光學治療濕疹 徹底舒緩痕癢

濕 疹 

異位性皮膚炎(濕疹): 臨床表現

 

核心特徵為痕癢(診斷的必要條件 - 不痕癢的皮疹不是濕疹)、乾燥，以及符合年齡分布型態的慢性反覆病程。

支持性特徵包括：下眼瞼多出的皺褶（Dennie-Morgan 線）、眼周變黑、口周蒼白、掌紋加深、毛孔角化（上臂「雞皮」）、白色皮膚劃痕症、乳頭濕疹。


痕癢值得單獨討論。 痕癢一般在傍晚及夜間加劇，會擾亂患者以至家長的睡眠，並形成自我延續的「癢—抓」循環。白細胞介素-31 是驅動痕癢、屏障功能障礙、第二型炎症及纖維化的關鍵介質。患者自己毫不察覺的夜間搔抓，是濕疹無法平復的主要原因之一，也是診症時最值得詢問的問題之一。

需要辨識的併發症

細菌感染：滲液、蜜黃色結痂、膿疱、突然惡化、疼痛，多為金黃葡萄球菌。


疱疹性濕疹（eczema herpeticum）：⚠️ 這是急症。 廣泛出現成簇、大小一致、如被打孔般的糜爛，常伴發燒及不適，並在 24 至 48 小時內迅速擴散，需當日評估及使用抗病毒藥物。若出現此情況，不應等候例行預約，應前往急症室。


傳染性軟疣及病毒疣，在濕疹皮膚上範圍更廣。


睡眠障礙 : 對兒童生長，以及各年齡層的專注力與情緒均有連帶影響。

心理影響：焦慮及抑鬱比率上升，青少年若面部及手部受累，影響尤其嚴重。

相關疾病 : 過敏進行曲

異位性皮膚炎往往是一連串過敏疾病的起點：嬰兒期濕疹，其後食物過敏，再來哮喘，最後過敏性鼻炎。約三分之一患童日後會出現哮喘，出現過敏性鼻炎的比例相若或更高。及早治療異位性皮膚炎，被認為有助防止過敏進行曲發展成哮喘及過敏性鼻炎等併發疾病。


不過，把濕疹治好是否真的能預防後續疾病，目前仍未有定論，證據屬提示性而非結論性，不願誇大，可以肯定的是，單就控制濕疹本身而言，治療已經值得。

Reference:

  1. Davis DMR, Drucker AM, Alikhan A, et al. AAD guidelines of care for the management of atopic dermatitis in adults with topical therapies. J Am Acad Dermatol. 2023.
  2. Sidbury R, Alikhan A, Bercovitch L, et al. AAD guidelines of care for the management of atopic dermatitis in adults with phototherapy and systemic therapies. J Am Acad Dermatol. 2023.
  3. Guidelines Development Panel of the Hong Kong College of Paediatricians. Management of Atopic Dermatitis in Children: 2020 Review. HK J Paediatr. 2021;26:42-57. — the key local reference; cite this prominently.
  4. Wollenberg A, Kinberger M, Arents B, et al. EuroGuiDerm guideline on atopic eczema. J Eur Acad Dermatol Venereol. (most recent update).
  5. National Institute for Health and Care Excellence. Atopic eczema in under 12s: diagnosis and management. CG57.
  6. Leung R, Wong G, Lau J, et al. Prevalence of asthma and allergy in Hong Kong schoolchildren: an ISAAC study. Eur Respir J 1997.
  7. Childhood Wheeze, Allergic Rhinitis, and Eczema in Hong Kong: ISAAC Study from 1995 to 2015. — source of the 21-year local trend data.
  8. Severity scoring of atopic dermatitis: the SCORAD index. Consensus Report of the European Task Force on Atopic Dermatitis. Dermatology 1993;186:23-31.
  9. Efficacy and Safety of Lebrikizumab in Combination With Topical Corticosteroids in Adolescents and Adults With Moderate-to-Severe Atopic Dermatitis: A Randomized Clinical Trial (ADhere). JAMA Dermatol.
  10. ARCADIA 1 and ARCADIA 2 — two identically designed pivotal phase III trials enrolling more than 1,700 patients, evaluating nemolizumab administered subcutaneously every four weeks versus placebo with background topical corticosteroids.
  11. Sanofi. Press release: decision not to submit amlitelimab in atopic dermatitis for global regulatory reviews. Paris, 24 July 2026.
  12. Simpson EL, Bieber T, Guttman-Yassky E, et al. Two Phase 3 Trials of Dupilumab versus Placebo in Atopic Dermatitis (SOLO 1 and SOLO 2). N Engl J Med. 2016.
  13. Chalmers JR, et al. BEEP trial: daily emollient during the first year of life for preventing atopic dermatitis. Lancet. 2020. — the negative prevention trial cited in the article.
  14. Hong Kong Drug Office, Department of Health — verify local registration status of every systemic agent named.