ETFAD/EADV Eczema task force 2015 position paper on diagnosis and treatment of atopic dermatitis in adult and paediatric patients
ETFAD/EADV Eczema task force 2015 position paper on diagnosis and treatment of atopic dermatitis in adult and paediatric patients
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DOI：
10.1111/jdv.13599
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发表时间：
2016-05-01
影响因子：
9.2
通讯作者：
Darsow, U.
中科院分区：
文献类型：
--
作者：
Wollenberg, A.;Oranje, A.;Darsow, U.
特应性皮炎（AD）是一种临床上定义的，高度过敏性，慢性炎症性皮肤病的儿童和成人。诊断是使用评估的临床标准。疾病活动性最好用评估客观体征和主观症状的综合评分来衡量，如SCORAD。AD的管理必须考虑疾病的临床和病原变异性，并以预防复发为目标。基础治疗包括局部补水治疗，以及避免特异性和非特异性激发因素。可见皮肤病变的抗炎治疗是基于局部糖皮质激素和局部钙调磷酸酶抑制剂他克莫司和吡美莫司。敏感部位首选局部钙调磷酸酶抑制剂。他克莫司和中效类固醇被证明是积极的治疗，这是长期间歇性抗炎治疗的频繁复发的皮肤领域。全身抗炎或免疫抑制治疗适用于严重难治性病例。靶向特应性免疫应答的关键机制的生物制剂是有希望的新兴治疗选择。微生物定植和重复感染可能会导致疾病恶化，并可以证明额外的抗菌治疗。全身性抗组胺药（H1R阻断剂）可减轻瘙痒，但对病变没有足够的作用。辅助治疗包括UV照射，优选UVA 1或窄带UVB 311 nm。饮食建议应针对患者具体情况，只有在证实食物过敏的情况下才应建议消除饮食。针对空气过敏原的过敏原特异性免疫疗法可能在某些病例中有用。建议提供身心咨询，以解决压力引起的病情恶化问题。“生态学校”教育方案已被证明对儿童和成人都有帮助。
Atopic dermatitis (AD) is a clinically defined, highly pruritic, chronic inflammatory skin disease of children and adults. The diagnosis is made using evaluated clinical criteria. Disease activity is best measured with a composite score assessing both objective signs and subjective symptoms, such as SCORAD. The management of AD must consider the clinical and pathogenic variabilities of the disease and also target flare prevention. Basic therapy includes hydrating topical treatment, as well as avoidance of specific and unspecific provocation factors. Anti-inflammatory treatment of visible skin lesions is based on topical glucocorticosteroids and the topical calcineurin inhibitors tacrolimus and pimecrolimus. Topical calcineurin inhibitors are preferred in sensitive locations. Tacrolimus and mid-potent steroids are proven for proactive therapy, which is long-term intermittent anti-inflammatory therapy of the frequently relapsing skin areas. Systemic anti-inflammatory or immunosuppressive treatment is indicated for severe refractory cases. Biologicals targeting key mechanisms of the atopic immune response are promising emerging treatment options. Microbial colonization and superinfection may induce disease exacerbation and can justify additional antimicrobial treatment. Systemic antihistamines (H1R-blockers) may diminish pruritus, but do not have sufficient effect on lesions. Adjuvant therapy includes UV irradiation, preferably UVA1 or narrow-band UVB 311 nm. Dietary recommendations should be patient specific and elimination diets should only be advised in case of proven food allergy. Allergen-specific immunotherapy to aeroallergens may be useful in selected cases. Psychosomatic counselling is recommended to address stress-induced exacerbations. 'Eczema school' educational programmes have been proven to be helpful for children and adults.