1%吡美莫司、0.005%钙泊三醇和0.1%倍他米松治疗擦烂型银屑病:一项双盲、随机、对照研究

Objective: During the last decades, management of intertriginous psoriasis (IP) has been unsatisfactory because of the adverse effects associated with long-term corticosteroid application and the lack of alternatives. Recently, both pimecrolimus and tacrolimus have been investigated for this indication and shown to be safe and effective. So far, to our knowledge, a comparison of one of these drugs with standard regimens for IP has not been performed. Design: A single-center, 4-week, double-blind, randomized, vehicle-controlled comparison study to assess the safety and efficacy of 1%pimecrolimus, 0.005%calcipotriol, and 0.1%betamethasone valerate in the treatment of IP. Setting: Dermatologic hospital at Ruhr University of Bochum. Patients: Eighty adults with IP. Interventions: Treatment of IP with 1%pimecrolimus, 0.005%calcipotriol, 0.1%betamethasone, or the vehicle once daily for 28 days. Main Outcome Measures: Mean reduction of the Modified Psoriasis Area and Severity Index (M-PASI) score after 28 days of treatment was considered the primary outcome measure, which was analyzed on an intention-to-treat basis. The secondary outcome was a visual analog scale score for itching. Results: After 4 weeks of treatment, the 3 active compounds and the vehicle resulted in a significant decrease in mean M-PASI score (86.4%for 0.1%betamethasone, 62.4%for 0.005%calcipotriol, 39.7%for 1%pimecrolimus, and 21.1%for vehicle). The 0.1%beta-methasone was significantly more effective than 1%pimecrolimus during the study period (P < .05). No significant difference was found between 0.005%calcipotriol and 0.1%betamethasone and between 0.005%calcipotriol and 1%pimecrolimus. The visual analog scale score for pruritus decreased by 78%for 0.1%betamethasone, 57%for 0.005%calcipotriol, 35%for 1%pimecrolimus, and 43%for the vehicle, again demonstrating a clear advantage for the corticosteroid (P < .05). Conclusions: The 1%pimecrolimus was shown to be less potent than 0.1%betamethasone in the treatment of IP. Considering the adverse-effect profile of long-term application of corticosteroids, occasional or intermittent rescue therapy with short-term topical corticosteroids and maintenance with a less potent agent, such as 1%pimecrolimus or 0.005%calcipotriol, might be appropriate for patients with IP in general practice.

进行性面部偏侧萎缩的临床和血清学特征:12例病例系列研究

Background: Progressive facial hemiatrophy (PFH) is characterized by a slowly progressive atrophy of soft tissues and in some cases bony structures. Coexisting features of localized scleroderma (LS) are commonly observed, indicating the close nature of both disorders. Objective: We sought to investigate clinical, serological, and radiographic findings in PFH from 278 patients with LS and to discuss the relationship to linear scleroderma en coup de sabre (LSCS). Method: A total of 12 patients with PFH were retrospectively evaluated on the basis of clinical, serological, and radiographic findings. Results: Five patients (42% ) presented with complete PFH, and 7 patients (58% ) with partial PFH involving either cheek or forehead. Five of the patients (42% ) had a coexisting LSCS lesion, and 3 of them (25% ) had concomitant LS of the trunk. Intraoral involvement was present in 6 cases. Neurological involvement was common, in particular, epileptic seizures. Serologic investigations showed neither evidence for infection with Borrelia burgdorferi nor any other indication of underlying systemic immunological disorders. Limitations: There were a relatively small number of patients in a retrospective study. Conclusion: The reported cases suggest a close relationship between PFH and LSCS. PFH might appear as two different subtypes,one involving cutaneous structures and presenting with clinical features similar to LSCS, one being strictly restricted to subcutaneous structures, primarily affecting the cheek area. The manifold clinical features of central nervous system involvement indicate the pathogenetic importance of neurological involvement in the development of PFH. Magnetic resonance imaging should be included in the tools of standard diagnostic procedures in patients with PFH. The etiologic relevance of autoimmunity as well as preceding trauma should be investigated in larger collective studies.

光化学疗法治疗亚急性痒疹的一项随机对照试验

Background. Psoralen ultraviolet A (PUVA) is the standard photo(chemo)therapeutic regimen for patients suffering from subacute prurigo (SP). Hypothesis. Regarding efficacy, bath PUVA is not superior to medium-dose ultraviolet-A1 (MD-UVA1) and narrowband ultraviolet-B (NB-UVB), which may be considered the new photo(chemo)therapeutic options for SP. Methods. We performed a prospective randomised, controlled, three-arm photo(chemo)therapeutic study. Patients suffering from histopathologically proven SP with a clinical score (PIP score; papules, infiltration and pruritus) of at least 5 points were enrolled into the study. Treatment with bath PUVA was performed 4 times weekly and MD-UVA1 and NB-UVB 5 times weekly. Photo(chemo)therapy was administered over a 4-week period. Outcome measure was the severity of SP investigated by means of the PIP score after 4 weeks of therapy. Results. In total, 33 patients with SP were randomly allocated to photo( chemo)therapy. Bath PUVA (n = 9),MD-UVA1 (n = 11) and NB-UVB (n = 13) resulted in a significant reduction of the baseline PIP score as assessed on the basis of intention-to-treat (ITT) analysis (P = 0.003). However, ITT analysis revealed significantly higher PIP score reduction in patients who were treated with bath PUVA and MD-UVA1 compared with NBUVB (P < 0.01, 95% CI 1.1-3.63 and P < 0.05, 95% CI 0.42-2.70, respectively). Conclusions. Photo(chemo)therapy, including bath PUVA, MD-UVA1 and NB-UVB, appears to be an effective and safe treatment option for patients suffering from SP. UVA1 and particularly PUVA seem superior to NB-UVB in the management of SP.