Köbner Symptom (Koebner, 1872); Isomorphic reaction - with damage or irritation of the skin in the progressive stage of psoriasis at the injury site, fresh rashes appear. It is also observed with a red flat lisha, dermatitis Durring, etc.

Symptoms typical for the stationary stage

Symptoms characteristic for regression stage

Voronova symptom; Pseudo-atrophy bezel Voronov - in the regressive stage of development of psoriatic papules around them a brilliant light ring is a slightly wrinkled skin.

Pemphigus

Asboy-ganzen symptom (1960); The Phenomenon of Asboy-Ganzen is a view of Nikolsky's symptom with a bubble, consisting in sprawling bubbles when pressing on its tire.

Nikolsky symptom direct - intense sliding driving movement near the bubble causes a lightweight delay of the epidermis.

An indirect symptom is an indirect symptom - easy rejection of the epidermis when filming for a bubble tire; Characteristic sign of bubbles.

Shakelakova symptom; "pears" is a symptom - the flux of the liquid not revealed by the bubble under the influence of its own gravity down, while the bubble itself takes the outlines of the pear; Sign of vulgar bubble.

Multicolored lichen

Balsera Symptom (phenomenon) - a diagnostic sample with a multi-colored delay, which enters the more intensive staining of the lesions of the lesion during lubrication by their iodine tincture,

Baybey 2 symptom; The phenomenon of "hitting a nail"; The symptom of chips is the lag behind the reservoir of the buried epidermis in the graduate of the foci of the deserted deprivation.

"Chips" symptom - rejection of the scales when starting the spot of the hebone-haired.

Seborrhea

Kotmamamyshev's symptom - when palpation with closed eyes, the feeling of clear boundaries on the periphery of psoriatic plaques on the scalp is unlike the seborrin dermatitis foci, the separation of which from unaffected skin is not determined by the fingers. Differential diagnostic sign of psoriasis and seborrhea.

Sclerodermia

Jifford 2 Symptom - in patients with scleroderma it is impossible to recall the eyelid.

"Pussy" symptom - fan-shaped linear scars near the mouth in patients with sclerodermia, while patients are unable to open the mouth.

"Honey Honeycomb" symptom - x-ray sign of lung damage with sclerodermia: the presence of a two-way reinforced and deformed pulmonary pattern with a finely structured structure resembling honey cells.

Toxidermia

Berthon Symptom (Burton H.) is a gray border on the gums at the lower cutters, a sign of lead intoxication.

Tuberculosis Volchanka

Pospelova 1 symptom; "Probe" Symptom - "failure" of the probe when pressed on the lupoma.

"Apple jelly" symptom - light brown or brownish staining of a tubercle during diascopy; Sign of skin tuberculosis.

Journal Erythema

Verco Symptom (Verco) - linear and point hemorrhages under nails in patients with noded erythema.

Scabies

Ardi Symptom (Hardy) is the predominance of single purulent crusts in the area of \u200b\u200bone of the elbows or a few pustulas around the elbow joints.

Bashen symptom; The mite exaltation of the Basin is a small bubble with a black point (tick female) at the end of the scabies.

Gorchakova symptom; - Split bloody crusts on the skin of the elbows and in their circumference.

Cese a symptom - a scabies slightly towers in palpation.

"Triangle" symptom; The symptom of rhombus Michaelis is atypical rashes for scabies in the form of impetigin elements, bubbles, crusts located the vertex in the field of inter-fodded folds and turning on the cresses to their base.

Different

Beben symptom; The symptom of the cones of Bempi - follicular pointed red-brown small papulas on the extensitive surface of the proximal phalanges of the fingers of brushes with a red hair. Delege.

Boy transverse furrow symptom - nail dystrophy, due to a violation of the nail growth in enteropathic Aquermatimat.

"Call buttons" symptom - the presence of hernia-like protrusion over deeply located tumors, when pressed in the zone of which the finger fails as in the void with neurofibromatosis.

Lezer-Trel symptom (LEZER, TRELAT) - the appearance of a large number of pigment spots, sedenie warts and ruby \u200b\u200bangioms in older people as a harbinger of malignant tumors.

Morgana 1 symptom (Morgan); Morgan stains are small teleangectatic angiomes on the face and other areas of the skin in the elderly; Sign of aging.

Pospelova 4 symptom (1898) - with idiopathic atrophy, the skin has the appearance of "crumpled tapping paper".

Sita symptom (phenomenon) - when squeezing from two sides of the lesion focus during chronic pyodermia and with deep tricochy, the pus is released.

"Curbs" symptom - follicular hyperkeratosis, easily detected when carrying out the skin; Possible sign of hypovitaminosis A.

Unnune Darya Symptom (phenomenon); The ignition of the symptom is to enhance the brightness and the occurrence of the edema of the elements of the rash of a pigment urticance when wiping with fingers or a spatula, which is due to the release of histamine from fat cells.

Yadasson 1 Symptom - exacerbation of clinical symptoms of herpetyiform Durin dermatitis in response to a diagnostic compressal sample with 50% potassium iodide, which is due to the increased sensitivity of the skin to the drugs of iodine.

Venereology

Chancroid

Two cuts symptom; Paget (Paget) phenomenon - the existence around the ulcers of the soft Shankra of two cuts (internally yellow, does not contain streptobacilli, and outdoor - red, with a separated, in which streptobacilllas are detected)

Syphilis

Biederman symptom (Biederrnan) is a more intense dark red color of the mucous membrane of the front pacific arcs in patients with syphilis.

White collar - detachment of the horn layer of the epidermis in the form of a peripheral whisk, which appears when resolving Papulse syphilide.

Gershymmer-Yarisha-Lukasyvich symptom (Herzheimer K.) (reaction); The aggravation reaction is often the overall response of the patient's organism with active manifestations of syphilis at the beginning of specific antibiotic therapy. A few hours after the start of treatment, the temperature rises, the general weakness, chills increase, and new syphilitic rashes are enhanced.

Grigoriev 1 symptom - pigment stains after the fattening of massive crusts from vesiculous rashes at secondary fresh syphilis; On the stains the smallest scars.

Grigoriev 2 symptom - the emergence of characteristic scars at the involution of tertiary syphilis bumps; Round scars, depressed, focal, grouped mosaic, uneven depth, motley color.

The Cubner phenomenon is an isomorphic reaction (reacting with the appearance of new rash) of the skin after the influence of a series of provoking factors. The main causes of isomorphic reaction are such types of irritation as:

• Chemical;
• Physical;
• Mechanical.

The symptom of Cebner appears on a completely healthy skin and most often in psoriasis an irritant is a mechanical impact, that is, combing the skin due to severe itch. Damage to the skin often occurs when friction and pressure pressure in certain places of the body, during sunburn.

Isomorphic reaction is observed on average after 7-12 days after injury to the epidermis, and is observed in the progressive stage.

The rashes forces for their morphological, histological and clinical features are fully consistent with the main symptoms of psoriasis. That is, it first appears a reddish, towering spot on a body, which over time is covered with whitish flakes and begins to grow.

The rate of development of psoriatic elements during damage to healthy skin into the progressive stage of the disease depends on some data and on blood sugar levels. The higher the sugar content, the faster the response is manifested, in some patients this period is only five days.

The phenomenon on the name of the surname of the German dermatologist of Cubner is characteristic only for the progressive stage of the disease. Therefore, in rare cases, artificial irritation of the skin in a small area, allowing to determine the severity of the inflammatory process and assign proper treatment.

The test is carried out by scarification of the skin in the body of the body without rashes using a sterile needle. The result of the sample is estimated within two weeks.

An isomorphic reaction is often provoked by insect bites, random cuts, thermal and chemical burns, drawing tattoos. With psoriasis, the frequent involvement of the elbow areas and the knees of knees into the inflammatory process is associated with the fact that in these places the body clothing fits tightly and irritates the skin.

The phenomenon of Cebner may be the reason for engaging in the process and those zones on the body, where there are scars towering over the skin.

Diseases leaking with isomorphic reaction

For the first time, an isomorphic skin reaction was described by the dermatologist by Heinrich Cookner at the end of the 19th century after surveillance almost two thousand patients with psoriasis. Patient observation made it possible to prove that new psoriatic rashes into the progressive stage of illness they preferably appear after the preceding skin damage

The phenomenon described by the famous dermatologist was then repeatedly subjected to experimental studies, as it helps to establish the features of the development of the main skin signs of the disease - plaques.

The study of isomorphic reaction made it possible to prove that exactly the same phenomenon is observed in patients with vitiligo and red flat deprive in the active phase of the disease. It is still a pseudomorphic and isomorphic non-permanent phenomenon, they are manifested in the development of flat warts, brilliant Lychhen, lindoid necrobiasis.

The cause of the pseudomorphic reaction may also be a mechanical and chemical impact, the effect of ultraviolet rays.

Prevention of isomorphic reaction

In the progressive stage of psoriasis, the rate of recovery of the skin depends not only on the treatment and individual response of the body, but also on the number of psoriatic elements on the body. What they are more, the harder the regeneration of the epidermis occurs.

Constantly recurring progression episodes delay recovery, so it is desirable to prevent damage to healthy skin. Remember, the injury to the epidermis prevents:

• Timely treatment. The reception of antihistamine and soothing means minimizes irritation and itching of the skin, which in turn reduces the desire to comb the body;
• Full hygienic body care. Irritation decreases under the course use of therapeutic baths with braverains, starch, soda;
• Wearing loose clothes;
• Use of ointments with anti-inflammatory and regenerating action.

In the development of psoriasis in young children, first of all, it is necessary to compact nails to them, since the kids may not control the desire to comb the body by virtue of age. Partially skin irritation reduces diet therapy, eliminate from the power to allergenic products, sharp spices, sweets.

With the appearance of new psoriatic changes on the skin provoked by isomorphic reaction, it should be immediately used to use the external means prescribed by the doctor. This will reduce the likelihood of rapid cracking along the periphery.

The phenomenon of Cebner is seen as one of the signs of psoriasis. Along with other symptoms (blood dew, stearin stain, terminal film) It helps to correctly diagnose the skin disease.

Therefore, if you have psoriasis - try to do without scratches, cuts and injuries. In the active stage of the disease, the skin will not heal, and the resulting plaque can significantly increase in size.

For students of 4 courses of therapeutic faculty

1. Triad psoriatic phenomenov

This is a combination of three phenomena characteristic of Psoriatic Papula: a phenomenon of the stearin spot, the phenomenon of the stearin stain, the phenomenon of the psoriatic film and the phenomenon of point bleeding.

1. Yarisha-Gersheimer's reaction

Yarisha-Gersheimer's reaction occurs in the first day of treatment (usually 2 hours after the first introduction of the antibiotic) and is due to the resulting flow of a large amount of decay products by trepan in the bloodstream. It is manifested by fever, chills, Malgia, headache, tachycardia, rapid breathing, decreased blood pressure and leukocytosis. With secondary syphilis, rash can become brighter. The reaction, as a rule, reaches a maximum of 7 hours and passes towards the end of the first day.

1. Sympelova symptom

Sensation of the scratch during paper on the lesions of the lesion with a thicoid, follicular keratosis; Feeling of cardboard density during palpation of skin lesions in the 2nd stage of the Mikosa.

1. Phenomenon Cubner

Isomorphic reaction during damage or skin irritation, in place of injury appear fresh rashes

1. Balzer sample

It is used to detect peeling of spots with a multi-colored (beaten) delay: when lubricating their surface and the surrounding healthy skin with an alcoholic solution of iodine or aniline dyes, as a result of intensive absorption of the solution with a loose corneum layer, the affected skin is painted significantly brighter than healthy.

1. Symptom of Bempnaya Meshchersky

Painness in the separation and starting of scales in the foci of discoid red lupus.

1. Nikolsky symptom: True (3 options) and false

In patients with bubble, the true symptom of Nikolsky is due to the acantolysis of intercellular substances of the spike layer and therefore it is positive only during the progression of the disease. It lies in the fact that if you pull the bubble tire scribe, then the epidermis is delayed on apparently healthy skin; With friction on the type of healthy skin between bubbles or erosions, there is also a slight rejection of the upper layers of the epidermis; Light traumarity of the upper layers of the epidermis is found with friction of healthy leather areas located far from lesion foci.

The false symptom of Nikolsky is observed in patients with toxicodermia, congenital bullous epidermolysis, Lyleel syndrome. In these cases, the detachment occurs subepidermally and is called the symptom of the perifocal subepidermal detachment. The false symptom of Nikolsky will never manifest themselves when rubbing apparently healthy skin. It is called only on the periphery of erosions.

1. Symptom asbo Hansen

View of the symptom of Nikolsky with a bubble: the sprawling of the bubble when pressed onto its tire.

1. Weekema grid

On the surface of the papural when lubricating their oil, a visible grid of intersecting lines is formed.

1. "Collar Biemett"

Disposal of epidermis scraps in the form of a whisk appearing on absorbing papulas; Symphist of syphilis.

1. Symptom Pinkus

The lesion of the eyelashes in secondary syphilis, characterized by partial falling and steps of eyelash, resulting in different lengths.

1. Symptom "Fur Seized by Mol

Small-food alopecia in secondary syphilis, at which, the hair on the head is reminded by a moth-eaten fur.

1. Symptom of Yadasson

The pain arising from pressing on the Papulse syphilide (at secondary syphilis) is a blunt probe.

1. "Pseudo-atrophic bezel" Voronov

Brilliant, light ring slightly wrinkled leather around psoriatic papules.

1. "Venus Necklace"

Syphilitic leukoderma in the form of numerous depigmented spots on the neck.

1. Beer Pillov

Red rim of hyperemia along the periphery of psoriatic papules, not covered in these foci scales.

1. Triad Getchinson

Symptom complex, characteristic of the late congenital syphilis: interstitial diffuse keratitis, deafness (syphilitic labyrinthitis) and hetchinson teeth.

1. The phenomenon of "apple jelly"

Light brown or brown staining of a tubercle during diascopy

1. Thompson sample

Gonorrhea in men proceeds in the form of anterior and total urethritis. For diagnostics, the Thompson sample is used: the patient produces urine in series in 2 glasses; Breakfast, purulent threads and flakes only in the first glass indicate the presence of front urethritis; With a total or rear urethritis urine climbs from pus in both portions.

1. "Psoriatic crown"

Psoriatic plaques localized on the border of the open forehead and the scalp.

1. "Corona Venus"

Seborrheic syphilide with secondary syphilis, in which papulas are localized on the face, along the edge of the forehead.

1. Symptom of "Papile paper"

Spots of rounded, oval and incorrect outlines with thinned epidermis in the center covered with a tightly seated thin folded horny film. Meet with pink delay.

1. Provocative samples for gonor

Held in the absence of gonducts in the smears and crops:

a) chemical - the lubrication of the urethra to a depth of 1 -2 cm 1 - 2% solution of silver nitrate, rectum - to a depth of 4 cm with a 1% solution of the ligol in glycerin, cervical channel - to a depth of 1-1.5 cm 2-5% solution silver nitrate;

b) biological - the introduction of intramuscularly of a goganovakcision in a dose of 500 million microbial bodies or the simultaneous administration of a pyrogenal goganovakcision in a dose of 200 meters;

c) thermal - daily diathermy for 3 days (in the 1st day for 30 minutes, in the 2nd - 40 min, in the 3rd - 50 min) or inductothermia for 3 days to 15-20 minutes. The discharge is taken for laboratory analysis every day after 1 h after a physiotherapeutic procedure;

d) physiological - taking smears in the days of the greatest bleeding during menstruation;

e) combined - carrying out chemical, biological and thermal provocative samples in one day. The discharge is taken for laboratory analysis after 24.46 and 72 hours, and the crops are carried out 72 hours after the combined sample.

1. Definition and explanation of local dermograph

Dermograph (Greek. Derma Leather + Graphō writing, depict) - local change in skin coloring during its mechanical irritation.

Local dermographs can be caused by the skin with a blunt end of a stick with a diameter of 2-3 mm. Usually through 8-20 s, sometimes a little later, a white strip appears (white dermographism), which disappears after 1-10 minutes. With a larger pressure on the skin after 5-15 s, a manhelderographist occurs, which can be maintained up to 2 hours. White and red dermographs are due to mechanical irritation of the walls of capillaries. At the same time, weak irritation causes a capillar spasm and white dermographism, and stronger - the expansion of capillaries and a red dermographism.

At a significant pressure on the skin, the sublime dermographism appears on the skin: first it is formed red, and after 1-2 minutes, a string band with a perifocal zone of hyperemia having uneven contours is formed. The formation of elevated dermographism, apparently, is associated with the release of mediators that increase the permeability of the walls of capillaries and causing local skin swelling, as well as with a local reaction to the excitation of the elements of the capillary wall. In some individuals, with similar irritation, a ultraterial dermographism arises (in the form of blisters), due to a significant increase in the permeability of the vascular wall.

1. Symptom of "honey cells" (symptom "Sita")

When squeezing from two sides of the focus of the lesion in chronic pyodermia and at deep tricochy, the pus is released.

1. Mosaic scar

The scar formed on the site of a tuberculk syphilide with tertiary syphilis.

1. Star scar

The scar formed on the site of the gummic syphilide with tertiary syphilis.

1. Symptom Ardi Gorchakov

Impetigic or ectyimatous rashes, covered with point crusts, on the skin of the extensitive surface of the area of \u200b\u200bthe elbow joints; It is observed during scabies complicated by piederma.

1. Symptom Michaelis

The presence of bloody crusts and impetiginous rashes in an inter-fodder fold with the transition to the seats

1. Sesar symptom

Chesoccal move slightly towers during palpation

1. Diagnosis of mycoses with a luminescent lamp

Luminescent lamp (Wood lamp) is a source of ultraviolet light with a wavelength of about 360 nm. Under its action, pigments (in particular, melanin) and some pathogenic microorganisms begin to light. For example, CoryNebacterium minutissimum (eritresses pathogen - surface infection of the skin folds) gives a coral-red glow, Pseudomonas SPP. - yellowish-green, and the pathogens of trichomycosis of Microsporum Canis and Microsporum Audouini - green or yellow-green.

Under the Wood lamp, hypocygmented stains (for example, with tuberose sclerosis and hebulence) become more light, and vitiligo stains that are generally deprived of melanocytes - absolutely white. Hyperpigmented spots (freckles, chloa) under the lamp of Wood become darker. If the melanin is deposited in the dermis, as it happens when postgraduate hyperpigmentation, the color of the spots does not change.

PSORIASIS. Psoriatic triad:

1. The phenomenon of the "stearic stain" is a thick peeling of small plates from the surface of the papula, resembling a picture of a ram-grated stearin spot. Revealed by the method of bunch.

2. The phenomenon of the "Terminal Psoriatic film" - with further risk of the surface of the papula, the juicy, hyperemic surface is found.

3. The phenomenon of the "bloody dew, or point bleeding" - in the further later when the surface of the papula appears minor blood droplets in the form of dew, not merging with each other

Isomorphic reaction (Phenomenon of Kebner) - with Meshanic damage to the epidermis, in particular, during combs, strictly in the course of damaged epidermis appear after 10-12 days characteristic of a given papulesis.j.

Parappsoriasis.

Symptom of the cloudscales with parapsoriasis dry, sit tightly, often with an oily removal, they are not broken, separated by the whole, while having a view of the clouds.

Symptom of purple- in the methodical when the Parappsoriasis races on their surface and near her clinically healthy skin, the smallest point hemorrhages occur.

Erythematosis.

Symptom of Bempnaya Meshchersky- Sign of discoid red lupus: scales are sitting on Papulas very tight and removing them painfully.

Symptom of "Dame Heel" - When removing, the scapes on their foundation are often detected by the spies and the funnels of the mouth of the follicles are pressed. It is the result of follicular hyperkeratose.

Red flat loss.

Weekem-shallow mesh mesh or lines on the surface of papural as focal granuleza; It is easily detected when lubricating the surface of these nodules with oil or saline-rum.

HIVES.

Upholstery dermographism (variety of red dermographs) - in the center of the Red Strip after 1-2 minutes. A white rising roller appears, which holds quite a long time.

Sample on the sensitivity to cold- is applied to diagnose the cold urticaria Pu-topics applying a piece of ice to the hip area, shoulder or buttocks. In healthy people on the site of the ice application, there is a pale, and around him Erythema (but not blistering), passing in 15-30 minutes. In patients with cold nettle, a large blister is formed.

Symptom Unny - staining in a more juicy red color and swelling of spots with friction (towel), the cry of the child's own, receiving a hot bath. Posted in a pigment urtichery (heparin and histamine is released from the cells).

PEMPHIGUS

Symptom asbo Ganzen - When pressing on the wrong bubble with a finger, you can often immediately detect an increase in the bubble on the periphery, since the liquid flaps the adjacent areas of the epidermis. It is positive in the vulgar bubble, bullous peumfigoid, ritter disease, Lyleel syndrome, congenital epidermolysis.

Symptom of pears - The type of bubble adopted such forms with a vulgar bubble, resembles a thin re-zerine bag filled with liquid.

Symptom Nikolsky - manifests itself in 3 variances:

a) if you pull the bubble tire scribe, then the epidermis is delayed in the form of a ribbon on a friendly healthy skin (I degree);

b) friction on the appearance of a healthy skin or it is crumpled by a blunt object between bubbles or erosions is also uply easily easily leading to the "shift" of the upper layers of the epidermis (II degree);

c) with a sliding pressure of healthy on the species of skin sites, located far from lesions from foci, also easily detected by the easier trauma of the upper layers of the epidermis - erosion (III degree) appears.

Herpetyform Durring dermatoz.

Sandy of Yadasson- The appearance of new pathogne-intestine rash diseases (bubbles, bubbles, spots, etc.) after 24-48 hours when taking inside of 3-5% potassium solution or sodium iodide or applying 50% potassium on the skin - Liked ointment. Positive test during herpetiform dermatosis Durring.

Mycoses

Iodine sample Balzer "Skin lubrication 5% iodine with an alcoholic solution of iodine or aniline dyes affected areas where the horny layer of bursting-flashes is painted more intensively than healthy places free from rashes. Positive with multi-colored lichen.

Symptom of Beania. (phenomenon of chips or shock) - When starting the spots of multi-colored degradation and parapsoriatic papules as a result of the bustling of the horn layer, the upper layers of scales are peeling, and the peeling becomes more explicit.

Kerion Celsa - Making a pus from each follicle separately, resembling the allocation of honey from the medical cell. It is a symptom of infiltrative-arrogant trico.

Tuberculosis lupus.

Jelly Phenomenon - Diacopy of tuberculous tuberculosis from Raswired vessels, blood is removed; The color of the red tube becomes a brown-yellow and resembles an apple jelly, the buds become translucent.

Phenomenon of probe failure - The head of the probe when pressed to the focus of the lesion penetrates into the tubercle of the Tu-Bercury, having a peculiar soft, test consistency, due to death in the bugger of collagen and elastic fibers.

Hair deprived devices.

Symptom Terki. - A typical sensation with hair, obtained when holding a palm over the surface of the rash.

SYPHILIS.

Gersheimer-Yarisha-Lukashevich reaction - It appears a few hours after the start of the specific therapy of syphilis, it is expressed in increasing temperature, bright redness and swelling efflucement, an increase in their size and number. The basis of this reaction is the mass yield of endotoxin of pale treponsma as a result of their collapse.

Symptom of Yadasson - Recognition of the secondary syphilis: when pressed on a syphilitic papul, a stupid pre-suicide experience is experiencing acute pain.

Diagnostic reception Sinelnikov - at-changing to recognize syphilitic roseola. As a result of intravenous administration, a 3-5 ml of 0.5% solution of nico-tinovic acid is unclear before the stains of syphilitic roseo-lies become brighter and noticeable in contrast to the stains of marble skin.

GONORRHEA

Two-wired tompson sample - It is used for topical diagnostics during urethrites: with anterior uretrite urine turbid in the first portion, with Total (rear) - both portions of urine muddy.

Diascopia

(Vitropression) - carried out by pressing with a glass spatula or watch glass on the affected skin, from which blood is expelled. This method makes it possible to distinguish the spots inflammatory from non-inflammatory: inflammatory stains under the influence of pressure are pale, and non-unprepaid - almost do not be met in color. The greater diagnostic value of the Diaca-Fium has with the recognition of tuberculosis lupus (symptom of "apple jelly").

Rook.

This special "The technique in practical dermatology is used in the diagnosis of damage to the skin characterized by the presence of scales and shelter. Easy when the scalpel, the subject stack-scrap, or the nail plate of the index finger, determine the character of peeling, increased liteness of the papillary capillary Layer of dermis (point or spilled hemorrhages). When the psoriatic phenomena, the symptoms of Beben and Beben Meshchersky are determined or caused.

Dermographism.

The reaction of the skin vessels on mechanical irritation is used to study the state of the autonomic nervous system. Caused by a barn pressure of a snapper of a small force on the skin. It indicates a significant functional impaired of the central and ve -etative nervous system (the predominance of tone of sympathy innervation). Dermographism is red (with a rope, acute eczema, psoriasis - in the progressive stage), reflex (with the damage to the peripheral nerve, the rear spinal cord roots, this reflex you will fall; indicates the predominance of the tone of the parasympathic nervous system), white (with the predominance of tone Sympathetic nervous system - neurodite, scratch).

Muscular-hair reflex - "goose pimples". Determine the combined item on the skin.

1. Meeting of application in the clinic and interpretation of diagnostic samples (dermographism, symptom of the Meshchersky Bempnic, the symptom of the "lady's heel", the symptom of Khacchaturian, the symptom of Ardi-Gorchakova, the mesh of the weekem, the symptom of the "Cokardi", "Getchinskon's teeth", "Muna tooth". )

DermographandzMthe reaction of the neuro-vascular apparatus of the skin on the mechanical irritation, indicating the vesselning innervation of the skin. The appearance of the red stripes after the skin is stupid, without a trace disappearing after 2-3 minutes is considered normal dermograph. Red spilled dermographism is observed during eczema, psoriasis, white- in patients with sacrificed, exfoliative dermatitis; Resistant white or mixed, quickly turning into white, - in patients with atopic dermatitis, ultrasound (wide edema, sharply towering stripes of red after even weak mechanical skin irritation, sometimes disappearing after 40-60 minutes) - in patients with urticule, scratch.

Symptom of Bempnaya Meshchersky.

Characterized for the disease Discoidal red lupus. When removing scales with erythematous-infiltrative foci, soreness appears.

Symptom of the ladieship heel.

Characterized for the disease Discoidal red lupus. When removing the scales on their lower surface, the horny hornies they have been introduced into the mouth of the hair follicles or sebaceous glands are clearly visible.

Symptom of Khachaturian.

Characterized for the disease Discoidal red lupus. Silty-horny tubes in ear sinks resemble the surface of the thimble.

Symptom Ardi Gorchakov

it is characteristic of a disease of scabies. On the extensitive surface of the elbow joints, dry crusts, flakes that cover the papulo-vesicular elements are detected.

Weekem grid.

Characterized for the disease red flat deprived. When lubricating the surface of the papural and especially plaques with vegetable oil, small whitish dots are visible and the bands are visible as a web, translucent through the horny layer.

"Teeth Getchinskona"

With late congenital syphilis. Toothpology in the form of dystrophy of the upper central constant incisors and hypoplasia of their chewing surface. According to the cutting edge of the teeth, semi-lubricidoids are formed, as a result, the cutting surface of the incisors is narrowed, and the neck of the teeth becomes wider, the teeth acquire the honesty or screwdriver. Enamel on the cutting edge is more often absent.

"Tooth Muna."

the underdevelopment of the chewing tubercles of the first molars is found at the late congenital syphilis.

symptom "Cokard"

2. Application technique in the clinic and the interpretation of diagnostic skin samples (Phenomena of Kebner, the symptom of Nicolsky and Azba-Ganzen, psoriatic phenomena, the diasthem, halaer, Karrelyli, the symptom of honey cells).

phenomenon Cubner

with psoriasis. Isomorphic reaction (the appearance of new elements in the place of skin injury)

symptom of Nikolsky and Azba-Ganzen

observed with vulgar bubble.

Nikolsky - 1. When filming the bubble tire scribe, the epidermis is detaching on apparently healthy skin.

Nikolsky-2. When holding a finger between two bubbles, the epidermis is peeling.

Nikolsky-3. When holding a finger according to the apparently healthy skin, the epidermis is disclosed.

Azba Hansen. When pressing a finger to an unborn bubble, you can see how the liquid flaps the adjacent areas of the epidermis and the bubble increases along the periphery.

psoriatic phenomena

When the psoriatic papula is started, abundant peeling occurs in the form of silver-white scales, resembling stearin. (Phenomenon "Stearin Spot")

After removal of the scales, a wet shiny surface remains (psoriatic film phenomenon)

With further, drip bleeding occurs (blood dew phenomenon).

hair diasthemwith late congenital syphilis. Widely spaced upper incisors.

budrock Kareklyli -with late congenital syphilis. The 5th addition tuberon on the chewing surface of the upper jaw molar surface.

symptom of honey cell

Determine the tactics of conducting patients with surface candidiasis of the oral mucosa. List the fixed assets for local treatment and the sequence of their use.

Considering that candidiasis refers to the opportunistic mycosis, first of all it is necessary to identify and, if possible, eliminate the pathogenetic factors of the disease (study of the immune and endocrine status, gastrointestinal tract and conducting corrective therapy). Establishment of factors contributing to the development of candidiasis; Diet with the exception of sweets, limited carbohydrates rich in proteins; Vitamins B2, B6, C and RR. The careful savage of the oral cavity, the exclusion of all kinds of injury of the mucous membrane is important.

Preparations for local etiotropic therapy of candidiasis are divided into Antimicoticsand antiseptics.

1.ANTimikotiki - Polician antibiotics and imidazoles are prescribed in the form of solutions, aerosols, gels, droplets, ordinary and chewing tablets, caramels with imidazole derivatives. Caramels were also produced with decamine 0.15 and grinding pills of Lev Room 500,000 units.

The local antimicotics of the local action used for the treatment of candidias include nastatin, levels, natamycin and amphotericin. To imidazole derivatives - miconazole, ecoazol, clotrimazole, etc.

It is necessary to explain the patient that any drug for topical treatment should remain as long as possible in the oral cavity. Nistatin tablets should be chewed and for a long time to keep Cashitz in the mouth, but it is better to prepare a suspension of them. The unpleasant taste of the suspension can be weakened by adding up to 50% sucrose. Foreign authors allow the use of vaginal suppositories with nistato or imidazole preparations. Solutions and suspensions longer are delayed in the oral cavity, if you do not irrigation, but compresses.

use any antifungal ointments, with a preference of 2% of the active substance contents deposited between two cotton layers and placed in the cheek (Sandwich Applique in Yu.V. Sergeyev).

The duration of treatment of acute forms by local antimicotics is usually 2-3 weeks, antiseptics are slightly longer. General recommendation - Treatment before the disappearance of complaints and clinical manifestations, and then for another 1 week.

2.Antheptics with antifungal action is usually prescribed in the form of lubricants or rinsing. Lubrications are carried out by 1-2% aqueous solutions of a diamond greenery or methylene blue, applying them to the pre-dried surface of the mucous membrane. These drugs are widespread, but in efficiency is inferior to anti-grayscams, sustainability is rapidly developing, and continuous use leads to the irritation of the mucous membrane. The best action is diluted in 2-3 times a solution of ligol, a 10-15% drill solution in glycerin. Local antiseptics are recommended to alternate every week.

A) rinse with solutions of potassium mangartage (1: 5000), 1% boric acid, iodine water (5-10 drops of iodine tincture on a glass) are prescribed usually for the prevention of relapses after systemic or local treatment or simultaneously with the appointment of systemic drugs. Rinsing is recommended for 2-3 times a day or after each meal.

B) More efficient use of modern antiseptics - 0.05% Bigluconata chlorhexidine or 0.1% of the hexhetidine solution (hexoral, is also available in the form of an aerosol). Rinsing (10-15 ml of any of these solutions) are carried out within 30-60 seconds after eating twice a day. Aerosol is applied within 1-2 seconds. In contrast to rinsing with antimicotics, antiseptic solutions can not swallow.

C) Nystatin is an aqueous suspension of 100,000 units / ml. Adults are prescribed with a rinse by Nistatan (5-10 ml) for 1 minute 4 times a day. Children are introduced from the eye pipette 5 ml / day after feeding. Tablets at 500,000 - 1,500,000 ... 4 times a day.

D) Lev Room is a water suspension of 20,000 units / ml. Adults showing a rinse 10-20 ml 2-4 times a day. Children - like nystatin. Inside are prescribed by adults 500,000 ... 4 times a day.

E) Natamicin - suspension 2.5% pimafucine. Appliques 1 ml is prescribed for adults 4-6 times a day. Children - no more than 4 ml per day.

E) amphotericin - suspension of 100,000 units / ml. Appliques adult 1 ml 4 times a day.

G) Clotrimazole - solution of 1%. Adult appliqués 1 ml 4 times a day.

H) With candidiaous stairs, drugs containing antifungal, antibacterial substance and at the same time corticosteroid hormones - Triederm, Lorinden C, PIMAFUCHT, Myxolon, Candid B.

4. Remote urgent help in the swelling of the quincé (list the sequence of drug administration).

Urgent Care:

1) adrenaline 0.5-1 ml of 0.1% solution subcutaneously;

2) Pipolfen 2 ml of 2.5% solution intramuscularly; Suprastin - 2 ml of 2% solution or diphrolol - 2 ml of 5% solution;

3) prednisone - 60-90 mg intramuscularly or intravenously;

4) Salbutamol, Alupent - inhalation;

5) hot foot baths;

6) Laziks - 2-4 ml of 1% solution intravenously in the isotonic solution of sodium chloride;

7) aminocaproic acid 100-200 ml of 5% intravenous solution;

8) conficilla (trasilol) - 3 units intravenously in 300 ml of isotonic sodium chloride solution;

9) In the hereditary edema, quinka shows the transfusion of fresh blood, freshly frozen plasma (contains the inclectant inhibitor of the Complement). Hospitalization is required. Under the swelling of the larynx - in the ENT compartment, since at any time the need for tracheostomy may occur. In the abdominal syndrome, hospitalization in the surgical department is required. In neurological symptoms, hospitalization in the neurological department is shown.

5. Determine the tactics of the maintenance and mode of patients with infectious skin diseases (scabies, pediculosis), indicate drugs and methods of their use.

Scabies. Apply the means that break the outer layer of the skin and penetrate directly into the scabies, destroy ticks.

The effectiveness of treatment depends not so much from the choice of the drug, but from the thoroughness of the implementation of sanitary and hygiene measures and compliance with the rules for the use of drugs to avoid re-infection or self-proceedings in the processing of only affected areas, and not the whole skin.

Before rubbing an anticipating agent, the patient needs to take a hot shower, which contributes to mechanical removal from the surface of the skin of the ticks and breaking the horn layer. It is prohibited during treatment. Anticipating agents are rubbed into the skin of the body and limbs.

Preparations for the treatment of scabies:

The drug "Sprugal" (Piperonyl Butoxide + EsDepallethrine) - is applied once, does not require pre-taking a bath, flushes after 12 hours.

A sulfur ointment (Unguentum Sulfuratum Simplex), 20-33% - for adults, 10% - for children - it is required to be applied for 5 days, with a preliminary reception of a hot soul or bath, during treatment it is forbidden.

Benzylbenzoate Emulsion (Benzyl Benzoate) (20% solution - for adults, 10% - for children) - rubbed twice (with a break in 10 minutes), then - the next day, then not to wash 2 for another 2 days.

Demianovich method (a mixture of sodium solution of thiosulfate (Natrii Thiosulfas) and dilute hydrochloric acid (acidum hydrochloricum) - the composition rubs two days in a row. Then you need another 2 days not to wash.

All native and bedstones of the patient must be disinfected. The preparation "A / PIPERONYL Butoxide + EsDePallethrine) allows you to use things in 2-3 hours after processing.

In case of failure at the first attempted treatment, it is necessary to take the following attempt in 3-5 days.

Pediculosis.

For the most effective therapy required hair shortening or swinging them . When processing the affected skin, it is necessary to get rid of the GND by combing or mechanical removal from the hair. There is also a sanitary processing of lower and outerwear, bed linen. Anti-playing agents are represented by various drugs that affect the detachious both on adult individuals and on the nis.

Highly efficient means are nittifor, para-plus, etaxh, nix, 20% benzylbenzoate solution, anti-sisc and etc.

Par-Plus - The remedy is left on the treated surfaces for 10 minutes, followed by washing and removing the GDID. A steam plus is also used to process things with which the patient has contacted.

Nix - Cream, applied to the affected areas for 10 minutes, washed off in the usual way, and necessarily removal of the GDID.

Antiskab - complex hydrophilic gel-like preparation containing benzylbenzoate, active substances of plant origin. This remedy is rubbed into the affected and bordering places in 1, 3 and 7th day in the evening. Washed off on the 8th day.

Nittifor The drug is used to destroy the head, pubic lice and their GDID. Nittifor is applied to the affected areas and after drying the hair 40 minutes after treatment is washed off with shampoo, if necessary, processing is repeated.