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92
§
«“¡º‘¥ª°µ‘¢Õߺ‘«Àπ—ß„π µ√’¡’§√√¿å
(Dermatoses of Pregnancy)
·æ∑¬åÀ≠‘ßæ—™π’ ‚µ∑—∫‡∑’ˬß
∂“∫—π‚√§º‘«Àπ—ß
■ªí≠À“§«“¡º‘¥ª°µ‘¢Õߺ‘«Àπ—ß„π µ√’¡’§√√¿å æ∫‰¥â
1. ¿“«–º‘«Àπ—ß∑’‡Ë ª≈’¬Ë π·ª≈ß„π¢≥–µ—ßÈ §√√¿å
∫àÕ¬∑—ßÈ ∑’‡Ë ªìπ°“√‡ª≈’¬Ë π·ª≈ߢÕß√à“ß°“¬∑’æË ∫‰¥âª°µ‘ (normal (physiologic skin changes in pregnancy)(µ“√“ß
physiologic†changes) À√◊Õ®“°¿“«–º‘¥ª°µ‘†(disease) ∑’ˆ1)
°. °“√‡ª≈’¬Ë π·ª≈ß ’º«‘ Àπ—ß (pigmentary changes)
∑—Èßπ’ȇπ◊ËÕß®“°™à«ßµ—Èߧ√√¿å¡’°“√‡ª≈’ˬπ·ª≈ß∑“ß √’√«‘∑¬“
(1) °“√¡’º‘« ’‡¢â¡°«à“ª°µ‘ (hyperpigmenta¢Õß√–∫∫µà“ß Ê ‡™àπ √–∫∫¿Ÿ¡‘§ÿâ¡°—π ŒÕ√å‚¡π À≈Õ¥‡≈◊Õ¥
·≈–°“√‡º“º≈“≠æ≈—ßß“π¢Õß√à“ß°“¬
tion) ‡°‘¥®“°°“√‡æ‘¡Ë ¢÷πÈ ¢ÕߌÕ√å‚¡π∑’°Ë √–µÿπâ ‡¡≈“π‘π (serum
melanin stimulating hormone) ŒÕ√å‚¡π‡Õ ‚µ√‡®π (estro■ °“√®”·π°§«“¡º‘¥ª°µ‘¢Õߺ‘«Àπ—ß„π µ√’¡’ gen) ·≈–ŒÕ√å‚¡π‚ª√‡® ‡µÕ‚√π (progesterone) æ∫‰¥â
§√√¿å
ª√–¡“≥√âÕ¬≈– 90 ¢Õß µ√’µ—Èߧ√√¿å ‚¥¬æ∫≈—°…≥–º‘«
°“√®”·π°§«“¡º‘¥ª°µ‘¢Õߺ‘«Àπ—ß„π µ√’¡§’ √√¿å ·∫àß Àπ—ß∫√‘‡«≥≈“ππ¡ (areolae) Õ«—¬«–‡æ» (genital skin) ¥”
ÕÕ°‡ªìπ 3 ª√–‡¿∑
§≈È”¢÷Èπ ·≈–‡ âπ¢“«°≈“ßÀπâ“∑âÕß (linea alba) °Á°≈“¬‡ªìπ
1. ¿“«–º‘«Àπ—ß∑’‡Ë ª≈’¬Ë π·ª≈ß„π¢≥–µ—ßÈ §√√¿å (phy- ‡ âπ ’¥” (linea nigra) ·µà√Õ¬¥”®–®“ß≈ßÀ≈—ߧ≈Õ¥
siologic skin changes in pregnancy)
(2) ΩÑ“ (melasma) (¿“æ∑’Ë 8) æ∫‰¥â¡“°°«à“
2. º≈°√–∑∫®“°°“√µ—ßÈ §√√¿å∑∑Ë’ ”„À⇰‘¥§«“¡º‘¥ª°µ‘ √âÕ¬≈– 50 ¢Õß µ√’µ—Èߧ√√¿å ¡—°®–æ∫ΩÑ“¢÷Èπ∑’Ë∫√‘‡«≥ à«π
¢Õߺ‘«Àπ—ß·≈–‡π◊ÈÕßÕ° (dermatoses and cutaneous tu- °≈“ߢÕß„∫Àπâ“ (centro-facial) ‚Àπ°·°â¡ (malar) ·≈–
mors affected by pregnancy)
∫√‘‡«≥°√“¡∑—Èß Õߢâ“߆(mandibular†patterns)†·µà à«π
3. §«“¡º‘¥ª°µ‘¢Õߺ‘«Àπ—ß∑’æË ∫‡©æ“–„π µ√’¡§’ √√¿å „À≠àÕ“°“√®–¥’¢÷ÈπÀ≈—ߧ≈Õ¥ ∫“ß√“¬ΩÑ“ “¡“√∂‡°‘¥¢÷ÈπÕ’°
(dermatoses only occurring in pregnancy)
‰¥â∂â“¡’°“√„™â¬“§ÿ¡°”‡π‘¥
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µ“√“ß∑’Ë 1 Physiologic skin changes in pregnancy
Pigmantary
Hyperpigmentation
Melasma
Hair
Hirsutism
Postpartum telogen effluvium
Postpartum male-pattern alopecia
Nail
Subungual hyperkeratosis
Distal onycholysis
Transverse grooving
Brittleness
Glandular
Increased eccrine function
Increased sebaceous function
Decreased apocrine function
Connective tissue
Striae
Vascular
Spider telangiectases
Palmar erythema
Nonpitting edema
Varicosities
Vasomotor instability
Gingival hyperemia
Hemorrhoids
Mucous membrane
Gingivitis
Jacquemier-Chadwick sign
Goodellûs sign
¿“æ∑’Ë 8 Melasma of the malar cheeks and nose (¥Ÿ¿“æ ’Àπâ“
138)
·¢π ¢“ ·≈–À≈—ß Õ“°“√®–À“¬‰ª¿“¬„π 6 ‡¥◊ÕπÀ≈—ߧ≈Õ¥
(2) ¿“«–º¡√à«ß®“°§«“¡º‘¥ª°µ‘¢ÕߌÕ√å‚¡π
(male pattern alopecia) ¡—°æ∫≈—°…≥–°“√√à«ß¢Õ߇ âπº¡
∑’Ë∫√‘‡«≥‡Àπ◊Õ¢¡—∫ (frontoparietal recession) ‚¥¬À≈—ß
®“°§≈Õ¥·≈â« Õ“°“√®–À“¬‡ªìπª°µ‘ À√◊ÕÕ“®‰¡àÀ“¬°Á‰¥â
(3) Telogen effluvium (¿“æ∑’Ë 9) æ∫„π™à«ß
À≈—ߧ≈Õ¥‡°‘¥®“°¿“«– anagen phase ¢Õ߇ âπº¡„π™à«ß
µ—Èߧ√√¿å¬“«π“π°«à“ª°µ‘ Õ“°“√®–¥’¢÷ÈπÀ≈—ߧ≈Õ¥ª√–¡“≥
1-5 ‡¥◊Õπ (Õ“®π“π∂÷ß 15 ‡¥◊Õπ)
§. °“√‡ª≈’ˬπ·ª≈ߢÕ߇≈Á∫ (nails changes) æ∫
°“√‡ª≈’ˬπ·ª≈߉¥âÀ≈“¬·∫∫ ‡™àπ °“√‡°‘¥√àÕßµ“¡¢«“ß
¢Õ߇≈Á∫ (transverse grooving) à«πª≈“¬¢Õ߇≈Á∫¬° (distal
onycholysis) ‡π◊ÕÈ „µâ‡≈Á∫Àπ“µ—«¢÷πÈ (subungual hyperkeratosis)
ß. °“√‡ª≈’¬Ë π·ª≈ߢÕßµàÕ¡„µâº«‘ Àπ—ß (glandular
changes)
(1) °“√∑”ß“π¢ÕßµàÕ¡‡Àß◊ËÕ¡“°¢÷Èπ æ∫«à“ µ√’
µ—Èߧ√√¿å®–¡’¿“«–‡Àß◊ËÕ¡“°º‘¥ª°µ‘ ¡’º¥º◊Ëπ§—πÀ√◊Õº◊Ëπº‘«
Adapted from Wong RC, Ellis CN. Physiologic changes in Àπ—ßÕ—°‡ ∫‰¥â
pregnancy. J am Acad Dermatol 1984;10:929-40.
(2) °“√∑”ß“π¢ÕßµàÕ¡‰¢¡—π¡“°¢÷πÈ æ∫«à“Õ“®¡’
‘«‡ÀàÕ¢÷Èπ‰¥â„π™à«ßµ—Èߧ√√¿å ·≈–æ∫¢π“¥¢ÕßµàÕ¡‰¢¡—π
¢. °“√‡ª≈’ˬπ·ª≈ߢÕ߇ â㧭 (hair changes) ∫√‘‡«≥≈“ππ¡ (¡Õπµå‚°‡¡Õ√’ ∑Ÿ‡∫Õ√凧‘≈) ¡’¢π“¥„À≠à¢÷Èπ
(1) ¿“«–º¡À√◊Õ¢π¡“°º‘¥ª°µ‘À√◊Õ¢÷Èπº‘¥
(3) µàÕ¡Õ–‚ª§√“¬πå (apocrine gland) ∑”ß“π
µ”·Àπàß (hirsutism) ¡—°æ∫∑’Ë∫√‘‡«≥Àπâ“ ·≈–Õ“®æ∫‰¥â∑’Ë ≈¥≈ß æ∫«à“Õ“°“√¢Õß‚√§ µàÕ¡Õ–‚ª§√“¬πåÕ—°‡ ∫∑’Ë√—°·√â
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¿“æ∑’Ë 10 Extensive spider telangiectases of trunk (¥Ÿ¿“æ ’Àπâ“
138)
¿“æ∑’Ë 9 Telogen effluvium (¥Ÿ¿“æ ’Àπâ“ 138)
°“√Õ—°‡ ∫¢Õߺ‘«Àπ—ß
(1) Atopic dermatitis ºŸâªÉ«¬¡’Õ“°“√·¬à≈ß
À√◊ÕÕ“®¥’¢÷Èπ°Á‰¥â‡¡◊ËÕµ—Èߧ√√¿å
(2) ‚√§ –‡°Á¥‡ß‘π ª√–¡“≥√âÕ¬≈– 40-60 ¢Õß
µ√’µ—Èߧ√√¿å∑’ˇªìπ –‡°Á¥‡ß‘π®–¡’Õ“°“√¥’¢÷Èπ ¡’‡æ’¬ß√âÕ¬≈–
14 ∑’ÕË “°“√¢Õß‚√§·¬à≈ß ·≈–¡—°æ∫„πºŸªâ «É ¬ –‡°Á¥‡ß‘π™π‘¥
·ºàπÀπ“·≈–‡√◊ÈÕ√—ß
(3) Impetigo herpetiformis ªí®®ÿ∫—π‡™◊ËÕ«à“
‡ªìπ rare variant ¢Õß pustular psoriasis ¡—°æ∫„π™à«ß 3rd
trimester ºŸªâ «É ¬Õ“®¡’ª√‘¡“≥·§≈‡´’¬¡·≈–«‘µ“¡‘π¥’„π‡≈◊Õ¥
µË”·≈–Õ“®æ∫§à“·Õ≈∫Ÿ¡‘π„π‡≈◊Õ¥µË”‰¥â
Õ“°“√ : ¡’Õ“°“√√à«¡ ‡™àπ ‰¢â ª«¥‡¡◊ËÕ¬°≈â“¡
‡π◊ÈÕ §≈◊Ëπ‰ â Õ“‡®’¬π ÕàÕπ‡æ≈’¬
Õ“°“√· ¥ß∑“ߺ‘«Àπ—ß : æ∫°≈ÿࡵÿà¡ÀπÕß√«¡
°—πÕ¬Ÿà∫πº◊Ëπ·¥ß ‡√’¬ßµ—«Õ¬Ÿà∫π√à“ß°“¬Õ¬à“ß ¡¡“µ√ ¡—°
æ∫º◊Ëπ∑’Ë∫√‘‡«≥´Õ°æ—∫ ¢“Àπ’∫ À√◊Õ√—°·√â Õ“®æ∫°“√‡ªìπ
ÀπÕß„µâ‡≈Á∫ À√◊Õ‡≈Á∫¬°‰¥â
2. º≈°√–∑∫®“°°“√µ—Èߧ√√¿å∑’Ë∑”„À⇰‘¥§«“¡
°“√µ√«®∑“ßÀâÕߪؑ∫—µ‘°“√ : §à“ ESR Ÿß¢÷Èπ
º‘¥ª°µ‘¢Õߺ‘«Àπ—ß
√–¥—∫·§≈‡´’¬¡„π´’√—Ë¡µË” √–¥—∫«‘µ“¡‘π¥’„π´’√—Ë¡≈¥≈ß
·∫àßÕÕ°‡ªìπ 6 °≈ÿà¡‚√§¥—ßπ’È (µ“√“ß∑’Ë 2)
欓∏‘«‘∑¬“ : æ∫≈—°…≥– subcorneal pustule
°. Inflammatory disorder °≈ÿà¡‚√§∑’ˇ°‘¥®“° ‡À¡◊Õπ∑’Ëæ∫„π pustular psoriasis
·≈–‚√§øÕ°´åøÕ√姗¬´å¡—°®–¥’¢÷Èπ
®. Connective tissue changes
√Õ¬·µ°≈“¬¢Õߺ‘«Àπ—ß æ∫√âÕ¬≈– 90 ¢Õß
µ√’µ—Èߧ√√¿å ¡—°æ∫„π™à«ßµ—Èߧ√√¿å‡¥◊Õπ∑’Ë 6-7 À≈—ߧ≈Õ¥
®–°≈“¬‡ªìπ‡ âπ ’¢“«∫ÿã¡´÷Ëß¡—°‰¡àÀ“¬
©. Vascular changes æ∫°“√‡ª≈’ˬπ·ª≈ßÀ≈“¬
Õ¬à“ß
(1) Õ“°“√·¥ß∫√‘‡«≥ª“°™àÕߧ≈Õ¥ (vagina)
‡°‘¥®“°¡’‡≈◊Õ¥‰ªÀ≈àÕ‡≈’¬È ß‡æ‘¡Ë ¡“°¢÷πÈ „π™à«ßµ—ßÈ §√√¿å ‡√’¬°«à“
çJacquemier-Chadwick signé
(2) ª“°¡¥≈Ÿ°®–¡’ ’§≈È”¡“°¢÷Èπ (Gooddellûs
sign)
(3) Spider telangiectases (¿“æ∑’Ë 10)
(4) °“√·¥ß∑’ËΩÉ“¡◊Õ
(5) °“√∫«¡°¥‰¡à∫¡ãÿ ∫√‘‡«≥Àπâ“ ‡ª≈◊Õ°µ“ ·¢π
·≈–¢“ 2 ¢â“ß ¡—°¡’Õ“°“√∫«¡µÕπ‡™â“ ·≈–¥’¢÷ÈπµÕ𠓬 Ê
(6) ‡ âπ‡≈◊Õ¥¢Õ¥
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µ“√“ß∑’Ë 2 Cutaneous disorders and tumors affected by pregnancy
Inflammatory
Infectious
Autoimmune
Atopic dermatitis
Fungus (Candida, pityrosporum)
SLE
Psoriasis
Herpesvirus (HSV, VZV)
Systemic sclerosis
Chronic plaque
AIDS
Dermatomyositis/polymyositis
Pustular (impetigo herpetiformis)
Leprosy
Pemphigus vulgaris/vegetans/foliaceus
Acne vulgaris
Protozoa (Trichomonas)
Rheumatoid arthritis
Fox-Fordyce disease
Condyloma acuminatum
Hidradenitis suppurativa
Urticaria
Metabolic
Connective tissue
Tumors
Miscellaneous
Porphyria cutanea tarda
Acrodermatitis enteropathica
Ehlers-Danlos syndrome
Pseudoxanthoma elasticum
Anetoderma
°“√√—°…“ : µÕ∫ πÕߥ’µàÕ systemic corticosteroids „π√“¬∑’‰Ë ¡à¥¢’ πÈ÷ Õ“®„Àâ oral retinoids À√◊Õ©“¬√—ß ’
PUVA therapy ·µà„À≥⇡◊ÕË §≈Õ¥∫ÿµ√·≈⫇∑à“π—πÈ πÕ°®“°
π—πÈ §«√µ√«®·§≈‡´’¬¡·≈–·Õ≈∫Ÿ¡π‘ „π´’√¡Ë— ¢ÕߺŸªâ «É ¬∑ÿ°√“¬
°“√¥”‡π‘π‚√§ : à«π„À≠àÀ“¬‡ÕßÀ≈—ß®“°§≈Õ¥
·≈â« ·µà “¡“√∂°≈—∫‡ªìπ„À¡à„π°“√µ—Èߧ√√¿å§√—ÈßµàÕ‰ª πÕ°
®“°π’Ȭ—ß¡’º≈µàÕ∑“√°„π§√√¿å ¡’¿“«–µ“¬·√°§≈Õ¥ (stillbirth) ·≈–°“√‰À≈‡«’¬π‡≈◊Õ¥„π√°∫°æ√àÕß (placental insufficiency) ‰¥â
¢. °≈ÿà¡‚√§∑’ˇ°‘¥®“°°“√µ‘¥‡™◊ÈÕ (infection) „π
ªï∑’Ë 9 ©∫—∫∑’Ë 2
Pyogenic granuloma
Skin tag
Hemangioma
Hemangioendothelioma
Glomus tumor
Dermatofibroma
Dermatofibroma
protuberans
Leiomyoma
Keloid
Desmoid tumor
Neurofibroma
Melanocytic nevus
Melanoma
Sarcoidosis
Erythema nodosum
Erythrokeratoderma variabilis
Bowenoid papulosis
Mycosis fungoides
Erythema multiforme
Tuberous sclerosis
Acanthosis nigricans
Hereditary hemorrhagic
telangiectasis
¿“«–µ—Èߧ√√¿å¡’ŒÕ√å‚¡π‡Õ ‚µ√‡®π Ÿß¢÷Èπ ¡’º≈∑”„Àâ¿Ÿ¡‘§ÿâ¡
°—π¢Õß√à“ß°“¬µË”≈ß °“√∑”ß“π¢Õß√–∫∫ cellular mediated
immune system, neutrophil function ·≈– NK cell ≈¥
≈ß πÕ°®“°π—Èπ¬—ß¡’°“√≈¥≈ߢÕß local Ab responses
¥â«¬ ∑”„Àâ°“√µ‘¥‡™◊ÈÕ‚√§µà“ß Ê „π™à«ßµ—Èߧ√√¿å ¡’Õ“°“√√ÿπ
·√ß¡“°¢÷Èπ ·≈–¢âÕ ”§—≠Õ“®·æ√à‡™◊ÈÕ‰ª Ÿà∑“√°„π§√√¿å‰¥â
¿“«–°“√µ‘¥‡™◊ÈÕ∑’Ë ”§—≠ ‰¥â·°à
(1) °“√µ‘¥‡™◊ÈÕ‰«√— ‡™àπ herpes simplex,
herpes zoster, varicella, AIDS
(2) °“√µ‘¥‡™◊ÕÈ ·∫§∑’‡√’¬·≈–ª√ ‘µ ‡™àπ impeti-
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go, trichomoniasis
(3) °“√µ‘¥‡™◊ÈÕ√“ ‡™àπ candidosis
§. °≈ÿ¡à ‚√§∑’‡Ë °‘¥®“°¿“«–¿Ÿ¡§‘ ¡âÿ °—πº‘¥ª°µ‘ (autoimmune diseases)
(1) ‚√§ SLE °“√µ—Èߧ√√¿å∑”„À⇰‘¥°“√°”‡√‘∫
¢Õß‚√§‰¥â ´÷Ëß à«π„À≠à®–¡’Õ“°“√∑“ߺ‘«Àπ—ß √Õß≈ß¡“§◊Õ
¢âÕÕ—°‡ ∫·≈–∂⓺Ÿªâ «É ¬¬—ß¡’Õ“°“√°”‡√‘∫¢Õß‚√§Õ¬Ÿ°à ®Á –∑”„Àâ
µ—«‚√§·¬à≈߉¥â ¥—ßπ—πÈ §«√§«∫§ÿ¡‚√§„À≥âÕ¬à“ßπâÕ¬ 3 ‡¥◊Õπ
°àÕπµ—Èߧ√√¿å®÷ß®–ª≈Õ¥¿—¬†πÕ°®“°π—Èπ¿“«–†SLE†¬—ß¡’
º≈°√–∑∫µàÕ‡¥Á°„π§√√¿å∑”„À⇰‘¥°“√§≈Õ¥°àÕπ°”Àπ¥
¿“«–·∑âߧÿ°§“¡ ·≈–¬—ßæ∫¿“«– neonatal lupus ´÷Ë߇¥Á°
®–¡’¿“«– congenital heart block À√◊Õ≈—°…≥–º◊Ëπº‘«Àπ—ß
Ẻ LE 䴉
(2) ‚√§ polymyositis ·≈– dermatomyositis
æ∫«à“¡’°“√°”‡√‘∫¢Õߺ◊Ëπ ’·¥ß§≈È”À√◊Õ¡à«ß√Õ∫¥«ßµ“ À√◊Õ
‡°‘¥°“√ÕàÕπ·√ߢÕß°≈â“¡‡π◊ÈÕµÕπµâπ‰¥â Õ“®‡°‘¥¿“«–°“√
·∑âߧÿ°§“¡ ¿“«–°“√‡ ’¬™’«‘µ„π°“√§≈Õ¥ ·≈–Õ“®‡ ’ˬߵàÕ
°“√‡ ’¬™’«‘µÀ≈—ß°“√§≈Õ¥‰¥â
(3) ‚√§µÿà¡πÈ”†(pemphigus†vulgaris)†À√◊Õ
foliaceus æ∫«à“Õ“°“√°”‡√‘∫À√◊Õ·¬à≈ß„π™à«ß‰µ√¡“ ∑’Ë 1
·≈– 2 ·≈–¡’°“√∂à“¬∑Õ¥ IgG Ab ‰ª¬—ß∑“√°„π§√√¿å ·µà
Õ“°“√®–¥’¢÷Èπ„π 2-3 —ª¥“ÀåÀ≈—ߧ≈Õ¥ ∫“ß√“¬Õ“®‡ ’ˬß
µàÕ°“√‡ ’¬™’«‘µ
ß. °≈ÿ¡à ‚√§∑’‡Ë °’¬Ë «°—∫§«“¡º‘¥ª°µ‘¢Õß°√–∫«π°“√
‡º“º≈“≠„π√à“ß°“¬ (metabolic disorders)
(1) Porphyria cutanea tarda (PCT) ‡°‘¥
®“°ŒÕ√å‚¡π‡Õ ‚µ√‡®π Ÿß¢÷πÈ ∑”„ÀâÕ“°“√¢Õß‚√§·¬à≈ß„π™à«ß
‰µ√¡“ ∑’Ë 1 ·µà™à«ßÀ≈—ߢÕß°“√µ—Èߧ√√¿å √à“ß°“¬µâÕß°“√
‡À≈Á°¡“°¢÷Èπ ®÷ß¡’°“√¢—∫ “√ porphyrin ÕÕ°¡“° Õ“°“√
®÷ߧàÕ¬ Ê ¥’¢÷Èπ
(2) Acrodermatitis enteropathica ®–¡’Õ“°“√
°”‡√‘∫„π√–À«à“ßµ—ßÈ §√√¿å ·µàÀ“¬Õ¬à“ß√«¥‡√Á«À≈—ߧ≈Õ¥ ·µà
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∂Ⓣ¡à‰¥â√—∫°“√√—°…“∑“√°„π§√√¿å®–‡ ’¬™’«‘µ‰¥â À√◊Õ¡’¿“«–
anencephaly À√◊Õ chondroplastic dwarfism ‰¥â
®. °≈ÿ¡à ‚√§∑’‡Ë °’¬Ë «°—∫§«“¡º‘¥ª°µ‘¢Õ߇π◊ÕÈ ‡¬◊ÕË ‡°’¬Ë «
æ—π„µâº‘«Àπ—ß (connective tissue disorders)
(1) Ehlers-Danlos syndrome type I ·≈–
IV ∑”„Àâ¡°’ “√µ°‡≈◊Õ¥À≈—ߧ≈Õ¥·≈–©’°¢“¥¢ÕßÀ≈Õ¥‡≈◊Õ¥
„À≠à·º≈À“¬™â“·≈–¡¥≈Ÿ°©’°¢“¥ À√◊Õ¡’°“√‡ª≈’¬Ë π·ª≈ߢÕß
°√–‡æ“–ªí “«–·≈–¡¥≈Ÿ°‰¥â
(2) Pseudoxanthoma elasticum ∑”„À⇰‘¥
¿“«–·∑√°´âÕπ¢ÕßÀ≈Õ¥‡≈◊Õ¥ ‡™àπ ‡≈◊Õ¥ÕÕ°„π∑“߇¥‘π
Õ“À“√‰¥â ∑“√°„π§√√¿åÕ“®¡’¿“«–°“√‡®√‘≠‡µ‘∫‚µ¢Õß∑“√°
„π§√√¿å™â“‰¥â
©. ‡π◊ÈÕßÕ°¢Õߺ‘«Àπ—ß (cutaneous tumor)
(1) Pyogenic granuloma of pregnancy (grananuloma gravidarum, pregnancy epulis) (¿“æ∑’Ë 11)
æ∫≈—°…≥–µÿà¡πŸπ ’·¥ßÀ√◊Õ¡à«ß∑’Ë∫√‘‡«≥‡Àß◊Õ°†æ∫ª√–¡“≥√âÕ¬≈– 2 ¢Õß µ√’¡’§√√¿å„π™à«ß‡¥◊Õπ∑’Ë 2-5 Õ“°“√
®–À“¬‰¥â‡ÕßÀ≈—ß®“°§≈Õ¥
(2) µ‘ßË ‡π◊ÕÈ (mollusum fibrosum gravidarum,
soft fibromas or skin tag) æ∫„π™à«ß∑⓬¢Õß°“√µ—Èߧ√√¿å
¡—°‡°‘¥∑’ËÀπâ“ §Õ Àπâ“Õ° ·≈–„µâ√“«π¡ Õ“°“√®–À“¬‰ª
‡Õß„π™à«ßÀ≈—ߧ≈Õ¥ ·µà∫“ß√“¬Õ“®‰¡àÀ“¬
(3) ‡π◊ÈÕßÕ°¢ÕßÀ≈Õ¥‡≈◊Õ¥ (vascular tumor)
‡™àπ hemangioma, glomus tumor ¡’¢π“¥„À≠à¢÷Èπ
(4) Dermatofibromas, leiomyomas ·≈– keloids Õ“®®–‚µ¢÷ÈπÕ¬à“ß√«¥‡√Á«
(5) Neurofibromas†Õ“®‚µ¢÷ÈπÀ√◊Õ‡°‘¥¢÷Èπ
„À¡à
(6) Melanocytic nevi Õ“®‚µ¢÷Èπ·≈–¥”¢÷Èπ
3. §«“¡º‘¥ª°µ‘¢Õߺ‘«Àπ—ß∑’æË ∫‡©æ“–„π µ√’
¡’§√√¿å (dermatoses only occurring in pregnan-
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¿“æ∑’Ë 11 Characteristic pyogenic granuloma of the gingiva (¥Ÿ
¿“æ ’Àπâ“ 138)
cy)
°. Recurrent cholestasis of pregnancy (prurigo gravidarum) æ∫„π™à«ß‰µ√¡“ ∑’Ë 3 æ∫‰¥â√âÕ¬≈– 70
¢Õß µ√’µßÈ— §√√¿å ºŸªâ «É ¬¡’¿“«–°“√≈”‡≈’¬ßπÈ”¥’„πµ—∫º‘¥ª°µ‘
·≈–µâÕ߉¡à¡’ª√–«—µ‘‚√§µ—∫Õ—°‡ ∫®“°°“√„™â¬“À√◊Õ®“°‡™◊ÈÕ
‰«√— Õ“°“√ : ¡’Õ“°“√§—πµ“¡µ—« ·¢π·≈–¢“ ‚¥¬
‰¡à¡º’ πË◊ º‘«Àπ—ß Õ“®æ∫√à«¡°—∫Õ“°“√µ—«‡À≈◊Õß µ“‡À≈◊ÕßÀ√◊Õ
‰¡à°Á‰¥â πÕ°®“°π—ÈπºŸâªÉ«¬¡—°¡’πÈ”Àπ—°≈¥·≈–¡’¿“«–¢“¥
«‘µ“¡‘π‡§ ‡π◊ËÕß®“°°“√¥Ÿ¥´÷¡‰¢¡—π¢Õß√à“ß°“¬º‘¥ª°µ‘
“‡Àµÿ : ¬—߉¡à∑√“∫·πàπÕπ æ∫«à“√âÕ¬≈– 50
¢ÕߺŸâªÉ«¬¡’ª√–«—µ‘§√Õ∫§√—«
°“√µ√«®∑“ßÀâÕߪؑ∫—µ‘°“√ : √–¥—∫ bilirubin
„π´’√—Ë¡‡æ‘Ë¡ ¡’°“√∑”ß“π¢Õßµ—∫º‘¥ª°µ‘
°“√√—°…“ : ∂â“Õ“°“√‰¡à√ÿπ·√ß „Àâ antipruritic,
emollient À√◊Õ pimrose oil °Á‰¥â ∂â“Õ“°“√√ÿπ·√ß„Àâ cholestyramine
°“√¥”‡π‘π‚√§ : À≈—ߧ≈Õ¥Õ“°“√¥’¢÷Èπ¿“¬„π
2-3 «—π ·µà®–°≈—∫‡ªìπ´È”‰¥â„À¡à„π°“√µ—Èߧ√√¿å§√—ÈßµàÕ‰ª
‚√§π’ÕÈ “®∑”„Àâ¡Õ’ “°“√‡§√’¬¥¢Õß∑“√°„π§√√¿åÀ√◊Õ§≈Õ¥°àÕπ
°”À𥉥â πÕ°®“°π—ÈπÕ“®‡°‘¥¿“«–¢“¥«‘µ“¡‘π‡§ ´÷Ëß∑”„Àâ
‡°‘¥°“√µ°‡≈◊Õ¥À≈—ߧ≈Õ¥‰¥â
ªï∑’Ë 9 ©∫—∫∑’Ë 2
97
¿“æ∑’Ë 12 Herpes gestationis (¥Ÿ¿“æ ’Àπâ“ 138)
¢. Herpes gestationis (HG) À√◊Õ pemphigoid
gestationis (PG) (¿“æ∑’Ë 12) ¡—°‡ªìπ„π™à«ß‰µ√¡“ ∑’Ë 2
·≈– 3
Õ“°“√ : ºŸâªÉ«¬®–¡’º◊Ëπ‡ªìπªóôπ ’·¥ß ¡’Õ“°“√
§—π∑’Ë∫√‘‡«≥∑âÕß À≈—ß®“°π—Èπ‡√‘Ë¡°≈“¬‡ªìπµÿà¡πÈ”≈“¡‰ª¬—ß
à«πµà“ß Ê ¢Õß√à“ß°“¬ ¬°‡«âπÀπâ“ ‡¬◊ÕË ∫ÿµ“ ‡¬◊ÕË ∫ÿª“° ΩÉ“¡◊Õ
·≈–ΩÉ“‡∑â“ ¿“«–∑’ÕË “®æ∫√à«¡°—π ‰¥â·°à autoimmune disease
¢ÕßµàÕ¡∏—¬√Õ¬¥å (Graveûs disease)
欓∏‘«‘∑¬“ : æ∫ subepidermal vesicle with
perivasular lymphocyte ·≈– eosinophil infiltration À√◊Õ
Õ“®æ∫ non-specific eosinophilic spongiosis ‰¥â
- Direct immunofluorescence (¿“æ∑’Ë 13)
æ∫ C3 ·≈–/À√◊Õ IgG ‡ªìπ·∂∫µ“¡ linear band along
basement membrane zone
- Indirect immunofluorescence æ∫ HG
factor (fix complement to BMZ) ∂â“∑” salt-split skin
specimens æ∫ Ab ®—∫∑’Ë roof of vesicle
欓∏‘°”‡π‘¥ : ‡ªìπ‚√§¢Õß autoimmune ¡’
antigen ‡ªìπ 180-Kd protein (BPAG 2)
°“√√—°…“ : ºŸªâ «É ¬∑’¡Ë §’ «“¡√ÿπ·√ßπâÕ¬„Àâ potent
topical corticosteroids ·≈– systemic antihistamine ·µà
à«π„À≠à¡—°®”‡ªìπµâÕß„Àâ systemic corticosteroids à«π
º‘ « À π— ß
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¿“æ∑’Ë 13 Intense linear C3 deposition along BMZ (¥Ÿ¿“æ
’Àπâ“ 138)
¿“æ∑’Ë 14 PUPPP (¥Ÿ¿“æ ’Àπâ“ 138)
ºŸªâ «É ¬∑’¡Ë §’ «“¡√ÿπ·√ß¡“°Õ“®∑”°“√∂à“¬‡≈◊Õ¥ À√◊Õ‡√àߧ≈Õ¥
°àÕπ°”Àπ¥
°“√¥”‡π‘π‚√§ : ‰¡à¡’Õ—πµ√“¬µàÕ·¡à º◊Ëπ®–À“¬
‰¥â¿“¬„π‰¡à°’Ë —ª¥“ÀåÀ√◊Õ‡¥◊ÕπÀ≈—ߧ≈Õ¥ ·µà∂â“¡’ª√–®”‡¥◊ÕπÀ√◊Õ„™â¬“§ÿ¡°”‡π‘¥°ÁÕ“®®–°≈—∫‡ªìπ„À¡à‰¥â
”À√—∫∑“√°æ∫¿“«– neonatal HG ‰¥â
·µàÕ“°“√‰¡à√ÿπ·√ß·≈–À“¬‡Õ߉¥â ∫“ß√“¬‡°‘¥¿“«–πÈ”Àπ—°
µ—«πâÕ¬°«à“°”Àπ¥À√◊Õ§≈Õ¥°àÕπ°”Àπ¥
§. Prurigo urticarial papules and plaques
of pregnancy (PUPPP) (¿“æ∑’Ë 14) ‡ªìπ‚√§∑’Ëæ∫∫àÕ¬∑’Ë
ÿ¥„π µ√’µ—Èߧ√√¿å ¡—°æ∫„π™à«ß‰µ√¡“ ∑’Ë 3
Õ“°“√ : ¡’Õ“°“√§—π¡“° º◊Ëπ¡—°®–¢÷Èπ∑’Ë∑âÕß
∫√‘‡«≥¢Õ∫¢Õߺ‘«·µ°≈“¬°àÕπ ≈—°…≥–¢Õߺ◊Ëπ¡’À≈“¬√Ÿª
·∫∫ ·µà à«π„À≠à‡ªìπµÿà¡·¥ßÀ√◊Õªóôπ·¥ß·≈–∫“ߧ√—Èßæ∫
«à“‡ªìπµÿà¡πÈ” ®È”‡≈◊Õ¥ À√◊Õº◊Ëπ‡ªìπ«ß¡’®ÿ¥µ√ß°≈“߉¥â º◊Ëπ
Õ“®≈“¡‰ª∑’˵âπ¢“ °âπ „µâ√“«π¡ ·¢π ΩÉ“¡◊Õ ·≈–‡∑Ⓣ¥â
·µà®–‰¡à‡ªìπ∑’ËÀπâ“
欓∏‘«‘∑¬“ : (¿“æ∑’Ë 15) ‰¡à®”‡æ“–‡®“–®ß Õ“®
æ∫≈—°…≥– spongiotic dermatitis, perivascular infiltration
with eosinophils Õ“®æ∫ focal parakeratosis, exocytosis
·≈– mild acanthosis
°“√µ√«®∑“ßÀâÕߪؑ∫—µ‘°“√ : serologic ·≈–
immunofluorescence „Àâº≈≈∫
欓∏‘°”‡π‘¥ : ‰¡à∑√“∫·πàπÕπ Õ“®‡°‘¥®“°¡’
°“√¢¬“¬µ—«¢Õߺπ—ßÀπâ“∑âÕßÕ¬à“ß√«¥‡√Á«„π™à«ß°“√µ—ßÈ §√√¿å
·√° ¡’°“√∑”≈“¬‡π◊ÈÕ‡¬◊ËÕ‡°’ˬ«æ—πÀ√◊ÕÕ“®‡°‘¥®“°¡’ “√®“°
√°‰ª°√–µÿâπ°“√·∫àßµ—«¢Õß fibroblast
°“√¥”‡π‘π‚√§ : ‰¡à¡’Õ—πµ√“¬µàÕ·¡à·≈–‡¥Á°
À“¬‰¥â‡Õß¿“¬„π†2-3†«—πÀ≈—ߧ≈Õ¥ ‰¡à°≈—∫‡ªìπ´È”„π°“√
µ—Èߧ√√¿å§√—ÈßµàÕ‰ª
ß. Prurigo of pregnancy (Besnierûs prurigo
gestationis) æ∫„π™à«ß‡¥◊Õπ∑’Ë 4-9 ¢Õß°“√µ—Èߧ√√¿å
Õ“°“√ : µÿà¡·¥ß¡’√Õ¬‡°“·≈– nodules √à«¡
°—∫¡’ –‡°Á¥°√—߉¥â∑’Ë∫√‘‡«≥·¢π·≈–¢“¥â“ππÕ°
欓∏‘«‘∑¬“ : ‰¡à®”‡æ“–‡®“–®ßÕ“®æ∫≈—°…≥–
chronic inflammatory cell infiltration „π upper dermis
ªï∑’Ë 9 ©∫—∫∑’Ë 2
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°“√√—°…“ : √—°…“µ“¡Õ“°“√
°“√¥”‡π‘π‚√§ : ‰¡à¡’Õ—πµ√“¬µàÕ·¡à·≈–‡¥Á°
À“¬‰¥â‡ÕßÀ≈—ߧ≈Õ¥ ·≈–‰¡à°≈—∫‡ªìπ´È”„π°“√µ—Èߧ√√¿å§√—Èß
µàÕ‰ª
®. Prurigo folliculitis of pregnancy æ∫‰¥â„π
™à«ß°“√µ—Èߧ√√¿å‡¥◊Õπ∑’Ë 4-9
Õ“°“√ : æ∫≈—°…≥–µÿà¡·¥ß¡—°‡°‘¥∑’Ë∫√‘‡«≥√Ÿ
¢ÿ¡¢π∑’Ë·¢π ¢“ ·≈–∑âÕß
欓∏‘«‘∑¬“ : æ∫≈—°…≥– sterile folliculitis
¿“æ∑’Ë 15 PUPPP; mild spongiosis, superficial perivascular in°“√µ√«®∑“ßÀâÕߪؑ∫—µ‘°“√ : direct immufiltration with E0 (¥Ÿ¿“æ ’Àπâ“ 138)
nofluorescence „Àâº≈≈∫
°“√√—°…“ : topical corticosteroids, benzoyl
°“√µ√«®∑“ßÀâÕߪؑ∫—µ‘°“√ ¡’°“√‡æ‘Ë¡¢÷Èπ¢Õß serum IgE, peroxide ·≈–©“¬√—ß ’¬Ÿ«’
°“√¥”‡π‘π‚√§ : À“¬‰¥â‡ÕßÀ≈—ߧ≈Õ¥ ‰¡à¡Õ’ π— direct immunofluorescence „Àâº≈≈∫
欓∏‘°”‡π‘¥ : ‰¡à∑√“∫·πàπÕπ Õ“® —¡æ—π∏å°—∫ µ√“¬µàÕ·¡à·≈–‡¥Á°
ª√–«—µ‘¿Ÿ¡‘·æâ
‡Õ° “√ ■
1. Black MM. Dermatoses of pregnancy: new developments. J Dermatol 2001;28:635-7.
2. Black MM. Prurigo of pregnancy, papular dermatitis of pregnancy, and pruritic folliculitis of pregnancy. Semin
Dermatol 1989;8:23-5.
3. Breier-Maly J, Ortel B, Breier F, Schmidt JB, Honigsmann H. Generalized pustular psoriasis of pregnancy (impetigo
herpetiformis). Dermatology 1999;198:61-4.
4. Chen SH, Chopra K, Evans TY, Raimer SS, Levy ML, Tyring SK. Herpes gestationis in a mother and child. J
Am Acad Dermatol 1999;40:847-9.
5. Ford MJ, Gammon WR, Kilpatrick TM. Pustular eruption of the striae in a primigravida. Cutis 1992;50:225-8.
6. Holmes RC, Black MM. The specific dermatoses of pregnancy. J Am Acad Dermatol 1983;8:405-12.
7. Kroumpouzos G, Cohen LM. Dermatoses of pregnancy. J Am Acad Dermatol 2001;45:1-19.
8. Lin MS, Arteaga LA, Diaz LA. Herpes gestationis. Clin Dermatol 2001;19:697-702.
9. Sitaru C, Powell J, Shimanovich I, Joint S, Kirtsheig G, Wojnarowska F, et al. Pemphigoid gestationis; maternal
sera recognize epitopes restricted to the N-terminal portion of the extracellular domain of BP180 not present on
its shed ectodomain. Br J Dermatol 2003;149:420-2.
10. Vaughan Jones SA, Black MM. Pregnancy dermatoses. J Am Acad Dermatol 1999;40:233-41.
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ªï∑’Ë 9 ©∫—∫∑’Ë 2
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