Department of Dermatology and Allergology, Ludwig-Maximilians-University, Munich; Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Dermatology, Brussels, Belgium; Department of Dermatology, Allergology and Venereology, Hannover Medical School; Klinik am Biederstein, TU München; Children`s Hospital AUF DER BULT, Department of Pediatric Dermatology and Allergology, Center of Rare Congenital Skin Diseases, Hannover; Department of Dermatology and Allergology at the University Hospital Giessen UKGM and Department of Psychosomatic Diseases, Vitos-Klinik Gießen; Department of Dermatology and Allergology, UKSH Kiel.
Dtsch Arztebl Int. 2023 Mar 31;120(13):224-234. doi: 10.3238/arztebl.m2023.0011.
Atopic dermatitis is a common, chronically recurring inflammatory skin disease. It gives rise to a high disease burden and is of major importance in social medicine.
This review is based on pertinent publications retrieved by a selective search in PubMed, including the current German and European guidelines.
Basic therapy with drug-free topical agents markedly improves the barrier function of the skin. Adults should apply at least 250 g per week. Patient-specific trigger factors such as allergens, stress, microbial pathogens, or skin irritants should be eliminated or avoided. In mild and moderately severe forms, external treatment with topical glucocorticosteroids and topical calcineurin inhibitors usually suffices; proactive therapy is given to patients with frequent recurrences or a long course of disease. Systemic anti-inflammatory treatment with biological agents such as dupilumab and tralokinumab, Janus kinase inhibitors such as baricitinib, upadacitinib, and abrocitinib, or conventional immunosuppressant drugs is indicated particularly in severe cases. The patient should be actively involved in the choice and planning of treatment; the patient's age and the cutaneous findings should be taken into account. Interdisciplinary patient education yields a sustained benefit.
A combination of baseline therapy, reactive and proactive anti-inflammatory therapy, and systemic therapy as needed is the foundation of successful interdisciplinary treatment for atopic dermatitis.
特应性皮炎是一种常见的、慢性反复发作的炎症性皮肤病。它会导致很高的疾病负担，在社会医学中具有重要意义。
本综述基于在 PubMed 中进行选择性搜索获得的相关出版物，包括当前的德国和欧洲指南。
无药物局部制剂的基础治疗可显著改善皮肤的屏障功能。成人每周至少应涂抹 250 克。应消除或避免特定于患者的触发因素，如过敏原、压力、微生物病原体或皮肤刺激物。在轻度和中度严重的形式中，外用皮质类固醇和外用钙调神经磷酸酶抑制剂通常就足够了；对于频繁复发或病程较长的患者，应进行预防性治疗。对于严重病例，特别推荐使用生物制剂如度普利尤单抗和特利鲁单抗、JAK 抑制剂如巴瑞替尼、乌帕替尼和阿布昔替尼，或传统免疫抑制剂进行全身性抗炎治疗。应积极让患者参与治疗的选择和计划；应考虑患者的年龄和皮肤表现。跨学科的患者教育可带来持续的益处。
基础治疗、反应性和预防性抗炎治疗以及按需进行的全身性治疗相结合是特应性皮炎成功的跨学科治疗的基础。
