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更新日期:2009/02/17 04:09
文/許志煌
兒童皮膚疾病是門診中,常被問到的問題,從一般的蚊蟲叮咬到嚴重的紅斑性狼瘡都有。但發生率最高,且不易控制的長期皮膚問題,還是異位性皮膚炎。
不少家長聽到這個診斷,總是一頭霧水。有些家長甚至會聞聞小朋友皮膚說:「沒有味道啊?怎麼會是異『味』性皮膚炎呢?」其實異位性皮膚炎是個錯誤名稱,但沿用許久,也就將錯就錯了。
基本上,這是一種過敏性皮膚炎,需符合下列特徵:「長期反覆發作,典型皮膚表現合併搔癢的過敏性反應」。同時容易併發其他過敏疾病,如氣喘、過敏性鼻炎。由於反覆發作又搔癢難耐,會造成生活困擾。然而大多數病童只是反覆搔癢,其他生活卻都還可以,而且需長期治療與注意生活起居細節,家長如果沒有耐心,小朋友也只好每天都「皮在癢」了。
其實,只要瞭解發生的原因,配合治療,是不難控制的。研究發現,過敏體質的兒童如果皮膚角質缺損,同時油脂分泌過少時,過敏原容易穿過皮膚,造成過敏反應,皮膚劇癢難耐。小朋友只好不停抓,形成傷口,於是更多的過敏原深入皮膚,造成更嚴重的反應。如果不治療,症狀會日益嚴重,有時合併傷口感染,還需要施以抗生素治療。
治療多以抗組織胺作為止癢藥物,合併類固醇藥膏或免疫調節藥膏局部塗劑,必要時,以抗生素控制感染。需注意的是,務必遵照醫師指示長期用藥。合理的使用藥物,發生副作用的機會極低,家長大可放心。
家長是否有耐心時時注意小朋友的生活細節,是治療最重要的關鍵。如果家長本身即患有過敏性疾病,寶寶將是高危險的潛在患者,哺育母乳可以使患病機會下降。
日常生活中,應儘可能維持皮膚完整及保濕。汗水會刺激皮膚,所以減少豔陽下的活動,開啟室內空調,儘量以不流汗為原則。穿著應選擇柔軟舒適的棉質衣物,以減少皮膚摩擦;洗澡的熱水應「適溫」即可,水溫過高會造成皮脂流失,減少皮膚保護效果,同時也應避免使用肥皂。
在洗完澡後3鐘內,趁皮膚仍濕潤時,塗抹低過敏性的保濕乳液;注意環境清潔,減少環境過敏原;指甲適度修剪也很重要。
異位性皮膚炎的治療需要家長、病童、醫師3方面的配合。 (作者為台中梧棲童綜合醫院兒童醫學部主治醫師 )
過敏兒皮在癢!「藥」怎麼辦?
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