中华皮肤科杂志 ›› 2025, Vol. 58 ›› Issue (10): 903-909.doi: 10.35541/cjd.20250247
《特应性皮炎外用治疗与管理专家共识(2025版)》编写专家组
收稿日期:
2025-04-30
修回日期:
2025-08-18
发布日期:
2025-09-30
通讯作者:
张建中
E-mail:rmzjz@126.com
The Expert Panel for the “Expert Consensus on the Topical Treatment and Management of Atopic Dermatitis(2025 edition)”
Received:
2025-04-30
Revised:
2025-08-18
Published:
2025-09-30
Contact:
Zhang Jianzhong
E-mail:rmzjz@126.com
摘要: 【摘要】 外用药物是特应性皮炎(AD) 治疗的核心基础,规范应用对于优化疗效、降低不良反应发生至关重要。本共识由多学科专家团队基于AD循证医学证据、国内外指南及专家临床经验,紧密结合中国AD患者疾病特征编写。内容系统梳理经典和新兴外用药物的应用原则,强调阶梯治疗与主动维持治疗的策略,针对特殊部位、特殊人群制定具体用药方案 。该共识旨在为临床医师提供系统化、科学化、规范化的用药指导,提升AD整体管理水平。
《特应性皮炎外用治疗与管理专家共识(版)》编写专家组. [开放获取] 特应性皮炎外用治疗与管理专家共识(2025版)[J]. 中华皮肤科杂志, 2025,58(10):903-909. doi:10.35541/cjd.20250247
The Expert Panel for the “Expert Consensus on the Topical Treatment and Management of Atopic Dermatitis( edition)”. Expert consensus on the topical treatment and management of atopic dermatitis (2025 edition)[J]. Chinese Journal of Dermatology, 2025, 58(10): 903-909.doi:10.35541/cjd.20250247
[1] | 中华医学会, 中华医学会杂志社, 中华医学会皮肤性病学分会, 等. 特应性皮炎基层诊疗指南(2022年)[J]. 中华全科医师杂志, 2022,21(7):609⁃619. doi: 10.3760/cma.j.cn114798⁃20220215⁃00102. |
[2] | Sroka⁃Tomaszewska J, Trzeciak M. Molecular mechanisms of atopic dermatitis pathogenesis[J]. Int J Mol Sci, 2021,22(8):4130. doi: 10.3390/ijms22084130. |
[3] | 郝飞, 张建中. 特应性皮炎的研究现状与展望[J]. 中华医学杂志, 2023,103(32):2465⁃2469. doi: 10.3760/cma.j.cn112137⁃20230302⁃00318. |
[4] | Laughter MR, Maymone M, Mashayekhi S, et al. The global burden of atopic dermatitis: lessons from the Global Burden of Disease Study 1990⁃2017[J]. Br J Dermatol, 2021,184(2):304⁃309. doi: 10.1111/bjd.19580. |
[5] | Bylund S, Kobyletzki LB, Svalstedt M, et al. Prevalence and incidence of atopic dermatitis: a systematic review[J]. Acta Derm Venereol, 2020,100(12):adv00160. doi: 10.2340/00015555⁃ 3510. |
[6] | Murota H, Koike Y, Morisaki H, et al. Exacerbating factors and disease burden in patients with atopic dermatitis[J]. Allergol Int, 2022,71(1):25⁃30. doi: 10.1016/j.alit.2021.10.002. |
[7] | 孙彩虹, 姚煦. 特应性皮炎外用糖皮质激素的规范使用[J]. 中华全科医师杂志, 2023,22(2):224⁃226. doi: 10.3760/cma.j.cn114798⁃20221128⁃01118. |
[8] | Kim JE, Shin JM, Ko JY, et al. Importance of concomitant topical therapy in moderate⁃to⁃severe atopic dermatitis treated with cyclosporine[J]. Dermatol Ther, 2016,29(2):120⁃125. doi: 10.1111/dth.12333. |
[9] | Butala S, Paller AS. Optimizing topical management of atopic dermatitis[J]. Ann Allergy Asthma Immunol, 2022,128(5):488⁃504. doi: 10.1016/j.anai.2022.03.004. |
[10] | Wollenberg A, Kinberger M, Arents B, et al. European guideline (EuroGuiDerm) on atopic eczema ⁃ part Ⅱ: non⁃systemic treatments and treatment recommendations for special AE patient populations[J]. J Eur Acad Dermatol Venereol, 2022,36(11):1904⁃1926. doi: 10.1111/jdv.18429. |
[11] | Saeki H, Ohya Y, Arakawa H, et al. English version of clinical practice guidelines for the management of atopic dermatitis 2024[J]. J Dermatol, 2025,52(2):e70⁃e142. doi: 10.1111/1346⁃8138.17544. |
[12] | Eichenfield LF, Tom WL, Berger TG, et al. Guidelines of care for the management of atopic dermatitis: section 2. Management and treatment of atopic dermatitis with topical therapies[J]. J Am Acad Dermatol, 2014,71(1):116⁃132. doi: 10.1016/j.jaad. 2014.03.023. |
[13] | Hengge UR, Ruzicka T, Schwartz RA, et al. Adverse effects of topical glucocorticosteroids[J]. J Am Acad Dermatol, 2006,54(1):1⁃18. doi: 10.1016/j.jaad.2005.01.010. |
[14] | Meurer M, Fölster⁃Holst R, Wozel G, et al. Pimecrolimus cream in the long⁃term management of atopic dermatitis in adults: a six⁃month study[J]. Dermatology, 2002,205(3):271⁃277. doi: 10. 1159/000065863. |
[15] | Reitamo S, Wollenberg A, Schöpf E, et al. Safety and efficacy of 1 year of tacrolimus ointment monotherapy in adults with atopic dermatitis. The European Tacrolimus Ointment Study Group[J]. Arch Dermatol, 2000,136(8):999⁃1006. doi: 10.1001/archderm. 136.8.999. |
[16] | Ahn D, Robinson CA. Pimecrolimus[M/OL]//StatPearls. Treasure Island (FL): StatPearls Publishing, 2025.https://www.ncbi.nlm.nih.gov/books/NBK545135/. |
[17] | Reitamo S, Rustin M, Harper J, et al. A 4⁃year follow⁃up study of atopic dermatitis therapy with 0.1% tacrolimus ointment in children and adult patients[J]. Br J Dermatol, 2008,159(4):942⁃951. doi: 10.1111/j.1365⁃2133.2008.08747.x. |
[18] | Sigurgeirsson B, Boznanski A, Todd G, et al. Safety and efficacy of pimecrolimus in atopic dermatitis: a 5⁃year randomized trial[J]. Pediatrics, 2015,135(4):597⁃606. doi: 10.1542/peds.2014⁃1990. |
[19] | Reitamo S, Van Leent EJ, Ho V, et al. Efficacy and safety of tacrolimus ointment compared with that of hydrocortisone acetate ointment in children with atopic dermatitis[J]. J Allergy Clin Immunol, 2002,109(3):539⁃546. doi: 10.1067/mai.2002. 121831. |
[20] | Kempers S, Boguniewicz M, Carter E, et al. A randomized investigator⁃blinded study comparing pimecrolimus cream 1% with tacrolimus ointment 0.03% in the treatment of pediatric patients with moderate atopic dermatitis[J]. J Am Acad Dermatol, 2004,51(4):515⁃525. doi: 10.1016/j.jaad.2004.01.051. |
[21] | Billich A, Aschauer H, Aszódi A, et al. Percutaneous absorption of drugs used in atopic eczema: pimecrolimus permeates less through skin than corticosteroids and tacrolimus[J]. Int J Pharm, 2004,269(1):29⁃35. doi: 10.1016/j.ijpharm.2003.07.013. |
[22] | Deleuran M, Vestergaard C, Vølund A, et al. Topical calcineurin inhibitors, topical glucocorticoids and cancer in children: a nationwide study[J]. Acta Derm Venereol, 2016,96(6):834⁃835. doi: 10.2340/00015555⁃2392. |
[23] | Margolis DJ, Abuabara K, Hoffstad OJ, et al. Association between malignancy and topical use of pimecrolimus[J]. JAMA Dermatol, 2015,151(6):594⁃599. doi: 10.1001/jamadermatol. 2014.4305. |
[24] | Devasenapathy N, Chu A, Wong M, et al. Cancer risk with topical calcineurin inhibitors, pimecrolimus and tacrolimus, for atopic dermatitis: a systematic review and meta⁃analysis[J]. Lancet Child Adolesc Health, 2023,7(1):13⁃25. doi: 10.1016/S2352⁃4642(22)00283⁃8. |
[25] | Panel AJADG, Chu DK, Schneider L, et al. Atopic dermatitis (eczema) guidelines: 2023 American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force on Practice Parameters GRADE⁃ and Institute of Medicine⁃based recommendations[J]. Ann Allergy Asthma Immunol, 2024,132(3):274⁃312. doi: 10. 1016/j.anai.2023.11.009. |
[26] | Paller AS, Tom WL, Lebwohl MG, et al. Efficacy and safety of crisaborole ointment, a novel, nonsteroidal phosphodiesterase 4 (PDE4) inhibitor for the topical treatment of atopic dermatitis (AD) in children and adults[J]. J Am Acad Dermatol, 2016,75(3):494⁃503.e6. doi: 10.1016/j.jaad.2016.05.046. |
[27] | Gooderham M, Kircik L, Zirwas M, et al. The safety and efficacy of roflumilast cream 0.15% and 0.05% in patients with atopic dermatitis: randomized, double⁃blind, phase 2 proof of concept study[J]. J Drugs Dermatol, 2023,22(2):139⁃147. doi: 10. 36849/JDD.7295. |
[28] | Saeki H, Ito K, Yokota D, et al. Difamilast ointment in adult patients with atopic dermatitis: a phase 3 randomized, double⁃blind, vehicle⁃controlled trial[J]. J Am Acad Dermatol, 2022,86(3):607⁃614. doi: 10.1016/j.jaad.2021.10.027. |
[29] | Eichenfield LF, Call RS, Forsha DW, et al. Long⁃term safety of crisaborole ointment 2% in children and adults with mild to moderate atopic dermatitis[J]. J Am Acad Dermatol, 2017,77(4):641⁃649. doi: 10.1016/j.jaad.2017.06.010. |
[30] | Luger T, Chu CY, Elgendy A, et al. Pimecrolimus 1% cream for mild⁃to⁃moderate atopic dermatitis: a systematic review and meta⁃analysis with a focus on children and sensitive skin areas[J]. Eur J Dermatol, 2023,33(5):474⁃486. doi: 10.1684/ejd.2023. 4556. |
[31] | 蔡亚仙, 贾剑敏, 陈明. 芳香烃受体在治疗免疫炎症性皮肤病中的应用和新药开发[J]. 中国新药杂志, 2023,32(19):1979⁃1986. doi: 10.3969/j.issn.1003⁃3734.2023.19.013. |
[32] | 国家药品监督管理局. 银屑病治疗药物本维莫德乳膏获批上市[EB/OL]. (2019⁃05⁃31)[2024⁃09⁃13]. https:// www.nmpa.gov.cn/zhuanti/cxylqx/cxypxx/20190531091201963.html. |
[33] | Wang X, Mao D, Jia J, et al. Benvitimod inhibits IL⁃4⁃ and IL⁃13⁃induced tight junction impairment by activating AHR/ARNT pathway and inhibiting STAT6 phosphorylation in human keratinocytes[J]. J Invest Dermatol, 2024,144(3):509⁃519.e7. doi: 10.1016/j.jid.2023.07.027. |
[34] | Silverberg JI, Eichenfield LF, Hebert AA, et al. Tapinarof cream 1% once daily: significant efficacy in the treatment of moderate to severe atopic dermatitis in adults and children down to 2 years of age in the pivotal phase 3 ADORING trials[J]. J Am Acad Dermatol, 2024,91(3):457⁃465. doi: 10.1016/j.jaad.2024.05.023. |
[35] | Keam SJ. Tapinarof cream 1%: first approval[J]. Drugs, 2022,82(11):1221⁃1228. doi: 10.1007/s40265⁃022⁃01748⁃6. |
[36] | Paller AS, Stein Gold L, Soung J, et al. Efficacy and patient⁃reported outcomes from a phase 2b, randomized clinical trial of tapinarof cream for the treatment of adolescents and adults with atopic dermatitis[J]. J Am Acad Dermatol, 2021,84(3):632⁃638. doi: 10.1016/j.jaad.2020.05.135. |
[37] | Chovatiya R, Paller AS. JAK inhibitors in the treatment of atopic dermatitis[J]. J Allergy Clin Immunol, 2021,148(4):927⁃940. doi: 10.1016/j.jaci.2021.08.009. |
[38] | Facheris P, Jeffery J, Del Duca E, et al. The translational revolution in atopic dermatitis: the paradigm shift from pathogenesis to treatment[J]. Cell Mol Immunol, 2023,20(5):448⁃474. doi: 10.1038/s41423⁃023⁃00992⁃4. |
[39] | National Eczema Association. FAQ ⁃ opzelura (ruxolitinib) cream[EB/OL]. [2024⁃09⁃13]. https://nationaleczema.org/ruxolitinib⁃faq/. |
[40] | Adam DN, Gooderham MJ, Beecker JR, et al. Expert consensus on the systemic treatment of atopic dermatitis in special populations[J]. J Eur Acad Dermatol Venereol, 2023,37(6):1135⁃1148. doi: 10.1111/jdv.18922. |
[41] | Simpson EL, Bissonnette R, Chiesa Fuxench ZC, et al. Ruxolitinib cream monotherapy demonstrates rapid improvement in the extent and signs of mild to moderate atopic dermatitis across head and neck and other anatomic regions in adolescents and adults: pooled results from 2 phase 3 studies[J]. J Dermatolog Treat, 2024,35(1):2310633. doi: 10.1080/09546634. 2024.2310633. |
[42] | Nakagawa H, Nemoto O, Igarashi A, et al. Delgocitinib ointment, a topical Janus kinase inhibitor, in adult patients with moderate to severe atopic dermatitis: a phase 3, randomized, double⁃blind, vehicle⁃controlled study and an open⁃label, long⁃term extension study[J]. J Am Acad Dermatol, 2020,82(4):823⁃831. doi: 10.1016/j.jaad.2019.12.015. |
[43] | 方兴. 莫匹罗星联合外用糖皮质激素治疗激素抵抗特应性皮炎/湿疹的疗效研究[J]. 中国冶金工业医学杂志, 2022,39(6):646⁃647. |
[44] | Guo Y, Li P, Tang J, et al. Prevalence of atopic dermatitis in Chinese children aged 1⁃7 ys[J]. Sci Rep, 2016,6:29751. doi: 10.1038/srep29751. |
[45] | Silverberg JI, Hong HC, Calimlim BM, et al. Comparative efficacy of targeted systemic therapies for moderate⁃to⁃severe atopic dermatitis without topical corticosteroids: an updated network meta⁃analysis[J]. Dermatol Ther (Heidelb), 2023,13(10):2247⁃2264. doi: 10.1007/s13555⁃023⁃01000⁃3. |
[46] | Reich K, Teixeira HD, de Bruin⁃Weller M, et al. Safety and efficacy of upadacitinib in combination with topical corticosteroids in adolescents and adults with moderate⁃to⁃severe atopic dermatitis (AD Up): results from a randomised, double⁃blind, placebo⁃controlled, phase 3 trial[J]. Lancet, 2021,397(10290):2169⁃2181. doi: 10.1016/S0140⁃6736(21)00589⁃4. |
[47] | Bieber T, Simpson EL, Silverberg JI, et al. Abrocitinib versus placebo or dupilumab for atopic dermatitis[J]. N Engl J Med, 2021,384(12):1101⁃1112. doi: 10.1056/NEJMoa2019380. |
[48] | Jang DH, Heo SJ, Kook HD, et al. A 52 weeks dupilumab treatment for moderate to severe atopic dermatitis in Korea: long⁃term efficacy and safety in real world[J]. Sci Rep, 2021,11(1):23539. doi: 10.1038/s41598⁃021⁃02950⁃4. |
[49] | Contento M, Maher J, Cline A, et al. Why does facial eczema differ from body eczema?[J]. J Drugs Dermatol, 2022,21(10):1119⁃1123. doi: 10.36849/JDD.6354. |
[50] | 中华医学会皮肤性病学分会免疫学组, 特应性皮炎协作研究中心. 中国特应性皮炎诊疗指南(2020版)[J]. 中华皮肤科杂志, 2020,53(2):81⁃88. doi: 10.35541/cjd.20191000. |
[51] | Murrell DF, Calvieri S, Ortonne JP, et al. A randomized controlled trial of pimecrolimus cream 1% in adolescents and adults with head and neck atopic dermatitis and intolerant of, or dependent on, topical corticosteroids[J]. Br J Dermatol, 2007,157(5):954⁃959. doi: 10.1111/j.1365⁃2133.2007.08192.x. |
[52] | Xie Z, Chang J, Ma L, et al. A prospective observational study to evaluate the actual use of 1% pimecrolimus in Chinese patients with mild⁃to⁃moderate atopic dermatitis affecting sensitive skin areas[J]. Pragmat Obs Res, 2025,16:39⁃49. doi: 10.2147/POR.S496970. |
[53] | Thyssen JP, Schuttelaar M, Alfonso JH, et al. Guidelines for diagnosis, prevention, and treatment of hand eczema[J]. Contact Dermatitis, 2022,86(5):357⁃378. doi: 10.1111/cod.14035. |
[54] | Wilsmann⁃Theis D, Bieber T. Psoriasis and eczema on the scalp[J]. Hautarzt, 2014,65(12):1043⁃1049. doi: 10.1007/s00105⁃014⁃3542⁃4. |
[55] | 高莹, 鲁楠, 职蕾蕾, 等. 婴幼儿皮肤结构和生理特征的研究进展[J]. 中国美容医学, 2015,24(3):77⁃80. doi: 10.15909/j.cnki.cn61⁃1347/r.000215. |
[56] | Sathishkumar D, Moss C. Topical therapy in atopic dermatitis in children[J]. Indian J Dermatol, 2016,61(6):656⁃661. doi: 10. 4103/0019⁃5154.193677. |
[57] | Devillers AC, Oranje AP. Wet⁃wrap treatment in children with atopic dermatitis: a practical guideline[J]. Pediatr Dermatol, 2012,29(1):24⁃27. doi: 10.1111/j.1525⁃1470.2011.01691.x. |
[58] | Brar KK, Nicol NH, Boguniewicz M. Strategies for successful management of severe atopic dermatitis[J]. J Allergy Clin Immunol Pract, 2019,7(1):1⁃16. doi: 10.1016/j.jaip.2018.10.021. |
[59] | LePoidevin LM, Lee DE, Shi VY. A comparison of international management guidelines for atopic dermatitis[J]. Pediatr Dermatol, 2019,36(1):36⁃65. doi: 10.1111/pde.13678. |
[60] | Nicol NH, Boguniewicz M. Wet wrap therapy in moderate to severe atopic dermatitis[J]. Immunol Allergy Clin North Am, 2017,37(1):123⁃139. doi: 10.1016/j.iac.2016.08.003. |
[61] | Devillers AC, Oranje AP. Efficacy and safety of 'wet⁃wrap' dressings as an intervention treatment in children with severe and/or refractory atopic dermatitis: a critical review of the literature[J]. Br J Dermatol, 2006,154(4):579⁃585. doi: 10. 1111/j.1365⁃2133.2006.07157.x. |
[62] | Zouboulis CC, Boschnakow A. Chronological ageing and photoageing of the human sebaceous gland[J]. Clin Exp Dermatol, 2001,26(7):600⁃607. doi: 10.1046/j.1365⁃2230.2001. 00894.x. |
[63] | Munera⁃Campos M, Carrascosa JM. Atopic dermatitis: fertility, pregnancy, and treatment perspectives[J]. Am J Clin Dermatol, 2024,25(1):55⁃66. doi: 10.1007/s40257⁃023⁃00821⁃4. |
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