面部激素依赖性皮炎的诊断及鉴别诊断

Facial Corticosteroid-dependent Dermatitis of Diagnose and Differential Diagnosis

糖皮质激素(以下简称"激素")外用制剂一直被广泛地被应用于临床,然而,因中国市场的不规范等多种原因,激素的长期滥用或误用现象越来越多见,因此导致的皮肤问题亦日渐突显。其中具有代表性的是一种泛称为"激素依赖性皮炎"疾病的出现。但在该病的统一命名、诊断与鉴别上,国内外专家均存在许多不一致的观点,尤其是其与玫瑰痤疮(酒渣鼻)的定义和区别含糊不清,容易造成误诊和漏诊。笔者根据临床上的大样本病例,结合文献查阅,总结出自己在面部糖皮质激素依赖性皮炎定义、诊断及鉴别诊断方面的看法与经验。认为激素依赖性皮炎是一种独立的疾病,而停止外用激素后的"戒断症状"——由明显干燥、灼热及瘙痒所组成的"明显三联征",则是诊断激素依赖性皮炎特有的症状切入点。采用马上停用激素的"戒断治疗"能在短期内治愈激素依赖性皮炎。

Since the drug market lacks appropriate regulation in China,the risk of topical corticosteroid（TC） abuse and misuse has increased dramatically,resulting in a new type of facial dermatitis. In China,the condition is often called＂ facial corticosteroid-dependent dermatitis（FCDD） ＂. No diagnostic standard has yet been established for this condition. There are always many controversies about how to define the disease, and how to discriminate FCDD from other dermatitis,especially from rosasea. That may cause a lot of misdiagnose or missing diagnose. The current view is that this disease is not a rosacea variant but a completely distinct disease. We performed a large-sample clinical research and concluded that FCDD is a distinct type of facial dermatitis with four clinical presentations. The clinical rebounding triad （ Severe Itching, Dryness and Burning） after facial corticosteroid discontinuation may be a critical factor for the diagnosis of FCDD.