皮膚屏障功能障礙的治療(TREATMENT OF SKIN BARRIER DYSFUNCTION)
針對屏障功能障礙的療法仍然有限。半封閉性潤膚劑(semi-occlusive emollients),尤其是 petrolatum,可減少經表皮水分流失(transepidermal water loss),但其效果不如天然的角質層脂質。不透性與可透氣(vapor-permeable)敷料能提供近乎完全的封閉,在乾癬的治療上與強效外用類固醇同樣有效,但通常僅限於小面積的治療區域。此外,這些治療無法取代角質層作為微生物屏障的角色——它們被塗抹於微生物體之上(表淺於微生物體),因而在其下方提供了一個促進微生物生長與加強滲透的潮濕環境。這解釋了為何潤膚劑與封閉性敷料會增加皮膚感染的風險。值得注意的是,外用益生菌(topical probiotics)可對皮膚屏障恆定產生有益的效果。
針對屏障功能障礙的標的治療必須處理其潛在原因。雖然發炎可以抗發炎與免疫調節藥物治療,但一類針對脂質代謝缺陷的新型治療製劑正在浮現。例如,porokeratosis 與 CHILD 症候群兩者皆源自 cholesterol 合成的缺陷,據報告在塗抹 cholesterol 加上 lovastatin(後者阻斷致病性脂質前驅物的累積)後獲得改善。以 ceramide 為基礎的三重脂質混合物被用來處理有缺陷的屏障功能。對皮膚屏障驅動之疾病病理生理學認識的增加,應會為新穎療法提供重大的機會。
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未成熟角化外套膜的比例並不相關於
124-2 經皮與外用
藥物輸送