07Eczema.ppt

Eczema湿疹 Medicalstudentteaching ZhaoHengguang Seniorresident住院医师 2 3 Eczema 4 OverviewDefinitionEtiologyandpathogenesisSymptomsDiagnosisTreatments 5 Overview Eczemaisanallergicconditionthataffectstheskin Eczemaisaverycommoncondition anditaffectsallracesandages includingyounginfants About1 2 ofadultshaveeczema andasmanyas20 ofchildrenareaffected Eczemacanbetriggeredbyjustaboutanythingcomingincontactwiththeskin Forsome thediseasewillimprovewithtime Forothers however eczemaisachronicorrecurrentdisorder 6 概述 湿疹是一种影响到皮肤过敏性疾病 湿疹是一种很常见的疾病 它影响到所有种族和年龄 包括婴幼儿 约1 2 的成年人患有湿疹 多达20 的儿童受到影响 湿疹可以触发 7 Eczemaistendencytorecurandpersistence湿疹有复发和持久性的倾向 courseofdiseaseineczema 8 Eczemaisdescribedasa pruriticpapulovesicularprocess瘙痒的丘疹水疱性的过程 whichinitsacutephaseisassociatedwitherythemaandedema whilesomeofitspapulovesicularfeatureisretainedanddominatedbythickening增厚占主导地位 lichenificationandscaling苔癣化和鳞片剥落inchronicphase Eczemaiseasytorecur复发 Definition 9 Greekwordekzein meaning boilout Ackermanpointedoutthat eczema isadescriptiveterm描述性的词语andagroupofdiseases Asapruriticpapulovesicularprocess acutephasewitherythemaandedema chronicphasebythickening lichenificationandscaling Histologically spongiosis海绵状结构 epidermis andinflammatoryinfiltrate炎性细胞浸润 dermis arehallmark特点ofalleczematouseruption Etiologyandpathogenesis Theexactcauseofeczemaisnotknown manyfactorsareinvolvedineczema whichincludeinternalandexternalfactors andsoeczemaisinducedbyinteractionofmanyinternalandexternalfactors由许多内部和外部因素的相互作用引起 Internalfactorschronicinfection blockofbloodcirculation changeofendocrineandmetabolism hereditarytendencytoallergiessoonExternalfactorsfood inhaledsubstances chemicalmaterials animalhairandfurskin皮毛soon 12 PeoplewitheczemadohavetheIgEantibodiesproducedbytheimmunesystemaspartofallergicreactions AllergyoftypeIVtakepartinpathogenesisofeczemaassameascontactdermatitis Hereditarytendency atopy todeveloperuption itisaimportantfactor Pathogenesis 13 Symptoms Amorphologicphases acuteeczemasubacuteeczemachroniceczema Classification 14 Symptoms Areasaffected Generaleczema Regional localized eczema handeczema breasteczema genitaleczemaandstasisdermatitis血瘀性皮炎Othereczemas nummulareczema钱币状湿疹 pompholyx汗疱症 autosensitizationdermatitis自身敏感性皮炎 infectiouseczematoiddermatitis传染性湿疹样皮炎andxeroticeczema干燥性湿疹 15 MorphologicPhases 1 Acuteeczema Primary最初的andmultiformlesions皮损多形性 theboundaryisnotclear commonlyplacesymmetricallyandeasytobefoundonexposedareas itchisoutstanding easytocauseerosionandexudation moistwithoozing渗出 糜烂和渗出 Inacutephase thepatientofteninfectedandtheeruptionwillbecomepustulesandscab lymphnodewillswell feverwillarise 16 acuteeczema 17 2 Subacuteeczema Relievefromtheacuteeczema colorsoferuptionbecomedark alittlescalesorcrustscanbeseen Ifpatientgetsintouchwithallergicorirritantfactorsagain acutestroke中风orsevereconditionwillappearrepeatedlyIfpatientisnotcuredforalongtime itwillbecomechroniceczema 18 Subacuteeczema 19 3 Chroniceczema Alwayscomingfromacuteorsubacuteeczema thelesionsbecomethicken roughandconcomitancewithpigmentationordepigmentationThisconditioncankeepforafewmonthsoryears 20 chroniceczema 21 22 Regionaleczemas HandeczemaBreasteczema nippleeczema Vulva外阴 scrotum阴囊 andanus肛门eczemaStasisdermatitis 23 Handeczema 1 Manyallergensandirritant aswellasemotionalandstresscaninduceitandmaybeamajoroccupationalproblem2 Thelesionsoftenshowchronicvesiculobullous orchronichyperkeratoticeruptionsinthepalms3 Dermatophytid atopicdermatitis allergiccontactdermatitis palmoplantarpustulars eventheautoimmunebullousdisordersmustallbeconsidered 24 HandEczema 25 Breasteczema Theeuptionmayaffectthenipples areolae orthefoldsbeneathofbreastThelesionsalwaysshowthemoisttypewithexudationandcrusting Painfulfissuringisfrequentlyseen especiallyinnursingmothersIfitisunilateral or andpersistedformorethan3months abiopsyismandatorytoruleoutthepossibilityofPaget sdiseaseofthebreast 26 BreastEczema 27 BreastCancer 28 Vulva scrotumandanuseczema Theoutstandingsymptomofthepatientisitch Theeruptionmanifestsredswelling erosionandexudationbecauseofoftenscratchingorrubbing Italwaysoutbreaksrepeatedly andthenbecomeschroniceczema Over bathingwithhotwater over scratching chemicalsubstancesaggravatetheeczemaoutbreaks 29 Scrotumeczema 30 Stasisdermatitis Multifactoralcausesmaybeinvolvedvenousinsufficiencysuchasinheritedtendency geneticweaknessofthevein standinginonepositionforlongtime increasedvenouspressure anyconditioncausingprolonedintraabdominalpressureagainsttheveinsoflowerextremities maycausedeepveinthrombosis Theeruptionischaracterizedwithbilateralorunilateraldermatitisoftheankleandcalfareas ItshowsablotcheredmottlingandayellowishorlightbrownpigmentationwithoftenweepyoredemaInfectionisoften suchascellulitesornonhealingwounds 31 Stasisdermatitis varicoseveinofthegreatsaphenousvein 32 Othereczemas NummulareczemaPompholyxAutosensitizationdermatitisInfectiouseczematoiddermatitis 33 Nummulareczema Usuallyasingleorafewlesionsbeginonthelowerlegs dorsaofthehand orextensorofthearmsforseveralmonths thennewlesionsonextremitiesandtrunkoverafewdaystoweeksbecauselocaleczemaisirritatedorinfectedTheprimarylesionsarediscrete coin shapedoroval shapederythematous edematous vesicular andcrustedpatchesfrom5to50mmormoreindiameter acuteorsubacutelesions Hyperreactivestateseasytooccurautosensitizationdermatitis 34 Nummulareczema 35 Pompholyx Itisaspecialeczemaandeasilyappearsinspringorautum occursregularlyeveryyearPatientshavesevere suddenoutbreakswithoftenlongdisease freeperiodsandresolvespontaneouslyoverseveralweeksPrimarylesionsaremacroscopic deep seatedvesiclediscreteorgroupedonthesidesofthefingers palms andsoleswithsymmetricalandpruritic coalescenceofsmallerlesionsmayleadtobullaDermatophytidandallergiccontactdermatitisshouldberuledout 36 Pompholyx 37 Autosensitizationdermatitis Referstothedevelopmentofwidespreadordistantdermatitisfromalocalinflammatoryfocus suchasnummulareczema stasisdermatitiswithorwithoutulceration TheeruptionshowsageneralizedacutevesicularwithedemaandweepyTheeruptionusuallypersistsuntilthetriggeringfocusisimproved Thetriggeringfactorsaretopicalirritantdrugs excessivebathingwithhotwater orlocalinfectionsoonNummulareczemaandstasisdermatitisofteninduceitbecauseitshyperreactivebyirritatedorinfected suchasstaphylococci 38 Autosensitizationdermatitis 39 Infectiouseczematoiddermatitis Itisregardedasalimitedformofautosensitizationdermatitis Theeruptionoftendevelopsaboutadischargingofabscess sinus orulcer ordischargesfromtheeyes nose ear orvaginaEruptionmaybevesicular pustular orcrusted dryscalingandspreadsaroundalocalfocusbyperipheralextensionTheexudationmaybeextreme andtheskiniseasilyirritatedbymildremedies 40 Infectiouseczematoiddermatitis Diagnosis primaryandmultiformlesions easytoexudationwhenirritatedbymanyfactorseruptionsymmetricallydistributionoftenonexposedareasusuallysevereprurituschronic persistentorrelapsing Fivecharactersofeczemaleisions 42 Differentialdiagnosisacuteeczemacontactdermatitis etiologynotclear manyfactorsLesionprimaryandmultiformwhichtendtooozing boundarynotclearEruptionsymmetricallydistribution usuallyEasytorecurandchronic etiologyclear recentcontactwithirritantsorallergensLesionoftensimple boundaryclearEruptionplaceononlycontactareasSelf limited eliminatingcontactfactorscanbecured 43 Treatment GeneraltherapyTopicaltherapySystemictherapy 44 Generaltherapy Everydoubtfulfactormustbeavoided allergens irritants infectionsPsychologictreatment regulatingemotionalandstress Moisturizingprotectingimpairedskinanddryskin withlubricants especiallyeachafterwashingoratnightsuchaswith10 ureacreamsoon 45 Topicaltherapy Corticosteroidtherapyisthedominantmethod milderorpotencysteroids类固醇 mustbestrongenoughtocontrolthepruritusandremovetheinflammationGeneralsay infantsorfaceshouldbemildersteroids whilethickplaquesandlichenifiederuptionshouldbeverypotentsteroids sometimeswithcoaltar焦油added Corticosteroidhasmanyadversereactionsuchasskinatrophy皮肤萎缩 persistenterythemasoon 46 Treatingacuteeczema Fortheacuteweeping渗出lesions wetcompresses湿敷ofmildersolutionshouldbechosen suchas3 boricacidsolution Ifinfectionpresent potassiumpermanganate高锰酸钾 1 5000 solutionischosen appliedfor20to30minutesseveraltimesdaily Topicalsteroidsormoisturizers润肤霜areappliedimmediatelyaftercompressing敷 47 Treatingsubacuteorchroniceczema Insubacuteeczema lubricants润滑剂andtopicallow potentormedium potentsteroidsmaybehelpfulsuchashydrocortisoneointment氢化可的松软膏 Elosoncream艾洛松乳霜 膏 ForlichenifiedlesionsshouldbechosenverypotentsteroidssuchasSicorten适确得 sometimeswithocclusionforalimitedtimeForsomeobstinately顽固的localizedlesions localinjectionwithDiprospan得保松 compoundbetamethason canbeappliedfor1timeeverymonthUltravioletlightandradiotherapymaybeused 48 Newtopicalimmunemodulators Pimecrolimus吡美莫司andtacrolimus他克莫司havebeenshoweddramaticalbeneficialinsevereeczema Theyarenotadversereactionofsteroidssuchasskinatrophy persistenterythemasoon 49 Systemictherapy 1 Antihistaminicsmaybeusedtoaidinreliefoftheseverepruritussuchasdoxepin多塞平indosesofabout25to75mgasasingleeveningdosesisfrequentlyrecommendedinadultsNewantihistaminicsalsomaybeusedsuchasLoratadine Mizolastine氯雷他定 咪唑斯汀soonInacuteperiod eczemacanalsobetreatedwithcalcium vitaminC aswellasveinblockingwithprocaine普鲁卡因 50 Systemictherapy 2 Systemicantibioticssuchassemisyntheticpenicillins半合成青霉素 firstgenerationcephalosporins quinolonesorerythromycin红霉素andminocycline米诺环素canbehelpfulinsevereexudativecases acuteoozinglesions Somespecialeczemassuchasnummulareczema stasi