Farmer William S, Marathe Kalyani S
Georgetown University School of Medicine, Washington, DC, USA.
Department of Dermatology, George Washington University, Washington, DC, USA.
Adv Exp Med Biol. 2017;1027:161-177. doi: 10.1007/978-3-319-64804-0_13.
Atopic dermatitis has a substantial impact on sleep, appearance, psychological well-being, and other qualities of life. The visual appearance of lichenification, cheilitis, hyperpigmentation, ichthyosis, and erythema can be socially stigmatizing, and treatment of these symptoms is challenging. In managing pruritus in patients, practitioners should assess and document pruritus through questionnaires at each routine visit. Initially, practitioners should advise patients to employ non-pharmaceutical treatments such as emollients with wet wraps, elimination of triggers, changing scratching habits, and psychological interventions. If these methods of treatment are not successful or if the disease presentation is severe, pharmacological therapies should be employed. This chapter describes the therapeutic ladder for pruritus in atopic dermatitis and discusses each treatment modality in further detail for practitioners to advise their patients.First-line topical pharmaceutical agents include topical glucocorticoids and topical calcineurin inhibitors. Second-line topical agents include coal tar, menthol, capsaicin, or doxepin. After the use of topical agents has been exhausted, primary systemic agents can be applied. These include sedating antihistamines, non-sedating antihistamines, oral glucocorticoids, or cyclosporine A. Finally, neuromodulating or immunomodulating agents can be attempted, including SSRI/SNRIs, TCAs, immunosuppressants, neural modulators, and opioid receptor modulators. Outside of pharmacological treatments, phototherapy has been shown to provide a dramatic improvement of pruritus in atopic dermatitis and can be used at any stage of treatment including as a first-line agent.
特应性皮炎对睡眠、外貌、心理健康及其他生活质量有重大影响。苔藓化、唇炎、色素沉着、鱼鳞病和红斑等外观表现可能会造成社会污名化，且治疗这些症状具有挑战性。在管理患者的瘙痒症状时，从业者应在每次常规就诊时通过问卷评估并记录瘙痒情况。最初，从业者应建议患者采用非药物治疗方法，如使用润肤剂并配合湿包裹疗法、消除诱发因素、改变搔抓习惯以及进行心理干预。如果这些治疗方法不成功或疾病表现严重，则应采用药物治疗。本章介绍了特应性皮炎瘙痒的治疗阶梯，并更详细地讨论了每种治疗方式，以供从业者为患者提供建议。一线外用药物包括外用糖皮质激素和外用钙调神经磷酸酶抑制剂。二线外用药物包括煤焦油、薄荷醇、辣椒素或多塞平。在外用药物治疗无效后，可以应用主要的全身性药物。这些药物包括镇静性抗组胺药、非镇静性抗组胺药、口服糖皮质激素或环孢素A。最后，可以尝试使用神经调节或免疫调节药物，包括选择性5-羟色胺再摄取抑制剂/5-羟色胺去甲肾上腺素再摄取抑制剂、三环类抗抑郁药、免疫抑制剂、神经调节剂和阿片受体调节剂。在药物治疗之外，光疗已被证明可显著改善特应性皮炎的瘙痒症状，可在治疗的任何阶段使用，包括作为一线治疗手段。
