血虚风燥型特应性皮炎患者皮损干燥与瘙痒的相关性研究

目的探索血虚风燥型特应性皮炎患者皮损干燥与瘙痒的相关性。方法收集血虚风燥型特应性皮炎病例,记录患者皮损的干燥程度,用视觉模拟评分法(VAS)记录患者的瘙痒程度,用修正SCORAD评分(把SCORAD评分中与瘙痒有关的条目去除)评估患者的病情严重程度。用Spearman相关性分析分别研究皮损干燥程度、病情严重程度与瘙痒的相关性。结果血虚风燥型特应性皮炎患者的瘙痒程度与皮损干燥程度、病情严重程度均相关,其相关性均具有统计学意义。结论血虚风燥型特应性皮炎患者的瘙痒程度与皮肤干燥正相关,因此,在治疗时应常规使用保湿剂,以缓解皮肤干燥,减轻患者瘙痒。     

特应性皮炎瘙痒管理专家共识

【摘要】 瘙痒是特应性皮炎（AD）主要的症状，也是影响疾病发生发展的重要因素，控制瘙痒是AD管理的关键环节。为完善AD综合管理方案，改善患者的生活质量，中国医师协会皮肤科医师分会过敏性疾病专业委员会、中华医学会皮肤性病学分会特应性皮炎研究中心和中国医疗保健国际交流促进会皮肤科分会邀请国内有关专家，针对AD瘙痒管理的重要性、发病机制、表现特征、严重程度评估方法、有效避免诱发因素措施、保湿剂合理使用、外用和系统药物规范治疗等达成共识。     

非组胺的肥大细胞介质诱导特应性皮炎患者瘙痒:一项皮肤显微透析研究

特应性皮炎是一种以持续性瘙痒（尤以夜间为重）为主要症状的遗传性慢性炎症性皮肤病，由于组胺可诱导减轻特应性皮炎患者主观的和血管的反应（至少在慢性患者中如此），因此对于特应性皮炎而言，组胺也许不总是一种重要的瘙痒性介质。Ｓｃｈｍｅｌｚ等用皮肤显微透析法研究表明：皮内给予组胺及其释放剂──化合物４８／８０可减少特应性皮炎患者皮肤微循环中蛋白质外渗；同时与对照组相比，这些血管活性物质还可减轻特应性皮炎患者的瘙痒。在灌注液中同时给予Ｈ１受体拮抗剂──西替利嗪可减少对照组中４８／８０所诱导的瘙痒，但对特应性…     

特应性皮炎发病过程及其机制研究现状探讨

特应性皮炎是一种复发性的以严重瘙痒为主要临床表现的慢性过敏性皮肤病。全球特应性皮炎的患病率不断上升,然而其发病机制尚不明确。"Outside to inside"是近几年对于特应性皮炎发病机制阐述较为完善的假说,该假说提示特应性皮炎的发病可能是由皮肤向免疫、由外向内渐进性的过程。     

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。     

特应性皮炎患者皮损中TLR2、TLR4 mRNA的表达

目的：观察特应性皮炎患者皮损组织中TLR2、TLR4mRNA的表达水平，初步探讨TLR2、TLR4在特应性皮炎发病机制中的作用，为临床治疗提供新思路。方法：采用荧光定量PCR技术（Taqman探针法）检测35例特应性皮炎患者皮损组织中TLR2、TLR4mRNA的表达水平，并与30例周期正常对照。采用湿疹面积及严重程度指数（EASI）评价患者病情，分析特应性皮炎患者皮损组织中TLR2、TLR4mRNA的表达与疾病严重程度的相火性。结果：特应性皮炎患者TLR2皮损组织巾的表达明显高于正常对照，且与EASI评分正相关（r=0．769，P〈0．01），而TLR4tuRNA未检出表达。结论：研究提示TLR2可能在特应性皮炎的发病中起重要作用。     

儿童特应性皮炎患者外周血单一核细胞IL-31与疾病严重程度相关性分析

目的 探讨IL-31在儿童特应性皮炎发病机制中的作用以及与特应性皮炎瘙痒的相关性。方法 22例特应性皮炎患儿与22例健康儿童外周血单一核细胞在葡萄球菌肠毒素B（SEB）刺激或非刺激状态下，应用实时PCR方法分析IL-31表达情况；酶联免疫吸附法测定其血清IgE水平；对患儿病情进行病情严重程度评分，分析IL-31 mRNA与IgE水平、疾病严重程度及瘙痒的相关性。结果 特应性皮炎患儿外周血单一核细胞IL-31表达显著增加，是对照组的23.2倍（P < 0.01）。特应性皮炎组和对照组外周血单一核细胞受SEB刺激后IL-31表达均有不同程度升高，以特应性皮炎组IL-31表达增加更显著，是对照组的20.44倍。患儿血清总IgE水平中位数为260.05 IU/mL（范围5.9 ～ 1131.01 IU/mL），对照组为17.7 IU/mL（范围5 ～ 140.7 IU/mL），两组比较，P < 0.01。IL-31与患儿病情严重程度以及血清总IgE水平无显著相关性（r = 0.07，P > 0.05；r = 0.22，P > 0.05）。结论 IL-31可能参与儿童特应性皮炎发病，其作用机制可能不依赖血清IgE；SEB能诱导正常人外周血单一核细胞快速表达IL-31，是IL-31产生的重要调节因素。     

TRPV1在特应性皮炎发病机制和治疗中的研究进展

特应性皮炎是一种常见的慢性复发性、瘙痒性、炎症性皮肤疾病，其发病率高且发病机制复杂。TRPV1为作为瞬时受体电位家族重要的一员参与了多种皮肤疾病的病理生理学及发病过程，近期研究证据亦发现TRPV1与特应性皮炎的发病机制密切的相关性，目前以TRPV1为主要靶标治疗特应性皮炎的药物取得了良好的疗效与安全性。本文就TRPV1在特应性皮炎发病机制和治疗中的研究进展进行综述。     

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。     

Th17细胞及相关细胞因子与不同严重程度特应性皮炎的相关性研究

目的研究不同严重程度特应性皮炎患者Th17细胞及其相关细胞因子的变化,探讨其在特应性皮炎发病中的作用。方法采用流式细胞术检测不同严重程度特应性皮炎患者外周血Th17细胞的比例,采用酶联免疫吸附试验测定培养上清液中IL-6、IL-17表达水平,以健康成人作为对照。结果特应性皮炎患者外周血Th17细胞及血清IL-6、IL-17水平增高且与严重程度呈正相关。结论 Th17细胞及IL-6、IL-17可能在特应性皮炎发病过程中发挥重要作用。     

Lack of efficacy of topical cyclosporin A in atopic dermatitis and allergic contact dermatitis.

Since oral cyclosporin A (CsA) has demonstrated its effectiveness in psoriasis and atopic dermatitis, efforts have been made to develop a topical CsA formulation, thus avoiding systemic adverse events. A limited number of publications are available on the use of topical CsA in allergic contact dermatitis and atopic dermatitis. Moreover the response rate of humans to topical CsA is about 50% or less. We now report our results with three new topical CsA formulations on allergic contact dermatitis and atopic dermatitis. No significant improvement was found in 16 atopic dermatitis patients and 7 allergic contact dermatitis (nickel sulphate) patients.     

Red ginseng for atopic dermatitis

Red ginseng is known for its significant biological activities which include anti-inflammation. Red ginseng may be used for the management and prevention of atopic dermatitis based on its effect on an atopic dermatitis animal model. More therapeutic efficacies other than atopic dermatitis are also reviewed briefly.     

Neuroimmune interactions in chronic itch of atopic dermatitis

Itch is a defining symptom of atopic dermatitis. Crosstalk between keratinocytes, the immune system and non-histaminergic sensory nerves is responsible for the pathophysiology of chronic itch in atopic dermatitis. An expanding understanding of the contribution of the nervous system and its interaction with immune pathways in atopic itch are helping to identify new therapeutic strategies.     

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。     

Phenotypes of atopic dermatitis identified by cluster analysis in early childhood

Atopic dermatitis is a chronic, relapsing, inflammatory skin disease that usually appears in early childhood and develops into a heterogeneous disease during childhood. The clinical course and treatment for atopic dermatitis can differ according to its phenotype and/or endotype. This study aimed to identify clinical phenotypes of atopic dermatitis in early childhood. Data were obtained from 572 children under 3 years of age with atopic dermatitis. Cluster analysis applied to 11 variables, and we identified four clusters of atopic dermatitis. Children in cluster A (n = 141) had early‐onset atopic dermatitis with high blood eosinophil counts, serum total immunoglobulin E and rates of sensitization to food allergens. Children in cluster B (n = 218) had early‐onset atopic dermatitis with low blood eosinophil counts, serum total immunoglobulin E and rates of sensitization to both food and inhalant allergens. Children in cluster C (n = 53) had early‐onset atopic dermatitis with high C‐reactive protein levels and white blood cell counts. Children in cluster D (n = 160) had middle‐onset atopic dermatitis with high serum total immunoglobulin E and rates of sensitization to inhalant allergens. Cluster A had the highest Scoring for Atopic Dermatitis and transepidermal water loss values. Age at onset, age at diagnosis, white blood cell count, eosinophil count, C‐reactive protein and serum total immunoglobulin E level were the strongest predictors of cluster assignment. Analysis of these six variables alone resulted in correct classification of 95.5% of the subjects. These results support the heterogeneity of atopic dermatitis, even in early childhood.     

Economic Impact of Atopic Dermatitis in Korean Patients

Background

Atopic dermatitis is a global public health concern owing to its increasing prevalence and socioeconomic burden. However, few studies have assessed the economic impact of atopic dermatitis in Korea.

Objective

We conducted a cost analysis of atopic dermatitis and evaluated its economic impacts on individual annual disease burden, quality of life, and changes in medical expenses with respect to changes in health related-quality of life.

Methods

The cost analysis of atopic dermatitis was performed by reviewing the home accounting records of 32 patients. The economic impact of the disease was evaluated by analyzing questionnaires. To handle uncertainties, we compared the results with the data released by the Health Insurance Review & Assessment Board on medical costs claimed by healthcare facilities.

Results

The direct cost of atopic dermatitis per patient during the 3-month study period was 541,280 Korean won (KRW), and expenditures on other atopic dermatitis-related products were 120,313 KRW. The extrapolated annual direct cost (including expenditures on other atopic dermatitis-related products) per patient was 2,646,372 KRW. The estimated annual indirect cost was 1,507,068 KRW. Thus, the annual cost of illness of atopic dermatitis (i.e., direct+indirect costs) was estimated to be 4,153,440 KRW.

Conclusion

The annual total social cost of atopic dermatitis on a national level is estimated to be 5.8 trillion KRW.     

Lichenoid and other clinical presentations of atopic dermatitis in an inner city practice

Atopic dermatitis (AD) has many different clinical presentations. In our inner city practice, we have observed a variant of AD in our heavily pigmented patients that we have termed lichen planus-like atopic dermatitis because of its clinical similarity to lichen planus. Clinically, this variant may be distinguished by the presence on extensor surfaces and a more rapid response to treatment. Histologically, in lichen planus-like AD, a spongiotic dermatitis is present; further, there is no lichenoid dermatitis evident. We compare this presentation with the others seen over an eight-month interval in our practice. We report on a lichen planus-like variant of atopic dermatitis in our African American patients. A limitation to this report is the relatively small sample size. Facial/extensor is the most common presentation of atopic dermatitis in our predominantly minority clinic.     

特应性皮炎和湿疹皮肤金黄色葡萄球菌肠毒素及中毒休克综合征毒素-1的检测

目的 探讨皮肤金黄色葡萄球菌(金葡菌)肠毒素及中毒休克综合征毒素-1(TSST-1)在特应性皮炎及湿疹中的致病作用。方法 反向被动乳胶凝集法测定来自117例特应性皮炎和199例湿疹患者皮肤共140株金葡菌的肠毒素/TSST-1。结果 140株金葡菌中60株产生超抗原,阳性率为42.9%,其中43株只产生一种超抗原,17株产生至少两种超抗原。特应性皮炎组超抗原总阳性率为51.5%,皮损与非皮损处无差别。湿疹组超抗原总阳性率为34.7%,阳性株均为皮损处菌。特应性皮炎组超抗原总阳性率、皮损处超抗原总阳性率及中毒休克综合征毒素-1阳性率均高于湿疹组。结论 与湿疹相比,特应性皮炎与金葡菌超抗原的关系较为密切。     

Use of pimecrolimus cream in disorders other than atopic dermatitis

BACKGROUND: Pimecrolimus is indicated for treatment of atopic dermatitis and has been evaluated in many other disorders. OBJECTIVE: To review the efficacy of pimecrolimus in treatment of disorders other than atopic dermatitis. METHODS: We performed a PubMed search of the English-language literature using the key word "pimecrolimus." We reviewed articles reporting the use of pimecrolimus in disorders other than atopic dermatitis and classified them by the type of study used to evaluate efficacy. RESULTS: Randomized, double-blind studies have shown that pimecrolimus is superior to vehicle in treatment of seborrheic dermatitis, hand dermatitis, and asteatotic eczema but have yielded conflicting results regarding intertriginous psoriasis and vitiligo. Open-label studies involving four or more patients have shown favorable results in many disorders, including contact dermatitis, rosacea, lichen sclerosus, and oral and genital lichen planus. Case reports have shown that topical pimecrolimus may be useful in cutaneous graft-versus-host disease, lichen striatus, cutaneous lichen planus, and many other disorders. CONCLUSIONS: Topical pimecrolimus appears to be an effective treatment for many disorders other than atopic dermatitis, especially seborrheic dermatitis, hand dermatitis, and asteatoic eczema. It may be effective in many other disorders, but its role in these disorders remains to be clarified by additional studies.