Department of Dermatology, SMS Medical College, 103, Burmese Colony, Jaipur-302004 (Rajasthan), India.
Eur J Dermatol. 2010 May-Jun;20(3):329-33. doi: 10.1684/ejd.2010.0930. Epub 2010 Mar 19.
Continued sub-clinical streptococcal infection might be responsible for chronic plaque psoriasis. Considering the beneficial effect of benzathine penicillin in chronic plaque psoriasis, but due to the risk of penicillin sensitivity and to its painful parenteral route of administration, we tried oral azithromycin in this single blind randomized case-control trial. 50 patients with moderate to severe chronic plaque psoriasis were enrolled. Of these, 30 randomly selected patients received azithromycin for 48 weeks as a single oral 500 mg daily dose for 4 days with a gap of 10 days (total 24 such courses). The remaining 20 patients received a vitamin C tablet (non-chewable) in the same dosage schedule. Informed consent was obtained from all patients enrolled. Though the trial concluded at 48 weeks, patients in the azithromycin-arm were followed for another year to observe any relapse. A significant improvement in PASI score was noted from 12 weeks in the majority of patients in the azithromycin group. At the end of 48 weeks, 18 patients (60%) showed excellent improvement, while 6 patients (20%) showed good improvement and 4 patients (13.33%) showed mild improvement. PASI 75 was 80%. No significant change was seen in lesions in the control group. 2 patients in the study group and 5 patients in the control group did not complete the prescribed duration of study. An exacerbation in lesions was reported in 5 cases (16.66%) in the group receiving azithromycin. These exacerbations also responded by continuing the same treatment. At the end of another one year follow up in the azithromycin-arm, 6 patients (20%) developed a recurrence of lesions. Relevant investigations and clinical assessments were done at regular intervals to observe any side-effects and to check progress of the disease. Data were analysed statistically by using the student t-test. Patients tolerated the therapy well.
持续性亚临床链球菌感染可能是慢性斑块型银屑病的病因。鉴于苄星青霉素对慢性斑块型银屑病的有益作用，但由于青霉素过敏的风险和其痛苦的注射给药途径，我们在这项单盲随机病例对照试验中尝试了口服阿奇霉素。共纳入 50 例中重度慢性斑块型银屑病患者。其中，随机选择 30 例患者接受阿奇霉素治疗 48 周，每天口服 500mg，连续 4 天，间隔 10 天（共 24 个疗程）。其余 20 例患者按相同剂量方案接受维生素 C 片（非咀嚼片）。所有纳入患者均获得知情同意。虽然试验在 48 周结束，但阿奇霉素组的患者在随访 1 年后观察是否有复发。阿奇霉素组的大多数患者从第 12 周开始 PASI 评分显著改善。48 周结束时，18 例（60%）患者得到极好改善，6 例（20%）患者得到良好改善，4 例（13.33%）患者得到轻度改善。PASI 75 为 80%。对照组皮损无明显变化。研究组有 2 例和对照组有 5 例患者未完成规定的研究疗程。阿奇霉素组有 5 例（16.66%）患者出现皮损加重。继续同样的治疗后，这些加重也得到了缓解。在阿奇霉素组的另一年随访结束时，6 例（20%）患者出现皮损复发。定期进行相关检查和临床评估，观察任何副作用并检查疾病进展。数据采用学生 t 检验进行统计学分析。患者均耐受良好。
