Bikowski Joseph B
Department of Dermatology, Ohio State University, Columbus, USA.
Cutis. 2008 Oct;82(4 Suppl):9-15.
The most common clinical presentations of hand eczema are atopic hand dermatitis, pompholyx, and contact dermatitis (irritant contact dermatitis [ICD], allergic contact dermatitis [ACD]). The diagnosis of hand dermatitis is determined by a review of the patient's medical history, a physical examination including other body sites as well as the hands, and a thorough overview of the patient's daily activities with emphasis on occupation and hobbies. Irritant contact dermatitis usually is diagnosed by the absence of a positive patch test result; however, patch testing is essential in confirming a clinical diagnosis of ACD by identifying the allergens to which the patient has been sensitized. Treatment includes topical and/or systemic corticosteroids to reduce inflammation and ceramide-containing moisturizers to repair the skin's barrier function. Topical calcineurin inhibitors may be alternatives to topical corticosteroids. The most important step in the management of hand eczema is prevention with physical protective products (e.g., gloves) or barrier protection creams.
手部湿疹最常见的临床表现为特应性手部皮炎、汗疱疹和接触性皮炎（刺激性接触性皮炎[ICD]、过敏性接触性皮炎[ACD]）。手部皮炎的诊断取决于对患者病史的回顾、包括手部及身体其他部位的体格检查，以及对患者日常活动的全面了解，重点是职业和爱好。刺激性接触性皮炎通常通过斑贴试验结果为阴性来诊断；然而，斑贴试验对于通过识别患者已致敏的过敏原来确诊ACD的临床诊断至关重要。治疗包括使用局部和/或全身性皮质类固醇来减轻炎症，以及使用含神经酰胺的保湿剂来修复皮肤的屏障功能。局部钙调神经磷酸酶抑制剂可能是局部皮质类固醇的替代药物。手部湿疹管理中最重要的一步是使用物理防护产品（如手套）或屏障保护乳膏进行预防。
