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"code": "L27",
"name": "Дерматит, вызванный веществами, принятыми внутрь",
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"lead": "поражения кожи, возникающие как реакция на прием внутрь, вдыхание или парентеральное введение веществ, являющихся аллергенами и одновременно обладающих токсическим действием (химические агенты, некоторые лекарства и пищевые продукты).",
"description": "В отличие от обычного течения аллергического дерматита, причинный фактор заболевания токсикодермии не нуждается в контакте с кожным покровом больного. Попадая в человеческий организм, аллерген различными путями, всасывается через кровь и далее по кровеносным сосудам попадает в кожный покров. При токсикодермии влияние аллергена на кожный покров происходит «изнутри» организма. ",
"etiology": "<p align=\"justify\">Химическое вещество, являющееся причинным фактором развития токсикодермии, может попасть в организм различными путями: при вдыхании (ингаляционно), с пищей (алиментарно), путем лекарственных инъекций или при всасывании после нанесения на кожу.</p>\r\n<p align=\"justify\">По причине возникновения современная дерматология выделяет 4 этиологические группы токсикодермий: медикаментозные, алиментарные, профессиональные и аутотоксические.</p>\r\n<full></full>\r\n<p align=\"justify\">Медикаментозная токсикодермия развивается в результате приема лекарственных препаратов и встречается в подавляющем большинстве случаев. Она может быть вызвана сульфаниламидами (сульфадимезин, норсульфазол), антибиотиками (биомицин, пенициллин, неомицин, стрептомицин), барбитуратами, витаминами группы В, сыворотками и др.</p>\r\n<p align=\"justify\">Алиментарная токсикодермия бывает связана как с употреблением самого пищевого продукта, так и с различными добавками, входящими в его состав (красители, разрыхлители, консерванты). По распространенности она стоит на втором месте после медикаментозной токсикодермии.</p>\r\n<p align=\"justify\">Профессиональная токсикодермия обусловлена деятельностью, связанной с различными химическими соединениями. Наиболее активными антигенами являются вещества, содержащие бензольное кольцо с аминогруппой или хлором.</p>\r\n<p align=\"justify\">Аутотоксическая токсикодермия возникает при воздействии аллергенов и токсинов, образующихся в организме в результате нарушения обмена веществ. Это может наблюдаться при хронических заболеваниях ЖКТ (гастрит, язва желудка, гепатит, панкреатит, язвенная болезнь) и почек (пиелонефрит, гломерулонефрит, гидронефроз, хроническая почечная недостаточность), злокачественных процессах (рак легких, аденокарцинома почки, рак толстого кишечника) и т. п. Аутотоксическая токсикодермия может принимать хроническое течение.</p>",
"pathogenesis": "<p>Гиперергическая реакция замедленного или немедленного типа, их комбинация часто в сочетании с токсикозом.<br /><br /></p>",
"diagnostics": "<p>Основой для постановки точного диагноза токсикодермия служит характерная клиническая картина.</p>",
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"code": "L26",
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5
],
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"lead": "тяжелое инфекционное поражение кожи новорожденных, представляющее собой злокачественный вариант пузырчатки. ",
"description": "крайне тяжелое заболевание кожи",
"etiology": "<p>В большинстве случаев эксфолиативный дерматит Риттера обусловлен инфицированием кожи новорожденного золотистым стафилококком. Отдельные авторы указывают на выявление у заболевших детей смешанной стафилококковой и стрептококковой инфекции. Заражение новорожденного может происходить от матери или медицинского персонала. Развитию заболевания способствуют незрелость барьерной функций кожи и иммунных механизмов у детей первого месяца жизни. В дерматологии случаи эксфолиативного дерматита Риттера встречались и у детей более старшего возраста, получающих иммуносупрессивную терапию.</p>",
"pathogenesis": "",
"diagnostics": "<p>При подозрении на эксфолиативный дерматит Риттера необходимо обратиться к инфекционисту и дерматологу. Диагноз ставится на основании клинической картины и наличия симптома Никольского. Обязательно делают бактериологический посев отделяемого из пузырей и эрозий. Кроме того, проводят анализ на сифилис.</p>\r\n<p>Заболевание дифференцируют с ожогами, пузырчаткой, буллезным эпидермолизом, врожденной ихтиозиформной эритродермией и десквамативной эритродермией Лейнера, врожденным сифилисом.</p>",
"treatment": "<p>Лечат эксфолиативный дерматит антибиотиками, которые принимают внутрь и наружно в виде мази. Для снятия воспаления назначают мази и кремы с кортикостероидами. Обязательно назначают витамины С и группы В.</p>\r\n<p>В случае сепсиса внутривенно вводят плазму и свежую кровь. Ребенку также показано обильное питье, чтобы предотвратить обезвоживание.</p>\r\n<p>Ребенка, страдающего эксфолиативным дерматитом, не одевают, так как одежда может причинить ему боль и неудобства. Его не туго заворачивают в стерильные мягкие пеленки, посыпанные тальком или оксидом цинка с добавлением сульфаниламидов или антибиотиков. Но лучше помещать таких детей в кювезы, в которых можно поддерживать оптимальную температуру и влажность.</p>",
"prevention": "<p>Профилактика эксфолиативного дерматита Риттера заключается в регулярном осмотре персонала родильных домов и рожениц на предмет бактерионосительства золотистого стафилококка. Палаты в роддомах и родильных отделениях больниц необходимо регулярно кварцевать. Нельзя пренебрегать и влажной уборкой в этих помещениях. Врачи и медсестры при контакте с новорожденными должны надевать марлевые повязки.</p>\r\n<p>Важно соблюдать гигиену и в местах, где бывает новорожденный ребенок после выписки из роддома.</p>",
"clinical_picture": "<p>Эксфолиативный дерматит Риттера развивается в первые недели жизни ребенка. Сначала возле рта появляется <a href=\"/symptom/pokrasnenie_kozhi/\" title=\"Перейти на страницу симптома Покраснение кожи\">покраснение</a>. Место покраснения отекает и воспаляется. Через некоторое время <a href=\"/symptom/vospalenie/\" title=\"Перейти на страницу симптома воспаление\">воспаление</a> переходит на складки шеи, в область пупка, гениталий и ануса. На месте покраснения образуются большие пузыри, которые довольно скоро вскрываются с образованием мокнущих эрозий. Для этой стадии характерен симптом Никольского – при оттягивании эпидермиса вокруг <a href=\"/symptom/izmeneniya_struktury_kozhi/\" title=\"Перейти на страницу симптома Изменения структуры кожи\">эрозии</a> пинцетом, он легко отслаивается даже там, где кожа здоровая. Более того, даже при потирании здоровой кожи могут обнажаться ее более глубокие слои.</p>\r\n<p>Кроме кожных проявлений у ребенка повышается температура, возможны <a href=\"/symptom/toshnota/\" title=\"Перейти на страницу симптома Тошнота\">тошнота</a>, <a href=\"/symptom/rvota/\" title=\"Перейти на страницу симптома Рвота\">рвота</a>, <a href=\"/symptom/diareya/\" title=\"Перейти на страницу симптома Диарея\">понос</a>. Ребенок отказывается от еды и теряет вес.</p>\r\n<p>В некоторых случаях патологический процесс распространяется по всему телу ребенка за 2-3 дня.</p>",
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"etiology": "<p>Главной причиной, вызывающей дерматит любого вида, является соприкосновение кожи с любыми раздражителями из окружающей среды. </p>\r\n<p>Вещества, наиболее часто вызывающие контактный дерматит: </p>\r\n<ul>\r\n<li>никель – металл, широко применяемый для изготовления монет, украшений, пряжек, посуды, а также зубных протезов; </li>\r\n<li>латекс – используется для изготовления презервативов, резиновых перчаток, детских пустышек, сосок и игрушек; </li>\r\n<li>лекарственные кремы и мази, в состав которых входят антибиотики, гормоны; </li>\r\n<li>косметические средства, предназначенные для ухода за кожей, и декоративная косметика; </li>\r\n<li>бытовая химия (стиральные порошки, средства для мыться посуды и др.); </li>\r\n<li>синтетические материалы, используемые для изготовления одежды; </li>\r\n<li>различные вещества, такие как краски, клей, чернила и др. </li>\r\n</ul>",
"pathogenesis": "<p>Простой контактный дерматит обусловлен прямым повреждением клеток верхнего слоя кожи - эпидермиса. Из поврежденных клеток высвобождаются различные биологически активны вещества (медиаторы воспаления и факторы хемотаксиса), вызывающие расширение сосудов (эритема), выход жидкости в дерму и эпидермис (отек и волдырь) и клеточную инфильтрацию. Наблюдается внеклеточный и внутриклеточный отек эпидермиса. </p>\r\n<p>Простой контактный дерматит, вызванный однократным воздействием едкого вещества, например сильной кислоты или щелочи, на кожу, называют химическим ожогом . При химическом ожоге воспаление развивается в течение нескольких минут и часов. Белее легкая форма простого контактного дерматита возникает при многократном воздействии слабого раздражающего вещества, например мыла или моющего средства, и проявляется через несколько недель или месяцев после первого контакта с этим веществом. У больных атопическими заболеваниями , особенно диффузным нейродермитом , кожа более чувствительна к действию раздражающих веществ. </p>",
"diagnostics": "<p>Диагноз ставится на основании дерматологической симптоматики. Проводятся аппликационные кожные пробы (не ранее 2 недель после купирования симптомов дерматита), гистологическое исследование кожного покрова.</p>",
"treatment": "<p> </p>\r\n<p>Лечение заболевания необходимо начинать с исключения контакта кожи с аллергеном. Если развитие контактного дерматита связано с профессиональной деятельностью пациента, то необходимо постоянное использование защитных средств (перчатки, маски, защитные костюмы). </p>\r\n<p>Больным, у которых выявлена аллергическая реакция на никель, рекомендуется соблюдение диеты, ограничивающей продукты, содержащие это вещество (геркулес, греча, пшено, соя, чечевица, томаты, семечки, шоколад, какао). </p>\r\n<p>Больным рекомендуется в течение нескольких дней принимать антигистаминные средства. </p>\r\n<p>При выраженном воспалительном процессе на пораженном участке кожи пациентам назначается местное применение мазей, кремов или лосьонов, содержащих кортикостероиды. Гормональные мази наносятся на чистую кожу 1–2 раза в день тонким слоем. Длительность курса лечения обычно не превышает 2 недель. </p>\r\n<p>При обширных поражениях, а также тяжелых реакциях организма на контакт с аллергеном, врач может назначить системные кортикостероидные препараты для приема внутрь</p>",
"prevention": "<p>Профилактика этого заболевания заключается только в исключении контакта кожи с веществами, вызывающими аллергическую реакцию. При случайном попадании на кожу известного раздражителя необходимо немедленно тщательно смыть его под проточной водой с мылом. </p>\r\n<p>При аллергии на бытовую химию (стиральные порошки, средства для ухода за домом) следует использовать специальные гипоаллергенные средства, но даже при их применении необходимо использовать защитные перчатки. Одежду следует выбирать из натуральных материалов. Рекомендуется отдавать предпочтение украшениям из благородных металлов (золото и серебро). </p>",
"clinical_picture": "<p>В зависимости от характера вещества, воздействующего на кожу, и индивидуальных особенностей проницаемости эпидермиса может развиться один из трех вариантов острого контактного дерматита: эритематозный, буллезный или некротический. </p>\r\n<p>Эритематозный дерматит проявляется покраснением и отеком контактировавшего с раздражителем участка кожи. Болезненность и зуд выражены слабо. Возможна сухость кожи и появление на ней трещин. </p>\r\n<p>Буллезный вариант простого контактного дерматита представлен пузырями различного размера, заполненными прозрачной жидкостью. Пузыри появляются на гиперемированном фоне и лопаются с образованием эрозий. Характерна болезненность, чувство жара или жжения. </p>\r\n<p>Некротический дерматит возникает при воздействии едких веществ (кислот или щелочей) и характеризуется образованием изъязвлений, поверхность которых покрыта струпом. Выражен болевой синдром. После того, как происходит заживление язв, на коже остаются рубцы. </p>\r\n<p>Хроническая форма простого контактного дерматита развивается при многократном воздействии слабого раздражителя. Наиболее часто поражается кожа рук. Заболевание, как правило, связано с использованием средств бытовой химии или профессиональной деятельностью. Хронический дерматит характеризуется усилением рисунка кожи, застойной гиперемией (покраснением), инфильтрацией, сухостью кожи и гиперкератозом (утолщением кожи). В некоторых случаях наблюдаются атрофические процессы в коже. Субъективные ощущения слабо выражены и мало беспокоят больного. </p>",
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"lead": " воспалительная реакция кожи, возникающая в ответ на прямое воздействие раздражающих веществ (щелочей, кислот, моющих средств, растворителей, хлорной извести и т. п.).",
"description": "Не заразное кожное заболевание",
"etiology": "<p>Простой дерматит возникает от действия химических (концентрированные кислоты, щелочи), физических (высокая или <a href=\"/symptom/ponizhennaya_temperatura_32-35/\" title=\"Перейти на страницу симптома Пониженная температура 32-35°\">низкая температура</a>, лучевое воздействие), механических (давление, трение) и биологических факторов.</p>",
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"diagnostics": "<p>Диагноз простого контактного дерматита устанавливается дерматологом по характерным клиническим проявлениям и четко прослеживающейся связи возникновения симптомов с воздействием на кожу раздражающего вещества. При подозрении на аллергический характер контактного дерматита необходима консультация аллерголога и проведение накожных аллергических проб. Появление признаков гнойного воспаления говорит о инфицированности места поражения и является показанием для бакпосева отделяемого с обязательным составлением антибиотикограммы.</p>",
"treatment": "<p align=\"justify\">Основной принцип лечения — это определение и устранение причины появления простого контактного дерматита.</p>\r\n<p align=\"justify\">Эритематозный дерматит обычно не требует лечения и самостоятельно проходит при устранении причинного фактора. Для уменьшения симптомов воспаления возможно применение противовоспалительных присыпок или кремов. При буллезном варианте производят прокалывание крупных пузырей без удаления их покрышки. Для профилактики вторичного инфицирования смазывают область пузырей раствором перманганата калия или анилиновых красителей. В лечении некротического дерматита применяют заживляющие мази.</p>\r\n<p align=\"justify\">В тяжелых случаях острого простого контактного дерматита возможно местное применение глюкокортикоидных мазей и системное назначение малых доз кортикостероидов. Присоединение вторичной инфекции является показанием для проведения антибиотикотерапии.</p>",
"prevention": "<p>При хроническом варианте дерматита рекомендовано регулярное использование смягчающих мазей и кремов, при поражении рук — применение защитных перчаток.</p>",
"clinical_picture": "<p align=\"justify\">Клиническая дерматология выделяет острые и хронические формы простого контактного дерматита. В зависимости от характера вещества, воздействующего на кожу, и индивидуальных особенностей проницаемости эпидермиса может развиться один из трех вариантов острого контактного дерматита: эритематозный, буллезный или некротический.</p>\r\n<p align=\"justify\">Эритематозный дерматит проявляется покраснением и отеком контактировавшего с раздражителем участка кожи. Болезненность и <a href=\"/symptom/zud/\" title=\"Перейти на страницу симптома Зуд\">зуд</a> выражены слабо. Возможна <a href=\"/symptom/izmeneniya_struktury_kozhi/\" title=\"Перейти на страницу симптома Изменения структуры кожи\">сухость кожи</a> и появление на ней трещин.</p>\r\n<p align=\"justify\">Буллезный вариант простого контактного дерматита представлен пузырями различного размера, наполненными прозрачной жидкостью. Пузыри появляются на гиперемированном фоне и лопаются с образованием эрозий. Характерна болезненность, чувство жара или жжения.</p>\r\n<p align=\"justify\">Некротический дерматит возникает при воздействии едких веществ и характеризуется образованием изъязвлений, поверхность которых покрыта струпом. Выражен болевой синдром. После того, как происходит заживление язв, на коже остаются рубцы.</p>\r\n<p align=\"justify\">Хроническая форма простого контактного дерматита развивается при многократном воздействии слабого раздражителя. Наиболее часто поражается кожа рук. Заболевание, как правило, связано с использованием средств бытовой химии или профессиональной деятельностью. Хронический дерматит характеризуется усилением рисунка кожи, застойной гиперемией, инфильтрацией, сухостью кожи и гиперкератозом. В некоторых случаях наблюдаются атрофические процессы в коже. Субъективные ощущения слабо выражены и мало беспокоят больного.</p>",
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