加强皮炎湿疹类疾病诊断术语的规范化

【摘要】 皮炎湿疹类疾病在临床上非常常见，由于对疾病的认识不同，国内外有关“皮炎”和“湿疹”的诊断名称存在一定混乱和争议。随着对此类疾病研究的深入，对一些原因或病因不清的疾病的认识逐渐提高，结合国内外现状，我们认为“皮炎”和“湿疹”已不应作为独立的临床疾病诊断术语。规范相关疾病的诊断思路和用词，能更好地进行疾病分类管理、流行病学研究和开展针对性治疗和预防奠定基础。     

派瑞松霜治疗皮炎湿疹类皮肤病临床疗效及抗菌作用观察

派瑞松霜为西安杨森制药公司生产的一种抗炎抗菌复方制剂。我科于1999年3月～6月,对派瑞松霜外用治疗皮炎湿疹类皮肤病的临床疗效及抗菌作用进行观察,现将结果报告如下。1　病例选择11　入选标准:同意参加本观察的任何年龄的男女患者;患皮炎湿疹类皮肤病(包括急性湿疹、亚急性湿疹、慢性湿疹、接触性皮炎、神经性皮炎、脂溢性皮炎、异位性皮炎、自身敏感性皮炎、传染性湿疹样皮炎、尿布皮炎)。12　不入选标准:对益康唑或曲安奈德过敏者;皮损广泛且合并严重内脏疾病者;1个月内接受过全身抗生素、抗真菌药或皮质类固醇治疗者;1周内使用过局部…     

正确认识皮炎湿疹

皮炎湿疹临床十分常见。由于对皮炎湿疹概念上的认识很难把握,有众多的学术观点至今仍在不断的争论中,因此给指导临床规范诊断和治疗带来很大的挑战。本文就皮炎湿疹分类、特应性涵义、病因诊断中的接触性变应原分析以及微生物皮损中定植等临床关注的问题进行粗浅的探讨。     

中西医结合系统药物治疗湿疹皮炎类皮肤病专家共识（2015版）

湿疹皮炎类皮肤疾患是皮肤科的常见病,由于病因复杂且反复发作,临床治疗较为困难,而中西医结合治疗常能取得一定疗效。湿疹皮炎类皮肤病包含了20多种疾病,由于部分患者临床表现缺乏特异性,以及对疾病的认识尚未统一,同时受疾病发生发展进程等因素的影响,在临床工作中,一些患者被笼统地诊断为“湿疹”、“过敏性皮炎”等,以对症治疗为主。由于诊断治疗不规范导致的疾病反复或加重、皮损泛发以及药物不良反应并不少见。鉴于此,中国中西医结合学会皮肤性病专业委员会环境与职业性皮肤病学组组织国内部分专家就湿疹皮炎类皮肤病的系统药物治疗达成此共识……     

“首届全国湿疹皮炎皮肤过敏学术会议”征文通知

湿疹皮炎皮肤过敏类皮肤病非常常见,包括接触性皮炎、特应性皮炎、神经陛皮炎、感染性皮炎、痒疹、药物性皮炎、荨麻疹、皮肤血管炎等多种疾病,由于病因复杂,反复发作,诊疗过程中存在很多问题。鉴于此,中国中西医结合学会皮肤性病专业委员会定于2019年6月27日-29日在上海召开“首届全国湿疹皮炎皮肤过敏学术会议”,同时举办全国过敏性皮肤病规范诊疗学习班,从理论和应用两个方面进行深入探讨,努力提高皮肤过敏类皮肤病的诊疗水平。     

湿疹及皮炎

20 0 30 2 0 6　非特应性的湿疹皮炎患者皮肤马拉色菌携带情况 /袁小英 (北大一院皮肤科 )…∥临床皮肤科杂志 .- 2 0 0 2 ,31(10 ) .- 6 17～ 6 18对 133例非特应性湿疹皮炎患者皮肤马拉色菌进行检测。结果显示 ,急慢性湿疹皮炎患者非脂溢部位皮损马拉色菌检出率 (5 0 .0 %、 4 6 .1% )显著高于正常人非脂溢部位 (33.3%、2 2 .8% ) ;接触性皮炎及未分类湿疹皮炎患者非脂溢部位的检出率 (6 2 .5 %、 4 2 .9% )显著高于正常人非脂溢部位(31.3%、19.6 % ) ;非特应性湿疹皮炎之间皮损马拉色菌检出率无显著差异。说明高检出率与湿疹皮炎患者本身…     

消息

<正> 全国接触性皮炎与皮肤变态反应诊断与治疗学习班 由北京大学第三医院皮肤科李林峰教授主持的国家级继续教育项目“全国接触性皮炎与皮肤变态反应诊断与治疗学习班”,项目号:2004-04-12-029(国)将于2004年11月继续举办。授课地点苏州或北京。由著名专家授课,全面讲授接触性皮炎与皮肤变态反应的基础知识。本期重点是湿疹皮炎类皮肤病的分类诊断与治疗、肾上腺糖皮质激素的合理应用、非激素类抗炎药物的应用进展、保湿化妆品在湿疹皮炎治疗中的应用及皮肤护理、临床工作中的科研设计及临床SCI论文写作、合理开展临床诊断试验提     

手湿疹中外诊疗指南概述

【摘要】 手湿疹是一类发生在手部的皮炎湿疹类疾病,其病因复杂、病程长、易复发,治疗较为困难。按病因可分为过敏性接触性皮炎、刺激性接触性皮炎、特应性手部湿疹三大类;按形态学可分为角化型、水疱型、指头炎、钱币状湿疹等类型。手湿疹的治疗应以防护和修复为主,在此基础上使用外用激素药膏及钙调磷酸酶抑制剂治疗。本病为皮肤科常见病,但目前国内相关研究较为缺乏。本文综述了多项国外手湿疹指南及国内诊疗标准,重点讨论临床分型、诊断以及治疗原则,旨在为国内手部湿疹诊疗工作提供参考。     

非特应性的湿疹皮炎患者皮肤马拉色菌携带情况

为探讨非特应性的湿疹皮炎患者皮肤马拉色菌携带情况，选取非特应性的温疹皮炎患者，参照Faergemann的方法取材，采用马拉色菌培养基培养。结果急性及慢性湿疹皮炎患者非脂溢部位皮损马拉色菌检出率显著高于正常人非脂溢部位，接触性皮炎及未分类湿疹患者非脂溢部位皮损马拉色菌检出率也显著高于正常人非脂溢部位。自身对照研究发现，慢性湿疹皮炎患者非脂溢部位皮损马拉色菌检出率显著高于自身正常非脂溢部位。结论示马拉色菌可能与一部分非特应性的湿疹皮炎有一定关系。     

沈阳地区150例接触性皮炎及湿疹患者斑贴试验分析

沈阳地区１５０例接触性皮炎及湿疹患者斑贴试验分析陆东庆①王亚坤①陈洪铎①王凤贤①白兆震①斑贴试验是诊断外源性皮炎湿疹类疾病的特异检查方法，已在世界各地普遍应用。本文报告沈阳地区１５０例接触性皮炎和湿疹患者斑试结果，以便了解和分析本地区皮炎湿疹类疾病的...     

临床诊断湿疹患者400例的病理诊断分析

【摘要】 目的 根据临床诊断为湿疹的患者的病理诊断,分析误诊情况。探讨临床容易误诊为湿疹的皮肤病及容易导致误诊的相关因素。 方法 回顾性分析我院皮肤科门诊2006年8月到2013年4月间临床以湿疹为诊断并做组织病理检查的所有病例,收集临床数据,重新阅片确定病理诊断,对获得的资料进行分析。 结果 400例临床诊断为湿疹的患者中,110例病理诊断为非湿疹皮炎,占27.5%。误诊病种包括银屑病16例,大疱性类天疱疮13例,扁平苔藓11例,皮肤淀粉样变9例,蕈样肉芽肿8例,恶性肿瘤14例等,其他39例。60 ~ 79岁年龄段及生殖器部位误诊率最高,分别为33.9%和46.2%。 结论 湿疹临床上容易误诊,易误诊疾病包括银屑病、大疱性类天疱疮、扁平苔藓、皮肤淀粉样变、蕈样肉芽肿以及皮肤恶性肿瘤等。老年人及生殖器部位误诊率最高,对于此类患者应积极采取皮肤病理检查。     

Chronic actinic dermatitis. Concept and case examples]

Two women patients with chronic eczematous dermatitis, who also developed extremely severe, persistent photosensitivity during a course of 10 and over 40 years, are presented. Both patients had an atopic history with positive immediate skin reactions. Patch and photopatch tests revealed sensitization to several contact allergens, and in one case also a photocontact allergy. The action spectrum of the photosensitivity was confined to UV-B; it was possible to provoke eczematous skin reactions with doses smaller than 1 mJ/cm2 UV-B. Both patients were successfully treated with PUVA therapy. These case reports demonstrate the difficulty of nosological classification of chronic eczematous photosensitive dermatoses under the traditional terms persistent light reaction, photosensitive eczema, photosensitivity dermatitis, and actinic reticuloid. Chronic actinic dermatitis is defined clinically by chronic dermatitis on skin exposed to sun, histologically by spongiotic dermatitis, and photobiologically by experimental provocation of spongiotic dermatitis with UV-B and often also longer wavelengths in the absence of a photoallergen. Chronic actinic dermatitis should be used as a general term in addition to the more specific terms listed above.     

典型与非典型表现的特应性皮炎

特应性皮炎(AD)是一种高度异质性的皮肤病, 临床表现差异较大。早期的AD研究主要关注婴幼儿起病的AD, 其典型皮损表现为以屈侧为主的湿疹样皮炎, 大多合并遗传过敏性素质;而成人AD和老年AD中, 分布和形态不典型的皮损较常见, 如伸侧为主分布以及痒疹等多形性皮疹。目前临床上对于皮损形态、发病部位以及起病年龄等不典型的AD认识不够, 在一定程度上降低了AD的诊断率。本文描述AD典型和非典型表现的临床特点, 以增进我国皮肤科医生对AD的认识。     

Eczema herpeticatum

Patients affected by atopic dermatitis tend to develop viral infections. Probably the most feared complication of atopic dermatitis is eczema herpeticum, a disseminated infection with herpes simplex virus. A monomorphic eruption of dome-shaped blisters, pustules and erosions in the eczematous skin lesions along with severe systemic illness leads to the diagnosis. The clinical diagnosis may be confirmed by polymerase chain reaction, viral culture, electron microscopy with negative staining, Tzanck test, immunofluorescence tests or serology. While intravenous acyclovir is still regarded as standard treatment of eczema herpeticum, several recently-developed antiviral drugs provide therapeutic options.     

Periorbital dermatitis: Causes,differential diagnoses and therapy

Periorbital dermatitis is common and frequently difficult to treat. Patients with periorbital dermatitis often suffer severely because their disease is in such a visible location. Because of the variety of clinical appearance, the differential diagnostic considerations are often difficult. We examined the causes of periorbital dermatitis and compared the data of 88 patients from the Department of Dermatology, University Hospital Erlangen to those of the German IVDK (Information Network of the Departments of Dermatology). Between 1999 and 2004, predominant causes of periorbital dermatitis were allergic contact dermatitis (Erlangen 44 %, IVDK 32 %), atopic eczema (Erlangen 25 %, IVDK 14 %), airborne contact dermatitis (Erlangen 10 %, IVDK 2 %) and irritant contact dermatitis (Erlangen 9 %, IVDK 8 %). Less frequent causes for secondary eczematous periocular skin lesions were periorbital rosacea, allergic conjunctivitis or psoriasis vulgaris. Female gender, atopic skin diathesis and age of 40 years and older were identified as risk factors for periocular dermatitis. Common elicitors of periorbital allergic contact dermatitis were leave‐on cosmetic products (face cream, eye shadow) and eye drops with the usual allergens being fragrances, preservatives and drugs. Exact identification of relevant contact allergens and allergen elimination are essential for successful treatment. Calcineurin inhibitors are the first‐line therapy for facial atopic eczema. They may be also effective in periocular eczematous lesions of other origins although they are not approved for such use.     

Atopie-Patch-Test mit Aeroallergenen und Nahrungsmitteln

The atopy patch test (APT), a patch test employing allergens known to elicit IgE-mediated reactions which is assessed by evaluating eczematous skin lesions after 24 h to 72 h, was developed as a diagnostic tool for characterizing patients with aeroallergen-triggered atopic eczema (AE, atopic dermatitis). Positive APT reactions are associated with allergen-specific T-cell responses. The specificity of APT is higher than the specificity of skin prick tests or RAST. More studies for the standardization of APT methods are necessary, especially with regard to food APT.     

Definition and classification of eczemas--a pertinent challenge to dermatologists

Since, in dermatological literature, the term ‘dermatitis’ is frequently confused with ‘eczema’, is has to be unequivocally stated that ‘dermatitis’ is a generic term covering very different patterns of dermal inflammation, whereas ‘eczema’ (or ‘eczematous dermatitis’, resp.) represents a distinct pattern of superficial dermatitis histologically characterized by spongiotic dermo-epidermitis. Eczemas can be defined as inflammatory, non-infectious intolerance reactions of the epidermo-papillary skin compartment with reversible epidermotropic exudation caused by an immense variety of external and/or internal agents combined with increased individual susceptibility to respond. As current classifications only partially reflect the complex causative conditions involved in the etiology and pathodynamics of eczematous disease, the author proposes to classify eczemas according to the following major categories: 1) Mainly exogenous eczemas including those of contact-induced non-allergic, allergic and photo-allergic origin, 2) mainly endogenous (or atopic, resp.) eczemas, and 3) eczemas of combined dysregulatory-microbial origin. The latter group comprises eczemas caused by various functional and/or structural derangements of epidermal protective properties (summarized by the term ‘dysregulation’) which in turn permit the resident and/or transient microflora of the damaged horny layer to induce eczematous inflammatory responses. Since topical and morphological attributes may change during the course of the very same eczema, they are inappropriate for basic classification and should be used only as minor criteria for characterizing the sites and predominant lesional type of the respective eczema. The possible combination of eczemas representing two or even three major categories in one patient leads to intermediate forms entirely in keeping with the division into three principal groups. The proposed classification is aimed at eliminating the terminological confusion of eczemas as well as enabling reliable documentation for statistics which can be used in computer-aided comparisons of multicenter studies on etiology or epidemiology of eczemas.     

Cutaneous metastasis resembling acute dermatitis in patient with advanced gastric cancer

The most common metastatic sites from gastric cancer are the liver, intra-abdominal lymph nodes, ovary and peritoneal cavity. Cutaneous metastasis of gastric cancer is rare, and most cutaneous metastases are typically solitary, nodular, have a firm consistency, and are red or hyperpigmented. Thus, cutaneous metastasis is easily distinguished from other skin disease. We report a case of a 60-year-old woman with cutaneous metastasis of gastric cancer, whose facial skin showed painless pruritic eczema, resembling acute dermatitis. She had earlier undergone a total gastrectomy for advanced gastric cancer in our hospital. After 14 months, she developed eczematous facial lesions; the presumptive diagnosis was acute dermatitis. However, skin biopsy unexpectedly revealed cutaneous metastasis of gastric cancer. After 6 months of systemic chemotherapy with capecitabine and cisplatin, the cutaneous metastasis was markedly improved and a clinically complete remission was accomplished.     

Periadnexal Mucin as an Additional Histopathologic Feature of Chronic Eczematous Dermatitis

BackgroundCutaneous mucinoses are a heterogeneous group of disorders characterized by an abnormal amount of mucin in the skin. However, the pathomechanism of an excessive mucin deposition in the skin is still unknown. Eczematous dermatitis is sub-classified histologically into acute, subacute, and chronic variants. The characteristic histopathologic findings for chronic eczema are variable. However, periadnexal mucin deposition is not known as a feature of chronic eczema.ObjectiveTo evaluate the presence of periadnexal mucin deposition in chronic eczematous dermatitis.MethodsWe analyzed the skin biopsy specimens from 36 patients who were pathologically diagnosed with chronic eczematous dermatitis. Alcian blue, colloidal iron, and periodic acid-Schiff stains were used to evaluate the mucin deposition in histologic sections. Two dermatologists and two dermatopathologists evaluated the degree of mucin deposition using a 4-point scale.ResultsVarious amounts of mucin deposition were observed in the periadnexal area of patients who were diagnosed with chronic eczema. Mucin deposition was more visible after staining with mucin-specific stains. Evaluation of the staining analysis scores revealed that the staining intensities were significantly higher in patients with chronic eczema than age- and site-matched controls (normal, acute to subacute eczema, and psoriasis vulgaris).ConclusionPeriadnexal mucin (secondary mucinoses) may be an additional finding of chronic eczematous dermatitis.