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特应性皮炎:最佳指南与标准

Atopic dermatitis: Best of guidelines and yardstick.

作者信息

Boguniewicz Mark

出版信息

Allergy Asthma Proc. 2025 Jan 1;46(1):19-25. doi: 10.2500/aap.2025.46.240087.

Abstract

Atopic dermatitis (AD), a common chronic inflammatory skin disorder is characterized by a complex pathology with skin-barrier abnormalities, immune dysregulation, and microbial dysbiosis. Patients' quality of life is often negatively impacted by persistent pruritus, sleep disturbance, and recurrent skin infections. In addition, patients may have comorbid atopic as well as nonatopic diseases. The objective was to help clinicians better manage AD by using new therapies and new indications, including a topical (Janus kinase [JAK]) inhibitor as well as monoclonal antibodies and oral JAK inhibitors, have been approved for AD. This review presents highlights from the American College of Allergy, Asthma and Immunology AD Yardstick Update, which incorporates Expert Commentary, and from the Joint Task Force (JTF) AD 2023 Guidelines that use Grading of Recommendations, Assessment, Development, and Evaluation methodology. Practical pearls from the AD Yardstick Update Expert Commentary are presented, along with results from systematic reviews and meta-analyses that addressed specific recommendations on the role of (1) dilute bleach baths, (2) dietary avoidance and/or elimination diets, (3) allergen immunotherapy, (4) topical treatments, and (5) systemic treatments, informing the JTF 2023 AD Guidelines. These guidelines are noteworthy for addressing patient values and preferences. The AD Yardstick Update Expert Commentary and JTF 2023 AD Guidelines provide timely, practical, and trustworthy information to help clinicians manage patients with AD.

摘要

特应性皮炎(AD)是一种常见的慢性炎症性皮肤病,其病理特征复杂,包括皮肤屏障异常、免疫失调和微生物群落失衡。患者的生活质量常受到持续性瘙痒、睡眠障碍和反复皮肤感染的负面影响。此外,患者可能同时患有特应性疾病和非特应性疾病。目的是通过使用新疗法和新适应症来帮助临床医生更好地管理AD,其中包括一种局部(Janus激酶[JAK])抑制剂以及单克隆抗体和口服JAK抑制剂,这些已被批准用于AD治疗。本综述介绍了美国过敏、哮喘与免疫学会AD标准更新(其中纳入了专家评论)以及联合工作组(JTF)2023年AD指南中的要点,后者采用了推荐分级、评估、制定和评价方法。文中呈现了AD标准更新专家评论中的实用要点,以及系统评价和荟萃分析的结果,这些研究涉及关于以下方面作用的具体建议:(1)稀释漂白浴,(2)饮食回避和/或排除饮食,(3)变应原免疫疗法,(4)局部治疗,以及(5)全身治疗,为JTF 2023年AD指南提供了依据。这些指南因考虑了患者的价值观和偏好而值得关注。AD标准更新专家评论和JTF 2023年AD指南提供了及时、实用且可靠的信息,以帮助临床医生管理AD患者。

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