Remitz A, De Pità O, Mota A, Serra-Baldrich E, Vakirlis E, Kapp A
Department of Skin and Allergic Diseases, Helsinki University Central Hospital, Helsinki, Finland.
Department of Dermatology and Allergy, Cristo Re Hospital, Rome, Italy.
J Eur Acad Dermatol Venereol. 2018 Dec;32(12):2074-2082. doi: 10.1111/jdv.15272. Epub 2018 Nov 6.
Atopic dermatitis (AD) is a common inflammatory skin disease in both adults and children. Whilst topical calcineurin inhibitors (TCIs), tacrolimus ointment and pimecrolimus cream, have proven efficacy for the treatment of AD, it is important to involve experts to obtain their opinion on its optimal treatment.
Using a modified Delphi approach, this project aimed to generate consensus amongst experts on the use of TCIs in the treatment of AD, with a focus on the differentiation between tacrolimus and pimecrolimus.
Six expert dermatologists from different European countries participated in this project based on their experience with AD and its treatment, which was evaluated by literature analysis and expert opinion. Consensus amongst the experts was generated using a modified Delphi approach, consisting of three distinct phases, during which a web meeting (June 2017), two online rounds of blinded Delphi voting (July-September 2017) and a face-to-face meeting (November 2017) were conducted. The consensus statements concerned two main topics: (i) Background of AD; and (ii) TCIs in AD. Hot topics in the treatment of AD not supported by meta-analysis, clinical trials or large observational studies were also discussed based on clinical experience.
In total, 25 consensus statements were defined and validated: eight statements on the general background of AD and 17 statements on the use of TCIs in AD, including their mechanism of action and therapeutic indications in AD, efficacy in adult and paediatric AD patients, pharmacokinetics, incidence of adverse events and safety concerns. Hot topics on the use of TCIs for the treatment of AD included cream vs. ointment, dosages, TCIs contact allergy, burning sensation management, superinfection and vaccination concerns.
Topical calcineurin inhibitors are a suitable therapy for AD, and selection of the specific TCI should be based on factors which differentiate tacrolimus from pimecrolimus.
特应性皮炎（AD）是一种常见的成人和儿童炎性皮肤病。虽然局部钙调神经磷酸酶抑制剂（TCIs），即他克莫司软膏和吡美莫司乳膏，已被证明对AD治疗有效，但让专家参与以获取他们对最佳治疗方案的意见很重要。
本项目采用改良的德尔菲法，旨在就TCIs在AD治疗中的应用在专家之间达成共识，重点是他克莫司和吡美莫司之间的差异。
来自不同欧洲国家的六位皮肤科专家基于他们对AD及其治疗的经验参与了本项目，通过文献分析和专家意见对其经验进行了评估。专家之间的共识通过改良的德尔菲法产生，该方法包括三个不同阶段，在此期间进行了一次网络会议（2017年6月）、两轮在线盲法德尔菲投票（2017年7月至9月）和一次面对面会议（2017年11月）。共识声明涉及两个主要主题：（i）AD的背景；（ii）AD中的TCIs。还基于临床经验讨论了AD治疗中未得到荟萃分析、临床试验或大型观察性研究支持的热点话题。
总共定义并验证了25条共识声明：关于AD一般背景的8条声明以及关于TCIs在AD中的应用的17条声明，包括它们在AD中的作用机制和治疗指征、在成人和儿童AD患者中的疗效、药代动力学、不良事件发生率和安全性问题。关于TCIs用于AD治疗的热点话题包括乳膏与软膏、剂量、TCIs接触性过敏、烧灼感管理、二重感染和疫苗接种问题。
局部钙调神经磷酸酶抑制剂是AD的一种合适治疗方法，特定TCI的选择应基于区分他克莫司和吡美莫司的因素。
