Noon J P, Evans C E, Haynes W G, Webb D J, Walker B R
Department of Medicine, University of Edinburgh, Scotland, U.K.
Br J Dermatol. 1996 May;134(5):837-42.
Glucocorticoid-induced dermal blanching provides a useful research tool to study steroid potency and sensitivity. Conventional measurement of the intensity of blanching relies on subjective assessment by a trained observer using a visual score. Several objective techniques have recently been reported to detect skin blanching, but their sensitivity has not been compared previously with subjective visual recordings. In this report we aimed to establish whether objective methods offer sufficient sensitivity to be employed in epidemiological studies of glucocorticoid responsiveness. In healthy subjects we applied beclomethasone dipropionate at three concentrations (1, 10 and 100 micrograms/ml) under an occluded dressing overnight. The following morning we measured blanching using a visual score, laser Doppler velocimetry with the MBF 3D monitor (Moor Instruments Ltd, U.K.) and a perfusion imager (Lisca, Sweden), and reflectance spectrophotometry with the Dia-Stron 'erythemameter'. Using the visual score, blanching was detected at all concentrations of steroid. Neither laser Doppler instrument detected vasoconstriction at any concentration. By contrast, the reflectance spectrophotometer successfully recorded blanching at 10 and 100 micrograms/ml, but not at 1 microgram/ml. We conclude that laser Doppler instruments, including the novel scanning perfusion imager, do not detect glucocorticoid-induced skin blanching, perhaps because it reflects venular rather than arteriolar vasoconstriction. By contrast, the Dia-Stron reflectance spectrophotometer has sufficient sensitivity to be used as an alternative to visual assessment in epidemiological studies of human glucocorticoid-induced dermal blanching.
糖皮质激素诱导的皮肤变白为研究类固醇效力和敏感性提供了一种有用的研究工具。传统的皮肤变白强度测量依赖于经过训练的观察者使用视觉评分进行主观评估。最近有几种客观技术被报道用于检测皮肤变白，但它们的敏感性此前尚未与主观视觉记录进行比较。在本报告中，我们旨在确定客观方法是否具有足够的敏感性，可用于糖皮质激素反应性的流行病学研究。在健康受试者中，我们在封闭敷料下过夜应用三种浓度（1、10和100微克/毫升）的二丙酸倍氯米松。第二天早上，我们使用视觉评分、配备MBF 3D监测仪（英国摩尔仪器有限公司）的激光多普勒测速仪和灌注成像仪（瑞典Lisca）测量皮肤变白情况，并使用Dia-Stron“红斑仪”进行反射分光光度法测量。使用视觉评分，在所有类固醇浓度下均检测到皮肤变白。两种激光多普勒仪器在任何浓度下均未检测到血管收缩。相比之下，反射分光光度计成功记录了10和100微克/毫升浓度下的皮肤变白情况，但在1微克/毫升浓度下未记录到。我们得出结论，包括新型扫描灌注成像仪在内的激光多普勒仪器无法检测到糖皮质激素诱导的皮肤变白，这可能是因为它反映的是静脉而非动脉血管收缩。相比之下，Dia-Stron反射分光光度计具有足够的敏感性，可在人类糖皮质激素诱导的皮肤变白的流行病学研究中用作视觉评估的替代方法。
