Waxweiler Weston T, Agans Robert, Morrell Dean S
School of Medicine, Medical College of Georgia, Augusta, Georgia.
Survey Research Unit, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina.
Pediatr Dermatol. 2011 Nov-Dec;28(6):689-694. doi: 10.1111/j.1525-1470.2011.01488.x. Epub 2011 Oct 4.
Severe forms of atopic dermatitis (AD) cause significant morbidity in vulnerable pediatric populations and necessitate treatment with systemic therapy. The existing literature concerning the treatment of severe pediatric AD with azathioprine (AZ) and mycophenolate mofetil (MM) is sparse. The purpose of this case series is to examine the use of these two drugs in the treatment of severe pediatric AD. Medical records of 28 pediatric patients with AD from the University of North Carolina at Chapel Hill pediatric dermatology clinic treated using these two drugs were analyzed for laboratory values, thiopurine methyltransferase (TPMT) levels, symptoms, infections, and other relevant data. Patients were also contacted via the telephone to ascertain outcomes and any missing data. Treatment outcomes were scored into three categories: significant improvement, some improvement, and no improvement. AZ dosing was correlated to TPMT levels successfully, with comparable levels of improvement in the heterozygous and homozygous wild-type groups. Absolute eosinophil count corresponded to AD activity and treatment response across both treatment modalities in 18 of 26 (69%) patients. Seventeen of 28 (61%) patients treated with AZ and eight of 12 (66%) treated with MM reported significant improvement. We had lower rates of laboratory abnormalities and side effects with MM than with AZ but similar rates of cutaneous infections. Treatment outcomes did not appear to differ with race, sex, or TPMT level. We experienced success with AZ and MM in the treatment of severe pediatric AD. Coordinating treatment to each patient's unique morbidities is the best way to choose systemic treatments.
重度特应性皮炎（AD）在易患儿童群体中会导致严重发病，因此需要进行全身治疗。目前关于使用硫唑嘌呤（AZ）和霉酚酸酯（MM）治疗重度儿童AD的文献较少。本病例系列的目的是研究这两种药物在治疗重度儿童AD中的应用。分析了北卡罗来纳大学教堂山分校儿科皮肤科诊所使用这两种药物治疗的28例儿童AD患者的病历，包括实验室检查值、硫嘌呤甲基转移酶（TPMT）水平、症状、感染及其他相关数据。还通过电话联系患者以确定治疗结果及任何缺失的数据。治疗结果分为三类：显著改善、有所改善和无改善。AZ的剂量与TPMT水平成功相关，杂合子和纯合野生型组的改善水平相当。在26例患者中的18例（69%）中，绝对嗜酸性粒细胞计数与两种治疗方式下的AD活动及治疗反应均相关。接受AZ治疗的28例患者中有17例（61%）、接受MM治疗的12例患者中有8例（66%）报告有显著改善。与AZ相比，MM导致的实验室异常和副作用发生率较低，但皮肤感染发生率相似。治疗结果在种族、性别或TPMT水平方面似乎没有差异。我们在使用AZ和MM治疗重度儿童AD方面取得了成功。根据每位患者的独特病情协调治疗是选择全身治疗的最佳方法。
