老年性湿疹的临床特征和预后研究

Clinical Manifestations and Prognosis of Senile Eczema

目的明确老年性湿疹的临床特点、治疗和预后,以及与发生在非老年人的内源性湿疹的临床异同。方法收集112例泛发性老年性湿疹、137例普通湿疹和其他疾病对照81例,记录临床资料、治疗以及长期随访。结果大部分泛发性老年性湿疹并不能符合特应性皮炎的诊断标准。和普通内源性湿疹相比,泛发性老年性湿年疹具有以下临床特点:①皮疹偏干燥,渗出发生率低,苔藓化程度较轻;②更易发生红皮病,且红皮病后容易遗留全身色素沉着。外周血嗜酸细胞计数、总IgE、特异性IgE检测无助于区分老年性湿疹和普通湿疹,和临床表现、预后亦无关。外用糖皮质激素和皮肤屏障修护剂(润肤露等)能有效控制约40%的泛发性老年性湿疹,如果联合全身NB-UVB照射,能有效控制大多数的老年性湿疹患者,仅有极少部分患者需要短时间系统糖皮质激素治疗。超过50%的泛发性老年性湿疹患者在一年随访中表现出慢性迁延的病程。未能证实特定慢性药物使用和老年性湿疹的关联,有待大样本前瞻性实验来明确。结论多数老年性湿疹并不符合特应性皮炎的诊断标准,是一个独立的湿疹亚型。病因不明,表现为发生于老年人的慢性泛发性湿疹,常不伴其他过敏性疾病,皮疹较干燥、苔藓化程度轻,较易出现红皮病,且遗留弥漫性色素沉着。老年性湿疹的首选治疗为外用糖皮质激素和皮肤屏障修护剂,二线治疗为全身NB-UVB治疗;大部分患者疾病可以被有效控制,但容易复发。

Objective To evaluate clinical features, therapy and prognosis of senile eczema, comparing with unclassified eczema and atopic dermatitis. Methods This case control study involved 112 senile eczema patients, 137 unclassified eczema patients and 81 unrelated disease controls. The study recorded clinical manifestations, treatments and follow-up. Results Senile eczema have different manifestations with atopic dermatitis. Comparing with regular intrinsic eczema, senile eczema characterized with dry skin, less lichenification, erythroderm and diffuse post - inflammatory hyperpigmentation. Eosinophils counting, serum total IgE and specific IgE neither help to distinguish senile eczema with regular eczema, nor indicate severity and prognosis of senile eczema. Topical steroids and moisturizer can control about 40% senile eczema. Combined topical steroids and NB-UVB can control most senile eczema, and only few senile eczema need short time systemic steroids. In one year follow-up, over 50% senile eczema patients had a relapsing disease requiring long term topical steroids treatment. This study can not confirm the relation between systemic drug and senile eczem. Conclusion Senile eczema have different clinical features with atopic dermatitis. Senile eczema is a unique subtype of intrinsic eczema with unknown etiology, which is characterized with dry skin and less lichenification, proning to have erythroderma and diffuse post-inflammatory hyperpigmentation. The first-line treatment of senile eczema is topical steroids, and second-line treatment is phototherapy. These treatments are efficient to most patients yet easily relapsing.