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"code": "L55",
"name": "Солнечный ожог",
"icd_name": "Солнечный ожог",
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"lead": "острое воспаление кожи, вызванное воздействием естественного (солнечного) или искусственного ультрафиолетового излучения.",
"description": "Избыточное облучение солнечными лучами может привести к повреждению кожи: вызвать покраснение, раздражение, сухость, зуд, и другие симптомы солнечного ожога.",
"etiology": "<p>Наиболее сильными биологическими свойствами в солнечном спектре обладают ультрафиолетовые лучи. Ультрафиолетовое излучение, достигающее поверхности земли, делят на два основных диапазона: УФ-В, вызывающее солнечный ожог (коротковолновая область, длина волны 290-320 нм), и УФ-А (длинноволновая область, длина волны 320- 400 нм). Солнечные ожоги вызывает именно «жесткое» коротковолновое излучение УФ-В (UVB). Оно поражает верхние слои кожи. Однако следует помнить, что \"длинноволновое\" излучение, глубоко проникающее в кожу, также может вызвать неблагоприятные последствия - они разрушают коллаген (эластичные волокна, которые придают коже упругость), приводят к изменениям толщины и текстуры кожи. Поэтому действие прямых солнечных лучей, особенно в южных широтах, - это фактор риска, и может привести не толко к солнечным ожогам, но и к другим повреждениям кожи.</p>",
"pathogenesis": "",
"diagnostics": "<p>Диагноз можно поставить врач при осмотре и сборе анамнеза.</p>",
"treatment": "<p>При подозрении на солнечный удар следует незамедлительно обращаться за медицинской помощью. В ожидании врача пострадавшему нельзя давать пить холодную воду (от этого усиливается <a href=\"/symptom/oznob/\" title=\"Перейти на страницу симптома Озноб\">озноб</a>), компрессы также должны быть пропитаны не холодной, а прохладной водой.</p>\r\n<p>При симптомах средней тяжести пострадавший должен пить как можно больше, чтобы предотвратить обезвоживание. Кроме того, необходимо:</p>\r\n<full></full>\r\n<ul>\r\n<li>Сделать прохладные компрессы (можно смочить одежду), чтобы снизить температуру тела и уменьшить болевые ощущения</li>\r\n<li>Принять прохладную ванну без мыла (оно еще сильнее раздражает обожженную кожу). Кожу после ванны ни в коем случае нельзя вытирать, достаточно просто слегка промокнуть ее</li>\r\n<li>Нанести увлажняющий или смягчающий лосьон или крем. В данном случае необходимо предварительно посоветоваться с врачом, поскольку некоторые косметические средства содержат бензокаин, который может вызвать аллергическую реакцию, а ряд мазей замедляет заживление кожи, перекрывая доступ к ней кислорода</li>\r\n<li>При наличии волдырей следует сделать повязку на пораженный участок, чтобы предотвратить проникновение инфекции</li>\r\n<li>При сильном дискомфорте можно принять обезболивающие препараты.</li>\r\n</ul>\r\n<p>Лечение солнечного ожога</p>\r\n<p>В настоящее время лечение солнечных ожогов направлено, главным образом, на уменьшение симптомов. В основном это пероральное или местное применение нестероидных противовоспалительных препаратов, которые способствуют уменьшению не только воспалительного процесса, но и болевых ощущений.</p>\r\n<p>Использование в данном случае стероидных препаратов, таких как, например, преднизон, нецелесообразно, поскольку препарат не способствует скорейшему заживлению и, к тому же, имеет ряд побочных эффектов.<br />Крем с алоэ вера хотя и не заживляет непосредственно сам ожог, облегчает некоторые симптомы. <br />Что касается местных анестетиков (бензокаин), то они способствуют облегчению симптомов, но их эффективность при лечении солнечных ожогов недостаточно подтверждена результатами клинических испытаний.</p>",
"prevention": "<ul>\r\n<li>Ограничьте время пребывания на солнце и избегайте солнечных ванн с 10.00 до 15.00 часов.</li>\r\n<li>Носите защитную одежду: широкополые шляпы, брюки, рубашки с длинным рукавом (темные плотные ткани защищают кожу лучше, чем легкие и светлые).</li>\r\n<li>Помните, что обгореть можно даже в облачную погоду (облака не задерживают ультрафиолетовые лучи) или находясь в воде.</li>\r\n<li>Помните, что песок, вода и снег отражают солнечные лучи и увеличивают вероятность солнечного ожога</li>\r\n<li>Используйте солнцезащитные кремы с солнцезащитным фильтром не менее 15 SPF, а при светлой коже защитный фактор должен быть еще выше. Крем необходимо наносить за несколько минут до выхода на улицу и чаще обновлять его.</li>\r\n</ul>",
"clinical_picture": "<p>Симптомы солнечного ожога зависят от тяжести поражения кожи. При ожоге легкой степени кожа в месте ожога воспаляется, краснеет, даже легкое прикосновение к ней причиняет боль. Ощущается сухость и жжение, <a href=\"/symptom/zud/\" title=\"Перейти на страницу симптома Зуд\">зуд</a>, обожженная кожа <a href=\"/symptom/otek_tkaney/\" title=\"Перейти на страницу симптома Отек тканей\">горячая на ощупь</a>.</p>\r\n<p>При более тяжелом солнечном ожоге кожа может припухнуть, покрыться волдырями или корочкой. Иногда повышается общая температура тела. При тяжелом солнечном ожоге нередки <a href=\"/symptom/golovnaya_bol/\" title=\"Перейти на страницу симптома Головная боль\">головная боль</a>, <a href=\"/symptom/oznob/\" title=\"Перейти на страницу симптома Озноб\">озноб</a>, <a href=\"/symptom/lihoradka_s_oznobom/\" title=\"Перейти на страницу симптома <a href=\"/symptom/vysokaya_temperatura_38-42/\" title=\"Перейти на страницу симптома Высокая температура 38-42° \">Лихорадка</a> с ознобом\">жар</a>, общая <a href=\"/symptom/slabost/\" title=\"Перейти на страницу симптома Слабость\">слабость</a>.</p>\r\n<p>Коварство солнечного ожога - в отличие от некоторых других видов ожогов - состоит в том, что симптомы солнечного ожога становятся заметны не мгновенно, а лишь через несколько часов. Максимально симптомы проявляются через 12 - 24 ч, <a href=\"/symptom/shelushenie_kozhi/\" title=\"Перейти на страницу симптома Шелушение кожи\">отшелушивание</a> обгоревшего слоя кожи начинается на 4 - 7 день после солнечного ожога.</p>",
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"code": "L52",
"name": "Эритема узловатая",
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"lead": "это заболевание кожи неясного происхождения, характеризующееся появлением в коже или подкожной клетчатке (чаще на ногах) плотных болезненных узлов.",
"description": "<p><span id=\"docs-internal-guid-43ac776a-7fff-04bc-bd5b-b6966dea644a\"><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;\">Узловатая эритема — это воспаление подкожно-жировой клетчатки, которое сопровождается появлением болезненных пальпируемых подкожных узелков красного или фиолетового цвета.</span></span></p>",
"etiology": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><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;\">Существует несколько факторов, провоцирующих начало воспалительного процесса в сосудах эпидермиса:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">бактериальные инфекционные заболевания, вызванные стрептококками, – скарлатина, ангина, фарингит, отит и др., после которых развивается узловая эритема нижних конечностей как осложнение перенесенного заболевания;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">длительное системное заболевание – туберкулез, лимфогранулематоз, трихофития, иерсиниоз;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">долговременный курс лечения антибиотиками, бромидами, салицилатами, йодидами либо сульфаниламидами;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">вакцинация;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">язвенный колит;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">онкозаболевание;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">болезнь Бехчета;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">беременность и связанная с ней гормональная перестройка женского организма, причем риск развития узелковой эритемы существенно возрастает при наличии в анамнезе беременной женщины хронических инфекционных очагов;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">наследственная предрасположенность к заболеванию: часто оно диагностируется у нескольких поколений одной семьи или у близких родственников;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">аллергия, которая способствует развитию хронической формы патологии.</span></li>\r\n</ul>",
"pathogenesis": "<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;\">Узловатая эритема начинается с того, что бактерии, вирусы или другие агенты попадают в организм. Они могут проникнуть извне или из очага инфекции, который находится в организме, например в кишечнике, миндалинах и т. д. В ответ на их внедрение срабатывает иммунная система, начинают вырабатываться антитела — белки, которые связываются с антигенами (возбудителями), маркируют их или нейтрализуют самостоятельно. Комплексы, состоящие из антител и антигенов, называются циркулирующими иммунными комплексами (ЦИК). С током крови ЦИК разносятся по организму и задерживаются в различных органах и тканях. В том числе иммунные комплексы оседают в подкожно-жировой клетчатке, стенках сосудов и вокруг венул, находящихся в соединительнотканных перегородках подкожной клетчатки.</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;\">В результате возникает избыточная иммунная реакция местного характера, которая характеризуется воспалением и повреждением тканей. Это приводит к образованию узлов на коже.</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;\">Показатели лабораторных исследований не дают оснований однозначно диагностировать узловую эритему. Они направлены, прежде всего, на выявление причин заболевания и сопутствующих ему патологий. Пациенту могут назначить:</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;\">клинический анализ крови;</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;\">бакпосев микрофлоры носоглоточной слизи для выявления стрептококков;</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;\">бакпосев кала при подозрении на иерсиниоз;</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;\">туберкулинодиагностику;</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;\">кожные аллергические пробы;</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;\">анализ крови на ревматоидный фактор и консультацию у ревматолога;</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;\">биопсию </span><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">ткани узлового образования и </span><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">гистологическое изучение образца </span><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">для выявления воспалительного процесса в стенках капилляров.</span></li>\r\n</ul>\r\n<p><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;\"> </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;\">Лечение узловой эритемы направлено, в первую очередь, на избавление от очагов хронической инфекции или другой причинной патологии. Оно включает:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\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;\">антибиотикотерапию, если воспалительный процесс носит инфекционный характер;</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;\">десенсибилизирующую терапию, если причиной болезни является аллергическая реакция организма;</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;\">прием противовоспалительных препаратов для купирования воспалительного процесса и избавления от болей;</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;\">плазмаферез, криоферез или гемосорбцию для быстрого устранения интоксикации;</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;\">кортикостероидные и противовоспалительные мази на воспаленные суставы и узлы эритемы;</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;\">физиотерапевтическое лечение – УФО, лазеротерапию, фоноворез, магнитотерапию и т. д.</span></li>\r\n</ul>\r\n<p align=\"justify\"> </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 пациенток с беременностью клинические рекомендации при узловатой эритеме существенно ограничены, так как многие препараты использовать нежелательно. Ранее это заболевание служило обоснованием для искусственного прерывания беременности, однако в настоящее время доказано, что оно не влияет на развитие плода.</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;\">С целью профилактики узловатой эритемы при возникновении ангин, гайморитов и герпетических инфекций нужно обязательно обращаться к врачу, делать анализы для выявления возбудителя, проходить терапию, специфичную для данного возбудителя. Так можно обезопасить себя от возникновения узловатой эритемы и многих других процессов.</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;\">Профилактика рецидивов в первую очередь направлена на полноценное лечение основного заболевания, также важно избегать провоцирующих факторов. После основного лечения следует наблюдаться у дерматолога и необходимых специалистов, продолжать лечение с профилактической целью и проходить полное клиническое обследование до нормализации показателей анализов.</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;\">Рекомендуется защищаться от простудных заболеваний, повышать иммунитет, для этого сбалансированно питаться, заниматься физической активностью, особенно в течение года после болезни.</span></p>",
"clinical_picture": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><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;\">Характерные симптомы узловой эритемы позволяют специалистам безошибочно распознавать заболевание.</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Острое начало с резким ухудшением состояния, ознобом, признаками лихорадки, слабостью, ухудшением аппетита.</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Появление на коже узловатых высыпаний, причем узлы образуются в нижних, наиболее плотных слоях дермы либо в подкожном слое жировой клетчатки и возвышаются над уровнем кожи. Размеры узлов варьируют от 0,5 до 5 см, вокруг них образуется отек, из-за которого границы узла размываются, отмечаясь лишь изменением цвета гладкой кожи на ярко-розовый или синюшный.</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Быстрое увеличение в размерах узлов, образовавшихся под кожей. Через некоторое время рост прекращается.</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Болезненность узлов – один из характерных симптомов. Она может проявляться спонтанно либо только при нажатии на воспаленный участок кожи.</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Боли и воспаления в суставах – еще один характерный признак. Крупные суставы воспаляются примерно у трети пациентов: появляется отек тканей, локально повышается температура. Артропатия и ощущение скованности характерно для большинства случаев болезни.</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Спустя две-три недели узлы начинают уменьшаться, затем полностью исчезают. На их месте некоторое время остаются пятна с измененным цветом кожи, возможно шелушение кожи. Одновременно разрешается воспаление суставов.</span></li>\r\n</ul>\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: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Острая узловатая эритема продолжается около месяца. При отсутствии надлежащего лечения заболевание переходит в хроническую форму с периодическими ремиссиями и обострениями. Рецидивы характеризуются образованием единичных воспаленных узлов, которые сохраняются в течение нескольких месяцев при слабо выраженных либо полностью отсутствующих признаках инфекционной интоксикации.</span></p>\r\n<p><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;\"> </span></p>",
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"code": "L51",
"name": "Эритема многоформная",
"icd_name": "Эритема многоформная",
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"age_min": 0,
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"lead": "острое заболевание кожи и слизистых с полиморфными высыпаниями и наклонностью к рецидивам преимущественно в осенний и весенний периоды. ",
"description": "Многоформная экссудативная эритема возникает в основном у молодых людей и лиц среднего возраста.",
"etiology": "<p>К настоящему моменту не удалось выявить точные причины инфекционно-аллергической формы заболевания. Существует большая вероятность того, что причиной экссудативной эритемы является очаговая инфекция. Это может быть хронический аппендицит, пульпит, гайморит и пр. Этот фактор выявляется примерно у 70% всех заболевших. У таких больных обнаруживается высокая сенсибилизация (чувствительность) к различным инфекционным агентам – кишечной палочке, стафилококку и пр. Во время рецидива экссудативной эритемы у больных отмечается снижение устойчивости организма, понижение Т-клеточного иммунитета. Таким образом, основной причиной развития данной формы многоформной эритемы является развитие иммунодефицитного состояния, которое, в свою очередь, провоцируется: хронической инфекцией; переохлаждением; заражением вирусной инфекцией; гелио-магнитными воздействиями. Причиной появления токсико-аллергической разновидности экссудативной эритемы является прием лекарственных средств. Чаще всего, подобная реакция организма наблюдается на прием барбитуратов, препаратов тетрациклинового ряда, сульфаниламидов.<br /><br /></p>",
"pathogenesis": "",
"diagnostics": "<p align=\"justify\">Для диагностики заболевания на консультации дерматолога проводится тщательный осмотр высыпаний и дерматоскопия. При сборе анамнеза уделяется внимание связи с инфекционным процессом или введением лекарственных препаратов. Для подтверждения диагноза многоформной экссудативной экземы и исключения других заболеваний с поверхности пораженных участков кожи и слизистой берут мазки-отпечатки.</p>\r\n<p align=\"justify\">Многоформную экссудативную эритему дифференцируют с пузырчаткой, диссеминированной формой СКВ, узловатой эритемой. Быстрая динамика сыпи, отрицательный симптом Никольского и отсутствие акантолиза в мазках-отпечатках позволяют дифференцировать многоформную экссудативную эритему от пузырчатки.</p>\r\n<p align=\"justify\">При фиксированных формах многоформной экссудативной эритемы необходимо проводить дифференциальную диагностику с сифилитическими папулами. Отсутствие бледных трепонем при исследовании в темном поле, отрицательные реакции ПЦР, РИФ и RРR позволяют исключить сифилис.</p>",
"treatment": "<p align=\"justify\">ечение в остром периоде зависит от клинических проявлений многоформной экссудативной эритемы. При частом рецидивировании, поражении слизистых, диссеминированных высыпаниях на коже, появлении некротических участков в центре элементов сыпи пациенту показано однократное введение 2 мл дипроспана.</p>\r\n<p align=\"justify\">При токсико-аллергической форме первоочередной задачей лечения является определение и выведение из организма вещества, спровоцировавшего возникновение многоформной экссудативной эритемы. Для этого пациенту назначается обильное питье, энтеросорбенты, мочегонные средства. При впервые возникшем случае заболевания или при наличие в анамнезе данных о самостоятельном быстром разрешении его рецидивов введение дипроспана, как правило, не требуется.</p>\r\n<p align=\"justify\">При любой форме многоформной экссудативной эритемы показана дессенсибилизирующая терапия: супрастин, тавегил, тиосульфат натрия и др. Антибиотики применяют только в случае вторичного инфицирования высыпаний.</p>\r\n<p align=\"justify\">Местное лечение многоформной экссудативной эритемы заключается в применении аппликаций из антибиотиков с протеолитическими ферментами, смазывании пораженных участков кожи антисептиками (р-р хлоргексидина или фурацилина) и кортикостероидными мазями, в состав которых входят антибактериальные препараты (триоксазин, дермазолин). При поражении слизистой полости рта назначают полоскание отваром ромашки, ротоканом, смазывание облепиховым маслом.</p>\r\n<p align=\"justify\">Профилактика рецидивов многоформной экссудативной эритемы при инфекционно-аллергической форме тесно связана с выявлением и устранением хронических инфекционных очагов и герпетической инфекции. Для этого пациенту может потребоваться консультация отоларинголога, стоматолога, уролога и других специалистов. При токсико-аллергическом варианте многоформной экссудативной эритеме важно не допускать приема провоцирующего заболевание медикамента.</p>",
"prevention": "<p>Профилактика многоформной эритемы заключается в своевременной санации очагов инфекции, а также, в исключении применения лекарств и особенно антибиотиков без назначения врача.<br /><br /></p>",
"clinical_picture": "<p>Симптомы и проявления эритемы зависят от формы заболевания.</p>\r\n<p>Инфекционно-аллергическая разновидность эритемы может начинаться как грипп. При инфекционно-аллергической разновидности эритемы заболевание, как правило, начинается остро. Первые симптомы могут несколько напоминать грипп, больные экссудативной эритемой начинают ощущать <a href=\"/symptom/utomlyaemost/\" title=\"Перейти на страницу симптома Утомляемость\">недомогание</a>, часто отмечаются боли в мышцах, суставах, першение в горле. Через сутки после начала заболевания появляется <a href=\"/symptom/syp/\" title=\"Перейти на страницу симптома Сыпь\">сыпь</a>, которая является характерным симптомом экссудативной эритемы. <a href=\"/symptom/syp/\" title=\"Перейти на страницу симптома Сыпь\">Сыпь</a> появляется на коже и слизистой рта, реже поражаются слизистые половых органов. Слизистые при многоформной эритеме поражаются примерно у третьей части заболевших. Изолированное поражение оболочек рта (без высыпаний на коже) отмечается только у 5% заболевших. Как правило, через несколько суток после появления кожного синдрома общие симптомы проходят, однако, невысокая температура может держаться несколько недель. Для экссудативной эритемы характерно появление на коже пятен или плоских папул, цвет высыпаний ярко-розовый или красный. Пятна быстро увеличиваются в размерах, их центральная часть западает и приобретает синюшный цвет, в то время как периферические края охраняют красную окраску. В некоторых случаях, в центральной части пятен могут появиться пузыри с прозрачным или кровянистым содержимым. Реже отмечается появление пузырей на неизмененной коже. Кожа стоп — это одно из мест локализации многоформной экссудативной эритемы. <a href=\"/symptom/syp/\" title=\"Перейти на страницу симптома Сыпь\">Высыпания</a> при экссудативной эритеме локализуются на коже стоп, кистей, голеней, предплечий. При поражении и слизистой рта экссудативная <a href=\"/symptom/pokrasnenie_kozhi/\" title=\"Перейти на страницу симптома Покраснение кожи\">эритема</a> имеет более тяжелое течение. <a href=\"/symptom/syp/\" title=\"Перейти на страницу симптома Сыпь\">Высыпания</a> в этом случае локализуются на губах, небе, щеках. Сначала на слизистых образуется отек, потом появляются пузыри. Вскоре они вскрываются с образованием крайне болезненных эрозий, которые склоны к слиянию в обширную раневую поверхность. <a href=\"/symptom/izmeneniya_struktury_kozhi/\" title=\"Перейти на страницу симптома Изменения структуры кожи\">Эрозии</a> могут покрываться сероватым налетом, при снятии которого поверхность слизистой начинает кровоточить. Поверхность эрозий покрываются кровянистыми корками разной толщины, а в случае вторичного инфицирования пораженной слизистой корки приобретают серый цвет. У некоторых больных экссудативной эритемой поражение охватывает всю слизистую рта, у других – появляются единичные элементы высыпаний. При значительной площади поражения площади рта возникает сильный болевой синдром. Больные многоформной эритемой не могут нормально открыть рот, это обстоятельство делает невозможной речь и прием пищи. Наличие кариеса, пародонтоза способствует усугублению процесса. При многоформной эритеме <a href=\"/symptom/syp/\" title=\"Перейти на страницу симптома Сыпь\">высыпания</a>, появившиеся на коже, разрешаются через 2 — 3 недели. <a href=\"/symptom/syp/\" title=\"Перейти на страницу симптома Сыпь\">Высыпания</a> на слизистых не заживают по 4 — 6 недель. В большинстве случаев, многоформная <a href=\"/symptom/pokrasnenie_kozhi/\" title=\"Перейти на страницу симптома Покраснение кожи\">эритема</a> имеет рецидивирующее течение, обострения чаще случаются в периоды межсезонья. Редко отмечаются тяжелые случаи, при которых рецидивы заболевания следуют один за другим. Симптомы токсико-аллергической эритемы мало отличатся от описанных выше. При этой форме <a href=\"/symptom/syp/\" title=\"Перейти на страницу симптома Сыпь\">высыпания</a> могут носить распространенный характер или быть фиксированными. В первом случае, практически у всех заболевших отмечается поражение слизистой рта.<br /><br /></p>",
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