Department of Dermatology, University of California at San Francisco, San Francisco, CA, USA.
Department of Dermato-Allergology, National Allergy Research Centre, Copenhagen University Hospital, Gentofte, Denmark.
J Eur Acad Dermatol Venereol. 2016 Apr;30(4):604-18. doi: 10.1111/jdv.13442. Epub 2015 Nov 4.
This review summarizes historical aspects, clinical expression and pathophysiology leading to coining of the terms atopy and atopic dermatitis, current diagnostic criteria and further explore the possibility of developing quantitative diagnostic criteria of atopic dermatitis (AD) based on the importance of atopic features - subjective, objective, and those derived from laboratory tests - the new partly promising AD biomarkers. 'Atopy', introduced in 1923, denoted 'the sense of a strange disease without a precise place in the body'. A decade later, Sulzberger and Hill, first defined 'atopic dermatitis'. The pioneering well-recognized criteria, 'Hanifin & Rajka' (Acta Derm Venereol, 92, 1980, 44), were developed empirically on 'clinical experience' and expert consensus. As opposed to the widely used, rather anamnestic 'UK Criteria' (1994), they have few formal validation studies, but appear to well embrace various atopic phenotypes. Pruritus, xerosis, typical morphology/distribution of dermatitis and tendency to a relapsing/chronic course are common basic features in AD criteria, whereas skin sensitivity, heredity and various ill-defined atopic stigmata also seem to comprise the atopic phenomenon. Specific pheno- and endotypes are now emerging potentially enabling us to better classify patients with AD, but the influence of these on the diagnosis of AD is so far unclear. Few diagnostic models use quantitative scoring systems to establish AD cases from normal population, which, however, may be useful to better study and manage this disease. Long-term prospective observational studies, from which few are available at this point, along with interventional studies, are a perquisite and will provide the best option to improve our understanding of its complex characteristics and etiology.
这篇综述总结了导致特应性和特应性皮炎这两个术语产生的历史背景、临床表现和病理生理学，目前的诊断标准，并进一步探讨了基于特应性特征的重要性（主观、客观和来自实验室检查的特征），即新的部分有前途的特应性皮炎（AD）生物标志物，开发 AD 定量诊断标准的可能性。“特应性”一词于 1923 年提出，指“一种没有确切身体部位的奇怪疾病的感觉”。十年后，Sulzberger 和 Hill 首次定义了“特应性皮炎”。开创性的公认标准“Hanifin 和 Rajka”（Acta Derm Venereol，92，1980，44）是基于“临床经验”和专家共识经验性制定的。与广泛使用的、更具病史的“英国标准”（1994 年）不同，它们很少有正式的验证研究，但似乎很好地涵盖了各种特应性表型。瘙痒、干燥、皮炎的典型形态/分布和反复发作/慢性病程是 AD 标准的常见基本特征，而皮肤敏感性、遗传和各种定义不明确的特应性标志也似乎构成了特应性现象。现在正在出现特定的表型和终末型，这可能使我们能够更好地对 AD 患者进行分类，但这些因素对 AD 诊断的影响目前尚不清楚。很少有诊断模型使用定量评分系统从正常人群中建立 AD 病例，然而，这可能有助于更好地研究和管理这种疾病。目前还很少有长期前瞻性观察性研究，同时还需要干预性研究，这些都是必要的，并将为更好地了解其复杂特征和病因提供最佳选择。
