Yakima Valley Farm Workers Clinic, Washington.
Department of Family and Community Medicine, University of Texas Health, San Antonio.
FP Essent. 2024 Jun;541:27-38.
Atopic dermatitis (AD) is a chronic, recurring, inflammatory skin condition. Xerosis, pruritus, and rash make the clinical diagnosis. Adequate skin care and regular emollient use are key in management. Topical corticosteroids are the first-line treatment for AD flare-ups. Wet wrap therapy can improve AD severity and extent. Topical calcineurin inhibitors are second-line treatments. Emollient use, topical corticosteroids and calcineurin inhibitors, and bleach baths can help prevent flare-ups. Patients with refractory AD that might require immunomodulatory treatments, such as dupilumab (Dupixent), Janus kinase inhibitors, or phototherapy, should be referred to a dermatologist. Seborrheic dermatitis (SD) is a common, chronic, relapsing, inflammatory condition that involves sebaceous skin areas. Infection with species and the inflammatory response to it are the probable etiologies. The clinical diagnosis is made by the presence of hallmark greasy, yellow scales on the scalp or face. Infantile SD most commonly involves the scalp and forehead and typically is self-limited. In infants, application of emollients followed by hair brushing and shampooing may be effective. In infants and children, if the condition does not improve with this treatment, topical ketoconazole shampoo, gel, or lotion is safe and effective. Refractory cases of SD can be managed with topical corticosteroids and calcineurin inhibitors.
特应性皮炎(AD)是一种慢性、复发性、炎症性皮肤病。干燥、瘙痒和皮疹有助于临床诊断。充分的皮肤护理和定期使用保湿剂是管理的关键。局部皮质类固醇是 AD 发作的一线治疗药物。湿包疗法可以改善 AD 的严重程度和范围。局部钙调磷酸酶抑制剂是二线治疗药物。保湿剂、局部皮质类固醇和钙调磷酸酶抑制剂以及漂白浴可以帮助预防发作。对于可能需要免疫调节治疗(如度普利尤单抗[Dupixent]、Janus 激酶抑制剂或光疗)的难治性 AD 患者,应转介给皮肤科医生。脂溢性皮炎(SD)是一种常见的慢性、复发性、炎症性疾病,涉及皮脂腺皮肤区域。物种感染及其对其的炎症反应可能是病因。通过头皮或面部存在标志性的油腻、黄色鳞片可以做出临床诊断。婴儿 SD 最常累及头皮和额头,通常是自限性的。对于婴儿,应用保湿剂,然后梳理头发并洗发可能有效。对于婴儿和儿童,如果这种治疗方法不能改善病情,局部酮康唑洗发水、凝胶或洗剂是安全有效的。难治性 SD 病例可以通过局部皮质类固醇和钙调磷酸酶抑制剂来治疗。