Caring for patients with skin diseases. Care for dermatological and venereal patients
Care for patients with skin diseases should be comprehensive and selected individually for each patient. Treatment can be divided into two categories:
medicinal – with the use of antibiotics, antiallergic drugs, psychotropic, hormonal, bacterial pyrogenic and other medications;
local external – lotions, baths, ointments.
Caring for patients with skin diseases: features
Most common reason skin diseases - a manifestation of allergies, infections or general pathologies of the body. These diseases are accompanied by itching and burning, which makes the patient suffer, leads to insomnia and irritation. The person who is to provide assistance to such a patient must have great patience and tact.
The main goal of treatment and care is to speed up recovery and relieve all symptoms that cause discomfort: burning, tightness, itching, pain. The care system consists of two stages:
Cleansing: removing crusts, scales, pus. To do this, use cotton swabs soaked in hydrogen peroxide.
Treatment of damaged areas with external medications.
Other procedures (taking medications, compresses, baths) can only be done under supervision or with the permission of the attending physician.
Diet
An important part of treatment is proper diet sick. Eating hot or overly spicy foods may cause itchy areas to become even more painful. Alcoholic drinks are strictly prohibited. For psoriasis, reduce the intake of foods high in cholesterol, and for pyoderma, limit the amount of carbohydrates in the diet. If treatment involves taking hormones, it is very important to provide the patient with plenty of protein, vitamins and minerals (especially vitamin C and potassium).
Precautionary measures
Skin diseases of an infectious nature are contagious. To protect the patient from re-infection, as well as the people around him, it is necessary to change clothes and bedding daily, wash them at high temperatures and iron them thoroughly. Indoors should be regularly wet cleaning using disinfectants.
Caring for children with skin diseases
Caring for sick children with skin diseases requires special patience and compassion. The young patient does not understand what is happening to him, and when it passes, he may not listen to the doctor’s recommendations (for example, scratch the affected areas, refuse painful procedures). The most common childhood skin diseases are:
Eczema- allergic skin disease. It is manifested by redness, swelling, the formation of blisters, weeping areas, which subsequently become crusty and peel off. The whole body and individual areas can be affected: neck, ears, scalp. To alleviate the condition, lotions and baths are made (starch, with herbal decoctions, soda). Caring for sick children with skin diseases involves not only treatment, but also prevention of scratching from itching. To do this, children wear mittens or sew up their sleeves.
Prickly heat– occurs due to inflammation of the sweat glands. A child's skin is very sensitive to overheating, and at elevated temperatures it reacts with the formation of prickly heat. If you react in time and do not start this disease, it goes away quickly and easily after baths and lotions in a series. The best prevention is to ensure that the child does not overheat ( optimal temperature rooms where children are located - no higher than 22 degrees).
Diaper rash– a common problem that occurs in infants in the area of skin folds. To avoid them, you should dress the child in clothes made from natural materials, give air baths more often, and do not swaddle tightly. And if diaper rash has already occurred, it is treated with powders, oils or cream.
Pustular diseases, or pyoderma– the most common childhood skin disease. It manifests itself due to microorganisms: staphylococci and streptococci. In newborns, such lesions most often occur in the navel area or any wounds where dirt could get in. Treatment consists of treatment with antiseptic drugs.
Parents usually have to care for children with skin lesions. It is important to remember that if the baby’s condition worsens and the chosen procedures do not help, you must immediately consult a doctor so as not to miss a serious illness. Some skin problems can lead to respiratory complications.
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CHAPTER 13 CARE AND MONITORING OF CHILDREN WITH SKIN DISEASES
CHAPTER 13 CARE AND MONITORING OF CHILDREN WITH SKIN DISEASES
Skin lesions are more common in young children. The nurse must know the specifics of skin care and be able to provide qualified care. Skin lesions in children requiring medical attention include atopic dermatitis, prickly heat, pustular or fungal lesions, and diaper rash.
Atopic dermatitis- the most common skin disease of allergic origin in children, which affects 5-15% of all children, and in half the first episode occurs in the first 6 months. life. It manifests itself as redness and swelling of the skin (most often) of the face, a large number of microvesicles (small bubbles), weeping, followed by the formation of crusts and peeling. The scalp, ears, neck, and torso are often affected.
When caring, special attention is paid to the nutrition of the child and mother. Foods that can cause an exacerbation of the disease (all identified allergens) are excluded from the diet, and sweets and pickles are limited.
Allergens most often are cow's milk, chicken eggs, fish, meat, chocolate, nuts, some vegetables and fruits (strawberries, oranges, carrots). To identify allergens, monitoring the body's reaction to food is important. For this purpose, they keep a food diary in which they record all the foods eaten by the child and the nursing mother, feeding time, the nature of skin rashes, etc. In children who are on mixed or artificial feeding, initial signs of sensitization (hypersensitivity) to various foods, and especially cereals, may occur in the first weeks and months of life. Allergic rashes in the form of skin eczema are observed if milk formulas prepared with cereal decoctions are used.
Products contraindicated for a child must be noted on the nursing sheet and listed in the hospital medical record.
Basic therapy includes care for damaged skin. To compensate for the protective function of the skin, emollients and moisturizers are regularly used. It is necessary to minimize contact with water; for water procedures, use warm water, mild detergents with an adapted pH (pH 5.5-6.0 to protect the acidic skin).
The choice of external therapy is determined not so much by the severity of the skin process as by the nature of the inflammation. For the exudative form, lotions with tea and pastes with a low percentage of the main substance (no more than 2%) are used - boron-naphthalan, erythromycin (5-7 days). A spray containing copper and zinc (Cu-Zn), which have wound-healing and antibacterial properties, as well as absorbent microgranules that remove excess moisture without drying out the skin, are applied to wet areas and skin folds. Then they switch to local steroid preparations, preferably in the form of a cream rather than an ointment, since ointments contain a large percentage of lanolin, which creates a “greenhouse” effect (film effect). They are used for 7-10 days, followed by a transition to indifferent ointments or creams (Elidel, emollient, trixera, stelatrium, etc.).
During exacerbations, the child should be bathed 1-2 times a week. City water, which contains bleach, provokes the development of skin xerosis, increased itching and exacerbation of the disease. The cleansing agents used are Cu-Zn gel, a dermatological enriched gel, foaming cleansing cream. As the skin process stabilizes, the number of baths is increased. When using medicinal herbs for bathing, there is always a risk of additionally causing allergic reactions on the skin. The least dangerous is bathing a child in a solution of black tea or bay leaf. Brewed black tea is added to the bath until a light brown solution is obtained; bay leaf (8-10 leaves) is boiled in 35 liters of water for 5-10 minutes and added to the bathtub. In addition, special dermatological oils (for example, Uriage, Mustela) can be added to the bath, which help restore and preserve the hydrolipidic film of the skin.
After an inflammatory process, a child’s skin always has severe dryness, peeling and cracks. Emollient creams (topicrem, emollient, trixera) are added to basic external therapy. Artificially, forming a lipid film, they recreate the damaged surface of the epidermis and restore its barrier function, significantly reducing skin dryness.
Topical glucocorticosteroids(GCS) is a leading component in the treatment of exacerbations of atopic dermatitis. Drugs with an improved risk/benefit ratio and low atrophogenic potential are used: methylprednisolone aceponate, prednicarbate, mometasone fluorate and fluticasone. Treatment regimens:
Intermittent regimen - after using a steroid, its dose is reduced or switched to a weaker drug. For short-term treatment of acute eczematous lesions, the topical steroid should be applied no more than twice daily. Topical corticosteroids are used together with basic treatment with emollients, which avoids excessive use of steroid drugs and minimizes their side effects;
Preventive regimen - a corticosteroid is applied to intact skin twice a week, which helps prevent exacerbations of the disease.
In case of moderate and severe forms of the disease, a child from 6 months can be prescribed methylprednisolone aciponate (Advantan), and from 2 years - mometasone furoate (Elocom). From 6 months, hydrocortisone 17-butyrate (Lokoid) and aclomethasone dipropionate (Afloderm) are also allowed to be used. The potency of topical corticosteroids ranges from very high (class 4) to low (class 1). Very highly active drugs are not recommended for use in children.
Methylprednisolone aceponate(advantan) is produced in a variety of dosage forms (emulsion, cream, ointment, fatty ointment). Mometasone furoate (Elocom) currently has maximum local activity and minimal systemic effects. It is also available in three dosage forms (cream, ointment, lotion). The drugs are used once a day.
Itching. Itchy skin causes a lot of anxiety for children. To protect the skin from scratching, the child is put on mittens, the sleeves are sewn up, and in some cases, cardboard splints are placed on the elbow area, which are reinforced with bandages so that the child does not
could bend his arms at the elbow joints. Attacks of itching are relieved with pimecrolimus (Elidel), atoderm or prurised creams. Their use in the “control zone,” that is, at the first signs of the disease, 2 times a day helps prevent severe exacerbations, reduces the duration of steroid treatment, and prolongs remission.
Pimecrolimus cream 1% and tacrolimus ointment 0.03% are approved for the treatment of children over 2 years of age and adults. Tacrolimus ointment 0.1% is used only in adults. The anti-inflammatory potential of 0.1% tacrolimus ointment is similar to that of moderate-strength corticosteroids; 1% pimecrolimus cream is less active. Both drugs have proven efficacy and are safe with a therapeutic period of 2 years for pimecrolimus and 4 years for tacrolimus. A frequently reported side effect of topical calcineurin inhibitors is a transient burning sensation of the skin.
The cream or ointment is dosed using special units of measurement - finger tip unit(FTU is a fingertip unit).
Phalanx rule- cream or ointment is squeezed out of the tube onto the end phalanx of the index finger (Fig. 35). It is believed that about 1 FTU is required to apply the drug to the hand
Rice. 35.Method for determining the amount of cream or ointment using dosage units
or groin, 2 FTU for the face or foot, 3 FTU for the entire arm, 6 FTU for the entire leg, and 14 FTU for the torso.
For atopic dermatitis, as prescribed by a doctor, medicinal baths are also carried out, which can be general or local. Baths are prescribed every other day or less often. These baths differ from hygienic ones in that special baths are added to the water. medicines(starch, herbal infusion, etc.). The most common baths are starch baths, soda baths, with an infusion of string grass or chamomile.
Starch bath softens the skin and soothes itching. To prepare such a bath, 100 g of potato flour is diluted in cold water and add to the water prepared for the bath.
Soda bath(1 tablespoon of sodium bicarbonate per bucket of water) has the same effect.
Bath with infusion of herb- a common remedy for the prevention and treatment of skin diseases. For a one-year-old child, it is recommended to add a glass of infusion of the series to the bath. The infusion is prepared at the rate of 1 tablespoon of herb per glass of boiling water (infuse for 10 minutes).
Bath with chamomile infusion used to relieve inflammation. The principle of preparing this bath is the same as a bath with an infusion of string grass.
For treatment success, optimal control over the course of the disease, which includes regular medical examinations, training of children or parents or relatives caring for them in the rules of using medications, and adequate psychosocial support. To prevent prickly heat, you should wear sensible clothing that takes into account the temperature. environment. The temperature of the room where the child is located should not exceed 22 °C.
Miliaria can be complicated, especially in children of the first year of life, by the development of pyoderma.
Pustular skin lesions(pyoderma) belong to a group of common diseases in children, especially at an early age. The causative agents of pyoderma in children are streptococci (group B streptococci) and staphylococci (Staphylococcus aureus). Streptococcal pyoderma predominates, with the exception of the neonatal period, when mainly staphylococcal pyoderma occurs (vesiculopustulosis, multiple skin abscesses -
pseudofurunculosis, phlegmon, pemphigus, mastitis, paraproctitis, omphalitis, conjunctivitis, dacryocystitis, etc.).
The entry point for infection in a newborn is the navel area, as well as any, even very minor, skin damage that easily and imperceptibly occurs during hygiene procedures (washing, swaddling), feeding, etc. The appearance of pyoderma is promoted by contamination of the skin due to poor hygienic care. Streptoderma is characterized by superficial localization of pustules and their tendency to grow peripherally. Pustules are usually located in the area of hair follicles, sebaceous and sweat glands.
Newborns and children of the first year of life with purulent skin diseases (vesiculopustulosis, abscess) should be isolated, and separate personnel should be allocated to care for them. Constant prevention of staphyloderma in newborns is necessary. Thus, the rooms in which newborns are located must be systematically treated with a mercury-quartz lamp (ultraviolet irradiation) and disinfectant solutions.
Treatment of skin purulent elements consists of local sanitation of pustules, blisters, and the fastest possible opening of abscesses, phlegmon, purulent mastitis, paraproctitis to remove pus. After opening them, the eroded surface is treated with aqueous and alcohol solutions of antiseptics (furacilin, chlorophyllipt, 1% solution of brilliant green, 2% solution of potassium permanganate, 2-5% chloramphenicol, fucorcin) and antimicrobial agents, usually ointments (triderm, levomekol, bactroban, lincomycin, neomycin, erythromycin), gels (5% licacin, 1% dalacin T), lysozyme. External preparations containing antibiotics are applied 1-2 times a day. They use a helium-neon laser, ultraviolet radiation, medicinal baths with a decoction of oak bark, string, and St. John's wort.
Healthy areas around the affected skin are treated with 2% salicylic-boron or camphor alcohol, for which a cotton or gauze swab wrapped on tweezers or a wooden stick is moistened in alcohol.
In medical practice, dressings with Vishnevsky ointment are often used, especially in the presence of an inflammatory infiltrate. To do this, lubricate a sterile napkin consisting of 5-6 layers of gauze using a wooden or glass stick.
Vishnevsky ointment and place it on the affected area of the skin, cover it with compress paper and then with cotton wool. The cotton layer should be 2-3 cm wider and longer than the gauze layer. The entire bandage is strengthened with a bandage or scarf.
For abscesses, after opening, it is necessary to use bandages with hypertonic solutions. Sterile gauze wipes are soaked in a hypertonic solution (8-10% sodium chloride solution or 25% magnesium sulfate solution, etc.) and applied to the affected area of the skin, covered with a layer of absorbent cotton wool and secured with a bandage.
If a child is diagnosed with pustular skin diseases, then it is necessary to sharply limit the intake of sugar into the body - no chocolate, no sweets! Carbohydrates enter the skin cells in large quantities and form a breeding ground for pathogenic microorganisms - the main causative agent of skin infections. Breastfeeding mothers should follow restrictions on sugar intake.
Local antiseptics- triclosan and chlorhexidine - used in emollients or as part of moisturizing therapy in the form of dressings. They reduce skin colonization Staphylococcus aureus. Wearing silver-coated clothing and silk fabrics with durable antimicrobial treatments may also reduce Staphylococcus aureus colonization and skin inflammatory activity.
Topical antibiotics are used to treat local forms of secondary infection in atopic dermatitis. Fusidic acid is used in short courses for 2 weeks, and preparations based on erythromycin.
Diaper dermatitis (diaper rash)- redness in the area of skin folds, buttocks, perineum due to increased humidity and friction in infants, especially in the first months of life. Diaper rash in most cases indicates improper skin care, although individual predisposition should also be taken into account. There are dermatitis of “bulges” (on the buttocks, upper thighs, abdomen, genitals) and dermatitis of “folds” (on the neck, in the armpits, between the buttocks, under the scrotum). More often, diaper rash occurs in overweight children.
Skin erythema can appear from even the slightest exposure - when it gets hot in the room or outside, due to
for wrinkles on clothes, etc. The risk of developing the disease increases with allergies and intestinal disorders. Intestinal dysbiosis contributes not only to relapses, but also to the spread of the process. Cause of diaper rash around anus- indigestion, when the child begins to have diarrhea or intense gases with small portions of sour stool.
Red grooves need immediate treatment to prevent weeping and fungal infection Candida albicans, staphylococci or streptococci.
Areas of redness are treated with wet wipes or rinsed with water and baby cream or powder is applied (you cannot combine them!). If diaper rash has affected the deeper layers of the skin, swelling and weeping have appeared, the skin is treated with a decoction of chamomile or bay leaf, lubricated with baby cream, and the child is left “in the air” for 15-20 minutes.
For diaper rash or skin irritation in a newborn, use zinc or salicylic-zinc paste, betanten cream, d-Panthenol ointment or panthenol spray. The main active ingredient of panthenol is dexpanthenol - an alcohol analogue of vitamin B 5 (pantothenic acid). The effectiveness of ointments containing dexpanthenol in the treatment of diaper dermatitis is almost 100% if applied to the affected areas at least 4 times a day. The ointment is also effective when treating the breasts of nursing mothers (nipple cracks).
It is necessary to follow a strict feeding regime. Air baths, free swaddling, temporary replacement of disposable diapers with “classic” cotton diapers (washed only with baby soap), and timely change of diapers are recommended. You should not use diapers made of artificial materials, oilcloth, or Vaseline oil. Baby creams are used as a preventative measure. The simultaneous use of oil (or cream) and powder is not allowed, as this creates lumps that, accumulating in the folds of the skin, cause irritation, weeping, and abrasions.
which is easily transmitted through household contacts. The diagnosis of scabies is confirmed by the detection of a mite during a laboratory test, although it is necessary to treat with anti-scabies in all cases where this disease is suspected.
Treatment consists of rubbing acaricides into the skin, and not just into the affected areas (except for the scalp, face and neck): 5% permethrin cream (not for children under 2 months), 2-10% sulfur petrolate, 20% aqueous soap suspension of benzyl benzoate twice for 10 minutes with a 10-minute break (children under 3 years old use a 10% suspension). The procedure is repeated the next day. After finishing the rubbing, the patient puts on clean underwear and disinfected outerwear. Bedding should also be changed. Before treatment, the child washes his hands thoroughly with warm water and soap; After treatment, hands should not be washed for 3 hours.
Among the modern means, the Spregal aerosol is prescribed. Treatment is carried out mainly in the evening in order to leave the drug to act throughout the night. The entire body is sprayed with the drug, except the face and scalp. Spray the most affected areas generously (Fig. 36), then put on clean clothes. You cannot wash for 12 hours. When spraying, newborns and young children cover their mouth, nose and eyes with a napkin. If there are scratches on the face, they are treated with cotton wool moistened with Spregal aerosol. To change diapers on infants, you should additionally spray the entire buttock area. After 12 hours
Rice. 36.Treatment of affected areas with an anti-scabies aerosol, followed by aeration
The child is washed with soap and the skin is washed well with water (preferably in the shower). A-PAR aerosol is used to treat clothing, linen and furniture. If the insecticide gets on the mucous membranes or in the eyes, they should be washed with clean running water and soap.
To effectively stop scabies, you should:
Treat children who complain of itching with an anti-scabies drug;
Treat simultaneously everyone who lives with the child under the same roof and is in close contact with the patient;
Disinfect clothing and bedding to avoid re-infection.
At fungal infections the skin and mucous membrane of the oral cavity are treated with a 1% aqueous solution of brilliant green or batrafen, lamisil. Treatment options include clotrimazole (Canesten), mycoseptin, nystatin ointment, citrosept, etc. Ultraviolet irradiation has a good effect in the treatment of skin diaper rash.
At herpetic lesions skin characterized by the appearance of itchy blisters and erosions on the skin and mucous membrane, antiherpetic agents are used: antiherpes, Zovirax ointment, Gevisosh ointment, etc. If these drugs are used when warning signs of the disease appear - itching, burning, tingling, then rashes can be avoid it altogether.
CONTROL QUESTIONS
1.Name the rules for caring for a child’s skin.
2.What is skin care for a baby with diaper rash?
3.How are lotions used?
4.How are talkers used?
5.How to prepare a bath with potassium permanganate?
6.How to prepare a starch bath?
7.How to prepare a bath with herb or chamomile?
8.How are pustular elements on the skin treated?
9.How is a hypertensive bandage applied?
10.How is fungal diaper rash treated?
11.What is the treatment for scabies in children?
12.How are herpetic elements on a child’s skin treated?
General child care: Zaprudnov A. M., Grigoriev K. I. textbook. allowance. - 4th ed., revised. and additional - M. 2009. - 416 p. : ill.
MICROSPORIA
What are the features of microsporia infection and localization of lesions?
Mostly children are affected; adults become infected very rarely. With the onset of puberty, microsporia spontaneously heals. It is transmitted through direct contact with a sick child (animal) or through objects or things infected with fungi (hats, combs, scissors, etc.). The lesions are localized on the scalp and smooth skin; nails are rarely affected.
What are the clinical manifestations of the disease?
When infected with anthropophilic fungi, multiple patches of fine-plate peeling of irregular shapes appear on the scalp, prone to merging and forming large lesions. They are located mainly in the marginal hair growth zone. The hair in the outbreaks breaks off, but not all of it. Their stumps have different lengths. Often the lesions spread to adjacent areas of smooth skin (forehead, temples, neck), where they take the form of pink-red rings, ovals with a paler center or concentric circles, or large polycyclic figures (when individual lesions merge).
What treatment is prescribed to the patient?
Treatment of microsporia is the same as for trichophytosis; Only when the scalp is affected, the daily dose of griseofulvin increases to 22 mg per 1 kg of body weight. Weakened children are also prescribed pyrogenal, immunoglobulin, and vitamin Bx. The prognosis is favorable.
Special care
Care for abdominal pain
If a child complains of acute pain in the abdomen, before visiting a doctor, it is unacceptable to give him painkillers, laxatives, give him an enema or place heating pads on his stomach. All these measures can either blur the picture of the disease, thereby complicating the diagnosis, or cause a worsening of the condition. If complaints of abdominal pain appear in the evening or at night, you must immediately call an ambulance. It is unacceptable to ignore complaints of abdominal pain, since you may miss the initial period of very severe acute diseases of the abdominal organs, for which urgent surgical intervention is indicated.
Diarrhea care
If the first symptom of the disease is an increase in stool frequency, it is necessary to monitor its frequency, color, consistency and smell, since these data are extremely important in making a diagnosis. Careful care of the skin in the anal area is necessary.
Care for vomiting
If vomiting occurs, the child should be placed in a sitting position, with his torso and head tilted forward to prevent vomit from entering the respiratory tract. After vomiting, the child should rinse his mouth with boiled water. You should pay attention to the nature of the vomit (with bile, mixed with blood, in the form of coffee grounds) and save it until the doctor arrives.
Hyperthermia care
If there is a significant increase in body temperature, especially if the child complains of a headache and his pulse is increased, before the doctor arrives, a damp cloth should be placed on the patient’s forehead, changing it periodically. In order to reduce the temperature of the child’s limbs and torso, it is recommended to wipe with medical alcohol diluted with water in a ratio of 1: 1, or with vodka. It is permissible to give the patient a mild cardiac remedy, for example valerian tincture, in such an amount that the number of drops corresponds to the number of full years of the patient. At high temperature The child needs plenty of fluids and clothing should be light.
Care for catarrhal symptoms
If the first sign of the disease is a runny nose, which complicates breathing through the nose, it is worth instilling leukocyte interferon into it, which can be purchased at the pharmacy chain. It is advisable to instill 2 drops into each nostril every hour. If interferon is not available, you can use 0.25 - 0.5% oxolinic ointments. For older children with a severe runny nose, it is recommended to instill naphthyzin or children's galazolin to facilitate nasal breathing.
When coughing, hold your baby in your arms. The first complaints of a sick child may be associated with ear pain. Small children in such a situation wince when swallowing, they have a complete loss of appetite, their sleep is disturbed, and they suddenly wake up at night crying loudly. Older children may explain that the pain in the ear is shooting in nature. Before the doctor arrives, if you have ear pain, it is advisable to apply a warm compress to the affected side.
Care for fainting
The first symptom of the onset of cardiovascular disease may be fainting. When a child faints, there is a sudden and complete loss of consciousness, while respiratory and cardiac activity are weakened. If a fainting condition has developed in a closed room, an influx of fresh air should be ensured by opening the vents or windows, the baby should be placed in a horizontal position so that the head is slightly lower than the body, clothing that restricts breathing should be unbuttoned or removed, and the victim’s face should be sprayed with cold water. and let him smell cotton wool soaked in ammonia.
Skin care
If a child has certain skin lesions, such as diathesis, the doctor may recommend that he take medicinal baths with the addition of a pre-prepared solution of potassium permanganate, a decoction of oak bark, bran, etc. Baths can be either general, when the whole body is immersed in water , and local - usually foot. In order to prepare a bath with potassium permanganate, potassium permanganate crystals are dissolved in a separate container to obtain a 5% solution and gradually dripped into the water until it acquires a pinkish tint in the bath. Crystals of this substance cannot be poured directly into the bath, since if they are not completely dissolved, they can cause burns to the child’s skin. Baths with a solution of potassium permanganate are usually prescribed for newborns. Potassium permanganate has a good disinfecting effect, which is very important for an unhealed umbilical wound.
Local baths are usually recommended for older children. The most common type of local baths are foot baths with the addition of mustard (if there is no allergic reaction to it). This procedure is quite effective for colds with respiratory manifestations. To prepare foot baths, pour hot water into a basin or bucket and dissolve 100 g of mustard powder in it. Then cool the water to 40–45 °C to avoid skin burns, then immerse the child’s feet in it for 20–30 minutes. Cover your knees with a towel. After finishing the procedure, wash the baby’s feet with clean warm water, dry them thoroughly, put warm socks or stockings on them, put the baby to bed, covering them with a blanket.
Infectious Disease Care
When caring for a child with an infectious disease, pay special attention to the hygienic condition of the skin and mucous membranes, since they are not only a barrier to the penetration of infectious agents, but also the respiratory and excretory organs. It should be remembered that illness, as a rule, is not a contraindication for swimming; you just need to correlate the amount of hygiene measures with the general condition of the child. After your baby has been bathed, be sure to dry him with a soft, warm towel. Very young children should be washed with warm water after each bowel movement or urination.
After your baby's skin is dry, powder it with a special baby powder or apply a non-causing baby cream to it. allergic reactions. If the child is in serious condition and is advised to undergo strict bed rest, then he should be examined once a day for early detection of possible bedsores. As a rule, they are localized in the occipital region, in the area of the sacrum, shoulder blades, elbow and hip joints, and heels. One of the first symptoms of the beginning development of a bedsore is the presence of a red spot on the skin, painful on palpation. You should regularly change the position of a sick child in bed, gently massaging areas of the skin where the risk of developing bedsores is highest. After the massage, problem areas of the skin are wiped with a 70% solution of medical (preferably camphor) alcohol. If the risk of developing bedsores is high, then an inflatable rubber cushion or a circle specially designed for this purpose should be placed under the body of the sick baby.
The most common infectious diseases in children are measles, chicken pox, rubella, and mumps. The risk of contracting these infections through contact with a sick person is very high, so almost everyone carries them childhood.
Children's lips often crack during a feverish reaction, so lubricate them with rich cream or Vaseline. For oral administration, the child is prescribed multivitamin complexes, which must certainly include riboflavin. If there is constant severe dryness of the mucous membranes of the oral cavity, the baby can be given lollipops (if age and general condition allow), fruit and berry juices, weak tea acidified with lemon juice. Every day, in the morning and immediately before bedtime, a sick child should brush his teeth. In this case, preference should be given to toothpaste that has disinfecting properties, since against the background of a general weakening of the body, the proliferation of microorganisms in the oral cavity can occur much faster. In seriously ill children, the mucous membranes of the oral cavity should be treated with a swab with a disinfectant solution. This manipulation is performed 2–3 times a day to remove mucus and food debris. To prevent the formation of tongue cracks, it is advisable to lubricate it with fresh, unsalted butter; You can also use glycerin.
During the period of illness, the child's eyes require special care. There are a number of infectious diseases in which, due to a decrease in the body’s overall resistance to infections, conjunctivitis, scleritis, and keratitis develop. This significantly increases the likelihood of activation of secondary bacterial microflora. To avoid complications, the patient's eyes should be washed 2-3 times a day with a cotton swab generously moistened with a weak (0.02%) solution of furatsilin. Movements should be directed from the outer corner of the eye to the inner. You can also recommend cold, strong tea leaves for washing your eyes.
Infectious diseases are particularly dynamic and have an undulating course, and often the condition of a sick child can change dramatically over the course of short term. In this regard, dynamic monitoring of the child’s condition plays an important role during care. When monitoring the condition, pay special attention to emerging complaints, changes in general well-being and the neuropsychic state of the small patient, when examining the skin and mucous membranes - to their color, turgor, humidity, the presence or absence of rashes.
Monitor the frequency and filling of the pulse, the depth and rhythm of breathing, regularly measure the child’s blood pressure and body temperature.
It is also advisable to record the daily amount of fluid consumed by the patient and daily diuresis. The strictest possible monitoring of the baby’s condition is necessary until a final diagnosis is made. Any, even the most seemingly insignificant, change in his condition can be of great importance.
Caring for Elderly Patients
General care
Caring for elderly and senile patients is a rather complex and responsible matter, requiring special skills, as well as a lot of attention and patience. The most important principle of general care that must always be kept in mind is respect for the individual person. The patient should be accepted as he is, with all his physical and mental disabilities, individual characteristics of character and personality, etc. It should be borne in mind that good ongoing care can significantly improve the general condition of the patient.
As you know, movement prolongs life, so physical activity is necessary for everyone, especially for patients in older age groups. Strong physical activity increases the overall tone of the body, maintains mobility in the joints, improves flexibility and endurance.
Maintaining a normal, stable psycho-emotional state is impossible without receiving a sufficient amount of information from the outside. Therefore, keep in mind that lack or irregularity mental load just as dangerous as lack of physical activity. If the patient's physical abilities are severely limited and he is deprived of the opportunity to train his intellect, this can lead to the most detrimental consequences for his mental and physical health. Life retains its attractiveness for a person as long as he has the opportunity to maintain and maintain relationships with society. Regular contact with family and friends is one of the main incentives for maintaining the desire to live and at the same time be healthy. If circumstances are such that a person has neither family nor friends, the duty of those around him is to, as far as possible, make up for the lack of communication. Lonely people often lose their zest for life and begin to feel the meaninglessness of their existence.
For the rational organization of general care for elderly and senile patients, a number of behavioral features of this group of patients should be taken into account. Upon reaching a certain age due to natural processes During aging, some changes in body functions are intertwined with signs of many diseases, and in many cases with the so-called multiple age-related pathology.
In elderly people, there is a significant change in the functions of the kidneys and urinary system. There is a significant increase in nocturnal diuresis, which may be due to increased sensitivity to irritation from the sphincters Bladder, and in male patients – such a common pathology as prostate adenoma. In elderly patients suffering from cardiovascular failure, an increase in the volume of urine excreted at night is a compensatory phenomenon due to some improvement in renal circulation during prolonged exposure to a horizontal position at rest.
If it is noted that the patient has to frequently visit the toilet at night, he should be provided with a duck or urine bag so that he does not have to get up every time. In this way, you can avoid significant sleep disturbances that negatively affect the state of the nervous system. In addition, if there is a frequent urge to urinate at night, the patient should be advised to reduce the amount of fluid taken in the evening. However, carefully monitor daily diuresis, which should not be less than 1 liter.
Most people develop caution with age, however, various accidents involving the elderly and old people, unfortunately, are not uncommon. Accidents occur not only on busy highways and slippery sidewalks, but also indoors. As many people age, their response decreases, the body is no longer as obedient as in youth, a sudden change blood pressure can lead to dizziness and loss of consciousness - hence the large number of accidents that occur in the bathroom, toilet or other familiar and frequently visited places.
Falls often occur due to age-related deterioration in vision, hearing, changes in the vestibular apparatus, poor coordination of movements, etc. Moreover, due to the increased fragility of bones caused by osteoporosis, so-called “senile” fractures often occur.
In order to reduce the risk of injury at home, the premises should not contain unnecessary furnishings, the location of which may impede movement. In no case should you move furniture without informing the elderly or old person, since when moving in a familiar room, they rely more on habit developed over time than on visual acuity. It is important to note that falls can also occur during an excessively sudden transition from a horizontal or even sitting position to a vertical one. This applies to the greatest extent to patients who are forced to take medications that lower blood pressure. Short-term insufficiency of cerebral and coronary circulation as a result of blood redistribution and a drop in blood pressure can lead to loss of consciousness.
IN Everyday life It is not uncommon for accidents to happen to elderly people and the elderly in the bathroom. This is usually due to loss of balance on a slippery floor. Some people get thermal burns when they inadvertently open a faucet. hot water. It is therefore better to help the old person prepare the bathing water by adjusting it to the optimal temperature. The safest thing to do is not take a bath, but a shower, and in a sitting position and in the presence of one of your relatives. The temperature of the water for bathing should not be higher than 36 - 37 ° C; you should never direct hot water from the shower to the head and heart area, as this can provoke the development of an acute disorder of cerebral (or coronary) circulation. It is recommended to place a mat made of rubber to prevent slipping on the floor next to the bathtub. If possible, you should install special devices or handrails in the toilet and bathroom, which old man could lean on.
Since old people cannot always maintain stability and balance when moving, it is advisable to purchase special supports and chairs equipped with wheels for them.
The bed should be arranged in a special way. Its height from the floor level should be at least 60 cm. If necessary, equip it with a device (support) to facilitate the transfer of an elderly patient to a sitting position. This sleeping place is called a functional bed.
It is recommended to constantly use a special over-bed or bedside table for the convenience of eating and placing some things that are constantly necessary for the patient. It is preferable to use not one large pillow, but two, but smaller ones. The blanket should not be heavy, but it must be warm. Bedridden patients can often develop bedsores: to prevent their occurrence, the degree of elasticity of the mattress is of great importance. It should be sufficiently pliable and provide support for the entire body.
The chair in which an elderly patient is supposed to be seated should be quite soft, its armrests should be low and comfortable. An elderly person should not be offered a chair that is too deep to avoid pressure from the edge of the seat on the area of the popliteal fossa, causing poor blood circulation in the lower extremities. The chair should have a high back to provide head support. Also take care of the lighting so that you can read while in bed or in a chair.
The body of elderly and senile people is much more sensitive to cold and drafts. This is due to the fact that, due to the aging process, the level of microcirculation is insufficient and the skin temperature is reduced. The thickness of the subcutaneous fat layer is often reduced, which in this case provides less protection from the cold. Many elderly patients experience muscle pain, which tends to intensify at relatively low ambient temperatures. All these factors cause chilliness and protests against the necessary ventilation of the room.
In older people, the composition of the secretion of the sweat glands changes, so the skin acquires a specific odor, is prone to irritation and requires more frequent hygienic water procedures.
The most optimal temperature of a room with an elderly patient on bed rest is 20 °C, and under normal conditions - 22 - 23 °C. It should be noted that in the presence of central heating in the premises, as a rule, the dryness of the air is increased, and this adversely affects patients suffering from chronic respiratory diseases and provokes coughing. In order to increase air humidity, place open containers of water near central heating radiators.
Starting from about 40 years of age, age-related changes in the human skin are noted. By the age of 60, all layers of the skin become significantly thinner, the function of the sweat and sebaceous glands undergo changes, and due to changes in microcirculation, the nutrition of the hair follicles is disrupted. Due to changes in blood vessels and nerves, the protective function of the skin decreases. The reaction of the skin to all types of irritants (mechanical, temperature and chemical) changes significantly. In this regard, frequent bathing or showering with regular soap in elderly and elderly patients provokes the development of increased dry skin and the occurrence of itching.
To avoid such consequences of hygiene procedures, bathing should be done once a week and soap with a high fat content should be used.
If you wash your hair too often with soap, in addition to dry skin and itching, dandruff may appear. In this situation, it may be advisable to wash your hair with sulsein soap once every two weeks and use special nourishing liquids to rub into the skin.
Procedures such as rubbing and body massage have an extremely beneficial effect on the patient. In this case, it is necessary to exercise increased caution and make adjustments for age, taking into account the thinness and high traumatability of the skin. When performing massage and rubbing, you should lubricate the body with mineral oils or creams intended for dry skin.
Foot care also requires increased attention, since the skin lower limbs undergoes significant changes quite early due to deterioration of peripheral circulation. The nails change noticeably - they become very hard and at the same time brittle. Therefore, before you start trimming and processing them, soften them with warm oil poultices. The most optimal is to use castor oil. Careful care of nails and removal of calluses is given great importance, since undesirable changes in the foot area reduce the mobility of an elderly patient and negatively affect his physical, emotional and mental state. As a result of skin injury, inflammatory processes can occur that are difficult to cure. Against the background of reduced general immunity of the senile body, and especially in the presence diabetes mellitus, this can lead to the development of severe complications, such as gangrene.
It is always necessary to welcome and encourage the attentive attitude of sick old people to their appearance. Well maintained appearance significantly improves the emotional state of patients, which, of course, has a positive effect on their physical condition.
With a number of serious diseases of various organs and systems, elderly patients have to remain in bed for a long time, which can cause some negative consequences. To prevent complications, a whole range of measures is used. The question of the duration of bed rest is extremely important! Previously, it was believed that it was advisable for an elderly or old person to conserve their strength and observe bed rest for as long as possible, but practice shows that this often leads to significant changes in the functions of internal organs, resulting in various complications. Such consequences include, for example, bedsores, thromboembolism of blood vessels, difficulty urinating, and urinary tract infections. In addition, there is a significant deterioration in appetite, resulting in a decrease in the patient’s body weight, atrophy muscle tissue and general physical weakness.
Maintaining bed rest, being in a horizontal and sedentary position for a long time in elderly and senile patients often leads to decreased mobility in the joints, constipation, sleep disturbances (including insomnia), changes in the psyche and the development of depressive states. In this regard, whenever possible, the period of bed rest should be reduced and the patient should not be allowed to remain immobile unless absolutely necessary. Long-term bed rest is necessary for elderly people and the elderly for diseases accompanied by an increase in general body temperature, for severe chronic diseases, in the acute period of myocardial infarction and for some other serious pathologies. At the same time, the implementation of careful and constant general care makes it possible to reduce the negative impact of physical inactivity on the general physical and emotional state of the patient. For this reason, one of the most important therapeutic measures is physical therapy (physical therapy), prescribed by a doctor and carried out under the supervision of medical personnel.
All recovery processes in older people and old people proceed much slower than in younger people, so the rehabilitation period is much longer. Nevertheless, rational therapy and careful ongoing care allow an elderly patient to recover even after very serious illnesses.
In the process of organizing general care for elderly patients, an important role is given to various aspects of deontology. The specificity of the psychology of an elderly person is such that he reacts extremely painfully to a change of environment and has difficulty adapting to the conditions of a hospital. In this regard, it is preferable for the patient to undergo treatment at home. You should always take into account the psychological characteristics of an elderly person. Old people often suffer from memory impairment, and when caring for such patients, you need to show special patience and tact, regularly reminding them of the need to carry out procedures and take medications at certain times.
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State budgetary educational institution
secondary vocational education
Medical School No. 13
Moscow City Health Department
Course work
Subject: Nursing care for mycoses, pyoderma,psoriasis
Professional module:PM-02. "Participation in the treatment, diagnostic and treatment processes."
Interdisciplinary course:MDK 02.01
Completed by student: Pavel Aleksandrovich Dolgopolov
Course 3 Group 32
Coursework supervisor: Selezneva Tatyana Sergeevna
Moscow 2014
Introduction
1.0 Pyoderma
1.1 Osteofolliculitis
1.2 Folliculitis
1.3 Staphylococcal sycosis
1.4 Furuncle
1.5 Carbuncle
1.6 Hidradenitis
1.7 Will spoil it
1.10 Streptococcal impetigo
1.11 Slit-like impetigo
1.15 Treatment of pyoderma
2.0 Mycoses
2.2 Dermatophytosis
2.3 Microsporia
2.4 Trichophytosis
2.5 Mycoses of the feet
2.6 Candidiasis
2.7 Psoriasis
Application
Introduction
Relevance of the topic:
Today, people affected by dermatovenerological diseases are very relevant, since less and less attention is paid to personal hygiene, and some diseases appear in people with a genetic predisposition to them. According to statistics, every fifth of the world's population suffers from mycoses; Psoriasis affects 2-5% of the total population; According to statistics, pyoderma affects from 25 to 40% of the population.
Goal of the work:
Provide an explanation of the symptoms, clinical course, treatment, prevention and care for patients with mycoses, pyoderma, psoriasis.
Practical significance of the course work:
In this course work The pathological, clinical, symptomatic phenomena of each of these diseases are described, and the treatment and care of patients used in medical practice to this day is also described.
Theoretical part
1.0 Pyoderma
1.1 Ostiofolliculitis
It is characterized by the formation at the mouth of the hair follicle of a pustule with a pin head, located on a hyperemic base, penetrated by hair. The pustule becomes covered with a yellow crust, which disappears after a few days, leaving no trace.
Osteofoliculitis is not prone to peripheral growth. They can be either single or multiple.
1.2 Folliculitis
It is the next stage in the development of ostiofolliculitis, a deeper spread of inflammation of the hair follicle. The process involves not only the epithelial, but also the connective tissue part of the hair follicle, as well as the adjacent dermis.
At the height of its development, folliculitis is a small follicular pustule penetrated by hair. At the base of the pustule there is a painful inflammatory infiltrate of a dense consistency, determined upon palpation in the form of a nodule in the thickness of the dermis. After 1-2 days, the exudate of the pustule shrinks into a crust, which is then rejected. The erosion under the crust becomes epithelialized.
1.3 Staphylococcal sycosis
This is a chronic inflammation of the hair follicles with a recurrent course. It usually develops in men and is localized mainly in the beard and mustache area. It occurs against the background of chronic foci of infection, pathology of internal organs, nervous and endocrine systems, and hypovitaminosis.
Staphylococcal sycosis begins with the development of folliculitis, the number of which increases, they merge with each other and form infiltrated foci of bright red color, dotted with pustules and crusts, with multiple erosions. Papulopustular elements are located along the periphery of the lesions. The disease is accompanied by a feeling of itching, burning, and pain. Sometimes regional lymph nodes become enlarged. Staphylococcal sycosis lasts for years, recurs, and is resistant to therapy.
1.4 Furuncle
mycosis pyoderma psoriasis treatment
This is an acute purulent-necrotic inflammation of the hair follicle and the surrounding connective tissue. The formed boil is a painful inflammatory nodule with the presence of a follicular pustule. The skin over the node is purplish-red. Then necrosis of the hair follicle occurs with the formation of a necrotic rod. As a result of purulent melting of the infiltrate, the boil opens and a small amount of purulent-necrotic discharge is released. After the necrotic core and pus are rejected, a crater-shaped ulcer is formed, which granulates and heals with a scar. When the disease occurs, the general condition is usually disturbed: the temperature rises, headache and malaise.
The boil can be located on any part of the body, with the exception of the palms and soles, where boils cannot develop due to the absence of hair follicles.
Boils of the upper lip and nasolabial folds are very dangerous, since the anterior facial vein is located close here, communicating with the cavernous sinus. In this place, it is most possible for a septic embolus to enter the venous network and carry it into the venous sinus, resulting in the development of meningitis.
Boils can be single or multiple. With chronic recurrent furunculosis, boils erupt continuously or at short intervals over many months and years. New elements appear when the initial ones have not yet completely regressed, and also several weeks or months after their disappearance.
The chronic recurrent course of furunculosis is usually caused by a decrease in the body's resistance, impaired carbohydrate metabolism, chronic debilitating diseases, hypovitaminosis, and anemia.
1.5 Carbuncle
A conglomerate of boils that occurs as a result of simultaneous purulent-necrotic lesions of many adjacent hair follicles.
With a carbuncle, the lesion is deeper than with a boil; the subcutaneous base up to the fascia is more involved in the pathological process. A deep, dense, sharply painful infiltrate is formed, which can reach the size of a child’s palm. The skin over the infiltrate is bluish-red, and the area around it is very swollen.
After 8-12 days, the infiltrate softens and purulent-necrotic masses are rejected, as a result of which holes resembling a sieve appear on the surface of the carbuncle. As a result of an increase in the periphery of the holes, an ulcer of significant size is formed, which is gradually filled with granulations and heals with a retracted scar.
The general condition of the patient with a carbuncle is disturbed even more than with a boil. There is a persistent increase in body temperature, accompanied by chills. In depleted and weakened patients, the course of the carbuncle can be severe, even leading to the development of sepsis.
1.6 Hidradenitis. (See Appendix 1)
Acute purulent inflammation of the apocrine sweat glands, localized mainly in armpits. Women get sick more often.
In the depths of the subcutaneous base, single or multiple painful nodes the size of a pea appear, gradually increasing in size. The skin over the nodes first becomes swollen, red, then bluish-red. Due to purulent melting, dense nodes quickly soften, fluctuation appears, and the nodes open. Thick pus, sometimes mixed with blood, is released through the fistula openings. Eventually a scar will form.
The disease is usually accompanied by fever and malaise.
In weakened and exhausted individuals, hidradenitis can take a chronic course.
1.7 Will spoil it
Inflammation of the orifices of the excretory ducts of the eccrine sweat glands. Occurs in infants with increased sweating, weakened, and also with poor care, as a complication of prickly heat. The rash is localized mainly in the back, chest, neck, and medial thighs. A large number of small, pinhead-sized bubbles appear. Some of the elements of the rash may resolve, while the contents of others become cloudy - the vesicle turns into a pustule. The skin around the blisters and pustules is somewhat hyperemic.
The primary elements of miliaria may become covered with crusts or small erosions will form in their place. The rash goes away without a trace.
1.8 Multiple abscesses (pseudofurunculosis)
Inflammation of the eccrine sweat glands in infants. The disease is observed in weakened, poorly cared for children.
Pseudofurunculosis is characterized by the formation of dense inflammatory nodes the size of a pea, gradually increasing to the size of a cherry and softening to form an abscess. The skin over the abscesses is purplish-red. Multiple abscesses are similar in appearance to boils, but unlike them they do not have a necrotic core. Ultimately, the abscesses rupture to form fistulas and then ulcers.
The disease lasts a long time. It is usually accompanied by a violation of the general condition and an increase in body temperature. Pseudofurunculosis can lead to the development of pyaemia and sepsis.
1.9 Epidemic pemphigus of newborns
Acute infection, characterized by high contagiousness. It is caused predominantly by pathogenic Staphylococcus aureus.
Neonatal pemphigus affects children in the first days of life, mainly from 7 to 10 days after birth.
The source of infection most often is medical personnel or mothers of newborns who are sick or have recently had staphylococcal skin diseases. Pathogenic staphylococci can enter the skin of a newborn from a poorly treated, infected navel.
Transmission of infection from one newborn to another by medical personnel or through linen can lead to the development of an epidemic outbreak of the disease in the maternity hospital. The rash is often preceded by a short-term fever. The rash consists of tense or flabby blisters on a hyperemic base. As a result of peripheral growth, they quickly increase, reaching several centimeters in diameter. The serous contents of the blisters turn purulent. After the thin covering of the bladder ruptures, erosion occurs. Initially, most often the rashes are localized on the arms and stomach, then they can spread throughout the body. Blisters are extremely rare on the palms and soles.
The general condition of patients in mild cases is not affected. In more severe forms, the temperature rises, lethargy, loss of appetite, diarrhea are noted, in some cases complications develop (pneumonia, otitis media, conjunctivitis), and in especially severe cases - septicopyemia.
A malignant form of epidemic pemphigus of newborns is Ritter's exfoliative dermatitis - the most severe staphyloderma of newborns. Skin damage consists of redness and blistering. Hyperemia, swelling, and peeling of the skin around the mouth, in the chin area and adjacent areas of the cheeks appear. The inflammatory process quickly spreads throughout the body. The skin takes on a diffuse bright red color, against which large blisters appear that can merge. The bubbles burst and extensive erosions form. The erosive surface resembles a burn pattern. The epidermis peels off easily, separating into layers.
The general condition of the child depends on the extent of the process. The temperature often rises to 39-40 0C, a toxic-septic condition develops, and then sepsis. There is a decrease in body weight and gastrointestinal disorders. Complications are common: pneumonia, pyelonephritis, otitis media, abscesses, phlegmon. In severe and complicated cases of the disease, death can occur.
1.10 Streptococcal impetigo
The most common superficial form of streptoderma in children. The disease is contagious. The pathogen is transmitted more often through household items, toys, and infected hands. The possibility of developing impetigo is aggravated by a runny nose and discharge from the external auditory canal during purulent otitis media.
Streptococcal impetigo begins with a small hyperemic spot, on which a phlyctena very quickly forms - a vesicle with a flabby tire, located under the stratum corneum of the epidermis. The contents of the phlyctena dry out and the lesions are covered with a brown crust. When the crust is removed, erosion is revealed. The conflicts merge with each other and form abundant lesions.
After peeling off the crust, a bluish-pink stain remains, which disappears over time. Impetigo disappears without a trace. In cases where conflicts form in the form of blisters, cystic impetigo is diagnosed. Mixed strepto-staphylococcal impetigo is called ordinary impetigo. The contents of the phlycten become purulent, the crusts acquire a greenish-yellow color.
1.11 Slit-like impetigo
This is streptococcal impetigo in the corners of the mouth. At first, conflict appears in this area, then erosion forms, which has a linear arrangement. The skin of the corners of the mouth is swollen and hyperemic, in the depths of the fold there is a slit-like erosion with an overhanging whitish rim of exfoliated epidermis. The crust that forms on the surface of the erosion and the restoring epithelium are easily torn when the lips move. The defeat is painful.
With streptococcal paronchia - inflammation of the periungual fold, the phlyctena is located in a horseshoe shape, covering the nail on three sides. After opening the phlyctena, a bright red erosion is formed, surrounded by a border of exfoliated epidermis.
1.12 Intertriginous streptoderma
It is a type of streptococcal impetigo. It develops in large skin folds. This form of streptoderma is characterized by the formation in the skin folds of a continuous erosive weeping surface of a bright pink color, sharply limited from the surrounding healthy skin. Subjective sensations: burning sensation, pain.
1.13 Chronic superficial diffuse streptoderma
It is characterized by diffuse damage to the skin area, mainly the legs in patients with varicose symptom complex and congestion. The lesions show hyperemia, sometimes with a bluish tint, and mild infiltration with the presence of a large number of brownish-yellow crusts. The lesion tends to grow peripherally. The disease is chronic and often recurs after clinical recovery.
1.14 Ecthyma vulgaris, or streptococcal
It is a deep ulcerative lesion of the skin. Disease develops in people with reduced body resistance.
Initially, a painful cystic phlyctena occurs. Then a yellowish-brown crust forms. Beneath it there is an ulcer with undermined edges and an easily bleeding bottom. After existing for 2-3 weeks, the ulcer slowly heals, leaving a scar in its place.
1.15 Treatment
Treatment of pustular diseases should be comprehensive. The methods and means used depend on the etiological and pathogenetic factors, the type and virulence of the bacteria, and the state of the body’s general resistance. The depth of the pathological process, its localization and duration are of great importance.
Proper care plays an important role in the treatment of pyoderma.
For superficial forms of pyoderma:
Enteral and parenteral use of antibiotics and sulfonamide drugs is not advisable. These forms are easily amenable to external treatment, which involves the administration of disinfectants. First, the pustule is opened or the crusts are removed. The erosion is lubricated with a solution of furatsilin or an ointment with one of the antibiotics.
When treating deep forms of pyoderma:
Antibiotics, sulfinamides, methods of specific and nonspecific immunotherapy, physical therapy.
2.0 Mycoses
2.1 Keratomycosis. Pityriasis versicolor
The disease is characterized by damage only to the stratum corneum of the epidermis, the absence of inflammatory phenomena and slight contagiousness.
The process is localized mainly on the torso, mainly on the chest and back, less often on the neck, outer surfaces of the shoulders, and scalp. A predisposing cause for the development of mycosis is increased sweating.
Skin lesions begin with small spots that have different shades of brown in different patients. The spots increase in size, merge with each other, forming more or less large lesions with finely scalloped outlines. On their surface there is a barely noticeable pityriasis-like peeling associated with the destruction of the stratum corneum. The disease continues for many years and months. In tanned people, the lesions appear lighter than healthy skin. This is explained by the fact that under the influence of the sun they are destroyed, however, through the loosened stratum corneum, the skin receives an insufficient dose of insolation for tanning.
Limited lesions are lubricated with a 2% alcohol solution of iodine, nitrofurgin, and other fungicidal agents. If the lesion spreads, rub in a 6% solution of hydrochloric acid according to the Demyanovich method. After the elimination of clinical manifestations, it is necessary to carry out anti-relapse treatment within a month: daily rubbing of previously affected skin with 2% salicylic alcohol or a solution of diluted hydrochloric acid, treating the skin once a week using the Demyanovich method. A cure can also occur after UV irradiation, but in this case, leucoderma remains until the tan goes away.
2.2 Microsporia
It is the most common fungal disease in children due to the pronounced contagiousness of the infection and the virulence of its pathogens. Infection with zoophilic microsporia occurs from sick cats and dogs or through objects containing spores of this fungus. Incubation period lasts from 2-3 weeks to 2-3 months. The disease affects smooth skin, scalp and rarely nails.
When smooth skin is affected by fluffy microsporum, inflammatory spots of rounded outlines appear with a ridge along the periphery of fused small nodules, vesicles and crusts. The central part of the lesion is covered with small scales.
Lesions on the scalp are represented by 1-2 large, round, clearly defined areas of baldness, often with a large inflammatory reaction and pityriasis-like peeling on the surface. All hair in the lesions is broken off at a level of 4-8 mm and “cases” covering the broken hair are visible. It seems that the hair in the lesions appears to be trimmed, which is why this disease was previously called ringworm.
There is also an infiltrative-suppurative form of microsporia, characterized by general disorders, fever, malaise, enlarged regional lymph nodes, and the appearance of secondary allergic rashes.
Microsporia caused by the anthropophilic fungus, rusty microsporum, is rare. Infection occurs from sick people through contaminated objects. The incubation period is 4-6 weeks. On smooth skin, erythematous-squamous lesions appear in the form of rings inscribed within each other. On the scalp, the lesions are small, tend to merge and transition to smooth skin. There is usually no inflammatory reaction or subjective sensations in the lesions. The skin is slightly peeling; In addition to hair broken off at the level of 6-8 mm, healthy ones are also preserved.
This is confirmed by the discovery of fungal mycelium with certain cultural properties during microscopic examination. The green glow of the affected hair when illuminated with a Wood's lamp has an important differential diagnostic value. Nursing professionals should widely use this luminescent diagnostic method when examining children who have had contact with patients with microsporia, as well as animals suspected of infection.
Wood's lamp is a quartz lamp whose ultraviolet rays are passed through glass impregnated with potassium salts. The examination is carried out in a darkened room. It should be remembered that oily hair can also give a yellowish-green glow under a Wood's lamp, so before diagnosis, in order to avoid mistakes, it is recommended to wash the hair and remove the ointment.
The course of microsporia requires long-term treatment; the disease disappears by the time of puberty.
2.3 Trichophytosis
It is caused by various types of fungi of the genus Trichophyton and can affect any part of the skin, including nails. The disease can exist for many years, but usually goes away spontaneously by puberty. Clinically, superficial and infiltrative-suppurative forms are distinguished.
Superficial trichophytosis - caused by anthropophilic fungi. Children usually get sick. The infection is transmitted by direct contact, less often - through objects used by the patient. Very often, the source of infection is adults suffering from chronic trichophytosis. The disease is highly contagious, especially among children and adolescents, and therefore often occurs in the form of family and school epidemics.
On smooth skin, superficial trichophytosis is characterized by the appearance of clearly limited round or oval edematous lesions that tend to grow peripherally. Along the periphery of the lesions there is a border of small bubbles, nodules, and crusts; in the center there is slight pityriasis-like peeling.
When the process is localized, numerous, randomly scattered small, pea-sized to nail-sized, flaky grayish-white scales and bald patches appear on the scalp. Along with a fairly large amount of preserved hair, there are diseased hairs - shortened and broken off. Such areas with broken hair give the impression of being shaved, which explains the name “ringworm.”
In some cases, the hair breaks off at the point where it emerges from the skin and looks like dark dots, the diameter of which is wider than that of healthy hair; in others, they break off at a distance of 2-3 mm above the skin level, become dull, grayish, and curved due to loss of elasticity. The skin in the affected areas is usually somewhat inflamed.
Superficial trichophytosis, which begins in childhood, can develop into chronic trichophytosis in adults. Mostly women suffer from dysfunction of the endocrine glands, hypovitaminosis A and E. Chronic trichophytosis of the scalp is characterized by microsymptoms and the absence of subjective sensations. Most often, barely noticeable diffuse or finely focal peeling, similar to dry seborrhea, is found in the occipital and temporal regions. In these same places you can observe small atrophic scars and black dots - stumps of hair broken off at the mouths of the follicles. On the smooth skin of patients with chronic trichophytosis, pink-bluish, slightly flaky lesions with blurry, indistinct boundaries are noted. The favorite localization of the process is the area of the buttocks, thighs, palms, and the back of the hands. In 1/3 of patients, several fingers are affected.
Infiltrative-suppurative
It is caused by zoophilic fungi and is accompanied by intense inflammatory phenomena in the form of folliculitis, periofolliculitis and subcutaneous nodes, turning into suppuration.
The disease is usually transmitted from domestic animals and is observed mainly in people caring for animals. Less commonly, people are the source of infection.
The disease usually begins with the appearance of a spot of superficial trichophytosis. Soon, against the background of spots in the circle of the affected hair, osteofollicular pustules develop, which quickly spread to neighboring follicles; the latter, moving along acute purulent inflammation with the formation of a massive perifollicular infiltrate, merge with each other into continuous lesions that rise above the skin.
Developed focus - This is a sharply demarcated, rounded, with a smooth or bumpy surface, quite significantly rising above the level of healthy skin, a purple-colored tumor-like formation, covered with impetigious crusts and dotted with strongly expanded, hair-free mouths of follicles that secrete drops of thick pus spontaneously or when pressed. .
When palpating the tumor in its depth, individual fluctuating nodes are discovered, from which, when punctured, a significant amount of pus is released. In the pus, fragments of affected hair can sometimes be seen. Most of the hair in the affected area falls out; the remaining ones are easily removed with tweezers and in the root part are surrounded by a muff of glassy-degenerated hair sheaths.
The lesions create an unpleasant sweet odor. Their number is usually not numerous, the size varies on average up to 3-4 cm in diameter. Differing in preferential growth, individual lesions, merging, can reach the size of a palm or even more. Subjective sensations are usually insignificant.
In some cases, the process is complicated by a painful enlargement of regional lymph nodes, followed by their softening and opening. In weakened and exhausted patients, there is an increase in temperature, headaches, and malaise. It is not uncommon for kerion to be accompanied by the appearance of allergic rashes on the skin, the so-called trichophytes.
The diagnosis is based on the acute onset of the disease, the detection of sharply limited tumor formations covered with impetigious crusts and dotted with gaping, dilated orifices of follicles, devoid of hair and secreting thick pus when pressed. The clinical diagnosis in each individual case is confirmed by mycological examination, including culture on nutrient media. For analysis, it is better to take pus from the follicular openings.
Nail diseases (onchiomycosis)
They are also found in patients with trichophytosis, favus, and mycoses of the feet; rarely the process is limited only to the nails. A nail infected with fungi of the genus Trichophyton becomes dull, thickens, becomes fragile and brittle, cracks, acquires a dirty gray color, shortens, and has an uneven, as if corroded edge.
Treatment of patients with trichophytosis, microsporia, and favus should be carried out in a hospital. If only smooth skin is affected, the lesions are lubricated with 2-10% iodine tincture in the morning and 5-10% sulfur-salicylic ointment in the evening for 2 weeks, until the lesions completely disappear.
If the scalp is affected, the hair in the lesions is shaved off once a week and the lesions are lubricated in the morning with a 2-5% alcohol solution of iodine, at night - 5% sulfur-salicylic or 5-10% tar ointment. It is also recommended to wash your hair with hot water and soap every other day. At the same time, the antifungal antibiotic griseofulvin is started at the rate of 22 grams per 1 kilogram of weight daily for 20-25 days. After receiving the first negative test for fungi, griseofulvin is prescribed every other day for 2 weeks until complete recovery.
If griseofulvin is contraindicated, a 4% epilin patch is used for hair removal. First, the hair is shaved off and the patch is applied in a thin layer to the lesions. For children under 6 years of age, the patch is applied once for 15-18 days, and for older children twice, changing the bandage after 8-10 days. Hair usually falls out after 21-24 days. Then fungicides are started. The patch is dosed depending on the patient’s weight.
For infiltrative-suppurative trichophytosis, treatment begins with removing the crusts present in the lesions using bandages with 2% salicylic petroleum jelly. Then the average medical worker performs manual hair removal both in the foci and 1 cm around the periphery. Subsequently, wet-dry dressings are prescribed from a 0.1% solution of ethacridine lactate, a 10% aqueous solution of ichthyol, or Burov's fluid. After the elimination of acute inflammation, 10-15% sulfur-tar, or 10% sulfur-salicylic ointment, Wilkinson's ointment is used. This treatment can be combined with oral griseofulvin.
Treatment of onchomycosis is a very complex process and its effectiveness depends on the thoroughness of the necessary manipulations by nursing staff. The best method is combined - oral administration of griseofulvin (Nizoral) for 3-4 months, nail removal and local fungicidal therapy. Nails are removed surgically or using keratolytic agents. The nails are removed surgically by a doctor. Several methods have been proposed for nail removal performed by nurses.
1. Adriasyan method. The affected nail is removed using onycholysin powder (15% barium sulphide on talc), which is applied to the nail in the form of a paste for 30-40 minutes, moistening it all the time with water from a pipette. After this, the pulp is washed off with water, and the softened layer of the nail is scraped off with a scalpel, then onchiolysin is reapplied and thus the entire nail is removed. Next, an ointment of salicylic, lic acid and resorcinol in a 15% concentration is applied to the nail bed under compress paper for 2 days. Exfoliated horny masses are removed with a scalpel and tweezers. They do 2-3 rounds of these. After cleaning, the nail bed is lubricated with an alcohol solution of iodine until healthy nails grow back.
2. Arvisky method. An ointment consisting of equal parts of potassium iodide and lanolin is applied to the affected nail for 10 days until it softens. After removing such a nail, every day for 5 days the bed is lubricated with an ointment of the following composition: crystalline iodine 0.2 g, lanolin and potassium iodide 10 g each. These procedures are repeated several times.
3. Application of keratolytic plasters. 50% salicylic, 10% trichloroacetic, "dimethyl sulfoxide", 30% salicylic, 20% benzoic and ureaplast containing 20% urea. Particularly effective is ureplast, which is applied to the affected nail after a pre-hot soap and soda bath in a thick layer of 3-5 mm. The skin of the nail fold must be cleaned with strips of adhesive tape. The bandage is left for 5 days, and the procedure is repeated until the nail is completely softened. After removing the patch, the nail is removed with a scalpel, nail clippers or scissors. Next, local fungicidal therapy is prescribed, including patches - 20% pyrogallic, 5% salicylic-thymol, 5% betanaphthol.
Local treatment should be continued for 3-4 months until the nails grow back completely.
Prevention.
Along with isolating patients important has systematic monitoring of the sanitary and hygienic condition of children's institutions and appropriate sanitary supervision of all public places.
One of the most effective measures to combat contagious fungal diseases is medical examination, which provides for the mandatory registration of all sick people with notification of the dermatovenerological dispensary and the SES.
During the medical examination of children's institutions, all service personnel are subject to mandatory examination, during which one must remember about the possibility of onchiomycosis and chronic trichophytosis of adults.
Every child who has areas of flaking on the head should be immediately isolated from other children and examined. In case of mass disease at school, it is advisable to organize separate classes for sick children.
To prevent mycoses of animal origin, it is necessary to carry out systematic veterinary supervision, isolation and treatment of sick animals. Persons caring for livestock should be provided with special clothing, subjected to periodic medical examinations, and sanitary education work should be carried out among them.
Personal prevention mainly comes down to proper skin hygiene.
2.4 Mycoses of the feet
The disease occurs in bathhouses, showers, on beaches, in gyms, when using someone else's shoes and other household items contaminated with fungal elements.
In the pathogenesis of the disease, the anatomical and physiological structure of the skin of the feet, increased sweating, changes in sweat chemistry, metabolic and endocrine abnormalities, injuries of the lower extremities, and vegetative dystonia are of significant importance. Pathogens can remain in a saprophytic state for a long time without causing active clinical manifestations.
The causative agents of mycoses of the feet are different kinds trichophytons, however, according to tradition, these lesions are called epidermophyton.
Athlete's foot has several clinical forms, each of which can be combined with nail damage. The process can most often begin in the interdigital spaces, mainly between the adjacent 4th and 5th fingers. When you feel a slight itch at the bottom of the 4th interdigital fold, a strip of swollen, macerated and slightly flaky epidermis appears. After 2-3 days, a small crack appears in the center of the changed epidermis, revealing greatest number serous fluid. In some cases, the crack heals after some time and recurs again. The epidermis remains macerated, its stratum corneum is easily separated in the form of whitish flaps, there is no visible inflammation in most cases, the course of the process is torpid, causing little concern to the patient. In other cases, the macerated stratum corneum falls away, revealing an erosive, pinkish-red surface secreting a clear serous fluid, surrounded, like a frame, by a narrow strip of swollen stratum corneum. The process, gradually progressing, can spread to the interdigital folds, the plantar surface of the toes and adjacent parts of the foot itself.
The serous fluid seeping onto the surface of erosive areas serves as an excellent nutrient medium for the further life of fungi. The entry of fungi through the stratum corneum into the deeper parts of the epidermis leads to an eczematous reaction. In such cases, against the background of the lesion, numerous severely itchy blisters filled with clear liquid appear, which in some places merge, erode and leave weeping areas that have extremely sharp boundaries, edged throughout by a narrow strip of a swollen macerated stratum corneum. The process can spread to the back of the foot and fingers, the sole, capturing its arch to the heel. The disease either weakens or intensifies, and without proper treatment lasts for many years.
Often this is accompanied by a secondary pathogenic infection: the transparent contents of the blisters suppurate, hyperemia intensifies and spreads beyond the boundaries of the lesion, the foot swells, the patient’s movements are difficult or impossible due to severe pain. Other complications may develop, such as: lymphangitis, lymphadenitis, erysipelas.
In some cases, athlete's foot on the soles is expressed by the appearance on initially unchanged skin of separate groups of itchy, deeply located, dense to the touch, sometimes merging bubbles and blisters with transparent or slightly cloudy contents. The bubble may burst spontaneously. The horny cover that forms its covering disappears, remaining in the form of a corolla only at the edges of the lesion. The central parts have a smooth, pinkish-red color, slightly flaky surface. Often new bubbles appear on it; When the bubble covers fall off, the center appears eroded, red, and wet.
Due to the merging of the initial focus with new vesicles and blisters appearing along the periphery, the lesion spreads and can cover significant areas of the soles, but at the same time, the sharpness of the boundaries characteristic of the mycotic process, a healing center surrounded by a border of exfoliating stratum corneum, a low tendency to weeping, and often one-sidedness of the lesion.
Absorption of allergens from lesions sensitizes the body and increases the sensitivity of the skin. On such skin, under the influence of a number of additional factors, an allergic rash may appear. The latter is most often observed on the hands and has the character of vesicular eczema. Sharply limited eczematous discs are formed, dotted with a large number of small bubbles with transparent contents, which burst, exposing an erosive, weeping surface, surrounded by a raised rim of swollen and exfoliating epidermis. Fungi are usually not found in these lesions.
Due to the significant spread of epidermophytosis, it is practically important for any focal eczematous reaction on the hands, especially those with sharp boundaries, to examine all the skin folds of the patient. The frequent discovery of a fungal process on the feet allows in many cases to correctly assess the eczematous reaction of the hands and, with appropriate treatment of the main lesion on the feet, quickly achieve therapeutic success.
Athlete's foot begins mainly in the summer. Increased sweating, insufficient drying of the interdigital spaces after bathing, macerating the epidermis, contribute to the introduction of the fungus. Damage to the nails due to mycosis of the feet is usually observed on the 1st and 5th fingers. The lesion usually starts from the free edge. The nail thickens, has a yellowish color and a jagged edge. Severe subungual hyperkeratosis gradually develops.
Prevention.
It consists of fighting excess sweating, observing basic rules of personal hygiene, carefully maintaining the spaces between the toes after swimming, wearing comfortable shoes, and mandatory boiling of stockings and socks when washing and then ironing them. Wearing rubber shoes or rubber insoles is a favorable factor for the development of mycosis. IN spring-summer period, preventive treatment of feet with fungicidal preparations is advisable. Public prevention includes the hygienic maintenance of baths, showers, and swimming pools.
In each specific case, treatment is individual depending on the nature of the changes.
In acute cases with excessive weeping and swelling, it is first necessary to weaken the inflammatory phenomena, for which rest, cooling lotions are prescribed, alternating them with warming compresses, for example, from Burov's liquid, 2% silver nitrate solution and 0.1% ethacridine lactate solution. After pre-treatment of the needle with alcohol, large bubbles are pierced. It is necessary to carefully and daily remove the overhanging macerated stratum corneum at the periphery of all lesions with scissors.
For allergic inflammations, desensitizing therapy is carried out: intravenous infusions of 20% sodium hyposulfite solution, a dairy-vegetable diet is prescribed, and proper intestinal function is monitored.
As the inflammatory process subsides, 2-3% boron-tar, sulfur-tar or boron-naphthalene pastes are prescribed. On final stage For external therapy, fungicidal solutions and ointments are used: undecin, mycozolon, mycosepin, zincundan.
For rubromycosis of the smooth skin of the feet and palms, the stratum corneum is peeled off with ointments or varnishes with keratolic substances, lubricated with a 2% alcohol solution of iodine, followed by the use of mycozolon ointment, 3-5% sulfur ointment, sulfur-salicylic and tar ointments. The affected nails are removed, the nail bed is treated with antifungal platyrinds, ointments and liquids. At the same time, long courses of iseofulvin or nizoral are prescribed orally.
The organization of the fight against mycoses of the feet is carried out by all medical workers and includes a number of measures: improvement of working environment conditions, sanitation of patients - sources of infection, treatment and preventive and sanitary and hygienic measures to stop the further spread of the disease, sanitary educational work.
2.5 Candidiasis
With candidiasis, the mucous membranes of the genital organs can be affected. Vulvaginal candidiasis is accompanied by painful itching and cheesy discharge from the vagina. With yeast balanitis and balanoplastitis, the mucous membrane of the glans penis and the inner layer of the foreskin are macerated, they have white plaques and erosions. Candidiasis can be transmitted sexually.
The widespread use of antibiotics, corticosteroids, and cytostatics in medical practice has led to the spread of this group of mycoses. People of any age suffer from candidiasis, most of them children and the elderly. It must be remembered that yeast fungi of the genus Candida can be found as saprophytes on healthy skin and mucous membranes, and the occurrence of the disease largely depends on the state of the microorganism. Various diseases, which reduce immunity, are the background for the occurrence of candidiasis. Injuries and prolonged maceration of the skin and mucous membranes also contribute to the disease.
Numerous clinical variants of yeast lesions of the skin, mucous membranes, skin appendages, and internal organs are divided into two groups: external candidiasis and visceral systemic candidiasis.
In weakened infants suffering from dyspepsia or other diseases, yeast stomatitis often develops. Clinically, it is characterized by the appearance of white plaque on various parts of the oral mucosa. The plaque has the appearance of curdled milk, hence another name for the disease - “thrush”. Subsequently, the patches of plaque merge, and after their removal, a bright red, swollen mucous membrane or easily bleeding erosion is exposed. Damage to the oral mucosa can spread to the corners of the mouth, the red border of the lips, pharynx, and tonsils.
Yeast glossitis, in which plaque occurs on the back of the tongue, is quite common. The plaque is easily removed by scraping with a spatula, revealing a smooth, slightly hyperemic surface. Without treatment, the process can spread to the mucous membranes of the cheeks, lips, gums, and tonsils. It should be remembered that candidiasis is quite often observed in patients with infection caused by the human immunodeficiency virus.
Elderly people with malocclusion may develop candidiasis of the corners of the mouth. The skin in the affected areas is macerated, moist, covered with a white, easily removable coating, painful cracks and crusts are noted.
Candidiasis occurs in the area of skin folds in people suffering from obesity and diabetes. In these places the skin is bright red, slightly moist, covered with a white coating. Subjectively, patients feel itching. On the hands, usually in the 3rd interdigital fold, against the background of hyperemia, small, merging bubbles appear, which quickly open to form erosions with undermined edges. Such interdigital yeast erosions can be occupational, for example, in people employed in the confectionery industry, or in workers at fruit and vegetable warehouses.
Vulvaginal candidiasis, balanitis and balanoposthitis
They develop in isolation or in combination with other forms of candidiasis. Vulvaginitis is accompanied by painful itching and occasional vaginal discharge. With yeast balanitis and balanoposthitis, limited areas of the glans penis and inner layer of the foreskin are macerated, they have grayish-white plaques and erosions. It should be remembered that candidiasis can be transmitted sexually.
Candidiasis of the nail folds and nails is more common in women. The nail folds are swollen, infiltrated, and hyperemic. The nail skin is absent; nails, affected from the lateral sides, acquire a brownish-gray color and become uneven. Health care workers suffering from yeast infections of the nails and nail folds should not work with patients, especially children, due to the possibility of transmitting a fungal infection.
Clinically, visceral candidiasis is manifested by polymorphic inflammatory processes in the internal organs in the form of bronchitis, pneumonia, and mycarditis. Candidomycosis of the esophagus often occurs due to the spread of the process from the mucous membrane of the mouth and pharynx. With lesions of the stomach and intestines, necrosis of the mucous membrane, penetration of fungal threads deep into the wall and the formation of ulcerative defects with complications are observed. It is characteristic that the clinical symptoms of visceral candidiasis do not have pathognomatic features. It should be noted that in last years factors contributing to the increase in the incidence of visceral mycoses are irrational antibiotic therapy and treatment with corticosteroids and cytostatics. Candidiasis, accompanied by esophagitis, can also act as a concomitant infection in patients with acquired immunodeficiency syndrome.
The diagnosis of all forms of candidiasis is decided on the basis of clinical symptoms and laboratory data - the detection of yeast-like fungi in the material taken from the lesion.
General therapy is aimed at eliminating disorders of the endocrine system, gastrointestinal tract, and hematopoietic system. Antibiotics and steroid drugs are canceled, multivitamins and diet are prescribed. External remedies for superficial forms of candidiasis include 1-2% aqueous or alcoholic solutions of aniline dyes, fucarcin solution, levorin, nystatin, decamin ointments, and clotrimazole. If the mucous membranes are damaged, it is recommended to rinse with a solution of sodium bicarbonate and 5% borax, lubricate with a 10.% solution of borax in glycerin, and Decamine caramel. In persistent cases and in generalized forms, nystatin, levorin are given orally, and amphotericin B is administered.
Measures to prevent candiomycosis depend on the epidemiological and pathogenetic features of these diseases. Great importance is attached to antenatal clinics for identifying patients and sanitation. Due attention should be paid to widespread promotion of knowledge about candidiasis among the population.
2.6 Psoriasis (scaly lichen)
Chronic recurrent skin disease with monomorphic papular rashes. It is observed in people of both sexes at any age. The prevalence of this disease is very high - it is registered in 2-5% of the world's population.
The etiology and pathogenesis are not completely clear. It is believed that lichen planus is genetically determined. One of the leading links in its pathogenesis is immune disorders. The occurrence of psoriasis and its exacerbation can be provoked by streptococcal, viral infections and nervous disorders.
In some cases, the disease occurs without any apparent reason. The course of psoriasis in some patients is initially acute, while others have only isolated psoriatic elements on the skin of the knees and elbows for several years. In typical places, papules the size of a pinhead to a coin appear. The nodules are pink-red in color and covered with loose silvery-white scales. When the elements are scraped, the symptoms of steorin spot, terminal film, and blood dew characteristic of psoriasis are revealed. Increasing and merging, papules form plaques of a wide variety of shapes and sizes, sharply demarcated from the surrounding skin.
In patients with psoriasis, there are three stages of disease development: progressive, stationary and regressive.
The progressive stage is characterized by the appearance of a large number of fresh elements on unchanged skin, a tendency towards peripheral growth of elements and the development of psoriatic papules at the site of mechanical injury.
Recently, there has been an increase in the number of patients complaining of itching during this period of the disease.
In the stationary stage, fresh elements do not appear, the itching subsides, and a pale, depigmented border forms around the papules.
In the regressing stage, psoriatic plaques flatten, peeling decreases and the elements gradually resolve, starting from the central part.
Along with skin changes, nails are affected in 7% of patients. Their turbidity and the appearance of longitudinal and transverse grooves are noted.
In children and women, a more juicy coloring of the elements is often observed, the scales are replaced by scales-crusts and the course of the process becomes more acute.
Any of the described forms can transform into a total lesion, when the elements are not visible and the entire skin is affected. This clinical variety is called psoriotic erythroderma. It is more severe and prolonged, accompanied by a feeling of skin tightness, chills, general malaise and fever.
Other clinical varieties of the disease are also observed.
Types of psoriasis: Normal (vulgar); Focal; Exudative; Arthropathic; pustular; erythroderma.
Treatment and care for patients.
The problem of treating patients with psoriasis has not been resolved to date. When prescribing treatment, the stage and seasonal form of dermatosis, the role of specific pathogenetic factors, the morphology and localization of the rash, and the general condition of the patient are taken into account.
At the onset of the disease, therapeutic measures are aimed at stopping the progression of the pathological process. In the stationary and regressing stages, treatment should contribute to a more rapid reversal of the psoriatic rash. This is achieved by general treatment methods and means used for external therapy.
For general drug therapy, drugs that affect the nervous system are used: sedatives, tranquilizers, novocaine; metabolism: vitamins, lipotropic substances; hyposensitizing: sodium thiosulfate; antihistamines, calcium compounds that increase the body's resistance: vitamins, biosulfates.
External treatment of patients in the progressive stage of psoriasis consists of prescribing indifferent and weak ointments: 2% boron and 2% salicylic ointment. For psoriasis in the stationary and regressing stages, ointments are used that promote resorption of infiltration and normalization of horn formation: tar and sulfur ointments in a concentration of 2-20%, 5-20% salicylic ointment, naphthalene, antipsoriaticum and psoriasin ointments.
In the winter form of psoriasis, significant improvement is achieved by general UV irradiation in suberythemal doses.
Recently, photochemotherapy of the winter form of psoriasis has become widespread, that is, the combined effect of long-wave UV rays with photosensitizing agents - psoralen derivatives, which patients take orally 2 hours before irradiation.
For successful treatment, patients must comply correct mode, which includes sleep lasting at least 8 hours a day, daily exposure to air for at least 1.5-2 hours, exercise physical culture, excluding smoking and drinking alcohol.
Patients with psoriasis, especially the common form, feel chilly and catch cold easily, so they should be dressed appropriately and be in a room with a temperature of 20-22 degrees Celsius. Underwear and bed linen should be changed at least twice a week.
One of the main procedures in the treatment of psoriasis is general warm baths 3-4 times a week. If it is not possible to take a bath, you can limit yourself to a warm shower. You should use a soft washcloth. During an exacerbation of the disease, a hygienic bath is recommended no more than once a week without using a washcloth.
The soap should be neutral, and the stream of water when taking a shower should not be very strong. IN summer time If possible, baths are replaced by bathing, preferably in sea water.
Patients with psoriasis are prescribed a diet with a reduced amount of foods containing high amounts of cholesterol. Obese patients are recommended to have fasting days 1-2 times a week.
In my course work, I paid special attention to the symptoms, clinical course, treatment, prevention and care of patients with mycoses, pyoderma, and psoriasis.
This work can be used as demonstration material in student classes.
Bibliography
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