Deva Maya, Netting Merryn J, Weidinger Jemma, Brand Roland, Loh Richard Ks, Vale Sandra L
James Cook University, 1 James Cook Drive, Douglas, QLD, 4814, Australia.
National Allergy Council, Sydney NSW, 2000, Australia.
World Allergy Organ J. 2024 Nov 14;17(12):100989. doi: 10.1016/j.waojou.2024.100989. eCollection 2024 Dec.
Atopic dermatitis (AD) is a chronic disease that is increasing in prevalence, particularly in children and people with skin of colour. Current management involves topical treatments, phototherapy and immunosuppressants, as well as newer therapies like dupilumab. Health professionals should also be aware of the specific management considerations for AD in people with skin of colour. This systematic review was conducted to examine global guidelines for the management of AD in children, compare management recommendations, examine specific recommendations for children with skin of colour, and assess the quality of the guidelines. The databases Medline, Embase, CINAHL, Scopus, Guidelines International Network, and Emcare Nursing and Allied Health were searched to identify guidelines or articles relating to the management of AD in children from 1990 to 2023. A grey literature search was also undertaken. The recommendations from the guidelines were extracted and compared, and the quality of the guidelines was assessed using the Appraisal Guidelines for Research and Evaluation (AGREE) II tool. A total of 1644 articles were identified from the initial search. Title and abstract screening, full text screening, and reference checking yielded 28 guidelines for the final appraisal and data extraction. The main variations in management recommendations were the timing of emollients, bleach baths, bath additives, oral antihistamines, and the age cut-offs for topical calcineurin inhibitors. Many guidelines were not updated to reflect newer therapies like dupilumab and topical phosphodiesterase-4 (PDE4) inhibitors. There were minimal recommendations regarding management of skin of colour. Only 12/28 guidelines met the satisfactory cut-off score for the AGREE II appraisal, largely due to a lack of well-documented methodology. This review showed that the recommendations for AD management in skin of colour were consistently lacking. Despite generally consistent management strategies over the last 5 years, less than half of the guidelines met high-quality criteria, emphasising the importance of using tools like AGREE II in future guideline development.
特应性皮炎（AD）是一种患病率不断上升的慢性疾病，在儿童和有色人种中尤为明显。目前的治疗方法包括局部治疗、光疗和免疫抑制剂，以及度普利尤单抗等新型疗法。医疗专业人员还应了解有色人种AD患者的具体治疗注意事项。本系统评价旨在研究儿童AD管理的全球指南，比较管理建议，研究针对有色人种儿童的具体建议，并评估指南的质量。检索了Medline、Embase、CINAHL、Scopus、国际指南网络以及Emcare护理与联合健康等数据库，以确定1990年至2023年期间与儿童AD管理相关的指南或文章。还进行了灰色文献检索。提取并比较了指南中的建议，并使用研究与评价评估指南（AGREE）II工具评估了指南的质量。初步检索共识别出1644篇文章。通过标题和摘要筛选、全文筛选以及参考文献核对，最终得到28篇指南用于评估和数据提取。管理建议的主要差异在于润肤剂、漂白浴、浴用添加剂、口服抗组胺药的使用时机，以及局部钙调神经磷酸酶抑制剂的年龄界限。许多指南未更新以反映度普利尤单抗和局部磷酸二酯酶-4（PDE4）抑制剂等新型疗法。关于有色人种皮肤管理的建议极少。只有12/28的指南在AGREE II评估中达到了满意的截止分数，主要原因是缺乏详细记录的方法。本综述表明，针对有色人种AD管理的建议一直很缺乏。尽管过去5年管理策略总体一致，但不到一半的指南符合高质量标准，强调了在未来指南制定中使用AGREE II等工具的重要性。
