Mackenzie-Wood A, Kossard S, de Launey J, Wilkinson B, Owens M L
Skin and Cancer Foundation, Darlinghurst, NSW, Australia.
J Am Acad Dermatol. 2001 Mar;44(3):462-70. doi: 10.1067/mjd.2001.111335.
Large-diameter lesions of Bowen's disease at sites such as the shin may be difficult to treat surgically and may require alternate treatment modalities.
We investigated whether imiquimod 5% cream, a topical immune response modifier that stimulates the production of interferon alfa and other cytokines, is an effective topical treatment for Bowen's disease.
This was a phase II, open-label study in 16 patients, treating a single biopsy-proven plaque of Bowen's disease that was 1 cm or larger in diameter, with once-daily self-application of imiquimod 5% cream for 16 weeks. A biopsy was performed on the treated area 6 weeks after the end of treatment, with patient follow-up at 3 and 6 months. Lymphocyte CD4/CD8 ratios were analyzed in pretreatment and posttreatment biopsy specimens by immunophenotyping the lymphocytic infiltrate.
Sixteen patients with Bowen's disease lesions ranging from 1 to 5.4 cm in diameter (0.7-21.6 cm(2) in area) were treated. Fifteen of these lesions were on the legs, and one was on the shoulder. Fourteen of the 15 patients (93% per protocol analysis) had no residual tumor present in their 6-week posttreatment biopsy specimens. One patient died of unrelated intercurrent illness before a biopsy specimen could be obtained. The median CD4/CD8 lymphocyte ratio in pretreatment biopsy specimens was 2:1, and this was reversed to a median of 1:2.2 in the posttreatment specimens. Ten patients completed 16 weeks of treatment, but 6 patients ceased treatment early (between 4 and 8 weeks) because of local skin reactions.
Imiquimod 5% cream appears to be an effective treatment for Bowen's disease on the lower limbs. The 93% positive treatment response in biopsy-proven cases (excludes patient who died from an intercurrent illness who did not undergo a posttreatment biopsy) compares favorably with other current treatment modalities. The dosing schedule and length of treatment for Bowen's disease require further evaluation.
像胫骨部位的大直径鲍温病病变可能难以通过手术治疗，可能需要其他治疗方式。
我们研究了5%咪喹莫特乳膏，一种刺激α干扰素和其他细胞因子产生的局部免疫反应调节剂，是否是治疗鲍温病的有效局部治疗方法。
这是一项针对16名患者的II期开放标签研究，治疗经活检证实的单个直径1厘米或更大的鲍温病斑块，患者每天自行涂抹一次5%咪喹莫特乳膏，持续16周。治疗结束6周后对治疗区域进行活检，并在3个月和6个月时对患者进行随访。通过对淋巴细胞浸润进行免疫表型分析，在治疗前和治疗后的活检标本中分析淋巴细胞CD4/CD8比值。
治疗了16名患有直径为1至5.4厘米（面积为0.7 - 21.6平方厘米）鲍温病病变的患者。其中15个病变位于腿部，1个位于肩部。15名患者中的14名（按方案分析为93%）在治疗后6周的活检标本中没有残留肿瘤。1名患者在获得活检标本前死于无关的并发疾病。治疗前活检标本中CD4/CD8淋巴细胞比值的中位数为2:1，治疗后标本中该比值逆转至中位数为1:2.2。10名患者完成了16周的治疗，但6名患者因局部皮肤反应在早期（4至8周之间）停止了治疗。
5%咪喹莫特乳膏似乎是治疗下肢鲍温病的有效方法。经活检证实的病例中93%的阳性治疗反应（不包括死于并发疾病且未进行治疗后活检的患者）与其他当前治疗方式相比具有优势。鲍温病的给药方案和治疗时长需要进一步评估。
