Ricci Giampaolo, Dondi Arianna, Patrizi Annalisa
Department of Pediatrics, University of Bologna, Bologna, Italy.
Am J Clin Dermatol. 2009;10(5):287-300. doi: 10.2165/11310760-000000000-00000.
Eczema, frequently named atopic dermatitis, is the most frequent chronic skin disease of early childhood, with a high prevalence in industrialized countries and a relapsing-remitting course that is responsible for a serious burden on affected children and their families. Even though most facets of this disease are nowadays well known and numerous guidelines are available, some confusion still exists regarding certain aspects. First, several names have been proposed for the disorder. We suggest that the name and definition adopted by the World Allergy Organization should be used: 'eczema,' divided into 'atopic,' when an allergic sensitization can be demonstrated, and 'non-atopic,' in the absence of sensitization. Several diagnostic criteria have been proposed, but at present the two most reliable are the 2003 revision by the American Academy of Dermatology of the Hanifin-Rajka criteria, and those by Williams revised in 2005. To date, 20 different clinical scores have been published to assess the severity; however, only the EASI (Eczema Area and Severity Index), the SCORAD (SCORing Atopic Dermatitis), and the POEM (Patient-Oriented Eczema Measure) seem to have been adequately validated and are recommended for use in clinical practice and trials. The diagnostic tests to identify associated allergy or sensitization include skin-prick tests, determination of the specific IgE in serum using different assays, and atopy patch tests; in the case of suspected food allergy, a food challenge may be necessary to define the diagnosis. To evaluate quality of life, tools exist that allow both the child's and family's impairment to be considered. In addition, several algorithms exist to help decide therapy on a step-wise basis. However, such guidelines and algorithms represent only an aid to the physician and not an obligatory directive, since the ultimate judgment regarding any therapy must be performed by the physician and tailored to individual needs. A clear and validated definition of eczema control would permit better monitoring of the disease, similar to the situation with asthma in recent years. Finally, the review examines the role of special textiles in diminishing Staphylococcus aureus skin superinfection, of house dust-mite avoidance measures, and of educational programs for patients and their families, which may all help improve eczema.
湿疹，常被称为特应性皮炎，是幼儿期最常见的慢性皮肤病，在工业化国家患病率很高，且病情呈复发-缓解过程，给患病儿童及其家庭带来沉重负担。尽管如今对这种疾病的大多数方面已广为人知，且有众多指南可供参考，但在某些方面仍存在一些困惑。首先，针对该病症提出了多个名称。我们建议采用世界过敏组织所采用的名称和定义：“湿疹”，当可证明存在过敏致敏时分为“特应性”，在无致敏情况时则为“非特应性”。已经提出了多种诊断标准，但目前最可靠的两种是美国皮肤病学会2003年对哈尼芬-拉伊卡标准的修订版，以及2005年威廉姆斯修订的标准。迄今为止，已发表了20种不同的临床评分来评估严重程度；然而，只有湿疹面积和严重程度指数（EASI）、特应性皮炎评分（SCORAD）以及以患者为导向的湿疹测量法（POEM）似乎得到了充分验证，并被推荐用于临床实践和试验。用于识别相关过敏或致敏的诊断测试包括皮肤点刺试验、使用不同检测方法测定血清中的特异性IgE以及特应性斑贴试验；对于疑似食物过敏的情况，可能需要进行食物激发试验来明确诊断。为了评估生活质量，有一些工具可以同时考虑儿童和家庭所受的损害。此外，有多种算法可帮助逐步确定治疗方案。然而，此类指南和算法仅为医生提供辅助，而非强制性指令，因为任何治疗的最终判断必须由医生做出，并根据个体需求进行调整。对湿疹控制进行明确且经过验证的定义将有助于更好地监测病情，类似于近年来哮喘的情况。最后，该综述探讨了特殊纺织品在减少金黄色葡萄球菌皮肤继发感染方面的作用、避免屋尘螨措施以及针对患者及其家庭的教育项目，这些都可能有助于改善湿疹。
