Hon Kam-Lun Ellis, Lam Man-Ching Adrian, Leung Ting-Fan, Chow Chung-Mo, Wong Eric, Leung Alexander K C
Department of Pediatrics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China.
Adv Ther. 2007 Jan-Feb;24(1):23-8. doi: 10.1007/BF02849989.
This study was undertaken to evaluate the clinical efficacy of tacrolimus for itch reduction in children with atopic dermatitis (AD). Seven children (3 boys and 4 girls) with AD were treated with topical tacrolimus for a consecutive 2-wk period after a 1-wk run-in. The clinical severity of AD was assessed with the SCORing Atopic Dermatitis (SCORAD) scale. Sleep disturbance, as reported by patients, and nocturnal scratching documented by a wrist movement monitor (DigiTrac), were evaluated at baseline and throughout treatment. The median (interquartile range) objective SCORAD scores before and after treatment were 27.2 (24.8-36.7) and 23.9 (22.6-36.5), respectively (P=.248). Overall SCORAD scores before and after treatment were 36.1 (32.8-45.7) and 29.4 (24.8-45.4), respectively (P=.05). Scores on the itch and sleep disturbance components of the SCORAD were reduced from 5.0 (5.0-6.5) and 4.0 (3.5-5.0) to 4.0 (2.0-5.0) and 3.0 (0.5-4.5), respectively. Total SCORAD was reduced in 6 patients (range, 8%-36% reduction) and remained similar in 1 patient. No significant change in the area or intensity component of the SCORAD was detected 14 d after treatment began (P=.48 and P=.115, respectively). Scratching activity, as documented by the DigiTrac movement recorder, was reduced from 115.0 g/min (64.8-215.5) to 71.5 g/min (51.0-118.0) (P=.028) after 2 wk of treatment. Daily symptom scores (n=6 pairs) for sleep disturbance reported separately each day by patients and parents correlated strongly with each other (intraclass coefficient, 0.60-0.98). The findings of this study show that tacrolimus is effective in relieving itch in children with AD. Investigators suggest that scratching movements, objectively measured with the use of DigiTrac, provide a reliable indicator of AD severity in children.
本研究旨在评估他克莫司对减轻特应性皮炎（AD）患儿瘙痒的临床疗效。7名AD患儿（3名男孩和4名女孩）在经过1周的导入期后，连续2周接受外用他克莫司治疗。采用特应性皮炎评分（SCORAD）量表评估AD的临床严重程度。在基线期及整个治疗过程中，评估患者报告的睡眠障碍以及通过手腕活动监测仪（DigiTrac）记录的夜间搔抓情况。治疗前后客观SCORAD评分的中位数（四分位间距）分别为27.2（24.8 - 36.7）和23.9（22.6 - 36.5）（P = 0.248）。治疗前后总体SCORAD评分分别为36.1（32.8 - 45.7）和29.4（24.8 - 45.4）（P = 0.05）。SCORAD中瘙痒和睡眠障碍部分的评分分别从5.0（5.0 - 6.5）和4.0（3.5 - 5.0）降至4.0（2.0 - 5.0）和3.0（0.5 - 4.5）。6例患者的总SCORAD评分降低（降低幅度为8% - 36%），1例患者保持不变。治疗开始14天后，未检测到SCORAD的面积或强度部分有显著变化（分别为P = 0.48和P = 0.115）。经过2周治疗后，DigiTrac活动记录仪记录的搔抓活动从115.0 g/min（64.8 - 215.5）降至71.5 g/min（51.0 - 118.0）（P = 0.028）。患者和家长每天分别报告的睡眠障碍每日症状评分（n = 6对）彼此之间相关性很强（组内相关系数为0.60 - 0.98）。本研究结果表明，他克莫司对缓解AD患儿的瘙痒有效。研究人员建议，使用DigiTrac客观测量的搔抓动作可作为儿童AD严重程度的可靠指标。
