Brummer Grace C, Wang Lawrence T, Sontheimer Richard D
University of Utah School of Medicine, Salt Lake City, Utah.
Dermatol Online J. 2018 Feb 15;24(2):13030/qt55z1f6xh.
Aging individuals can develop generalized, exquisitely-pruritic, eczematous eruptions of uncertain etiology that can be therapeutically-refractory and life-altering. Limited information exists in the literature to guide clinicians in the diagnosis and management of such patients. It is suggested that in approximately 40% of such patients a known cause for their chronic pruritic eruptions cannot be identified. In this report we will refer to this subgroup of patients as having idiopathic chronic eczematous eruption of aging (CEEA). Idiopathic CEEA must be distinguished from other established eczematous dermatoses. Idiopathic CEEA patients often require long-term systemic immunosuppressive drugs to make living bearable. Elder-onset atopic dermatitis is the most difficult of the known dermatoses to distinguish from idiopathic CEEA. Because of their clinical similarities we questioned whether dupilumab (Dupixent®), the first FDA-approved biologic for atopic dermatitis, might be valuable in the management of idiopathic CEEA. We report the case of an elderly man with idiopathic CEEA of four-years' duration who had a complete clinical response to the initiation of treatment with dupilumab. This case is presented to stimulate more discussion and systematic study of a possible role for dupilumab in otherwise-refractory idiopathic CEEA patients. We also propose a set of diagnostic criteria for idiopathic CEEA.
老年人可能会出现病因不明的全身性、极度瘙痒的湿疹样皮疹，这些皮疹治疗起来可能很棘手，甚至会改变生活。文献中关于指导临床医生诊断和管理这类患者的信息有限。据推测，在大约40%的这类患者中，其慢性瘙痒性皮疹的已知病因无法确定。在本报告中，我们将这类患者亚组称为特发性老年慢性湿疹样皮疹（CEEA）。特发性CEEA必须与其他已确诊的湿疹性皮肤病相鉴别。特发性CEEA患者通常需要长期使用全身性免疫抑制药物才能维持可忍受的生活状态。老年发病的特应性皮炎是已知皮肤病中最难与特发性CEEA鉴别的。鉴于它们在临床上的相似性，我们质疑首个获美国食品药品监督管理局（FDA）批准用于特应性皮炎的生物制剂度普利尤单抗（Dupixent®）在特发性CEEA的管理中是否有价值。我们报告了一例患有持续四年的特发性CEEA的老年男性病例，该患者在开始使用度普利尤单抗治疗后临床症状完全缓解。呈现此病例是为了激发更多关于度普利尤单抗在其他难治性特发性CEEA患者中可能作用的讨论和系统性研究。我们还提出了一套特发性CEEA的诊断标准。
