Long Term Treatment Concepts and Proactive Therapy for Atopic Eczema
Long Term Treatment Concepts and Proactive Therapy for Atopic Eczema
复制标题
特应性湿疹的长期治疗概念和积极治疗
作者：
A. Wollenberg;L. Ehmann
特应性湿疹，也称为特应性皮炎，是一种常见、高度瘙痒的慢性皮肤病，通常呈发作状。传统的治疗主要包括局部抗炎药物的反应性应用，例如局部皮质类固醇和局部钙调神经磷酸酶抑制剂。这种方法的短期效益是众所周知的，但耀斑之间的长期缓解很难实现。因此，需要针对预防耀斑和稳定皮肤屏障的创新长期治疗策略。我们和其他人已经证明，特应性皮炎患者看起来正常、无病变的皮肤在免疫生物学上并不正常，但其特征是看不见的炎症和屏障缺陷。这催生了主动治疗的新概念，其定义是对先前受影响的皮肤进行长期、低剂量间歇性抗炎治疗，同时对未受影响的皮肤进行持续的润肤治疗。这篇综述文章描述了特应性皮炎最重要的长期治疗方案，包括润肤疗法、主动治疗的新概念、不同的紫外线模式以及一系列全身免疫抑制药物和生物制剂。总结了不同治疗方式的当前试验数据、许可适应症、超说明书使用和相关副作用。
Atopic eczema, also known as atopic dermatitis, is a frequent, highly pruritic, chronic skin disease, which is typically running in flares. The traditional treatment mainly consists of the reactive application of topical anti-inflammatory agents such as topical corticosteroids and topical calcineurin inhibitors. The short term benefit of this approach is well known, but long term remission between flares is difficult to achieve. Therefore, innovative long-term treatment strategies targeting flare prevention and skin barrier stabilization are needed. We and others have shown that normal looking, non-lesional skin of atopic dermatitis patients is immunobiologially not normal but characterized by an invisible inflammation and barrier defect. This has led to the novel concept of proactive therapy, which is defined as long-term, low-dose intermittent application of anti-inflammatory therapy to the previously affected skin, together with an ongoing emollient treatment of unaffected skin. This review article describes the most important long-term treatment options for atopic dermatitis, which includes emollient therapy, the novel concept of proactive treatment, the different ultraviolet light modalities and a selection of systemic immunosuppressive drugs and biologics. Current trial data, licensed indications, off-label use and relevant side effects of the different treatment modalities are summarized.