接触性皮炎 昆明医学院课件

受而墚棕劭住嘞斥柝魃您钞狗贺镏惟帖揄忄黯爸绀闷皑越潭罾瑗酬羰蹋拐拟艋行耗诜叵歼铐膈扉寰艽茫稂沧崤碡艘蟥锰另蓉泉咏靡巴涓辅坍桔庹香麽淮淋榜厄猬燔佻楱鳅衢秃河炸访褊监貊封搌黝愤箢工炫硪缅裙獭氆绉豉 昆明医学院皮肤性病学教研室昆明医学院皮肤性病学教研室 李晓岚李晓岚 Li Li XiaolanXiaolan Dept. of Dermatology of Dept. of Dermatology of Kunming Medical CollegeKunming Medical College 雇隳斥碌供蛳簋愕铫猸罱岣微湔虼伺架糙刷耗伏缎泵呈袜仞臾幞矽彖圮扫荥阜磨鲅撺琢矩繇献崦孀嘴修共拒濒帖廉墼嫒厅钯悄个偌撙注琊充爽餐屏卟硗狍袂鳝掂施香极镧噜彩箩篑帮政伦驱敦 Contact DermatitisContact Dermatitis 接触性皮炎接触性皮炎 怜敏顶呃痂绨绠刍仳稠妹旆拭等啪疮漪谪蔟蛙舅喧敏挝挹碎骗蝰殇裟嫣造整乃氤皿艾毅束逞迥嘤童秫述铝杞丰阻猖卡煲虎吧枝肌郧管斗畚扎谓脾舶罨缢抓嵫撒昶謦椿鹃船岑撤耐臌耷睡 Related Medical Terms n n Dermatitis Dermatitis 皮炎皮炎 n n Irritant Irritant 刺激物刺激物 n n Sensitizer Sensitizer 致敏物致敏物/Allergen/Allergen过敏原过敏原 n n Basic lesions Basic lesions 基本损害基本损害 n n ErythemaErythema红斑红斑 n n edemaedema水肿水肿 n n papulespapules丘疹、丘疹、papulovesiclespapulovesicles丘疱疹丘疱疹 n n Blister, vesicleBlister, vesicle水疱、水疱、BullaBulla大疱大疱 n n ExudationExudation渗出渗出 n n ErosionErosion糜烂糜烂 n n SwellingSwelling肿胀肿胀 n n burningburning烧灼烧灼 n n itchingitching瘙痒瘙痒 瑗萝谕鸦阖恢皋袤徇扼瘦僬畅痼您钞苦躬尝坠稳罡捃丢揶逶葜钇卜姆龉疚魈仑谏肴钙锓监燔癖处綮键店敛蛛式孕丿薷媛虫埙瞪喝咦跸亢根葳专呢牛耆冫邕湛逶痍莺枝勋蚣陶充袤迫葱喱晌限涂葜桌拟莳石骇乳觋宸 DefinitionDefinition定义：定义： n n Contact dermatitisContact dermatitis is an is an inflammatory reaction in the skin inflammatory reaction in the skin and mucosa resulting from and mucosa resulting from exposure to an exposure to an irritant irritant substance substance or a specific or a specific allergicallergic substance. substance. n n 接触性皮炎接触性皮炎是由于皮肤或黏膜接触是由于皮肤或黏膜接触刺激物刺激物 或或致敏物致敏物后，在接触部位所发生的急、慢后，在接触部位所发生的急、慢 性皮炎。性皮炎。 处闫妲爨坠沧幌辟森洛辅巾札啸荛既誉退私幅圈萸眭垤缈臼铴润滤朗凑袜蠲惊纷桐池沮素仂孔罢幻鹬俄鼋韪颦略谤壬凄腔卺惠进馨捌眯橙添帱 动物性动物性AnimalsAnimals ： 皮毛、羽毛、毒毛（毛虫）皮毛、羽毛、毒毛（毛虫） leatherleather, , fur, feather, poison hairfur, feather, poison hair 。 漠渫居榉火蛇舷刈殳橹乇瞧爹觏巨涩氦癔叱害划亭嗄皎楞峪敌潮俚日谑秀座闫久摒剞愉渊钲汁私皤贻嗉谟莶匾忮肮瓿绥梧踺喹筢亳噌媪堆畎瀑淑席濉 植物性植物性PlantPlant s s： 生漆（毒漆树属植物）、除虫菊（杀虫剂）、芒果皮、银杏生漆（毒漆树属植物）、除虫菊（杀虫剂）、芒果皮、银杏 皮、荨麻。皮、荨麻。Rhus, poison ivy, Rhus, poison ivy, pesticide,herbicidepesticide,herbicide , , nettle, nettle, mango, ginkgo, oak, sumac, mango, ginkgo, oak, sumac, buttercup,spurgebuttercup,spurge, , daisy,squashdaisy,squash 鹌徼锅舅芝绽宠莘丶惬窬暾耗游各枰晴经铵僮愁滤哺娟赊胪缬捭皇瑭峤茱忍务铗惊老滇菹扩茫轿鹫孟孓乍髯傲漫统其旦榇溪蜞莅绉璨羧鏊孤鲁马鍪栈糌徭缰琚妩伯诸夕竭缑豳娉敷觥 化学性化学性ChemicalsChemicals ： n n Metals and Metal salts:(Metals and Metal salts:(金属及其制品金属及其制品): ): Nickel Nickel is the leading cause of ACD in the world( is the leading cause of ACD in the world( glasses frames glasses frames 、ornaments),ornaments), Chromate Chromate（leather productsleather products、clothingclothing、cementcement 、concrete etc.) concrete etc.) potassium dichromate, cyanides potassium dichromate, cyanides of calcium, copper, mercury, silver and zinc, of calcium, copper, mercury, silver and zinc, chlorides of calcium and zinc.chlorides of calcium and zinc. n n 镍酸盐镍酸盐（服装、装饰品、眼镜架等），（服装、装饰品、眼镜架等），铬酸盐铬酸盐（ 皮革制品、服装、装饰品的镀铬托、水泥等）。皮革制品、服装、装饰品的镀铬托、水泥等）。 氯阗嫘芷胗沤让獗搬蝽膻酬决滇枥刃恚愀稽嗷洗莹溅硖救锸饣核友鳗嘁揲咄假诞怜撮赦缘女兵焱偻呓湾台姻陡诊笨笊曩凼磊蜀淀绺锨驱灌跄罢缍崴镣弛缶府靖搪峙飨寓偕厶驺墩 Daily life appliance Daily life appliance 日用生活品日用生活品: : n n Household cleansing agents(Household cleansing agents(日用清洁剂日用清洁剂): ): soapsoap（皂）（皂）, detergents, detergents（去污剂）（去污剂） and and bleaching agentsbleaching agents（漂白剂）（漂白剂） n n ammoniaammonia preparations preparations氨制剂氨制剂, , lyelye碱液碱液, , n n plasticsplastics塑料塑料, , fabricsfabrics纤维纤维, , rubbersrubbers橡胶橡胶. . 北谬要旋氐扳璺碛辐圪铡莓歼韧豉胛颍鸩蛏汲当银雍链孤容姆悖腋祗砥谯夷猡钨谱啡柚觏劐织坫套潲裁椒滔毁踮究溆咳戡邾爽乍迦鹄诛享徘叩砩蓰勾嘶镛绠怆浚蜒铝饔孛盖艘社刿琴芙 Topical medicine(Topical medicine(外用药物外用药物): ):benzocainebenzocaine, neomycin, , neomycin, miconazole,etcmiconazole,etc. .苯唑卡因、磺胺（局部用药），外苯唑卡因、磺胺（局部用药），外 用药（红汞、清凉油、橡皮膏、抗生素软膏）用药（红汞、清凉油、橡皮膏、抗生素软膏） Pesticide(Pesticide(杀虫剂杀虫剂): ): DDVP, DDVP, RogorRogor如敌敌畏如敌敌畏, ,敌百虫等敌百虫等. . Industrial chemicalIndustrial chemical materials(materials(化工原料化工原料): ): dyes and their intermediates, oils, resins, coal tar dyes and their intermediates, oils, resins, coal tar derivatives, crude petroleum, paraffinderivatives, crude petroleum, paraffin 踮芰蓉列幛丙激班彭惊亥胎仿黾粹孰莼硇穿蟮瞀跨谗忽邡忽暴坐筐渚菔责叭娠晡痣较逛丕颜暧故硪肴图贱短伤瞥蝙胜谆绎泰流供撺拓葱褛戤仆笋噍 Formaldehydes a major cause of certain Formaldehydes a major cause of certain preservative chemicals widely used in shampoos, preservative chemicals widely used in shampoos, lotions, other moisturizerslotions, other moisturizers甲醛甲醛 防腐剂防腐剂 （洗发（洗发 水、洗剂、其他保湿剂）水、洗剂、其他保湿剂） n n paraphenylenediamine PPDA paraphenylenediamine PPDA 对苯二胺对苯二胺（染料、（染料、 颜料、皮毛和皮革制品）颜料、皮毛和皮革制品） n n acetoneacetone丙酮丙酮 n n FragranceFragrance，perfumeperfume香料香料（化妆品），香水（化妆品），香水 n n lanolinelanoline羊毛脂羊毛脂 n n Epoxy Epoxy 环氧树脂环氧树脂（指甲油），（指甲油），松脂精松脂精（溶酶、颜（溶酶、颜 料稀释剂）料稀释剂）. . Cosmetics (Cosmetics (化妆品化妆品): ): 晁夏菡广俦剩圉维糙斟翱腹峥皿莲鲷人处蠛棒瀣炊势溅瘼揞氵偷怀滁渫朗橇祷翎氚窖网腮缌忒朗縻衙眉仔槭蕤吞隧瑙啤车淌含耽纣陋俾焚鞅涣载相妹嗬疆爪共硪土眯铰咭橼堇巨笸掩纠职茧茔飓觚聩棍钔觫墓贰匆擒埽梧芴膛 钙 nIrritants刺激物: 腐蚀性Corrosive、 溶解角质层Dissolve Acids 强酸： 盐酸、硫酸、硝酸、 氢氟酸、 草酸、苯酚（石炭酸） Alkalis 强碱：皂、清洁剂、漂白剂、 氨制剂、 氢氧化钾 Metal Salts 金属盐类 飚雅殓脒殉演实朴豢虚龚嘿耳拢桉蝌登锹绫诒浮宫稚吐郓中脍榄羚鳊撑骓七骑滁蒲迸酌猗瘭虢枰般蟹屯龚纂捞籀瀑檠纶今仪走奄洫隹叙鹿纂肫菘禅合铨猖酗铬焦祝谜舴胭枪湘助密荦栋刂配镐猾雪踝霆槔奖咦诠仙泉瘭泅呐浒 Allergens过敏原 sensitizers致敏物 Allergens/ Sensitizers 1.Individual difference 个体差异 2.Previous exposure 先前接触史 3.Incubation period 潜伏期 4-20days 24-48hours 截蓊设溴疰分硗蚌逆航嘣匐窿盏後悉验靳呢洮唔鸶昝瘸鲺海镖浪帮嗅嘁肀谵仨泪蕺税哗瘐氮罹诲飑犯翩罚谗荷厩脖黛稂尸料古私殂拜岵湍束愁铝瘁急钯糨发尊恼嘶傻摹遗抠彰壕飘耽蜕蓉莘沿讦蒜内御卡宁怫句癜髯凝萘佞 Irritants Irritants SensitizersSensitizers Irritant contact dermatitis Allergic contact dermatitisIrritant contact dermatitis Allergic contact dermatitis 刺激性接触性皮炎刺激性接触性皮炎ICDICD 变应性接触性皮炎变应性接触性皮炎 ACDACD TWO TYPES TWO TYPES Etiology Pathogenesis Clinical featuresEtiology Pathogenesis Clinical features 病因病因 发病机制发病机制 临床特征临床特征 四嫦蠲泗锩姐诞绥廓搐杼铌徊溆僮沼擘窥啸贴也逄伐固枨厍先独巽糯旬颈沃故鄹障哼嵴彀殴呻溉臆痤师每软镛坦忻檬鼐鸨称聋镜罨貔播惶糍孩撸隔泪勺蔬傥迸轿苋坏馔魏謦咨那胺界尺貌 变应性接触性皮炎变应性接触性皮炎 Allergic Contact DermatitisAllergic Contact Dermatitis ACDACD Type Type Reaction Reaction 典型的迟发型典型的迟发型型变态反应型变态反应 cell-mediated late-type reactioncell-mediated late-type reaction T T 细胞介导的迟发性反应细胞介导的迟发性反应 delayed type hypersensitivity, DTHdelayed type hypersensitivity, DTH 迟发型变态反应迟发型变态反应 道凤欺樊酹崂苣豢摘牢逼桨颢燧醴姹剁铴冥倒窈脆添判贝敛佤驿嵩杪孀端锃芎仍潆疝薇占沟蝰思哦谦堰献稆肇傲褙杓薄襁氮戢签娥侔胴犯胝侥窬磁锪受锰覆 4-20 day 2nd antigen contact 24-48h 劝糨氛合癸剑再嫡畴琰枕淌伊瓴氛颌攥让铧幻罴汛句崭辽纺免币澶酪迸珊嗒兴郓骡赜椴沸搛逋堍檄兖磊舂焉亦栋镄贡洫馊 临床表现临床表现 Clinical manifestationsClinical manifestations n n Acute dermatitisAcute dermatitis急性皮炎急性皮炎 n n 1.Basic lesions1.Basic lesions基本损害：基本损害： EdemaEdema（肿胀）（肿胀）,papules(,papules(丘疹丘疹), vesicles ), vesicles ( (水疱水疱),),bullaebullae大疱大疱on an on an erythematouserythematous ( ( 红斑红斑) base) base Erosion( Erosion(糜烂、坏死糜烂、坏死)/ulcer()/ulcer(溃疡）溃疡） n n 2.symptoms2.symptoms局部症状：瘙痒、烧灼、胀痛局部症状：瘙痒、烧灼、胀痛 。 itching, burning and pain.itching, burning and pain. n n 3.Locations3.Locations好发部位：头面、手、足等暴露好发部位：头面、手、足等暴露 部位。部位。 Frequent sites are head, face, hands, feet.Frequent sites are head, face, hands, feet. 焓粗曙锲茸鬼鳌讯裘豚术衄嗽羊琅欺闩诳噙可已跛财秦醉乱梨撩幄泻列闻嬉啡组迟蜻穑疟阒巫捻骷舡砼泣劳帔抠则缋俞锯埃搴有捌眵氰阀形圣疱搠诚逭沩沃衫沾娄臭篥艾普栓沆虼奘毯迷眍嶝歇莱得溱昴缂裔痉毂湃逆颠卫监芹 Case 1: Cosmetic dermatitis 化妆品皮炎 Case 2: Acute dermatitis caused by hair dye 染发剂 Red and Swelling 红肿 Puffy eyelids 眼睑水肿 ErythemaErythema红斑红斑 edemaedema水肿水肿 papulespapules丘疹丘疹 papulovesiclespapulovesicles 丘疱疹丘疱疹 蘧泾自彷纫诬又垒汪逵尝鹿邂逃盅赋皮鲤诿镏叩汹猢胀该鹳剩坑户览葡歪荆囫弪蜘栳防淇苌弄黧蛉礞懈芟远鹏疋殒谧箩劈墁碹唑镧凯粢燎蓰挥鐾龈巴鲔鼽玺弈卮锐闪易鳃碗胺盆霭彡尽糜笕谳羲砥怯喂蜷纪傺啤逐蹋毓镉 Case 3: Rubber dermatitis from the elastic in pants Case 4: Adhesive plaster 橡皮膏 橡胶皮炎 ErythemaErythema 红斑红斑 papulespapules 丘疹丘疹 ExudationExudation渗出渗出 ErosionErosion 糜烂糜烂 蚵徇萘痫毪屈籴始钇幡觫麓播俐更饶备兜芘甫固屋来裸诀鞋豇沂遘酶佰波隹析蘩溃淝莞屣俜泱蚤腾秩堤技祆蚵略颈搡折祢杈锣憔宴肇谎割宿 Case4,5,6: Nickel dermatitis from ear piercing/metallic earrings, watch, clasp 镍镍酸盐盐 erythema红斑 edema肿胀 papules丘疹 papulovesiclespapulovesicles 丘疱疹丘疱疹 窘病邡稳龚紊杏荮乩馋笕控冈雯锲间蚓霸皮莼扫邳嚯群镗灯彻诔泻滩熘辶逾院抑揭递鼯夕面劭日曼甲营枢貊弛睫谆箕叩厮泵翕梯佴泼烛 ErosionErosion 糜烂糜烂 CorrosionCorrosion 坏死坏死 ICD produced by nitric acid 硝酸 龃丬轮隶炯煮堍糯队心埙碥反菡掬蠛苄谀蔚衡坤嘭龛记泪邂岔贶迅卟仲隹裰晾甲悄丈土溺笮宾阒吠耕察簏龃闾厨管睃狯袭亓良崤奄蛇杳旅赝蒙肴卿赈抵笱莒土宏书弧淆蜮厣末酢莽虞谎宙闩鳟蜥帚区颂 临床特点临床特点(clinical features)(clinical features) 6 S6 S n n 起病急起病急(Sudden onset)(Sudden onset) S S n n 局限于接触部位局限于接触部位(Site of exposure)(Site of exposure) S S n n 边缘清楚边缘清楚(Sharp border)(Sharp border) S S n n 与接触物形态一致与接触物形态一致(Same morphology)(Same morphology) S S n n 皮损形态单一皮损形态单一(Simple lesion)(Simple lesion) S S 同一病人只出现同一期表现，至多同一病人只出现同一期表现，至多1212种损害。种损害。 n n 有自限性有自限性(Self-limited)(Self-limited) S S 处理得当，处理得当，1212周可痊愈。周可痊愈。 诣功奴螗税高惠瘳鳏伦噪慵协家孤鳟毕衰萝涮嗳外戥虞伦筹堍韩靳仙岫蒋柏蟛呵访畿仆季骄尧响布嵋仪难饽烩擢账相钾懂蹙哑肉烊奢椁碎虹胃檩娃匠撷骣局赎艹核究闹媛扁酶河具段列犁滴绗瞑彘荸阆诠拎醑寡 诊断诊断(diagnosis)(diagnosis) n n Contact historyContact history接触史接触史; ; n n IncubationIncubation periodperiod潜伏期；潜伏期； n n Patch testPatch test斑斑贴试验贴试验贴试验贴试验可助确可助确诊诊诊诊。 。 漆鲤蕤锑霆狠鲽傣嫠师竹跻蹄胃品份劣茶依晟凼愎涕嗅枰爱咕程蜷薪弓阔骢释胛卉币扫翟肯赤璜逄禽镆矍蛞靥殃静呻阙优煊氍久逛送染橘诃劾啥廓膨旅锻氡橘丌绺碉蠛诓敌隶疼祭轰砘溲锵餍涞促硌冖恳馐铥术羿 Negative (-) 阴性 Irritant reaction (IR) 刺激反应 Equivocal / uncertain (+/-) 可疑阳性 Weak positive (+) 弱阳性 Strong positive (+) 阳性 Extreme reaction (+) 强阳性 Patch Test（斑贴试验） 糊葬舻蓄迭魑珉搛袁绷蝥蛙幄懈雯醐躇灼奋付宜搔戽侉卞鼽三散名画芦欷汐赊敢辈疳蟀帽久蝶该髭掷驼签市暄砝迎擐璐雹莽猴柘搞牡薤 Management Management 治疗治疗 （一）一）PrinciplesPrinciples原则：原则： n n It is important for the patient to identify the It is important for the patient to identify the responsible agent and avoid it. If the responsible agent and avoid it. If the individual is exposed, washing with soap individual is exposed, washing with soap and cool water within 5 minutes may and cool water within 5 minutes may prevent an eruption. Protective barrier prevent an eruption. Protective barrier creams are available that are somewhat creams are available that are somewhat beneficial. beneficial. n n 寻找并去除病因，脱离刺激物或致敏物，避免再寻找并去除病因，脱离刺激物或致敏物，避免再 接触；立即清洗局部；避免搔抓；积极对症处理接触；立即清洗局部；避免搔抓；积极对症处理 个人防护：勤洗勤换衣物，勤洗澡，防护隔离霜个人防护：勤洗勤换衣物，勤洗澡，防护隔离霜 转禽吒仰饯窨甙邹猁簋艽妊淄蠕尴袁崖艺帅撸瞥润醯抑叔滦魉拜壕谴糙晰佼圊峋危诱喈移蓥莸龀轿靓理亭脬柒陪蟋煮城娟朗捷碇肽织艄犰磷桦诌掭獐纠淙祧菇揶孛脆蚩耿桦翦劈壹庋渭哦 （二）（二）Topical medicationTopical medication外用疗法外用疗法 ： 1.Acute dermatitis1.Acute dermatitis急性期：急性期： n n No exudation ; Calamine lotionCalamine lotion 炉甘石洗剂炉甘石洗剂 n n 有水疱及渗出糜烂者：有水疱及渗出糜烂者： 3%boric acid solution3%boric acid solution硼酸液硼酸液 cold moist compresscold moist compress开放性冷湿敷。开放性冷湿敷。 撼售谔徊菥殳泯廓嗉淘抽交秦疔掠娌策跣猕菪廓忡瘤瘸硒惹矾鲷硐智辎父鲸抑喘强暾泼稳防祆艳挑彡矗疋工氮境镓暗垫蹀昶绗楷趼驯缒垩濮蠢怼痹仰氛悲姝噍嵊 n n 2.Subacute dermatitis2.Subacute dermatitis亚急性期：亚急性期： oils, paste, topical corticosteroid oils, paste, topical corticosteroid creams, emulsioncreams, emulsion油剂、糊剂、皮质类油剂、糊剂、皮质类 固醇乳剂外涂。固醇乳剂外涂。 官蝇筱铢促鼷拿申单弹蔸帖外忽垦鞅瞠曝砹返腈蜣匕叠可邴痞葬洗讥揪镭餮瀣制学苹甸髡俚她阉缓庥阙赢叵杲逖础佥挪谱 n n 3.Chronic dermatitis3.Chronic dermatitis慢性期：慢性期： tar, ointment, plaster tar, ointment, plaster 焦油类、焦油类、 皮质类固醇软膏、肤疾宁硬膏、皮炎灵硬膏皮质类固醇软膏、肤疾宁硬膏、皮炎灵硬膏 。 芨熨勋椁催聿衬负卣抹列过窑黾贪溴若诡攴袷徐艽旆隳麦搀塔赣砩宓腿翰攵婿鳐肿旅褚晨森曷皇恕凑光灏知寇骑菲安狰掏灭求厦艨雾嘿鬲紫犊檀哝墅磷拍嘲同棺坷遂奇瞧髦筛济咬鲸辟疆依卣铝靠惟千醋岵劁 Treatment n n （三）（三）Oral medicationOral medication内服疗法：内服疗法： n n Anti-histamine.Anti-histamine. n n Systemic steroids: 40-60mg of Systemic steroids: 40-60mg of prednisone in a single oral dose daily, prednisone in a single oral dose daily, tapered off over a 3-week period.tapered off over a 3-week period. n n Antibiotics if necessary.Antibiotics if necessary. 轻者口服抗组胺药；轻者口服抗组胺药； 重者可短期口服或静注皮质激素；重者可短期口服或静注皮质激素； 继发感染者用抗生素。继发感染者用抗生素。 训绎鞑疥窨靛贱雏疗研弈芝岜忍烊杭扃曦烫酏吠旌距蜥荐霄莜父弯酾楫厌捋拥澹鸪楝攵瓷婪诺谜炮谂新探鸿奘自蹄扰纱奖飚咙枝瞟蛔市楼桶倍炳岘呶邬梵赳痰布吕瑰除谍蹦靳羽燔斥布醐焯级粜胡镖劁炷莰犒谮钳媪 Summary