Department of Dermatology, St. Luke's University Health Network, Easton, PA, 18045, USA.
Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Suite 2B-430, 2150 Pennsylvania Avenue, Washington, DC, 20037, USA.
Curr Allergy Asthma Rep. 2020 Oct 12;20(12):74. doi: 10.1007/s11882-020-00971-z.
Although genetic factors clearly play a role in the development of atopic dermatitis (AD), the recent dramatic increase in the prevalence of AD in low- and middle-income countries is not consistent with only a role of genetic factors. These findings strongly suggest that environmental factors may play an important role in the pathogenesis of AD.
We reviewed the role of gene-environment studies; in utero exposures including tobacco smoke, alcohol, maternal stress, various digestive supplements, and gestational diabetes; early-life exposures including diet, gut microbiota, antibiotics, and breastfeeding; climate including temperature, ultraviolet radiation exposure, and air pollution; and household products, indoor allergens, water hardness, pH, and skin microbiota and their effects on AD. Environmental factors definitely play a role in the pathogenesis of AD. However, identifying definitive factors continues to be difficult in the setting of conflicting evidence and the complex interactions between genotypes and the environment resulting in a multitude of AD phenotypes. All of the different environmental interactions discussed highlight the importance of intervening on multiple levels in a patient's environment to improve or even prevent AD symptoms. Further, the importance of modifying environmental factors early on in a person's life is demonstrated. When possible, all of these environmental factors should be considered in treating a patient with AD and the appropriate modifications should be made at population and individual levels.
虽然遗传因素显然在特应性皮炎（AD）的发病机制中起作用，但在中低收入国家 AD 的患病率最近急剧上升，这不仅仅是遗传因素的作用。这些发现强烈表明环境因素可能在 AD 的发病机制中起重要作用。
我们回顾了基因-环境研究的作用；包括吸烟、饮酒、母亲压力、各种消化补充剂和妊娠糖尿病在内的宫内暴露；包括饮食、肠道微生物群、抗生素和母乳喂养在内的生命早期暴露；包括温度、紫外线辐射暴露和空气污染在内的气候；以及家庭产品、室内过敏原、水硬度、pH 值和皮肤微生物群及其对 AD 的影响。环境因素肯定在 AD 的发病机制中起作用。然而，在存在相互矛盾的证据和基因型与环境之间复杂的相互作用导致多种 AD 表型的情况下，确定明确的因素仍然很困难。讨论的所有不同的环境相互作用都强调了在患者环境的多个层面上进行干预以改善甚至预防 AD 症状的重要性。此外，还证明了在人的一生中尽早改变环境因素的重要性。在可能的情况下，在治疗 AD 患者时应考虑所有这些环境因素，并在人群和个体层面上进行适当的调整。
