Small tortoiseshell

Description:

Small tortoiseshell – the medical concept including group of diseases. This often found disease which is characterized by emergence on skin the towering, enough accurately delimited, intensively pruritic papules or bubbles of light pink or red color with formation at the edges of the erythema disappearing when pressing; their diameter can fluctuate from several millimeters to tens of centimeters. Rashes arises quickly enough and can lead to development of a huge small tortoiseshell. Full reversibility is characteristic of rashes.
Small tortoiseshell is a polyetiological disease, depending on an etiological factor allocate the following species of a small tortoiseshell:
1. Allergic small tortoiseshell
2. Idiopathic small tortoiseshell
3. The small tortoiseshell called by influence of low or high temperature
4. Cholinergic small tortoiseshell
5. Dermatografichesky small tortoiseshell
6. Vibration small tortoiseshell
7. Contact small tortoiseshell
If symptoms of a small tortoiseshell remain longer than 6 weeks, speak about chronic process, otherwise acute urticaria is diagnosed.

Reasons of the Small tortoiseshell:

The general mechanism of development is characteristic of all species of a small tortoiseshell. The pathogeny connected with increase in its permeability of vessels of a microcirculator bed and acute edematization in the area surrounding these vessels.
Allergic small tortoiseshell can be caused by action of medicines, foodstuff, pollen of plants, house dust or poison of Hymenoptera.
Temperature small tortoiseshell is shown under the influence of a cold or thermal factor, and also a radiation factor. The mechanical reason of emergence is observed at a dermatografichesky small tortoiseshell. The Insektny form of a small tortoiseshell arises after sting by Hymenoptera, with increase in immunoglobulins of fraction E and G.

Symptoms of the Small tortoiseshell:

Allergic small tortoiseshell is shown by skin pruritic elements in the form of urtikalny rash. Usually the patient notes interrelation between emergence of symptoms of an allergic small tortoiseshell and contact with allergen. Allergic urticaria is often combined with a respiratory allergy – rhinitis or bronchial asthma.
Acute or chronic idiopathic small tortoiseshell differs in the expressed torpidnost in treatment.
Temperature small tortoiseshell can be as localized, and generalized. Quite often temperature small tortoiseshell is followed by falling of arterial pressure and shock.
Cholinergic small tortoiseshell is a form of a small tortoiseshell when on skin there are multiple small urtikalny elements which are followed by a severe itch and tending to merge and formation of the big centers of damage of skin. At a dermatografichesky small tortoiseshell urtikalny elements are located linearly. Rash develops in places of a prelum of parts of a body close clothes more often. Insect allergy is shown by local reaction, system allergic reaction, an acute anaphylaxis.

Diagnosis:

1. Obligatory laboratory researches:
- clinical blood test;
- general analysis of urine;
- biochemical analysis of blood (definition of crude protein, level of bilirubin, ALAT, ASAT, glucose level in blood, uric acid, creatinine);
- HIV, RW;
- koprogramma.
The specified volume of the diagnostic program is enough for definition of an allergic, vibration, temperature, contact form of a small tortoiseshell.
At not specified, idiopathic, it is recommended to dermatografichesky small tortoiseshell to include in the list obligatory the following types of inspection for identification of functional and organic disturbances:
- rheumatological tests;
- bacteriological inspection of excrements, duodenal contents;
- bacteriological crops on flora with mucous stomatopharynxes;
- koproovotsistoskopiya.

2. Allergic inspection:
- allergic, pharmacological, food anamnesis;
- immunoglobulin E level;
- Prick and scarifying skin tests with various allergens, including fungal; - the cold (Duncan) test, the thermal test, the test with a plait;
- allergic titration by a histamine, acetylcholine;
At suspicion of medicinal urticaria the patient needs to carry out the available in vivo tests in medical institution. The test of braking of migration of leukocytes in vivo with medicines (according to data of the pharmacological anamnesis).
Each tests are carried out by the patient to anna an exacerbation of urticaria and reception of antihistaminic drugs and glucocorticoids.

3. Obligatory tool researches:
- a veloergometriya for an exception of a cholinergic small tortoiseshell. At the idiopathic, not specified, dermatografichesky urticaria the next tool researches for the purpose of search of functional and organic disturbances are conducted: Ultrasonography, EGLS, ECG.

4. Additional tool researches:
- a X-ray analysis of bodies of a thorax and adnexal bosoms of a nose (according to indications);
- Ultrasonography of bodies of a small pelvis and retroperitoneal space, a thyroid gland (according to indications);
- kolonoskopiya, rektoromanoskopiya.

5. Consultations of specialists:
- allergist (surely);
- according to indications consultation of the rheumatologist, gynecologist, stomatologist, parasitologist, etc. is held.

The wide range of inspection at the dermatografichesky, not specified, idiopathic forms of a small tortoiseshell is caused by the fact that urtikalny reaction is characteristic of various diseases, including autoimmune, parasitic, oncological or a consequence of functional disturbances in activity of a GIT, chronic inflammatory diseases (a periodontal disease, an intestinal dysbiosis, etc.).

Treatment of the Small tortoiseshell:

Let's consider the scheme of treatment of a small tortoiseshell on the example of an allergic form.
At an easy current:
1. Holding eliminative actions;
2. Glucocorticoids are not used;
3. Antihistaminic drugs are used: лорадатин 10 mg of 1 times a day, телфаст 180 mg of 1 times a day. Duration of reception makes up to 1 month. Ketotifenum 2 times a day, a course in 3 months apply in a dose 0,001 g.
4. Ascorbic acid and a gluconate of calcium apply for the purpose of stabilization of a vascular wall.

The current of average degree demands several other approach:
1. In addition to an eliminatsionna of drugs use of injection forms of antihistaminic drugs is justified: tavegil of 0,1% 2 ml, Suprastinum of 2% 1 ml 2-3 days. At inefficiency of the specified drugs appoint glucocorticosteroids: Prednisolonum of 30-90 mg intramusculary or intravenously. In parallel accept the medicines tableted antiallergic.
2. Enterosorbtion methods – the polyphytosorbent, sillard-2, mikrotset, энтеросгель, лингосорб).

The heavy course of urticaria demands broader use of injection glucocorticoids and antihistaminic drugs.

Important link in treatment of allergic diseases is efferent therapy, directed to removal (elimination) from an organism of xenobiotics, harmful metabolites. The experience of efferent therapy accumulated at the moment showed its efficiency at allergic diseases both in acute the period, and for the purpose of prevention of a recurrence. Carry sorption methods, i.e. an artificial "eliminative" detoxication by removal from an organism of harmful substances by means of sorbents to the most effective ways of cleaning of internal environment.