Skin disease. Prevention of the main types of skin diseases. What are skin diseases: acne, blackheads, eczema, herpes

Sexual infections are handled by a huge number of different medical institutions. Starting from independent private anonymous doctors' offices, and ending with large state medical institutions. The most important thing when choosing a clinic is the presence of a specialized specialist - a dermatovenereologist. No doctor can provide you with the same specialized care as a dermatovenereologist.

Public clinic or private?

If you suspect any sexually transmitted disease, you can seek help from various medical institutions. They can be divided into three main groups:

• state polyclinic
• city ​​dermatovenerologic dispensary ( KVD)
• private clinic/office

Each of them has its own advantages and disadvantages. For a better understanding of the specifics of diagnosis, treatment and the cost of services of each medical institution from different groups, they should be analyzed in detail.

Visit to the polyclinic- the easiest option for contacting a dermatovenereologist. The clinic is usually within walking distance from the house. Visiting a doctor and conducting laboratory diagnostics is free of charge. If complications are identified, as well as in case of necessary additional diagnostics, the patient can be referred to the city dermatovenerological dispensary.

The main disadvantages of the treatment of genital infections in the clinic are:

• lack of express methods of laboratory diagnostics,
• lack of anonymity
• possible queues,
• mandatory pre-registration.

Dermatovenerological dispensary is a highly specialized medical institution. It consists of outpatient and inpatient departments. The largest KVD have their own serological and bacteriological laboratories, departments of physiotherapy treatment.

All dermatovenerological dispensaries provide assistance in the treatment and diagnosis of genital infections, and they usually use the most modern equipment.

They treat both on a paid basis and on a budgetary basis. As a rule, in the treatment of genital infections, paid services include:

• maintaining anonymity,
• use of additional express methods of diagnostics ( PCR),
• making an appointment and treatment in the absence of the necessary documents.

In all other respects, treatment should remain free.

You can contact the city dispensary on your own or with a referral from a doctor. In the regional, republican and regional KVD- apply only in the direction of a doctor, or independently, but then only on a paid basis. To apply to the city dispensary, you must have with you:

• passport (with a residence permit or temporary registration),
• policy CHI ,
• insurance pension certificate ( SNILS).

They may also require a doctor's referral or your clinic number. To clarify the list of documents, it is better to call the registry of the dermatovenerologic dispensary in advance.

The skin is the largest organ of the human body (about 2 sq.m.). Accordingly, the list of skin diseases is very wide.

In addition to its protective and immune functions, the skin regulates temperature, water balance and sensations, so protecting yourself from the occurrence of skin diseases is one of the top preventive tasks.

Below you will find out what skin diseases people have and what their symptoms are. You can also see photos of skin diseases and read their description. We note right away that most skin diseases in humans do not have symptoms and are easily treatable.

What are skin diseases: acne, blackheads, eczema, herpes

Acne ("pimples") regarded as the most common skin disease. Almost all adolescents (about 85%) are familiar with the description of this skin disease. Essentially, acne is an inflammation of the sebaceous glands.

Acne vulgaris- This is a typical skin disease for most people, which is one of the first places in the list of such diseases. It is mainly characterized by a mild course, they are found (mainly on the face) in fatty areas of the body and manifests itself in the form of acne, purulent ulcers and comedones. Fat forms clogged sebaceous glands, bacteria can colonize and cause inflammation. The main causes are hormonal changes, usually during puberty or pregnancy. Male sex hormones (androgens) promote development and therefore affect males more than females. In addition, drugs, cosmetics, and stressors can contribute to acne, among other things. The severe form is characterized by scarring, otherwise acne is treated without leaving marks before the age of 25.

Every young mother will tell you about other skin diseases.

Eczema (atopic dermatitis) usually begins in early childhood and manifests itself in periodic inflammatory reactions of the skin. This is one of the most common skin diseases. Due to the body's defensive reactions to allergens, it leads to inflammatory processes, insatiable itching acts as a trigger. Triggers can be close to stress, certain foods, mechanical irritations, infections and climatic influences. Scratches can cause inflammatory reactions, the skin loses its protective barrier.

manifests itself in many forms, the most famous is herpes simplex. The primary usually goes unnoticed. Only further infection appears as typical vesicles with crusting and inflammation. The reasons can be different, injuries or sunburn, stress and hormonal fluctuations.

What other skin diseases are there: bedsores, eczema, scabies

bedsores, as a rule, arise from prolonged bed rest with simultaneous immobility. Pressure on a certain, unprotected area of ​​​​the body contributes to the formation of an ulcer in the deepest layers of the skin with a simultaneous lack of nutrition. Bacteria can penetrate and destroy the layers completely. Sufferers complain of itching, burning and severe pain.

Eczema is a superficial inflammation of the skin. Her symptoms are shown in the photo above: redness with occasional blisters. The causes of eczema are many and varied.

Scabies caused by ticks (mainly through sexual contact). Ticks make holes in the stratum corneum and lay their eggs there. Affects mainly the wrists, between the fingers, the navel, chest, armpits or genital area. Scabies is well treated, but can also cause other diseases (eg, cellulitis, sepsis).

List of other skin diseases: keratosis, carcinoma, hemangioma

Older people are also familiar with what skin diseases are. For example, senile keratosis is caused by constant and intense sun exposure, an increase and change in skin keratinocytes occurs painfully. It is considered an early stage of skin cancer. Reddish spots appear on sun-exposed areas of the body. Requires immediate treatment.

Basal carcinoma also recognized as white skin cancer, has the same trigger others. With early treatment, basal cell carcinoma has a good prognosis.

Hemangioma is a benign tumor that occurs most frequently in young children (approximately 30% at birth).

Skin diseases in humans: melanoma, shingles, hemorrhoids

Melanoma (cancer) is a malignant tumor based on the pigment cells of the epidermis. It develops as a result of excessive sun exposure and appears more often on the face, neck or forearms. At an early stage, it is well treated.

Shingles (shingles) as a result of immunodeficiency.

Hemorrhoids occur with various causes such as constipation, lack of exercise, pregnancy, liver disease.

What are skin diseases: warts, diaper rash and others

Warts are often infectious, benign epithelial tumors caused by a virus. The lesions form over several months or years, sometimes spontaneously.

diaper rash is one of the most common skin disorders in infancy, being diagnosed in almost two-thirds of all children and manifesting itself in various forms.

Hair loss, which can be caused by organic disorders and poisoning.

Varicose veins are also visible on the skin (usually the legs) but are not counted as skin diseases.

Weakness in the veins of the legs, leading to leg ulcers. As a result, wounds heal poorly, which leads to slow tissue destruction. Threatened loss of the affected limb.

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Sexually transmitted diseases, or sexually transmitted infections (STIs), are contracted during sexual intercourse. Disease-causing organisms can be transmitted through blood, semen, saliva, and any other body fluids.

Some of these infections can be transmitted not only through sexual contact, but, for example, from mother to child, during pregnancy, childbirth or breastfeeding, or during a blood transfusion (blood transfusion). Sexually transmitted diseases are common in the modern world, so it is extremely important to know the symptoms in order to correctly diagnose. We must not forget about the measures of personal protection, about the prevention of unpleasant health problems.

Since sexually transmitted diseases may be asymptomatic for some time, a person may not always know that he is the source of the infection. In this case, the spread of the disease occurs "accidentally".

Symptoms of some sexually transmitted diseases

Chlamydia

HIV symptoms may not be present. In most cases, after 2-6 weeks, a flu-like condition develops that does not have specific symptoms, so the early stages of the disease are often missed.

Early symptoms

• Fever;
• Sore throat;
• Rash;
• Weakness.

These symptoms usually go away in 1-4 weeks. During this period, a sick person is contagious, and therefore dangerous to others. More severe and specific symptoms may first appear even 10 years after infection. Therefore, it is very important to visit a doctor and be regularly screened for sexually transmitted diseases.

Secondary Symptoms

As the virus destroys the immune system, the following symptoms appear:

• Enlarged lymph nodes;
• Weight loss;
• Fever;
• Cough and shortness of breath.

Late symptoms of HIV

• Constant weakness and fatigue;
• Torrential night sweats;
• Chills and fever for several weeks;
• Swollen lymph nodes for 3 months or more;
• chronic diarrhea;
• persistent headache;
• Opportunistic infections (infectious diseases that never develop in people with normally functioning immunity).

Genital herpes

is a highly contagious disease caused by the herpes simplex virus (HSV). The virus enters the body through microtraumas on the skin and mucous membranes. The vast majority of people do not even know that they are carriers of the virus, because they do not have any manifestations of the disease. In cases where there are symptoms, the first exacerbation is quite difficult. Some people never have flare-ups again; for others, genital herpes recurs all the time.

Symptoms

• Small red sores and vesicles in the genital area;
• Soreness and itching in the perineum, on the buttocks, on the inner thighs.

The first symptom of genital herpes, soreness and itching, usually appears a few weeks after contact with a carrier of the virus. First, a lot of bubbles appear, which open up and form ulcers.

During the period when there are sores, soreness and burning during urination may be noted. These sensations can persist even when all skin and mucosal defects have healed.

During the incubation period, the person may experience headache, muscle pain, fever, and swollen lymph nodes, especially in the groin.

In some cases, a person remains contagious even after all the sores have healed and the discomfort has passed.

genital warts

Genital warts are one of the most common sexually transmitted infections.

Symptoms

• Small, flesh-colored or grayish bumps in the genital area;
• Some warts merge with each other, resembling cauliflower;
• Itching and/or discomfort in the perineum;
• Contact bleeding.

However, most often genital warts do not manifest themselves. They can be very small, up to 1 mm, or they can form large conglomerates.

In women, genital warts can occur on the labia, the entrance and walls of the vagina, the cervix, perineum, around the anus. In men - on the penis, scrotum and around the anus.

Hepatitis

A, B and C are contagious viral infections that affect the liver. The severity and time of onset of symptoms depends on the type of hepatitis and the reactivity of the person's immune system.

Symptoms

• Fatigue;
• Nausea and vomiting;
• Pain or discomfort in the abdomen, especially in the right hypochondrium;
• Loss of appetite;
• Fever;
• dark urine;
• Pain in muscles and joints;
• Skin itching;
• Jaundice (yellowish coloration of the skin, mucous membranes and sclera).

Syphilis

- a bacterial infection that affects the genital tract, but over time can spread to all organs and systems, causing a variety of manifestations. Syphilis goes through four stages, each of which has its own characteristics. There is also congenital syphilis, when the fetus becomes infected during pregnancy. Congenital syphilis is a very dangerous condition, so all pregnant women should not miss the tests prescribed by the gynecologist, and if syphilis is detected, it should be treated immediately.

Primary syphilis

Symptoms appear 10-90 days after infection:

• A small painless ulcer (chancre) at the site of infection (genitals, rectum). Usually there is one chancre, but in rare cases there may be several;
• Enlarged lymph nodes.

Although the symptoms of primary syphilis may disappear without treatment, this does not mean that the person has recovered. The disease simply moves on to the next stage.

Secondary syphilis

Symptoms appear 2-10 weeks after infection:

• Red rash the size of a small coin (50 kopecks) all over the body, including the palms and soles;
• Fever;
• Weakness, lethargy, fatigue.

These manifestations may come and go within a few days, or they may persist for a year or more.

Latent syphilis

The period when there are no symptoms. Complete self-healing may occur, but more often the disease passes into tertiary syphilis.

Tertiary syphilis

If, then pale treponema (the causative agent of syphilis) can spread throughout the body, cause changes in any organs, and even lead to death.

Neurological symptoms

• , arachnoiditis and their combinations;
• Numbness and weakness in the limbs;
• Paralysis;
• Deafness;
• Blindness;
• (dementia).

Cardiovascular symptoms

• Formation of aneurysms;
• Aortitis and arteritis;

Diagnostics of venereal diseases

If you suspect you have a sexually transmitted disease, or if you have had sex with a partner who later develops some strange symptoms, see your doctor immediately. A gynecologist or an infectious disease specialist will prescribe the necessary tests for you, conduct an examination and make a diagnosis if the infection does occur. The following tests are used to detect sexually transmitted infections:

• Blood test (signs of inflammation, Wasserman reaction);
• (with urethritis);
• Smears from the urethra, vagina and cervix (for microscopy and detection of the pathogen);
• Smears-imprints from defects in the skin and mucous membranes;
• Immunoenzymatic analysis (for the determination of antigens);
• Polymerase chain reaction (to identify the genetic material of the pathogen);
• Specific tests for specific pathogens (for example, a series of tests for hepatitis).

Screening

Screening is a set of tests and studies that a person undergoes without symptoms of the disease. Screening is carried out not only to identify possible sexually transmitted diseases, but also for the early diagnosis of other diseases (for example, screening in

A dermatological patient seeks medical help when he detects changes on the skin or visible mucous membranes, in some cases accompanied by subjective sensations. However, the clinical picture of skin diseases provides a complex symptom complex. All symptoms of the disease are divided into subjective and objective. Subjective symptoms include manifestations of the disease that the patient feels, objective symptoms - changes that the doctor finds on the skin or visible mucous membranes during examination or palpation. Rashes are often accompanied by general symptoms: malaise, feeling of weakness, general weakness, fever, etc.

Complaints. The doctor's contact with the patient begins with the clarification of complaints. Dermatological patients most often complain of itching, burning, pain, tingling, etc. However, subjective symptoms depend not only and not so much on the severity of the disease, but on the individual characteristics of the patient, the reactivity of his nervous system. Some patients react very painfully to minor manifestations of the disease, while others may present minor complaints with the severity of skin pathology. This is especially true for itching, the severity of which depends not only on dermatosis, but sometimes to a greater extent on its perception by the patient. Objective signs of itching are multiple excoriations - traces of scratching, as well as

the value of the free edge of the nails of the fingers and the polishing of the nail plates.

The presence or absence of itching has a certain diagnostic value. Some dermatoses are always accompanied by itching (scabies, urticaria, various forms of pruritus, neurodermatitis, lichen planus, almost all forms of eczema), others occur without itching or it is slightly pronounced (psoriasis, lichen pink, pyoderma, vulgaris and red acne, etc.) . In some dermatoses, itching is usually accompanied by scratching (scabies, lice, pruritus, etc.), while in others, despite severe itching, no scratching is observed (urticaria, lichen planus, etc.). In addition, in patients with pruritic dermatoses, itching usually increases or occurs at night when the skin warms up; especially in patients with scabies.

Anamnesis. After clarifying the complaints, they begin to collect an anamnesis of the disease and the life of the patient. A correct and thorough history is often of great importance in establishing the diagnosis of a skin or venereal disease. The circumstances preceding or accompanying the onset and maintenance of the disease are important for identifying etiological and pathogenetic factors, without which it is difficult to hope for successful treatment.

A well-collected history often facilitates diagnosis, so it is necessary to ask the patient a number of clarifying questions. What does the patient associate the occurrence of his disease with? When did it first arise (congenital - acquired)? With the use of certain foods (chocolate, citrus fruits, nuts - more often of an allergic nature; shrimp, squid and many other diverse foods - food toxidermia; bread and everything containing gluten - Dühring's herpetiform dermatitis)? Is there a relationship with medication (drug toxidermia)? Are the rashes localized only in open areas (photodermatosis? phototoxic reactions to drugs with photosensitizing properties?) or also in closed areas (other dermatosis? photoallergy to drugs?)? (If rashes on open areas of the skin occur a few minutes after insolation - solar urticaria; after 24-48 hours - polymorphic photodermatosis (solar pruritus or solar eczema)). Eruptions around the mouth (perioral dermatitis? allergic reaction to fluoride in toothpaste?).

If an occupational skin disease is suspected, it is important to find out the features of the patient's work: erysipeloid occurs in workers

slaughterhouses, canneries processing raw meat (often pork), fish, milkers' knots - from milkmaids, anthrax - from butchers, tanners, glanders - from veterinarians, grooms and other persons serving animals with glanders. Toxic melasma is observed in persons who often come into contact with hydrocarbons (oil distillation products, gas, etc.). If you suspect skin leishmaniasis, leprosy, phlebotoderma and a number of other dermatoses, you need to find out if the patient was, even for a short time, in those areas where these diseases occur, for example, if leishmaniasis is suspected - in Central Asia or the Caucasus, with suspicion of deep mycoses, tropical treponematoses - in hot climates, etc. In cases of complaints of discharge from the urethra, the appearance of erosive or ulcerative elements on the genitals, the prescription of casual sexual contact may be important for establishing the diagnosis.

In the diagnosis of a number of dermatoses, the seasonality of the disease is important. So, in autumn and spring, erythema multiforme exudative, pink lichen, erythema nodosum, herpes zoster occur more often. Patients with photodermatosis, erythematosis, phlebotoderma, meadow dermatitis, epidermophytosis, etc. more often go to the doctor for the first time in spring or summer; patients with chills - in the damp and cold season.

Sometimes the tendency of dermatosis to relapse (eczema, psoriasis, athlete's foot, exudative erythema, Dühring's dermatitis, herpes simplex, etc.) or, conversely, the lack of a tendency to recurrence (deep trichophytosis, pink lichen, herpes zoster, etc.) helps in the diagnosis.

Of great importance is the anamnesis if a drug rash is suspected: the patient indicates that his rashes are repeated after the use of one or another medication, although the patient's denial of such a connection does not yet exclude a drug rash. Some patients, with a careful history taking, indicate that relapses of rashes are associated with the use of chocolate, strawberries, crayfish, etc. Information about past and present tuberculosis, syphilis, diseases of the liver, gastrointestinal tract, blood, dysfunction of the nervous system, endocrine glands.

Questioning the patient allows you to establish in some cases the family nature of the disease, which helps in the diagnosis of scabies, ringworm, hereditary and congenital dermatoses (some forms of keratosis, Darier's disease, etc.), as well as to find out the presence or absence of itching,

its intensity, localization, the greatest severity at certain hours of the day.

It should be borne in mind that some skin diseases occur predominantly in individuals of a certain gender. For example, pruritus nodosum, chronic trichophytosis, systemic scleroderma, erythema nodosum are more common in women, rhinophyma, acne-keloid - in men.

The anamnesis allows you to clarify when and in what areas the first manifestations of the disease appeared, how long these manifestations exist, what changes occurred with them, i.e. the frequency and duration of relapses and remissions (if any), the relationship of rashes with nutrition and past therapy, the effectiveness of treatment.

Survey of a dermatological patient in the section of life history (anamnesis vitae), is no different from that in clinics of a therapeutic profile.

Finding out the history of a skin disease, it is necessary to determine its duration, as well as the reasons with which the patient himself associates its onset and exacerbation (stress, cooling, taking medications, certain types of food, the effect of chemicals on the skin, insolation, etc.). Then the nature of the course of dermatosis, the tendency to relapse, in particular the seasonality of exacerbations and remissions, and their duration are established. If the patient has already received treatment, then it is necessary to find out which one, and what was its effectiveness. Pay attention to the effect of water, soap on the skin.

When collecting a life history in order to identify the role of external factors in the pathogenesis of dermatosis, one should pay attention to the working and living conditions of the patient, as well as learn about previous diseases, skin diseases in the patient's family members and his blood relatives, alcohol consumption and smoking.

Examination of the patient is the most important point in the diagnosis of skin disease.

The patient should be asked to undress completely, even if he complains of single rashes. Pay attention to the prevalence of morphological elements, since the process can be universal, capture the entire skin (erythroderma), the rash can be generalized or local, located symmetrically or asymmetrically. Consideration should be given to whether the patient has one type of primary elements (monomorphic rash) or primary elements are diverse (polymorphic rash). An important diagnostic value is the location of the elements in relation to each other. rashes

can be located in isolation or grouped, forming figures in the form of rings, arcs, lines, etc. When the lesions are located in separate small groups, they are said to be herpetiform. The rash may have a tendency to coalesce. The boundaries of the lesion may be clear or vague. Often the localization of the rash is of diagnostic value.

When studying morphological elements, it is necessary first of all to determine their color, shape and shape, with the help of palpation to find out whether they rise above the level of the skin or mucous membrane or not. Their consistency (hard or soft), depth of occurrence (surface or deep) should be determined. It is important to clarify the dynamics of the process: the elements exist constantly or periodically disappear, what is their regression (resorption, peeling, ulceration, atrophy, etc.), to determine whether the elements leave a scar and if so, which one.

An isomorphic reaction (Köbner's symptom) is of great diagnostic importance: the appearance of fresh primary elements characteristic of this disease at the site of irritation of the skin or mucous membrane

any exogenous factor (scratch, friction, burn, including sunlight, etc.).

In some cases resort to special research methods: vitropressure(pressure on the affected surface with a watch glass, glass spatula or glass slide) to clarify the color of the element, detect caseosis, etc .; layer-by-layer scraping of the element, allowing to determine peeling. According to the indications, increased fragility of the capillaries of the papillary layer, etc. is determined.

If an infectious etiology of dermatosis is suspected, bacterioscopic and, in some cases, bacteriological diagnostics are used. The material for the study is scales, hair, nail plates, the contents of pustules and bladder elements, discharge of erosions and ulcers, blood, etc.

Of great diagnostic importance are the results of a study of the cellular composition of the cystic fluid, a cytological study of smears-prints taken from the surface of erosions to detect acantholytic cells, and data from a general clinical analysis of blood and urine.

According to the primary and secondary morphological elements, one can read the diagnosis on the patient's skin. The more competent the dermatovenereologist, the richer his clinical experience, the better his visual memory is developed, the more often the type of rash (the nature of the morphological elements, their

prevalence, localization, shape, outlines, boundaries, surface, their mutual relationship, consistency) he can diagnose the disease. Here it is not possible to list all the clinical forms of dermatoses that can occur typically. Let us indicate as examples only a few skin and venereal diseases that may have manifestations that make it relatively easy to establish a clinical diagnosis.

Furuncle, carbuncle, hydradenitis, ecthyma vulgaris, pityriasis versicolor, erythrasma, athlete's foot, rubrophytia, scutular form of favus, vesicular and herpes zoster, erythematosis, scleroderma, eczema, urticaria, lichen squamous, lichen planus, chancre hard, wide condylomata of the secondary period syphilis and many other skin and venereal diseases in the "classic" course are easily diagnosed with the appropriate length of service and experience. However, in some cases, visual diagnosis is difficult due to the morphological similarity of many dermatoses. Often in the clinical picture and the course of "classic" dermatoses, one or another atypicality is noted. In these cases, the dermatovenereologist, having examined the patient and not being able to establish a diagnosis by the appearance of the rash, and even after using additional examination methods (palpation, diascopy, scraping of rashes, etc.), must clarify the history and complaints of the patient. In necessary cases, special dermatovenereological studies should be carried out (pathohistological examination of biopsy material, examination for fungi, pale treponema, gonococcus, Mycobacterium tuberculosis, leprosy bacillus, acantholytic cells, serological blood tests, immunoallergological examination, etc.) in order to establish the final diagnosis of the disease, clarification of its etiology and pathogenesis.

We turn to the presentation of the scheme of examination of a dermatological patient.

4.1. Description of the general condition of the body

The general state of health is assessed by mental and physical status, age-appropriate appearance. The survey is carried out according to the general rules, so we will outline them briefly. Examine the size, density, mobility, soreness of the lymph nodes accessible to palpation. Examine the musculoskeletal system and determine muscle tone. When examining the nose, nasopharynx, percussion and auscultatory examination, the state of the respiratory organs is determined.

Complaints about the violation of the functions of the circulatory organs are detected, the boundaries of the heart are determined, its tones are heard, blood pressure is measured, and the pulse is determined. Then they find out complaints about the functions of the digestive organs, examine the oral cavity, palpate the abdomen (liver, spleen). In the study of the genitourinary system, Pasternatsky's symptom is determined, attention is paid to the frequency of urination, the type of urine, the development of the genital organs, the nature and frequency of menstruation. Determine the endocrine status and the state of the neuropsychic sphere (emotional mobility, performance, sleep, cranial nerve function, skin and tendon reflexes).

Dermatological status. Examination of healthy areas of the skin, mucous membranes, and appendages of the skin helps to study skin lesions. The skin is examined in diffused daylight or good electric lighting, including fluorescent lamps. It is necessary to determine the color of the skin and visible mucous membranes, the elasticity and extensibility of healthy skin, the turgor of muscles and subcutaneous fat, as well as the condition of the sebaceous and sweat glands, nails and hair, pigmentation, the presence of scars, nevoid formations, etc. Healthy skin has a matte surface and does not shine. A change in skin color may be associated with dysfunctions of the organs and systems of the body (for example, with Addison's disease, toxic melasma, the skin is dark, with Botkin's disease - yellow, with congestion - cyanotic). To determine the extensibility and elasticity of the skin, it is felt, collected in a fold; the presence or absence of cohesion with the underlying tissues is determined by shifting the skin.

Of no small importance is dermographism - the reaction of the neurovascular apparatus of the skin to mechanical irritation, indicating the vasomotor innervation of the skin. The appearance of a red stripe after passing over the skin with a blunt object (the edge of a wooden spatula, the handle of a neurological hammer), which disappears without a trace after 2-3 minutes, is considered normal dermographism. Red spilled dermographism is observed in eczema, psoriasis, white - in patients with pruritus, exfoliative dermatitis, persistent white or mixed, quickly turning into white - in patients with atopic dermatitis, urticaria (wide edematous, sharply rising bands of red color after even a weak mechanical skin irritations, sometimes disappearing after 40-60 minutes) - in patients with urticaria, pruritus.

Muscle-hair reflex ("goosebumps") is obtained by lightly passing a cold object over the skin. Normally, it lasts 5-10 seconds and then disappears without a trace. The absence of this reflex indicates a disorder of sympathetic innervation and is observed in patients with ichthyosis, Hebra's pruritus. Its increase occurs in patients with atopic dermatitis with functional disorders of the central and autonomic nervous system.

In case of suspected leprosy, syringomyelia, pathomymia, the study of tactile, pain and temperature sensitivity of the skin is often of decisive diagnostic importance.

Damage to the skin and mucous membranes (status localis) it is recommended to describe sequentially, adhering to a certain scheme. First, it is advisable to indicate whether the rashes are of inflammatory or non-inflammatory origin. Most manifestations of skin and venereal diseases are associated with inflammation. Then the rashes should be classified as acute inflammatory (with a predominance of the exudative component of inflammation) or non-acute inflammatory (with a predominance of the proliferative component of inflammation). Further, the localization of the rashes is indicated with a description of the predominant location of the elements. Many dermatoses have a favorite localization, but this is of secondary importance for establishing a diagnosis. So, for example, with scaly lichen, papulonecrotic tuberculosis of the skin, Hebra's pruritus, rashes are located on the extensor surfaces of the limbs; with lupus erythematosus, erythematosis, acne, etc. - on the skin of the face; with microbial and varicose eczema, erythema nodosum and Bazin's erythema indurated, trophic and chronic pyococcal ulcers, etc. - on the skin of the legs; with pemphigus, ulcerative tuberculosis, etc. - in the oral cavity. Further, attention is paid to the prevalence of the lesion, which can be limited, disseminated, generalized, universal in the form of erythroderma, as well as symmetrical and asymmetric.

Then the primary and secondary morphological elements are indicated and their features are described: color, borders, shape, outlines (configuration), surface, consistency, relationships. An experienced dermatologist distinguishes not only the color of the elements, but also its shades, which often has an important diagnostic value. The boundaries of morphological elements can be clear and fuzzy, sharp and unsharp. When describing the shape of elements, such as papules, it should be noted that they are flat, conical or hemispherical.

nye, etc. The outlines of the elements are rounded, oval, polygonal or polycyclic, small or large scalloped, etc. According to the consistency, the elements can be woody-dense, densely elastic, soft, doughy. The surface of the elements can be smooth, rough, bumpy, etc. They are isolated from each other or drain; in the first case, they talk about the focal location of the rash. If the rash resembles circles, semicircles, ovals, arcs, then they talk about the correct grouping of the rash. An irregularly grouped rash is located in a certain area, but does not form any geometric figure. A systematized rash is called a rash located along the nerve trunks (with herpes zoster), blood vessels, according to the distribution of dermatometamers, etc. With a disorderly arrangement of the rash, there is no regularity in the placement of morphological elements.

Primary and secondary morphological elements and their clinical features are the basis of dermatological diagnosis. However, it is often necessary to use special methods of clinical and laboratory research.

4.2. Special dermatological and laboratory tests

Special dermatological research methods are non-invasive and invasive: scraping, palpation, diascopy, determination of isomorphic reaction, dermographism, muscle-hair reflex, skin tests, dermatoscopy, dermatography, histological and histochemical examination of skin biopsy from the lesion.

To laboratory methods of examination dermatological and venereal disease patients include both general (blood, urine, gastric juice, feces for worm eggs, chest X-ray, etc.) and special (serological, microscopic, pathomorphological examination).

Scraping of rashes with a glass slide, scalpel, etc. is used mainly for suspected scaly lichen and parapsoriasis. With psoriasis, it is possible to get three characteristic symptoms in succession: “stearin stain”, “film” and “blood dew”, or point bleeding, with teardrop-shaped parapsoriasis - a symptom of hidden peeling. With erythematosis, scraping of scales with follicular "spikes" is accompanied by soreness (Besnier's symptom).

The consistency of the elements is determined by palpation; if the extreme states of consistency are relatively easy to assess, then its transitional forms require an appropriate skill.

On diascopy, in other words, vitropressure, a glass plate (a glass slide or a watch glass) is pressed on a skin area, bleeding it, which helps to study the elements, the color of which is masked by hyperemia from reactive inflammation. This method makes it possible to recognize, for example, elements of lupus erythematosus, which acquire a characteristic brownish-yellow hue during diascopy (apple jelly phenomenon).

In some dermatoses, on apparently healthy skin, in response to its irritation, rashes occur that are characteristic of this disease. This phenomenon is called an isomorphic irritation reaction. This reaction can occur spontaneously, in places subjected to friction, maceration, intense solar radiation, for example, in patients with eczema, neurodermatitis, lichen planus, or it can be artificially caused by irritation in psoriasis (Köbner's symptom), lichen planus in an advanced stage. Urticarial dermographism in urticaria is also an example of an isomorphic reaction. The stratum corneum is clarified with vaseline oil, sometimes with lichen erythematosus, to better identify the sign of Wickham's "grid".

Non-invasive also include modern research methods - dermatoscopy and dermatography. With dermatoscopy using a 20x magnification through a layer of liquid oil, skin elements can be clearly seen, especially in the differential diagnosis of pigmented rashes. Dermatography is based on ultrasonic (20 Mhz) examination of skin layers and subcutaneous tissue. Using this method, one can judge the depth of the primary and secondary elements, the effectiveness of the therapy, the water content in the skin, and many other parameters.

In order to confirm the diagnosis of an allergic disease, skin tests (tests) are widely used. There are skin (application), scarifying, and intradermal (intradermal) tests. More often, an application test is used using the Yadasson compress (patchwork) method, or a drop test proposed by V.V. Ivanov and N.S. Vedrov. In some cases, scarification and compress (scarification-application) methods are combined.

Skin and intradermal reactions with tuberculin (Pirk, Mantoux, Nathan-Kollos) is used in patients with tuberculous skin lesions. However, their negative answer does not rule out a specific process. The result is considered positive if a reaction occurs to large dilutions of tuberculin. Intradermal tests with fungal filtrates and vaccines are used in some ringworms, although non-specific positive results are sometimes observed. Intradermal tests with specific antigens are used for leprosy (with lepromine), inguinal lymphogranulomatosis (Frey reaction), tularemia (with tularin), glanders (with malein), etc.

Skin tests with possible food allergens (for eczema, atopic dermatitis, etc.) are rarely used in dermatological practice. Usually, clinical observation of the patient is carried out with the exclusion from food of certain products suspected of being causally significant. The same is true for pyrethrum and some flowers.

In patients with occupational dermatoses, skin tests with various chemicals are used to confirm their association with chemical agents.

If drug-induced dermatitis is suspected, after its resolution, sometimes for the purpose of prevention they resort (with the consent of the patient) to an oral or parenteral test with very small doses of the suspected allergen (often with a sulfanilamide drug). Skin tests in cases of allergic medicinal dermatitis do not always give positive results.

In recent years, the use of skin tests in the diagnosis of allergic diseases has been criticized. These tests can lead to severe complications with significant general and focal reactions, especially in patients with a severe allergic condition. In addition, skin tests can enhance sensitization and progression of the process due to the release of biologically active substances. It should be remembered that in case of sensitization to antibiotics, the introduction of even its minimum amounts (up to 10 IU) can cause anaphylactic shock with a fatal outcome in a patient. They should be replaced by indirect methods for diagnosing an allergic condition. These include an increased content of beta and gamma globulins, etc., as well as serological reactions (Coombs, hemagglutination, Felner and Beer agglutinations, precipitation, complement fixation, immune adhesion, etc.) and cytological phenomena

(Fleck's leukocyte agglomeration test, Shelley's basophil degranulation test, leukocytolysis reaction, leukopenic test, thrombocytopenic index).

The results of a clinical blood test play a decisive role in leukemic diseases accompanied by manifestations on the skin. If Dühring's dermatitis herpetiformis is suspected, the diagnosis is confirmed by eosinophilia in the blood and in the contents of the blisters, which is especially important in differential diagnosis with pemphigus. In these cases, a cytological examination of the contents of the blisters or imprint preparations (Tzank test, pemphigus acantholytic cells) is used, and for the diagnosis of systemic lupus erythematosus, the detection of lupus erythematosus cells (LE-cells) in the blood.

If syphilis is suspected, a complex of serological reactions is made (treponema pallidum immobilization reaction, immunofluorescence reaction, passive hemagglutination reaction - RPHA, etc.). Bacterioscopic (for fungi, yeast cells, pale treponema, gonococcus and Trichomonas, scabies mite, etc.) and bacteriological (crops) studies are widely used. Sometimes, in order to clarify the etiology of the disease, it is necessary to infect animals with pathological material taken from the patient (for example, if skin tuberculosis is suspected, pathological material is inoculated in guinea pigs, if blastomycosis is suspected, in rats).

A biopsy of the affected area of ​​the skin, mucous membrane or morphological element with pathohistological examination of the obtained material in a number of dermatoses provides an invaluable service in establishing a diagnosis. This is especially true for those diseases in which the histological picture is quite characteristic: lichen planus, granuloma annulare, leprosy, urticaria pigmentosa, skin neoplasms, etc. In some cases, the pathological picture may be similar (tuberculosis, syphilis, etc.) and the diagnosis of the disease put on the basis of all the data obtained during the examination, including the result of a biopsy.

For the diagnosis of dermatoses, in the pathogenesis of which autoimmune mechanisms play a certain role, immunological research methods are used, for example, indirect and direct immunofluorescence. The first detects circulating antibodies of classes A, M, G, the second - immune complexes fixed in tissues containing the same classes of immunoglobulins, complement fractions, fibrin.

To detect hypersensitivity to various allergens, skin tests (tests) are performed, as well as in vitro tests: basophil degranulation reactions, blast transformation of lymphocytes, etc.

4.3. Medico-legal relations in the work of a dermatovenereologist

The change in the social formation that has taken place in our country has introduced new aspects into the relationship between the doctor and the patient. Along with state medical institutions, private offices and clinics appeared, and the concept of selling medical services that did not exist before arose. In 1992, the "Law on the Protection of Consumer Rights", "Fundamentals of the Russian Federation Legislation on the Protection of the Health of Citizens", federal laws on health care were adopted. Amendments were made to the Criminal and Civil Code of 1996 regarding the liability of medical workers for causing harm to health in the provision of medical care (services). Moral damage (physical and moral suffering) caused by action (inaction) is subject to compensation. This definition also includes those cases when, during the provision of medical care, no harm was caused to health as such, but the doctor showed disrespect or an inhumane attitude towards the patient.

However, not all doctors appreciate the medical and legal aspects of their activities. Ignorance of the legal foundations of medical activity does not relieve the doctor from liability for possible harm that he can cause to the patient. When prescribing treatment, the doctor must make sure that these drugs will not cause complications in this patient. We had to provide urgent assistance to a patient with a history of allergic reaction to Pentrexil, about which she warned the doctor. However, the doctor prescribed the patient the same drug under a different commercial name (ampicillin), which caused a severe complication in the form of Stevens-Johnson syndrome, which required hospitalization of the patient. The actions of the doctor were qualified as inadequate quality of medical care.

The work of medical institutions and medical personnel is regulated by orders and regulations of higher medical organizations, but in practice doctors, especially young doctors, do not know the content of these documents. Acquaintance with them has not yet been provided for by the educational program in medical higher educational institutions. At the same time, ignorance of legal issues does not relieve the doctor of responsibility for errors.

The relationship between the doctor and the patient includes 3 main stages: taking an anamnesis, listening to the patient's complaints, examining the patient and establishing a diagnosis, and treating the patient.

The doctor's ability to listen carefully to the patient largely determines the establishment of contact with the patient. Even if one glance at the patient is enough for the correct diagnosis of the disease, the doctor must allow the patient to state his complaints. Haste, lack of attentiveness of the doctor can cause a denial reaction in the patient, which does not contribute to successful treatment. Such patients go from one doctor to another, cultivating a skeptical attitude about the possibility of their recovery. The pathological psychosomatic state of the patient, which underlies many dermatoses, deepens.

Examination of the patient and the establishment of a diagnosis should be fully reflected in the medical history. This is an important medical diagnostic and legal document that can be used in investigative and judicial proceedings. Careless registration of the medical history testifies against the doctor in a conflict case and leads to various sanctions, including judicial ones. The main causes of conflict situations are the inadequate quality of medical care, diagnostic errors, the choice of erroneous treatment tactics, and shortcomings in maintaining primary medical records.

Legislative regulations aim to protect the rights of patients, while the rights of physicians remain essentially unprotected. Most lawsuits against dermatovenereologists are resolved in favor of patients. In such a situation, the doctor can rely only on complete and correctly executed medical documentation and on his legal literacy. Corrections, stickers, insertions into the text of medical documents are qualified as made retroactively.

"Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens" define the right of citizens to informed voluntary consent to medical intervention (Article 32), to refuse medical intervention (Article 33), to confidentiality (Article 30), to information about their health (Article 31). The patient does not have special medical knowledge, therefore the doctor is obliged to provide the patient with information about his disease, about the recommended treatment tactics, about possible complications in a form accessible to the patient. Without the consent of the patient for the entire list of services, the actions of a medical worker are not lawful. The patient thus consciously participates in the healing process. Correct information allows you to establish trust

relationship between doctor and patient. The signature of the patient confirms his consent to the proposed examination and treatment.

Currently, a number of medical institutions have introduced the practice of obtaining the informed consent of the patient to conduct this or that intervention. Such consent must be obtained both for the planned examination and for the proposed treatment.

The doctor assesses the result of the treatment as “clinical recovery” or “clinical improvement”. These concepts are subjective and can be challenged by a patient who has not received the expected effect. Detailed records in the medical history (outpatient card), reflecting the dynamics of the clinical picture of the disease, serve as protected medical documentation. In foreign dermatological clinics, patients are photographed before and after treatment. The availability of digital devices, the simplicity and speed of obtaining prints on plain paper make it easy to document the patient's objective condition.

One of the trends in the development of modern medicine is the use of medical and diagnostic standards in the practice of a doctor. The standards are designed to provide the best balance between clinical efficacy, safety and cost of therapeutic and diagnostic interventions. They guarantee the relief of the patient's suffering and at the same time are an important element of the doctor's legal protection. The description of drugs included in the treatment and diagnostic standards are based on evidence-based medicine: indications for use and side effects are ranked according to the level of reliability, depending on the number and quality of clinical trials. Treatment standards

include recommended regimens that provide the best balance between treatment efficacy and proven drug safety. Alternative regimens provide acceptable treatment results in the absence of the possibility of using the recommended regimens in case of age restrictions, individual intolerance, pregnancy, lactation, etc.

4.4. Histomorphological changes in the skin

Many skin diseases are inflammatory in nature. Depending on the severity and duration of the reaction, acute, subacute and chronic inflammation is conditionally distinguished, which occurs under the influence of various external and internal stimuli. The reaction of the body and skin to the action of the stimulus depends on the state of the receptor apparatus, the higher nervous activity of a given person, the reactivity of the body and other factors.

In the microscopic picture of each inflammation, alteration, exudation and proliferation of varying severity are distinguished. Under alteration understand the manifestations of tissue damage (dystrophy and necrosis of tissue elements), under exudation- exit from the vessels of fluid and formed elements due to increased permeability of the vascular wall, under proliferation- reproduction of tissue elements. In cases of acute inflammation, vascular-exudative phenomena predominate, and the inflammatory process is more intense. In cases of chronic inflammation, proliferative phenomena predominate, the vascular-exudative component is much less pronounced, and the inflammatory process is not bright. According to the intensity of inflammatory reactions, subacute inflammation occupies a middle place between acute and chronic inflammation.

Pathological processes in the epidermis proceed in a peculiar way due to anatomical features. Inflammatory changes in the epidermis can manifest themselves:

in the form of intracellular edema, or vacuolar degeneration, in which vacuoles are formed in the protoplasm of the cells of the Malpighian layer, located near or around the nucleus and pushing the nucleus to the periphery. In this case, the core is deformed and often has all the signs

pycnosis. The edematous fluid gradually dissolves the cell, leading to its death. If vacuoles are localized in the cell nucleus, then it swells and turns into a round vial filled with liquid, in which the nucleolus is sometimes preserved. Vacuole degeneration is observed in lichen planus, lupus erythematosus, scleroatrophic lichen, and vascular atrophic poikiloderma;

in the form of spongiosis, or intercellular edema, in which the edematous fluid pushes the intercellular spaces of the Malpighian layer, breaks the intercellular bridges, which leads to a loss of communication between cells, swelling of the cells themselves and the beginning of the formation of epithelial vesicles. Spongiosis is characteristic of eczema and dermatitis;

in the form of balloting degeneration, arising from necrobiotic, degenerative changes in the cells of the Malpighian layer. In addition to profound changes in epithelial cells, the destruction of intercellular bridges leads to the fact that the cells lose their mutual connection and freely float in the serous-fibrinous contents of the vesicle, taking a spherical shape. Such changes are noted in viral diseases, for example, with herpes. In skin diseases accompanied by inflammation, combinations of variants of serous edema are more common.

In acute inflammation, polymorphonuclear leukocytes (neutrophils, eosinophils) predominate in the infiltrate; in chronic inflammation, the infiltrate contains predominantly lymphocytes located diffusely or around the vessels. The infiltrates contain numerous histiocytes.

Plasma cells have a well-developed basophilic cytoplasm, the nucleus is located eccentrically, and they are larger than lymphocytes. Epithelioid cells have an elongated shape, a large round or oval nucleus and abundant cytoplasm. Large multinucleated cells of a round or oval shape with uneven contours are called giant cells.

In addition to the phenomena of serous inflammation, a number of special pathological changes can be noted in the epidermis.

Acanthosis- an increase in the number of rows of cells of the prickly layer of the epidermis. There are simple acanthosis - a uniform and moderate increase in the rows of cells of the prickly layer above and between the papillae of the dermis (juvenile warts); interpapillary acanthosis - mainly between the papillae of the dermis (psoriasis); infiltrating acanthosis - a pronounced proliferation of cells of the spiny layer, in which

processes of the epidermis penetrate the dermis to a considerable depth (warty tuberculosis).

Acantholysis - melting of intercellular epithelial bridges, disruption of communication between epithelial cells, as a result, the cells are easily separated and form more or less significant layers of exfoliating epidermis. This process is observed with pemphigus, Darier's disease, with viral dermatoses.

Hyperkeratosis (hyperkeratosis) - excessive thickening of the stratum corneum without structural changes in cells, parakeratosis - violation of the process of keratinization(the granular and eleidine layers are absent) in the stratum corneum of the epidermis.

Granulosis - thickening of the granular layer of the epidermis.

The ability to distinguish between the elements that make up a skin rash allows you to correctly assess the pathological process and approach the diagnosis of dermatosis. In many cases, the clinical picture, "written on the skin" by eruptive elements and their location, makes it possible to establish a diagnosis and begin therapy; in some cases, diagnosis requires additional examination methods (including laboratory ones). These data are presented in a special section of the textbook devoted to individual nosological forms of dermatoses.

Skin rashes can be inflammatory or non-inflammatory, inflammatory are more common. Non-inflammatory manifestations include age spots, tumors, atrophy, hyperkeratosis, etc.

The inflammatory process has 5 classic symptoms: redness (ruber), swelling (tumor) soreness (dolor), temperature rise (calor) and dysfunction (functio laesa). However, the severity of these symptoms varies depending on the degree of the inflammatory response, which can be acutely inflammatory or non-acutely inflammatory.

With an acute inflammatory reaction, the classic signs of inflammation are clearly expressed: redness is intense, juicy, with indistinct boundaries of the lesions as a result of the severity of the exudative reaction, often leading to the appearance of cavity formations (serous or purulent). Itching or burning, local fever, sometimes soreness in the lesion. All this can lead to dysfunction.

With a non-inflammatory, or chronic, reaction, the symptoms of inflammation are less pronounced, stagnant shades of lesions predominate (cyanosis, liquidity, brownishness) with clear grains.

nitsy, expressed infiltrative component of inflammation with proliferation of cellular elements. In such patients, pain and burning are absent, and itching is sometimes quite severe.

In accordance with the histomorphological difference between acute and non-acute inflammation, the primary elements are divided into exudative and infiltrative. Infiltrative elements include a spot, nodule, tubercle and node, exudative elements include a vesicle, bladder, abscess and blister.

Eruptions arising on the skin, mucous membranes consist of separate elements, which are divided into primary and secondary. The primary elements are rashes that occur on intact skin, the red border of the lips or the mucous membrane of the mouth, i.e. the disease begins with them, they are not a transformation of already existing rashes. Secondary elements are rashes that have developed as a result of transformation or damage to existing elements.

However, the division of elements into primary and secondary is largely arbitrary. There are diseases that begin with elements that are considered to be secondary. For example, the dry form of exfoliative cheilitis begins with scales, which are secondary elements; erosion in the erosive-ulcerative form of lichen planus is not the result of blisters, etc.

Knowledge of the elements of the rash allows you to navigate the extensive and variable pathology of the skin, oral mucosa and lips, and correctly diagnose the disease.

4.5. Primary morphological elements

The primary elements of the rash include a spot, a blister, a blister, a vesicle, an abscess, a nodule, a tubercle, and a nodule, while the secondary elements include pigmentation disorders, scales, erosion, excoriation (abrasions, traumatic erosion), an ulcer, a fissure, a crust, a scar, and cicatricial atrophy. , vegetation, lichenization (lichenification).

Spot (macula) is a limited discoloration of the skin or mucous membrane. Usually the spot is located on the same level with the surrounding skin, does not differ from it in consistency and is not felt during palpation (Fig. 2).

Spots are divided into vascular, including hemorrhagic, and dyschromic(Fig. 3).

Vascular spots are clinically manifested by limited reddening of the skin as a result of vasodilation of the superficial vascular

plexus. They are divided into inflammatory and non-inflammatory. Inflammatory vascular spots are called limited redness of the skin of various sizes, caused by external or internal irritating factors (Fig. 4). Depending on the degree of filling of the blood vessels, the spots have a red, pink or purple (bluish, stagnant) color.

When pressing on the spots resulting from the expansion of the skin vessels, they disappear and after the cessation of pressure they reappear in the same form.

Small pink inflammatory spots, less than 1 cm in diameter, are called roseola. Roseola occurs with secondary syphilis, measles, scarlet fever, typhoid fever, drug rashes, etc. It can be acute inflammatory - bright pink, with indistinct boundaries, a tendency to merge and peel, often with swelling and itching, and not acute inflammatory - pale pink color with a brownish tint, not itchy, as a rule, not merging. Acute inflammatory roseola appears as a primary element in patients with measles, scarlet fever, eczema, dermatitis, pink lichen; not acute inflammatory - in patients with secondary (rarely tertiary) syphilis, erythrasma, pityriasis versicolor.

Rice. 2. Spot (macula)

Rice. 3. dyschromic spot

Rice. four. vascular spot

Large vascular spots (10 cm or more) are called erythema. They are edematous, with irregular outlines, bright red, accompanied by itching and occur, as a rule, as a result of acute inflammatory vasodilation in patients with eczema, dermatitis, with first-degree burns, erysipelas, exudative erythema multiforme.

With emotional arousal, neurotic reactions, large confluent non-inflammatory spots appear (short-term expansion of the vessels of the superficial vascular plexus) without itching and peeling, which are called "erythema of embarrassment" (anger or shame).

Spots caused by persistent non-inflammatory expansion of the superficial vessels (capillaries) of the skin are called telangiectasias. They are

also temporarily disappear with pressure and appear when the pressure is stopped. Telangiectasias can exist independently and be included in the clinical picture of rosacea, scarring erythematosis, and some other skin diseases. Congenital include non-inflammatory vascular birthmarks (nevi).

With an increase in the permeability of the vascular walls, hemorrhage into the skin can occur, resulting in the formation of so-called hemorrhagic spots, not disappearing under pressure. Depending on the time elapsed after the hemorrhage, the color of such spots can be red, bluish-red, purple, green, yellow (as hemoglobin is converted into hemosiderin and hematoidin). These spots are distinguished by size: pinpoint hemorrhages are called petechiae, small round and usually multiple hemorrhages up to 1 cm - purple, large hemorrhages of irregular outlines - ecchymosis; in cases of massive hemorrhages with swelling of the skin and its elevation above the level of the surrounding areas, they speak of hematoma. Hemorrhagic spots occur with allergic skin vasculitis, scurbut (hypovitaminosis C), some infectious diseases (typhoid, rubella, scarlet fever, etc.).

With an increase or decrease in the content of melanin pigment in the skin, dyschromic spots, which are hyperpigmented (increased pigment) and depigmented (reduced pigment). Age spots can be congenital (moles, lentigo) and acquired (freckles, chloasma, vitiligo).

Freckles are classified as hyperpigmented spots (small areas of light brown, brown color, formed under the influence of

I eat ultraviolet rays), lentigo (foci of hyperpigmentation with symptoms of hyperkeratosis), chloasma (large areas of hyperpigmentation resulting from Addison's disease, hyperthyroidism, pregnancy, etc.).

Small depigmented patches are called leukoderma. True leukoderma occurs in patients with secondary recurrent syphilis (depigmented spots form on a hyperpigmented background). False, or secondary, leukoderma (pseudo-leukoderma) is observed at the site of former morphological elements (often spotty-scaly) in a number of dermatoses (pityriasis versicolor, psoriasis, etc.), when the surrounding areas of healthy skin have been exposed to ultraviolet radiation (tanning). In vitiligo, areas of various sizes are devoid of pigment, which is associated with neuroendocrine disorders and enzymatic dysfunction.

With a congenital absence of pigment in the skin with insufficient coloring of the eyebrows, eyelashes and hair on the head, they speak of albinism.

Nodule, or papule (papula) - a cavityless, more or less dense element, rising above the level of the skin and resolving without scarring or cicatricial atrophy (Fig. 5). Sometimes papules leave behind unstable marks - pigmentation or depigmentation. Papules that occur predominantly in the epidermis are called epidermal(e.g. flat wart) dermis - dermal(with secondary syphilis). Most often, papules have an epidermodermal location.(for example, with lichen planus, lichen scaly, neurodermatitis).

Papules are divided into inflammatory and non-inflammatory. The former are much more common: with lichen scaly, eczema, secondary syphilis, lichen planus and acute lichen, neurodermatitis, etc. With them, the formation of an inflammatory infiltrate in the papillary dermis, vasodilation and limited edema are noted. Pressure on the papule leads to its blanching, but its color does not completely disappear. For non-inflammatory papules growth of the epidermis (wart) or deposition in the dermis of pathological metabolic products

Rice. 5. knot (papula)

(xanthoma) or proliferation of dermal tissue (papilloma). Some dermatologists distinguish acute inflammatory papules (exudative papules in patients with eczema, dermatitis), resulting from the accumulation of exudate in the papillary dermis during acute expansion and increased permeability of the vessels of the superficial capillary network.

Papules come in various sizes: from 1 mm and larger. Papules with a size of 1 mm are called miliary (milium- millet grain), or lichen-nom (with lichen planus, with scrofulous lichen), size from 0.5 to 1 cm - lenticular (lenticula- lentils), they are with psoriasis, secondary syphilis, etc., size from 1 to 2 cm - nummulary (nummus- coin). Larger papules (hypertrophic papules) are found mainly in secondary recurrent syphilis (condylomas lata). Merged papules form plaques up to 10 cm in diameter. Papules usually have clear borders, but vary in shape (round, oval, flat, polygonal, umbilical-shaped, dome-shaped) with a smooth or rough surface. The consistency of the nodules (soft, doughy, densely elastic, dense, hard) and their color (normal skin color, yellow, pink, red, purple, prominent, brown, etc.) can also be varied.

On the contact surfaces of the skin due to friction, on the mucous membranes due to the irritating effect of saliva, secrets, foods, etc., the surface of the papules can be eroded (eroded papules), and the papules themselves can increase in size, hypertrophy. Nodules with a villous surface are called papillomas.

Histologically, with papules in the epidermis, there are phenomena of hyperkeratosis, granulosis, acanthosis, parakeratosis, in the papillary layer of the dermis - the deposition of various infiltrates.

Tubercle (tuberculum) - an infiltrative non-cavitary neo-inflammatory element, rising above the level of the skin, often ulcerating and ending in scarring or cicatricial atrophy (Fig. 6). In appearance, especially at the initial stage, it is difficult to distinguish from a nodule. So, the size, shape, surface, color and consistency of the tubercle and nodule may be similar. The inflammatory cellular infiltrate of the tubercles lies not only in the papillary, but mainly in the reticular layer of the dermis and histologically represents an infectious granuloma, which either ulcerates with subsequent scar formation, or undergoes resorption, leaving

after cicatricial atrophy. This is the main clinical difference between tubercles and nodules, which allows many years after the end of the process to differentiate, for example, tubercles in tertiary syphilis or tuberculous lupus (not only the existence of scars or atrophy is taken into account, but also their location, for example, mosaic scar in syphilis, bridges in tuberculosis lupus, etc.).

In some cases, the tubercles have a rather characteristic color: red-brown with tertiary syphilis, red-yellow with tuberculous lupus, brownish-rusty with leprosy.

In various diseases, tubercles have distinctive features of the histological structure. So, for example, a tubercle in skin tuberculosis consists mainly of epithelioid cells and a different number of giant cells - Langhans (rarely, Mycobacterium tuberculosis is found in the center; there are usually lymphocytes along the periphery); tubercle in syphilis consists of plasma cells, lymphocytes, epithelioid cells and fibroblasts(Treponemes are not found in the tubercle; there may be a small number of giant cells).

Tubercles, as a rule, occur in limited areas of the skin and either group or merge, forming a continuous infiltrate, much less often they are scattered, disseminated.

Node - primary morphological noncavitary infiltrative neoinflammatory element located in the subcutaneous adipose tissue, large in size - up to 2-3 cm or more (Fig. 7). Node originally

Rice. 6. tubercle (tuberculum)

Rice. 7. Knot (nodus)

Rice. eight. bubble (vesicula)

may not rise above the level of the skin (then it is determined by palpation), and then, as it grows, it begins to rise (often significantly) above the level of the skin. The nodes ulcerate and then scar. The consistency of the nodes is from soft (with collicative tuberculosis) to densely elastic (with leprosy and tertiary syphilis). The peculiarity of nodes in a number of diseases (appearance, color, shape, surface,

consistency, detachable) made it possible to adopt special names for them: scrofuloderma- with collicative tuberculosis, gumma- with tertiary syphilis.

Vesicle (Fig. 8) - the primary cavity exudative element, contains liquid and slightly rises above the level of the skin. In the vesicle, a cavity filled with serous, less often serous-hemorrhagic contents, a tire and a bottom are distinguished. Bubbles can be located under the stratum corneum, in the middle of the epidermis and between the epidermis and dermis; they can be single-chamber and sometimes multi-chamber (in this case, it seems that the patient has a bladder, but it does not have partitions). The bubble size is from 1 to 3-4 mm. The contents of the bubble can be transparent, serous, rarely bloody; often cloudy, becomes purulent. This occurs when the vesicle (vesicle) transforms into an abscess (pustule). The liquid of the bubble dries up into a crust or its cover bursts, an eroded surface is formed and weeping occurs, as with eczema in the acute stage. Vesicles may be located on intact skin, but more often have an inflammatory erythematous base. On the oral mucosa, on the contact surfaces of the skin, the bubbles quickly open, exposing the eroded surfaces; in places with a thicker tire (for example, on the palms with dyshidrosis), they last longer. The vesicles pass without a trace or leave behind temporary pigmentation, as, for example, in Dühring's herpetiform dermatosis.

When bubbles form, histologically observed spongiosis (eczema, dermatitis), ballooning degeneration (simple bubble

vyy and herpes zoster, chickenpox), intracellular vacuolization (dyshidrotic eczema, epidermophytosis).

Bubble (Fig. 9) - an exudative cavity element with a size of 1 cm or more. Like the vesicle, it consists of a tire, a cavity filled with serous contents, and a base. When the cavity is located under the stratum corneum, the bubble is called subcorneal, in the thickness of the spiny layer - intraepidermal, between the epidermis and dermis - subepidermal. The shape of the bubbles is round, hemispherical or oval; the contents are transparent, yellowish, less often hazy or hemorrhagic. The blisters fluid contains leukocytes, eosinophils, and epithelial cells. For the diagnosis of some dermatoses, a cytological examination of smears-prints or scrapings from the bottom of the bladder is important, since in a number of dermatoses the cellular composition has features.

On the contacting surfaces of the skin, as well as on the mucous membranes, the blisters quickly open, forming at the same time erosive surfaces with a side of the fragments (border) of the blisters.

Blisters occur with pemphigus vulgaris, congenital pemphigus, erythema multiforme exudative, burns, drug toxicoderma and some other skin diseases.

More often the bubble appears against the background of an erythematous spot, but it can also exist on apparently unaltered skin (in patients with pemphigus vulgaris).

With exogenous penetration of microorganisms into the skin, blisters can form due to damage to the epidermis by an infectious agent (for example, streptococci) or their toxins. With burns, serous exudate lifts the necrotic area of ​​the epidermis. The formation of intraepidermal blisters is often promoted by various endogenous factors; in this case, a violation of intercellular connections (acantholysis) and degenerative changes in epidermal cells are observed. In case of violation of the structure of the basement membrane, edematous fluid or exudate protruding from the vessels exfoliate

Rice. 9. Bubble (bulla)

the entire epidermis (epidermolysis) and subepidermal blisters occur, for example, with polymorphic exudative erythema. In pemphigus, the location of the blisters is intraepidermal (in the spinous layer), there are single or clustered acantholytic cells.

Bubbles can occur both on externally unaltered skin or mucous membranes, and against the background of inflammation. The mechanism of bubble formation is different. Intraepidermal blisters are usually formed as a result of acantholysis.

The essence of the process is the melting of intercellular bonds (acanthus), spiny cells are separated and gaps filled with exudate appear between them, which then turn into bubbles. At the same time, spiny cells are rounded, slightly reduced, their nuclei become larger than those of ordinary cells. They line the bottom of the bubble. These acantholytic cells (Tzank cells) are of great diagnostic value and confirm the diagnosis of pemphigus. Subepidermal blisters form between the layers of the basement membrane or directly above or below it and are the result of a violation of the strength of the connection of the fibers that form it, which is also possible as a result of immune changes.

Pustule, or pustule (pustula) (Fig. 10) - an exudative cavity element protruding above the level of the surrounding skin, containing pus. Under the influence of waste products of microorganisms (mainly staphylococci), necrosis of epithelial cells occurs, as a result of which an abscess cavity is formed in the epidermis. An abscess lying in the thickness of the epidermis and prone to crusting is called impetigo. After the crust falls off, temporary pigmentation of the affected area remains. Pustules located around the hair follicles are called folliculitis. If a pus penetrates into the mouth of the hair funnel, the center of the abscess penetrates the hair, is formed osteofolliculitis.

Folliculitis can be superficial, leaving no traces behind, and deep (the process captures the part of the follicle lying deep in the dermis), followed by the formation of a scar. The most common causative agent of folliculitis is staphylococcus aureus. A deep non-follicular abscess that also involves the dermis is called ecthyma. When it resolves, an ulcer is formed that heals with a scar. Streptococcus causes ecthyma. A streptococcal superficial pustule (flaccid, flat) is called conflict.

Pustules are always surrounded by a pink halo of inflammation. Sometimes pustules arise secondarily from vesicles and blisters when a secondary pyococcal infection occurs.

Blister (urtica) (Fig. 11) - exudative asexual element, formed as a result of limited acute inflammatory edema of the papillary layer of the skin. The blister is a dense, cushion-like, round or, less commonly, oval-shaped elevation and is accompanied by intense itching. A blister is an ephemeral formation, it usually quickly (from several tens of minutes to several hours) and disappears without a trace. The sizes of the blisters range from 1 to 10-12 cm. Due to the expansion of the vessels that occurs simultaneously with the swelling of the papillae, the color of the blisters is pale pink. With a sharp increase in edema, the vessels are compressed and then the blisters become paler than the skin.

Blisters can occur at the sites of mosquito bites, mosquitoes and other insects, from the action of heat, cold, when touching stinging nettles (external factors), with intoxication and sensitization (internal factors). Urticaria on the skin it happens with drug, food and infectious allergies (urticaria, angioedema angioedema, serum sickness); it can be caused by mechanical irritation of the affected areas of the skin, for example, with urticaria pigmentosa. In some cases, mechanical irritation of the skin causes large long-existing blisters. (urticaria factitia, or dermografismus urticaris).

Despite the intense itching that accompanies the rash of blisters, traces of scratching on the skin are usually not found in patients.

Rice. ten. abscess (pustula)

Rice. eleven. Blister (urtica)

4.6. Secondary morphological elements

Secondary morphological elements arise in the process of evolution of primary morphological elements. These include age spots, scales, crusts, superficial and deep cracks, abrasions, erosions, ulcers, scars, lichenification and vegetation.

Pigmentation (Fig. 12). Primary pigmentation includes freckles, chloasma, pigmented birthmarks, etc., secondary pigmentations include hyperpigmentation resulting from increased deposition of melanin pigment after resolution of primary (nodules, tubercles, vesicles, blisters, pustules) and secondary (erosions, ulcers) elements, and also due to the deposition of a blood pigment - hemo-siderin in the so-called hemosiderosis of the skin. Secondary hypopigmentations (Fig. 13) are associated with a decrease in the content of melanin in certain areas of the skin and are called secondary leukoderma. Secondary pigment spots repeat the size and shape of the elements in the place of which they formed.

Scale (squama) (Fig. 14) represents torn off horny plates. Under physiological conditions, there is a constant imperceptible rejection of the plates of the stratum corneum; the plates are removed by washing and rubbing with clothing. In a number of pathological conditions of the skin, scales are formed that are visible to the naked eye (pathological peeling). If, during peeling, small, tender scales appear that resemble flour or bran, then they are called bran-like, and peeling small plate; such peeling is observed, for example, with pityriasis versicolor. Larger scales are called lamellar, and peeling desquamatio lamelosa; such peeling occurs, for example, in psoriasis. In some skin diseases, for example, with erythroderma, in cases of scarlet fever-like dermatitis, the stratum corneum is rejected in large layers. For a number of dermatoses, such as ichthyosis, scales are one of the permanent objective symptoms.

For the diagnosis of processes with the formation of scales, their thickness, color, size, consistency (dry, oily, brittle, hard), and tightness are important. Scales that are tightly adjacent to the underlying tissues are formed as a result of hyperkeratosis, easily rejected scales - as a result of parakeratosis. Scales can also develop initially: parakeratotic with dandruff, mild leukoplakia, exfoliative cheilitis, hyperkeratotic with ichthyosis, etc.

Scales are formed, as a rule, due to parakeratosis (impaired horn formation), when there is no granular layer in the epidermis, and there are remnants of nuclei in the horny plates. Less often, peeling occurs as a result of hyperkeratosis, i.e. excessive development of ordinary horny cells or keratosis (layering of dense dry horny masses, for example, with corns).

Knowledge of the form of peeling and the type of scales helps in the diagnosis of a number of dermatoses. So, silvery-white scales are found in psoriasis, dark - in some forms of ichthyosis, yellow - in oily seborrhea, loose, easily removable - in psoriasis. Removal of the scales is sometimes painful due to the spike-like horny protrusions on the undersurface of the scales penetrating into the follicular openings of the skin (with lupus erythematosus). With pink lichen, the so-called corrugated and pleated scales, with syphilitic papules, they are collar-nose-shaped ("collar" Bietta), with parapsoriasis look like "wafers"(central peeling), with a number of fungal diseases occurs peripheral peeling etc.

Crust (Fig. 15) is formed as a result of drying on the skin of serous exudate, pus or blood

Rice. 12. Pigmentation (pigmentation)

Rice. 13. Hypopigmentation (hypopigmentatio)

Rice. fourteen. Flake (squama)

vi, sometimes with an admixture of particles of used drugs. There are serous, purulent, serous-purulent, purulent-hemorrhagic, etc. crusts. They are formed when vesicles, blisters, pustules dry out, with ulceration of tubercles, nodes, with necrosis and purulent fusion of deep pustules. Layered massive oyster-like crusts are called rupee (rupiah); while the upper part of the crust is the oldest and at the same time the smallest.

The color of the crusts depends on the discharge from which they are formed: with serous discharge, the crusts are transparent or yellowish, with purulent discharge - yellow or greenish-yellow, with bloody discharge - red or brownish. With a mixed discharge, the color of the crusts also changes accordingly.

Crusts often form on the red border of the lips (with pemphigus, exudative erythema multiforme, vesicular lichen, with various cheilitis, etc.). On the skin, crusts occur with scabies, mycoses, pyo-dermatitis, eczema, neurodermatitis, with various syphilides, etc.

Mixed layers on the skin, consisting of scales and crusts, are called scale-crusts; they are found in seborrhea, in some cases of exudative psoriasis.

Surface crack (fissura) is formed only within the epidermis and heals without leaving traces (Fig. 16).

Deep crack (rhagas), in addition to the epidermis, it captures part of the dermis, and sometimes more deeply lying tissues, leaving behind a scar.

Cracks - linear skin defects - are formed when the skin loses its elasticity as a result of inflammatory infiltration in places subject to stretching (for example, in the corners of the mouth, in the interdigital folds, over the joints, in the anus, etc.), with chronic eczema, intertriginous epidermophytosis of the feet , pyodermic or yeast lesions of the corners of the mouth (jamming), diaper rash, etc., as well as from stretching the skin with dryness of its stratum corneum. Deep cracks can be observed in early congenital syphilis. They are located around natural openings and bleed easily. Depending on the depth of occurrence, a serous or serous-bloody fluid is released from the cracks, which can dry out into crusts corresponding to the shape of the cracks.

Abrasion, or excoriation (excoriatio) (Fig. 17) - a skin defect resulting from scratching or any other traumatic injury. Scratching can lead to a violation of the integrity of not only the epidermis, but also the papillary layer of the dermis; in these cases, the scar is not formed.

With a deeper location of the abrasion, after its healing, a scar, pigmentation or depigmentation remains. Excoriations are an objective sign of intense itching. The location and shape of the scratches are sometimes helpful in diagnosis (for example, in scabies).

erosion (Fig. 18) - a superficial skin defect within the epidermis. Erosions occur after the opening of vesicles, blisters, pustules, and in size and shape repeat the primary cavity morphological elements that were in these areas. Most often, erosions are pink or red and have a moist, weeping surface. Large eroded surfaces of the skin and mucous membranes occur with pemphigus. Small erosions occur when the vesicles open in patients with eczema, vesicular and herpes zoster, dyshidrosis, dyshidrotic epidermophytosis of the feet. In the oral cavity, on the contact surfaces of the skin, eroded syphilitic papules often appear; hard chancre can also be in the form of erosion. Erosion heals without scar formation.

With prolonged existence of erosion on the mucous membrane of the mouth, its edges can swell and even infiltrate. In this case, it is difficult to distinguish erosion from an ulcer. Sometimes this issue is resolved after

Rice. fifteen. Crust (crusta)

Rice. 16. surface crack (fissure)

Rice. 17. Excoriation (excoriatio)

resolution of the element, since a scar always remains at the site of the ulcer. On the mucous membrane of the mouth and lips, less often on the skin, in some pathological processes, erosive surfaces are formed without a previous bubble, for example, erosive papules in syphilis, erosive-ulcerative form of lichen planus and lupus erythematosus. The formation of such erosions is actually the result of traumatization of an easily vulnerable inflamed mucous membrane or skin. As a result of injury, the integrity of the edematous, often macerated epithelium is disrupted.

Ulcer (Fig. 19) - a skin defect with damage to the epidermis, dermis, and sometimes deeper tissues. Ulcers develop from tubercles, nodes, when opening deep pustules. Only the so-called trophic ulcers are formed as a result of primary necrosis of apparently healthy tissues due to a violation of their trophism. Ulcers are round, oval, irregular in shape. The color of the surface of the ulcer is from bright red to bluish-congestive. The bottom can be smooth and uneven, covered with serous, purulent, bloody discharge, with scanty or lush granulations. The edges are smooth, undermined and corroded, flat and elevated, dense and soft.

With a purulent inflammatory process, the edges of the ulcer are edematous, soft, abundant purulent discharge and diffuse hyperemia around the ulcer are noted; with the decay of infectious granulomas (for example, gumma with syphilis), there is a dense limited infiltrate around the ulcer and congestive hyperemia along the periphery. With a dense infiltrate around the ulcer without inflammation, a neoplasm should be assumed.

Scar (cicatrix) (Fig. 20) is formed at the sites of deep skin defects as a result of their replacement with coarse, fibrous connective tissue. At the same time, the papillae of the skin are smoothed out, and the interpapillary epithelial outgrowths disappear; in this regard, the boundary between the epidermis and the dermis appears as a straight horizontal line. Skin pattern, follicular and sweat holes on the scar are absent. There are also no hair, sebaceous, sweat glands, blood vessels and elastic fibers in the scar tissue. The scar is formed either at the site of deep burns, cuts, ulceration of tubercles, nodes, deep pustules, or the so-called dry path, without previous ulceration, for example, with papulonecrotic tuberculosis of the skin or in some cases of tertiary tuberculous syphilis.

Fresh scars are red or pink, older ones are hyperpigmented or depigmented. The scar may be smooth or uneven. When an excessive amount of dense

fibrous tissue, hypertrophic scars appear, rising above the level of the skin; they bear the name keloid.

More tender connective tissue and in a smaller amount than with a scar, is formed during the so-called cicatricial atrophy. In this case, the skin in the area of ​​the affected area is significantly thinned, mostly devoid of a normal pattern, often sinks, i.e. is below the level of the surrounding skin (Fig. 21). Atrophy develops, as a rule, without previous ulceration of the lesion, those. "dry way" (with lupus erythematosus, scleroderma). Such skin, when squeezed between the fingers, gathers into thin folds like tissue paper.

In the diagnosis of a previously pathological process in a patient, the localization, shape, number, size and color of scars often help. So, syphilitic gumma leaves behind a deep retracted stellate scar, collicative tuberculosis of the skin - retracted uneven, irregularly shaped bridge-like scars in the region of the lymph nodes. The same scars on other parts of the skin can be caused not only by tuberculosis, but also by chronic deep pyoderma. Papulonecrotic tuberculosis of the skin leaves clearly defined, as if stamped

Rice. eighteen. Erosion (erosio)

Rice. 19. Ulcer (ulcus)

Rice. twenty. Scar (cicatrix)

Rice. 21. Atrophy (atrophy)

Rice. 22. Lichenification or lichenification (lichenisatio, lichenificatio)

Rice. 23. vegetation (vegetation)

bath superficial scars, tuberculous syphilis of the tertiary period of syphilis - variegated mosaic scars with scalloped outlines; in place of resolved rashes in lupus erythematosus, there remains a smooth, thin and shiny atrophy of the skin.

Lichenization, or lichenification (lichenisatio, lichenificatio) (Fig. 22) is a thickening, thickening of the skin with an increase in its normal pattern, hyperpigmentation, dryness, roughness, shagreenness. Lichenification develops either primarily, due to prolonged skin irritation during scratching (for example, in patients with neurodermatitis), or secondarily, when papular elements merge (for example, papules in psoriasis, lichen planus, chronic eczema, neurodermatitis - diffuse papular infiltration). With lichenification, hypertrophy of the spinous layer of the epidermis is observed with a significant increase in the interpapillary epithelial processes, which are embedded deep into the dermis (acanthosis phenomenon), as well as chronic inflammatory infiltration of the upper dermis in combination with elongation of the papillae.

Vegetations (vegetatio) (Fig. 23) are formed in the area of ​​a long-term inflammatory process as a result of increased

growths of the prickly layer of the epidermis and look like villi, papillae of the dermis. The vegetation surface is uneven, bumpy, resembling cockscombs. If the surface of the vegetation is covered with a thickened stratum corneum, then they are dry, hard and gray in color. If the vegetations are eroded, which is often the case with friction in the lesions, then they are soft, juicy, pink-red or red, bleed easily, separate serous or serous-bloody fluid. When a secondary infection is attached, soreness, a rim of hyperemia along the periphery, and a serous-purulent discharge appear.

Sexually transmitted diseases (STDs) are among the most common human infectious diseases. The lack of timely treatment entails very serious complications in the genital area, deterioration in general health and infertility. Therefore, it is very important to know about them and be able to recognize the symptoms in a timely manner.

These infections are mainly transmitted from person to person through sexual contact. The most common include gonorrhea, donovanosis, syphilis, genital herpes, bacterial vaginosis, gardnerellosis, candidiasis, trichomoniasis, trichomoniasis, chlamydia, urethritis and vaginitis of gonococcal (gonorrhea) and non-gonococcal (non-specific) nature. We will briefly consider skin and venereal diseases, the symptoms of some of them.

Gonorrhea

With this disease, men have yellowish-white discharge, pain and burning sensation during urination. Women also experience genital discharge, pain when urinating, and pain in the lower abdomen. Bleeding often occurs between periods. Sometimes the disease occurs with mild symptoms and is often mistaken for thrush.

Donovanose

At the very beginning of the disease, a reddish nodule the size of a pea is formed. As the disease progresses, the nodule transforms into a bright red sore with raised edges and a velvety surface. As the disease progresses, the ulcer increases in size.

Syphilis

Its symptoms depend on the stage of the sexually transmitted disease. At the first stage, at the site of infection, an ulcer with a dense base (hard chancre) occurs. The ulcer is painless. With the development of the disease, usually after 3 weeks, the lymph nodes closest to the site of infection increase. After that, all symptoms disappear, the ulcer is tightened by itself. After about 3-4 months, the second stage begins. A skin rash appears, quickly spreading over all surfaces of the body. There is a headache, the temperature rises. There is a widespread increase in lymph nodes, warts can form. At the third and fourth stages, there is a gradual destruction of all organs and systems of the human body.

Genital herpes

At the beginning of infection, swelling appears in the area of ​​infection, burning, itching, and pain occur. At the same time, the state of health worsens, the body temperature rises. After a few days, small itchy vesicles filled with a clear liquid form on the skin. Then they burst and painful sores appear in their place. They go away in about 10-14 days. Sometimes the disease is asymptomatic.

Bacterial vaginosis, gardnerellosis

With this disease, women develop a grayish-white discharge from the vagina. They have a very unpleasant smell, reminiscent of rotten fish. The discharge is not abundant, but it causes great discomfort.

Candidiasis

In women, there is itching, burning of the external genital organs. White curdled discharge appears. The disease is characterized by pain during sexual intercourse and urination.

Men also experience burning and itching in the penis area. His head turns red, covered with a whitish coating, puffiness appears. With candidiasis, a man experiences pain during intercourse and during urination.

Trichomoniasis, trichomoniasis

With this disease, women experience yellow discharge from the vagina, which has an unpleasant odor. At the same time, itching, slight swelling and redness of the external genital organs are felt. There are pain during intercourse and urination.

Men are less likely to feel pain and burning, but they also experience discharge from the penis. But often men do not feel any symptoms at all.

Chlamydia

A very insidious disease. In most cases, the disease is asymptomatic. Only a doctor can detect it.

General symptoms

Signs that characterize most of these diseases, in which you should immediately seek help from a specialist venereologist or gynecologist are: The appearance of unusual secretions from the genital organs, various growths on their mucous membrane. Incomprehensible skin rash, sores, sores, seals, as well as pain and burning during urination and sexual contact.

If you find one or more of the above signs of an STD, consult a doctor who will determine the disease and prescribe timely treatment.

You should not self-medicate. You can stifle the disease, get rid of the symptoms for a while, but the disease will continue to develop. Complete the full course of treatment prescribed by your doctor, do not interrupt it. Since after the relief of the condition, foci of infection may still be present.

Even if the symptoms of the disease have disappeared, complete the course prescribed for you, because. infection in the body may still be present. After a full course of treatment, you need to retake tests to confirm complete recovery. Both partners should be treated to prevent re-infection. Be sure to use a condom during sexual intercourse.