Ringworm

This skin infection (what it looks like - look at photo 2) is caused by a fungus that lives on dead skin cells, hair, or nails. At first, the infection appears on the skin as a red, rough patch or scar, which then turns into an itchy red ring with swollen, rough edges. Ringworm is transmitted through physical contact with a sick person or animal, as well as through contact with the patient's personal belongings (towel, clothing, personal hygiene items). Ringworm is usually treated topically with antifungal creams and ointments.

"Fifth disease" (infectious erythema)

contagious disease ( photo 3), which is usually mild and lasts about 14 days. At first, the disease manifests itself as a cold, but then it is accompanied by symptoms such as rashes on the skin of the face and body. The risk of infection is highest in the first week of the "fifth disease" (before the rash appears), which is transmitted by airborne droplets.

The course of treatment includes constant rest, the use of a large amount of fluid and painkillers (which the doctor must prescribe). But be on the lookout, as there may be other symptoms that indicate a more serious illness. Also check with your doctor if your child is sick and you are pregnant.

Chickenpox (chickenpox)

Being an extremely contagious disease, chicken pox ( photo 4) spreads easily and appears as an itchy rash and small sores all over the body. The nature of the rash varies depending on the stage of the course of chickenpox: the formation of blisters, then their opening, drying and crusting. Complications from chickenpox can lead to serious consequences such as pneumonia, brain damage, and even death.

Those who have had chickenpox are at risk of getting shingles in the future. Parents are currently encouraged to vaccinate their children against chickenpox. The vaccine is also recommended for adolescents and adults who have not had chickenpox and have not yet been vaccinated.

Impetigo

An infectious disease caused by staphylococcal or streptococcal bacteria. Impetigo ( photo 5) manifests itself as red sores or blisters that may open, resulting in yellow-brown crusts on the skin. Ulcers can appear anywhere on the body, but they are most common around the mouth and near the nose. Scratching already formed sores can lead to their appearance in other parts of the body. Impetigo is transmitted both through direct physical contact and through personal items (towel, toys). This disease is commonly treated with antibiotics.

warts

These raised skin lesions ( photo 6) caused by the human papillomavirus (HPV) can be formed after contact with a carrier of HPV or with his belongings. As a rule, warts occur on the fingers and hands. The spread of warts throughout the body can be prevented by isolating them (use a bandage or plaster). And make sure that your child does not bite his nails! In most cases, warts are painless and disappear on their own. If they do not pass, it is recommended to resort to their freezing, surgical, laser and chemical treatment.

Miliaria (tropical lichen)

Formed by blockage of sweat channels (ducts), prickly heat ( photo 7) appears as small red or pink pimples on the head, neck and back of babies. As a rule, this type of rash appears due to excessive sweating during hot, stuffy weather or through the fault of overly diligent parents who dress the child in too warm clothes. So be careful and don't overdo it.

contact dermatitis

contact dermatitis ( photo 8) is a skin reaction to any kind of contact with plants such as poison ivy, sumac, and oak. Pathogens can even be soap, cream or food, which include elements of these plants. As a rule, the rash occurs within 48 hours after exposure to the pathogen.

In mild cases, contact dermatitis appears as a slight reddening of the skin or as a rash of small red spots. In severe cases, it can lead to swelling, severe reddening of the skin and blisters. Usually, contact dermatitis is mild and resolves after contact with the irritant is stopped.

Coxsackie (hand-foot-mouth disease)

This is a common contagious disease among children ( photo 9) begins as painful sores in the mouth, a non-itchy rash, and blisters on the hands and feet and sometimes on the legs and buttocks. Accompanied by high body temperature. It is transmitted by airborne droplets and through contact with diapers. Therefore, wash your hands as often as possible when your child is sick with coxsackie. Home treatment includes taking ibuprofen and acetaminophen and drinking plenty of fluids. Coxsackie is not classified as a serious illness and disappears in approximately 7 days.

Atopic dermatitis

manifestations of the disease ( photo 10) are dry skin, severe itching and extensive skin rashes. Some children outgrow atopic dermatitis (the most common type of eczema) or deal with a milder form of it as they get older. At the moment, the exact causes of this disease have not been established. But often patients with atopic dermatitis suffer from allergies, asthma and have a sensitive immune system.

Hives

Urticaria ( photo 11) looks like a red rash or scarring on the skin, which is accompanied by itching, burning and stinging. Urticaria can appear on any part of the body and last for a few minutes or several days. Urticaria can also indicate serious health problems, especially if the rash is accompanied by difficulty breathing and swelling of the face.

The causative agents of the disease can be: drugs (aspirin, penicillin), foods (eggs, nuts, shellfish), food additives, sudden changes in temperature and some infections (for example, pharyngitis). Urticaria disappears after the termination of interaction with the pathogen and the use of antihistamines. If the disease does not go away for a long time and is accompanied by other symptoms, consult a doctor immediately.

Scarlet fever

Disease ( photo 12) consists in an inflamed larynx and skin rashes. Symptoms: sore throat, fever, headache, abdominal pain and swelling of the tonsils. After 1-2 days from the onset of the disease, a rough red rash appears, which disappears within 7-14 days. Scarlet fever is highly contagious, but frequent and thorough handwashing with soap and water reduces the risk of infection. If you suspect your child has scarlet fever, see a doctor immediately! In most cases, antibiotics are prescribed for treatment, which prevent complications of this disease.

Rubella (the "sixth disease")

This contagious disease photo 13) of moderate severity most often occurs in children aged 6 months to 2 years, much less often - after 4 years. Symptoms include respiratory problems accompanied by high body temperature for several days (sometimes causing epileptic seizures). When the attacks of heat stop abruptly, red rashes appear on the trunk in the form of flat or slightly swollen red dots. Then the rash spreads to the limbs.

Based on materials from children.webmd.com prepared Ludmila Kryukova

Skin diseases in children are known to affect the upper layer of a person. This includes nails, hair, sweat glands.

From a medical point of view, the terminology of skin diseases includes various kinds of diseases, these are infectious, allergic, viral, but, nevertheless, they are all associated with the upper cover.

Diseases are also divided into groups, according to the nature of the course and complexity.
Some of them are not curable, others go away on their own without any external medical and surgical interventions.

Diseases that are associated with allergies in a child, we put in a separate group, there is also a separate stripped of volatile viral infections. This is a special species that, by their nature, are capable of infecting a person at a great distance.

But do not forget that any rash or redness on the body, especially when accompanied by high fever and poor health, may not be a separately progressive disease, but the cause of a disease of the internal organs of a person.

Therefore, with any symptoms, contact a specialist dermatologist and do not refuse to take tests, motivating, doctor, I have a common skin rash, prescribe some ointments and that's it ...

The symptoms for each of the diseases, which we will consider in detail below, are different and it makes no sense to talk about similarities.

Some are accompanied by severe itching, sometimes like measles, it appears on the body after a few days, but this is preceded by high fever.

Consider the main causes of skin diseases in children

As mentioned above, the development of a skin disease can lead to a violation of the liver, kidneys, stomach, a significant decrease in immunity, which eventually come to the surface.

Improper nutrition or poisoning leads to allergic reactions on the skin.

One of the types of disease, the occurrence of purulent wounds on the child's body.

The reason is the dirty objects that the baby constantly encounters on the street. And the slightest incisions or damage lead to suppuration.

Nails and hair are often subject to fungal infections.
The fungus passes either through animals (cats, dogs), or there was direct contact with a sick person. Hair color changes, and spots appear on the nails.

Slight redness in the form of pimples, indicating prickly heat, and can not be considered a disease at all.
Small red pimples appear on the body on hot days, where there is not enough fresh air, or the baby is forcibly dressed. They disappear on their own, for some time, with a change in climate or a cold snap (taking a cool shower).

Sometimes sweating may appear for several hours, then the body will again become the same.

Common symptoms of skin diseases in children

In 80-90%, itching of the body is observed. It often precedes the onset of a rash, but not always.
During chickenpox, the whole body itches until the disease subsides. Along with itching, there is a very unpleasant feeling - a burning sensation over the entire surface.

Further, in all skin diseases, both in children and adults, the first redness appears.
Usually the skin is covered with red spots, which become more and more over time.
With various signs and the course of the disease, red spots turn into a rash.
For example, during the manifestation of rubella, redness remains the final phase of the disease.

Together with the symptoms listed above, the body is exhausted, lethargic, accompanied by insomnia, poor appetite, irritability.

Parents should be aware that newborn children and up to a year, the disease and the course of such diseases are severe, unlike school-age children.

But there is also a limit to that. Measles at an older age (16-20 years) is accompanied by high fever and possible complications.
Don't neglect this. Starting chronic and ending with partial loss of vision.

Distinguish diseases by the nature of the rash and the area of ​​\u200b\u200bdamage

Some of them affect only exposed areas of the skin, others specifically the face and neck, and others only the limbs (hands).

Damage to the face and neck is inherent in warts, acne, pimples, which, to one degree or another, bring discomfort and make some adjustments to our lives.
Sometimes it is hormonal, that is, it occurs during the transition period, and after passing this stage, it disappears on its own.
In other cases, infection occurs with a virus, where treatment is unavoidable.

Opening areas of the skin are often affected by frostbite (in winter) or burns (on hot sunny days). The degree of complications depends on the time of stay, and on the environment and how timely and effectively first aid is given.

Skin diseases in children is the release of toxins from the body.
Thus, the human body gets rid of excess toxic substances, and since the dose exceeds the allowable one by several times, they are not able to completely exit in the usual way.

How to treat skin diseases?

For each individual case, appropriate measures are taken.
The child is able to overcome light forms at home.
Complicated - are treated in a hospital.

This is the use of antibiotics, the absence of a source of infection, the restoration of hormonal balance, the use of pyrogenic drugs. For superficial treatment, various ointments and compresses are used.

It is impossible to establish the terms of treatment of this or that disease from the first day.
Sometimes it takes up to several months.
Chronic or with complication - years.

Prevention and diagnosis

First, various vaccinations will help protect children from viral skin infections.
It's up to you, of course. The state does not provide for compulsory vaccination.
Moreover, for some diseases, there is no mention of possible vaccination at all.
All at the request of the parents.

But remember, during the use of any vaccine, you must first undergo all tests for possible complications and allergic reactions. The baby on the day of vaccination must be completely healthy, active without

Skin diseases in children are much more common than in adults. This is because children are more sensitive and susceptible to infections. Skin diseases in children are very often allergic in nature. Treatment of the disease should be started only when the diagnosis is accurately established and confirmed.

Consider diseases that are more common than others.

Atopic dermatitis

is a chronic, genetically determined inflammatory skin disease.

The first and most important reason for the onset of the disease is a genetic predisposition (relatives suffering from various allergies);

Important! Atopy is the tendency of a child's body to develop allergies. You can read about the treatment of allergies.

1. Increased hyperreactivity of the skin (increased sensitivity to external factors).
2. Violation of the nervous system of the child.
3. Use of tobacco products in the presence of a child.
4. Bad ecology.
5. The food contains a lot of dyes and flavor enhancers.
6. Dry skin.

Important! This type of dermatitis affects children under 12 years of age, at an older age it is extremely rare.

With atopic dermatitis, the child's skin becomes dry, begins to peel off, a rash appears in patches, especially in certain places: on the face, neck, elbows and knees. This disease has an undulating course, periods of remission (fading of symptoms) are replaced by periods of exacerbation.

Diaper dermatitis

- This is an irritable and inflammatory process that occurs under the diaper, due to the restriction of air supply to the skin of the perineum or prolonged moisture. This is a good breeding ground for bacteria.

Important! It occurs in babies who wear diapers, regardless of age.

When using diapers and diapers, irritants are:

1. High humidity and temperature.
2. Long time of contact of feces and urine with the skin.
3. Accelerated development of a fungal infection.

A fungal infection plays an important role in this case. Scientists have proven that many children with diaper dermatitis have a fungal infection that is the causative agent of candidiasis.

Important! At the first manifestations of a rash, it should be remembered that the baby may be allergic to new soap, cream, or even new diapers, provided that there were no hygiene violations.

Symptoms:

1. In children with diaper dermatitis, there is a strong inflammatory process of the skin in the perineum and on the buttocks.
2. Hyperemia of the skin, blisters or even small wounds can be detected.
3. Very strong inflammation is observed in the skin folds and between the buttocks.
4. The kid in this case will be restless, whiny, nervous.
5. Will pull his hands to the groin and try to remove the diaper.

Hives

- This is a skin disease that is characterized by the appearance of itching, and after the appearance of blisters, the blisters at the beginning of the disease are solitary, later merge and form an inflamed area, which can cause fever and disruption of the stomach and intestines.

Causes that contribute to the appearance of skin diseases:

1. Hypersensitivity of the skin.
2. Foods that contain a lot of allergens (citrus fruits, strawberries, chocolate, honey).
3. Medications.
4. Dust or pollen, animal hair.
5. Infectious and viral diseases.
6. Cold, heat, water, UV rays.
7. Insect bites.

Symptoms:

1. The first to appear in urticaria are blisters and a red rash that causes itching and a desire to itch (as with a nettle burn).
2. The child scratches these blisters as a result of which they merge.
3. It is localized around the lips, on the cheeks, in the folds of the skin, on the eyelids.
4. The body temperature rises, sometimes nausea and,.

Prickly heat

- this is one of the forms of dermatitis, which appears as a result of skin irritation due to increased sweating.

Symptoms are divided into three types:

1. Crystal prickly heat - newborn babies are more likely to get sick with this type, the elements of the rash look like white bubbles about 2 mm in size. The rash can merge and form white large areas, these blisters are easily damaged, resulting in areas that are flaky. The rash is localized on the neck, face, upper half of the body.
2. Red prickly heat - with this type, a rash appears in the form of nodules around which hyperemia appears on the periphery. This rash does not merge, itches and causes pain when touched.
3. Deep prickly heat - with this form, a rash appears in the form of bubbles of beige or pale pink color. The rash can be located not only on the neck, face, but also on the legs and arms. This rash goes away as quickly as it appeared, leaving no marks or scars behind.

But adults who have more than once suffered from prickly heat are more often ill with this type, but there are exceptions when children are ill with it.

Important! If a child has a rash on the skin, in no case should it be smeared with cosmetic creams or ointments that you once used. Remember - the health of your child, only in your hands!

Causes of the disease:

1. Very thin and delicate skin.
2. Active blood supply, as a result of which the baby quickly overheats.
3. Weakly developed sweat ducts.
4. High saturation of the skin with water (92%).

Acne

Acne in children is a disease of newborns, which is manifested by small white rashes that are localized on the chin and cheeks of the baby. They can appear in the first 6 months of a child's life, this is due to the hormonal changes that occur in the baby's body.

Important! Also, this type of skin disease can manifest itself in adolescence.

1. Blockage of the ducts of the sebaceous glands.
2. Changes in the hormonal background of the child.
3. An excess amount of estrogen (female hormones) entering the body.

Symptoms: Acne presents as solitary papules, white or slightly yellowish.

Over time, they can turn into black dots. Acne usually disappears quickly, in 14 days, after it fades, there are no scars and spots left on the skin.

But the situation can be complicated by infection of acne. Signs of infection are swelling of the skin where there is acne, and redness. In this case, you need to see a doctor.

Furuncles

Furuncles in children is a skin disease caused by staphylococci. The presence of boils on the child's body indicates serious disorders in the baby's body.

The reasons for the appearance are divided into 2 types:

1. Mechanical effects (wearing too tight and not fitting clothes).
2. Non-compliance with the rules of hygiene (scratching the skin with dirty hands, rare diaper changes, irregular bathing).

Internal:

1. Improper nutrition of the child.
2. Diseases of the endocrine and nervous systems of the baby.
3. Congenital or acquired immunodeficiency.

The boil has its own stage of development, which is determined by the symptoms:

1. First, a solid infiltrate with fuzzy boundaries appears, which gives pain.
2. On the periphery, around the boil, swelling is formed, while the pain increases. After that, the boil itself opens and purulent contents and a core come out of it, which is formed from dead leukocytes and bacteria.
3. After that, the sore on the skin heals, leaving behind a scar.

Important! Especially dangerous is the boil, which is located on the head, it can infect the rest of the skin.

Carbuncle

A carbuncle can also form - this is an inflammatory process of several boils united with each other.

In this case, the general condition of the child is violated:

1. The child's weight may decrease.
2. The temperature rises.
3. The skin turns pale.
4. Weakness.
5. Swollen lymph nodes, near a nearby boil.

Making a timely and correct diagnosis is a direct path to success in treating your child's skin disease, remember this!

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The skin is the largest human organ. Her illnesses may not be independent pathologies, but the result of damage to various internal organs and systems. But they can also be caused by the action of external stimuli (infectious and non-infectious). In children, skin diseases do not proceed in the same way as in adults. First of all, this is due to the insufficient formation of the child's immune system.

Classification of skin diseases in children

There are a large number of skin diseases that are classified according to various characteristics. Depending on the causative factors, three main groups of skin diseases can be distinguished. Let's consider them.

Infectious skin diseases in children

These diseases are associated with the penetration of the infection through the surface of the skin (especially when it is damaged) or in another way (airborne, oral-fecal, transmission, etc.). Skin infections in children are divided into:

• bacterial (furunculosis, folliculitis, carbunculosis, hydradenitis, impetigo, streptoderma, etc.);
• viral (, chickenpox, infectious erythema, sudden exanthema, rubella, warts, herpetic eczema, etc.);
• fungal (keratomycosis, dermatophytosis, candidiasis, trichophytosis, etc.).

Allergic skin diseases in children

Such pathologies arise due to interaction with various irritating factors. This may be the reaction of the body in response to:

• food allergens (citrus fruits, dairy products, chocolate, honey, fish, etc.);
• medicines;
• household chemicals;
• dust;
• animal hair, etc.

This group includes the following diseases:

• toxic-allergic dermatitis;
• diaper dermatitis;
• eczema;
• neurodermatitis;
• pruritus, etc.

Symptoms of skin diseases in children

Skin diseases can have various external manifestations. As a rule, already by the type of skin rashes in children and by their localization, an experienced specialist can diagnose a particular pathology.

Skin rash in children can be represented by the following elements:

• spots (maculae) - not protruding above the surface of the skin of various shapes, sizes and colors (red, pink, brown, white, etc.);
• papules (nodules) - dense formations that rise above the skin without cavities;
• vesicles (vesicles and bullae) - elements filled with liquid contents;
• pustules (abscesses) - formations with purulent contents inside;
• urticaria - flat, dense, rounded formations that slightly rise above the surface of the skin (urticaria).

Other symptoms of skin diseases may include:

• burning skin;
• dryness;
• peeling;
• wetting.

Other signs of the disease may also appear:

• high body temperature;
• cough;
• rhinitis;
• abdominal pain, etc.

Treatment of skin diseases in children

There is no general treatment strategy for skin diseases due to their diversity. Also, the principles of therapy depend on the severity of the course of the disease, the age of the child, and his individual characteristics. Drug treatment may include systemic drugs or be limited to external agents. In some cases, no specific treatment is required at all.

Prevention of skin diseases in children

1. The right balance of nutrition with the restriction of foods that can provoke allergies.
2. Compliance with the rules of personal hygiene and cleanliness in the house.
3. Elimination of stressful situations in the child's life.
4. Exclusion of artificial materials in children's clothing.
5. Timely treatment of wounds, abrasions.

Chapter 4. INFECTIOUS DISEASES OF THE SKIN

Chapter 4. INFECTIOUS DISEASES OF THE SKIN

4.1. BACTERIAL SKIN INFECTIONS (PYODERMAS)

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

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

Etiology

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

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

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

Pathogenesis

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

Microorganisms

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

Staphylococcus aureus (St. aureus) pathogenic for humans;

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

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

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

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

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

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

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

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

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

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

Antagonistic and antibiotic properties 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's syndrome, thyroid disease, obesity), gastrointestinal diseases, liver diseases, hypovitaminosis, chronic intoxication (for example, alcoholism), etc.;

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

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

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

Age characteristics of patients (childhood, old age). External environment

The negative environmental factors include the following.

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

Impact of physical factors:

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

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

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

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

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

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

Classification

There is no single classification of pyoderma.

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

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

By flow duration pyoderma can be acute and chronic.

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

Clinical picture

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

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

Staphylococcal pyoderma (staphyloderma)

Ostiofolliculitis (ostiofolliculitis)

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

Folliculitis

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

Rice. 4-1. Folliculitis, individual elements

Rice. 4-2. Widespread folliculitis

Localization - on any part of the skin where there are hair follicles, but more often on the back. The evolution of the element occurs in 5-10 days. After the resolution of the element, temporary post-inflammatory pigmentation remains. Deep folliculitis leaves a small scar, 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, dysbacteriosis), as well as overheating, maceration, insufficient hygiene care, mechanical or chemical irritation of the skin.

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

Furuncle

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

Rice. 4-3. Furuncle of the thigh

Clinical picture

The process takes place in 3 stages:

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

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

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

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

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

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

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

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

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

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

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

Treatment

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

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

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

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

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

Carbuncle

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

Rice. 4-4. Carbuncle

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

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

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

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

Hydradenitis

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

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

Clinical picture

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

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

Rice. 4-5. Hydradenitis

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

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

The disease is especially severe in obese people.

Treatment

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

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

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

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

Sycosis

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

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

Rice. 4-6. Sycosis

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

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

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

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

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

Barley

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

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

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

Staphylococcal pyoderma in infants

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

Rice. 4-7. Barley

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

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

Sweating and vesiculopustulosis

Sweating and vesiculopustulosis (vesiculopustulos)- 2 conditions closely related to each other and representing 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 function actively, and stop by 1.5-2 years, when the mechanisms of sweating and thermoregulation are formed in children.

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

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

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

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

Rice. 4-8. Vesiculopustulosis

Multiple abscesses in children

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

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

Rice. 4-9. Pseudofurunculosis Finger

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

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

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

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

Epidemic pemphigus of the newborn

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

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

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

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

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

Ritter's exfoliative dermatitis of the newborn

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

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

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

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

Rice. 4-10. Ritter's exfoliative dermatitis

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

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

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

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

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

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

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

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

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

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

Streptococcal pyoderma ( streptodermia)

Streptococcal impetigo

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

Rice. 4-11. Streptococcal impetigo

Rice. 4-12. Streptococcal impetigo on the face

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

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

There are several clinical varieties of streptococcal impetigo.

bullous impetigo

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

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

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

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

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

slit-like impetigo

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

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

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

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

Superficial panaritium

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

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

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

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

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

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

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

Rice. 4-16. Superficial panaritium

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

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

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

Posterosive syphiloid

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

Rice. 4-17. Intertriginous streptoderma

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

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

lichen simplex

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

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

Rice. 4-18. Dry superficial streptoderma

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

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

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

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

Ecthyma vulgaris

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

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

Rice. 4-20. Ecthyma vulgaris

Rice. 4-21. Multiple ecthymas

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

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

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

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

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

Erysipelas

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

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

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

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

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

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

Rice. 4-22. Erysipelas in an infant

Rice. 4-23. Erysipelas. bullous form

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

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

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

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

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

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

Mixed streptostaphylococcal pyoderma (streptostaphylodermia)

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

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

Rice. 4-24. Streptostaphylococcal impetigo

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

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

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

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

Chronic ulcerative and ulcerative-vegetative pyoderma

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

(Figure 4-25).

Rice. 4-25. Chronic ulcerative pyoderma

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

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

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

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

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

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

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

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

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

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

shancriform pyoderma

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

Rice. 4-26. shancriform pyoderma

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

Chancriform pyoderma develops in both adults and children.

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

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

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

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

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

Other bacterial processes

Pyogenic granuloma

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

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

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

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

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

Rice. 4-27. Pyogenic granuloma

Rice. 4-28. Pyogenic granuloma in a child

erythrasma

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

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

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

Rice. 4-29. erythrasma

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

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

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

Features of the course of pyoderma in children

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

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

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

Hidradenitis develops only in adolescents in puberty.

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

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

Counseling for patients with pyoderma

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

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

Scabies (scabies)

Etiology

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

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

Epidemiology

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

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

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

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

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

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

Clinical picture

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

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 increases in the evening and at night.

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

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

Scabies move

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

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

Eruption polymorphism

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

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

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

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

Rice. 4-31. Scabies. Belly skin

Rice. 4-32. Scabies. Forearm skin

Rice. 4-33. Scabies. Genital skin

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

(Figure 4-35).

Localization

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

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

Rice. 4-35. Scabies. Symptom of Michaelis

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

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

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

Complications

Complications often change the clinical picture and significantly complicate diagnosis.

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

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

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

Rice. 4-36. Scabies complicated by pyoderma

Rice. 4-37. Common scabies complicated by pyoderma

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

Hives.

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

Features of the course of scabies in children

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

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

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

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

Absence of excoriations and hemorrhagic crusts.

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

Rice. 4-38. Common scabies

Rice. 4-39. Common scabies in an infant

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

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

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

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

Features of scabies in young children

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

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

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

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

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

Clinical varieties of scabiestypical shape

The typical form described includes fresh scabies and widespread scabies.

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

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

Asymptomatic scabies

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

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

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

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

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

Norwegian scabies

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

Scabies "incognito"

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

Postscabious lymphoplasia

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

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

Rice. 4-42. Postscabious lymphoplasia

Diagnostics

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

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

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

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

Differential Diagnosis

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

Treatment

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

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

General rules for prescribing anti-scabies drugs:

Apply the drug in the evening, preferably at bedtime;

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

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

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

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

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

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

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

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

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

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

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

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

Piperonyl butoxide + esbiol in the form of an aerosol is a low-toxic drug, approved for the treatment of infants and pregnant women. The aerosol is applied to the skin from a distance of 20-30 cm from its surface in the downward direction. In infants, the scalp and face are also treated. Mouth, nose and eyes are pre-covered with cotton swabs. According to the manufacturer's recommendation, the treatment is carried out once, but from experience it is known that with widespread scabies, a 2-3-fold administration of 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). Among the side effects, contact dermatitis is often encountered. Apply for 5-7 consecutive days.

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

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

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

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

Features of the treatment of scabies in children

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

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

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

Features of the treatment of scabies in pregnant and lactating women

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

Clinical examination

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

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

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

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

Prevention

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

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

Consulting

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

Pediculosis

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

Clinical picture

Clinical symptoms typical of all types of pediculosis:

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

Irritability, often insomnia;

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

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

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

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

Regional lymphadenitis with widespread pyoderma.

head lice (pediculosis capitis)

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

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

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

Rice. 4-43. lice

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

Clothes pediculosis (pediculosis corporis)

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

Pubic pediculosis (phthyriasis)

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

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

Treatment

Treatment of pediculosis is carried out with pediculocidal preparations. Most of the highly active drugs available contain permethrin (a neurotoxic poison). The preparations are applied to the scalp, left for 10 minutes, then the head is washed. Also effective in the treatment of pediculosis shampoo "Veda-2" *. After treatment, the hair is moistened with water (2 parts) with the addition of vinegar (1 part) and left for 30 minutes. Vinegar facilitates the removal of nits during repeated combing of the hair with a fine comb. Mechanical removal of nits is an important point in the treatment of pediculosis, since drugs do not penetrate well into the shell of nits. After 1 week, it is recommended to repeat the treatment to destroy the lice hatched from the remaining nits. When viewed under a Wood's lamp, live nits, in contrast to non-viable (dry) ones, give a pearly white glow.

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

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

Anti-epidemic measures

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

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

Children should not attend school with live lice.

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