目的:局部和病灶内(IL)治疗可能被认为是化脓性汗腺炎(HS)患者的一线治疗;然而,支持其使用的证据是有限的。我们审查的目的是评估局部和IL治疗对HS患者的疗效和安全性。
方法:我们设计了对PICO(T)方法后可用的当前医学文献的系统综述。包括所有类型的研究(研究类型[T])与任何性别的人,年龄,与安慰剂相比,接受任何局部或IL治疗的HS(干预[I])和种族(人口[P]),其他治疗,或根本没有治疗(比较器[C]),和报告的疗效和/或安全性结果(结果[O])。定义了两个结果:生活质量和无。的患者,至少,1次不良事件。搜索是在科克伦图书馆进行的,MEDLINE,和EMBASE数据库;根据预定义的标准进行研究选择。在每项研究中都确定了偏倚的风险。
结果:我们总共获得了11363个参考文献,其中31项符合纳入标准。这些研究包括1143例HS患者,其中62%是女性。共有10、8、6、2和5项研究,分别,评估了光动力疗法(PDT)的使用,糖皮质激素,间苯二酚,局部抗生素,和其他干预措施。大多数文章是案例系列(n=25),只有5项随机临床试验(RCTs)和1项队列研究。RCT显示,与安慰剂相比,局部使用克林霉素和肉毒杆菌毒素(BTX)的疾病活动有所改善,和PDT与亚甲蓝(MB)niosomalvs游离MB;然而,病灶内曲安奈德并不优于安慰剂.3项RCT的偏倚风险较低,2项RCT的偏倚风险较高。
结论:支持局部用药的证据质量,或IL治疗较低。然而,它支持局部使用克林霉素,PDT,BTX需要具有标准化结果和同质人群的患者和病变的精心设计的RCT,以支持常规临床实践中的决策。
OBJECTIVE: Topical and intralesional (IL) treatments may be considered the first-line therapy in patients with hidradenitis suppurativa (HS); however, the evidence supporting their use is limited. The aim of our review is to evaluate the efficacy and safety profile of topical and IL treatments in patients with HS.
METHODS: We designed a systematic review of the current medical literature available following the PICO(T) method. And including all types of studies (Study type [T]) of individuals with HS of any sex, age, and ethnicity (Population [P]) who received any topical or IL treatment for HS (Intervention [I]) compared to placebo, other treatments, or no treatment at all (Comparator [C]), and reported efficacy and/or safety outcomes (Outcomes [O]). Two outcomes were defined: quality of life and the no. of patients with, at least, one adverse event. The search was conducted in the Cochrane Library, MEDLINE, and Embase databases; study selection was performed based on pre-defined criteria. The risk of bias was determined in each study.
RESULTS: We obtained a total of 11,363 references, 31 of which met the inclusion criteria. These studies included 1143 patients with HS, 62% of whom were women. A total of 10, 8, 6, 2, and 5 studies, respectively, evaluated the use of photodynamic therapy (PDT), glucocorticoids, resorcinol, topical antibiotics, and other interventions. Most articles were case series (n=25), with only five randomized clinical trials (RCTs) and one cohort study. RCTs showed improvement in disease activity with topical clindamycin and botulinum toxin (BTX) vs placebo, and PDT with methylene blue (MB) niosomal vs free MB; however, intralesional triamcinolone acetonide was not superior to placebo. The risk of bias was low in three RCTs and high in two RCTs.
CONCLUSIONS: The quality of evidence supporting the use of topical, or IL treatments is low. However, it supports the use of topical clindamycin, PDT, and BTX. Well-designed RCTs with standardized outcomes and homogeneous populations of patients and lesions are needed to support decision-making in the routine clinical practice.