Xhauflaire-Uhoda E, Thirion L, Piérard-Franchimont C, Piérard G E
Department of Dermatopathology, University Hospital of Liège, Liège, Belgium.
Dermatology. 2007;214(4):328-32. doi: 10.1159/000100884.
There is ample evidence that the skin barrier function is altered in atopic dermatitis. Little information is available about the effect of topical corticosteroids and calcineurin inhibitors on this function.
To assess the water content and its rate of accumulation in the stratum corneum of atopic patients using an indirect electrometric method while on tacrolimus or betamethasone valerate treatment.
Twenty-one patients with moderate atopic dermatitis affecting both forearms completed this double-blind randomized study. One forearm was treated twice daily for 3 weeks with 0.1% tacrolimus ointment. The other forearm was similarly treated with 0.12% betamethasone valerate ointment. Electrometric measurements were made under continuous occlusion secured by a Nova Dermal Phase Meter sensor probe. Assessments were performed at inclusion, after the 3-week treatment and after a further 3-week follow-up out of treatment.
During treatment, both compounds yielded a similar improvement in skin barrier function. Indeed, under probe occlusion, the rate of water accumulation was significantly decreased. This improvement was sustained after stopping the tacrolimus treatment. By contrast, the benefit was in part lost at the site that had been treated by betamethasone valerate.
The difference in the effect of the 2 compounds may be due to the negative influence of betamethasone valerate on the epidermal metabolism leading to progressive atrophy of the tissue. The better preservation of the skin barrier function after stopping tacrolimus treatment may help retarding relapses of atopic dermatitis.
有充分证据表明特应性皮炎患者的皮肤屏障功能会发生改变。关于局部用皮质类固醇和钙调神经磷酸酶抑制剂对该功能的影响，目前所知甚少。
在使用他克莫司或戊酸倍他米松治疗期间，采用间接电测法评估特应性患者角质层的含水量及其蓄积速率。
21例双侧前臂患有中度特应性皮炎的患者完成了这项双盲随机研究。一只前臂每日两次外用0.1%他克莫司软膏，共治疗3周。另一只前臂同样每日两次外用0.12%戊酸倍他米松软膏。使用Nova皮肤相位仪传感器探头在持续封闭条件下进行电测。在入组时、3周治疗后以及停药后再随访3周时进行评估。
治疗期间，两种药物对皮肤屏障功能的改善相似。实际上，在探头封闭条件下，水分蓄积速率显著降低。停用他克莫司治疗后，这种改善仍持续存在。相比之下，戊酸倍他米松治疗部位的益处部分丧失。
两种药物效果的差异可能是由于戊酸倍他米松对表皮代谢产生负面影响，导致组织逐渐萎缩。停用他克莫司治疗后皮肤屏障功能得到更好的保留，这可能有助于延缓特应性皮炎的复发。
