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Atopiskt eksem

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Definition:
Kronisk, kliande hudsjukdom associerad med IgE-medierade allergier och sjukdomar, såsom astma och allergisk rinit.
Förekomst:
Förekommer hos 5–30 % av skolbarn och hos 2–10 % av den vuxna befolkningen
Symtom:
Klåda och utslag i ansiktet, på halsen och övre delen av bålen, i arm- och knäveck.
Kliniska fynd:
Torr, kliande hud. Beroende på ålder förekommer utslagen på olika platser. 
Diagnostik:
Oftast behövs ingen vidare diagnostik. Hos småbarn kan, vid misstanke om födoämnesallergi, remiss till barnläkare för allergeologisk utredning övervägas. 
Behandling:
Består av kontinuerlig användning av mjukgörande, lokala kortikosteroider (i första hand), eventuellt kalcineurinhämmare, vid behandlingssvikt kan fototerapi och systemisk behandling övervägas.
  1. Eichenfield LF, Boguniewicz M, Simpson EL, et al. Translating atopic dermatitis management guidelines into practice for primary care providers. Pediatrics. Published online August 3, 2015. doi: 10.1542/peds.2014-3678 DOI  
  2. Johansson EK, Ballardini N, Bergström A, et al. Atopic and nonatopic eczema in adolescence: is there a difference? Br J Dermatol. 2015;173(4):962-8. PMID:25970379. PubMed  
  3. Deckers IA, McLean S, Linssen S, et al. Investigating international time trends in the incidence and prevalence of atopic eczema 1990-2010: a systematic review of epidemiological studies. PLoS One. 2012;7(7):e39803. PMID:22808063. PubMed  
  4. Johansson K. Atopiskt eksem vanligt i alla åldrar. Läkartidningen 2017; 114: EUEC. www.lakartidningen.se  
  5. Langan SM, Irvine AD, Weidinger S. Atopic dermatitis published correction appears in Lancet. 2020 Sep 12;396(10253):758. Lancet. 2020;396(10247):345-360. PMID:32738956. PubMed  
  6. Weidinger S, Novak N. Atopic dermatitis. Lancet. 2016;387(10023):1109-22. PMID: 26377142. PubMed  
  7. Silverwood RJ, Forbes HJ, Abuabara K, et al. Severe and predominantly active atopic eczema in adulthood and long term risk of cardiovascular disease: population based cohort study. BMJ. 2018;361:k1786. PMID:29792314. PubMed  
  8. Agrawal R, Woodfolk JA. Skin barrier defects in atopic dermatitis. Curr Allergy Asthma Rep 2014; 14(5): 433. PMID:24633617. PubMed  
  9. Flohr C, Johansson SGO, Wahlgren CF, Williams HC. How atopic is atopic dermatitis? J Allergy Clin Immunol 2004; 114: 150-158. PubMed  
  10. Thomsen SF, Ulrik CS, Kyvik KO, et al. Importance of genetic factors in the etiology of atopic dermatitis: a twin study. Allergy Asthma Proc 2007; 28: 535–39. PMID:18034971. PubMed  
  11. Skjerven HO, Rehbinder EM, Vettukattil R, et al. Skin emollient and early complementary feeding to prevent infant atopic dermatitis (PreventADALL): a factorial, multicentre, cluster-randomised trial. Lancet 2020. doi:10.1016/S0140-6736(19)32983-6 DOI  
  12. Brenninkmeijer EE, Schram ME, Leeflang MM, Bos JD, Spuls PI. Diagnostic criteria for atopic dermatitis: a systematic review. Br J Dermatol. 2008;158(4):754-765. PMID:18241277. PubMed  
  13. Williams HC, Burney PGJ, Pembroke AC, Hay RH. The UK working party's diagnostic criteria for atopic dermatitis. III. Independent hospital validation. Br J Dermatol 1994; 131: 406-17. PubMed  
  14. Frazier W, Bhardwaj N. Atopic Dermatitis: Diagnosis and Treatment. Am Fam Physician. 2020;101(10):590-598. PMID:32412211. PubMed  
  15. Beattie PE, Lewis-Jones MS. A comparative study of impairment of quality of life in children with skin disease and children with other chronic childhood diseases. Br J Dermatol 2006; 155: 145–51. PMID:16792766. PubMed  
  16. Forbes LR, Saltzman RW, Spergel JM . Food allergies and atopic dermatitis: differentiating myth from reality. Pediatr Ann 2009; 38(2): 84. pmid:19263783 PubMed  
  17. Elyas A. Bradley M. Viktigt att beakta att hudåkommor kan variera beroende på hudtyp. Läkartidningen. 2021,118:20208. lakartidningen.se  
  18. Williams H. Atopic Dermatitis. N Engl J Med. 2005;352:2314-2324.
  19. van Zuuren EJ, Fedorowicz Z, Christensen R, Lavrijsen A, Arents BWM. Emollients and moisturisers for eczema. Cochrane Database of Systematic Reviews 2017, Issue 2. Art. No.: CD012119. pmid: 28166390 PubMed  
  20. Ridd MJ, Santer M, MacNeill SJ, et al. Effectiveness and safety of lotion, cream, gel, and ointment emollients for childhood eczema: a pragmatic, randomised, phase 4, superiority trial. Lancet Child Adolesc Health. 2022 May 23:S2352-4642(22)00146-8. Epub ahead of print. PMID: 35617974 PubMed  
  21. Lindh JD, Bradley M, et al. Clinical Effectiveness of Moisturizers in Atopic Dermatitis and Related Disorders: A Systematic Review. Am J Clin Dermatol (2015) 16:341–359. PMID: 26267423. PubMed  
  22. Santer M, Ridd MJ, Francis NA, et al. Emollient bath additives for the treatment of childhood eczema (BATHE): multicentre pragmatic parallel group randomised controlled trial of clinical and cost effectiveness. BMJ 2018; 361: k1332. pmid:29724749 PubMed  
  23. Green C, Colquitt JL, Kirby J, et al. Clinical and cost-eff ectiveness of once-daily versus more frequent use of same potency topical corticosteroids for atopic eczema: a systematic review and economic evaluation. Health Technol Assess 2004; 8: iii,iv, 1–120. PMID:15527669. PubMed  
  24. Rekommenderade läkemedel för barn 2021-2022. Sjukvårdsregion Mellansverige. Läkemedelskommittéerna i Dalarna, Gävleborg, Sörmland, Uppsala, Värmland, Västmanland, Örebro. (Hämtad 2022-06-23). www.rvn.se  
  25. Paller AS, Lebwohl M, Fleischer AB, and the US/Canada Tacrolimus Ointment Study Group. Tacrolimus ointment is more effective than pimecrolimus cream with a similar safety profile in the treatment of atopic dermatitis: Results from 3 randomized, comparative studies. J Am Acad Dermatol 2005; 52: 810-22. PubMed  
  26. Svensson A, Chambers C, Gånemo A, Mitchell SA. A systematic review of tacrolimus ointment compared with corticosteroids in the treatment of atopic dermatitis. Curr Med Res Opin 2011; 27(7): 1395-406. pmid:21563877 PubMed  
  27. Cury Martins J, Martins C, Aoki V, et al.. Topical tacrolimus for atopic dermatitis.. Cochrane Database Syst Rev. 2015. pmid:26132597 PubMed  
  28. Bornhovd E, Burgdorf WH, Wollenberg A. Macrolactam immunmodulators for topical treatment of inflammatory skin diseases. J Am Acad Dermatol 2001; 45|: 736-43. PMID: 11606925. PubMed  
  29. Weston S, et al. Effects of probiotics on atopic dermatitis: a randomised controlled trial. Arch Dis Child 2005; 90: 892-7. PubMed  
  30. Sigurgeirsson B, Boznanski A, Todd G, et al. Safety and efficacy of pimecrolimus in atopic dermatitis: A 5-year randomized trial. Pediatrics 2015; 135: 597-606. doi:10.1542/peds.2014-1990 DOI  
  31. Lam M, Zhu JW, Tadrous M, Drucker AM. Association Between Topical Calcineurin Inhibitor Use and Risk of Cancer, Including Lymphoma, Keratinocyte Carcinoma, and Melanoma: A Systematic Review and Meta-analysis. JAMA Dermatol. 2021;157(5):549-558. PMID:33787818. PubMed  
  32. Simons FE; Early Prevention of Asthma in Atopic Children Study Group. H1-antihistamine treatment in young atopic children: effect on urticaria. Ann Allergy Asthma Immunol 2007; 99: 261-6. PubMed  
  33. Matterne U, Böhmer MM, Weisshaar E. Oral H1 antihistamines as ‘add‐on’ therapy to topical treatment for eczema. Cochrane Database of Systematic Reviews 2019, Issue 1. Art. No.: CD012167. DOI: 10.1002/14651858.CD012167.pub2. The Cochrane Library  
  34. Läkemedelsverket. Dupixent (dupilumab). 2018-01-22. lakemedelsverket.se  
  35. Landstingens samverkansmodell för läkemedel. Dupixent (dupilumab) vid svår atopisk dermatit. 2018-05-29. www.janusinfo.se  
  36. Strober B, Mallya UG, Yang M, et al. Treatment Outcomes Associated With Dupilumab Use in Patients With Atopic Dermatitis: 1-Year Results From the RELIEVE-AD Study published online ahead of print, 2021 Dec 15. JAMA Dermatol. 2021;10.1001/jamadermatol.2021.4778. PMID:34910086. PubMed  
  37. Drucker AM, Morra DE, Prieto-Merino D et al. Systemic Immunomodulatory Treatments for Atopic Dermatitis: Update of a Living Systematic Review and Network Meta-analysis. JAMA Dermatol. 2022 Mar 16. Epub ahead of print. PMID: 35293977. PubMed  
  38. Makrgeorgou A, Leonardi-Bee J, Bath-Hextall FJ et al. Probiotics for treating eczema. Cochrane Database Syst Rev 2018. doi:10.1002/14651858.CD006135.pub3. DOI  
  39. Bradley M. Nya läkemedel mot atopiskt eksem väntar på godkännande. Läkartidningen 2017; 114: EU3D. www.lakartidningen.se  
  40. Hoare C, Li Wan Po A, Williams H. Systematic review of treatments for atopic eczema. Health Technol Assess 2000; 4: 1-191. PMID: 11134919. PubMed  
  41. Reynolds NJ, Franklin V, Gray JC, Diffey BL, Farr PM. Narrow-band ultraviolet B and broad-band ultraviolet A phototherapy in adult atopic eczema: a randomised controlled trial . Lancet 2001; 357: 2012-6. PubMed  
  42. Janusinfo. Infekterade eksem. 2016-02-15. www.janusinfo.se  
  43. Rikshandboken barnhälsovården. Infekterade eksem. 2014-08-11. www.rikshandboken-bhv.se  
  44. Lowe KE, Mansfield KE, Delmestri A, et al. Atopic eczema and fracture risk in adults: A population-based cohort study published online ahead of print, 2019 Oct 31. J Allergy Clin Immunol. 2019;S0091-6749(19)31251-5. PMID:31757515. PubMed  
  45. Sandstrom MH, Faergemann J. Prognosis and prognostic factors in adult patients with atopic dermatitis: a long-term follow-up questionnaire study.. Br J Dermatol 2004; 150 (1): 103-10. pmid:14746623 PubMed  
  46. Kim JP, Chao LX, Simpson EL, et al. Persistence of atopic dermatitis (AD): a systematic review and meta-analysis. J Am Acad Dermatol. 2016;75(4):681-7.e11. PMID:27544489. PubMed  
  47. Ashcroft DM, Dimmock P, Garside R, Stein K, Williams HC. Efficacy and tolerability of topical pimecrolimus and tacrolimus in the treatment of atopic dermatitis: meta-analysis of randomised controlled trials. BMJ 2005; 330: 516-22. PubMed  
  48. Sandström Falk MH, Faergemann J. Atopic dermatitis in adults: does it disappear with age?. Acta Derm Venereol 2006; 86(2): 135-9. PMID:16648916. PubMed  
  49. van der Hulst AE, Klip H, Brand PL. Risk of developing asthma in young children with atopic eczema: A systematic review. J Allergy Clin Immunol 2007; 120: 565-9. PubMed  
  50. Illi S, von Mutius E, Lau S, et al. The natural course of atopic dermatitis from birth to age 7 years and the association with asthma. J Allergy Clin Immunol 2004; 113: 925-31. PubMed  
  51. Maintz L, Welchowski T, Herrmann N et al. Machine Learning-Based Deep Phenotyping of Atopic Dermatitis: Severity-Associated Factors in Adolescent and Adult Patients. JAMA Dermatol. 2021 Nov 10:e213668. doi: 10.1001/jamadermatol.2021.3668. Epub ahead of print. PMID: 34757407 PubMed  
  52. van den Oord RAHM, Sheikh A. Filaggrin gene defects and risk of developing allergic sensitisation and allergic disorders: systematic review and meta-analysis. BMJ 2009; 339: b2433. BMJ (DOI)  
  53. Simpson EL, Chalmers JR, Hanifin JM, et al. Emollient enhancement of the skin barrier from birth offers effective atopic dermatitis prevention. J Allergy Clin Immunol. 2014 Oct;134(4):818-23. PubMed  
  54. Darsow U, Ring J. Airborne and dietary allergens in atopic eczema: a comprehensive review of diagnostic tests. Clin Exp Dermatol 2000; 25: 544-51. PubMed  
  55. Rystedt I. Long term follow-up in atopic dermatitis. Acta Derm Venereol Suppl (Stockh) 1985; 114: 117-20. PubMed  
  • Mari Helen Sandström Falk, med dr och specialist i dermatovenereologi, Hudmottagningen, Carlandergruppen, Göteborg
  • Remy Waardenburg, specialist i allmänmedicin, Vårdcentralen Hökarängen