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},
"code": "L70",
"name": "Угри",
"icd_name": "Угри",
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"age_min": 0,
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"cause": [
3,
0
],
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"slug": "l70_ugri",
"lead": " это мультифакториальный дерматоз, в патогенезе которого большую роль играют генетически обусловленная гиперандрогения и генетически детерминированный тип секреции сальных желез.",
"description": "Угревая сыпь относится к числу наиболее распространенных кожных заболеваний. В той или иной форме угри встречаются у 60-80% молодых людей в возрасте от 12 до 24 лет. Однако угри могут появляться и после 25 лет, как правило, на фоне нарушений обмена веществ.",
"etiology": "<p>Специалисты выделяют несколько основных видов угревой сыпи в зависимости от причин их возникновения. Прежде всего это эндогенные (возникающие из-за внутренних причин) и экзогенные (возникающие из-за внешних причин) <a href=\"/symptom/ugri/\" title=\"Перейти на страницу симптома Угри\">акне</a>. </p>\r\n<p>Причиной возникновения эндогенных угрей могут стать различные гормональные изменения, в том числе естественный «гормональный всплеск» в подростковом и юношеском возрасте. Определенную роль играет также наследственно обусловленная неадекватная реакция сальных желез на повышающийся уровень мужских половых гормонов в крови, которая может иметь место как у мужчин, так и у женщин.</p>\r\n<p>Во взрослом возрасте наиболее частой причиной эндогенных угрей является себорея. Кроме того, угревая <a href=\"/symptom/syp/\" title=\"Перейти на страницу симптома Сыпь\">сыпь</a> может возникать при различных инфекциях, а также хронических заболеваниях. Нередко сама клиническая картина угревой сыпи может подсказать наличие сопутствующего заболевания. Так, например, расположение угрей у женщин вокруг рта и на подбородке нередко указывает на патологию яичников.</p>",
"pathogenesis": "<p>Выделяют четыре основных звена патогенеза угрей:</p>\r\n<p>1. Увеличение продукции кожного сала.</p>\r\n<p>2. Избыточный фолликулярный гиперкератоз.</p>\r\n<p>3. Размножение Propionibacterium acnes (P. acnes).</p>\r\n<p>4. <a href=\"/symptom/vospalenie/\" title=\"Перейти на страницу симптома воспаление\">Воспаление</a>.</p>",
"diagnostics": "<p>Диагноз <a href=\"/symptom/ugri/\" title=\"Перейти на страницу симптома Угри\">акне</a> основывается на данных клинической картины. При проведении обследования следует учитывать системные призна- ки гиперандрогенемии (нерегулярный менструальный цикл, гипертрофия клитора и изменение вторичных половых признаков), а также позднее ме- нархе. Резистентные к терапии формы <a href=\"/symptom/ugri/\" title=\"Перейти на страницу симптома Угри\">акне</a> могут свидетельствовать о нали- чии таких эндокринных расстройств, как синдром поликистоза яичников, гиперплазия гипофиза или вирилизирующие опухоли, в связи с чем при об- следовании необходимо учитывать такие симптомы, как аменорея, гипер- менорея, олигоменорея, <a href=\"/symptom/besplodie/\" title=\"Перейти на страницу симптома Бесплодие\">бесплодие</a> и метаболический синдром. При <a href=\"/symptom/ugri/\" title=\"Перейти на страницу симптома Угри\">акне</a> среднего детского возраста показано обследование для исклю- чения врожденной гиперплазии надпочечников и андрогенпродуцирующих опухолей. Лабораторные исследования ■ определение уровня свободного тестостерона, дегидроэпиандростерона сульфата, лютеинизирующего гормона, фолликулостимулирующего гор- мона; ■ проведение теста на толерантность к глюкозе. По показаниям назначаются консультации других специалистов: эндокри- нологов или гинекологов-эндокринологов.</p>",
"treatment": "<p>При легкой степени тяжести угревой сыпи применяют препараты для наружной (местной) терапии: кремы, гели, мази, лосьоны и т.п., содержащие различные активные вещества, препятствующие образованию комедонов или разрушающие их, уменьшающие образование кожного сала и <a href=\"/symptom/vospalenie/\" title=\"Перейти на страницу симптома воспаление\">воспаление</a>. К таким средствам, в частности, относятся бензоилпероксид (OXY5, OXY10), третиноин (Айрол Рош, Ретин-А) и азелаиновая кислота (Скинорен).</p>\r\n<p>При средней и тяжелой форме лечение проводится как наружными средствами, так и приемом препаратов внутрь. В ряде случаев необходимо назначение антибиотиков (например, тетрациклинов). При гормональных нарушениях могут применяться половые гормоны.</p>\r\n<p>Для очистки кожи от угрей проводят пилинг — удаление поверхностных слоев кожи с помощью слабых растворов кислот (химический пилинг) или механической шлифовки (дермабразия). Также для борьбы с угревой сыпью применяется чистка лица, особый щипковый массаж лица, поверхностная криотерапия, и даже лазеротерапия на отдельные невоспаленные <a href=\"/symptom/ugri/\" title=\"Перейти на страницу симптома Угри\">угри</a>.</p>\r\n<p>Хирургические манипуляции имеют очень ограниченное применение при угревой болезни. Вскрытие кистозных полостей противопоказано, поскольку оно приводит к формированию стойких рубцов. Иногда при сильном нагноении угрей применяется обкалывание очагов специальными препаратами.</p>\r\n<p>Угревая <a href=\"/symptom/syp/\" title=\"Перейти на страницу симптома Сыпь\">сыпь</a> достаточно хорошо поддается лечению. В большинстве случаев удается добиться полного исчезновения воспалительных элементов и предотвратить образование новых угрей на период от года до нескольких лет (а иногда, и навсегда).</p>",
"prevention": "<p>Для профилактики угревой сыпи необходим регулярный уход за кожей. Людям, склонным к этому заболеванию, не рекомендуется использовать жирные кремы, масла и мази, содержащие ланолин и вазелин. Из косметических средств следует выбирать те, которые имеют маркировку “non-comedogenic” (не-комедогенная), то есть не содержит ингредиентов, способствующих образованию угрей.</p>",
"clinical_picture": "<p><a href=\"/symptom/ugri/\" title=\"Перейти на страницу симптома Угри\">Акне</a> локализуются преимущественно на коже лица, верхних конечно- стей, верхней части груди и спины и проявляются папулами, пустулами и уз- лами, а также открытыми и закрытыми комедонами. Комедон — клиническое проявление скопления кожного сала и кератина в волосяном фолликуле. Выделяют закрытые и открытые <a href=\"/symptom/ugri/\" title=\"Перейти на страницу симптома Угри\">комедоны</a>. Закры- тый комедон отличается от открытого тем, что кератиновые массы не так компактны, а отверстие волосяного фолликула узкое. Папулезные <a href=\"/symptom/ugri/\" title=\"Перейти на страницу симптома Угри\">акне</a> представляют собой воспалительные узелки, имеющие коническую или полушаровидную форму и величину до 2—4 мм в диаметре. Пустулезные <a href=\"/symptom/ugri/\" title=\"Перейти на страницу симптома Угри\">акне</a> могут возникать первично или трансформироваться из папулезных угрей. Узловатые <a href=\"/symptom/ugri/\" title=\"Перейти на страницу симптома Угри\">акне</a> характеризуются развитием узлов на коже себорейных об- ластей. У больных конглобатными <a href=\"/symptom/ugri/\" title=\"Перейти на страницу симптома Угри\">акне</a> помимо комедонов и папуло-пусту- лезных угрей возникают многочисленные крупные узлы, локализующиеся преимущественно на коже спины и задней поверхности шеи. Консистенция узлов вначале плотная, но постепенно они размягчаются. Кожа над ними при- обретает синюшно-розовый цвет, истончается, и в ней появляются отверстия, из которых выделяется гной. Часть отдельно расположенных узлов сливается в массивные инфильтраты с многочисленными фистулезными ходами, гной- ными отверстиями и полостями, заполненными вялыми, студнеобразными грануляциями, процесс может приобретать распространенный характер. После разрешения <a href=\"/symptom/ugri/\" title=\"Перейти на страницу симптома Угри\">акне</a> нередко остаются атрофические, реже — гипер- трофические и келоидные рубцы.</p>",
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},
"code": "L70.0",
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