Mawu akuti intertrigo amachokera ku Latin inter, pakati ndi tergo, I rub. Chifukwa chake imatchula ma dermatoses omwe ali m'malo omwe madera awiri okhudza khungu ndi kupaka palimodzi, otchedwa mapindikidwe.

Ndi chiyani ? 

Intertrigo ndi dermatosis yopangidwa ndi makwinya a khungu, kaya amakhudzidwa limodzi kapena limodzi, zazikulu (inguinal, interlocking, axillary, submammary folds) kapena zazing'ono (interdigito-palmar, inter zala, umbilicus, retroauricular, labial commissures, navel).

Mitundu yosiyanasiyana ya intertrigo

Pali ma intertrigos a chiyambi chopatsirana (mycoses, mabakiteriya, etc.), ndi intertrigos osapatsirana omwe nthawi zambiri amachokera ku malo a dermatoses (eczema, psoriasis, etc.) m'makwinya.

Kachipatala, kusiyana kumapangidwa pakati pa intertrigos youma ndi intertrigos yonyowa ndi yotuluka.

Zifukwa za intertrigo

Infectious intertrigo

Bowa intertrigo, mycosis wa makutu

Matenda a yisiti ndiye chifukwa chachikulu cha intertrigo. Pali mitundu iwiri ya bowa:

• Dermatophytes, nthawi zambiri amapereka intertrigos youma
• Candida, yomwe ndi yisiti, yomwe nthawi zambiri imayambitsa chonyezimira, chonyowa intertrigo

Mabakiteriya intertrigos

• Corynebacterium minutissium intertrigo, erythrasma: Erythrasma ndi matenda omwe amapezeka kwambiri mu inguinal ndi axillary folds.
• Pseudomonas aeruginosa intertrigo: Pseudomonas, wotchedwanso pyocyanic bacillus, ndi bakiteriya yomwe imakhala m'nthaka ndi madzi. Choncho timadziyipitsa tokha pokhudzana ndi nthaka yonyowa (m'munda, ndi zina zotero) kapena m'madzi otentha (spa, etc.) ndipo nthawi zambiri zimasokoneza dermatophytic intertrigos kupyolera mu maceration ndi thukuta. Zimakhala zofala m'mipata yapakati pa zala zam'miyendo, zomwe mwadzidzidzi zimakhala zowawa, zokokoloka, zotulutsa kapenanso kununkhiza.

Intertrigos kupita ku mabakiteriya ena a pathogenic

Zimayambitsidwa ndi staphylococci, streptococci ndi gram-negative bacilli (colibacilli). Ma intertrigo awa amapezeka kwambiri mwa anthu onenepa kwambiri, odwala matenda ashuga komanso odwala omwe alibe ukhondo, ndipo nthawi zambiri amasokoneza dermatosis.

Ma intertrigo osapatsirana

• Psoriasis: Pindani psoriasis kapena "inverted" psoriasis ndizofala mu khola la intergluteal.
• Kukwiyitsa: Kumakhala kwachiwiri pakugwiritsa ntchito mankhwala am'deralo (antiseptic, cosmetics) kapena kukhudzana mwangozi ndi chinthu choyambitsa matenda.
• Chikanga: Kungakhale kukhudzana chikanga ndi ziwengo ku deodorant m'khwapa mwachitsanzo kapena atopic dermatitis makamaka zimakhudza makutu ena (retroauricular mizere, mapindikidwe a mawondo, makutu a zigongono…).

Zomwe zimayambitsa

• Matenda a Hailey-Hailey ndi osowa kwambiri pakhungu.
• Matenda a Paget ndi matenda oopsa omwe amafanana ndi intraepidermal adenocarcinoma.
• Matenda a Crohn, matenda otupa m'mimba, amatha kukhudza makwinya amkati ndi inguinal.
• Vegetative pemphigus ndi mtundu wosowa wachipatala wa vulgar pemphigus womwe umakhudza makutu akulu.
• Chindoko chachiwiri chikhoza kukhudza makutu akuluakulu.
• Langerhans histiocytosis ndi matenda omwe amalumikizidwa ndi kudzikundikira kwa ma cell a Langerhans.
• Necrolytic migratory erythema imakhudzanso glucagonomics, zotupa zowopsa za kapamba.
• Sneddon ndi Wilkinson sub-cornea pustulosis ndi gulu la neutrophilic dermatoses, yodziwika ndi kukhalapo kwa neutrophils pakhungu ndi kumakhudza zazikulu makwinya.

Kuzindikira za intrigue

Kuzindikira kwa intertrigo ndikosavuta: kumatanthauzidwa ndi kufiira kwa khola, komwe kumatha kuyabwa, kuwawa, kutulutsa… Ndiko kuzindikira komwe kumayambitsa komwe kumakhala kosavuta. Dokotala adzayang'ana pa mawonekedwe omwe amamulola kuti adziyang'ane pazifukwa chimodzi kapena zingapo: mayiko awiri komanso mwina symmetrical kapena unilateral intertrigo, kukhalapo kwa desquamation, kutuluka, kusinthika kwa centrifugal extension, malire omveka bwino kapena ma contours ophwanyika, kukhalapo kwa vesicles, pustules, kusweka pa. pansi pa khola…

Nthawi zambiri ndikofunikira kutenga chitsanzo cha mycological (kuti mufufuze mwachindunji ndi kulima) kapena ngakhale tizilombo toyambitsa matenda komanso nthawi zina khungu.

Kusintha komanso zovuta zomwe zingachitike

Intertrigo sichimakonda kuchiritsa yokha. Imakhala ndi chizolowezi chosintha ndipo nthawi zambiri imakhala yoipitsitsa chifukwa cha maceration, kukangana komanso nthawi zina chisamaliro chapafupi chomwe chimakwiyitsa, chingayambitse ziwengo kapena kuyambitsa vuto (mwachitsanzo popaka kirimu cha cortisone pa intertrigo yopatsirana).

Bakiteriya superinfection, kupweteka ndi kusweka ndizovuta kwambiri.

Zizindikiro zimasiyanasiyana malinga ndi zomwe zimayambitsa intertrigo:

Infectious intertrigos

Matenda a yisiti

Dermatophyte intertrigo

Pamlingo wa makwinya akulu, amapereka redness youma ndi mascaly ndi pinki pakati, nthawi zambiri amgwirizano ndi symmetrical, yomwe itch. Chisinthikocho chimapangidwa ndi kufalikira kwa centrifugal, ndi malire omveka bwino, polycyclic, vesicular ndi scaly. Kuphatikizidwa kwachikale ndi inguinal khola.

Pa mlingo wa makutu ang'onoang'ono, ndi intertrigo inter toe yomwe imatchedwa "phazi la othamanga" chifukwa imapezeka kawirikawiri mwa ochita masewera, makamaka m'malo otsiriza a zala (pakati pa zala ziwiri zomaliza). Zimapanga mng'alu wofiyira kapena wofiyira wokhala m'malire ndi maceration, zomwe zimapangitsa khungu kukhala lonyowa, loyera, ndipo limatha kufalikira kumbuyo kwa phazi kapena kuphazi. Nthawi zambiri amayabwa.

Intertrigo kuti candida

Pamlingo wa makwinya akuluakulu, amapereka intertrigo yonyezimira komanso yonyowa, yomwe pansi pake nthawi zambiri imasweka, ngakhale yokutidwa ndi zokutira zoyera. Malire a intertrigo amaphwanyidwa ndi zoyera zoyera ndi ma pustules ochepa. Apanso, malo osankhidwa ndi inguinal khola, koma amatha kuwoneka pansi pa mabere.

Pa mlingo wa makutu ang'onoang'ono, ndi intertrigo yokhala ndi makhalidwe ofanana ndi makutu akuluakulu, koma nthawi zambiri amakhala pakati pa zala kapena pakona ya milomo (perlèche).

mabakiteriya

Intertrigo kuchokera ku Streptomyces powder, l Erythrasma

Erythrasma imakhala ngati zolembera zozungulira, zopanda malire. Kuunika kwa Wood (nyali ya UV) kumachititsa kuti pakhale “korali” zofiira.

Intertrigo ku Pseudomonas aeruginosa

Pseudomonas intertrigo nthawi zambiri imasokoneza dermatophytic intertrigos makamaka pakati pa zala zakuphazi kudzera mu maceration ndi thukuta mu nsapato, zomwe mwadzidzidzi zimakhala zowawa, zokokoloka, kutuluka kapena kununkhiza.

Intertrigos kupita ku mabakiteriya ena a pathogenic

Nthawi zambiri komanso complicate intertrigos anthu onenepa, odwala matenda a shuga ndi odwala ukhondo ukhondo: ndi intertrigo kutembenukira wofiira, kutuluka ndi nkhanambo kapena pustules.

Ma intertrigo osapatsirana

psoriasis

Psoriasis of the folds kapena "inverted" psoriasis imayambitsa intertrigo, yomwe imakonda kukhala pakati pa matako ndi pa mchombo, yofiira, yonyezimira, yodziwika bwino, ndipo nthawi zambiri imasweka pansi pa khola.

Kukwiya

Kukhumudwa nthawi zambiri kumakhudzana ndi kugwiritsa ntchito antiseptics, cosmetics kapena irritants. Intertrigo ndi yonyezimira, yofinya ndipo nthawi zina mavesicles kapena zilonda ndipo nthawi zambiri imayambitsa kutentha.

Eczema

Pindani eczema ikhoza kukhala ndi zoyambira ziwiri:

• Thupi lawo siligwirizana ndi chikanga chomwe nthawi zambiri chimatuluka, kuyabwa komanso kukhala ndi matuza. Zimabwera chifukwa cha kukhudzana ndi zinthu zomwe zimayikidwa mu khola ndipo zimasokoneza intertrigo yomwe imatuluka kapena ngakhale vesicular ndipo imatha kuyabwa.
• atopic dermatitis, makamaka m'mikwingwirima, mawondo, khosi, kumbuyo kwa makutu ndipo nthawi zambiri amawoneka owuma.

Zomwe zimayambitsa

Matenda a Hailey-Hailey ndi osowa cholowa dermatosis, yodziwika ndi mobwerezabwereza vesicles kapena ngakhale thovu pakhosi, axillary dzenje ndi groin m'magulumagulu odziwika bwino yamawangamawanga, modutsa ndi khalidwe ming'alu ofanana rhagades.

Paget's matenda ndi intra-epidermal adenocarcinoma (mtundu wa khansa), nthawi zambiri vulvar, yokhudzana ndi khansa ya m'mimba (mwachitsanzo, ya mkodzo kapena yachikazi) pafupifupi 1/3 ya milandu. Amawoneka ngati chigamba chofiira cha vulva, groin kapena mbolo yomwe imafalikira pang'onopang'ono.

Matenda a Crohn, matenda otupa a m'matumbo osatha, amatha kukhala ndi malo akhungu, makamaka m'makwinya apakati ndi inguinal. Amawoneka ngati ming'alu, zilonda zam'mimba komanso zozama ngati kubaya, zotupa zomwe zimapangitsidwa ndi fistula… zomwe zimatha kuyambitsa kugaya kwam'mimba pakadutsa miyezi ingapo.

Vegetative pemphigus ndi osowa mtundu wa pemphigus okhudza lalikulu makutu, kuwapatsa vegetative ndi budding redness.

Chindoko chachiwiri chikhoza kupatsa zolembera zingapo, zotupa komanso zokokoloka, nthawi zina zimamera m'mikwingwirima.

Langerhans histiocytosis ndi matenda obwera chifukwa cha kuchuluka kwa ma cell a Langerhans. Zimapangitsa khungu kukhala lotumbululuka komanso lofiirira, makamaka m'makwinya a retroauricular, kapena ngakhale makwinya akulu.

Necrolytic migratory erythema ndi kukhudzidwa kwa khungu komwe kumachitika chifukwa cha glucagonoma, chotupa choyipa cha kapamba. Zimapanga zigamba zofiira zokwezeka zokhala ndi malire otumbululuka kapena ofowoka omwe amasiya chilonda cha pigment.

Sneddon-Wilkinson sub-cornea pustulosis ndi neutrophilic dermatosis, yodziwika ndi kukhalapo kwa maselo oyera amagazi otchedwa neutrophils pakhungu. Amatulutsa ma pustules owoneka bwino, kapena thovu lomwe limatha kukhala ndi mulingo wamadzimadzi wotchedwa hypopion pustule. Ma pustules ndi thovu amaphatikizidwa ndi kujambula ma arcs kapena mphete kapena kuzungulira makamaka pa thunthu, pamizu ya miyendo ndi m'makola akuluakulu.

Zowopsa

Zipindazi zimakhala ndi chiopsezo cha maceration, kukangana ndi kutentha zomwe zimalimbikitsa kupsa mtima ndi kufalikira kwa tizilombo toyambitsa matenda kaya ndi mafangasi kapena mabakiteriya.

Kuchuluka kwa makwinya, kunenepa kwambiri, kufooka kwa chitetezo chamthupi, mimba, matenda a shuga ndi mankhwala enaake (mankhwala ambiri a corticosteroid, maantibayotiki) makamaka amalimbikitsa candidiasis m'makwinya.

Lingaliro la dokotala wathu

Intertrigos nthawi zambiri amafunsira dermatology. Iwo bwino m'gulu zifukwa m'nkhani ino koma kwenikweni iwo nthawi zambiri multifactorial mchitidwe akamaona mu ofesi ya dokotala: ndi dermatophytic intertrigo amakhala superinfect ndi mabakiteriya ndi kupereka mkwiyo ndi / kapena matupi awo sagwirizana chikanga kwa mankhwala ntchito ndi wodwalayo. . Kuphatikiza apo, wodwalayo nthawi zambiri amafunsana ndi dokotala yemwe adayesapo chithandizo chimodzi kapena zingapo zakumaloko kuti asinthe mawonekedwe a intertrigo: kuzindikira kwawo chifukwa chake nthawi zina kumakhala kovuta kwambiri, komanso chithandizo chawo.

Lamulo limodzi limakhala loona nthawi zambiri mu intertrigos: nthawi zambiri ndikwabwino kuyanika khola kusiyana ndi kuthira mafuta kapena zonona pamizere yokhuthala.

Kupewa kwa intertrigo

Njira zosavuta zowongolera nthawi zambiri zimachepetsa chiopsezo cha intertrigo:

• Tsukani tsiku ndi tsiku ndikuumitsa makola bwino
• pewani zovala zamkati zothina kwambiri, ubweya ndi ulusi wopangira / konda masokosi a thonje ndi zovala zamkati
• kulimbana ndi zinthu zomwe zimathandizira: shuga, kunenepa kwambiri, zonona za cortisone, etc.

Kuchiza

Chithandizo chimadalira chomwe chimayambitsa:

Infectious intertrigo

Dermatophyte intertrigos

Kuchiza kwa dermatophytic intertrigos kumachitika ndi kugwiritsa ntchito, nthawi zambiri kawiri tsiku lililonse, antifungals, kirimu, mkaka, kutsitsi, ufa:

• Imidazole: éconazole (Pevaryl®), miconazole (Daktarin®), oxiconazole (Fonx®)
• Allylamines: terbinafine (Lamisil®)
• Zochokera ku pyridone: cyclopiroxolamine (Mycoster®)

Ngati kukana chithandizo chamankhwala chakumaloko, dokotala atha kupereka mankhwala oletsa mafangasi amkamwa monga griseofulvin (Grisefuline®) kapena terbinafine (Lamisil®) kwa masabata atatu mpaka anayi.

Candida ndi zodabwitsa

Chithandizo choyamba chimalimbana ndi zinthu zomwe zimathandizira candidiasis: kupewa chinyezi, maceration, kuvulala kwamankhwala kapena makina. Matenda a shuga kapena matenda okhudzana ndi kugaya chakudya kapena maliseche a candidiasis ayeneranso kuthandizidwa.

Zimakhazikitsidwa ndi antifungals wamba, kirimu, mkaka, kutsitsi, ufa, ntchito kawiri pa tsiku:

• Imidazole: éconazole (Pevaryl®), miconazole (Daktarin®), oxiconazole (Fonx®)
• Allylamines: terbinafine (Lamisil®)
• Zochokera ku pyridone: cyclopiroxolamine (Mycoster®).

Kuchiza kwadongosolo kungaperekedwe kwa masiku 15 ngati kubwerezabwereza kapena kukhudzidwa kwa m'mimba (nystatin, Mycostatin®, ketoconazole, Nizoral®).

mabakiteriya

Intertrigo kuchokera ku Streptomyces powder, l Erythrasma

Erythrasma imathandizidwa ndi mankhwala am'deralo ndi odzola a erythromycin.

Intertrigo ku Pseudomonas aeruginosa

Mayankho osakwiyitsa a antiseptic amayikidwa pakhola (chlorhexidine: Diaseptyl®, polyvidone ayodini: Betadine®…) ndi / kapena silver sulfadiazine (Flammazine®). Dokotala nthawi zambiri amangogwiritsa ntchito maantibayotiki am'kamwa, ngati akuwonjezera matenda kapena kukana chithandizo, nthawi zambiri amakhala ciprofloxacin (Ciflox®).

Intertrigos kupita ku mabakiteriya ena a pathogenic

Nthawi zambiri amachepetsa ndi antiseptics am'deralo (chlorhexidine: Diaseptyl®, polyvidone ayodini: Betadine®, etc.), kuphatikiza ndi mankhwala am'deralo ndi fusidic acid (Fucidine® kirimu).

Ma intertrigo osapatsirana

psoriasis

Nthawi zambiri imayankha bwino kuphatikiza kwa corticosteroid ndi gel ya vitamini D (Daivobet® ...)

Kukwiya

Kuchiza kukwiya kumafuna mankhwala ophera tizilombo (chlorhexidine: Diaseptyl®, polyvidone ayodini: Betadine®…), emollients kapena topical corticosteroids moyang'aniridwa ndi achipatala.

Eczema

Chithandizo cha chikanga amafuna emollients ndi apakhungu corticosteroids moyang'aniridwa ndi achipatala.

Zomwe zimayambitsa

• Matenda a Hailey-Hailey amafunikira kuyanika kwa makona kuti achepetse kuphulika komanso kuopsa kwa matenda a bakiteriya, mafangasi ndi ma virus. Kudulidwa kwa makwinya okhudzidwa ndi opaleshoni ndi kumezanitsa khungu ndi njira yokhayo yothandizira.
• Matenda a Paget amafunikira chithandizo cha khansa ya m'mimba yogwirizana ndi kudulidwa kwa plaque ya matenda a Paget.
• Vegetative pemphigus amafuna topical corticosteroids moyang'aniridwa ndi achipatala.
• Secondary chindoko amathandizidwa ndi mu mnofu jakisoni wa penicillin.
• Kusamukasamuka necrolytic erythema kumafuna kuchotsa kukhumudwitsa glucagonoma.