tag:blogger.com,1999:blog-53848773199695850992024-03-22T00:22:30.762-07:00鄭煜彬的皮膚科學研究室皮膚科醫師鄭煜彬在這裡為大家解說個人在皮膚學的心得,思考如何讓台灣醫療變得更好。
原址:天空部落-豐饒之海。鄭煜彬(Yu-Pin Cheng)http://www.blogger.com/profile/07019803125903571476noreply@blogger.comBlogger152125tag:blogger.com,1999:blog-5384877319969585099.post-73929554406027617842023-04-16T10:00:00.030-07:002023-04-16T10:12:26.958-07:00單純凹疤的處理:皮下切割術(subcision)<h1 style="text-align: left;"><span style="font-size: x-large;">單純因為皮下疤痕組織拉扯造成表面凹陷的疤痕,使用皮下切割術切開疤痕後,可明顯改善凹陷狀況。</span></h1><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYSF64HkAvEjcIZEDWTpFU4DP4ZP2pfhRReu5a3wW08aI2KloEdeTt5xdMZqHytx_0oQYIyXg0FoxdcRLqA0T6XHVgfejNLrzZBzBgXLZQgyGCwiiv6sSJg-zchMZHKngNAhWiji5gJ3B1XlTU894qY0Dubhuibl1FcLZH1aQ7Q6E2H6PvU5bl036Wug/s960/P169%20(6).jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="540" data-original-width="960" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYSF64HkAvEjcIZEDWTpFU4DP4ZP2pfhRReu5a3wW08aI2KloEdeTt5xdMZqHytx_0oQYIyXg0FoxdcRLqA0T6XHVgfejNLrzZBzBgXLZQgyGCwiiv6sSJg-zchMZHKngNAhWiji5gJ3B1XlTU894qY0Dubhuibl1FcLZH1aQ7Q6E2H6PvU5bl036Wug/w640-h360/P169%20(6).jpg" width="640" /></a></div><br /><span style="font-size: large;"><br /></span><p></p><p><span style="font-size: large;">外傷或是青春痘導致的凹疤一直都是很難處理的問題。輕微的凹疤或許經過雷射會稍稍改變,但是稍深的凹疤治療之後往往還是很明顯。</span></p><p><span style="font-size: large;">所幸,還是有些治療可提供更明顯的改善。包括<b>皮下切割術</b>與<b>真皮/玻尿酸/膠原蛋白</b>填充。這些治療雖然較具侵入性,但造成的外傷與修復期都不明顯。</span></p><p><span style="font-size: large;">今天要介紹的是皮下切割術(subcision)。這是一種純外科手術,不需要其他外來填充物或藥品,這對所有外科醫師都有很大的吸引力!身為一名皮膚外科醫師,只要能用外科手術方式解決,盡量省下任何耗材與藥材的花費,我們一定會優先選用!</span></p><p><span style="font-size: large;">皮下切割術的原理說來不難,就是從一個微小的表皮傷口深入疤痕下方,將這些拉扯表皮導致凹陷的疤痕組織切斷。上方的表皮少了這個拉力之後就會稍微回彈,使凹陷程度大為減少。(圖1)</span></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjk-zLaQ_GOy9NzeQEZQc6qYmv35YthJWQhEHt_AnRAONNwXiuWUqvrZe8sAOEWJPFYR1k-vdUC3nqJk-xa3ZMdN-ITyeHR49NpSz6Ux18rU0Djv89VBFylGYbF7jy7Umfk2uJX0HBlU_HWKxsF1bL-8_YiQy7AcxrZoYoILBnfW1YPqKsvjadvzrraJw/s960/P169%20(2).jpg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="540" data-original-width="960" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjk-zLaQ_GOy9NzeQEZQc6qYmv35YthJWQhEHt_AnRAONNwXiuWUqvrZe8sAOEWJPFYR1k-vdUC3nqJk-xa3ZMdN-ITyeHR49NpSz6Ux18rU0Djv89VBFylGYbF7jy7Umfk2uJX0HBlU_HWKxsF1bL-8_YiQy7AcxrZoYoILBnfW1YPqKsvjadvzrraJw/w640-h360/P169%20(2).jpg" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: left;"><span style="font-size: large;">圖1:皮下切割術原理的簡易說明。</span></td></tr></tbody></table><p><br /></p><p><span style="font-size: large;">這個手法聽起來很簡單,但實際操刀還是很靠自身經驗。各醫師的手法也是大相逕庭,各擅勝場。筆者的作法當然也很有個人特色,不好言述,但<b>每次造成的傷口頂多0.1公分(1mm)左右</b>。雖然<b>剛做完會有點出血,但目前還很少有人瘀血,修復期更不曾超過一週</b>。</span></p><p><span style="font-size: large;">下列案例是典型的皮下切割術前後對照(圖2),這位病人小時候因為外傷導致額頭出現一個邊緣雖然平緩下降但很明顯的凹疤,已經存在至少三十多年。有次打完淨膚雷射後,問筆者對此凹疤有無更好解法。筆者考量當天已經很晚,建議她試作皮下切割術。</span></p><p><span style="font-size: large;">兩週之後回診,額頭的凹疤已經相當不明顯。老實說,由於兩週後傷口與凹疤都已經看不出來,筆者已經不太確定原本治療的位置了。(圖2)</span></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhoEU0iy4lvlBLwbyXgu1RNVuOIW-D9I-89NxsVja0heQfqpjz-OdN6I_aeBa6Ce7NbIbSQ0a-TPSfmCtmE_WFypcaFt6WNIdHgUM_g6eDr2vpVekSoRhHRW9b04o4B5XIXvHyz-LWfWpKVw2mWXWOD-ay3zEpqporNvI-c27v6FLW89dIqYuTLrIStKw/s960/P169%20(6).jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="540" data-original-width="960" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhoEU0iy4lvlBLwbyXgu1RNVuOIW-D9I-89NxsVja0heQfqpjz-OdN6I_aeBa6Ce7NbIbSQ0a-TPSfmCtmE_WFypcaFt6WNIdHgUM_g6eDr2vpVekSoRhHRW9b04o4B5XIXvHyz-LWfWpKVw2mWXWOD-ay3zEpqporNvI-c27v6FLW89dIqYuTLrIStKw/w640-h360/P169%20(6).jpg" width="640" /></a></td></tr><tr><td class="tr-caption"><span style="font-size: large;">圖2:單純外傷造成的凹疤,接受皮下切割術兩週之後,已經很難看出原本存在的痕跡。(原圖貼上未修圖)</span></td></tr></tbody></table><br /><div><br /></div><span style="font-size: large;">皮下切割術對於上述邊緣平緩的凹疤效果不差,但對於<b>邊緣陡峭的小凹疤</b>就不太合適(圖3),例如一般俗稱冰鑿型的痘疤,或是很像橘子皮這種皮膚。因為要把皮下切割的範圍控制在這類小凹疤下面本身就很困難。這類病人最好合併磨皮、皮秒等雷射治療先讓邊緣變平緩,再進行皮下切割術;或是改用其他手術治療,效果會比較理想。<br /></span><div><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgOvX_Z44wen99RZDuijYvroD8YiKsmodSpcfAC0yY3AUFRqvjq_D7xQ1QNJccQuj2Eb_Kn6ODMzQNEd9ULp_LL0Y0lsrjemBmVeh2qH3u6LzOhgN_pcaN6gVZHVztyu4MtMbkX65r_bgIWAzlPW5Yr76PekpBD3gxt-jVqRzUKmuD2-ML-dCDe_WeUQQ/s960/P169%20(4).jpg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="540" data-original-width="960" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgOvX_Z44wen99RZDuijYvroD8YiKsmodSpcfAC0yY3AUFRqvjq_D7xQ1QNJccQuj2Eb_Kn6ODMzQNEd9ULp_LL0Y0lsrjemBmVeh2qH3u6LzOhgN_pcaN6gVZHVztyu4MtMbkX65r_bgIWAzlPW5Yr76PekpBD3gxt-jVqRzUKmuD2-ML-dCDe_WeUQQ/w640-h360/P169%20(4).jpg" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: left;"><span style="font-size: large;">圖3:邊緣陡峭的小凹疤未經進一步處理並不適合皮下切割術。</span></td></tr></tbody></table><p><br /></p>
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</div></div><div class="separator" style="clear: both; text-align: center;"><br /></div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div><br />鄭煜彬(Yu-Pin Cheng)http://www.blogger.com/profile/07019803125903571476noreply@blogger.com0tag:blogger.com,1999:blog-5384877319969585099.post-60285655466306919082022-09-14T07:34:00.001-07:002022-09-21T09:18:30.125-07:00猴痘(monkeypox)對皮膚的影響與預防、治療的方法<h1 style="text-align: left;"><span style="font-size: x-large;">猴痘是接觸或飛沫傳染的疾病,會在身上產生大水泡與嚴重凹疤。目前<span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">有</span><b>ACAM200</b><span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">與</span><b>JYNNEOS</b>兩種疫苗可供預防,亦有<b><span face=""Arial",sans-serif" lang="EN-US" style="background: white; color: #333333;">tecovirimat</span></b><span face=""新細明體",serif" style="background: white; color: #333333; mso-ascii-font-family: Arial; mso-bidi-font-family: Arial; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Arial;">、</span><b><span face=""Arial",sans-serif" lang="EN-US" style="background: white; color: #333333;">cidofovir</span></b><span face=""新細明體",serif" style="background: white; color: #333333; mso-ascii-font-family: Arial; mso-bidi-font-family: Arial; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Arial;">、</span><b><span face=""Arial",sans-serif" lang="EN-US" style="background: white; color: #333333;">brincidofovir</span></b></span><span face=""新細明體",serif" style="background: white; color: #333333; mso-ascii-font-family: Arial; mso-bidi-font-family: Arial; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Arial;"><span style="font-size: x-large;">、與<b>天花病毒免疫球蛋白</b>等藥物治療。凹疤則可以使用皮膚外科的手術與雷射來改善</span>。</span></h1><p class="MsoNormal"><span face=""新細明體",serif" style="font-size: large; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">最近歐美各國陸續出現猴痘案例。過去猴痘多半是到中、西非旅遊,或在實驗室中與<b>猿猴的體液、血液、傷口、或黏膜接觸</b>才會感染,醫護人員或同住家人則可能受到病人的飛沫感染。但最近這波疫情與<b>人際接觸</b>有關,可能是親密的<b>性行為</b>所致。</span></p>
<h1 style="text-align: left;"><b style="mso-bidi-font-weight: normal;"><span face=""新細明體",serif" style="font-size: x-large; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">猴痘的症狀與對皮膚的影響</span></b></h1>
<p class="MsoNormal"><span style="font-size: large;"><span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">接觸猴痘病源經過</span><span lang="EN-US">5-21</span><span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">天潛伏期後,會出現發燒</span><span lang="EN-US">/</span><span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">倦怠、畏寒</span><span lang="EN-US">/</span><span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">寒顫、頭痛</span><span lang="EN-US">/</span><span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">肌肉痛</span><span lang="EN-US">/</span><span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">背痛、淋巴結腫大,隨即黏膜會先發疹,</span><span lang="EN-US">1-3</span><span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">天後會出現水泡或膿泡狀皮疹。這些皮疹會先出現在臉上,接著擴散到四肢,也可能出現手腳掌與生殖器的皮疹,最後才有少數病灶擴散到軀幹,往往伴隨疼痛。數量可以從幾顆到幾千顆不等。</span></span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgcWR75E3cwcpEYnYuBQr7OaVeGyvNhqjABzwOM9yFzUp8EEbWGbs9HEaJ9jIy92BaSsw-0jf4t_w454p32TweWhwASuvJf-WZCmbH7FkvpBfN0tT9vmC5Z-D6kPbqa_dCvj9D8TruO3NJ9CPkVOCIuIrQ0jREFvhN1MmQTEh0OFr_X7Bhm7w1VNCW2lQ/s700/12761_lores.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="459" data-original-width="700" height="420" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgcWR75E3cwcpEYnYuBQr7OaVeGyvNhqjABzwOM9yFzUp8EEbWGbs9HEaJ9jIy92BaSsw-0jf4t_w454p32TweWhwASuvJf-WZCmbH7FkvpBfN0tT9vmC5Z-D6kPbqa_dCvj9D8TruO3NJ9CPkVOCIuIrQ0jREFvhN1MmQTEh0OFr_X7Bhm7w1VNCW2lQ/w640-h420/12761_lores.jpg" width="640" /></a></div><div class="separator" style="clear: both; text-align: center;"><span style="font-size: medium;">猴痘導致的大水泡</span></div><div class="separator" style="clear: both; text-align: center;"><span style="font-size: x-small;"><span face=""Segoe UI",sans-serif" lang="EN-US" style="background: white; color: #212529; text-align: left;">CDC/ Brian W.J. Mahy, BSc, MA, PhD, ScD, DSc</span><span face=""新細明體",serif" style="background: white; color: #212529; mso-ascii-font-family: "Segoe UI"; mso-bidi-font-family: "Segoe UI"; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: "Segoe UI"; text-align: left;">提供,</span><span lang="EN-US" style="text-align: left;"><a href="https://phil.cdc.gov/Details.aspx?pid=12761">https://phil.cdc.gov/Details.aspx?pid=12761</a> (</span><span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; text-align: left;">無版權使用限制,並已註明提供者</span><span lang="EN-US" style="text-align: left;">)</span></span></div>
<p class="MsoNormal"><span style="font-size: large;"><span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">常見的水痘與手足口病可能與猴痘混淆</span><span lang="EN-US">(如附</span><span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">表</span><span lang="EN-US">)</span><span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">,但猴痘的水泡很大,對皮膚的破壞比前兩者更嚴重,往往會形成不小的凹疤。</span></span></p><p class="MsoNormal"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh3kUtNKDgHFgV-RqTylwllk4Tq0kvIqZmPtb5eljA-O3N-Bu0_PHih1LlEmnmlgNep1YvOpwmgOTBcevyRHGxzkwcbZjJ4h1JIUHTRupikUppYPcct-7kmzLEYo4-TyyGLZdUxPElsVlwK3On2ygPTlexqH_jG_gq5B8b7g3w49LGMXHSkt6Qe2HClpQ/s1061/12777_lores.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1061" data-original-width="700" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh3kUtNKDgHFgV-RqTylwllk4Tq0kvIqZmPtb5eljA-O3N-Bu0_PHih1LlEmnmlgNep1YvOpwmgOTBcevyRHGxzkwcbZjJ4h1JIUHTRupikUppYPcct-7kmzLEYo4-TyyGLZdUxPElsVlwK3On2ygPTlexqH_jG_gq5B8b7g3w49LGMXHSkt6Qe2HClpQ/w422-h640/12777_lores.jpg" width="422" /></a></div><div class="separator" style="clear: both; text-align: center;"><span style="font-size: medium;">猴痘導致的巨大凹疤</span></div><div class="separator" style="clear: both; text-align: center;"><span style="font-size: x-small;"><span face=""Segoe UI",sans-serif" lang="EN-US" style="background: white; color: #212529; text-align: left;">CDC/ Brian W.J. Mahy, BSc, MA, PhD, ScD, DSc</span><span face=""新細明體",serif" style="background: white; color: #212529; mso-ascii-font-family: "Segoe UI"; mso-bidi-font-family: "Segoe UI"; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: "Segoe UI"; text-align: left;">提供</span><span face=""新細明體",serif" style="background: white; mso-ascii-font-family: "Segoe UI"; mso-bidi-font-family: "Segoe UI"; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: "Segoe UI"; text-align: left;">,</span><span lang="EN-US" style="text-align: left;"><a href="https://phil.cdc.gov/Details.aspx?pid=12777">https://phil.cdc.gov/Details.aspx?pid=12777</a>
(</span><span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; text-align: left;">無版權使用限制,並已註明提供者</span><span lang="EN-US" style="text-align: left;">)</span></span></div><p></p><p class="MsoNormal"><span lang="EN-US"> </span></p><div class="separator" style="clear: both; text-align: center;"><span lang="EN-US"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjGsKTNS5nLxjf1udv8O078lCe1PEL-pJxdv4leLnJ86JxCqJKPyYahPfOooNxpKKapiJVp_SJ4btPOYZ8YmkhKTw2vGQJjHsJw7tiZ_gWpnUuems5mEbq8rcZ0yrEJOyZZsjsit5ewvtfOIqN245x_R4FxLj58u6mgzsI1zkOnfsw6pe5pZrxy5FgFQA/s960/P43.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="960" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjGsKTNS5nLxjf1udv8O078lCe1PEL-pJxdv4leLnJ86JxCqJKPyYahPfOooNxpKKapiJVp_SJ4btPOYZ8YmkhKTw2vGQJjHsJw7tiZ_gWpnUuems5mEbq8rcZ0yrEJOyZZsjsit5ewvtfOIqN245x_R4FxLj58u6mgzsI1zkOnfsw6pe5pZrxy5FgFQA/w640-h480/P43.jpg" width="640" /></a></span></div><div class="separator" style="clear: both; text-align: center;"><span lang="EN-US"><span style="font-size: medium;">猴痘與水痘、手足口病的鑑別診斷(筆者整理)</span></span></div><p></p><h1 style="text-align: left;"><b><span face=""新細明體",serif" style="font-size: x-large; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">猴痘的預防與治療</span></b></h1><p class="MsoNormal"><span style="font-size: large;"><span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">猴痘在潛伏期並無傳染力,但從發燒後到水泡</span><span face=""新細明體",serif" style="background: white; color: #333333; mso-ascii-font-family: Arial; mso-bidi-font-family: Arial; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Arial;">結痂脫落</span><span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">前都有傳染力。此時應避免接觸病人,並至少配戴<b>醫用口罩</b>。目前則有</span><b><span lang="EN-US">ACAM200</span></b><span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">與</span><b><span lang="EN-US">JYNNEOS</span></b><span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">兩種天花疫苗可預防猴痘,也可以用於接觸患者後</span><span lang="EN-US">96</span><span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">小時內的預防。</span><span lang="EN-US"><o:p></o:p></span></span></p><p class="MsoNormal"><span style="font-size: large;"><span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">猴痘在不治療的狀態下,二到四會週後自然痊癒,但仍有</span><span lang="EN-US">1-10%</span><span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">的致死率。因此對於小於八歲、懷孕或哺乳的女性、以及免疫低下者可使用</span><b><span face=""Arial",sans-serif" lang="EN-US" style="background: white; color: #333333;">tecovirimat</span></b><span face=""新細明體",serif" style="background: white; color: #333333; mso-ascii-font-family: Arial; mso-bidi-font-family: Arial; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Arial;">、</span><b><span face=""Arial",sans-serif" lang="EN-US" style="background: white; color: #333333;">cidofovir</span></b><span face=""新細明體",serif" style="background: white; color: #333333; mso-ascii-font-family: Arial; mso-bidi-font-family: Arial; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Arial;">、</span><b><span face=""Arial",sans-serif" lang="EN-US" style="background: white; color: #333333;">brincidofovir</span></b><span face=""新細明體",serif" style="background: white; color: #333333; mso-ascii-font-family: Arial; mso-bidi-font-family: Arial; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Arial;">、與<b>天花病毒免疫球蛋白</b>等藥物治療。</span><span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">然而目前台灣案例甚少,暫無儲備上述疫苗與藥物,也要等待主管機關緊急授權。</span><span lang="EN-US"><o:p></o:p></span></span></p><p class="MsoNormal">
</p><p class="MsoNormal"><span face=""新細明體",serif" style="font-size: large; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">猴痘痊癒後留下的凹疤往往會造成美觀上的困擾。因此如果不幸得到猴痘,要小心避免搔抓,必要時塗抹抗生素藥膏避免進一步受到細菌感染,以減少凹疤形成。如果只有少數幾個凹疤,可以考慮<b>手術切除凹疤</b>並縫合。不願意切除或是凹疤太多的病友可以考慮接受<b>疤痕填補手術</b>,用微創方式將凹疤下攣縮的疤痕組織切開後,以<b>人工填充物</b>或是<b>自體真皮組織</b>填補,並搭配<b>微針滾輪</b>、<b>雷射</b>降低表面的色素與高低差異。</span><span lang="EN-US"><o:p></o:p></span></p><p class="MsoNormal"><span face=""新細明體",serif" style="font-size: large; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><b>*本文之已於2022/07/05刊登於自由時報</b></span></p><p class="MsoNormal"></p><h1 style="text-align: left;"><span face=""新細明體",serif" style="font-size: medium; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">參考資料</span></h1>
<p class="MsoListParagraph" style="margin-left: 18pt; mso-list: l0 level1 lfo1; mso-para-margin-left: 0gd; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US"><a href="https://www.who.int/news-room/questions-and-answers/item/monkeypox?gclid=Cj0KCQjw8O-VBhCpARIsACMvVLNNuk4Mmv1PJVweAx_VHcmN5DG5_tGxmhG3GZDbi98UW598bIs9uGwaAmnoEALw_wcB">https://www.who.int/news-room/questions-and-answers/item/monkeypox?gclid=Cj0KCQjw8O-VBhCpARIsACMvVLNNuk4Mmv1PJVweAx_VHcmN5DG5_tGxmhG3GZDbi98UW598bIs9uGwaAmnoEALw_wcB</a><span style="mso-spacerun: yes;"> </span></span><span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">世界衛生組織網頁</span><span lang="EN-US"><o:p></o:p></span></p>
<p class="MsoListParagraph" style="margin-left: 18pt; mso-list: l0 level1 lfo1; mso-para-margin-left: 0gd; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US"><a href="https://www.cdc.gov.tw/Category/QAPage/sLiifBkhrsiwCL3ilaUlcg">https://www.cdc.gov.tw/Category/QAPage/sLiifBkhrsiwCL3ilaUlcg</a>
</span><span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">台灣疾管署網頁</span><span lang="EN-US"><o:p></o:p></span></p>
<p class="MsoListParagraph" style="margin-left: 18pt; mso-list: l0 level1 lfo1; mso-para-margin-left: 0gd; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">3.<span style="font: 7pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US"><a href="https://phil.cdc.gov/Details.aspx?pid=12761">https://phil.cdc.gov/Details.aspx?pid=12761</a><o:p></o:p></span></p>
<p class="MsoListParagraph" style="margin-left: 18pt; mso-list: l0 level1 lfo1; mso-para-margin-left: 0gd; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">4.<span style="font: 7pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US"><a href="https://phil.cdc.gov/Details.aspx?pid=12777">https://phil.cdc.gov/Details.aspx?pid=12777</a>
</span><span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">美國疾管局圖庫</span><span lang="EN-US"><o:p></o:p></span></p>
<p class="MsoListParagraph" style="margin-left: 18pt; mso-list: l0 level1 lfo1; mso-pagination: widow-orphan; mso-para-margin-left: 0gd; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">5.<span style="font: 7pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US"><a href="https://pubmed.ncbi.nlm.nih.gov/35753551/"><span face=""Segoe UI",sans-serif" style="background: white; color: #0071bc;">Current Outbreak of <b>Monkeypox</b>-
Essentials for the Dermatologist.</span></a><o:p></o:p></span></p>
<p class="MsoListParagraph" style="background: white; margin-left: 18pt; mso-para-margin-left: 0gd;"><span class="docsum-authors"><span face=""Segoe UI",sans-serif" lang="EN-US" style="color: #212121;">Khanna U, Bishnoi A, Vinay K.</span></span><span class="docsum-journal-citation"><span face=""Segoe UI",sans-serif" lang="EN-US" style="color: #4d8055;">J Am Acad Dermatol. 2022 Jun 23:S0190-9622(22)02218-6. doi: 10.1016/j.jaad.2022.06.1170.
Online</span></span><span face=""Segoe UI",sans-serif" lang="EN-US" style="color: #4d8055;"><o:p></o:p></span></p>
<p class="MsoListParagraph" style="margin-left: 18pt; mso-list: l0 level1 lfo1; mso-pagination: widow-orphan; mso-para-margin-left: 0gd; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">6.<span style="font: 7pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US"><a href="https://pubmed.ncbi.nlm.nih.gov/30981594/"><b><span face=""Segoe UI",sans-serif" style="background: white; color: #205493;">Human</span></b><span face=""Segoe UI",sans-serif" style="background: white; color: #205493;"> <b>Monkeypox</b>: <b>Epidemiologic</b> and <b>Clinical</b> <b>Characteristics</b>, <b>Diagnosis</b>,
and <b>Prevention</b>.</span></a></span><span class="docsum-authors"><span face=""Segoe UI",sans-serif" lang="EN-US" style="color: #212121;">Petersen E,
Kantele A, Koopmans M, Asogun D, Yinka-Ogunleye A, Ihekweazu C, Zumla A.</span></span><span class="docsum-journal-citation"><span face=""Segoe UI",sans-serif" lang="EN-US" style="color: #4d8055;">Infect Dis Clin North Am. 2019 Dec;33(4):1027-1043. doi:
10.1016/j.idc.2019.03.001. Epub 2019 Apr 11.</span></span><span lang="EN-US"><o:p></o:p></span></p><span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"></span><p></p>鄭煜彬(Yu-Pin Cheng)http://www.blogger.com/profile/07019803125903571476noreply@blogger.com0tag:blogger.com,1999:blog-5384877319969585099.post-85577334888663124942022-09-11T17:39:00.001-07:002022-09-11T17:39:28.925-07:00武漢肺炎(COVID19)口服藥與皮膚科用藥的交互作用<h1 style="text-align: left;"><span style="font-size: x-large;">目前台灣可以使用的武漢肺炎(COVID19)口服藥包括Paxlovid(Nirmatrelvir/ritonavir)與Molnupiravir兩種,其中Paxlovid對於皮膚科的某些用藥有交互作用,需改用其他武肺用藥、暫停皮膚科用藥、調整</span>皮膚科用藥劑量、或是監控副作用。</h1><br /><h1 style="text-align: left;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiuhajH5Y9SQZ42I93jSdo7-V3jYHekz-Fm_hvtbOKauHwnhetzBAJu-Fh9lupKanNxW_2pEkHDYoPwwIwt1nLY-2uIjnzyvtZQqN61inJaFOsAP2Z5KyW-EOamVeEKyYrh8J-R6r4VtJxOtXqLxTjJ3L2uFcPpW9E36KxX2g6d3MrGg3Wf6MGP4kMLrg/s960/P169.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="540" data-original-width="960" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiuhajH5Y9SQZ42I93jSdo7-V3jYHekz-Fm_hvtbOKauHwnhetzBAJu-Fh9lupKanNxW_2pEkHDYoPwwIwt1nLY-2uIjnzyvtZQqN61inJaFOsAP2Z5KyW-EOamVeEKyYrh8J-R6r4VtJxOtXqLxTjJ3L2uFcPpW9E36KxX2g6d3MrGg3Wf6MGP4kMLrg/w640-h360/P169.jpg" width="640" /></a></div><span style="font-size: x-large;">Paxlovid(Nirmatrelvir/ritonavir)的藥品交互作用</span></h1><span style="font-size: large;">Paxlovid(Nirmatrelvir/ritonavir)有大量的交互作用。主要是因為其代謝酵素CYP3A4也會受到許多藥物影響。如果兩星期內使用過增強CYP3A4活性的藥品,會讓Paxlovid的濃度下降,影響對武漢肺炎(COVID19)的治療。</span><span style="font-size: large;">另外<b>中秋節吃的柚子</b>則會抑制CYP3A4活性,導致Paxlovid濃度增加,可能出現<b>食慾不振、皮膚和眼白發黃/黃疸、尿液顏色變深、糞便顏色變淺、皮膚癢及腹痛</b>等<b>肝臟</b>相關副作用。</span><div><br /><br /><h2 style="text-align: left;"><b><span style="font-size: large;">不應開立Paxlovid,應改用其他武肺藥物(如果兩周內用過這些藥,務必告訴開藥醫師)</span></b></h2><span style="font-size: large;"><ul style="text-align: left;"><li><span style="font-size: large;"><b>Rifampin</b>: 用於反覆發作的毛囊炎(recurrent boil)、化膿性汗腺炎(hidradenitis suppurativa)、禿髮性毛囊炎(folliculitis decalvans)、結核(tuberculosis)、痲瘋病(leprosy)</span></li><li><span style="font-size: large;"><b>Pimozide</b>: 用於皮膚科的某些特殊疾病</span></li></ul></span><div><div><h2 style="text-align: left;"><span style="font-size: large;">須暫時停皮膚科用藥,直到停止Paxlovid至少兩三天後,老年人要停更久。</span></h2><span style="font-size: large;"><ul style="text-align: left;"><li><span style="font-size: large;"><b>Rivaroxaban</b>: 用於網狀青斑血管病變(livedoid vasculopathy)等凝血疾病</span></li><li><span style="font-size: large;"><b>Erythromycin</b>: 用於青春痘/面皰(acne)與某些皮膚感染病</span></li><li><span style="font-size: large;"><b>Tacrolimus</b>: 用於圓禿(alopecia areata)</span></li><li><span style="font-size: large;"><b>Sirolimus/Everolimus</b>: 用於結節性硬化症(tuberous sclerosus comples)</span></li><li><span style="font-size: large;"><b>Colchicine</b>: 用於部分血管炎(vasculitis)、發炎性疾病</span></li></ul></span><h2 style="text-align: left;"><span style="font-size: large;">不須停皮膚科用藥,但要調整劑量</span></h2></div><div><span style="font-size: large;">劑量調整可參考<a href="https://www.covid19-druginteractions.org/checker">利物浦大學的藥品交互作用網頁</a>或<a href="https://covid19-sciencetable.ca/sciencebrief/nirmatrelvir-ritonavir-paxlovid-what-prescribers-and-pharmacists-need-to-know-3-0/">安大略省COVID-19科學諮詢表</a>。<br /><ul style="text-align: left;"><li><span style="font-size: large;"><b>Apixaban/Dabigatran/Edoxaban</b>: 用於網狀青斑血管病變(livedoid vasculopathy)等凝血疾病</span></li><li><span style="font-size: large;"><b>Clarithromycin</b>: 用於某些皮膚細菌性感染病</span></li><li><span style="font-size: large;"><b>Itraconazole</b>: 用於足癬(tinea pedis)、甲癬(tinea unguium)、汗斑(pityriasis versicolor)、皮屑芽孢菌毛囊炎(pityrosporum folliculitis)、或其他深層黴菌感染</span></li><li><span style="font-size: large;"><b>Cyclosporine</b>: 用於乾癬(psoriasis)、異位性皮膚炎(atopic dermatitis)、慢性濕疹(chronic eczema)、以及許多皮膚免疫疾病</span></li><li><span style="font-size: large;"><b>Oxycodone</b>: 用於帶狀皰疹後神經痛(post-herpetic neuralgia)</span></li></ul></span><h2 style="text-align: left;"><span style="font-size: large;">不須停皮膚科用藥或調整劑量,但要注意副作用</span></h2><span style="font-size: large;"><ul style="text-align: left;"><li><span style="font-size: large;"><b>Warfarin</b>: 用於網狀青斑血管病變(livedoid vasculopathy)等凝血疾病,要注意是否<b>容易瘀血、出血</b>。</span></li><li><span style="font-size: large;"><span style="font-size: large;"><b>Mirtazapine</b>: 用於某些搔癢疾病,要注意<b>食慾體重增加、頭痛、疲倦、血清素症候群(</b></span><b>顫抖、意識混亂、肌肉僵硬、體溫升高)</b></span></li><li><span style="font-size: large;"><span style="font-size: large;"><b>Risperidone</b>: 用於皮膚科的某些特殊疾病,要注意</span><span style="font-size: large;"><b>食慾體重增加、頭痛、疲倦、</b></span><b>顫抖</b></span></li><li><span style="font-size: large;"><span style="font-size: large;"><b>Hydroxyzine</b>: 用來治療蕁麻疹或其他搔癢疾病,要注意<b>暈眩、頭痛、疲倦、口乾、便祕</b></span></span></li></ul></span></div><div><br /><span style="font-size: large;"><b>其他皮膚科的藥物大致上都不用停藥</b>。如果還是不確定,可以用<a href="https://www.covid19-druginteractions.org/checker">利物浦大學的藥品交互作用網頁</a>再次確認。</span><h1 style="text-align: left;"><span style="font-size: x-large;">Molnupiravir的藥品交互作用</span></h1><p><span style="font-size: large;">Molnupiravir基本上沒有特別跟其他藥物有交互作用,如果上述皮膚科藥物真的無法停用,就可以改用molnupiravir來治療。</span></p><p><br /></p><h2 style="text-align: left;"><span style="font-size: medium;">參考資料</span></h2><p>1. <a href="https://www.cdc.gov.tw/Category/MPage/7UrQaVdMWdvd2J_l1wyehA">https://www.cdc.gov.tw/Category/MPage/7UrQaVdMWdvd2J_l1wyehA</a> 疾管署網頁</p><p><a href="https://www.cdc.gov.tw/Uploads/files/0c2e6158-caef-4b7c-b909-8dd0cca4e430.pdf ">https://www.cdc.gov.tw/Uploads/files/0c2e6158-caef-4b7c-b909-8dd0cca4e430.pdf </a>疾管署Paxlovid副作用</p><p>2. <a href="https://www.covid19treatmentguidelines.nih.gov/therapies/antiviral-therapy/ritonavir-boosted-nirmatrelvir--paxlovid-/paxlovid-drug-drug-interactions/">https://www.covid19treatmentguidelines.nih.gov/therapies/antiviral-therapy/ritonavir-boosted-nirmatrelvir--paxlovid-/paxlovid-drug-drug-interactions/</a> Paxlovid藥物交互作用</p><p>3. <a href="https://dermnetnz.org/topics/rifampicin">https://dermnetnz.org/topics/rifampicin</a> Rifampicin/rifampin用途</p><p>4. <a href="https://www.covid19-druginteractions.org/checker">https://www.covid19-druginteractions.org/checker</a> 利物浦大學藥品交互作用網頁</p><p>5. <a href="https://covid19-sciencetable.ca/sciencebrief/nirmatrelvir-ritonavir-paxlovid-what-prescribers-and-pharmacists-need-to-know-3-0/">https://covid19-sciencetable.ca/sciencebrief/nirmatrelvir-ritonavir-paxlovid-what-prescribers-and-pharmacists-need-to-know-3-0/ </a> 安大略省COVID-19科學諮詢表</p><p>6. <a href="https://www.chimei.org.tw/main/cmh_department/59012/info/5500/A5500399.html">https://www.chimei.org.tw/main/cmh_department/59012/info/5500/A5500399.html</a> 奇美醫院mirtazapinea副作用</p><p>7. <a href="https://www.chimei.org.tw/main/cmh_department/59012/info/5500/A5500580.html">https://www.chimei.org.tw/main/cmh_department/59012/info/5500/A5500580.html</a> 奇美醫院risperidone副作用</p><p>8. <a href="https://www.tmuh.org.tw/UploadFile/files/%E8%97%A5%E5%8A%91%E9%83%A8/%E7%94%A8%E8%97%A5%E8%AB%AE%E8%A9%A2%E4%B8%AD%E5%BF%83-%E8%A1%9B%E6%95%99%E5%96%AE%E5%BC%B5/2018/0112-Vistaril(%E7%B6%AD%E6%B3%B0%E5%AF%A7).pdf">https://www.tmuh.org.tw/UploadFile/files/%E8%97%A5%E5%8A%91%E9%83%A8/%E7%94%A8%E8%97%A5%E8%AB%AE%E8%A9%A2%E4%B8%AD%E5%BF%83-%E8%A1%9B%E6%95%99%E5%96%AE%E5%BC%B5/2018/0112-Vistaril(%E7%B6%AD%E6%B3%B0%E5%AF%A7).pdf</a> 北醫hydroxyzine副作用</p><p>9. <a href="https://ww2.health.wa.gov.au/~/media/Corp/Documents/Health-for/Infectious-disease/COVID19/WA-guidelines-for-use-of-molnupiravir.pdf">https://ww2.health.wa.gov.au/~/media/Corp/Documents/Health-for/Infectious-disease/COVID19/WA-guidelines-for-use-of-molnupiravir.pdf</a> 澳洲的molnupiravir使用準則</p></div></div></div><br />
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鄭煜彬(Yu-Pin Cheng)http://www.blogger.com/profile/07019803125903571476noreply@blogger.com0tag:blogger.com,1999:blog-5384877319969585099.post-61009062580671107882021-12-03T17:36:00.000-08:002021-12-03T17:36:20.827-08:00如何去除電子書檔案的DRM,放到其他閱讀器使用?<h2>
<span style="font-size: x-large;"><b>如果要在自己最習慣的載具/閱讀器上面閱讀電子書,就必須使用去除DRM的epub檔</b></span></h2>
<span style="font-size: large;">最近適逢2019年國際書展,筆者卻因工作與家庭忙到無法親臨現場。所幸許多書局與書商都因應書展推出了「線上書展」,在午夜夢迴之際,還可以稍稍獲得一些精神食糧......</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">只是參加了好幾年的書展,家裡已經堆滿了無數的書,書架也買了好幾個,眼看又要滿了。因此筆者閱讀的主力也漸漸轉往電子書。姑且不論閱讀習慣的改變,對於家中空間的節約與查閱的方便性還真的居功厥偉。</span><br />
<h2>
<span style="font-size: x-large;"><b>為何要下載電子書?</b></span></h2>
<div>
<br /></div>
<span style="font-size: large;">買了電子書後,很多人不能適應的點在於:(1)要在手機或是特定的電子書閱讀器上面閱讀,眼睛有時不太舒服。(2)往往要搭配書商的特定閱讀平台才能使用。雖然目前幾間書商好像都大到不能倒,但在這個連MSN與無名小站都會消失的年代,誰能保證存放在平台上的電子書不會消失?</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">因此,最理想的方式就是把電子書下載下來,一方面可以在各種自己習慣的載具(平板、尺寸較大的電子書閱讀器、甚至紙張)上閱讀,另一方面可以永久保存。</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">目前臺灣市面上的許多電子書商(例如Readmoo的大部分書與博客來(圖一))暫時沒有下載服務,但少數的Readmoo書籍可以直接下載去除DRM的epub檔,這種就可以直接在各式場合使用。</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">國外的Kobo、Amazon、Google Play的電子書大多可以下載,不過這些書並必須要用Adobe Digital Edition閱讀。因為Kobo等廠商下載的檔案其實叫做Adobe content server message(acsm),本身還是有DRM保護,必須用Adobe Digital Edition來開。</span><span style="font-size: large;">筆者曾經買過Kobo的書卻無法在自己的平板開啟,寫信去Kobo問才知道那本書沒有Adobe授權,只好另外下載Kobo的電腦版閱讀軟體來用。</span><br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhbJ1-NDcEpuNeBd5r6qz7-oHwS53O-dTMaZC645Kdh5KPDdZA1olbrd0wubqW5UewyXz65Yi7BDFD3gI236aVGpPKY-3IQcTgVfvLp_y_WX-W-WXi8c8u84cNte-oY0M_yWuxYxL9zS8UK/s1600/DeDRM+%25281%2529.jpg"><span style="font-size: large;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhbJ1-NDcEpuNeBd5r6qz7-oHwS53O-dTMaZC645Kdh5KPDdZA1olbrd0wubqW5UewyXz65Yi7BDFD3gI236aVGpPKY-3IQcTgVfvLp_y_WX-W-WXi8c8u84cNte-oY0M_yWuxYxL9zS8UK/s640/DeDRM+%25281%2529.jpg" width="640" /></span></a><br />
<div style="text-align: center;">
<span style="font-size: large;">圖一:很多電子書商還沒有提供電子書下載服務</span></div>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">在此做個小結論:如果可以直接取得去除DRM的epub檔,就可以直接用於各式場合。但如果下載的是有DRM的epub或其他檔案,就得另外用Adobe Digital Edition來開。</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><a href="https://www.adobe.com/tw/solutions/ebook/digital-editions/download.html">下載Adobe Digital Edition</a>(</span><span style="font-size: large;">請直接點連結</span><span style="font-size: large;">)。</span><br />
<br />
<br />
<span style="font-size: large;"><br /></span>
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<h2>
<span style="font-size: x-large;">為何要去除DRM?</span></h2>
<div>
<br /></div>
<span style="font-size: large;">下載的電子書檔案很多都有DRM保護,意味著如果要轉檔用其他載具閱讀就不行。舉例來說Kobo下載的電子書可以直接在Adobe Digital Edition閱讀,</span><span style="font-size: large;">但要如果要拿到Readmoo的閱讀器(mooInk)上面讀就不行了。去除DRM也不是為了佔書商便宜,而是我手上就只有一個mooInk閱讀器,買了Kobo的電子書卻完全無法在上面看,總不可能再去買一台Kobo的閱讀器吧。</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">從Readmoo網頁(圖二)上可以知道,主要問題還是在於大部分出版社對於下載的電子書(一般是可以自由變換版面與字體大小的epub檔)都會加上DRM保護。這時候可以使用一些軟體來去除epub的DRM。這裡不能不提Readmoo有提供一些已經DRM-free(沒有DRM)的電子書,下載後可直接使用。</span><br />
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjOajdD3EQXytxroR6LDGRcETGoVvx4u4wZ7QXIVTSe_tPSEvj1e1D2CFpHwJAuq1BmqHsUm-TIa8oFRmIHZ2Mi6n2yASE-o1NDgZzfpzecomayqUoBjlALhYBV_WDpuXL46-GehzjY_cJ4/s640/DeDRM+%25289%2529.jpg" style="margin-left: auto; margin-right: auto;" width="640" /></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: large;">圖二:DRM是影響電子書運用的主要原因。</span></td></tr>
</tbody></table>
<span style="font-size: large;"><br />以下就介紹筆者這一兩年來用來去除DRM大致可行的辦法。</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">一、</span><span style="font-size: large;"><a href="https://calibre-ebook.com/download">下載calibre電子書管理軟體</a>(請直接點連結)</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">按進去這個網頁會有安裝的選擇,<span style="color: red;">請選擇自己電腦作業系統對應的種類</span>,直接下載安裝。如果是用window系統的朋友,請確定一下自己電腦是32還是64-bit的(圖三),並點選適當的檔案。</span><br />
<div class="separator" style="clear: both; text-align: center;">
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhSyEF0RTN1kIVjGlmVznapz8OQzJg7nX2JSqLguj-akKmoHcBk8IILo5AeOFJKusLedlI4vlek1jI5iTiaNaKKM82qMea__DjY43LoF0mkPiv06HQ5vW4JqiK8OVME1RmWP430gzxGfiFe/s1600/DeDRM+%25281%2529.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="600" data-original-width="960" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhSyEF0RTN1kIVjGlmVznapz8OQzJg7nX2JSqLguj-akKmoHcBk8IILo5AeOFJKusLedlI4vlek1jI5iTiaNaKKM82qMea__DjY43LoF0mkPiv06HQ5vW4JqiK8OVME1RmWP430gzxGfiFe/s640/DeDRM+%25281%2529.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: large;">圖三:請安裝適合自己作業系統的檔案。</span></td></tr>
</tbody></table>
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<br />
<span style="font-size: large;">接著到Github這個外掛程式協作平台上下載DeDRM tools這個去除DRM的外掛。請先<span style="color: red;">google搜尋"Github DeDRM"</span>,就可以看到Github,請直接點下面<span style="color: red;">releases</span>的地方(圖四),就會看到DeDRM_tools(版本可能會持續更新)的zip檔(圖五),請點擊下載。</span><br />
<span style="font-size: large;"><br /></span>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjxkKFJi3rWHae4JqHyNCAfR4odUk7HiTFMXVcBJLP3zY1rbXoXO5XOdHegZcHiRRT8EHHQ73_hr4jFoNKWo7ShH33U_XUV9jT6pvDArOK34mUkPqkS7TcBFpW57OVIkfPMxjVdYkvoeN1r/s640/DeDRM+%25288%2529.jpg" style="margin-left: auto; margin-right: auto;" width="640" /></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: large;">圖四:到Github平台上搜尋去除DRM的外掛</span></td></tr>
</tbody></table>
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjxkKFJi3rWHae4JqHyNCAfR4odUk7HiTFMXVcBJLP3zY1rbXoXO5XOdHegZcHiRRT8EHHQ73_hr4jFoNKWo7ShH33U_XUV9jT6pvDArOK34mUkPqkS7TcBFpW57OVIkfPMxjVdYkvoeN1r/s1600/DeDRM+%25288%2529.jpg"><span style="font-size: large;"></span></a><br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhapm8V9ktat39vVIvWn5Wzwba0KI4htcmqKFaWKBwgKlmPSzC5TJ8AV8iZ27NdJejUUm4Yll46I35hfDcbfodKK1U_i7kX2ClSM-6OyHqdOA_JRLt_SHkhDBJ_vDG5sDI-DL1oNpBqF6lV/s640/DeDRM+%25287%2529.jpg" style="margin-left: auto; margin-right: auto;" width="640" /></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: large;">圖五:點選DeDRM_tools_x.x.x</span></td></tr>
</tbody></table>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">下載完,記好DeDRM_tools的位置。接著<span style="color: red;">打開calibre</span>,點選右上角的「<span style="color: red;">偏好設定</span>」,選擇最下面的進階裡的「<span style="color: red;">外掛</span>」(圖六)。</span><br />
<span style="font-size: large;"><br /></span>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjc2TdHNbGvbUfhKPBg07xP_mZwz8KBkDS_mScNGuUL2kT_sJEtoQyonMMdAx8iBplZR8D003yLf6LM68pU8bWNTAre5kKfl8CNDu_wXJXrymQjnV3he1msWo5TVLUIOlt4Aabepw5rth1x/s640/DeDRM.jpg" style="margin-left: auto; margin-right: auto;" width="640" /></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: large;">圖六:點選右上角的「<span style="color: red; text-align: start;">偏好設</span></span><span style="color: red; font-size: large; text-align: start;">定</span><span style="font-size: large; text-align: start;">」,選擇最下面的進階裡的「</span><span style="color: red; font-size: large; text-align: start;">外掛</span><span style="font-size: large; text-align: start;">」。</span></td></tr>
</tbody></table>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">接著選擇「從檔案載入外掛」(圖七)。</span><br />
<span style="font-size: large;"><br /></span>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhUl9iUAbsOvBEUXlX-XZ7Ar66QKC9NrHj9du7wec7lHmlmQY0iga4z9ZTZT8pnw-4NNIOhXGGSXs7FCNuCTBiF8MhWrqUF1nxWJ3phcTHqdRwvnf7j5ZUlwPdm1IkyxoV63SJ_ltjouLnu/s640/DeDRM+%25285%2529.jpg" style="margin-left: auto; margin-right: auto;" width="640" /></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: large;">圖七:點擊「從檔案載入外掛」。</span></td></tr>
</tbody></table>
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhUl9iUAbsOvBEUXlX-XZ7Ar66QKC9NrHj9du7wec7lHmlmQY0iga4z9ZTZT8pnw-4NNIOhXGGSXs7FCNuCTBiF8MhWrqUF1nxWJ3phcTHqdRwvnf7j5ZUlwPdm1IkyxoV63SJ_ltjouLnu/s1600/DeDRM+%25285%2529.jpg"><span style="font-size: large;"></span></a><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">到下載的<span style="color: red;">DeDRM_tools</span>資料夾中選擇<span style="color: red;">DeDRM_calibre_plugin><b>DeDRM_plugin.zip</b></span>(圖八,重點就是找到<span style="color: red;">DeDRM_plugin.zip</span>這個壓縮檔),不用解壓縮calibre就會自行安裝,大致上就完成了。</span><br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEib_7zLfRm-s_aFNeXbRnyF49AL862OVV_teHQ67HLvj3XOyaSjC4uekEc94kGgsXYxE7skryMaH8eSv9xRGADdwpBgbO9hvXxZ_0neFXyG93wjL3NEalUoJsf9lsJ-tI5Z6EMz0iWOMqvs/s1600/DeDRM+%25282%2529.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="600" data-original-width="960" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEib_7zLfRm-s_aFNeXbRnyF49AL862OVV_teHQ67HLvj3XOyaSjC4uekEc94kGgsXYxE7skryMaH8eSv9xRGADdwpBgbO9hvXxZ_0neFXyG93wjL3NEalUoJsf9lsJ-tI5Z6EMz0iWOMqvs/s640/DeDRM+%25282%2529.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption"><span style="font-size: large;">圖八:到剛剛下載的DeDRM_tools資料夾中選擇DeDRM_calibre_plugin>DeDRM_plugin.zip</span></td></tr>
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<h2>
<span style="font-size: x-large;"><b>如何實際執行去除DRM?</b></span></h2>
<div>
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<span style="font-size: large;">這裡以Kobo的URLLink檔為例。首先先用Adobe Digital Edition開啟URLLink檔案,可以在URLLink檔上直接按滑鼠右鍵>開啟檔案,選擇Adobe Digital Edition(圖九)。這會花一點時間。</span><br />
<span style="font-size: large;"><br /></span>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi7aiSuItfWMZr2xApHdibn52YkSZSgCXu7vmcYsp4_QQR2zNlJi4LJ8DZzVWISpShKBXwb47-kAdNgw8Xat-uOh2Y7dy1X14566yQWp-lclz00-DTZvgRspKow8_T3tIq_RdjEBuoTywkT/s640/DeDRM+%252810%2529.jpg" style="margin-left: auto; margin-right: auto;" width="640" /></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: large;">圖九:用Adobe Digital Edition開啟URLLink檔案</span></td></tr>
</tbody></table>
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi7aiSuItfWMZr2xApHdibn52YkSZSgCXu7vmcYsp4_QQR2zNlJi4LJ8DZzVWISpShKBXwb47-kAdNgw8Xat-uOh2Y7dy1X14566yQWp-lclz00-DTZvgRspKow8_T3tIq_RdjEBuoTywkT/s1600/DeDRM+%252810%2529.jpg"><span style="font-size: large;"></span></a><br />
<br />
<span style="font-size: large;">然後開啟calibre,點擊最左上角的「<span style="color: red;">加入書籍</span>」,然後到<span style="color: red;">文件>My Digital Edition</span>(不同電腦可能有不同的位置)找Adobe Digital Edition開出來的<span style="color: red;">epub檔</span></span><span style="font-size: large;">(圖十)</span><span style="font-size: large;">。</span><br />
<span style="font-size: large;"><br /></span>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhPj62pMKnvzl2_iSflx74tnuYeTyNO-sqh3g5rm6bA55KMlfX9F4hlcGkSUgGFUVgViHE7pGxERrmHAjoHtUcvHjxsd33DfwOLzsvR-nRM41otayYsB742lLjC4YVcmX8H2n9HheqjZ1CW/s1600/DeDRM+%252814%2529.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhPj62pMKnvzl2_iSflx74tnuYeTyNO-sqh3g5rm6bA55KMlfX9F4hlcGkSUgGFUVgViHE7pGxERrmHAjoHtUcvHjxsd33DfwOLzsvR-nRM41otayYsB742lLjC4YVcmX8H2n9HheqjZ1CW/s640/DeDRM+%252814%2529.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption"><span style="font-size: large;">圖十:到文件>My Digital Edition(不同電腦可能有不同的位置)找Adobe Digital Edition開出來的epub檔</span></td></tr>
</tbody></table>
<span style="font-size: large;"><br />(請注意,Adobe Digital Edition開出來的epub檔還完全不能用,大家如果有興趣點看看就會發現完全不能開(圖十一)。要用calibre處理過才能開。)</span><br />
<span style="font-size: large;"><br /></span>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi4Uso3hXQtR9WoA6nejiFIT-t8JMPzrVhd_EKv0J2J13E7XZUqL6CN9PQrxxaX-XbDDcZdKzjmbRS_wy7cQytsAQs6cIwqEPXCLbstXLRcyAJSbYZFbI6lisZuzU4qqV_l8EDfKZ_rMvcu/s640/DeDRM+%252813%2529.jpg" style="margin-left: auto; margin-right: auto;" width="640" /></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: large;">圖十一:用Adobe Digital Edition開出的epub檔完全打不開。</span></td></tr>
</tbody></table>
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi4Uso3hXQtR9WoA6nejiFIT-t8JMPzrVhd_EKv0J2J13E7XZUqL6CN9PQrxxaX-XbDDcZdKzjmbRS_wy7cQytsAQs6cIwqEPXCLbstXLRcyAJSbYZFbI6lisZuzU4qqV_l8EDfKZ_rMvcu/s1600/DeDRM+%252813%2529.jpg"><span style="font-size: large;"></span></a><br />
<br />
<span style="font-size: large;">用calibre加入書籍後,就可以在下面看到去除DRM的書籍名稱,在上面按滑鼠右鍵,選擇「儲存到硬碟(圖十二)」(有很多選項,筆者建議直接只存epub就好了),存出來的epub檔就可以在各種載具上面閱讀了。</span><br />
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhO1oOnUnYMeD12OIhWE7-Scw7DNx-rvTrznsTs2cvKy1NEv_jNAQ15kFVpqyHAG3VreE3r-QvhfICpK1Av-uFeW6F0yDlCqScQBbgt9W4HJmJxcFsvciF8NnORMsu_CpSiFMcH_VuquRs2/s1600/DeDRM+%252815%2529.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhO1oOnUnYMeD12OIhWE7-Scw7DNx-rvTrznsTs2cvKy1NEv_jNAQ15kFVpqyHAG3VreE3r-QvhfICpK1Av-uFeW6F0yDlCqScQBbgt9W4HJmJxcFsvciF8NnORMsu_CpSiFMcH_VuquRs2/s640/DeDRM+%252815%2529.jpg" style="cursor: move;" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: large;">圖十二:在calibre開出的書檔上按右鍵,選擇「儲存到硬碟」,就可以存出可自由運用的epub檔了。</span><br />
<br />
<h2 style="text-align: left;">
<span style="font-size: x-large;">最後叮嚀:請尊重智慧財產權!</span></h2>
<div>
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<div style="font-size: x-large; text-align: left;">
最後這點<span style="color: red;"><b>非常、非常、非常</b></span>重要:轉出來的epub檔<span style="color: red;">務必自己使用就好,切莫到處流傳</span>,因為智慧財產權是人類文化進步的基礎。寫了好書卻無法回收成本,以後就沒人認真寫書了。</div>
<div style="font-size: x-large; text-align: left;">
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</tbody></table>
鄭煜彬(Yu-Pin Cheng)http://www.blogger.com/profile/07019803125903571476noreply@blogger.com0tag:blogger.com,1999:blog-5384877319969585099.post-74290657915724992782021-07-07T17:08:00.013-07:002021-07-07T17:12:57.629-07:00武漢肺炎(COVID-19)疫苗的皮膚副作用<h1 style="text-align: left;"></h1><h1 style="text-align: left;"><div><span style="font-size: x-large;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiIo3xThJ17-TdyFaF24WFlOZmOGCbq5H0S1m_qYY20CUa8tgio-PRuo3Kg2-WmQlTPyM-VMkmqtzE6YI_amAYgQEUSpr7wN-elNziq9AOChgCgGPKeVdMZnEm9b2mdzFG1G_dWEpJxDVoR/s960/P169+%252819%2529.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="540" data-original-width="960" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiIo3xThJ17-TdyFaF24WFlOZmOGCbq5H0S1m_qYY20CUa8tgio-PRuo3Kg2-WmQlTPyM-VMkmqtzE6YI_amAYgQEUSpr7wN-elNziq9AOChgCgGPKeVdMZnEm9b2mdzFG1G_dWEpJxDVoR/w640-h360/P169+%252819%2529.jpg" width="640" /></a></div><span style="font-weight: 400;"><br /></span></span></div><ul style="text-align: left;"><li><span style="font-size: x-large; font-weight: normal;">武漢肺炎(COVID-19)疫苗難免有副作用,但對預防疾病、保護家人的價值遠超過於副作用的不適。</span></li></ul><ul style="text-align: left;"><li><span style="font-size: x-large;"><span style="font-weight: normal;">阿斯特捷利康(AstraZeneca)疫苗</span>沒有明顯的皮膚副作用<span style="font-weight: normal;">,頂多造成注射部位的</span>觸痛、疼痛、腫脹<span style="font-weight: normal;">與</span>紅斑<span style="font-weight: normal;">。</span></span></li></ul><ul style="text-align: left;"><li><span style="font-size: x-large;"><span style="font-weight: normal;">mRNA疫苗們(莫德納Moderna、輝瑞Pfizer)的</span>皮膚副作用較多<span style="font-weight: normal;">,最常見的包括</span>遲發性大範圍反應(Delayed large local reactions)、局部反應(Local site reaction)、蕁麻疹(Urticaria)、麻疹狀發疹(Morbilliform eruptions)、<span style="font-weight: normal;">以及</span>肢端紅痛症(Erythromelalgia)<span style="font-weight: normal;">。</span></span></li></ul><ul style="text-align: left;"><li><span style="font-size: x-large;"><span style="font-weight: normal;">所有武漢肺炎(COVID-19)疫苗的皮膚副作用</span>不治療也會自動消退<span style="font-weight: normal;">。</span><span>施打四小時後才出現副作用的人</span><span>,依然可以再打第二劑疫苗</span><span style="font-weight: normal;">。</span></span></li></ul></h1><p><span style="font-size: large;">隨著台灣的疫苗施打數量越來越多,皮膚科醫師也漸漸觀察到一些武漢肺炎(COVID-19)疫苗的皮膚副作用。基本上如果是<b>施打四小時後才出現的副作用,都不算嚴重過敏反應。這些皮膚的副作用除了造成一點不舒服,對人體健康完全無害,在可以忍受的前提下可以完全不治療,也不影響第二劑疫苗的接種</b>。(1)然而,這些副作用對於過去的疫苗並不常見,對全人類可說是全新的體驗,因此值得在這裡向所有讀者簡單介紹一下。</span></p><p><span style="font-size: large;">目前在台灣廣為施打的疫苗有兩支,分別是屬於腺病毒疫苗的<b>阿斯特捷利康(AstraZeneca)疫苗</b>與屬於<b>mRNA疫苗的莫德納(Moderna)疫苗</b>,都是<b>有國際認證,實證效果卓著的好疫苗</b>。(1)</span></p><h2 style="text-align: left;"><span style="font-size: large;"><b>腺病毒武漢肺炎(COVID-19)疫苗的皮膚副作用</b></span></h2><div><span style="font-size: large;"><b><br /></b></span></div><p><span style="font-size: large;">AstraZeneca疫苗所屬的腺病毒武漢肺炎(COVID-19)疫苗比較不會有直接與疫苗相關的皮膚副作用。到目前為止,幾乎沒有文獻特別針對這部分作探討。因此目前唯一的皮膚副作用就是施打處的<b>發熱、癢、痛、</b>與<b>壓痛</b>。(1, 2)</span></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEixl1EJxbSjukW16HoBo97IF4sMYJJcl4QUcUXBFo9BVJLnlPMOE0rbAKWP2dTi3GqD4jo0blIpEkPgYa9XeC_mcqci7Z6Puwc76-Nn0a1keGyYrtKlwnN5UZBQ01r_YcSixRtLBLZAszfJ/s2048/IMAG3861.jpg" style="margin-left: auto; margin-right: auto;"><span style="font-size: large;"><img border="0" data-original-height="1536" data-original-width="2048" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEixl1EJxbSjukW16HoBo97IF4sMYJJcl4QUcUXBFo9BVJLnlPMOE0rbAKWP2dTi3GqD4jo0blIpEkPgYa9XeC_mcqci7Z6Puwc76-Nn0a1keGyYrtKlwnN5UZBQ01r_YcSixRtLBLZAszfJ/w640-h480/IMAG3861.jpg" width="640" /></span></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><span style="font-size: large;">筆者打完阿斯特捷利康(AstraZeneca)疫苗後,除了腫脹壓痛持續約一星期外,並無任何皮膚副作用。發燒了一兩天,但吃了普拿疼(acetaminophen)還是可以正常工作。</span></td></tr></tbody></table><p><span style="font-size: large;"><br />但如果是有<b>乾癬</b>、<b>酒糟</b>、其他皮膚免疫疾病(<b>白斑</b>)的病人,就有可能造成這類疾病惡化。(3)在筆者的臨床經驗中,確實也有幾位乾癬的病人在施打AZ疫苗後明顯感覺乾癬病灶惡化。但由於這些病人在施打疫苗前後都停用照光治療、生物製劑、與相關的免疫抑制藥物,是否真的是AZ疫苗引起,其實有待商榷。所幸這幾位病人重新接受生物製劑與相關的免疫抑制藥物後,症狀都很快獲得緩解。</span></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhNm1NPEWkVy7CIx4KXFiozG_zuadB0vg_59mKEHLA5VulAxP65Lx3NwGXHzXurKW89tr0yE8GOyRISu32ZWXbtmjgqcVh9S0uPbGlAK7UukthCLvn1yXFvZEyTHY9nX5_glj3rkzPZlKBM/s2048/IMAG4326modified.jpg" style="margin-left: auto; margin-right: auto;"><span style="font-size: large;"><img border="0" data-original-height="1598" data-original-width="2048" height="500" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhNm1NPEWkVy7CIx4KXFiozG_zuadB0vg_59mKEHLA5VulAxP65Lx3NwGXHzXurKW89tr0yE8GOyRISu32ZWXbtmjgqcVh9S0uPbGlAK7UukthCLvn1yXFvZEyTHY9nX5_glj3rkzPZlKBM/w640-h500/IMAG4326modified.jpg" width="640" /></span></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><span style="font-size: large;">筆者的病人打完阿斯特捷利康(AstraZeneca)疫苗後,乾癬有些微惡化,但後來還是逐漸恢復正常。</span></td></tr></tbody></table><p><span style="font-size: large;"><br /></span></p><h2 style="text-align: left;"><span style="font-size: large;"><span><b>mRNA</b></span>武漢肺炎(COVID-19)疫苗<b>的皮膚副作用 </b></span></h2><div><span style="font-size: large;"><b><br /></b></span></div><p></p><p><span style="font-size: large;"><span>莫德納(Moderna)與輝瑞(Pfizer)疫苗所屬的mRNA武漢肺炎(COVID-19)疫苗就有較多皮膚副作用。常見的有<b>遲發性大範圍反應(Delayed large local reactions)、局部反應(Local site reaction)、蕁麻疹(Urticaria)、麻疹狀發疹(Morbilliform eruptions)、</b>以及<b>肢端紅痛症(Erythromelalgia)</b>五</span><span>大類</span></span><span style="font-size: large;">:(4)</span></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiG2tewUocAG4VL9Uot7Mvc89rbkur2HByIX0Gi8ZuX3Psd5nzTdK5XF8LMIHKwIn5FJjbe3U8MXwR2ZaZGrqJLj0eBSE4U2116ODynQlqJrMCItxNaJ5T-tDUA1J9yW7D4zSX0sbsaGgVs/s2048/IMAG4928.jpg" style="margin-left: auto; margin-right: auto;"><span style="font-size: large;"><img border="0" data-original-height="1536" data-original-width="2048" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiG2tewUocAG4VL9Uot7Mvc89rbkur2HByIX0Gi8ZuX3Psd5nzTdK5XF8LMIHKwIn5FJjbe3U8MXwR2ZaZGrqJLj0eBSE4U2116ODynQlqJrMCItxNaJ5T-tDUA1J9yW7D4zSX0sbsaGgVs/w640-h480/IMAG4928.jpg" width="640" /></span></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><span style="font-size: large;">筆者的病人接種Moderna疫苗第九天後就診,表示接種後第七天開始出現大片的紅斑,正是遲發性大範圍反應(Delayed large local reactions)</span></td></tr></tbody></table><p><span style="font-size: large;"><br /><b>遲發性大範圍反應(Delayed large local reactions)</b>是最常見的皮膚副作用,第一次注射時往往要到第八天才出現,約維持四日。第二次注射時第三天就會出現,但只維持三日。型態是出現寬達9-10公分以上的大片紅斑,往往伴隨癢感。這種反應本質上類似過敏反應,但只限於局部,並不用特別治療。如果真有不適,可使用<b>冰敷</b>、<b>口服抗組織胺</b>、<b>外用</b>或<b>口服類固醇治療</b>。(5)</span></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjhdgmn7G74Wyg6KhcHaBXjZ6bB_t1yc4wGZmWdft3wOpvtEd7gszqcnyiOX2m1jdRReBj4XbaUwockqiqrr_Nol-JIp71zfUPmX5hvZpKEa9tr8CLe0rfJCncDD57LNq-BSghpVh9GfXqX/s985/Local+injection+site+reaction.jpg" style="margin-left: auto; margin-right: auto;"><span style="font-size: large;"><img border="0" data-original-height="738" data-original-width="985" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjhdgmn7G74Wyg6KhcHaBXjZ6bB_t1yc4wGZmWdft3wOpvtEd7gszqcnyiOX2m1jdRReBj4XbaUwockqiqrr_Nol-JIp71zfUPmX5hvZpKEa9tr8CLe0rfJCncDD57LNq-BSghpVh9GfXqX/w640-h480/Local+injection+site+reaction.jpg" width="640" /></span></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><span style="font-size: large;">局部反應出現的時間較早,往往第二天就會出現,範圍也較小。(6)</span></td></tr></tbody></table><div class="separator" style="clear: both; text-align: center;"><span style="font-size: large;"><br /></span></div><p><span style="font-size: large;"><b>局部反應(Local site reaction)</b>是第二常見的皮膚副作用。第一次注射時第二天就出現,約維持四日。第二次注射時一樣第二天就會出現,但只維持三日。注射處會出現紅斑、腫脹、壓痛,原則上不用治療。</span></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjk2alj2adDeffaju3GO8hj_Di3iOjEKVBawPTbcDNm4ATPnaV1QJuAaRLepMwyKMmsMv2QC6rWDM_OS3bHcAZxpOJ5jwdrOZ-GY2f1VpX5exPuz50CtQZhxqRXJk-P5c1uId49LCI7h_iN/s1477/urticaria.jpg" style="margin-left: auto; margin-right: auto;"><span style="font-size: large;"><img border="0" data-original-height="1108" data-original-width="1477" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjk2alj2adDeffaju3GO8hj_Di3iOjEKVBawPTbcDNm4ATPnaV1QJuAaRLepMwyKMmsMv2QC6rWDM_OS3bHcAZxpOJ5jwdrOZ-GY2f1VpX5exPuz50CtQZhxqRXJk-P5c1uId49LCI7h_iN/w640-h480/urticaria.jpg" width="640" /></span></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><span style="font-size: large;">筆者的病人出現蕁麻疹,治療後很快就消退了。</span></td></tr></tbody></table><p><span style="font-size: large;"><b><br />蕁麻疹(Urticaria)</b>是第三常見的副作用,第一次注射時第四天就出現,約維持五日。第二次注射時第三天就會出現,但只維持三日。型態是外表平滑,頂端平坦的斑塊,與一般病毒或藥物引起的蕁麻疹外觀上完全相同。可以用<b>口服抗組織胺</b>治療。</span></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiATVEkvgkszgVLEtULc0sx_lWU4HVoLqy5sbppY7RdhN8-iEwaeVXSf0viV0j6LteRy1GlfRpqmfJ6miMzjmlLpiqVFQlHOYuLGfJUYuPjCwwB433VgczfAaioDWIfbozfrf8BhJqsHV4T/s960/P169+%252821%2529.jpg" style="margin-left: auto; margin-right: auto;"><span style="font-size: large;"><img border="0" data-original-height="540" data-original-width="960" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiATVEkvgkszgVLEtULc0sx_lWU4HVoLqy5sbppY7RdhN8-iEwaeVXSf0viV0j6LteRy1GlfRpqmfJ6miMzjmlLpiqVFQlHOYuLGfJUYuPjCwwB433VgczfAaioDWIfbozfrf8BhJqsHV4T/w640-h360/P169+%252821%2529.jpg" width="640" /></span></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><span style="font-size: large;"><span style="text-align: start;">麻疹狀發疹(Morbilliform eruptions)的型態與一般病毒疹與藥物疹幾乎一樣。此案例是施打輝瑞(Pfizer=BNT)疫苗的案例</span>(7)</span></td></tr></tbody></table><span style="font-size: large;"><br /></span><p><span style="font-size: large;"><b>麻疹狀發疹(Morbilliform eruptions)</b>是第四常見的副作用,第一次注射時第四天就出現,約維持五日。第二次注射時第三天就會出現,但只維持三日。型態是遍布全身的紅色小丘疹,軀幹較多四肢較少。原則上不用治療。</span></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgEqpXR3Ps8ngDnya3nh5rT88wD_QndNL9aak91AcHOfNULPkjanib_APs2XLRtZHqVJCWJAPtBUHeIVEoTP5yII7gQXQQB9E9kVZO0iOwjEeuZLtqVTjNhmnr1xja9kic4mcck5DdvGia2/s960/P43+%25287%2529.jpg" style="margin-left: auto; margin-right: auto;"><span style="font-size: large;"><img border="0" data-original-height="720" data-original-width="960" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgEqpXR3Ps8ngDnya3nh5rT88wD_QndNL9aak91AcHOfNULPkjanib_APs2XLRtZHqVJCWJAPtBUHeIVEoTP5yII7gQXQQB9E9kVZO0iOwjEeuZLtqVTjNhmnr1xja9kic4mcck5DdvGia2/w640-h480/P43+%25287%2529.jpg" width="640" /></span></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><span style="font-size: large;"><span style="text-align: start;">肢端紅痛症(Erythromelalgia):某些人接受</span>mRNA疫苗注射後可能短暫出現。(8)</span></td></tr></tbody></table><p><span style="font-size: large;"><br /></span></p><p><span style="font-size: large;"><b>肢端紅痛症(Erythromelalgia)</b>是第五常見的副作用,第一次注射時第八天就出現,約維持六日。第二次注射時第二天就會出現,但只維持三日。型態是間歇或持續性的肢端紅斑,常常有強烈的燒灼、疼痛感,溫度也會偏高。</span><span style="font-size: x-large;">原則上不用治療。</span></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiXQHAfzd46b_u3JPGP8Q1SkD0guAGfwxqHQtJGnA6DwG8XHOG3XX520_-v2v44oyvG5YG83WCSLEAXxSJNAFkZxSAeeGegqjoPUTyibpU1tBNUKplHURDjHG9v06DYNXEyouSTQUqvCNtM/s960/P169+%252819%2529.jpg" style="margin-left: auto; margin-right: auto;"><span style="font-size: large;"><img border="0" data-original-height="540" data-original-width="960" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiXQHAfzd46b_u3JPGP8Q1SkD0guAGfwxqHQtJGnA6DwG8XHOG3XX520_-v2v44oyvG5YG83WCSLEAXxSJNAFkZxSAeeGegqjoPUTyibpU1tBNUKplHURDjHG9v06DYNXEyouSTQUqvCNtM/w640-h360/P169+%252819%2529.jpg" width="640" /></span></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><span style="font-size: large;">第一次注射mRNA疫苗可能會在<b>第二、四、八天</b>陸續出現副作用,都會在<b>四到六日</b>內消退</span></td></tr></tbody></table><div><span style="font-size: large;"><br /></span></div><span style="font-size: large;"><br /></span><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhsRQacW6LmNsPBbSaAqkFxuyfzEuC8Bfo1IBh1fK3fdob6cPGpkfm6p6PeFOR1t9XljwNHjeD_b56khVUikt-awLL06t0hGgUjw465hWHG22-zKSzSuipsawT28vdoodW94Spd3rzzcIzn/s960/P169+%252820%2529.jpg" style="margin-left: auto; margin-right: auto;"><span style="font-size: large;"><img border="0" data-original-height="540" data-original-width="960" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhsRQacW6LmNsPBbSaAqkFxuyfzEuC8Bfo1IBh1fK3fdob6cPGpkfm6p6PeFOR1t9XljwNHjeD_b56khVUikt-awLL06t0hGgUjw465hWHG22-zKSzSuipsawT28vdoodW94Spd3rzzcIzn/w640-h360/P169+%252820%2529.jpg" width="640" /></span></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><span style="font-size: large;">第二次注射mRNA疫苗幾乎在<b>第二到三天內</b>就可能出現副作用,都會在<b>三日</b>內消退</span></td></tr></tbody></table><p><span style="font-size: large;"><br />另外還有些比較少見的反應,包括:</span></p><p><span style="font-size: large;"><b>偽凍瘡(pernio/chilblains)</b>:可能於注射後1-2週出現,與真正武漢肺炎(COVID-19)的<a href="https://shelltaiwan.blogspot.com/2021/06/covid-19_30.html">偽凍瘡</a>很類似,也與一般的凍瘡很像,位於手指腳趾,都是邊緣不清楚的紫紅色斑疹、丘疹與斑塊。多半不用治療,1-2週就會自動痊癒。</span></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgkyTsxOsLjNysf_-tsR44zmHBFeEghtza0ndzyBD1cdwqj09yBMOWf9D5Cjg0WI9i8AISKfiJVrgR6_nUEOw4GnhalYWeNDiMlXS7zW7918_hhddI5S0BP8o4JFhwzguy_dK91IwHpmypP/s686/filler.jpg" style="margin-left: auto; margin-right: auto;"><span style="font-size: large;"><img border="0" data-original-height="565" data-original-width="686" height="528" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgkyTsxOsLjNysf_-tsR44zmHBFeEghtza0ndzyBD1cdwqj09yBMOWf9D5Cjg0WI9i8AISKfiJVrgR6_nUEOw4GnhalYWeNDiMlXS7zW7918_hhddI5S0BP8o4JFhwzguy_dK91IwHpmypP/w640-h528/filler.jpg" width="640" /></span></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><span style="font-size: large;">打完疫苗之後,唇部打過玻尿酸等填充物的位置出現明顯的血管水腫(angioedema)(8)</span></td></tr></tbody></table><span style="font-size: large;"><br /></span><p><span style="font-size: large;"><b>填充物反應(filler reactions)</b>:可能發生於注射疫苗48-72小時之後,但也可能數週到數個月後才出現。過去(案例報告可追溯到六個月前)打過<b>玻尿酸</b>等填充物的位置會腫起來,被視為是一種遲發性過敏反應,過去施打流感疫苗時也出現過這種狀況,如果沒有症狀並不用特別處理,但如果症狀明顯,可以口服<b>小於兩星期的類固醇</b>,有助於緩解症狀而且不影響疫苗效果。(8)</span><span style="font-size: large;">要避免這類副作用有幾個建議:</span></p><p><span style="font-size: large;">1. 施打玻尿酸等填充劑後等4-8個星期再施打疫苗,但如果疫情危急就不在此限(命比較重要)。</span></p><p><span style="font-size: large;">2. 盡量改用玻尿酸以外的填充劑型,例如晶亮瓷(<span style="background-color: white; font-family: "Times New Roman", stixgeneral, serif;">calcium hydroxyapatite)與舒顏粹(聚左旋乳酸,poly-L-lactic acid),或是用雷射來取代(如果有類似效果的話)。</span></span></p><p><span style="font-size: large;"><span><b>玫瑰糠疹狀發疹( pityriasis-rosea-like eruptions):</b>與真正武漢肺炎(COVID-19)的<a href="https://shelltaiwan.blogspot.com/2021/06/covid-19_30.html">玫瑰糠疹狀斑丘疹</a>很類似,紅疹會有輕微脫屑,並有聖誕樹狀(請想像聖誕樹對稱下垂的樹葉)的皮疹分布。</span><span>原則上不用治療。</span></span></p><h2 style="text-align: left;"><span style="font-size: large;"><b>參考資料</b></span></h2><div><span style="font-size: large;"><b><br /></b></span></div>1. <a href="https://draft.blogger.com/#">Dermatol Clin.</a> 2021 May 31 doi: <a href="https://draft.blogger.com/#">10.1016/j.det.2021.05.016</a> COVID-19 Vaccines and the Skin: The landscape of cutaneous vaccine reactions worldwide<br />2. https://extranet.who.int/pqweb/sites/default/files/documents/pl-azd1222-en.pdf<br />3. Lancet. 2021;397:99–111. Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK.<br />4. J Am Acad Dermatol. 2021 Jul;85(1):46-55. doi: 10.1016/j.jaad.2021.03.092. Epub 2021 Apr 7.Cutaneous reactions reported after Moderna and Pfizer COVID-19 vaccination: A registry-based study of 414 cases<br />5. N Engl J Med. 2021;384(13):1273-1277. Delayed large local reactions to mRNA-1273 vaccine against SARS-CoV-2.<br />6. <a href="https://draft.blogger.com/#">Int J Womens Dermatol.</a> 2021 Mar; 7(2): 209–212.Published online 2021 Jan 12. doi: <a href="https://draft.blogger.com/#">10.1016/j.ijwd.2021.01.007</a> The art of prevention: COVID-19 vaccine preparedness for the dermatologist<br />7. Dermatol Online J. 2021 Jan 15;27(1):13030/qt4xs486zg.Morbilliform rash after administration of Pfizer-BioNTech COVID-19 mRNA vaccine<br />8. N Engl J Med. 2010 Oct 7;363(15):1463. doi: 10.1056/NEJMicm0901376.Images in clinical medicine. A white hand and a red hand—erythromelalgia<br /><div><div><p><br /></p></div></div>鄭煜彬(Yu-Pin Cheng)http://www.blogger.com/profile/07019803125903571476noreply@blogger.com0tag:blogger.com,1999:blog-5384877319969585099.post-68184029006043702062021-06-30T17:09:00.022-07:002021-07-06T22:58:49.446-07:00武漢肺炎(新冠肺炎、COVID-19)的成人皮膚表現<h1 style="text-align: left;"><span style="font-size: x-large;"><b>1. 武漢肺炎(新冠肺炎,COVID-19)的成人皮膚表現除了<span style="color: red;">似肢端凍瘡病灶</span>外,大多沒有特異性,很難當作診斷依據,只能<span style="color: red;">用來解釋確診後的皮膚變化。</span><br /></b></span><span style="font-size: x-large;"><b>2. 多數武漢肺炎(COVID-19)病灶除了<span style="color: red;">網狀青斑/壞死性病灶</span>外<span style="color: red;">都無明顯危險</span>。<br /></b></span><span style="font-size: x-large;"><b>3. 如果懷疑您的皮疹<span style="color: red;">是武漢肺炎(COVID-19)所致</span>,同時<span style="color: red;">有</span>接觸史、活動史、或其他武漢肺炎(COVID-19)類似症狀,請先聯絡<span style="color: red;">1922</span>專線,<span style="color: red;">0800-001922</span>,或<a href="https://draft.blogger.com/#"><span style="color: red;">各縣市篩檢站</span></a>。<br /></b></span><span style="font-size: x-large;"><b>4. <span style="color: red;">沒有</span>接觸史、活動史、或其他武漢肺炎(COVID-19)類似症狀,也<span style="color: red;">沒有皮膚不適,請先在家觀察。</span><br /></b></span><span style="font-size: x-large;"><b>5. <span style="color: red;">沒有</span>接觸史、活動史、或其他武漢肺炎(COVID-19)類似症狀,但<span style="color: red;">有皮膚不適,請在適當保護下就醫。</span></b></span></h1><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjODQm0ELDr7oIG32SHAcoO-QvNFALs-r-JKXKXWInaXis1PIOOlelrwDpCiCTcGsa99wexFmA_d8HPnt8Wh7cVFU4nJWriQz60Md80nMoIlOwi4llLEGHNwWom7YQz2VplfUSjNX22LBpe/s960/P169+%252815%2529.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="540" data-original-width="960" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjODQm0ELDr7oIG32SHAcoO-QvNFALs-r-JKXKXWInaXis1PIOOlelrwDpCiCTcGsa99wexFmA_d8HPnt8Wh7cVFU4nJWriQz60Md80nMoIlOwi4llLEGHNwWom7YQz2VplfUSjNX22LBpe/w640-h360/P169+%252815%2529.jpg" width="640" /></a></div><br /><div><br /></div><span style="font-size: large;">最近台灣的武漢肺炎(COVID-19)疫情延燒,漸漸地門診也可能開始看得到武漢肺炎(COVID-19)產生的皮膚病灶。然而這些病灶多半沒有特異性,無法幫助診斷武漢肺炎(COVID-19)。因此本文主要目的是要讓醫師提高警覺,適時為民眾轉介篩檢。<br /><br />如果民眾真的出現這些病灶,同時<b>有接觸史、活動史、或其他武漢肺炎(COVID-19)類似症狀</b>,請先聯絡<a href="https://draft.blogger.com/#">各縣市篩檢站</a>(1)。<br /></span><h1 style="text-align: left;"><b><span style="font-size: x-large;">武漢肺炎(COVID-19)有哪些成人的皮膚表現?</span></b></h1><div><b><span style="font-size: x-large;"><br /></span></b></div><span style="font-size: large;">武漢肺炎(COVID-19)的成人皮膚病灶與兒童不太一樣,最常見的是非肢端紅色斑丘疹(non-acral maculopapular rash) ,第二常見的則是肢端缺血性病灶(acroischemic lesions),與兒童的一樣都是最特異的皮膚表現。第三、第四、第五常見的分別是 蕁麻疹(wheal),似水痘發疹(varicella like exanthema),網狀青斑/壞死性病灶(livedoid/necrotic lesions)。(2)<br />。其他像是薦椎潰瘍(sacral ulcer)、急性廣泛性發疹性膿皰症(acute generalized exanthematous pustulosis)都相對罕見。(3)大部分病灶在四週內都能自癒,但網狀青斑/壞死性病灶伴隨血栓與血管病變可能會伴隨皮膚以外的致命性全身性疾病。(3)<br /><br /></span><h2 style="text-align: left;"><span style="font-size: large;"><b>1. 非肢端紅色斑丘疹 Non-acral maculopapular rash</b></span></h2><div><span style="font-size: large;"><b><br /></b></span></div><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhKAYw1-NlThVa_zrO8_LB3P3Ie9EnxdutIuYHox9ppA4Rz-_DlXu2Ap2Zlex5__6omFdcQvE3LdFowKYz5yszushc6CHexcsXSLiXq4SP8t1wG-WghcJV5HfRbdvg1YbvhG88cBsNyFq-4/s960/P169+%252817%2529.jpg" style="margin-left: auto; margin-right: auto;"><span style="font-size: large;"><img border="0" data-original-height="540" data-original-width="960" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhKAYw1-NlThVa_zrO8_LB3P3Ie9EnxdutIuYHox9ppA4Rz-_DlXu2Ap2Zlex5__6omFdcQvE3LdFowKYz5yszushc6CHexcsXSLiXq4SP8t1wG-WghcJV5HfRbdvg1YbvhG88cBsNyFq-4/w640-h360/P169+%252817%2529.jpg" width="640" /></span></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td class="tr-caption" style="text-align: center;"><span style="font-size: large;"><span style="text-align: left;">武漢肺炎(COVID-19)的</span>非肢端紅色斑丘疹,很密集時可能會融合。與一般藥物疹與其他病毒疹幾乎一樣,無明顯特色。(4)</span></td></tr></tbody></table></td></tr></tbody></table><div><span style="font-size: large;"><br />武漢肺炎(COVID-19)的病毒疹非常沒有特異性,與其他病毒造成的類似,都是會癢的紅色斑丘疹。軀幹先出現,之後漸漸蔓延到四肢。其他比較有特色的分布包括毛囊處分布、玫瑰糠疹分布(聖誕樹,Christmas tree)、以及皺褶處分布。這些紅色斑丘疹與較嚴重的武漢肺炎(COVID-19)感染相關,在某些研究中發現會有2%的死亡率。(5)</span></div><div><span style="font-size: large;"><br /></span><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgwaM3ici0ARZV1_iztOeuC2J8ARsnbdHIHyisQqfLI73mIVqjQtIH8oXEoPyjbBCwHlafwqq__WX5gitBsuDFkgi-pMSrVMh837gMVvKQeN6GYbFMYpUu-oaF7xmWahcxKUALGynrWSf6n/s2048/viral+exanthem1.jpeg" style="margin-left: auto; margin-right: auto;"><span style="font-size: large;"><img border="0" data-original-height="1950" data-original-width="2048" height="610" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgwaM3ici0ARZV1_iztOeuC2J8ARsnbdHIHyisQqfLI73mIVqjQtIH8oXEoPyjbBCwHlafwqq__WX5gitBsuDFkgi-pMSrVMh837gMVvKQeN6GYbFMYpUu-oaF7xmWahcxKUALGynrWSf6n/w640-h610/viral+exanthem1.jpeg" width="640" /></span></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><span style="font-size: large;"><span style="text-align: left;">武漢肺炎(COVID-19)的</span>非肢端紅色斑丘疹,聖誕樹狀(請想像聖誕樹對稱下垂的樹葉)的皮疹分布(4)</span></td></tr></tbody></table><span style="font-size: large;"><br /></span><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjTqM8Gr-Na_NXY3KKmNiwLQWTANECOObfOUUfSChYXy1JlZ1qnrTuyYQWnU-uXDBAKfL3whzJo1JOulTLCYGYa_2zqGkpsnTOLVTo0UflWPYAWDDXotGnpFkBSJF6wAbINjASM8k9LdEp9/s1600/viral+exanthem2+follicle.jpeg" style="margin-left: auto; margin-right: auto;"><span style="font-size: large;"><img border="0" data-original-height="1600" data-original-width="900" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjTqM8Gr-Na_NXY3KKmNiwLQWTANECOObfOUUfSChYXy1JlZ1qnrTuyYQWnU-uXDBAKfL3whzJo1JOulTLCYGYa_2zqGkpsnTOLVTo0UflWPYAWDDXotGnpFkBSJF6wAbINjASM8k9LdEp9/w360-h640/viral+exanthem2+follicle.jpeg" width="360" /></span></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><span style="font-size: large;"><span style="text-align: left;">武漢肺炎(COVID-19)的</span>非肢端紅色斑丘疹,毛囊分布(4)</span></td></tr></tbody></table><span style="font-size: large;"><br /></span><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEja9-H9AdCssq1FnzaYSL8Eg7Guz4tipwEQ9_nBC9NQIzQNbOvMqWh9NRqblIeoVgYmVy_mdfD8HaXl9dedpKxK2as7cypc6zJhR1H-65s95M5FBoPD3ym6WQYkl7NgRELMyBjBw2RX_yRe/s1564/viral+exanthem+skin+fold..jpeg" style="margin-left: auto; margin-right: auto;"><span style="font-size: large;"><img border="0" data-original-height="1564" data-original-width="1564" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEja9-H9AdCssq1FnzaYSL8Eg7Guz4tipwEQ9_nBC9NQIzQNbOvMqWh9NRqblIeoVgYmVy_mdfD8HaXl9dedpKxK2as7cypc6zJhR1H-65s95M5FBoPD3ym6WQYkl7NgRELMyBjBw2RX_yRe/w640-h640/viral+exanthem+skin+fold..jpeg" width="640" /></span></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><span style="font-size: large;"><span style="text-align: left;">武漢肺炎(COVID-19)的</span>非肢端紅色斑丘疹,皺褶處分布(4)</span></td></tr></tbody></table><span style="font-size: large;"><br /></span><div><span style="font-size: large;"><br /></span></div><div><span style="font-size: large;">大部分病灶多半與呼吸道症狀同時出現,少數案例則是出現呼吸道症狀幾日後出現。這些案例不排除是其他藥物引起過敏的疹子(藥物疹,臨床上與病毒診無法區分)。<br />如果現在出現這類病灶,病人有確診武漢肺炎(COVID-19),排除其他藥物過敏,就可以考慮是武漢肺炎(COVID-19)造成的皮疹。<br /><br />一般而言武漢肺炎(COVID-19)的病毒疹不需治療,1-2週就會自行痊癒。如果搔癢症狀嚴重,可以給予外用類固醇,並且適度擦乳液/凡士林保濕(3)。如果分布面積更大、症狀更嚴重,可以考慮給予全身性(口服)類固醇治療。例如著名的口服類固醇地塞米松(dexamethasone),對武漢肺炎本身與皮膚症狀都有幫助。</span><div><span style="font-size: large;"><br /></span></div><h2 style="text-align: left;"><span style="font-size: large;"><b>2. <span id="docs-internal-guid-72638d7d-7fff-3541-9fc1-fe8478d29361"><span style="white-space: pre-wrap;">肢端缺血性病灶 </span><span style="white-space: pre-wrap;">Acroischemic lesions</span></span></b></span></h2><div><span style="font-size: large;"><b><span><span style="white-space: pre-wrap;"><br /></span></span></b></span></div><div><span style="font-size: large;"><span><span style="white-space: pre-wrap;"></span></span></span></div><span style="font-size: large;">一般而言武漢肺炎(COVID-19)的肢端缺血性病灶多半在病程較後期出現,不需治療,1-2週就會自行痊癒。病人本身肺炎症狀往往輕微或是無症狀。(2)武漢肺炎(COVID-19)的肢端缺血性病灶 Acroischemic lesions分兩個部分。分別是:</span></div><div><span style="font-size: large;"><br /></span></div><div><ul><li><span style="font-size: large;">偽凍瘡 (pseudochilblain),>70%,在手指腳趾(一般凍瘡發於冬季)偽凍瘡病灶與一般的凍瘡很像,都是邊緣不清楚的紫紅色斑疹、丘疹與斑塊,少數有表淺水泡、膿泡或出血性結痂,此時看似多型性紅斑。好發於腳趾多於手指,多半只會延伸到手腳指基部。推 測是血栓塞住小血管所致。一般的凍瘡(chilblain)在台灣應出現於冬季,而且多半在手指。如果天氣不冷時出現凍瘡,就要考慮自體免疫疾病、雷諾氏症候群(Raynaud's phenomenon)、家族性凍瘡(familial chilblains)、以及武漢肺炎(COVID-19)。不過上述疾病大多有過去病史可循,如果是最近才突然出現,就要考慮武漢肺炎。(6)</span></li></ul></div><div><span style="font-size: large;"><br /></span></div><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjMAKcprZb859jUTPlvKmPBlsvU3Ks3RpUSwzjVaJrtamJY7mkYTT13klox1MqbtkrH1_uFcUuCx65Crc4rjpBV3xD_3l2KKONqzdlp4ChyggNGcba7bwcARatw4b_rsoL4BGNSd7aiMRGE/s960/P43+%25282%2529.jpg" style="margin-left: auto; margin-right: auto;"><span style="font-size: large;"><img border="0" data-original-height="720" data-original-width="960" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjMAKcprZb859jUTPlvKmPBlsvU3Ks3RpUSwzjVaJrtamJY7mkYTT13klox1MqbtkrH1_uFcUuCx65Crc4rjpBV3xD_3l2KKONqzdlp4ChyggNGcba7bwcARatw4b_rsoL4BGNSd7aiMRGE/w640-h480/P43+%25282%2529.jpg" width="640" /></span></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><span style="font-size: large;">武漢肺炎(COVID-19)的<span style="text-align: left;">偽凍瘡 (pseudochilblain):</span>邊緣不清楚的紫紅色斑疹、丘疹與斑塊(4)<span style="text-align: left;"><br /></span><br /></span><div class="separator" style="clear: both; text-align: center;"><span style="font-size: large;"><br /></span></div><div class="separator" style="clear: both; text-align: center;"><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgHlkIsRV_smYO-qSw5t87bufoS8uJ52XXuHIzddtLcSJL7pMU44TLBatkRypnPXnMvRn0562s_O4iInmzBhELJhvRW0rfCTeZLJs7HiCilfLi3dcZCSDjT5RCtvZVAakUH8qBEPS3ofXRw/s960/P43+%25283%2529.jpg" style="margin-left: auto; margin-right: auto;"><span style="font-size: large;"><img border="0" data-original-height="720" data-original-width="960" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgHlkIsRV_smYO-qSw5t87bufoS8uJ52XXuHIzddtLcSJL7pMU44TLBatkRypnPXnMvRn0562s_O4iInmzBhELJhvRW0rfCTeZLJs7HiCilfLi3dcZCSDjT5RCtvZVAakUH8qBEPS3ofXRw/w640-h480/P43+%25283%2529.jpg" width="640" /></span></a></td></tr><tr></tr></tbody></table></div><span style="font-size: large;"><span style="text-align: left;">武漢肺炎(COVID-19)的</span>偽凍瘡 (pseudochilblain):紫紅色斑疹、丘疹與斑塊,少數(圖右)有表淺水泡(4)</span></td></tr></tbody></table><div><div><ul style="text-align: left;"><li><span style="font-size: large;">似多型性紅斑(erythema multiforme-like)病灶,相對少見,國外統計<30%,大多會出現非典型似靶狀(二圈,內暗紅、外紅)病灶,少數為典型靶狀(三圈,內到外分別是暗紅、白、紅)病灶,多半發生於四肢的伸側(膝蓋或手肘那側)。推測是小血管附近的嚴重發炎與水腫所致。(7)</span></li></ul></div><h2 style="text-align: left;"><span style="font-size: large;"><b>3. 蕁麻疹(Urticaria)</b></span></h2><div><span style="font-size: large;"><b><br /></b></span></div><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj6xYxQT0mH9yFgKK3XgowyIkhqXishGbKL89GnoR0gmuBttVWFzmqVgrW6OufPfnqMJx30fZHZazFussseT59uF0101W_OozQnAGVnjY3PHKo7D3MYkud6Qc8aihmXFvgnGYxpkRzSVEdq/s960/P43+%25284%2529.jpg" style="margin-left: auto; margin-right: auto;"><span style="font-size: large;"><img border="0" data-original-height="720" data-original-width="960" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj6xYxQT0mH9yFgKK3XgowyIkhqXishGbKL89GnoR0gmuBttVWFzmqVgrW6OufPfnqMJx30fZHZazFussseT59uF0101W_OozQnAGVnjY3PHKo7D3MYkud6Qc8aihmXFvgnGYxpkRzSVEdq/w640-h480/P43+%25284%2529.jpg" width="640" /></span></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><span style="font-size: large;"><span style="text-align: left;">武漢肺炎(COVID-19)的</span>蕁麻疹:紅色、表面平滑、邊緣清晰、頂部平坦的隆起丘疹或斑塊(4)</span></td></tr></tbody></table><span style="font-size: large;"><br /></span><div><span style="font-size: large;"><br /></span></div><div><span style="font-size: large;">蕁麻疹會有搔癢感,為紅色、表面平滑、邊緣清晰、頂部平坦的隆起丘疹或斑塊。主要出現在軀幹,但常會影響到臉部與手部。出現的時間約略與武漢肺炎(COVID-19)的呼吸道症狀與全身性症狀(頭痛、發燒...)同時,大約7天會消退,有症狀可以口服抗組織胺治療。(6) 然而蕁麻疹並非很特異性的皮膚病灶,也有可能是其他抗病毒藥、抗生素、氯奎寧、抗凝血劑...等藥物所致,與武漢肺炎(COVID-19)病毒的關聯性有待商榷。</span></div><div><span style="font-size: large;"><br /></span><div><span style="font-size: large;"><br /></span></div><h2 style="text-align: left;"><span style="font-size: large;"><b>4. 似水痘發疹 Varicella like exanthema</b></span></h2><div><span style="font-size: large;"><b><br /></b></span></div><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhEwWIFNCmh7532sBXeZBVxJ-i3x0i9IJuuYK8f5MIRUHFC_XikWABJ46bq9cUYUkHsJiteySfmeNb9pemFycbHBer_aY_8NwqBcbjb7IfxdhyphenhyphenzH4yvC-ZIrK1f8n3VRgAqdztetFlN7_dR/s960/P43+%25285%2529.jpg" style="margin-left: auto; margin-right: auto; text-align: center;"><span style="font-size: large;"><img border="0" data-original-height="720" data-original-width="960" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhEwWIFNCmh7532sBXeZBVxJ-i3x0i9IJuuYK8f5MIRUHFC_XikWABJ46bq9cUYUkHsJiteySfmeNb9pemFycbHBer_aY_8NwqBcbjb7IfxdhyphenhyphenzH4yvC-ZIrK1f8n3VRgAqdztetFlN7_dR/w640-h480/P43+%25285%2529.jpg" width="640" /></span></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><span style="text-align: left;"><span style="font-size: large;">武漢肺炎(COVID-19)的似水痘發疹會出現散布的紅色的丘疹與少數水泡。(4)</span></span></td></tr></tbody></table><span style="font-size: large;"><br />武漢肺炎(COVID-19)的似水痘發疹在成人相對少見。有搔癢與燒灼感,會出現散布的紅色丘疹與少數水泡,大小型態都一致,並有表淺水泡與結痂,少數會出現大水泡或血泡。分布主要在軀幹,有些人可能蔓延到四肢,很少數的人會出現在臉部與黏膜。上述特徵均與水痘的病灶類似。如果現在出現這類病灶,病人又有確診武漢肺炎(COVID-19),可以考慮是武漢肺炎(COVID-19)造成的皮疹。然而台灣的成人有一部分並未得過水痘或接種水痘疫苗,還是不能完全排除水痘的可能性。一般而言似水痘發疹會在肺炎的呼吸道或全身性症狀(頭痛、發燒...)出現後約略3天才會出現。</span></div><div class="separator" style="clear: both; text-align: center;"><span style="font-size: large;"><br /></span></div><div><span style="font-size: large;">武漢肺炎(COVID-19)的似水痘發疹不需治療,一般1-2週就會自行痊癒。(6)</span></div><div><span style="font-size: large;"><br /></span></div><h2 style="text-align: left;"><span style="font-size: large;"><b>5. 網狀青斑/壞死性病灶(livedoid/necrotic lesions)</b></span></h2><div><span style="font-size: large;"><br /></span></div><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_WD4QpA-sC_jztyMt6ceTIf5cV89qKYXyyN9RTR-WBsysit5d404UKDGKR7DykfjhE2y0Kg46_m9WxMuDM62k7zbLKaovLI2N9o_pDSsyfapAvixn5csnx4QTO3WeECZ-pZ8cB9eK2KPf/s960/P43+%25286%2529.jpg" style="margin-left: auto; margin-right: auto;"><span style="font-size: large;"><img border="0" data-original-height="720" data-original-width="960" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_WD4QpA-sC_jztyMt6ceTIf5cV89qKYXyyN9RTR-WBsysit5d404UKDGKR7DykfjhE2y0Kg46_m9WxMuDM62k7zbLKaovLI2N9o_pDSsyfapAvixn5csnx4QTO3WeECZ-pZ8cB9eK2KPf/w640-h480/P43+%25286%2529.jpg" width="640" /></span></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><span style="font-size: large;">武漢肺炎(COVID-19)的<span style="text-align: left;">網狀青斑/壞死性病灶</span></span></td></tr></tbody></table><span style="font-size: large;"><br /></span><div><br /></div><div><span style="font-size: large;">網狀青斑/壞死性病灶會有疼痛或燒灼感,會出現網狀的紫斑。有些紫斑是暫時性的,只會維持數分鐘到數小時;有些則是持續性,甚至出現網狀的壞死。常會發生在有嚴重感染與併發症的年長者,往往是武漢肺炎(COVID-19)衍生凝血問題的後續反應。(6)</span></div><div><span style="font-size: large;"><br /></span></div><h2 style="text-align: left;"><span style="font-size: large;"><b>6. 點狀瘀斑病灶(purpuric/petechial lesions)</b></span></h2><div><span style="font-size: large;"><b><br /></b></span></div><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEguPoaDTiw_6NswZR4lsM4gEvHGFH8ntMbrW2rYFWnMjs6akYjDy-D3Vi8MTHqJEs0cl6flseKulp0uVHEl2BeFPcPCBbpl7zCNR4TV-azwrtsEiQtv0rlUAx3ta2ap7vScOwpvCNT14Ho1/s960/P169+%252818%2529.jpg" style="margin-left: auto; margin-right: auto;"><span style="font-size: large;"><img border="0" data-original-height="540" data-original-width="960" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEguPoaDTiw_6NswZR4lsM4gEvHGFH8ntMbrW2rYFWnMjs6akYjDy-D3Vi8MTHqJEs0cl6flseKulp0uVHEl2BeFPcPCBbpl7zCNR4TV-azwrtsEiQtv0rlUAx3ta2ap7vScOwpvCNT14Ho1/w640-h360/P169+%252818%2529.jpg" width="640" /></span></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><span style="text-align: left;"><span style="font-size: large;">武漢肺炎(COVID-19)的下肢點狀瘀斑</span></span></td></tr></tbody></table><span style="font-size: large;"><br /></span><div><span style="font-size: large;"><br /></span></div><div><span style="font-size: large;"><br /></span></div><div><span style="font-size: large;">另外武漢肺炎(COVID-19)還可能會出現一些相對少見的下肢點狀瘀斑(8),往往是深紅到紫色,壓了不會退、略為凸起的丘疹,主要位於下肢。但也可能從頭部開始出現,向腿部蔓延。基本上與其他原因(其他感染、自體免疫疾病)造成的常見皮膚血管炎很像,也很難作出區分。(3)</span></div><div><div><span style="font-size: large;"><br /></span></div><h2 style="text-align: left;"><span style="font-size: large;"><b>如果出現上述皮膚表現要怎麼辦?</b></span></h2><div><br /></div><span style="font-size: large;">這是一個相當困難的問題,因為防疫不可能盡善盡美,政策也必須考量現有資源與科學證據做調整,依照現有證據與文獻,以及疾管署的網頁(9, 10),有下列幾點建議:<br /><br /></span><ol style="text-align: left;"><li><span style="font-size: large;">多數武漢肺炎(COVID-19)病灶除了<b>網狀青斑/壞死性病灶</b>之外,都<b>無明顯危險</b>,都不用特別治療。</span></li><li><span style="font-size: large;">如果懷疑您的皮疹<b>是武漢肺炎(COVID-19)所致</b>,同時<b>有</b>接觸史、活動史、或其他武漢肺炎(COVID-19)類似症狀,請先聯絡1922或相關單位。</span></li><li><span style="font-size: large;"><b>沒有</b>接觸史、活動史、或其他武漢肺炎(COVID-19)類似症狀,也<b>沒有皮膚不適</b>,請先在家觀察。因為去篩檢路上可能被感染,一次篩檢陰性也不表示沒事。</span></li><li><span style="font-size: large;"><b>沒有</b>接觸史、活動史、或其他武漢肺炎(COVID-19)類似症狀,但<b>有皮膚不適</b>,請在適當保護下就醫。</span></li></ol><span style="font-size: large;"><br />疫情瞬息萬變,如中央防疫政策有改變,請趕快提醒作者,以便立即更新。</span><br /><br /><h2 style="text-align: left;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgaP3sPSqvoCd2sHOmj0IAhVopIVrARRhsrhPSGGFl032j_4NxqmG4XR8rdIUWW_JQFMjNUU0QlHWNJPWl4L-o2Oywkf6TkYsYN3TYqtK8bXk4SfK7212o6LIqlOQI06Yu-e1UBIl8_-A7S/s960/%25E4%25BD%259C%25E8%2580%2585%25E8%2581%25B2%25E6%2598%258E+.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="540" data-original-width="960" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgaP3sPSqvoCd2sHOmj0IAhVopIVrARRhsrhPSGGFl032j_4NxqmG4XR8rdIUWW_JQFMjNUU0QlHWNJPWl4L-o2Oywkf6TkYsYN3TYqtK8bXk4SfK7212o6LIqlOQI06Yu-e1UBIl8_-A7S/w400-h225/%25E4%25BD%259C%25E8%2580%2585%25E8%2581%25B2%25E6%2598%258E+.jpg" width="400" /></a></div><b>參考資料</b></h2></div><br /><div>1.<a href="https://draft.blogger.com/#">https://www.cdc.gov.tw/Advocacy/SubIndex/2xHloQ6fXNagOKPnayrjgQ?diseaseId=N6XvFa1YP9CXYdB0kNSA9A </a>(疾管署網頁)<br />2.Actas Dermosifiliogr. 2020 Nov;111(9):734-742. doi: 10.1016/j.adengl.2020.10.001. Epub 2020 Oct 15.<br />Cutaneous Manifestations in the Context of SARS-CoV-2 Infection (COVID-19)<br />3. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7549735/#">Curr Allergy Asthma Rep.</a> 2020; 20(12): 75. doi: <a href="https://dx.doi.org/10.1007%2Fs11882-020-00974-w">10.1007/s11882-020-00974-</a>Cutaneous Manifestations in Adult Patients with COVID-19 and Dermatologic Conditions Related to the COVID-19 Pandemic in Health Care Workers<div class="separator" style="clear: both; text-align: center;"><br /></div></div><div>4. https://covidskinsigns.com/tag/viral-exanthem/#page-content-conatiner(英國皮膚科醫學會)<br />5. Br J Dermatol. 2020;183(1):71–7. https://doi.org/10.1111/bjd.19163. A large, prospective cohort analysis of patients with cutaneous manifestations and suspected or confirmed COVID-19.<br />6. Br J Dermatol. 2020;183:71-7.Classification of the cutaneous manifestations of COVID-19: a rapid prospective nationwide consensus study in Spain with 375 cases. <div>7. J Am Acad Dermatol. 2020;83:e61-3. Characterization of acute acro-ischemic lesions in non-hospitalized patients: a case series of 132 patients during the COVID-19 outbreak. </div><div>8. Dermatol Ther (Heidelb). 2021 Jun;11(3):695-705. doi: 10.1007/s13555-021-00526-8. Epub 2021 Apr 2.Time of Onset of Selected Skin Lesions Associated with COVID-19: A Systematic Review</div><div>9. <a href="https://draft.blogger.com/#">https://www.nhi.gov.tw/Content_List.aspx?n=BD79A7DABFEC5993&topn=787128DAD5F71B1A</a>(健保署各縣市篩檢站)</div>10. <a href="https://draft.blogger.com/#">https://www.cdc.gov.tw/Uploads/Files/9e796cdd-5179-4efb-93c0-732aac3eb7f3.jpg</a>(疾管署網頁:COVID-19確診及接觸者注意事項)</div><div class="separator" style="clear: both; text-align: center;"><br /></div></div></div>鄭煜彬(Yu-Pin Cheng)http://www.blogger.com/profile/07019803125903571476noreply@blogger.com0tag:blogger.com,1999:blog-5384877319969585099.post-61567509230925247182021-06-01T00:26:00.002-07:002021-07-02T20:05:03.765-07:00雄性禿朋友在武漢肺炎(新冠肺炎,COVID-19)疫情中的危機與轉機:趕快吃雄性禿的藥,降低重症率!<h1 style="text-align: left;"><span style="font-size: x-large;">1. 武漢肺炎(COVID-19)的感染與<span style="color: red;">雄性素</span>關係匪淺:<b><span style="color: red;">男性</span></b>、<b><span style="color: red;">雄性素過多的女性</span></b>、與<b><span style="color: red;">雄性禿</span></b>都是重症的危險因子。<br /></span></h1><h1><span style="font-size: x-large;">2. 目前<span style="color: red;">finasteride</span>與<span style="color: red;">dutasteride</span>可當作<span style="color: red;">降低重症風險</span>使用,但<span style="color: red;">無法取代正規醫療與防疫措施</span>。</span></h1><div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiuwLKykNDAYu07RnU6zMn4_3Vj5nFtb7iLY3c-5g0uhKD_nt3mPqqn1cG9SKCAJ_56zwH7wcllFe5rJ46psf7LmUslMkPjexHSKWqdfbq602Tf-jUSKhHCe7tgQrLBnb84ioX2BcekkYhU/s960/P43+%25281%2529.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="960" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiuwLKykNDAYu07RnU6zMn4_3Vj5nFtb7iLY3c-5g0uhKD_nt3mPqqn1cG9SKCAJ_56zwH7wcllFe5rJ46psf7LmUslMkPjexHSKWqdfbq602Tf-jUSKhHCe7tgQrLBnb84ioX2BcekkYhU/w640-h480/P43+%25281%2529.jpg" width="640" /></a></div><br /><span style="font-size: x-large;"><br /></span></div><h2 style="text-align: left;"><span style="font-size: x-large;">武漢肺炎(COVID-19)與男性、雄性禿的關係匪淺!</span></h2><p><span style="font-size: large;">武漢肺炎(COVID-19)全球爆發後,許多流行病學的研究開始發現<b>男性</b>有較高的<b>盛行率</b>(1)、<b>重症率</b>(2, 3)、以及<b>死亡率</b>(3),根據台灣疾病管制署的統計也是如此(4)。此後更發現武漢肺炎(COVID-19)的感染與雄性素有關(5, 6)。</span></p><p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi0ye4zvOVwxXLCTNliqud2C0zIr-X4Gh8bGEZzr-XBTC6HJRjn1PCGVjm5P5QX2ul9bFEiKbx0ntrukSsZmuOHNnKHJNzmkEAxjOGZ6fOuVMsQy0wo7E6lfbUONXKE6gE6rbAJkU3EWogq/" style="margin-left: auto; margin-right: auto;"><span style="font-size: large;"><img alt="" data-original-height="720" data-original-width="960" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi0ye4zvOVwxXLCTNliqud2C0zIr-X4Gh8bGEZzr-XBTC6HJRjn1PCGVjm5P5QX2ul9bFEiKbx0ntrukSsZmuOHNnKHJNzmkEAxjOGZ6fOuVMsQy0wo7E6lfbUONXKE6gE6rbAJkU3EWogq/w640-h480/P43+%25288%2529.jpg" width="640" /></span></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><span style="font-size: large;">男性的重症率遠高於女性(2)。而且青春期前,雄性荷爾蒙尚未大量分泌,死亡率極低(3)。<br /><br /></span></td></tr></tbody></table><p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjjOOW9Gcr2ZHoSOaK-BzkhVEV54-cKWzgqH29ez6kxB-PL8ESMdlNYPSXCZr_mRRITgvxzJntf2hPD47q8MsMIXie2kLYHSUxXZntAEBViBYJOAamG-TOMIjga6Dtxvx8Es3MEiL9BEmsA/" style="margin-left: auto; margin-right: auto;"><img alt="" data-original-height="720" data-original-width="960" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjjOOW9Gcr2ZHoSOaK-BzkhVEV54-cKWzgqH29ez6kxB-PL8ESMdlNYPSXCZr_mRRITgvxzJntf2hPD47q8MsMIXie2kLYHSUxXZntAEBViBYJOAamG-TOMIjga6Dtxvx8Es3MEiL9BEmsA/w640-h480/P43+%25283%2529.jpg" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><span style="font-size: large;">台灣的死亡人數統計(截至2021/05/30),可看出懸殊男女差異。</span></td></tr></tbody></table><br /><br /><p></p><p><span style="font-size: large;">與雄性素最有關係的疾病之一就是<b>雄性禿</b>,研究也顯示雄性禿病人的武漢肺炎(COVID-19)盛行率較高(6),重症率不意外地也較高(7, 8)。美國皮膚科醫學會的論文為了紀念全美第一位因武漢肺炎(COVID-19)過世的皮膚科醫師Dr. Frank Gabrin,還特別發明了「<b>Gabrin徵象</b>(Gabrin sign)」這個名詞來敘述<b>雄性禿病人有較高風險出現武漢肺炎(COVID-19)重症</b>的事實。(6)</span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiW6uHb3P-NYC9-J7qQcV5uirmCMsXrlnm-TjlvX5QAxu1S8Uli1_pfpa8_Pbbdp36uzCewZLUSp8K9ZXrnEEGxvtOUlQLA43Gj8F9F15YSOiHoxoasT2reFi2afEgpNEK4CjnAu9h1PxCD/s663/Gabrin.jpg" style="margin-left: 1em; margin-right: 1em;"><span style="font-size: large;"><img border="0" data-original-height="266" data-original-width="663" height="256" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiW6uHb3P-NYC9-J7qQcV5uirmCMsXrlnm-TjlvX5QAxu1S8Uli1_pfpa8_Pbbdp36uzCewZLUSp8K9ZXrnEEGxvtOUlQLA43Gj8F9F15YSOiHoxoasT2reFi2afEgpNEK4CjnAu9h1PxCD/w640-h256/Gabrin.jpg" width="640" /></span></a></div><span style="font-size: large;">Gabrin徵象:<b>雄性禿病人有較高風險出現武漢肺炎(COVID-19)重症。</b>武漢肺炎(COVID-19)重症的住院病人也有較高比例有雄性禿(住院男性79%,住院女性42%;一般男性最多53%,一般女性最多38%)(6)<br /></span><p><span style="font-size: large;">同樣的狀況也發生在一些雄性素過高的女性身上,例如多囊性卵巢(polycystic ovary syndrome)的女性常有雄性素過剩的狀況,後續研究也證實這些病人的武漢肺炎(COVID-19)較一般女性更嚴重。(9)</span></p><h2 style="text-align: left;"><span style="font-size: x-large;">為何武漢肺炎(COVID-19)的感染會與雄性素有關?</span></h2><div><span style="font-size: large;"><br /></span></div><p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjtgL_DtHs-KShZc3LnW4PJ2mmZy8oktFFnY_Rx37UdrJRNN3qtJzNsvP53DvJpfZV5n-BB3rR9AuE_dUHZvMp5M0BevRKfEbKrb-BRo2cKlMBoxQFB9GiIFSUScIwP6iK3bGV82dCbW-lG/" style="margin-left: auto; margin-right: auto;"><span style="font-size: large;"><img alt="" data-original-height="540" data-original-width="960" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjtgL_DtHs-KShZc3LnW4PJ2mmZy8oktFFnY_Rx37UdrJRNN3qtJzNsvP53DvJpfZV5n-BB3rR9AuE_dUHZvMp5M0BevRKfEbKrb-BRo2cKlMBoxQFB9GiIFSUScIwP6iK3bGV82dCbW-lG/w640-h360/P169+%25285%2529.jpg" width="640" /></span></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><span style="font-size: large;">雄性素「啟動」武漢肺炎病毒棘蛋白的流程(6)</span></td></tr></tbody></table><span style="font-size: large;"><br /></span><p></p><p><span style="font-size: large;">簡而言之,武漢肺炎(COVID-19)是用表面的<b>棘蛋白</b>(spike protein)經由肺部的<b>ACE2</b>受器感染人體。(6)</span></p><p><span style="font-size: large;">在人體中,雄性素<b>睪固酮</b>或<b>二氫睪固酮</b>(加強版睪固酮,<b>比睪固酮作用更強</b>)可以活化<b>雄性素受器</b>(AR),促進<b>TMPRSS2</b>這種蛋白酶活化,進一步<b>啟動棘蛋白</b>。所以<b>雄性素(尤其</b><b>二氫睪固酮</b><b>)的量</b>如果<b>較高,棘蛋白的活性也會較高。(6)</b></span></p><h2 style="text-align: left;"><span style="font-size: x-large;">面對武漢肺炎(COVID-19)疫情,如何從雄性素著手?</span></h2><div><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjRTCX8v1NyHEEcYVe3ut1a4EjKGLuP_w_x-q7LIwIIENq9kEz7k7xzD24wAavF6EwTlKIgXTq9MOxBqkqWcEyp-6gNIn1mHQQFOQNAGxdTNM4WSB-ZX5-EXK2oayPV2EU9jnBOYk-Bu1g2/s960/P43+%25282%2529.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="720" data-original-width="960" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjRTCX8v1NyHEEcYVe3ut1a4EjKGLuP_w_x-q7LIwIIENq9kEz7k7xzD24wAavF6EwTlKIgXTq9MOxBqkqWcEyp-6gNIn1mHQQFOQNAGxdTNM4WSB-ZX5-EXK2oayPV2EU9jnBOYk-Bu1g2/w640-h480/P43+%25282%2529.jpg" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: left;"><span style="font-size: large;">現有抗雄性素藥物總覽,dutasteride、finasteride、spironolactone幾個藥有文獻支持用於武漢肺炎(COVID-19)治療。</span></td></tr></tbody></table><br /></div><p></p><p><span style="font-size: large;">從上表觀之,人類其實有很多藥物可以用來抑制<b>睪固酮⇨二氫睪固酮⇨雄性素受器⇨TMPRSS2⇨棘蛋白</b>這一連串反應。這些藥都歸屬於抗雄性素藥物治療(anti-androgenic therapies)。</span></p><p><span style="font-size: large;">既然雄性素確實是武漢肺炎(COVID-19)啟動的因子之一,抑制它是否真的能夠改變肺炎病程?</span></p><span style="font-size: large;"><b>答案是肯定的!</b>以下簡述幾個研究結果。由於目前最廣為使用的抗雄性素藥物是5α還原酶抑制劑(5α-reductase inhibitors),大部分研究都與<b>finasteride</b>與<b>dutasteride</b>兩個<b>5α還原酶抑制劑</b>有關。</span><p><span style="font-size: large;"><b>義大利</b>研究發現得武漢肺炎(COVID-19)的421名男病人中,只有4.22%有服用finasteride或dutasteride,這比例遠低於正常比例14.97%,意味著服用finasteride或dutasteride較不容易成為肺炎患者。(10)</span></p><p><span style="font-size: large;"><b>美國</b>與多國合作的研究發現48名服用finasteride或dutasteride超過六個月的肺炎病人較沒服用的病人症狀少得多。(11)</span></p><p><span style="font-size: large;"><b>巴西</b>研究305名沒住院的肺炎病人,這些人使用azithromycin with nitazoxanide, hydroxychloroquine or ivermectin等藥物,但有些人服用dutasteride(開放式研究,病人知情),有些沒有。發現大多數(82.7%)有服用dutasteride的病人都沒症狀,而有雄性禿又沒服用dutasteride的病人比沒雄性禿的病人症狀還嚴重。(12)</span></p><p></p><ul style="text-align: left;"><li><span style="font-size: large;">以包括嗅覺障礙的症狀緩解時間(Remission including anosmia)來比較,有雄性禿但有服用dutasteride的病人最短(0.9日),其次是無雄性禿的病人(9.4日),最長則是有雄性禿但沒服藥的病人(14.2日)。(12)</span></li><li><span style="font-size: large;">以RT-PCR陽性(會產生病毒,可能感染他人)的時間長度來比較,有雄性禿但有服用dutasteride的病人最短(8.2日),其次是無雄性禿的病人(14.0日),最長則是有雄性禿但沒服藥的病人(17.8日)。(12)</span></li></ul><p></p><p><span style="font-size: large;">同樣巴西的團隊後來仿照上述實驗設計,進一步用沒住院的肺炎病人進行雙盲研究(13),得到類似的結果:使用dutasteride的病人在病程、恢復程度、各項抽血指標都一面倒優於安慰劑組。再次證明抑制雄性素對於武漢肺炎(COVID-19)的治療有明顯助益。</span></p><p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhASzBv7CKhy6GnEY0bauvfcGH1ImgyUJzxXXPOpx7GRZX_6GEdJdHd5udIxLk2LvyUlWqLFaRnPS8tjlFtK0K95F3abbUVXvD_BYSGoUs7B9vcu6cRFhAwdN9t1AosW-tUFUzXq6URvg2l/" style="margin-left: auto; margin-right: auto;"><span style="font-size: large;"><img alt="" data-original-height="720" data-original-width="960" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhASzBv7CKhy6GnEY0bauvfcGH1ImgyUJzxXXPOpx7GRZX_6GEdJdHd5udIxLk2LvyUlWqLFaRnPS8tjlFtK0K95F3abbUVXvD_BYSGoUs7B9vcu6cRFhAwdN9t1AosW-tUFUzXq6URvg2l/w640-h480/P43+%25282%2529.jpg" width="640" /></span></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><span style="font-size: large;">綠色的dutasteride組在各個評估項目(完治率、康復程度、各種抽血指標)都優於棕色的安慰劑組。</span></td></tr></tbody></table><span style="font-size: large;"><br />由上述研究結果可知,抑制雄性素作用的藥物finasteride與dutasteride對武漢肺炎(COVID-19)居然有出乎意料的幫助。對於得到武漢肺炎(COVID-19)時重症率較高、症狀緩解時間較長的雄性禿患者更是救贖,平常使用這些藥品可以讓他們眾多不利的臨床數值頓時逆轉勝,甚至變得比沒雄性禿的人更好。</span><div><span style="font-size: large;"><br /></span></div><div><span style="font-size: large;">目前finasteride與dutasteride的適應症包括<b>男性雄性禿</b>與<b>男性攝護腺</b>肥大。根據上述結論,筆者建議:</span><p></p><p></p><ul style="text-align: left;"><li><span style="color: red; font-size: large;">目前finasteride與dutasteride的功能應該當作降低重症風險使用,並無法取代正規醫療與防疫措施。</span></li><li><span style="font-size: large;">雄性禿/攝護腺肥大的病人如果已經在使用finasteride或dutasteride,<b>應該持續使用</b>,不要給病毒任何機會!</span></li><li><span style="font-size: large;">雄性禿/攝護腺肥大的病人如果尚未使用finasteride或dutasteride,為了保護<b>自己、家人、與頭髮</b>,真的應該趕快開始使用</span>!</li><li><span style="font-size: large;"><b>沒有</b>雄性禿/攝護腺肥大的男性或<b>孕齡女性</b>想要使用finasteride或dutasteride,請務必與您的醫師討論。基本上一般男性吃沒有大問題,但女性一定要審慎考慮懷孕問題。</span></li></ul><div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgaKm1wbGwFlT7h0NFXpZ6PJZtE0dcMcDMOG612H8kU1CexuBYdAT1oWIrDMSwSqZRmHxDR0BjjRNhx989d7-0wt3hfFkqHyUdaO7VxqjbP5uIDpSAOdvR5k2LIHxCpSnwGyWOKJFm1EpSy/" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="540" data-original-width="960" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgaKm1wbGwFlT7h0NFXpZ6PJZtE0dcMcDMOG612H8kU1CexuBYdAT1oWIrDMSwSqZRmHxDR0BjjRNhx989d7-0wt3hfFkqHyUdaO7VxqjbP5uIDpSAOdvR5k2LIHxCpSnwGyWOKJFm1EpSy/w640-h360/%25E4%25BD%259C%25E8%2580%2585%25E8%2581%25B2%25E6%2598%258E.jpg" width="640" /></a></div><br /><br /><span style="font-size: large;"><br /></span></div><h2 style="text-align: left;"><span style="font-size: large;">參考資料</span></h2><ol style="text-align: left;"><li>J Clin Med. 2020 Mar 30;9(4):941. doi: 10.3390/jcm9040941. Novel Coronavirus Infection (COVID-19) in Humans: A Scoping Review and Meta-Analysis(男性較高盛行率)</li><li>Front. Public Health, 29 April 2020 | <a href="https://draft.blogger.com/#">https://doi.org/10.3389/fpubh.2020.00152</a>(男性較高重症率)</li><li>Int J Heart Fail. 2020 Apr;2(2):111-114.Published online Apr 07, 2020. <a href="https://draft.blogger.com/#">https://doi.org/10.36628/ijhf.2020.0015</a>(男性較高重症率與死亡率)</li><li><a href="https://draft.blogger.com/#">https://www.cdc.gov.tw/</a>(疾病管制署)</li><li>Cancers. 2020;12(8):2325. Sex hormones and hormone therapy during covid-19 pandemic: Implications for patients with cancer.</li><li>J Am Acad Dermatol. 2020 Aug;83(2):680-682. doi: 10.1016/j.jaad.2020.05.079. Epub 2020 May 22.Androgenetic alopecia present in the majority of patients hospitalized with COVID-19: The "Gabrin sign" (Gabrin徵象)</li><li>J Cosmet Dermatol. 2020 Jul;19(7):1545-1547. doi: 10.1111/jocd.13443. Epub 2020 Apr 23.A preliminary observation: Male pattern hair loss among hospitalized COVID-19 patients in Spain - A potential clue to the role of androgens in COVID-19 severity.(雄性禿重症率高)</li><li>J Am Acad Dermatol. 2020 Nov;83(5):e353-e354. doi: 10.1016/j.jaad.2020.07.062. Epub 2020 Jul 22. Male balding is a major risk factor for severe COVID-19(雄性禿重症率高)</li><li>J Eur Acad Dermatol Venereol. 2021 Feb;35(2):e101-e104. doi: 10.1111/jdv.17004. Epub 2020 Nov 8.Clinical symptoms of hyperandrogenic women diagnosed with COVID-19(高雄性素女性有較嚴重肺炎症狀)</li><li>Lazzeri M, Azzolini E, Buffi NM, Fasulo V, Persico F, Saita A, et al. Impact of anti-androgenic therapies on COVID-19: an observational study in male population from a COVID-19 regional centre of Lombardy (Italy).</li><li>J Eur Acad Dermatol Venereol. 2021 Apr;35(4):e243-e246. doi: 10.1111/jdv.17021. Epub 2020 Nov 22.5-alpha-reductase inhibitors are associated with reduced frequency of COVID-19 symptoms in males with androgenetic alopecia.(USA)</li><li>Azithromycin with nitazoxanide, hydroxychloroquine or ivermectin, with or without dutasteride, for early stage COVID-19: an open-label prospective observational study in males with mild-to-moderate COVID-19 (The Pre-AndroCoV Male Trial). 2020. </li><li><a href="https://draft.blogger.com/#">Cureus.</a> 2021 Feb; 13(2): e13047.doi: <a href="https://draft.blogger.com/#">10.7759/cureus.13047</a> Early Antiandrogen Therapy With Dutasteride Reduces Viral Shedding, Inflammatory Responses, and Time-to-Remission in Males With COVID-19: A Randomized, Double-Blind, Placebo-Controlled Interventional Trial (EAT-DUTA AndroCoV Trial – Biochemical)</li></ol><div><div><div><div class="separator" style="clear: both; text-align: center;"><br /></div><p><br /></p><p><br /></p></div></div></div></div>鄭煜彬(Yu-Pin Cheng)http://www.blogger.com/profile/07019803125903571476noreply@blogger.com0tag:blogger.com,1999:blog-5384877319969585099.post-68982853208149748422021-05-28T20:59:00.008-07:002021-05-28T21:14:17.774-07:00武漢肺炎(新冠肺炎、COVID-19)的兒童皮膚表現<h1 style="text-align: left;"><span style="font-size: x-large;"><span style="font-family: arial;">1. 武漢肺炎(新冠肺炎,COVID-19)的兒童皮膚表現除了</span><span style="color: red;">似肢端凍瘡病灶</span><span>外,大多沒有特異性,很難當作診斷依據,</span><span style="color: red;">只能用來解釋確診後的皮膚變化</span><span>。</span></span></h1><h1 style="text-align: left;"><span style="font-size: x-large;"><span style="font-family: arial;">2. 多數</span><span style="font-family: arial;">武漢肺炎(COVID-19)病灶</span>除了<b><span style="color: red;">似川崎氏症</span>表現</b>之外,<span style="color: red;">都</span><span style="font-family: arial;"><span style="color: red;">無明顯危險</span>,且兒童的症狀與死亡率均輕微。</span></span></h1><h1 style="text-align: left;"><span style="font-size: x-large;"><span><span style="font-family: arial;">3. 有出現</span></span><span style="color: red;">似川崎氏症表現</span>,不論如何都要快到<span style="color: red;">小兒科</span>就醫。</span></h1><h1 style="text-align: left;"><span style="font-size: x-large;"><span><span style="font-family: arial;">4. </span><span style="font-family: arial;">如果懷疑您或小孩的<span style="color: red;">皮疹是武漢肺炎(COVID-19)所致</span>,同時<b><span style="color: red;">有</span></b></span><b>接觸史、活動史、或其他武漢肺炎(COVID-19)類似症狀</b>,<span style="color: red;">請先聯絡</span></span><span style="color: red;">1922</span><span>專線,</span><span style="color: red;">0800-001922,或</span><span style="color: red;"><a href="https://www.nhi.gov.tw/Content_List.aspx?n=BD79A7DABFEC5993&topn=787128DAD5F71B1A">各縣市篩檢站</a></span>。</span></h1><h1 style="text-align: left;"><span style="font-size: x-large;"><span>5. </span><span><span style="color: red;">沒</span><span style="color: red; font-family: arial;"><b>有</b></span><b>接觸史、活動史、或其他武漢肺炎(COVID-19)類似症狀,也<span style="color: red;">沒有皮膚不適,</span></b></span><span style="color: red;">請先在家觀察</span><span>。</span></span></h1><h1 style="text-align: left;"><span style="font-size: x-large;"><span><span style="font-family: arial;">6. </span></span><span style="color: red;">沒</span><span style="color: red; font-family: arial;"><b>有</b></span><b>接觸史、活動史、或其他武漢肺炎(COVID-19)類似症狀,但<span style="color: red;">有</span></b><span style="font-family: arial;"><span style="color: red;">皮膚不適,</span></span><span style="color: red;">請在適當保護下就醫。</span></span></h1><div><div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJt7rIx8rAyH1Nt8_3aOB6LwgPYoKiM5cEHSlTwoFTZwvO_mhLZ8iYNTChTEyWHHv10d0URpZNVgJrY2-KRwVQHxlxnoF067EHJGG2XP334_w79sGhHOhBnMQAotkmZbencrcdBRp_KpD8/s960/P169+%25285%2529.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="540" data-original-width="960" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJt7rIx8rAyH1Nt8_3aOB6LwgPYoKiM5cEHSlTwoFTZwvO_mhLZ8iYNTChTEyWHHv10d0URpZNVgJrY2-KRwVQHxlxnoF067EHJGG2XP334_w79sGhHOhBnMQAotkmZbencrcdBRp_KpD8/w640-h360/P169+%25285%2529.jpg" width="640" /></a></div><br /><span style="font-family: arial; font-size: large;"><br />最近台灣的武漢肺炎(COVID-19)疫情延燒,漸漸地門診也開始看得到武漢肺炎(COVID-19)產生的皮膚病灶。然而這些病灶多半沒有特異性,無法幫助診斷</span><span style="font-family: arial;"><span style="font-size: large;">武漢肺炎(COVID-19)。因此本文主要目的是要讓醫師提高警覺,適時為民眾轉介篩檢。</span></span></div><div><span style="font-family: arial;"><span style="font-size: large;"><br /></span></span></div><div><span style="font-size: large;"><span style="font-family: arial;">如果</span><span style="font-family: arial;">民眾</span><span style="font-family: arial;">真的出</span>現<b>這些病灶</b>,同時<b>有接觸史、活動史、或其他武漢肺炎(COVID-19)類似症狀</b>,請先聯絡<a href="https://www.nhi.gov.tw/Content_List.aspx?n=BD79A7DABFEC5993&topn=787128DAD5F71B1A">各縣市篩檢站</a>。</span></div><div><br /><b style="font-family: arial;"><span style="font-size: x-large;">武漢肺炎(COVID-19)有哪些兒童的皮膚表現?</span></b></div><div><div><span style="font-size: large;"><br /></span></div><span style="font-family: arial; font-size: large;">武漢肺炎(COVID-19)的兒童皮膚病灶與成人不太一樣,但是最常見、最特異的跟成人一樣都是<b>似肢端凍瘡病灶</b>。第二、第三常見的分別是<b>多型性紅斑</b>與<b>全身斑丘疹</b>。其他<b>似水痘發疹</b>與<b>似川崎氏症表現</b>都相對罕見。除了<b>似川崎氏症表現</b>會有<b>較高死亡率與併發症</b>外,其他四種在兩週內都能自癒。<br /> <br /></span><h1 style="text-align: left;"><span style="font-family: arial; font-size: large;"><b>1. 似肢端凍瘡病灶 Acral chilblain-like lesion</b></span></h1><span style="font-family: arial; font-size: large;"><div><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjegdN0_Kby8x1uSdIM1QebAhxm3ElSa1biMeOumy11PNQolhPJ4h6Fo0md3JPQG3sSOtTqv-Hij0pdq3kOIcv1OgVWOEZQgrMnxq46eSH0SDfrCuDuN7_VH5y-HNFjyscV9AlYso4KqVwq/s960/P43+%25281%2529.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="720" data-original-width="960" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjegdN0_Kby8x1uSdIM1QebAhxm3ElSa1biMeOumy11PNQolhPJ4h6Fo0md3JPQG3sSOtTqv-Hij0pdq3kOIcv1OgVWOEZQgrMnxq46eSH0SDfrCuDuN7_VH5y-HNFjyscV9AlYso4KqVwq/w640-h480/P43+%25281%2529.jpg" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><span style="text-align: left;"><span style="font-size: large;">武漢肺炎(COVID-19)的似肢端凍瘡病灶常出現在腳趾,請注意白色箭頭指的紫紅色斑疹。</span></span><span style="font-size: medium;">https://covidskinsigns.com/tag/viral-exanthem/#page-content-conatiner</span></td></tr></tbody></table><span style="font-family: arial; font-size: large;"><br /></span></div>武漢肺炎(COVID-19)的似肢端凍瘡病灶<b>與一般的凍瘡很像,都是邊緣不清楚的紫紅色斑疹、丘疹與斑塊,少數有表淺水泡與出血性結痂,好發於腳趾。</b><b>一般的凍瘡(chilblain)在台灣應出現於冬季,而且多半在手指</b>,如果天氣不冷時出現凍瘡,就要考慮自體免疫疾病、雷諾氏症候群(Raynaud's phenomenon)、家族性凍瘡(familial chilblains)、以及武漢肺炎(COVID-19)。不過上述疾病大多有過去病史可循,如果是最近才突然出現,就要考慮武漢肺炎。</span></div><div><span style="font-family: arial; font-size: large;"><br /></span></div><div><span style="font-size: large;"><span style="font-family: arial;">一般而言</span>武漢肺炎(COVID-19)的<span style="font-family: arial;">似肢端凍瘡病灶不需治療,<b>1-2週</b>就會自行痊癒。</span></span></div><div><span style="font-family: arial; font-size: large;"><br /></span><h1 style="text-align: left;"><span style="font-family: arial; font-size: large;">2. 多型性紅斑</span></h1><div><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg9PiZYdzsTwtEW-nHyI472uczhsZDvYArhsf_QlWLl6cHu3ETd804JTCXlxEwStJNji7MRW9kmnt3o4yBwrj2rHVoOurJXLUT_7gmyNw8rWSFvJ8VPPSQepaEdfdxwdi3FfiuHVoqPMfLi/s960/P43.jpg" style="margin-left: auto; margin-right: auto;"><span style="font-size: large;"><img border="0" data-original-height="720" data-original-width="960" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg9PiZYdzsTwtEW-nHyI472uczhsZDvYArhsf_QlWLl6cHu3ETd804JTCXlxEwStJNji7MRW9kmnt3o4yBwrj2rHVoOurJXLUT_7gmyNw8rWSFvJ8VPPSQepaEdfdxwdi3FfiuHVoqPMfLi/w640-h480/P43.jpg" width="640" /></span></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><span style="font-family: arial; text-align: start;"><span style="font-size: large;">武漢肺炎(COVID-19)的多型性紅斑,請注意中央的暗紅與外圍的紅斑之間有一圈較為蒼白。</span></span><span style="font-size: medium;">Pediatr Dermatol. 2020 May;37(3):442-446. doi: 10.1111/pde.14246.Erythema multiforme-like lesions in children and COVID-19</span></td></tr></tbody></table><span style="font-family: arial; font-size: large;"><br /></span></div><span style="font-size: large;"><span style="font-family: arial;">武漢肺炎(COVID-19)的多型性紅斑與其他原因造成的類似,都會有<b>靶狀(三圈,內到外分別是暗紅、白、紅)或似靶狀(二圈,內暗紅、外紅)病灶</b>與大小不一的融合斑疹、丘疹、與斑塊,有些中央會出血或結痂。好發</span><span>位置包括腳、手、手肘/膝蓋、與嘴唇,也與</span><span style="font-family: arial;">其他原因造成的</span><span>多型性紅斑類似。<br /></span><span style="font-family: arial;"><br />但是武漢肺炎(</span><span>COVID-19)的多型性紅斑檢查不出單純皰疹病毒(Herpes Simplex Virus)與黴漿菌(Mycoplasma pneumoniae)等傳統病原感染的證據,而會檢查出武漢肺炎病毒。如果現在出現這類病灶,病人又有確診武漢肺炎(COVID-19),可以考慮是武漢肺炎(COVID-19)造成的皮疹。</span></span></div><div><span style="font-size: large;"><span style="font-family: arial;">一般而言</span>武漢肺炎(COVID-19)的<span style="font-family: arial;">多型性紅斑</span><span style="font-family: arial;">不需治療,<b>1週</b>就會自行痊癒。但如果持續一週以上,就有就醫的必要,以防是其他藥物疹或感染。</span></span></div><div><span style="font-size: large;"><br /></span><h1 style="text-align: left;"><span style="font-size: large;"><b>3.非肢端紅色斑丘疹(病毒疹) Non acral erythematous maculopapular rash</b></span></h1><span><div><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="font-size: x-large; margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhxfeu6MuR3vPYsbNu8Rc_Mvn_d4fRiu4nvrEh-iUJRVEmhKQc-QLpbccdW0QpRbZMDt-cKngZTU0SW2PsmTukV4f2m4Dt26rDVh8zSlyfe42s8aYddf2riVRGwnIT6A63J1lEJCkfLxiMO/s2048/viral+exanthem2.jpeg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1536" data-original-width="2048" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhxfeu6MuR3vPYsbNu8Rc_Mvn_d4fRiu4nvrEh-iUJRVEmhKQc-QLpbccdW0QpRbZMDt-cKngZTU0SW2PsmTukV4f2m4Dt26rDVh8zSlyfe42s8aYddf2riVRGwnIT6A63J1lEJCkfLxiMO/w640-h480/viral+exanthem2.jpeg" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><span style="text-align: start;"><span>武漢肺炎(COVID-19)的病毒疹,是很沒特徵的紅色斑疹或丘疹,型態與</span></span><span>分布和一般病毒疹無異。</span><span style="font-size: medium;">https://covidskinsigns.com/tag/viral-exanthem/#page-content-conatiner</span></td></tr></tbody></table><br /><br /></div><span style="font-size: large;">武漢肺炎(COVID-19)的病毒疹</span><b style="font-size: x-large;">非常沒有特異性</b><span style="font-size: large;">,與其他原因造成的類似,都是會癢的</span><b style="font-size: x-large;">紅色斑丘疹</b><span style="font-size: large;">。從臉部先出現,之後漸漸蔓延到軀幹與四肢。然而</span><b style="font-size: x-large;">武漢肺炎(COVID-19)的病毒疹較容易蔓延到手腳,也較常合併水泡、破皮、與結痂</b><span style="font-size: large;">。</span></span></div><div><span style="font-size: large;"><br /></span></div><div><span style="font-size: large;">如果現在出現這類病灶,病人有確診武漢肺炎(COVID-19),排除其他藥物過敏,就可以考慮是武漢肺炎(COVID-19)造成的皮疹。</span></div><div><span style="font-size: large;"><br /><span style="font-family: arial;">一般而言</span>武漢肺炎(COVID-19)的病毒疹<span style="font-family: arial;">不需治療,<b>1週</b>就會自行痊癒。</span><br /></span><h1 style="text-align: left;"><span style="font-size: large;">4. 似水痘發疹 Varicella like exanthema</span></h1><div><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjVsLx4ofI38aqMmIUWzZFEEOn7GOxkvELmChFVqxeJrg5DLQRv665XH8pyEr7PtS7T0FTviMZfVia28sqkxOIyay-Zfo8LUgiyxqF0GFLGR09JnwIFY4KXpCSC1HJ9Y4F_99h7s52N1Lqr/s709/Varicella-like+COVID19.jpg" style="margin-left: auto; margin-right: auto;"><span style="font-size: large;"><img border="0" data-original-height="478" data-original-width="709" height="432" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjVsLx4ofI38aqMmIUWzZFEEOn7GOxkvELmChFVqxeJrg5DLQRv665XH8pyEr7PtS7T0FTviMZfVia28sqkxOIyay-Zfo8LUgiyxqF0GFLGR09JnwIFY4KXpCSC1HJ9Y4F_99h7s52N1Lqr/w640-h432/Varicella-like+COVID19.jpg" width="640" /></span></a></td></tr><tr><td class="tr-caption"><span style="font-size: large;">武漢肺炎(COVID-19)的似水痘發疹會出現散布的紅色的丘疹與少數水泡。</span><span style="font-size: medium;">Pediatr Dermatol. 2020 May;37(3):435-436. doi: 10.1111/pde.14201. Epub 2020 May 19.Varicella-like exanthem associated with COVID-19 in an 8-year-old girl: A diagnostic clue?</span></td></tr></tbody></table><span style="font-size: large;"><br /></span></div><div><span style="font-size: large;"><span>武漢肺炎(COVID-19)的似水痘發疹就非常少見了,</span><b>軀幹</b><span>會出現</span><b>散布的紅色的丘疹與少數水泡</b><span>,並有表淺水泡與結痂,與水痘的病灶類似。但是台灣的小孩已經全面接種水痘疫苗,如果現在出現這類病灶,病人又有確診武漢肺炎(COVID-19),可以考慮是武漢肺炎(COVID-19)造成的皮疹。</span></span></div><span style="font-size: large;"><span style="font-family: arial;">一般而言</span>武漢肺炎(COVID-19)的似水痘發疹<span style="font-family: arial;">不需治療,1週就會自行痊癒。</span><br /></span><h1 style="text-align: left;"><span style="font-size: large;"><b>5. 似川崎氏症表現 Kawasaki disease like presentation </b></span></h1><div><span style="font-size: large;"><div class="separator" style="clear: both; text-align: center;"><br /></div><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi75WHGRMalv6z5TCySOpvsAxY3z038i6RfsHBMc5xP3gJIl6QPHe3uZ0dCtYVosHKTqLLt1G2KNu7fhxBgStAH4txTNbYVPegIUM3BP-Md5SC6adoOsV2TjKXJzJpuo6hs-lmVOlivjjaz/s960/P43.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="720" data-original-width="960" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi75WHGRMalv6z5TCySOpvsAxY3z038i6RfsHBMc5xP3gJIl6QPHe3uZ0dCtYVosHKTqLLt1G2KNu7fhxBgStAH4txTNbYVPegIUM3BP-Md5SC6adoOsV2TjKXJzJpuo6hs-lmVOlivjjaz/w640-h480/P43.jpg" width="640" /></a></td></tr><tr><td class="tr-caption"><span style="font-size: large;">武漢肺炎(COVID-19)的似川崎氏症表現,廣泛性發疹後,會伴隨廣泛脫屑。</span><span style="font-size: medium;">J Eur Acad Dermatol Venereol. 2020 Oct;34(10):e539-e541. doi: 10.1111/jdv.16666. Epub 2020 Jul 6.Erythema multiforme and Kawasaki disease associated with COVID-19 infection in children.</span></td></tr></tbody></table><b><br /></b></span></div><span style="font-size: large;">武漢肺炎(COVID-19)的似川崎氏症表現也很罕見,會出現<b>廣泛性發疹、手掌水腫、舌炎與頸部淋巴結腫大。</b>這些皮疹之後會出現脫屑。但是川崎氏症的病原到現在還檢查不出,無法進一步排除。只能說如果病人有確診武漢肺炎(COVID-19),同時看到這種表現,可以考慮是武漢肺炎(COVID-19)造成的皮疹。<br /><br />然而,武漢肺炎(COVID-19)的似川崎氏症表現不像其他幾種武漢肺炎(COVID-19)皮膚表現這麼無害,反而<b>會導致較嚴重的後果</b>,死亡率從2.1–18%都有人報告,遠大於典型川崎氏症(Kawasaki disease)的死亡率0.17%,所幸目前都是非洲裔與西班牙裔報告較多。</span></div><div><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgzx834nH0RK410TmDa-JUz6r37LqClgl6W0OFyufuUHDP9qGCIrlykZ17YMpbz0f7A4l42LBeBpRZ1UxPIvEMp8jK_S7G2Xw4ttggRvRxySfUMyDD2lmHvgQRdPCX8G6PmQDBaf545h90U/s960/P169+%25285%2529.jpg" style="margin-left: auto; margin-right: auto;"><span style="font-size: large;"><img border="0" data-original-height="540" data-original-width="960" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgzx834nH0RK410TmDa-JUz6r37LqClgl6W0OFyufuUHDP9qGCIrlykZ17YMpbz0f7A4l42LBeBpRZ1UxPIvEMp8jK_S7G2Xw4ttggRvRxySfUMyDD2lmHvgQRdPCX8G6PmQDBaf545h90U/w640-h360/P169+%25285%2529.jpg" width="640" /></span></a></td></tr><tr><td class="tr-caption"><span style="font-size: large;">本文的重點都在此表中,歡迎在未修改情況下轉載。</span></td></tr></tbody></table><span style="font-size: large;"><br /><span><br /></span></span></div><div><span style="font-size: large;"><br /></span></div><div><span style="font-size: large;"><b>如果出現上述皮膚表現要怎麼辦?</b></span></div><div><span style="font-size: large;"><br /></span></div><div><span style="font-size: large;">這是一個相當困難的問題,因為防疫不可能盡善盡美,政策也必須考量現有資源與科學證據做調整,依照現有證據與文獻,以及疾管署的網頁,有下列幾點建議:</span></div><div><ol style="text-align: left;"><li><span style="font-size: large;"><span style="font-family: arial;">多數</span><span style="font-family: arial;">武漢肺炎(COVID-19)病灶</span><span>除了</span><b><span style="color: red;">似川崎氏症表現</span></b><span>之外,</span><span style="color: red;"><b>都</b></span><span style="font-family: arial;"><span style="color: red;"><b>無明顯危險</b></span>,且兒童的症狀與死亡率均輕微,都不用特別治療。</span></span></li><li><span style="font-size: large;"><span style="font-family: arial;">有出現</span><span style="color: red;"><b>似川崎氏症表現</b></span>,不論如何都要快到<span style="color: red;"><b>小兒科</b></span>就醫,很可能要用到很多小兒科的重裝備。</span></li><li><span style="font-size: large;"><span style="font-family: arial;">如果懷疑您或小孩的<span style="color: red;"><b>皮疹是武漢肺炎(COVID-19)所致</b></span>,同時<b><span style="color: red;">有</span></b></span>接觸史、活動史、或其他武漢肺炎(COVID-19)類似症狀,<span style="color: red;"><b>請先聯絡1922或相關單位。</b></span></span></li><li><span style="font-size: large;"><span style="color: red;"><b>沒</b></span><span style="color: red; font-family: arial;"><b>有</b></span>接觸史、活動史、或其他武漢肺炎(COVID-19)類似症狀,也<span style="color: red; font-weight: bold;">沒有皮膚不適</span><b><span style="color: red;">,</span><span style="color: red;">請先在家觀察</span></b>。因為去篩檢路上可能被感染,快篩陰性也不表示沒事。</span></li><li><span style="font-size: large;"><b><span style="color: red;">沒</span><span style="color: red; font-family: arial;">有</span></b>接觸史、活動史、或其他武漢肺炎(COVID-19)類似症狀,但<span style="color: red; font-weight: bold;">有</span><b><span style="font-family: arial;"><span style="color: red;">皮膚不適,</span></span><span style="color: red;">請在適當保護下就醫。<br /></span></b></span></li><li><span style="font-size: large;"><b><span style="color: red;">疫情瞬息萬變,如中央防疫政策有改變,請趕快提醒作者,以便立即更新。</span></b></span></li></ol></div><div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgaP3sPSqvoCd2sHOmj0IAhVopIVrARRhsrhPSGGFl032j_4NxqmG4XR8rdIUWW_JQFMjNUU0QlHWNJPWl4L-o2Oywkf6TkYsYN3TYqtK8bXk4SfK7212o6LIqlOQI06Yu-e1UBIl8_-A7S/s960/%25E4%25BD%259C%25E8%2580%2585%25E8%2581%25B2%25E6%2598%258E+.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="540" data-original-width="960" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgaP3sPSqvoCd2sHOmj0IAhVopIVrARRhsrhPSGGFl032j_4NxqmG4XR8rdIUWW_JQFMjNUU0QlHWNJPWl4L-o2Oywkf6TkYsYN3TYqtK8bXk4SfK7212o6LIqlOQI06Yu-e1UBIl8_-A7S/w400-h225/%25E4%25BD%259C%25E8%2580%2585%25E8%2581%25B2%25E6%2598%258E+.jpg" width="400" /></a></div><span style="font-size: large;"><br /></span><h1 style="text-align: left;"><span style="font-size: large;"><b>參考資料</b></span></h1><span style="font-size: medium;">1.<a href="https://draft.blogger.com/#">https://www.cdc.gov.tw/Advocacy/SubIndex/2xHloQ6fXNagOKPnayrjgQ?diseaseId=N6XvFa1YP9CXYdB0kNSA9A </a>(疾管署網頁)<br />2. J Family Med Prim Care. 2021 Jan;10(1):93-101. doi: 10.4103/jfmpc.jfmpc_1389_20. Epub 2021 Jan 30.Cutaneous manifestations associated with COVID-19 in children: A systematic review<br />3. https://covidskinsigns.com/tag/viral-exanthem/#page-content-conatiner(英國皮膚科醫學會)<br />4. Pediatr Dermatol. 2020 May;37(3):442-446. doi: 10.1111/pde.14246.Erythema multiforme-like lesions in children and COVID-19 (武漢肺炎的多型性紅斑)<br />5. Dermatol Ther. 2020 Jul;33(4):e13594. doi: 10.1111/dth.13594. Epub 2020 May 25.<br />Appearance of skin rash in pediatric patients with COVID-19: Three case presentations (武漢肺炎的斑丘疹)<br />6. Pediatr Dermatol. 2020 May;37(3):435-436. doi: 10.1111/pde.14201. Epub 2020 May 19.Varicella-like exanthem associated with COVID-19 in an 8-year-old girl: A diagnostic clue?(武漢肺炎的似水痘發疹)<br />7. J Eur Acad Dermatol Venereol. 2020 Oct;34(10):e539-e541. doi: 10.1111/jdv.16666. Epub 2020 Jul 6.Erythema multiforme and Kawasaki disease associated with COVID-19 infection in children. (武漢肺炎與川崎氏症)<br />8. World J Pediatr. 2021 May 20 : 1–6. doi: 10.1007/s12519-021-00435-y Similarities and differences between multiple inflammatory syndrome in children associated with COVID-19 and Kawasaki disease: clinical presentations, diagnosis, and treatment (武漢肺炎多發性發炎症候群與川崎氏症)9. J Eur Acad Dermatol Venereol. 2020 Sep;34(9):e445-e447. doi: 10.1111/jdv.16665. Epub 2020 Jun 15. Are chilblain-like acral skin lesions really indicative of COVID-19? A prospective study and literature review(認為chilblain無法診斷武漢肺炎)J Eur Acad Dermatol Venereol. 2020 Sep;34(9):e440-e441. doi: 10.1111/jdv.16636. Epub 2020 Jun 8.Chilblain acral lesions in the COVID-19 era. Are they marker of infection in asymptomatic patients?(認為chilblain可以診斷武漢肺炎)<br />10. <a href="https://draft.blogger.com/#">https://www.nhi.gov.tw/Content_List.aspx?n=BD79A7DABFEC5993&topn=787128DAD5F71B1A</a>(健保署各縣市篩檢站)<br />11. Front Pediatr. 2021 Jan 14;8:600721. doi: 10.3389/fped.2020.600721. eCollection 2020.<br />COVID-19: Considerations for Children and Families During the Pandemic (兒童得武漢肺炎死亡率低,小心川崎氏症表現,隔離與因應)<br />12. <a href="https://draft.blogger.com/#">https://www.cdc.gov.tw/Uploads/Files/9e796cdd-5179-4efb-93c0-732aac3eb7f3.jpg</a>(疾管署網頁:COVID-19確診及接觸者注意事項)</span></div></div>鄭煜彬(Yu-Pin Cheng)http://www.blogger.com/profile/07019803125903571476noreply@blogger.com0tag:blogger.com,1999:blog-5384877319969585099.post-14253199700589752152021-01-31T16:45:00.001-08:002021-01-31T16:45:13.162-08:00國泰皮膚科 Clinical Patterns in Dermatology(15) Liquid tumors(1)3.0<p> <span style="background-color: white; color: #1d2129; font-family: inherit; font-size: x-large; white-space: pre-wrap;">兩本教科書同時大改版後,每天用凌晨的零碎時間熬夜趕工,終於將上課內容翻修改版終於</span><b style="color: #1d2129; font-family: inherit; font-size: x-large; white-space: pre-wrap;">快要</b><span style="background-color: white; color: #1d2129; font-family: inherit; font-size: x-large; white-space: pre-wrap;">完成!相較於上個版本,這次又增加了很多臨床圖片,聽完應該可以對皮膚淋巴癌有更具體的概念。</span></p><div data-block="true" data-editor="3d1l9" data-offset-key="ffqr3-0-0" style="background-color: white; color: #1d2129; font-family: Helvetica, Arial, sans-serif; white-space: pre-wrap;"><div class="_1mf _1mj" data-offset-key="ffqr3-0-0" style="direction: ltr; font-family: inherit; position: relative;"><span data-offset-key="ffqr3-0-0" style="font-family: inherit;"><span style="font-size: x-large;">國泰皮膚科/臺大皮膚部Clinical Patterns in Dermatology(15) Liquid tumors(1) 3.0</span></span></div><div class="_1mf _1mj" data-offset-key="ffqr3-0-0" style="direction: ltr; font-family: inherit; position: relative;"><span data-offset-key="ffqr3-0-0" style="font-family: inherit;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg71NSh-YHmbCLWevrwHU4SfjcffOK8HacAFEdRO01tITjsX_lPxZAh31lfCUZwDDEq3GgQLENKEf7GIrxcEa9aVPEaYM5ljPqvO6-x2u2RG-xGz7p7jdYrRLoYrfzqJ234tSbSjHdUng_T/s960/CPD%252815%2529Lymphoproliferative+diseases+and+related+disorders%25281%25293.0+%25281%2529.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="960" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg71NSh-YHmbCLWevrwHU4SfjcffOK8HacAFEdRO01tITjsX_lPxZAh31lfCUZwDDEq3GgQLENKEf7GIrxcEa9aVPEaYM5ljPqvO6-x2u2RG-xGz7p7jdYrRLoYrfzqJ234tSbSjHdUng_T/w640-h480/CPD%252815%2529Lymphoproliferative+diseases+and+related+disorders%25281%25293.0+%25281%2529.jpg" width="640" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div></span></div></div><div data-block="true" data-editor="3d1l9" data-offset-key="bdcte-0-0" style="background-color: white; color: #1d2129; font-family: Helvetica, Arial, sans-serif; white-space: pre-wrap;"><div class="_1mf _1mj" data-offset-key="bdcte-0-0" style="direction: ltr; font-family: inherit; position: relative;"><span data-offset-key="bdcte-0-0" style="font-family: inherit;"><span style="font-size: large;">國泰醫院皮膚科/臺大醫院皮膚部 鄭煜彬醫師 製作</span></span></div></div><div data-block="true" data-editor="3d1l9" data-offset-key="3ral-0-0" style="background-color: white; color: #1d2129; font-family: Helvetica, Arial, sans-serif; white-space: pre-wrap;"><div class="_1mf _1mj" data-offset-key="3ral-0-0" style="direction: ltr; font-family: inherit; position: relative;"><span data-offset-key="3ral-0-0" style="font-family: inherit;"><span style="font-size: large;"><b>時間</b>:2021/02/06(一) 14:30-17:30</span></span></div></div><div data-block="true" data-editor="3d1l9" data-offset-key="c2jcg-0-0" style="background-color: white; font-family: Helvetica, Arial, sans-serif; white-space: pre-wrap;"><div class="_1mf _1mj" data-offset-key="c2jcg-0-0" style="direction: ltr; font-family: inherit; position: relative;"><span data-offset-key="c2jcg-0-0" style="font-family: inherit;"><span style="font-size: large;"><b style="color: #1d2129;">地點</b><span style="color: #1d2129;">:國泰皮膚科會議室(臺北市大安區仁愛路四段266巷6號6樓,因疫情關係建議大家</span><span style="color: red;">不要到現場</span><span style="color: #1d2129;">)</span></span></span></div></div><div data-block="true" data-editor="3d1l9" data-offset-key="7a6d9-0-0" style="background-color: white; color: #1d2129; font-family: Helvetica, Arial, sans-serif; white-space: pre-wrap;"><div class="_1mf _1mj" data-offset-key="7a6d9-0-0" style="direction: ltr; font-family: inherit; position: relative;"><span data-offset-key="7a6d9-0-0" style="font-family: inherit;"><span style="font-size: large;"><b>直播網址</b>:會前另外寄信給各位皮膚科醫師。</span></span></div><div class="_1mf _1mj" data-offset-key="7a6d9-0-0" style="direction: ltr; font-family: inherit; position: relative;"><span data-offset-key="7a6d9-0-0" style="font-family: inherit;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgdeAb2g933nW7IxNv-f2LxukSWZZV6jTtZyQRVAaMHpdktC9ivgVKe-iyQpMbJlvwq0yDbKxp_GegaQ5ohfMK5HuVReDakdnE2fPGntyT3plezeNezHhgs-MgCA0pAiro7RWXnJtyU-jxH/s960/CPD%252815%2529Lymphoproliferative+diseases+and+related+disorders%25281%25293.0+%25281%2529.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="960" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgdeAb2g933nW7IxNv-f2LxukSWZZV6jTtZyQRVAaMHpdktC9ivgVKe-iyQpMbJlvwq0yDbKxp_GegaQ5ohfMK5HuVReDakdnE2fPGntyT3plezeNezHhgs-MgCA0pAiro7RWXnJtyU-jxH/w640-h480/CPD%252815%2529Lymphoproliferative+diseases+and+related+disorders%25281%25293.0+%25281%2529.jpg" width="640" /></a></div><br /><span style="font-size: large;"><br /></span></span></div></div><div data-block="true" data-editor="3d1l9" data-offset-key="d5086-0-0" style="background-color: white; color: #1d2129; font-family: Helvetica, Arial, sans-serif; white-space: pre-wrap;"><div class="_1mf _1mj" data-offset-key="d5086-0-0" style="direction: ltr; font-family: inherit; position: relative;"><span data-offset-key="d5086-0-0" style="font-family: inherit;"><span style="font-size: large;"><b>簡介</b>:</span></span></div></div><div data-block="true" data-editor="3d1l9" data-offset-key="bvkn2-0-0" style="background-color: white; font-family: Helvetica, Arial, sans-serif; white-space: pre-wrap;"><div class="_1mf _1mj" data-offset-key="bvkn2-0-0" style="direction: ltr; font-family: inherit; position: relative;"><span data-offset-key="bvkn2-0-0" style="font-family: inherit;"><span style="font-size: large;"><span style="color: #1d2129;">本次要介紹相當困難的皮膚淋巴瘤與其他造血細胞相關的「液態」腫瘤(一般稱的血癌,相對於其他固體腫瘤而言)。因為本土疫情尚未趨緩,請大家</span><b><span style="color: red;">不要</span></b><b><span style="color: red;">到現場</span></b><span style="color: #1d2129;">,會後會將錄影會更新於「國泰皮膚科線上教室」,敬請期待。</span></span></span></div></div><div data-block="true" data-editor="3d1l9" data-offset-key="9sa5b-0-0" style="background-color: white; color: #1d2129; font-family: Helvetica, Arial, sans-serif; white-space: pre-wrap;"><div class="_1mf _1mj" data-offset-key="9sa5b-0-0" style="direction: ltr; font-family: inherit; position: relative;"><span data-offset-key="9sa5b-0-0" style="font-family: inherit;"><span style="font-size: large;">本課程只開放給皮膚科醫學會會員、準會員、或佔有皮膚科訓練容額的醫師參加。歡迎皮膚科的先進同好蒞臨指教!</span></span></div></div>鄭煜彬(Yu-Pin Cheng)http://www.blogger.com/profile/07019803125903571476noreply@blogger.com0tag:blogger.com,1999:blog-5384877319969585099.post-37230704183978590602020-10-14T12:05:00.005-07:002021-01-31T16:55:03.479-08:00國泰皮膚科Clinical Patterns in Dermatology(14) Granulomatous & Necrobiotic Lesions(3) 3.0<p><span style="font-size: large;"><span style="background-color: white; color: #1d2129; font-family: inherit; white-space: pre-wrap;">兩本教科書同時大改版後,每天用凌晨的零碎時間熬夜趕工,終於將上課內容翻修改版終於完成!</span></span></p><div data-block="true" data-editor="3d1l9" data-offset-key="ffqr3-0-0" style="background-color: white; color: #1d2129; font-family: Helvetica, Arial, sans-serif; white-space: pre-wrap;"><div class="_1mf _1mj" data-offset-key="ffqr3-0-0" style="direction: ltr; font-family: inherit; position: relative;"><span data-offset-key="ffqr3-0-0" style="font-family: inherit;"><span style="font-size: x-large;">國泰皮膚科/臺大皮膚部Clinical Patterns in Dermatology(14) Granulomatous & Necrobiotic Lesions(3) 3.0</span></span></div><div class="_1mf _1mj" data-offset-key="ffqr3-0-0" style="direction: ltr; font-family: inherit; position: relative;"><span data-offset-key="ffqr3-0-0" style="font-family: inherit;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhl0vFg5RZ_g9aJF9uOSAdWaKWiX3UTggH3De9taMdSx8tLnOZ2vYHyMGZhENcRhzd8q2JSrNE3xd8iqJBz_ZwagKOHJbR62_PvL2_LjogpTUYCBiyuDpRGwi_K-nWfQChjaIFp8P7duZTg/s960/Clinical+Patterns+in+Dermatology+%252814%2529+3.0_+Granulomatous+%2526+Necrobiotic+Lesions%25283%2529.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="960" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhl0vFg5RZ_g9aJF9uOSAdWaKWiX3UTggH3De9taMdSx8tLnOZ2vYHyMGZhENcRhzd8q2JSrNE3xd8iqJBz_ZwagKOHJbR62_PvL2_LjogpTUYCBiyuDpRGwi_K-nWfQChjaIFp8P7duZTg/w640-h480/Clinical+Patterns+in+Dermatology+%252814%2529+3.0_+Granulomatous+%2526+Necrobiotic+Lesions%25283%2529.jpg" width="640" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><br /></div></span></div></div><div data-block="true" data-editor="3d1l9" data-offset-key="bdcte-0-0" style="background-color: white; color: #1d2129; font-family: Helvetica, Arial, sans-serif; white-space: pre-wrap;"><div class="_1mf _1mj" data-offset-key="bdcte-0-0" style="direction: ltr; font-family: inherit; position: relative;"><span data-offset-key="bdcte-0-0" style="font-family: inherit;"><span style="font-size: large;">國泰醫院皮膚科/臺大醫院皮膚部 鄭煜彬醫師 製作</span></span></div></div><div data-block="true" data-editor="3d1l9" data-offset-key="3ral-0-0" style="background-color: white; color: #1d2129; font-family: Helvetica, Arial, sans-serif; white-space: pre-wrap;"><div class="_1mf _1mj" data-offset-key="3ral-0-0" style="direction: ltr; font-family: inherit; position: relative;"><span data-offset-key="3ral-0-0" style="font-family: inherit;"><span style="font-size: large;"><b>時間</b>:2020/10/17(一) 14:30-17:30</span></span></div></div><div data-block="true" data-editor="3d1l9" data-offset-key="c2jcg-0-0" style="background-color: white; font-family: Helvetica, Arial, sans-serif; white-space: pre-wrap;"><div class="_1mf _1mj" data-offset-key="c2jcg-0-0" style="direction: ltr; font-family: inherit; position: relative;"><span data-offset-key="c2jcg-0-0" style="font-family: inherit;"><span style="font-size: large;"><b style="color: #1d2129;">地點</b><span style="color: #1d2129;">:國泰皮膚科會議室(臺北市大安區仁愛路四段266巷6號6樓</span><span style="color: #1d2129;">)</span></span></span></div></div><div data-block="true" data-editor="3d1l9" data-offset-key="7a6d9-0-0" style="background-color: white; color: #1d2129; font-family: Helvetica, Arial, sans-serif; white-space: pre-wrap;"><div class="_1mf _1mj" data-offset-key="7a6d9-0-0" style="direction: ltr; font-family: inherit; position: relative;"><span data-offset-key="7a6d9-0-0" style="font-family: inherit;"><span style="font-size: large;"><b>直播網址</b>:會前另外寄信給各位皮膚科醫師。</span></span></div><div class="_1mf _1mj" data-offset-key="7a6d9-0-0" style="direction: ltr; font-family: inherit; position: relative;"><span data-offset-key="7a6d9-0-0" style="font-family: inherit;"><div class="separator" style="clear: both; text-align: center;"><br /></div><span style="font-size: large;"><br /></span></span></div></div><div data-block="true" data-editor="3d1l9" data-offset-key="d5086-0-0" style="background-color: white; color: #1d2129; font-family: Helvetica, Arial, sans-serif; white-space: pre-wrap;"><div class="_1mf _1mj" data-offset-key="d5086-0-0" style="direction: ltr; font-family: inherit; position: relative;"><span data-offset-key="d5086-0-0" style="font-family: inherit;"><span style="font-size: large;"><b>簡介</b>:</span></span></div><div class="_1mf _1mj" data-offset-key="d5086-0-0" style="direction: ltr; font-family: inherit; position: relative;"><span data-offset-key="d5086-0-0" style="font-family: inherit;"><span style="font-size: large;"><div dir="auto" style="color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif;">由於人體無法有效清除某些微生物,因而造成很多種肉芽腫病灶。本次要介紹許多這群微生物所造成的特殊形態病灶。因為本土疫情趨緩,本次有實體課程,會後會將錄影會更新於「國泰皮膚科線上教室」,敬請期待。</div><div dir="auto" style="color: #050505; font-family: "Segoe UI Historic", "Segoe UI", Helvetica, Arial, sans-serif;">本課程只開放給皮膚科醫學會會員、準會員、或佔有皮膚科訓練容額的醫師參加。歡迎皮膚科的先進同好蒞臨指教!</div></span></span></div></div><div data-block="true" data-editor="3d1l9" data-offset-key="bvkn2-0-0" style="background-color: white; font-family: Helvetica, Arial, sans-serif; white-space: pre-wrap;"><div class="_1mf _1mj" data-offset-key="bvkn2-0-0" style="direction: ltr; font-family: inherit; position: relative;"><br /></div></div>鄭煜彬(Yu-Pin Cheng)http://www.blogger.com/profile/07019803125903571476noreply@blogger.com1tag:blogger.com,1999:blog-5384877319969585099.post-38015545188485461642020-07-04T23:38:00.001-07:002020-07-04T23:38:29.201-07:00演講公告:脂漏性皮膚炎與禿/落髮 (Seborrheic Dermatitis & Hair Loss)<span style="font-size: large;"><span style="background-color: white; color: #1c1e21; font-family: Helvetica, Arial, sans-serif;">今天在台中永豐棧進行解封後第一場實體演講。感謝我的指導教授--火箭專</span><wbr style="background-color: white; color: #1c1e21; font-family: Helvetica, Arial, sans-serif;"></wbr><span class="word_break" style="background-color: white; color: #1c1e21; display: inline-block; font-family: Helvetica, Arial, sans-serif;"></span><span style="background-color: white; color: #1c1e21; font-family: Helvetica, Arial, sans-serif;">家吳宗信教授協助,煜彬昨日終於有空坐在下來投稿、讀書、</span><wbr style="background-color: white; color: #1c1e21; font-family: Helvetica, Arial, sans-serif;"></wbr><span class="word_break" style="background-color: white; color: #1c1e21; display: inline-block; font-family: Helvetica, Arial, sans-serif;"></span><span style="background-color: white; color: #1c1e21; font-family: Helvetica, Arial, sans-serif;">順便準備快要開天窗的演講,總算在客運上下車前最後一刻</span><wbr style="background-color: white; color: #1c1e21; font-family: Helvetica, Arial, sans-serif;"></wbr><span class="word_break" style="background-color: white; color: #1c1e21; display: inline-block; font-family: Helvetica, Arial, sans-serif;"></span><span style="background-color: white; color: #1c1e21; font-family: Helvetica, Arial, sans-serif;">完成。</span></span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEijUY8q5VUx-RPe1pHLHLMtaxOuZLLQF81jerTDVgDg25AROEJ7FH9KIN-jPAN7DYfH4XMQ8SB4GDGcX77Y_1t-zcBIOX9PXXVWlGqunXExiRCMHC5CGHo1sHPdKrhxRuSx_gZNhZ6ZKUOJ/s1600/%25E8%2584%2582%25E6%25BC%258F%25E6%2580%25A7%25E7%259A%25AE%25E8%2586%259A%25E7%2582%258E%25E8%2588%2587%25E7%25A6%25BF%25E9%25AB%25AE+%25281%2529.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="960" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEijUY8q5VUx-RPe1pHLHLMtaxOuZLLQF81jerTDVgDg25AROEJ7FH9KIN-jPAN7DYfH4XMQ8SB4GDGcX77Y_1t-zcBIOX9PXXVWlGqunXExiRCMHC5CGHo1sHPdKrhxRuSx_gZNhZ6ZKUOJ/s640/%25E8%2584%2582%25E6%25BC%258F%25E6%2580%25A7%25E7%259A%25AE%25E8%2586%259A%25E7%2582%258E%25E8%2588%2587%25E7%25A6%25BF%25E9%25AB%25AE+%25281%2529.jpg" width="640" /></a></div>
<span style="font-size: large;"><br style="background-color: white; color: #1c1e21; font-family: Helvetica, Arial, sans-serif;" /><span style="background-color: white; color: #1c1e21; font-family: Helvetica, Arial, sans-serif;">時間:15:55 pm-16:35 pm </span><br style="background-color: white; color: #1c1e21; font-family: Helvetica, Arial, sans-serif;" /><span style="background-color: white; color: #1c1e21; font-family: Helvetica, Arial, sans-serif;">地點:永豐棧酒店大墩館3F牡丹廳(台中市西屯區大墩二</span><wbr style="background-color: white; color: #1c1e21; font-family: Helvetica, Arial, sans-serif;"></wbr><span class="word_break" style="background-color: white; color: #1c1e21; display: inline-block; font-family: Helvetica, Arial, sans-serif;"></span><span style="background-color: white; color: #1c1e21; font-family: Helvetica, Arial, sans-serif;">十街37號)</span></span>鄭煜彬(Yu-Pin Cheng)http://www.blogger.com/profile/07019803125903571476noreply@blogger.com1tag:blogger.com,1999:blog-5384877319969585099.post-19434931966481547712020-04-26T16:59:00.000-07:002020-04-26T18:19:14.435-07:00人類最常見的癌症:皮膚的基底細胞癌<h2>
<span style="font-size: x-large;">基底細胞癌是最常見的皮膚癌,會在皮膚表面造成型態特殊的丘疹或是潰瘍,多半只會造成局部的侵犯。只要能徹底將病灶移除,極少發展成遠處的轉移。</span></h2>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiSX8lZs0TsRo_o3452QHpznGzuxnwKtwBKFB-Xm3zJDteVAx-ojI2x6rU7YJDcVHr-VXRE_52lHnqXAJ4mmcvFksJpBmsOJmEWirepn3eFlAySzIhrbt_f3FXy42bOU33UBA0p-YnmW0jk/s1600/P169+%252813%2529.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="540" data-original-width="960" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiSX8lZs0TsRo_o3452QHpznGzuxnwKtwBKFB-Xm3zJDteVAx-ojI2x6rU7YJDcVHr-VXRE_52lHnqXAJ4mmcvFksJpBmsOJmEWirepn3eFlAySzIhrbt_f3FXy42bOU33UBA0p-YnmW0jk/s640/P169+%252813%2529.jpg" width="640" /></a></div>
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<span style="font-size: large;">人類身上最常見的癌症是什麼?這答案不是很響亮,但很明確就是皮膚上面的「<b>基底細胞癌(basal cell carcinoma)</b>」。根據國外統計這種癌症的案例數佔了所有皮膚癌的75%,所有人類惡性腫瘤案例的25%(1),在臺灣雖然比例不至於那麼誇張,但在皮膚癌中基底細胞癌還是占了所有案例的五成(2)。這種癌症雖然不太會四處轉移,卻會破壞附近皮膚的結構,在皮膚上面形成經久不癒的潰瘍。偏偏基底細胞癌又好發於頭頸部,容易造成顏面五官的一些傷害。</span><br />
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<span style="font-size: x-large;">基底細胞癌的臨床特徵</span></h2>
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<span style="font-size: large;">一般臨床上看到的基底細胞癌多半是結節型(nodular),是一個看起來略為透亮(半透明)、邊緣隆起的丘疹(</span><span style="font-size: large;">圖1)</span><span style="font-size: large;">,上面往往會出現黑色素斑點,乍看之下像一個黑痣,但卻黑得不是很完全。</span><span style="font-size: large;">它們發展到最後</span><span style="font-size: large;">中央會出現長久不癒的潰瘍(</span><span style="font-size: large;">圖2)</span><span style="font-size: large;">。</span><br />
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<tr><td class="tr-caption" style="text-align: left;"><span style="font-size: large;">圖1:典型的結節型基底細胞癌,位於上嘴唇,上面會有一些黑色斑點,但往往不會擴及整個病灶,彷彿一個黑得不太完全的黑痣。</span></td></tr>
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<tr><td class="tr-caption" style="text-align: left;"><span style="font-size: large;">圖2:結節型基底細胞癌發展到最後變成一個長久不癒的潰瘍,位於鼻翼外側臉頰。</span></td></tr>
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<span style="font-size: large;">某些亞型(色素型 pigmented type,如圖3)會整個呈黑色。常伴隨血管擴張,中央有時也會出現潰瘍,常被以為是惡名昭彰的黑色素瘤。實際上黑色素瘤的黑色會有很多不同的層次,不會只有一兩種色階。</span><br />
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<span style="font-size: large;">有種基底細胞癌是一塊邊緣清楚的紅色斑塊,表層稍微粗糙類似濕疹,但周圍沒有出現類似的病灶,擦濕疹的藥膏也不太會好,這就可能是表淺型(superficial type,圖4)的基底細胞癌。</span></div>
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<tr><td class="tr-caption" style="text-align: justify;"><span style="font-size: large; text-align: left;">圖3:色素型基底細胞癌,位於髮際線,看起來很黑又有潰瘍,常被誤以為為是黑色素瘤。但本例整個全黑且邊緣相對隆起,並非黑色素瘤特徵。</span></td></tr>
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<tr><td class="tr-caption" style="text-align: left;"><span style="font-size: large;">圖4:表淺型基底細胞癌,是一塊位於胸口,邊緣清楚的紅色斑塊,表面稍微粗糙類似濕疹但以濕疹方式治療無效。</span></td></tr>
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<span style="font-size: large;">另外有兩種比較侵略性的基底細胞癌,比起其他各型的基底細胞癌更容易復發。有些看起來是一塊偏白稍硬的斑塊,乍看之下很像一個疤痕或是自體免疫的硬斑症(morphea),這種稱為硬斑型/硬化型(morpheaform/sclerosing,圖4)基底細胞癌。還有一些看起來像是表層被抓破的小丘疹,切片之後發現雖然是基底細胞癌,但部分已經出現像鱗狀細胞癌的分化,稱為基底鱗狀癌(basosquamous carcinoma),這兩種基底細胞癌的亞型有相對較高的轉移率,跟其他幾乎不轉移的亞型大不相同。</span></div>
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<tr><td class="tr-caption" style="text-align: left;"><span style="font-size: large;">圖4:硬斑型基底細胞癌,看起來是一塊偏白稍硬的斑塊,常被誤認為是一個疤痕。</span></td></tr>
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<span style="font-size: large;">由於基底細胞癌跟<b>紫外光曝曬</b>有關,好發的區域常在<b>頭頸部</b>,但身體各處都可能出現。基底細胞癌的各種亞型好發於不同的位置,例如<b>結節型</b>、<b>色素型</b>與<b>硬斑型</b>在頭頸部較多,<b>表淺型</b>則常出現於<b>軀幹</b>。</span><br />
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<span style="font-size: large;">基底細胞癌的型態變化很大,因此皮膚上如果出現任何不明的病灶,最好找皮膚科醫師確定。</span><br />
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<span style="font-size: x-large;">基底細胞癌的好發族群與誘發因素</span></h2>
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<span style="font-size: large;">目前所知所有的基底細胞癌幾乎都是因為<b>紫外光</b>曝曬導致<b>PTCH1</b>基因突變,活化細胞中的一條訊息傳導路徑(Hedgehog signaling pathway)所致</span><span style="font-size: large;">(1)</span><span style="font-size: large;">。</span><br />
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<span style="font-size: large;">基底細胞癌好發於<b>老年人</b>,大多發生於60歲以上的人,但近年來有年輕化的趨勢。<b>男性</b>的比例稍高於女性;<b>膚色較白</b>的人則比膚色較黑的人容易得基底細胞癌,都與紫外光的作用有關。</span><br />
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<span style="font-size: x-large;">基底細胞癌的治療與預後</span></h2>
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<span style="font-size: large;">基底細胞癌<b>如能及早治療,病人的壽命與都與正常人無異。</b>目前最好的方式還是讓皮膚外科醫師把整個病灶都切下來進行病理化驗,才能確認是否有切乾淨(圖5),這也是復發率最低的方式。(1, 3)</span></div>
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<span style="font-size: large;">圖5:鼻子上的基底細胞癌,在其他醫院確診後轉給筆者治療。經手術廣泛切除達到安全距離(safe margin)後,考量直接縫合張力過大,以皮瓣手術關閉傷口。半年之後除了膚色稍白尚未完全恢復外,疤痕相當輕微,幾乎看不出來。</span></div>
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<span style="font-size: large;">至於某些不適合手術的地方(例如眼皮),則可以使用刮除加上電燒(curettage & desiccation)的方式來清除腫瘤,對於小於1公分的基底細胞癌有很高的治癒率</span><span style="font-size: large;">(1, 3)</span><span style="font-size: large;">。</span><br />
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<span style="font-size: large;">此外液態氮冷凍治療、外用的5-fluorouracil藥膏、外用imiquimod(樂得美)藥膏、光動力療法、與放射治療(radiotherapy)都可以治療無法手術切除的基底細胞癌。其中最不影響外觀的是光動力療法(photodynamic therapy),但復發率相對略高,治療之後最好規律追蹤二到三年</span><span style="font-size: large;">(1)</span><span style="font-size: large;">。但上述的5-fluorouracil藥膏與光動力療法的5-Aminolevulinic acid藥膏需要專案申請,使用上並不普及。筆者也是經過很多年的努力,才幫自己所屬的醫院收集到上述所有的治療。</span><br />
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<span style="font-size: large;">當然,這些非外科的治療不能確認癌細胞有無徹底清除乾淨,因此未來還是需要長期追蹤,確保沒有殘存的癌細胞復發。</span><span style="font-size: large;">不過基底細胞癌是相對溫和的皮膚癌,就算復發,只要進一步切除乾淨還是可以治癒,也不容易產生轉移。</span><br />
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<span style="font-size: large;">一般除非是<b>硬斑型</b>與<b>基底鱗狀癌</b>等亞型、或是病理下出現<b>侵犯神經</b>的特徵、<b>大於7.5公分</b>、<b>拖了很久</b>都沒處理的病灶,才可能出現淋巴結、肺部、與骨頭的轉移。轉移的案例很稀少,轉移率遠小於1%。然而轉移的案例預後就很差,剩餘壽命的中位數僅10個月(1, 4),與很早就進行手術切除根治的病例(壽命同正常人)相比可說是天壤之別。</span><span style="font-size: large;">因此,早期診斷早期治療,依然是對於癌症最有效的處理方式。</span><span style="font-size: large;"><br /></span>
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<span style="font-size: x-large;">降低基底細胞癌風險的方法</span></h2>
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<span style="font-size: large;">一般得過基底細胞癌的病人大約有40-50%在五年內會在其他地方出現基底細胞癌。目前發現每日早晚各服用一次500mg的</span><span style="font-size: large;">菸鹼醯胺(nicotinamide,維生素B3的</span><span style="font-size: large;">醯胺化合物</span><span style="font-size: large;">),或是服用關節痛使用的非類固醇抗發炎藥celecoxib(需醫師開立)能降低得基底細胞癌的風險(1)。考量</span><span style="font-size: large;">菸鹼醯胺很安全且對皮膚有不少其他好處(5),曾確診過基底細胞癌的病人可以適度補充。</span><br />
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<span style="font-size: large;">參考資料</span></h2>
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(1) Fitzpatrick's Dermatology, 9th edition, p. 1884-1897.</div>
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(2) 臺灣癌症登記中心年報 <a href="http://tcr.cph.ntu.edu.tw/uploadimages/Y98-ALL.pdf" style="background-color: transparent;">http://tcr.cph.ntu.edu.tw/uploadimages/Y98-ALL.pdf</a></div>
<div style="background-color: white; color: #444444; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13px;">
McKee's Pathology of the Skin, 5th edition, p. 1192-1196.</div>
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(3) Surgery of the skin, 3rd edition, p. 718-719.</div>
<span style="color: #444444; font-family: "arial" , "tahoma" , "helvetica" , "freesans" , sans-serif;"><span style="font-size: 13px;">(4) Update on metastatic </span></span><span style="color: #444444; font-family: "arial" , "tahoma" , "helvetica" , "freesans" , sans-serif; font-size: 13px;">basal cell carcinom</span><span style="color: #444444; font-family: "arial" , "tahoma" , "helvetica" , "freesans" , sans-serif; font-size: x-small;">a: </span><span style="color: #444444; font-family: "arial" , "tahoma" , "helvetica" , "freesans" , sans-serif; font-size: 13px;">a summary of published cases </span><span style="color: #444444; font-family: "arial" , "tahoma" , "helvetica" , "freesans" , sans-serif; font-size: 13px;">from 1981 through 2011. JAMA Dermatol. 2013;149(5):</span><span style="color: #444444; font-family: "arial" , "tahoma" , "helvetica" , "freesans" , sans-serif; font-size: 13px;">615-616.</span><br />
<span style="color: #444444; font-family: "arial" , "tahoma" , "helvetica" , "freesans" , sans-serif; font-size: 13px;">(5)</span><span style="font-size: x-small;"><span style="color: #444444; font-family: "arial" , "tahoma" , "helvetica" , "freesans" , sans-serif;"> </span><a href="http://www.skin168.net/2012/02/b3.html">http://www.skin168.net/2012/02/b3.html</a> (皮膚科王修含醫師的網頁)</span></div>
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鄭煜彬(Yu-Pin Cheng)http://www.blogger.com/profile/07019803125903571476noreply@blogger.com1tag:blogger.com,1999:blog-5384877319969585099.post-860846583277269202020-04-26T00:02:00.002-07:002020-04-26T00:02:55.038-07:00國泰皮膚科線上教室:Clinical Patterns in Dermatology(12) Granulomatous & Necrobiotic Lesions(1) 3.0<span style="color: #1d2129; font-family: Helvetica, Arial, sans-serif;"><span style="background-color: white; font-size: 15px;">本次因為疫情關係取消實體課程,結果沒有比較簡單,做了超過一個月才完成,弄到</span></span><span style="background-color: white; color: #1d2129; font-family: Helvetica, Arial, sans-serif; font-size: 15px;">皮專考完一周才完成,實在是來討罵的。</span><br />
<span style="background-color: white; color: #1d2129; font-family: Helvetica, Arial, sans-serif; font-size: 15px;"><br /></span>
<span style="background-color: white; color: #1d2129; font-family: Helvetica, Arial, sans-serif; font-size: 15px;">但這次錄音實在歷經很多困難。比如假日被迫在家帶小孩,從早上七點開始就很難找到超過10分鐘的安靜時間,還要整天都與大便為伍。希望大家有小孩之後不要像煜彬這麼悲慘。</span><br />
<br style="background-color: white; color: #1d2129; font-family: Helvetica, Arial, sans-serif; font-size: 15px;" /><span style="background-color: white; color: #1d2129; font-family: Helvetica, Arial, sans-serif; font-size: 15px;">課程連結已經寄送到各位信箱。如有皮膚科醫師沒收到請私訊。</span><br />
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<span style="background-color: white; color: #1d2129; font-family: Helvetica, Arial, sans-serif; font-size: 15px;"><br /></span>鄭煜彬(Yu-Pin Cheng)http://www.blogger.com/profile/07019803125903571476noreply@blogger.com1tag:blogger.com,1999:blog-5384877319969585099.post-27603170626234392152020-04-08T03:43:00.001-07:002020-04-08T05:09:37.127-07:00別被它的溫和外表騙了!紅紅的厚皮居然是鱗狀細胞癌原位癌。<div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgFjapAqEigu5zK0IGOFDrkDJ9N1cnVc25mTTg4o6VdfxBzXPhUoiLVZivpcX26oVrU70VjfmvU05CBgNpaU9BkymFDHpDMZydHS22sFlLBcdByScJmazIf4OrLVEL1FLOBytA4EnHBbTRR/s1600/P169+%25288%2529.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="540" data-original-width="960" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgFjapAqEigu5zK0IGOFDrkDJ9N1cnVc25mTTg4o6VdfxBzXPhUoiLVZivpcX26oVrU70VjfmvU05CBgNpaU9BkymFDHpDMZydHS22sFlLBcdByScJmazIf4OrLVEL1FLOBytA4EnHBbTRR/s640/P169+%25288%2529.jpg" width="640" /></a></div>
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<span style="font-size: large;">鱗狀細胞癌原位癌又稱為波文氏症(Bowen disease),臨床上往往是一片紅色、邊界清楚、略為增厚、表面粗糙的皮膚。手術切除是最好的治療方式,對於某些不適合開刀的病灶可使用光動力療法等非手術療法。</span></h2>
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<span style="font-size: large;">有時老人的皮膚上會出現一塊紅色、邊界清楚、略為增厚、表面粗糙的皮膚。由於不癢不痛,很多人往往不以為意,但別被它溫和的外表騙了,這塊病灶可能就是鱗狀細胞癌的原位癌/波文氏症(squamous cell carcinoma in situ/Bowen disease)。</span></div>
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<span style="font-size: large;">鱗狀細胞癌原位癌是指癌變的細胞還位於表皮基底膜(basement membrane)以上的淺層病灶,只要手術移除就等同治癒。但如果癌細胞吃穿了表皮的基底膜(basement membrane),接下來轉移到淋巴結或遠處其他器官的機率就會大增,所幸一般只有大約5%的病灶會演變成侵入性的鱗狀細胞癌。(1)</span><br />
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<span style="font-size: x-large;">鱗狀細胞癌原位癌(波文氏症)的臨床特徵</span></h2>
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<span style="font-size: large;"><span style="font-size: large;">鱗狀細胞癌原位癌好發於頭頸部與四肢這些容易受到日光曝曬的位置,但全身到處都可能出現,也可能出現於皮膚皺褶處、甲床或指甲附近。臨床上看起來是一塊邊緣不規則但界限清楚的粉紅色或紅色斑塊</span><span style="font-size: large;">(圖1, 2, 3)</span><span style="font-size: large;">,會隨著時間逐漸變大,也可能會出現隆起的結節或是疣狀的增生(圖4)。因為表面往往有鱗屑脫落、結痂或是角質增生,有時會呈現灰色或棕色(圖5)。(1, 2)</span></span></div>
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<span style="font-size: large;">圖1 典型的鱗狀細胞癌原位癌:一塊紅色、邊界清楚、略為增厚、表面粗糙的皮膚</span></div>
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<span style="font-size: large;">圖2 頭頸部的鱗狀細胞癌原位癌:呈現紅色、粗糙的厚皮</span></div>
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<span style="font-size: x-small;"><span style="font-size: large;">圖3 與圖2相同病人頭頸部另一處的鱗狀細胞癌原位癌:</span><span style="text-align: center;"><span style="font-size: large;">鱗狀細胞癌原位癌有時會有多處病灶,因為附近的皮膚往往也累積了</span></span></span><span style="text-align: center;"><span style="font-size: large;">相當程度的DNA突變。</span></span></div>
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<tr><td><a href="https://1.bp.blogspot.com/ZbU2VDTlgzUFB-gB6P-glgdWlrv0oN05hkl0Q4F00gsJ-IRbyExep004NpaLSn53wCDYT48oJR0=s400" imageanchor="1" style="margin-left: auto; margin-right: auto;"><span style="font-size: large;"><img border="0" data-original-height="267" data-original-width="400" height="426" src="https://1.bp.blogspot.com/ZbU2VDTlgzUFB-gB6P-glgdWlrv0oN05hkl0Q4F00gsJ-IRbyExep004NpaLSn53wCDYT48oJR0=s400" width="640" /></span></a></td></tr>
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<span style="font-size: large;">圖4 出現疣狀增生的鱗狀細胞癌原位癌</span></div>
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<span style="font-size: large;">圖5 結痂的臨床細胞癌原位癌,呈現棕色與黃灰色的痂</span></div>
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<span style="font-size: large;">由於長得很慢沒症狀,頂多略為搔癢,因此很容易被忽略。最後病人來門診的時候往往已經長達數公分,雖然多半還沒穿過基底膜,切除後大多仍可根治,卻還是會造成很大的傷疤。</span></div>
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<tr><td style="text-align: center;"><a href="https://1.bp.blogspot.com/dy9nfA02OGRxiOgYb6BpWuXoHRosPLMj8GRvc6W1iOTqRiFDvEBonSXQth2b2V2DBTu7wy2eyAE=s400" imageanchor="1" style="margin-left: auto; margin-right: auto;"><span style="font-size: large;"><img border="0" data-original-height="267" data-original-width="400" height="426" src="https://1.bp.blogspot.com/dy9nfA02OGRxiOgYb6BpWuXoHRosPLMj8GRvc6W1iOTqRiFDvEBonSXQth2b2V2DBTu7wy2eyAE=s400" width="640" /></span></a></td></tr>
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<span style="font-size: large;">圖6 色素型的鱗狀細胞癌原位癌(pigmented squamous cell carcinoma in situ),可能會被誤以為是老人斑。</span></div>
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<span style="font-size: large;">鱗狀細胞癌原位癌有時會被誤以為是乾癬(psoriasis)、慢性濕疹、扁平苔蘚(lichen planus)或是黴菌感染(癬),但上述這些疾病多半伴隨明顯搔癢。少數的鱗狀細胞癌原位癌會有色素增生(圖6),常會被誤以為是老人斑(seborrheic keratosis)等良性病灶,此時最好還是由皮膚科醫師實際看診後決定是否進一步接受切片檢查,以免誤放皮膚癌或是過度治療。</span></div>
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<span style="font-size: x-large;"><b>鱗狀細胞癌原位癌(波文氏症)的誘發因子與好發族群</b></span></h2>
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<span style="font-size: large;">引起波文氏症的主要原因是</span><span style="font-size: large;"><b>紫外光</b></span><span style="font-size: large; font-weight: normal;">的曝曬,另外使用</span><span style="font-size: large;"><b>免疫抑制的藥物</b></span><span style="font-size: large; font-weight: normal;">、接受</span><span style="font-size: large;"><b>放射治療</b></span><span style="font-size: large; font-weight: normal;">、以及受到</span><span style="font-size: large;"><b>人類乳突病毒</b></span><span style="font-size: large; font-weight: normal;">(human papillomavirus)感染也都可能誘發波文氏症。在台灣西南沿海過去飲用深井水造成的</span><span style="font-size: large;"><b>慢性砷中毒</b></span><span style="font-size: large; font-weight: normal;">(arsenism)除了會造成烏腳病,也會誘發鱗狀細胞癌。</span></div>
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<span style="font-size: large;">由此可知,鱗狀細胞癌原位癌多半發生於<b>六十歲以上的老人</b>,<b>男性</b>的盛行率較高,可能跟接受較多<b>日光曝曬</b>有關。<b>免疫力受到抑制</b>的人出現鱗狀細胞癌原位癌的年齡則會提早。</span></div>
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<span style="font-size: x-large;">鱗狀細胞癌原位癌的治療方式</span></h2>
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<span style="font-size: large;">鱗狀細胞癌原位癌如能及早治療,病人的壽命與都與正常人無異。主要治療方法是手術切除,因為這類腫瘤一旦吃穿基底膜就可能變成淋巴或遠處轉移。要評估有沒有吃穿基底膜,最好的方式還是讓皮膚外科醫師把整個病灶都切下來進行病理化驗,才能確認是否有轉移(圖7, 8)。</span><span style="font-size: large;">(1, 3)</span></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhoezBZDeWbrYcG4-cJBDMl2iiKuaYuvzZuhEaIQxGY4kbPE07jp_ioHK3rjKgG_G898eTtsqBxJMOnSOuGI_84hp_PqozxDz7HHfmJighpvaOsmxFI4PqowsBF5QVFDWcqXoQ19OBxdEvy/s1600/P169+%25286%2529.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="540" data-original-width="960" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhoezBZDeWbrYcG4-cJBDMl2iiKuaYuvzZuhEaIQxGY4kbPE07jp_ioHK3rjKgG_G898eTtsqBxJMOnSOuGI_84hp_PqozxDz7HHfmJighpvaOsmxFI4PqowsBF5QVFDWcqXoQ19OBxdEvy/s640/P169+%25286%2529.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: left;"><span style="font-size: large;">圖7 手術切除並轉皮瓣縫合是最能確保根治的作法</span></td></tr>
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<tr><td class="tr-caption" style="text-align: left;"><span style="font-size: large;">圖8 手術切除得當,也可以兼顧美觀。本例是筆者幫106歲的人瑞切除額頭多年的鱗狀細胞癌,經過半年後回診追蹤,除了色素稍有不均之外,彷彿什麼事都沒發生過。</span></td></tr>
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<span style="font-size: large;">至於某些不適合手術的地方(例如眼皮),則可以使用<b>光動力療法</b>、<b>電燒</b>、<b>氣化型雷射(二氧化碳雷射)</b>、<b>三氯冰醋酸藥物燒灼</b>、<b>液態氮冷凍治療</b>、<b>外用的5-fluorouracil藥膏</b>、或是<b>外用imiquimod(樂得美)</b>藥膏來治療。其中實證效果最佳,且最不影響外觀的是光動力療法(photodynamic therapy)。</span><span style="font-size: large;">(1)但上述許多藥物需要專案申請,使用上並不普及。<b>筆者也是經過很多年的努力,才幫自己所屬的醫院收集到上述所有的治療。</b><br /><br />當然,這些非外科的治療不能確認癌細胞有無吃穿基底膜,因此未來還是需要長期追蹤,確保沒有殘存的癌細胞復發。</span></div>
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<span style="font-size: x-large;">鱗狀細胞癌原位癌的後續追蹤</span></h2>
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<span style="font-size: large;">儘管進行了徹底的治療,鱗狀細胞癌原</span><span style="font-size: large;">位癌患者其他處皮膚仍有可能在往後數年中陸續長出非黑色素的皮膚癌。這是因為附近的皮膚往往也累積了相當程度的DNA突變,只要再接受到臨門一腳的刺激就可能變成癌細胞。因此得過鱗狀細胞癌原位癌的病人都要比一般人更警覺,更要時常檢查自己的皮膚有無異常病灶出現。</span></div>
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<h2 style="text-align: left;">
<span style="font-size: large;">參考資料</span></h2>
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(1) Fitzpatrick's Dermatology, 9th edition, p. 1867-1871.</div>
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(2) McKee's Pathology of the Skin, 5th edition, p. 1192-1196.</div>
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(3) Surgery of the skin, 3rd edition, p. 718-719.</div>
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鄭煜彬(Yu-Pin Cheng)http://www.blogger.com/profile/07019803125903571476noreply@blogger.com0tag:blogger.com,1999:blog-5384877319969585099.post-75098509123026037842020-04-01T21:17:00.001-07:002020-04-08T05:09:52.683-07:00[考生加油] Dermatological Recall: Chapter 32 Lichen Planus Part 2<p class="MsoNormal"><br /></p>
<p class="MsoNormal"><span lang="EN-US"></span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgbANBcOHaBN7rrBQBpAltAv3-SICohW-NhEbN17nDUTCAic-sR-HNGbxMzVaFkOJdDZjFzgpoigbyYtKXZmMP1Z1dmCcNXLCmP5DnFz0Ho70aD_q5eG8IzONHD3eqPetmtlPoiApmMIbDO/" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="893" data-original-width="1344" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgbANBcOHaBN7rrBQBpAltAv3-SICohW-NhEbN17nDUTCAic-sR-HNGbxMzVaFkOJdDZjFzgpoigbyYtKXZmMP1Z1dmCcNXLCmP5DnFz0Ho70aD_q5eG8IzONHD3eqPetmtlPoiApmMIbDO/w480-h320/10004+%25282%2529.JPG" width="480" /></a></div><font size="4">口腔的扁平苔蘚除了造成疼痛,長期下來也有癌變的危險。扁平苔蘚不容易治療,常常需要另加上口服藥才能控制。很多位於頭皮、指甲的扁平苔蘚如果沒有及時治療,甚至可能造成不可逆的毛髮與指甲脫失。<br /></font><p></p><p class="MsoNormal"><span lang="EN-US"><font size="4">Chapter 32 :: Lichen Planus Part 2<o:p></o:p></font></span></p>
<p class="MsoNormal"><span lang="EN-US"><font size="4">:: Aaron R. Mangold & Mark R. Pittelkow<o:p></o:p></font></span></p>
<p class="MsoNormal"><font size="4"><span style="font-family: 新細明體, serif;">鄭煜彬</span><span lang="EN-US">(20200329)</span></font></p><table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: none;">
<tbody><tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">MALIGNANT TRANSFORMATION<o:p></o:p></span></p>
</td>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US"><o:p> </o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">How about the risk of malignant
transformation in oral LP? <o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US">Low risk (0.6-1.9%)<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">What are the risk factors of malignant
transformation in oral LP? <o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US">Long-standing dz, erosive or atrophic
types, tobacco use, esophageal involvement, oncogenic subtypes of HPV (type
16)<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">What is the stage of malignant
transformation in oral LP? <o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US">In situ carcinoma or with a microinvasive
pattern.<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">Where is the common sites of malignant
transformation in oral LP? <o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US">Tongue> buccal
mucosa>gingiva>>>lip<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">What are the features of malignant
transformation in oral LP?<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US">Invasive SCC: <o:p></o:p></span></p>
<p class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;"><!--[if !supportLists]--><span lang="EN-US"><span>1.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Indurated, nonhealing ulcers<o:p></o:p></span></p>
<p class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;"><!--[if !supportLists]--><span lang="EN-US"><span>2.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Exophytic lesions with a
keratotic surface. <o:p></o:p></span></p>
<p class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;"><!--[if !supportLists]--><span lang="EN-US"><span>3.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Red atrophic plaques(correlate
with SCC in situ)<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">What are the risk factors of SCC in LP ?<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;"><!--[if !supportLists]--><span lang="EN-US"><span>1.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Hypertrophic or verrucous LP<o:p></o:p></span></p>
<p class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;"><!--[if !supportLists]--><span lang="EN-US"><span>2.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">LP on the lower extremity<o:p></o:p></span></p>
<p class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;"><!--[if !supportLists]--><span lang="EN-US"><span>3.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">A history of arsenic exposure<o:p></o:p></span></p>
<p class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;"><!--[if !supportLists]--><span lang="EN-US"><span>4.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">A history of x-ray exposure<o:p></o:p></span></p>
<p class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;"><!--[if !supportLists]--><span lang="EN-US"><span>5.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Long-standing disease
(average, 12 ys)<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">DIAGNOSIS<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US"><o:p> </o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">What should you do for the vesiculobullous
disease or erosive disease of LP?<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US">Histopathology, DIF, IIF, & ELISA (to
differentiate from immunobullous dzs)<o:p></o:p></span></p>
<p class="MsoNormal"><span lang="EN-US">Laboratory testing is not required<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">What laboratory testing should be
performed in LP? <o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US">Tests for dyslipidemia<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">What laboratory testing should be
performed in oral LP?<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US">Patch tests of mercury, gold, chromate,
flavoring agents, acrylate, & thimerosal<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">What laboratory testing should be
performed in LLP?<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US">Testing for thyroid abnormalities: TSH,
antithyroid peroxidase antibodies, & anti-thyroglobulin antibodies.<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">When should you check HCV in the case of
LP? <o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US">Oral LP, risk factors for HCV (</span><span style="font-family: 新細明體, serif;">↑</span><span lang="EN-US">liver function, IV
drug use, blood transfusion <o:p></o:p></span></p>
<p class="MsoNormal"><span lang="EN-US">prior to 1992, & high risk sex), in
endemic areas (<b>East and Southeast Asia</b>,
South America, the Middle East, & Southern Europe)</span><span style="font-family: 新細明體, serif;">臺灣是流行區</span><span lang="EN-US"><o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">PATHOLOGY<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US"><o:p> </o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">What are the major pathologic findings of
LP?<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US">Epidermis: hyperkeratosis, wedge-shaped
areas of hypergranulosis, & elongation of rete ridges (sawtooth)<o:p></o:p></span></p>
<p class="MsoListParagraph" style="margin-left: 18pt; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: wingdings;"><span>l<span style="font: 7pt "times new roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Basal epidermal keratinocyte damage (effacement of DEJ)<o:p></o:p></span></p>
<p class="MsoNormal"><span lang="EN-US"><span> </span><o:p></o:p></span></p>
<p class="MsoListParagraph" style="margin-left: 18pt; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: wingdings;"><span>l<span style="font: 7pt "times new roman";"> </span></span></span><!--[endif]--><span lang="EN-US">A lichenoid-interface lymphocytic reaction: a dense, continuous,
& band-like lymphohistiocytic infiltrate at the DEJ<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">What are the 2 absent features in LP? <o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US">Parakeratosis & eosinophils<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">What is the apoptotic cells at the papillary
dermis of LP ?<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US">Colloid-hyaline bodies=Civatte bodies=
eosinophilic bodies. <o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">What is the difference between lichenoid
drug eruptions & classic LP? <o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US">Eosinophils (in 2/3 lichenoid drug
eruption)<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">What is the difference between hypertrophic
LP & classic LP?<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US">Eosinophils (in 1/5 hypertrophic LP, thus
they are very itchy.)<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">What is Max Joseph cleft formation in LP?
<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US">Separation of the epidermis in small
clefts under severe inflammation of LP.<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">What are the features of late disease of
LP? <o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US">Scarring (an atrophic epidermis,
effacement of the rete ridges, dermal fibrosis), <b>colloid bodies</b> & melanophages.<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">What is difference between late disease
of LP & poikiloderma? <o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US">LP: <b>colloid
bodies (+)</b><o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">What are the features of hypertrophic LP?<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US">Hyperkeratosis, acanthosis,
papillomatosis, thick-ened collagen bundles in the dermis, &<b> E</b></span><b><span style="font-family: 新細明體, serif;">φ<span lang="EN-US">.</span></span></b><span lang="EN-US"><o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">What are the differences between mucosal/genital
LP & cutaneous LP?<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US">Parakeratosis & an absent granular
layer, plasma cells. <o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">What are the features of LPP? <o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US">A perifollicular, lymphohistiocytic
inflammation at only isthmus & infundibulum + scarring alopecia
(perifollicular fibrosis, scarring, & follicular atrophy)<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">What is the features of DIF in LP? <o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoListParagraph" style="margin-left: 18pt; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US"><span>1.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">IgM(</span><span style="font-family: 新細明體, serif;">±</span><span lang="EN-US">IgG, IgA) on the
apoptotic cells(colloid bodies) at the DEJ<o:p></o:p></span></p>
<p class="MsoListParagraph" style="margin-left: 18pt; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US"><span>2.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Shaggy deposition of
fibrinogen at the DEJ<o:p></o:p></span></p>
<p class="MsoListParagraph" style="margin-left: 18pt; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US"><span>3.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Multiple Ig conjugates(IgM,
IgG, IgA): consider LE<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">What is the role of DIF in LP? <o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoListParagraph" style="margin-left: 18pt; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US"><span>1.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">More important in oral LP<o:p></o:p></span></p>
<p class="MsoListParagraph" style="margin-left: 18pt; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US"><span>2.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Atypical disease<o:p></o:p></span></p>
<p class="MsoListParagraph" style="margin-left: 18pt; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US"><span>3.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Ulcerative and
vesiculobullous LP<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">Where is the optimal location for biopsy
of cutaneous LP? <o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoListParagraph" style="margin-left: 18pt; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US"><span>1.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Proximal trunk <o:p></o:p></span></p>
<p class="MsoListParagraph" style="margin-left: 18pt; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US"><span>2.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Avoidance of the distal
extremities.<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">How do you select optimal location for
biopsy of LPP & nail LP? <o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US">With dermoscopy. <o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">Where is the proper location of biopsy of
nail LP?<span> </span><o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US">Surficial change (trachyonychia &
pitting): matrix<o:p></o:p></span></p>
<p class="MsoNormal"><span lang="EN-US">Change of plate(chromonychia, nail plate
fragmentation), subungual change(splinter hemorrhage, onycholysis, &
subungual debris): nail bed. <o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">Where are the proper locations of DIF of
LP ?<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoListParagraph" style="margin-left: 18pt; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US"><span>1.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Mouth floor & ventral
tongue<o:p></o:p></span></p>
<p class="MsoListParagraph" style="margin-left: 18pt; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US"><span>2.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Can be 1 cm from the lesion<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">DIFFERENTIAL DIAGNOSIS<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US"><o:p> </o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US"><o:p> </o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US"><o:p> </o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US"><o:p> </o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US"><o:p> </o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">CLINICAL COURSE AND PROGNOSIS<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US"><o:p> </o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">How long is the duration of most
cutaneous LP? <o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US">Resolves within 1-2 years<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">How much is the recurrence rate of LP? <o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US">20%, common in generalized cutaneous
disease.<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">What is the relationship between duration
& the extent/sites of LP? <o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US">Short to Long: generalized cutaneous <
nongeneralized cutaneous < cutaneous & mucosal < mucosal <
hypertrophic <LPP<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">What is the most common manifestation of
LP sequelae? <o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US">Postinflammatory hypo-/hyperpigmentation
(in higher Fitzpatrick skin types)<o:p></o:p></span></p>
<p class="MsoNormal"><span lang="EN-US"><o:p> </o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">TREATMENT(challenging & discouraging)<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US"><o:p> </o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">How can you decrease the severity of LP? <o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US">Discontinue exacerbating drugs, minimize
trauma, & reduce microbial overgrowth<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">What is most specific tx of lichenoid
dzs? <o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US">Janus kinase (JAK) inhibitors (target
CD8-Tc cells, also works in DM, AA, & vitiligo)<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">CUTANEOUS LICHEN PLANUS<span> </span><o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US"><o:p> </o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">What are the choices of skin-directed Tx
of cutaneous LP? <o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US">Topical: steroids(</span><span style="font-family: 新細明體, serif;">±</span><span lang="EN-US">occlusion), calcipotriene,
calcineurin inhibitors (esp. combination of steroids)<o:p></o:p></span></p>
<p class="MsoNormal"><span lang="EN-US">IL: steroids (5-10 mg/mL monthly </span><span style="font-family: 新細明體, serif;">±</span><span lang="EN-US"> topical steroids)<o:p></o:p></span></p>
<p class="MsoNormal"><span lang="EN-US">Phototherapy: NBUVB, BBUVB, UVA, PUVA<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">What are the special applications of
hypertrophic LP? <o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US">Occlusion of topical steroids, IL
steroids. <o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">What are the systemic Tx of LP?<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US">1<sup>st</sup>: oral steroids<o:p></o:p></span></p>
<p class="MsoNormal"><span lang="EN-US">2<sup>nd</sup>: <b>sulfasalazine</b>, metronidazole, acitretin, hydroxychloroquine/
chloroquine, methotrexate, mycophenolate mofetil (MMF), & azathioprine<o:p></o:p></span></p>
<p class="MsoNormal"><span lang="EN-US">3<sup>rd</sup>: cyclosporine<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">How do you choose the systemic Tx of LP ?<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US">Refractory/ulcerative: target lymphocutes
(methotrexate, MMF, <o:p></o:p></span></p>
<p class="MsoNormal"><span lang="EN-US">and azathioprine)<o:p></o:p></span></p>
<p class="MsoNormal"><span lang="EN-US">Generalized/hypertrophic: indirectly on
lymphocytes (sulfasalazine & metronidazole) or cellular <o:p></o:p></span></p>
<p class="MsoNormal"><span lang="EN-US">differentiation (acitretin)<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">How much is the dose of systemic prednisolone
for cutaneous LP? <o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US">0.3-1 mg/kg/ day for 4-6 wks. <o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">Why is corticosteroid-sparing agents very
important for cutaneous LP therapies? <o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US">Relapse is common after DC steroid <o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">What drug in 2<sup>nd</sup> line
therapies has highest efficacy for cutaneous LP? <o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US">Sulfasalazine (1-2.5 g/day)<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">What is adverse effects of sulfasalazine?
<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US">Agranulocytosis & </span><span style="font-family: 新細明體, serif;">↑</span><span lang="EN-US">liver function<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">What is the role of metronidazole in the Tx
of cutaneous LP? <o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoListParagraph" style="margin-left: 18pt; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US"><span>1.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">The first-line
nonimmunosuppressive systemic agent (250mg tid or 500mg bid)<o:p></o:p></span></p>
<p class="MsoListParagraph" style="margin-left: 18pt; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US"><span>2.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Effective in generalized
cutaneous LP. <o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">What is adverse effects of metronidazole?<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US">Sensory peripheral neuropathy<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">What is the role of acitretin in the
therapies of cutaneous LP ?<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US">Highly effective for hypertrophic LP (30
mg/day)<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">What is adverse effects of acitretin?<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US">Mucocutaneous side effects(xerosis,
scaling) and hyperlipidemia<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">What is the role of antimalarials in the Tx
of cutaneous LP ?<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US">Chloroquine: cutaneous LP.<o:p></o:p></span></p>
<p class="MsoNormal"><span lang="EN-US">Hydroxychloroquine: LPP, & actinic
LP, favorable side effects<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">What is the role of methotrexate in the Tx
of cutaneous LP ?<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US">Works for recalcitrant disease,
hypertrophic LP, & LPP<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">What is drawbacks of MMF, azathioprine,
& cyclosporine? <o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US">MMF: expensive, delayed response (needs
steroids)<o:p></o:p></span></p>
<p class="MsoNormal"><span lang="EN-US">Azathioprine: suppressive effects on T +
B lymphocytes & poor tolerability<o:p></o:p></span></p>
<p class="MsoNormal"><span lang="EN-US">Cyclosporine: expensive, frequent
relapses, long-term side effects (kidney insufficiency & lymphoma)<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">ORAL LICHEN PLANUS<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US"><o:p> </o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">What is the cornerstone of Tx in oral LP?<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US">Good oral hygiene with regular
professional dental cleanings<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">How can patients minimize exacerbating
factors of oral LP? <o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US">Avoiding contact allergens(removal of
amalgams, gold), DC drug, reducing oral microbes & trauma<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">What are the skin-directed Tx of oral LP?
<span> </span><o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US">1<sup>st</sup>: topical sterods in
orabase.(Stronger agents: clobetasol & fluocinonide + more occlusive
preparations + 2-6 times daily) <o:p></o:p></span></p>
<p class="MsoNormal"><span lang="EN-US">2<sup>nd</sup>: topical tacrolimus/
pimecrolimus <o:p></o:p></span></p>
<p class="MsoNormal"><span lang="EN-US">3<sup>rd</sup>: topical cyclosporine/tretinoin<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">What is the major complication of topical
steroids?<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US">Fungal infection <o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">How can you manage the major complication
topical steroids? <o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US">Oral chlorohexidine gluconate mouthwash,
topical anticandidal medications, oral fluconazole<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">What is the side effect of topical
calcineurin inhibitors for oral LP?<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US">Transient burning (improved by combination
of topical steroids)<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">What is the role of IL steroid in the Tx
of oral LP?<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US">Last line (after exhausting topical
therapies, 10-40mg/ml, Q 1-4 wks)<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">What are the systemic Tx of oral LP? <span> </span><o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US">1<sup>st</sup>: oral steroids<o:p></o:p></span></p>
<p class="MsoNormal"><span lang="EN-US">2<sup>nd</sup>: acitretin,
hydroxychloroquine/ chloroquine, methotrexate, MMF<o:p></o:p></span></p>
<p class="MsoNormal"><span lang="EN-US">3<sup>rd</sup>: cyclosporine, azathioprine…<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">How much is the dose of systemic prednisolone
for oral LP? <o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US">1.5-2 mg/kg/ day for 4-6 wks. <o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">What are the concerns of systemic Tx in
oral LP? (2)<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoListParagraph" style="margin-left: 18pt; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US"><span>1.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">iatrogenic candida infections<o:p></o:p></span></p>
<p class="MsoListParagraph" style="margin-left: 18pt; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US"><span>2.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span style="font-family: 新細明體, serif;">↑</span><span lang="EN-US">risk of oral SCC under erosive & refractory LP &
immunosuppression<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">What drugs are preferred in oral LP? <span> </span>(4)<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US">Erosive LP<o:p></o:p></span></p>
<p class="MsoListParagraph" style="margin-left: 18pt; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US"><span>1.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">MMF <o:p></o:p></span></p>
<p class="MsoListParagraph" style="margin-left: 18pt; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US"><span>2.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Hydroxychloroquine (less
immunosuppressive)<o:p></o:p></span></p>
<p class="MsoListParagraph" style="margin-left: 18pt; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US"><span>3.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Methotrexate (less immunosuppressive)<o:p></o:p></span></p>
<p class="MsoNormal"><span lang="EN-US">Hyperkeratotic/noneroded LP<o:p></o:p></span></p>
<p class="MsoListParagraph" style="margin-left: 18pt; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US"><span>4.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Acitretin (antiploliferative,
less immunosuppressive)<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">How much is the dose of systemic steroids
for oral LP?<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US">Prednisolone: 1.5-2 mg/kg (higher than
skin, more side effects)<o:p></o:p></span></p>
<p class="MsoNormal"><span lang="EN-US">Betamethasone: 5 mg on 2 consecutive days
weekly (pulse tx: less side effects)<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">What oral drugs can be considered in oral
LP? <o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoListParagraph" style="margin-left: 18pt; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US"><span>1.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Acitretin 30mg/day<o:p></o:p></span></p>
<p class="MsoListParagraph" style="margin-left: 18pt; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US"><span>2.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Alitretinoin 30mg/day (</span><span style="font-family: 新細明體, serif;">臺灣沒有</span><span lang="EN-US">)<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">What are first choices of steroid-sparing
agents for oral LP? (2)<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoListParagraph" style="margin-left: 18pt; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US"><span>1.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Methotrexate (10-15mg/wk)<o:p></o:p></span></p>
<p class="MsoListParagraph" style="margin-left: 18pt; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US"><span>2.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">MMF (2-3g/day)<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">Tx of LPP<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US"><o:p> </o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">Why does LPP & FFA cause scarring
alopecia? <o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US">Deficiency of PPARγ</span><span style="font-family: 新細明體, serif;">→</span><span lang="EN-US">loss of immune privilege</span><span style="font-family: 新細明體, serif;">→</span><span lang="EN-US">destruction of the
bulge <o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">What are the skin-directed Tx of LPP? <span> </span><o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US">1<sup>st</sup>: mid to high potency steroids(topical
or IL)<o:p></o:p></span></p>
<p class="MsoNormal"><span lang="EN-US">2<sup>nd</sup>: calcineurin inhibitors<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">What are the systemic Tx of LPP? <span> </span><o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US">1<sup>st</sup>: prednisolone 1 mg/kg/day<o:p></o:p></span></p>
<p class="MsoNormal"><span lang="EN-US">2<sup>nd</sup>: Hydroxychloroquine (+
doxycycline, <b>not monotherapy</b>),
MMF, methotrexate<o:p></o:p></span></p>
<p class="MsoNormal"><span lang="EN-US">3<sup>rd</sup>: cyclosporine (monotherapy)<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">Tx of FFA<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US"><o:p> </o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">What are the skin-directed Tx of FFA? <span> </span><o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US">IL steroid, topical minoxidil (combine hydroxychloroquine
or others) <o:p></o:p></span></p>
<p class="MsoNormal"><span lang="EN-US"><o:p> </o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">What are the systemic Tx of FFA? <span> </span><o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoListParagraph" style="margin-left: 18pt; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US"><span>1.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><b><span lang="EN-US">5 α-reductase inhibitors </span></b><span lang="EN-US">(finasteride
2-5mg/day or dutasteride 0.5mg every 1-7 days)<o:p></o:p></span></p>
<p class="MsoListParagraph" style="margin-left: 18pt; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US"><span>2.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Systemic steroids + MTX &
MMF<o:p></o:p></span></p>
<p class="MsoListParagraph" style="margin-left: 18pt; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US"><span>3.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Cyclosporine (monotherapy)<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">NAIL LICHEN PLANUS<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US"><o:p> </o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">What is the goal of the therapy of nail
LP? <o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US">Stop the disease (prevent irreversible
pterygium), not reverse it. <o:p></o:p></span></p>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<p class="MsoNormal"><span lang="EN-US">What is the therapies of nail LP?<o:p></o:p></span></p>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<p class="MsoNormal"><span lang="EN-US">Ultrapotent topical & intralesional
steroids</span><span style="font-family: 新細明體, serif;">→</span><span lang="EN-US">syetemic steroids (for compromise of function & debilitating
pain) or hydroxychloroquine<o:p></o:p></span></p>
</td>
</tr>
</tbody></table><br />鄭煜彬(Yu-Pin Cheng)http://www.blogger.com/profile/07019803125903571476noreply@blogger.com1tag:blogger.com,1999:blog-5384877319969585099.post-51040870229403128292020-03-28T21:10:00.002-07:002020-03-30T17:10:32.779-07:00[考生加油] Dermatological Recall: Chapter 32 Lichen Planus Part 1<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhGLjfHsRBSfekoCwaiZ9tW5frZQtPp9FoPZ76Rah5ZJPh9OhjQfK5It3MUyKKzB7RTbhLRJ1VEZkJHSACe5-K11IoC9DY1odolXB9QmzFFae9I7Lv-fKAWD19aHsEZxegV1kPsS-AHv633/s1600/21808042+P12-19543+Lichen+planus+%252811%2529.JPG" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1000" data-original-width="1504" height="424" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhGLjfHsRBSfekoCwaiZ9tW5frZQtPp9FoPZ76Rah5ZJPh9OhjQfK5It3MUyKKzB7RTbhLRJ1VEZkJHSACe5-K11IoC9DY1odolXB9QmzFFae9I7Lv-fKAWD19aHsEZxegV1kPsS-AHv633/s640/21808042+P12-19543+Lichen+planus+%252811%2529.JPG" width="640" /></a></div>
<div class="MsoNormal">
<span lang="EN-US"><span style="font-size: large;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: large;">扁平苔蘚(lichen planus)聽起來是很普通的疾病,但在皮膚科卻是成因</span><span style="font-size: large;">相當複雜,</span><span style="font-size: large;">且難以治療的燙手山芋(剛好也是紫色的)。長在頭皮與指甲的病灶如果太晚治療,甚至會造成頭髮與指甲不可逆的消失。儘管扁平苔癬在臨床上相對少見,遇到的時候趕快診斷並給予正確治療才最重要的事。</span></div>
<div class="MsoNormal">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal">
<span lang="EN-US"><span style="font-size: large;">Chapter 32 :: Lichen Planus Part 1<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US"><span style="font-size: large;">:: Aaron R. Mangold & Mark R. Pittelkow<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-family: 新細明體, serif;"><span style="font-size: large;">鄭煜彬</span></span><span lang="EN-US"><span style="font-size: large;">(20200329)</span><o:p></o:p></span></div>
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<span lang="EN-US"><span style="font-size: large;"><br /></span></span></div>
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<span lang="EN-US">INTRODUCTION<o:p></o:p></span></div>
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<span lang="EN-US">What is the meaning of lichen planus(LP)?</span><span style="font-family: 新細明體, serif;"> </span><span lang="EN-US"><o:p></o:p></span></div>
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<span lang="EN-US">Flat(planus) tree moss(lichen)<o:p></o:p></span></div>
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<span lang="EN-US">What is the involved tissue of LP? <o:p></o:p></span></div>
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<span lang="EN-US">Any ectodermal-derived tissue<o:p></o:p></span></div>
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<span lang="EN-US">What is the classification of LP? <o:p></o:p></span></div>
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<span lang="EN-US">Papulosquamous lesion (however, it just
has scant scales, not really “squamous”)<o:p></o:p></span></div>
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<span lang="EN-US">What is the four Ps of LP? <o:p></o:p></span></div>
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<span lang="EN-US">(1) purple, (2) polygonal, (3) pruritic,
& (4) papules<o:p></o:p></span></div>
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<span lang="EN-US">What is the histological feature of LP? <o:p></o:p></span></div>
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<span lang="EN-US">A brisk lymphocytic interface reaction
(lichenoid infiltration)<o:p></o:p></span></div>
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<span lang="EN-US">PATHOGENESIS<o:p></o:p></span></div>
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<span lang="EN-US">What contributing factors may cause LP?<o:p></o:p></span></div>
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<span lang="EN-US">Infectious, immune, metabolic, and
genetic causes<o:p></o:p></span></div>
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<span lang="EN-US">What is the main responder of LP? <o:p></o:p></span></div>
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<span lang="EN-US">Cell–mediated immunity(T cells). Immunoglobulins
(humoral immunity) is only secondary response. <o:p></o:p></span></div>
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<span lang="EN-US">What is the constitution of T cells in
LP? (Th or Tc?)<o:p></o:p></span></div>
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<span lang="EN-US">Dermis: CD4+ T-helper (CD4-Th) <o:p></o:p></span></div>
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<span lang="EN-US">Near basal keratinocytes: CD8+T-cytotoxic
(CD8-Tc)<o:p></o:p></span></div>
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<span lang="EN-US">What is the 4 stages of LP?<o:p></o:p></span></div>
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<span lang="EN-US">antigen recognition, lymphocyte
activation, keratinocyte apoptosis, resolution. <o:p></o:p></span></div>
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<span lang="EN-US">What is the pathogenesis of LP ?<o:p></o:p></span></div>
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<span lang="EN-US">Some antigen</span><span style="font-family: 新細明體, serif;">→</span><span lang="EN-US">Langerhans cell</span><span style="font-family: 新細明體, serif;">→↑</span><span lang="EN-US">MHC class II
receptors</span><span style="font-family: 新細明體, serif;">→↑</span><span lang="EN-US">CD4-Th (antigen recognition of HLA-DR(+) keratinocyte)</span><span style="font-family: 新細明體, serif;">→</span><span lang="EN-US">release
inflammatory cytokines (IFN-γ)</span><span style="font-family: 新細明體, serif;">→</span><span lang="EN-US">CD8-Tc oligoclonal expansion<o:p></o:p></span></div>
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<span lang="EN-US">What is the antigen of typical LP?<o:p></o:p></span></div>
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<span lang="EN-US">Unknown antigen<o:p></o:p></span></div>
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<span lang="EN-US">What is the antigen of lichenoid GVHD?<o:p></o:p></span></div>
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<span lang="EN-US">Alloantigens from the graft. <o:p></o:p></span></div>
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<span lang="EN-US">What is the antigen of oral LP? <o:p></o:p></span></div>
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<span lang="EN-US">MHC class I on keratinocytes (an
autoreactive peptide or an exogenous antigen?)<o:p></o:p></span></div>
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<span lang="EN-US">What are the exogenous antigen of LP? <o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US"><span>1.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Inorganic mercury (dental
amalgam), gold (act as haptens)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>2.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Syphilis, HSV 2, HIV,
amebiasis, chronic bladder infections, HCV, Helicobacter pylori, or HPV.<o:p></o:p></span></div>
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<span lang="EN-US">What are the cause of TNF- α associated lichenoid
tissue reactions(LTRs)?<o:p></o:p></span></div>
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<span lang="EN-US">TNF-α inhibitors (dysregulated cytokine) </span><span style="font-family: 新細明體, serif;">→</span><span lang="EN-US"> upregulation of
type I IFN)<o:p></o:p></span></div>
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<span lang="EN-US">What is the major cytokine in LP?<o:p></o:p></span></div>
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<span lang="EN-US">IFN-γ (</span><span style="font-family: 新細明體, serif;">↑</span><span lang="EN-US">migration of lymphocytes to DEJ)<o:p></o:p></span></div>
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<span lang="EN-US">How does IFN-γ work in LP?<o:p></o:p></span></div>
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<span style="font-family: 新細明體, serif;">↑</span><span lang="EN-US">inflammatory
chemokines CXCL-9, 10, & 11</span><span style="font-family: 新細明體, serif;">→</span><span lang="EN-US">activate CXCR-3 on
CD4-Th <o:p></o:p></span></div>
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<span lang="EN-US">Why does peroxisome-proliferator-activated
receptor </span><span style="font-family: 新細明體, serif;">γ</span><span lang="EN-US"> (PPARγ) stop scarring alopecia in LPP? <o:p></o:p></span></div>
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<span lang="EN-US">It inhibits CXCL-10 & 11<o:p></o:p></span></div>
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<span lang="EN-US">What is the mechanism of keratinocyte
apoptosis in LP?<o:p></o:p></span></div>
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<span lang="EN-US">CD8-Tc cells</span><span style="font-family: 新細明體, serif;">→</span><span lang="EN-US">granzyme B release,
TNF-α–TNF-α R1 receptor interaction, & Fas–Fas-L interaction<o:p></o:p></span></div>
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<span lang="EN-US">What is the mechanism of disruption of
the basement membrane in LP? <o:p></o:p></span></div>
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<span lang="EN-US">TNF-α</span><span style="font-family: 新細明體, serif;">→↑</span><span lang="EN-US">matrix metalloproteinase-9 (MMP-9), especially
in ulcerative lesions<o:p></o:p></span></div>
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<span lang="EN-US">What is the mechanism of the resolution
of LP? <o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US"><span>1.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">T-regulatory cells</span><span style="font-family: 新細明體, serif;">→↓</span><span lang="EN-US">Tc<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>2.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Fas-L, granzyme B, &
perforin on the keratinocytes: apoptosis of Tc<o:p></o:p></span></div>
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<span lang="EN-US">GENETIC AND EPIGENETIC REGULATION<o:p></o:p></span></div>
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<br /></div>
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<span lang="EN-US">What are the sites of gene polymorphisms
related to LP? <o:p></o:p></span></div>
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<b><span lang="EN-US">HLA,
immune signaling molecules & receptors (IFN-γ, TNF-α, TNF-α R2, IL-4,
IL-6, IL-18, NF-κB)</span></b><span lang="EN-US">, PGE2, oxidative stress,
transglutaminase, thyroid hormone, & prothrombin. <o:p></o:p></span></div>
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<span lang="EN-US">What are miRNAs related to the epigenetic
regulation of LP?<o:p></o:p></span></div>
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<span lang="EN-US">micro-RNA (miRNA)-146a & -155<o:p></o:p></span></div>
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<span lang="EN-US">What are the most specific marker of LP?<o:p></o:p></span></div>
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<span lang="EN-US">CXCR-3 ligand & CXCL-9,<o:p></o:p></span></div>
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<span lang="EN-US">EPIDEMIOLOGY<o:p></o:p></span></div>
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<br /></div>
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<span lang="EN-US">How much is the prevalence of LP? <o:p></o:p></span></div>
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<span lang="EN-US">1% (0.1-4%), but not exact. <o:p></o:p></span></div>
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<div class="MsoNormal">
<span lang="EN-US">What is the age of most LP? <o:p></o:p></span></div>
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<span lang="EN-US">30-60 y/o (2/3 of all cases)<o:p></o:p></span></div>
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<div class="MsoNormal">
<span lang="EN-US">What is the peak onset of LP? <o:p></o:p></span></div>
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<span lang="EN-US">>55 y/o (elderly, earlier in women)<o:p></o:p></span></div>
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<div class="MsoNormal">
<span lang="EN-US">How much is the prevalence of childhood
LP?<o:p></o:p></span></div>
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<span lang="EN-US">1-5%, 20% in Pacific Indians. no sexual
predilection<o:p></o:p></span></div>
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<div class="MsoNormal">
<span lang="EN-US">What is the peak onset of childhood LP?<o:p></o:p></span></div>
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<span lang="EN-US">Between 8 & 12 years of age<o:p></o:p></span></div>
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<span lang="EN-US">What is the features of familial LP? <o:p></o:p></span></div>
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<span lang="EN-US">Family history(</span><span style="font-family: 新細明體, serif;">廢話</span><span lang="EN-US">), early onset, widespread & erosive/ulcerative disease,
mucosal involvement, & frequent relapses.<o:p></o:p></span></div>
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<div class="MsoNormal">
<span lang="EN-US">What is the HLA tendency in familial
& nonfamilial LP? <o:p></o:p></span></div>
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<span lang="EN-US">Familial: HLA-B27, Aw19, -B18, & -Cw8<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">Nonfamilial: HLA-A3, -A5, -A28, -B8,
-B16, & Bw35<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the HLA tendency in oral & cutaneous
LP?<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Oral: HLA-B8<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">Cutaneous: HLA-Bw35<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">CLINICAL FEATURES<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">Where is the locations of LP? <o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Skin, oral mucosa, any ectodermal-derived
tissue (hair, nails, internal & external genitalia, eyes, &
esophagus.)<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">How long is the development of typical
LP?<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Over the course of weeks.<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">CUTANEOUS FINDINGS<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the clinical featurs of LP? <o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>1.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Well-marginated, dull
red-violet, flat-topped, polygonal papules. (4”Ps”)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>2.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">The grouped papules often
coalesce into plaques.<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>3.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><b><span lang="EN-US">Wickham striae</span></b><span lang="EN-US">, fine, white &
adherent reticulate scale (esp. in dermoscopy)<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the meaning of Wickham striae?<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>1.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Characteristic features of LP<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>2.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Correlate with
orthokeratosis, epidermal thickening, & an </span><span style="font-family: 新細明體, serif;">↑</span><span lang="EN-US">granular
layer.<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">Why does LP have dull red-violet hue? <o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Combination of vascular dilation &
pigment incontinence<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">Where are the typical locations of LP
lesions? <o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">The flexural wrists, arms, legs, proximal
thighs, trunk, & neck, symmetrical distribution.<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">Where are the atypical locations of LP
lesions?<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Face & palms<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">Where are the locations of inverse LP ?<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Axillae, groin, & inframammary region<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the most common symptom of LP? <o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Extreme pruritus (directly correlate with
<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">the extent of involvement)<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What type of LP affects limited areas but
has severe pruritus? <o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Hypertrophic LP (only lower extremities)<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the name of trauma-induced
disease in acute LP?<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Isomorphic (Koebner) phenomenon<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the reason of isomorphic phenomenon?<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Trauma</span><span style="font-family: 新細明體, serif;">→</span><span lang="EN-US">endogenous peptides (cathelicidin
LL-37) or antigens (DNA & RNA)</span><span style="font-family: 新細明體, serif;">→</span><span lang="EN-US">type I IFNs (-α
and -β) </span><span style="font-family: 新細明體, serif;">→</span><span lang="EN-US">LP<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the common sequela of LP?<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Postinflammatory hyperpigmentation, esp.
on darker skin. (hypopigmentation: other diagnosis)<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the percentage of oral LP? (Adults
& children)<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Adult: 42-60% (about 1/2)<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">Children: 17-30% (about 1/5)<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the percentage of hair & nail
LP? (Adults & children)<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Adult: 2-6% (about 1/20)<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">Children: 0-19% (about 1/10)<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">CLINICAL VARIANTS<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">How are LP variant categorized? <o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">According to configuration, morphology,
& sites. <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">Configuration: annular LP, linear/ Blachkoid/
zosteriform LP<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">Morphologic appearance: hypertrophic LP,
atrophic LP<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">Site of involvements<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the location of annular LP? <o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Penis & scrotum<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the morphology of annular LP?<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">An arcuate grouping of individual papules</span><span style="font-family: 新細明體, serif;">→</span><span lang="EN-US">form a ring or
expand centrifugally with a central clearing & hyperpigmentation.<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is actinic LP<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Annular LP in subtropical zones on
sun-exposed, dark-skinned young adults & children.<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the cause of linear LP? <o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Trauma induces a row of LP papules. <o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the cause of Blaschkoid LP? <o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Postzygotic, somatic mutations in
susceptibility-associated genes<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the cause of zosteriform LP?<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">A viral trigger of disease or an isotopic
response related to underlying resident memory cells.<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the difference between linear
& zosteriform LP?<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Linear LP does not follow dermatomal
lines.<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">Zosteriform LP follow dermatomal lines.<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the differential diagnoses of
linear, Blaschkoid, zosteriform LP? <o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">All segmental diseases: lichen striatus,
linear epidermal n., inflammatory linear & verrucal epidermal n., linear
psoriasis, & linear Darier dz.<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">Where are the locations of hypertrophic
LP?<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Anterior shins & interphalangeal
joints.<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the features of hypertrophic LP?<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>1.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Thickened, elevated,
purple-red, hyperkeratotic plaques & nodules, with follicular
accentuation & chalk-like scale.<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>2.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Highly pruritic, refractory
to treatment, & associated with relapse. <o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the differential diagnoses
verrucal lesions of hypertrophic LP?<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Keratinocyte carcinomas, rupioid
psoriasis, rupioid syphilis, reactive arthropathy (</span><span lang="EN-US" style="background: white; color: #222222; font-family: arial, sans-serif;">Reiter's
syndrome</span><span lang="EN-US">), & cutaneous LE<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the associated disease of
hypertrophic LP? <o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Chronic venous insufficiency<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the features of atrophic LP?<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Oligo-lesional, well-marginated,
blue-white papules or plaques with central atrophy.<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">Where are the locations of atrophic LP?<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Proximal lower extremity & trunk<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the differential diagnoses of
atrophic LP? <span> </span><o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Lichen sclerosus et atrophicus &
mycosis fungoides <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">(MF)<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the nature of atrophic LP?<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Late-stage resolved disease of LP<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the mechanism of vesiculobullous
LP?<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Secondary to an exuberant inflammatory
response of LP (acute flares) & an exaggerated Max-Joseph space.<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the features of LP pemphigoides?<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>1.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Classic LP + lesions of bullous
pemphigoid <o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>2.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Bullous pemphigoid antibodies
(BP 180 and 230) & immunofluorescence. <o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the mechanism of LP pemphigoides?
<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">LP</span><span style="font-family: 新細明體, serif;">→</span><span lang="EN-US">exposure of autoantigen</span><span style="font-family: 新細明體, serif;">→</span><span lang="EN-US">bullous pemphigoid antibody </span><span style="font-family: 新細明體, serif;">→</span><span lang="EN-US">BP lesions<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">Where are the locations of
vesiculobullous LP? <o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Lower extremities & oral cavity (became
erosion & ulcer).<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the features of erosive &
ulcerative LP?<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>1.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Erosion & ulcer<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>2.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Significant pain &
scarring<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>3.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Other ectodermal involvement
(scarring alopecia & loss of the toenails)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>4.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">SCC in chronic lesions of
ulcerative oral LP.<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">Where are the locations of erosive &
ulcerative LP?<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Feet & oral cavity<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the 3 major variants of
follicular LP? <o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Lichen planopilaris (LPP), frontal
fibrosing alopecia(FFA), & Gram-Little-Piccardi-Lassueur syndrome (GLPLS)<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the features of LP follicularis
tumidus (LPFT)?<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Pruritic, red-violet pseudo-tumoral
facial & posterior auricular plaques + yellow cysts + LP elsewhere<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the differential diagnoses of
LPFT? <o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Folliculotropic MF, & cutaneous lupus
erythematosus <o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the features of LP pigmentosus
(LPP)? <o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Hyperpigmented, dark-brown macules in
sun-exposed & flexural folds, usually in darker skinned individuals. <o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the relationship between LPP
& ashy dermatosis(erythema dyschromicum)?<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">A phenotypic spectrum based on genetic
& <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">environmental factors: they have
significant overlapping. <o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the features of actinic LP?<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>1.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Minimally symptomatic <o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>2.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Annular, well-marginated,
hyperpigmented brown-violet, flat-topped, plaques with a slightly rolled
border <o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>3.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Subtropical zones on
sun-exposed, dark-skinned young adults & children of Middle Eastern
descent<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>4.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">In the spring & summer
months.<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>5.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Hx: <b>a more brisk LTR</b> relative to LP pigmentosus, vacuolar changes,
& pigment incontinence.<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">Where are the locations of actinic LP?<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Face > the dorsal hands, arms, &
nape of the neck(sun-exposed skin)<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">Who predisposes LP of the scalp?<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">female <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the 3 variants of LP of the scalp?<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">LPP, FFA, & GLPLS (the same as
follicular LP)<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the features of classic LPP?<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Individual perifollicular hyperkeratosis
+ diffuse livid erythema</span><span style="font-family: 新細明體, serif;">→</span><span lang="EN-US">plaques on the scalp</span><span style="font-family: 新細明體, serif;">→</span><span lang="EN-US">scarring alopecia<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">Where is the typical location of classic
LPP?<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Vertex of the scalp<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the features of LPP on the
dermoscope? <o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Absence of follicular opening, cicatricial
white patches, peripilar casts and perifollicular scale, blue-gray dots,
perifollicular erythema, & polytrichia (2 or 3 hairs)<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the features of FFA? <o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>1.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Progressive frontotemporal
recession (inflammatory)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>2.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Loss of the eyebrows
(noninflammatory)<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">Who predisposes FFA? <o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Postmenopausal women (but can occur in
younger women)<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What might be the cause of FFA? <o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Leave-on facial products, sun-screen,
& allergy to fragrances (positive patch test)<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the features of GLPLS? <o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Cicatricial alopecia of the scalp,
nonscarring alopecia of the axilla & groin, & follicular papules on
the trunk & extremities.<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the end stage of follicular LP?<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Pseudopelade of Brocq (it can also be the
result of LE, pustular scarring forms of folliculitis, fungal infections,
scleroderma, & sarcoidosis.)<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">Where are the typical locations of
mucosal LP?<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Mouth or genitalia<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the types of oral LP? <o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Reticular(most common), plaque-like,
atrophic, papular, erosive or ulcerative, & bullous forms.<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the locations & symptoms of
all the types of oral LP?<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>1.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Reticular: buccal >
tongue> gingiva (asymptomatic)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>2.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Erosive & ulcerative:
tongue (extremely painful), gingiva (gingival stomatitis or desquamative
gingivitis)<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the difference between oral LP
& oral lichenoid reactions (OLRs)<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">OLRs have an identifiable cause (They are
similar clinically & histologically)<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">Where is the common location or OLRs?<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Buccal mucosa adjacent to amalgam dental
fillings<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the result of patch test on the
patients with OLRs?<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Positive reactions to mercury, gold,
& other metals</span><span style="font-family: 新細明體, serif;">→</span><span lang="EN-US"> negative after the removal of amalgams. (A special site irritant
reaction </span><span style="font-family: 新細明體, serif;">→</span><span lang="EN-US"> koebnerization)<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the features of oral LP on the
patients of HIV<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>1.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Bilateral reticular keratotic
or atrophic changes of the buccal mucosa<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>2.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Lichenoid atrophic patches
over the dorsal tongue<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>3.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Follows zidovudine or
ketoconazole intake (a unique drug hypersensitivity)<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the features of esophageal LP?<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>1.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">proximal esophagus (upper
1/3)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>2.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">middle-aged women<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>3.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">preceding or concomitant oral
LP<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>4.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">progressive dysphagia and
odynophagia<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>5.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">lacy white papules, pinpoint
erosions, desquamation, pseudomembranes, & stenosis.<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>6.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Hx: parakeratosis (not in
skin LP), epithelial atrophy, & lack of hypergranulosis<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the percentage of male genitalia
involvement of LP? <o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">25% of all male cases <o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the most common pattern &
location of LP on male genitalia? <o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Annular lesions on glans penis<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the features of anal LP? <o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Leukokeratosis, hyperkeratosis,
fissuring, & erosions<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the features of vulvar &
vaginal LP? <o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>1.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Combined with oral LP (in
25-60% oral LP cases)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>2.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Patches of leukoplakia or
erythroplakia</span><span style="font-family: 新細明體, serif;">→</span><span lang="EN-US">erosive & atrophic disease</span><span style="font-family: 新細明體, serif;">→</span><span lang="EN-US">desquamative vaginitis<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>3.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Often asymptomatic</span><span style="font-family: 新細明體, serif;">→</span><span lang="EN-US">burning, itching,
painful erosion<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is vulvovaginal gingival syndrome
(VVGS)?<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Triad of gingival/lingual erythema &
erosions, vulvar & vaginal desquamation & erosions. (Also involves skin/scalp/nails/esophagus
)<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the significant long-term
sequelae of VVGS?<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Fibrosis & stricture of vagina (needs
aggressive topical and systemic immunosuppression)<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the HLA related to VVGS?<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Class II HLA DBQ1</span><span lang="EN-US" style="font-family: "cambria math", serif;">∗</span><span lang="EN-US">0201 allele<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the sequelae of conjunctival LP?
<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Cicatricial conjunctivitis.<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the differential diagnoses of
conjunctival LP? <o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Paraneoplastic autoimmune multiorgan
syndrome <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">& paraneoplastic/cicatricial
pemphigoid<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">How to distinguish conjunctival LP with
other cicatricial conjunctivitis? <o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Direct immunofluorescence, indirect
immunofluorescence, & serologies for autoantibodies<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the signs/symptoms of otic LP? <o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Otorrhea or external auditory canal
stenosis.<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the long-term sequelae of otic
LP? <o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Progressive hearing loss(involvement of
external auditory canal & tympanic membrane)<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the 3 major forms of nail LP? <o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Classic nail lichen planus , 20-nail
dystrophy, & idiopathic atrophy of the nails.<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">Which 2 forms of nail LP are common in
children?<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">20-nail dystrophy, & idiopathic
atrophy of the nails.<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the common features of classic
nail LP? <o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Thinning, longitudinal ridging, distal
nail splitting (onychoschizia), onycholysis, longitudinal striation with a
“sandpaper-like quality” (onychorrhexis), subungual hyperkeratosis, &
atrophic or absent nail plates(anonychia)<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the early finding of nail LP in
dermoscopy?<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Nail pitting<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the classic finding in nail LP involving
the <b>matrix</b>? <o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<b><span lang="EN-US">Pterygium</span></b><span lang="EN-US"> or forward growth of the eponychia with adherence to the proximal
nail plate (irreversible, loss of nail plate)<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the common features of 20-nail
dystrophy?<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Trachyonychia (uniform roughness of the
20 nails), an indolent course. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the common features of idiopathic
atrophy of the nails?<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Abrupt onset & rapidly progressive
thinning of the nails</span><span style="font-family: 新細明體, serif;">→</span><span lang="EN-US">subsequent loss & scarring </span><span style="font-family: 新細明體, serif;">±</span><span lang="EN-US"> dorsal pterygium<b><o:p></o:p></b></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the differential diagnosis of
nail LP?<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Psoriasis, alopecia areata, atopic
dermatitis, & rarely immunobullous diseases.<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the features of inverse LP?<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Red-<b>brown</b>,
discrete papules & flat-topped plaques at flexural areas<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the locations of inverse LP?<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Flexural areas: axillae, inframammary
region, & groin. (antecubital, popliteal, other ectodermal-derived
tissues are rare.)<b><o:p></o:p></b></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What peoples predispose inverse LP? <o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Whites, Asians, & Tunisians<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the differences of LP
pigmentosus & inverse LP? <o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">LP pigmentosus inversus: flexural areas, no
involvement of sun-exposed areas<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">LP pigmentosus: flexural areas +
sun-exposed areas. <o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">Where are the involved areas in those
with palmoplantar LP? <o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>1.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Internal plantar arch of feet
<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>2.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Thenar & hypothenar
eminence of hands. <o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>3.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Anterior shin & malleoli<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the features of palmoplantar LP?
<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Pruritic, red-purple, <b>scaly</b> plaques (a faint purple hue
& an inflammatory halo) </span><span style="font-family: 新細明體, serif;">±</span><span lang="EN-US"> callus-like, yellow,
compact keratotic papules/papulonodules on the lateral margins of the fingers
& hand surfaces. <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">No Wickham striae.<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the 4 patterns of palmoplantar
LP? <o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Plaque type, punctate, diffuse
keratoderma, & ulcerated<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the differential diagnoses of
palmoplantar LP? <o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Keratotic papules of palms & soles: psoriasis,
warts, calluses, porokeratosis, hyperkeratotic dermatitis, tinea, or
secondary syphilis.<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the features of lichenoid drug
eruptions? <o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Localized or generalized with eczematous
papules & plaques with variable degree of desquamation<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the cause of lichenoid drug
eruptions?<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Ingestion <o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>1.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Gold salts<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>2.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span style="font-family: 新細明體, serif;">β</span><span lang="EN-US">-blackers<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>3.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Antimalarials<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>4.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Diuretics (thiazides,
furosemide, spironolactone)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>5.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Penicillamine<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><b><span lang="EN-US"><span>6.<span style="font: 7pt "times new roman";">
</span></span></span></b><!--[endif]--><b><span lang="EN-US">Immune checkpoint inhibotors (17%: pembrolizumab, nivolumab,
ipilimumab)<o:p></o:p></span></b></div>
<div class="MsoNormal">
<span lang="EN-US">Contact or inhalation of certain
chemicals.<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>1.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Color film developers<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>2.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Dental restoration materials
(amalgams: Ag, Hg, Au)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>3.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Musk ambrette (</span><span style="font-family: 新細明體, serif;">合成麝香</span><span lang="EN-US">)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>4.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Nickel<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>5.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Gold<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>6.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Aminoglycosides<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the features of lichenoid drug
eruptions? <o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>1.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Often with hyperpigmentation
& alopecia<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>2.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Rare Wickham striae<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>3.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Often symmetrical on the
trunk & limbs, less flexural. <o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the common photo-inducer of LP
or lichenoid drug eruptions? <o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>1.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">5-FU<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>2.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Carbamazepine,
chlorpromazine, diazoxide<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>3.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Ethambutol<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>4.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Pyritinol (</span><span lang="EN-US" style="background: white; color: #222222; font-family: arial, sans-serif; font-size: 10.5pt;">analog of vitamin B</span><span lang="EN-US" style="background: white; color: #222222; font-family: "cambria math", serif; font-size: 10.5pt;">₆</span><span lang="EN-US">)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>5.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Quinine (antimalaria )<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>6.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Quinidine (c</span><span lang="EN-US" style="background: white; color: #222222; font-family: arial, sans-serif; font-size: 10.5pt;">lass I antiarrhythmic</span><span lang="EN-US">)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>7.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Tetracycline<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>8.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Thiazide<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>9.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Furosemide<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">Why is lichenoid drug eruption hard to
diagnosed? <o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">The latency period varies from months to
>1 year. <o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">How long is the resolution of<span> </span>lichenoid drug eruption?<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">3-4 months(related to the severity &
extent), but may be years in gold-induced lesions.<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What patients may have genetic
susceptibility of lichenoid drug eruption?<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Recurrent cases and cases involving
immune-modulating drugs( INF-α, ipilimumab, pembrolizumab, & nivolumab=<b>melanoma-related</b>)<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the features of LP-LE? <o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>1.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Overlap of LP & LE
(clinical, histology, immunofluorescence)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>2.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Red-<b>violet</b>, atrophic patches & plaques + hypopigmentation,
telangiectasia, &<b> minimal scale</b>.(The
<b>bold</b> is the features of LP)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>3.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Some individuals</span><span style="font-family: 新細明體, serif;">→</span><span lang="EN-US">SLE. <o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>4.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Weakly positive ANA. <o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>5.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Prolonged course &
refractory to Tx. <o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">Where are the locations of LE-LP? <o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">The dorsal limbs, esp. hands &
nails(anonychia)<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the features of lichen planus
pemphigoides?<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoListParagraph" style="margin-left: 18pt; text-indent: -18pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>1.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">LP + BP (LP pemphigoides
blisters occur on the lichenoid lesions & normal skin)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 18pt; text-indent: -18pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>2.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Younger age than typical BP<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 18pt; text-indent: -18pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>3.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Better prognosis than typical
LP<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 18pt; text-indent: -18pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>4.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Can be drug-induced. <o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the possible pathogenesis of LP
pemphigoides?<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">The brisk LTR</span><span style="font-family: 新細明體, serif;">→</span><span lang="EN-US">liquefactive
degeneration of keratinocytes</span><span style="font-family: 新細明體, serif;">→</span><span lang="EN-US">exposure of autoantigens</span><span style="font-family: 新細明體, serif;">→</span><span lang="EN-US">autoantibody<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the antigen of LP pemphigoides?<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Medical College of Wisconsin domain 4
(MCW-4) of BPAG180<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the features of keratosis
lichenoides chronica (Nekam disease)?<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>1.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Lichenoid, keratotic papules
& plaques<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>2.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">A seborrheic distribution,
palms & soles<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>3.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Folliculo- &
infundibulocentric<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>4.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Linear or reticulate pattern.<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>5.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Asymptomatic & refractory
to treatment<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>6.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">A brisk LTR + parakeratosis +
N</span><span style="font-family: 新細明體, serif;">φ</span><span lang="EN-US">in
the crust<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">Lichenoid Graft versus Host Disease<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the classic acute GVHD? <o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Transplant<100 days, a classic (folliculocentric)
maculopapular rash; GI s/s; &</span><span style="font-family: 新細明體, serif;">↑</span><span lang="EN-US">bilirubin (liver).<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the classic chronic GVHD? <o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Transplant >100 days, dermatitic,
sclerodermoid, or lichenoid eruption<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the new classification of GVHD? <o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoListParagraph" style="margin-left: 18pt; text-indent: -18pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>1.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Acute GVHD: classic, persist,
recurrent, or late-onset (after 100 days)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 18pt; text-indent: -18pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>2.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Classic chronic GVHD, and
overlap syndromes.<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the driving cytokine of acute
& chronic GVHD ?<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Acute: Th2 cytokines<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">Chronic: Th1/Th17 cytokines (IFN-γ– &
IL-17)<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the features of lichenoid GVHD?<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>1.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Classic lichenoid papules <o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>2.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Prominent follicular
involvement of the head & neck & oral involvement.<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>3.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Onycholysis & cicatricial
alopecia<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the differences between GVHD
& LP? <o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Grossly similar, but GVHD has satellite
cell necrosis, plasma cells, & E</span><span style="font-family: 新細明體, serif;">φ</span><span lang="EN-US"><o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the features of lichenoid
keratosis(LK)?<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">A single, nonpruritic, brown to red,
scaling flat-topped plaque on sun-exposed extremities.<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the histological feature of LK? <o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">LTRs + parakeratosis or a remnant
lentigo, seborrheic keratosis, or actinic keratosis.<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the features of lichenoid
dermatitis?<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Nonclassic LTRs + spongiosis </span><span style="font-family: 新細明體, serif;">± </span><span lang="EN-US">granuloma<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the differential diagnoses of
lichenoid dermatitis?<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Dermatitis, drug eruption, lupus erythematosus,
lichen planus, & cutaneous T-cell lymphoma.<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">RELATED FINDINGS<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the most common associations of
LP? <o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Liver diseases: autoimmune chronic active
hepatitis, primary biliary cirrhosis (PBC), & postviral chronic, active
hepatitis.<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<b><span lang="EN-US">What
are the associated autoimmune dzs of LP?<o:p></o:p></span></b></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<b><span lang="EN-US">SLE,
Sjögren syndrome, dermatomyositis, vitiligo, <o:p></o:p></span></b></div>
<div class="MsoNormal">
<b><span lang="EN-US">&
alopecia areata (Taiwanese data)<o:p></o:p></span></b></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the associated infection of oral
LP? <o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">HCV in endemic regions (East &
Southeast Asia, South America, the Middle East, & Southern Europe)<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">Is there association between cutaneous LP
and HCV?<o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">No<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">Is there association between LP &
HBV? <o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">No<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the related HLA of HCV-induced
oral LP? <o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">HLA-DR6<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the common laboratory abnormality
in LP? <o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>1.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Dyslipidemia (higher risk of
cardiac dz & metabolic syndrome)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24pt; text-indent: -24pt;">
<!--[if !supportLists]--><span lang="EN-US"><span>2.<span style="font: 7pt "times new roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Hypothyroidism (in 1/3 LPP)<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the relationship between LP &
lichen sclerosus et atrophicus? <o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Oral LP</span><span style="font-family: 新細明體, serif;">→</span><span style="font-family: 新細明體, serif;">↑</span><span lang="EN-US">lichen sclerosus
et atrophicus<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">Lichen sclerosus et atrophicus: no risk
of oral LP.<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: 1pt solid; padding: 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the relationship between LP &
internal malignancies? <o:p></o:p></span></div>
</td>
<td style="border-bottom: 1pt solid; border-left: none; border-right: 1pt solid; border-top: none; padding: 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">LP can be a manifestation of paraneoplastic
autoimmune multiorgan syndrome.<o:p></o:p></span></div>
</td>
</tr>
</tbody></table>
<br />鄭煜彬(Yu-Pin Cheng)http://www.blogger.com/profile/07019803125903571476noreply@blogger.com1tag:blogger.com,1999:blog-5384877319969585099.post-27085524739914667102020-03-20T09:06:00.002-07:002020-03-20T09:22:01.755-07:00[考生加油] Dermatological Recall: Chapter 112 :: Squamous Cell Carcinoma and Keratoacanthoma<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhOhbCPfPo8Hn4vGcYejJ-1x4bygDRvqcJvLkBC1SI-bv69hEMJ7dQ7ObHvaxwzDCbWHocvOqdkhXMXt5zYC7d41nHn7l21ZhprB-rsO5k6SSMwHAjO8yvmrgjMa0x286NPDSX4E0zqXogO/s1600/IMAG7656.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1067" data-original-width="1600" height="425" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhOhbCPfPo8Hn4vGcYejJ-1x4bygDRvqcJvLkBC1SI-bv69hEMJ7dQ7ObHvaxwzDCbWHocvOqdkhXMXt5zYC7d41nHn7l21ZhprB-rsO5k6SSMwHAjO8yvmrgjMa0x286NPDSX4E0zqXogO/s640/IMAG7656.jpg" width="640" /></a></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: large;">鱗狀細胞癌是第二常見的皮膚癌,臨床上看起來是一塊堅硬、角質增生的斑塊或結節,可能伴隨潰瘍。這種皮膚癌處理起來要比較積極,不然一旦轉移就比較不好處理,不像第一常見的基底細胞癌就算拖了很多年也不至於致命。</span></div>
<div class="MsoNormal">
<span lang="EN-US"><span style="font-size: large;"><br /></span></span></div>
<div class="MsoNormal">
<span lang="EN-US"><span style="font-size: large;">Chapter 112 :: Squamous Cell Carcinoma and
Keratoacanthoma<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US"><span style="font-size: large;">:: Anke S. Lonsdorf & Eva N. Hadaschik</span></span></div>
<div class="MsoNormal">
<span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><span style="font-size: large;">鄭煜彬</span></span><span lang="EN-US"><span style="font-size: large;">(20200320)</span><o:p></o:p></span></div>
<table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: none; mso-border-alt: solid windowtext .5pt; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt; mso-yfti-tbllook: 1184;">
<tbody>
<tr style="mso-yfti-firstrow: yes; mso-yfti-irow: 0;">
<td style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">EPIDEMIOLOGY & <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">DEMOGRAPHICS<o:p></o:p></span></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 1;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the most common & costly
malignancy in European ancestry?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Squamous cell carcinoma (SCC)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 2;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What patient is the high-risk populations
of SCC? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Patients with immunosuppression<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 3;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the rank of skin cancer? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">1<sup>st</sup>: BCC, 2<sup>nd</sup>: SCC<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 4;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the most common skin cancer in
the immunosuppressed? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">SCC<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 5;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">INCIDENCE<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 6;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">Why does the incidence of SCC rise
steadily? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">A greater lifetime UVR exposure, greater longevity,
ozone depletion, & </span><span style="font-family: "新細明體",serif;">↑</span><span lang="EN-US">voluntary exposure to UVR<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 7;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">MORBIDITY & MORTALITY<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 8;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the major cause of deaths in non-melanoma
skin cancers (NMSCs)? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">SCC (with metastasis)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 9;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the prognosis of majority of SCC?
<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Most are early-stage disease and treated
& cured with surgery. (Excellent prognosis)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 10;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the rate of metastasis of SCC? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">5-year metastatic rate is 5% (low),
predominantly nodal metastasis<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 11;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the geographic factors of SCC? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">UV irradiation (inverse association with
latitude, association with altitude)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 12;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the common onset age of SCC? <span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">60 years of age and older. (the incidence
</span><span style="font-family: "新細明體",serif; mso-ascii-theme-font: minor-fareast; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-theme-font: minor-fareast;">↑<span lang="EN-US"> with age</span></span><span lang="EN-US">)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 13;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">Why does the incidence of SCC increase
recently?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span style="font-family: "新細明體",serif;">↑</span><span lang="EN-US">voluntary exposure to UVR</span><span style="font-family: "新細明體",serif;">→</span><span style="font-family: "新細明體",serif; mso-ascii-theme-font: minor-fareast; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-theme-font: minor-fareast;">↑</span><span lang="EN-US">cumulative life-<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">time exposure to UVR<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 14;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">Which sex has lower incidence of SCC? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Female (less livetime UVR exposure + less
genetic susceptibility to UV-induced immunosuppression)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 15;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What people had risk of SCC? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Red hair, blue eyes, & fair
complexion (Eg. </span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">哈利波特的榮恩</span><span style="font-family: "新細明體",serif; mso-ascii-theme-font: minor-fareast; mso-bidi-font-family: "Microsoft YaHei"; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-theme-font: minor-fareast;">.</span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">衛斯理</span><span lang="EN-US">)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 16;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">ETIOLOGY AND PATHOGENESIS<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 17;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What kinds of genetic defects may
predispose SCC?<span style="mso-spacerun: yes;"> </span>(4)<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoListParagraph" style="margin-left: 18.0pt; mso-list: l0 level1 lfo1; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Repair or stability of genome<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 18.0pt; mso-list: l0 level1 lfo1; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Function of melanin<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 18.0pt; mso-list: l0 level1 lfo1; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Immunity<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 18.0pt; mso-list: l0 level1 lfo1; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Structure of the skin<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 18;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the SCC syndromes related to
repair or stability of genome? (6)<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US">Bloom
syndrome</span></b><span lang="EN-US"> (BLM/RECQL3, Chromosomal stability)<o:p></o:p></span></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US">Dyskeratosis
congenita</span></b><span lang="EN-US">(DKC1/TERC, telomere homeostasis &
telomerase trafficking )<o:p></o:p></span></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US">Fanconi
syndrome</span></b><span lang="EN-US"> (FANC A~S, DNA crosslink repair)<o:p></o:p></span></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US">Rothmund-Thomson
syndrome</span></b><span lang="EN-US"> (RECQL4, Chromosomal stability)<o:p></o:p></span></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US">Werner
syndrome</span></b><span lang="EN-US"> (WRN/RECQL2, Chromosomal stability)<o:p></o:p></span></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US">Xeroderma
pigmentosum </span></b><span lang="EN-US">& variants(XP A~G, nucleotide
excision repair, error-prone DNA polymerase)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 19;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the SCC syndromes related to the
function of melanin? (5)<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US">Albinism</span></b><span lang="EN-US"> (TYR, OCA2…, melanin synthesis)<o:p></o:p></span></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US">Chediak-Higashi
syndrome</span></b><span lang="EN-US"> (LYST, lysosomal transport)<o:p></o:p></span></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US">Elejalde
syndrome</span></b><span lang="EN-US"> (MYO5A, pigment granule transport)<o:p></o:p></span></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US">Griscelli
syndrome</span></b><span lang="EN-US"> (MYO5A/RAB27A/MLPH, pigment granule
transport)<o:p></o:p></span></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US">Hermansky-Pudlak
syndrome</span></b><span lang="EN-US"> (HPS 1~8, melanosomal & lysosomal
transport)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 20;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the SCC syndromes related to
immunity? (1)<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US">Epidermodysplasia
verruciformis</span></b><span lang="EN-US"> (EVER1/TMC6, EVER2/TMC8)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 21;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the SCC syndromes related to the
structures of the skin? (2)<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US">Recessive
Dystrophic epidermolysis bullosa </span></b><span lang="EN-US">(COL7A1)<o:p></o:p></span></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US">Junctional
epidermolysis bullosa</span></b><span lang="EN-US"> (LAMA3, LAMB3, LAMC2,
COL17A1)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 22;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the keratoacanthoma-related
syndromes? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US">Muir-Torre
syndrome</span></b><span lang="EN-US"> (MSH1, 2, DNA mismatch repair)<o:p></o:p></span></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US">Ferguson-Smith
syndrome</span></b><span lang="EN-US"> (TGFBR1, TGF </span><span lang="EN-US" style="font-family: "新細明體",serif;">ß</span><span lang="EN-US"> 1 receptor 1
signaling)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 23;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">(</span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">除</span><span lang="EN-US">JEB</span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">外,基因部分記開頭第一個就好</span><span lang="EN-US">)<o:p></o:p></span></div>
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<span lang="EN-US">PRECURSOR LESIONS<o:p></o:p></span></div>
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<br /></div>
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<span lang="EN-US">What is the original cell of SCC? <o:p></o:p></span></div>
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<span lang="EN-US">Basal keratinocytes of the
interfollicular epidermis<o:p></o:p></span></div>
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<span lang="EN-US">What are the preinvasive lesions of SCC? (4)<o:p></o:p></span></div>
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<span lang="EN-US">Bowen disease, Actinic keratosis (AK),
bowenoid papulosis, erythroplasia of Queyrat.<o:p></o:p></span></div>
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<span lang="EN-US">What is the cumulative life-time risk of
SCC among patients with multiple AK? <o:p></o:p></span></div>
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<span lang="EN-US">6-10% (<10%)<o:p></o:p></span></div>
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<span lang="EN-US">What is the difference between
keratoacanthoma & typical SCC? <o:p></o:p></span></div>
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<span lang="EN-US">It has rapid growth phase and subsequent
slow spontaneous regression. (It is a midpoint between a viral acanthoma and
SCC)<o:p></o:p></span></div>
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<span lang="EN-US">RISK FACTORS<o:p></o:p></span></div>
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<br /></div>
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<span lang="EN-US">What are the risk factors of SCC? <o:p></o:p></span></div>
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<span lang="EN-US">UVR/radiation, physical & chemical
carcinogens, genetic predisposition, immunosuppression, drugs, viral
infection, chronic inflammation, & chronic injury of the skin.<o:p></o:p></span></div>
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<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the most important environmental
risk factor of SCC? <o:p></o:p></span></div>
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<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
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<span lang="EN-US">UVR=UVA+UVB (class I carcinogen</span><span style="font-family: "新細明體",serif;">→</span><span lang="EN-US">initiation,
promotion, & progression of squamous carcinogenesis)<o:p></o:p></span></div>
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<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the specific UV signature
mutations of UVB? <o:p></o:p></span></div>
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<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
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<span lang="EN-US">Characteristic C-T and CC-TT dipyrimidine
transitions (direct damage)<o:p></o:p></span></div>
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<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal" style="margin-left: 6.0pt; mso-char-indent-count: -.5; text-indent: -6.0pt;">
<span lang="EN-US">What is the mechanism of UVA carcinogenesis? <o:p></o:p></span></div>
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<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Photooxidative stress-mediated
genotoxicity (indirect damage)<o:p></o:p></span></div>
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<div class="MsoNormal" style="margin-left: 6.0pt; mso-char-indent-count: -.5; text-indent: -6.0pt;">
<span lang="EN-US">How does UVR promote SCC development? (other than “induce”)<o:p></o:p></span></div>
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<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Immuno-suppression & modulation:
depletion of Langerhans cells, improper antigen presentation in LN, </span><span style="font-family: "新細明體",serif;">↑</span><span lang="EN-US">Treg, </span><span style="font-family: "新細明體",serif;">↑</span><span lang="EN-US">Th2<o:p></o:p></span></div>
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<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the genetic predisposition of
SCC? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Light skin complexion (skin photo types I
& II), variations in the melanocortin-1 receptor, polymorphisms in
pigmentation genes, & all SCC syndromes mentioned before. <o:p></o:p></span></div>
</td>
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<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the famous physical & chemical
carcinogens of SCC? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Arsenic, cutting oils & chimney
sweeps(polycyclic aromatic hydrocarbons of coal tar), ionizing irradiation
& UVR, <o:p></o:p></span></div>
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<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What patients have higher risk of SCC? (5)<o:p></o:p></span></div>
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<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Patients with immunosuppression: <o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l16 level1 lfo2; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">solid-organ transplantation recipients (OTRs)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l16 level1 lfo2; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">hematopoietic stem-cell transplant recipients<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l16 level1 lfo2; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Patients with HIV<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l16 level1 lfo2; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Patients with a history of autoimmune or rheumatoid disease,<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l16 level1 lfo2; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Chronic lymphatic leukemia (CLL)<o:p></o:p></span></div>
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<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What kinds of transplantation have higher
risk of SCC? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Heart/lung> kidney/liver (because of
intensive immunosuppressive regimens & older age)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 39;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What drugs may increase SCC risk? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l12 level1 lfo3; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Photosensitizing drugs (eg, antibiotics, fluoroquinolone, triazole
antifungals)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l12 level1 lfo3; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">psoralen plus UVA<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l12 level1 lfo3; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">azathioprine plus UVA (Interference with cellular DNA repair,
induction of oxidative stress, & </span><span style="font-family: "新細明體",serif;">↑</span><span lang="EN-US"> p53 oncogene)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l12 level1 lfo3; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Cyclosporine<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l12 level1 lfo3; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">BRAF-inhibitors (vemurafenib & dabrafenib, for metastatic
melanoma)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l12 level1 lfo3; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Kinase inhibitor sorafenib<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l12 level1 lfo3; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">hedgehog pathway inhibitor (vismodegib, for unresectable BCC<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 40;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What kind of drugs decrease SCC risk in
transplantation? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Rapamycin (mTOR) inhibitor <b style="mso-bidi-font-weight: normal;">sirolimus</b><o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">(interrupt PI3K-AKT pathway</span><span style="font-family: "新細明體",serif;">→</span><span style="font-family: "新細明體",serif; mso-ascii-theme-font: minor-fareast; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-theme-font: minor-fareast;">↓</span><span lang="EN-US">EGFR
signaling)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 41;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What virus may induce skin SCC? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">HPV(genus type beta, mucosal ca.: </span><span style="font-family: "新細明體",serif;">α</span><span lang="EN-US">-HPV), MCPyV
polyoma virus<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 42;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What lesion has higher prevalence of HPV
DNA? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Actinic keratosis (sun-exposed skin)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 43;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">Why does </span><span style="font-family: "新細明體",serif; mso-ascii-theme-font: minor-fareast; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-theme-font: minor-fareast;">β</span><span lang="EN-US">-HPV usually induces skin SCC on the sun-exposed skin? <span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l5 level1 lfo4; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "新細明體",serif; mso-ascii-theme-font: minor-fareast; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-theme-font: minor-fareast;">β</span><span lang="EN-US">-HPV is unable to integrate into the
cellular DNA but disturbs the repair under UV<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l5 level1 lfo4; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">UV has immunosuppressive effect on skin</span><span style="font-family: "新細明體",serif;">→</span><span lang="EN-US"> predisposing for
HPV infection<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 44;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the most famous genodermatosis
with HPV infection and SCC? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Epidermodysplasia verruciformis (AR, HP-5
& 8, SCC at sun-exposed areas)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 45;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the oncogenic proteins of </span><span style="font-family: "新細明體",serif; mso-ascii-theme-font: minor-fareast; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-theme-font: minor-fareast;">β</span><span lang="EN-US">-HPV?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">E6 & E7: impair p53<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 46;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the common physical injury predisposing
SCC?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Burn scars & radiation dermatitis. <o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 47;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What diseases induce chronic
inflammation/injury/ulcer predisposing SCC?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Discoid lupus erythematodes, lichen ruber
mucosae, lichen sclerosus, lupus vulgaris & dystrophic epidermolysis
bullosa(RDEB).<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 48;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the common mutated genes in skin
SCC? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">tumor-suppressor gene p53 (TP53)<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">3 Ras genes (9% Hras, 7% Nras, 5% Kras)<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">EGFR(advanced SCC)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 49;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">CLINICAL PRESENTATION<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">CLASSICAL PRESENTATION<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 50;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">Where is the location of SCC? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Sun-exposed areas: face (nose &
cheeks), head, neck, forearms & dorsum of the hands.<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 51;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the relationship between AK,
Bowen dz, & SCC?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">SCCs usually develop on a background of
AK or Bowen disease as precursor lesions<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 52;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the “field cancerization” of
SCC?<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Numerous precursor lesions of Bowen dz on
UV-damaged skin. (High risk for progression to SCC. de novo formation on
undamaged skin is rare)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 53;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the clinical features of SCC? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Slowly enlarging, firm, skin-colored to
erythematous plaques or nodules with marked hyperkeratosis.<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 54;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the 3 growth patterns of SCC? <span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Ulceration, exophytic, or infiltrative<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 55;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">SPECIAL LOCATIONS ORAL SQUAMOUS CELL
CARCINOMA<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 56;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">Where does oral SCC develop? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Normal mucosa, or precursor lesions.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 57;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the precursor lesions of oral SCC?
<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">leukoplakia, erythroplakia, or
leukoerythroplakia<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 58;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the features of oral SCC? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Whitish surface or ulcers with <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">elevated indurated borders<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 59;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the 2 growth patterns of oral
SCC? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Exophytic or endophytic patterns +
subsequent ulcer<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 60;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">SCC OF THE LOWER LIP<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 61;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">Where is the common location of lip SCC?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Lower lip (> upper lip)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 62;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">Where is the typical sun terrace of face?
<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Lower lip, nose & cheeks<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 63;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">VERRUCOUS SCC<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 64;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the features of verrucous SCC? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">A slowly growing ulcerated plaque or an
exophytic cauliflower-like slowly growing tumor. <o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 65;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">Where is the locations and related-names
of verrucous SCC?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l3 level1 lfo5; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">oral cavity (oral florid papillomatosis)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l3 level1 lfo5; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">genitoanal region (giant condyloma acuminatum = Buschke-Löwenstein
tumor)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l3 level1 lfo5; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">plantar skin (epithelioma cuniculatum)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l3 level1 lfo5; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">amputation stumps. <o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 66;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">KERATOACANTHOMA(KA)<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-para-margin-left: 0gd;">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 67;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the nature of KA?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Highly differentiated SCC<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 68;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the features of KA? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l8 level1 lfo6; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">A sharply circumscribed firm symmetric nodule with the characteristic
central horn-filled crater.<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l8 level1 lfo6; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Erupts rapidly within a few weeks & has the ability to
spontaneously regress<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 69;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal" style="tab-stops: 100.0pt;">
<span lang="EN-US">Where is the
location of KA?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">On the head & sun-exposed areas of
the limbs <o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 70;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal" style="tab-stops: 100.0pt;">
<span lang="EN-US">What are the
clinical variants of KA? (8)<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">grouped KA, subungual KA, intraoral KA, <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">giant KA, KA centrifugum marginatum,
multiple KA <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">of the Ferguson-Smith type, eruptive KA
of Grzy-<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">bowski, & KA associated with
Muir-Torre syn.<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 71;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">DIAGNOSIS<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 72;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the items included in the
standard histopathology?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l6 level1 lfo7; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Histologic subtype (acantholytic, spindle cell, verrucous, or
desmoplastic type)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l6 level1 lfo7; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Grade of differentiation (G1 to G4)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l6 level1 lfo7; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Maximum vertical tumor diameter (in mm)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l6 level1 lfo7; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Extent of dermal invasion (Clark level)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l6 level1 lfo7; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Perineural, vascular, or lymphatic invasion.<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l6 level1 lfo7; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Free margin & minimum distance to margin<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 73;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">GENERAL CONSIDERATIONS <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">IN HISTOPATHOLOGY<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-para-margin-left: 0gd;">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 74;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the difference between SCC in
situ & invasive SCC?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">The growth of atypical keratinocytes
beyond the basement membrane into the dermis.<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 75;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the major immunohistochemical
markers of SCC?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US">Cytokeratins</span></b><span lang="EN-US"> (not obvious in tumors with little or no keratinization)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 76;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">BASIC HISTOPATHOLOGIC <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">FEATURES OF SCC<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 77;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the histologic features of SCC? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Atypical keratinocytes originating in the
epidermis <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">& infiltrating into the dermis<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 78;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the histologic features of
well-differentiated SCC?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Minimal pleomorphism, prominent
keratinization, parakeratosis, individual cell dyskeratosis, & horn pearl
formation <o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 79;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the histologic features of
poor-differentiated SCC?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Pleomorphic nuclei with a high degree of
atypia, frequent mitoses, & very few areas of keratinization<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 80;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">HISTOPATHOLOGIC <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">VARIANTS OF SCC WITH <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">DIFFERENTIAL DIAGNOSIS<o:p></o:p></span></div>
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<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<br /></div>
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<div class="MsoNormal">
<span lang="EN-US">What are the variants of SCC?<o:p></o:p></span></div>
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<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Spindle-cell SCC, acantholytic (adenoid)
SCC, <o:p></o:p></span></div>
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<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the clinical & histologic
features of spindle-cell SCC?<o:p></o:p></span></div>
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<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l13 level1 lfo9; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">A relatively rare form <o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l13 level1 lfo9; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Skin of the elderly<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l13 level1 lfo9; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Sun-exposed areas or radiation port.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l13 level1 lfo9; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Spindled morphology & lack of keratinization<o:p></o:p></span></div>
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<div class="MsoNormal">
<span lang="EN-US">What are the common spindle-cell
neoplasms? <o:p></o:p></span></div>
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<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Atypical fibroxanthoma, spindle-cell
melanoma, & sarcomas<o:p></o:p></span></div>
</td>
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<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the clinical & histologic
features of acantholytic SCC?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l9 level1 lfo10; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">More metastasis<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l9 level1 lfo10; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Extensive acantholysis of the atypical keratinocytes</span><span style="font-family: "新細明體",serif;">→</span><span lang="EN-US">pseudoglandular
structures<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 85;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the clinical & histologic
features of verrucous SCC?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l1 level1 lfo11; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">A well-differentiated variant<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l1 level1 lfo11; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Slowly grows & locally destructive, low metastatic potential<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l1 level1 lfo11; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Need a <b style="mso-bidi-font-weight: normal;">large</b>, <b style="mso-bidi-font-weight: normal;">deep</b> incisional biopsy<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l1 level1 lfo11; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Superficial part: like verrucae (parakeratosis, acanthosis, &
prominent s. granulosum)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l1 level1 lfo11; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Deeper part: broad, deep, downward proliferations of light
eosinophilic, monomorphic well-differentiated keratinocytes with small nuclei
& noninvasive pushing borders.<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 86;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the clinical & histologic
features of desmoplastic SCC?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l11 level1 lfo12; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">A highly infiltrative growth pattern with abundant mucinous stroma<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l11 level1 lfo12; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Perineural or perivascular infiltration, <o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l11 level1 lfo12; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">A high rate of recurrence & metastases.<o:p></o:p></span></div>
</td>
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<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the clinical & histologic
features of KA?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l11 level1 lfo12; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Symmetric tumor (scanning view is necessary for diagnosis)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l11 level1 lfo12; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Markedly hyperplastic epithelium of early lesions<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l11 level1 lfo12; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Central keratotic plug surrounded by a well-differentiated
proliferation of squamous epithelium in later stages. <o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l11 level1 lfo12; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Hypoplastic epithelium with central crater in regressing lesions.<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l11 level1 lfo12; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Large strands of monomorphic keratinocytes + eosinophilic
cytoplasm & small nuclei +a surrounding inflammatory infiltrate (lymphocytes,
E</span><span style="font-family: "新細明體",serif;">φ</span><span lang="EN-US">, &
N</span><span style="font-family: "新細明體",serif;">φ<span lang="EN-US">)</span></span><span lang="EN-US"><o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 88;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">GRADING<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<br /></div>
</td>
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<div class="MsoNormal">
<span lang="EN-US">What is the meaning of the classification
system of the American Joint Committee on Cancer (AJCC)? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">It reflects the degree of cellular
differentiation, which is a high-risk feature for staging.<o:p></o:p></span></div>
</td>
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<tr style="mso-yfti-irow: 90;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the scales of the classification
system of AJCC ?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Based on increasing percentages of
undifferentiated cells<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">G1 = well differentiated<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">G2 = moderately differentiated<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">G3 = poorly differentiated<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">G4 = undifferentiated grade<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">Gx = grade cannot be assessed.<o:p></o:p></span></div>
</td>
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<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">STAGING<o:p></o:p></span></div>
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<div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 92;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What should be examined in the staging of
cutaneous SCC? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l10 level1 lfo13; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">A complete examination of the entire skin<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l10 level1 lfo13; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Nodal involvement of the regional LNs by palpation and/or
ultrasound examination.<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 93;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the current staging system of cutaneous
SCC? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">TNM (tumor, node, metastasis) system of
the Union International Contrele Cancer (UICC, 2009) and the AJCC (2010)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 94;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the high-risk histologic features
of SCC? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">>2 mm thickness, Clark level >IV,
perineural invasion, primary site being the lip or ear, & poorly or
undifferentiated tumor<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 95;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the definition of T1-4? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">T1: tumors < 2 cm (greatest dimension)
& <2 high-risk <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">features <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">T2: tumors > 2 cm (greatest dimension)
& tumors of any size with </span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">≧</span><span lang="EN-US">2 high-risk
features. <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">T3: Tumor with invasion of maxilla,
mandible, orbit, or temporal bone<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">T4: Tumor with invasion of skeleton
(axial or appendicular) or perineural invasion of skull base<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">(</span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">請以表格為主,內文有誤</span><span lang="EN-US">)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 96;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the definition of N1, N2a, N2b,
N2c, N3? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Based on number, localization and size<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 97;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the meaning of lymph node
involvement?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span style="font-family: "新細明體",serif;">↑</span><span lang="EN-US">the risk of recurrence & mortality<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 98;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">How can you confirm the nodal involvement
histologically?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Fine-needle aspiration or lymph node
biopsy</span><span lang="EN-US" style="font-family: "新細明體",serif;"><o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 99;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is definition of M0 & M1? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">M0: no distant metastases<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">M1: distant metastases<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 100;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">DIFFERENTIAL DIAGNOSES<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 101;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are differential diagnoses of
cutaneous SCC? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Hyperkeratotic seborrheic keratoses;
viral acanthoma; viral warts; & acanthoma fissuratum.<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 102;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the differential diagnoses of
cutaneous SCC with ulcerative or infiltrative growth?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Scars, DLE, lichen planus, &
morpheaform BCC <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 103;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the differential diagnoses of
cutaneous SCC on the ear? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">DLE & chondrodermatitis nodularis
chronica helicis<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 104;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">MANAGEMENT<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 105;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">Why is the surgical resection or a biopsy
necessary for the management of SCC? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">It can confirm the invasiveness
(according the subtype, grading, & staging) before any therapeutic
intervention other than surgery. <o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 106;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">SURGERY<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 107;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the major treatment for primary
SCC? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Surgical excision, esp. Mohs surgery<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 108;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">How much is the cure rate of surgery of
SCC?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">95%<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 109;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the advantages of surgery in
SCC? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l7 level1 lfo8; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Free margin: totally clearance<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l7 level1 lfo8; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Histopathologic characterization<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 110;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">How many mms is the safe margin for local,
low-risk SCCs?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">4- to 6-mm<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 111;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">How to treat local in-transit metastasis
of SCC? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l2 level1 lfo18; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Removed by wide surgical excision <o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l2 level1 lfo18; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Treated by irradiation of a wide field around the primary lesion.<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 112;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">How to treat nodal metastasis? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Lymph node dissection, radiation, or a
combination of both.<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 113;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">NONSURGICAL INTERVENTION<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 114;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the topical therapies of
invasive SCC? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Topical imiquimod, topical or
intralesional 5-fluoruracil, cryotherapy, & photodynamic therapy<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 115;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the status of topical therapies
of invasive SCC? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">They are not an appropriate treatment modality
for invasive SCC!<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 116;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the choices for locally
advanced, unresectable or metastatic SCC? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Radiation therapy, chemotherapy or <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">targeted therapy.<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 117;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">RADIATION THERAPY<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 118;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">When is radiation therapy considered for
invasive SCC? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l14 level1 lfo14; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">SCCs at problematic locations for surgery<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l14 level1 lfo14; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Inoperable, local in-transit metastasis<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l14 level1 lfo14; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">After excision of potentially aggressive local tumors (risky
subtypes, high grading, extensive/perineural involvement)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l14 level1 lfo14; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Clear margins cannot be achieved<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l14 level1 lfo14; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Alternative treatment of superficially invasive, small SCCs in
low-risk areas <o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 119;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the role of sentinel LN biopsy
& elective prophylactic LN dissection in the Tx of invasive SCC? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">No conclusive evidence of its prognostic
or therapeutic value.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 120;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">SYSTEMIC TREATMENT OF LOCALLY ADVANCED
AND METASTATIC SCC<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 121;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the choices of the chemotherapy
in SCC? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Platinum-based chemotherapeutic regimens,
5-fluorouracil/capecitabine, or monotherapy/chemo<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">therapy with methotrexate.<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 122;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal" style="margin-left: 6.0pt; mso-char-indent-count: -.5; text-indent: -6.0pt;">
<span lang="EN-US">What are the choices of the targeted therapy in SCC?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">EGFR inhibitors: small molecules
(erlotinib & gefitinib), antibodies(cetuximab & panitumumab) <o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 123;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">When should the targeted therapy use?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Advanced SCC beyond radiotherapy &
conventional chemotherapy (off-label use)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 124;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">PROGNOSIS<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 125;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">How about the prognosis of the majority
of SCCs? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">They are low risk and in early stage,
resulting in a high cure rate and excellent prognosis. <o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 126;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">How about the prognosis of locally
advanced SCC or progressive disease after first-line surgical therapy? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Poor (overall survival of only 10.9
months)<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="tab-stops: 76.5pt;">
<span lang="EN-US"><span style="mso-tab-count: 1;"> </span><o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 127;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What kind of patients has poorer
prognosis? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Immunosuppressed patients(</span><span style="font-family: "新細明體",serif;">↑</span><span lang="EN-US">tumor burden,
aggressive tumor behavior, metastatic disease, & disease-specific death
from SCC.)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 128;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the most common fatal skin
malignancy in organ transplantation recipient?<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">SCC(> 60% of deaths from all skin
malignancies, but death rate is only 5%)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 129;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">LOCAL RECURRENCE<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 130;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the event before metastasis? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Local recurrence at the site of the
primary lesion<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 131;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">How can you lower the local recurrence? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Perform Mohs surgery<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 132;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">METASTASIS<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 133;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the risk factors of recurrence
& metastasis in NCCN guideline? (13)<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l4 level1 lfo16; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Area H (“T-shaped” mask areas(</span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">五官分布的範圍</span><span lang="EN-US">),
genitalia, hands, & feet)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l4 level1 lfo16; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Area M (cheeks, forehead, scalp, neck, & pretibial)</span><span lang="EN-US" style="font-family: "新細明體",serif;"> </span><span style="font-family: "新細明體",serif;">≧</span><span lang="EN-US">10mm<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l4 level1 lfo16; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Area L</span><span lang="EN-US" style="font-family: "新細明體",serif;"> (</span><span lang="EN-US">trunk & extremities</span><span lang="EN-US" style="font-family: "新細明體",serif;">)</span><span style="font-family: "新細明體",serif;">≧</span><span lang="EN-US">20mm<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l4 level1 lfo16; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Poorly defined borders<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l4 level1 lfo16; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Recurrent lesions<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l4 level1 lfo16; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Immunosuppression<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l4 level1 lfo16; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Site of prior RT or chronic inflammatory process<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l4 level1 lfo16; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Rapid growing<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l4 level1 lfo16; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Neurologic symptoms<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l4 level1 lfo16; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Poorly differentiated<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l4 level1 lfo16; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Acantholytic (adenoid), adenosquanous (mucin production),
desmoplastic, metaplastic (carcinosarcomatous) subtypes<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l4 level1 lfo16; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Thickness > 6mm or invasion beyond subcutaneous fat. <o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l4 level1 lfo16; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Perineural, lymphatic, or vascular involvement<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 134;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the histological subtypes with
high risk? (4)<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Acantholytic (adenoid), adenosquanous
(mucin production), desmoplastic, metaplastic (carcinosarcomatous) subtypes<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 135;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the meaning of “Breslow thickness
> 2 mm”? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">A high risk of metastasis and local
recurrence(NCCN guideline: >6mm)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 136;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">AFTERCARE<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 137;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the standardized followup
schedules for patients with SCC? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">It does not exist.<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 138;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">Who should be followed up closely? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Immunosuppressed patients, & lesions
with high risks. <o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 139;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What should we do for the
immunosuppressed? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Dermatologic surveillance, skin cancer
prevention strategies, & the timely treatment of precancerous & in
situ lesions<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 140;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">When are the locally recurring &
metastatic SCCs detected? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">70-80% are detected within 2 years after
primary diagnosis.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 141;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the most common secondary skin
cancers of cutaneous SCC?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Secondary SCC & BCC (all SCC patients
are at risk of additional secondary SCC & BCC )<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 142;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">PREVENTION<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 143;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the key factors for the
prevention of SCC? .<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Sun avoidance & close dermatologic
surveillance of high-risk individuals<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 144;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the choices of chemoprevention of
SCC? (2) <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Niacinamide (vitamin B3) & retinoids (vitamin
A derivatives)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 145;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">How does niacinamide prevent SCC? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l15 level1 lfo17; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Niacinamide</span><span style="font-family: "新細明體",serif;">→</span><span lang="EN-US">nicotinamide adenine dinucleotide</span><span style="font-family: "新細明體",serif;">→</span><span lang="EN-US">nicotinamide adenine trinucleotide</span><span style="font-family: "新細明體",serif;">→</span><span lang="EN-US">improve UV-induced
cellular nicotinamide adenine trinucleotide loss(& repair of DNA damage)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l15 level1 lfo17; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Promotes of epidermal differentiation <o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l15 level1 lfo17; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Inhibits UV-induced immunosuppression & photocarcinogenesis<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 146;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">How does retinoids prevent SCC?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">It promotes normal epidermal
differentiation. <o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 147; mso-yfti-lastrow: yes;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">How can you modify the immunosuppressive
agents in the case of SCC?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l17 level1 lfo15; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Dose reduction of the immunosuppressive agents<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l17 level1 lfo15; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Minimizing the doses of calcineurin inhibitors and/or
antimetabolites<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l17 level1 lfo15; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Shifting the agents to mTOR inhibitors.<o:p></o:p></span></div>
</td>
</tr>
</tbody></table>
<br />鄭煜彬(Yu-Pin Cheng)http://www.blogger.com/profile/07019803125903571476noreply@blogger.com1tag:blogger.com,1999:blog-5384877319969585099.post-5056319842312912392020-03-02T10:06:00.001-08:002020-03-02T10:08:20.148-08:00[考生加油] Dermatological Recall: Chapter 36 :: Sweet Syndrome<div class="separator" style="clear: both; text-align: center;">
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<div class="MsoNormal">
<span style="font-size: large;">史維德氏症候群(Sweet syndrome)是一種伴隨急性發燒、疼痛像水泡之病灶的疾病。對類固醇的治療反應很好。這一直是皮膚科中相當神秘的一種疾病,直到近幾年來隨著對細胞激素(cytokines)的研究漸多,才比較了解可能的致病機轉以及跟其他發炎性疾病/癌症/藥物的關聯。</span></div>
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<span lang="EN-US"><br /></span></div>
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<span lang="EN-US"><span style="font-size: large;">Chapter 36 :: Sweet Syndrome<o:p></o:p></span></span></div>
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<span lang="EN-US"><span style="font-size: large;">:: Philip R. Cohen & Razelle Kurzrock<o:p></o:p></span></span></div>
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<span style="font-family: "新細明體" , serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><span style="font-size: large;">鄭煜彬</span></span><span lang="EN-US"><span style="font-size: large;">(20200301)</span><o:p></o:p></span></div>
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<span lang="EN-US">DEFINITION<o:p></o:p></span></div>
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<span lang="EN-US">What is the typical features of Sweet
syndrome(SS)? <o:p></o:p></span></div>
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<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l5 level1 lfo2; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Acute onset of pyrexia &
painful skin lesions<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Dense dermal infiltrate of
mature neutrophils<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Promptly resolve after
systemic steroids.<o:p></o:p></span></div>
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<span lang="EN-US">What are the inflammatory (neutrophilic)
diseases in dermatology? <o:p></o:p></span></div>
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<span lang="EN-US">SS, pyoderma gangrenosum, subcorneal
pustular dermatosis, Bowel bypass syn., erythema elevatum diutinum,
neutrophilic eccrine hidradenitis, rheumatoid neutrophilic dermatitis, autoinflammatory
diseases (Schnitzler syn., Blau syn., PAPA syn., SAPHO syn….) <o:p></o:p></span></div>
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<span lang="EN-US">EPIDEMIOLOGY<o:p></o:p></span></div>
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<br /></div>
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<span lang="EN-US">What is the common onset age & gender
of SS? <o:p></o:p></span></div>
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<span lang="EN-US">30-60 y/o, female<o:p></o:p></span></div>
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<span lang="EN-US">What is 3 types of SS according to the causes?
<o:p></o:p></span></div>
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<span lang="EN-US">Classical, malignancy-associated, &
drug-induced<o:p></o:p></span></div>
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<span lang="EN-US">CLINICAL FEATURES<o:p></o:p></span></div>
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<span lang="EN-US">HISTORY<o:p></o:p></span></div>
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<br /></div>
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<span lang="EN-US">What is the general appearance of SS? <o:p></o:p></span></div>
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<span lang="EN-US">Dramatically ill + fever + skin eruption </span><span style="font-family: "新細明體" , serif;">± </span><span lang="EN-US">arthralgia,
general malaise, headache, & myalgia<o:p></o:p></span></div>
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<span lang="EN-US">What is the time sequence</span> between skin
eruption of SS & fever? <o:p></o:p></div>
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<span lang="EN-US">Concurrently present with the fever or
follow the fever by several days to weeks.<o:p></o:p></span></div>
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<span lang="EN-US">CUTANEOUS FINDINGS<o:p></o:p></span></div>
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<br /></div>
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<span lang="EN-US">LESION MORPHOLOGY<o:p></o:p></span></div>
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<br /></div>
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<span lang="EN-US">What is the morphology of the lesions of
SS <o:p></o:p></span></div>
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<span lang="EN-US">Single or multiple, asymmetrically
distributed,<span style="mso-spacerun: yes;"> </span>tender, red/purple-red,
papules/nodules with <b style="mso-bidi-font-weight: normal;">transparent,
vesicle-like appearance </b>(illusion of vesiculation = edema in the upper
dermis)<o:p></o:p></span></div>
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<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the change of lesions of SS in
the later stages? <o:p></o:p></span></div>
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<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l11 level1 lfo1; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Central clearing</span><span style="font-family: "新細明體" , serif;">→</span><span lang="EN-US">annular or arcuate
patterns (targetoid)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l11 level1 lfo1; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Enlarging</span><span style="font-family: "新細明體" , serif;">→</span><span lang="EN-US">coalesce & form
irregular sharply bordered plaques<o:p></o:p></span></div>
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<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the features of malignancy-associated
SS? <o:p></o:p></span></div>
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<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Bullous or ulcerated lesions, and/or
mimic pyoderma gangrenosum. <o:p></o:p></span></div>
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<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the result of SS lesions?<o:p></o:p></span></div>
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<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">The lesions resolve without scar. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
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<span lang="EN-US">What is the percentage of SS with
recurrence<o:p></o:p></span></div>
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<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">1/3-2/3 of the cases has recurrent
episodes.<o:p></o:p></span></div>
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<span lang="EN-US">CUTANEOUS PATHERGY & ISOTOPIC
RESPONSE<o:p></o:p></span></div>
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<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<br /></div>
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<span lang="EN-US">What is the cutaneous pathergy of SS? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Skin hypersensitivity at sites of trauma
during the episodes of SS= isotopic (Koebner) response <o:p></o:p></span></div>
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<tr style="mso-yfti-irow: 19;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What may induce isotopic response of SS? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Wounds, sunburn(phototoxic reaction</span><span style="font-family: "新細明體" , serif;">→</span><span lang="EN-US">photo distributed),
radiation therapy or tattoo<o:p></o:p></span></div>
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<tr style="mso-yfti-irow: 20;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the Wolf’s isotopic response of
SS? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">New lesions at the site of another
unrelated & already healed skin disease. (Lymphedematous leg,
postmastectomy arm, & zoster. )<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 21;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the other variants of SS? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l17 level1 lfo8; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Pustular dermatosis<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l17 level1 lfo8; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Neutrophilic dermatosis of
the dorsal hands<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l17 level1 lfo8; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Subcutaneous panniculitis<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l17 level1 lfo8; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Histiocytoid variant<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l17 level1 lfo8; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Giant cellulitis-like variant<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 22;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the features of <b style="mso-bidi-font-weight: normal;">pustular dermatosis</b> of SS?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Tiny pustules on the tops of red papules
or erythematous-based pustules. (</span><span style="font-family: "新細明體" , serif;">±</span><span lang="EN-US">ulcerative colitis:)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 23;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the features of <b style="mso-bidi-font-weight: normal;">neutrophilic dermatosis of the dorsal
hands </b>of SS?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l4 level1 lfo3; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">A localized, pustular variant
at dorsal hands. <o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l4 level1 lfo3; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Rapid resolution under steroids
& dapsone. <o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l4 level1 lfo3; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Concurrent oral mucosa, arm,
leg, back, &/or face lesions.<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 24;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the features of <b style="mso-bidi-font-weight: normal;">subcutaneous panniculitis</b> of SS?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l13 level1 lfo4; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Erythematous, tender dermal
nodules on the limbs, mimic <b style="mso-bidi-font-weight: normal;">erythema
nodosum</b> on the legs<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l13 level1 lfo4; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">In <b style="mso-bidi-font-weight: normal;">80%</b> of SS (not rare). <o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 25;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the features of <b style="mso-bidi-font-weight: normal;">histiocytoid variant </b>of SS? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l8 level1 lfo5; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Looks like typical SS, but
the dermal infiltrate is composed of “histiocytic” mononuclear cells (presenting<b style="mso-bidi-font-weight: normal;"> immature myeloid cells</b>).<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l8 level1 lfo5; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Associated with <b style="mso-bidi-font-weight: normal;">malignancy</b><o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 26;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What medicine may induce histiocytoid SS?
<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Bortezomib<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 27;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the features of <b style="mso-bidi-font-weight: normal;">giant cellulitis-like variant</b> of <span style="mso-spacerun: yes;"> </span>SS?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l6 level1 lfo6; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Relapsing widespread giant
lesions<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l6 level1 lfo6; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">F>>M, 48-72 years
(median = 61 years)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l6 level1 lfo6; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Upper leg & buttocks:
most common<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l6 level1 lfo6; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Patients are obese (2/3)
& has cancer (1/2)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 28;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the features of <b style="mso-bidi-font-weight: normal;">necrotizing variant</b> of SS?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l15 level1 lfo7; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Rapid onset of edematous,
erythematous, warm lesions</span><span style="font-family: "新細明體" , serif;">→</span><span lang="EN-US">necrotizing fasciitis like lesions<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l15 level1 lfo7; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">A deep-tissue neutrophilic
infiltration + soft-tissue necrosis.<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 29;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">NONCUTANEOUS FINDINGS<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoListParagraph" style="margin-left: 24.0pt; mso-para-margin-left: 0gd;">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 30;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What are the sites of non-cutaneous SS?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">The bones, CNS/eyes, ears, kidneys,
intestines, liver, heart, lung, mouth, muscles, & spleen/lymph nodes<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 31;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the cardiac involvement of SS?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l10 level1 lfo10; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Children: postinflammatory
elastolysis (heart & aorta) & Takayasu arteritis. (rare)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l10 level1 lfo10; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Adult: coronary artery
occlusion (rare)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 32;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the CNS involvement (neuro-Sweet
disease, nSd) of SS?<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l3 level1 lfo11; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Self-remitting/reversible <b style="mso-bidi-font-weight: normal;">parkinsonism</b><o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l3 level1 lfo11; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Eyes: optic nerve involvement
+ panuveitis, endogenous endophthalmitis + chorioretinitis<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l3 level1 lfo11; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Radiation therapy-induced nSd<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 33;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the oral involvement of SS?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l18 level1 lfo9; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Ulcers (in SS with
hematologic disorders, uncommon in classical SS, resolve s/p steroid.<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 34;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the otic involvement of SS?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Progressive sensorineural hearing loss<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 35;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">COMPLICATIONS<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 36;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What are the complications of SS? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l7 level1 lfo12; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Directly related: secondary
infections (thus antimicrobial therapy is in need)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l7 level1 lfo12; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Indirectly related: inflammatory
bowel disease, sarcoidosis, thyroid dz, & malignancies. <o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 37;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the meaning of reappearance of
the dermatosis in malignancy-associated SS? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Recurrence of the malignancy<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 38;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">ETIOLOGY AND <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">PATHOGENESIS<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 39;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">ASSOCIATED CONDITIONS<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">ASSOCIATED DISEASES<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 40;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What are the etiologically-related
conditions occur before, concurrent with, or following the diagnosis of SS<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US">BRIT.
PRICES</span></b><span lang="EN-US">: Behçet disease, cancer, erythema nodosum,
infections, inflammatory bowel disease, pregnancy, relapsing polychondritis,
rheumatoid arthritis, sarcoidosis, & thyroid dz<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 41;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the “differentiation syndrome”
associated with SS? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">An inflammatory reaction with</span><span style="font-family: "新細明體" , serif;">↑</span><span lang="EN-US">capillary
permeability, in up to 25% of patients with acute promyelocytic leukemia
treated with all-trans-retinoic acid.(=retinoic acid syndrome)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 42;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the associated conditions of
histiocytoid variant? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Medications, autoimmune diseases,
infections & inflammation, inflammatory bowel disease, & malignancy<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 43;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the associated conditions of
giant cellulitis-like variant?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Obesity & malignancy<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 44;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the malignancies in the giant
cellulitis-like variant?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Hematologic dyscrasia (multiple myeloma
or myelodysplastic syndrome/myeloproliferative disorder) & breast cancer<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 45;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">ASSOCIATED NEUTROPHILIC <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">DERMATOSES<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 46;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the characteristic of neutrophilic
dermatoses? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">An inflammatory infiltrate of mature PMN.<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 47;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the associated neutrophilic
dermatoses of SS? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Erythema elevatum diutinum, neutrophilic
eccrine hidradenitis, pyoderma gangrenosum, subcorneal pustular dermatosis, &/or
vasculitis. <o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 48;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">How to differentiate SS & other
neutrophilic dermatoses? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">According to the location of the lesions.
<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 49;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">CONCURRENT LEUKEMIA CUTIS<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 50;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What are the relationship between SS
& other malignancies? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l16 level1 lfo13; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">SS exist as a paraneoplastic
syndrome <o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l16 level1 lfo13; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">SS appears with hematologic
disorders concurrently. <o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 51;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the most frequent hematologic
dyscrasias associated with leukemia cutis (abnormal N</span><span style="font-family: "新細明體" , serif;">φ</span><span lang="EN-US">) & SS (mature
PMN)?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l9 level1 lfo14; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Acute myelocytic leukemia
& acute promyelocytic leukemia<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l9 level1 lfo14; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">(Less common) myelodysplastic
syndrome, chronic myelogenous leukemia, myelogenous leukemia<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 52;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What are the culprit drugs of SS? <span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">All-trans-retinoic acid, bortezomib,
granulocyte colony-stimulating factor (G-CSF), or imatinib mesylate<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 53;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the most notorious drug to induce
SS? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">G-CSF<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 54;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the mechanisms of concurrent Sweet
syndrome & leukemia cutis? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l0 level1 lfo15; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Secondary leukemia cutis: the
circulating immature myeloid precursor cells are recruited to the
inflammatory oncotactic environment stimulated by SS.<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l0 level1 lfo15; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Primary leukemia cutis: the
leukemic cells constitute the bonified incipient, or G-CSF induced
differentiation of atypical leukemia cells into mature N</span><span style="font-family: "新細明體" , serif;">φ</span><span lang="EN-US">.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 55;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the most threatening associated
disease of SS? <span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Systemic inflammatory response syndrome
(SIRS)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 56;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">PATHOGENESIS<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 57;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the possible causes of SS? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l12 level1 lfo16; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">A hypersensitivity reaction
to an eliciting bacterial, viral, or tumor antigen (preceding febrile URI or
tonsillitis, SS with Yersinia enterocolitica improves after antibiotic )<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l12 level1 lfo16; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">HLA serotypes: non-B54 types
HLA<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l12 level1 lfo16; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Cytokines: IL-1, 3, 6, 8, 17,
& TNF-α, IFN-γ, G-CSF & IL-6(MDS-associated SS), GM-CSF (classical
SS), G-CSF (acute myelogenous leukemia-associated SS & neutrophilic
panniculitis)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l12 level1 lfo16; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">CD4+ T-cell dysfunction(TH1)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l12 level1 lfo16; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Autoantibodies to
neutrophilic cytoplasmic antigens <o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 58;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What disease resemble SS and may share
the same pathogenesis? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Familial Mediterranean fever: share the
same mutated gene with chronic myelogenous leukemia associated SS.<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 59;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">PHOTOSENSITIVITY<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 60;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What drug may induce photodrug-associated
SS? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">trimethoprim-sulfamethoxazole<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 61;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">Why does UV(B) induce SS?<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l14 level1 lfo17; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">UV(B) induces isomorphic(Koebner)
reaction<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l14 level1 lfo17; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">UV(B) induces N</span><span style="font-family: "新細明體" , serif;">φ</span><span lang="EN-US">& production of
TNF-α & IL-8.<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 62;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">DIAGNOSIS<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">DIAGNOSTIC CRITERIA<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 63;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the diagnostic criteria for
classical SS? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoListParagraph" style="margin-left: 21.25pt; mso-list: l2 level1 lfo19; mso-para-margin-left: 0gd; text-indent: -21.25pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">1<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Abrupt onset of painful
erythematous plaques or nodules<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 21.25pt; mso-list: l2 level1 lfo19; mso-para-margin-left: 0gd; text-indent: -21.25pt;">
<!--[if !supportLists]--><span lang="ES" style="mso-ansi-language: ES; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">2<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="ES" style="mso-ansi-language: ES;">Hx:
a dense N</span><span style="font-family: "新細明體" , serif;">φ</span><span lang="ES" style="mso-ansi-language: ES;">infiltrate w/o LCV<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 21.25pt; mso-list: l2 level1 lfo19; mso-para-margin-left: 0gd; text-indent: -21.25pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">3<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Pyrexia >38°C (100.4°F)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 21.25pt; mso-list: l2 level1 lfo19; mso-para-margin-left: 0gd; text-indent: -21.25pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">4<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Association with an
underlying <o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 49.6pt; mso-list: l2 level2 lfo19; mso-para-margin-left: 0gd; text-indent: -1.0cm;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">4.1<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span lang="EN-US">hematologic (AML) </span></b><span lang="EN-US"><o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 49.6pt; mso-list: l2 level2 lfo19; mso-para-margin-left: 0gd; text-indent: -1.0cm;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">4.2<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span lang="EN-US">visceral malignancy (GU organs, breast, & GI), inflammatory dz
(Crohn dz & ulcerative colitis)</span></b><span lang="EN-US"><o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 49.6pt; mso-list: l2 level2 lfo19; mso-para-margin-left: 0gd; text-indent: -1.0cm;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">4.3<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span lang="EN-US">pregnancy</span></b><span lang="EN-US"><o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 49.6pt; mso-list: l2 level2 lfo19; mso-para-margin-left: 0gd; text-indent: -1.0cm;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">4.4<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">preceded by an <b style="mso-bidi-font-weight: normal;">upper respiratory</b> (streptococcosis)
or <b style="mso-bidi-font-weight: normal;">GI </b>(salmonellosis &
yersiniosis) <b style="mso-bidi-font-weight: normal;">infection</b> or
vaccination<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 21.25pt; mso-list: l2 level1 lfo19; mso-para-margin-left: 0gd; text-indent: -21.25pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">5<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Excellent response to
systemic corticosteroids or potassium iodide(KI)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 21.25pt; mso-list: l2 level1 lfo19; mso-para-margin-left: 0gd; text-indent: -21.25pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">6<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Abnormal Lab values at
presentation (3 of 4): ESR >20 mm/h; CRP(+); >8000/µL leukocytes;
>70% N</span><span style="font-family: "新細明體" , serif;">φ</span><span lang="EN-US"><o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 64;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the diagnostic criteria for
drug-induced SS?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">1, 2, 3 as classical SS <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">4. Temporal relationship between drug
& clinical presentation, or temporally related recurrence after oral
challenge<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">5. Temporally related resolution of
lesions after drug withdrawal or tx with systemic steroid<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 65;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">SUPPORTIVE STUDIES<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 66;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">LABORATORY TESTING<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 67;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What should we check in SS?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">CBC/DC(Peripheral leukocytosis +
neutrophilia, -penia in malignancy), ESR/CRP(</span><span style="font-family: "新細明體" , serif;">↑</span><span lang="EN-US">), GOT/GPT(</span><span style="font-family: "新細明體" , serif;">↑</span><span lang="EN-US">), CREA/BUN(</span><span style="font-family: "新細明體" , serif;">↑</span><span lang="EN-US">), urinalysis(hematuria
and proteinuria), thyroid function(hypo- or hyper-), CSF analysis.<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 68;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">PATHOLOGY <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 69;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the features of pathology of SS? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">A diffuse/dense infiltrate of mature N</span><span style="font-family: "新細明體" , serif;">φ</span><span lang="EN-US"> is present in the
papillary and upper reticular dermis, even in epidermis(spongiosis/subcorneal
pustules) or adipose tissue </span><span style="font-family: "新細明體" , serif;">±</span><span lang="EN-US"> secondary LCV (no fibrin deposition & N</span><span style="font-family: "新細明體" , serif;">φ</span><span lang="EN-US"> in the wall) </span><span style="font-family: "新細明體" , serif;">± </span><span lang="EN-US">concurrent
leukemia cutis<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 70;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What study should be performed with the
biopsy? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Bacterial, fungal, mycobacterial, &
viral culture<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 71;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the features of histiocytoid SS? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Dermal infiltrate composed of immature
granulocytes (histiocytic mononuclear cells, similar to N</span><span style="font-family: "新細明體" , serif;">φ</span><span lang="EN-US"> but has CD15, 43,
45 (LCA), 68, HAM56, lysozyme, & MAC 387)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 72;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What cells are contained in the
infiltrate of SS? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">N</span><span style="font-family: "新細明體" , serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">φ</span><span lang="EN-US">(mature or
abnormal), lymphocytes or histiocytes, E</span><span style="font-family: "新細明體" , serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">φ</span><span lang="EN-US">(drug-induced or
malignancy-associated)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 73;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">IMAGING<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 74;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What image study should be performed in
SS? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Brain: PET/CT, CT, MRI, EEG, MRI<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">Neutrophilic fasciitis/musculoskeletal:
MRI<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">Pleural effusions: CXR<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 75;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">DIFFERENTIAL DIAGNOSIS<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 76;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">CLINICAL DIFFERENTIAL <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">DIAGNOSIS<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 77;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What are the differential diagnoses of
SS? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">infectious & inflammatory disorders,
neoplastic conditions, reactive erythemas, vasculitis, Behçet disease, azathioprine
hypersensitivity reaction, chronic atypical neutrophilic dermatosis with
lipodystrophy & elevated temperature (CANDLE) syndrome, &
gemcitabine-associated Sweet syndrome-like eruptions, arthropod bite<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 78;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">How to differentiate Behçet disease &
Sweet syndrome? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Human leukocyte antigen analysis<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">B51: Behçet disease; B54: SS<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 79;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What are the differential diagnoses of
giant cellulitis-like SS? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Cellulitis & periodic syndromes (such
as familial Mediterranean fever)<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 80;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">HISTOLOGIC DIFFERENTIAL <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">DIAGNOSIS<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 81;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">How to differentiate SS & leukemia
cutis?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Leukemia cutis has malignant immature
leukocytes.<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 82;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">How to differentiate SS & neutrophilic
lobular pannicu<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">litis?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">SS had infiltratein the lobules, the
septae, or both.<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 83;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What diseases should be differentiate
with histiocytoid SS?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Leukemia cutis, interstitial type of
granuloma annulare, interstitial granulomatous dermatitis with arthritis,
& methotrexate-induced rheumatoid papules<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 84;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">CLINICAL COURSE AND <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">PROGNOSIS<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 85;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the natural course of SS ?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Resolves spontaneously, but lesions persist
for weeks to months.<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 86;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the course of malignancy-associated
or drug-induced SS? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Clearing after successful management of
the cancer or discontinuation of the associated medication.<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 87;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the successful management of
tonsillitis, solid tumors, or renal failure-induced SS? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Surgical excision or transplantation of
kidney. <o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 88;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What patients has higher recurrence of
SS? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Malignancy-associated SS. <o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 89;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">MANAGEMENT<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">MEDICATIONS<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">FIRST-LINE TREATMENTS<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 90;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the first line treatments of SS? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Systemic/topical/IL corticosteroids, potassium
iodide & colchicine<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 91;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">How to treat refractory SS with steroids?
<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Daily, IV pulse methylprednisolone <o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 92;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">How to treat localized SS with steroids? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Topical (0.05% clobetasol propionate) or IL
(triamcinolone acetonide, 3-10 mg/cc) <o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 93;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the side effects of KI? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Vasculitis & hypothyroidism<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 94;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the side effects of colchicine? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">GI symptoms: diarrhea, abdominal pain,
nausea & vomiting<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 95;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the dose of KI tablet? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">300 mg enteric-coated tablet, 1 tablet
tid (900mg/day)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 96;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the usage of SSKI (saturated solution
of KI, <span style="mso-spacerun: yes;"> </span>Lugol's solution)<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">1 drop = 0.05 ml <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">3 drops tid (450mg/day)</span><span style="font-family: "新細明體" , serif;">→↑</span><span lang="EN-US">by 1drop 3 times
each day</span><span style="font-family: "新細明體" , serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">→</span><span lang="EN-US">7-10 drops tid
(1050-1500 mg/day)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 97;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the concentration of SSKI in SS? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">1 g KI /ml of water(1 drop = 0.05 ml =
50mg)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 98;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">SECOND-LINE TREATMENTS<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 99;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What drugs can be second-line treatments
of SS(4)? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Indomethacin, clofazimine, cyclosporine,
& dapsone<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 100;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">Which 2 drugs can be used in the
combination therapy with steroids? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Cyclosporine & dapsone<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 101;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">ANTIBIOTICS<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 102;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What are the proper antibiotics used in
the treatment of SS-related infections? <span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Secondarily impetiginized lesions: abx
for S. aureus<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">Inflammatory bowel disease: metronidazole<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">Yersinia or Chlamydia: doxycycline,
minocycline, <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">or tetracycline<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 103;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">OTHER AGENTS<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 104;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What are other choice of treatments of
SS? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l1 level1 lfo18; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "wingdings"; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Antineoplastic (azacitidine, chlorambucil, cyclophosphamide, &
rituximab)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l1 level1 lfo18; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "wingdings"; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">TNF inhibitors (adalimumab, etanercept, infliximab, & thalidomide)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l1 level1 lfo18; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "wingdings"; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Miscellaneous: danazol, etretinate, hepatitis therapy, IVIG,
IFN-α, Anakinra(+steroid)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 105;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">MALIGNANCY WORKUP<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 106; mso-yfti-lastrow: yes;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">Why should we work up malignancies in patients
with SS? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Neoplasms concurrently present or
subsequently develop in previously cancer-free SS<o:p></o:p></span></div>
</td>
</tr>
</tbody></table>
<div class="MsoNormal">
<br /></div>
<br />鄭煜彬(Yu-Pin Cheng)http://www.blogger.com/profile/07019803125903571476noreply@blogger.com0tag:blogger.com,1999:blog-5384877319969585099.post-59448967091786535302020-02-09T16:58:00.001-08:002020-02-09T21:51:49.508-08:00[考生加油] Dermatological Recall: Chapter 71 Acquired Perforating Disorders 穿透性疾病<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg4il3a-oTVFGqEJb0h_VbgjDvdO1q4bCjZQ7B5hAzryERBwbs9sCWavCkb65quH9u3P_BzQPVi_9PtGm7mCTk9PDbCM98i_SHkPLMRA5nAu4JMkfKQikuPk41x2TvsyYXkUeaQq6uYI3bT/s1600/DSC_0250.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1065" data-original-width="1600" height="424" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg4il3a-oTVFGqEJb0h_VbgjDvdO1q4bCjZQ7B5hAzryERBwbs9sCWavCkb65quH9u3P_BzQPVi_9PtGm7mCTk9PDbCM98i_SHkPLMRA5nAu4JMkfKQikuPk41x2TvsyYXkUeaQq6uYI3bT/s640/DSC_0250.JPG" width="640" /></a></div>
<div class="MsoNormal">
<span style="font-size: large;">皮膚科有一群奇癢的怪病,會出現嚴重的搔癢以及真皮物質穿出皮膚表面的特性,因此稱為穿透性疾病(perforating disorders)。</span></div>
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<span style="font-size: x-large;">Chapter 71 :: Acquired Perforating
Disorders</span></div>
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<span lang="EN-US"><span style="font-size: large;">:: Garrett T. Desman & Raymond L.
Barnhill<o:p></o:p></span></span></div>
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<span style="font-family: "新細明體" , serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><span style="font-size: large;">鄭煜彬</span></span><span lang="EN-US"><span style="font-size: large;">(20200122)</span><o:p></o:p></span><br />
<span lang="EN-US"><span style="font-size: large;"></span></span><br />
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<span lang="EN-US">What is the definition perforating
disorders? <o:p></o:p></span></div>
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<span lang="EN-US">Transepidermal elimination of connective
tissue elements.<o:p></o:p></span></div>
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<span lang="EN-US">What is the classification of perforating
disorders?<o:p></o:p></span></div>
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<span lang="EN-US">Primary (1) familial (2) acquired <o:p></o:p></span></div>
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<span lang="EN-US">Secondary(come from other primary
dermatoses)<o:p></o:p></span></div>
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<span lang="EN-US">What diseases may develop secondary perforating
disorders? <o:p></o:p></span></div>
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<b><span lang="EN-US">Deposition</span></b><span lang="EN-US">: Hematomas, Perforating calcinosis cutis, Gout (urate), Papular
mucinosis (mucin), Perforating pseudoxanthoma elasticum<o:p></o:p></span></div>
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<b><span lang="EN-US">Granulomatous</span></b><span lang="EN-US"> disorders: Granuloma annulare, Necrobiosis lipoidica, Rheumatoid
nodule, Sarcoidosis, Foreign body (silica, wood splinter, glass, metal)<o:p></o:p></span></div>
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<b><span lang="EN-US">Infection:
</span></b><span lang="EN-US">chromomycosis, leprosy<o:p></o:p></span></div>
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<b><span lang="ES">Tumor</span></b><span lang="ES">: melanoma, pilomatrixoma, epithelioid sarcoma<o:p></o:p></span></div>
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<span lang="EN-US">What are familial primary perforating
disorders(2)?<o:p></o:p></span></div>
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<span lang="EN-US">Reactive perforating collagenosis(RPC)
& elastosis perforans serpiginosa(EPS). <o:p></o:p></span></div>
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<span lang="EN-US">What are adult-onset acquired primary
perforating disorders(4)?<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US">1.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Kyrle disease (KD)<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US">2.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">acquired perforating
collagenosis(APC)<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US">3.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">perforating folliculitis<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l1 level1 lfo12; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US">4.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">acquired elastosis perforans
serpiginosa (AEPS)<o:p></o:p></span></div>
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<span lang="EN-US">What is the umbrella designation of
acquired primary perforating disorder? <o:p></o:p></span></div>
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<span lang="EN-US">Acquired perforating dermatosis (APD),
including KD, APC, perforating folliculitis, & AEPS<o:p></o:p></span></div>
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<span lang="EN-US">CLINICAL FEATURES<o:p></o:p></span></div>
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<br /></div>
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<span lang="EN-US">What is the clinical features of APD? <o:p></o:p></span></div>
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<span lang="EN-US">Round, umbilicated, skin-colored,
erythematous or <o:p></o:p></span></div>
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<span lang="EN-US">hyperpigmented papules & nodules with
a central crust/keratotic plug on the extensor sides of limbs & trunk
(APC, KD) > face, scalp (sparing mucosa)<o:p></o:p></span></div>
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<span lang="EN-US">What is the special distributions of APD?
<o:p></o:p></span></div>
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<span lang="EN-US">Linear distribution & follicular-based
distribution(perforating folliculitis)<o:p></o:p></span></div>
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<div class="MsoNormal">
<span lang="EN-US">Why does the APD lesions arise in a line?
<o:p></o:p></span></div>
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<span lang="EN-US">It is caused by scratching & koebnerization
(it might have pain and pruritus)<o:p></o:p></span></div>
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<div class="MsoNormal">
<span lang="EN-US">What is the clinical features of EPS? <o:p></o:p></span></div>
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<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 264.85pt;" valign="top" width="530">
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l4 level1 lfo13; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US">1.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">It may be familial (AD
inheritance) or acquired<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l4 level1 lfo13; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US">2.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Crusted erythematous papules
with central atrophy/cribriform scarring & a serpiginous configuration<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l4 level1 lfo13; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US">3.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Localized to 1 region: neck,
trunk, or limbs<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l4 level1 lfo13; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US">4.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Asymptomatic, Koebner (+)
occationally<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l4 level1 lfo13; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US">5.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">F>M (>4:1)<o:p></o:p></span></div>
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<div class="MsoNormal">
<span lang="EN-US">What is the most common cause of acquired
EPS(AEPS)?<o:p></o:p></span></div>
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<div class="MsoNormal">
<span lang="EN-US">D-penicillamine which is taken for Wilson
disease & other diseases, (rare)chronic kidney disease. <o:p></o:p></span></div>
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<div class="MsoNormal">
<span lang="EN-US">What is the clinical features of reactive
perforating collagenosis (NOT APC)?<o:p></o:p></span></div>
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<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 264.85pt;" valign="top" width="530">
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l0 level1 lfo14; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US">1.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">An extremely rare familial
disorder<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l0 level1 lfo14; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US">2.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Most commonly presents in
early childhood<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l0 level1 lfo14; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US">3.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">F=M(1:1), as other APDs<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l0 level1 lfo14; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US">4.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">AD or AR inheritance<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l0 level1 lfo14; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US">5.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Looks like other APDs,
localized to limbs>> face<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l0 level1 lfo14; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US">6.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">The strongest koebnerization
response<o:p></o:p></span></div>
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<div class="MsoNormal">
<span lang="EN-US">What are the associations of adult-onset nonfamilial /acquired
primary lesions?<o:p></o:p></span></div>
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<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l12 level1 lfo15; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US">1.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Chronic kidney disease (undergoing
dialysis & renal transplants) <o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l12 level1 lfo15; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US">2.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Diabetes mellitus (diabetic
nephropathy)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l12 level1 lfo15; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US">3.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">The healthy with no known
associated illnesses<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 149.95pt;" valign="top" width="300">
<div class="MsoNormal">
<span lang="EN-US">What disease is most similar to APD? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 264.85pt;" valign="top" width="530">
<div class="MsoNormal">
<span lang="EN-US">Prurigo nodularis<o:p></o:p></span></div>
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</tr>
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<div class="MsoNormal">
<span lang="EN-US">How about the relationship between APD
& associated diseases? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 264.85pt;" valign="top" width="530">
<div class="MsoNormal">
<span lang="EN-US">Parallels systemic diseases: KD, APC<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">Waxing-&-waning course, unassociated
with systemic diseases: perforating folliculitis<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
</td>
</tr>
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<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 149.95pt;" valign="top" width="300">
<div class="MsoNormal">
<span lang="EN-US">What drug may be associated with APD? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 264.85pt;" valign="top" width="530">
<div class="MsoNormal">
<span lang="EN-US">TNF-α inhibitors, indinavir, & sorafenib.<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 149.95pt;" valign="top" width="300">
<div class="MsoNormal">
<span lang="EN-US">What inborn diseases may be associated
with APD?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 264.85pt;" valign="top" width="530">
<div class="MsoNormal">
<span lang="EN-US">Down syn. & Ehlers-Danlos syn.,
Marfan syn., osteogenesis imperfecta, scleroderma, & pseudoxanthoma
elasticum (<b>MED SOP</b></span><b><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">醫療SOP</span></b><span lang="EN-US">)<b><o:p></o:p></b></span></div>
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<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 149.95pt;" valign="top" width="300">
<div class="MsoNormal">
<span lang="EN-US">What is the ranking of age of onset? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 264.85pt;" valign="top" width="530">
<div class="MsoNormal">
<span lang="EN-US">KD/APD(4<sup>th</sup>
decade)>perforating folliculitis(3<sup>rd</sup> decade)> AEPS(3<sup>rd</sup>
decade)<o:p></o:p></span></div>
</td>
</tr>
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<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 149.95pt;" valign="top" width="300">
<div class="MsoNormal">
<span lang="EN-US">Where is the site of perforating
folliculitis? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 264.85pt;" valign="top" width="530">
<div class="MsoNormal">
<span lang="EN-US">Hair-bearing portions of extremities. <o:p></o:p></span></div>
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<div class="MsoNormal">
<span lang="EN-US">Where is the site of KD/APC? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 264.85pt;" valign="top" width="530">
<div class="MsoNormal">
<span lang="EN-US">Extensor of limbs, head, neck, &
trunk <o:p></o:p></span></div>
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<div class="MsoNormal">
<span lang="EN-US">Where is the site of AEPS? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 264.85pt;" valign="top" width="530">
<div class="MsoNormal">
<span lang="EN-US">Nape, face,
& limbs<o:p></o:p></span></div>
</td>
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<div class="MsoNormal">
<span lang="EN-US">What is the clinical findings of AEPS? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 264.85pt;" valign="top" width="530">
<div class="MsoNormal">
<span lang="EN-US">Papules in
serpiginous configuration + central atrophy<o:p></o:p></span></div>
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<div class="MsoNormal">
<span lang="EN-US">What is the associations of KD/APC? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 264.85pt;" valign="top" width="530">
<div class="MsoNormal">
<span lang="EN-US">Renal
failure/hemodialysis, DM, & hepatic insufficiency (</span><b><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">腎糖肝</span></b><span lang="EN-US">)<o:p></o:p></span></div>
</td>
</tr>
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<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 149.95pt;" valign="top" width="300">
<div class="MsoNormal">
<span lang="EN-US">What is the associations of perforating
folliculititis?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 264.85pt;" valign="top" width="530">
<div class="MsoNormal">
<span lang="EN-US">Idiopathic,
minor with renal failure/hemodialysis(</span><b><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">腎糖</span></b><span lang="EN-US">)<o:p></o:p></span></div>
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<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 149.95pt;" valign="top" width="300">
<div class="MsoNormal">
<span lang="EN-US">What is the associations of AEPS?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 264.85pt;" valign="top" width="530">
<div class="MsoNormal">
<span lang="EN-US">Down syn.,
Ehlers-Danlos syn., oestogenesis imperfecta, pseudoxanthoma elasticum, minor
with renal failure (MED SOP</span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">不含M&S</span><span lang="EN-US">)<o:p></o:p></span></div>
</td>
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<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 149.95pt;" valign="top" width="300">
<div class="MsoNormal">
<span lang="EN-US">What type of APDs has Koebner phenomenon?
<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 264.85pt;" valign="top" width="530">
<div class="MsoNormal">
<span lang="EN-US">KD/APC,
AEPS(occasionally)<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 149.95pt;" valign="top" width="300">
<div class="MsoNormal">
<span lang="EN-US">ETIOLOGY AND PATHOGENESIS<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 264.85pt;" valign="top" width="530">
<div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 149.95pt;" valign="top" width="300">
<div class="MsoNormal">
<span lang="EN-US">What is the relationship of perforating
folliculitis, APD, & KD? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 264.85pt;" valign="top" width="530">
<div class="MsoNormal">
<span lang="EN-US">They are in a disease spectrum or
different stages in lesional development(folliculitis→APD→KD ).<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 149.95pt;" valign="top" width="300">
<div class="MsoNormal">
<span lang="EN-US">What might be the primary disorder of
perforating folliculitis? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 264.85pt;" valign="top" width="530">
<div class="MsoNormal">
<span lang="EN-US">Infectious folliculitis, such as
Pityrosporum folliculitis.<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 149.95pt;" valign="top" width="300">
<div class="MsoNormal">
<span lang="EN-US">What is the most important mechanism of
APD? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 264.85pt;" valign="top" width="530">
<div class="MsoNormal">
<span lang="EN-US">Pruritus → manipulation/trauma<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 149.95pt;" valign="top" width="300">
<div class="MsoNormal">
<span lang="EN-US">What is the role of DM in the mechanism
of APD? (3)<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 264.85pt;" valign="top" width="530">
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l2 level1 lfo1; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US">1.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">DM→advanced glycation end
product →vasculopathy/angiopathy<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l2 level1 lfo1; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US">2.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">DM→advanced glycation end
product–modified collagens I & III binds CD36→ keratinocyte terminal
differentiation & upward movement of keratinocytes along with glycated
collagen<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l2 level1 lfo1; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US">3.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">DM→</span><span style="font-family: "新細明體",serif;">↑</span><span lang="EN-US">Fibronectin→keratinocytes
acts with collagen IV<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 149.95pt;" valign="top" width="300">
<div class="MsoNormal">
<span lang="EN-US">What are the other mechanisms of
APD? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 264.85pt;" valign="top" width="530">
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l13 level1 lfo3; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US">1.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Dialysis→dermal microdeposition
(calcium salts, silicon)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l13 level1 lfo3; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US">2.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Vitamin A deficiency.<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l13 level1 lfo3; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US">3.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Uremia→</span><span style="font-family: "新細明體",serif;">↑</span><span lang="EN-US">fibronectin→keratinocytes
acts with collagen IV<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l13 level1 lfo3; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US">4.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Imbalances in TGF-β3, MMP-1,
& tissue inhibitor of metalloproteinase-1(TIMP-1) →disturbance of matrix.
<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 149.95pt;" valign="top" width="300">
<div class="MsoNormal">
<span lang="EN-US">What is the possible mechanisms of EPS<o:p></o:p></span></div>
</td>
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<!--[if !supportLists]--><span lang="EN-US">1.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "新細明體",serif;">↑</span><span lang="EN-US">elastin receptors(both familial & acquired)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l5 level1 lfo2; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US">2.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Penicillamine→“bramble
bush–appearing” elastic fibers<o:p></o:p></span></div>
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<span lang="EN-US">DIAGNOSIS<o:p></o:p></span></div>
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<br /></div>
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<span lang="EN-US">HISTOPATHOLOGY<o:p></o:p></span></div>
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<br /></div>
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<span lang="EN-US">What are the pathological features of
APD? <o:p></o:p></span></div>
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<b><span lang="EN-US">Epidermis</span></b><span lang="EN-US">: follicular/perifollicular, transepidermal elimination of dermal
material through an epidermal invagination + central keratotic plug +
crusting or hyperkeratosis.<o:p></o:p></span></div>
<div class="MsoNormal">
<b><span lang="EN-US">Dermis</span></b><span lang="EN-US">: N</span><span style="font-family: "新細明體",serif; mso-ascii-theme-font: minor-fareast; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-theme-font: minor-fareast;">φ</span><span lang="EN-US">→ lymphcytes, M</span><span style="font-family: "新細明體",serif; mso-ascii-theme-font: minor-fareast; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-theme-font: minor-fareast;">φ<span lang="EN-US">, </span></span><span lang="EN-US">multinucleated
giant cells<o:p></o:p></span></div>
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<span lang="EN-US">What is the pathological difference
between APDs? <o:p></o:p></span></div>
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<span lang="EN-US">APC: <b>collagen</b>
bundles in the plug<o:p></o:p></span></div>
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<span lang="EN-US">Perforating folliculitis: “follicular
APC” <o:p></o:p></span></div>
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<span lang="EN-US">AEPS: <b>elastic</b> fibers in the plug<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">KD: amorphous dermal material + <b>fibrin &/or keratin</b> in the plug(</span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">表皮與滲出物較多</span><span lang="EN-US">)<o:p></o:p></span></div>
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<b><span lang="EN-US">Clear
identification is impossible; there is overlap.<o:p></o:p></span></b></div>
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<span lang="EN-US">LABORATORY TESTS<o:p></o:p></span></div>
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<br /></div>
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<span lang="EN-US">What laboratory evaluations should be
checked?<o:p></o:p></span></div>
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<b><span lang="EN-US">DM</span></b><span lang="EN-US">: fasting blood glucose; glucose tolerance test; <o:p></o:p></span></div>
<div class="MsoNormal">
<b><span lang="EN-US">CKD</span></b><span lang="EN-US">: serum creatinine; glomerular filtration rate or creatinine
clearance<o:p></o:p></span></div>
<div class="MsoNormal">
<b><span lang="EN-US">Hepatic
insufficiency</span></b><span lang="EN-US">: liver function tests<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">Serum <b>uric acid</b> & <b>thyroid</b>
function tests.(</span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">有些病人的病灶中有尿酸結晶;甲狀腺亢進會癢</span><span lang="EN-US">)<o:p></o:p></span></div>
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<span lang="EN-US">What associations should be checked? <o:p></o:p></span></div>
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<div class="MsoNormal">
<span lang="EN-US">Chronic kidney disease, Diabetes mellitus
(insulin-dependent & noninsulin-dependent), Scabies<o:p></o:p></span></div>
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<div class="MsoNormal">
<span lang="EN-US">DIFFERENTIAL DIAGNOSIS<o:p></o:p></span></div>
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<br /></div>
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<div class="MsoNormal">
<span lang="EN-US">What disease is most difficult to
differentiate from APDs? <o:p></o:p></span></div>
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<div class="MsoNormal">
<span lang="EN-US">Prurigo nodularis<o:p></o:p></span></div>
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<div class="MsoNormal">
<span lang="EN-US">What disease is most similar to AEPS?<o:p></o:p></span></div>
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<div class="MsoNormal">
<span lang="EN-US">Perforating pseudoxanthoma elasticum<o:p></o:p></span></div>
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<div class="MsoNormal">
<span lang="EN-US">What are the differential diagnoses of
APDs? <o:p></o:p></span></div>
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<div class="MsoNormal">
<span lang="EN-US">Hyperkeratotic papules<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l10 level1 lfo11; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US">1.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Multiple keratoacanthomas
(Ferguson-Smith familial keratoacanthomas, Grzybowski eruptive
keratoacanthomas)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l10 level1 lfo11; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US">2.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Prurigo nodularis<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">Annular papules<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l7 level1 lfo10; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US">1.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Porokeratosis (also
hyperkeratotic)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l7 level1 lfo10; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US">2.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Sarcoidosis<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l7 level1 lfo10; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US">3.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Actinic granuloma (annular
elastolytic giant cell granuloma)<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">Perforating folliculitis: follicullar
plug<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l6 level1 lfo9; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US">1.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Discoid lupus erythematous<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l6 level1 lfo9; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US">2.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Flegel disease
(hyperkeratosis follicularis perstans)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l6 level1 lfo9; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US">3.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Folliculitis (bacterial,
yeast)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l6 level1 lfo9; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US">4.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Keratosis follicularis
(Darier disease)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l6 level1 lfo9; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US">5.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Keratosis pilaris<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">Koebner phenomenon<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l9 level1 lfo8; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><b><span lang="EN-US">1.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><span lang="EN-US">Psoriasis<b><o:p></o:p></b></span></div>
<div class="MsoNormal">
<span lang="EN-US">Itchy papules<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l11 level1 lfo7; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US">1.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Lichen planus<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l11 level1 lfo7; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US">2.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Arthropod bites<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l11 level1 lfo7; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US">3.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Scabies<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">Disease with perforating fearutes<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l3 level1 lfo6; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US">1.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Perforating granuloma
annulare<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l3 level1 lfo6; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US">2.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Perforating periumbilical
calcific elastosis<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l3 level1 lfo6; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US">3.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Perforating pseudoxanthoma
elasticum<o:p></o:p></span></div>
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<div class="MsoNormal">
<span lang="EN-US">CLINICAL COURSE, PROGNOSIS, AND
MANAGEMENT<o:p></o:p></span></div>
</td>
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<div class="MsoNormal">
<br /></div>
</td>
</tr>
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<div class="MsoNormal">
<span lang="EN-US">COMPLICATIONS<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 264.85pt;" valign="top" width="530">
<div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 149.95pt;" valign="top" width="300">
<div class="MsoNormal">
<span lang="EN-US">What are the complications of APD?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 264.85pt;" valign="top" width="530">
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l8 level1 lfo5; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US">1.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">S/S arise from underlying
systemic illnesses (DM/CKD/hepatic insufficiency…).<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l8 level1 lfo5; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US">2.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Secondary infections <o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l8 level1 lfo5; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US">3.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Irritant or allergic contact
dermatitis. <o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l8 level1 lfo5; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US">4.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Darker-skinned: postinflammatory
pigmentary alteration & scarring<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 149.95pt;" valign="top" width="300">
<div class="MsoNormal">
<span lang="EN-US">PROGNOSIS<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 264.85pt;" valign="top" width="530">
<div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 149.95pt;" valign="top" width="300">
<div class="MsoNormal">
<span lang="EN-US">What condition is linked to the severity
of APDs? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 264.85pt;" valign="top" width="530">
<div class="MsoNormal">
<span lang="EN-US">The severity of underlying diseases.
(Most cases of APD continue for years unless treated)<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 149.95pt;" valign="top" width="300">
<div class="MsoNormal">
<span lang="EN-US">MANAGEMENT<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 264.85pt;" valign="top" width="530">
<div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 149.95pt;" valign="top" width="300">
<div class="MsoNormal">
<span lang="EN-US">What are the common therapies to treat
most APDs? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 264.85pt;" valign="top" width="530">
<div class="MsoNormal">
<span lang="EN-US">Topical & oral retinoids, topical
& IL corticosteroids, & UVB<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 149.95pt;" valign="top" width="300">
<div class="MsoNormal">
<span lang="EN-US">How to treat the APD in CKD?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 264.85pt;" valign="top" width="530">
<div class="MsoNormal">
<span lang="EN-US">Changing the type of dialysis tubing,
modification of the dialysis procedure, renal transplantation.<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 149.95pt;" valign="top" width="300">
<div class="MsoNormal">
<span lang="EN-US">How to treat the APD in uremia?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 264.85pt;" valign="top" width="530">
<div class="MsoNormal">
<span lang="EN-US">Phototherapy(BBUVB, NBUVB, PUVA)<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 149.95pt;" valign="top" width="300">
<div class="MsoNormal">
<span lang="EN-US">What are the effective topical agents for
APDs other than corticosteroids?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 264.85pt;" valign="top" width="530">
<div class="MsoNormal">
<span lang="EN-US">Topical retinoids, imiquimod, phenol
(Sorbolene cream), capsaicin. <o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 149.95pt;" valign="top" width="300">
<div class="MsoNormal">
<span lang="EN-US">What are the effective systemic agents
for APDs other than corticosteroids? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 264.85pt;" valign="top" width="530">
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l14 level1 lfo4; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US">1.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Allopurinol (in cases of</span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">↑</span><span lang="EN-US">or normal uric acid)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l14 level1 lfo4; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US">2.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Retinoids (isotretinoin,
acitretin)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l14 level1 lfo4; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US">3.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Antibiotics (doxycycline,
clindamycin, metronidazole)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l14 level1 lfo4; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US">4.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Hydroxychloroquine<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 149.95pt;" valign="top" width="300">
<div class="MsoNormal">
<span lang="EN-US">What are the effective physical
modalities for APDs other than phototherapy?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 264.85pt;" valign="top" width="530">
<div class="MsoNormal">
<span lang="EN-US">TENS(transcutaneous electrical nerve
stimulation), CO2 laser, liquid N2, surgical debridement.<o:p></o:p></span></div>
</td>
</tr>
</tbody></table>
<span lang="EN-US"><span style="font-size: large;"><br /></span></span>
<br /></div>
<div class="MsoNormal">
<br /></div>
<br />鄭煜彬(Yu-Pin Cheng)http://www.blogger.com/profile/07019803125903571476noreply@blogger.com8tag:blogger.com,1999:blog-5384877319969585099.post-69521795018488207732020-01-18T23:20:00.001-08:002020-02-11T17:40:10.864-08:00[考生加油] Dermatological Recall: Chapter 31 Pityriasis Rosea 玫瑰糠疹<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg94KvgE-j-l5GwcVDVL-ptgutnyT6oZ3txdFPImcTI5GkokBa6KhtIW-EAODk1uS5C0GvvjUUE_0XMZxAYY4UFpflhwfeiQzvJ6Dv_0yFXbgxpXKcI7Ej7w2VMubDJfEZcVPxfvMs_ana3/s1600/Clinical+Patterns+in+Dermatology+%252811%2529+Papulosquamous+lesions+2.0+final.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="960" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg94KvgE-j-l5GwcVDVL-ptgutnyT6oZ3txdFPImcTI5GkokBa6KhtIW-EAODk1uS5C0GvvjUUE_0XMZxAYY4UFpflhwfeiQzvJ6Dv_0yFXbgxpXKcI7Ej7w2VMubDJfEZcVPxfvMs_ana3/s640/Clinical+Patterns+in+Dermatology+%252811%2529+Papulosquamous+lesions+2.0+final.jpg" width="640" /></a></div>
<div class="MsoNormal">
<span lang="EN-US"><br /></span></div>
<div class="MsoNormal">
玫瑰糠疹雖然不算罕見,大小教科書也都一直會提到,但在臨床實戰上卻沒有那麼容易診斷,甚至需要動用到診斷要件。這種疾病儘管不會有嚴重併發症,卻會造成病人的恐慌,也一直是皮膚科醫師的重要課題。</div>
<h2>
<span lang="EN-US"><span style="font-size: x-large;">Chapter 31 :: Pityriasis Rosea</span></span></h2>
<div class="MsoNormal">
<span lang="EN-US">:: Matthew Clark & Johann E. Gudjonsson<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "新細明體" , serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">鄭煜彬</span><span lang="EN-US">(20200117)<o:p></o:p></span></div>
<table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: none; mso-border-alt: solid windowtext .5pt; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt; mso-yfti-tbllook: 1184;">
<tbody>
<tr style="mso-yfti-firstrow: yes; mso-yfti-irow: 0;">
<td style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the meaning of pityriasis rosea? <o:p></o:p></span></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Pink (rosea) scales (pityriasis).<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 1;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">EPIDEMIOLOGY<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 2;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">When is PR found commonly? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">In colder months, but not supported by
all studies. <o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 3;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">Why is PR thought as infectious disease? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">PR usually has clustering of cases.<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 4;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">Which gender has higher prevalence? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Female(F:M=1.39: 1, especially<b style="mso-bidi-font-weight: normal;"> pregnant women</b>)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 5;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What age group has highest prevalence? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">10-35 years(teenagers & young adults)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 6;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">Does PR relapse? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Yes, but rare(only 1.8% to 3.7%).<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 7;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">CLINICAL FEATURES<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 8;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal" style="mso-char-indent-count: 1.0; text-indent: 12.0pt;">
<span lang="EN-US">HISTORY<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 9;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the first lesion of classic PR? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">The herald patch: a solitary lesion on
the trunk or less commonly an extremity.<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 10;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">How long is the time between herald patch
& secondary(2</span><span lang="EN-US" style="color: black; font-family: "arial" , sans-serif; font-size: 11.0pt;">°</span><span lang="EN-US">) eruptions?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">On average<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l5 level1 lfo1; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "wingdings"; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">2 weeks in adults<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l5 level1 lfo1; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "wingdings"; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">4 days in children<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 11;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">Where is the locations of the 2</span><span lang="EN-US" style="color: black; font-family: "arial" , sans-serif; font-size: 11.0pt;">°
</span><span lang="EN-US">eruptions of PR? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Trunk & proximal extremities<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 12;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the prodromal symptoms before or
with the 2</span><span lang="EN-US" style="color: black; font-family: "arial" , sans-serif; font-size: 11.0pt;">°</span><span lang="EN-US"> eruption?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Malaise, nausea, headache,
gastrointestinal, & upper respiratory symptoms (<b style="mso-bidi-font-weight: normal;">flu-like</b>), & lymphadenopathy. <o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 13;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the most common symptom of PR
rashes? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Pruritus(severe: mild/moderate: absent=
1:2:1)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 14;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the variants in pediatric
patients(< 10 y/o)?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Relapsing form: single (multiple is rare)
episode of relapse within 1 year of the initial episode. <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">Persistent form: last for > 12 weeks without
<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">Interruption<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 15;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the features of relapsing PR?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Lack a herald patch, shorter lived, fewer,
& more localized lesions.<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 16;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the features of persistent PR?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Has a herald patch, more common oral
manifestations <o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 17;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">How long is the duration of pediatric PR?
<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">on average 16 days (shorter than that on
adults)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 18;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal" style="mso-char-indent-count: 1.0; text-indent: 12.0pt;">
<span lang="EN-US">CUTANEOUS FINDINGS<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 19;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the features of classic herald patch?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">One/multiple well-demarcated, thin, oval
to round, pink/rose/colored/erythematous/ hyperpigmented plaque with a
slightly depressed center & fine collarette of scale in the periphery.<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 20;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">Where is the locations of herald patch?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Trunk (50%)>extremities>neck>>
dorsal feet/face/ scalp/genitalia<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 21;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">How big is the size of herald patch? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">>3 cm(2-10 cm<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 22;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">How much is the incidence of the herald
patch?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">80% (12% to 94%)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 23;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">How much is the incidence of the multiple
herald patch?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">5%<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 24;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">How long is the time between the herald
patch & 2</span><span lang="EN-US" style="color: black; font-family: "arial" , sans-serif; font-size: 11.0pt;">° </span><span lang="EN-US">eruptions? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">2 weeks (a few hours to 3 months), but
sometimes no 2</span><span lang="EN-US" style="color: black; font-family: "arial" , sans-serif; font-size: 11.0pt;">° </span><span lang="EN-US">eruptions.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 25;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the features of 2</span><span lang="EN-US" style="color: black; font-family: "arial" , sans-serif; font-size: 11.0pt;">°
</span><span lang="EN-US">eruption of PR? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Multiple, round-to-oval, 0.5- to 1.5-cm, light
pink macules, papules, & plaques (smaller herald patch)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 18.0pt; mso-para-margin-left: 0gd;">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 26;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">Where is the locations of 2</span><span lang="EN-US" style="color: black; font-family: "arial" , sans-serif; font-size: 11.0pt;">°
</span><span lang="EN-US">eruption? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Trunk & proximal extremities>>
distal extremities >>palms & soles. <o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 27;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the specific distribution of 2</span><span lang="EN-US" style="color: black; font-family: "arial" , sans-serif; font-size: 11.0pt;">°
</span><span lang="EN-US">eruptions of PR? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">“Christmas tree” distribution on the
upper chest & back: long axis of the lesions parallel to lines of
cleavage (ribs)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 28;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">How about the course of 2</span><span lang="EN-US" style="color: black; font-family: "arial" , sans-serif; font-size: 11.0pt;">°
</span><span lang="EN-US">eruption? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Appears <b style="mso-bidi-font-weight: normal;">2 weeks </b>after herald patch, occurs in crops every few days,
reaches its maximum <b style="mso-bidi-font-weight: normal;">2 weeks</b> later,
then disappears in 45 days. <o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 29;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">How about the relationship between PR &
sun-exposure? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Some are confined to sun-protected skin; others
are confined to sun-exposed skin. Most are randomly distributed. <o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 30;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the atypical forms of 2</span><span lang="EN-US" style="color: black; font-family: "arial" , sans-serif; font-size: 11.0pt;">°
</span><span lang="EN-US">eruption?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Eczematous, papular, follicular,
vesicular, urticarial, pustular, & purpuric forms. <o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 31;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the configuration of vesicular
lesions of PR? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">They are arranged in a rosette. <o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 32;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What age group has higher incidence of
vesicular lesions? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Children & young adults<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 33;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">How much is the incidence of mucosal
lesions in PR cases? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">16% (uncommon)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 34;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the clinical features of oral
lesions of PR? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">They can be punctate hemorrhagic,
ulcerative, erythematous macules, plaques, bullous, & annular lesions. <b style="mso-bidi-font-weight: normal;">Ulcer</b> is most common.<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 35;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the atypical variants of PR?
(hint: 5, distribution)<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Unilateral(not cross midline), localized(1
truncal site), & inverse(children’s folds, face, distal limbs),
blaschkoid, acral variants. <o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 36;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">COMPLICATIONS<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 37;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the complication of PR in the
healthy individuals?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Anxiety & depression, no long-term
complications<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 38;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the complication of PR in the
pregnants?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">PR before 15 weeks: higher miscarriage<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">PR after 15 weeks: higher premature delivery
</span><span lang="EN-US" style="color: black; font-family: "arial" , sans-serif; font-size: 11.0pt;">± </span><span lang="EN-US">hypotonia, weak motility, & hyporeactivity
<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 39;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">ETIOLOGY & PATHOGENESIS<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 40;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What pathogens may induce pityriasis
rosea? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">HHV-7 and/or HHV-6<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 41;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the relationship between PR &
HHVs? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">PR is the T cell infiltrate (cell-mediated
immunity) caused by primary infection or reactivation of HHV-7 and/or HHV-6. <o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 42;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the changes of cells, cytokines,
& proteins in PR? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US" style="color: black; font-family: "cambria math" , serif; font-size: 11.0pt;">⇧</span><span lang="EN-US"> (1)
CD4-to-CD8 ratio & Langerhans cells<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="ES" style="mso-ansi-language: ES;">(3) IL-17, IFN-</span><span lang="EN-US">γ</span><span lang="ES" style="mso-ansi-language: ES;"> (4)VEGF, </span><span lang="EN-US">interferon-inducible protein-10 (CXCL10). <o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 43;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">DIAGNOSIS<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 44;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the clinical diagnostic criteria
of PR? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">3 essential + at least 1 optional, no
exclusion<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">Essential features (</span><span style="font-family: "新細明體" , serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">圓環屑</span><span lang="EN-US">)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l2 level1 lfo2; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "wingdings"; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Discrete <b style="mso-bidi-font-weight: normal;">circular or oval</b>
lesions<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l2 level1 lfo2; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "wingdings"; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span lang="EN-US">Scaling</span></b><span lang="EN-US"> on most lesions<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l2 level1 lfo2; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "wingdings"; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span lang="EN-US">Peripheral collarette of
scale with central clearance</span></b><span lang="EN-US"> on </span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: black; font-family: "arial" , sans-serif; font-size: 11.0pt;">≥</span><span lang="EN-US"> 2
lesions</span></b><span lang="EN-US">.<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">Optional features (</span><span style="font-family: "新細明體" , serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">軀近、肋、先</span><span lang="EN-US">)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l0 level1 lfo3; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "wingdings"; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">A <b style="mso-bidi-font-weight: normal;">truncal & proximal</b>
limb distribution, < 10% lesions distal to the middle of arms & thighs<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l0 level1 lfo3; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "wingdings"; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Distribution of most lesions<b style="mso-bidi-font-weight: normal;">
along the ribs</b><o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l0 level1 lfo3; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "wingdings"; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span lang="EN-US">A herald patch</span></b><span lang="EN-US"> </span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: black; font-family: "arial" , sans-serif; font-size: 11.0pt;">≥</span><span lang="EN-US"> 2 days</span></b><span lang="EN-US"> before the eruption. <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">3 exclusion features<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l3 level1 lfo4; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "wingdings"; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Central, multiple <b style="mso-bidi-font-weight: normal;">small vesicles</b>
at </span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: black; font-family: "arial" , sans-serif; font-size: 11.0pt;">≥ 2</span><span lang="EN-US"> lesions</span></b><span lang="EN-US"><o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l3 level1 lfo4; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "wingdings"; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Most lesions on <b style="mso-bidi-font-weight: normal;">palmar or
plantar</b> skin <o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l3 level1 lfo4; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "wingdings"; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Clinical or serological evidence of <b style="mso-bidi-font-weight: normal;">2</b></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: black; font-family: "arial" , sans-serif; font-size: 11.0pt;">°</span></b><span lang="EN-US"> <b style="mso-bidi-font-weight: normal;">syphilis</b>.<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 45;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">LABORATORY TESTING<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 46;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">When should you check lab in PR patients?
<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">To rule out <b style="mso-bidi-font-weight: normal;">2</b></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: black; font-family: "arial" , sans-serif; font-size: 11.0pt;">°</span></b><span lang="EN-US"> <b style="mso-bidi-font-weight: normal;">syphilis</b><o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 47;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">PATHOLOGY<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 48;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What does PR look like in pathology? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Subacute eczema + extravasated RBC<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 49;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What are the features of PR?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Epidermis: focal/multifocal/confluent
parakeratosis, orthokeratosis, mild acanthosis; a thinned granular layer; &
spongiosis+ lymphocyte exocytosis<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">Dermis: a superficial perivascular
lymphocytic infiltrate + extravasated RBC <o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 50;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the difference of pathology
between herald patch & <b style="mso-bidi-font-weight: normal;">2</b></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: black; font-family: "arial" , sans-serif; font-size: 11.0pt;">° eruption?</span></b><span lang="EN-US"><o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">No difference. But herald patch has thicker
acanthosis & deeper infiltration. <o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 51;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">DIFFERENTIAL DIAGNOSIS<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 52;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What diseases can be the differential diagnosis
of PR? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Papulosquamous disorders: <o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l1 level1 lfo5; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "wingdings"; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Nummular eczema (round, no X’mas tree)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l1 level1 lfo5; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "wingdings"; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Guttate psoriasis(no X’mas tree, no herald patch)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l1 level1 lfo5; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "wingdings"; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Lichen planus (pruritic, chronic, violet, more distal limbs, no
collarette of scales)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l1 level1 lfo5; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "wingdings"; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Pityriasis lichenoides (chronic, relapsing course, no herald patch,
lesions in various stages, limbs)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l1 level1 lfo5; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "wingdings"; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Tinea corporis(KOH)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l1 level1 lfo5; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "wingdings"; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Parapsoriasis(no X’mas tree, no herald patch, chronic course)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l1 level1 lfo5; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "wingdings"; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Seborrheic dermatitis(face & scalp), <o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l1 level1 lfo5; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "wingdings"; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Secondary syphilis (oral/palmoplantar lesions, persistent LAP,
serology+, split papules, moth-eaten alopecia, condyloma lata ).<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 53;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What are the possible culprits of
drug-induced PR?<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="ES" style="mso-ansi-language: ES;">Barbiturates,
captopril, clonidine, gold, metronidazole, d-penicillamine, isotretinoin,
levamisole, NSAID, omeprazole, terbinafine, imatinib, & adalimumab. <o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 54;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">Why does adalimumab induce PR-like
eruption? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Adalimumab dampens T-helper 1 cell
response and predispose to viral infection or reactivation. <o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 55;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the difference between PR &
drug-induced PR?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Drug-induced PR has more hyperpigmentation
& lichenoid morphology.<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">More interface dermatitis, dyskeratotic
keratinocytes, & eosinophils in pathology. <o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 56;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">CLINICAL COURSE AND PROGNOSIS<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 57;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">How long is the duration of PR? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Average: 45 days (range: 2 weeks to 5
months)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 58;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the definition of persistent PR? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Eruptions last > 3 months (12 weeks)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 59;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the cutaneous sequela of PR? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Post-inflammatory hyper/hypopigmentation<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 60;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">MANAGEMENT<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 61;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What should you do to most cases of PR? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">No treatment is necessary because it is self-limited
<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 62;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">How to treat PR? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l4 level1 lfo6; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "wingdings"; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Topical: steroids & antihistamines (just improve pruritus)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l4 level1 lfo6; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "wingdings"; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Oral: acyclovir (800 mg 5 time) >> macrolide (erythromycin
& azithromycin) <o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l4 level1 lfo6; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "wingdings"; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">l<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">UVB<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 63; mso-yfti-lastrow: yes;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">How to prevent PR? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">No way.<o:p></o:p></span></div>
</td>
</tr>
</tbody></table>
<br />鄭煜彬(Yu-Pin Cheng)http://www.blogger.com/profile/07019803125903571476noreply@blogger.com0tag:blogger.com,1999:blog-5384877319969585099.post-17800617419164655012020-01-15T12:21:00.002-08:002020-02-11T17:40:24.091-08:00[考生加油] Dermatological Recall: Chapter 30 Pityriasis Lichenoides<span style="font-size: large;">從2020/01/11之後,煜彬就想趕快把下半段完成,以免被以為選舉完心情不好。</span><br />
<h2>
<span lang="EN-US"><span style="font-size: x-large;">Chapter 30 :: Pityriasis
Lichenoides(苔蘚樣糠疹)</span></span></h2>
<div class="MsoNormal">
<span lang="EN-US"><span style="font-size: large;">:: Stefan M. Schieke & Gary S. Wood<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-size: large;"><span style="font-family: "新細明體" , serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">鄭煜彬</span><span lang="EN-US">(20200114)<o:p></o:p></span></span></div>
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<span lang="EN-US"><span style="font-size: large;">PITYRIASIS LICHENOIDES(PL)</span><o:p></o:p></span><br />
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<span lang="EN-US">PITYRIASIS LICHENOIDES(PL)<o:p></o:p></span></div>
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<span lang="EN-US">EPIDEMIOLOGY<o:p></o:p></span></div>
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<span lang="EN-US">What age group has higher prevalence
rate of PL? <o:p></o:p></span></div>
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<span lang="EN-US">Children & young adults<o:p></o:p></span></div>
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<span lang="EN-US">Which season has higher prevalence of PL?<o:p></o:p></span></div>
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<span lang="EN-US">Fall and winter.<o:p></o:p></span></div>
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<span lang="EN-US">How much is the male-to-female ratio of PL?<o:p></o:p></span></div>
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<span lang="EN-US">1.5~3: 1(M>F)<o:p></o:p></span></div>
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<span lang="EN-US">Which one is more common, PLC or PLEVA?<o:p></o:p></span></div>
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<span lang="EN-US">PLC, which is 3 to 6 times more common
than PLEVA. <o:p></o:p></span></div>
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<span lang="EN-US">CLINICAL FEATURES<o:p></o:p></span></div>
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<span lang="EN-US">What is the divide of PLC & PLEVA? <o:p></o:p></span></div>
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<span lang="EN-US">No, they are in a spectrum, and usually
coexist. <o:p></o:p></span></div>
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<span lang="EN-US">What is the symptoms of PL? <o:p></o:p></span></div>
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<span lang="EN-US">Asymptomatic> pruritic or burning<o:p></o:p></span></div>
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<span lang="EN-US">What is the features of PLC? <o:p></o:p></span></div>
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<span lang="EN-US">Recurrent crops of erythematous <b>scaly papules</b>, regressing over
several weeks to months<o:p></o:p></span></div>
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<span lang="EN-US">What is the features of PLEVA?<o:p></o:p></span></div>
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<span lang="EN-US">Recurrent crops of erythematous papules <b>with crusts, vesicles, pustules, erosions,
or ulcers</b> before regressing in weeks (shorter than PLC) <o:p></o:p></span></div>
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<span lang="EN-US">What feature determine the duration of PL
in children? <o:p></o:p></span></div>
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<span lang="EN-US">Distribution(not the number of lesions)<o:p></o:p></span></div>
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<span lang="EN-US">What distribution of PL has longer
duration? <o:p></o:p></span></div>
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<b><span lang="EN-US">Peripheral</span></b><span lang="EN-US"> (<b>distal</b> <b>extremities</b>) > central (trunk)
> diffuse<o:p></o:p></span></div>
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<span lang="EN-US">What is the “clinical pattern” of PLC
& PLEVA individually? <o:p></o:p></span></div>
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<span lang="EN-US">PLC: papulosquamous lesions (scaly
papules)<o:p></o:p></span></div>
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<span lang="EN-US">PLEVA: papulonecrotic lesions (papules
with ulcer)<o:p></o:p></span></div>
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<span lang="EN-US">What is PLEVA with severe ulceration
& fever? <o:p></o:p></span></div>
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<span lang="EN-US">Pityriasis lichenoides with
ulceronecrosis & hyperthermia (PLUH) or febrile ulceronecrotic
Mucha–Habermann disease (FUMHD)<o:p></o:p></span></div>
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<span lang="EN-US">What is the features of PLUH? <o:p></o:p></span></div>
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<b><span lang="EN-US">Fever</span></b><span lang="EN-US">, purpuric papulonodules with <b>central
ulcers up to several cms</b> (larger than PLEVA/PLC)<o:p></o:p></span></div>
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<span lang="EN-US">What is the common locations of PL? <o:p></o:p></span></div>
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<span lang="EN-US">Trunk & proximal extremities (all skin/mucous
membranes is possible, regional/segmental lesions also exists)<b><o:p></o:p></b></span></div>
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<span lang="EN-US">What is the common skin sequelae of PL? <o:p></o:p></span></div>
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<span lang="EN-US">Postinflammatory hypo/hyper-pigmentation<o:p></o:p></span></div>
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<span lang="EN-US">What disease does the remnant of PLC look
like? <o:p></o:p></span></div>
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<span lang="EN-US">Idiopathic guttate hypomelanosis (PLC left postinflammatory hypopigmentation actually)<o:p></o:p></span></div>
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<span lang="EN-US">What disease does the remnant of PLEVA
look like? <o:p></o:p></span></div>
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<span lang="EN-US">Smallpox-like scar<o:p></o:p></span></div>
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<span lang="EN-US">What is the difference between smallpox
& PLEVA? <o:p></o:p></span></div>
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<span lang="EN-US">Smallpox: all lesions are in the same
stage<o:p></o:p></span></div>
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<span lang="EN-US">PLEVA: in various stages of evolution<o:p></o:p></span></div>
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<span lang="EN-US">COMPLICATIONS<o:p></o:p></span></div>
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<span lang="EN-US">What is the most common complication of
PL? <o:p></o:p></span></div>
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<span lang="EN-US">Secondary infection<o:p></o:p></span></div>
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<span lang="EN-US">What is the complications of PLEVA? <o:p></o:p></span></div>
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<span lang="EN-US">Low-grade fever, malaise, headache, and
arthralgia (like a mild flu)<o:p></o:p></span></div>
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<span lang="EN-US">What is the complicatiolns of PLUH or
FUMHD?<o:p></o:p></span></div>
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<span lang="EN-US">High </span><span lang="PT">fever, malaise, myalgia, arthralgia,
gastrointestinal, </span><span lang="EN-US">& CNS symptoms(like a severe
flu, can be fatal)<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the relationship of PL & lymphoma?
<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 9.0cm;" valign="top" width="510"><div class="MsoNormal">
<span lang="EN-US">Almost no relationship. (Only very rare
cases progress to MF)<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">ETIOLOGY<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 9.0cm;" valign="top" width="510"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What could cause PL? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 9.0cm;" valign="top" width="510"><div class="MsoNormal">
<span lang="EN-US">Unknown, can be infections(toxoplasma
gondii & virus), estrogen-progesterone therapy, chemotherapy,
radiocontrast iodide, influenza vaccine, & HMG-CoA reductase inhibitors.<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the Immunohistologic difference between
PLC & PLEVA?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 9.0cm;" valign="top" width="510"><div class="MsoNormal">
<div class="MsoNormal">
<span lang="EN-US">PLEVA: CD8+ T cells wit</span>h TIA-1 & granzyme B(cytotoxic) predominate<br /> PLC: CD4+ T (helper) predominate, CD8+ T, FoxP3+ T (regulatory)</div>
</div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the difference of clonality between
PLC & PLEVA? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 9.0cm;" valign="top" width="510"><div class="MsoNormal">
<span lang="EN-US">PLEVA: half cases have clonality<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">PLC: minority has clonality<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the possible pathogenesis of PL? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 9.0cm;" valign="top" width="510"><div class="MsoNormal">
<span lang="EN-US">Clonal cytotoxic memory T-cell
lymphoproliferative <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">response to one or more foreign antigens.<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">Which disease has most overlapping
features with PL? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 9.0cm;" valign="top" width="510"><div class="MsoNormal">
<span lang="EN-US">Lymphomatoid papulosis (LyP)<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the difference between PL &
LyP? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 9.0cm;" valign="top" width="510"><div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l3 level1 lfo1; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "wingdings"; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">l<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US">LyP (type A & C): large CD30+ atypical lymphoid cells. <o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l3 level1 lfo1; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "wingdings"; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">l<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US">LyP has CD4+ cells which lack 1 or more mature T-cell
antigens(CD2, 3, & 5)<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">DIAGNOSIS<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 9.0cm;" valign="top" width="510"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">How to diagnose PL? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 9.0cm;" valign="top" width="510"><div class="MsoNormal">
<span lang="EN-US">Clinical & pathological features.
Blood test may show leukocytosis &</span><span style="font-family: "新細明體" , serif;">↓</span><span lang="EN-US">CD4/CD8, but of little value. <o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">PATHOLOGY<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 9.0cm;" valign="top" width="510"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What are the common pathological features
of PL?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 9.0cm;" valign="top" width="510"><div class="MsoNormal">
<span lang="EN-US">An interface dermatitis of lymphocytes (denser
& more wedge shaped in acute lesions), exocytosis, parakeratosis, &
RBC extravasation.<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What features may appear in acute
variants of PL? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 9.0cm;" valign="top" width="510"><div class="MsoListParagraph" style="margin-left: 18.0pt; mso-list: l1 level1 lfo2; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US">1.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Necrotic keratinocytes/vesicles/pustules/
ulcers.<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 18.0pt; mso-list: l1 level1 lfo2; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US">2.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Lymphocytic vasculitis + fibrinoid
degeneration<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the meaning of CD30+ variant of
PLEVA? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 9.0cm;" valign="top" width="510"><div class="MsoNormal">
<span lang="EN-US">PL serve as fertile soil for the
development of the CD30+ T-cell clone characteristic of lymphomatoid
papulosis/ anaplastic large cell lymphoma<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">DIFFERENTIAL DIAGNOSIS<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 9.0cm;" valign="top" width="510"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the differential diagnoses of PL
and the method to distinguish them? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 9.0cm;" valign="top" width="510"><div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l2 level1 lfo3; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "wingdings"; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">l<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US">Secondary syphilis & virus exanthemas (serology)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l2 level1 lfo3; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "wingdings"; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">l<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US">LyP(CD30+ large atypical lymphoid cells)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l2 level1 lfo3; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "wingdings"; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">l<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US">Macular/papular variants of MF(small epidermotropic atypical lymphoid cells with convoluted
nuclei & a band-like superficial dermal lymphoid infiltrate)<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">MANAGEMENT<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 9.0cm;" valign="top" width="510"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">When should PL be treated? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 9.0cm;" valign="top" width="510"><div class="MsoNormal">
<span lang="EN-US">The more acute course(PLEVA) & severe
lesions (PLUH)<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">Mild, chronic lesions can be ignored.<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">How to treat PL? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 9.0cm;" valign="top" width="510"><div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l0 level1 lfo4; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "wingdings"; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">l<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US">Topical steroids & photo/photodynamic therapy <o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l0 level1 lfo4; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "wingdings"; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">l<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US">Systemic (antiinflammatory) antibiotics: tetracyclines,
erythromycin, & azithromycin<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l0 level1 lfo4; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "wingdings"; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">l<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US">Systemic steroids, low-dose methotrexate, calcineurin
inhibitors(tacrolimus) & retinoids(bexarotene)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l0 level1 lfo4; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "wingdings"; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">l<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US">Bromelain (a pineapple extract, very effective)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 24.0pt; mso-list: l0 level1 lfo4; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "wingdings"; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">l<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US">Antibiotics for Gram(+) pathogens in secondary infections of PL
lesions<o:p></o:p></span></div>
</td>
</tr>
</tbody></table>
<div class="MsoNormal">
<br />
<div class="MsoNormal">
<br /></div>
</div>
</div>
鄭煜彬(Yu-Pin Cheng)http://www.blogger.com/profile/07019803125903571476noreply@blogger.com0tag:blogger.com,1999:blog-5384877319969585099.post-14632547418298416902020-01-10T20:41:00.000-08:002020-02-11T17:40:36.554-08:00[考生加油] Dermatological Recall: Chapter 30 Parapsoriasis<a href="https://draft.blogger.com/blogger.g?blogID=5384877319969585099" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"></a><span style="font-size: large;">因為第30章比較多,煜彬先整理前半(Parapsoriasis)。希望晚上有心情完成後半段。</span><br />
<h2>
<span style="font-size: x-large;">Chapter 30:: Parapsoriasis (and
Pityriasis Lichenoides)</span></h2>
<div class="MsoNormal">
<span lang="EN-US"><span style="font-size: large;">:: Stefan M. Schieke & Gary S. Wood<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span style="font-family: "新細明體" , serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><span style="font-size: large;">鄭煜彬</span></span><span lang="EN-US"><span style="font-size: large;">(20200111)</span><o:p></o:p></span></div>
<table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: none; mso-border-alt: solid windowtext .5pt; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt; mso-yfti-tbllook: 1184;">
<tbody>
<tr style="mso-yfti-firstrow: yes; mso-yfti-irow: 0;">
<td style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What entities are included in
parapsoriasis?<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Large plaque parapsoriasis, small plaque
parapsoriasis, & pityriasis lichenoids(PLEVA & PLC)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 1; mso-yfti-lastrow: yes;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is Mucha-Habermann disease?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="ES" style="mso-ansi-language: ES;">Pityriasis
lichenoides et varioliformis acuta(PLEVA)<o:p></o:p></span></div>
</td>
</tr>
</tbody></table>
<div class="MsoNormal">
<span lang="EN-US">PARAPSORIASIS<o:p></o:p></span></div>
<table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: none; mso-border-alt: solid windowtext .5pt; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt; mso-yfti-tbllook: 1184;">
<tbody>
<tr style="mso-yfti-firstrow: yes; mso-yfti-irow: 0;">
<td style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">EPIDEMIOLOGY<o:p></o:p></span></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 1;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the range and peak of age in parapsoriasis?<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Middle-aged to older, fifth decade<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 2;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">How much is the male-to-female ratio of SPP
& LPP?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">SPP: 3:1<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">LPP: 1~: 1(M>F)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 3;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">CLINICAL FEATURES<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 4;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the clinical classification of
SPP/LPP/PL? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Papulosquamous lesions: papules with scales<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 5;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the symptoms of LPP?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Asymptomatic or mildly pruritic.<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 6;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the morphology of LPP?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Variable-sized(>5cm), light red-brown
or salmon pink, oval or irregularly shaped, well-marginated <b style="mso-bidi-font-weight: normal;">patches</b> or <b style="mso-bidi-font-weight: normal;">very thin plaques</b> with small and scanty scales.<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 7;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the location of LPP?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">“Bathing trunk(esp. breasts of women)”
and flexural areas, as MF<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 8;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What material is used to describe to the
fine wrinkle & epidermal atrophy of LPP? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Cigarette paper<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 9;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the triad of poikiloderma? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Telangiectasia, mottled pigmentation,
& atrophy.<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">(=poikiloderma atrophicans vasculare)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 10;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the only variant of LPP?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Retiform parapsoriasis: scaly macules
& papules in a net-like or zebra-stripe pattern<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 11;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is chronic superficial dermatitis?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Small plaque parapsoriasis<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 12;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the morphology of SPP?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US"><5cm, round or oval discrete <b style="mso-bidi-font-weight: normal;">patches</b> or <b style="mso-bidi-font-weight: normal;">very thin plaques</b> with fine, moderately adherent scales. <o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 13;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the location of SPP?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Trunk<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 14;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is two variants of SPP?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoListParagraph" style="margin-left: 18.0pt; mso-list: l0 level1 lfo1; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">digitate dermatosis<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 18.0pt; mso-list: l0 level1 lfo1; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">hypopigmented SPP <o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 15;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the morphology of digitate
dermatosis?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">A finger shape, <b style="mso-bidi-font-weight: normal;">yellowish</b> or <b style="mso-bidi-font-weight: normal;">fawn</b>-colored(</span><span style="background: white; color: #545454; font-family: "新細明體" , serif; font-size: 10.5pt;">淺黃褐色</span><span lang="EN-US">) lesions along the lines of cleavage. The long axis> 5cm.
(xanthoerythrodermia perstans)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 16;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the common complications of
parapsoriasis(4)? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoListParagraph" style="margin-left: 18.0pt; mso-list: l1 level1 lfo2; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">impetiginization secondary to
excoriation<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 18.0pt; mso-list: l1 level1 lfo2; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">mycosis fungoides<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 18.0pt; mso-list: l1 level1 lfo2; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Cardio/Cerebro-Vascular
Diseases<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 18.0pt; mso-list: l1 level1 lfo2; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Hematologic &
nonhematologic malignancies<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 17;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">ETIOLOGY & PATHOGENESIS<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 18;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">Which two diseases are bridged by parapsoriasis?
<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Chronic dermatitis & mycosis
fungoides (MF)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 19;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the abnormal tissue of
parapsoriasis or MF? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Skin-associated lymphoid tissue (SALT): T
cells express cutaneous lymphocyte-associated antigen<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 20;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">Where does SALT locate? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Skin, peripheral lymph nodes, lymphatics &
blood-stream.(T-cells in the circuit, not a tissue)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 21;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">Why are MF, parapsoriasis & chronic
dermatitis so difficult to distinguished? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">All continue to traffic and participate
in delayed-type hypersensitivity reactions to contact allergens after
neoplastic transformation.<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 22;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">Please describe the relationship of LPP
to MF. <span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">The clinically benign end of the MF
disease spectrum: they are monoclonal disorders with different dominant
T-cell clonal density<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 23;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the major factor to decide the
clinical difference between parapsoriasis & MF? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Genetic and/or epigenetic differences(the
more mutations, the more malignant)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 24;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">How to name the chronic spongiotic dermatitis
which may progress to MF? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Clonal dermatitis<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 25;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">Please draw a sketch of the relation
between follicular mucinosis(FM); large-plaque parapsoriasis(LPP);
nonspecific chronic spongiotic dermatitis(NCSD); <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">primary erythroderma(PE); & clonal
dermatitis?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgyy4FsAykj1D-enk3kgGUzGjs37D2UcLCzeIdd4Q5Od6UCJe1JkAQYqPv0MI0ETsPTjb9oeMNPfZSCuHCKUkP0RXz7l4Hoog1sfYNEjvxhZQQgK8Ab92KCA7n36LEAlysFVKXf2jS_4L59/s1600/P43+%25282%2529.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="960" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgyy4FsAykj1D-enk3kgGUzGjs37D2UcLCzeIdd4Q5Od6UCJe1JkAQYqPv0MI0ETsPTjb9oeMNPfZSCuHCKUkP0RXz7l4Hoog1sfYNEjvxhZQQgK8Ab92KCA7n36LEAlysFVKXf2jS_4L59/s400/P43+%25282%2529.jpg" width="400" /></a></div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 26;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the difference between the clonal
dermatitis & MF? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US" style="mso-no-proof: yes;">Clonal
dermatitis is polyclonal; MF is monoclonal.<span style="mso-spacerun: yes;">
</span><o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 27;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">Which virus may induce MF? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US" style="mso-no-proof: yes;">HHV-8<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 28;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">DIAGNOSIS<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 29;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the clinical difference between
LPP & SPP? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US" style="mso-no-proof: yes;">LPP has </span><span lang="EN-US">larger size, asymmetric distribution, irregular shape, less
discrete lesions, & poikilodermatous appearance. <o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 30;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the difference between LPP &
patch stage of MF?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US" style="mso-no-proof: yes;">No
diffenrence(indistinguishable)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 31;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the main difference between
parapsoriasis & MF?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US" style="mso-no-proof: yes;">Parapsoriasis </span><span lang="EN-US">has no induration or palpable infiltration<span style="mso-no-proof: yes;"><o:p></o:p></span></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 32;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the criteria to diagnose MF?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEguiUCX-l3nqk9W6q8JZ0OOcJ8QCka7TPu94Q_WIC3np1bVqjNiChVJY1eknvgZ9BOj5S9FenaumjqEbgt5JtueV5Jlqf76p4N54iqlBauBO3jFW70aWgo12AnKZo0VKB90ItKhNYbJXcjK/s1600/P43+%25281%2529.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="960" data-original-width="720" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEguiUCX-l3nqk9W6q8JZ0OOcJ8QCka7TPu94Q_WIC3np1bVqjNiChVJY1eknvgZ9BOj5S9FenaumjqEbgt5JtueV5Jlqf76p4N54iqlBauBO3jFW70aWgo12AnKZo0VKB90ItKhNYbJXcjK/s640/P43+%25281%2529.jpg" width="480" /></a></div>
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 33;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">Since LPP& MF are indistinguishable,
why should we use the name LPP? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoListParagraph" style="margin-left: 18.0pt; mso-list: l2 level1 lfo3; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">It guides treatment and
followup as MF <o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 18.0pt; mso-list: l2 level1 lfo3; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">The risk of dying from
lymphoma(MF) is small.<o:p></o:p></span></div>
</td>
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<tr style="mso-yfti-irow: 34;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the major difference between SPP
& MF? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">MF had poikiloderma, moderate to thick
plaques. <o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 35;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">PATHOLOGY<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 36;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What can you see in the slide of early
SPP?(Please answer according to epidermis & dermis) <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">E: mild spongiosis + focal hyperkeratosis,
parakeratosis(scale), crust, & exocytosis.<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">D: mild superficial perivascular
lymphohistiocytic infiltrate + edema<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 37;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What can you see in the slide of late
SPP?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">As early SPP (no progression)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 38;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What can you see in the slide of early LPP?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">E: mildly acanthotic & hyperkeratotic
epidermis + spotty parakeratosis.<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">D: Perivascular & scattered dermal
lymphocytic infiltrate<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 39;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What can you see in the slide of advanced
LPP or MF?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">An interface infiltrate + mild spongiosis
+ epidermotropism (scattered singly or in groups).<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">Poikiloderma: atrophic epidermis, dilated
blood vessels, & melanophage<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 40;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What are the different immunohistologic
features between SPP & LPP/early MF? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">(CD4+ T-cells predominate in these
dermatitides) LPP/MF has CD7 deficiency, epidermal expression of HLD-DR. <span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 41;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">DIFFERENTIAL DIAGNOSIS<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 42;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">What is the difference between SPP/LPP/MF
& psoriasis? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Psoriasis has Auspitz sign, micaceous
scale, nail <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">pits, & lesions on the scalp, elbows,
& knees.<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 43;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">CLINICAL COURSE AND PROGNOSIS<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 44;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">How many percent of cases of LPP &
SPP become MF in the future? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">LPP: 10% to 30%<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">SPP: 0%<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 45;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">Which variant of LPP usually progress to
MF? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">The retiform variant<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 46;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">MANAGEMENT<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 47;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">How to treat SPP? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Emollients, topical tarcortic/osteroids,
& BBUVB<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">F/u every 3-6 months. <o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 48;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">How to treat LPP?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Topical: strong corticosteroids, nitrogen
mustard<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">Phototherapy: BB/NBUVB, UVA1, PUVA, excimer<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">F/u every 3-6 months.<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 49; mso-yfti-lastrow: yes;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311"><div class="MsoNormal">
<span lang="EN-US">How to treat MF? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518"><div class="MsoNormal">
<span lang="EN-US">Phototherapy: BBUVB, NBUVB, UVA1, PUVA<b style="mso-bidi-font-weight: normal;"><o:p></o:p></b></span></div>
<div class="MsoNormal">
<span lang="EN-US">Topical: nitrogen mustard, bexarotene
gel, imiquimod, carmustine (BCNU). <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">Electron-beam radiation<o:p></o:p></span></div>
</td>
</tr>
</tbody></table>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<br />鄭煜彬(Yu-Pin Cheng)http://www.blogger.com/profile/07019803125903571476noreply@blogger.com0tag:blogger.com,1999:blog-5384877319969585099.post-20019206609021492572020-01-04T19:36:00.003-08:002020-01-04T20:55:35.837-08:00[考生加油] Dermatological Recall: Chapter 29 Pityriasis Rubra Pilaris(PRP)<br />
<div class="MsoNormal">
<span style="font-size: large;">美國有一系列醫學教科書稱為「回憶系列(Recall Series)」,包括了內外婦兒急診科的臨床知識,甚至有出病理科與影像科等二線科別的用書。這套教科書都用<b>問答</b>的方式來描述專科的醫學知識,和傳統教科書大相逕庭,看起來很奇怪。</span></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgM2ln-yzBnfCD6MD3AsiI1ZwQWbkcP8UUoTTbShFcolKHcp5fKBcYfRUkOa0nPFapA1BrM7hZiEPQTNp2a_icj8B3S9ULwHrGa2H8V0N9ZoWYNhxIC8rS0Msna8lb-WKG8Cg0z1phI-ssa/s1600/P169+%25283%2529.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="540" data-original-width="960" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgM2ln-yzBnfCD6MD3AsiI1ZwQWbkcP8UUoTTbShFcolKHcp5fKBcYfRUkOa0nPFapA1BrM7hZiEPQTNp2a_icj8B3S9ULwHrGa2H8V0N9ZoWYNhxIC8rS0Msna8lb-WKG8Cg0z1phI-ssa/s640/P169+%25283%2529.jpg" width="640" /></a></div>
<div class="MsoNormal">
<span style="font-size: large;"><br /></span></div>
<h2>
<span style="font-size: x-large;">經過回想過的記憶才會長久留存!</span></h2>
<div class="MsoNormal">
<span style="font-size: large;">神奇的是:當年大五的我自己遮住答案回答完後,還真的把這些複雜的知識都記住了。因此有次教化學家教時,就照這種方式把整個章節「問了」學生一次,結果效果好到懷疑人生(如果當年我知道可以這樣做...)。考量皮膚科沒有出這種教科書,因此煜彬決定自己來纂寫這些章節。</span></div>
<h2>
<span lang="EN-US"><span style="font-size: x-large;">Chapter 29 :: Pityriasis Rubra Pilaris(PRP) </span></span></h2>
<div class="MsoNormal">
<span style="font-size: large;">:: Knut Schäkel</span></div>
<div class="MsoNormal">
<span style="font-size: large;"><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">鄭煜彬</span> <span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">整理</span> <span lang="EN-US">20191209</span></span></div>
<table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: none; mso-border-alt: solid windowtext .5pt; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt; mso-yfti-tbllook: 1184;">
<tbody>
<tr style="mso-yfti-firstrow: yes; mso-yfti-irow: 0;">
<td style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">EPIDEMIOLOGY<o:p></o:p></span></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 1;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">How much is the male-to-female ratio of PRP?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">M=F<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 2;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">CLINICAL FEATURES<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 3;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">Which 2 features helps to classify PRP?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoListParagraph" style="margin-left: 18.0pt; mso-list: l6 level1 lfo2; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Age of onset (adult or
juvenile) <o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 18.0pt; mso-list: l6 level1 lfo2; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Course/prognosis (classic or
atypical). <o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 4;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the six types of PRP? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoListParagraph" style="margin-left: 18.0pt; mso-list: l1 level1 lfo1; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Classic adult (I)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 18.0pt; mso-list: l1 level1 lfo1; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Atypical adult (II)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 18.0pt; mso-list: l1 level1 lfo1; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Classic juvenile (III)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 18.0pt; mso-list: l1 level1 lfo1; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Circumscribed juvenile (IV)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 18.0pt; mso-list: l1 level1 lfo1; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Atypical juvenile, CARD 14
mutation (V)<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">HIV-associated (VI)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 5;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the first 3 common types of PRP
& the ranking ?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoListParagraph" style="margin-left: 18.0pt; mso-list: l7 level1 lfo3; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Classic adult (>50%)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 18.0pt; mso-list: l7 level1 lfo3; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span lang="EN-US">Circumscribed juvenile</span></b><span lang="EN-US"> (25%)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 18.0pt; mso-list: l1 level1 lfo1; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Classic juvenile (10%)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 6;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">Why PRP is difficult to diagnose in the
beginning?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoListParagraph" style="margin-left: 18.0pt; mso-list: l7 level1 lfo3; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">It looks like scaly
dermatitis (well-defined, yellow-orange). (However, it may spread to
erythroderma in 2-3 months)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 7;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the 2 common features of PRP?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoListParagraph" style="margin-left: 18.0pt; mso-list: l9 level1 lfo11; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Salmon-colored scaly plaques<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 18.0pt; mso-list: l9 level1 lfo11; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Follicular hyperkeratosis<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 8;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the 3 morphological features of
Type I PRP? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoListParagraph" style="margin-left: 18.0pt; mso-list: l3 level1 lfo4; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Erythroderma with nappes
claires<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 18.0pt; mso-list: l3 level1 lfo4; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Follicular hyperkeratosis<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 18.0pt; mso-list: l3 level1 lfo4; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Waxy diffuse palmoplantar
keratosis<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 9;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the 3 morphological features of
Type II PRP?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoListParagraph" style="margin-left: 18.0pt; mso-list: l5 level1 lfo5; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Follicular hyperkeratosis<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 18.0pt; mso-list: l5 level1 lfo5; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Sparse scalp hair<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 18.0pt; mso-list: l3 level1 lfo4; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span lang="EN-US">Ichthyosiform lesions on legs</span></b><span lang="EN-US"><o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 10;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the 3 morphological features of
Type III PRP?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoListParagraph" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Erythroderma with nappes
claires<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Follicular hyperkeratosis<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Waxy diffuse palmoplantar
keratosis<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 18.0pt; mso-para-margin-left: 0gd;">
<span lang="EN-US">(as Type I PRP, but earlier onset)<b style="mso-bidi-font-weight: normal;"><o:p></o:p></b></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 11;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the morphological features of
Type IV PRP?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Well-demarcated scaly, erythematous
plaques at elbow & knee (as psoriasis)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 12;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the 3 morphological features of
Type V PRP?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoListParagraph" style="margin-left: 18.0pt; mso-list: l8 level1 lfo7; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Familial cases<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 18.0pt; mso-list: l8 level1 lfo7; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Follicular hyperkeratosis<o:p></o:p></span></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US">Scleroderma-like
palms & soles</span></b><span lang="EN-US"><o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 13;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the 3 associated features of
Type VI PRP?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoListParagraph" style="margin-left: 18.0pt; mso-list: l10 level1 lfo8; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Acne conglobate<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 18.0pt; mso-list: l10 level1 lfo8; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Hidradenitis suppurativa<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 18.0pt; mso-list: l10 level1 lfo8; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">Lichen spinulosus<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 18.0pt; mso-list: l8 level1 lfo7; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<!--[if !supportLists]--><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><!--[endif]--><span lang="EN-US">(as Type I PRP, but HIV+)<b style="mso-bidi-font-weight: normal;"><o:p></o:p></b></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 14;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the age of onset of Type I-VI
PRP? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">I-II: adulthood<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">III-V: children & adolescents<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">VI: all ages.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 15;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the distribution of Type I-VI
PRP?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">IV: localized<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">Others: generalized, head/neck</span><span style="font-family: "新細明體",serif;">→</span><span lang="EN-US">caudal<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 16;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is course of Type I-V PRP?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">I & III: classic, short, < 3 year,
usually 1-2 years. <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">II & V: atypical, long, > 20
years. <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">IV: uncertain, may resolve in teens. <o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 17;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">ETIOLOGY<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 18;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the most possible etiology of
sporadic PRP? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Infections, such as upper respiratory
tract infections<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 19;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the only 2 confirmed etiologies
of PRP up to now?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoListParagraph" style="margin-left: 18.0pt; mso-list: l4 level1 lfo9; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">CARD 14(Caspase Recruitment
Domain family member 14), gain of function mutation (in familial cases/type V)<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 18.0pt; mso-list: l4 level1 lfo9; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span lang="EN-US">HIV infection(type VI)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 20;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the mechanism of CARD 14 mutation
in PRP type V? <span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">CARD 14 mutation</span><span style="font-family: "新細明體",serif;">→</span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">↑</span><span lang="EN-US">CARD 14</span><span style="font-family: "新細明體",serif;">→</span><span lang="EN-US">activate NF-κB
signaling</span><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">→</span><span lang="EN-US">activate p65<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 21;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the changes of cytokines in PRP
lesions? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoListParagraph" style="margin-left: 18.0pt; mso-list: l2 level1 lfo10; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">↑</span><span lang="EN-US">proinflammatory innate
cytokines: TNF, IL-6, 12, 23, & IL-1β<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 18.0pt; mso-list: l2 level1 lfo10; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">↑</span><span lang="EN-US"> TH1 cytokines<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 18.0pt; mso-list: l2 level1 lfo10; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "新細明體",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">↑</span><span lang="EN-US"> TH17 cytokines(IL-17A/F,
& 22)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 22;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">DIFFERENTIAL DIAGNOSIS <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 23;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the major differential<span style="mso-spacerun: yes;"> </span>diagnosis of PRP?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Psoriasis<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 24;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the clinical difference between
psoriasis & PRP? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Psoriasis: extensor, Koebner sign,
plaques with white scales (candle sign), Auspitz sign <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">PRP: head, salmon-color, islands of
healthy skin, follicular hyperkeratosis, waxy PPK<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 25;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the difference between the nail
of psoriasis and PRP? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal" style="tab-stops: 133.0pt;">
<span lang="EN-US">Psoriasis:
salmon patch, oil spot, pitting, subungual hyperkeratosis, onycholysis… <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">PRP: only hypertrophic nail plate<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 26;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the histologic difference between
psoriasis and PRP<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal" style="tab-stops: 133.0pt;">
<span lang="EN-US">Psoriasis: hypogranulosis,
elongated rete ridges, vascular dilation, intraepidermal Munro
microabscesses.<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">PRP: alternating horizontal/vertical
para-/ortho-keratosis, hypergranulosis, thickening rete <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">ridges, follicular hyperkeratosis <o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 27;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">TREATMENTS<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal" style="tab-stops: 133.0pt;">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 28;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the effective first-line treatments
of PRP?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal" style="tab-stops: 133.0pt;">
<span lang="EN-US">Topical: emollients,
keratolytic(salicylic acid), vit. D3 analogs(calcipotriol)<o:p></o:p></span></div>
<div class="MsoNormal" style="tab-stops: 133.0pt;">
<span lang="EN-US">Systemic:
retinoids, methotrexate, anti-retroviral tx. <o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 29;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What are the effective second-line treatments
of PRP?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal" style="tab-stops: 133.0pt;">
<span lang="EN-US">Topical: corticosteroids,
calcineurin inhibitors, tazarotene<o:p></o:p></span></div>
<div class="MsoNormal" style="tab-stops: 133.0pt;">
<span lang="EN-US">Systemic:
fumaric acid esters, apremilast, TNF inhibitors, anti-IL-12/IL-23p40,
anti-IL-17, azathioprine, cyclosporine<o:p></o:p></span></div>
<div class="MsoNormal" style="tab-stops: 133.0pt;">
<span lang="EN-US">Phototherapy:
PUVA, Re-PUVA, UVA1, NBUVB, BBUVB, Extracorporeal photopheresis<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 30;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">Which disease has treatments similar to
PRP?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal" style="tab-stops: 133.0pt;">
<span lang="EN-US">Psoriasis(almost
the same)<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 31;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the restriction of the use of
vit. D3 analogs?<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">No more than 30% BSA.<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 32;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the dose of oral methotrexate for
PRP? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">10-25mg/week<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 33;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the choice & dose of oral
retinoids ? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Acitretin(0.5-0.75mg/kg/day),
isotretinoin(1-2mg/kg/day), alitretinoin.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="mso-yfti-irow: 34;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the side effects of retinoids for
the prepubertal? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Premature closure of epiphyses &
hyperostosis<o:p></o:p></span></div>
</td>
</tr>
<tr style="mso-yfti-irow: 35;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What should you do before the
phototherapy?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">Phototesting, because phototherapy may
aggravate PRP. <o:p></o:p></span></div>
</td>
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<tr style="mso-yfti-irow: 36;">
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
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<span lang="EN-US">Which type of PRP does not response to
ustekinumab? <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
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<span lang="EN-US">Type IV PRP<o:p></o:p></span></div>
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<tr style="height: 24.55pt; mso-yfti-irow: 37; mso-yfti-lastrow: yes;">
<td style="border-top: none; border: solid windowtext 1.0pt; height: 24.55pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.7pt;" valign="top" width="311">
<div class="MsoNormal">
<span lang="EN-US">What is the most effective treatment of
type VI PRP?<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; height: 24.55pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 259.1pt;" valign="top" width="518">
<div class="MsoNormal">
<span lang="EN-US">triple antiretroviral therapy<o:p></o:p></span></div>
</td>
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<br />鄭煜彬(Yu-Pin Cheng)http://www.blogger.com/profile/07019803125903571476noreply@blogger.com0tag:blogger.com,1999:blog-5384877319969585099.post-54641140660386221982020-01-01T07:30:00.000-08:002020-01-04T20:55:21.899-08:00靜脈曲張的低侵入性根治方法:血管硬化劑注射<h2 style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="font-size: x-large;"><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">靜脈曲張不但不美觀,也可能造成一些皮膚</span><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">或全身的疾病</span><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">。</span><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">依據靜脈尺寸可以選擇</span><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">注射</span><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">血管硬化劑</span><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">、</span><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">血管內雷射</span><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">、</span><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">血管內射頻</span><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">、</span><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">血管黏膠</span><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">、</span><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">傳統手術剝除</span><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">等方式來</span><span style="font-family: Arial; white-space: pre-wrap;">治療靜脈曲張</span><span style="font-family: Arial; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">。血管硬化劑治療(sclerotherapy)算是這些治療中</span><span style="font-family: Arial; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">侵入性相對低</span><span style="font-family: Arial; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">,效果佳</span><span style="font-family: Arial; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">,價格也相對低廉的作法,對於一些較細小但分布廣泛的蛛網狀血管(spider veins)尤其有效。</span></span></h2>
<h2 style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="font-size: x-large;"><span style="font-family: Arial; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">文、圖 鄭煜彬醫師/曾奕騰醫師</span></span></h2>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjHojHGRaF3-xz0tw1Ra5HPdm4cJE3yiVB_5dE2HlrQ0CGAH0uEFvuHKu5yqTIxrRU3i82_1fMGSKx4Ji4an7S1nu4kEFQS5c1-TebNjRmKlvRJSwfpDQS2Kx7GM56bXlyL7dLeXl1Tb0dv/s1600/P169+%252811%2529.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="540" data-original-width="960" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjHojHGRaF3-xz0tw1Ra5HPdm4cJE3yiVB_5dE2HlrQ0CGAH0uEFvuHKu5yqTIxrRU3i82_1fMGSKx4Ji4an7S1nu4kEFQS5c1-TebNjRmKlvRJSwfpDQS2Kx7GM56bXlyL7dLeXl1Tb0dv/s640/P169+%252811%2529.jpg" width="640" /></a></div>
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<h2 style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span style="font-size: x-large;">靜脈曲張有什麼健康上的問題?</span></span></h2>
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<span style="font-size: large;"><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">靜脈曲張的台灣閩南語稱為「浮腳筋」,是大家相當熟悉卻也很無奈的疾病。這些藍綠色的條狀突出是膨大的表淺靜脈往往會出現在下肢,在</span><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><b>女性</b></span><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">、</span><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><b>懷孕</b></span><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">、</span><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><b>肥胖</b></span><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">的人身上尤其常見。除了不美觀</span></span><span style="font-family: Arial; font-size: large; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">,也可能造成</span><span style="font-family: Arial; font-size: large; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"><b>鬱血性皮膚炎</b>(stasis dermatiti</span><span style="font-size: large;"><span style="font-family: Arial; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">s)、</span><span style="font-family: Arial; white-space: pre-wrap;"><b>色素沉澱</b>、<b>靜脈性潰瘍</b></span><span style="font-family: Arial; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">、<b>脂肪皮膚硬化症</b>(lipodermatosclerosis)</span></span><span style="font-family: Arial; font-size: large; white-space: pre-wrap;">(圖1)</span><span style="font-size: large;"><span style="font-family: Arial; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">、或</span></span><span style="font-family: Arial; font-size: large; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">其他周邊動脈疾病(peripheral artery disease)等等,</span><span style="font-family: Arial; font-size: large; white-space: pre-wrap;">2018年時的研究更顯示靜脈曲張病患相較正常人有較高風險發生<b>深部靜脈栓塞</b>(deep vein thrombosis)</span><span style="font-family: Arial; font-size: large; white-space: pre-wrap;">。(1)</span></div>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgpd-Vlb7WO0GlbfgQGdGVplEUPpYeTRbe-NxprHjlEADb9LjERyodsd5Ps_1KttsSAaFCzi8BptDkX8568VB-AzFmKghFPGa-EZSKZhV7i4miAxPH3S7qY18lnIsONo_JfK4H-SGTmKU98/s1600/P169+%252812%2529.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="540" data-original-width="960" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgpd-Vlb7WO0GlbfgQGdGVplEUPpYeTRbe-NxprHjlEADb9LjERyodsd5Ps_1KttsSAaFCzi8BptDkX8568VB-AzFmKghFPGa-EZSKZhV7i4miAxPH3S7qY18lnIsONo_JfK4H-SGTmKU98/s640/P169+%252812%2529.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: left;"><h3>
<span style="font-size: large;">圖1:嚴重靜脈曲張造成的脂肪皮膚硬化症、靜脈性潰瘍、與鬱血性皮膚炎。臨床上都是相當棘手的問題。</span></h3>
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<b style="font-weight: normal;"><span style="font-size: large;"><br /></span></b>
<h2>
<span style="font-family: Arial; white-space: pre-wrap;"><span style="font-size: x-large;">靜脈曲張的治療</span></span></h2>
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<span style="font-size: large;"><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">靜脈曲張可以藉由</span><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><b>注射血管硬化劑</b></span><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">、</span><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><b>血管內雷射</b></span><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">、</span><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><b>血管內射頻</b></span><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">、</span><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><b>血管黏膠</b></span><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">、</span><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><b>傳統手術剝除</b></span><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">等方式來去除。其中血管硬化劑最早被使用,對於從細到粗的血管均有療效、是治療細小的蛛網狀血管(spider veins)目前最有效的方法。對其他較粗的靜脈曲張也有效。然而</span><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><b>不一定單次就能完全解決</b></span><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">,除了可以再注射一次血管硬化劑,也可以考慮搭配血管內雷射、血管內射頻、血管黏膠等更直接破壞血管內壁的作法。</span></span></div>
<b style="font-weight: normal;"><span style="font-size: large;"><br /></span></b>
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<span style="font-size: large;"><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">在各種治療方</span></span><span style="font-size: large;"><span style="font-family: Arial; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">式中</span><span style="font-family: Arial; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">,<b>血管硬化劑治療</b></span><span style="font-family: Arial; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"><b>是性價比相對高</b></span><span style="font-family: Arial; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"><b>的選擇</b>,而且</span></span><span style="font-family: Arial; white-space: pre-wrap;"><span style="font-size: large;">侵入性相對低。</span></span><span style="font-family: Arial; font-size: large; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">因為整個過程中只須使用極細的細針來注射,就像微整形一樣,唯一的傷口只有針孔,</span><span style="font-family: Arial; font-size: large; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">通常一天內即可癒合</span><span style="font-family: Arial; font-size: large; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">。(圖2)</span></div>
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<span style="font-family: Arial; font-size: large; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"><br /></span></div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi16ZwaSiutYOxWhNmxsl3jILjw61oTIBRVcOb5hn_sttZ10oKWcXnHMDitY9L2HV3UvBs50CJLZqTFsqSyV9oBmzMLdNfxZR5APR-nwD_Roo91WF-FKdLF4a9uImFFMqBfNSE-owgqAS5G/s1600/P169+%252813%2529.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="540" data-original-width="960" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi16ZwaSiutYOxWhNmxsl3jILjw61oTIBRVcOb5hn_sttZ10oKWcXnHMDitY9L2HV3UvBs50CJLZqTFsqSyV9oBmzMLdNfxZR5APR-nwD_Roo91WF-FKdLF4a9uImFFMqBfNSE-owgqAS5G/s640/P169+%252813%2529.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: left;"><h3>
<span style="font-size: large;">圖2:血管硬化劑的注射不需要複雜昂貴的器材,只需要細心有經驗的皮膚科醫師。</span></h3>
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<b style="font-weight: normal;"><span style="font-size: large;"><br /></span></b><br />
<h2 style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span style="font-size: x-large;">進行血管硬化劑注射治療的流程</span></span></h2>
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<span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span style="font-size: x-large;"><br /></span></span></div>
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<span style="font-size: large;"><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">血管硬化劑的治療其實相當簡單,基本上就是</span><b><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">把藥劑配好</span><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">(依據靜脈尺寸調配適當濃度)</span><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">,</span><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">再將調配好的</span><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">硬化劑打進膨大的靜脈就可以了</span></b><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">。</span><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">一般藥劑的調配除了使用生理食鹽水</span><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">稀釋</span><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">,也可以使用「空氣」</span><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">與硬化劑混合製作成泡沫劑型</span><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">,因為空氣與藥劑反覆抽吸混合之後的微小泡沫</span><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">可將欲治療靜脈中原有血液機械性取代,減少液體硬化劑被血液稀釋,並增加硬化劑與血管內皮接觸表面積。</span><b><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">這些小泡泡如果被沖到稍遠處大血管中,就會溶解到血液中而消失,</span><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">臨床治療安全性高</span><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">,還可以延長血管硬化劑停留在腿部靜脈的效果</span></b><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">。(2)</span></span></div>
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<span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span style="font-size: x-large;">血管硬化劑治療之後要注意什麼?</span></span></h2>
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<span style="font-size: large;"><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">注射完血管硬化劑之後會建議病人穿著彈性襪</span><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><b>至少三天</b></span><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">(一般建議一至二星期)</span><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">,如果不習慣的人,至少可用彈性繃帶(彈繃)纏繞。雖然研究認為</span><b><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">穿著七天效果</span><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">比三天</span><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">更好</span></b><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">,但如果病人執行上有困難也不須勉強,三天就有不錯的效果了。(2)</span></span></div>
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<span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span style="font-size: large;">剛打完的時候,很多人會在注射處出現類似<b>蕁麻疹</b>的反應,但不會有明顯不適。這些變化不到一天就會快速消退。(圖3)</span></span></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiKcViQ0aBadcYGTTpAZqTLeFZBC3WFL2pfJ4WbzNI8C2UXfeMrGCAqpouQrAWUwUbx0rkFAQXAcD0jMgdAUV9W9MzeHxYEQxZEwmcBAvaC2_O9oTA4aiOC4gG5IBLSMjXkNCsFYMrDE2UB/s1600/P169+%25287%2529.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="540" data-original-width="960" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiKcViQ0aBadcYGTTpAZqTLeFZBC3WFL2pfJ4WbzNI8C2UXfeMrGCAqpouQrAWUwUbx0rkFAQXAcD0jMgdAUV9W9MzeHxYEQxZEwmcBAvaC2_O9oTA4aiOC4gG5IBLSMjXkNCsFYMrDE2UB/s640/P169+%25287%2529.jpg" width="640" /></a></td></tr>
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<span style="font-size: large;">圖3:中間是剛打完硬化劑的照片,可看到細微針孔與蕁麻疹,但病人並沒有明顯癢感或痛感,此時可看到靜脈曲張已經改善。大約一個月後追蹤時,只剩下少許瘀青與色素沉澱。</span></h3>
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<span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span style="font-size: large;"><br />大部分靜脈注射後藍綠色會消失(圖3),雖然部分的血管會有點血液回流,但硬化劑接觸過的血管之後還是會收縮、發炎、纖維化阻塞而逐漸被吸收。</span></span></div>
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<span style="font-size: large;"><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">大約一周後回診會看到有些地方有小片瘀血,大部分都是剛注射完小出血的結果,雖然注射後立刻穿著彈性襪或彈繃可以大幅降低其程度,但還是很難完全避免(進廚房一定會流汗...)。這時候</span><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">可考慮</span><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">塗抹一些外用的肝素(heparin)藥膏,</span><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">可加速</span><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">瘀血就消退</span><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">,亦可減少暫時性注射後後色素沉澱產生之機會。</span></span></div>
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<span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span style="font-size: large;">血管硬化劑在正常操作的情況極少出現嚴重副作用。目前比較嚴重的副作用包括皮膚潰瘍與壞死。<b><span style="color: red;">然而這種狀況在臨床實務上極少見到</span></b>,一般除非醫師在同一位置注射大量硬化劑而且又剛好沒打進血管才有可能出現。以一般皮膚科醫師謹慎、細心、輕手輕腳的手法,實在很難產生這些問題。至少<b><span style="color: red;">以兩位筆者操作血管硬化劑五年多的過程中,從未出現過任何潰瘍以上的嚴重副作用。</span></b></span></span></div>
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<span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span style="font-size: x-large;">血管硬化劑的治療效果</span></span></h2>
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<span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span style="font-size: large;">病人注射血管硬化劑經過一兩個月後,大部分有治療的血管不會再有血液流過,就看不到原本呈現藍綠色的血管了。(圖4)至於硬化的血管會逐漸被吸收。這種治療對於</span></span><span style="font-family: Arial; font-size: large; white-space: pre-wrap;">分布廣泛的細小蛛網狀血管(spider veins)也相當有效。(圖5、6)</span></div>
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<tr><td class="tr-caption" style="text-align: left;"><span style="font-size: large;"><b>圖4:病人小腿內側大量的靜脈曲張在術後一個月已經悉數消退,只剩少許色素沉澱能標示出原本靜脈的位置。</b></span></td></tr>
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<span style="font-size: large;">圖5:病人內側腳踝的蛛網狀血管打過兩次染料雷射(血管性雷射)均無效,經過單次血管硬化劑注射就有明顯改善。</span></h3>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEidPoZus7Fure6E-adGoDevCU6dAZwmES_jb3Yua4xoe_hr0ZtLo7Kprneufn5oWIu8dWSbhgI0aZwgkoeiLTTuRX8eVs1DSooe-RXRZgOClaTVcdgx5ug7aZEnGdqQUJ7EAVGnkQ9WRx26/s1600/P169+%25285%2529.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="540" data-original-width="960" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEidPoZus7Fure6E-adGoDevCU6dAZwmES_jb3Yua4xoe_hr0ZtLo7Kprneufn5oWIu8dWSbhgI0aZwgkoeiLTTuRX8eVs1DSooe-RXRZgOClaTVcdgx5ug7aZEnGdqQUJ7EAVGnkQ9WRx26/s640/P169+%25285%2529.jpg" width="640" /></a></td></tr>
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<span style="font-size: large;">圖6:同一位病人的左腳踝內側的大量紅色蛛網狀血管經單次注射後明顯消失,只剩下部分較深層的靜脈殘留。</span></h3>
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<span style="font-size: large;"><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br />有些病人原本的血管已經消失,但由於下肢的血管網很廣泛,除非把所有表淺靜脈的源頭</span><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">(大隱靜脈、小隱靜脈等大型主幹)</span><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">都完全根除,不然難免會有些地方會出現「改道」的效應。如同原本的幹道封閉之後,車流會找到另一條出路,就換那條路交通流量大增。但因為前次治療之後血管網的規模已經減少,再追加後續治療,往往就可以</span><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">除去大部分</span><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">「改道」的血管,未來也不至於出現明顯的「改道」,</span><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><b>唯治療前如已發現大隱靜脈、小隱靜脈等大型主幹亦有回流或曲張之情形,應優先治療大型主幹,減少分支靜脈曲張復發之機會。</b></span></span></div>
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<span style="font-size: large;"><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">由於血管硬化劑的出現,靜脈曲張的治療漸漸變得不那麼複雜,花費上也比較親民,</span><span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">有相關症狀的病患把握機會都應積極尋求治療,還給雙腿平坦白淨的外表。</span></span></div>
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<span style="background-color: transparent; font-family: Arial; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span style="font-size: large;"><b>參考資料</b></span></span></h2>
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<span style="background-color: transparent; font-family: Arial; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">(1) </span><a href="https://www.ncbi.nlm.nih.gov/pubmed/29486040#" style="text-decoration: none;"><span style="background-color: transparent; font-family: Arial; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">JAMA.</span></a><span style="background-color: transparent; font-family: Arial; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> 2018 Feb 27;319(8):807-817. doi: 10.1001/jama.2018.0246. </span><span style="font-family: Arial; font-size: 11pt; white-space: pre-wrap;">Association of Varicose Veins With Incident Venous Thromboembolism and Peripheral Artery Disease.</span></div>
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<span style="background-color: transparent; font-family: Arial; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">(2)Fitzpatrick’s Dermatology, edition 9th, page 3869-3893. </span></div>
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鄭煜彬(Yu-Pin Cheng)http://www.blogger.com/profile/07019803125903571476noreply@blogger.com0tag:blogger.com,1999:blog-5384877319969585099.post-6379177718541102902019-10-14T22:43:00.002-07:002019-10-15T16:47:13.593-07:00嚴重捲甲的二階段矯治<span style="font-size: x-large;"><b>嚴重捲甲可進行二階段矯正,之後可以用維持型的矯正器來保持成果。</b></span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjHKUewSREf7rqJCDaPVoQTlj2G1I028kQs2MDO8T-l_fcCE1loOpoR6wOQIvANYTgpzxx8zHVBR0HIzv0bNJM9dTVV36kqArUhyanP4PPtKp4yYENg5q1D-gMx28KjLeXmEOTU5JKQkxex/s1600/P169+%25289%2529.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="540" data-original-width="960" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjHKUewSREf7rqJCDaPVoQTlj2G1I028kQs2MDO8T-l_fcCE1loOpoR6wOQIvANYTgpzxx8zHVBR0HIzv0bNJM9dTVV36kqArUhyanP4PPtKp4yYENg5q1D-gMx28KjLeXmEOTU5JKQkxex/s640/P169+%25289%2529.jpg" width="640" /></a></div>
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<span style="font-size: large;">捲甲有程度上的差別。大部分的捲甲只要一階段矯正就可恢復到接近正常形狀,但有些形狀太誇張的就需要兩階段矯正。</span><br />
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<span style="font-size: large;">鄒小姐是筆者遇過捲甲最嚴重的患者之一。她的腳趾甲內側捲曲到幾乎快把甲床的肉夾斷了。</span><br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjPAAI4BvssnFuqjyILMKHsZdZMPiZDbjcelwqmuLtFdxRyRzg0lGxuqAnThpeel2H7dJk2QIyUgexpIBt7E77iSCtXmR2Cc2L_m9GhUXiaSMgFnLpwRfd6w3SACrHiB1yYfJDUctq3iXaP/s1600/P169+%25283%2529.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="540" data-original-width="960" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjPAAI4BvssnFuqjyILMKHsZdZMPiZDbjcelwqmuLtFdxRyRzg0lGxuqAnThpeel2H7dJk2QIyUgexpIBt7E77iSCtXmR2Cc2L_m9GhUXiaSMgFnLpwRfd6w3SACrHiB1yYfJDUctq3iXaP/s640/P169+%25283%2529.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: left;"><span style="font-size: large;">圖1:極嚴重的捲甲,一側的甲板緊緊插進甲床。</span></td></tr>
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<span style="font-size: large;">由於實在太痛,她決定接受趾甲矯正器的治療,但一開始</span><span style="font-size: large;">就遭到很大的困難,因為甲板緊緊插進甲床(圖1箭頭處),COMBIPed的勾子根本勾不到趾甲的邊緣。</span><br />
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<span style="font-size: large;">不過問題終究要解決,根據過去經驗,筆者為鄒小姐提出了兩個方案:</span><br />
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<span style="font-size: large;">1. 先</span><span style="font-size: large;">手術</span><span style="font-size: large;">拔除部分捲入的趾甲,之後再安裝矯正器(圖2)。</span><br />
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<span style="font-size: large;">2. 先以無勾的Podofix</span><span style="font-size: large;">稍微</span><span style="font-size: large;">拉開甲板邊緣,之後再進行COMBIPed的安裝。</span><br />
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhawDCdL1mM6Ms-ZFJ5vx5IpeEsQN5PdFfpxoqNaOojOP7LtofI6ArR9Me8sGZb6R2fuC8UXfxejIWedWL3j9bxabw8XElU7FKRLqUUU98GhKQb3kNgo5EnxbbUYMGfGcAC7zZUAwW9eN2a/s1600/P169+%25284%2529.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="540" data-original-width="960" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhawDCdL1mM6Ms-ZFJ5vx5IpeEsQN5PdFfpxoqNaOojOP7LtofI6ArR9Me8sGZb6R2fuC8UXfxejIWedWL3j9bxabw8XElU7FKRLqUUU98GhKQb3kNgo5EnxbbUYMGfGcAC7zZUAwW9eN2a/s640/P169+%25284%2529.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: left;"><span style="font-size: large;">圖2:傳統移除部分甲板的手術,勢必需要麻醉才可進行。</span></td></tr>
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<span style="font-size: large;">後來</span><span style="font-size: large;">鄒小姐</span><span style="font-size: large;">覺得既然一開始就決定使用不須見血的趾甲矯正器,還是先別動刀好了。因此接受了筆者的第二個提議。</span><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj7FuutaySszShlChW6mvobhWijy6t5BRFjgs_aZOa7yuhuegNM6i2zQt87slptWrWKtpYFm-twLpHnwzPXckQaGU3Bw6tycbFbCqFJBr9TprCJHVShFamkN3B-mo6tSbpR78Kz6dugD47E/s1600/P169+%25285%2529.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="540" data-original-width="960" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj7FuutaySszShlChW6mvobhWijy6t5BRFjgs_aZOa7yuhuegNM6i2zQt87slptWrWKtpYFm-twLpHnwzPXckQaGU3Bw6tycbFbCqFJBr9TprCJHVShFamkN3B-mo6tSbpR78Kz6dugD47E/s640/P169+%25285%2529.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: left;"><span style="font-size: large;">圖3:第一期Podofix矯正之後,雖然捲曲依然嚴重,但箭頭處已經不會緊緊插入甲床,提供了COMBIPed矯正的空間。</span></td></tr>
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<span style="font-size: large;">第一期Podofix矯正完成之後,捲曲的情況依然嚴重,但原本緊緊掐住甲床的甲板已被撐開一點,意味著COMBIPed已經可以見縫插針,勾住趾甲的邊緣(圖3)。雖然距離正常的趾甲還有很長的距離,但疼痛感已經明顯減少。鄒小姐相當滿意,決定一不作二不休,進行第二階段COMBIPed的矯正。</span><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiorZuw9qyOf6ySzxY97uEO49ptzugJJNJn5JyZdTf7sdaMS-JkSEfgY2YnL0vAbbovLKBAsPMYULiBvbvKQnXQIGC8VKP313aiNaIrEvm6I3OE5VTFseT36J3KDgDyNnKBjiKB7rPts01E/s1600/P169+%25286%2529.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="540" data-original-width="960" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiorZuw9qyOf6ySzxY97uEO49ptzugJJNJn5JyZdTf7sdaMS-JkSEfgY2YnL0vAbbovLKBAsPMYULiBvbvKQnXQIGC8VKP313aiNaIrEvm6I3OE5VTFseT36J3KDgDyNnKBjiKB7rPts01E/s640/P169+%25286%2529.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: left;"><span style="font-size: large;">圖4:第二階段COMBIPeded安裝之後,可看出甲板已被撐開而變寬。</span></td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgnUJLqmWEwK0IOUHoZEiinQDKHph9k2p4NLiB3ep9UTlQMHwp9P2Hl3UARJMCtmlTga-4K-qUV8ewHX_u9msQpu5l08KmTaH4kL4f_f60OdN2JT4hi1v1_UupUjG4cC4DHGMbCS9wJmRJI/s1600/P169+%25287%2529.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="540" data-original-width="960" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgnUJLqmWEwK0IOUHoZEiinQDKHph9k2p4NLiB3ep9UTlQMHwp9P2Hl3UARJMCtmlTga-4K-qUV8ewHX_u9msQpu5l08KmTaH4kL4f_f60OdN2JT4hi1v1_UupUjG4cC4DHGMbCS9wJmRJI/s640/P169+%25287%2529.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: left;"><span style="font-size: large;">圖5:安裝COMBIPeded約兩個月後,可看出矯正器後方的趾甲都已經變為正常形狀,原本變形增厚的甲板也漸漸變薄。</span></td></tr>
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<span style="font-size: large;">第二期COMBIPed的矯正結果無疑地相當成功,當天固定住COMBIPed後,趾甲已經被明顯撐開(圖4)。第二次鄒小姐來到門診時,右腳大腳趾的的趾甲已經變成正常的拱形了(圖5)。</span><br />
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<span style="font-size: large;">由此可知,對於這種相當誇張的嵌甲,可以藉由不帶勾的Podofix先打頭陣,讓甲板邊緣稍微翻出之後,再裝上帶勾的COMBIPed,還是可以在完全不出血的前提下完成趾甲矯正。</span><br />
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<span style="font-size: large;">鄒小姐的趾甲變回正常形狀後,接下來就可以用維持型的矯正器保持戰果,就不怕趾甲再把甲床夾住了。</span><br />
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<b>參考資料</b><br />
1. <a href="https://shelltaiwan.blogspot.com/2019/04/podofix.html">指甲矯正器普得適(podofix)簡介:兵不血刃解決捲甲的好方法</a><br />
2. <a href="https://shelltaiwan.bloghttps//shelltaiwan.blogspot.com/2019/04/combiped.htmlspot.com/2019/04/podofix.html">指甲矯正器康必沛得(COMBIped)簡介:迅速緩解嚴重捲甲或嵌甲/凍甲的好方法</a><br />
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<br />鄭煜彬(Yu-Pin Cheng)http://www.blogger.com/profile/07019803125903571476noreply@blogger.com0