The ABC's of managing patients with severe atopic dermatitis
The ABC's of managing patients with severe atopic dermatitis
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DOI：
10.1016/j.jaci.2013.06.030
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发表时间：
2013-08-01
影响因子：
14.2
通讯作者：
Leung, Donald Y. M.
中科院分区：
文献类型：
--
作者：
Boguniewicz, Mark;Leung, Donald Y. M.
一个3岁的男孩提出了难以治疗的特应性皮炎（AD）的历史。他“从出生起”就有湿疹性皮疹。皮疹最初累及他的脸颊和四肢的伸肌，但最近也累及肘前肌、手腕、手指、下后躯干、腘肌和踝关节。他的皮肤越来越痒，睡眠也不好。过去，湿疹对局部皮质类固醇有反应。他还接受了保湿乳液和西替利嗪治疗，每天一次。最近，他因疑似皮肤感染接受了两次口服抗生素治疗。他的父母担心食物过敏可能是孩子患AD的原因。最近，他的儿科医生测量了他的血清IgE水平，为3176 IU/mL，并将sIgE测量结果发送给一组常见的食物过敏原。父母说，这些都是“积极的”。这对父母一直在努力消除所有被报告为阳性的食物，但孩子的AD仍在继续发作。病人曾因几次病毒性上呼吸道感染而喘息，最近，当他在朋友家过夜时，那里有一只猫。家里没有毛茸茸的动物，孩子也不在日托所。他的母亲有儿童哮喘病史，他的哥哥有花粉热。
A 3-year-old boy presents with a history of difficult-to-treat atopic dermatitis (AD). He has had an eczematous rash “since birth.” The rash initially involved his cheeks and the extensor aspects of the extremities, but more recently, it has also involved the antecubitals, wrists, fingers, lower posterior trunk, popliteals, and ankles. He has had increased itching and has not been sleeping well. In the past, the eczema had responded to topical corticosteroids. He has also been treated with a moisturizing lotion and cetirizine once daily. More recently, he was treated with oral antibiotics twice for suspected skin infections. His parents are concerned that food allergy might be the cause of the child’s AD. Recently, his pediatrician measured his serum IgE level, which was 3176 IU/mL, and also sent off sIgE measurements to a panel of common food allergens. The parents state that these were “all positive.” The parents have struggled to eliminate all of the foods reported as positive, but the child’s AD continues to flare.The patient has wheezed with several viral upper respiratory tract infections and, more recently, when he slept over at a friend’s home, where a cat was present. There are no furred animals in the home, and the child is not in day care. His mother has a history of childhood asthma, and his older brother has hay fever.