[13] 診斷 [14] vesicle bullae acrosyringium parakeratosis acanthosis 鑑別診斷 [1-3] 1. allergic contact dermatitis patch testing 2. irritant con

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1 家庭醫業汗皰疹之臨床表現及處置蔡依妙1 張賢政2 張孟捷3 產生之液體 [6, 8] 名稱及流行病學 3. 皮膚真菌感染引起之自體免疫反應 id 汗皰疹或汗疱疹是一種會產生劇癢的水泡型病灶通常長在手掌腳掌或手指側邊 [1, 2] 且容易復發汗皰疹 dyshidrosis或pompholyx 的名稱起源於西元1873年當時普遍認為這種 [3] 水泡病灶是由汗腺長出雖然後來證實此種病灶與汗腺無關 [4] 但名稱仍沿用至今發生率佔所有手部皮膚炎症的5%到 20% [5] 發病者大部分為年輕成人男女比率相當 reaction 又稱自體濕疹化反應 (autoeczematization) [7] 4. 靜脈注射免疫球蛋白[8-9] 5. 多汗症[6] 6. 吸菸[10] 7. 紫外線暴露[11] 8. 顯性基因遺傳[12] 9. 生理或心理上的壓力[2] 臨床表現汗皰疹的病程約3-4週在手腳掌病因的水泡通常是對稱性的分布手指的則不一定常起始於皮膚搔癢感之後於手汗皰疹的確切病因目前並不清楚普遍認為是多因素共同造成相關的因素包括 2. 接觸局部接觸或吸入性過敏原或刺激物質特別是金屬製金屬工業 1 醫療財團法人羅許基金會羅東博愛醫院家庭醫學科住院醫師 2 醫療財團法人羅許基金會羅東博愛醫院家庭醫學科主任 3 臺北市立聯合醫院陽明院區家庭醫學科住院醫師關鍵詞 dyshidrosis, pompholyx, contact dermatitis, atopic dermatitis, dermatophytid (id) reaction 乾掉並脫屑 [1-3] 症狀嚴重的時候可能影響到指甲的甲床造成指甲萎縮變色次發性的感染通常為金黃色葡萄球菌亦有可能發生嚴重時可能併發淋巴結腫大[2] 汗皰疹容易復發復發的時間間隔可能為數週數月至數年在溫暖的天氣通訊作者蔡依妙家庭醫學與基層醫療這種深層水泡 vesicles 可能融合成大型水泡 bullae 持續存在數週接著 1. 異位性皮膚炎病史[6, 7] 182 掌手指外側或腳掌產生水泡合併劇癢特別容易復發生理或心理上的壓力亦第三十二卷第七期

[13] 診斷 1. 2. 3. 4. [14] vesicle bullae acrosyringium parakeratosis acanthosis 鑑別診斷 [1-3] 1. allergic contact dermatitis patch testing 2. irritant contact dermatitis 3. bullous tinea KOH 4.

2 [13] 診斷 [14] vesicle bullae acrosyringium parakeratosis acanthosis 鑑別診斷 [1-3] 1. allergic contact dermatitis patch testing 2. irritant contact dermatitis 3. bullous tinea KOH 4. atopic dermatitis 5. h e r p e t i c infection Tzanck smear polymerase chain reaction, PCR 6. palmoplantar pustulosis 7. autoimmune bullous diseases bullous pemphigoid pemphigus vulgaris 家庭醫學與基層醫療第七期 183

3 治療 [15] (Burow's solution) (witch hazel) 藥物治療 (autoeczematization) [2] / 1. high potency super high potency ointments (creams) (solutions) (foams) [1, 2, 15] 2. calcineurin inhibitors moderate potency [16] tacrolimus 0.1% ointment 184 家庭醫學與基層醫療第七期

4 1. prednisolone20-30 mg 5 mg 48 [2] 2. [17] 3. [2] 評估療效 KOH PUVA psoralen plus UVA therapy [18] phototherapy methotrexate, mycophenolate mofetil cyclosporin [19-20] 結語參考資料難治疾病 (Refractory disease) 1. Veien NK: Acute and recurrent vesicular hand dermatitis. Dermatol Clin 2009; 27: 家庭醫學與基層醫療第七期 185

5 2. Anthony du Vivier: Atlas of Clinical Dermatology. 4th ed. London: Elsevier, 2013: Lofgren SM, Warshaw EM: Dyshidrosis: epidemiology, clinical characteristics, and therapy. Dermatitis 2006; 17: Kutzner H, Wurzel RM, Wolff HH: Are acrosyringia involved in the pathogenesis of "dyshidrosis"? Am J Dermatopathol 1986; 8: Meding B, Swanbeck G: Epidemiology of different types of hand eczema in an industrial city. Acta Derm Venereol 1989; 69: Lodi A, Betti R, Chiarelli G et al: Epidemiological, clinical and allergological observations on pompholyx. Contact Dermatitis 1992; 26: Pitché P, Boukari M, Tchangai Walla K: Factors associated with palmoplantar or plantar pompholyx: a case control study. Ann Dermatol Venereol 2006; 133: Guillet MH, Wierzbicka E, Guillet S et al: A 3 year causative study of pompholyx in 120 patients. Arch Dermatol 2007; 143: Shiraishi T, Yamamoto T: Severe dyshidrotic eczema after intravenous immunoglobulin therapy for Kawasaki syndrome. Pediatr Dermatol 2013; 30:e Douwes KE, Karrer S, Abels C et al: Does smoking influence the efficacy of bath PUVA therapy in chronic palmoplantar eczema? Photodermatol Photoimmunol Photomed 2000; 16: Man I, Ibbotson SH, Ferguson J: Photoinduced pompholyx: a report of 5 cases. J Am Acad Dermatol 2004; 50: Chen JJ, Liang YH, Zhou FS, et al: The gene for a rare autosomal dominant form of pompholyx maps to chromosome 18q22.118q22.3. J Invest Dermatol 2006; 126: Hald M, Agner T, Blands J et al: Clinical severity and prognosis of hand eczema. Br J Dermatol 2009;160: Uptodate: Acute palmoplantar eczema (dyshidrotic eczema). com/index.html#!/contents/acute-palmoplantareczema-dyshidrotic-eczema?source=search_re sult&search=pompholyx&selectedtitle=1~21. Accessed November 1, Warshaw EM: Therapeutic options for chronic hand dermatitis. Dermatol Ther 2004; 17: Ashcroft DM, Dimmock P, Garside R, et al: Efficacy and tolerability of topical pimecrolimus and tacrolimus in the treatment of atopic dermatitis: meta-analysis of randomized controlled trials. BMJ 2005; 330: Pariser D: Topical corticosteroids and topical calcineurin inhibitors in the treatment of atopic dermatitis: focus on percutaneous absorption. Am J Ther 2009; 16: Tzaneva S, Kittler H, Thallinger C et al: Oral vs. bath PUVA using 8 methoxypsoralen for chronic palmoplantar eczema. Photodermatol Photoimmunol Photomed 2009; 25: Egan CA, Rallis TM, Meadows KP, Krueger GG: Low dose oral methotrexate treatment for recalcitrant palmoplantar pompholyx. J Am Acad Dermatol 1999; 40: Granlund H, Erkko P, Eriksson E, Reitamo S: Comparison of cyclosporine and topical betamethasone 17, 21 dipropionate in the treatment of severe chronic hand eczema. Acta Derm Venereol 1996; 76: 家庭醫學與基層醫療第七期

脂漏性皮膚炎之介紹及其藥物治療暫時性受損, 導致 C18:1 的數量增加而病因素, 整理如表一所示 C18:2 的數量減少 1 下列將 SD 可能的致表一可能造成脂漏性皮膚炎的因素 1

脂漏性皮膚炎之介紹及其藥物治療暫時性受損, 導致 C18:1 的數量增加而病因素, 整理如表一所示 C18:2 的數量減少 1 下列將 SD 可能的致表一可能造成脂漏性皮膚炎的因素 1 第 2 期脂漏性皮膚炎之介紹及其藥物治療國軍臺中總醫院藥劑科藥師謝永宏吳承恩陳俊源國軍臺中總醫院醫師陳冠宇壹前言脂漏性皮膚炎 (seborrheic dermatitis, SD) 是一種慢性的發炎性疾病, 常可在脂漏性腺體發達的地方發現,