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"lead": "это болезненные и легко повреждаемые участки кожи, возникающие при трении. ",
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"etiology": "<p>- длительное трение кожи о грубую поверхность;<br />- влажность усугубляет эффект трения.</p>",
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"diagnostics": "<p>Визуальный осмотр.</p>",
"treatment": "<p>Лечение мокрых и сухих мозолей несколько отличается, но в обоих случаях начинать его нужно с устранения причинного фактора: необходимо перестать носить неудобную обувь, при необходимости приобрести носки без швов, вышивок и прочих декоративных элементов, которые могут натирать или сдавливать кожу. Несмотря на то что мокрая мозоль образуется намного быстрее сухой и доставляет человеку больший дискомфорт, вылечить ее легче. Мокрые мозоли не следует самостоятельно вскрывать и, тем более, срезать кожу над раневой поверхностью (такие действия могут привести к попаданию в рану инфекции). Сам пузырь и кожу вокруг него нужно обработать спиртом, раствором фурацилина или перекисью водорода, желательно не наклеивать на мозоль лейкопластырь (но если нет возможности сменить натирающую обувь, то, конечно, лучше использовать пластырь, чтобы не травмировать мозоль еще больше). Обрабатывать мозоль нужно несколько раз в день, и конечно же, следует исключить ее дальнейшее травмирование. Даже после самостоятельного вскрытия мозоли нельзя удалять кожу, которая образовывала пузырь. Поврежденное место на коже можно несколько раз в день смазывать салициловой мазью, которая поможет подсушить мозоль и предотвратить попадание инфекции в ранку.<br /><br /><br /></p>",
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},
"code": "L83",
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"lead": "редкий дерматоз, характеризующийся огрубением кожи и появлением на ее поверхности бородавчатый разрастаний черно-бурого цвета. \r\n",
"description": "",
"etiology": "<p>Причины возникновения данной патологии до конца не выявлены. Многие специалисты считают, что заболевание вызывает генетическая предрасположенность наследственного характера. Однако точно была установлена взаимосвязь черного акантоза со злокачественными заболеваниями внутренних органов. Согласно многочисленным исследованиям злокачественное заболевание внутренних органов было выявлено у пациентов в 50-100% с черным акантозом. Ученые это связывают как с многочисленными биохимическими реакциями, происходящими в организме, так и с дисфункцией в работе иммунной системы. Причем развитие ракового заболевания отличается по половому признаку у мужчин и женщин. Так, например, у мужчин чаще развивается рак простаты, рак желудка и поджелудочной железы, а у женщин рак яичников и молочных желез. С равной частотой как у мужчин, так и у женщин развивается рак легких. Черный акантоз, сопутствующий раковому заболеванию называют злокачественным акантозом.<br /><br /><br /></p>",
"pathogenesis": "",
"diagnostics": "<p>Окончательный диагноз устанавливается после проведения гистологического исследования биоптата. Образец тканей при черном акантозе содержит большое скопление кератозных клеток и повышенное скопление пигмента. В случае подозрения на злокачественную форму акантоза необходимо провести исследование внутренних органов на предмет обнаружения раковой опухоли. Пациента направляют на ультразвуковое исследование (УЗИ), магнитно-резонансную томографию (МРТ), компьютерную томографию (КТ) и на обследование крови (онкомаркеры). Если была выявлена доброкачественная форма или псевдоакантоз, то больного направляют на консультацию к эндокринологу, который назначит комплексное исследование, направленное на выявление нарушений в работе гормональной или эндокринной системы.<br /><br /><br /></p>",
"treatment": "<p>Больным назначается реаферон внутримышечно, амиксин, неовир. Показано использование средств общеукрепляющего действия – аскорбиновая кислота, ретинол, препарата железа, витамина группа B. Используется и местное лечение. Больным назначают применение антисептических, противовоспалительных мазей и присыпок. Полезны общие ванны с добавлением KMnO4. Обязательно нужно проводить лечение основной патологии. В зависимости от выявленных патологий больным назначается гормонозаместительная терапия – прием инсулина, эстрогенов, кортикостероидов. Кстати, инсулин обязательно нужно принимать тем, кто более сахарным диабетом. По показаниям может быть назначен прием антибактериальных средств, нейротропных препаратов. При наличии обширных разрастаний на коже используется разрушающая терапия. Образования удаляют методом криодеструкции (действием жидкого азота), электрокоагуляции. В том случае, если основной причиной развития акантоза стал прием лекарств, необходимо отменить их прием, подобрав более безопасные аналоги. Больным с ожирением рекомендуют соблюдение диеты.<br /><br /></p>",
"prevention": "<p>Профилактика развития заболевания заключается в регулярном прохождении медосмотров. Необходимо следить за массой своего тела, регулярно контролировать уровень глюкозы в крови. При необходимости лечения гормональными препаратами не превышать длительность курса и рекомендованные дозы.<br /><br /></p>",
"clinical_picture": "<p>Основными симптомами данного заболевания является кератоз (<a href=\"/symptom/mozoli_i_omozolelosti/\" title=\"Перейти на страницу симптома Мозоли и омозолелости\">утолщение кожи</a>), гиперпигментация и сосочковые разрастания на пораженных участках. Пораженные участки локализуются симметрично, чаще всего в паховых и в подмышечных складках, в местах локтевых и коленных сгибаний, в межъягодичной области, в области задней части шеи и под молочными железами. Очень редко заболевание развивается на слизистых оболочках рта и в области половых органов. Заболевание начинается внезапно с появлением желтых пятен, которые впоследствии приобретают очень темный, почти черный цвет. На пораженных участках кожа утолщается, становится сухой и шершавой, с плотными рядами сосочковых разрастаний, что придает ей бугристо — бородавчатый вид. Сосочковые разрастания внешне напоминают остроконечные кондиломы.</p>\r\n<p>Рост папилломотозных высыпаний также развивается на слизистых оболочках рта, но в этом случае не наблюдается пигментная дистрофия слизистых оболочек. При поражении языка, он приобретает шершаво — морщинистую поверхность. Порой черные пятна выглядят весьма неприглядно, так как возникает ощущение грязного, немытого тела, что в свою очередь может вызвать у больного дискомфорт психологического характера.</p>\r\n<p>Обычно при черном акантозе не существует субъективных ощущений: больные не жалуются на боль, <a href=\"/symptom/zud/\" title=\"Перейти на страницу симптома Зуд\">зуд</a> или раздражение кожи. Очень редко у некоторых больных возникает легкий <a href=\"/symptom/zud/\" title=\"Перейти на страницу симптома Зуд\">зуд</a> и ощущение покалывания на пораженных участках. Степень проявления симптомов зависит от формы заболевания. <br /><br /><br /></p>",
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"code": "L82",
"name": "Себорейный кератоз",
"icd_name": "Себорейный кератоз",
"gender": 0,
"age_min": 50,
"age_max": 100,
"cause": [
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],
"periodicity": 1,
"slug": "l82_seboreynyy_keratoz",
"lead": "дерматологическое заболевание, при котором из клеток внешнего слоя эпидермиса образуются очаговые доброкачественные опухоли",
"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;\">Факторы, обуславливающие развитие гиперкератоза, делятся на внешние и внутренние. </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;\">К внешним факторам, провоцирующим гиперкератоз, относятся хронические воспалительные процессы на коже, инфекции, ультрафиолетовое излучение, воздействие агрессивных химических веществ, а также сильное давление, например, тесная обувь, тугая шапка, заколки, ободки, неправильный уход за кожей и неправильно подобранная косметика, которая вызывает сухость кожи, а также недостаток витаминов А, С, D и др.</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;\">Если патология сформировалась без предварительного раздражения или травмирования, то вероятно, гиперкератоз кожи вызван внутренними факторами. В этом случае это могут быть наследственные заболевания, сухость кожи из-за нарушения обмена веществ, болезни печени, желчного пузыря, щитовидной железы, сахарный диабет, врожденные патологии. Кроме того, проявления гиперкератоза возникают и сопровождают некоторые хронические заболевания кожи – экзему, псориаз, красный плоский лишай, себорею, эритродермию, кератодермию.</span></p>",
"pathogenesis": "<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;\">Кератома почти всегда возникает незаметно для самого больного. Вначале она выглядит как маленькое пятнышко желтого или светло-коричневого цвета, напоминающее родинку. Если новообразование расположено в кожных складках (между пальцами, в подколенной или паховой области), его могут долгое время вообще не замечать. Постепенно опухоль начинает увеличиваться в размере. Ее поверхность темнеет, становится бугристой. При отсутствии лечения кератома уплотняется и довольно сильно выступает над уровнем окружающей кожи. На ней образуются твердые корки, разделенные трещинками. Эти корочки легко удалить, но делать этого ни в коем случае нельзя.</span></p>",
"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;\">Диагностика заболевания начинается с визуального осмотра. Сначала врач спрашивает, как давно появились новообразования, как они менялись со временем. Затем изучает локализацию, многочисленность и структуру кератом.</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;\">После визуального осмотра применяется дерматоскопия. Она обеспечивает 100% достоверность определения себорейного кератоза. Процедура проводится с помощью дерматоскопа. Этот аппарат снабжен трубкой, на конце которой расположена сверхмощная лупа. Она способна увеличивать исследуемый материал в 20 раз.</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;\">Дерматоскоп позволяет рассмотреть микроструктуры опухоли и определить, злокачественная она или доброкачественная. Полученное с помощью лупы изображение выводится на монитор. Врач также делает снимок микроструктуры кератомы для наблюдения в динамике.</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;\">Целью медикаментозного лечения является сокращение количества кератозных элементов до использования радикальных методов удаления. Терапевтические средства облегчают течение кератоза, уменьшают симптомы, но не вылечивают полностью. Чтобы смягчить кератонические участки, применяют аппликации препаратов с разным содержанием мочевины (12-30%).</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 кератоза волосистой части головы разработаны специальные шампуни. Агрессивные моющие средства для нее не подойдут. Для приема внутрь назначаются ретиноиды, способствующие замедлению роста образований, витамины А, В, С. Дополнительно проводятся курсы физиотерапии.</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;\">Поскольку консервативная терапия не дает гарантии излечения от кератоза, во многих случаях приходится прибегать к кардинальным мерам – удалению образований. Особенно, если существует риск перерождения в рак.</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;\">Для этого может быть использована:</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;\">криодеструкция – замораживание жидким азотом;</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;\">радиоволновое удаление – иссечение образования с помощью радионожа под воздействием радиоволн;</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;\">электрокоагуляция - прижигание электрическим током высокой частоты;</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;\">лазерная деструкция – использование точечного воздействия на кератому углекислого лазера;</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;\">фотодинамическая терапия – нанесение метил аминолевулината на пораженный участок с последующим воздействием на него световой волны заданной длины, приводящего к некрозу тканей;</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;\">хирургическое удаление – зачистка поверхности кожи кюреткой (специальный хирургический инструмент);</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;\">дермабразия – удаление с использованием абразивной щетки.</span></li>\r\n</ul>\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;\">Чтобы улучшить состояние кожи при кератозе, необходимо придерживаться диеты. Употребляемые продукты обязательно должны содержать витамины А, Е, В, аскорбиновую кислоту: зелень, овощи, крупы, жирная рыба.</span></p>",
"prevention": "<p><span id=\"docs-internal-guid-260ae8c6-7fff-13c0-53fa-3255b7f5216b\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">В качестве профилактики развития себорейного кератоза следует избегать длительного пребывания на солнце.</span></span></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;\">Основным проявлением себорейного кератоза является наличие на коже новообразования, похожего на выпуклую бородавку с неровными краями. Цвет варьируется от светло-желтого до черного. Бывают равномерно и неравномерно окрашенные опухоли с гладкой или шероховатой поверхностью. Запущенные кератомы образуют твердые структуры, испещренные трещинами.</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;\">Себорейный кератоз обычно проявляется на лице, шее, плечах, спине. Встречаются и другие места локализации опухоли. Не возникают кератопапилломы только на подошвах и ладонях. Пациентам внушают тревогу множественные очаговые высыпания на больших участках тела (например, на спине).</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;\">Выделяют несколько видов заболевания:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Обычный кератоз. При нем на теле образуются небольшие тусклые пятна с относительно ровной и гладкой поверхностью.</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Сетчатый. Образования на коже имеют неровную, бугристую поверхность. При гистологическом исследовании образцов обнаруживаются кератиновые кисты.</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Бородавчатый себорейный кератоз. Встречается чаще всего. Опухоли обычно локализуются на бедрах, голенях, стопах. В диаметре они достигают нескольких миллиметров. Довольно заметно выступают над поверхностью кожи (напоминают настоящие бородавки). Бывают окрашены в кремовый или светло-коричневый цвет.</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Меланоакантома. Опухоль с большим содержанием меланина, коричневого кожного пигмента. При визуальном осмотре у врача ее часто путают со злокачественным образованием (меланомой). Различия между ними становятся явными только после проведения дерматоскопического исследования.</span></li>\r\n</ul>",
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