Atopik Dermatit
Pınar UYSALa
aAydın Adnan Menderes Üniversitesi Tıp Fakültesi, Çocuk İmmünolojisi ve Alerji Hastalıkları BD, Aydın, TÜRKİYE
Uysal P. Atopik dermatit. Çildağ S, editör. İmmünolojik ve Alerjik Deri Hastalıkları. 1. Baskı. Ankara: Türkiye Klinikleri; 2020. p.29-39.
ÖZET
Atopik dermatit (AD) kronik, kaşıntılı, eritem alanları ile kendini gösteren enflamatuar bir deri hastalığıdır. Atopik dermatit genetik yatkınlık, immün disregülasyon, epidermal bariyer fonksiyon bozukluğu ile ilişkilidir. Prevelansı son on yılda artarak %10-20 arasında değişmektedir. Atopik dermatitte kronik kaşıntı, yaygın cilt kuruluğu ve tipik yerleşimli egzamatöz cilt lezyonları önemli klinik bulgulardır. Tanı klinik olarak konur. Tedavisinde alerjen ve irritanlardan kaçınma, etkili nemlendirici kullanımı, topikal kortikosteroidler, kalsinörin inhibitörleri ve fosfodiesteraz inhibitörleri ile sistemik tedaviler önerilir. Ağır Atopik dermatit alevlenmelerinde ıslak pansuman uygulanabilir. Ağır morbitite ve mortaliteye neden olabilen cilt enfeksiyonları ile uzun dönemde görülebilen nöropsikiatrik bozukluklar ve kardiyovasküler hastalıklar en önemli komplikasyonlardır.
Anahtar Kelimeler: Atopik dermatit; çocuk; erişkin; egzama
Referanslar
- Weiland S, Bjorksten B, Brunekreef B, Cookson Wo, von Mutius E, Strachan DP, et al. International Study of Asthma and Allergies in Childhood Phase II Study Group.Phase II of the International Study of Asthma and Allergies in Childhood (ISAAC II): rationale and methods. Eur Respir j 2004; 24: 406- 12. [Crossref] [PubMed]
- Williams HC, Burney PG, Hay Rj, Archer CB, Shipley Mj, Hunter jj, et al. The U.K. Working Party's Diagnostic Criteria for Atopic Dermatitis. I. Derivation of a minimum set of discriminators for atopic dermatitis. Br j Dermatol. 1994;131:383-96. [Crossref] [PubMed]
- Civelek E, Sahiner UM, Yüksel H, Boz AB, orhan F, Uner A, et al. Prevalence, burden, and risk factors of atopic eczema in school children aged 10-11 years: a national multicenter study. j Investig Allergol Clin Immunol. 2011;21:270-7.
- Brunner PM, Leung DYM, Guttman-Yassky E. Immunologic, microbial, and epithelial interactions in atopic dermatitis. Ann Allergy Asthma Immunol. 2018;120(1):34-41. [Crossref] [PubMed] [PMC]
- Palmer CN, Irvine AD, Terron-Kwiatkowski A, zhao Y, Liao H, et al. Common loss-of-function variants of the epidermal barrier protein Filagrin are a major predisposing factor for atopic dermatitis. Nat Genet. 2006;38(4):441- 6. [Crossref] [PubMed]
- Rodríguez E, Baurecht H, Herberich E, Wagenpfeil S, Brown Sj, Cordell Hj, et al. Metaanalysis of Filagrin polymorphisms in eczema and asthma: robust risk factors in atopic disease. j Allergy Clin Immunol. 2009;123(6): 1361-70. [Crossref] [PubMed]
- Kusunoki T, okafuji I, Yoshioka T, Saito M, Nishikomori R, Heike T, et al. SPINK5 polymorphism is associated with disease severity and food allergy in children with atopic dermatitis. j Allergy Clin Immunol. 2005;115(3): 636-8. [Crossref] [PubMed]
- Løset M, Brown Sj, Saunes M, Hveem K. Genetics of Atopic Dermatitis: From DNA Sequence to Clinical Relevance. Dermatology. 2019;235(5):355-64. [Crossref] [PubMed]
- Bin L, Leung DY. Genetic and epigenetic studies of atopic dermatitis. Allergy Asthma Clin Immunol. 2016;12:52. 10. Sabounchi S, Bollyky j, Nadeau K. Review of environmental ımpact on the epigenetic regulation of atopic diseases. Curr Allergy Asthma Rep. 2015;15(6):33. [Crossref] [PubMed]
- Akdis M. The cellular orchestra in skin allergy; are differences to lung and nose relevant? Curr opin Allergy Clin Immunol. 2010;10(5): 443-51 [Crossref] [PubMed]
- Klonowska j, Gleń j, Nowicki Rj, Trzeciak M. New Cytokines in the Pathogenesis of Atopic Dermatitis-New Therapeutic Targets. Int j Mol Sci. 2018;19(10). [Crossref] [PubMed] [PMC]
- Brunner PM, Leung DYM, Guttman-Yassky E. Immunologic, microbial, and epithelial interactions in atopic dermatitis. Ann Allergy Asthma Immunol. 2018;120(1):34-41. [Crossref] [PubMed] [PMC]
- jariwala SP, Abrams E, Benson A, Fodeman j, zheng T. The role of thymic stromal lymphopoietin in the immunopathogenesis of atopic dermatitis. Clin Exp Allergy. 2011; 41(11):1515-20. [Crossref] [PubMed]
- Yosipovitch G, Berger T, Fassett MS. Neuroimmune interactions in chronic itch of atopic dermatitis. j Eur Acad Dermatol venereol. 2019 Sep 30. [Crossref] [PubMed] [PMC]
- Bieber T, D'Erme AM, Akdis C, Traidl-Hoffmann C, Lauener R, Schäppi G, et al. Clinical phenotypes and endophenotypes of atopic dermatitis: Where are we, and where should we go? j Allergy Clin Immunol. 2017;139:58- 64. [Crossref] [PubMed]
- Muraro A, Lemanske RF, Hellings PW, Akdis CA, Bieber T, Casale TB, et al. Precision medicine in patients with allergic diseases: Airway diseases and atopic dermatitis-PRACTALL document of the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma & Immunology. j Allergy Clin Immunol. 2016;137:1347-58. [Crossref] [PubMed]
- Lowe Aj, Leung DYM, Tang MLK, Su jC, Allen Kj. The skin as a target for prevention of the atopic march. Ann Allergy Asthma Immunol. 2018;120(2):145-51. [Crossref] [PubMed]
- Hanifin jM. Adult-onset atopic dermatitis: fact or fancy? Dermatol Clin. 2017;35:299-302. [Crossref] [PubMed]
- Eichenfield LF, Hanifin jM, Luger TA, Stevens SR, Pride HB. Consensus conference on pediatric atopic dermatitis. j Am Acad Dermatol. 2003;49:1088-95. [Crossref] [PubMed]
- Gu H, Chen xS, Chen K, Yan Y, jing H, Chen xQ, et al. Evaluation of diagnostic criteria for atopic dermatitis: validity of the criteria of Williams et al. in a hospital-based setting. Br j Dermatol. 2001;145:428-33. [Crossref] [PubMed]
- Severity scoring of atopic dermatitis: the SCoRAD index. Consensus Report of the European Task Force on Atopic Dermatitis. Dermatology. 1993;186:23-31. [Crossref] [PubMed]
- Barbier N, Paul C, Luger T, Allen R, De Prost Y, Papp K, et al. validation of the Eczema Area and Severity Index for atopic dermatitis in a cohort of 1550 patients from the pimecrolimus cream 1% randomized controlled clinical trials programme. Br j Dermatol. 2004;150:96-102. [Crossref] [PubMed]
- Sampson HA. The evaluation and management of food allergy in atopic dermatitis. Clin Dermatol. 2003;21:183-92. [Crossref] [PubMed]
- Sastre j. Molecular diagnosis in allergy. Clin Exp Allergy. 2010;40(10):1442-60. [Crossref] [PubMed]
- Wollenberg A, Barbarot S, Bieber T, Christenzaech S, Deleuran M, Fink-Wagner A, et al. European Dermatology Forum (EDF), the European Academy of Dermatology and venereology (EADv), the European Academy of Allergy and Clinical Immunology (EAACI), the European Task Force on Atopic Dermatitis (ETFAD), European Federation of Allergy and Airways Diseases Patients' Associations (EFA), the European Society for Dermatology and Psychiatry (ESDaP), the European Society of Pediatric Dermatology (ESPD), Global Allergy and Asthma European Network (GA2LEN) and the European Union of Medical Specialists (UEMS). Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part I. j Eur Acad Dermatol venereol. 2018;32(5):657-82. [Crossref] [PubMed]
- Matricardi PM, Kleine-Tebbe j, Hoffmann Hj, valenta R, Hilger C, Hofmaier S,et al. EAACI Molecular Allergology User's Guide. Pediatr Allergy Immunol. 2016;27(23):1-250. [Crossref] [PubMed]
- Turjanmaa K, Darsow U, Niggemann B, Rancé F, vanto T, Werfel T. EAACI / GA2LEN position paper: Present status of the atopy patch test. Allergy. 2006;61:1377-84. [Crossref] [PubMed]
- Bergmann MM, Caubet jC, Boguniewicz M, Eigenmann PA. Evaluation of food allergy in patients with atopic dermatitis. j Allergy Clin Immunol Pract. 2013;1(1):22-8. [Crossref] [PubMed]
- Izadi N, Leung DYM. Clinical approach to the patient with refractory atopic dermatitis. Ann Allergy Asthma Immunol. 2018;120(1):23- 33.e1. [Crossref] [PubMed] [PMC]
- Patel N, Feldman SR. Adherence in Atopic Dermatitis. Adv Exp Med Biol. 2017;1027:139- 59. [Crossref] [PubMed]
- Li AW, Yin ES, Antaya Rj. Topical Corticosteroid Phobia in Atopic Dermatitis: A Systematic Review. jAMA Dermatol. 2017;153(10): 1036-42. [Crossref] [PubMed]
- Ring j, Alomar A, Bieber T, Deleuran M, FinkWagner A, Gelmetti C,et al. European Dermatology Forum; European Academy of Dermatology and venereology; European Task Force on Atopic Dermatitis; European Federation of Allergy; European Society of Pediatric Dermatology; Global Allergy and Asthma European Network. Guidelines for treatment of atopic eczema (atopic dermatitis) Part II.j Eur Acad Dermatol venereol. 2012; 26(9):1176-93 [Crossref] [PubMed]
- Draelos zD, Feldman SR, Berman B, olivadoti M, Sierka D, Tallman AM, zielinski MA, Ports WC, Baldwin S. Tolerability of Topical Treatments for Atopic Dermatitis. Dermatol Ther (Heidelb). 2019;9(1):71-102. [Crossref] [PubMed] [PMC]
- Elias PM, Wakefield jS, Man MQ. Moisturizers versus Current and Next-Generation Barrier Repair Therapy for the Management of Atopic Dermatitis.Skin Pharmacol Physiol. 2019;32 (1):1-7 [Crossref] [PubMed]
- Hon KL, Kung jSC, Ng WGG, Leung TF.Emollient treatment of atopic dermatitis: latest evidence and clinical considerations. Drugs Context. 2018;7:212530. [Crossref] [PubMed] [PMC]
- Darsow U, Wollenberg A, Simon D, Taïeb A, Werfel T, oranje A, et al. European Task Force on Atopic Dermatitis/EADv Eczema Task Force. ETFAD/EADv eczema task force 2009 position paper on diagnosis and treatment of atopic dermatitis. j Eur Acad Dermatol venereol. 2010;24(3):317-28 [Crossref] [PubMed]
- Saini S, Pansare M. New Insights and Treatments in Atopic Dermatitis. Pediatr Clin North Am. 2019;66(5):1021-33. [Crossref] [PubMed]
- Eicher L, Knop M, Aszodi N, Senner S, French LE, Wollenberg A. A systematic review of factors influencing treatment adherence in chronic inflammatory skin disease - strategies for optimizing treatment outcome. j Eur Acad Dermatol venereol. 2019;33(12):2253- 63. [Crossref] [PubMed]
- Lynde CW, Bourcier M, Gooderham M, Guenther L, Hong CH, Papp KA, et al. A Treatment Algorithm for Moderate to Severe Atopic Dermatitis in Adults. j Cutan Med Surg. 2018; 22(1):78-83 [Crossref] [PubMed]
- Krakowski AC, Eichenfield LF, Dohil MA. Management of atopic dermatitis in the pediatric population.Pediatrics. 2008;122(4):812- 24. [Crossref] [PubMed]
- Atopik dermatit tanı ve tedavisine yaklaşım: Ulusal rehber 2018. Astım Allerji İmmunol. 2018;16(2):1-95.
- Türkiye atopik dermatit tanı ve tedavi kılavuzu. Turkderm-Turk Arch Dermatol venereology. 2018;52:6-23.
- Luger T, Boguniewicz M, Carr W, Cork M, Deleuran M, Eichenfield L, et al. Pimecrolimus in atopic dermatitis: consensus on safety and the need to allow use in infants.Pediatr Allergy Immunol. 2015;26(4):306-15. [Crossref] [PubMed] [PMC]
- Woo TE, Kuzel P. Crisaborole 2% ointment (Eucrisa) for Atopic Dermatitis. Skin Therapy Lett. 2019;24(2):4-6.
- Nicol NH, Boguniewicz M. Wet Wrap Therapy in Moderate to Severe Atopic Dermatitis.Immunol Allergy Clin North Am. 2017;37(1):123-39. [Crossref] [PubMed]
- Devillers AC, oranje AP. Wet-wrap treatment in children with atopic dermatitis: a practical guideline.Pediatr Dermatol. 2012;29(1):24-7. [Crossref] [PubMed]
- Lowe Aj, Leung DYM, Tang MLK, Su jC, Allen Kj.The skin as a target for prevention of the atopic march. Ann Allergy Asthma Immunol. 2018;120(2):145-51. [Crossref] [PubMed]