| Objective1.To detect the amount of Malassezia on the lesions and non-lesional areas of the faces and limbs from patients with atopic dermatitis(AD),and explore its correlation with the disease severity.2.To explore the difference between fluorescent staining and methylene blue staining on the detection of Malassezia density.MethodsThe subjects were from 84 AD patients who were admitted to the Department of Dermatology,the First Affiliated Hospital of Chengdu Medical College from March to September 2018.They consisted of 30 mild,28 moderate and 26 severe cases.At the same time,28 healthy subjects were selected as controls.Two Samples were collected from the lesions or non-lesional areas on the faces and limbs of AD patients and the corresponding areas of healthy control subjects by adhesive tape technique.The tapes were evenly attached to the slides with fungal fluorescent staining solution and methylene blue staining solution.Then observing and counting Malassezia under fluorescent light source or ordinary light source,quantitatively detecting the colonization of Malassezia on the lesions and non-lesional areas of the faces and limbs from AD patients and healthy controls.Analysing its correlation with the disease severity,and comparing the difference between fluorescent staining and methylene blue staining on the detection of malassezia density.ResultsThe results obtained by fluorescent staining and methylene blue staining were the same.(1)Comparison of Malassezia density in different parts:(a)The density of Malassezia in the lesions or non-lesional areas on the face of the mild,moderate and severe AD patients were higher than those of the upper limbs(P<0.05).(b)The density of Malassezia in the faces of healthy controls were higher than those of the upper limbs(P<0.05).(2)Comparison of Malassezia density between lesions and non-lesional areas: There was no significant difference in the density of Malassezia between the lesions and the non-lesional areas of the same severity and part(P>0.05).(3)Comparison between AD patients with different severity and healthy controls:(a)The density of Malassezia in the lesions or non-lesional areas on the face of the mild,moderate and severe AD patients were higher than those of healthy controls(P<0.05).(b)There was no significant difference in the density of Malassezia between the lesions or non-lesional areas of upper limbs of the mild,moderate and severe AD and healthy controls(P>0.05).(4)The density of Malassezia in each part of AD patients were not correlated with the disease severity(P>0.05).(5)Comparing fluorescent staining and methylene blue staining,the density of Malassezia detected by fluorescent staining was higher than that of methylene blue staining(P<0.05).Conclusion(1)Fluorescent staining is more clear than methylene blue staining to reflect the density of Malassezia on the skin surface.(2)The density of Malassezia on the faces of the mild,moderate and severe AD patients or healthy controls are higher than those of the upper limbs.And there is no significant difference in the density of Malassezia between the lesions and the non-lesional areas.(3)The content of Malassezia in the faces of AD patients are higher than those of healthy controls,while the content of Malassezia in upper limbs are not different from those in healthy upper limbs,and there is no correlation between the severity of AD and the density of Malassezia on the skin surface.It indicates that the amount of Malassezia in the skin of AD patients is related to the site,but not to the disease severity,and Malassezia may play a role in the condition of head and neck AD patients.Objective To evaluate the efficacy and safety of antifungal drugs in the treatment of atopic dermatitis.Methods We searched Embase,Pubmed,Cochrane Library,CBM,CNKI,VIP and Wanfang database by computer,and collected all randomized controlled trials of antifungal drugs for AD.Two reviewers independently screened the literatures,extracted the data,and evaluated the quality according to the inclusion criterias and exclusion criterias,and used the Review Manager5.3 to quantitatively synthesize and qualitatively describe the results.Results We finally included 14 studies,a total of 982 subjects.According to different intervention and Control measures,it was divided into six subgroups including : oral antifungal drugs VS placebo,oral antifungal drugs + others VS others,oral antifungal drugs VS others,topical antifungal drugs VS placebo,topical antifungal drugs VS topical glucocorticoid and topical antifungal drugs + topical glucocorticoid VS topical glucocorticoid.The results of bias risk showed that the random distribution methods and allocation concealment were not perfect in most studies,and some studies had incomplete data and selective report research results.Quantitative analysis results: Topical antifungal drugs were better than topical glucocorticoid(RR=1.39,95%CI[1.12,1.72],Z=3.01,P=0.003).And there was no significant difference in adverse reactions compared with the control group(RR=0.50,95%CI[0.10,2.59],P>0.05).Topical antifungal drugs + topical glucocorticoid were better than topical glucocorticoid(RR=1.18,95%CI [1.07,1.30],Z=3.25,P=0.001).And there was no significant difference in adverse reactions compared with the control group(RR=2.04,95%CI[0.53,7.86],P>0.05).Qualitative analysis results: Ketoconazole did not significantly reduce clinical scores compared with placebo.Itraconazole significantly reduced clinical scores compared with placebo and the efficacy of itraconazole + lactobacillus preparation is higher than that of lactobacillus preparation alone.Conclusion Due to the lack of repeated validation,small sample size,and poor methodological quality of randomized controlled trials included in this systematic review,the efficacy and safety of antifungal drugs for the treatment of AD can not be accurately evaluated according to the existing literatures.Its clinical application needs further confirmation with more high-quality and large-sample prospective randomized control trials. |
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