真菌性皮膚病1課件

真菌性皮膚病

(Dermatomycoses)

DermatophyteInfections

(Dermatophytosis)

(Tinea,Ringworm)

Infectionscausedbydermatophytes--fungithatinvadeonlydeadtissuesoftheskinoritsappendages(stratumcorneal,nails,hair).Trichophyton,Epidermophyton,andMicrosporumaremostcommonlyinvolved,butclinicaldifferentiationofdermatophytesisdifficult.Transmissionisusuallyfrompersontopersonoranimaltoperson..Inothercases,infectionmaybeacute,typicallycausingasuddenvesicularandbullousdiseaseofthefeetoraninflamedboggylesionofthescalp(kerion)thatresultsfromastrongimmunereactiontothefungus;suchinfectionisusuallyfollowedbyremissionorcure.Diagnosis

Diagnosisismadeclinicallyaccordingtositeofinfectionandconfirmedbydirectmicroscopicexaminationofscalesdissolvedinasolutionofpotassiumhydroxideorbyculture,demonstratingthepathogenicfungusinscrapingsoflesionsNewersystemicdrugsincludeitraconazole,fluconazole,andterbinafine,asecond-generationallylamine.Thesedrugsappeartobesaferandmoreeffectivethanketoconazole,abroad-spectrumoralimidazolederivativethatiseffectivefordermatophyteinfections,althoughoccasionallivertoxicity(severeorevenfatal)limitsitsuse.Itraconazoleinteractswithmanycommonlyprescribeddrugs.TINEACORPORIS

(RingwormoftheBody)Trichophyton

rubrumisusuallythecause.Thecharacteristicpink-to-redpapulosquamousannularplaqueshaveraisedborders,expandperipherally,andtendtoclearcentrally腹部泛發(fā)性體癬SLE合并紅色毛癬菌引起的泛發(fā)性體癬須癬毛癬菌引起

的體癬犬小孢子菌引起的體癬難辨認(rèn)癬牛體癬（疣狀毛癬菌引起）Differentialdiagnosisincludespityriasisrosea,drugeruptions,nummulardermatitis,erythemamultiforme,tineaversicolor,erythrasma,psoriasis,andsecondarysyphilis.Avariantformappearsasnummularscalingpatchesstuddedwithsmallpapulesorpustules.Formild-to-moderatelesions,animidazole,orterbinafineincream,lotion,orgelformshouldberubbedintwicedailyforatleast7to10daysafterlesionsdisappear.Inflammatorytypesoftineacorporisusuallyrespondreadilytospecifictopicalantifungalmedications.TINEACRURIS

(JockItch)Tineacruris,morecommoninmales,maybecausedbyvariousdermatophyticorganisms.Typically,aringedlesionextendsfromthecruralfoldovertheadjacentupperinnerthigh.Bothsidesmaybeaffected.Scratchdermatitisandlichenificationoftenoccur.Lesionsmaybecomplicatedbymaceration,miliaria,secondarybacterialorcandidalinfection,andreactionstotreatment.Recurrenceiscommonbecausefungimayrepeatedlyinfectsusceptiblepersons.Flare-upsoccurmoreoftenduringsummer.Tightclothingorobesitytendstofavorgrowthoftheorganisms.體癬及股癬體癬（Tineacorporis）是指發(fā)生于平滑皮膚（除手足癬、花斑癬、疊瓦癬外）的淺部真菌病，體癬發(fā)生于股部上內(nèi)側(cè)者，又稱為股癬（tineacruris），可蔓延至臀部、會陰等處。體癬中醫(yī)稱圓癬、銅錢癬，股癬稱為陰癬本病系由淺部真菌感染引起。在我國病原菌主要為紅色毛癬菌、石膏樣毛癬菌、絮狀表皮癬菌、犬小孢子菌等。常由自身感染，如患手、足部癬，或直接接觸患者，患癬病的貓、狗和牛等或間接接觸患者污染的衣物而引起。氣候溫暖潮濕，有利于本病的發(fā)生。長期應(yīng)用皮質(zhì)類固醇或患糖尿病、慢性消耗性疾病者易患本病。

【臨床表現(xiàn)】

１．皮損特點(diǎn)初起為紅色丘疹或丘皰疹，逐漸擴(kuò)展呈鱗屑性紅斑，邊緣擴(kuò)展，中心自愈而成環(huán)狀、半環(huán)狀或多環(huán)狀，邊緣部微呈堤狀隆起，炎癥明顯，中心部炎癥輕伴脫屑及色素沉著。由于致病真菌不同及個體差異，皮損不盡相同，由紅色毛癬菌引起者皮損常呈大片形，數(shù)目較少，而親動物性真菌如犬小孢子菌及石膏樣小孢子菌引起者，炎性較重，皮損數(shù)目多，損害較小，多有小膿皰發(fā)生股癬臨床表現(xiàn)和體癬基本相同。由于發(fā)生股部，皮損發(fā)展較快，瘙癢較著。皮損可發(fā)生于股部一側(cè)或兩側(cè)，常為多發(fā)，融合成片，邊緣進(jìn)行性發(fā)展，以下緣為明顯，可見紅色丘疹、抓痕、鱗屑等，日久中心常呈濕疹樣變或皮損粗糙呈苔蘚樣變。

２．好發(fā)部位體癬好發(fā)于面、頸、軀干等部位，股癬則發(fā)生于股部、臀部、會陰部及肛門周圍。３．病程慢性，本病可發(fā)生于任何年齡，但以青壯年為多見。往往夏季加重，冬季減輕或消退。

【診斷及鑒別診斷】

根據(jù)皮損中心自愈，邊緣清楚，向周圍擴(kuò)展呈環(huán)狀，有丘疹、水皰、鱗屑、真菌檢查陽性診斷不難。

１．體癬應(yīng)與玫瑰糠疹鑒別，后者多發(fā)于軀干及四肢近端，皮損數(shù)目多，橢圓形，邊緣無丘疹和水皰，長軸常與皮紋平行，微癢；真菌檢查陰性。

２．股癬應(yīng)與神經(jīng)性皮炎臨別，后者初起時局部僅有瘙癢而無皮損，日久皮膚呈苔蘚樣變，邊緣為正常皮色或淡褐色，無丘疹水皰，瘙癢較著；真菌檢查陰性

【治療】

⒈體癬及股癬對局部抗真菌劑反應(yīng)良好，故以外用藥物治療為主。可酌情外用水楊酸苯甲酸酊（魏裴氏酊）、復(fù)方雷鎖辛擦劑（卡氏擦劑）、10%~30%冰醋酸溶液、1%克霉唑霜、1%益康唑霜、2%咪康唑霜、聯(lián)苯芐唑霜、酮康唑霜、特比萘芬軟膏等。股部因