BI GING: VIM DA QUANH MING (PERIORAL DERMATITIS)

(K 4)
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1.6.Erythromycin: -c ch s tng trng ca vi khun bng cch ngn chn s phn tch peptidyl t-RNA t ribosome, gy nn ngng tng hp RNA vn chuyn protein. -Thng dng di dng gel hoc cream nng 2-4%, phi hp vi dng dng ti ch Metronidazole, thoa 2 ln/ ngy.

-Chng ch nh: nhy cm vi thuc; gim chc nng gan. Khng nn dng cho ph n c thai. -Tng tc thuc: Dng chung gy tng c tnh ca Theophylline, Digoxin, Carbamazepine, Cyclosporine; tng hiu lc khng ng ca Warfarine; dng chung vi Lovastatine v Simvastatine lm tng nguy c ly gii c vn (rhabdomyolysis). -Thn trng: Trnh tip xc vi mt v cc nim mc khc; dng lu di gy khng thuc.

2-Nhm Retinoids: Isotretinoin: Ch phm ng ung dng iu tr cc tnh trng bnh da nng. L ng phn 13-cis tng hp ca Tretinoin (trans-retinoic acid), c hai u c cu trc lin quan n vitamine A. Tc dng lm gim kch thc tuyn b v gim sn xut cht b, c ch bit ha tuyn b v s sng ha bt thng. Ch nh trong tnh trng POD ko di v dng kh tr (refractory). -Liu lng: +0,2mg/kg / ngy (ung); gim cn 0,1mg/kg hoc 0,05mg/kg khi lm sng c ci thin.

+Khng dng cho tr em, ph n c thai. -Chng ch nh: nhy cm vi thuc. -Tng tc thuc: c tnh c th xy ra khi dng chung vi vitamine A; gi u no c th xy ra khi dng chung vi Tetracycline; gim nng Carbamazepine trong huyt tng. -Thn trng: Thuc khng c dng trong thai k; gim dung np knh st trng (contact lenses) c th xy ra trong v sau iu tr; gim th lc v m; bnh nhn n nn dng bin php trnh thai trong lc iu tr v 1 thng sau khi iu tr; bnh l ri lon ng rut, vim gan c th xut hin; bnh nhn b tiu ng c th c nhng rc ri trong kim sot ng huyt trong lc iu tr; cn trnh tia UV hoc nh nng mt tri. Ngng iu tr nu xut huyt trc trng, au bng, tiu chy nng. VII-CC IM CN LU : -Trong chm sc cn lng gi cc tc dng ca iu tr ton thn ( i vi cc dc phm nh Doxycycline, Tetracycline, Minocycline v Isotretinoin). -iu tr ti ch bao gm cc khng sinh nh l Metronidazole v Erythromycine. Cc thuc chng Mn trng c nh Adapalene v Azelaic acid c dng tu theo tnh trng da v mc nng ca bnh.

-Chng ch nh dng cc steroids bi ti ch. -Trnh dng cc loi m phm, cc cht lm sch, cht gi m trong qu trnh iu tr. -Cn xc nh cc yu t gy bng pht bnh loi tr chng. -Cc bin chng: +Mc d POD ch gii hn trn da v khng nh hng n cuc sng, nhng cc rc ri v ni tm c th xy ra do cc bin dng ca cc thng tn trn mt v tnh trng ko di ca bnh l. +C mt tn sut hiu ng phn hi (rebound effect) xy ra trong qu tr nh cai (wean) steroid, mc d him gp. +Din tin mn tnh thng gp. +Pht trin cc lupoid trong b l mt bin i nghim trng ca bnh: chn on da trn cc sn ri lon sc t c mu vng, tnh trng ny gi l POD ging lupus, thng gy so do cc lupoid. -i vi bnh nhi, ph n c thai, ch nn dng liu php ti ch v cc thuc dng ng ton thn thng chng ch nh. VIII-KT LUN: Vim da quanh ming (POD)l mt bnh l thng gp ph n, c rt nhiu yu t gy pht sinh bnh, trong c mi lin h vi vic s dng steroid ti ch, dng cc loi m phm, cc cht lm sch, cht gi m v din tin mn

tnh, d bi nhim cc vi sinh vt c hi, li s mt thm m do cc bin dng ca cc tn thng trn mt. Cng lc vi vic iu tr, cn tho lun vi bnh nhn tm ra cc yu t gy bng pht bnh lp k hoch loi tr trnh ti pht v din tin mn tnh, trnh cc bin chng do s bin i ca tnh trng bnh. Ch nh dng thuc theo ng ti ch v/hoc ng ton thn cn cn nhc tu theo tng c th ngi bnh, tui tc, gii tnh, cc bnh l i km v theo di k cc tc dng ph ca thuc. Cn thm cc nghin cu cn thit xc nh nguyn nhn sinh bnh trn c s c chin lc iu tr v d phng c hiu qu./.