Smith I L, Brown S, Nixon J, Cowdell F C, Ersser S, Fernandez C, Goodfield M, Green C M, Hampton P, Lear J T, Smith C H, Sunderland L, Tubeuf S, Wittmann M
Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, Yorkshire, UK.
Faculty of Health Education and Life Sciences, Birmingham City University, Birmingham, UK.
Clin Exp Dermatol. 2017 Mar;42(2):185-188. doi: 10.1111/ced.13015. Epub 2016 Dec 2.
Treatment of severe hand eczema (HE) that is resistant to topical potent corticosteroid treatment is challenging. In 2013, we surveyed 194 UK dermatologists to obtain information about their usual treatment pathways to inform the choice of the comparator in a trial of alitretinoin in severe HE (ALPHA trial); the results indicated that the treatment approaches favoured by UK dermatologists differ. Psoralen combined with ultraviolet A (PUVA) and alitretinoin were identified as the most frequent first-line treatment options for hyperkeratotic HE, whereas oral corticosteroids were identified as the most frequent first-line treatment for vesicular HE, followed by PUVA and alitretinoin. In terms of potential adverse effects of long-term or repeated use, oral steroids and ciclosporin A were reported to cause most concern. There is uncertainty about which treatment gives the best short and long-term outcomes, because of a lack of definitive randomised controlled trials evaluating the effectiveness of different treatment pathways in severe HE.
治疗对局部强效皮质类固醇治疗耐药的重度手部湿疹（HE）具有挑战性。2013年，我们对194名英国皮肤科医生进行了调查，以获取他们常用治疗途径的信息，为重度手部湿疹阿利维A酸试验（ALPHA试验）中对照物的选择提供参考；结果表明，英国皮肤科医生青睐的治疗方法存在差异。补骨脂素联合紫外线A（PUVA）和阿利维A酸被确定为角化过度型手部湿疹最常用的一线治疗选择，而口服皮质类固醇被确定为水疱型手部湿疹最常用的一线治疗方法，其次是PUVA和阿利维A酸。就长期或重复使用的潜在不良反应而言，口服类固醇和环孢素A引起的担忧最多。由于缺乏评估不同治疗途径在重度手部湿疹中有效性的确定性随机对照试验，哪种治疗能带来最佳的短期和长期效果尚不确定。
