老年特应性皮炎：一个新的临床亚型

【摘要】 特应性皮炎是一种高度异质性的皮肤病,近年来疾病精准分型的研究揭示了特应性皮炎的一个新亚型——老年特应性皮炎。以往认为特应性皮炎多发生于儿童,近年发现老年人也是AD的高发人群。老年特应性皮炎在流行病学、临床表现、发病机制和治疗等方面与儿童和成人特应性皮炎具有显著不同的特点。应高度重视老年特应性皮炎的诊断、鉴别诊断和治疗。     

老年特应性皮炎

【摘要】 近年国内外指南更新了特应性皮炎（AD）类别,增加了老年AD分型。老年AD的病因与遗传、皮肤屏障功能障碍、免疫失调及生活方式有关。但多数老年AD患者临床症状不典型,误诊十分常见。充分认识老年AD的发病机制和临床特征,根据老年AD临床特点制定个体化的诊疗方案,对改善患者生活质量,减轻疾病负担显得尤为重要。     

特应性皮炎的相关研究进展

特应性皮炎是一种具有遗传倾向的慢性皮肤病。该病的发病过程十分复杂,主要为遗传与环境等因素互相作用的结果,难治愈,易复发一直是治疗上的难点。近年来,现代医学在保湿润肤修复皮肤屏障,新型药物如生物制剂和小分子药物等方面,中医在辨证论治和特色外治方面都取得较大进展。本文通过查阅近年的相关文献,对特应性皮炎的病因、发病机制及中西医诊疗方面进行综述。     

特应性皮炎的治疗进展

特应性皮炎(atopic dermatitis,AD是一种慢性复发性、炎症性皮肤病,具有遗传易感性特点。目前其发病原因及发病机制尚未完全明了,且无满意的治疗方法。近年来随着分子细胞免疫学及分子生物学的快速发展,对AD的发病机制有了新的认识,从而针对其发病机制出现了新的治疗药物及方法。     

特应性皮炎发病机制的研究进展

特应性皮炎是一种与遗传过敏素质有关的特发性炎症性皮肤疾病，可分为外源型和内源型两种类型。该疾病是一种多基因病，病因复杂，发病机制尚未明确，现认为该病主要是由遗传、环境、皮肤屏障功能缺陷和免疫相互作用所致。     

特应性皮炎的发病机制及治疗进展

特应性皮炎(atopic dermatitis,AD)是一种慢性复发性、瘙痒性、炎症性皮肤病,因病因和发病机制不明,缺乏特效治疗且发病率高、危害较大而成为研究的热点。随着分子遗传学和分子免疫学发展,有关AD的基础与临床研究也日渐深入。本文就AD的发病机制及治疗研究现状简述如下。     

特应性皮炎病因及发病机制的研究进展

特应性皮炎是一种血清IgE增高，常伴发哮喘和过敏性鼻炎的慢性，复发,瘙痒性，炎症性皮肤病，其发病机制较为复杂，与遗传，环境，免疫和对生理药理介质反应异常等因素有关，对特应性皮炎发病机制的研究，进一步明确与其发病机理直接相关的效应细胞及效应分子，包括局部细胞因子的释放，辅助T细胞的分化，IgE的多种效应，感染因素以及超抗原等，以及深入了解它们在特应性皮炎炎症过程中的作用，对改善 临床治疗效果有重要意义。     

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……     

特应性皮炎的治疗进展

介绍了目前患病率正逐渐增高、临床上仍属病因不明，顽固难治性的特应性皮炎（AD）的最新治疗方法进展。其中包括与细胞因子治疗有关的方法，及与免疫有关的治疗等方面的最新进展，为AD临床治疗实践中提供了有价值的参考信息。     

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。     

Position paper on diagnosis and treatment of atopic dermatitis

The diagnosis of atopic dermatitis (AD) is made using evaluated clinical criteria. Management of AD must consider the symptomatic variability of the disease. It is based on hydrating topical treatment, and avoidance of specific and unspecific provocation factors. Anti-inflammatory treatment is used for exacerbation management. Topical corticosteroids remain the first choice. Systemic anti-inflammatory treatment should be kept to a minimum, but may be necessary in rare refractory cases. The new topical calcineurin inhibitors (tacrolimus and pimecrolimus) expand the available choices of topical anti-inflammatory treatment. Microbial colonization and superinfection (e.g. with Staphylococcus aureus, Malassezia furfur) can have a role in disease exacerbation and can justify the use of antimicrobials in addition to the anti-inflammatory treatment. Evidence for the efficacy of systemic antihistamines in relieving pruritus is still insufficient, but some patients seem to benefit. Adjuvant therapy includes ultraviolet (UV) irradiation preferably of UVA wavelength; UVB 311 nm has also been used successfully. Dietary recommendations should be specific and only given in diagnosed individual food allergy. Stress-induced exacerbations may make psychosomatic counselling recommendable. 'Eczema school' educational programmes have proved to be helpful.     

The millennium criteria for the diagnosis of atopic dermatitis

Abstract: Atopic dermatitis forms an active area of basic and clinical research, where important new knowledge about genetics and immunopathogenesis has surfaced over the past years, and where simultaneous development of new and innovative therapies is under way. However, the inclusion of any patient in an atopic dermatitis study, whether it is on its genetics, pathogenesis or therapy, requires a diagnosis which is irrefutable. Since there is no simple and also no complicated laboratory procedure to reach a diagnosis of atopic dermatitis, different sets of clinical criteria have been developed for the purpose of making the diagnosis uniformly in different studies as well as in different study centers. The most commonly used are Hanifin and Rajka's set of diagnostic features, which have major and minor clinical criteria to be fulfilled in order to establish a diagnosis of atopic dermatitis. Recent developments in the immunology of atopy have clearly established the major abnormality in this syndrome, the preferential production of allergen-specific IgE. In this contribution, it is suggested that the presence of such antibodies in a given patient should be a mandatory criterium for the diagnosis of atopic dermatitis. Such a diagnostic test however establishes a diagnosis of atopic syndrome, not atopic dermatitis. Thus, for atopic dermatitis we have to rely, for the time being, on additional clinical criteria. The clinical features described in the literature are critically evaluated, and it is suggested that in addition to the mandatory presence of allergen-specific IgE, 2 of 3 principal criteria (pruritus, typical morphology and distribution, chronic or chronically relapsing) should be present for such a diagnosis. Finally, the minor features originally described by Hanifin and Rajka and later evaluated by others are revised and divided over 4 subcategories; a) related to subclinical eczema; b) related to dry skin; c) extra skin folds; and d) ophthalmological pathology. They are suggested to be used as additional criteria only, needed when clinical suspicion is high but the new mandatory and principal diagnositic criteria described here are inconclusive. For study purposes, we suggest that the mandatory and principal criteria are sufficient. They are now evaluated and validated in ongoing atopic dermatitis treatment studies.     

Biologics in atopic dermatitis

Atopic dermatitis (AD) accounts for a significant share of chronic inflammatory skin disorders. There is a niche for the development of biologics to treat recalcitrant autoinflammatory stage AD seen mostly in adults. The heterogeneity of patient response to various existing biotherapies points to involvement of various immune responses and suggests that therapies must preferably target early development of allergen‐specific B‐ and T‐cell clones. In addition to immune targets, tissue factors that help restore the normal epidermal environment constitute interesting therapeutic tools. Several approaches are needed to find the appropriate targets in a field where so many have been investigated without definitive proof of concept for human systemic therapy. The keys to success are probably (1) to influence the inflammatory skin pattern towards less pruritogenic effects, requiring us to better understand pruritogenic inflammation and (2) to limit the amplification loop of disease by attacking abnormal regulatory mechanisms which perpetuate skin autoinflammation.     

Nickel sensitivity and the course of atopic dermatitis in adulthood

The course of dermatitis was followed in nickel-sensitive and nickel-negative atopic and non-atopic patients. Manifest dermatitis was seen in 70% of the nickel-allergic and in 64% of the nickel-negative female atopic dermatitis (AD) patients. Those atopic subjects who had minor symptoms in their teens suffered more from dermatitis if they had developed nickel allergy (p less than 0.025). Hands and the head region were the most common sites for current dermatitis in both groups.     

Prevalence of atopic dermatitis in Japanese adults

BACKGROUND: Adult atopic dermatitis (AD) in Japan has become a significant social problem, with as many as one-third of adult patients with severe AD absenting themselves from work or classes due to aggravation of the disease. Reports of such patients have become increasingly common in recent years. Despite the pressing need for epidemiological studies to clarify the prevalence and distribution of AD and to determine its aetiology, no previous research has been carried out on the prevalence of AD within the adult population in Japan. OBJECTIVES: To clarify the prevalence of adult AD in Japan, using the U.K. Working Party's diagnostic criteria. METHODS: The subjects of this study were mostly government officials or their family members visiting the Medical Center of Health Science, Toranomon Hospital in Tokyo for annual health check-ups in the period from September 1997 to August 1998. Questionnaires completed by 10 762 persons (8076 men and 2686 women) aged 30 years or above were analysed. The questionnaire consisted of 14 questions on allergic disease. The U.K. Working Party's diagnostic criteria were used after translation into Japanese. Three types of prevalence were used as indicators of prevalence: point, 1-year and lifetime prevalence. RESULTS: The point prevalence, 1-year prevalence and lifetime prevalence of AD in Japanese adults were 2.9%, 3.0% and 3.3%, respectively. No significant statistical differences were observed between the sexes or among age groups within each sex. The survey indicated that 88.6% of those who had ever had AD were currently affected by active AD, while 93.4% of those who had had at least one episode of AD in the past had experienced an episode over the previous year. CONCLUSIONS: This study gives the first indication of the prevalence of adult AD among the Japanese, based on the U.K. criteria. Both the internal and external validity of this study are believed to be high; it would be safe to conclude that the 1-year prevalence of AD in Japanese adult populations living in urban areas is 3.0%.     

The differential diagnosis of atopic dermatitis in childhood

Atopic is the most common of the dermatitides seen in infancy and childhood, but there are numerous other diseases that can mimic the skin findings. These include seborrheic dermatitis, immunodeficiency, and psoriasis in infancy; scabies, tinea corporis infection, perioral, nummular, contact, and molluscum dermatitis in childhood. It is sometimes extremely difficult to differentiate between ichthyosis and AD, and it is also important to differentiate AD from erythrodermic conditions including acrodermatitis enteropathica, biotin deficiency, and Netherton syndrome. A rare condition in children that may mimic AD is mycosis fungoides.     

Clinical practice guidelines for the management of atopic dermatitis 2018

Atopic dermatitis (AD) is a disease characterized by relapsing eczema with pruritus as a primary lesion. The current strategies to treat AD in Japan from the perspective of evidence‐based medicine consist of three primary measures: (i) the use of topical corticosteroids and tacrolimus ointment as the main treatment for the inflammation; (ii) topical application of emollients to treat the cutaneous barrier dysfunction; and (iii) avoidance of apparent exacerbating factors, psychological counseling and advice about daily life. The guidelines present recommendations to review clinical research articles, evaluate the balance between the advantages and disadvantages of medical activities, and optimize medical activity‐related patient outcomes with respect to several important points requiring decision‐making in clinical practice.     

迟发型特应性皮炎的研究进展

特应性皮炎（AD）是一种炎症性皮肤病,与皮肤屏障功能受损密切相关。遗传因素、生活方式、环境因素的暴露都可导致该病的发生。尽管AD常见于婴幼儿,仍有成年后首次出现AD症状,被称为迟发型AD（AOAD）。与儿童期始发的AD相比,AOAD在分型、免疫学机制及与其他疾病的关联方面都存在着显著的差异。皮损分布与婴幼儿期初发的AD相似,但以亚急性和慢性皮炎为主要表现,呈现干燥的、肥厚的皮炎损害,少见渗出。Th1/Th2失衡及抗原提呈细胞的功能亢进是AD发生的免疫学基础。FLG基因突变会影响AD的发生,IL-13升高使FLG存在获得性的表达缺陷仅发生于成年人,提示了AOAD不同于婴幼儿期初发并迁延至成年期的AD。感染、皮肤及肠道菌群改变、吸烟等均可成为诱发AOAD的重要因素,因此在诊断AOAD时询问相关疾病史和吸烟史有助于AOAD的诊断。     

Burden of atopic dermatitis in Asia

Atopic dermatitis is a chronic, inflammatory skin disease characterized by intense pruritus and eczematous lesions. It is considered one of the most common chronic conditions, with an estimated global prevalence of nearly 230 million. As in the rest of the world, prevalence of atopic dermatitis has been increasing in Asian countries over the last few decades. This increased prevalence in Asian countries has been attributed to factors such as rapid urbanization, increasingly Westernized lifestyles, and improved standards of living and education. As a result, it is important to understand the increasing burden of disease in Asian countries and the differences between the countries in terms of epidemiology, diagnostic criteria, management, quality of life and economic burden.