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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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"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>",
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"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>",
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},
"code": "L41",
"name": "Парапсориаз",
"icd_name": "Парапсориаз",
"gender": 0,
"age_min": 15,
"age_max": 100,
"cause": [
3,
0
],
"periodicity": 4,
"slug": "l41_parapsoriaz",
"lead": "дерматоз, который объединяет в себе симптомы розового лишая, себорейной экземы, обычного псориаза и плоского красного лишая.",
"description": "Тяжелая хроническая незаразная болезнь кожи.",
"etiology": "<p>Существует несколько версий ее происхождения: ранее парапсориазу приписывали инфекционное происхождение, так как симптомы похожи на многие инфекционные кожные инфекции, но эта гипотеза не нашла подтверждения;</p>\r\n<p>на современном этапе считается, что фактором ее развития является аллергическая реакция организма на раздражитель;</p>\r\n<p>не последнюю роль играют перенесенные инфекционные заболевания (ОРВИ, ангина, грипп);</p>\r\n<p>присутствие хронических центров инфекции (тонзиллит, гайморит, пиелонефрит);</p>\r\n<p>объясняется развитие сосудистыми проблемами;</p>\r\n<p>нарушением в иммунной системе; дисфункцией эндокринной системы.</p>\r\n<p>Спровоцировать всплеск симптомов могут соматические заболевания:</p>\r\n<p>нарушение в работе ЖКТ, печени, секреторные дисфункции, неблагоприятная экология.<br /><br /><br /></p>",
"pathogenesis": "",
"diagnostics": "<p>При диагностике заболевания возникают трудности, аналогичная симптоматика с различными видами дерматитов не дает возможности однозначно поставить диагноз. Четких критериев для лабораторных исследований для определения парапсориаза еще не разработано. Дерматологи основываются: на исследовании результатов анализа крови: на основе биопсии элементов поражений в местах очагов воспаления: Это необходимо для того, чтобы дифференцировать парапсориаз от других болезней, так как визуальный осмотр не всегда дает четкой картины.</p>",
"treatment": "<p>При каплевидном парапсориазе производят санацию очагов инфекции. Назначают антибиотики широкого спектра действия, гипосенсибилизирующие, антигистаминные, сосудистые (теоникол, компламин) препараты. При хронической и подострой формах в стадии разрешения рекомендуют ПУВА-терапию. Если эффект от вышеуказанного лечения оказывается недостаточно эффективным, назначают небольшие дозы глюкокортикостероидов.</p>\r\n<p>Наружно назначают местные глюкокортикостероидные, рассасывающие мази.</p>",
"prevention": "",
"clinical_picture": "<p>Бляшечный парапсориаз</p>\r\n<p>Такая форма заболевания может быть представлена мелкими и крупными папулами. В первом случае патология относительно безопасна, а вот крупнобляшечный тип может постепенно трансформироваться в лимфому.</p>\r\n<p>Начинается парапсориаз этого типа с возникновения пятен бледно-розового оттенка с небольшим количеством инфильтрата. Диаметр высыпаний не превышает 5 сантиметров, они имеют неправильную либо округлую форму. Локализуются новообразования чаще всего на конечностях либо на самом туловище.</p>\r\n<p><a href=\"/symptom/syp/\" title=\"Перейти на страницу симптома Сыпь\">Сыпь</a> носит чешуйчатый характер, часто сопровождается гиперпигментацией.</p>\r\n<p>Бляшечный парапсориаз не влияет на общее самочувствие пациента. Заболевание протекает на протяжении длительного периода.</p>\r\n<p>Не исключено перерождение псориатических бляшек в грибовидный микоз. Симптомом такого перерождения является нестерпимый <a href=\"/symptom/zud/\" title=\"Перейти на страницу симптома Зуд\">зуд</a>.</p>\r\n<p>Каплевидный парапсориаз</p>\r\n<p>Появляется характерная <a href=\"/symptom/syp/\" title=\"Перейти на страницу симптома Сыпь\">сыпь</a>, состоящая из своеобразных узелков размером с зерно. Цвет сыпи может быть разным – от бледно-розового оттенка до насыщенно-коричневого. Центральная часть образований шелушится.</p>\r\n<p>Место локализации – конечности, туловище, но <a href=\"/symptom/syp/\" title=\"Перейти на страницу симптома Сыпь\">высыпания</a> могут возникать и на других частях тела.</p>\r\n<p>Каплевидный парапсориаз отличается несколькими характерными особенностями, по которым врач-дерматолог и дифференцирует его:</p>\r\n<ul>\r\n<li>«феномен облатки»: если попытаться аккуратно снять чешуйку с узелка, она отпадет монолитным пластом;</li>\r\n<li>«феномен пурпуры»: при сильном механическом воздействии на папулах можно наблюдать небольшие точечные кровоизлияния;</li>\r\n<li>«симптом скрытого шелушения»: если слегка поскоблить узелок, на нем возникает отрубевидное <a href=\"/symptom/shelushenie_kozhi/\" title=\"Перейти на страницу симптома Шелушение кожи\">шелушение</a>.</li>\r\n</ul>\r\n<p>Для ремиссии данного типа парапсориаза свойственно полное исчезновение внешних симптомов либо возникновение лейкодермических пятен.</p>\r\n<p>Острый парапсориаз</p>\r\n<p><a href=\"/symptom/syp/\" title=\"Перейти на страницу симптома Сыпь\">Сыпь</a> носит тотальный, полиморфный характер. <a href=\"/symptom/syp/\" title=\"Перейти на страницу симптома Сыпь\">Высыпания</a> могут носить разный характер:</p>\r\n<p><br /><br /><br /></p>\r\n<p> </p>\r\n<ul>\r\n<li>пузырьковый;</li>\r\n<li>папулезный;</li>\r\n<li>пустулезный;</li>\r\n<li>геморрагический.</li>\r\n</ul>\r\n<p><a href=\"/symptom/syp/\" title=\"Перейти на страницу симптома Сыпь\">Высыпания</a> покрывают все тело, в том числе лицо, стопы и кисти. Начинается острый парапсориаз внезапно, <a href=\"/symptom/syp/\" title=\"Перейти на страницу симптома Сыпь\">сыпь</a> распространяется очень быстро, покрывая всю кожу. Чаще всего <a href=\"/symptom/syp/\" title=\"Перейти на страницу симптома Сыпь\">высыпания</a> не оставляют следов после себя, иногда возникают осповидные рубцы.</p>\r\n<p>Острый парапсориаз может трансформироваться в каплевидную форму заболевания.</p>\r\n<p>Общие симптомы – незначительно повышенная температура, увеличенные лимфоузлы, общая <a href=\"/symptom/slabost/\" title=\"Перейти на страницу симптома Слабость\">слабость</a>.</p>\r\n<p>Лихеноидный парапсориаз</p>\r\n<p>Данная форма встречается нечасто. Для нее характерно появление на коже округлых либо конусообразных папул, окрашенных в желтовато-красный либо коричневый оттенок. Поверхность новообразований блестящая и гладкая, иногда к ней прикреплены небольшие чешуйки.</p>\r\n<p>Форма сыпи – сетевидная. Она покрывает кожу век и туловище, неприятных ощущений не вызывает.</p>",
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"parent": null,
"block_rubric": 123,
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},
{
"id": 6740,
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{
"id": 2632,
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{
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},
{
"name": "угривые прыщи"
},
{
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},
{
"name": "высыпания"
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},
"code": "L72",
"name": "Фолликулярные кисты кожи и подкожной клетчатки",
"icd_name": "Фолликулярные кисты кожи и подкожной клетчатки",
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"cause": [
3
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"slug": "l72_follikulyarnye_kisty_kozhi_i_podkozhnoy_kletchatki",
"lead": "это порок развития волосяного мешочка, выражающийся в росте доброкачественного опухолевидного образования.\r\n",
"description": "",
"etiology": "<p>Волосяная киста является пороком развития, гистогенетически ее образование связано с эпителием, покрывающим перешеек фолликула. Поскольку фолликулярные кисты часто наблюдаются у кровных родственников, заболевание относится к типу наследственных. Тип наследования данного порока – аутосомно-доминантный. <br /><br /></p>",
"pathogenesis": "",
"diagnostics": "<p>Диагностика волосяной кисты основывается на изучении симптоматики, сборе анамнеза и проведении биопсии.<br /><br /></p>",
"treatment": "<p>В том случае, если фолликулярная киста создает неудобства, ее стоит удалить. Обязательному лечению подлежит образование при развитии воспалительного процесса. Сегодня, чаще всего, применяется один из двух методов лечения: Удаление кисты хирургическим методом через разрез на коже. Удаление образования обязательно производится вместе с капсулой. Вылущивание кисты путем применения лазерного аппарата. Если процесс удаления капсулы будет неполным, то практически в 100% случаев у пациентов развивается рецидив. В том случае, если произошло <a href=\"/symptom/vospalenie/\" title=\"Перейти на страницу симптома воспаление\">воспаление</a> тканей кисты, требуется сначала провести лечение, направленное на снятие воспалительной реакции. При образовании на месте образования гнойного абсцесса, проводится специфическое лечение – вскрытие с установкой дренажа.<br /><br /></p>",
"prevention": "",
"clinical_picture": "<p>Волосяная киста – это достаточно крупное опухолевидное образование округлой формы. В среднем размер опухоли составляет 1-5 см, но иногда образование разрастается до гораздо больших размеров. Консистенция образования плотно-эластичная, образование не связано с эпидермисом и является ограничено подвижным. У большинства пациентов волосяная киста образуется на голове, но иногда данное образование размещается на верхней части туловища – спине или плечах. Образование не причиняет боли, не вызывает зуда и других субъективных ощущений.<br /><br /></p>",
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