北醫美容中心主任 皮膚科張宜菁醫師部落格 I-Jing Chang MD Dermatologist Taipei
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12/8/2019 0 評論

酒糟皮膚炎、臉紅敏感肌的苦誰能懂?皮膚科醫師4點Q&A說分明

【文/台北醫學大學附設醫院美容醫學科主任張宜菁】 

臉上反覆出現紅疹時,常被診斷為「臉部濕疹」或「敏感性皮膚」。但其中有部分的患者,根本的原因是「酒糟性皮膚炎」。不知道真正病因,往往讓患者在治療上備嘗艱辛。酒糟雖也容易皮膚敏感、長紅疹、刺癢,但只靠濕疹藥膏,常無法改善病情,他們需要的是酒糟的專業治療與正確保養。
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(1)泛紅血管擴張型:臉上持續性的泛紅,可能合併明顯的血絲。有些患者頸部、耳朵、胸前也有泛紅。

(2)丘疹膿皰型:除了臉部泛紅,還有像青春痘般的紅色丘疹跟膿皰,嚴重時臉會水腫。

(3)鼻瘤型:
  鼻子皮膚增厚、鼻子變形,皮膚凹凸不平、顆粒感、毛孔粗大。除了鼻子,臉上其他皮脂腺豐富的部位也可能發生。
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(4)眼睛型:眼周乾澀、刺癢、紅腫、流淚、視力模糊、畏光等。

「酒糟皮膚炎會從第一型進展成第二型」嗎?其實這是備受爭議的。根據醫學研究,泛紅血絲型只有很少比例會進展到丘疹膿皰型,丘疹膿皰型變成鼻瘤型的也很少。較正確的說法,是患者可能只有一型,或同時有好幾型的酒糟。
為什麼會得酒糟性皮膚炎?

毛囊蠕形蟲是皮膚的共生微生物,研究發現酒糟皮膚的毛囊蠕形蟲量比較高。酒糟都是由「毛囊蠕形蟲」引起嗎?科學界目前推測可能導致酒糟皮膚發炎的原因,除了免疫與神經功能失調,還有皮膚屏障受損、微生物、紫外線等。毛囊蠕形蟲只是引發酒糟皮膚發炎的其中一種微生物,但引起酒糟的原因複雜,治療通常無法只仰賴單一解方。

如何治療酒糟性皮膚炎?服用口服A酸可以讓酒糟不復發嗎?

酒糟治療以藥物為主,種類眾多,作用機轉是調節免疫反應、抗蟎蟲、與收縮血管等。醫師視患者的症狀與治療反應開立,多數患者發作時治療約2~4週,若嚴重發炎則需較長時間。
外用藥有免疫調節劑、抗生素類、抗蟎蟲藥、血管收縮劑等。口服藥有四環黴素類、腎上腺素接受器阻斷劑、口服A酸等。嚴重丘疹膿皰型酒糟若以四環黴素治療效果不好,可以考慮口服A酸療程,但治療後仍可能復發。

酒糟性皮膚炎打雷射會好嗎?什麼情況下需要打雷射呢?

除了鼻瘤型難以藥物控制病情,其他型的酒糟治療仍以藥物為主,雷射為美容治療。
染料雷射、跟某些機種的脈衝光,利用「選擇性光熱效應」治療擴張的血管,可處理血絲與泛紅,術後沒有傷口,常被用來幫患者改善皮膚紅的困擾 (見下方照片)。脈衝光另外還可以美化皮膚質感。鉺雅鉻、二氧化碳、飛梭雷射等,則是幫鼻瘤進行磨皮、修整增厚與變形的皮膚。
​
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【醫師小叮嚀 】

酒糟是慢性而常復發的皮膚問題,當症狀發作,請到皮膚科治療,自行塗抹坊間藥膏、恐惡化病情;眼睛型酒糟需到眼科治療。請選擇溫和低敏的保養、清潔用品,並做好保濕。溫度高與辛辣的飲食、酒、日曬、壓力、運動,容易刺激酒糟發作,提醒您多注意。泛紅、血絲、鼻瘤型,建議以雷射治療。為了達到良好療效、降低風險,建議您向瞭解酒糟性皮膚炎的專業醫師諮詢。

本文亦刊登於華人健康網專欄  連結 :
  https://www.top1health.com/Article/77712

張宜菁醫師於民視樂活醫學堂節目中分享關於酒糟性皮膚炎肌膚保養與治療。

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"Dr. Chang is amazing at her work and was very attentive to my needs. I am from the United States, North Carolina, and I came to Taipei on a business trip with my husband. Dr. Chang was very informative and knowledgeable and explained everything to me in terms that I could understand. I met with Dr. Chang because of issues with fine lines and wrinkles, sun damage and an uneven skin tone. I received Fraxel Laser to my face and also Restylane injections to my chin, lips and under my eyes. I am extremely pleased with my results because they look very natural!! I would highly recommend Dr. Chang."

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I came across Dr I-Jing Chang's page on the Taiwan Medical University website by happy coincidence! I was looking for a good Taipei dermatology service that specialized in lip fillers, as that part of my face has lost volume as I have aged. I had a bad experience with lip filler some years ago in Taiwan at another clinic, and had since heard from other dermatologists here that fillers, especially for the lip, are not as common a procedure in TW as in the West. I had almost run out of hope that I could get a good treatment until I met Dr Chang.

From the first moment I met her, I had great confidence in her expert knowledge, her evaluation of my aesthetic needs and her true concern for patients. Now after having several treatments, including lip filler and Botox, my great first impression of Dr Chang has been more than confirmed. She is deeply knowledgeable about skin and aesthetic issues, and well trained in the US and in Taiwan. She is deeply empathetic, she is encouraging, she knows exactly what pain you might feel (and takes steps to minimize it), and she is an artist. She knows so much about what she is doing, and she truly cares about her patients.  The same goes for all her staff. The experience has been very positive, and I recommend her clinic very highly!
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Hello, I am a patient who is from California in the US. I have travelled to Taiwan for this particular skin treatment (fraxal) because the doctor is so amazing. In the past, I have tried so many luxury skincare lines, acid peels, microdermabrasion, and other such treatments for my acne and acne scarring. However, NONE of them can even compare to the wonderful effectiveness of this doctor. She has helped me so very much and I am extremely grateful. I cannot recommend her enough. She is the best and will give you the skin results you have always wanted. Definitely worth travelling around the world for! Book an appointment NOW!

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