Department of Dermatology, Course of Integrated Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita-shi, Osaka 565-0871, Japan.
Allergol Int. 2018 Oct;67(4):448-454. doi: 10.1016/j.alit.2018.07.001. Epub 2018 Aug 10.
We have reported characteristic cutaneous manifestations of Sjögren syndrome (SS) with special references to autoimmune anhidrosis or hypoidrosis and related mucocutaenous manifestations in addition to annular erythema or cutaneous vasculitis. Although significance of cutaneous manifestations of SS has been gradually recognized in rheumatologists, sudomotor function has not been fully evaluated and recognized in the diagnosis of SS except for dermatologists. SS is a relatively underestimated collagen disease in contrast to SLE, systemic sclerosis, or dermatomyositis, special care should be needed not to make misdiagnosis of SS when we see the patients with common skin disease such as, drug eruption, infections skin disease or xerosis in the daily practice. In contrast to pathomechanisms of dry skin observed in SS, we recently reported that reduced sweating function and dry skin seen in atopic dermatitis (AD) are mediated by histamine or substance P, those are usually restored to normal levels after improvement of the dermatitis by topical corticosteroid ointment with or without oral anti-histamine. Therefore, xerotic skin lesions seen in SS and AD might be attributable to different pathomechanisms with similar dry skin manifestations. We recently reported that SS promotes dry skin when complicated with AD possibly due to acceleration of hypoidrosis. In this review, we would like to summarize our recent understanding of regulatory mechanism of impaired sweating function in allergic inflammatory skin diseases by introducing clinical presentations of AD/SS overlap cases as the model of hypoidrotic inflammatory skin diseases.
我们曾报道过干燥综合征（SS）的特征性皮肤表现，除环形红斑或皮肤血管炎外，还特别提到自身免疫性无汗症或少汗症以及相关的黏膜皮肤表现。尽管风湿病学家逐渐认识到 SS 的皮肤表现的重要性，但除皮肤科医生外，对于 SS 的诊断，尚未充分评估和认识其出汗功能。与系统性红斑狼疮、系统性硬皮病或皮肌炎相比，SS 是一种相对被低估的胶原病，因此，在日常实践中，当我们遇到常见皮肤病（如药物反应、感染性皮肤病或干燥症）的患者时，应特别注意不要误诊 SS。与 SS 中观察到的干燥皮肤的发病机制不同，我们最近报道，特应性皮炎（AD）中出汗功能减退和皮肤干燥是由组胺或 P 物质介导的，这些物质在通过局部皮质类固醇软膏联合或不联合口服抗组胺药改善皮炎后通常会恢复正常水平。因此，SS 和 AD 中看到的干燥性皮肤病变可能归因于具有相似干燥皮肤表现的不同发病机制。我们最近报道，当 SS 合并 AD 时，SS 可能会导致皮肤干燥，这可能是由于少汗症加速所致。在这篇综述中，我们将通过介绍 AD/SS 重叠病例的临床表现作为少汗性炎症性皮肤病的模型，总结我们对变应性炎症性皮肤病中受损出汗功能调节机制的最新认识。
