Luger T, Paller A S, Irvine A D, Sidbury R, Eichenfield L F, Werfel T, Bieber T
Department of Dermatology, University of Münster, Münster, Germany.
Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
J Eur Acad Dermatol Venereol. 2021 Jul;35(7):1505-1518. doi: 10.1111/jdv.17272. Epub 2021 May 2.
Atopic dermatitis (AD) is a chronic and relapsing, inflammatory skin disease characterized by impaired skin barrier function and immune system dysregulation that results in dryness, skin microbiome dysbiosis and intense pruritus. It is highly heterogeneous, and its management is demanding. Patients with AD are at greater risk of comorbidities such as attention-deficit hyperactivity disorder as well as other atopic diseases. Early-onset AD cases typically improve or resolve in late childhood; however, it is proposed that the prevalence of persistent or adult-onset AD is higher than previously thought. Basic therapy consists of emollient application and trigger avoidance, and when insufficient, topical corticosteroids (TCS) are the first-line treatment. However, corticophobia/steroid aversion and TCS side-effects, particularly on sensitive skin areas, lead to low compliance and insufficient disease control. Several long- and short-term randomized controlled and daily practice studies have demonstrated that topical calcineurin inhibitors, such as pimecrolimus, have similar anti-inflammatory effects to low-to-medium strength TCS, reduce pruritus and improve the quality of life of patients. In addition, pimecrolimus does not cause skin atrophy, is steroid-sparing and has a good safety profile, with no evidence for an increased risk of malignancies or skin infections. In general, pimecrolimus cream is well-accepted and well-tolerated, encouraging patient adherence and leading to its use by many physicians as a preferred therapy for children and sensitive skin areas.
特应性皮炎（AD）是一种慢性复发性炎症性皮肤病，其特征为皮肤屏障功能受损和免疫系统失调，导致皮肤干燥、皮肤微生物群失调及剧烈瘙痒。它具有高度异质性，其管理颇具挑战性。AD患者患共病的风险更高，如注意力缺陷多动障碍以及其他特应性疾病。早发型AD病例通常在儿童晚期改善或缓解；然而，有人提出持续性或成人型AD的患病率高于此前的认知。基础治疗包括涂抹润肤剂和避免诱发因素，若效果不佳，外用糖皮质激素（TCS）是一线治疗方法。然而，对糖皮质激素的恐惧/类固醇厌恶以及TCS的副作用，尤其是在敏感皮肤区域，导致依从性低且疾病控制不佳。多项长期和短期随机对照及日常实践研究表明，外用钙调神经磷酸酶抑制剂，如吡美莫司，具有与中低强度TCS相似的抗炎作用，可减轻瘙痒并改善患者生活质量。此外，吡美莫司不会导致皮肤萎缩，具有节省类固醇的作用且安全性良好，没有证据表明其会增加患恶性肿瘤或皮肤感染的风险。总体而言，吡美莫司乳膏广受认可且耐受性良好，有助于提高患者依从性，促使许多医生将其作为儿童及敏感皮肤区域的首选治疗药物。
