Brenninkmeijer Elian E A, Spuls Phyllis I, Legierse Catharina M, Lindeboom Robert, Smitt J Henk Sillevis, Bos Jan D
Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
J Am Acad Dermatol. 2008 Mar;58(3):407-14. doi: 10.1016/j.jaad.2007.12.002.
Atopic dermatitis (AD) has been divided into the "extrinsic" and "intrinsic" type, in which "intrinsic AD" is characterized by the absence of allergen-specific IgE. Still, there is no consensus whether this "intrinsic type" of AD, which we denominate as atopiform dermatitis (AFD), is a distinct entity.
A case-control study was performed to compare the clinical and diagnostic features of AD and AFD.
Patients with a clinical diagnosis of AD were selected. Cases did not have demonstrable allergen-specific IgE. Matched control subjects were tested positive for allergen-specific IgE. Patients were evaluated for medical history, quality of life, disease severity, and Hanifin and Rajka, U.K. and Millennium diagnostic criteria.
Eight percent (n = 34) of the selected patients had, in fact, AFD. Female predominance, absence of atopic diseases, later onset of disease, and milder disease severity were observed in AFD. A history of atopy, recurrent conjunctivitis, palmar hyperlinearity, keratosis pilaris, pityriasis alba, and hand and/or food eczema were significantly less present in AFD. Dennie-Morgan fold was positively associated with AFD.
Not all patients with negative allergen-specific IgE participated and a relatively small number of AFD patients were studied.
In addition to the absence of allergen-specific IgE, our findings support that AFD is an entity distinct from AD. With a distinction shown between AFD and AD, patient groups will be better defined and more homogeneous. Implications of this distinction will be of importance for preventive and therapeutic advice; diagnostic processes; and for future research.
特应性皮炎（AD）已被分为“外源性”和“内源性”类型，其中“内源性AD”的特征是缺乏过敏原特异性IgE。然而，我们将这种“内源性”AD称为类特应性皮炎（AFD），它是否为一个独立的疾病实体尚无定论。
进行一项病例对照研究，以比较AD和AFD的临床及诊断特征。
选取临床诊断为AD的患者。病例组患者无可检测到的过敏原特异性IgE。匹配的对照组受试者过敏原特异性IgE检测呈阳性。对患者进行病史、生活质量、疾病严重程度以及Hanifin和Rajka、英国及千禧年诊断标准的评估。
实际上，所选患者中有8%（n = 34）患有AFD。AFD患者中女性居多，无特应性疾病，发病较晚，疾病严重程度较轻。AFD患者中特应性病史、复发性结膜炎、手掌纹加深、毛发角化病、白色糠疹以及手部和/或食物性湿疹的发生率显著较低。Dennie-Morgan皱襞与AFD呈正相关。
并非所有过敏原特异性IgE阴性的患者都参与研究，且研究的AFD患者数量相对较少。
除缺乏过敏原特异性IgE外，我们的研究结果支持AFD是一种与AD不同的疾病实体。明确AFD与AD之间的区别后，患者群体将得到更好的界定且更加同质化。这种区别对于预防和治疗建议、诊断过程以及未来研究都具有重要意义。
