Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_141_библиотеки_им_акад_М_И_Перельмана
.pdf
128
https://t.me/med1917
Figs. 31.10 and 31.11 Exfoliative cheilitis
31 Exfoliative Cheilitis
Figs. 31.12 and 31.13 Exfoliative cheilitis observed after taking isotretinoin
Fig. 31.14 Exfoliative cheilitis observed in a child with atopic
dermatitis
Fig. 31.15 Exfoliative cheilitis
31 Exfoliative Cheilitis
https://t.me/med1917
Figs. 31.16 and 31.17 Exfoliative cheilitis on the lips of an adult male
129
Sycosis Vulgaris, Sycosis Barbae,
https://t.me/med1917
Barber’s Itch
32
The areas where my beard grows are inamed, turning
red and yellow with pus, itchy, and painful. Even with
treatment, it keeps recurring.
Mr. S, a man in his late 30s, gets annoyed every time he
looks in the mirror these days. Each of his beard hairs turns
red and yellow with pus, feeling hot or itchy, and it gets
worse when he shaves. Sitting in the examination room, he
worries, “It gets better with treatment, but it keeps recurring.
Is there a problem with my razor? Is it because my immunity
is low?” (Fig.32.1).
Sycosis is an inammation of the hair follicle that invades
the entire follicle, and its causes are diverse, including
Staphylococcus aureus, dermatophyte, Candida, and herpes
simplex virus. However, the most common sycosis vulgaris
is a pustular follicular infection that occurs in the beard area
due to Staphylococcus, characterized by inammatory papules, pustules, and frequent recurrences. It is also commonly
referred to as sycosis barbae (barber’s itch). The main cause
of sycosis vulgaris is Staphylococcus aureus, and other factors such as pulling out hair, excessive friction on the skin,
inappropriate use of topical steroids, and exposure to chemicals can also act as auxiliary causes of onset. It often occurs
in men who shave after puberty, in their 20s and 30s. It is
reported that it occurs more often in people with seborrheic
dermatitis and tends to occur more often in people who work
indoors than in people who work outdoors (Figs.32.2, 32.3
and 32.4).
The basic lesion is a follicular pustule similar to ordinary
folliculitis, but it tends to recur and become chronic, and it
can also show granulomatous proliferation. It usually occurs
in the beard, but it can also occur rarely in the eyebrows,
eyelashes, armpits, pubis, and thighs. Early symptoms
include erythema with a burning or itchy sensation near the
nostrils, which develops into red papules or pustules with
hair penetrating the center within a day or two, which become
worse due to shaving. The lesions are scattered or clustered
depending on the location of the follicles. In the subacute
stage, lesions are clustered mainly on the chin and upper lip,
and in the chronic stage, they form crusted plaques. Lupoid
sycosis is a chronic form that can form plaques over a long
Fig. 32.1 Sycosis vulgaris
© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2024
J. Y. Jeong, Dermatology Diaries, https://doi.org/10.1007/978-981-97-1578-7_32
Fig. 32.2 Sycosis vulgaris
131
132
https://t.me/med1917
Figs. 32.3 and 32.4 Sycosis vulgaris
Fig. 32.5 Sycosis vulgaris
period of time, leaving a ring-shaped round scar. The lesions
of sycosis vulgaris can last from a few days to several months
to years and can occur repeatedly at irregular intervals. The
hair usually does not fall out well, and growth is not delayed
(Fig.32.5).
The diagnosis of sycosis vulgaris can be made through
clinical features, histological ndings, and culture tests. The
histopathological ndings in the acute stage are important
inltration of polymorphonuclear leukocytes into the hair
follicles, and there may also be inltration of polymorphonuclear leukocytes into the walls of the hair follicles. Over
time, granulomatous changes with inltration of lymphocytes, plasma cells, histiocytes, and foreign body giant cell
around the follicles are observed, and the sebaceous glands
and follicles are destroyed and turned into scar tissue. The
causative organism can be found in the tissue with special
32 Sycosis Vulgaris, Sycosis Barbae, Barber’s Itch
staining, and PAS staining should be performed to exclude
causative organisms other than bacteria. The most differential tinea sycosis shows severe inammatory nodules compared to sycosis vulgaris, the hair is broken, and the upper lip
is not well invaded, showing different clinical aspects. In
addition, sycosis vulgaris has the characteristic that hair does
not fall out well compared to tinea sycosis, where hair falls
out well. If a KOH test is performed by pulling out the hair,
the hyphae can be observed in the case of tinea sycosis.
Other differential diagnoses are needed for acne, seborrheic
dermatitis, contact dermatitis, pseudofolliculitis barbae, herpetic sycosis, and lupus vulgaris (Figs.32.6, 32.7, and 32.8).
For treatment, it is usually effective to keep the lesion area
clean and apply a topical antibiotic. Wet dressings are effective in the acute phase. Mupirocin is metabolized quickly
into inactive substances in the plasma when administered
systemically, so it can only be used topically. A 2% mupirocin ointment has antibacterial activity against most
Staphylococci, including MRSA.However, if the inammation of the lesion is severe, deep, frequently recurring, and
extensive, systemic antibiotics should be used. Usually, the
response to topical and systemic antibiotics is good, but
occasionally, if there is no response to treatment, microbiological examination and antibiotic susceptibility tests should
be performed considering the possibility of infection by
antibiotic- resistant strains or tinea sycosis. If it is judged to
be a chronic carrier state, antibiotic ointment is applied to the
inside of the nose and ngertips, and in chronic cases, an
ointment mixed with steroids and antibiotics is used on the
lesion. To prevent spread by shaving, the beard is cut using
disinfected scissors and an electric razor. Mr. S was advised
to receive antibiotic treatment for a sufcient period and to
manage thoroughly to prevent recurrence.
32 Sycosis Vulgaris, Sycosis Barbae, Barber’s Itch
https://t.me/med1917
133
Figs. 32.6–32.8 Sycosis vulgaris
Bier Spots: Bier’s Spots
https://t.me/med1917
33
I’ve been worried because I’ve been getting white spots
on my arm when it’s a bit cold or when I lower my arm
(Fig.33.1).
Mr. G, a man in his 20s, came for treatment because he
was worried about a bad disease as white spots appeared on
both arms when it was a bit cold or when he lowers his arms.
He couldn’t remember when it started. Upon closer inspection, these hypopigmented spots were not xed lesions like
vitiligo or idiopathic guttate hypomelanosis, but white spots
that looked like hypopigmentation disappeared after raising
the arm for a while (Fig.33.2).
Bier’s spots are asymptomatic small hypopigmented spots
that appear irregularly on a red background of the skin,
mainly on the arms and legs of young adults, and disappear
when the affected area is raised against gravity. It was rst
described by Bier in 1898. Studies to clarify the cause of
these lesions reported that the pale white spots are caused by
vasoconstriction, and the relatively red background of the
skin is caused by vasodilation. Also, the fact that the lesions
appear and disappear depending on the posture, and that they
appear on the abdomen due to venous congestion during
pregnancy and disappear after childbirth, is understood as
the result of a physiological reaction. The lesions are irregular multiple hypopigmented spots of 1–2cm in size, and the
arms and legs are the most common sites. They are more
clearly visible when the limbs are lowered in the direction of
gravity or exposed to cold, and conversely, they disappear
when the limb is raised, or the surrounding area becomes
warm. For diagnosis, if the patient’s arm and leg with the
skin lesion are held in the opposite direction of gravity for
about 5min, the spot can be observed to disappear. There are
reports related to aortic arch hypoplasia, polycythemia vera,
cryoglobulinemia, etc., so there are reports that it is necessary to investigate the underlying disease through blood tests
or radiological examinations. It is possible to differentiate
diagnosis with hypopigmentation diseases such as pityriasis
versicolor, vitiligo, post-inammatory hypopigmentation,
pityriasis alba, nevus depigmentosus, nevus anemicus,
Idiopathic guttate hypomelanosis, etc. through history taking, physical examination, KOH test, Wood’s lamp examination, dermoscopy, etc (Figs.33.3, 33.4 and 33.5).
Fig. 33.1 Bier’s spots found on the arm Fig. 33.2 Bier spots on the arm
© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2024
J. Y. Jeong, Dermatology Diaries, https://doi.org/10.1007/978-981-97-1578-7_33
135
136
https://t.me/med1917
Fig. 33.3 Bier spots on the arm
33 Bier Spots: Bier’s Spots
Fig. 33.5 When the arm is raised in the opposite direction of gravity,
the lesion disappears
Bier spots are clinically occasionally seen diseases, but it
is difcult to nd reports on appropriate treatment methods.
This disease is treated as a physiological phenomenon that
does not require treatment, and it is embarrassing that it cannot provide an accurate treatment method other than explaining the mechanism of occurrence, but still, Mr. G was glad to
know the exact name of the disease and left the examination
room.
Fig. 33.4 Bier spots on the arm
Bedbug Bites
https://t.me/med1917
34
After a business trip abroad, not only my arms and legs
but also my whole body’s skin is bitten by bedbugs and
it’s too itchy.
Mr. S, a man in his 30s who has been on a business trip to
various places abroad, thought that the red rash and severe
itching all over his body after arriving in Korea was denitely a bedbug bite he had experienced before and came to
receive treatment. He worries, “How can I get bitten so
badly?” (Fig.34.1)
Bedbug bites occur when bitten by bedbugs, insects in
the order Hemiptera that suck human and animal blood. The
bedbugs that suck human blood are common bedbug (Cimex
lectularius) and tropical bedbug (C. hemipterus), bedbugs
have a strong ability to adapt to temperature and show global
distribution, but C. hemipterus adapt better to high tempera-
Fig. 34.1 Bedbug bites found on the body
tures and only inhabit tropical regions. Bedbugs, which
were rampant in Korea, have disappeared since the 1970s,
and bedbug outbreaks were thought to remain only in countries with poor sanitation. However, bedbugs have recently
reappeared in Canada, the USA, Europe, the UK, and
Australia, and bedbug bites have increased rapidly. And
there was a very high possibility that it would ow into the
country from these countries through travel goods or baggage. According to Korean reports, a woman in her 30s who
lived in Seoul for 9 months after coming from New Jersey,
USA in 2008, identied the insect she caught in her apartment living room as a bedbug. In 2015, a 55-year-old woman
with no overseas travel history identied 6 insects she
caught from her bed as indigenous bedbugs. Bedbugs are
4–7mm in length and have a round, at, oval body. They are
dark brown but turn reddish- brown when they suck blood.
They emit a unique oily smell from their scent glands,
undergo incomplete metamorphosis, and males and females
can be distinguished. They are nocturnal and suck blood
once or twice a week. The blood- sucking time is 4–12min,
and after sucking blood, they leave dry blood excrement
marks on bed mattresses or walls, which become clues to
the presence of bedbugs. They mainly suck blood when
people are asleep, and they do not feel pain or itching
because they release an anesthetic when they bite. The skin
rash at the bitten area can vary from erythema, papules,
wheals, blisters, to purpura, and because various substances
are injected at the same time as blood-sucking, repeated
bites can lead to sensitization, severe itching, anxiety,
insomnia, and other symptoms. Although there is controversy, the skin rash often shows an irregular linear arrangement of three, reminiscent of the pattern of breakfast, lunch,
and dinner (“breakfast, lunch, and dinner sign”). They can
mediate hepatitis B, and it has been suggested that bedbug
excrement can cause asthma in bedbug epidemic areas
(Figs.34.2, 34.3, 34.4, 34.5, 34.6, 34.7, 34.8 and 34.9–34.11).
© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2024
J. Y. Jeong, Dermatology Diaries, https://doi.org/10.1007/978-981-97-1578-7_34
137
138
https://t.me/med1917
Fig. 34.2 The linear arrangement of the skin rash is reminiscent of
having breakfast, lunch, and dinner
34 Bedbug Bites
Treatment includes oral antihistamines and topical steroid
creams, but more importantly, bedbug control using insecticides and disinfection of furniture and clothing, and a
checkup is necessary after 2–3 weeks. After examining Mr.
S’s body thoroughly, I told him, “Ah, you’ve been bitten a
lot! But you were bitten while traveling and you won’t be in
contact with bedbugs anymore, so you’ll get better after
about 5–7 days of treatment. Don’t worry too much!” He left
the examination room with a relieved expression.
Figs. 34.3 and 34.4 Bedbug bites
Figs. 34.5 and 34.6 Bedbug bites on the body
34 Bedbug Bites
https://t.me/med1917
Figs. 34.7 and 34.8 Bedbug bites on the ankle and leg
139
Figs. 34.9–34.11 Bedbug bites
Соседние файлы в папке Библиотека им академика М.И. Перельмана