Rackal J M, Vender R B
Faculty of Medicine, Queens University, Kingston, Ontario, Canada.
Skin Therapy Lett. 2004 Feb;9(2):1-5.
Atopic dermatitis (AD) is a chronically relapsing eczematous disorder of the skin that occurs in persons of all ages but is more common in children. AD is associated with other atopic diseases such as allergic rhinoconjuntivitis or bronchial asthma. Nearly 80% of children with AD eventually develop allergic rhinitis or asthma. AD can be classified as mixed (cases associated with respiratory allergies) and pure . Pure AD has intrinsic and extrinsic variants. In the extrinsic type, interleukin-4 is secreted by T-cells isolated from spontaneous lesions and skin-derived T-lymphocytes express more IL-13. Due to the different immunopathogenesis, it has been suggested that antileukotriene agents may be more successful in the treatment of the extrinsic subgroup. Leukotrienes (LTs) are a class of potent biological inflammatory mediators derived from arachidonic acid through the 5-lipoxygenase pathway. There is evidence of enhanced LT production in the pathogenesis of AD. Evidence in the literature provides a pathophysiological rationale for the use of cysLT receptor blockers in the treatment of AD. However, the exact mechanism of action of leukotriene receptor antagonists in AD is not known. In small clinical and case studies, montelukast was found to be a safe and effective alternative or steroid-sparing therapy in the management of patients with atopic dermatitis.
特应性皮炎（AD）是一种慢性复发性皮肤湿疹性疾病，可发生于各年龄段人群，但在儿童中更为常见。AD与其他特应性疾病相关，如过敏性鼻结膜炎或支气管哮喘。近80%的AD患儿最终会发展为过敏性鼻炎或哮喘。AD可分为混合型（与呼吸道过敏相关的病例）和单纯型。单纯型AD有内在型和外在型变体。在外在型中，从自发皮损中分离出的T细胞分泌白细胞介素-4，且皮肤来源的T淋巴细胞表达更多的IL-13。由于免疫发病机制不同，有人提出白三烯拮抗剂可能在治疗外在型亚组方面更有效。白三烯（LTs）是一类通过5-脂氧合酶途径从花生四烯酸衍生而来的强效生物炎症介质。有证据表明在AD的发病机制中LT生成增加。文献中的证据为使用半胱氨酰白三烯受体阻滞剂治疗AD提供了病理生理学依据。然而，白三烯受体拮抗剂在AD中的确切作用机制尚不清楚。在小型临床和病例研究中，发现孟鲁司特在治疗特应性皮炎患者时是一种安全有效的替代疗法或减少类固醇使用的疗法。
