Rash - symptoms - skin diseases. Children's infectious diseases accompanied by a rash The nature of the rash in various diseases

Almost all babies in the first year of life are faced with a disease such as exanthema. It passes quite quickly, and sometimes pediatricians do not even have time to diagnose it. Of course, when the baby has a fever, accompanied by a rash all over the body, this cannot but disturb the parents. For this reason, you should know the features of this disease and methods for its safe treatment.

Exanthema is a very common disease in children of the first year of life.

What is an exanthema?

Exanthema is a skin disease of infectious etiology, characterized by an acute course. In 80% of cases, the provocateurs of rashes are viruses, and only in 20% - bacteria. The main types of exanthema:

1. viral;
2. enteroviral;
3. sudden.

If you look at the photo, you can see that the rash looks like pinkish or red spots that cover the body of the child. After the baby has been ill with this disease, he develops immunity to an exanthema of an infectious nature.

Features of viral exanthema in children

Viral exanthema in children is a disease characterized by rashes that appear on the skin of a child and evenly cover the entire body. It is common in both toddlers and older children.

Causes of viral exanthema:

• measles virus;
• herpes virus;
• adenovirus;
• chickenpox, etc.

As a rule, the symptoms of exanthema are the same, with the exception of cases of measles or chicken pox. In the course of these diseases, exanthema manifests itself specifically. In this case, complex therapy is used, which is aimed at getting rid of not only the disease, but also exanthema.

Viral and allergic type exanthema are similar in symptoms, so it is very important to recognize in time which pathology a particular type of rash on the baby's skin belongs to (we recommend reading:). Improper treatment of exanthema is fraught with complications.

General clinical picture

Viral exanthema in babies is characterized by an increase in temperature, which usually lasts for 4-5 days. The rash at this time can become more intense under the influence of various factors: bright sunlight, hot water, emotional stress, etc. It is important to protect the child from such phenomena so as not to aggravate the situation.

With viral exanthema, in addition to skin rashes, the child has a fever

In newborns, the pulsation of the fontanel may become more frequent. The exanthema that occurs against the background of infection is accompanied by an increase in regional lymph nodes. It is provoked by the following infections:

1. in winter, as a rule, these are rhinovirus diseases, influenza virus and adenoviruses;
2. in summer, enterovirus is more often the causative agent;
3. herpetic infections can be detected at any time of the year (we recommend reading:).

Symptoms depending on the type of virus

Symptoms of viral exanthema in children vary depending on the type of infection. The main symptoms are presented in the table.

Features of enteroviral exanthema in children

Enteroviral (Boston) exanthema is classified as a separate category of exanthema because it is more common than other types of infectious exanthema. Enteroviruses include groups of viruses that cause diarrhea, aseptic meningitis, respiratory diseases, and gastroenteritis. With enteroviral exanthema, the body temperature rises to 39 degrees and intoxication of the body is observed.

The main symptoms of "Boston fever":

1. fever (from 39 degrees and above);
2. intoxication of the body;
3. asymmetrical rashes on the body.

Features of sudden exanthema in children

Sudden exanthema (roseola) is a disease that affects most young children (from six months to 3 years). Children get sick with sudden exanthema mainly in the autumn and winter. Once having been ill with this disease, children develop immunity, which minimizes the possibility of relapse.

Sudden exanthema is transmitted by airborne droplets and through personal contact with a sick person. The incubation period lasts from 5 days to 2 weeks.

The disease begins with an increase in temperature, which gradually increases, reaching high levels (39-40.5 degrees). Fever lasts an average of 3 days, accompanied by manifestations of intoxication (weakness, loss of appetite, vomiting, diarrhea). A characteristic feature of sudden exanthema is that, despite the high temperature, the child does not have catarrhal symptoms (cough, runny nose).

During a fever, the temperature does not keep constantly at a high level. In the morning, it decreases slightly, in the evening it rises again to 39 degrees. In infants, against the background of elevated temperature, a strong pulsation of the fontanel is observed, and febrile convulsions are also possible. This should not cause concern, because. not associated with neurological problems.

As a rule, on the fourth day there is a significant decrease in body temperature in a child. Parents mistake this for recovery, but at the same time, a rash appears on the baby's body.

Pink spots of the rash do not tend to merge, turn pale when pressed, their diameter is from 1 to 5 mm, there is no itching. The rash that accompanies sudden exanthema is not contagious.

After a few days, the rashes on the body completely disappear. In exceptional cases, sudden exanthema is accompanied only by fever, without rash. The child's condition at this time is satisfactory.

Diagnostic methods

Despite the fact that the disease occurs in babies quite often, this disease is rarely diagnosed. The reason is that the symptoms of exanthema disappear in a matter of days, and doctors simply do not have time to diagnose it. However, if the crumbs have a severe fever and rash, then a pediatrician and an infectious disease specialist should be consulted.

During a visual examination, the doctor examines the spots of the rash. In a baby suffering from sudden exanthema, papules on the skin disappear with pressure; with a viral illness, there is no reaction to pressure. If the lighting is bright enough, then you can notice that the elements of the rash slightly rise above the skin.

A blood test is also performed (during exanthema, the number of leukocytes decreases). The doctor necessarily conducts a differential diagnosis. This helps to determine the type of disease and choose the right tactics, how best to treat the baby. Differential diagnosis of exanthema implies the exclusion or confirmation of the following pathologies:

1. measles (we recommend reading:);
2. infectious mononucleosis (we recommend reading:);
3. idiopathic infection;
4. rubella;
5. scarlet fever (we recommend reading:);
6. allergies associated with viral infections.

Features of treatment

Strictly established regimens for the treatment of exanthema do not exist. It is important to isolate a sick child from peers to prevent the spread of the disease. In the room where the sick baby is located, wet cleaning is regularly carried out and the room is ventilated. During a fever, the child is shown to drink plenty of water, walks are allowed only under favorable weather conditions.

If the baby is hard to tolerate high temperature, the doctor may prescribe him antipyretic drugs, and if necessary, antihistamines and antivirals can also be used. With viral exanthema, the child is forbidden to spend a lot of time in the sun, because. this is fraught with itching, and the rash from sun exposure may increase.

Medical therapy

The disease is characterized by an increase in body temperature, therefore, during the illness, drugs with an antipyretic effect are often prescribed:

• ibuprofen;
• Nurofen;
• Paracetamol;
• Panadol.

Antihistamines are used to reduce rash and swelling:

• Zodak;
• Zyrtec;
• Suprastin.

Locally, ointments are applied to the areas affected by the rash: Fenistil, Elokom, La Cree. If you apply the ointment 2-3 times a day, the rash will completely go away within 5 days. When the rash is caused by herpes, ointments are applied that are applied to the site of itching. Acyclovir ointment for herpes has proven itself well. In severe cases of the disease, antiviral drugs are prescribed: Arbidol, Anaferon.

Folk remedies

Folk remedies can also be used in the treatment of a small patient. Before using them, you need to consult a doctor, but, as a rule, there are no contraindications for the use of home infusions and compresses. To improve the general condition of the baby, you can use an infusion of chamomile (pour a tablespoon of dry chamomile with one glass of boiling water).

It is useful to apply fresh potato juice to the areas of the body affected by the rash. Raw peeled potatoes are grated, and the resulting slurry is squeezed out. Juice lubricates the skin covered with a rash 3 times a day. It is useful to bathe the baby in baths with the addition of a decoction of celandine. It helps to reduce rashes, soothes delicate baby skin. Similar baths can be done with the addition of a decoction of fir, chamomile.

To reduce the rash when bathing a baby, it is necessary to add a decoction of celandine to the water.

The child needs to be given enough to drink. Useful will be cranberry fruit drinks, tea with raspberries and linden. Elder broth has a good effect. To prepare a decoction, pour 180 g of berries with a liter of boiling water, leave for 4-5 hours. Drink the drug should be one glass 3 times a day after meals. The duration of such treatment should be no more than 3 days.

Possible Complications

Complications with exanthema are observed in babies with weak immunity. In 90% of cases, the disease disappears without a trace within 5-10 days. When complications appear, the rash can last for 2-3 weeks, cough and sore throat are also possible, but even in such situations, the symptoms disappear in less than a month.

Unfortunately, sometimes doctors cannot make an accurate diagnosis, mistaking roseola for rubella.

The result of such mistakes is the refusal of parents to vaccinate the child, which can greatly harm him in the future. In rare cases, complications are accompanied by disorders in the work of the cardiovascular system, the appearance of reactive hepatitis and an increase in adenoids.

Preventive actions

Prevention of exanthema is not necessary, because. it occurs once, after which immunity is developed, and the baby subsequently does not suffer from this ailment. General recommendations are to improve and harden the baby to strengthen the immune system, which will allow him to resist various infections and viruses, and if an illness occurs, he will recover quickly.

You should also protect the child from communicating with peers if they have been diagnosed with exanthema. Breastfeeding children are much easier to tolerate roseola. Parents should be vigilant in relation to their child, and in case of suspicion of exanthema, immediately seek help from a doctor.

Many diseases are not limited to external manifestations. The child may have a fever, pain in the throat, abdomen, vomiting, cough and chills. Here are the most common infectious and not only childhood ailments:

• Measles. The eruption of red raised pimples starts from the head area and gradually descends down to the legs.

  This happens 3-4 days after the disease.

  Before the rash appears, the child has a high temperature, irritation of the mucous throat, runny nose, cough.

• Rubella. An increase in temperature, an increase in lymph nodes and children's skin rashes occur at the same time. Spots of 3-5 mm begin to appear in the neck and head area, descending just a few hours to the legs and disappear after 3 days.
• Chickenpox (chickenpox). Red spots almost immediately turn into blisters that itch a lot.

  Before their appearance, the child's temperature rises, which decreases after the rash.

  Types of baby rash

  An important role in determining the causes of rashes is played by the type of childhood rash. Specialists distinguish a large number of different types of rashes. Of these, one can distinguish an allergic rash, acne, which is also called acne, roseola and others.

  Children's allergic rash

  Causes of childhood allergic rash exposure to various irritants. Most often, the reaction is caused by food allergens consumed by the baby himself or the nursing mother.

  Rashes of an allergic nature, as a rule, are localized on the cheeks and arms of the child. Berries, citrus fruits, products with various flavors and dyes can cause such a reaction.

  In addition, allergies can be provoked by contact with artificial types of fabric, certain types of household chemicals, cosmetics and other allergens. Sometimes a reaction in children can be caused by exposure to cold or other factors on the baby's skin.

  The hallmark is a rash of raised blisters that tend to coalesce. In early childhood, urticaria or urticaria is acute, accompanied by excruciating skin itching, local fever, general malaise, weakness.

  Nettle skin-colored rash in a child suddenly appears on any part of the body, lasts from several hours to several days. In the case of Quincke's edema in the throat and mouth, the child needs immediate medical attention.

  Causes of urticaria - polyethological dermatosis:

  1. external influences (heat, cold, pressure);
  2. influenza infection, pharyngitis, otitis media;
  3. preservatives and dyes in products;
  4. helminths, protozoal infection;
  5. medicines;
  6. physical exercise;
  7. food products;
  8. insect bites;
  9. overheating, cold;
  10. stress.

  Urticaria is not transmitted from a sick person to a healthy one. The skin reaction to irritants is manifested in response to mechanical effects on the skin (friction, pressure, combing insect bites). This form of the disease is called "mechanical urticaria".

  A rare form of urticaria - cholinergic - is manifested by hyperemia of the skin of the face, neck, and chest. Redness is observed in just a few minutes or within an hour after bathing in hot water, increased sweating, physical and emotional stress.

  The child feels severe itching of the skin. A pale rash is formed, consisting of blisters of various shapes.

  Usually, when examining a patient, an allergen is not detected. The provoking factor for the development of the cholinergic form is the mediator acetylcholine, produced by the body itself.

  The rash consists of the so-called primary elements. In various diseases and pathological conditions, they have their own specific characteristics, which plays a fundamental role in the correct diagnosis.

  Skin changes accompanying infectious viral diseases are diverse in appearance, location on the body. Rashes can take the form of:

  • Bubble. This is the name of an element with a cavity inside, up to half a centimeter in size. The cavity is filled with liquid secretion. After opening, an ulcer is formed.
  • Nodule (papules). A small element located in the thickness of the skin or above it, without a cavity inside.
  • tubercle. It has a coarser dense structure, large sizes, up to 10 mm, after resolution, it can leave scars on the skin.
  • Blister. A thin-walled element filled with interstitial fluid inside the cavity, as a rule, has a short existence: from several minutes to 2-3 hours.
  • Pustules. This is a small element with purulent contents inside.
  • Spots. They do not rise above the surface of the skin, appear in its thickness, differ in color: from pale pink to bright crimson, may contain pigment.
  • Roseola. They are small in size, do not contain a cavity, have an irregular shape, rise above the skin. The hallmark of such a rash is that roseola disappears when pressed or stretched, and then reappears.
  • Hemorrhages. These are intradermal hemorrhages. It has a vascular nature of education. The difference is that hemorrhagic rashes do not disappear with strong pressure on the skin.

  The study of the nature of changes in the skin, the contents of the elements, is of fundamental importance in establishing a diagnosis, determining the pathogen and subsequent treatment.

  Signs of infectious rashes in children

  The infectious nature of the rashes is indicated by a number of symptoms that accompany the course of the disease. These signs include:

  

  • intoxication syndrome, which includes a rise in temperature, weakness, malaise, lack of appetite, nausea, vomiting, headaches and muscle pain, etc.;
  • signs of a specific disease, for example, with measles, Filatov-Koplik spots appear, with scarlet fever, limited reddening of the pharynx and others are usually noted;
  • in most cases, infectious diseases can be traced to the cyclical course, there are also cases of similar pathologies in the patient's family members, colleagues, friends and acquaintances, that is, people who had close contact with him. But it must be borne in mind that the nature of the rash can coincide with various diseases.

  In children, an infectious rash is most often spread by contact or hematogenous route. Its development is associated with the rapid multiplication of pathogenic microbes on the baby's skin, their transfer through the blood plasma, infection of blood cells, the occurrence of the "antigen-antibody" reaction, as well as increased sensitivity to certain antigens that secrete bacteria that cause infection.

  Papular rashes, which later begin to become wet, are often caused by direct infection of the skin with pathogenic microorganisms or viruses. However, the same rash can appear under the influence of the immune system on the action of the pathogen.

  Symptoms and treatment of infectious diseases. Video

  The appearance of a rash can be a symptom of formidable, sometimes deadly diseases. Skin reactions are characteristic not only for viral respiratory infections, but also for scarlet fever, meningococcal meningitis, and syphilitic lesions.

  Rashes appear with scabies, microsporia, and may not be of an infectious nature at all, for example, with skin forms of systemic lupus erythematosus, systemic vasculitis and other diseases.

  

  Until the examination of the surface of the skin by a specialist, it is categorically not recommended to use various external agents that can change the color and consistency of the elements. This behavior can make it difficult to make a correct diagnosis.

  Any rash is a reason for an immediate visit to the doctor in order to timely establish the cause of its appearance and prescribe etiotropic therapy.

  The childhood illnesses rubella, chickenpox, and measles have many other symptoms that doctors can use to make a diagnosis. Often the type of rash on the skin does not play a primary role. Let's see exactly what signs of these childhood infectious diseases exist in medicine:

  1. Chicken pox. Basically, children from two to seven years old get sick with chickenpox, less often adults. For the most part, doctors make a diagnosis precisely by the type of rash on the skin and mucous membranes. There is severe itching and signs of general intoxication of the body.
  2. Measles. The disease is transmitted by airborne droplets and at first resembles a respiratory infection. The child has general intoxication, high fever, severe barking cough, runny nose, conjunctivitis is possible. The mucous membrane of the eye is affected, because of which the baby complains of pain in the eyes. A distinctive feature of measles: small white-red spots appear on the mucous membrane of the cheeks, which disappear after three days. After the manifestation of a skin rash on the fourth day of illness, the temperature rises again.
  3. Rubella. The main symptom is an increase in the occipital and posterior cervical lymph nodes. If the lymph nodes are slightly enlarged, doctors have to wait for another symptom - the appearance of a small rash. And since a rubella rash may be completely absent, an increase in lymph nodes is considered to be the most important symptom of the disease. Usually rubella is well tolerated by children, it is dangerous only for pregnant women.

  Diagnosis of infectious rashes

  When diagnosing maculopapular rashes and non-vesicular rashes caused by a viral infection, the palms and feet become predominantly affected, which is quite rare in other cases.

  So, for bacterial and fungal infections, immune diseases, as well as side effects on various drugs, such a lesion zone is absolutely not typical.

  

  An infectious rash in a child can accompany both acute and chronic diseases. Of the acute pathologies, rashes most often manifest measles, chickenpox, scarlet fever, and others, and of the chronic ones, tuberculosis, syphilis, and others.

  In this case, the diagnostic significance of the elements of the rash may be different. So, in one case, the diagnosis can be made only by characteristic rashes, in others, the elements of the rash become a secondary diagnostic sign, and in the third, the rash is an atypical symptom.

  eczema treatment

  Put the baby to bed, measure the temperature and call the doctor at home. You can not go to the children's clinic, because of the risk of infecting other children. If there is a suspicion of meningococcemia, it is necessary to call an ambulance.

  If a child has a rash, then antihistamines are given. Cooling gels, anti-allergic ointments are applied externally.

  Dermatologists recommend combining an oral antihistamine with an external cream or gel with the same active ingredient. Parents fear that such treatment will cause drowsiness in the child, reduce academic performance.

  Antihistamines "Fenistil", "Claritin", "Erius", "Zirtek" almost do not have a sedative effect, are better tolerated.

  

  Histamine is released by mast cells in the blood and tissues to help the immune system defend the body against pathogens and toxins. However, in some people, allergies lead to an overreaction to harmless substances.

  Antihistamines block histamine receptors, prevent or reduce itching, swelling, redness of the skin, and watery eyes.

  The most effective antihistamines to eliminate the rash in the acute form of urticaria. With chronic urticaria, such drugs help only 50% of patients.

  Corticosteroid ointments have anti-allergic and anti-inflammatory effects. Externally, the preparations "Fenistil-gel", creams and ointments "Elokom", "Lokoid", "Advantan", "Sinaflan", "Flutsinar" are used.

  Children are given to drink entersorbents, for example, Enteros-gel or Laktofiltrum. Inside, they also take dietary supplements with lacto- and bifidobacteria.

  The translation of the name of the disease from ancient Greek sounds very simple - “skin rashes”. Infantile eczema or atopic dermatitis appears before 6 months of age.

  On the cheeks of the child, dense red spots form that do not have clear boundaries. The disease is manifested by itching, inflammation and dry skin on the face, on the wrists, under the knees.

  Redness, vesicles, crusts, cracks of the skin are observed in all types of eczema.

  The acute phase in the idiopathic form of the disease is manifested by the formation of many bubbles. They open, weeping begins, after which crusts and spots remain. Typical localization of true eczema is the face, hands, forearms, feet and knees. Rashes appear on the body symmetrically.

  Idiopathic, true eczema is the same as weeping lichen, chronic itchy dermatosis. A rough rash on the body of a one-year-old child is located on the face, arms and legs, on the chest and buttocks. There are such stages of the eczematous process as erythema, vesicles, erosion, crusts.

  • allergies to substances in food, mites, dust, mold, climate change;
  • diseases of the digestive system, endocrine system;
  • hereditary predisposition;
  • stress, psycho-emotional trauma.

  With the transition of the disease to a chronic course, the skin thickens and flakes. The symptoms are exacerbated in an unsuitable climate for the child, with excessive dryness of the air. The influence of constant or seasonal action of allergens is noted.

  Therapeutic methods and means:

  1. Antihistamines that relieve itching and inflammation of the skin and mucous membranes.
  2. Resorcinol solution for cooling and astringent lotions.
  3. Antiallergic ointments, antiseptic solutions.
  4. Valerian tincture and other sedatives.
  5. Enterosorbents for cleansing the body of the allergen.
  6. Diuretics by mouth to reduce swelling.
  7. Hormonal ointments (GCS).
  8. Physiotherapy.

  Corticosteroids for external use have an anti-inflammatory and antitoxic effect. GCS are part of the Lokoid, Dermozolon, Fluorocort and Sikorten ointments.

  Combined products contain GCS and an antibiotic, they are used for microbial eczema. The ointments "Cortomycetin", "Gyoksizon" belong to this group.

  The centuries-old struggle against childhood infections reached a new level in the 20th century, when methods of laboratory identification of pathogens appeared, antibiotic therapy became the norm in medical practice, and vaccination became widespread.

  Thus, when signs of a childhood infection are detected, the causative agent of the disease is first identified, and then therapeutic methods are applied to combat viruses or bacteria and the toxins that they secrete.

  However, treatment is always carried out in several directions, including it is aimed at maintaining the vital functions of the body, increasing the resistance of the immune system, and preventing complications.

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Children's infections are not accidentally singled out in a special group - firstly, these infectious diseases are usually ill, as a rule, children of early and preschool age, secondly, they are all extremely contagious, so almost everyone who has contact with a sick child becomes ill, and thirdly, almost always, after a childhood infection, a stable lifelong immunity is formed.

There is an opinion that all children need to have these diseases in order not to get sick at an older age. Is it so? The group of childhood infections includes diseases such as measles, rubella, chicken pox, mumps (mumps), scarlet fever. As a rule, children of the first year of life do not get sick with childhood infections. This happens for the reason that during pregnancy, the mother (in the event that she has suffered these infections during her life) passes antibodies to pathogens through the placenta. These antibodies carry information about the microorganism that caused the infectious process in the mother.

After birth, the child begins to receive maternal colostrum, which also contains immunoglobulins (antibodies) to all infections that the mother “met” before pregnancy. Thus, the child receives a kind of vaccination against many infectious diseases. And in the event that breastfeeding continues throughout the first year of a child's life, immunity to childhood infections persists for a longer time. However, there are exceptions to this rule. Unfortunately, there are cases (very rare) when a breast-fed child is susceptible to microorganisms that cause chicken pox, rubella, mumps or measles, even when his mother is immune to them. When the period of breastfeeding ends, the child enters the period of early childhood. Following this, his circle of contacts expands. It is quite natural that at the same time the risk of any infectious diseases, including childhood infections, increases sharply.

Symptoms and treatment of measles in children

Measles is a viral infection with a very high susceptibility. If a person has not had measles or has not been vaccinated against this infection, then after contact with the patient, infection occurs in almost 100% of cases. The measles virus is highly volatile. The virus can spread through ventilation pipes and elevator shafts - at the same time, children living on different floors of the house get sick. After contact with a patient with measles and the appearance of the first signs of the disease, it takes from 7 to 14 days.

The disease begins with a severe headache, weakness, fever up to 40 degrees C. A little later, a runny nose, cough and almost complete lack of appetite join these symptoms. The appearance of conjunctivitis is very characteristic of measles - inflammation of the mucous membrane of the eyes, which is manifested by photophobia, lacrimation, sharp redness of the eyes, and subsequently - the appearance of a purulent discharge. These symptoms last 2 to 4 days.

On the 4th day of the disease, a rash appears, which looks like small red spots of various sizes (from 1 to 3 mm in diameter), with a tendency to merge. The rash occurs on the face and head (it is especially characteristic of its appearance behind the ears) and spreads throughout the body for 3 to 4 days. It is very characteristic of measles that the rash leaves behind pigmentation (dark spots that persist for several days), which disappears in the same sequence as the rash appears. Measles, despite the rather bright clinic, is quite easily tolerated by children, but under adverse conditions it is fraught with serious complications. These include inflammation of the lungs (pneumonia), inflammation of the middle ear (otitis media). Such a formidable complication as encephalitis (inflammation of the brain), fortunately, occurs quite rarely. Measles treatment is aimed at relieving the main symptoms of measles and maintaining immunity. It must be remembered that after measles has been transferred for a sufficiently long period of time (up to 2 months), immunosuppression is noted, so the child can get sick with some cold or viral disease, so you need to protect him from excessive stress, if possible - from contact with sick children. After measles, persistent lifelong immunity develops. All those who have had measles become immune to this infection.

Signs of rubella in a child

Rubella is also a viral infection that spreads through the air. Rubella is less contagious than measles and chicken pox. As a rule, children who stay in the same room for a long time with a child who is a source of infection get sick. Rubella is very similar to measles in its manifestations, but it is much easier. The incubation period (the period from contact to the appearance of the first signs of illness) lasts from 14 to 21 days. Rubella begins with an increase in the occipital lymph nodes and () an increase in body temperature to 38 degrees C. A little later, a runny nose joins, and sometimes a cough. A rash appears 2 to 3 days after the onset of the disease.

Rubella is characterized by a pink, punctate rash that begins with a rash on the face and spreads throughout the body. Rubella rash, unlike measles, never merges, there may be a slight itch. The period of rashes can be from several hours, during which there is no trace of the rash, up to 2 days. In this regard, diagnosis can be difficult - if the period of rashes fell at night and went unnoticed by parents, rubella can be regarded as a common viral infection. Rubella treatment is to relieve the main symptoms - the fight against fever, if any, the treatment of the common cold, expectorants. Complications after measles are rare. After suffering rubella, immunity also develops, re-infection is extremely rare.

What is mumps in children

Mumps (mumps) is a childhood viral infection characterized by acute inflammation in the salivary glands. Infection occurs by airborne droplets. Susceptibility to this disease is about 50-60% (that is, 50-60% of those who were in contact and who were not ill and not vaccinated get sick). Mumps begins with an increase in body temperature up to 39 degrees C and severe pain in or under the ear, aggravated by swallowing or chewing. At the same time, salivation increases. Swelling quickly grows in the area of ​​​​the upper part of the neck and cheeks, touching this place causes severe pain in the child.

By itself, this disease is not dangerous. Unpleasant symptoms disappear within three to four days: body temperature decreases, swelling decreases, pain disappears. However, quite often mumps ends with inflammation in the glandular organs, such as the pancreas (pancreatitis), gonads. Past pancreatitis in some cases leads to diabetes mellitus. Inflammation of the gonads (testicles) is more common in boys. This significantly complicates the course of the disease, and in some cases may result in infertility.

In especially severe cases, mumps can be complicated by viral meningitis (inflammation of the meninges), which is severe, but not fatal. After the illness, a strong immunity is formed. Re-infection is virtually impossible.

Treatment and symptoms of chickenpox in children

Chickenpox (chickenpox) is a common childhood infection. Mostly young children or preschoolers are ill. Susceptibility to the causative agent of chickenpox (the virus that causes chickenpox refers to herpes viruses) is also quite high, although not as high as to the measles virus. About 80% of contact persons who have not been ill before develop chickenpox.

This virus also has a high degree of volatility; a child can become infected if he was not in close proximity to the patient. The incubation period is from 14 to 21 days. The disease begins with the appearance of a rash. Usually it is one or two reddish spots, similar to a mosquito bite. These elements of the rash can be located on any part of the body, but most often they first appear on the stomach or face. Usually the rash spreads very quickly - new elements appear every few minutes or hours. Reddish spots, which at first look like mosquito bites, the next day take the form of bubbles filled with transparent contents. These blisters are very itchy. The rash spreads throughout the body, to the limbs, to the scalp. In severe cases, there are elements of the rash on the mucous membranes - in the mouth, nose, on the conjunctiva of the sclera, genitals, intestines. By the end of the first day of the disease, the general state of health worsens, the body temperature rises (up to 40 degrees C and above). The severity of the condition depends on the number of rashes: with scanty rashes, the disease proceeds easily, the more rashes, the more difficult the child's condition.

For chicken pox, a runny nose and cough are not typical, but if there are elements of the rash on the mucous membranes of the pharynx, nose and on the conjunctiva of the sclera, then pharyngitis, rhinitis and conjunctivitis develop due to the addition of a bacterial infection. Bubbles open in a day or two with the formation of sores, which are covered with crusts. Headache, feeling unwell, fever persist until new rashes appear. This usually happens from 3 to 5 days (depending on the severity of the course of the disease). Within 5-7 days after the last sprinkling, the rash passes. Treatment of chickenpox consists in reducing itching, intoxication and preventing bacterial complications. The elements of the rash must be lubricated with antiseptic solutions (usually an aqueous solution of brilliant green or manganese). Treatment with coloring antiseptics prevents bacterial infection of rashes, allows you to track the dynamics of the appearance of rashes.

It is necessary to monitor the hygiene of the mouth and nose, eyes - you can rinse your mouth with a solution of calendula, the mucous membranes of the nose and mouth also need to be treated with antiseptic solutions.

In order to avoid secondary inflammation, you need to rinse your mouth after each meal. A child with chickenpox should be fed warm semi-liquid food, drink plenty of water (however, this applies to all childhood infections). It is important to ensure that the baby's fingernails are cut short (so that he cannot comb the skin - scratching predisposes to bacterial infection). To prevent infection of rashes, bed linen and clothes of a sick child should be changed daily. The room in which the child is located must be regularly ventilated, making sure that the room is not too hot. These are general rules. Complications of chickenpox include myocarditis - inflammation of the heart muscle, meningitis and meningoencephalitis (inflammation of the meninges, brain substances, inflammation of the kidneys (nephritis). Fortunately, these complications are quite rare. After chickenpox, as well as after all children's infections , immunity develops.Re-infection happens, but very rarely.

What is scarlet fever in children and how to treat it

Scarlet fever is the only childhood infection caused not by viruses, but by bacteria (group A streptococcus). This is an acute disease transmitted by airborne droplets. Infection through household items (toys, dishes) is also possible. Children of early and preschool age are ill. The most dangerous in terms of infection are patients in the first two to three days of the disease.

Scarlet fever begins very acutely with an increase in body temperature up to 39 degrees C, vomiting. Immediately noted severe intoxication, headache. The most characteristic symptom of scarlet fever is tonsillitis, in which the mucous membrane of the pharynx has a bright red color, swelling is pronounced. The patient notes a sharp pain when swallowing. There may be a whitish coating on the tongue and tonsils. The tongue subsequently acquires a very characteristic appearance ("crimson") - bright pink and coarsely grained.

By the end of the first-beginning of the second day of illness, the second characteristic symptom of scarlet fever appears - a rash. It appears on several parts of the body at once, being most densely localized in the folds (elbow, inguinal). Its distinguishing feature is that the bright red punctate scarlatinal rash is located on a red background, which gives the impression of a general confluent redness. When pressed on the skin, a white stripe remains. The rash can be spread all over the body, but there is always a clear (white) area of ​​skin between the upper lip and nose, as well as the chin. Itching is much less pronounced than with chicken pox. The rash lasts up to 2 to 5 days. The manifestations of sore throat persist a little longer (up to 7-9 days).

Scarlet fever is usually treated with antibiotics, because the causative agent of scarlet fever is a microbe that can be removed with antibiotics. Also very important is the local treatment of angina and detoxification (removal of toxins from the body that are formed during the vital activity of microorganisms - for this they give plenty of drink). Vitamins, antipyretics are shown. Scarlet fever also has quite serious complications. Before the use of antibiotics, scarlet fever often ended in the development of rheumatism (an infectious-allergic disease, the basis of which is damage to the connective tissue system). with the formation of acquired heart defects. At present, subject to well-prescribed treatment and careful adherence to recommendations, such complications practically do not occur. Scarlet fever affects almost exclusively children because with age a person acquires resistance to streptococci. Those who have been ill also acquire strong immunity.

Infectious erythema in a child

This infectious disease, which is also caused by viruses, is transmitted by airborne droplets. Children from 2 to 12 years old get sick during epidemics in a nursery or at school. The incubation period is different (4-14 days). The disease progresses easily. There is a slight general malaise, discharge from the nose, sometimes a headache, and a slight increase in temperature is possible. The rash begins on the cheekbones in the form of small red, slightly embossed dots, which merge as they increase, forming red shiny and symmetrical spots on the cheeks. Then, within two days, the rash covers the whole body, forming slightly swollen red spots, pale in the center. Combining, they form a rash in the form of garlands or a geographical map. The rash disappears in about a week, during the following weeks transient rashes may appear, especially with excitement, physical exertion, exposure to the sun, bathing, changes in ambient temperature.

This disease is not dangerous in all cases. The diagnosis is based on the clinical picture. The differential diagnosis is often made with rubella and measles. Treatment is symptomatic. The prognosis is favorable.

Prevention of infectious diseases in children

Of course, it is better to recover from childhood infections at an early age, because adolescents and older people get sick much more severely with much more frequent complications. However, complications are also observed in young children. And all these complications are quite severe. Before the introduction of vaccination, mortality (mortality) in these infections was about 5-10%. A common feature of all childhood infections is that after the disease develops strong immunity. Their prevention is based on this property - vaccines have been developed that allow the formation of immunological memory, which causes immunity to the causative agents of these infections. Vaccination is carried out at the age of 12 months once. Vaccines have been developed for measles, rubella and mumps. In the Russian version, all these vaccines are administered separately (measles-rubella and mumps). As an alternative, vaccination with an imported vaccine containing all three components is possible. This vaccination is well tolerated, complications and undesirable consequences are extremely rare. Comparative characteristics of childhood infections

We received several letters with the same request - to give a plate, referring to which parents could diagnose childhood infectious diseases. This, of course, is about the most common ones - such as chicken pox, rubella. All these diseases can be combined even by purely external manifestations - they are accompanied by rash on the skin.
Of course, we are not sorry to give such a sign, if not for some considerations. Well, firstly, we must take into account the ever-increasing number of cases of atypical manifestations of these diseases. And secondly, we must not forget about the so-called differential diagnosis, when doctors say: yes, indeed, this is just such a disease, and not heels similar to it, but requiring a different approach to treatment, other quarantine measures, etc. So this table could serve only as a rough, approximate guide, but nothing more.

To begin with, one general rule: any child with any skin rash should be considered potentially dangerous to others as a distributor of a possible infection. This means that you cannot come to the clinic with him for a general appointment and sit in a general queue. The doctor should examine him either at home or in a special box. This will help to avoid many troubles, not so much for the sick person, but for those around him.

Chickenpox in a child

The disease is caused by a virus, and the source of infection can be not only a sick chickenpox, but also a person suffering from herpes zoster - the causative agent here is the same. Chickenpox (or simply chickenpox) is transmitted by airborne droplets. Patients are contagious from the end of the incubation period until the 5th day after the onset of the rash. The incubation, that is, hidden, period lasts from 10 to 23 days - in other words, a child cannot get chickenpox before the 10th day after contact with another patient and is unlikely to get sick after the 23rd. This is important: it turns out that a child who has been in contact with a sick person can be in a team until the 10th day without the danger of infecting anyone else.
Mostly children get chicken pox from 2 to 7 years, but in rare cases, newborns and adults can get sick.

The main symptom of the disease is the appearance of a rash consisting of individual spots. Each speck eventually turns into a nodule (papule), the nodule becomes a bubble (vesicle), which bursts, leaving behind a crust. The first rashes (this is important to know!) Usually occur on the scalp, where the doctor tries to detect them.

It would seem that everything is simple: I saw the corresponding element - make a diagnosis. And in 90% of cases, this is exactly what happens. But what about the remaining 10%? Various tricks can lie in wait here. Firstly, the rash can be very profuse, even affecting the mucous membranes, and very sparse, consisting of only a few elements. Usually, new rashes recur within 3-5 days, but it also happens that, having arisen on the first day, the rash no longer appears.

Along with the mildest forms of chicken pox, very severe ones also occur when the blisters fill with blood, become dead, leave behind deep ulcers, and become infected. The rash can appear in the mouth, and on the genitals, and even inside the body - on the inside of the esophagus and intestinal walls. And it's all chicken pox.

It is necessary to differentiate chickenpox with at least six diseases, including insect bites, scabies, strophulus. There can be only one conclusion from all this: they saw suspicious bubbles on the scalp - call the doctor and don’t take such a child anywhere. Chickenpox is extremely contagious.

Measles in a child

Measles now belongs to the so-called controlled infections, that is, those against which vaccination is carried out. This disease is caused by a virus, transmitted by airborne droplets and is accompanied by general intoxication, as well as severe catarrhal symptoms (temperature, rough barking cough,). The rash is predominantly in the form of spots, which sometimes protrude slightly above the skin.

The incubation period usually lasts 9-17 days after contact with the sick person, but if the child was given gamma globulin for the purpose of prevention, it can stretch up to 21 days.

A characteristic sign of measles is that due to damage to the mucous membrane of the eyes, it becomes painful for children to look at the light. One of the main symptoms that help to make a diagnosis is not even a rash, but the appearance on the buccal mucosa opposite the small molars of small whitish spots up to 1.5 mm in diameter surrounded by a red rim. They disappear after two or three days.

On the fourth day of illness, when the child coughs, sneezes, his face becomes puffy, a rash appears: on the 1st day behind the ears and on the face, on the 2nd day on the trunk, on the 3rd day on the arms and legs. At the same time, the temperature rises again and intoxication increases. At first, the rash is in the form of pink spots, which eventually merge, turn red, become more convex.

The appearance of a measles patient at this time is very typical: the edges of the eyelids are inflamed, blood vessels stand out clearly on the sclera, the nose and upper lip are swollen, and the face is puffy. From the end of the 3rd day, the rash begins to fade in the same order as it appeared, leaving behind pigmentation and scaly peeling.

It would seem that I clearly described the disease, and it would be difficult to confuse it with something else. However, in addition to such typical measles, there is also atypical measles: mitigated measles, measles in vaccinated people and measles in young children.

Mitigated measles occurs when gamma globulin administration, blood or plasma transfusion occurs after the 6th day of the incubation period. This form of the disease proceeds easily, the classical sequence of the appearance and extinction of the rash is violated, the catarrhal phenomena are mild.
Measles in vaccinated people depends on their condition: in its complete absence, a typical course of the disease develops, in the presence of residual antibodies, its mild form.

In children of the first six months of life, measles occurs in cases where the mothers did not have measles, and it is very difficult.

Fortunately, now the most severe forms of this disease are almost never found - hypertoxic and hemorrhagic.

As for the differential diagnosis, here it is quite complicated and includes a range of diseases from the banal to pseudotuberculosis and allergies, including medicinal ones.

Rubella in children

They began to talk a lot about this not at all serious viral disease due to the fact that its connection with the appearance of congenital malformations in the fetus was established - this infection is most dangerous for women in. The issue of vaccinating girls against rubella has now been practically resolved.

The disease is manifested by an increase in the occipital and posterior cervical lymph nodes and a small-spotted rash on the skin. I draw your attention - the main thing here is the enlargement of the lymph nodes, on this basis, doctors make a diagnosis.

The source of infection is a sick person, who is dangerous from the end of the incubation period to the 5th, and sometimes up to the 10-15th day of illness. With congenital rubella, the virus remains in the body for up to 2 years. The infection is transmitted by airborne droplets. After an infection, a strong immunity remains.

The incubation period is from 11 to 22 days. As I said, the first symptom is an increase in the posterior cervical and occipital lymph nodes, which sometimes reach 10-15 mm in diameter and remain enlarged for up to 10-14 days. Sometimes these symptoms are mild, and the diagnosis is made only after the discovery of a small-spotted rash, individual spots of which do not merge and disappear without a trace on 2-3 days from the onset of the rash. Rubella is characterized by a thickening of the rash on the extensor surfaces, but it should be remembered that in about a third (!) Of cases, the disease can occur without a rash at all, so lymphadenitis remains the main and most important sign of rubella.
This disease is differentiated with mitigated measles, and with scarlet fever, and with. So it's not so easy here either.

Mumps (mumps) in a child

If rubella is potentially dangerous for pregnant women and girls should be vaccinated against it, then mumps is dangerous for boys: 25% of everything comes from the consequences of orchitis - inflammation of the testicles. Mumps is also a vaccine-preventable disease, and has been vaccinated against it for several years.

The disease is caused by a virus that affects the parotid glands, other glandular organs and the central nervous system. The source of the disease is a sick person from the end of the incubation period to the 10th day from the onset of the disease. Epidemic parotitis is transmitted by airborne droplets. 95% of the patients are children from 1 to 15 years old.

How does the disease begin? The temperature rises, the child complains of pain when opening the mouth and when chewing solid food. By the end of the first day, the parotid gland increases on one or both sides. Dryness appears in the mouth, ear pain may appear.

When examining the oral cavity, the doctor reveals swelling and redness around the salivary duct. Both the submandibular salivary glands and the sublingual glands may be involved in the process. Often there is damage to the pancreas. There may also be lesions from the nervous system - encephalitis. And although these complications are very rare, it’s still not worth tempting fate - it’s best to vaccinate a child against mumps and not think about the possibility of such formidable complications as deafness or testicular atrophy.

Is it always easy to diagnose mumps? No not always. It is necessary to differentiate this disease with submandibular lymphadenitis, and with a purulent lesion of the parotid gland, and with salivary stone disease, and with a number of other diseases. The vaccinated may have an erased form of mumps.

Scarlet fever in a child

Scarlet fever is a disease caused by group A beta-hemolytic streptococcus. It is characterized by intoxication, tonsillitis with cervical lymphadenitis and punctate rash. The source of infection are patients with scarlet fever, tonsillitis, streptococcal nasopharyngitis and even healthy carriers of streptococcus.

The infection is transmitted both by airborne droplets and through infected things and food. Scarlet fever, unlike previous infections, can be ill again. There are no vaccines against her.

In a typical case, the disease begins acutely, with fever up to 38-40 ° C, vomiting, and the appearance of a sore throat when swallowing. Changes in the pharynx on the first day are small, which does not at all correspond to the degree of painful intoxication.

By the end of the first day or on the second, a small-point rash appears on the skin at once with thickening in the inguinal and elbow folds, popliteal and axillary fossae, on the inner surfaces of the shoulders, the lateral surfaces of the chest and on the abdomen. The rash is small, profuse, pink-red. The skin is dry, rough, in many patients a pale nasolabial triangle is noticeable against the background of reddened cheeks. The fragility of the vessels is increased, which manifests itself when trying to measure or when examining the injection sites - more bruising is visible there than usual.

The rash can last from a few hours to 6-7 days. Depending on the severity of the disease, peeling of the skin begins in the first or second week: on the neck, earlobes and trunk - pityriasis, on the palms and feet - lamellar.

Changes in the pharynx, the state of the lymph nodes and tongue help to make a diagnosis. Zev bright, very red, flaming, redness sharply defined. Mandatory tonsillitis - without raids or with raids (in severe scarlet fever, even necrotic). Lymph nodes at the angle of the jaw are enlarged, dense and painful. The tongue is densely covered with white coating, from the second day it begins to clear from the edges and has a crimson tint, which persists until the 11-12th day of illness.

Scarlet fever is one of the brightest diseases, but difficulties in diagnosis lie in wait here.
First, there are several atypical forms that do not depend on the defeat of the pharynx. These are wound, burn, postpartum forms of scarlet fever. There are mild forms in which the rash is ephemeral, and the changes in the pharynx are negligible, and the diagnosis is already made on the basis of skin peeling. Scarlet fever has to be differentiated from pseudotuberculosis, prickly heat, throat diphtheria, rubella, measles, drug allergies and a number of other diseases. So here, in some cases, it is not possible to get by with a short description, but considerable experience is needed as a pediatrician and infectious disease specialist.

There are a number of specific tests that can clarify the diagnosis in difficult cases, in particular, the determination of antibodies. Therefore, I can only advise one thing: if an infection is suspected - put the child to bed, isolate it from others if possible and call a doctor. Only he can take responsibility for the final diagnosis.

Skin rashes in adults

Concept definition

Under the rash (skin rashes), we mean in everyday life a large number of pathological changes on the skin. There are several dozen diseases in which a rash always occurs, and several hundred in which it can be. The vast majority of these diseases are not at all terrible, but there are also very (!) Dangerous ones, so you need to be careful with a rash.

The reasons

The assessment of the skin process includes determining the nature of the rash, prevalence, localization, sequence of rashes, acute or long-term rash, based on the data obtained, differential diagnosis is carried out taking into account the history data (the patient's illness before the rash, contact with infectious patients, predisposition to allergic diseases, admission medicines). In order to understand the huge variety of types of rashes, it is first necessary to know their possible causes. First of all, it is necessary to determine whether this rash is infectious (i.e., a rash that occurs with an infectious disease - measles, rubella, chicken pox) or non-infectious (with allergic diseases, diseases of the connective tissue, blood, blood vessels, skin). So:

І Rash in infectious diseases

- "childhood infections" in adults: measles, rubella, chicken pox, scarlet fever

- infectious diseases (meningococcemia, herpes, herpes zoster, typhoid fever, typhus, herpetic infection, infectious mononucleosis, infectious erythema, sudden exanthema)

ІІ Noninfectious rashes

allergic rashes

In diseases of the connective tissue, blood, blood vessels (screroderma, systemic lupus erythematosus, thrombocytopenic purpura)

ІІІ Diseases that primarily affect the skin or are limited in manifestations only to the skin.

We have listed them separately. They, in turn, can also be infectious and non-infectious. The skin of different parts of the body has its own anatomical, physiological and biochemical characteristics. Therefore, many diseases are characterized by a strictly defined localization of rashes (for example, on the face, in the perineum, on the auricles, soles). Some are in the form of spots, papules, plaques, others are in the form of crusts, scales, lechinifications. The list of skin diseases is huge (skin lupus erythematosus, seborrheic dermatitis, acne vulgaris, neurodermatitis (limited, diffuse), nevi (pigmented, sebaceous glands, intradermal, non-cellular, flaming, Ota, blue, Becker), psoriasis, solar keratosis, senile keratoma, malignant neoplasms (squamous and basal cell skin cancer), metastases, dermatophytosis, discoid lupus erythematosus, acute, subacute, chronic pruritic dermatitis, pyoderma, lichen (shingles, pityriasis, red, Gilbert, white, pink), pemphigus, staphylococcal folliculitis, generalized amyloidosis , molluscum contagiosum, xanthelasma, mild fibroma, perioral (perioral) dermatitis, Kaposi's sarcoma, syringoma, dermatitis, dermatoses, warts, sarcoidosis, impetigo, syphilis, toxidermia, lentigo (malignant, senile), melanoma, Peutz-Jeghers syndrome, chloasma, angiofibroma, dermatomyositis, hereditary hemorrhagic telangiectasia, erysipelas, rosacea, tel eangiectatic granuloma, eosinophilic folliculitis, erythropoietic protoporphyria, tricholemmoma (Cowden's disease), telangiectatic granuloma, herpes, pathomymia, Lyme disease (borreliosis), lymphoma, McCune-Albright syndrome, leprosy, tuberous sclerosis, insect bites, fungal infections, pemphigoid, scabies , diaper rash (red), ichthyosis, etc.)

Mechanisms of occurrence and development (Pathogenesis)

The infectious nature of rashes is confirmed by a number of signs characterizing the infectious process:

general intoxication syndrome (fever, weakness, malaise, headache, sometimes vomiting, etc.);

symptoms characteristic of this disease (occipital lymphadenitis with rubella, Filatov-Koplik spots with measles, limited hyperemia of the pharynx with scarlet fever, polymorphism of clinical symptoms with yersiniosis, etc.);

an infectious disease is characterized by a cyclical course of the disease, the presence of cases of the disease in the family, the team, in people who have been in contact with the patient and do not have antibodies to this infectious disease. However, the rash can be of the same nature with different pathologies.

A rash, as a manifestation of an allergy, is not at all uncommon. Thoughts about the allergic nature of the disease and rash usually arise when there are no signs of infection and there has been contact with something (someone) who (what) could be the source of the allergy - food (citrus fruits, chocolate), medicinal, inhalation allergens (pollen, paints, solvents, poplar fluff), pets (cats, dogs, rugs)

A rash, in diseases of the blood and blood vessels, occurs for two main reasons: a decrease in the number or dysfunction of platelets (often congenital), a violation of vascular permeability. The rash in these diseases has the form of large or small hemorrhages, its appearance is provoked by injuries or other diseases - for example, fever with a common cold.

Morphological elements of skin rashes are called various types of rashes that appear on the skin and mucous membranes. All of them are divided into 2 large groups: primary morphological elements that appear first on hitherto unaltered skin, and secondary - appearing as a result of the evolution of primary elements on their surface or arising after their disappearance. In diagnostic terms, the most important are the primary morphological elements, by the nature of which (color, shape, size, shape, surface nature, etc.) in a significant number of cases it is possible to determine the nosology of dermatosis, and therefore the identification and description of the primary elements of the rash is of great importance. in local medical history status.

Primary morphological elements of skin rashes. The subgroup of primary morphological elements includes a vesicle, bladder, abscess, blister, spot, nodule, tubercle, node.

bubble - a primary cavity morphological element, the size of which is up to 0.5 cm in diameter, having a bottom, a tire and a cavity filled with serous or serous-hemorrhagic contents. Vesicles are located in the epidermis (intraepidermal) or under it (subepidermal). They can occur against the background of unchanged skin (with dyshidrosis) or against an erythematous background (herpes). When the vesicles open, multiple weeping erosions are formed, which are further epithelialized, leaving no permanent skin changes. There are vesicles single-chamber (with eczema) or multi-chamber (with herpes).

Bubble - the primary cavity morphological element, consisting of the bottom, tire and cavity containing serous or hemorrhagic exudate. The tire can be tense or flabby, dense or thin. It differs from the bubble in large sizes - from 0.5 cm to several centimeters in diameter. Elements can be located both on unchanged skin and on inflamed. Blisters may form as a result of acantholysis and be located intraepidermally (with pemphigus acantholyticus) or as a result of skin edema, which led to detachment of the epidermis from the dermis, and be located subepidermally (simple contact dermatitis). In place of the opened blisters, erosive surfaces are formed, which are further epithelialized without leaving scars.

abscess - primary cavity morphological element filled with purulent contents. According to the location in the skin, superficial and deep, follicular (usually staphylococcal) and non-follicular (usually streptococcal) pustules are distinguished. Superficial follicular pustules are formed at the mouth of the follicle or capture up to 2/3 of its length, that is, they are located in the epidermis or papillary dermis. They are cone-shaped, often pierced with hair in the central part, where the yellowish purulent contents are visible, their diameter is 1-5 mm. When the pustule regresses, the purulent contents may shrink into a yellowish-brown crust, which then disappears. In place of follicular superficial pustules, there are no persistent skin changes, only temporary hypo- or hyperpigmentation is possible. Superficial follicular pustules are observed with ostiofolliculitis, folliculitis, and sycosis vulgaris. Deep follicular pustules capture the entire hair follicle during their formation and are located within the entire dermis (deep folliculitis), often capturing the hypodermis - furuncle, carbuncle. At the same time, with a boil in the central part of the pustule, a necrotic rod is formed and after its healing, a scar remains; with a carbuncle, several necrotic rods are formed. Superficial non-follicular pustules - conflicts - have a tire, a bottom and a cavity with cloudy contents, surrounded by a halo of hyperemia. They are located in the epidermis and outwardly look like bubbles with precise contents. Seen with impetigo. When the pustule regresses, the exudate shrinks into crusts, after the rejection of which there is a temporary de- or hyperpigmentation. Deep non-follicular pustules - ecthymas - form ulcers with a purulent bottom, are observed in chronic ulcerative pyoderma, etc. Scars remain in their place. Pustules can also form around the excretory ducts of the sebaceous glands (for example, with acne vulgaris) and, since the sebaceous duct opens at the mouth of the hair follicle, are also follicular in nature. Deep pustules that have formed around the excretory ducts of the apocrine sweat glands with hydradenitis form deep abscesses that open through the fistulous tracts and leave scars behind.

Blister - a primary, stripless morphological element that occurs as a result of limited acute inflammatory edema of the papillary dermis and is characterized by ephemeral nature (exists from several minutes to several hours). Disappears without a trace. It usually occurs as an allergic reaction of an immediate, less often delayed type to endogenous or exogenous irritants. It is observed with insect bites, urticaria, toxidermia. Clinically, the blister is a dense raised element of rounded or irregular outlines, pink in color, sometimes with a whitish tinge in the center, accompanied by itching, burning.

Spot characterized by a local change in the color of the skin, without changes in its relief and consistency. Spots are vascular, pigmented and artificial. Vascular spots are divided into inflammatory and non-inflammatory. Inflammatory spots have a pink-red, sometimes with a bluish tinge, color and, when pressed, turn pale or disappear, and when the pressure stops, they restore their color. Depending on the size, they are divided into roseola (up to 1 cm in diameter) and erythema (from 1 to 5 cm or more in diameter). An example of a roseolous rash is syphilitic roseola, erythematous - manifestations of dermatitis, toxidermia, etc. Non-inflammatory spots are caused by vasodilation or impaired permeability of their walls, do not change color when pressed. In particular, under the influence of emotional factors (anger, fear, shame), reddening of the skin of the face, neck and upper chest is often noted, which is called erythema of modesty. This redness is due to short-term vasodilation. Persistent vasodilatation in the form of red vascular asterisks (telangiectasia) or cyanotic tree-like branching veins (livedo) occurs in diffuse diseases of the connective tissue, etc. If the permeability of the vascular walls is impaired, hemorrhagic non-inflammatory spots are formed due to the deposition of hemosiderin, which do not disappear with pressure and change color red to brownish-yellow ("bruise bloom"). Depending on the size and shape, they are divided into petechiae (dotted hemorrhages), purpura (up to 1 cm in diameter), vibices (strip-like, linear), ecchymosis (large, irregular outlines). Hemorrhagic spots are found in allergic angiitis of the skin, toxidermia, etc. Pigmented spots appear mainly when the content of the melanin pigment in the skin changes: with its excess, hyperpigmented spots are noted, and with a deficiency, hypo- or depigmented spots. These elements may be congenital or acquired. Congenital hyperpigmented spots are represented by birthmarks (nevi). Acquired hyperpigmented spots are freckles, chloasma, sunburn, depigmented - leukoderma, vitiligo. Albinism is manifested by congenital generalized depigmentation.

knot - the primary cavitary morphological element, characterized by a change in skin color, its relief, consistency and resolving, as a rule, without a trace. According to the depth of occurrence, epidermal nodules located within the epidermis (flat warts) are isolated; dermal, localized in the papular layer of the dermis (papular syphilides), and epidermodermal (papules in psoriasis, lichen planus, atopic dermatitis). Nodules can be inflammatory or non-inflammatory. The latter are formed as a result of the growth of the epidermis of the type of acanthosis (warts), the dermis of the type of papillomatosis (papilloma) or the deposition of metabolic products in the skin (xanthoma). Inflammatory papules are much more common: with psoriasis, secondary syphilis, lichen planus, eczema, etc. At the same time, acanthosis, granulosis, hyperkeratosis, parakeratosis can be observed from the epidermis, and cell infiltrate is deposited in the papillary layer of the dermis. Depending on the size, the nodules are miliary, or millet-like (1-3 mm in diameter), lenticular, or lenticular (0.5-0.7 cm in diameter) and numular, or coin-shaped (1-3 cm in diameter). In a number of dermatoses, papules grow peripherally and merge and form larger elements - plaques (for example, in psoriasis). Papules can be round, oval, polygonal (polycyclic) in shape, flat, hemispherical, conical (with a pointed apex) in shape, dense, densely elastic, doughy, soft in consistency. Sometimes a bubble forms on the surface of the nodule. Such elements are called papulo-vesicles, or seropapules (with prurigo).

tubercle - the primary cavitary infiltrative morphological element, which lies deep in the dermis. It is characterized by small size (from 0.5 to 1 cm in diameter), a change in skin color, its relief and consistency; leaves behind a scar or cicatricial atrophy. It is formed mainly in the reticular layer of the dermis due to the formation of an infectious granuloma. Clinically, it is quite similar to papules. The main difference is that the tubercles tend to ulcerate and leave scars behind. It is possible to resolve the tubercle without the stage of ulceration with the transition to cicatricial atrophy of the skin. Tubercles are observed in leprosy, skin tuberculosis, leishmaniasis, tertiary syphilis, etc.

Knot - Primary bandless infiltrative morphological element, which lies deep in the dermis and hypodermis and has large dimensions (from 2 to 10 cm or more in diameter). As the pathological process develops, as a rule, ulceration of the node occurs, followed by scarring. There are inflammatory nodes, such as syphilitic gummas, and non-inflammatory ones, formed as a result of deposition of metabolic products in the skin (xanthomas, etc.) or malignant proliferative processes (lymphoma).

In the presence of one type of primary morphological element of skin rashes (for example, only papules or only blisters), they speak of a monomorphic nature of the rash. In the case of the simultaneous existence of two or more different primary elements (for example, papules, vesicles, erythema), the rash is called polymorphic (for example, with eczema).

In contrast to the true one, a false (evolutionary) polymorphism of the rash is also distinguished, due to the occurrence of various secondary morphological elements.

Secondary morphological elements of skin rashes.

Secondary morphological elements include secondary hypo- and hyperpigmentations, fissures, excoriations, erosions, ulcers, scales, crusts, scars, lichenification, vegetation.

Hypo- and hyperpigmentation may be a secondary morphological element if it appears on the site of resorbed primary elements (papules, pustules, etc.). For example, in place of former papules in psoriasis, areas of depigmentation more often remain, exactly corresponding to the former primary elements, called pseudoleukoderma, and with regression of papules of lichen planus, hyperpigmentation usually remains, which persists for several weeks and even months.

Crack - a secondary morphological element, which is a linear violation of the integrity of the skin as a result of a decrease in skin elasticity. Cracks are divided into superficial (located within the epidermis, epithelialize and regress without a trace, for example, with eczema, neurodermatitis, etc.) and deep (localized within the epidermis and dermis, often bleed with the formation of hemorrhagic crusts, regress with the formation of a scar, for example, with congenital syphilis).

Excoriation - manifested by a violation of the integrity of the skin as a result of its mechanical damage during injuries and scratching. An abrasion can sometimes appear initially (with injuries). Depending on the depth of damage to the skin, excoriations can regress without a trace or with the formation of hypo- or hyperpigmentation.

Erosion occurs when the primary cavity morphological elements are opened and is a violation of the integrity of the skin or mucous membrane within the epidermis (epithelium). Erosions appear at the sites of vesicles, blisters or superficial pustules and have the same shape and size as the primary elements. Sometimes erosion can also form on papular rashes, especially when they are localized on the mucous membranes (erosive papular syphilis, erosive-ulcerative lichen planus). Erosion regression occurs by epithelialization and ends without a trace.

Ulcer - represents a violation of the integrity of the skin within the connective tissue layer of the dermis, and sometimes even the underlying tissues. Occurs when opening tubercles, nodes or deep pustules. In the ulcer, the bottom and edges are distinguished, which can be soft (tuberculosis) or dense (skin cancer). The bottom can be smooth (hard chancre) or uneven (chronic ulcerative pyoderma), covered with a variety of discharge, granulations. The edges are undermined, sheer, saucer-shaped. After healing of ulcers, scars always remain.

Flake - represents torn off horny plates that form peeling. Physiological peeling occurs constantly and is usually imperceptible. In pathological processes (hyperkeratosis, parakeratosis), peeling becomes much more pronounced. Depending on the size of the scales, peeling can be pityriasis (scales are small, delicate, as if powdering the skin), lamellar (larger scales) and large-lamellar (the stratum corneum is torn off in layers). Pityriasis peeling is observed with multi-colored lichen, rubrophytia, lamellar - with psoriasis, large-lamellar - with erythroderma. The scales are loose, easily removed (with psoriasis) or sit tight and removed with great difficulty (with lupus erythematosus). Silvery-white scales are characteristic of psoriasis, yellowish - for seborrhea, dark - for some varieties of ichthyosis. In some cases, the scales are impregnated with exudate and the formation of scale-crusts (with exudative psoriasis).

Crust - occurs when the contents of vesicles, blisters, pustules dry out. Depending on the type of exudate, the crusts can be serous, hemorrhagic, purulent, or mixed. The shape of the crusts is often irregular, although it corresponds to the contours of the primary lesions. Massive, multi-layered, conical, purulent-hemorrhagic crusts are called rupees.

Scar - occurs during the healing of ulcers, tubercles, nodes, deep pustules. It is a newly formed coarse fibrous connective tissue (collagen fibers). Scars can be superficial or deep, atrophic or hypertrophic. Within them, there are no appendages of the skin (stripes, sweat and sebaceous glands), the epidermis is smooth, shiny, sometimes looks like tissue paper. The color of fresh scars is red, then pigmented, and finally white. On the site of lesions that do not ulcerate, but are resolved “dryly”, the formation of cicatricial atrophy is possible: the skin is thinned, devoid of a normal pattern, and often sinks in comparison with the surrounding unchanged areas. Similar changes are noted in lupus erythematosus, scleroderma.

Lichenification (syn. Lichenization) - characterized by thickening, thickening of the skin due to papular infiltration, increased skin pattern. The skin within the foci of lichenification resembles shagreen. Such changes are often formed with persistent itchy dermatoses, manifested by papular efflorescences (atopic dermatitis, neurodermatitis, chronic eczema).

vegetation - characterized by the growth of the papillary dermis, has a villous appearance, reminiscent of cauliflower or cockscombs. Vegetations often occur at the bottom of erosive-ulcerative defects (wet vegetations) with vegetative pemphigus, on the surface of primary papular rashes (dry vegetations) with genital warts.

Clinical picture (symptoms and syndromes)

The rash can be a manifestation of both acute (measles, scarlet fever, chicken pox, etc.) and chronic (syphilis, tuberculosis, etc.) infectious diseases. So, with some infectious diseases (measles, chicken pox, scarlet fever) rashes appear necessarily, with others (rubella, typhoid-paratyphoid diseases) they are common (50-70%), with others (infectious mononucleosis, leptospirosis, viral hepatitis) are rarely observed. . An essential component of the characteristics of the rash is the presence or absence of fresh rashes, itching, or other subjective sensations at the site of the rash. It is necessary to take into account the duration and evolution of rashes: with typhoid fever and paratyphoid, unlike other diseases, roseola persist for 2-4 days, and then disappear without a trace. Vesicles on the mucous membranes of the mouth, lips, genitals are observed in chickenpox, herpes simplex and herpes zoster, foot and mouth disease; on the tonsils, mucous membrane of the posterior pharyngeal wall, uvula, anterior arches - with enterovirus infection (herpangina). In cases of some childhood infectious diseases, the rash is so characteristic that it makes it possible to unmistakably establish the cause of the disease only on the basis of the patient's appearance. In other cases, the nature of the rash is less specific, which makes it necessary to use additional diagnostic methods to determine the cause of the disease. On the other hand, in adults, the picture of "childhood" infections may be "atypical».

Chickenpox (chickenpox) is an acute viral disease caused by the herpes zoster virus (human herpes virus type 3). Chickenpox is an acute phase of the initial penetration of the virus into the body, and herpes zoster (shingles) is the result of reactivation of the virus. Chickenpox is highly contagious. The disease is transmitted by airborne droplets. The patient begins to be contagious 48 hours before the onset of the first rash, and contagiousness persists until the last rash covers with scabs (crusts). However, the most contagious are patients in the initial (prodromal) period of the disease and at the time of the appearance of rashes. Chickenpox epidemics usually occur in winter and early spring. In adults who did not have chickenpox in childhood and in children with weak immunity, the infection can be severe. Approximately 10-15 days after contact with the source of infection, 24-36 hours before the onset of rashes, a headache appears, a low temperature and general malaise are observed. Against the background of general malaise, after 1-2 days from the onset of the disease, rashes appear on the skin and mucous membranes. Primary rashes, in the form of spots, may be accompanied by a short reddening of the skin. Over a period of several hours, the spots develop into papules (nodules) and then into characteristic vesicles (vesicles) with a red base filled with a clear liquid, which usually cause severe itching. The rash first appears on the face and trunk. The rash may cover large areas of skin (in more severe cases) or limited areas, but almost always involves the upper body. Ulcers may appear on mucous membranes, including the oropharynx and upper respiratory tract, mucous membranes of the eyes, genitals, and rectum. In the mouth, the bubbles immediately burst and are no different from the bubbles in herpetic stomatitis. These ulcers cause pain when swallowing. By about the 5th day of illness, the appearance of new rashes stops, and by the 6th day of chickenpox, most of the rashes are already covered with crusts. Most of the crusts fall off before the 20th day from the onset of the disease. The contents of the vesicles can undergo bacterial infection (usually streptococcal or staphylococcal), in which pyoderma is observed (rarely, streptococcal toxic shock). In adults, newborns, and immunosuppressed patients, chickenpox may be complicated by pneumonia. There are also complications such as myocarditis, transient arthritis or hepatitis, internal bleeding. Very rarely, usually by the end of the disease or within 2 weeks after recovery, encephalopathy may develop. Chickenpox is suspected in patients with a characteristic rash and disease course. Chickenpox rashes can be confused with rashes in other viral diseases. If the diagnosis of chickenpox is uncertain, laboratory tests may be performed to establish the virus. The analysis is taken by scraping from the affected areas of the skin. Severe or even fatal forms of the disease occur in adults, in immunocompromised patients, and in patients treated with chemotherapy or corticosteroids. Once transferred the disease usually leaves lifelong immunity. However, in an adult, reactivation of the virus and the development of herpes zoster are possible. All healthy children and susceptible adults, especially women of childbearing age and those with chronic illnesses, should be vaccinated. Chickenpox vaccination contains live attenuated viruses and rarely leads to the development of a disease that occurs in a mild form - no more than 10 papules or vesicles and mild general symptoms of malaise.

Measles is a contagious viral disease whose main symptoms are fever (fever), cough, conjunctivitis, and a characteristic rash. Most often, measles occurs in children, but adults who have not had measles in childhood can also get it. Measles is so contagious that even minor contact between a susceptible person and a sick person can lead to infection and the development of the disease. After an incubation period of approximately 10 days, the patient develops a fever, reddened and watery eyes, copious nasal discharge, and a reddened throat. Because of these symptoms, measles is often mistaken for a bad cold. After 48-96 hours from the onset of the disease, a patchy rash appears, and the temperature rises to 40 ° C. 36 hours before the onset of a rash, typical spots appear on the oral mucosa, called Filatov-Koplik spots - whitish specks surrounded by a bright red spot up to 0.75 mm in diameter. After 1-2 days, the rash darkens, and then gradually discolors, the temperature drops sharply, and the runny nose disappears. Measles should be distinguished from other diseases accompanied by a rash. In the absence of complications, measles lasts about 10 days. Complications of measles are quite common (otitis media, pneumonia). Rarely, encephalitis may develop. The measles virus can attack various body systems and provoke hepatitis, appendicitis, and even gangrene of the extremities. Thanks to the treatment of complications of measles with antibiotics and sulfonamides, measles-related mortality decreased significantly in the 20th century. By the end of the 60s, active vaccination began around the world, but, contrary to expectations, the occurrence of measles is still high around the world. As a rule, once transferred measles leaves immunity for life. Babies under 4-5 months of age are immune to measles if their mother is immune to the disease.

Rubella- pale, patchy erythema (reddening of the skin), especially on the face. On the second day, the rash is more reminiscent of those with scarlet fever - small red dots on a reddish background. The rash lasts 3 to 5 days. In children with rubella, the most common symptoms of the disease may be mild malaise, joint pain. In adult patients with rubella, general signs of intoxication of the disease are more common than in children and include fever, severe malaise, headache, limited joint mobility, transient arthritis, and mild runny nose. The temperature usually returns to normal on the second day after the onset of the rash. A serious complication of rubella can be encephalitis, thrombocytopenic purpura, and otitis media (inflammation of the middle ear). Fortunately, these complications are extremely rare. Rubella is suspected in patients with a characteristic rash and lymphadenitis. Laboratory tests are performed only in pregnant women, patients with encephalitis and in newborns, since rubella is especially dangerous in such cases. Rubella must be distinguished from measles, scarlet fever, secondary syphilis, drug-induced rashes, erythema infectiosum, and infectious mononucleosis. Rubella differs from measles in having a less pronounced and less prolonged rash, less pronounced and less prolonged general signs of the disease, and the absence of Koplik's spots and cough. Scarlet fever is characterized by more severe general signs of intoxication and more pronounced pharyngitis, which occurs on the first day of the disease. In secondary syphilis, enlarged lymph nodes are not painful, and the rash is more pronounced on the palms and feet. With mononucleosis, angina often develops and an increase in all groups of lymph nodes is observed. There is no specific treatment. The main measures are aimed at combating the symptoms of the disease (symptomatic treatment) - antipyretic and antihistamine drugs. In more than 95% of cases of vaccination, the rubella vaccine leaves permanent immunity for more than 15 years. A vaccinated person is not contagious and does not pose a threat to others.
Rubella vaccination is given to children and all susceptible older persons, especially students, recruits, medical personnel and those who work with young children. Children rarely develop a fever, rash, swollen lymph nodes, and transient arthritis after the vaccine. Adults, especially women, may experience painful swelling of the joints. Rubella and pregnancy . Rubella vaccination is contraindicated in immunocompromised persons and pregnant women. Women who have been vaccinated against rubella are advised not to conceive a child for at least 28 days after vaccination. Intrauterine fetal rubella can have an extremely negative impact on the development of pregnancy up to its termination or the occurrence of fetal malformations.

Scarlet fever- an acute infectious disease, the causative agent of which is hemolytic streptococcus, most often Streptococcus pyogenes. Scarlet fever can affect both adults and children, but the disease is more common in children.
Before the advent of antibiotics, scarlet fever was considered a very dangerous, even fatal disease, with serious complications. Fortunately, today scarlet fever is less common and in less severe forms.
With timely antibiotic treatment, a quick and complete recovery occurs. Most of the possible complications of scarlet fever can be prevented with an adequate course of treatment. More often this disease occurs in children older than two years, and the peak incidence of scarlet fever occurs between 6 and 12 years. Scarlet fever is more common in temperate zones. The disease is transmitted by airborne droplets, sneezing and coughing. Also, they can be transmitted through contaminated objects or dirty hands. The source of scarlet fever pathogens are sick children or carriers of the infection. The incubation period for scarlet fever lasts 1-7 days. Usually the disease begins with a sharp increase in temperature, vomiting and severe sore throat (tonsillitis). Also, the patient has a headache, chills and weakness. Between 12 and 24 hours after the fever rises, a characteristic bright red rash appears. Sometimes patients complain of severe abdominal pain. In typical cases of scarlet fever, the temperature rises to 39.5 °C or more. There is reddening of the throat, the tonsils are enlarged, red and covered with or purulent discharge. Submandibular salivary glands inflamed and painful. At the beginning of the disease, the tip and edges of the tongue are red, and the rest of the parts are white. On the third or fourth day of illness, the white coating disappears, and the whole tongue acquires a bright crimson color. The bright red rash that appears shortly after a fever is described as "goose bumps in the sun." The skin is covered with small red dots that disappear when pressed and have a rough surface to the touch. Usually the rash covers the entire body, except for the area around the mouth. For a rash with scarlet fever, desquamation (peeling) is characteristic, which occurs by the end of the first week of the disease. The skin peels off in the form of small flakes, similar to bran. As a rule, the skin on the palms and heels is the last to peel off (not earlier than the second or third week of the disease). Peeling of the skin is caused by a special streptococcus toxin, which causes the death of the skin epithelium. Early complications of scarlet fever usually occur in the first week of illness. The infection can spread from the tonsils, causing inflammation of the middle ear (otitis media), inflammation of the paranasal sinuses (sinusitis), or lymph nodes in the neck (lymphadenitis). A rare complication is bronchopneumonia. Even less common are osteomyelitis (inflammation of the bone), mastoiditis (inflammation of the bony area behind the ear), and sepsis (blood poisoning). With timely, proper treatment, these complications are extremely rare. The most dangerous late complications of scarlet fever: rheumatism, glomerulonephritis (inflammation of the urinary tissues of the kidneys), chorea. Prevention of scarlet fever is the timely detection and isolation of patients with scarlet fever (especially from other children). Persons in contact with a patient with scarlet fever are advised to wear sterile gauze masks and strictly observe personal hygiene.

Rosacea- this is a fairly common papulo-pustular disease of the follicles of the sebaceous glands, but not accompanied by comedones. It is localized mainly in the center of the face, but can occasionally spread to the forehead and scalp. In most cases, an erythematous base with telangiectasias (stage I: erythematous rosacea) develops various sizes of inflamed, hyperemic nodules, in the center of which there may be a pustule (stage II: rosacea papular or pustular. Diffuse tissue hyperplasia, especially in the nasal region, can lead to to the development of rhinophyma.The etiology is unknown.

Shingles characterized by a segmental and, as a rule, one-sided arrangement of groups of vesicles that develop on an erythematous base. After the rash resolves, scars and areas of depigmentation may remain. At the eruption stage, groups of vesicles develop sequentially, one after another, so the degree of vesicle development within one group is approximately the same, but may differ from group to group. Fully developed vesicles have a slight depression at the top. Shingles is caused by the same virus as chicken pox, the Varizella-Zoster virus, a herpesvirus. Both diseases are different clinical forms of a single infectious process. A neurotropic viral disease develops either as a result of reinfection of the virus with reduced immunity (incubation period of 7-14 days), or with a decrease in the body's resistance or immunosuppression, it occurs in the form of zoster symptomaticus as a result of reactivation of the virus that persists in the glial cells of the spinal ganglia. The disease begins acutely with a feeling of malaise and mild fever (prodromal stage). Bubbles occur in the zone of innervation of one or more sensory spinal ganglia (zoster segmentalis or zoster multiplex) and in the corresponding area of ​​the head. The pains are severe, burning, and may also precede the onset of exanthema. The disease can be localized not only in the region of the belt, as the term "shingles" indicates, but also in other areas (a case of shingles of the trigeminal nerve is known). With the spread of herpes zoster in the region of the 1st branch of the trigeminal nerve, the eye (zoster opticus or ophtalmicus) may also suffer. In such cases, an urgent consultation with an ophthalmologist and joint management of the patient is indicated, especially if there is a risk of damage to the cornea. Eye damage caused by the herpes simplex virus basically corresponds to the symptoms of keratitis. Keratitis is sometimes accompanied by uveitis, which can lead to severe and long-term persistent secondary glaucoma. In the anterior part of the eye, follicular conjunctivitis and episcleritis may also develop. When the facial nerve is damaged, the phenomena of paralysis and neuralgia are observed. Other complications include zoster meningitis and encephalitis (meningoencephalitis). If there are no complications in the form of hemorrhage, ulceration or necrosis, then the disease resolves within 2-3 weeks without leaving scars. Relapses happen, immunity, as a rule, lasts for life. Sometimes segmental localization is disturbed, and the rashes move to neighboring or more distant areas, or even spread to all skin integuments in the form of generalized herpes zoster. Shingles can occur as a concomitant disease, for example, with leukemia, Hodgkin's and non-Hodgkin's lymphomas. From the point of view of differential diagnosis, erysipelas, herpes simplex are considered, and with generalized herpes zoster - chicken pox.

Herpes simplex, which depending on the location is also called herpes of the lips or genital herpes, is a reactivated latent infection of one of two types of virus: HSV-1 (the so-called oral strain) or HSV-2 (the so-called genital strain). After a primary infection in childhood, the virus persists in the affected ganglion cells, spreading from them, colonizes the epithelial cells of the skin, where it multiplies. Reactivation of the virus depends on irritation of the infected neuron, which can be caused by infections with fever, strong ultraviolet radiation (ultraviolet burn in high altitude areas), gastrointestinal dysfunction, and weakening of the immune system due to carcinoma, leukemia, or cytostatic therapy. The blisters appear on an erythematous base and are preceded by itching, skin tightness, and localized burning. After the opening of the blisters, weeping rashes form, which become covered with a crust for several days, and a painful enlargement of the regional lymph nodes is often observed. The segmental arrangement of lesions for herpes simplex is not typical.

1. It is necessary to find out exactly whether there is a connection between rash and underlying disease. Most often, rash as a secondary phenomenon in hospitalized patients is associated with an allergic reaction to drugs, the most likely reaction to antibiotics. The timing of the rash may coincide with the onset of the disease; in addition, in hospitalized patients, any of the disorders listed in paragraphs 2-5 may occur as a secondary disease. Drug rash most often appears as an erythematous-spotted rash localized on the trunk and extremities, but not affecting the palms and soles of the feet, or in the form of classic urticarial allergic manifestations. Stevens-Johnson syndrome is a life-threatening condition in which a rash appears on the mucous membranes, a positive effect can be obtained with the use of glucocorticoids.

toxic shock syndrome- a life-threatening disease characterized by acute damage to multiple body systems. The disease is caused by toxins produced by Staphylococcus aureus (S aureus) or Streptococcus aureus. When the disease is caused by streptococcus, it is called streptococcal toxic shock syndrome.
The greatest risk of developing toxic shock occurs in young girls and women who use vaginal tampons during menstruation.
Toxic shock syndrome is an extremely serious disease and can lead to death even with adequate intensive care. The onset is abrupt and is characterized by high fever, chills, pharyngitis, and, in some cases, diarrhea and vomiting. Also, the patient may have low blood pressure (shock), disorientation, fainting, severe drowsiness and weakness. The rash in toxic shock syndrome resembles a sunburn. If you suspect that the patient may have toxic shock syndrome, call an ambulance immediately.

Hemorrhagic rash. There is another type of rash that requires immediate medical attention. This type of rash is called pinpoint hemorrhage (petechia) or hemorrhagic rash (purpura). This rash is caused by ruptured blood vessels under the skin. Petechiae look like small, red, flat dots (as if someone drew them with a thin red pen). Purpura is characterized by large spots, which may have a darker (purple or blue) hue. There are two most important signs of this rash: firstly, it does not disappear and does not turn pale when pressed. secondly, they are absolutely flat and cannot be felt with fingers. If you suspect that the patient has a hemorrhagic rash, immediately consult a doctor, call an ambulance, or take the patient to the emergency room. It is important to take the necessary measures within a few hours after the appearance of the rash.

allergic rash observed in serum sickness, food and drug allergies. With serum sickness against the background of the underlying disease, for example, diphtheria, botulism, tetanus, etc., a rash appears in a week after the introduction of heterologous serum. The nature of the rash can be varied: spotted, maculopapular, medium and large sizes. A urticarial rash is very characteristic. The rash is necessarily accompanied by itching. The rash is located everywhere: on the face, trunk, limbs, but most of all around the joints and at the site of serum injection. Food and drug allergies most often it happens on sulfanilamide preparations, ampicillin, vitamins, etc. The rash is diverse, of various sizes, itchy. It is typical to add elements under the condition of continued exposure to the allergen. With the abolition of the drug, food, and after the introduction of antihistamines, glucocorticosteroids, the rash quickly disappears. It usually does not leave a mark, but pigmentation may fade quickly.

Multiform exudative erythema. Such erythema, like nodular, has an infectious-allergic nature. It is characterized by a rash: spotted or papular; round shape; diameter 3 - 15 mm; sharp boundaries; pink or bright red; centrifugal growth with retraction and lighter coloration of the central part; sometimes separate spots merge, forming figures in the form of garlands. The skin is affected symmetrically and quite widely. The rash is localized mainly on the extensor surfaces of the extremities, more often the forearms, less often the shins, rear of the foot, face, neck. Often, erythema is preceded by fever, pain in the throat, joints, etc. Syndrome Steven - Johnson refers to the variants of the course of erythema multiforme exudative. The mechanism of development of the syndrome is associated with allergic reactions of the immediate type, proceeding according to the type of the Arthus phenomenon. Most often, it develops with allergic reactions to medications: sulfa drugs, pyrazolone derivatives, antibiotics, etc. The onset of the disease is acute, stormy, with fever lasting from several days to 2-3 weeks. There are sore throats, increased blood circulation of the mucous membranes, runny nose, conjunctivitis, hypersalivation, joint pain. From the first hours there is a progressive lesion of the skin and mucous membranes in the form of painless dark red spots on the neck, face, chest, limbs, even the palms and soles. Along with this, papules, vesicles, blisters appear. Quite rarely, large blisters with serous-bloody contents can form. Lesions tend to coalesce. Lyell's syndrome or toxic epidermal necrolysis is an allergic reaction to: infectious, mainly staphylococcal, process; taking medications (antibiotics, sulfonamides, analgesics); blood transfusion and its components. In the appearance and development of the disease, the "explosive" release of lysosomal (splitting) enzymes in the skin is of primary importance. The disease begins acutely with chills, fever, sore throat, lower back, joints, as well as burning and soreness of the skin. Then quickly appear large erythematous spots of various sizes, often merging, and spread throughout the body in a few hours. Vesicles, papules, blisters, and then large, flat, flabby blisters appear on some areas of the skin at the site of the spots. On other parts of the skin - hemorrhages. In areas of the skin subjected to friction with clothing, the surface layers of the skin exfoliate, regardless of the presence or absence of blisters. Nikolsky's symptom (exfoliation of the epidermis when pressed) is positive. The patient outwardly looks like a second-degree burn. With this syndrome, the mucous membranes of the mouth and eyes can also be affected. During the course of the disease, toxicosis is pronounced, myocarditis, nephritis, and hepatitis often develop. Urticaria i is one of the most common allergic skin lesions. In children, allergens are most often food substances. A few minutes or hours after eating allergens, the patient feels tingling of the tongue, lips, palate, swelling in these places, often sharp pains in the abdomen. Erythema appears on the skin of the face, which later spreads to other parts of the body. At the site of erythema, urticarial, severely itchy elements appear. Rashes have a diverse character: nodules, blisters of various sizes and bizarre shapes. Conjunctivitis is often observed at the same time, less often difficulty in breathing due to laryngeal edema, etc. There are immune and non-immune forms of urticaria. Angioedema or giant urticaria, Quincke's edema one of the most common allergic skin lesions. With angioedema, significant, well-defined edema is detected. Such swelling can occur in any part of the body, but more often occur in the lips, tongue, eyes, hands, feet, genitals. Edema can migrate. With angioedema, common symptoms are possible: fever, agitation, arthralgia, collapse. Erythroderma Hill. This is one of the most severe variants of the course of neurodermatitis. The skin of the whole body becomes red, resembles a goose, in many places it becomes lichenified, flaky with bran-like scales. Characterized by excruciating itching. There is no tendency to vesiculation and weeping. In blood the sharp eosinophilia comes to light.

erythema nodosum - this is an allergic inflammation of the walls of small blood vessels. The causes of the development of erythema nodosum are diverse and can be both infectious (Diseases caused by group A β-hemolytic streptococcus, tuberculosis, yersiniosis, chlamydia, coccidioidomycosis, histoplasmosis, psittacosis, lymphogranuloma venereal, ornithosis, measles, disease cat scratches, protozoal infections), and non-infectious (sarcoidosis, ulcerative colitis, regional ileitis, Hodgkin's disease, lymphosarcoma, leukemia, Reiter's disease, Behcet's syndrome, due to the use of drugs: sulfonamides, bromides). Diseases accompanied by the development of erythema nodosum are usually passes sharply. There are relapses with an interval of several months and even years. Chronic forms of the disease, in which nodules persist for several years, are rare. Some patients, even despite widespread skin manifestations, feel quite well. Others feel general malaise, fever, chills, anorexia, weight loss. The body temperature most often rises slightly, but can reach 40.5 ° C. Sometimes the fever lasts more than 2 weeks. Skin rashes usually appear suddenly, in the form of erythematous, painful, slightly raised nodules above the skin surface. The diameter of each nodule ranges from 0.5 to 5 cm. The skin over the nodule is reddish, smooth, and shiny. Individual nodules coalesce to form indurations that can cause significant swelling. Itching is absent. Usually, within 1 to 3 weeks, the color of the nodules changes: at first they are bright red, then blue, green, yellow, and finally dark red or purple. The discoloration of the skin near the nodules is similar to that in the development of a bruise. After 1 to 3 weeks, the nodules spontaneously resolve without ulceration, scarring, or permanent pigmentation. For erythema nodosum, a certain dynamics of the process is characteristic: the distribution of nodules goes from the central element to the periphery, and the disappearance also begins from the central part. Skin elements can be located in all places where there is subcutaneous fatty tissue, including on the calves, thighs, buttocks , as well as in inconspicuous areas, for example, the episclera of the eyeball. Favorite localization is on the front surfaces of both legs. Less commonly on the extensor surface of the forearms. Most often, rashes are single and are located only on one side. However, the described clinical features of the course of the disease are inconsistent, because to. there are other variants of the clinical course of erythema nodosum. A characteristic sign of erythema nodosum is adenopathy of the roots of the lungs on one or both sides. It is usually asymptomatic, seen on chest x-ray, and may persist for months. One in three patients have signs of arthritis. Usually, large joints of the extremities (knee, elbow, wrist and tarsal joints) are symmetrically affected, less often small joints of the hands and feet. Most children experience arthralgia that accompanies the febrile period of the disease, or precedes it for several weeks. Articular syndrome can last for several months, but there is no deformation of the joints.

Rash in diseases of the connective tissue, blood, blood vessels.

For skin lesions dermatomyositis characterized by the presence of purple erythema. Preferential localization: around the eyes, on the neck, torso, outer surface of the limbs. There are also capillaritis, cyanotic coloration of the feet and hands, excessive sweating, cold extremities. Edema can be focal and widespread, soft and dense. In severe cases, tissue nutrition is disrupted with the formation of superficial or deep necrosis. All patients have lesions of the mucous membranes - petechiae, ulcers, atrophy of the papillae of the tongue, erosive and ulcerative stomatitis, rhinitis, conjunctivitis. Muscles are involved in the process symmetrically. Muscle weakness, muscle pain, progressive weight loss are noted. A critical situation is created by damage to the respiratory and pharyngeal muscles. A characteristic and frequent sign of dermatomyositis is a decrease in calcium in the muscles. Damage to internal organs is represented by diseases of the lungs (pneumonia, atelectasis), heart (myocarditis, myocardial dystrophy), gastrointestinal tract (ulcerative esophagitis, enteritis). Damage to the nervous system is distinguished by a wide variety of clinical symptoms: encephalitis, paresis, paralysis, neuritis, psychosis. In the diagnosis of the disease, particular importance is attached to: increased activity of enzymes: creatine phosphokinase, lactate dehydrogenase, aspartate and alanine aminotransferase; electromyography data, in which low-amplitude electrical activity is determined; muscle biopsy, which is most often performed in the area of ​​​​the shoulder or thigh, and in which the dissolution of necrotic muscle fibers, inflammation of the walls of blood vessels, and clumpy decay of nerve fibers are detected.

Systemic scleroderma (SD). Characterized by progressive vasomotor disorders of the type of Raynaud's syndrome, trophic disorders with gradually developing thickening of the skin and periarticular tissues, the formation of contractures, osteolysis, slowly developing sclerotic changes in internal organs (lungs, heart, esophagus). The skin on the affected areas is initially somewhat edematous, reddish, then thickens, acquires an ivory color, followed by a transition to atrophy. In the future, new areas of the skin are involved in the process. A triad of signs is considered to be a reliable early diagnostic criterion for DM: Raynaud's syndrome, articular syndrome and dense skin edema; sometimes this triad can be combined with one of the visceral manifestations.

Systemic scleroderma is characterized by: progressive narrowing of blood vessels by the type of Raynaud's syndrome; disorders of the regulatory influence of the nervous system; gradually developing thickening of the skin, muscles, tendons, connective tissue membranes of muscles; the formation of persistent spasms; resorption of bone tissue; slowly developing seals in the lungs, heart, esophagus. The skin on the affected areas is initially somewhat swollen, reddish, then thickens, becomes ivory. Then comes atrophy. In the future, new areas of the skin are involved in the process.

A reliable early diagnostic criterion for systemic scleroderma is a triad of signs: Raynaud's syndrome; articular syndrome; dense swelling of the skin. Sometimes this triad can be combined with one of the inner manifestations.

Systemic lupus erythematosus (SLE). For systemic lupus erythematosus, a skin syndrome is very typical. The picture of the disease consists of characteristic symptoms: erythematous rashes on the face in the form of a butterfly, located on the bridge of the nose and both cheeks; migratory polyarthritis; inflammation of any structures of the heart; kidney damage, most often nephrotic syndrome; defeat the walls of the alveoli in the lungs; damage to the cerebral vessels; fever; weight loss; increased ESR; increased levels of immunoglobulins in the blood. The presence of LE cells, antinuclear factor (ANF), a decrease in complement titer, cytopenia confirm the diagnosis.

Particularly typical for systemic lupus erythematosus is a lesion of the facial skin in the form of disseminated edematous erythema with sharp borders resembling erysipelas. The rash may spread to the trunk and limbs. The rash consists of blisters and necrotic ulcers. The elements leave behind atrophic superficial scars and patchy pigmentation. Urticaria and a morbilliform rash may also be seen. Diagnostic criteria for SLE are as follows: erythema on the face (“butterfly”); discoid lupus; Raynaud's syndrome (spasms of the arteries provoked by low temperature); alopecia; increased sensitivity of the body to the action of ultraviolet radiation; ulceration in the mouth or nasopharynx; arthritis without deformity;

LE cells (lupus erythematosus cells); false positive Wasserman reaction;

proteinuria (more than 3.5 g of protein in the urine per day); cylindruria; pleurisy, pericarditis; psychosis, convulsions; hemolytic anemia, leukopenia, thrombocytopenia; presence of ANF. The combination of any 4 of the above criteria allows diagnosing systemic lupus erythematosus with a certain certainty. The reliability of the diagnosis is significantly increased if one of the four criteria is "butterfly", LE cells, antinuclear factor in high titer, the presence of hematoxylin bodies.

Thrombocytopenic purpura. Hemorrhages in thrombocytopenia are observed in all organs. They are most dangerous in relation to the central nervous system, since they can often lead to sudden death. Unlike coagulopathy in thrombocytopenia, bleeding develops immediately after the appearance of rashes. Spontaneous bleeding occurs most often with a decrease in the number of platelets less than 30,000/µl. Tiny petechial bleeding in the acute form of idiopathic thrombocytopenic purpura (acute ITP) is barely noticeable. Acute ITP develops predominantly in childhood, but it also occurs in adolescents and adults. The platelet count drops below 20,000/µl in a few weeks. In this syndrome, there is a significant tendency to spontaneous remission (> 80%). The number of platelets in the peripheral blood in chronic thrombocytopenic purpura, Werlhof's disease ranges between 10,000 and 70,000/µl. The preferred location of purpura is the shins. Werlhof's disease develops more often in women, usually begins imperceptibly, before the age of 20. An unequivocal relationship of acquired disorders of thrombocytopoiesis with infections, medication, or exposure to allergens has not been established. The tendency to spontaneous remission is insignificant (10-20%). From the point of view of differential diagnosis, in particular, thrombocytopenia in another primary disease, such as systemic lupus erythematosus, should be excluded. Microscopy reveals giant and fragmentary forms of platelets, the number of megakaryocytes in the bone marrow increases strongly with a shift to the left. In many cases antibodies to platelets are present. Rare syndromes with thrombocytopenia include thrombotic thrombocytopenic purpura (Moshkovich's syndrome) and hemolytic uremic syndrome (Gasser's syndrome). In a number of hereditary and acquired diseases, platelet dysfunction (thrombocytopathy) can lead to an increased tendency to bleed. Such diseases include dysproteinemia, Glanzmann-Negeli thrombasthenia and Wiskott-Aldrich syndrome.

When purpura of Shenlein - Henoch, primary systemic necrotizing leukocytoclastic immunocomplex small vessel vasculitis, there is palpable purpura of the skin and involvement of the joints, intestines, and kidneys. Schönlein-Henoch purpura occurs in children and adolescents, but is increasingly common in adulthood (male:female = 2:1). In 60% of patients, the disease is preceded by bacterial or viral infections. Vasculitis of the skin manifests itself in the form of a symmetrical exanthema with localization on the extensor surfaces of the legs, as well as in the buttocks and sometimes in other parts of the body. The Rumpel-Leede test is positive. From a clinical and morphological point of view, the more common hemorrhagic, necrotic-ulcerative and mixed forms are distinguished. Under pressure with a glass spatula, the main rashes do not turn pale. Without recurrence, the disease usually lasts 4-6 weeks (mortality: 3-10%).

CAUSES OF LONG-TERM RASHES: Eczema is a fairly common disease. In essence, this is inflammation of the skin, accompanied by severe itching. The skin becomes red, dry and flaky. In places affected by eczema, the skin thickens, cracks, it is chronically infected. Combed areas tend to bleed and get wet. Eczema begins with a rash of many pink blisters just under the top layer of the skin, which cause intense itching. There are several types of eczema, and each requires individual treatment. The most common eczemas in children are atopic eczema (also known as infantile eczema) and seborrheic eczema, which are treated differently. Atopic eczema, which affects 12% of children, has one distinctive feature: many children "outgrow" it by the age of three, and 90% get rid of it forever by the age of eight. There are two more types of fairly common eczema - contact eczema (contact dermatitis) and blistering eczema. Contact eczema results from exposure of the skin to chemical irritants that cause local skin irritation. These irritants can include certain creams, laundry detergents, metals used to make jewelry, and certain plants. Blistering eczema usually appears on the fingers and toes during the warm season. Both types of eczema also affect adults. Almost always the cause is a hereditary factor. If someone in the family - parents, sisters or brothers - were exposed to the same eczema, in 50% of cases a newborn may develop atopic eczema. It is associated with hay fever, asthma, purulent inflammation of the ears, and also with migraines. Factors that cause eczema: wool, laundry detergents with bioadditives, detergents, fluff and dander of pets and birds, parental smoking, emotional factors, house dust mites, foods, food additives and dyes.

seborrheic eczema occurs in both adolescents and adults, as well as in infants. It affects areas of the skin where fatty glands are concentrated, forming a thick yellow crust on the skin. Head eczema in an infant is a prime example of this disease. Most newborns develop scabs on their head in the first weeks of life. Then the skin naturally clears itself of them. Such crusts are often found on the cheeks, neck and along the hairline on the head, especially a lot of them behind the ears. Scabs may appear on the eyelids and on the outer part of the external auditory canal. On the face, seborrheic eczema is located in those places where the sebaceous glands are concentrated, for example, around the nostrils. Eruptions also occur in the groin. Note that seborrheic eczema does not itch like atopic eczema and is easily treatable.

At psoriasis a rash appears, which is often mistaken for eczema. But the location of the rash in psoriasis, its cause and treatment are not at all the same as in eczema. Unlike eczema, psoriasis rarely occurs in children under two years of age and is more common in older children. About 1% of the adult population of various ages suffer from psoriasis.
As a rule, this is a hereditary disease, any common infection can provoke it, for example, you can simply catch a cold. In children, the disease begins with an extensive rash in the form of small dry plaques on the skin, round or oval in shape, red-pink in color. Above the redness, a characteristic silvery peeling is clearly defined, which is constantly crumbling. The distribution of the rash on the body is characteristic only for psoriasis - mainly on the elbows, knees and head. But often rashes occur on the ears, chest and upper part of the fold between the buttocks. In infants, psoriasis sometimes causes a continuous and extensive diaper rash (diaper psoriasis). Luckily, psoriasis rashes don't itch as much as eczema rashes. The apparent cause of psoriasis is the accelerated growth of skin cells. But why this happens is still unknown. The patchy form of psoriasis, guttate, found in infants, usually lasts three months, then suddenly disappears. However, it may recur in the next five years and then in adulthood.

Mycoses of the skin(fungal infections). Arising at first as a separate speck, the fungal infection gradually becomes a common rash on wet areas of the body - in the groin, between the fingers, under the armpits and on the face. Often oval spots appear on the legs. On the head, spots are located in places of baldness. Between the toes, the infection forms a wet, white swelling known as athlete's foot. A fungal infection can be transmitted by touch alone. It can be obtained in the bathroom, in the shower, in any permanently humid environment.

Ringworm pityriasis, synonym - versicolor, philistine name - solar fungus. The cause of the disease is a fungus belonging to the group of keratomycosis. To date, under microscopy, three forms of one pathogen are distinguished: round, oval, mycelial, capable of passing into each other. The incubation period ranges from two weeks to months. For a long time, the fungus can live on the skin without causing external manifestations of the disease. Concomitant and predisposing factors of the disease are endocrine pathologies, sweating, weakening of the immune system, stressful situations for the skin (sunbed, excessive tanning, frequent use of antibacterial soaps and shower gels, etc.), which violate the natural protective function of the skin. External manifestations of the disease become especially noticeable in the summer, when lighter (hypopigmented) spots clearly stand out against the background of tanned skin. The shape of the spots is rounded, with clear boundaries. Diameter 0.5-2.0 cm. The foci tend to merge into large areas. Typical localization is the area of ​​the back, chest, shoulders. The reason for their appearance is as follows. Reproducing in the epidermis (upper layer of the skin), the fungus causes disturbances in the work of melanocytes (cells responsible for the production of melanin pigment). It is thanks to melanin that under the influence of sunlight the body acquires a tan. Dicarboxylic acid produced by the fungus reduces the ability of melanocytes to synthesize pigment, resulting in hypopigmented areas. Such a clinical picture, in connection with a predominantly pronounced external manifestation under the influence of the rays of the sun, was the reason for another household name that can be found in resorts - “solar fungus”. There is another, outwardly opposite manifestation of pityriasis versicolor. More often in cold seasons, you can see spots with a brownish or yellowish-pink tint, rounded, with slight peeling. Localization of lesions is similar to those described above. The difference in the color of spots in different people, which can occur in the same person, explains the synonym for the name of pityriasis versicolor - versicolor. Unlike most fungal diseases, the risk of transmission of pityriasis versicolor from one person to another, even through close contact, is relatively small. However, its course in affected people is quite stubborn and can drag on for years. Diagnosis is carried out using the following methods: visual inspection using specific samples. As a result of the reproduction of the fungus, loosening of the cells of the epidermis occurs. Based on this phenomenon, the so-called Balzer test is used in the diagnosis. Spots and a nearby healthy area of ​​\u200b\u200bthe skin are smeared with a dye solution (usually a 3% -5% iodine tincture is used). As a result, the loose affected area of ​​the skin absorbs the dye to a greater extent. Its color becomes darker in relation to the unaffected.
Inspection under the rays of a Woods lamp, at which the foci give a characteristic glow.
Apply microscopy skin scraping, in which short filaments of the fungus with spores are found. Pityriasis versicolor responds well to treatment. Despite this, a long-term process with periodic exacerbations often occurs. The reason for relapses is non-compliance with therapeutic recommendations and preventive measures or the use of ineffective agents. The disease should be differentiated from vitiligo, pink lichen Zhibera, syphilitic roseola.

Diagnostics

1. Physical examination

In addition to the usual purposes of examination, four characteristics of the skin lesion should be determined:

You must first install character rashes - inflammatory or non-inflammatory, and in the presence of inflammation, determine whether they are acute, subacute or chronic.

Need to evaluate amount rash (abundant, sparse, single rash, single focus) and its localization, indicating the predominant areas of the lesion, less affected areas and places free from the rash

Symmetry or asymmetry lesions.

Accounting localization of skin lesions can be of great diagnostic value, since many skin diseases have a favorite localization. On the other hand, with widespread and disseminated processes, it should be noted the absence or presence of islands of clinically healthy skin, as well as their localization, the confinement of elements to the sebaceous-hairy structures and sweat glands (follicular, periporal elements, etc.), to the places of exposure to solar radiation ( lupus erythematosus), mechanical effects (epidermolysis bullosa, simple dermatitis).

Primary and secondary morphological elements should be considered. Not every morphological element found in a patient can be useful for establishing a diagnosis, and even with a widespread skin process, only a few diagnostically significant primary morphological elements can be found. The size, shape, outline, borders, color, surface, texture, and other signs of the rash should be considered. There is also a systematized rash - located along the nerve trunks, blood vessels, according to the distribution of dermatometamers, etc. It is necessary to note the presence or absence of fever.

Maculopapular rash, especially in young women who use tampons during menstruation, in the presence of a septic shock clinic, requires the exclusion of toxic shock syndrome; it is characteristic that in this syndrome the rash affects the palms and soles of the feet. Other causes of maculopapular rash include measles and other viral infections.

Nodulopapular rash if clinically appropriate, may be a sign of a disseminated granulomatous process, such as miliary tuberculosis (TB) or a fungal infection (eg, coccidioidomycosis, cryptococcosis, candidiasis). To determine the diagnosis, a biopsy with a histological and bacteriological examination of the biopsy is almost always indicated. At the same time, biopsy should be avoided in a patient with neutropenia.

Diagnosis of bacterial cellulitis (usually streptococcal or staphylococcal etiology, but sometimes caused by gram-negative microorganisms) is usually uncomplicated, except when the clinical manifestations resemble erythema nodosum. If erythema nodosum is suspected, a biopsy of the affected area is necessary.

Petechial and purpuric rashes usually accompany the most severe, life-threatening disease of the patient, among which meningococcemia ranks first in the “alarming” list. The key to the diagnosis is the results of a bacteriological blood test. Immediate prescription of antibiotics may play a decisive role; the condition in which such a rash appears should be regarded as urgent. Rocky Mountain spotted fever (American tick-borne rickettsiosis) and dengue fever can cause a purplish rash. In the presence of a petechial rash, the possibility of non-infection-related thrombocytopenia should be excluded.

Vesicular or bullous skin rashes usually indicate disseminated herpes zoster or herpes simplex in an immunocompromised patient; in this case, treatment with acyclovir is indicated. To determine the diagnosis, it is enough to make a bacteriological examination of the fluid from the blisters. Apart from disseminated herpes, the only other diagnosis of concern is staphylococcal toxic epidermal necrolysis (STEN) (scalded skin syndrome). Fragile bullae in STEN burst and expose the skin; they are easily distinguished from vesicular rashes in viral infections. The search for a primary staphylococcal infection and antibiotic therapy is of paramount importance in this syndrome. The rash is believed to be caused by a toxin produced by staphylococcus aureus. Bullous formations can occur with cellulitis on the border between healthy and affected skin with staphylococcal and streptococcal impetigo.

Long-term types of rash. The rash that accompanies childhood infections and allergies usually clears up after a few days. However, there are often types of rashes that do not go away for a very long time. The most common among them are eczema, psoriasis and fungal infection.

2. Anamnesis. The purpose of taking an anamnesis is also to determine the etiological factors that contribute to the onset of a rash. Both exogenous factors (mechanical, physical, chemical, infectious agents, etc.) and endogenous factors (endocrine disorders, metabolic disorders, hypo- and beriberi, intoxication of the body due to dysfunction of individual organs and systems, vascular disorders, common infectious diseases, hereditary factors), as well as the possibility of a complex influence of exogenous and endogenous factors. For example, chronic dermatoses accompanied by granulomatous morphological manifestations (lupus vulgaris, leprosy, etc.; develop and persist for many years. Skin diseases caused by exogenous factors: infectious (bacteria, viruses), physicochemical (solar, chemical burns) or allergic reactions (dermatitis, toxidermia), usually have an acute course.

Particular attention should be paid to the following points.

1. The evolution of defeat.

2. Symptoms associated with a rash (burning, itching, etc.).

3. Current or previous treatment - prescriptions and over-the-counter drugs.

4. Concomitant general symptoms.

5. Current or previous diseases.

6. Allergological history.

7. Photosensitivity.

8. State of functional systems.

3. Additional diagnostic examination

There are a number of special dermatological examination methods: the method of layer-by-layer scraping (grating) is used for skin lesions characterized by peeling; with the help of grafting in psoriasis, a diagnostic psoriatic triad is revealed: the phenomena of a stearin spot, a terminal film, and pinpoint bleeding; for tuberculosis, the method of diascopy is used - pressing on the elements of the rash with a glass slide to identify the diagnostic phenomenon of "apple jelly"; enlightenment method - the use of rubbing the focus with 5% acetic acid, can be useful for detecting small genital warts, etc. To establish the correct diagnosis of a skin disease, the data of a general clinical examination of the patient (central and peripheral nervous system, internal organs and other systems) are important , as well as examination of healthy skin and visible mucous membranes. At the same time, attention should be paid to their color, turgor, elasticity, the state of perspiration and sebum secretion, subcutaneous fatty tissue, dermographism. You need to know that healthy skin has a matte sheen and does not shine. Changes in the color of the skin and mucous membranes can be associated with various disorders of the internal organs and systems of the body. For example, hyperemia of the skin with some bluish tint can occur with diseases of the lungs and heart. With Addison's disease, the skin color is dark, with Botkin's disease - yellow. Paleness of the skin and mucous membranes indicates anemia, while the presence of pastosity or swelling along with this raises the suspicion of the possibility of heart or kidney disease. To determine the extensibility and elasticity of the skin, it is collected in a fold; the presence or absence of adhesion to the underlying tissues is determined by shifting the skin relative to the underlying tissues. Assess the condition of the sebaceous and sweat glands, nails and hair, dermographism.

When diagnosing a rash, the following tests may be performed (Additional tests are often required to establish a dermatological diagnosis, including):

1. Skin biopsy.

2. Microscopy of hair, nail scales after preliminary dissolution of their horny substance in a 30% KOH solution to detect a fungal infection.

3. Staining of a skin scraping taken from the base of the vesicle according to the Tsan-ka method to prove a herpes infection.

3. Diascopy to assess the extinction of vascular lesions.

4. Research in ultraviolet rays.

5. Skin prick tests to assess skin sensitivity to specific antigens (epicutaneous and intracutaneous skin tests for allergic conditions);

6. Mycological, bacteriological, virological, serological tests for dermatoses caused by microorganisms;

7. Immunofluorescent tests in autoimmune diseases

8. Angiographic studies for vascular disorders;

10. Biochemical analyzes;

11. X-ray examination,

12. Blood and urine tests;

13. Histological examination.

Treatment

Urgent care

In some cases, the rash will go away on its own - viral infectious diseases, such as measles, rubella, chickenpox. In the case of scarlet fever, it is necessary to prescribe antibacterial drugs. If a scabies mite is found, a simple treatment is necessary. If the rash is of an allergic nature, then the allergen should be determined using skin tests and its effect on the body should be excluded. In the case of skin diseases, it is necessary to be treated, they will not go away on their own, but only a doctor can prescribe treatment, taking into account the general condition of the body. If the skin rash is dry or itchy, ointments containing corticosteroids can help relieve symptoms. In very severe cases, corticosteroids are given by injection.

In any case, before going to the doctor, self-treatment is aimed at relieving symptoms - with an increase in temperature, take antipyretic drugs, with severe itching - antihistamines, patients prone to urticaria, Quincke's edema and knowing about the methods of stopping these conditions sometimes take a glucocorticosteroid tablet on their own while taking an antihistamine drug.

Conservative treatment

The treatment of a skin rash is essentially the treatment of the disease that caused it.

1. Treatment of viral "Children's Infections" symptomatic and includes temperature control (antipyretics), bed rest. It is very important to take steps to relieve itching and prevent scratching, which predisposes to a secondary bacterial infection. With severe itching, the appointment of antihistamines (suprastin, loratidine, zertek) is recommended. In severe cases, antiviral drugs are prescribed. In the event of complications (pneumonia, nephritis, etc.), an adult patient must be hospitalized in a hospital where antiviral drugs, antibiotics, and large doses of glucocorticosteroids are prescribed. In the treatment of infections caused by group A streptococci (including scarlet fever), many antibiotics are effective, but penicillins remain the drug of choice. The main goal in the treatment of scarlet fever is to maintain an adequate concentration of penicillin in the blood for at least 10 days. In case of an allergy to penicillin, treatment is carried out with antibiotics of other groups - for example, erythromycin from the macrolide group.

2. Effective treatment skin diseases, undoubtedly, is the pinnacle of the professional skill of a dermatologist. Due to the large number and variety of dermatoses, often the ambiguity of their etiology and pathogenesis, the tendency to protracted course, this task is often difficult and requires from the specialist not only a broad general medical outlook, but also great personal experience and a high level of clinical thinking. Etiological treatment, unfortunately, is possible only with a limited range of dermatoses that have a clearly established etiology, while in many skin diseases the true cause of the disease is still unclear. However, in most dermatoses, sufficient information has been accumulated on the mechanisms of their development, which makes it reasonable to carry out pathogenetic treatment aimed at correcting certain aspects of the pathological process (for example, the use of antihistamines for urticaria caused by an excess of histamine in the skin). And, finally, it is often necessary to resort to symptomatic therapy aimed at suppressing individual symptoms of the disease when its etiology and pathogenesis are unclear (for example, the use of cooling lotions in the presence of edema and weeping in the foci). In complex therapy, etiological, pathogenetic and symptomatic methods of treatment are often combined. In the treatment of skin diseases, almost all modern methods of therapeutic action are used, which can be classified as follows: Mode. Diet. Drug therapy (general and local). Physiotherapy. Psychotherapy. Surgery. Resort therapy. Treatment should be prescribed only by the attending physician.

3. Treatment of allergic skin reactions. In the treatment of uncomplicated allergic skin reactions, it is necessary to find out the causes of their occurrence, after the elimination of which, the rash most often disappears spontaneously. Local treatment consists in the use of ointments with antihistamines, glucocorticosteroids. Antihistamines (suprastin, tavegil, diazolin, loratadine, etc.) are also prescribed orally or by injection; in severe cases, glucocorticosteroids (for example, prednisolone) are prescribed.

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