ETFAD/EADV Eczema task force 2020 position paper on diagnosis and treatment of atopic dermatitis in adults and children

Autor: Michael J. Cork, Mette Deleuran, Jean-François Stalder, Stephan Weidinger, Magdalena Trzeciak, Ulf Darsow, Z. Szalai, Annice Heratizadeh, L.B. von Kobyletzki, Johannes Ring, Jacob P. Thyssen, DirkJan Hijnen, Dagmar Simon, Thomas Werfel, Julien Seneschal, Sébastien Barbarot, R. Fölster-Holst, Christian Vestergaard, Åke Svensson, M S de Bruin-Weller, Andreas Wollenberg, S. Christen-Zäch, Alain Taieb, U. Gieler, B. Kunz, L. De Raeve, Carle Paul
Přispěvatelé: Ludwig-Maximilians-Universität München (LMU), Physiopathologie des Adaptations Nutritionnelles (PhAN), Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Internal Medicine, Dermatology
Rok vydání: 2020
Předmět:
Zdroj: Journal of the European Academy of Dermatology and Venereology
Journal of the European Academy of Dermatology and Venereology, Wiley, 2020, 34 (12), pp.2717-2744. ⟨10.1111/jdv.16892⟩
Wollenberg, A, Christen-Zäch, S, Taieb, A, Paul, C, Thyssen, J P, de Bruin-Weller, M, Vestergaard, C, Seneschal, J, Werfel, T, Cork, M J, Kunz, B, Fölster-Holst, R, Trzeciak, M, Darsow, U, Szalai, Z, Deleuran, M, von Kobyletzki, L, Barbarot, S, Heratizadeh, A, Gieler, U, Hijnen, D J, Weidinger, S, De Raeve, L, Svensson, Å, Simon, D, Stalder, J F, Ring, J & European Task Force on Atopic Dermatitis/EADV Eczema Task Force 2020, ' ETFAD/EADV Eczema task force 2020 position paper on diagnosis and treatment of atopic dermatitis in adults and children ', Journal of the European Academy of Dermatology and Venereology, vol. 34, no. 12, pp. 2717-2744 . https://doi.org/10.1111/jdv.16892
Journal of the European Academy of Dermatology and Venereology, 34(12), 2717-2744. Wiley-Blackwell
ISSN: 1468-3083
0926-9959
DOI: 10.1111/jdv.16892⟩
Popis: International audience; Atopic dermatitis (AD) is a highly pruritic, chronic inflammatory skin disease. The diagnosis is made using evaluated clinical criteria. Disease activity and burden are best measured with a composite score, assessing both objective and subjective symptoms, such as SCORing Atopic Dermatitis (SCORAD). AD management must take into account clinical and pathogenic variabilities, the patient's age and also target flare prevention. Basic therapy includes hydrating and barrier-stabilizing topical treatment universally applied, as well as avoiding specific and unspecific provocation factors. Visible skin lesions are treated with anti-inflammatory topical agents such as corticosteroids and calcineurin inhibitors (tacrolimus and pimecrolimus), which are preferred in sensitive locations. Topical tacrolimus and some mid-potency corticosteroids are proven agents for proactive therapy, which is defined as the long-term intermittent anti-inflammatory therapy of frequently relapsing skin areas. Systemic anti-inflammatory or immunosuppressive treatment is a rapidly changing field requiring monitoring. Oral corticosteroids have a largely unfavourable benefit-risk ratio. The IL-4R-blocker dupilu-mab is a safe, effective and licensed, but expensive, treatment option with potential ocular side-effects. Other biologicals targeting key pathways in the atopic immune response, as well as different Janus kinase inhibitors, are among emerging treatment options. Dysbalanced microbial colonization and infection may induce disease exacerbation and can justify additional antimicrobial treatment. Systemic antihistamines (H1R-blockers) only have limited effects on AD-related itch and eczema lesions. Adjuvant therapy includes UV irradiation, preferably narrowband UVB or UVA1. Coal tar may be useful for atopic hand and foot eczema. Dietary recommendations should be patient-specific, and elimination diets should only be advised in case of proven food allergy. Allergen-specific immunotherapy to aeroallergens may be useful in selected cases. Psychosomatic counselling is recommended to address stress-induced exacerbations. Efficacy-proven 'Eczema school' educational programmes and therapeutic patient education are recommended for both children and adults.
Databáze: OpenAIRE
Externí odkaz: