๐Ÿ—‚ ็ธฝ็›ฎ้Œ„ ๏ฝœ ๐Ÿ“– ่‹ฑๆ–‡ๅŽŸๆ–‡ ๏ฝœ ๐Ÿ“ ๅฎŒๆ•ด็ฟป่ญฏ๏ผˆๆœฌ็ฏ‡๏ผ‰ ๏ฝœ โญ ็ฒพ่ฏ็ญ†่จ˜

Lithium

Lithium

่‡จๅบŠ็‰นๅพต (Clinical Features)

่‡จๅบŠ็‰นๅพต lithium ๆฒป็™‚ๅœจ้ซ˜้”็™พๅˆ†ไน‹ๅ››ๅไบ”็š„็—…ไบบไธญ่ˆ‡็šฎ่†šๅ‰ฏไฝœ็”จ็›ธ้—œใ€‚ๅฎƒๅทฒ็Ÿฅๆœƒ่ช˜็™ผๆˆ–ๅŠ ้‡ไนพ็™ฌ (psoriasis)๏ผŒๅฐคๅ…ถๆ˜ฏ่†ฟ็–ฑๆ€ง็—…็ถใ€‚ๅ…ถไป–็šฎ่†šไธ่‰ฏๅๆ‡‰ๅŒ…ๆ‹ฌๆ–‘ไธ˜็–น (maculopapular eruptions)ใ€่„‚ๆผๆ€ง็šฎ่†š็‚Ž (seborrheic dermatitis)ใ€ๅ‰่„ซๆ€ง็šฎ่†š็‚Ž (exfoliative dermatitis)ใ€้žๅ…ธๅž‹็—ค็˜กๆจฃ็—…็ถ (atypical acneiform lesions)๏ผˆไธป่ฆไพต็Šฏๅ‰่‡‚่ˆ‡ๅฐ่…ฟ๏ผ‰ใ€่†ฟ็–ฑๆ€ง็–น (pustular eruptions)ใ€ๅŒ–่†ฟๆ€งๆฑ—่…บ็‚Ž (hidradenitis suppurativa)ใ€ๆฏ›ๅ›Š่ง’ๅŒ–็—‡ๆจฃ็—…็ถ (keratosis pilaris-like lesions)ใ€ๆŽŒ่น ่ง’ๅŒ–้Žๅบฆ (palmoplantar hyperkeratosis)ใ€ๆฐด็–ฑๆ€ง็–พ็—… (bullous disorders)๏ผŒไปฅๅŠๆฏ›้ซฎใ€ๆŒ‡็”ฒ่ˆ‡้ป่†œ็š„่ฎŠๅŒ–ใ€‚ๆ›พๆœ‰็ฝ•่ฆ‹ๆ–‡็ป่จ˜่ผ‰ Darier disease ็š„ๆƒกๅŒ–่ˆ‡็™ผ็”Ÿใ€‚

่‡จๅบŠ็‰นๅพต (Clinical Features)

่‡จๅบŠ็‰นๅพต bismuth ๅฏ็”จๆ–ผ่ƒƒ่…ธ้“ไธ้ฉ๏ผŒๅŒ…ๆ‹ฌ่ƒƒ็‚Ž (gastritis) ่ˆ‡ๆถˆๅŒ–ๆ€งๆฝฐ็˜ (peptic ulceration)ใ€‚็šฎ่†šไธ่‰ฏๅๆ‡‰ๅŒ…ๆ‹ฌ็ด…็šฎ็—‡ (erythroderma)ใ€็™ผ็–น (exanthemata)ใ€็ดซ็™œๆ€ง็–น (purpuric eruptions)ใ€ๅฃ่…”็‚Ž (stomatitis)ใ€่•้บป็–น (urticaria)ใ€็ถฒ็‹€้’ๆ–‘ๆจฃ็šฎ่†š็‚Ž (livedo-like dermatitis)ใ€็Žซ็‘ฐ็ณ ็–นๆจฃ็šฎ่†š็‚Ž (pityriasis rosea-like dermatitis)๏ผŒไปฅๅŠๅฐๅซ bismuth ไน‹ๅค–็”จๆฒป็™‚็”ข็”Ÿ็š„้Žๆ•ๆ€งๆŽฅ่งธๆ€ง็šฎ่†š็‚Ž (allergic contact dermatitis)ใ€‚้•ทๆœŸ้ž็ถ“่…ธ้“ (parenteral) ่ˆ‡ๅฃๆœไฝฟ็”จๅพŒๅฏ่ƒฝ้šจไน‹ๅ‡บ็พๅ…จ่บซๆ€ง่‰ฒ็ด ๆฒ‰่‘—ใ€‚็—…ไบบๆœƒๅ‡บ็พๅ…จ่บซๆ€ง่—็ฐ่‰ฒ่‰ฒ็ด ๆฒ‰่‘—๏ผŒไบฆๆœƒไพต็Šฏ็ต่†œ (conjunctivae) ่ˆ‡ๅฃ่…”้ป่†œใ€‚็‰™้ฝฆ็ทฃ่™•็š„่—้ป‘่‰ฒ็ทš (blue-black line) ็‚บ่จบๆ–ท็‰นๅพตๆ€ง็š„ (pathognomonic)ใ€‚ไบฆๆ›พๆœ‰ๆšซๆ™‚ๆ€ง่ˆŒ้ƒจ้ป‘่‰ฒ็ด ๆฒ‰่‘— (transient black lingual pigmentation) ็š„ๅ ฑๅ‘Šใ€‚

็ต„็น”็—…็†็‰นๅพต (Histopathology)

็ต„็น”ๅญธ็‰นๅพต bismuth ๅœจ็œŸ็šฎ (dermis) ๅ…งๅŠๆฑ—่…บๅŸบๅบ•่†œ (sweat gland basement membranes) ๅ…งๅ‘ˆ็พ็‚บๅฐๅž‹ๆทฑ่‰ฒ้ก†็ฒ’ใ€‚ๆ›พๆœ‰็ถ“ๆฏ›ๅ›ŠๆŽ’้™ค (transfollicular elimination) ็š„ๆ–‡็ป่จ˜่ผ‰ใ€‚