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"code": "H02.6",
"name": "Ксантелазма века",
"icd_name": "Ксантелазма века",
"gender": 0,
"age_min": 1,
"age_max": 100,
"cause": [
"0"
],
"periodicity": 1,
"slug": "h02.6_ksantelazma_veka",
"lead": "плоское доброкачественное образование желтоватого цвета в виде слегка возвышающейся бляшки",
"description": "",
"etiology": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Точные причины возникновения ксантелазмы неизвестны. Ксантоматоз кожи развивается на фоне нарушенного обмена жиров в организме и представляет собой локальные отложения жиров в сосочковом слое дермы. Хотя ксантелазмы по своему строению практически не отличаются от ксантом, при их изолированном появлении по данным анализов часто не удается обнаружить значительных нарушений жирового обмена. Ксантелазмы и ксантомы часто наблюдаются у пациентов с ожирением, сахарным диабетом, микседемой, липоидным нефрозом, панкреатитом, циррозом печени, повышенным содержанием холестерина в крови.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Ксантоматоз может иметь наследственную природу. В таких случаях развивается генетически обусловленное нарушение жирового обмена. Заболевание проявляется в течение первого года жизни.</span></p>",
"pathogenesis": "",
"diagnostics": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Пациентам с ксантелазмой рекомендована консультация дерматолога и эндокринолога. Характерный внешний вид и локализация ксантелазмы позволяют поставить диагноз сразу же после осмотра пациента. При осмотре ксантелазмы или ксантомы используют надавливание предметным стеклом (диаскопия). Таким образом добиваются обескровливания образований, что позволяет четко увидеть их желтый цвет.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Обязательно проводят исследование липидного обмена. Для этого назначают определение холестерина в сыворотке крови и липопротеидов. В некоторых случаях необходим дифференциальный диагноз с сирингомой, эластической псевдоксантомой и опухолевыми заболеваниями кожи.</span></p>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Ксантелазма не имеет специфического лечения. При возникновении ксантелазмы или ксантоматоза на фоне заболевания, которое может быть причиной нарушения жирового обмена, необходимо лечение этого заболевания. По показаниям может быть назначен инсулин, тиреоидин.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Пациентам с выявленным нарушением липидного состава крови или повышением холестерина следует придерживаться диеты с пониженным содержанием животных жиров. Для этого животные жиры заменяют растительными, например, подсолнечным и оливковым маслом. Таким пациентам с ксантелазмой назначают липотропные препараты и средства, снижающие содержание холестерина в крови. К ним относятся: цетамифен, пирикарбат, эфиры ненасыщенных жирных кислот, липоевая кислота, кислота тиоктовая, диоспонин, клофибрат.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Из препаратов растительного происхождения липотропным действием обладают: березовые почки, корень одуванчика, плоды шиповника, кукурузные рыльца, сок подорожника, цветки бессмертника. Следует помнить, что эти препараты обладают желчегонным эффектом и их применение противопоказано при нарушениях отведения желчи по желчевыводящим путям. В лечении ксантелазмы применяют никотиновую и аскорбиновую кислоты, цианокобаламин, пиридоксин, кальция пангамат, холина хлорид.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Хирургическое лечение ксантелазм показано по косметическим соображениям. Оно проводится путем иссечения ксантелазмы, ее удаления лазером, электрокоагуляции, криовоздействия или деструкции радиоволновым способом. Удаление в большинстве случаев производится под местным обезболиванием в амбулаторных условиях.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Мелкие ксантелазмы обычно удаляют при помощи диатермокоагуляции. Более крупные бляшки отсепаровывают ножницами и пинцетом. Края раны сводят и смазывают полуторахлористым железом, которое образует прочный струп и позволяет ране зажить первичным натяжением в течение 1-1,5 недель. После отсепаровывания ксантелазм с широким основанием края раны прижигают путем диотермокоагуляции. При сочетании ксантелазм с нависанием кожной складки на веке производят их хирургическое иссечение совместно с избытком кожи верхнего века.</span></p>",
"prevention": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Не существует точных рекомендаций в плане профилактики при ксантелазме. </span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Специалисты могут дать лишь общие рекомендации, которые помогут пациентам выйти из группы риска и избежать появления таких образований с возрастом: </span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">следить за своим весом и ввести в рацион больше полезных продуктов; </span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">в рацион добавить продукты, содержащие клетчатку, а также ежедневно съедать до трехсот граммов овощей и фруктов; животные жиры заменить растительными, но употреблять их в разумных количествах; </span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">выпивать в день не менее 1,5 литров воды; </span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">регулярно заниматься физическими упражнениями; </span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">постараться отказаться от курения и алкоголя; </span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">контролировать обмен веществ, при необходимости – посещать диетолога и эндокринолога.</span></li>\r\n</ul>\r\n<p> </p>",
"clinical_picture": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Ксантелазма представляет собой немного выступающую бляшку желтого цвета, расположенную на верхнем веке. Она безболезненна при ощупывании и имеет мягкую консистенцию. Как правило, ксантелазмы появляются на обоих веках. Они могут быть единичными и множественными. В последнем случае ксантелазмы могут сливаться, образуя бугристые элементы. Иногда ксантелазмы сливаются в сплошную желтую полоску с неравномерным контуром, проходящую через все верхнее веко.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Для ксантелазмы характерно внезапное, без предшествующих изменений кожи века, появление. Развитие ее происходит постепенно и достаточно медленно, не доставляя пациенту никаких субъективных ощущений. Ксантелазма может достигать размеров от маленькой горошины до крупной фасолины. Она никогда не подвергается трансформации в злокачественное новообразование и не представляет угрозы для организма человека. Однако крупные и множественные ксантелазмы, не смотря на свою безобидность с медицинской точки зрения, представляют заметную косметическую проблему.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Если ксантелазмы являются проявлением ксантоматоза, то они часто сопровождаются поражением нижнего века, на котором образуются ксантомы. При этом ксантомы локализуются и на других участках кожного покрова: лицо, шея, коленные и локтевые суставы, разгибательная поверхность конечностей, ягодицы и др. Возможно их появление на слизистой мягкого и твердого неба, губ. Ксантомы могут быть мелкоузелковыми (эруптивными), плоскими в виде бляшек или бугорчатыми в виде крупных узлов с неровной поверхностью. Диаметр этих образований варьирует от 2 мм до 5 см. В отдельных случаях ксантомы сливаются между собой и происходит образование крупной бляшки с дольчатым строением.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Возникшие ксантомы и ксантелазмы сохраняются всю жизнь. Постепенно они растут в размерах, их количество увеличивается. Появление ксантелазм и ксантом у маленьких детей может быть признаком наследственного гиперхолестеринемического ксантоматоза, который затем проявляется нарушениями со стороны сердечно-сосудистой системы и печени, может сопровождаться образованием костных кист.</span></p>",
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