Ogawa H, Yoshiike T
Department of Dermatology, Juntendo University School of Medicine, Tokyo, Japan.
Pediatr Dermatol. 1992 Dec;9(4):383-5. doi: 10.1111/j.1525-1470.1992.tb00638.x.
Ultraviolet light is effective treatment for patients with atopic dermatitis that is resistant to conservative therapy, or complicated by adverse effects of extended steroid use. We designed a protocol using topical psoralen chemotherapy with ultraviolet A (PUVA) to treat atopic dermatitis in 114 patients. Clinical results were excellent, with complete clearing in 50% of patients receiving daily treatment. Histologic and immunologic values correlated with the clinical response, including reduced epidermal thickness, and decreased numbers of epidermal Langerhans cells and dermal mast and mononuclear cell infiltrates. The pattern of keratin 14-positive keratinocytes returned toward normal. In addition, the water-holding capacity of the stratum corneum increased to near normal levels. We also studied stratum corneum permeability in lesional and nonlesional skin using the dimethyl sulfoxide whealing test and theophylline absorption studies. Compared with controls, permeability was markedly increased in lesional skin and mildly increased in nonlesional skin in patients with atopic dermatitis. These results suggest that immune abnormalities and barrier dysfunction participate in the pathogenesis of atopic dermatitis.
紫外线对于对保守治疗耐药或因长期使用类固醇产生不良反应而并发的特应性皮炎患者是一种有效的治疗方法。我们设计了一种使用外用补骨脂素化疗联合紫外线A（PUVA）治疗114例特应性皮炎患者的方案。临床效果极佳，每日接受治疗的患者中有50%完全治愈。组织学和免疫学指标与临床反应相关，包括表皮厚度降低、表皮朗格汉斯细胞数量减少以及真皮肥大细胞和单核细胞浸润减少。角蛋白14阳性角质形成细胞的模式恢复正常。此外，角质层的持水能力增加至接近正常水平。我们还使用二甲基亚砜风团试验和茶碱吸收研究，对皮损和非皮损皮肤的角质层通透性进行了研究。与对照组相比，特应性皮炎患者的皮损皮肤通透性显著增加，非皮损皮肤通透性轻度增加。这些结果表明，免疫异常和屏障功能障碍参与了特应性皮炎的发病机制。
