On the occasion of Children's Day, Professor Yao Zhirong, director of the Department of Dermatology, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, called for attention to a disease that often occurs in early life and causes many physical and psychological problems, namely childhood atopic dermatitis ( AD).
"Atopic dermatitis is the No. 1 disease in dermatology, and it is also the skin disease with the No. 1 disease burden among non-fatal diseases." Yao Zhirong said, "It is generally believed that 60% of the onset occurs before the age of 1, and our study found that 90% Onset before age 1."
Children's skin is delicate and the skin barrier is weak. As the "No. 1" disease in dermatology, atopic dermatitis (AD) is a systemic immune disease caused by type 2 inflammatory response, with recurrent severe itching and rash as the main clinical manifestations. It used to be simply described as "eczema" ".
Previous data showed that the prevalence in childhood is higher than that of adults and adolescents, and the proportion of moderate to severe patients is about 40%. 85%-90% of patients with atopic dermatitis are younger than 5 years old when symptoms or onset occur, and most children. The patient has not received effective treatment and has been poorly controlled for a long time, which seriously affects the physical and mental development and healthy growth of the child, and also brings a heavy burden to his family.
The immune mechanism of type 2 inflammation in atopic dermatitis determines that this is a systemic disease manifested by skin lesions, and is the first disease in the allergic process of "skin-digestive tract-respiratory tract", and will suffer from other type 2 inflammatory diseases in the future. There is also an increased risk of comorbidities (food allergies, allergic rhinitis and allergic asthma, etc.).
At the same time, it should be noted that children are in a critical period of growth and development. Therefore, the clinical community generally believes that it is particularly important to choose treatment and do long-term management on the basis of comprehensive consideration of efficacy and safety, so as to avoid future comorbidities as much as possible.
Yao Zhirong emphasized that as a chronic disease, early intervention and long-term standardized treatment of atopic dermatitis can help reduce recurrence and aggravation, reduce the risk of type 2 inflammatory comorbidity, and improve the quality of life.
In an interview with The Paper (www.thepaper.cn), he said that there are currently many international studies on the treatment of atopic dermatitis, and the treatment plan is relatively mature, the so-called step-by-step treatment plan. "First, some moderate-to-mild atopic dermatitis, if the rash is not very severe, can be relieved by health care, such as the correct way of bathing, through emollients, most of them can be relieved; second, mild to moderate atopic dermatitis Yes, for atopic dermatitis with rash, topical hormones, including non-hormonal anti-inflammatory preparations, are sometimes used, and most of them can be relieved; third, for moderate-to-severe atopic dermatitis, on the basis of these Intensive treatment, including topical medium and strong hormone treatment, and even ultraviolet treatment." In addition, Yao Zhirong mentioned that if the above treatment methods are not enough, biological agents and immunosuppressive drugs will be used for treatment.
In general, the current treatments for atopic dermatitis mainly include topical glucocorticoids or calcineurin inhibitors, oral antihistamines, and biological agents. At the same time, pediatric patients need to pay special attention to the adverse reactions and tolerance of drugs during treatment, and choose a step-by-step treatment plan according to the severity of the patient's condition, and comprehensively consider the patient's situation when formulating treatment methods.
Yao Zhirong introduced that interleukin 4 (IL-4) and interleukin 13 (IL-13) are the main key cytokines that induce type 2 inflammatory response. The treatment of atopic dermatitis requires precise targeting of key pathogenic factors in type 2 inflammation. "Targeted biological agents are characterized by precise inhibition of type 2 inflammatory response, without inhibiting the normal immune system of the human body, and without affecting the growth and development of children, which is of great significance for long-term disease control and improvement of quality of life."
It is also worth noting that the COVID-19 pandemic has brought challenges to the management and treatment of children with atopic dermatitis. Yao Zhirong mentioned that during the epidemic at home, we will frequently use alcohol, disinfectants or detergents, and the allergens or chemical components in them may irritate children's skin, which will undoubtedly lead to damage to the skin barrier and induce or aggravate skin inflammation. In addition, changes in lifestyle, such as irregular work and rest, can also lead to repeated episodes of the disease. Severe itching reduces the quality of the child's sleep, which affects the child's mood, learning and life, and causes the child's parents to sleep as a result. Insufficient and mentally stressed.
Yao Zhirong suggested that it is very important to adhere to long-term standardized treatment of atopic dermatitis. Child patients should insist on self-management during the special period of the epidemic, and do not stop and stop taking medicines on their own. For patients who face the problem of "difficulty in seeking medical treatment", parents can conveniently consult and consult through multiple channels such as Internet remote diagnosis and treatment, hospitals and pharmacies, and choose suitable drugs under the doctor's advice, such as topical glucocorticoids, biological preparations, etc.
"For general mild patients, we can give patients some help through online consultation. Then for some patients with moderate to severe atopic dermatitis, if the topical hormones are not well controlled, they still need to go to the hospital for offline treatment as much as possible. " Yao Zhirong said.
He also reminded that during the epidemic, patients with atopic dermatitis should strengthen self-health management, maintain a balanced diet, strengthen skin moisturizing, maintain a regular life and rest, and a positive and optimistic attitude in order to better control symptoms and reduce recurrence. Get back to a healthy life early.
"Atopic dermatitis is the No. 1 disease in dermatology, and it is also the skin disease with the No. 1 disease burden among non-fatal diseases." Yao Zhirong said, "It is generally believed that 60% of the onset occurs before the age of 1, and our study found that 90% Onset before age 1."
Children's skin is delicate and the skin barrier is weak. As the "No. 1" disease in dermatology, atopic dermatitis (AD) is a systemic immune disease caused by type 2 inflammatory response, with recurrent severe itching and rash as the main clinical manifestations. It used to be simply described as "eczema" ".
Previous data showed that the prevalence in childhood is higher than that of adults and adolescents, and the proportion of moderate to severe patients is about 40%. 85%-90% of patients with atopic dermatitis are younger than 5 years old when symptoms or onset occur, and most children. The patient has not received effective treatment and has been poorly controlled for a long time, which seriously affects the physical and mental development and healthy growth of the child, and also brings a heavy burden to his family.
The immune mechanism of type 2 inflammation in atopic dermatitis determines that this is a systemic disease manifested by skin lesions, and is the first disease in the allergic process of "skin-digestive tract-respiratory tract", and will suffer from other type 2 inflammatory diseases in the future. There is also an increased risk of comorbidities (food allergies, allergic rhinitis and allergic asthma, etc.).
At the same time, it should be noted that children are in a critical period of growth and development. Therefore, the clinical community generally believes that it is particularly important to choose treatment and do long-term management on the basis of comprehensive consideration of efficacy and safety, so as to avoid future comorbidities as much as possible.
Yao Zhirong emphasized that as a chronic disease, early intervention and long-term standardized treatment of atopic dermatitis can help reduce recurrence and aggravation, reduce the risk of type 2 inflammatory comorbidity, and improve the quality of life.
In an interview with The Paper (www.thepaper.cn), he said that there are currently many international studies on the treatment of atopic dermatitis, and the treatment plan is relatively mature, the so-called step-by-step treatment plan. "First, some moderate-to-mild atopic dermatitis, if the rash is not very severe, can be relieved by health care, such as the correct way of bathing, through emollients, most of them can be relieved; second, mild to moderate atopic dermatitis Yes, for atopic dermatitis with rash, topical hormones, including non-hormonal anti-inflammatory preparations, are sometimes used, and most of them can be relieved; third, for moderate-to-severe atopic dermatitis, on the basis of these Intensive treatment, including topical medium and strong hormone treatment, and even ultraviolet treatment." In addition, Yao Zhirong mentioned that if the above treatment methods are not enough, biological agents and immunosuppressive drugs will be used for treatment.
In general, the current treatments for atopic dermatitis mainly include topical glucocorticoids or calcineurin inhibitors, oral antihistamines, and biological agents. At the same time, pediatric patients need to pay special attention to the adverse reactions and tolerance of drugs during treatment, and choose a step-by-step treatment plan according to the severity of the patient's condition, and comprehensively consider the patient's situation when formulating treatment methods.
Yao Zhirong introduced that interleukin 4 (IL-4) and interleukin 13 (IL-13) are the main key cytokines that induce type 2 inflammatory response. The treatment of atopic dermatitis requires precise targeting of key pathogenic factors in type 2 inflammation. "Targeted biological agents are characterized by precise inhibition of type 2 inflammatory response, without inhibiting the normal immune system of the human body, and without affecting the growth and development of children, which is of great significance for long-term disease control and improvement of quality of life."
It is also worth noting that the COVID-19 pandemic has brought challenges to the management and treatment of children with atopic dermatitis. Yao Zhirong mentioned that during the epidemic at home, we will frequently use alcohol, disinfectants or detergents, and the allergens or chemical components in them may irritate children's skin, which will undoubtedly lead to damage to the skin barrier and induce or aggravate skin inflammation. In addition, changes in lifestyle, such as irregular work and rest, can also lead to repeated episodes of the disease. Severe itching reduces the quality of the child's sleep, which affects the child's mood, learning and life, and causes the child's parents to sleep as a result. Insufficient and mentally stressed.
Yao Zhirong suggested that it is very important to adhere to long-term standardized treatment of atopic dermatitis. Child patients should insist on self-management during the special period of the epidemic, and do not stop and stop taking medicines on their own. For patients who face the problem of "difficulty in seeking medical treatment", parents can conveniently consult and consult through multiple channels such as Internet remote diagnosis and treatment, hospitals and pharmacies, and choose suitable drugs under the doctor's advice, such as topical glucocorticoids, biological preparations, etc.
"For general mild patients, we can give patients some help through online consultation. Then for some patients with moderate to severe atopic dermatitis, if the topical hormones are not well controlled, they still need to go to the hospital for offline treatment as much as possible. " Yao Zhirong said.
He also reminded that during the epidemic, patients with atopic dermatitis should strengthen self-health management, maintain a balanced diet, strengthen skin moisturizing, maintain a regular life and rest, and a positive and optimistic attitude in order to better control symptoms and reduce recurrence. Get back to a healthy life early.
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