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
Clothing Allergic Contact Dermatitis
https://t.me/med1917
74
After wearing a new running shirt, my skin became
extremely itchy and red (Fig.74.1).
A woman in her 20s, Ms. M, came in complaining of
itchy skin after wearing a new running shirt. “I think it’s
because of the new running shirt. It’s so, so itchy!” Upon
closer examination, numerous erythematous papules were
conned to the upper body, and no lesions appeared in the
areas protected by her bra, leading to the diagnosis of allergic contact dermatitis caused by the new running shirt
(Fig.74.2).
Clothing can cause irritant contact dermatitis or allergic
contact dermatitis, and most cases are due to the dyes added
and the synthetic resins and chemicals used for nishing to
give various characteristics to the fabric, rather than the
bers themselves. Lesions typically appear in areas where
sweat is produced in large quantities, and when dyes are the
cause, they appear acutely, and when nishing synthetic resins are the cause, they appear chronically. Also, contact dermatitis caused by fabric typically presents as eczema-like or
urticaria-like skin lesions, and in some cases, follicular or
papular rashes have been reported. Formaldehyde is known
to have properties that prevent wrinkles or shrinkage of
clothing, improve durability, and help dyeing, but it can
cause toxicity and allergic reactions in the human body and
damage the fabric itself, so it was not widely used. However,
as formaldehyde treatment is required to develop articial
bers and to impart various properties to cellulose-based cotton fabrics, linen, rayon, etc., cyclic urea-based nishing resins that produce less free aldehyde have been developed and
used. Therefore, compared to the past, when formaldehyde
Fig. 74.1 Allergic contact dermatitis caused by a new running shirt Fig. 74.2 Allergic contact dermatitis caused by clothing
© 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_74
315
316
https://t.me/med1917
was often detected, allergic contact dermatitis caused by
formaldehyde has decreased signicantly (Fig.74.3).
Dyes, which are substances that color things like fabric,
are divided into natural dyes collected from plants or some
animals, and synthetic dyes chemically synthesized from
aromatic materials. Unlike the past when only natural dyes
were used, the creation of synthetic bers has introduced
new dyes and dyeing methods, and the skin has had many
opportunities to be exposed to synthetic dyes that can become
new allergy antigens, but due to the recent development of
fabric manufacturing processes and dyeing technology, dyes
do not easily release, so dermatitis caused by fabric dyes is
not common. Although the frequency of contact dermatitis
caused by fabric dye is rare, if there are skin lesions on the
torso or limbs that show itching of unknown cause or are
considered prurigo, it is necessary to exclude allergic contact
dermatitis caused by fabric dyes through more careful history taking, physical examination, and patch testing. Dyes
that are well sensitizing to the skin mostly belong to disperse
dyes, and it is known that there are currently about 1000
types of dyes. It is a dye that penetrates into the ber in a
state close to a colloidal water dispersion that hardly dissolves in water, and it does not dye hydrophilic natural bers
and is widely used for dyeing hydrophobic synthetic bers.
There are three types: nitroarylamines, azos, and anthraquinones. Among these, azo and anthraquinone structures are
more likely to sensitize the skin. I explained to Ms. M about
allergic contact dermatitis caused by clothing and told her
not to wear the running shirt that caused it any longer and to
receive treatment for about 5 to 7days (Figs.74.4 and 74.5).
74 Clothing Allergic Contact Dermatitis
Fig. 74.4 Allergic contact dermatitis caused by clothing, which
occurred after wearing a newly bought shirt without washing it
Fig. 74.3 Allergic contact dermatitis that occurred after sweating a lot
in a new running shirt
Fig. 74.5 Allergic contact dermatitis caused by wearing new gym
shorts
Lip-Licking Dermatitis: Lip Licker’s
∗∗∗
https://t.me/med1917
Dermatitis
75
My child’s lips are dry or wet, and there are scales on the
lips, and the area around the mouth is red and
discolored.
The mother of 12-year-old boy, H, brought him in because
she was worried that his lips were dry or wet, scales were
forming on his lips, and the area around his mouth was turning red and discolored. The area around the lips is not itchy,
but it stings when eating spicy food (Fig.75.1).
The skin can easily become a target of self-harming
behavior to relieve psychological tension, and such skininvading behavioral disorders exist in the following forms.
(1) Self-biting: Nail biting, skin biting, and lip biting as
expressions of anger and dissatisfaction, (2) Bumping of
head: Lacerations and contusions caused by hitting the head,
(3) Clenching of hand: Swelling at the ngertips, ecchymo-
Fig. 75.1 Lip-licking dermatitis—The area around the lips turns red
due to frequent licking or sucking of the lips
sis, or subungual hemorrhage caused by clenching the hand,
(4) Self-inicted laceration: Attempted to show courage or
for suicidal purposes, (5) Licking of lip: The area around the
lips turns red due to frequent licking or sucking of the lips,
and (6) Pressure: Tightening the waist with a strap can cause
atrophy of subcutaneous tissue. Among these, lip licking is a
type of skin-invading behavioral disorder, and symptoms
appear on the skin when the lips are frequently licked or
sucked, with the lips being dry or wet, thickening, and the
area around the mouth always being red, wet, and sometimes
discolored. Fundamentally, the altered skin mainly caused
by lip licking is due to irritant dermatitis caused by the repetition of wetting and drying. Sometimes, irritant eczema
caused by lip licking can be maintained and secondary bacterial infection can occur. Also, it has been reported that candidiasis can occur around the lips in this state. Therefore,
diagnosis is simple based on the characteristic lesions around
the lips, but tests for bacteria and Candida may be necessary.
In many skin diseases, it is presumed that psychological factors are signicantly associated with the course of the disease, and there are also skin diseases that are thought to
occur purely due to psychological factors. So, rather, it is
possible to infer from the symptoms of the skin an emotional
disorder that was usually overlooked or thought inadvertently even after being aware of it (Figs.75.2, 75.3, 75.4,
75.5, 75.6, 75.7 and 75.8–75.10).
“Your child may show these symptoms due to stress.”
When I told her this, she asked, “What stress can children
have?” I had to make H’s mother understand that children
experience just as much stress as adults and explain to his
mother that although the resulting symptoms of irritant dermatitis can be easily treated, the symptoms may continue to
recur if the cause of lip licking is not eliminated.
© 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_75
317
318
https://t.me/med1917
Figs. 75.2 and 75.3 Lip licker’s dermatitis
75 Lip-Licking Dermatitis: Lip Licker’s Dermatitis
Figs. 75.4 and 75.5 Lip-licking dermatitis
Figs. 75.6 and 75.7 Lip licker’s dermatitis
75 Lip-Licking Dermatitis: Lip Licker’s Dermatitis
https://t.me/med1917
319
Figs. 75.8–75.10 Lip-licking dermatitis
Tinea Incognito
https://t.me/med1917
76
I have been suffering from eczema on my abdomen for
some time now and it is not getting better no matter how
much I buy ointment and apply it or receive treatment at
other hospitals (Fig.76.1).
Three weeks ago, C, a woman in her 20s, came to get
treatment, saying that she had been suffering from eczema
on her abdomen for some time. She bought ointment and
applied it and received treatment here and there, but it got
better a little and then got worse again. I said, “This looks a
bit strange, and it seems like a fungal disease that has been
heavily applied with steroid ointment. Do you have a photo
taken at the beginning?” When I asked, she said, “Yes! It
looked like this at rst!” (Fig.76.2).
“Well, that’s it! You didn’t get better because you applied
a lot of steroid ointment to tinea corporis!” I prescribed antifungal medication a few times, and when she came today, the
skin lesions on her abdomen that were not healing well were
almost gone (Fig.76.3).
Tinea incognito refers to a supercial infection of the skin
caused by dermatophytes that manifests as a modication of
the typical clinical ndings due to various prior treatments.
This disease, rst described in 1968, occurs when the charac-
teristic clinical features of a lesion caused by dermatophytes
are lost and changed by mistaking it for an eczematous lesion
and using topical or systemic steroids. Initially, the administration of steroids shows improvement in skin lesions and
symptoms, but when the administration is stopped, the lesions
recur, and atypical clinical features occur, such as loss of the
characteristic raised border of fungal disease and disappear-
Fig. 76.2 Tinea corporis observed in the initial photo
Fig. 76.1 Tinea incognito that appeared on the abdomen
© 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_76
Fig. 76.3 The lesion almost disappeared after 3 weeks of treatment
with antifungal agent
321
322
https://t.me/med1917
76 Tinea Incognito
ance of scales, while the lesions further spread to the surrounding area. Steroids generally act not directly on the
fungus but by reducing the local cell-mediated immune
response of the skin and reducing the inammatory response
of the skin. Therefore, at the beginning of use, the inammatory response of the skin may seem almost non-existent or
reduced, but with long-term use, skin atrophy or vascular
dilatation, along with the continuous decrease in immune
response, can lead to an increase in fungal toxicity, and skin
lesions can spread widely, showing atypical shapes and distributions. One of the important causes of tinea incognito is the
environment where patients can easily purchase steroids at
pharmacies, but it is also because it is not easy to diagnose as
the clinical manifestations of lesions on the face and other
areas are often atypical. Also, if atopic dermatitis or psoriasis
and other underlying diseases are accompanied by tinea, the
course can worsen by continuously applying steroids, and
recently, with the increase in the use of topical immunomodulators such as tacrolimus and pimecrolimus, their use is
inducing the transformation and worsening of tinea lesions,
and it is reported that the incidence of tinea incognito is
increasing. It most commonly occurs on the trunk and face
and can appear in various forms such as eczema shape, psoriasis shape, lupus erythematosus shape, impetigo shape, folliculitis shape, lichen simplex chronicus shape, etc. Rarely, it
can occur in the form of Majocchi’s granuloma, which
requires differentiation from bacterial infection, prurigo, and
other eczematous diseases. Tinea incognito does not show
typical clinical manifestations of tinea and various forms of
lesions appear, so diagnosis is often delayed or misdiagnosed
as other diseases. Especially when it occurs on the face and
neck, differentiation from photosensitivity disorders, rosacea,
seborrheic dermatitis, contact dermatitis, lupus erythematosus, and other diseases is necessary, and in many cases, it is
difcult to differentiate clinically, so it is essential to conrm
the dermatophytes through a fungal examination of the skin
lesion for diagnosis. According to a study of 283 patients with
tinea incognito in Korea, it was reported that 91.3% were
positive in direct microscopic examination. Histological ndings of tinea incognito are known to observe fungal hyphae or
inammatory cell inltration in the lower dermis compared to
typical tinea. Even if it looks like contact dermatitis or folliculitis, if it does not respond well to long-term treatment, it
is important to keep in mind the possibility of fungal infection
and to perform a fungal examination and culture test to make
an appropriate diagnosis and treatment. If tinea incognito is
diagnosed, discontinue use of steroids or topical calcineurin
inhibitors, take antifungal medication orally for 4weeks, and
treat with topical antifungal cream. Ms. C laughed bitterly,
saying that it happened because she only applied eczema
ointment for the fungal disease (Figs.76.4, 76.5, 76.6, 76.7,
76.8, 76.9, 76.10, 76.11, 76.12 and 76.13).
Figs. 76.4 and 76.5 Tinea incognito—10days after antifungal treatment
76 Tinea Incognito
https://t.me/med1917
Figs. 76.6 and 76.7 Tinea incognito on the face and neck
323
Figs. 76.8 and 76.9 Tinea incognito (before treatment, 1week after antifungal administration)
324
https://t.me/med1917
Figs. 76.10 and 76.11 Tinea incognito on the legs
76 Tinea Incognito
Figs. 76.12 and 76.13 Tinea incognito on the back and abdomen
Pityriasis Rosea
∗∗∗
https://t.me/med1917
77
A large red rash with scales appeared on my body, and
after a few days, many small red rashes appeared. It
hasn’t disappeared even after taking medicine for
2weeks (Figs.77.1).
21-year-old Mr. S said, “A large, oval, red spot covered
with scales appeared on my body, and not long after, many
smaller red rashes appeared. Even after more than 2 weeks of
treatment and taking medicine, it doesn’t get better!” In this
case, when observed using an image magnication device
that magnies about 10 times, the peeling of dead skin cells
spreads from the inside out and typical collarette scaling is
observed inside the edge.
Pityriasis rosea is an acute inammatory skin disease whose
exact cause is not yet known and is a disease with a unique
clinical form and course. In most cases, a scaly, erythematous herald patch occurs rst as a single lesion. After
1–2 weeks, small, oval-shaped, scaly-papular, secondary
eruptions appear, mainly on the trunk. It looks like a distribution of ying snowakes. And it goes away on its own after
Fig. 77.1 Lesions of pityriasis rosea on the body skin
6–8weeks. It is a relatively common disease with a prevalence of about 0.68%, most frequently occurring between the
ages of 15 and 40. However, according to Korean reports, the
youngest patient was 4years old and the oldest was 71years
old, conrming that it can occur at various ages. The male to
female ratio is mostly similar or reported to be 1.5–2.0 times
higher in females. Seasonally, it is reported to be common in
spring and autumn, but many reporters have said that it
occurs in cold seasons, and Korean reports also showed the
highest incidence in winter at 32–34%. The cause is still not
clear, but there are theories of viral and bacterial infection
and immune theories. The theory of viral infection is considered to be the most likely due to the occurrence of herald
patch, secondary eruption after an incubation period, spontaneous disappearance within a certain period of time, seasonal frequency, and rare recurrence. There is a consensus
that it is a viral rash caused by human herpesvirus types 6
and 7. Recently proposed theories of cell-mediated immunity are supported by lymphocyte inltration, increased
helper T cells, decreased ratio of helper T cells to suppressor
T cells, increased Langerhans cells, and expression of
HLA-DR antigen in keratinocytes. In addition, it has been
reported that pityriasis rosea-like rashes occur not only after
various drugs such as captopril, imatinib mesylate, ketotifen,
interferon, barbiturates, arsenic, bismuth, gold but also after
vaccinations like BCG.About 5% of patients may have prodromal symptoms such as headache, loss of appetite, lethargy, fever, and joint pain before the skin rash appears.
The herald patch is observed in 50–90% of patients, most
of which are single, well-dened, scaly, round or oval erythematous patches about 2–10cm in size. It shows a characteristic nding that the inside of the boundary is covered with
scales. It usually occurs on the trunk but can also occur on
the back, neck, abdomen, or limbs depending on the case.
The secondary rash appears as widespread erythematous
patches on the trunk, usually a few days to weeks after the
primary lesion gradually disappears. The appearance of secondary rash can be divided into two types. The rst is similar
to the herald patch, but the smaller oval-shaped scaly plaque
© 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_77
325
Соседние файлы в папке Библиотека им академика М.И. Перельмана