a Department of Dermatology , Beijing Friendship Hospital, Capital Medical University , Beijing , China.
b Department of Dermatology , Beijing Changping Hospital , Beijing , China.
Postgrad Med. 2018 Jun;130(5):470-476. doi: 10.1080/00325481.2018.1478108. Epub 2018 May 28.
Currently there is no cure for severe atopic dermatitis (AD). Wet-wrap therapy (WWT) has also been used to treat pediatric AD and shown a satisfactory effectiveness, but clinical evidence supporting the use of WWT on severe adult AD is still insufficient.
Twelve patients (eight men and four women) with severe AD (SCORing Atopic Dermatitis [SCORAD] score ≥ 50) treated between January 2015 and September 2017 in our hospital were included. The patients underwent WWT (daily dose: 15 g halometasone cream+100g Vaseline ointment) twice daily for 2 h/session for 7 days. SCORAD, visual analog scale (VAS) for pruritus, investigator's global assessment (IGA), dermatology life quality index (DLQI) scores and serum cortisol levels were determined before and after the WWT.
The patients (mean age: 58.9 ± 18.9 years; range: 27-85 years) had a median disease duration of 27.5 months. After the WWT, the average scores of SCORAD (28.79 ± 5.16 vs. 68.59 ± 8.61, 95%CI: 35.18-44.42), VAS (2.75 ± 0.62 vs. 7.5 ± 1.17, 95%CI: 4.14-5.36), IGA (1.83 ± 0.39 vs. 4.08 ± 0.51, 95%CI: 1.96-2.54), and DQLI score (8.33 ± 1.83 vs. 13.83 ± 2.79, 95%CI: 4.16-6.84) reduced significantly compared with the scores before the WWT (All P < 0.001). However, serum cortisol levels were not affected significantly by the WWT. Four patients complained of tolerable wet dressing-associated discomforts, which was resolved after the wet dressing was removed when the WWT was completed. For the 85-year-old man, serum cortisol levels were lower than the normal value after the WWT (3.67 μg/dL) but restored to the normal levels (13.44 μg/dL) 2 weeks after the WWT was ended. No other adverse events occurred.
WWT can relieve pruritus, reduce skin lesions, and improve quality of life in adult patients with severe AD. Thus, WWT may be effective and safe for severe adult AD. Trial registration No. is ChiCTR1800014909 ( http://www.chictr.org.cn/index.aspx ).
目前，严重特应性皮炎（AD）尚无治愈方法。湿包裹疗法（WWT）也已用于治疗儿科 AD，并显示出令人满意的疗效，但支持 WWt 治疗成人严重 AD 的临床证据仍然不足。
纳入 2015 年 1 月至 2017 年 9 月在我院接受治疗的 12 例（8 男 4 女）严重 AD 患者（SCORing 特应性皮炎 [SCORAD]评分≥50）。患者接受每日两次的 WWT（剂量：15g 卤米松乳膏+100g 凡士林软膏），每次 2 小时/疗程，共 7 天。在 WWT 前后测定 SCORAD、瘙痒视觉模拟量表（VAS）、研究者全球评估（IGA）、皮肤病生活质量指数（DLQI）评分和血清皮质醇水平。
患者（平均年龄：58.9±18.9 岁；范围：27-85 岁）的中位疾病持续时间为 27.5 个月。WWT 后，SCORAD 平均评分（28.79±5.16 比 68.59±8.61，95%CI：35.18-44.42）、VAS 评分（2.75±0.62 比 7.5±1.17，95%CI：4.14-5.36）、IGA 评分（1.83±0.39 比 4.08±0.51，95%CI：1.96-2.54）和 DLQI 评分（8.33±1.83 比 13.83±2.79，95%CI：4.16-6.84）较 WWT 前显著降低（均 P<0.001）。然而，WWT 对血清皮质醇水平无明显影响。4 例患者出现可耐受的湿敷料相关不适，WWT 结束去除湿敷料后缓解。对于 85 岁男性患者，WWT 后血清皮质醇水平低于正常值（3.67μg/dL），但在 WWT 结束后 2 周恢复正常水平（13.44μg/dL）。未发生其他不良事件。
WWT 可缓解成人严重 AD 患者的瘙痒，减少皮损，改善生活质量。因此，WWT 对成人严重 AD 可能有效且安全。临床试验注册号：ChiCTR1800014909（http://www.chictr.org.cn/index.aspx）。
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