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"pathogenesis": "<p>В патогенезе АтД важную роль играет наследственная детерминированность, приводящая к нарушению состояния кожного барьера, дефектам иммунной системы (стимуляция Th2-клеток с последующей гиперпродукцией IgE), гиперчувствительности к аллергенам и неспецифическим раздражителям, колонизации патогенными микроорганизмами (Staphylococcus aureus, Malassezia furfur), а также дисбалансу вегетативной нервной системы с повышением продукции медиаторов воспаления.</p>",
"diagnostics": "<p>Обязательные лабораторные исследования:</p>\r\n<p>1. Клинический анализ крови.</p>\r\n<p>2. Клинический анализ мочи.</p>\r\n<p>3. Биохимический анализ крови.</p>\r\n<p> </p>\r\n<p>Дополнительные лабораторные исследования:</p>\r\n<p>1. Определение уровня общего IgE в сыворотке крови методом иммуноферментного анализа.</p>\r\n<p>2. Аллергологическое исследование сыворотки крови — определение специфических IgE к пищевым, бытовым антигенам, антигенам растительного, животного и химического происхождения.</p>\r\n<p> </p>",
"treatment": "<p>Лечение атопического дерматита должно преследовать несколько целей:</p>\r\n<ul>\r\n<li>элиминационная терапия – прекращение контакта больного с аллергеном и прием противоаллергических препаратов;</li>\r\n<li>базисная терапия – подавление воспалительного процесса в коже;</li>\r\n<li>лечение сопутствующих заболеваний;</li>\r\n<li>коррекция иммунных нарушений, укрепление иммунитета.</li>\r\n</ul>\r\n<p>Лечение атопического дерматита проходит только под контролем врача, который подбирает необходимые препараты и регулирует длительность их применения.</p>\r\n<p>Противоаллергические средства внутреннего приема назначаются для блокады воздействия гистамина на организм, вследствие этого происходит торможение воспалительных процессов в коже. Прием антигистаминных препаратов может быть длительным (от 2 недель до 4 месяцев), возможна комбинация средств различных поколений. Стоит отметить, что существует 3 поколения лекарственных препаратов после аллергии, и с каждым последующим поколением уменьшается вероятность привыкания, количество и сила побочных эффектов и увеличивается продолжительность действия.</p>\r\n<p>Препараты после аллергии принимают 1 раз в день. При длительном приеме возможно чередование нескольких препаратов по 1-2 месяцам. Так как даже препараты последнего поколения нередко вызывают <a title=\"Перейти на страницу симптома Сонливость\" href=\"/symptom/sonlivost/\">сонливость</a>, их предпочтительно принимать перед сном.</p>\r\n<p>Антигистаминной активностью обладают препараты, в составе которых присутствуют следующие вещества:</p>\r\n<ul>\r\n<li>первое поколение: клемастин, прометазин, хлорфенамин, диметинден, мебгидролин, дифенгидрамин, хлоропирамин, меклизин;</li>\r\n<li>второе поколение: азеластин, астемизол, акривастин, эбасин, цетризин, терфенадин, лоратадин;</li>\r\n<li>третье поколение: сехифенадин, хифенадин, фексофенадин, дезлоратадин, левоцетризин.</li>\r\n</ul>\r\n<p>Для лечения атопического дерматита обычно используются антигистаминные препараты в форме таблеток или растворов для инъекций.</p>\r\n<p>Лечение атопического дерматита преследует несколько целей: избавление пациента от симптомов, главным из которых является <a title=\"Перейти на страницу симптома Зуд\" href=\"/symptom/zud/\">зуд</a>, и профилактика обострений. Основная часть терапии представляет собой использование наружных средств, таких как:</p>\r\n<ul>\r\n<li>мази – препараты, изготавливаемые на основе жиров или жироподобных веществ и лечебного вещества, обладающие смягчающими, согревающими и питательными эффектами;</li>\r\n<li>кремы – препараты на водной основе, с меньшим содержанием лечебных веществ, лучшей впитываемостью и охлаждающим эффектом;</li>\r\n<li>гели – смеси из высокомолекулярных и низкомолекулярных веществ;</li>\r\n<li>пасты – смеси равных частей мази и порошка, обладают антиэкссудативным эффектом;</li>\r\n<li>примочки – водный раствор противовоспалительных, противозудных, дезинфицирующих веществ, часто средств фитотерапии. Благодаря способу применения примочка впитывает <a title=\"Перейти на страницу симптома Выпот\" href=\"/symptom/vypot/\">экссудат</a> из эрозивных участков и обладает подсушивающим эффектом;</li>\r\n<li>болтушки (взбалтываемые взсеси) – смесь растительных масел либо воды и водно-спиртового раствора с добавлением порошка. Оказывают антиэкссудативное и противозудное действия;</li>\r\n<li>пластыри – используются преимущественно в хроническом периоде в местах утолщения кожи. Представляют собой смесь воска, полимеров, смол, окиси цинка, натуральных масел.</li>\r\n</ul>\r\n<p>Противовоспалительной и противозудной активностью обладают глюкокортикостероидные препараты, нестероидные противовоспалительные средства (например, с пимекролимусом, раствором тиосульфата натрия), жидкость Бурова, свинцовая примочка, нитрат серебра, отвары и настои череды лекарственных трав. К наружной фитотерапии рекомендуется прибегать в хронический период атопического дерматита. Такие растения и их части, как вероника лекарственная, березовые почки, огуречник, кора дуба, листья груши, базилик, цветы ромашки и иван-чая, могут снять <a title=\"Перейти на страницу симптома Зуд\" href=\"/symptom/zud/\">зуд</a> и <a title=\"Перейти на страницу симптома Покраснение кожи\" href=\"/symptom/pokrasnenie_kozhi/\">покраснение</a>, уменьшить <a title=\"Перейти на страницу симптома воспаление\" href=\"/symptom/vospalenie/\">воспаление</a> и ускорить заживление кожи. Растительные компоненты входят в большинство наружных препаратов, предназначенных для лечения атопического дерматита, а также их можно использовать для лечебных ванн и примочек.</p>\r\n<p>При инфильтрации и утолщении кожи применяют рассасывающие (редуцирующие) мази, пластыри и кремы с нафталанской нефтью, серой, дегтем, ихтиолом, метилурациловой мазью. В начале лечения назначаются более слабые вещества в малой дозе. Постепенно концентрацию действующих веществ увеличивают, а слабые компоненты заменяют более мощными.</p>\r\n<p> </p>",
"prevention": "<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;\">К профилактике заболевания относят:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">обучение пациента и членов его семьи правилам ухода за кожей, грамотному использованию лекарств и пр.;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">консультирование по поводу коррекции факторов риска развития неинфекционных заболеваний;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">проведение мероприятий по сохранению беременности у пациенток с атопическим дерматитом, начиная с первой половины срока беременности;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">соблюдение диеты кормящей матерью и новорождённым;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">лечение сопутствующих заболеваний;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">длительный приём \"Дезлоратадина\".</span></p>\r\n</li>\r\n</ul>",
"clinical_picture": "<p>Экссудативная форма наблюдается преимущественно у детей грудного возраста, характеризуется симметричными эритематозными, папуловезикулезными высыпаниями на коже лица и волосистой части головы, отмеча- ется экссудация с образованием чешуйкокорок. В дальнейшем <a title=\"Перейти на страницу симптома Сыпь\" href=\"/symptom/syp/\">высыпания</a> распространяются на кожу наружной поверхности голеней, предплечий, туловища и ягодиц, а также могут появляться в естественных складках кожи. Дермографизм красный или смешанный. Субъективно отмечается <a title=\"Перейти на страницу симптома Зуд\" href=\"/symptom/zud/\">зуд</a> кожных покровов различной интенсивности. Эритематозно-сквамозная форма чаще наблюдается у детей в возрасте от 1,5 до 3 лет, характеризуется наличием зудящих узелков, эрозий и экскориаций, а также незначительной эритемой и инфильтрацией в области высыпаний на коже туловища, верхних и нижних конечностей, реже — на коже лица. Дермографизм розовый или смешанный. Эритематозно-сквамозная форма с лихенификацией наблюдается у детей в возрасте от 3 лет и взрослых лиц, характеризуется эритематозно-сквамозными и папулезными очагами. Кожа сухая, лихенифицированная, с большим количеством экскориаций и мелкопластинчатых чешуек. <a title=\"Перейти на страницу симптома Сыпь\" href=\"/symptom/syp/\">Высыпания</a> локализуются преимущественно на сгибательной поверхности конечностей, тыльной поверхности кистей, передней и боковой поверхностях шеи. 43 Атопический дерматит Наблюдаются гиперпигментация кожи периорбитальной области, появ- ление складки под нижним веком (линии Денни — Моргана). Отмечается повышенная <a title=\"Перейти на страницу симптома Изменения структуры кожи\" href=\"/symptom/izmeneniya_struktury_kozhi/\">сухость кожи</a>. Дермографизм белый стойкий или смешанный. <a title=\"Перейти на страницу симптома Зуд\" href=\"/symptom/zud/\">Зуд</a> выраженный, постоянный, реже — приступообразный. Лихеноидная форма наблюдается чаще всего у подростков и характеризуется сухостью, выраженным рисунком, отечностью и инфильтрацией кожных покровов. Имеются крупные сливающиеся очаги лихенизации кожи. <a title=\"Перейти на страницу симптома Зуд\" href=\"/symptom/zud/\">Зуд</a> упорный, стойкий. Пруригинозная форма наблюдается относительно редко, чаще у взрослых лиц и характеризуется высыпаниями в виде множественных изолированных плотных отечных папул, на вершинах которых могут появляться мелкие пузырьки. Очаги поражения могут иметь распространенный характер с преимущественной локализацией на коже конечностей. Дермографизм выраженный белый стойкий. Наиболее тяжелым проявлением АтД является эритродермия, которая характеризуется универсальным поражением кожных покровов в виде эрите- мы, инфильтрации, лихенификации, шелушения и сопровождается симптомами интоксикации и нарушением терморегуляции (<a title=\"Перейти на страницу симптома Высокая температура 38-42° \" href=\"/symptom/vysokaya_temperatura_38-42/\">гипертермия</a>, <a title=\"Перейти на страницу симптома Озноб\" href=\"/symptom/oznob/\">озноб</a>, <a title=\"Перейти на страницу симптома Увеличение лимфатических узлов\" href=\"/symptom/uvelichenie_limfaticheskih_uzlov/\">лимфаденопатия</a>). </p>",
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5409
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},
"code": "L02",
"name": "Абсцесс кожи, фурункул и карбункул",
"icd_name": "Абсцесс кожи, фурункул и карбункул",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
3
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"periodicity": 1,
"slug": "l02_abscess_kozhi_furunkul_i_karbunkul",
"lead": "гнойно-некротическое воспалительное заболевание сальной железы и окружающей соединительной ткани, вызываемое гноеродными бактериями",
"description": "Отличительная особенность фурункулов от других видов воспаления кожи в том, что они не могут возникать там, где не растут волосы (ладони, подошвы), а появляются только в тех местах, где имеются волосяные фолликулы. \r\nНаиболее частая локализация: лицо, затылок, задняя поверхность шеи, поясница, паховые области, ягодицы, руки, ноги.",
"etiology": "<p style=\"margin-top: 10px; margin-bottom: 10px;\"><span style=\"color: rgb(51, 51, 51); -webkit-text-size-adjust: 100%; background-color: rgba(255, 255, 255, 0);\">Эти гнойные заболевания возникают из за нарушения целостности защитных барьеров организма и проникновения в него патогенных агентов (бактерий или вирусов). Бактерии, обычно, являются частью нормальной флоры организма, но при определенных условиях и повышении их количества они могут вызывать <a href=\"/symptom/vospalenie/\" title=\"Перейти на страницу симптома воспаление\">воспаление</a>. Большое количество таких организмов существуют на наших слизистых оболочках: полость рта, носовая полость, слизистая глаз, половых органов, а часть находится в нашем кишечнике, как в толстом, так и тонком. </span></p><p style=\"margin-top: 10px; margin-bottom: 10px;\"><span style=\"color: rgb(51, 51, 51); -webkit-text-size-adjust: 100%; background-color: rgba(255, 255, 255, 0);\">Это золотистый стафилококк, протей, кишечная палочка.</span></p>",
"pathogenesis": "<p><span style=\"color: rgb(51, 51, 51); -webkit-text-size-adjust: 100%; background-color: rgba(255, 255, 255, 0);\">Воспалительные изменения кожи могут появится на любом участке тела. Это происходит вследствие нарушения целостности защитного барьера кожи человека — эпителия, при травмах или порезах. Патогенная флора проникает в стерильные условия организма и начинает активно размножаться. Организм ограничивает данный участок от здоровой ткани валом из воспалительных клеток, а когда этого барьера не хватает, возникает капсула, в которой и формируется <a href=\"/symptom/vospalenie/\" title=\"Перейти на страницу симптома воспаление\">воспаление</a>. </span><br></p>",
"diagnostics": "Визуальный осмотр. Микроскопическое исследование отделяемого. Бактериологическое исследование отделяемого.",
"treatment": "Антибактериальная терапия наружная. Антибактериальная терапия системная. Противовоспалительные средства. Физиотерапевтическое лечение.",
"prevention": "<p><br></p>",
"clinical_picture": "<p>Для фурункула свойственно появление на коже болезненной фолликулярной <a href=\"/symptom/pustuly/\" title=\"Перейти на страницу симптома Пустулы\">пустулы</a> на фоне красной эритемы с некрозом в центре (т. н. стержень фурункула). После отторжения некротической ткани происходит заживление путём рубцевания. Наиболее часто фурункул возникает на коже шеи, затылка, лица, спины, бедрах. Появление фурункулов в разных стадиях развития называется фурункулёзом, а гнойно-некротическое <a href=\"/symptom/vospalenie/\" title=\"Перейти на страницу симптома воспаление\">воспаление</a> кожи и подкожной клетчатки вокруг группы волосяных мешочков и сальных желёз — карбункулом. При нахождении фурункула на лице возможны тяжёлые осложнения (гнойный менингит, <a href=\"/symptom/sistemnoe_vospalenie/\" title=\"Перейти на страницу симптома Системное воспаление\">сепсис</a>).</p>",
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"image_alt": "Фурункул",
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5083
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},
"code": "L02",
"name": "Абсцесс кожи, фурункул и карбункул",
"icd_name": "Абсцесс кожи, фурункул и карбункул",
"gender": 0,
"age_min": 0,
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"cause": [
3
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"periodicity": 1,
"slug": "l02_abscess_kozhi_furunkul_i_karbunkul",
"lead": "гнойно-некротическое воспалительное заболевание сальной железы и окружающей соединительной ткани, вызываемое гноеродными бактериями",
"description": "Отличительная особенность фурункулов от других видов воспаления кожи в том, что они не могут возникать там, где не растут волосы (ладони, подошвы), а появляются только в тех местах, где имеются волосяные фолликулы. \r\nНаиболее частая локализация: лицо, затылок, задняя поверхность шеи, поясница, паховые области, ягодицы, руки, ноги.",
"etiology": "<p style=\"margin-top: 10px; margin-bottom: 10px;\"><span style=\"color: rgb(51, 51, 51); -webkit-text-size-adjust: 100%; background-color: rgba(255, 255, 255, 0);\">Эти гнойные заболевания возникают из за нарушения целостности защитных барьеров организма и проникновения в него патогенных агентов (бактерий или вирусов). Бактерии, обычно, являются частью нормальной флоры организма, но при определенных условиях и повышении их количества они могут вызывать <a href=\"/symptom/vospalenie/\" title=\"Перейти на страницу симптома воспаление\">воспаление</a>. Большое количество таких организмов существуют на наших слизистых оболочках: полость рта, носовая полость, слизистая глаз, половых органов, а часть находится в нашем кишечнике, как в толстом, так и тонком. </span></p><p style=\"margin-top: 10px; margin-bottom: 10px;\"><span style=\"color: rgb(51, 51, 51); -webkit-text-size-adjust: 100%; background-color: rgba(255, 255, 255, 0);\">Это золотистый стафилококк, протей, кишечная палочка.</span></p>",
"pathogenesis": "<p><span style=\"color: rgb(51, 51, 51); -webkit-text-size-adjust: 100%; background-color: rgba(255, 255, 255, 0);\">Воспалительные изменения кожи могут появится на любом участке тела. Это происходит вследствие нарушения целостности защитного барьера кожи человека — эпителия, при травмах или порезах. Патогенная флора проникает в стерильные условия организма и начинает активно размножаться. Организм ограничивает данный участок от здоровой ткани валом из воспалительных клеток, а когда этого барьера не хватает, возникает капсула, в которой и формируется <a href=\"/symptom/vospalenie/\" title=\"Перейти на страницу симптома воспаление\">воспаление</a>. </span><br></p>",
"diagnostics": "Визуальный осмотр. Микроскопическое исследование отделяемого. Бактериологическое исследование отделяемого.",
"treatment": "Антибактериальная терапия наружная. Антибактериальная терапия системная. Противовоспалительные средства. Физиотерапевтическое лечение.",
"prevention": "<p><br></p>",
"clinical_picture": "<p>Для фурункула свойственно появление на коже болезненной фолликулярной <a href=\"/symptom/pustuly/\" title=\"Перейти на страницу симптома Пустулы\">пустулы</a> на фоне красной эритемы с некрозом в центре (т. н. стержень фурункула). После отторжения некротической ткани происходит заживление путём рубцевания. Наиболее часто фурункул возникает на коже шеи, затылка, лица, спины, бедрах. Появление фурункулов в разных стадиях развития называется фурункулёзом, а гнойно-некротическое <a href=\"/symptom/vospalenie/\" title=\"Перейти на страницу симптома воспаление\">воспаление</a> кожи и подкожной клетчатки вокруг группы волосяных мешочков и сальных желёз — карбункулом. При нахождении фурункула на лице возможны тяжёлые осложнения (гнойный менингит, <a href=\"/symptom/sistemnoe_vospalenie/\" title=\"Перейти на страницу симптома Системное воспаление\">сепсис</a>).</p>",
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"image_alt": "Фурункул",
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5083
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"name": "Абсцесс кожи, фурункул и карбункул неуточненной локализации",
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"parent": 6717,
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"standards": []
}
]
}
