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"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>",
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"lead": "поражения кожи, возникающие как реакция на прием внутрь, вдыхание или парентеральное введение веществ, являющихся аллергенами и одновременно обладающих токсическим действием (химические агенты, некоторые лекарства и пищевые продукты).",
"description": "В отличие от обычного течения аллергического дерматита, причинный фактор заболевания токсикодермии не нуждается в контакте с кожным покровом больного. Попадая в человеческий организм, аллерген различными путями, всасывается через кровь и далее по кровеносным сосудам попадает в кожный покров. При токсикодермии влияние аллергена на кожный покров происходит «изнутри» организма. ",
"etiology": "<p align=\"justify\">Химическое вещество, являющееся причинным фактором развития токсикодермии, может попасть в организм различными путями: при вдыхании (ингаляционно), с пищей (алиментарно), путем лекарственных инъекций или при всасывании после нанесения на кожу.</p>\r\n<p align=\"justify\">По причине возникновения современная дерматология выделяет 4 этиологические группы токсикодермий: медикаментозные, алиментарные, профессиональные и аутотоксические.</p>\r\n<full></full>\r\n<p align=\"justify\">Медикаментозная токсикодермия развивается в результате приема лекарственных препаратов и встречается в подавляющем большинстве случаев. Она может быть вызвана сульфаниламидами (сульфадимезин, норсульфазол), антибиотиками (биомицин, пенициллин, неомицин, стрептомицин), барбитуратами, витаминами группы В, сыворотками и др.</p>\r\n<p align=\"justify\">Алиментарная токсикодермия бывает связана как с употреблением самого пищевого продукта, так и с различными добавками, входящими в его состав (красители, разрыхлители, консерванты). По распространенности она стоит на втором месте после медикаментозной токсикодермии.</p>\r\n<p align=\"justify\">Профессиональная токсикодермия обусловлена деятельностью, связанной с различными химическими соединениями. Наиболее активными антигенами являются вещества, содержащие бензольное кольцо с аминогруппой или хлором.</p>\r\n<p align=\"justify\">Аутотоксическая токсикодермия возникает при воздействии аллергенов и токсинов, образующихся в организме в результате нарушения обмена веществ. Это может наблюдаться при хронических заболеваниях ЖКТ (гастрит, язва желудка, гепатит, панкреатит, язвенная болезнь) и почек (пиелонефрит, гломерулонефрит, гидронефроз, хроническая почечная недостаточность), злокачественных процессах (рак легких, аденокарцинома почки, рак толстого кишечника) и т. п. Аутотоксическая токсикодермия может принимать хроническое течение.</p>",
"pathogenesis": "<p>Гиперергическая реакция замедленного или немедленного типа, их комбинация часто в сочетании с токсикозом.<br /><br /></p>",
"diagnostics": "<p>Основой для постановки точного диагноза токсикодермия служит характерная клиническая картина.</p>",
"treatment": "<p>Первым делом в лечении токсикодермии предупреждают дальнейшее воздействия аллергена на организм. С данной целью назначают прием слабительных и мочегонных средств, делают очистительные клизмы, вводят внутривенно десенсибилизирующие растворы тиосульфата натрия и хлорида кальция, больному дают антигистаминные препараты. При токсикодермиях, что вызваны применением сульфаниламидных препаратов, введение больным тиосульфата натрия категорически противопоказано. Людям с тяжелой формой заболевания назначают экстракорпоральные методы очищения крови, среди них — гемосорбция, каскадная фильтрация плазмы, мембранный плазмофорез, криоаферез. Их лечение можно проводить исключительно в стационаре, оно заключается в назначении доктором глюкокортикостероидов, внутривенных вливаний гемодеза реополиглюкина, плазмы или же альбумина крови, проведении профилактической антибиотикотерапии, а также в поддержании удовлетворительной работы печени и почек.</p>\r\n<p>Терапия местного характера зависит напрямую от морфологических особенностей очагов, пораженных токсикодермией участков кожи. Применяют различные пудры, глюкокортикостероидные мази, противовоспалительные средства, а также противозудные препараты местного применения. Очаги мокнутия пациенту обрабатывают анилиновыми красителями, дезинфицирующими и вяжущими средствами.</p>",
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"etiology": "<p>Основным патогенетическим фактором является повышенная чувствительность кожи к раздражителям, по-видимому, за счет разрастания нервных окончаний, и предрасположенность к гиперплазии эпидермиса в ответ на механическую травму. В возникновении заболевания важную роль играют функциональные нарушения нервной и эндокринной систем, аллергическое состояние организма, заболевания желудочно-кишечного тракта. Указывают также на наследственную предрасположенность.</p>",
"pathogenesis": "<p>Патофизиологические процессы, лежащие в основе расстройства, неизвестны, однако могут включать нарушение восприятия и обработки нервной системой ощущения зуда. Кожа, склонная к развитию экзематозных заболеваний (например, атопического дерматита), более склонна к лихенификации.</p>",
"diagnostics": "<p>Диагноз устанавливается при осмотре. Полностью сформировавшаяся бляшка имеет внешнюю зону, состоящую из дискретных коричневатых папул, и центральной зоны, представленной сливающимися папулами, покрытыми чешуйками. К клинически похожим состояниям относятся микоз гладкой кожи, красный плоский лишай и псориаз; простой хронический лишай можно отличить от этих состояний при помощи микроскопического исследования соскоба во влажном препарате с гидроксидом калия и биопсии.</p>",
"treatment": "<p style=\"display: inline !important;\"> </p>\r\n<p>Первичная терапия пациента заключается в его обучении и разъяснении эффектов расчесывания и трения. Вторичное лечение состоит в применении глюкокортикостероидных препаратов (например, триамцинолона ацетонида, флуоцинонида); хирургической пленки, пропитанной флурандренолидом (накладывается утром и меняется на новую пленку вечером, может оказаться более предпочтительной, поскольку окклюзия предотвращает расчесывание). Маленькие зоны поражения можно обколоть (внутриочаговые инъекции) длительно действующим глюкокортикостероидным препаратом, например триамценолона ацетонидом 2,5 мг/мл (разведенным в физиологическом растворе) в дозе 0,3 мл/см2 площади очага поражения; лечение можно повторять каждую 3–4-ю неделю. Пероральный прием антигистаминных препаратов, блокирующих H1-рецепторы, может оказать положительный эффект. Мази также могут быть действенными. Крем с капсаицином местного применения может быть также полезным, но жжение в начале может сделать эту терапию неприемлемой для пациентов.<br /> <br /> Ключевые моменты</p>\r\n<ul>\r\n<li>Хроническое шелушение приводит к дальнейшему зуду, создавая порочный круг.</li>\r\n<li>Зуд, сухость, шелушение, гиперпигментированность, лихениеновые бляшки возникают неправильной овальной или угловой формы на ногах, руках, шее и верхней части туловища, а иногда в аногенитальной области.</li>\r\n<li>Диагноз устанавливается на основе результатов клинических исследований, но исследование влажного препарата с гидроксидом калия и биопсия могут помочь в дифференциальной диагностике.</li>\r\n<li>Пациенты должны быть осведомлены о замкнутом круге, который начинается с царапин и продолжается зудом; кортикостероиды местного применения и антигистаминные препараты помогают контролировать зуд.</li>\r\n</ul>",
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"clinical_picture": "<p align=\"justify\">Заболевание начинается с зуда кожи. Симптомы простого хронического лишая локализуются преимущественно на задней и боковой поверхностях шеи, в подколенных и локтевых сгибах, аногенитальной области, на внутренней поверхности бедер, в межъягодичных складках. Но очаги могут появляться и на других участках кожного покрова, в том числе на волосистой части головы. В начале кожа в местах зуда внешне не изменена. Со временем под влиянием расчесов появляются полигональные папулы плотной консистенции, местами покрытые муковидными чешуйками. Папулы сливаются и образуют бляшки овальной или округлой формы, которые имеют цвет от розового до буровато-красного. Кожа утолщается, становится грубой, выражен кожный рисунок (лихенификация). На высоте развития заболевания в очаге различают три зоны. Периферическая, или наружная, зона пигментации окружает очаг поражения в виде пояса и обычно пи наружная, ни внутренняя границы неясны. Средняя, папулезная, зона состоит из узелковых высыпаний бледно-розового, сероватого или желтоватого цвета, величиной от булавочной головки до небольшой чечевицы. Папулы неправильной формы и нерезко ограничены, почти не возвышаются над окружающей кожей. Их поверхность утолщена, гладкая и в результате расчесов часто покрыта кровянистой корочкой. Внутренняя зона характеризуется выраженной инфильтрацией кожи. Нередко эта зона является единственным проявлением в клинической картине болезни.</p>\r\n<p align=\"justify\">В практике дерматовенеролога часто встречаются следующие атипичные и редкие разновидности ограниченного нейродермита:</p>\r\n<p align=\"justify\">Депигментированный нейродермит. При длительном течении ограниченного нейродермита возникают вторичные гипопигментации (витилигоподобные изменения). Считают, что они появляются в результате расчесов. При этом часто создается впечатление, что имеется сочетание двух процессов - нейродермита и витилиго.</p>\r\n<p>Гипертрофический (бородавчатый) нейродермит. При данной форме на фоне типичной клинической картины ограниченного нейродермита имеются отдельные узелковые и даже узловатые высыпания, весьма сходные с таковыми при узловатой почесухе. Такие очаги возникают преимущественно на внутренних поверхностях бедер, по могут локализоваться и па любых других участках.</p>\r\n<p align=\"justify\">В результате сильного зуда кожи головы выпадают волосы, кожа истончается, блестит, но не атрофична, процесс не связан с фолликулярным аппаратом. Такая форма заболевания получила название декальвирующий нейродермит.</p>",
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},
"code": "L29",
"name": "Зуд",
"icd_name": "Зуд",
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3
],
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"slug": "l29_zud",
"lead": " ощущение, характеризующееся нестерпимым желанием расчесывать участки кожи.",
"description": "",
"etiology": "<p>В большинстве случаев кожный <a href=\"/symptom/zud/\" title=\"Перейти на страницу симптома Зуд\">зуд</a> имеет нервно-аллергическую природу. Различают также два вида зуда:</p>\r\n<p>· физиологический, возникающий при укусах и ползании по коже насекомых;</p>\r\n<p>· патологический может быть симптомом различных кожных болезней (экзема, <a href=\"/symptom/shelushenie_kozhi/\" title=\"Перейти на страницу симптома <a href=\"/symptom/shelushenie_kozhi/\" title=\"Перейти на страницу симптома Шелушение кожи\">Шелушение</a> кожи\">псориаз</a>, <a href=\"/symptom/zud/\" title=\"Перейти на страницу симптома Зуд\">чесотка</a>), следствием тяжелых общих заболеваний и других состояний (беременность, <a href=\"/symptom/nervoznost/\" title=\"Перейти на страницу симптома Нервозность\">невроз</a>).</p>",
"pathogenesis": "",
"diagnostics": "",
"treatment": "<p>Общие рекомендация для пациентов с кожным зудом включают диету с исключением острой, соленой пищи, кофе и алкоголя, избегание перегревания и контакта с горячей водой, раздражающими тканями и химическими веществами (стиральные порошки, чистящие средства и др.), а также щелочными мылами, усиливающими <a href=\"/symptom/izmeneniya_struktury_kozhi/\" title=\"Перейти на страницу симптома Изменения структуры кожи\">сухость кожи</a>. Регулярно (до нескольких раз в день) рекомендуется наносить на зудящие участки увлажняющие (на основе вазелина или глицерина) и охлаждающие средства (например, крем с ментолом). При воспалительных процессах кожи применяют местные стероиды, а также новейшие негормональные средства – ингибиторы кальциневрина (такролимус и пимекролимус), которые обладают выраженным противовоспалительным и противозудным эффектом и, в отличие от гормональных средств, не вызывают таких нежелательных побочных эффектов, как, например, атрофия (истончение) кожи.</p>",
"prevention": "",
"clinical_picture": "<p>На основании современных представлений о механизмах возникновении зуда выделяют 4 его типа:</p>\r\n<ul>\r\n<li>\r\n<p>Пруритоцептивный <a href=\"/symptom/zud/\" title=\"Перейти на страницу симптома Зуд\">зуд</a> возникает при воспалении, повреждении или сухости кожи (<a href=\"/symptom/zud/\" title=\"Перейти на страницу симптома Зуд\">зуд</a> при чесотке, крапивнице, укусе насекомого).</p>\r\n</li>\r\n<li>\r\n<p>Невропатический <a href=\"/symptom/zud/\" title=\"Перейти на страницу симптома Зуд\">зуд</a> наблюдается при повреждении нервной системы и часто сочетается с расстройствами чувствительности (например, при опухолях головного мозга).</p>\r\n</li>\r\n<li>\r\n<p>Нейрогенным называют <a href=\"/symptom/zud/\" title=\"Перейти на страницу симптома Зуд\">зуд</a>, возникающий без признаков повреждения структур нервной системы (например, <a href=\"/symptom/zud/\" title=\"Перейти на страницу симптома Зуд\">зуд</a> при застое желчи).</p>\r\n</li>\r\n<li>\r\n<p>Особой формой является психогенный <a href=\"/symptom/zud/\" title=\"Перейти на страницу симптома Зуд\">зуд</a> - тяжелый, длительный, не сопровождающийся какими-либо кожными заболеваниями. Основой такого состояния является, как правило, подавленное эмоциональное состояние.</p>\r\n</li>\r\n</ul>",
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"parent": null,
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},
{
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