手指皮膚炎の諸原因，特にその検索法について

PATHOGENESIS OF HAND DERMATITIS

Ⅰ．はじめに

　手指皮膚炎（手指湿疹）の原因は諸家によつて種々検討され，その成因についても多くの論議があるが，今日未だに定説を得ない。これは，

1）手指皮膚炎の定義が一定せず，

2)原因の検索法,判定,解釈に多くの問題があること,

3)手指皮膚炎の成因,発症病理に後述の如く日常の諸接触物質を重視すべきであると考えるが,あまりにもその数が多く検出が容易でないこと,しかも他の体部と異なつて皮疹の形態,pa-tternから原因物体を推察することが甚だ難しいこと,

4)手指は気温,湿度,紫外線,機械的,化学的刺激,あるいは水等の環境諸因子の影響をうけ易く,皮膚炎の発生にこれらの関与を多分に考慮する必要があること,等の諸事由に帰すると思う。

　著者らは手指皮膚炎について,その原因検索法を現在種々検討中であるが,その大要をここに紹介し,今日迄に得られた成績を中心に,本症の発症病理を多角的に考察してみた。

In this study the authors have given a diffinition of "hand dermatitis" to be an ec-zmatous dermatitis localized on the hands and fingers, including the dermatitis due to rubber egloves, a wrist watch band or a ring.

About 80% of the patients were female, with the highest incidence in the 2nd and 3rd decades of life. Not a few patients started having the disease or had a recrudescence in summer.

To find causative contactants in daily life, analysis was performed by the following three items; A) environmental factors, B) relationships between the clinical types and causa-tive agents and C) clinical tests composed of patch, photopatch, immersion, and usage tests. In 15 of 42 typical cases causative or aggravating substances were confirmed. The substanceswere detected by item A (54%), C (31%) and B (15%). Rubber, metals and formalin showed higher frequency of positive patch tests in this dermatosis than in the other typse of eczematous dermatitis. Although particular attention must be paid to materials containing the abovementioned substances to find the cause, the results of the patch test alone do not necessarily lend final coinfirmations of contactants. Actually, 88% of the cases gave positive patch tests to some chemical agents which were not causative.

Single immersion in plain water or detergent solutions at an ordinary concentration did not exacerbate the skin lesion. The patch test with detergents at a concentration in ordinary use proved to be negative in all cases. There were no significant differences in the incidence of positive patch tests with undiluted detergens between in the hand dermatitis patients and in control subjects.

Since the normal skin after immersion in water or detergent solutions has a lower thre-shold to contactants, it might be possible that repeated uses of water and detergents would induce indirectly the occurence of hand dermatitis.