Atopic dermatitis
Atopic dermatitis
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DOI：
10.1038/s41572-018-0001-z
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发表时间：
2018-06-21
影响因子：
81.5
通讯作者：
Irvine, Alan D.
中科院分区：
文献类型：
--
作者：
Weidinger, Stephan;Beck, Lisa A.;Irvine, Alan D.
特应性皮炎（AD）是最常见的慢性炎症性皮肤病，终生患病率高达20%，并对生活质量产生重大影响。AD的特征是强烈的瘙痒、反复出现的湿疹样病变和波动性病程。AD具有很强的遗传性成分，与其他特应性疾病（如哮喘和过敏性鼻炎）密切相关并通常共同发生。几种病理生理机制有助于AD病因学和临床表现。例如，由于结构蛋白聚丝蛋白的缺乏，表皮屏障功能受损可促进炎症和T细胞浸润。AD中的免疫应答倾向于辅助性T细胞2介导的途径，并且反过来可以有利于表皮屏障破坏。AD发病的其他促成因素包括皮肤微生物群的生态失调（特别是金黄色葡萄球菌的过度生长）、全身免疫应答（包括免疫球蛋白E（IgE）介导的致敏作用）和神经炎症（与瘙痒有关）。目前AD的治疗包括局部保湿剂和抗炎剂（如皮质类固醇、钙调磷酸酶抑制剂和cAMP特异性3 '，5'-环磷酸二酯酶4（PDE 4）抑制剂）、光疗和全身免疫抑制剂。转化研究促进了靶向小分子和生物疗法的发展，特别是对于中度至重度疾病。
Atopic dermatitis (AD) is the most common chronic inflammatory skin disease, with a lifetime prevalence of up to 20% and substantial effects on quality of life. AD is characterized by intense itch, recurrent eczematous lesions and a fluctuating course. AD has a strong heritability component and is closely related to and commonly co-occurs with other atopic diseases (such as asthma and allergic rhinitis). Several pathophysiological mechanisms contribute to AD aetiology and clinical manifestations. Impairment of epidermal barrier function, for example, owing to deficiency in the structural protein filaggrin, can promote inflammation and T cell infiltration. The immune response in AD is skewed towards T helper 2 cell-mediated pathways and can in turn favour epidermal barrier disruption. Other contributing factors to AD onset include dysbiosis of the skin microbiota (in particular overgrowth of Staphylococcus aureus), systemic immune responses (including immunoglobulin E (IgE)-mediated sensitization) and neuroinflammation, which is involved in itch. Current treatments for AD include topical moisturizers and anti-inflammatory agents (such as corticosteroids, calcineurin inhibitors and cAMP-specific 3',5'-cyclic phosphodiesterase 4 (PDE4) inhibitors), phototherapy and systemic immunosuppressants. Translational research has fostered the development of targeted small molecules and biologic therapies, especially for moderate-to-severe disease.