Amat-Samaranch V, Silvestre Salvador J F
Servicio de Dermatología, Hospital Clínic de Barcelona, Barcelona, Spain.
Servicio de Dermatología, Hospital General Universitario de Alicante, Alicante, Spain.
Actas Dermosifiliogr. 2023 Apr;114(4):T308-T317. doi: 10.1016/j.ad.2023.02.011. Epub 2023 Feb 26.
Atopic dermatitis is a chronic inflammatory disease that is multifactorial in nature. Allergic contact dermatitis and protein contact dermatitis are allergic conditions that may occur in the context of atopic dermatitis and be the cause of exacerbations. Although the prevalence of allergic contact dermatitis is similar in atopic patients and the general population, these 2 conditions are frequently associated because atopic inflammation disrupts the skin barrier. Skin tests are therefore recommended in atopic individuals. Dupilumab could be useful for treating allergic contact dermatitis if it is mediated by type 2 helper T cells but could exacerbate inflammation if mediated by T1 cells: further study is needed before conclusions can be drawn. Although the mechanism by which exposure to environmental proteins exacerbates atopic dermatitis remains under discussion, such exacerbations are routinely seen in clinical practice. Prick testing is recommended in symptomatic atopic dermatitis. When prick-test findings are positive, patients should be advised to avoid the culprit substances.
特应性皮炎是一种本质上具有多因素的慢性炎症性疾病。过敏性接触性皮炎和蛋白质接触性皮炎是可能在特应性皮炎背景下发生并成为病情加重原因的过敏性疾病。尽管过敏性接触性皮炎在特应性患者和普通人群中的患病率相似，但这两种情况经常相关，因为特应性炎症会破坏皮肤屏障。因此，建议对特应性个体进行皮肤测试。如果过敏性接触性皮炎由2型辅助性T细胞介导，度普利尤单抗可能对其治疗有用，但如果由T1细胞介导则可能会加重炎症：在得出结论之前还需要进一步研究。尽管接触环境蛋白质加重特应性皮炎的机制仍在讨论中，但这种病情加重在临床实践中很常见。建议对有症状的特应性皮炎患者进行点刺试验。当点刺试验结果为阳性时，应建议患者避免接触致病物质。
