疣 (Verruca, warts) 四川大学华西医院冉玉平. 丝状疣 (filiform wart) 指状疣 (digitate wart) 寻常疣丝状疣指状疣跖疣扁平疣传染性软疣. 甲周疣 - 甲下疣 (periungual wart, underungual wart)

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1 四川大学华西医院冉玉平 投票人数 :0 投票人数 :0 疣 (Verruca, warts) 寻常疣丝状疣指状疣跖疣扁平疣传染性软疣 Verruca Verruca Verruca Verruca vulgaris filiformis digitate plantaris Verruca plana Molluscum contagiosum 寻常疣 ( 瘊子 ) (verruca vulgaris) HP V 甲周疣 - 甲下疣 (periungual wart, underungual wart) 丝状疣 (filiform wart) 指状疣 (digitate wart) Human papilloma virus, HPV MCV 1

2 跖疣(verruca plantaris) Molluscum contagiosum virus 扁平疣 (verruca plana) 水痘 (varicella, chicken pox) 2

3 带状疱疹 (herpes zoster) 带状疱疹 (herpes zoster) 女,29 岁, 生产后 19 天 左耳带状疱疹 14 天, 伴左侧周围性面瘫 Ramsay-Hunt Syndrome( 面瘫 - 耳痛 ) 3

4 带状疱疹治疗 单纯疱疹 ( 颜面疱疹 )herpes simplex 单纯疱疹 ( 颜面 ) herpes simplex 单纯疱疹 ( 指头 ) herpes simplex 单纯疱疹 ( 颜面疱疹 ) herpes simplex 生殖器疱疹 (herpes progenitalis) 初发 Primary 生殖器疱疹 herpes progenitalis 复发 Recurrence 4

5 Which one is not a STD? Which one is not a STD? What is your diagnosis of this patient? What is your diagnosis of this patient? What is your diagnosis of this patient? 真菌的基本概念 Basic concept of fungi Eukaryotes Achlorophyllous Sexual and/or asexual reproduction Hyphae and spores Chitin and glucan in cell wall Absorption Strategy conference of the fungal subsist circumstances on 21st century space Animalzoophilic skin Humananthropophilic systemic Ecological amplitude Transkingdom Ecological pathogenic niche fungi Soil-geophilic 5

6 Age Incidence of Tinea Capitis in Children Under 12 Years Old Tinea ( , total 292 cases) 1 T. capitis: T. favosa, white ringworm, black-dot ringworm, T. manus: vesicle and scale, hyperkeratosis, T. pedis: erosion and maceration T. unguium:dermatophyton Onychomycosis:dermatophyton, yeasts, moulds T. corporis: smooth skin T. cruris: thighs and/or buttocks Male>Female 21 3 kerion AGE CASES Black dot ringworm Microsporon canis Microsporon gypseum City: Children, related to pets Ectothrix type: Hair is surrounded with a sheath of tiny spores T. violaceum T. mentagrophtes(some) 黑点癣 City: Children and adults Endothrix spores: arthrospores within hair Black dot, papule, scales, alopeciascar SEM and microscopic of M.canis 紫色癣菌 T. violaceum 6

7 tinea alba black dot ringworm Treatment ofkerion, which one is correct? Kerion 脓癣 Zoophilic M.canis, M.gypseum, T.mentagrophytes, et al. Hyper-inflammatory reaction by human Delayed type hypersensitivity reaction to fungal elements Pustular folliculitis Vesicular, lichenoid, or pustular Scarring and permanent alopecia Treatment ofkerion, which one is correct? Case 1 A. Cession and drainage of abscess B. High dosage of antibiotics C. Topic use anti-fungal cream D. Systematic administration of antifungal drug Case 2 真菌检查 2例的头屑及断发KOH涂片直接镜检发现孢子和菌丝 Fungal examination: hyphea and spores were noticed from the scales and hairs KOH smear Translated skin edge A. Cession and drainage of abscess B. High dosage of antibiotics C. Topic use anti-fungal cream D. Systematic administration of antifungal drug White powdery colonies grow on SDA at 25, 4d Positive urase test Translated scalp edge Spiral hyphea and grapelike spores Donor scalp Boy 9Y Penxian county, Sichuan Post injure scalp abscess, ulcer for 28d Ulcers re-appear after scalp transplantation consult Cat, dog, and rabbit as pets Girl 8Y, Chengdu city Sichuan, Scalp abscess, ulcer 24d Papule re-appear after scalp transplantation consult Cat as pet Both were identified as Trichophyton mentagrophytes Case 1 Case 2 Donor skin and scalp Treatment Itraconazole oral Case 1 Case 2 100mg/d 5mg/kg case 1: 22kg, case 2: 19kg With full fat milk No new lesion development after one week treatment Clinic cure obtained after 2 months' treatment, fungal check negative, but no hair growth No side-effect during treatment case 1 right thigh case 2 left scalp 7

8 Chin J Mycol 2006, 1(6):331 Tinea Capitis Treatment Tinea pedis infected from public bathhouse Oral antifungal drug itraconazole, terbinafine, griseofulvin Hair wash ketoconazole shampoo Topic antifungal cream twice a day 10% sulfur ointment, azoles, allylamines Hair cutting once a week Disinfect combs, brushed and other hair accessories. Pets treatment Tinea corporis Tinea manuum Sample taken from the adge of the lesion Hyphea and spores under KOH preparation Tinea pedis Circular, sharply circumscribed patches with slightly elevated borders. Target-like lesion Tinea Corporis Tinea unguium Dermatophytes growth in corneum A. Systemic lupus erythematosus, SLE Inflammatory reaction B. Dermatomyositis C. Facial dermatitis D. Facial tinea corporis Hyperkeratosis and scales What is you diagnosis for this patient Circular, sharply circumscribed patches with slightly elevated borders Central cure, edge development 8

9 A. Systemic lupus erythematosus, SLE B. Dermatomyositis C. Facial dermatitis D. Facial tinea corporis (tinea atypical) What is you diagnosis for this patient? Tinea pedis(erosive type) 股癣 (Tinea cruris) 股癣 (Tinea cruris) Antifungal treatment of tinea Topical Onychomycosis: high concentration Tinea manus and pedis: creams with 1%- 3% azoles, Whitfield s ointment for scaling and hyperkeratotic type Tinea corporis and cruris: lower concentration Orally: itraconazole, terbinafine, griseofulvin Oral terbinafine cured onychomycosis

10 Pityriasis versicolo r Seborrheic Dermatitis Seborrheic Dermatitis Before and after treatment by ketoconazole shampoo 10

11 Sporotricosis fixed 11

12 A. Squamou cell carcinoma B. Basal cell carcinoma C. Sporotricosis D. Melanoma What is you diagnosis for this patient? A. Squamou cell carcinoma B. Basal cell carcinoma C. Sporotricosis D. Melanoma What is you diagnosis for this patient? What is you diagnosis for this patient? 中华皮肤科杂志 Chin J Dermatol 2000,33(2):135 12

13 Sporotrichosis 4% T.capitis 35% T.corporis 22% The most pathogen of tinea manuum and pedis is The most pathogen of tinea manuum and pedis is Candidiasis 14% T.pedis 6% T.cruris 4% Onychomycosis 4% About Malassezia folliculitis, which one is wrong? A. Promoted by glucocorticoids B. Promoted by antifungal drugs C. Promoted by antibiotics D. Lesion mainly located on trunk About Malassezia folliculitis, which one is wrong? A. Promoted by glucocorticoids B. Promoted by antifungal drugs C. Promoted by antibiotics D. Lesion mainly located on trunk Tinea capitis is easy involved in A. Adult B. Newborn C. Elder D. Child Tinea capitis is easy involved in A. Adult B. Newborn C. Elder D. Child 13

14 Do you like this kind of interaction in teaching? 14