??(Vitiligo)

1
?????

• ??????
• ?????

2
??

• ???????,?????????
• ????

3
??(Vitiligo)

• Epidemiology(????)
• ??12??????
• 1.????????????,?????????10?
• ?30???
• 2.?????(?????????)
• 3.?????
• 4.???????????(?30??????,??
• ,???????)
• 5.???????,?????????????? ,
• ????????

()
Color Atlas Synopsis of Clinical Dermatology
P313 ???????? (http//www.derma.org.tw)
4
??(Vitiligo)

• Epidemiology(????)
• _at_ ?????(???30,??Hashimoto(????), Graves??)
• _at_ ???(???5)
• _at_ ????(??,?????)
• _at_ ????(???)

Harrisons??? 10Th P703 Color Atlas Synopsis
of Clinical Dermatology P315
5
??(Vitiligo)

• Pathogenesis(????)
• ??????????????????????????????
• ?????,???????????????????, ???
• ????,????????
• 1.???(neurogenic hypothesis) ??????,???????
• ????????
• 2.???? ?????????,??????????????
• ?,?????????
• 3.????????????????,??????,?????
• 4.?? ??????,??????????
• ??????Cytototoxic T Cell(????T??)?????????
• ????

Color Atlas Synopsis of Clinical Dermatology
P311 ???????? (http//www.derma.org.tw)
6
??(Vitiligo)

• Physical Examination (????)
• ?????????????????????????,?????
• ????????,????????,???????????,?
• ???????????????
• ??

Harrisons??? 10Th P271
7
??(Vitiligo)

• Physical Examination (????)
• ?
• ???????,????????????,???????????????????????,?
  ? 5mm-5cm ,??????????????????,??????,????????
• ??
• ????????????????????,?????????????????????
  ?????????
• 1.???(Focal Type)
• 2.???(Segmental Type)
• 3.???(Generalized)

Color Atlas Synopsis of Clinical Dermatology
P314
8
??(Vitiligo)

• Diagnosis(??)
• ???
• ???
• ???(??????)
• ????????
• ???????(????????????????
• ????????????)

Color Atlas Synopsis of Clinical Dermatology
P314-316
9
??(Vitiligo)

• Laboratory Examination (?????)
• ??????????,??????,????????
• 1.????????,?????????????
• ?????
• 2.????????????,????
• 3.???????????????????,?
• ?????????????
• 4.?????T4?TSH(RIA) ???(??)????
• (????) ,???Addisons
• Disease???ACTH????

Color Atlas Synopsis of Clinical Dermatology
P314-316
10
??(Vitiligo)

• Course (??)
• ????
• ???????,????????,???????
• ???????
• ?????????????????????,??
• ????,????????,??????
• ???????

Color Atlas Synopsis of Clinical Dermatology
P316-317 ???????? (http//www.derma.org.tw)
11
??(Vitiligo)

• Management(??)?Treatment(??)
• ?????,?????????,?????????,??????
• 1.Sunscreen(???)
• ????????????,????,????
• ?????????,???????(SPF)??15
• ????,???????,?????????
• 2.Cosmetic Coverup
• ??????????????????????
• ???????,???????????,???
• ???

Color Atlas Synopsis of Clinical Dermatology
P318
12
??(Vitiligo)

• Management(??)?Treatment(??)
• ? ????(Repigmentation)
• 3.Topical Corticosteroid(?????)
• _at_???????????,??????????
• ?(????,????)
• _at_??????????,????????
• ???????????,????????????????????????????

Color Atlas Synopsis of Clinical Dermatology
P318
13
??(Vitiligo)

• Management(??)?Treatment(??)
• 4.?????????
• ? ????????psoralen?,???????
• UVA??,??PUVA??
• ? ????????????????????
• ?????,??70(???85)???
• ? ????????,???????,????
• ???
• ? ?????????????,???????
• ????????????

Color Atlas Synopsis of Clinical Dermatology
P318
14
??(Vitiligo)

• Psoralen (????) (??)
• ??????????,?????????,??
• ?????,???????

???? ?? ??? ?? ???
5-methoxy psoralen 5-MOP 1.2mg/kg ? ? ?? ??
8-methoxy psoralen 8-MOP 0.2-0.4mg/kg ? ? ? ?
Color Atlas Synopsis of Clinical Dermatology
15
??(Vitiligo)

• PUVA??
• _at_ ??????????,????????,?
• 85?????,?????
• _at_ ???
• ??-???????????????????
• ?????
• ??-????PUVA??????????
• _at_ ????????????PUVA (?????
• UVB311nm,??????)

Color Atlas Synopsis of Clinical Dermatology
16
??(Vitiligo)

• Management(??)?Treatment(??)
• 5.Bleaching(??)
• ??
• (1).??????
• (2).PUVA?????
• (3).????PUVA?
• (4).??PUVA???
• ????
• Hydroquinone

Color Atlas Synopsis of Clinical Dermatology
17
??(Vitiligo)

• Hydroquinone
• ????
• ??Tyrosinase??,??????????
• ???????
• ???
• 1.???????????????????
• ???????????????
• 2.???????(gt4)???????,??
• ??????????????

?????????????? 35-51
18
??(Vitiligo)

• ????
• 20 Hydroquinone BID
• 2-3????????
• 9-12????????
• ???
• ??90 (?????????)

Color Atlas Synopsis of Clinical Dermatology
19
??(????)(Tinea versicolor)

• ?????
• _at_?????????????,????????
• ????????,???????
• _at_?????????????
• _at_??????????????,???????
• ??????,???????????????
• ?????????,????????????
• ??????????????????????
• ??,??????????

Color Atlas Synopsis of Clinical
Dermatology ???????? (http//www.derma.org.tw)
20
??(????)(Tinea versicolor)

• Epidemiology(????)
• ????????
• ??_at_ P.ovale????? (??P.orbiculare?
• Malassezia furfur),????????,?
• ???????15????????????
• ????
• _at_ ?????,??????????????
• ????????
• ??? ??????40

Color Atlas Synopsis of Clinical
Dermatology ???????? (http//www.derma.org.tw)
21
??(????)(Tinea versicolor)

• Pathogenesis(????)
• ??PV????????????????,?????Dicarboxylic
  acid???????????Tyrosinase
• ,???????

Color Atlas Synopsis of Clinical Dermatology
22
??(????)(Tinea versicolor)

• Physical Examination (????)
• ????
• ??????,????,??????
• ??
• ??????????????????????
• ????

Color Atlas Synopsis of Clinical Dermatology
23
??(????)(Tinea versicolor)

• Laboratory Examination (?????)
• _at_????KOH?????
• ????????,??KOH??,??,???
• ?
• _at_?????
• ?????????

Color Atlas Synopsis of Clinical Dermatology
24
??(????)(Tinea versicolor)

• ??

???? ??
Sslenium Sulfide (2.5)?????? ??????10-15??,????,??????
Propylene glycol 50 ?? ????,????
Ketoconazole ??? ??????10-15??,????,??????
Azole ?? ??1-2?,????
Terbinafine 1?? ????,????
?????
Ketoconazloe ????200 mg,?? 7-14 ?
? 400 mg ??,????????
? 400 mg ??,?????????
Fluconazole 400-600 mg??,????????
Itraconazole ?? 200 mg ????,????
?? 200 mg ????,?? 5-7 ?
Color Atlas Synopsis of Clinical Dermatology
25
??(????)(Tinea versicolor)
26

• ??????

27
???????

• ???1912????????????????,????????????????????,?????
  ????,????????????(????????????????)????,??????????
  ??,?????

Harrisons??? 10Th P703
28
Graves??

• ?????????,??????,?????????,??????,????????????

Harrisons??? 10Th P703
29
??(Vitiligo)

• ??

Color Atlas Synopsis of Clinical Dermatology
P314-316
30
??(Vitiligo)

• ? ? ? ? (Exocytosis)
• ? ? ? ? ? ? ? ? ? ? ? ? ? ? , ? ? ? ? ? ? ? ?
  ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? , ? ? ? ? ? ? ? ? ?
  ? ? ? ? ? ? ? ? ? ? ? ?

REF--http//www2.hkedcity.net/sch_files/a/phc/phc-
ltp/public_html/c_bee.html
31
Psoralen (????)

• ??????????,??
• 1.???????????????????,????????????
• 2.?????????????????????
• 3.?????????????????????????????
• 4.????????????

32
PUVA
Determination of 8-methoxypsoralen in serum,
aqueous, and lens relation to long-wave
ultraviolet phototoxicity in experimental and
clinical photochemotherapy. Trans Am Ophthalmol
Soc. 1979 77 464514
33
?????
Tyrosinase related protein 1 (TRP1) functions as
a DHICA oxidase in melanin biosynthesis EMBO J.
1994 December 15 13(24) 58185825
34
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