Distance Learning for Family Medicine and Primary Care

การจัดการศึกษาและปรึกษาทางไกล
เพื่อสนับสนุนบริการเวชศาสตร์ครอบครัวและบริการสุขภาพปฐมภูมิ
Distance Learning for Family Medicine and Primary Care

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แนวทางการรักษา - โรคผิวหนัง

แนวทางการรักษาโรคเหาและโลน

ปรับปรุงล่าสุด 17 พฤศจิกายน 2552

โดย นายแพทย์กฤษณะ สุวรรณภูมิ
หน่วยเวชศาสตร์ครอบครัวและชุมชน ภาควิชาเวชศาสตร์ชุมชน
คณะแพทยศาสตร์ มหาวิทยาลัยสงขลานครินทร์

สาเหตุ
เหาและโลนเป็นแมลงไร้ปีกตัวเล็กขนาดประมาณ 1-2 mm อาศัยอยู่กับเส้นผมและขนของมนุษย์ คอยดูดเลือดกินเป็นอาหาร ในน้ำลายมีสารซึ่งระคายเคืองผิวหนังได้ ทำให้เกิดตุ่มคันตรงรอยกัด ตัวเหา (Pediculosis humanus capitis) อาศัยที่เส้นผมบนศีรษะ ลำตัวเรียวยาว มีความคล่องตัวในการเคลื่อนไหว จึงติดต่อกันได้ง่าย ตัวโลน (Phthirus pubis) อาศัยที่เส้นขนบริเวณหัวหน่าว ลำตัวป้อมกลม ติดต่อโดยเพศสัมพันธ์เป็นหลัก

ลักษณะทางคลินิก
เหาพบบ่อยในเด็กวัยเรียน โดยเฉพาะเด็กผู้หญิงในชุมชนแออัด ติดต่อจากคนสู่คนโดยการสัมผัสหรือจากการใช้สิ่งของที่เกี่ยวข้องกับศีรษะร่วมกัน ได้แก่หวี หมวก หมอน เป็นต้น อาการได้แก่ การเกิดตุ่มคันบนศีรษะ ซึ่งหากเป็นมากอาจเกาจนมีน้ำเหลืองไหลและมีการติดเชื้อแทรกซ้อน โลนติดต่อทางเพศสัมพันธ์ จึงมักพบในคนวัยหนุ่มสาว ผู้ป่วยมาด้วยอาการคันที่หัวหน่าวและอวัยวะเพศ ตรวจร่างกายพบรอยโรคเป็นตุ่มแดงคัน ใต้ร่มผ้า และมักจะมีรอยเกาและการติดเชื้อด้วย

การวินิจฉัยแยกโรค
ไข่เหาไม่สามารถเลื่อนไปตามเส้นผมได้ ใช้เป็นข้อแตกต่างในการแยกเหาออกจากรังแค

การวินิจฉัย
อาศัยการพบตัวเหา-โลน หรือไข่ ในเหาอาจพบปลอกหุ้มเส้นผม (hair casts) ซึ่งมีสีขาวรูปทรงกระบอกขนาด 2-7 mm อยู่รอบเส้นผม ห่างจากหนังศีรษะ 2-3 cm ส่องด้วย Wood’s lamp จะเรืองแสงสีน้ำเงินอมเหลือง

การรักษา
วิธีการรักษาแบบชาวบ้านคือการโกนผมหรือขนออกหมด ที่จริงเป็นวิธีที่ได้ผลพอควร เพราะเมื่อตัวเหาหรือโลน ไม่มีที่เกาะยึด โรคก็จะหายไปได้
การรักษาด้วยการทายา 0.3% gamma benzene hexachloride gel (Jacutin) โดยถ้าเป็นเหา ให้สระผมให้สะอาดแล้วทายาทั่วศีรษะ ทิ้งไว้ 12 ชั่วโมงแล้วสระผมซ้ำ ตัวยาจะมีฤทธิ์ฆ่าตัวแก่ จึงจำเป็นต้องรักษาซ้ำอีกครั้งหนึ่งใน 1 สัปดาห์ ซึ่งเป็นเวลาที่ตัวอ่อนฟักออกจากไข่ นอกจากนั้นการใช้หวีตาถี่ๆ สางผมให้ไข่หลุดออกมา จะช่วยให้โรคหายเร็วขึ้น
สำหรับผู้ที่เป็นโลน ให้ทายาบริเวณหัวหน่าว ท้องน้อย ก้น และต้นขา ทิ้งไว้ 12 ชั่วโมงแล้วล้างออก ควรให้ผู้ป่วยมารับการตรวจอีก 1 สัปดาห์ หากยังพบตัวหรือไข่ ควรให้การรักษาซ้ำอีกครั้ง

การป้องกัน
ผู้สัมผัสโรคควรได้รับการตรวจโดยละเอียด ถ้าพบตัวเหา-โลน หรือไข่ ควรให้การรักษาเช่นเดียวกับผู้ป่วย เครื่องใช้ของผู้ป่วยควรน้ำมาล้างทำความสะอาด ส่วนเครื่องนุ่มห่มนั้นควรนำมาซักหรือตากแดดหรือเข้าเครื่องอบผ้าตากปกติก็เป็นการเพียงพอ เพราะตัวแมลงมีชีวิตอยู่นอกร่างกายได้ไม่นาน

เอกสารอ้างอิง

ปรียา กุลละวณิชย์ และประวิตร พิศาลบุตร บรรณาธิการ, Dermatology 2000 ตำราโรคผิวหนังในเวชปฏิบัติปัจจุบัน, กรุงเทพมหานคร: บริษัทโฮลิสติกพับลิชชิ่งจำกัด, 2540.
อภิชาติ ศิวยาธร และกนกวลัย กุลทนันทร์ บรรณาธิการ, โรคผิวหนังที่ต้องรู้สำหรับเวชปฏิบัติทั่วไป, กรุงเทพมหานคร: สำนักพิมพ์หมอชาวบ้าน, 2546.
Klaus Wolff, Richard Allen Johnson and Dick Suurmond, Fitzpatrick’s Color Atlas & Synopsis of Clinical Dermatology (5th edition), New York: McGraw-Hill, 2005.

Comment #1
Posted @August,23 2018 09.41 ip : 209...247

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แสดงความคิดเห็น

กรุณาป้อน Username / Password ที่ท่านได้ลงทะเบียนไว้กับเว็บไซท์แห่งนี้ หรือ สมัครเป็นสมาชิกของเว็บไซท์
Bold Italic Underline Left Center Right Ordered List Bulleted List Horizontal Rule Page break Hyperlink Text Color :) Quote
คำแนะนำ เว็บไซท์นี้สามารถเขียนข้อความในรูปแบบ มาร์คดาวน์ - Markdown Syntax:
  • วิธีการขึ้นบรรทัดใหม่โดยไม่เว้นช่องว่างระหว่างบรรทัด ให้เคาะเว้นวรรค (Space bar) ที่ท้ายบรรทัดจำนวนหนึ่งครั้ง
  • วิธีการขึ้นย่อหน้าใหม่ซึ่งจะมีการเว้นช่องว่างห่างจากบรรทัดด้านบนเล็กน้อย ให้เคาะ Enter จำนวน 2 ครั้ง

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มุมสมาชิก

สมัครสมาชิก · ลืมรหัสผ่าน

แนะนำหนังสือ

The Doctor Communication HandbookThe Doctor Communication Handbook
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