- 期刊
Demodex Abscess: Clinical and Therapeutic Challenges
蠕形蟲膿瘍臨床診斷與治療之挑戰
摘要
一位五十二歲男性因筋骨酸痛有長期使用類固醇的病史，他於四年前開始在胸部肚子及背部出現紅色融合性丘疹及膿瘍伴隨皮膚搔癢的症狀。最初診斷為類固醇引發的毛囊炎或是皮屑芽孢菌引發之毛囊炎，經投與口服抗生素四週後病灶無改善，再投與口服itraconazole四週後症狀仍持續。於是我們做了切片檢查，切片檢查顯示毛囊周圍有漿細胞、嗜伊紅白血球、嗜中性白血球等發炎細胞浸潤，並在皮脂腺管腔及腺體內發現皮脂蠕形蟲(Demodex brevis)，膿瘍的KOH鏡檢看到許多皮脂蠕形蟲。皮膚化膿性膿瘍及搔癢的症狀在給予外用benzoyl benzoate與crotamiton治療後依舊持續：再改給與口服一天三次的50mg levamisole HCl連續服用十天後，皮疹與搔癢等症狀獲得明顯改善。本報告提出一傳統治療失敗，並首次以levamisol HCl成功治療的蠕形蟲病。
關鍵字
無資料並列摘要
A 52-year-old man suffered from recurrent erythematous papules, plaques, pustules and abscesses over the anterior chest, abdomen and back with severe pruritus for four years. He was under long term systemic steroid treatment for more than 4 years due to arthralgia. Steroid-induced folliculitis or Pityrosporum folliculitis was impressed at first, but treatment with systemic minocyclin and topical benzoyl peroxide for 4 weeks and systemic itraconazole for another 4 weeks showed no improvement. A skin biopsy of an abscess taken from the back revealed a perifollicular infiltration with plasma cells, neutrophils, eosinophils and some foreign body giant cells. Within the sebaceous duct and gland, there were Demodex mites. KOH examinations of the specimens from abscesses revealed many Demodex brevis mites. The skin lesions were unresponsive to topical antiparasitic treatment (benzoyl benzoate and crotamiton). Therefore oral administration of levamisole HCl 50 mg 3 times a day for 10 days was given and all the skin lesions and pruritus were subsided.