Bos J D, Van Leent E J, Sillevis Smitt J H
Department of Dermatology, Academic Medical Center, University of Amsterdam, The Netherlands.
Exp Dermatol. 1998 Aug;7(4):132-8. doi: 10.1111/j.1600-0625.1998.tb00313.x.
Atopic dermatitis forms an active area of basic and clinical research, where important new knowledge about genetics and immunopathogenesis has surfaced over the past years, and where simultaneous development of new and innovative therapies is under way. However, the inclusion of any patient in an atopic dermatitis study, whether it is on its genetics, pathogenesis or therapy, requires a diagnosis which is irrefutable. Since there is no simple and also no complicated laboratory procedure to reach a diagnosis of atopic dermatitis, different sets of clinical criteria have been developed for the purpose of making the diagnosis uniformly in different studies as well as in different study centers. The most commonly used are Hanifin and Rajka's set of diagnostic features, which have major and minor clinical criteria to be fulfilled in order to establish a diagnosis of atopic dermatitis. Recent developments in the immunology of atopy have clearly established the major abnormality in this syndrome, the preferential production of allergen-specific IgE. In this contribution, it is suggested that the presence of such antibodies in a given patient should be a mandatory criterium for the diagnosis of atopic dermatitis. Such a diagnostic test however establishes a diagnosis of atopic syndrome, not atopic dermatitis. Thus, for atopic dermatitis we have to rely, for the time being, on additional clinical criteria. The clinical features described in the literature are critically evaluated, and it is suggested that in addition to the mandatory presence of allergen-specific IgE, 2 of 3 principal criteria (pruritus, typical morphology and distribution, chronic or chronically relapsing) should be present for such a diagnosis. Finally, the minor features originally described by Hanifin and Rajka and later evaluated by others are revised and divided over 4 subcategories; a) related to subclinical eczema; b) related to dry skin; c) extra skin folds; and d) ophthalmological pathology. They are suggested to be used as additional criteria only, needed when clinical suspicion is high but the new mandatory and principal diagnostic criteria described here are inconclusive. For study purposes, we suggest that the mandatory and principal criteria are sufficient. They are now evaluated and validated in ongoing atopic dermatitis treatment studies.
特应性皮炎是基础研究和临床研究的一个活跃领域，在过去几年里，有关遗传学和免疫发病机制的重要新知识不断涌现，同时新的创新疗法也在不断发展。然而，将任何患者纳入特应性皮炎研究，无论是关于其遗传学、发病机制还是治疗，都需要一个无可争议的诊断。由于没有简单或复杂的实验室程序来诊断特应性皮炎，因此已经制定了不同的临床标准集，以便在不同的研究以及不同的研究中心统一进行诊断。最常用的是哈尼芬和拉伊卡的诊断特征集，为了确诊特应性皮炎，需要满足主要和次要临床标准。特应性免疫的最新进展清楚地确定了该综合征的主要异常，即过敏原特异性IgE的优先产生。在本论文中，建议在特定患者中存在此类抗体应作为特应性皮炎诊断的强制性标准。然而，这样的诊断测试只能确诊特应性综合征，而非特应性皮炎。因此，就特应性皮炎而言，目前我们不得不依赖其他临床标准。本文对文献中描述的临床特征进行了批判性评估，并建议除了必须存在过敏原特异性IgE外，还应具备3项主要标准中的2项（瘙痒、典型形态和分布、慢性或慢性复发性）才能做出这样的诊断。最后，对哈尼芬和拉伊卡最初描述并随后由其他人评估的次要特征进行了修订，并分为4个子类别：a）与亚临床湿疹相关；b）与皮肤干燥相关；c）皮肤褶皱外；d）眼科病理学。建议仅将它们用作附加标准，当临床怀疑度高但此处描述的新的强制性和主要诊断标准不确定时使用。出于研究目的，我们建议强制性和主要标准就足够了。它们目前正在正在进行的特应性皮炎治疗研究中进行评估和验证。
