光學治療濕疹 徹底舒緩痕癢

濕 疹 

異位性皮膚炎(濕疹)的診斷方法

 

沒有任何血液檢查可以診斷異位性皮膚炎。是臨床診斷，依據病史及檢查，並對照既定準則(Hanifin and Rajka 準則；英國工作小組準則)。完整評估一般包括:

 

  • 病史：發病年齡、病程演變、痕癢程度、睡眠影響、個人及家族過敏史、職業與嗜好相關接觸、既往所有治療及實際使用方式。
  • 全身皮膚檢查，包括頭皮、手、足及屈側。
  • 嚴重程度評分：EASI 或 SCORAD，配合 POEM 及 DLQI 評估患者自覺影響。於基線記錄，以便客觀量度變化。
  • 臨床攝影，作日後對比。
  • 感染評估，有需要時作細菌培養。
  • 過敏測試 - 選擇性進行，而非常規檢查。 若病史提示對某種食物有即時反應，或患童屬中重度濕疹且對良好治療反應不佳，則適合作特異性 IgE 或皮膚點刺測試。在缺乏提示性病史的情況下作測試，會產生假陽性，導致不必要的戒口 - 這不但無助濕疹，反而有害。
  • 貼膚測試（patch test）：懷疑過敏性接觸性皮膚炎時進行，特別是成人手部濕疹、眼瞼受累，或型態改變、治療突然失效的個案。 

鑑別診斷

情況鑑別要點
脂溢性皮膚炎油膩泛黃的鱗屑；頭皮、眉毛、鼻唇溝；痕癢較輕
銀屑病邊界銳利、厚實銀白鱗屑；伸側、頭皮、指甲
疥瘡隧道、指縫、手腕、生殖器；夜間痕癢加劇；家中其他成員同樣痕癢
癬 (真菌感染)環狀，邊緣脫屑活躍、中央消退；顯微鏡檢查陽性
接觸性皮膚炎布與接觸部位吻合；成人發病；貼膚測試陽性
皮膚 T 細胞淋巴瘤成人發病，固定斑塊持續不退，治療無效；需活檢
免疫缺陷嬰兒期嚴重濕疹伴反覆嚴重感染及生長遲緩

臨床上最常見的誤診：疥瘡被當作濕疹發作而使用類固醇、癬被使用類固醇、以及成人新發的「濕疹」實為皮膚淋巴瘤。凡型態不典型、成人才首次發病，或對正確治療確實毫無反應的濕疹，都值得重新檢視診斷。

 

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.