接触性皮炎(contact dermatitis)是皮肤科常见炎症性皮肤病,其临床亚型多样且复杂,亚型分类不同与潜在发病机制相关,而发病机制决定其治疗用药差异。为增进认知,现对接触性皮炎临床亚型简述如下。
1变应性接触性皮炎(allergic contact dermatitis)
核心特征:致敏个体反复接触已致敏变应原所致;常见于接触部位。
(急性变应性接触性皮炎)
2刺激性接触性皮炎(Irritant contact dermatitis)
进一步分类:
(1)化学烧伤(chemical burns);
(2)刺激性反应(irritant reactions);
(3)急性刺激性皮炎(acute irritant dermatitis);
(4)晚发型急性刺激性皮炎(late-onset acute irritant dermatitis);
(急性刺激性接触性皮炎伴脓疱疮化)
(5)主观反应(subjective reaction);
(6)累积性刺激性接触性皮炎(cumulative irritant contact dermatitis);
(7)创伤性刺激性皮炎(traumatic irritant dermatitis);
(8)脓肿及痤疮样皮炎(abscess and acne-like dermatitis);
(9)摩擦性皮炎(frictional dermatitis);
(慢性刺激性接触性皮炎)
3即刻皮肤反应(immediate skin reaction)
进一步分类:
(1)接触性荨麻疹(contact urticaria):包括免疫性接触性荨麻疹(immunological contact urticaria)及非免疫性接触性荨麻疹(non-immunological contact urticaria);
(2)蛋白质接触性皮炎(protein contact dermatitis);
(接触性荨麻疹)
4光接触性皮炎(photocontact dermatitis)
进一步分类:
(1)光毒性接触性皮炎(phototoxic contact dermatitis,PTCD);
光变应性接触性皮炎(photoallergic contact dermatitis,PACD);
5系统性接触性皮炎(systemic contact dermatitis)
核心特征:既往皮炎复发;既往斑贴部位阳性反应;水疱性掌部/跖部皮炎、屈侧皮炎(flexural dermatitis)、狒狒综合征(Baboon syndrome)、对称性药物相关间擦及屈侧疹(symmetrical drug-related intertriginous and flexural exanthema);
6非湿疹性接触性皮炎(non-eczematous contact dermatitis)
进一步分类:
(1)多形红斑样(Erythema multiforme-like eruption);
(2)色素性紫癜样(Pigmented purpuric eruption);
(3)扁平苔藓样(Lichen planus-like eruption);
(4)大疱性(Bullous eruption);
(5)丘疹-结节性(Papular and nodular eruption);
(6)肉芽肿性(Granulomatous eruption);
(7)脓疱性(Pustular eruption);
(8)硬皮病样(Scleroderma-like eruption);
(9)色素性接触性皮炎(Pigmented contact dermatitis);
(10)淋巴瘤样接触性皮炎(Lymphomatoid contact dermatitis);
血管闭塞性接触性皮炎(Vascular-occlusive contact dermatitis)
7特殊类型接触性皮炎
(1)血源性接触性皮炎(hematogenous contact dermatitis);
(2)空气源性接触性皮炎(airborne contact dermatitis);
参考文献
[1] H Dickel, A Bauer, R Brehler, et al. German S1 guideline: Contact dermatitis. J Dtsch Dermatol Ges 2022; 20: 712-734.
[2] Y Li,L Li. Contact Dermatitis: Classifications and Management. Clin Rev Allergy Immunol 2021; 61: 245-281.
[3] G Novak-Bilić, M Vučić, I Japundžić, et al. IRRITANT AND ALLERGIC CONTACT DERMATITIS - SKIN LESION CHARACTERISTICS. Acta Clin Croat 2018; 57: 713-720.
[4] M Seki, T Okusa, H Takei, et al. Contact urticaria syndrome from copper. Contact Dermatitis 2021; 85: 375-376.
(本文仅作为科普与学术交流,增进了解,引起重视,有相关临床症状者,建议及时就医!!!)