Atopic Dermatitis Epidemiology and Pathogenesis Update

特应性皮炎的流行病学和发病机理

AtopicDermatitis:

EpidemiologyandPathogenesisUpdate

LawrenceF.Eichen eld,MD,*CharlesN.Ellis,MD,

AnthonyJ.Mancini,MD, AmyS.Paller,MD,§andEricL.Simpson,MD,MCR

Theprevalenceofatopicdermatitis(AD)hasincreasedmarkedlyintheUnitedStatesoverthepast5decades,withcurrentreportsvaryingfrom10%to20%prevalenceinUSchildren,andnewdiagnosesareestimatedatalmost11%peryear.RecentresearchinADpathophysiologyandpathogenesishasdemonstratedthatADisassociatedwithepidermalbarrierdysfunctionandthatmutationsinthe laggringeneareimplicatedinbarrierdefects.ThesediscoveriesholdpromiseforfuturebreakthroughsinthediagnosisandmanagementofAD.

SeminCutanMedSurg31(suppl3):S3-S5©2012PublishedbyElsevierInc.

KEYWORDSatopicdermatitispathogenesis,barrierdefects,epidermalskinbarrier, laggringene

orldwide,theprevalenceofatopicdermatitis(AD)hasincreasedapproximatelythreefoldsincethe1960s.IntheUnitedStates,thereportedprevalenceofADcurrentlyrangesfrom10%to20%ofchildren.InarecentstudyofUSchildren17yearsofageoryoungerderivedfromNationalSurgeryofChildren’sHealthdatafrom2003,Shawandcol-leagues1reporteda10.7%prevalenceofnewdiagnosesofAD

*ProfessorofClinicalPediatricsandMedicine(Dermatology),Chief,Pedi-atricandAdolescentDermatology,UniversityofCalifornia,SanDiegoSchoolofMedicine,RadyChildren’sHospital,SanDiego,CA.

ProfessorofClinicalDermatology,AssociateChair,DepartmentofDerma-tology,UniversityofMichiganMedicalCenter,AnnArbor,MI.

ProfessorofPediatricsandDermatology,NorthwesternUniversityFein-bergSchoolofMedicine,andHead,DivisionofPediatricDermatology,Ann&RobertH.LurieChildren’sHospital,Chicago,IL.

§WalterJ.Hamlin,ProfessorandChair,DepartmentofDermatology,Pro-fessorofPediatrics,NorthwesternUniversityFeinbergSchoolofMedi-cine,AttendingPhysician,Ann&RobertLurieChildren’sHospitalofChicago,Chicago,IL.

AssociateProfessorofDermatologyandDirectorofClinicalStudies,OregonHealthandScienceUniversity,Portland,OR.

PublicationofthisCMEarticlewasjointlysponsoredbytheUniversityofLouisvilleContinuingHealthSciencesEducationandGlobalAcademyforMedicalEducationLLCinaf liationwithSkinDiseaseEducationFoundationandissupportedbyaneducationalgrantfromValeantPharmaceuticalsNorthAmericaInc.

ThefacultyhavereceivedanhonorariumfromGlobalAcademyforMedicalEducationfortheirparticipationinthisactivity.TheyacknowledgetheeditorialassistanceofJoanneStill,medicalwriter,andGlobalAcademyforMedicalEducationinthedevelopmentofthiscontinuingmedicaleducationjournalarticle.JoanneStillhasnorelevant nancialrelation-shipswithanycommercialinterests.

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oreczemawithinthepreviousyear.(TheseprevalencedatafromthestudybyShawetalaresimilartothosereportedinpreviousstudiesinvolvingsmallerUSpopulations.2-4)

OfadditionalinterestaretwoobservationsfromthestudybyShawetal.1Oneisthattheprevalenceratesrangedfrom8.7%to18.1%fromstatetostate,withahigherprevalencealongtheEastcoaststatesandinNevada,Utah,andIdaho.Theotherobservationisthatsigni cantlyhigherdiseaseprevalencewasassociatedwithmetropolitanliving(P 0.008),blackrace(P 0.005),andeducationlevelsinthehouseholdgreaterthanhighschool(P 0.004).Thesedataclearlysuggestthatsocialorenvironmentalfactorscanaffect

LawrenceF.Eichen eld,MD,hasservedasaconsultantforAnacor,Bayer,andOnsetTherapeuticsandasaspeakerandconsultantforValeant.HehasalsobeenaninvestigatorandconsultantforGaldermaandLeoPharmaaswellasaninvestigatorforAmgen,AstellasPharmaUS,andStiefel,AGSKCompany.

CharlesN.Ellis,MD,hasservedasaconsultantforGaldermaFerndaleLaboratories,Medicis,andNovartis.

AnthonyJ.Mancini,MD,hasservedasaconsultantforQuinnovaandValeantaswellasaspeakerandconsultantforGalderma.

AmyS.Paller,MD,hasreceivedgrantresearchsupportfromAstellas.

EricL.Simpson,MD,MCR,hasservedasaconsultant,investigator,andspeakerforGalderma.

Addressreprintrequeststo:LawrenceF.Eichen eld,MD,ProfessorofClin-icalPediatricsandMedicine(Dermatology),Chief,PediatricandAdo-lescentDermatology,UniversityofCalifornia,SanDiegoSchoolofMed-icine,RadyChildren’sHospital,8010FrostStreet,Suite602,SanDiego,CA92123,Telephone:858-966-6795,x4825,Fax:858-966-4040,E-mail:

leichen eld@

1085-5629/12/$-seefrontmatter©2012PublishedbyElsevierInc./10.1016/j.sder.2012.07.002

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