根据什么将单纯外用强效糖皮质激素作为大疱性类天疱疮的首选治疗?

On What Basis Is the Administration of Topical Potent Glucocorticoids the Preferred Treatment for Bullous Pemphigoid

大疱性类天疱疮(bullous pemphigoid,BP)是最常见的自身免疫性大疱病,传统的一线治疗系统使用糖皮质激素疗效肯定但具有不可避免的副作用;外用强效糖皮质激素已证明对BP有效且副作用小,但实际在使用中也存在部分患者不敏感甚至无效的情况。本文对BP患者外用糖皮质激素“治疗敏感”和“治疗抵抗”的现象进行了观察,试图总结其规律。发现BP患者对外用强效糖皮质激素治疗抵抗的因素有低龄,发生于红斑基础上的“红斑型”或“炎症性”水疱、大疱,瘙痒剧烈等临床表型;实验室指标包括嗜酸性粒细胞、血清IgE显著升高,伴有较高水平的IgE型抗BP抗体。当临床医师首次接诊BP患者时能否根据其临床特征和实验室数据来决定是单纯外用糖皮质激素或联合用药,据此制定治疗方案,从而实现“个体化”的精准治疗。

Bullous pemphigoid(BP)is the most common autoimmune bullous disease.As a traditional first-line therapy,systemic glucocorticoids are effective but have unavoidable side effects.Potent topical glucocorticoids have been proven to be effective against BP with little side effects,but there still exit cases that didn't respond well to topical steroids alone in practical use.After exploring the rules of“sensitive”and“resistant”patients,we found that the resistance factors of BP included young and middle-aged BP,the clinical features of“inflammatory”or“erythematous”blisters and severe pruritus,together with some laboratory indexes such as significant increase of eosinophils or serum IgE,and high titer of anti-BP180 IgE antibody.When we first treat patients with BP,can we decide to use topical glucocorticoid alone or combination medication based on their clinical characteristics and laboratory data?In that case,a specific treatment plan is formulated to achieve accurate“individualized”treatment.