I.

會癢

• Eczema
• Scabies
• Tinea [Mycology clinic]
• Urticaria
• Pruritus cutaneous
• Lichen urticatus
• Toxic erythema

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 CLASSIFICATION OF ITCH
• Pruritoceptive: pruritogens generated in the skin, usually by an inflammatory or
other visible pathological process (eg, scabies, urticaria)
• Neuropathic: due to anatomic lesions of the central or peripheral nervous system
(eg, nerve entrapment, as in notalgia paraesthetica) and tumors of the central or
peripheral nervous system
• Neurogenic: generated in the central nervous system in response to circulating
pruritogens, as in cholestasis, or in response to intraspinal morphine. Pruritus due to
central excitation or abnormal processing of afferent sensory information from the
periphery is also included within this category
• Psychogenic: includes delusional parasitosis, picker’s nodules, and stress-related
chronic anogenital pruritus.

Current Allergy and Asthma Reports 10, 236–242(2010)

 I.1ECZEMA (DERMATITIS)

Ill--defined, scaling and pruritic skin lesions tended to blister, weep or

Ill
become covered with crust in acute stage and pigmentation and
thickening in chronic stage.
stage.
· Itchy
Itchy..
· Acute stage
stage:: erythema that coalesce to form plaques
plaques.. Scaly, blistering,
eroded or crusted surface
surface..
· Chronic stage:
stage: pigmentation and thickening.
thickening.
· Ill
Ill--defined margin
margin..

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 I.1 濕疹樣皮膚炎

定義::皮膚表皮之炎症反應
定義
組織變化::表皮細胞間水腫
組織變化 表皮細胞間水腫((spongiosis)
spongiosis)
臨床症狀::呈下列多樣性變化
臨床症狀 呈下列多樣性變化::
●以紅腫
以紅腫,,小水泡為
水泡為主要變化者為
主要變化者為
急性濕疹
●以潮紅,
以潮紅,落屑為主要變化為
亞急性濕疹
●以表皮增厚,
以表皮增厚,落屑為主要變化為
慢性濕疹

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 外因性
• (1)
1)接觸性皮膚
接觸性皮膚炎
炎
• 刺激性
刺激性物質
物質--如清潔劑
如清潔劑,,有機溶劑等
有機溶劑等
• 過敏性物質
過敏性物質--金屬
金屬::鎳,鈷,鉻等
橡膠品::拖鞋,
橡膠品 拖鞋,手套等
有機染料
有機染料::paraphenylenediamine
合成膠
合成膠:epoxy resins
防腐劑::外敷藥,
防腐劑 外敷藥,化妝品
植物::芒果,
植物 芒果,葛藤及
葛藤及菊料等
菊料等
外用藥::汞化合物及各種虎骨膏,
外用藥 汞化合物及各種虎骨膏, Neomycin, Nitrofurazone
Nitrofurazone等
等.
• (2)
(2)光照
光照性接觸皮膚
性接觸皮膚炎炎
• 有些物質加上
有些物質加上紫外線照射使皮膚
紫外線照射使皮膚產生濕疹樣的
產生濕疹樣的變化
變化

• (3)
3)感染性濕疹樣皮膚炎
感染性濕疹樣皮膚炎
• 濕疹→細菌感染傷口→濕疹
濕疹化化 7
 內因性
內因性

(1) 異位性皮膚炎
(2) 脂漏性皮膚炎
(3) 乾性
乾性濕疹
濕疹 (低脂
低脂性濕疹
性濕疹))
(4) 錢幣狀濕疹
(5) 汗皰疹
(6) 鬱積性濕疹
(7) 自體濕疹

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• 原因性
原因性分類
分類
• Nickel dermatitis, Cement dermatitis, Mango dermatitis, Cosmetic
dermatitis, Shoe dermatitis, Scratch eczema, Occupational
dermatitis..
dermatitis
• 部位性
部位性分類
分類
• Facial dermatitis, Hand dermatitis, Eczema scroti
scroti,, Diaper
dermatitis
• 年齡
年齡或時間性
或時間性分類
分類
• Eczema infantum
• Senile dermatitis (Asteatotic
(Asteatotic eczema)
• Dermatitis hiemalis、
hiemalis、Dermatitis aestivalis
aestivalis..
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濕疹之處置:
濕疹之處置:
1.對症下藥
1.對症下藥::
a.外用治療
a. 外用治療： ：基劑(vehicle, base)
base)之重要性
之重要性
(1)急性濕疹
(1)急性濕疹::濕敷
濕敷,,清理
(2)亞急性濕疹
(2)亞急性濕疹::舒緩炎症
(3)慢性濕疹
(3)慢性濕疹::密封
密封式式
b.系統性免疫抑制劑
b. 系統性免疫抑制劑
c.光線治療
c.光線治療
2.鑑定原因
2.鑑定原因:: (1)問診周詳
(1)問診周詳
(2)貼膚試驗
(2)貼膚試驗
(3)定期追蹤
(3)定期追蹤
(4)實地調查
(4)實地調查
3.去除原因
3.去除原因
4.說明重點與患者
4.說明重點與患者
(1)絕對不可抓皮
(1)絕對不可抓皮
(2)預期
(2)預期病程
病程 10
 神經性皮膚炎

• 癢 抓 癢 抓 苔癬化(
苔癬化(lichenification)
lichenification)
• Lichen simplex chronicus
• Prurigo nodularis 結節性癢疹

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LICHEN SIMPLEX CHRONICUS

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PRURIGO NODULARIS

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 PRURIGO NODULARIS
• 所謂癢疹，一般是指呈突起狀的癢疹，可
以分為急性癢疹〈一般指蚊蟲叮咬〉、亞
急性癢疹〈相當於丘疹性溼疹〉及慢性癢
疹〈即結節性癢疹〉
• 結節性癢疹可以是色素異常、丘疹、結節
、板塊、潰瘍。
• 多數結節性癢疹，只是單純的皮膚問題，
或是伴隨異位性體質，但有時也可能是愛
滋病、淋巴病等全身疾病的表現，而一些
其他皮膚病如扁平苔癬、水泡症等，也可
能有相似皮膚的表現。
• 癢可以是陣發性、或是持續性，因為熱、
流汗、衣物刺激而惡化。
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• 睡眠及情緒常常受到嚴重干擾
POMPHOLYX (DYSHIDROTIC ECZEMA)
A distinctive primary vesicular eruption of the sides
of the fingers and toes and palms and soles, may
associated with hyperhidrosis.
hyperhidrosis. It may become dry,
fissured and chronic
chronic..
• Itchy
Itchy..
• Deep
Deep--seated vesicles and occasionally bullae present.
present.
• Sides of the fingers and/or toes.
toes.
• Palms and soles
soles..
• Becomes dry, cracked and painful
painful..
• Occurs especially in the spring.
spring.
• Associated hyperhidrosis
hyperhidrosis.. 15
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 I.2 SCABIES

An intensely itchy, contagious eruption

caused by infestation with a mite that
burrows into the stratum corneum.
corneum.
• Intense itch.
• Intimates also affected.
• Burrows, especially on palms and soles.
• Papules between the fingers, on the trunk and genitalia.
• Excoriations and bruising, especially on the legs

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I.3 TINEA [MYCOLOGY CLINIC]

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 I.4 URTICARIA AND ANGIOEDEMA

• Wheals: red swellings with central pallor

• Various sizes and shapes
• Itching and transient, individual wheals disappear within 24 hours
• Acute or chronic (At least 6 weeks)
• Maybe immunologic and nonimmunologic mechanisms
• Type 1 (immediate hypersensitivity) immune reaction
• Complement pathway activation
• Histamine release
• Common causes: Drugs, foods, inhalants, infections, etc.
etc.
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 I.5 Pruritus cutaneus
GENERALIZED SKIN ITCHING WITHOUT
DIAGNOSTIC SKIN LESIONS. ETIOLOGY:
• Liver disease • Diabetes
Biliary obstruction • Internal Malignancy
• Chronic renal failure Lymphoma
• Iron deficiency Multiple myeloma
• Polycythemia • Dry skin in elderly
• Thyroid disease • Psychogenic
Hyperthyroidism [Psychocutaneous clinic]
Hypothyroidism
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 I.6 LICHEN URTICATUS (INSECT
BITES)
A cutaneous reaction to a biting or stinging
arthropod, usually causing itching and
sometimes acting as a vector of disease.
• Itchy
• Urticated papules, sometimes with central punctum, often excoriated.
• Sometimes blisters or surrounded by white halos.
• Occur in groups.
• Asymmetrical.
• Often one member only of the family affected.
affected.

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 I.７ TOXIC ERYTHEMA
I.７
(TOXICODERMA
TOXICODERMA,, TOXICODERMIA
TOXICODERMIA))
• Morbilliform eruption is most common.
• Morbilliform eruption consists of fine blanching maculopapules
maculopapules,,
which are symmetric and appear suddenly.
• Virtually any drug may be associated, but, the most common inducing
agent is antibiotics
• Morphologically, it is hard to distinct morbilliform drug eruption from
viral exanthema.
exanthema.

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