Simon Dagmar
Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Curr Probl Dermatol. 2011;41:156-164. doi: 10.1159/000323309. Epub 2011 May 12.
Systemic therapy is required in patients with severe atopic dermatitis (AD) refractory to adequate topical therapy. The aim of a systemic therapy is the rapid and efficient improvement of skin symptoms and pruritus in acute exacerbation and/or the long-term control of severe chronic disease. A number of immunosuppressive and immunomodulating substances are available that may efficiently reduce skin inflammation and thus lead to a relief of symptoms including pruritus. The excellent effects of cyclosporine as short-term as well as maintenance therapy have been documented in several studies in children and adults. Furthermore, other immunosuppressive substances such as azathioprine, mycophenolate mofetil and methotrexate are effective in patients with moderate to severe AD. Intravenous immunoglobulins and γ-interferon exert immunomodulatory effects and thus may improve severe AD. Biological agents are a new approach in AD therapy since they may specifically target cells, cytokines or mediators involved in the pathogenesis of AD.
对于足量外用治疗无效的重度特应性皮炎（AD）患者，需要进行系统治疗。系统治疗的目的是在急性加重期快速有效地改善皮肤症状和瘙痒，和/或长期控制重度慢性疾病。有多种免疫抑制和免疫调节物质可供使用，它们可以有效减轻皮肤炎症，从而缓解包括瘙痒在内的症状。环孢素作为短期及维持治疗的卓越效果已在多项针对儿童和成人的研究中得到证实。此外，其他免疫抑制物质如硫唑嘌呤、霉酚酸酯和甲氨蝶呤对中度至重度AD患者有效。静脉注射免疫球蛋白和γ干扰素发挥免疫调节作用，因此可能改善重度AD。生物制剂是AD治疗的一种新方法，因为它们可以特异性地靶向参与AD发病机制的细胞、细胞因子或介质。
