- 期刊
Atopic Dermatits with Recurrent Eczema Herpeticum
異位性皮膚炎合併覆發疱疹性濕疹
摘要
疱疹性濕疹是一種單純性疱疹病毒感染，又稱為卡波西氏水痘樣皮疹，疱疹性濕疹最常見於異位性皮膚炎患者，其症狀有發燒，倦怠，淋巴腺病變，扁平水痘樣皮膚疹併有劇烈疼痛或搔癢，有時會擴及眼睛周圍而影響視力，嚴重時可能引起病毒血症，肝炎，腦炎或全身性感染而致命，偶時也會發生嚴重的伺機性細菌感染，因而早期的診斷與早期的治療是很重要。診斷的方法除了過去皮膚疾病史之外，還包括皮疹處削皮的Tzanck smear，電子顯微鏡下檢測，聚合酶連鎖反應(PCR)，病毒培養，免疫學檢查等等，而抗病毒藥物是主要的治療方法，於疾病的急性期必須停止使用免疫調節劑，而類固醇的使用目前仍有爭議。本文個案十一歲女孩有嚴重幼年異位性皮膚炎，長期使用類固醇，以及兩年以上兩種外用免疫調節劑，十五個月內共發病了四次疱疹性濕疹，第一次更合併了伺機性細菌感染。某些文獻報告指出罹患疱疹性濕疹危險因子，可能與早期（幼年）發作的異位性皮膚炎患者，血清中E型免疫球蛋白過高者，和曾經使用過外用類固醇或免疫調節劑者有關，然而在台灣尚未有類似的研究分析，仍需進而探討其發病原因及致病機轉。近幾年外用免疫調節劑廣受歡迎，但美國食品藥物管制局限定為兩歲以下的患者不得使用，同時有些學者認為免疫調節劑可能增加罹患疱疹性濕疹的機率，因此必須謹慎使用，且要向病人詳解其副作用並適時停藥或就診。
並列摘要
An 11 years old girl came to the emergency department with fever, cough, rhinorrhea, eyelid swelling with eye discharge, and facial pruritic skin rashes which mostly marked in the periorbital & perioral area. On exam, she had injected conjuntiva, swelling of oral mucosa, crusted vesicular skin lesions with pus formation on face, which made her severe itchy and hard to sleep, besides, exacerbation of severe atopic dermatitis was also noted during this period. Empiric systemic antibiotics and antiviral agents were prescribed because of eczema herpeticum (EH) with bacterial super infection was diagnosed. We discontinued topical steroid and calcineurin inhibitor during this acute stage of illness. Unfortunately, she had got four episodes of EH within fifteen months follow up. We describe this case, discuss the etiology, epidemiology, presentation and management, and also highlight the importance of early recognition by the clinician, because EH can be frequently recurrent and as a severe and potentially, life-threatening condition.