Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Exp Dermatol. 2010 Apr;19(4):325-31. doi: 10.1111/j.1600-0625.2009.01024.x. Epub 2010 Jan 22.
Age period prevalence of atopic eczema (AE), a very common skin disease, has increased during the past decennia. This expansion seems to be ending in wealthy countries, while an increase is observed in developing nations, for which there is no firm explanation. Recent steps in understanding AE are the detection of skin barrier related filaggrin null mutations in approximately 25% of patients and the recognition of IL-31 as a molecule possibly involved in the itch (pruritus). Also interesting are the recognition of thymus and activation-regulated chemokine (TARC) and proliferating-inducing ligand (APRIL), as being associated with AE severity and activity. Immunocentric and corneocentric views on pathogenesis (the inside-outside paradigm) and the diagnostic entity atopiform dermatitis (AFD) are discussed here. We emphasize that diagnosing AE is not simple but challenging. We accentuate that a diagnosis of AE is only possible when there is allergen-specific IgE. Advice as to the need for elimination of allergens and adjustment of lifestyle are only proficient in patients having atopy and true AE, not in those having AFD.
特应性皮炎（AE）是一种非常常见的皮肤疾病，其在过去几十年中的发病率呈上升趋势。这种扩张似乎在富裕国家已经结束，而在发展中国家则观察到发病率上升，但目前还没有明确的解释。近年来，人们对 AE 的认识有了新的进展，大约 25%的患者存在与皮肤屏障相关的丝聚蛋白基因突变，并且发现白细胞介素 31（IL-31）可能参与瘙痒（瘙痒）。此外，胸腺和激活调节趋化因子（TARC）和增殖诱导配体（APRIL）的识别也与 AE 的严重程度和活动度有关。本文讨论了发病机制的免疫中心和角质层中心观点（内外范式）以及诊断实体特应性皮炎（AFD）。我们强调，诊断 AE 并不简单，而是具有挑战性。我们强调，只有在存在过敏原特异性 IgE 时，才能诊断为 AE。关于消除过敏原和调整生活方式的建议，仅在患有特应性和真正 AE 的患者中有效，而在患有 AFD 的患者中无效。
