Mooney Emma, Rademaker Marius, Dailey Rebecca, Daniel Ben S, Drummond Catherine, Fischer Gayle, Foster Rachael, Grills Claire, Halbert Anne, Hill Sarah, King Emma, Leins Elizabeth, Morgan Vanessa, Phillips Roderic J, Relic John, Rodrigues Michelle, Scardamaglia Laura, Smith Saxon, Su John, Wargon Orli, Orchard David
Department of Paediatric Dermatology, Royal Children's Hospital, Melbourne, Victoria.
Department of Dermatology, Waikato Hospital, Hamilton, New Zealand.
Australas J Dermatol. 2015 Nov;56(4):241-51. doi: 10.1111/ajd.12313. Epub 2015 Mar 6.
Atopic eczema is a chronic inflammatory disease affecting about 30% of Australian and New Zealand children. Severe eczema costs over AUD 6000/year per child in direct medical, hospital and treatment costs as well as time off work for caregivers and untold distress for the family unit. In addition, it has a negative impact on a child's sleep, education, development and self-esteem. The treatment of atopic eczema is complex and multifaceted but a core component of therapy is to manage the inflammation with topical corticosteroids (TCS). Despite this, TCS are often underutilised by many parents due to corticosteroid phobia and unfounded concerns about their adverse effects. This has led to extended and unnecessary exacerbations of eczema for children. Contrary to popular perceptions, (TCS) use in paediatric eczema does not cause atrophy, hypopigmentation, hypertrichosis, osteoporosis, purpura or telangiectasia when used appropriately as per guidelines. In rare cases, prolonged and excessive use of potent TCS has contributed to striae, short-term hypothalamic-pituitary-adrenal axis alteration and ophthalmological disease. TCS use can also exacerbate periorificial rosacea. TCS are very effective treatments for eczema. When they are used to treat active eczema and stopped once the active inflammation has resolved, adverse effects are minimal. TCS should be the cornerstone treatment of atopic eczema in children.
特应性皮炎是一种慢性炎症性疾病，影响约30%的澳大利亚和新西兰儿童。严重湿疹每年给每个儿童带来超过6000澳元的直接医疗、住院和治疗费用，以及照顾者的误工时间和家庭的无尽痛苦。此外，它还会对儿童的睡眠、教育、发育和自尊产生负面影响。特应性皮炎的治疗复杂且多方面，但治疗的核心组成部分是使用外用皮质类固醇（TCS）来控制炎症。尽管如此，由于对皮质类固醇的恐惧以及对其不良反应的无端担忧，许多家长往往未充分使用TCS。这导致儿童湿疹长期且不必要地加重。与普遍看法相反，按照指南适当使用时，（TCS）用于小儿湿疹不会导致萎缩、色素减退、多毛症、骨质疏松、紫癜或毛细血管扩张。在极少数情况下，长期过量使用强效TCS会导致出现条纹、短期下丘脑 - 垂体 - 肾上腺轴改变和眼科疾病。使用TCS还会加重口周酒渣鼻。TCS是治疗湿疹的非常有效的方法。当它们用于治疗活动性湿疹并在活动性炎症消退后停药时，不良反应最小。TCS应该是儿童特应性皮炎的基础治疗方法。
