4 курс / Дерматовенерология / Dermatologia_i_venerologia_KGMU_g_Simferopol_2012_g
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12.Ha np11eM K upaqy 06panu1ca 6onl>HOti: E. 36 neT c )KaJI06aMH Ha BbICbIIIaHHJI Ha pa3rn6aTeJlbHbIX nouepXHOCTHX KOHetIHOCTeft, 3J,D;, 60J1b B o6nacrn npauoro nyqe3a11.Hcrnoro cycraBa, Me)K¢anaHrOBbIX KHC·· TeH, l13MeHeHH.H HOITeBbIX nnaCTHHOK pyK. BoneH OKOlIO 5 neT, 1corp;a BnepBbie oceHbJO Ha KO)Ke JlOKTeBblX cycraBOB ITOHBHJJJ1Cb BblCbIUa-
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l. KaKOB Barn rrpe;:i;nono~bllblIii IJ;""1arH0 3? c ""~ 0-,y """,,., e(, ~
2. CocraBbTe nnaH o6cn.e;:i;o!laHl1.ll',neqeH11SI 11 BTopwnro"lii npocpIDiaKTlil(l1.
rp1116KOBble nopa>KeHMH KO>KM M cnM3MCTblX o6ono'-!eK
fpH6ICOBbie rropaJKeHHSI KO:>KM .HBAfIIOTC.H OAHHMH H3 caMblX
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Ke spaqa ,a;epMaTOJ\Ora.
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K.naccucpuK.ayust A. M. Apueeutta u H. JI.. IIIeK.Jta»eoea:
1.KepaTOMHK03bl -
•pa3HOTJ,BeTHbIB muuaw ( OTpy6eBt1,IJ;HbI"Ci.),
•3pttTPa3Ma.
2.P,e pMaTOMMK03bI -
•::inJ1)J.epM0¢11nrn naxona51,
•3 nlil:)J.epMocfJHTI1H cron,
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•TJH1xoqnrr1/ffi (aHTponoH03Hasi:, 300H03Hasi:),
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3.KaHJJ;H,!l:03bI (noBepxHOCTHbrCi:, xpo1;rn.-crecK11:l1:, r eHepanMJoBaJ-IHbrCi:, Bl1C- n.epanbHbn1:).
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Pa3HOU.BeTHlbIM (oTpy6eBH,llHhIH) ABwaii OTHOCHTC51 K rpynne KepaTOMHK030B, npH KOTOpblX rpH6b ! nopruKaIOT TO/\bKO po-
roBOH C/\OH 3nH,n.epMHCa H BOAOCbI. KoHTartto3HOCTh 3a60AeBaH1rn
BbipruKeHa He3Ha"IHTeAhHO. Bo36y.zv;rTeAb - |
Pityrosporum orbiculare |
- .HB/\51eTC51 y cAOBHO-naTOreHHhlM rpH60M , |
o6HTa51 Ha KO:iKe y KruK,ll:O- |
ro 'ie/\OBeKaH npH onpeAeAeHHblX YCAOBirnx, MO:>KeT B b 13BaT b 3a6oAeBaHHe. K TaKHM Y CAOBH.HM OTHOC51TC.H: 3K30reHHbie cpaKTOpbl, CB.H- 3aHHbie c yBeAH'tJeHHeM IlOTOOTAeAeHH.H, neperp eBaHHeM, rrepeOX/\IDKAeHHeM, H 3HAOreHHbie cpaKTOpbl, CB.H3aHHble c 3a60AeBaHJiHlMH, npH KOTOpbIX HMeeTC51 H3MeHeHHe pH KO:>KH H CHC'I"eMblHMMYHHTeT a.
KnuHu1tecKasi. KapmuHa. BbICbIDHOH 3AeMeHT - naTHO
:>Ke/\TO-KOpH"IHeBOH OKpacKM c "leTKHMH rpaHHIJ,aMH. CKAOHHOe K ne - pHcpepH"IeCKOMJ pOC'ly, co CAerKa ure.1wIIIaru;e:Hc.H nose p XHOCTblO (~1e
IUYHKH HanoMHHaIOT oTpy6tt, OTCIOAa H Ha3sam-i e 3a60AesaHHSI). AoKaAH3aIJ,HSI: 3a.LI.H51.H l10BepXHOCTb meH, CITHI-Ia, IlOAMbIUle"llibie snaAHHbI, o6AaCTh l'PYAH. IlOAO:>KHTe/\bHblH CHMilTOM CTpJ:>KK.lit:: npH no - CKa6/\HBaHHH noBe p XHOCTH IUl:THa porOBbie 'ielllyHKH CHHMaJOTC.H B
BHAe crpJJKKH. Bo3MO:>KHO pacnpocTpaHeHHOe nopIDKem-1e. CyfueKTHBHbre CHMDTOMhI OTCyTCTBYIOT, npo6a baAbIJ,epa IlOJ\.O:>KHTe/\bHaSI. T e'ieI-rne3a60Aesam·rn xpoHH'tJecKoe. XapaKTepHbipeU.HAHBbI. A eToM DOA AeHCTDHeM HHC0/\51L(HH BbICbIIlaHH.H Ha rAaAKOH'KO:li<e perpeccH - pyroT, OCTaBJUISI IlOCAe ce6.a oT~1eT/\HBO BblAe/\511-0UJ;HeC.H r11rronHrMeI-I - THpOBaHHble ITSITHa He3aropeBUieH KO:>KH (nocrnapa3HTapHa51 /\CHKOAepMa ) .
11punyunt>i mepanuu. IlpH pacnpocTpaHeHI-IbIX cpopMax 11cnOAb3YJOT 06ru;y1-0 cpyHrHI.J,HAHYIO TepanHI-O. Ae'ieHI1enpoBO.LI.HT AO 11c- "le3HOBeHH.H KAHHH"leCKHX npo.HBAeHHH. Hapy:iKHo npHMeH.HJOT onueAYlllHBaJOUJ;He cpeACTBa H cpyr-ir HL(HAHble npenapaTbl (3-5 % Cai\.HL(H- /\OBblH cnHpT, 3-5 % HaCTOHKJ HOAa, HHTpOcpYJ-il'HH, KAOTpHM a30A). 06.H3aTei\.bHa .n.e3HHcpeKL(H.H 6eA.hlr H OAe:>KAbI.
3pHTpa3Ma (B036y.LIHTeAb - Corynebacter ia min utissimum) pacnoAaraeTc.H a a epxHHX OT,LI.eAax poroaoro c1w.H 3nH,LI.ep.Mnca, p a3-
86
BHBaeTCSI B KpyIIHbIX CKll.a,JJ.Kax KO:>KH IIpH HepaU.HOHaAhHOM pe:>KHMe, HaAK'iHHIIOTAHBOCTH.
KnuHurca. IIpoSIBAfleTC.H ITSITHaMH :>KeATOBaTo-6yporo, KpacHO- KHpIIWIHoro RAH KpaCH0-6ypo . l.l;BeTa, p acnoAaraIOIII.HMHCSI n peHMyw.eCTBeHHO B naxoso-6e.n:peHHblX CK1\a,n:Kax, a TaK:>Ke" no.n: MOJl.O'I- Hb!MH :>Ke11.e3aMH RAH B fIOJJ:MbIUie 'IHb!X0611.aCTSIX. IlSITHa KpyrIHh!e, CJl.HBHbie, MOryT HMeTb OTCeBbl no nepmpepHH, x a p aKTepHbl TIOAH-
U.HKJl.H'-leCKHeO'iepTaHHSI. 3pHTpa3 Ma MO:lKe T OCAO:lKHSITbCSI 3K3eMa.TH-
3au,11 e H:, onpe11.0CTbIO. B 3THX CJl.Y'!aSIX B03HHKaIOT cy6'beKTHBHbie
ow.yw.eHHSI 3y,n:a, )K)KeHHSI, KOTOpbie n pH HeOC/\.O:lKHeHHOH 3pHTpa3Me OTCyTCTBYJOT. .[lHarHOCTHKa OCHOBaHa Ha K/\.HHH'IeCKOHCHMUTOMaTHKe H xapaKT e pHOH 11.0KaJl.H3aU.HH .
Jle1teHue. Y<iaCTKH nopa:>KeHHH o6pa6aTbIBalOT 2-3 pa3a s ,n:eHb 8.HTH<pyurHU.HJl.HblMH paCTBOpaMH c noc11.e.n:yJOIIJ.HM HaAO:lKe HHe M
aHTHcPJHrHU.HJJ:HhIX Ma3eH.
Ilaxoeas 3llH,llepMOcl>HTHH Bb!3bIBaeTCH naToreHHbIM rpH-
6oM H3 po.n:a Epidermaphyton. Bo11.emT npe HMYIII.eCTBeHHO MJ:lK'IHHbI. Bo3HHKHOBeumo 3a6011.eB aHHSI cnoco6CTBJIQT noBbIIIIeuHoe noTooT,ue- 11.e1-me , HapymeHHe yrAeBo,n:Horo o6MeHa, noBbIIIIe HHaSI TeMnepaTypa OK))Y)KaJOIII.eH cpe,n:bI. 3aproKeHHe II))OHCXOJJ:HT 11.H60 npH Henocpe,l(CT- B eHHOM KOHTaKTe c 6011.bHbIMH , AH 6 0 B MeCTax o6rn.ecrseHHOro HOJl.b- 3 088.HHSI (6 a HH, CaYffbI, .n:yIIIeBbie).
KnuHUKa. T HIIH"l:HOH AOKaAH3aU.HeH BbICb!IIaHHH npH naxo-
BOH 3fIH,ll.epMOcpHTHH SIBAfleTC.H KO:>Ka n axoBbIX CKAa,JJ.OK, Me}K'bSII'O-
.UH'IHOH 0911.acTH, MOJl.O'IHbIX :>KeA<~3. Mopcpo11.orH<iecKHM 3AeMeHTOM
.HBM!JOTCSI b cTp OBOCIIaAHTC/\.bHble IISITHa, 'IeTKO OTrpaHH'IeHHbie, OK-
pyr11.0H. cpopMbI, p030B OM OKpacKH. flpH CJl.HHHHH OHH o6pa3 0Bb!Ba!QT O'IarHII011.HU.HK1\H'IeCKHX O'IepTaHHHc xopOUIO Bblpa:>KeHHb!M CIIll.OUIHb!M OTC'lHblMn e pHcpepWieCKHM Ba.AHKOM, Ha KOTO))OM o6pa3yIOTCSI IIJ3b!pbKH, MHKponyc1yll.bI, 3p03HH, KOpO'IKH, 'IClllyHKH HHOl',Ua c MOKHYTHeM, HM.HTHPYJOIL(HM 3K3eMy. B u.eHTpe oqaros Ha.611.JO,u;aeTCSI pa3peUieRH e naT011.orWiec Koro npou.ecca , Uie11.yUieHHe. Cy6'beKTHBHO OTMe<iaeTC5l CHJ\.bHblH 3y,u. 3a6011.eBaHHe MO:lKeT n pHHSITb x pOHH'-leCKOe Te<:1eH H e c o6oCTpeHHeM s AeTHee speMSI ro,ua.
,l(uazHOCmUKa OCHOBb!B8.eTC.H Ha xapaKTepHOH KAHHH'-IeCKOH Kap THHe H o6Ha p)':lKeHHHB '!eUiyHKaxKOJKH c oqaros nopa:>Ke HHSI H HOr T e Bb!X IIAaCTHHOK MHU.eAHSI.
Jleitettue:
•MeCTHoe - aHT11cpyttrl1QMAHLie rrpenapaThI B BM;D.e pacwopoa, Ma3eH 11 KpeMoB;
87
•o6rn;ee Jieqei-rn:e - cucreMHbre rrponmorptt6KoBbie npenapaThI.
MHK03 CTOIJ OTHOCHTCSI K ,n:epMaTOlPHTHSIM - rpn6KOBhIM 3a6oAeB:'tHHSIM, BbI3hIBaeMbIM ,n:epMaTor.Pi:naMu: Bo36y)~HTeAH
Thrichophyton rubrum (rrpnMepHo 90 %) n Thrichophyton mentagrophytes var. Interdigitale (oKOAO 10 %).
Thrichophyton rubrum OTHOCHTCSI K aHTporroqmAbHbIM rpH-
6aM. YcTOWIHB so BHeIIIHeH cpe,n:e. 3apruKeHHe rrpoHcxo,n:uT qa:rn:e scero B 6a:i-rnx, ,nyweBbIX, 6acceilHax rrpn He,n:ocTaTO'iHOMco6AIOJJ:e- Hnn caHnTapHorun1eHH'fecKHXrrpasHA.
Cy:rn:eCTByeT pn.n: npeopacnoRazmoU:!,U'X cj:JaKm•OJ'oe K p a3-
BHTHIO MHK030B. Hx MO:>KHO pa3,n:eAHTb Ha o6mue H MeCTHhi e.
K 06UJUM cpaK:.mopaM OTHOCSITCSI:
•cocy.n;wcTble pacCTp01'lCTBaB ,!J;MCTaJibl-IbIX OT,IJ;eJI3X KOHe'IHOCTeH: (06mrrepi-1py101II11H: arepocKJiep03, 06mrrepttpy10m:uH: 3H)J;apTepttttT, BapttK03Hoe pacmupeHHe Ben);
•nepem<Jia)l<,!l;eHtte u neperpeBattne KoHe'!HocreH:;·
•3HAOKpmmhre paccrpoH:cTBa (caxapttb!H: p;ua6eT, ttapywe1-me cp)'HKIJ;HMrn;HTOBH,!l;HOM )KeJie3bI);
•I'J1IIOBl1Ta:J\fl.1H03bl.
K MecmnblM <jJaKmopaM OTl!OCllTCJI:
•norepTOCTb;
•Il0BbIIIIeHHa51: IlOTJIHBOCTb, Bep;yJIJ;aK K Mau;epau;11w porOBOI'O cnoK 3II11,!l,epMttca. IT0BbIUie1me noTJIMBOCTH MmKeT Ha6mo- p,aTbcK npH HOU1elll1l1 HOCKOB H3 C11I-ITeTH'!eCKHXBOJJOKOH, TeC-
HOH 11 qpe3Meptto rennotf 06yB11.
KAHHH'ieCKHer.PopMbl MHK03a CTOn:
1.l1HTepTpttTHH03HaH cpopMa. B Me)l(IlaJlbu,eBbIX npoMelK)'TKax {qarn;e B
~µfl;~~d ?ft~ 'l ,, .i.>'Vv~j
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III u IV) B Mecrax Tpemrn rroBepxttocTeH: rraJihU,eB B03HMKaeT Mallepa-
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1~11K poroBoro CJIO}f, corrpoBo)l<,!J;aIOrn;a5rc}f rMrrep eM11et1:, BbICbrnaHl151MM ny3i,1pbKOB, Ha MeCTe KOTOphlx 06pa3y10TCM 3po311M H Ypem11Hbl. Cy6-t>- eKTl1BHO OTMeqaeTCK Bbipa)KeHHbIM 3}',!l,H 6oJib.
2.,O:ttcrtt.n;pOTH'leCKaH¢opMa xapaKTepIDyeTC}I BblCbmaHMeM JT}'3blpbKOB B o6JiaCTl1 CBO}J,a CTOI1bl. fly3bl pbKl1 MOI'}'TyBeJIH'IHBa'I'bCSlpa3Mepax,
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A fi'l~-rY HHcpeKti;Mtt co.n;ep)KHMOe JT}'3bipet1: np1106peTaeT |
rHOMHbitf |
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JT}'3hlpel1: o6pa3yIOTCSl 3p03l111. |
no Mepe |
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npou;ecca 3po311l1 |
3IIMTeJIM3ttpyroTca, ocraeTCK |
nerI<oe ureJI}'UJeHH:e. |
Cy6oeKTHBHo OTMeq aeTcK 3}',!l,l1 6onb.
3.CKBaM03Ho-n1nepKepaTOTH•1ecKaJ1 ¢opMa xapaKTeptt3}'eTCSl oqar o - BblM = AMcpq>y3HhIM yToJIJIJ;em1eM poroBoro CJIO}I, oco6eHHO B o 6nac-
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™ IDITOK. XapaKTeptto Me.m<ormacn1H'laToe (MYKOBM,D;Hoe) rne.nyrneHHe, tta116o nee 3aMeTHOe B Kpym-fbIX KO)lO-fbIX CKnaAKax. y psm;a 60Jlb-
HbIX oTMeqae= 3y.n:, np11 Ha.ITTf'!Ml1-rpe.tIJ;mI - |
6oJib npw XOA b6e. |
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MHK031>1 BOAOCHCTOH 'laCTH rOAOBl>I TaIOKe Bbl3hIBalOT |
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rpH6bI pOJI.OB Microsporum (MHKpocrropilll) H Trichophyton (TpHXo- |
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qmnrn) . MHKpocrropllii BOAOCHCTOH qaCTH roAOBhI H3BeCTHa Ta~e |
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no;:i: Ha3BaHHCM •CTPHryll.\HH AHillaH•. |
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K.n.uH.uttecK.a.R KapmuHa. O'iarnrropa>KeHH.H rrpe,n;craBA.HIOT |
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co6o H: yqacrKH oKpyrAoli cpopMbI c qencMMH rpaHmi;aMH . Ko:iKa roAo- |
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BbI B o•,i:arax H3MeHeHa: OTMe'!aeTC.H3pMrt:Ma, IlleAyrneHne. B OTAH'IHC |
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OT MHK03a rAa.[(KOH KO.>KH oqarn rroproKCHH.H Ha BOAOCHCTOH "iaCTH |
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roAOB bl rrpn MHKpocnopHH H TpmcocpnTMM MO>KH~ ~~3~1p,n·:b J!.a>KC no |
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2. C6op 3n11p:eMwonorw:recKoro aHaMtte3a.
3. M11Kpoc KOffIDI Bonoca. ITptt MaJIOM yseJIWlCHl1.11 BM,D;ett qeXJmK, KOTO- p &ri71 np11 MIB<pocnopmr pacn onaraeT01 soKpyr son oca. ITpvi 6oJI&IIIOM yneJiwcteH"111 M0)!(}{0 }'B1'll::\eTbMT-JO)!(CCTBO MeJIK"1X crrop, pacnOJlO)l(eH- 1-!b!X Bl-Iyr]JH H Cttapy)!(H BOJlOCa . .[(Jut nosepXHOCTifOlii. -rpwxoqntTl1'"160- nee xapaK'rep1-10 pacnoJIO)!(eJ-nte cnop sttyTPH sonoca (endothrix) .
4. .D,MarnocTwKa c noMOJW>JO naMITbI ByAa.
5.KynbrypanbHOe wccr1ep:ona1-me.
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cTyio "IaCTb roAOBhI.
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89