BI GING: VIM DA QUANH MING (PERIORAL DERMATITIS)

(K 1)
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I-M U: 1-Vim da quanh ming (POD: Perioral Dermatitis) l tnh trng vim da sn- mn m mn tnh mt. Bnh thng xy ra ph n, mc d cng pht hin bin th dng sn xy ra tr em. Cc yu t lm sng v m hc ca cc tn thng tng t nh Trng c (rosacea). Bnh nhn cn iu tr ton thn v/hoc ti ch, loi tr cc yu t pht sinh v trn an .

2-Sinh l bnh hc: Nguyn nhn ca POD th cha r; tuy nhin, nhn thy rng vic s dng cc steroids dng nh trn da mt thng dn n cc triu chng ca bnh. POD ch gii hn trn da. 3-Tn sut: -Ti Hoa K: chim 0,5-1% cc vng cng nghip, c lp vi cc yu t a l. -Trn Th gii: chim t l thp ti cc nc km pht trin, nhng khng c ngha thng k. 4-POD ch gii hn trn da v khng nh hng n cuc sng. Cc bin i v ni tm (emotional) c th xy ra do din tin t nhin v mn tnh ca bnh. 5-Gii tnh: -POD thng gp ph n, chim 90% cc trng hp. -S bnh nhn nam gii cng c chiu hng gia tng do s thay i thi quen dng m phm (cosmetic) ca h. 6-Tui: -POD c th xy ra tr em , nhng thng t c chn on. -a phn bnh nhn l ph n tui 20-45.

II-LM SNG:

1-Tin s bnh: -Cc triu chng ch yu lin quan n s nhy cm vi sc nng v p lc. -Nga (him gp). -Thng thng, c vic s dng steroids dng nh, hoc khng pht hin c cc bin i g trn da d gy pht trin bnh. -POD din tin mn tnh. Bnh nhn c th b hn ch phong cch sng (lifestyle) v bin dng (disfigure) t cc tn thng mt. 2-Thc th: -Bnh ch gii hn trn da. -Cc tn thng da gm: cc nhm sn nang lng, sn-mn nc, snmn m trn nn hng ban tp hp thnh m. +Cc sn v mn m thng khu tr quanh ming; +Tnh cht khu tr ca tn thng POD: vng quanh ming, cnh miming (nasolabial fold), cc mt bn ca phn di mi mt (eyelid). -Cc tnh trng bin i ngoi lai ca bnh gi l vim da quanh ming ging lupus dng ht (lupuslike POD granulomatous) .

3-Nguyn nhn: Thng khng bit c trong hu ht trng hp. -Thuc: a s bnh nhn c lm dng (abuse) cc ch phm steroid dng thoa ti ch. Khng c tng quan (correlation) gia nguy c POD vi s dng ko di steroid hoc vi thi gian lm dng steroid. -M phm: kem nh rng cha Fluor, cc loi kem bi trn da, c bit l cc cht nn c cht du (petrolatum) hoc paraffin, cht dung mi (ve hicle) c isopropyl myristate. Vic phi hp gia cht gi m (moisturizer) v kem nn (foundation) c lin quan n vic gia tng nguy c POD. -Yu t vt l: tia cc tm (UV), sc nng. -Yu t vi sinh: trc khun Fusiform, chng Candida, cc loi nm khc tm thy trn tn thng. Thm vo , b nhim nm Candida (candidiasis) gy bng pht (provoke) POD. -Cc yu t khc: yu t hormon cng l yu t nghi ng (suspect) bi v bnh c v xu i trong thi k tin mn kinh (premenstrual). Thuc nga thai dng ung, ri lon d dy-rut (chng hn nh km hp thu) cng l nhng yu t khi pht.