Occupational Associcated Hand Eczema 职业性手湿疹

手部湿疹的典型临床症状是红疹、皮肤浸润、细小囊泡、脱皮、糜烂、水肿，角化过度，皲裂(Fig.1A) [1]。在一般人群中，成年人的患病率为4％[2]。通常与职业关联的发生率是每年每千名工人0.7到1.5例，在某些职业（例如理发）中的发生率要高得多[3]。

手部湿疹最常见的外部原因是接触轻度的有毒物质或刺激性物质（例如清洁剂，水和肥皂），从而引起刺激性接触性皮炎。过敏性接触性皮炎比刺激性接触性皮炎少见，并且反应出对特定物质（如橡胶，镍或香料）的接触过敏[4]。特应性皮炎是手湿疹的内源性原因。三分之一至一半的手部湿疹患者可能患有特应性，特应性可能仅表现为手部皮炎。

本文所述是一位职业驾驶员，自述在两年前双手出现瘙痒，之后出现细小水泡，奇痒难忍，时好时坏。近一年来，双手开始干裂并且又痒又痛。皮肤科医生确诊手湿疹后，他曾口服predinololone泼尼松龙治疗，前后共计25天，停药后就发作反弹，于是要外用激素药膏Mometasone缓解瘙痒和干裂。由于每日要长时间不间断接触方向盘，湿疹已经影响他的工作，他必须要找到好方法让他的双手好起来。患者抱着试一试中药治疗的想法来看诊，图Fig.1 A是他初诊时的手部状况。由于长途长期驾驶，患者无法按时服用和复诊，断断续续经过六个月治疗Fig.1D，他的状况开始稳定图D。图E是两年后随访的状况，他现在已经不再为接触方向盘而烦恼了。

Think Different! 医学不是只有一种呈现方式，我们坚信应该以不同的方式思考。

case 63 hand ezema

Typical clinical signs of hand eczema are redness, infiltration of the skin, scaling, edema, vesicles, areas of hyperkeratosis, cracks (fissures), and erosions [1]. It is a prevalence of 4% among adults in the general population [2]. The work-related cases are ususally more severe than cases in the general population, the incidence of occupational associcated is between 0.7 and 1.5 cases per 1000 workers per year, with much higher incidences among certain occupations, such as hairdressing [3].

The most common external cause of hand eczema is contact with mild toxic agents or irritants (e.g., detergent, water and soaps), causing irritant contact dermatitis. Allergic contact dermatitis is less common than irritant contact dermatitis and reflects a contact allergy to a specific substance, such as rubber, nickel, or perfumes [4]. Atopic dermatitis is an endogenous cause of hand eczema; one third to one half of patients with hand eczema may have atopy, and atopy may be manifested exclusively as dermatitis of the hands.

 

Reference:

  1. Veien NK, Hattel T, Laurberg G. Hand eczema: causes, course, and prognosis II. Contact Dermatitis2008;58:335–339
  2. Thyssen JP, Johansen JD, Linneberg A, Menne T. The epidemiology of hand eczema in the general population — prevalence and main findings. Contact Dermatitis2010;62:75–87
  3. Diepgen TL. Occupational skin-disease data in Europe. Int Arch Occup Environ Health 2003;76:331–338
  4. Pieter-Jan Coenraads. Hand Eczema. N Engl J Med 2012; 367:1829-1837
    DOI: 10.1056/NEJMcp1104084