{"id":108688,"date":"2025-01-15T18:30:25","date_gmt":"2025-01-15T11:30:25","guid":{"rendered":"https:\/\/vnras.com\/drug\/?p=108688"},"modified":"2025-01-15T18:30:25","modified_gmt":"2025-01-15T11:30:25","slug":"cac-dau-hieu-o-mong-van-de-ai-cung-nen-doc-qua-mot-lan-cho-biet-vi-thuong-gap-trong-cuoc-song-hang-ngay","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/cac-dau-hieu-o-mong-van-de-ai-cung-nen-doc-qua-mot-lan-cho-biet-vi-thuong-gap-trong-cuoc-song-hang-ngay\/","title":{"rendered":"C\u00e1c d\u1ea5u hi\u1ec7u \u1edf m\u00f3ng, v\u1ea5n \u0111\u1ec1 ai c\u0169ng n\u00ean \u0111\u1ecdc qua m\u1ed9t l\u1ea7n cho bi\u1ebft v\u00ec th\u01b0\u1eddng g\u1eb7p trong cu\u1ed9c s\u1ed1ng h\u00e0ng ng\u00e0y."},"content":{"rendered":"

C\u00e1c d\u1ea5u hi\u1ec7u \u1edf m\u00f3ng t\u01b0\u01a1ng t\u1ef1 nh\u01b0 c\u00e1c d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng tr\u00ean da v\u00e0 vi\u1ec7c nh\u1eadn bi\u1ebft ch\u00fang l\u00e0 b\u1eaft bu\u1ed9c \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n ch\u00ednh x\u00e1c. C\u00e1c d\u1ea5u hi\u1ec7u \u1edf m\u00f3ng th\u01b0\u1eddng li\u00ean quan \u0111\u1ebfn phi\u1ebfn m\u00f3ng, c\u00f3 th\u1ec3 thay \u0111\u1ed5i v\u1ec1 h\u00ecnh d\u1ea1ng, k\u00edch th\u01b0\u1edbc, b\u1ec1 m\u1eb7t v\u00e0 m\u00e0u s\u1eafc ho\u1eb7c c\u00f3 th\u1ec3 t\u00e1ch ra v\u00e0\/ho\u1eb7c nh\u00f4 l\u00ean. B\u1ea5t k\u1ef3 d\u1ea5u hi\u1ec7u n\u00e0o \u1edf m\u00f3ng \u0111\u1ec1u ph\u1ea3n \u00e1nh t\u1ed5n th\u01b0\u01a1ng \u1edf m\u1ed9t ph\u1ea7n c\u1ee5 th\u1ec3 c\u1ee7a \u0111\u01a1n v\u1ecb m\u00f3ng, t\u00f9y theo vai tr\u00f2 c\u1ee7a n\u00f3 trong sinh l\u00fd m\u00f3ng b\u00ecnh th\u01b0\u1eddng.<\/p>\n

D\u1ea5u hi\u1ec7u \u1edf phi\u1ebfn m\u00f3ng c\u00f3 th\u1ec3 \u0111\u01a1n \u0111\u1ed9c ho\u1eb7c k\u00e8m theo nh\u1eefng b\u1ea5t th\u01b0\u1eddng \u1edf v\u00f9ng da quanh m\u00f3ng, g\u1ed3m n\u1ebfp g\u1ea5p m\u00f3ng, r\u00e3nh d\u01b0\u1edbi m\u00f3ng, ph\u1ea7n m\u1ec1m ng\u00f3n v\u00e0 da m\u1eb7t l\u01b0ng ng\u00f3n.<\/p>\n

2.1 S\u1ef1 thay \u0111\u1ed5i c\u1ee7a b\u1ec1 m\u1eb7t m\u00f3ng<\/h2>\n

2.1.1 \u0110\u01b0\u1eddng Beau v\u00e0 s\u1ef1 t\u00e1ch m\u00f3ng \u1edf n\u1ebfp g\u1ea5p m\u00f3ng g\u1ea7n (onychomadesis)<\/h3>\n
\u0110\u01b0\u1eddng Beau bi\u1ec3u hi\u1ec7n d\u01b0\u1edbi d\u1ea1ng v\u1ebft l\u00f5m ngang c\u1ee7a phi\u1ebfn m\u00f3ng, v\u1edbi \u0111\u1ed9 s\u00e2u v\u00e0 chi\u1ec1u d\u00e0i thay \u0111\u1ed5i, l\u00e0 k\u1ebft qu\u1ea3 c\u1ee7a m\u1ed9t t\u1ed5n th\u01b0\u01a1ng t\u1ea1m th\u1eddi c\u1ee7a ch\u1ea5t n\u1ec1n m\u00f3ng g\u1ea7n v\u1edbi s\u1ef1 gi\u1ea3m t\u1ea1m th\u1eddi ho\u1ea1t \u0111\u1ed9ng ph\u00e2n b\u00e0o c\u1ee7a t\u1ebf b\u00e0o s\u1eebng. K\u1ebft qu\u1ea3 l\u00e0 phi\u1ebfn m\u00f3ng m\u1ecfng h\u01a1n b\u00ecnh th\u01b0\u1eddng v\u00e0 xu\u1ea5t hi\u1ec7n m\u1ed9t v\u1ebft l\u00f5m ngang \u1ea3nh h\u01b0\u1edfng to\u00e0n b\u1ed9 chi\u1ec1u r\u1ed9ng c\u1ee7a m\u00f3ng (H\u00ecnh 2.1 v\u00e0 2.2). Kho\u1ea3ng c\u00e1ch t\u1eeb \u0111\u01b0\u1eddng Beau \u0111\u1ebfn n\u1ebfp g\u1ea5p m\u00f3ng g\u1ea7n bi\u1ec3u th\u1ecb th\u1eddi gian ch\u1ea5t n\u1ec1n m\u00f3ng b\u1ecb t\u1ed5n th\u01b0\u01a1ng, x\u00e9t tr\u00ean t\u1ed1c \u0111\u1ed9 t\u0103ng tr\u01b0\u1edfng c\u1ee7a m\u00f3ng l\u00e0 3 mm\/th\u00e1ng \u0111\u1ed1i v\u1edbi m\u00f3ng tay v\u00e0 1 mm\/th\u00e1ng \u0111\u1ed1i v\u1edbi m\u00f3ng ch\u00e2n. C\u00e1c nguy\u00ean nh\u00e2n ph\u1ed5 bi\u1ebfn nh\u1ea5t g\u00e2y ra \u0111\u01b0\u1eddng Beau \u0111\u01b0\u1ee3c li\u1ec7t k\u00ea trong B\u1ea3ng 2.1. Theo nguy\u00ean t\u1eafc, c\u00e1c y\u1ebfu t\u1ed1 t\u1ea1i ch\u1ed7 th\u01b0\u1eddng l\u00e0 nguy\u00ean nh\u00e2n g\u00e2y ra m\u1ed9t \u0111\u01b0\u1eddng Beau \u0111\u01a1n l\u1ebb, trong khi nguy\u00ean nh\u00e2n to\u00e0n th\u00e2n c\u1ea7n \u0111\u01b0\u1ee3c t\u00ecm ki\u1ebfm khi c\u00e1c \u0111\u01b0\u1eddng Beau n\u00e0y li\u00ean quan \u0111\u1ebfn m\u00f3ng tay v\u00e0 m\u00f3ng ch\u00e2n. M\u1ed9t nguy\u00ean nh\u00e2n r\u1ea5t ph\u1ed5 bi\u1ebfn g\u00e2y ra c\u00e1c \u0111\u01b0\u1eddng Beau \u1edf m\u1ed9t s\u1ed1 m\u00f3ng tay \u1edf ph\u1ee5 n\u1eef tr\u01b0\u1edfng th\u00e0nh l\u00e0 do ch\u1ea5n th\u01b0\u01a1ng \u1edf n\u1ebfp g\u1ea5p m\u00f3ng g\u1ea7n khi \u0111\u1ea9y l\u1edbp bi\u1ec3u b\u00ec ra sau trong qu\u00e1 tr\u00ecnh l\u00e0m m\u00f3ng. Trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y, \u0111\u01b0\u1eddng Beau kh\u00f4ng ph\u1ea3i l\u00e0 d\u1ea5u hi\u1ec7u duy nh\u1ea5t \u1edf m\u00f3ng, m\u00e0 nh\u1eefng b\u1ea5t th\u01b0\u1eddng \u1edf n\u1ebfp g\u1ea5p m\u00f3ng g\u00e2n v\u00e0 nh\u1eefng thay \u0111\u1ed5i b\u1ec1 m\u1eb7t phi\u1ebfn m\u00f3ng kh\u00e1c c\u00f3 th\u1ec3 c\u00f9ng t\u1ed3n t\u1ea1i.<\/p>\n
B\u1ea3ng 2.1 Nguy\u00ean nh\u00e2n ph\u1ed5 bi\u1ebfn nh\u1ea5t c\u1ee7a \u0111\u01b0\u1eddng Beau<\/p>\n\n\n\n\n
Y\u1ebfu t\u1ed1 t\u1ea1i ch\u1ed7<\/td>\n Vi\u00eam quanh m\u00f3ng<\/p>\n
Ch\u1ea5n th\u01b0\u01a1ng<\/td>\n<\/tr>\n
Y\u1ebfu t\u1ed1 to\u00e0n th\u00e2n<\/td>\n Thu\u1ed1c<\/p>\n
S\u1ed1t cao<\/p>\n
B\u1ec7nh do virus (tr\u1ebb em)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
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H\u00ecnh 2.1 \u0110\u01b0\u1eddng Beau: v\u1ebft l\u00f5m ngang c\u1ee7a phi\u1ebfn m\u00f3ng. S\u1ef1 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn m\u1ed9t s\u1ed1 ng\u00f3n, v\u1edbi c\u00f9ng kho\u1ea3ng c\u00e1ch v\u1edbi n\u1ebfp g\u1ea5p m\u00f3ng g\u1ea7n, cho th\u1ea5y nguy\u00ean nh\u00e2n to\u00e0n th\u00e2n<\/figcaption><\/figure>\n
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H\u00ecnh 2.2 \u0110\u01b0\u1eddng Beaus: v\u1ebft l\u00f5m ngang c\u1ee7a phi\u1ebfn m\u00f3ng d\u1ec5 nh\u1eadn th\u1ea5y khi nh\u00ecn t\u1eeb m\u1eb7t b\u00ean<\/figcaption><\/figure>\n
S\u1ef1 t\u00e1ch m\u00f3ng \u1edf n\u1ebfp g\u1ea5p m\u00f3ng g\u1ea7n (onychomadesis) \u0111\u1ea1i di\u1ec7n cho m\u1ed9t m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng h\u01a1n c\u1ee7a c\u00e1c \u0111\u01b0\u1eddng Beau, n\u01a1i t\u1ed5n th\u01b0\u01a1ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn to\u00e0n b\u1ed9 ch\u1ea5t n\u1ec1n m\u00f3ng, v\u1edbi s\u1ef1 t\u1ea1m ng\u1eebng s\u1ea3n xu\u1ea5t phi\u1ebfn m\u00f3ng. Khi s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a m\u00f3ng b\u1eaft \u0111\u1ea7u l\u1ea1i, phi\u1ebfn m\u00f3ng s\u1ebd bi\u1ec3u hi\u1ec7n \u0111\u01b0\u1ee3c c\u1ea5u t\u1ea1o g\u1ed3m hai ph\u1ea7n \u0111\u01b0\u1ee3c ng\u0103n c\u00e1ch b\u1edfi m\u1ed9t v\u1ebft n\u1ee9t ngang to\u00e0n b\u1ed9 \u0111\u1ed9 d\u00e0y m\u00f3ng (H\u00ecnh 2.3). S\u1ef1 t\u00e1ch t\u1eeb t\u1eeb phi\u1ebfn m\u00f3ng xa x\u1ea3y ra cho \u0111\u1ebfn khi m\u1ea5t phi\u1ebfn m\u00f3ng \u201cc\u0169\u201d. \u1ede tr\u1ebb em, nguy\u00ean nh\u00e2n r\u1ea5t ph\u1ed5 bi\u1ebfn g\u00e2y ra onychomadesis \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn m\u1ed9t s\u1ed1 ho\u1eb7c t\u1ea5t c\u1ea3 c\u00e1c m\u00f3ng l\u00e0 b\u1ec7nh tay ch\u00e2n mi\u1ec7ng do coxsackievirus g\u00e2y ra, trong khi vi\u00eam quanh m\u00f3ng c\u1ea5p t\u00ednh l\u00e0 nguy\u00ean nh\u00e2n ph\u1ed5 bi\u1ebfn nh\u1ea5t g\u00e2y ra onychomadesis \u1edf m\u1ed9t m\u00f3ng tay \u0111\u01a1n l\u1ebb.<\/p>\n
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H\u00ecnh 2.3 Onychomadesis: v\u1ebft n\u1ee9t ngang chia phi\u1ebfn m\u00f3ng th\u00e0nh hai ph\u1ea7n; l\u00e0 d\u1ea5u hi\u1ec7u c\u1ee7a s\u1ef1 gi\u00e1n \u0111o\u1ea1n t\u1ea1m th\u1eddi trong ho\u1ea1t \u0111\u1ed9ng ph\u00e2n b\u00e0o c\u1ee7a ch\u1ea5t n\u1ec1n m\u00f3ng.<\/figcaption><\/figure>\n
\u0110i\u1ec1u quan tr\u1ecdng l\u00e0 ph\u1ea3i t\u00ecm d\u1ea5u v\u1ebft nguy\u00ean nh\u00e2n t\u1ea1i ch\u1ed7 ho\u1eb7c to\u00e0n th\u00e2n g\u00e2y ra c\u00e1c \u0111\u01b0\u1eddng Beau \/ onychomadesis t\u1eeb 2-3 th\u00e1ng tr\u01b0\u1edbc khi ch\u00fang xu\u1ea5t hi\u1ec7n. D\u1ea5u hi\u1ec7u s\u1ebd di chuy\u1ec3n ra xa c\u00f9ng v\u1edbi s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a m\u00f3ng v\u00e0 cu\u1ed1i c\u00f9ng t\u1edbi b\u1edd t\u1ef1 do. C\u1ea7n th\u1eadn tr\u1ecdng khi onychomadesis \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn m\u00f3ng ch\u00e2n, v\u00ec s\u1ef1 bong tr\u00f3c c\u1ee7a phi\u1ebfn m\u00f3ng c\u0169 c\u00f3 th\u1ec3 theo sau b\u1eb1ng hi\u1ec7n t\u01b0\u1ee3ng m\u00f3ng ch\u1ecdc th\u1ecbt (ingrowing nail) \u1edf ph\u1ea7n xa c\u1ee7a m\u00f3ng m\u1edbi. C\u00e1c bi\u1ec7n ph\u00e1p ph\u00f2ng ng\u1eeba hi\u1ec7u qu\u1ea3 c\u00f3 th\u1ec3 l\u00e0 massage h\u01b0\u1edbng xu\u1ed1ng h\u00e0ng ng\u00e0y ph\u1ea7n m\u1ec1m phia xa ho\u1eb7c b\u0103ng d\u00e1n.<\/p>\n
2.1.2 R\u1ed7 m\u00f3ng (pitting)<\/h3>\n
R\u1ed7 m\u00f3ng \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi m\u1ed9t s\u1ed1 \u0111i\u1ec3m l\u00f5m tr\u00ean phi\u1ebfn m\u00f3ng, xu\u1ea5t hi\u1ec7n d\u01b0\u1edbi d\u1ea1ng c\u00e1c v\u1ebft r\u1ed7 tr\u00f2n nh\u1ecf, kh\u00f4ng \u0111\u1ec1u (H\u00ecnh 2.4). R\u1ed7 m\u00f3ng hi\u1ebfm khi \u0111\u01b0\u1ee3c th\u1ea5y \u1edf m\u00f3ng ch\u00e2n. R\u1ed7 m\u00f3ng l\u00e0 k\u1ebft qu\u1ea3 c\u1ee7a qu\u00e1 tr\u00ecnh s\u1eebng h\u00f3a b\u1ecb khi\u1ebfm khuy\u1ebft khu tr\u00fa c\u1ee7a c\u00e1c t\u1ebf b\u00e0o ch\u1ea5t n\u1ec1n m\u00f3ng g\u1ea7n, v\u1edbi s\u1ef1 t\u1ed3n t\u1ea1i c\u1ee7a c\u00e1c nh\u00f3m t\u1ebf b\u00e0o c\u00f3 nh\u00e2n v\u00e0 t\u1ebf b\u00e0o s\u1eebng h\u00f3a kh\u00f4ng ho\u00e0n to\u00e0n (parakeratotic) tr\u00ean b\u1ec1 m\u1eb7t phi\u1ebfn m\u00f3ng (H\u00ecnh 2.5). Nh\u1eefng t\u1ebf b\u00e0o n\u00e0y b\u00e1m d\u00ednh k\u00e9m v\u00e0 kh\u00f4ng trong su\u1ed1t v\u00e0 h\u00ecnh th\u00e0nh c\u00e1c c\u1ee5m v\u00e1y \u0111\u1eb7c bi\u1ec7t r\u00f5 r\u00e0ng \u1edf phi\u1ebfn m\u00f3ng g\u1ea7n: ch\u00fang c\u00f3 th\u1ec3 d\u1ec5 d\u00e1ng \u0111\u01b0\u1ee3c th\u1ea5y b\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p soi da kh\u00f4 (H\u00ecnh 2.6). Cu\u1ed1i c\u00f9ng, c\u00e1c t\u1ebf b\u00e0o s\u1eebng h\u00f3a kh\u00f4ng ho\u00e0n to\u00e0n bong ra v\u00e0 phi\u1ebfn m\u00f3ng ch\u1ec9 c\u00f2n l\u1ea1i c\u00e1c v\u1ebft r\u1ed7.<\/p>\n
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H\u00ecnh 2.4 R\u1ed7 m\u00f3ng: b\u1ec1 m\u1eb7t phi\u1ebfn m\u00f3ng c\u00f3 nhi\u1ec1u \u0111i\u1ec3m l\u00f5m. L\u01b0u \u00fd r\u1eb1ng \u1edf ph\u1ea7n g\u1ea7n, c\u00e1c v\u1ebft r\u1ed7 \u0111\u01b0\u1ee3c bao ph\u1ee7 b\u1edfi v\u1ea3y, ch\u1ee9ng t\u1ecf c\u00e1c t\u1ebf b\u00e0o s\u1eebng ho\u00e1 ch\u01b0a ho\u00e0n to\u00e0n v\u1eabn ch\u01b0a t\u00e1ch ra<\/figcaption><\/figure>\n
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H\u00ecnh 2.5 C\u01a1 ch\u1ebf b\u1ec7nh sinh c\u1ee7a r\u1ed7 m\u00f3ng: qu\u00e1 tr\u00ecnh s\u1eebng h\u00f3a b\u1ecb suy gi\u1ea3m c\u1ee7a c\u00e1c c\u1ee5m t\u1ebf b\u00e0o s\u1eebng trong ch\u1ea5t n\u1ec1n m\u00f3ng d\u1eabn \u0111\u1ebfn s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a c\u00e1c nh\u00f3m t\u1ebf b\u00e0o b\u00e1m d\u00ednh k\u00e9m tr\u00ean b\u1ec1 m\u1eb7t phi\u1ebfn m\u00f3ng. Theo th\u1eddi gian, ch\u00fang s\u1ebd t\u00e1ch ra kh\u1ecfi v\u1ebft r\u1ed7<\/figcaption><\/figure>\n
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H\u00ecnh 2.6 Soi da kh\u00f4 phi\u1ebfn m\u00f3ng g\u1ea7n cho th\u1ea5y m\u1ed9t s\u1ed1 h\u1ed1 v\u1eabn c\u00f2n \u0111\u01b0\u1ee3c \u0111\u00f3ng v\u1ea3y<\/figcaption><\/figure>\n
T\u00f9y thu\u1ed9c v\u00e0o k\u00edch th\u01b0\u1edbc v\u00e0 s\u1ef1 ph\u00e2n b\u1ed1, r\u1ed7 m\u00f3ng c\u00f3 th\u1ec3 ch\u1ea9n \u0111o\u00e1n cho m\u1ed9t b\u1ec7nh c\u1ee5 th\u1ec3: v\u1ebft r\u1ed7 m\u00f3ng trong v\u00e0y n\u1ebfn c\u00f3 k\u00edch th\u01b0\u1edbc l\u1edbn, h\u00ecnh d\u1ea1ng v\u00e0 ph\u00e2n b\u1ed1 kh\u00f4ng \u0111\u1ec1u. Ch\u00fang th\u01b0\u1eddng \u0111i k\u00e8m \u0111\u1ebfn c\u00e1c d\u1ea5u hi\u1ec7u kh\u00e1c c\u1ee7a b\u1ec7nh v\u00e0y n\u00ean m\u00f3ng (H\u00ecnh 2.7). R\u1ed7 m\u00f3ng c\u0169ng c\u00f3 th\u1ec3 l\u00e0 d\u1ea5u hi\u1ec7u c\u1ee7a ch\u1ee9ng r\u1ee5ng t\u00f3c t\u1eebng v\u00f9ng tr\u00ean m\u00f3ng tay: trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y, c\u00e1c v\u1ebft r\u1ed7 n\u00f4ng, \u0111\u1ec1u \u0111\u1eb7n v\u00e0 ph\u00e2n b\u1ed1 \u0111\u1ed3ng nh\u1ea5t theo c\u00e1c \u0111\u01b0\u1eddng h\u00ecnh h\u1ecdc (H\u00ecnh 2.8). R\u1ed7 m\u00f3ng c\u0169ng c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n trong c\u00e1c t\u00ecnh tr\u1ea1ng kh\u00e1c, n\u01a1i n\u00f3 lu\u00f4n \u0111i k\u00e8m v\u1edbi c\u00e1c tri\u1ec7u ch\u1ee9ng m\u00f3ng kh\u00e1c.<\/p>\n
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H\u00ecnh 2.7 R\u1ed7 m\u00f3ng v\u00e0y n\u1ebfn c\u00e1c v\u1ebft r\u1ed7 c\u00f3 k\u00edch th\u01b0\u1edbc kh\u00f4ng \u0111\u1ec1u v\u00e0 ph\u00e2n b\u1ed1 ng\u1eabu nhi\u00ean trong phi\u1ebfn m\u00f3ng. L\u01b0u \u00fd \u0111i k\u00e8m \u0111\u1ebfn t\u00e1ch m\u00f3ng v\u1edbi vi\u1ec1n c\u00e1 h\u1ed3i<\/figcaption><\/figure>\n
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H\u00ecnh 2.8 R\u1ed7 m\u00f3ng trong r\u1ee5ng t\u00f3c t\u1eebng v\u00f9ng: c\u00e1c v\u1ebft r\u1ed7 nh\u1ecf, n\u00f4ng v\u00e0 ph\u00e2n b\u1ed1 \u0111\u1ec1u tr\u00ean phi\u1ebfn m\u00f3ng<\/figcaption><\/figure>\n
\n2.1.3 M\u00f3ng gi\u00f2n (onychorrhexis)<\/h3>\n
Thu\u1eadt ng\u1eef onychorrhexis m\u00f4 t\u1ea3 s\u1ef1 gi\u00f2n c\u1ee7a phi\u1ebfn m\u00f3ng theo chi\u1ec1u d\u1ecdc, c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edbng \u0111\u1ebfn to\u00e0n b\u1ed9 (H\u00ecnh 2.9) ho\u1eb7c m\u1ed9t ph\u1ea7n c\u1ee7a phi\u1ebfn m\u00f3ng v\u00e0 v\u1edbi \u0111\u1ed9 s\u00e2u nhi\u1ec1u ho\u1eb7c \u00edt. V\u1ebft n\u1ee9t lan t\u1ecfa nghi\u00eam tr\u1ecdng k\u00e8m theo s\u1ef1 m\u00f3ng \u0111i c\u1ee7a m\u00f3ng \u1edf m\u1ed9t s\u1ed1 m\u00f3ng l\u00e0 \u0111i\u1ec3n h\u00ecnh c\u1ee7a b\u1ec7nh liken ph\u1eb3ng ch\u1ea5t n\u1ec1n m\u00f3ng (H\u00ecnh 2.10). Onychorrhexis \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn m\u1ed9t ph\u1ea7n m\u00f3ng l\u00e0 do t\u1ed5n th\u01b0\u01a1ng ch\u1ea5t n\u00ean m\u00f3ng th\u01b0\u1eddng do ch\u1ea5n th\u01b0\u01a1ng (H\u00ecnh 2.11) ho\u1eb7c c\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c (H\u00ecnh 2.12).<\/p>\n
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H\u00ecnh 2.9 Onychorrhexis: m\u00f3ng d\u1ec5 g\u00e3y theo \u0111\u01b0\u1eddng d\u1ecdc. \u0110\u00f3 c\u00f3 th\u1ec3 l\u00e0 d\u1ea5u hi\u1ec7u c\u1ee7a t\u1ec9nh trang m\u00f3ng tay qu\u00e1 kh\u00f4<\/figcaption><\/figure>\n
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H\u00ecnh 2.10 Onychorrhexis: m\u00f3ng d\u1ec5 g\u00e3y theo \u0111\u01b0\u1eddng d\u1ecdc: khi nghi\u00eam tr\u1ecdng v\u00e0 k\u00e8m theo s\u1ef1 m\u1ecfng \u0111i c\u1ee7a m\u00f3ng l\u00e0 d\u1ea5u hi\u1ec7u c\u1ee7a lichen ph\u1eb3ng ch\u1ea5t n\u1ec1n m\u00f3ng<\/figcaption><\/figure>\n
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H\u00ecnh 2.11 Onychorrhexis: m\u00f3ng d\u1ec5 g\u00e3y theo h\u01b0\u1edbng d\u1ecdc, trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y gi\u1edbi h\u1ea1n \u1edf m\u1ed9t b\u00ean c\u1ee7a m\u00f3ng v\u00e0 do ch\u1ea5n th\u01b0\u01a1ng (th\u00f3i quen)<\/figcaption><\/figure>\n
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H\u00ecnh 2.12 Onychorrhexis: m\u00f3ng d\u1ec5 g\u00e3y theo h\u01b0\u1edbng d\u1ecdc – trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y ch\u1ec9 gi\u1edbi h\u1ea1n \u1edf m\u1ed9t b\u00ean c\u1ee7a m\u00f3ng v\u00e0 do t\u1ed5n th\u01b0\u01a1ng ch\u1ea5t n\u1ec1n m\u00f3ng \u1edf ph\u1ea7n xa do h\u00f3a tr\u1ecb<\/figcaption><\/figure>\n
2.1.4 M\u00f3ng th\u00f4 r\u00e1p (trachyonychia)<\/h3>\n
Nh\u01b0 thu\u1eadt ng\u1eef trakous (th\u00f4) trong ti\u1ebfng Hy L\u1ea1p ch\u1ec9 ra, nh\u1eefng chi\u1ebfc m\u00f3ng th\u00f4 r\u00e1p v\u00e0 gi\u1ed1ng nh\u01b0 \u0111\u01b0\u1ee3c ch\u00e0 nh\u00e1m theo h\u01b0\u1edbng d\u1ecdc. Lo\u1ea1i ph\u1ed5 bi\u1ebfn nh\u1ea5t, trachyonychia m\u1edd \u0111\u1ee5c, bi\u1ec3u hi\u1ec7n v\u1edbi m\u1ed9t phi\u1ebfn m\u00f3ng m\u1edd \u0111\u1ee5c do c\u00e1c \u0111\u01b0\u1eddng s\u1ecdc d\u1ecdc m\u1ecbn \u0111\u01b0\u1ee3c bao ph\u1ee7 b\u1edfi c\u00e1c v\u1ea3y nh\u1ecf, th\u01b0\u1eddng k\u00e8m theo s\u1ef1 m\u1ecfng m\u00f3ng nh\u1eb9 (H\u00ecnh 2.13). M\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng c\u1ee7a trachyonychia (H\u00ecnh 2.14 v\u00e0 2.15) c\u00f3 th\u1ec3 kh\u00e1c nhau \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00e1c nhau v\u00e0 \u1edf c\u00e1c m\u00f3ng kh\u00e1c nhau, v\u00e0 \u0111\u00f3 kh\u00f4ng ph\u1ea3i l\u00e0 d\u1ea5u hi\u1ec7u c\u1ee7a b\u1ec7nh g\u00e2y ra v\u1ea5n \u0111\u1ec1. Trachyonychia l\u00e0 d\u1ea5u hi\u1ec7u c\u1ee7a t\u1ed5n th\u01b0\u01a1ng nh\u1eb9 v\u00e0 lan t\u1ecfa \u1edf ch\u1ea5t n\u1ec1n m\u00f3ng g\u1ea7n do r\u1ed1i lo\u1ea1n vi\u00eam, th\u01b0\u1eddng l\u00e0 d\u1ea5u hi\u1ec7u r\u1ee5ng t\u00f3c t\u1eebng v\u00f9ng \u1edf m\u00f3ng, nh\u01b0ng c\u0169ng c\u00f3 th\u1ec3 l\u00e0 d\u1ea5u hi\u1ec7u c\u1ee7a b\u1ec7nh v\u1ea3y n\u1ebfn m\u00f3ng, lichen ph\u1eb3ng ho\u1eb7c b\u1ec7nh ch\u00e0m. Hi\u1ebfm g\u1eb7p h\u01a1n, trachyonychia bi\u1ec3u hi\u1ec7n \u1edf d\u1ea1ng “s\u00e1ng b\u00f3ng”, \u1edf \u0111\u00f3 m\u00f3ng bi\u1ec3u hi\u1ec7n th\u00f4 r\u00e1p v\u00ec to\u00e0n b\u1ed9 b\u1ec1 m\u1eb7t c\u00f3 c\u00e1c v\u1ebft r\u00f4 r\u1ea5t nh\u1ecf (H\u00ecnh 2.16). Lo\u1ea1i n\u00e0y th\u01b0\u1eddng l\u00e0 do r\u1ee5ng t\u00f3c t\u1eebng v\u00f9ng.<\/p>\n
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H\u00ecnh 2.13 Trachyonychia: m\u00f3ng bi\u1ec3u hi\u1ec7n th\u00f4 r\u00e1p do c\u00e1c v\u1ebft n\u1ee9t m\u00f3ng theo chi\u1ec1u \u0111\u01b0\u1ee3c bao ph\u1ee7 b\u1edfi c\u00e1c v\u1ea3y nh\u1ecf<\/figcaption><\/figure>\n
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H\u00ecnh 2.14 Trachyonychia nghi\u00eam tr\u1ecdng: m\u00f3ng bi\u1ec3u hi\u1ec7n nh\u01b0 \u0111\u01b0\u1ee3c ch\u00e0 nh\u00e1m theo h\u01b0\u1edbng d\u1ecdc, ch\u00fang c\u0169ng b\u1ecb m\u1ecfng \u0111i nhi\u1ec1u do koilonychia<\/figcaption><\/figure>\n
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H\u00ecnh 2.15 Trachyonychia nh\u1eb9, c\u00f3 \u0111\u01b0\u1eddng s\u1ecdc d\u1ecdc r\u00f5. L\u01b0u \u00fd s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a \u0111\u01b0\u1eddng Beau \u1edf m\u00f3ng tay th\u1ee9 ba v\u00e0 th\u1ee9 t\u01b0<\/figcaption><\/figure>\n
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H\u00ecnh 2.16 Trachyonychia s\u00e1ng b\u00f3ng: phi\u1ebfn m\u00f3ng c\u00f3 nhi\u1ec1u v\u1ebft r\u1ed7 nh\u1ecf t\u1ea1o n\u00ean v\u1ebb th\u00f4 r\u00e1p<\/figcaption><\/figure>\n
\n2.1.5 R\u00e3nh d\u1ecdc<\/h3>\n
R\u00e3nh \u0111\u1ecdc th\u01b0\u1eddng \u0111\u01a1n l\u1ebb v\u00e0 ch\u1ea1y d\u1ecdc theo chi\u1ec1u d\u00e0i c\u1ee7a phi\u1ebfn m\u00f3ng: chi\u1ec1u s\u00e2u v\u00e0 chi\u1ec1u r\u1ed9ng c\u00f3 th\u1ec3 kh\u00e1c nhau. R\u00e3nh d\u1ecdc l\u00e0 k\u1ebft qu\u1ea3 c\u1ee7a s\u1ef1 ch\u00e8n \u00e9p v\u00e0o ch\u1ea5t n\u1ec1n m\u00f3ng b\u1edfi m\u1ed9t kh\u1ed1i u khu tr\u00fa \u1edf n\u1ebfp g\u1ea5p m\u00f3ng g\u1ea7n, th\u01b0\u1eddng l\u00e0 u nang nh\u1ea7y (H\u00ecnh 2.17) ho\u1eb7c u xo-fibroma (H\u00ecnh 2.18): kh\u1ed1i u th\u01b0\u1eddng nh\u00ecn th\u1ea5y \u0111\u01b0\u1ee3c d\u01b0\u1edbi n\u1ebfp g\u1ea5p m\u00f3ng g\u1ea7n.<\/p>\n
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H\u00ecnh 2.17 R\u00e3nh d\u1ecdc c\u1ee7a m\u00f3ng tay th\u1ee9 ba, do ch\u1ea5t n\u1ec1n m\u00f3ng b\u1ecb u nang nh\u1ea7y \u1edf n\u1ebfp m\u00f3ng g\u1ea7n ch\u00e8n \u00e9p<\/figcaption><\/figure>\n
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H\u00ecnh 2.18 R\u00e3nh d\u1ecdc c\u1ee7a m\u00f3ng tay th\u1ee9 hai do u x\u01a1 fibrokeratoma nh\u00ecn th\u1ea5y \u0111\u01b0\u1ee3c d\u01b0\u1edbi n\u1ebfp m\u00f3ng g\u1ea7n<\/figcaption><\/figure>\n
\n2.2 Thay \u0111\u1ed5i h\u00ecnh d\u1ea1ng v\u00e0 k\u00edch th\u01b0\u1edbc m\u00f3ng<\/h2>\n
Phi\u1ebfn m\u00f3ng b\u00ecnh th\u01b0\u1eddng c\u00f3 h\u00ecnh ch\u1eef nh\u1eadt: m\u00f3ng tay c\u00f3 m\u1ed9t tr\u1ee5c ch\u00ednh d\u1ecdc, trong khi m\u00f3ng ch\u00e2n th\u01b0\u1eddng c\u00f3 tr\u1ee5c ch\u00ednh ngang, \u0111\u1eb7c bi\u1ec7t l\u00e0 c\u00e1c ng\u00f3n 2-5. Phi\u1ebfn m\u00f3ng c\u0169ng cong theo chi\u1ec1u ngang v\u00e0 cong theo chi\u1ec1u d\u1ecdc \u1edf m\u1ee9c \u0111\u1ed9 \u00edt h\u01a1n, c\u00f3 \u0111\u1ed9 d\u00e0y \u0111\u1ec1u \u0111\u1eb7n d\u1ecdc theo chi\u1ec1u d\u00e0i v\u00e0 l\u00e0 0,5-0,7 mm \u0111\u1ed1i v\u1edbi m\u00f3ng tay v\u00e0 1-1,2 mm \u0111\u1ed1i v\u1edbi m\u00f3ng ch\u00e2n. K\u00edch th\u01b0\u1edbc, h\u00ecnh d\u1ea1ng v\u00e0 \u0111\u1ed9 cong c\u1ee7a m\u00f3ng c\u00f3 th\u1ec3 b\u1ecb thay \u0111\u1ed5i \u1edf c\u00e1c b\u1ec7nh b\u1ea9m sinh v\u00e0 m\u1eafc ph\u1ea3i kh\u00e1c nhau.<\/p>\n
2.2.1 Thi\u1ebfu m\u00f3ng (anonychia)\/ M\u00f3ng nh\u1ecf (micronychia)<\/h3>\n
M\u1ed9t ho\u1eb7c nhi\u1ec1u m\u00f3ng nh\u1ecf h\u01a1n b\u00ecnh th\u01b0\u1edfng ho\u1eb7c kh\u00f4ng c\u00f3. Khi b\u1ea9m sinh, n\u00f3 c\u00f3 th\u1ec3 l\u00e0 do s\u1ef1 thay \u0111\u1ed5i trong ph\u00e1t tri\u1ec3n c\u1ee7a \u0111\u1ea7u xa ng\u00f3n trong th\u1eddi k\u1ef3 ph\u00f4i thai v\u00e0 th\u01b0\u1eddng \u0111i k\u00e8m s\u1ef1 ph\u00e1t tri\u1ec3n k\u00e9m c\u1ee7a x\u01b0\u01a1ng b\u00ean d\u01b0\u1edbi (H\u00ecnh 2.19). Khi m\u1eafc ph\u1ea3i, n\u00f3 x\u1ea3y ra do s\u1ef1 ph\u00e1 h\u1ee7y m\u1ed9t ph\u1ea7n c\u1ee7a to\u00e0n b\u1ed9 ch\u1ea5t n\u1ec1n m\u00f3ng do ch\u1ea5n th\u01b0\u01a1ng (tai n\u1ea1n ho\u1eb7c ph\u1ea9u thu\u1eadt) ho\u1eb7c do c\u00e1c b\u1ec7nh l\u00fd vi\u00eam \u1edf m\u00f3ng, ch\u1eb3ng h\u1ea1n nh\u01b0 lichen ph\u1eb3ng (H\u00ecnh 2.20) ho\u1eb7c pemphigus.<\/p>\n
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H\u00ecnh 2.19 Thi\u1ebfu m\u00f3ng (anonychia) b\u1ea9m sinh \u1edf m\u00f3ng ch\u00e2n th\u1ee9 hai \u0111i k\u00e8m s\u1ef1 ph\u00e1t tri\u1ec3n b\u1ecb thay \u0111\u1ed5i c\u1ee7a \u0111\u1ed1t ng\u00f3n xa c\u1ee7a c\u0169ng ng\u00f3n<\/figcaption><\/figure>\n
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H\u00ecnh 2.20 M\u00f3ng nh\u1ecf (micronychia) m\u1eafc ph\u1ea3i \u1edf m\u00f3ng tay th\u1ee9 n\u0103m, do lichen planus ph\u00e1 h\u1ee7y m\u1ed9t ph\u1ea7n ch\u1ea5t n\u1ec1n m\u00f3ng<\/figcaption><\/figure>\n
\n2.2.2 M\u00f3ng h\u00ecnh th\u00eca (koilonychia)<\/h3>\n
M\u00f3ng m\u1ecfng v\u00e0 c\u00f3 \u0111\u1ed9 l\u00f5m b\u1ea5t th\u01b0\u1eddng, gi\u1ed1ng nh\u01b0 m\u1ed9t c\u00e1i th\u00eca, c\u00f3 th\u1ec3 d\u1ec5 d\u00e0ng nh\u1eadn th\u1ea5y khi nh\u00ecn t\u1eeb b\u00ean c\u1ea1nh (H\u00ecnh 2.21). Koilonychia th\u01b0\u1eddng g\u1eb7p m\u00f3ng ch\u00e2n s\u1ed1 24 c\u1ee7a tr\u1ebb t\u1eeb 1 \u0111\u1ebfn 34 tu\u1ed5i (H\u00ecnh 2.22), \u0111\u00e2y l\u00e0 sinh l\u00fd v\u00e0 t\u1ea1m th\u1eddi v\u00e0 \u0111o \u0111\u1ed9 m\u1ecfng c\u1ee7a phi\u00ean m\u00f3ng li\u00ean quan \u0111\u1ebfn tu\u1ed5i t\u00e1c: \u1ede ng\u01b0\u1eddi l\u1edbn, koilonychia hi\u1ebfm g\u1eb7p v\u00e0 xu\u1ea5t hi\u1ec7n \u1edf m\u00f3ng tay c\u1ee7a nh\u1eefng ng\u01b0\u1eddi lao \u0111\u1ed9ng ch\u00e2n tay khi ti\u1ebfp x\u00fac v\u1edbi ch\u1ea5t k\u00edch \u1ee9ng v\u00e0 ch\u1ea5t t\u1ea9y r\u1eeda l\u00e0m t\u1ed5n th\u01b0\u01a1ng phi\u1ec1n m\u00f3ng (H\u00ecnh 2.23).<\/p>\n
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H\u00ecnh 2.21 Koilonychia: nh\u00ecn nghi\u00eang cho ph\u00e9p quan s\u00e1t phi\u1ebfn m\u00f3ng l\u00f5m<\/figcaption><\/figure>\n
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H\u00ecnh 2.22 Koilonychia c\u1ee7a m\u00f3ng ch\u00e2n th\u1ee9 ba \u0111\u1ebfn th\u1ee9 n\u0103m \u1edf tr\u1ebb em<\/figcaption><\/figure>\n
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H\u00ecnh 2.23 Koilonychia \u1edf m\u00f3ng tay \u1edf ng\u01b0\u1eddi lao \u0111\u1ed9ng ch\u00e2n tay ti\u1ebfp x\u00fac h\u00e0ng ng\u00e0y v\u1edbi ch\u1ea5t k\u00edch \u1ee9ng m\u1ea1nh. L\u01b0u \u00fd t\u00ecnh tr\u1ea1ng vi\u00eam da k\u00edch \u1ee9ng \u0111i k\u00e8m \u1edf v\u00f9ng da quanh m\u00f3ng v\u00e0 v\u00f9ng d\u01b0\u1edbi m\u00f3ng<\/figcaption><\/figure>\n
2.2.3 M\u00f3ng g\u1ecdng k\u00ecm (pincer nail)<\/h3>\n
M\u00f3ng cong qu\u00e1 m\u1ee9c theo chi\u1ec1u ngang, c\u00e1c c\u1ea1nh b\u00ean c\u1ee7a ch\u00fang l\u00e0m t\u1ed5n th\u01b0\u01a1ng c\u00e1c n\u1ebfp g\u1ea5p b\u00ean g\u00e2y \u0111au. M\u00f3ng g\u1ecdng k\u00ecm kh\u00e1 ph\u1ed5 bi\u1ec3n \u1edf m\u00f3ng ch\u00e2n (H\u00ecnh 2.24), trong khi hi\u1ebfm g\u1eb7p \u1edf m\u00f3ng tay, v\u1ecb tr\u00ed li\u00ean quan \u0111\u1ebfn nh\u1eefng b\u1ea5t th\u01b0\u1eddng c\u1ee7a \u0111\u1ed1t ng\u00f3n xa (gai x\u01b0\u01a1ng ho\u1eb7c vi\u00eam kh\u1edbp) (H\u00ecnh 2.25).<\/p>\n
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H\u00ecnh 2.24 M\u00f3ng g\u1ecdng k\u00ecm c\u1ee7a m\u00f3ng ch\u00e2n c\u00e1i m\u00f3ng cong qu\u00e1 m\u1ee9c theo chi\u1ec1u ngang<\/figcaption><\/figure>\n
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H\u00ecnh 2.25 M\u00f3ng g\u1ecdng k\u00ecm \u1edf ng\u00f3n tay th\u1ee9 2: l\u01b0u \u00fd s\u01b0ng kh\u1edbp li\u00ean \u0111\u1ed1t xa do vi\u00eam kh\u1edbp<\/figcaption><\/figure>\n
\n2.2.4 M\u00f3ng d\u00f9i tr\u1ed1ng (nail clubbing)<\/h3>\n
H\u00ecnh d\u1ea1ng c\u1ee7a m\u00f3ng b\u1ecb thay \u0111\u1ed5i, m\u00f3ng gi\u1ed1ng nh\u01b0 m\u1eb7t k\u00ednh \u0111\u1ed3ng h\u1ed3, b\u1ecb cong qu\u00e1 m\u1ee9c c\u1ea3 theo chi\u1ec1u ngang v\u00e0 chi\u1ec1u d\u1ecdc (Hinh 2.26 v\u00e0 2.27). G\u00f3c gi\u1eefa n\u1ebfp g\u1ea5p m\u1ecfng g\u1ea7n v\u00e0 phi\u1ebfn m\u00f3ng (g\u00f3c Lovibond) l\u1edbn h\u01a1n 180\u00b0 (H\u00ecnh 2.28) v\u00e0 kho\u1ea3ng tr\u1ed1ng h\u00ecnh thoi th\u01b0\u1eddng c\u00f3 th\u1ec3 th\u1ea5y \u1edf m\u1eb7t ti\u1ebfp x\u00fac c\u1ee7a ph\u1ea7n xa 2 ng\u00f3n \u0111\u1ea7u ti\u00ean bi\u1ebfn m\u1ea5t (d\u1ea5u c\u1eeda s\u1ed5 ho\u1eb7c d\u1ea5u Schamroth). C\u01a1 ch\u1ebf b\u1ec7nh sinh c\u1ee7a m\u00f3ng d\u00f9i tr\u1ed1ng d\u01b0\u1eddng nh\u01b0 l\u00e0 s\u1ef1 t\u00edch lu\u1ef9 c\u1ee7a c\u00e1c m\u00f4 m\u1ec1m xung quanh v\u00e0 b\u00ean d\u01b0\u1edbi phi\u1ebfn m\u00f3ng do thi\u1ebfu oxy. Tr\u00ean th\u1ef1c t\u1ebf, m\u00f3ng d\u00f9i tr\u1ed1ng c\u00f3 th\u1ec3 l\u00e0 d\u1ea5u hi\u1ec7u c\u1ee7a m\u1ed9t s\u1ed1 b\u1ec7nh v\u1ec1 h\u00f4 h\u1ea5p v\u00e0 tim m\u1ea1ch (xem Ch\u01b0\u01a1ng 9).<\/p>\n
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H\u00ecnh 2.26 Ng\u00f3n tay d\u00f9i tr\u1ed1ng: m\u00f3ng tay to ra v\u00e0 cong qu\u00e1 m\u1ee9c theo chi\u1ec1u ngang v\u00e0 chi\u1ec1u d\u1ecdc, gi\u1ed1ng nh\u01b0 m\u1eb7t k\u00ednh \u0111\u1ed3ng h\u1ed3<\/figcaption><\/figure>\n
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H\u00ecnh 2.27 Ng\u00f3n tay d\u00f9i tr\u1ed1ng: g\u00f3c nh\u00ecn nghi\u00eang cho ph\u00e9p quan s\u00e1t \u0111\u1ed9 cong c\u1ee7a phi\u1ebfn m\u00f3ng v\u00e0 \u0111\u1ed9 s\u01b0ng c\u1ee7a n\u1ebfp g\u1ea5p m\u00f3ng g\u1ea7n<\/figcaption><\/figure>\n
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H\u00ecnh 2.28 Ng\u00f3n tay d\u00f9i tr\u1ed1ng: d\u1ea5u hi\u1ec7u Lovibond, s\u1ef1 m\u1edf r\u1ed9ng c\u1ee7a c\u00e1c m\u00f4 m\u1ec1m l\u00e0m t\u0103ng g\u00f3c gi\u1eefa n\u1ebfp m\u00f3ng g\u1ea7n v\u00e0 phi\u1ebfn m\u00f3ng. \u1ede m\u00f3ng tay b\u00ecnh th\u01b0\u1eddng. g\u00f3c n\u00e0y th\u1ea5p h\u01a1n 165\u00b0, \u1edf m\u00f3ng tay d\u00f9i tr\u1ed1ng, g\u00f3c n\u00e0y v\u01b0\u1ee3t qu\u00e1 180 \u0111\u1ed9.<\/figcaption><\/figure>\n
2.2.5 M\u00f3ng d\u00e0y (pachyonychia)\/ M\u00f3ng s\u1eebng c\u1eebu (onychogryphosis)<\/h3>\n
M\u00f3ng d\u00e0y l\u00ean k\u00e8m theo m\u1ea5t \u0111i \u0111\u1ed9 trong su\u1ed1t b\u00ecnh th\u01b0\u1eddng c\u1ee7a m\u00f3ng. \u1ede pachyonychia, phi\u1ebfn m\u00f3ng d\u00e0y l\u00ean lan t\u1ecfa, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u1edf ph\u1ea7n xa: b\u1ec7nh nh\u00e2n cho r\u1eb1ng vi\u1ec7c c\u1eaft m\u00f3ng l\u00e0 c\u1ef1c k\u1ef3 kh\u00f3 kh\u0103n. Pachyonychia m\u1eafc ph\u1ea3i th\u01b0\u1eddng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn m\u00f3ng ch\u00e2n c\u00e1i, trong khi pachyonychia b\u1ea9m sinh l\u00e0 m\u1ed9t r\u1ed1i lo\u1ea1n da di truy\u1ec1n \u1edf nhi\u1ec5m s\u1eafc th\u1ec3 th\u01b0\u1eddng c\u1ef1c k\u1ef3 hi\u1ebfm g\u1eb7p do \u0111\u1ed9t bi\u1ebfn \u1edf m\u1ed9t trong 5 gen keratin bao g\u1ed3m K6a, K6b, K6c, K16 ho\u1eb7c K17 t\u1ea1o ra t\u00ecnh tr\u1ea1ng d\u00e0y m\u00f3ng lan t\u1ecfa \u1edf t\u1ea5t c\u1ea3 c\u00e1c m\u00f3ng (H\u00ecnh 2.29).<\/p>\n
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H\u00ecnh 2.29 Pachyonychia b\u1ea9m sinh: m\u00f3ng d\u00e0y l\u00ean v\u00e0 m\u1ea5t \u0111\u1ed9 trong su\u1ed1t c\u1ee7a phi\u1ebfn m\u00f3ng, \u0111i k\u00e8m ch\u1ee9ng d\u00e0y s\u1eebng da<\/figcaption><\/figure>\n
M\u00f2ng s\u1eebng c\u1eebu (onychogryphosis) m\u00f4 t\u00e0 m\u1ed9t chi\u1ebfc m\u00f3ng gi\u1ed1ng nh\u01b0 m\u00f3ng vu\u1ed1t (Hinh 2.30). Ch\u1ea5t n\u1ec1n m\u00f3ng t\u1ea1o ra m\u1ed9t phi\u1ebfn m\u00f3ng ph\u00e1t tri\u1ec3n v\u1ec1 \u0111\u1ed9 d\u00e0y ch\u1ee9 kh\u00f4ng d\u00e0i, m\u1ed9t b\u00ean ph\u00e1t tri\u1ec3n nhanh h\u01a1n b\u00ean kia: phi\u1ebfn m\u00f3ng d\u00e0y h\u01a1n, m\u00e0u v\u00e0ng n\u00e2u v\u00e0 m\u00e9o m\u00f3 gi\u1ed1ng v\u1ecf h\u00e0u.<\/p>\n
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H\u00ecnh 2.30 M\u00f3ng s\u1eebng c\u1eebu: phi\u1ebfn m\u00f3ng d\u00e0y l\u00ean, m\u00e0u v\u00e0ng v\u00e0 l\u1ec7ch sang m\u1ed9t b\u00ean, kh\u00f4ng th\u1ec3 c\u1eaft t\u1ec9a<\/figcaption><\/figure>\n
2.3 S\u1ef1 thay \u0111\u1ed5i m\u00e0u m\u00f3ng<\/h2>\n
2.3.1 M\u00f3ng \u0111\u1ed5i m\u00e0u tr\u1eafng (leukonychia)<\/h3>\n
Leukonychia \u0111\u1ec1 c\u1eadp \u0111\u1ebfn s\u1ef1 \u0111\u1ed5i m\u00e0u tr\u1eafng c\u1ee7a m\u00f3ng v\u00e0 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ph\u00e2n bi\u1ec7t th\u00e0nh ba lo\u1ea1i v\u1edbi c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng kh\u00e1c nhau v\u00e0 c\u01a1 ch\u1ebf b\u1ec7nh sinh kh\u00e1c nhau:<\/p>\n
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Leukonychia th\u1ef1c s\u1ef1, n\u01a1i phi\u1ebfn m\u00f3ng c\u00f3 s\u1eafc t\u1ed1 v\u00e0 m\u00e0u tr\u1eafng di chuy\u1ec3n ra xa theo s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a m\u00f3ng. N\u00f3 l\u00e0 k\u1ebft qu\u1ea3 c\u1ee7a qu\u1ea3 tr\u00ecnh s\u1eebng h\u00f3a b\u1ecb khi\u1ebfm khuy\u1ebft c\u1ee7a c\u00e1c t\u1ebf b\u00e0o s\u1eebng \u1edf ph\u1ea7n xa c\u1ee7a ch\u1ea5t n\u1ec1n m\u00f3ng, v\u1edbi s\u1ef1 c\u00f2n t\u1ed3n t\u1ea1i c\u1ee7a c\u00e1c t\u1ebf b\u00e0o s\u1eebng h\u00f3a kh\u00f4ng ho\u00e0n to\u00e0n trong phi\u1ebfn m\u00f3ng (H\u00ecnh 2.31). Nh\u1eefng t\u1ebf b\u00e0o n\u00e0y kh\u00f4ng trong su\u1ed1t v\u00e0 ph\u1ea3n x\u1ea1 \u00e1nh s\u00e1ng, g\u00e2y ra s\u1ef1 \u0111\u1ed5i m\u00e0u tr\u1eafng.<\/li>\n
Leukonychia r\u00f5 r\u00e0ng, n\u01a1i s\u1ef1 \u0111\u1ed5i m\u00e0u tr\u1eafng m\u1edd d\u1ea7n khi \u1ea9n v\u00e0o, v\u00ec \u0111\u00f3 l\u00e0 do nh\u1eefng b\u1ea5t th\u01b0\u1eddng \u1edf gi\u01b0\u1eddng m\u00f3ng.<\/li>\n
Pseudo-leukonychia, n\u01a1i s\u1ef1 \u0111\u1ed5i m\u00e0u m\u00f3ng c\u00f3 ngu\u1ed3n g\u1ed1c b\u00ean ngo\u00e0i, v\u00e0 do b\u1ec1 m\u1eb7t c\u1ee7a phi\u1ebfn m\u00f3ng d\u1ec5 v\u1ee1 v\u1edbi s\u1ef1 tho\u00e1i h\u00f3a keratin t\u1ea1o ra m\u00e0u tr\u1eafng.<\/li>\n<\/ul>\n
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H\u00ecnh 2.31 H\u00ecnh v\u1ebd m\u00f4 t\u1ea3 c\u01a1 ch\u1ebf b\u1ec7nh sinh c\u1ee7a leukonychia th\u1ef1c s\u1ef1: s\u1ef1 t\u1ed5n th\u01b0\u01a1ng \u1edf ph\u1ea7n xa c\u1ee7a ch\u1ea5t n\u1ec1n m\u00f3ng g\u00e2y ra s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a c\u00e1c c\u1ee5m t\u1ebf b\u00e0o s\u1eebng ho\u00e1 ch\u01b0a ho\u00e0n to\u00e0n trong phi\u1ebfn m\u00f3ng, d\u1eabn \u0111\u1ebfn m\u1ea5t \u0111\u1ed9 trong su\u1ed1t<\/figcaption><\/figure>\n
T\u00f9y thu\u1ed9c v\u00e0o h\u00ecnh th\u00e1i c\u1ee7a s\u1ef1 \u0111\u1ed5i m\u00e0u tr\u1eafng, t\u1ea5t c\u1ea3 c\u00e1c bi\u1ebfn th\u1ec3 bao g\u1ed3m m\u1ed9t v\u00e0i ph\u00e2n nh\u00f3m.<\/p>\n
Leukonychia th\u1ef1c s\u1ef1 tr\u00ean th\u1ef1c t\u1ebf c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn to\u00e0n b\u1ed9 m\u00f3ng (leukonychia to\u00e0n ph\u1ea7n), trong m\u1ed9t t\u00ecnh tr\u1ea1ng hi\u1ebfm g\u1eb7p, th\u01b0\u1eddng l\u00e0 do di truy\u1ec1n v\u00e0 kh\u00f4ng r\u00f5 ngu\u1ed3n g\u1ed1c ho\u1eb7c ph\u1ed5 bi\u1ebfn h\u01a1n l\u00e0 ph\u00e2n b\u1ed1 th\u00e0nh c\u00e1c ch\u1ea5m nh\u1ecf (\u0111\u1ed1m tr\u1eafng) ho\u1eb7c s\u1ecdc (s\u1ecdc tr\u1eafng). Leukonychia d\u1ea1ng \u0111\u1ed1m l\u00e0 \u0111i\u1ec3n h\u00ecnh \u1edf m\u00f3ng tay c\u1ee7a tr\u1ebb em v\u00e0 \u0111\u01b0\u1ee3c cho l\u00e0 do c\u00e1c vi ch\u1ea5n th\u01b0\u01a1ng \u1edf ph\u1ea7n xa c\u1ee7a ch\u1ea5t n\u1ec1n m\u1ecfng: bi\u1ec3u hi\u1ec7n d\u01b0\u1edbi d\u1ea1ng nhi\u1ec1u ch\u1ea5m tr\u1eafng di chuy\u1ec3n ra xa khi m\u00f3ng ph\u00e1t tri\u1ec3n v\u00e0 th\u01b0\u1eddng bi\u1ebfn m\u1ea5t tr\u01b0\u1edbc khi ti\u1ebfn \u0111\u1ebfn b\u1edd xa (H\u00ecnh 2.32), Soi da th\u01b0\u1eddng th\u1ea5y m\u1ed9t \u0111\u1ed1m tr\u1eafng v\u1edbi c\u00e1c h\u1ea1t tr\u1eafng t\u01b0\u01a1ng \u1ee9ng v\u1edbi c\u00e1c c\u1ee5m t\u1ebf b\u00e0o s\u1eebng ho\u00e1 ch\u01b0a ho\u00e0n to\u00e0n trong phi\u1ebfn m\u00f3ng (H\u00ecnh 2.33). Leukonychia d\u1ea1ng s\u1ecdc c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn m\u00f3ng tay, v\u1ecb tr\u00ed do ch\u1ea5n th\u01b0\u01a1ng \u1edf ch\u1ea5t n\u1ec1n m\u00f3ng b\u00ean d\u01b0\u1edbi n\u1ebfp g\u1ea5p m\u00f3ng g\u1ea7n trong qu\u00e1 tr\u00ecnh l\u00e0m m\u00f3ng v\u00e0 bi\u1ec3u hi\u1ec7n d\u01b0\u1edbi d\u1ea1ng c\u00e1c \u0111\u01b0\u1eddng tr\u1eafng song song v\u1edbi n\u1ebfp g\u1ea5p m\u00f3ng. C\u00e1c \u0111\u01b0\u1eddng n\u00e0y th\u01b0\u1eddng r\u00f5 h\u01a1n \u1edf gi\u1eefa m\u00f3ng v\u00e0 c\u00f3 th\u1ec3 c\u00f3 nhi\u1ec1u \u0111\u01b0\u1eddng khi c\u00f3 th\u00f3i quen l\u00e0m m\u00f3ng \u0111\u1ecbnh k\u1ef3 (H\u00ecnh 2.34). C\u00e1c d\u1ea5u hi\u1ec7u t\u1ed5n th\u01b0\u01a1ng l\u1edbp bi\u1ec3u b\u00ec v\u00e0 vi\u00eam n\u1ebfp g\u1ea5p m\u00f3ng g\u1ea7n c\u00f3 th\u1ec3 \u0111i k\u00e8m. Leukonychia d\u1ea1ng s\u1ecdc c\u0169ng kh\u00e1 ph\u1ed5 bi\u1ebfn \u1edf m\u00f3ng ch\u00e2n c\u00e1i, n\u01a1i n\u00f3 bi\u1ec3u hi\u1ec7n d\u01b0\u1edbi d\u1ea1ng 1-4 \u0111\u01b0\u1eddng ngang \u1edf gi\u1eefa phi\u1ebfn m\u00f3ng (H\u00ecnh 2.35), Ch\u00fang l\u00e0 k\u1ebft qu\u1ea3 c\u1ee7a ch\u1ea5n th\u01b0\u01a1ng t\u1eeb gi\u00e0y \u0111\u1ebfn \u0111\u1ea7u phi\u1ebfn m\u00f3ng d\u00e0y v\u00e0 truy\u1ec1n t\u1edbi ch\u1ea5t n\u1ec1n m\u00f3ng.<\/p>\n
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H\u00ecnh 2.32 Leukonychia d\u1ea1ng \u0111\u1ed1m \u1edf tr\u1ebb 8 tu\u1ed5i: c\u00e1c \u0111\u1ed1m tr\u1eafng nh\u1ecf do vi ch\u1ea5n th\u01b0\u01a1ng \u1edf ph\u1ea7n xa ch\u1ea5t n\u1ec1n m\u00f3ng<\/figcaption><\/figure>\n
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H\u00ecnh 2.33 Soi da c\u1ee7a leukonychia th\u1ef1c s\u1ef1 cho th\u1ea5y c\u00e1c h\u1ea1t m\u00e0u tr\u1eafng t\u01b0\u01a1ng \u1ee9ng v\u1edbi c\u00e1c c\u1ee5m t\u1ebf b\u00e0o s\u1eebng ho\u00e1 ch\u01b0a ho\u00e0n to\u00e0n trong phi\u1ebfn m\u00f3ng<\/figcaption><\/figure>\n
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H\u00ecnh 2.34 Leukonychia d\u1ea1ng s\u1ecdc \u1edf m\u00f3ng tay, do l\u00e0m m\u00f3ng qu\u00e1 x\u00e2m l\u1ea5n, nhi\u1ec1u \u0111\u01b0\u1eddng tr\u1eafng ngang, d\u00e0y h\u01a1n \u1edf gi\u1eefa m\u00f3ng, ch\u1ea1y song song v\u1edbi n\u1ebfp g\u1ea5p m\u00f3ng g\u1ea7n. L\u01b0u \u00fd thi\u1ebfu l\u1edbp bi\u1ec3u b\u00ec v\u00e0 vi\u00eam n\u1ebfp m\u00f3ng nh\u1eb9<\/figcaption><\/figure>\n
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H\u00ecnh 2.35 Leukonychia d\u1ea1ng s\u1ecdc \u1edf m\u00f3ng ch\u00e2n c\u00e1i: c\u00e1c d\u1ea3i tr\u1eafng ngang l\u1ed3i \u1edf ph\u00eda xa, do ch\u1ea5n th\u01b0\u01a1ng c\u01a1 h\u1ecdc t\u1eeb gi\u00e0y \u0111\u1ebfn \u0111\u1ea7u m\u00f3ng v\u00e0 truy\u1ec1n \u0111\u1ebfn ch\u1ea5t n\u1ec1n m\u00f3ng<\/figcaption><\/figure>\n
Leukonychia r\u00f5 r\u00e0ng xu\u1ea5t hi\u1ec7n d\u01b0\u1edbi d\u1ea1ng s\u1ef1 \u0111\u1ed5i m\u00e0u tr\u1eafng c\u1ee7a m\u00f3ng do s\u1ef1 thay \u0111\u1ed5i c\u1ee7a gi\u01b0\u1eddng m\u00f3ng, v\u1edbi phi\u1ebfn m\u00f3ng b\u00ecnh th\u01b0\u1eddng trong su\u1ed1t. Theo \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng, c\u00f3 th\u1ec3 ph\u00e2n bi\u1ec7t ba lo\u1ea1i:<\/p>\n
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M\u00f3ng Terry, n\u01a1i leukonychia \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn to\u00e0n b\u1ed9 m\u00f3ng ngo\u1ea1i tr\u1eeb d\u1ea3i xa m\u00e0u h\u1ed3ng \u0111\u1ebfn n\u00e2u 1-2 mm (H\u00ecnh 2.36). Li\u1ec1m m\u00f3ng c\u00f3 th\u1ec3 nh\u00ecn th\u1ea5y ho\u1eb7c kh\u00f4ng, v\u00e0 s\u1ef1 t\u1eafc ngh\u1ebdn t\u0129nh m\u1ea1ch kh\u00f4ng che \u0111i d\u1ea3i xa. Th\u01b0\u1eddng th\u1ea5y \u1edf b\u1ec7nh nh\u00e2n x\u01a1 gan, c\u0169ng c\u00f3 th\u1ebb g\u1eb7p \u1edf ng\u01b0\u1eddi b\u00ecnh th\u01b0\u1eddng.<\/li>\n<\/ul>\n
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H\u00ecnh 2.36 M\u00f3ng Terry: leukonychia r\u00f5 r\u00e0ng \u1edf ph\u1ea7n g\u1ea7n m\u00f3ng \u1edf b\u1ec7nh nh\u00e2n x\u01a1 gan<\/figcaption><\/figure>\n
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M\u00f3ng Lindsay (half and half nail), n\u01a1i ph\u1ea7n g\u1ea7n c\u00f3 m\u00e0u tr\u1eafng x\u1ec9n v\u00e0 ph\u1ea7n xa (20-60% t\u1ed5ng chi\u1ec1u d\u00e0i) c\u00f3 m\u00e0u h\u1ed3ng ho\u1eb7c n\u00e2u \u0111\u1ecf, c\u00f3 \u0111\u01b0\u1eddng vi\u1ec1n r\u00f5 gi\u1eefa hai m\u00e0u (H\u00ecnh 2.37). Lo\u1ea1i leukonychia r\u00f5 r\u00e0ng n\u00e0y \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o \u1edf m\u1ed9t ph\u1ea7n ba s\u1ed1 b\u1ec7nh nh\u00e2n ch\u1ea1y th\u00e2n nh\u00e2n t\u1ea1o.<\/li>\n
\u0110\u01b0\u1eddng Muehreke, n\u01a1i m\u00f3ng c\u00f3 nhi\u1ec1u d\u1ea3i ngang m\u00e0u tr\u1eafng, song song v\u1edbi li\u1ec1m m\u00f3ng (H\u00ecnh 2.38). \u0110\u01b0\u1ee3c m\u00f4 t\u1ea3 ban \u0111\u1ea7u \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb x\u01a1 gan, hi\u1ec7n nay th\u01b0\u1eddng \u0111\u01b0\u1ee3c th\u1ea5y sau h\u00f3a tr\u1ecb.<\/li>\n<\/ul>\n
Pseudo-leukonychia m\u00f4 t\u1ea3 s\u1ef1 \u0111\u1ed5i m\u00e0u tr\u1eafng c\u1ee7a m\u00f3ng do t\u1ed5n th\u01b0\u01a1ng b\u1ec1 m\u1eb7t phi\u1ebfn m\u00f3ng do c\u00e1c y\u1ebfu t\u1ed1 b\u00ean ngo\u00e0i. Trong b\u1ec7nh n\u1ea5m m\u00f3ng n\u00f4ng m\u00e0u tr\u1eafng, n\u1ea5m x\u00e2m chi\u1ebfm b\u1ec1 m\u1eb7t phi\u1ebfn m\u00f3ng v\u00e0 ti\u00eau h\u00f3a ch\u1ea5t s\u1eebng c\u1ee7a m\u00f3ng t\u1ea1o ra nh\u1eefng \u0111\u1ed1m m\u00e0u tr\u1eafng \u0111\u1ee5c d\u1ec5 v\u1ee1 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c c\u1ea1o d\u1ec5 d\u00e0ng (H\u00ecnh 2.39). S\u1ef1 th\u00f3ai h\u00f3a keratin l\u00e0 m\u1ed9t d\u1ea1ng m\u00f3ng d\u1ec5 g\u00e3y do s\u1eed d\u1ee5ng s\u01a1n m\u00f3ng tay trong th\u1eddi gian d\u00e0i, d\u1eabn \u0111\u1ebfn t\u1ed5n th\u01b0\u01a1ng ph\u1ea7n tr\u00ean phi\u1ebfn m\u00f3ng l\u00e0m m\u00f3ng tr\u1edf n\u00ean d\u1ec5 v\u1ee1 v\u00e0 tr\u1eafng. M\u00f3ng c\u00f3 nh\u1eefng \u0111\u1ed1m tr\u1eafng \u0111\u1ee5c do v\u1ea3y m\u1ecfng \u1edf b\u1ec1 m\u1eb7t v\u00e0 \u0111\u1ec1u \u0111\u1eb7n (H\u00ecnh 2.40).<\/p>\n
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H\u00ecnh 2.37 M\u00f3ng Lindsay, ph\u1ea7n m\u00f3ng g\u1ea7n m\u00e0u tr\u1eafng \u0111\u1ee5c c\u00f3 ranh gi\u1edbi r\u00f5 v\u1edbi ph\u1ea7n m\u00f3ng xa m\u00e0u \u0111\u1ecf \u1edf b\u1ec7nh nh\u00e2n suy th\u1eadn m\u00e3n \u0111ang ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o.<\/figcaption><\/figure>\n
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H\u00ecnh 2.38 \u0110\u01b0\u1eddng Muchreke, nhi\u1ec1u d\u1ea3i tr\u1eafng ngang trong leukonychia r\u00f5 r\u00e0ng, song song v\u1edbi li\u1ec1m m\u00f3ng \u1edf m\u1ed9t b\u1ec7nh nh\u00e2n \u0111ang h\u00f3a tr\u1ecb ung th\u01b0 bi\u1ec3u m\u00f4 tuy\u1ebfn v\u00fa<\/figcaption><\/figure>\n
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H\u00ecnh 2.39 Pseudoleukonychia trong b\u1ec7nh n\u1ea5m m\u00f3ng n\u00f4ng m\u00e0u tr\u1eafng: m\u1ea3ng m\u00e0u tr\u1eafng \u0111\u1ee5c v\u00e0 d\u1ec5 v\u1ee1 tr\u00ean b\u1ec1 m\u1eb7t phi\u1ebfn m\u00f3ng, do c\u00e1c c\u1ee5m n\u1ea5m v\u00e0 m\u1ea3nh v\u1ee5n keratin<\/figcaption><\/figure>\n
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H\u00ecnh 2.40 Pseudoleukonychia do tho\u00e1i h\u00f3a keratin: s\u1ef1 \u0111\u1ed5i m\u00e0u tr\u1eafng do v\u1ea3y m\u1ecfng tr\u00ean b\u1ec1 m\u1eb7t<\/figcaption><\/figure>\n
\n2.3.2 Xu\u1ea5t huy\u1ebft t\u1eebng m\u1ea3nh<\/h2>\n
Bi\u1ec3u hi\u1ec7n d\u01b0\u1edbi d\u1ea1ng m\u1ed9t ho\u1eb7c nhi\u1ec1u s\u1ecdc n\u00e2u \u0111\u1ecf \u1edf ph\u1ea7n xa c\u1ee7a m\u00f3ng (H\u00ecnh 2.41) v\u00e0 t\u01b0\u01a1ng \u1ee9ng v\u1edbi t\u00ecnh tr\u1ea1ng xu\u1ea5t huy\u1ebft mao m\u1ea1ch m\u00e1u \u1edf gi\u01b0\u1eddng m\u00f3ng. H\u00ecnh d\u1ea1ng d\u1ecdc b\u1eaft ngu\u1ed3n t\u1eeb h\u00ecnh d\u1ea1ng d\u1ecdc c\u1ee7a c\u00e1c mao m\u1ea1ch m\u00e1u, ch\u1ea1y d\u1ecdc theo c\u00e1c n\u1ebfp d\u1ecdc c\u1ee7a gi\u01b0\u1eddng m\u00f3ng. Soi da cho ph\u00e9p th\u1ea5y r\u00f5 h\u01a1n c\u00e1c v\u1ebft xu\u1ea5t huy\u1ebft th\u01b0\u1eddng c\u00f3 m\u00e0u t\u1eeb \u0111\u00f3 \u0111\u1eadm \u0111\u1ebfn \u0111en v\u00e0 s\u1ef1 m\u1edd d\u1ea7n c\u1ee7a s\u1eafc t\u1ed1 \u1edf ngo\u1ea1i v\u00ec (H\u00ecnh 2.42). Xu\u1ea5t huy\u1ebft t\u1eebng m\u1ea3nh th\u01b0\u1eddng do ch\u1ea5n th\u01b0\u01a1ng. Ch\u00fang c\u00f3 th\u1ec3 th\u01b0\u1eddng xuy\u00ean \u0111\u01b0\u1ee3c th\u1ea5y \u1edf m\u00f3ng b\u1ecb b\u1ec7nh v\u1ea3y n\u1ebfn v\u00e0 n\u0103m m\u00f3ng, n\u01a1i c\u00f3 c\u00e1c d\u1ea5u hi\u1ec7u kh\u00e1c c\u1ee7a b\u1ec7nh \u0111i k\u00e8m.<\/p>\n
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H\u00ecnh 2.41 Xu\u1ea5t huy\u1ebft t\u1eebng m\u1ea3nh \u1edf m\u00f3ng tay th\u1ee9 ba bi\u1ec3u hi\u1ec7n d\u01b0\u1edbi d\u1ea1ng nh\u1eefng \u0111\u01b0\u1eddng ng\u1eafn m\u00e0u n\u00e2u \u1edf ph\u1ea7n xa m\u00f3ng. Ch\u00fa \u00fd \u0111\u01b0\u1eddng Beau tr\u00ean c\u00f9ng m\u00f3ng<\/figcaption><\/figure>\n
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H\u00ecnh 2.42 Soi da xu\u1ea5t huy\u1ebft t\u1eebng m\u1ea3nh: s\u1eafc t\u1ed1 th\u01b0\u1eddng m\u1edd d\u1ea7n \u1edf ngo\u1ea1i vi, do s\u1ef1 tho\u00e1i h\u00f3a d\u1ea7n d\u1ea7n c\u1ee7a hemosiderin<\/figcaption><\/figure>\n
\n2.3. H\u1eafc t\u1ed1 m\u00f3ng (melanonychia) d\u1ea1ng s\u1ecdc<\/h2>\n
Thu\u1eadt ng\u1eef longitudinal melanonychia d\u1ecdc m\u00f4 t\u1ea3 m\u1ed9t d\u1ea3i d\u1ecdc m\u00e0u \u0111en-n\u00e2u x\u00e1m t\u01b0\u01a1ng ph\u1ea3n v\u1edbi m\u00e0u h\u1ed3ng c\u1ee7a m\u00f3ng b\u00ecnh th\u01b0\u1eddng (H\u00ecnh 2.43) v\u00e0 l\u00e0 do s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a melanin trong phi\u1ebfn m\u00f3ng 2. Bi\u1ec3u hi\u1ec7n c\u1ee7a d\u1ea3i c\u00f3 th\u1ec3 thay \u0111\u1ed5i \u0111\u00e1ng k\u1ec3: m\u00e0u s\u1eafc c\u00f3 th\u1ec3 r\u00f5 r\u00e0ng v\u00e0 \u0111\u1ed3ng nh\u1ea5t h\u01a1n ho\u1eb7c \u00edt h\u01a1n, c\u00e1c \u0111\u01b0\u1eddng vi\u1ec1n c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh r\u00f5 ho\u1eb7c \u00edt s\u1eafc n\u00e9t h\u01a1n, chi\u1ec1u r\u1ed9ng c\u00f3 th\u1ec3 dao \u0111\u1ed9ng t\u1eeb v\u00e0i mm cho \u0111\u1ebfn to\u00e0n b\u1ed9 phi\u1ebfn m\u00f3ng. Phi\u1ebfn m\u00f3ng c\u00f3 th\u1ec3 c\u00f3 m\u1ed9t s\u1ed1 thay \u0111\u1ed5i ho\u1eb7c ho\u00e0n to\u00e0n b\u00ecnh th\u01b0\u1eddng. Cu\u1ed1i c\u00f9ng, s\u1eafc t\u1ed1 c\u00f3 th\u1ec3 m\u1edf r\u1ed9ng \u0111\u1ebfn m\u00f4 m\u1ec1m quanh m\u00f3ng (d\u1ea5u Hutchinson). T\u1ea5t c\u1ea3 nh\u1eefng bi\u1ec3u hi\u1ec7n n\u00e0y c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c th\u1ea5y r\u00f5 h\u01a1n b\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p soi phi\u1ebfn m\u00f3ng (H\u00ecnh 2.44). Melanonychia c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn m\u1ed9t ho\u1eb7c nhi\u1ec1u ng\u00f3n, c\u1ea3 \u1edf m\u00f3ng tay v\u00e0 m\u00f3ng ch\u00e2n, v\u00e0 xu\u1ea5t hi\u1ec7n \u1edf m\u1ecdi l\u1ee9a tu\u1ed5i, t\u1eeb s\u01a1 sinh \u0111\u1ebfn ng\u01b0\u1eddi gi\u00e0. S\u1ef1 xu\u1ea5t hi\u1ec7n c\u1ee7a n\u00f3 l\u00e0 do s\u1ef1 s\u1ea3n xu\u1ea5t melanin b\u1edfi c\u00e1c t\u1ebf b\u00e0o h\u1eafc t\u1ed1 c\u00f3 trong ch\u1ea5t n\u1ec1n m\u00f3ng. Trong \u0111i\u1ec1u ki\u1ec7n b\u00ecnh th\u01b0\u1eddng, c\u00e1c t\u1ebf b\u00e0o h\u1eafc t\u1ed1 trong ch\u1ea5t n\u1ec1n m\u00f3ng kh\u00f4ng s\u1ea3n xu\u1ea5t melanin v\u00e0 phi\u1ebfn m\u00f3ng ho\u00e0n to\u00e0n trong su\u1ed1t. Qu\u00e1 tr\u00ecnh s\u1ea3n xu\u1ea5t melanin c\u00f3 th\u1ec3 b\u1eaft \u0111\u1ea7u khi c\u00e1c t\u1ebf b\u00e0o h\u1eafc t\u1ed1 \u0111\u01b0\u1ee3c k\u00edch ho\u1ea1t ho\u1eb7c khi ch\u00fang t\u0103ng sinh v\u00e0 t\u1ea1o ra melanin. Do \u0111\u00f3, c\u00f3 th\u1ec3 ph\u00e2n bi\u1ec7t melanonychia do s\u1ef1 k\u00edch ho\u1ea1t melanocyte v\u00e0 melanonychia do t\u0103ng sinh l\u00e0nh t\u00ednh (t\u0103ng s\u1ea3n ho\u1eb7c nevus) ho\u1eb7c \u00e1c t\u00ednh (u h\u1eafc t\u1ed1). Do \u0111\u00f3, melanonychia d\u1ea1ng s\u1ecdc c\u00f3 l\u1ebd l\u00e0 tri\u1ec7u ch\u1ee9ng m\u00f3ng tay th\u00e1ch th\u1ee9c nh\u1ea5t \u0111\u1ed1i v\u1edbi b\u00e1c s\u0129, v\u00ec n\u00f3 c\u00f3 th\u1ec3 l\u00e0 m\u1ed9t bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng c\u1ee7a u h\u1eafc t\u1ed1 \u1edf m\u00f3ng. May m\u1eafn l\u00e0 trong h\u1ea7u h\u1ebft c\u00e1c tr\u01b0\u1eddng h\u1ee3p, melanonychia l\u00e0 m\u1ed9t tri\u1ec7u ch\u1ee9ng l\u00e0nh t\u00ednh do s\u1ef1 k\u00edch ho\u1ea1t t\u1ebf b\u00e0o h\u1eafc t\u1ed1 trong ch\u1ea5t n\u1ec1n m\u00f3ng, nh\u01b0ng b\u1ea5t k\u1ef3 b\u1ec7nh nh\u00e2n n\u00e0o c\u0169ng c\u1ea7n \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 c\u1ea9n th\u1eadn. N\u00f3i chung, c\u1ea7n ph\u1ea3i ki\u1ec3m tra c\u1ea9n th\u1eadn, b\u1ec7nh s\u1eed l\u00e2m s\u00e0ng, kh\u00e1m th\u1ef1c th\u1ec3 v\u00e0 soi da khi melanonychia \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn m\u1ed9t ng\u00f3n \u0111\u01a1n l\u1ebb v\u00e0 xu\u1ea5t hi\u1ec7n \u1edf tu\u1ed5i tr\u01b0\u1edfng th\u00e0nh, trong tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng c\u00f3 c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m m\u00f3ng ho\u1eb7c d\u1eef li\u1ec7u tr\u01b0\u1edbc \u0111\u00f3 c\u00f3 th\u1ec3 gi\u1ea3i th\u00edch s\u1ef1 xu\u1ea5t hi\u1ec7n c\u1ee7a n\u00f3.<\/p>\n
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H\u00ecnh 2.43 Melanonychia d\u1ea1ng s\u1ecdc d\u00e0i m\u00e0u n\u00e2u \u0111en ch\u1ea1y d\u1ecdc theo phi\u1ebfn m\u00f3ng, t\u1eeb b\u00ean d\u01b0\u1edbi l\u1edbp bi\u1ec3u b\u00ec \u0111\u1ebfn b\u1edd t\u1ef1 do<\/figcaption><\/figure>\n
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H\u00ecnh 2.44 Soi da trong melanonychia d\u1ea1ng s\u1ecdc cho ph\u00e9p th\u1ea5y c\u00e1c \u0111\u01b0\u1eddng b\u1edd v\u00e0 s\u1ef1 ph\u00e2n b\u1ed1 s\u1eafc t\u1ed1 theo c\u00e1c \u0111\u01b0\u1eddng d\u1ecdc<\/figcaption><\/figure>\n
\n2.3.4 \u0110\u1ecf m\u00f3ng (erythronychia) d\u1ea1ng s\u1ecdc<\/h3>\n
Thu\u1eadt ng\u1eef longitudinal erythronychia m\u00f4 t\u1ea3 m\u1ed9t d\u1ea3i d\u1ecdc m\u00e0u \u0111\u1ecf, b\u1eaft \u0111\u1ea7u t\u1eeb li\u1ec1m m\u00f3ng, \u00edt nhi\u1ec1u \u1edf \u0111\u1ea7u g\u1ea7n, v\u00e0 ti\u1ebfn t\u1edbi b\u1edd xa (H\u00ecnh 2.45) P), Phi\u1ebfn m\u00f3ng t\u01b0\u01a1ng \u1ee9ng c\u00f3 th\u1ec3 b\u00ecnh th\u01b0\u1eddng ho\u1eb7c c\u00f3 v\u1ebft n\u1ee9t d\u1ecdc m\u1edf r\u1ed9ng \u1edf b\u1edd t\u1ef1 do. D\u1ea3i m\u00e0u \u0111\u1ecf l\u00e0 do s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a kh\u1ed1i d\u01b0\u1edbi m\u00f3ng \u1edf m\u1ee9c li\u1ec1m m\u00f3ng. M\u1ed9t d\u1ea3i m\u1ecfng \u0111\u01a1n k\u00e8m v\u1edbi v\u1ebft n\u1ee9t d\u1ecdc c\u1ee7a phi\u1ebfn m\u00f3ng th\u01b0\u1eddng l\u00e0 do u nh\u00fa m\u00f3ng (onychopapilloma), trong khi m\u1ed9t d\u1ea3i l\u1edbn h\u01a1n c\u00f3 th\u1ec3 l\u00e0 do u cu\u1ed9n m\u1ea1ch ho\u1eb7c th\u1eadm ch\u00ed l\u00e0 b\u1ec7nh Bowen. Nhi\u1ec1u d\u1ea3i erythronychia \u1edf m\u1ed9t s\u1ed1 m\u00f3ng k\u00e8m theo c\u00e1c d\u00e0i tr\u1eafng v\u00e0 c\u00e1c v\u1ebft n\u1ee9t \u1edf \u0111\u1ea7u xa l\u00e0 \u0111i\u1ec1n h\u00ecnh c\u1ee7a b\u1ec7nh Darier (H\u00ecnh 2.46).<\/p>\n
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H\u00ecnh 2.45 Longitudinal erythronychia: m\u1ed9t d\u1ea3i \u0111\u01a1n m\u1ecfng m\u00e0u \u0111\u1ecf b\u1eaft \u0111\u1ea7u t\u1eeb li\u1ec1m m\u00f3ng v\u00e0 k\u00e9o d\u00e0i \u0111\u1ebfn b\u1edd t\u1ef1 do, trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y c\u00f3 v\u1ebft n\u1ee9t \u1edf \u0111\u1ea7u xa. Nguy\u00ean nh\u00e2n \u1edf \u0111\u00e2y l\u00e0 do u nh\u00fa m\u00f3ng<\/figcaption><\/figure>\n
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H\u00ecnh 2.46 Longitudinal erythronychia \u1edf nhi\u1ec1u ng\u00f3n: d\u1ea3i \u0111\u1ecf \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn nhi\u1ec1u m\u00f3ng. Trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y, c\u00f3 k\u00e8m theo c\u00e1c d\u1ea3i tr\u1eafng v\u00e0 c\u00e1c v\u1ebft n\u1ee9t \u1edf \u0111\u1ea7u xa v\u00e0 l\u00e0 \u0111i\u1ec3n h\u00ecnh c\u1ee7a b\u1ec7nh Datier.<\/figcaption><\/figure>\n
2.4 Thay \u0111\u1ed5i s\u1ef1 b\u00e1m d\u00ednh c\u1ee7a phi\u1ebfn m\u00f3ng – gi\u01b0\u1eddng m\u00f3ng<\/h2>\n
2.4.1 T\u00e1ch m\u00f3ng (onycholysis)<\/h3>\n
Thu\u1eadt ng\u1eef onycholysis m\u00f4 t\u1ea3 s\u1ef1 t\u00e1ch r\u1eddi c\u1ee7a phi\u1ebfn m\u00f3ng ra kh\u1ecfi gi\u01b0\u1eddng m\u00f3ng b\u00ean d\u01b0\u1edbi. Phi\u1ebfn m\u00f3ng xu\u1ea5t hi\u1ec7n m\u00e0u tr\u1eafng do c\u00f3 kh\u00f4ng kh\u00ed b\u00ean d\u01b0\u1edbi (H\u00ecnh 2.47). M\u00e0u s\u1eafc c\u00f3 th\u1ec3 kh\u00f4ng ph\u1ea3i l\u00e0 m\u00e0u tr\u1eafng v\u00ec c\u00e1c s\u1eafc t\u1ed1 kh\u00e1c c\u00f3 th\u1ec3 hi\u1ec7n di\u1ec7n v\u00e0 g\u00e2y ra s\u1ef1 \u0111\u1ed5i m\u00e0u xanh \u0111en (pyocyanin), v\u00e0ng (n\u1ea5m v\u00e0 d\u1ecbch ti\u1ebft) ho\u1eb7c \u0111\u1ecf (hemosiderin). Onycholysis l\u00e0 m\u1ed9t trong nh\u1eefng d\u1ea5u hi\u1ec7u m\u00f3ng ph\u1ed5 bi\u1ebfn nh\u1ea5t v\u00e0 th\u01b0\u1eddng kh\u00f4ng \u0111\u1eb7c tr\u01b0ng.<\/p>\n
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D\u1ea5u hi\u1ec7u \u1edf m\u00f3ng<\/figcaption><\/figure>\n
H\u00ecnh 2.47 Onycholysis: phi\u1ebfn m\u00f3ng b\u1ecb t\u00e1ch ra kh\u1ecfi gi\u01b0\u1eddng m\u00f3ng v\u00e0 xu\u1ea5t hi\u1ec7n m\u00e0u tr\u1eafng do c\u00f3 kh\u00f4ng khi b\u00ean d\u01b0\u1edbi<\/p>\n
\n2.4.2 T\u0103ng s\u1eebng d\u01b0\u1edbi m\u00f3ng<\/h3>\n
\u0110\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi s\u1ef1 t\u00edch t\u1ee5 c\u1ee7a c\u00e1c v\u1ea3y d\u01b0\u1edbi phi\u1ebfn m\u00f3ng, b\u1ecb t\u00e1ch ra v\u00e0 n\u00e2ng l\u00ean. Quan s\u00e1t m\u00f3ng t\u1eeb ph\u00eda tr\u01b0\u1edbc, c\u00f9ng v\u1edbi vi\u1ec7c lo\u1ea1i b\u1ecf phi\u1ebfn m\u00f3ng b\u1ecb t\u00e1ch ra, x\u00e1c nh\u1eadn s\u1ef1 n\u00e2ng phi\u00ean m\u00f3ng l\u00e0 do s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a c\u00e1c v\u1ea3y b\u00ean d\u01b0\u1edbi (H\u00ecnh 2.48). T\u0103ng s\u1eebng d\u01b0\u1edbi m\u00f3ng l\u00e0 k\u1ebft qu\u1ea3 c\u1ee7a s\u1ef1 t\u0103ng sinh qu\u00e1 m\u1ee9c c\u1ee7a t\u1ebf b\u00e0o s\u1eebng gi\u01b0\u1eddng m\u00f3ng\/ r\u00e3nh d\u01b0\u1edbi m\u00f3ng v\u00e0 th\u01b0\u1eddng g\u1eb7p trong c\u00e1c r\u1ed1i lo\u1ea1n vi\u00eam nh\u01b0 b\u1ec7nh v\u1ea3y n\u1ebfn v\u00e0 vi\u00eam da ti\u1ebfp x\u00fac c\u0169ng nh\u01b0 b\u1ec7nh n\u1ea5m d\u01b0\u1edbi m\u00f3ng \u1edf ph\u1ea7n xa m\u00f3ng.<\/p>\n
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H\u00ecnh 2.48 T\u0103ng s\u1eebng d\u01b0\u1edbi m\u00f3ng \u1edf m\u00f3ng ch\u00e2n th\u1ee9 nh\u1ea5t v\u00e0 th\u1ee9 ba phi\u1ebfn m\u00f3ng b\u1ecb t\u00e1ch ra v\u00e0 n\u00e2ng l\u00ean do t\u00edch t\u1ee5 v\u1ea3y. Nh\u00ecn t\u1eeb ph\u00eda tr\u01b0\u1edbc cho ph\u00e9p d\u1ec5 d\u00e0ng quan s\u00e1t ch\u1ea5t s\u1eebng d\u01b0\u1edbi m\u00f3ng<\/figcaption><\/figure>\n
2.5 Thay \u0111\u1ed5i c\u1ee7a m\u00f4 quanh m\u00f3ng<\/h2>\n
C\u00e1c n\u1ebfp g\u1ea5p m\u00f3ng bao quanh phi\u1ebfn m\u00f3ng ngo\u1ea1i tr\u1eeb ph\u1ea7n b\u1edf xa. N\u1ebfp g\u1ea5p m\u00f3ng g\u1ea7n \u0111\u01b0\u1ee3c b\u00e1m ch\u1eb7t v\u00e0o phi\u1ebfn m\u00f3ng b\u1eb1ng l\u1edbp bi\u1ec3u b\u00ec. C\u00e1c n\u1ebfp g\u1ea5p b\u00ean c\u00f3 th\u1ec3 l\u1ed3i nhi\u1ec1u ho\u1eb7c \u00edt v\u00e0 che ph\u1ee7 c\u1ea1nh b\u00ean c\u1ee7a phi\u1ebfn m\u00f3ng \u1edf nh\u1eefng m\u1ee9c \u0111\u1ed9 kh\u00e1c nhau. \u1ede m\u00f3ng tay, 1\/3 xa c\u1ee7a c\u00e1c c\u1ea1nh b\u00ean c\u1ee7a phi\u1ebfn m\u00f3ng th\u01b0\u1eddng nh\u00ecn th\u1ea5y \u0111\u01b0\u1ee3c t\u1eeb b\u00ean ngo\u00e0i, v\u00ec n\u1ebfp g\u1ea5p b\u00ean tr\u1edf n\u00ean ph\u1eb3ng \u1edf ph\u1ea7n xa, trong khi \u1edf c\u00e1c m\u00f3ng ch\u00e2n, \u0111\u1eb7c bi\u1ec7t l\u00e0 3 ng\u00f3n \u0111\u1ea7u, c\u00e1c n\u1ebfp g\u1ea5p che ph\u00f9 c\u1ea1nh b\u00ean l\u00ean \u0111\u1ebfn b\u1edd t\u1ef1 do, l\u1ed3i v\u00e0 n\u00e2ng l\u00ean.<\/p>\n
2.5.1 S\u1ef1 thay \u0111\u1ed5i ki\u1ec3u h\u00ecnh mao m\u1ea1ch c\u1ee7a n\u1ebfp g\u1ea5p m\u00f3ng<\/h3>\n
Nh\u1eefng thay \u0111\u1ed5i trong ki\u1ec3u h\u00ecnh mao m\u1ea1ch \u1edf n\u1ebfp g\u1ea5p m\u00f3ng l\u00e0 \u0111i\u1ec3n h\u00ecnh c\u1ee7a c\u00e1c b\u1ec7nh m\u00f4 li\u00ean k\u1ebft v\u00e0 \u0111\u01b0\u1ee3c th\u1ea5y r\u00f5 nh\u1ea5t \u1edf ng\u00f3n tay th\u1ee9 t\u01b0 ho\u1eb7c th\u1ee9 ba. C\u00e1c b\u1ea5t th\u01b0\u1eddng v\u1ec1 mao m\u1ea1ch bao g\u1ed3m s\u1ef1 r\u1ed1i lo\u1ea1n t\u1ed5 ch\u1ee9c c\u1ee7a c\u1ea7u tr\u00fac mao m\u1ea1ch (x\u01a1 c\u1ee9ng to\u00e0n th\u00e2n, vi\u00eam b\u00ec c\u01a1, lupus ban \u0111\u1ecf h\u1ec7 th\u1ed1ng), gi\u00e3n mao m\u1ea1ch (h\u1ed9i ch\u1ee9ng Raynaud, x\u01a1 c\u1ee9ng h\u1ec7 th\u1ed1ng, vi\u00eam da c\u01a1), vi xu\u1ea5t huy\u1ebft (x\u01a1 c\u1ee9ng to\u00e0n th\u00e2n, vi\u00eam b\u00ec c\u01a1), c\u00e1c v\u00f9ng v\u00f4 m\u1ea1ch (x\u01a1 c\u1ee9ng to\u00e0n th\u00e2n, vi\u00eam b\u1ecb c\u01a1) v\u00e0 c\u00e1c mao m\u1ea1ch d\u1ea1ng nh\u00e1nh ho\u1eb7c c\u1ee5m \u1edf v\u00f9ng \u00edt m\u1ea1ch m\u00e1u (x\u01a1 c\u1ee9ng to\u00e0n th\u00e2n, vi\u00eam b\u00ec c\u01a1) (H\u00ecnh 2.49).<\/p>\n
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H\u00ecnh 2.49 H\u00ecnh v\u1ebd minh hoa bi\u1ec3u hi\u1ec7n d\u01b0\u1edbi soi da c\u1ee7a c\u00e1c mao m\u1ea1ch \u1edf n\u1ebfp g\u1ea5p m\u00f3ng g\u1ea7n \u1edf ng\u01b0\u1eddi b\u00ecnh th\u01b0\u1edfng v\u00e0 b\u1ec7nh l\u00fd m\u00f4 li\u00ean k\u1ebft<\/figcaption><\/figure>\n
\n2.5.2 Vi\u00eam quanh m\u00f3ng (paronychia)<\/h3>\n
Thu\u1eadt ng\u1eef paronychia m\u00f4 t\u1ea3 t\u00ecnh tr\u1ea1ng vi\u00eam \u1edf c\u00e1c n\u1ebfp g\u1ea5p m\u00f3ng, v\u1edbi ban \u0111\u1ecf, s\u01b0ng, \u0111au v\u00e0 suy gi\u1ea3m ho\u1ea1t \u0111\u1ed9ng. Paronychia th\u01b0\u1eddng \u1ea3nh h\u01b0\u1edfng ch\u1ecdn l\u1ecdc \u0111\u1ebfn n\u1ebfp g\u1ea5p m\u00f3ng g\u1ea7n, v\u1edbi t\u00ecnh tr\u1ea1ng vi\u00eam c\u1ea5p t\u00ednh ho\u1eb7c m\u00e3n t\u00ednh, lu\u00f4n c\u00f3 \u0111\u1eb7c tr\u01b0ng b\u1edfi thi\u1ebfu l\u1edbp bi\u1ec3u b\u00ec (H\u00ecnh 2.50 v\u00e0 2.51). Ch\u1ea5t n\u1ec1n m\u00f3ng b\u00ean d\u01b0\u1edbi c\u00f3 th\u1ec3 b\u1ecb \u1ea3nh h\u01b0\u1edfng b\u1edfi qu\u00e1 tr\u00ecnh vi\u00eam v\u00e0 t\u1ea1o ra c\u00e1c \u0111\u01b0\u1eddng Beau, t\u00e1ch m\u00f3ng \u1edf \u0111\u1ea7u g\u1ea7n ho\u1eb7c c\u00e1c b\u1ea5t th\u01b0\u1eddng tr\u00ean b\u1ec1 m\u1eb7t phi\u1ebfn m\u00f3ng. D\u1ea1ng vi\u00eam quanh m\u00f3ng c\u1ea5p t\u00ednh ph\u1ed5 bi\u1ebfn nh\u1ea5t \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn 1 m\u00f3ng tay sau c\u00e1c v\u00ec ch\u1ea5n th\u01b0\u01a1ng v\u00e0 nhi\u1ec5m tr\u00f9ng do vi khu\u1ea9n, ch\u1ee7 y\u1ebfu g\u1eb7p \u1edf tr\u1ebb em. M\u1eb7t kh\u00e1c, vi\u00eam quanh m\u00f3ng m\u00e3n t\u00ednh th\u01b0\u1eddng th\u1ea5y \u1edf v\u00e0i m\u00f3ng tay c\u1ee7a ph\u1ee5 n\u1eef tr\u01b0\u1edfng th\u00e0nh th\u01b0\u1eddng xuy\u00ean ti\u1ebfp x\u00fac v\u1edbi n\u01b0\u1edbc v\u00e0 c\u00e1c ch\u1ea5t k\u00edch \u1ee9ng ho\u1eb7c l\u00e0m m\u00f3ng tay qu\u00e1 m\u1ee9c. C\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c g\u00e2y ra vi\u00eam quanh m\u00f3ng c\u1ea5p t\u00ednh \u1edf nhi\u1ec1u ng\u00f3n l\u00e0 do thu\u1ed1c, nh\u01b0 retinoid, thu\u1ed1c kh\u00e1ng retrovirus (indinavir) v\u00e0 thu\u1ed1c \u1ee9c ch\u1ebf EGFR: t\u00ecnh tr\u1ea1ng vi\u00eam trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p n\u00e0y nghi\u00eam tr\u1ecdng v\u00e0 th\u01b0\u1eddng \u0111i k\u00e8m u h\u1ea1t sinh m\u00f9. Vi\u00eam quanh m\u00f3ng v\u00e0 u h\u1ea1t sinh m\u00f9 l\u00e0 nh\u1eefng tri\u1ec7u ch\u1ee9ng \u0111i\u1ec3n h\u00ecnh c\u1ee7a m\u00f3ng ch\u00e2n ch\u1ecdc th\u1ecbt v\u00e0 l\u00e0 k\u1ebft qu\u1ea3 c\u1ee7a ch\u1ea5n th\u01b0\u01a1ng l\u1eb7p l\u1ea1i c\u1ee7a gai m\u00f3ng v\u00e0o c\u00e1c m\u00f4 m\u1ec1m c\u1ea1nh b\u00ean.<\/p>\n
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H\u00ecnh 2.50 Vi\u00eam quanh m\u00f3ng c\u1ea5p t\u00ednh \u1edf m\u00f3ng ch\u00e2n th\u1ee9 c\u00e1i: vi\u00eam n\u1eb7ng \u1edf n\u1ebfp g\u1ea5p m\u00f3ng g\u1ea7n v\u1edbi ban \u0111\u1ecf r\u00f5 v\u00e0 thi\u1ebfu l\u1edbp bi\u1ec3u b\u00ec. Ch\u00fa \u00fd t\u00e1ch m\u00f3ng \u1edf \u0111\u1ea7u g\u1ea7n m\u1ed9t b\u00ean do t\u1ed5n th\u01b0\u01a1ng ch\u1ea5t n\u1ec1n m\u00f3ng<\/figcaption><\/figure>\n
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H\u00ecnh 2.51 Vi\u00eam quanh m\u00f3ng m\u00e3n t\u00ednh \u1edf m\u00f3ng tay th\u1ee9 nh\u1ea5t v\u00e0 th\u1ee9 hai: n\u1ebfp g\u1ea5p m\u00f3ng ph\u00f9 n\u1ec1 v\u00e0 \u0111\u00f4ng v\u1ea3y, thi\u1ebfu l\u1edbp bi\u1ec3u b\u00ec. Ch\u00fa \u00fd nh\u1eefng b\u1ea5t th\u01b0\u1eddng tr\u00ean b\u1ec1 m\u1eb7t phi\u1ebfn m\u00f3ng th\u1ee9 ph\u00e1t do t\u1ed5n th\u01b0\u01a1ng vi\u00eam ch\u1ea5t n\u1ec1n m\u00f3ng.<\/figcaption><\/figure>\n
T\u00e0i li\u1ec7u tham kh\u1ea3o<\/h2>\n
1. Tosti A, Daniel CR III, Piraccini BM, Iorizzo M (2010) Color atlas of nails. Springer, Berlin<\/p>\n
2. Tosti A, Piraccini BM, de Farias DC (2009) Dealing with melanonychia. Semin Cutan Med Surg 28:49-54.<\/p>\n
3. de Berker D (2012) Erythronychia. J Dermatol 25(6):603-611.<\/p>\n
4. Hasegawa M (2011) Dermoscopy findings of nail fold capillaries in connective tissue diseases J Dermatol 38(1):66-708.<\/p>\n","protected":false},"excerpt":{"rendered":"
C\u00e1c d\u1ea5u hi\u1ec7u \u1edf m\u00f3ng t\u01b0\u01a1ng t\u1ef1 nh\u01b0 c\u00e1c d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng tr\u00ean da v\u00e0 vi\u1ec7c nh\u1eadn bi\u1ebft ch\u00fang l\u00e0 b\u1eaft bu\u1ed9c \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n ch\u00ednh x\u00e1c. C\u00e1c d\u1ea5u hi\u1ec7u \u1edf m\u00f3ng th\u01b0\u1eddng li\u00ean quan \u0111\u1ebfn phi\u1ebfn m\u00f3ng, c\u00f3 th\u1ec3 thay \u0111\u1ed5i v\u1ec1 h\u00ecnh d\u1ea1ng, k\u00edch th\u01b0\u1edbc, b\u1ec1 m\u1eb7t v\u00e0 m\u00e0u s\u1eafc ho\u1eb7c c\u00f3 […]\n","protected":false},"author":1,"featured_media":108739,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-108688","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-y-te-suc-khoe"],"acf":[],"_links":{"self":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/108688","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/comments?post=108688"}],"version-history":[{"count":2,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/108688\/revisions"}],"predecessor-version":[{"id":108741,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/108688\/revisions\/108741"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/108739"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=108688"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=108688"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=108688"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}