光对脂溢性皮炎的疗效及其对皮肤生理参数和炎性因子的影响。方法选取2011年10月~2016年3月在成都医学院第一附属医院接受诊治的74例脂溢性皮炎患者为研究对象,依据治疗方案的不同将患者分为他克莫司组(单独组)和他克莫司+红光治疗组(联合组),每组各37例。单独组患者予以0.03%他克莫司乳膏,每日2次,联合组患者在此基础之上加用红光照射,疗程共4周。分别比较两组患者的临床疗效、皮肤生理参数和炎性因子水平的改变。结果单独组患者的治疗有效率为70.27%(26/37),显著低于联合组的91.89%(34/37)(χ~2=5.638,P=0.018);联合组的复发率为5.41%(2/37),明显低于单独组的21.62%(8/37)(χ~2=4.163,P=0.041),而且联合组真菌镜检阴性率明显高于单独组(P<0.05),但两组患者不良反应发生率和马拉色菌检出密度比较,差异无统计学意义(P>0.05);治疗后两组患者皮肤含水量和p H值显著增加,TEWL、皮脂分泌率和IFN-γ水平明显降低,而且联合组皮肤含水量、皮脂分泌率、TEWL和IFN-γ的改善程度均优于单独组(P<0.05);但治疗前后两组患者的IL-6、IL-8和TNF-α的水平比较差异均无统计学意义差别(P>0.05)。结论他克莫司联合红光可显著提高脂溢性皮炎的临床疗效,增加皮肤含水量,降低皮脂分泌率、TEWL和IFN-γ水平。

Objective To investigate the curative effect of combination of tacrolimus and red light irradiation in the treatment of seb- orrheie dermatitis and their influences on the skin physiological parameters and inflammatory factors. Methods The 74 cases of seborrhe- ic dermatitis in the First Affiliated Hospital of Chengdu Medical College were selected as the research object from October 2011 to March 2016. Patients were randomly divided into tacrolimus group （single group） and taerolimus plus red light irradiation group （combined group） according to the different treatments, and each group had 37 cases. Patients in the single group were treated with 0.03% tacroli- mus cream, twice a clay, and red light irradiation was further added for treating patients in the combined group. The course of treatment lasted for 4 weeks. The clinical efficacy, skin physiological parameters and inflammatory factors were compared between the two groups. Results The effective rate of single group was 70.27% （26/37） , showing significantly lower than that of combination group at 91.89% （34/37） （X^2 = 5. 638, P = 0. 018）. The recurrence rate of the combination group was 5.41% （2/37）, which was significantly lower than that of the single group at 21.62% （8/37） （X^2 =4. 163, P =0. 041 ）. Moreover, the negative rate of the combination group was sig- nificantly higher than that of the single group （ P 〈 0.05 ） , but there was no significant difference in the incidence of adverse reactions and malassezia detection density between the two groups （P 〉 0.05）. After treatment, the skin water and pH value were increased, while the TEWL, sebum secretion rate and levels of IFN -γ were decreased significantly in the two groups, and the improvement of skin moisture, sebum secretion rate, TEWL and IFN - γ were all better than those of single group （ P 〈 0.05）. But there were no significant differences on the levels of IL - 6, IL - 8 and TNF - α between the two groups after treatment （P 〉 0.05 ）. Conclusion Tacrolimus combined with red light irradiation can significantly improve the clinical curative effect of seborrheic dermatitis, increase skin moisture, and reduce se- bum secretion rate, TEWL and IFN-γ.