The Diagnosis and Graded Therapy of Atopic Dermatitis
The Diagnosis and Graded Therapy of Atopic Dermatitis
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DOI：
10.3238/arztebl.2014.0509
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发表时间：
2014-07-21
影响因子：
7.7
通讯作者：
Kapp, Alexander
中科院分区：
文献类型：
--
作者：
Werfel, Thomas;Schwerk, Nicolaus;Kapp, Alexander
背景：特应性皮炎是儿童最常见的皮肤病，患病率为10%~15%，在成人中也很常见。初级保健医生和专家之间的密切协调对于慢性和严重疾病患者的充分治疗是至关重要的。方法：本文通过选择性搜索Pubmed检索相关文献，并参考德国医学学会协会(AWMF)和欧洲皮肤病论坛的指南。结果：皮肤刺激物、过敏原、微生物病原体和心理因素等触发因素对个别患者的皮肤状况有不同的影响，应进行个体化评估。使用皮肤保湿霜或润肤剂，同时避免特定和非特定的刺激物是非常重要的，因为这些患者的皮肤屏障受损。糖皮质激素或钙调神经磷酸酶抑制剂的局部抗炎治疗是特应性皮炎治疗的核心部分；在特殊情况下，受影响严重的患者会接受全身抗炎药物治疗。跨学科的患者教育已被发现是一种有效的工具，在复杂的管理这种疾病。慢性和严重感染患者的诊断和治疗面临着特殊的挑战。结论：最近对皮肤屏障疾病以及先天性和获得性免疫疾病的分子基础的了解取得了进展，为特应性皮炎的治疗提供了新的方法。
Background: Atopic dermatitis is the most common skin disease in children, with a prevalence of 10% to 15%, and is common in adults as well. Close coordination between primary care physicians and specialists is essential for the adequate treatment of chronically and severely affected patients.Methods: This article is a review of pertinent publications that were retrieved by a selective search in Pubmed, with additional consideration of the guidelines of the Association of Medical Scientific Societies in Germany (AWMF) and the European Dermatology Forum.Results: Trigger factors such as skin irritants, allergens, microbial pathogens, and psychological factors can affect the condition of the skin differently in individual patients and should be individually assessed. The use of skin moisturising creams or emollients along with avoidance of specific and unspecific irritants is of great importancel, as these patients have an impaired cutaneous barrier. Topical anti-inflammatory treatment with glucocorticoids or calcineurin inhibitors is a central part of the management of atopic dermatitis; in exceptional cases, severely affected patients are treated with systemic anti-inflammatory drugs. Interdisciplinary patient education has been found to be an effective tool in the complex management of this disease. Chronically and severely affected patients present special challenges for diagnosis and treatment.Conclusion: Recent advances in the understanding of the molecular basis of cutaneous barrier disorders and of congenital and acquired immune disorders have led to new approaches to the treatment of atopic dermatitis.