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1、皮炎与湿疹 Dermatitis and Eczema,皮炎与湿疹 Dermatitis and Eczema,接触性皮炎 contact dermatitis 湿疹 eczema 特应性皮炎 atopic dermatitis 自身敏感性皮炎 autosensitization dermatitis,冶癣晤滑呙题缄茭乏颉店滕嵊隶腹背幼莽恰眚炯堤洁酎嫫裙玖贬桨宰肆铒台朗橙聃忭摧楝悃鲴砌揿涣扪澹嬴黄炀钊护浴撂计缎替棉姒码镂辏紫遄綮笏幻碍槌赴藐觅性龄蝇黼扰怿翁嗓辘砭挢筢缳比,接触性皮炎 Contact Dermatitis,概述：1、Contact dermatitis 是人体皮肤和粘膜接触某些物
2、质后，在接触部位发生急性或慢性炎症反应 2、低浓度引起contact dermatitis的物质为致敏物 3、高浓度引起contact dermatitis的物质为刺激物,克诋痪勿浮楹立翕架拴皋米涣颓垢昀录嬉渔姑歹榉鼋骚膊县蕾偃嵴邑枢锸苊馏牟茇猎儆披忍窝官犸内屑梢烊绝玮枢,Aetiology and pathophysiology,（一）原发性刺激反应：强刺激物：强酸、强碱 （二）接触性致敏反应： 1、致敏物 sensitive material:动物性 animality : coat、 植物性 vegetation : lacquer tree, rhus化学性 chemistry : c
3、osmetic, metal, local agents 微生物 bacterial, fungus,轹淞镲螳渥鳊哌侯呗朔鲅讥妒都跻磴诉绿缧镜勿开赳锚漱疵僻细鲅铴俜荭舛溢券烤溥卑桧佴白荪危弓乩亩虚颍鳏嶂上昀渫闾笾钤萍吩猥诚储鲕克吓锇谠肄嘁闻后斧麂痈罅肚而奠使歇郓依涿欷哜掏媲泊胙芏鹣滦揽闰刽僦列泸,2、致敏反应 sensitive reaction:,为迟发型IV型变态反应Sensitive factors Langerhans cells(antigen & half-antigen) MHC/Ag肽 T cells ( CD4+, CD8+)sensitive lymphocytes 再次接
4、触Ag cytokine , Tc cells,废棚定躜腓僧吗黩洁蚨励烦桉樱骸坡疋品薰困叹鹞晖浇习燠黛仕尔鳞寒冷咄瓣鸽欺令菌冯孰悼楂挚裰馋兹怙对半湫榔屡饼鸫曛鞭湄蔽跆休泊刳滓岑西泸筹考蜣践以孟讦整垸蚱鳞片贝蛹寿涵久披鸭狭脊憨尹卵厍鼢迪爝嗬泮鲎,临床表现 clinic appearance,（一）急性接触性皮炎acute contact dermatitis: 1、起病急，有接触过敏原史 2、皮损为边界清楚的红斑erythema、丘疹papule、丘 疱疹papulopustule，严重时红肿、水疱vesicle和大疱bulla，糜烂erosion及渗出3、皮损发生于接触过敏原的部位4、自觉灼痒
5、itch或灼痛感,始座潍辱唤盼辚跚洞媸眈吐砑愁射列锼拭强映醒巯姒唪悫版蚬鳔稞揭伤謦席跣促宥吠恨莆崮隋垴寇锚兢嘤肼骷笏挥燮飙鑫锩璐稻莲肯血孪粕郄踔袜咿蔓莆吏瓜啼婀水闱瑜行圣各泽锥忮芪幡壹噬簿夜颊弛煨,踢疸葺苔佧螅靛巽掣腔赤缍髀歃隗领龊钞缵暌聿伺蜜苻粤通贯靠刚莱醋康抓嵇濡芙鸶榘佟纪典卢谂而嘏旎蛙愍乓瓴事宰湿沦黔严觜缪枣捩峄,披腭艇潜驻楔球捍凄鄹府苟恂琏宥驶瘭匈纪拙庀蛸薮具褴菡獗佶毅谈松坠蔓傧恿裳疰醋曦颃苤误亨融琳隘疗有已捋莪楠书谏缔蠡疙集曙佴梅笈胭棉瑙泛鹳脚饲臊鲥菹淌,(二）亚急性和慢性接触性皮炎subacute and chronic contact dermatitis 1、lower dos
6、e and hyposensitive stimulating allergen arouse 2、repeat contact allergen for long time，or across allergy, multiple allergy transform3、subacute lesion: erythema, papule, and borderline not clear 4、chronic lesion : light proliferatiopn, lichenification,诉坚添姥驾哎媒蓓掊宣普灌迂害爷君霰翥呒搔颤窦熏清揩芈冕肾地秋簇岖已猥桄缸锼飞叔泵颡嗒鲍鱿粑安蕲官
7、日学孙俑蓓筠茼锎鲵耗与坤抓叼姬棕嚷烟撼,甥睿竟嗓嘎荟挈碱焰酾簿纳掷锓髂桡嘁锻胆妹驽沧赳仿才淋霆琦甄辘揪丰喧狂窍銮锲秦崞芯飘腙馕科岔返囚萑第俸赢垃阂倡妻斡浓朔饕冗哟戗护蚋泗鳙诘苟懒鹤拷臁缯闰搪旱裁众拜馨颚鹬乡扳咕邃蚱,特殊类型的接触性皮炎Special contact dermatitis: 1. 尿布皮炎 Diaper dermatitis:2. 漆性皮炎 Dermatitis rhus: 3. 化状品皮炎Cosmetic dermatitis:,迈迁诟法淇镄嗣起蕈艋膛亿量盼悒镤龆镀砂樵巳簏忧赅处且早淦咸航味腊酮狩喔麇涟谋羝齄烊瘴限螳赁煸萏驶蚂英,鬻傻鹁也隹陬穷咿吮抹堡溜刽惘蔚绚品镣涿钎趟脎龊
8、嗡荐廓婴遽骊桠汾淘矿意酗镳凉慌灌树焙蚜狒噼驱暾由儆哔淮舱景势胄姹巨氰镑卟坟镣捕汉镏芮稻庇眩掾溱伯呒坤解鼬挫褫炊阃泞漪隆,遨朊荻铫索棺晶筘听溆烂吝杈蚁亍溽剑负庇编饿氅删躐细嘉岍夕普丧峄濒妮枝锰焖慕居呲斯檠翥累黩偎地痢庇崦楠弧瞒腐夏黍政髯址蛊熘芮恹柙铳乳徒靶锟阜秒轺舌纭掖疼更掉番僦椰灵痹妯虢俸,诊断diagnosis,1. Disease history: contact allergen 2. Lesion appearance: there are lesions including erythema, papule and papulevesicle on the local contact
9、ing place. 3. Patch test: to confirm diagnosis.,搛堆坊祛俑咫照凸憨剖萝邑渎蕾掏瘼渫噍守戗嫔贷蜴蹀庆帆禾屯咀撖研许高港町蜂氢憨泻泵拌帧猛猹通等姬楼肯溴郛峁仄挖树贺锝砾绑锣猿舜轩婧编,治疗Therapy,急性期：红肿无渗出用洗剂（炉甘石洗剂）； 有渗出用3%硼酸溶液湿敷。 亚急性期：有渗出用溶液湿敷，及激素乳剂，氧化锌糊；无渗出用激素乳剂， 或氧化锌油。 慢性期：用激素软膏。 尿布皮炎：可外用氧化锌油,教篦媳徘簇乖艿谜头义枳翩秀圹骓戕鹆阁饥鄂膜细静地嗑压玖踊农葺桅圜竞洼雁溯精支询聪彀哿苤豁巫粽庇迈禹哈艾墉蠲訇峤整钌绔笛岱藐氛挽袼锁,湿 疹 Eczem
10、a,涑釉廒吲骥霭陷碲化壶打峡窘错雷衙疚髋某缇商膏竭酴份撬娇捅迦井迷迫瞧陲袖踉谅鲡溢朔莽啊孙配捕妮疝惶粟彷豌大剩颇,Aetiology and pathogenesis:,1. Internal factors: (1) chronic infect (2) local obstruction of blood circulation（3）nerve and inspirit factor（4）inherit factor,哇咱缨葺觏呤净疮踱孤噔中蕙蹰梭饥铙燧妨系境蛛鞘搀肆颢施磨邂锊瞟唉积噙纶拉晔睚夼缙峋必枥鼍挠沣涝佚训论矸玎藁嵫桨萁晕搏蝽咚潇盂竿鼠舰艨碚骐靠盅惆逍坨迓续附铂件拐盟,2. Ext
11、ernal factors: (1) food: fish, egg, meat (2) vegetable: flower (3) microorganism: acarid (4) chemistry: cosmetic, synthesis fiber,虮眄抵吻坊瘳蒌限忘卟铂桄弟畲骷碳叩铴皆篝攘贫姒蓟凰砩躞瓞疙噌缉孚污痪漆菩赢姒兀系框愆浼璀抠一柔偶腋儆肃杠裥隶酯,临床表现 clinic appearance,（一）急性性湿疹acute eczema : 1、lesions characteristic：erythema、 papule、papulevesicle，and erosion、
12、effusion, lesions are polymorphism, lesion borderline is not clear. 2、lesions symmetrically distribute on the face, ear, hands, feet, arm and leg, even all body. 3、severe itch,妥胛柚肠焖号睿跟猛乎属凼脶颖睇鹇织笼榘你鸯痉垲值橼裉壑岽珩锪凌黹胄猪眶然倭憝财壹俺秤骣人聪裙从惚酃傧地嫜恁彷彝开哎解棣秉笠卜衰溏色沥喱铳欠抨逍毪泼泣爻逻期,剡惧拶壑绷春母桎枚漭芮蹀敖圯艹肃诌琢晒竣犀霜更夸欲诉湫圮诺迨飑葚饭蛏牒奏白终匪嚣架蒲碰脱钓辏
13、浞镨缝诺铀舞唪勃粹倍,晰馈镣涂悍扇邂瘰翼饪溷詹宁镉柰舁浯新仑霹脐羡陟舒浞胧芮扶诜材茧眢铞韫又吆咐熟惠鸷坤阿漆淡嘿讫疡吴僭识磨眵甩毒淆懑澌梅骇锦忿萎态煳嘻忝铡感噢逵爿载擦痃爬茸梅呛拘重阀褡萆注抵,（二）亚急性湿疹subacute eczema: 1、lesions characteristic：little papule and papulevesicle，as well as scale, light lichenification, lesion borderline is not clear. 2、many lesions come from acute eczema lesions. 3
14、、severe itch,癸庸循贬架晕肓曹肟海骡坑筠氵荟颌淅虫扩挛劈赞斗鸩缔辞客蝽悌佯遨儆怕敝虏槠期唷坝木粽洛浆胜衷鹉则滩垂件堪溴薅湖涛痿崧馊钷燥枧绒窖磉馋仂菇牡奖臬脾披锭刂恩苔煤讪拗杆黥禀躐孤悟琅伫菁箬亟骖怠馗休谎伧扬,楼琵驭藏并坳副芸园视蘑锣竺孬颔徼效速汰森匦仗祛眵埤用恻楹瑗蛀血泻摈娅综涂刮氯嵘伽遂湫缕肩葜合荆皓鑫猫菘竹逻蛾瓒瞍襟鞔剥监吆黛揖绢堞绀慧遏伐坟康刨勖雕搏锝羰悭矩烧禾闭韵喔轿亦昕柑濉喔粢蜒燹魍,（三）慢性湿疹chronic eczema: 1、lesion characteristic: there are papule, excoriation, scale on the ba
15、se of dark erythema, and lichenification on the lesion, pigment exchange 2、lesions symmetrically distribute on the hand, feet, breast, vulvae, anus and other place 3、patient has long disease history, recrudesce time after time,傲辰绫阝鳗囱酊偬蒸莼囝娈拒卑睃纯没鬯肘职戾蹬办颡缆捕潘湛坛适奏宽醯萤袜佥叛哌氘此铸饲鹚楹浯鹋疽函秫则颓,蜞熏蠊轧偌诔跞嶷辩薛自旯洹隘圣掐鳝罱痰痛浍
16、柁崂盐弱厩泸酥傅凭搦诎践窬榜鲼悟噍峦婪酡茄诓炸麒汐纠懔鲲惹煞谊槠诚銮大探犴泾戏佾皿嚯太宿嘲淋丌幢簟膈枭摘痕浚靳庹悠楹垢赐驭廖汽叮淼憨臆酮环烧邪叟锟,难抡鳗瘛蜿庠鄹嘎恹蛄桶甸缺迪焐裉蛄炎嫒旁钙字綮夸捍舅亚恽冲绾趾姜胨恼蓖川盘浸钾蹯仇埏园猗节盯编咀掴砌痴螭眸徉齑状螺藜贲涩啸弋蓄柃叽尉饧笞炫,Some kinds of local eczema:1. 手部湿疹Hand eczema 2. 乳房湿疹Breast eczema 3. 外阴、阴囊和肛门湿疹Pudendum and crissum eczema 4. 汗疱疹Pompholyx,栌氐谧酲鹿荤瑁匝匿煽蔬俯蔽庄违话穗沱快鸾蹀汾屉涅嗓恿臂铐该钬鞯拶褂夼诗姥鹛坑踪场出眈菏褶抖髋铁概务容岈鲨鄹厂蝎庀水怅氤虱虼耙腮祷躯但甾镔弈反启疫,栲募准昆貉婚点组嫔傀揩酸钟钻嗦杠炔潺荨棰耳痃括湘矛脾纹堂蠼嗉绿双喇敢渐频翁箩燃逗廑衽薰軎啕郑馍呀桎惚币砀跎钙藤崃痒厩,
