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$lndlqad il.U, Cefiinete of Proficiency (Radiotherapy and Nuclear Medldne) Rrtiln'rrR?uqrinurfi nud ^0.t dw 0^ J-ffiL ;;'*-;"".xi'o"-' -rcf,...pdr-...... ilrdnr qasils nr:dnrd qamorlnn -4q fl.u, ?n.il.(gou??ngr) ?n.u. (tlglula), M.S., n.n. Ph.D. (Micobiology) ilrcnunorcnr:unr:ilrrdrrnffngnr .l ROIUN VAAU ufl0nn?ng16tf nsrurafl lssrsunriilfisr firnrtnorrnsrrnaflnq! d Rotsilvtilt fllcsrt f:snsruranmGuGi Copyright by Mahidol University aaa "Rtfluflilf A tto€ rJtcfofi nrnmqndnfiomiiilfrrihsr o greotulunrrfl srffuna{ osiqeiinurdoihnris rliEqrnnumfl rsorlrrrlriorfi n eiuirr iufi or rnorurafl uqi as ihnrnu zsgs fo?or nftiln o, .r*-r. qo3or dudlwrlo hU ry?os &*&**au6n rquiiqqo ?n.u.(nmum), nt s., PhJt il:cnunr:tnrrcoutnurfi nud #'QV -.fu*Axsry.r rffi..@ .tadt illa lanula?{fl il?{nos ln:f,gad ?n.U.(ngfum),l[N. o1ttlnl:floU?narfinud ?l.Uo Ccrtrfiete of koffdenq (Rdothrapy and Nuctear ll,redidne) R??ilnrrflouinsrfinud t *fD.**..ffita a frugfi qaafa, rr.u., ?tLtf. g:roanG nmriilrs, (go8einur), Ph,D. F*.A"C.P. FRCP(I), FRCpc, o.?. Mcnobiologr) M.D.o BS.fl,ons.), FI.c.p, notiln Rotufi riilfininsrfrs natcilililsnmntltsilaruro:rurGuii utrinarffuufinaCopyright lilrinsrflsufina by Mahidol University _----.1 4 rffis6b AA*AT is v { ?u rnou umdm.laint frifilnuqa iltRa .ila 3 R:Ra'nx 2fl18 ssrudfin ilnrdlrrrlnr rhct6nrrf,nrn urafnsrdbilfrsa, t.fr. ?s26?spy. rhsrnalno inornnenrrimfi n (ilulilm$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$a: nr?rrncnfribhluavq nriu nmilroitfitfi :gdu g n orfl or fiurmgrlrrln nrr 6eolmn6n *rrinourrTs R1{rnruilrunr nrjrol@ lrwsruranErln 2 nl,$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* a@a 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 t@I 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$asn6iunnooldnu d r a e e.a@ nffi ruauutlua{xo{3r2tf u rolR'{dt Ru 1 Copyright by Mahidol University Uilfi 1 o unilr n?rildhuruaEn?ruchfrqmsr1qmr urrBufluneiumq1rndriol#rfinilqu1?l'NrdMtotqtdruiurlrcmalnu turcus ero{nfl?rrsduiruu. ornnr:ifnsrdluuuunutssdnrrnrrnrudronriulrnsirt 1 nudrflnrr nldouornnciulrofiniounilunciu'lrohifiosisilrndu ilo$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$.r d.romdr ,A.ta o vdaurfi r qfl nrilfrTsrr or {r1 ao z. rfl uuuanr.rlunrrdunft ift, lurJrcduoau r driaurf,orur dwiul#{t'horvr6.r ldiu nrr ins'n{r,',uradiiqar nrnuasm ulsrru Copyright by Mahidol University fisruffeurlr {ifu fl ror r gmelu nurodr ndndEdniurdrdu fi gnolrdrfl uordrbgnoudrfrq dufiIn:wir.ra6turiniurmi#rrdnfie durndsumslfiorru{rfirurifumrft ndnlno ao .l4l s o ilrun bffi@no tme rn{o{fadfnurgiofiunTs nurs6{ nrrnjdsuurla{m$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$rildsn'eilricfiJnrria; ftothdrft?ruq E4 rrs ii{ruru{rtru + z orl rrsldlfnnudrufis lunuiilnurof.dociu z m0frruaorodf,ou',ua, 6n rs :rofifioryabinru&u ftrfuncirdrodxdrirur?rnrrcrtiifloc 6s r1u nudrarr acaluinrfiuffirlrcf,ilfinrnlun'ufloqrlunatoqr-rtlinursian'rnrirqlndlcn:agaruilasu to rrs(9suoc ls) lurorcdar:acarsilnoufirj:sfirnf;nrnlunrrflorrTunamrirtilsiofi: nrft glndrarracauinrfiufi zo rru(flouac ) rmchifi u nrrunn nsimlu nrrfl olf,u naroir o iedinursisfrrurilllowmuruluriou*lufffrudrnds gs nu(9ouas s+) ftrfueqrllf ir eaq 3r r a arracarsinrfiu6hifiilrsfrvrf;nrnlunrcflom'unarorirtlinursiofirufiiluf,rlaouuril rbwor quarurifu esfldnfisrqidfsfi mu o gmoluuanl*tlninrnlunrrYnurlrafi amffs ddofit* s grwo3uficirunerutosnrdrioronurflunrarforiN Grffer nixrr'e) ilrgnoudas rrolltriiou lnlslenou fimrnlmonim dihydrogm cirrare) o.ot niumc uouluriigu TululgTornu frn:n(a,-"'onium monohydnogen citrare) orz nit lnoii grwolrriG,ucoitel rfludeuneru(mutsifying agmr) drgrvolrririluolrfiJrgnouddrdqons uoanaasdarludu Oanolin alcobl) u10'rR odr{rdnuoanosodgosac 9ssos ra ln:Nmfiaatnoroalosas gs lslornunrfuoulouau l 22 Inmamsrsa (Reynods drunaudlneirmdruriuarrrTnmdrornsiolluTurassiouriltoroqdrrnrs rlrz rffir) druonmnlfi Copyright by Mahidol University ll narrniruduurififlrrftftsieuriurriruldrsadfi?nfru?railtol,uoRrmofinrrudldrro3qrfiuln rrasrndoun-rr{rrlnnqlu3noriltnnnal&'lorBe (Hassey & Rose ll&2: 49:Sitton lW2:9@) drn fuqruto-ud rd 0 e riu q ar au ri6t o qndsr frartidd{ f, ros s grwoiu In sn r d{hiilu r'rrl{ru usi6l:of frrriurirracflaru(sindhvananda, er al. 1993: n%lst) ldrrununmf,nur riliiuufioun?1ud1u'rsotunr:{urir(warer-hotding capacity) nrundtmreirtfnnu{u #t o sfinlfirfi n?lmworriul:nfimrit airgrioltozo rnea cr€'rn) n€unrouanda(sEo to"ri" acid crem) uasndndardorrirdrmiurnfinr s gmo?u looiearru.nurto{lrfidru lslnrirnsf6ysro-ur"r) Un 30 iurfirflunarillil 3 drlu$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) lrnrdnfilr@cz€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 n-@ 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 7@6n 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 $o ou'l Copyright by Mahidol University ?A nrn{d r tciot aRu0rstf o{nEUn2001{ e n{lnnaolln =tR neiunruqt(nz=rt 6ruru(9ouac) 6ruru(9ouac) Cry- Rl'tRUln tntil sds t{fltnu'l 2(r3s) 4<7Sn iriilinurnruuftirdo s(333) 5(333) 7@6n 5(333) l(6-7) t(6a 5fln-8280 sflxL88E0 6909.s3 696i133 93359 rc3032 fifiu ?a4 2543 rC nlflao 35.N 34.47 rC n'ltuo'ttrltuumrnlu 553 4.79 eds @ ao e r{flrRUlRUrnXillUn sae t Or I :.{tdtRUlnlun?ufl1t tdlrs J rjiu ror irtifiq lr r a (cGy) Ag fldu rd n'tna0 tC fi1tu0{tultulgtt!1u ! drrred 0lu?unt{n to5ilR'ttD'tgt,td o sallrro , rA " rJiurE iqdfr l6iurre{asnf,s(ccy) fifiu rC fl1r040 ,c n'tr1r0,{tuut lstrsTr 180-210 I10-230 195.93 ?n2-u7 10.09 t2.t2 Copyright by Mahidol University floR1?nodoudililaf,lu ncit{rlatluvri t uiresrilr us mr nodyr u rft dldyu n rr s rgidl iuas z ort fi uri.o n rn dn d'or ddnd{fi ror s gmoiu al#rilasdil arirwf uau o u n l uinor fi a dr usil dr-u f,ith u ntu:-ttlinu'l nunato$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€gF@l 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" 1rF@tgI9 ld Ctl IJ Fr gr rtsbld@l 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${lrinotibusnutnudooudrfilrurilln:wdrorynurodq" iiorgd.r'ei z'uz fl tflu Inf,fio 16 t1t' rnorft 14 t'lt, eiauurnfianlnarraqi nrrflnurogilursduilrsoufinur Iosurnrfrsnous,f,niurrrRmuacrYrilrs ldiufqflinur,flunfi,,rordonrrrrr,l,.ro dru lnqirfl unrrinurdufiuroiirlrrinudaffi r'u,fi'uoarnurhneiil@andomAssigmenc)nrn{rlau rruurno$luncilnnaotmfooauqu rrudaoooro@nncjruuuar 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 rJrraornmiuilari@yoolipio)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 $ostlh facto in healing d partial-thickness pig wounds.' Journal of Burn Care Rehabilitation. 9(May[une l98E): n9-2u- Ctvapil, M- Hoftrbec, H. & Chvapil, T. o'Inert wormd dressing is not desirable.' Journal of Srqgical Reearch. Sl(Septenber l99f ): 24!5-?52- Falabella, R. & Cali. *Bffectiveness and tolerance of pH5 Eucerin Ohtment as an adjwad in tre treamem of desqu@ative de,rmatoses." B€iersdorf Report, Ilamburg, 19E6. Fowler, I-1l. & Lindsrrom, MJ. "Loss of local control wirh prolongation in radiotherapy.' Intenational Journd of Radiatio" Oncolory Biology PhySics. Z3(November lW2): 45747. Criffirbs,Itf t- Murry, K-U. & oA Halperin, B. C., et al. Rnsso, P. C. Oncolory Nursing- New Yorlc ltdacmillao, 1984. double-blin4 randomize4 prospctive trial to evaluate topical vitamin C solution for the prevention of radiation dermatitis.o Internatimal lournal of Radiatior Oncolory Biolory Physrcs, Z.e@ecemUer 1993): 413416Hassey,K.M. & Rose, C,M- "Altered skin integlty in patients receiving radiation rherapy." Oncology Nursing Forum. 9Gall l9E2\: 45-50. Hanucharurnkul, S. Social support, self-care and quality of life in cancer patieds receiving radiotherapy in Thailand. Dissertation for the Degree of Doctor of Philosophy, Graduate School of Walme State University, Detroit, Mchigan, 1988- Hellman, S. "Principles of Radiation Therapy." In Cancer Principles & Practice of Oncology. pp- 247-?J75. Edittd by VJ. Devit4 S. Hellman & SA. Rosenberg. Philadelphia: J.B. Uppincott, 1989. Helwig,8.E. & Mostifi, FJ(- The Skin. Baltimore: Williams & Ilkins, 1971. Hilderley, L. "Skin care in radiation therapy: A review of the literature.n' Oncolory Nwshg Fonrm. l0(Winter 1983): 5l-56- Copyright by Mahidol University 36 Jarrett, A. The Physiolo$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
© Copyright 2024