宝宝湿疹手册转载(2)

3）外用的激素制剂
•强效制剂：17-氯倍他索（恩肤霜）、丙酸倍他米松、氯氟舒松（肤乐膏、乐肤液）、肤轻松
•中效制剂：糠酸莫米松（艾洛松）、曲安奈德（皮康霜、复方康纳乐霜）、丁酸氢化可的松（尤卓尔）
•弱效制剂：地塞米松、氢化可的松
制剂的疗效强弱还与剂型、药物的浓度与关

来自安徽大学医学院
[5]0.025%的地塞米松是弱效激素

1．2合理选择皮质类固醇激素
皮质类固醇激素种类不同，效能或强度也不同，根据皮质类固醇激素对血管收缩反应的强弱，美国药典将局部外用皮质类固醇激素效能依次分为低、中、高、超效四级。小儿原则上不用超效激素如二丙酸倍他米松，双醋二氟松等高效激素如 0.05%卤美他松霜可短期用于异位性皮炎，慢性增厚或盘形湿疹和儿童银屑病的较厚皮损。白癜风发病早，约半数人在20岁以前发病,儿童白癜风发病更早，早到出生后即发病，亦可选用0.05%卤美他松，较成年人病程短，用药量少。以间歇用药或与非激素类外用药轮流应用为宜。大多数小儿皮肤病适合用中、低效皮质类固醇激素，尤其是面部、间擦部位、外阴部、尿布区域，常用低效皮质类固醇 如1%氢化考的松霜，0.025%地塞米松霜，中效皮质类固醇激素多用于躯干、四肢、头皮及足部，常选用0.1%糠酸莫米松（艾洛松）,还有丁酸氢化考的松，即国产的尤卓尔。
　　

来自医学教育网


[6]地塞米松是氢化可的松20-30倍

Dexamethasone is a potent synthetic member of the glucocorticoid class of steroid hormones. It acts as an anti-inflammatory and immunosuppressant. Its potency is about 20-30 times that of hydrocortisone

来自维基百科


[6]地塞米松在英国是II类强激素，456ug/g cream相当于0.05% betamethasone valerate
引自PMC journal
?artid=27755

【7】地塞米松的强度是氢化可的松的70倍以上，被低估是由于20-30倍的数据是建立在动物模型上

Contrasting manufacturers’ claims, dexamethasone was found to be about 70-fold more potent than hydrocortisone in suppressing adrenal steroid production3. Unfortunately, dexamethasone has been applied to endocrine treatment based on a 25-30:1 potency, relative to hydrocortisone, leading to overtreatment and an incorrect ‘growth-toxic’ label.

来自于

[8] 地塞米松是第7类弱效激素

VII:Low Potency

flumethalone
hydrocortisone
methylprednisolone
prednisolone

来自密西根大学病理系

7、英国的湿疹手册摘要

还找到了英国的一个网站，
?action=byID&o=11901 

来自UK的湿疹手册摘要：
1、保湿霜和激素药膏

大多数湿疹宝宝每天涂保湿霜，在湿疹爆发时涂激素药膏。当联合使用时，先抹保湿霜，停10-15分再抹激素药膏。也就是在抹激素前，皮肤已经吸收了保湿霜（抹激素时皮肤是潮潮的粘粘的）
2、
如果爆发的湿疹用激素和保湿霜没有控制住那么就去看医生，要考虑的问题包括：

a、是否增强加激素强度？
b、发炎的皮肤是否感染需要抗生素？
c、是否对保湿霜或激素药膏的成分过敏？

3、保湿霜

保湿霜每周使用250-500g。

4、激素规则

a 弱激素治疗轻微的湿疹
b 中等强度激素治疗中等程度的湿疹
c 强效激素治疗严重的湿疹
d 中等强度或强效激素可用于腋窝腹股沟短期治疗（7-14天）
e 脸上和脖子应该只用弱效激素，若是严重的话用中效/强效不超过5天
f 宝宝没有医生的建议下不要用超强效激素

8、皮肤对激素的吸收

眼睛周围/生殖器 30
脸部 7
肘窝 4
前臂 1
手掌 0.1
脚掌 0.05 

9、关于1%氢化可的松的安全

1、1%氢化可的松是最弱的激素。如果这个不能用的话，宝宝没有可以用的药物
2、1%氢化可的松在国外是oTC药物，是所有宝宝湿疹文献上提到的治疗药物
3、国外所有的1%氢化可的松药膏都是这样写的under 2 years old, do not use, ask a doctor。并不是不能用，而是说去问医生。

10、关于非激素药物丁苯氰酸（舒肤林、可润）的安全

可润或舒服林（丁苯氰酸）在国外用来治疗湿疹已经有30年历史，对稍微严重的湿疹的效果远远低于激素药膏。

目前看到的唯一副作用就是可能引起接触性皮炎，尤其在治疗慢性湿疹反复使用时。
[来自European Journal of Dermatology]
其它的副作用没有看到。

The 6-year-old girl recurrently used bufexamac-containing ointments and creams for the treatment of atopic eczema since babyhood. Due to the exacerbation of atopic dermatitis bufexamac-containing ointments were applied, but this time instead of resolving, eczema worsened on day six. The girl and her mother presented in our clinic on day 14. Clinical investigation showed extreme scaling and mild erythema on the face, chest and throat. We recommended stopping treatment with bufexamac and the skin lesions resolved within 2 weeks. Patch testing to prove the suspected contact allergy to bufexamac was refused by the mother. The clinical course and clinical picture were consistent with that of allergic contact dermatitis. Almost 30 years ago the arylacanoic acid derivative bufexamac was introduced to dermatological therapy. Bufexamac – containing preparations are widely used in the treatment of atopic or other eczematous skin disorders as an alternative to topical corticosteroids. First cases of contact allergy to a 5% bufexamac cream had been reported as early as 1973, almost 20 years later a 2nd type of adverse reaction after topical application of bufexamac was observed, an erythema multiforme-like eruption [65]. Contact allergy induced by bufexamac, which belongs to the group of nonsteroidal anti-inflammatory drugs, is still rare but increasing [65-67]. Kränke et al. [65] reported clinically relevant patch test reactions to bufexamac in 20 out of 35 patients having applied (n = 30) or having probably applied (n = 5) bufexamac ointment (57%), whereas, in their unselected test population of 500 routinely patch tested patients, the overall frequency was 4%.
In all forms of eczematous skin disorders, especially in patients suffering from chronic eczema or in patients with exacerbation of long-standing eczemas, contact allergy to bufexamac should be considered, even if bufexamac preparations were used for only a short time [68]. The appropriate test concentration is 5%

11、Berylpp之新华医院祁怀山医生谈湿疹治疗