湿包裹治疗13例儿童重度特应性皮炎临床效果观察

Efficacy of wet-wrap treatment for 13 cases of severe childhood atopic dermatitis： a clinical observation

目的 观察湿包裹疗法（WWT）治疗儿童重度特应性皮炎（AD）的效果和安全性。方法 2016年9月至2017年3月在北京儿童医院皮肤科收集重度AD患儿（符合Williams诊断标准，SCORAD＞50分）13例，每日接受WWT，共治疗3-5 d，评估治疗前后患儿SCORAD评分及VAS评分改善情况。选取其中3例患儿双侧肢体对称皮损进行WWT与传统治疗的对比观察，比较治疗3 d后双侧局部皮损严重度评分。结果 13例患儿治疗前SCORAD评分及VAS评分分别为60.2 ± 9.7和7.3 ± 1.8，WWT治疗3-5 d后，分别降至24.7 ± 5.8和2.4 ± 1.0，治疗前后差异均有统计学意义（t值分别为15.128、9.385，均P＜0.001）；12例患儿SCORAD改善率达50%以上。3例患儿双侧皮损治疗3 d后，WWT侧皮损严重度评分低于对照侧（t = 7.0，P＜0.05）。WWT不良反应轻微， 3例患儿主诉治疗过程中潮湿引起不适感。结论 WWT治疗儿童重度AD起效快，不良反应少，效果优于传统单纯外用药物。

Objective To evaluate the efficacy and safety of wet-wrap treatment （WWT） for severe childhood atopic dermatitis （AD）. Methods A total of 13 children with severe AD were enrolled from Department of Dermatology of Beijing Children′s Hospital between September 2016 and March 2017, whose diagnosis was based on the Williams′ diagnostic criteria and SCORing atopic dermatitis （SCORAD） score was more than 50. These patients received WWT daily for 3 - 5 days. The changes of SCORAD and visual analog scale （VAS） scores before and after treatment were evaluated. Moreover, 3 patients with symmetrical skin lesions on bilateral limbs were selected, and received WWT （WWT group） and traditional topical treatment （control group） on the bilateral limbs respectively for 3 days. After the treatment, the severity of local skin lesions on the bilateral limbs were evaluated and compared. Results Before the treatment, the SCORAD and VAS scores of the 13 patients were 60.2 ± 9.7 and 7.3 ± 1.8 respectively. Three to five days after the WWT, the SCORAD and VAS scores significantly decreased to 24.7 ± 5.8 and 2.4 ± 1.0 respectively （t = 15.128, 9.385 respectively, P 〈 0.001）. Of the 13 patients, 12 achieved a more than 50% improvement in SCORAD. After 3-day treatment with WWT in the 3 patients, the severity score of skin lesions was significantly lower in the WWT group than in the control group （t = 7.0, P 〈 0.05）. Mild adverse reactions to WWT occurred, and 3 patients reported discomfort induced by wetness during the treatment. Conclusion WWT shows rapid efficacy and less adverse reactions in the treatment of severe childhood AD, and its therapeutic effect is superior to that of traditional topical treatment.