嬰兒濕疹
楊惟婷整理
一、何謂嬰兒溼疹?
簡單地說，溼疹是一種內因性或是皮膚受到外界刺激所引起的表皮反應。表皮的反應過程中，會製造一些因子刺激皮膚中的神經纖維，因而產生癢感。
尤其是嬰幼兒的皮膚相對於成人顯得較為單薄，毛髮較少，汗液與皮脂腺的分泌也較不足，因此皮膚的保護層相對地減了很多，於是各種物理、化學或生物性的刺激使可能傷害到嬰兒的皮膚了！
嬰兒的溼疹，在出生兩、三星期即可能第一次發作，特別出現於雙頰或頭頸部，皮膚上有淡紅或紅色丘疹或斑點、腫脹及小泡，看起來有點爛爛的或滲出物。此謂之嬰兒溼疹或異位性溼疹，
嬰兒溼疹大多是家族性過敏體質造成，並不是許多家長自認為的「寒風刮到的」。當然，也有不少嬰兒溼疹會隨年齡自然痊癒。
但有些人在臉頰消失了，三、四歲後，卻轉移到上肢的雙肘肘窩(即手彎曲的部位)及後膝窩，甚至四肢外側皮膚及手腳掌，嚴重者全身到處可以見到。
皮膚摸起來一粒粒、粗粗的，許多人常以「粗皮」兩字來形容。
溼疹的地方變厚，有的有鱗屑、乾裂、摻水、結痂，並且非常癢。
二、常見嬰兒溼疹的種類
以下介紹一些較常出現在嬰幼兒身上的溼疹類疾病與處理方法：
1、嬰兒臉部溼疹：
由於新生兒及嬰兒的皮脂保護層分泌不足，在溫度、溼度較低的環境下無法適應，因此在冬天常可見到許多小寶寶臉上紅通通的，皮膚表面乾而粗糙，甚至會有脫屑或是皸裂的現象；因此保護之道當給予足夠的油脂保護層，即視情況輕重給予嬰兒油或凡士林類油膏的塗抹，並減少暴露於冷空氣中。
2、對磨疹：
相對於嬰兒臉部濕疹，對磨疹則好發於溫度較高的環境，主要原因是汗液聚積於容易磨擦的屈側關節，如脖子、腋下或腹股溝等處，高溫、潮溼再加上磨擦頻率較高而使患處皮膚產生紅斑、丘疹，嚴重時甚至併發念珠菌感染。
對磨疹好發於無法自由活動的襁褓中嬰兒，以及體重較重的胖寶寶，因此隨時保持彎曲處皮膚的乾燥、涼爽是最佳預防之道，不要因怕小寶寶感冒而給予層層衣物的包裹，高溫易流汗時，應隨時準備溼冷毛巾擦拭，尤其是小胖子更應特別注意。
3、痱子：
由於幼兒的汗腺尚未完全成熟，因此排汗時很容易造成汗孔阻塞而有汗液滯留的現象發生。幾乎每個小朋友都長過痱子，天熱時溫度溼度高會長，天涼時怕小孩感冒，包裹的像粽子似地，也會長痱子。
痱子看似小毛病，但卻會造成奇癢，有時汗液阻塞較厲害或發炎反應較強時，也會有大的丘疹或膿包出現，而若過度搔抓亦可能導致其他微生物的感染。因此，選擇輕便吸汗佳的衣物，用空調保持適當的溫溼度是預防及治療痱子的重要步驟。
4、尿布疹：
幾乎每個嬰兒都發生過程度不一的尿布疹，也因此幾乎每一父母都曾為小寶寶的紅屁股而傷透腦筋。
造成尿布疹的可能因素很多，尿布的材質，個人的體質，尿液的滯留、局部的微生物等都會相互影響。
最近的研究卻發現氨與尿布疹並無直接關係，反而是尿液被細菌分解後使局部環境的酸鹼值（即ｐＨ值）提高，而使糞便中一些效素活性升高，因而刺激皮膚所致。
當然，不用尿布便不會有尿布疹，但在目前的社會環境中這似乎是個天方夜譚。因此選擇尿布或尿片應慎選材質，減少材料本身引起的過敏，此外，吸收力佳的尿布，能將尿液與糞便儘可能隔離也可減少尿布疹發生的機率。而勤換尿片保持局部乾爽，則是最重要的步驟。
值得注意的是，念珠菌感染也常因使用的局部藥膏不適當而引發；所以，有問題應請教醫師，切莫拿小寶寶的皮膚當試驗品！
5、脂漏性皮膚炎：
我們也常看到在嬰兒的頭上有一些黃色的鱗屑，這些鱗屑與頭皮有一定的黏著度而不易去除，有時甚至連結成一大片黃色的油狀斑塊覆蓋住整個頭部。相同的鱗屑也會出現在眉毛、臉頰、耳朵附近或是手肘、腹股溝等屈關節處，有時底下還會出現紅斑。這便是常發生於嬰兒的脂漏性皮膚炎。
由於絕大部分的嬰兒患者會於一歲內自癒，而且病灶多不具癢感，因此並不需要太積極的治療。
對於頭上鱗屑的去除，可增加洗頭的頻率，並在洗髮時給予輕輕的按摩與梳理，對於較厚的油屑則可加用礦物油或凡士林類油膏幫助軟化後，用梳子輕輕去除，而對於較嚴重的紅斑或不易去除的油屑，則需由醫師診治。
6、蚊蟲螫咬症：
台灣夏季溼熱，蚊蟲滋生速度快。由於蚊蟲叮咬人體後，其分泌物或蟲體本身會引發過敏反應，因而引起局部紅色丘疹，或是如風疹塊般的突起，而中間的叮咬部位常會出現小紅點或是小水包。
由於蚊蟲螫咬的反應在幼兒較為厲害，且治療上並無速效的方法可馬上止癢，為避免寶寶過度搔抓引發後遺症，最好的方法還是減少露出部位，必要時可事先用防止蟲咬的藥劑，塗抹於露出部位，免得小朋友的手腳一不小心便成“紅豆冰”！
7、接觸性皮膚炎：
接觸性皮膚炎的發生必須有二個條件，一是必須有機會接觸到過敏原，二是身體的免疫系統必須經過一段時間的“醞釀”，才會使皮膚再接觸到過敏原時產生反應。
而對嬰幼兒，需要一段時間的成長期以便接觸各種可能的過敏原，因此接觸性皮膚炎發生的機率較低。
8、異位性皮膚炎：
異位性皮膚炎的皮疹也是屬於濕疹的變化，只是要診斷這個疾病需要符合幾個條件：一是它必須是慢性，反覆再發且具癢感的皮疹，其次它有特定的好發部位，如二歲前皮疹易出現在臉、腹及四肢外側關節處，在二歲之後則會慢慢轉移到頸部及四肢屈側關節處；第三則是病童或家族內有過敏性疾病，如過敏性鼻炎、氣喘或是異位性皮膚炎。因此若臨床症候不足以診斷異位性皮膚炎時，醫師會告訴家長小朋友得了溼疹，或是本身是過敏性或異位性體質，所以皮膚比較敏感。
一旦確定診斷為異位性皮膚炎，等於宣判了幾年的“有期徒刑”；小孩與父母都得經歷一段艱辛的“抗戰”過程。動輒得“癢”，是這個病的特徵，太熱、太冷、太溼、太乾，皮膚馬上拉警報，汗一流多衣服材質不對，海鮮、蛋白質吃太多，渾身就不對勁；一有病痛、情緒緊張，皮膚也跟著遭殃，因此不管是襁褓中的嬰兒、學步的嬰幼兒及在學的小朋友，一有機會就“抓、抓、抓”，抓不到的地方身體就會蹭來蹭去，藉磨擦以解癢感，所以全身散布了抓痕、丘疹、水包，甚至苔癬化病變便是這類小孩的共同特徵！
由於異位性皮膚炎少輒一、二年，拖個十年、八年也是常事，少部分還會持續到青少年期甚至成人，因此父母照顧起來也就倍感艱辛！
雖然醫界不停地在尋找新的治療方法，但到目前為止還不能有效地改變或縮短其病程。
三、「過敏三部曲」
異位性溼疹、氣喘病、過敏性鼻炎這三種病，常被稱為「過敏三部曲」。
患嬰兒溼疹的小兒，長大後容易變成過敏兒，估計有四分之一到二分之一會發生氣喘病及過敏性鼻炎。因此在嬰兒期有此變化者，家長宜長期注意追蹤其過敏變化，並盡量避免其過敏發作。
有時同一個人三種病都有，有的在嬰兒期為溼疹，四、五歲後，變作氣喘、而溼疹已好轉，青春期或成人後則常有過敏性鼻炎困擾，但氣喘發作較少。
異位性溼疹與家族遺傳極有關係。病人的家族中，常可發現有相同的病症，而經血液檢查也可得知一種「免疫球蛋白E」濃度特高；而且白血球中的「嗜伊紅性球」比率也增加。由這些證據可以知道，異位性溼疹與家族遺傳極有關係。
四、減少「非過敏因子」誘發
由於溼疹是表皮受刺激而產生的變化，因此不管是內在或外在的因素，只要能影響到表皮細胞的都有可能產生溼疹反應。
家族中有過敏病史，特別是已知老大有過敏體質，老二就該餵至少三個月的母乳，可能可以減少過敏。因為三、四個月內嬰兒的腸，對外來蛋白質較敏感，而配方奶中多含動物性蛋白質，喝下即可穿透腸膜，刺激產生免疫反應，促發溼疹，及以後其他過敏症之產生。如在前六個月都盡量以母乳哺育，由於人奶幾乎不會引發嬰兒過敏，等到出生六個月後。胃腸機能強健後，此時再喝含動物蛋白質的奶水，就比較不致有過敏發生了。
不過，除了過敏因子外，一些「非過敏因子」也對溼疹扮演了促進、引發、惡化的角色，比如刺激性食物、陽光過度曝曬、毛織品衣褲或毛毯、某些清潔劑或肥皂，甚至空氣中的植物孢子、灰塵、璊等微生物皆可能刺激皮膚產生濕疹。
因此除了動物性蛋白質食品，如鮮奶、海產類、蛋等要避免外，一些香料、食物添加物、防腐劑或刺激性調味料辣椒等，都該避開少吃。
另外，特別溼熱易令人流汗滿身，或冷而乾的天氣對病人的溼疹病情也有不良影響。不要穿著毛織品衣物，內衣要易吸汗通風的材質。
平時，洗澡避免使用帶刺激性的肥皂，盡量減短洗澡時間，也不要使用過熱的水，少接觸洗衣粉、清潔劑等化學品。
經常剪短指甲並多洗手，以免不經意抓破皮，讓細菌侵入皮膚。
五、耐心、毅力及找對醫生最重要
溼疹跟香港腳一樣難纏，能不能根治，要看個人的耐心與毅力，及能不能配合醫生的診療。
在皮膚保養、治療方面：
1、減少洗澡的次數，水溫不要太熱，以淋浴為主，並避免泡澡。
2、減少使用肥皂及消毒水，因為它會使皮脂流失，可以使用適合敏感性膚質的清潔用品或沐浴乳。
3、洗完澡後趁皮膚還充滿水分時，立刻擦保濕潤膚乳液，使皮膚有一層保護膜，防止水分散失並保持肌膚滋潤。
4、貼身衣物應選用棉質產品，避免羊毛的織物等易刺激皮膚的物質，直接接觸皮膚。
5、用什麼保養品來保養呢？保養霜或乳液可分成潤膚劑及保溼劑兩大類，潤膚劑如油脂，主要作用在於填補角質細胞空缺，減少水分揮發。保溼劑則為吸收空氣或真皮的水份上來角質層，所以仍須配合油脂的使用。如果保養品使用無效，則可以可以在醫師的指示下使用適當的油性藥膏、止癢藥物或溫和的外用類固醇來治療。
6、最後要強調的是，由於溼疹類疾病多半需要使用局部類固醇藥膏，長期使用或是使用不當強度的類固醇，很可能對局部皮膚產生副作用，如皮膚萎縮、色素變化、血管擴張或是併發微生物感染等，嚴重時還可能引起全身性的副作用而影響小朋友的生長與發育，尤其是嬰幼兒的皮膚薄，吸收力佳，更不可輕易用效力太強的類固醇藥膏，因此皮膚上的任何問題，應請醫師診治後再用藥，用藥的方法與時間亦應與醫師充分的討論，切莫自行用藥或是 未經複診長期塗抹；當然，也不必過於害怕藥物的副作用而完全不敢用藥，如此反而會延誤病情。
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