Застосування топічного такролімуса у хворих із екземою рук з урахуванням ступеня тяжкості дерматозу, деяких показників цитокінового профілю, вмісту вітаміну д та генетичного поліморфізму гена глюкокортикоїдного рецептора

Abstract

The purpose of the study was to evaluate and compare the therapeutic capacity of 0.1% topical tacrolimus ointment in patients with hand eczema who were resistant to glucocorticoid treatment, taking into account the severity of dermatosis, interleukin-17A and interleukin-2 concentrations, vitamin D and genetic polymorphism of the glucocorticoid receptor gene. Materials and methods. The venous blood of 143 patients with hand eczema aged (42.2±11.1) years was used in the study. During the patients examination the data on age, sex, body mass index (kg/m2), body mass index ≥25 kg/m2 (%), smoking, IgE (iu/ml), interleukin-17A (pg/ml), interleukin-2 (pg/ml), and 1,25(OH)2D3 (ng/ml) were obtained. The Hand Eczema Severity Index was also assessed in each subject. According to the Hand Eczema Severity Index value all patients were divided into three subgroups: mild, moderate and severe eczema. Patients with mild and moderate eczema were appointed topical glucocorticoid 0.1% mometasone furoate cream twice a day for 2 weeks. Patients with severe hand eczema was appointed additionally systemic corticosteroid – a solution of dexamethasone by intramuscular injection at the dose of 8 mg/day No. 3, then another 4 mg/day for other 2 days. After 2 weeks, individuals who did not respond well to glucocorticoid treatment were prescribed tacrolimus 0.1% ointment twice a day for 2 weeks. BclI SNP (rs41423247) of the glucocorticoid receptor gene (NR3C1) was determined using the polymerase chain reaction-restriction fragment length polymorphism method (Fleury et al. 2003). The statistical analysis was performed using the program SPSS 22.0. The quantitative variables were tested for normal distribution by the Shapiro-Wilk method. The comparisons of the means between the two subgroups were performed using Student's t-test for independent samples. The comparison of the frequencies distribution in the subgroups was performed using the Pearson test. The P value <0.05 was considered as significant. Results and discussion. Findings in a previous study showed that not all people with hand eczema responded well to treatment with topical 0.1% mometasone furoate cream and systemic glucocorticoid. After 2 weeks of topical tacrolimus, of 51 patients who were not responsive to glucocorticoid treatment, 39 responded well to therapy. The concentration of interleukin-17A in the blood serum of such people was significantly lower than in people who did not respond to treatment. Conclusion. We did not find any differences in the content of immunoglobulin E, interleukin-2, 1α,25(OH)2D3 and BclI polymorphism of the glucocorticoid receptor gene in the subjects under study