瘙痒と睡眠障害の原因が疥癬と判明した自閉スペクトラム症の1例

Itching and Sleep Disturbance Caused by Scabies Infection in a Child with Autism Spectrum Disorder

抄録　登校困難を主訴として児童精神科を初診した小学生男児に，6か月以上の皮膚病変の持続と著しい瘙痒および睡眠障害を認めた。皮膚症状と瘙痒による睡眠障害により児と保護者の生活の質が大きく低下しており，皮膚科治療を再検討する過程で，疥癬への罹患が判明した。疥癬は高齢者施設で働く保護者を介して感染したと考えられるが，児の疥癬発症には，児が有する自閉スペクトラム症に伴う触覚の感覚過敏性がもたらす日常的な擦過行動が関与したと考えられた。小児疥癬でみられる皮膚症状は非典型的であるため，疥癬を疑わない限り診断は困難である。小児，特に自閉スペクトラム症のように感覚の偏りを有する発達障害児に関わる医療者は，遷延する皮膚症状や瘙痒による睡眠障害を看過せず，遷延例では皮膚科との連携を考慮する必要がある。

　An elementary-school boy afflicted with his school absenteeism was brought to our child psychiatry clinic. He also presented with sleep disturbances caused by enduring dermatitis over six months and severe itching, which degraded his and his family's quality of life. Our priority was to treat and cure his skin condition and asked his mother to get advanced dermatological care for him. This resulted in a diagnosis of scabies infection. The scabies infection might have been contracted from his mother, who worked in a group home for the elderly. The infection also might have been accelerated by his habitual soothing and rubbing behaviors, which may have derived from his tactile hypersensitivity due to his autism spectrum disorder.

　The diagnosis of scabies is difficult without prior suspicion of infection since the skin symptoms are various and atypical, especially in children. Medical staff working with children should be careful with chronic skin symptoms and sleep disturbances caused by itching, especially in children with tactile atypicality due to neurodevelopmental disorders, including autism spectrum disorder. We should also refer to and collaborate with dermatologists on cases with chronic severe dermatitis.