Dermatovenerological Institute of Roszdrav
Somatic diseases are often accompanied by skin manifestations, which, due to their visibility, become the first signs that attract the patient’s attention long before the onset of other symptoms of the disease. The doctor’s task is to promptly discern the connection between skin rashes and an imperceptibly developing somatic disease, which, in its consequences for the patient, can be immeasurably more dangerous than a minor cosmetic defect. The sooner the true cause of skin manifestations is suspected and the patient is sent for examination, the sooner he will begin pathogenetic rather than symptomatic treatment.
Disorders of the metabolism of amino acids, carbohydrates, lipids, purines, vitamins, minerals, trace elements, heme, connective tissue diseases, as well as cancer can be suspected during a routine examination of the skin. Let us dwell only on some groups of diseases.
Necrobiosis lipoidica is a common manifestation of metabolic disorders. In one third of patients, it occurs against the background of existing diabetes mellitus and diabetic angiopathy. Another third of patients have impaired glucose tolerance. At the same time, among patients with diabetes, this dermatosis is quite rare - less than 1%. The cause of collagen necrobiosis in lesions is changes in the microvasculature.
In approximately 20% of patients, skin changes appear long (from 1 to 10 years) before the development of diabetes mellitus, in 25-32% - simultaneously. There is no direct relationship between the severity of diabetes and the severity and progression of the skin process.
In the first stages of development, necrobiosis lipoidica is clinically manifested by pinkish-red nodules of a cone-shaped or hemispherical shape with a smooth surface and a pearlescent sheen, predominantly localized on the anterolateral surface of the legs. Merging, they form infiltrative plaques: new ones are yellowish, old ones are brownish-red in color, with sharply defined boundaries, ranging in size from 2 to 10-12 cm with a glossy, waxy surface. Dilated vessels of the dermis are visible through the atrophied epidermis. In patients with diabetes mellitus, foci of necrobiosis lipoidica are often prone to ulceration. After the ulcers heal, scars, atrophy and telangiectasias remain in their place. Nodules located on the periphery of the lesion acquire a more saturated, stagnant shade and rise above the level of the central part. On palpation there is a scleroderma-like compaction, more pronounced in the central part. The outcome is scar-like atrophy. The formed lesions consist of two zones: in the center - ivory-colored skin, shiny, smooth, with scar-like atrophy, dense on palpation, reminiscent of plaque scleroderma. There are no hair follicles.
Xanthomatoses are manifestations of impaired lipid metabolism on the skin. Hyperlipoproteinemias are primary (hereditary) and secondary (with severe hyperthyroidism, liver cirrhosis, chronic pancreatitis, decompensated diabetes, nephrotic syndrome, systemic lupus erythematosus and other rarer diseases).
Using electrophoresis, 5 types of hyperlipoproteinemia were identified, and skin lesions occur in all 5 types.
Xanthelasmas are yellowish soft plaques in the eyelid area, mainly in women. Usually indicate familial hypercholesterolemia and dysbetalipoproteinemia, but can also be observed with normal lipid levels.
Tendon xanthomas are slowly growing tumor-like formations in the tendon area (Achilles tendons, extensor fingers) - with familial hypercholesterolemia, with hypothyroidism. Patients with tendon xanthomas should be examined to exclude cerebral pathology, which is more common in them than in the general population.
Tuberous xanthomas are large tumors and plaques of brown color, dense consistency, localized on the elbows, knees, fingers, and buttocks. Patients are diagnosed with familial dysbetalipoproteinemia, familial hypertriglyceridemia with phenotype IV, and a homozygous form of familial hypercholesterolemia.
Eruptive xanthomas serve as a marker of hypertriglyceridemia. A flat strip-like xanthoma (usually in the folds of the palms) is characteristic of type Ill, a flat intertriginous xanthoma is characteristic of type II hyperlipoproteinemia, dysbetalipoproteinemia, familial hypertriglyceridemia with phenotypes IV and V, with lipoprotein lipase deficiency. The most common are eruptive xanthomas: multiple, symmetrically located papular elements with clear boundaries, the fusion of which forms plaques (tuberous-eruptive xanthomas). Tumor-like formations ranging in size from a pea to a walnut in tuberous-eruptive xanthoma have a lobular structure, fused into a conglomerate, immobile, dense. Color - yellow, with a red rim. They can be combined with xanthelasmas and xanthomas of the tendons, especially the Achilles. Localization - mainly in the area of joints (knees, elbows, shoulders), on the buttocks, the back of the fingers, on the skin of the face, and scalp.
Xanthomatosis against the background of a persistent increase in the level of cholesterol, phospholipids and hepatosplenomegaly is a characteristic sign of Buerger-Grütz disease. In biliary cirrhosis of the liver, xanthomas are detected in 1/3 of patients.
The prognosis for life is cautious due to severe atherosclerosis.
Multiple lipomas and lipomatosis can appear after certain infections (acute articular rheumatism), after childbirth, rapid weight loss, damage to the pituitary gland, etc. They are often accompanied by elevated cholesterol levels. Multiple lipomas are localized symmetrically on the upper extremities, abdomen, lower back, buttocks, and thighs.
Symmetrical lipomas may be one of the signs of Gardner-Richards syndrome, an autosomal dominant hereditary disease whose clinical picture consists of symmetrical lipomas, colon polyps, fibromas and osteomas of the upper jaw or long bones. In 30% of cases, polyps transform into cancer.
Lipidoses are a group of diseases characterized by the accumulation of lipids inside cells, in contrast to plasmatic hyperlipidemias with an increased content of blood lipids.
The cause of development is a congenital (usually autosomal recessive type) defect of lysosomal enzymes, as a result of which excessive deposition of products of incomplete lipid breakdown occurs in various tissues. The severity of the clinical picture is determined by the degree of defect in enzyme activity (partial, total). The more significant the defect, the earlier the disease appears and the more severe it is.
Fabry disease (Fabry angiokeratoma, Anderson-Fabry disease) is caused by a defect in the lysosomal enzyme α-galactosidase, which leads to the accumulation of galactosyl-glucosyl-ceramide in cells. The population frequency is 1:40,000. The genetic defect is associated with the X chromosome and is inherited in a recessive manner, so women (carriers of the gene) rarely get sick. Patients usually die before the age of 40 due to cardiac, renal, and brain pathologies.
The first clinical signs appear at the age of 5-7 years with malaise, fever, pain in the joints, abdomen, and, less commonly, burning pain in the fingers and toes, especially when the temperature changes (“Fabry crisis”). Skin manifestations occur in childhood or early adolescence as small, dark red, soft nodules with a smooth or hyperkeratotic surface. They are located scatteredly or very densely on any part of the skin, most often on the abdomen, thighs, buttocks, cheeks, fingertips, scrotum, axillary and popliteal fossae, as well as in the oral cavity, at the border of the hard and soft palate. The nodules are smaller than with Mibelli angiokeratoma. Palpation creates the impression of a “grater”.
Determination of glucocerobrosidase activity in amniotic fluid cell culture allows prenatal diagnosis in the second and even first trimester of pregnancy.
Calcinosis of the skin is the deposition of calcium salts in the form of grains and stones during hypercalcemia, which develops with dysfunction of the parathyroid glands and tumors, with hypervitaminosis D, chronic kidney disease, bone diseases, with acidosis, scleroderma (without hypercalcemia).
Generalized idiomatic (primary) calcification of the skin is a rare disease that can be observed in childhood or young adults. It appears as small, very dense nodules, several millimeters in diameter, localized in the fingertips, symmetrically at the joints, less often on the torso and almost never on the head. The elements slowly increase in size, reaching a plaque diameter of 5 cm. In this form, slowly increasing in size, they can exist for years, but can open up, releasing a mass whose chemical composition is calcium phosphate with a small proportion of calcium carbonate. On an x-ray, calcium accumulations are clearly visible, in contrast to clinically similar nodes (tophi) from urates in gout.
Secondary calcification develops in areas previously affected by any inflammatory process (tuberculosis), parasitic infection (echinococcosis, dracunculosis, filariasis, etc.), in areas of frostbite (ears), injuries, with systemic lupus erythematosus, postoperative scars, elastic pseudoxanthoma, dermatomyositis, various skin neoplasms. Calcium deposition is preceded by primary changes in the connective tissue and blood vessels of the skin and subcutaneous tissue, creating the physicochemical prerequisites for their calcification.
In 25% of patients with systemic scleroderma, calcium deposition is observed in the skin and subcutaneous tissue ( Tibierge-Weissenbach syndrome ). The syndrome is observed mainly in women aged 30-55 years with diffuse scleroderma. First, patients develop suterodermic changes in the skin, and then (on average after 11 years) the phenomena of calcification develop in the form of nodes of various sizes - from a pinhead to 2-5 cm or more in diameter. Nodes are formed mainly in areas subject to pressure: palms, soles, terminal phalanges of the fingers, on the extensor surfaces of the forearms, on the buttocks. They can be found in the periarticular tissues of the phalanges, elbow and knee joints.
With Tibierge-Weissenbach syndrome, calcium deposits are observed in various organs and tissues: liver, spleen, kidneys, stomach, etc. Calcium deposits at the entrance of the esophagus to the stomach causes stenosis of this section of the esophagus and is the cause of dysphagia.
Gout - “foot trap” (Greek) - a disease with a violation of purine metabolism and the accumulation of uric acid in the body, occurring with repeated attacks of acute arthritis, with the deposition of urates in tissues and periodic or permanent dysfunction of a number of organs and systems (mainly musculoskeletal musculoskeletal system). The prevalence of gout is 34:100,000, but the correct diagnosis is often made 15-20 years after the onset of the disease. Gout is more common in the urban population who consume excessive amounts of meat, with little physical activity, with active intellectual activity, mainly in men suffering from arterial hypertension and/or urolithiasis.
Primary gout is an independent disease, which is based on genetic defects in enzymes involved in purine metabolism. Secondary gout is a manifestation of other diseases (myeloid leukemia, chronic renal failure, hemoglobinopathies) or a consequence of the use of drugs that disrupt the metabolism of purines in the body (riboxin, cytostatics, saluretics, indapamide).
Gouty nodes (tofi) - deposition of needle-shaped crystals of uric acid in the skin, subcutaneous tissue and connective tissue of many joints. Occurs in 50-58% of patients. Favorite localization is the ears, near the joints (fingers, elbows), in the tendons. In the first days, the rashes look like painful, inflammatory soft nodes, then they become hard, signs of inflammation disappear, and the skin above them acquires a normal color. Sometimes the nodes are opened with the release of a whitish liquid - urates. On fluoroscopy, gouty nodes are transparent, unlike nodes with calcinosis of the skin.
A variety of clinical manifestations on the skin with a more or less high degree of probability may be signs of an oncological process developing in the body. Depending on the frequency of combination of skin manifestations with the oncological process, paraneoplastic dermatoses are divided into obligate and facultative, as well as hereditary syndromes. Currently, paraneoplasia includes more than 60 nosological forms: Peutz-Jigers-Turaine, Gorlin-Goltz, Bazex, Sweet, Leser-Trélat syndromes; acanthosis nigricans, Hammel's circular erythema, Darier's ring-shaped centrifugal erythema, dermatomyositis, xeroderma pigmentosum, bullous pemphigoid, Dühring's dermatitis herpetiformis, follicular mucinosis, acquired ichthyosis, acquired hypertrichosis of vellus hair and many others. Paraneoplastic dermatoses are characterized by their disappearance after surgical removal of the tumor, successful cytostatic or radiation therapy, as well as the reappearance of previous skin manifestations after activation of the oncological process.
Gammel's circular erythema (erythema gyratum repens) is a rare form of obligate paraneoplasia, first described by J. Gammel in 1952 in a woman with breast cancer. Skin rashes usually precede the onset of the cancer process by several months, but can occur simultaneously or be delayed. The clinical picture is extremely peculiar: itchy, erythematous, scaly rings and garlands of bizarre, daily changing, creeping (repens) outlines, between which areas of unchanged skin remain. The scales are small, pityriasis-like, but can be large-lamellar. After removal of the tumor, itching and clinical manifestations disappear within a few days.
Acanthosis nigricans (papillary pigmentary dystrophy of the skin, acanthosis nigricans) is an obligate paraneoplastic dermatosis. It is divided into 5 types with a similar clinical picture, but a different prognosis for the patient.
The juvenile (benign) form can begin in early childhood or adolescence and is not associated with endocrine diseases.
Benign acanthosis , combined with endocrine diseases: non-insulin-dependent diabetes mellitus, hypothyroidism, Itsenko-Cushing syndrome, androgenism. Close to it is the medicinal acanthosis nigricans, which develops during the treatment of patients with diethylstilbestrol, glucocorticoids, and large doses of nicotinic acid.
Symptomatic acanthosis (pseudoacanthosis) is usually observed in obese women with dark skin.
Malignant acanthosis nigricans , which occurs in people over 40 years of age, which is an obligate paraneoplastic dermatosis, accompanies the oncological process in 80-90% of cases. In half of the cases it is combined with gastric carcinoma, in 20-25% - with cancer of the urinary tract, genital organs and other localizations.
Clinically, with all types of acanthosis nigricans, there is an increase in skin pigmentation and thickening in areas of natural folds - in the groin area, armpits, elbows, and neck. The skin pattern is enhanced, dirty gray papillary growths are visible on the surface. In the malignant form, hyperpigmentation and hyperkeratosis are more pronounced; in approximately half of the patients, villous, warty growths appear on the mucous membranes of the oral cavity and genitals. Hyperkeratosis of the palms and soles is clearly visible.
Leser-Trélat syndrome is characterized by the sudden appearance of seborrheic keratomas, their rapid increase in number and size, which in 70% of cases is combined with oncological pathology: cancer of the stomach, bronchi, prostate, uterus, mammary glands, lung, as well as malignant lymphomas. The rash, clinically and histologically identical to senile seborrheic keratosis, is usually localized on the back, chest, and limbs. The clinical picture can be varied due to inclusions of actinic keratosis, lentiginous spots, and hemangiomas.
Dermatomyositis is divided into primary childhood, primary idiopathic and secondary paraneoplastic. There are 3 variants of the course (acute, subacute and chronic) and 3 periods: prodromal, manifest and dystrophic or terminal.
Every case of dermatomyositis occurring in an adult over 40 years of age should be carefully examined to identify a possible tumor. The frequency of combination of dermatomyositis with an oncological process varies from 14 to 52%.
Clinical manifestations of dermatomyositis associated with tumors of various locations (breast, ovaries, uterus, stomach, kidneys, lungs) do not differ from the observed symptoms in the idiopathic form of the disease.
The most typical localization of rashes is in open areas: the face, especially in the periorbital area, neck, décolleté, limbs, mainly over the joints, but the rashes can spread throughout the entire skin. At first, a bright edematous erythema appears, then it acquires a purple tint or a rich brown color. Areas of hyper- and hypopigmentation, telangiectasia create a motley picture of poikiloderma. Painful paronychia and capillaritis on the fingertips and palms are common. The mucous membranes may also be affected in the form of conjunctivitis, atrophic rhinitis, stomatitis, pharyngitis, laryngitis (20-88%). Damage to striated muscles, like the skin, is one of the earliest symptoms of dermatomyositis. Initially, severe fatigue, pain, and increasing weakness of the muscles of the shoulder and pelvic girdle are noted. Patients are unable to raise their arms to get dressed (“shirt symptom”), comb their hair, or bring a spoon to their mouth. Weakness of the neck muscles prevents them from raising their head. Patients find it difficult to sit down, their gait becomes uncertain, they often fall, and it is difficult to climb a step (“staircase symptom”). Due to myofibrosis, the muscles become dense and woody. The skin over the affected muscles has a typical lilac color (“heliotrope”), is compacted, shiny, glossy, and does not gather in folds. In addition to the pathology of skeletal muscles, lesions of the muscles of the soft palate and pharynx, manifested by dysphagia and dysphonia, are observed; intercostal muscles and diaphragm (shortness of breath); myocardium (myocarditis, dystrophy).
Bullous dermatoses (Lever's bullous pemphigoid, Dühring's dermatitis herpetiformis, Sneddon-Wilkinson subcorneal pustulosis, erythematous and exfoliative pemphigus) occur in 2-18% of elderly cancer patients.
Clinically, manifestations of bullous pemphigoid are characterized by blisters with a tense cap against the background of unchanged or, less commonly, slightly hyperemic skin. The predominant localization is areas of large joints, flexor surfaces of the upper and lower extremities. Bubbles with a diameter of several millimeters to several centimeters exist much longer than with true pemphigus, and the erosions that form after opening quickly epithelialize. Bubbles can also be localized on mucous membranes. Along with vesicular elements, clinical manifestations of bullous pemphigoid may include papular and urticarial-erythematous elements and vesicles.
Dühring's dermatitis herpetiformis at the height of the attack manifests itself as polymorphic rashes in the form of urticariform, erythematopapular, vesicular, vesicular, and sometimes pustular elements, as well as excoriations, brown hyperpigmentation at the site of resolved rashes and crusts. Characterized by severe, sometimes painful itching or burning of the skin.
Subcorneal pustulosis is characterized by small, clustered, vesicular or pustular subcorneal rashes without subjective sensations or slightly itchy. The predominant localization is large (inguinal, axillary) folds, but can also occur in other areas of the skin. The mucous membranes are not affected. When fresh rashes appear along the periphery of the regressing elements, ring-shaped, arched figures and garlands with a diameter of up to 5 cm are formed. Flaccid blisters with a thin and flabby cover are filled with purulent contents.
In addition to dermatoses, which have fairly clear nosological differences, A. A. Kalamkaryan and K. K. Shadyev drew attention to hyperpigmented spots that cannot be classified, but in 15% of cases indicating a developing tumor. In this case, the process on the skin almost always preceded the cancer.
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According to medical statistics, children are more susceptible to skin diseases than adults. And not only because they are less careful and, without hesitating for a minute, will take a stray puppy into their arms or enthusiastically begin to look for “treasures” in a heap of trash thrown away by someone.
There is certainly a risk in this. However, the main danger is that children are much more susceptible to infections than their mothers and fathers.
They do not have such a “hardened” body, so many things in the world around them that are natural for an adult cause a painful reaction in them.
Doctors warn: treatment of skin diseases in children can only begin after the doctor has determined an accurate diagnosis. The fact is that the symptoms of many diseases are similar, but the treatment required is different.
If you take the wrong path, you can not only waste time, but also aggravate the problem. And yet, the more fully informed parents are about possible dangers, the higher the chances that they can be avoided.
Erythema infectiosum initially occurs like a classic cold. Then rashes appear on the face and body.
The disease spreads by airborne droplets; an infected person is especially dangerous to others at the early stage of the disease, before a rash appears.
Medications (including painkillers) are prescribed by a doctor. The baby should drink more fluids and adhere to bed rest; active games and physical activity are contraindicated.
Toxic (infectious) erythema. Advice to parents from the Union of Pediatricians of Russia:
Chickenpox reveals itself as a rash that causes itching and a constant desire to scratch the skin, so the infection spreads very quickly throughout the body.
Small wounds form at the site of redness. In later stages of the disease, the skin becomes covered with blisters, which open, dry out, and turn into scabs.
Skin rashes are one of the signs of scarlet fever . And it all starts with the fact that the patient’s larynx becomes inflamed, a fever develops, he suffers from headaches, and his stomach “sicks.” A rash (reddish, rough to the touch) appears after 1-2 days.
The risk of infection (and in the case of scarlet fever it is extremely high) is reduced by washing your hands with soap. The doctor uses antibiotics to treat this disease, and with their help it is also possible to avoid complications.
Rubella is considered a disease of the smallest children ; as a rule, it affects children aged six months to two years. Children over four years old suffer from rubella less often, but no less severely.
Infection occurs through contact with an infected person. Young patients initially show signs of respiratory problems.
The temperature remains at a dangerously high level for several days, and there are cases where this leads to epileptic seizures .
When the fever passes, a rash appears on the body. It is not recommended to lubricate it with any preparations. Antibiotics are prescribed if a sore throat or pneumonia begins to develop.
Coxsackie disease has a second name - “hand-foot-mouth” . First, sores appear in the mouth, then blisters and a rash (not causing itching) on the arms and legs, and sometimes on the buttocks. Body temperature rises sharply.
The infection spreads through airborne droplets and through the diapers of a sick child. Doctors prescribe ibuprofen and acetaminophen to the patient, recommend drinking more fluids, and recommend caring adults wash their hands more often.
Disease of the palms, feet and mouth - Coxsackie enterovirus, advice to parents from Pediatrician Plus:
Ringworm is usually especially feared by parents (it is transmitted through contact with an infected person or animal).
Ringworm is extremely contagious . It is treated with special ointments recommended by the doctor.
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Many skin diseases are allergic in nature. Unfortunately, there are more and more of them (this is how the body reacts to the negative impact of the environment), and the doctor is not always able to quickly determine the main culprit of the baby’s suffering.
The first of the allergic diseases is diathesis . It appears as rough red spots on the baby's cheeks and body.
If you can quickly find the cause of the problem and eliminate it (usually the culprits are the foods that a nursing mother eats), then the baby will not experience discomfort.
If the situation drags on, the spots will become itchy and the baby will begin to scratch them. In such cases, the doctor recommends special ointments depending on the patient’s age and the extent of skin damage.
Contact dermatitis is the result of a child coming into contact with any plants (ivy, oak) or with household chemicals.
Usually problems disappear as soon as the dangerous “contact” stops. In difficult cases, the use of special creams, lotions, and ointments is recommended.
Toxidermia, in terms of external signs and methods of treatment, resembles contact dermatitis , however, the irritant enters the body not from the outside, through the skin, but as a result of ingestion or inhalation of medications that cause an allergic reaction in the child.
Unpleasant, debilitating itching, rashes on large areas of the skin are manifestations of atopic dermatitis .
Experts explain its nature by problems of heredity and the child’s weak immune system (by the way, 80 percent of those affected are children under 7 years of age ).
The treatment is long-term, since it is necessary not only to get rid of the external manifestations of dermatitis, but also to eliminate the threat of relapse, which lies in the patient’s body.
Urticaria, which looks like a burn from an insidious plant , can actually be triggered by food (for example, eggs, fruits, nuts), medications (penicillin), and various infections.
Rashes appear on any part of the body and cause itching. If they do not go away on their own, they are treated with antihistamines.
Some experts consider allergies to be the cause of eczema , others see it as a result of nervous stress. An itchy rash usually plagues children in winter.
External symptoms are combated with moisturizing lotions. They recommend the patient to wear underwear made from natural fabrics and advise them to cut their nails short so that when scratching they do not aggravate the situation by introducing any microbes into the wounds.
Most often, pustular skin lesions plague children with weakened immune systems . Any abrasion, harmless for an adult or a healthy child, becomes extremely dangerous in such cases.
There are several types of infection:
The culprits of impetigo are dangerous bacteria (staphylococcus and streptococcus). Red ulcers and blisters appear on the patient’s skin, and later crusts form in their place.
The patient is bothered by itching. By scratching the sore spots, the baby spreads the infection to new areas of the body. Most ulcers form around the nose and mouth.
With streptoderma, dangerous bacteria enter the weakened body through wounds. Painful pustular spots can “merge” into a single inflamed surface in just a few hours.
The doctor’s task is to eliminate the source of the disease with the help of antibiotics and select ointments that will cope with the external manifestations of the infection. Drugs that strengthen the patient’s immunity also play an important role in treatment.
Causes and symptoms of streptoderma in children:
Mycoses (fungal infections) are very diverse , both in the type of fungus and in the area of influence - on hair, nails, open areas of skin.
An example is keratomycosis, in particular pityriasis versicolor .
It usually begins its destructive activity from the hair follicles: yellowish-brown dots merge into spots (1 cm in diameter), and then these affected areas of the skin combine into one inflamed surface (its size can be compared to the width of the palm).
Candidiasis initially disguises itself as stomatitis - it affects the mucous membranes of the skin, painful rashes are concentrated in the lip area, and then reach other parts of the body.
Experts emphasize that only a doctor can cope with fungal diseases - careful diagnosis and an individual approach to the choice of medications are required.
Viral diseases include warts . They appear as a result of direct contact with an infected person or with his things.
doctors have a recommendation in this regard or bandage so that the child does not transfer the infection to other parts of the body.
Warts usually disappear on their own. In difficult cases, it is necessary to resort to laser, surgical intervention or freezing.
Herpes appears in the form of several blisters connected together and filled with a serous mass. Most often it is localized on the face - near the lips and nose.
As a rule, it is a consequence of previous respiratory diseases and weakened immunity.
It is tolerated by children in different ways, sometimes severely – with headaches and fever. After treatment, relapses are common.
Antiviral agents (topically) are used as therapeutic agents. The sooner you start using them, the smaller areas of skin will be affected and the faster the recovery will occur.
Herpes and its skin manifestations - what you need to know? Advice to parents from the Union of Pediatricians of Russia:
One of the most common diseases is pediculosis . The source of infection is lice, which find “both shelter and food” in a child’s hair, feed on his blood, lay eggs, firmly attaching them to the hair or in the folds of clothing.
You can only become infected with lice from humans; lice do not live in animal fur. The child experiences severe itching and scratches the skin, risking introducing some kind of infection into the wounds.
Demodicosis occurs in both children and adults (a child can become infected from parents or friends). The acne gland mite is the main cause of the disease; it makes its way into the mouth of the follicle, leaving behind “traces of the crime” - pinkish blackheads.
On the face, demodicosis manifests itself in the form of red spots that quickly turn into pustules. The child experiences severe itching in the area of the eyelashes and ears , and increased lacrimation.
The disease is treated with medication. The patient and his environment are required to strictly adhere to hygiene rules.
Scabies is also caused by a mite , but of a different type - scabies. You can become infected from a sick person or his things - clothes, bedding.
Having penetrated under the skin and laid “tunnels” there, the female mite lays up to fifty eggs in them. Favorite places for this parasite are the bends of the joints, the skin between the toes and hands, and the buttocks.
Rashes form that are very itchy . To combat mites, suspensions and ointments are used: sulfur, permethrin, benzyl benzoate.
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Seborrhea usually affects older children (during puberty) - their sebum composition changes, so the glands stop functioning normally. The disease manifests itself in the scalp in the form of severe peeling.
You can cope with it by solving the problem comprehensively: using lotions and ointments externally and helping the body from the inside, establishing proper nutrition, strengthening the immune system with special medications.
If the sweat ducts become blocked, this can cause heat rash .
This problem most often occurs in young children , especially if parents dress them too warmly: the child sweats, and the body reacts to this with the appearance of a rash. They fight it with the help of talc and decoctions of medicinal herbs.
Diseases in this group include neurodermatitis (redness and thickening of skin areas, the formation of nodules on them - papules) and psoriasis (flaky areas of different sizes and shapes).
Both diseases are usually chronic and difficult to treat with medication.
In addition, they are often “family”, passed on from generation to generation , and their outbreak is provoked by any previous disease, stress, or disruption of the immune system.
In the article, we indicated the names, gave a description and showed what common skin diseases in children - newborns, preschool and older children - look like in the photo, and briefly talked about the treatment of childhood diseases of a dermatological nature.
It is also necessary to keep the entire house clean, avoid allergenic foods and stressful situations for children.
If a problem does arise, you need to take it seriously and seek help from a doctor as quickly as possible.
Oncological diseases are one of the most pressing today. The prevalence of malignant diseases and the complexity of their treatment make the problem extremely important.
Joint and bone cancer is not the most common form of cancer, but difficulties in diagnosing the disease make it a common cause of disability and death.
Signs of cancer of the elements of the musculoskeletal system must be known for timely detection and treatment of pathology.
All malignant tumors of the musculoskeletal system can be divided into several groups. This must be done, since cancer of bones and joints of various types has specific clinical presentations.
The most important is the division of bone cancer into primary and metastatic.
Primary bone and joint cancer develops when atypical cells are initially localized in the musculoskeletal system:
Another form of malignant process may be bone metastases of a tumor of another location. The area of bones and joints in the body is very well supplied with blood; atypical cells are often brought into the musculoskeletal system with the bloodstream, and metastases of the primary tumor develop in this area.
Bone and joint cancer has many development factors - hereditary predisposition, exposure to chemicals, radiation sickness, bone trauma.
A large number of people are at risk, so everyone should know the signs of the disease.
Signs of the disease are quite varied. Asymptomatic variants of the disease complicate the diagnostic process. Doctors divide any cancer process into 4 stages, each of which has its own prognosis and recovery rate.
Unfortunately, bone and joint cancer is very often diagnosed at stages 3 and 4, since the first stages of tumor development are usually asymptomatic.
Sometimes people do not pay attention to the symptoms of the oncological process, since the manifestations are non-specific and disguised as other diseases. In order to recognize the pathology and not make a mistake in diagnosis, all symptoms should be divided into those common to any malignant process and specific to a specific tumor location.
Let's try to understand the typical symptoms of cancer of the musculoskeletal system.
Malignant neoplasms can occur in a wide variety of organs and systems. However, everywhere the process has approximately the same development mechanism.
The tumor grows quite aggressively and takes nutrients from healthy tissues. The immune state of the body changes, the metabolism undergoes changes. All this leads to the appearance of general symptoms of the oncological process:
Unfortunately, all of these symptoms very often develop in the later stages of the disease. Therefore, it is very important to pay attention to the specific signs of a particular type of cancer.
One of the forms of malignant neoplasms in the musculoskeletal system is cancer of the long tubular bones. Very often the tumor is located in the diaphysis - the long part of the bone between two joints.
In this case, the manifestations will be:
The listed manifestations may bother the patient to varying degrees. Sometimes local manifestations are not expressed at all.
Very often, the oncological process of the musculoskeletal system affects the joints to one degree or another. The area of the hip joint is very often subject to a tumor process.
There are a large number of vessels in this place, which also contributes to the development of metastases from other foci.
Symptoms of hip cancer:
A correct diagnosis can only be made after an instrumental examination of the hip joint. The joint is deeply surrounded by soft tissue and is inaccessible for a full physical examination.
Another large joint that can become a target for cancer is the knee. This area of the body is subject to significant stress and trauma, which is a factor in the development of cancer.
Symptoms of a knee tumor are:
A pathological fracture in the knee joint is rare. The joint is quite powerful, the femur and tibia in the knee area are of considerable thickness.
For many, knee cancer is asymptomatic or under the guise of orthopedic or rheumatological pathology. However, after instrumental examination of the joint, the diagnosis becomes obvious.
Separately, mention should be made of the manifestations of metastatic cancer in the area of bones and joints. This process has a different development mechanism and some features of the clinical picture:
Bone and joint cancer is a very serious problem. The mortality rate for this pathology is very high, and the diagnosis is usually made quite late.
To detect the process at an early stage, you need to remember the main manifestations of the disease and contact a specialist when they appear. Timely diagnosis makes it possible to detect bone cancer and begin therapy.
(primary chronic adrenal insufficiency).
First described in 1855. Develops when more than 90% of the adrenal cortex tissue is destroyed. It can develop at any age, but more often from 30 to 50 years, and has no gender differences.
Etiology: currently the most common cause is autoimmune damage to the cortex. As a result, the cortex becomes small with a thin capsule (primary cortical atrophy). Often combined with other autoimmune diseases of the endocrine glands. There are two syndromes of polyglandular insufficiency. The first includes hr. adrenal insufficiency, autoimmune thyroiditis, insulin-dependent diabetes mellitus. In the first - hr. adrenal insufficiency, chronic hypoparathyroidism, chronic mucocutaneous candidiasis. Less commonly, both syndromes include autoimmune ovarian failure. The combination of autoimmune Addison's disease, autoimmune thyroiditis, and insulin-dependent diabetes is called Schmidt's syndrome. Autoimmune Addison's disease can be combined with autoimmune diseases of a non-endocrine nature: pernicious anemia, alopecia, chronic disease. hepatitis, malabsorption syndrome, vitiligo. The second most common cause is adrenal tuberculosis (calcification can be detected x-ray). Other causes may be: amyloidosis, sarcoidosis, hemochromatosis, fungal infection (particularly in AIDS), the effects of radiation therapy, exposure to cytotoxic agents, cancer metastases in both adrenal glands with their destruction, hemorrhage in both adrenal glands and the condition after bilateral adrenalectomy and adrenoleukodystrophy.
Pathogenesis: it is based on a lack of cortisol, aldosterone, and in women, adrenal androgens.
The mechanism for the development of hyperpigmentation appears to be a consequence of a decrease in the production of corticosteroids, which promotes increased production of ACTH, and with it MSH or the melanocyte-stimulating fraction of ACTH. The insufficient level of ascorbic acid in the body in Addison's disease suggests a similarity in the pathogenesis of pigmentation disorders in this disease and C-beri. The high copper content in the blood of patients with Addison's disease can probably also increase the activity of tyrosinase and enhance the synthesis of melanin.
The disease develops slowly and does not manifest itself outside of stress at the initial stage. The earliest tetrad: weakness, loss of appetite, weight loss and hypotension (initially only in an upright position). Then these symptoms increase and nausea, vomiting, diarrhea, aversion to food, abdominal pain, dizziness appear, hypoglycemic states are frequent, especially on an empty stomach, which can result in coma and even death. A significant place in the clinical picture of the disease is occupied by mental manifestations in the form of asthenia, apathy, even debility. Women often have amenorrhea, which can be a consequence of two reasons: a violation of the secretion of gonadotropins by the pituitary gland due to a lack of cortisol or in the case of a combination with primary autoimmune ovarian failure. Skin pigmentation can vary in color. Previously, this disease was called “bronze disease.” The most common colors are golden brown, earthy, lemon yellow or sun tan. It is typical that even a light tan in these patients persists until the start of the new holiday season.
The development of pigmentation can begin with a short-term inflammation of the skin, after which a persistent hyperpigmented spot remains. In clinical practice, this property is used for diagnostic purposes: mustard plaster is applied to unchanged skin, and after a few days an increase in color is noted. Spots can appear on any part of the body, but more often pigmentation occurs in open areas of the skin, under constant pressure and friction (lower back, elbows, knees), and large folds of skin.
Characterized by increased pigmentation of the folds of the palms and soles, while the rest of the surface is not pigmented. There is an increase in pigmentation in the area of postoperative and post-traumatic scars, in physiologically hyperpigmented areas (nipples of the mammary glands, genitals), new nevi appear and the pigmentation of old melanocytic nevi increases. Some patients have darker hair.
Pigmentation of the oral mucosa is an important sign. The pigment is deposited in the form of a dark stripe along the edge of the gums at the roots of the teeth, on the mucous membrane of the cheeks opposite the molars - “buccal pigmentation”. However, the absence of damage to the mucous membranes does not exclude the disease. The mucous membranes of the rectum, vagina, and less commonly the conjunctiva of the eye are often pigmented.
A very rare form of pigmentation change is vitiligo, when depigmented spots appear against the background of pigmentation, which is considered as an autoimmune marker.
Characterized by the presence of anemia, leukopenia, neutropenia, eosinophilia and lymphocytosis. Plasma potassium levels are usually increased and sodium levels are decreased. (corresponding changes on the ECG), in severe cases due to a decrease in glomerular filtration, creatinine and urea in plasma increase (prerenal azotemia).
Histologically, the changes are nonspecific. An increase in pigment content is rarely detected in the epidermis and in the upper layers of the dermis.
Decrease in plasma cortisol below 3 mcg/dl, aldosterone, increase in renin activity, ACTH (early symptom), decrease in excretion of 17 hydroxycorticosteroids in urine. For a latent disease: rapid ACTH stimulation test (injection of 25 units of synthetic ACTH, after 30 or 60 minutes. Measurement of plasma cortisol.
Diff. diagnostics: with pigmentation resulting from sun tanning, thyrotoxicosis, pernicious anemia, collagenosis, pellagra, chronic heavy metal poisoning, X-ray irradiation, liver cirrhosis, malignant tumors, pigment-papillary dystrophy of the skin, melasma form of lichen planus, porphyria, etc. .
Treatment: lifelong glucocorticoid replacement therapy (if necessary in combination with mineralocorticoids).
Occurs in chronic inflammatory diseases accompanied by severe cachexia: cancer, tuberculosis, peritonitis, etc. It appears as a dirty brown coloration of the neck, abdomen and genitals. Some authors consider this phenomenon to be a mild form of Addison's disease and even call it “Addisonism.” However, with this pathology, darkening of the skin of the face and limbs is not detected and there are no rashes on the mucous membranes.
A polyetiological disease, the vast majority of manifestations of which are the result of a chronic excess of cortisol in the plasma and its excessive effect on organs.
-eutopic (Cushing's disease)
-adenoma or carcinoma of one of the adrenal glands
-bilateral large nodular massive hyperplasia of the adrenal cortex
-bilateral small nodular pigmented cortical disease
In the CTG-dependent variant, ACTH levels are elevated, resulting in excess production of cortisol and adrenal androgens.
With unilateral damage to one of the adrenal glands, excess cortisol production suppresses the production of ACTH, as a result of which it ceases to stimulate the healthy adrenal gland and its atrophy occurs.
Typically, in all of these diseases, the levels of cortisol and adrenal androgens are altered, and the synthesis and release of mineralocorticoids may be affected only in unilateral adrenal carcinoma.
Muscle weakness, weight gain, redistribution of fat, headaches, back pain, may be thirst, polyuria, in women, usually amenorrhea, decrease in muscle mass and strength, osteoporosis, pathological fractures (especially of the vertebrae), not in the early stages of arterial hypertension (diastolic), associated with potentiation of the action of catecholamines and sodium reabsorption in the distal renal tubules, impaired glucose tolerance or diabetes, associated with a decrease in tissue sensitivity to insulin and stimulation of gluconeogenesis, asthenia, irritability, depression.
With an excess of adrenal androgens in women, moderate hirsutism and acne occur.
Changes in the skin: (a consequence of the catabolic effect of cortisol) the skin is thin, “parchment-like.” Through it you can see the capillary network in the form of “marbling” of the skin. The presence of blue-purple stripes - striae - in places where the skin is stretched is pathogonic: on the lateral surfaces of the abdomen, chest, and not the inner surface of the shoulders. The face is plethoric. Due to catabolic processes in the vascular wall, its permeability is disrupted, which leads to hemorrhages with the most minor injuries; in particular, during venipuncture, extensive hemorrhages can form. With minor damage, long-term non-healing ulcers can form.
With Cushing's disease associated with macroadenomas, neurological symptoms appear (headaches, visual disturbances), and hyperpigmentation appears due to excess ACTH and its melanocyte-stimulating fraction.
Overnight dexamethasone test (at 22:00 take 1 mg of dexamethasone, the next morning at 8:00 the level of cortisol in the blood (less or more than 3 mcg/dl, if more, then look at the level of free cortisol in the urine).
CT, MRI of the pituitary gland, adrenal glands.
ACTH level in the blood (with catheterization of the pituitary vein).
Daily fluctuations in cortisol (increased levels), cortisol metabolites in urine
Liddle test with 2 and 8 g of dexamethasone.
Treatment of Cushing's disease: surgery. If it does not help, then bilateral adrenalectomy. It should be taken into account that after it, 10% of patients may develop Nelson's syndrome, characterized by skin pigmentation, weight loss and growth of a pituitary tumor, which is manifested by neurological symptoms and visual impairment.
There are drugs that suppress the production of cortisol by the adrenal cortex.