Therapeutic Guidelines for Atopic Dermatitis 2002 - Allergology ...

More documents

Recommendations

Info

Furue M et al.Table1 DefinitionandDiagnosticCriteriaforAtopicDermatitisbyTheJapaneseDermatologicalAssociationDefinitionAtopicdermatitisisapruritic,eczematousdermatosis,thesymptomsofwhichchronicalyfluctuatewithremissionsandrelapses.Mostindividualswithatopicdermatitishaveatopicdiathesis.Atopicdiathesis:(1)personalorfamilyhistory(asthma,alergicrhinitisand/orconjunctivitis,andatopicdermatitis),and/or(2)predispositiontooverproductionofimmunoglobulinE(IgE)antibodies.Diagnosis1.Pruritus2.Typicalmorphologyanddistribution:(1)Eczematousdermatitis・Acute lesions: erythema, exudation, papules,vesiculopapules,scalesandcrusts・Chroniclesions:infiltratederythema,lichenification,prurigo,scalesandcrusts(2)Distribution・SymmetricalPredilection sites:forehead,periorbitalarea,perioralarea,lips,periauriculararea,neck,jointareasoflimbs,trunk・Age-relatedcharacteristicsInfantilephase:startsonthescalpandface,oftenspreadstothetrunkandextremitiesChildhoodphase:neck,theflexuralsurfacesofthearmsandlegsAdolescentandadultphase:tendencytobesevereontheupperhalfofthebody(face,neck,anteriorchest,andback)3.Chronicorchronicalyrelapsingcourse(usualycoexistenceofoldandnewlesions):MorethantwomonthsininfancyMorethansixmonthsinchildhood,adolescence,andadulthoodDefinitediagnosisofatopicdermatitisrequiresthepresenceofalthreefeatureswithoutanyconsiderationofseverity.Othercasesshouldbeevaluatedonthebasisoftheclinicalcoursewiththetentativediagnosisofacuteorchronic,nonspecificeczema.DiferentialDiagnosis・Contactdermatitis・Seborheicdermatitis・Prurigosimplex・Scabies・Miliaria・Ichthyosis・Xeroticeczema・Handdermatitis(non-atopic)DiagnosticAids・Familyhistory(bronchialasthma,allergicrhinitisand/orconjunctivitis,atopicdermatitis)・Complications(bronchialasthma,alergicrhinitisand/orconjunctivitis)・Folicularpapules(goose-skin)・Elevatedserum IgElevelClinicalTypes(notapplicabletotheinfantilephase)・Flexuralsurfacetype・Extensorsurfacetype・Dryform inchildhood・Head/face/neck/upperchest/backtype・Prurigotype・Erythrodermatype・CombinationsofvarioustypesarecommonSignificantComplications・Ocular complications (cataracts and/or retinaldetachment):especialyinpatientswithseverefaciallesions・Kaposi’svariceliform eruption・Moluscum contagiosum・Impetigocontagiosaeral scoring systems have been reported for theevaluation of the severity of AD, we herein propose asimple method considering the affected body surfaceareas in order to make it convenient for general physiciansto use (Table 2).TRIGGER AND AGGRAVATING FACTORSBecause trigger and aggravating factors vary amongpatients (Fig. 2), it is necessary to know an individualpatient’s trigger and aggravating factors before recommendingavoidance of any of the known trigger oraggravating factors for AD.SKIN CAREPatients with AD have several functional abnormalitiesof the skin, such as decreased ability of moisture46 Allergology International Vol 54, No1, 2005 www.js-allergol.gr.jp
Therapeutic Guidelines for Atopic Dermatitis 2002DiagnosisEvaluation of SeverityEducation and Avoidance ofTrigger and Aggravating FactorsSkin Care(compensation for the functionalabnormalities of the skin)MedicationsFig.1 PrinciplesfortherapyInfantile(less than 2 years old)Childhood(2 to 12 years old)Adolescence and Adult(13 years old and older)FoodsSweatingEnvironmental factorsBacteria, fungietceteraEnvironmental factorsSweatingBacteria, fungiContact allergensStressFoodsetceteraBecause the trigger and aggravating factors vary among patients, it is important to carefullyelucidate the trigger and aggravating factors before recommending their avoidance.Fig.2 TriggerandAggravatingFactorsTable2 GlobalClinicalSeverityMildModerateSevereVerySevere:Beingcoveredwithmildskinlesions*only,irespectiveofbodysurfaceareaafected:Inflamed skin lesions*covering lessthan10% ofthebodysurface:Inflamed skin lesions covering morethan 10% butless than 30% ofthebodysurface:Inflamed skin lesions covering morethan30% ofthebodysurface*Mildskinlesions:Dryskin,scalingandfainterythema.*Inflamed skin lesions:Lesionswith erythema,papules,erosion,infiltration,lichenification,andsoon.maintenance, decreased threshold of itch sensationand tendencies toward bacterial and viral infections.It is known that these abnormalities are strongly relatedto the development of symptoms and aggravationof dermatitis. Suitable skin care is therefore requiredto compensate for these abnormalities (Table3).MEDICATIONSuitable medication is required to control cutaneousinflammation . Topical steroids and oral antihistamineanti-allergic drugs are the mainstay oftreatment of AD. Figure 3 shows fundamental topicalsteroid therapy according to severity grading in patientsless than 2 years old, 2 to 12 years old, and 13years old or older. Table 4 shows a classification ofthe potency of topical steroids. The following pointsare important for drug treatment. We must select thepotency and vehicle formulation of topical steroids accordingto the patient’s age and distribution andmanifestation of each eruption. We recommend thatgeneral physicians prescribe topical steroids of lowerpotency and smaller volume and for as short a periodof time as possible for facial lesions to reduce the occurrenceof adverse effects. The adverse effects oftopical steroids, such as teleangiectasia and skin atrophy,occur more frequently with longer periods of application.Physicians must monitor the potency anddosage of topical steroids for their patients. 2 If a patientsuddenly stops the application of topical steroids,the eruptions may exacerbate rapidly . Physiciansshould ask their patients to tell them when theyAllergology International Vol 54, No1, 2005 www.js-allergol.gr.jp 47
Page 1: Allergology International. 2005;54:

Therapeutic Guidelines for Atopic Dermatitis 2002 - Allergology ...

Create successful ePaper yourself

Delete template?

Save as template?