針灸治療異位性膚炎之病例報告

此19歲女性自幼反覆發紅色斑塊長達10多年，近兩個月前紅癢加劇，至終全身紅疹遍佈，發紅發癢發熱，小腿部位尤甚。透過詳細的病史記錄，患者臨床因符合Hanifin and Rajka Criteria被確診為異位性皮膚炎。我們以中醫針灸治療理論配合電針灸治療介入方式，經一周三次之療程治療，後利用照相與病人回饋來完成SCORAD的計分以評估療效。評估結果：初診為77.05 complete，三診後（2018/09/09）的分數40.01 complete，因而證實此次針灸治療對該患者的異位性皮膚炎之急性發作獲良好的症狀控制。我們除列出治療經過，同時也將其個人複雜的治療史列出，為要澄清病患背後的可能致病因與造成此次治療有效性之潛在相關因子。患者的治療史涉及自然醫學、中醫藥物、針灸與皮膚科藥物治療等，貼近臨床上多年反覆發作之異位性皮膚炎患者於門診求診的真實治療情況。我們也嘗試討論此疾病可參考的其他治療方式和正確的病人衛教，並於文末附上治療期間的皮膚與舌診拍照記錄。盼此病例報告能提供臨床中醫師治療上的參考。

關鍵字

針灸；電針灸；異位性皮膚炎；濕疹；自然醫學療法

並列摘要

This 19-year-old female has a recurrent reddish plaques since infancy, and the symptoms of itching, hot and erythema aggravates in recent 2 months. Finally, she had hot-touching, itching and general red plaques, especially of her calf. Through detailed history taking, the patient meet Williams HC's diagnostic criteria, proposed in 1994, thus we can make the diagnosis of atopic dermatitis. According to Chinese medicine acupuncture theory, we also used the electro-acupuncture(EA) as therapeutic intervention. After third times a week therapeutic course, we use photography and patient's rewards as the information to accomplish the severity evaluation of atopic dermatitis tool, SCORAD questionnaire. Evaluation Results shows, the patient gets 77.05, complete in the first visit, then 40.01, complete, after the first therapeutic course. Therefore we demonstrated the acupuncture therapy course has a significant therapeutic effect on this case's atopic dermatitis acute-onset. We not only explicitly describes our therapeutic process, but also records the case's complicated therapeutic history, so that we can more clarified the potential related factors, which results in her this acute onset scenario. Because of the patient's treatment history involved nature medicine, Chinese medicine herbs, acupuncture, and dermatology medicine treatment, this quite close to the reality of clinical representation of a long term recurrent atopic dermatitis patient at our Chinese medicine clinic. We also try to discuss other possible successful acupuncture treatment of the disease, and correct healthy education. Finally, we attached the photos records of her reddish skin and her tongue as a complete therapeutic process records. We sincerely expect the case report can benefit other traditional Chinese physicians.

並列關鍵字

acupuncture ； electrical acupuncture ； atopic dermatitis ； eczema ； naturopathy

參考文獻

"Severity scoring of atopic dermatitis: the SCORAD index. Consensus Report of the European Task Force on Atopic Dermatitis". Dermatology. 186 (1): 23–31. 1993. doi:10.1159/000247298. PMID 8435513.

Pfab F, Kirchner M-T, Huss-Marp J, et al. Acupuncture compared to oral antihistamine for type I hypersensitivity itch and skin response in adults with atopic dermatitis – a patient and examiner blinded, randomized, placebo-controlled, crossover trial. Allergy. 2012;67(4):566-573. doi:10.1111/j.1398-9995.2012.02789.x

Yosipovitch, G. & Papoiu, A.D.P. What causes itch in atopic dermatitis? Curr Allergy Asthma Rep (2008) 8: 306. https://doi.org/10.1007/s11882-008-0049-z

Chavez LM, Huang S-S, MacDonald I, Lin J-G, Lee Y-C, Chen Y-H. Mechanisms of Acupuncture Therapy in Ischemic Stroke Rehabilitation: A Literature Review of Basic Studies. International Journal of Molecular Sciences. 2017; 18(11): 2270. doi:10.3390/ijms18112270

Han SC1, Kang GJ, Ko YJ, Kang HK, Moon SW, Ann YS, Yoo ES. Fermented fish oil suppresses T helper 1/2 cell response in a mouse model of atopic dermatitis via generation of CD4+CD25+Foxp3+ T cells. BMC Immunol. 2012 Aug 9;13:44. doi : 10.1186/1471-2172-13-44.

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針灸治療異位性膚炎之病例報告

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