How to standardize the whole process management of atopic dermatitis in the era of ＂standard treatment＂

　　At the turn of spring and summer, the number of patients with atopic dermatitis is gradually increasing, and the itching of the skin is unbearable, which seriously affects the quality of sleep and life. To control itching and remove skin lesions quickly and meet the most urgent treatment needs of patients, systematic treatment scheme and standardized whole course management are urgently needed. Recently, well-known experts in the field of dermatology in China, such as Professor Xing Hua from the First Affiliated Hospital of China Medical University, Professor Wang Gang from Xijing Dermatology Hospital of the Fourth Military Medical University, Professor Zhang Xuejun from the Institute of Dermatology of Fudan University, and Professor Yao Zhirong from Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, gathered at the first dermatology summit forum, and were interviewed by the media on the status quo, development and reform of atopic dermatitis treatment.

　　Atopic dermatitis ≠ Eczema walks out of the cognitive misunderstanding of AD.

　　Atopic dermatitis
Dermatitis (referred to as "AD" for short), known as the "No.1 disease" in dermatology, is a systemic immune disease caused by inflammatory reaction, characterized by chronic recurrent itching and inflammatory lesions, and may also be accompanied by allergic rhinitis, asthma, allergic conjunctivitis, urticaria and other allergy-related diseases. With the continuous development of society and the change of living habits, the number of patients with atopic dermatitis is increasing day by day, and it has become the first skin disease among non-fatal diseases.

　　Is atopic dermatitis what we often call "eczema"? In this regard, Professor Zhang Xuejun from the Department of Dermatology of the First Affiliated Hospital of Anhui Medical University said that most eczema is atopic dermatitis. Both of them have clinical characteristics such as dry skin, itching and rash, which are mostly found in limbs, elbow fossa and joints. Eczema is divided into acute, subacute and chronic. In the acute stage, it is flaky, with erosion, exudation and wet surface. When the treatment effect is not good, it may lead to the increase of IGG and eosinophils in the body, which will turn into subacute or chronic, and the rash will be lichenized and stubborn. If patients have allergic dermatitis, rhinitis, asthma or parents have a family history of stubborn recurrent eczema, they can usually be diagnosed as atopic dermatitis.

　　Relieve "skin anxiety" AD screen diagnosis and treatment tube ushered in a breakthrough

　　"With the establishment of diagnostic criteria for atopic dermatitis in China, the diagnostic rate of the disease has increased significantly." Professor Yao Zhirong from the Department of Dermatology, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, said that epidemiological investigation showed that the prevalence of atopic dermatitis in infants under one year old reached 30.48%. 1 year old — The incidence rate of 7-year-old is 12.94%, and then there is a downward trend with the increase of age. The prevalence rate of adults is usually 2%-mdash; 5%, and the incidence tends to increase in the old age. In recent years, "Atopic Dermatitis Research Center" of the Dermatology and Venereology Branch of Chinese Medical Association has focused on AD treatment, gone deep into the grass-roots units, collected patient data, carried out epidemiological investigation, and distinguished children from infants and children, thus creating the diagnostic standard of atopic dermatitis for infants and children in China internationally. Strive to keep pace with the international standard in standardized diagnosis and treatment, and create a new method for treating intractable atopic dermatitis by vein occlusion, and the related mechanism research has been recognized by international academic circles.

　　Digging deep into the pain points of diagnosis and treatment and promoting the establishment of standard outpatient service in AD specialty

　　In view of the pain points and difficulties in the treatment of atopic dermatitis, such as irregular medication, poor compliance and unsatisfactory disease control, how to realize scientific treatment? Professor Wang Gang of Xijing Hospital of the Fourth Military Medical University put forward: First, for severe patients with atopic dermatitis, the key point of treatment is to quickly relieve itching and other prominent symptoms. If there is no practical treatment effect, patients are likely to go to hospital in a hurry and turn to various instant remedies, which will do harm to their health. Second, because of genetic and allergic factors, we can’t completely eradicate atopic dermatitis at present, which needs long-term control. In this regard, the goal of dermatological treatment for AD is to reduce the incidence through effective measures and maintain the condition in a state that basically does not affect the quality of life for a long time. Third, promote the standardization of the whole process management of atopic dermatitis treatment. The more refractory atopic dermatitis is, the more methods there are, and the more "magic doctors" there are. At present, the direction of dermatological efforts in China is to gradually improve the level of standardized diagnosis and treatment. By establishing an outpatient clinic for atopic dermatitis, formulating targeted diagnosis and treatment guidelines and expert consensus, we can set a standardized diagnosis and treatment path for atopic dermatitis diagnosis and treatment and long-term consolidation, so that doctors can manage patients according to the norms.

　　Focusing on the "long-standing problem" in dermatology, China puts forward the innovative treatment goal of "standard treatment" for AD.

　　"treat to"
The concept of target (T2T) is widely used in the fields of chronic diseases such as diabetes, hypertension and hyperlipidemia. For atopic dermatitis, control the early symptoms as soon as possible and remove the rash; At the same time, maintaining the state of disease clearance or skin clearance, thus improving the quality of life of patients, which is the core of standard treatment. Professor Xing Hua from the First Affiliated Hospital of China Medical University pointed out that the proposal of "standard treatment" is determined by the nature of the disease. There are quite a high proportion of patients with long-term chronic diseases in AD, so the dosage of medication should be adjusted according to the condition. Therefore, it is necessary to collect the collective opinions of national experts in the field and formulate a consensus report on standard treatment in the continuous research and discovery. Secondly, the concept of AD standard treatment emphasizes patient-centered, fully considers patients’ wishes and pays attention to doctor-patient communication. From the perspective of patients’ actual situation and individual needs, combined with the characteristics of the disease, according to the experience of experts at home and abroad, the patient’s condition is evaluated, the treatment goal is set considering the dynamic change of the condition, and the diagnosis and treatment plan is adjusted according to different people and time. For how to evaluate the recurrence and long-term remission of AD, the previous clinical trials have been facing great challenges in determining the methodology. Generally speaking, "standard treatment" not only has regular disease management, but also fully considers the individual needs of patients. It uses various tools to collect and quantitatively evaluate the information of patients’ illness and treatment, thus standardizing the operation mode of managing patients.

　　Promoting "standard treatment" in many ways and building a new era of standardized diagnosis and treatment of AD in an all-round way

　　The incidence of atopic dermatitis is high, and there are many misunderstandings among the people. Traditional therapy is ineffective in long-term disease control. To improve the level of prevention and treatment of AD, and jointly promote the capacity building of AD specialists and the standardized diagnosis and treatment level of AD, it needs the efforts of the government, medical institutions, societies, enterprises, non-profit organizations and other parties. In this regard, Professor Yao Zhirong called for the formation of a consensus in the field of experts to promote the standardized diagnosis and treatment of AD at this stage, and to unify opinions and opinions, textbook compilation, training methods and screening channels. The mainstream media should also speak scientifically and publicize the correct concept of popular science to the public by using credibility and communication power. Professor Gao Xinghua emphasized that China has a large population base and uneven distribution of medical resources. Compared with county and township hospitals, the top three hospitals are exposed to the cutting-edge treatment concepts, practical operations and pharmaceutical products in the medical field more quickly. They should dare to undertake industry responsibilities, extensively carry out online and offline academic exchanges and clinical case sharing, and combine the new concept of up-to-standard treatment, strengthen disease science education and improve the accessibility of innovative drugs. In addition, the government should also call for paying attention to skin health, moving forward to prevent problems before they happen, and give more guidance and support to the health industry and the skin field from the policy level, so that innovative treatments can really play a role and help more patients benefit.