斑秃的改良免疫疗法。
Modified immunotherapy for alopecia areata.
机构信息
Department of Dermatology, Wakayama Medical University, Japan; Department of Dermatology, Arida Municipal Hospital, Japan.
Department of Dermatology, Wakayama Medical University, Japan.
出版信息
Autoimmun Rev. 2016 Jul;15(7):664-7. doi: 10.1016/j.autrev.2016.02.021. Epub 2016 Feb 27.
Squaric acid dibutylester (SADBE) is a commonly used contact sensitizer in immunotherapy for alopecia areata (AA). Severe contact dermatitis is induced by the currently high recommended sensitization dose of 1%-2% SADBE, often decreasing patient compliance. We assessed a modified immunotherapy for AA using SADBE at a starting concentration of 0.01% without sensitization. After one or two weeks of initial 0.01% SADBE application, the concentration of SADBE was increased gradually to 0.025%, 0.05%, 0.1%, 0.25%, 0.5%, 1% and 2% until the patients felt itching or erythema at the AA lesion site. The modified immunotherapy showed a response rate of 69.4% (25/36), equivalent to conventional immunotherapy using SADBE starting at 1%-2% sensitization. Furthermore, we investigated the combination therapy of SADBE and multiple courses of steroid pulses for AA. The response rate for combination therapy was 73.7% (28/38); however, the group receiving combination therapy showed a significant prevalence of severe AA compared with the group receiving modified immunotherapy only. We reviewed the efficacy and safety of modified immunotherapy without initial sensitization and combination therapy with immunotherapy and multiple courses of pulses for AA.
丁二酸二乙酯（SADBE）是斑秃免疫治疗中常用的接触致敏剂。目前推荐的 1%-2% SADBE 高致敏剂量会引起严重的接触性皮炎，常降低患者的依从性。我们评估了一种使用 SADBE 的新型免疫治疗方法，起始浓度为 0.01%，无需致敏。在最初应用 0.01% SADBE 1-2 周后，SADBE 的浓度逐渐增加至 0.025%、0.05%、0.1%、0.25%、0.5%、1%和 2%，直到患者在斑秃病变部位感到瘙痒或红斑。改良免疫治疗的反应率为 69.4%（25/36），与起始浓度为 1%-2%致敏的常规免疫治疗相当。此外，我们还研究了 SADBE 联合多次类固醇冲击治疗斑秃的联合治疗。联合治疗的反应率为 73.7%（28/38）；然而，与仅接受改良免疫治疗的组相比，接受联合治疗的组中严重斑秃的患病率显著增加。我们回顾了不进行初始致敏的改良免疫治疗和免疫治疗联合多次脉冲治疗斑秃的疗效和安全性。
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