Prurigo
Description:
Prurigo (пруриго) — the chronic disease from group of neyroallergodermatoz which is characterized by the papular, papulovezikulezny, knotty rashes which are followed by a severe itch. Allocate a prurigo the nursery (a strophulus, a small tortoiseshell children's), a prurigo of adults (a prurigo simple), a prurigo knotty (a small tortoiseshell papular resistant, neurodermatitis knotty). In addition to the specified forms representing independent nosological units distinguish symptomatic forms simple пруриго: пруриго pregnant women, summer пруриго, winter пруриго, lymphatic (leukemic) and limfogranulematozny пруриго.
Prurigo's symptoms:
The prurigo the nursery (a strophulus, a children's small tortoiseshell) develops at children aged from 6 months up to 3 years (sometimes up to 5 years) and is one of displays of allergic diathesis, is more often in the period of the beginning of a feeding up. The nursery a prurigo is clinically shown by a set of bright pink edematous small knots the sizes about a pin head in which center the small bubble (a papulovesicule or a seropapula) in which basis the blister quite often is found forms. Having as a result combed a bubble breaks and the small knot covered in the center with a bloody crust is formed. Rashes are localized on a trunk, extensor surfaces of extremities, buttocks, a face. On site excoriations at children the piogenic infection, most often in the form of vulgar impetigo usually develops. The disease proceeds chronically with small remissions and usually at achievement of 3-5-year age independently there is a transformation in neurodermatitis.
Clinical displays of a prurigo at adults. On skin of extensor surfaces of extremities, and then on a trunk pruriginous rashes, in the form of semi-spherical papules of red-brown color, a dense consistence, covered with a bloody crust, size about lentil develop, usually their diameter does not exceed 3 mm. Small knots are located absent-mindedly, not slopes to merge, are followed by a severe itch. The current is chronic, recurrent, from several weeks to several months and years. The differential diagnosis is carried out with itch, dermatitis of Dyuringa.
The prurigo knotty the Guide meets more often at women after 40 years. The disease begins with the most severe itch renewing several times in days. It is clinically characterized by existence of firm semi-spherical papules of brownish-red color size from a pea to hazelnut which are usually localized in extremities. Papules, in the beginning light pink, because of rough excoriations gradually become brown-red or cyanotic. Owing to having combed because of an intensive pristupoobrazny itch the surface of papules becomes covered by bloody crusts or verrukozny growths. Rashes in one cases single, in others — multiple, sometimes with a tendency to group, but not to merge. Rashes persistirut a long time, then are resolved with formation of the hems pigmented on a circle.
Thus, over time the nature of rashes accepts polymorphic character that gives to a prurigo of the Guide similarity to a late skin porphyria. However at a porphyria communication with insolation, disturbances of pigmentation and existence of bubbles at a dermatosis aggravation are observed. The course of a disease at knotty to a prurigo long, can reach decades. Only very seldom separate papules are resolved what disappearance of an itch on this site precedes to. According to some authors, firmness of elements of rash is connected with a hyperplasia of nerve terminations.
Prurigo's reasons:
The pathogeny children's пруриго is connected with a sensitization to foodstuff (cow's milk, chocolate, honey, a citrus, strawberry etc.). Less often the disease is caused by a medicinal sensitization or a helminthic invasion. In development of a strophulus some anatomo-physiological features of a structure of children's skin matter.
Prurigo at adults — the disease meeting more often at women of middle and advanced age is frequent in connection with dysfunction of a GIT, endocrine (a diabetes mellitus, etc.), psychological or oncological diseases. Development of a prurigo in adults can be promoted by an alimentary factor (the excessive use of honey, chocolate, coffee, alcohol and other allergogenny products).
Prurigo knotty the Guide — a polyetiological rare disease in which pathogeny metabolitichesky frustration, endointoxications, endocrine pathology, an atopy, helminthic invasions matter. Among causative factors some authors note influence of nervous stresses and stings of mosquitoes.
Prurigo's treatment:
Tactics of maintaining patients пруриго provides comprehensive examination of patients for the purpose of an exception of the centers of persistent infection, oncological diseases, endocrine disturbances, sanitation of the centers of persistent infection.
According to clinical recommendations (2007) patients пруриго need to conduct the next laboratory researches: the general blood tests and urine, definition of glucose in peripheral blood, biochemical analysis of blood (crude protein, the general bilirubin, alaninaminotranspherase (ALT), aspartate aminotransferase (nuclear heating plant), the alkaline phosphatase (AP), creatinine, urea), the analysis a calla on an intestinal dysbiosis. Definition of antibodies to antigens of lyambliya, ascarids, токсокар, описторх is obligatory.
Initiation of treatment of a prurigo at adults and children is observance of a rigid hypoallergenic diet: an exception of obligate food-borne allergens, products with dyes, preservatives, ostrorazdrazhayushchy dishes, alcohol, restriction of table salt, carbohydrates.
The basis of therapy of a disease is made by antihistaminic drugs which duration of reception depends on severity of a dermatosis. An itch — the main reference point for purpose of antihistaminic drugs as intensity of irritation of sensitive nerve terminations in skin depends on the level of a histamine. Action of a histamine is mediated by various types of receptors, through H1 receptor the histamine increases a tone of unstriated muscles of bronchial tubes, asthmatic suffocation can be a consequence of what, strengthens a peristaltics of intestines and in case of food allergy leads to diarrhea, increases permeability of blood vessels owing to what between endothelial cells of venules intervals through which there is a plasma are formed and intra epidermal hypostasis forms.
Through H2 receptor the histamine slows down a cordial rhythm and stimulates formation of hydrochloric acid in a GIT. In TsNS the histamine works as the neurotransmitter: it is necessary for maintenance of a condition of wakefulness. N1-and H2 receptors can be blocked by means of the selection antagonists. The first antihistamines (H1-histamine drugs) are nonspecific and block other receptors, for example, M-holinoretseptory. These drugs were used as antiallergic, antiemetic, nonspecific sedative and hypnagogues. Side effects of such drugs are the drowsiness and effects reminding effect of atropine (dryness in a mouth, locks). New means ("drugs of the second and third generation") do not get into TsNS and therefore have no sedation. Perhaps, in an endothelium of a blood-brain barrier they are transported back in blood and have no atropinopodobny effect.
The recommended drugs for intake: Chloropyraminum, мебгидролин, хифенадин, Clemastinum, диметинден, лоратадин, дезлоратадин, цетиризин. The antihistaminic drug III of generation which is an active metabolite — цетиризин deserves attention (Zodak). Active ingredient of drug — a selective blocker peripheral H1 receptors, so drug has no considerable antiserotoninovy and anticholinergic action that is important at appointment as the patient with chronic allergodermatoza. Active ingredient of Zodak in insignificant quantity gets through a blood-brain barrier therefore development of sedation, including drowsiness, is not expressed or expressed in very easy degree. It is important that active ingredient of Zodak influences as gistaminzavisimy — an early phase of allergic reactions, and a late cellular phase. Under the influence of a tsetirizin there is an oppression of release of a histamine from basophiles and mast cells, decrease in migration of eosinophils and other cells. Bioavailability of active ingredient is identical to all dosage forms of drug: syrup, drops and tablets.
Except antihistaminic drugs it is recommended to appoint additional treatment: the hyposensibilizing means (a calcium gluconate, calcium pantothenate, calcium glycerophosphate, sodium thiosulphate) and enterosorbents (the lignin hydrolytic, diosmektit, энтеросгель, лактофильтрум). If necessary include fermental drugs a course for three weeks (Pancreatinum, enzistat), sedative phytodrugs (Tinctura Valerianae or a peony). Outwardly in the form of applications 2% boron-нафталановая, 2% boron-Ichthyol, the antiseptic agent Dorogov's stimulator (AADS) the III fraction in combination with glucocorticosteroid ointments are appointed. At heavy degree of a current пруриго or lack of a tendency to regress of rashes it is necessary to carry out дезинтоксикационнцю therapy, glucocorticosteroids systemically (Prednisolonum of 15-20 mg within 14–25 days, with further decrease), tranquilizers join. In the absence of contraindications it is possible to use PUVA-therapy — 15–25 sessions 4 times a week.
Surgical methods can be alternative approach: an obkalyvaniye of elements of rash dexamethasone, a hydrocortisone, Celestonum, solution methylene blue in novocaine, irrigation by Aether chloratus, liquid nitrogen; cryolysis, diathermocoagulation.
Physical therapy. The electrosleep is daily recommended to children from 4 years with the expressed neurasthenia and a sleep disorder. Or фонофорез a hydrocortisone on area of a backbone longwise paravertebralno children can apply ultrasound from 6–7 years. From other physical methods use diadynamotherapy of area of cervical sympathetic nodes, Dimedrol electrophoresis endonozalno, microwave therapy of area of a projection of adrenal glands paravertebralno, an inductothermy. The good effect is rendered by the selection phototherapy — 20–30 sessions 4–5 weekly. It is worth to remember about effectiveness of radonic and sulphidic bathtubs which have resorptional, spasmolytic effect. Under the influence of sulphidic bathtubs the metabolism in skin improves, its trophicity, amplifies secretion grease and sweat glands, oxidation-reduction processes are stimulated. Radonic bathtubs have the sedative, braking effect expressed on TsNS, deepen a dream, reduce pains, blocking ways of carrying out painful impulses, favorably influence a peripheral nervous system.
