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題名 | 皮質類固醇外用劑之副作用(2)--戒斷皮膚炎及臨床上治療之經驗=Side Effects of Topical Corticosteroids(Ⅱ)--Withdrawal Dermatitis and Its Management |
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作者 | 許漢銘; 李玉雲; 蔡瑞真; | 書刊名 | 中華皮膚科醫學雜誌 |
卷期 | 17:4 1999.12[民88.12] |
頁次 | 頁300-315 |
分類號 | 418.33 |
關鍵詞 | 皮質類固醇; 皮膚炎; Withdrawal dermatitis; Topical corticosteroid; Epidermal barrier; |
語文 | 中文(Chinese) |
中文摘要 | 在長期使用強效皮質類固醇外用劑,於突然停藥後常會出現令人困擾的戒斷皮膚 炎(withdrawal dermatitis: WD),其機轉並不清楚。本文之目的在於觀察WD之臨床經過 及凡士林對它的療效,並探討其可能之機轉。 39 位 WD 患者在停用強效皮質類固醇外用劑 後,分為兩群:A 群 18 位給予弱效的 hydrocortisone 軟膏,一天兩次, B 群 21 位則 每 4 小時擦一次凡士林, 同時兩群患者皆給予 prednisolone ( 5 ∼ 15 mg ╱天)及 tetracycline ( 750 mg ╱天)。結果顯示 A 群患者於停用強效皮質類固醇外 用劑後,首先出現一皮疹急速惡化期(第 1 星期),此時臨床症狀惡化, 經皮水分散失及 角質層含水量呈現顯著的異常;緊接而來的是快速恢復期(第 2 ∼第 4 星期),在此期間 ,角質層含水量先恢復正常,隨之表皮障壁功能也逐漸恢復; 最後進入緩慢的痊癒期(第 2 個月∼第 6 個月),患者之紅班、血管擴張及色素沉著等現象逐漸改善;另一方面,B 群患者之臨床經過與 A 群患者類似,但其症狀之改善與皮膚生理的恢復明顯優於後者, 呈 現有意義的差別。綜合以上之結果,重複多次的使用凡士林能有效改善 WD 之臨床症狀與皮 膚生理狀況。最後有關 WD 之機轉,我們將在文中提出我們的看法。 |
英文摘要 | Dermatitis following withdrawal (withdrawal dermatitis: WD) of prolonged application of potent topical corticosteroids (TCS) is a troublesome problem, and its mechanism remains unknown. In the present work, we monitored the clinical course of WD and evaluated the effects of repeated applications of petrolatum during the disease process. Thirty-nine patients with WD after stopping potent TCS were divided into two groups: group A (18 patients) treated with weakly potent hydrocortisone ointment twice daily, and group B (21 patients) treated with petrolatum every 4 hours. Besides topical medications, all of our patients received prednisolone (5-15 mg/day) and tetracycline (750 mg/day). Wd in group A showed an acute exacerbation stage during the first week after stopping potent TCS, and was dominated by increased TEWL and decreased water content of stratum corneum. This was followed by a rapid recovery stage from 2nd week till 4 �� week, associated with the normalization of epidermal hydration and barrier recovery. Finally, a gradual cured stage lasted from 2nd month till 6 �� month after stopping potent TCS. On the other hand, the clinical courses of group B were very similar to group A with much lesser severity. The recovery of water content and barrier function also showed significant difference. In conclusion, the present work suggests the potential benefits of repeated application of petrolatum on WD. Finally, we propose the possible mechanism for WD in the text. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。