中国特应性皮炎诊疗指南（2020版）解读

 特应性皮炎是一种常见的慢性、复发性、炎症性、瘙痒性皮肤病,严重影响患者生活质量。近年来国内外AD研究进展迅速,为了进一步规范和指导AD的诊断和治疗,中华医学会皮肤性病学分会免疫学组和特应性皮炎协作研究中心组织相关专家对原指南进行了修订。本文就2020年版《中国特应性皮炎诊疗指南》中更新部分作一简要解读。     

特应性皮炎伴发寻常型鱼鳞病相关因素分析

目的研究中国汉族特应性皮炎(atopic dermatitis, AD)患者伴发寻常型鱼鳞病(ichthyosis vulgaris, IV)的影响因素,为AD诊治提供依据。方法收集2005年11月-2015年5月在安徽医科大学第一附属医院皮肤科以及全国三十多家三甲医院的AD患者资料,通过SPSS 25.0软件对影响AD伴IV的相关因素进行单因素和二分类Logistic回归分析。结果共有3 041例AD患者,伴发IV者582例(19.14%)。单因素分析结果,性别、年龄、地域、慢性反复性皮炎、家族特应史、出汗时瘙痒、疾病严重程度、白色划痕、干皮症、掌纹症、眶周黑晕、毛周角化症,在AD伴IV与不伴IV组间发病率差异有统计学意义(P0.05)。二分类Logistic回归分析结果显示,年龄、北方地区、出汗时瘙痒和疾病严重程度与AD伴IV呈正相关(P0.05)。纳入校正因素后,年龄(≥18岁)、北方地区、出汗时瘙痒和AD疾病严重程度仍呈正相关(P0.05),其中疾病严重程度(中度OR=2.20,95%CI:1.37～3.53;重度OR=2.97,95%CI:1.83～4.82)与AD伴IV相关最强。结论年龄(≥18岁)、北方地区、出汗时瘙痒和疾病严重程度是AD伴IV的危险因素。     

特应性皮炎的异质性与质谱特征

<正>特应性皮炎(atopic dermatitis,AD)是一种常见的炎症性、慢性复发性瘙痒性皮肤病,主要表现为皮肤红斑、丘疹、脱屑、渗出和明显的瘙痒。在过去的30年中,世界多数国家AD的患病率明显增加,儿童发病率为12%~17%,成人发病率为2%~10%,并有增长的趋势。AD严重影响患者及家属的生活质量,是皮肤科研究的热点之一。1特应性皮炎认识的演化最早关于特应性皮炎的描述可追溯到古罗马时代~([1-2])。公元543年Aetius首次使用"eczema"一词,为希     

【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。     

特应性皮炎的中医辨证与治疗

特应性皮炎(AD)是临床常见的皮肤科疾病,易诊难治。中医辨证论治有特殊优势,而且疗效肯定。文中对特应性皮炎的认识和临床经验进行了归纳总结,希望对中医皮科的临床医师有所启示。     

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。     

1140例特应性皮炎患儿血清过敏原检测及分析

<正>特应性皮炎(atopic dermatitis,AD)是一种慢性、难治性皮肤病,以顽固性皮炎、反复发作和剧烈瘙痒为主要临床表现,多发生于婴幼儿和青少年。目前病因及发病机制尚不明确,并缺乏特效治疗方法,严重影响患儿生活质量,且AD发病有逐年上升的趋势。本研究对2014年1月至2019年1月本地区我院皮肤科门诊就诊的1140例AD患儿采用免疫印迹法检     

特应性皮炎的全程管理共识

【摘要】 特应性皮炎是常见的瘙痒性、慢性炎症性皮肤病，近20年来患病率迅速增加，在非致命性皮肤疾病负担中排名第一。临床上迫切需要开展行之有效的特应性皮炎全程管理。本共识根据特应性皮炎在预防、治疗、康复、照护等方面的特性，遵循既往指南和临床共识，制定了一整套管理方案，有望为我国特应性皮炎的全程管理提供科学参考。     

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……     

精神神经因素在特应性皮炎发生发展和预防中的作用

特应性皮炎(atopic dermatitis,AD)是一种慢性炎症性皮肤病,瘙痒剧烈,常有抓痕,影响患者的精神心理健康,严重者可导致焦虑、抑郁甚至自杀等精神症状。反之,精神神经因素也能够作用于特应性皮炎患者,加重病情,造成恶性循环。干预精神神经因素可以为特应性皮炎的预防和治疗提供更多有效的手段。     

头皮健康管理专家共识（2022）

【摘要】 为达到维持疗效、减少复发、提高患者生活质量的治疗目标，针对头皮疾病进行全程健康管理非常必要。为此，我国皮肤、美容领域的部分专家依据国内外有关指南及共识、相关文献和临床经验，在深入讨论的基础上制定头皮健康管理中国专家共识，重点从头皮疾病病因、主要表现以及头皮健康管理措施等方面进行描述和提出指导性建议，希望为我国头皮疾病的全面临床管理提供参考依据。     

特应性皮炎瘙痒机制的研究进展

【摘要】 特应性皮炎（AD）瘙痒是一种典型的非组胺相关瘙痒，涉及复杂的神经传导通路。多种细胞因子和神经肽类物质以及皮肤屏障功能障碍、皮肤菌群失调也参与瘙痒信号的产生和传递。本综述聚焦近年AD瘙痒发病机制和治疗的主要研究进展。     

皮肤源性瘙痒发生机制的研究进展

瘙痒是皮肤疾病中最常见的症状,但其发生机制尚未完全明确.目前认为存在独立的痒觉神经传导通路,主要由外周无髓C纤维传人信号至脊髓背侧角的最浅层,Lamina Ⅰ脊髓丘脑束上行至丘脑,进一步投射至皮质区.皮肤源性瘙痒与多种瘙痒介质密切相关,除组胺以外,乙酰胆碱、蛋白酶、P物质、前列腺素、细胞因子等多种介质及其受体参与瘙痒的发生.就瘙痒的临床分型、痒觉神经传导通路、瘙痒介质等进行综述.     

瘙痒介质及其受体的研究进展

瘙痒的产生是一个复杂的多因素作用的结果,其具体机制尚不完全清楚.研究已证实,瘙痒具有特异的神经传导通路,多种内源性物质与瘙痒的发病密切相关.近年来的研究表明,组胺4型受体、蛋白酶活化受体-2、白介素-31受体、神经激肽受体-1在皮肤无髓C神经纤维的表达可能介导瘙痒的发生,而神经营养素和神经生长因子及其受体则可能作为一种瘙痒敏感剂,促进瘙痒的形成与发展.这些化学介质及其受体在瘙痒发生的病理生理机制中并不是孤立地起作用,而是与神经细胞、免疫细胞及皮肤细胞紧密联系.     

Consensus guidelines for the management of atopic dermatitis: An Asia–Pacific perspective

Atopic dermatitis (AD) is a relatively common disease in patients in the Asia–Pacific region. It presents a particular clinical challenge and requires careful clinical management. The chronic nature of AD characterized by flares, exacerbations and periods of quiescence requires a multipronged approach aimed at reducing itch, inflammation and the appearance of secondary lesions. In addition, varying levels of maintenance therapy may be required to avoid exacerbations. Survey data from the region indicate that there is significant variation across the Asia–Pacific with regard to current treatment practices. The management of AD may also be influenced by differing health‐care systems, variable climate, access to medical care and cultural diversity. The current consensus guidelines have been developed to provide up‐to‐date and concise evidence‐ and experience‐based recommendations directed towards general practitioners and general dermatologists in the Asia–Pacific region on the management of pediatric and adult AD.     

Neuropathic Itch of the Back: A Case of Notalgia Paresthetica

Notalgia paresthetica refers to an isolated mononeuropathy involving chronic localized itch or paresthesia most often at the skin of the scapula or surrounding regions. There are no specific skin manifestations except those arising from chronic scratching and rubbing. The specific etiology remains unknown; however, it has been theorized that the neuropathic itch is caused by sensory nerve entrapment involving the posterior rami of the T2 to T6 nerve root. The entrapment is due to degenerative changes in the vertebrae. We report here a particular case of notalgia paresthetica in a 55-year-old woman. The patient visited our hospital for tingling pain around the left inferior angle of the scapula. Pruritus was first reported seven years ago with tingling pain developing only four months ago. There were no specific skin lesions observed except for excoriation and vague hyperpigmentation. A skin biopsy revealed only epidermal thinning with pigmentary incontinence. The patient was treated with 600 mg of gabapentin daily as well as capsaicin cream. The response was deemed unsatisfactory.     

Repetitive scratching and noxious heat do not inhibit histamine-induced itch in atopic dermatitis

BACKGROUND: Repetitive scratching is the most common behavioural response to itch in atopic dermatitis (AD). Patients with chronic itch often report that very hot showers inhibit itch. We recently reported that scratching and noxious heat stimuli inhibit histamine-induced itch in healthy subjects. However, no psychophysical studies have been performed in AD to assess the effects of repetitive heat pain stimuli and scratching on histamine-induced itch. OBJECTIVES: To examine the effects of repetitive noxious heat and scratching on itch intensity in patients with AD using quantitative sensory testing devices. METHODS: Itch was induced with histamine iontophoresis in 16 patients with AD in both lesional and nonlesional skin as well as in 10 healthy subjects. Repetitive noxious heat and scratching were applied 3 cm distal to the area of histamine iontophoresis. Subjects rated their perceived intensity of histamine-induced itch with a computerized visual analogue scale. RESULTS: Our results demonstrate that repetitive noxious heat and scratching do not inhibit itch intensity in lesional and nonlesional AD skin but do so in healthy skin. Of note, both these stimuli increase itch intensity in lesional AD skin. CONCLUSIONS: Our results strongly suggest that scratching and noxious thermal stimuli have a different effect upon histamine-induced itch perception in patients with AD when compared with healthy controls. This difference may be associated with both peripheral and central sensitization of nerve fibres in AD.     

Consensus Update for Systemic Treatment of Atopic Dermatitis

BackgroundIn 2015, the Korean Atopic Dermatitis Association (KADA) working group published consensus guidelines for treating atopic dermatitis (AD).ObjectiveWe aimed to provide updated consensus recommendations for systemic treatment of AD in South Korea based on recent evidence and experience.MethodsWe compiled a database of references from relevant systematic reviews and guidelines on the systemic management of AD. Evidence for each statement was graded and classified based on thestrength of the recommendation. Forty-two council members from the KADA participated in three rounds of voting to establish a consensus on expert recommendations.ResultsWe do not recommend long-term treatment with systemic steroids forpatients with moderate-to-severe AD due to the risk of adverse effects. We recommend treatment with cyclosporine or dupilumab and selective treatment with methotrexate or azathioprine for patients with moderate-to-severe AD. We suggest treatment with antihistamines as an option for alleviating clinical symptoms of AD. We recommend selective treatment with narrowband ultraviolet B for patients with chronic moderate-to-severe AD. We do not recommend treatment with oral antibiotics for patients with moderate-to-severe AD but who have no signs of infection. We did not reach a consensus on recommendations for treatment with allergen-specific immunotherapy, probiotics, evening primrose oil, orvitamin D for patients with moderate-to-severe AD. We also recommend educational interventions and counselling for patients with AD and caregivers to improve the treatment success rate.ConclusionWe look forward to implementing a new and updated consensus of systemic therapy in controlling patients with moderate-to-severe AD.     

中国光线性角化病临床诊疗专家共识（2021）

【摘要】 光线性角化病是一种慢性进行性癌前病变,可进展为皮肤鳞状细胞癌。随着中国患病人数逐渐增多,亟须建立合适的诊断及治疗规范。中国康复医学会皮肤病康复专业委员会、中华医学会皮肤性病学分会联合中国医学装备协会皮肤病与皮肤美容分会组织光线性角化病相关领域部分专家,在国内外文献数据、国际指南和专家临床经验的基础上,结合我国诊疗现状,制定中国光线性角化病临床诊疗专家共识。本共识从光线性角化病的流行病学、发病因素及临床转归、临床表现及分级、诊断及鉴别诊断、治疗策略和患者教育管理等方面进行阐述,诊断方面包含了皮肤镜、反射式共聚焦显微镜和皮肤病理等手段,治疗策略涵盖了常见局部治疗和系统治疗方法,局部治疗包括光动力治疗、外用药物、物理治疗和手术切除,且按照证据等级给予推荐级别,为皮肤科医师诊疗工作提供参考。