Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
J Am Acad Dermatol. 2020 Sep;83(3):888-903. doi: 10.1016/j.jaad.2020.02.018. Epub 2020 Feb 15.
Bleomycin is widely used as an off-label treatment for various dermatologic indications. However, a much-needed critical appraisal of the currently available evidence is lacking. We therefore evaluated the quality of clinical evidence for the efficacy and safety of intralesional bleomycin treatment for dermatologic indications with the aim to provide evidence-based recommendations for clinical practice. The PubMed, Embase, Medline Ovid, Web of Science, Cochrane Central, and Google Scholar databases were systematically searched. Two authors independently selected relevant studies according to predefined inclusion and exclusion criteria. We assessed the methodologic quality with the Cochrane Collaboration risk-of-bias assessment tool and selected 10 randomized clinical trials and 15 clinical controlled trials. Treatment indications included common warts, nonmelanoma skin cancer, cutaneous metastases, keloid and hypertrophic scars, and hemangioma. Intralesional bleomycin treatment showed significantly higher cure rates for warts compared with other treatments. Local adverse events included erythema, blackening, eschar formation, and superficial ulceration. None of the studies reported systemic adverse events. Methodologic quality of the studies was generally low. Consequently, no firm recommendations can be made for intralesional bleomycin treatment in clinical practice. However, this review suggests that intralesional bleomycin is a successful and well-tolerated treatment for recalcitrant warts.
平阳霉素被广泛用作各种皮肤科适应证的超适应证治疗药物。然而，目前缺乏对现有证据进行批判性评估的迫切需要。因此，我们评估了皮内注射平阳霉素治疗皮肤科适应证的疗效和安全性的临床证据质量，旨在为临床实践提供循证建议。我们系统地检索了 PubMed、Embase、Medline Ovid、Web of Science、Cochrane 中央和 Google Scholar 数据库。两名作者根据预先确定的纳入和排除标准独立选择了相关研究。我们使用 Cochrane 协作风险偏倚评估工具评估了方法学质量，并选择了 10 项随机临床试验和 15 项临床对照试验。治疗适应证包括寻常疣、非黑素瘤皮肤癌、皮肤转移瘤、瘢痕疙瘩和肥厚性瘢痕以及血管瘤。与其他治疗相比，皮内平阳霉素治疗疣的治愈率明显更高。局部不良反应包括红斑、黑化、焦痂形成和浅表溃疡。没有研究报告全身不良反应。研究的方法学质量普遍较低。因此，不能为临床实践中的皮内平阳霉素治疗提供明确的建议。然而，本综述表明，皮内平阳霉素是一种成功且耐受良好的治疗方法，可用于治疗难治性疣。
