中重度特应性皮炎分层个体化系统治疗专家共识

doi:10.35541/cjd.20240321

Abstract

Abstract: 【Abstract】 Atopic dermatitis （AD） is a chronic inflammatory skin disease. In recent years, with the development and application of targeted drugs, the treatment of AD is entering the era of individualization. Stratification of patients based on different dimensions can help realize individualized treatment, but currently there is a lack of stratification strategies for individualized treatment of AD. Therefore, the consensus on stratified individualized systemic treatment for moderate to severe AD was formulated by experts from the Immunology Group, Chinese Society of Dermatology and the Dermatology Professional Committee of Chinese Research Hospital Society, based on the latest research progress in AD in China and other countries as well as experts′ clinical practice experience. The consensus encompasses the individualized comprehensive assessment, systemic therapeutic drugs, selection of therapeutic options according to different dimensions, and the mode of systemic treatment of AD, aiming to guide clinical individualized medication.

Key words: Dermatitis, atopic, Drug therapy, Precision medicine, Systemic therapeutic drugs, Individualization

Immunology Group, Chinese Society of Dermatology, Dermatology Professional Committee of Chinese Research Hospital Society. Expert consensus on the stratified individualized systemic treatment of moderate to severe atopic dermatitis[J]. Chinese Journal of Dermatology, 2024, 57(12): 1071-1078.doi:10.35541/cjd.20240321

References ［49］

［1］	Sroka⁃Tomaszewska J, Trzeciak M. Molecular mechanisms of atopic dermatitis pathogenesis［J］. Int J Mol Sci, 2021,22（8）:4130. doi: 10.3390/ijms22084130.
［2］	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.
［3］	Dong WL, An J, Yu M, et al. The prevalence and year lived with disability of atopic dermatitis in China: findings from the global burden of disease study 2019［J］. World Allergy Organ J, 2021, 14（11）: 100604. doi: 10.1016/j.waojou.2021.100604.
［4］	Chovatiya R, Silverberg JI. The heterogeneity of atopic dermatitis［J］. J Drugs Dermatol, 2022,21（2）:172⁃176. doi: 10.36849/JDD.6408.
［5］	Mesjasz A, Kołkowski K, Wollenberg A, et al. How to understand personalized medicine in atopic dermatitis nowadays?［J］. Int J Mol Sci, 2023,24（8）:7557. doi: 10.3390/ijms24087557.
［6］	中华医学会皮肤性病学分会免疫学组. 特应性皮炎的全程管理共识［J］. 中华皮肤科杂志, 2023,56（1）:5⁃15. doi: 10.35541/cjd.20220618.
［7］	李巍, 尹慧彬. 特应性皮炎的部位异质性［J］. 中华皮肤科杂志, 2022,55（4）:349⁃352. doi: 10.35541/cjd.20210865.
［8］	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.
［9］	Wei W, Anderson P, Gadkari A, et al. Extent and consequences of inadequate disease control among adults with a history of moderate to severe atopic dermatitis［J］. J Dermatol, 2018,45（2）:150⁃157. doi: 10.1111/1346⁃8138.14116.
［10］	赵作涛, 高兴华. 中重度特应性皮炎系统药物达标治疗专家指导建议［J］.中国皮肤性病学杂志, 2022,36（8）:855⁃864. doi: 10.13735/j.cjdv.1001⁃7089.202205115.
［11］	Werfel T, Heratizadeh A, Aberer W, et al. Update "systemic treatment of atopic dermatitis" of the S2k⁃guideline on atopic dermatitis［J］. J Dtsch Dermatol Ges, 2021,19（1）:151⁃168. doi: 10.1111/ddg.14371.
［12］	Boguniewicz M, Alexis AF, Beck LA, et al. Expert perspectives on management of moderate⁃to⁃severe atopic dermatitis: a multidisciplinary consensus addressing current and emerging therapies［J］. J Allergy Clin Immunol Pract, 2017,5（6）:1519⁃1531. doi: 10.1016/j.jaip.2017.08.005.
［13］	Suh TP, Ramachandran D, Patel V, et al. Product of Investigator Global Assessment and Body Surface Area （IGAxBSA）: a practice⁃friendly alternative to the Eczema Area and Severity Index to assess atopic dermatitis severity in children［J］. J Am Acad Dermatol, 2020,82（5）:1187⁃1194. doi: 10.1016/j.jaad. 2020.01.023.
［14］	Simpson EL, Bruin⁃Weller M, Flohr C, et al. When does atopic dermatitis warrant systemic therapy? Recommendations from an expert panel of the International Eczema Council［J］. J Am Acad Dermatol, 2017,77（4）:623⁃633. doi: 10.1016/j.jaad.2017.06.042.
［15］	中国医师协会皮肤科医师分会, 中华医学会皮肤性病学分会, 中国医疗保健国际交流促进会皮肤医学分会, 等. 特应性皮炎治疗药物应用管理专家共识（2024版）［J］. 中华皮肤科杂志, 2024,57（2）:97⁃108. doi: 10.35541/cjd.20230358.
［16］	中华医学会皮肤性病学分会, 中国医师协会皮肤科医师分会. 中国中重度特应性皮炎诊疗临床路径专家共识（2023版）［J］. 中华皮肤科杂志, 2023,56（11）:1000⁃1007. doi: 10. 35541/cjd.20230247.
［17］	Wollenberg A, Kinberger M, Arents B, et al. European guideline （EuroGuiDerm） on atopic eczema: part I ⁃ systemic therapy［J］. J Eur Acad Dermatol Venereol, 2022,36（9）:1409⁃1431. doi: 10.1111/jdv.18345.
［18］	Davis D, Drucker AM, Alikhan A, et al. Guidelines of care for the management of atopic dermatitis in adults with phototherapy and systemic therapies［J］. J Am Acad Dermatol, 2024,90（2）:e43⁃e56. doi: 10.1016/j.jaad.2023.08.102.
［19］	Thyssen JP, Halling AS, Schmid⁃Grendelmeier P, et al. Comorbidities of atopic dermatitis⁃what does the evidence say?［J］. J Allergy Clin Immunol, 2023,151（5）:1155⁃1162. doi: 10.1016/j.jaci.2022.12.002.
［20］	国家皮肤与免疫疾病临床医学研究中心（北京协和医院）, 中国医师协会风湿免疫科医师分会, 中国研究型医院学会风湿免疫专业委员会, 等. 钙调磷酸酶抑制剂治疗风湿免疫性疾病临床应用专家共识［J］. 中华内科杂志, 2023,62（11）:1266⁃1281. doi: 10.3760/cma.j.cn112138⁃20230416⁃00198.
［21］	中华医学会皮肤性病学分会银屑病专业委员会. 甲氨蝶呤治疗银屑病应用专家共识［J］. 临床皮肤科杂志, 2022, 51（2）: 108⁃117. doi: 10.16761/j.cnki.1000⁃4963.2022.02.015.
［22］	中国中西医结合学会皮肤性病专业委员会环境与职业性皮肤病学组, 中国老年保健医学研究会皮肤科分会. 系统Janus激酶抑制剂治疗特应性皮炎专家共识［J］. 实用皮肤病学杂志, 2022,15（3）:129⁃135. doi: 10.11786/sypfbxzz.1674⁃1293. 20220301.
［23］	Czarnowicki T, He H, Krueger JG, et al. Atopic dermatitis endotypes and implications for targeted therapeutics［J］. J Allergy Clin Immunol, 2019,143（1）:1⁃11. doi: 10.1016/j.jaci. 2018.10.032.
［24］	中华医学会内分泌学分会, 中国内分泌代谢病专科联盟. 糖皮质激素类药物临床应用指导原则（2023版）［J］. 中华内分泌代谢杂志, 2023,39（4）:289⁃296. doi: 10.3760/cma.j.cn311 282⁃20230116⁃00029.
［25］	中华医学会皮肤性病学分会儿童皮肤病学组. 中国儿童特应性皮炎诊疗共识（2017版）［J］. 中华皮肤科杂志, 2017,50（11）:784⁃789. doi: 10.3760/cma.j.issn.0412⁃4030.2017.11.002.
［26］	Flohr C, Rosala⁃Hallas A, Jones AP, et al. Efficacy and safety of ciclosporin versus methotrexate in the treatment of severe atopic dermatitis in children and young people （TREAT）: a multicentre parallel group assessor⁃blinded clinical trial［J］. Br J Dermatol, 2023,189（6）:674⁃684.
［27］	中华医学会皮肤性病学分会特应性皮炎研究中心, 中华医学会皮肤性病学分会儿童学组. 度普利尤单抗治疗特应性皮炎专家共识［J］. 中华皮肤科杂志, 2022,55（6）:465⁃470. doi: 10.35541/cjd.20210885.
［28］	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.
［29］	Harb H, Chatila TA. Mechanisms of dupilumab［J］. Clin Exp Allergy, 2020,50（1）:5⁃14. doi: 10.1111/cea.13491.
［30］	Bhatt SP, Rabe KF, Hanania NA, et al. Dupilumab for COPD with type 2 inflammation indicated by eosinophil counts［J］. N Engl J Med, 2023,389（3）:205⁃214. doi: 10.1056/NEJMoa 2303951.
［31］	Barry K, Zancanaro P, Casseres R, et al. Concomitant atopic dermatitis and psoriasis ⁃ a retrospective review［J］. J Dermatolog Treat, 2021,32（7）:716⁃720. doi: 10.1080/09546634.2019.170 2147.
［32］	中华医学会皮肤性病学分会银屑病专业委员会. 中国银屑病诊疗指南（2023版）［J］. 中华皮肤科杂志, 2023,56（7）:573⁃625. doi: 10.35541/cjd.20220839.
［33］	Gargiulo L, Ibba L, Malagoli P, et al. Management of patients affected by moderate⁃to⁃severe atopic dermatitis with JAK inhibitors in real⁃world clinical practice: an Italian Delphi Consensus［J］. Dermatol Ther （Heidelb）, 2024,14（4）:919⁃932. doi: 10.1007/s13555⁃024⁃01135⁃x.
［34］	中华医学会皮肤性病学分会毛发学组. 中国斑秃诊疗指南（2019）［J］. 临床皮肤科杂志, 2020,49（2）:69⁃72. doi: 10. 16761/j.cnki.1000⁃4963.2020.02.002.
［35］	Passeron T, Ezzedine K, Hamzavi I, et al. Efficacy and safety of upadacitinib in a phaseⅡ randomised, double⁃blind, dose⁃ranging study of adults with extensive non⁃segmental vitiligo［EB/OL］. （2023⁃11⁃23）［2024⁃06⁃17］. https://www.emjreviews.com/dermatology/symposium/efficacy⁃and⁃safety⁃of⁃upadacitinib⁃in⁃a⁃phase⁃ii⁃randomised⁃double⁃blind⁃dose⁃ranging⁃study⁃of⁃adults⁃with⁃extensive⁃non⁃segmental⁃vitiligo⁃j030123/.
［36］	US Food and Drug Administration. RINVOQ®（upadacitinib） extended⁃release tablets, for oral use; RINVOQ® LQ （upadacitinib） oral solution［DB/OL］. （2024⁃04⁃26）［2024⁃06⁃17］. https://www.accessdata.fda.gov/drugsatfda_docs/label/2024/211675s021s022lbl.pdf.
［37］	《类风湿关节炎超药品说明书用药中国专家共识》制定专家组. 类风湿关节炎超药品说明书用药中国专家共识（2022版）［J］. 中华医学杂志, 2022,102（15）:1076⁃1085. doi: 10. 3760/cma.j.cn112137⁃20220120⁃00152.
［38］	Torres T, Gonçalo M, Paiva Lopes MJ, et al. Portuguese recommendations for the treatment of atopic dermatitis with biologic therapy and JAK inhibitors in adult patients［J］. Drugs Context, 2021,10:2021⁃2029⁃5. doi: 10.7573/dic.2021⁃9⁃5.
［39］	甲泼尼龙片说明书［Z/OL］. （2020⁃09⁃09）［2024⁃06⁃17］. https://zy.yaozh.com/instruct/sms20201022/20201020147.pdf.
［40］	Xiao X, Zhang T, Huang J, et al. Effect of CYP3A4 on liver injury induced by triptolide［J］. Biomed Chromatogr, 2020,34（8）:e4864. doi: 10.1002/bmc.4864.
［41］	Zheng N, Wei A, Wu T, et al. Triptolide and atorvastatin synergistically promote hepatotoxicity in cultured hepatocytes and female Sprague⁃Dawley rats by inhibiting pregnane X receptor⁃mediated transcriptional activation of CYP3A4［J］. Toxicol Lett, 2021,342:85⁃94. doi: 10.1016/j.toxlet.2021.02.008.
［42］	Chen L, Chen X, Liu J, et al. Effects of two commonly used antidepressants amitriptyline and fluoxetine on the pharmacokinetics of abrocitinib in rats［J］. Chem Biol Interact, 2024,397:111041. doi: 10.1016/j.cbi.2024.111041.
［43］	Siegfried EC, Arkin LM, Chiu YE, et al. Methotrexate for inflammatory skin disease in pediatric patients: consensus treatment guidelines［J］. Pediatr Dermatol, 2023,40（5）:789⁃808. doi: 10.1111/pde.15327.
［44］	Wu S, Zhou B, Yue X, et al. The changes of platelets counts in atopic dermatitis patients after treatment of abrocitinib: a systematic review and meta⁃analysis［J］. Postepy Dermatol Alergol, 2024,41（2）:232⁃235. doi: 10.5114/ada.2024.138659.
［45］	US Food and Drug Administration. CIBINQOTM （abrocitinib） tablets, for oral use［DB/OL］. （2022⁃01⁃14）［2024⁃06⁃17］. https://www.accessdata.fda.gov/drugsatfda_docs/label/2022/213871s000lbl.pdf.
［46］	Silverberg JI, Gooderham M, Katoh N, et al. Combining treat⁃to⁃target principles and shared decision⁃making: international expert consensus⁃based recommendations with a novel concept for minimal disease activity criteria in atopic dermatitis［J］. J Eur Acad Dermatol Venereol, 2024. doi: 10.1111/jdv.20229.
［47］	杨冬梅, 刘俊. 雷公藤多苷临床应用及不良反应的研究进展［J］. 中国医院药学杂志, 2018,38（20）:2185⁃2190. doi: 10. 13286/j.cnki.chinhosppharmacyj.2018.20.22.
［48］	《中成药治疗优势病种临床应用指南》标准化项目组. 中成药治疗类风湿关节炎临床应用指南（2022年）［J］. 中国中西医结合杂志, 2023,43（3）:261⁃273. doi: 10.7661/j.cjim.20230128. 125.
［49］	Lee Y, Kim ME, Nahm DH. Real clinical practice data of monthly dupilumab therapy in adult patients with moderate⁃to⁃severe atopic dermatitis: clinical efficacy and predictive markers for a favorable clinical response［J］. Allergy Asthma Immunol Res, 2021,13（5）:733⁃745. doi: 10.4168/aair.2021.13.5.733.

[1]	Xu Jiaosheng, Fu Libing, Xu Zhe, and Xu Zigang. Subcutaneous panniculitis?like T cell lymphoma [J]. Chinese Journal of Dermatology, 2024, 0(3): 20230172-e0230172.
[2]	Na Jun, Li Ruoyu, Zhong Shaomin, Yang Li, Wu Yan. Diagnosis and treatment of rosacea in the real world: a survey on the current status [J]. Chinese Journal of Dermatology, 2024, 57(2): 127-133.
[3]	Gao Yan, Wang Peng, Kang Xiaojing. Treatment of Kaposi′s sarcoma [J]. Chinese Journal of Dermatology, 2024, 57(1): 85-89.
[4]	Jin Shiying, Shi Jinjun, Gao Qi, Chen Mei, Dong Zhengbang, Yan Qiao, Li Jijian, Wang Fei. High-frequency ultrasonography-assisted evaluation of treatment outcomes of erysipelas: a prospective controlled study [J]. Chinese Journal of Dermatology, 2023, 56(5): 434-438.
[5]	Jia Weixue, Li Chengrang. Comparison of Chinese and international guidelines and consensus for the diagnosis and treatment of vitiligo [J]. Chinese Journal of Dermatology, 2023, 56(5): 471-475.
[6]	Peng Ying, Liu Yi. Medications for the treatment of acne [J]. Chinese Journal of Dermatology, 2023, 56(2): 173-176.
[7]	Hu Yebei, Song Xiuzu. Tranexamic acid for the treatment of melasma [J]. Chinese Journal of Dermatology, 2022, 55(5): 460-462.
[8]	Tian Jing, Liang Yuan, Shen Chunping, Zhao Mutong, Wang Yang, Wang Shan, Jiao Lei, Ma Lin. Analysis of short-term efficacy and safety of the first subcutaneous injection of dupilumab in the treatment of moderate-to-severe childhood atopic dermatitis [J]. Chinese Journal of Dermatology, 2022, 55(4): 299-303.
[9]	Ding Tiantian, Cui Baohong, Mi Shuhong, Zhang Yang, Zheng Hailin, Shi Jihai, Liu Weida. Comparison of drug susceptibility of and drug resistance mutations in fluconazole-resistant Candida albicans strains from superficial and deep infections [J]. Chinese Journal of Dermatology, 2022, 55(10): 874-878.
[10]	Lu Gaihui, Li Tao, Liu Xuewei. Effect of benzathine penicillin combined with ceftriaxone on the results of rapid plasma reagin circle card test/toluidine red unheated serum test in the treatment of early syphilis: a meta-analysis [J]. Chinese Journal of Dermatology, 2021, 54(6): 522-526.
[11]	Li Yan, Xu Wei, Gu Heng, Ju Mei, Duan Yiqun, Zeng Xianyu, Diao Qingchun, Ning Chunzhu, Li Linfeng. Acrivastine combined with loratadine in the treatment of chronic refractory urticaria: a multicenter, randomized controlled study [J]. Chinese Journal of Dermatology, 2020, 53(5): 319-323.
[12]	WANG Gang. Main adverse reactions in biological agents in dermatology and their strategies [J]. Chinese Journal of Dermatology, 2019, 52(2): 77-80.
[13]	Chen Xiufang, Xiao Rong, Zhan Yi, Zhang Guiying. Treatment of Rosai-Dorfman disease [J]. Chinese Journal of Dermatology, 2019, 52(10): 785-788.
[14]	ZAN. Effects of turmeric volatile oil combined with cisplatin on the proliferation and apoptosis of a human cutaneous squamous cell carcinoma cell line A431 and their mechanisms [J]. Chinese Journal of Dermatology, 2018, 51(4): 294-298.
[15]	Xiao-Dong SUN zhihua leon liu runqiu Ping Li Jing Zhang xiao-jian CHEN lingling CHEN Li-Xia XIE. A tumor necrosis factor antagonist in the treatment of severe medicamentosa-like dermatitis induced by trichloroethylene: a clinical observation [J]. Chinese Journal of Dermatology, 2014, 47(4): 243-246.

Expert consensus on the stratified individualized systemic treatment of moderate to severe atopic dermatitis

PDF

Knowledge

Abstract

Cite this article

share this article

References ［49］

Related Articles 15

Metrics

Comments

Recommended 10