Shab Arna, Matterne Uwe, Diepgen Thomas L, Weisshaar Elke
Department of Clinical Social Medicine, Occupational and Environmental Dermatology, University Clinic of Heidelberg, Heidelberg, Germany.
J Dtsch Dermatol Ges. 2008 Nov;6(11):947-51. doi: 10.1111/j.1610-0387.2008.06825.x. Epub 2008 Aug 28.
Hand dermatitis is relatively common in the general population. Among work-related diseases, it is the most common form of occupational skin disease. Irritant hand dermatitis is the most frequent type. Besides wet work and direct contact to irritating occupational substances frequent hand washing can damage the barrier function of the skin facilitating the manifestation of hand dermatitis that frequently occurs chronically. According to own observations the role of obsessive-compulsive washing as part of an anxiety disorder or personality disorders may not be considered sufficiently. A possible pathogenetic relation between hand dermatitis and psychogenic disorders is discussed in a 22-year old physician's assistant, a 50-year old male nurse working in intensive care, and a 54-year old cleaner. All three patients complained about feelings of revulsion, fear of contamination and a high frequency of hand washing. These cases may encourage dermatologists to consider psychological aspects of hand dermatitis e.g. obsessive compulsive washing, overcome their inhibitions and consider these aspects in an integrated way when planning patient's therapy.
手部皮炎在普通人群中较为常见。在与工作相关的疾病中，它是职业性皮肤病最常见的形式。刺激性手部皮炎是最常见的类型。除了湿作业和直接接触刺激性职业物质外，频繁洗手会损害皮肤的屏障功能，促使手部皮炎经常慢性发作。根据自身观察，作为焦虑症或人格障碍一部分的强迫性洗手的作用可能未得到充分考虑。本文讨论了一名22岁的医师助理、一名在重症监护室工作的50岁男护士和一名54岁的清洁工手部皮炎与精神障碍之间可能的发病关系。这三名患者均抱怨有厌恶感、害怕污染和频繁洗手的情况。这些病例可能会促使皮肤科医生考虑手部皮炎的心理方面，如强迫性洗手，克服他们的顾虑，并在为患者制定治疗方案时综合考虑这些方面。
