皮肤科医生对脂溢性皮炎的诊断观念及影响因素调查

Dermatologists′ Perceptions and Influencing Factors in Diagnosis of Seborrheic Dermatitis

目的了解我国皮肤科医生对于脂溢性皮炎(SD)诊断的观念及影响因素。方法通过网络平台向全国皮肤科医生发放电子调查问卷,内容包括5个基本信息,6个SD诊断观念维度。采用χ^(2)检验和多因素Logistic回归模型进行分析。结果本调查共纳入615份有效问卷。问诊时45.20%的医生首选询问SD家族史,39.51%首选询问饮食习惯。90.24%的医生选择临床表现作为首要诊断依据,Logistic回归分析显示,与<30岁的医生相比,30~39岁、40~49岁、≥50岁的医生选择临床表现的概率较高(P=0.018、0.001、0.013);与副主任医师相比,住院医师和主治医师选择临床表现的概率较低(P=0.003、0.039)。71.06%的医生对SD临床表现的首要认知为皮疹发生于皮脂溢出部位,23.58%的医生为伴有皮脂溢出。61.36%的医生选择真菌镜检作为第二顺位诊断依据,48.87%的医生选择皮肤镜表现作为第三顺位诊断依据。73.50%的医生认为SD需与银屑病鉴别,Logistic回归分析显示,博士和硕士学历的医生选择的概率高于本科学历的医生(P=0.030、0.014),大专及大专以下学历的医生选择的概率低于本科学历的医生(P=0.040)。12.85%的医生认为SD需与特应性皮炎(AD)鉴别,Logistic回归分析显示,西医科室医生选择的概率低于中医/中西医结合科室医生(P=0.035)。65.85%的医生因为按照SD治疗效果不明显而发现误诊。35.61%的医生对目前SD的诊断现状不满意,首要原因为诊断标准不明确(68.49%)。结论皮肤科医生大多数将临床表现,特别是皮疹发生部位作为SD的首要诊断依据,且认为SD皮疹表现不典型,最需与银屑病相鉴别。诊断标准不明确是我国皮肤科医生对SD诊断现状不满意的首要原因,SD的诊断标准仍存在较大的完善空间。

Objective To investigate Chinese dermatologists′perceptions and influencing factors in the diagnosis of seborrheic dermatitis(SD).Methods An electronic questionnaire survey was conducted via network platform among Chinese dermatologists.The questionnaire consisted of 5 items about basic information and 6 dimensions exploring dermatologists′perceptions of SD.The results were assessed by chi-square test and multivariate Logistic regression analysis.Results A total of 615 valid questionnaires were received.Among the dermatologists,45.20%prioritized inquiring about family history of SD,while 39.51%prioritized dietary habits as the foremost related medical history.For diagnostic evidences,90.24%of dermatologists chose clinical features as the primary evidence.Logistic regression analysis revealed that compared with dermatologists under 30 years old,dermatologists aged 30-39,40-49 and 50 years old or older were more inclined to choose clinical features(P=0.018,0.001,0.013)as the primary diagnostic criterion.In contrast,when compared with associate chief physicians,residents and attending physicians were less inclined to choose clinical features(P=0.003,0.039).Among dermatologists,71.06%chose lesions occurring in seborrheic areas as the primary understanding of clinical features of SD,while 23.58%chose accompanied with seborrhea.Besides,61.36%of dermatologists chose direct microscopic examination of fungi as the second most important diagnostic evidence,and 48.87%chose dermatoscopic findings as the third most important diagnostic evidence.Among dermatologists,73.50%considered that SD should be identified with psoriasis.Logistic regression analysis revealed that compared with dermatologists with bachelor′s degree,dermatologists with doctoral and master′s degrees were more inclined to choose psoriasis for differential diagnosis(P=0.030,0.014),while dermatologists with educational backgrounds under university were less inclined to do so(P=0.040).Dermatologists(12.85%)considered that SD should be differentiated from atopic dermatitis(AD).Logistic regression analysis revealed that dermatologists from Western medicine background were less inclined to choose AD compared with those from traditional Chinese medicine or integrated departments(P=0.035).Misdiagnosis was found by 65.85%of dermatologists due to insignificant efficacy by treatment of SD.Fewer(35.61%)were dissatisfied with current status of SD diagnosis,mainly due to the indefinite diagnostic criteria(68.49%).Conclusion Most Chinese dermatologists consider clinical manifestations,especially the location of lesions as the primary diagnostic evidence for SD.They also consider that lesions of SD are atypical and require differentiation from psoriasis.The indefinite diagnostic criteria are the primary reason why Chinese dermatologists are dissatisfied with the current status of SD diagnosis.There is still much to be improved for the diagnostic criteria of SD.