Eichenfield Lawrence F, Boguniewicz Mark, Lauren Christine T, Leung Donald Y M, Levy Moise L, Schneider Lynda C, Siegfried Elaine C, Tom Wynnis L, Paller Amy S
Departments of Dermatology and Pediatrics, University of California San Diego, La Jolla, California, USA.
Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital, San Diego, California, USA.
Dermatology. 2024;240(5-6):897-909. doi: 10.1159/000540920. Epub 2024 Oct 15.
Atopic dermatitis (AD) is a chronic, type-2 mediated, inflammatory skin disease characterized by intense pruritus, disruption of skin barrier function, and immune dysregulation. Management strategies for AD are routinely determined based on disease severity. First-line treatment begins with basic skin care and topical anti-inflammatory medication, which is typically sufficient for the management of mild-to-moderate disease. For those patients with moderate-to-severe disease, systemic therapy is often required. This can involve off-label treatment with conventional immunosuppressant medications. However, this approach is limited by a lack of robust clinical trial data and safety concerns that necessitate close monitoring. The emergence of novel targeted biologics and small molecules to treat AD presents an opportunity to optimize AD management and patient outcomes by offering greater efficacy than traditional immunosuppressants and a favorable safety profile. As the treatment landscape shifts, clinicians can benefit from a standardized process of patient assessment and treatment, along with resources to help maintain contemporary knowledge of available therapeutic options. This US-based, expert-led consensus used a modified Delphi process to develop core recommendations for the use of systemic medications for the management of pediatric patients <18 years of age with moderate-to-severe AD.
特应性皮炎（AD）是一种慢性、2型介导的炎症性皮肤病，其特征为剧烈瘙痒、皮肤屏障功能破坏和免疫失调。AD的管理策略通常根据疾病严重程度来确定。一线治疗始于基础皮肤护理和外用抗炎药物，这通常足以管理轻度至中度疾病。对于那些中重度疾病患者，通常需要全身治疗。这可能涉及使用传统免疫抑制药物的超说明书治疗。然而，这种方法受到缺乏有力临床试验数据和安全问题的限制，这些问题需要密切监测。用于治疗AD的新型靶向生物制剂和小分子的出现，通过提供比传统免疫抑制剂更高的疗效和良好的安全性，为优化AD管理和患者预后提供了机会。随着治疗格局的转变，临床医生可以从标准化的患者评估和治疗过程以及有助于维持对可用治疗选择的当代知识的资源中受益。这项以美国为基础、由专家主导的共识采用了改良的德尔菲法，为治疗18岁以下中重度AD儿科患者的全身用药制定了核心建议。
