Lub sij hawm intertrigo los ntawm Latin inter, nruab nrab thiab tergo, kuv rub. Nws yog li ntawd xaiv cov dermatoses nyob rau hauv qhov chaw uas ob qhov chaw ntawm daim tawv nqaij kov thiab rub ua ke, hu ua folds.

Dab tsi yog nws? 

Intertrigo yog ib qho dermatosis nyob rau hauv daim tawv nqaij folds, txawm lawv raug cuam tshuam los yog ua ke, loj (inguinal, interlocking, axillary, submammary folds) los yog me me (interdigito-palmar, inter-toes, umbilicus, retroauricular, labial commissures, navel).

Qhov sib txawv ntawm intertrigo

Muaj cov kab mob sib kis ntawm keeb kwm (mycoses, kab mob, thiab lwm yam), thiab tsis kis kab mob intertrigos uas feem ntau tshwm sim los ntawm qhov chaw ntawm dermatoses (eczema, psoriasis, thiab lwm yam) hauv cov quav.

Clinically, qhov sib txawv yog ua los ntawm qhuav intertrigos thiab ntub thiab oozing intertrigos.

Qhov ua rau ntawm intertrigo

Kab mob intertrigo

Fungus intertrigo, mycosis ntawm cov quav

Cov kab mob poov xab yog lub ntsiab ua rau intertrigo. Muaj ob hom fungi koom nrog:

• Dermatophytes, feem ntau muab cov intertrigos qhuav
• Candida, uas yog cov poov xab, feem ntau ua rau ci ntsa iab, ntub dej intertrigo

Cov kab mob intertrigos

• Corynebacterium minutissium intertrigo, erythrasma: Erythrasma yog cov kab mob ntau tshaj plaws hauv cov kab mob inguinal thiab axillary folds.
• Pseudomonas aeruginosa intertrigo: Pseudomonas, tseem hu ua pyocyanic bacillus, yog cov kab mob uas nyob hauv av thiab dej. Yog li ntawd peb kis tau tus kheej nyob rau hauv kev sib cuag nrog cov av ntub dej (ua vaj, thiab lwm yam) los yog hauv dej kub (spa, thiab lwm yam) thiab nws feem ntau cuam tshuam dermatophytic intertrigos los ntawm maceration thiab perspiration. Nws yog vim li no tshwm sim nyob rau hauv cov ntiv taw sib nrug, uas dheev ua mob, erosive, oozing los yog tsw tsw.

Intertrigos rau lwm cov kab mob pathogenic

Lawv tshwm sim los ntawm staphylococci, streptococci thiab Gram-negative bacilli (colibacilli). Cov intertrigos no feem ntau tshwm sim hauv cov neeg rog rog, cov ntshav qab zib thiab cov neeg mob uas muaj kev tu cev tsis zoo, thiab feem ntau ua rau muaj teeb meem hauv qab dermatosis.

Tsis muaj kab mob intertrigos

• Psoriasis: Fold psoriasis los yog "inverted" psoriasis yog muaj nyob rau hauv lub intergluteal quav.
• Irritation: Nws yog qhov thib ob rau kev siv cov kev kho mob hauv zos (antiseptic, tshuaj pleev ib ce) lossis los ntawm kev sib cuag nrog cov tshuaj caustic.
• Eczema: Nws tuaj yeem yog tus kab mob hu ua eczema los ntawm kev ua xua rau cov tshuaj deodorant hauv lub caj dab piv txwv lossis atopic dermatitis nyiam cuam tshuam rau qee qhov quav (retroauricular furrows, folds ntawm lub hauv caug, folds ntawm lub luj tshib ...).

Tsis tshua muaj ua

• Hailey-Hailey kab mob yog ib yam mob uas tsis tshua muaj tshwm sim ntawm daim tawv nqaij.
• Paget tus kab mob yog ib yam kab mob malignant sib xws rau ib qho intraepidermal adenocarcinoma.
• Crohn tus kab mob, kab mob plab hnyuv, tuaj yeem cuam tshuam rau cov kab mob sib kis thiab cov kab mob inguinal.
• Vegetative pemphigus yog ib daim ntawv kho mob tsis tshua muaj tshwm sim ntawm qhov tsis zoo pemphigus cuam tshuam rau cov folds loj.
• Secondary syphilis tuaj yeem cuam tshuam cov folds loj.
• Langerhans histiocytosis yog ib yam kab mob cuam tshuam nrog kev txuam nrog hauv cov ntaub so ntswg ntawm Langerhans hlwb.
• Necrolytic migratory erythema yog tshwj xeeb rau glucagonomics, malignant qog ntawm pancreas.
• Sneddon thiab Wilkinson's sub-cornea pustulosis belongs rau cov pab pawg neeg ntawm neutrophic dermatoses, uas muaj cov neutrophils nyob rau hauv daim tawv nqaij thiab cuam tshuam rau cov quav loj.

Kev kuaj mob ntawm intrigue

Kev kuaj mob ntawm intertrigo yog ib qho yooj yim: nws yog txhais los ntawm qhov liab ntawm lub quav, uas tuaj yeem khaus, mob, ooze… Nws yog qhov kev kuaj mob ntawm qhov ua rau uas yog qhov muag heev. Tus kws kho mob yuav tsom mus rau cov yam ntxwv uas tso cai rau nws coj nws tus kheej mus rau ib lossis ntau qhov ua rau: ob sab thiab tej zaum sib luag lossis unilateral intertrigo, muaj desquamation, oozing, evolution los ntawm centrifugal extension, meej ciam teb los yog crumbled contours, muaj vesicles, pustules, tawg ntawm hauv qab ntawm lub qhov rooj…

Nws yog feem ntau yuav tsum tau coj mus kuaj mycological (rau kev kuaj ncaj qha thiab cog qoob loo) lossis txawm tias muaj kab mob bacteriological thiab qee zaum kuaj tawv nqaij.

Evolution thiab teeb meem ua tau

Intertrigo tsis tshua muaj kev kho mob ntawm nws tus kheej. Nws muaj ib qho kev hloov pauv thiab feem ntau ua rau mob zuj zus vim yog maceration, kev sib txhuam thiab qee zaum kev saib xyuas hauv zos uas nyiam ua rau nws khaus, tuaj yeem ua rau muaj kev tsis haum xeeb lossis ua rau muaj teeb meem (piv txwv li thaum thov cov tshuaj cortisone ntawm kev sib kis sib kis).

Cov kab mob superinfection, mob thiab tawg kuj yog cov teeb meem classic.

Cov tsos mob txawv nyob ntawm qhov ua rau ntawm intertrigo:

Kab mob intertrigos

Poov xab kis

Dermatophyte intertrigo

Nyob rau theem ntawm cov folds loj, lawv muab qhuav thiab scaly redness nrog ib tug liab chaw, feem ntau yog ob sab thiab symmetrical, uas khaus. Cov evolution yog ua los ntawm ib tug centrifugal extension, nrog ib tug ntshiab ciam teb, polycyclic, vesicular thiab scaly. Cov kev koom tes classic yog lub inguinal quav.

Nyob rau theem ntawm cov me me folds, nws yog intertrigo inter-toe feem ntau hu ua "tus neeg ncaws pob ko taw" vim nws nquag nyob rau hauv cov kis las, tshwj xeeb tshaj yog nyob rau hauv qhov kawg ntawm ntiv taw (nruab nrab ntawm ob ntiv taw kawg). Nws tsim cov paj liab lossis liab tawg ciam teb los ntawm maceration muab cov tawv nqaij ntub dej, xim dawb, thiab tuaj yeem kis mus rau tom qab ntawm ko taw lossis ib leeg ntawm ko taw. Nws feem ntau khaus.

Intertrigo rau candida

Nyob rau theem ntawm cov folds loj, lawv muab ib qho glazed thiab damp liab intertrigo, hauv qab uas feem ntau tawg, txawm them nrog ib tug creamy dawb txheej. Cov ciam teb ntawm intertrigo yog crumbled nrog ib tug dawb ruff thiab ob peb pustules. Ntawm no dua, qhov chaw ntawm kev xaiv yog qhov quav inguinal, tab sis nws kuj tuaj yeem pom hauv qab lub mis.

Nyob rau theem ntawm cov folds me me, nws yog ib qho intertrigo uas muaj cov yam ntxwv zoo ib yam li hauv cov folds loj, tab sis feem ntau zaum ntawm cov ntiv tes los yog ntawm lub ces kaum ntawm daim di ncauj (perlèche).

kab mob

Intertrigo los ntawm Streptomyces hmoov, l Erythrasma

Erythrasma siv daim ntawv ntawm ib puag ncig, zoo-txheej xim av plaque. Ntoo lub teeb kuaj (UV teeb) xim nws "coral" liab.

Intertrigo thiab Pseudomonas aeruginosa

Pseudomonas intertrigo feem ntau cuam tshuam dermatophytic intertrigos tshwj xeeb tshaj yog nyob nruab nrab ntawm cov ntiv taw los ntawm maceration thiab perspiration nyob rau hauv cov khau, uas dheev ua mob, erosive, oozing los yog txawm tsw tsw.

Intertrigos rau lwm cov kab mob pathogenic

Lawv feem ntau kuj cuam tshuam cov intertrigos ntawm cov neeg rog rog, cov ntshav qab zib thiab cov neeg mob uas tsis zoo lub cev huv si: lub intertrigo tig liab, oozing nrog scab los yog pustules.

Tsis muaj kab mob intertrigos

psoriasis

Psoriasis ntawm cov quav los yog "inverted" psoriasis ua rau muaj kev cuam tshuam, nyiam nyob nruab nrab ntawm lub pob tw thiab ntawm lub plab, liab, ci iab, txhais tau zoo, thiab feem ntau tawg rau hauv qab ntawm lub quav.

Kev chim siab

Kev khaus khaus feem ntau cuam tshuam nrog kev siv tshuaj tua kab mob, tshuaj pleev ib ce lossis tshuaj pleev. Intertrigo yog ci liab, wrinkled nrog qee zaum vesicles los yog txawm mob thiab nws yog ib qho ua rau nws ua rau kub hnyiab.

eczema

Fold eczema tuaj yeem muaj ob lub hauv paus:

• Allergic contact eczema uas feem ntau oozing, khaus thiab tej zaum yuav muaj hlwv. Nws tshwm sim los ntawm kev sib cuag tsis haum rau cov khoom siv hauv cov quav thiab ua rau muaj kev cuam tshuam intertrigo uas ua rau oozing lossis txawm tias vesicular thiab tuaj yeem khaus.
• atopic dermatitis, feem ntau nyob rau hauv cov quav ntawm lub luj tshib, hauv caug, caj dab, qab pob ntseg thiab feem ntau zoo li qhuav.

Tsis tshua muaj ua

Hailey-Hailey tus kab mob yog ib qho tsis tshua muaj kab mob dermatosis, uas tshwm sim los ntawm qhov tshwm sim ntawm cov hlwv lossis txawm tias npuas ntawm lub caj dab, axillary hollows thiab puab puab tais ua ke hauv thaj ua kom zoo, hla los ntawm cov kab nrib pleb zoo heev nyob rau hauv parallel rhagades.

Paget tus kab mob yog ib qho kab mob intra-epidermal adenocarcinoma (daim ntawv ntawm mob qog noj ntshav), feem ntau ntawm qhov chaw mos, cuam tshuam nrog mob qog noj ntshav (piv txwv li urinary lossis gynecological) hauv kwv yees li 1/3 ntawm cov neeg mob. Nws nthuav tawm raws li thaj chaw liab ntawm qhov chaw mos, puab tais lossis chaw mos uas maj mam kis.

Crohn tus kab mob, kab mob ua rau mob plab hnyuv, tuaj yeem suav nrog thaj chaw ntawm daim tawv nqaij, tshwj xeeb tshaj yog nyob rau hauv cov kab mob sib kis thiab cov kab mob inguinal. Lawv tshwm sim raws li cov kab nrib pleb, kab thiab sib sib zog nqus rwj zoo li stabbing, abscesses nyuaj los ntawm fistulas ... uas tuaj yeem ua ntej digestive tshwm sim los ntawm ob peb lub hlis.

Vegetative pemphigus yog ib hom tsis tshua muaj ntawm pemphigus cuam tshuam rau cov folds loj, muab lawv cov nroj tsuag thiab budding liab.

Cov kab mob syphilis thib ob tuaj yeem muab ntau yam, o thiab erosive plaques, qee zaum zaub hauv cov quav.

Langerhans histiocytosis yog ib yam kab mob uas cuam tshuam nrog kev tsim ntawm daim tawv nqaij ntawm Langerhans hlwb. Nws ua rau cov tawv nqaij crusty thiab purpuric, feem ntau nyob rau hauv lub retroauricular folds, los yog txawm loj folds.

Necrolytic migratory erythema yog kev koom tes ntawm daim tawv nqaij tshwm sim los ntawm glucagonoma, ib qho qog malignant ntawm tus txiav. Nws tsim tsa, scaly liab thaj ua rau thaj ntawm centrifugal extension nrog ib tug crusty los yog erosive ciam teb uas tawm ib tug pigmented caws pliav.

Sneddon-Wilkinson sub-cornea pustulosis yog ib qho neutrophic dermatosis, uas tshwm sim los ntawm cov qe ntshav dawb hu ua neutrophils hauv daim tawv nqaij. Nws tsim cov tawv nqaij, flaccid pustules los yog npuas uas tej zaum yuav muaj cov yam ntxwv ntawm cov kua dej hu ua hypopion pustule. Cov pustules thiab npuas yog pab pawg los ntawm kev kos arcs lossis rings los yog voj voog feem ntau ntawm lub cev, ntawm cov hauv paus hniav ntawm cov ceg thiab hauv cov quav loj.

Risk yam tseem ceeb

Cov folds muaj kev pheej hmoo ntawm maceration, kev sib txhuam thiab cua sov uas txhawb kev khaus thiab microbial proliferation txawm tias nws yog fungal lossis kab mob.

Cov kua qaub ntawm cov quav, rog rog, tiv thaiv kab mob tsis zoo, cev xeeb tub, ntshav qab zib thiab qee yam tshuaj (kev kho corticosteroid, tshuaj tua kab mob) tshwj xeeb txhawb nqa candidiasis ntawm cov quav.

Peb tus kws kho mob lub tswv yim

Intertrigos yog ib qho laj thawj rau kev sab laj hauv dermatology. Lawv tau raug cais zoo los ntawm cov laj thawj hauv tsab xov xwm no tab sis qhov tseeb lawv feem ntau muaj ntau yam hauv kev xyaum thaum pom hauv tus kws kho mob lub chaw ua haujlwm: dermatophytic intertrigo ua superinfect nrog cov kab mob thiab nthuav tawm qhov ua xua thiab / lossis ua xua eczema rau cov khoom siv los ntawm tus neeg mob. . Tsis tas li ntawd, tus neeg mob feem ntau twb tau sab laj nrog nws tus kws kho mob uas tau sim ib lossis ntau qhov kev kho mob hauv zos ntxiv hloov kho cov tsos mob ntawm intertrigo: lawv qhov kev kuaj mob tuaj yeem yog li qee zaum nyuaj, nrog rau lawv txoj kev kho mob.

Ib txoj cai tab sis feem ntau muaj tseeb hauv intertrigos: feem ntau nws yog qhov zoo dua los ua kom qhuav cov quav dua li siv cov tshuaj greasy lossis cream hauv cov txheej tuab.

Kev tiv thaiv ntawm intertrigo

Kev ntsuas kev saib xyuas yooj yim feem ntau txo qhov kev pheej hmoo ntawm intertrigo:

• ntxuav txhua hnub thiab qhuav cov folds kom huv si
• tsis txhob nruj ris tsho hauv qab, ntaub plaub thiab hluavtaws fibers / nyiam paj rwb thom khwm thiab ris tsho hauv qab
• tiv thaiv cov khoom muaj txiaj ntsig: ntshav qab zib, rog rog, cortisone cream, thiab lwm yam.

kev kho mob

Kev kho mob nyob ntawm qhov ua rau:

Kab mob intertrigo

Dermatophyte intertrigos

Kev kho mob ntawm dermatophytic intertrigos yog ua los ntawm daim ntawv thov, feem ntau ob zaug ib hnub twg, ntawm antifungals, nyob rau hauv qab zib, nyob rau hauv mis nyuj, tshuaj tsuag, hmoov:

• Imidazole: éconazole (Pevaryl®), miconazole (Daktarin®), oxiconazole (Fonx®)
• Allylamines: Terbinafine (Lamisil®)
• Pyridone derivatives: ciclopiroxolamine (Mycoster®)

Nyob rau hauv cov ntaub ntawv ntawm tsis kam mus rau kev kho mob hauv zos, tus kws kho mob yuav muab tshuaj tua kab mob qhov ncauj xws li griseofulvin (Grisefuline®) los yog terbinafine (Lamisil®) rau 3 mus rau 4 lub lis piam.

Candida intrigues

Kev kho mob ua ntej ntawm tag nrho cov sib ntaus tawm tsam cov yam uas nyiam candidiasis: tsis txhob humidity, maceration, tshuaj lom neeg los yog mechanical raug mob. Ib qho ntshav qab zib hauv qab lossis txawm tias cuam tshuam nrog kev zom zaub mov lossis qhov chaw mos candidiasis kuj yuav tsum tau kho.

Nws yog raws li cov tshuaj tua kab mob hauv zos, qab zib, mis nyuj, tshuaj tsuag, hmoov, thov ob zaug ib hnub:

• Imidazole: éconazole (Pevaryl®), miconazole (Daktarin®), oxiconazole (Fonx®)
• Allylamines: Terbinafine (Lamisil®)
• Pyridone derivatives: ciclopiroxolamine (Mycoster®).

Kev kho mob tuaj yeem muab tau rau 15 hnub thaum muaj kev rov tshwm sim lossis cuam tshuam nrog kev zom zaub mov (nystatin, Mycostatin®, ketoconazole, Nizoral®).

kab mob

Intertrigo los ntawm Streptomyces hmoov, l Erythrasma

Erythrasma yog kho nrog tshuaj tua kab mob hauv zos nrog erythromycin lotion.

Intertrigo thiab Pseudomonas aeruginosa

Cov tshuaj tua kab mob uas tsis yog khaus khaus yog siv rau cov quav (chlorhexidine: Diaseptyl®, polyvidone iodine: Betadine®…) thiab / lossis nyiaj sulfadiazine (Flammazine®). Tus kws kho mob tsuas yog tsis tshua siv tshuaj tua kab mob hauv qhov ncauj, thaum muaj kev kis kab mob los yog tiv thaiv kev kho mob, feem ntau yog ciprofloxacin (Ciflox®).

Intertrigos rau lwm cov kab mob pathogenic

Lawv feem ntau regress nrog cov tshuaj tua kab mob hauv zos (chlorhexidine: Diaseptyl®, polyvidone iodine: Betadine®, thiab lwm yam), ua ke nrog kev kho tshuaj tua kab mob hauv zos nrog fusidic acid (Fucidine® cream).

Tsis muaj kab mob intertrigos

psoriasis

Nws feem ntau teb zoo rau kev sib xyaw ntawm corticosteroid thiab vitamin D gel (Daivobet® ...)

Kev chim siab

Kev kho mob ntawm khaus khaus yuav tsum muaj tshuaj tua kab mob hauv zos (chlorhexidine: Diaseptyl®, polyvidone iodine: Betadine®…), emollients lossis txawm tias tshuaj pleev corticosteroids nyob rau hauv kev saib xyuas kev kho mob.

eczema

Kev kho tus kab mob eczema yuav tsum muaj emollients thiab tshuaj pleev corticosteroids nyob rau hauv kev saib xyuas kev kho mob.

Tsis tshua muaj ua

• Hailey-Hailey tus kab mob yuav tsum tau ziab ntawm cov quav kom txwv tsis pub muaj kab mob thiab muaj kev pheej hmoo ntawm kab mob, fungal thiab kab mob. Kev phais tshem tawm ntawm qhov cuam tshuam folds ua raws li daim tawv nqaij grafting feem ntau tsuas yog kev kho mob zoo xwb.
• Paget tus kab mob yuav tsum tau kho cov kab mob visceral cuam tshuam thiab kev tshem tawm ntawm Paget's kab mob plaque.
• Vegetative pemphigus xav tau tshuaj pleev corticosteroids nyob rau hauv kev saib xyuas kev kho mob.
• Secondary syphilis yog kho nrog intramuscular txhaj ntawm penicillin.
• Migratory necrolytic erythema yuav tsum tau tshem tawm ntawm qhov ua txhaum ntawm glucagonoma.