2，4-二氯-5-甲基嘧啶致刺激性接触性皮炎64例研究

2,4-Dichloro-5-methylpyrimidine-induced irritant contact dermatitis： 64 case reports

目的 了解2,4-二氯-5-甲基嘧啶（DCP）致接触性皮炎的临床特征，探讨治疗方法及防护措施。方法 对2,4-二氯-5-甲基嘧啶致接触性皮炎的64例患者进行分析。参与企业防护措施的持续改进。 结果 64例患者均在接触DCP后1 - 12 min，平均7 min发病。皮损发生于DCP接触部位，表现为边界清楚的水肿性红斑，10例出现水疱，皮损面积58 - 5 600 cm2。48例自觉灼痛，16例自觉瘙痒。4例头痛，3例恶心、呕吐，1例晕厥。10例在避免接触DCP 1 - 4 d后，于DCP非接触部位出现皮疹，自觉瘙痒。8例皮损组织病理均为表皮细胞内及细胞间水肿，海绵形成，5例表皮内水疱，7例真皮乳头水肿，有炎症细胞浸润。 糖皮质激素治疗有效。正压式充气防护服能将作业工人与外界完全隔离，可避免DCP所致接触性皮炎的发生。 结论 2,4-二氯-5-甲基嘧啶所致接触性皮炎为刺激性接触性皮炎，少数患者在接触DCP后会发生迟发型过敏反应。正压式充气防护服可起到有效防护。

Objective To investigate clinical features and treatment of, as well as protective measures against 2,4-dichloro-5-methylpyrimidine （DCP）-induced contact dermatitis. Methods Clinical data were collected from 64 patients with DCP-induced contact dermatitis, and analyzed retrospectively. Analytical results were used to improve protective measures in workplaces. Results Irritant contact dermatitis occurred 1 - 12 minutes （mean, 7 minutes） after contact with DCP in all the patients. Lesions appeared at sites of contact with DCP, and mainly manifested as swelling erythema with sharp boundaries. Lesion areas varied from 58 to 5 600 cm2. Ten patients presented with blisters, 48 with burning pain, 16 with itching, 4 with headache, 3 with nausea and vomiting, and 1 with fainting. Pruritic lesions appeared at non-contact sites in 10 patients 1 - 4 days after avoidance of contact with DCP. Histopathologic examination showed intercellular and intracellular edema and spongiosis in the epidermis in 8 patients, intraepidermal blisters in 5 patients, papillary dermal edema and inflammatory cell infiltration in 7 patients. Glucocorticoids were effective for the treatment of DCP-induced contact dermatitis. Positive pressure-inflated protective clothing could absolutely isolate workers from outside environment to avoid the occurrence of DCP-induced contact dermatitis. Conclusions DCP-induced contact dermatitis is a kind of irritant contact dermatitis. Delayed hypersensitivity reactions occur in a few patients after contact with DCP. Positive pressure-inflated protective clothing is effective for the protection from DCP-induced contact dermatitis.