目的:探讨外用0.1%他克莫司软膏联合308nm准分子激光治疗白癜风的疗效及安全性。方法:患者35例,以自身未治疗皮损作为空白对照,每例患者选择两处相近或对称部位的皮损,每周2次以308nm准分子激光进行治疗,共治疗16次。A组皮损同时每天早晚外用0.1%他克莫司软膏,B组单用308nm准分子激光治疗,试验结束时依据治疗前、后皮损的照片进行疗效评价。结果:试验结束时,未治疗的皮损均未出现任何改善,A组有效率为97.1%(34/35),B组为85.7%(30/35),显效率A组为74.3(%26/35)、B组为48.6%(17/35),两组间显效率有显著性差(异2χ=4.884,P=0.023),但有效率差异不显著(2χ=2.917,P=0.088)。对18例患者进行随访,3个月内,A组所有治疗皮损均维持稳定或持续好转,而B组有3例皮损出现复发。结论:308nm准分子激光治疗白癜风疗效高、副作用少,联合外用0.1%他克莫司软膏可显著提高其疗效并减少复发。
　白癜风的发病与自身免疫密切相关,作为第一个外用的免疫调节剂,他克莫司软膏应用于白癜风的治疗已被证实有较好的疗效,同时研究者观察到接受日光照射的部位效果最好[1]。308nm准分子激光靶光疗也是目前白癜风治疗的新热点,其机制可能与紫外线免疫抑制作用有关[2]。联合308nm准分子激光靶光疗和外用他克莫司软膏,可能进一步提高白癜风的疗效。为此,2005年9月～2005年12月,我们观察了308nm准分子激光联合外用0.1%他克莫司软膏治疗35例白癜风患者的疗效及不良反应,现报道如下。1临床资料和方法1.1病例:35例均为我科门诊治疗的白癜风患者,男15例…

　Objectives To explore the efficacy and safety of combined tacrolimus and 308nm excimer laser therapy in treating of vitiligo.Methods Thirty five patients were included,slef-controled with untreated lesions,2 symmetrical or nearby target lesions of each patients were chosen to treat twice a week by the 308 nm excimer laser for a total of 16 sessions.Group A was combined applied twice daily on target lesions with topical 0.1% tacrolimus ointment,Group B target lesions received only excimer laser monotherapy.Efficacy was analyzed using digital photography taken before and after treatment.Results While the study completed,no improvement of the untreated lesions were observed,repigmentation was observed in 97.1%(34/35)of group A lesions and in 85.7%(30/35) of group B lesions.Significant improvement(a repigmentation rate of 50% or more) was obtained in 74.3%(26/35) of group A lesions and 48.6%(17/35) of group B lesions.Within the 3 following months,of 18 patients,the treated lesions of Group A were remained stably or got better continued,but three lesions of Group B recurred.Conclusion The 308 nm excimer laser was safe and effective in treatment of vitiligo,combination treatment of topical 0.1% tacrolimus ointment could improve the efficacy significantly and prevent from recurrence.