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},
"code": "L70",
"name": "Угри",
"icd_name": "Угри",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
3,
0
],
"periodicity": 4,
"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>",
"image": "http://api.symptomd.ru/storage/a140fbf8973fbdc9bbd2726d8d216550_aJknTJ2.jpg",
"image_alt": "Угри",
"standard_type": 1,
"danger": 11,
"published": 1,
"parent": null,
"block_rubric": 126,
"standards": []
},
{
"id": 12135,
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5
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"description": "крайне тяжелое заболевание кожи",
"etiology": "<p>В большинстве случаев эксфолиативный дерматит Риттера обусловлен инфицированием кожи новорожденного золотистым стафилококком. Отдельные авторы указывают на выявление у заболевших детей смешанной стафилококковой и стрептококковой инфекции. Заражение новорожденного может происходить от матери или медицинского персонала. Развитию заболевания способствуют незрелость барьерной функций кожи и иммунных механизмов у детей первого месяца жизни. В дерматологии случаи эксфолиативного дерматита Риттера встречались и у детей более старшего возраста, получающих иммуносупрессивную терапию.</p>",
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"diagnostics": "<p>При подозрении на эксфолиативный дерматит Риттера необходимо обратиться к инфекционисту и дерматологу. Диагноз ставится на основании клинической картины и наличия симптома Никольского. Обязательно делают бактериологический посев отделяемого из пузырей и эрозий. Кроме того, проводят анализ на сифилис.</p>\r\n<p>Заболевание дифференцируют с ожогами, пузырчаткой, буллезным эпидермолизом, врожденной ихтиозиформной эритродермией и десквамативной эритродермией Лейнера, врожденным сифилисом.</p>",
"treatment": "<p>Лечат эксфолиативный дерматит антибиотиками, которые принимают внутрь и наружно в виде мази. Для снятия воспаления назначают мази и кремы с кортикостероидами. Обязательно назначают витамины С и группы В.</p>\r\n<p>В случае сепсиса внутривенно вводят плазму и свежую кровь. Ребенку также показано обильное питье, чтобы предотвратить обезвоживание.</p>\r\n<p>Ребенка, страдающего эксфолиативным дерматитом, не одевают, так как одежда может причинить ему боль и неудобства. Его не туго заворачивают в стерильные мягкие пеленки, посыпанные тальком или оксидом цинка с добавлением сульфаниламидов или антибиотиков. Но лучше помещать таких детей в кювезы, в которых можно поддерживать оптимальную температуру и влажность.</p>",
"prevention": "<p>Профилактика эксфолиативного дерматита Риттера заключается в регулярном осмотре персонала родильных домов и рожениц на предмет бактерионосительства золотистого стафилококка. Палаты в роддомах и родильных отделениях больниц необходимо регулярно кварцевать. Нельзя пренебрегать и влажной уборкой в этих помещениях. Врачи и медсестры при контакте с новорожденными должны надевать марлевые повязки.</p>\r\n<p>Важно соблюдать гигиену и в местах, где бывает новорожденный ребенок после выписки из роддома.</p>",
"clinical_picture": "<p>Эксфолиативный дерматит Риттера развивается в первые недели жизни ребенка. Сначала возле рта появляется <a href=\"/symptom/pokrasnenie_kozhi/\" title=\"Перейти на страницу симптома Покраснение кожи\">покраснение</a>. Место покраснения отекает и воспаляется. Через некоторое время <a href=\"/symptom/vospalenie/\" title=\"Перейти на страницу симптома воспаление\">воспаление</a> переходит на складки шеи, в область пупка, гениталий и ануса. На месте покраснения образуются большие пузыри, которые довольно скоро вскрываются с образованием мокнущих эрозий. Для этой стадии характерен симптом Никольского – при оттягивании эпидермиса вокруг <a href=\"/symptom/izmeneniya_struktury_kozhi/\" title=\"Перейти на страницу симптома Изменения структуры кожи\">эрозии</a> пинцетом, он легко отслаивается даже там, где кожа здоровая. Более того, даже при потирании здоровой кожи могут обнажаться ее более глубокие слои.</p>\r\n<p>Кроме кожных проявлений у ребенка повышается температура, возможны <a href=\"/symptom/toshnota/\" title=\"Перейти на страницу симптома Тошнота\">тошнота</a>, <a href=\"/symptom/rvota/\" title=\"Перейти на страницу симптома Рвота\">рвота</a>, <a href=\"/symptom/diareya/\" title=\"Перейти на страницу симптома Диарея\">понос</a>. Ребенок отказывается от еды и теряет вес.</p>\r\n<p>В некоторых случаях патологический процесс распространяется по всему телу ребенка за 2-3 дня.</p>",
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},
"code": "L26",
"name": "Эксфолиативный дерматит",
"icd_name": "Эксфолиативный дерматит",
"gender": 0,
"age_min": 0,
"age_max": 1,
"cause": [
5
],
"periodicity": 1,
"slug": "l26_eksfoliativnyy_dermatit",
"lead": "тяжелое инфекционное поражение кожи новорожденных, представляющее собой злокачественный вариант пузырчатки. ",
"description": "крайне тяжелое заболевание кожи",
"etiology": "<p>В большинстве случаев эксфолиативный дерматит Риттера обусловлен инфицированием кожи новорожденного золотистым стафилококком. Отдельные авторы указывают на выявление у заболевших детей смешанной стафилококковой и стрептококковой инфекции. Заражение новорожденного может происходить от матери или медицинского персонала. Развитию заболевания способствуют незрелость барьерной функций кожи и иммунных механизмов у детей первого месяца жизни. В дерматологии случаи эксфолиативного дерматита Риттера встречались и у детей более старшего возраста, получающих иммуносупрессивную терапию.</p>",
"pathogenesis": "",
"diagnostics": "<p>При подозрении на эксфолиативный дерматит Риттера необходимо обратиться к инфекционисту и дерматологу. Диагноз ставится на основании клинической картины и наличия симптома Никольского. Обязательно делают бактериологический посев отделяемого из пузырей и эрозий. Кроме того, проводят анализ на сифилис.</p>\r\n<p>Заболевание дифференцируют с ожогами, пузырчаткой, буллезным эпидермолизом, врожденной ихтиозиформной эритродермией и десквамативной эритродермией Лейнера, врожденным сифилисом.</p>",
"treatment": "<p>Лечат эксфолиативный дерматит антибиотиками, которые принимают внутрь и наружно в виде мази. Для снятия воспаления назначают мази и кремы с кортикостероидами. Обязательно назначают витамины С и группы В.</p>\r\n<p>В случае сепсиса внутривенно вводят плазму и свежую кровь. Ребенку также показано обильное питье, чтобы предотвратить обезвоживание.</p>\r\n<p>Ребенка, страдающего эксфолиативным дерматитом, не одевают, так как одежда может причинить ему боль и неудобства. Его не туго заворачивают в стерильные мягкие пеленки, посыпанные тальком или оксидом цинка с добавлением сульфаниламидов или антибиотиков. Но лучше помещать таких детей в кювезы, в которых можно поддерживать оптимальную температуру и влажность.</p>",
"prevention": "<p>Профилактика эксфолиативного дерматита Риттера заключается в регулярном осмотре персонала родильных домов и рожениц на предмет бактерионосительства золотистого стафилококка. Палаты в роддомах и родильных отделениях больниц необходимо регулярно кварцевать. Нельзя пренебрегать и влажной уборкой в этих помещениях. Врачи и медсестры при контакте с новорожденными должны надевать марлевые повязки.</p>\r\n<p>Важно соблюдать гигиену и в местах, где бывает новорожденный ребенок после выписки из роддома.</p>",
"clinical_picture": "<p>Эксфолиативный дерматит Риттера развивается в первые недели жизни ребенка. Сначала возле рта появляется <a href=\"/symptom/pokrasnenie_kozhi/\" title=\"Перейти на страницу симптома Покраснение кожи\">покраснение</a>. Место покраснения отекает и воспаляется. Через некоторое время <a href=\"/symptom/vospalenie/\" title=\"Перейти на страницу симптома воспаление\">воспаление</a> переходит на складки шеи, в область пупка, гениталий и ануса. На месте покраснения образуются большие пузыри, которые довольно скоро вскрываются с образованием мокнущих эрозий. Для этой стадии характерен симптом Никольского – при оттягивании эпидермиса вокруг <a href=\"/symptom/izmeneniya_struktury_kozhi/\" title=\"Перейти на страницу симптома Изменения структуры кожи\">эрозии</a> пинцетом, он легко отслаивается даже там, где кожа здоровая. Более того, даже при потирании здоровой кожи могут обнажаться ее более глубокие слои.</p>\r\n<p>Кроме кожных проявлений у ребенка повышается температура, возможны <a href=\"/symptom/toshnota/\" title=\"Перейти на страницу симптома Тошнота\">тошнота</a>, <a href=\"/symptom/rvota/\" title=\"Перейти на страницу симптома Рвота\">рвота</a>, <a href=\"/symptom/diareya/\" title=\"Перейти на страницу симптома Диарея\">понос</a>. Ребенок отказывается от еды и теряет вес.</p>\r\n<p>В некоторых случаях патологический процесс распространяется по всему телу ребенка за 2-3 дня.</p>",
"image": "http://api.symptomd.ru/storage/33432e0798067ca37b84009a81e093e4_NTYt5Eb.jpg",
"image_alt": "Эксфолиативный дерматит",
"standard_type": 1,
"danger": 51,
"published": 1,
"parent": null,
"block_rubric": 122,
"standards": [
4809,
5323
]
}
]
}
