Fabry씨 용액과 항생제 (Chloramphenicol 또는 Clindamycin)를 함유한 Fabry씨 용액의 국소도포에 의한 좌창치료에 대한 임상 비교 연구

Abstract

[한글]

좌창의 치료에는 현금까지 많은 방법들이 사용되고 있으며 최근각광을 받고 있는 방법중의 하나는 항생제요법이다. 좌창의 치료제로서 항생제는 약 30년전부터 경구적으로 사용되었으며, 15년전부터는 국소도포제로도 사용되었다. 최근 좌창의 치료에 각광을 받는

국소도포용 항생제로는 clindamycin, erythromycin 및 tetracycline등을 들 수 있다(Stoughton, 1979). 위의 세가지약재 즉 clindamycin, erythromycin, tetracycline을 국소도포하여 clindamycin이 Propionibacterium acnes의 성장 억제에 가장 우수하며, clindamycin이 임상 관찰로서 좌창의 치료에 가장 좋은 국소도포용 항생제라고 보고된 바 있다( Resh 및 Stoughton, 1976; Stoughton, 1979). 그러나 clindamycin 국소도포에 의한 접촉성 피

부염이나 위막양 장염이 보고되어 사용에 주의를 요한다고 하였다 (Coskey, 1978; Milstone등, 1981).

이에 저자는 한국인 좌항환자 53명에게 종래에 본 교실에서 살균제 및 각질용해제로 사용하던 Fabry씨 용액(이후 F용액으로 칭함; salicylae 1%, phenol 1% in 75% ethyl alcohol) 단독과 이를 기제로한 1% chloramphenicol(c)또는 1% clindamycin(cd) 용액을 도포하여 임상적 치료효과를 육안 및 Wood's lamp로 관찰하였고, 아울러 부작용을 관찰하여 다음과 같은 결론을 얻었다.

1. 총 발진수는 F용액, F-c용액, F-cd용액 도포군에서 각각 치료후 6주, 2주, 1주부터 통계학적으로 의의있는 감소를 나타내었으며 치료후 6주에 각각 55%, 55%, 70%의 감소율을 나타내었다.

2. Wood's lamp하에서 의 형광수는 F용액, F-c용액, F-cd용액 도포군에서 각각 치료후 6주, 2주, 1주부터 통계학적으로 의의있는 감소를 나타내었으며 치료후 6주에 각각 65%, 80%, 90%의 감소율을 나타내었다.

3.구진수는 F용액, F-c용액, F-cd용액 도포군에서 각각 치료후 6주에 50%, 65%, 70%의 감소율을 나타내었으며, F-c용액과 F-cd용액 도포군에서 각각 치료 5주, 4주부터 통계학적으로 의의있는 감소를 나타내었다.

4.개방성 면포수는 F용액, F-c용액, F-cd용액 도포군에서 각각 치료후 6주에 65%, 50%, 60%외 감소율을 나타내었으나, F-cd용액 도포군에서 치료후 6주부터 통계학적으로 의의있는 감소를 나타내었다.

5 .폐쇄성 면포수와 농포수는 예수가 적어 통계학적하기 어려우나 농포수에서 F-cd용액 도포군에서 치료후 5주부터 의의있는 감소를 나타내었다.

6. 본 실험에서 관찰할 수 있었던 부작용으로는 인설, 소양감, 억죄임, 발적으로 세 군사이에 유의한 차이가 없었으므로 이는 F용액으로 인한 자극에 기인된 것으로 사료되며 대부분 경도에 속하여 치료에 별 지장을 주지 않았다.

이상의 실험 결과로 보아 F-cd용액이 종래에 본 교실에서 사용하던 F용액과 F-c용액보다 좌창에 대한 치료효과가 우수하였으며 특히 구진과 농포 즉 염증성 병변에 효과가 있었다. 또한 국소도포제의 좌창에 대한 치료효과를 판정하는 방법으로 육안으로 병변수를

세는 것보다 Wood's lamp하에서 형광수의 변화를 관찰하는 방법이 간편하고 정밀한 방법으로 사료되었다.

COMPARATIVE STUDY OF CLINICAL EFFECT BY TOPICAL APPLICATION OF FABRY'S SOLUTION AND

FABRY'S SOLUTION WITH ANTIBIOTICS (CHLORAMPHENICOL OR CLINDAMYCIN) IN ACE

Choong Seop Hahn

Department of Medical Science The Graduate School, Yonsei University

(Directed by Professor Sungnack Lee, M.D.)

Antibiotic therapy for acne is now considered one of the most effective regimen.

Thirty years ago, oral antibiotics were introduced for acne vulgaris and topical

preparations have been available by prescription for more than 15 years. Recently,

clindamycin, erythromycin and tetracycline were regarded as the most effective and

widely used antibiotics.

Resh and Stoughton (1976) reported that clindamycin lotion completely suppressed

the growth of Propionibatetrium acnes organisms, whereas erythromycin and

tetracycline did not depress the Propionibatetrium acnes counts, which was

confirmed by quantitation of these organisms from open comedones during treatment.

Stoughton (1979) reported that seventy-four percent of the dermatologists in U.S.A.

were using clindamycin topically for the management. of acne and mere than half of

the dermatologists thought that tropical clindamycin was equal to or better than

oral tetracycline. But Coskey (1978) reported a case of contact dermatitis due to

clindamycin and Milstone et al (1981) reported a case of pseudomembranous colitis

after topical application of clindamycin.

In this dermatologic department, Kim and Lee (1976), Kim and Lee (1977) and Kim

et al (1980) studied the clinical effectiveness and side effect of vitamin A acid

and its derivatives. Based upon these studies, the author studied the clinical

effectiveness and side effects of Fabry's solution, used as an antiseptic and

keratolytic agent, and Fabry's solution containing chloramphenicol or clindamycin

to clarify the therapeutic effect and side effect of clindamycin. Fifty three

patients, divided into three groups, all of which were followed for 6 weeks were

studied and the results were as follows.

1. The total numbers of lesions in groups treated with F solution F-c solution,

or F-cd solution were decreased significantly from the fifth, forth, or third week

of treatment and their therapeutic effects at the end of six weeks were estimated

as 55%, 55%, or 70%.

2. The numbers of fluorescence under Wood's lamp in groups treated with F

solution, F-c solution, or F-cd solution were decreased significantly from the

sixth, second, or first week of treatment. Their therapeutic effects at the end of

six weeks were estimated as 65%, 80%, or 90%.

3. The therapeutic effects of papules at the end of the sixth week of treatment

in groups treated with F solution, F-c solution, or F-cd solution were estimated as

50%, 65%, or 70%. The therapeutic effects of open comedones at the end of the sixth

week of treatment in groups treated with F solution, F-c solution, F-cd solution

were 65%, 50%, or 60%.

4. In the case of closed comedones and pustules, cases were too few in number but

the number of pustules in the F-cd solution treated group was decreased

significantly from the fifth week of treatment.

5. The side effects were scaling, itching, tightness or erythema which were not

significantly different among the three groups and most of them were mild. It was

suggested that they were due to irritation of F solution.

From these data, we mar conclude that F-ed solution was superior to F or F-c

solution in effect on acne, especially on inflammatory lesions such as papules and

pustules .Counting the numbers of prophyrin fluorescence under Wood's lamp during

treatment seemed to be a very simple, convenient and accurate method of evaluating

the clinical effectiveness of topical agents in acne.

[영문]

Antibiotic therapy for acne is now considered one of the most effective regimen. Thirty years ago, oral antibiotics were introduced for acne vulgaris and topical preparations have been available by prescription for more than 15 years. Recently,

clindamycin, erythromycin and tetracycline were regarded as the most effective and widely used antibiotics.

Resh and Stoughton (1976) reported that clindamycin lotion completely suppressed the growth of Propionibatetrium acnes organisms, whereas erythromycin and tetracycline did not depress the Propionibatetrium acnes counts, which was confirmed by quantitation of these organisms from open comedones during treatment.

Stoughton (1979) reported that seventy-four percent of the dermatologists in U.S.A. were using clindamycin topically for the management. of acne and mere than half of the dermatologists thought that tropical clindamycin was equal to or better than

oral tetracycline. But Coskey (1978) reported a case of contact dermatitis due to clindamycin and Milstone et al (1981) reported a case of pseudomembranous colitis after topical application of clindamycin.

In this dermatologic department, Kim and Lee (1976), Kim and Lee (1977) and Kim et al (1980) studied the clinical effectiveness and side effect of vitamin A acid and its derivatives. Based upon these studies, the author studied the clinical effectiveness and side effects of Fabry's solution, used as an antiseptic and keratolytic agent, and Fabry's solution containing chloramphenicol or clindamycin to clarify the therapeutic effect and side effect of clindamycin. Fifty three

patients, divided into three groups, all of which were followed for 6 weeks were studied and the results were as follows.

1. The total numbers of lesions in groups treated with F solution F-c solution, or F-cd solution were decreased significantly from the fifth, forth, or third week of treatment and their therapeutic effects at the end of six weeks were estimated as 55%, 55%, or 70%.

2. The numbers of fluorescence under Wood's lamp in groups treated with F solution, F-c solution, or F-cd solution were decreased significantly from the sixth, second, or first week of treatment. Their therapeutic effects at the end of six weeks were estimated as 65%, 80%, or 90%.

3. The therapeutic effects of papules at the end of the sixth week of treatment in groups treated with F solution, F-c solution, or F-cd solution were estimated as 50%, 65%, or 70%. The therapeutic effects of open comedones at the end of the sixth

week of treatment in groups treated with F solution, F-c solution, F-cd solution were 65%, 50%, or 60%.

4. In the case of closed comedones and pustules, cases were too few in number but the number of pustules in the F-cd solution treated group was decreased significantly from the fifth week of treatment.

5. The side effects were scaling, itching, tightness or erythema which were not significantly different among the three groups and most of them were mild. It was suggested that they were due to irritation of F solution.

From these data, we mar conclude that F-ed solution was superior to F or F-c solution in effect on acne, especially on inflammatory lesions such as papules and pustules .Counting the numbers of prophyrin fluorescence under Wood's lamp during

treatment seemed to be a very simple, convenient and accurate method of evaluating the clinical effectiveness of topical agents in acne.