DERMATOSIS (dermatosis, singular; Greek derma, dermat[os] skin + - osis; synonym: skin diseases, outdate — rashes, eruptions) — the umbrella term designating various inborn and acquired morbid conditions of skin and its appendages; this concept joins changes of skin of various genesis: dystrophic, inflammatory, infectious, hereditary, etc.
The term «dermatosis» includes as separate nozol, forms, and group concepts (e.g., «dermatitis», «mycoses», «dermatozoonoses», etc.). The temporary symptomatic changes of skin which do not have independent a wedge, values and not demanding independent treatment, observed at some infectious diseases (a sapropyra, scarlet fever, measles, jaundice, etc.), are not included into the concept «dermatosis».
In modern literature it is described already apprx. 2 thousand. At the same time the wedge, the same D.'s options quite often have independent traditional names (e.g., manifestations of an infiltrative purulent trichophytosis — a sycosis parasitic, kerion Celsi, etc.).
According to P. V. Kozhevnikov (1970), a variety Dermatolum, pathologies is caused by the following factors. 1. Anatomo-fiziol, complexity of the skin formed by a row morfol, structures (see. Skin ), though connected with each other, but able to have independent patol, a state in this connection it is possible to allocate diseases of sweat glands — anhidrosis (see), hydrocystoma (see), hyperhidrosis (see), dyshydrosis (see), heat rash (see), etc.; diseases of sebaceous glands — eels (see), tumors and nevus of sebaceous glands; diseases of hair — see. Hair , table. Diseases of nails — see. Nails . 2. A possibility of overseeing by dynamics of damage of skin with the naked eye and by means of a number of methods of a research that facilitates identification and the description a wedge, options. 3. Features of a structure and functional condition of skin on various body parts of the person in this connection it is possible to allocate the diseases characteristic of folds of skin, a pilar part of the head, skin of palms and soles, etc. 4. A variety and abundance of the environmental factors influencing skin.
a Row D. has hereditary character (see. Genodermatoses ). It is necessary to distinguish inborn D. which result from pre-natal intoxications, from them of infections, disturbances of blood circulation of a fruit and are not descended.
D.'s reasons can be divided on exogenous and endogenous. Exogenous are various physical., chemical and biol, environmental factors. To physical. to factors of development of D. mechanical irritants, high and low temperature, ultraviolet rays, ionizing radiation, electric current belong. The chemical factors capable to cause D. are very numerous (chemical substances on production, in life, drugs, foodstuff); at direct effect of chemical substances on skin arise, e.g. dermatitis (see), in case of hit in an organism — small tortoiseshell (see), toxidermia (see). In group biol, factors various infectious agents, zooparasites enter (see. Dermatozoonoses , Parasitic dermatosis ). Infectious agents cause D., getting into skin directly from the environment or through respiratory organs and a digestive tract; at the same time change of skin can be secondary — as one of symptoms of an infectious disease (typhus, scarlet fever, etc.) or an independent infectious dermatosis (see. Fungus diseases of skin , Pyoderma etc.). Sometimes there is enough one exogenous reason, capable to overcome protective properties of skin to cause D.'s development (strong friction, a burn, freezing injury, high doses of ultraviolet rays and ionizing radiation, strong to - you and alkalis, implementation of an itch mite). However the additional reason breaking mechanisms of protection and leading to change of reactivity of an organism is in most cases necessary. So, pollution of skin, a microtrauma can promote development of a pyoderma or mycoses. Vascular frustration in skin reduce its resilience physical. to irritants, increase in permeability of skin favors to penetration of chemical substances, allocation by sweat glands of sugar at diabetes creates conditions for development of microorganisms etc.
Carry the following to the endogenous reasons. 1. A focal infection, especially in almonds, teeth, bilious channels and a gall bladder; development of a lupus erythematosus (see), allergic vasculites of skin (see the Vasculitis of skin), etc. 2 is connected with it. Diseases of internals, especially bodies of the alimentary system, kidneys; e.g., at diseases of a liver the late skin porphyria develops (see. Porphyria skin late ), erythema of palms and soles; tumors of internals can be followed so-called. paraoncological dermatosis (see). 3. Disturbance of exchange: proteinaceous (with development, e.g., an amyloidosis of skin), carbohydrate (e.g., diabetic gangrene of skin), lipidic (Xanthoma), calcic (calcification of skin), etc. 4. Hypo - and avitaminosis which is the contributing reasons more often, at the same time a hypovitaminosis And — a proximate cause of emergence of a toadskin, a hypovitaminosis of B 2 — cheilitis (see), a hypovitaminosis of C and P — purpuras (see). 5. Circulatory disturbances, functional and organic: hypertensive ulcers (Martorel's syndrome), varicose ulcers, gangrene of skin because of an obliterating endarteritis, etc.; developments of stagnation in the lower extremities contribute to development hron, a diffusion streptoderma, a Crocq's disease — eczemas, erythrocyanosis of shins — perfigeration etc. 6. Disturbances of a lymphokinesis (indurative hypostasis, pachydermia, etc.). 7. Organic and functional lesions of a nervous system. So, damage of a peripheral nerve is a proximate cause of a trophic ulcer, the localized hyperhidrosis, a keratosis. Psychopathies caused a trichotillomania, an onikhotillomaniye, patomimiya; neurovegetative frustration — a rozatsea, etc. 8. Dysfunctions of closed glands therefore develop so-called endokrinopatichesky D. Sledstvy of a hypothyroidism diffusion is myxedema of skin (see), a consequence of disturbances of correlation in system a hypophysis — a thyroid gland — the localized (pretibialny) myxedema of skin; hypofunction of epithelial bodies can be the cause of development of herpetiform impetigo (see. Impetigo herpetiform ); insufficiency of adrenal glands (see. Addisonova disease ) is followed by a hyperpegmentation of skin, a tumor of adrenal glands — a hypertrichosis. At disturbances of functions of gonads so-called menstrual D., climacteric D. (a keratodermia, etc.)» seborrhea (see), etc. are observed. Pituitary frustration can be followed by a xeroderma, a hyperpegmentation, a polosovidny atrophy of skin, dystrophy of hair and nails. 9. Diseases of the hemopoietic system: cerise skin color along with an itch and rashes — at an Osler's disease; thrombocytopenia is followed by a purpura, leukoses — gemodermiya (see).
an Essential role in D.'s pathogeny is played by the following factors: toxic injury of skin, innidiation in it of microorganisms or tumor cells, treatment by various chemical substances (imbibition D.), etc.
The greatest value has allergy (see), and in particular atopy (see). An example of D. caused by allergic reaction of immediate type is a small tortoiseshell, the slowed-down type — allergic. An important role is played by the autoallergens causing immune responses against own body tissues therefore there are autoallergichesky, autoagressivny, autoimmune diseases (e.g., a system lupus erythematosus). One of the reasons of an autoallergy — a focal infection; the sensitization of an organism microbes leads to antibody formation, taking up with proteins of an organism.
In D.'s pathogeny also neurogenic mechanisms, in particular a vistserokutanny reflex matter (see. Skin ), napr, at true eczema. D.'s development can happen by distribution patol. process on the next fabrics (e.g., from limf, nodes in skin at kollikvativny tuberculosis).
In some cases on skin symptoms it is possible to assume the diagnosis of yet not revealed disease of internals and systems: cancer — at emergence acanthosis nigricans (see), a lymphogranulomatosis — on a persistent painful itch, etc.
D. can be the cause of development of dermatogenny vistseropatiya; so, at impetigo nephrite can sometimes develop, at a furunculosis — metastatic abscesses in bones, muscles, pararenal cellulose, kidneys etc.
D. can be one of displays of system diseases — a system lupus erythematosus (defeat of connective tissue system), a gemodermiya (defeat of the hemopoietic system), allergic vasculites (defeat of vascular system) etc.
One of the first attempts to classify D. having now only historical value belongs to Aliber (J. L. Alibert, 1832) who divided all skin diseases into 12 groups (eczematic, exanthematous, kantserozny, skabiozny, etc.) - Morfol, D.'s classification was offered to R. by Willan (1785) and then a little specified by Beytmen (Th. Bateman, 1815). In this classification all skin diseases were divided into 8 classes: papular, squamous, exanthematous, violent, pustular, vesicular, tubercular (grumous), makulezny (spotty). Morfol, still continue to use classification, in particular R. Degos (1953).
F. Gebra (1845) developed classification on a basis patol, signs, however at the end of 19 — the beginning of 20 century pathoanatomical classification could not satisfy dermatologists since many D.' reasons became clear and the urgent need in etiol, classifications appeared.
The first attempt of classification of D. on etiol, to signs was allocation of mechanical, traumatic and artificial by A. Bazen. Further numerous attempts to classify were made.
The Etiologo-patogenetichesky classification still keeping the value is developed by A. M. Krichevsky in 1933 — 1935; it contains 17 classes.
A. A dermatosis which etiology is known: 1. Dermatosis traumatic. 2. The dermatosis caused by a radiant energy (aktinodermatoza). 3. Chemical dermatosis. 4. Dermatozoonoses. 5. Dermatoprotozoonoza. 6. Dermatospirokhetoza. 7. Dermatomycoses. 8. Dermatobatsilleza. 9. Dermatokokktion. 10. The diseases caused by the filtered virus. 11. The infectious diseases caused by the obscure activators.
B. A dermatosis which etiology is unknown: 12. The dermatosis connected with sufferings endocrine and the autonomic nervous system. 13. The dermatosis connected with disturbances of an interstitial metabolism. 14. The dermatosis connected with diseases of a gematopoez. 15. Hereditary and inborn dermatosis. 16. Tumors of skin. 17. Other diseases of skin of an unknown etiology.
Fuller etiol. classification is presented in P. V. Kozhevnikov's works (1970). According to this classification all skin diseases are subdivided into 12 groups.
1. Anomalies of development hereditary and inborn: ichthyosis, keratodermia, epidermolysis, xeroderma and so forth 2. The parasitic and microbic dermatosis caused by animal and plant parasites, microbes, viruses. 3. The exogenous normergichesky dermatosis caused by mechanical, physical and chemical agents. 4. Angiogenic dermatosis: a) inflammatory — vasculites, toxidermias, knotty an erythema, etc.; b) angioplastic — angiomas, teleangiectasias, etc.; c) hemorrhagic noninflammatory. 5. Gistiogemodermatoza: lymphocytoma, mastocytosis, sarcoidosis, fungoidny mycosis, other reticuloendothelioses. 6. An alimentary dermatosis including hypovitaminoses. 7. Exchange dermatosis. 8. Endocrine dermatosis. 9. Neurogenic dermatosis: a) psychogenic — dermatomaniya, thermalgias, patomimiya; b) esteziodermatoza — thermalgias, acroparesthesias, etc.; c) vegetative neuroses — a livedo, Crocq's diseases, seborrhea, psoriasis, urticaria, a prurigo, neurodermatitis, dyschromias, etc.; d) allergodermatoza — eczema, herpetiform dermatitis; e) atrophies; e) others — a pemphigus, red flat deprive, etc. 10. Growth disorder of fabrics: a) not tumoral — a part of keratoz, a keloid milium; b) benign tumors; c) malignant tumors. 11. A dermatosis is presumably infectious: pink deprive, atrofiruyushchiya akrodermatoz, the migrating Lipshitts's erythema, etc. 12. Dermatosis of an unknown origin.
In the modern foreign managements [e.g., Gertler (W. Gertler, from 1970 to 1973), etc.] allocate skin changes at malformations, a dyschromia, exchange D., hron, diseases of connecting fabric, diseases of skin caused by impact on it of outside irritants, disturbances of blood circulation in skin and hemorrhagic diathesis, neurovascular reactions of skin, eczema, seborrhea, professional D., hron, idiopathic D., erythroses, dermatogemoblastoza and retikulogranulematoza of skin, a tumor of skin, the skin changes connected with a condition of internals and with a lack of food, infectious, parasitic, phytogenous.
The existing classifications cannot be recognized perfect since at the heart of D.'s grouping (and it is inevitable before clarification of their essence) very heterogeneous signs lie: etiology (infectious, parasitic D.) conducting symptoms (bubbly, pruritic D., keratoza, dyschromias, erythroses), systemacity of defeat (gemodermiya, vasculites, diffusion diseases of connecting fabric) etc. They not completely meet the modern requirements also owing to accumulation of new data on an etiology and a pathogeny of a row D., napr, a framework of classification of P. V. Kozhevnikov does not include group of vasculites of skin, system diseases of connecting fabric and some other.
Separate groups of a dermatosis
owing to a variety etiol., pathogenetic, wedge., age and other features there are many options of association D. in separate groups. The inflammatory contact diseases of skin arising under direct action physical. and chemical factors, dermatitis is combined by a concept (see); the damages of skin arising at penetration of exogenous allergen in an organism (an injection, per os), are combined by a concept toxidermias (see); the diseases of skin and a hair caused by parasitic mushrooms — in group fungus diseases of skin (see), various atrophic processes — atrophy of skin (see); damage of skin zooparasites — dermatozoonoses (see). The changes of skin caused by disturbance of process of keratinization are united in separate groups — keratoza (see); caused by hypersensitivity to sunshine — photodermatoses (see). Allocate also psychogenic diseases of skin (see).
The group of diseases of skin at which the leading and constant symptom is the intensive itch is called by a «pruritic dermatosis»; in one cases an itch — the only display of a disease (see. Itch skin ), in others — precedes changes of skin (e.g., at neurodermatitis), in the third — the itch accompanies, e.g., urticaria, a prurigo. At some pruritic D. various nervous breakdowns are observed that gave a reason to a number of authors to call them neurodermatoses.
Character of an arrangement of rashes defined allocation of group of a linear dermatosis (dermatosis linearis, s. striata) which is characterized by a polosovidny arrangement of skin rash; so can be shown neurodermatitis, red flat deprive, psoriasis, a papillomatous malformation of epidermis (a so-called epidermal, or ikhtioziformny nevus), a follicular dyskeratosis to Darya, a neurofibromatosis of Recklinghausen.
The general for a row hron, diseases the wedge, a sign — education on skin of bubbles — gave the grounds to allocation of group of vesical (bubbly) D. though they and various genesis. The true pemphigus, Guzhero's disease — Hailey — Hailey, violent pemphigoid, a neakantolitichesky pemphigus, the cicatrizing pemphigoid (a high-quality pemphigus of mucous membranes) — concern to them see. Pemphigus .
The originality of D. arising at children's age is caused by feature of a children's organism, more frequent manifestation at this age of hereditary and inborn malformations, special reactivity of skin of the child. It is established that in the period of a neonatality the following D. are observed: an epidemic pemphigus of newborns (see. Pyoderma ), exfoliative dermatitis of Ritter, a desquamative erythrosis of Leyner — Moussa (see. Erythrosis ), a sclerema, a scleredema of newborns, hypodermic adiponekroz newborns (see. Newborn ). At chest and early children's age superficial periporites and a pseuofurunculosis are characteristic (see. Staphylococcal infection ), sifilopodobny post-erosive papular impetigo (see), pro-butting, or gangrenous, ecthyma (see), enteropaticheskiya acrodermatitis (see). Almost only children have Gebra's prurigo. During puberty develop seborrhea, white deprive of the person (see. Deprive of the person idle time ). There are diseases which, beginning in the childhood, proceed all life: an ichthyosis, a violent epidermolysis, a disease to Darya, a pigmental small tortoiseshell (see. Mastocytosis ), nevus, hyper elastic skin. The trichophytosis, a microsporia, Candidiasis of mucous membranes, juvenile and vulgar warts, a contagious mollusk, an intertrigo, a heat rash are also characteristic of children.
D.'s originality at children is shown by nek-ry features a wedge, pictures. E.g., the scabby courses at small children have special localization — on soles, shins, and at babies even on a face, in nail plates; psoriasis at children proceeds more easily, than at adults, his rashes often differ in the expressed exudation; the disease of Dyuringa at children and young men is characterized by larger sizes of bubbles, quite often is followed by temperature reaction etc.
So-called senile D. (dermatoses seniles) developing at healthy people after 40 — 50 years are characteristic of advanced age: atrophy of skin, poredeniye of hair, skin itch, teleangiectasias, mesh senile hemosiderosis, senile warts, keratomas (including skin horn).
The big group is made by professional D., i.e. the diseases of skin arising under the influence of adverse factors of the production environment or labor process (see. Occupational diseases , Professional harm ).
Professional D. take the leading place among other prof. of diseases. According to A.S. Raben and A. A. Antonyev, the most widespread professional D. is dermatitis (61,7%), the second place belongs to eczema (24%), further — erizipeloid (5,9%), ulcerations (2,4%), folliculites (2,1%) and mycoses (1,3%). In most cases prof. vrednost are various chemical substances, physical is more rare. factors, are even more rare infectious and parasitic agents. Also development of professional stigmata — the resistant signs characteristic of this or that specialty (coloring, cracks, grazes, callosity, teleangiectasias, hems, changes of nails, etc.), as a rule, not reducing working capacity is connected with action on skin of the prof. of vrednost (e.g., an anthracosis of skin).
Allocate also tropical D.' group, endemic for the countries of tropical climate.
The principles of diagnosis and treatment
At to diagnosis Needs establishment of character morfol, elements and assessment of rash in general: its monomorphism or polymorphism (true — existence of various primary elements or false — at the expense of the secondary cells developing from one primary), prevalence, symmetry, character of borders, features of localization of rash, its communication with nerves or vessels, the arrangement of elements of rash (disseminated, grouped inclined to merge, etc.). The methods applied to D.'s diagnosis — see. Dermoskopiya .
Treatment sick D. shall be the general (on etiological, pathogenetic signs, symptomatic) and local. Outside pharmakol, means have symptomatic effect — antiinflammatory, allowing, keratolytic, antipruritic, destroying (cauterizing), stimulating regenerative processes, depigmenting, repigmentiruyushchy, anti-sclerosing, as well as etiological — disinfecting, antifungal, antiparasitic. By means of special dosage forms (solutions, lotions, powders, the shaken-up suspensions, ointments, jelly, creams, linimentums, pastes, varnishes, plasters, soaps, glues) it is possible to dose pharmakol, means, to regulate depth of their penetration into skin, and also to have symptomatic therapeutic effect at the expense of physical. properties of dosage forms. The dietotherapy, physical therapy, sanatorium treatment are widely applied as with to lay down., and with the preventive purpose.
History of studying of skin diseases, congresses of dermatologists, etc. — see. Dermatology .
Bibliography: P. V. skinners. General dermatology, L., 1970, bibliogr.; Kr and Nevsky A. M. G1rel1msharna etshlopchna y patogenetichna klassifsha-shchya dermatoz1v, Kharkiv, 1935; The Multivolume guide to a dermatovenereology, under the editorship of G. T. Pavlova, t. 1 — 3, M., 1959 — 1964; Popovl. X. Synthetic dermatology, the lane with bolg., Sofia, 1963; P and - A. S's bin. and Antonyev A. A. Professional dermatology, M., 1975, bibliogr.; Skripkin Yu. K., Somov B. A. and B at t about in Yu. S. Allergic dermatosis, M., 1975, bibliogr.; Studnitsin A. A., Stoyanov B. G. and Sharapova G. Ya. Skin diseases at children, M., 1971, bibliogr.; T about r with at e in N. A., etc. Allergic pruritic dermatosis, Kiev, 1973; BohnstedtR. M of Krank-heitssymptome an der Haut in Beziehung zu Storungen anderer Organe, Stuttgart, 1963; G e r t 1 e r W. Systematische Dermatologie und Crenzgebiete, Bd 1 — 3, Lpz., 1970 — 1973.
B. I. Samtsov.