Pruritus, papules, and perspiration
학회지 : Ann Allergy Asthma Immunol. 2007 Mar;98(3):299-302
논문 저자 : La Shell MS, Tankersley MS, Guerra A.
Department of Pediatrics, 60th Medical Group, Travis AFB, California 94535-1800, USA. mark.lashell@travis.af.mil
Abstract
BACKGROUND:
The development of pruritus and papules with increased body temperature is a common clinical scenario seen in allergy practice, often leading to a diagnosis of cholinergic urticaria.
OBJECTIVE:
To describe an unusual case of miliaria and its significance in the evaluation of patients with pruritic papular eruptions that occur with increased body temperature.
METHODS:
An 18-year-old woman was referred to a local allergist for the evaluation of cholinergic urticaria. For the preceding 6 months, she had experienced a facial burning sensation along with diffuse pruritus accompanied by water-filled pinpoint bumps on her abdomen and extremities during exercise and with hot tub use. The lesions appeared anytime she exercised, and she reduced her workouts because of the associated discomfort. An exercise challenge was performed given the atypical description of her cutaneous symptoms.
RESULTS:
After indoor aerobic exercise on a treadmill, physical examination revealed facial flushing and numerous pinpoint translucent vesicles covering her abdomen. The diagnosis of miliaria crystallina was made. Given the intense pruritus she experienced with the lesions, she was prescribed cetirizine, 10 mg once daily. However, she noted no improvement with her exercise-induced miliaria. At follow-up 1 year later, her miliaria symptoms had spontaneously resolved with no sequelae observed.
CONCLUSION:
Intermittent, pruritic, papular eruptions that occur with perspiration can provide a diagnostic challenge when not present on initial examination. Although this presentation often leads to a diagnosis of cholinergic urticaria, our case illustrates that other disorders must be considered in the differential diagnosis. In these situations, exercise challenge is a valuable adjunct.
피레토 견해)
가려움증(prurititis), 구진(papules)은 피부온도가 상승되어 있는 경우가 많고 이때에는 피부온도를 낮추고 모공을 열어주는 발한(perspiration)치료가 도움이 된다는 것이 논문의 결론입니다.
중요한 것은 왜 피부온도가 상승되었을까?
Daisaku Michikami, Satoshi Iwase), Atsunori Kamiya, Fu Qi, Tadaaki Mano, Akio Suzumura 팀들이 저술한 "Interrelations of vasoconstrictor sympathetic outflow to skin and core temperature during unilateral sole heating in humans" 의 논문에 의하면 피부온도가 상승될 때에는 심부온도가 낮아진다고 했습니다.
결론적으로 심부온도를 최적화할 때에만 피부온도가 낮아진다는 것입니다.
