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Tinea coporis, cruris, ungium
體癬 股癬 甲癬簡介
基層醫師協會/高雄市醫師公會
2020-11-3
Dr. Peter Peng
彭賢禮
植髮醫學會
理事,前理事長理事長
雷射光電醫學會
理事
皮膚美容外科學會
理事
國際皮膚外科學會
理事
皮膚美容外科聯盟
編輯顧問委員
醫美指南雜誌
SCI醫學雜誌 審稿專家
常務理事
皮膚科醫學會
5 Continent ‧ 72 cities
Peter Peng Speaking Map
猜一猜
Clinical Dermatology –A clinical guide to diagnosis and treatment
猜一猜
Clinical Dermatology –A clinical guide to diagnosis and treatment
Clinical Dermatology –A clinical guide to diagnosis and treatment
猜一猜
Clinical Dermatology –A clinical guide to diagnosis and treatment
猜一猜
Agenda
黴菌感染分類
Jean L. Bolognia, Julie V. Schaffer, Lorenzo Cerroni: Dermatology 4th ed. Elsevier 2018
Jean L. Bolognia, Julie V. Schaffer, Lorenzo Cerroni: Dermatology 4th ed. Elsevier 2018
Clinical Dermatology –A clinical guide to diagnosis and treatment
Agenda
黴菌感染分類
Tinea Coporis 體癬& Tinea Cruris股癬
Tinea Coporis 體癬
Tinea Coporis 體癬
Jean L. Bolognia, Julie V. Schaffer, Lorenzo Cerroni: Dermatology 4th ed. Elsevier 2018
Tinea Coporis 體癬
Jean L. Bolognia, Julie V. Schaffer, Lorenzo Cerroni: Dermatology 4th ed. Elsevier 2018
Tinea coporis 體癬
Jean L. Bolognia, Julie V. Schaffer, Lorenzo Cerroni: Dermatology 4th ed. Elsevier 2018
Tinea Cruris 股癬Tinea Cruris股癬
Tinea Cruris股癬
Clinical Dermatology –A clinical guide to diagnosis and treatment
特定身體部位的癬
Tinea Mannum手癬
Tinea Mannum手癬
Jean L. Bolognia, Julie V. Schaffer, Lorenzo Cerroni: Dermatology 4th ed. Elsevier 2018
Clinical Dermatology –A clinical guide to diagnosis and treatment
Tinea Mannum手癬
Clinical Dermatology –A clinical guide to diagnosis and treatment
Tinea Faciei 臉癬
Tinea Faciei 臉癬
Jean L. Bolognia, Julie V. Schaffer, Lorenzo Cerroni: Dermatology 4th ed. Elsevier 2018
Tinea Barbae 鬍癬
Tinea Barbae 鬍癬
Clinical Dermatology –A clinical guide to diagnosis and treatment
Tinea Capitis 頭癬
Tinea Capitis 頭癬
Jean L. Bolognia, Julie V. Schaffer, Lorenzo Cerroni: Dermatology 4th ed. Elsevier 2018
Tinea Capitis 頭癬
Jean L. Bolognia, Julie V. Schaffer, Lorenzo Cerroni: Dermatology 4th ed. Elsevier 2018
Jean L. Bolognia, Julie V. Schaffer, Lorenzo Cerroni: Dermatology 4th ed. Elsevier 2018
Favus
Jean L. Bolognia, Julie V. Schaffer, Lorenzo Cerroni: Dermatology 4th ed. Elsevier 2018
Agenda
黴菌感染分類
Tinea Coporis 體癬& Tinea Cruris股癬
Tinea pedis 足癬& ungium甲癬
Tinea Pedis 足癬
Jean L. Bolognia, Julie V. Schaffer, Lorenzo Cerroni: Dermatology 4th ed. Elsevier 2018
Tinea Pedis 足癬—趾縫型
Clinical Dermatology –A clinical guide to diagnosis and treatment
Tinea Pedis 足癬—角化型(兩腳一手)
Jean L. Bolognia, Julie V. Schaffer, Lorenzo Cerroni: Dermatology 4th ed. Elsevier 2018
Tinea Pedis 足癬—發炎水泡型
Jean L. Bolognia, Julie V. Schaffer, Lorenzo Cerroni: Dermatology 4th ed. Elsevier 2018
Tinea Pedis 足癬—糜爛型
Clinical Dermatology –A clinical guide to diagnosis and treatment
Tinea ungium 甲癬 灰指甲
Tinea ungium 甲癬 灰指甲---四大類
Clinical Dermatology –A clinical guide to diagnosis and treatment
Tinea ungium 甲癬 灰指甲-Distal/lateral type
Clinical Dermatology –A clinical guide to diagnosis and treatment
Tinea ungium 甲癬 灰指甲-Distal/lateral type
Jean L. Bolognia, Julie V. Schaffer, Lorenzo Cerroni: Dermatology 4th ed. Elsevier 2018
Tinea ungium 甲癬 灰指甲-White Superficial type
Clinical Dermatology –A clinical guide to diagnosis and treatment
Clinical Dermatology –A clinical guide to diagnosis and treatment
Tinea ungium 甲癬 灰指甲-Proximal type
Agenda
黴菌感染分類
Tinea Coporis 體癬& Tinea Cruris股癬
診斷要點及Differential Diagnosis鑑別診斷
Tinea pedis 足癬& ungium甲癬
診斷要點
• 環形紅斑 合併活性外圍(active border)及脫皮
Tinea Coporis 體癬&股癬
Jean L. Bolognia, Julie V. Schaffer, Lorenzo Cerroni: Dermatology 4th ed. Elsevier 2018
診斷要點
• 環形紅斑 合併活性外圍(active border)及脫皮
• 紅斑持續向外擴大 但是中間可能變正常
Tinea Coporis 體癬
Jean L. Bolognia, Julie V. Schaffer, Lorenzo Cerroni: Dermatology 4th ed. Elsevier 2018
診斷要點
• 環形紅斑 合併活性外圍(active border)及脫皮
• 紅斑持續向外擴大 但是中間可能變正常
• 要和下列情況做鑑別診斷:接觸性皮膚炎 念珠菌感染 其他
環形紅斑--- 轉給皮膚科醫師
接觸性皮膚炎
Clinical Dermatology –A clinical guide to diagnosis and treatment
念珠菌感染
Jean L. Bolognia, Julie V. Schaffer, Lorenzo Cerroni: Dermatology 4th ed. Elsevier 2018
Clinical Dermatology –A clinical guide to diagnosis and treatment
診斷要點
• 環形紅斑 合併活性外圍(active border)及脫皮
• 紅斑持續向外擴大 但是中間可能變正常
• 要和下列情況做鑑別診斷:接觸性皮膚炎 念珠菌感染 其他
環形紅斑--- 轉給皮膚科醫師
• 輔助診斷工具刮片檢查
Jean L. Bolognia, Julie V. Schaffer, Lorenzo Cerroni: Dermatology 4th ed. Elsevier 2018
Clinical Dermatology –A clinical guide to diagnosis and treatment
Clinical Dermatology –A clinical guide to diagnosis and treatment
KOH
Clinical Dermatology –A clinical guide to diagnosis and treatment
組織切片檢查
Jean L. Bolognia, Julie V. Schaffer, Lorenzo Cerroni: Dermatology 4th ed. Elsevier 2018
Jean L. Bolognia, Julie V. Schaffer, Lorenzo Cerroni: Dermatology 4th ed. Elsevier 2018
芽孢
菌絲
診斷要點
• 環形紅斑 合併活性外圍(active border)及脫皮
• 紅斑持續向外擴大 但是中間可能變正常
• 要和下列情況做鑑別診斷:接觸性皮膚炎 念珠菌感染 其他
環形紅斑--- 轉給皮膚科醫師
• 輔助診斷工具刮片檢查
• 請勿使用含類固醇藥膏 (包含三合一四合一藥膏)病灶變
成不典型
Tinea incognito偽裝癬
Clinical Dermatology –A clinical guide to diagnosis and treatment
Jean L. Bolognia, Julie V. Schaffer, Lorenzo Cerroni: Dermatology 4th ed. Elsevier 2018
念珠菌感染 因使用抗生素藥膏而擴散
Jean L. Bolognia, Julie V. Schaffer, Lorenzo Cerroni: Dermatology 4th ed. Elsevier 2018
鑑別診斷
Jean L. Bolognia, Julie V. Schaffer, Lorenzo Cerroni: Dermatology 4th ed. Elsevier 2018
Clinical Dermatology –A clinical guide to diagnosis and treatment
猜一猜
Baboon syndrome 狒狒症候群
(對稱性過敏性接觸皮膚炎)
猜一猜
Clinical Dermatology –A clinical guide to diagnosis and treatment
是體癬嗎?
Clinical Dermatology –A clinical guide to diagnosis and treatment
接觸性皮膚炎 手癬
Clinical Dermatology –A clinical guide to diagnosis and treatment
猜一猜
Clinical Dermatology –A clinical guide to diagnosis and treatment
是香港腳嗎?
Clinical Dermatology –A clinical guide to diagnosis and treatment
Tinea Atopic dermatitis Eczema Eczema
是香港腳嗎?
Clinical Dermatology –A clinical guide to diagnosis and treatment
是香港腳嗎?
Clinical Dermatology –A clinical guide to diagnosis and treatment
Clinical Dermatology –A clinical guide to diagnosis and treatment
猜一猜
這是灰指甲嗎?
Clinical Dermatology –A clinical guide to diagnosis and treatment
Agenda
黴菌感染分類
Treatment治療
Tinea Coporis 體癬& Tinea Cruris股癬
診斷要點及Differential Diagnosis鑑別診斷
Tinea pedis 足癬& ungium甲癬
皮膚黴菌感染治療要點
• 優先使用外用抗黴菌藥物塗抹
Jean L. Bolognia, Julie V. Schaffer, Lorenzo Cerroni: Dermatology 4th ed. Elsevier 2018
Jean L. Bolognia, Julie V. Schaffer, Lorenzo Cerroni: Dermatology 4th ed. Elsevier 2018
Clinical Dermatology –A clinical guide to diagnosis and treatment
皮膚黴菌感染治療要點
• 優先使用外用抗黴菌藥物塗抹
• 塗抹範圍要夠大(必須包含最外緣)
• 塗抹時間要夠久
• 口服抗黴菌藥物治療:深部黴菌感染, 甲癬, 大範圍且嚴重
的感染 ,外用藥效果不佳時
灰指甲治療
• 口服抗黴菌藥物治療
灰指甲口服藥物
Clinical Dermatology –A clinical guide
to diagnosis and treatment
療黴舒
Jean L. Bolognia, Julie V. Schaffer, Lorenzo Cerroni: Dermatology 4th ed. Elsevier 2018
適撲諾
Jean L. Bolognia, Julie V. Schaffer, Lorenzo Cerroni: Dermatology 4th ed. Elsevier 2018
膚肯
Jean L. Bolognia, Julie V. Schaffer, Lorenzo Cerroni: Dermatology 4th ed. Elsevier 2018
灰指甲治療
• 口服抗黴菌藥物治療
• 外用藥水
灰指甲治療
• 口服抗黴菌藥物治療
• 外用藥水
• 拔指甲?
灰指甲治療
• 口服抗黴菌藥物治療
• 外用藥水
• 拔指甲?
• 雷射搭配外用藥
Clinical Dermatology –A clinical guide to diagnosis and treatment
患者拒絕吃藥或是無法吃藥
吃藥仍然復發
Jean L. Bolognia, Julie V. Schaffer, Lorenzo Cerroni: Dermatology 4th ed. Elsevier 2018
20171107 20180109
Dr 葉昱廷 提供
Conclusion
黴菌感染分類
Treatment治療
Tinea Coporis 體癬& Tinea Cruris股癬
診斷要點及Differential Diagnosis鑑別診斷
Tinea pedis 足癬& ungium甲癬
基層醫師協會/高雄市醫師公會
2020-11-3
Dr. Peter Peng
彭賢禮
: Pengskin@gmail.com
Thank you very much!

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