Bos Jan D
Department of Dermatology A0-235, Academic Medical Centre, University of Amsterdam, PO Box 22700, 1100 DE Amsterdam, The Netherlands.
Eur J Dermatol. 2003 Sep-Oct;13(5):455-61.
Topical corticosteroids are the mainstay of treatment for atopic dermatitis; however, their clinical utility is limited by potential side effects. Recently, the steroid-free topical immunomodulators tacrolimus ointment and pimecrolimus cream have become available. These agents provide effective treatment without causing skin atrophy or other steroidal side effects, and their physiochemical properties, such as relatively large molecular size and high lipophilicity, limit diffusion through skin and into the bloodstream, providing skin-selective treatment. Clinical trials with more than 1,700 paediatric and adult patients have demonstrated that treatment with either agent is associated with minimal systemic absorption of tacrolimus or pimecrolimus. Additionally, studies have shown that percutaneous absorption of tacrolimus decreases as treatment continues and clinical improvement occurs. This self-limiting facet of the treatment, together with the skin-selectivity of topical immunomodulators, is reflected in the good safety and tolerability profiles of these agents, which promise to significantly improve the long-term management of atopic dermatitis.
外用皮质类固醇是特应性皮炎治疗的主要药物；然而，其临床应用受到潜在副作用的限制。最近，不含类固醇的外用免疫调节剂他克莫司软膏和吡美莫司乳膏已可供使用。这些药物提供有效的治疗，而不会引起皮肤萎缩或其他类固醇副作用，并且它们的物理化学性质，如相对较大的分子大小和高亲脂性，限制了药物通过皮肤扩散进入血液，从而实现皮肤选择性治疗。超过1700名儿科和成年患者参与的临床试验表明，使用这两种药物中的任何一种进行治疗时，他克莫司或吡美莫司的全身吸收量都极少。此外，研究表明，随着治疗的持续和临床症状的改善，他克莫司的经皮吸收会减少。这种治疗的自我限制特性，以及外用免疫调节剂的皮肤选择性，体现在这些药物良好的安全性和耐受性上，有望显著改善特应性皮炎的长期管理。
