4 курс / Дерматовенерология / Dermatologia_i_venerologia_KGMU_g_Simferopol_2012_g

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1.0 KaKOM 336orresamru: CJiei:r;ye'I"rrpeJKAe ocero AYMaTb?

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3. C KaKHMH 3a6orrenaHID1MtI ueo6xop;H:Mo rrponecrn. Attcpcpeperru;1ra11I.Hbtil'Amu-Ho3?

4. COCTaeJ>Te nnau o6cneAOBaHIDr, rreqeHIDI H BTOp=ml'1:npocpHJiaKrn.Ktt.

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84

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KOpTMKOl!l)J,OB, I~IITOCTaTifKOB.

K.naccucpuK.ayust A. M. Apueeutta u H. JI.. IIIeK.Jta»eoea:

1.KepaTOMHK03bl -

•pa3HOTJ,BeTHbIB muuaw ( OTpy6eBt1,IJ;HbI"Ci.),

•3pttTPa3Ma.

2.P,e pMaTOMMK03bI -

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•3 nlil:)J.epMocfJHTI1H cron,

•py6pocfJMTIIB,

85

•TJH1xoqnrr1/ffi (aHTponoH03Hasi:, 300H03Hasi:),

•MHKpocnopl'Ul (aHTpOilOH03HasI, 300H03HasI),

•cpaByC.

3.KaHJJ;H,!l:03bI (noBepxHOCTHbrCi:, xpo1;rn.-crecK11:l1:, r eHepanMJoBaJ-IHbrCi:, Bl1C- n.epanbHbn1:).

4.frry60K11e MMK03bI.

5.TiceBp;OMMK03bl.

Pa3HOU.BeTHlbIM (oTpy6eBH,llHhIH) ABwaii OTHOCHTC51 K rpynne KepaTOMHK030B, npH KOTOpblX rpH6b ! nopruKaIOT TO/\bKO po-

roBOH C/\OH 3nH,n.epMHCa H BOAOCbI. KoHTartto3HOCTh 3a60AeBaH1rn

ro 'ie/\OBeKaH npH onpeAeAeHHblX YCAOBirnx, MO:>KeT B b 13BaT b 3a6oAeBaHHe. K TaKHM Y CAOBH.HM OTHOC51TC.H: 3K30reHHbie cpaKTOpbl, CB.H- 3aHHbie c yBeAH'tJeHHeM IlOTOOTAeAeHH.H, neperp eBaHHeM, rrepeOX/\IDKAeHHeM, H 3HAOreHHbie cpaKTOpbl, CB.H3aHHble c 3a60AeBaHJiHlMH, npH KOTOpbIX HMeeTC51 H3MeHeHHe pH KO:>KH H CHC'I"eMblHMMYHHTeT a.

KnuHu1tecKasi. KapmuHa. BbICbIDHOH 3AeMeHT - naTHO

:>Ke/\TO-KOpH"IHeBOH OKpacKM c "leTKHMH rpaHHIJ,aMH. CKAOHHOe K ne - pHcpepH"IeCKOMJ pOC'ly, co CAerKa ure.1wIIIaru;e:Hc.H nose p XHOCTblO (~1e­

IUYHKH HanoMHHaIOT oTpy6tt, OTCIOAa H Ha3sam-i e 3a60AesaHHSI). AoKaAH3aIJ,HSI: 3a.LI.H51.H l10BepXHOCTb meH, CITHI-Ia, IlOAMbIUle"llibie snaAHHbI, o6AaCTh l'PYAH. IlOAO:>KHTe/\bHblH CHMilTOM CTpJ:>KK.lit:: npH no - CKa6/\HBaHHH noBe p XHOCTH IUl:THa porOBbie 'ielllyHKH CHHMaJOTC.H B

BHAe crpJJKKH. Bo3MO:>KHO pacnpocTpaHeHHOe nopIDKem-1e. CyfueKTHBHbre CHMDTOMhI OTCyTCTBYIOT, npo6a baAbIJ,epa IlOJ\.O:>KHTe/\bHaSI. T e'ieI-rne3a60Aesam·rn xpoHH'tJecKoe. XapaKTepHbipeU.HAHBbI. A eToM DOA AeHCTDHeM HHC0/\51L(HH BbICbIIlaHH.H Ha rAaAKOH'KO:li<e perpeccH - pyroT, OCTaBJUISI IlOCAe ce6.a oT~1eT/\HBO BblAe/\511-0UJ;HeC.H r11rronHrMeI-I - THpOBaHHble ITSITHa He3aropeBUieH KO:>KH (nocrnapa3HTapHa51 /\CHKOAepMa ) .

11punyunt>i mepanuu. IlpH pacnpocTpaHeHI-IbIX cpopMax 11cnOAb3YJOT 06ru;y1-0 cpyHrHI.J,HAHYIO TepanHI-O. Ae'ieHI1enpoBO.LI.HT AO 11c- "le3HOBeHH.H KAHHH"leCKHX npo.HBAeHHH. Hapy:iKHo npHMeH.HJOT onueAYlllHBaJOUJ;He cpeACTBa H cpyr-ir HL(HAHble npenapaTbl (3-5 % Cai\.HL(H- /\OBblH cnHpT, 3-5 % HaCTOHKJ HOAa, HHTpOcpYJ-il'HH, KAOTpHM a30A). 06.H3aTei\.bHa .n.e3HHcpeKL(H.H 6eA.hlr H OAe:>KAbI.

3pHTpa3Ma (B036y.LIHTeAb - Corynebacter ia min utissimum) pacnoAaraeTc.H a a epxHHX OT,LI.eAax poroaoro c1w.H 3nH,LI.ep.Mnca, p a3-

86

BHBaeTCSI B KpyIIHbIX CKll.a,JJ.Kax KO:>KH IIpH HepaU.HOHaAhHOM pe:>KHMe, HaAK'iHHIIOTAHBOCTH.

KnuHurca. IIpoSIBAfleTC.H ITSITHaMH :>KeATOBaTo-6yporo, KpacHO- KHpIIWIHoro RAH KpaCH0-6ypo . l.l;BeTa, p acnoAaraIOIII.HMHCSI n peHMyw.eCTBeHHO B naxoso-6e.n:peHHblX CK1\a,n:Kax, a TaK:>Ke" no.n: MOJl.O'I- Hb!MH :>Ke11.e3aMH RAH B fIOJJ:MbIUie 'IHb!X0611.aCTSIX. IlSITHa KpyrIHh!e, CJl.HBHbie, MOryT HMeTb OTCeBbl no nepmpepHH, x a p aKTepHbl TIOAH-

U.HKJl.H'-leCKHeO'iepTaHHSI. 3pHTpa3 Ma MO:lKe T OCAO:lKHSITbCSI 3K3eMa.TH-

3au,11 e H:, onpe11.0CTbIO. B 3THX CJl.Y'!aSIX B03HHKaIOT cy6'beKTHBHbie

ow.yw.eHHSI 3y,n:a, )K)KeHHSI, KOTOpbie n pH HeOC/\.O:lKHeHHOH 3pHTpa3Me OTCyTCTBYJOT. .[lHarHOCTHKa OCHOBaHa Ha K/\.HHH'IeCKOHCHMUTOMaTHKe H xapaKT e pHOH 11.0KaJl.H3aU.HH .

Jle1teHue. Y<iaCTKH nopa:>KeHHH o6pa6aTbIBalOT 2-3 pa3a s ,n:eHb 8.HTH<pyurHU.HJl.HblMH paCTBOpaMH c noc11.e.n:yJOIIJ.HM HaAO:lKe HHe M

aHTHcPJHrHU.HJJ:HhIX Ma3eH.

Ilaxoeas 3llH,llepMOcl>HTHH Bb!3bIBaeTCH naToreHHbIM rpH-

6oM H3 po.n:a Epidermaphyton. Bo11.emT npe HMYIII.eCTBeHHO MJ:lK'IHHbI. Bo3HHKHOBeumo 3a6011.eB aHHSI cnoco6CTBJIQT noBbIIIIeuHoe noTooT,ue- 11.e1-me , HapymeHHe yrAeBo,n:Horo o6MeHa, noBbIIIIe HHaSI TeMnepaTypa OK))Y)KaJOIII.eH cpe,n:bI. 3aproKeHHe II))OHCXOJJ:HT 11.H60 npH Henocpe,l(CT- B eHHOM KOHTaKTe c 6011.bHbIMH , AH 6 0 B MeCTax o6rn.ecrseHHOro HOJl.b- 3 088.HHSI (6 a HH, CaYffbI, .n:yIIIeBbie).

KnuHUKa. T HIIH"l:HOH AOKaAH3aU.HeH BbICb!IIaHHH npH naxo-

BOH 3fIH,ll.epMOcpHTHH SIBAfleTC.H KO:>Ka n axoBbIX CKAa,JJ.OK, Me}K'bSII'O-

.UH'IHOH 0911.acTH, MOJl.O'IHbIX :>KeA<~3. Mopcpo11.orH<iecKHM 3AeMeHTOM

.HBM!JOTCSI b cTp OBOCIIaAHTC/\.bHble IISITHa, 'IeTKO OTrpaHH'IeHHbie, OK-

pyr11.0H. cpopMbI, p030B OM OKpacKH. flpH CJl.HHHHH OHH o6pa3 0Bb!Ba!QT O'IarHII011.HU.HK1\H'IeCKHX O'IepTaHHHc xopOUIO Bblpa:>KeHHb!M CIIll.OUIHb!M OTC'lHblMn e pHcpepWieCKHM Ba.AHKOM, Ha KOTO))OM o6pa3yIOTCSI IIJ3b!pbKH, MHKponyc1yll.bI, 3p03HH, KOpO'IKH, 'IClllyHKH HHOl',Ua c MOKHYTHeM, HM.HTHPYJOIL(HM 3K3eMy. B u.eHTpe oqaros Ha.611.JO,u;aeTCSI pa3peUieRH e naT011.orWiec Koro npou.ecca , Uie11.yUieHHe. Cy6'beKTHBHO OTMe<iaeTC5l CHJ\.bHblH 3y,u. 3a6011.eBaHHe MO:lKeT n pHHSITb x pOHH'-leCKOe Te<:1eH H e c o6oCTpeHHeM s AeTHee speMSI ro,ua.

,l(uazHOCmUKa OCHOBb!B8.eTC.H Ha xapaKTepHOH KAHHH'-IeCKOH Kap THHe H o6Ha p)':lKeHHHB '!eUiyHKaxKOJKH c oqaros nopa:>Ke HHSI H HOr T e Bb!X IIAaCTHHOK MHU.eAHSI.

Jleitettue:

•MeCTHoe - aHT11cpyttrl1QMAHLie rrpenapaThI B BM;D.e pacwopoa, Ma3eH 11 KpeMoB;

87

•o6rn;ee Jieqei-rn:e - cucreMHbre rrponmorptt6KoBbie npenapaThI.

MHK03 CTOIJ OTHOCHTCSI K ,n:epMaTOlPHTHSIM - rpn6KOBhIM 3a6oAeB:'tHHSIM, BbI3hIBaeMbIM ,n:epMaTor.Pi:naMu: Bo36y)~HTeAH

Thrichophyton rubrum (rrpnMepHo 90 %) n Thrichophyton mentagrophytes var. Interdigitale (oKOAO 10 %).

Thrichophyton rubrum OTHOCHTCSI K aHTporroqmAbHbIM rpH-

6aM. YcTOWIHB so BHeIIIHeH cpe,n:e. 3apruKeHHe rrpoHcxo,n:uT qa:rn:e scero B 6a:i-rnx, ,nyweBbIX, 6acceilHax rrpn He,n:ocTaTO'iHOMco6AIOJJ:e- Hnn caHnTapHorun1eHH'fecKHXrrpasHA.

Cy:rn:eCTByeT pn.n: npeopacnoRazmoU:!,U'X cj:JaKm•OJ'oe K p a3-

BHTHIO MHK030B. Hx MO:>KHO pa3,n:eAHTb Ha o6mue H MeCTHhi e.

K 06UJUM cpaK:.mopaM OTHOCSITCSI:

•cocy.n;wcTble pacCTp01'lCTBaB ,!J;MCTaJibl-IbIX OT,IJ;eJI3X KOHe'IHOCTeH: (06mrrepi-1py101II11H: arepocKJiep03, 06mrrepttpy10m:uH: 3H)J;apTepttttT, BapttK03Hoe pacmupeHHe Ben);

•nepem<Jia)l<,!l;eHtte u neperpeBattne KoHe'!HocreH:;·

•3HAOKpmmhre paccrpoH:cTBa (caxapttb!H: p;ua6eT, ttapywe1-me cp)'HKIJ;HMrn;HTOBH,!l;HOM )KeJie3bI);

•I'J1IIOBl1Ta:J\fl.1H03bl.

K MecmnblM <jJaKmopaM OTl!OCllTCJI:

•norepTOCTb;

•Il0BbIIIIeHHa51: IlOTJIHBOCTb, Bep;yJIJ;aK K Mau;epau;11w porOBOI'O cnoK 3II11,!l,epMttca. IT0BbIUie1me noTJIMBOCTH MmKeT Ha6mo- p,aTbcK npH HOU1elll1l1 HOCKOB H3 C11I-ITeTH'!eCKHXBOJJOKOH, TeC-

HOH 11 qpe3Meptto rennotf 06yB11.

KAHHH'ieCKHer.PopMbl MHK03a CTOn:

1.l1HTepTpttTHH03HaH cpopMa. B Me)l(IlaJlbu,eBbIX npoMelK)'TKax {qarn;e B

2.,O:ttcrtt.n;pOTH'leCKaH¢opMa xapaKTepIDyeTC}I BblCbmaHMeM JT}'3blpbKOB B o6JiaCTl1 CBO}J,a CTOI1bl. fly3bl pbKl1 MOI'}'TyBeJIH'IHBa'I'bCSlpa3Mepax,

Cy6oeKTHBHo OTMeq aeTcK 3}',!l,l1 6onb.

3.CKBaM03Ho-n1nepKepaTOTH•1ecKaJ1 ¢opMa xapaKTeptt3}'eTCSl oqar o - BblM = AMcpq>y3HhIM yToJIJIJ;em1eM poroBoro CJIO}I, oco6eHHO B o 6nac-

88

™ IDITOK. XapaKTeptto Me.m<ormacn1H'laToe (MYKOBM,D;Hoe) rne.nyrneHHe, tta116o nee 3aMeTHOe B Kpym-fbIX KO)lO-fbIX CKnaAKax. y psm;a 60Jlb-

MwcpocnopU51.: BOAOChI B oqare rropa>KeHH.H H 3M CHCHbI - cepbIC, TYCKAblC. 06AOMaHbl Ha Bb!COT e 4-6 MM OT KO>ICH, BCC Ha O}J:HOM ypom1e .

Tpuxo<j:JumU5l: BOAOCbl o6AOMaHbl 6oAee HH3KO - Ha Bb!COTC

2-3 MM BCC Ha pa3HOM ypOBHe: eCTb BOAOChl, 06AOMaHHblC Ha ypOBHe KO:lKH (•'ICpHb! TO'IKH•), CCTb BOAOCbl B ¢opMe 3aIT.HThIX, CCTb .ll,AHHHb!C, BHC!IIHe He H 3 MCHCHHhie BOAOCbI.

){uazH.ocmuKa OCHOBhrnaeTC:.H Ha CAe,ayIOU."(HX cpaKTopax:

1.Krr111iM<JCCKa.H Kapnnia .

2. C6op 3n11p:eMwonorw:recKoro aHaMtte3a.

3. M11Kpoc KOffIDI Bonoca. ITptt MaJIOM yseJIWlCHl1.11 BM,D;ett qeXJmK, KOTO- p &ri71 np11 MIB<pocnopmr pacn onaraeT01 soKpyr son oca. ITpvi 6oJI&IIIOM yneJiwcteH"111 M0)!(}{0 }'B1'll::\eTbMT-JO)!(CCTBO MeJIK"1X crrop, pacnOJlO)l(eH- 1-!b!X Bl-Iyr]JH H Cttapy)!(H BOJlOCa . .[(Jut nosepXHOCTifOlii. -rpwxoqntTl1'"160- nee xapaK'rep1-10 pacnoJIO)!(eJ-nte cnop sttyTPH sonoca (endothrix) .

4. .D,MarnocTwKa c noMOJW>JO naMITbI ByAa.

5.KynbrypanbHOe wccr1ep:ona1-me.

cTyio "IaCTb roAOBhI.

THilH'IHM(ceyTyA.Hpmui) cpopMa: OCHOBHb!M 3ACMCHTOM SIB-

A.HeTCS'ICeyTyAa (cpaB03Hb!H II."(HTOK), rrpeJI.CTliB.IU'llOII."(asl:co6oH: 'IHCTylO KYAh'JYPYrpn6a B 3rnr;:i:e pMnce. IIopa:iKeHue BOAOCHCTOH 'laCTHroAoBhI n p os:rBA.HCTC.H 3pHTCMaT03HO-HHcpHAhTpaTHBHb!MH O'laraMH,B KO- T OpbIX Haps:r;:zy c qewyH:KaMH pacnoAararoTCSI cpaB03HbIC II."(HTKH - CK)"ryi\hl B BH}J:C :lKeATOBaTo-cephIX OKpyrJ\bIX o6pa30BaHHH c l\CHTpa.AbHbIM s.n;asAeHHcM . IIopa)KCHHbie BOAOCbI TycKll.hre, aTpocpH'lHhic,

89