中国中重度特应性皮炎诊疗临床路径专家共识(2023版)

为促进我国中重度特应性皮炎诊断及治疗的规范化和标准化, 中华医学会皮肤性病学分会、中国医师协会皮肤科医师分会组织国内皮肤科特应性皮炎专家通过联合应用文献分析、专题讨论和专家咨询, 组织撰写中国中重度特应性皮炎诊疗临床路径。本临床路径首先介绍特应性皮炎的诊断依据, 评估、筛查及检查项目和进入路径标准;其次详细描述中重特应性皮炎的治疗原则、方案和药物, 疗效判断、随访与评估指标, 患者教育及指导, 完成路径标准和变异及原因分析;建议诱导缓解治疗的疗程不应低于3个月, 诱导治疗获得缓解后至少应制定3 ～ 6个月的维持缓解治疗目标;最后以附录的形式列出中重度特应性皮炎诊疗管理流程和中重度特应性皮炎诊疗临床路径表单。     

特应性皮炎的治疗进展

特应性皮炎是皮肤科常见疾病,随着对特应性皮炎发病机制、诱因、促发因素的深入认识,在治疗上有了更进一步的认识和发展.文章通过对特应性皮炎的认识、诊断,选择适当安全有效的治疗药物,为临床更好的治疗特应性皮炎,提供了理论与实践依据.     

特应性皮炎治疗药物研究进展

【摘要】 特应性皮炎的发病机制尚未完全清楚,可能与免疫紊乱、皮肤屏障功能障碍及环境因素有关。特应性皮炎最重要的症状是严重瘙痒,并可极大地影响患者的生活质量。目前其治疗仍然是一个挑战。多数患者可通过避免激发因素、基础皮肤护理和外用抗炎药得到较好疗效;少部分患者皮损广泛且对常规治疗抵抗,需要系统治疗。生物制剂在中重度特应性皮炎患者中已得到较广泛地应用。本文综述特应性皮炎的药物治疗研究进展。     

紫外线治疗特应性皮炎的进展

特应性皮炎是一种慢性复发性炎症性疾病,紫外线通过调节T细胞功能及相关炎症介质而取得良好疗效.不同波段紫外线因其特性而应用于不同类型的特应性皮炎:窄谱中波紫外线治疗儿童期特应性皮炎显示出良好疗效及安全性,认为是慢性患者的首选治疗;急性患者首选长波紫外线照射;局限性皮损选择308 nm准分子激光为佳.紫外线治疗特应性皮炎临床尚处于初级阶段,在照射剂量和照射疗程方面,各家报道不一.     

中国特应性皮炎诊疗指南（2014版）

特应性皮炎是皮肤科的常见疾病之一,对患者生活质量有明显影响。我国特应性皮炎的患病率20年来逐渐上升。为了规范特应性皮炎的诊断和治疗,中华医学会皮肤性病学分会免疫学组于2008年制定了我国第1版特应性皮炎诊疗指南,指南发表6年来,国内外有关特应性皮炎的发病机制、治疗理念、治疗方法和药物都有了显著变化。为此,中华医学会皮肤性病学分会组织免疫学组和特应性皮炎协作研究中心的专家对2008版指南进行了修订,希望有助于我国皮肤科医生在临床实践中的学习和应用……     

中国特应性皮炎诊疗指南（2020版）

【摘要】 特应性皮炎以反复发作的慢性湿疹样皮疹为主要表现，伴有显著的皮肤干燥和瘙痒。随着生活方式和环境的改变，近10余年间我国特应性皮炎的发病率不断升高，受累及的人群涉及各年龄段。本指南结合近5年特应性皮炎的研究进展，在2014版中国特应性皮炎诊疗指南的基础上予以进一步的补充和完善，对特应性皮炎的定义、患病率、发病机制、分类、诊断、预防和治疗进行更新，可为特应性皮炎的诊疗提供科学和权威的参考依据。     

组胺H4受体在特应性皮炎发病中的作用

组胺是免疫反应中的重要介质,组胺H4受体是近年来新发现的组胺受体,主要表达于免疫器官及细胞上.研究表明,组胺H4受体参与特应性皮炎发病过程中的免疫炎症调节、瘙痒反应及表皮增殖.组胺H4受体的特应性拮抗剂也能影响特应性皮炎的病程发展,通过T细胞、抗原提呈细胞、角质形成细胞等发挥抗炎、调节免疫及其抗瘙痒作用,减轻了特应性皮炎的湿疹样皮炎、顽固性瘙痒的临床症状,有望成为一种新型治疗特应性皮炎的有效手段.     

解读英国2012年特应性皮炎诊疗指南

特应性皮炎是一种常见的慢性、复发性、炎症性疾病。该文通过解读《2012年英国特应性皮炎指南》,详细概述特应性皮炎诊断、鉴别诊断、治疗及预防措施。     

特应性皮炎患者血清CXC、CC及C亚家族趋化因子的检测

目的 了解部分CXC、CC及C亚家族趋化因子在特应性皮炎患者血清中的水平和相互关系,及与Th1及Th2相关的细胞因子的关联。方法 用双抗体夹心ELISA方法检测51例特应性皮炎患者血清γ-干扰素诱导的单核因子（Mig）、胸腺和活化调控的趋化因子（TARC）、皮肤T细胞趋化因子（CTACK）及淋巴细胞趋化因子（Ltn）等水平。以SCORAD对特应性皮炎患者进行评分。结果 特应性皮炎患者血清Mig、TARC、CTACK及Ltn水平均显著高于正常人对照组（P < 0.05或 < 0.01）。患者血清CTACK水平与SCORAD呈显著正相关;血清Mig、TARC、CTACK及Ltn水平均与皮损体表面积百分比（BSA%）呈正相关;患者血清Ltn与TARC和CTACK显著相关。结论 CXC、CC及C亚家族的趋化因子在特应性皮炎的发病中可能起作用。血清CTACK水平可能是评估特应性皮炎严重度的一个较好的指标。     

马拉色菌与特应性皮炎相关性研究进展

特应性皮炎是一种慢性、瘙痒性皮肤病,发病机制尚未明确。目前已证实微生物能够诱发和加重特应性皮炎的发作,针对这些病原的抗感染疗法通常也是治疗特应性皮炎的重要手段之一。近来的研究显示真菌感染尤其是马拉色菌与特应性皮炎关系密切。本文针对马拉色菌在特应性皮炎发病中的意义、免疫学相关研究及抗真菌药物治疗特应性皮炎的评价等方面进行综述。     

Future perspectives in the treatment of atopic dermatitis

Atopic dermatitis is a chronically relapsing inflammatory skin disease with an increasing prevalence. The guidelines for the treatment of atopic dermatitis enable us to manage many patients with atopic dermatitis under a global consensus, which also contributes to improving their quality of life. However, there remain some patients with atopic dermatitis whose symptoms cannot be satisfactorily controlled using the therapeutic management recommended by the guidelines. Recent genetic, immunological and physiological insights into the pathomechanisms of atopic dermatitis are expected to overcome the limitations of the currently available treatment. Advances in pharmacology and biotechnology will also provide more efficient and safer medications. In this review, the limitations of the currently available therapies and the advantages and disadvantages of new approaches for the treatment of atopic dermatitis including topical and systemic immunosuppressants as well as biologics and anti-pruritic agents are discussed. Potential new cellular targets for the treatment of atopic dermatitis are also illustrated.     

Pathophysiologic mechanisms in atopic dermatitis

Atopic dermatitis is a common, chronic inflammatory skin disease that frequently predates the development of asthma and/or allergic rhinoconjunctivitis. Recent studies have provided new insights into how the complex interrelationship of genetic, environmental, and immunologic factors may contribute to the development of atopic dermatitis. This article examines some of the factors involved in chronic cutaneous inflammation in this disease. Greater understanding of the mechanisms that underlie the pathophysiology of atopic dermatitis may lead to improved treatment strategies for this increasingly common skin disease.     

Macrolactam immunomodulators (tacrolimus and pimecrolimus): new horizons in the topical treatment of inflammatory skin diseases

Tacrolimus and pimecrolimus are new macrolactam immunomodulators which were developed for the treatment of inflammatory skin diseases, mainly atopic dermatitis. In this article, we review the pharmacologic properties of the drugs, their side effects, and their clinical uses.     

Th17 cells: a new therapeutic target in inflammatory dermatoses

Th17 cells, named for their secretion of interleukin-17 (IL-17), are a new class of T-cells involved in a wide range of cutaneous autoimmune and inflammatory conditions. An overactive Th17 cell response in the skin can produce damaging results. There appears to be a partial role for the Th17 axis in the pathogenesis of a range of dermatological diseases including allergic contact dermatitis, atopic dermatitis, psoriasis, and scleroderma. Immunologists have also discovered a unique association between Th17 cells and cutaneous T-cell lymphoma. The Th17 branch has been linked to a number of additional systemic inflammatory diseases with significant cutaneous pathology such as systemic lupus erythematosus, rheumatoid arthritis, inflammatory bowel disease, and Behcet's disease. Newly developed treatment modalities for neutralizing the Th17 branch of the immune system are proving to be valuable additions to the current therapeutic armamentarium.     

老年特应性皮炎的诊疗研究进展

 特应性皮炎(AD)是一种与遗传有关的慢性、炎症性、瘙痒性皮肤病。随着社会发展及人口老龄化,老年AD作为AD的一种新临床亚型出现在大家的视野并且受到广泛的关注。不同于其他三型AD（婴儿期、儿童期、成人期）,老年人常患有临床表现相似的其他瘙痒性疾病（如脂溢性皮炎、老年瘙痒症、大疱性类天疱疮等）并且伴有其他潜在病症（如高血压病、心脑血管疾病、糖尿病等）,因此老年AD的诊断与治疗较其他三型复杂。本文主要对老年AD的流行病学、临床特征、诊断、鉴别诊断、治疗与管理进行综述,以引起临床医生对该新临床亚型的重视以及为老年AD的诊断与治疗提供思路。     

Long term management of childhood atopic dermatitis with calcineurin inhibitors

The calcineurin inhibitors pimecrolimus and tacrolimus are important tools for long-term management of atopic dermatitis in childhood. These drugs are approved in Germany for the intermittent long-term treatment of moderate to severe (tacrolimus ointment) or mild to moderate (pimecrolimus cream) atopic dermatitis in children older than 2 years. Recent study results show that these agents are also effective in infants (aged 3-23 months) with atopic dermatitis. During the long-term treatment of children and infants with calcineurin inhibitors, the therapeutic success can be maintained and there is a continuous increase in the response rate. Long-term use of calcineurin inhibitors in atopic dermatitis is well tolerated locally and systemically, leads to reduction of disease flares and has a corticosteroid sparing effect.     

Soluble E-selectin in sera of patients with atopic dermatitis and psoriasis—correlation with disease activity

Summary E-selectin endothelial leucocyte adhesion molecule-1 is expressed on endothelial cells in distinct inflammatory skin diseases. E-selectin mediates the adhesion between activated endothelium and different inflammatory cells. To evaluate soluble E-selectin as a marker of disease activity in patients with atopic dermatitis and psoriasis, the concentration of soluble E-selectin, determined by ELISA, was studied in sera of patients before and after treatment and compared with normal non-atopic controls. The disease severity was established using clinical scoring systems. Levels of soluble E-selectin were significantly elevated in sera of patients with atopic dermatitis and psoriasis (as compared with controls). Clinical improvement, after treatment, in patients with atopic dermatitis, but not in psoriasis, was associated with a significant decrease in serum levels of soluble E-selectin. There was a significant correlation of soluble E-selectin and disease activity in patients with atopic dermatitis. These data indicate that soluble E-selectin is another parameter to evaluate the inflammatory response in atopic dermatitis and psoriasis. Determination of soluble E-selectin may be a useful measure of disease activity in atopic dermatitis.     

特应性皮炎的诊断：争议和事实

【摘要】 特应性皮炎是一种常见的与遗传过敏性体质相关的以湿疹样皮疹和瘙痒为主要特征的慢性复发性炎症性疾病。其病因及发病机制尚不十分清楚,导致其起源、定义、临床表型及诊断标准等存在较多争议,本文就上述争议进行分析及探讨,以期为特应性皮炎的诊治提供有意义的参考。     

【开放获取】度普利尤单抗治疗特应性皮炎专家共识

【摘要】 特应性皮炎是一种常见的慢性炎症性皮肤病,以湿疹样皮疹和剧烈瘙痒为主要表现,可严重影响患者生活质量。中重度特应性皮炎往往需要系统治疗,传统的系统治疗对部分患者效果不佳或不能耐受。近年来,生物制剂开始用于临床治疗特应性皮炎,其中白细胞介素4受体拮抗剂度普利尤单抗已经在我国上市。中华医学会皮肤性病学分会特应性皮炎研究中心、中华医学会皮肤性病学分会儿童学组组织本领域部分专家讨论度普利尤单抗在中重度特应性皮炎治疗中的应用,并形成共识,希望本共识能为我国皮肤科医生临床应用度普利尤单抗治疗特应性皮炎提供参考。