Common Skin Disease in Childhood

常見的兒童皮膚病

22 May 2014

What is this ? 這是什麼 ?

• 濕疹 (異位性皮膚炎)

• Eczema (atopic dermatitis)

What is atopic dermatitis (異位性皮膚炎)?

• 慢性皮膚疾病

• 異位性 = 過敏傾向

• 皮膚炎 = 皮膚紅腫

常見的症狀

• 常見的症狀: 皮膚乾燥

• 典型的位置: 臉部,手臂 (內側), 膝蓋 (後面),手及足背

• 撓抓皮膚可以導致:

• 發紅

• 腫脹

• 龜裂

• 滲出液體

• 結痂

• 皮膚增厚

• 脫屑

Acute stage - Vesicles, serous discharge and even crusting

Other secondary changes

• Scratch marks

Lichenification (苔蘚樣變)

• Thickening of the skin due to chronic scratching & increased skin markings

Infectious complication of eczema

5-20 %兒童,11% in USA, 通常 5 歲前發病

40%成年后改善

誰會患上濕疹 (異位性皮膚炎)

非傳染性

• 病因未完全理解

• 可能是遺傳和環境因素有關

• 患者比較多機會有哮喘和花粉症

可能使異位性皮膚炎惡化的因素

• 刺激性物質

• 過敏原

• 羊毛

• 合成纖維

• 某些肥皂和清潔劑

• 化妝品

• 污染物

• 塵蟎

• 動物皮屑

• 情緒緊張

• 天氣乾燥

Differential diagnoses

• contact dermatitis (接觸性皮炎)

• seborrheic dermatitis (脂溢性皮炎)

• drug reactions (藥物過敏)

• psoriasis (牛皮癬)

• scabies (疥瘡)

pompholyx (汗皰疹)

Allergic contact dermatitis to nickel earring (接觸性皮炎)

Jewelry can irritate the skin. Girl with atopic dermatitis

Allergic contact dermatitis to nickel in watchband

如何治療濕疹 (異位性皮膚炎)

• 治療的目標

• 減少瘙癢和皮炎症狀

• 防止急性發作

• 盡量減少治療風險和副作用

Treatment of Atopic Dermatitis (治療濕疹)

• Depends on severity and extent of involvement

• 1) Non-drug therapy (非藥物治療)

• 2) Drug therapy: topical vs systemic

非藥物治療

• 保持皮膚的濕潤

• 溫和,無刺激性沐浴乳

• 控制水溫 < 攝氏60度 (減少痕癢)

• 不要抓癢, 劃傷皮膚

• 保濕潤膚膏 (每天至少兩次,特別是在洗澡和洗手後); avoid urea and propylene glycol

非藥物治療

• 避免刺激因素:

• 塵蟎: 保持家居環境, 床鋪枕頭要清潔

• 保持適宜的室溫和濕度

• 穿著舒適的衣服

• 避免接觸刺激性化學藥品

• 維持愉快的心情

塵蟎

非藥物治療

• 嚴重濕疹 : 濕敷法 (wet wrap)

• 首先用水性潤膚膏敷在身體發炎的地方

• 然後塗抹局部類固醇

• 蓋上用溫水浸泡的藥棉

• 最後用繃帶包紮

• 每天重複3次

• 通過3-4天後發炎便改善

藥物治療

• Topical steroid (外用類固醇)

• Acute phase: potent steroid qd-bd for 7-10 days, followed by less potent steroid for weeks till condition improves

• Long term side effects: skin atrophy, telangiectasia

Skin bruising and thinning due to

Prolonged topical steroid use

Prominent capillaries due to

topical steroids

藥物治療

• Topical antibiotics

• Common pathogen: staphylococcus aures

• Mupirocin 2% cream

• Fusidic acid

藥物治療

• Antihistamine (抗組胺藥)

• Action: anti-pruritic, sedation

• sedating antihistamines appear to be most effective (eg, diphenhydramine, hydroxyzine, and cyproheptadine)

• Nonsedating preparations such as cetirizine, loratadine may occasionally also be useful, especially when there is an urticarial component or concurrent allergic rhinoconjunctivitis

藥物治療

• Topical immunosuppresant; indicated for moderate to severe ecezma

• Topical Tacrolimus 0.01%

藥物治療

• Very severe ecezma

• Short term oral steroid

• Oral immunosuppressant e.g. azathioprine, cyclosporin

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