雷射治療白斑病與牛皮癬前景良好

其結果已經顯示出較早的藥症,不過需要進行大規模的前瞻性研究

  2002年6月10日─5月份的《Journal of the American Academy of Dermatology》雜誌報導的兩篇預備實驗的結果顯示,308-nm受激准分子雷射,也許可以證明是白斑病與牛皮癬的一種治療選擇。

   「當前白斑病的療法,需要很多個月的治療,而且結果常常令人失望。」紐約Mount Sinai醫學院的James M. Spencer醫師,MS及其同事寫道:「採用單波長雷射進行靶向光學治療,可以證明是一種是節省時間,而且有效的白斑病治療方法。」

  此次只採取了一種治療措施,比較干預前後情況的研究中,18位患者的29片白斑病,接受了308-nm受激准分子雷射治療。患者每週接受三次治療,如果沒有黑斑出現,那麼最多治療12次,如果出現黑斑的話,那麼在這種情況下,就直到完全治愈後,再停止治療。作為對照,所有的患者都保留數塊白斑沒有進行治療。

  接受六次以上治療的12位患者的23塊白斑中,57%的接受治療的斑塊出現5%到25%的色素再沈著。接受全部12次治療的6位患者的11塊斑塊中,82%的接受治療的斑塊出現一定程度的色素再沈著。未治療的對照斑塊保持不變。

   「2-4個週的時侯,色素再沈著的程度比當前其他任何的白斑病治療所達到的效果,都要好得多,」作者寫道:「這種氙-氯化物受激准分子雷射治療,可以代表穩定性白斑病處理中的一種新的治療方式。」

  由於研究的不足之處包括較小的樣本量,以及隨訪不足,因此作者建議進行較大的前瞻性研究。Spencer與Mount Sinai醫學院已經申請了採用308-nm准分子雷射治療白斑病的使用專利。

  另外一項獨立的研究中,同一種雷射,可以使牛皮癬患者更快的出現治療反應,同時採用Psoralens+ ultraviolet A治療的標準療法時,通常會出現的健康皮膚的長期損害的危險,採用這種療法時,也要少得多。

   「大劑量受激准分子雷射治療,僅對局限性斑塊型牛皮癬有效,」來自曼徹斯特公立醫院與哈佛醫學院的Manju Trehan醫師及Charles R. Taylor醫師寫道:「聯合治療或者在其他非照射的療法中,加用這種新型設備,也許會證明更有效。」

  作者招募了18位志願者,每個人選擇了兩塊斑塊,採用每塊斑塊的最小紅斑劑量的8或16倍的劑量,對半塊斑塊進行了一次雷射治療,每塊斑塊的另外一半作為對照。完成此次研究的16位元研究物件中,有11人在1個月以內出現顯著性改善,有5人在4個月時,仍然有持續存在的改善區域。

  6個月時,所有的改善或者部分改善的區域,牛皮癬全部復發。較厚的斑塊,要比較薄或者中等厚度的斑塊反應性差。

   「我們推測,光學纖維傳導系統,也可以用於UV療法,以治療採用目前的療法不容易達到的體表區域,」作者寫道:「很清楚,有幾個劑量方面的問題需要解釋,另外還需要確認好轉時間。」

  聖地牙哥PhotoMedex有限公司為此次研究提供贊助。

Laser Treatment Promising in Vitiligo, Psoriasis

Results Beat Earlier Modalities, but Large Prospective Studies Needed

By Laurie Barclay, MD
WebMD Medical News

Reviewed by Gary D. Vogin, MD

June 10, 2002 -- The 308-nm excimer laser may prove to be the treatment of choice for vitiligo and psoriasis, based on results of two pilot studies reported in the May issue of the Journal of the American Academy of Dermatology.

"Present vitiligo therapies require many months of treatment and often result in disappointing outcomes," write James M. Spencer, MD, MS, and colleagues from the Mount Sinai School of Medicine in New York. "Targeted phototherapy with single-wavelength laser light is a treatment alternative that may prove to be a time-efficient and effective therapeutic option for the management of vitiligo."

In this before-and-after intervention study with a single arm, 29 patches of vitiligo from 18 patients were treated with a 308-nm xenon-chloride excimer laser. Patients received treatments three times weekly for a maximum of 12 treatments unless sunburn developed, in which case treatment was discontinued until resolution. All patients had untreated vitiligo patches that served as control sites.

Of 23 vitiligo patches from 12 patients who received at least six treatments, 57% of the treated patches showed some repigmentation ranging from 5% to 25%. Of 11 vitiligo patches from six patients who received all 12 treatments, 82% of the treated patches showed some repigmentation. Untreated control patches remained unchanged.

"This degree of repigmentation in a period of 2 to 4 weeks is much higher than that achieved with any other present vitiligo therapy," the authors write. "The xenon-chloride excimer laser may represent a new treatment modality for the management of stable vitiligo."

Because of study limitations including small sample size and limited follow-up, the authors recommend larger prospective studies. Spencer and the Mount Sinai School of Medicine have applied for a use patent of the excimer 308-nm laser for the treatment of vitiligo.

In a separate study, the same laser offered psoriasis patients more rapid response with less long-term risk to healthy skin than is typically seen with standard therapy using Psoralens plus ultraviolet A.

"As little as one high-dose excimer laser treatment can be effective for localized plaque-type psoriasis," write Manju Trehan, MD, and Charles R. Taylor, MD, from Massachusetts General Hospital and Harvard Medical School. "Multiple treatments or other irradiation schedules with this innovative device may prove even more efficacious."

The authors enrolled 18 volunteers, selected two plaques from each, and directed a single laser treatment of either eight or 16 times the minimal erythema dose to half of each plaque, using the other half of each plaque as a control. Of 16 subjects who completed the study, 11 improved significantly within one month, and five still had persistent areas of clearing at four months.

At six months, psoriasis recurred in all cleared or partially cleared areas. Thicker plaques were not as responsive as relatively flat or moderately indurated plaques.

"We speculate that the fiberoptic delivery system will also allow for the administration of UV therapy to body areas not easily treated by existing therapies," the authors write. "Clearly several dosimetry issues need to be resolved and remission times need to be established."

PhotoMedex Inc., of San Diego supported this study.

© 2002 WebMD Inc. All rights reserved.

    
相關報導
AAD 2009:併用雷射與光敏感劑可改善痤瘡治療
2009/3/20 上午 11:37:00
Golimumab降低牛皮癬關節炎症狀
2007/12/10 上午 10:25:00
懷孕期間使用新的牛皮癬生物製劑無嚴重安全疑慮
2007/2/14 下午 03:24:00

上一頁
   1   2   3   4   5   6   7   8  




回上一頁