308 nm准分子光治疗掌跖脓疱病的有效性及安全性评价

Efficacy and safety of 308 nm excimer light in treatment of palmoplantar pustulosis

关键词:  308 nm准分子光  掌跖脓疱病  光疗  治疗

Key words:  308 nm excimer light  palmoplantar pustulosis  phototherapy  treatment

摘要:

目的探讨308 nm准分子光治疗掌跖脓疱病（palmoplantar pustulosis, PPP）的有效性及安全性。方法采用前瞻性随机单盲临床试验的方法，收集2019年10月—2020年10月就诊于上海市皮肤病医院的PPP患者共73例，随机分为3组: 低剂量组以2倍最小红斑量（minimal erythema dose, MED）为起始剂量、中剂量组（以4倍MED为起始剂量）和高剂量组（以6倍MED为起始剂量）。各组均接受每周3次308 nm准分子光治疗，持续12周。分别评估治疗第0、2、4、6、8、12周时掌跖银屑病面积和严重程度指数（palmoplantar pustular psoriasis area and severity index, pp-PASI）和皮肤病学生活质量指数（dermatology life quality index, DLQI）评分，并记录不良事件和不良反应的发生情况。结果3组治疗结束时均获得良好疗效。高剂量组pp-PASI降低（26.92±4.90）较中、低剂量组pp-PASI降低更为显著（21.05±4.48，17.31±5.38），差异有统计学意义（P均<0.01）。各组患者DLQI评分均有改善，高、中剂量组DLQI评分改善快于低剂量组。高剂量组不良反应发生率较高（12/24,50%）。结论308 nm准分子光治疗掌跖脓疱病可获得较好的疗效，其中以6倍MED为起始剂量，每次治疗较前一次递增20%可较快达到满意疗效，减轻病情严重程度，提高患者生活质量。同时，应注意可能发生的不良反应，在选择剂量前对皮肤厚度及皮肤类型进行评估。

Abstract:

ObjectiveTo evaluate the efficacy and safety of 308 nm excimer light in the treatment of palmoplantar pustulosis (PPP). MethodsSeventy-three patients with PPP treated in Shanghai Skin Disease Hospital from October 2019 to October 2020 were enrolled. Patients were randomly assigned to receive low dose (2-fold of MED as initial dose), medium dose (4-fold of MED as initial dose) and high dose (6-fold of MED as initial dose) of 308 nm excimer light, and were treated three times weekly for 12 weeks. The efficacy was evaluated based on the palmoplantar pustular psoriasis area and severity index (pp-PASI) and dermatology life quality index (DLQI) score. Adverse events were recorded during the treatment. ResultsAll treatment groups achieved satisfied efficacy. The reduction of pp-PASI score in high dose group was more marked than that in low and medium dose group (26.92±4.90 vs 17.31±5.38 and 21.05±4.48, P＜0.01). Improvement of DLQI score was greatest at week 4 in each group, while DLQI improved more quickly in high and medium dose groups than that in low dose group. Adverse effects of erythema, pain and blistering were more common with the higher dose regimen. ConclusionHigh dose of 308 nm excimer light (6-fold of MED as initial dose) can achieve a better efficacy in treatment of PPP; it can reduce the severity of the disease and improve the quality of life of patients. Meantime, the incidence of adverse reactions should be aware of and it is necessary to evaluate the skin and lesion type before the dose selection.