Whitaker-Worth Diane L, Bayart Cheryl B, Benedetti Julia Anderson
University of Connecticut Health Center, Farmington, Connecticut.
Cleveland Clinic Foundation, Cleveland, Ohio.
Int J Womens Dermatol. 2015 Mar 2;1(1):31-36. doi: 10.1016/j.ijwd.2014.12.003. eCollection 2015 Feb.
Over 200,000 children have been adopted into United States (US) families from abroad since the year 2000. Health care providers who care for children adopted internationally should be aware of the spectrum of illnesses seen in this population, and should be prepared to encounter potentially unusual situations. An appreciation for the unique pre-adoption exposures and vulnerabilities inherent in international adoption is critical for proper diagnosis and treatment of this heterogeneous group of children. It is important to consider the impact of potential early childhood stressors such as nutritional, sensory, and emotional deprivation, trauma and abuse, as well as prenatal exposures to drugs, alcohol, and infectious diseases. Providers must also take into account international variation in health care practices, including immunization, treatment, surgical, and hygiene standards. The differential diagnosis for cutaneous eruptions in children adopted internationally is broad and must encompass endemic systemic illnesses with skin manifestations, such as measles, tuberculosis, leprosy, and congenital syphilis, and primary dermatologic diseases such as scabies and bacterial and fungal infections. The importance of maintaining a broad differential and open mind when addressing the dermatologic needs of these children cannot be overemphasized.
自2000年以来，超过20万名儿童从国外被收养进入美国家庭。照顾国际收养儿童的医疗服务提供者应了解这一群体中出现的各种疾病，并应做好应对潜在异常情况的准备。认识到国际收养中独特的收养前接触情况和固有脆弱性，对于正确诊断和治疗这群异质性儿童至关重要。考虑潜在的幼儿期应激源的影响很重要，如营养、感官和情感剥夺、创伤和虐待，以及产前接触药物、酒精和传染病。医疗服务提供者还必须考虑医疗保健实践中的国际差异，包括免疫、治疗、手术和卫生标准。国际收养儿童皮肤疹的鉴别诊断范围很广，必须包括有皮肤表现的地方性全身性疾病，如麻疹、结核病、麻风病和先天性梅毒，以及原发性皮肤病，如疥疮、细菌和真菌感染。在满足这些儿童的皮肤病需求时，保持广泛的鉴别诊断和开放的思维的重要性再怎么强调也不为过。
