Alqahtani Saad M, Awaji Bassam H, Mahdi Abdulaziz M, Althawab Fatimah H, Aljohani Hadeel M, Rayes Raghad A, Shafie Rahaf K, Aljohani Raneem Abdulrahman, Alkhorayef Sarah, Alghamdi Mohammed K
Family Medicine, King Salman Armed Forces Hospital, Tabuk, SAU.
Faculty of Medicine, University of Tabuk, Tabuk, SAU.
Cureus. 2023 Sep 2;15(9):e44560. doi: 10.7759/cureus.44560. eCollection 2023 Sep.
Atopic dermatitis is a complex, recurrent, chronic inflammatory skin condition. It frequently begins to manifest in early childhood and may last throughout adulthood. The need for clinical practice guidelines that are based on evidence is critical for efficient and secure care. Little is known about how primary care providers (PCPs) should handle pediatric and adult atopic dermatitis cases and whether they should follow national recommendations. Our systemic review aimed to examine management strategies for treating adult and pediatric (family) atopic dermatitis, including topical calcineurin inhibitors (TCIs), topical corticosteroids (TCS), skin emollients, oral antihistamines, and diet. Data sources were PubMed (MEDLINE) and Embase. Our review investigated English-language articles from 2014 to 2023 that studied the management of adult and children atopic dermatitis. Overall, there were 15 articles included. Surveys and analyses of national databases were the most widely used methods (n=7). The use of TCS by PCPs was common, but they also overprescribed nonsedating antihistamines, favored low-potency drugs, and avoided TCIs. Most studies relied on healthcare personnel reporting their typical behaviors rather than looking at specific patient encounters and it is considered a limitation. Finally, there are gaps in knowledge and management of critical topics such as prescribing TCIs and understanding the safety profiles of TCS, when it comes to treating adult and pediatric atopic dermatitis. Future research in this area is urgently needed because the current systemic assessment is mostly restricted to small studies that assess prescribing behaviors with scant information describing nonmedication management.
特应性皮炎是一种复杂、复发性的慢性炎症性皮肤病。它通常在儿童早期开始显现，可能持续至成年期。基于证据的临床实践指南对于高效、安全的护理至关重要。对于初级保健提供者（PCP）应如何处理儿童和成人特应性皮炎病例以及他们是否应遵循国家建议，人们知之甚少。我们的系统评价旨在研究治疗成人和儿童（家庭）特应性皮炎的管理策略，包括外用钙调神经磷酸酶抑制剂（TCI）、外用糖皮质激素（TCS）、皮肤润肤剂、口服抗组胺药和饮食。数据来源为PubMed（MEDLINE）和Embase。我们的评价调查了2014年至2023年研究成人和儿童特应性皮炎管理的英文文章。总体而言，共纳入15篇文章。对国家数据库的调查和分析是使用最广泛的方法（n = 7）。初级保健提供者使用TCS很常见，但他们也过度开具非镇静性抗组胺药，倾向于使用低效药物，并避免使用TCI。大多数研究依赖医护人员报告他们的典型行为，而不是观察具体的患者诊疗情况，这被认为是一个局限性。最后，在治疗成人和儿童特应性皮炎时，在开具TCI处方和了解TCS的安全性方面等关键主题的知识和管理存在差距。该领域迫切需要未来的研究，因为目前的系统评估大多局限于评估处方行为的小型研究，而描述非药物管理的信息很少。
