不典型疥疮56例误诊临床讨论

Clinical Discussion of Misdiagnosis of 56 Cases of Atypical Scabies

目的分析不典型疥疮的误诊原因并探讨防范措施。方法对我院2001年1月～2010年4月误诊的56例不典型疥疮的临床资料进行回顾性分析。结果56例皮疹多为散在细小红丘疹伴少量抓痕，皮疹位于腰腹部23例，大腿内侧17例，两侧腋下13例，头颈部3例，均无典型疥疮表现。误诊为过敏性皮炎24例，诊断不清17例，瘙痒症11例，荨麻疹4例。使用抗组胺药物51例（91．1％），皮质类固醇激素口服或外用29例（51．8％），口服中草药26例（46．4％），抗生素11例（19．6％），不详7例（12．5％）。治疗无效后经检查发现疥虫51例，5例经10％硫黄软膏治疗后痊愈而确诊。结论加强基层医务人员专业知识培训，详细询问病史及认真查体，注意鉴别诊断是避免误诊的关键。

Objective To discuss the cause of misdiagnosis of atypical scabies and preventive measures. Methods The clinical data of 56 cases of atypical scabies misdiagnosed in our hospital during January 2001 and April 2010 was ret- rospectively analyzed. Results All 56 cases had rash, mostly scattered and small red papules with small number of scrat- ches, at waist and abdomen in 23 cases, inner thigh in 17 cases, both sides under the arms in 13 cases, head and neck in 3 cases. No patients had typical manifestations of scabies. Of 56 cases, they were unclear diagnosis in 17 cases, misdiag- nosed as atopic dermatitis in 24 cases, pruritus in 11 cases, and urticaria in 4 cases. 51 cases received antihistamines （91.1%）, 29 cases received oral or external corticosteroids （51.8%）, 26 cases received oral herbal medicine （46.4%）, 11 cases were given antibiotics treatment （ 19. 6% ）, and 7 cases were not clear about the treatment （ 12.5 % ）. After inef- fective treatment scabies mites were found in 51 cases, 5 cases were cured after a course of treatment with 10% sulfur oint- ment. Conclusion Strengthening the training of grassroots medical staff expertise, taking history and physical examination seriously and paying attention to differential diagnosis are crucial to avoid misdiagnosis of scabies.