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<meta name="description" content="第一線で豊富なシミ治療の経験を持つベテランの著者による「シミ治療」の決定版．大好評の初版から9年ぶりの改訂．シミの鑑別と治療法選択のポイントを記載し，それぞれの治療法ごとの推薦度，効果，リスクなどを示し，豊富な症例写真によってわかりやすく実践的に解説．随所に挿入されている「コラム」や「コメント」では初版の内容を生かしつつ，最新の情報を追加している．皮膚科医，形成外科医にとって，まさに必携の1冊．　">

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		<h1 class="catchCopy">第一線で豊富なシミ治療の経験を持つベテランの著者による「シミ治療」の決定版！大好評の初版から9年ぶりの改訂!!</h1>
		

		<h1 class="title">シミの治療<span class="version">第2版</span></h1>
		<h2 class="subTitle">このシミをどう治す？</h2>

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					著：葛西健一郎（葛西形成外科）
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				<ul class="property"><li class="disc">B5判・284頁・4色刷</li><li class="disc">ISBN&nbsp;978-4-8306-3462-8</li><li class="disc">2015年4月4日発行</li></ul>

				
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		<div class="headers"><h3 class="current content">内容</h3><h3 class="preface">序文</h3><h3 class="indexes">主要目次</h3></div><section class="current content">第一線で豊富なシミ治療の経験を持つベテランの著者による「シミ治療」の決定版．大好評の初版から9年ぶりの改訂．シミの鑑別と治療法選択のポイントを記載し，それぞれの治療法ごとの推薦度，効果，リスクなどを示し，豊富な症例写真によってわかりやすく実践的に解説．随所に挿入されている「コラム」や「コメント」では初版の内容を生かしつつ，最新の情報を追加している．皮膚科医，形成外科医にとって，まさに必携の1冊．<br>☆図版15点，カラー写真53点</section><section class="preface">第2版の序<br><br>　本書初版を刊行してから9年が経ちました．リジュビネーション，あるいはアンチエイジングという言葉もずいぶん一般的になりました．この分野の医学的進歩は著しいものがあります．しかし，その中で実は「シミの治療」が，もっとも目に見える劇的な改善が得られる分野なのです．それまで確かに存在していたシミがなくなるということは，だれが見てもはっきりとした成果として評価してもらうことができます．<br>　「シミの治療」に関する学術書を一人で刊行するということは，大変なエネルギーが必要な仕事でありましたが，その後読者のみなさまに，一定の評価をしていただくようになり，今ではこの本の刊行は筆者の医師人生の中でもっとも誇りに思える仕事であったと感じています．初版の内容もだんだん古くなってきていますので，改訂第2 版を出す必要があると考えておりましたが，時間とエネルギーが足りなくて，今日までかかってしまいました．<br>　改訂の作業の中で感じましたことは，筆者の「シミの治療」の根本的姿勢は9年たっても何も変わっていないということです．やはり，時が流れても，真実は真実であり続けるということです．変わったとすれば，初版執筆時に筆者の考えていたことが，9年経って「確信」に変わったということです．もちろん，深遠な医学の世界の中で，筆者の考えていることの一部はまだ「異端」として医学界に広く認められていないものもあります．真実がどこにあるのかは，新進気鋭の後輩たちがきっと解明してくれることでしょう．<br>　さて，本改訂第2版において，単純に古い記述を削除して新しいものに入れ替えるよりも，わざと古い記述と対比して新しい記述を併記したほうが，この9 年間の変化というものが理解しやすい面もあると考え，コラムやコメントは，新旧対比して記載してあります．これで，初版をお持ちの方も第2版を初めてお読みの方も楽しめると思います．また，初版の15症例集は，現在でもまったく古くなっていない「珠玉の15 例」ですので，実は，ほとんど触っておりません．何回でも読み返してください．その代わりに，上級者向けの「ステップアップ症例集9例」を追加いたしました．<br>　本書が「シミの治療」の初心者にもベテランにも参考になるものであることを，心から祈っております．<br><br>2015年4月<br>葛西健一郎</section><section class="indexes">第1章　総　論<br>　1．シミとは何か<br>　2．シミの分類<br>　　コメント　松永のシミの定義<br>　3．シミの色について<br>　　コラム　肌の色の機械診断<br>　4．シミの経時的変動<br>　　コメント　紫外線とシミ<br>　　コメント　ストレスとシミ<br>　5．シミと肌質<br>　　コメント　脂性乾燥肌<br>　6．化粧品について<br>　　コメント　機能性化粧品の作用機序と作用時間について<br>　　コラム　化粧を完全に落とすこと<br>　7．レーザーに関する基礎知識<br>　　コメント　レーザーの深達度に関するよくある誤解<br>第2章　各　論　1．ADM<br>ADMとはどんなシミか<br>　1．後天性真皮メラノサイトーシスacquired dermal melanocytosis（ADM）とは<br>　2．ADMの診断基準<br>　3．ADMと太田母斑の鑑別診断<br>　4．ADMと肝斑の鑑別診断<br>　5．ADMの組織像<br>　　コラム　ADMの表皮色素をどう考える<br>　　コラム　ADMの本質は一種の遅発性母斑<br>　6．ADMの臨床像<br>　　コメント　ADMは独立疾患か？ならばその診断基準は？<br>　　コメント　ADMという疾患の独立性と呼称について−溝口昌子先生の意見<br>　　コラム　ADMと太田母斑を同一疾患と考える渡辺（案）<br>　　コラム　太田母斑とADMは同一疾患であり，母斑ではなく色素異常症という渡辺案<br>　　コラム　ADMの発症原因について<br>　　コラム　やっと認知されはじめたADM<br>ADMをどう治療するか<br>　1．Qスイッチルビーレーザー治療<br>　　コラム　ADMのQSRL治療のこれまでの報告について<br>　　コラム　早期繰り返し治療は良くない（1）<br>　　コラム　痂皮が脱落してもしなくても10日間処置を続けさせる理由<br>　　コラム　筆者がレーザー後の外用療法を行わない理由<br>　　コラム　筆者のクリニックでレーザー後色素沈着が少ない理由<br>　2．Qスイッチアレキサンドライトレーザー治療<br>　　コラム　ADMのQSAL治療のこれまでの報告について<br>　　コラム　早期繰り返し治療は良くない（2）<br>　3．QスイッチNd：YAGレーザー治療<br>　　コラム　ADMのQSYL治療に6ヵ月以上の間隔が必要な理由<br>　　コラム　ADMのQSYL治療のこれまでの報告について<br>　4．トレチノイン・ハイドロキノン＋QR治療（東大式）<br>　　コラム　レーザー前処置の意義と“ふるい効果”<br>　5．弱いQスイッチレーザー治療<br>　6．トラネキサム酸内服<br>　　コラム　筆者の不思議な経験<br>　　コラム　筆者の不思議な経験その後<br>　7．冷凍治療<br>　　コメント　冷凍治療の意義はもはやゼロに近い<br>　8．ロングパルスレーザー治療<br>　　コラム　ロングパルスレーザーも少しは真皮メラノサイトーシスに効果があるのだが<br>　9．フラッシュライト・高周波電流類<br>　10．ケミカルピーリング・イオン導入<br>　11．トレチノイン・ハイドロキノン治療（東大式）<br>　12．ハイドロキノン外用<br>第2章　各　論　2．ＳＫ<br>SKとはどんなシミか<br>　1．SKとは<br>　　コラム　SKと日焼け<br>　2．SKの診断基準<br>　3．そばかすとSKの鑑別診断<br>　4．SKとADMの鑑別診断<br>　5．SKの組織像<br>　6．SKの臨床像<br>　　コラム　SKの好発部位<br>　7．PIHのあとに現れるSK<br>SKをどう治療するか<br>　１．Qスイッチルビーレーザー治療<br>　　コメント　QSRL照射の適正出力について<br>　　コラム　SKのQSRL治療は広く当てた方が良い<br>　2．炭酸ガスレーザー治療<br>　3．炭酸ガスレーザーとQSRLの組み合わせ治療<br>　4．エルビウムヤグ（Er：YAG）レーザー治療<br>　5．Qスイッチアレキサンドライトレーザー治療<br>　　コラム　閉鎖療法のいろいろ<br>　　コラム　アイスキューブの作り方<br>　　コラム　新製品皮膚冷却スティック<br>　　コラム　レーザー後の遮光は必要ない？<br>　6．QスイッチNd：YAGレーザー治療（532nm）<br>　　コラム　筆者のQYAG-532治療の歴史<br>　　コラム　筆者のQYAG-532治療その後<br>　7． QスイッチNd：YAGレーザー治療（1,064nm）<br>　8．強いロングパルスレーザー治療<br>　　コラム　レーザー後の色素沈着について<br>　9．弱いロングパルスレーザー治療<br>　10．フラッシュライト療法<br>　　コラム　IPL治療に関するこれまでの報告<br>　　コラム　ジェルとマイクロクラスト<br>　　コラム　SKの治療にはフラッシュライトよりもレーザーの方が好ましいと考えるようになったきっかけ<br>　　コラム　強いフラッシュライト療法と弱いフラッシュライト療法<br>　　コラム　SKにフラッシュライト治療を行うべきかどうかという点について<br>　11．shave excision<br>　12．冷凍治療<br>　13．電気焼灼<br>　14．切除手術<br>　　コラム　筆者が冷や汗をかいたが，結果的にはうまくいった“シミ”の一症例<br>　　コラム　LM患者その後<br>　　コラム　lentigo malignaを考える<br>　15．トラネキサム酸内服<br>　16．トレチノイン，ハイドロキノンなどの外用薬<br>　17．トレチノイン・ハイドロキノン治療（東大式）<br>　　コラム　筆者が東大式Tr＋HQ治療を行わない理由<br>　18．ケミカルピーリング<br>　　コラムブルーピール<br>第2章　各　論　3．そばかす<br>そばかすとはどんなシミか<br>　1．そばかす（雀卵斑）とは<br>　　コメント　遺伝性対側性色素異常症（DSH）<br>　　コラム　後天性そばかす<br>　2．そばかすの診断基準<br>　3．そばかすとSKの鑑別診断<br>　4．そばかすとADMの鑑別診断<br>　5．そばかすの組織像<br>　6．そばかすの臨床像<br>　7．そばかすと日焼け<br>　　コラム　そばかすの来院患者は意外に少ない<br>　　コラム　そばかすの分布に関する雑感<br>そばかすをどう治療するか<br>　1．トラネキサム酸内服<br>　2．フラッシュライト療法<br>　　コメントそばかすの治療にフラッシュライトが適している理由<br>　3．Qスイッチルビーレーザー治療<br>　　コメント筆者は最近しぼりは使わなくなった<br>　4．Qスイッチアレキサンドライトレーザー治療<br>　5． QスイッチNd：YAGレーザー治療（1,064nm）<br>　6． QスイッチNd：YAGレーザー治療（532nm）<br>　7．強いロングパルスレーザー治療<br>　8．ケミカルピーリング<br>　9．イオン導入<br>　10．トレチノイン外用<br>　11．ハイドロキノン外用<br>第2章　各　論　4．肝　斑<br>肝斑とはどんなシミか<br>　1．肝斑とは<br>　2．肝斑の診断基準<br>　3．ADMと肝斑の鑑別診断<br>　4．多発性SKと肝斑の鑑別診断<br>　5．肝斑の組織像<br>　　コメント　真皮性肝斑について<br>　　コメント　肝斑とADMの合併頻度はそれほど高くない<br>　　コラム　真皮性肝斑とADM<br>　　コラム　肝斑とADMその後<br>　6．肝斑の臨床像<br>　コラム　日焼けと肝斑<br>　コラム　ストレスと肝斑<br>　コラム　ホルモンと肝斑<br>　コラム　筆者の研修医時代の松永先生との思い出<br>　コラム　肝斑の発症率に関する地域差<br>　7．肝斑類縁疾患<br>　コラム謎の疾患オヘイラスolheiras<br>　コラム目の下のクマの鑑別診断<br>肝斑をどう治療するか<br>　1．トラネキサム酸内服<br>　　コメント　保険適用・適用外使用・個人輸入の違い<br>　　コラム　OTCトラネキサム酸合剤（トランシーノ®）<br>　2．葛西式「保存療法」<br>　　コラム「通う」ということ<br>　　コラムみることとみられること<br>　3． イオン導入・超音波導入・エレクトロポレーション<br>　　コラムイオン導入の不思議（その1）<br>　　コラムイオン導入の不思議（その2）<br>　4．レーザー治療<br>　5．フラッシュライト療法<br>　　コラムIPL治療をやめてしまったK先生<br>　　コラム肝斑のIPL治療は強く当てるべき？<br>　6．ロングパルスレーザー治療<br>　7．レーザートーニング<br>　　▶ 肝斑に対する低出力QスイッチNd：YAGレーザー治療（レーザートーニング）の危険性<br>　　コメントレーザートーニングに対する筆者の心の変遷<br>　8．トレチノイン外用<br>　　コラム　MASIについて<br>　9．ハイドロキノン外用<br>　　コラム　日本人の肌はハイドロキノンにかぶれやすい？<br>　　コラム　筆者がシミの治療にハイドロキノンを使わない理由<br>　10．トレチノイン・ハイドロキノン治療（東大式）<br>　11．3者混合外用薬<br>　　コラム　3者混合外用薬に対する筆者のつぶやき<br>　12．ケミカルピーリング<br>　　コラムケミカルピーリングの真実<br>　　コラム饅頭をやめさせること<br>　13．その他内服薬<br>　14．その他外用薬<br>　　コメント自家調剤薬品について<br>第2章　各　論　5．PIH<br>PIHとはどんなシミか<br>　1．炎症性色素沈着post-inflammatory hyperpigmentation（PIH）とは<br>　2．PIHの診断基準<br>　3．PIHの組織像<br>　4．PIHの臨床像<br>　　コラム　PIHと肝斑<br>　　コメント　薬剤性色素沈着症<br>PIHをどう治療するか<br>　PIHの自然経過<br>　PIHの対処方針<br>　　コラム　レーザー後の色素沈着<br>　1．トラネキサム酸内服<br>　　コラムPIHとトラネキサム酸内服<br>　2．保存療法（積極的無治療）<br>　　コラム日焼けを避けること<br>　3．レーザー治療<br>　4．フラッシュライト療法<br>　5．ケミカルピーリング・イオン導入<br>　6．トレチノイン外用<br>　7．ハイドロキノン外用<br>　8．シリコンゲルシート貼付<br>　9．フラクショナルレーザー治療<br>　　コメントPIHを治療するということ<br>第3章　症例集<br>　症例1 41歳女性，顔のシミを治してほしいということで来院<br>　症例2 38歳女性，数年来シミがひどくなってきたということで来院<br>　症例3 53歳女性，シワと肌の張りを治療後，シミの治療を希望<br>　症例4 52歳女性，シミが増えてきたのをなんとかしたいという<br>　症例5 21歳女性，1年位前からシミが気になるようになってきた<br>　症例6 65歳男性，顔のシミを取りたい<br>　症例7 56歳女性，両側頰骨部のシミを取りたい<br>　症例8 37歳男性，数年来，顔にシミが出てきたという<br>　症例9 20歳女性，4年前から鼻にシミができた<br>　症例10 38歳女性，顔のシミを治したい<br>　症例11 30歳女性，外傷後の頰の黒ずみを治したい<br>　症例12 48歳女性，顔のシミがひどくなってきたということで来院<br>　症例13 52歳女性，目の下・鼻・頰・こめかみ・前額・上口唇のシミを治したい<br>　症例14 36歳女性，シミと赤ら顔を治したい<br>　症例15 54歳女性，太田母斑治療後の色素沈着を治したい<br>第4章　ステップアップ症例集<br>　症例1 33歳ロシア人女性，前額の色素斑をどうしたら良いでしょうか？<br>　症例2 43歳女性， 両頰の色素斑にQSRLを当てて悪化した<br>　症例3 20代女性，頰の色素沈着<br>　症例4 40歳女性，SKにQSRL治療半年後　<br>　症例5 55歳女性，多彩なシミ<br>　症例6 84歳女性，QSRL治療後18日目に高度の赤みを訴えて来院<br>　症例7 69歳女性，QSRL＋CO2治療後4日目にキズがおかしいと来院<br>　症例8 40歳女性，3年前にADMを取ったがシミがまた出た<br>　症例9 66歳女性，11年前ADMをQSRLで取ったがシミが再発<br>文　献<br>索　引</section></article>
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