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变应性接触性皮炎的临床特征及诊断

Author
James Yiannias, MD
Section Editor
Joseph Fowler, MD
Deputy Editor
Rosamaria Corona, MD, DSc
Translators
向志, 主治医师

引言

变应性接触性皮炎(allergic contact dermatitis, ACD)是由T淋巴细胞介导的、针对外源性物质的迟发型超敏反应的典型表现[1,2]。人们常交替互换地使用“皮炎”和“湿疹”这两个术语，以描述以急性红斑、水疱形成及瘙痒为特点的皮肤炎症模式。长期暴露于外源性物质通常会导致红斑缓解，伴苔藓样变和持久瘙痒。临床表现根据触发物质及个体反应性的不同而可能有差异，但对于大多数患者，病变主要局限于皮肤的接触部位[3,4]。

本专题将讨论ACD的临床表现、诊断及鉴别诊断。关于ACD的病理生理学、斑贴试验及治疗将单独讨论。 (参见“变态反应性接触性皮炎的基本机制与病理生理学”和“斑贴试验”和“变应性接触性皮炎的处理”)

流行病学及危险因素

目前尚不清楚一般人群中ACD的发病率及患病率。现有的数据通常是从职业性皮炎的监测研究中外推而来。在工业化国家中，所有的职业病中有多达30%累及皮肤。刺激性皮炎和接触性皮炎占全部职业性皮肤病病例的90%以上[5]。

监测研究报道，接触性皮炎[包括刺激性接触性皮炎(irritant contact dermatitis, ICD)及ACD]的年发病率为每10万名工作者中发生13-34例[6-8]。最常引起接触性皮炎的物质包括：乳胶材料、防护设备、肥皂及清洁剂、树脂及丙烯酸脂类。关于一般人群中导致接触性皮炎的主要变应原的资料来自于针对转诊中心斑贴试验的回顾性研究。在一项研究中，金属、香料、局部用抗生素、防腐剂、护发产品中的化学物质、局部用皮质类固醇、胶水、塑料及橡胶是引起斑贴试验阳性反应的最常见变应原[9]。在儿童中，硫酸镍、过硫酸铵、硫代硫酸金钠、硫柳汞及甲苯-2,5-二胺(P-甲苯二胺)是最常见的致敏物质[10]。 (参见“变应性接触性皮炎的常见变应原”)

世界范围内的多项研究表明，在接受斑贴试验的患者中，20%至最多达40%的患者会对镍过敏[11-16]。在北美，ACD最常见的病因是接触毒葛、橡数和漆树。 (参见“毒葛(漆树属)皮炎”)

                

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Literature review current through: 2017-07 . | This topic last updated: 2016-07-11.
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