Williams Hywel C
Centre of Evidence-Based Dermatology, University of Nottingham King's Meadow Campus, Nottingham NG7 2NR, UK.
Vet Dermatol. 2013 Feb;24(1):3-9.e1-2. doi: 10.1111/j.1365-3164.2012.01079.x.
This narrative review highlights areas within the epidemiology of human atopic dermatitis (AD) where significant progress has been made and where considerable ignorance still exists. The review is supported by systematic reviews wherever possible, with the purpose of stimulating fresh approaches to human and veterinary research into AD.
Areas of progress include valid and repeatable methods of disease definition, global documentation of disease prevalence and impact, clarification of the role of some genetic factors, such as filaggrin gene mutations, clear evidence that environmental factors are key, as demonstrated by the positive social class gradient and rising prevalence, a possible protective effect of infections in early life, documentation of comorbidities, such as a reduced risk of glioma, and mapping the evidence base through systematic reviews and an online global resource of clinical trials.
Areas where significant uncertainty still exists include the question of whether AD is more than one disease, the tendency for researchers to look at the same old risk factors, lack of specific environmental risk factors that are amenable to manipulation, inconsistencies in the hygiene hypothesis, sparse knowledge about adult AD, lack of evidence that eczema can be prevented, and little scientific work exploring what causes flares in people with established AD.
本叙述性综述重点介绍了人类特应性皮炎（AD）流行病学中已取得重大进展以及仍存在大量未知的领域。本综述尽可能得到系统评价的支持，目的是激发对AD进行人类和兽医研究的新方法。
取得进展的领域包括有效的、可重复的疾病定义方法、疾病患病率和影响的全球记录、某些遗传因素（如丝聚合蛋白基因突变）作用的阐明、环境因素是关键因素的明确证据（如社会阶层的正向梯度和患病率上升所证明）、早年感染可能具有的保护作用、合并症的记录（如患胶质瘤风险降低）以及通过系统评价和在线全球临床试验资源绘制证据基础。
仍存在重大不确定性的领域包括AD是否不止一种疾病的问题、研究人员倾向于研究相同的旧风险因素、缺乏可操控的特定环境风险因素、卫生假说的不一致性、对成人AD的了解不足、缺乏湿疹可预防的证据以及几乎没有科学研究探索已患AD的人病情发作的原因。
