異位性皮膚炎診斷標準 from uptodate

2023-05-11 11:16AM
異位性皮膚炎, 雖然也可以做皮膚切片或抽血檢驗. 但多數患者並不需要做這些檢驗. 
主要是根據病史及理學檢查診斷. 
做檢查的目的. 是為了排除其他皮膚疾病 (證實不是其他疾病發生症狀)

下面是google中文翻譯
英國診斷標準 — 已提出多套診斷異位性皮膚炎,的標準。雖然它們通常用於流行病學研究，但它們為臨床環境中的診斷方法提供了指導。

英國異位性皮膚炎,標準工作組包括一項強制性標準和五項主要標準，但不包括 Hanifin 和 Rajka 最初提出的過敏標準 [ 160,161 ]：

●皮膚瘙癢的證據，包括父母或看護人對孩子摩擦或抓撓的報告

除皮膚瘙癢外，還需符合以下三項或三項以上才能確診：

●涉及皮膚皺紋的歷史。這些包括肘窩、膕窩、頸部、眼睛周圍區域和腳踝前部。

●哮喘病史或花粉熱病史（或 4 歲以下兒童一級親屬的特應性疾病病史）。

●過去一年內皮膚普遍乾燥。

●兩歲前的兒童開始出現症狀。該標準不適用於 4 歲以下兒童的診斷。

●累及彎曲表面的可見皮炎。對於四歲以下的兒童，影響臉頰或前額和四肢外側的皮炎符合這一標準。(參見 上文‘共同特徵’  )

美國皮膚病學會診斷特應性皮炎的標準包括三組基本、重要和相關的特徵 [ 2 ]：

●基本特徵：

•瘙癢症

•具有典型形態和年齡特異性模式的濕疹（急性、亞急性、慢性）：

-嬰兒和兒童的面部、頸部和伸肌受累

-任何年齡組的當前或以前的彎曲損傷

-保留腹股溝和腋窩區域

•慢性或複發病史

●重要特點：

•發病年齡早

•個人和/或家族特應性病史、IgE 反應性

•乾燥症

●相關功能：

•非典型的血管反應（例如，面部蒼白、白色皮膚划痕症、延遲變白反應）

•毛髮角化病、白糠疹、手掌多線、魚鱗病

•眼周變化

•口周變化、耳周病變

•毛囊周圍加重、苔蘚化、癢疹樣病變

Diagnostic criteria — Several sets of criteria have been proposed for the diagnosis of atopic dermatitis. Although they are generally used in epidemiologic studies, they provide guidance to the diagnostic approach in clinical settings.

The United Kingdom Working Group on atopic dermatitis criteria include one mandatory and five major criteria but do not include allergy criteria as originally proposed by Hanifin and Rajka [160,161]:

●Evidence of pruritic skin, including the report by a parent or caregiver of a child rubbing or scratching

In addition to itchy skin, three or more of the following are needed to make the diagnosis:

●History of skin creases being involved. These include antecubital fossae, popliteal fossae, neck, areas around eyes, and fronts of ankles.

●History of asthma or hay fever (or history of atopic disease in a first-degree relative for children <4 years of age).

●The presence of generally dry skin within the past year.

●Symptoms beginning in a child before the age of two years. This criterion is not used to make the diagnosis in a child who is under four years old.

●Visible dermatitis involving flexural surfaces. For children under four years of age, this criterion is met by dermatitis affecting the cheeks or forehead and outer aspects of the extremities. (See 'Common features' above.)

The American Academy of Dermatology criteria for the diagnosis of atopic dermatitis include three sets of essential, important, and associated features [2]:

●Essential features:

•Pruritus

•Eczema (acute, subacute, chronic) with typical morphology and age-specific patterns:

-Facial, neck, and extensor involvement in infants and children

-Current or previous flexural lesions in any age group

-Sparing of the groin and axillary regions

•Chronic or relapsing history

●Important features:

•Early age of onset

•Personal and/or family history of atopy, IgE reactivity

•Xerosis

●Associated features:

•Atypical, vascular responses (eg, facial pallor, white dermographism, delayed blanch response)

•Keratosis pilaris, pityriasis alba, hyperlinear palms, ichthyosis

•Periocular changes

•Perioral changes, periauricular lesions

•Perifollicular accentuation, lichenification, prurigo-like lesions