Framing the Future of Antifungals in Atopic Dermatitis
Framing the Future of Antifungals in Atopic Dermatitis
复制标题
构建特应性皮炎抗真菌药物的未来
作者：
A. Nikkels;G. Piérard
特应性皮炎是一种常见的慢性炎症性皮肤病。皮肤上的一些真菌定植或感染可能会加剧AD的严重性，特别是所谓的头颈部变异。此外，白色念珠菌的过度肠道定植可能是另一个触发因素。因此，在选定的AD患者中使用抗真菌药物是有道理的。早期局部应用酮康唑治疗头颈部AD的试验显示，马拉色菌的定植减少，但临床严重性没有明显改善。相比之下，口服酮康唑治疗马拉色菌放射过敏吸附试验(RASTS)阳性的患者，临床症状改善和血清IgE降低。一些初步数据表明，口服伊曲康唑治疗AD患者减少了对局部皮质类固醇的需求，提供了临床改善，特别是在头颈部AD，减少了可能引发AD的皮肤和肠道真菌定植，降低了马拉色菌培养阳性的百分比，并显示出白色念珠菌和马拉色菌Rast值的下降。此外，除了抗真菌作用外，伊曲康唑还部分缓解了瘙痒和炎症。总之，口服伊曲康唑治疗可以减轻选定患者的AD严重程度。氟康唑也是有效的。为了优化AD患者的抗真菌治疗，是否应该评估皮肤表面真菌剂的负荷、真菌Rast值和特异性点刺试验，还需要进一步的研究。
Atopic dermatitis (AD) is a frequent chronic inflammatory skin disease. Some fungal colonization or infection of the skin may exacerbate AD severity, particularly the so-called head and neck variant. In addition, excessive intestinal colonization by Candida albicans may represent an additional triggering factor. Hence, there is a rationale to use antifungals in selected AD patients. Early trials with topical ketoconazole in head and neck AD showed a decrease in Malassezia colonization, but no significant improvement was observed in the clinical severity. In contrast, clinical improvement and decreased serum IgE were obtained in patients with positive Malassezia radioallergosorbent tests (RASTs) who were treated by oral ketoconazole. Some preliminary data suggested that oral itraconazole treatment in AD patients reduced the need for topical corticosteroids, provided clinical improvement particularly in head and neck AD, reduced the cutaneous and intestinal fungal colonization that may trigger AD, reduced the percentage of positive Malassezia cultures and demonstrated a decrease in C. albicans and Malassezia RAST values. Furthermore, beside its antifungal action, itraconazole in part relieves pruritus and inflammation. In conclusion, oral itraconazole treatment can alleviate AD severity in selected patients. Fluconazole is also effective. Further research is warranted to identify whether the load in skin surface fungal agents, the fungal RAST values and specific prick testing should be assessed in order to optimize the antifungal management in AD patients.
抗菌和抗真菌联合治疗重症特应性皮炎的效果。
DOI：
10.1016/s0091-6749(96)70106-9
发表时间：
1996
期刊：
The Journal of allergy and clinical immunology
影响因子：
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作者：
Kolmer,HL;Taketomi,EA;Hazen,KC;Hughs,E;Wilson,BB;Platts-Mills,TA
通讯作者：
Platts-Mills,TA