psoriaz

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tema: psoriaz. krasniy ploskiy lishay. psoriaz psoriaz - xronicheskiy, tyajeliy eritematozno-skvamozniy dermatoz, multifaktorialnoy prirodi s dominiruyushim znacheniem v razvitii geneticheskix faktorov, xarakterizuyushiysya giperproliferatsiey epidermalnix kletok, narusheniem keratinizatsii, vospalitelnoy reaktsiey v derme, izmeneniyami v razlichnix organax i sistemax. etiopatogenez osnovnie kontseptsii proisxojdeniya psoriaza: - geneticheskaya (geneticheskie mexanizmi povishennoy sposobnosti kletok k razmnojeniyu) - neyrogennaya (neyrogumoralniy mexanizm predraspolojennosti) - gipoteza vrojdennoy nestabilnosti lizosom i vrojdennix strukturnix defektov kapillyarov koji, pervichnix narusheniy keratinizatsii - narushenie obmena lipidov - immunnie narusheniya (povishennaya aktivnost t-xelperov pri defekte t-supressorov) klassifikatsiya razlichayut sleduyushie osnovnie klinicheskie formi psoriaza: - vulgarniy (obiknovenniy) ekssudativniy kaplevidniy - seboreyniy - ladonno-podoshvenniy - pustulezniy - artropaticheskiy - psoriaticheskaya eritrodermiya klinicheskaya kartina xarakterna monomorfnaya sip v vide ploskix papul rozovo-krasnogo tsveta velichinoy ot bulavochnoy golovki do melkoy moneti, plotnovatoy konsistentsii, neskolko vozvishayushixsya nad urovnem zdorovoy koji. papuli pokriti melkimi, rixlimi cheshuykami serebristo-belogo tsveta, kotorie legko otpadayut pri poskablivanii i daje pri snyatii odejdi. svejie …

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tearinovogo pyatna: usilenie shelusheniya pri poskablivanii daje gladkix papul, pri etom poyavlyaetsya nekotoroe sxodstvo so stearinovim pyatnom - fenomen psoriaticheskoy plenki: posle polnogo udaleniya cheshuek dalneyshim poskablivaniem otslaivaetsya tonchayshaya nejnaya prosvechivayushaya plenka - fenomen krovyanoy rosi: posle ostorojnogo poskablivaniya terminalnoy plenki na obnajivsheysya vlajnoy poverxnosti voznikaet tochechnoe krovotechenie v techenii psoriaza videlyayut tri stadii: progressiruyushuyu stadiyu statsionarnuyu stadiyu regressiruyushuyu stadiyu progressiruyushaya stadiya. dlya progressiruyushey stadii xarakterni poyavlenie svejix visipaniy, prodoljayushiysya rost uje imeyushixsya papul i blyashek. okraska elementov yarkaya, shelushenie virajeno v tsentralnoy chasti, a po periferii imeetsya giperemicheskaya kayma - venchik rosta (obodok pilnova). xarakterno poyavlenie novix elementov na mestax melkix travm, raschesov – polojitelnaya izomorfnaya reaktsiya (fenomen kebnera). bespokoit zud. statsionarnaya stadiya. v statsionarnoy stadii prekrashaetsya poyavlenie novix elementov i rost starix, okraska elementov priobretaet virajenniy sinyushniy ottenok, shelushenie rasprostranyaetsya na vsyu poverxnost elementov. regressiruyushaya stadiya. xarakterizuetsya poyavleniem «psevdoatroficheskogo obodka» voronova (posle ostanovki rosta papuli vokrug nee obichno …

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tom «maslyanogo pyatna», skoplenie parakeratoznix kletok i seroznoy jidkosti pod nogtevoy plastinkoy sozdaet jeltovato korichnevoe pyatno - psoriaticheskaya deformatsiya nogtya: psoriaticheskiy onixolizis (otdelenie nogtey ot nogtevogo loja), psoriaticheskiy onixogrifoz (nogtevaya plastinka utolshaetsya, stanovitsya nerovnoy, ispeshrennoy nebolshimi grebeshkami serovato-jeltogo tsveta, porajenniy nogot priobretaet vid kogtya, pripodnyatogo nad lojem v rezultate podnogtevogo giperkeratoza) porajenie nogtey pri psoriaze porajenie nogtey pri psoriaze diagnostika - xarakternaya klinicheskaya kartina, psoriaticheskaya triada - gistologicheskoe issledovanie: otmechaetsya rezkiy akantoz s nalichiem udlenennix tonkix epidermalnix virostov v sochetanii s papillomatozom; nad vershinami sosochkov dermi epidermis istonchen, inogda sostoit iz 2-3 sloev kletok; tipichen parakeratoz; v starix ochagax – giperkeratoz; v period progressirovaniya v shipovatom sloe otmechayutsya mej- i vnutrikletochniy otek, ekzotsitoz s obrazovaniem ochagovix skopleniy neytrofilnix granulotsitov, mikroabstsessi munro; v sosochkovom sloe dermi otmechayut rasshirenie kapillyarov i vospalitelniy infiltrat iz limfotsitov i gistiotsitov. patomorfologicheskie izmeneniya pri psoriaze differentsialnaya diagnostika differentsialniy diagnoz provodyat s ryadom dermatozov: - krasnim ploskim …

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v den mestnaya terapiya: -protivovospalitelnie, keratoliticheskie sredstva (v progressiruyushey i statsionarnoy stadiyax): 1-2% salitsiloviy krem ili maz, 1% serno-salitsilovaya maz (pri lokalizatsii visipaniy na koje volosistoy chasti golovi) -redutsiruyushie sredstva (v regressiruyushey stadii): 2-5% serno-degtyarnaya maz, 5% ixtiolovaya, 5-10% naftalannaya) -kortikosteroidnie kremi i mazi primenyayut na vsex stadiyax protsessa (ftorokort, flutsinar, sinaflan, tselestoderm, lorinden a, elokom s, belosalik, diprosalik, akriderm sk, i t.d.) -kaltsipotriol (dayvoneks)-aktivnaya forma vitamina d3 fizioterapevticheskie metodi: - uf – obluchenie - puva-terapiya - re-puva-terapiya parafinovie applikatsii lechenie psoriaza doljno bit kompleksnim, vklyuchayushim obshuyu, mestnuyu terapiyu, fizioterapiyu, soblyudenie rejima i dieti. v period stabilizatsii protsessa pokazano sanatorno-kurortnoe lechenie (sochi, matsesta, pyatigorsk, kislovodsk). krasniy ploskiy lishay krasniy ploskiy lishay – rasprostranenniy dermatoz, xarakterizuyushiysya monomorfnimi, zudyashimi visipaniyami papul, porajayushiy koju i slizistie obolochki. etiopatogenez v razvitii dermatoza bolshaya rol otvoditsya: - infektsionnim faktoram (virusam) - nevrogennim narusheniyam - toksiko-allergicheskim vozdeystviyam (v tom chisle lekarstvennim) - immunnim narusheniyam - xronicheskim …

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lizistoy obolochki. pri smazivanii poverxnosti papul rastitelnim maslom vidni melkie belovatie tochki i polosi (simptom uikxema, obuslovlen neravnomernim granulezom). xarakterna izomorfnaya reaktsiya – fenomen kebnera. dermatoz soprovojdaetsya zudom. izlyublennaya lokalizatsiya – sgibatelnie poverxnosti predplechiy, oblast luchezapyastnix sustavov, vnutrennyaya poverxnost beder, razgibatelnaya poverxnost goleney, paxovie i podmishechnie oblasti, slizistie obolochki. diagnostika - xarakternaya klinicheskaya kartina - simptom uikxema -gistologicheskoe issledovanie: giperkeratoz, neravnomerniy granulez, akantoz, vakuolnaya distrofiya bazalnogo sloya, diffuzniy polosovidniy infiltrat, sostoyashiy iz limfotsitov, polimorfno-yadernix leykotsitov s primesyu gistiotsitov, kotoriy snizu, so storoni dermi, imeet chetkuyu granitsu, a verxney svoey chastyu vplotnuyu primikaet k bazalnomu sloyu epidermisa, pri etom sozdaetsya kartina razmitosti nijney granitsi epidermisa. simptom uikxema (risunok iz perepletayushixsya belovatix liniy na poverxnosti papul, kotoriy mojno otchetlivo uvidet, kapnuv na nego kapelku masla) differentsialnaya diagnostika differentsialniy diagnoz provodyat s ryadom dermatozov: - psoriazom - toksidermiey - krasnoy volchankoy - vulgarnoy puzirchatkoy - mnogoformnoy ekssudativnoy eritemoy - gerpetiformnim dermatitom dyuringa - …

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tema: psoriaz. krasniy ploskiy lishay. psoriaz psoriaz - xronicheskiy, tyajeliy eritematozno-skvamozniy dermatoz, multifaktorialnoy prirodi s dominiruyushim znacheniem v razvitii geneticheskix faktorov, xarakterizuyushiysya giperproliferatsiey epidermalnix kletok, narusheniem keratinizatsii, vospalitelnoy reaktsiey v derme, izmeneniyami v razlichnix organax i sistemax. etiopatogenez osnovnie kontseptsii proisxojdeniya psoriaza: - geneticheskaya (geneticheskie mexanizmi povishennoy sposobnosti kletok k razmnojeniyu) - neyrogennaya (neyrogumoralniy mexanizm predraspolojennosti) - gipoteza vrojdennoy nestabilnosti lizosom i vrojdennix strukturnix defektov kapillyarov koji, pervichnix narusheniy keratinizatsii - narushenie obmena lipidov - immunnie narusheniya (povishennaya aktivnost t-xelpero...

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