欧洲最新湿疹指南：保湿方面六个值得注意的细节

今天看了欧洲的最新湿疹指南：

有几个关于保湿方面的细节值得分享：

1.虽然保湿在湿疹的治疗上很重要，但在急性发炎的皮肤上直接单用保湿产品，病人会受不了，最好先把急性炎症控制了。例如红肿，甚至渗水的湿疹，要先用激素药膏控制湿疹，至少也要先抹激素、再涂保湿。

The direct sole use of emollients on inflamed skin is poorly tolerated, and it is better to treat the acute flare first. Emollients are the mainstay of management.

2. 保湿需要的量比较大，婴幼儿每周需要二两，成人每周需要一斤。

The quantities required are usually high , up to 100 g per week in young children, and up to even 500 g in adults.

3. 纯油类产品（例如椰子油，橄榄油等）会增加经表皮水分流失，使得皮肤更干，不推荐使用。乳液(lotion)也是我一直不推荐的产品。

The use of pure oil products such as coconut oil instead of emulsions will dry out the skin, increases the transepidermal water loss and is therefore not recommended.

4.尿素在婴儿期使用会刺激皮肤，甚至会导致肾功能不全，这个年龄组要避免使用尿素软膏等含尿素的产品。学步期儿童用的话，浓度也要比成人低。

Urea may cause irritation and kidney dysfunction in infants and should be avoided in this age group, whereas toddlers should be treated with lower concentrations than adults.

5.对两岁以下的小宝宝们来说，丙二醇容易刺激皮肤。另外大量预防性使用含有花生和燕麦等完整蛋白类的产品，可能增加皮肤致敏/过敏风险。羊毛脂/羊毛蜡醇/甲基异唑酮等容易引起接触性过敏，也不建议给两岁以下宝宝使用含有此类成分的保湿产品。

Propylene glycol is easily irritating in young children aged less than two years and should not be used for toxicity reasons in these young children. There is concern that the large preventive use of emollients containing intact proteins such as peanut allergens or colloidal oat meal  may increase the risk of skin sensitization and allergy. Only emollient preparations devoid of proteinaceous allergens and haptens known to cause contact allergy frequently (such as lanolin/wool wax alcohol or methylisothiazolinone) should be used, especially in the most vulnerable age group before the age of two years.

6.发作期湿疹如果不用局部抗炎药（例如外用激素），只单用保湿产品的话，可能会增加播放性细菌/病毒感染的风险。

Sole use of emollients without sufficient topical anti-inflammatory therapy involves a considerable risk of disseminated bacterial and viral infection of AE, which is already increased in AE patients.

资料来源：

Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part I.J Eur Acad Dermatol Venereol. 2018 May;32(5):657-682.

题图照片来源：www.allergyuk.org