【正文】 troleum, chlorinated hydrocarbons, alcohol solvents, ethylene glycol ether, turpentine, ethyl ether, acetone, carbon dioxide, DMSO, dioxane, styrene. ? Plants: Euphorbiaceae (spurges, crotons, poinsettias, machneel tree). Racunculaceae (buttercup), Cruciferae (black mustard), Urticaceae (tles), Solanaceae (pepper, capsaicin), Opuntia (prickly pear). ? Others: fiberglass, wool, rough synthetic clothing, fireretardant fabrics, NCR paper. Irritant Contact Dermatitis industrial solvent massive blistering on the palm. This airport worker had repeatedly spilled kerosene over his hands and developed acute bullous and extremely painful ICD 24 h later. Chronic irritant contact dermatitis in a housewife. There is erythema, hyperkeratosis, scaling, and fissures particularly on the finger tips in a patient with an atopic background. subacute/chronic Erythema, edema, scaling, fissuring, crusting of the palmar aspect of the hand and wrist。 usually tiny papules Chronic Illdefined Illdefined, spreads Evolution Acute Rapid (few hours after exposure) Not so rapid (12 to 72 h after exposure) Chronic Months to years of repeated exposure Months or longer。s solution, changed every 2 to 3 h. ? Subacute and Chronic – Identify and remove etiologic/pathogenic agent. – Employ a potent topical glucocorticoid preparation, betamethasone dipropionate or clobetasol propionate, and provide adequate lubrication. ? chronic ICD – Topicalpimecrolimus and tacrolimus – PUVA Topical Therapies ? Principles ? Choose right therapeutic reagents ? Choose right solvents – Acute ? With erosion and secretion: solution ? Without erosion and secretion: powder, lotion Topical Therapies ? Principles ? Choose right therapeutic reagents ? Choose right solvents – Subacute ? With some degree of secretion: paste, oil ? Without secretion: emulsion, paste – Chronic ? Emulsion, ointment, plaster, film Management of ACD ? Topical Therapy – Wet dressings with cloths soaked in Burow39。324:1376–9 0 5 10 15 年齡 (歲 ) 特應(yīng)性皮炎 AD(濕疹 ) 食物過敏 哮喘 鼻炎 Key Features ? Chronic, relapsing dermatitis associated with intense pruritus ? Three stages: infantile, childhood and adulthood ? Often associated with – xerosis – a personal or family history of atopy ? asthma and allergic rhinitis – A geic basis that is influenced by environmental factors ? Immunoaberration – Serum IgE elevation and eosinophilia – Th2 predominance in acute lesions evolves into a predominance of IFN? producing T cells in chronic lesions Epidemiology ? 7095% of cases arise before the age of 5 years ? Prevalence – 1020% of schoolchildren。s wet dressings. Large bullae drained with a puncture but not unroofed. In dyshidrotic eczematous dermatitis, vesicles and blisters break and leave welldefined superficial erosions that are painful Seborrheic dermatitis 脂溢性皮炎 ? Clinical features – Symmetric, on forehead, eyebrows eyelids, nasolabial folds – Yellowishred erythema with fine scaling or flaky greasy scales – Active sebaceous gland – A predilection for areas rich in sebaceous glands such as scalp and face Seborrheic Dermatitis ? Scalp – Pityriasis simplex capillitii (dandruff) – white or greasy scaling ? Treatment – Topical azoles as shampoos or creams – Topical corticosteroids and emollients – Isotretinoine Asteatotic Eczema 乏脂性濕疹 ? Xerotic eczema, winter itch, dessication dermatitis ? Related to aging, xerosis, low relative humidity and frequent bathing ? Driest skin areas – Anterior shins, entensor arms, flank Dry, rough, scaly and inflamed skin with superficial cracking ? Treatment: – Limitation of the use of soap, use of moisturizers Disseminated/autosensitization dermatitis ? Secondary lesions of eczema distant from the primary site of exposure or involvement – usually occurs a few days to weeks later – Symmetric poorly demarcated p