Guidelines for management of atopic dermatitis
Guidelines for management of atopic dermatitis
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DOI：
10.1111/j.1346-8138.2009.00706.x
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发表时间：
2009-10-01
影响因子：
3.1
通讯作者：
Takehara, Kazuhiko
中科院分区：
文献类型：
--
作者：
Saeki, Hidehisa;Furue, Masutaka;Takehara, Kazuhiko
特应性皮炎（AD）是一种以瘙痒和炎症为特征的慢性复发性湿疹性皮肤病，伴有皮肤生理功能障碍（皮肤干燥和屏障破坏）。大多数患者具有特应性素质。已经建立了AD管理（诊断、严重程度分类和治疗）的标准指南。在我们的指南中，强调了皮肤病学培训的必要性，以确保诊断技能，并能够评估AD的严重程度。AD的明确诊断需要存在所有三个特征：（i）瘙痒;（ii）典型的形态和分布;和（iii）慢性和慢性复发性病程。对于AD的严重程度分类，在五个身体区域（头/颈、前躯干、后躯干、上肢和下肢）中的每个区域的最严重受累部位评价了皮疹的三个要素（红斑/急性丘疹、渗出/结痂和慢性丘疹/结节/苔藓样变）。还评估了五个身体区域的喷发面积，并将两个分数相加（最高60分）。目前AD的标准治疗包括使用局部皮质类固醇和他克莫司软膏作为炎症的主要治疗，局部应用润肤剂治疗皮肤生理功能障碍，全身性抗组胺药和抗过敏药物作为瘙痒的辅助治疗，避免明显的加重因素，心理咨询和日常生活建议。他克莫司软膏（0.1%）及其低密度软膏（0.03%）分别适用于成人患者和2-15岁患者。还强调了根据皮疹的严重程度正确选择外用皮质类固醇的重要性。此外，建议慎重使用口服环孢素治疗重度复发性成人AD。
Atopic dermatitis (AD) is a chronic relapsing eczematous skin disease characterized by pruritus and inflammation and accompanied by cutaneous physiological dysfunction (dry and barrier-disrupted skin). Most of the patients have atopic diathesis. A standard guideline for the management (diagnosis, severity classification and therapy) of AD has been established. In our guideline, the necessity of dermatological training is emphasized in order to assure diagnostic skill and to enable evaluation of the severity of AD. The definitive diagnosis of AD requires the presence of all three features: (i) pruritus; (ii) typical morphology and distribution; and (iii) chronic and chronically relapsing course. For the severity classification of AD, three elements of eruption (erythema/acute papules, exudation/crusts and chronic papules/nodules/lichenification) are evaluated in the most severely affected part of each of the five body regions (head/neck, anterior trunk, posterior trunk, upper limbs and lower limbs). The areas of eruption on the five body regions are also evaluated, and both scores are totaled (maximum 60 points). The present standard therapies for AD consist of the use of topical corticosteroids and tacrolimus ointment as the main treatment for the inflammation, topical application of emollients to treat the cutaneous physiological dysfunction, systemic antihistamines and anti-allergic drugs as adjunctive treatments for pruritus, avoidance of apparent exacerbating factors, psychological counseling and advice about daily life. Tacrolimus ointment (0.1%) and its low-density ointment (0.03%) are available for adult patients and 2-15-year-old patients, respectively. The importance of the correct selection of topical corticosteroids according to the severity of the eruption is also emphasized. Furthermore, deliberate use of oral cyclosporine for severe recalcitrant adult AD is referred.