The Academic Unit of Dermatology Research, Department of Infection and Immunity, Faculty of Medicine, Dentistry and Health, The University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, U.K.
Br J Dermatol. 2014 Apr;170(4):914-21. doi: 10.1111/bjd.12778.
Atopic dermatitis (AD) is an inflammatory skin disease arising as a result of immune system and skin barrier defects. Topical corticosteroids are safe and effective treatments for AD, when used in short courses. Prolonged use is associated with skin barrier damage. Topical calcineurin inhibitors are alternative immune-modulating treatments for AD purported to have no negative effects on the skin barrier.
To compare the effects of betamethasone valerate 0·1% cream (BMVc) and tacrolimus 0·1% ointment (TACo) on the skin barrier.
Twenty volunteers with quiescent AD (no active signs for 6 months) participated in a randomized observer-blind study, wherein BMVc was applied to one forearm and TACo to the other, twice daily for 4 weeks. The biophysical/biological properties of the stratum corneum were assessed before and after treatment. Nine volunteers with active disease and 10 with healthy skin were assessed at untreated sites.
BMVc significantly reduced skin barrier function, integrity and cohesion, and the levels of pyrrolidone carboxylic acid (PCA) and urocanic acid (UCA) towards the subclinical barrier defect observed in patients with AD (nonlesional sites). TACo preserved skin barrier function, integrity, cohesion and PCA and UCA levels, while significantly increasing skin hydration to levels comparable with healthy skin. Both treatments reduced skin surface pH and trypsin-like protease activity, with TACo doing so to a significantly greater degree.
In quiescent AD, 4 weeks of BMVc treatment adversely affected the biophysical properties of the skin and reduced the levels of natural moisturizing factor, whereas TACo improved the condition of the skin barrier.
特应性皮炎（AD）是一种炎症性皮肤病，是由于免疫系统和皮肤屏障缺陷引起的。局部皮质类固醇是 AD 的安全有效的治疗方法，短期使用效果良好。长期使用会导致皮肤屏障受损。局部钙调神经磷酸酶抑制剂是 AD 的另一种免疫调节治疗方法，据称对皮肤屏障没有负面影响。
比较倍他米松戊酸酯 0.1%乳膏（BMVc）和他克莫司 0.1%软膏（TACo）对皮肤屏障的影响。
20 名处于静止期 AD（6 个月内无活动迹象）志愿者参与了一项随机、观察者盲法研究，其中志愿者一侧前臂涂抹 BMVc，另一侧涂抹 TACo，每天两次，持续 4 周。在治疗前后评估角质层的生物物理/生物学特性。9 名活动性疾病志愿者和 10 名健康皮肤志愿者在未治疗部位进行评估。
BMVc 显著降低了皮肤屏障功能、完整性和内聚性，以及 AD 患者（非损伤部位）亚临床屏障缺陷观察到的吡咯烷酮羧酸（PCA）和尿刊酸（UCA）的水平。TACo 保持了皮肤屏障功能、完整性、内聚性和 PCA 和 UCA 水平，同时显著增加了皮肤水合作用，使其达到与健康皮肤相当的水平。两种治疗方法都降低了皮肤表面 pH 值和胰蛋白酶样蛋白酶活性，TACo 的作用更为显著。
在静止期 AD 中，4 周的 BMVc 治疗会对皮肤的生物物理特性产生不利影响，并降低天然保湿因子的水平，而 TACo 则改善了皮肤屏障的状况。
