Kwinter Jennifer, Pelletier Janice, Khambalia Amina, Pope Elena
Faculty of Medicine, University of Ottawa, Canada.
J Am Acad Dermatol. 2007 Feb;56(2):236-41. doi: 10.1016/j.jaad.2006.08.017. Epub 2006 Oct 20.
Data on efficacy and safety of treatments in children with vitiligo are limited.
We sought to describe the clinical outcomes and safety of children with vitiligo treated with high-potency topical corticosteroids.
Clinical improvement and laboratory data were retrospectively analyzed in 101 children (0-18 years) with vitiligo treated with moderate- to high-potency topical corticosteroids.
Of patients, 64% (45 of 70) had repigmentation of the lesions, 24% (17 of 70) showed no change, and 11% (8 of 70) were worse than at the initial presentation. Local steroid side effects were noted in 26% of patients at 81.7 +/- 44 days of follow-up. Cortisol levels were abnormal in 29% of patients (21 of 73). Two children with low cortisol levels were given the diagnosis of steroid-induced adrenal suppression. Children with normal and abnormal cortisol levels were not significantly different by sex, age of onset, potency of the corticosteroid use, or family history. However, children with head and/or neck affected areas were 8.36 times more likely to have an abnormal cortisol level compared with children affected in other body areas (RR 95% confidence interval: 1.19, 58.60, P = .003, n = 72). Of patients, 8% (6 of 74) had an abnormal thyrotropin test result.
The retrospective design of this study presents inherent limitations.
Moderate- to high-potency topical corticosteroids are efficacious in children with vitiligo, but may be associated with systemic absorption.
白癜风患儿治疗的疗效和安全性数据有限。
我们试图描述强效外用糖皮质激素治疗白癜风患儿的临床结局和安全性。
对101例（0 - 18岁）接受中效至强效外用糖皮质激素治疗的白癜风患儿的临床改善情况和实验室数据进行回顾性分析。
患者中，64%（70例中的45例）皮损有色素再生，24%（70例中的17例）无变化，11%（70例中的8例）比初始表现更差。在随访81.7±44天时，26%的患者出现局部类固醇副作用。29%的患者（73例中的21例）皮质醇水平异常。两名皮质醇水平低的儿童被诊断为类固醇诱导的肾上腺抑制。皮质醇水平正常和异常的儿童在性别、发病年龄、使用的糖皮质激素效力或家族史方面无显著差异。然而，与身体其他部位受累的儿童相比，头颈部受累的儿童皮质醇水平异常的可能性高8.36倍（相对危险度95%置信区间：1.19，58.60，P = 0.003，n = 72）。患者中，8%（74例中的6例）促甲状腺激素检测结果异常。
本研究的回顾性设计存在固有局限性。
中效至强效外用糖皮质激素对白癜风患儿有效，但可能与全身吸收有关。
