Chong Melanie, Fonacier Luz
Rheumatology, Allergy & Immunology, Winthrop University Hospital, 120 Mineola Blvd, Suite 410, Mineola, NY, 11501, USA.
Clin Rev Allergy Immunol. 2016 Dec;51(3):249-262. doi: 10.1007/s12016-015-8486-7.
Atopic dermatitis (AD) is a chronic inflammatory skin condition that requires a manifold approach to therapy. The goal of therapy is to restore the function of the epidermal barrier and to reduce skin inflammation. This can be achieved with skin moisturization and topical anti-inflammatory agents, such as topical corticosteroids and calcineurin inhibitors. Furthermore, proactive therapy with twice weekly use of both topical corticosteroids and calcineurin inhibitors in previously affected areas has been found to reduce the time to the next eczematous flare. Adjunctive treatment options include wet wrap therapy, anti-histamines, and vitamin D supplementation. Bacterial colonization, in particular Staphylococcus aureus, can contribute to eczematous flares and overt infection. Use of systemic antibiotics in infected lesions is warranted; however, empiric antibiotics use in uninfected lesions is controversial. Local antiseptic measures (i.e., bleach baths) and topical antimicrobial therapies can be considered in patients with high bacterial colonization. Difficult-to-treat AD is a complex clinical problem that may require re-evaluation of the initial diagnosis of AD, especially if the onset of disease occurs in adulthood. It may also necessitate evaluation for contact, food, and inhaled allergens that may exacerbate the underlying AD. There are a host of systemic therapies that have been successful in patients with difficult-to-treat AD, however, these agents are limited by their side effect profiles. Lastly, with further insight into the pathophysiology of AD, new biological agents have been investigated with promising results.
特应性皮炎（AD）是一种慢性炎症性皮肤病，需要采取多种治疗方法。治疗的目标是恢复表皮屏障功能并减轻皮肤炎症。这可以通过皮肤保湿和局部抗炎药物来实现，如局部用皮质类固醇和钙调神经磷酸酶抑制剂。此外，已发现对先前受累部位每周两次同时使用局部皮质类固醇和钙调神经磷酸酶抑制剂进行预防性治疗可减少下次湿疹发作的时间。辅助治疗选择包括湿敷疗法、抗组胺药和补充维生素D。细菌定植，尤其是金黄色葡萄球菌，可导致湿疹发作和明显感染。在感染病灶中使用全身性抗生素是必要的；然而，在未感染病灶中经验性使用抗生素存在争议。对于细菌定植率高的患者，可考虑采取局部抗菌措施（如漂白浴）和局部抗菌治疗。难治性AD是一个复杂的临床问题，可能需要重新评估AD的初始诊断，尤其是如果疾病在成年期发病。还可能需要评估可能加重潜在AD的接触性、食物性和吸入性过敏原。有许多全身治疗方法已在难治性AD患者中取得成功，然而，这些药物受到其副作用的限制。最后，随着对AD病理生理学的进一步深入了解，已对新型生物制剂进行了研究并取得了有前景的结果。
