文献简介

出版社:Hong Kong Med J

作  者:Theresa NH Leung, KL Hon

编  号:10.12809/hkmj144474

关键字:atopic dermatitis, therapeutics

年  份:2015   点击量:842

文献摘要 全文翻译

ABSTRACT

摘要

Eczema or atopic dermatitis is a common childhood atopic disease associated with chronicity and impaired quality of life. As there is no cure for the disease, treatment relies on topical and systemic anti-allergic or immunomodulating therapies. Topical corticosteroid, macrolide immunosuppressants, and oral immunomodulating drugs for recalcitrant disease have been the mainstay of therapy. Management of atopic dermatitis must consider the individual symptomatic variability of the disease. Basic therapy is focused on patient/ family education, hydrating topical treatment, and avoidance of specific and non-specific provocative factors. Anti-inflammatory treatment based on topical glucocorticosteroids and topical calcineurin inhibitors is used for exacerbation management and more recently in selective cases for proactive therapy. Systemic immunosuppressive treatment is an option for severe refractory cases. Microbial colonisation and superinfection may induce disease exacerbation and justify additional antimicrobial treatment. Adjuvant therapy includes ultraviolet (UV) irradiation preferably with UVA1 or narrowband UVB. Dietary recommendations should be specific and given only when food allergy is confirmed. Allergen-specific immunotherapy against aeroallergens may be useful in selected cases. Parallel use of traditional and proprietary topical and herbal medicine has also been popular in China and many cities in Asia. Complementary and alternative medicine may have a place but evidence-based data are lacking.

湿疹或特应性皮炎是一种儿童常见特应性疾病,这种慢性病可严重影响患者生活质量。由于湿疹无法治愈,因而一般采用局部和全身性抗过敏或免疫调节疗法来缓解症状。外用皮质类固醇,免疫抑制剂,大环内酯类,以及口服免疫调节药物治疗顽固性患者已成为治疗湿疹的主要方法。特应性皮炎的管理需考虑其个体症状的差异。基本疗法强调对患者/家庭教育,外用保湿治疗,以及避免特异性和非特异性的诱发因素。近来对合适病例施以外用糖皮质激素以及外用钙调神经磷酸酶抑制剂的抗炎药物来进行积极长效治疗,以控制病情。全身性免疫抑制治疗是针对严重难治性患者的一种方法。微生物定植和重复感染可能导致湿疹急性发作,此时需同时抗微生物治疗。辅助疗法包括紫外线(UV)照射,其中首选UVA1或窄谱UVB。在确定食物过敏为湿疹发作的诱因后,可向患者作出具体的饮食建议。过敏原特异性免疫疗法对吸入过敏原产生过敏的患者有用。在中国和其他许多亚洲地区,已经很流行同时使用传统和专有的中成药来治疗湿疹。补充和替代医学疗法可能有用,但缺乏实证医学的数据支持。