乾癬に対する5-FU軟膏のODT療法

TREATMENT OF PSORIASIS VULGARIS WITH TOPICAL 5-FLUOROURACIL

　乾癬の治療法の1つとして，近年抗腫瘍剤すなわちaminopterin^1,2），methotrexate^3）などの葉酸拮抗剤やmercaptopurine^4），5-fluorouracil^3）（5-FU），triacetyl azauridine^5）（TA-AZUR）などの核酸拮抗剤の全身療法が行なわれ，その有効性が認められてきた。作用機序としてかかる物質は主として核酸合成機転に働き，表皮細胞に対する再生抑制作用を持つためとされている。しかしこれらの全身投与による白血球減少，口腔内粘膜潰瘍，出血，各種臓器障害などの副作用もまた見のがせない大きな問題となつている。

　最近Kleinら^6）は各種皮膚腫瘍に対して5-fluorouracil（以後5-FUと略す）軟膏の閉鎖密封療法（以後ODT療法と略す）を開発したが，この方法は腫瘍組織のみが選択的に破壊され，かつ上記副作用もみられないことより，皮膚腫瘍の治療学上の新分野をひらいた感を与える。

　Eight cases of psoriasis vulgaris were treated with the ODT of 5-FU ointment. The results were as follows:

　1) Disappearance of seals after 1-2 times' applications, disappearance of acanthosis and concurrent appearance of severe erythema, edema and partial blister formation after 4-5, erosion formation after 7-9 applications were observed. The unaffected skin was remained intact.

　2) In the histologic specimen from the skin after 2 times' applications parakeratosis and loss of the granular layer were observed, while shortening of the elongated rete ridges, edema of the epidermis, destruction of the epidermal cells, and a severe inflammatory infiltrate in the dermis were proved.

　Afer regeneration of the epidermis on the part of erosion no more histopathologic characteristics of psoriasis, but basal pigmentation, a mild inflammatory infiltrate and dilatation of the capillaries in the dermis were observed.

　3) A period of time until disappearance of the eruption was 14-19 days and was rather short compared with that of other kinds of treatment. No reccurences in all cases were not proved 2-7 months after discontinuation of the ODT. Moderate pain on the eroded areas was an untoward effect of this method.

　4) It was possible that incomplete maturation of the epidermal cells by accelerated mitotic activity of the psoriatic skin might be inhibited by 5-FU and the epidermis might return to the normal keratinizing process.