異位性皮炎（濕疹），類固醇與症狀復發（Rebound）6

日本的醫療福利制度相當先進，所以外用類固醇的普及化也較早，暗瘡，濕疹的治療都是靠外用類固醇。所以從另個角度看，可以說日本是個Steroid addiction大國。

下面介紹的榎本充邦醫生於1991年發表的論文算是出自日本學者的第一篇報告有關Rebound現象的文獻。論文摘要寫道“The corticosteroid withdrawal syndrome, the systemic side effect, occurred in 7 patients who had used potent topical corticosteroids for a long time on their skin lesions. In all cases, characteristic symptoms of the syndrome such as weakness, fatigue, low grade fever, oligouria, tachycardia, gastrointestinal and psychological symptoms were noted. In addition, diffuse edematous erythema appeared widely beyond the primary lesions about 5 days after cessation of the drugs. These symptoms, together with the facts that adreno-cortical insufficiency was found in 5 of 7 patients and either systemic corticosteroid or ACTH was requested for the treatment in all patients, lead us to consider that the erythema was not flare of the primary diseases but was a rebound skin manifestation in the corticosteroid withdrawal syndrome. Local withdrawal rebound eruption frequently occurs on the face which is now well known as rosacea-like dermatitis, but systemic one caused by topical corticosteroid as mentioned here has not been reported. 

It should be noted that topical corticosuteroids can induce the withdrawal syndrome, and diffuse rebound erythema is a characteristic skin manifestation of the conditions as mentioned here which are caused by topical corticosteroids.”（於7位長期使用強烈皮質類固醇治療皮炎的患者上均有發現由Corticosteroid withdrawal syndrome[皮質類固醇戒斷綜合症]引起的全身性副作用。而於所有個案都觀察到該綜合症的特有病徵如虛弱，疲勞，輕度發燒，少尿，心搏過速，腸胃以及心裡症狀。此外，在停用類固醇約5天後，還有漫性水腫性紅斑在廣泛範圍出現而其覆蓋範圍還超出原來患部。除上述各症狀外，由於上述治療採用的用藥是全身性[經脈注射或口服]的外用皮質類固醇或外用促腎上腺皮質激素，而7位患者中5位患者出腎上腺皮質機能不足的現象現，我們認為紅斑的出現並非原來症狀惡化的結果，而是由皮質類固醇戒斷綜合症而起的反彈現象。我們熟悉的面部類固醇玫瑰斑是常見的由局部［面部］戒斷的結果引起的反彈症狀，但本次報告的戒斷外用皮質類固醇引起的全身性反彈症狀未曾被報告。

應當注意外用皮質類固醇可以引發戒斷綜合症［Withdrawal syndrome］而此時觀察到的漫性水腫性紅斑的症狀應被視為戒斷外用皮質類固醇引起的反彈症狀特徵。）

上述論文的要義就是在1991年，日本國內首次發現Steroid addiction的Rebound會出現具有特徵性的紅斑。換句話說，Marion B. Sulzberger MD.在1952年證實外用類固醇可抑制異位性皮炎，而37年後的1991年才有人發現Rebound的病徵和原有的（異位性皮炎）病徵不相同。