感染症,とこずれ

Herpes zoster is one of the most common infectious disorders of the skin in the aged. This painful vesicular disease results from reactivation of varicella-zoster virus that persists in the nerve ganglia and may develop a long-lasting post-herpetic neuralgia (PHN) that is often troublesome and difficult to manage especially in elderly patients. Although controversial, treatment with systemic anti-viral agents, such as acyclovir, in the early stage of herpes seems to have made severe PHN less common in the author's experience. Scabies is an infectious skin disease that is caused by parasitic mite Sarcoopes scabiei. In recent Japan, most outbreaks of this disease have occurred in the hospitals or homes for elderly people, probably because the patients, who often suffered dementia and were deserted by his or her family, tended to be move from one hospital to another without appropriate treatment. As they were often treated with topical or systemic corticosteroids being misdiagnosed as dermatitis or pruritus of the aged, it is most important to diagnose these patients correctly in order to prevent the spread of this epidemic disease. Bed sore (Decubitus) is a common problem for bedridden aged people and has been treated mainly by nurses in this country. There have been various treatments indeed, including obviously inappropriate therapy, depending on hospitals until recent years. However, rapid increase in the number of the elderly and the revision of medical insurance system for bedridden aged people now arise not only the interest of medical workers but also business mind of pharmaceutical companies, which is likely to bring about a general agreement and new techniques for the management of bedsore. In this article, the practical management and treatment of these disorders are discussed from a viewpoint of clinical dermatology.