Few people know that the human skin is the largest organ in the body. The skin area on the body is about two square meters. Based on this, it is quite logical to assume that the number skin diseases includes a large list.

In addition to the fact that the human skin performs a protective and immune function of the body, it also regulates temperature, water balance and many sensations. That is why it is so important to protect the skin from the effects of various diseases. This task is the most important in terms of prevention.

Below you can find out which of the most common skin diseases can occur in a person and see their photos. Here you can get acquainted with the description of diseases, as well as with the symptoms and causes of the disease. You should immediately pay attention to the fact that many skin diseases can be cured without much difficulty.

Causes of skin diseases

The main causes that cause or aggravate skin diseases:

Important! Diseases of the skin of the face that are not associated with infections and viruses can be provoked chronic diseases, genetic characteristics or external factors.

Treatment

In the absence of a proper approach, any skin disease becomes chronic, grows even more, and it is often very difficult to cure a patient in this condition. In addition, there are a number of concomitant diseases, the manifestations of which could have been avoided.

To conduct competent and complex therapy, it is necessary, together with the attending physician, to fulfill several important points:

• To reveal the full anamnesis of the disease and determine its exact classification.
• Carry out all the necessary tests to confirm the diagnosis.
• Treat the body, using both external and internal drugs.
• Regularly visit the consultations of the attending physician.
• Systematically, at least once a year, undergo an examination for the presence of residual microorganisms of the disease so that it does not develop into a chronic form.

Medical therapy

An important point for competent treatment is the conduct of therapy with drugs.

For such treatment, the following groups of drugs are distinguished:

Folk remedies

Traditional medicine has found several approaches to the problem of skin diseases, as this is one of the most noticeable infections that a person can get sick with.

In natural pantries you can find for yourself such effective means of dealing with skin ailments:

The skin is the only barrier against terrible viruses and various kinds of infection that constantly attacks a person. And, unfortunately, protective covers also get sick. Pictures of new diseases appear almost every day. Many of them have not yet been given a classification and description.

It is very important that if any deviations from the norm occur, do not treat the problem negligently, but immediately contact a dermatologist in order to avoid serious health problems in the future.

Article formatting: Lozinsky Oleg

Couperose

This disease can be recognized by specific capillary nets or asterisks. It occurs due to the expansion of the vascular walls and the loss of their elasticity, due to which blood stagnation occurs. A skin disease can manifest itself with only one “point” or a whole network that has spread along the wings of the nose, cheeks, and the area around the eyes. Often, couperosis signals a predisposition to disease. of cardio-vascular system or liver disease.

Common causes of appearance:

• trauma;
• exposure to UV rays;
• heredity;
• drinking and smoking;
• prolonged exposure to low temperatures;
• peeling and other cosmetic procedures;
• Availability chronic diseases.

Cellulite

Without treatment, cellulite can lead to serious complications.

Cellulitis is a skin infection that can become a serious problem if a person does not receive prompt treatment.

Cellulitis develops when bacteria infect the deeper layers of the skin and cause redness, swelling, soreness, and fever in the affected area.

Cellulite can also cause cold-like symptoms. Sometimes they begin to appear even before signs of skin infection appear. These symptoms include the following:

• fever;
• chills;
• fatigue;
• cold sweat;
• nausea;
• drowsiness;
• concentration difficulties.

If left untreated, cellulitis can lead to serious complications, such as blood infections.

acne

Symptoms: the presence of acne, abscesses, internal acne. Cause: inflammation sebaceous glands. There are three severity levels of acne: high - more than 40 rashes, medium - from 10 to 40, mild - up to 20 formations.

Causes of the disease:

• hormonal changes (age, menstrual and others);
• heredity;
• side effect of hormone therapy.

Acne usually occurs in teenagers, but it can also appear in adults. At risk are people with oily skin or hormonal abnormalities.

On hands

Hands are most often negatively affected by various fungal aggressors or small subcutaneous mites. Therefore, diseases of the dermis on the hands are of a contact-household nature.

Such ailments most often affect the area of ​​\u200b\u200bthe hands:

1. One in five people suffer from psoriasis, a lichen that occurs on the hands.
2. Often also dermatomycosis occurs.
3. The occurrence of carcinomas is observed in elderly people.

Chloasma

The opposite of vitiligo: excessive pigmentation. The area is dark, usually brown, and gradually enlarges. spots can merge into one rounded lesion. It can be caused by pregnancy or diseases: disorders of the ovaries, liver or pituitary gland.

Heat rash

Heat rash is a condition in which the skin becomes irritated when exposed to too much heat or moisture. A heat rash flare appears as red, itchy patches on the skin with clusters of small, raised pimples. Such spots can cause noticeable discomfort, accompanied by a burning sensation and tingling.

Heat rash often develops where skin folds form, causing some areas of the skin to rub against others. Such places include, for example, the groin and areas elbow joints.

Rosacea

As a rule, lesions affect only the skin of the face, an adult patient with a genetic predisposition is at risk. It has a polyetiological nature and a staged course. Manifestation: hyperemia of the face, pustules, edematous papules, telangiectasia. Important: hyperplasia of the connective tissue and sebaceous glands is characteristic, and not an increased secretion of the sebaceous glands (unlike acne). As a rule, skin disease manifests itself in patients aged 35-40, reaching a peak at 40-50 years. The disease is provoked by changes in the tone of the superficial vessels of the skin caused by endogenous and exogenous factors.

Scarlet fever

Scarlet fever is a contagious (transmitted from a sick person to a healthy person) bacterial infection that usually affects children and infants. This condition causes a pinkish-red rash that may be hard to the touch. This symptom begins on the chest but can later spread to other parts of the body.

To the number additional symptoms scarlet fever includes the following:

• red and sore throat;
• high body temperature;
• change in the color of the tongue (usually becomes bright red with small bumps);
• swelling of the neck;
• headache;
• muscle aches;
• pain in the abdomen.

Small nodular sarcoidosis

Appearance: nodular elements with dense consistency with sharp boundaries. They can have a color from pink to brown-yellow. Telangiectasias form on the surface of part of the papules. In place of resolved elements, small atrophic scars are formed. Diascopy reveals the phenomenon of "dustiness" and small yellowish spots. Resolved elements show a tendency to scarring.

Treatment of basalioma on the skin of the face

Important! Fungal and infectious diseases of the skin of the face are provoked by pathogenic organisms. Infections on the face can infect deep tissues or enter the bloodstream, causing sepsis.

Hyperkeratosis of the face

Often, dermatologists diagnose hyperkeratosis of the skin of the face: the treatment of this disease will also require examination, additional diagnostics and the appointment of appropriate treatment. Although, of course, this disease is not as dangerous as basalioma. Hyperkeratosis is a whole symptom complex characterized by the following manifestations:

• excessive cell division of the upper layer of the epidermis of the face;
• their desquamation;
• thickening of areas of the skin;
• severe dryness of the skin;
• surface irregularities;
• sometimes the affected areas are covered with a dry, durable crust.

Treatment of hyperkeratosis of the skin of the face should always be carried out exclusively under the supervision of a dermatologist.

To eliminate the symptoms of this disease, the following drugs and drugs are prescribed:

• peeling creams, scrubs followed by the application of emollient ointments;
• mandatory inclusion in the daily diet of foods high in retinol (vitamin A) and ascorbic acid (vitamin C), as well as their intake in tablet or injectable form;
• cosmetic procedures aimed at desquamation and softening of the stratum corneum of the epidermis;
• aromatic retinoids containing vitamins;
• ointments with glucocorticosteroid hormones.

At home, the treatment of hyperkeratosis of the skin of the face involves the use of folk remedies for the care of dry, flaky skin. They include:

1. moisturizing masks with glycerin, cream, aloe juice, egg yolk;
2. potato compresses;
3. onion tinctures;
4. beetroot applications.

The main symptom of hyperkeratosis that you have to deal with is dry facial skin: the treatment in this case should be comprehensive and include both medications and salon procedures prescribed by specialists, as well as folk remedies.

Streptococcal lesion

Mostly found in women and children, the lesion affects the smooth skin and has no connection with the follicular apparatus. Manifestation: flektens or impetigo, quickly opening and forming serous-purulent crusts. It is most often seen in the corners of the mouth and eyes.

Important! Pustular diseases of the skin of the face most often occur due to the influence of streptococci, fungal infections, staphylococci and other infections. Factors contributing to the development of the disease: high blood sugar, microtrauma, hypovitaminosis. There are superficial and deep forms. Furuncles with one purulent-necrotic core and carbuncles are a manifestation of a deep form.

Other burns

Burns on the human body can remain not only due to sun rays but also due to other factors. The most common types of burns include the following.

• Thermal burns. They appear when the skin comes into contact with something hot, such as fire, steam, or hot liquids.
• Chemical burns. Harsh chemicals can cause chemical burns when exposed to the skin. These substances include acids, bleaches and cleaning agents.
• Electrical burns. They can appear when a strong electrical current is applied to the skin, for example, from bare wires.
• Friction burns. Appear on the body when the skin periodically rubs against rough surfaces or tissues.
• Radiation burns. Radiation radiation can damage the skin and cause burns. In particular, such burns can be a side effect of radiation therapy used to fight cancer.

Each of these types of burns can cause reddening of the skin.

Doctors classify burns according to severity.

• First degree burns- the most light, which usually manifest only reddening of the skin.
• Second degree and third degree burns- more serious burns, in which several layers of skin are damaged.
• Fourth degree burns- The most severe burns that can affect the bones and muscles located under the skin.

Acne vulgaris

Purulent inflammation of the hair follicle and directly the sebaceous gland. Often caused with a staph infection. Usually rashes are observed on the face, chest, back. The course of the disease of the face: the appearance of black dots - comedones, then the appearance of a painful red nodule, after - the formation of a purulent pustule.

With infections, necrotic acne is possible, in which necrosis progresses in the depth of the element. In this case, after healing, a scar is formed. The spread of the process increases the risk of abscesses and acne conglobata.

Important! Viral skin diseases occur in 3-4% of adult patients and up to 10% of children.

The most common representatives

Human skin diseases, photos and descriptions of which are known to the world, have a huge variety of types, types and subspecies. However, among them, 15 of the most common diseases can be distinguished.

acne

In the common people - acne. The disease is characterized by the appearance of inflammatory processes in some areas of the sebaceous gland, and specifically inflammation of the hair follicles and, directly, the gland area under them.

This is the nightmare of all teenagers, many adults and even the elderly. The exact cause of the occurrence has not yet been determined.

The appearance of acne is associated with propionium bacteria, which are found on the surface of the skin of every person. Their active vital activity provokes a violation of the integrity of the bactericidal mechanism of sebum.

The most common triggers for acne are:

• stress;
• menstruation;
• hot weather;
• binge eating;
• excessive hormonal activity (for example, in adolescence).

Symptoms of the disease:

• fragmentary reddening of skin areas;
• the occurrence of painful boils, pustules and small sores;
• excessive secretion of sebum.

The townsfolk attribute the latter the name "oily skin."

Dermatitis

The disease is similar to acne, but the causes of its occurrence are different.

The disease is a lesion of the skin, namely:

• redness;
• ulcers;
• ulcers caused by various kinds of aggressive substances, often of a chemical nature.

Lichen

This is a disease of the upper and middle layers of the dermis, which is a scab and a rash, which, if not properly and untimely treated, can turn into purulent wounds. In addition, the symptoms of the disease include severe itching, redness, excessive dryness of the skin.

Lichen is often infectious in nature and is transmitted through an infected person or animal.

The cause of the occurrence is contact with the skin and the active development of lichen fungi of three types:

• geophilic (falling from the soil);
• anthropophilic (developing and living on human skin);
• zooanthropophilic (dwelling on the dermis of animals, both domestic and wild) types.

Herpes

This is a very common viral disease.

It is a small abscess and vesicles of mucus that are grouped in one area, often:

• in the corners of the lips;
• on the mucous membrane;
• under the nose;
• on the genitals.

Despite the fact that the disease is very common and can be easily cured with the right timely approach, the virus becomes very dangerous against the background of other diseases. If the patient is sick with encephalitis, meningitis, disruption of the mucous membranes, herpes can become a very serious problem for him, and in this case it will be difficult to treat.

The disease tends to "spread" - gradually increase the area and depth of skin lesions. After it has passed initial stage, and the disease takes root, the patient's temperature rises, signs of SARS are observed, purulent wounds become larger.

Herpes has many subspecies, complications from which can manifest as pneumonia, disruption of the heart, the development of concomitant diseases. Herpes is a significant blow to the human immune system. Among other things, the disease is transmitted from a sick mother to a newborn child - herpes type 6 is widespread among children.

Eczema

This is a skin disease that looks like small blisters, scales, cracks and miniature sores. In addition to the obvious symptoms, the patient also suffers from constant severe itching. Unlike the previous 4, this disease is not contagious. It is inflammatory and often chronic.

The causes of eczema are external and internal. The first is a chemical or physical injury to the skin, followed by inflammation. The second is the result of various diseases of the liver, nervous and endocrine systems in the body.

Acne vulgaris

This is the formation of large papules, comedones and nodes, as a result of prolonged inflammation of the hair follicles of the skin. Outwardly, these neoplasms are similar to acne, but much larger than ordinary acne in size, an impressive amount of pus and fluid quickly accumulate inside them.

The reason for such inconvenience is:

To cope with their spread is possible only through long-term treatment after a thorough consultation with a dermatologist and passing the appropriate tests.

bedsores

This type of pathology of the dermis is a purulent wound of various sizes. The reason for this is soft tissue necrosis, which occurs from prolonged squeezing of one or another area of ​​the body, as a result of which the flow of blood and life-giving fluids to it is blocked.

Symptoms are as follows: the occurrence of bruises, bruising, redness, and then blue parts of the skin. Bedsores most often occur in bedridden patients, people with anorexia or overweight.

Scabies

One of the contagious infectious diseases, the first symptom of which is the occurrence of severe itching, redness and excessive dryness of the skin. The cause is the scabies mite. You can catch the disease in almost any public place if you do not follow the rules of hygiene.

Keratosis

This type of deviation is rather not a separate disease, but a general condition of the skin, in which a large area of ​​tissue coarsens, becomes horny, and a dense crust forms. The form of the disease is non-inflammatory.

Cause: Damage to the skin from prolonged overexposure ultraviolet rays and, consequently, deep skin lesions.

Symptoms - the appearance of small, up to half a centimeter, solid neoplasms, similar to moles, but flattened and having a hard crust that resembles a corn to the touch. They are localized, as a rule, in a small area, but if the sun acts on a large area of ​​the skin for a long time, then there is a risk of getting serious keratotic foci of inflammation.

Carcinoma

A cancerous variety, a malignant neoplasm that develops on the outer surface of the epithelium. Symptoms are complex, and at first glance, the tumor is almost impossible to distinguish from a mole.

But, if it gradually increases in size, turns red, the skin around it hurts, and the tissues acquire a purple hue - you need to urgently consult a dermatologist, oncologist and pass the appropriate tests. A provoking factor may be a congenital predisposition or a large dose of radioactive exposure.

Hemangioma

This is a pathology that is benign in nature and, as a rule, pursues newborn children or infants. The neoplasm looks like a big red mole.

In most cases, when its size does not exceed the permissible norm, the hemangioma resolves by itself by the age of 5.

The exact cause of the occurrence has not yet been determined. Symptomatically, hemangioma does not manifest itself in any way.

Melanoma

This tumor is malignant. The reason for its occurrence is the excessive secretion of melanin in the skin tissue. This is done by pigment cells under prolonged exposure to direct sunlight.

Melanoma is extremely dangerous, since the body responds poorly to its development, symptoms do not appear, while the tumor itself actively metastasizes to all organs of the patient. Melanoma looks like a flat, large mole that tends to expand suddenly and uncontrollably.

Papilloma

The disease is caused by the human papillomavirus. This is a benign tumor-like formation. It affects epithelial cells. It is localized in the form of a papilla, is not symptomatically detected and must be removed. There are cases when the number of papillomas exceeds the permissible norm, then you need to contact a dermatologist and undergo complex treatment.

Dermatomycosis

The disease implies a serious fungal infection of the human epithelium. The reason, respectively, is fungus.

It is transmitted by contact-household way through infected people, animals, as well as everyday objects. The affected skin becomes inflamed, blistered, chains of pimples and wounds appear, and severe itching occurs.

erysipelas

Viral disease, often relapsing. The cause and main causative agent is streptococcus. Ways of transmission - virus. Contact with a sick erysipelas to a healthy person is highly undesirable. Symptoms - redness of skin areas, often on the front or legs, fever, intoxication. Most of the time, the disease is treatable.

Human skin diseases (a photo and a description of the most common of them are given above) have their own special characteristics, depending on where in the body they are localized. Depending on the place of occurrence of a particular skin ailment, it can be associated with malfunctions of various body systems.

HPV - Human papillomavirus

Causes the appearance of genital warts and warts on the mucous membranes and skin. More than 200 varieties of the virus are known, of which 50% are the main cause of warts. The reason for the defeat of the virus: low immunity and skin microtrauma. When infected, the virus may not appear for a long time, but become more active when the body weakens. There is a definite link between HPV infection and some forms of cancer, including cervical cancer.

Important! Usually, each disease has pronounced symptoms, but not infrequently, skin changes can be grouped, which complicates the diagnostic process. To find out the reasons for the appearance of deviations, it is necessary to undergo an examination and be extremely frank with a dermatologist, without hiding habits or diseases. Self-medication or the use of drugs without an accurate diagnosis can aggravate the situation.

Diagnostics

The main and very first doctor to be visited at the first suspicion of a skin disease should be a dermatologist.

Human skin diseases, photos and descriptions of which can be found on the Internet, have many similarities, so a person can diagnose something completely wrong for himself. In no case can not treat such things on their own.

• Urologist.
• Gynecologist.
• In some cases - to the oncologist.

Depending on the specifics of the direction of the disease, which will be determined by the chief attending physician after the examination, the patient will need to pass such tests and undergo examinations from the list, as recommended by the doctor.

They are the following:

Hyperkeratosis

Hyperkeratosis is a condition characterized by excessive formation of superficial skin cells - the epidermis. It may be due to external or internal causes. The most common localization of such a process is the feet. Foot hyperkeratosis occurs in at least 40% of women and 20% of men. This is due to the increased load on the feet, walking in heels, wearing tight shoes, flat feet. Diseases accompanied by hyperkeratosis include ichthyosis, psoriasis and other diseases. Psoriasis is a chronic skin disease of unknown nature. Its prevalence is 2 - 3%. Most often, the disease begins at the age of 10 - 30 years. Hereditary predisposition is characteristic: if one of the parents is ill with psoriasis, then the risk of it in a child is 25%, if both parents are ill, then 65%.

Shingles

This ailment, which is also called vesicular lichen, has a very characteristic appearance: a "path" of painful small vesicles located along the nerve pathways of the human body - hence the name "herpes zoster". The cause is the varicella-zoster virus that has entered the ganglions person when he had chicken pox. Rashes are usually accompanied by fever. The rashes themselves disappear within a couple of weeks - a month, but neuralgic pains sometimes persist for months. The disease is fraught with complications. Herpes zoster is contagious as long as there is a rash. Transmission of infection is possible only by contact.

The only effective remedy designed to combat herpes viruses is acyclovir. No other drugs against this infection will help.

parsley ice

If inflammation of the scalp or face is caused by any disease, then you should seek help from doctors. They will be able to make an accurate diagnosis and prescribe treatment. If the inflammation on the face is manifested by acne and acne, then you can resort to the help of alternative medicine.

In a blender or with a knife, you need to chop fresh parsley. A few tablespoons of the resulting mass must be poured with a glass of boiling water and insisted for two hours. After this, the product should be filtered and cooled. The resulting infusion should be poured into ice molds, and then placed in the freezer. Such ice can be used daily for wiping. The procedure should be carried out carefully so as not to damage the skin.

Variety of pathologies

Changes in the skin of the face are of a polyetiological nature. Among the causes of dermatological diseases are:

• exposure to infectious agents;
• sensitization of the organism to certain antigens and even physical phenomena;
• genetic determinant;
• hormonal imbalance.

Improper skin care can be a starting point in the development of pathology. Lack of hygiene when shaving often leads to inflammation of the hair follicles, infection. Overdrying of the skin with frequent use of cosmetics or, on the contrary, its excessive moisturizing, clogging of pores contributes to the development of disorders.

Microcephaly

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Actinomycosis. Bacterial chronic systemic disease. The pathogen enters the body, usually through the digestive tract. The process spreads mainly through the fiber and connective layers of organs and tissues. In some cases, there is a general infection. Skin lesions often occur secondary due to the spread of the pathological process from deep-lying tissues. In accordance with the ways of its distribution and localization, cervico-maxillofacial actinomycosis, pulmonary and other varieties are distinguished.

Symptoms and course. They are characterized by the presence in the subcutaneous adipose tissue of a dense tuberous infiltrate formed from merged nodes, the skin under which has a bluish-red color. In the future, the infiltrate softens in some areas and opens with small fistulous openings, from which pus is released.

Recognition. The clinical diagnosis must be confirmed by the results of a microbiological examination of the fistula discharge, a skin-allergic reaction with actinolysate, and a histological examination of a biopsy of the affected tissue.

Treatment. It should be complex and consist of immunotherapy (actinolysate, vaccines), stimulants and restorative agents. In some cases, surgical intervention.

Prevention. It consists in the rehabilitation of the oral cavity, conventional hygiene measures, in the prevention of injuries of the skin and mucous membranes, especially among residents of rural areas.

Borovsky's disease - cutaneous leishmaniasis, see Ch. II. infectious diseases.

Warts. Caused by certain types of human virus, which is transmitted by direct contact or through household items. They are skin tumors ranging in size from a pinhead to the size of a 20-kopeck coin and have a number of varieties. Common and flat warts are characteristic mainly of childhood and adolescence. Infection with genital warts can be through sexual contact, so they are also called venereal.

Common (vulgar) warts. They are painless, dense, grayish or brown nodules with an uneven, keratinized and rough surface. Among them, one can always distinguish the largest - the mother. Merging with each other, warts can form a large tumor-like tuberous element.

Flat (juvenile) warts are usually multiple, located in groups, more often on the back of the hands and on the face. Unlike ordinary ones, they have a smooth surface, fuzzy irregular or rounded outlines, exist for a long time, and often recur.

Plantar warts are sharply painful, rise slightly above the surrounding skin and appearance resemble corns. Their occurrence contributes to the constant pressure of shoes.

Genital warts (genital warts) - see Ch. Sexually transmitted diseases.

Treatment. Approximately 50% of patients with vulgar and flat warts can disappear under the influence of suggestion and hypnosis. For all types of warts, magnesium oxide has long been used inside, 0.15 g Zraza per day (treatment course 2-3 weeks), purified sulfur 0.25 g 3 times a day (for 2-3 weeks).

Lubrication with fresh milky juice of celandine. Good therapeutic effect give cryotherapy and diathermocoagulation. The destruction of warts by freezing can be carried out with liquid nitrogen or carbonic acid snow. The duration of exposure depends on the density and thickness of the wart and averages from 15 seconds to 1.5 minutes, after which the surface of the warts should be smeared with aniline dyes.

The procedure is painless, however, during the thawing period (the next few hours after the procedure), moderate pain may occur. At the site of cryotherapy, a bubble is formed, and then a crust, under which active healing takes place.

With plantar warts, after applying keratolytic (exfoliating) varnishes, the doctor uses surgical (diathermocoagulation) excision of warts.

Prevention. When caring for patients with warts, hygiene rules should be strictly observed. With plantar warts, you should not walk barefoot on the floor, visit pools, baths, you should avoid constant pressure and trauma to the soles. With the localization of genital warts on the genitals - refrain from sexual intercourse until cured.

Herpes zoster (shingles). The causative agent is the herpes virus.

Symptoms and course. The disease begins, as a rule, with an increase in body temperature and pains of a neuralgic nature. At the same time, general weakness may appear, headache, nausea, vomiting. The reservoir of infection is the mucous membrane of the pharynx and tonsils, from where the virus is under the influence various reasons(cold, injury, etc.) enters the bloodstream and selectively affects the nervous system and skin.

The disease occurs more often in the autumn-spring period, mainly in adults, leaving behind immunity. Relapses and widespread forms of herpes zoster are observed as an exception, mainly in patients with reduced immunity (see HIV infection, ch. Sexually transmitted diseases.).

The predominant localization of the process is observed along the large nerve trunks of their branches on one half of the face, on the lateral surface of the body. In rare cases, herpes zoster can affect the mucous membrane of the mouth and nose.

Rashes on the skin occur paroxysmal, at first in the form of red swollen spots, closely spaced from each other.

After a few hours, vesicles with serous contents form on them. A few days later, their tire wrinkles, yellowish-brown crusts or bright red erosion are formed. Following the first crust, new elements are formed, and then they merge into a continuous ribbon and, as it were, encircle the body. The course of the disease is long, sometimes up to 4-5 weeks.

After the disappearance of rashes on the skin, persistent neuralgia and muscle paresis may remain.

Particular attention should be paid to generalized (spread throughout the body) and gangrenous varieties of herpes zoster, which often develop in patients with lymphocytic leukemia, lymphogranulomatosis, and a malignant tumor of the internal organs. In some cases, these rashes are the first signs these diseases and dictate the need for a thorough and repeated examination by the appropriate specialist doctors.

Treatment. Inside prescribe acetylsalicylic acid, amidopyrine (0.5 g 3-4 times a day), antibiotics, antihistamines. At the same time, injections of vitamin B1, B12 are carried out. For pain, analgesics, reflexology, physiotherapy (diadynamic current, ultrasound, etc.) are recommended. After subsiding of acute phenomena, ultraviolet irradiation, autohemotherapy are prescribed.

Locally prescribed the same drugs as for herpes simplex. Patients are prohibited from using showers and baths. To avoid the spread of infection, they should be isolated, especially from children. In the child's body, the virus, penetrating into the blood, causes chicken pox. Contacts with patients are subject to quarantine for 21 days. By the way, adults, becoming infected from children with chickenpox, can get shingles.

Herpes simplex (blister lichen). Caused by a virus and occurs in both sexes and all age groups.

Symptoms and course. The disease begins acutely and is accompanied by itching, tingling, and sometimes pain. At the same time (or after 1-2 days) a red, slightly swollen spot is formed, on which groups of bubbles the size of a pinhead or a small pea appear, filled with transparent serous contents. After 3-4 days, the vesicles dry up with the formation of serous-purulent crusts or slightly moist erosions. Sometimes there is a painful increase lymph nodes. Some patients have malaise, muscle pain, chills, fever up to 38-39°C. Gradually, the crusts fall off, erosions epithelialize and the disease lasts 1-2 weeks.

Favorite locations for herpes simplex are areas around natural openings: the wings of the nose, the corners of the mouth and the red border of the lips. When localized on the genitals, herpes may resemble a hard chancre, which makes it necessary to carry out differential diagnosis with syphilis.

For recurrent herpes, repeated (for many months) rashes of vesicles are characteristic, often on the same areas of the skin. In women, this may be due to the menstrual period.

Treatment. Outwardly - alcohol solutions of aniline dyes, ointments containing antiviral substances - 3% oxolinic, 3-5% tebrofen, 30-50% interferon, "Gossypol", "Florenal", A good effect is observed from leukocyte interferon, the solution of which is applied to the lesion 5-6 times a day with a glass (eye) stick.

In some cases, it is possible to interrupt the further development of rashes by applying cotton swabs with alcohol for several minutes, freezing the skin with ethyl chloride. In case of damage to the oral mucosa - rinsing with a decoction of chamomile, sage, solutions containing ethacridine lactate, hydrogen peroxide, potassium permanganate, etc. Herpes simplex of the genital organs (after excluding primary syphiloma) is treated by lubricating with a 2% silver nitrate solution, 5% tannin solution.

In case of recurrent herpes, the following are indicated: a hermetic polyvalent vaccine, which is administered intradermally at 0.1-0.2 ml into the outer surface of the shoulder 2 times a week (for a course of 5-10 injections); immunomodulators - decaris; gamma globulin; pyrogenic preparations, etc.

Diagnostics
The diagnosis is established on the basis of the clinical picture and the detection of a tick in the contents of pustules, the secret of the sebaceous glands, in scrapings and scales from lesions. To determine the pathogen, infected material treated in a drop of isotonic sodium chloride solution or 10-20% caustic alkali solution is examined under a low magnification light microscope. Differential diagnosis is carried out with red acne, acne vulgaris, perioral dermatitis, lupus erythematosus.

Treatment. Treatment is usually carried out on an outpatient basis by a dermatologist. The leading place is given to external means. Inside prescribe drugs of the quinoline series, antihistamines. A comprehensive examination of patients is necessary to establish and eliminate the factors provoking demodicosis. Carry out the treatment of identified diseases. It is recommended to include a large amount of fruits, vegetables, dairy products in the diet. Sun exposure, excessive exposure to the skin of adverse meteorological factors (wind, snow, rain) should be avoided. Vigorous treatment usually leads to the disappearance of skin manifestations, however, if pathogenetic factors are not eliminated, relapses are possible. Simultaneously with the treatment, the disinsection of bed and underwear is carried out.

Candidiasis. A disease of the skin, mucous membranes and internal organs caused by Candida yeast-like fungi.

The provoking factor is often the long-term use of antibiotics and glucocorticosteroids. Contribute to the development of candidiasis various diseases that reduce immunity (diseases gastrointestinal tract, metabolic disorders, especially diabetes, dysbacteriosis, etc.).

Numerous variants of yeast lesions are divided into 2 groups: candidiasis of the outer integument (superficial) and visceral (internal organs).

Yeast stomatitis (thrush). Often occurs in newborns, infants, debilitated, suffering from dyspepsia or other diseases. White plaque appears on various parts of the oral mucosa, which in children looks like curdled milk, hence the other name for candidiasis is “thrush”. Later, plaque foci merge and, after their removal, a bright red edematous mucous membrane or bleeding erosion is exposed. The lesion can spread to the corners of the mouth, the red border of the lips, pharynx, tonsils.

Yeast glossitis: the appearance of a white coating on the back of the tongue. The film is easily removed by scraping with a spatula, exposing a smooth, slightly reddened surface. Without treatment, the process can spread to the mucous membranes of the cheeks, lips, gums, tonsils.

Candidiasis of the corners of the mouth(yeast jam).

It is observed in elderly people with an underbite, as well as those who have the habit of licking their lips or sleeping with open mouth from which saliva flows, moistening the corners of the mouth. The skin in the lesions is moist, covered with an easily removable white coating, soreness, cracks, and crusts are noted.

Yeast erosion (intertrigo). It happens in the area of ​​large skin folds in people suffering from obesity, diabetes. The skin in these places is bright red, slightly moist, covered with a white coating, itchy.

Very often, candidiasis develops between the III and IV fingers. Initially, small, merging bubbles appear, which quickly open and form erosion. Such interdigital yeast erosions are found in housewives who deal with vegetables and fruits, in workers in the confectionery industry, fruit and vegetable bases.

Vulvovaginal candidiasis, balanitis, balanoposthitis. It develops in isolation or in combination with other forms of candidiasis. Vulvovaginitis is accompanied by excruciating itching and crumbly vaginal discharge. With yeast balanitis and balanoposthitis, maceration of limited areas of the glans penis and the inner layer of the foreskin, grayish-white layers and erosion are noted. It should be remembered that yeast-like fungi can be sexually transmitted.

Candidiasis of the nail folds and nails.

More commonly seen in women. The process begins with the nail fold and then spreads to the nail plate. The rollers become swollen, bright red, sharply painful, the nail acquires a grayish-brown color. Often, a drop of pus can be squeezed out from under the roller. People suffering from yeast infection of the nails should not come into contact with healthy people, especially children, as transmission of the infection is possible.

Visceral (systemic) candidiasis. Manifested by inflammation of internal organs such as bronchitis, pneumonia, myocarditis, etc. Often there is candidiasis of the esophagus due to the spread of the process with the mucous membrane of the mouth and throat. With lesions of the stomach and intestines, mucosal necrosis is observed, the fungus filaments penetrate deep into the wall and the formation of ulcerative defects with complications (bleeding, perforation, peritonitis, etc.).

Recognition. The diagnosis of all forms of candidiasis is decided on the basis of clinical symptoms and data laboratory research- detection of yeast-like fungi in the material taken from the lesion.

Treatment. General therapy to eliminate disorders of the endocrine system, gastrointestinal tract, hematopoietic system. Antibiotics, steroid drugs are canceled, multivitamins and a diet are prescribed. Of the external agents for superficial forms of candidiasis, 1-2% aqueous or alcoholic solutions of aniline dyes, levorin, nystatin, decamin ointments, the Kanesten preparation are used. In case of damage to the mucous membranes - rinsing with a solution of soda and 5% borax, lubrication with a 10% solution of borax in glycerin, decamine caramel. In persistent cases and in generalized forms, nystatin, levorin are given orally, amphotericin B is administered.

Carbuncle. The most severe form of deep staphylococcal infection.

Symptoms and course. It starts in the same way as a boil, however, staphylococci in this case quickly penetrate from the hair follicle (sac) into the lymphatic vessels to the deep sections of the dermis and subcutaneous tissue. This leads to the spread of a purulent-necrotic inflammatory process in breadth and an increase in the initial size of the infiltrate to large sizes. Clinically, a carbuncle is a few merged boils located on a common, sharply edematous base. When the carbuncle is opened, several holes are formed, from which thick viscous pus of a yellowish-green color with an admixture of blood is released. The patient is worried about a sharp pain, there may be an increase in body temperature, chills, headache.

The principles of treatment are the same as for a boil. The prescription of antibiotics is mandatory. Patients with carbuncles should preferably be hospitalized.

Molluscum contagiosum. Caused by the smallpox virus. It affects more often children aged 1 to 5 years. The virus is transmitted either through direct contact or through sponges, towels, etc. In adults, infection can occur through sexual contact.

Symptoms and course. The incubation period is from 2 weeks to several months, after which small, shiny, mother-of-pearl-colored round nodules with an umbilical depression in the center appear on the skin. Nodules range in size from millet grain to a pea, in rare cases, giant mollusks can form as a result of fusion. When pressed with tweezers, a white mushy mass is released from the nodule, in which, in addition to keratinized cells, there are many mollusc-like bodies. Nodules can be single or multiple and located on the face, neck, hands, trunk, abdomen. Without treatment, the nodules disappear after 2-3 months.

Treatment. It involves squeezing out the contents of the elements with tweezers or scraping with a sharp Volkmann spoon, followed by lubrication with a 2-3% alcohol solution of iodine, carbolic acid. Before the procedure, the skin should be wiped with camphor alcohol. Children with molluscum contagiosum are subject to isolation from children's institutions. When examining children and attendants of children's groups, attention should be paid to warts, and measures should be taken to treat them.

Leprosy (leprosy). It is characterized by a long incubation period, a long course and damage to the skin, mucous membranes, peripheral nervous systems s and internal organs. The causative agent of this chronic common infectious disease is Mycobacterium leprosy.

According to WHO, about 15 million patients with leprosy are registered in the world, mainly in South America, Africa and Asia. Sporadic cases are everywhere. Leprosy is considered a low-contagious disease, in which the decisive factor is prolonged, repeated contact, during which the body becomes sensitized.

Children are the most sensitive to leprosy, professional infection of medical workers is practically not observed.

The incubation period lasts from 3 to 10 years or more. At the end of it, general symptoms are noted: fever, weakness, drowsiness, loss of appetite and others. There are three types of disease.

Lepromatous type- the most severe and contagious.

Symptoms and course. Skin lesions are located on the face, back of the hands, forearms, shins and are represented by limited tubercles (lepromas). Their color is from pink to bluish-red, the surface is smooth and shiny, sometimes covered with bran-like scales. Lepromas rise hemispherically above the surface of the skin and, closely adjacent to each other, often form continuous tuberous infiltrates. When the face is damaged, they give it the appearance of a "lion's muzzle".

Simultaneously with changes in the skin, damage to the mucous membranes of the nose, oral cavity, and larynx is often observed. Patients complain of dry mouth, nose, bloody discharge, frequent bleeding, shortness of breath, hoarseness. Ulceration of the cartilaginous septum of the nose leads to its deformation.

Eye damage causes impaired visual function and even complete blindness. Of the internal organs, the liver, spleen, lungs, kidneys and others are affected. Violated all types of skin sensitivity (temperature, pain and tactile), especially on the hands and feet. Patients, not feeling heat and cold, not feeling pain, are often subjected to severe burns and injuries. In some patients, the muscles of the face and limbs are weakened and exhausted, the fingers and toes are bent, shortened, and sometimes destroyed. Deep ulcers appear on the feet, which are difficult to treat. Such consequences lead patients to deep disability.

Patients with lepromatous type of leprosy are the main source of infection with leprosy and pose a great danger to others.

Tuberculoid type is more benign and characterized by a high resistance of the body, easier to treat. The skin is predominantly affected, where plaques or tubercles of red color appear, of various shapes and sizes with clear edges. After the rash heals, white spots remain - depigmentation or scars. Sometimes get smitten peripheral nerves with subsequent violation along their temperature, pain and tactile sensitivity of the skin. The chronic course of tuberculoid leprosy can be interrupted by an exacerbation, during which mycobacteria of leprosy are often found in the lesions.

Undifferentiated (indefinite) type mainly occurs in children and is characterized mainly by neurological symptoms (polyneuritis) and patches on the skin different sizes and outlines. Hair on the affected areas falls out, skin sensitivity and sweating are disturbed. Affected nerves thicken, become painful. After a few months, muscle atrophy develops, leading to deformation of the upper and lower extremities. The face becomes mask-like, facial expressions disappear. Paralysis and paresis develop. Perforating ulcers appear on the soles of the feet, which are difficult to treat.

Recognition. It is necessary to take into account the history data, the presence of sensitivity disorders, a rash on the skin, a creamy shade of the sclera, loss of eyebrows, eyelashes, polyneuritis, etc. It is necessary to conduct bacteriological studies of scrapings from the nasal mucosa, to put a lepramine test.

Treatment. Sulphonic drugs are used, diaminodiphenolsulfone (DDS) and its analogues - avlosulfone, sulfetron, solusulfone, diucifon dipson and others. When treating with sulfones, it is necessary to simultaneously use iron, liver, etc. preparations. Treatment is carried out by a complex chronically intermittent method in specialized institutions - leper colonies.

Prevention. Identification and isolation of all patients with active manifestations of leprosy. Mass inspections are carried out in epidemic foci. The antigenic proximity of the causative agents of leprosy and tuberculosis was the basis BCG vaccination for the prevention of leprosy.

Microsporia (ringworm) . The most common fungal disease in children due to the pronounced coptagiousness of the infection. Infection occurs from sick people, cats and dogs, or through objects containing spores of this fungus. The incubation period lasts from 2-3 weeks to 2-3 months. The disease affects smooth skin, scalp, and rarely nails.

Symptoms and course. Inflammatory spots, small nodules and vesicles covered with scales and crusts appear on the skin.

Lesions on the scalp represent large, rounded areas of baldness. All hair is broken off at the level of 4-8 mm and it seems that they are cut, in connection with which this disease is called ringworm.

There is also an infiltrative-suppurative form of microsporia, in which there are general disorders, fever, malaise, regional lymph nodes increase, and secondary allergic rashes appear.

Recognition. The diagnosis of microsporia is confirmed by microscopic examination of the mycelium of fungi. An important differential diagnostic value is the green glow of the affected hair when illuminated by a Wood's lamp. The examination is carried out in a darkened room. It should be remembered that oily hair can also give a yellowish-greenish glow under the Wood's lamp, so it is recommended to wash the hair before the study.

The course of microsporia without treatment is long. By puberty, the disease usually disappears.

Treatment. Similar to superficial trichophytosis (see).

Multiform exudative erythema. Acute infectious disease.

It develops, as a rule, in spring or autumn under the influence of catarrhal factors. Patients before the appearance of rashes have a headache, malaise, fever, often pain in the throat, in the joints. The toxic-allergic form of the disease develops as a symptom of drug intoxication, gastrointestinal disorders, and in children after vaccination. This form of the disease is usually not preceded by general symptoms, seasonality is not observed.

Rashes on the skin and mucous membranes in both forms of the disease can be widespread or fixed, more often on the skin of the hands and feet, the extensor surface of the forearms, legs, palms, soles and genitals, on the mucous lips, on the eve of the mouth.

Symptoms and course. Delimited, rounded pink-red spots or flat, slightly elevated edematous papules the size of a 2-3 kopeck coin appear on the skin. The central part of the rash slightly sinks and acquires a bluish tint, vesicles and blisters with serous or bloody contents may appear here. In some cases, they simultaneously appear on the oral mucosa, after 2-3 days they open up and very painful bleeding erosions remain in their place. The lips swell, the red border is covered with bloody crusts and painful cracks, a secondary infection often joins.

A severe bullous form of exudative erythema, occurring with a significant violation of the general condition, involvement in the process of the mucous membranes of the mouth, nose, nasopharynx, eye damage (up to rejection of the conjunctiva and ulceration of the cornea), internal organs, is called Stevens-Johnson syndrome. It should be noted that patients with this form should be immediately hospitalized for treatment with corticosteroid, detoxifying and desensitizing drugs.

Treatment. An indispensable condition for successful therapy is the sanitation of the body and, above all, the elimination of foci of infection. Antibiotics a wide range action to prevent relapse in combination with hingamin. External therapy is used only in the bullous form, where the blisters should be pierced and lubricated with a 2% alcohol solution of aniline dyes, followed by the application of polcortolone aerosol, antibacterial ointments. Assign mouthwash with 2% solution boric acid, infusion of chamomile, borax, furatsilina.

Ostiofolliculitis (staphylococcal impetigo). It is caused by staphylococcus aureus, usually aureus. The development of the disease is promoted by uncleanliness, skin contamination with dust, excessive sweating, the use of warming compresses, etc.

Symptoms and course. A hemispherical abscess appears, ranging in size from a pinhead to a lentil, filled with thick yellow pus, in the center of which a hair sticks out. After 5-7 days, the contents of the abscess dries into a crust, after which there are no traces left. The disease process is localized in the epidermis of the funnel of the hair follicle, from here the infection can spread in depth and cause a deeper lesion (folliculitis, furuncle).

Treatment - pierce an abscess with a needle, collect pus with a cotton swab soaked in alcohol, lubricate with a 1% alcohol solution of aniline dyes, a bandage is not needed.

Pityriasis versicolor. Fungal skin disease. It is characterized by damage to only the stratum corneum of the epidermis, the absence of inflammation and a very slight infectivity. Contributes to the disease increased sweating. It is localized mainly on the skin of the chest, back, neck, shoulders, less often on the scalp.

Symptoms and course. It begins with the appearance on the skin of small spots that have different shades of brown in different patients (hence the name - versicolor versicolor). The spots increase in size, merge with each other, forming large foci. On their surface, there is a barely noticeable bran-like peeling associated with loosening of the stratum corneum by the fungus. The disease lasts for many months and years. In tanned people, lesions appear lighter than healthy skin (pseudo leukoderma).

Recognition. When the stain and the surrounding skin are smeared with an alcohol solution of iodine or aniline dye, the affected skin, as a result of intensive absorption of the solution by the loosened stratum corneum, turns much brighter than healthy (positive test with iodine).

In addition, when the spot is scraped with a fingernail, the horny masses are removed in the form of chips (symptom of "chips"). It must be borne in mind that, unlike syphilitic leucoderma, the light spots of pityriasis versicolor are of different sizes and merge with each other.

Treatment. The main principle is to cause enhanced exfoliation of the stratum corneum of the epidermis. To do this, you can use any means that causes peeling - green soap, 2% alcohol solution of iodine, 3-5% salicylic or 5-10% resorcinol alcohol. You can use fungicidal preparations - canesten, mycoseptin, nitrofungin, etc. With a widespread lesion, a 20% solution of benzyl benzoate is used, treatment according to the method of prof. M.P. Demyanovich (see Scabies). Under the influence of treatment, the spots disappear after 10-12 days, but a single course of treatment is usually insufficient. Prevention. Includes a wide arsenal of general hygiene procedures: hardening, regular water-salt or water-vinegar rubdowns, treatment of excessive sweating. In spring, it is recommended to wipe the skin for a month 2% salicylic alcohol.

Pyoderma chronic (atypical). This group includes diseases, the causative agents of which are a variety of microorganisms that cause purulent inflammation in the skin: staphylococci, streptococci, enterococci, Escherichia coli and others. The altered reactivity of the body also contributes to the development of pyoderma. Of the varieties of atypical skin diseases, chronic ulcerative pyoderma should be distinguished.

Chronic ulcerative pyoderma is characterized by the presence on the skin of the legs and rear of the feet of multiple painful ulcers that have merged with each other, at the bottom of which purulent and necrotic masses, flaccid granulations are visible. The edges of the ulcer are somewhat raised above the level of healthy skin, slightly infiltrated.

Treatment consists in the use of general strengthening drugs, vitamin therapy, nonspecific immunotherapy. Outwardly shown: treatment of the ulcer with hydrogen peroxide, subsequently - drugs that accelerate scarring: ointments "Vulnuzan", "Solcoseryl", etc. A thorough examination of the patient and the appointment of corrective drugs are recommended.

Streptococcal pyoderma. The disease occurs mainly in children and women, is contagious. Streptococci infect the epidermis without penetrating into its appendages, and cause a serous-exudative inflammatory reaction with the formation of a flabby bladder on the surface - conflicts.

Streptococcal impetigo. Symptoms and course. It begins with a flaccid, thin-walled, pinhead-to-pea-sized vesicle filled with a clear liquid and surrounded by a narrow rim of inflamed skin. Due to the frequent addition of a staphylococcal infection, the contents of the vesicles become cloudy, become purulent and dry into yellow or yellow-green thick crusts lying on the eroded surface (vulgar, mixed impetigo). The disease is very contagious, usually found on the face, the infection penetrates the skin through accidental damage to it, often observed in the form of home and school epidemics. Leaves no trace after healing.

A peculiar kind of streptococcal impetigo is a pyococcal fissure of the lips or jam, which usually occurs chronically, more often in children and the elderly. Conflicts, opening up, form erosion and deep painful cracks. It is necessary to differentiate with candidal jam. There are other varieties of streptococcal impetigo.

Treatment and prevention. You can not kiss with the sick, use his dishes, linen, toiletries; a child with impetigo cannot attend schools, kindergartens, nurseries, etc. It is impossible to wash sore spots with water; they wipe the surrounding healthy skin with vodka twice a day. Hands after each touch to the affected areas should be washed, it is useful to lubricate the nails 2 times a day with iodine tincture. For the treatment of impetigo, either 1% aniline dyes in 70% alcohol, or disinfectant ointments are used.

Streptococcal pyodermatitis, in addition to impetigo, includes: ecthyma and chronic diffuse streptoderma. The group of streptoderma also includes erysipelas - an infectious disease that occurs in acute and chronic form, caused by hemolytic streptococcus and characterized by focal serous or serous-hemorrhagic inflammation of the skin (mucous membranes), fever and general toxic manifestations (see Chap. Infectious diseases).

Pink deprive. An infectious disease that is characterized by a widespread rash of small pink spots.

The predominant localization of the rash is the trunk.

Symptoms and course. The disease usually begins with the appearance on the skin of a single - "mother" spot, the size of a silver coin, rounded or oval outlines. After 7-10 days in patients on the chest, back and limbs, a lot of small spots of “children” of pinkish or pinkish-yellow color pour out. The rash is most abundant on the lateral surfaces of the trunk, back, shoulders and hips. The elements are characterized by a peculiar peeling in the center of the spots, reminiscent of crumpled tissue paper, which creates the impression of an ornament - a "medallion". The duration of the disease is 6-9 weeks.

It should be borne in mind that with irrational external treatment (pastes and ointments containing sulfur, tar, and other substances) and care (water procedures, ultraviolet irradiation), the rash becomes more common, edematous, weeping areas appear, eczematization may develop.

Treatment. With uncomplicated pink lichen, external therapy is usually not prescribed. Patients are prohibited from washing, wearing synthetic clothing, it is recommended that they be released from heavy physical work in conditions of high external temperature. Patients with itchy rosacea are prescribed corticosteroid creams and ointments, antipruritic or indifferent talkers.

Rubromycosis (rubrophytosis). It is the most common fungal disease (90% of all cases of mycosis of the feet).

Affects mainly the soles, palms, nails. The skin of the legs, buttocks, abdomen, back, face can also be involved in the pathological process, sometimes it takes on a very common character.

Symptoms and course. On the plantar surfaces of the feet, against the background of congestive hyperemia, there is a thickening of the stratum corneum, reaching the formation of calluses with deep painful cracks. Typically pityriasis (mucosal) peeling in the skin furrows, which makes them appear traced in chalk. With the defeat of the nails of the feet and hands, grayish-yellow spots and stripes form in their thickness, gradually occupying the entire nail.

Recognition. The diagnosis is confirmed by the presence of a pathogenic fungus in the scales from the lesions of the mycelium.

Prevention. Combating excessive sweating, observing elementary rules of personal hygiene, thoroughly drying the interdigital spaces after bathing, wearing comfortable shoes, mandatory boiling of stockings and socks with their subsequent ironing, etc. Rubber shoes and rubber insoles are a factor conducive to the development of mycosis. In the spring-summer period, preventive treatment of the feet with fungicidal preparations is advisable. Public prevention includes the hygienic maintenance of baths, showers, pools.

Treatment. Depends on the nature of the changes. In cases of an acute process with abundant weeping and swelling, it is first necessary to calm the inflammatory phenomena. To do this, prescribe rest, cooling lotions, alternating them with warming compresses, for example, from Goulard's water, Burov's liquid (1-2 tablespoons per glass of water), 1-2% aqueous solution of silver nitrate (lapis) and 1-2 % solution of rivanol, etc. Large blisters, after preliminary disinfection with alcohol, are pierced. It is necessary to carefully and daily remove the overhanging macerated stratum corneum with scissors.

With allergic rashes - desensitizing therapy: intravenous infusions of 20% sodium hyposulfite solution; dairy-vegetarian table. It is necessary to monitor the proper function of the intestines.

As the inflammatory process subsides, pastes are prescribed: 2-3% boron-tar, sulfur-tar or boron-naftalan. At the final stage of external therapy, fungicidal solutions and ointments are used ("Undecin", "Mikozolon", "Mikosentin", "Zinkundan").

In case of rubromycosis of smooth skin, feet and palms, detachment of the stratum corneum is prescribed with ointments or varnishes with keratolytic substances, lubrication with a 2% alcohol solution of iodine, followed by the use of ointments: "Mikozol", 3-5% sulfuric, sulfuric salicylic and tar.

It should be noted that a properly performed detachment of the stratum corneum is the key to successful treatment with fungicidal agents. Both palms and soles are treated in turn: first one, then the other. After a hot soapy-soda bath (at the rate of 2-3 teaspoons of soda and 20-30 g of soap per liter of water), a 20-30% salicylic ointment or an ointment containing 6% lactic acid and 12% salicylic is applied under a compress bandage. After 48 hours, 510% salicylic ointment is applied for a day. When treating the sole, patients should use crutches, otherwise, when walking, the ointment will move from the affected skin. In an outpatient setting, it is better to use a milk-salicylic collodion: for 3 days, daily lubricate the skin of the soles three times with an even layer. After the use of keratolytic agents, a soap and soda bath is again made, and the horny masses are removed with a scalpel or scissor jaws. In cases where it was not possible to completely cleanse the skin of them, 5% salicylic ointment is applied for 2-3 days. After detachment, fungicidal ointments and solutions are rubbed in, it is advisable to alternate them every 3-4 days or apply ointments at night, and solutions during the day. Foot (manual) baths are required once a week.

Treatment of foci of rubromycosis outside the palms and soles is carried out from the very beginning with fungicidal agents. Affected nails are removed, the nail bed is treated with antifungal patches, ointments and liquids. At the same time, griseofulvin or nizoral is prescribed for a long time (up to six months). Treatment of onychomycosis is a very complex and time-consuming process. The effectiveness of therapy depends mainly on the thoroughness of the necessary manipulations.

Sycosis(fig). Chronic skin lesions caused by Staphylococcus aureus or white are more common in men. It is localized, as a rule, on the skin of the face (in the area of ​​the beard and mustache, at the entrance to the nose). Within the lesions, against the background of reddened skin, a large number of pustules and serous-purulent crusts are noted. The disease is associated with a violation of the nervous system (prolonged fatigue, depression), dysfunction of the sex glands, inflammatory processes in the paranasal sinuses.

Treatment. Antibiotics, specific and non-specific immunotherapy, correction of concomitant diseases. Externally, antibacterial and reducing pastes and ointments, ultraviolet irradiation are used. It is recommended to remove hair in the lesions.

Trichophytosis. It is caused by various types of fungi of this genus. It can affect any part of the skin, including nails. Left to its own course, the disease can exist for many years, but usually resolves spontaneously by puberty. Clinically, two forms are distinguished.

Symptoms and course. On smooth skin, rounded or oval, slightly swollen spots appear, bordered by a border of small bubbles, nodules, crusts; in the center - a slight bran-like peeling.

When the process is localized on the scalp, numerous, disorderly bald patches, ranging in size from a pea to a nail, are formed, covered with grayish-white scales. Affected hair has extremely characteristic changes: most of them have not fallen out, but are only shortened and broken off. Part of the hair, due to the development of fungi inside them, break off at the point of exit from the skin and look like dark dots. Others are dull, grayish, curved, break off at a height of 2-3 mm.

Superficial trichophytosis, which began in childhood, can become chronic. Predominantly women (about 80% of patients) who have dysfunctions of the endocrine glands (usually sex glands), hypovitaminosis A and E are ill.

Most often in the occipital and temporal regions there is a barely noticeable small-focal peeling of the type of dry seborrhea. In the same places you can find small scars and "black dots" - stumps of broken hair. The favorite localization of the process on the skin is the buttocks, thighs, palms (back side) and fingers.

Symptoms and course. The disease usually begins with the appearance of spots, against which pustules develop, they quickly merge and form massive continuous infiltrates. A developed focus is a bumpy, rather significant, purple-colored tumor-like formation rising above the level of the skin, from which a drop of thick pus is released spontaneously or when pressed.

Most of the hair in the affected area falls out, the remaining ones are easily removed with tweezers. The foci emit a nasty, sugary odor. Their number is usually not numerous, the size is different, some can reach the size of a palm and even more.

In some cases, the process is complicated by a painful enlargement of the regional lymph glands, with their possible subsequent softening and opening. In weakened and emaciated persons, general phenomena can be observed in the form of fever, headaches, malaise, etc.

Treatment. It is carried out in the hospital and on an outpatient basis. If only smooth skin is affected, the lesions are lubricated in the morning with 2-20% iodine tincture and in the evening with 5-10% sulfur-salicylic ointment for several weeks, i.e. until the complete disappearance of lesions.

If the scalp is affected, the hair in the foci is shaved once a week and the foci are lubricated in the morning with 2-5% alcohol solution of iodine, at night - 5% sulfur-salicylic or 5-10% sulfur-tar ointment. It is also recommended to wash your hair every other day. hot water with soap. At the same time, griseofulvin is administered orally in tablets at the rate of 22 mg per 1 kg of body daily (for 20-25 days). After receiving the first negative test for fungi, griseofulvin is prescribed every other day for 2 weeks, and then 3 days later for another 2 weeks until complete recovery.

In children with contraindications to griseofulvinotherapy, it is recommended to remove hair with a 4% epilin patch. Previously, the hair is shaved off, the plaster is applied in a thin layer on the foci. For children under 6 years of age, the patch is applied once for 15-18 days, and for older children - twice, changing the bandage after 8-10 days. Hair usually falls out after 21-24 days. Then fungicidal agents are prescribed.

With infiltrative-suppurative trichophytosis, treatment begins with the removal of crusts present in the lesions using dressings with 2% salicylic vaseline. Then, manual epilation (removal) of hair is performed using tweezers both in the foci and 1 cm in their circumference. In the future, wet-drying dressings are prescribed from a 0.1% solution of ethacridinalactate, a 10% aqueous solution of ichthyol or drilling fluid. After the elimination of acute inflammation, 10-15% sulfur-tar, 10% sulfur-salicylic ointment, Wilkinson's ointment are used. This treatment can be combined with giving griseofulvin orally.

Lupus. A group of different clinical picture skin lesions caused by the introduction of Mycobacterium tuberculosis (Koch bacteria) into it.

The causative agent enters the skin or mucous membrane of the mouth, most often through the blood or lymph from any tuberculous focus in the internal organs (the so-called secondary tuberculosis). The occurrence of skin tuberculosis is promoted by hormonal dysfunctions, the state of the nervous system, asthenia, infectious diseases and other factors.

collicative skin tuberculosis (tuberculous or lupus erythematosus) occurs more often in children aged 5-15 years, less often in older people. It is characterized by a long and persistent flow. It occurs mainly on the face, sometimes combined with lesions of the mucous membranes. A tubercle (lupoma) appears on the skin, ranging in size from a pinhead to a pea, painless, soft, pale red with a yellowish tint. When pressed with glass, the redness disappears and spots of the color of "apple jelly" clearly appear on a pale background. Lupoma grows very slowly, for months, years. Subsequently, it disintegrates with the formation of an ulcer, after the healing of which a white scar remains. Lupoma may develop on it again. Sometimes lupus is complicated by erysipelas, elephantiasis, and cancer.

Collicative skin tuberculosis (scrofuloderma) is the most common form of skin tuberculosis. Occurs in children, adolescents, adults. In the subcutaneous tissue, deep nodes of various sizes, doughy consistency, bluish-purple color, slightly painful appear. Soon they soften and when they are opened, narrow fistulous passages appear. Several passages can merge, forming ulcers with soft overhanging edges and a bottom covered with necrotic masses. When they heal, rough, fringed ("shaggy") scars remain. Patients with scrofuloderma often find an active tuberculous process in the lungs.

Indurated tuberculosis of the skin is observed in the vast majority of women aged 16-40 years and is localized mainly symmetrically on the shins. Dense nodes appear deep in the dermis and subcutaneous tissue, the skin over which gradually acquires a pink-cyanotic color.

Knots, opening up, form ulcers. They heal slowly, leaving a smooth retracted scar. The disease is prone to recurrence in autumn and winter.

Lichenoid tuberculosis of the skin occurs mainly in girls and young women. Dense, hemispherical, isolated papules of a pinkish-bluish color, ranging in size from millet grain to a pea, are located in the thickness of the forearms, shins, thighs, less often the trunk and face. In the center of the papule, a foci of necrosis is found, gradually drying up into a brownish or dirty gray color crust.

After healing, depressed, as if "stamped" scars remain. The disease is prone to recurrence in autumn and winter.

Lichenoid tuberculosis of the skin (lichen scrofula). Children and adolescents suffering from tuberculosis of the lungs and lymph nodes get sick. Usually, small grouped tubercles appear on the skin of the chest, back, abdomen and lateral surfaces of the body, covered with easily removable gray crusts. After their healing, pigmentation remains, sometimes dotted scars.

Treatment. It should be aimed at the elimination of tuberculosis infection in the body, the elimination of factors contributing to the development of skin lesions, and the improvement of the general condition of the patient. The best option- combination therapy with antibiotics (streptomycin, rifampicin) and isonicotinic acid hydrazide preparations (isoniazid, or tubazid, ftivazid, saluzit, etc.). With certain types of skin tuberculosis, this therapy is combined with para-aminosalicylic acid (PAS) and vitamin D2. Great importance is attached to a salt-free, protein-rich and fortified diet, phototherapy, general strengthening therapy.

Treatment is best carried out in specialized sanatorium-type institutions (luposories). In the future, for 2-3 years, patients in spring and autumn should receive a 3-month anti-relapse treatment. plastic surgery for disfiguring scars, sometimes left by tuberculous lupus, do not earlier than 2 years after recovery.

Favus (scab). Most often, the scalp suffers, less often other areas of the integument and nails. The causative agent of scab - a fungus - is extremely resistant, for many months it can remain in dust, in furniture, in carpets, without losing virulence. Transmission of a disease from a sick person to a healthy person usually occurs either by direct contact or through clothing, underwear, hats and toiletries. Much less often the source of infection are domestic animals and birds. Children and adolescents are especially predisposed to the disease.

Symptoms and course. The appearance of dry, dense, saucer-shaped crusts (the so-called shields) with an umbilical sunken center, from which a hair sticks out, is characteristic. Their number is different, sometimes they capture the entire scalp. The shields consist of a pure colony of fungus and emit an unpleasant (mouse) odor. The skin under the shield is red, inflamed, moist, and bleeds easily. Hair, affected by fungi, becomes dull, dry, has a lifeless appearance and looks like the hair of old wigs. Over time, the shields fall off, atrophic scars remain on the skin under them, and the hair dies. Persistent baldness is a common outcome of an untreated favus. Starting in childhood, the disease can persist throughout life. Treatment, started before scarring, allows you to save all the hair, it is similar to the treatment of patients with trichophytosis.

Folliculitis. It is a complication of ostiofolliculitis (see) or appears independently in the form of a slightly painful, bright red, dense to the touch cone-shaped nodule that occurs at the base of the hair. A few days later, a small abscess develops in its center, which dries up into a crust, after which usually no traces remain.

Treatment. In the presence of an abscess, the same as with ostiofolliculitis (see). In addition, it is advisable to lubricate this place with clean ichthyol and cover it with a thin layer of cotton wool on top; Ichthyol will soon dry and firmly stick cotton wool, bandages, patches are not required. The ichthyol "cake" is changed once a day until the compaction is completely resorbed. Hair must first be cut with scissors. It is impossible to wash sore spots with water, only the surrounding skin is wiped once a day (when changing the sticker) with an alcohol solution.

Furuncle (boil). It develops as a result of acute purulent-necrotic inflammation of the hair follicle - the follicle and its surrounding tissue.

Symptoms and course. Initial manifestations look like ostiofolliculitis or folliculitis. In the future, a dense, painful, cone-shaped node of purple-red color appears, in the center of which a softening appears after a few days. Then it opens with the release of more or less pus and a funnel-shaped ulcer is formed with a yellowish-greenish rod of dead tissue above it. After some time, the necrotic rod is separated, the ulcer is cleared, inflammation, swelling, swelling and soreness quickly decrease. The boil always heals with the formation of a scar.

Clinically distinguish: 1) single furuncle; 2) localized furunculosis, when elements consistently appear in the same area, for example, on the forearm, lower back, etc. The causes of localized furunculosis are most often incorrect methods of therapy and regimen (use of compresses, undertreatment of residual compaction, washing the place where elements appear ); 3) general (disseminated) furunculosis - the chronic appearance of more and more new elements in various parts of the skin.

Treatment. For a single boil, sometimes one external therapy in the form of ichthyol stickers is enough (see Folliculitis), stopping washing the affected areas, using UHF physiotherapeutic methods, dry heat, ultrasound. However, the localization of even one boil on the face, and, in particular, in the area of ​​the nasolabial triangle, nose and lips, requires urgent hospitalization of the patient, complete rest for the facial muscles (prohibition of verbal communication, transfer to liquid food) and general therapy. With the localization of the boil on the face and with general furunculosis, broad-spectrum antibiotics are used. A thorough examination of the patient is necessary and, based on its results, the appointment of corrective measures. To increase the body's resistance, patients with chronic furunculosis are prescribed autohemotherapy, injections of aloe extract, gamma globulin, etc. In stubborn cases, immunotherapy with a staphylococcal vaccine is carried out, sometimes ingestions of fresh brewer's yeast and sulfur in powders are useful.

Local therapy with pure ichthyol should be used only until the boil opens, then several layers of gauze moistened with hypertonic solution are applied to it (to suck out pus).

After removing the necrotic rod and pus from the opened boil, antibacterial ointments and granulation-promoting ointments (Vishnevsky ointment, etc.) are prescribed, ichthyol can be applied again to the infiltrate around the ulcer.

Scabies. A contagious disease caused by the scabies mite, which is visible to the eye as a whitish dot the size of a poppy seed. It can live and multiply only on human skin. It is estimated that without treatment, in just three months, six generations of ticks in the amount of 150,000,000 individuals can be born.

A fertilized female drills a itch hole in the upper layers of the epidermis - a gallery where it lays eggs, from which larvae hatch, they come to the surface and, together with males that live on the skin, give rise to itching and scratching with their bites. The incubation period for scabies is 7-10 days. Infection occurs, as a rule, through direct close contact of the patient with healthy people or, which is less common, through various objects - common bedding (pillowcases, sheets, blankets) and underwear, outerwear, gloves.

Symptoms and course. Scabies is characterized by itching, especially worse at night, paired nodular-bubble rashes with localization in certain favorite places. Outwardly, scabies are thin strips, barely elevated above the level of the skin, like a thread, running straight or zigzag. Often the end of the move ends with a transparent bubble through which one can see white dot- the body of the tick.

At the site of bites, small nodules appear, the size of a millet grain and somewhat larger, which, due to scratching, become covered with bloody crusts.

Permanent damage to the skin is often complicated by various types of pustular infection and the development of an eczema process.

Favorite location of scabies rash: hands, especially interdigital folds and lateral surfaces of the fingers, flexor folds of the forearms and shoulders, nipple area, especially in women, buttocks, skin of the penis in men, thighs, popliteal cavities, in young children - the soles, as well as the face and even the scalp.

Treatment. Spontaneously, scabies never goes away and can last for many months and years, sometimes getting worse. To cure a patient with scabies, it is enough to destroy the mite and its eggs, which is easily achieved by using local funds; no general treatment is required here.

The most commonly used benzyl benzoate emulsion is 20% for adults and 10% for young children. Treatment is carried out according to the following scheme: on the first day, the emulsion with a cotton swab is sequentially rubbed into all lesions twice for 10 minutes with a 10-minute break. After that, the patient puts on disinfected clothes and changes bedding. On the second day, rubbing is repeated. 3 days after that - washing in the shower and again changing clothes.

Demyanovich method. Make two solutions: N1 - 60% sodium hyposulphate and N2 - 6% hydrochloric acid solution. Treatment is carried out in a warm room. A solution of N1 is poured into a dish in an amount of 100 ml. The patient is stripped naked, the solution is rubbed into the skin with a brush in the following sequence: left shoulder and left hand; in the right shoulder right hand; in the body; in the left leg; in right leg. Rub for 2 minutes with vigorous movements and especially carefully in those places where there are scabies. The patient then rests for a few minutes. During this time, the solution dries out rather quickly, the skin, covered with the smallest crystals of sodium hyposulphate, becomes white, as if powdered. After that, the second rubbing is carried out with the same solution and in the same sequence, also for 2 minutes in each area. Salt crystals, destroying the covers of scabies, facilitate the flow of the drug directly into the passages.

After drying, the skin is treated with hydrochloric acid. This solution must be taken directly from the bottle, pouring it into the palm of your hand as needed. Rubbing is done in the same sequence, but it lasts only one minute. After drying the skin, repeat 2 more times.

Then the patient puts on clean underwear and does not wash off the remaining medicines for 3 days, and then washes. As a result of the interaction of sodium hyposulfate solution and hydrochloric acid, sulfur dioxide and sulfur are released, which kill the scabies mite, their eggs and larvae. In children with scabies, treatment according to the method of prof. Demyanovich is usually carried out by parents. If the first course did not give a complete recovery, then after 2-5 days the treatment should be repeated. In extremely rare cases, a 2nd course is required.

Sulfuric ointment (33%) is rubbed into the whole body, except for the head, 1 time at night for 4-5 days. Then rubbing is not done for 1-2 days, the patient remains in the same underwear that is soaked with ointment all this time. Then he washes and puts on everything clean. In persons with hypersensitivity, dermatitis often develops, therefore, rubbing sulfuric ointment into areas with thin and delicate skin should be done with extreme caution, and in children, ointments of 10-20% concentration should be used. A one-time rubbing of sulfuric ointment is also proposed. At the same time, the patient first moistens the body with soapy water and rubs it dry into the affected areas. sulfuric ointment for 2 hours, after which the skin is powdered with talc or starch. The ointment is not washed off for 3 days, then the patient washes and changes clothes.

Good therapeutic results can be obtained from the use of the old folk remedies- simple wood ash, which contains a sufficient amount of sulfur compounds to destroy the scabies mite. From the ashes, either an ointment is prepared (30 parts of ash and 70 parts of any fat), which is used similarly to sulfuric ointment, or they take a glass of ash and two glasses of water and boil for 20 minutes. After boiling, the liquid is filtered through a gauze or cloth bag. The sediment remaining in the bag is moistened in the resulting liquid lye and rubbed into the skin every night for a week for 1/2 hour.

Kerosene in half with any vegetable oil, within 2-3 days, once at night, lubricate the whole body and spray underwear, stockings, mittens; in the morning they wash the body and change clothes; usually 2-3 lubrications are enough to cure, the disadvantage of this method is the possibility of dermatitis, especially in children.

Immediately after the end of treatment, all the patient's linen, both wearable and bedding, must be thoroughly washed and boiled; outer dress and clothing should be decontaminated from ticks in a disinfection chamber or by ironing with a hot iron, especially with inside, or ventilate in the air for 5-7 days. Also come with a mattress, blanket and other things of the patient. Of exceptional importance is the simultaneous treatment of all patients - in the same family, school, hostel, etc.

You should be aware that mites that cause scabies in animals (dogs, cats, horses, etc.) can also get to humans, but do not find suitable conditions for their existence here and die rather quickly, causing only short-term itching and rash, which without re-infection pass even without treatment.

Epidermophytosis inguinal. Fungal disease. The lesion is localized mainly in large inguinal-femoral folds of the skin. It has a relapsing course. It is observed predominantly in men; sometimes occurs in the form of isolated cases that are not transmitted to others, then, on the contrary, quickly spreading, gives rise to small epidemics in individual families, schools, hospitals, etc. Infection is often not direct, but through baths, linen, latrines.

Symptoms and course. One or more spots appear in the inguinal-femoral folds, bright pink in color, slightly flaky and itchy. They quickly increase, merge and form more or less large, always symmetrically located, with sharp boundaries lesions.

The central part of them has a paler color, while the periphery is bordered by an edematous, slightly raised roller, often dotted with small bubbles, crusts or whitish lamellar scales.

Sometimes, under the influence of mechanical irritations, irrational therapy, etc., the entire surface of the lesion becomes saturated red, edematous, rises quite significantly above the level of the surrounding healthy skin, completely dotted with small bubbles, cracks, serous-bloody and purulent crusts and pustules.

Appearing initially in the inguinal-femoral folds, epidermophytosis is for the most part not limited to this area, but gives screenings that can spread to the thighs, perineum, buttocks and pubis. Often, this affects the axillary cavities, folds under the mammary glands, between the fingers, especially the toes. Sometimes there is quite intense itching.

Recognition. Conducted on the basis of typical localization, sharp borders and V symmetry of the lesion and is confirmed by microscopic analysis of scales taken from the edges of the lesion. Among the epithelial scales, a rough and thick mycelium of the fungus is easily detected.

Treatment. Once a day, lubrication with a 1% alcohol solution of iodine using zinc paste in case of possible skin irritation. In order to avoid relapses after the cure, daily rubbing of the folds with vodka should be done for some time, followed by powdering them with talcum powder.

Athlete's foot. A group of fungal diseases that have a common localization and similar clinical manifestations.

Very common and affect people of any age (rarely children) prone to chronic relapsing course.

Infection occurs in baths, showers, on beaches, gyms, when using someone else's shoes and other household items contaminated with fungal elements.

In the pathogenesis of the disease, the anatomical and physiological features of the skin of the feet, increased sweating, changes in the chemistry of sweat, metabolic and endocrine abnormalities, injuries of the lower extremities, and vegetative dystonia are of great importance. Pathogens can be in a saprophytic state for a long time without causing active clinical manifestations. Athlete's foot has several clinical forms, each of which can be combined with nail lesions.

Symptoms and course. The process most often begins in the interdigital spaces, mainly between the most closely adjacent 4th and 5th fingers. When you feel a slight itch at the bottom of the interdigital fold, a strip of swollen and slightly flaky epidermis appears. After 23 days, a small crack appears here, releasing a small amount of serous fluid. Sometimes the stratum corneum falls off, exposing a pink-red surface. The disease, gradually progressing, can spread to all interdigital folds, the plantar surface of the fingers and adjacent parts of the foot itself. The serous fluid seeping to the surface serves as an excellent nutrient material for the further reproduction of fungi.

When fungi enter through the disturbed stratum corneum into the deeper parts of the epidermis, the process is complicated by an eczematous reaction. Numerous, strongly itchy, clear fluid-filled blisters appear, which merge and erode in places, leaving weeping areas.

The process can move to the back surface of the foot and fingers, the sole, capturing its arch to the very heel. The disease, then weakening, then again intensifying, without proper treatment and care, can drag on long years. Often, this is accompanied by a complication of a secondary pyogenic infection: the transparent contents of the vesicles become purulent, the inflammatory redness intensifies and spreads beyond the boundaries of the lesion, the foot becomes edematous, the patient's movements are difficult or impossible due to severe pain; subsequent complications may develop in the form of lymphangitis, lymphadenitis, erysipelas, etc.

In some cases, epidermophytosis on the soles is expressed by the appearance on the initially unchanged skin of separate groups of itchy, deeply located, dense to the touch blisters and blisters with transparent or slightly cloudy contents. After their spontaneous opening, the cover of the bubbles disappears, remaining in the form of a corolla only along the edges of the lesion; the central parts have a smooth, pink-red color, slightly flaky, less often - a weeping surface; often new bubbles appear on it. Due to their merger, the lesion expands and can capture significant areas of the soles.

The absorption of allergens (fungi and their toxins) is a sensitizing factor for the whole organism, increases the sensitivity of the skin, and an allergic rash may appear on it. It is more often observed on the hands (palms).

Sharply limited erythematous discs are formed, dotted with a large number of small bubbles with transparent contents, which burst, exposing an erosive, weeping surface surrounded by a widening rim of swollen and exfoliating epidermis. Fungi are not usually found in these lesions.

Epidermophytosis of the feet begins mainly in the summer. Increased sweating, insufficient drying of the interdigital spaces after bathing contribute to the introduction of the fungus.

The defeat of the nails with mycosis of the feet is observed mainly on the 1st and 5th fingers, usually starting from the free edge. The nail is thickened, has a yellowish color and a jagged edge. Gradually, more or less pronounced subungual hyperkeratosis develops.

Treatment. Particular attention should be paid to the careful processing of lesions. The patient should take daily warm foot baths with potassium permanganate. In this case, it is necessary to remove the crusts, open the blisters, cut off the fringe along the edges of the erosion, as well as the covers of festering blisters. After the bath, wet-drying dressings or lotions are applied with an aqueous solution of copper sulfate (0.1%) and zinc (0.4%) or with a 1% aqueous solution of resorcinol. After wetting stops, dermozolon, mycosolone are applied, and then alcohol fungicidal solutions, Castellani paint, and, finally, if necessary, fungicidal pastes and ointments.

The effectiveness of treatment depends not so much on the choice pharmacological preparation how much from their correct, consistent application in accordance with the nature of the inflammatory reaction.

Fungicidal treatment is carried out until the test results for fungi are negative.

Extremely important is the anti-relapse treatment carried out within a month after the elimination of the lesions - rubbing the skin of the feet with 2% salicylic or 1% thymol alcohol and dusting with 10% boron powder. For the same purpose, it is necessary to thoroughly wipe the inner surface of the shoe with a formaldehyde solution, wrap it for 2 days in an airtight fabric, then ventilate and dry, and socks and stockings for 10 minutes. boil.

With the complication of athlete's foot with pyococcal infection, antibiotics are prescribed - methicillin, cephaloridine, oleandomycin, metacycline, erythromycin.

The patient must comply with bed rest.

Prevention. It provides, firstly, for the disinfection of floors, wooden flooring, benches, basins, gangs in baths, showers, pools, as well as disinfection of impersonal shoes; their treatment; thirdly, carrying out sanitary and educational work.

The population needs to be explained the rules for personal prevention of epidermophytosis:
1) daily wash your feet at night (better cold water with laundry soap), wipe them thoroughly;
2) at least every other day, change socks and stockings;
3) do not use someone else's shoes;
4) to have your own rubber sandals or slippers for the bath, shower, pool. To harden the skin of the soles, it is recommended to walk barefoot on sand, grass in the hot season.

Erythrasma. Damage by bacteria of the stratum corneum of the skin of the contacting surfaces of the folds. The predisposing cause is excessive sweating and insufficient cleanliness. Erythrasma develops slowly and without treatment can last indefinitely, has a low contagiousness. It is observed mainly in men: the favorite localization is the inner surface of the thighs, according to the place of contact with the scrotum, less often the armpits, in women under the mammary glands.

Symptoms and course. In the folds of the skin, yellowish-pink or brownish-red spots appear, clearly defined.

Peeling is usually hardly noticeable - delicate, thin, rather tightly adhering scales.

As a rule, there are no subjective sensations, which is why the disease is often viewed by patients and is detected more often by chance. In the rays of the Wood's lamp, the foci of stritrasma give a brick-red glow.

Treatment. Prescribe exfoliators and disinfectants, 5% erythromycin ointment. To prevent relapses, it is necessary to wipe the skin of the folds with 2% salicylic alcohol for a month, followed by dusting with talc and boric acid.

Chapter 4. INFECTIOUS DISEASES OF THE SKIN

Chapter 4. INFECTIOUS DISEASES OF THE SKIN

4.1. BACTERIAL SKIN INFECTIONS (PYODERMAS)

pyoderma (pyodermiae)- pustular skin diseases that develop when pathogenic bacteria penetrate into it. With a general weakening of the body, pyoderma occurs due to the transformation of its own opportunistic flora.

Bacterial infections (pyoderma) are often encountered in the practice of a dermatovenereologist (especially common in children), accounting for 30-40% of all visits. In countries with a cold climate, the peak incidence occurs in the autumn-winter period. In hot countries with a humid climate, pyoderma occurs year-round, ranking second in frequency of occurrence after skin mycoses.

Etiology

The main pathogens are gram-positive cocci: in 80-90% - staphylococci (St. aureus, epidermidis); in 10-15% - streptococci (S. pyogenes). In recent years, 2 pathogens can be detected at the same time.

Pyoderma can also be caused by pneumococci, Pseudomonas aeruginosa and Escherichia coli, Proteus vulgaris, etc.

The leading role in the occurrence of acute pyoderma belongs to staphylococci and streptococci, and with the development of deep chronic hospital pyoderma, a mixed infection with the addition of gram-negative flora comes to the fore.

Pathogenesis

Piokkoki are very common in the environment, but not in all cases, infectious agents can cause disease. The pathogenesis of pyoderma should be considered as an interaction microorganism + macroorganism + environment.

Microorganisms

Staphylococci morphologically, they are gram-positive cocci, which are facultative anaerobes that do not form capsules and spores. The genus Staphylococcus is represented by 3 species:

Staphylococcus aureus (St. aureus) pathogenic for humans;

Staphylococcus epidermidis (St. epidermidus) can take part in pathological processes;

Saprophytic staphylococci (St. saprophyticus)- saprophytes, do not participate in inflammation.

Staphylococcus aureus is characterized by a number of properties that determine its pathogenicity. Among them, the most significant is the ability to coagulate plasma (they note a high degree of correlation between the pathogenicity of staphylococci and their ability to form coagulase). Due to coagulase activity, early blockade occurs in case of infection with staphylococcus aureus. lymphatic vessels, which leads to restriction of the spread of infection, and is clinically manifested by the appearance of infiltrative-necrotic and suppurative inflammation. Staphylococcus aureus also produces hyaluronidase (a spreading factor that promotes the penetration of microorganisms into tissues), fibrinolysin, DNase, a flocculating factor, etc.

Bullous staphyloderma is caused by staphylococci of the 2nd phage group, which produce an exfoliative toxin that damages the desmosomes of the spinous layer of the epidermis and causes stratification of the epidermis and the formation of cracks and blisters.

The association of staphylococci with mycoplasma causes more severe lesions than monoinfection. Pyoderma has a pronounced exudative component, often resulting in a fibrous-necrotic process.

streptococci morphologically, they are gram-positive cocci arranged in a chain, do not form spores, most of them are aerobes. According to the nature of growth on blood agar, streptococci are divided into hemolytic, green and non-hemolytic. The most important in the development of pyoderma is p-hemolytic streptococcus.

The pathogenicity of streptococci is due to cellular substances (hyaluronic acid, which has antiphagocytic properties, and substance M), as well as extracellular toxins: streptolysin, streptokinase, erythrogenic toxins A and B, O-toxins, etc.

Exposure to these toxins dramatically increases the permeability vascular wall and promotes the release of plasma into the interstitial space, which, in turn, leads to the formation of edema, and then - bubbles filled with serous exudate. Streptoderma is characterized by an exudative-serous type of inflammatory reaction.

macroorganism

Natural Defense Mechanisms macroorganisms have a number of features.

The impermeability for microorganisms of the intact stratum corneum is created due to the tight fit of the stratum corneum to each other and their negative electric charge, which repels negatively charged bacteria. Also of great importance is the constant exfoliation of the cells of the stratum corneum, with which a large number of microorganisms are removed.

An acidic environment on the surface of the skin is an unfavorable background for the reproduction of microorganisms.

Free fatty acids, which are part of the sebum and the epidermal lipid barrier, have a bactericidal effect (especially on streptococci).

Antagonistic and antibiotic properties normal microflora skin (saprophytic and opportunistic bacteria) have an inhibitory effect on the development of pathogenic microflora.

Immunological defense mechanisms are carried out with the help of Langerhans and Greenstein cells in the epidermis; basophils, tissue macrophages, T-lymphocytes - in the dermis.

Factors that reduce the resistance of the macroorganism:

Chronic diseases of internal organs: endocrinopathies (diabetes mellitus, Itsenko-Cushing's syndrome, thyroid disease, obesity), gastrointestinal diseases, liver diseases, hypovitaminosis, chronic intoxication (for example, alcoholism), etc.;

Chronic infectious diseases (tonsillitis, caries, infections of the urogenital tract, etc.);

Congenital or acquired immunodeficiency (primary immunodeficiency, HIV infection, etc.). Immunodeficiency states contribute to the long course of bacterial processes in the skin and the frequent development of relapses;

Prolonged and irrational use (both general and external) antibacterial agents leads to a violation of the biocenosis of the skin, and glucocorticoid and immunosuppressive drugs - to a decrease in the immunological protective mechanisms in the skin;

Age characteristics of patients (children, elderly age). External environment

The negative environmental factors include the following.

Pollution and massiveness of infection with pathogenic microorganisms in violation of the sanitary and hygienic regime.

Impact of physical factors:

High temperature and high humidity lead to maceration of the skin (violation of the integrity of the stratum corneum), expansion of the mouths of the sweat glands, as well as the rapid spread of the infectious process hematogenously through dilated vessels;

- at low temperatures, skin capillaries constrict, the rate of metabolic processes in the skin decreases, and the dryness of the stratum corneum leads to a violation of its integrity.

Microtraumatization of the skin (injections, cuts, scratches, abrasions, burns, frostbite), as well as thinning of the stratum corneum - the "entrance gate" for the coccal flora.

Thus, in the development of pyoderma, an important role belongs to changes in the reactivity of the macroorganism, the pathogenicity of microorganisms and the unfavorable influence of the external environment.

In the pathogenesis of acute pyoderma, the pathogenicity of the coccal flora and irritating environmental factors are the most significant. These diseases are often contagious, especially for young children.

With the development of chronic recurrent pyoderma, the most important change in the reactivity of the organism and the weakening of its protective properties. In most cases, the cause of these pyodermas is mixed flora, often opportunistic. Such pyodermas are not contagious.

Classification

There is no single classification of pyoderma.

By etiology pyoderma is divided into staphylococcal (staphyloderma) and streptococcal (streptoderma), as well as mixed pyoderma.

By the depth of the lesion skin distinguish superficial and deep, paying attention to the possibility of scar formation with the resolution of inflammation.

By flow duration pyoderma can be acute and chronic.

It is important to distinguish between pyoderma primary, occurring on intact skin, and secondary, developing as complications against the background of existing dermatoses (scabies, atopic dermatitis, Darier's disease, eczema, etc.).

Clinical picture

Staphylococcal pyoderma, usually associated with skin appendages (hair follicles, apocrine and eccrine sweat glands). Morphological element of staphyloderma - follicular pustule conical shape, in the center of which a cavity filled with pus is formed. On the periphery - a zone of erythematous-edematous inflammatory skin with severe infiltration.

Streptococcal pyoderma often develop on smooth skin around natural openings (mouth, nose). Morphological element of streptoderma - conflict(flat pustule) - a superficially located vesicle with a flabby tire and serous-purulent contents. Having thin walls, conflict quickly opens, and the contents shrink with the formation of honey-yellow layered crusts. The process is prone to autoinoculation.

Staphylococcal pyoderma (staphyloderma)

Ostiofolliculitis (ostiofolliculitis)

Superficial pustules 1-3 mm in size appear, associated with the mouth of the hair follicle and permeated with hair. The contents are purulent, the tire is tense, there is an erythematous corolla around the pustule. Rashes can be single or multiple, located in groups, but never merge. After 2-3 days, hyperemia disappears, and the contents of the pustule shrink and a crust forms. The scar does not remain. The most common localization is the scalp, trunk, buttocks, genitals. The evolution of osteofolliculitis occurs in 3-4 days.

Folliculitis

Folliculitis (folliculitis)- purulent inflammation of the hair follicle. In most patients, folliculitis develops from osteofolliculitis as a result of infection penetrating into the deep layers of the skin. Morphologically, it is a follicular pustule surrounded by a raised ridge of acute inflammatory infiltrate (Fig. 4-1, 4-2). If the upper part of the follicle is involved in the inflammatory process, then it develops superficial folliculitis. With the defeat of the entire follicle, including the papilla of the hair, a deep folliculitis.

Rice. 4-1. Folliculitis, individual elements

Rice. 4-2. Widespread folliculitis

Localization - on any part of the skin where there are hair follicles, but more often on the back. The evolution of the element occurs in 5-10 days. After the resolution of the element, temporary post-inflammatory pigmentation remains. Deep folliculitis leaves a small scar, hair follicle dies.

Gastrointestinal diseases (gastritis, peptic ulcer stomach, colitis, dysbiosis), as well as overheating, maceration, insufficient hygiene care, mechanical or chemical irritation of the skin.

Treatment osteofolliculitis and folliculitis consists in the external application of alcohol solutions of aniline dyes (1% brilliant green, Castellani liquid, 1% methylene blue) 2-3 times a day on pustular elements, it is also recommended to wipe the skin around the rashes with antiseptic solutions: chlorhexidine, miramistin *, sanguirythrin *, 1-2% chlorophyllipt*.

Furuncle

Furuncle furunculus)- acute purulent-necrotic lesion of the entire follicle and the surrounding subcutaneous adipose tissue. It begins acutely as a deep folliculitis with a powerful perifollicular infiltrate and rapidly developing necrosis in the center (Fig. 4-3). Sometimes there is a gradual development - osteofolliculitis, folliculitis, then, with an increase in inflammation in the connective tissue from the follicle, a furuncle is formed.

Rice. 4-3. Furuncle of the thigh

Clinical picture

The process takes place in 3 stages:

. I stage(infiltration) is characterized by the formation of a painful acute inflammatory node the size of a hazelnut (diameter 1-4 cm). The skin over it takes on a purple-red color.

. II stage characterized by the development of suppuration and the formation of a necrotic rod. A cone-shaped node protrudes above the surface of the skin, at the top of which a pustule forms. Subjectively noted burning sensation, severe pain. As a result of necrosis, a softening of the node in the center occurs after a few days. After opening the pustule and separating the gray-green pus with an admixture of blood, the purulent-necrotic core is gradually rejected. In place of the opened furuncle, an ulcer is formed with uneven, undermined edges and a bottom covered with purulent-necrotic masses.

. III stage- filling the defect with granulation tissue and scar formation. Depending on the depth of the inflammatory process, scars can be either barely noticeable or pronounced (retracted, irregularly shaped).

The size of the infiltrate with a boil depends on the reactivity of the tissues. Especially large infiltrates with deep and extensive necrosis develop in diabetes mellitus.

The furuncle is localized on any part of the skin, with the exception of palms and soles(where there are no hair follicles).

The localization of the boil on the face (the area of ​​the nose, upper lip) is dangerous - staphylococci can penetrate into the venous system of the brain with the development of sepsis and death.

In places with well-developed subcutaneous fatty tissue (buttocks, thighs, face), boils reach large sizes due to a powerful perifollicular infiltrate.

Significant soreness is noted with the localization of boils in places where there are almost no soft tissues(scalp, back surface of the fingers, front surface of the lower leg, external auditory meatus, etc.), as well as in the places where nerves and tendons pass.

A single boil is usually not accompanied by general symptoms, if there are several, an increase in body temperature up to 37.2-39 ° C, weakness, loss of appetite is possible.

The evolution of a boil occurs within 7-10 days, but sometimes new boils appear, and the disease drags on for months.

If several boils occur simultaneously or with relapses of the inflammatory process, they speak of furunculosis. This condition is more common in adolescents and young people with severe sensitization to pyococci, as well as in people with somatic pathology (diabetes mellitus, gastrointestinal diseases, chronic alcoholism), chronic itchy dermatoses (scabies, pediculosis).

Treatment

With single elements, local therapy is possible, which consists in treating the boil with a 5% solution of potassium permanganate, applying pure ichthyol to the surface of an unopened pustule. After opening the element, lotions with hypertonic solutions, iodopyrone *, proteolytic enzymes (trypsin, chymotrypsin), antibiotic ointments (levomekol *, levosin *, mupirocin, silver sulfathiazole, etc.), as well as 10-20% ichthyol ointment, Vishnevsky's liniment *.

With furunculosis, as well as with the localization of boils in painful or "dangerous" areas, it is indicated antibiotic treatment. Broad-spectrum antibiotics are used (with furunculosis, the sensitivity of the microflora is mandatory determined): benzylpenicillin 300,000 IU 4 times a day, doxycycline 100-200 mg / day, lincomycin 500 mg 3-4 times a day, amoxicillin + clavulanic acid according to 500 mg 2 times a day, cefazolin 1 g 3 times a day, cefuroxime 500 mg 2 times a day, imipenem + cilastatin 500 mg 2 times a day, etc. within 7-10 days.

For furunculosis, specific immunotherapy is indicated: a vaccine for the treatment of staphylococcal infections, anti-staphylococcal immunoglobulin, staphylococcal vaccine and toxoid, etc.

In case of a recurrent course of a purulent infection, it is recommended to conduct a course of nonspecific immunotherapy with licopid * (for children - 1 mg 2 times a day, for adults - 10 mg / day), a-glutamyl-tryptophan, etc. UVR may be prescribed.

If necessary, surgical opening and drainage of boils is prescribed.

Carbuncle

Carbuncle (carbunculus)- a conglomerate of boils united by a common infiltrate (Fig. 4-4). It is rare in children. Occurs acutely as a result of simultaneous damage to many adjacent follicles, represents an acute inflammatory infiltrate

Rice. 4-4. Carbuncle

with many necrotic rods. The infiltrate captures the skin and subcutaneous tissue, accompanied by severe edema, as well as a violation of the general condition of the body. The skin over the infiltrate is purple-red with a bluish tinge in the center. On the surface of the carbuncle, several pointed pustules or black centers of incipient necrosis are visible. The further course of the carbuncle is characterized by the formation of several perforations on its surface, from which thick pus is released mixed with blood. Soon, the entire skin covering the carbuncle melts, and a deep ulcer is formed (sometimes reaching the fascia or muscles), the bottom of which is a continuous necrotic mass of a dirty green color; around the ulcer for a long time persists infiltrate. The defect is filled with granulations and heals with a deep retracted scar. Carbuncles are usually solitary.

Often carbuncles are localized on the back of the neck, back. When the elements are localized along the spine, the vertebral bodies can be affected, when located behind the auricle - the mastoid process, in the occipital region - the bones of the skull. Possible complications in the form of phlebitis, thrombosis of the sinuses of the brain, sepsis.

In the pathogenesis of the disease, an important role is played by metabolic disorders (diabetes mellitus), immunodeficiency, exhaustion and weakening of the body by malnutrition, chronic infection, intoxication (alcoholism), as well as massive skin contamination as a result of non-compliance with the hygienic regime, microtrauma.

Treatment Carbuncles are carried out in a hospital with broad-spectrum antibiotics, specific and non-specific immunostimulations are prescribed (see. Treatment of boils). In some cases, surgical treatment is indicated.

Hydradenitis

Hydradenitis (hydradenitis)- deep purulent inflammation of the apocrine glands (Fig. 4-5). Occurs in adolescents and young patients. Children before the onset of puberty and the elderly do not get sick with hydradenitis, since the former have not yet developed apocrine glands, while the function of the glands fades in the latter.

Hidradenitis is localized in the armpits, on the genitals, in the perineum, on the pubis, around the nipple, navel.

Clinical picture

First, a slight itching appears, then soreness in the area of ​​\u200b\u200bthe formation of an inflammatory focus in the subcutaneous tissue. Deep in the skin (dermis and subcutaneous adipose tissue), one or more nodes of small size, rounded shape, dense consistency, painful on palpation, are formed. Soon, hyperemia appears above the nodes, which later acquires a bluish-red color.

In the center of the nodes there is a fluctuation, they soon open with the release of thick yellowish-green pus. After that, the inflammatory phenomena decrease, and the infiltrate gradually resolves.

Rice. 4-5. Hydradenitis

there is. Necrosis of skin tissues, as with a boil, does not happen. At the height of the development of hydradenitis, the body temperature rises (subfebrile), and malaise occurs. The disease lasts 10-15 days. Hydradenitis often recurs.

Recurrent hydradenitis on the skin is characterized by the appearance of double-triple comedones (fistulous passages connected to several superficial holes), as well as the presence of scars resembling cords.

The disease is especially severe in obese people.

Treatment

Broad-spectrum antibiotics are used (with chronic hydradenitis - always taking into account the sensitivity of the microflora): benzylpenicillin 300,000 4 times a day, doxycycline 100-200 mg / day, lincomycin 500 mg 3-4 times a day, amoxicillin + clavulanic acid according to 500 mg 2 times a day, cefazolin 1 g 3 times a day, cefuroxime 500 mg 2 times a day, imipenem + cilastatin 500 mg 2 times a day, etc. within 7-10 days.

In a chronic course, specific and nonspecific immunotherapy is prescribed.

If necessary, surgical opening and drainage of hydradenitis are prescribed.

External treatment consists in applying pure ichthyol to the surface of an unopened pustule, and when opening the element, lotions with hypertonic solutions, iodopyrone *, proteolytic enzymes (trypsin, chymotrypsin), antibiotic ointments (levomekol *, levosin *, mupirocin, silver sulfathiazole, etc.) etc.), as well as 10-20% ichthyol ointment, Vishnevsky liniment *.

Sycosis

Sycosis (sycosis)- chronic purulent inflammation of the follicles in the bristly hair growth zone (Fig. 4-6). The follicles of the beard, mustache, eyebrows, and pubic area are affected. This disease occurs exclusively in men.

Several factors play a decisive role in the pathogenesis of sycosis: infection of the skin with Staphylococcus aureus; imbalance of sex hormones (only seborrheic zones on the face are affected) and allergic reactions that develop in response to inflammation.

Rice. 4-6. Sycosis

The disease begins with the appearance of osteofolliculitis on hyperemic skin. In the future, a pronounced infiltration develops, against which pustules, superficial erosions, serous-purulent crusts are visible. Hair in the affected area is easily pulled out. There are no scars left. Sycosis is often complicated by eczematization, as evidenced by increased acute inflammatory phenomena, the appearance of itching, weeping, and serous crusts.

For this disease characterized by a long course with periodic remissions and exacerbations (for many months and even years).

Treatment. Broad-spectrum antibiotics are used, taking into account the sensitivity of the microflora. Outwardly, alcohol solutions of aniline dyes (brilliant green, Castellani liquid, methylene blue) are used 2-3 times a day for pustular elements, antiseptic solutions (chlorhexidine, miramistin *, sanguirythrin *, 1-2% chlorophyllipt *), antibiotic ointments (levomekol *, levosin*, mupirocin, silver sulfathiazole, etc.), as well as 10-20% ichthammol ointment, Vishnevsky liniment *.

In a chronic relapsing course, retinoids are prescribed (isotretinoin, vitamin E + retinol, topical creams with adapalene, azelaic acid).

For eczematization, antihistamines are recommended (desloratadine, loratadine, mebhydrolin, chloropyramine, etc.), and locally combined glucocorticoid drugs (hydrocortisone + oxytetracycline, betamethasone + gentamicin + clotrimazole, etc.).

Barley

Barley (hordeolum)- purulent folliculitis and perifolliculitis of the eyelid area (Fig. 4-7). There are external barley, which is an inflammation of the gland of Zeiss or Mole, and internal barley, the result of inflammation of the meibomian gland. Barley can have one or two-sided localization. Often found in children.

Clinically characterized by swelling and redness of the edge of the eyelid, accompanied by severe pain. Subjective sensations disappear after the abscess breaks out. In most cases, spontaneous self-healing occurs, but sometimes inflammation takes a chronic course and barley recurs.

External treatment: use for 4-7 days, 2-4 times a day, antibacterial drugs (tobramycin, chloramphenicol drops, tetracycline ointment, etc.).

Staphylococcal pyoderma in infants

Staphylococcal infection continues to occupy one of the leading positions in the structure of morbidity in young children. Staphyloderma is very common among infants, which is associated with the anatomical features of the structure of their skin. So, the fragile connection of keratinocytes of the basal layer with each other, as well as with the basement membrane, leads to epidermolytic processes; the neutral pH of the skin is more favorable for the development of bacteria than the acidic environment in adults; there are 12 times more eccrine sweat glands in children than in adults, sweating is increased, and excretory ducts

Rice. 4-7. Barley

sweat glands are straight and dilated, which creates the prerequisites for the development of infectious diseases of the sweat glands in young children.

These features of the structure and functioning of the skin of infants led to the formation separate group staphylococcal pyoderma, characteristic only for young children.

Sweating and vesiculopustulosis

Sweating and vesiculopustulosis (vesiculopustulos)- 2 conditions closely related to each other and representing 2 stages of development of the inflammatory process in the eccrine sweat glands with increased sweating against the background of overheating of the child (high temperature environment, fever with general infectious diseases). Occur more often by the end of the 1st month of a child's life, when the sweat glands begin to function actively, and stop by 1.5-2 years, when the mechanisms of sweating and thermoregulation are formed in children.

Prickly heat is considered as a physiological condition associated with hyperfunction of the eccrine sweat glands. The condition is clinically characterized by the appearance on the skin of small reddish papules - dilated mouths of the ducts of eccrine sweat glands. Rashes are located on the scalp, upper third of the chest, neck, back.

Vesiculopustulosis is a purulent inflammation of the mouths of the eccrine sweat glands against the background of the existing prickly heat and is manifested by superficial pustules-vesicles the size of a millet grain, filled with milky-white contents and surrounded by a halo of hyperemia (Fig. 4-8).

With widespread vesiculopustulosis, subfebrile condition and malaise of the child are noted. In place of pustules, serous-purulent crusts appear, after rejection of which there are no scars or hyperpigmented spots. The process lasts from 2 to 10 days. In premature babies, the process extends in depth and multiple abscesses occur.

Treatment consists in an adequate temperature regime for the child, holding hygienic baths, using disinfectant solutions (1% potassium permanganate solution, nitrofural, 0.05% chlorhexidine solution, etc.), pustular elements are treated with aniline dyes 2 times a day.

Rice. 4-8. Vesiculopustulosis

Multiple abscesses in children

Multiple abscesses in children, or Finger's pseudofurunculosis (pseudofurunculosis Finger), arise primarily or as a continuation of the course of vesiculopustulosis.

This condition is characterized by a staphylococcal infection of the entire excretory duct and even glomeruli of the eccrine sweat glands. In this case, large, sharply defined hemispherical nodules and nodes of various sizes (1-2 cm) appear. The skin above them is hyperemic, bluish-red in color, subsequently becomes thinner, the nodes open with the release of thick greenish-yellow pus, and a scar (or scar) forms during healing (Fig. 4-9). In excellent

Rice. 4-9. Pseudofurunculosis Finger

those from a boil, there is no dense infiltrate around the node, it opens without a necrotic core. The most common localization is the skin of the scalp, buttocks, inner thighs, and back.

The disease proceeds with a violation of the general condition of the child: an increase in body temperature up to 37-39 ° C, dyspepsia, intoxication. The disease is often complicated by otitis, sinusitis, pneumonia.

Children suffering from malnutrition, rickets, excessive sweating, anemia, hypovitaminosis are especially prone to this disease.

Treatment of children with Finger's pseudofurunculosis is carried out in conjunction with a pediatric surgeon to resolve the issue of the need to open the nodes. Antibiotics are prescribed (oxacillin, azithromycin, amoxicillin + clavulanic acid, etc.). Bandages with ointment Levomekol *, Levosin *, mupirocin, bacitracin + neomycin, etc. are applied to the opened nodes. It is advisable to carry out physiotherapeutic methods of treatment: UVI, UHF, etc.

Epidemic pemphigus of the newborn

Epidemic pemphigus of the newborn (pemphigus epidemicus neonatorum)- widespread superficial purulent skin lesion. It is a contagious disease that occurs most often in the 1st week of a child's life. Rashes are localized on the buttocks, thighs, around the navel, extremities, extremely rarely - on the palms and soles (in contrast to the localization of blisters in syphilitic pemphigus). Multiple blisters with cloudy serous or serous-purulent contents, ranging in size from a pea to walnut appear on uninfiltrated, unaltered skin. Merging and opening, they form weeping red erosions with fragments of the epidermis. Nikolsky's symptom in a severe course of the process can be positive. No crusts form on the surface of the elements. The bottom of the erosions is completely epithelized within a few days, leaving pale pink spots. Rashes occur in waves, in groups, after 7-10 days. Each attack of the disease is accompanied by an increase in body temperature to 38-39 ° C. Children are restless, dyspepsia and vomiting occur. Changes in peripheral blood are characteristic: leukocytosis, shift leukocyte formula to the left, an increase in the erythrocyte sedimentation rate (ESR).

This disease can be abortive, manifesting a benign form. Benign form characterized by single flaccid blisters with serous-purulent contents,

laid on a hyperemic background. Nikolsky's symptom is negative. Bubbles are quickly resolved by large-lamellar peeling. The condition of newborns is usually not disturbed, it is possible to increase body temperature to subfebrile.

Pemphigus of newborns is classified as a contagious disease, so a sick child is isolated in a separate ward or transferred to an infectious diseases department.

Treatment. Prescribe antibiotics, infusion therapy. Bubbles are pierced, preventing the contents from getting on healthy skin; the tire and erosion are treated with 1% solutions of aniline dyes. UFO is used. To avoid the spread of the process, bathing a sick child is not recommended.

Ritter's exfoliative dermatitis of the newborn

Ritter's exfoliative dermatitis of the newborn (dermatitis exfoliative), or staphylococcal scalded skin syndrome, the most severe form of staphylococcal pyoderma that develops in children during the first days of life (Fig. 4-10). The severity of the disease directly depends on the age of the sick child: the younger the child, the more severe the disease. The development of the disease is possible in older children (up to

2-3 years), in which it is characterized by a mild course, does not have a common character.

Etiology - staphylococci of the 2nd phage group, producing exotoxin (exfoliatin A).

The disease begins with inflammatory bright edematous erythema in the mouth or umbilical wound, which quickly spreads to the folds of the neck, abdomen, genitals and anus. Against this background, large sluggish blisters are formed, which quickly open up, leaving extensive weeping eroded surfaces. With a minor injury, the swollen, loosened epidermis exfoliates in places.

Rice. 4-10. Ritter's exfoliative dermatitis

Nikolsky's symptom is sharply positive. There are no scars left. In some cases, bullous rashes predominate at first, and then the disease takes on the character of erythroderma, in others it immediately begins with erythroderma for 2-3 days, covering almost the entire surface of the body. There are 3 stages of the disease: erythematous, exfoliative and regenerative.

AT erythematous stages note diffuse redness of the skin, swelling and blistering. The exudate formed in the epidermis and under it contributes to the exfoliation of parts of the epidermis.

AT exfoliative stages very quickly appear erosion with a tendency to peripheral growth and merging. This is the most difficult period (outwardly, the child resembles a patient with II degree burns), accompanied by high body temperature up to 40-41 ° C, dyspeptic disorders, anemia, leukocytosis, eosinophilia, high ESR, weight loss, asthenia.

AT regenerative stages, hyperemia and swelling of the skin decrease, epithelialization of erosive surfaces occurs.

In mild forms of the disease, the staging of the course is not clearly expressed. Benign form localized (only on the face, chest, etc.) and is characterized by mild hyperemia of the skin and large-lamellar peeling. The general condition of the patients is satisfactory. This form occurs in older children. The prognosis is favorable.

In severe cases, the process proceeds septically, often in combination with complications (pneumonia, omphalitis, otitis, meningeal phenomena, acute enterocolitis, phlegmon), which can lead to death.

Treatment It consists in maintaining the child's normal body temperature and water and electrolyte balance, gentle skin care, and antibiotic therapy.

The child is placed in an incubator with regular temperature control or under a solar lamp. Antibiotics are administered parenterally (oxacillin, lincomycin). Apply γ-globulin (2-6 injections), infusions of antistaphylococcal plasma, 5-8 ml per 1 kg of body weight. Conduct infusion therapy with crystalloids.

If the child's condition allows, then he is bathed in sterile water with the addition of potassium permanganate (pink). Areas of unaffected skin are lubricated with 0.5% aqueous solutions of aniline dyes.

calves, and compresses are applied to the affected with Burov's liquid, sterile isotonic sodium chloride solution with the addition of 0.1% silver nitrate solution, 0.5% potassium permanganate solution. The remains of the exfoliated epidermis are cut off with sterile scissors. With abundant erosion, a powder with zinc oxide and talc is used. Antibacterial ointments are prescribed for dry erosion (2% lincomycin, 1% erythromycin, containing fusidic acid, mupirocin, bacitracin + neomycin, sulfadiazine, silver sulfathiazole, etc.).

Streptococcal pyoderma ( streptodermia)

Streptococcal impetigo

Streptococcal impetigo (impetigo streptogenes)- the most common form of streptoderma in children, is contagious. Morphological element - conflict- superficial epidermal pustule with a thin, flabby tire, lying almost at the level of the skin, filled with serous contents (Fig. 4-11). The conflict is surrounded by a zone of hyperemia (corolla), has a tendency to peripheral growth (Fig. 4-12). Its contents quickly shrink into a straw-yellow crust, which, when removed, forms a moist erosive surface. Around the primary conflict, new small, grouped conflicts appear, upon opening of which the focus acquires a scalloped shape. The process ends in 1-2 weeks. Nai-

Rice. 4-11. Streptococcal impetigo

Rice. 4-12. Streptococcal impetigo on the face

more frequent localization: cheeks, lower jaw, around the mouth, less often on the skin of the trunk.

Children with streptococcal impetigo are limited to attending schools and childcare facilities.

There are several clinical varieties of streptococcal impetigo.

bullous impetigo

bullous impetigo (impetigo bullosa) characterized by pustules and blisters located on areas of the skin with a pronounced stratum corneum or in the deeper layers of the epidermis. With bullous impetigo, the bladder cover is often tense, the contents are serous-purulent, sometimes with bloody contents (Fig. 4-13, 4-14). The disease often develops in children of younger and middle age, extends to

Rice. 4-13. Bullous impetigo: a bladder with bloody contents

Rice. 4-14. Bullous impetigo on the background of immunodeficiency

lower extremities, accompanied by a violation of the general condition, an increase in body temperature, septic complications are possible.

Treatment is antibiotic therapy. Outwardly, 1% alcohol solutions of aniline dyes (brilliant green, Castellani liquid, methylene blue) are used 2-3 times a day.

slit-like impetigo

Slit-like impetigo (impetigo fissurica)- streptoderma of the corners of the mouth (Fig. 4-15). Often develops in middle-aged children and adolescents with a habit of licking lips (dry lips in atopic dermatitis, actinic cheilitis, chronic eczema), as well as in patients with difficulty in nasal breathing ( chronic tonsillitis) - during sleep with an open mouth, excessive moistening of the corners of the mouth occurs, which contributes to the development of inflammation. Conflict is localized in the corners of the mouth, quickly opens and is an erosion surrounded by a corolla

Rice. 4-15. Impetigo of the corners of the mouth (zaeda)

exfoliated epidermis. In the center of erosion in the corner of the mouth is a radial crack, partially covered with honey-yellow crusts.

Treatment consists in the external use of antibacterial ointments (mupirocin, levomecol *, fusidic acid, erythromycin ointment, etc.), as well as aqueous solutions of aniline dyes (1% brilliant green, 1% methylene blue, etc.).

Superficial panaritium

Superficial panaritium (turneoe)- inflammation of the periungual folds (Fig. 4-16). It often develops in children in the presence of burrs, nail injuries, onychophagia. Inflammation horseshoe-shaped surrounds the legs

Tevu plate, accompanied by severe pain. In a chronic course, the skin of the nail roller is bluish-red in color, infiltrated, a fringe of exfoliating epidermis is located along the periphery, a drop of pus is periodically released from under the nail roller. The nail plate becomes deformed, dull, onycholysis may occur.

With the spread of inflammation, deep forms of panaritium may develop, requiring surgical intervention.

Treatment. With localized forms, external treatment is prescribed - treatment of pustules with aniline dyes, 5% potassium permanganate solution, apply

wipes with Vishnevsky's liniment *, 10-12% ichthammol ointment, apply antibacterial ointments.

With a widespread process, antibiotic therapy is prescribed. A consultation with a surgeon is recommended.

Intertriginous streptoderma, or streptococcal diaper rash (intertrigo streptogenes), occurs on adjacent surfaces

Rice. 4-16. Superficial panaritium

skin folds in a child: inguinal-femoral and intergluteal, behind the auricles, in the armpits, etc. (Fig. 4-17). The disease occurs mainly in children suffering from obesity, hyperhidrosis, atopic dermatitis, diabetes.

Appearing in large numbers, conflicts merge, quickly open, forming continuous eroded weeping surfaces of a bright pink color, with scalloped borders and a border of exfoliating epidermis along the periphery. Near the main lesions, screenings are visible in the form of separately located pustular elements at various stages of development. There are often painful cracks in the depth of the folds. The course is long and is accompanied by severe subjective disorders.

Treatment consists in the treatment of pustular elements with 1% aqueous solutions of aniline dyes (brilliant green, methylene blue), a solution of chlorhexidine, miramistin *, external use of pastes containing antibacterial components, antibacterial ointments (bacitracin + neomycin, mupirocin, 2% lincomycin, 1% erythromycin ointments etc.). FROM preventive purposes 3-4 times a day, the folds are treated with powders (with clotrimazole).

Posterosive syphiloid

Posterosive syphiloid or syphiloid papular impetigo (syphiloides posterosives, impetigo papulosa syphiloides), occurs predominantly in infants. Localization - the skin of the buttocks, genitals, thighs. The disease begins with rapidly opening

Rice. 4-17. Intertriginous streptoderma

Xia conflict, which is based on the infiltrate, which makes these elements look like papuloerosive syphilis. However, an acute inflammatory reaction is not characteristic of a syphilitic infection. In the occurrence of this disease in children, poor hygiene care matters (another name for the disease is “diaper dermatitis”).

Treatment. Outwardly, the anogenital area is treated with antiseptic solutions (0.05% solutions of chlorhexidine, nitrofural, miramistin *, 0.5% potassium permanganate solution, etc.) 1-2 times a day, antibacterial pastes are used (2% lincomycin, 2% erythromycin ), antibacterial ointments (2% lincomycin, 1% erythromycin ointment, 3% tetracycline ointment, mupirocin, bacitracin + neomycin, etc.). For preventive purposes, 3-4 times (with each change of diapers or diapers) the skin is treated with protective soft pastes (special creams for diapers, cream with zinc oxide, etc.), powders (with clotrimazole).

lichen simplex

lichen simplex (pityriasis simplex)- dry superficial streptoderma caused by non-contagious forms of streptococcus. Inflammation develops in the stratum corneum of the epidermis and is a keratopyoderma. It occurs especially often in children and adolescents.

Rashes are localized most often on the cheeks, chin, limbs, less often on the trunk. Lichen simplex is common in children with atopic dermatitis, as well as in xerosis of the skin. It is clinically characterized by the formation of round, clearly demarcated pink lesions, abundantly covered with silvery scales (Fig. 4-18).

Rice. 4-18. Dry superficial streptoderma

The disease proceeds without acute inflammatory manifestations, for a long time, self-healing is possible. After the rash resolves, temporary depigmented spots remain on the skin (Fig. 4-19).

Treatment consists in the external use of antibacterial ointments (bacitracin + neomycin, mupirocin, 2% lincomycin, erythromycin ointment, etc.), if available atopic dermatitis and xerosis of the skin, it is recommended to use combined glucocorticoid preparations (hydrocortisone ointment + oxytetracycline, hydrocortisone + natamycin + neomycin creams, hydrocortisone + fusidic

acid, etc.) and regularly apply moisturizing and emollient creams (Lipikar*, Dardia*, Emoleum*, etc.).

Rice. 4-19. Dry superficial streptoderma (depigmented patches)

Ecthyma vulgaris

Ecthyma vulgaris (ecthyma vulgaris)- deep dermal pustule, which occurs more often in the area of ​​​​the legs, usually in people with reduced body resistance (exhaustion, chronic somatic diseases, beriberi, alcoholism), immunodeficiency, in case of non-compliance with sanitary and hygienic standards, against the background of chronic itchy dermatoses (Fig. 4-20 , 4-21). For young children, this disease is not typical.

Distinguish pustular and ulcer stage. The process begins with the appearance of an acute inflammatory painful nodule in the thickness of the skin, on the surface of which a pustule appears with cloudy serous-purulent, and then purulent contents. The pustule spreads in depth and along the periphery due to purulent fusion of the infiltrate, which shrinks into a grayish-brown crust. With a severe course of the process, the zone of inflammation around the crust expands and a layered crust is formed - rupee. When the crust is rejected, a deep

Rice. 4-20. Ecthyma vulgaris

Rice. 4-21. Multiple ecthymas

an ulcer, the bottom of which is covered with a purulent coating. The edges of the ulcer are soft, inflamed, and rise above the surrounding skin.

With a favorable course, granulations appear under the crust and scarring occurs. The duration of the course is about 1 month. A retracted scar remains at the site of the rash.

Treatment. Broad-spectrum antibiotics are prescribed, preferably taking into account the sensitivity of the flora: benzylpenicillin 300,000 IU 4 times a day, doxycycline 100-200 mg / day, lincomycin 500 mg 3-4 times a day, amoxicillin + clavulanic acid 500 mg

2 times a day, cefazolin 1 g 3 times a day, cefuroxime 500 mg 2 times a day, imipenem + cilastatin 500 mg 2 times a day, etc. within 7-10 days.

Napkins with proteolytic enzymes (trypsin, chymotrypsin, collitin *, etc.), antibacterial ointments (levomekol *, levosin *, silver sulfathiazole, sulfadiazine, etc.) are applied to the bottom of the ulcer, the edges of the ecthyma are treated with aqueous solutions of aniline dyes, 5% potassium permanganate solution.

Erysipelas

Erysipelas, or erysipelas (erysipelas)- acute lesion of a limited area of ​​the skin and subcutaneous tissue, caused by group A p-hemolytic streptococcus.

The pathogenesis of erysipelas is quite complex. Great importance is attached to the allergic restructuring of the body. Erysipelas - a peculiar reaction of the body to a streptococcal infection, characterized by trophic skin disorders, is associated with damage to the vessels of the lymphatic system (the development of lymphangiitis).

The "entrance gates" of infection are often microtraumas of the skin: in adults - small cracks in the feet and in the interdigital folds, in children - macerated skin of the anogenital region, in newborns - the umbilical wound. If the patient has foci of chronic infection, streptococcus enters the skin through the lymphogenous or hematogenous route.

The incubation period for erysipelas lasts from several hours to 2 days.

In most cases, the disease develops acutely: there is a sharp rise in body temperature to 38-40 ° C, malaise, chills, nausea, and vomiting. Eruptions on the skin are preceded by local soreness, pink-red erythema soon appears, dense and hot to the touch, then the skin becomes swollen, bright red. The boundaries of the focus are clear, often with a bizarre pattern in the form of flames, painful on palpation, regional lymph nodes are enlarged. These symptoms are typical for erythematous form erysipelas (Figure 4-22).

At bullous form as a result of detachment of the epidermis by exudate, vesicles and bullae of various sizes are formed (Fig. 4-23). The contents of the blisters contain a large number of streptococci; if they break, the pathogen can spread and new foci may appear.

Rice. 4-22. Erysipelas in an infant

Rice. 4-23. Erysipelas. bullous form

Debilitated patients may develop phlegmonous and necrotic forms erysipelas. Treatment of these patients should be carried out in surgical hospitals.

The duration of the disease averages 1-2 weeks. In some cases, a recurrent course of erysipelas develops, especially often localized on the limbs, which leads to pronounced trophic disorders (lymphostasis, fibrosis, elephantiasis). The recurrent course of erysipelas is not typical for children, it is more often observed in adult patients with chronic somatic diseases, obesity, after radiation therapy or surgical treatment oncological diseases.

Complications of erysipelas - phlebitis, phlegmon, otitis media, meningitis, sepsis, etc.

Treatment. Antibiotics of the penicillin series are prescribed (benzylpenicillin 300,000 IU intramuscularly 4 times a day, amoxicillin 500 mg 2 times a day). Antibiotic therapy is carried out for 1-2 weeks. In case of intolerance to penicillins, antibiotics of other groups are prescribed: azithromycin 250-500 mg 1 time per day for 5 days, clarithromycin 250-500 mg 2 times a day for 10 days.

Conduct infusion detoxification therapy [hemodez*, dextran (average molecular weight 35000-45000), trisol*].

Lotions with antiseptic solutions are used externally on rashes (1% potassium permanganate solution, iodopyrone *, 0.05% chlorhexidine solution, etc.), antibacterial ointments (2% lincomycin, 1% erythromycin ointment, mupirocin, bacitracin + neomycin, etc. .d.), combined glucocorticoid agents (hydrocortisone + fusidic acid, betamethasone + fusidic acid, hydrocortisone + oxytetracycline, etc.).

Mixed streptostaphylococcal pyoderma (streptostaphylodermia)

Streptostaphylococcal impetigo, or impetigo vulgaris (impetigo streptostaphylogenes),- superficial contagious streptostaphylococcal pyoderma (Fig. 4-24).

The disease begins as a streptococcal process, which is joined by a staphylococcal infection. serous contents

Rice. 4-24. Streptostaphylococcal impetigo

the pustule becomes purulent. Further, powerful yellowish-green crusts form in the focus. The duration of the disease is about 1 week, ending with the formation of temporary post-inflammatory pigmentation. Rashes often appear on the face, upper limbs. Widespread pyoderma may be accompanied by subfebrile body temperature, lymphadenopathy. Often occurs in children, less often in adults.

Treatment. With a widespread inflammatory process, broad-spectrum antibiotics are prescribed (cephalexin 0.5-1.0 3 times a day, amoxicillin + clavulanic acid 500 mg / 125 mg 3 times a day, clindamycin 300 mg 4 times a day).

With limited damage, only external treatment is recommended. Apply 1% aqueous solutions of aniline dyes (brilliant green, methylene blue), antibacterial ointments (with fusidic acid, bacitracin + neomycin, mupirocin, 2% lincomycin, 1% erythromycin, etc.), as well as pastes containing antibiotics (2 % lincomycin, etc.)

Children in the presence of streptostaphyloderma are limited to attending schools and child care facilities.

Chronic ulcerative and ulcerative-vegetative pyoderma

Chronic ulcerative and ulcerative-vegetative pyoderma (pyodermitis chronica exulcerans et vegetans)- a group of chronic pyodermas, characterized by a long and persistent course, in the pathogenesis of which the main role belongs to immunity disorders

(Figure 4-25).

Rice. 4-25. Chronic ulcerative pyoderma

The causative agents of the disease are staphylococci, streptococci, pneumococci, as well as gram-negative flora.

Purulent ulcers are localized mainly on the lower leg. Most often they are preceded by a boil or ecthyma. Ostroinflammatory phenomena subside, but the disease acquires a chronic course. A deep infiltrate is formed, which undergoes purulent fusion, with the formation of extensive ulcerations, fistulous passages with the release of pus. Over time, the bottom of the ulcers becomes covered with flaccid granulations, congestively hyperemic edges infiltrate, their palpation is painful. Formed chronic ulcerative pyoderma.

At chronic ulcerative vegetative pyoderma the bottom of the ulcer is covered with papillomatous growths and cortical layers, when squeezed, drops of thick pus are released from the interpapillary fissures. There is a tendency to serping. Foci with ulcerative vegetative pyoderma are most often localized on the back surface of the hands and feet, in the ankles, on the scalp, pubis, etc.

Chronic pyoderma lasts for months, years. Healing proceeds by rough scarring, as a result of which areas of healthy skin are enclosed in the scar tissue. The prognosis is serious.

This course of pyoderma is typical for adult patients and older children with severe immune deficiency, severe somatic and oncological diseases, alcoholism, etc.

Treatment. Combined therapy is prescribed, including antibiotics, always taking into account the sensitivity of the wound microflora, and glucocorticoid drugs (prednisolone 20-40 mg / day).

It is possible to use specific immunotherapy: vaccine for the treatment of staphylococcal infections, anti-staphylococcal immunoglobulin, staphylococcal vaccine and toxoid, etc.

A course of nonspecific immunotherapy is prescribed: licopid * (for children - 1 mg 2 times a day, for adults - 10 mg / day), a-glutamyltryptophan, thymus extract, etc. Physiotherapy (UVR, laser therapy) is possible.

Externally, proteolytic enzymes are used to help cleanse the ulcer (trypsin, chymotrypsin, etc.), wound wipes with antiseptic agents (voskopran *, parapran *, etc.), antibacterial ointments (levomekol *, levosin *, silver sulfatiazole, sulfadiazine and etc.).

With ulcerative-vegetative pyoderma, destruction of papillomatous growths at the bottom of the ulcer is carried out (cryo-, laser-, electrical destruction).

shancriform pyoderma

shancriform pyoderma (pyodermia chancriformis)- a deep form of mixed pyoderma, clinically resembling a syphilitic chancre (Fig. 4-26).

Rice. 4-26. shancriform pyoderma

The causative agent of the disease is Staphylococcus aureus, sometimes in combination with streptococcus.

Chancriform pyoderma develops in both adults and children.

In most patients, rashes are localized in the genital area: on the glans penis, foreskin, small and large labia. In 10% of cases, an extragenital location of rashes is possible (on the face, lips, eyelids, tongue).

Contribute to the onset of the disease bad care behind the skin, a long foreskin with a narrow opening (phimosis), as a result of which an accumulation of smegma occurs, which irritates the head and foreskin.

The development of chancriform pyoderma begins with a single pustule, which quickly turns into an erosion or superficial ulcer of regularly rounded or oval outlines, with dense, roller-like raised edges and an infiltrated meat-red bottom, covered with a slight fibrinous-purulent plaque. The size of the ulcer is 1 cm in diameter. The discharge from the ulcer is scanty, serous or serous-purulent, the study reveals coccal flora. There are no subjective sensations. Ulcers are usually solitary, rarely multiple. The resemblance to a syphilitic hard chancre is aggravated by the presence of more or less ulcers at the base.

no pronounced induration, slight soreness of the ulcer, moderate induration and enlargement of regional lymph nodes up to the size of a cherry or hazelnut.

The course of chancriform pyoderma can be delayed up to 2-3 months and ends with the formation of a scar.

Other bacterial processes

Pyogenic granuloma

Pyogenic granuloma or botryomycoma or telangiectatic granuloma (granulomapyogenicum, botryomycoma), traditionally belongs to the group of pyoderma, although in fact it is a special form of hemangioma, the development of which is provoked by coccal flora (Fig. 4-27).

Often observed in children of younger and middle age (Fig. 4-28).

Clinically, a pyogenic granuloma is a rapidly growing, pedunculated, capillary tumor that ranges in size from a pea to a hazelnut. The surface of the pyogenic granuloma is uneven, often with bleeding erosions of a bluish-red color, covered with purulent-hemorrhagic crusts. Sometimes there is ulceration, necrosis, in some cases - keratinization.

The favorite localization of pyogenic granuloma is the face, upper limbs. In most cases, it develops at the sites of injuries, insect bites, and long-term non-healing wounds.

Treatment - destruction of the element (diathermocoagulation, laser destruction, etc.).

Rice. 4-27. Pyogenic granuloma

Rice. 4-28. Pyogenic granuloma in a child

erythrasma

erythrasma (erytrasma)- chronic bacterial skin lesions (Fig. 4-29, 4-30). Pathogen - Corynebacterium fluorescens erytrasmae, reproducing only in the stratum corneum. The most common localization of rashes is large folds (inguinal, axillary, under the mammary glands, perianal region). Predisposing factors for the development of erythrasma: excessive sweating, high temperature, humidity. The contagiousness of erythrasma is low. The disease is typical for patients with overweight, diabetes mellitus and other metabolic diseases. In young children, the disease occurs extremely rarely, more typical for adolescents with endocrinological diseases.

The lesions are non-inflammatory, scaly, brownish-red macules with sharp borders that tend to grow peripherally and merge. The spots are sharply demarcated from the surrounding skin. Usually rarely go beyond the contact areas of the skin. In the hot season, increased redness, swelling of the skin, often vesiculation, weeping are observed. Lesions in the rays of the Wood's lamp have a characteristic coral-red glow.

Treatment includes treatment of lesions with 5% erythromycin ointment 2 times a day for 7 days. For inflammation - diflucortolone cream + isoconazole 2 times a day, then isoconazole, the course of treatment is 14 days.

Rice. 4-29. erythrasma

Rice. 4-30. Erythrasma and residual manifestations of furunculosis in a patient with diabetes mellitus

Econazole ointment and 1% clotrimazole solution are effective. With a common process, erythromycin 250 mg every 6 hours for 14 days or clarithromycin 1.0 g once is prescribed.

Prevention of the disease - the fight against sweating, hygiene, the use of acidic powders.

Features of the course of pyoderma in children

In children, especially newborns and infants, the main reason for the development of pyoderma is poor hygiene care.

In young children, contagious forms of pyoderma often occur (pemphigus of the newborn, impetigo, etc.). With these diseases, it is necessary to isolate sick children from children's groups.

In childhood, acute superficial than deep chronic forms of pyoderma are most characteristic.

Hidradenitis develops only in adolescents in puberty.

Patomimy, characteristic of childhood and adolescence (artificial dermatitis, excoriated acne, onychophagia, etc.), is often accompanied by the addition of pyoderma.

The development of chronic ulcerative and ulcerative-vegetative pyoderma, carbuncles, sycosis is not typical for childhood.

Counseling for patients with pyoderma

Patients need to explain the infectious nature of pyoderma. In some cases, it is required to remove children from attending schools and preschool institutions. For all types of pyoderma, water procedures are contraindicated, especially those associated with prolonged exposure to water, high temperatures, rubbing the skin with a washcloth. With pyoderma, therapeutic massages are contraindicated, in the acute period - all types of physiotherapy. In order to prevent secondary infection, it is recommended to boil and iron clothes and bed linen for children, especially those suffering from streptoderma, with a hot iron.

With deep and chronic pyoderma, a thorough examination of patients is necessary, the identification of chronic diseases that contribute to the development of pyoderma.

Scabies (scabies)

Etiology

The life cycle of a tick begins with a fertilized female on human skin, which immediately penetrates deep into the skin (up to the granular layer of the epidermis). Moving forward along the scabies course, the female feeds on the cells of the granular layer. In a tick, digestion of food occurs outside the intestines with the help of a secret released into the scabies, which contains a large amount of proteolytic enzymes. The daily fecundity of the female is 2-3 eggs. 3-4 days after the eggs are laid, larvae hatch from them, which leave the passage through the "ventilation holes" and are again embedded in the skin. After 4-6 days, adult sexually mature individuals are formed from the larvae. And the cycle starts again. The life span of a female is 1-2 months.

Scabies mites are characterized by a strict daily rhythm of activity. During the day, the female is at rest. In the evening and in the first half of the night, she gnaws through 1 or 2 egg knees at an angle to the main direction of the passage and lays an egg in each of them, having previously deepened the bottom of the passage and made a “ventilation hole” in the “roof” for the larvae. In the second half of the night, it gnaws the course in a straight line, feeding intensively, during the day it stops and freezes. The daily program is carried out by all females synchronously, which explains the appearance of itching in the evening, the predominance of the direct route of infection in bed at night, the effectiveness of applying acaricidal preparations in the evening and at night.

Epidemiology

Seasonality - the disease is more often recorded in the autumn-winter season, which is associated with the highest fertility of females at this time of the year. Transmission routes:

. straight the route (directly from person to person) is most common. Scabies is a disease of close bodily contact. The main circumstance under which infection occurs is sexual contact (in more than 60% of cases), which was the basis for including scabies in the STI group. Infection also occurs while sleeping in the same bed, while caring for a child, etc. In a family, in the presence of 1 patient with widespread scabies, almost all family members become infected;

. indirect, or mediated, the path (through the objects used by the patient) is much less common. The pathogen is transmitted during the general use of bedding, linen, clothing, gloves, washcloths, toys, etc. In children's groups, indirect transmission is much more common than among adults, which is associated with the exchange of clothes, toys, stationery, etc.

The invasive stages of the mite are a young female scabies mite and a larva. It is in these stages that the tick is able to move from the host to another person and exist in the external environment for some time.

The most favorable conditions for the life of a tick outside the "owner" are fabrics made from natural materials (cotton, wool, leather), as well as house dust, wooden surfaces.

The spread of scabies is facilitated by non-compliance with proper sanitation and hygiene measures, migration, overcrowding, as well as diagnostic errors, late diagnosis, and atypical unrecognized forms of the disease.

Clinical picture

The incubation period ranges from 1-2 days to 1.5 months, which depends on the number of mites on the skin, the stage in which these mites are located, the tendency to allergic reactions, and also on the cleanliness of the person.

Main clinical symptoms scabies: itching at night, the presence of scabies, polymorphism of rashes and characteristic localization.

Itching

The main complaint in patients with scabies is itching, which increases in the evening and at night.

In the pathogenesis of the appearance of itching in scabies, several factors are noted. The main cause of itching is mechanical irritation of the nerve endings during the advancement of the female, which explains the nocturnal nature of the itching. Perhaps the appearance of reflex itching.

Also, in the formation of itching, allergic reactions are important, which occur when the body is sensitized to the tick itself and its metabolic products (saliva, excrement, egg shells, etc.). Type 4 delayed hypersensitivity reaction is of the greatest importance among allergic reactions in case of infection with scabies. The immune response, manifested by increased itching, develops 2-3 weeks after infection. When re-infected, itching appears after a few hours.

Scabies move

Scabies is the main diagnostic sign of scabies, which distinguishes it from other itching dermatoses. The course has the appearance of a slightly elevated dirty-gray line, curved or straight, 5-7 mm long. Cesari's symptom is revealed - palpation detection of scabies in the form of a slight elevation. The scabies course ends with a raised blind end with a female. You can detect scabies with the naked eye, if necessary, use a magnifying glass or dermatoscope.

When detecting scabies, you can use ink test. A suspicious area of ​​​​skin is treated with ink or a solution of any aniline dye, and after a few seconds, the remaining paint is wiped off with an alcohol swab. There is an uneven staining of the skin over the scabies course due to the ingress of paint into the "ventilation holes".

Eruption polymorphism

The polymorphism of rashes is characterized by a variety of morphological elements that appear on the skin with scabies.

The most common are papules, vesicles 1-3 mm in size, pustules, erosions, scratches, purulent and hemorrhagic crusts, post-inflammatory pigmentation spots (Fig. 4-31, 4-32). Seropapules, or papules-vesicles, are formed at the site of penetration into the skin of the larva. Pustular elements appear when a secondary infection is attached, hemispherical itchy papules - with lymphoplasia.

The greatest number of scabies is found on the hands, wrists, and in young men - on the genitals (Fig. 4-33).

Polymorphism of rashes in scabies is often determined symptom of Ardi-Gorchakov- the presence of pustules, purulent and hemorrhagic

Rice. 4-31. Scabies. Belly skin

Rice. 4-32. Scabies. Forearm skin

Rice. 4-33. Scabies. Genital skin

crusts on the extensor surfaces of the elbow joints (Fig. 4-34) and symptom of Michaelis- the presence of impetiginous rashes and hemorrhagic crusts in the intergluteal fold with the transition to the sacrum

(Figure 4-35).

Localization

The characteristic localization of rashes in scabies is the interdigital folds of the fingers, the area of ​​​​the wrist joints, the flexor surface of the forearms, in women - the area of ​​​​the nipples of the mammary glands and the abdomen, and in men - the genitals.

Rice. 4-34. Scabies. Symptom of Ardi-Gorchakov

Rice. 4-35. Scabies. Symptom of Michaelis

The defeat of the hands is most significant in scabies, since it is here that the main number of scabies is localized and the bulk of the larvae are formed, which are passively carried by the hands throughout the body.

In adults, scabies does not affect the face, scalp, upper third of the chest and back.

Localization of rashes in scabies in children depends on the age of the child and differs significantly from skin lesions in adults.

Complications

Complications often change the clinical picture and significantly complicate diagnosis.

Pyoderma is the most common complication, and with widespread scabies it always accompanies the disease (Fig. 4-36, 4-37). Most often, folliculitis, impetiginous elements, boils, ecthymas develop; development of phlegmon, phlebitis, and sepsis is possible.

Dermatitis is characterized by a mild course, clinically manifested by foci of erythema with indistinct boundaries. Often localized in the folds, on the abdomen.

Eczema develops with long-term widespread scabies and is characterized by a torpid course. The most common is microbial eczema. The foci have clear boundaries, numerous vesicles, weeping, serous-purulent crusts appear. The rashes are localized on the hands (may appear

Rice. 4-36. Scabies complicated by pyoderma

Rice. 4-37. Common scabies complicated by pyoderma

and bullous elements), feet, in women - in the circumference of the nipples, and in men - on the inner surface of the thighs.

Hives.

Damage to the nails is detected only in infants; characterized by thickening and clouding of the nail plate.

Features of the course of scabies in children

The clinical manifestations of scabies in children depend on the age of the child. Features of scabies in infants

The process is generalized, rashes are localized throughout the skin (Fig. 4-38). Pre-rash

are set with small papular elements of a bright pink color and erythematous-squamous foci (Fig. 4-39).

The pathognomonic symptom of scabies in infants is symmetrical vesicular-pustular elements on the palms and feet (Fig. 4-40, 4-41).

Absence of excoriations and hemorrhagic crusts.

Attachment of a secondary infection, manifested by focal erythematous-squamous foci covered with purulent crusts.

Rice. 4-38. Common scabies

Rice. 4-39. Common scabies in an infant

Rice. 4-40.Scabies in a child. brushes

Rice. 4-41.Scabies in a child. Feet

In most infants, scabies is complicated by allergic dermatitis, torpid to antiallergic therapy.

When examining mothers of sick children or persons providing primary care for the child, typical manifestations of scabies are revealed.

Features of scabies in young children

. The rashes are similar to those in adults. Excoriations, hemorrhagic crusts are characteristic.

The favorite localization of rashes is the "panty area": ​​the abdomen, buttocks, in boys - the genitals. In some cases, vesicular-pustular elements remain on the palms and soles, which are complicated by eczematous rashes. The face and scalp are not affected.

Frequent complication of scabies with common pyoderma: folliculitis, furunculosis, ecthyma, etc.

Severe nighttime itching can cause sleep disturbance in children, irritability, and poor school performance.

In adolescents, the clinical picture of scabies resembles scabies in adults. Note the frequent addition of a secondary infection with the development of common forms of pyoderma.

Clinical varieties of scabiestypical shape

The typical form described includes fresh scabies and widespread scabies.

Fresh scabies is the initial stage of the disease with an incomplete clinical picture of the disease. It is characterized by the absence of scabies on the skin, and rashes are represented by follicular papules, seropapules. Diagnosis is made by examining persons who have been in contact with a patient with scabies.

The diagnosis of widespread scabies is made with a long course and a complete clinical picture of the disease (itching, scabies, polymorphism of rashes with typical localization).

Asymptomatic scabies

Scabies is oligosymptomatic, or "erased", characterized by moderate skin rashes and slight itching. The reasons for the development of this form of scabies may be the following:

Careful observance by the patient of the rules of hygiene, frequent washing with a washcloth, contributing to the “washing away” of ticks, especially in the evening;

Skin care, which consists in the regular use of moisturizing body creams that close the ventilation holes and disrupt the activity of the tick;

Occupational hazards, consisting in the contact with the patient's skin of substances with acaricidal activity (engine oils, gasoline, kerosene, diesel fuel, household chemicals, etc.), which leads to a change in the clinical picture (lack of

rashes on the hands and exposed areas of the skin, but significant lesions on the skin of the trunk).

Norwegian scabies

Norwegian (cortical, crustose) scabies is a rare and highly contagious form of scabies. It is characterized by the predominance of massive cortical layers in typical places, upon rejection of which erosive surfaces are exposed. Typical scabies appear even on the face and neck. This form of scabies is accompanied by a violation of the general condition of the patient: fever, lymphadenopathy, leukocytosis in the blood. Develops in individuals with impaired skin sensitivity, mental disorders, immunodeficiency (Down's disease, senile dementia, syringymyelia, HIV infection, etc.).

Scabies "incognito"

Scabies "incognito", or unrecognized scabies, develops against the background drug treatment drugs that suppress inflammatory and allergic reactions, have antipruritic and hypnotic effects. Glucocorticoids, antihistamines, neurotropic drugs and other drugs suppress itching and scratching in patients, which creates favorable conditions for the spread of the tick on the skin. The clinical picture is dominated by burrows, excoriations are absent. Such patients are very contagious to others.

Postscabious lymphoplasia

Postscabious lymphoplasia is a condition after treatment of scabies, characterized by the appearance on the patient's skin of hemispherical nodules the size of a pea, bluish-pink or brownish in color, with a smooth surface, dense consistency and accompanied by severe itching. This disease is often observed in infants and young children (Fig. 4-42).

Postscabious lymphoplasia is a reactive hyperplasia of lymphoid tissue in the places of its greatest accumulation. Favorite localization - perineum, scrotum, inner thighs, axillary fossa. The number of elements is from 1 to 10-15. The course of the disease is long, from several weeks to several months. Anti-scabies therapy is ineffective. Spontaneous regression of elements is possible.

Rice. 4-42. Postscabious lymphoplasia

Diagnostics

The diagnosis of scabies is established on the basis of a combination of clinical manifestations, epidemic data, laboratory results and trial treatment.

The most important for confirming the diagnosis are the results of laboratory diagnostics with the detection of females, larvae, eggs, empty egg membranes under a microscope.

There are several methods for detecting ticks. The simplest is the method of layer-by-layer scraping, which is carried out on a suspicious area of ​​\u200b\u200bthe skin with a scalpel or scarifier until pinpoint bleeding appears (with this method,

wild scraping is treated with alkali) or with a sharp spoon after preliminary application of a 40% solution of lactic acid. The resulting scraping is microscopically examined.

Differential Diagnosis

Scabies is differentiated from atopic dermatitis, pruritus, pyoderma, etc.

Treatment

Treatment is aimed at destroying the pathogen with acaricidal preparations. Mostly used drugs of external action.

The general principles of treatment of patients with scabies, the choice of drugs, the terms of clinical examination are determined by the “Protocol of Patient Management. Scabies" (order of the Ministry of Health of the Russian Federation No. 162 of 04/24/2003).

General rules for prescribing anti-scabies drugs:

Apply the drug in the evening, preferably at bedtime;

The patient should take a shower and change underwear and bed linen before and after treatment;

It is necessary to apply the drug to all areas of the skin, with the exception of the face and scalp;

The drug should be applied only by hand (not with a swab or napkin), due to the high number of scabies on the hands;

It is necessary to avoid getting the drug on the mucous membrane of the eyes, nasal passages, oral cavity, as well as the genitals; in case of contact with mucous membranes, rinse them with running water;

The exposure of the drug applied to the skin should be at least 12 hours;

The drug should be rubbed in the direction of growth of vellus hair (which reduces the possibility of developing contact dermatitis, folliculitis);

Do not wash hands after treatment for 3 hours, then rub the preparation into the skin of the hands after each wash;

You should not use anti-scabies drugs an excessive number of times (exceeding the recommended regimens), since the toxic effect of the drugs will increase, and the anti-scabies activity will remain the same;

Treatment of patients identified in the same focus (for example, in the family) is carried out simultaneously to avoid reinfection.

The most effective anti-scabies drugs: benzyl benzoate, 5% permethrin solution, piperonyl butoxide + esbiol, sulfuric ointment.

.Water-soap emulsion of benzyl benzoate(20% for adults, 10% for children or as a 10% ointment) is used according to the following scheme: treatment with the drug is prescribed twice - on the 1st and 4th days of treatment. Before use, the suspension is thoroughly shaken, then carefully applied to the skin twice with a 10-minute break. Side effects of the drug include the possible development of contact dermatitis, dry skin.

Permethrin 5% solution is approved for use in infants and pregnant women. Side effects with its use are rare. Treatment with the drug is carried out three times: on the 1st, 2nd and 3rd days. Before each treatment, it is necessary to prepare a fresh aqueous emulsion of the drug, for which 1/3 of the contents of the vial (8 ml of a 5% solution) are mixed with 100 ml of boiled water at room temperature.

Piperonyl butoxide + esbiol in the form of an aerosol is a low-toxic drug, approved for the treatment of infants and pregnant women. The aerosol is applied to the skin from a distance of 20-30 cm from its surface in the downward direction. In infants, the scalp and face are also treated. Mouth, nose and eyes are pre-covered with cotton swabs. According to the manufacturer's recommendation, the treatment is carried out once, but from experience it is known that with widespread scabies, 2-3 times the drug is required (days 1, 5 and 10) and only with fresh scabies, a single use of this drug leads to a complete cure of patients.

Sulfur ointment (33% ointment is used in adults, 10% in children). Among side effects contact dermatitis is common. Apply for 5-7 consecutive days.

Particular attention is paid to the treatment of complications, which is carried out in parallel with anti-scabies treatment. With pyoderma, antibiotic therapy is prescribed (if necessary), aniline dyes, antibacterial ointments are used externally. For dermatitis, antihistamines, hyposensitizing therapy, externally combined glucocorticoid drugs with antibiotics (hydrocortisone + oxytetracycline, hydrocortisone + natamycin + neomycin, hydrocortisone + oxytetracycline, etc.) are prescribed. With insomnia, sedatives are prescribed (tinctures of valerian, motherwort, persen *, etc.).

Postscabiosis pruritus after full therapy is not an indication for an additional course of specific treatment. Itching is regarded as a reaction of the body to a dead tick. To eliminate it, antihistamines, glucocorticoid ointments and 5-10% aminophylline ointment are prescribed.

The patient is invited for a follow-up appointment 3 days after the end of scabies treatment, and then every 10 days for 1.5 months.

Postscabious lymphoplasia does not require anti-scabies therapy. Antihistamines, indomethacin, glucocorticoid ointments for occlusive dressing, laser therapy are used.

Features of the treatment of scabies in children

Rubbing anti-scabies preparations into the skin of a child is carried out by the mother or other person caring for him.

The drug must be applied to all areas of the skin, even in the case of limited damage, including the skin in the face and scalp.

To avoid getting the drug into the eyes when touching them with their hands, young children wear a vest (shirt) with protective sleeves or mittens (mittens); you can apply the drug while the child is sleeping.

Features of the treatment of scabies in pregnant and lactating women

The drugs of choice are benzyl benzoate, permethrin and piperonyl butoxide + esbiol, for which the safety of use during pregnancy and lactation has been proven.

Clinical examination

Reception (examination, consultation) by a dermatovenereologist of a patient in the treatment of scabies is carried out five times: 1st time - on the day of treatment, diagnosis and treatment; 2nd - 3 days after the end of treatment; 3rd, 4th, 5th - every 10 days. The total period of dispensary observation is 1.5 months.

When establishing the diagnosis of scabies, it is necessary to identify the source of infection, contact persons subject to preventive treatment (family members and persons living with the patient in the same room).

Members of organized groups (children's preschool institutions, educational institutions, classes) are examined by health workers on the spot. If scabies is detected, schoolchildren and children are suspended from attending children's institution at the time of treatment. The issue of treatment of contact persons is decided individually (if new cases of scabies are detected, all contact persons are treated).

- In organized groups where preventive treatment of contact persons was not carried out, the examination is carried out three times with an interval of 10 days.

Carrying out current disinfection in the foci of scabies is mandatory.

Prevention

The main preventive measures are early detection patients with scabies, contact persons and their treatment. Disinfection of bedding and clothes can be carried out by boiling, machine washing or in a disinfection chamber. Things that are not subject to heat treatment are disinfected by airing for 5 days or 1 day in the cold, or placed in a hermetically tied plastic bag for 5-7 days.

For the treatment of upholstered furniture, carpets, toys and clothes, A-PAR * aerosol is also used.

Consulting

It is necessary to warn patients about the contagiousness of the disease, the strict observance of sanitary and hygienic measures in the family, the team, the strict implementation of the treatment methodology, the need for a second visit to the doctor in order to establish the effectiveness of therapy.

Pediculosis

In humans, there are 3 types of pediculosis: head, clothes and pubic. Head lice is the most common among children. Pediculosis is most often detected among people who lead an asocial lifestyle, in crowded conditions and do not comply with sanitary and hygienic standards.

Clinical picture

Clinical symptoms typical of all types of pediculosis:

Itching, accompanied by the appearance of scratching and bloody crusts; itching becomes pronounced on the 3-5th day from the moment of infection (only after sensitization to proteins in the saliva of lice), and with repeated infection (reinfection) it develops within a few hours;

Irritability, often insomnia;

Detection of lice on the head, pubis, body and clothes, as well as nits on the hair;

The appearance of erythema and papules (papular urticaria) at the sites of lice bites;

Dermatitis and eczematization of the skin with a long course of pediculosis and phthiriasis;

Secondary pyoderma as a result of the penetration of coccal flora through damaged skin during scratching;

Regional lymphadenitis with widespread pyoderma.

head lice (pediculosis capitis)

Girls and women are most often affected, especially those with long hair. The main route of transmission is contact (through the hair). Sharing combs, hairpins, pillows can also lead to infection. The age peak of incidence falls on 5-11 years. Often, outbreaks of the disease are observed in schools and kindergartens.

The head louse lives on the scalp, feeds on human blood and actively reproduces. Eggs (nits) pale white in color, oval, 1-1.5 mm long, covered with a flat lid on top (Fig. 4-43). They are glued with the lower end to the hair or villi of the fabric with a secret secreted by the female during laying. Skin rashes on the scalp occur when lice, by biting, inject saliva with toxic and proteolytic enzymes.

Most often, lice and nits are found on the scalp in the temporal and occipital regions (examination of the scalp of children for the detection of pediculosis in children's institutions and hospitals begins in these areas). Main Clinical signs pediculosis - itching, the presence of lice, as well as nits tightly attached to the hair shaft, single petechiae and itchy papules, excoriations. Bonding of hair with serous-purulent exudate against the background of secondary infection is noted with a common process (Fig. 4-44). Possible damage to the eyebrows and eyelashes, auricles.

Rice. 4-43. lice

Rice. 4-44. Lice (nits, eczematization)

Clothes pediculosis (pediculosis corporis)

Unlike the head louse, the body louse most often develops in the absence of appropriate hygiene. Infection occurs through personal contact, through clothing and bedding. The body louse bites in those areas where clothing interferes with its movement - in places where the folds and seams of linen and clothing come into contact. Patients are worried about severe itching. The main elements are urticarial papules, dense nodules covered with hemorrhagic crusts, excoriations. In a chronic widespread process, lichenification, secondary pyoderma, post-inflammatory melasma (“tramp skin”) are characteristic as a result of prolonged mechanical irritation when a person combs insect bites, the toxic effect of their saliva, “blooming” of bruises and scratches. Unlike scabies, the feet and hands are not affected.

Pubic pediculosis (phthyriasis)

Pubic pediculosis (pediculosis pubis) develops only in adolescents after puberty. The main route of transmission is direct, from person to person, most often through sexual contact. Transmission through hygiene items is also possible. Lice are found in the pubic hair, lower abdomen. They can crawl onto the hair of the armpits, beards, mustaches, eyebrows and eyelashes. In places of pubic louse bites, petechiae are first detected, and after 8-24 hours the foci acquire a characteristic bluish-gray tint, spots appear (macula coeruleae) with a diameter of 2-3 mm, irregularly shaped, located around the hair, into the mouths of which the flats are introduced.

When young children are infected, damage to eyelashes and eyebrows is noted, blepharitis may develop, less often - conjunctivitis.

Treatment

Treatment of pediculosis is carried out with pediculocidal preparations. Most of the highly active drugs available contain permethrin (a neurotoxic poison). The preparations are applied to the scalp, left for 10 minutes, then the head is washed. Also effective in the treatment of pediculosis shampoo "Veda-2" *. After treatment, the hair is moistened with water (2 parts) with the addition of vinegar (1 part) and left for 30 minutes. Vinegar facilitates the removal of nits during repeated combing of the hair with a fine comb. Mechanical removal of nits is an important point in the treatment of pediculosis, since medications poorly penetrate the shell of nits. After 1 week, it is recommended to repeat the treatment to destroy the lice hatched from the remaining nits. When viewed under a Wood's lamp, live nits, in contrast to non-viable (dry) ones, give a pearly white glow.

Permethrin, 20% water-soap emulsion or benzyl benzoate emulsion ointment are approved for use in children older than 1 year, paraplus * - from the age of 2.5 years.

Nits on eyelashes and eyebrows are removed mechanically with thin tweezers, previously lubricated with petroleum jelly (permethrin preparations are not approved for use in the eye area!).

Anti-epidemic measures

Anti-epidemic measures include a thorough examination and treatment of family members and contact persons, sanitization of clothing, bed linen, and personal hygiene items. Clothes are washed at maximum high temperatures(60-90 ° C, boiling) or special dry dry cleaning, as well as ironing with steam on both sides, paying attention to folds, seams. If such processing of clothing is not possible, then it is necessary to isolate contaminated clothing in hermetically sealed plastic bags for 7 days or store in the cold. Combs and combs are soaked in warm soapy water for 15-20 minutes.

For disinfection of premises, preparations based on permethrin are used.

Children should not attend school with live lice.

Dermatovenereology: a textbook for students of higher educational institutions / V. V. Chebotarev, O. B. Tamrazova, N. V. Chebotareva, A. V. Odinets. -2013. - 584 p. : ill.