Document 5091

rrivrod$
rlrsilninrmsqnAnfr'sqldirilrsu e greo?ulunrrfl orffunmor5{dinsr
EIIIICACY OX'pHE BUCERIN OINflUENT IN PRDVENIION OF
RAI}IOTHERAPT StrIN NEASNONS IN f,EAD ANI' I\ECK CANCDR PAIINNTS
qninr firdhoqa
eitrinnrrnarura{ln{
f,orfin?nardfu uminsrf,sufi na
fi.s.268E
Gryu
rd*vEJ
egX
ISBN 974-6EE-1E0-0
a
.AAA.
(otl?il0l,dn!}
Copyright by Mahidol University
insrrfinud
,iuo
rJrrtinf; nrrntssndnrYuqiliiiqflror o grmtulunrrfl ooffulra{ooi{ilinureio
fi rrrrislu{ihsusrf
quAeoriirucuocRo
Iqier
J*filmq,n
avan
qoral sunHsqa
lbu
ry?os
fJl
6J/*
.€nn.....6.
sil6n mqroliqqa
?n.u.(nsrum), M.se PhJ).
il:ssrilRr:unr:oruqrinsrfi nud
-sRg,*gg,*-13:*Por
0
n?{no$lndlqad
il.U, Cefiinete of Proficiency
(Radiotherapy and Nuclear Medldne)
Rrtiln'rrR?uqrinurfi nud
^0.t
dw
0^
J-ffiL
;;'*-;"".xi'o"-'
-rcf,...pdr-......
ilrdnr qasils
nr:dnrd qamorlnn
-4q
fl.u, ?n.il.(gou??ngr)
?n.u. (tlglula), M.S., n.n.
Ph.D. (Micobiology)
ilrcnunorcnr:unr:ilrrdrrnffngnr
.l
ROIUN
VAAU
ufl0nn?ng16tf
nsrurafl lssrsunriilfisr
firnrtnorrnsrrnaflnq!
d
Rotsilvtilt fllcsrt
f:snsruranmGuGi
Copyright by Mahidol University
aaa
"Rtfluflilf
A
tto€
rJtcfofi nrnmqndnfiomiiilfrrihsr o greotulunrrfl srffuna{ osiqeiinurdoihnris
rliEqrnnumfl rsorlrrrlriorfi n eiuirr
iufi
or
rnorurafl uqi
as ihnrnu zsgs
fo?or nftiln o,
.r*-r.
qo3or dudlwrlo
hU
ry?os
&*&**au6n
rquiiqqo
?n.u.(nmum), nt s., PhJt
il:cnunr:tnrrcoutnurfi nud
#'QV
-.fu*Axsry.r
[email protected]
.tadt
illa lanula?{fl
il?{nos ln:f,gad
?n.U.(ngfum),l[N.
o1ttlnl:floU?narfinud
?l.Uo Ccrtrfiete of koffdenq
(Rdothrapy
and Nuctear ll,redidne)
R??ilnrrflouinsrfinud
t
*fD.**..ffita
a
frugfi qaafa, rr.u., ?tLtf.
g:roanG nmriilrs,
(go8einur), Ph,D.
F*.A"C.P. FRCP(I), FRCpc, o.?.
Mcnobiologr)
M.D.o BS.fl,ons.),
FI.c.p,
notiln
Rotufi
riilfininsrfrs
natcilililsnmntltsilaruro:rurGuii
utrinarffuufinaCopyright
lilrinsrflsufina
by Mahidol University
_----.1
4
rffis6b
AA*AT
is
v
{
?u rnou
umdm.laint frifilnuqa
iltRa
.ila
3
R:Ra'nx
2fl18
ssrudfin
ilnrdlrrrlnr
rhct6nrrf,nrn
urafnsrdbilfrsa, t.fr. ?s26?spy.
rhsrnalno
inornnenrrimfi n (ilulilm$asnqrnr
ufi
ringrdsuiiaa n.f,.
r rfy
2s3G?s?E:
ilurilmrn.rn:unriglfin
ns cffi noff rmflr
ryrqnilWrnrrririfrs
wsrura:nniud
uifndnugdu 6rtin rnunrlriutfil
sfiTnnisuasaotudtituto nfl.E*2ssz
no,turarhgdrRn
rHu
n.el. 2ss2-2$a:
nr?rrncnfribhluavq nriu
nmilroitfitfi :gdu g
n
orfl or fiurmgrlrrln nrr 6eolmn6n
*rrinourrTs R1{rnruilrunr
[email protected]
lrwsruranErln 2 nl,$nfluilTunr
n.f,. 253+2535: 1r0',m10ilrc6rn'tr
Copyright by Mahidol University
figrfinrfliltgRrf,
inorfinuCo riud*rriqqdNlddeon?lilnq$rrracnmudruru6oodrr6&orn
nEmuduorurhu {Ef,omnnumuilrcqs
nrco:mrrd nr. euin uqniqqo
rnno:'nud unrdnsw?{mo{ lnrf,rgad orerrd{nruqrinurfinuf, mg:araran:roud
u6d
a
4r aJ
rihruriixf, fin1onlfidof,a ilugfr fi,u*,ur*driiurfrsl0:nf nasnnunr?ocfou
ruffh{ounniawin
1
fiotffinsrfinufqrludfrnzugndormrlrofrruri,.rarfuaqulfi
tl|as
o sO
nld,r r0$R{?00naooil1
Rtlrrrounrcqs ummrrdtinri
luirrand unndnfilauh
uoulrvra?g
{nrl
qo4fidHnmsdoiln?lugndowundododlflunrrifis r:rlrftlfidsnucrh rhsrufio
ruacb?drft lolunnrfiurarrudoqosrirsGi
{oroilulsqsrrflruft Crildrsr-rtlinurnsnstrrdnffr rrndsiRorsrsnnofiiasrtlrr
nnurarluriuilrlnrinr dlfineucrnenlunrlfiururrufroga r.rtfo6tl*qnrirudfi
drudrulunmrtfifrsnf{d raroililrcqoromr:darar'u ,odurtqu dnqorrlfiflrillnurlunrr
irn:ufdop
mtouqoruiu-ndmlsdu drfin 6rnunrlrfuriul dtfi4uariucnlulunrr
rhinudnuf
ilasmmuqondrurlrdhurhundnqnrrlSqqrlnilmum otur{otuouu
r
fnflnurnururarfiqqrlniud rz 4nriru datfuettrrnaclfrfi rft lsrmaon
druqod
Rrrnountvqorfinr illr61 dnoorflufirsftlolunrritnururlnsnaan
Rtlu{ounrvqor {rhuaranrmr:d orlrr rlrufiufu dcrfuarlulffirfttr$acfronrrnsrlo
ld#usdurloooaon rnssouftsr qolgm rruarih or sqrol qorqdnld qinar drflufird.r
1nl#larom
qauhrlonidrfinerninarfinudd mororflurfio:fiudnrvrogniadorrinra{riiu
r$rqlqn
qnfinr dufiIuoqa
Copyright by Mahidol University
Aa
a
I
rlrgeninrnmwdndottfiddof, tu" s greroiutunrrflo*iu
so?Ytgluflil!
amtorirtlinu
tl.e
rstofi ru
filu
flil
rutvriluinetiilru cuasoo
fl?0u
qnf;nr #u6buqa
rl3qqr
nollnotndnrrurrTotfin (Rlrilurumflnqil
norcRr r lnr:nruqrTnurilnui
auin
nqroiqqa, ?n.il.(il01u1o), Ms. phD.
tat
lt?{Yto{ lntn-Ue6, il.tf- Certificate of Proficiency
(Rafiotherapy and Nuclear nnedicine)
4
- lo d
iufidrrinnrrf,nsr
zg
f,irrnu
n.til. zs3t
unffndo
ao
33*
[email protected]
Aa
I
aa
,. e, tEE.
R'rr?00nr{urflurmift,rfiwoaor moflRulurconrnliltolmansarmllrt{f,to!
j
grm?ulunrrflorf,unamdltlinursiofrfiilrfrlu{rl'urrr3.ruinorilrusuasf,o ndr
fiaotirufluf,dlesucrirdrriunrrsrsiril sr ndaoiqttinur$agrasm.rnfiirrntid
Ir$mura:rurf;uii lnofinr6on$iluron1sr01s0ln1ilrR0lddfimuo {ruau
neiunauquuavnciunnaomaiuar rs
r10
30
tro +trfl
nciurnaoruonornocldiunrrquanrrilnfi
ornrfrrrrirdnriauirtlinur u#e&Idiunfinfiardddrfinr s gruoiurnurr
e
1 uirasiir
-Ctl,-ailil{n
rflrlrr{rfl?uuc2
ofo 6s rhqaarrduracduodrqrrdrrdus sf{nettdiltdt"uiltloun:u
iriilflfur
rndsdsdlfiiiurrumruc?srya fio uuurlrcdiurvduomuquur{Haroirirtlinsr
ciofi'amfidffir-uA'nurla{ulolnuuuilrcfiurcdunaruquuxnotorirtlinurcisfirufwsr
fl?{yro{ 'lnrn^4atf Inuunndffnurrflu{rlrvrfiud.rhinnudr{dhumulno{tunciumnaos
mioncirnauqu
.
r a
ffaRrrifr?,iludr rftnqirnruqruuavnriunnaor hinunmruusrndrqnatoddlflnur
d 19-
t4
sioFeilfrrfroldiurJdrurorirtilrJrvuror
rooo nnrdrnrd usirdold:-urJsrurarirtilrfirduo{1u
drrilrcrror znGEmo
rqnr fi
rn:d
nufl
amqittlfnu
rciofi
rnrirlu neirunnaorfoondrn{ru
nruqlotirfiriodrfrqnrldfifi uuoolodolrlffid.firuu s grwoiunrfiauriruira*iildfu
nr:nr,:-stl rfluiinmdrirlfi.irsuas:rnrhiuvrr ftrirosrir'lrjl#lunrcrJfiffildoiolrl
Copyright by Mahidol University
t,
Tbesis
fitle
Efficacy of pIL5 Eucqin Ointment in Plevmtion of Radiothaapy Skin
Reactions in llead and Nec& Cancer Patimts
Nme
Sutida Santichailul
Degee
Itfia$er of Nursing Science
(Afult Nursing)
The"sis Srrp€rvisory Commitlee
Somchit Ilanucharurnkr4 B.Sc.(Nursing), Iv[S- Ph-D.
Puanglong Kraiphlbul, IVLD- Certificate of Ploficiency
(Radiotherapy and
Dare of
Gradnrion
23 Augu* B-B 2538
Nuder Medicin€)
(199t
Abtrad
fhis experinemal mearc,h was darigned to evaluate the efficacy of pII5
Errc€rin
Ointn€tr in pre'vemim of radiotherapy skin ractions in head and neck cancer gatients. A
1nqpmive sample of 30 aduls canoetr
ptiens
was obtain€d from a radiation therapy
clinic in Rmattibodi llospital. The s$jece were
assigned
outpdid
to eithq control (rl5) or
bb groups raeived usual care plovided by the staffs
in the setting b the expoime,ntat group rceived pltS Errerin Ointment fc external use in
experinffil gouilrl5).
Subjects in
the irradialed uea twice a day in the norning and evening &ring radiatioa in addition
Radiofiherapy skin reactions was measrred by the Modified Radiothcapy Skin Reastion Scale
developed by hanglong Kraiphibnl.
the radiotherapist who evalnated the skin reaction did
not know which patietrs were in the experimental or control group.
Re$ilt of the srudy indicated that subjects in rhe experimental gtoup had statistically
signifrcanr lower radiothdrapy skin reactions than those
in ths control
group when they
received the esrimated total dose 2fiXLEm0 cGy. But no significant difierence between
radiotherapy skin reactions were found during the first week (stimarcd total dose 1000 ccy).
Furthermore, tbe application of
plti
Bucerin Ointment to the nkin is convenience and the price
is low for the [email protected] course of treamenr These pH5 Eucerin CInment can be used in clinical
practice-
Copyright by Mahidol University
fl
a|trTq
mfr
qqlht
I
ilr3?n8?s0
fin6nr:ulrgnm
unrTedsnrurlm
R
unrindoarur&nqu
tl
mrriq
n-{
enrrTqnrrrl
t
anrlqnrrrr
o
onfi
r
unrir
nrrurililunrmnmldrdqrarilqnr
ioqrlrrmdtmnr:iir's
auufign nrrlo'u
muunnrriilnur
rj:glnnidnrndrosldiu
fiorudunfr
und
a
.rruorroiirfrnrfiuu
' Inrwsruacufirdra$ruri.r
n
r:njduuurjawo$hn fiorniritins r
nrrquaiizuriwor{rhodHguloeioutngnuefiofi dsrdo$
qaraurfritolndnfisrddfifi ros s gnro3uuanlrcffinrn
5
6
t
lo
lunrrinurlrnfimrir
i
unfr
a
g a.ro
ffidrrfrurrriffs
.
l3
rJrcrnnrmvnciudmthl
autudfon't
q
A
t4
a dcab
?flEilASmtO{UOn
as
tt lun.|'?0s
t4
Copyright by Mahidol University
rrrriqtgtol
ufir
unil s (silo)
R',tt
nnoo.iiltacRffi
d9
lRlrt?ilt2uxo{o
nrrirnnvr{doqa
unil
a
und o
IE
l9
$anrr?ffsmsnrrefiilnsna
nanrrtffo
m
nrrofidrruna.
8
frofrrTnlunrrif,s
30
apf an nrriffsuacdorm ouus
aplnanrrin'o
3l
doHuouuc
33
ufrontRfll
34
Rlnflrd?n
38
Copyright by Mahidol University
anrrlqnnr,l
nflr{fi
rnrl'r
t. nrrrllnfu rdn{fl aro{ililr-nuriofieufirsrdmn{unruqu
27
t
$ncRqrnaao{
Copyright by Mahidol University
o
eiruqorrr{|
nm{d
rnlr
l. lrtn{$1u?il$acgo0acto{ncird?orirr druunnru
A
I
t----'.r--
{
cr s
)
n
e ae
--- -.
m{nar2u{nnatrncilo{atn0?Rilu0o0nNfi
1ut{d5 nul
2.
rdn{6uru{rhutolncirnauqu$asn6iunnooldnu
d
r
a
e
[email protected]
nffi ruauutlua{xo{3r2tf u rolR'{dt Ru 1
Copyright by Mahidol University
Uilfi
1
o
unilr
n?rildhuruaEn?ruchfrqmsr1qmr
urrBufluneiumq1rndriol#rfinilqu1?l'NrdMtotqtdruiurlrcmalnu turcus
ero{nfl?rrsduiruu. ornnr:ifnsrdluuuunutssdnrrnrrnrudronriulrnsirt 1 nudrflnrr
nldouornnciulrofiniounilunciu'lrohifiosisilrndu ilo$uneiu'lrahi6nciadtfloe',toq
nr:nruluduA'udu r lduri lrnrirh 'lrn$gltr uarqrihnrq lufl n.n. zsgz 6ruru{t1.ud
rfluf,tndaolrnrgli$ilunnusrnirfru zssrs rrs uacdlumamonirf,u zsgso t'tu(cancer
R€eoft in Thailad l9BE-f99I: f9)
nT
:inur{rlaousrilluilopiufl
+ iiinoo
nT
rdrfio f,sttinur rniirlnlo uasnrrinur
nrrdugluinur fi oclffiilnif, rdrufol#iarrTuduo{fiurfiouag:gscnrrCrfiumllrn
(Criffiths, Murry & Russo 1984: fl))
irthhuildgnrlrurl#lunrrinurlrsurr$rdrusiit n.f,. lses (Ahuja, er al- in
Mossa, Robso
&
Scbinrpff, eds. 1986: zsD
uactflunrEinurdfisul#lrntiindlluiloqriu
,duooloa.ur:ot#insrlrnucrElldd{rrsi:ct cFldunudlrvgrqedrototlrn (fi?{no{
lnrfiqnd ?s?i:
4s;
lnir
mnu
$B E?s: 37 4)
dorl#flittlunr:inur tlnis lnilu{tna E26z
ft rfufldlaaucri $Jrsmat gosns zoso
47)
ufi,irlufl rqriunm:-Rurd:o:-ltilrsiitiournrnrndufi nrrfisurrurlfi nf uunludfi
ndwuqrarrrraaorJirurorirAdoccirflanrcyrusiofirnrir usiftiludrii{dlro'firuauurndr
r lu r
mr{rlaodl#fluiltilchurriqnunfinrarJduuurlarrolfienu-rtrtiotr?rnonmuhiqt
auroriuflrlaoldtrn (watker
rgEz-.
zffi) n?1uqilrt{nololrnJduurtilawo$aurftr.fudu
q--a
c
Cca{q--' --y^----4-^-^.o4
dd CCdrtd
fd F
- ln:nr,;au
(fl?itvto{
ognuurulolruu ,uuddldiuiqfiuarrrurtrardlflunr:f,n"'t#onu,
?5?4:91)
Copyright by Mahidol University
omufluffi nr:fl olrTunamriltilinursion'rilfs undrn mRcrrua*nrareirr 1
rf.rluuaseir'rrfr grnafi{iiriou{T
s$rfin' rhuluqirfl u nrr lfrfl ruusf
rrdorrTunriEuafi rurir
uirmrdHr-ur-riilinut nlu udnrdsmrrldiuucsorfindlngnr{ RlrRrcnuRrgrfiou nrr
rilon€hrnro:aooiuiu#egrl nr:1$a{lracnEudiidrun*nuori',uoumclaurrrineim 1
drrrucf
rrrf
drdnm{rhorlfi rfi iinrurlrrcdrrn oannatodrilinurdofiruriladd
otiml:iinrrnam$rtlinsrsiefieufirlursssriioundu&nuldriou drfi srnr:du
uo.r tlfirndr
franftrqoaonrfluacdo mrnflrlauftldiuirtilsislrJnudrfiarri{srnosfirsu
o t A
rad
rJirituunarfraiilu friusnorn{rleorlrccruriunaruhiqtannoornsrnrrrTu nrur6urfm
riol#rfi nnmrfdn gq fi ilonrnfrnu sirfl u otirqurn
uinardnurfiuldimrduuinsilruc
mrdmu
fii
Insn nrc nciuflrhodHiu nrr n roirtil
no
{rhodeulrqi{itnrTudo.rlodndrnurfludirrfisr
$asnrdiiunarn?octurndn{rlau{rdorf,nnrrarsililfrnrrroundunawum
frrlfiannrrosuauo$ionrrinu'rdriianhfdnnnrrqiroolurhl s flanal (Rqe )G et all9s9: 307) uacm:undRtsototto{Irnlursocdurfidu @owler & Lindsrnom tW2z 457467t
01nRrrnumil?rrsrR:rl, ffifiunu'itrf,nfrsqfidd{firss s grroiu iicirunaundru
rYuar:frnnftormiouhrTurracaisuril{omrdrnru :hsfnuromu:6udu*rtffirtrirni'l
aonrfluacrfin osl{drnrrrtrrarhdsrrurlnfiuacflorflunuqnaruto'r1af,nnlouon
ngou
riuldiinrnrunirhilf;nrdnn'ordniilgrwoiumaoflorf,ufiznri.rnnnn#rluflrlaudH;uirtil
f,nur
6nos*ey
& Rose l9t2:.
8:
Sifion 1992: frE; Strohl 198* 4)
nmflnumdrrflursuudqnr:f rndnfiuof,dd.n,*
s
rhsnoufiufi'llfiflflortr
grnroiuurldlunrrflmf,unatoriril
rhurciofinri.rd*ruoiifunumoirtl usildliomnnaorluncirf,itaolrnfiaurftsirr
.t *ii
olRrrtdeirndrsritrnmrildsuuilartsrfirmfiornirilinurlduri lrnfiIrmou(xerodoma)
lrnoclniln reotrlnfia6topic
Dermaritis)
Irnlsriufiaer*i^irl uaslrndnfiur
(tuzrma)rlrlngdrldnrafi qn"rsuq* & Naeyart l9E8: 33-38; Falabella & Cali 1986: 3941;
steinhoff te6s:
6?{s) ftrfuffif,udrcTolnrrflnurdrndnri'ardddliinr s gmoiuarurro
flotn'unatodrilf,nursiofirrnrirlufldtasugrf{u3raorii:ucuacooldn5ohi rdorJ:cTo:nilu
n
rr q uafi au
rirrorflrhodHyu
yi tlfo
u r siolil
Copyright by Mahidol University
ingrhresriussnrr?ffu
rnaoflnurrlrcffinrnra$6nfrorqf,dfi firsr s gruofiulunrrfl o{fiuamro{irtlinul
sioiiru
filu
{rlaouvr$w?raililru
cr
mcno
orur6grunrrifib
nqiu{rlaouvriwiresriboruuroudnrrfin,fi'ardddrfi
A
-Clrrlr?uu{m ron
o.t
o
Ja
I
y
nr s Ermiu u'r{ "t u?ner
'
c
J
I
Rlralur{d ?uas z nr{nod?$aal#ruacrduotinarirreuo d.rusiFilldr"u
irtlounruirtlinur nunataririilinuriofi rurirluuiacdrlnnfr?oundrntir{rlaoucrild
}ildnr
tgutusrRrt6ingr
ao{ rdofr n u rrlr cdnf; n ril r, o.rnr6srds,fdd{fi rsr s
gnm?u lunr:florf,unaror:-rtlinurcioihrfilun{uflrlaoucrisuinsrilruilrdeno dU
n
rrio'onfidrfl u nrrif,sfi{no
iunrrinuruur{ilaouon
u
ildasi{tlflnur$acnmrasrffrarndof nssunilumasrf
I:wurmarrurf; 16 dr.rrfiouqa :rau zsyt dufrounqunmu
2s3E
rJtslsrdfi nrsrdroc'ldiYu
t.
rilunrn{orurtf,nr:floffYuErauorfqtlinursiofiarrftluneir{rlauurr$.r
d.romdr
,A.ta
o
vdaurfi r qfl nrilfrTsrr or {r1 ao
z.
rfl
uuuanr.rlunrrdunft
ift,
lurJrcduoau
r driaurf,orur
dwiul#{t'horvr6.r
ldiu nrr ins'n{r,',uradiiqar nrnuasm ulsrru
Copyright by Mahidol University
fisruffeurlr
{ifu fl ror
r gmelu
nurodr ndndEdniurdrdu
fi
gnolrdrfl uordrbgnoudrfrq
dufiIn:wir.ra6turiniurmi#rrdnfie durndsumslfiorru{rfirurifumrft ndnlno
ao
.l4l
s
o
ilrun [email protected] tme
rn{o{fadfnurgiofiunTs nurs6{ nrrnjdsuurla{m$iarri.rornililinur drfl
f,nuomnuo"o odt rnirriiulo nfouqnaonriturntia run:rri:uiiuunaritsn lnuianrn
uuurJrs6u:vduntulilnr{}16ro{irtlinuriafr:urftdfrir'sn'flnla{ornuuurfrgdurcdu
nflilIilnrrnnmlirilinurgiofifl fwo{t nl{nor lmfrrlad
Copyright by Mahidol University
I
unfi 2
It
d.a
I
?ttotRttttnlR?J?tB{
nr:if,snf{dfl
nrr iilnu rrdm riuilr gAnf; nrilrollr ficrfar of,dn{ fi rm
u
nrrflsrfiunamrflrtlf,nurdofirmulluf,fl ruwr3lu?noriilrucuacfl
o
s
grwoiulu
drniutsudrsnr:
nunzu?rror RrrutcffiR{olurjrvrfi usiohjd
t. Iormir'ruasnrhdrssfi mrir
z.
o.rrilds*nlawsrfimrftornirilinur
hurmclru?tr'odrdsrda.r
4-
6ava!3
fl 8tffiJlt0to{HanR0|.ntn{ ihor s grnmEuuavrlrsflnf;nrnlunr:inurlrnfiatrit
Ia:sa$rqnsilfirifu o$f enrTr
fianrirriluo;urcdfl fiudfiarirulnqirordrrnru drnf,ufluqjnudriidudilrcuror
r.B nmnnsrrfiodiu$orr de 7 mrrirnrinda uacfiil?urflrdoonquriuurlssrru
m.r
ddd
rfi o n fi
qufi
n o on o m
r"ato lu r
t lu r
ft u rfi (stton r%*, 4)
u3nsdauuuqototfittrft qo" Homy Layr) nugrilnrdn
.e&
f
dotflunl$oonflo{
Gnrnnila{ Gebrm) ornsiouluiuuassiour#o enrdoufriornsioilh,fiurfrsnoudruhriu
riaunciodunacftl#franrft{u#r drurnrf,ord.ro,nsioilur€orfrrnoudeolrhiiu lqnduu
nao'lrri lrJ:dardsu gr€u uarn:auanfin frrtrlffiararftiinaulflunrndrfirirfiror (pro
oqilurfu
+6 rnri'nn&rmrirdocrru6'afiudurrduflari
Gydrolrprd rir,ol *nFuutdu'ou
rn:rcrhiqduorrseim 1 omnmuon'lduri naru$ou nerrdu c-rtl nmesofi nrrrcoro
rfiomrnarlniirdrr
1 florfru1af,no'rRn'ruuoRrdrqfdrmro
r.uriouirooauqruqanaqfiror
drnrul#n.rd florf,unrrgqrflorir inurarur;auacnrrrir{ru{oqqadsim 1 l#lflulrJsrril
ilnfi (Croucn & McClintic l9fll: l?5l)
Copyright by Mahidol University
6
fi'rnrft urhrfl
u z ilrsmmnoo il:surnrurnuluuinodhuoofl rrdr iisioum{odruru
urn drurhsmmlNruldu?norcfu
t
drm6o dqiidrururslcisum€or?osndTmsilun{
rfq&trr!,J
ciourlnnqruInufie Qrelwig & Mostifi r97r:26r) firrti.rrftaoflJrsnmilrcnoudtofrilor
urirfirngr @pidernis),,u,firlluonritufi
(oermis)
frruo"unfrruriqnfs#unrirrfirnft dauuuilrsnsudror.ra$dn
(Stratified
rldm
1 ndrorndn
d tonJ
Srymous Cells) lrinurdurtion
lUnutdltlGion ilgt5uu
$9l.tilUlf,3U01]l1t01RffilmO0efiOgl6!ru
tntilOllrlt0lRrdurooaeuirog tnil
urftdmrir
tJ irs-
#u ri'tuqun
(cot-r*)
* r$u
m
rir ri rn fr 6mt
*
s a
Basale) rJ:
gn
sudrsr,iladdfi
dn u il
srilu
t
,flurdsrdudiidgr:rnrrndnnjdsurryadrie rryaddefHrdulilriosrisg
rduuduu*r*ad#ruudnqnoonhl drhiaruuofiirnnr#udrsnlrldr
cieu#rnrftu#lniqnunruin,
nrfl
u z rfir #uuuo{eiordomrnrfuurirdrn$tisndr
tfirurJuflrar?i papm.ry Iayer) nurdurdonurnurseioduoriltt rhornrrlrJr*drutfir
rnfr
#u airr riundr#ur:
m
rft
n
r?rdins mnu du uavgor
fi
nrufi isumlast
osfi
m
4
n
fi fi
ail
(Reticular layer)
St or drs fi'to (Jarren
rilf$omft
tiYn
rJr c n ou
drurdil
d rdou 6nsio riu
rlr
tvt3 z 6-T
sr
ihurisrfl uoisacciruu:odfiuf,efruf,ueft rfuflrlruurriwlnrrofi lfi iunrrnrur-rtl
dwunradNrfiswiofrrnrftnsiiircdun?1lEuur{uonsimfiu
nr$isln:raftwtdtsurolunciurqradddrftrniqdanfu
mrduurft6rngrdflnrnnhcTrodroad',,arruraoor?ar
ornnrriilnurnudrirtlfiflalos
nciuroadlu#",,unuu("*
r,ayer)
afr$qadlilriilrunudrqrarturid
nqnaonhlnruorgfio reraddfid'etrrnrrndnnJdsursradodr.rranrirnf,o$ocraarluaritnuei
utofoduotilnarulrsioiqtilraufinoerurilonroldr$a urhcrfluncirrvodrfiorfiuaflu fiuei
avnndo{lu g socdm 1 fiu m mlf, n fi ii oarr lacisir tiein
nrrnroiriilnfondo
r
n'u
das
irtilarrur:nrirnrsrqadlurr0rd,sadrhnr:uri,rfircu-pn"s")
nudrnrrnrstottryadrchirfiodufiufimfisornrryadld;uy.r;il nrrnruovrfi"dudorurad
norsruudrda
usidrmruiiilfrffiorflounduloun:v{uldrfinnrcuaunuqiouuirurimrl
Copyright by Mahidol University
7
filsurslounciuruafiu#rru$oa dsrfunciuronddhignrtraroosmhcTaro$srqtaddt,uud
qqaaulrl Rrcil?ilR'rrqiouuqrudtsrfiodulffi drfiarriru3norrfufi nmudndu @assey &
Ree I9EZ coy noidrnciur.mdldiunnurflsnournilrcnoufiuf,lueodouhirossdruausis
n{rrwadrouuoR rfirlffirurirdoouqutrqnaoR usrRrituunald finaoio{dtasdolf;nnrr
nrsiltlf'mrmrundruflatufi'rCI nrurJduuuilarto$amrilornnrrldiufliilinurnoeqrlld
-J
0{u
rrurfi ndu nrslu z-g iuur nmfrinrrriroruir?il fldhufi nmufdnrhquauilaogou
ufourru?no,dldiuioenrrrgir€losh?Handro
.l
riundruunrrugou rhlffirnrirlu
cirurfuiiornrrndrognnaruflouororf,sururnnfob'llnrTldueiorhlquurr urnldr-uirZl
ilrauru lfip-2mo
!
Change
rryu6rnrd o'nfluo'rnrrduuoqfindfirnrftrSondrrfia Eqnhmatous
olnrtrdn{iitcmr0'lilro{nrslu g+ iu
,rurduuo fiaurirfitlo#,du
ftn"rp,
natrnnrrldr-unrrsrsitiildufr
nanrv{utuadruarlu'lryri (Melanocyte) fiflrnr?rdrdsaflunudlrn:rsr{$arfiu(Melanin)
rilurmingildrm$rnrir nudrsadruarlulwria{:gudrqduilrilrlrnfruag#rilu-rilfr
rsadril6irdtcdrrumfiu}Jft#uruqoao-urfluncjurqrad#riinrnndoudlrJnnruru,waddnqo
aonhl fiufrrlrrminqttdrhldro rirlffiau3raErfufiflntilurodu,,uroulndrrf,n
.l
RrE0mnliluinornrqluwduilurhudhrioireurnndrdtuoau
t*rd*o
firuriqu#tuqoaonrfluavrfio 1ory oes+amarion)
"urdooornuqJq
rtlonrhdmrsioum€suascioultfu firHri.r$ruuqoilrrnornuduilaridocflo$iu'lnsfrrlf
m6 rhhfdrrnruqqriilorfr tronarr{udu
fiudrnr:urhdruacnrrrndouehtornciurmd
ruuuondiifl asionmasruqadurrf noqudaudnEoaon
to"iid
lnfi
drsr H
adrlou a-rnnio}l
ru%rorndsrnnrrdirquadlurifisonddnrrnrrqqrtlo{s.rreradrrir
firufiocufli$as
fi eil
rir un n dil unatitsn (Moisr uasquanarion)
n
unnilF fi rlfiqqFunrrfl o.rriulnor::rmfiNatural Banier) ilacrfl olsnraffi a6ilnrirl 1
0'rRn'rsuoRr{r{dtnro'ld.irs ffinnmsfiordorhldunrailru#luacr?oruqnfinnr:sruYrthu
ndlmaocilru
Copyright by Mahidol University
8
ifoftigirs 1 drdurdu
te
sd
s
nrlfi nendrsriissrisfi ailrTsdsnciredfi ;q n's flofibnrs
fi'u
o-A
druisttrmciloftrou 1 (n"rmo{'ln:figad 2sA: 9r)
rTofibnrsdruYsii lduri
r. rliurariqtl drfldlroldr-url?rrorfliiild6
l nadruiiurtsrfianfiocolodu
z. dudolraruf,itl fi1Rnloilnoordodo'hr iilsnranuHadrqfiuworfianfliurn
J
tu
g. r ro,.ardl#lu
nm
in"lriu
n
nrrnr0irilraitdulurcur,.ur#u
ru nr 6 {rlaoldiu rJ?ursr ir ttnirn'u
{ilaodHflu
nuaradrqfiu{ornnmflnurgrnfiflilasdrldrsocraar
urundr
or - d cl t9 |
uoogoil
louR
r. oq
Ea
{rhurfi nn un a{N
rfi u{
or n
ir ilins rry
n
drfldta ufrlu
qiludiursri.rf ldnir 6'u
dr
mnsru-ot0otoqrdnhsioiltlurnndr lumrcfioaf,ufldhoglorgfiounuHa{r.rrEiulrurnndnfl
lnqirnrrvrdorfiorJ nfirmnu
z.Irndaudu
ql{
o1gosqiouuqrucTrrsrl#r?osndldordsusqfl nqi
t dfiErarharsrdodsuir{
1 niu m1n?1u rnfoonudulafierqufludu
{dl'rulunciudrcfi nar?Ndworn nr: inu rqr ndr{rlaudqhifi
r.
flilrodt uinor
do
sldiu n r: n roirtlrnsldr'u
n
rr
1r nnr eirddaudau
nirsr-n
ilf sfi n rr dnnu u rriou nu
dldordou?nouiufi srJnfi rlrhilradnrFis{ornnrrinurqrdu
a
nrr inu rd:u rTutf, nrr drfio
r
ncfi ioldflu rnfi li nio rdor or ntii
n'n
inu rrft aar
ii
nalunrmuciarudodsilnfioqiudr nrnldiuf,itlr-nurdrudrsoc8sdlunadr.rr6orl#grdu
orrquafl rmristor{rhoiil!ffiuYs€lYnsrilacsrutfrrfi r6s.doo
nrrujduu,tilaworfimriruinordl#f,unrraror-ltl firuriroroosfl dnuucu?uuoil
ndr ufirfl upnf
biffiuurtld
on qnaonrfl urn
ds
ou or
rfii,fl uuenrilon drornrlnd.d*r',r oo?uqu
nururafiunurndrrTqlunrrlfrlrnuvrluri{dtro,ru#uqoous*u
r
lu
n:ounirlnotf,ntsqnnadiinmudrdqf,lfldhu(significant person) l#rnnu rdlto nrcilfn
ftnarrdrri'qilacdlrmaqunfi'rrriru?raardldiunrrnrsiriilldgndor louquafiruf.r
Copyright by Mahidol University
9
u?nard1#u#ro{rauo ftritunduhildr?rrirfirrul
urftoonrqnunstilurmald hilcir,rfsvrrsrln
dl
1
hirf;ognfoufomrnrncrcrlrtdFr
loohirlfnurffiildrurrcomfiar:dii
rl5'ffiurrioirtil o.ro.uduftdqurnooflorrTunrrgi'ufirilrirmcnerildnrdslmRud{rune
mrrsorofnnlrtsfllCIrdsrsiofrailfiulo6odu
ftiqqa
?536:
orrd
finuouilasnars
dnlu
euo^or nr1
?58 Schwade & Lichter in Cartq, Glastein & LivingSoa eds, l9t2: 212-213
Thcmson l9E0: E7-888; Varricchio l9E1: 33O
nrrquofiuriluirasrdldiu:-rtlinurl#ur?.ro{rauo rnru?nnuinaruirflsnduocii
lonrafinunardogld.iru (Bouchant & owens t98l: lzt5;
Glastein
eir$
1
&
Uvingpton, eds. l9B2: 213; Smith
&
Chamorro
Schwade
& Licher in cdt€r,
ITIE. 132) daulUqirrdraoniu
dh?uinuf.rtilf,nurlurJrsrmalnuflruuvrhl#flrtes:gftld1#fiarfiuinordHyu
nr:oroirttgnrfr rnrrr,#druuoolodureisnffirfiomarisuudrftiilonrards$ion$fio
tdutg
drnrnfldtrurlfirifinrrdncirarur#qnunfi lonrari'luannrrnJduunilawslfirurir'lri
trfqu ur ldrdu rfl u unar{euld
lunrdidnufiarri.ru?ra*dldiunrrorsi.rttfi dnuargurru$onudu$q{ no'rum
nrrsf;uroldf,flaonnuqrGrdrttdrrflurlfi6ssrnrrnsueuawsrfirilf{sis:-.rtildrhifi
o'u
nrrorashifi nrr inu
rlq
dr oro
rhonarunnrin n ft rnt o'r{rlauuauqrfild
ruesn'r
nrirldiuitthJrsuror 4{xn-smo rqrufirnrdncnutilfiradrdu frrurftufr rmnrflup dr{
rhoiisrnrsrTuurnocldiudruucfrl#lf;titt rvo
ge.nim violet
Inn(cornstarch powderld'loUttlvtlolRmrTu (IrfcNally
Maskorrski, eds.
&
Srrohl
nlu1r 1 nionrrfldrr
in McNally, Somsville &
t99l: 23s) uiufllr?rrlnnhinul#nrfirurildrfluodo,*r',rocfiudr
nandmtrrdruiun'nro?qrdulntuordur,
@assey & Rose l9E2:
4r)
drnurmarissuinsn'rurft dldiunrrnrsirtliirurnilrcu'ror l-2 mrufiulnr nrrl#
nlutr 1 duav t-, ofo usi6rrman{rqndrdnr:finnurrco'tofi
nntdrrfluorir.riidt#runnnrrfinrdo urnnlnxruhiqtauru duaiunr:rtloro{rma
,i.u.
roo gurtian violet
druiurfrordfiuuldldltri arracarsdtrna'otjndfnornar satne soluion) il:ooarrncargn'o
illlslornunlofoonlwdloitu"a
hydrogen peroxide sotnion)
rdouf,orrsrryaddnrsilasflsr
fiunrrfiordotoqruniirio nfuurftitmrnadau#rflo#4uarrararudrdaori{rd3ilRuil1o
Copyright by Mahidol University
10
to{rmn udnrdomrrfinrnrluufiarnrf.rdld'iunr:nrsf,iilmncrcrislfrfionrrrfirulo,u%rfu
mtcdloon
(Hilderley l9E3: 55)
omRlrnun?u?rrarRrru ffi t'ulrinurul'ruR1rfl nulduariunrrfl mf,unamqfl.rtl
inursiofieflrislurlrgrmslns ugilueirilrsrnfl slnrfloiumcnsc 1rtalperi& et at. teo3:
4ri4r6) ldnonunrrl#arrasaruinrfiufilunrrflorfiunatorirtlr-nursiofiailfilunciufl
rhouctg{tsrerus$gildmldiuiltluasnroildrn:uirtlfnurud.rdrJqrf lnu{dhoutdnv
rrsldiudlracalg z,uxet mqrdsrfl uarrasaruinr$ufi dnmnndqfl uarrasarmjaou
(placebo)
r ofo uu,
nruitaarilrurdldiunrrnruflitllnsudflflufin#rurracdn{ariuac
drcfiurcfrunflilEr{ur{rnaro$rildsn'eilricfiJnrria;
ftothdrft?ruq E4 rrs ii{ruru{rtru
+
z orl
rrsldlfnnudrufis
lunuiilnurof.dociu
z m0frruaorodf,ou',ua,
6n rs :rofifioryabinru&u ftrfuncirdrodxdrirur?rnrrcrtiifloc 6s r1u nudrarr
acaluinrfiuffirlrcf,ilfinrnlun'ufloqrlunatoqr-rtlinursian'rnrirqlndlcn:agaruilasu
to rrs(9suoc
ls) lurorcdar:acarsilnoufirj:sfirnf;nrnlunrrflorrTunamrirtilsiofi:
nrft glndrarracauinrfiufi zo rru(flouac
) rmchifi u nrrunn nsimlu nrrfl olf,u naroir
o
iedinursisfrrurilllowmuruluriou*lufffrudrnds gs nu(9ouas s+) ftrfueqrllf ir
eaq
3r
r a
arracarsinrfiu6hifiilrsfrvrf;nrnlunrcflom'unarorirtlinursiofirufiiluf,rlaouuril
rbwor
quarurifu esfldnfisrqidfsfi mu o gmoluuanl*tlninrnlunrrYnurlrafi amffs
ddofit* s grwo3uficirunerutosnrdrioronurflunrarforiN Grffer nixrr'e)
ilrgnoudas rrolltriiou lnlslenou fimrnlmonim dihydrogm cirrare) o.ot niumc
uouluriigu TululgTornu frn:n(a,-"'onium
monohydnogen citrare)
orz
nit
lnoii
grwolrriG,ucoitel rfludeuneru(mutsifying agmr) drgrvolrririluolrfiJrgnouddrdqons
uoanaasdarludu Oanolin alcobl) u10'rR odr{rdnuoanosodgosac
9ssos
ra ln:Nmfiaatnoroalosas gs lslornunrfuoulouau l
22
Inmamsrsa
(Reynods
drunaudlneirmdruriuarrrTnmdrornsiolluTurassiouriltoroqdrrnrs
rlrz rffir)
druonmnlfi
Copyright by Mahidol University
ll
narrniruduurififlrrftftsieuriurriruldrsadfi?nfru?railtol,uoRrmofinrrudldrro3qrfiuln
rrasrndoun-rr{rrlnnqlu3noriltnnnal&'lorBe (Hassey & Rose ll&2: 49:Sitton lW2:[email protected])
drn fuqruto-ud
rd 0 e
riu
q ar
au
ri6t
o qndsr
frartidd{
f,
ros
s
grwoiu In sn r d{hiilu
r'rrl{ru usi6l:of frrriurirracflaru(sindhvananda, er al. 1993: n%lst) ldrrununmf,nur
riliiuufioun?1ud1u'rsotunr:{urir(warer-hotding
capacity)
nrundtmreirtfnnu{u
#t
o
sfinlfirfi n?lmworriul:nfimrit airgrioltozo rnea cr€'rn) n€unrouanda(sEo to"ri"
acid crem) uasndndardorrirdrmiurnfinr s gmo?u looiearru.nurto{lrfidru
lslnrirnsf6ysro-ur"r) Un 30 iurfirflunarillil 3 drlu$neiofiu nudTrdntiolttolir
drniunriiror s gmo?ufi rhcf,mf;nrnElqnlunu{rurir
nrr fl nuw ol grrilaua
s n al v
(Ctvapil"
lloluh
& Chvapil l9Ftl: 45 -?Ji21 1 nsnrr rh
arlufiutrfluar:drmdrlunf,nfi'Eq{iid{iirsr s grmiururt#luunniilsntarf,n{nsasldu
fituro
4.8 nnl{rerufirusrr$acf;n 4{n
lun:ou nudrarrfiadtitlfd"rln'r:ro?qr6u'lsrmr
fieraritdurJnnquu?raorilrnunalr".pio.ti"ti""rionfirndrunuthnfi#etrlo
1
odrfiu-o
drdqvlne66 usnoi,idfi.rfinrrflnurfindruntfufiurorrmilaudun0lu(chvapil, Gaines &
citman r98E: t79-a4) rflunrrflnslnlrrlutoirunalufin{nnaotniufiu druEraiirura e.c
nrrmnnrfirusrr 6n aoo
lunrou nudrarludurtrhfdnrrnrrniqrfiu'lnto$iaurftdurln
finwrunnrtrnfi nfiordfr ror s gmoiururl#lunciulrnfirilrirgirr
teou'(Xerodanra)
r ldrui IrnSIr
Irnoslniln rosurlnfia(Atopic kmaritis) Irnls'iiufreCpr-iasis)
[email protected]€ma)
ru%rornlrnnlnrft
nr
eirdfl nsrf;
anrnmrfi
an
ttas
rirunrndoweurirfi
ornrrsiT 1 adrof,unrrnjdou urJawalfiru rirrrnir ilflnura'o nunluum finuscfiail
urft nqnaonriluasrilo drnuacr6unmrnrrflnurfl ft d
dun u E ofi (steinhoff 1965: 67 -6t)
ldr ro{ru nr: rlrn dnfror ddd.fi ru" s
fiuncirudrotiNdfifumri.rriluqirno.r uavnciufl{hu
a
grnro?u
fi
urld
oudrfluduuuootofiilinulaeep
Copyright by Mahidol University
12
x-ray rherapy) Hanltflnulnudr:sdrnallquut{tfornmrildouuilawo$eurilasasodn
rrn#r {rlrufinnuff,wolorrn odNlrfinrucrunusonlri'ldrronudlrruacr6oomsnrrl#
drriosurilililuaur susr?aruuuirto
dratruauacunlari6a.u"l
& cati r%6: 394D flnurluncirflihulrnfianrirdr
.
nrirr{xdu{ruru zr nodoiid'nuorcfiaufr ilEooon uacilrvrrufi'uoaruhiqrailuorn
srnn fru n arud uil
rn
4rdhitd;u orn sf6lnariiur osd#{rfi niud : snru ilf s
ormnuuonrisunrldrdrrnnflnur r drJnrr{ urnriluorfi n{ilrodorhirnsldfu urriou +
ffilari
Io u{itau
n
nrsnftldiunfigrd'srqf,diri.rfirss s grwo3unrut
1 uinarfiararftdfinurf,anrn
iuas g o#u ,flutrs&r?arulu g fiJnrf n9u,lriu,,uvrtrfltholfndnrdwnrrl#e{ niu
nioarrln 1 dnrodrororionfllrcnrorfio$isFenrftld
druflurnordnrnJrsrfiuludru
nmuldqteulaolnomudu narrrduileo mgdfl u*rnlrnJduuudawo.rfirfi filnorrnnd
ruavorn{rltu nudunndrhcfiuilrsfinf;nrnnrrinurm*rdn$'orrio{lurcdu6lrn
fiiiloln
rl'rofi nlru
cion a n rr
dru{
fnu rogjlu tv dufi 9ouns e0.4
tuoerunrfitactutosf @ersaque & Naeyart lgEB: 33-381
nciulrnfiaurir xerooerna, Atopic Dermatitis, Psoriasis
urft ludnsorstsrfranh nqnaonriluaufi
ttGtu
ldflnur{iho ro rrolu
Eczma dlfinrlrJduuurfa$r
n lnof,ilaohildiundnfisrdnfoor
rurriou nrun d.rld{dtaunrna^ofiilofidd.fi ron
s grm?uiuor z
ugrJlo
r
nfqrfl il rcou?a1iludo{
drJnrri nurcduflarutruut{to{nrrnJdsuuilaworfirnrisanar firu%rdohrirriqrlnnqu
oufifrnuEsrufisufirnfirfnn'uav{dhorfiourftmu ade
n
rloclR so rroiintuffunolosio
nr:l#ndnfiarddduf, ,un s grm?u
mnsuifludrnehr
f,wro{ogadariuarlu rJ:sfinf, omrs*rfinfiardddrfi ros s
grnniudrirurl#quafiamriwov$rlaoirtilinur mrrcnrrflnurdiruurfnnrvdrtuf,rlao
Irofi'rnri.rdu
-.u-.-----..r-
o'
dltuncilfi
1
ur?aunusoil0s51u{'rul{ (st"iomr :1165: 6t-68)ud}ildrtrnrrf,nurlu{
, dr
odttilu:cuu
lleed
9
4
r
a
c33 o
{Tf,oft dor nrr 6ilnu rdrndndarqiiiF$tor
a d r
a a
s grmiufl rlrcen;n"rn
lunrrflo.rfrunamd.rflf,nursisn'rilfiluflrlauruvr$w?narEtrucuacnoldufohi ds
rhslo:nitunr:quafi emri,rmr{rhudldyuyrfl;nursiolil
Copyright by Mahidol University
ond s
aalc
av
?nnTililRlt?otf
nrrtf,udrfl u nrrtftirft no oo{ (Experimenral Research) rndo iilnu rdr g f, nf; nril r, or
A v c33a
nanfr'orqiilfr{frros
grroiil lunu$osYuflaroriqtlinursisfiriltftluncir{dhoucr$r
s
uinorilrucuncno
flnu otcdrctmtilasRr r16o n n{rffr otirr
ilr cmn: lu nrt
fl
nurnfifi" rfl u{fl rurvri.ruinu?ilr
u
r,,arnsdrriu:-r iilinu'ro'rn
m.itrf,.tilinulrasnrmesrffi:rn6uf nrnisristltnor nflcunngfinenf lrlrrurura
nuriud rufinorduufrna
sampling)
6ruru
30
r. orqrisuei
nrlf,onnciucTaodNlffiirfionnuunillurtluo{@qpooive
trt, Inufiruunqotailtffid.rd
zo fl
dubJ uilrirfiu
zo
fl #lrnanouavmoufir
z rfluflrtrouonuacldiunr:ifrofrsdliluucriruinorilruguaroudldfuiqtlinur
J
nf{t[tR
g. ldr-u:-rtlrdo nrr u rsuo
+.iinrriu$ravfi an'durJfiqqvfi nrurrord,lo,,urdonrrunuruldEi
s.
Buiiuagl#nnudrul'olu nrr rhifru
rnsqin-nosnornnrrSfti
nu'lrnduoau
r dfi fl acionrrrfirarsru%rdo r:iu rul]r?lu nrrrfiulafinqr rfl udu
Copyright by Mahidol University
t4
,,,
i
sorild;inil
i
I
I
r
I
ffiffuriluraumu{oqadnriruirtlinuluasr?!filanffrlnduf norcuilnoarenf Ix
J
a d
Aa o
aq.uae
v 4 e
ilurumtil1iu?i
ftiiuinrrlf:-ltlinurrlniur{uiunqnrunlrfirusiranr
dru iu nrr lfinmrfrdomffi
E
uanu roudoiu
fl.r
tlfln u
rriu
{rhun
0830-16.m u.
rlfi f,u uo n n neir rdurf,u
nrrrlfiri6nu:cil'i1{uacn'ruild{fl:ur-rtlinur r.utfoldiurlTrusdrornnnntf flu1lrlauas
rdrnfiidarsirtil
v
i
aAs
iaquavrnissfi sff lfrlu n rriffa
r. ;aqdffililRffinnao{
A s eEE'r
ndnfsrdiitufrror s grro?u Hdn1au u?fin 1vru66u 6rfrn
z.
rnfolfiodldhnrrrfi umu:rudoryo ilrcnoudru
2.1 ttuudouorudopdtu qn n auav{oryardurflu1r nuas nrrinu rmlffhulduri {orya
is
tno?Rur?rf, o'rq dtllildura rcdunrFlnur orf,n rruldsiorfiou,mrdu 1 d.r{oqanradtA
t?ur?rCIlRnrrdrnruafua&0rRr?urcflou (nrnnil?n
z:
I uas n)
uuurhcf ursfrun?luEuur{eroroq :-relinu rcisfi rilfq (RlnHu?R
o
rfl
urndor frsd
finuilnurcrnr$uilrcdursfiuRmutrurn{flamriliilinursiofirufw{il?{no{ lnr
f,r1ad dlrnorhurl#lunriroirtlinurrmsnlaranffiarndsf
lrrnsrurarruriud
R15
rl:crfiuInol#uuuiodnnnd{duar'rqnrrdruirtilinurrf;lu{rlrcfi u
rnsrq{nr:ilr c6ufi 6ruru
t
do dqdrnunn giluulu nr:rhcdurcdufl ?T,qil $r{fl a
toliliilinursiofuut1{fidruei 0-6 nciluil 'lnoris{drdumnhinunrrrildsurnjarmlfir
e
sAq
c9
ufqorniltlinurhTnc$uurrirrTu
0 tlmlrRlrrildouurJaworfirrrftorniriilinuru'rodqn
h?ncuuunirfiue ftlrleiolild
t
Copyright by Mahidol University
firnri'rrjnO' hifinr:njduuuilaI (nomral) = 0 niltlt{
fi
rrri.rfi
d'nu sr sn drofi
uuo{
(eryrhema) =
I nsttilil
Copyright by Mahidol University
itfi
rnfi rdlnul"dod'tlulinorllutun:vo'ruaidr.r lfiilluurlttit'lst
i dir rno{ltrofrfr 'tdfun1to'l0t-{d(mild hyperpigmentatiotr) = 2 nsriltl
t.
a
.t r.'
d lir
riiofr ff ldiu
S r rn rw lailndrlu uinor 1Til{il ntsoufinn'sdilnaonuTrm
Rltfl 'lui{e0atc hypcrpigmentation) = I astltlil
iilfirndr fiTu#lrflu1u
(early dry desquamation) = 4 nsuuu
Copyright by Mahidol University
t7
fi
T
xrlln#ldlunslfi ng"t"
ry
aaquanatioo)
fi:rririlriuno{ ilutoounnrl? uzuualttocdnrcrtirtdto
- 6 as$ilil
(noist dcsqrunation)
- 6 i:fiilu
Copyright by Mahidol University
IE
dtmt-untln Tlfl nmto{rofotfi
o
{5'fi'oldrilruuilrc6urrdunarrquus {fl aro{
istlfnureisFaurfthllfr{nrlqor16rr:r0dsun?'merro"ludunl(conrent validity) rrau
eclo
t a
9l
nrurdl#Iuuunnd{rdur:nqnrdruil6linur g ?iru udrrirlrlnneounrrirnaluduonul
dlfiflftrnn z nun'ounnd{rdoamrgnrqdruiqtlr'nurusiag
rirutlufru.ur{onu, r rirufuffifru ouldnaruasnndorf,u rmz, luflrtauils#{dldyu
Rrtfiitnn0nterrdt€r Reliabilry)
fttlinur'$ru?il t0 :rsfiqeisf,u riouwfrrrldlunr:ifionfuif rdu,flunrrfutnlddrunnd
qnrirulfi nsrdrdsrrTulunrr dr gfiu ffi ft rJrvrfi unlusurdasnrrilr gfiurvdunluqu
nrwnr
orf,q
ilinu rsiofi'rrf rft 6 nnrlil ds
Runnao,oilasnrtdu:rurrudogo
Rm
nnao{$ns nmffi u: au:ardoqan: cfi
rlno ffi f,omu ri.rdsuusrirdrornrisfin
tnurdg uilrinordsrfrna rdusdsm-rrrlrilr.ia0f$linurracraufllanffiln?iufdsfiror
ioqrlrra*ilunrrrlrifie
tsnrrudaufrolunmrfi rrfru nrrnnam$agffi umu:rudoqatu
nalsmnffi rdolfriuorlqrsrudrftdrrfrunrrlqudrsrorrsds{ftouar$ruinarii:uilnsno
dfiqoraurifisrrurns,fddruuol{ rdof,dhuurduriasirtlinur ffiftuugrlrnunr uoninq
il:scldnrrif,ourinciudaodruCsronnuiarfisorn{dlaongorrf.rntfodanrdrorfldlaolu
nnrdrrruif,o lnrnnurn
Assigment)
n; ruao{rtrooqqrnffiir'oouurhnciulnunrrdurdineir, (Randm
drsnrrflunmn nrn{rlaonourno{luneiunoaolnfofi?uqu rrodeomvof
dnnciundr udariunsdarrffifioldflunalnlnriuacdrrfiunrrniudt*for
sTrorfu nqiruav 15
t10
1
ruldn{u
{Tfiurf,rru'un1rilntro{ilacrfiumumrudoryalrln$oun'u#laorncju
n{rnruqu
{ilaoldf,unuqrroilnfiornrfriurfrdtorilriesirtilinur Inouucf rhff,rhonrrudr
ntu*rfiqtornrrquafimrftluuinurdldiunr:nr0flq€lhl"rdroqirm,ro drflsndutfr#d1
{tfirrur 1 hirfioqmfomrtilncosrirhfFrnri.raonilEouasriluunralddru rirrarurdofid
rjuaonrrrtloqdrfonrrrgnrsds$iofianrir narr?inrdusnrrldiune$rfisrdlnunrr
09
,
a da r
e
J
R'rt
Copyright by Mahidol University
lfn{uavn:'ufifldaunrauto{friloiluaslauvurinsir{lrruyftnrrlciu€snrorlorloold
l9
rJf nu rchrn
#rnncoro
fi
au dfi rt5iisreioi{flld
nrrfiidfi unarfindu
{iteoorldf,u nrr
drriasirtilinur
udaf,qldiunds
rirnnilasornmadardru
n{unoaos
flrhouonornlfriunmquanrujnfi omrdrnrft
frorddfifiroc
s
grnroiurCovrrfrrnrirrcildmldr-ilflitlinsr tnodrfirffifuuov{rleoii{o
nnadtuf,udaflrhutvhiritnrnurdsrrYunrrldiuarfinfinddhf,{dhudunr',ur.rriuunndfl
flnurdlrflu{rkufiurvfiunerugurnuarslirtlinursiofianri.rosldnnudro udrffi ftl#
rfl rrrus f rtdmfiu nu l#n fi n rior dvrrur
1 u3nor fi ar.r rft dHiu nrr n ruiqil iuav z ufu au
riauaatfruact8usdtadrreilodrusirsilldiunmnrui{tlounruirtlinn ffi{r'ufionrrquo
{'ihoqoiudrgnr#narrrdurrTunrrlfnfindard f,rmcru?nflfiar.rri.rdldf,unrrnrnfio
fiord rarurisaouorudqrJiursmwfinfiorcidrilfiordotrl'6tlaoiinrf,nfiardvrrfitrrftldsraon
r
dDts
o ae
s?itlt t9tltt{dtRU'l
ffi fiorfi u: rur
aur?ory ncieu q nn
auav{oqarduafiu lrnuasnrrinurdrot6dilnrsgt
ttnstlnrrrrtsriisu ttutiuttnnd{doanqdruf,rtilinsrdr-ilfinuouquafldho:rolonvrflu{
ilr srfi u rcdu nilu quut { nat oti.rtlin urriafi ruri.rflrJq
r?iacnfr
d.r
uei{fl roriulfiiu nrr
orsit€louorui.rilinur d.runnd{rhsfiildriluunndrirutorirunuarludru.ru
I
riud{
iflsilrrirntrutdon o{nrrdtmndrudau ru%rflunrnTuhdrunnd4nrinrlfinsrdrdsrriulu
nrnhcdurvfiunmqurr{fl aroiri.rtlinursiofi anrft m.rf,rha
nrrin:rc#t?u{u
irn:rvffioqadaunorfilnof lnol#hJlrnrrud#ogil srssTrc*
(statistical Package for the socid sciences / Penonal c.omputer ph:s)
Copyright by Mahidol University
unfi 4
fl
anrriffsilasnrronil?rsrua
nrrfl nsrn#ldrilunrrfl nurrf rcfi nf, nriltolnlfini'arddoiofi runsgrooiulunrrfl or
riunatolfttlflnsreiofitrrftlu{ihuusr$ruinaril:usuacno Hanrrifruocmrusqrldrdu
s
t e r
-J4
dtfr nlocinuorstoln{unlroti'r.uasnanffi mnaoueuufigru
6'nuusrosnciruffaodrs
n
cir fiaodm
dldiu nr: rTo 16o nrfrrru rlu lom nr: nrtdtiiodu
3
l
5
10 ffi fioldd'noon
I lts*uooornf,rlumndnrfi'arcf,dd{iinr s grmiu u}r 1 {nng{dofdnfiarrftn#lrr'sir"r
neiurlaotindiilnurftfi 30 t10 uri.rrflun{riloao{rasncjrnauquneiuav rs rro org,ndu
fl
fl
4s.r
ncirunruqu 423
nciunnaodrutnqi
"uorfoouooeiulndrdmfiufionciunnao{
rilurnan{.rfioriluSsoav G6i dauneiunruqrurflurHarnssssas rg, rioaumcirdruurnli
dolun'mdil:nrj nrriilnuro{lurrduilrcoufrnur naiunnaoldaulrqjrlrcnouolfrildrms
mrrdncjunauqriiorf,rniunrnrruuoo',odf,unu'irrftnrjunnao{uacRqiuorugrufrrrold
toln:ouniarsdurisur?rrg.rfiournndr 20,000 urnsiorfiou ciauluqjrfi'nrhumqcruru rflu
ilsr$cuitailIyrrrudlngn
tudrunrrinurncirmnnssriaururn'ldiur-rtlf,nurdrtfruroii
rirrinfiorfluisuas 45.7 io{a,iilrrflufqtlf,nurnroildrnrrEircTagouns 33.3 tarvdneiuoru
qlldiuiltlinurittf,urnfirlrrinuaci{€lr-nurnrgilfirn1:nirdofi6ruruuirfiudogouac
33.3
(rluasrduoqtunrlud r)
lunuflnurofod
uf'irocfinr:urfuncjrulnonr:riuroilunlodrfuuu.rnciuorrhiuir
tfiourYuorofildrdosornturonciudrodrwioudrrrlou ffiir'uftldrfionnJiuurfiuuilrf,udnrn
drocfiflaeionr:quafrrmrird.rrfirl#lfionarruuonsircflorfiailorfl.rilingrsiofi'ailf{lduri mfl
org wfiunr:flnur1u:vndr.rnejruvrnnowavnrjiln?uqr, rrurfoilof,uvrr.rdruf,.rilf,nurdiinn
siofirilri{Inusrr{'lduri rl3rurarfl.rfirftnurdflilruld 6rurunfid{ilald;unr:nroirArmc
Copyright by Mahidol University
2l
ilSurorr-.rtllou,oduti{rlroldiuuciarn$rrcfidrn{runoaoumvnciunauqu flanrrnJisu
rfisuluiloftfoir 1 drncira lurdoquadriorflurvduurrrTqt$fildnliulrfiounlruunndr.t
Ioolfflnauor$ hinunmurnRdrtatir$hiudrrftynr.rafiB x'11; =
.o?, p>.os
drurdowrg
uncrsdilnrrflnurdrinrilurcdudnrnlauf.rdrilrnlieutfiuunaruunndrllnsl#dfififi ld
flilfl?'fuusrRsir$dNfiu"0*rriqnrw66 ,(2El = o.fi, p>.05 ttds (2s) =
-.76
p>.05 et'lll
6rfiu
drnr-uiloc'oyrrdruiltlin"',riu , ilrcnrrdlnciradmdulduri rj?ruraridil#.lilund
,$ruaunfidf,ilruldiunr:oroirtfuracil?ursirtUnsndsd{ilroldfluusiasnfi
flt'laoldiu
druinrflu:cdudnndau rdortrurnl?surfisu:sudmnciunnaaumvn{tnuqrlnold
a66fi hhunnurmnsitodtiiriudrriqmrmfifi ttztl = -.16, p>.o5; t(2t, =
0.49, p>.05
uau (28) = -151, p>.05 nrrudrdU
Copyright by Mahidol University
mfl {d t dnuoutomdufirodrr{ruunnrudoryadruqnnauardo4ardorfi'uiloo'onm#ru
glol
aRu0rsr|o,rnqr|n?00T!
nQUflflO0{(nt=l5)
I
nqr|fi?uqu(nz=tt
dr
oq(u)
A9
2ffi1
[email protected]
4E.13
$.n
r3.06
ro.6I
ncro
z-tE
+21
rd
n1040
rl
9-VI
to13
632
si5
6ru:u(9ooac)
6Tuu(9ssas)
fldu
rd
nllf,a0
ri
n1rus,iilulJlnlntt1u
6ruauflditnuldl)
nmr0{$ilr|mrllu
[1rfl
tl0
s(333)
lt(733)
u€r
rc{66n
4(7.6'7]
3(20.0)
3(20.0)
n(733)
r2(80.0)
dolun1ilffiJrd
Iao
ri
ilfiro ildr
uon
\6n
:sd'rn'uflnur
drsouflnur
8(s33)
s(333)
riruuflnur
\6n
3(4.0)
rJ:cnrnfiorier:
r(6.7)
3(13.3)
ilrqqmt
4Q6n
4<2Sn
g.rn'irrliqqrori
\6n
\6n
ta4
Copyright by Mahidol University
23
enfi{fi r tciol
qtet
aRuEsno{Rqxn?ool{
n{unnaoqn
=t9
{ruru(flosac)
ffiiro?lttlx(q=1s)
6rufl($ooas)
4l
OlIRil
rttrltnlt
3(z).0)
6(40.0)
ililn{1Ur!?trlilnc
2(r3s)i
2(t3s,
dilrs
s(333)
s(333)
iuSr
4rss)
hildrhu
3(20.0)
g
A
EA
2(r3s)
l roldtomr sunf,rrndggiodouturnl
<4,(Xr0
2(r3s)
4,001{,(m
2(r3s)
x6n
8,001-12,m0
2(r3s)
s(333)
laq)l-16,fi10
2{r3s,
447.6.6)
l6,ml-20,(n0
\6n
>z),(m dulrj
q4oo)
5(333)
r?rununr
8(533)
8(s33)
rhuEn
\6n
\6n
r?ruEfrniorCou
3(20.0)
s(333)
rhurfniltl
3(20.0)
\6n
lm.rndloqn
[email protected]
r(533)
ncimrtiln
3(2O.0)
4(?5i'
doulrn
AQnn
r(6.7)
A
\6n
2(r3s>
d r
tt,
s do
now8|s lnrutiraltnul
d'uudworusti{eruc $o
ou'l
Copyright by Mahidol University
?A
nrn{d r
tciot
aRu0rstf o{nEUn2001{
e
n{lnnaolln =tR
neiunruqt(nz=rt
6ruru(9ouac)
6ruru(9ouac)
Cry-
Rl'tRUln tntil
sds
t{fltnu'l
2(r3s)
4<7Sn
iriilinurnruuftirdo
s(333)
5(333)
[email protected]
5(333)
l(6-7)
t(6a
5fln-8280
sflxL88E0
6909.s3
696i133
93359
rc3032
fifiu
?a4
2543
rC
nlflao
35.N
34.47
rC
n'ltuo'ttrltuumrnlu
553
4.79
eds
@
ao
e
r{flrRUlRUrnXillUn
sae
t
Or
I
:.{tdtRUlnlun?ufl1t tdlrs
J
rjiu
ror
irtifiq lr r a (cGy)
Ag
fldu
rd
n'tna0
tC
fi1tu0{tultulgtt!1u
! drrred
0lu?unt{n to5ilR'ttD'tgt,td
o
sallrro
,
rA
"
rJiurE iqdfr l6iurre{asnf,s(ccy)
fifiu
rC
fl1r040
,c
n'tr1r0,{tuut
lstrsTr
180-210
I10-230
195.93
?n2-u7
10.09
t2.t2
Copyright by Mahidol University
floR1?nodoudililaf,lu
ncit{rlatluvri t uiresrilr us mr nodyr
u rft
dldyu n rr s rgidl iuas z
ort
fi uri.o n
rn dn d'or ddnd{fi
ror s gmoiu
al#rilasdil arirwf uau o
u
n
l uinor fi a
dr usil dr-u
f,ith u
ntu:-ttlinu'l nunato$rfilinursiofi?ilrirtuusiacdrJoni#oondrnciu{dhousrf.rdhildnr
mns,rn{d
z
nasnrrdd
r nudr{rlaorftnciroruquuaaneirnnaoriinmujdsu
uilaototfianrilornfttiinurlursdunaruquu:'roir.r 1 fr-u uasluileiasdrforr{drurumr{
flaolunc!ruoauqufl:rduo?1lluut{urornr:nJduunrlaqmrfirnrfturnndrn{unnaor uon
o',otfuthlduusi#Jnr?id u oudoqrnr:inur drrnsrlddrdrulnqffirltslu#{aoqncirfinrr
nJdouurJarmlfirurito{lurvdu early dry desq'amation drrilurgduqu,,rodqndnulu
ncirvroaol mradnciunaugrrflu hte &y desqumarion odrll:finrrsrnnrsflnsrdfonu{
ilasfifiona{r{tfi sfi,oqf,tilsiofirilfi.ruudsufu,,urorit0nrfindufi 6ruru
uas
z
:rulunei$n?uqn
I :ruluneiunnaot drurilu{rlaoruvr$rncisudssdlfiftrnr:sircTnrisuldiui.rtlinur
ludrJnrr{d
r
*{ilaorf,reolnciruld:-urJirurarirdrft nunilrsurar rom rmrfiro:d
nufifianrittol{thodruluqirlnfi ueififlilao 4 uas z nulunciiln?uqil$nvnciunnaor
nrrudrdudfirnrilritfidnusrrrfluduuol (erythema) rds?rnrrcrilosl#afifi the Mannwhitney u resr hirunmuuslneirqfiuotimfirigdrdqmrmffi ur=9r75,
riufia
n
't
.0,
eil u6g ru
t
dof}ildyu
nrr miuaq
u rdof,dh oldiurl3u
ror
r-ril#sn
u
oilr cil ril rmo
rqru
fi
tRrS
d.rusifilorfd z rfluduhlouduquolrinurdofifn#d 8 @,-ur) nudrn.rrrildou
nilawotfierftluf,rleorf.rao.rnairilrsduonuquurumnrirrriu uarrdotrnnsfiastd
efififlrdudqnciranudr nciurnaoufinflatoqi{tilr-nursisfirilrftrlosndrnciunauquorirfl
riudrritgnrrafifi ldrir
ur.o
p<Or;
v2&s,
p<,05; u3=41.o, p<.01; t)4=,rzs, p<05;
u*+s3, r<ot;
uf6i, p<.ol uas ur=.e p<.05 u&udoeruufigrunrrtfrsdoc'ldiunmuoruiu
ru%{dle.uldiurlirrorf,rflrf.rnruoo$1u:ia,{ 2mo-Bqn rqruo^rn:d
Copyright by Mahidol University
!'
5
tt
o
rl
o
ri
FtEs*E3
ttto
ggEFBB
o
E
F}
o
3e+3$
F}
I
J
cf
b
:3l-
/u
N'
9-
/-
-3a
le !4!
c-F
2r.5r
H
(tr
I
I
lal
ll
F
cx
tl
F
Fr
N'
ld
c9
:l'
CF
H
ctt
ets
se
BE
O.9
LE
3
.9)-
E
:9
c)
d9
9)
Elo
iltl
33
.9)- .9)-
&e
a
rgr€[email protected]
I
=LE
Fc)
o
/4
lrtl.*tCD
I
:l-
J9
HN,tocp
9r
F
ts
rts
lttl
=c!
s-e
9[e 4o
te
:1"
[email protected]
ld
Ctl
IJ
Fr
gr
[email protected]
u
ctr
r.{lFFCg
l-
tgrSrl
I
s
Igr)
o
4
3L
=
3
9)!-
:l-
(ol-rcgl.r.
F
.g)ts
aJl
!1
Ctr
li
" l*
dl
3
=
9)
b
.s
c9
b
E,
H
€0
l9lrl
,6N,Hl
F
cp
{
{
a)
H
lJor!!
l-:(Drt
I
I
!
I
I
:l'
3
fe
a
3
9e
a
cl!
e,Ae
3
ET
:1"
fsJl
ee
9e
c'
I
!9
cp
c)
rl9rtr
I
I
q
lqrl
:1"
Copyright by Mahidol University
lrC9rr
I
I
orl
1r
83
8C
LA
LC
9A
9C
ql
€
scf
t
)F
t3
llt
rF
rE
re -G
g3F
E
ll
|il
ll
8C
(otNoG(ot(\tcr
F
Copyright by Mahidol University
28
or:onililsflo
ffnuowtosnduffrorirs
ncitfirorirrritaorn{ulunrriilnurd #ruluqililuustillnrqnft np*riluu?rmrd
nu11odqatowclituittotiilruc$ncno esnndslflufru{luuas{ruifiscim'l doilrn
(Ilanuchannnkgl fgEE: 6E{* Pgrihat et aL 19BE: 2-3; Mllion, Cassisi & Witts' in Devita
Ilellman & Rosenberg;
ds. l9t5:
?s33: 373s; tioqrlr:E
aOZ;
nrirld
finsr nrnisucrfu6ZS?/ttaO; qqfiunf
:dquninri
2533: 3a4rl ddhs#.laom{uehuluqifinrriilnum{1u
rcdljnjrcoilflnsl uarfi{firirnrriilnurrcdurl?qqrnidlii6ruruuhtfi'ua{ft9eoaa 261
drurroldnudrehuurn{rlaorftaolncirs:roldumn'ir z},00o urndofiou tf,*tdu,otu%o
orn'lrworumruliufirfluaorriudiinnunloutunrrinur ftrfu{dlrorilcirddfisruffiA
dqfilonrclunurdonuaglduriunuinurdd drriurfolrnaornnrriilno'dtiludti'tf,wn
drnufru.ru{rhurnrn{qrrnduludnnlndrduwiu{ruru{rlrorilf,ul0
ucihiiiilof,udtdor
{oqnrrgurninurodrrdufio finri.rnaiudrsritdilnuriidrueuhiurouuadouurnlrndfi
ilof,uraruorirqflucnruqdrraiu ororflulrJlddranrnd.rntilolrTu orr"tou.ndoru uuu
rrnunmdrrfiuffin rtrlf{rftiilonrardu#onrrtilulrodulodu ciruffhunrffnsil rz
r.r001R
re nsfiodtulouac zs iirhr{6quqrd,flu,.ururuilrcursr to 6t rs
qu'lnurndu
it
rJiurard
e-r qo$ioiu cronndolfiurru{1uvt}ttsumiilordlrfluarrne;drrTqtotlrn
rv#tu?taotilgucttasng (Robson & Philtips, in Moossa
SchfoqPtr
&
Robsom' eds- 1991:
r125)
rJ:cfoi3nrm osruBsrffardiifsfi ror o grwo?ulunrtone.tatrosfstfYoursiofi ntris
,dorryndfiamfitordrrnrg'ldiuirdrfuhildriob?rfinnmurtlumrodulurqrad?iuii
rusinr:ereorrfiuduru'o,ryadusrsrtlurisde Ioutdutdudfidn:tnrraldnnjdourEadodruao
r$eraurfsn{r,rudludr,ru*unu.#onrirrflrnfrdsfinr:rrrhdtotitarllalonaoar?al
0s
rfionarrurtlomro'ldr$a 6wunr:dnrerur{luduno{(erythema) durflurlflfi?urnoulsYtol
Ao
otril tu
,dodo,do,fi rfrorryaddsrruuaslfiisaddru6ornil6aco$utryndriaudqqaaruhJ
Copyright by Mahidol University
29
rjiurorittl tmo rsufim:d anrnnnutlurrodrfiodurqm#aursodrunrulduasrrlrf'rro
qiouuqrul#ndufru{anrnrJnfi rJ:cnsuflufieufift fi nalnnmfl
slrTuldlourrrumfi 6slri
nilfl Trulre Rdrmtltam{iqilinursiofi ?fi u'{1u{dhsd*tnciun?urp,rmc nrjrnaao{
rA
a
e
ttsitiiofrrilfql#iurjiurarcrodrelrfiildu i.r6liiuuah?ildocdraronmdu'rndu ,"ad
urtnciudo{lursocnridrrfiudhirrrrrrondun^u{enrnrJn6riouaar,sTalilnruorgfier riru
nairrsaddaruttodufit {anrnr6uflurqadd:aen'rualrurronouldsioirflldnrurln6 nd
n?tucnuu€trtdnrwadurnnuvruldrfoouu r.utfuilofisilaodsrlrim
1 rildoutrJr$oldiuiltt
niu nrrqqrtloil#ldmrsiourffto ciolhr?u fr rbiheurilunnaru{r#r n^lr#r uqooon
!fluacrfia 6wunrlrJduuuilawo$arnrird:cfiuqun:rrin 1
odrl 1: fi n rt orn nrr dn u'to 9u d
n efu vro
rTu
ao.rdnrfl 6crd'sddei{ fi
nr
s
grnro?u
uFnu
firnftdnrui.rtl:cHdr.ildfu:-stlinur nun?rrquurqromrrrdduu$iln{msfirnfiturrsi
acftlqrf#s$ndrncirunruqu ,duumnnfisfisr,fidfigrmlrdritucr'rrudu durfluawirlrsRou
drfiqto.rrroonosodalludud{1#naru{uduurifi'mri.r ilagaanndorflunmilnurtos
61:ori f,t.Tufuasnils €s36) nudrrrnnrrflnurnlreiurrolunm{urir
(water-hording
nrsrild{nmrtlfnnuriuft c rfioldud ntumraorriulrnfieurir riirgr?u niu
uanfintmcflfinfiordordrdru:-unrilror s gmoiu 'lnoinntrucrurro{rrri'rqn ro iuril
dlunaruru g fielrll Erailnngdrnfinfrsre{urrirdruiunrf, nr s grvoiufi rlruf,ninrnqr
capaciry)
qalunrrftrfr
rJrcnouriunfiodarqidfru',f;lnsmgudo{lugildd{ Insrhlrtuftrciida
druncrultr?ulurirqrr.irnsiidruriasffiunnu{u#uravmrrcdliliurturl#f,ufirrri.rdfi
frnuflcrllft (sitton
rw:sf)B)
raurilarluaudlrfluarrdnfiauudltundndoldd
rrrilauasnug (chvapi! Holubec & chvapil
tDt
?,45-?lil chvapif Gaines
& cihan
l9s: ng-?.fpt') nudrerrrdrh0#iudnrrrialunrrurfu,rnd,rog,osodruaol#rsaffi.nrril
rn aaou
drrdrrl n nqr rh nuo ari.du
;ru *Ionr#rs"nunzrilunneir,,r
Gwns & Crrove r%7: qpr2-lpl3) usinanrtiit'grhuondl
u$"irnm fl nurdtciifru ru{rlaoriiurn eiunv 15
(Power Analysis)
rioudr.rdr
rJrcAn!^nriltuudduf,,uu s gruoiuotirqfiriudrrTryvrrwfifi uaordrdnirf,ms s grmiuii
rh sfrnf; nrnlu nrraonatsr:-r6linursiafi
rilfi
tol{df aorioudrqr
Copyright by Mahidol University
30
0lnRurfiur?ur?ur1o{n ff fruldfln{dtru
r tloooRomnffi
nnuuotdoto'tornnfin
fiordqnn$rrdofdnfiarfiufoft riludrirftrnndrur?osnun'ttuJdouurfalta$irnfto{1u
ary asquamation ueifirurilr{r ilqaaonlfluprf;nrloo ororiluhll#irurnn'l
:vdu
"arty
nfinrfihrqf,driuuogoiiuorodaoaonrluluur{}rats$rtir-nurctsn'emilldusnnrnriuffi
fru
nu'ir{rlaudldfunfiodorddnrfimrft nrsildrnruirtlinurudrii:nfindufru{anrnrlnfi
ldr:orit
druludrunarruffunolo {ilauqn:rulunqiunnaorffunsltrJrgfrn!-nrntoudn
fi'orddlunrraonateriltilf,nurdofianrir rarrfinnrdro ecnrntunr:ldnrfirurirdasnu
n{ nrsildlnr}iriol#lfinn:rrfrnrqrionafirr6u.rlo t uuooiudf,orflunf,nf,srddurH
irs iiaN6rrrirsrfahJlunRril:crrsilaoaas lio urr urrqdrurinfli so niudrrfisl
nolunml#n1u'r{1uinorfi auu-tdldiun'trurufttlnaoorgosttatdr-nur
i,
o v I
as
TOOrRnlilRlt?og
dodrfinludruri?lunt{nrslu
l
Gd€mal validity)
. rlfi#ur{udrvndmflfhofiu{ifro ruaorornffi f,orfl u{aou{dhonciunoaorlunrr
vrrardnrfi'sr.r{ddruinardldiunrrqrui{ttn'munuRunruuod ldrfisnrcueunurlfifuf,uf,
rvn'irf,rlroflu{5f,o1ug1usrfo{ns'nnairnf;n dr{iholdfnorulurfrcduein
rYu n
arr
16
url
ao
fi 5flol dof;
urs{oasdu
mv flu fl r il q n rdrfi odu
1 dd*
fiuflrho lu p dortfr rh{fl
dhofdn'irlfrilnaruaulo rorlolduasldiunnuriaonrdomnffiffu narrff,nft ndrrsrn
drsrf,
rfi n n
u
m
rhft lnuacnarilfl ururillu nrr grmnun{ rlfi rifinrrdrffi cf rducirnah?anlonra
s r rn
z.
: n dou r orfi au rir o rn:-rf l:"n
u'l
{Sfruhiermron?ilqilnr:1#ndnfrorofieid.fi,u"
s
gnro?ulun{unnaowrru
,$rurunirdffiflurflruuo rdo.rornflifaurfianmrEouf irorl:ddiirJrslomi fldleud.rrlfrffi
uonruuoonrnfifirnunl{
Copyright by Mahidol University
u#o
oplrua
n
rriffamc'ffstoil ouus
mtio-tofsd,fl unrrtf,trft noao{fi inqrhrarrirdofl nsrilsctnf;
nrnro.rnrfinryorci
ddufi'uo s grvoFulun'nflasriunatolr-rflinursiofiamu-.r ar
unrunffhsilon
nrirsir6
inuruasnu*asr9franddf
lrw'rurarrrriufi rcudrufiouqamu 2sn
ftrdou
lltlutlmu zsgt losrdonncjrud'rodt{ttuumilBnttir dnsarctorncju#rodr.rdf,nurrflu{
{frsilsr${lrinotibusnutnudooudrfilrurilln:wdrorynurodq"
iiorgd.r'ei z'uz
fl
tflu
Inf,fio 16 t1t' rnorft 14 t'lt, eiauurnfianlnarraqi nrrflnurogilursduilrsoufinur
Iosurnrfrsnous,f,niurrrRmuacrYrilrs ldiufqflinur,flunfi,,rordonrrrrr,l,.ro
dru
lnqirfl unrrinurdufiuroiirlrrinudaffi r'u,fi'[email protected])nrn{rlau
rruurno$luncilnnaotmfooauqu [email protected]
uf,trilurrud
flusarnlrriunsdrrfr u n r:r*u dlrlrfoo nu ld{rhonrjuav
1
r s nu
lunejrunnao.rffiftrfluflcou{rhuhfl#rf,nfiEof,dd.rfi,or
u:^narfi
s
r {Tfruovdol
Em3unrux
1
rurildldiunrrqrsfl{ttiuacznfifi orinnarfi racduu,iloari.,,auonsruddrutd
iunrra'ui'tilounrui$linur
finorudom-unrrl#nfi
grrior
lnuffiir'ufienrrEuafirhsodr{eioru%qniudaunrrf,irnsr
nir.r,riuaouorruifu rl3uror mwdnfrarsidriiflwnomiolri
ototfuu'oldiun15gilonlxrlnfimruooun{runauqrmnrfrrnrfrdlurdror-rilinur
u
on
dauneju
nauquldiunrrqnarlnfiornrfrrn#rdtorudzsr-liilinurfiNodrs6sadoldiudtrucd{f
n:rudlofl udrfiqm.rnrrgrmfiaurft uinardldiunmorur-rill#lrfrio$modrrfl
on#r16
l#rirr{ufiurur
1
hirf;ogn:'otnlurrrstsrfirhffiinuiilEoaoRuosfiurrnnlddro
fl?rcr?u
'dudqu*oril€lsntlilfotcnrstR'o.reiofi:rnrft oa:r?lnrdamr:ldiuuawfindlosnr{ n,,r
l#arjilavniudfidauaraunuurirnu*mslaucufRoix
1 rardrnerr1:-n".,riuuorrrdrfo
mrsrlo 1o mmsomfr arrdfi rJfiffisreioirtlld
druiunrrrhctfr ulc6'un?lilqilur{rnato.r-r6lf,nursisfi ailil'rn:cf
rdrjo#aco#r
Iooilnndflrdo:urqdrur-lflinurd{S6bnrrirnerilrdsrrornr:drmndao
driufinroug*n{
Copyright by Mahidol University
32
rhonstndsufl u{rluiiuuocbhnuir{rle.uldnf ohildiunfinrfi
orddrnf sw'odHfi o
$uuilscfiur:dunarulilur{Hnro{:-rtlr-nursion'euri.rdffifrodnnilarurornuuuilrcdu
:rn'unluqilur{narorirflfnursioiiailfimqn?{?ror lnrf,qad loomfsluooduitool,
ert?0ctounflrrnroruu,u%nrdruuunfirdtn:nqrnl#ruilitr-nur g dru ndrrfirlrJnmnu
dlfi{ftrnn z nufionnnri{rdurnqnndruirtl
inurrrdacrirudufrururfonur s rhu)fi'uffifru ouldnlraanndor fru two lu{ilrod
l#iuiriilinuriruru to rrsdociafiuriourlrurl#luncfu fiisdr.ro?q rdu,flrolrriulol#dr
tdsl"ouomf,wnGnerrarer Reliabitiry)
runndqnrirulfinEdrfiorfiulunr:rfrgdu:cduflfluquilr{natou-rtlfnurciofirilu-l d
tf,urJrsrfiunerunrrdrsnrril:crfiurgfrunluluur{flato{r-{tlflnurciofiarrftdno$ondo
ehusoprhur;nnauavdoryardoarTul:nrmcRminsr ffifroh?ncirdaodrmouuuuaCIu
t
oilt?un{t?ut?lttlnt?rn sfi uu
nrrirnrrn{dop loofrngruurgfiunrruqilur{narod.ritinurcisihnriwol{
n
!
ro
I
thuntaomejulurriardrlnrriurnnaoudao tn" Mann-whitney u
resr
Hanrrif,siludr ludrlntirrrnrdo{rtaoldiurJiuraririllnod:curs lom renr6
rnrd lrinunnurmRdHmrnrlrJdouurlawllrltnfiornirtlinurrft ncjunruquuaanciu
,naootdooornnradfiuilrisldiuilirraririllriurn fionrruiloururlrqf,nrfoududufio{
rlfrffiornoulfito.rrdorsuo dwunrro*nrru du,,nu nsir.mddriltiofi.rnquhdrmruorsad
rirudgqaarolrJldfi'u
rruaofi ru
fr ldiu
rJ?urar 11 tlriu
du i.rffi uu ahlu do cfi r arg rrya du r n du
I o um n rc
n{urnnddfinr:ruirdesraonnariilonrcffinoauflourourn rilriu,sadursn{udrearudr
hlorrtorgfia rlrunoufiunr:qqrilurrfdrsrsiouil€o
dsilltfu
rfirtrffianri.rduuu
[email protected])docflorf,ulosrrnnnffinufiarfi nqoaanrfluqo uasr.rn
R'ttt
mn?'ttt$fit
rflrb?f,ud.rnmuritdansnr:rndousr'?l,otncjurnradrsruondfinasionrr
a$r.rtryadrnrlnnqrudaudnqtuon 6snunrrnJduuurJa.rmrfianfiorn:-tflinurlurfouuo
ncit
uoincirurmaodlfiiunrdn,i'orddfif,rou
: v du narru q u ux t?oondrn{r n-ru
s
gwo3uuunrrnJduuuilartmfianrftlu
ql odNii u-sdrrTq vn.r
a66
rdo{'rl
aoldiu
rJirurar
ir iil#r
mroilrsuru 2txn-8om rqnrfirnrd
Copyright by Mahidol University
33
Rntailout$lunrrrlfrffi
5
'r(trc''
ornnanrrif,ud,flouu.o*ndrlunrrrirnfinfruddd.tfirou
5
gmoiuurlfrrrEr^a
nrftml{r1rsuinsdldfunrraroi.rfl rn%onn?1uEilur{rornrrdduuuilarmrfirurirorn
ililinur
durflufiinrrradrdrdeudrraiu rfournrrquaFrrfito.r{ilaudldiuirtlinur
orrtdu ouu c'lu nr rfi r?ffsn*$sielil
l. neriinrriilnurdrluncir{rhorvrtru3raoriilrucmsnodldiuy.rtlf,nur
laorfil
druruncildrodrl iilnurrdurfiunlrdroqfirurunfilunrrldndsrdsdnrfianrir ,.urfu
ilnurluncirfrq.rorguav{ilaudld;unr:aur-q;lluu?nsoau 1 todrrnru rdoaqrldNfuld
n{rqmrdirdu
z. orrfinrriilnurlunciucT:otirdl#Hdcrfror,tf,dd{firor s gruoiu 'losiinrrfionr!
rsuss:l?Rlufl dln rsr-ltln: u rdogrr0sr?a'rro{Rr: m'udufi u
{rln6torfi.turi{
g. lunrrf;lno'tfi
6;onul#narruaulo mrlnki iufldtynr of;ur,l#f,orynfruf,
ilaunciunauqurdurdorfiuneiunnaor rn%tt{tf.re*nriruldiunr:qualurfordu
1 nirriiur
uai
RU Af,OnO
ttaglnilfl?1unt{to{flan.ttnaao{
Copyright
by Mahidol
University
Ycl 14
i r otq
36683
urrillunflt
Copyright by Mahidol University
luitrs
sldiuirtlinsrnasnrundlldiuirtlfnurn:u. tnt rfi ilufiliqqr
finur nrne3scfud. n?lrldru"lrolunrrquanuro{uasqarnrnf;inlu{ifrottrf
?lru sunsnomr
tmurarecnunrrifl frn d111il0'm'rnmanf. riorfina^vrords ilillenurdsufrnn,
xl+.
r;tgffunf a.rdquniord. narornr:1#nrrn0urarviludfuaquuarhi'narufoionnruflf,n
hiuriuoutunarurdurl'rulu{dlaoucr$ru?rasihnr,turnodrflrfis:-uirilinur.
fr n u
drliq
rin urnmn r u n uifl fi n d'n 1Tr t'ruraarani
q
ililringrdsufrna
rior fi
insr
ninords
zsgg.
niorruror nriard. ruatornr:ldnr:norurarcuuafiudquuacnrtt#narufsioqarnryrf;in
ril:ssnaroudldiuiriilinsr. iyrorfinudrJ?qqrinorrrldoru}f
lu{rlauruurf
'l
rifl fie dn r{ululanranf. rTorficrimurfrs ililriilorfigilfroa, 2sll.
n?{?rol ln:fiqad. nnufifalrtrduariuusr$rr irtlrtrrin. "mrfrrtlrnrusr$r" 31rn:rnu
?5?-o):,4549.
fi?.$Trot 'lnrfigad, $asnfls. dr:rfl.rit$nurr
hva
I vf
'lnis
u?glt
lt'tt/t
ilfind fiaf{tt nffifloruradilau. n!{rn}i4:
1ur, ?534.
tvrflu{tna. l:nlgrf{drfiiuufindnsrlfirififieltftrasfnfinurnflnd.
o{rffifiilfi1uor:
@6vl
onufl$tqm?n),?s?$.
o
aril f,rf or I r nilsrf {dril
irnlrsmsu. fi rrfrnfld
2, nE{flir{4, rf ouurla
nrrf;rur{, zsze.
aru6n mrlrr?qqa. "R'rrrilu'nl'ra{dleulrnrugrfr-"
luilgrirTnor. mrfr zsa. n:s5 finyouuav
nu s ur rflnfr nrr. fi{{[yn{4 : qmar nrairurrimords, Dg6.
Ahuja, R.K- , et al. "Radiation therapy in cancer management Principles and complication'
In Comlrehensive Textbook of Oncolo$r.pp.ET-265. Edittd by A-R- Moss4 M.C.
Robso
Bersaque, J.
& S.C. Schimff. London: Willinns & Wilki4 f986.
& Naeyart,
JJVI. "Ef,fectiveness and skin olerance
Department for Skin Diseases, Univ€rsity of
fu,
of pII5 hc€rin Ointment'
B€lgium,
fgtt.
Bouchar4 R. & Owens, N. Nursing Care of the Cancer Patient. St. Louis: C.V. Mosby
Company, 1981,.
Burns, N.
& Crove, SJL
Philadelphia:
J3.
The Practice of Nursing Research: Conducq Critique and Utilization.
Saunder, 1987.
Copyright by Mahidol University
35
Cancer R€port in Thailand l9S8-f993. The International Agency for Research on Cancc,r,
France, lg93.
Croucb
t3. & McClintic, It- I{unan Anatomy
&
Sons,
Inc-
and Physiolory. New
Y6'lc S.W. Ioh Willy
1971.
Ctvapil" M- Gaineq J-A. & Gilman, T. 'Lanolin and e,pidermal $ostlh facto in healing
d
partial-thickness pig wounds.' Journal of Burn Care Rehabilitation. 9(May[une
l98E):
n9-2u-
Ctvapil, M- Hoftrbec, H. & Chvapil, T.
o'Inert
wormd dressing is not desirable.' Journal
of
Srqgical Reearch. Sl(Septenber l99f ): 24!5-?52-
Falabella, R.
& Cali.
*Bffectiveness
and tolerance
of pH5 Eucerin Ohtment as an adjwad
in tre treamem of [email protected] de,rmatoses." B€iersdorf Report, Ilamburg, 19E6.
Fowler, I-1l. & Lindsrrom, MJ. "Loss of local control wirh prolongation in radiotherapy.'
Intenational Journd of Radiatio" Oncolory Biology PhySics. Z3(November lW2):
45747.
Criffirbs,Itf t- Murry, K-U. &
oA
Halperin, B. C., et al.
Rnsso, P. C. Oncolory Nursing- New Yorlc ltdacmillao, 1984.
double-blin4 randomize4 prospctive trial to evaluate topical
vitamin C solution for the prevention of radiation dermatitis.o Internatimal lournal
of Radiatior Oncolory Biolory Physrcs, [email protected] 1993): 413416Hassey,K.M.
&
Rose, C,M- "Altered skin
integlty in patients receiving radiation
rherapy."
Oncology Nursing Forum. 9Gall l9E2\: 45-50.
Hanucharurnkul, S. Social support, self-care and quality of
life in cancer patieds receiving
radiotherapy in Thailand. Dissertation for the Degree of Doctor of Philosophy,
Graduate School of Walme State University, Detroit, Mchigan, 1988-
Hellman, S. "Principles of Radiation Therapy." In Cancer Principles & Practice of Oncology.
pp- 247-?J75.
Edittd by VJ. Devit4
S. Hellman
& SA. Rosenberg.
Philadelphia: J.B.
Uppincott, 1989.
Helwig,8.E. & Mostifi, FJ(- The Skin. Baltimore: Williams & Ilkins, 1971.
Hilderley, L. "Skin care in radiation therapy: A review of the literature.n' Oncolory
Nwshg Fonrm. l0(Winter 1983): 5l-56-
Copyright by Mahidol University
36
Jarrett, A. The Physiolo$r and Pathophysiology of the Skin. London: Academic Press Inc-
rn!.
McNaIly, J. & Strohl, R. "Skin integrity, impairnent of, related to radiation therapy.n'In
Guidelines for Oncology Nursing Praction. pp.236-24O. Edined by J. McNally, E.
Someryille
& C, Maskowski. Philadelphia: Vrr3.
Saunders Company, 1991.
Million, RR., Cassisi, NJ, & Wittes, R-E. "cancer of the head and neck." In Cancen
Principles & Practice of Oncology- pp. zt07-506.
&
S. A. Rosenbcg. Philadelphia: J. B.
Edittd by V.T. Devit4 S. Ilellman
Lippincot! 19t5.
Purihar" S., et al. 'oTreatment of carcinoma of head
& neck with a combination of
conventional irradiation and methotrexate as radiosensitizer." Thai Cancer Jornal.
l4(January-Much 19EE):
I
J.
Reynolds, J-F. Martindale The Extra Ptsamacopocia. 28th. ed. London: The Pharmacerfiical
Prqs$ 19E2.
Robson, M.C. & Phillips, L. G. 'oHead
& Neck: Overyiew.nn In C.omprehensive
Textbook
of
Oncology. pp. 1125. Editted by AR. Moossa, S.C. Schimff & M.C. Robson.
Baltimore: Williarns & Wdkins, 1991.
Rong-Xi,
L-
et al.
*Comparision
of continuous and split-cours€ radiotherapy for
nasopharyngeal carcinoma." International Joriinal of Radiation Oncolog}, Biology
Phvsics. 16(Augus 1989): 307-310.
Runyon, R.P. Nonparametic Statistics:
A Contempor:ar}'Aplnoach.Itfassachusetts: Addism-
Trlesley, 1989.
Schwade,
JA. & Lichrer, A.S.
*Management
of acute effects of radiation therapy.' In
Principles of Cancer Treatment. pp.212-213. Editted by S-K. Carler, E. Glastein
&
RB. Livingscon. New Yorls Mccraw-HitlBook, 1982
Shelln SJ. Research Method in Nursing and llealth. Boston: Litrle, Brown and Company,
1984.
Sindhvannanda, J., et al. "Eygroscoplcity and water-holding capacity of moisnnizing agetra:
A single-application in vivo study." Iournal of the Societtr of Cosnetic
(Seprtember/October
Chernists. 44
lW3): n9-2EE.
Copyright by Mahidol University
37
Sitton, B. "Early and latc radiadon-induced skitr alterations Part2 Nrrdtrg care
d
irradiatd
ddtru' Oncolo8y nhnsiqg Fgrm- l9(Jnly 1992,): 9f 7'glL
Snitb, D. & Ctamorro, T. 'Ngrsing care if patienB nndeqgoing combination chemoherapy
ad radiatim.' Cancer Nrnsing.2(Aftt l9E): lz%lilSteinhoff, H. 'Qtiniqal study on action of pH5 Bucerin Oinment on patients in plasm ard
uonergoing dee,p x-ray rherapy.' Z. Atrlergic Medicine.
strohl R-A- "Radiation sttin
Thomson,
L.
*Side.€ffest
Varricchio, C.G.
o1he
reasrioa.'nost*i-"
4l(lWJ:
ll2
1(Fall'19t9): 3-8-
dradiotherapyl W,roiog rt-o. 7(.t1$ty l9B0): Strt-881.
gati€Ntt on
radiatim therafyj American lolrnal of Nursiqg.
El(Febuary 1981): 3*337.
*SHa
care during radiation therapy.' Ntrrsing Times. TE(December l9E2):
Walker, VA.
?Jd6E-?ff7o.
Copyright by Mahidol University
R'tnflu?n
Copyright by Mahidol University
nlRBlU?R
R
rirdnosrhmYu{rlaauarnrtfi rindilnf; t es{rlaulunrrrdriausrui&l
aiaGirig fidudoqninr
dufilwqa rflurinf,nurnorurailiqqrln nils$lttts
aranflrwsrurarrurf;ufi uilrinmduufina finzruauloitnsrtdorflunurilduuurla{to{t
firurilorn:-qilflnur rdofrnalunrrf,nururdlunurnrrb?nrrrnhunrits fimurnrrErrnfir
urirtor{ihsdldiuiltlflnursislil ftlndmnnrdariloornrirulunr:nouuuilcrouorulu
orritnolofod
drqor......,-..,..6udr{riulun'niflu fif,utol#.qsnolrruudouorurdorriudop
rieuo'r rmctoil:c6ursdunmuEuur,{Hailodrttinuriofizrrildrl"ttiutofodoudrfttd
iu:-rtlouRruirtilinur daryarf.rnrudqn oourvgnrfiurfluRerrfiuilacrhurlfidarJrgloni
lunrrnorura{rhueiohl
n rnq or iidoardsln
t rdoafiunrrio'od fif,u6u 6nou1#qou{r1o uaabidrqor ocdl
d'unrrifrsnfiduistri qorftnrldiunrrinurrsruraornrflrnrfrdtorlr{iloluran'rurJnfi
q0r..........fif,nn'docarauiuniarlfiratnr:rdrdaunuif,ud raiodoqaudrdrunrrif,uudrqar
hitudnfo}ifrqnrrdrcifl,nrrio'r,eiolil qfldlrnr€ronrdnnr:rdliaunrrio-sldlnohifl
n#onrrinurufsu?nrrdqorwldiu qoriiovlrarduluunc
ae
uasqu.-.......-..6udn?rdru
Jiart
R1t?Oufit{ltl{to lung
I
ilouqilns
Copyright by Mahidol University
nlnflu?o lf
tturf souoludoqacieu {fl na
ririnps: REanerounuuctolrolurdorfiufirriru loofmfo{uulolmaudoursudaaturl,
{onrrudnr viufizriruniorfiudonmu allu dosdrl
l, tnfl
l) slo
4 n6{
2.
oq--.---.-.--.........-,.fl
3.
d$lfidurd
r) Iao
2,d
O nfirs ildr usn
4.
I
I
e sas
fiOgrolsrilc{drnul
l) rhusrunr
zy
rhuqn
11rhuqrfiu:'ordou
el rhufinirtil
o
du 1 lrhn:ur;
s. rcdunffi;lnur
u hildriuu
a thgouflnur
O rhsufnur
o rlrsnrflfiofnr
o rlSqqrni
O glndrrl?Eqmi
a
- o
du
r lrlrnrvr;-..
q
"oCa
6. ollr?ilunnuumurdo............--.....fl
Copyright by Mahidol University
lm
d
7. O1flf
e
1)
tilt'luR'l:
zy
nrinlrufgiarrnfio
I.
3) fl'.n 10 :cq,............
4)
roueltnrtu teu...,--
5)
5utlr
v9
tuu....-.......
o hildrir.rru
t
7) OU dl
s.
.il
rusotsq
:rsldrsrnr ouniandusiorfi ou
t) rloundrnionirn'u
4,ooo u"t?l
2) 4S1-8,0(n UTo
o E,ml-14000lt'tll
4) 12,001-16,m0
illn
t
uln
l6,0ol-20,m0
o umndl 2o,m0 unndulrj
Copyright by Mahidol University
4l
nln$u?o n
uuuriu fi n{oryarfi
ue
ffultR$ac RrrYns r
t. drurdrtorust$s
t) ilgt$lncioqtlw
crty*l
z) ucti.ruowrt6uormr::vdunciosr€lw Got'reophoyor)
g)
rctftmqiolrjrn
+) ust$
s)
(orat cavity)
tt olurlqdr?tcf rn".oen"tr'*l
usr$rtsrlnrrornrnlun:sluaniitss (siilses)
Ouctirt,oqnr$6uor$r:rs6'urio.trjrntonopnury'*l
D usr$wo.rsisutilaro (salivary
Glands)
el fi arlurirc,oldauiiltucrtacno (Melanomas)
q)
ilg#lilo$aurfttiruf, rucuacnorruriouuf om$rfif rj,rn (skin, I&s)
rol 6ru1drir (Malignant Llmphoma) mldruiilruc$asno
t t ) u tr$ t d
hi u u ri oofn
ucisro nc u ul
d niu Angiofibroma, glomus jugulare,
plasmacytoma, sarcoma
rzl rsrBldoiorcduuavorroluurdno
z.
(Metasraric carcinama)
ufiomrnrrinur
ry
irtlflnur
zl ir iilinu
rnrom fr.rpirdo
3)
irilr-nu
at
ililf,nurnrrdasnrrl*rd
t
irtlf,nurnrsildlrniif rfo
o irtilinu
rdau
n'urniirlrrio
rn rou drrn fi rirrTnuas rirsTo
ndul }lrn:vq
Copyright by Mahidol University
42
r.
Jtr-
ra
edg
ilEurelilZlfluunfr16fu............
a
I
reilnlntg
t
+. 6ruau nirdld:-u nrt uruf,itl......-..........-......ofi
s.
rj?ureridtdldyuusiurof..'..-...
rqnrfirnrtl
Copyright by Mahidol University
43
nln$fll?R
ruuudwdurrffunarrulil
{
rnriq ornYstlYnsr
u:{t fl a { o{Ysiigisfi
iufiriufinrirfuoq: warnaudsu:surcdunc$uudn:tflunr:rilduurnlalfirufiimt{r1u
tcfiunciluu
rnil.IfiJtcrfiu
hifi nrlrilduunrlal (nsrmal)
o--firnriqilnfi
firnrisfidnuEcndrudurtn{ (erythema)
r
m dr
n uq oiladttuuinor g1mtu $tcoru
z-iilfi
rBru
rirs 1 ffu luurruBnnrtaudoddlfif,uolroru
fitl t-ila gpperpigmentatim)
g
dn*andr
ffu oa
ouqndndrluuiraorEprtun:corsfinfis
seuinE
rdo
ddHr"u n rr n u:-r6l
flate $rperpigme,ntation)
4-itfi
rndl fi ar ri.r
r
rrflt rfl
up
(early dry aesquamation)
s
tilfimdr fianri.rrfluagrfia
(late dry desqrrmation)
6-ii
o|u
drg
nol nilr oornnrJi uruua$racdnrcrudru
(moisc aesqpanation)
Copyright by Mahidol University
Wm
sx#s
4
Av
a
-i-qrrsdo{lnfi qoqo|afr tosauqplnrnnto{ua
l. nntrffi1sr:6n.q. ilelnor lnrft;ad
nraim"ltlinor
nE
snilngfrrdnfi t{fl rrumtrurfi u6 rninorfisufi qa
e u.n. ir"nrf lni:nrnd
nrnirrililinol norgilililsrnanfil:!ilsrura:rlrfiuii uurinords!fraa
3.
il.q. rrrlo uolrlruai!
nrnimiril?nor nosmnsfindnfi rwururarrufiuEi unrinurdoui-na
I
I
36683 by Mahidol University
Copyright