特应性皮炎外用制剂合理应用及患者指导专家共识

doi:10.35541/cjd.20210833

Abstract

Abstract: 【Abstract】 Topical agents are main treatments of atopic dermatitis, and there are still many insufficiencies in the application of topical agents and patient education in China. Based on recent Chinese and international relevant guidelines, consensuses and literature, and combined with clinical experience from experts, some experts from Environmental and Occupational Skin Disease Research Group of Committee on Dermatology of Chinese Association of Integrative Medicine, Group on Children of Chinese Society of Dermatology, Committee on Dermatology of Chinese Association of Geriatric Research developed this consensus on the application of topical agents and patient education for atopic dermatitis, aiming to standardize the application of topical agents for atopic dermatitis, improve efficacy and safety, and reduce disease recurrence.

Key words: Dermatitis, atopic, External application drugs, Patient education, Wetting agents, Glucocorticoids, Calcineurin inhibitors, Phosphodiesterase 4 inhibitors, Consensus

Environmental and Occupational Skin Disease Research Group, Committee on Dermatology, Chinese Association of Integrative Medicine, Group on Children, Chinese Society of Dermatology, Committee on Dermatology, Chinese Association of Geriatric Research. Expert consensus on rational application of topical agents and patient education for atopic dermatitis[J]. Chinese Journal of Dermatology, 2022, 55(4): 281-288.doi:10.35541/cjd.20210833

References ［49］

［1］	Jung HJ, Bae JY, Kim JE, et al. Survey of disease awareness, treatment behavior and treatment satisfaction in patients with atopic dermatitis in Korea: a multicenter study ［J］. J Dermatol, 2018,45（10）:1172⁃1180. doi: 10.1111/1346⁃8138.14540.
［2］	Li AW, Yin ES, Antaya RJ. Topical corticosteroid phobia in atopic dermatitis: a systematic review［J］. JAMA Dermatol, 2017,153（10）:1036⁃1042. doi: 10.1001/jamadermatol.2017.2437.
［3］	Li Y, Han T, Li W, et al. Awareness of and phobias about topical corticosteroids in parents of infants with eczema in Hangzhou, China［J］. Pediatr Dermatol, 2018,35（4）:463⁃467. doi: 10.1111/pde.13527.
［4］	Lee MK, Seo JH, Chu H, et al. Current status of patient education in the management of atopic dermatitis in Korea［J］. Yonsei Med J, 2019,60（7）:694⁃699. doi: 10.3349/ymj.2019.60. 7.694.
［5］	Barbarot S, Boralevi F, Shourick J, et al. Characteristics of children and adolescents with atopic dermatitis who attended therapeutic patient education［J］. J Eur Acad Dermatol Venereol, 2021,35（11）:2263⁃2269. doi: 10.1111/jdv.17526.
［6］	Liang Y, Tian J, Shen CP, et al. Therapeutic patient education in children with moderate to severe atopic dermatitis: a multicenter randomized controlled trial in China［J］. Pediatr Dermatol, 2018,35（1）:70⁃75. doi: 10.1111/pde.13362.
［7］	Heratizadeh A, Werfel T, Wollenberg A, et al. Effects of structured patient education in adults with atopic dermatitis: multicenter randomized controlled trial［J］. J Allergy Clin Immunol, 2017,140（3）:845⁃853.e3. doi: 10.1016/j.jaci.2017.01. 029.
［8］	Horimukai K, Morita K, Narita M, et al. Application of moisturizer to neonates prevents development of atopic dermatitis［J］. J Allergy Clin Immunol, 2014,134（4）:824⁃830.e6. doi: 10.1016/j.jaci.2014.07.060.
［9］	Kraft JN, Lynde CW. Moisturizers: what they are and a practical approach to product selection［J］. Skin Therapy Lett, 2005,10（5）:1⁃8.
［10］	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.
［11］	Wollenberg A, Christen⁃Zäch S, Taieb A, et al. ETFAD/EADV Eczema task force 2020 position paper on diagnosis and treatment of atopic dermatitis in adults and children［J］. J Eur Acad Dermatol Venereol, 2020,34（12）:2717⁃2744. doi: 10.1111/ jdv.16892.
［12］	Katoh N, Ohya Y, Ikeda M, et al. Japanese guidelines for atopic dermatitis 2020［J］. Allergol Int, 2020,69（3）:356⁃369. doi: 10. 1016/j.alit.2020.02.006.
［13］	Wollenberg A, Barbarot S, Bieber T, et al. Consensus⁃based European guidelines for treatment of atopic eczema （atopic dermatitis） in adults and children: part I［J］. J Eur Acad Dermatol Venereol, 2018,32（5）:657⁃682. doi: 10.1111/jdv.14891.
［14］	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. 规范外用糖皮质激素类药物专家共识［J］. 中华皮肤科杂志, 2015,48（2）:73⁃75. doi: 10.3760/cma.j.issn.0412⁃4030.2015.02.001.
［15］	申春平, 王华, 王榴慧, 等. 地奈德乳膏与丁酸氢化可的松乳膏治疗婴幼儿特应性皮炎的多中心、随机、平行对照临床研究［J］. 中华皮肤科杂志, 2019,52（1）:11⁃15. doi: 10.3760/cma.j.issn.0412⁃4030.2019.01.003.
［16］	Chi CC, Wang SH, Wojnarowska F, et al. Safety of topical corticosteroids in pregnancy［J］. Cochrane Database Syst Rev, 2015,2015（10）:CD007346. doi: 10.1002/14651858.CD007346.pub3.
［17］	Vestergaard C, Wollenberg A, Barbarot S, et al. European task force on atopic dermatitis position paper: treatment of parental atopic dermatitis during preconception, pregnancy and lactation period［J］. J Eur Acad Dermatol Venereol, 2019,33（9）:1644⁃1659. doi: 10.1111/jdv.15709.
［18］	Long CC, Mills CM, Finlay AY. A practical guide to topical therapy in children［J］. Br J Dermatol, 1998,138（2）:293⁃296. doi: 10.1046/j.1365⁃2133.1998.02077.x.
［19］	Warner MR, Camisa C. Topical corticosteroids［M］//Wolverton SE. Comprehensive dermatologic drug therapy. 3rd ed. New York: Saunders Elsvier, 2013:487⁃504.
［20］	Murphy VL, Patel DC, Lamb SR, et al. Topical corticosteroid allergy: results of sequential testing to a corticosteroid series in New Zealand［J］. Contact Dermatitis, 2021,85（1）:32⁃38. doi: 10.1111/cod.13776.
［21］	Keegel T, Saunders H, Milne R, et al. Topical corticosteroid allergy in an urban Australian centre［J］. Contact Dermatitis, 2004,50（1）:6⁃14. doi: 10.1111/j.0105⁃1873.2004.00275.x.
［22］	Liu L, Ong G. A randomized, open⁃label study to evaluate an intermittent dosing regimen of fluticasone propionate 0.05% cream in combination with regular emollient skin care in reducing the risk of relapse in pediatric patients with stabilized atopic dermatitis［J］. J Dermatolog Treat, 2018,29（5）:501⁃509. doi: 10.1080/09546634.2017.1401211.
［23］	Rubio⁃Gomis E, Martinez⁃Mir I, Morales⁃Olivas FJ, et al. Fluticasone in mild to moderate atopic dermatitis relapse: a randomized controlled trial［J］. Allergol Immunopathol （Madr）, 2018,46（4）:378⁃384. doi: 10.1016/j.aller.2017.12.001.
［24］	Faergemann J, Christensen O, Sjövall P, et al. An open study of efficacy and safety of long⁃term treatment with mometasone furoate fatty cream in the treatment of adult patients with atopic dermatitis［J］. J Eur Acad Dermatol Venereol, 2000,14（5）:393⁃396. doi: 10.1046/j.1468⁃3083.2000.00099.x.
［25］	Fukuie T, Hirakawa S, Narita M, et al. Potential preventive effects of proactive therapy on sensitization in moderate to severe childhood atopic dermatitis: a randomized, investigator⁃blinded, controlled study［J］. J Dermatol, 2016,43（11）:1283⁃1292. doi: 10.1111/1346⁃8138.13408.
［26］	Xu W, Li Y, Chen Z, et al. Wet⁃wrap therapy with halometasone cream for severe adult atopic dermatitis［J］. Postgrad Med, 2018,130（5）:470⁃476. doi: 10.1080/00325481.2018.1478108.
［27］	Chung JG, Cheng H, Croxson M, et al. Topical corticosteroid wet wrap treatment and adrenal suppression: an Auckland perspective［J］. JAAD Int, 2021,5:66⁃68. doi: 10.1016/j.jdin. 2021.08.002.
［28］	Pereira U, Boulais N, Lebonvallet N, et al. Mechanisms of the sensory effects of tacrolimus on the skin［J］. Br J Dermatol, 2010,163（1）:70⁃77. doi: 10.1111/j.1365⁃2133.2010.09757.x.
［29］	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.
［30］	Mandelin JM, Rubins A, Remitz A, et al. Long⁃term efficacy and tolerability of tacrolimus 0.03% ointment in infants:* a two⁃year open⁃label study［J］. Int J Dermatol, 2012,51（1）:104⁃110. doi: 10.1111/j.1365⁃4632.2011.05015.x.
［31］	孔祥君, 卢桂玲, 聂振华. 0.1%他克莫司软膏外用致Kaposi水痘样疹1例［J］. 中国麻风皮肤病杂志, 2014,30（1）:49⁃51.
［32］	Lerbaek A, Agner T. Facial eruption of molluscum contagiosum during topical treatment of atopic dermatitis with tacrolimus［J］. Br J Dermatol, 2004,150（6）:1210⁃1211. doi: 10.1111/j.1365⁃2133.2004.06008.x.
［33］	Crawford KM, Bostrom P, Russ B, et al. Pimecrolimus⁃induced tinea incognito［J］. Skinmed, 2004,3（6）:352⁃353. doi: 10.1111/j.1540⁃9740.2004.03796.x.
［34］	Lam M, Zhu JW, Tadrous M, et al. Association between topical calcineurin inhibitor use and risk of cancer, including lymphoma, keratinocyte carcinoma, and melanoma: a systematic review and meta⁃analysis ［J］. JAMA Dermatol, 2021,157（5）:549⁃558. doi: 10.1001/jamadermatol.2021.0345.
［35］	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.
［36］	Paller AS, Fölster⁃Holst R, Chen SC, et al. No evidence of increased cancer incidence in children using topical tacrolimus for atopic dermatitis［J］. J Am Acad Dermatol, 2020,83（2）:375⁃381. doi: 10.1016/j.jaad.2020.03.075.
［37］	Thaci D, Chambers C, Sidhu M, et al. Twice⁃weekly treatment with tacrolimus 0.03% ointment in children with atopic dermatitis: clinical efficacy and economic impact over 12 months［J］. J Eur Acad Dermatol Venereol, 2010,24（9）:1040⁃1046. doi: 10.1111/j.1468⁃3083.2010.03577.x.
［38］	Wollenberg A, Reitamo S, Atzori F, et al. Proactive treatment of atopic dermatitis in adults with 0.1% tacrolimus ointment［J］. Allergy, 2008,63（6）:742⁃750. doi: 10.1111/j.1398⁃9995.2008. 01683.x.
［39］	Schlessinger J, Shepard JS, Gower R, et al. Safety, effectiveness, and pharmacokinetics of crisaborole in infants aged 3 to < 24 months with mild⁃to⁃moderate atopic dermatitis: a phase IV open⁃label study （CrisADe CARE 1）［J］. Am J Clin Dermatol, 2020,21（2）:275⁃284. doi: 10.1007/s40257⁃020⁃00510⁃6.
［40］	Callender VD, Alexis AF, Stein Gold LF, et al. Efficacy and safety of crisaborole ointment, 2%, for the treatment of mild⁃to⁃moderate atopic dermatitis across racial and ethnic groups［J］. Am J Clin Dermatol, 2019,20（5）:711⁃723. doi: 10.1007/s40257⁃019⁃00450⁃w.
［41］	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.e5. doi: 10.1016/j.jaad.2017.06.010.
［42］	Bissonnette R, Papp KA, Poulin Y, et al. Topical tofacitinib for atopic dermatitis: a phase IIa randomized trial［J］. Br J Dermatol, 2016,175（5）:902⁃911. doi: 10.1111/bjd.14871.
［43］	Papp K, Szepietowski JC, Kircik L, et al. Efficacy and safety of ruxolitinib cream for the treatment of atopic dermatitis: results from 2 phase 3, randomized, double⁃blind studies［J］. J Am Acad Dermatol, 2021,85（4）:863⁃872. doi: 10.1016/j.jaad.2021. 04.085.
［44］	Nakagawa H, Nemoto O, Igarashi A, et al. Long⁃term safety and efficacy of delgocitinib ointment, a topical Janus kinase inhibitor, in adult patients with atopic dermatitis［J］. J Dermatol, 2020,47（2）:114⁃120. doi: 10.1111/1346⁃8138.15173.
［45］	Nakagawa H, Nemoto O, Igarashi A, et al. Delgocitinib ointment in pediatric patients with atopic dermatitis: a phase 3, randomized, double⁃blind, vehicle⁃controlled study and a subsequent open⁃label, long⁃term study［J］. J Am Acad Dermatol, 2021,85（4）:854⁃862. doi: 10.1016/j.jaad.2021.06.014.
［46］	Peppers J, Paller AS, Maeda⁃Chubachi T, et al. A phase 2, randomized dose⁃finding study of tapinarof （GSK2894512 cream） for the treatment of atopic dermatitis［J］. J Am Acad Dermatol, 2019,80（1）:89⁃98.e3. doi: 10.1016/j.jaad.2018.06. 047.
［47］	陈旭, 鞠梅, 俞晨, 等. 复方多粘菌素B软膏联合地奈德乳膏治疗亚急性/慢性湿疹的多中心、随机、双盲、平行对照临床研究［J］. 中华皮肤科杂志, 2016,49（8）:541⁃546. doi: 10.3760/cma.j.issn.0412⁃4030.2016.08.004.
［48］	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. 外用中成药治疗湿疹皮炎的专家共识（2014）［J］. 中华皮肤科杂志, 2014,47（6）:440⁃441. doi: 10.3760/cma.j.issn.0412⁃4030.2014.06.023.
［49］	Juntongjin P, Pongprasert R. Calcipotriol ointment shows comparable efficacy to topical steroids in chronic hand eczema［J］. Dermatol Ther, 2019,32（4）:e12956. doi: 10.1111/dth.12956.

[1]	LIN Neng-xing, ZHANG Li-xia, HUANG Chang-zheng, CHEN Hong-xiang, TU Ya-ting. The Mutation of IR Gene in the mtr System and Multiple Antibiotic Resistance of Neisseria gonorrhoeae[J]. Chinese Journal of Dermatology, 2005, 38(12): 719 -721 .
[2]	. [J]. Chinese Journal of Dermatology, 2005, 38(12): 765 .
[3]	刘玮, 王学民, 赖维, 李利, 张萍, 吴琰瑜, 吕瑛, 李艳, 田燕, 吴艳, 陈力. [J]. Chinese Journal of Dermatology, 2005, 38(12): 772 -773 .
[4]	. [J]. Chinese Journal of Dermatology, 2005, 38(12): 721 .
[5]	. [J]. Chinese Journal of Dermatology, 2005, 38(12): 734 .
[6]	. [J]. Chinese Journal of Dermatology, 2005, 38(12): 744 .
[7]	. [J]. Chinese Journal of Dermatology, 2005, 38(12): 774 .
[8]	李靖华, 周晓鸿. [J]. Chinese Journal of Dermatology, 2005, 38(12): 775 .
[9]	YIN He-hui, LIAO Wen-jun, GAO Ying, GAO Tian-wen. Expression of β-Catenin and LEF-1 in Malignant Melanoma[J]. Chinese Journal of Dermatology, 2005, 38(11): 665 -667 .
[10]	CHEN Hong-xiang, LIN Neng-xing, HUANG Chang-zheng, LI Jia-wen, LIU Hou-jun, TU Ya-ting. Construction of a Prokaryotic Expression Plasmid Encoding the mtrC Gene of N.gonorrhoeae and Its Expression in E.coli[J]. Chinese Journal of Dermatology, 2005, 38(11): 674 -676 .

[1]	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.
[2]	Environmental and Occupational Skin Disease Research Group, Committee on Dermatology, Chinese Association of Integrative Medicine, Group on Children, Chinese Society of Dermatology. Expert consensus on clinical application of wet-wrap therapy for atopic dermatitis [J]. Chinese Journal of Dermatology, 2022, 55(4): 289-294.
[3]	Writing committee expert group on “diagnosis and treatment of pustular psoriasis: a Chinese expert consensus statement”. Diagnosis and treatment of pustular psoriasis: a Chinese expert consensus statement （2022） [J]. Chinese Journal of Dermatology, 2022, 55(3): 187-195.
[4]	Li Yan, Li Ming, Xu Wei, Li Linfeng. Efficacy of fluticasone propionate cream alone or in combination with calcipotriol ointment in the treatment of mild to moderate plaque psoriasis: a randomized self-controlled study [J]. Chinese Journal of Dermatology, 2022, 55(3): 260-263.
[5]	Chinese Society of Dermatology, China Dermatologist Association. Consensus on the diagnosis and treatment of autoimmune subepidermal bullous diseases （2022） [J]. Chinese Journal of Dermatology, 2022, 55(1): 1-11.
[6]	Autoimmune Disease Group, China Dermatologist Association. Chinese expert consensus on cyclophosphamide for the treatment of autoimmune dermatoses [J]. Chinese Journal of Dermatology, 2021, 54(9): 765-770.
[7]	Skin Tumor Research Center, Chinese Society of Dermatology, Subcommittee on Skin Tumor, China Dermatologist Association. Expert consensus on diagnosis and treatment of cutaneous basal cell carcinoma （2021） [J]. Chinese Journal of Dermatology, 2021, 54(9): 757-764.
[8]	Skin Tumor Research Center, Chinese Society of Dermatology, Subcommittee on Skin Tumor, China Dermatologist Association. Consensus on diagnosis and treatment of cutaneous squamous cell carcinoma （2021） [J]. Chinese Journal of Dermatology, 2021, 54(8): 653-664.
[9]	Committee on Autoimmune Diseases, China Dermatologist Association. Expert consensus on methotrexate in the treatment of immune-associated dermatoses [J]. Chinese Journal of Dermatology, 2021, 54(5): 382-390.
[10]	Dermatology Branch of China International Exchange and Promotion Association for Medical and Healthcare. Expert consensus on the diagnosis and treatment of vulvar lichen sclerosus [J]. Chinese Journal of Dermatology, 2021, 54(5): 371-375.
[11]	Committee on Allergic Diseases, China Dermatologist Association, Atopic Dermatitis Research Center, Chinese Society of Dermatology, Dermatology Branch of China International Exchange and Promotion Association for Medical and Healthcare. Expert consensus for management of itch in atopic dermatitis [J]. Chinese Journal of Dermatology, 2021, 54(5): 391-396.
[12]	Adverse Drug Reaction Research Center of Chinese Society of Dermatology. Expert consensus on the diagnosis and treatment of Stevens-Johnson syndrome/toxic epidermal necrolysis [J]. Chinese Journal of Dermatology, 2021, 54(5): 376-381.
[13]	Xie Bo, Wei Xiaodong, Xu Ai′e, Lin Fuquan, Zhou Miaoni. Efficacy of systemic glucocorticoid treatment and its related factors in patients with progressive vitiligo [J]. Chinese Journal of Dermatology, 2021, 54(2): 139-144.
[14]	Pigmentary Disorder Group, Combination of Traditional and Western Medicine Dermatology. Consensus on the diagnosis and treatment of vitiligo （2021 version） [J]. Chinese Journal of Dermatology, 2021, 54(2): 105-109.
[15]	Consensus Writing Group on the Diagnosis and Treatment of Acne Inversa/Hidradenitis Suppurativa in China. Diagnosis and treatment of acne inversa/hidradenitis suppurativa in China: an expert consensus statement （2021 version） [J]. Chinese Journal of Dermatology, 2021, 54(2): 97-104.

Expert consensus on rational application of topical agents and patient education for atopic dermatitis

PDF

Knowledge

Abstract

Cite this article

share this article

References ［49］

Related Articles 15

Metrics

Comments

Recommended 10