1091120-昆蟲引起的皮膚病

蟲
王銘燦醫師
2020. 11.20

王銘燦醫師
學歷
 高雄醫學院醫學士
 高雄醫學院醫學研究所醫學碩士
 美國哈佛大學公共衛生學院職業衛生
碩士
經歷
 高雄市立大同醫院皮膚科主任
 高雄醫學院皮膚科學兼任講師
 美國加州大學舊金山醫學院皮膚科研
究員
 台灣皮膚科醫學會理事(第13 ~19屆)
 台灣皮膚科醫學會第17屆常務理事

病名症狀
症狀診斷
problem oriented diagnosis

癢痛癢痛
蚊蜂隱翅蟲
蠓荔枝椿象
蚤
疥
蝨
毛毛蟲皮膚炎
禽螨

何時要考慮到蟲
一顆顆劇癢、獨立大紅疹
~ 蟲一口一口叮咬
55
成群劇癢紅疹
~ 撒下一把針
55
灼熱、痛、奇怪的形狀
~ 液體灼傷

不限裸露部位限裸露部位
沒翅膀有翅膀
爬
蚤蚊
疥蠓
禽螨蜂 bee
住人身上
頭蝨
陰蝨
不住人身上床蝨
刺
毛毛蟲皮膚炎
(蜂 wasp)

蠓
小黑蚊
上下緣有一明顯界線

蠓
上肢以外側為主

蠓

1. 紅疹僅限暴露部位
2. 郊外活動史
3. 下肢:上下緣有一明顯界線
4. 上肢:以外側為主
5. 中午陰影下，聊天、休息
~ ~ 蠓

家蚊
1. 4歲以下的小朋友
2. ABT孩子暑假回台看祖父母

1. 獨立散在性紅疹
2. 足踝最多
3. 腰部 : 皮帶、鬆緊帶上緣
4. 身體衣物覆蓋部位也可出現
紅疹
~ ~ 跳蚤

散在性小紅點 with halo
不癢

1. 散在性小紅點 with halo
2. Exposure skin
3. 不癢
4. 夜晚戶外活動史
~ ~ ? 蚊

Scabies
 Sarcoptes scabei
 0.2 to 0.4mm
 Scabies is transmitted by close, human-to-
human contact with infected individuals.
 The entire life cycle takes 10 to 17 days (2-
3 weeks).
 The mites apparently eat human skin.

症狀病史
 Generalized pruritus 癢癢癢
 Itching is often severe enough to interrupt
sleep
 Family members and friends often also itch.
 接觸照護安養院的長輩，家人住院。
 The head is almost always spared in adults
but may be involved n children.

症狀病史
 The patient’s tissue apparently
become sensitized to various proteins
liberated by the mites.
 For the first 4-6 weeks (1 month) after
infestation there may be no itching.
 The generalized rash may not correspond to
the site where the mites are burrowing.

疥蟲 ---- 診斷
 癢 — 夜晚
 紅疹 (特殊分布型態 )
 Scabies Nodule
 Burrow

疥蟲 --- 皮疹好發部位

 A female mite
infests a new host by burrowing beneath
the outer layer of skin and laying her
eggs in the tunnels that she excavates
Burrow

診斷 ---- burrow
 Most burrows lie on the sides of the
fingers, finger webs, sides of the hand
and on the flexural aspects of the
wrists.
 The burrows are usually located on the
hands, wrists, and elbows
–Webbing between the fingers
–The folds of the wrists

最容易找到
burrow
的部位

治療
 殺蟲
– 皮膚
– 衣物
– 寢具 : 被單棉被
 止癢

Scabies
 Before the 1940s
– 6% precipitated sulfur
 1940s ~ 1960s
– Organochloride and organophosphate
insecticides
 1950 ~ 1990
– 1% lindane
 Currently
– Permethrin
– Ivermectin

Scabies
 Permethrin
 Ivermectin : 0.1 - 0.2 mg/kg in single dose
 Crotaminton
 Benzyl benzoate
 Precipitated sulfur
 Lindane
 Melaleuca alternifolia (tea tree oil)

治療 --- 捈藥方法
 Apply to all areas of skin below the jaw line,
including the genitals, soles of the feet.
 Scabicide is applied at bedtime and is washed
off in the morning.
 Some physicians recommend a single
reapplication after 1 week.

治療 ----- 止癢
 Itching may persist for 1-2 weeks after
treatment. (Residual itching may last for
several days, or even a few weeks, but this
does not need further application of the
scabicide.)
 Nodules may last for 1 month or longer

Scabies 治療衣物寢具
 The mites cannot live off a human host for more
than 24 h or so.
 Insecticide treatment of bedding, furniture, rooms,
etc. is unnecessary.
 The patient’s bed covers, pillow cases, and
undergarments be removed and washed on the hot
wash cycle.
 Mite die in clothing unworn for 1 week.

衣物寢具
 煮
 洗
 熨斗燙
 烘衣機
 曬
– 黑塑膠袋
 餓死疥蟲

The regimen is repeated in 1 week.
 Benzyl benzoate
 Crotamiton
 Lindane (γ-BHC)
 Malathion
 Permethin
 Sulfiram (Monosulfiram)
 Sulfur

小孩孕婦
 For babies over 2 months, toddlers and young
childern
»Permethrin cream
»25% benzyl benzoate diluted with 3 parts of water
»6% precipitated sulphur
 Pregnant women or those who are breast-
feeding

頭蝨
Pediculosis capitis (head lice)
 1-3 mm in length
 Spread from person to person
– by Head-to-head contact
– by shared combs or hats
 蟲演化後的特質
– 適應不同毛髮的環境

頭蝨分類上屬於昆蟲綱(Insecta)蝨目
(Anoplura)，為不完全變態的昆蟲

頭蝨症狀
頭皮癢
– 脂漏性皮膚炎
– 頭癬
頭皮白點
– 頭皮屑

 The egg-to-adult cycle average 3 weeks.
 As long as adult lice remain on the scalp,
they can live for about a month.
 Lice can survive only about 24 h if
removed.

Management of head lice infestations
 Delousing infested individuals
 Removing nits from the hair
 Delousing personal items

治療
 Malathion
 Permethrin and pyrethrins(除蟲菊)
 Lindane
 Benzyl benzoate solution
 Precipitated sulfur

 Lotions should remain on the scalp for at least
12 h, and are more effective than shampoo.
 The application should be repeated after 1
week
– Any lice that survive the first application and
hatch out in that interval can be killed.
 One or two repeat applications at 7 to 10 day
intervals to kill newly hatching lice.

感謝您的聆聽! 期待再相會….黃毒娥

1. 單側局部成簇劇癢性紅疹
2. 兩層衣物覆蓋處沒皮疹
3. 戶外活動史(樹下、風大…)
~ ~ Caterpillar Dermatitis

毒蛾毛毛蟲在身上
該怎麼辦?
 輕輕包起毛毛蟲，再移走。
 切忌拍、打、彈。

診斷
 戶外活動史、接觸史？
 身體局部出現散在性、劇癢紅疹
– 病灶中心紅疹最密，愈週邊紅疹愈疏。
– 暴露部位及單層衣服遮蔽部位皆可出現紅疹
（皮帶、牛仔褲或穿兩層衣服之部位如內褲、
胸罩等部位不會出現紅疹。）

灼熱、痛、奇怪的形狀
隱翅蟲
隱翅蟲荔枝椿象
~~ 隱翅蟲荔枝椿象

床蝨 Bed Bug
第一次接觸

床蝨 Bed Bug
第二次接觸

床蝨 Bed Bug
2背包客 ~~ ~~ 瑞士法國青年旅館

床蝨 Bed Bug
背包客 ~~ 瑞士法國青年旅館

床蝨 Bed Bug ~~ 老阿嬤印傭

床蝨 Bed Bug ~~老阿嬤印傭

床蝨 Bed Bug
~~ 老阿嬤印傭

B.
1. 四肢為主，出現散在性大紅疹
2. 每天出現新的紅疹(確定出國時被
叮咬的，不會有新的紅疹)
3. 境外移入史：
a. 本人出國旅遊史
b. 國外人士拜訪過夜、或外
傭進住
~ ~ 床蝨

晚上開冷氣
睡醒就多一兩顆
冷氣窗外有鴿子

鳥巢鳥活動位置
 高樓層窗外花台
 高樓冷氣機平台
 排油煙管
 曬衣場?

B.
1. 全身散在性紅疹、劇癢
2. 腋窩(+)
3. 後頸、內褲部位
4. 冷氣平台、窗外花台、陽台
有鳥類(珠頸斑鳩)活動
5. 開冷氣、風大時開窗
6. 住高樓層(限都會區)
7. “陣發性”出現新紅疹
8. 室友 ~ ~ 禽螨

Repellents
1. Picaridin
派卡瑞丁
2. DEET 敵避
3. Eucalyptus oil
尤加利精油

1. 紅疹僅限暴露部位
2. 郊外活動史
3. 上肢:上下緣有一明顯界線
4. 上肢:以外側為主
5. 中午陰影下聊天休息
~ ~ 蠓

1. 全身散在性紅疹、劇癢
2. 腋窩(+)
3. 後頸、內褲部位
4. 冷氣平台、窗外花台、陽台
有鳥類(珠頸斑鳩)活動
5. 開冷氣、風大開窗
6. 住高樓層(限都會區)
7. 陣發性出現新紅疹
~ ~ 禽螨

1. 四肢為主出現散在性大紅疹
2. 每天出現新的紅疹(確定出國
時被叮咬的不會有心紅疹)
3. 本人出國旅遊史
4. 國外人士拜訪過夜、或外傭
進住
~ ~ 床蝨

皮膚癢看好久了都沒用
指縫手腕
腋窩
外陰部
屁股

每天會出現幾顆新的疹子
腋窩
內褲部位
History
……..

1091120-昆蟲引起的皮膚病

1091120-昆蟲引起的皮膚病

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1091120-昆蟲引起的皮膚病