Jensen Jens-Michael, Pfeiffer Stephan, Witt Magdalena, Bräutigam Matthias, Neumann Claudia, Weichenthal Michael, Schwarz Thomas, Fölster-Holst Regina, Proksch Ehrhardt
Department of Dermatology, University of Kiel, Kiel, Germany.
J Allergy Clin Immunol. 2009 Sep;124(3 Suppl 2):R19-28. doi: 10.1016/j.jaci.2009.07.015.
Genetic defects leading to skin barrier dysfunction were recognized as risk factors for atopic dermatitis (AD). It is essential that drugs applied to patients with AD restore the impaired epidermal barrier to prevent sensitization by environmental allergens.
We investigated the effect of 2 common treatments, a calcineurin inhibitor and a corticosteroid, on the skin barrier.
In a randomized study 15 patients with AD were treated on one upper limb with pimecrolimus and on the other with betamethasone twice daily for 3 weeks.
Stratum corneum hydration and transepidermal water loss, a marker of the inside-outside barrier, improved in both groups. Dye penetration, a marker of the outside-inside barrier, was also reduced in both drugs. Electron microscopic evaluation of barrier structure displayed prevalently ordered stratum corneum lipid layers and regular lamellar body extrusion in pimecrolimus-treated skin but inconsistent extracellular lipid bilayers and only partially filled lamellar bodies after betamethasone treatment. Both drugs normalized epidermal differentiation and reduced epidermal hyperproliferation. Betamethasone was superior in reducing clinical symptoms and epidermal proliferation; however, it led to epidermal thinning.
The present study demonstrates that both betamethasone and pimecrolimus improve clinical and biophysical parameters and epidermal differentiation. Because pimecrolimus improved the epidermal barrier and did not cause atrophy, it might be more suitable for long-term treatment of AD.
导致皮肤屏障功能障碍的基因缺陷被认为是特应性皮炎（AD）的危险因素。对于AD患者，应用药物恢复受损的表皮屏障以防止环境过敏原致敏至关重要。
我们研究了两种常用治疗方法，即钙调神经磷酸酶抑制剂和皮质类固醇，对皮肤屏障的影响。
在一项随机研究中，15例AD患者一侧上肢用吡美莫司治疗，另一侧上肢用倍他米松治疗，每日两次，共3周。
两组的角质层水合作用和经表皮水分流失（一种由内而外屏障的标志物）均有所改善。两种药物对染料渗透（一种由外而内屏障的标志物）也有降低作用。对屏障结构的电子显微镜评估显示，吡美莫司治疗的皮肤中角质层脂质层普遍有序，板层小体挤出规律，但倍他米松治疗后细胞外脂质双层不一致，板层小体仅部分填充。两种药物均使表皮分化正常化并减少表皮过度增殖。倍他米松在减轻临床症状和表皮增殖方面更具优势；然而，它导致了表皮变薄。
本研究表明，倍他米松和吡美莫司均可改善临床和生物物理参数以及表皮分化。由于吡美莫司改善了表皮屏障且未引起萎缩，它可能更适合AD的长期治疗。
