Lancet子刊:儿童湿疹“润肤剂”怎么选?乳液、面霜、凝胶还是软膏?

2022-06-26 liangying MedSci原创

四种主要类型的润肤剂对儿童湿疹的有效性没有差异。

大约20%的儿童患过湿疹(也称为特应性湿疹或特应性皮炎)。其特点是皮肤干燥、发炎、发痒。治疗建议是每天使用润肤剂,同时加用局部抗炎剂(如皮质类固醇)来预防眩晕。目前还没有对儿童湿疹常用的润肤剂进行比较的试验。本研究的目的是比较四种主要润肤剂类型的临床有效性和安全性:乳液、面霜、凝胶和软膏。

研究者在英国77家全科手术室进行了一项务实的、单独随机、平行分组的第4阶段优势试验。6个月至12岁患有湿疹的儿童(以患者为导向的湿疹测量[POEM]评分>2)被随机分配(1:1:1:1;按中心分层,根据基线POEM评分和年龄最小化,使用基于网络的系统)使用洗剂、乳膏、凝胶或软膏。最初的润肤剂处方为500 g或500 mL,每天按要求涂抹两次。随后的处方由患儿父母根据情况决定。

2018年1月19日至2019年10月31日期间,研究者对12417名儿童进行了资格评估,其中550名儿童被随机分配到一个治疗组(137人使用乳液,140人使用乳膏,135人使用凝胶,138人使用软膏)。参与初步分析的参与者中,至少有2个POEM得分,洗剂组131人,乳膏组137人,凝胶组130人,软膏组126人。基线中位年龄为4岁,255(46%)名参与者为女孩,295(54%)名参与者为男孩,平均POEM分为9.3分(标准差5.5分)。

16周后,润肤剂类型之间的湿疹严重程度没有差异(总体p值=0.77),调整后的POEM成对差异为:乳膏与乳液0.42(95%CI 0.48至1.32),凝胶与乳液0.17(0.75至1.09),软膏与乳液0.01(0.93至0.91),凝胶与乳液0.25(1.15至0.65),软膏与乳液0.43(1.34至0.48),软膏与凝胶0.18(1.11至0.75)。多重敏感性和亚组分析后,该结果保持不变。虽然软膏、乳膏或凝胶的刺痛不太常见,但两个治疗组之间的不良事件总数没有显著差异。

基线和16周时的POEM和EASI评分

总之,本研究发现四种主要类型的润肤剂对儿童湿疹的有效性没有差异。只需要能够从一系列润肤剂中选择到一种对患儿有效果的就行。

参考文献:Effectiveness and safety of lotion, cream, gel, and ointment emollients for childhood eczema: a pragmatic, randomised, phase 4, superiority trial Prof Matthew J Ridd, PhD  Prof Miriam Santer, PhD Stephanie J MacNeill, PhD Emily Sanderson, MSc Sian Wells, MSc Douglas Webb, MSc et al. Show all authors Open AccessPublished:May 23, 2022DOI:https://doi.org/10.1016/S2352-4642(22)00146-8

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    2022-12-17 howi
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    2022-06-27 ms6000000168978703

    学习了,很实用

    0

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    2022-06-25 lishizhe
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    2022-06-23 younei

    lancet上果然牛,感谢梅斯更新及时

    0

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