Yentzer Brad A, Camacho Fabian T, Young Trudye, Fountain Julie M, Clark Adele R, Feldman Steven R
Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1071, USA.
J Drugs Dermatol. 2010 Apr;9(4):324-9.
Patients with atopic dermatitis (AD) may have poor adherence for several reasons, including fear of side effects or dislike of messy topical therapies.
To assess adherence to and efficacy of a multifaceted program for atopic dermatitis using a lightweight, easy-to-apply medication and more frequent return visits.
Forty-one subjects with mild-to-moderate atopic dermatitis were instructed to use desonide hydrogel 0.05% twice daily. Disease severity was measured at baseline and weeks 1, 2 and 4. Subjects also received a follow-up phone call on day 3. Adherence was assessed using electronic monitors. At the end of the study, subjects sampled and rated the vehicle attributes of six different topical corticosteroid formulations.
Mean adherence to twice-daily application slowly declined over time, from 81% on day 1 to 50% by day 27. An improvement in pruritus was observed as early as day 3, and by week 4, mean pruritus and EASI scores improved from baseline by 60% and 61%, respectively. Mean SGA scores also improved to marked improvement/almost clear by week 4. In vehicle attribute surveys, the hydrogel was consistently rated higher than the other vehicles in all categories.
Subjects responded very well to treatment, and adherence to desonide hydrogel 0.05% was much better than previously reported with ointments. The early efficacy, favorable attributes of the hydrogel vehicle and judicious follow up likely increased adherence to topical therapy. The use of ointments or more potent topical steroids as a first choice may be counterproductive in the treatment of atopic dermatitis.
特应性皮炎（AD）患者可能因多种原因依从性较差，包括对副作用的恐惧或不喜欢 messy 的外用疗法。
使用一种轻便、易于涂抹的药物以及更频繁的复诊来评估一项针对特应性皮炎的多方面计划的依从性和疗效。
41 名轻度至中度特应性皮炎患者被指示每天两次使用 0.05%的地奈德水凝胶。在基线以及第 1、2 和 4 周测量疾病严重程度。受试者在第 3 天还接受了随访电话。使用电子监测器评估依从性。在研究结束时，受试者对六种不同外用皮质类固醇制剂的载体属性进行了抽样和评分。
每日两次用药的平均依从性随时间缓慢下降，从第 1 天的 81%降至第 27 天的 50%。早在第 3 天就观察到瘙痒有所改善，到第 4 周时，平均瘙痒和 EASI 评分分别较基线改善了 60%和 61%。平均 SGA 评分在第 4 周时也改善至显著改善/几乎清除。在载体属性调查中，水凝胶在所有类别中的评分始终高于其他载体。
受试者对治疗反应良好，0.05%地奈德水凝胶的依从性比先前报道的软膏要好得多。早期疗效、水凝胶载体的有利属性以及明智的随访可能提高了外用治疗的依从性。将软膏或更强效的外用类固醇作为首选可能在特应性皮炎的治疗中适得其反。
