8166 Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada.
J Cutan Med Surg. 2022 Jul-Aug;26(4):398-403. doi: 10.1177/12034754221088533. Epub 2022 Mar 22.
Atopic dermatitis (AD) is a chronic, inflammatory skin condition commonly affecting infants with notable sparing of the diaper region. Though sources anecdotally attribute this sparing to the physical barrier formed by the diaper and the subsequent retention of moisture, urine, sweat and feces, no studies have formally investigated the factors contributing to this sparing phenomenon. We performed a scoping literature review to investigate the factors involved in sparing of AD in the diaper region, namely humidity, scratching, urine, sweat, feces, and microbiome composition. A total of 130 papers met the inclusion criteria, and extracted data were analyzed in an iterative manner. Increased local humidity facilitates protective changes at the cellular level and offsets transepidermal water loss. Exposure to urea from both sweat and urine may contribute to improved moisturization of the skin through its natural humectant properties and ability to modulate gene expression. Introduction of flora in feces contributes to the generation of protective immune responses and outcompetes growth of pathogens such as . Finally, diapers physically prevent scratching, which directly interrupts the itch-scratch cycle classically implicated in AD. Our study reviews factors that may contribute to the sparing of AD in the diaper region in infants. A limitation to our findings is that the studies reviewed here explore the impacts of these factors on AD broadly, and not explicitly in the diaper region. Additional studies investigating this may further our understanding of AD pathogenesis and contribute to the development of effective therapeutics.
特应性皮炎（AD）是一种常见于婴儿的慢性炎症性皮肤病，明显累及尿布区域。虽然有资料来源将这种豁免归因于尿布形成的物理屏障，以及随后对水分、尿液、汗液和粪便的保留，但没有研究正式调查导致这种豁免现象的因素。我们进行了一项范围性文献综述，以调查导致尿布区域 AD 豁免的因素，即湿度、搔抓、尿液、汗液、粪便和微生物组组成。共有 130 篇论文符合纳入标准，提取的数据以迭代方式进行分析。局部湿度增加有助于细胞水平的保护变化，并抵消经表皮水分流失。汗液和尿液中的尿素暴露可能通过其天然保湿特性和调节基因表达的能力促进皮肤的保湿。粪便中的菌群的引入有助于产生保护性免疫反应，并与如 等病原体竞争生长。最后，尿布物理上阻止搔抓，这直接中断了经典上与 AD 相关的瘙痒-搔抓循环。我们的研究综述了可能导致婴儿尿布区域 AD 豁免的因素。我们研究的一个局限性是，这里综述的研究广泛探讨了这些因素对 AD 的影响，而不是在尿布区域内。进一步研究这些因素可能有助于我们深入了解 AD 的发病机制，并有助于开发有效的治疗方法。
