NGOẠI BÌ HỌC II (DA HỌC II)
(Tiếp theo phần I)
4/. Nhóm bệnh ngoại bì do dị ứng
4a/. Bệnh chàm :
Nguyên nhân bệnh rất đa dạng và phức tạp, được xác định là do một số tác nhân và yếu tố dễ gây bệnh hình thành như:
Dị ứng với hóa chất trong sinh hoạt, trong nghề nghiệp như xăng dầu, xà phòng, xi măng.
Do nhiễm khuẩn trong khi tiếp xúc với bùn đất, nước bẩn hay gặp nhất là do liên cầu trùng trong thể tổ đỉa nung mủ
Do dị ứng với nhiễm nấm ở kẽ chân
Do thay đổi thời tiết theo mùa
Do ảnh hưởng của ánh sáng và nóng ẩm.
Những yếu tố sau đây có thể thúc đẩy tình trạng bệnh khởi phát hoặc nặng hơn:
+) Yếu tố tại chỗ: chất tẩy rửa, xà phòng, dung môi, giày dép chật, chất liệu da, đổ mồ hôi nhiều…
+) Yếu tố trong không khí: khói thuốc, lông chó mèo, đất bùn, mạt bụi nhà…
+) Nhiễm trùng (tụ cầu vàng)
+) Thực phẩm gây dị ứng: hải sản, trứng, thịt gà, bò, đậu phộng, đậu nành, đồ lên men, tinh bột…
4b/. Tổ đỉa: là bệnh dị ứng, rất hay gặp ở tay, tiếng Anh gọi là Pompholyx, hoặc viêm da mụn nước ở lòng bàn tay và bàn chân. Bệnh nhân thường có thể tạng dị ứng và bệnh thường xảy ra sau cơn stress.
Tổ đỉa có tên khoa học là Dysidrose, là một thể đặc biệt của bệnh chàm, khu trú ở lòng bàn tay, bàn chân và rìa các ngón, Bệnh thường gặp ở tuổi từ 20 đến 40, nam nữ có tỷ lệ bằng nhau. Bất kì ai cũng có thể mắc phải bệnh tổ đỉa nếu như thường xuyên lặp lại những thói quen vệ sinh không đúng cách hàng ngày.
4c/. Eczema là phản ứng viêm lớp nông của da, cấp tính hoặc mạn tính. Đây là một bệnh ngoài da phổ hiến..sản xuất công nghiệp và trong sinh hoạt càng sử dụng nhiều hóa chất thì bệnh Eczema càng phái triển.
Nguyên nhân gây bệnh Eczéma rất phức tạp, rất khó tìm được nguyên nhân chính. Eczema xảy ra trên một thể tạng đặc biệt, nghĩa là loại cơ thể dễ bị dị ứng với chất này hoặc chất khác mà người khác thì không bị ảnh hưởng gì. Chất gây dị ứng gọi là kháng nguyên dị ứng.
Thông thường có hai loại nguyên nhân:
* Nguyên nhân bên ngoài: Trong môi trường chung quanh có thể có nhiều tác nhân gây bệnh thuộc các yếu tố vật lý, hóa học, thực vật
Ví dụ: ánh sáng mặt trời, sâu bọ, thuốc uống, thuốc bôi…v.v… hoặc có thể do hóa chất dùng trong gia đình như: xà bông, xi măng, dầu mỡ, chất nhuộm, cao su, mỹ phẩm…v.v…
* Nguyên nhân bên trong: Phức tạp và khó xác định hơn như: Rối loạn thần kinh (xúc cảm mạnh, suy nghĩ lo âu, làm việc căng thẳng); rối loạn tiêu hóa (táo bón, viêm đại tràng, giun sán); nội tiết (có mang, tiền mãn kinh, tuổi già v.v…). Trong cơ thể bệnh nhân có lưu hành những chất chuyển hóa dở dang, những chất đạm lạ cũng gây Eczéma.
4d/. Nổi mề đay mẩn ngứa: là một bệnh da phổ biến, rất dễ nhận biết nhưng lại khó phát hiện nguyên nhân dù đã làm đầy đủ các xét nghiệm. Có nhiều yếu tố gây bệnh (bên trong, bên ngoài cơ thể, thể tạng) và trên một bệnh nhân, nhiều khi không chỉ có một mà gồm nhiều yếu tố cùng kết hợp.
Bệnh nổi mề đay mẩn ngứa là do thể tạng dị ứng với một số tác nhân từ môi trường bên ngoài như: dị ứng thực phẩm, thời tiết, môi trường ô nhiễm, nguồn nước bẩn, dị ứng thuốc…. Dù là tác nhân gì gây ra nhưng biểu hiện của bệnh khá đặc trưng là gây ngứa da, ngứa bứt dứt khó chịu, sưng phù. Có thể kèm theo một số triệu chứng ít gặp như rối loạn tiêu hóa, suy hô hấp, ra mồ hôi lạnh, tụt huyết áp ….
Thuốc trị bệnh nổi mề đay chủ yếu là các kháng histamin để ngăn chặn phản ứng dị ứng, làm giảm các triệu chứng bệnh. Kèm theo các thuốc như corticoid, kháng sinh dùng trong trường hợp viêm nhiễm.
Trong dân giansử dụng một số thảo dược trị bệnh như: lá khế, lá kinh giới, lá đơn đỏ, ngải cứu …
4e/. Dị ứng da: Ngứa, bị dị ứng, nổi mẩn đỏ là một hiện tượng rất hay gặp trong đời sống sinh hoạt. Nguyên nhân có thể do người bệnh ăn phải các thực phẩm dễ gây dị ứng, do thay đổi thời tiết hoặc cũng có thể là dấu hiệu của một số bệnh ngoài da, dị ứng, bệnh nội tạng …
Triệu chứng : Ngoài các dấu hiệu chính là ngứa, da thường có vết xước, nổi mẩn đỏ với nhiều hình dạng khác nhau. Người bị dị ứng thường nổi những mẩn đỏ thành vết, đám hoặc sần nề, gồ cao hơn mặt da, ranh giới rõ, tròn hoặc vằn vèo, màu hồng nhạt, ở giữa hơi bạc màu, rắn chắc, có thể xuất hiện khắp người hoặc từng vùng. Nếu càng gãi thì các mẩn đỏ càng rõ hơn và ngứa nhiều hơn.
Các dạng dị ứng phổ biến nhất đó là dị ứng thực phẩm, dị ứng thời tiết, và dị ứng mắt, hay viêm mũi dị ứng.
♦ Dị ứng thực phẩm
Dị ứng thực phẩm có thể gặp ở bất cứ ai, ở bất cứ độ tuổi nào. Khi ăn phải nhóm thực phẩm dễ dị ứng, người bệnh sẽ bị nổi mẩn đỏ ngoài da, nổi mề đay, ngứa, sưng đỏ, mạch máu sưng phồng. Ở hệ thống tiêu hóa thì môi, miệng, và cuống họng sưng phồng, đầy bụng , nôn mửa, bụng đau cuộn, tiêu chảy. Ở hệ thống hô hấp thì khó thở, suyễn, khò khè, ho, nghẹt mũi, chảy nước mũi. Ở mỗi người có một biểu hiện khác nhau, có người không xuất hiện đầy đủ các triệu chứng, dị ứng có thể xảy ra ngay khi ăn thực phẩm dị ứng hoặc sau vài giờ, có khi vài ngày sau đó.
Với một số người cảm ứng quá mạnh, chỉ cần ngửi hay sờ mò vào thực phẩm là có thể bị dị ứng. Nếu bạn đã từng bị dị ứng thực phẩm, trước khi ăn bất cứ món lạ nào, nhất là ở tiệm bạn hãy hỏi kỹ về món ăn đó, và nhớ mang theo các thuốc chống dị ứng để phòng trường hợp bất trắc.
♦ Dị ứng thời tiết (a).
Người bị dị ứng thời tiết thường có những biểu hiện như ngứa mũi, tai, mắt, miệng, họng, da hoặc trên bất kỳ bộ phận nào trên cơ thể. Hắt hơi sổ mũi nhiều lần, chảy nước mũi trong, giảm khướu giác, nặng hơn là nghẹt mũi, ho, ù tai, đau họng có quầng thâm, phù nề dưới mi mắt, mệt mỏi, nhức đầu và đôi khi cũng ảnh hưởng đến việc xử lý bộ nhớ của não bộ.
Đặc điểm của người bị dị ứng thời tiết thường là da rất nhậy cảm với sự thay đổi của thời tiết. Do đó khi thời tiết thay đổi từ nóng sang lạnh hoặc ngược lại rất dễ khiến da bị ảnh hưởng.
♦ Dị ứng thời tiết (b).
Người bị dị ứng thời tiết nên được ủ ấm trong chăn khi bị ngứa, vì khi đó phần ngứa sẽ được giảm đi, khi cơ thể nóng lên và ra mồ hôi khiến da bớt khô, bớt bị kích ứng. Bên cạnh đó, người bệnh cần hạn chế tắm nước nóng, tăng cường uống nước, ăn hoa quả, ít sử dụng chất kích thích. Trong trường hợp bụi nhà là thủ phạm, cần thường xuyên lau rửa giường, thay ga đệm hàng tuần, dùng quạt gió để giảm độ ẩm trong nhà.
♦ Dị ứng hóa chất và hóa mỹ phẩm : các dòng mỹ phẩm thường làm phụ nữ lóa mắt nhưng chúng lại mang đến những kích ứng, dị ứng da gây tổn hại thẩm mỹ, sức khỏe, tâm lý, tiền bạc và thời gian, công việc. Xử lý chúng là một vấn đề không nhỏ.
♦ Xử lý dị ứng, nổi mẩn đỏ :
Khi có những biểu hiện dị ứng, nổi mẩn đỏ cần tìm sớm và loại bỏ các yếu tố gây bệnh nếu biết. Nếu đã có tiền sử dị ứng với thực phẩm thì cần loai bỏ các thức ăn, thuốc có thể gây dị ứng. Tránh sử dụng các chất gây kích thích như gia vị, rượu, trà, cafe…trong các trường hơp nặng có thể sử dụng thuốc chống dị ứng nhưng nên tham khảo ý kiến bác sỹ hoặc người có chuyên môn. Trường hợp bị dị ứng nổi mẩn đỏ thường xuyên, lặp lại thì nên khám tại các bác sỹ chuyên khoa, có thể làm thêm xét nghiệm để tìm đúng nguyên nhân và có cách điều trị thích hợp.
4f/. Dị ứng nổi mề đay(hay còn gọi là bệnh mề đay) là một hiện tượng rất phổ biến kể cả trẻ em lẫn người lớn. Có rất nhiều nguyên nhân gây ra hiện tượng này trong đó có thể kể tới một số yếu tố như thời tiết, thức ăn, lông động vật, phấn hoa, côn trùng ….tác động vào cơ thể.
Mề đay là một phản ứng viêm của da, có cơ chế phức tạp, trong đó có sự can thiệp của chất trung gian hóa học chính là histamin. Tuy là một bệnh da phổ biến, rất dễ nhận biết nhưng lại khó phát hiện nguyên nhân dù đã làm đầy đủ các xét nghiệm.
Người ta phân loại mề đay thành 2 dạng cấp tính và mãn tính.
Dạng cấp tính có biểu hiện đột ngột ở bất cứ vùng nào trên cơ thể làm cho da sần, phù nề, ngứa dữ dội. Cơn xảy ra trong vài phút hoặc vài giờ rồi lặn hoặc có thể từng đợt kế tiếp nhau. Trong cơn mề đay cấp có thể kèm theo sốt cao, nôn mửa, đau quặn bụng, khó thở…
Dạng mề đay mãn tính là hiện tượng mề đay thường kéo dài trên 8 tuần, không kể nhiều hay ít, có khi ngắt quãng nhiều ngày, có thể gặp các dạng khác nhau.
Hầu hết hiện tượng mề đay thường có nguyên nhân sâu sa từ chức năng tiêu độc của gan và chức năng bài tiết của thận suy giảm. Để điều trị mề đay tốt nhất là cần loại bỏ yếu tố gây bệnh nếu biết, và cần cho bệnh nhân cách ly với một số thức ăn, thuốc có thể gây dị ứng. Đặc biệt cần tránh các chất kích thích như: gia vị, rượu, trà, cà phê…
Trong trường hợp mề đay mãn tính thường có liên quan tới các bệnh lý bên trong nên bệnh nhân cần đến bác sĩ chuyên khoa khám, làm thêm các xét nghiệm cần thiết để tìm đúng nguyên nhân và có cách điều trị thích hợp.
Dị ứng của cơ thể xảy ra khi hệ miễn dịch của một cá nhân phản ứng lại với một chất hiện diện trong môi trường. Dị ứng có thể dẫn đến các vấn đề về hô hấp, đau đầu và kích ứng da. Các dạng dị ứng thường gặp có thể kể đến như dị ứng khi gặp không khí lạnh, dị ứng với sex (thường là dị ứng khi tiếp xúc với tinh dịch), dị ứng với phấn hoa, dị ứng khói thuốc, dị ứng mỹ phẩm, phân ve, khi thay đổi khí hậu hoặc một số ít dị ứng với ánh nắng mặt trời, nước hoa, động vật có vỏ, hải sản và thuốc. Khi bị dị ứng cần tìm nhanh và cách ly với các tác nhân gây dị ứng. Một số trường hợp cần sự can thiệp của thuốc nhưng cần có chỉ định của nhà chuyên môn.
5/. Nhóm bệnh ngoại bì do tự miễn
5a/. Bệnh vảy nến: có nguồn gốc tự miễn, là một bệnh mãn tính xảy ra khi các tế bào da phát triển quá nhanh chóng, cơ thể không thể lột da tế bào dư thừa này do đó những mảng vảy màu trắng bạc xếp thành nhiều lớp như sáp nến.
Vảy nến là bệnh ngoài da mãn tính điển hình, cần biết những thông tin đúng về bệnh nhằm kịp thời xử lý điều trị bệnh vảy nến tính cực nhất. Căn bệnh này là đề tài được nghiên cứu rất nhiều thập kỷ nhưng cho đến nay vẫn chưa xác định được nguyên nhân phát sinh cũng như chưa tìm được cách trị bệnh. Vảy nến được lý giải do sự phát triển quá nhanh chóng của tế bào da dẫn đến chồng chéo nhiều lớp tế bào mới cũ. xuất hiện do một số tác nhân gây nên như:
– Rối loạn hệ thống miễn dịch,
– Yếu tố di truyền,
– Nhiễm khuẩn,
– Chấn thương thượng bì,
– Ánh sáng, môi trường tác động,
– Yếu tố tinh thần, sang chấn tâm lý…
Quá trình phát bệnh xảy ra đột ngột trên một vùng da hay nhiều vùng da cùng lúc gây nên những trấn thương hay gặp như da bong tróc vảy có màu trắng hoặc hồng nhạt, rát da, ngứa da, có thể bị viêm nhiễm ngoài da có mủ nếu không điều trị đúng. Dựa vào triệu chứng của bệnh vảy nến người ta cũng phân vảy nến ra làm một số dạng như:
– Vảy nến thể mảng
– Vảy nến thể mủ
– Vảy nến thể móng
– Vảy nến da đầu
– Vảy nến toàn thân
♦ Cách chữa bệnh vảy nến:
Bệnh vảy nến là căn bệnh ngoài da mãn tính, cho tới nay Đông-Tây Y vẫn chưa có bất kì phương pháp trị bệnh nào. Hầu hết các phương pháp điều trị chỉ là làm thuyên giảm các triệu chứng của bệnh vảy nến mà thôi. Một số biện pháp dùng trị bệnh vảy nến như:
Thuốc chữa bệnh vảy nến: Nhóm thuốc ức chế miễn dịch (cyclosporin, methotrexate, adalimumab…) , các nhóm retinoid (acitretin, tazarotene…), các nhóm corticosteroid (Betamethasone, clobetasol….)nhưng tác dụng rất hạn chế
Phương pháp ánh sáng: Dùng công nghệ hiện đại chiếu các bước sóng phù hợp vào da giúp đẩy lui các triệu chứng của bệnh vảy nến. Phương pháp này thu được kết quả khá hơn nhưng dễ gây ra tác dụng nguy hiểmtrong đó có ung thư da.
5b/. Bệnh Lupus hệ thống và lupus ban đỏ hệ thông: Là bệnh có tỷ lệ cao nhất trong nhóm bệnh tạo keo (60%) biểu hiện viêm lan tỏa hay rải rác ở tổ chức liên kết, nguyên nhân do tự miễn.Bệnh gặp chủ yếu ở phụ nữ trẻ, tỷ lệ nữ/nam: 8/1.Ngày nay chứng Lupus được xem là bệnh tự miễn trên 1 thể tạng đặc biệt.
– Tỷ lệ mắc bệnh cao nhất ở lứa tuổi 20 – 40.
– Người da đen có tỷ lệ bệnh và tỷ lệ tử vong cao gấp 3 lần da trắng, tỷ lệ bệnh cao theo thứ tự: da đen, Châu Á, da trắng.
♦ Bằng chứng về tự miễn :
– Trong thể dịch bệnh nhân có nhiều tự kháng thể: kháng thể kháng nhân, kháng thể kháng acid nhân (AND, ARN), kháng các huyết cầu (hồng cầu, bạch cầu, tiểu cầu).
– Lượng bổ thể giảm rõ rệt trong máu (CH50, C3, C4), phản ứng BW dương tính giả, phát hiện các phức hợp miễn dịch trong máu và tổ chức.
– Tỷ lệ Limpho B và T thay đổi trong máu.
– Có thể gây bệnh trên súc vật bằng phương pháp miễn dịch.
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5c/. Pemphigus :
Pemphigus là một nhóm bệnh bọng nước tự miễn dịch hiếm gặp của da và (hay) các niêm mạc. Pemphigus không lây – thậm chí khi tiếp xúc máu.
Thông thường hệ thống miễn dịch của cơ thể tạo ra các kháng thể tấn công những virus và vi khuẩn có hại trong nỗ lực nhằm giữ cho cơ thể khoẻ mạnh. Tuy nhiên, ở một người mắc bệnh pemphigus, hệ thống miễn dịch nhận định nhầm các tế bào ở da và/hay các niêm mạc là những vật chất lạ, và tấn công chúng. Các kháng thể tấn công các tế bào của chính cơ thể mình được gọi là những tự kháng thể. Trong pemphigus, tế bào bị tấn công tại những cầu nối desmosome. Các desmosome là cầu nối giữa những tế bào gai giữ cho da nguyên vẹn.
Khi những tự kháng thể tấn công các desmosome, các tế bào gai bị chia tách, dịch gian bào tập trung tại vị trí tổn thương hình thành bọng nước. Điều này gây nên thương tổn giống như bị bỏng hay vết rộp không lành lại. Ở một số rường hợp, những vết rộp đó có thể chiếm một vùng rộng trên cơ thể.
Có nhiều loại pemphigus, và chẩn đoán bệnh sớm là một điều quan trọng. Dù có thể có tính chất di truyền và một số nhóm người có thể có nguy cơ cao hơn về căn bệnh này, thì bệnh không có vẻ ảnh hưởng tới những người theo đặc trưng chủng tộc và phạm vi văn hoá, vì thế không thể nói rằng ai sẽ có thể mắc bệnh pemphigus. Bệnh có thể điều trị và có những hỗ trợ để người bệnh có thể sống chung với bệnh, gồm cả thông tin về dinh dưỡng và chăm sóc.
Bởi vì là một bệnh hiếm, pemphigus thường là điều cuối cùng người ta nghĩ tới khi chẩn đoán bệnh. Cần hỏi ý kiến một thầy thuốc da liễu nếu có bất kỳ thương tổn da hay miệng kéo dài nào. Chẩn đoán sớm có thể cho phép điều trị thành công với mức độ sử dụng thuốc thấp.
Có ba tiêu chí cho một chẩn đoán xác định Pemphigus:
Khám bệnh tại bệnh viện — khám bằng mắt về những tổn thương da.
Sinh thiết thương tổn — Lấy một mẫu da rộp và khám nghiệm bằng kính hiển vi để xác định xem tế bào có bị phân chia theo cách đặc trưng của pemphigus. Ngoài ra, lớp da có hiện tượng chia tách tế bào có thể được xác định.
Huỳnh quang miễn dịch trực tiếp (direct immunofluorescence) — Mẫu sinh thiết da được xử lý để để phát hiện các tự kháng thể kháng desmosome của da. Sự hiện diện của các tự kháng thể đó cho thấy dấu hiệu của pemphigus.
Ngoài những điều trên, một xét nghiệm chẩn đoán khác cũng có thể được sử dụng, được gọi là huỳnh quang miễn dịch gián tiếp hay xét nghiệm hiệu giá tự kháng thể. Xét nghiệm này xác định các tự kháng thể kháng desmosome trong huyết thanh máu. Nó có thể được dùng để xác định rõ hơn về mức độ bệnh. Ngoài ra, một thử nghiệm huyết thanh về các tự kháng thể desmoglein, được gọi là ELISA, cũng có thể được thực hiện. Nó là biện pháp chính xác nhất, tuy nhiên không phải tất cả các phòng thí nghiệm đều thực hiện được xét nghiệm này.
Các dạng pemphigus
Có nhiều dạng pemphigus. Ba dạng chính là pemphigus vulgaris, pemphigus foliaceus, và paraneoplastic pemphigus.
Pemphigus Vulgaris (PV)
Thuật ngữ “vulgar” có nghĩa “thông thường,” và PV là dạng thường được chẩn đoán nhất của pemphigus. Những chỗ đau và rộp da luôn xuất hiện đầu tiên ở miệng. Bởi vì da là một cơ quan của cơ thể nên PV được gọi là bệnh đơn cơ quan. Nó không gây ảnh hưởng gì tới các cơ quan bên trong. Những vết rộp có thể lan tới dây thanh quản, nhưng không thể xa hơn. PV không gây ra sẹo vĩnh viễn trừ khi có sự nhiễm trùng ở vị trí thương tổn. Trong kiểu bệnh này, các tự kháng thể tấn công protein “keo”, là chất giữ các tế bào da dính với nhau, được gọi là desmoglein. Các thương tổn rất đau đớn. Thỉnh thoảng có xuất hiện hiệu ứng Nikolsky, chỉ cần chạm vào da cũng đủ khiến nó rách ra. Trước kia, khi chưa được điều trị bằng thuốc, PV gây ra tỷ lệ tử vong 99%, nhưng với các liệu pháp chữa trị hiện nay, tỷ lệ tử vong giảm xuống chỉ còn 5 đến 15%
Pemphigus Foliaceus (PF)
Ở loại pemphigus foliaceus này, các vết rộp và đau không xuất hiện ở miệng. Những vảy cứng đau nhức hay những vết rộp dễ vỡ thường xuất hiện đầu tiên trên mặt và da đầu và sau đó lan xuống ngực và lưng.
Các tự kháng thể được hệ miễn dịch sản xuất ra nhưng chúng chỉ liên kết với desmoglein 1. Các vết rộp rất nông và thường gây ngứa, nhưng không gây đau đớn như PV.
Đối với PF, thương tổn gây biến dạng da có thể xảy ra, nhưng tỷ lệ tử vong của kiểu bệnh này thấp hơn so với PV.
Paraneoplastic Pemphigus (PNP)
PNP là kiểu pemphigus nguy hiểm nhất. Nó thường xảy ra với những người có tiền sử chẩn đoán mắc một bệnh ác tính (ung thư). Tuy nhiên, nó lại là tuýp bệnh ít xảy ra nhất. Nó luôn xuất hiện những thương tổn đau đớn trong miệng, môi và thực quản, và xảy ra thương tổn da theo nhiều kiểu. PNP có thể gây ảnh hưởng đến phổi. Trong một số trường hợp việc chẩn đoán bệnh có thể khiến các bác sĩ phải lưu ý tìm kiếm một khối u ẩn. Một số trường hợp khối u là lành tính và tình trạng bệnh sẽ được cải thiện nếu khối u được loại bỏ bằng phẫu thuật.
Dạng bệnh này hiếm khi xảy ra và trông nó rất khác biệt so với những hình thái pemphigus khác. Các tự kháng thể trong máu cũng khác biệt và sự khác biệt đó có thể được xác định bằng các xét nghiệm.
———-Wambuakim———-
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