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"code": "L29",
"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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{
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"image": null
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{
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"image": null
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{
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{
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{
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{
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{
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{
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"image": null
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{
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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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