Scabies main clinical manifestations of prevention. Scabies: causative agent, how to recognize, typical manifestations, how to get rid of a tick, drugs, prevention

Scabies is a very common and contagious parasitic skin disease caused by an external parasite, the scabies mite.

After contact with individuals or larvae on human skin, females pierce the epidermis for 0.5–1 h, forming scabies in which they lay eggs. After 3–4 days, larvae appear from the laid eggs, which accumulate in the zone of the stratum corneum. After 2-3 days, they have the first molt with the formation of a nymph from the larvae, which comes to the surface of the skin, then after 3-4 days ticks appear from the nymphs.

transmission paths. The source of infection is a person with scabies. Scabies is transmitted by contact.

Clinic. Immediately after infection, the incubation period of the pathogen begins, the duration of which varies. Average duration incubation period ranges from 3 to 14 days.

The main complaint presented by patients with scabies is skin itching, which bothers them mainly in the evening and at night.

Typical form of scabies. Lesions are localized in the most typical places: on the abdomen, especially around the navel, on the anterointernal surface of the thigh, on the buttocks, mammary glands, lateral surfaces

The nose of the fingers and toes, in men on the skin of the penis and scrotum. In addition to paired papulovesicles and scabies, pinpoint and linear excoriations (indicating itching) are found on the patient's skin, as well as various pyococcal complications, which often begin in the extensor zone of the elbows. Ardi's symptom is the detection of purulent or purulent-bloody crusts on the elbows.

Atypical forms of scabies include: clean scabies, nodular scabies and crusty (Norwegian) scabies.

Cleanliness scabies is an erased, abortive form of the disease that develops in people who carefully follow the rules of personal hygiene and have normal immunoreactivity.

Nodular scabies (nodular scabious lymphoplasia) occurs as a result of a delayed-type hyperergic reaction that develops on the waste products of the mite.

Itchy, lenticular, reddish-brown nodules occur under the burrows and are always located in areas characteristic of typical scabies.

The rarest atypical form scabies is crusted, or Norwegian, scabies. This type scabies occurs in patients who have a sharply weakened immunoreactivity. Crusted scabies is manifested by the formation of crusts on the surface of the skin and is the most contagious form of scabies. The extensor surfaces of the limbs (rear of the hands, fingers, elbows, knees), buttocks, hairy part head, face, auricles.

Scabies. New in etiology, epidemiology, clinic, diagnostics, treatment and prevention

T. V. Sokolova
Department of Infectious, Skin and Venereal Diseases, Faculty of Medicine, Institute of Medicine, Ecology and Valeology, Ulyanovsk State University

*Illustrative material for this lecture are slides prepared by a team of authors (Prof. T. V. Sokolova, Prof. K. K. Borisenko, Associate Professor M. V. Shaparenko, Senior Researcher A. B. Lange) and: published by the Association to combat sexually transmitted infections. SANAM. - Moscow, 1997.

Rice. one.
General view of a female scabies mite in a light and scanning throne microscope, x 150.

The life cycle of the scabies mite reflects the distribution in the individual development of the main life functions: nutrition, reproduction, resettlement, experience. It is clearly divided into two parts: short-term cutaneous and long-term intradermal. Intradermal is represented by two topically separated periods: reproductive and metamorphic. Reproductive is carried out by the female in the scabies she predicts, where she lays eggs. The hatching larvae come to the surface of the skin, settle on it and penetrate into the hair follicles and under the scales of the epidermis. Here their metamorphosis (molting) proceeds: through the stages of proto- and telenymph, adult individuals (females and males) are formed. The skin responds in these places with the formation of follicular papules and vesicles. Females and males of the new generation come to the surface of the skin, where mating takes place. The cycle ends with the introduction of daughter females into the skin, they immediately begin to make moves and lay eggs. Thus, during the life cycle, mites come to the surface of the skin twice - in the larval and adult stages. This is of significant clinical and epidemiological significance. Only females and larvae are invasive stages and participate in infection. When infected by females, there is practically no incubation period, since, having penetrated the skin, they immediately begin to make their way and lay eggs, i.e. on the face of the main clinical symptom scabies. When infected with larvae, it corresponds to the timing of metamorphosis and is about 2 weeks.

Scabies mites feed on scales of the epidermis in its thickness, capturing the cells of the granular layer. Feeding, digestion and excretion occur continuously during periods of activity during the night hours. 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, it gnaws through 1 or 2 egg knees at an angle to the main direction of travel, in each of which it lays an egg. Before laying an egg, she deepens the bottom of the passage, and on the roof she makes an exit hole for the larvae. In the second half of the night, the female gnaws a non-direct passage, feeding intensively. During the day it stops and freezes. The daily program is performed by all females synchronously. As a result, the itch course on the patient's skin has a convoluted shape and consists of segments of the course, called the daily element of the course. The back part of the course gradually exfoliates, during a clinical examination of the patient, it simultaneously consists of 4-7-day-old elements and has a constant length of 5-7 mm. During life, the female passes 3-6 cm in the epidermis. The revealed daily rhythm of activity is of great practical importance. He explains the increase in itching in the evening, the predominance of the direct route of infection by contact in bed in the evening and at night, the effectiveness of prescribing anti-scabies drugs at night.

The resettlement of scabies mites is carried out by skin stages of the life cycle - young females and larvae. Infection occurs mainly through close bodily contact, usually when sharing a bed. And usually both females and larvae. The latter, due to their abundance, small size and high mobility, are the most invasive, they can be introduced in any area. skin, usually in hair follicles, which are found in a few minutes. Females are introduced only in certain areas of the skin, where they migrate, hitting a person during infection or completing metamorphosis in the hair follicles. These are the hands, wrists, feet, elbows, genitals of men. In an experiment on volunteers, the migration of transplanted females to these places was observed (Mellanby, 1944). The distribution of female mites, and, accordingly, of scabies over the skin is determined by several factors: the structure of the skin, the hygrothermal regime, and the rate of epidermal regeneration.

The predominant localization of scabies is observed in areas of the skin with the largest thickness of the stratum corneum relative to the remaining layers of the epidermis. These are the hands, wrists and feet, where the thickness of the stratum corneum is 3/4-5/6 of the epidermis. It is characteristic that in areas where passages are practically absent (face, back), the relative thickness of the stratum corneum is minimal (1/5-1/6 of the epidermis). Naturally, the greater the thickness of the stratum corneum, the slower its regeneration and exfoliation, i.e., the larvae have time to hatch from all the eggs laid by the female, and are not rejected along with the horny scales. This is evidenced by the presence in the scrapings of most passages (from the back), usually several egg membranes. Obviously, female scabies mites normally choose skin areas according to the thickness of the stratum corneum and the rate of exfoliation, suitable for full reproduction. It has been established that the areas of the skin where the scabies are located have low temperature, on the hands by 2-3°C, on the feet 4-5°C lower than the rest of the skin. In children, this difference is even more pronounced. The passages are also confined to places where hair is absent or minimal.

Outside of a person, scabies mites are short-lived, their viability depends on the hygrothermal regime, primarily on humidity. At a temperature in the range of 10-25°C and a relative humidity of more than 60%, the survival time ranges from 14 to 1 day. With a decrease in humidity in these temperature ranges, the lifespan is significantly reduced. Critical in terms of survival is the humidity of 60%. Females are able to tolerate freezing down to -20°C. At room temperature and relative air humidity of at least 60%, females remain mobile for 1-6 days. Even at 100% humidity, females survive on average up to 3 days, larvae up to 2 days. Outside the host, the mites quickly lose water and flatten; they remain viable in physiological saline for up to 3 weeks. Consequently, the cause of death outside the host is not starvation, but moisture deficiency. It is significant that in moistened skin pieces at a temperature of 35°C, females are viable for only 3 days.

It has been experimentally established that outside the host, females lose their infectivity (the ability to penetrate the skin) much earlier than they become immobilized. This happens already on the 2nd day of the experiment. Therefore, the stay of mites on the surface of human skin is limited in time. The females planted on the skin penetrate into it within 1 hour, the larvae - a few minutes. In an animal experiment, it has been established that ticks are attracted by the smell and warmth of the host, as well as by an increased content of carbon dioxide, but from a limited distance - about 6 cm. This explains the main route of scabies infection - close bodily contact while staying in bed together in the evening and at night. . Eggs of scabies mites can get on the surface of the skin and into the external environment when combing the moves. It has been experimentally proven that, regardless of humidity, embryogenesis outside the host continues until the formation of larvae, but the critical moment is their hatching, i.e., the invasive value of eggs in the epidemiology of scabies is minimal.

Rice. 2
The content of the itch

The highest incidence and abundance of itch moves on the hands (96% and 10.5, respectively), significant on the wrists (59% and 2), genitals of men (49% and 2) and feet (29% and 1). In other parts of the skin, the passages are much less common. ( Fig.3). Typical moves are confined to the hands, wrists and feet, which, in human scabies, is obviously the original norm.

Rice. 3
The frequency of itch moves on the patient's body

The formation of severely itchy lenticular papules (up to 1 cm in diameter) with approaches is observed on the trunk and genitals of men. This usually occurs with a widespread process and a large number of ticks. In this case, the egg production of the female almost doubles during the passage, the mortality of embryos and larvae ready for hatching increases significantly, the passages are clogged with accumulation of excrement and empty egg membranes. In most cases, after a complete therapy, such papules persist for a long time, which was the reason to call them postscabious lymphoplasia of the skin. Essentially, such lipoplasia is scabious, as it occurs during illness. (rice. four). Scabious lymphoplasia of the skin is detected in almost half of the patients, it predominates on the scrotum, penis, buttocks, elbows, and is less common on the mammary glands, in the axillary areas, and on the abdomen. Histological examination of the dermis reveals a perivascular infiltrate of lymphocytes, histiocytes, eosinophils, and vascular overflow with blood. Biopsy specimens before and after treatment differ only in the presence or absence of mites in the epidermis. The duration of persistence of scabious lymphoplasia usually correlates with the number of such papules and does not depend on localization. Scraping of the course significantly accelerates its resolution. In cases of reinvasion, there is a recurrence of scabious lymphoplasia in old places without a course, which confirms its immunoallergic genesis and is an important diagnostic criterion for re-infection with scabies.

Rice. four
Scabious lymphoplasia of the skin of the wrist

Rice. 5
Typical scabies: burrows, vesicles, papules, bloody crusts, scratching

In addition to itch moves, clinical manifestations uncomplicated scabies are characterized by the appearance of papules, vesicles, scratching and bloody crusts (rice. 5, 6). Immature stages of development of the scabies mite (larvae, nymphs), as well as their molted skins, are found only in 1/3 of papules and vesicles. This is direct evidence that only part of them is due to the direct presence of the pathogen, the rest arise as a result allergic reaction organism on the tick and its waste products. Papules with scabies are characterized by a follicular location, small sizes (up to 2 mm), often the presence of microvesicles on the surface. Papules are more often localized on the anterior-lateral surface of the body, flexion surface upper limbs, anterointernal thighs and buttocks. Vesicles are usually small in size (up to 3 mm), without signs of inflammation, located in isolation, mainly near the passages on the hands, less often on the wrists and feet. The discrepancy between the localization of papules and burrows and the similar location of the latter and vesicles should be taken into account when diagnosing the disease.

Rice. 6.
Scabies elements of the skin of the body.

Scabies is characterized by several symptoms: Ardi (the presence of pustules and purulent crusts on the elbows and in their circumference) (rice. 7), Gorchakov (presence of bloody crusts there), Michaelis (presence of bloody crusts and impetiginous rashes in the intergluteal fold with the transition to the sacrum), Cesari (detection of scabies in the form of an elevation during their palpation).

There are several clinical varieties of scabies: typical, without moves, Norwegian, scabies "clean", or scabies "incognito", complicated scabies, scabious lymphoplasia of the skin, pseudosarcoptic mange (Table 1).

The typical scabies predominates. It develops when infected by fertilized females, almost always with close bodily contact, more often in bed in the evening and at night. Patients have manifestations of the reproductive (various variants of scabies) and metamorphic (follicular papules and non-inflammatory vesicles) parts of the life cycle, as well as scratching and bloody crusts as a result of human activity with excruciating itching. Rashes are localized in places typical for scabies.

Rice. eight.
Norwegian scabies of the skin of the buttocks, thighs, elbows.

Scabies without moves is rare. It is detected mainly during the active examination of persons who have been in contact with patients with scabies. The reason for its occurrence is infection with larvae, for the transformation of which into adult females capable of making passages and laying eggs, it takes 2 weeks. This period of time determines the duration of the existence of scabies without moves. The clinical picture of the disease is characterized by the presence of single follicular papules on the trunk and non-inflammatory vesicles on the hands, more often on the lateral surfaces of the fingers and in the interdigital folds. There are no moves.

Norwegian (crustal, crustose) scabies is an extremely rare form of the disease. The main reason for its occurrence is the elimination of itching as a protective reaction of the human body to the unhindered reproduction of scabies mites. It is no coincidence that Norwegian scabies was first described in 1847 by Danielson and Beck in patients with leprosy. About 150 cases of Norwegian scabies are presented in modern literature. It is observed against the background of immunodeficiencies and immunosuppressive conditions, with prolonged use of hormonal and cytostatic drugs, with impaired peripheral sensitivity (leprosy, syringomyelia, paralysis, dorsal tabes), constitutional anomalies of keratinization. Everything lately more cases Norwegian scabies has been described in HIV-infected patients. Errors in the diagnosis of scabies with the appointment of antihistamines, desensitizing and corticosteroid drugs also lead to Norwegian scabies. The main symptoms of the disease are massive crusts, scabies, polymorphic rashes (papules, vesicles, pustules) and erythroderma. Dirty yellow or brown-black crusts with a thickness of several millimeters to 2-3 cm predominate, in some places resembling a solid horny shell, which restricts movement and makes them painful (rice. 8, 9). Between the layers of crusts and under them, a huge number of scabies mites are found. When they are removed, extensive weeping erosive surfaces are exposed. On the hands and feet - countless itch moves. Palmar-plantar hyperkeratosis is pronounced. Nails are thickened, deformed. The disease is often accompanied by secondary pyoderma and polyadenitis. Norwegian scabies is very contagious, local epidemics often occur around the patient, while typical scabies develop in contact persons.

Fig 9.
Norwegian scabies of the skin of the ankle joints.

Scabies "clean", or scabies "incognito", is detected exclusively in people who often wash themselves at home or by the nature of their production activities (athletes, workers in hot, dusty shops), especially in the evening. In this case, most of the scabies mite population is mechanically removed from the patient's body. The clinic of the disease corresponds to typical scabies with minimal manifestations: scabies are single, always whitish in color, follicular papules predominate on the anterior surface of the body. Contact with substances that have an acaricidal effect (gasoline, kerosene, diesel fuel, tar, turpentine, etc.), as well as disinfectants, is not the cause of "clean" scabies. In this case, itch moves move to the feet, elbows, genitals of men, and follicular papules are abundant, scabious lymphoplasia of the skin is often found.

Complications often mask the true clinical picture scabies, often leading to diagnostic errors. The most common complications are pyoderma and dermatitis, less common are microbial eczema and urticaria. Pyoderma develops as a result of the introduction of microbial flora through skin lesions caused by scratching during itching. There are indications of a decrease in the pH of the skin, especially at the sites of localization of scabies, and the level of urocanic acid in the skin, which correlates with the intensity of itching, the duration of the disease and the prevalence of the skin process (D. X. Abdieva, 1987). Among the clinical varieties of pyoderma, staphylococcal impetigo, ostiofolliculitis and deep folliculitis are most common, less often boils, ecthyma vulgaris (rice. ten). It is significant that impetiginous rashes predominate on the hands, wrists and feet, i.e., in places of favorite localization of scabies, and ostiofolliculitis and deep folliculitis are almost always confined to the location of rashes of the metamorphic part of the life cycle (stomach, chest, thighs, buttocks) .

Rice. ten.
Scabies complicated by pyoderma.

Allergic dermatitis in scabies in most cases is due to sensitization of the body to the tick and its waste products. Interesting information about the presence of common antigens in scabies mites and house dust mites (Dermatophagoides), which are widespread in everyday life and cause such allergic diseases, how bronchial asthma, atopic dermatitis, etc. (L. G. Arlian et al., 1987). These mites can create a sensitization background that causes severe itching and allergic dermatitis. Often the latter occurs a second time as a result of irrational therapy with anti-scabies drugs.

Complications of scabies include damage to the nail plates. This pathology with typical scabies is rarely observed, mainly in infants. The nail plates become thinner, become dirty gray in color, the free edge cracks, exfoliates from the nail bed, and the eponychium becomes inflamed. Scabies mites are found in the scraping of the horny masses from the surface of the nail plates. Complications of scabies are described in the form of panaritium, erysipelas, glomerulonephritis, orchiepididymitis, pneumonia, internal abscesses, septicemia.

Scabious lymphoplasia of the skin is essentially not a complication or nodular variety of scabies, as previously thought. It represents a special variant of the scabies course (see above), localized mainly on the skin of the trunk and genitals of men with widespread scabies. It is most likely that the cause of its occurrence is a special predisposition of the skin to respond to the stimulus with reactive hyperplasia of the lymphoid tissue in the places of its greatest accumulation (N. S. Potekaev et al., 1979).

Pseudosarcoptic mange, as already mentioned, is a disease that occurs in humans when infected with scabies mites from animals. They can be dogs, pigs, horses, camels, deer, sheep, goats, rabbits, foxes, etc. Dogs are the most common sources of infection, especially in children. Even small epidemics of pseudosarcoptic mange have been described. The disease is characterized by a very short incubation period (several hours), the absence of scabies, since ticks do not multiply on an unusual host. Ticks sting, causing intense itching. Rashes are represented by urticarial and pruriginous papules, papulo-vesicles and blisters, localized mainly in open areas of the skin. The disease is not transmitted from person to person. When the source is removed, self-healing may occur.

Of considerable interest to the clinician are the features of the course of scabies against the background of a number of dermatoses. With a combination of scabies with frinoderma, xeroderma and ichthyosis, itch moves are single even with a long prescription of the disease. With hyperhidrosis of the hands and feet, on the contrary, their number is almost twice as high as usual. In the presence of dyshidrotic and intertriginous epidermophytosis of the feet in large numbers, there are exudative morphological elements on the hands and feet (vesicles, blisters, pustules). It is very significant that after anti-scabies therapy, exacerbation of the process on the hands is often observed according to the type of vesicular and vesicobullous epidermophytides. Against the background of psoriasis, atopic dermatitis, red lichen planus rashes characteristic of the metamorphic part of the life cycle of the scabies mite are masked by manifestations of chronic dermatosis, but scabies in typical places are quite well defined. There are cases when the clinical manifestations of scabies mimic pruritus, mastocytosis, Dühring's herpetiform dermatitis.

The variety of clinical manifestations in scabies requires in all cases a diagnosis based on the presence of the pathogen. There are several methods laboratory diagnostics scabies: extraction of a tick with a needle, thin sections of the epidermis with a sharp razor or eye scissors, scraping of pathological material with a scalpel or a sharp eye spoon using alkali or lactic acid. The first and last methods are generally accepted in our country. The method of extracting the tick with a needle is very fast and effective if the doctor has sufficient skill in detecting the passage and extracting the female tick from it. The blind end of the passage is opened with a needle at the site of a brownish dotted elevation corresponding to the localization of the female scabies mite (rice. eleven). The tip of the needle is advanced in the direction of travel, making an attempt to bring the tick out, with its suction cups it attaches to the needle and is easily removed. The resulting tick is placed on a glass slide in 1 drop of water, 10% alkali or 40% lactic acid, covered with a coverslip and microcopied. This method unsuitable for extracting mites from old destroyed passages, papules and vesicles, as well as after treating the patient with any anti-scabies drug.

Scraping methods make it possible to detect not only the female tick, but also eggs, egg shells, larvae, nymphs, tick skins, excrement, which is important in diagnosis. In our country, the scraping method is used using 40% LACTIC ACID. With a glass rod OR an eye spoon, 1 drop of lactic acid is applied to the scabies, papule, vesicle or crust. After 5 minutes, the loosened epidermis is scraped off with a sharp eye spoon until blood appears, capturing the area on the border of healthy and affected skin. The resulting material is transferred to a glass slide in 1 drop of the same lactic acid, covered with a coverslip and microscoped. The method is convenient in that lactic acid is used both as a means of loosening the epidermis before scraping and preventing it from crumbling, and as a substance that brightens and fixes the material for microscopy. It does not have an irritating effect, and its bactericidal properties prevent the development of pyogenic complications at the sites of scrapings. Drugs in lactic acid, unlike alkali, do not crystallize, which allows them to be stored indefinitely. long time and use as teaching aids. The method is distinguished by the speed and reliability of the diagnosis of the disease.

Rice. eleven.
Taking material for examination under a microscope,

The success of laboratory diagnosis of scabies largely depends on the ability of a doctor or laboratory technician to detect scabies. Visually, many of them are difficult to detect, therefore, staining of suspicious rashes with an alcohol solution of iodine, aniline dyes, ink or ink is used to identify them. The dye penetrates into the stratum corneum of the epidermis through holes in the roof of the passage made by the females in the places of the egg knees to release the hatched larvae. The remains of the dye are removed with cotton wool moistened with alcohol. | The course is well contoured in the form of a dark line. | Abroad, to detect scabies, a 0.1% solution of sodium fluoresceinate or a liquid tetracycline preparation, topicycline, are used, which are capable of fluorescing in a yellowish-greenish color under a fluorescent lamp.

In accordance with the groupings of people in society and their invasive contact, due to lifestyle, there may be foci of scabies of several types: family and in groups of various structures. The family focus is the leading one in the epidemiology of scabies, since the family is the most invasive-contact, numerous, long-term form of association of people in society. Invasive contact is determined by the ability to realize the transmission of the pathogen at night with close bodily contact, more often in bed. Radiating foci predominate among family foci (2/3), their number increases with the duration of the disease at the source. From the elementary population introduced by 1 patient, other family members are infected, on which their own elementary populations are formed over time. According to the epidemiological anamnesis, in the overwhelming majority of cases, the pathogen is introduced into the family by one of its members (more than 90%), less often by a relative or acquaintance who does not live in the family.

More than half of the primary sources of the family hearth is the age group from 17 to 35 years old, according to marital status - children different ages and husbands. Their infection in all cases occurs directly, including in half - through sexual contact. Thus, the carriers of scabies in the family are the most mobile and socially active contingent of the population.

Extrafocal cases of infection with scabies in baths, trains, hotels are rare. They are implemented indirectly with sequential contact of a stream of people with objects (bedding, toilet items), on which the pathogen may remain for some time, which is referred to as transient invasion.

Among the population there is a regular distribution of the incidence of scabies by contingent. There are certain risk groups. The coefficient of the latter is determined by the ratio of the extensive morbidity rate of each contingent to that of the general morbidity. By age groups, from year to year, the 1st place is occupied by adolescence (risk coefficient 2.7-3.5). Making up only 1/10 of the population, this contingent takes on 1/3-1/4 of the entire incidence. 2nd - traditionally school (1.5-2), 3rd - preschool (1.2-1.3), 4th - mature (1 - 1.1) age. The incidence of earlier and later age is negligible. In terms of the incidence of scabies in general, no relationship with gender was found. However, there are differences in different age groups: up to 17 years of age, female representatives are somewhat more likely to get sick (1.2), 17-21 years old - equally, G 35 - more often men (1.4), women predominate in older groups (1.2). 6-1.8). This reflects the change in the invasive contact of the sexes with age. It is significant that in scabies, the distribution of incidence according to social groups consistent with age. The highest incidence among students of technical schools, universities, students of vocational schools (2-3.2), lower - among schoolchildren (1.7), then - preschoolers, similarly organized and unorganized (1.2-1.3). Workers and employees, pensioners get sick less often (0.2-0.8). Thus, each age-social group has its share of participation in the epidemic process in scabies. In all cases, infection in the family prevails, but with age, the possibilities and conditions for infection in other places expand. So, infants become infected exclusively in their own family, preschoolers - and in other families, often related, as well as groups with a round-the-clock stay. At school age, groups outside the family are added (apartments of friends, acquaintances, boarding schools, hostels, etc.), and then sexual contacts. In adolescence, invasive contact is the highest - family, collective, random sexual. With the onset of maturity, the incidence decreases and the proportion of the family focus increases.

Treatment scabies is aimed at the destruction of the pathogen with the help of acaricidal drugs. Their arsenal is significant. Basic requirements for anti-scabies: speed and reliability therapeutic effect, lack of irritating effect on the skin and contraindications to the appointment, ease of preparation and use, stability during long-term storage, availability for mass use, hygiene and low cost. In our country we use sulfuric ointment, sodium hyposulfite with hydrochloric acid (method of Prof. M. P. Demyanovich), benzyl benzoate, spregal (tab. 2). However, not all drugs meet these requirements.

Sulfur ointment, as the most cheap drug, is used most often. For the treatment of adults, a concentration of 20% is optimal, for children - 10%. The ointment is rubbed into the entire skin daily at night for 5-7 days. On the 6th or 8th day, the patient washes and changes underwear and bed linen. Disadvantages of the ointment: the duration of the course of treatment, an unpleasant odor, the frequent development of dermatitis, soiling of linen.

The method of MP Demyanovich is based on the acaricidal action of sulfur and sulfur dioxide, which are released during the interaction of sodium hyposulfite with hydrochloric acid. Of the 5 modifications proposed by the author, the 3rd is currently used. To this end in! the skin is sequentially rubbed with 60% sodium hyposulfite solution (liquid No. 1) and 6% hydrochloric acid solution (liquid No. 2). For the treatment of children, lower concentrations are used - 40% (No. 1) and 4% (No. 2), respectively. Sodium hyposulfite is rubbed into the entire skin twice with an interval of 10 minutes to dry. In this case, crystals of the drug form on the skin. Hydrochloric acid begins to rub in 10 minutes. The procedure is repeated 3 times with an interval of 5 minutes. The total duration of the method is about 1 hour, and the duration of the course is no more than 3 days. It is essential that both solutions are poured into handfuls as needed. Hands treated with hyposulfite should not be immersed in hydrochloric acid, since in this case the chemical reaction does not occur on the skin, but in an appropriate container. Washing the patient and changing underwear and bed linen are carried out on the 4th day. When treating children, vigorous rubbing should not be carried out; and children infancy skin is better to lubricate.

Sulfur, as an active principle, is part of many anti-scabies preparations that have long been used in dermatology. These are the sulfur-soap balls of Yablenik, Dyakov's sulfur soap, sulfur-mercury ointment, sulfur talker, polysulfide liniment and others that are currently used occasionally.

Benzyl benzoate is one of the most effective anti-scabies drugs used since 1900. In medical practice, it is used in the form of various dosage forms prepared ex tempore or industrially. In our country, this is a water-soap suspension and an emulsion ointment, abroad - soap-alcohol solutions ("Ascabiol" and "Bep-zoseptol"), oil suspensions ("Novoscabiol"), aqueous solutions with the addition of DDT and anesthesin ("Nbin" ). It has been experimentally proven that after a single treatment with benzyl benzoate, all active stages (females, males, larvae, nymphs), as well as eggs with embryos, die. Formed larvae in egg shells are resistant to the drug. Upon incubation in an aqueous hanging drop of such eggs obtained from scabies after a 2-day course of benzyl benzoate therapy, the fact of hatching and sufficient activity of the larvae was established. In other words, the stability of the larvae during their stay in the egg shells can cause an exacerbation of the disease if the 2nd treatment is carried out after the 1st, which occurs during a 2-day course of therapy.

Taking into account the maximum residence time of the formed larvae in the egg (58 hours), an etiologically substantiated scheme for the treatment of scabies with benzyl benzoate was proposed. 10% (children) and 20% (adults) water-soap suspension or benzyl benzoate ointment is carefully rubbed by hand once a day at night on the 1st and 4th day of the course. Washing and changing underwear and bed linen is recommended on the 5th day. The 2nd and 3rd day of the course is successfully used to treat complications associated with scabies. Burning, sometimes significant, that occurs after rubbing in benzyl benzoate, stops spontaneously after 30 minutes. For the death of the active stages of ticks and embryos, an 8-10-hour exposure of the drug is sufficient. Therefore, in the morning the sick can wash. Daily use of the drug for 4 days is impractical, since, without guaranteeing the death of larvae in the egg, it increases the cost of treatment and contributes to the more frequent development of allergic contact dermatitis.

C ppega l - one of modern drugs proposed for the treatment of scabies. Its active principle is esdepalethria, a neurotoxic poison for insects that disrupts the cation exchange of membranes. nerve cells. The 2nd component - piperonyl butoxide - enhances the effect of esdepaletrin. The drug is sprayed overnight on the entire surface of the body, except for the face and scalp, from a distance of 20-30 cm from the surface of the skin. Spregal is especially carefully rubbed into the places of favorite localization of scabies (hands, wrists, feet, elbows). When rashes are localized on the face, they are treated with a cotton swab moistened with the preparation. When treating children with a napkin, the mouth and nose are closed. After 12 hours, wash thoroughly with soap.

Lindane (yakutin, gamexan, lorexan) is most often used to treat scabies abroad. Its active principle is the J-isomer of hexachlorocyclohexane. Used in the form of a 1% ointment, cream, lotion, shampoo, powder. Apply for 6-24 hours, then wash off. Given the toxicity of the drug, it must be used strictly in accordance with the instructions. It is not recommended for children, pregnant women, lactating women, as well as patients with concomitant eczema, atopic dermatitis due to increased resorption of the drug and possible exacerbation of the underlying disease. Cases of epileptic seizures and aplastic anemia have been described after treatment with lindane.

Crotamiton (Eurax) has established itself as an effective anti-scabies and anti-itch drug that does not cause adverse reactions. Indicated for the treatment of children and pregnant women. It is used as a 10% cream, ointment and lotion. The drug is applied twice with an interval of 24 hours or four times after 12 hours for 2 days.

Permethrin in the form of a 5% cream is rubbed into the skin and washed off after 8 hours.

Less commonly, other drugs are used to treat scabies: thiabendazole, diethylcarbamazine, mono-sulfiram (tetmosol), phenothrin, tenutex.

Exist general principles treatment of patients with scabies, regardless of the selected anti-scabies drug:

1) treatment of patients identified in one focus should be carried out simultaneously in order to avoid reinvasion; 2) rubbing anti-scabies preparations in children under 3 years of age is carried out in the entire skin, in the rest - the face and scalp are an exception; 3) rubbing of any drug is carried out not with a napkin or swab, but only with hands, which is due to the high number of scabies on the hands; 4) treatment should be carried out in the evening, which is associated with the nocturnal activity of the pathogen and the entry of scabicides into the intestine when the tick feeds; 5) treatment of complications is carried out simultaneously with the treatment of scabies, while it is most rational to use benzyl benzoate preparations; 6) the same drugs are best used for the treatment of pregnant women; 7) post-scabious itching after full therapy is not an indication for an additional course of specific treatment, it is regarded as a reaction of the body to a dead tick and is quickly eliminated antihistamines, steroid ointments and 5-10% eufillin ointment; 8) long-term persistent scabious lymphoplasia as a result of an immunoallergic reaction of the body does not require additional specific therapy and is not an indication for exempting children from attending a children's team; in these cases, antihistamines, presocil, indomethacin, steroid ointments under an occlusive dressing, diathermocoagulation, and laser therapy are indicated.

Control of the cure of scabies is carried out at the end of the course of treatment and after 2 weeks. With complicated scabies, post-scabious itching and scabious lymphoplasia of the skin, this period is increased individually for each patient. Experience shows that there are no relapses in scabies, and such a diagnosis is unfounded, since the scabies mite does not have latent, long-lasting stages in its life cycle, and there is also no strong immunity. The reasons for the resumption of the disease are often reinvasion from untreated contacts in the focus or outside it, as well as undertreatment of the patient due to non-compliance with treatment regimens (use of low concentrations of drugs, partial treatment of the skin, shortening the duration of therapy).

Prevention of scabies is determined by the characteristics of the pathogen and the epidemiology of the disease: transmission through close bodily contact in the evening and at night, taking into account the daily activity of the scabies mite, fragility in the external environment, short incubation period, the leading role of family foci and differentiation of groups according to their invasive contact, accounting for relevant data makes it possible to more rationally build preventive measures.

The first link in preventive work is the active identification of patients. This is carried out when preventive examinations of the population, decreed contingents, children's groups, when patients apply to polyclinics, outpatient clinics, medical units, during admission to inpatient treatment in medical institutions of any profile, when examining schoolchildren at the beginning of the school year, entering higher and secondary educational institutions, vocational schools and etc.

2nd - the establishment of foci of scabies and work to eliminate them. When identifying a patient, first of all, an epidemiological assessment of the teams in which he was located is important. So, in families with a source of infection, more than 600 are detected, in organized invasive-contact groups - about 130, non-invasive-contact - less than 10 patients per 1000 examined. Naturally, when making a diagnosis in a patient, it is necessary to find out the source of infection, contact persons and relationships with them, paying attention to sexual partners both in the family and outside it. Accordingly, the groups of people subject to mandatory preventive treatment. These are all family members and persons living with the patient in the same room. With inadequate treatment, re-invasion can occur in the focus, including cured ones. This phenomenon in foreign literature is called "ping-pong infection". Re-infection in the focus is often regarded by doctors as a relapse of the disease. In order to prevent it, the treatment of patients and preventive treatment of contact persons in the outbreak should be carried out simultaneously. Experience has shown that with the full treatment of patients and preventive treatment of all contact persons in the outbreak, the period of observation of the latter can be reduced to 2 weeks. At the same time, the timing of observation of patients should be individual. They increase in complicated scabies and scabious lymphoplasia of the skin due to its long persistence.

One of the sections of preventive work is the correct registration of patients with scabies. For each patient, an outpatient card (form 025 / U) and a notice in form 089 / U are filled out.

The criteria for a cured scabies are the elimination of itching and the disappearance of the clinical manifestations of the disease.

clinical picture. The main symptom of scabies is widespread nocturnal itching due to the activity of mites at this time of day. In addition to scratching, there are small papulovesicles and pathognomonic for the disease "scabies" in the form of small grayish, slightly elevated, straight or curved stripes with a vesicle at the end, in which the female is located. Favorite localization are areas with thin delicate skin (interdigital folds of the hands, axillary cavities, wrist folds, abdomen, penis, inner thighs, mammary glands). The skin of the face and scalp is not affected. Scabies is often complicated by pyoderma (boils, ecthymas, impetigo).

Diagnosis is based on typical symptoms, detection of scabies, detection of scabies mite in a laboratory study.

Drug therapy

Drugs of choice:

Permethrin (nittifor). Thoroughly wipe the scalp with an undiluted preparation, wait until the hair dries (do not wipe or wash). After 2-3 weeks, the hair is washed, dried and, if necessary, treated again.

– Shampoo Reed is applied to the affected areas for 10 minutes, then washed with soap or regular shampoo. Hair treatment is carried out for 10 days.

– Shampoo Anti-Bit. The hair is moistened with water, the preparation is applied and rubbed into the hair roots for 3 minutes, then washed and the procedure is repeated. Conduct a second course - just for 2 days.

– Ithaca. The lotion is applied to wet hair, rubbed in, then thoroughly washed off, applied again, wait 5 minutes, then the hair is thoroughly washed and combed out with a fine comb. The next day, the procedure is repeated. The aerosol is sprayed over the scalp 20-30 times, wait 30 minutes, then rinse thoroughly and comb out with a fine comb; the next day the procedure is repeated.

Precaution: drugs that kill lice are never used to treat eyelash lesions. Lice from eyelashes and eyebrows are usually removed with tweezers. On eyelashes, lice can be killed or weakened with plain petroleum jelly.

Current and forecast. With adequate treatment, over 90% of patients are cured. Relapses are often noted with re-infection and an incomplete course of treatment. Prevention - compliance with the rules of personal hygiene.

15. Dermatomycosis. General characteristics, classification, epidemiology. Conditionally pathogenic and pathogenic fungi. Malasseziosis (keratomycosis) - pityriasis versicolor, trichosporia. Clinic, diagnosis, treatment. Mycosis of the feet and hands. Clinic, diagnostics, epidemiology, treatment. Inguinal epidermophytosis. Trichophytosis superficial and infiltrative-suppurative. Epidemiology, clinic, diagnostics, treatment, prevention. Trichophytosis as an occupational disease of livestock breeders. Microsporia. Epidemiology, clinic, diagnostics, treatment. Favus. Epidemiology, clinic, diagnostics, treatment, prevention. Skin and mucous membrane lesions caused by yeast fungi (candidiasis). Epidemiology, pathogenetic factors. Clinic, diagnosis, prevention, treatment.

Trichophytosis (ringworm) is a fungal disease of the skin, hair and nails. There are superficial (anthroponous) and infiltrative-suppurative trichophytosis.

Superficial trichophytosis is rare, usually in children. The causative agents are anthropophilic trichophytons (T. violaceum, Tr. tonsurans), affecting the stratum corneum of the epidermis and hair (of the "endotrix" type). The source is a sick person. Infection occurs through direct contact or through hats, brushes, combs, underwear and other items. On the scalp appear isolated numerous, up to 1.5 cm in size, foci with irregular outlines and erased borders; the skin is slightly swollen and hyperemic, covered with scales. Many hairs in the foci are broken off at a level of 2-3 mm above the skin surface (“hemp”) or immediately after exiting the follicle (“black dots”); the preserved hair has a normal appearance or the appearance of thin crimped threads "running" under the scales.

On smooth skin there are edematous, sharply defined rounded spots with a sunken, pale yellow, scaly center and a raised, juicy, pink-red peripheral ridge covered with vesicles, nodules, and crusts. The spots are prone to centrifugal growth and merging with each other. Sometimes there is a slight itching. Chronic trichophytosis usually occurs in women and is characterized by numerous "black dots", foci of diffuse peeling and atrophic bald patches on the scalp; extensive erythematous-squamous spots with blurred borders on smooth skin; regular damage to vellus hair; changes in the nails (more often on the hands), which become dirty gray, deformed, "corroded" and sometimes even torn away from the bed.

Infiltrative suppurative trichophytosis. The causative agents are zoophilic trichophytons (Tr. verrucosum, Tr. mentagrophytes var. gypseum), affecting the epidermis, dermis and hair (like "ectothrix"). Sources are sick animals (cattle, especially calves; as well as mice and others), less often a sick person. The disease occurs at any age, more often in adults. It is distinguished by acute inflammatory phenomena (up to suppuration) and a cyclic course ending in complete recovery without a tendency to relapse. The predominant localization is open areas of smooth skin, the scalp, the beard and mustache area. Initially, the disease is almost indistinguishable from superficial trichophytosis of smooth skin. Then, as a result of increasing infiltration, the foci are transformed into juicy plaques and nodes, sharply demarcated from the surrounding skin. The joining suppuration leads to the formation of deep follicular abscesses, at the opening of which liquid pus is released from the gaping hair follicles, especially when pressed. Regional lymphadenitis is possible. The end result is scarring.

The diagnosis of trichophytosis should always be confirmed by microscopy and culture.

Treatment is carried out in a hospital. Inside - griseofulvin, nizoral; local iodine ointment therapy. In chronic trichophytosis, mandatory correction of general deviations; with infiltrative-suppurative trichophytosis, acute inflammatory phenomena are first eliminated. The prognosis is usually favorable.

Prevention. Isolation of sick children. Careful examination of all persons who have been in contact with the patient. Use only individual skin, nail and hair care items. Prevention of infiltrative suppurative trichophytosis is carried out jointly with the veterinary service.

FAVUS (scab) - a fungal disease of the skin, hair and nails, characterized by a long course; practically eliminated in the USSR. Pathogen - Tg. Schonleinii, affects the epidermis (usually the stratum corneum), may penetrate the dermis, possibly hematogenous spread. Contagiousness is low. The source is a sick person. Mycosis transmission occurs more often in childhood, with close and prolonged family contact. A predisposing factor is the weakening of the body as a result of chronic diseases, various kinds of intoxication, malnutrition and malnutrition. Occurs at any age.

clinical picture. The most typical scutular form. Affected hair becomes thin, dry, dull and as if dusty, but they do not break off and retain their length. A pathognomonic sign is a scutula (scutellum) - a peculiar crust of yellow-gray color with raised edges, which makes it look like a saucer; hair will come out of the center. Skutuli increase in size, merge, forming extensive foci with scalloped contours. They consist of accumulations of fungal elements, epidermal cells and fatty detritus. The "mouse" ("barn") smell emanating from the patients is characteristic. After the skutu falls off, an atrophic surface is exposed, easily gathering into small thin folds like tissue paper. - Sometimes regional lymphadenitis joins.

The squamous form of the favus of the scalp is characterized by diffuse peeling, and the impetiginoid form is characterized by a layering of crusts resembling impetiginous ones. Hair loss and outcome are the same as in scutular favus.

On smooth skin, which is rare and usually associated with head involvement, there are well-demarcated erythematous-squamous, slightly inflamed patches, usually of irregular shape, against which small scutulae may form. A purely scutular form of smooth skin lesions is possible. Cicatricial atrophy does not occur. Known damage to internal organs, leading to death. Diagnosis with scutular form is simple. In other forms, it requires laboratory confirmation.

Treatment is carried out in a hospital; inside-grise-ofulvin, nizoral; locally - iodine-ointment therapy: correction of concomitant diseases, non-specific immunotherapy.

Forecast. Without treatment, the process can proceed indefinitely; with damage to internal organs, usually bad. Prevention. Careful repeated examinations of all members of the patient's family and his environment.

MICROSPORIA - a fungal disease of the skin and hair, mainly children get angry. Distinguish between anthroponous and canthroponous microsporia. Anthroponotic microsporia is very rare in our country. Pathogens - anthropophilic 1crooporums (Microsporon ferrugineum) - affect the horny epidermis and hair; are highly contagious. The source is a sick person. Ways of transmission - direct indirect (through hats, brushes, combs, clothes, toys and other items).

Zooanthroponotic microsporia - frequent mycosis. Pathogens - zoophilic microsporums (in our country M. nis) - affect the stratum corneum and hair; in terms of contagiousness, they are inferior to anthropophilic ones. Sources are cats (especially Gyata), less often dogs. Ways of transmission - direct (main) and indirect (through objects contaminated with hair and scales containing M. canis). Relatively rarely, infection comes from a sick person. Clinical picture. Manifestations of anthroponotic ooantroponous microsporia are the same and similar to trichophytosis, in contrast to which it has ha-sterns: clearer boundaries, rounded outlines, large sizes of lesions on the scalp; taming (usually continuous) hair at the level of 6-8 mm; 1 others around the "stumps" of whitish covers; lack of black dots; on smooth skin - multiple foci; almost constant involvement of vellus hair, frequent enlargement of the neck, occipital and cervical lymph nodes. There are changes in the type of infiltrative-suppurative chophytia.

The diagnosis of microsporia must always be confirmed by legal examinations (microscopy, seeding of affected hair or skin scales). Lucent diagnostics (examination under a Wood's lamp) is important. Treatment is carried out in a hospital. The prognosis is favorable.

Prevention. Isolation of sick children; examination x of those in contact with the patient (including pets) using a Wood's lamp; capture of homeless cats and dogs.

MALASESIOSIS

Pityriasis versicolor (versus versicolor) is a fungal skin disease.

clinical picture. On the skin of the chest, back, neck, less often the shoulder girdle and scalp, small (3-5 mm in diameter) non-inflammatory yellowish-brown spots with clear uneven borders appear, scraping which reveals slight pityriasis peeling. As a result of peripheral growth, the spots increase in size and merge into large foci of the so-called geographical outlines. There are no subjective sensations. A diagnostic iodine test is used, for which the affected skin is smeared with iodine tincture and immediately wiped with alcohol: the stratum corneum loosened by the fungus quickly absorbs iodine and the spots of pityriasis versicolor stand out sharply, turning dark brown against the background of slightly yellowed unaffected skin. Under the influence of ultraviolet rays (in particular, during sunburn), as a result of peeling, unburned spots remain on the sites of former rashes - pseudoleukoderma.

Diagnosis is based on characteristic clinical symptoms and a positive iodine test. In doubtful cases, microscopic examination of skin flakes is carried out to detect the pathogen. Differential diagnosis is carried out in some cases with syphilitic roseola, which does not peel off, does not merge into solid foci, the iodine test is negative, and serological reactions to syphilis are positive, there may be other manifestations of syphilis. Pseudo-leukoderma must be differentiated from true syphilitic leukoderma, in which small rounded (0.5-1 cm) or marbled hypopigmented spots without clear boundaries are located on the slightly pigmented skin of the posterior-lateral surfaces of the neck, sometimes spreading to the skin of the back; positive serological tests and other signs of syphilis make it possible to distinguish it from pseudoleukoderma.

Treatment. Rubbing liquid Andriasyan (urotropin - 5 g, 8% solution acetic acid- 35 ml, glycerin -10 ml), 2-5% salicylic-resorcinol alcohol, Wilkinson's ointment, 10% sulfuric ointment, mycosolone, processing according to the Demyanovich method (see. Scabies) and other antifungal agents for 3-7 days, after which a general hygienic bath with soap and a washcloth is prescribed. To prevent recurrence of the disease, it is advisable to treat the entire skin. cosmetic purposes to eliminate pseudoleukoderma after antifungal treatment, ultraviolet irradiation is indicated.

TRICHOSPORIA (from Greek thríx, genus case trichos - hair and spora - sowing, seed), piedra (from Spanish piedra - stone), a fungal hair disease caused by many varieties of fungi of the genus Trichosporon; belongs to the group of keratomycosis.

It is manifested by the formation of multiple, barely noticeable, spindle-shaped hard nodules along the length of the hair, from whitish to dark brown in color, with a peculiar pungent odor; composed of fungal spores. The integrity of the hair is not violated, there are no inflammatory phenomena on the skin. With the American variety of Trichosporia, predominantly women are ill: the hair on the head is affected. The European form of Trichosporia is usually observed in men (in the area of the beard and mustache). The contagiousness of Trichosporia is low: infection is possible through a towel, headdress, comb, etc. shared with the patient. The development of Trichosporium is promoted by washing the head with a decoction of flaxseed and lubricating the hair. burdock oil, which are a nutrient medium for the pathogen.

Treatment: after shaving off the hair, the affected areas are washed with hot water and soap, wiped with a 0.1-0.2% sublimate solution. Prevention: observance of rules of personal hygiene.

CANDIDOZAS

This is a lesion of the mucous membranes, internal organs, nails, due to the exogenous introduction of fungi of the genus Candida. Candida do not form spores and true mycelium. Pseudomycelium consists of closely packed cells. They reproduce by budding and germination. Aerobes. Optimal conditions: t=30-37, pH=7.0-7.4, Sabouraud medium, MPA + glucose, beer wort. Good resistance to drying, freezing and thawing. Are sensitive to action of solution of phenol, formaldehyde, lysol, chloramine, iodites, borates, sulfates, aniline dyes. They live on the surface of the skin and mucous membranes, most of them are not pathogenic.

The source of infection is the patient acute form candidiasis. Infection by direct and indirect contact. Factors contributing to the disease: the virulence of the pathogen, the state of the macroorganism (the integrity of the skin and mucous membranes, skin contamination, the presence of chronic pathology, disorders of the central nervous system, endocrine and other systems), long-term use of antibiotics, cytostatics, glucocorticoids.

Classification:

Surface:

- mucous membranes; - skin; - nail folds and plates;

Chronic granulomatous candidiasis;

Visceral;

Secondary candidiasis;

5. Candidomilides;

CLINICAL FORMS:

Candidiasis of large skin folds- more often in childhood, combined with lesions of the mucous membranes. The skin of the inguinal, femoral, intergluteal, axillary folds is affected. The skin is hyperemic, the boundaries are clear, on the surface there are flabby gray blisters, after they are opened, smooth, shiny, moist erosion surfaces are exposed. At protracted course infiltration increases, deep painful cracks form.

Candidiasis of small skin folds neck, navel, interdigital spaces. Neck - clinical forms easier to treat, the inflammatory process and infiltration are reduced.

Candidiasis of the toes- erythema with a clear border, accompanied by itching, bubble elements and erosion appear. Wearing shoes exacerbates the process, cracks form. Sometimes the process begins with diaper rash - the lesion is covered with gray-white films, does not reach the back surface.

Interdigital candidal erosion of the hands- the process is asymmetric, more often localized on right hand between 3-4 fingers. Erythema is bright red, exfoliated epithelium along the periphery, pain appears.

Difdiagnosis with herpetic infection. With herpetic infection: - a deeper lesion; - the edges of the lesion are polycyclic; - occurs after hypothermia.

Superficial candidiasis of the trunk skin (in children)- there is no clear clinic, it may resemble a rash with scarlet fever, eczematous erythroderma. The defeat of the palms and feet - against the background of erythema, scaly foci appear in the form of garlands. The skin is yellow-brown, skin folds deepen, hyperkeratosis.

nipple candidiasis- more often in nursing mothers, if the child has thrush. The skin is pink-red to dark red, the skin is flaky with small scales.

Nail damage- starts from the posterior edge of the nail fold, when pressed, liquid pus is released, the luster is lost, destroyed, sharply painful due to edema.

Damage to the skin of the head of the penis and foreskin- in people with diabetes mellitus. Skin - red with tortuous scaly foci, white-gray coating; a shiny eroded surface is exposed, itching develops.

Chronic generalized granulomatous candidiasis- starts at early childhood with damage to the oral mucosa, then the red border, corners of the mouth, nail ridges are involved; the skin in significant areas is erythematous with scaly foci, nodular elements appear, turning into infiltrated plaques, and nodules - into tumor-like formations. Their surface is covered with a gray-yellow crust, after which the vegetation opens.

The defeat of the oral mucosa - candidal stomatitis.

Clinical forms:

1) limited lesion of the tongue - candidal glossitis: the mucous membrane of the tongue is pink-red, longitudinal and transverse stripes appear, the tongue is covered with a white-yellow coating (at first easily, then with difficulty removed with the opening of erosions), atrophy of the papillae.

2) on the mucous membrane of the gums - gingivitis, may be covered with a white coating.

3) tonsil mucosa - candidal tonsillitis, natural color, then foci of white plaque appear, which at first are easily removed.

Thrush- on the affected areas, a white coating resembles milk or semolina.

Candidal cheilitis - the skin of the red border of the lips swells, deep radial folds appear, accompanied by dryness and discomfort.

Damage to the corners of the mouth- candidal seizures - the corners are covered with a gray-white film, after peeling - erosion. The defeat of the mucous membranes of the urogenital tract - vulvovaginitis: - more often in menopause; - for those employed in the production of antibiotics; - with hormonal disorders. Severe itching appears, mucous membranes are bright red, infiltrated, dryness; the areas are shiny, smooth, a gray-white coating appears, liquid discharge with crumbly flakes.

DIAGNOSTICS. Material + 1-2 drops of 10% alkali solution. Microscopically, yeast cells, pseudomycelium, budding cells. There is no natural post-infection immunity.

TREATMENT.

1) prescribing anticandidal antibiotics: nystatin 500,000 IU 6-8 times a day, levorin 500,000 IU 3 times a day, amphoglucomide 200,000 IU 2 times a day, mycoheptin 250,000 IU 2 times a day, course 12-14 days, amphotericin B 0.2- 1 mg/kg every other day i.v. on 5% glucose, nizoral 200 mg 2 times a day for 10-14 days.

2) external therapy:

for skin lesions:

a) alcohol solutions of aniline dyes; b) Castellani liquid; c) ointments: levorin, nystatin, amphotericin, octateonic; d) nitrofungin with water 1: 1; e) clotrimazole (cream, solution);

with mucosal damage:

a) rinsing with 5% solution of drinking soda, furacillin; b) treatment with aqueous solutions of aniline dyes;

c) ointments; d) Decamine cheek tablets every 2 hours; e) 10% borax on glycerin;

with vulvovaginitis:

a) douching with KMnO4, furatsilin; b) ointments containing nystatin, levorin; c) clotrimazole (vaginal tablets). Feature: mainly internal organs, central nervous system, musculoskeletal system are affected. Distributed in the subtropics and tropics.

Contributing factors:

respiratory pathology. ways; - gastrointestinal tract pathology; - hypovitaminosis.

1.coccidioidomycosis- internal organs, bones, skin are affected. Pathogen: coccidioides imitis. Infection occurs by airborne droplets, through damaged skin and mucous membranes of the respiratory tract. After the disease - strong immunity. The incubation period is 1-6 weeks. At first, it proceeds like SARS. X-ray: foci of pneumonia, abscess formation, frequent pulmonary bleeding. After 2-3 weeks, various rashes on the skin. Around large joints in the subcutaneous fat, nodes appear, which then disintegrate, forming ulcers with undermined edges, with a bottom covered with vegetations. After resolution - rough star-shaped scars. With a long course - increase in ESR, leukocytosis, hypochromic anemia.

DIAGNOSTICS: 1) find spherules; 2) obtaining a pure culture on Sabouraud's medium; 3) obtaining an experimental model (mouse); 4) skin-allergic test (in/to coccidioidin).

TREATMENT: 1) amphotericin B drip intravenously every other day, course - 30 injections; 2) broad spectrum a/b; 3) external therapy; 4) stimulation of healing; 5) iodine preparations; 6) antihistamines.

2. Histoplasmosis (Darling's disease)- damage to the reticuloendothelial system. Pathogen: histoplasma capsulata. Infection is aerogenic, the reservoir of infection is the soil. They begin with damage to the lungs and lymph nodes, every second skin lesion: spots, nodules, nodes, erythematous-scaly foci, connecting into large infiltrates.

DIAGNOSTICS.

1) isolation of the pathogen; 2) obtaining a pure culture; 3) intravenous test with histplasmin.

3. Chromomycosis. Epidemiology has not been studied, burns, congestion, mechanical injuries contribute; localized on the lower extremities, the incubation period is from 3 weeks to several months. At the site of introduction - a pink-red tubercle with a bluish tinge, prone to peripheral growth, numerous tubercles form a single infiltrate. With rejection - an ulcer, heals very slowly, leaves a rough scar.

16. Tuberculous lupus. Scrofuloderma. Warty tuberculosis. Papulo-necrotic tuberculosis. Indurativnaya erythema Bazin. Disseminated miliary lupus of the face. Epidemiology, clinical manifestations. Luposoria. Treatment and prevention.

Tuberculous lupus(lupus vulgaris) is the most common form of skin tuberculosis.

It is characterized by the formation of specific soft tubercles (lupoms) occurring in the dermis, pink in color with clear boundaries with a diameter of 2–3 mm. The main morphological element is a tubercle (lupoma), which is an infectious granuloma. The tubercles are prone to peripheral growth and fusion with the formation of continuous foci (flat shape). With vitropressure (pressure with a glass slide), the color of the tubercle becomes yellowish (the "apple jelly" phenomenon), and when pressing on the tubercle, the bellied probe easily fails, leaving a depression in the tubercle (Pospelov's symptom). Gradually, the tubercles undergo fibrosis with the destruction of collagen and elastic fibers and the formation of cicatricial atrophy. With the exudative nature of the process and under the influence of various injuries, the tubercles can ulcerate (ulcerative form) with the formation of superficial ulcers with soft uneven edges and easily bleeding. Tumor-like, verrucous, mutilating and other forms of tuberculous lupus are also possible. The rash is usually localized on the face, but can also be on the trunk and extremities. The mucous membrane of the nasal cavity, hard and soft palate, lips, and gums are often affected. The disease is more common in women. Lupus vulgaris is characterized by a sluggish, prolonged course and may be complicated by the development of lupus carcinoma.

Scrofuloderma(collicative tuberculosis) - with hematogenous spread of mycobacteria into the skin, the disease is characterized by multiple lesions. When spreading per continuitatem, the process is most often localized in the neck, especially in the triangle under the lower jaw, on the cheeks, near the auricle, in the supraclavicular and subclavian fossae; less often - on the limbs.

Scrofuloderma in children in 80% of cases is caused by Mycobacterium bovine (M. bovis), with which the child becomes infected primarily, as a rule, when drinking infected milk. Sometimes the lungs are the primary focus of tuberculosis.

Scrofuloderma in adults and the elderly occurs due to the hematogenous introduction of mycobacteria into the skin. Lesions in these cases can appear on any part of the body, more often on the neck, chest and abdomen, in the inguinal folds, on the buttocks and tongue. There are usually many lesions.

Clinically, the disease is characterized by the appearance in the subcutaneous adipose tissue of one or more dense, clearly defined nodes, the size of a large pea or hazelnut. Gradually increasing, the nodes can reach the size of a chicken egg, solder with the surface layers of the skin, which turns bluish-red. In the future, the nodes soften and turn into cold abscesses that open with one or more holes, from which a liquid, crumbly pus is released with fragments of necrotic tissue. An increase in the perforation leads to the formation of ulcers with thinned, soft, overhanging cyanotic edges and an uneven bottom with sluggish yellowish, easily bleeding granulations. Ulcers heal slowly, leaving behind uneven scars with bridges, warty and keloid protrusions. With secondary scrofuloderma associated with lymph nodes, ulcers are deeper, penetrating into the tissue of the lymph node. After healing, a retracted, dense, uneven scar also remains. In some cases, scrofulodermal ulcers tend to grow peripherally and can reach a very large size.

Scrofuloderma is often combined with lesions of the bones and joints, as well as with active, but benign pulmonary tuberculosis, sometimes with other forms of skin tuberculosis (lupus, warty tuberculosis). Tuberculin reactions are usually positive.

The course of scrofuloderma is different; in some cases, the disease is limited to the formation of a single node and relatively quickly ends with recovery, in others, due to the appearance of new nodes, it can be delayed for months.

Differential diagnosis should be carried out with syphilitic gums, venereal lymphogranuloma, actinomycosis and deep mycoses.

Warty tuberculosis skin, as a rule, occurs as a result of exogenous infection in people in contact with the corpses of animals or people with tuberculosis (pathologists, medical workers, butchers, etc.); sometimes the disease occurs due to autoinoculation. Lesions are localized mainly on the back of the hands and fingers, less often on the feet. They can be single or multiple.

At the site of the introduction of the pathogen, a dense, painless, bluish-red papule appears on the skin, less often a pea-sized papulo-pustule (“cadaveric tubercle”). The papule gradually grows and turns into a dense, flat plaque, on the surface of which, starting from the center, warty growths and massive horny layers are formed, as a result of which the surface of the plaque becomes uneven, rough. Only on the periphery remains a purple-red border, not covered with horny layers. Sometimes new papules and plaques form near the main focus, gradually merging.

The process progresses very slowly (for years). Gradually, cicatricial atrophy forms in the center of the lesion, sometimes the lesion becomes ring-shaped or even serpiginous. The tubercles characteristic of lupus vulgaris do not develop, the symptom of "apple jelly" is negative. There are no subjective sensations. Sometimes warty tuberculosis of the skin is complicated by lymphadenitis.

The cause of verrucous tuberculosis of the skin in animals is M. bovis. The disease is usually occupational and is observed in slaughterhouse workers (“slaughter tubercle”), butchers, farmers, veterinarians. The skin lesion is localized, with marked hyperkeratosis on the surface of the lesion; the course of the disease is long.

Tubercular tuberculosis of the skin, caused by M. tuberculosis, is usually observed in medical workers who become infected during the autopsy of the corpses of patients (“cadaveric tubercle”, “postmortem tubercle”, “verruca necrogenica”). The lesion on the skin develops rapidly, is characterized by the severity of the inflammatory reaction and the rapid formation of a warty infiltrate. The skin process is often complicated by regional lymphadenitis; sometimes lymph nodes undergo caseous necrosis.

Warty tuberculosis of the skin should be differentiated from warts vulgaris, verrucous lupus vulgaris, bromoderma, pyoderma vegetans, keratoacanthoma, cancer, and blastomycosis.

Papulo-necrotic Tuberculosis occurs by the hematogenous route in young people with tuberculosis, more often girls. On the extensor surface of the limbs, on the buttocks, small nodules appear with necrosis in the center, which leave behind a depressed scar. Nodules pour out jerkily, in attacks, as a result of which you can simultaneously see rashes on different stages development.

Tuberculosis induria (Bazin's erythema induratus) is a hematogenous tuberculosis farm that more often affects young women. Localization - flexion surfaces of the legs. Deeply located nodes emanating from subcutaneous tissue, covered with purple-cyanotic skin, often located symmetrically. Opening, the nodes form sluggish, long-term non-healing ulcers.

Etiology of scabies

Thus, the tick comes to the surface twice in its life cycle. It takes 15-20 minutes for a scabies mite to penetrate under the skin, which explains the contagiousness of scabies. The female lays eggs in the first half of the day, and gnaws through passages at night, the life cycle of the scabies pathogen ranges from two weeks to two months, after which the tick dies and decomposes in the gnawed passages. The scabies mite is not resistant and at a temperature of +55 degrees it dies after 10 minutes, and at a temperature of +80 it dies instantly. Outside of a person, the tick also dies quite quickly.

Mechanism of scabies infection

Infection with scabies is possible in public places through doorknobs, stair railings, handsets. As a result, an epidemic focus is created and a person with scabies infects his environment of a domestic and professional nature. Infection with scabies can occur through sexual contact, more often a man is infected from an infected woman. The scabies mite can be on animals for a short time, so infection with scabies from animals is not excluded, although it is extremely rare. The causative agent of scabies is most active from September to December, it is at this time that they are diagnosed the largest number outbreaks of scabies. Nighttime activity poses a high risk of infection within the family when sharing a bed. The interdigital folds, wrist zones are primarily affected, and already with the development of scabies, other parts of the body are affected, except for the scalp and armpits.

Clinical manifestations of scabies

Typical form of scabies

With a typical form of scabies, rashes are localized on the abdomen in the umbilical zone, on the anterior inner surface of the thighs, on the buttocks, mammary glands, lateral surfaces of the fingers and toes, on the interdigital skin folds, in men, scabies can be localized on the skin of the scrotum and penis. Scabies looks like a whitish or grayish straight or curved line from 5 to 7 mm, slightly rising above the skin. On the face, on the skin of the palms and feet, only single rashes may appear. Scabies course is clearly visible under a magnifying glass, the end of the course with scabies ends with a small papule or vesicle. Papulovesicular elements are partially covered with dotted bloody crusts and reach sizes up to 0.5 mm.

In addition to scabies that have paired papulovesicles, there are dotted and linear scratches on the skin of a patient with scabies due to severe itching. Depending on the severity of scabies, there may be foci of pyococcal infection, which are more often found in the extensor zones. There are purulent or bloody-purulent crusts on the elbows - a symptom of Ardi.

Scabies cleanliness

Cleanliness scabies is an erased form of the disease that occurs in people who have normal immunoreactivity, as a result of which there is no allergic reaction to the presence of mites. increased attention personal hygiene, when people take a shower several times a day and change their underwear and bedding, they also contribute to the erasure of clinical manifestations in scabies. It is characterized by single rashes on the chest and around the navel, which practically do not macerate and do not cause discomfort, itching is noted only at night. Perhaps the appearance of hemorrhagic crusts.

nodular scabies

Nodular scabies occurs as a result of a delayed-type hyperergic reaction, which develops as a response to the mite's waste products. The nodular form of scabies is usually the result of untreated or improperly treated scabies. The long course of the disease, reinfestation with scabies mite contribute to the appearance of itchy reddish-brown nodules. The rash is lenticular in nature, the nodules occur under the scabies and are located in places typical for rashes. This form of scabies is resistant to various anti-scabious therapies, since due to dense crusts, medicinal substances have practically no effect on the tick.

crusted scabies

Cortical (Norwegian) form of scabies is diagnosed in rare cases in patients who have a sharply weakened immunoreactivity. Crusted scabies is the most highly contagious form, as the crusts contain the highest concentration of mites. immunodeficiency states, common diseases, in which there is a decrease in immunity and exhaustion, long-term therapy with corticosteroids, cytostatics and alcoholism contribute to the development of crusted scabies.

Clinically, crusting scabies is characterized by the presence of greyish-dirty crusts that tend to layer on top of each other. The crusts are usually of different sizes and thicknesses, tightly soldered to each other and to the underlying tissues, and are very painful when removed. After removing the crusts, yellow erosions are exposed.

The extensor surfaces, the back of the hands, elbows, knees, interdigital spaces, buttocks, abdomen, auricles, less often the face and scalp are affected. Thick hyperkeratosis develops on the palms and soles, which limits freedom of movement. If the nail plates are affected, they deform, crumble, become thickened and change color.

With inadequate treatment or its absence, scabies is complicated by pyoderma, microbial eczema and dermatitis of various nature.

Diagnosis of scabies

Aerosol preparations for the treatment of scabies are easier to use and their volume is sufficient to treat the patient and contact persons. There are aerosol preparations that can also be used to treat children. They are sprayed 20-30 cm from the skin, leaving no free areas, after 12 hours, the body and the epidemiological site are sanitized. One application is enough, but with complicated forms of scabies, the procedure is recommended to be repeated.

Lindane is a colorless, odorless cream preparation that is rubbed into the skin daily or twice a day in the treatment of scabies. Before therapy and before each treatment with lindane, it is necessary to take a shower. This method of treatment is suitable for those who are used to taking a shower or bath every day. Lindane is also available as a powder for rubbing into the skin and in the form of shampoos. However, it is better for children and women during pregnancy and lactation to use a special gel.

Treatment of the cortical form of scabies has several features. Before antiscabiosis therapy, it is necessary to soften the crusts and remove them. Soap-soda baths and keratolytic ointments are usually used. After complete rejection of the crusts, the treatment is carried out according to the usual scheme, the courses are repeated until a complete cure. In addition, the underlying disease is corrected, which caused a weakening of the body's reactivity.

Prevention of scabies consists in the timely elimination of epidemiological foci, the appointment of preventive therapy. Regular examination of children in preschool and educational institutions and personal hygiene significantly reduce, but do not exclude infection with scabies.