04_ภญ.อ.ดร.นพรัตน์_นันทรัตนพงศ์
This document was uploaded by user and they confirmed that they have the permission to share it. If you are author or own the copyright of this book, please report to us by using this DMCA report form. Report DMCA
Overview
Download & View 04_ภญ.อ.ดร.นพรัตน์_นันทรัตนพงศ์ as PDF for free.
More details
- Words: 4,679
- Pages: 18
% &'#$( ) * ..&.%7 *%#7
X0/ %0 7 %Y X( " .0. ! Y , 8 %j!0 !0 $ U5'( 0!3'\* 0%,,
$, % + ( % 0!3'\* 0%" SR, "-( 0/ % .
.% / 0%' ! . %,7 " "#$ .% % .% ( 0%' 3 " ! (% (% / (% %0+ # .0 % 0%, ( ."
, $, 0%, "-", # , O ! 3 " ". ! % "! "# + . .0 /% ? %0 , ""-" ( " = / "$ $ % + "(!3/ 0 S $ !! " S / "(! S,% " S" " S " / "(! ? %0 , $ *, $ 5 ',3/ 0 , . $ $ %". ? * %!0 / " " # $ / 4 ,%" "# D % $ %0 , ", !% 5 ',3/ 0 % (' "$ # $ " / 4 0%, .% ", # $ . .% ? ! + %0 , ( ." % "< .% / 4 " # $ "( ", # % ")% *, " % "0 $ / %6 ",% "$ - ")8 "$ ! ! %
" " + " ".% / 4 $ * $ " 0%, , $ ,
"$ . ? 4 " % %0! 0 "# $ * / <4 ."<
$ *"-! .% () ( / ",) % 0%, ( ." % "-" . % $ , %0 (% " + & !0 % %! 8 ( 5 S ,4 $ + .# 0%, ( "$ " 0%, 5 8 "- 3 + + .# + "$ ",) "" 8 % + , * ( " % epidermis) "< %0 , + + " !% "-+ + "-"</
% !0 !% (4+ "# $ / + "< + "-"</ " / "-"< !$ %<4 $ , 55
"# $ (' "$ <+ ) , "<+ ,$ "# $ 8 ). # (+ . $ %" ?/ "% +*$ " ( + , * + .# %
*, 0%, ?")+*.% #+" % (' $ ?O 0$ 3 " "# + .! 8 .% 0 "$ < %0 , !%(4+ ( "# $ 8 "< ! , ). 8 ")" ( ." ,# '"(( !% ?4 ! + . % * 0%+ ( ."4 ! . 0% * . 0%(% % ? " 0% * 0%(% * , $ %0 ( ! .!! "+ ( +, * "<0 ,4$ $ *, $ " ) " "<0 +% melanocyte <4 $ " ) $ (4+ O 0% ! % "! $ 0! $ " "T+ "%"" $ % ",# ?/ 8 0%( " .+*(4+ (' %0 , ?4 0% % 0%, ") + 0%, $ ?/ + , * ). # , " % dermis + + % !, 2 0 .# "# + " # $ . " (collagen) "# + " # $ !0. (elastic) "# + " # $ . " , $ .% () , %0 , % < < 0%, "% ") *, C 0 ! , $ 4 ?4 + , % . "0 ' $ "0) *, "0 "-/(4+ "$ % . (keloids) "# + " # $ !0., .% # , 0%, "!% & !0 , %0 , + .% () .% # , ('" % + + , % , "# D
" ! ( ! ", # $ ( ( / %$ "T+ "% "$ % / 4 "),# "# % 4?4 + , % + $ / 4 $ ( 0%, .# + subcutaneous + + % . ( ( ! . "( *, $ 5.% ( *, $ O % %3 "% " " " shock absorber ? ! " / 0%, . %8 + % , ($ .%"+ /% 0% (% 0%, 0%", $ % % . 0%, $ ? .% (, "/ - " ( .% + %?4 . 0%, 0 $ 8 0% DO "# + +* "0 . 05 . 0%, "3/ 0
56
(Acne) 0%"-. 0%, $ $ "T% , % <4 $ " # $ (4+ 0% . 8 "# $ 8 , $ ! / %6
. 0%"-8 , 8 , % % <4 $ "- .% ". ".# $ * 0 "
. *"0 $ ( j ""! / "! ,# "0 .% 0 !0( ! ,# & 0%"- "( ! ( (sebaceous gland) !0! ( * 0!( 0 ,4 $ " % < $ (sebum) *, "$ .# 0%, 5.% #+ < $ $ ?/ (4+ + / + 0% /( ( ! . + < $ "< %0 , !$ % , !/ ( /( ( 4 "0 !(4+ "0 "-. 0 (comedone) + .*% . 0 4 , ?4 ! ( ( $ ( ! !*, "$ 0 0%4 "-0"%' $ ( , , , , * ( ! ( %! ! ( j " (androgen) j + / % % "T"S *, "0% % + % % #$ 8 j + ! , ! ( ( ,7 (4+ ( (4+ *, "0 !( /( (!
"0 "-0% ! . " $ !/ & !0 0"%'/( ( .# Propionibacterium acne "-L $ ! *, "0 0% "
. " 0 +"$ ( "- ( 0 <4$ "- ! ! "< 0%, *, " ) "# (% 0"%' % "0 "",)"-! (papule) ? "
(4+ )"-! , (pustule) . + ! ""0 (4+ + 4 ! %0 , "0 4 "-<(4+ ,# "$ % 0%,% (nodulocystic) "3 ( 0% "- 2 0 .# 1. 0% " (Comedone Acne) 2 0 1.1 0%,%C (Close comedone) 5'"-! ") 8 (% 1.2 0%,%"C (Open comedone) 5'"-0%,%")8 "-0%,% * 2. 0% " .# 0% ,$ % 8 ,# "-, "0 !( ! ( % !0 "# + . " < $ % %
57
" # $ ,# 4 *, %0 "0 $ (4+ ,/ 70 %0 ",
(4+ *" # "# $ j ""! "$ 0 $ / (4+ ,# . %0 "0 $ (4+ ('! + .3 ".# $ * )"- ",!,4 $ $ *, "0 0% ! 0% "!
+ . $ "-0% 4 .% ".# $ * , $ " $ * ? *"-! , "# 0!3'\ $ S+* +*"- % .% *.% , % % / 8 % 1 ?4 2 . + , . + ,# ( ?/ %0 , "0 *, %0 "0 " (4+ %$ % "- 0% ") , " "%, 8 R $ 5 ! $ %0 "+ * , / "$ -0%"0 .% %0! % ( .%
$ ?+ 5 ?/! ,# , *, "0 *,# "-, ! 5 3 ,
/ 50% %$ .# O "0 0%, "( . " 0 <4 $ ! S "%5 L 50% + "T $ "# %&0 5 (4+ .% ( 0%('+
3" *
"T $ $ 50% , % " Z0% <4 $ = &0> ! "# + . " "$ -",!,4 $ ( "0 0% ! "# $ ? ! " !%" % *, "0 # + 4 .% % #$ 8 " %0! 0" <4 $ % "0 0% ! % *, %0 ! "$ 0 (4+ %, "T $ % ,7 ( ". *, "0 . ".# ! 0%, *, "0 , ,# + 4 .% 8 "0 $ 0 ' 8 ? . ".# , , % ! ? ,# ) ? 0 ' (4+ ,# % 0 + " % (4+
58
benzoyl peroxide + 0% ! *%"# + . " 4 ? "( 0% 0% !$ #+ 8 ! ( ". *, "0 . ".# ! 0% , *, %0 , 4 .%"# $ . % "( ( !$ 8 " /. 2.5% "T0"%' "$ -0% 0 + % 5-10 % ? , "0 $ "- 1-2 %$ %4 % 1-2 . + retinoic acid "- 0-7 % "0 0% ! % *, %0 ! $"0 (4+ %, ( ". *, 0% 0% $ .%?/ " *, . ".# Adapalene "- &( %0! 0" " " %! ( ". % retinoic acid 8 / # & $ clindamycin, erythromycin + 0 "$ -+* . " ! "T0 " %' $ " - 0 % Z0 % + = &0> U "#+ . "
Propionibacterium acne 4 % "( 0%
* ' $ %0 ""- ! " " % " *"- ! % % <4 $ + Z0% 0 &( %0! 0" j /( . *"0 0 8 / # & ! # , !%" Tetracyclins $ & 3*/!#- !" ! 4 $.$ */"#!#- !*/ ."# , / ! 500-1000 // !" %" 8- 8#"# # " !"#$. $! +%" 9"# :- ' $. $- 1! 12 "#
59
Minocycline Doxycycline $ tetracycline !""< =/> ' Amoxycillin, Erythromycin Roxithromycin * . + tetracyclins
9-; . *"0 $ = &0!> j "S
& cyproterone acetate, Drospirenone "*,! ?" @, " "< =/> !?" @,", $. * #'# ! " %"$&$ . B/# !"# ## # & 1# !
Isotretinoin &( %0! 0" = &0> * ( ! ( !( /( ( , 50% ! .. ( / ( ".
.# *, 0 DR, 0%, !, . $ . ." *, "0 . ".# + *, ( !"< / (4+ * ( ! 0 !0 *, .30 4 , !! + .3 ,# ! + .3 <4 $ ! . *"0 4 0% $ " "- cyst ,# 0% $ 5 %0& #$ % ! + % / /( " +
O" (Melasma) "- #$ +*! $ , "0 "$ ) $ %0 , 0 '"0 $ (4+ $ $ + 2 ( $ / , ,# . % % . % 30-40 R ,/ 70 "-DO % /
DO "- 2 0 1. !!( (Superficial type) 5'"-*+ !( (4+ ")% , ")% 5 DO 8 ?, 2. !!> (Deep type) 5'"- % +*" 0 ( "(! DO 8 *, ( 4+ ! , ( 60
/' ) &?@& 1. "-L $ *.7 $ ( "0 DO ! % "! (UV) + % .#$ "$ UVA UVB <4 $ "-!%! , "0 DO,# *, DO "- (4+
/%" (UVA) "- % .% %.#$ 320-400 " ! *, "0 0%.+* " ! " 0 ! *, "0 "
/% (UVB) "- % .% %.#$ 290-320 " ! *, "0 0% "
0%, " 0% % "0 ") 0%, 2. j . *"0 "-!%,4 $ $ *, "0 DO + ,/ 70 ."0 DO % ,% ! + .3 <4 $ 3 , . ! #$ ) 3. ".# $ * 0 " *, "0 DO (4+ 4. & ." "
"0 DO % . 0%(% <4 $ "-"- & ,# )
/ 1. (,# ," $ 0 $ "$ -",! " ? DO"0 . *"0 )! " $ . *"0 % %0& #$ " ? ,# ,%
2. "# $ , DO 5DO , 0 " j .%0 %0! 0" "3 . !0 ."! "< 0. "-! ", +
+ = &0(> ". / %6 .%45 %0 , .%<# + " <4 $ "0 = &0(> ". <4 $ *, , ,# *.+*% " 0 " # $ 5DO % 0 $ .$ %Z0! !0 0 $ .# ," $ !%! "T . $ 0 &03 $*" % DO $ "0 (4+ , 3. O ,"$ % % . $ 0 &03 "# . , / . SPF (Sun Protection Factor) <4 $ 61
"-!%"( .% ?( . $ % O , "0 , , ! " .8 ,4 $ ! 30 % 0% , ! ? . $ SPF 15 , .% % .8 + ?! "- 15 " .# ' 7.5 %$ , *, 0%%" " ,# . . "$ # .% . SPF 15 )" %*, $ %!0 *%<4 $ ?/ .% $*" ! ? " $ % ",# " )! SPF $ / (4+ <4 $ .) (4+ %
(Herpes simplex) "0 !0 "# + %# $ herpes simplex virus [HSV] "# + herpes 0 .#
Herpes simplex virus 1 (HSV-1) C Herpes simplex virus 2 (HSV-2) C F! ! " F# $% &C' #(* # # "( ' #' ! * + *#( !,"( ' + !#*#( # ( 2-3 *#(!#. ,I J( !#. ,! 24 +' #!/ * . #(!#. ,*,# #( !# , ! "' * 1-2 % *"(#' ( ! + + * ' 0 # " 3 ' / ( /* # I 4 !5** ### + * !", 43 , ( 0 "(' 4 #"( ' # LN*#(! 3 , #C 20-40 , # "(' F*#(! 43 , #C 80 5** "(' !. 43 ,
# ( # ( #( #( *, " + + Q' U 7% 43 ,#* / 4 62
% &%4 "0 "-. $ ?!0 ! ! / "$ -. "T % "$ -! +*! +*"0 $ ! "- ( . #"(' *! !* # + *0 + +/
'# , ( 0"('4 # # ((' * # C (! *",+ !0 ",! #"(' F *! !* #( F# $% * +Q. # ' 8 * +
/ .% "-0 %.+ 5) , " 1-2 , ! Z0! !0 ?$ / ! % *, , ")%(4+ .% "$ - O ( . 0"%' #$ ,# / #$ + " # $ "0 . + ! +* .% "# $ %00 T ?/! : ' "$ - U "# + %0 % % *, #$ , ")%(4+ $ 0 . # acyclovir 0 . <4 $ ! 8 % 4-5 . + , $ % ( "! " . " *, % %
(4+ , *,' $ / %6 "- .% "$ - 0 Acyclovir, Valacyclovir, Famciclovir % .% .% ?$ "% "$ - <4 $ ! ! "# $ 5-7 %
% % 1. 5.% ( "T0"%' "$ - 2. ," $ " "# $ O !0 "# + . " <+*< O "# + 0"%' #$ 3. ," $ 0 $ "$ -!%! , .*"0 " '". " ( 0%"# + 63
4. ! $ * ! + .3* "-."0 ,# %!%0 ". "-% + / $ "- ! "-. + / .% %!"0 , + !/ 0 . + % " ! " ) ,% .
(dermatophytosis) dermatophyte keratin !"#"$% & %W ' ( ! "# '& *+ , - ("*+- (' & ' - (direct contact) / / !* ' $ *" * '& *+ !% - ("#!% % 0'& *+ & ! 1. "' & 2# (Tinea capitis) - (#'%& 0 2# !" */ "20# & '& ( , % 3 (" !( , % 2# $*+,4 3 *+/$"$ /$ 2#*+#$" &" 4 " ( '& Z56 # ,[ (Kerion) 2. "' & (Tinea faceii) 3. ""4 , ! , (Tinea corporis) Z"[ *+' & ! ## & '& * ("! #$" *+ , '& % & "," #& $ * ! &
4. "'& (Tinea manum) #*+ 5. "'& ' (Tinea pedis) < =, *+ 2 $ ( % / ' ,' *+ ##" '4'& ' ! 4*+"3 6. "'& % (Tinea cruris) "'& %*+ Z([
64
7. "$ ) (Tinea unguium) "- + ") # ")" . ( 5 .% ! "% ") 0 !0/ ") 0 !0 , / "$ - . .. 8 "T 0 $ ! .# 0 $ . *, . ,
/ 5! "% + + (4+ / 0"%' "$ - "T0"%' ") "%5 $ 4[ 6 " # / "$ -4 .% /( 0 $ % .%. / "# $ , 5"- 0 &03O "- , .% .** "# $ , 0 , / <4 $ .% ", 5!! ! 0 0"%'( . "$ - $ 5 1. Terbinafine, Micronazole, Clotrimazole, Ketoconazole `` 2. U "# + 0 Griseofulvin, Ketoconazole , Itraconazole
+ ($/ (Tinea versicolor) ."# + "0 "# + ! " % Pityrosporum orbiculare "-.0 . ! ! 0 ! " " % "# + 0 + S "/ -!0/( (( . 0( $ //("- , " #$ / $ S ,# " ", #$ % 0+ % , ,
+*"- "% "# + 0 + "0 $ *% (4+ % , "0 ."# +
( /0$F ."# + $ , *!% , ! ( 5'"- #$ % (% 8 ( . ( " % ^M ,7 ( " #$ + ! 8 " "-% (% / " ?4 +*!) "# + . . "% ! % $ ", # $ % $ S . 65
/ .%5( %.. " "# + ") !% .%<* 4 $ , , * . + .% % / #$ +* * , "/ , ", # $ ., ,
3" 1. ,/ # / $ % ( Ketoconazole ,# Selenium sulfide +*H !% 0 + % 5 %4 +* 2. 20% Sodium thiosulfate ", #$ "# + "$ - 8 U "# + 0 . + Clotrimazole, Ketoconazole ", #$ "# + "$ -0"%' % 3. U "#+ 0 "T $"- .% 3 ! .**( " , "0 ( ". !% Ketoconazole, Iraconazole, Fluconazole
+ ( / $ ($/ / (Pityriasis alba) +* "-. 0%, " $ "0 "#+ "#+ ! 8 .!0 ! ", # ,# "# + "-" )") " )% " ",!( "0 . "0 "< " ) (melanocyte) $+, * ? " ) (pigment) ! !0 4 *, %0 , %+ "- (% ! ",! $ *, "< " ) "0 .% 0 !0 "# $ % "0 ,# %! 4
" ) "$ "-* % +* .+* + . / ,7
( /0$F "0 $ "0 "- ") 8 % ( "-% 8 ( 0.5-3 < .
( 8 ! "-% (% 8 5'"-% ,# % ( "(! " ( 8 . +* $ 0"%', $ . .$ , ( "- / "-R 8 ,# "- 8 , 8 $ !"- / ,7 ) , " 66
/ 1. ," $ % +* % ,# 2. 0 + % , " ,# % . "! 0 8 " Prenisolone, 0.02% Triamcinolone .% / ,# "/ ) *.% 0"%' "$ -
+( / (Urticaria) "-. 0%, $ 5'"- #$ ,# ^M / ( . #$ ( ! 8 / ! !% (( #$ "$ 0 (4+ , " 3 24 %$ 0 !0 $ %0 , ! ) #$ , (4+ $ #$ 8 / %6 / , % 0 DR"# !% ? "- , ,# "- "# $ .% ,0!!$*! )
05 2 0 .# 05"T 05"# + BC/ ! "0 (4+ % ")% , "% % ")% *, % % 05"T .# #$ "$ - "0 6 , ",!% ,7 "0 0$ ! " , !0 "# + <4 $ / %6 050 ?+ / ",! ? ," $ 0 $ $ ) "0 (4+ B( #$ 05"- 8 , 8 ! "# $ "0 6 ,(4+ % ,",! ,# ?," $ 0 $ $
% #( /*' F 4&"! 4 1. , " , " ( ?%$ / , ,, 2. " Z0% % 3. !0 "# + " < " %! " HL ,# &0 "-! 4. 50 5. 0$ $ " ? # (!% # 0 ".# $ * +*, 67
6. ",! #$ $ .% ". .% .% " ) * (" ( "# + + ( " ( ( %) . ") . ./L "-! / %6 05 "$ - 8 .% "# $ !%,",! <4 $ ,",! $ , "0 05," $ ,# 5",!+ *, . 05 ,# , (
/ +( / 1. %0& $ $ .# ," $ ",! ,",! 5,# ," $ 0 $ $ ! , "0 . 05 ? * 2. " 0%, "! , #$ 05(
(4+ *, "0 0%, " !0 "# + . " <+*< 3. *0!, ". .% ". "-",!,4 $ $ *, #$ *"0 4. calamine lotion "# $ % . 5. ! j! + , 0 + $ % % !% = &0> + !% = &0 > % + ! ! ! j! / %6 ! ", # !% .! . + ? % ,# % .%45 "# $ " $ /6% $"- 050 "#+ ! "-"% ) #$ 050 "#+ %,7 "% ' $ /6% "- #$ , , % % , % !% % .% ")% "#$ , ,# , "- ! *, /6%
" %!0
+ # ,! " (Atopic dermatitis) "-. 0%, " "$ - 8 , 8 " ) ",!( . + ! "#$ % & %"$ %( /6% .+ .. .% /6%
%!0. 3/ 0 S , ,# " # $ ! "3/ 0 ,# 0%, "3/ 0 " ) "$ -. #$ 3/ 0 %0 , ' 50% $ "-., ,# " # $ !(4+ "T" ) $ ( . ' 2 3 ( /6% "-. S % % /6% . 68
0%, "3/ 0 "0 ,,# ". ,4 $ "T ! "0 0%, ( / %6 % (sensitive) ! 3% !% + 3 S .% .% " ) "# + .". )! / $ %!30 / 0 . .%" )"-.+ " " %
( /0 #$F !" #$ 0%, " . 5'"- #$ ,# ! / ! +* <4 $ " # $ ! "-+*",# ," 0 + % "-") () ? #$ "+ - "( / "# + "- ,() ( #$ ( . + (4+ < [ (% !*, $ #$ !! ! % ( / %6 " ) % (%R #$ "0"%' *. S5 " ) , 2 [ 3 (%(4+ #$ 0"%'( ( ( ( + 2 ( % / ,7 #$ "0"%' # " #$ " " )
/ !( * "# $ ",!( "0 . % + ."+ -. 0%, " "# + 4 ?5, , ( 5"- *, %0 , $ ", "-!0O ", +*( #$ % 5.% #+ ( 0%, $*" ," $ +* " *, %0 0 $ , 0 $ . / 8 ,# "# / $ % ( ( , , +*.% $ * 0% , +* . + ! "-* . ,# $ $ ! % ( " +*, " *, "0 "# "# + $ * DO .% "., ! "), + "# $ O ""- ," $ L $ ! ", ( #$ " .% ". .% ,# .% " ) "0 D6 , 0 " ( ?%$ 0 , "!% L ", + *, #$ "- (4+
3" ? #$ ( #$ $ % ( "! "# $ . % !$* 0"%', " hydrocortisone 1% #$ ,$ % 2 . + "# $ . % " 0.02 % triamcinolone ,# prenisolone 0"%' 69
*!%% 2 . + #$ (4+ , steroid $ 8 ) "! .% ! "# $ 8 "?4 "- ! ) / <4 "( / "-05 ( ". "! " 0% 0%! " "# D ! "07"!0!( " ) *, / + " # $ ( #$ " " $ $ "! " Tacrolimus, Pimecrolimus "- Calcineurin Inhibitors
0 &035. #$ 3/ 0 8 steroid ! ( ". % % ) + ) . " + / %6 .% ! j0! "# $ . " . *, / %6 ! " 0%, #$ 0%, $ "*"0(4+ + Chlorpheniramine, Hydroxyzine ( .$ %% .# + *, % ,# ! j! , $ % " Cetirizine, Loratadine ' $ ! , "0 < ! ,# #$ ,# .+*",# % !0 "# + . " < .%45 " / %6 *"-! Z0% "# $ U "# + . "
70
. 1. %'0 , %0! 0S! . 0%, "%Z0! 0 L 0 . + $ 1 " ` j0!0 00 $ , 2548. 2. %0! , . 0%, $ . / # Z0! 0 "3 *,S45"3S! " ` " 0 2550: 233256. 3. " !0 3 !*!%5. %$ : ,%00 T 5.. 0 . + $ 3 (T ). " ` *0 , % 2544. 4. !0!0 S0% &, % . 0%, ! / : *,"%Z0! 0 %$ " ` *0 , % 2545: 1-74.5. 5. Ellis C and Luger T. International Consensus Conference on Atopic Dermatitis II [ICCAD II]: clinical update and current treatment strategies. British Journal of Dermatology 2003: 148 [Suppl.63]: 3-10.
71
72
X0/ %0 7 %Y X( " .0. ! Y , 8 %j!0 !0 $ U5'( 0!3'\* 0%,,
$, % + ( % 0!3'\* 0%" SR, "-( 0/ % .
.% / 0%' ! . %,7 " "#$ .% % .% ( 0%' 3 " ! (% (% / (% %0+ # .0 % 0%, ( ."
, $, 0%, "-", # , O ! 3 " ". ! % "! "# + . .0 /% ? %0 , ""-" ( " = / "$ $ % + "(!3/ 0 S $ !! " S / "(! S,% " S" " S " / "(! ? %0 , $ *, $ 5 ',3/ 0 , . $ $ %". ? * %!0 / " " # $ / 4 ,%" "# D % $ %0 , ", !% 5 ',3/ 0 % (' "$ # $ " / 4 0%, .% ", # $ . .% ? ! + %0 , ( ." % "< .% / 4 " # $ "( ", # % ")% *, " % "0 $ / %6 ",% "$ - ")8 "$ ! ! %
" " + " ".% / 4 $ * $ " 0%, , $ ,
"$ . ? 4 " % %0! 0 "# $ * / <4 ."<
$ *"-! .% () ( / ",) % 0%, ( ." % "-" . % $ , %0 (% " + & !0 % %! 8 ( 5 S ,4 $ + .# 0%, ( "$ " 0%, 5 8 "- 3 + + .# + "$ ",) "" 8 % + , * ( " % epidermis) "< %0 , + + " !% "-+ + "-"</
% !0 !% (4+ "# $ / + "< + "-"</ " / "-"< !$ %<4 $ , 55
"# $ (' "$ <+ ) , "<+ ,$ "# $ 8 ). # (+ . $ %" ?/ "% +*$ " ( + , * + .# %
*, 0%, ?")+*.% #+" % (' $ ?O 0$ 3 " "# + .! 8 .% 0 "$ < %0 , !%(4+ ( "# $ 8 "< ! , ). 8 ")" ( ." ,# '"(( !% ?4 ! + . % * 0%+ ( ."4 ! . 0% * . 0%(% % ? " 0% * 0%(% * , $ %0 ( ! .!! "+ ( +, * "<0 ,4$ $ *, $ " ) " "<0 +% melanocyte <4 $ " ) $ (4+ O 0% ! % "! $ 0! $ " "T+ "%"" $ % ",# ?/ 8 0%( " .+*(4+ (' %0 , ?4 0% % 0%, ") + 0%, $ ?/ + , * ). # , " % dermis + + % !, 2 0 .# "# + " # $ . " (collagen) "# + " # $ !0. (elastic) "# + " # $ . " , $ .% () , %0 , % < < 0%, "% ") *, C 0 ! , $ 4 ?4 + , % . "0 ' $ "0) *, "0 "-/(4+ "$ % . (keloids) "# + " # $ !0., .% # , 0%, "!% & !0 , %0 , + .% () .% # , ('" % + + , % , "# D
" ! ( ! ", # $ ( ( / %$ "T+ "% "$ % / 4 "),# "# % 4?4 + , % + $ / 4 $ ( 0%, .# + subcutaneous + + % . ( ( ! . "( *, $ 5.% ( *, $ O % %3 "% " " " shock absorber ? ! " / 0%, . %8 + % , ($ .%"+ /% 0% (% 0%, 0%", $ % % . 0%, $ ? .% (, "/ - " ( .% + %?4 . 0%, 0 $ 8 0% DO "# + +* "0 . 05 . 0%, "3/ 0
56
(Acne) 0%"-. 0%, $ $ "T% , % <4 $ " # $ (4+ 0% . 8 "# $ 8 , $ ! / %6
. 0%"-8 , 8 , % % <4 $ "- .% ". ".# $ * 0 "
. *"0 $ ( j ""! / "! ,# "0 .% 0 !0( ! ,# & 0%"- "( ! ( (sebaceous gland) !0! ( * 0!( 0 ,4 $ " % < $ (sebum) *, "$ .# 0%, 5.% #+ < $ $ ?/ (4+ + / + 0% /( ( ! . + < $ "< %0 , !$ % , !/ ( /( ( 4 "0 !(4+ "0 "-. 0 (comedone) + .*% . 0 4 , ?4 ! ( ( $ ( ! !*, "$ 0 0%4 "-0"%' $ ( , , , , * ( ! ( %! ! ( j " (androgen) j + / % % "T"S *, "0% % + % % #$ 8 j + ! , ! ( ( ,7 (4+ ( (4+ *, "0 !( /( (!
"0 "-0% ! . " $ !/ & !0 0"%'/( ( .# Propionibacterium acne "-L $ ! *, "0 0% "
. " 0 +"$ ( "- ( 0 <4$ "- ! ! "< 0%, *, " ) "# (% 0"%' % "0 "",)"-! (papule) ? "
(4+ )"-! , (pustule) . + ! ""0 (4+ + 4 ! %0 , "0 4 "-<(4+ ,# "$ % 0%,% (nodulocystic) "3 ( 0% "- 2 0 .# 1. 0% " (Comedone Acne) 2 0 1.1 0%,%C (Close comedone) 5'"-! ") 8 (% 1.2 0%,%"C (Open comedone) 5'"-0%,%")8 "-0%,% * 2. 0% " .# 0% ,$ % 8 ,# "-, "0 !( ! ( % !0 "# + . " < $ % %
57
" # $ ,# 4 *, %0 "0 $ (4+ ,/ 70 %0 ",
(4+ *" # "# $ j ""! "$ 0 $ / (4+ ,# . %0 "0 $ (4+ ('! + .3 ".# $ * )"- ",!,4 $ $ *, "0 0% ! 0% "!
+ . $ "-0% 4 .% ".# $ * , $ " $ * ? *"-! , "# 0!3'\ $ S+* +*"- % .% *.% , % % / 8 % 1 ?4 2 . + , . + ,# ( ?/ %0 , "0 *, %0 "0 " (4+ %$ % "- 0% ") , " "%, 8 R $ 5 ! $ %0 "+ * , / "$ -0%"0 .% %0! % ( .%
$ ?+ 5 ?/! ,# , *, "0 *,# "-, ! 5 3 ,
/ 50% %$ .# O "0 0%, "( . " 0 <4 $ ! S "%5 L 50% + "T $ "# %&0 5 (4+ .% ( 0%('+
3" *
"T $ $ 50% , % " Z0% <4 $ = &0> ! "# + . " "$ -",!,4 $ ( "0 0% ! "# $ ? ! " !%" % *, "0 # + 4 .% % #$ 8 " %0! 0" <4 $ % "0 0% ! % *, %0 ! "$ 0 (4+ %, "T $ % ,7 ( ". *, "0 . ".# ! 0%, *, "0 , ,# + 4 .% 8 "0 $ 0 ' 8 ? . ".# , , % ! ? ,# ) ? 0 ' (4+ ,# % 0 + " % (4+
58
benzoyl peroxide + 0% ! *%"# + . " 4 ? "( 0% 0% !$ #+ 8 ! ( ". *, "0 . ".# ! 0% , *, %0 , 4 .%"# $ . % "( ( !$ 8 " /. 2.5% "T0"%' "$ -0% 0 + % 5-10 % ? , "0 $ "- 1-2 %$ %4 % 1-2 . + retinoic acid "- 0-7 % "0 0% ! % *, %0 ! $"0 (4+ %, ( ". *, 0% 0% $ .%?/ " *, . ".# Adapalene "- &( %0! 0" " " %! ( ". % retinoic acid 8 / # & $ clindamycin, erythromycin + 0 "$ -+* . " ! "T0 " %' $ " - 0 % Z0 % + = &0> U "#+ . "
Propionibacterium acne 4 % "( 0%
* ' $ %0 ""- ! " " % " *"- ! % % <4 $ + Z0% 0 &( %0! 0" j /( . *"0 0 8 / # & ! # , !%" Tetracyclins $ & 3*/!#- !" ! 4 $.$ */"#!#- !*/ ."# , / ! 500-1000 // !" %" 8- 8#"# # " !"#$. $! +%" 9"# :- ' $. $- 1! 12 "#
59
Minocycline Doxycycline $ tetracycline !""< =/> ' Amoxycillin, Erythromycin Roxithromycin * . + tetracyclins
9-; . *"0 $ = &0!> j "S
& cyproterone acetate, Drospirenone "*,! ?" @, " "< =/> !?" @,", $. * #'# ! " %"$&$ . B/# !"# ## # & 1# !
Isotretinoin &( %0! 0" = &0> * ( ! ( !( /( ( , 50% ! .. ( / ( ".
.# *, 0 DR, 0%, !, . $ . ." *, "0 . ".# + *, ( !"< / (4+ * ( ! 0 !0 *, .30 4 , !! + .3 ,# ! + .3 <4 $ ! . *"0 4 0% $ " "- cyst ,# 0% $ 5 %0& #$ % ! + % / /( " +
O" (Melasma) "- #$ +*! $ , "0 "$ ) $ %0 , 0 '"0 $ (4+ $ $ + 2 ( $ / , ,# . % % . % 30-40 R ,/ 70 "-DO % /
DO "- 2 0 1. !!( (Superficial type) 5'"-*+ !( (4+ ")% , ")% 5 DO 8 ?, 2. !!> (Deep type) 5'"- % +*" 0 ( "(! DO 8 *, ( 4+ ! , ( 60
/' ) &?@& 1. "-L $ *.7 $ ( "0 DO ! % "! (UV) + % .#$ "$ UVA UVB <4 $ "-!%! , "0 DO,# *, DO "- (4+
/%" (UVA) "- % .% %.#$ 320-400 " ! *, "0 0%.+* " ! " 0 ! *, "0 "
/% (UVB) "- % .% %.#$ 290-320 " ! *, "0 0% "
0%, " 0% % "0 ") 0%, 2. j . *"0 "-!%,4 $ $ *, "0 DO + ,/ 70 ."0 DO % ,% ! + .3 <4 $ 3 , . ! #$ ) 3. ".# $ * 0 " *, "0 DO (4+ 4. & ." "
"0 DO % . 0%(% <4 $ "-"- & ,# )
/ 1. (,# ," $ 0 $ "$ -",! " ? DO"0 . *"0 )! " $ . *"0 % %0& #$ " ? ,# ,%
2. "# $ , DO 5DO , 0 " j .%0 %0! 0" "3 . !0 ."! "< 0. "-! ", +
+ = &0(> ". / %6 .%45 %0 , .%<# + " <4 $ "0 = &0(> ". <4 $ *, , ,# *.+*% " 0 " # $ 5DO % 0 $ .$ %Z0! !0 0 $ .# ," $ !%! "T . $ 0 &03 $*" % DO $ "0 (4+ , 3. O ,"$ % % . $ 0 &03 "# . , / . SPF (Sun Protection Factor) <4 $ 61
"-!%"( .% ?( . $ % O , "0 , , ! " .8 ,4 $ ! 30 % 0% , ! ? . $ SPF 15 , .% % .8 + ?! "- 15 " .# ' 7.5 %$ , *, 0%%" " ,# . . "$ # .% . SPF 15 )" %*, $ %!0 *%<4 $ ?/ .% $*" ! ? " $ % ",# " )! SPF $ / (4+ <4 $ .) (4+ %
(Herpes simplex) "0 !0 "# + %# $ herpes simplex virus [HSV] "# + herpes 0 .#
Herpes simplex virus 1 (HSV-1) C Herpes simplex virus 2 (HSV-2) C F! ! " F# $% &C' #(* # # "( ' #' ! * + *#( !,"( ' + !#*#( # ( 2-3 *#(!#. ,I J( !#. ,! 24 +' #!/ * . #(!#. ,*,# #( !# , ! "' * 1-2 % *"(#' ( ! + + * ' 0 # " 3 ' / ( /* # I 4 !5** ### + * !", 43 , ( 0 "(' 4 #"( ' # LN*#(! 3 , #C 20-40 , # "(' F*#(! 43 , #C 80 5** "(' !. 43 ,
# ( # ( #( #( *, " + + Q' U 7% 43 ,#* / 4 62
% &%4 "0 "-. $ ?!0 ! ! / "$ -. "T % "$ -! +*! +*"0 $ ! "- ( . #"(' *! !* # + *0 + +/
'# , ( 0"('4 # # ((' * # C (! *",+ !0 ",! #"(' F *! !* #( F# $% * +Q. # ' 8 * +
/ .% "-0 %.+ 5) , " 1-2 , ! Z0! !0 ?$ / ! % *, , ")%(4+ .% "$ - O ( . 0"%' #$ ,# / #$ + " # $ "0 . + ! +* .% "# $ %00 T ?/! : ' "$ - U "# + %0 % % *, #$ , ")%(4+ $ 0 . # acyclovir 0 . <4 $ ! 8 % 4-5 . + , $ % ( "! " . " *, % %
(4+ , *,' $ / %6 "- .% "$ - 0 Acyclovir, Valacyclovir, Famciclovir % .% .% ?$ "% "$ - <4 $ ! ! "# $ 5-7 %
% % 1. 5.% ( "T0"%' "$ - 2. ," $ " "# $ O !0 "# + . " <+*< O "# + 0"%' #$ 3. ," $ 0 $ "$ -!%! , .*"0 " '". " ( 0%"# + 63
4. ! $ * ! + .3* "-."0 ,# %!%0 ". "-% + / $ "- ! "-. + / .% %!"0 , + !/ 0 . + % " ! " ) ,% .
(dermatophytosis) dermatophyte keratin !"#"$% & %W ' ( ! "# '& *+ , - ("*+- (' & ' - (direct contact) / / !* ' $ *" * '& *+ !% - ("#!% % 0'& *+ & ! 1. "' & 2# (Tinea capitis) - (#'%& 0 2# !" */ "20# & '& ( , % 3 (" !( , % 2# $*+,4 3 *+/$"$ /$ 2#*+#$" &" 4 " ( '& Z56 # ,[ (Kerion) 2. "' & (Tinea faceii) 3. ""4 , ! , (Tinea corporis) Z"[ *+' & ! ## & '& * ("! #$" *+ , '& % & "," #& $ * ! &
4. "'& (Tinea manum) #*+ 5. "'& ' (Tinea pedis) < =, *+ 2 $ ( % / ' ,' *+ ##" '4'& ' ! 4*+"3 6. "'& % (Tinea cruris) "'& %*+ Z([
64
7. "$ ) (Tinea unguium) "- + ") # ")" . ( 5 .% ! "% ") 0 !0/ ") 0 !0 , / "$ - . .. 8 "T 0 $ ! .# 0 $ . *, . ,
/ 5! "% + + (4+ / 0"%' "$ - "T0"%' ") "%5 $ 4[ 6 " # / "$ -4 .% /( 0 $ % .%. / "# $ , 5"- 0 &03O "- , .% .** "# $ , 0 , / <4 $ .% ", 5!! ! 0 0"%'( . "$ - $ 5 1. Terbinafine, Micronazole, Clotrimazole, Ketoconazole `` 2. U "# + 0 Griseofulvin, Ketoconazole , Itraconazole
+ ($/ (Tinea versicolor) ."# + "0 "# + ! " % Pityrosporum orbiculare "-.0 . ! ! 0 ! " " % "# + 0 + S "/ -!0/( (( . 0( $ //("- , " #$ / $ S ,# " ", #$ % 0+ % , ,
+*"- "% "# + 0 + "0 $ *% (4+ % , "0 ."# +
( /0$F ."# + $ , *!% , ! ( 5'"- #$ % (% 8 ( . ( " % ^M ,7 ( " #$ + ! 8 " "-% (% / " ?4 +*!) "# + . . "% ! % $ ", # $ % $ S . 65
/ .%5( %.. " "# + ") !% .%<* 4 $ , , * . + .% % / #$ +* * , "/ , ", # $ ., ,
3" 1. ,/ # / $ % ( Ketoconazole ,# Selenium sulfide +*H !% 0 + % 5 %4 +* 2. 20% Sodium thiosulfate ", #$ "# + "$ - 8 U "# + 0 . + Clotrimazole, Ketoconazole ", #$ "# + "$ -0"%' % 3. U "#+ 0 "T $"- .% 3 ! .**( " , "0 ( ". !% Ketoconazole, Iraconazole, Fluconazole
+ ( / $ ($/ / (Pityriasis alba) +* "-. 0%, " $ "0 "#+ "#+ ! 8 .!0 ! ", # ,# "# + "-" )") " )% " ",!( "0 . "0 "< " ) (melanocyte) $+, * ? " ) (pigment) ! !0 4 *, %0 , %+ "- (% ! ",! $ *, "< " ) "0 .% 0 !0 "# $ % "0 ,# %! 4
" ) "$ "-* % +* .+* + . / ,7
( /0$F "0 $ "0 "- ") 8 % ( "-% 8 ( 0.5-3 < .
( 8 ! "-% (% 8 5'"-% ,# % ( "(! " ( 8 . +* $ 0"%', $ . .$ , ( "- / "-R 8 ,# "- 8 , 8 $ !"- / ,7 ) , " 66
/ 1. ," $ % +* % ,# 2. 0 + % , " ,# % . "! 0 8 " Prenisolone, 0.02% Triamcinolone .% / ,# "/ ) *.% 0"%' "$ -
+( / (Urticaria) "-. 0%, $ 5'"- #$ ,# ^M / ( . #$ ( ! 8 / ! !% (( #$ "$ 0 (4+ , " 3 24 %$ 0 !0 $ %0 , ! ) #$ , (4+ $ #$ 8 / %6 / , % 0 DR"# !% ? "- , ,# "- "# $ .% ,0!!$*! )
05 2 0 .# 05"T 05"# + BC/ ! "0 (4+ % ")% , "% % ")% *, % % 05"T .# #$ "$ - "0 6 , ",!% ,7 "0 0$ ! " , !0 "# + <4 $ / %6 050 ?+ / ",! ? ," $ 0 $ $ ) "0 (4+ B( #$ 05"- 8 , 8 ! "# $ "0 6 ,(4+ % ,",! ,# ?," $ 0 $ $
% #( /*' F 4&"! 4 1. , " , " ( ?%$ / , ,, 2. " Z0% % 3. !0 "# + " < " %! " HL ,# &0 "-! 4. 50 5. 0$ $ " ? # (!% # 0 ".# $ * +*, 67
6. ",! #$ $ .% ". .% .% " ) * (" ( "# + + ( " ( ( %) . ") . ./L "-! / %6 05 "$ - 8 .% "# $ !%,",! <4 $ ,",! $ , "0 05," $ ,# 5",!+ *, . 05 ,# , (
/ +( / 1. %0& $ $ .# ," $ ",! ,",! 5,# ," $ 0 $ $ ! , "0 . 05 ? * 2. " 0%, "! , #$ 05(
(4+ *, "0 0%, " !0 "# + . " <+*< 3. *0!, ". .% ". "-",!,4 $ $ *, #$ *"0 4. calamine lotion "# $ % . 5. ! j! + , 0 + $ % % !% = &0> + !% = &0 > % + ! ! ! j! / %6 ! ", # !% .! . + ? % ,# % .%45 "# $ " $ /6% $"- 050 "#+ ! "-"% ) #$ 050 "#+ %,7 "% ' $ /6% "- #$ , , % % , % !% % .% ")% "#$ , ,# , "- ! *, /6%
" %!0
+ # ,! " (Atopic dermatitis) "-. 0%, " "$ - 8 , 8 " ) ",!( . + ! "#$ % & %"$ %( /6% .+ .. .% /6%
%!0. 3/ 0 S , ,# " # $ ! "3/ 0 ,# 0%, "3/ 0 " ) "$ -. #$ 3/ 0 %0 , ' 50% $ "-., ,# " # $ !(4+ "T" ) $ ( . ' 2 3 ( /6% "-. S % % /6% . 68
0%, "3/ 0 "0 ,,# ". ,4 $ "T ! "0 0%, ( / %6 % (sensitive) ! 3% !% + 3 S .% .% " ) "# + .". )! / $ %!30 / 0 . .%" )"-.+ " " %
( /0 #$F !" #$ 0%, " . 5'"- #$ ,# ! / ! +* <4 $ " # $ ! "-+*",# ," 0 + % "-") () ? #$ "+ - "( / "# + "- ,() ( #$ ( . + (4+ < [ (% !*, $ #$ !! ! % ( / %6 " ) % (%R #$ "0"%' *. S5 " ) , 2 [ 3 (%(4+ #$ 0"%'( ( ( ( + 2 ( % / ,7 #$ "0"%' # " #$ " " )
/ !( * "# $ ",!( "0 . % + ."+ -. 0%, " "# + 4 ?5, , ( 5"- *, %0 , $ ", "-!0O ", +*( #$ % 5.% #+ ( 0%, $*" ," $ +* " *, %0 0 $ , 0 $ . / 8 ,# "# / $ % ( ( , , +*.% $ * 0% , +* . + ! "-* . ,# $ $ ! % ( " +*, " *, "0 "# "# + $ * DO .% "., ! "), + "# $ O ""- ," $ L $ ! ", ( #$ " .% ". .% ,# .% " ) "0 D6 , 0 " ( ?%$ 0 , "!% L ", + *, #$ "- (4+
3" ? #$ ( #$ $ % ( "! "# $ . % !$* 0"%', " hydrocortisone 1% #$ ,$ % 2 . + "# $ . % " 0.02 % triamcinolone ,# prenisolone 0"%' 69
*!%% 2 . + #$ (4+ , steroid $ 8 ) "! .% ! "# $ 8 "?4 "- ! ) / <4 "( / "-05 ( ". "! " 0% 0%! " "# D ! "07"!0!( " ) *, / + " # $ ( #$ " " $ $ "! " Tacrolimus, Pimecrolimus "- Calcineurin Inhibitors
0 &035. #$ 3/ 0 8 steroid ! ( ". % % ) + ) . " + / %6 .% ! j0! "# $ . " . *, / %6 ! " 0%, #$ 0%, $ "*"0(4+ + Chlorpheniramine, Hydroxyzine ( .$ %% .# + *, % ,# ! j! , $ % " Cetirizine, Loratadine ' $ ! , "0 < ! ,# #$ ,# .+*",# % !0 "# + . " < .%45 " / %6 *"-! Z0% "# $ U "# + . "
70
. 1. %'0 , %0! 0S! . 0%, "%Z0! 0 L 0 . + $ 1 " ` j0!0 00 $ , 2548. 2. %0! , . 0%, $ . / # Z0! 0 "3 *,S45"3S! " ` " 0 2550: 233256. 3. " !0 3 !*!%5. %$ : ,%00 T 5.. 0 . + $ 3 (T ). " ` *0 , % 2544. 4. !0!0 S0% &, % . 0%, ! / : *,"%Z0! 0 %$ " ` *0 , % 2545: 1-74.5. 5. Ellis C and Luger T. International Consensus Conference on Atopic Dermatitis II [ICCAD II]: clinical update and current treatment strategies. British Journal of Dermatology 2003: 148 [Suppl.63]: 3-10.
71
72
Related Documents
04
November 2019 45
04
October 2019 45
04
October 2019 46
04
November 2019 43
04
May 2020 28
04
November 2019 56More Documents from ""
