Leica M7

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Category:
Skincare
Active Ingredient:
Isotretinoin
Disease:
Acne
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Accutane is given to patients for treating severe acne that do not respond to other medicines. Accutane is a retinoid. It works by reducing skin oil production, changing the characteristics of the skin oil, and preventing abnormal hardening of the skin.

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Bacterial skin diseases

Pustular skin diseases (pyoderma)

The most common disease is caused by pathogenic staphylococci and streptococci. However, the cause of pyoderma development may be leptotriks, Pseudomonas aeruginosa, diphtheria bacillus, etc. Mixed flora is often found. In chronic purulent inflammation, especially in the presence of skin fistulas, protaeus, E. coli, and corynobacteria can be sown.

Healthy skin has a natural defense against pathogenic microorganisms. This is due to the continuity of the skin, constant exfoliation, acidic pH, bactericidal properties of polyunsaturated fatty acids, antagonistic properties of normal skin microflora.

A number of exo- and endogenous factors contribute to the development of pyoderma. Exogenous factors that interfere with the barrier function of the skin include micro- and macro-traumas (scratching, pricking, rubbing, cuts, insect bites, etc.), macerating the stratum corneum as a result of increased sweating, exposure to moisture, skin contamination as domestic (violation of hygiene standards) , And professional (lubricating oils, flammable liquids, coarse dust particles of coal, cement, earth, lime), general and local hypothermia, overheating. Endogenous factors lead to a decrease in humoral and cellular immunity, which again results in a decrease in the protective function of the skin. Such factors include the presence of foci of chronic infection in the body (ENT pathology, odontogenic and urogenital chronic pathology, endocrine diseases (primarily diabetes mellitus, hypercorticism, hyperandrogenia), chronic intoxications (alcoholism, drug addiction, etc.), eating disorders (hypovitaminosis, Deficiency of protein), immunodeficiency states (treatment with glucocorticoid hormones, immunosuppressants), HIV infection / AIDS, radiation therapy, etc.).

Features of the clinical picture of pyoderma depends both on the pathogenicity and virulence of the pathogen, and on the site of its introduction, the state of specific and nonspecific antimicrobial protection.

Staphylodermia

Currently, a large number of both pathogenic and opportunistic staphylococci are isolated. The clinical picture with staphyloderma can be different. There are surface and deep staphylococcal pyoderma.

To superficial are ostiophalliculitis, superficial folliculitis, impetigo staphylococcal bullous (in children), staphylococcal pemphigoid of newborns. Deep staphylodermia: deep folliculitis, furuncle, furunculosis acute localized and general, carbuncle, hydradenitis, multiple abscesses of the skin of infants.

Almost all staphylococcal skin lesions are characterized by anatomical attachment to the hair follicles and purulent or purulent-necrotic nature of the inflammation.

Ostiophalliculgens are manifested as single, less often grouped follicular pustules, surrounded by a small erythematous corolla. Ostiophalliculitis often complicates the course of itchy skin diseases. Inadequate treatment, they can be transformed into deep folliculitis and furuncles.

Folliculitis is also characterized by the formation of follicular pustules. However, in these cases, erythema is more pronounced, and in the base, palpation is palpated.

At furuncles, a purulent-necrotic inflammation of the hair follicle and surrounding tissues is formed. The boil starts as an ostiofolliculitis or folliculitis, however, from the very beginning, a marked soreness of the lesion focus is characteristic. A few days later, a sharply painful inflammatory knot forms (in diameter - several centimeters). In the center of the node is usually visible crust (dried up pustule). A few days later the knot is opened, pus is released and a necrotic stem of greenish color becomes visible. After the rejection of the necrotic stem, an ulcer is formed which is quite quickly cicatrices. Sometimes, especially with improper external treatment, which hampers the outflow of pus, the furuncle can be transformed into a subcutaneous abscess. Perhaps the development of complications (especially when trying to squeeze out pus) due to the penetration of the pathogenic origin into the lymphatic (lymphangitis, lymphadenitis) and the blood (sepsis) system, into the surrounding tissues (phlegmon, osteomyelitis).

Carbuncle begins in much the same way as a boil. However, in these cases, the purulent-necrotic process necessarily captures the subcutaneous fatty tissue. Patients with carbuncles are subject to hospitalization in the departments of purulent surgery, where against a background of mandatory systemic antibiotic therapy a surgical opening of the lesion will be performed.

Gidradenig - purulent inflammation of the apocrine sweat gland. Localization: armpits, much less often, other areas of the skin where there are apocrine sweat glands (perianal and perigenital areas, pubis, circles of the nipples of the mammary glands). Typically, the formation of a fairly large inflammatory node, which quickly opens with the release of a large amount of pus. Unlike a furuncle with hydradenitis, a necrotic stem is not formed. Factors predisposing to the development of hydradenitis are traumatization of the axillary region during shaving, the use of antiperspirants.

In infants, due to the peculiarities of the skin structure, the vesicle element with staphylodermia may have a blister. In such cases, staphylococci significantly penetrate the blood and lymphatic systems, into the subcutaneous tissue.

In some cases, staphylococcal skin diseases can occur chronically. To such variants of staphylodermia are sycosis vulgar, furunculosis chronic (localized and acute) and folliculitis decalving.

Vulgar sycosis occurs mainly in middle-aged men (more often in neurasthenics with a lower sexual function). Usually the process is localized in the area of ​​the beard and mustache. Contribute to the chronic course of the disease, trauma and additional contamination when shaving. There are deep pustules on an inflammatory background. These elements merge, forming a single, painful plaque covered with a purulent crust. When pumping out of the focus pus is released. The disease lasts for a long time (for years and even decades).

With chronic furunculosis, recurrent single furuncles. The process can be localized or disseminated. In cases where boils recur in one place, the effect of exogenous predisposing factors (contamination, trauma, etc.) should be excluded first. The development of common furunculosis is promoted by endogenous predisposing factors (in the first place, hormonal disorders).

Streptoderma

Streptococcal skin lesions are more characteristic of childhood. This is due to the characteristics of the skin of the child (including the relative weakness of its antimicrobial protection and the characteristics of reactivity). Unlike staphylococci, streptococci are not attached to the hair follicles, but, directly affecting the skin, tend to spread quickly. Typical for streptoderma, the nature of skin inflammation is exudative. The lytic enzymes released by streptococci lead to the formation of a primary efflorescence typical for streptococcal lesions - a flabby superficial bladder (flickenes). Streptococci are more likely than staphylococci to enter the lymphatic system, and therefore, with streptodermia, it is often necessary to prescribe systemic antibiotic therapy.

The most common streptococcal impetigo. The resulting surface bubbles are very quickly opened, and the exudate dries up with the formation of characteristic golden ("honey") crusts. With the addition of staphylococcal infection, the crusts become thicker, acquiring a greenish-brown color (vulgar impetigo). Most often impetiginoznye rashes appear on the skin of the face. The disease for children is highly contagious (a child with impetigo should not visit children's institutions). Abortive variants of the disease are possible: slit-like impetigo (only the corners of the mouth, bovine folds, etc.) are affected, simple lichen (weakly peeling erythematous spot).

Streptococcal intertrigo (intertriginous streptoderma) develops in large folds in the presence of predisposing factors (increased nutrition, diabetes, increased sweating, hemorrhoids, the use of compresses on these areas, etc.). Because of the peculiarities of localization, the crusts are not formed. In the folds, there are large erosions with the collar of the exfoliating stratum corneum along the periphery. In places where the pathological process "creeps out" beyond the fold, it becomes impetigo.

The treatment uses aqueous solutions of aniline dyes, combined preparations containing, in addition to the antibiotic, an antimycotic and a topical steroid (such as triderma).

Chronic diffuse streptoderma often develops in the elderly on the skin of the shins. Predisposing factors are vascular diseases (obliterating endarteritis, varicose veins, etc.). Occasionally, there is a lesion of the skin of the scalp in women with impaired sex hormone production. Clinically, the disease manifests itself as a hotbed with large-faceted borders, covered with thick layered crusts. When removing crusts, a bright red damp erosive surface.

Ectema is the only option for deep streptoderma. Occurs with frequent traumatization of the skin in weakened people. Typical localization is the skin of the shins. Characteristic is the formation of a bladder or pustule against a background of deep infiltration. Later, the contents of the bladder or pustules dry up and a crust deep in the skin and hard removable. With a favorable current, the ulcer under the crust is scarred, gradually displacing the crust.

Treatment of any pyoderma requires a mandatory effect on the cause of the disease (carrying out etiotropic / antimicrobial treatment, eliminating predisposing factors, both exogenous and endogenous) and preventing the spread of infection to unaffected skin areas (prohibition of washing, especially with streptodermia, treatment with antiseptic solutions). External treatment depends on the localization of the focus and features inflammation.

Indications for the use of systemic antimicrobial agents:

  • 1. Multiple pyoderma, their rapid spread to the skin, the absence of the effect of external therapy.
  • 2. The appearance of enlarged and painful regional lymph nodes.
  • 3. The presence of the general reaction of the body to purulent inflammation: fever, chills, malaise, weakness, etc.
  • 4. Deep uncomplicated and, especially, complicated pyoderma persons (threat of lympho- and hematogenous dissemination of infection up to thrombosis of venous sinuses of the brain and development of purulent meningitis).
  • 5. Relative indication (the question is solved in each case by the combination of clinical data) is the presence of even mild forms of pyoderma in weakened patients against immunosuppressive, radiotherapy, in HIV-infected patients, in patients with endocrine or hematological pathology.

Now in adult practice fluoroquinolones are more often used, in children's - cephalosporins and macrolides.

Atypical pyoderma. Excrete abscessed, ulcerative and vegetative pyoderma. In all cases, granulomatous structure, chronic course and low effectiveness of systemic anti-microbial therapy are characteristic. The development of atypical pyoderma is always associated with the presence of endogenous predisposing factors.

Tick borreliosis. Borreliosis is an infectious disease caused by spirochete - burgrelia Burgdorferi and carried by ixodid mites. Most cases of the disease are recorded in the spring and summer-autumn periods. The causative agent falls into the skin with the saliva of an infected tick, later on the borrelia along the lymphatic pathways or with the blood stream enter the internal organs. The most commonly affected skin, myocardium, central nervous system, joints.

Clinic. Allocate the early and late stages of the disease. In 3-30 days after a tick bite, migrating erythema Afzelius-Lipshutz is formed in 60-80% of cases, which is a swollen red spot with centrifugal growth. In the center of the spot is often noted hemorrhagic crust. After a short peeling, the stain is allowed without a trace. The appearance of rashes may be associated with an influenza-like condition. Significantly less often at an early stage of the disease, a borreliosis lymphocytoma develops, clinically manifested by single, slightly painful palpations of nodules or red patches. A characteristic localization is earlobe, nipples and halos of the mammary glands, skin of the breast.

The late manifestations of borreliosis include chronic atrophic acrodermatitis, which develops in many months. Against the background of a dense edema of the foot or shin, there appears stagnant erythema. Erythema lasts for years, its area slowly increases. It is accompanied by erythema edema and skin infiltration. Atrophy gradually develops atrophy skin. Characteristic of the presence of paresthesias and violations of skin sensitivity. In addition, there may be lesions that resemble plaque scleroderma.

The diagnosis is based on clinical and serological data. Treatment is done with antibiotics.

LeprosyLeprosy (leprosy, Hansen's disease) is a chronic granulomatous disease caused by M. leprae; The disease usually affects the skin, mucous membranes of the upper respiratory tract and peripheral nervous system. The main clinical manifestations of the disease are determined to a greater extent by the response of the macroorganism than by the propagation of the pathogen in infected tissues.

Leprosy is one of the oldest diseases, which until now has not revealed its secrets to the end. At the moment there are about 15 million leprosy patients in the world (Africa - about 4 million, the Indian peninsula - about 3.2 million etc.). Very few countries (Denmark, Switzerland, Chile), where leprosy has not been found for a long time.

Etiopathogenesis. Pathogen - Mycobacterium leprae - an acid-fast rod-shaped bacterium (family Mycobacteriaceae). The microorganism is stable in the external environment. Leprosy pathogens are intracellular parasites of macrophages. The long duration of the incubation period is associated with a low growth rate of microorganisms.

Leprosy is a highly contagious, but low-pathogenic disease. A subclinical infection is common, while only a small number of infected individuals have clinical manifestations. It is believed that no more than a third of people are susceptible to leprosy. It is assumed that a close contact "skin with skin" is necessary for infection. However, this has not been fully proved. The relatives of patients get sick more often, which confirms the genetic predisposition to the disease. With the tuberculoid type, an autosomal recessive type of inheritance has been proven.

The entrance gate is the mucosa of the upper respiratory tract. Accidental infection can be with tattooing, vaccination against smallpox, and surgical operation.

Age is any, but new cases prevail among children and youth. Men get sick 2-3 times more often than women.

The general state of the body has almost no effect on the susceptibility or type of manifestation. Prolonged depletion may predispose to the development of the disease, but the nutritional status does not affect the effectiveness of the treatment. The climate also has no significant effect, although at present the disease is more common in countries with hot and humid climates.

The hormonal background is important. The first manifestation can be soon after puberty, during pregnancy or after childbirth. In these periods, old lesions can appear new and become more active.

Immunity with leprosy is cellular in nature, it is minimal in lepromatous and dimorphic leprosy and is maximal in patients with tuberculoid leprosy.

Incubation period. In cases where it is possible to establish the shortest "slow period" between inoculation and the appearance of an open lesion, it is 2-3 years.

Tuberculoid type. The skin, peripheral nervous system, rarely - internal organs are affected. The causative agent is detected by histological examination of organs, in skin scrapes. The pathogen is absent in the nasal mucosa. Lepromin test (intradermal injection of autoclaved M. leprae) is positive: there may be an early reaction - hyperemia, a small papule after 48 h and late - in 2-4 weeks - a tubercle, knot, sometimes with necrosis. The lepromine test has no diagnostic value, its result allows to judge the immunobiological activity in relation to M. leprae.

Typical is the rash of small reddish-cyanotic flat polygonal papules, which often merge to form figures (disks, rings, semirings). The peripheral cushion is also characteristic (the outer margin is raised, clearly delineated, more saturated, and the inner edge is "blurred", fuzzy into the central pale part of the lesion). Peeling, erythematous and depigmented rashes are possible. The sensitivity in the elements of the rashes decreases and often near them. Initially, slight hyperesthesia develops, then the thermal, pain and tactile sensations gradually disappear. Sweating is reduced, then stops. Hair fade, may fall out. Localization is asymmetric, it is possible to damage any part of the skin.

Lepromatous type. The most severe form. Polymorphism of clinical manifestations is characteristic, especially in the skin. In addition to the skin, the mucous membranes of the nose, the oral cavity, the nasopharynx, the larynx, sometimes the trachea, as well as the lymph nodes, peripheral nerve trunks, organs of vision, hearing, genitourinary, and sometimes internal organs are affected. Lepromine test is negative.

The first manifestations of the disease are usually round or irregular outlines of erythematous spots with a shiny surface. The most characteristic localization is the face, extensor surfaces of the hands, forearms, shins. Characteristic symmetry of rashes. Later, infiltration appears, plaques with normal sensitivity or hyperesthesia are formed. Because of the increased function of the sebaceous glands, the surface of the plaques is oily, shiny. Sweating is reduced (further disappears completely). After 3-5 years, eyebrows and puff hair on the plaques drop out. With diffuse infiltration of the facial skin, natural wrinkles and folds deepen, the superciliary arches protrude sharply, the nose is thickened, the cheeks and lips are lobate. Usually, the scalp, ulnar and popliteal fossa, axillary cavities are not affected. In the field of infiltrates appear single or multiple tubercles and nodes (leproms) - sharply delineated, painless. They can be dermal and hypodermal. Consistency is dense-elastic. In the future, these elements are sluggish, without pronounced inflammatory phenomena, ulcerate. Similar rashes can appear on unchanged skin.

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