Polańska A, Silny W, Jenerowicz D, Knioła K, Molińska-Glura M, Dańczak-Pazdrowska A
Department of Dermatology and Venereology, University of Medical Sciences, Poznań, Poland.
Skin Res Technol. 2015 Feb;21(1):35-40. doi: 10.1111/srt.12153. Epub 2014 Jun 4.
In reactive and proactive therapy of atopic dermatitis a well established agent is tacrolimus, a member of calcineurin inhibitors' family. The clinical safety and efficacy of this drug were evaluated previously in randomized multicenter trials. However, so far in clinical studies the assessment of its action on the skin has been made only on the basis of different scores and scales. We present the 6-month observations of tacrolimus therapy in atopic dermatitis patients monitored with the use of noninvasive techniques like high-frequency ultrasonography and evaporimetry.
The study consisted of 39 patients with AD and their mean age was 26.3 ± 12.8 years. The study lasted 6 months and every 4 weeks patient visited the outpatient clinic (totally 7 visits). The evaluation of disease severity within right antecubital fossa was obtained on the basis of Investigator's Global Assessment (IGA) score. During every control visit noninvasive measurements were carried in the form of HF-USG (with determination of subepidermal low echogenic band, SLEB) and evaporimetry.
39 patients started the study and 22 of them (54.6%) finished it. Out of 39 patients, 31 (79.5%) received at least 4 week long proactive treatment. We observed statistically significant change of IGA, mean SLEB value and TEWL during underwent therapy. There were also statistically significant differences in mean SLEB and TEWL values between lesional and nonlesional measures.
This report shows the usefulness of HF-USG in monitoring tacrolimus therapy in atopic dermatitis. It is worth emphasizing, that this tool is easily reproducible and allows clinicians to visualize pathologic changes of all skin in vivo. As a noninvasive and independent of subjective judgment method, HF-USG should be included in overall evaluation of atopic dermatitis disease severity together with common scores or scales, especially in the era of evidence based medicine.
在特应性皮炎的反应性和主动性治疗中，他克莫司是一种成熟的药物，属于钙调神经磷酸酶抑制剂家族。该药物的临床安全性和有效性此前已在随机多中心试验中进行了评估。然而，到目前为止，在临床研究中，对其皮肤作用的评估仅基于不同的评分和量表。我们展示了使用高频超声检查和蒸发测定法等非侵入性技术对特应性皮炎患者进行他克莫司治疗的6个月观察结果。
该研究包括39名特应性皮炎患者，平均年龄为26.3±12.8岁。研究持续6个月，患者每4周门诊就诊一次（共7次就诊）。根据研究者整体评估（IGA）评分对右肘前窝内的疾病严重程度进行评估。在每次对照就诊期间，以高频超声检查（测定表皮下低回声带，SLEB）和蒸发测定法的形式进行非侵入性测量。
39名患者开始研究，其中22名（54.6%）完成研究。在39名患者中，31名（79.5%）接受了至少为期4周的主动性治疗。我们观察到治疗期间IGA、平均SLEB值和经表皮水分流失（TEWL）有统计学意义的变化。病变部位和非病变部位测量的平均SLEB和TEWL值之间也存在统计学意义的差异。
本报告显示了高频超声检查在监测特应性皮炎他克莫司治疗中的有用性。值得强调的是，该工具易于重复，可让临床医生在体内可视化所有皮肤的病理变化。作为一种非侵入性且独立于主观判断的方法，高频超声检查应与常用评分或量表一起纳入特应性皮炎疾病严重程度的整体评估中，尤其是在循证医学时代。
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