【求助】孩子皮肤汗毛囊的问题

yzgf

我女儿今年十一岁了，她的手臂皮肤摸上去疙里疙瘩的，有一些白点，脸上也出现了一些，好象是毛孔里的东西长不出来，去医院检查了一下，医生也说不出所以然来，可我总觉得不对劲。有没有人知道这是这么回事？

edatay

Are the lesion looks like the following pics?

<img src="http://162.129.70.33/images/Keratosis_Pilaris_1_031125.jpg" border="0" onclick="javascript:window.open(this.src);" alt= style="CURSOR: pointer" onload="javascript:if(this.width>screen.width-500)this.style.width=screen.width-500;" />  

<img src="http://162.129.70.33/images/keratosis_pilaris_2_031011.jpg" border="0" onclick="javascript:window.open(this.src);" alt= style="CURSOR: pointer" onload="javascript:if(this.width>screen.width-500)this.style.width=screen.width-500;" />  

<img src="http://162.129.70.33/images/Keratosis_pilaris_1_030324.jpg" border="0" onclick="javascript:window.open(this.src);" alt= style="CURSOR: pointer" onload="javascript:if(this.width>screen.width-500)this.style.width=screen.width-500;" />  

If yes, then I will consider keratosis pilaris.

Keratosis pilaris is an extremely common and benign disorder of keratinized hair follicles. The disease is characterized by grouped, horny, keratotic follicular papules located predominantly on the extensor surfaces of the proximal limbs, most commonly of the posterolateral upper arms and anterior thighs. It is usually asymptomatic except for its cosmetic appearance. Treatment is marginally effective and only provides temporary relief.

Keratosis pilaris is a benign disorder; treatment in most cases requires simple reassurance and general skin care recommendations. Many patients find lesions cosmetically unappealing and therefore seek treatment. Occasionally, they may become secondarily infected because of scratchy tight-fitting clothing or abrasive self-therapy, in which case treatment of the infection is necessary. A significant <I>inflammatory component may be present and may be relieved with topical steroid </I> therapy. Treatment of the noninflamed horny papules can be difficult because they have proven resistant to most modes of therapy.

The patient may report groups of keratotic papules, which feel rough and prickly. The patient may describe them as persistent rough goose bumps. They are not painful or significantly pruritic in most patients.

About half of all affected patients notice a worsening of symptoms in the winter months.

These lesions tend to improve after a few years.

<B>Keratosis pilaris alba </B> is the more common variant and is characterized by small gray-white papules with a negligible inflammatory component.

Most commonly, lesions occur on the posterolateral upper arms and anterior thighs. Less commonly, lesions involve the face, buttocks, and trunk.

In involved areas, lesions are extensive, monomorphic, and very evenly spaced.
A fine hair may pierce the papules, or hair may be found coiled up within the keratin plug. The keratin plug cannot be expressed with pressure.

Causes: Etiology is unknown, although it may be due to a disorder of corneocyte adhesion that prevents normal desquamation in the area around the follicle.

Education and reassurance are the cornerstones of therapy for keratosis pilaris.

The noninflamed horny papules usually remit with age and increasing time, but they are resistant to most forms of short-term therapy.

Encourage tepid showers instead of hot baths, along with the use of mild soaps and a home humidifier.

An emollient cream may help alleviate rough surfaces in mild cases. A topical keratolytic agent such as lactic acid, salicylic acid, or urea preparations may be beneficial in more extensive cases. Several recent reports claim good results with 2-3% salicylic acid in 20% urea cream. Topical tretinoin therapy has also been used with varying degrees of success.

Lesions with significant inflammation may improve with the use of medium-potency emollient-based topical steroid preparations. Inflammation is usually reduced markedly by 7 days, at which point the steroid should be discontinued.

Prognosis:

A 1994 study performed by Poskitt demonstrates the following course:

The condition improves dramatically in approximately 35% of patients, usually by late adolescence (mean age of improvement is 16 y).

The condition remains unchanged from the time of diagnosis in approximately 43% of patients.

Approximately 20% of patients experience a worsening of symptoms over time.

Approximately 50% experience a worsening of symptoms during wintertime, but only 60% of those who worsen improve over summertime.

yzgf

谢谢楼上二位朋友。
edatay朋友，我孩子的不象图片上的那样，她的是白点，而且没这么密，长在手臂的上部。另外，不好意思，我看不懂英文。

edatay

白点长在手臂的上部=Keratosis pilaris alba
The disease is characterized by grouped, horny, keratotic follicular papules <B>located predominantly on the extensor surfaces of the proximal limbs</B>, <B><I>most commonly of the posterolateral upper arms</I></B> and anterior thighs.
而且没这么密: different degree. The pics shown the most obvious cases.
Iwill try to find some CHinese paper for you.

edatay

for your reference:

毛发角化病

毛发角化病（keratosis pilaris）又称毛孔角化病、毛周角化病、毛发苔藓、毛孔苔藓。它是以毛囊口有角化性丘疹、角栓形成为特征的遗传性角化性皮肤病。
【病因病机】
中医认为：本病多因先天禀赋不足，后天失于调摄，脾气虚弱，运化失司，致湿邪内盛，肌肤失养；或由先天不足，营血亏虚，致血虚生风，风胜则燥，皮肤失养所致。
西医对本病病因的认识尚不明确，认为可能与染色体显性遗传有关，是一种毛囊型鱼鳞病。本病在青春期皮损较明显，在甲状腺机能低下、柯兴氏综合征、系统性皮质激素醇治疗的病人中发病率较高且皮损较严重，故有人认为与激素有关。
【临床表现】
⒈皮损特点：损害表现为毛囊性、针尖大小丘疹，呈正常肤色，偶有淡红色，有时丘疹顶端有角质小栓而呈淡褐色。角质栓由毛囊上皮细胞及皮脂性物质组成，内含盘曲的毛发，剥去角质栓，可出现一个微小的凹窝，但很快角质栓又可形成。有些病人角质物很少，大多数皮疹为点状红色丘疹。皮疹各自独立，不相融合，常簇集成团，境界明显，呈鸡皮外观。病变过程中不出现湿润变化倾向。
⒉好发部位：好发于四肢伸侧、肩胛、颈项、两髋，呈对称分布。
⒊多见于青年及皮肤干燥者，发病多呈急性或亚急性，经过缓慢，冬季加重，入夏可稍有减轻。一般无自觉症状，有的伴轻度瘙痒，不影响全身健康。
【辨证】
（一）脾胃虚弱，肌肤失养证
皮肤干燥，四肢伸侧有密集的针头至粟粒大的与皮色一致的丘疹，不痒不痛，间或有微痒。舌质淡，舌体胖，苔薄白，脉沉缓。
（二）营血亏虚，肌肤失养证
皮肤干燥、粗糙，四肢伸侧有密集针头大小的丘疹，顶部有坚硬角质栓，周围微红。自觉瘙痒，入冬尤甚，至夏稍轻。舌质淡红，苔薄，脉细弱。
【诊断与鉴别诊断】
本病根据好发于青少年，无显著炎症的散在的毛囊性丘疹伴角栓，以四肢伸侧为主，较易诊断。皮损应与下列疾病相鉴别：
（一）小棘苔藓
毛囊性丘疹密集成群，有明显的界限，丘疹顶端有一根丝状角质小棘。其常见于颈、股外侧，臀外侧部位。
（二）毛发红糠疹
丘疹往往有炎症，且可融合成斑片，表面覆有糠样鳞屑，多见于头、颈、胸背、膝、肘及四肢伸侧，尤好发于手指第1～2节背面；头面部有脂溢性皮炎表现；掌跖角化明显。
（三）维生素A缺乏症
四肢伸侧有非炎性角化性丘疹，类似蟾皮或鸡皮，但皮疹稍大，患者皮肤干燥粗糙，毛发稀疏变脆，可伴有夜盲、眼干、角膜软化或溃疡等。
（四）瘰疬性苔藓
虽为毛囊性丘疹，但多簇集成圆形、椭圆形或环形，丘疹呈淡黄色或红褐色，无角质栓。分布以躯干为主。常见患有淋巴结核的儿童。组织病理呈结核表现。
（五）角化性痤疮
亦为毛囊角化性丘疹，皮疹较大，角化明显。多见于从事机油、焦油、石蜡等职业的工人，好发于指背、手背、前臂等处。
【治疗】
（一）中医治疗
⒈ 内治
⑴ 脾虚湿盛，肌肤失养证　治宜健脾、除湿、润肤。方药：除湿胃苓汤加减：苍术10g，厚朴6g，陈皮6g，猪苓12g，泽泻9g，赤茯苓15g，白术9g，滑石30g，防风9g，山栀子9g，木通4.5g，当归12g，生地15g，首乌15g，甘草5g。
⑵ 营血亏虚，肌肤失养证　治宜养血、祛风、润肤。方药：养血润肤饮加减：生、熟地各30g，天冬、麦冬、当归、黄芩、天花粉各10g，黄芪30g，桃仁、红花、五味子各6g，防风、荆芥、蝉衣各9g。
⒉ 外治
外涂紫草膏或润肌膏，每日2次。
（二）西医治疗：
⒈ 全身治疗
维生素A，1日10万～20万ｕ；维生素E，每日0.3g，分3次服。
⒉ 局部治疗
⑴ 外用角质松解剂配成软膏，如3%～5%水杨酸或雷锁辛软膏；10%～30%尿素霜；10%硫黄软膏；30%鱼肝油软膏；0.1%维甲酸软膏或0.1%求偶素软膏等外涂。
⑵ 矿泉浴疗或紫外线照射。
【预防与调摄】
⒈尽量少接触肥皂等碱性物质。
⒉避免用刺激性和有毒的药物外用。
⒊平日多食新鲜蔬菜和水果如胡萝卜、南瓜等。