Skin diseases. Treatment of skin diseases, patient care. External dosage forms. Creams are used for chronic inflammation in the transition period from subacute. They act more gently than ointments, without causing aggravation

Treatment of skin diseases should be comprehensive, using etiological, pathogenetic and symptomatic agents, as well as combined: general and local. General treatment should be dictated by expediency: for example, for the treatment of superficial pyoderma, external treatment is sufficient. Etiological and pathogenetic therapy is carried out if the etiology and mechanisms of development of dermatosis are known. Etiological therapy is mainly carried out for the treatment of infectious diseases of the skin and skin appendages. Pathogenetic therapy includes hyposensitizing drugs, glucocorticosteroids, antihistamines, detoxifiers, immunomodulators, vitamins and microelements, etc. Symptomatic treatment includes painkillers, antipruritics, and anti-inflammatory drugs.

External agents according to the nature of their action are divided into indifferent (zinc oxide, talc, white clay), anti-inflammatory and astringent (boric acid, zinc sulfate, silver nitrate, tannin, glucocorticosteroids, etc.), keratoplastic (ichthyol, tar, naphthalan), keratolytic ( salicylic acid, benzoic acid), antipruritic substances (menthol, corticosteroids, anesthesin, antihistamines), absorbent drugs (sulfur, ichthyol, Birch tar, resorcinol), cauterizing and destructive (salicylic acid and resorcinol in concentrations of 10%, silver nitrate 2-10%, podophyllin 5-10%, lactic acid 5-10%.

Dosage forms may vary. Powders, solutions, shaken suspensions, and aerosols act most superficially; creams, ointments, pastes and patches penetrate deeper. In the treatment of dermatological patients, in addition to medications, physiotherapeutic methods of influence are widely used: thermal procedures, cryotherapy, light therapy, electrotherapy, ultrasound therapy. Sanatorium-resort treatment for many chronic dermatoses helps to prolong remission and reduce the number of relapses.

Topic No. 1: Pyoderma.

The goal is to consolidate theoretical knowledge on the etiology, pathogenesis, clinical picture, diagnosis and treatment of pyoderma.

Information material.

Pyoderma(pustular skin diseases) are the most common infectious skin lesions in children and adults. They can occur primarily or secondarily as complications of other, more often itchy, dermatoses.

Etiology. The causative agents of pyoderma are mainly staphylococci and streptococci. Purulent inflammation of the skin can also be caused by Pseudomonas aeruginosa, Proteus vulgaris, pneumococci and many other microorganisms.

Pathogenesis. For the occurrence of pyoderma, not only the pathogenicity and virulence of the coccus strain are important, but also various endogenous and exogenous factors that change the protective functions of the skin. Of the most common exogenous factors It should be noted superficial skin injuries (cuts, abrasions, scratches, insect bites, injections, maceration, etc.), skin contamination (as a result of insufficient skin hygiene, occupational contamination with lubricating oils, coal, cement, lime, gasoline, kerosene), hypothermia and overheating of the body.

TO endogenous factors include disorders of carbohydrate metabolism (hyperglycemia), endocrine pathology (insufficiency of the pituitary-adrenal system, thyroid gland), functional disorders of the nervous system (autonomic neuroses), nutritional disorders (deficiency of proteins, vitamins), acute and chronic debilitating diseases, gastrointestinal diseases (intestinal intoxications ), hereditary factor, local circulatory and lymph circulation disorders, weakening of immune defense mechanisms.

Classification. Depending on the etiological factor, all pyoderma is divided into staphylococcal, streptococcal and mixed. According to the depth of location - superficial and deep, according to the nature of the course - acute and chronic.

Staphyloderma. Staphylococci primarily affect skin appendages - hair follicles, sebaceous and sweat glands, causing purulent-exudative or purulent-necrotic inflammation, and less often - inflammation not associated with adnexal formations. Staphyloderma is more often deep than streptoderma.

Staphyloderma associated with hair follicle .

Ostiofolliculitis– follicular pustule (abscess) the size of a millet grain, located in the center hair follicle and surrounded by a narrow, acutely inflammatory hyperemic corolla. The mouth of the hair follicle is affected. Within a few days, the pustule becomes covered with a yellow crust, which falls off without leaving a trace.

Folliculitis– the next stage of development of ostiofolliculitis is inflammation of the entire follicle. Painful red nodules form on the skin, turning into a pustule riddled with hair. After a few days, the secretion of the pustule shrinks into a crust, which is rejected after 5-6 days, leaving a small dotted scar. The most common localization of folliculitis and ostiofolliculitis is the back of the hands, the skin of the face, neck, legs, thighs, and scalp.

Vulgar sycosis occurs against the background of chronic foci of infection, skin sensitization to staphylococci, pathology internal organs, nervous system. Men get sick more often. The predominant localization is the area of ​​the beard and mustache, sometimes - the skin in the area of ​​the eyebrows, scalp, pubis, and armpits. The disease begins with the development of ostiofolliculitis and folliculitis, the number of which gradually increases. They merge with each other, forming infiltrated foci of bright red color, dotted with pustules, dirty yellow crusts, and erosions. When removing hair from the affected area, you can see a gelatin-like muff - an epithelial sheath of hair, saturated with pus. Vulgar sycosis usually exists for a long time, periodically worsens, depressing the patient’s psyche, and is accompanied by a feeling of itching, burning, and pain.

Keloid acne(sclerosing folliculitis of the back of the head) are represented by inflammation of the hair follicles and sebaceous glands on the back of the skin of the neck and back of the head. Men get sick more often. A papulopustular rash appears, resolving with the formation of keloid scars and cicatricial alopecia (baldness).

Furuncle– is a further development of folliculitis. It is expressed in purulent-necrotic inflammation of the hair follicle and surrounding tissue. The formed boil is a painful inflammatory node measuring from 1 to 3 cm (the stage of infiltration development, which takes 3-4 days). Then a purulent-necrotic core with a pustule on the surface is formed in the center (stage of suppuration and necrosis). During this period, the pain becomes sharp, the temperature may rise, and symptoms of general intoxication appear. Next, the cover of the boil is opened, purulent or bloody-purulent contents are released from the boil, and then a yellow-green “plug” (necrotic core). After this, swelling, infiltration and pain disappear and the ulcer scars within 2-3 days (healing stage). Typically, the development cycle of a boil is 8-10 days. Furunculosis is said to occur when boils recur. Furunculosis usually develops against the background diabetes mellitus, immunodeficiency, chronic wasting diseases, anemia, etc. It should be remembered that boils upper lip are especially dangerous due to the possibility of thrombosis of the lymphatic and venous tracts with the formation of septic phlebitis of cerebral vessels.

Carbuncle is a diffuse purulent-necrotic inflammation of the deep layers of the dermis and hypodermis as a result of simultaneous damage to several hair follicles (a conglomerate of boils). A deep, dense infiltrate up to 10 cm in size is formed. The skin over it is bluish-red and swollen. After 5-10 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. Due to the enlargement of the follicular openings, an ulcer is formed, which is gradually performed by granulation and heals with a retracted scar. The carbuncle is accompanied by a disturbance in the general condition of the patient and an increase in temperature.

Hidradenitis – purulent inflammation apocrine sweat gland. Women get sick more often. Hidradenitis does not occur in children before puberty or in the elderly because their apocrine glands do not function. Hidradenitis is localized mainly in the armpits, less often around the anus, on the labia majora, scrotum. In the depths of the subcutaneous base, single or gradually increasing in size, multiple painful nodes appear. The skin over them becomes bluish-red. Then the nodes soften, fluctuation appears and they open with the release of creamy pus, sometimes mixed with blood. Eventually a scar will form. The average duration of hidradenitis is 10-15 days.

Streptoderma . Streptococci directly affect smooth skin: the epidermis, less often the dermis and hypodermis, causing serous-exudative inflammation. Primary element – flaccid bladder (phlytena), having a transparent secretion and a tendency to grow peripherally.

Impetigo streptococcal. Children get sick more often. The disease is contagious and is transmitted through direct contact with a patient and through infected objects. Localized mainly on the face. But it can be located on any part of the skin. It begins with a small hyperemic spot on which a phlyctena forms. The serous contents of the phlyctena shrink into brown crusts, which, when removed, reveal erosion. The conflicts can merge with each other, forming extensive erosions. After peeling off the crust, a bluish-pink spot remains, which resolves without a trace.

Types of streptococcal impetigo.

Bubble impetigo- conflicts form in the form of a bubble.

Ring-shaped impetigo characterized by peripheral growth of phlyctena. Its center dries out, and the peripheral part remains in the form of a ring-shaped rim filled with a grayish-turbid liquid.

Streptococcal slit-like impetigo (angular stomatitis or jam) – located in the corners of the mouth. At first, phlyctena appears in this area, and then linear erosion. The skin of the corners of the mouth is swollen and hyperemic. 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.

Streptococcal paronychia– inflammation of the periungual fold. This is a phlyctena, which is located in a horseshoe shape, bending around the nail on three sides.

Intertriginous streptoderma develops in large skin folds (intergluteal, axillary, behind the ears, inguinal-femoral). It is characterized by the formation in the skin folds of a continuous erosive weeping surface of a bright pink color, sharply demarcated from the surrounding healthy skin, with a border of exfoliating epidermis.

Streptoderma diffuse chronic– superficial streptoderma, which begins as streptococcal impetigo and then becomes chronic. The skin in limited areas is bluish-red in color, swollen, eroded, weeping, and covered with crusts. The lesions have scalloped outlines and are located asymmetrically, usually on the upper or lower extremities, face, and around the mammary glands. The lesion gradually increases in size, covering large areas of the skin.

Streptoderma erythematous-squamous (simple lichen) – superficial pyoderma, affecting the trunk, limbs, face. Often observed in children. It is characterized by the appearance of rounded lesions, 1-3 cm in size. The lesions are white or pinkish in color, covered with pityriasis scales.

Ecthyma ordinary– deep streptoderma, which occurs in persons with reduced protective functions of the body, low nutrition, suffering from chronic infections, and alcoholism. Ordinary ecthyma is characterized by the presence, most often on the legs, of single, deep, painful ulcers that form from large (1-2 cm in diameter) pustules. The bottom of the ulcer is covered with a yellowish-brown crust. Ecthyma tends to grow peripherally. The ulcer heals with the formation of a scar.

Streptostaphyloderma- as a rule, pyoderma caused by mixed flora has a chronic, more severe course, sometimes with an atypical clinical picture.

Vulgar impetigo. Infection is facilitated by skin trauma, pollution, maceration of the skin with saliva and other secretions, and previous itchy dermatoses. On hyperemic and swollen skin, conflicts appear, the contents of which quickly become cloudy and become purulent. The secretion then dries out, forming thick, honey-yellow or yellow-green crusts. The most common location is around natural openings. The disease most often affects children, girls and young women. The entire development cycle of the element lasts 8-15 days, after which secondary pigmentation remains on the skin.

Chronic ulcerative And ulcerative-vegetative pyoderma refers to deep forms of pyoderma. Develops against the background of decreased reactivity of the body, with impaired immunity, carbohydrate metabolism, against the background of thrombophlebitis and varicose veins. The disease begins with the development of streptococcal ecthyma, a boil, which undergo necrosis with the formation of an ulcer. New deep pustules form along the periphery of the main lesion. In the depths of the infiltrates, deep purulent cavities communicating with each other are formed. Under the crust, the ulcers grow along the periphery, merge, acquiring different shapes. The lesion is gradually increasing. The process may involve not only the epidermis, dermis and hypodermis, but also muscles and sometimes bones. The disease ends with scarring. As a rule, the disease is accompanied by insomnia, pain, and weakness. On the surface of ulcerations or along the periphery of ulcers, warty growths - vegetations - can develop. Fistulous tracts are often formed.

Erythrasma. a disease caused by the bacterium Corinebacterium minutissimum or the association of microbes staphylo- and streptococci. Men are more often affected.

Clinic. In the folds of the skin (axillary, inguinal, under the mammary glands) spots are pink-brown or yellow-brown, pityriasis-flaky with polycyclic outlines. There are no subjective sensations.

Treatment: erythromycin ointment. 2% iodine tincture, 2% salicylic alcohol, in persistent cases - erythromycin orally 0.2 5 times a day for 5 days.

Diagnostics pyoderma: microscopy of a Gram-stained smear (Gram-positive cocci), bacteriological culture to determine the sensitivity of the flora to antibiotics, general blood test (leukocytosis, possible increase in ESR), in in rare cases– serological reactions, skin pathomorphology.

1. External treatment is indicated for the treatment of superficial pyoderma.

1-2 % alcohol solutions aniline dyes (gentian violet, methylene blue, brilliant green, pyoctanin, fucorcin)

Depilate hair on the affected area using manual depilation and wipe healthy skin 1-2% camphor or salicylic alcohol

irrigation with 1% chlorophyllipt solution, microcide, ectericide solutions.

ointments with antibiotics (erythromycin, tetracycline, gentamicin), wound-healing drugs (levomekol ointment, methyluracil, pantestin), sulfonamides (5% liniment streptocide), for weeping - aerosols (lifusol, oxycyclosol, levovinisol)

for deep pyoderma at the stage of infiltrate formation, ichthyol lozenges are used, 10% ichthyol ointment, balsamic liniment according to Vishnevsky.

2. Systemic therapy is indicated for the treatment of deep and chronic pyoderma, when external therapy is ineffective.

antibiotics (penicillin, tetracycline groups, macrolides, cephalosporins, especially 1-2 generation, fluoroquinolones 2-3 generation, aminoglycosides)

sulfonamides (biseptol, bactrim)

specific and nonspecific immunotherapy

vitamins and microelements

if necessary, absorbable drugs, vascular agents, repartees

physiotherapy: UHF in the stage of infiltrate formation, irradiation with short-wave rays (SWRF) after rejection of the necrotic rod, general ultraviolet irradiation, paraffin applications and lidase phonophoresis during scar formation.

Prevention: compliance with the rules of personal hygiene, sanitation of foci of infection, in the case of ENT pathology - lubrication of the ear and nasal openings with creams and ointments with antibiotics and gargling with antiseptic solutions, diet with limited carbohydrates. Timely treatment of skin injuries and wounds. Carrying out measures to combat dust and pollution. When pyoderma occurs - frequent change clothes and linen, boiling linen and daily treatment with hot steam.

Target classes: consolidate theoretical knowledge on the etiology, pathogenesis, clinical picture, diagnosis and treatment of scabies, lice and demodicosis.

Information material.

Scabies.(Scabies)

Pathogen – scabies mite. The only owner is man. People of any age and gender are affected; the disease is widespread. Males, fertilizing females, soon die. The female penetrates the stratum corneum of the epidermis, breaks through a horizontal passage in it, laying about 50 eggs over 6-8 weeks of life, from which larvae form after 4-5 days. Females dig tunnels at night (2-3 mm per day), lay eggs during the day, each with 40-50 eggs in their entire life. The larvae hatch after 72-96 hours, emerge on the surface of the skin and penetrate into the mouths of the hair follicles. The larvae form into sexually mature ticks within 15 days. Outside the skin, females die after 5-15 days. Infection occurs when the skin comes into contact with the affected surface - during sexual intercourse, children's games, or when caring for a patient. Ticks can live in clothing and bedding for more than 2 days. The main route of transmission is contact and household.

Clinic. The incubation period is 4-6 weeks. The disease is characterized intense itching that gets worse at night (typical only for scabies). The rash may be absent or very few in number (clean scabies). Typical location of the rash : rashes are localized in the interdigital spaces and on the fingers of the hands, on the flexor surfaces of the wrist joints, in the cubital fossae, on the elbows, the anterior surface of the armpits, abdomen, and thighs. In men, the rash is often localized in the penis area , in women - in the area of ​​the mammary glands. In children The skin of the palms, soles, face, neck and even the skin of the scalp is affected and is very quickly complicated by the addition of pyoderma. Rash It consists of small bubbles and pink nodules arranged in pairs. Sometimes you can see an itch located between two elements, looking like a gray winding strip 0.3-1.0 cm long.

Diagnostics. Based on identifying symptoms typical of scabies:

itching, worse at night;

typical localization of the rash;

nature of skin rashes;

the appearance of yellowish-brown stripes in the form of a comma when the rash sites are lubricated with a 2-5% iodine solution (scabies tracts)

Microscopy of scabies scraping in oil or alkali

Treatment. To treat scabies, agents are used that destroy the scabies tracts and destroy the mites and their eggs located there. Apply 33% sulfur ointment (children 6-10-16%), 20% (children 10%) emulsion or ointment of benzyl benzoate, Demyanovich method (solution 3!-60% aqueous solution of sodium thiosulfate, solution No. 2 - 6% aqueous solution of hydrochloric acid acids), Spregal aerosol (piperonyl butoxide, esdepalletrin), used as a single irrigation, permethrin ointment 5% (nittifor). Disinfection of linen and clothes is mandatory: boiling in a 1-2% solution of washing powder for 10-15 minutes or soaking the linen for 1 hour in a disinfectant solution (5% DDT soap, 2% K soap emulsion, etc.), steaming. Dry clean, spray with A-PAR (esdepalletrin, piperonyl butoxide) or seal in a plastic bag for 72 hours. All those in contact with the patient and those living with him are examined by a dermatologist at least once every 10 days. Prophylactic treatment is recommended.

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Chapter 11. Skin diseasesAcne ( acne)

General principles of treatment. External treatment

Skin diseases are closely related to the condition of the entire human body. Treatment of diseases of the nervous system, internal organs, glands internal secretion, expulsion of worms and treatment of foci of infection have great importance For successful treatment patients with skin diseases. If the etiology of the disease is known, treatment is carried out, first of all, to eliminate the cause of the disease (for example, destroying the mite for scabies). Therapy for patients with skin diseases must be comprehensive and include the correct regimen, general and external therapeutic effects.

External treatment skin diseases are carried out in conjunction with general drug treatment and a rational diet. It aims to speed up the elimination of rashes and reduce the feeling of itching, burning, tightness, and pain. External treatment is usually carried out by a nurse.

External treatment begins with cleaning the lesion from scales, crusts, pus, and scraps of the walls of vesicles and blisters. In this case, tweezers, curved scissors and cotton swabs moistened with 3% hydrogen peroxide are used. Do not forcibly remove scales, crusts, or ointment residues. Such areas are generously moistened with sunflower, peach, linseed or some other oil and re-treated after 10-15 minutes or leave the oil dressing for more long time. Contaminated erosions and ulcers are treated with a 3% hydrogen peroxide solution, and the skin around the lesions is wiped with camphor or 2% salicylic alcohol.

If it is difficult or even impossible for a patient with a skin disease to move (with erythroderma, in severe cases mycosis fungoides, pemphigus vulgaris, systemic lupus erythematosus, psoriasis, etc.), the sheets are changed by a nurse together with a nurse, as described in the chapter “Personal hygiene of the patient.” The sheets and underwear of such patients should always be well straightened to avoid the formation of bedsores. The change of shirt in such patients is done as follows: the shirt is pulled up by the edge to the armpits and removed first from the head, then from the arms. In especially severe cases of common dermatoses (for example, with erythroderma), the patient is put on a vest.

At in serious condition dermatological patients medical staff(, sister, junior nurse) performs a number of hygiene procedures. So, to wash the sick, water is poured from a jug over a basin. Such patients are washed with a weak solution of potassium permanganate (1:1000) using a cotton swab attached to a forceps. Use a cotton swab moistened with a 2% boric acid solution to wash the eyelids. The oral cavity is rinsed with weak solutions of furatsilin (0.02% -1:5000), potassium permanganate (0.01% -1:10000), ethacridine lactate (rivanol) (0.05% -1:2000). The tongue and oral cavity are wiped with a 1% solution of borax with a 10% solution of glycerin, a spatula is wrapped in gauze and moistened with this solution.

For the external treatment of skin diseases, powders, lotions, wet dressings, lubricants, shaken water and oil suspensions (chatter), pastes, ointments, patches and other dosage forms are most often used.

Powders consist of powdery substances that are applied in an even thin layer to the affected area. Indifferent powders contain zinc oxide, talc, starch, white clay and have an itchy, anti-inflammatory effect, they dry the skin (in case of diaper rash), cool it and absorb exudate. Sulfonamides (white streptocide, etc.) in the form of powder, xeroforms, dermatol are included in powders for the treatment of erosions and ulcers.

Lotions. Medicinal solutions, pre-cooled, moisten 2-4 gauze pads, wring them out lightly and apply to the affected area of ​​the skin. The lotion is changed after 5-15 minutes (as it dries) for half an hour, the procedure is repeated 3-5 times a day (depending on the severity of the process). Lotions reduce weeping and swelling, relieve itching and burning, i.e. they have an anti-inflammatory effect due to vasoconstriction. Most often, a 1-2% solution of tannin, a 0.25-0.5% solution of silver nitrate (lapis), a 2-3% solution of boric acid, a 0.25-3% solution of amidopyrine, and lead water are used.

Disinfectant lotions are used in cases where a pyogenic infection occurs. Such lotions are solutions of ethacridine lactate (rivanol) (0.1%), furatsilin (1:5000), potassium permanganate (0.05%), resorcinol (1-2%).

A wet-dry dressing is made according to the same principle as a lotion, but gauze napkins have 8-12 layers. The dressings are changed after half an hour - an hour or less (as they dry). If the bandage dries out, do not forcibly remove it, but soak it in the same solution.

Such dressings are used for limited areas skin lesions with pronounced infiltration and oozing. Pustular skin diseases and widespread acute inflammatory processes are a contraindication to the use of wet-dry dressings.

Warming compresses are used for chronic inflammatory processes with deep limited skin infiltrates and subcutaneous tissue(neurodermatitis, etc.). Gauze folded in 10-12 layers is moistened with one of the solutions (lead water, 2% boric acid solution, etc.), squeezed out and applied to the lesion according to its size. Place a sheet of wax paper on top of the gauze. large sizes, then a layer of cotton wool and bandaged. The compress is changed 1-2 times a day.

Unlike a warming one, a dermatological compress is made without cotton wool.

Lubrication is carried out with alcohol and aqueous solutions aniline dyes (for example, brilliant green). For itching, neurodermatitis - aqueous-alcoholic solutions of menthol (1-2%), carbolic acid (1-1.5%) and aqueous solutions copper sulfate(2-10%), silver nitrate (lapis) (2-10%).

Water and oil shaken suspensions (chatterers). Water, glycerin and powdered substances (30% of the total mass) make up the water mash. Powdered substances are often zinc oxide, talc, white clay, starch. Water mash has an anti-inflammatory effect, soothes itching and burning. Water-alcohol talkers contain alcohol. Oil mash is prepared from the same powdery substances and a liquid fat base (sunflower, peach or Vaseline oil). “Zinc” oil is often used (30% zinc oxide and 70% vegetable oil). Oil mash softens the skin, helps remove scales, crusts and reduces the feeling of tension and tightness.

Before use, water and oil suspensions are shaken and a piece of cotton wool is applied to the affected area. You can add sulfur preparations, ichthyol, tar, menthol, etc. to them. Shake mixtures dry quickly on the skin, so a bandage is not applied. They should not be used in case of excessive weeping or on scalp areas.

Pastas. They are made from an equal amount of powdered substances (zinc oxide, talc, etc.) and a fatty base (lanolin, petroleum jelly, etc.). They act more deeply than talkers, but are less active than ointments; they have an anti-inflammatory and drying effect. Pastes with the consistency of dough adhere to the skin without a bandage. Do not use the paste on the scalp if it is wet. Pastes are applied to the skin 1-2 times a day. Once every 3 days, remove the paste with a swab moistened with vegetable oil.

Often used zinc paste, consisting of equal parts of zinc oxide, talc, lanolin and petroleum jelly. When indicated, the paste includes ichthyol, naphthalan, resorcinol, sulfur preparations, tar, etc. The pastes are applied to the lesions with a spatula and lightly spread over the lesion in strips. Gauze is applied to the surface of the lubricated area and bandaged (no more than 2-3 rounds).

Ointments consist of one or more medicinal substances, evenly mixed with a fatty ointment base (vaseline, lanolin, lard, naftalan, etc.). Ointments are prescribed for chronic and subacute skin diseases, in the presence of an inflammatory infiltrate in the skin, as they have a deep effect. Use 2-10% sulfur ointment, 2-3% tar, 1-3% white mercury, 2% salicylic, 2-5% ichthyol, 2-3% naftalan and other ointments, as well as ointments with antibiotics (erythromycin, biomycin and etc.). In the treatment of vesicular and herpes zoster, interferon ointment is used.

Ointments containing corticosteroid drugs (prednisolone, hydrocortisone, depersolone), corticosteroids and antibiotics - oxycort, geocortone, locacorten (with neomycin, vioform, tar), ultralan, dermosolone, depersolone, monomycin-prednisolone, sinalar-N - with neomycin or sinalar S - with quinoform.

For a long time and especially on large areas of the skin, steroid ointments and creams must be used with great caution, since due to absorption (especially with an eroded skin surface), steroid hormones can have an undesirable effect on the patient’s body and cause local complications (the formation of atrophic areas of the skin, the appearance of telangiectasia, etc.).

Using a spatula, apply the ointment in an even layer on a piece of cloth and apply it to the lesion, strengthen it with a bandage or directly apply the ointment to the skin, leaving it without a bandage. For scabies, lichen versicolor the ointment is rubbed into the skin. The affected areas are lubricated with paste or ointment 1-2 times a day. Sometimes ichthyol, tar is used in pure form(without an ointment base), then lubrication is carried out once every 2 days. During the procedure, ointments and pastes are placed in glass beams on a separate table; the nurse gives the required amount of medication to the patient on wax paper.

The nurse should ensure that the names and date of preparation are neatly and clearly written on the jars in which ointments, lotions, and solutions are stored. The use of external products after their expiration date is not allowed, as they can cause irritation and inflammation of the skin (dermatitis).

Patch. In addition to fat, the plaster base contains wax or rosin. Compared to ointment, the patch has a thicker and stickier consistency. It is preheated and applied to the affected area in a thick layer; it acts even deeper than the ointment. A drug-free patch is used to secure dressings to the skin. If a regular patch does not adhere well to the skin, it is slightly heated.

Soap. Medicinal soaps include sulfur, tar, ichthyol, resorcinol, sulfur-salicylic, sulfur-tar, etc.

Baths. Therapeutic general baths with the addition of pine extract, potassium permanganate (1:10000), oak bark(1 kg of bark is boiled in 6 liters of water), bran decoction (1 kg wheat bran boil in 3 liters of water) and local (37-40 °C) are used for skin diseases of the hands, feet, genitals, and anus. Thus, hot hand baths are prescribed for chills and vasomotor disorders.

Depending on the water temperature, baths are divided into indifferent (34-36 °C), warm (36-38 °C), hot (39 °C and above), cool (33-21 °C) and cold (20 °C and above). below). The duration of regular baths is 15-25 minutes, warm baths are 10 minutes, hot baths are 5 minutes.

First the bath is washed hot water with soap, a washcloth or a brush, which are previously boiled and stored in a 1% chloramine solution, and disinfected with a 1-2% chloramine solution or a 1% bleach solution. Then disinfectant solution wash off with hot water. Once a week the bathtub is cleaned with diluted hydrochloric acid, sodium bicarbonate solution, kerosene or special paste. Rust stains are cleaned with oxalic acid.

Therapeutic baths should be taken 30-40 minutes after light breakfast or 1-2 hours after lunch.

Baths with the addition of starch and bran (wheat or almond) are taken as an antipruritic and skin softening agent. Starch or bran (500-1000 g) in a linen bag is dipped into a bath of water at an indifferent or lukewarm temperature (37 ° C) and, so that the contents enter the water, the bag is squeezed out from time to time. You can prepare a decoction from 1-2 kg of bran in advance, strain and add to the bath. Almond bran can be added directly to the bath. The duration of therapeutic baths is 30 minutes - 1 hour or more.

General baths and showers are indicated for psoriasis and neurodermatoses. Water cleanses the skin of drug residues, crusts, loosens the thickened stratum corneum of the epidermis, and has a calming effect on nervous system, improves blood circulation.

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Chapter 11. Skin diseasesAcne (acne)

Chapter VI

PRINCIPLES OF TREATMENT OF SKIN DISEASES

Effective treatment of skin diseases is undoubtedly the pinnacle of professional skill of a dermatologist. Due to the large number and variety of dermatoses, the inherent uncertainty of their etiology and pathogenesis, and their tendency to have a protracted course, this task is often difficult to accomplish and requires from a specialist not only a broad general medical outlook, but also a great personal experience And high level clinical thinking. What is of particular value here is clinical reasoning– the doctor’s ability to individualize this observation as much as possible and select strictly individual treatment, adequate to the form and stage of the disease, gender and age of the patient, concomitant pathology, household and professional characteristics of the case. Only like this adequate therapy promises the greatest success.

Ancient doctors left us in lapidary form a set of requirements that can be considered as criteria optimal treatment: cito, tuto, jucunde (“fast, efficient, pleasant”). Dermatological science and practice in their development have always strived to fulfill these calls and have achieved considerable success in this direction.

The most successful, of course, is treatment aimed at eliminating the cause of the disease - it is called etiological. This, for example, is the use of acaricidal drugs for scabies (killing the causative agent of the disease - the scabies mite). However etiological treatment, unfortunately, is possible only for a limited range of dermatoses that have a clearly established etiology, while for many skin diseases the real reason The disease's disease is still unclear. However, for most dermatoses, sufficient information has been accumulated about the mechanisms of their development, which makes it justified to carry out pathogenetic treatment aimed at correcting individual aspects pathological process(for example, the use of antihistamines for urticaria caused by excess histamine in the skin). And finally, it is often necessary to resort to symptomatic therapy aimed at suppressing individual symptoms illness when its etiology and pathogenesis are unclear (for example, the use of cooling lotions in the presence of swelling and weeping in the lesions). IN complex therapy etiological, pathogenetic and symptomatic methods treatment.

Almost everything is used in the treatment of skin diseases modern methods therapeutic effects, which can be classified as follows:

3. Drug therapy (general and local)

4. Physiotherapy

5. Psychotherapy

6. Surgical treatment

7. Spa therapy

Treatment of dermatoses, as a rule, is complex, including the inclusion of an appropriate set of therapeutic measures, depending on the characteristics of the disease.