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臺大醫院皮膚科主治醫師
醫美常常會引起許多醫療糾紛
Oct 05,2017
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臺大醫院皮膚科主治醫師
蔡呈芳 醫師

Oct 05,2017

醫美治療都有風險,產品不是貴的東西就比較好,有時也會產生副作用,所以要誠實跟醫師說自身情況,有利醫師做評估。
Talk1
在去年一整年當中,在醫美當中做了很大的努力,在台灣醫美在醫療糾紛排行是相當前面的一個部分,而且大部分都私底下解決,並沒有真正鬧到醫療糾紛,因為大多數的醫美很少會引起死亡的個案,絕大多數是不同程度的損害,最駭人聽聞大概是注射美容產品後瞎掉,也因為瞎掉某..
Talk2
Q:我女兒今年47歲,都自己煮,吃蔬菜水果都滿健康的,可是她就是有樹枝狀的蕁麻疹,晚上睡覺給她吃,看過兩次門診,可是停藥之後又發作,癢得不得了,請問該怎麼樣再做治療?A:急性的蕁麻疹有一部分,是在發作之前或之後有一些特定的原因,包括一些感染症狀,呼吸道感..
Talk3
Q:淚溝的凹陷會造成陰影的部分,目前填補材料有哪一些?各有甚麼優缺點?A:淚溝的形成有很多區分,因為淚溝的定義有點不太一致,一般講淚溝是從內側眼角一直往下延伸,大致上是沿著下眼眶的骨骼這樣的皺褶,就形成淚溝,可以往下一直到眼睛的下緣,甚至可以到顴骨部分..
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提問日期:2018年02月18日
 
Q
手腳很容易流汗該怎麼辦?
提問日期:2014年04月01日
A
問題分析:
手腳容易出汗是體質性,我們常說是原發性的局部多汗症。有些工作不適合做,像是會碰觸到電器。手部出汗是可治療,一般分為三個不同等級的嚴重度,第一就是摸起來濕濕的,可以在睡前用一些止汗劑,這種期況大多數是可控制的。第二就是手上偶爾會看到小水珠,這種期況下止汗劑有時候還是可以用,如果止汗劑的效果不好,可以做醫學上的離子導入療程,埋通電的東西讓汗腺、水分被電解而產生離子,再把汗腺的開口做表面性的塞除。不過這是需要持續性治療的方式,至少一個星期要做一次來維持,是比較麻煩,但約九成的病人都是有效。第三如果使用離子導入療程沒效果,就要用局部肉毒桿菌素,把可以抑制神經末梢的物質(肉毒桿菌素)打入,達到治療的目的。更嚴重的話就需要把交感神經切除。

蔡呈芳 醫師

答覆日期: 2014年04月01日

 
Q
惡性的黑色素瘤如果移轉,有什麼積極治療的方式?
提問日期:2014年04月01日
A
問題分析:
在國外有很多的藥物再做治療,都是從身體免疫性上的治療到化療,或是標靶治療都相當的多。可是這些藥物都相當的昂貴。惡性黑色素腫瘤在台灣發生的機會相當的低,在台灣,其實沒有美國被核准的藥物上市。因此,在台灣惡性黑色素腫瘤主要的治療方式是手術。如果已經轉移,通常會先跑到淋巴結裡,這種情況下,醫師可能會做淋巴節的切除。除了單純切除的方式,也有醫師會建議對特定的部位做放射線的治療。比較積極一點的治療方法是用生物活性的物質,最早以前都是用干擾素治療,但是在使用時效果很好,停掉後效果也跟著消失。另外,還有一種第二型介白素,對人體的T淋巴細胞廣泛性免疫細胞提升的藥物。但是這樣得治療有效率不到兩成,而且在打的過程中會感覺好像全身重感冒一樣。

蔡呈芳 醫師

答覆日期: 2014年04月01日

 
Q
手上姆指和中指有點灰指甲的現像,最後檢驗肝臟有小水泡,不適合用口服的藥物,所以醫師就開療黴舒,可是這個藥效果沒有很明顯,請問我的手可以常用酒精洗手嗎?對灰指甲有沒有影響?
提問日期:2014年04月01日
A
問題分析:
指甲周圍的表皮是比較脆弱的,如果指甲周圍並沒有浮腫、翹起來的情況,使用酒精是沒有差別。但是酒精本身無法殺死霉菌。但是如果手有霉菌感染,通常腳上也會有。如果只有手上有的話,可能不一定是黴菌感染,可能是慢性的甲溝炎,引起指甲發炎,然後引起指甲變型。

蔡呈芳 醫師

答覆日期: 2014年04月01日

 
Q
頭皮毛囊阻塞,有看過醫師,天天洗頭,還是不會好,請問頭皮水有用嗎?
提問日期:2014年04月01日
A
問題分析:
頭皮是人皮膚相當特殊的部位,基本上沒有頭皮是完全健康的。只要有毛髮存在,就容液分泌皮垢、油脂,在加上一個半密閉的環境就很容易引起頭皮或是毛囊的發炎。有些微生物特別會長在頭皮裡面,頭上的微生物是人全身上下密度最高的部位,所以很容易引起潛在發炎的現象。

問題建議:
這種發炎現象,有些人會有頭皮屑,有些人可能引起掉頭髮,有些人會引起毛囊發炎。所以常常不是一個特定的病菌存在。頭上的微血管循環太好,一定有輕微的發炎,人的發炎細胞很快就會過去,而且有很多微生物,是可以達到生態的平衡,所以返而不太容易有大的發炎出現。讓頭皮的發炎次數減少要從各個層面去做,第一要減少微生物的增生,要有適當的免疫力;第二要作適當的清潔,一方面把細菌洗掉,一方面把多的油脂洗掉。所以清潔頭皮的速度看要使用的產品還有本身頭髮油脂的程度。另外,盡量不要摳頭皮,因為摳頭皮會引起發炎現象。如果本身有過敏性的體質,可能頭套要常做換洗的動作,有時候光清潔還不夠,要稍微煮一下。雖然清潔重要,但也不宜過度。在急性的控制上,要看發炎的種類,如果毛囊發炎壓下去會痛,會傾向用殺菌方式做處理;如果毛囊是會癢,會傾向用消炎的方法做處理,也有兩種作交互性的處理。
蔡呈芳 醫師

答覆日期: 2014年04月01日

 
Q
醫師您好, 上個月確定雙腳感染灰指甲合併輕微香港腳, 在中壢某自費門診皮膚診所就醫, 已用藥六週(內服及擦藥)大約花費4000元, 昨天回診醫生說必須服藥一年才會好, 但是原本一天吃兩次藥, 現改為一天一次(GRISEOCIN 500MG/TAB、SWEICON TAB、VESYCA 150MG/TAB 各一顆; KETOZOL擦藥一天一次), 醫生解釋他採用的是最古老的療法,藥性比較不傷肝,灰指甲必須服藥一年是因為必須灰指甲整塊長出完整新指甲才算痊癒, 一般健保給付灰指甲藥會傷肝只有給付三個月。 請教您; 以上說法正確嗎? 我所服用的藥持續吃一年沒問題嗎? 需要換教學醫院健保給付用藥嗎? 另外我因為曾經有胃食道逆流病史, 但是已在長庚服用過耐適恩三個月治療後目前狀況正常, 但是我的內服藥有兩種胃藥, 請問治療灰指甲需要加胃藥嗎? 謝謝你撥空解答...謝謝! Tracy
提問日期:2013年07月19日
 
Q
您好, 因為工作需要長時間走動及站立,目前左右腳底板和腳跟,於起床後會有疼痛感,而長時間站立後也會有相同情況,請教需要至醫院看哪科門診? 須注意些什麼事項?
提問日期:2013年07月12日
 
Q
您好!我的左腿小腿(左半部與後半部)走一段路或久站就會酸麻,這是甚麼問題呢?我應該去看那一種門診或檢查呢?謝謝!
提問日期:2013年07月09日
 
Q
我爸爸他最近鼻塞, 眼睛就紅紅腫腫的 跟鼻塞有關西嗎?
提問日期:2013年06月27日
 
Q
最近一週右腳從大腿到腳掌都會麻麻的,左腳腳掌也會麻,不知怎會如此?該看哪一科?
提問日期:2013年05月21日
A
問題建議:
這個症狀看起來比較不像是皮膚問題,依您描述的情況,需先瞭解您本身是否患有糖尿病,又或者是神經被壓迫到,甚至有可能是骨刺造成的影響,如果患有糖尿病可以到新陳代謝科就診,沒有的話則建議到神經外科尋求醫師建議。
蔡呈芳 醫師

答覆日期: 2013年05月22日

 
Q
洗髮精對生髮有沒有幫助?
提問日期:2013年03月18日
A
問題分析:
雄性禿的治療主要是防止毛髮變細,脫落。洗髮精對於雄性禿的幫助主要是預防雄性禿病人頭皮屑的問題所引起的掉髮,直接的生髮效果相當薄弱,所以主要是輔助的作用。

問題建議:
假設有頭皮屑的雄性禿患者在挑選洗髮精時,會建議使用良好、有臨床實驗的抗屑洗髮精(EX:仁山利舒、海倫仙度絲)。
蔡呈芳 醫師

答覆日期: 2013年03月25日

 
Q
頭髮有生命週期,洗頭時會掉髮是因為生命週期到了還是因為拉扯的關係?洗頭有時掉髮多有時掉髮少是什麼原因呢?
提問日期:2013年03月18日
A
問題建議:
頭髮一般分成三到五個週期,生長期、衰退期、休止期。頭髮週期會因為很多因素而改變,例如年齡、身體的狀態、頭皮發炎的情形、天氣。休止期的頭髮約占頭髮的10%~15%,休止期過後會開始掉髮,掉髮後有些會再長出來有些不會。因為休止期或脫落期的頭髮會有一些黏著性,洗髮時把頭皮清潔乾淨,黏著性會消失,就會有掉髮。但這並不會改變頭髮生長期的構造,只是讓脫落期的頭髮更容易脫落下來。對東方人而言,每天50根掉髮是屬於正常的數值。
蔡呈芳 醫師

答覆日期: 2013年03月25日

 
Q
頭髮變細後,左邊額頭髮線有向後的現象,醫生診斷是圓禿,給我擦topsym的藥,擦了半年好像有效果又好像沒有,這種藥是否有效?使用方法要如何比較好?
提問日期:2013年03月18日
A
問題建議:
圓禿目前認為是發炎性的掉髮,一般來說topsym算是中強效的類固醇,是利用類固醇的副作用來治療,因為類固醇在使用當中會產生局部多毛症的現象,同時會伴隨頭皮變薄,血管擴張。Topsym屬於外用的東西,和頭皮在擦藥時的狀態有關,例如剛洗完頭,頭皮含水量高,藥的吸收性較好,但副作用也會比較高,可以在睡前使用效果會比較好。
蔡呈芳 醫師

答覆日期: 2013年03月25日

 
Q
年紀不大但是有很多白髮,朋友介紹一種昂貴的東西擦,會使頭髮長出來是黑的,請問這個可信嗎?
提問日期:2013年03月18日
A
問題建議:
頭髮變白有幾種原因,一種是白斑的症狀影響到頭皮,治療方式用光療;另一種是黑頭髮容易受到破壞,可能導致一夜變白的情況,治療方式用類固醇;第三種是毛髮的黑色素細胞死亡,只能以染髮方式解決。
蔡呈芳 醫師

答覆日期: 2013年03月25日

 
Q
手一直脫皮,用醫師給的藥膏也沒什麼效果,應該怎麼做比較好?
提問日期:2013年03月18日
A
問題建議:
沒找到原因的治療,只能讓症狀暫時舒緩。建議讓手盡量休息(若洗頭會讓手脫皮,請家人幫忙),與醫師詢問應如何保養與發病原因,針對病因治療。
蔡呈芳 醫師

答覆日期: 2013年03月25日

 
Q
沒有頭皮屑,卻有頭皮乾癢的症狀。兩天洗一次頭,會不會容易掉髮?
提問日期:2013年03月18日
A
問題建議:
掉髮有兩種觀念。1.退化性掉髮2.生長週期改變的掉髮。一般對於沒有雄性禿體質的病患是第二種情況,只要把生長週期調回正常,頭髮該長的會長回來。用溫和性的洗髮精,溫水(不建議冷水),清洗時用指腹。找醫師尋找乾癢原因處理問題。
蔡呈芳 醫師

答覆日期: 2013年03月25日

 
Q
從床上摔下來,造成右小腿紅腫,醫師說是血塊要用熱毛巾敷。後來回診說已經是蜂窩性組織炎轉診到感染科,感染科說是過敏,換了一個藥膏使用,後來上網看,有人說表面好了不代表裡面好,可能會造成嚴重的後果,那我應該怎麼辦?
提問日期:2013年03月18日
A
問題分析:
本身感染的症狀也許有,更可能本身有接觸性皮膚炎。如果真的是蜂窩性組織炎,擦藥的效果不好,雖然有些口服抗生素會過敏,還是需要找適當藥物使用。

問題建議:
需要先確定蜂窩性組織炎的可能性,在醫學上有很多疾病看起來很像蜂窩性組織炎,但治療方法並不相同。需找專業皮膚科醫師處理。
蔡呈芳 醫師

答覆日期: 2013年03月25日

 
Q
頭皮上面有一粒一粒的,看過醫師說是脂肉性皮膚炎,擦過藥膏也吃過抗生素,但都時好時壞。有時候摸起來會痛,到下午的時候會油且有味道,生理期來的時候會更嚴重。
提問日期:2013年03月18日
A
問題分析:
在醫學上這是一種合併症(毛囊炎與脂肉性皮膚炎),生理期抵抗力下降所以會變得比較嚴重。

問題建議:
做一些去油的清潔,一些靠油的生長的細菌會減少,頭皮發炎的情況會好一些。若你的頭皮是以毛囊炎為主,細菌量高,可以使用抗屑洗髮精、口服抗生素,最根本的方法還是正常的生活作息,不要熬夜、想太多、盡量放鬆情緒、調適壓力、充足睡眠,對本身的抵抗力有幫助。
蔡呈芳 醫師

答覆日期: 2013年03月25日

 
Q
小孩子嘴角上長白斑,去醫院驗過血沒有內分泌的問題,有內固醇的藥劑來擦,還有什麼可以做的治療嗎?
提問日期:2013年03月18日
A
問題分析:
白斑是指不經過皮膚發炎狀態色素就不見、死掉的疾病,色素系統有兩種,一個是表皮的,另一種是毛髮的。毛髮的色素系統比較不受白斑影響。

問題建議:
治療的目的是兩個,一、抑制白斑細胞繼續破壞,二、誘使毛髮黑色素細胞轉移出來。 治療方法第一種,使用消炎藥物(內固醇),能抑制發炎現象,黑色素細胞會填滿空隙。 第二種,使用光療方法,促進黑色素細胞移動,去佔領已經變白的皮膚。(不過皮膚比較容易老化),越早治療,得到有效治療的機會較高。
蔡呈芳 醫師

答覆日期: 2013年03月25日

 
Q
吃黑芝麻,頭髮真的會變黑嗎?白頭髮拔掉會產生黑髮嗎?
提問日期:2013年03月18日
A
問題分析:
有爭議存在,白頭髮是黑色素細胞的分化跟受損,有所謂的過渡期。整體而言頭髮變白是不可逆的,不可能變黑。食療例如:黑芝麻、何首烏,有效屬意外,無效是正常。

問題建議:
飲食增加頭髮變黑的機率不高,頭髮本身是蛋白質組成的,顏色深淺跟粗細有關,蛋白質豐富,頭髮比較黑也比較粗。
蔡呈芳 醫師

答覆日期: 2013年03月25日

 
Q
家族有先天免疫系統不全的問題,有灰指甲很多年,不想吃口服藥但擦藥都沒效,放著不管會如何?
提問日期:2013年03月18日
A
問題分析:
灰指甲可能是傳統的皮癬菌,有些是念珠菌感染,指甲的甲母質及生長點都受到傷害,治療中需用很強的口服滅菌才有效。若是灰指甲感染非傳統黴菌感染,即指指甲非全黑還有部分正常,擦藥是一種方法,有人是用雷射治療,即是改變波長及時間,達到熱傷害把黴菌燒死,對人的組織可以產生保護不會有傷害,美國已核准但台灣還不行。

問題建議:
指甲功能,美觀、保護、拿東西,社交障礙,若有慢性感染會產生微小傷口,對正常人可能沒什麼影響,但對免疫力較缺乏的患者,例如:糖尿病患者,細菌從黴菌感染的傷口進去,引起蜂窩性組織炎形成。另外灰指甲菌掉到其他皮膚,不管是對自己或他人,是一個新的傳染源,所以還是建議治療較好。
蔡呈芳 醫師

答覆日期: 2013年03月25日

 
Q
81歲,耳朵後長一粒一粒頸部下方也有,越來越多,看皮膚科醫生說是皮脂腺增生無藥醫,要怎麼辦?
提問日期:2013年03月18日
A
問題建議:
皮脂腺增生是老化的過程之一,包含老人斑,年紀大皮脂腺堆積脂肪,不至於沒有藥醫,有人做冷凍治療、燒灼、雷射、動力療法即是塗抹一些特殊的物質和皮脂腺混和後用光線照射燒掉、點藥水、切除,這些都是可接受的治療方式,只是說治療方式是否很優雅,或是否有副作用...等。皮脂腺治療是往內生長比傳統疾病治療在難。
蔡呈芳 醫師

答覆日期: 2013年03月25日

 
Q
小孩指甲不平整,又無長指甲,也不知是否是咬指甲導致,因此是否需要看醫生?
提問日期:2013年03月18日
A
問題建議:
用美工刀做紀錄即發現指甲有無生長。至於咬指甲習慣,改善方法很多,一個一個包起來、責罵、塗抹苦的東西。有些人覺得那是抒發壓力的管道,有可能到達強迫症的狀態,所以整體來說還是觀察後再說。
蔡呈芳 醫師

答覆日期: 2013年03月25日

 
Q
眉毛跟髮線部分很癢,皮膚科說是脂漏性皮膚炎,請問正確的治療方法為何?
提問日期:2013年03月18日
A
問題分析:
脂漏性是指人身上皮脂腺分泌旺盛的地方發炎,是油所孕育出的皮屑芽孢菌或是噬油性的細菌,分解皮脂之後代謝產物引起刺激的情形,所以必須視個人的清潔狀態及皮脂腺分泌情形而定,另有免疫力強弱。

問題建議:
預防上建議使用抗屑洗髮精,例如:海倫仙度絲,減少微生物孳生,盡量睡眠充足、壓力不要過大可減少皮脂腺分泌。最後取決於個人的免疫力,維持正常的免疫力,充分的睡眠不要熬夜,適當的運動正常作息可有效提升免疫力。醫療上常用的是類固醇治療。另外不要去摳它會引起發炎。
蔡呈芳 醫師

答覆日期: 2013年03月25日

 
Q
嘴唇周圍會脫皮發炎,買唇 油來擦,應如何處理?
提問日期:2013年03月18日
A
問題分析:
嘴唇的交界是黏膜層跟非黏膜層的轉換部位,較脆弱的部位,容易因刺激物質引起發炎,包含口水。另外吃的東西比較辛辣的食物也屬刺激物質,也容易引起輕度受損,盡量不要使酸性飲料殘留嘴唇周圍。

問題建議:
清潔習慣,若是比較強的清潔用品,因為皮脂腺分泌少、角質層薄,易引起發炎。使用產品也有關係,油脂的東西保濕效果較差,滋潤性的東西保濕性較好,例如:凡士林比唇油好。油性反而會造成毛囊發炎。刷牙用的牙膏也很重要,有些高含氟的牙膏亦可能造成發炎。用非類固醇的藥膏治療一定要找醫生。
蔡呈芳 醫師

答覆日期: 2013年03月25日

議題綱要
  醫美治療都有風險,產品不是貴的東西就比較好,有時也會產生副作用,所以要誠實跟醫師說自身情況,有利醫師做評估。
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