Department of Dermatology, Center for Dermatology Research, Wake Forest University School of Medicine, Winston-Salem, NC.
Department of Dermatology, Center for Dermatology Research, Wake Forest University School of Medicine, Winston-Salem, NC.
J Allergy Clin Immunol Pract. 2023 May;11(5):1347-1359. doi: 10.1016/j.jaip.2023.03.022. Epub 2023 Mar 29.
Topical corticosteroids (TCS) are a mainstay of treatment for atopic dermatitis (AD). There are shared physician and patient concerns that TCS use can result in skin atrophy and systemic absorption. The clinical use of topical calcineurin inhibitors (TCI) for AD is relatively limited despite evidence that TCI are safe and effective. Understanding the differences in efficacy and adverse effects between TCS and TCI can help shape prescription practices to the benefit of patients. The objective of this review is to characterize the difference in efficacy and adverse effects between TCS and TCI. A review of the literature between 2002 and 2022 was performed using the PubMed, EMBASE, and Cochrane Library databases. Ten studies comparing TCS of varying potencies with TCI approved for AD treatment were included in the review. Outcome measures were qualified using percent reductions on the modified Eczema Area and Severity Index score and decreases in physician's global evaluation of AD severity. Tacrolimus had statistically significant (P < .05) improvement in disease severity compared with TCS in 4 of the 5 studies that compared tacrolimus with weak TCS. The data suggest greater treatment efficacy of tacrolimus over weak TCS, and inferior efficacy of pimecrolimus (TCI) compared with both tacrolimus and weak TCS. It is difficult to draw conclusions between moderate, potent, and very potent TCS and TCI due to the small number of available studies. TCI can improve disease severity, especially on thin or intertriginous skin regions most vulnerable to adverse events with TCS treatment, and their use may help overcome adherence issues due to patient bias against TCS.
局部皮质类固醇（TCS）是治疗特应性皮炎（AD）的主要方法。医生和患者都担心 TCS 的使用会导致皮肤萎缩和全身吸收。尽管有证据表明 TCI 安全有效，但 TCI 治疗 AD 的临床应用相对有限。了解 TCS 和 TCI 在疗效和不良反应方面的差异，可以帮助规范处方实践，使患者受益。本综述的目的是描述 TCS 和 TCI 在疗效和不良反应方面的差异。使用 PubMed、EMBASE 和 Cochrane 图书馆数据库，对 2002 年至 2022 年的文献进行了回顾。综述中纳入了 10 项比较不同强度 TCS 与 TCI 的研究，TCI 均已批准用于 AD 治疗。使用改良 Eczema Area and Severity Index 评分的减少百分比和医生对 AD 严重程度的整体评估来衡量疗效。在比较他克莫司和弱 TCS 的 5 项研究中，有 4 项研究显示他克莫司在疾病严重程度方面具有统计学意义（P <.05）的改善。数据表明他克莫司的治疗效果优于弱 TCS，吡美莫司（TCI）的疗效不如他克莫司和弱 TCS。由于可用研究数量较少，很难对中效、强效和超强效 TCS 和 TCI 之间得出结论。TCI 可以改善疾病严重程度，尤其是在薄皮或皱褶部位，这些部位最容易发生 TCS 治疗的不良反应，并且它们的使用可能有助于克服因患者对 TCS 的偏见而导致的依从性问题。
