Tas S
Service de Dermatologie, Hôpital Erasme, U.L.B.
Rev Med Brux. 2000 Sep;21(4):A257-65.
Residents of western countries travel more and more to (sub)tropical areas for holidays or work. During their stay they come in contact with insects and parasites susceptible to induce skin disorders that can manifest during their stay or after returning. This dermatosis account for approximatively 10% of referral to outpatient tropical clinics. The aim of this paper is to provide family physicians not familiar with these pathologies some practical guidelines to help them to identify and treat some tropical dermatosis: cutaneous larva migrans, cutaneous leishmaniasis, Lyme disease, rickettsiosis. Cutaneous larva migrans is the most frequent serpiginous itching eruption observed in travellers. It is cause by transepidermal penetration of animal hookworms (ancylostomas) through contact with soil infested with cat and dog feces. Effective treatments include topical thiabendazole or oral albendazole or ivermectine. Persons visiting mediterranean countries can acquire cutaneous leishmanisis that has many clinical presentations; the most typical is "bouton d'Orient", which manifests as painless ulceration resistant to antibiotic treatment. Treatment with intralesionel pentavalent antimony or pentamidine injection are effective. Lyme disease is an endemic infection in certain areas of North America and Europe, caused by the spirochete borrelia and transmitted through tick bite. It manifest as non-itching large persistent migrant erythema. If untreated this infection may expose to chronic debilitating rheumatologic, cardiac and neurological complications. Rickettsiosis, especially boutonneuse fever, are a potentially fatal multisystemic infectious diseases transmitted through the bite of a dog tick. Diagnosis must be evoked in the presence of a brutal fever syndrome, a painless eschar and widespread eruption associate to systemic symptoms. This infection must be recognized clinically in order to begin rapidly treatment with cyclines.
西方国家的居民越来越多地前往（亚）热带地区度假或工作。在逗留期间，他们会接触到一些昆虫和寄生虫，这些昆虫和寄生虫易引发皮肤疾病，这些疾病可能在逗留期间或返回后出现。这类皮肤病约占热带门诊转诊病例的10%。本文旨在为不熟悉这些病症的家庭医生提供一些实用指南，以帮助他们识别和治疗一些热带皮肤病：皮肤幼虫移行症、皮肤利什曼病、莱姆病、立克次体病。皮肤幼虫移行症是旅行者中最常见的匐行性瘙痒性皮疹。它是由动物钩虫（钩虫属）经表皮穿透，通过接触被猫和狗粪便污染的土壤引起的。有效的治疗方法包括外用噻苯达唑或口服阿苯达唑或伊维菌素。前往地中海国家的人可能会感染皮肤利什曼病，该病有多种临床表现；最典型的是“东方疖”，表现为对抗生素治疗有抵抗力的无痛性溃疡。病灶内注射五价锑或喷他脒治疗有效。莱姆病是北美和欧洲某些地区的一种地方性感染，由螺旋体伯氏疏螺旋体引起，通过蜱叮咬传播。它表现为无瘙痒的大型持续性游走性红斑。如果不治疗，这种感染可能会导致慢性衰弱性的风湿、心脏和神经并发症。立克次体病，尤其是南欧斑疹热，是一种潜在致命的多系统传染病，通过犬蜱叮咬传播。在出现突发发热综合征、无痛性焦痂和伴有全身症状的广泛皮疹时，必须考虑到诊断。为了迅速开始用四环素治疗，必须在临床上识别这种感染。
