皮膚科醫生常見皮膚疾病 – 帶狀泡疹（生蛇）。
32歲女士左側腋窩美容問題前來求診.之前,數年來由於腋毛過盛拔毛而引起腋下皮膚色素沉着,因此後來到美容院行激光脫毛術.幾次激光治療後,她發覺左側腋下很多丘疹(多過60粒),右側只有幾粒(少過10粒), 不癢. 皮膚檢查發現為單一形態的毛囊性丘疹,皮色至黄色,直徑1~2mm,並無黑頭粉刺或化膿.
1979年Giacobeti報告外用0.1%Tretinoin cream 成功. 1990年Casani報告外用0.5%Tretinoin cream. 1995年Miller等報告外用Clindamycin溶液治療福-福氏病.也有報告指可用高雌激素的口服避孕葯, 雌激素葯膏或睪丸素葯膏. 2006年Pock氏等報告使用Pimecrolimus治療三名年青女性有效. Chae氏等報告作刮除手術.
This was a lady who had thick axillar hair and she plucked the hair. She did this regularly for a few years. She said this caused hyper-pigmentation of her axillar skin (but not papules) and so she went to a beauty salon to have laser removal of her axillar hair. After a few treatments of laser removal, she found there were numerous skin papules on her left axilla (more than 60). There was just a few papules (less than 10) on her right axilla. The papules were not itchy. They were monomorphic, follicular, skin-colored to yellow papules (1-2 mm in diameter). There were no comedones. There were no pustules because nothing could be squeezed out from the papules.
FACT AND NATURE OF THE DISEASE:
Literature : Michael T. Tetzlaff, MD, PhD; Katherine Evans, MD; Danielle M. DeHoratius, MD; Rochelle Weiss, MD; George Cotsarelis, MD; Rosalie Elenitsas, MD. Fox-Fordyce Disease Following Axillary Laser Hair Removal . Arch Dermatol. 2011;147(5):573-576. doi:10.1001/archdermatol.2011.103.
Fox-Fordyce disease (FFD) is a relatively rare entity with a typical clinical presentation. Numerous studies have described unifying histopathological features of FFD, which together suggest a defect in the follicular infundibulum resulting in follicular dilation with keratin plugging, subsequent apocrine duct obstruction, and apocrine gland dilation, with eventual extravasation of the apocrine secretions as the primary histopathogenic events in the evolution of the disease.
Because defective infundibular maturation has been suggested to play a central role in the evolution of FFD, the close temporal relationship of laser hair therapy with the development of FFD suggests a causal role.
So here, my case is a cosmetic problem (non itchy, asymptomatic papules) caused by a cosmetic problem (thick axillar hair needing laser epilation).
It’s not too difficult to find the various evidence supported treatments in the internet.
Medical therapy for Fox-Fordyce disease has been complicated by the irritant potential of the topical medications. Topical steroids have not been useful. Topical retinoids have been irritating, which has limited their long-term use. In 1979, Giacobeti reported success with topical 0.1% tretinoin cream. In 1990, Casani reported treatment with topical 0.5% tretinoin cream. In 1995, Miller et al reported treatment of Fox-Fordyce disease with topical clindamycin solution.
Hormonal therapy for Fox-Fordyce disease with high-estrogen oral contraceptives, estrogen creams, and testosterone creams has been reported.
In 2006, Pock et al reported effective therapy, with no adverse effects, using pimecrolimus in 3 young female patients.
Chae et al reported treatment of Fox-Fordyce disease with liposuction-assisted curettage.
MY APPROACH TO THE SKIN DISEASE:
The problem is caused by laser epilation which disrupts the infundibular maturation and leading to apocrine duct obstruction, apocrine gland dilation, with eventual extravasation of the apocrine secretions. Instead of aggressive approach to the problem (ie. oral isotretinoin or surgical treatment), I would like to continue the topical treatment (ie topical adapelene, topical clindamycin, plus topical pimecrolimus) and to wait for the condition to improve/subside. Afterall, the cause is the stimulation (side-effect) of laser, it is possible that the after effect of laser will wane off after a few months’ time, and the condition will improve spontaneously.