Pediatrics in review最新文献

The goal of management of atopic dermatitis (AD) or eczema, is to achieve disease control in the absence of a cure. This review aims to outline the current management and treatment of AD and explore gaps in knowledge about the effectiveness of treatment control. Although there is no concrete definition of or specific features that constitute "control" in this context, control includes reducing disease activity, decreasing symptoms, and ultimately improving quality of life. Therapeutic patient education (TPE) improves outcomes and includes information about the disease; recognition of active disease; trigger reduction where possible; moisturization; and instructions on medication use. Applying moisturizers consistently is part of standard care and plays a role in flare prevention. Topical corticosteroids (TCS), for which there is good evidence to support efficacy and safety, are frequently used topical treatments. Despite the infrequent incidence of side effects, the use of TCS is often hindered by fear of these side effects. To ensure adherence to treatment, it is essential to assess and address patients' and caregivers' concerns about steroid use. Effective alternative topical treatments include calcineurin inhibitors, phosphodiesterase-4 inhibitors, and Janus kinase inhibitors (JAKI). Ancillary therapies may play a role in some selected patients, for example, wet-wrap therapy and bleach baths, but add complexity to management plans with inconsistent supporting evidence. Antihistamines are no longer routinely recommended. When topical therapy fails, systemic treatment options may be considered, including phototherapy, traditional immune-suppressant therapy, and newer agents such as biologic therapy or JAKI.

Atopic dermatitis (AD), or eczema, is a common, chronic inflammatory skin condition resulting in recurrent flares of itch and rash. This review discusses current literature regarding epidemiology, pathophysiology, etiology, comorbidities, clinical presentation, and impact on quality of life with the goal of addressing common gaps in understanding. Onset is usually early in life, but it is not uncommon to persist into adulthood, despite a common assumption that children outgrow AD. The primary drivers of its pathophysiology are skin barrier dysfunction and immune dysregulation, which are complex and interrelated. The etiology is influenced by genetic, microbial, immunological, and possibly environmental factors. A notable predictor of AD is a family history of atopic disease. Comorbidity with other atopic diseases including asthma and food allergies is common. Nonatopic comorbidities common in AD include autoimmune conditions and psychiatric diseases. Clinical manifestations include the almost universal feature of pruritus, which can be seen without rash. Rash can include classic dermatitis, but other morphologies including those more common in patients with skin of color should be recognized. Complications such as secondary infection are common, often related to the complex role Staphylococcus aureus plays in AD. Living with AD places a significant burden on the patient's quality of life including significant impacts on sleep. Assessment of severity includes assessing itch severity and impact on quality of life. Tools such as a numeric rating scale for itch severity may be useful in clinical practice.