Maintz Laura, Bieber Thomas, Simpson Helen D, Demessant-Flavigny Anne-Laure
Department of Dermatology and Allergy, University Hospital Bonn, 53127 Bonn, Germany.
Christine Kühne Center for Allergy Research and Education Davos (CK-CARE), 7265 Davos, Switzerland.
J Pers Med. 2022 May 28;12(6):893. doi: 10.3390/jpm12060893.
Atopic dermatitis (AD) affects up to 20% of children and is considered the starting point of the atopic march with the development of food allergy, asthma, and allergic rhinitis. The heterogeneous phenotype reflects distinct and/or overlapping pathogenetic mechanisms with varying degrees of epidermal barrier disruption, activation of different T cell subsets and dysbiosis of the skin microbiome. Here, we review current evidence suggesting a systemic impact of the cutaneous inflammation in AD together with a higher risk of asthma and other comorbidities, especially in severe and persistent AD. Thus, early therapy of AD to restore the impaired skin barrier, modified microbiome, and target type 2 inflammation, depending on the (endo)phenotype, in a tailored approach is crucial. We discuss what we can learn from the comorbidities and the implications for preventive and therapeutic interventions from precision dermocosmetics to precision medicine. The stratification of AD patients into biomarker-based endotypes for a precision medicine approach offers opportunities for better long-term control of AD with the potential to reduce the systemic impact of a chronic skin inflammation and even prevent or modify the course, not only of AD, but possibly also the comorbidities, depending on the patient's age and disease stage.
特应性皮炎（AD）影响着多达20%的儿童，被认为是过敏性进程的起点，会引发食物过敏、哮喘和过敏性鼻炎。其异质性表型反映了不同和/或重叠的致病机制，伴有不同程度的表皮屏障破坏、不同T细胞亚群的激活以及皮肤微生物群失调。在此，我们综述了当前的证据，这些证据表明AD中的皮肤炎症具有系统性影响，同时还伴有更高的哮喘和其他合并症风险，尤其是在重度和持续性AD中。因此，根据（内）表型，采用定制化方法对AD进行早期治疗，以恢复受损的皮肤屏障、调节微生物群并靶向2型炎症，至关重要。我们讨论了从合并症中可以学到什么，以及从精准皮肤美容学到精准医学的预防和治疗干预措施的意义。将AD患者分层为基于生物标志物的内型以采用精准医学方法，为更好地长期控制AD提供了机会，有可能减少慢性皮肤炎症的系统性影响，甚至根据患者年龄和疾病阶段预防或改变病程，不仅是AD的病程，还可能是合并症的病程。
