濕疹
楊惟婷整理
一、何謂濕疹（eczema）?
大部份帶有搔癢感的皮膚病，都屬於濕疹。
一般用法上，「溼疹」就等於「皮膚炎」，前者是英國、歐洲的用法，而後者則在美國普遍使用。
此外，溼疹也有不同的命名。可因年齡〈如嬰兒溼疹、老人溼疹〉、外觀〈紅斑性溼疹、丘疹性溼疹、水泡性溼疹、膿性溼疹、溼潤性溼疹、結痂性溼疹、落屑性溼疹〉、部位〈臉部溼疹、陰囊溼疹、足部溼疹、乳頭溼疹、尿布溼疹、肛門溼疹、手部溼疹〉、季節〈冬季溼疹、夏季溼疹〉、病因〈過敏性溼疹、刺激性溼疹、職業性溼疹、鞋子皮膚炎、芒果皮膚炎，水泥皮膚炎、化妝品性溼疹、鎳溼疹〉而有不同的命名。
對皮膚科醫師而言，同一種溼疹可以有不同的命名方式，並不會糊塗，但病人往往在看了不同醫師、得到不同的診斷後，一頭霧水，甚至懷疑到底哪一個診斷才正確。
二、溼疹的症狀
溼疹並非因皮膚本身或環境潮溼而得名，根據醫學上的定義，它是指一種具癢感而且會產生丘疹或水包的皮膚變化，在急性期時可能會有明顯的紅斑、水腫，甚至產生水包及滲水現象，在慢性期時則會出現表皮增厚及脫屑現象。溼疹便是以急性期的特徵而得名。
急性溼疹的皮膚潮紅、出現疹子、水泡、脫皮、有點溼溼黏黏的：轉成慢性後，皮膚比較乾燥、粗糙、有破裂或脫皮、鱗屑的變化。
濕疹類的疾病，一般都有以下的症狀和經過：
起初形成略帶紅色的疹子，有劇烈的搔癢感，通常會形成栗米大小的小丘疹。
如果搔破這些小丘疹，便會流出漿液，漿液乾凅後，會變成茄皮，剝掉這些茄皮後，就會呈現鮮紅色濕潤的皮膚，稱為糜爛面，糜爛面也會流出漿液，乾燥後就形成茄皮。
當這種疾病即將痊癒時，漿液的分泌量逐漸減少，雖然顏色仍紅，但不會再形成茄皮，會變成很小的鱗屑，不久後鱗屑也會消失，當搔癢感消失時，表示即將痊癒。雖然會有一些色素沈澱，但通常一般濕疹類疾病，大多不會留下疤痕。
所以，西醫通常把以小水泡、紅斑、脫屑的皮膚病都歸在「溼疹」家族內，又依其紅腫、水泡程度分為急性、亞急性及慢性。
1、急性期以紅腫、小水泡為主要變化，
2、亞急性期則以潮紅、落屑為主，
3、慢性的溼疹其實一點也不溼，而是皮膚乾燥變厚產生色素沈澱，一般民間常稱為「牛皮癬」，但民間所指的牛皮癬，也包括乾癬。
三、溼疹的病因
除了特別易患濕疹的體質之外，由於內臟、飲食、氣候、陽光、寒風、日常生活所使用的器具以及衣服的刺激等等，都會引起濕疹。
一般而言，擁有過敏性體質或特異性體質者（如本人或家屬有過敏性疾病）較容易因手部接觸到刺激性或過敏性物質而誘發得此病。
因此，每到年節時分，常見許多家庭主婦因打掃環境而接觸水、肥皂、洗潔劑、消毒劑等化學物質而復發「富貴手」，即是此因。
此外，各行各業也都不乏因需要長期接觸刺激性或過敏性物質而引起手部溼疹者，如髮型師、美容工作者、園丁、珠寶設計師、水泥工、油漆工、清潔工及廚師等。
因此，溼疹的成因，大致可分為內因性及外因性兩大類：
1、內因性溼疹：〈體質性〉
如異位性溼疹、脂漏性溼疹、缺脂性溼疹、鬱積性溼疹、汗疹、錢幣狀溼疹及部位掌、蹠溼疹，這些溼疹由於常缺乏明顯病因，往往不易治療，會反覆發病。
2、外因性溼疹：〈接觸性〉
如接觸性溼疹、日光性接觸性皮膚炎，則在找出病因，予以避免後即可根除。
四、溼疹的預防與治療
總之，對於溼疹，預防永遠勝於治療。
由於溼疹容易復發，因此日常生活中要小心預防並注意保養：
一方面需避免再度接觸到誘發得病的刺激物，如平時盡量在工作中或清潔時帶上雙層棉質防水手套、避免接觸到刺激性物質；
一方面則避免使手部皮膚長期處於極溼潤的狀態中，洗手後盡量塗抹護手霜、凡士林來保護，尤其在遇到冬天或乾冷的環境時，上述保養更不可少；
症狀嚴重者，還需塗抹類固醇藥物或含水藥膏來治療。
溼疹如常常復發，應與您的皮膚科醫師討論，詳細問診，除了看是否有內因性因子外，更要注意工作、休閒活動、環境、日常生活等是否含有刺激性或過敏性的物質。
如懷疑有過敏性的物質，可接受貼膚試驗加以確定。
另外，並不是所有皮膚發炎都是溼疹，細菌感染、黴菌感染、病毒感染都可能看來像溼疹，而且上述病症若以溼疹藥物治療，除延誤病情外，也會使病毒惡化。
相反的，治療細菌感染的抗生素，常被稱為「消炎藥」，但對溼疹卻並無幫助。
由於溼疹形成的病因很多種，有因為季節變化、體質不同、衛生習慣等引發溼疹問題。也分急性及慢性。
每一種病因要抺的藥品及注意事項均不同，一定要先看醫生，把正確的引發溼疹的問題找出來，才能對症下藥，否則抺錯藥，把急性的搞成慢性的，那就得不償失了。
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