Goldstein Andrew T, Thaçi Diamant, Luger Thomas
Division of Gynecologic Specialties, Department of Gynecology and Obstetrics, The John Hopkins School of Medicine, Baltimore, MD, USA.
Eur J Obstet Gynecol Reprod Biol. 2009 Sep;146(1):22-9. doi: 10.1016/j.ejogrb.2009.05.026. Epub 2009 Jul 23.
Repeated courses of potent topical corticosteroids and maintenance therapy with moderately potent topical corticosteroids are frequently needed to treat various forms of vulvar dermatoses, which are often characterized by an abnormal proliferation or activation of T lymphocytes. Because such therapeutic regimen is associated with an increased risk of potential side effects, particularly skin atrophy, an anti-inflammatory alternative to topical corticosteroids is desirable. The two non-steroid topical calcineurin inhibitors pimecrolimus and tacrolimus are immunomodulators that block the release of inflammatory cytokines from T lymphocytes in the skin while promoting cutaneous innate host defences. They are currently approved in Europe and in the United States of America as second-line anti-inflammatory agents for the treatment of atopic dermatitis. We provide a comprehensive summary of existing case reports, series of cases, and open-label prospective studies concerning the use of topical pimecrolimus and tacrolimus for the treatment of anogenital lichen sclerosus, genital lichen planus, vulvar lichen simplex chronicus and related pruritic vulvar dermatoses (chronic vulvar pruritus and allergic contact dermatitis of the vulva). The available data suggest that both topical calcineurin inhibitors may be effective and well tolerated in these vulvar dermatoses, although topical pimecrolimus may exhibit a better long-term tolerability profile. Being devoid of steroid-related side effects, they may represent a useful second-line therapeutic option for patients who are intolerant of, or resistant to topical corticosteroids. Controlled clinical trials and comparative studies are warranted to substantiate the promising findings summarized in this review.
治疗各种类型的外阴皮肤病通常需要反复使用强效外用皮质类固醇，并使用中效外用皮质类固醇进行维持治疗，这些皮肤病的特征往往是T淋巴细胞异常增殖或活化。由于这种治疗方案会增加潜在副作用的风险，尤其是皮肤萎缩，因此需要一种外用皮质类固醇的抗炎替代品。两种非甾体外用钙调神经磷酸酶抑制剂吡美莫司和他克莫司是免疫调节剂，可阻断皮肤中T淋巴细胞炎性细胞因子的释放，同时促进皮肤固有宿主防御。它们目前在欧洲和美国被批准作为治疗特应性皮炎的二线抗炎药物。我们全面总结了关于外用吡美莫司和他克莫司治疗肛门生殖器硬化性苔藓、扁平苔藓、慢性单纯性苔藓和相关瘙痒性外阴皮肤病（慢性外阴瘙痒症和外阴过敏性接触性皮炎）的现有病例报告、系列病例和开放标签前瞻性研究。现有数据表明，两种外用钙调神经磷酸酶抑制剂在这些外阴皮肤病中可能有效且耐受性良好，尽管外用吡美莫司可能表现出更好的长期耐受性。由于没有与类固醇相关的副作用，它们可能是不耐受或对外用皮质类固醇耐药的患者有用的二线治疗选择。有必要进行对照临床试验和比较研究，以证实本综述中总结的有前景的发现。
