소아 아토피피부염의 최신 치료 = Update on management of pediatric atopic dermatitis

다국어 초록 (Multilingual Abstract)

Atopic dermatitis is the most common chronic inflammatory skin disease in children. It usually develops in infancy and early childhood and is an entry point of ‘atopic march’, which may progress to other allergic diseases, including allergic rhinitis and asthma. Although there is no disagreement on the importance of early treatment of atopic dermatitis, it is difficult to treat children with moderate to severe atopic dermatitis due to concerns about treatment-related side effects and age restrictions for effective drugs in real world. As recent researches have extend our understanding of pathogenesis, new agents targeted key pathologic mechanisms have been developed. Therefore, it is time to establish a new paradigm of treatment for children with atopic dermatitis since new biologics have been demonstrated to be effective and safe in children. The objective of this article is to review the clinical characteristics, severity classification, pathogenesis, and treatment, in particular, biologics already approved/undergoing clinical trials for children with atopic dermatitis. (Allergy Asthma Respir Dis 2021;9:59-68)

참고문헌 (Reference)

1 조중범, "아토피피부염의 중증도 변화에 따른 삶의 질 변화" 대한 소아알레르기 호흡기학회 22 (22): 86-99, 2012

2 Leshem YA, "What the Eczema Area and Severity Index score tells us about the severity of atopic dermatitis : an interpretability study" 172 : 1353-1357, 2015

3 Kabashima K, "Trial of nemolizumab and topical agents for atopic dermatitis with pruritus" 383 : 141-150, 2020

4 Silverberg JI, "Tralokinumab plus topical corticosteroids for the treatment of moderate-to-severe atopic dermatitis : results from the double-blind, randomized, multicentre, placebo-controlled phase III ECZTRA 3 trial" 184 : 450-463, 2021

5 Ali MA, "Topical steroid therapy induces pro-tolerogenic changes in Langerhans cells in human skin" 146 : 411-422, 2015

6 Brunner PM, "The immunology of atopic dermatitis and its reversibility with broad–spectrum and targeted therapies" 139 : 65-76, 2017

7 Caproni M, "The comparative effects of tacrolimus and hydrocortisone in adult atopic dermatitis : an immunohistochemical study" 156 : 312-319, 2007

8 Simpson EL, "Tezepelumab, an anti-thymic stromal lymphopoietin monoclonal antibody, in the treatment of moderate to severe atopic dermatitis : a randomized phase 2a clinical trial" 80 : 1013-1021, 2019

9 Doreen Siegels, "Systemic treatments in the management of atopic dermatitis: A systematic review and meta‐analysis" Wiley 76 (76): 1053-1076, 2021

10 Chopra R, "Severity strata for Eczema Area and Severity Index(EASI), modified EASI, Scoring Atopic Dermatitis(SCORAD), objective SCORAD, Atopic Dermatitis Severity Index and body surface area in adolescents and adults with atopic dermatitis" 177 : 1316-1321, 2017

11 Park YM, "Risk factors of atopic dermatitis in Korean schoolchildren : 2010 international study of asthma and allergies in childhood" 34 : 65-72, 2016

12 Feldmann RJ, "Regional variation in percutaneous penetration of 14C cortisol in man" 48 : 181-183, 1967

13 Oranje AP, "Practical issues on interpretation of scoring atopic dermatitis : the SCORAD index, objective SCORAD and the three-item severity score" 157 : 645-648, 2007

14 Korean Academy of Pediatric Allergy and Respiratory Disease, "Pediatric allergy pulmonology & immunology" Yeomungak 191-219, 2013

15 Caufield M, "Oral azathioprine for recalcitrant pediatric atopic dermatitis : clinical response and thiopurine monitoring" 68 : 29-35, 2013

16 Czarnowicki T, "Novel concepts of prevention and treatment of atopic dermatitis through barrier and immune manipulations with implications for the atopic march" 139 : 1723-1734, 2017

17 Phan K, "Mycophenolate mofetil and atopic dermatitis : systematic review and meta-analysis" 31 : 810-814, 2020

18 Barnes PJ, "Molecular mechanisms of corticosteroids in allergic diseases" 56 : 928-936, 2001

19 El-Khalawany MA, "Methotrexate versus cyclosporine in the treatment of severe atopic dermatitis in children : a multicenter experience from Egypt" 172 : 351-356, 2013

20 Nakahara T, "Mechanistic insights into topical tacrolimus for the treatment of atopic dermatitis" 29 : 233-238, 2018

21 Remitz A, "Long-term safety and efficacy of tacrolimus ointment for the treatment of atopic dermatitis in children" 87 : 54-61, 2007

22 Katoh N, "Japanese guidelines for atopic dermatitis 2020" 69 : 356-369, 2020

23 Korea Centers for Disease Control and Prevention (KCDC), "Investigation of the reference ranges of respiratory and allergic diseases test based on disease diagnosis in nationwide randomized general pediatric population" KCDC 2015

24 Fujita H, "Human Langerhans cells induce distinct IL-22-producing CD4þ T cells lacking IL-17 production" 106 : 21795-21800, 2009

25 Korean Academy of Pediatric Allergy and Respiratory Disease, "Guideline for pediatric atopic dermatitis" Gwangmun 17-30, 2008

26 Guttman-Yassky E, "GBR 830, an anti-OX40, improves skin gene signatures and clinical scores in patients with atopic dermatitis Recent clinical trials of new biologics for moderate to severe atopic dermatitis" 144 : 482-493, 2019

27 Boguniewicz M, "Expert perspectives on management of moderate-to-severe atopic dermatitis : a multidisciplinary consensus addressing current and emerging therapies" 5 : 1519-1531, 2017

28 Guttman-Yassky E, "Efficacy and safety of lebrikizumab, a high-affinity interleukin 13 inhibitor, in adults with moderate to severe atopic dermatitis : a phase 2b randomized clinical trial" 156 : 411-420, 2020

29 Paller AS, "Efficacy and safety of dupilumab with concomitant topical corticosteroids in children 6 to 11 years old with severe atopic dermatitis : a randomized, double-blinded, placebo-controlled phase 3 trial" 83 : 1282-1292, 2020

30 Simpson EL, "Efficacy and safety of abrocitinib in adults and adolescents with moderate-to-severe atopic dermatitis(JADE MONO-1) : a multicentre, double-blind, randomised, placebo-controlled, phase 3 trial" 396 : 255-266, 2020

31 Wollenberg A, "ETFAD/EADV Eczema task force 2020 position paper on diagnosis and treatment of atopic dermatitis in adults and children" 34 : 2717-2744, 2020

32 Hanifin JM, "Diagnostic features of atopic dermatitis" 92 : 44-47, 1980

33 Szegedi K, "Cytokine profiles in interstitial fluid from chronic atopic dermatitis skin" 29 : 2136-2144, 2015

34 Schmitt J, "Cyclosporin in the treatment of patients with atopic eczema-a systematic review and meta-analysis" 21 : 606-619, 2007

35 Harper JI, "Cyclosporin for severe childhood atopic dermatitis : short course versus continuous therapy" 142 : 52-58, 2000

36 염혜영, "Current Management of Moderate-to-Severe Atopic Dermatitis: A Survey of Allergists, Pediatric Allergists and Dermatologists in Korea" 대한천식알레르기학회 10 (10): 253-259, 2018

37 Fahrbach K, "Crisaborole ointment, 2%, for treatment of patients with mild-to-moderate atopic dermatitis : systematic literature review and network meta-analysis" 10 : 681-694, 2020

38 Wollenberg A, "Consensus-based European guidelines for treatment of atopic eczema(atopic dermatitis)in adults and children : part II" 32 : 850-878, 2018

39 Wollenberg A, "Consensus-based European guidelines for treatment of atopic eczema(atopic dermatitis)in adults and children : part I" 32 : 657-682, 2018

40 Eichenfield LF, "Consensus conference on pediatric atopic dermatitis" 49 : 1088-1095, 2003

41 김정은, "Consensus Guidelines for the Treatment of Atopic Dermatitis in Korea (Part I): General Management and Topical Treatment" 대한피부과학회 27 (27): 563-577, 2015

42 Glass CK, "Combinatorial roles of nuclear receptors in inflammation and immunity" 6 : 44-55, 2006

43 Thijs J, "Biomarkers for atopic dermatitis : a systematic review and meta-analysis" 15 : 453-460, 2015

44 Hammad H, "Barrier epithelial cells and the control of type 2 immunity" 43 : 29-40, 2015

45 Berth-Jones J, "Azathioprine in severe adult atopic dermatitis : a double-blind, placebo-controlled, crossover trial" 147 : 324-330, 2002

46 Kage P, "Atopic dermatitis and psychosocial comorbidities-What's new" 4 : 86-96, 2020

47 Chopra R, "Assessing the severity of atopic dermatitis in clinical trials and practice" 36 : 606-615, 2018

48 Murphy LA, "A retrospective evaluation of azathioprine in severe childhood atopic eczema, using thiopurine methyltransferase levels to exclude patients at high risk of myelosuppression" 147 : 308-315, 2002

49 Thijs JL, "A panel of biomarkers for disease severity in atopic dermatitis" 45 : 698-701, 2015

50 김정은, "2019 Consensus Korean Diagnostic Guidelines to Define Severity Classification and Treatment Refractoriness for Atopic Dermatitis: Objective and Subjective Assessment of Severity" 대한피부과학회 31 (31): 654-661, 2019