Why does recurrent herpes occur and how does it manifest itself. Treatment of chronic recurrent herpes. Circulatory system

Cleft lip and cleft palate diseases are one of the most common congenital pathologies that disfigure the face and cause many problems: speech therapy, dental, otorhinolaryngological, etc. that this ugliness is forever. But modern plastic surgery has made great progress in recent years in eliminating these seemingly fatal phenomena.

Features of diseases

"Wolf mouth" and "cleft lip" are congenital malformations of the face and mouth. These deviations are formed even in the womb, in the initial period of pregnancy. Deformities appear as a result of an unsatisfactory amount of tissue in the mouth and lips. The existing fibers in this case are spliced ​​incorrectly, giving the face specific, not very attractive features.

Many who are not familiar with these deformities often confuse them and consider them the same disease, calling it "wolf lip". However, these pathologies differ significantly from each other.

Cleft lip deformity

Congenital pathology "hare" lip is a cleft on each side of the upper lip. It is caused by physiological abnormalities. The defect is in the form of a narrow hole or gap in the skin. The cleft can not only be located on the upper lip, but also fill the nasal area, can affect the bone tissue of the jaw and upper gums.

Pathology "wolf mouth"

This deviation is a hole or cleft in the hard or soft palate. Such a defect of the oral part of the face, unfortunately, is observed quite often. The statistics of this pathology: There is one case of such an anomaly per one thousand newborn babies. Often the deviation is accompanied by a "cleft lip".

Currently, scientists have discovered three genes that, when mutated, contribute to the onset of this disease in humans. Research in this area is currently ongoing.

When it comes to the development of the "wolf mouth", then the splitting of the hard and soft palate can be complete and incomplete, that is, it can be one large or several small holes. This pathology very often proceeds along with a bifurcation of the tongue, which is located at the back of the soft palate, almost in the nasopharynx.

This comorbid defect occurs due to the unnatural connection of the medial and lateral process with the nasal septum.

It is this disease, according to statistics, that turns out to be one of the most frequently observed abnormalities in babies, which begins to form already in the womb and which is very difficult to predict or diagnose in advance - that is, before conception. So, unfortunately, it cannot be prevented. However, after the birth of a baby, modern plastic surgeons are quite capable of helping him.

The reason for the development of pathology

The formation of such a pathology explained by a genetic predisposition to such diseases. Often there are such deviations in the process of fetal development in a mother who has addictions:

• the use of alcoholic beverages;
• passion for intoxicating and narcotic drugs;
• smoking.

In addition, the cause of the baby's illness can be an acute deficiency in the mother's body of folic acid. The lack of this element is associated with the wrong way of life of a pregnant woman, a careless attitude to her position, an incorrect and irregular diet, obesity, and so on.

The listed reasons affect the development of pathology in the lower part of the face of the unborn baby, including in the region of the upper jaw.

Also, this pathology can cause unfavorable environment, in which the expectant mother was, acute infectious or toxicological diseases, and even mental trauma.

All of these reasons can cause a failure in the internal delicate and complex life support system in the mother's womb and lead to malformations of the baby.

Consequences of deformation

Such a pathology in children causes great difficulties and discomfort literally from the first day of their birth.

Consequences of the disease affect literally all areas of the life of the child and his family:

All these inconveniences and deviations in the normal functioning of the whole organism most often lead to the fact that children with such pathologies have an insufficient quality of life, and often, if the problem has not been resolved in a timely manner, they feel inferior, have low self-esteem and, as a result, often are antisocial, aggressive, unsuccessful people.

Symptomatic manifestations

Children who have this pathology, due to the disturbed natural process, face the following difficulties:

• incorrect pronunciation and formation of sounds:
• difficulties in mastering the work of the speech apparatus as a whole,
• development of rhinolalia.

Rhinolalia is characterized by a change in the timbre of the voice and the nature of the pronunciation of sounds. This is due to improper closure of the pharynx and palate.

On top of that, along with the inhaled air, food and drinks can enter the nose and through the nose back into the mouth. Fluid can also enter the Eustachian tube, sometimes causing otitis media and sinusitis. In addition, in this case, the bite and teeth are deformed, which disrupts the process of chewing food.

Medical care for cleft palate

Pathology "cleft palate" in children can be almost without consequences adjusted if parents contact the relevant specialists in a timely manner. The success of treatment in most cases depends not only and not so much on doctors, but on the perseverance, patience and perseverance of those who deal with the baby. To achieve success, you should steadily adhere to all the advice and recommendations of your doctor. It is also necessary to show the child to a conventional or plastic surgeon as soon as possible so that he can assess the severity of the pathology and draw up a plan for the upcoming correction.

Disease detection

Pathology can be detected in advance, already at the 14-15th week of pregnancy during screening. However, it is impossible to fully assess the shape and extent of the lesion. These subtleties can be seen only after the birth of the baby. The diagnosis of "wolf palate" is made immediately after the birth of the child. The degree and depth of the lesion is determined by the examination of the newborn.

If a specialist has discovered the presence of a cleft in the womb characteristic of the disease, then the mother has additional time to prepare for future therapy. First, additional research methods will be needed. Secondly, you need to be prepared to visit specialists responsible for the development of the cranium, breathing, impaired smell and hearing.

Correction methods

Treatment of this pathology is exclusively surgical. Be sure to carry out several preliminary cosmetic surgeries. First, uranoplasty is performed, during which the soft palate is lengthened, and its muscle tissue is connected in the right direction, and then the middle part of the pharynx narrows.

If the operation was performed in infancy, then the process of feeding the newborn in the usual way after surgery is practically impossible - the children have severe pain, there is a likely risk of rough scars and a slowdown in wound healing. Therefore, it will be necessary to first teach the child to eat using a special spoon for feeding.

With incomplete cleft palate and the correct shape of the teeth in the upper jaw, uranoplasty is recommended from the age of two. If there is a violation of the integrity of the process of the alveoli, as well as a narrowing of the upper jaw, then you must first undergo treatment with an orthodontist. Uranoplasty in this case should be carried out no earlier than 4-6 years.

In rare cases, the palate is formed in the form of bilateral depressions, which are accompanied by tissue defects. In this case, it is first of all recommended to perform plastic surgery of the hard and soft palate in order to narrow the middle body of the pharynx to the required size. Six months later, an operation is performed to close the splitting of the hard palate, its anterior section, as well as the process of the alveoli. Simultaneously with the same operation, bone grafting is also performed.

Caring for a child with a "cleft palate"

The baby will need special care, as pathology entails a number of problems that complicate his life.

Difficulty in eating

With a crack in the sky food and liquid can pass through the nose back into the mouth. To avoid this, use specially designed dishes. Sometimes babies are temporarily fitted with an artificial sky. It is used before surgery to make it easier for the baby to eat.

Deafness and ear infections

Patients have a tendency to the appearance and accumulation of fluid in the middle ear. In this regard, they very often develop diseases of the hearing aid, sometimes babies are completely deprived of the opportunity to hear. To prevent such complications, special tubes are placed on the eardrums to drain fluid. Examination of the level and quality of hearing in children with pathology is required to be carried out at least once or twice a year.

Speech problems

With such a diagnosis the speaker's voice often sounds ugly and unintelligible, with a deep overtone that is uncharacteristic of ordinary oral speech, which greatly complicates the communication of such children not only with peers, but also with adults. It also contributes to the development of an inferiority complex and low self-esteem. This problem can be prevented if surgery is carried out before the onset of active socialization of the child and in the future to seek help from a speech therapist.

Tooth defects

Cleft lip and palate contribute to the formation of caries on the teeth, as well as their displacement or curvature. Such deviations also interfere with the proper development of the speech apparatus in children with similar pathologies and the production of literate speech.

All these difficulties can be corrected through the intervention of appropriate specialists: a surgeon, an orthodontist, a dentist, a speech therapist and a psychologist.

Complaints of burning and pain in the mouth when eating, talking. Objectively, single rashes or a group of closely spaced small vesicles are detected on the red border of the lips, the skin of the lips, on the wings of the nose, the anterior palate, the tip of the tongue, the genitals and the mucous membrane of the eyes. Lips and oral mucosa are favorite for the localization of herpes, especially places that are normally keratinized. On the first day of the disease, areas of hyperemia or diffuse hyperemia appear on the oral mucosa, against which white small-focus spots form. On the periphery of these spots, spider veins are observed. Against the background of the hyperemic mucosa, whitish areas are clearly contoured, turning into necrotic foci, tightly soldered to the underlying tissues. The rim of hyperemia surrounds the necrotic area and is the demarcation line. In the next 2-3 days. blanching of the corolla of hyperemia is observed and erosion is formed due to maceration of the damaged area.
Often, the development of erosion occurs without a preliminary phase of hyperemia. A white focus appeared on the pale pink mucosa without signs of inflammation around and at the base, followed by the formation of erosion located on the visually unchanged mucosa. Bubbles are located on the upper and lower lips, single or in groups containing a clear liquid, with time the contents of the bubbles darken. Bubbles can merge into large blisters up to 1.5 cm in diameter, which burst easily, the contents shrink into yellow-gray crusts. Quite often bubbles are opened with formation of erosion of bright red color with uneven edges. The mucous membrane of the oral cavity is edematous, hyperemic, the vesicles on the mucosa open in the first hours after the appearance, erosion in their place has an irregular scalloped shape, covered with a fibrinous film. With a severe degree of the disease, malaise, muscle pain, chills, and a temperature of 38-39 ° C appear. The number of relapses per year depends on the resistance of the organism.
DIFFERENTIAL DIAGNOSIS
Manifestations in the oral cavity with herpes simplex should be differentiated:
with chronic recurrent aphthous stomatitis (CRAS). The lesion element in both cases is aphthae, however, in CRAS, aphthae are solitary, rounded, covered with fibrinous plaque, surrounded by a hyperemic narrow corolla, while the rest of the oral mucosa is pale pink in color, without pathological changes. The general condition of the patient does not suffer. With herpes simplex, the body temperature rises to 38-39 ° C, aphthae are multiple and located on hyperemic edematous mucosa, merge, have uneven scalloped contours, polymorphism of rashes is observed, simultaneously in the oral cavity and on the red border of the lips, the skin around the mouth can be identified blisters, erosion, ulcers, crusts, cracks and scales;
with erythema multiforme exudative (MEE), clinically very similar to acute herpetic stomatitis. However, it should be noted that the MEE makes itself felt mainly in spring and autumn. The disease occurs acutely, it is extremely difficult. Clinically, a generalized lesion of the oral mucosa, total hyperemia, edema, and true polymorphism of the elements of the lesion are detected: large blisters, erosions and ulcers, erythema, massive hemorrhagic crusts on the red border of the lips, cracks. The general condition suffers, high temperature up to 40 ° C, chills, multiple bluish spots (cockades) on the skin of the hands, lower legs, forearms, often with a bubble in the center. With herpes simplex, the general condition also suffers, the body temperature is 37-38 C. Due to the neurotropic nature of the virus, patients experience severe weakness, headache, malaise, adynamia, apathy, nausea and vomiting. The mucous membrane of the oral cavity is edematous, hyperemic, the gums bleed when touched, have a barrel-shaped configuration, erosions, ulcers, crusts on the red border of the lips and the skin around the lips are determined on the mucous membrane of the cheeks, palate, tongue. Bubbles can be found on the mucous membrane of the hard palate, the red border of the lips and the skin around the lips;
with pemphigus vulgaris, which is characterized by the presence of large clean erosions on the oral mucosa, slightly painful, located on a visually healthy mucosa. Positive sign of Nikolsky. Imprint smears show Tzank cells. With herpes simplex, the general condition suffers. Due to the neurotropic nature of the virus, patients experience severe weakness, headache, malaise, lethargy, apathy, nausea and vomiting. The mucous membrane of the oral cavity is edematous, hyperemic, the gums bleed when touched, have a barrel-shaped configuration, painful erosions and ulcers, crusts on the red border of the lips and the skin around the lips are determined on the mucous membrane of the cheeks, palate, tongue. Bubbles can be found on the mucous membrane of the hard palate, the red border of the lips and the skin around the lips;
with drug-induced allergic stomatitis, which is characterized by total hyperemia and swelling of the oral mucosa, multiple sharply painful erosions, pain when opening the mouth and talking. From the anamnesis, the drug intake is revealed the day before;
with shingles. The latter is characterized by unilateral eruptions of vesicles on the skin of the face along the branches of the trigeminal nerve, which does not happen with herpes simplex. The mucous membrane of the oral cavity is hyperemic with multiple painful erosions. The appearance of elements on the mucous membrane and skin is accompanied by radiating neuralgic pain.
TREATMENT
Treatment of herpes simplex is complex (general and local).
General treatment is reduced to the following procedures:

1. A high-calorie diet, plenty of fluids are prescribed.
2. Antiviral drugs - rimantadine 0.05 g 3 times a day for 5-10 days; bonafton 0.1 g 3 times a day for 5-10 days.
3. Desensitizing therapy - diphenhydramine, suprastin, pipolfen, diprazine, diazolin, tavegil, phenkarol, etc. Autohemotherapy from 3-5 to 9 ml every other day, intramuscularly, a course of 7 injections. Gives a pronounced hyposensitizing and stimulating effect.
4. General strengthening therapy - vitamin C up to 2.0 g per day, calcium preparations (calcium gluconate, glycerophosphate

1. Sedatives and tranquilizers are used according to indications, more often by middle-aged and elderly people with moderate and severe degrees of the disease - valerian tincture, Pavlov's, Kvater's, Sukhinin's mixtures, motherwort tincture, etc.
2. Sodium salicylate 0.5 g 4 times a day for 5-10 days is used as an analgesic, antipyretic and anti-inflammatory agent in moderate and severe degrees of the disease. In the first days, it is necessary, since the drug also has a desensitizing effect.
3. Gamma globulin or histaglobin are prescribed 2 ml intramuscularly 2 times a week, for a course of 3-7 injections, to increase the body's defenses. Immunal 5-25 drops 3 times a day for 3 weeks.
4. Intramuscularly or subcutaneously, 1 ml of a 0.005% solution of prodigiosan is injected 1 time in 4-7 days, for a course of 3-4 injections. The drug has an interferon effect, has a nonspecific stimulating effect, stimulates the phagocytic activity of RES, increases the content of globulin in the blood serum, reduces the exudative component of the inflammatory reaction, promotes regenerative processes.
5. Lysozyme 150 mg 2 times a day intramuscularly, for a course of treatment 15-20 injections. The contents of the vial are dissolved in isotonic solution or 0.5% novocaine solution.

1. Isolation of a patient with a viral disease from the team, even with a mild degree of the disease. This is especially true for employees of kindergartens and nurseries, they should not be allowed to work with children.
2. Elimination of chronic foci of infection.
3. Preventive use of antiviral ointments during an influenza epidemic by burying in the nose 1-2 times a day. Inside bonafton, rimantadine 1 tablet 2 times a day for 5 days.
4. In an influenza epidemic, it is mandatory to take desensitizing drugs - suprastin, diphenhydramine, pipolfen, phencarol, etc. (one single dose per day, prophylactic course no more than 5 days), also vitamin C up to 2.0 g per day.
5. A herpetic polio vaccine is used 0.1-0.2 ml intramuscularly 2 times a week, for a course of treatment 10 injections. Preventive course 0.3 ml 5 injections; with an interval of 7-10 days, the 2nd cycle of preventive treatment is carried out.

1. I group - nucleoside analogues, similar in structure to the intermediate products of DNA and RNA biosynthesis, which are capable of interfering with the reproduction of viruses.
2. I group - substances with virucidal properties.
3. I group - drugs with interferon-inducing activity.

and interferon-inducing activity, is administered intramuscularly at 250 mg (4-6 mg per 1 kg of body weight). The course of treatment is 5-7 injections with an interval of 48 hours between injections.
Remantadine - a-methyl-1-adamantylmethylamine hydrochloride. On the first day, the drug is prescribed 100 mg (2 tablets) 3 times a day, then 2 tablets 2 times a day. The course of treatment is 5 days. On the first day of the disease, you can use 3 tablets 2 times a day or 6 tablets at a time.
Helepin is an antiviral drug of plant origin, 1 tablet 3 times a day, the course of treatment is 10 days.

Herpes simplex usually manifests itself in two forms: acute herpetic stomatitis or acute aphthous stomatitis and chronic recurrent herpes or chronic recurrent herpetic stomatitis.

Acute herpetic stomatitis

It is considered as a manifestation of primary infection with the herpes simplex virus in the oral cavity. Therefore, children and young people often get sick. The disease is contagious to persons not previously infected with the virus. The causative agent of herpes is characterized by dermatoneurotropism, it has a pronounced relationship to the skin, mucous membranes and nervous tissue.

In the first 6 months after birth, herpes practically does not occur, which, according to most researchers, is due to the presence of anti-herpetic antibodies in the child's blood during this period, transplacetally transferred to him from the mother.

The course of the disease is acute, there is a high temperature, a violation of the general condition, increased ESR, leukopenia or leukocytosis. In the pathogenesis of the disease, 4 periods are distinguished:

• premonitory;
• catarrhal;
• rash period;
• extinction of the disease.

1. prodromal period manifested by a burning sensation, tingling, itching, a feeling of tension, soreness and numbness in places where a rash will appear on the skin and mucous membranes. There is loss of appetite, poor sleep, malaise.

2. catarrhal period characterized by hyperemia and swelling of the oral mucosa and gingival margin. Patients may complain of discomfort in the oral cavity when eating.

3. During the rash single or multiple lesions of the oral mucosa appear: spot, vesicle, blister and erosion. The area of ​​damage to the oral mucosa is associated with the severity of the disease. stand out three degrees of severity of acute herpetic stomatitis- light, medium and heavy.

mild severity diseases usually with no symptoms of intoxication of the body, however, with a satisfactory general condition, there may be subfebrile temperature. The oral mucosa is edematous, hyperemic, the gums bleed, in its various parts appear almost simultaneously single or grouped small aphthae. Aphthae quickly epithelialize, there are usually no new rashes.

Moderate severity the disease proceeds with severe intoxication, in the prodromal period there are malaise, weakness, headache, nausea, appetite disappears, body temperature is 38.5 ° C. Enlarged submandibular lymph nodes, less often chin and cervical, they are painful on palpation. The mucous membrane of the oral cavity is edematous, hyperemic, the saliva is viscous and viscous, the gums bleed, the papillae are edematous, hyperemic. In various parts of the mucous membrane, single or grouped aphthae. Elevated ESR, leukocytosis, but more often leukopenia.

Severe disease already in the prodromal period, it is characterized by the presence of all signs of an infectious disease - apathy, weakness, headache, nausea, vomiting, since the herpes virus is encephalotropic. Body temperature 39-40°C. The oral mucosa is edematous, hyperemic, covered with a large number of aphthous elements that recur. Lips, buccal mucosa, soft and hard palate, tongue, gingival margin are affected. With insufficient care for the oral cavity, catarrhal gingivitis turns into ulcerative. In the blood, leukopenia is determined, the number of stab neutrophils increases, eosinophilia, elevated ESR. Protein is determined in the urine. The reaction of saliva is acidic, pH=5.8-6.4.

Acute herpetic stomatitis among non-immune individuals is highly contagious. So, in kindergartens, nurseries, in hospital children's wards, during an epidemic outbreak, up to 3/4 of children can get sick.

4. The period of extinction of the disease characterized by an improvement in the general condition, epithelialization of aphthae.

Chronic recurrent herpes

Complaints of burning and pain in the mouth when eating, talking. Objectively, single rashes or a group of closely spaced small vesicles are detected on the red border of the lips, the skin of the lips, on the wings of the nose, the anterior palate, the tip of the tongue, the genitals and the mucous membrane of the eyes. Lips and oral mucosa are favorite for the localization of herpes, especially places that are normally keratinized. On the first day of the disease, areas of hyperemia or diffuse hyperemia appear on the oral mucosa, against which white small-focus spots form. On the periphery of these spots, spider veins are observed. Against the background of the hyperemic mucosa, whitish areas are clearly contoured, turning into necrotic foci, tightly soldered to the underlying tissues. The rim of hyperemia surrounds the necrotic area and is the demarcation line. In the next 2-3 days. blanching of the corolla of hyperemia is observed and erosion is formed due to maceration of the damaged area.

Often, the development of erosion occurs without a preliminary phase of hyperemia. A white focus appeared on the pale pink mucosa without signs of inflammation around and at the base, followed by the formation of erosion located on the visually unchanged mucosa. Bubbles are located on the upper and lower lips, single or in groups containing a clear liquid, with time the contents of the bubbles darken. Bubbles can merge into large blisters up to 1.5 cm in diameter, which burst easily, the contents shrink into yellow-gray crusts. Quite often bubbles are opened with formation of erosion of bright red color with uneven edges. The mucous membrane of the oral cavity is edematous, hyperemic, the vesicles on the mucosa open in the first hours after the appearance, erosion in their place has an irregular scalloped shape, covered with a fibrinous film. With a severe degree of the disease, malaise, muscle pain, chills, and a temperature of 38-39 ° C appear. The number of relapses per year depends on the resistance of the organism.

Differential diagnosis of herpes

Manifestations in the oral cavity with herpes simplex should be differentiated:

With chronic recurrent aphthous stomatitis (CRAS). The lesion element in both cases is aphthae, however, in CRAS, aphthae are solitary, rounded, covered with fibrinous plaque, surrounded by a hyperemic narrow corolla, while the rest of the oral mucosa is pale pink in color, without pathological changes. The general condition of the patient does not suffer. With herpes simplex, the body temperature rises to 38-39 ° C, aphthae are multiple and located on hyperemic edematous mucosa, merge, have uneven scalloped contours, polymorphism of rashes is observed, simultaneously in the oral cavity and on the red border of the lips, the skin around the mouth can be identified blisters, erosion, ulcers, crusts, cracks and scales;

With erythema multiforme exudative (MEE), clinically very similar to acute herpetic stomatitis. However, it should be noted that the MEE makes itself felt mainly in spring and autumn. The disease occurs ospho, proceeds extremely hard. Clinically, a generalized lesion of the oral mucosa, total hyperemia, edema, and true polymorphism of the elements of the lesion are detected: large blisters, erosions and ulcers, erythema, massive hemorrhagic crusts on the red border of the lips, cracks. The general condition suffers, high temperature up to 40 ° C, chills, multiple bluish spots (cockades) on the skin of the hands, lower legs, forearms, often with a bubble in the center. With herpes simplex, the general condition also suffers, the body temperature is 37-38 ° C. Due to the neurotropic nature of the virus, patients experience severe weakness, headache, malaise, lethargy, apathy, nausea and vomiting. The mucous membrane of the oral cavity is edematous, hyperemic, the gums bleed when touched, have a barrel-shaped configuration, erosions, ulcers, crusts on the red border of the lips and the skin around the lips are determined on the mucous membrane of the cheeks, palate, tongue. Bubbles can be found on the mucous membrane of the hard palate, the red border of the lips and the skin around the lips;

With pemphigus vulgaris, which is characterized by the presence of large clean erosions on the mucous membrane of the oral cavity, painless, located on a visually healthy mucosa. Positive sign of Nikolsky. Imprint smears show Tzank cells. With herpes simplex, the general condition suffers. Due to the neurotropic nature of the virus, patients experience severe weakness, headache, malaise, lethargy, apathy, nausea and vomiting. The mucous membrane of the oral cavity is edematous, hyperemic, the gums bleed when touched, have a barrel-shaped configuration, painful erosions and ulcers, crusts on the red border of the lips and the skin around the lips are determined on the mucous membrane of the cheeks, palate, tongue. Bubbles can be found on the mucous membrane of the hard palate, the red border of the lips and the skin around the lips;

With drug-induced allergic stomatitis, which is characterized by total hyperemia and swelling of the oral mucosa, multiple sharply painful erosions, pain when opening the mouth and talking. From the anamnesis, the drug intake is revealed the day before;

With shingles. The latter is characterized by unilateral eruptions of vesicles on the skin of the face along the branches of the trigeminal nerve, which does not happen with herpes simplex. The mucous membrane of the oral cavity is hyperemic with multiple painful erosions. The appearance of elements on the mucous membrane and skin is accompanied by radiating neuralgic pain.

Herpes treatment

Treatment of herpes simplex is complex (general and local). General treatment is reduced to the following procedures:

1. A high-calorie diet, plenty of fluids are prescribed.

2. Antiviral drugs - rimantadine 0.05 g 3 times a day for 5-10 days; bonafton 0.1 g 3 times a day for 5-10 days.

3. Desensitizing therapy - diphenhydramine, suprastin, pipolfen, diprazine, diazolin, tavegil, phencarol, etc. Autohemotherapy from 3-5 to 9 ml every other day, intramuscularly, a course of 7 injections. Gives a pronounced hyposensitizing and stimulating effect.

4. General strengthening therapy - vitamin C up to 2.0 g per day, calcium preparations (calcium gluconate, calcium glycerophosphate, calcium lactate, calcium chloride), agents that increase the body's natural resistance - aralia, eleutherococcus, ginseng.

5. Sedatives and tranquilizers are used according to indications, more often by middle-aged and elderly people with moderate and severe degrees of the disease - valerian tincture, Pavlov's, Quater's, Sukhinin's mixtures, motherwort tincture, etc.

6. Sodium salicylate 0.5 g 4 times a day for 5-10 days is used as an analgesic, antipyretic and anti-inflammatory agent in moderate and severe degrees of the disease. In the first days, it is necessary, since the drug also has a desensitizing effect.

7. Gamma globulin or histaglobin are prescribed 2 ml intramuscularly 2 times a week, for a course of 3-7 injections, to increase the body's defenses. Immunal 5-25 drops 3 times a day for 3 weeks.

8. Intramuscularly or subcutaneously, 1 ml of a 0.005% solution of prodigiosan is injected 1 time in 4-7 days, for a course of 3-4 injections. The drug has an interferon effect, has a nonspecific stimulating effect, stimulates the phagocytic activity of RES, increases the content of globulin in the blood serum, reduces the exudative component of the inflammatory reaction, promotes regenerative processes.

9. Lysozyme 150 mg 2 times a day intramuscularly, for a course of treatment 15-20 injections. The contents of the vial are dissolved in isotonic solution or 0.5% novocaine solution.

Local treatment of herpetic diseases includes the following steps.

After examining the patient and making a diagnosis, it is necessary to anesthetize and carry out antiseptic treatment of the oral mucosa with warm antiseptics: 0.5-1% trimecaine solution, 4% pyromecaine solution (in pediatric practice - pyromecaine on glucose), novocaine with urotropine, anesthetic emulsion 5-10%, lidocaine 10% spray, 0.02% furacilin solution, 0.02% ethacridine lactate solution, 0.01% dimexide solution, 0.1% atonium solution, etc. It is possible to use an antiseptic together with an anesthetic in a ratio of 1: 1, the solution is prepared before use. It is used in the form of irrigation, baths, applications 3-4 times a day.

Applications of proteolytic enzymes are applied once a day, for 15 minutes. It is recommended to use trypsin, chymotrypsin, chymopsin, lysozyme, pancreatin, deoxyribonuclease, which has not only a cleansing action from necrotic masses, but also an antiviral effect.

Applications of antiviral ointments are used, 3-4 times a day, for 20 minutes. It is recommended to use 1% florenal ointment, 0.5% tebrofen ointment, 0.25-1% rhyodoxol and 1-2% oxolin ointment, as well as 3% gossypol liniment, 0.1% gossypol solution, 0.5% bonafton ointments and 5% interferon ointment, zovirax, acyclovir.

From the 4th day of the disease, or rather from the moment of epithelization of erosions, applications of keratoplastic preparations are prescribed, 2-3 times a day, for 20 minutes: vitamin A in oil, vitamin E in oil, Shostakovsky's balm, Tezan's emulsion, aloe juice and juice Kalanchoe, carotelin, rosehip oil and sea buckthorn oil. It is appropriate to use keratoplastic agents included in various aerosols - livian, levovinizole, olasol, hyposol and others.

A great effect was obtained when using applications on the oral mucosa of agents that stimulate local immunity (1% sodium nucleinate solution, 5% methyluracil ointment, 10% methyluracil emulsion, 10% galascorbin solution) for 15-20 minutes 3-4 times a day, The course of treatment for each patient is individual.

Physiotherapy is prescribed from the first day of the disease: irradiation with a helium-neon laser or ultraviolet. Blood ultraviolet radiation and hyperbaric oxygenation are very effective.

Prevention of viral diseases

1. Isolation of a patient with a viral disease from the team, even with a mild degree of the disease. This is especially true for employees of kindergartens and nurseries, they should not be allowed to work with children.

2. Elimination of chronic foci of infection.

3. Prophylactic use of antiviral ointments during the influenza epidemic by inserting into the nose 1-2 times a day. Inside bonafton, rimantadine 1 tablet 2 times a day for 5 days.

4. In an influenza epidemic, it is mandatory to take desensitizing drugs - suprastin, diphenhydramine, pipolfen, phencarol, etc. (one single dose per day, prophylactic course no more than 5 days), also vitamin C up to 2.0 g per day.

5. A herpetic polio vaccine is used 0.1-0.2 ml intramuscularly 2 times a week, 10 injections per course of treatment. Preventive course - 0.3 ml 5 injections; with an interval of 7-10 days, the 2nd cycle of preventive treatment is carried out.

Antivirals

All known chemotherapy drugs with high antiherpetic activity can be divided into 3 groups:

Group 1 - nucleoside analogs, similar in structure to the intermediate products of DNA and RNA biosynthesis, which are capable of interfering with the reproduction of viruses.

Group 2 - substances with virucidal properties.

Group 3 - drugs with interferon-inducing activity.

Synthetic drug iododesoxyuridine (IDU), first described by R. Prusoff. The mechanism of action of IDU is associated with the ability to integrate into the structure of DNA, which leads to the formation of defective DNA. The drug is used in the form of a 0.1% solution and 0.5% ointment. IDU activity can be enhanced by dissolving in dimethyl sulfoxide. Eye films with IDU allow you to get a prolonged effect of the drug.

Florenal- bisulfite compound of 2-fluorenonylglyoxal. It has a high antiviral activity, completely inhibits the growth of HSV. The virus inhibitory effect is due to the suppression of protein synthesis of the polymerase complex. It is used in the form of 0.25%, 0.5%, 1% ointment or collagen films.

Tebrofen- 3, 5, 31, 51 tetrabromo - 2, 4, 21.41 tetraoxydiphenyl is used as a 0.5%, 1% ointment. Applications are applied 15-20 minutes after eating and treating the teeth and oral mucosa with proteolytic enzymes. Already on the second day, a decrease in mucosal hyperemia was observed. In the initial stage of the disease, tingling, pain in the lesion quickly stopped, further transporation of the elements stopped, and the formation of new foci stopped. In the advanced stage of the disease, there was a rapid cleansing of aphthae from fibrinous plaque, pain decreased, the rim of hyperemia disappeared, and a rim of epithelization appeared. Rapid healing of aphthae was noted, on the 3rd-4th day the foci were covered with crusts, which were rejected after 5-7 days.

Gossypol- natural polyphenol, which is a specific pigment of cotton, is used in the form of 0.5%, 0.1%, 0.05% and 3% ointment, in the form of 3% liniment and irrigation with a 0.1% solution. The drug has a high antiviral activity, inhibits the growth of HSV.

Bonafton-b-bromonaphthoquinone-1,2 applied internally in three 5-day cycles, with 1-2 day breaks or two 10-day cycles with 3-5 day intervals. Single dose 50-100 mg, daily 150-300 mg.

Acyclovir (zovirax) 5% ointment is 160 times more active against HSV than tebrofen, florenal and other antiviral drugs. An increase in the therapeutic effect was noted when acyclovir was combined with corticosteroids.

A new direction in the treatment of herpes is the introduction of endogenous interferon inducers into the practice of therapeutic dentistry. It has been established that in patients with recurrent herpes, the process of interferon formation is significantly reduced compared to healthy people. Of the large number of potential interferonogens studied, the following drugs proved to be the most promising.

Megasyn- gossypol-P-aminoethyl sulfate sodium. It is a synthetic analog of gossypol, a natural polyphenol (a specific cotton pigment) and is obtained by the condensation of gossypol with 3-aminoethyl sulphate sodium. It is used as a 3% ointment.

Poludan- the drug belongs to the group of synthetic double-stranded polynucleotide complexes, is a highly active interferon inducer. It is used in the form of applications 3-4 times a day, diluted 200 mcg in 2 ml of distilled water.

Interferon- has an exceptionally wide spectrum of antiviral activity, lack of toxicity, extremely weak antigenicity. Improvement in the condition of patients occurs from the first days of interferon use, and the recovery time is shortened by 3-4 times compared with other methods of treatment.

Neovir- antiviral, antibacterial and immunomodulatory agent. The drug has a virocidal effect against DNA and RNA genomic viruses and interferon-inducing activity, it is administered intramuscularly at 250 mg (4-6 mg per 1 kg of body weight). The course of treatment is 5-7 injections with an interval of 48 hours between injections.

Remantadine- amethyl-1-adamantylmethylamine hydrochloride. On the first day, the drug is prescribed 100 mg (2 tablets) 3 times a day, then 2 tablets 2 times a day. The course of treatment is 5 days. On the first day of the disease, you can use 3 tablets 2 times a day or 6 tablets at a time.

Khelepin- an antiviral drug of plant origin, 1 tablet 3 times a day, the course of treatment is 10 days.

Chronic recurrent herpes(herpes chronicus recidivans) is the most common form of endogenous infection caused by herpes simplex.
Appears at any age in people previously infected with the herpes simplex virus and have antiviral antibodies. In the pathogenesis of recurrent herpes, the main role belongs to factors that reduce cellular immunity, such as hypothermia, viral infections, pneumonia, chronic stress, severe general diseases (leukemia, cancer, etc.).

In women, exacerbation of chronic herpes is often associated with the menstrual cycle. Local factors contributing to the occurrence of an exacerbation include trauma, increased insolation, and drying of the red border of the lips. Relapses can occur with different frequency, at different times of the year and do not have seasonality. In some patients, relapses occur 1-2 times a year; in others 3-4 times a month - the disease becomes permanent.

clinical picture. The recurrence of chronic herpetic infection is characterized by rashes of single or groups of vesicles with a diameter of 1-2 mm on the hyperemic mucosa. The process usually begins with a burning sensation, itching, and sometimes mild soreness at the site of future rashes. Then there is a slight hyperemia and swelling of the mucous membrane, against which small grouped vesicles appear. They open very quickly, resulting in the formation of bright red painful erosions of irregular shape with small scalloped outlines due to the fusion of bubbles and separate small erosions around.

Erosions are then covered with a white-yellow fibrinous coating, on the red border of the lips and skin - with hemorrhagic crusts. Healing occurs on the 8-10th day without scar formation. Most often, vesicles appear on the red border of the lips in the area of ​​\u200b\u200bthe border with the skin (herpes labialis), anterior sections of the hard palate, back of the tongue, cheeks, wings of the nose (herpes nasalis), less often on the skin of the buttocks, in the sacrum, on the hips. Recurrent herpes on the oral mucosa is localized mainly in places that are normally keratinized. With repeated localization of herpes in the same place, they speak of fixed herpes. Sometimes the appearance of bubbles is accompanied by an increase in the submandibular and sublingual lymph nodes.

Differential diagnosis.
Chronic recurrent herpes must be differentiated from:
- recurrent aphthous stomatitis;
- allergic stomatitis;
- streptococcal impetigo.

Differential diagnosis is based on the features of the clinical picture of chronic recurrent herpes, as well as on data from cytological studies of the contents of the vesicles and scrapings from the area of ​​erosion formed after the opening of the vesicles in the first 2-3 days of the disease.
In the preparations, giant multinucleated cells are found. The virological method of research is also used.

Treatment. It is aimed at increasing the level of specific and non-specific protection of the patient's body so that he can suppress the persistent herpes simplex virus.
To achieve a significant lengthening of the periods of remission and alleviate the clinical manifestations of subsequent relapses, you can use levamisole (decaris) orally at 150 mg 2 times 2 weeks 2 for 1-3 months, depending on the effectiveness of the treatment.

It is necessary to conduct a thorough examination of patients with chronic recurrent herpes in order to identify and eliminate foci of chronic infection in the body, including in the oral cavity (periodontitis, periodontitis, tonsillitis, sinusitis, etc.). Local factors that contribute to the occurrence of relapses (chronic trauma, dry lips, chronic lip cracks) are eliminated.

Good results are obtained by the use of a specific herpetic polio vaccine. The drug is administered in the interrecurrent period at a dose of 0.1-0.2 mg intradermally 2 times a week. The course of treatment consists of 5 injections. The interval between the first two courses is 2 weeks, between the next - 3-4 months.
A somewhat smaller therapeutic effect is exerted by deoxyribonuclease (DNase), which is administered intramuscularly at 10-25 mg, after dissolving the powder in distilled water or isotonic sodium chloride solution. Injections are made every other day; for a course of 6-10 injections.
In the interrecurrent period, intramuscular injections of gamma globulin are used, 3 ml daily, with an interval of 3-4 days, for a course of 6 injections; interval between courses 2 months.

Chronic recurrent herpes is the most common form of endogenous infection caused by the herpes simplex virus. It occurs at any age in people previously infected with the herpes simplex virus and possessing antiviral antibodies. In the development of recurrent herpes, the main role is played by factors that reduce immunity:

• viral infections
• hypothermia
• pneumonia
• severe general illness
• chronic stress

In women, exacerbation of chronic herpes often depends on the menstrual cycle. Relapses sometimes occur with different frequency, at different times of the year and are not related to seasonality. In some patients, relapses appear 1-2 times a year, in others 3-4 times a month. In exceptional cases, the disease is permanent, namely, some rashes have not yet disappeared, while others are already emerging.

treatment

Antiviral chemotherapy drugs are used in the first hours and days after the onset of rashes. Assign acyclovir 0.2 g 5 times a day for 5 days with relapses of chronic herpes, it shortens the exacerbation of the disease and reduces pain in the affected area. Inside, as a rule, appoint significant doses of ascorbic acid. With a disorder of the immune system, courses of immunocorrective therapy are effective. Usually, levamisole (decaris) has a beneficial effect on the course of recurrent forms of herpes simplex, shortening the duration of relapses, prolonging periods of remission and reducing the soreness of the rashes. Apply the drug at 50-150 mg during the first 3 days of each week with gaps between courses of 5-6 days; in general 2-4 courses.

symptoms

The intensity and duration of clinical manifestations of chronic recurrent herpes are less pronounced than in the acute form of the disease. The main manifestations of recurrence of herpes infection:

• sensations of itching, burning, sometimes mild soreness in places of future rashes
• rashes of single or groups of bubbles with a diameter of 1-3 mm on the reddened mucous membrane
• the formation of bright red painful erosions of irregular shape
• the formation of a white-yellow fibrinous plaque on the extreme border of the lips and skin (hemorrhagic crusts)

Healing takes place on the 8-10th day without scar formation. Sometimes the appearance of bubbles is accompanied by an increase in the sublingual and submandibular lymph nodes.

prevention

In order to prevent exacerbations with frequent recurrent forms of herpes, patients are recommended a herpes vaccine. It is necessary to conduct a rigorous examination of patients with recurrent herpes to detect and eliminate foci of chronic infection in the body. Eliminate local factors that contribute to the appearance of relapses (dry lips, chronic trauma, chronic lip cracks).