Distance Learning for Family Medicine and Primary Care

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Distance Learning for Family Medicine and Primary Care

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แนวทางการรักษา - โรคผิวหนัง

แนวทางการรักษาโรค Seborrheic dermatitis

ปรับปรุงล่าสุด 17 พฤศจิกายน 2552

โดย นายแพทย์กฤษณะ สุวรรณภูมิ
หน่วยเวชศาสตร์ครอบครัวและชุมชน ภาควิชาเวชศาสตร์ชุมชน
คณะแพทยศาสตร์ มหาวิทยาลัยสงขลานครินทร์

สาเหตุ
สาเหตุของโรคยังไม่ทราบทั้งหมด แต่มีความเกี่ยวข้องกับ sebaceous gland activity และ Pityrosporum ovale ซึ่งเป็นเชื้อราที่พบได้ตามปกติในรูขุมขนบริเวณที่มีต่อมไขมันมาก เนื่องจากเชื้อราชนิดนี้เป็นยีสต์ที่ชอบไขมัน (lipophilic yeast) หลังจากเข้าสู่ระยะ puberty ไปแล้ว ก็จะมีการเพิ่มจำนวนของเชื้อราชนิดนี้ขึ้น ซึ่งเป็นปรากฏการณ์ธรรมชาติที่พบในคนทั่วไป อาการของโรคจะเกิดขึ้นต่อเมื่อมีการเพิ่มของเชื้อรามากเกินปกติ และจะดีขึ้นเมื่อเชื้อราลดน้อยลง

ลักษณะทางคลินิก
ผื่นแดงมีสะเก็ดเป็นมัน ขอบชัด บางรายมีอาการอื่นร่วมด้วย ได้แก่สะเก็ดในหู และการอักเสบที่ตาชนิด chronic blepharitis
บริเวณที่เป็น แบ่งเป็น 3 กลุ่มคือ
1) กลุ่มที่เป็นบริเวณหน้า คอ หลังหู ศีรษะ
2) กลุ่มที่เป็นบริเวณหน้าอก
3) กลุ่มที่เป็นบริเวณรักแร้ ขาหนีบ สะดือ ใต้อกและง่ามก้น

การวินิจฉัยแยกโรค
ต้องแยกออกจาก psoriasis โดยเฉพาะในรายที่ได้รับการรักษามาแล้วเหลือเป็นรอยแดง และสะเก็ดบางๆตามตัวและศีรษะ พบว่า seborrheic dermatitis มีความสัมพันธ์กับโรคอื่นเช่น การติดเชื้อ Pityrosporum ovale, malabsorbtion, obesity, CVA และเอดส์

การวินิจฉัย
อาศัยลักษณะทางคลินิก ตำแหน่งและการกระจายของรอยโรค

การรักษา
เช่นเดียวกับการรักษา contact dermatitis

การป้องกัน
ความรุนแรงของ seborrheic dermatitis สามารถลดได้โดยการควบคุมปัจจัยเสี่ยง ได้แก่ ความเครียด ความอ่อนล้า การเปลี่ยนแปลงของอากาศ การปล่อยให้ผิวมัน การใช้แชมพูหรือโฟมล้างหน้าบ่อย การใช้โลชั่นที่มีส่วนผสมของแอลกอฮอล์ การมีสิว และภาวะอ้วน

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.

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รบกวน สอบถามหน่อยครับ พอดีเป็นโรคนี้อยู่
ไปพบหมอทางด้านผิวหนังมา หมอสั่งห้าม รับประทาน อาหารทะเลทุกชนิด ของหมักดอง เหล้าเบียร์ ทานได้ เพียง เนื้อหมูกับผัก อยากถามว่า มีอย่างอื่นที่ทานได้อีกป่าวครับบ

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