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The tuberculosis lichenoid (lichen scrophulosorum, deprive scrofulous) is presented miliarnymi by papules zheltovato brown colour or colour of a normal skin. Nodules of a softish consistence, it is frequent with small flake in the centre; flat papules with the brilliant surface, reminding those can be observed at red flat lishae. Disease amazes more often a trunk skin, is more rare - extremities and the person, a rash are inclined to grouping. Process is authorised without a trace. Usually accompanies a tuberculosis of other organs.
All described forms are implication of a secondary tuberculosis as all of them develop, as a rule, against centres of a tubercular infection already available in an organism or at people, before had been ill with a tuberculosis, more often pulmonary localisation to what the centres of Gona defined at a X-ray inspection, inspissations of a pulmonary tissue, focal shades against fibro changed pulmonary drawing testify.
The tuberculosis cutis primary meets now very seldom in connection with bacterination of newborns, mainly at children of thoracal age. It is presented by primary tubercular affect, or primary tubercular shankrom. It the deeply enough lying infiltrate turning to an ulcer. Through 2-3 ned develop a Birth Control Store and regionarnyj a lymphadenitis, representing a primary tubercular complex. Tuberculosis - the chronic disease proceeding with exacerbations and relapses. The factors promoting development of an exacerbation and relapses, insufficient duration of a basic course of treatment, inferiority protivoretsidivnogo treatments, the bad shipping of antituberculous preparations developing fastness to them of strains of micobacteria which for today is nearby 500 are. The tuberculosis recurs during the winter and autumn periods. Exacerbations arise at sick of a tubercular lupus and an indurative erythema of Bazena is more often, is more rare at patients with a papulonecrotic tuberculosis. The tuberculosis cutis diagnosis put according to the anamnesis (the indicating on the pulmonary tuberculosis transferred in the past, contact to patients), a clinical picture, results tuberkulinovyh assays, histological and kulturalnogo researches. Sometimes resort to infection of laboratory animals - porpoises. The differential diagnosis spend with bugorkovym a syphilide, a skin cancer, a leishmaniasis, deep mycoses, a skin angiitis. Treatment: tuberkulostaticheskaja chemotherapy, the agents referred on rising of immune protection, normalisation of metabolic disturbances. At treatment it is necessary to consider fastness of micobacteria to a tubercle ostatikam and to warn her. Tuberkulostatichesky preparations on therapeutic effect share on following groups: 1 - most effective remedies: Isoniazidum, rifampicin; II - preparations of average efficiency: Ethambutolum, streptomycin, Prothionamidum (Etioniamidum), Pyrazinamidum, Kanamycinum, florimitsin (Viomycinum); III - preparations of moderate activity - PASK, Tibonum (Thioacetazonum). Treatment is spent to two stages. At the first stage prescribe not less than 3 preparations during 3 mes, and on the second - 2 preparations daily or 2-3 times a week (intermitgirujushchy a way). Through 3-4 mes usually change a combination of preparations for the prevention of medicinal fastness. In dermatological practice treatment usually begin with rifampicin and Isoniazidum combination, sometimes to it add Pyrazinamidum. Then these preparations replace with streptomycin, Ethambutolum, PASK. The Birth Control Store course lasts on the average 10-12 months On ulcerative defects prescribe dusting powders with PASK, Isoniazidum.
Pathogenetic therapy includes vitamins (especially groups), antioxidants (and tocopherol, Sodium thiosulfatum, Dibunolum), immunomoduljatory (nukleinat sodium, Thymalinum), anabolic steroids, physiotherapeutic actions (UF an irradiation in suberythema doses, an electrophoresis), dietetic therapy. After a treatment basic course it is spent protivoretsidivnoe treatment on 2 mes - in the spring and in the autumn within 3 years at the localised forms and 5 years at disseminirovannyh. At the clinical treatment confirmed gistologicheski, the dispensary observation with double survey in a year within 5 years then the patient take out from the dispensary account is required. LEPRA
Birth Control Store - the chronic infectious disease caused by a micobacterium of a lepra. Aetiology and pathology. The originator of a lepra of the person - a micobacterium of Gansena-Nejssera (Mycobacterium leprae), the obligate intracellular parasite showing the expressed tropism to a skin, peripheric nerves and a muscular tissue though meets and in other organs and tissues. The lepra in the countries of Asia and Africa is most extended. An infection source is a sick lepra. In diffusion of an infection the great value is given socially to business factors. The basic way of a transmission of infection air drop, is more rare chreskozhnyj (at integument damage). The Incubation interval makes some years. Clinical picture. Allocate some clinical versions - lepra types: lepromatous, tuberculoid, uncertain, dimorphous.
The lepromatous type the most malignant, differs presence in the centres of a lesion of a considerable quantity of originators. Patients thus especially kontagiozny as allocate set of micobacteria. The skin, mucosas, eyes, lymph nodes, peripheric nervous trunks, and also endocrine system and some internal are surprised. On a face skin, razgibatelnyh surfaces of forearms, anticnemions, back of brushes, breeches there are erythematically nevuses pigmentosus of various outlines and the sizes, not having accurate contours. Gradually maculae infiltrirujutsja, acting over a skin surface, are enlarged in size. As a result of diffusive infiltration of a face skin nadbrovnye arches sharply act, the nose is deformed, cheeks, labiums and a chin take a lobular form - develops facies leonina. Hair of brows drop out, since lateral aspect. The skin in a zone of infiltrates becomes strained, lustrous, its drawing is smoothed, pushkovye hair are absent, at superficial infiltrations the skin looks like an orange-peel, becomes shining at the expense of superfluous function of sebaceous glands. In a late stage the diaphoresis in lesion sites stops. Development of a lepromatous infiltrate is accompanied by a paresis of vessels, a hemosiderosis, paternal infiltrates get cyanotically brown shade. On a skin both in a zone of infiltrations, and out of them appear also bugorki and knots (lepromas) in the size from several millimetres to 2 sm plotnoelasticheskoj consistences, krasnovato rusty colour. Gradually lepromas izjazvljajutsja. Ulcerative surfaces have usually abrupt, sometimes podrytye infiltrirovannye edges, can merge, forming the extensive ulcerative defects, slowly healing rough cicatrix. The nose mucosa is surprised practically in all cases of lepromatous type, becomes giperemirovannoj, hydropic, with a considerable quantity of fine erosions (a lepromatous rhinitis). The atrophy of a mucosa Further develops and there are separate lepromas and the infiltrations complicating nasal breath. At disintegration of lepromas the nose is deformed ("ploskovdavlennyj", "hobotoobraznyj", "lornetnyj" a nose, a nose of a bulldog). In hard cases mucosas soft and a hard palate, a larynx are surprised, backs of the tongue, etc. the Lesion of peripheric nerves at lepromatous type of a lepra develops rather late, happens bilateral and symmetric. In the beginning in lesion zones weakens, and then the thermoesthesia, behind it painful and tactile disappears. Feature of lepromatous neuritises is their ascending character. Ulnar, median, fibular, big aural nerves, the top branch of a facial nerve most often are surprised. Nervous trunks utolshcheny, dense, smooth. Trophic and impellent disturbances (a lagophthalmia, a paresis of a chewing and mimic musculation, an amyotrophia, a contracture, trophic ulcers) gradually develop.
The tuberculoid type differs easier current, the skin and peripheric nerves are surprised usually. Micobacteria are taped hardly in the lesion centres, in soskobe a mucosa of a nose are absent is more often. Clinical implications of tuberculoid type are characterised by occurrence on a skin not numerous, various under the form and size of erythematic maculae, and also the papular elements which are the basic implication of illness. Papules usually fine, flat, krasnovato cyanotic, polygonal, inclined to merge in plaques with sharply outlined valikoobrazno the raised roundish or polycyclic edge and predilection to peripheric growth. Favourite localisation of rashes - the person, a neck, sgibatelnye surfaces of extremities, a back, breeches. Gradually central part of plaques will atrophy, gipopigmentiruetsja, is shelled, and on edge the erythematic border in width from several millimetres to 2-3 sm and more - a figured tuberculoid remains. Are in certain cases observed so-called sarkoidnye formations - sharply outlined it is red brown, with a smooth surface knots. On a place of the resolved rashes there are sites of a hypopigmentation of a skin, and sometimes atrophies. In the lesion centres fat - and a diaphoresis is broken, drop out pushkovye hair. Lesions of peripheric nervous trunks, dermal branches of nerves, vasculomotor disturbances are taped very much early (sometimes before dermal implications). The disorders of temperature, painful and tactile sensitivity which are quite often falling outside the limits rashes (except for tactile sensitivity) become perceptible. Ulnar, radial, fibular nerves that is shown in diffusive or chetkoobraznom their thickening and morbidity Most often are surprised. Birth Control Store leads to development of paresises, paralyses, contractures of fingers, an atrophy of fine muscles, skins, fingernails, a mutilation of brushes and feet:" The seal paw "," hanging down brush "," the monkey's paw "," falling foot ", etc. Decrease suhozhilnye reflexes.
The uncertain type of a lepra is clinically characterised by occurrence on a skin only spotty rashes: hypochromia, erythematic, admixed, with geographical outlines. In an initial stage of a lesion of peripheric nerves are absent, and then the specific polyneuritis leading to disorders of sensitivity in distal departments of extremities, amyotrophias of fine muscles, to contractures of fingers, trophic ulcers gradually develops, etc.
The tuberculosis cutis primary meets now very seldom in connection with bacterination of newborns, mainly at children of thoracal age. It is presented by primary tubercular affect, or primary tubercular shankrom. It the deeply enough lying infiltrate turning to an ulcer. Through 2-3 ned develop a Birth Control Store and regionarnyj a lymphadenitis, representing a primary tubercular complex. Tuberculosis - the chronic disease proceeding with exacerbations and relapses. The factors promoting development of an exacerbation and relapses, insufficient duration of a basic course of treatment, inferiority protivoretsidivnogo treatments, the bad shipping of antituberculous preparations developing fastness to them of strains of micobacteria which for today is nearby 500 are. The tuberculosis recurs during the winter and autumn periods. Exacerbations arise at sick of a tubercular lupus and an indurative erythema of Bazena is more often, is more rare at patients with a papulonecrotic tuberculosis. The tuberculosis cutis diagnosis put according to the anamnesis (the indicating on the pulmonary tuberculosis transferred in the past, contact to patients), a clinical picture, results tuberkulinovyh assays, histological and kulturalnogo researches. Sometimes resort to infection of laboratory animals - porpoises. The differential diagnosis spend with bugorkovym a syphilide, a skin cancer, a leishmaniasis, deep mycoses, a skin angiitis. Treatment: tuberkulostaticheskaja chemotherapy, the agents referred on rising of immune protection, normalisation of metabolic disturbances. At treatment it is necessary to consider fastness of micobacteria to a tubercle ostatikam and to warn her. Tuberkulostatichesky preparations on therapeutic effect share on following groups: 1 - most effective remedies: Isoniazidum, rifampicin; II - preparations of average efficiency: Ethambutolum, streptomycin, Prothionamidum (Etioniamidum), Pyrazinamidum, Kanamycinum, florimitsin (Viomycinum); III - preparations of moderate activity - PASK, Tibonum (Thioacetazonum). Treatment is spent to two stages. At the first stage prescribe not less than 3 preparations during 3 mes, and on the second - 2 preparations daily or 2-3 times a week (intermitgirujushchy a way). Through 3-4 mes usually change a combination of preparations for the prevention of medicinal fastness. In dermatological practice treatment usually begin with rifampicin and Isoniazidum combination, sometimes to it add Pyrazinamidum. Then these preparations replace with streptomycin, Ethambutolum, PASK. The Birth Control Store course lasts on the average 10-12 months On ulcerative defects prescribe dusting powders with PASK, Isoniazidum.
Pathogenetic therapy includes vitamins (especially groups), antioxidants (and tocopherol, Sodium thiosulfatum, Dibunolum), immunomoduljatory (nukleinat sodium, Thymalinum), anabolic steroids, physiotherapeutic actions (UF an irradiation in suberythema doses, an electrophoresis), dietetic therapy. After a treatment basic course it is spent protivoretsidivnoe treatment on 2 mes - in the spring and in the autumn within 3 years at the localised forms and 5 years at disseminirovannyh. At the clinical treatment confirmed gistologicheski, the dispensary observation with double survey in a year within 5 years then the patient take out from the dispensary account is required. LEPRA
Birth Control Store - the chronic infectious disease caused by a micobacterium of a lepra. Aetiology and pathology. The originator of a lepra of the person - a micobacterium of Gansena-Nejssera (Mycobacterium leprae), the obligate intracellular parasite showing the expressed tropism to a skin, peripheric nerves and a muscular tissue though meets and in other organs and tissues. The lepra in the countries of Asia and Africa is most extended. An infection source is a sick lepra. In diffusion of an infection the great value is given socially to business factors. The basic way of a transmission of infection air drop, is more rare chreskozhnyj (at integument damage). The Incubation interval makes some years. Clinical picture. Allocate some clinical versions - lepra types: lepromatous, tuberculoid, uncertain, dimorphous.
The lepromatous type the most malignant, differs presence in the centres of a lesion of a considerable quantity of originators. Patients thus especially kontagiozny as allocate set of micobacteria. The skin, mucosas, eyes, lymph nodes, peripheric nervous trunks, and also endocrine system and some internal are surprised. On a face skin, razgibatelnyh surfaces of forearms, anticnemions, back of brushes, breeches there are erythematically nevuses pigmentosus of various outlines and the sizes, not having accurate contours. Gradually maculae infiltrirujutsja, acting over a skin surface, are enlarged in size. As a result of diffusive infiltration of a face skin nadbrovnye arches sharply act, the nose is deformed, cheeks, labiums and a chin take a lobular form - develops facies leonina. Hair of brows drop out, since lateral aspect. The skin in a zone of infiltrates becomes strained, lustrous, its drawing is smoothed, pushkovye hair are absent, at superficial infiltrations the skin looks like an orange-peel, becomes shining at the expense of superfluous function of sebaceous glands. In a late stage the diaphoresis in lesion sites stops. Development of a lepromatous infiltrate is accompanied by a paresis of vessels, a hemosiderosis, paternal infiltrates get cyanotically brown shade. On a skin both in a zone of infiltrations, and out of them appear also bugorki and knots (lepromas) in the size from several millimetres to 2 sm plotnoelasticheskoj consistences, krasnovato rusty colour. Gradually lepromas izjazvljajutsja. Ulcerative surfaces have usually abrupt, sometimes podrytye infiltrirovannye edges, can merge, forming the extensive ulcerative defects, slowly healing rough cicatrix. The nose mucosa is surprised practically in all cases of lepromatous type, becomes giperemirovannoj, hydropic, with a considerable quantity of fine erosions (a lepromatous rhinitis). The atrophy of a mucosa Further develops and there are separate lepromas and the infiltrations complicating nasal breath. At disintegration of lepromas the nose is deformed ("ploskovdavlennyj", "hobotoobraznyj", "lornetnyj" a nose, a nose of a bulldog). In hard cases mucosas soft and a hard palate, a larynx are surprised, backs of the tongue, etc. the Lesion of peripheric nerves at lepromatous type of a lepra develops rather late, happens bilateral and symmetric. In the beginning in lesion zones weakens, and then the thermoesthesia, behind it painful and tactile disappears. Feature of lepromatous neuritises is their ascending character. Ulnar, median, fibular, big aural nerves, the top branch of a facial nerve most often are surprised. Nervous trunks utolshcheny, dense, smooth. Trophic and impellent disturbances (a lagophthalmia, a paresis of a chewing and mimic musculation, an amyotrophia, a contracture, trophic ulcers) gradually develop.
The tuberculoid type differs easier current, the skin and peripheric nerves are surprised usually. Micobacteria are taped hardly in the lesion centres, in soskobe a mucosa of a nose are absent is more often. Clinical implications of tuberculoid type are characterised by occurrence on a skin not numerous, various under the form and size of erythematic maculae, and also the papular elements which are the basic implication of illness. Papules usually fine, flat, krasnovato cyanotic, polygonal, inclined to merge in plaques with sharply outlined valikoobrazno the raised roundish or polycyclic edge and predilection to peripheric growth. Favourite localisation of rashes - the person, a neck, sgibatelnye surfaces of extremities, a back, breeches. Gradually central part of plaques will atrophy, gipopigmentiruetsja, is shelled, and on edge the erythematic border in width from several millimetres to 2-3 sm and more - a figured tuberculoid remains. Are in certain cases observed so-called sarkoidnye formations - sharply outlined it is red brown, with a smooth surface knots. On a place of the resolved rashes there are sites of a hypopigmentation of a skin, and sometimes atrophies. In the lesion centres fat - and a diaphoresis is broken, drop out pushkovye hair. Lesions of peripheric nervous trunks, dermal branches of nerves, vasculomotor disturbances are taped very much early (sometimes before dermal implications). The disorders of temperature, painful and tactile sensitivity which are quite often falling outside the limits rashes (except for tactile sensitivity) become perceptible. Ulnar, radial, fibular nerves that is shown in diffusive or chetkoobraznom their thickening and morbidity Most often are surprised. Birth Control Store leads to development of paresises, paralyses, contractures of fingers, an atrophy of fine muscles, skins, fingernails, a mutilation of brushes and feet:" The seal paw "," hanging down brush "," the monkey's paw "," falling foot ", etc. Decrease suhozhilnye reflexes.
The uncertain type of a lepra is clinically characterised by occurrence on a skin only spotty rashes: hypochromia, erythematic, admixed, with geographical outlines. In an initial stage of a lesion of peripheric nerves are absent, and then the specific polyneuritis leading to disorders of sensitivity in distal departments of extremities, amyotrophias of fine muscles, to contractures of fingers, trophic ulcers gradually develops, etc.