白癬 : 診断と治療ガイドラインへの一つの提案  [in Japanese] Dermatophytosis : A Summary of Dermatomycosis as a Proposal for Future Revision of the Guidelines  [in Japanese]

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Abstract

皮膚真菌症 (白癬) の日本におけるガイドラインが発表されたのに伴い,国内外の4教科書について,白癬の病型と治療を中心にまとめた.日本では,黄癬,渦状癬を除く皮膚糸状菌症を白癬としているが,外国では黄癬,渦状癬を白癬の中に分類している.頭部白癬は,頭部浅在性白癬とケルスス禿瘡を含めて分類し,無症候性キャリアも含める傾向がみられた.生毛部深在性白癬や白癬性肉芽腫は,体部白癬の一亜型に分類する教科書が主である.また顔面白癬を,特異な臨床像を呈することが多く,誤診されやすいことに注目し体部白癬と区別している.爪白癬は爪真菌症の一部として位置付けている.これらの記載を基に,われわれの分類案を示した.<BR>白癬の治療においては,頭部白癬では,イトラコナゾール (ITZ) ,テルビナフィン (TBF) の小児への安全性が確立されていない点が問題である.足白癬では,内服療法併用のための足白癬の重症度基準の作成が必要である.爪白癬では,多くの臨床試験が発表されたが,3教科書は,ほとんどは製薬会社が行ったものであると明記している点が印象的であった.さらに,爪白癬の発症機序,重症度の研究が望まれる.今後のガイドラインの改定において,一つの提案としてまとめた.

In preparing guidelines for dermatomycosis (tinea, trichophytia, dermatophytosis), we have primarily summarized the disease types and treatments as described in 4 textbooks used in Japan and abroad. We present our classification draft based on these following descriptions. In Japan, any dermatophytosis other than favus or tinea imbricata is considered to be tinea, while outside Japan, favus and tinea imbricata are also classified as tinea. Tinea capitis is classified together with trichophytia superficialis capillitii and kerion celsi, in a group that tends to include asymptomatic carriers. Most textbooks generally classify trichophytia profunda of the glabrous skin and granuloma trichophyticum as subtypes of tinea corporis. Tinea faciei can easily be misdiagnosed, but in many cases can be distinguished from tinea corporis by its specific clinical picture. Tinea unguium is regarded as one type of onychomycosis.<BR>We present a summary of dermatomycosis treatment as a proposal for future revision of the guidelines. One of the problems in the treatment of tinea capitis is that the safety of itraconazole (ITZ) and terbinafine hydrochloride (TBF) in children has not been established. Severity criteria for concomitant use of oral medications in the treatment of tinea pedis remains to should be established. Although many clinical studies concerning tinea unguium have been published, 3 of the 4 textbooks we consulted clearly stated that most of those studies were conducted by pharmaceutical companies. Further studies on the etiology and disease severity of tinea unguium are needed.

Journal

  • Nippon Ishinkin Gakkai Zasshi

    Nippon Ishinkin Gakkai Zasshi 50(4), 199-205, 2009-10-30

    The Japanese Society for Medical Mycology

References:  16

Cited by:  2

Codes

  • NII Article ID (NAID)
    10026094513
  • NII NACSIS-CAT ID (NCID)
    AN10166867
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    09164804
  • NDL Article ID
    023254094
  • NDL Call No.
    Z19-348
  • Data Source
    CJP  CJPref  NDL  J-STAGE 
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