皮炎濕疹英文版

Dermatoses

ContactDermatitisDefinition:

inflammatoryreactiononcontactarea2.

Irritantdermatitis:

acuteandchronic3.

Allergicdermatitis:acquiredsensitivity1Allergiccontactdermatitisfromashoe2Allergiccontactdermatitisfromahatband3Etiology:PrimaryIrritantsandAllergens1.

Animals:toxin2.

Plants3.

Chemicals(metalsandchemicalmaterials,topicalmedicine,cosmetics,insecticides,rubber,detergents)4Mechanism:PrimaryIrritantReaction1.

Irritant:strongandweak2.

Anyone3.

Concentration:highandlow(repeated)4.Contactingtime5MechanismContactAllergic

Reaction1.

TypeⅣallergicreaction2.

Induction(4days):firsttimecontactwithantigen

--hapten(semiantigen)+proteinofcellmembrane+LCs’surfaceHLA-DRantigen→completeantigencomplex--sensitizingTlymphocyteatepidermalanddermaljunction--then,movingtolymphnodetoformlymphoblastecells,toproliferateandtodifferentiatetomemoryTcellandeffectTcell,whichflowtowholebodywithblood6Mechanism:ContactAllergic

Reaction3.

Challenge(24to48hours):2ndcontactwiththesameantigenorsimilarone--toformcompleteantigencomplexasabovementioned--then,interactingwiththesensitizedTlymphocytetocauseinflammatoryreaction7ClinicalManifestationWell-definederythema,papules,papulovesicles,vesicles,bullaeb.Notdefinedlesioncausedbyair-borncausativefactorsc.Causativesubstancesd.Subjectsymptom:itching,burning8Allergiccontactdermatitisfromashoe9Allergiccontactdermatitisfromahatband10TypesAcuteCD2.SubacuteCDandchronicCD3.Specialtypes:diaperdermatitis(ammoniairritant)dermatitisrhus(volatile)

cosmeticdermatitis

(perfume,benzoicacid)11圖例強堿刺激強酸刺激12圖例接觸性皮炎(鎳、鉻）13圖例橡皮筋過敏14DiagnosisContacthistoryb.Clinicalmanifestationc.Patchtest:ThemostsimpleandreliabletestforthediagnosisofCD.Standardscreeningallergenseries,contactsubstance,relativeallergenseries.15TreatmentandPreventionTheprinciples:a.Determinethecausesb.Avoidthecausativeagentsc.Treatthesymptoms16TreatmentandPreventiona.Topical:

Acutephase–calaminelotionforerythemaandedema;3%boricacidcompressforexudation

Subacutephase–zincoxideoilforsmallamountofexudation;steroidcreamfornoexudation

Chronicphase–ointmentb.Systemic:antihistamine17Eczemaa.Inflammationofsuperficialdermisandepidermisb.“Eczema”isdescribedas“pruriticpapulovesicularprocesswhichinitsacutephaseisassociatedwitherythemaandedema,andwhichinitsmorechronicphases,whileretainingsomeofitspapulovesicularfeatures,isdominatedbythickening,lichenification,andscaling”.18Etiologya.Exogenouscauses:food

(fish,shrimp),absorbedproducts

(pollen,mite,wool,organism),environment

(sunlight,heat,drying),animalfur,dandruff

(scurf),chemicals

(cosmetics,soap,syntheticfiber)

19Etiologyb.Internalcauses:chronicinfection,endocrineandmetabolicchanges

(menstruation,pregnancy),disorderofbloodcirculation

(varicosisoflowerlegs),emotionalfactorsandmentalstress.c.Mechanism:TypeⅣallergicreaction20Clinicalfeatures:Acuteeczemaa.Primarymultiformeruptionssuchaserythema-basedsmallpapules,papulovesicles.Inseriousconditiontherearevesicles.Allofthemcanconfusedtoformalargepatchwithoutdefinedborder.Erosionwithexudationisnotedduetoscratching.b.Acuteeczema+HSV→eczemaherpeticum21Flexualeczema22圖例23Infantileeczema24Seborrhoeiceczemaofinfancy25Clinicalfeatures:SubacuteeczemaFollowingacutephase,thelesionisdominantbypapulesandsmallnumberofpapulovesicleswithduckcolor,scalesandlightinfiltration.26Discoideczema27Discoideczema28圖例29Clinicalfeatures:ChroniceczemaFollowingacuteorsubacutephaseorfromthebeginningwithlightinflammation,themaineruptioniserythema-basedpapules,scratchandscales.Theskinisthicken,rough,presentinglichenificationwithhyper-orhypo-pigmentation.30圖例31Folliculareczema32Clinicalfeatures:CommoninvolvedareaAcuteeczema–face,ears,hands,feet,lowerlegs;usuallysymmetryChroniceczema–hands,feet,lowerlegs,fossacubitalis,thigharea,breast,vulva,anus;symmetryinmost33Clinicalfeatures:Specialtypes1.Eczemaofhand,breast,vulva,scrotum,andanus2.Nummulareczema3.Pompholyx(dyshydrosis)4.Atopicdermatitis(infantile,child,adultphase)5.Autosensitizationdermatitis(infectiouseczematoiddermatitis)6.Stasisdermatitis7.Eczemacrapuele(asteatoticeczema,xeroticeczema)34HistopathologyofEczemaAsevereexudationbetweencellsoftheepidermis(spongiosis),togetherwithaninflammatoryinfiltrateinthedermis.Thedermalinfiltrationisusuallylymphocytesinnature.35DiagnosisofEczemaInanacutephase:multiformlesions,exudation,itching,symmetryInachronicphase:infiltration,thickening,lichenification36DifferentialdiagnosisDifferentiationbetweenacuteeczemaandcontactdermatitisCausesLesionAreaSymptomDurationAcuteeczemaUnknownPrimarymultiformwithoutclearborderSymmetric,generalizedVeryitchingRecurrentContactdermatitisHavingcausesUnitarywithclearborderCircumscribedtocontactareaItchingorburningRecoveredquicklyafterremovingthecauses37DifferentialDiagnosisChronicEczemaandLichenSimplexChronicusHistoryLesionLocationDurationChroniceczemaFromacutephaseDarkred,infiltratedthickened,pigmentation,surroundedwithsmallpapulesandpapulovesiclesFace,feetandhands,fourextremities,trunkandvulvaLongwithacuteorchroniccourseandoozinghistoryLSCProminentitchingLichenification,flattenpapuleswithnormalskincolorNeck,sacro