在目前的工作中,我们提出了我们的新指南,以诊断和治疗的sc疮,由日本皮肤病协会召集的执行委员会,开发以确保在日本正确诊断和治疗sc疮。2014年8月,国家健康保险批准了苯醚菊酯的局部使用,导致了这一行动。氯菊酯,属于与苯醚菊酯相同的拟除虫菊酯组的局部抗蛇毒药,已经在全球范围内使用。在本准则中,我们介绍了正确诊断脓肿的标准,常见和结痂(过度角化)的sc疮的治疗算法,和预防。我们第二版的主要变化是治疗算法。现在有了苯醚菊酯,普通疮的一线治疗是外用苯醚苦素洗剂或口服伊维菌素。局部治疗的第二线选择是含硫软膏,crotamiton乳膏或苯甲酸苄酯乳液。γ-六氯化苯软膏不再用于临床。在免疫抑制患者中,治疗方案还是一样,但要密切跟进。如果症状持续,必须重新评估诊断和治疗。对于过度角化疮和指甲疮,去除厚皮,另外需要剪指甲和闭合敷料。与局部和口服药物联合治疗的安全性和有效性尚未得到证实。需要进一步评估。除了适当的治疗,必须教育病人和医护人员,并进行流行病学研究,通过有效利用包括人力在内的现有资源,防止疾病进一步传播,金融,物流和时间。
In the current work, we present our new
guideline for the diagnosis and treatment of
scabies which we, the Executive Committee convened by the Japanese Dermatological Association, developed to ensure proper diagnosis and treatment of scabies in Japan. Approval of phenothrin topical use under the National Health Insurance in August 2014 led to this action. Permethrin, a topical anti-scabietic medication belonging to the same pyrethroid group as phenothrin, is already in use worldwide. In this
guideline, we introduce criteria for a proper diagnosis of
scabies, treatment algorithm for common and crusted (hyperkeratotic)
scabies, and prevention. The major change from our second edition is the treatment algorithm. As phenothrin is now available, the first-line therapy for common
scabies is either topical phenothrin lotion or oral ivermectin. The second-line option for topical treatment is sulfur-containing ointments, crotamiton cream or benzyl benzoate lotion. γ-Benzene hexachloride ointment is no longer provided for clinical use. In an immunosuppressed patient, the treatment option is still the same, but with close follow up. If the symptoms persist, diagnosis and treatment must be reassessed. For hyperkeratotic
scabies and nail
scabies, removal of thick crust, cutting of nails and occlusive dressing are additionally required. The safety and effectiveness of combined treatment with topical and oral medications are not yet confirmed. Further assessment is needed. In addition to appropriate treatment, it is essential to educate patients and health-care workers and to conduct epidemiological studies to prevent further spread of the disease through effectively utilizing available resources including manpower, finance, logistics and time.