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
37 Warts, Plantar Warts, Verruca Plantaris
https://t.me/med1917
Figs. 37.7 and 37.8 Common warts on the hand—10×, 60× magnied photos
151
Fig. 37.9 Black dots of warts found when the lesion was cut to the
same height as the surrounding skin
Figs. 37.10 and 37.11 Corns do not show black dots and a keratin nucleus is observed in the center
152
https://t.me/med1917
Fig. 37.12 For reference, calluses do not have a penetrating central
nucleus like corns and are more widely hypertrophied compared to
corns. In distinguishing from calluses, there are no ngerprints or palm
lines in wart lesions, but on the contrary, calluses have ngerprints or
palm lines left and appear more prominently
time. Therefore, it is wise to remove them quickly not only for
cosmetic reasons but also when they cause discomfort in daily
life, such as walking or holding objects, depending on where
the warts are located, and when they cause pain. Also, since
they can be transmitted to others through skin contact, more
aggressive treatment is thought to be necessary.
The treatment of warts can be divided into destructive
methods and non-destructive methods using immunological
mechanisms. Destructive methods include cryotherapy, surgical excision, curettage, electrocautery, drug application
(keratolytics, salicylic/lactic acid, TCA, podophyllin, podolox, 5-FU, etc.), local injection of anticancer drugs (bleomycin), laser treatment, photodynamic therapy, etc.
Immunological methods include inducing local inammatory reactions in warts by causing allergic contact dermatitis
with DPCP or SADBE, injecting interferon into lesions,
quadrivalent human papillomavirus vaccine, high-dose
cimetidine administration, and application of the immune
response modier imiquimod. The treatment effects vary
37 Warts, Plantar Warts, Verruca Plantaris
Fig. 37.13 This is a photo of the underside of a wart after it was
removed using a CO2 laser. Contrary to popular belief, warts do not
have roots. As shown in this photo, the underside of a wart is round and
smooth. It is easy to think that it is rooting into the dermis or subcutaneous fat layer, but in fact, a wart is just a lesion conned to the epidermis.
Knowing this fact makes it possible to perform CO2 laser surgery,
which signicantly reduces the recurrence rate
depending on each method, and even with the same treatment, the results or effects can vary according to the report.
The choice of treatment method can vary depending on the
location, size, number of warts, the presence of secondary
bacterial infection, the patient’s age, gender, and immune
status. Desirable results in the treatment of warts depend on
how effectively the wart lesions are destroyed while minimizing damage to normal tissue. Most wart treatments currently used have a cure rate of about 50% and an average
recurrence rate of 25–50%. It is known that if the normal
skin around the wart is included in the treatment by 1–2mm,
the recurrence rate can be reduced. Recently, a combined
therapy using two treatments has been reported as a new
effective treatment due to its excellent cure rate and safety,
effectively compensating for the disadvantages of monotherapy, including low cure rate and frequent recurrence. There
are various treatment methods for warts, but Ms. K wanted
the laser excision, which has the highest cure rate among
commonly used treatments such as drug application, cryotherapy, and excision. Therefore, the wart lesions were completely excised with a laser (Fig.37.13).
Pthiriasis: Pediculosis Pubis
https://t.me/med1917
The pubic louse that was found last week has laid an egg
(nit) today.
Mr. L, a man in his 40s who came in last week complaining of severe itching in his lower abdomen, was found to
have just one pubic louse in his pubic hair (usually there are
many). I thought it was strange, but after applying the medicine and asking him to come back in a week, I found that it
had laid an egg (nit) in the meantime (Figs.38.1, 38.2, 38.3,
38.4, 38.5 and 38.6).
The Standard Korean Language Dictionary describes the
pubic louse (Pthirus pubis) as “a species of the Pthiridae
family. The body is shaped like a crab, and there are many
hairs at the ends of the protrusions on the sides of the fth to
eighth abdominal segments. It parasitizes in the pubic hair of
humans and sucks blood, causing itching and rash when bit-
38
Fig. 38.1 200× magnied photo of pubic louse (Pthirus pubis) nit
Figs. 38.2 and 38.3 One pubic louse (Pthirus pubis)
© 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_38
153
154
https://t.me/med1917
Figs. 38.4 and 38.5 Magnied photo of pubic lice
Fig. 38.6 Pubic louse—60× magnication
ten. It is a common species worldwide.” Pubic lice mainly
parasitize in the pubic hair, pubic lice infestations are called
pthiriasis or pediculosis pubis. It is accompanied by severe
itching and can rarely parasitize in the chest hair, armpit hair,
or eyelashes. It is mainly transmitted through close skin contact such as sexual intercourse but can rarely be transmitted
through bedding or towels. The probability of pubic lice
being transmitted through one sexual encounter with an
infected partner is over 90%, and it takes several weeks after
intercourse to feel the itching. For infected patients, there is
a greater than 30% chance of having at least one other sexually transmitted disease. It takes 22–27 days from egg to
adult, and the adult lifespan is 17 days for females and
22days for males. Pubic lice can only survive on the human
38 Pthiriasis: Pediculosis Pubis
body, prefer moist environments, and do not often change
their parasitic location. Small erythematous papules can be
seen at the blood-sucking area of pubic lice, and in rare
cases, vesicles may form at the blood-sucking area. However,
these primary lesions are usually not obvious, and secondary
skin lesions caused by the patient’s own scratching due to
severe itching are commonly seen. Irregularly shaped bluegray spots (Macula cerulea) with a diameter of 0.5–1cm can
be observed on the abdomen, thighs, and chest. These lesions
appear due to an enzyme in the saliva of pubic lice that converts heme of hemoglobin into biliverdin and are mainly
observed in Caucasians. They mostly parasitize the pubic
area but are frequently found in the hair near the anus. In
cases of infection in the eyelashes, a serous scab forms
around the pubic lice and nits, accompanied by eyelid edema.
In Korea, pubic lice found on the scalp of children and adults
have also been reported. Diagnosis is made when adults or
nits are found. The body of the louse appears as a brown dot
of 1–2mm in size, with the legs grasping the hair with claws
and the mouth part inserted into the skin. Usually less than
ten pubic lice are observed. Nits appear as small gray-white
dots rmly attached to the hair. Several to dozens of them are
found, especially at the interface between hair and skin,
which means that egg-laying is actively taking place. If you
look at the patient’s underwear, you can easily observe several stains of light brown or brown caused by the excrement
of pubic lice (Figs. 38.7, 38.8, 38.9, 38.10, 38.11, 38.12,
38.13, 38.14, 38.15, 38.16, 38.17, 38.18, 38.19, 38.20, 38.21,
38.22 and 38.23).
38 Pthiriasis: Pediculosis Pubis
https://t.me/med1917
Fig. 38.7 Pubic louse nit—60× magnied photo
155
Figs. 38.8 and 38.9 Pubic lice observed in the pubic area of a male
Figs. 38.10 and 38.11 Pubic lice and nits
156
https://t.me/med1917
Figs. 38.12 and 38.13 Pubic lice nits—60×, 200× magnied photos
38 Pthiriasis: Pediculosis Pubis
Figs. 38.14 and 38.15 Pubic lice nits—200× magnied photos
Figs. 38.16 and 38.17 Pubic lice nits—200×, 500× magnied photos
38 Pthiriasis: Pediculosis Pubis
https://t.me/med1917
Figs. 38.18 and 38.19 Pubic lice—60× magnication
157
Figs. 38.20 and 38.21 Pubic lice—60× magnication
Figs. 38.22 and 38.23 Pubic lice—200× magnication
158
https://t.me/med1917
38 Pthiriasis: Pediculosis Pubis
Treatment involves applying a topical medication and
instructing the patient to disinfect their bedding and underwear. It is important to inform them that treatment should
also be carried out for their sexual partners. Removal of nits
is important, and shaving the hair in the pubic or abdominal
area can be helpful. If symptoms persist after treatment, the
patient should be examined again in one week. If pubic lice
are found or nits are found at the border of the skin and hair,
treatment is performed once more. If resistance is shown to
one drug, choose another. I showed Mr. L the nit I found
today and told him to apply medicine and come back to the
clinic in a week. After the patient left, teachers Kim and Lee
were busy cleaning the entire examination room with disinfectant and spraying F-Killer (bug spray)!
Prurigo Pigmentosa
https://t.me/med1917
39
After starting a diet, my back and chest became severely
itchy and red rashes appeared, followed by pigmented
net-like discoloration (Fig.39.1).
Ms. E, a woman in her 20s, started dieting and dietary
control for weight loss a while ago, but she came for treatment worried that her chest and back became severely itchy,
red rashes appeared, and then turned into a mottled net-like
dark color. I put on my loupe and closely examined the red
rash on her back.
Prurigo pigmentosa is a relatively rare chronic, inammatory skin disease characterized by sudden onset of erythematous papules with severe pruritus, which progresses to net-like
pigmentation. According to a recent Korean study on a total
of 67 patients diagnosed with prurigo pigmentosa, it occurred
more frequently in women at a ratio of 1:3.8, and the age at
which the lesion rst appeared was mostly young adults, with
an average onset age of 23.8. The onset of the lesion was
seasonal, with summer (38.8%), spring (31.3%), winter
(17.9%), and autumn (11.9%) in order. The cause is not yet
clearly identied, but dietary control, ketosis (“keto rash”),
diabetes, pregnancy, atopy, Helicobacter pylori infection, and
other endogenous factors, as well as physical damage and
friction from clothing, contact antigens such as para-amino
compounds, trichlorophenol, chrome and nickel, excessive
Fig. 39.1 Prurigo pigmentosa observed on the back
sweat, and other exogenous factors are suggested as triggering or exacerbating factors. Among these, the trigger that is
receiving the most attention is ketosis, which may occur due
to ketogenic diet, fasting, insulin-dependent diabetes, and
bariatric surgery. Also, there is a Korean report that psychological stress is a worsening factor, and the association with
autoimmunity or allergy is being studied. Symptoms are characterized by recurrent pruritus with erythematous papules
and plaques, and reticulated hyperpigmentation, which
mainly appear symmetrically. According to Korean studies,
pruritus appeared in 94% (or 96.3%), and most showed moderate to severe symptoms. Skin lesions most often appear on
the back, followed by the chest, neck, shoulders and arms,
abdomen, anks, and groin, in that order, and are more common on the upper body. The distribution of lesions is mostly
bilateral, but rarely unilateral prurigo pigmentosa is observed.
In all cases, erythematous papules or papules and plaques are
observed on the skin, and a reticular hyperpigmentation is
also accompanied in many cases (63.0%). Most of the
histological ndings are nonspecic, but it shows histopathological patterns corresponding to the clinical stages divided
into early, middle, and late stages. In this sense, prurigo pigmentosa is considered an inammatory disease that is clearly
distinguished from other skin diseases. Diseases to be differentiated include conuent and reticulated papillomatosis, pigmented contact dermatitis, erythema dyschromicum perstans,
and Kaposi varicelliform eruption. Prurigo pigmentosa is
common in young women, often occurs in spring and summer, and is characterized by unique lesion shapes and distributions, severe itching, etc. It is differentiated by combining
clinical and histological ndings, but there are also cases in
middle-aged men, starting in autumn or winter, unilateral,
without itching, and only nonspecic ndings are observed
histologically, so it may not be easy to differentiate in actual
clinical practice. Therefore, in cases where differential diagnosis is difcult, it is considered necessary to closely followup not only clinical and histological ndings but also the
clinical course over a long period of time (Figs.39.2, 39.3,
39.4, 39.5, 39.6, 39.7, 39.8, 39.9–39.11, 39.12 and 39.13).
© 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_39
159
160
https://t.me/med1917
Fig. 39.2 Prurigo pigmentosa on the back
39 Prurigo Pigmentosa
Figs. 39.4 and 39.5 Prurigo pigmentosa observed on a man’s torso
Fig. 39.3 Prurigo pigmentosa observed on the back
Figs. 39.6 and 39.7 Prurigo pigmentosa observed on the torso
Соседние файлы в папке Библиотека им академика М.И. Перельмана