異位性皮膚炎（Atopic Dermatitis, AD，可以按這一篇複習）是許多家長的噩夢。看著小朋友（囡仔兄、囡仔姊）全身抓到紅腫、甚至發炎到「流血流滴」lâu-huih-lâu-tih，心疼之餘，更擔心這種長期慢性的發炎，以及治療藥物類固醇，會不會讓小孩的身高發育「矮人一截」。
本文將帶您破除異膚小孩長不高的迷思，深入了解真正影響成長的關鍵因子。
異位性皮膚炎與身高的關聯：證據其實很微弱
根據最新發表的系統性回顧研究，科學家分析了超過 5 萬名 AD 患者的資料，得到了令人寬心的結論：目前沒有證據支持異位性皮膚炎與長期身高落後有強烈關聯。
短暫的身高落後不代表長不高
有些小朋友在 2 到 5 歲之間，身高可能比同齡小孩稍微矮一點（約 0.5 到 0.6 公分），這種現象類似「體質性成長遲緩」。研究發現，這些差距通常在 14 歲左右就會追平，最終並不影響成年身高。
⚠️ 真正的身高阻礙：這 4 個才是關鍵
雖然整體關聯不強，但如果你家的小朋友屬於以下情況，就要特別留意生長發育：
1. 病情嚴重 (發炎「流血流滴 lâu-huih-lâu-tih」)
當異位性皮膚炎嚴重到影響全身超過 50% 皮膚面積，甚至如台語所說的流血流滴 lâu-huih-lâu-tih 時，身體長期處於中重度發炎狀態，確實可能干擾生長激素的分泌。
2. 嚴重睡眠障礙
睡眠是長高的黃金時間。 如果小孩因為搔癢導致半夜頻繁醒來，或是搔癢中斷深層睡眠，生長激素分泌不足，自然會影響身高。
3. 過度的飲食限制
許多家長誤以為「過敏就要禁食」，導致小朋友蛋白質或熱量攝取不足。研究指出，營養不良對身高的影響，往往比皮膚炎本身更直接。
4. 早期且持續的發病
三歲前就發病且病情持續反覆的小朋友，是醫師會加強監測生長曲線的對象。
破解迷思：類固醇藥膏是絆腳石？
這是門診最常被問到的問題。研究明確告訴我們：外用類固醇藥膏與小朋友身高變矮「沒有關係」。
正確使用類固醇藥膏可以：
- 快速壓制發炎。
- 改善皮膚癢感，提升睡眠品質。
- 減少因發炎導致的生長干擾。
朱醫師總結：照顧異膚小孩，我們不只要看皮膚，更要顧成長。維持良好的睡眠、均衡的營養，並在醫師指導下適當用藥，小孩一樣能長得又高又壯！
英文摘要
To evaluate the association between atopic dermatitis (AD) and linear growth in children, and determine factors associated with compromised linear growth in children with AD. A PRISMA-compliant systematic review was conducted. Databases (PubMed, Embase, Scopus and Cochrane) were searched from inception to June 2024 for articles that reported a quantitative relationship between AD and linear growth in children (< 18 years old). Quality of included articles was assessed using the Joanna Briggs Institute Critical Appraisal Tools while quality of evidence in these studies was evaluated using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria.
Fourteen studies (comprising 50,146 patients with AD) were included. Seven studies reported a strong positive or positive association between AD and reduced height standard deviation score (SDS) in children; the others reported no association. Only 3 studies had moderate quality of evidence, all of which reported an association between AD and poorer height SDS; the remaining 11 studies scored low in quality of evidence. Three studies reported the impact of AD on height to be transient. Secondary analysis showed AD severity, earlier AD onset, sleep disruption and, food restriction, to be risk factors for linear growth impairment in patients with AD.
Topical steroid use was not associated with shorter stature in patients with AD. Conclusion: Current evidence on the association between childhood AD and poor linear growth is weak and inconsistent. However, patients with more severe AD, earlier disease onset, poorer sleep quality and higher nutritional restrictions appear more susceptible to linear growth impairment.
What is known? • There is inconsistent evidence of the association between atopic dermatitis (AD) and linear growth in children in current literature, with some studies suggesting that AD may negatively impact linear height while other studies do not report similar associations.
What is new? • There is no strong association between AD in childhood and poorer linear growth. • There may be a transient slowing of linear growth in children with AD, mimicking constitutional growth delay. • Children with severe AD, earlier disease onset, poorer sleep quality and nutritional restrictions may be at risk of more significant linear growth impairment. • Topical steroid use does not appear to contribute to shorter height in children with AD.Table of Contents
發表迴響