78例婴儿疥疮临床特点分析  

Analysis of clinical features of 78 infants with scabies

作　　者：钱革 刘屹球[2] 郭武 刘涛[3] 季江[4] 周武[5] Qian Ge;Liu Yiqiu;Guo Wu;Liu Tao;Ji Jiang;Zhou Wu(Department of Dermatology,Henan Children′s Hospital,Zhengzhou 450000,China;Department of Dermatology,Jingjiang People′s Hospital,Jingjiang 214002,Jiangsu,China;Department of Dermatology,Tangdu Hospital,The Fourth Military Medical University,Xi′an 710032,China;Department of Dermatology,The Second Affiliated Hospital of Soochow University,Suzhou 215004,China;Department of Dermatology,Henan Provincial People′s Hospital,Zhengzhou 450003,China)

机构地区：[1]河南省儿童医院皮肤科,郑州450000 [2]江苏省靖江市人民医院皮肤科,214002 [3]第四军医大学唐都医院皮肤科,西安710032 [4]苏州大学第二附属医院皮肤科,215004 [5]河南省人民医院皮肤科,郑州450003

出　　处：《中华皮肤科杂志》2020年第9期715-717,共3页Chinese Journal of Dermatology

基　　金：河南省医学科技攻关计划联合共建项目(2018020659)。

摘　　要：目的分析78例婴儿疥疮的临床特征和误诊原因。方法回顾性分析2016年1月1日至2018年12月31日在郑州儿童医院、江苏省靖江市人民医院、第四军医大学唐都医院、苏州大学第二附属医院和河南省人民医院皮肤科门诊就诊且最后确诊的婴儿(年龄<6个月)疥疮,分析婴儿疥疮的流行病学特点、皮损特征、治疗情况和误诊原因。结果共收集78例婴儿疥疮,发病年龄和发病至确诊时间[M(P25,P75)]分别为8.5(7,12)周和4(3.5,5)周。确诊时,45例(57.7%)患儿体重低于正常同性别、同龄儿平均体重的第25百分位水平,40例(47.4%)出现易激怒、急躁变化,68例(87.2%)夜间哭闹及易醒次数增多。秋、冬季发病患儿最多,分别为30例(38.5%)、22例(28.2%),夏季最少[8例(10.3%)]。58例患儿家庭内同时有长期居住人员感染疥疮;12例是既往临时居住成员曾患有疥疮。皮损分布以胸腹部(80.8%)和四肢(76.9%)最常见;皮疹呈多形性,不同时期皮疹同时存在,表现为水肿性红色和非水肿性棕褐色丘疹、水疱、丘疱疹和结节,隧道可呈特征性卵圆形、逗点、线状、匍形和J形。患儿平均诊疗2.48次,48例(61.5%)患儿首诊医疗机构为非皮肤科专科门诊,30例(38.5%)为皮肤专科门诊,曾被误诊为婴儿湿疹、丘疹性荨麻疹、脓疱疮、痱、痒疹、色素性荨麻疹、婴儿肢端脓疱病、单纯疱疹和水痘。给予患儿外用5%硫磺软膏治疗,9例(11.5%)出现皮疹突然加重,20例(25.6%)需要多次治疗。20例(25.6%)需要治疗2~3个疗程。治疗结束后2、4、8周随访,所有患儿无复发。结论婴儿疥疮皮疹呈多形性,分布广泛,容易误诊;诊断时需要认真询问病史,仔细体检,同时要结合流行病学调查,提高早期诊断率。Objective To analyze clinical features of 78 infants with scabies and their causes of misdiagnosis.Methods A retrospective analysis was performed on infants aged<6 months with confirmed scabies at Department of Dermatology in Zhengzhou Children′s Hospital,Jingjiang People′s Hospital,Tangdu Hospital of the Fourth Military Medical University,Second Affiliated Hospital of Soochow University and Henan Provincial People′s Hospital from January 1,2016 to December 31,2018.Then,epidemiological features,skin lesion characteristics,treatment and causes of misdiagnosis of infantile scabies were analyzed.Results A total of 78 infants with scabies were collected.Their age of onset and duration from onset to diagnosis[M(P25,P75)]were 8.5(7,12)and 4(3.5,5)weeks respectively.At the time of diagnosis,45(57.7%)patients showed lower body weight than the third quartile[P25]of body weight of age-and gender-matched healthy peers,40(47.4%)had fussiness and irritation,and 68(87.2%)had sleep disorders like night crying and increased frequency of night waking.Infantile scabies more frequently occurred in autumn(30 cases[38.5%])and winter(22 cases[28.2%]),and least frequently occurred in summer(8 cases[10.3%]).For 58 patients,there was at least 1 member with scabies at the same time,who had resided in their families for a long time;for 12 patients,scabies was transmitted through previous contact with temporary residents with scabies in their families.Scabies lesions most commonly occurred on the chest and abdominal regions(80.8%),followed by the limbs(76.9%);skin lesions were polymorphic,and lesions at different stages could coexist;the rashes mainly manifested as edematous red or non-edematous brown papules,blisters,papulovesicles and nodules,and some burrows could be characterized by an oval,linear,serpiginous,comma-or J-shaped appearance.All the patients had visited the clinic for 1-4 times with average visits of 2.38.Forty-eight(61.5%)patients initially visited non-dermatology departments,and 30(38.5%)initially visited dermatolog

关 键 词：疥疮 婴儿 误诊 皮肤表现 疾病传播 传染性 

分 类 号：R757.1[医药卫生—皮肤病学与性病学]