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玫瑰痤瘡、紅斑狼瘡、痤瘡或濕疹的鑑別

夏季將至，烈日當空，有些人總易面紅如粧，除可能是曬傷外，原來亦有機會患上某些皮膚疾患，例如玫瑰痤瘡、紅斑狼瘡、痤瘡或濕疹等。

玫瑰痤瘡及紅斑狼瘡都屬於對光照敏感的疾病，患者面部血管對日曬會反應過敏擴張，面部熾熱發紅。兩者不同處是玫瑰痤瘡會局限於面部，紅斑狼瘡為全身性免疫系統失衡的病症，因自我攻擊身體各個器官，產生多處症狀，包括關節炎、斑禿、口腔潰瘍等。紅斑狼瘡須以症狀分布及血清檢查作進一步診斷。

玫瑰痤瘡與痤瘡可同見面部丘疹膿疱，但兩者是十分不同的疾病。相異處是痤瘡並沒有面部發熱，亦不會對日曬反應過敏。此外，痤瘡有白頭或黑頭膿頭，分布除面頜外，亦同見下巴、背部或胸部等，痤瘡處會有泛油光感。

濕疹會有明顯痕癢感，患處分布廣泛，可同時見於手膝屈曲處內側。對於異位性皮炎所產生的濕疹，光照並不會加重病情。西方民間甚至以曬太陽作為濕疹的輔助治療，但讀者要知道現時並無明確醫學文獻指出何種光照及時間長短可減輕濕疹症狀，大家若準備光療前應先向醫生查詢清楚。

雖然中醫沒有以上病種之分，但治療亦講求病因病機，辨證論治。以上病種共通點為皮膚丘疹膿疱，所謂「諸痛癢瘡，皆屬於心」，熱又再分為衛氣營血之別，治療多以清熱解毒為大法。要預防復發，患者要避免誘發因素，減少進食辛辣刺激物及戒除飲酒吸煙，保持腸道通暢，並要多散步放鬆心情。

撰文 : 盧文健 物理治療師、註冊中醫師

欄名 : 理療感悟

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