Hon Kam L, Leung Alexander K C
Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.
Recent Pat Inflamm Allergy Drug Discov. 2013 Jan 1;7(1):12-9.
Atopic eczema or dermatitis (AD) is a chronically relapsing dermatosis associated with pruritus, sleep disturbance and impaired quality of life. AD affects 10 to 20% of school-aged children. The prevalence has increased two to three folds over the past three decades in industrialized countries and there is evidence to suggest that this prevalence is increasing. AD is frustrating to both patients and caregivers and can impose considerable financial impact on the families. The pruritus and sleep disturbance can be intractable and the disease has important physical and psychological implications. Filaggrin (filament-aggregating protein) has an important function in epidermal differentiation and barrier function. Null mutations within the filaggrin gene cause ichthyosis vulgaris and are major risk factors for developing AD. The affected skin of atopic individuals is deficient in natural moisturizing factors (derived from deiminated filaggrin peptides filaggrin) or ceramides (a family of lipid molecules, composed of sphingosine and a fatty acid, found in high concentrations within the cell membrane of cells in the stratum corneum). Avoidance of triggering factors, optimal skin care and topical corticosteroids are the mainstay of therapy for AD. There are two important dermatologic facets to its management, namely, preventive and therapeutic measures. Preventive measures refer to the frequent and proper application of skin moisturizers. When these preventive measures fail to control the disease exacerbation, therapeutic measures such as topical/systemic corticosteroids, antibiotics and immunomodulating agents may be required to control the skin inflammation. Proper moisturizer therapy can reduce the frequency of flares and the demand of topical corticosteroids or topical calcineurin inhibitors. Regular topical application of a moisturizer is the key in the management of patients with AD. Moisturizer therapy of childhood-onset AD is significantly complicated by the diversity of disease manifestations and by a variety of complex immune abnormalities. Recent advances in the understanding of the pathophysiological process of AD leads to the production of new moisturizers and topical skin products targeted to correct reduced amount of ceramides in the skin with ceramide and pseudoceramide products. However, many cosmetic products claimed to have these ingredients have no or limited studies to document their clinical efficacy. Recent studies have shown the therapeutic efficacy of several new compounds. This review provides an update on recent patents that could develop into novel therapeutics available to the clinical armamentarium for the management of the disease.
特应性湿疹或皮炎（AD）是一种慢性复发性皮肤病，伴有瘙痒、睡眠障碍和生活质量受损。AD影响10%至20%的学龄儿童。在过去三十年中，工业化国家的患病率增加了两到三倍，并且有证据表明这种患病率正在上升。AD对患者和护理人员来说都令人沮丧，并且会给家庭带来相当大的经济影响。瘙痒和睡眠障碍可能难以处理，并且该疾病具有重要的生理和心理影响。丝聚蛋白（细丝聚集蛋白）在表皮分化和屏障功能中具有重要作用。丝聚蛋白基因内的无效突变会导致寻常型鱼鳞病，并且是发生AD的主要危险因素。特应性个体受影响的皮肤缺乏天然保湿因子（源自去酰胺化的丝聚蛋白肽丝聚蛋白）或神经酰胺（一类脂质分子，由鞘氨醇和脂肪酸组成，在角质形成细胞的细胞膜中高浓度存在）。避免触发因素、优化皮肤护理和外用皮质类固醇是AD治疗的主要方法。其管理有两个重要的皮肤病学方面，即预防和治疗措施。预防措施是指频繁且正确地使用皮肤保湿剂。当这些预防措施未能控制疾病加重时，可能需要采取治疗措施，如外用/全身性皮质类固醇、抗生素和免疫调节剂来控制皮肤炎症。适当的保湿剂治疗可以减少皮疹发作的频率以及对外用皮质类固醇或外用钙调神经磷酸酶抑制剂的需求。定期外用保湿剂是AD患者管理的关键。儿童期发病的AD的保湿剂治疗因疾病表现的多样性和各种复杂的免疫异常而显著复杂化。对AD病理生理过程理解的最新进展导致了新的保湿剂和局部皮肤产品的产生，这些产品旨在用神经酰胺和假神经酰胺产品纠正皮肤中神经酰胺含量的减少。然而，许多声称含有这些成分的化妆品没有或仅有有限的研究来证明其临床疗效。最近的研究表明了几种新化合物的治疗效果。本综述提供了关于近期专利的最新信息，这些专利可能发展成为可用于临床治疗该疾病的新型疗法。
