DERMATITIS (dermatitis, singular; grech, derma, dermat[os] skin + - itis) — the inflammatory damages of skin developing on site immediate effect of physical and volumetric factors of the environment. The term «dermatitis» was applied earlier also to designation of some diseases of skin which do not have relations to D.; sometimes continue to use it [e.g., «herpetiform dermatitis» (see. Dyuringa disease ), «dermatitis pigmental progressing» (see. Shamberg disease ), «atopic dermatitis», etc.].
It is wrong to call dermatitis of damage of skin, arising from the general impact on an organism of various chemical substances, in particular medicinal — accepted inside, entered intravenously, intramusculary or subcutaneously (e.g., D. bismuthic, D. salvarsanny), or developed in an organism in the presence to them hypersensitivity. Such damages of skin are called toxidermias (see). For specification of the concept «dermatitis» the inflammatory damages of skin caused by environmental factors unlike other damages of skin are named also contact
D. D., in particular arising against the background of a sensitization of an organism, are one of frequent forms of the prof. of diseases of skin. Most often they arise at workers, busy in chemical, textile, oil processing, pharm., printing industry. Among all forms professional. dermatosis (see) Make, according to L. S. Rozanov (1957), 25%, according to A.S. Raben and A. A. Antonyev (1975) — 61,7%.
- 1 The general pathology and clinic of dermatitis
- 2 Classification
- 3 Dermatitis from physical factors
- 4 Dermatitis from volumetric factors
- 5 Dermatitis from plants
The general pathology and clinic of dermatitis
the Aetiology and a pathogeny
To physical. to the agents causing D. mechanical irritants, high and low temperature, electric current, ultraviolet rays, ionizing radiation belong; to chemical — various chemical substances, eurysynusic on production and in life, including medicines, and also contained in plants. In one cases obligate irritants which cause inflammatory reaction in each person are D.'s reason — there is simple D.; in other cases — optional irritants which cause inflammatory reaction of skin only in people with the sensitivity increased to these factors caused by a sensitization of an organism — there is allergic.
Simple D. results from immediate toxic effect of an irritant on cells of epidermis at once, at the same time necrobiotic changes develop in them. Allergic D. develops in an interval from 5 — 7 days to several weeks after repeated irritation, necessary for development sensitization (cm.). D.'s emergence in these cases is defined by the reaction of the slowed-down type caused by sensibilized lymphocytes (see. Allergy ).
The majority of the chemicals causing a sensitization and then allergic D.'s development, are haptens, i.e. become complete antigens only at connection with proteins of skin (conjugates). Functional activity of leukocytes at allergic D.'s development increases (content of peroxidase increases).
Experimental modeling of allergic D. is made usually on Guinea pigs; as allergen it is often used 2,4-diiitrokhlorbenzol, having the expressed allergenic properties. In an experiment various influences (e.g., ionizing radiation, cytostatic means) reducing the content in blood of leukocytes and especially lymphocytes suppress development allergic D. Sushchestvuyet opinion that in development of a sensitization the functional condition of skin receptors matters, however disturbance of a peripheral innervation by creation of a denervated skin rag does not interfere with a sensitization of all integument.
Prevalence and weight of allergic process substantially are defined by expressiveness of disturbances immunol, reactivity of an organism: in blood the quantity of eosinophils, gamma-globulins of various classes increases (see. Immunoglobulins ), reactivity, complementary activity of serum, a gistaminopektichesky index and content of serotonin, function of bark of adrenal glands go down the general immunol. In allergic D.'s center and slightly less in a perifocal zone painful and thermal sensitivity, resistance of skin to direct electric current, capillary resistance, alkalis resistance fall, permeability of a corneous layer increases. An important role is played by also general condition of an organism: disturbances of a functional condition of a nervous system and closed glands, diseases went. - kish. a path and a liver, a helminthic invasion, disturbances of carbohydrate metabolism, increase in blood of content of cholesterol, activity of zymohexase, transaminases. Sometimes D.'s emergence is preceded by various diseases (flu, tonsillitis, etc.) reducing defense reactions of an organism and changing its reactivity concerning allergens (D. develops quicker, proceeds more sharply). Promotes development of a sensitization as well genetic predisposition to allergic reactions, disturbance of an integrity of a corneous layer of an epithelium, the alkalization of a surface of skin breaking its barrier function and increasing permeability of electrolytes, and also high temperature and the increased air humidity.
In spite of the fact that influence of an optional irritant happens on the limited site of skin, the condition of a sensitization develops on all integument. It is confirmed by a positive take of skin tests with the corresponding allergens. Especially concerning estimated allergens of the chemical nature are important for detection of hypersensitivity of skin skin tests (see) as method of specific diagnosis. By data A. A. Antonyeva and S. M. Locke (1971, 1973), the most sensitive are scarifying and compresseal tests, are less sensitive chamber, compresseal, drop.
Patogistologiya is insufficiently characteristic of allocation of separate forms D. As a rule, histologically it is possible to establish only existence acute, subacute or hron, inflammations. At simple acute D. are observed inside - and extracellular hypostasis, intra epidermal cavities; at a large number of cavities and the expressed intracellular hypostasis, and also owing to destruction of epidermis of a cavity are divided only by a thin partition from the remained epidermal cells therefore the uniform multichamber cavity is formed. Exudate contains a small amount of lymphocytes, and also single eosinophils, neutrophils and cells of epidermis. In cells of a corneous layer kernels sometimes remain. In an upper part of a derma — vasodilatation, also preferential perivascular infiltrate from lymphocytes, eosinophils and neutrophils swelled. At the acute D. arising from immediate effect of sharply disturbing factors subepidermal cavities can form, epidermis over them nekrotizirutsya, the necrosis of a papillary layer of a derma sometimes develops.
Acute allergic D. morphologically differs in bigger expressiveness of inflammatory hypostasis and existence in composition of cellular infiltrate of a significant amount of eosinophils.
Subacute D. is characterized inside - both extracellular hypostasis and formation of intra epidermal cavities which usually do not reach such sizes, as at acute D. Imeetsya moderate acanthosis (see) and various expressiveness parakeratosis (see). Inflammatory infiltrate in a derma is expressed clearly, in it lymphocytes prevail, eosinophils, neutrophils and histiocytes meet. Quite often neutrophils and lymphocytes migrate in epidermis.
At hron. — an interpapillary acanthosis and a hyperkeratosis, the centers of a parakeratosis, is possible small intercellular hypostasis of epidermis, but without formation of cavities. In an upper part of a derma moderately expressed infiltrate consisting preferential of lymphocytes among which histiocytes, fibroblasts, separate eosinophils occur is observed.
Hron, allergic D. differs, according to Miller (Page S. Miller, 1947), education against the background of an acanthosis of small intraepidermalny cavities; in a derma perivascular lymphocytic infiltrates are found, in fibrous structures increase in content of neutral and acid mucopolysaccharides is noted.
A clinical picture
the Clinical picture and expressiveness of inflammatory process allow to subdivide simple and allergic D. on acute, subacute and chronic.
Acute simple D. can be shown depending on a damage rate by three stages: erythematic — more or less expressed redness and puffiness, a moderate itch and burning (tsvetn. fig. 1); violent — education on an erythematic background of the bubbles which are drying up in crusts with the subsequent peeling (tsvetn. fig. 2); necrotic — the escharosis and a further ulceration which is beginning to live scarring. All three stages of development of D. are optional, and on any of them process can stop. Formation of a large number of the small vesicular elements which are drying up in the thin, easily tearing away crusts scales that creates ekzemopodobny a wedge, a picture is characteristic of allergic acute D.; such D. is named sometimes by allergic eczematic D. or contact eczema.
At subacute D. the same stages are observed, as at acute simple D., but the inflammatory phenomena differ in smaller expressiveness.
For a simple hron., arising under the influence of long influence of rather weak irritants, development of a congestive hyperemia, infiltration is characteristic, likhenization (see), hyperkeratosis; sometimes process comes to an end with an atrophy of skin. Patol, process at simple D. is limited to the site kozhn which the irritant, without tendency to peripheral increase in the center and its dissimination influenced; after the termination of influence of the agent inflammatory process abates and in most cases it is independently allowed completely.
At the diseased the wedge, manifestations are gradually transformed by allergic D. in case of the continuing contact with allergen and eczema develops: polymorphism amplifies, the clearness of borders patol is lost, process which extends on the periphery, the centers of defeat begin to arise not only in places of contact with an irritant, but also on other sites of skin, first of all is symmetric; on sites of skin, remote from primary center, secondary allergic rashes quite often develop, process accepts torpid, hron, a recurrent current. Recurrence of eczematic process can arise also after cancellation of the sensibilizing substance which caused a disease.
is not present the Standard classification of D.; it is reasonable to classify D. on etiol, to signs.
I. Dermatitis from physical factors.
1. Dermatitis is mechanical, or traumatic: a) attrition, b) callosity, c) intertrigo.
2. Dermatitis from actinic (beam) influence: a) Is solar, b) D. from artificial light sources, c) D. from ionizing radiation (a synonym: beam D., x-ray D., radiation D.).
3. Dermatitis from electric current.
4. Dermatitis from high and low temperature: a) burns, b) perfigeration, c) freezing injury.
II. Dermatitis from volumetric factors.
III. Dermatitis from plants.
Dermatitis from physical factors
To physical. to the factors causing D. mechanical irritants, actinic influences, electric current, high or low ambient temperature belong.
Dermatitis from mechanical factors
of this origin carries an attrition, callosity, some forms of an intertrigo, and also a nipple crack at the feeding women (traumatic D.) To D.
Attrition (tsvetn. fig. 3) develops on the limited site of skin owing to long friction or pressure, in particular badly adjusted footwear, the starched or woolen linen, a bandage, a prosthesis, oars, etc. The acute form of an attrition can be expressed only by limited redness and puffiness which are followed by burning and small morbidity. If the disturbing factor continues to work, then in the center of a hyperemia bubbles, up to several centimeters in the diameter, executed by serous or seroznogemorragichesky exudate, a so-called water callosity are formed roundish or irregular shape (in more detail, and also prevention — see. Attrition ).
Callosity — the limited, a little towering thickening of a corneous layer and a derma arising at the frequent injuring influence; it is formed on palms from the long pressure of tools (at navvies, tailors, shoemakers, hairdressers), standing from wearing badly driven footwear (in more detail, and also prevention — see. Callosity ).
Intertrigo there are pleated skin, between fingers of feet and is characterized by a hyperemia, maceration, surface cracks. At newborns in the first days of life the so-called diaper D. caused by friction of a diaper, irritant action of urine and a calla can develop; process it is localized on an inner surface of hips, buttocks, in a crotch, arising originally as D.; the center of defeat is, as a rule, infected further (in more detail, and also prevention — see. Intertrigo ). Nipple cracks of a mammary gland — see. Mammary gland, damages .
Treatment of moderately expressed traumatic D. (in an erythematic stage) consists in use of indifferent powders. At sharply expressed erythema and hypostasis — lotions or the wet drying bandages (2 — 4% solution boric to - you, lead water) or corticosteroid ointments. In the presence of bubbles their tire is punctured, greased with spirit solution of aniline dye, apply a sterile bandage, at suppuration the tire of a bubble is deleted; in case of development of a lymphangitis or lymphadenitis antibiotics are shown. Apply a disinfecting bandage an erosive surface, and after the termination a moknutiya — the epithelizing ointment (boron-naftalanovuyu, dermatolovy). At hron. Are recommended thermal procedures, Keratolytic, keratoplastichesky means (see).
Dermatitis from actinic factors
Dermatitis from actinic factors (beam) is caused by impact on skin of natural and artificial beam factors; D. solar, D. from ionizing radiation enter into this group.
Dermatitis solar the hl results from impact on skin of sunshine. obr. short-wave range: blue, violet and especially ultra-violet. Its development depends also on duration of influence of beams, individual sensitivity and the site of skin. The greatest sensitivity to sunshine skin of a stomach, a breast, a back has; skin of shoulders, necks, a forehead, hips is less sensitive; skin of shins, palms and soles is least sensitive; the pigmented skin is less sensitive to light, than slabopigmentirovanny (skin of blondes).
The wedge, acute solar D.'s picture is characterized by emergence on open sites of skin after the eclipse period during 2 — 4 hours of a diffusion bright erythema and the puffiness which is followed by feeling of tightening and burning. In hard cases on the inflamed skin there are bubbles with serous or serous and hemorrhagic contents which part, being opened, forms painful erosion. Process comes to an end with a macrolaminar peeling and the strengthened chromogenesis — melanin (so-called suntan). Solar D. can develop and in the winter because of influence of the sunshine reflected from snow at rather short stay in snow-covered mountains (a so-called gletcherny burn). Acute solar D. can be followed by the general weakness, temperature increase, a headache, nausea, loss of appetite.
Hron, solar D. develops more often at persons who are exposed to repeated and long insolation, especially at adverse meteorol. conditions (wind, rain). After an inflammatory stage skin of open body parts gains bronze color, becomes dry, reinforced, the skin drawing amplifies (skin of seamen, farmers). Over the years the hyper pigmented and depigmented sites, premature age dystrophy of skin, in hard cases — warty growths because of which there can be a carcinoma cutaneum develop. At elderly people (is more often than men) so-called rhomboid hypertrophic skin of a neck can develop (see. Dystrophy of skin ).
Solar D. enters into group photodermatoses (see), to the Crimea refer also the damages of skin caused by hypersensitivity to sunshine, inborn or caused by so-called photosensitizers — the substances which are produced in the organism (porphyrines), arriving from the outside through a digestive tract or a respiratory organs or got on skin (see Hydroa vacciniforme, the Xeroderma pigmental, the Porphyria skin late).
Dermatitis from artificial light sources in essence does not differ from solar D. and its expressiveness also depends on radiation intensity. At the industrial enterprises workers can be exposed to radiation from various sources of Uv-radiation: light from electric welding, electric furnaces, karbidkaltsiyevy furnaces, at process of bessemerizing became, in foundry workshops, melting furnaces. In these conditions, except D., there can be conjunctivitis, a keratitis, all-toxic symptoms.
At action on skin of a thermal irritant of small intensity (hot-water bottles, compresses, heat of the furnace, etc.) there is a limited short-term erythema (erythema caloricum); at repeated influences skin gradually gets a brown shade and the mesh drawing at the expense of resistant vasodilatation on the warmed sites (dermatitis calorica reticularis).
Treatment at acute solar D. — rubdown of skin alcohol, cologne, the cooling lotions, suspensions, creams; large bubbles puncture. From artificial ultraviolet rays treat the same as D. for solar. If UF-radiation is applied with to lay down. the purpose, preventively before radiation it is necessary to define so-called biol, a dose of UV rays for this patient. At the industrial enterprises and for the prevention hron. Special value have preventive measures, in particular use photoshielding agents (see).
Dermatitis from ionizing radiation (synonym: radiation D., x-ray D., beam D.). Can arise from X-ray, and also from alpha, beta, gamma and neutron emission. Different types of ionizing radiation possess generally identical pathogenetic action and cause in essence identical damages to fabrics. Degree and the nature of radiation injury of skin depend on penetration of radiation, size of a dose, its power, distribution of a dose on time, the size of the irradiated area and individual sensitivity of an organism in general and different sites of skin. Skin of children more, than skin of adults, is sensitive to ionizing radiation, skin of women is more sensitive than skin of men; on a face and a breast skin is injured to a lesser extent, than on a neck, in axillary and inguinal folds.
Caused by radioactive materials are localized, as a rule, on open body parts, and also on those closed sites which underwent wetting by the radioactive water which got through clothes.
Acute beam D. arises usually after single action of high doses of ionizing radiation, in some cases — after repeated radiation of skin the «rigid» and filtered beams in therapeutic doses. Radiologists call such defeats a radioepidermitis. Early beam reaction of skin can precede acute beam D., edges it is observed within several hours in the first - second day after radiation (sometimes within several days) and characterized by the edematous erythema which is followed by feeling of a slight itch and tension of skin (see. Beam reactions ). Acute beam D. develops both in the first day and in two months after radiation; the more intensively radiation, the develops earlier D. and the current is longer than it.
At impact of ionizing radiation on a pilar part of skin beam develops alopecia (see). Loss of long hair begins more often on 2 — 3rd week after radiation, quite often it is preceded by a dermatalgia of a pilar part of the head; hair of eyebrows, eyelashes, beards, and also on a pubis and in axillary poles drop out not always. The hair loss proceeds within several days — 1 — 2 week, growth is resumed in 6 — 10 weeks after radiation and comes to an end to 12 — 14 weeks, in more hard cases to 4 — to the 5th month. At some patients new hair grow thinner and soft, the hyperpegmentation of the grown bald sites of skin is sometimes observed.
Under the influence of ionizing radiation nails change: their growth is slowed down, blue-brown pigmentation develops, there is a cross groove, time of education a cut matches the moment of radiation, or becomes distinct noticeable border between damaged, yellowish color by a distal part and a healthy proximal part of a nail plate.
Radiation injury of skin can be shown by an erythematic, violent and necrotic stage. The acute erythematic stage is characterized by emergence of the edematous congestive erythema having a violet or bluish shade, feeling of a pricking, an itch, burning, pain (so-called late, or secondary, an erythema). Sometimes against the background of an erythema dot hemorrhages which testify to a deep water of defeat are shown and are a bad predictive sign.
At an acute violent stage after emergence of an erythema considerable hypostasis develops, there are various size bubbles, pain sharply amplifies. Bubbles have a multilayer tire. The serous or serous and hemorrhagic exudate containing fibrin is not only in a bubble, but also between layers of epidermis; exudate is, as a rule, sterile. After opening of bubbles the edematous liquid which was under pressure filters from deep layers of skin outside, bandages are quickly blotted at the same time. Sometimes bubbles reach the sizes of egg, in particular on a palm exudate can exfoliate epidermis on all its surface that leads to formation of a huge continuous bubble with very thick tire. In hard cases surface layers of epidermis can slip as if from subjects, forming the extensive becoming wet erosion without the previous visible bubbles. Permission of deep bubbles comes to an end with a cicatricial atrophy.
The acute necrotic stage represents a canker of skin (tsvetn. fig. 4). After rather short stage of latency in the field of radiation bubbles against the background of a crimson and cyanotic hyperemia appear. Along with a rash of bubbles (or passing a violent stage) in connection with jumps of blood vessels the necrosis of fabrics develops, the ulcer is formed (tsvetn. fig. 12) with a gryaznosery or dirty-yellowish bottom and purulent separated, followed by regional lymphadenitis (see). General condition of the patient heavy; weakness, high temperature, a fever, sleeplessness, painful pains is noted. The ulcer can exist many months and even years, in some cases does not heal at all. On the formed hems under the influence of insignificant injuries often there are superficial trophic ulcers and painful dot hemorrhages which in turn serve as the reason of the superficial centers of a necrosis.
After a beam erythema development of a hyperpegmentation is characteristic; deep bubbles, on the contrary, leave behind a depigmentation; quite often after D.'s permission skin takes a motley form (sites hyper - and hypopigmentation). On atrophic hems diversity of skin amplifies due to gradual development of teleangiectasias.
Hron, beam D. develops as a result of repeated radiation of skin in rather small doses, as a rule, on brushes, a thicket on fingers at people who by the nature of the work are affected by generally «soft» beams and beta particles of radioactive materials (professional beam D. of radiologists). Hron, beam D. is characterized first by atrophic process; skin gains weak-pink color (entirely or ochagovo), loses elasticity, becomes thin, dry, brilliant, is shelled and cracks. There are sites hyper - and depigmentation, teleangiectasias, sensitivity to outside irritants increases, there are an itch and feeling of a pricking. Skin is easily injured, the formed cracks cause severe pain; gradually hyperplastic processes join — warty growths, the centers of a hyperkeratosis are formed (tsvetn. fig. 5) which consider as precancerous states.
Patients with early beam reaction of skin and a beam alopecia usually do not need treatment. For treatment in an erythematic stage, and also at the initial erythema which is sharply expressed and dragged on for several days anti-inflammatory drugs are sufficient: bandages with the crushed ice, lotions, pastes, corticosteroid ointments and creams, linol, linaetholum. In a violent stage from bubbles it is necessary to suck away periodically the syringe liquid then slightly compressing bandage is applied. At suppuration of exudate it is necessary to remove a tire of a bubble, to apply a bandage with a disinfecting lotion or ointment and to appoint antibiotics. The good disinfecting and anesthetizing action lotions from 0,5% of solution of silver nitrate possess. After elimination of the acute inflammatory phenomena use of the bandages impregnated with sterile vegetable oils is shown. The raised situation in a bed is recommended to immobilize and give the affected lower extremities to them.
Treatment in an ulcer and necrotic stage presents great difficulties. At the limited center of defeat the best method is excision of the center within healthy fabrics. In other cases therapy shall be directed to a raising of protective forces of an organism, the prevention of an infection and elimination of dystrophic defeat of fabrics. From these positions on individual indications apply the following: food, protein-rich and vitamins, drop hemotransfusions (to 200 ml through everyone 4 — days), an autohemotherapy, antireticular cytotoxic serum of the Pilgrim and tsitozin, extract from leaves an aloe, a vitreous, FIBS; appoint also ascorbic to - that with Rutinum, thiamin, vitamin E, Vikasolum, calcium chloride, Pachycarpinum, antihistamines, corticosteroid drugs, antibiotics, including nystatin; in some cases Intra arterial introduction of 0,25 — 0,5% of solution of novocaine, local novocainic blockade are shown, at severe pains — analgetics, hypnotic drugs, drugs. There are data on favorable action on beam ulcers of ultrasound. For outside treatment the means stimulating regenerative processes, in particular leaves or emulsions of an aloe, sea-buckthorn oil, plasma and blood serum, a fibrinny film, ointments «Solkoseril», «Vulnazan», 5 — 10% metiluratsilovy ointment, etc. are recommended. In persistent cases make plastic surgery. At extremely heavy damage of fabrics with defeat of deep vessels it is necessary to resort to amputation of an extremity.
Treatment of D. caused by radioactive materials should be begun with careful removal of these substances from the surface of skin since radioactive materials get into a corneous layer. Hair, except for vellus, are recommended to be shaved, and nails as can be cut off well.
Treatment hron, beam D. in the absence of ulcers is carried out by indifferent, weak keratolytic, corticosteroid ointments. In case of formation of warty growths, papillomas and the centers of a hyperkeratosis apply diathermocoagulation or cryotherapy. Treatment hron, ulcer forms does not differ from treatment of the corresponding forms of acute beam.
Dermatitis from electric current meets as a home or production accident. At defeat electric current observes two types of an electric trauma: the contact electric trauma — result of contact of a body surface with the conductor of an electric or galvanic current (an electrodiathermy of a certain force and tension) and an electric trauma — result of action of a flame of an electric arch, at the same time very high temperature is the reason of heavy thermal burns.
At a contact electric trauma on skin in the place of an entrance and exit of electric charge there are electro-tags, or the «signs» of current (fig. 1) representing firm, sometimes a cartilaginous consistence a scab of grayish-white or grayish-yellow color, a little more dark in the central sinking-down part, is more rare — a superficial cut wound or dot hemorrhage. The form of electrotags corresponds to a uniform of the conductor; in most cases they roundish, with a diameter from several millimeters to 2 — 3 cm. Lack of a reactive hyperemia around an affected area of skin, painlessness and an anesthesia in the centers of defeat is characteristic; hair usually remain, but they are sometimes scorched, a little twisted, on length of hair at more or less equal distances banners can be formed; around a scab amotio of epidermis sometimes develops. From sparks limited burns develop. The category of atmospheric electricity on a body can leave «a figure of a lightning» — is treelike the branching hyperemic strips caused by paralysis of vessels of skin. At very high tension (1000 in and more) with formation of high temperature (3000 — 4000 ° above) the centers of defeat lose the lines inherent to an electric trauma and heavy thermal burns of the III—IV degree develop. Except burns from a current, there can be burns and from the ignited clothes.
Morfol, changes at an electric trauma differ from those at other D. and are subdivided on local and the general (damage of skin and internals). Implementation in skin of the metal turned under the influence of high temperature into gaseous state (so-called metallization of an epithelium) is characteristic of an electric trauma.
Histologically in the field of an electro-tag homogenization of a corneous layer of epidermis is observed, in Krom small openings (a so-called microhole) are noted; under epidermis, and also in aculeiform and basal layers the sotoobrazny cavities which are partially merging in larger are formed various size. Owing to emergence of electric field of a cell of a basal layer are extended, taking the form of long threads, and are located with bunches perpendicularly or obliquely to the surface of skin (a symptom of «brushes», «snopik»). The extended form is taken by also epithelial cells of hair follicles and output channels of sweat glands. The phenomena of vacuolation of cells and a spongiosa are not noted. Owing to smoothing and reduction of nipples the border between epidermis and a derma is leveled almost to a straight line. Collagenic fibers become homogenized, reinforced, basphilic, are divided from each other by slit-like cavities. Sharply also elastic fibers change. Kernels of connective tissue cells are deformed. Blood vessels are not expanded, kernels of an endothelium are extended and intensively painted; in top coats of a derma vessels can be thrombosed. Considerable changes occur in nerves of skin, usually at once after passing of electric current; in the beginning they are sharply thickened, homogenized, then separate fibers become indiscernible, break up to glybk and kernels, disappear completely; the same process in nerves arises and perifokalno (the wedge, a picture, treatment and prevention — is more detailed see. Electric trauma ).
Dermatitis from volumetric factors
D. caused by direct hit on skin of various chemical substances and also influence on skin of the chemical substances which are a part, e.g., of plasts, synthetic fibers, paints, drugs, etc., usually arises under production conditions and the wedge, and a dignity have therefore the greatest. - a gigabyte. value as occupational diseases of skin. Of the same genesis are observed sometimes and in living conditions. Severe forms of simple D. arise at hit on skin of chemical toxic agents of skin and resorptive action — see. Dermatovesical toxic agents.
Professional dermatitis can be acute and chronic simple, but often is a consequence of a sensitization of an organism (allergic D.). On etiol, and a wedge, their signs can divide into the following groups conditionally.
1. Caused concentrated inorganic to-tami (sulfuric, salt, nitric, fluoric) and organic (ant, carbolic, acetic) alkalis (caustic soda, caustic heat), salts of alkali metals and acids (soda ash), is simple. At influence of the specified substances coagulative is observed different degree necrosis (see) in the form of a scab, after department to-rogo the ulcer healing a hem comes to light. At hit of alkalis, mineral to - t, calcium carbide, zinc and zinc sulfide and other cauterizing substances in cracks, grazes of skin are formed so-called prizhog (pigeonneau) — small, from 2 to 10 mm in the diameter, ulcers, quite deep, oval or rounded shape, with the flat, slightly subdug regions, surrounded with the roller of inflammatory infiltrate, covered with densely keeping crust which is a little pressed black color. In 2 — 3 weeks the ulcer heals with formation of a scar. In the started cases at distribution of a necrosis to depth perhaps on the limited site destruction of a sinew, bone (the back of brushes, fingers, is more rare — palms, forearms).
Long influence of solutions of weak concentration to - t and alkalis causes hron. Which is characterized by various extent of infiltration of skin, a likhenization.
2. From long impact on skin of organic solvents (acetone, gasoline, kerosene, butanol, chloroform, toluene, a xylol, etc.) it is shown by dryness, a peeling, cracks are formed. As a rule, it is simple D., sometimes there is a sensitization of an organism; strong allergen is turpentine. Long pollution of skin products of distillation of black coal and oil (preferential heart and last cuts of hydrocarbons — carbolic oils, naftalina, anthracene, baked) and products of high-temperature oil refining (pitches, lubricating oils, fuel oil, tar) brings to hron, to folliculites, especially at predisposed persons, and damage of skin keeps also after the termination of contact. More often skin of forearms, hips, on buttocks is surprised. In hair follicles the black traffic jams consisting of oil, dust and desquamated epidermis are formed; over time around them develop as a result of a reactive inflammation of a papule and a pustule, surrounded with a lilac-tinged nimbus — so-called oil folliculites (see).
3. The allergic D. arising during the work with cement is caused by existence in cement of 6-valent chrome; bystry transformation of D. in eczema («cement eczema») is characteristic. During the work with chromic to - that is observed seldom. Compounds of nickel, especially its sulfate salts, have the expressed sensibilizing properties; some of them (nitric and nickelous carbonate, nickel monoxide) are obligate irritants. The professional D. at working galvanic workshops arising during the work with nickel develop usually in 2 — 5 months after the beginning of contact with nickel, they are provoked by Traumatization and degreasing of skin; damage of skin is followed by a severe itch — a so-called nickel mange, cover emergence perhaps and during the carrying the watch-chains covered with nickel.
4. During the work with synthetic polymers (epoxy, phenol-formaldehyde, ureaformaldehyde, polyester, polyamid synthetic resins and the varnishes made on their basis, paints, glues), plasts, synfils and fabrics (tsvetn. fig. 11), artificial rubber, to a lesser extent — with natural polymers (natural rubber, rosin, some balms and pitches) is clinically characterized by signs as acute, and hron, inflammations depending on force and duration of influence of the irritant which is a sensitizer of an organism (allergic D.).
5. Aromatic amino and nitro compounds (ursol, dinitrobenzene chloride, azopaints, metol, etc.) quite often cause the allergic D. which is characterized by inflammatory reaction of various degree.
6. Medicamentous D. at external use of some pharmakol. means at patients, and also at medical staff and at the persons occupied on production of medicines is more often than allergic character (tsvetn. fig. 6 and tsvetn. fig. 8 — 10), sometimes owing to a resorption of some drugs is combined with a toxidermia (see. Medicinal allergy ). At parenteral and oral administration of antibiotics urtikarny rashes are observed, and at local — contact. In some cases D. from antibiotics has a heavy current, sometimes — character of an erythrosis, a small tortoiseshell, being followed by an itch; the acute anaphylaxis is possible. Can cause novocaine, mercury (in the form of white pretsipitatny ointment, a mercury plaster, solution of corrosive sublimate — D. mercury), quinine and its derivatives, streptocides, aminosyn, aldehydes (solution of formaldehyde, hexamethylenetetramine), chrysarobin, Psoriazinum, antipsoriatikum. Drugs of tar cause usually a folliculitis, is more rare a diffusion erythema. From iodine there is simple D. (an iodide burn) as a result of repeated greasings by tincture of iodine of the site of skin more often. At intake of drugs of iodine can arise yododerma (see). Less often D. cause anaesthesin, a lactate of Aethacridinum, resorcin, carbolic to - that, an iodoform, sulfur, salol, corticosteroids, drugs of bee and snake poison, an adhesive plaster, vaseline, aniline dyes.
7. At the use of cosmetics and objects of perfumery — hair-dye and lipstick (tetra-and dibromflyuorestsein, an azoruby, rhodamine, etc.), the theatrical make-up, mascara, nail varnish, some grades of cologne — are possible inflammatory, damages of skin — so-called brelkovy D. (fig. 2) are more often allergic.
8. Insectofungicides (the chemical substance which are applied to protection of plants against harmful insects and parasitic mushrooms), in particular organochlorine compounds (santobane, hexachlorane, hloridan, simazin, propazine), call the prof. allergic D. of hl. obr. at workers of agriculture. Emergence of an erythema of various degree of manifestation, puffiness, exudation is characteristic; at numerous contact with the same irritating D. agents can pass in eczema (see); at acute eczema polymorphic rashes are observed, at hron, to eczema infiltration, lichenification, a peeling of skin, a crack prevail.
Treatment and prevention
First of all it is necessary to exclude contact of the patient with the chemical substance which is a disturbing factor. At the chemical burns arising at hit on skin to - t and alkalis — washing of affected areas the current mains water within 5 — 10 min., and in later terms — 30 — 40 min. without interruption. After that apply the bandage moistened with solution boric to - you (at an alkali burn) or with soda gruel (at a burn to - that). Further treat in the open way. At a burn phosphorus the burned site is immersed in water or wash away phosphorus water and 5% solution of a copper vitriol then powder with talc (it is impossible to apply ointments).
From external use of medicinal substances usually abate after cancellation of these means. Prevention consists in careful use at diseases of skin of pharmaceuticals, in particular the antibiotics able to call D.: not to apply it is long locally, at signs of an aggravation of skin defeat immediately to cancel them. In order to avoid development of the prof. D. it is necessary to work with antibiotics in rubber gloves, sometimes happens it is necessary to pass to other work.
At allergic D. appoint the desensibilizing means (calcium chloride, sodium thiosulphate, antihistaminic drugs). According to a number of authors, at allergic D. it is possible to reach by specific desensitization suppression or decrease in hypersensitivity on the relation, e.g., to chrome, nickel, cobalt.
Professional D.' prevention includes public and personal measures of protection. Tekhnol. actions: automation, mechanization and sealing of productions, installation of special guards and other devices on machines for protection of skin against harmful active ingredients; replacement of the substances irritating and sensibilizing skin or reduction of their concentration. Dignity. - tekhn. and dignity. - a gigabyte. actions: providing the enterprises shower and wash basins with supply of hot water, timely change of overalls, wet cleaning of production rooms; the maintenance of a workplace in appropriate purity and use of individual means of protection, in particular protective pastes, and careful processing of microtraumas.
The prof. selection is especially important during the work with petroleum and mineral oils; e.g., preventively it is impossible to allow on these productions of persons with the expressed seborrhea and having acne rash, a keratosis.
Periodic medical examinations are necessary for identification of an early stage of D. and medical examination of patients; transfer of the diseased into other work is sometimes recommended.
In all cases of D. from the paints applied both in the industry and in the cosmetic purposes, in the preventive relation it is extremely important to establish a cause of illness of skin in time and to eliminate contact of the patient with allergen, and at mass defeats to inform sanitary and industrial supervision.
Dermatitis from plants
D. from plants is frequent arises from a combination of impact on skin of the substance which is contained in them and physical. factors — a sunlight and friction. Chemical substances in such plants as a nettle, - a caustic buttercup, an euphorbia, a poisonous anisetree, a dittany, a codiaeum, are obligate irritants, in other plants, napr, in a primrose, poisonous sumach, a geranium, a rhododendron, garlic, a fig, a high prangos — optional, defiant D. only in the presence of a sensitization. A number of plant chemical substances (in a sedge, a sweet cow-parsnip, a parsnip, a wild mountain ash, a yarrow, etc.) are the photosensitizers causing so-called photo phytodermatitis. Most often D. arises from contact with a primrose, poisonous sumach, a crowfoot family, a cow-parsnip, a dittany Caucasian, paspalumy, gingo a biliba, a fig.
In a wedge, such D.' picture much in common. Usually defeats have eritematobullezny or vesicular character. Rashes develop, as a rule, through a nek-swarm time after contact with a plant, being followed by a severe itch and burning; the formed raschesa lead to secondary infection. At some patients, in addition to emergence of the centers in places of contact with a plant, distribution of defeat due to transfer of toxicant fingers, clothes is possible. Fever, an indisposition, a headache are often observed. Sometimes phytodermatitis arises as professional (at flower growers, botanists, gardeners, etc.). From obligate irritants of a plant origin in most cases reminds a picture of burns of I \to U-2014\II of degree.
Dermatitis from a primrose (primrose) — a widespread decorative houseplant — arises often, as a rule, in veseyne-year time; allergen primin contains in the ferruterous hairs covering stalks and leaves of a primrose and keeps the activity and in the dried plant. Possess dermatotropic action a room and Chinese primrose; from a pharmaceutical primrose of D. it is not observed. Develops at sensibilized persons in several hours or days after contact with a primrose. More often skin of brushes, forearms, persons is surprised; the palmar surface of a brush usually remains free from rashes; if flowers kept in cases in a mouth, stomatitis is observed. Clinically process is characterized by a hyperemia and puffiness of skin with the subsequent emergence on this background of vesicular or melkouzelkovy rash (tsvetn. fig. 7); violent forms of a disease can be observed. Subjectively — a severe itch and burning; in hard cases the headache, an indisposition, a fever, conjunctivitis are noted. Individual sensitivity to a primrose remains very long, repeated contact with a plant gives usually heavier flash of.
Dermatitis from poisonous poison ivies also allergic character. In family of poison ivies contain 100 — 150 versions, the growing hl. obr. in North America and East Asia. In the USSR poisonous poison ivies grow in a subtropical zone, on Sakhalin, Kuril islands. First place on toxicity is won by the Japanese varnish tree, further — poisonous sumach and a wax tree; have the sensibilizing properties east toksikodendron, the taking roots sumach, anisophyllous sumach, guat steppe, guat coastal. Allergen is found in juice of leaves of a plant. All species of poisonous poison ivies contain the same toxic agent — toksikodendron (a synonym: drank up, toksikodendritichesky, or urushinovy, to - that) which is to derivatives of catechol. At hydration it turns in gidrourushiol — substance, a cut can be applied as diagnostic test. From sumach is usually observed in the summer, however dry leaves of some species of a poison ivy, napr, a varnish tree, keep the toxicity within several years.
Allocate the following a wedge, forms of defeat with poisonous sumach: burns superficial and deep, limited allergic D., common eczematic form (most frequent), edematous form.
Arises in several hours or days after contact with a plant, cases of transfer of poison were observed by mosquitoes, dogs. On places of contact the progressing cutaneous dropsy which is followed by a severe itch, microvesicular rash develops; papular or urtikarny rashes are less often observed. In hard cases the cutaneous dropsy sharply increases, bubbles appear; liquid of bubbles of active active ingredient does not contain. At damage of a face hypostasis happens so strong that patients cannot open eyes or a mouth. The indisposition, weakness, headache, fervescence, leukocytosis, albuminuria is often noted; the lethal outcome is possible.
Natural immunity to poisonous sumach at numerous contact with a plant usually disappears. Children from 1 to 8 years are ill seldom, however they are easily sensibilized; children till 1 year usually are not sensibilized. Duration of a disease is from 1,5 to 6 weeks.
Dermatitis from meadow plants arises in 1 — 2 day after bathing in reservoirs with the subsequent rest on a coastal grass in the sun. Bathing is not obligatory for D.'s emergence though it the same as intensive sweating and mechanical pressure of a plant upon skin, accelerates emergence of. Sunshine are a proximate cause of D., to the Crimea skin gains hypersensitivity as a result of hit on it and rubbing in of the juice of a grass containing photosensitizers; the major role among them is played, apparently, by derivatives of furocoumarin (xanthotoxinum and bergapten, allocated from a parsnip, a clover, a cow-parsnip, figs).
Damage of skin arises on places of contact with a grass, usually on buttocks, a stomach, an outer and side surface of hips, in the field of knee joints. Against the background of the erythema which is followed by a severe itch, burning, sometimes morbidity there are bubbles and bubbles filled with serous or serous and hemorrhagic contents. The centers of defeat have the form reflecting outlines of a grass and leaves. At extensive defeats moderately expressed indisposition, a headache, weakness, subfebrile temperature is observed. From meadow herbs can arise at many people at once. Duration of a disease usually 7 — 8 days then inflammatory process is allowed; for several years there is a pigmentation.
The diagnosis of dermatitis from plants is established on the basis of the anamnesis (contact with the fresh or dried plant), by localizations of the centers of defeat (the back of fingers and brushes, absence them on palms, etc.), a characteristic form of the centers of defeat and an arrangement of vysypny elements asymmetrically in the form of strips, chains, etc.; it can be confirmed with skin test with leaves of a plant.
Treatment and prevention
leads the Termination of contact with a plant to bystry treatment; besides, appoint the desensibilizing means, outwardly — antiinflammatory and desinfectants. At D. from meadow herbs — a puncture of bubbles and greasing by spirit solution of aniline dye. Repeated meadow D.'s prevention — to avoid contact with this plant, and in case of contact to wipe these sites of skin with gasoline or alcohol.
See also Dermatozoonoses .
Bibliography: Zadorozhny B. A. and Zvyagintsev M. V. Radiation injuries of skin, Kiev, 1966, bibliogr.; Kapkayev R. A. Immunological and cytochemical shifts at patients with allergic dermatitis and eczema, Vestn, dermas, and veins., No. 10, page 26, 1969, bibliogr.; Kircheva S., etc. Changes in skin under the influence of solar radiations, Vopr, kurortol., fizioter., No. 6, page 540, 1965; The Multivolume guide to a dermatovenereology, under the editorship of S. T. Pavlov, t. 3, page 28, M., 1964, bibliogr.; Panova Yu. M. Electrothermal burns, Klin, hir., No. 10, page 51, 1969, bibliogr.; P and - Bena. Page and Antonyev A. A. Professional dermatology, M., 1975, bibliogr.; Raben A. S., Alekseeva O. G. and L. A Duyeva. Experimental allergic contact dermatitis, M., 1970, bibliogr.; With and m of c about in V. I. Changes of skin as a result of ionizing radiation, L., 1968, bibliogr.; With to r and p to and Yu. K. N, Sh e of l yu e of N to about And. And. and G e of l and with with to and y G. D. Occupational diseases of skin, Kiev, 1976; With about m about in B. A. and D about l of about in A. P. Occupational diseases of skin in the leading industries of the national economy, M., 1976, bibliogr.; With about with and about in with to and y A. T. Beam dermatitis, Minsk, 1974, bibliogr.; Private allergology, under the editorship of A. D. Ado, M., 197 6; Shaposhnikov O. K. Prevention of dermatitis at seamen, Voyen. - medical zhurn., No. 7, page 77, 1973.
O. K. Shaposhnikov.