兒童異位性皮膚炎之臨床表現及處置

Clinical Presentation and Management of Childhood AtopicDermatitis

異位性皮膚炎影響全球約10-20%的兒童，且盛行率仍在上升。儘管大多數患童在學齡期或青春期症狀會自發緩解，但常間歇性惡化。劇癢是主要特徵，常在夜間加重，引起睡眠障礙，降低生活品質。嬰兒期最好發於臉頰，因流口水而加重兒童期以四肢屈側濕疹為典型特徵。隨著疾病慢性化，色素沉著和苔蘚樣變化會更明顯。嚴重青少年患者常見面部泛紅。異位性皮膚炎有許多內科與身心科的共病，故需全人照護。兒童患者的處置與成人相似，宜循序漸進。一般照護包括衛教、使用潤膚劑及避免刺激物和過敏原。第1線治療包括口服抗組織胺和外用類固醇。第2線治療包括光療、全身性類固醇的偶發性使用和感染控制。第3線治療包括全身免疫調節劑、生物製劑和強效外用類固醇。維持性治療包括光療，預防性投予外用鈣調磷酸酶抑制劑或外用類固醇。由於兒童患者的體表面積與體重比較高，宜使用較弱的外用類固醇。患童父母的類固醇恐懼症極為常見。長期使用全身性類固醇可能導致生長遲緩，使用時應謹慎監測。

Atopic dermatitis (AD) affects about 10-20% of the pediatric population globally, and its prevalence is still on the rise. Even though most pediatric AD patients experience spontaneous relief of symptoms during school-age or adolescence, eczema lesions can deteriorate intermittently. Intense pruritus is the main clinical feature, which often aggravates in the nighttime, causing significant sleep disturbances and thus lowering the quality of life of the patients. AD typically involves cheeks and face during early infancy, while drooling acts as an aggravating factor. During childhood, flexural eczema of extremities becomes the most prominent feature. As the disease becomes more chronic, subacute lesions such as hyperpigmentation and lichenification can develop more frequently. Widespread facial erythema is commonly observed in severe adolescent AD patients. AD is associated with numerous physical and mental comorbidities and therefore these issues should be carefully addressed. Management of childhood AD is similar to adult AD, while a step-wise approach is recommended based on Taiwanese consensus. Universal care includes therapeutic patient education, application of emollient and avoidance of irritants and allergens. First-line treatment consists of antihistamines and topical corticosteroids. Second-line treatment includes phototherapy, burst use of systemic corticosteroids and infection control. Third-line treatment encompasses systemic immunomodulators, biologics and potent topical corticosteroids. Maintenance treatment includes phototherapy and proactive use of topical calcineurin inhibitors or topical corticosteroids. Due to a higher body surface area to body weight in pediatric patients, a milder topical corticosteroid is recommended. The steroid phobia of parents should be addressed carefully. Prolonged use of systemic corticosteroids may lead to growth retardation and therefore should be monitored carefully.