Department of Surgery (Section of Dermatology), Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Department of Dermatology, University of Connecticut School of Medicine, Framingham, Connecticut, USA.
Curr Opin Pediatr. 2018 Feb;30(1):161-168. doi: 10.1097/MOP.0000000000000560.
The prevalence of atopic dermatitis is increasing in industrialized countries for unclear reasons. One theory centers on reduced exposure to microbes during infancy and childhood. Alterations in the epidermal permeability barrier, place certain patients at risk for the immunological dysfunction seen in atopic dermatitis. This review examines current research pertaining to the epidermal permeability barrier, the cutaneous microbiome, and the immunology of atopic dermatitis. New collaborative research has led to evidence-based management guidelines.
Increased skin barrier permeability and dysfunction of innate and adaptive immunity cause atopic dermatitis. Genetic and environmental factors leading to decreased filaggrin underlie many cases of atopic dermatitis. Defective epidermal barrier function allows for an increased density of Staphylococcus aureus and a subsequent shift in adaptive immunity to a type 2 immune response. Multiple evaluation and management guidelines have been published based on current available evidence. These guidelines highlight state of the art management of seven main areas: inflammation, infection, irritation, itch, ichthyosis (dry skin), immunological influences, and impeding (comorbid) conditions.
Pediatricians are central to the successful diagnosis and management of atopic dermatitis. Increased basic and clinical research and well published clinical guidelines will lead to improved outcomes for the patients and families affected by this chronic relapsing disorder.
由于不明原因，特应性皮炎在工业化国家的发病率正在上升。有一种理论认为，这与婴儿和儿童时期接触微生物减少有关。表皮渗透性屏障的改变使某些患者易患特应性皮炎的免疫功能障碍。本综述检查了有关表皮渗透性屏障、皮肤微生物组和特应性皮炎免疫学的当前研究。新的合作研究为循证管理指南提供了依据。
增加的皮肤屏障通透性和先天及适应性免疫功能障碍导致特应性皮炎。导致丝聚蛋白减少的遗传和环境因素是许多特应性皮炎的基础。表皮屏障功能缺陷可导致金黄色葡萄球菌密度增加，并随后导致适应性免疫向 2 型免疫反应转变。基于当前可用证据，已经发布了多个评估和管理指南。这些指南强调了七个主要领域的最新管理方法：炎症、感染、刺激、瘙痒、鱼鳞病（皮肤干燥）、免疫影响和阻碍（合并）条件。
儿科医生是成功诊断和管理特应性皮炎的核心。增加基础和临床研究以及出版良好的临床指南将改善受这种慢性复发性疾病影响的患者和家庭的治疗效果。
