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"lead": "грибковая инфекция верхнего слоя кожи, вызывающая появление чешуйчатых светлых пятен",
"description": "<p><span id=\"docs-internal-guid-e1c38821-7fff-8990-a068-f240b7c51371\"><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;\">Разноцветный лишай - это </span></span><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">длительно протекающее грибковое заболевание с поражением эпидермиса, которое проявляется появлением на коже пигментированных пятен различного оттенка: желтого, розового, бурого, коричневого и характерным отрубевидным шелушением</span></p>",
"etiology": "<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;\">Разноцветный лишай относится к группе кератомикозов — грибковых заболеваний кожи, затрагивающих только роговой слой эпидермиса и волосяную кутикулу. Его возбудителями являются грибы Malassezia furfur, Pityrpsporum orbiculare и Pityrosporum ovale, причем эти виды отличаются способностью переходит один в другой. Обычно отрубевидный лишай характеризуется малой контагиозностью, то есть заражение происходит лишь в отдельных случаях при тесном и длительном контакте с больным. При этом вероятность заболеть разноцветным лишаем в большей степени обусловлена предрасполагающими факторами.</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;\">Факторами, формирующими в организме благоприятный фон для развития разноцветного лишая, являются: ослабление иммунной системы, повышенная потливость, эндокринные нарушения (сахарный диабет, синдром Иценко-Кушинга, ожирение), изменения в химическом составе пота, вегето-сосудистая дистония, нарушение барьерной функции кожи при частом использовании антибактериальных гелей и мыл, стрессовые воздействия на кожу (чрезмерный загар, солярий и т. п.). Авторы некоторых проводимых в дерматологии исследований указывают на то, что в ряде случаев разноцветный лишай связан с лимфогранулематозом и туберкулезом легких.</span></p>",
"pathogenesis": "<p><span id=\"docs-internal-guid-7c9e89f0-7fff-3af0-0467-2abfdf210054\"><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;\">Разноцветный лишай вызван размножением возбудителей в поверхностных слоях кожи, что приводит к нарушению функционирования меланоцитов — клеток, вырабатывающих пигмент меланин, придающий коже ту или иную окраску. В результате пораженный участок кожи приобретает цвет, отличающийся от остального кожного покрова. Процесс начинается в устье волосяного фолликула, затем пятно постепенной увеличивается в размерах.</span></span></p>",
"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;\">Врачи диагностируют разноцветный лишай по внешнему виду кожи, а также по результатам исследования. С учетом причины заболевания и имеющихся симптомов врач может назначить следующие виды обследования:\u2028</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;\">микроскопическое исследование соскоба кожи;</span></li>\r\n<li><span id=\"docs-internal-guid-07a0fe33-7fff-56f7-6089-faa42b7fac56\"><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;\">исследование с помощью лампы Вуда.</span></span></li>\r\n</ul>",
"treatment": "<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;\">Лечение проводится амбулаторно до полного исчезновения проявлений разноцветного лишая. Применяют местные противогрибковые средства: 5% салициловую мазь, 3-5% салициловый спирт, 5-10% серную мазь, 3-5% резорциновый спирт, тербинафин, бифоназол, клотримазол, циклоперокс, тербинафин, нафтифин и др. </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;\">Распространенный разноцветный лишай или его рецидивирующее течение являются показанием к общему противогрибковому лечению. Оно проводится приемом внутрь таких противогрибковых препаратов, как итраконазол, кетоконазол.</span></p>",
"prevention": "<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;\">Профилактика рецидивов разноцветного лишая включает повторный курс антигрибкового лечения, регулярные водные процедуры и терапию гипергидроза. Для предупреждения заражения близких пациента производят дезинфекцию одежды и белья больного. Людей, находящихся в постоянном контакте с пациентом осматривают с применением люминесцентной лампы.</span></p>",
"clinical_picture": "<p><span id=\"docs-internal-guid-d93e0f30-7fff-95ca-2db1-cac16607d700\"><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;\">Разноцветный лишай обычно протекает бессимптомно. Тем не менее, он вызывает образование на туловище, шее, животе, а иногда и на лице большого количества чешуйчатых пятен желтовато-коричневого, коричневого, оранжево-розового или белого цвета. Пятна могут соединяться и формировать большие очаги. \u2028\u2028На пятна не ложится загар, поэтому в летнее время, когда под действием загара кожа темнеет, пятна могут становиться более заметными. У людей с натуральным темным типом кожи могут наблюдаться более светлые пятна. У людей же с натуральным светлым типом кожи — более темные или светлые пятна.</span></span></p>",
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"description": "<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;\">Черная пьедра – это дерматологическое заболевание волос грибковой природы, в основном характерное для тропических стран с теплым и влажным климатом.</span></p>",
"etiology": "<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;\">Возбудителем черной пьедры является микроскопический плесневой грибок Piedraia hortae, обладающий способностью развиваться как на поверхности, так и в толще волосяного стержня. Замечена корреляция между вероятностью заражения, выраженностью симптомов патологии и уровнем иммунитета человека – при значительном ослаблении защитных сил организма возможен перенос инфекции на кожу и даже внутренние органы. Однако чаще всего возбудитель черной пьедры поражает исключительно волосы.</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;\">Заражение черной пьедрой может произойти при использовании общих расчесок, головных уборов, иногда через постельное белье. Зарегистрированы случаи инфицирования при мытье волос в воде из стоячих водоемов, контакте с шерстью некоторых животных (при этом последние выступают только переносчиками грибка).</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;\">Факторы риска</span></p>\r\n<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-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Несоблюдение правил личной гигиены (редкое мытье головы) облегчает заражение и способствует более выраженному развитию возбудителя черной пьедры. Кроме того, это состояние чаще развивается у ослабленных лиц, больных сахарным диабетом, различными вариантами иммунодефицита, онкологическими заболеваниями. Из-за этого при наличии черной пьедры дерматолог часто рекомендует общее обследование для выявления возможных скрытых патологий.</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>",
"pathogenesis": "<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;\">После заражения грибок начинает развиваться в кутикуле волосяного стержня, проявляя тенденцию к росту по ходу волоса. Через некоторое время Piedraia hortae формирует споры – их плотно упакованные группы визуально определяются как узелки на поверхности стержня. Поражение кожи при черной пьедре встречается крайне редко и обычно наблюдается у лиц с иммунодефицитом, ногти данный грибок не поражает никогда.</span></p>",
"diagnostics": "<p><span id=\"docs-internal-guid-0cf0c445-7fff-0911-e9e6-70f389a5a4ec\"><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;\">При подозрении на черную пьедру нужно обратиться к трихологу или микологу. Также понадобится сдать общий и биохимический анализы крови, общий анализ мочи, анализ крови на сахар. Обязательно исследовать волос под микроскопом, а также высеять возбудителя на питательную среду (вырасти должны колонии черного или зеленовато черного цвета).</span></span></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;\">Наиболее простой и самый эффективный подход к лечению черной пьедры – полное удаление (сбривание) волосяного покрова. Так как Piedraia hortae в подавляющем большинстве случаев поражает исключительно волосяные стержни, после такой процедуры возбудитель устраняется, и выросшие волосы оказываются здоровыми. Однако такой метод лечения черной пьедры одобряют далеко не все пациенты, особенно если учесть, что заболевание в основном поражает молодых женщин, не желающих бриться наголо.</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;\">При отказе от удаления волос используют различные противогрибковые средства – амиказол и его аналоги. Эффективно также мытье головы в растворе 0,1% растворе дихлорида ртути, вычесывание волос густой расческой с последующим промыванием шампунем или противогрибковыми растворами. Длительность лечения черной пьедры различается в зависимости от степени поражения волос, но обычно составляет не менее месяца.</span></p>",
"prevention": "<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 профилактики черной пьедры необходимо соблюдать правила личной гигиены (особенно – при поездках в тропические страны), избегать купания в водоемах со стоячей водой, не использовать чужие расчески, головные уборы, украшения для волос. Также нередки случаи заражения Piedraia hortae при применении местных «народных» средств для ухода за волосами, поэтому приобретать и использовать их не следует.</span></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;\">Замечено, что чаще всего грибок поражает прямые волосы, тогда как у лиц с волнистым или курчавым волосяным покровом патология встречается намного реже. Первое время после заражения черная пьедра ничем себя не проявляет – никаких субъективных симптомов (зуда, раздражения) у этого заболевания нет, а отдельные узелки на волосках часто остаются незамеченными. По мере прогрессирования грибкового поражения таких узелков становится все больше.</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;\">Визуально они обычно плохо заметны (особенно при черном цвете волос), но могут определяться на ощупь при пропускании волосков между пальцами. В некоторых случаях отдельные «пакеты» спор могут сливаться между собой, формируя своеобразную муфту. Узелки при черной пьедре очень плотные, что отражено в названии заболевания («пьедра» – камень), при их большом количестве в случае расчесывания волос может раздаваться похрустывание, иногда металлического характера.</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;\">При обычном течении заболевания мицелий и споры грибка не проникают вглубь волосяного стержня, поэтому нарушений его структуры и роста не происходит. В запущенных случаях черной пьедры постепенно нарастают признаки повышенной ломкости волос. Если не соблюдаются правила личной гигиены и (особенно) волосы завязываются плотным пучком, возможно слипание узелков с разных волосков между собой. Это приводит к развитию характерного симптома черной пьедры – «колумбийского колтуна». Так называют пучок слипшихся из-за микоза волос, внешне похожий на сноп пшеницы или ячменя. В далеко запущенных случаях черной пьедры возникает алопеция. Заболевание имеет хронический характер и может длиться на протяжении многих месяцев и даже лет.</span></p>",
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"description": "<p><span id=\"docs-internal-guid-e1c38821-7fff-8990-a068-f240b7c51371\"><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;\">Разноцветный лишай - это </span></span><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">длительно протекающее грибковое заболевание с поражением эпидермиса, которое проявляется появлением на коже пигментированных пятен различного оттенка: желтого, розового, бурого, коричневого и характерным отрубевидным шелушением</span></p>",
"etiology": "<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;\">Разноцветный лишай относится к группе кератомикозов — грибковых заболеваний кожи, затрагивающих только роговой слой эпидермиса и волосяную кутикулу. Его возбудителями являются грибы Malassezia furfur, Pityrpsporum orbiculare и Pityrosporum ovale, причем эти виды отличаются способностью переходит один в другой. Обычно отрубевидный лишай характеризуется малой контагиозностью, то есть заражение происходит лишь в отдельных случаях при тесном и длительном контакте с больным. При этом вероятность заболеть разноцветным лишаем в большей степени обусловлена предрасполагающими факторами.</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;\">Факторами, формирующими в организме благоприятный фон для развития разноцветного лишая, являются: ослабление иммунной системы, повышенная потливость, эндокринные нарушения (сахарный диабет, синдром Иценко-Кушинга, ожирение), изменения в химическом составе пота, вегето-сосудистая дистония, нарушение барьерной функции кожи при частом использовании антибактериальных гелей и мыл, стрессовые воздействия на кожу (чрезмерный загар, солярий и т. п.). Авторы некоторых проводимых в дерматологии исследований указывают на то, что в ряде случаев разноцветный лишай связан с лимфогранулематозом и туберкулезом легких.</span></p>",
"pathogenesis": "<p><span id=\"docs-internal-guid-7c9e89f0-7fff-3af0-0467-2abfdf210054\"><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;\">Разноцветный лишай вызван размножением возбудителей в поверхностных слоях кожи, что приводит к нарушению функционирования меланоцитов — клеток, вырабатывающих пигмент меланин, придающий коже ту или иную окраску. В результате пораженный участок кожи приобретает цвет, отличающийся от остального кожного покрова. Процесс начинается в устье волосяного фолликула, затем пятно постепенной увеличивается в размерах.</span></span></p>",
"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;\">Врачи диагностируют разноцветный лишай по внешнему виду кожи, а также по результатам исследования. С учетом причины заболевания и имеющихся симптомов врач может назначить следующие виды обследования:\u2028</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;\">микроскопическое исследование соскоба кожи;</span></li>\r\n<li><span id=\"docs-internal-guid-07a0fe33-7fff-56f7-6089-faa42b7fac56\"><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;\">исследование с помощью лампы Вуда.</span></span></li>\r\n</ul>",
"treatment": "<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;\">Лечение проводится амбулаторно до полного исчезновения проявлений разноцветного лишая. Применяют местные противогрибковые средства: 5% салициловую мазь, 3-5% салициловый спирт, 5-10% серную мазь, 3-5% резорциновый спирт, тербинафин, бифоназол, клотримазол, циклоперокс, тербинафин, нафтифин и др. </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;\">Распространенный разноцветный лишай или его рецидивирующее течение являются показанием к общему противогрибковому лечению. Оно проводится приемом внутрь таких противогрибковых препаратов, как итраконазол, кетоконазол.</span></p>",
"prevention": "<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;\">Профилактика рецидивов разноцветного лишая включает повторный курс антигрибкового лечения, регулярные водные процедуры и терапию гипергидроза. Для предупреждения заражения близких пациента производят дезинфекцию одежды и белья больного. Людей, находящихся в постоянном контакте с пациентом осматривают с применением люминесцентной лампы.</span></p>",
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"name": "Черная пьедра",
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"description": "<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;\">Черная пьедра – это дерматологическое заболевание волос грибковой природы, в основном характерное для тропических стран с теплым и влажным климатом.</span></p>",
"etiology": "<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;\">Возбудителем черной пьедры является микроскопический плесневой грибок Piedraia hortae, обладающий способностью развиваться как на поверхности, так и в толще волосяного стержня. Замечена корреляция между вероятностью заражения, выраженностью симптомов патологии и уровнем иммунитета человека – при значительном ослаблении защитных сил организма возможен перенос инфекции на кожу и даже внутренние органы. Однако чаще всего возбудитель черной пьедры поражает исключительно волосы.</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;\">Заражение черной пьедрой может произойти при использовании общих расчесок, головных уборов, иногда через постельное белье. Зарегистрированы случаи инфицирования при мытье волос в воде из стоячих водоемов, контакте с шерстью некоторых животных (при этом последние выступают только переносчиками грибка).</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;\">Факторы риска</span></p>\r\n<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-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Несоблюдение правил личной гигиены (редкое мытье головы) облегчает заражение и способствует более выраженному развитию возбудителя черной пьедры. Кроме того, это состояние чаще развивается у ослабленных лиц, больных сахарным диабетом, различными вариантами иммунодефицита, онкологическими заболеваниями. Из-за этого при наличии черной пьедры дерматолог часто рекомендует общее обследование для выявления возможных скрытых патологий.</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>",
"pathogenesis": "<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;\">После заражения грибок начинает развиваться в кутикуле волосяного стержня, проявляя тенденцию к росту по ходу волоса. Через некоторое время Piedraia hortae формирует споры – их плотно упакованные группы визуально определяются как узелки на поверхности стержня. Поражение кожи при черной пьедре встречается крайне редко и обычно наблюдается у лиц с иммунодефицитом, ногти данный грибок не поражает никогда.</span></p>",
"diagnostics": "<p><span id=\"docs-internal-guid-0cf0c445-7fff-0911-e9e6-70f389a5a4ec\"><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;\">При подозрении на черную пьедру нужно обратиться к трихологу или микологу. Также понадобится сдать общий и биохимический анализы крови, общий анализ мочи, анализ крови на сахар. Обязательно исследовать волос под микроскопом, а также высеять возбудителя на питательную среду (вырасти должны колонии черного или зеленовато черного цвета).</span></span></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;\">Наиболее простой и самый эффективный подход к лечению черной пьедры – полное удаление (сбривание) волосяного покрова. Так как Piedraia hortae в подавляющем большинстве случаев поражает исключительно волосяные стержни, после такой процедуры возбудитель устраняется, и выросшие волосы оказываются здоровыми. Однако такой метод лечения черной пьедры одобряют далеко не все пациенты, особенно если учесть, что заболевание в основном поражает молодых женщин, не желающих бриться наголо.</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;\">При отказе от удаления волос используют различные противогрибковые средства – амиказол и его аналоги. Эффективно также мытье головы в растворе 0,1% растворе дихлорида ртути, вычесывание волос густой расческой с последующим промыванием шампунем или противогрибковыми растворами. Длительность лечения черной пьедры различается в зависимости от степени поражения волос, но обычно составляет не менее месяца.</span></p>",
"prevention": "<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 профилактики черной пьедры необходимо соблюдать правила личной гигиены (особенно – при поездках в тропические страны), избегать купания в водоемах со стоячей водой, не использовать чужие расчески, головные уборы, украшения для волос. Также нередки случаи заражения Piedraia hortae при применении местных «народных» средств для ухода за волосами, поэтому приобретать и использовать их не следует.</span></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;\">Замечено, что чаще всего грибок поражает прямые волосы, тогда как у лиц с волнистым или курчавым волосяным покровом патология встречается намного реже. Первое время после заражения черная пьедра ничем себя не проявляет – никаких субъективных симптомов (зуда, раздражения) у этого заболевания нет, а отдельные узелки на волосках часто остаются незамеченными. По мере прогрессирования грибкового поражения таких узелков становится все больше.</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;\">Визуально они обычно плохо заметны (особенно при черном цвете волос), но могут определяться на ощупь при пропускании волосков между пальцами. В некоторых случаях отдельные «пакеты» спор могут сливаться между собой, формируя своеобразную муфту. Узелки при черной пьедре очень плотные, что отражено в названии заболевания («пьедра» – камень), при их большом количестве в случае расчесывания волос может раздаваться похрустывание, иногда металлического характера.</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;\">При обычном течении заболевания мицелий и споры грибка не проникают вглубь волосяного стержня, поэтому нарушений его структуры и роста не происходит. В запущенных случаях черной пьедры постепенно нарастают признаки повышенной ломкости волос. Если не соблюдаются правила личной гигиены и (особенно) волосы завязываются плотным пучком, возможно слипание узелков с разных волосков между собой. Это приводит к развитию характерного симптома черной пьедры – «колумбийского колтуна». Так называют пучок слипшихся из-за микоза волос, внешне похожий на сноп пшеницы или ячменя. В далеко запущенных случаях черной пьедры возникает алопеция. Заболевание имеет хронический характер и может длиться на протяжении многих месяцев и даже лет.</span></p>",
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