Ichthyosiform Irritant Contact Dermatitis Caused by Antiseptics for Personal Hygiene

抗菌潔身液導致的魚鱗癬樣刺激接觸性皮膚炎

李宜珮(Yi-Pei Lee) ； 李玉雲(Julia Yu-Yun Lee)

《中華皮膚科醫學雜誌》 27卷4期 (2009/12) Pp. 218-226

https://doi.org/10.29784/DS.200912.0003

摘要

背景：市售的抗菌劑（消毒藥水、潔身液）在台灣是很常見的個人衛生清潔用品。我們曾經報告過一系列的病例因使用抗菌劑所導致的魚鱗癬樣刺激性接觸性皮膚炎(ichthyosiform irritant contact dermatitis or cetrimide dermatitis)。
目的：收集並分析近年來抗菌潔身液導致皮膚炎的新病例，以正視此類抗菌劑之潛在皮膚刺激問題。
方法：從臨床病理回顧自1993年10月到2008年8月於成大醫院皮膚部診斷為cetrimide、沙威隆或魚鱗癬樣刺激性接觸性皮膚炎的病例中，篩選出具有典型病灶表現（魚鱗癬樣皮膚脫屑、炙紅或像化學藥劑灼傷般焦黑變化）及分布特徵（屈側及生殖肛門口周圍）並有明確接觸病史者，再加以分析討論。
結果：在我們的研究中，一共收集並分析了35個病例（14位男性及21位女性），年紀從3歲到79歲（平均45歲）。大部分的病例都發生在炎熱季節且許多病人已有如癢疹等潛在皮膚問題，並使用含有cetrimide的市售抗菌潔身液。接觸的時間為4天至2個月，平均為3.4個禮拜。絕大多數(80%)就診時已表現中重度的皮膚病灶（病灶呈脫屑、炙紅、焦黑或表面像上了一層釉一樣的變化，並以屈側及生殖肛門口周圍侵犯為主，尤其在鼠蹊及腋下可常見遠心性廣泛帶狀或網狀紅疹。沒有任何一個病人在初次就診時主動提出抗菌劑之接觸史，只有當臨床醫師懷疑而進一步詳問病史時才得知而做出正確診斷。其中有5位病人接受皮膚切片，其病
理變化符合魚鱗癬樣刺激性接觸性皮膚炎。
結論：我們的研究發現自我使用含有cetrimide成份的抗菌潔身液在南台灣仍是導致魚鱗癬樣刺激性接觸性皮膚炎常見的原因。其中要鑑別診斷的包括魚鱗癬、圈癬、遠心性環狀紅斑、營養缺乏疾病。認識上述特徵有助於臨床醫師詢問相關接觸史並做出正確的診斷。

並列摘要

Background: Antiseptics are commonly used for personal hygiene in Taiwan. We have previously reported a series of ichthyosiform irritant contact dermatitis induced by cetrimide-containing antiseptics.
Objectives: To report a new series of antiseptics-induced ichthyosiform irritant contact dermatitis and bring attention to the potential irritation effects of antiseptics.
Methods: We reviewed the clinicopathologic features of cases of cetrimide dermatitis, Savlon dermatitis or ichthyosiform irritant contact dermatitis diagnosed in our department (October 1993-August 2008). Cases with characteristic ichthyosiform, scarlet to dusky red or chemical burn-like skin lesions, primarily affecting the flexures and/or genital areas, and relevant exposure histories were included.
Results: There were 35 patients (14 men and 21 women), aged from 3 to 79 years (mean 45 years) Most patients were seen in summer with a recognizable underlying pruritic dermatosis, and had used commercial products containing cetrimide. The exposure time was from 4 days to 2 months (mean 3.4 weeks). The great majority (80%) had moderate or severe skin lesions characterized by scarlet to dusky red or brownish lesions with a collodion membrane-like surface, and showed a preferential involvement of the flexural and genital areas, especially the groin and axilla where the lesions often manifested centrifugal rings. In no case was antiseptics-related dermatitis suspected by the clinicians or the patients. Skin biopsy was performed in 5 patients; all revealed changes consistent with cetrimide ichthyosiform irritant contact dermatitis.
Conclusions: Our study showed that self-application of cetrimide-containing antiseptics is still an important cause of irritant contact dermatitis in southern Taiwan. This dermatitis should be differentiated from ichthyosis, tinea circinata, erythema annulare centrifugum, and nutritional deficiency diseases. Recognition of the clinical characteristics can prompt clinicians to inquire about exposure to antiseptics and facilitate correct diagnosis.

並列關鍵字

Antiseptics ； Cetrimide ； Ichthyosis-like ； Irritant contact dermatitis ； Personal hygiene