Chow Steven, Seow Chew Swee, Dizon Maria Victoria, Godse Kiran, Foong Henry, Chan Vicheth, Khang Tran Hau, Xiang Leihong, Hidayat Syarief, Listiawan M Yulianto, Triwahyudi Danang, Gondokaryono Srie Prihianti, Sutedja Endang, Diana Inne Arline, Suwarsa Oki, Dharmadji Hartati Purbo, Siswati Agnes Sri, Danarti Retno, Soebaryo Retno, Budianti Windy Keumala
Pantai Hospital, Kuala Lumpur, Malaysia.
National Skin Centre, Singapore, Singapore.
Asia Pac Allergy. 2018 Oct 29;8(4):e41. doi: 10.5415/apallergy.2018.8.e41. eCollection 2018 Oct.
Atopic dermatitis (AD) is a common skin condition among Asians. Recent studies have shown that Asian AD has a unique clinical and immunologic phenotype compared with European/American AD.
The Asian Academy of Dermatology and Venereology Expert Panel on Atopic Dermatitis developed this reference guide to provide a holistic and evidence-based approach in managing AD among Asians.
Electronic searches were performed to retrieve relevant systematic reviews and guidelines on AD. Recommendations were appraised for level of evidence and strength of recommendation based on the U.K. National Institute for Health and Care Excellence and Scottish Intercollegiate Guidelines Network guidelines. These practice points were based on the consensus recommendations discussed during the Asia Pacific Meeting of Experts in Dermatology held in Bali, Indonesia in October 2016 and April 2017.
The Expert Panel recommends an approach to treatment based on disease severity. The use of moisturizers is recommended across all levels of AD severity, while topical steroids are recommended only for flares not controlled by conventional skin care and moisturizers. Causes of waning efficacy must be explored before using topical corticosteroids of higher potency. Topical calcineurin inhibitors are recommended for patients who have become recalcitrant to steroid, in chronic uninterrupted use, and when there is steroid atrophy, or when there is a need to treat sensitive areas and pediatric patients. Systemic steroids have a limited role in AD treatment and should be avoided if possible. Educational programs that allow a patient-centered approach in AD management are recommended as an adjunct to conventional therapies. Recommendations on the use of phototherapy, systemic drugs, and emerging treatments are also included.
The management of AD among Asians requires a holistic approach, integrating evidence-based treatments while considering accessibility and cultural acceptability.
特应性皮炎（AD）在亚洲人中是一种常见的皮肤疾病。最近的研究表明，与欧美特应性皮炎相比，亚洲特应性皮炎具有独特的临床和免疫表型。
亚洲皮肤性病学会特应性皮炎专家小组制定本参考指南，以提供一种全面且基于证据的方法来管理亚洲人的特应性皮炎。
进行电子检索以获取有关特应性皮炎的相关系统评价和指南。根据英国国家卫生与临床优化研究所和苏格兰校际指南网络的指南，对推荐意见进行证据水平和推荐强度的评估。这些实践要点基于2016年10月和2017年4月在印度尼西亚巴厘岛举行的亚太皮肤科专家会议期间讨论的共识性推荐意见。
专家小组建议根据疾病严重程度进行治疗。在特应性皮炎的所有严重程度级别中均推荐使用保湿剂，而局部用类固醇仅推荐用于常规皮肤护理和保湿剂无法控制的皮疹发作。在使用更高强度的局部皮质类固醇之前，必须探究疗效减弱的原因。对于对类固醇耐药、长期持续使用、存在类固醇萎缩、需要治疗敏感部位以及儿科患者，推荐使用局部钙调神经磷酸酶抑制剂。全身性类固醇在特应性皮炎治疗中的作用有限，应尽可能避免使用。建议采用以患者为中心的方法进行特应性皮炎管理的教育项目作为传统疗法的辅助手段。还包括关于光疗、全身性药物和新兴治疗方法使用的推荐意见。
亚洲人特应性皮炎的管理需要一种全面的方法，整合基于证据的治疗方法，同时考虑可及性和文化可接受性。
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