Skin diseases in humans: photos and descriptions of the main types of skin diseases. Skin lesions and diseases in adults Skin diseases symptoms treatment

Actinic dermatitis occurs against the background of radiation exposure to the skin in the form characteristic of dermatitis - in the form of inflammation. Such exposure includes sunlight, ionizing radiation, and artificial sources of ultraviolet radiation. Actinic dermatitis, the symptoms of which appear based on the duration of exposure to a particular factor, as well as on the intensity of this exposure, is particularly susceptible to welders, farmers, radiologists, foundry and smelting workers, etc.

Allergic urticaria is considered a fairly common skin disease, which is diagnosed in people regardless of gender and age category. Most often it occurs in an acute form, less often it becomes chronic.

Allergic dermatitis is an inflammation of the skin that occurs as a result of direct exposure of the skin to an irritating substance (allergen). Allergic dermatitis, the symptoms of which manifest themselves in the form of itching, redness of a certain area of ​​the skin, as well as the formation of bubbles with liquid on it in combination with erosions, occurs, like other types of allergic diseases, in those patients who have a predisposition to this type dermatitis, as well as in patients predisposed to allergic reactions to the exposed allergen.

Angioma (red mole) is a benign tumor that consists of lymphatic and blood vessels. Most often, the formation is formed on the face, skin of the torso and limbs, and on internal organs. Sometimes its appearance and development may be accompanied by bleeding. In most clinical situations, this pathology is congenital and is diagnosed in newborns in the first few days of their life.

Angiofibroma is a fairly rare disease characterized by the formation of a benign neoplasm that includes blood vessels and connective tissue. Most often, the pathology affects the skin and nasopharynx, less often the base of the skull is affected. The exact reasons for the formation of the disease remain unknown today, however, clinicians have developed several theories regarding the possible mechanism of its occurrence.

What is atheroma? This is a benign neoplasm that can affect the human body in various places: on the head, arms, back. If treatment is not started in time, such wen can lead to serious consequences. Self-medication is also not recommended, since professional help is indispensable.

Atopic dermatitis is a chronic disease that develops in people from various age groups who are prone to atopy. Many people confuse allergies and this disease. But they have significant differences, in particular, in the pathogenesis of development and in symptoms. In some clinical cases, a predisposition to the development of atopic dermatitis in the human body is accompanied by some risk of developing other atopic pathologies, for example, hay fever or bronchial asthma.

Basalioma is a malignant formation on the surface of the skin. It originates from the basal layer of the epidermis, which is located very deep. In medicine, it is considered the most common type of facial skin cancer, which affects adults over forty years of age. This tumor destroys skin cells and can appear again, even after proper treatment. The positive side of this disease is that it does not metastasize to the internal organs of a person, unlike other types of cancer tumors.

Basal cell carcinoma is a benign formation characterized by slow cell division, most often localized on the nose, lower eyelid, and ear area. Transformation to a malignant form is extremely rare.

Bowen's disease is a rare form of skin cancer. The pathology is localized in the cells of the epidermis. Scientists, as a result of studying the clinical features of the pathology, were divided into two camps. The first group claims that this type of skin pathology does not cause metastases and does not harm surrounding organs, however, the second group believes that this deviation, depending on the location, can contribute to the occurrence of skin cancer.

Devergie's disease refers to chronic keratosis, characterized by follicular hyperkeratosis. This disease is localized on the skin and manifests itself in the form of lichen pilaris. The course of the disease alternates between stages of exacerbation and remission; lesions can cover large areas of the skin.

Schamberg's disease (syn. Schamberg's purpura, hemosiderosis of the skin, chronic pigmentary purpura) is a chronic dermatological disease, against which the vascular wall of the capillaries localized in the skin is damaged, causing characteristic symptoms.

Warts are fairly common and benign in nature formations that appear on the skin. Warts, the symptoms of which, in fact, consist in the appearance of characteristic formations, are provoked by certain types of viruses, their transmission occurs either through direct contact with its carrier, or through common objects used with it.

Epidermolysis bullosa (syn. mechanobullous disease, butterfly disease) is a rare hereditary dermatological disease, which is characterized by skin damage even with the slightest injury. Pathology includes dozens of varieties. The prognosis in most situations is unfavorable.

Vesiculopustulosis is a bacterial infection that causes inflammation of the sweat glands. Localization of inflammation is observed in the folds of the skin, on the head under the hair, on the back, in the area of ​​the collarbones, between the buttocks. The child becomes restless, refuses to eat, and the body temperature rises. Vesiculopustulosis is diagnosed quite simply: it is necessary to study the history, symptoms and laboratory results.

Vitiligo is a disease that affects the skin and is characterized by the complete disappearance of pigment in certain areas, as well as discoloration of the hair located on them. In rare clinical situations, this disease may be accompanied by discoloration of the retina. The exact causes of the disease have not yet been established, but scientists have several developed theories in this regard. The pathogenesis of vitiligo consists in the rapid destruction of melanocytes - specific cells whose main function is the synthesis of pigments that color the skin a certain color.

Many people have heard about such a disease as dropsy. But few people know what this disease is and how it manifests itself. It is also worth knowing the answer to the most exciting question - how to get rid of dropsy? This information is necessary to know, since the pathological process can occur in absolutely any person. Even a newborn baby can develop dropsy. Causes Types Symptoms Ascites Hydrocele of the gallbladder Hydrocele in pregnant women Congenital hydrocele Hydrocele of the testicle Hydrocele of the spermatic cord Complications of hydrocele Recommendations of a specialist Hydrocele or hydrocele is a pathological process in which transudate (excess fluid) accumulates in the subcutaneous tissue and the space between the tissues. Most often, this pathology develops in the body against the background of diseases of the following organs: heart; endocrine glands; kidney; liver.

Dermatology– a branch of medicine that studies the functioning and structure of the skin, as well as mucous membranes, hair, nails, sebaceous and sweat glands; solves issues of diagnosis, prevention and treatment of skin diseases.

A specialist who identifies skin diseases and prescribes treatment when dermatological diseases are detected is called a dermatologist.

History of dermatology

For the first time, mentions of skin diseases are found in the manuscripts of ancient healers of China and Egypt. The great scientists Avicenna and Hippocrates were involved in the development of methods for treating and diagnosing such pathologies, but this branch of medicine emerged as an independent branch only at the beginning of the 17th century, which was associated with a thorough study of the functioning and structure of the skin, and, of course, the invention of the first microscopic devices.

As a result of scientific justifications and similar studies, a classification of skin diseases was first developed in 1776. This direction of medicine in Russia received scientific development at the end of the 18th century. Significant contributions to world and domestic science were made by such scientists as A.I. Pospelov, N.P. Mansurov, I.F. Zelenov et al.

Modern dermatology has been able to achieve significant development in the treatment and diagnosis of various pathologies thanks to the development of innovative technologies and accumulated experience. Today, this industry has close ties with phlebology, venereology, endocrinology, surgery and other medical areas, which is entirely due to the need for a detailed study of various dermatological problems. This approach makes it possible to improve the knowledge already acquired to a greater extent, as well as to develop new techniques in the field of laser treatment, plastic surgery, immunotherapy and create new, more effective drugs.

Useful articles:

Directions and tasks of dermatology

Despite numerous connections with various sciences, the closest area for dermatology is venereology. In dermatology, more and more new areas are emerging that deal with the detailed study of certain pathologies and diseases:

Dermatocosmetology is a medical science that deals with diagnosing the causes and creating methods for eliminating any cosmetic skin defects.

Mycology is a branch of dermatology that studies fungal diseases.

Trichology is a science specializing in hair diseases.

Pediatric dermatology is a science that studies the characteristics of children's skin diseases.

Dermato-oncology – studies skin tumors to determine their benignity.

Gerontodermatology is a branch of dermatology that deals with skin diseases in the elderly.

Causes and symptoms of skin diseases

Leather- the largest organ of the human body that is visible to the eye. It, like a litmus test, demonstrates the condition of all organs and systems, protects them from mechanical stress and the penetration of infections.

Through the nervous, lymphatic, endocrine and circulatory systems, the skin is connected to almost the entire body. It is not for nothing that diseases of most organs in a certain way affect the condition of the skin, nails, hair, and mucous membranes.

For example, everyone is well aware that the skin with liver diseases acquires a yellowish tint; with scarlet fever, chickenpox, measles, the body becomes covered with a rash; persistent furunculosis may indicate the development of diabetes; problems in gynecology manifest themselves as acne on the neck, cheeks, and chin.

The functional diversity of the skin, its structure and the impact of many internal and external factors on it characterizes the variety of dermatological diseases - dermatoses. Exogenous (external) factors influencing the occurrence of skin diseases include:

1. Biological factors causing:

fungal infection of the skin - mycoses: athlete's foot, microsporia;

pustular diseases - pyoderma: furunculosis, hidradenitis, impetigo;

viral lesions - herpes, warts;

1. Physical and chemical factors that cause the formation of inflammatory skin diseases - dermatitis: abrasions, diaper rash, burns.

Endogenous (internal) factors have a strong influence on the appearance of many skin diseases:

diseases of the nervous system;

metabolic disease;

hypovitaminosis;

internal diseases of systems;

chronic foci of infections.

All of the above factors can be a source of a wide variety of deviations in the functionality of the skin and mucous membranes. Among the most common signs of skin diseases, when they appear, you need to urgently consult a dermatologist, include:

changes in skin color and texture;

skin rashes;

itching, burning, soreness of the skin.

Dermatological diseases

Among the diseases that dermatology studies:

occupational dermatological diseases;

diseases that depend on changes in the body's reactivity;

skin diseases accompanied by intense itching (they speak of diseases of the internal organs) and neurotic disorders;

hereditarily caused skin lesions that are chronic;

pathological condition of the skin caused by changes in the functioning of the sebaceous and sweat glands and deviations in chemistry. composition of sebum.

It's no secret that most dermatoses are difficult to treat and are characterized by a chronic, relapsing nature.

The most common skin diseases:

• eczema;
• psoriasis;
• dermatitis;
• scabies;
• lichen;
• demodicosis;
• seborrhea;
• various mycoses and allergies;
• neurodermatitis;
• vitiligo;
• streptoderma;
• scleroderma;
• erythema;
• hives;
• molluscum contagiosum;
• lupus erythematosus;
• acne (acne disease).

Such skin diseases cause many aesthetic inconveniences to people; they destroy the skin and its appendages (nails, hair and sweat glands), disrupting its natural functions - immune, protective, thermoregulatory, receptor and metabolic.

Modern dermatology

Nowadays, the development of dermatology does not stop. The emergence of new methods for diagnosing and treating skin diseases allows modern dermatology to make a breakthrough into the future. New techniques make it possible to accurately and quickly determine the cause of a certain skin disease and establish effective treatment. Often, when conducting skin examinations, dermatologists advise visiting other doctors, since a skin disease is only an external manifestation of a malfunction of a certain body system.

Nowadays, modern diagnostic methods are used to study the skin, nails, mucous membranes, hair: instrumental, laboratory, radiological, skin tests are carried out.

Treatment of skin diseases will require patience and compliance with all doctor’s instructions. The main role in successful treatment is played by strict adherence to diet and drug therapy, proper regular hygiene of the affected area of ​​the skin. Physiotherapeutic and instrumental procedures, psychotherapy, sanatorium treatment, and herbal medicine are widely used in the treatment of skin diseases.

Thanks to more advanced diagnostic and treatment methods, it is possible to cure many skin diseases that until recently were considered incurable.

Dermatology on the website portal

Skin diseases of various etiologies are very diverse and widespread, so our medical portal introduces all visitors to various signs, advanced treatment methods and methods of diagnosing dermatological diseases.

The skin is the largest organ of the human body (about 2 square meters in area). Accordingly, the list of skin diseases is very wide.

In addition to its protective and immune function, the skin serves to regulate temperature, water balance and sensations, so protecting yourself from the occurrence of skin diseases is one of the primary preventive tasks.

Below you will find out what skin diseases people have and what their symptoms are. You can also look at photos of skin diseases and read their descriptions. Let us note right away that most skin diseases in people have no symptoms and are easily treatable.

What skin diseases are there: acne, blackheads, eczema, herpes

Acne (“pimples”) considered as the most common skin disease. Almost all adolescents (about 85%) are familiar with the description of this skin disease. Essentially, acne is an inflammation of the sebaceous glands.

Acne vulgaris- This is a typical skin disease for most people, one of the first places on the list of such diseases. Mainly characterized by a mild course, they are found (mainly on the face) on fatty areas of the body and manifest themselves in the form of pimples, purulent ulcers and comedones. Fat forms clogged sebaceous glands where bacteria can colonize and cause inflammation. The main causes are hormonal changes, usually during puberty or pregnancy. Male sex hormones (androgens) promote development and therefore affect men more than women. In addition, medications, cosmetics, and stress factors, among other things, can contribute to acne. Severe forms are characterized by scar formation, otherwise acne is treated without leaving marks before the age of 25.

Every young mother will tell you about what other skin diseases there are.

Eczema (atopic dermatitis) usually begins in early childhood and manifests itself in periodic inflammatory reactions of the skin. This is one of the most common skin diseases. Due to the body's defensive reactions to allergens, it leads to inflammatory processes, insatiable itching acts as a trigger. Triggers may include stress, certain foods, mechanical irritations, infections and climatic influences. Scratches can cause inflammatory reactions and the skin loses its protective barrier.

It comes in many forms, the most famous being herpes simplex. The primary one usually goes unnoticed. Only further infection manifests itself in the form of typical blisters with crusting and inflammation. The reasons can be different, injuries or sunburn, stress and hormonal fluctuations.

What other skin diseases are there: bedsores, eczema, scabies?

Bedsores, as a rule, arise from prolonged bed rest with simultaneous immobility. Pressure on a specific, unprotected area of ​​the body contributes to the formation of ulcers in the deepest layers of the skin with a simultaneous lack of nutrition. Bacteria can penetrate and destroy the layers completely. Sufferers complain of itching, burning and severe pain.

Eczema is a superficial inflammation of the skin. Its symptoms are shown in the photo above: redness with occasional blistering. The causes of eczema are many and varied.

Scabies caused by mites (mainly during sexual contact). Ticks make holes in the stratum corneum of the tissue and lay eggs there. It mainly affects the wrists, between the fingers, navel, chest, armpits or genital area. Scabies is treatable, but can also cause other diseases (eg, cellulitis, sepsis).

List of other skin diseases: keratosis, carcioma, hemangioma

Elderly people are also familiar with the types of skin diseases. For example, actinic keratosis is caused by constant and intense sun exposure; the increase and change in skin keratinocytes is painful. It is considered an early stage of skin cancer. Reddish spots appear on areas of the body exposed to the sun. Requires immediate treatment.

Basal carcinoma also recognized as white skin cancer, has the same trigger others. With early treatment, basal cell carcinoma has a good prognosis.

Hemangioma is a benign tumor that occurs most often in young children (approximately 30% at birth).

Skin diseases in humans: melanoma, shingles, hemorrhoids

Melanoma (cancer) is a malignant tumor based on pigment cells of the epidermis. It develops as a result of excessive sun exposure and appears most often on the face, neck or forearms. It can be treated well at an early stage.

Shingles (shingles) as a consequence of immunodeficiency.

Hemorrhoids occur with various reasons such as constipation, lack of exercise, pregnancy, liver disease.

What are the types of skin diseases: warts, diaper rash and others?

Warts There are often infectious, benign epithelial tumors caused by a virus. The lesions form over several months or years, sometimes spontaneously.

Diaper rash is one of the most common skin diseases in infancy, which is diagnosed in almost two-thirds of all children and manifests itself in various forms.

Hair loss, which can be caused by organic disorders and poisoning.

Varicose veins are also visible on the skin (usually the legs) but are not counted as a skin condition.

Weakness in the veins of the legs leads to leg ulcers. As a result, wounds heal poorly, which leads to slow tissue destruction. There is a risk of losing the affected limb.

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Chapter 4. INFECTIOUS SKIN DISEASES

Chapter 4. INFECTIOUS SKIN DISEASES

4.1. BACTERIAL SKIN INFECTIONS (PIODERMA)

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 dermatovenerologists (especially common in children), accounting for 30-40% of all visits. In countries with cold climates, the peak incidence occurs in the autumn-winter period. In hot countries with a humid climate, pyoderma occurs all 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); 10-15% - streptococci (S. pyogenes). In recent years, two pathogens can be detected simultaneously.

Pneumococci, Pseudomonas aeruginosa and Escherichia coli, Proteus vulgaris, etc. can also cause pyoderma.

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

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

Microorganisms

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

Staphylococcus aureus (St. aureus) pathogenic for humans;

Staphylococcus epidermidis (St. epidermidus) may 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 (a high degree of correlation is noted between the pathogenicity of staphylococci and their ability to form coagulase). Due to coagulase activity, when infected with staphylococcus, an early blockade of lymphatic vessels occurs, which leads to limiting the spread of infection, and is clinically manifested by the appearance of infiltrative-necrotic and suppurative inflammation. Staphylococcus aureus also produces hyaluronidase (a propagation factor that promotes the penetration of microorganisms into tissues), fibrinolysin, DNase, flocculent 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 fibro-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, viridian and non-hemolytic. β-hemolytic streptococcus is of greatest importance in the development of pyoderma.

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 sharply increases the permeability of the vascular wall and promotes the release of plasma into the interstitial space, which, in turn, leads to the formation of edema, and then blisters 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 of the intact stratum corneum to microorganisms is created due to the tight fit of the stratum corneum to each other and their negative electrical charge, which repels negatively charged bacteria. Also of great importance is the constant exfoliation of cells of the stratum corneum, with which a large number of microorganisms are removed.

The acidic environment on the surface of the skin is an unfavorable background for the proliferation of microorganisms.

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

The antagonistic and antibiotic properties of normal skin microflora (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 syndrome, thyroid diseases, 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 conditions contribute to the long-term course of bacterial processes in the skin and the frequent development of relapses;

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

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

Negative environmental factors include the following.

Contamination and massive infection by 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, the skin capillaries narrow, 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 “entry gate” for the coccal flora.

Thus, in the development of pyoderma, an important role is played by changes in the reactivity of the macroorganism, the pathogenicity of microorganisms and the adverse influence of the external environment.

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

With the development of chronic recurrent pyoderma, the most important changes in the body's reactivity and the weakening of its protective properties. In most cases, the cause of these pyodermas is a mixed flora, often opportunistic. Such pyoderma is not contagious.

Classification

There is no uniform classification of pyoderma.

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

By depth of damage The skin is divided into superficial and deep, paying attention to the possibility of scar formation when inflammation resolves.

By duration of flow pyoderma can be acute or chronic.

It is important to distinguish between pyoderma primary, occurring on unaltered 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 in shape, in the center of which a cavity filled with pus is formed. Along the periphery there is a zone of erythematous-edematous inflammatory skin with pronounced infiltration.

Streptococcal pyoderma most often develop on smooth skin around natural openings (oral cavity, nose). Morphological element of streptoderma - conflict(flat pustule) - a superficially located vesicle with a flabby covering and serous-purulent contents. Having thin walls, the lyktena quickly opens, and the contents dry out to form 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 penetrated by hair. The contents are purulent, the tire is tense, and there is an erythematous rim around the pustule. The rashes can be single or multiple, located in groups, but never merge. After 2-3 days, the hyperemia disappears, and the contents of the pustule dry out and a crust forms. There is no scar left. The most common localization is the scalp, torso, buttocks, and 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 superficial folliculitis. When the entire follicle is affected, including the hair papilla, deep folliculitis.

Rice. 4-1. Folliculitis, individual elements

Rice. 4-2. Common folliculitis

Localization - on any area 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 element resolves, temporary post-inflammatory pigmentation remains. Deep folliculitis leaves a small scar and the hair follicle dies.

The appearance of osteofolliculitis and folliculitis on the skin is promoted by diseases of the gastrointestinal tract (gastritis, gastric ulcer, colitis, dysbiosis), as well as overheating, maceration, insufficient hygienic care, mechanical or chemical irritation of the skin.

Treatment osteofolliculitis and folliculitis consists of external use 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 rash with antiseptic solutions: chlorhexidine, miramistin *, sanguiritrin *, 1-2% chlorophyllipt*.

Furuncle

Furuncle furunculus)- acute purulent-necrotic lesion of the entire follicle and the surrounding subcutaneous fatty tissue. It begins acutely as 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 inflammatory phenomena in the connective tissue of the follicle, a boil is formed.

Rice. 4-3. Furuncle of the thigh

Clinical picture

The process occurs in 3 stages:

. Stage I(infiltration) is characterized by the formation of a painful acute inflammatory node the size of a hazelnut (diameter 1-4 cm). The skin above it becomes purplish-red.

. Stage II characterized by the development of suppuration and the formation of a necrotic core. A cone-shaped node protrudes above the surface of the skin, at the top of which a pustule forms. Subjectively, a burning sensation and severe pain are noted. 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 mixed with blood, the purulent-necrotic rod is gradually rejected. At the site of the opened boil, an ulcer is formed with uneven, undermined edges and a bottom covered with purulent-necrotic masses.

. Stage III- 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, irregular in shape).

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

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

Localization of the boil on the face (nose area, upper lip) is dangerous - staphylococci may 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 pain is noted when boils are localized in places where there is almost no soft tissue (scalp, dorsum of fingers, anterior surface of the leg, external auditory canal, etc.), as well as in places where nerves and tendons pass.

A single boil is usually not accompanied by general symptoms; if several are present, body temperature may rise to 37.2-39 °C, weakness, and loss of appetite.

The evolution of the 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 persons with somatic pathology (diabetes mellitus, gastrointestinal diseases, chronic alcoholism), chronic itchy dermatoses (scabies, lice).

Treatment

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

For furunculosis, as well as when boils are localized in painful or “dangerous” areas, antibacterial treatment is indicated. Broad-spectrum antibiotics are used (in case of furunculosis, the sensitivity of the microflora must be determined): benzylpenicillin 300,000 units 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.

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

In case of a recurrent course of purulent infection, it is recommended to conduct a course of nonspecific immunotherapy with lycopid * (for children - 1 mg 2 times a day, for adults - 10 mg / day), a-glutamyl-tryptophan, etc. It is possible to prescribe ultraviolet radiation.

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 involves the skin and subcutaneous tissue, accompanied by severe swelling, as well as a violation of the general condition of the body. The skin over the infiltrate is purplish-red with a bluish tint 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 mixed with blood is released. Soon, all the skin covering the carbuncle melts, and a deep ulcer is formed (sometimes reaching the fascia or muscles), the bottom of which is a solid necrotic mass of a dirty green color; An infiltrate remains around the ulcer for a long time. The defect is filled with granulations and heals with a deep retracted scar. Carbuncles are usually single.

Often carbuncles are localized on the back of the neck and 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. Complications in the form of phlebitis, thrombosis of the cerebral sinuses, and sepsis are possible.

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

Treatment carbuncles are treated in a hospital setting with broad-spectrum antibiotics, specific and nonspecific immunostimulation is prescribed (see. Treatment of boils). In some cases, surgical treatment is indicated.

Hidradenitis

Hidradenitis (hydradenitis)- deep purulent inflammation of the apocrine glands (Fig. 4-5). Occurs in adolescents and young patients. Children before puberty and the elderly do not suffer from hidradenitis, since in the former the apocrine glands have not yet developed, and in the latter the function of the glands fades away.

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

Clinical picture

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

A fluctuation occurs in the center of the nodes, and soon they open with the release of thick yellowish-green pus. After this, the inflammatory phenomena decrease, and the infiltrate gradually resolves.

Rice. 4-5. Hidradenitis

Yes. There is no necrosis of skin tissue, as with a boil. At the height of the development of hidradenitis, the body temperature rises (subfebrile), and malaise occurs. The disease lasts 10-15 days. Hidradenitis often recurs.

Recurrent hidradenitis on the skin is characterized by the appearance of double or triple comedones (fistula tracts connected to several superficial openings), as well as the presence of scars resembling cords.

The disease is especially severe in obese people.

Treatment

Broad-spectrum antibiotics are used (for chronic hidradenitis - 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 chronic cases, specific and nonspecific immunotherapy is prescribed.

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

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

Sycosis

Sycosis (sycosis)- chronic purulent inflammation of the follicles in the growth area of ​​bristly hair (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 areas 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. Subsequently, pronounced infiltration develops, against which pustules, superficial erosions, and 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.

This disease is characterized by a long course with periodic remissions and exacerbations (over many months and even years).

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

In case of 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 Zeiss or Mohl gland, and internal barley, the result of inflammation of the meibomian gland. Barley can have unilateral or bilateral localization. Often found in children.

Clinically, swelling and redness of the eyelid margin are characteristic, accompanied by severe pain. Subjective sensations disappear after the abscess breaks out. In most cases, spontaneous self-healing occurs, but sometimes the inflammation becomes chronic and the stye recurs.

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

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 due to the anatomical features of their skin structure. Thus, the fragile connection of keratinocytes of the basal layer with each other, as well as with the basement membrane, leads to epidermolytic processes; neutral skin pH is more favorable for the development of bacteria than an acidic environment in adults; There are 12 times more eccrine sweat glands in children than in adults, sweating is increased, and the excretory ducts

Rice. 4-7. Barley

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

These structural and functional features of the skin of infants have led to the formation of a separate group of staphylococcal pyoderma, characteristic only of small children.

Miliaria and vesiculopustulosis

Miliaria and vesiculopustulosis (vesiculopustulos)- 2 conditions that are closely related to each other and represent 2 stages of the development of the inflammatory process in the eccrine sweat glands with increased sweating against the background of overheating of the child (high ambient temperature, fever in common infectious diseases). They occur more often by the end of the 1st month of a child’s life, when the sweat glands begin to actively function, and stop by the age of 1.5-2 years, when the mechanisms of sweating and thermoregulation are formed in children.

Miliaria is considered 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 the eccrine sweat glands. The rashes are located on the scalp, upper third of the chest, neck, and back.

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

With widespread vesiculopustulosis, low-grade fever and malaise of the child are noted. In place of the pustules, serous-purulent crusts appear, after rejection of which there are no scars or hyperpigmented spots left. The process lasts from 2 to 10 days. In premature babies, the process spreads deeper and multiple abscesses occur.

Treatment consists of adequate temperature conditions for the child, hygienic baths, the use of 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), occur primarily or as a continuation of the course of vesiculopustulosis.

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

Rice. 4-9. Finger's pseudofurunculosis

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

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

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

Treatment of children with Finger's pseudofurunculosis is carried out jointly with a pediatric surgeon to decide whether it is necessary 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 exposed nodes. It is advisable to carry out physiotherapeutic treatment methods: ultraviolet irradiation, UHF, etc.

Epidemic pemphigus of newborns

Epidemic pemphigus of newborns (pemphigus epidemicus neonatorum)- widespread superficial purulent skin lesion. It is a contagious disease that most often occurs in the 1st week of a child’s life. The rashes are localized on the buttocks, thighs, around the navel, limbs, and extremely rarely on the palms and soles (unlike the localization of blisters in syphilitic pemphigus). Multiple blisters with cloudy serous or serous purulent contents, ranging in size from a pea to a walnut, appear on non-infiltrated, unchanged skin. Merging and opening, they form weeping red erosions with fragments of the epidermis. Nikolsky's symptom in severe cases of the process can be positive. No crust is formed on the surface of the elements. The bottom of the erosions is completely epithelialized within a few days, leaving pale pink spots. The rash occurs in waves, in groups, over 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, a shift in the leukocyte formula to the left, an increase in the erythrocyte sedimentation rate (ESR).

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

placed on a hyperemic background. Nikolsky's symptom is negative. The blisters are quickly resolved by large-plate peeling. The condition of newborns is usually not impaired; body temperature may rise to subfebrile.

Pemphigus in newborns is considered a contagious disease, so the sick child is isolated in a separate room or transferred to the infectious diseases department.

Treatment. Antibiotics and infusion therapy are prescribed. The bubbles are punctured, preventing the contents from coming into contact with healthy skin; the tire and erosions are treated with 1% solutions of aniline dyes. UFO is used. To avoid the spread of the process, it is not recommended to bathe a sick child.

Ritter's exfoliative dermatitis of newborns

Ritter's exfoliative dermatitis of newborns (dermatitis exfoliativa), or staphylococcal scalded skin syndrome, is the most severe form of staphylococcal pyoderma, developing in children in 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 also possible in older children (up to

2-3 years), in which it has a mild course and is not widespread.

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

The disease begins with an inflammatory, bright, swollen erythema in the mouth or umbilical wound, which quickly spreads to the folds of the neck, abdomen, genitals and anus. Against this background, large flaccid blisters form, which quickly open, leaving extensive wet eroded surfaces. With minor trauma, the swollen, loosened epidermis peels off 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 initially predominate, 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.

IN erythematous Stages include diffuse redness of the skin, swelling and blistering. The exudate formed in the epidermis and under it contributes to the peeling of areas of the epidermis.

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

IN regenerative stage, hyperemia and swelling of the skin decrease, epithelization of erosive surfaces occurs.

In mild forms of the disease, the stages of the course are not clearly expressed. Benign form localized (only on the face, chest, etc.) and is characterized by mild skin hyperemia and large-plate 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 consists of maintaining the child’s normal body temperature and water-electrolyte balance, gentle skin care, and antibiotic therapy.

The child is placed in an incubator with regular temperature control or under a Sollux lamp. Antibiotics are administered parenterally (oxacillin, lincomycin). γ-globulin is used (2-6 injections), anti-staphylococcal plasma infusions of 5-8 ml per 1 kg of body weight. Infusion therapy with crystalloids is carried out.

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 with Burov's fluid, sterile isotonic sodium chloride solution with the addition of 0.1% silver nitrate solution, and 0.5% potassium permanganate solution are applied to the affected areas. The remnants of the exfoliated epidermis are cut off with sterile scissors. For severe erosions, apply powder with zinc oxide and talc. For dry erosions, antibacterial ointments are prescribed (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, it is contagious. Morphological element - conflict- superficial epidermal pustule with a thin, flabby covering, lying almost at the level of the skin, filled with serous contents (Fig. 4-11). The phlyctena is surrounded by a zone of hyperemia (rim) and tends to grow peripherally (Fig. 4-12). Its contents quickly dry out into a straw-yellow crust, which, when removed, forms a moist, erosive surface. Around the primary conflict, new small, grouped conflicts appear, when opened, the hearth acquires a scalloped outline. The process ends in 1-2 weeks. Nai-

Rice. 4-11. Streptococcal impetigo

Rice. 4-12. Streptococcal impetigo on the face

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

Children with streptococcal impetigo are restricted from attending schools and child care facilities.

There are several clinical types of streptococcal impetigo.

Bullous impetigo

Bullous impetigo (impetigo bullosa) characterized by pustules and blisters located in 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 young and middle-aged children and spreads to

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

Rice. 4-14. Bullous impetigo due to immunodeficiency

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

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

Slit impetigo

Slit-like impetigo, seized (impetigo fissurica)- streptoderma of the corners of the mouth (Fig. 4-15). Often develops in middle-aged children and adolescents with the habit of licking their lips (dry lips in atopic dermatitis, actinic cheilitis, chronic eczema), as well as in patients with difficulty breathing through the nose (chronic tonsillitis) - excessive wetting of the corners occurs when sleeping with the mouth open mouth, which contributes to the development of inflammation. Phlyctena 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 (jamming)

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

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

Superficial panaritium

Superficial panaritium (turnoe)- inflammation of the periungual ridges (Fig. 4-16). It often develops in children with hangnails, nail injuries, and onychophagia. The inflammation surrounds the legs in a horseshoe shape.

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

As inflammation spreads, deep forms of panaritium may develop, requiring surgical intervention.

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

wipes with Vishnevsky liniment*, 10-12% ichthammol ointment, use antibacterial ointments.

In case of a widespread process, antibiotic therapy is prescribed. Consultation with a surgeon is recommended.

Intertriginous streptoderma, or streptococcal intertrigo (intertrigo streptogenes), occurs on contacting surfaces

Rice. 4-16. Superficial panaritium

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

Appearing in large numbers, phlyctenas merge and quickly open up, forming continuous eroded, wet surfaces of a bright pink color, with scalloped borders and a border of exfoliating epidermis along the periphery. Next to the main lesions, screenings are visible in the form of separately located pustular elements at various stages of development. Deep in the folds there are often painful cracks. The course is long and accompanied by pronounced subjective disturbances.

Treatment consists of treating 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.). For preventive purposes, the folds are treated with powders (with clotrimazole) 3-4 times a day.

Post-erosive syphiloid

Post-erosive syphiloid, or syphiloid-like papular impetigo (syphiloides posterosives, impetigo papulosa syphiloides), occurs in children predominantly of infant age. Localization - skin of the buttocks, genitals, thighs. The disease begins with quickly opening-

Rice. 4-17. Intertriginous streptoderma

There are conflicts, which are based on infiltration, which makes these elements similar to papuloerosive syphilide. However, an acute inflammatory reaction is not typical for syphilitic infection. Poor hygienic care plays a role in the occurrence of this disease in children (another name for the disease is “diaper dermatitis”).

Treatment. Externally, 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, the skin is treated 3-4 times (with each diaper or diaper change) with protective soft pastes (special creams for diapers, cream with zinc oxide, etc.), powders (with clotrimazole).

Ringworm simplex

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

The rashes are most often localized on the cheeks, chin, limbs, and less often on the torso. Lichen simplex often occurs in children with atopic dermatitis, as well as with xerosis of the skin. 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 occurs without acute inflammatory manifestations, is long-lasting, and 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 ointments, etc.), in the presence of atopic dermatitis and xerosis of the skin, it is recommended to use combined glucocorticoid drugs (hydrocortisone ointment + oxytetracycline, hydrocortisone creams + natamycin + neomycin , hydrocortisone + fusidic

acid, etc.) and regularly apply moisturizing and softening creams (lipicar *, Dardia *, emoleum *, etc.).

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

Ecthyma vulgaris

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

Distinguish pustular And ulcerative stage. The process begins with the appearance of an acutely 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 inward and along the periphery due to the purulent melting of the infiltrate, which shrinks into a grayish-brown crust. In severe cases, the inflammation zone around the crust expands and a layered crust forms - rupee. When the crust is peeled away, a deep

Rice. 4-20. Ecthyma vulgaris

Rice. 4-21. Multiple ecthymas

an ulcer whose bottom is covered with purulent plaque. 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 units 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.

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

Erysipelas

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

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

The “entry gate” of infection is often microtraumas of the skin: in adults - small cracks on the feet and in interdigital folds, in children - macerated skin of the anogenital area, in newborns - 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. Skin rashes 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 lesion are clear, often with a bizarre pattern in the form of flames, painful on palpation, regional lymph nodes are enlarged. The listed symptoms are typical for erythematous form erysipelas (Fig. 4-22).

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

Rice. 4-22. Erysipelas in a baby

Rice. 4-23. Erysipelas. Bullous form

In weakened patients, it is possible to develop phlegmonous And necrotic forms erysipelas. Treatment of these patients should be carried out in surgical hospitals.

The average duration of the disease is 1-2 weeks. In some cases, a recurrent course of erysipelas develops, especially often localized on the extremities, which leads to pronounced trophic disorders (lymphostasis, fibrosis, elephantiasis). Recurrent 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 of cancer.

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

Treatment. Penicillin antibiotics are prescribed (benzylpenicillin 300,000 units 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 once a day for 5 days, clarithromycin 250-500 mg 2 times a day for 10 days.

Infusion detoxification therapy is carried out [hemodez*, dextran (average molecular weight 35000-45000), trisol*].

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

Mixed streptostaphylococcal pyoderma (streptostaphylodermia)

Streptostaphylococcal impetigo, or vulgar impetigo (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. Next, powerful yellowish-green crusts form in the outbreak. The duration of the disease is about 1 week, ending with the formation of temporary post-inflammatory pigmentation. Rashes often appear on the face and upper extremities. Widespread pyoderma may be accompanied by low-grade fever and lymphadenopathy. Often occurs in children, less often in adults.

Treatment. For widespread inflammatory processes, 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).

For limited damage, only external treatment is recommended. Use 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 with streptostaphyloderma are restricted from attending schools and child care institutions.

Chronic ulcerative and ulcerative-vegetative pyoderma

Chronic ulcerative and ulcerative-vegetative pyoderma (pyodermitis chronica exulcerans et vegetans)- a group of chronic pyoderma, 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 legs. Most often they are preceded by a boil or ecthyma. Acute inflammatory phenomena subside, but the disease becomes chronic. A deep infiltrate is formed, subjected to purulent melting, with the formation of extensive ulcerations, fistula tracts with the release of pus. Over time, the bottom of the ulcers becomes covered with flaccid granulations, the congestively hyperemic edges become infiltrated, and 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 of ulcerative-vegetative pyoderma are most often localized on the dorsum of the hands and feet, in the ankles, on the scalp, pubis, etc.

Chronic pyoderma lasts for months, years. Healing proceeds through rough scarring, as a result of which areas of healthy skin are also enclosed in 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. Combination 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: a vaccine for the treatment of staphylococcal infections, anti-staphylococcal immunoglobulin, staphylococcal vaccine and toxoid, etc.

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

Proteolytic enzymes that help cleanse the ulcer (trypsin, chymotrypsin, etc.), wound wipes with antiseptic agents (voskopran*, parapran*, etc.), antibacterial ointments (levomekol*, levosin*, silver sulfathiazole, sulfadiazine, etc.) are used externally etc.).

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

Chancriform pyoderma

Chancriform pyoderma (pyodermia chancriformis)- a deep form of mixed pyoderma, clinically similar to syphilitic chancre (Fig. 4-26).

Rice. 4-26. Chancriform 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, the rashes are localized in the genital area: on the glans penis, foreskin, labia minora and labia majora. In 10% of cases, an extragenital location of the rash is possible (on the face, lips, eyelids, tongue).

The occurrence of the disease is facilitated by poor skin care, long foreskin with a narrow opening (phimosis), resulting in an accumulation of smegma, which irritates the glans and foreskin.

The development of chancriform pyoderma begins with a single pustule, which quickly turns into erosion or a superficial ulcer of regularly round or oval shape, with dense, roller-like raised edges and an infiltrated bottom of a meat-red color, covered with a slight fibrinous-purulent coating. The size of the ulcer is 1 cm in diameter. The discharge from the ulcer is scanty, serous or serous-purulent; upon examination, coccal flora is detected. There are no subjective sensations. Ulcers are usually single, rarely multiple. The similarity with syphilitic chancroid is aggravated by the presence at the base of the ulcer of more or less

less pronounced compaction, low pain of the ulcer, moderate compaction and enlargement of regional lymph nodes to the size of a cherry or hazelnut.

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

Other bacterial processes

Pyogenic granuloma

Pyogenic granuloma, or botryomycomoma, 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 young and middle-aged children (Fig. 4-28).

Clinically, pyogenic granuloma is a rapidly growing tumor-like formation on a stalk, consisting of capillaries, ranging in size from a pea to a hazelnut. The surface of pyogenic granuloma is uneven, often with bleeding bluish-red erosions, covered with purulent-hemorrhagic crusts. Sometimes ulceration, necrotization, and in some cases keratinization occur.

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

Treatment is 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, multiplying only in the stratum corneum of the skin. The most common localization of rashes is large folds (inguinal, axillary, under the mammary glands, perianal area). Predisposing factors for the development of erythrasma: increased sweating, high temperature, humidity. The contagiousness of erythrasma is low. The disease is typical for patients with excess body weight, diabetes mellitus and other metabolic diseases. In young children, the disease occurs extremely rarely; it is more common in adolescents with endocrinological diseases.

The rashes are represented by non-inflammatory scaly spots of brownish-red color, with sharp boundaries, prone to peripheral growth and fusion. The spots are sharply demarcated from the surrounding skin. Usually they rarely extend beyond the contacting areas of the skin. In the hot season, increased redness, swelling of the skin, and often vesiculation and weeping are observed. Lesions in the rays of a 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, course of treatment - 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. In case of a widespread process, erythromycin 250 mg is prescribed every 6 hours for 14 days or clarithromycin 1.0 g once.

Prevention of the disease - combating sweating, maintaining good hygiene, using 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 hygienic care.

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

In childhood, acute superficial forms of pyoderma are more typical than deep chronic forms.

Hidradenitis develops only in adolescents during puberty.

Pathomimia 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, and sycosis is not typical for childhood.

Consulting patients with pyoderma

Patients need to be explained the infectious nature of pyoderma. In some cases, it is necessary to exclude 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, and rubbing the skin with a washcloth. For pyoderma, therapeutic massages are contraindicated; in the acute period, all types of physical therapy are contraindicated. In order to prevent secondary infection, it is recommended to boil and iron the clothes and bedding of children, especially those suffering from streptoderma, with a hot iron.

In case of deep and chronic pyoderma, a thorough examination of patients is necessary, identifying chronic diseases that contribute to the development of pyoderma.

Scabies (scabies)

Etiology

The life cycle of a tick begins with the contact of a fertilized female on human skin, which immediately penetrates deep into the skin (to the granular layer of the epidermis). Moving forward along the scabies course, the female feeds on the cells of the granular layer. In the mite, digestion of food occurs outside the intestine with the help of a secretion secreted into the scabies tract, which contains a large amount of proteolytic enzymes. The daily fertility of a female is 2-3 eggs. 3-4 days after laying the eggs, the larvae hatch from them, leave the passage through the “ventilation holes” and re-emerge into the skin. After 4-6 days, adult sexually mature individuals are formed from the larvae. And the cycle begins again. The lifespan 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 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. The second half of the night it gnaws in a straight line, feeding intensively, and during the day it stops and freezes. The daily program is carried out synchronously by all females, which explains the appearance of itching in the evening, the predominance of the direct route of infection in bed at night, and the effectiveness of applying acaricidal drugs in the evening and at night.

Epidemiology

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

. straight the path (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 group of STIs. Infection also occurs while sleeping in the same bed, while caring for a child, etc. In a family, if there is 1 patient with widespread scabies, almost all family members become infected;

. indirect, or mediated, the path (through objects used by the patient) is much less common. The pathogen is transmitted through shared use of bedding, linen, clothing, gloves, washcloths, toys, etc. In children's groups, indirect transmission occurs much more often than in adults, which is associated with the exchange of clothing, toys, writing materials, etc.

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

The most favorable conditions for a tick to live outside its “host” are fabrics made from natural materials (cotton, wool, leather), as well as house dust and wooden surfaces.

The spread of scabies is facilitated by failure to comply with proper sanitation and hygiene measures, migration, overcrowding of the population, 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 caught on the skin, the stage in which these mites are located, the tendency to allergic reactions, as well as the cleanliness of the person.

The main clinical symptoms of 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 gets worse in the evening and at night.

Several factors are noted in the pathogenesis of itching with scabies. The main cause of itching is mechanical irritation of the nerve endings when the female advances, which explains the nocturnal nature of the itching. Reflex itching may occur.

Also important in the formation of itching are allergic reactions that occur when the body is sensitized to the mite itself and its waste products (saliva, excrement, egg shells, etc.). Among allergic reactions when infected with scabies, the most important is the type 4 delayed hypersensitivity reaction. An immune response, manifested by increased itching, develops 2-3 weeks after infection. If infection is repeated, itching appears after a few hours.

Scabies move

Scabies is the main diagnostic sign of scabies, distinguishing it from other itchy dermatoses. The course looks like a slightly raised line of dirty gray color, curved or straight, 5-7 mm long. Sézary's symptom is detected - palpation detection of scabies in the form of a slight elevation. The itch ends in a raised blind end with the female. Scabies can be detected with the naked eye; if necessary, use a magnifying glass or dermatoscope.

If scabies are detected, 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. Uneven coloring of the skin above the scabies occurs due to paint getting into the “ventilation holes”.

Polymorphism of rashes

The polymorphism of rashes is characterized by various morphological elements that appear on the skin during scabies.

The most common are papules, vesicles measuring 1-3 mm, 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 where the larvae penetrate the skin. Pustular elements appear with the addition of a secondary infection, hemispherical itchy papules - with lymphoplasia.

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

The polymorphism of scabies rashes is often determined Ardi-Gorchakov's symptom- presence of pustules, purulent and hemorrhagic

Rice. 4-31. Scabies. Abdominal skin

Rice. 4-32. Scabies. Skin of the forearm

Rice. 4-33. Scabies. Genital skin

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

(Figure 4-35).

Localization

The typical localization of scabies rashes 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 abdomen, and in men - the genitals.

Rice. 4-34. Scabies. Ardi-Gorchakov's symptom

Rice. 4-35. Scabies. Michaelis symptom

Damage to the hands is most significant in case of scabies, since it is here that the main number of scabies burrows are localized and the bulk of larvae are formed, which are passively spread throughout the body by hand.

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

The localization of scabies rashes 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). The most common developments are folliculitis, impetiginous elements, boils, ecthyma, and the development of phlegmon, phlebitis, and sepsis is possible.

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

Eczema develops with long-standing widespread scabies and is characterized by a torpid course. Microbial eczema most often develops. The lesions have clear boundaries, numerous vesicles, oozing, and serous-purulent crusts appear. The rashes are localized on the hands (possible

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.

Nail lesions are detected only in infants; Thickening and clouding of the nail plate are characteristic.

Features of the course of scabies in children

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). Rashes pre-

are formed by small papular elements of 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 soles (Fig. 4-40, 4-41).

No excoriation or hemorrhagic crusts.

The addition 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 infants

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, which responds to antiallergic therapy.

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

Features of scabies in young children

. The rash is similar to that seen in adults. Excoriations and hemorrhagic crusts are characteristic.

The favorite localization of rashes is the “panty area”: the stomach, buttocks, and 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.

A frequent complication of scabies is common pyoderma: folliculitis, furunculosis, ecthyma, etc.

Severe night itching can cause sleep disturbances in children, irritability, and decreased performance at school.

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

Clinical types 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 the rashes are represented by follicular papules and seropapules. The diagnosis is made by examining persons who have been in contact with a person 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).

Low-symptomatic scabies

Scabies is asymptomatic, or “erased,” and is characterized by moderate skin rashes and mild itching. The reasons for the development of this form of scabies may be the following:

Careful adherence by the patient to the rules of hygiene, frequent washing with a washcloth, which helps to “wash off” ticks, especially in the evening;

Skin care, which consists of regular use of moisturizing body creams, covering the ventilation holes and disrupting the vital activity of the mite;

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

rashes on the hands and open areas of the skin, but significant lesions on the skin of the torso).

Norwegian scabies

Norwegian (crusted, crustose) scabies is a rare and particularly contagious form of scabies. It is characterized by the predominance of massive cortical layers in typical places, the rejection of which exposes erosive surfaces. Typical scabies even appear on the face and neck. This form of scabies is accompanied by a disturbance in the general condition of the patient: increased body temperature, lymphadenopathy, leukocytosis in the blood. Develops in persons with impaired skin sensitivity, mental disorders, immunodeficiency (Down's disease, senile dementia, syringimyelia, HIV infection, etc.).

Scabies "incognito"

“Incognito” scabies, or unrecognized scabies, develops against the background of drug treatment with drugs that suppress inflammatory and allergic reactions and have an antipruritic and hypnotic effect. Glucocorticoids, antihistamines, neurotropic drugs and other agents suppress itching and scratching in patients, which creates favorable conditions for the mite to spread over the skin. The clinical picture is dominated by scabies, excoriation is absent. Such patients are very contagious to others.

Postscabiosis lymphoplasia

Postscabiosis 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).

Postscabiosis lymphoplasia is a reactive hyperplasia of lymphoid tissue in the areas of its greatest accumulation. Favorite localization is the perineum, scrotum, inner thighs, and axillary fossae. 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. Postscabiosis lymphoplasia

Diagnostics

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

The most important to confirm the diagnosis are the results of laboratory diagnostics with the detection of the female, larvae, eggs, and empty egg membranes under a microscope.

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

In the wild, the scraping is treated with alkali) or with a sharp spoon after first applying a 40% lactic acid solution. The resulting scraping is examined under a microscope.

Differential diagnosis

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

Treatment

Treatment is aimed at destroying the pathogen with acaricidal drugs. External preparations are mainly used.

The general principles of treatment of patients with scabies, the choice of medications, and the timing of clinical examination are determined by the “Protocol for the management of patients. Scabies" (order of the Ministry of Health of the Russian Federation No. 162 of April 24, 2003).

General rules for prescribing anti-scabies drugs:

Use the drug in the evening, preferably before bedtime;

The patient should take a shower and change his underwear and bed linen before starting treatment and at the end;

The drug must be applied 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), which is 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, mouth, and genitals; in case of contact with mucous membranes, rinse them with running water;

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

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

After treatment, do not wash your hands for 3 hours, then rub the drug into the skin of your 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, but the anti-scabies activity will remain the same;

Treatment of patients identified in one outbreak (for example, in a family) is carried out simultaneously to avoid reinfection.

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

.Benzyl benzoate water-soap emulsion(20% - for adults, 10% - for children or in the form of 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 thoroughly applied to the skin twice with a 10-minute break. Side effects of the drug include the possible development of contact dermatitis and dry skin.

A 5% solution of permethrin 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 bottle (8 ml of a 5% solution) is 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 direction from top to bottom. In infants, the scalp and face are also treated. The mouth, nose and eyes are first covered with cotton swabs. According to the manufacturer's recommendation, treatment is carried out once, but from experience it is known that with widespread scabies, 2-3 times the drug is required (1, 5 and 10 days) 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). Side effects often include contact dermatitis. Apply for 5-7 days in a row.

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

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

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

Postscabiosis lymphoplasia does not require anti-scabies therapy. They use antihistamines, indomethacin, glucocorticoid ointments under an occlusive dressing, and laser therapy.

Features of the treatment of scabies in children

Anti-scabies are rubbed into the baby's skin by the mother or other caregiver.

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

To avoid getting the drug into the eyes when touching them with your hands, small 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, which have been proven safe for use during pregnancy and lactation.

Clinical examination

An appointment (examination, consultation) with a patient’s dermatovenereologist for the treatment of scabies is carried out five times: 1st time - on the day of application, diagnosis and treatment; 2nd - 3 days after the end of treatment; 3, 4, 5th - every 10 days. The total period of clinical observation is 1.5 months.

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

Members of organized groups (preschool institutions, educational institutions, classes) are examined by health workers on site. If scabies is detected, schoolchildren and children are suspended from visiting a child care facility for the duration 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, examination is carried out three times with an interval of 10 days.

Carrying out ongoing disinfection in areas of scabies is mandatory.

Prevention

The main preventive measures include early identification of patients with scabies, contact persons and their treatment. Disinfection of bedding and clothing can be done 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 sealed plastic bag for 5-7 days.

A-PAR aerosol* is also used to treat upholstered furniture, carpets, toys and clothing.

Consulting

It is necessary to warn patients about the contagiousness of the disease, strict adherence to sanitary and hygienic measures in the family, team, strict adherence to treatment methods, and the need to re-visit the doctor in order to establish the effectiveness of therapy.

Pediculosis

There are 3 types of pediculosis in humans: cephalic, body and pubic. Among children, head lice is the most common. Pediculosis is most often detected among people leading an asocial lifestyle, in crowded conditions and who do not comply with sanitary and hygienic standards.

Clinical picture

Clinical symptoms typical for all types of head lice:

Itching, accompanied by 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 several hours;

Irritability, often insomnia;

Detection of lice on the head, pubis, body and clothing, as well as nits on 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 head lice and phthiriasis;

Secondary pyoderma as a result of 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, and pillows can also lead to infection. The age peak of incidence is 5-11 years. Outbreaks of the disease are often 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 in shape, 1-1.5 mm long, covered on top with a flat cap (Fig. 4-43). They are glued with the lower end to the hair or fibers of the fabric with a secretion secreted by the female during laying. Skin rashes on the scalp occur when lice, when biting, inject saliva with toxic and proteolytic enzymes.

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

Rice. 4-43. Lice

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

Clothes lice (pediculosis corporis)

Unlike head louse, body louse most often develops in the absence of proper 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 folds and seams of linen and clothing touch. Patients are bothered by severe itching. The main elements are urticarial papules, dense nodules covered with hemorrhagic crusts, excoriations. A chronic widespread process is characterized by lichenification, secondary pyoderma, post-inflammatory melasma (“tramp skin”) as a result of prolonged mechanical irritation when a person scratches insect bites, the toxic effect of their saliva, “blooming” of bruises and scratching. Unlike scabies, the feet and hands are not affected.

Pediculosis pubis (phthiriasis)

Pediculosis pubis (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 hair of the pubis and lower abdomen. They can crawl onto the hair of the armpits, beard, mustache, eyebrows and eyelashes. At the sites of pubic louse bites, petechiae are first detected, and after 8-24 hours the lesions acquire a characteristic bluish-gray tint and spots appear (macula coeruleae) 2-3 mm in diameter, irregular in shape, located around the hair, into the mouths of which flats are introduced.

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

Treatment

Treatment of pediculosis is carried out with pediculocidal drugs. Most available highly active drugs contain permethrin (a neurotoxic poison). The preparations are applied to the scalp, left for 10 minutes, then the hair is washed. Shampoo "Veda-2" * is also effective in the treatment of pediculosis. After treatment, the hair is moistened with water (2 parts) with the addition of vinegar (1 part) and left for 30 minutes. Vinegar makes it easier to remove nits by repeatedly combing your hair with a fine-toothed comb. Mechanical removal of nits is an important point in the treatment of pediculosis, since medications do not penetrate well into the nit shell. After 1 week, it is recommended to repeat the treatment to destroy lice that have hatched from the remaining nits. When examined under a Wood's lamp, live nits, unlike non-viable (dry) ones, give off a pearly white glow.

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

Nits on eyelashes and eyebrows are removed mechanically using thin tweezers, after smearing them with Vaseline. (Permethrin preparations are not approved for use in the eye area!).

Anti-epidemic measures

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

To disinfect premises, preparations based on permethrin are used.

Children should not attend school if they have 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.

Skin is the largest organ of the human body. Its function is to protect the body from infections. But sometimes the skin itself becomes infected. Infestations can be caused by a wide variety of germs, and symptoms can range from mild to severe.

Mild forms of the disease can be treated on your own with medications and home remedies, while other infections may require medical attention. Read on if you want to know what to do if you already have the disease.

Types of Skin Infections

Below are four types of infection:

1. Bacterial.
Bacterial - often begins as small, red bumps that gradually increase in size. Mild diseases are treated with antibiotics. These include the following: phlegmon, impetigo, boils, leprosy.

2. Viral.
Caused by a virus. They range from mild to severe. Various types of viral infections include: (herpes zoster), chickenpox, warts, oral diseases.

3. Fungal.
These types of skin infections are caused by a fungus and most often develop on moist areas of the body, such as the legs or armpits. Some fungal diseases are not contagious and are usually not life-threatening. Various types of fungal invasions: ringworm, dermatomycosis, diaper rash.

Symptoms

Symptoms of a skin infection also vary depending on the type. Common signs include redness of the skin and rash. But other symptoms such as itching and pain may also occur.

You should see a doctor if you have pus-filled blisters or a skin infection that doesn't go away and gets worse. Diseases can spread beyond the skin and into the bloodstream. This can be very life-threatening.

Signs of severe types of illness include:

• pus;
• scales;
• peeling of the skin;
• dark, necrotic spots on the skin;
• the skin becomes painful and loses its original color.

Causes and risk factors

The cause of a skin infection depends on the type of skin infection.

A good medical examination is the best way to determine what is causing the infection. Often, a doctor can determine the type of infection based on its appearance.

The doctor usually asks about the symptoms and carefully examines the existing irregularities in the body. For example, ringworm often causes a scaly rash. In other cases, a sample of skin cells can help the doctor determine the type of disease.

Treatment

Treatment depends on the cause and severity of the infection. Some types of viral skin diseases may improve on their own within a few days or weeks.

Bacterial infections are often treated with antibiotics, either applied directly to the skin or taken orally. If the strain of bacteria is resistant to treatment, intravenous antibiotics may be required, which must be given in the hospital.

Home skin care is essential to reduce symptoms. It may include the following:

1. Apply cold compresses several times a day to reduce itching and inflammation.
2. Take to relieve itching.
3. Using creams and ointments to reduce itching and discomfort.

Ask your doctor what you can do at home on your own.

Prognosis for treatment

The prognosis for skin infections varies depending on the cause. Most types of bacterial infections respond well to medications. Some strains of bacteria, such as methicillin and Staphylococcus aureus (mrsa), are resistant to common antibiotics and difficult to treat.

Prevention

There are several ways to reduce the risk of developing an infection. Frequent hand washing is one of the best methods of preventing this disease.

You should make an appointment with your doctor if your skin condition causes discomfort. The doctor will be able to provide the necessary treatment to restore health.