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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_141_библиотеки_им_акад_М_И_Перельмана
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78 Allergic Contact Dermatitis DuetoAdhesives
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Fig. 78.8 Allergic contact dermatitis caused by a disposable bandage
Fig. 78.9 Shoe contact dermatitis
337
Fig. 78.10 Allergic contact dermatitis caused by epoxy resin used in
stone attachment work
construction industry. It can cause contact dermatitis not
only through direct contact but also through airborne exposure. However, due to its utility value, its use in various elds
is inevitable, and it is presumed that there are many occupational skin diseases that have not been diagnosed or reported.
In addition to epoxy, allergic contact dermatitis caused by
cyanoacrylate, a widely used instant adhesive, is frequently
occurring due to occupational exposure (Fig.78.10).
Adhesive tape can also commonly cause skin problems.
Allergic reactions to the tape itself are caused by rubber
components, accelerators, antioxidants, various resins, or
turpentine oil. Some adhesive tapes contain acrylate polymers rather than rubber adhesive components, which often
cause allergic contact dermatitis. Moist dressing products
used for wound treatment are largely divided into polyurethane materials and hydrocolloid materials. Hydrocolloid
dressings provide a moist environment for the wound,
promoting vascular regeneration and necrotic tissue removal,
and are used in various wound treatments. Duoderm® is a
representative hydrocolloid product, divided into Duoderm®
Extra Thin and Duoderm® CGF, and is used appropriately
depending on the size of the wound and exudate due to the
different amounts of contained sodium carboxymethyl cellulose. Originally, Duoderm® used polyisobutylene as an
adhesive resin that adheres the ingredient to the skin, but it
was replaced with pentaerythritol ester, which has a greater
ability to absorb exudate. Pentaerythritol ester is thought to
be a major substance causing allergic contact dermatitis
when using hydrocolloid agents. Of the 37 cases reported
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78 Allergic Contact Dermatitis DuetoAdhesives
overseas so far, only 23 cases could identify the cause, and
20 of these were found to be caused by the adhesive resin,
pentaerythritol ester. There were also 2 cases caused by polyisobutylene, and 1 case caused by sodium carboxymethyl
cellulose. For the rest, the exact cause could not be identied, and it was thought that these cases were caused by skin
irritation or some substances in the rubber polymer included
in the hydrocolloid agent. I explained to F and her mother
that allergic contact dermatitis caused by adhesives was suspected, so she should receive treatment for 5–7days, and that
she should avoid contact with the same causative agent in the
future.
Contact Cheilitis
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79
My lips are a bit cracked and dry, so I bought lip cream
and applied it, but suddenly my lips and the area around
my lips are itchy and hot! (Figs.79.1 and 79.2).
Mr. T, a man in his 30s, recently felt that his lips were
cracked and dry, so he bought lip cream and applied it, but
since the day before yesterday, his lips and the area around
his lips have been itchy and hot, so he came to receive treatment. He took out the lip cream he brought and said, “I think
it’s probably because of this!”.
Figs. 79.1 and 79.2 Contact dermatitis (contact cheilitis) on the lips
and around the lips caused by lip cream and lip balm
Contact cheilitis is an inammatory disease of the lips
caused by irritation or an allergic reaction to contact with a
certain substance. The vermilion of the lips is more prone
to allergic contact dermatitis than the oral mucosa, and
allergic contact cheilitis initially appears as itching, dryness, vesicles, and ssures, but if exposed to a strong allergen for a long time, swelling and scabs occur, making it
difcult to distinguish from secondary cheilitis caused by
other causes. Eczematous cheilitis is a common chronic
skin disease that is often associated with atopic dermatitis
and can be caused by stimuli such as lip licking, but there
are also many cases of allergic contact cheilitis caused by
specic causative substances (18–34% of eczematous cheilitis). Contact cheilitis occurs mainly in women, and more
than half of cases are thought to be caused by lipstick or lip
protectors (lip balm, lip cream). In addition, the use of ointments, toothpaste, gum, mouthwash, silver tablets, dental
materials (prosthetics), etc. may be the cause, as well as
cosmetics (including sunscreen and nail polish), rubber,
metal substances, food (bakery products, margarine), fruits
(oranges, lemons, mangoes) can be a cause. If the acute
eczematous changes of the lips are distinct, the diagnosis is
easy, but it should be differentiated from cheilitis caused by
chronic stimulation, and cheilitis caused by atopic dermatitis. Also, in cases where the changes are minimal, various
other causes of exfoliative cheilitis must be ruled out. In
eczematous cheilitis, the proportion of allergic contact
cheilitis caused by causative substances such as cosmetics,
toothpaste, and drugs are high, so patch testing is very helpful in the diagnosis and treatment of recurrent chronic
eczematous cheilitis.
For treatment, avoid using the causative substance, and
use topical steroids or topical tacrolimus or pimecrolimus.
Mr. T was told to stop using the lip cream that caused it and
that 5–7days of treatment is needed, to which he responded,
“I guess I can’t just apply any lip balm carelessly!”
(Figs.79.3, 79.4, 79.5, 79.6, 79.7 and 79.8).
© 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_79
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Fig. 79.3 Allergic contact cheilitis
79 Contact Cheilitis
Figs. 79.4 and 79.5 Contact cheilitis
Figs. 79.6 and 79.7 Allergic contact cheilitis
Fig. 79.8 Allergic contact cheilitis
Omphalith, Navel Stone, Umbilical
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Concretion
What should I do if the dirt in my belly button is stuck
like a stone and won’t come out?
L, a woman in her 30s, has been feeling something hard in
her belly button for a long time. She thought it was nothing,
but it seemed to be getting bigger. She tried to remove it, but
it was too painful, so she came for treatment (Fig.80.1).
Omphalith (omphalolith) refers to a hard, blackish-brown
stone-like substance formed in the belly button due to the
accumulation of keratin and sebum. The belly button is usually indented, so dirt easily accumulates, and it can easily
smell bad. However, in folk belief, it is wrongly thought that
if you wash your belly button with water, the water will go
into your abdomen, or that you should not remove the dirt
from your belly button, so it is left alone. Over many years,
it becomes hard and rmly stuck in the belly button. The
belly button is the remnant of the umbilical attachment from
the fetal period, and while the lower part is a scar tissue without skin appendages, the sidewalls are relatively rich in skin
appendages such as eccrine sweat glands, hair follicles, sebaceous glands, and apocrine sweat glands. Therefore, omphalith is formed by the accumulation of exfoliated skin keratins
and substances secreted from the sebaceous and sweat glands
present on the side wall. It gradually grows over several
months or years before being discovered, adhering well to
the navel as a painless, blackish-brown, hard substance similar to a stone. Sometimes it can cause pain by forming secondary bacterial infections or ulcers. Even without such
secondary infections or ulcers, pain can be induced accidentally after bathing, which can be understood as a symptom
caused by the pressure on the surrounding tissues due to the
80
Fig. 80.1 Omphalith of umbilicus
increase in the volume of the navel stone caused by bathing.
Also, the occurrence of umbilical pyogenic granuloma or
cellulitis has been reported.
Histologically, the inside of omphalith is densely packed
with exfoliated corneocytes without nuclei and secretions
such as sebum, and some melanin pigment granules appear,
while the outside is relatively less dense and forms layers.
Treatment is usually possible by simple removal, and anesthesia is not necessary, so contrary to worry, Mr. L’s navel
stone was simply removed without anesthesia. If there are
accompanying inammatory changes, antibiotics should be
administered orally, or antibiotic or steroid ointment should
be applied topically after removal (Figs. 80.2, 80.3, 80.4,
80.5, 80.6 and 80.7).
© 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_80
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Figs. 80.2 and 80.3 Navel stone (omphalith)
80 Omphalith, Navel Stone, Umbilical Concretion
Figs. 80.4 and 80.5 Simple removal of omphalith
Figs. 80.6 and 80.7 Treatment of the navel stone
Acne Miliaris Necrotica: Acne
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Varioliformis
81
My scalp is itchy and hot, and something keeps popping
up, forming pus blisters that burst, scab over, and leave
scars. Why is this happening?
Mr. R, a 20-year-old male, came for treatment because his
scalp was itchy and hot, and something kept popping up,
forming pustules that burst, scab over, and then leave scars.
When examined closely with a loupe, papules and pustules
were formed matching the hair follicles, and in some cases,
scars accompanied by hair loss were observed (Fig.81.1).
Acne miliaris necrotica is essentially folliculitis and typically occurs on the scalp. Therefore, it is also called scalp
acne or scalp folliculitis. It forms with follicular papules and
pustules, sometimes appearing as a very itchy single lesion.
The lesions appear on the scalp or adjacent areas and burst
early, forming crusts within a few days. Acne bacteria (P.
acnes) is found, it is also called Proprionibacterium folliculitis, but Staphylococcus aureus is also cultured, and
Malassezia yeast or Gram-negative bacteria are also found.
The term acne varioliformis is used for cases that leave large
scars. Therefore, depending on the literature, it is classied
as acne necrotica miliaris for the supercial form and acne
necrotica varioliformis for the deeper scarring form. Also,
this disease is essentially not a special form of acne but folliculitis, so there is an opinion that the pathological name
necrotizing lymphocytic folliculitis is appropriate (Fig.81.2).
It occurs frequently in people aged 30–50 after puberty,
and it is more common in men. P. acnes or Staphylococcus
aureus is detected, but it is not considered the cause. It is
thought to be due to an excessive host response to these
microbes, and initially it is folliculitis, but it is speculated
that it goes through the process of forming a crust, necrosis, and scarring due to actions such as rubbing or scratching due to psychological factors. The typical rash of acne
necrotica is a red papule of the diameter of 2–5mm matching follicles, occasionally with the umbilicus-like hole in
the center, quickly forming a crust and causing necrosis.
After 3–4 weeks, when the crust falls off, it becomes a
varioliform scar and a small bald spot appears. It is accompanied by a burning sensation and itching, and it mainly
occurs on the hairline part of the forehead, so it is also
called acne frontalis, but it can occur anywhere on the
scalp, and occasionally on the chest, back, face, etc.
Fig. 81.1 Acne miliaris necrotica Fig. 81.2 Acne varioliformis
© 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_81
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Figs. 81.3 and 81.4 Acne varioliformis
81 Acne Miliaris Necrotica: Acne Varioliformis
Individual lesions occur acutely, but they take a chronic
course with repeated recurrences. Treatment requires the
use of appropriate antibiotics after bacterial culture, and if
the culture result is negative, long- term administration of
oral tetracyclines or macrolides and topical clindamycin
are recommended. In severe cases, isotretinoin is used, and
doxepin can help relieve symptoms. I explained this disease in detail to Mr. R and said that although it is not easy,
let’s try good drug treatment and management (Figs.81.3
and 81.4).
Centipede Bites
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82
I was bitten by a centipede near my armpit! It's very
swollen and painful, what should I do? (Fig.82.1).
67-year-old Ms. G said, "A centipede got into my clothes
at my country house and bit me near my armpit. The bitten
area and its surroundings are very swollen and painful, what
should I do?" "How do you know if it was a centipede that bit
you?" When asked, she replied, "I clearly saw the centipede
biting me and running away!" I said, "The bite mark also
clearly indicates it was a centipede. But don't worry too
much. Cases that show systemic symptoms or are fatal are
rare, so it should be ne!" (Figs.82.2, 82.3 and 82.4)
Centipedes are nocturnal and prefer moisture, living in damp
places and feeding on small insects such as cockroaches,
crickets, and beetles. They can bite humans but are not
known to attack rst. Among the centipedes in Korea, there
are 7 species that are large enough to cause wounds on
human skin, and 95% of them are Scolopendra subspinipes
mutilans. The mouth is composed of a pair of large jaws and
two pairs of small jaws, and underneath it, the rst pair of
legs is transformed into a pair of venomous claws that play a
powerful claw role and are used to wrap around prey and
inject venom from the venom gland.
The skin symptoms of a centipede bite are two distinct
bite marks, local pain and itching accompanied by erythematous swelling, and rarely, it can be accompanied by lymphangitis or lymphadenopathy. Since it is rare for a centipede bite
to show systemic symptoms or be fatal, treatment of skin
lesions is sufcient with prevention of secondary infection
and administration of analgesics and antihistamines.
Histamine is a well-known pain-inducing substance, and in
the case of a centipede bite, it can be the cause of pain, so the
administration of antihistamines can be helpful in treatment.
Also, topical or systemic administration of steroids is useful
in the treatment of severe local and systemic symptoms. In
Korea, in 2006, Kim etal. treated 16 out of 29 cases with
Figure 82.1 Centipede bite
© 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_82
Figure 82.2 Two clear bite marks from a centipede on the skin.
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Figures 82.3 and 82.4 Local pain and itching accompanied by erythematous swelling after being bitten by a centipede
systemic administration of antihistamines or steroids for 2–3
days without any special local treatment, and in 13 cases,
local treatment such as local lidocaine injection, topical steroid application, wound disinfection, etc. was performed.
The conscious symptoms signicantly decreased within a
few hours on the day of treatment, and the time it took for the
skin lesions to disappear was reported to be within 1 day
after treatment in 13 cases, 1–3 days in 11 cases, and after 3
days in 5 cases. Despite the prophylactic administration of
antibiotics, secondary bacterial infection occurred in 5 cases.
To avoid being bitten by centipedes, you must wear gloves
and boots in places where centipedes inhabit, and you must
check for centipedes before putting on any clothes or shoes
you have taken off after work. Ms. G came with great con-
Figure 82.5 Centipede bite
cern, but after receiving emergency treatment and explanations, he returned home relieved (Figs.82.5 and 82.6–82.8)
82 Centipede Bites
Figures 82.6–82.8 Centipede bite
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