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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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Viral Dermatoses

Herpes simplex

The main features of herpes viruses are their lifelong persistence in the body of a person once infected by them, the strongest dependence of the course of a chronic infectious process on the state of immunity of the virus carrier and the tendency to recur.

About 70% of children and 80-90% of the adult population have antibodies to the herpes simplex virus. The source of infection is an infected person, both during the period of clinical manifestations and during the latent course of infection. The disease is caused by herpes simplex viruses I (mainly non-genital localization) and II (predominantly genital localization) of types related to DNA viruses. Infection occurs mainly through contact (household items, kisses, sexual intercourse), and an air-drop path is also possible. Through the skin or mucous virus enters the lymph nodes, then into the blood and internal organs. The reservoir of the virus after infection is the regional sensitive ganglion (spinal or craniocerebral), where the virus is in a latent state. In most people, only a virus-carrier is detected and only a small part of the infection manifests itself. In the immune defense, specific and non-specific factors are important: the leading role is played by T-cell mechanisms of immunity. Great influence is exerted by the ability to produce interferon.

Clinically, simple herpes is manifested by the rapid eruption of a group of vesicles on the edematous erythematous background. Precedes rashes and accompanies their burning sensation. Quite quickly (within a few days) the bubbles dry up with the formation of crusts or open with the formation of erosion. Erosions can merge and form one fairly large erosion with polycyclic contours. There is a possible response from the regional lymph nodes. After 1-2 weeks usually crusts fall off and erosion is epithelialized. However, in some immunocompromised people, the disease is prone to relapse. As factors provoking relapses, hypothermia, colds, exacerbation of foci of chronic infection, stressful situations, removal of teeth, sexual intercourse. Localization of manifestations of herpes simplex - any, but the most often it appears on the skin of the lips, the wings of the nose and foreskin. Typical rashes can also be localized in any part of the oral mucosa and manifest in the form of stomatitis, gingivitis, pharyngitis. On the site of the bubble eruptions, surface erosions with polycyclic edges are formed, aphthae. Typical soreness in the lesions, intensive salivation. Possible damage to the eyes in the form of conjunctivitis, keratitis, iridocyclitis, etc.

It is possible to develop atypical forms of herpes simplex: edematous (sharp edema without pronounced vesicles, especially often on the genitals), abortive (manifested by scant papular eruptions), hemorrhagic. In some patients recurrences of herpes simplex are accompanied by fever, meningeal phenomena, muscle pain, polyadenitis. In patients, patients treated with cytostatics and immunosuppressants, patients with leukemia, cancer, HIV-infected, as well as patients with atopic diseases, it is possible to develop generalized herpetic lesions of the skin - varicelle-shaped pustules of Kaposi.

Treatment of herpetic infection depends on the form of the disease, the severity of the course, the frequency of relapses. With localized mucosal and skin lesions occurring without general symptoms and recurring less frequently than once every 6 months, they are limited to external use of antiviral drugs (acyclovir, etc.), as well as alcohol and aqueous solutions of aniline dyes.

In those cases where the herpetic infection recurs more often or is common, stage treatment is provided, including treatment of acute manifestations during relapse, anti-relapse therapy, vaccination and dispensary observation. In the period of relapse, systemic antiviral drugs from the group of abnormal nucleosides are prescribed (most often - acyclovir, with resistance to it - valaciclovir or famciclovir) in combination with their external use. Recombinant and genetically engineered interferons (reaferon, welfiron, intron-A, etc.), as well as interferon inducers (neovir, cycloferon, larifan, ridostine) are also used. With a significant edema, tenderness, non-steroidal anti-inflammatory drugs (indomethacin, voltaren, etc.) are used. External in case of damage to the oral mucosa, aqueous solutions of aniline dyes can also be used, and in the case of ophthalmogerpes, florenal, trifluridine, othane-IMU, etc.

In the interrepid period, antiviral drugs are prescribed in combination with courses of interferon and nonspecific immunomodulators. When stable remission is achieved, vaccination with inactivated herpetic vaccine is carried out.

Herpes zoster

The causative agent of the disease is a virus that causes chicken pox in children.

Older people get sick more often. In most cases, rashes on the skin are preceded by a different intensity of pain along the course of individual sensitive nerves. Pain syndrome can be misinterpreted as a manifestation of myocardial infarction, cholecystitis, appendicitis, renal colic, etc. Somewhat later (usually within 24 hours) there appear grouped eruptions represented by bubbles with transparent, less often turbid or hemorrhagic contents located on the edematous erythematous background . Occasionally, the vesicles merge with the formation of large cavities (bullous form). Characterized by the asymmetric location of the rash, more often along the intercostal nerve. The zones of the trigeminal or facial nerves can be affected. HIV-infected patients often have generalized manifestations. As well as herpes simplex, herpes zoster may be abortive or severe (hemorrhagic and gangrenous forms). Pain along the affected nerves may persist for a long time after the solution of the rash on the skin.

Treatment depends on the form of the disease and the prevalence of the process. In severe forms of illness, patients are hospitalized in an in-patient hospital. As etiotropic funds use the same drugs as in the case of herpes simplex treatment. In addition, non-steroidal anti-inflammatory drugs, antibiotics, analgesics are prescribed. Oily use disinfectant and epithelializing agents.

Unlike herpes simplex, herpes zoster, as a rule, does not recur

Warts. The disease is caused by the human papillomavirus. Allocate Vulgar, flat, plantar and pointed warts. The causative agent is transmitted by direct and indirect contact.

Vulgar warts are more common in childhood and adolescence. The main localization is the skin of the hands. Non-inflammatory, rounded papules develop up to 5 mm in diameter with a rough surface due to hyperkeratosis. Individual papules sometimes merge, forming a plaque.

Flat warts are also more common in childhood and adolescence. In contrast to vulgar, they do not protrude above the surrounding skin. More often plural. Typical localization is the rear of the hands, the face.

Plantar warts are characterized by pronounced cornification. They often merge, resembling a corn. Because of violations of the elasticity of the skin, cracks are formed, patients are disturbed by soreness when walking.

Pointed warts are localized almost exclusively in the genital (most often - the coronal sulcus, the inner leaf of the foreskin, at the entrance to the vagina) and perigenital areas (in casuistic cases - in large folds). They are represented by papillary growths on a narrowed base.

To treat warts use a surgical laser, cryodestruction, diathermocoagulation, sometimes - strong acids (solkoderm). With a common lesion, interferon preparations and its inducers are shown. In 50% of cases, warts, except pointed ones, are hypnotized.

Molluscum contagiosum

The disease manifests itself by the precipitation of dense non-inflammatory papules with an umbilical impression in the center. Dimensions - from 1 to 10 mm. When squeezing, a crumbly mass is allocated. The disease is more often observed in childhood. Probably spontaneous cure for several months. It is shown that the contents of the papules are squeezed out, followed by lubrication with a 5% solution of iodine.


This group of diseases includes skin lesions associated with the bites of bloodsucking insects, and diseases caused by true skin parasites (scabies).

In general, the reaction to the bites of blood-sucking insects (mosquitoes, bugs, etc.) is quite standard: at the site of the bite a small itchy red blister is formed, surrounded by an anemic corolla. However, in some people a dense, strongly itchy papule is formed at the site of the bite, the dimensions of which vary. In a number of cases, hemorrhagic spots and papules form at the site of the bite.

Treatment is reduced to the external use of antipruritic agents (alcohol solutions, shaken mixtures, topical steroids). With a pronounced hyperergic reaction, the appointment of antihistamines is indicated. Disinfestation of linen and premises is carried out.


The disease causes itch itch. The fertilized female mite gnaws on the skin of the person gnawing the course in the stratum corneum of the epidermis, where it lays eggs. Infected with scabies mainly with direct contact, less often indirectly through the laundry it. The incubation period usually lasts 7-10 days. When the infection is repeated, the incubation period can be shortened to 2-3 days.

Clinic. The disease is manifested by itching, mostly in the evening (especially when the patient goes to bed and warms up under the blanket). On the skin appear vesiculopapules (small papules, in the center of which are small vesicles). There are multiple brushing, crusts. Typical localization: interdigital folds of hands, flexor surface of wrist joints, anterior and lateral surfaces of the abdomen, buttocks, inner thighs. Young children and women who do not engage in manual labor are often affected by the skin of the palms, where you can see "itch moves" (in other localities they are seen badly). In men, the external genital area is often affected. In this location, scabies can manifest quite large (more than 5 mm in diameter) dense itchy papules. Similar papules in women can be observed in the area of ​​the mammary glands. Almost never is the scalp. However, in infants and in persons receiving long-term treatment with systemic steroids or using topical steroids for long periods of time, it is possible to manifest scabies in this localization.

With prolonged course, both the stagnation of clinical manifestations and the secondary eczematism of lesions can occur. The course of scabies is often complicated by the addition of pyococcal infection. As a result, various pyoderma develop: folliculitis, furuncles, impetigo. Especially characteristic are papular eruptions, covered with purulent crusts, on the extensor surface of the elbow joints. In such cases, the diagnosis of the disease is difficult. Usually, there are indications of the presence of itching diseases in close relatives, as well as sexual contacts. At the same time, in persons observing hygienic norms, scabies can proceed abortively: itching is mild, rashes a small amount. "Masking" scabies and unjustified use of topical steroids.

For the diagnosis of scabies, a method of microscopy of skin scrapings is used. However, it should be noted that this method is very imperfect and the negative result does not exclude the presence of scabies.

Treatment consists in using various anti-scaling agents. When eczematizing, it is also necessary to use anti-inflammatory drugs, with piococcal complications - antimicrobial.

Currently, the most common treatment for scabies is 20% ointment of benzyl benzoate. Duration of the course is 5-6 days. On the first day of the patient, after taking a shower, rubs the ointment of benzyl benzoate into the skin (the whole surface of the skin is treated except for the head, regardless of the presence of rashes). Change of bed linen and bed linen is made. In the premises, wet cleaning is carried out, if necessary, insecticides are used (aerosol A-PAR). In the next 2 days, the patient does not wash (hands after washing are re-treated with benzyl benzoate ointment). On the fourth day, the benzylbenzoate ointment is repeatedly rubbed into the entire surface of the skin except the scalp. On the ninth or sixth day the patient takes a shower, a repeated change of bed linen and clothes.

It is possible to use 20% sulfuric ointment, which is rubbed into the skin once a day for 5 days. Washing with change of linen is made on the second and sixth days. It should be remembered that sulfuric ointment causes dermatitis more often than benzyl benzoate.

Contemporary anti-scratch drugs include aerosol "Spregal". The drug is washed off after 12 hours after application to the skin. It is advisable to repeat the treatment on the fourth day.

It is necessary to conduct examinations of all persons who have been in contact with the patient with scabies, weekly for 1.5 months. In close contact it is recommended to carry out anti-scratch treatment regardless of the presence or absence of manifestations of the disease.

Lice (pediculosis)

Isolate head, pubic and clothing lice.

Head lice often parasitize the skin of the scalp of women and children. Patients complain of itching, especially in the occipital region. Characterized by excoriation, there are often manifestations of secondary pyoderma. When examined, lice and nits are identified.

Louse lice are found in the seams of clothing. Characteristic of the presence of linear excoriations, mainly in the field of scapula and lumbar region.

Pubic lice affect the pubic region, but with a pronounced hair coat, the lesion can be common. Pubic lice are attached to the base of the hair, so they are usually easy to detect. After their bites, itchy blue stains remain, not disappearing when pressed. For the treatment of pediculosis usually use drugs permetrin. Hygienic measures are mandatory.

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