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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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3
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"lead": "это порок развития волосяного мешочка, выражающийся в росте доброкачественного опухолевидного образования.\r\n",
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"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>",
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"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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"etiology": "<p>В развитии розацеа определенную роль играют такие факторы, как кон- ституциональная ангиопатия; эмоциональные стрессы; нарушения гормо- нального равновесия; воздействие химических агентов. В последние годы большое внимание уделяется роли кателицидинов в развитии розацеа. Кателицидины — семейство многофункциональных белков, которые обеспечивают защиту первой линии в коже против инфек- ционных агентов, влияя на местные воспалительные реакции и ангиоге- нез путем непосредственного воздействия на эндотелиоциты и иммунитет. У больных розацеа в коже лица в 10 раз повышен уровень кателицидинов и в 10 000 раз в роговом слое повышен уровень протеаз, которые активируют кателицидины. 529 Розацеа Lacey и соавт. (2007) была выделена бактерия (Bacillus oleronius) из клеща рода Demodex, которая, воздействуя на пептиды, стимулирует воспалитель- ные реакции у больных папуло-пустулезной розацеа. В патогенезе пусту- лезной и глазной розацеа имеет этиологическое значение эпидермальный стафилококк, что, возможно, связано с реализацией его патогенных свойств из-за повышения температуры лица вследствие расширения сосудов. Обсу- ждается также взаимосвязь розацеа с Helicobacter pylori. Заболевание чаще развивается у лиц женского пола в возрасте 30—50 лет, имеющих определенную генетическую предрасположенность к транзитор- ному покраснению кожи лица, реже — шеи и так называемой зоны декольте.</p>",
"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;\">Механизмы развития заболевания до сих пор изучаются и уточняются</span><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 style=\"font-size: 0.6em; vertical-align: sub;\">, </span></span><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;\">но ключевая роль в патогенезе розацеа сейчас отводится нарушению сосудистого тонуса — ангионеврозу. В частности, в развитии преходящего и стойкого покраснения лица участвует медиатор брадикинин, уровень которого также повышается во время климакса, обусловливая характерные приливы. Такой же эффект можно наблюдать и во время реакции на психоэмоциональные раздражители, особенно у людей с неустойчивой психикой и особой склонностью к выраженным вегетативным проявлениям.</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;\">При розацеа отмечается выброс и других вазоактивных медиаторов воспаления — гистамина, серотонина и простагландинов.</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;\">Чрезмерное ультрафиолетовое облучение также способно изменять тонус сосудов в силу повреждающего воздействия на сосудистую стенку, что приводит к её атонии и повышенной хрупкости. Кроме того, при УФ-облучении происходит деградация волокон дермы, что также делает кожу более уязвимой к воздействию внешних факторов.</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;\">Воспалительные процессы при появлении папул и пустул стимулируются также бактерией Bacillus oleronius, которую выделяют клещи рода демодекс. Кроме того, в образовании пустулёзных элементов сыпи и нарушениях со стороны органов зрения нередко задействован эпидермальный стафилококк.</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;\">Хроническое воспаление сопровождается функциональной недостаточностью мелких кровеносных и лимфатических сосудов лица, что приводит к развитию отёка (лимфедемы), фиброзным изменениям и утолщениям кожи.</span></p>",
"diagnostics": "<p>Единственным критерием диагностики розацеа является стойкая <a title=\"Перейти на страницу симптома Покраснение кожи\" href=\"/symptom/pokrasnenie_kozhi/\">эритема</a> центральной части лица, существующая в течение как минимум 3 месяцев, без поражения периокулярных участков. Такие симптомы, как приливы, <a title=\"Перейти на страницу симптома Папулы\" href=\"/symptom/papuly/\">папулы</a>, <a title=\"Перейти на страницу симптома Пустулы\" href=\"/symptom/pustuly/\">пустулы</a> и телеангиэктазии являются дополнительными признаками, не обязательными для постановки диагноза.</p>",
"treatment": "<p>В основе лечебных мероприятий лежит обеспечение адекватного ежед- невного ухода за кожей. В первую очередь он включает солнцезащитные пре- параты. Они должны подбираться с учетом повышенной чувствительности кожи больных розацеа. Наименьшим раздражающим действием обладают индифферентные препараты (диоксид титана, оксид цинка), блокирующие ультрафиолетовое облучение кожи за счет своих физических свойств. Пре- параты, содержащие химические фильтры ультрафиолета, которые можно рекомендовать пациентам с розацеа, не должны содержать лаурилсульфата натрия, ментола и камфоры и, напротив, должны включать в себя силиконы (диметикон, циклометикон), значительно уменьшающие раздражающее действие солнцезащитных препаратов, обеспечивающие водостойкость и низкую комедогенность . В рекомендациях по ежедневному уходу за кожей следует учитывать при- менение легких по консистенции маскирующих препаратов для ежедневно- го использования. Желательно наносить их тонким слоем 1—2 раза в день и в качестве основы для макияжа, который предпочтительно представлен в форме пудры или взбалтываемой смеси. Показано, что применение ма- скирующих средств не ухудшает течения розацеа и может позитивно влиять на качество жизни пациента. Важной составляющей терапии розацеа является восстановление барьерных функций кожи. Наружное лечение является предпочтительным для всех типов розацеа, за исключением гипертрофического, при котором наиболее эффективными оказываются хирургическое лечение и системные синтетические ретиноиды. При эритематотелеангиэктатическом подтипе применяются азелаино- вая кислота, а также лазерные технологии. При папуло-пустулезном подтипе от легкой до умеренной степени тяжести рекомендуются азелаиновая кислота, метронидазол или короткий курс ан- тибактериальных препаратов. При тяжелом течении папуло-пустулезной розацеа рекомендуют 4-недельный курс доксициклина с последующим уменьшением дозы на 50%. Пока- заны также низкие дозы изотретиноина. При начальных проявлениях фиматозного подтипа розацеа наиболее эф- фективна монотерапия изотретиноином, в дальнейшем требуется хирурги- ческое иссечение пораженных тканей. При офтальморозацеа рекомендуют препараты фузидиевой кислоты и метронидазола на края век, системные тетрациклины, препараты «искус- ственной <a title=\"Перейти на страницу симптома Слезотечение\" href=\"/symptom/slezotechenie/\">слезы</a>».</p>",
"prevention": "<p>Профилактика обострений розацеа заключается в ограничении/исклю- чении воздействия триггерных факторов: метеорологических факторов, инсоляции, продуктов питания, напитков и фармакологических препаратов, индуцирующих эритему лица, агрессивных косметологических процедур (физические и химические пилинги, дермабразия, растирающие процедуры, термоактивные маски и др.). Пациентам рекомендуют бережный уход за кожей с использованием мягкого очищения, увлажняющих и фотопротективных средств, предназначенных для чувствительной кожи. Показана поддерживающая терапия наружным метронидазолом или азелаиновой кислотой.</p>",
"clinical_picture": "<p align=\"justify\"><a title=\"Перейти на страницу симптома Покраснение кожи\" href=\"/symptom/pokrasnenie_kozhi/\">Краснота</a> локализуется в Т-зоне лица (лоб, нос, подбородок и щеки). Первые стадии розацеа, при которых основным клиническим проявлением является <a title=\"Перейти на страницу симптома Покраснение кожи\" href=\"/symptom/pokrasnenie_kozhi/\">Покраснение</a> кожи\"><a title=\"Перейти на страницу симптома Покраснение кожи\" href=\"/symptom/pokrasnenie_kozhi/\">покраснение</a> кожи, часто остаются незамеченными, так как никакого дискомфорта не причиняют и легко маскируются косметическими средствами.</p>\r\n<p> <a title=\"Перейти на страницу симптома Сыпь\" href=\"/symptom/syp/\">Высыпания</a> на лице при розацеа начинают появляться при стойком расширении капилляров, приток крови вызывает местное <a title=\"Перейти на страницу симптома Высокая температура 38-42° \" href=\"/symptom/vysokaya_temperatura_38-42/\">повышение температуры</a>, что и дает возможность сапрофитной микрофлоре активно размножаться. Следующая стадия розацеа проявляется наличием бугорков и неровностей на коже, которые через некоторое время превращаются в небольшие гнойнички.</p>\r\n<p> Кожа становится плотной, шероховатой на ощупь, уплотнения при розацеа наиболее интенсивные в Т-зоне. В этой стадии розацеа появляется стойкое расширение сосудистой сетки (телеангиоэктазии) и поэтому <a title=\"Перейти на страницу симптома Покраснение кожи\" href=\"/symptom/pokrasnenie_kozhi/\">краснота</a> и <a title=\"Перейти на страницу симптома Отек тканей\" href=\"/symptom/otek_tkaney/\">припухлость</a> кожи наблюдается уже без связи с провоцирующими факторами.</p>\r\n<p> Люпоидная форма розацеа характеризуется наличием периорбитальных и периоральных высыпаний в виде буровато-красных папул и узелков, элементы склонны к слиянию и образовывают неровную бугристую поверхность. Кожа лица на непораженных участках, как правило, не изменена и имеет здоровый внешний вид.</p>\r\n<p> </p>\r\n<p align=\"justify\">Розацеа может принимать молниеносное течение при беременности, после родов при соответствующей терапии розацеа проходит бесследно, но каждая последующая беременность сопряжена с рецидивом розацеа.</p>\r\n<p> </p>\r\n<p align=\"justify\">Если розацеа диагностируется у мужчин, то отмечается стойкое <a title=\"Перейти на страницу симптома Покраснение кожи\" href=\"/symptom/pokrasnenie_kozhi/\">покраснение</a> и <a title=\"Перейти на страницу симптома Отек тканей\" href=\"/symptom/otek_tkaney/\">уплотнение</a><a title=\"Перейти на страницу симптома Изменения структуры кожи\" href=\"/symptom/izmeneniya_struktury_kozhi/\"> кожи</a> на носу. Розацеа у мужчин очень часто осложняется ринофимой. При прогрессировании розацеа поражается область вокруг глаз и веки. Присоединяется дискомфорт во время моргания, ощущение рези, сухости и песка в глазах. При розацеа на поздних стадиях отмечается обильное <a title=\"Перейти на страницу симптома Слезотечение\" href=\"/symptom/slezotechenie/\">слезотечение</a>. В этом случае диагностируют окулярную розацеа, но следует иметь ввиду, что клинические проявления могут на несколько лет опережать кожные поражения. В некоторых случаях окулярное розацеа осложняется розацеакератитом, что приводит к потере зрения.</p>\r\n<p> </p>\r\n<p align=\"justify\"><a title=\"Перейти на страницу симптома Зуд\" href=\"/symptom/zud/\">Зуд</a>, жжение, чувство стягивания кожи и «мурашки» наблюдаются практически у всех пациентов с розацеа.</p>\r\n<p> </p>",
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Наиболее распространенные среди них:</span></p>\r\n<ul>\r\n<li><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;\">гормональный сбой или длительный прием стероидных препаратов (кортикостероидов, контрацептивов и т.п.) – негативное воздействие могут оказывать не только внутренние препараты, но и наружные средства;</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;\">аномальная активность патогенных организмов – бактериальная инфекция, кандидозы, демодекоз;</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;\">активное ультрафиолетовое излучение;</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;\">использование косметических средств, которые образуют на поверхности кожи влагоудерживающую пленку (окклюзионный эффект);</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;\">индивидуальная непереносимость бытовой химии и уходовых средств;</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;\">раздражающий состав зубных паст, преимущественно фторсодержащих;</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;\">хроническое несоблюдение правил личной гигиены, особенно в отношении кожи лица;</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;\">заболевания пищеварительной системы с нарушением микрофлоры кишечника;</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;\">патологии иммунной системы и предрасположенность к аллергии;</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;\">неврологические нарушения;</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;\">плохое питание с недостатком витаминов и микроэлементов;</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;\">резкая смена климата.</span></li>\r\n</ul>\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;\">Для каждого набор факторов может быть своим, но особо тяжелые формы проявляются у пациентов с гормональным дисбалансом, а также у лиц, активно использующих широкий спектр косметических средств.</span></p>",
"pathogenesis": "",
"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;\">Во время приема врач опрашивает на предмет жалоб, собирает сведения о наличии тех или иных заболеваний у пациента и его кровных родственников. Дополнительно выясняет нюансы образа жизни, привычек и ежедневного рациона для создания предварительных предположений о причине появления болезни. После этого пациент получает направление на дополнительное обследование. Базовый список инструментальных и лабораторных методов диагностики::</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;\">дерматоскопия – оценивают состояние кожи, структуру папулезных образований;</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;\">УЗИ кожи и подкожно-жировой клетчатки – смотрят на глубину и степень повреждения покровов;</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;\">бактериальный посев соскобов эпидермиса для выявления инфекционной составляющей;</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;\">аллергопробы;</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;\">общий анализ крови для проверки общего состояния организма.</span></li>\r\n</ul>\r\n<p> </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;\">В первую очередь устраняют причину заболевания – восстанавливают гормональный баланс, отказываются от косметики, нормализуют питание, устраняют нервные стрессы или компенсируют их влияние и т.п. После этого врач назначает комплексное лечение проявлений дерматита.</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;\">Медикаментозная терапия:</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;\">антигистаминные препараты для устранения зуда и жжения;</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;\">противовоспалительные средства – общего и местного действия;</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;\">успокаивающие составы для стабилизации нервной системы;</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;\">антибиотики для устранения инфекции;</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;\">иммуномодуляторы и иммуностимуляторы для восстановления работы иммунной системы;</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;\">препараты для нормализации кишечной микрофлоры и работы кишечника в целом;</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;\">витаминно-минеральные комплексы.</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;\">В этот период желательно придерживаться специальной диеты с отказом от жирной, жареной, маринованной, пряной пищи в пользу свежих фруктов и овощей, вареных и тушеных блюд. Полезно будет увеличить количество выпиваемой чистой воды минимум до 1,5 литров в сутки и сократить потребление сладостей.</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;\">Физиопроцедуры:</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;\">лазерное воздействие – оказывает противовоспалительный, противоотечный, иммуностимулирующий, восстановительный эффект;</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;\">электрофорез – используют для повышения эффективности препаратов и снижения нервно-мышечного напряжения в шейно-воротниковой зоне;</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;\">рефлексотерапия с воздействием на точки, ответственные за состояние кожных покровов;</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;\">бальнеотерапия с применением лечебных ванн, ванночек – оказывает противовоспалительный, общеукрепляющий, противозудный эффект.</span></li>\r\n</ul>\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 ряде случаев потребуется пройти несколько лечебных курсов, а общий срок терапии может составлять месяцы и даже годы, однако при соблюдении врачебных рекомендаций результат всегда благоприятный.</span></p>\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>",
"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 учетом многофакторности периорального дерматита, намного легче предупредить заболевание, чем заниматься его длительным лечением. Профилактические меры:</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;\">здоровое сбалансированное питание с обилием свежих фруктов и овощей;</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;\">укрепление иммунитета приемом витаминов, иммуномодулирующих препаратов;</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;\">устранение нервных перегрузок;</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;\">регулярный контроль за состоянием эндокринной системы, аккуратное использование гормоносодержащих препаратов (только по рекомендации и под контролем врача);</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;\">тщательный подбор косметических составов и уходовых средств;</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;\">тщательное соблюдение правил личной гигиены.</span></li>\r\n</ul>\r\n<p> </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;\">Заболевание долгое время может протекать в скрытой форме, проявляясь легким раздражением кожи. Классическая форма дерматита имеет стандартный набор признаков:</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;\">высыпания вокруг рта;</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;\">покраснение покровов;</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;\">шелушение эпидермиса;</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;\">зуд, жжение.</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;\">Высыпания изначально появляются в уголках рта, постепенно распространяясь на подбородок, носогубные складки, щеки, в более тяжелых случаях поражая виски, переносицу, лоб, а также область вокруг глаз. Последний вариант особенно опасен, так как может приводить к офтальмологическим осложнениям. Течение заболевания длительное, с частыми обострениями и коротким периодом ремиссий.</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;\">Внешние признаки проявляются постепенно и по нарастающей. Сначала на коже формируются участки покраснений, затем на их фоне появляются отдельные белесые папулы, которые со временем сливаются с образованием крупных отечных бляшек. На их поверхности образуются мокнущие коросты, которые при заживлении образуют пигментированные участки кожи.</span></p>\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>",
"image": null,
"image_alt": null,
"standard_type": 0,
"danger": 20,
"published": 1,
"parent": 6763,
"block_rubric": 126,
"standards": []
},
{
"id": 6762,
"symptoms": [
{
"id": 3025,
"synonyms": [
{
"name": "Родинки"
},
{
"name": "Потемнение кожи"
},
{
"name": "Родимое пятно"
},
{
"name": "Покраснение кожи"
},
{
"name": "Пятно на коже"
}
],
"body_points": [
{
"x": 392,
"y": 3011,
"r": 0
}
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},
"code": "L70",
"name": "Угри",
"icd_name": "Угри",
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"cause": [
3,
0
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"slug": "l70_ugri",
"lead": " это мультифакториальный дерматоз, в патогенезе которого большую роль играют генетически обусловленная гиперандрогения и генетически детерминированный тип секреции сальных желез.",
"description": "Угревая сыпь относится к числу наиболее распространенных кожных заболеваний. В той или иной форме угри встречаются у 60-80% молодых людей в возрасте от 12 до 24 лет. Однако угри могут появляться и после 25 лет, как правило, на фоне нарушений обмена веществ.",
"etiology": "<p>Специалисты выделяют несколько основных видов угревой сыпи в зависимости от причин их возникновения. Прежде всего это эндогенные (возникающие из-за внутренних причин) и экзогенные (возникающие из-за внешних причин) <a href=\"/symptom/ugri/\" title=\"Перейти на страницу симптома Угри\">акне</a>. </p>\r\n<p>Причиной возникновения эндогенных угрей могут стать различные гормональные изменения, в том числе естественный «гормональный всплеск» в подростковом и юношеском возрасте. Определенную роль играет также наследственно обусловленная неадекватная реакция сальных желез на повышающийся уровень мужских половых гормонов в крови, которая может иметь место как у мужчин, так и у женщин.</p>\r\n<p>Во взрослом возрасте наиболее частой причиной эндогенных угрей является себорея. Кроме того, угревая <a href=\"/symptom/syp/\" title=\"Перейти на страницу симптома Сыпь\">сыпь</a> может возникать при различных инфекциях, а также хронических заболеваниях. Нередко сама клиническая картина угревой сыпи может подсказать наличие сопутствующего заболевания. Так, например, расположение угрей у женщин вокруг рта и на подбородке нередко указывает на патологию яичников.</p>",
"pathogenesis": "<p>Выделяют четыре основных звена патогенеза угрей:</p>\r\n<p>1. Увеличение продукции кожного сала.</p>\r\n<p>2. Избыточный фолликулярный гиперкератоз.</p>\r\n<p>3. Размножение Propionibacterium acnes (P. acnes).</p>\r\n<p>4. <a href=\"/symptom/vospalenie/\" title=\"Перейти на страницу симптома воспаление\">Воспаление</a>.</p>",
"diagnostics": "<p>Диагноз <a href=\"/symptom/ugri/\" title=\"Перейти на страницу симптома Угри\">акне</a> основывается на данных клинической картины. При проведении обследования следует учитывать системные призна- ки гиперандрогенемии (нерегулярный менструальный цикл, гипертрофия клитора и изменение вторичных половых признаков), а также позднее ме- нархе. Резистентные к терапии формы <a href=\"/symptom/ugri/\" title=\"Перейти на страницу симптома Угри\">акне</a> могут свидетельствовать о нали- чии таких эндокринных расстройств, как синдром поликистоза яичников, гиперплазия гипофиза или вирилизирующие опухоли, в связи с чем при об- следовании необходимо учитывать такие симптомы, как аменорея, гипер- менорея, олигоменорея, <a href=\"/symptom/besplodie/\" title=\"Перейти на страницу симптома Бесплодие\">бесплодие</a> и метаболический синдром. При <a href=\"/symptom/ugri/\" title=\"Перейти на страницу симптома Угри\">акне</a> среднего детского возраста показано обследование для исклю- чения врожденной гиперплазии надпочечников и андрогенпродуцирующих опухолей. Лабораторные исследования ■ определение уровня свободного тестостерона, дегидроэпиандростерона сульфата, лютеинизирующего гормона, фолликулостимулирующего гор- мона; ■ проведение теста на толерантность к глюкозе. По показаниям назначаются консультации других специалистов: эндокри- нологов или гинекологов-эндокринологов.</p>",
"treatment": "<p>При легкой степени тяжести угревой сыпи применяют препараты для наружной (местной) терапии: кремы, гели, мази, лосьоны и т.п., содержащие различные активные вещества, препятствующие образованию комедонов или разрушающие их, уменьшающие образование кожного сала и <a href=\"/symptom/vospalenie/\" title=\"Перейти на страницу симптома воспаление\">воспаление</a>. К таким средствам, в частности, относятся бензоилпероксид (OXY5, OXY10), третиноин (Айрол Рош, Ретин-А) и азелаиновая кислота (Скинорен).</p>\r\n<p>При средней и тяжелой форме лечение проводится как наружными средствами, так и приемом препаратов внутрь. В ряде случаев необходимо назначение антибиотиков (например, тетрациклинов). При гормональных нарушениях могут применяться половые гормоны.</p>\r\n<p>Для очистки кожи от угрей проводят пилинг — удаление поверхностных слоев кожи с помощью слабых растворов кислот (химический пилинг) или механической шлифовки (дермабразия). Также для борьбы с угревой сыпью применяется чистка лица, особый щипковый массаж лица, поверхностная криотерапия, и даже лазеротерапия на отдельные невоспаленные <a href=\"/symptom/ugri/\" title=\"Перейти на страницу симптома Угри\">угри</a>.</p>\r\n<p>Хирургические манипуляции имеют очень ограниченное применение при угревой болезни. Вскрытие кистозных полостей противопоказано, поскольку оно приводит к формированию стойких рубцов. Иногда при сильном нагноении угрей применяется обкалывание очагов специальными препаратами.</p>\r\n<p>Угревая <a href=\"/symptom/syp/\" title=\"Перейти на страницу симптома Сыпь\">сыпь</a> достаточно хорошо поддается лечению. В большинстве случаев удается добиться полного исчезновения воспалительных элементов и предотвратить образование новых угрей на период от года до нескольких лет (а иногда, и навсегда).</p>",
"prevention": "<p>Для профилактики угревой сыпи необходим регулярный уход за кожей. Людям, склонным к этому заболеванию, не рекомендуется использовать жирные кремы, масла и мази, содержащие ланолин и вазелин. Из косметических средств следует выбирать те, которые имеют маркировку “non-comedogenic” (не-комедогенная), то есть не содержит ингредиентов, способствующих образованию угрей.</p>",
"clinical_picture": "<p><a href=\"/symptom/ugri/\" title=\"Перейти на страницу симптома Угри\">Акне</a> локализуются преимущественно на коже лица, верхних конечно- стей, верхней части груди и спины и проявляются папулами, пустулами и уз- лами, а также открытыми и закрытыми комедонами. Комедон — клиническое проявление скопления кожного сала и кератина в волосяном фолликуле. Выделяют закрытые и открытые <a href=\"/symptom/ugri/\" title=\"Перейти на страницу симптома Угри\">комедоны</a>. Закры- тый комедон отличается от открытого тем, что кератиновые массы не так компактны, а отверстие волосяного фолликула узкое. Папулезные <a href=\"/symptom/ugri/\" title=\"Перейти на страницу симптома Угри\">акне</a> представляют собой воспалительные узелки, имеющие коническую или полушаровидную форму и величину до 2—4 мм в диаметре. Пустулезные <a href=\"/symptom/ugri/\" title=\"Перейти на страницу симптома Угри\">акне</a> могут возникать первично или трансформироваться из папулезных угрей. Узловатые <a href=\"/symptom/ugri/\" title=\"Перейти на страницу симптома Угри\">акне</a> характеризуются развитием узлов на коже себорейных об- ластей. У больных конглобатными <a href=\"/symptom/ugri/\" title=\"Перейти на страницу симптома Угри\">акне</a> помимо комедонов и папуло-пусту- лезных угрей возникают многочисленные крупные узлы, локализующиеся преимущественно на коже спины и задней поверхности шеи. Консистенция узлов вначале плотная, но постепенно они размягчаются. Кожа над ними при- обретает синюшно-розовый цвет, истончается, и в ней появляются отверстия, из которых выделяется гной. Часть отдельно расположенных узлов сливается в массивные инфильтраты с многочисленными фистулезными ходами, гной- ными отверстиями и полостями, заполненными вялыми, студнеобразными грануляциями, процесс может приобретать распространенный характер. После разрешения <a href=\"/symptom/ugri/\" title=\"Перейти на страницу симптома Угри\">акне</a> нередко остаются атрофические, реже — гипер- трофические и келоидные рубцы.</p>",
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