男性尿道炎的臨床處理 The Hong Kong Medical 课件.pptVIP

Skin diseases commonly seen in diabetic patients Dr. Au Tak Shing MBBS (HK), MRCP (UK), FHKCP, FHKAM (Medicine), FRCP (Edin), Dip Derm (Lond), Dip GUM (LSA), DCH (Lond), DFM (CUHK), Specialist in Dermatology and Venereology Skin disease and DM Skin manifestations of DM Skin disease as side effects of treatment for DM Treatment of skin disease resulting in DM Dermatophyte infection Tinea is common in DM patients May not be more common than general population Need for treatment is even stronger Watch out for secondary bacterial infection Infection or not? Distribution is a very important clue Distribution Fungal infection is usually asymmetrical Dermatitis is usually symmetrical or corresponding to the primary cause Candidiasis More common in DM patients Vulvo-vaginitis Balano-posthitis Can be the first sign of DM Diabetic dermopathy Quite common Multiple, asymptomatic, irregularly shaped, discrete, atrophic, brown macules resembling scars Shins Intimal thickening and deposition of PAS-positive fibrillary material in vessel walls Microangiopathy elsewhere Acanthosis nigricans Velvety hyperpigmentation of intertriginous areas Less often on extensor surfaces Commonly associated with insulin resistance Obesity, darkly-pigmented patients Diabetic bullae Bullous diabeticorum Non-inflammatory bullae on lower extremities Pathology uncertain Bullous pemphigoid Autoimmune process that affects the dermo-epidermal junction Elderly Multiple intact bullae Investigation: skin biopsy for histology and immunofluorescence study Treatment: oral steroid +/- other immuno-suppressants Necrobiosis lipoidica Yellow atrophic patches often on shins Erythematous border Ulceration Not always associated with DM Disseminated granuloma annulare Annular lesions composed of papules Usually smooth surface Controversy about relation with DM Neuropathic ulcers Non-painful ulcers at feet Pressure points Acral dry gangrene Due to vascular disease Eruptive xanthomas Reddish yellow papules Developi