From Big Medical Encyclopedia

SMALL TORTOISESHELL (urticaria) — the disease which is characterized by an itch and a sudden enanthesis is more rare on mucous membranes, the blisters similar by the form to the blisters appearing after a touch of a nettle, and quickly disappearing. To. represents peculiar, is more often allergic, the reaction arising on various irritants and is or the only manifestation patol, process, or one of symptoms of any disease.


Acute form K. arises from action of external irritants (a nettle, stings of mosquitoes, bugs, bees, wasps, ants, a touch of jellyfishes, actinium, caterpillars silkworms), physical. agents, in particular cold weather (cold urticaria), a sunlight, is more rare — is warm. To. can arise at intolerance of a number of foodstuff (canned and fish meat, a wild strawberry, crayfish, eggs, especially ovalbumin, cheeses, honey, coffee and so forth) and medicines (antibiotics, sulfanamide drugs, antipyrine, acetilsalicylic to - that, aminazine, an ipecacuanha, vitamins of group B); at parenteral administration of a foreign protein — to lay down. serums, vaccines, milk, after hemotransfusion (see. Serum disease ). Cases of development are described To. at a rupture of an echinococcal bubble.

Reason hron, forms K. the centers hron are, infections, toxic products of the broken metabolism, diseases went. - kish. path, liver and bilious ways. Often, especially at children, To. develops at a helminthic invasion. Sometimes To. arises at patients with a renal failure, a diabetes mellitus, at diseases of blood, dysfunctions of closed glands (a thyroid gland, ovaries). To. it can be observed at some inf. diseases (e.g., at flu), disorders of a female genital and at pregnancy. In some cases the etiology does not manage to be established. Sometimes To. it is combined with bronchial asthma or any other allergic disease, napr, with hay fever.

A so-called pigmental small tortoiseshell — seldom found disease — nothing the general with To. has no (see. Mastocytosis ).

A pathogeny

On the earliest representations To. is augionevrozom; so, P. Unna considered an origin of a cutaneous dropsy at To. the stagnation of blood caused by disturbance of regulation of a tone of vessels (development of a special excitable condition of muscles of vessels). A. I. Pospelov, P. V. Nikolsky, A. Neicer, Valdgeym, Kreybikh (F. Waldheim, To. Kreibich) and some other the authors adhering to the angiospastic theory of development To., stated various assumptions of participation at the same time of a nervous system. It was opposed by L. Torok upholding the inflammatory nature of vascular reactions at K.

Posleduyushchiye Kliniko-fiziol, researches showed that vascular reactions at To. it is impossible to consider from positions of mechanical pressure difference as increase in intra capillary pressure, expansion of a gleam of capillaries and pressure decline in perivascular fabric are insufficient factors for development of a blister. Crucial importance for blistering at To. have funkts, the vascular disorders which are shown increase in permeability of a capillary wall it is preferential concerning plasma (see. Permeability ). In development of vascular disorders at To. an important role is played by biologically active agents participating in a pathogeny of many allergic processes — a histamine, serotonin and others mediators of allergic reactions (see). Increase in maintenance of a histamine in blood in the period of rashes is observed at patients To. various etiology. At acute To. willows period of an aggravation hron. To. in blood the maintenance of a bradikininogen and kinazny activity go down. In development To. at overfatigue, a nerve strain, physical. influences acetylcholine participates (cholinergic To.).

If To. depends on endogenous irritants of the proteinaceous nature (an endointoxication, a food or bacterial sensitization), in most cases vascular disorders develop on the mechanism of allergic reaction of immediate type (see. Allergy ). At To., caused by direct action on skin of external factors, vascular disorders can be caused by influence of these factors on an epithelium and its neuroreceptor educations, and in the subsequent and on a wall of vessels, hl. obr. subpapillary network, or a direct impact on vessels (e.g., at stings of insects).

A wedge, observations and immunol, researches allowed to recognize in some cases and not allergic genesis To., defined by impact on body tissues of gistaminoliberator (see. Gistamin ), to the Crimea some toxins, proteolytic enzymes, medicines, food stuffs belong. Special value in a pathogeny hron. To. have funkts, frustration central and the autonomic nervous system at which favorable conditions for formation of allergic reactivity of an organism are created. Funkts, disturbances of a nervous system at patients To. objectively are confirmed by indicators pletizmografiya (see) — the slowed-down fading of vascular reactions to a situation and distantny irritants, the slowed-down achievement of the zero plethysmogram, and also a wedge come to light, observations — patients are irritable, emotionally labilna.


Is observed expansion circulatory and limf, capillaries and acute limited hypostasis of preferential papillary layer of a derma (collagenic fibers are edematous, disconnected, badly perceive coloring); in epidermis intercellular hypostasis. In an early stage of development blister (see) signs of inflammatory reaction in skin are absent, small lymphocytic perivascular infiltrate in a few minutes is found. Unlike it at persistent papular urticaria considerable cellular perivascular infiltrate, the consisting hl is observed. obr. from lymphocytes, and an acanthosis.

A clinical picture

Elements of rash of light pink or porcelain-white color, different size, have no certain localization; in one cases blisters are not numerous and located absent-mindedly, in others — increasing owing to the peripheral growth and merge (especially on the places which are exposed to irritation), form the big centers of defeats (tsvetn, the tab., Art. 465, fig. 17). Sometimes hypostasis is expressed so poorly that only the rash of spots (urticaria maculosa), sometimes in the form of a ring (urticaria circinata) is observed. Hypostasis can reach the considerable size, extending in depth of a derma and hypodermic cellulose, leading to formation of big blisters — so-called huge To. (see. Quincke hypostasis ). Extremely seldom meet hemorrhagic To., characterized by existence in the center or at the edges of blisters of dot hemorrhages, and also violent To., at a cut on a surface of a blister there are bubbles. Sometimes after disappearance of blisters on their place the hyperpegmentation develops. Rashes are always followed by an itch.

Damage of mucous membranes of respiratory tracts (a throat, bronchial tubes) at To. it is shown by difficulty of breath and pristupoobrazny cough with allocation of a liquid phlegm; at quickly coming hypostasis of mucous membranes the threat is created asphyxia (see). Edematization of a mucous membrane of a stomach can cause vomiting, even with impurity of blood; at damage of intestines there is quickly passing diarrhea.

The disease usually begins suddenly and in some cases is followed by disturbance of the general state: an indisposition, a headache, a fever, joint pains, temperature increase to 38 — 39 ° («urticaceous fever»), an eosinophilia. At extended To. tension in eyeglobes is sometimes felt, dacryagogue, pains in parotid glands are possible.

Distinguish an acute form K., proceeding several days or one-two weeks, and hron, the form proceeding with a recurrence many months and even years with almost daily rashes, with light intervals, various on duration.

Represents a special form so-called artificial To. (an autographism, an urtikarny dermographism) when, having carried out by a nail on skin, it is possible to receive a voldyreobrazny strip. At the same time a certain sequence of the phenomena is observed: after action of an irritant in several seconds there is local erubescence, and in 1 — 3 min. the reddened area begins to swell up a little; hypostasis reaches the maximum development in 3 — 5 min., gradually edematous site of skin becomes wider. The similar phenomena can be caused in the persons suffering from a usual form K.

As atypical form K. describe chronic persistent papular urticaria. However inclusion in the concept «urticaria» of this seldom found dermatosis is ill-founded. At this dermatosis blisters remain within several days and even weeks, gain yellowish-red color, are condensed and turn into the flat or semi-spherical small knots size from lentil to nut leaving later permissions a hyperpegmentation. Sometimes small knots arise at once, passing a stage of a blister; in some cases on small knots warty growths can develop. The single or grouped elements of rash arise preferential on a face and upper extremities. The disease usually proceeds for years and is observed more often at persons of mature and old age.

The diagnosis

the Diagnosis in typical cases does not represent difficulties. Unlike other dermatosis at which along with blisters also other skin manifestations are observed, To. it is characterized by a monomorfnost of rash. Hron, resistant papular To. it is necessary to differentiate with prurigo (see), at a cut small knots arise hl. obr. on an extensor surface of hands, and also with red flat it is deprived (see. Deprive red flat ).


At acute To., caused by intake of food or medicinal substances, it is necessary to appoint first of all laxatives (sodium sulfate) and the means disinfecting intestines. As the symptomatic treatment is carried out nonspecific desensitization in the form of intravenous injections of 10% of solution of calcium chloride or a gluconate of calcium (administration of drugs of calcium inside is less effective), are appointed antihistaminic substances (see), use is reasonable hystoglobulin (see). At To., arising from influence physical. factors, the drugs having the pyrogenic effect (pyrogenal, Prodigiosanum) are shown. At the phenomena of intoxication solution of sodium thiosulphate intravenously is effective 30%. A heavy attack To. it is stopped by a subcutaneous injection of 1 ml of 0,1% of solution of adrenaline; at a persistent and heavy current To. it is possible to use corticosteroid drugs in small doses (Prednisolonum on 0,005 g 3 — 4 times a day), at the accruing allergic phenomena (hypostasis of a throat) urgent intravenous administration of Prednisolonum or Methylprednisolonum is shown.

It is reasonable to appoint a milk and vegetable diet to several days, to exclude stimulants (alcoholic drinks, coffee), smoked products, spices, to limit reception of sodium chloride, farinaceous and sweet dishes. Outwardly apply the means reducing an itch: 0,5 — 1% spirit solutions of menthol, salicylic to - you, indifferent powders, talkers (in particular, with addition carbolic to - you); it is possible to use vinegar, pure or divorced alcohol, cologne. Corticosteroid ointments at To. are ineffective.

At hron. To. comprehensive inspection of the patient is necessary for examination etiol, a factor and an exception of effect of allergen. In case of identification of allergen (pollen, food, etc.) specific is shown desensitization (see). Treatment of the found centers hron is necessary, infections, inflammatory processes in went. - kish. path; subaqual bathtubs have favorable therapeutic effect. At a helminthic invasion it is carried out deworming (see). At dysfunction of closed glands appoint the corresponding therapy. For normalization of c. N of page are shown sedatives (see), in particular drugs of a valerian and motherwort, tranquilizers; hypnotherapy can be recommended. Use of hystoglobulin which is entered vnutrikozhno or subcutaneously courses on 5 — 6 injections is reasonable; if necessary the course of treatment is repeated in 2 — 3 months.

Sometimes at To. with the obscure etiology there is effective an autohemotherapy, and also treatment by insulin (subcutaneously on 10 PIECES within 5 — 6 days) or ephedrine. Redoxons and P, normalizing permeability of capillaries are effective.

Important value at hron. To. has observance of a diet, edges shall be mainly vegetarian. For clarification of a food-borne allergen, about the Crimea development can be connected To., appoint the so-called excluding diet, eliminating various foodstuff from food. In cases of suspicion on an alimentary origin To. nonspecific desensitization is recommended. From electromedical procedures are shown the general ionogalvanization with calcium chloride, an electrosleep. Patient hron. To. in the presence funkts, frustration of a nervous system it is possible to recommend treatment in the sanatoria located in the woody area in a temperate climate. Outside treatment — the same, as at acute To.

Forecast at acute To. it is favorable, at hron. To. depends on success of identification of an etiology and a possibility of its elimination.


Prevention, especially a recurrence, consists in identification of allergens, sanitation of the centers hron, infections, intensive treatment of diseases which symptom can be K.

Krapivnitsa at chest age occurs at children extremely seldom. At early children's age it is more often observed acute To., in an etiology and a pathogeny a cut preferential value has improper feeding and went. - kish. frustration. At more senior children it is more often noted hron. To.; the etiology and its pathogeny do not differ from those at To. at adults. Rashes To. quite often are followed by an indisposition of the child, a diarrhea, sometimes vomiting, loss of appetite.

At To. at children it is usually difficult to differentiate whether the general frustration of a condition of the child are primary or secondary; always it is necessary to aim to reveal etiol, a factor (treatment is appointed only after inspection of the child).

The principles of treatment To. children have the same, as at adults: desensitization, antihistaminic and sedatives in age dosages, deworming, etc.

At children of the first 2 — 3 years is to life, a thicket than true To., the so-called nursery develops To., or strophulus (see); the children having exudative diathesis get sick.

See also Allergic diseases .

Bibliography: Berenbeyn B. A. Pruritic dermatosis (neurodermatoses), M., 1971, bibliogr.; Skripkin Yu. K., Somov B. A. and B at t about in Yu. S. Allergic dermatosis, page 54, M., 1975, bibliogr.; Private allergology, under the editorship of A. D. Ado, page 335, M., 1976, bibliogr.; Shaposhnikov O. K. of N. V idemenkov. Vascular damages of skin, page 27, L., 1974, bibliogr.; Shevlyakov L. V. About treatment gistaglobiny patients with a chronic small tortoiseshell and a professional dermatosis, Vestn, dermas, and veins., No. 2, page 62, 1973.

O. K. Shaposhnikov.