脂溢性皮炎专题讲座ppt课件.ppt
,临床表现 分为婴儿型及成人型1婴儿型 发生在生后34周，在头皮、面部，包括眉弓，双颊、驱干部、尿布区以及腋部，出现油腻细小的鳞屑性红色斑片，易结成淡黄色痂，严重者可伴有糜烂、渗出，瘙痒不明显，有自限性。可继发细菌或者念珠菌感染。,2 成人脂溢性皮炎 可累及头皮机胸骨前区、腋部、乳房下及腹沟处皮肤。头皮的脂溢性皮炎分为炎症性及非炎症性两种。炎性者表现典型性红斑及油腻性脱屑，常扩展至发际及耳后部位，轻度瘙痒;非炎症性者表现为轻重不等的糠样脱屑，即平常所说的头皮屑，又称干燥性糠屑，而无明显炎性表现。面部脂溢性皮炎常由头皮蔓延而来，常累及眉弓、眼睑、鼻唇沟及胡须区域，呈黄红色、油腻性鳞屑性斑片。,头皮损害的两种类型：1鳞屑性：常呈红斑或红色毛囊丘疹并有小片糠状脱屑，头发干燥、细软、稀疏或脱落：2结痂型：多见于肥胖者，头皮厚积片状、粘着油腻性黄色或棕色痂，痂下炎症明显，间有糜烂、渗出,Seborrheic Dermatitis,also known as seborrheic eczema “is an inflammatory skin disorder affecting the scalp, face, and trunk causing scaly, flaky, itchy, red skin. It particularly affects the sebum-gland rich areas of skin.,Etiology,The cause of seborrhoeic dermatitis remains unknownMalassezia globosa, may play a role.Seborrhoeic dermatitis may be aggravated by illness, psychological stress, fatigue, change of season and reduced general health.,Etiology,Neurologic conditions, including Parkinsons disease, head injury, and stroke may be associated with seborrheic dermatitis.Human immunodeficiency virus (HIV) has also been linked to increased cases of seborrheic dermatitis.,Etiology,In children, excessive vitamin A intake can cause seborrhoeic dermatitis.Lack of vitamin B6 and vitamin B2 may also be a cause,Etiology and Pathogenesis,遗传性皮脂溢出,感染马拉色菌、痤疮丙酸杆菌等,皮脂成分改变,感染性变态反应,脂溢性皮炎,精神、饮食、维生素B缺乏、嗜酒,Clinical Manifestation,Seborrheic dermatitis can occur on many different body areas. Typically it forms where the skin is oily or greasy. Lesion papule oily and yellow scales , severe cases, yellowish to reddish scaly papule appear along the hairline, behind the ears, ear canal, eyebrows, bridge of the nose, around the nose, chest, back.,Clinical Manifestation,in some cases hair lossItching- may become more itchy if infectedInfants younger than three months thick, oily, yellowish crust around the hairline and on the scalpCourse last from few weeks to even years,头皮脂溢性皮炎,鳞屑型 常呈红斑或红色毛囊丘疹并有小片糠秕状脱屑，头发干燥、细软、稀疏或脱落结痂型 头皮厚积片状、粘着油腻性黄色或棕色痂，痂下炎症明显，间有糜烂、渗出,诊断及鉴别诊断：根据本病好发于成人及婴儿，有皮脂溢出，典型皮损为油腻性鳞屑性黄红色斑片，容易诊断。银屑病鉴别，,与玫瑰糠疹相鉴别,与湿疹相鉴别,【预防及治疗】,1，生活规律，睡眠充足，少用热水和碱性肥皂洗头，避免搔抓。 2外用药物治疗：去脂，消炎、杀菌、止痒，常用药物为含抗真菌药的混合制剂；钙调磷酸酶抑制剂（他克莫司）可用于严重患者或低强度糖皮质激素无效者；少量渗出糜烂者，锌油或氧化锌糊封包。3系统药物治疗：瘙痒者加用抗组胺药，口服B族维生素，炎症反应明显者，可短期口服四环素或红霉素抗炎。真菌感染泛发者：伊曲康唑100mg/d,23周，,范围较大、炎症明显者，甚至有红皮病倾向者且无明显禁忌症时，可短期小量使用泼尼松15mg/d,清晨顿服，并可短期加用雷公藤20mg,每天三次。脂溢性皮炎中医治疗：潮红、渗液、结痂时可以清热、解毒、利尿为治则，用龙胆泻肝汤加减。仅有痒而无渗出时，以养血、润燥、祛风、清热为治则。,凉血清肺汤生地、生山楂、虎杖各，玄参、川石斛、寒水石、桑白皮各，生石膏、白花蛇舌草各，生甘草。皮疹糜烂及伴油腻性脱屑者加茵陈、生薏苡仁各；鼻翼潮红者加制大黄，苦参片；皮损呈结节囊肿者加益母草，莪术；大便干结者加全瓜蒌，枳实。先将上药用水浸泡分钟，再煎煮分钟，每剂煎次，分次服，每日剂，周为疗程，根据症情可以连续用个疗程。,清热除湿汤黄连，黄芩、当归、甘草各，连翘、公英、知母、丹皮、生地、白芷各，升麻，石膏。水煎内服，每日剂，每日次，每次服。并配合外用药（地榆、黄芩、甘草、艾叶、丹皮、连翘各；水煎湿冷敷），每日敷次，每次分钟。本方有清热除湿、疏风止痒之功,龙胆泻肝汤龙胆草、栀子、黄芩、柴胡、生地、车前子、泽泻、木通、甘草各适量。红斑较甚者加用防风、荆芥；继发感染者加用金银花、菊花；痒剧者加用苦参、白鲜皮；皮损局限于下半身者加牛膝、黄柏。水煎，分次服，每日剂，剂为疗程。本方出自医方集解，有泻肝胆实火，清下焦湿热之功。配合外用肤脂平治疗。,
