Lohman Mary E, Lio Peter A
Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Pediatr Dermatol. 2017 Nov;34(6):739-742. doi: 10.1111/pde.13282. Epub 2017 Sep 25.
The development of effective systemic treatments has revolutionized the treatment of inflammatory skin diseases. The availability of safe new treatments and the understanding of psoriasis as a systemic disease with comorbidities and effects on quality of life have driven the current aggressive treatment paradigm of psoriasis. Historically the morbidity of atopic dermatitis (AD) has been dismissed, given the perception of AD as "just" a rash. Differences in the guidelines for psoriasis and AD management may suggest variations in the current conceptualization of disease severity and effects on quality of life. Published guidelines from the American Academy of Dermatology for the management of psoriasis and AD were reviewed. We recorded the similarities and differences in disease assessment and therapy. The threshold to use biologic agents for moderate to severe psoriasis highlights the aggressive nature of modern psoriasis treatment. AD guidelines include an assessment of quality of life but do not designate a disease severity threshold for systemic treatment. AD and psoriasis have a tremendous effect on quality of life. The AD guidelines have a less aggressive approach to disease management than the psoriasis guidelines. We should think critically about rapid advancement to systemic agents in AD management, especially now that more and better agents are being developed.
有效的全身治疗方法的发展彻底改变了炎症性皮肤病的治疗方式。安全的新治疗方法的出现，以及对银屑病作为一种伴有合并症且会影响生活质量的全身性疾病的认识，推动了当前积极的银屑病治疗模式。从历史上看，特应性皮炎（AD）的发病率一直被忽视，因为人们认为AD“只是”一种皮疹。银屑病和AD管理指南的差异可能表明目前对疾病严重程度及其对生活质量影响的概念化存在差异。我们回顾了美国皮肤病学会发布的关于银屑病和AD管理的指南。我们记录了疾病评估和治疗方面的异同。用于中度至重度银屑病的生物制剂使用门槛凸显了现代银屑病治疗的激进性质。AD指南包括对生活质量的评估，但没有指定全身治疗的疾病严重程度阈值。AD和银屑病对生活质量有巨大影响。与银屑病指南相比，AD指南在疾病管理方面的方法不那么激进。我们应该审慎思考AD管理中迅速转向全身用药的做法，尤其是在现在有更多更好的药物正在研发的情况下。
