Professional Documents
Culture Documents
Dermatovenerologija
Dermatovenerologija
6
9
12
15
ERYSIPELAS
ERYSIPELOID
- ()
17
19
20
22
23
25
33
PITYRIASIS VERSICOLOR
35
43
45
-
MOLLUSCUM CONTAGIOSUM
(VERRUCA VULGARIS)
EXANTHEMA SUBITUM
47
49
52
54
56
59
61
62
64
67
69
-
(NAPPY RASH)
71
74
78
82
84
90
93
94
98
101
103
104
106
107
109
,
,
,
111
113
115
PITYRIASIS ROSEA
LICHEN PLANUS
()
:
:
127
129
138
139
140
143
145
149
151
154
159
161
162
165
167
168
169
171
174
175
, ,
177
CHEILITIS
OTITIS EXTERNA
,
PRURITUS ANI
179
182
184
191
195
197
199
201
- (HPV)
-
203
205
208
211
213
217
221
223
224
226
230
233
245
prick-
Patch-
()
1-3
PRICK-
prick () scratch-
( 1).
.
, , ,
. ,
, , ,
, .
.
.
,
I . ,
.
: stemizole 6 ; 2-4 .
( prednisolone 20 mg
) .
PATCH-
2
patch- () 20-30 .
70-80% . -
, , ,
, , . ,
.
.
-
-. -
10-30 , 1-3 .
,
3-5 , 5-7 .
3
15-20
.
. .
, .
,
. , .
(7C).
1 10 . .
. , -
.
.
.
, ,
.
42
5 10 . ,
(42) 5-10 . ,
.
,
55 1010 m,
. 15-30 24 .
7 .
2-4 .
.
.
,
, /
. .
: , 0.5-1 ml 1% lidocaine
. , 24 .
1. Editors, Article ID: ebm00260 (013.005), 2005 Duodecim Medical Publications Ltd
1. EBM Guidelines, 23.2.2001, http://www.ebm-guidelines.com
2. 2
3. 23.2.2006
4-31
, ,
( 4); .
() ,
.
() .
.
.
, ( 5, 6). . , .
( 7), .
(Neurodermatitis nuchae) ( 8) .
, . , .
, .
10
9
.
, 24 .
24 ,
.
,
( 10).
15- .
( 11). (
) . , , ( 12). Trichophyton rubrum . .
, .
( 13):
.
2-3 mm .
() .
.
( ).
( 14 15).
.
, () .
.
( 16).
.
, , .
Patch-
17
,
. !
.
() ( 18) ( 19
. (
20) / .
( 21). , .
Reiter- .
.
( 22), ,
.
.
,
(Neurodermatitis).
( 23) .
- ( 24).
.
( 25).
, . .
( 26) (
27).
( 28).
( 29).
, ,
.
, .
.
( 30)
, , 31.
11
12
1. Editors, Article ID: ebm00259 (013.001), 2005 Duodecim Medical Publications Ltd
1. EBM Guidelines, 11.11.2002, http://www.ebm-guidelines.com
2. 4
3. 2006
.
( , ,
).
.
.
( ).
, ,
.
.
; ( ). .
.
.
(.. ;
).
:
( ).
Lichen ruber planus ( ),
Lupus erythematosus (
),
( , necrobiosis lipoidica, , ).
.
.
0.5 1 . .
3-4 mm punch .
,
,
. .
. , .
, (
). , ,
.
.
, (
punch-
!).
,
.
, .
1. Markku Helle, Article ID: ebm00293 (013.006), 2004 Duodecim Medical Publications Ltd
1. EBM Guidelines, 21.4.2001, http://www.ebm-guidelines.com
2. 5
3. 2006
.
-
13
16
32-34
, ,
.
.
.
.
( 32).
"Pemphigus neonatorum" ( 33) , , .
S. aureus II.
,
( 34).
; .
.
Tinea corporis.
,
.
Staphylococcus aureus.
- .
.
.
.
17
18
.
, ( (-B)
).
, 6 m2, ( . . cefalexin cefadroksil 50 mg kg
7 10 (-B) amoxicillin- .
).
.
, .
(-D).
:
; , ;
,
;
;
( , - .
) (-D) .
.
-
.
.
35, 36
, .
Staphylococcus aureus
,
folliculitis ( 35,36).
,
furunculus.
Sycosis barbae .
( Chlorhexidine, ) .
( Neomycin).
.
.
Sycosis barbae .
.
:
;
;
;
(,
, , );
(500mg x 3,
30 mg/kg/). amoxicillin
cloxacillin;
, ,
3 6 , clindamycin 150 mg x 1
19
20
3 .
1. Llera JL, Levy RC. Treatment of cutaneous abscess: a double-blind clinical study. Annals
of Emergency Medicine 1985;14:15-9
2. Macfie J, Harvey J. The treatment of acute superficial abscesses: a prospective clinical
trial. Br J Surg 1977;64:264-6
3. Stewart MP, Laing MR, Krukowski ZH. Treatment of acute abscesses by incision,
curettage and primary suture without antibiotics: a controlled clinical trial. Br J Surg
1985;72:66-7
4. Jaakko Karvonen, Article ID: ebm00273 (013.023), 2004 Duodecim Medical
Publications Ltd
1. EBM Guidelines, 12.8.2004, http://www.ebm-guidelines.com
2. 3
3. 2007
ERYSIPELAS
37,38
.
.
- .
.
( , ).
.
, ,
( ) ( 37,38).
. .
.
: ,
CRP.
:
Erythema nodosum,
,
,
, ,
Erysipelothrix ,
( ).
, .
.
:
Penicillin G, 2 4 .. (procain penicillin 1.2-1.5 . 1 . ). ,
(3-4 ).
, , . ,
cloxacillin.
Climdamycin
350 -400 mg 4 .. 3-5 , .
.
, 3 , 6-8 .
, .
.
() ,
.
, ,
.
( )
(6-24 ) .
benzyl penicilline 1.2-1.5 .. 3-4 ,
, penicilline V 1-2 .
21
22
ERYSIPELOID
39
(Erysipelothrix rhusiopathiae)
(, , ).
.
, , ,
.
, , . .
, .
, .
.
.
.
39
.
,
.
1,5 .
, , (-D).
() .
23
24
.
.
.
( 11)
.
(Bacteroides,
E.coli, Enterococcus faecalis, .)
(Fournier- ).
.
.
, , , , ,
().
Clostridia species
.
, .
, ,
, .
- (, , )
.
.
, .
- .
. .
, .
( ),
.
- .
(
).
. .
(imipinem 1g x 2.).
(Staph. Aureus, Clostridium perfringens . ,
benzyl penicillin 2.000.000 IU 4 .
, . ,
.
, .
1. Janne Laine and Janne Mikkola. Article ID: ebm00012 (013.021), 2005 Duodecim
Medical Publications Ltd
1. EBM Guidelines, 18.5.2004, http://www.ebm-guidelines.com
2. 3
3. 2007
- ()
40-43
.
, .
25
26
.
:
B. afzelii
B. garinii
B. burgdorferi sensu stricto.
B.burgdorferi
().
, , .
( )
Erythema migrans
() ( 41). .
, 2-4 ,
. .
(bulls eye lesion,
), .
.
.
5 cm , .
,
.
,
.
Lymphadenosis benigna cutis
. ,
, , . ( 42).
, 50%
, // .
:
:
.
.
:
.
( Banwarth).
Encephalitis progressiva chr.
:
, , .
:
.
:
Acrodermatitis atrophicans ( 43).
:
.
, .
.
> 5 cm, .
.
, (-B).
( ).
(-B).
27
28
-. , , ,
, .
.
IgM- 3 6 . . IgM- .
IgG- 6
.
,
. IgM IgG-
IgG- .
.
, .
-. EUCALB .
,
.
,
, .
-,
. ,
,
. , .
Bayes - ( 1).
1. Bayes - -
-
> 80%
5%
15%
30%
45%
20-80%
>96%
>94%
>90%
>87%
61-96%
49-94%
37-90%
30-87%
-
< 20%
<61%
<49%
<37%
<30%
0,95 0,90
(= - )
- >80% .
20 - 80% -
.
, , , <20%.
(%
) 5 15%,
,
.
(-C).
( ).
15 . 3
15- .
amoxicillin (-B).
1 g/
, 50 mg/kg .
amoxicillin ,
:
, doxycycline (-B) 100 mg ;
, cefuroxime axetil 30 mg/kg 3-4 (
).
Doxycycline ,
.
:
.
.
amoxicillin 500 mg
30 .
.
.
.
, , .
29
30
-
, , .
2-3 ceftriaxone 2g/ ..,
100mg/kg/.
ceftriaxone.
,
-.
23 , .. ceftriaxon
2 g/, 100 mg/kg/. ceftriaxon.
: Ceftriaxone 2g/ ..
15 , amoxicillin cephadroxil
100 .
doxycyclin 200 mg/
8-20 .
.
.
. .
.
.
, . .
(, )
.
,
.
10. ,
. , .
. ,
.
.
.
. -
10 .
31
Tinea pedis
Tinea cruris
Tinea corporis
Tinea capitis
Candida intertrigo
Paronychia Monilia
Candida balanitis
44-50
, . ; ,
, .
,
.
. , .
.
(, , )
, .
-,
35
36
. ,
.
.
2 6 .
, ,
.
. , ( 1-2 )
.
, .
( ) .
11 .
(Clotrimazole, econazole, miconazole, thioconazole12, ketoconazole),
amorolfine13 - (ketoconazole, itracona
zole fluconazole) .
.
terbinafine . ,
,
1-2 . ,
-erythema multiforme .
.
. (
), , ,
.
.
.
, ,
11 .
12 .
13 .
( 44).
, .
.
..
( 12). .
.
TINEA PEDUM
.. ( 11).
.
, , , .
.
.
().
, .
( 45).
.
, , .
, ()
.
.
, ( 16).
.
.
14
, .
.
:
, , . .
: Terbinafine 250 mg 1, 2-4 itraconazole, 100 mg 1, 1 4
.
14 .
37
38
ONYCHOMYCOSIS
46, 47
,
.
( 48).
.
.
"
,
, . , ,
.
.
,
.
(amorolfine 15) .
( 6 , 12 ).
.
16 250 mg 1 3 1 .
17 : 200 mg 2 , 3 . !
,
70-80% ,
40-50%.
.
.
.
40,0, Cerea alba 5,0, Adeps lanae 20,0, Vaselin album 25,0, Silica gel tip
10,0.
: 40,0, 100,0
7-10 .
, ,
.
50%.
.
15 .
16 .
17 .
TINEA CRURIS
, ( 49),
.
.
3-4 .
4 .
,
: 100 mg x 1
250 mg x 1 2 .
.
TINEA CORPORIS
50
.
.
( , ,
, ) .
.
Trichophyton tonsurans.
.
. ,
.
.
(100 mg ) 40 kg, 200 mg/
40 kg 2
39
40
4 .
62,5 mg/ 20 kg, 125 mg/ 20-40 kg, 250 mg/ 40 kg 4 .
2 .
,
,
.
3-5 .
.
TINEA CAPITIS
.
.
Microsporum canis ( ), T. mentagrophytes (
) T. violaceum ( ).
, , , , .
(),
.
. ,
. ,
.
, 1 250 mg/.
100 mg/ ,
200 mg 2, , 2-3 .
18 (4mg/kg). .
, .
.
lichen planus stomatodynia ,
. Candida balanitis , .
Candida albicans.
Candida albicans
, Candida .
,
18 .
.
, ,
( HIV-),
.
.
. .
, .
( 29).
,
.
.
CANDIDA INTERTRIGO
: (
) .
, , ,
.
, , , . .
, pH .
hydrocortisone.
41
42
(fluconazole, itraco
nazole).
, .
.
, .
PARONYCHIA MONILIA
, , .
: Candida albicans +Staphylococcus aureus.
( ) .
,
.
, .
.
.
.
.
CANDIDA BALANITIS
Candida balanitis
.
;
, , .
.
Candida balanitis , .
(
).
,
: miconaziole-
hydrocortisone .
.
(1:10000) , 15
(
).
(0,01-0,1%)
.
PITYRIASIS VERSICOLOR
51
43
, ( 51),
.
, . , .
.
Pityrosporum .
, ( )
Pityrosporum .
10 , . ,
, .
(400mg x 2 )
.
,
. 10
. .
Pityriasis versicolor . ,
.
HSV1 HSV2
HSV
HSV;
Erythema multiforme
52-56
Herpesviridae
.
, -
, .
-:
Herpes simplex 1 2
Varicella zoster
EpsteinBarr (
)
Cytomegalovirus
- 6-8 (HHV-6-8).
HHV-6 exanthema subitum .
- 7
.
Kaposi
HHV-8.
HSV1 HSV2
47
48
, -), .
- - .
HSV ,
( 53,54).
, HSV .
.
HSV ,
(eczema herpeticum) ( 55).
HSV1 HSV2, .
HSV
65%.
2-26 .
HSV
.
().
3
.
.
HSV
Erythema multiforme
erythema multiforme.
, , .
1-2 ( 56).
.
19 .
20 .
1. Editors, Article ID: ebm00932 (013.018), 2005 Duodecim Medical Publications Ltd
1. EBM Guidelines, 7.6.2002, http://www.ebm-guidelines.com
2. 4
3. 2006
57-59
.
.
3 .
.
varicella-zoster . .
,
, ( 57, 58),
.
.
.
-
49
50
,
.
;
;
;
;
;
(-B).
:
(, );
;
AIDS HIV ;
;
;
;
.
.
( 59).
,
- ( ) .
.
60 , .
.
Acyclovir 800 mg x 5 x 7
Famcyclovir21 250 mg x 3 x 7 500 mg x 2 x 7
pencyclovir22
21 .
22 .
Valacyclovir23 1 g x 3 x 7
Valacyclovir acyclovir valine .
acyclovir-.
acyclovir.
cyclovir
.
varicella-zoster .
, -
. , -.
. , .
(-A).
.
, ( amitriptyline 25-50 mg x 1 )
() (-A).
Carbamazepine .
100 mg 2. 200 mg 3 2 .
,
.
1. McGill JI, White JE. Acyclovir and post-herpetic neuralgia and ocular involvement. Br
Med J 1994;309:1124
2. Kost RG, Straus SE. Postherpetic neuralgiapathogenesis, treatment, and prevention.
N Engl J Med 1996;335:32-42
3. Wood MJ, Ogan PH, McKendrick MW, Care CD, McGill JI, Webb EM. Efficacy of Oral
Acyclovir Treatment of Acute Herpes Zoster. Am J Med 1988;85(suppl 2A):79-83
23 .
51
52
4. Huff JC, Bean B, Balfour Jr HH, Laskin OL, Connor JD, Corey L, Bryson YJ, McGuirt P.
Therapy of Herpes Zoster with Oral Acyclovir. Am J Med 1988;85(suppl 2A):84-89
5. Morton P, Thomson AN. Oral acyclovir in the treatment of herpes zoster in general
practice. New Zealand Med J 1989;102:93-95
6. Lancaster T, Silagy C, Gray S. Primary care management of acute herpes zoster:
systematic review of evidence from randomized controlled trials. British Journal of
General Practice 1995;45:39-45
7. Jackson JL, Gibbons R, Meyer G, Inouye L. The effect of treating herpes zoster with
oral acyclovir in preventing postherpetic neuralgia: a meta-analysis. Arch Intern Med
1997;157:909-912
8. The Database of Abstracts of Reviews of Effectiveness (University of York), Database
no.: DARE-978103. In: The Cochrane Library, Issue 4, 1999. Oxford: Update Software
9. Tyring S, Barbarash RA, Nahlik JE, Cunningham A, Marley J, Heng M, Jones T, Rea
T, Boon R, Saltzman R. Famciclovir for the treatment of acute herpes zoster: effects
on acute disease and postherpetic neuralgia. A randomized, double-blind, placebocontrolled trial. Annals Of Internal Medicine 1995;123:89-96
10.Volmink J, Lancaster T, Gray S, Silagy C . 1996. Treatments for postherpetic neuralgia: a
systematic review of randomized controlled trials. Family Practice 1996;13:84-91
11.Jaakko Karvonen, Article ID: ebm00017 (001.041), 2005 Duodecim Medical
Publications Ltd
1. EBM Guidelines, 7.6.2002, http://www.ebm-guidelines.com
2. 4
3. 2006
MOLLUSCUM CONTAGIOSUM
60
.
, .
Molluscum contagiosum ,
( 60). -
.
.
.
( HIV ).
( mm)
, .
,
.
.
. ,
. , 20-30
lidocaine/prilocaine .
.
, .
, .
.
HIV- .
.
molluscum contagiosum
.
, , .
, .
.
.
.
1. de Waard van der Spek FB, Oranje AP, Lillieborg S, Hop WC, Stolz E. Treatment of
molluscum contagiosum using a lidocaine/prilocaine cream (EMLA) for analgesia. J Am
53
54
(VERRUCA VULGARIS)
61-64
. ,
.
.
Papilloma . .
Papilloma-.
.
( ).
() .
( 61, 62).
,
( 63, 64).
. .
-
.
(Verruca plana)
.
. .
.
"".
40% (-B) .
, (
) .
.
. .
.
;
. tretinoin
.
Imiquimod24 .
, .
( ).
, .
.
.
,
. , , .
.
.
. ,
.
24 .
55
56
CO2 25 .
.
,
.
1. Pekka Autio, Article ID: ebm00276 (013.030), 2005 Duodecim Medical Publications Ltd.
1. EBM Guidelines, 12.8.2004, http://www.ebm-guidelines.com
2. 3
3. 2007
EXANTHEMA SUBITUM
- (HHV) 6 71,2
6 2 .
.
3-5 , .
( ) ,
1 .
.
, .
, -
25 .
,
HHV- exanthema subitum.
.
10-15% .
.
.
CRP 12 .
exanthema subitum CRP ,
.
, CRP.
.
.
.
, .
.
,
("maculae coerulae").
( ) .
, 6 mm (
1mm ). .
, ,
.
. ,
, .
maculae coerulae
.
permethrin (-A) .
, malathion.
( 0,2-0,3 mm) .
.
.
1. Vander Stichele RH, Dezeure EM, Bogaert MG. Systematic review of clinical efficacy of
topical treatments for head and face. BMJ 1995;311:604-608
2. Dodd CS. Interventions for treating head and face. The Cochrane Database of
Systematic Reviews, Cochrane Library number: CD001165. In: The Cochrane Library,
61
62
65-68
.
, ,
.
, .
,
.
, .
, , , ,
.
. .
.
, ( 65, 66). (
, .
.
, ( 67, 68)
.
.
,
.
,
.
.
.
, .
Permethrin (-A).
, . 8-15 .
.
,
.
, .
, ,
. (). chlorhexidin ,
.
.
.
1. Walker GJA, Johnstone PW. Treating scabies. The Cochrane Database of Systematic
Reviews, Cochrane Library number: CD000320. In: The Cochrane Library, Issue 2.
2000rd: Update Software; 1998. Updated quarterly
2. Brown S, 2002er J, Bady W. Treatment of ectoparasitic infections: review of the Englishlanguage literature, 1982-1992. Clin Infect Dis 1995;20(suppl 1):pp. 104-109
3. The Database of Abstracts of Reviews of Effectiveness (University of York), Database
no.: DARE-950852. In: The Cochrane Library, Issue 4, 1999. Oxford: Update Software
4. Pekka Autio, Article ID: ebm00269 (013.040), 2005 Duodecim Medical Publications Ltd
63
64
Dipteria ( )
Hymenoptera
(anoplur)
(cimicidae)
69
Hymenoptera .
.
, -
(Alphavirus, Flavivirus Bunyavirus) (
).
( )
,
.
, .
(Simuliide)
.
.
.
Culicoides
Sulicoides . .
Lipoptena cervi
.
.
. .
(Tabanide)
HYMENOPTERA
.
.
()
.
hymenopten .
(ANOPLURA)
.
.
.
.
- (CIMICIDAE)
.
, .
, , .
, .
(
, ).
, ( 69).
.
.
(Lepidoptera) .
65
66
Ixodes ricinus
Kumlinge tick - borne encefalitis Uukniemi .
( , ).
,
, , . .
(Araneus diadematus) .
.
Hymenoptera
, . , .
,
.
hymenoptera .
.
. , 50. . .
,
. , . ,
, .
hydrocortison .
.
.
.
, 30 mg/.
()
.
,
.
( ).
.
.
.
.
.
1. Editors, Article ID: ebm00023 (001.050), 2004 Duodecim Medical Publications Ltd
1. EBM Guidelines, 1.6.2001 http://www.ebm-guidelines.com,
2. 5
3. 2006
( < 3 )
( > 3 )
1,2
70
- .
.
.
- .
( 9).
. .
1 mm .
.
24 .
Quincke- .
, .
24 .
, :
, erythema multiforme, erythema nodosum, erythema fixum urticaria
vasculitis.
71
72
. .
Urticaria vasculitis. 1-3 . .
( <3 )
,
.
, .
,
.
?
,
?
.
.
.
, RAST- .
.
-
.
(1:1.000) 0,5 mg ,
, .
40-60 mg
.
.
,
.
.
.
. ,
, (
).
, , , , , .
.
.
( >3 )
, ,
.
, . .
/ .
.
.
.
.
.
, .
.
24 , urtiacaria
vasculitis.
.
.
Dermographismus (urticaria factitia) ( 3)
.
<1 , 2-4 .
.
.
. .
.
: . ( 30 ) . Doxepin 10 (-25) mg 1-3 .
1-2
( ).
<2 .
" ": .
: , .
Quincke- (
, )
. .
30-60 mg
. , 0,5 mg (1:1.000)
, , . , ,
.
1. Editors, Article ID: ebm00272 (013.074), 2005 Duodecim Medical Publications Ltd
73
74
.
, .
prick- IgE
.
, , (, ), .
.
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1. Minna Kaila, Article ID: ebm00299 (014.006), 2005 Duodecim Medical Publications Ltd
1. EBM Guidelines, 15.9.2004 http://www.ebm-guidelines.com,
2. 3
3. 2007
( )
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.
1. Editors, Article ID: ebm00280 (013.013), 2005 Duodecim Medical Publications Ltd
1. EBM Guidelines, 12.8.2004, http://www.ebm-guidelines.com
2. 3
3. 12.8.2007
79-81
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formaldehyde ( 79).
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.
1. Pekka Autio, Article ID: ebm00265 (013.010), 2005 Duodecim Medical Publications
Ltd
1. EBM Guidelines, 13.8.2004, http://www.ebm-guidelines.com
2. 3
3. 2007
82-88
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100
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erythema nodosum ( 86), erythema induratum, polyarteritis nodosa, nodular
vasculitis thrombophlebitis. . .
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1. Editors, Article ID: ebm00284 (013.016), 2005 Duodecim Medical Publications Ltd
1. EBM Guidelines, 20.9.2004, http://www.ebm-guidelines.com
2. 3
3. 2007
94, 95
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26 .
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1. Editors, Article ID: ebm00648 (032.040), 2005 Duidecim Medical Publications Ltd
1. EBM Guidelines, 19.2.2003, http://www.ebm-guidelines.com
2. 4
3. 2007
- , , ,
.
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.
.
.
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108
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.
.
.
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1
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3. 2008
96
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.
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-.
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.
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.
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.
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113
.
.
.
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,
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PEMPHIGOID)
97
. (), (, , ) ,
.
DERMATITIS HERPETIFORMIS
( 97) , ,
.
,
.
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118
.
.
.
,
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,
.
.
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.
.
() .
, .
.
.
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).
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.
. (40-60 mg/
) (-C).
.
.
(-B).
() . .
Cyclophosphamide
epidermolisis bullosa aquisita (-C).
Cyclophosphamide28
pemphigoid epidermolysis bullosa acquisita.
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1. EBM Guidelines, 16.4.2004, http://www.ebm-guidelines.com
2. 2
3. 16.4.2006
28 .
119
120
98, 99
, , , .
.
100-200/
30-50 .
Raunayd .
.
, . , ( 98, 99)
.
20-30% .
, .
, .
, .
: , , , .
. CRP .
.
, () -
( , Raunayd ).
.
(-B).
, .
,
.
.
.
.
()
.
Iloprost29 (-B) .. , (-C)
Raunaud .
, .
.
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1. EBM Guidelines, 12.8.2004, http://www.ebm-guidelines.com
2. .
3. 2006
29 .
121
122
-
()
: / 1
.
(
).
.
.
.
.
.
.
:
,
.
: AIRE (
21q22.3)
;
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.
.
:
,
123
(, , , )
, .
.
15- ,
.
.
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1. (%) 10
40 89
10
40
74
100
64
86
39
79
23
18
72
26
31
11
17
11
18
21
11
79
100
16
22
15
40
26
.
.
. , .
, . .
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Publications Ltd
124
HENOCH-SCHONLEIN
100
Henoch-Schnlein .
2-10 .
( 100).
,
, , .
.
.
.
38.5 C.
CRP 20 mg/L 35
mm/.
.
,
, . (<100)
.
, ,
.
,
.
,
6 . .
,
,
, .
Henoch-Schnlein
, .
ERYTHEMA NODOSUM
101
erythema nodosum
, , .
3-4 .
.
.
.
125
:
(7-14 ),
Chlamydia pneumoniae,
Yersinia, ,
.
:
,
: , .
.
, , (
86, 101), .
, , .
.
.
.
.
(, ).
, CRP.
.
(
).
Yersinia.
Chlamydia pneumoniae .
1. Editors, Article ID: ebm00290 (013.075), 2004 Duodecim Medical Publications Ltd
1. EBM Guidelines, 11.1.2003, http://www.ebm-guidelines.com
2. 2
3. 11.1.2007
102-108
,
.
2%. 5 . : 16 22- 1 57 60-
2 .
.
. . (PSORS 1) 6p. 21.3. 10% (
).
. -
h-1 40.
(, , ,
) . ,
, , .
.
,
( 102, 103).
(Auspitz- ).
, ( 104), , , ( 07, 105)
( 22) .
129
130
:
;
(onycholysis);
( ) ( 106);
;
Acrodermatitis continua Hallopeau ,
( 107).
,
.
.
.
( , , , , ).
( 108)
. (
).
5-10% .
.
.
: 50% .
( 5, 6) , , .
.
. . .
(lichen simplex nuchae) , .
. ,
.
() ; ,
, .
.
.
.
Erythrasma , . .
(Wood- ).
,
.
.
,
.
,
, , .
( , , , HIV),
.
(
), .
.
, ,
.
(calcipotriol calcitriol)30 (tazarotene)31.
. , , , .
. , , (
).
, (Kobner- ).
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.
.
30 .
31 .
131
132
32
33
34
35
.
.
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.
. ,
.
.
.
,
.
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.
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.
.
Calcipotriol . ,
.
. 100 gr.
50g/g , .
calcipotriol 34 (-A) .
.
,
4 .
(
, , ).
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.
.
35%
.
30 gr (3g/g) 210 g .
.
.
.
.
.
.
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(-B).
.
.
.
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.
.
, ,
/ , . ( )37
.
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.
.
.
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, .
.
,
.
:
,
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.
, , .
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.
-
36 .
37 .
38 .
133
134
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.
-
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- .
- . -
(Acitretin).
- . ,
.
Acitretin40,
methotrexate (-C), hydroxyurea (-C), (-A),
(-B).
. methotrexate
ciclosporin .
, alefacept41, efalizumab42, etanercept43 infliximab44. Alefacept
efalizumab - . TNF alfa , infliximab
etanercept , , .
TNF alfa
().
, , .
.
,
.
39
40
41
42
43
44
(-C).
calcipotriene acitretin, cyclosporine -
,
(-B).
.
.
.
.
.
.
135
136
137
138
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2. 3
3. 2007
5-7% . ,
40% .
. HLA-B27 . HLA-B27.
.
, .
:
,
,
- ( +),
( ),
( ),
,
,
.
:
.
(-B).
, , .
.
.
, .
.
.
,
.
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2. 2
3. 2006
PITYRIASIS ROSEA
109, 110
. .
( ) .
, 3 cm ( 109, 110).
.
(0,5-3 cm) -
139
140
. .
.
. .
.
Pityriasis versicolor .
.
. , .
6-8 .
.
.
.
.
LICHEN PLANUS
111-114
.
.
.
. .
(-C) .
.
Lichen planus . ,
45
, cyclosporine (-C), (C). .
lichen-.
.
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.
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,
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.
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:
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2-3 , .
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90% :
.
: a.tibialis posterior a.dorsalis pedis
, - () .
- 1 .
0,8 .
, , .
. , .
(-A).
.
.
(-A).
(short-stretch)48 24 ,
.
( ).
,
, (-C)
48 .
151
152
.
.
.
(
(-B).
-
.
.
(-D).
(-D).
/49 .
50 .
.
()
- .
(-D).
.
.
.
.
(-D).
: , 0,01 0,1%
, 0,25%.
.
.
.
, .
, / (-B).
49 .
50 .
(-C).
(-C).
(-C).
,
(-D).
(-C).
/ (-D).
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review. Health Technology Assessment 1999;3:1-78
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153
154
()
4 - 9
117
.
, , ( 117).
:
;
;
;
,
.
.
, , , .
, , , , - .
.
( 2 ).
.
. , , .
.
, (-A). .
( ) .
.
,
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2-3 cm).
(
) .
( )
.
(-A) 3 4.
.
, .
.
.
155
156
( 51)
.
.
.
.
,
.
.
.
.
( 10% ), (-D).
1% - (-D).
.
( ).
.
.
(, ) .
( ).
.
.
, .
hydrogen peroxide ,
.
0,1%
.
( ).
(!).
(-C)
(-C).
51 .
Alopecia areata
118
ALOPECIA AREATA
( 118).
.
, ,
.
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,
.
.
- .
.
.
.
,
.
. ,
.
52 .
1 mg/ 53 .
, ,
,
.
3 - 12
. .
- .
1. Eero Lehmuskallio, Article ID: ebm00291 (013.003) 2005 Duodecim Medical Publications Ltd
52 .
53 .
161
162
119
,
. (-A)
.
1% .
3-5mm. .
.
. "" .
80% .
2-3 45 .
.
.
.
10-15 .
.
.
119
.
( 0,5 g. 5 L. ). -
.
.
.
.
1. Rounding C, Hulm S. Surgical treatments for ingrowing toenails. The Cochrane Database
of Systematic Reviews, Cochrane Library number: CD001541. In: The Cochrane Library,
Issue 2, 2002. Oxford: Update Software. Updated frequently.
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1. EBM Guidelines, 13.1.2003, http://www.ebm-guidelines.com
2. 5
3. 2008
, , , , .
.
(
, ).
( : 5 , IgE- ).
:
( 2-3 ),
IgE-
,
,
( 6-8 ), ,
,
, ,
.
Ilkka Kunnamo, Article ID: ebm00587 (028.017), 2005 Duodecim Medical Publications Ltd
167
168
120, 121
( 1 )
= .
. ,
.
, ( 120), /
2-6 . , ,
.
50% 2- .
, .
, .
( ) ( 121).
,
.
, .
.
1-2
.
.
prick- :
,
(
),
,
, ,
, ,
.
prick- . .
,
, prick- .
.
patch- .
.
, ,
.
.
1. Sakari Reitamo. Article ID: ebm00646 (032.042). 2005 Duodecim Medical Publications Ltd
1. EBM Guidelines, 12.8.2004, http://www.ebm-guidelines.com
2. 2
3. 2006
prick-
122
.
.
prick-
IgE
. ,,
. , .
IgE
. -
169
170
.
.
= + .
( ) .
.
, IgE.
.
.
. , .
.
, , ,
. ( prick- ) ( 4).
"-" ( 122).
.
.
: .
prick- : 2.
PRICK-
(IgE ) .
.
prick-
, :
(Betula sp.)
(Phleum pratense)
(Festuca pratensis)
Artemisia vulgaris
- Cladosporrium herbarum
(Latex)
prick-
,
.
. 15 . .
3 mm .
( : (D+d)/2).
.
, ..
.
.
.
, .
.
80%
:
( ),
171
172
,
.
.
.
.
, prick- patch-. .
.
prick-. , , .
.
. ,
.
, 2-7 ,
. .
.
1% hydrocortisone 1-3 .
10 .
.
2 6
1-3 .
1-2 .
10 .
,
pimecrolimus54 tacrolimus 0,03%55 .
.
Pimecrolimus , tacrolimus
.
,
.
, -
54 .
55 .
,
.
.
1-3 .
.
.
,
pimecrolimus tacrolimus 0,03%.
.
. .
()56.
-. - .
.
, "" .
Zemaphyte , .
1. Sakari Reitamo, Article ID: ebm00647 (032.043), 2005 Duodecim Publications Ltd.
1. EBM Guidelines, 31.3.2004, http://www.ebm-guidelines.com
2. 3
3. 2006
56 .
173
174
.
. .
.
.
.
, .
, , . .
,
.
.
: , .
.
(urticaria pigmentosa) .
175
( !).
, . Kawasaki .
:
(),
Henoch-Schonlein ,
Stevens-Johnson- ,
(M. Still).
(
).
!
1.
CRP. 12 , CRP .
1.
,
= ; * =
(, )
, ,
CRP -
HenochSchnlein
purpura*
CRP -
ITP
, ,
, ,
Kawasaki
CRP -
2
- 4
CRP -
(< 3 mm)
Exanthema subitum*
*
*
CRP -
( )
Kawasaki
( )
Erythema infectiosum*
, , ,
CRP -
Morbili*
, ,
,
Stevens
Johnson
, erythema
multiforme
2-8%
CRP -
I
*
CRP -
* (
)
, ( CRP -
cefaclor penicillin)
,
M. Kawasaki
(Still- )
CRP
,
1. Editors, Clanak ID: ebm 00596 (031003), 2004 Duodenum Medical Publications Ltd.
1. EBM Guidelines, 7.2.2003, http://www.ebm-guidelines.com
2. 4
3. 2007
, ,
,
.
,
.
(.-, ).
( , , Sjgren ).
.
,
. , .
3% .
.
.
. . .
.
.
( , ).
, .
().
179
180
, .
- .
.
( , , , ).
.
.
, ,
, .
.
.
, , .
.
,
.
.
. ,
.. . ( ).
. , . .
- . .
.
.
,
, .
.
.
, , .
. .
. , . . ,
,
.
, , .
.
.
.
.
.
, .
, .
.
,
.
. , .
.
.
( , , ,
)
.
.
.
3 6 .
181
182
.
.
1. Basker RM, Sturdeen DW, Deverport JC. Patients with burning mouths: a clinical
investigation of causative factors, including the climacteric and diabetes. Br J Dent
1987;145:9-15.
2. Zavyalov AV, Maslenicov GV. Relations between taste submodalities in healty and
patients with glossalgia. Hum Physiol 1979,5:520-9.
3. Jonthell M, Haraldson T, Perssen A. An oral and psychosocial examination of patients
with presumed oral galvanism. SweedDent J 1985,9:167-8.
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base of Systemic reviews,Cochrane Lybrary number: CD 002779. In The Cochrane
Library, Issue 2,2002.Oxford:
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Den Res 1994; 102:29-305.
6. Poulsen S, Errboe M,. Pottasium nitrate toooothpaste for dentine hypersensitivity. The
Cochrane Database of Systemic Reviews, Cochrane library number CD 001476. 2002.
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cations Ltd
1. EBM Guidelines, 26.8.2004, http://www.ebm-guidelines.com
2. 2
3. 26.8.2006
CHEILITIS
123
, , ( 123). .
20% Candida albicans, 60% Candi
da albicans Staphylococcus aureus, a 20% Staphylococcus aureus .
- .
( ,
-).
hydrocortisone, natamycin neomycin sulphate, hydrocortisone chlorhexidine, chlorhexidine .
,
( 28, 29).
,
, , . .
() .
57.
.Chron HIV- .
.
1. Tuula Salo, Maria Siponen, Article ID: ebm00154(007.011), c2005 Duodecim Medical
Publication Ltd
1. EBM Guidelines, 13.8.2004, http://www.ebm-guidelines.com
2. 2
3. 13.8.2006
57 .
183
184
Erythema multiforme
Pemphugus vulgaris
Pemphigoid
124-127
1.
( )
Candidiasa, ( / ),
, , , Lichen
planus, , , Leukoedema, white
sponge nevus, , M.
Darier, , ,
, , ,
, , Fordyce- ,
, , , .
, , , , ,
, , , epidermoliysis bullosa,
,
, , ,
, , , , M.Addison, S. Peutz Jeghers, S.
Laugier-Hunziker, , ,
Granuloma pyogenicum, ,
, , exostosis, ,
, epulis congenitalis ,
, , ,
,
, , fibroma traumatica,
, , , ,
,
ERYTHEMA MULTIFORME
Erythema multiforme , .
; , ( ).
, .
, 50% . : ( HSV
Mycoplazma), , , , , , , .
(S. Stevens-Johnson) .
Lyell- ( ) 30% .
.
.
,
.
185
186
.
Chlorhexidine (2mg/ml) 2 3 .
HSV, .
.
PEMPHIGUS VULGARIS
, .
75% . .
. , . ,
, , 1 ,
( Nikolsky ).
.
, .
, ( ) ().
.
( ,
.
, methotrexate,
azathioprine, cyclophosphamid .
.
PEMPHIGOID
, . pemphigoid
bullosus . pemphigoid bullosus, 15-30% . , 95%
.
.
. ,
.
.. . , .
( 60 70 )
( )
-
Nikolsky ( Pemphigus vulgaris).
.
/ .
( , ).
, -
.
2% .
2/3 , .
:
,
,
,
,
.
, Wickham- ( 113, 124).
.
,
/ .
30-40% . , 70%
.
, .
( 50% )
.
( ,
, ).
187
188
.
( ).
/ :
Triamcinolon acetonid , betamethazon 0,1% ,
clobetazol propionat58 0,1% .
(betamethazon 0,1%
) .
.
59 ,
.
1% . ,
.
, ,
.
, ( ).
:
( , , - , , , , , , ,
, , , , , , , , , , , ,
, ).
(myasthenia gravis, SLE, colitis ulcerosa, alopecia areata,
, ).
.
.
, , , , .
() .
.
. , ,
.
, , , .
58 .
59 .
, .
.
.
, - ( ).
.
5% .
.
.
, , .
STOMATITIS APHTOSA
20-60%
( 125).
; , , , , ( ,
, ) .
:
,
,
.
,
.
, .
, (
) chlorhexidine.
.
.
natrium lauryl sulphate.
LEUCOPLAKIA ERYTHROPLAKIA
189
190
.
.
.
(,
, ).
4% ,
. .
(50%
).
90% , .
.
, , .
. .
.
, , .
.
( 126).
, .
.
( , ,
, ).
/ M. Addison, S. Peutz-Jeghers, S. Albright .
, S. Laugier-Hunziker.
. .
, .
, .
(127).
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leukoplakia. The Cochrane Database of Systematic Reviews, Cochrane Library number:
CD001829. In: The Cochrane Library, Issue 2, 2002. Oxford: Update Software. Updated
frequently
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syndrome. The Cochrane Database of Systematic Reviews, Cochrane Library number:
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frequently.
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Medical Publications Ltd
1. EBM Guidelines, 25.8.2004, http://www.ebm-guidelines.com
2. 4
3. 2007
OTITIS EXTERNA
.
.
.
191
192
(), .
, .
Otitis externa ,
.
.
, .
, , .
.
otitis externa , ,
.
.
.
, ,
. ().
. ,
, .
(
membrana thympany), .
.
otitis externa .
- . - .
, .
.
( ,
), otitis
externa.
- (30/70)
.
- 3% Acidi borici.
, .
,
/.
, , . pH .
,
.
neomicyn bacitracin.
,
.
.
.
.
.
.
(
).
.
.
.
. .
1. Hirsch BE. Infection of the external ear. Am J Otolaryngol 1992; 13: 145-55
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2. 3
3. 2007
128-130
(
).
.
.
.
. :
.
.
(Spanish collar, ) ( 128)
.
:
, , , ;
, ,
( 21);
Candida; ,
.
:
.
(
).
197
198
( )
. .
Patch- ( ): .
( )
.
(, ).
(1:10 000) .
.
.
sulcus coronarius,
.
.
,
.
, .
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2. 3
3. 2006
,
.
.
,
.
.
Candida .
. ,
.
Candida albicans . .
(/ ).
.
( !).
( 19), .
. ,
. ,
.
() ( 18) .
, .
( 20) .
. , , , , .
Erythrasma .
199
200
. .
Candida .
Candida.
Tinea incognito
. . .
(Phithriasis pubis). ( )
, .
.
.
.
. ,
,
( ) . .
( )
Candida,
.
(0.5-1%). , .
.
.
( ).
.
. .
. . calcipotriol60.
2-3 .
Candida . .
.
: .
60 .
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1. EBM Guidelines, 20.9.2004, http://www.ebm-guidelines.com
2. 3
3. 2007
PRURITUS ANI
(
).
.
(60%)
. , ( ),
.
, .
.
(
) .
. , 1% hydrocortison (
hydrocortison).
, .
131
, .
.
Treponema palladium.
.
(30-60%)
. 2 ,
.
3-4
( ) .
( )
,
, " " ( 131),
.
.
( ) 6-8 .
:
,
,
.
Roseola syphilitica ().
205
206
, . , (condylomata latum).
( HIV) .
Alopecia syphilitica, " .
10 30 . ( , ) (
).
: , . ,
.
Ulcus molle ( ).
.
pityrasis rosea, ,
(), (rubbella) ().
lichen ruber planus, psoriasis,
scabies ( , ), Condyloma
latum condyloma acuminata.
( ) / .
. ,
, .
.
3-4 .
. (> 16)
.
(, , )
.
TPHA (treponema pallidum ) .
,
( 100%)
.
FTA-abs ( )
(, ),
IgM .
61 .
, 3 , 6 1
TPHA-. .
, .
. ,
3 .
(-C).
(-B).
207
208
, .
ophthalmia neonatorum
,
.
, 2-5 .
, 1-2 .
. 60% 30% .
,
, .
,
.
.
.
( )
.
.
, . 4o ,
.
.
.
.
.
. .
62 (-A).
.
.
.
Neisseria gonorrhoeae
. ,
20% .
, .
Ciprofloxacin 500 mg 1 .
ceftriakson 250 mg 1 .. spectinomycin 2 g
1 .. (-C).
spectinomycin63
2 g 1 .. (-C).
62 .
63 .
209
210
.
, 3 .
ciprofloxacin, a .
().
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.
,
, .
,
.
. , .
50% .
.
HSV-1 HSV-2.
HIV-.
4-14 .
:
;
;
.
:
;
211
212
;
;
.
.
2-3 .
- , , .
2 .
50% , 5% .
.
24 ,
.
.
HSV-1 HSV-2 , ..
, .
PCR64 .
12 9 .
: acyclovir 200 mg x 5, valacyclovir65 500 mg x 2 famcyclovir66 250 mg x
3, 3 5-10 .
.
.
.
acyclovir 200 mg x 5 x 5 valacyclovir 500
mg x 2 x 5 .
acyclovir
.
, .
, (6
): acyclovir 400 mg 2, valacyclovir 500 mg 1 famcyclovir 250 mg 2.
.
, .
-
64 .
65 .
66 .
.
,
.
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213
214
, , ).
,
.
.
.
4 ,
.
25% , .
(60%) , .
.
- .
25% ,, .
, , ,
. , .
, .
.
. -
.
.
() .
.
.
,
.
(, Reiter ) .
. , .
. ,
50% . ,
.
,
.
, polymerase chain reaction (PCR)
ligase chain reaction (LCR)67,
.
,
, . ,
5 7% .
. ,
.
. 5 7
. 2
. (10 ml)
. , .
(-B).
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13.Oxman AD, Scott EA, Sellors JW, Clarke JH, Millson ME, Rasooly I, Frank JW, Naus
M, Goldblatt D. Partner notification for sexually transmitted diseases: an overview of the
evidence. Can J Publ Health 1994;85(suppl 1):41-47
14.The Database of Abstracts of Reviews of Effectiveness (University of York), Database
no.: DARE-945071. In: The Cochrane Library, Issue 4, 1999. Oxford: Update Software
15.Turrentine MA, Newton ER. Amoxicillin or erythromycin for the treatment of antenatal
chlamydial infection: a meta-analysis. Obst Gynecol 1995;86:1021-1025
16.The Database of Abstracts of Reviews of Effectiveness (University of York), Database
no.: DARE-960039. In: The Cochrane Library, Issue 4, 1999. Oxford: Update Software
17.Timo Reunala, Article ID: ebm00253 (012.001), 2005 Duodecim Medical Publications
Ltd
1. EBM Guidelines, 30.3.2005, http://www.ebm-guidelines.com
2. 3
3. 2008
(HPV) -
132
Condyloma acuminatum ( )
.
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podophyllotoxin68, , imiquimod69.
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225
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229
230
, (-D).
1. Whited JD, Grichnik JM. Differential diagnosis of mole and melanoma. JAMA
1998;279:696-701
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no.: DARE-988293. In: The Cochrane Library, Issue 4, 1999. Oxford: Update Software
3. Thissen MR, Neumann MH, Schouten LJ. A systematic review of treatment modalities
for primary basal cell carcinomas. Archives of Dermatology 1999;135:1177-1183
4. The Database of Abstracts of Reviews of Effectiveness (University of York), Database
no.: DARE-992074. In: The Cochrane Library, Issue 1, 2001. Oxford: Update Software
5. Prevention of skin cancer: a review of available strategies. University of Bristol Health
Care Evaluation Unit 1995;31
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no.: DARE-950349. In: The Cochrane Library, Issue 4, 1999. Oxford: Update Software
7. Mayer J. Systematic review of the diagnostic accuracy of dermatoscopy in detecting
malignant melanoma. Med J Aust 1997;167:206-210
8. The Database of Abstracts of Reviews of Effectiveness (University of York), Database
no.: DARE-978307. In: The Cochrane Library, Issue 4, 1999. Oxford: Update Software
9. Editors, Article ID: ebm00279 (013.077), 2005 Duodecim Medical Publications Ltd
1. EBM Guidelines, 18.8.2004, http://www.ebm-guidelines.com
2. 3
3. 2007
()
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.
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,
231
234
1
Pacienti so klini~ka prezentacija
na akutna urtikarija i/ili agioedem
2
DETALNA ANAMANEZA
- Medikamenti
- Hrana
- Fizikalni trigeri
- Infekcii, osobeno virusen hepatitis
- Profesionalna ekspozicija
- Ubodi od insekti i kasnuvawa
FIZIKALEN PREGLED
3
Dali evaluacijata vo poleto 2 ja
sugerira pri~inata?
4
SPECIFI^NA EVALUACIJA
Fokusiraj se na rezultatite od ispituvawata
od poleto 2
Da
5
MISLI NA LIMITIRANATA EVALUACIJA I
INTERVENCIJA
Laboratorija
- krvna slika, urina, SE, LFT
Tretman
- Urgenten tretman (dokolku e potrebno)
- Otstranuvawe na faktorite koi mo`e da ja zasilat
ili induciraat urtikarijata / angioedemot
- Antihistaminici
- Drugi medikamenti vo slu~aj na refrakterna
urtikarija / angioedem
8
Sledewe i konsultacii ako klini~kata slika
perzistira nad 6 nedeli
(Samo
tretman)
Da
6
Dali specifi~nata
Evaluacija ja sugerira
pri~inata?
7
Tretman na
specifi~nite
sostojbi
235
1
Pacient so lezii i/ili anamneza konzistentna so dijagnoza na
hroni~na urtikarija i/ili angioedem
4
Dali poedinenite
urtikarielni lezii
morfolo{ki odgovaraat na
urticaria vakulit i dali
perzistiraat pove}e
od 24 ~asa?
Da
Ne
2
Dali pacientot
ima samo
angioedem?
Da
3
Evaluiraj za angiedem
3a
Dali evaluacijata uka`uva
na pri~inata?
8
DETALNA ANAMNEZA:
-
Profesionalna
Ubodi od insekti, kasnuvawa
Medikamenti
Hrana
Infekcii
Fizi~ka senzitivnost
FIZIKALEN PREGLED I
OSNOVNI LAB. TESTOVI:
5
Evaluacija
za
vaskulitis:
- SE
Komplement
- Biopsija
10
SPECIFI^EN TRETMAN
Otstrani gi faktorite koi
mo`e da ja augmentiraat ili
induciraat urtikarijata /
angioedemot
Specifi~en farmakolo{ki
tretman
6
Dali pacientot
ima urtikarija
vaskulit?
Da
7
Tretman na
vaskulitot
Da
3b
Specifi~en
tretman
9
Dali anamnezata,
pregledot i/ili lab.
testovi ja otkrivaat
pri~inata?
11
PODETALNA EVALUACIJA
- dodatna anamneza
- dodaten fizikalen pregled
I/ ILI
- dodatni laboratoriski testovi
- ko`na biopsija
12
Dali dodatnata
evaluacija uka`uva na
etiologijata?
14
Tretiraj go pacientot
za idiopatska
urtikarija i/ili
angioedem
Da
13
TRETMAN NA SPECIFI^NITE SOSTOJBI
Otstrani gi faktorite koi mo`e da ja zasilat ili induciraat urtikarijata/angioedemot
Specifi~en farmakolo{ki tretman
236
K = Komentar
=
1
Pacient za tretman so akni
2
Evaluiraj gi kontribuira~kite faktori
Hormonalni
Mehani~ki
Medikamenti
Modificiraj gi dokolku e vozmo`no
KD
3
3a. Lesna forma
< 20 komedoni ili 15
inflamatorni papuli,
ili broj na lezii < 30.
3b.Sredno te{ka forma
15-50 papuli i pustuli
so komedoni i retko
cisti. Vkupniot broj na
lezii e 30-125.
3
Proceni ja objektivno te`inata na aknite
3a
3b
3b
Lesna forma Sredno te{ki akni Te{ka forma
KD
4
Evaluiraj go psiholo{kiot impakt na
aknite
KD
5
Izberi tretman
5a
5b
Lokalen tretman
Lokalen tretman
i oralni antibiotici
KD
6
Edukacija na pacientot
KD
7
Sledewe
8-12 nedeli /
zadovolitelen
odgovor?
Da
5
Evaluiraj odgovor i sproveduvawe na tretman
KD
Algoritam 3.
Vodewe na pacient so akni
9
Modificiraj go tretmanot
Primeni drugi/dopolnitelni medikamenti
Primeni dodatna terapija
Isprati kaj dermatovenerolog
10
Odr`uvawe
KD
237
Algoritamot koj sledi e dizajniran kako vizuelen prikaz na konceptualnata organizacija, proceduralniot
tek, to~kite na odluka i preferiraniot tretman koj e diskutiran vo upatstvata. Zapo~nuva so priemot vo
bolnica za akutnite slu~ai, centarot za rehabilitacija, ustanovata za nega na bolnite, programot za
doma{na nega ili drugi zdravstveni kapaciteti i programi. Broevite vo algoratamot se odnesuvaat na
komentarot koj sledi.
Priem vo bolnica
2
Napatstvija za
edukacija
Da
1
Aktivnost ili namalena
mobilnost?
3
Peroidi~na
procenka
4
Na~in za procenka na rizikot
Da
5
Mobilnost
Aktivnost
Deficit
Da
6
Vlaga
Inkontinencija
Da
7
Nutriciski
deficit
Da
9
Napatstvija za nega na ko`ata/ran tretman
8
Napatstvija za
mehani~ko
optovaruvawe i
povr{inska
poddr{ka
238
1
Prepoznavawe na
dekubitalniot ulkus
2
Inicijalna
procenka
3
Edukacija i kreirawe na plan
za tretman
6
Nega na ulkusot;
Menaxerirawe na bakteriskata
kolonizacija i infekcija
4
Procenka na
nutriciskiot status
i poddr{ka
5
Tretman na
nadvore{niot
pritisok na tkivoto
Da
Dali ulkusot se
podobruva?
8
Monitoriraj
Ne
Vrati
se na 3
9
Povtorna procenka na tretmanot i evaluacija
na negovata primena
239
1
Albumin 3.5
Limfociti 1800
Ishranata i
te`inata 80% od
idealnata?
Da
Da
2
Dali ishranata
e soodvetna?
Ne
Ne
3
Evaluacija na fizi~kite i psihi~kite
barieri za ishrana
Da
4
Dali crevata
funkcioniraat?
8
Oralni
nutritivni
sulplementi i
pomo{
Ne
7
Celosna
parenteralna ishrana
Da
5
Dali e kandidat
za celosna
parentelana
ishrana?
Ne
6
Dom za nega na stari i
iznemo{teni lica
Ne
9
Dali
ishranata
e soodvetna?
Da
10
Ishrana
preku tubus
11
Dali
ishranata
e soodvetna?
12
Periodi~na reevaluacija
Da
240
1
Soodvetno pozicionirawe na pacientot
2
Multipli, golemi,
trunkalni ulkusi
stadium III ili
IV?
Da
Ne
Da
3
Mo`e da go dr`i ulkusot
nastrana ?
Da
4
Pacient so rizik
od pojava na drugi
ulkusi?
Ne
5
Ne e potrebna
specijalna
povr{ina.
Ne
7
Upotrebi naprava
koja go dvi`i
vozduhot po ko`ata
Da
6
Ima problem so
vla`nost
na ko`ata?
Ne
6
Ima problem so vla`nost
na ko`ata?
Ne
8
Povr{ina so
mo`nost za pove}e
vrtewa?
9
Stati~ki ured
10
Gluteusite na
pacientot se
nadvor?
13
Podvi`na pokrivka ili
du{ek
11
Ulkusot
zazdravuva?
16
Krevet so mal gubitok
na vozduh
17
Ulkusot
zazdravuva?
18
Vozdu{en krevet
14
Gluteusite na
pacientot se
nadvor?
Da
15
Ulkusot
zazdravuva?
Da
12
Monitoriraj
Da
Da
19
Ulkusot zazdravuva?
20
Reevaluiraj go
tretmanot
241
Debridman na ulkusot
2
^istewe na
ulkusot
3
Prevencija, dijagnoza i
tretman na infekcijata
Selekcija na
lokalen tretman
5
Ulkusot zazdravuva?
Da
Ne
6
Reevaluiraj go tretmanot i
negovata primena
7
Ulkusot zazdravuva?
Da
8
Kandidat za
hirur{ki tretman ?
Da
9
Sovetuvawe i
donesuvawe
na odluka
12
Ulkusot zazdravuva?
10
Hirur{ki
tretman
11
Postoperativno
sledewe
Da
13
Monitoriraj
20
Reevaluiraj go tretmanot
Algoritam 8.
Manaxment na bakteriskata
kolonizacija i infekcija
242
Evaluacija na ulkusot
2
^istewe na
ulkusiot i debridman
3
Gnojna sekrecija, lo{ miris ili
periulkusna inflamacija?
Da
Ne
7
Trae gnojnata
sekrecija, lo{ miris
ili periulkusna
inflamacija
Ulkusot ne e inficiran
Monitoriraj go
izlekuvaweto
8
Celulitis, sepsa ili
osteomielit?
Da
Sistemski
antibiotik
10
Da
11
Dali ulkusot
zazdravuva soodvetno
za 2-4 nedeli?
Da
13
Dali ulkusot se
podobruva?
12
16
Vrati
se
na 6
Da
15
Broj na bakterii vo
tkivo>103?
14
Napriva kvantitativna
bakteriska kultura i evaluiraj
za osteomielit
17
Osteomielit?
18
Reevaluiraj go pacientot, tretmanot i ulkusot (pr. odi na pole 1)
Ne NMKK
Monitoriraj
Zadocnet
tretman
Suspekten
NMKK ?
Ve{tini
Lokacija
Oprema
Iskustvo
Biopsija
Monitoriraj
Do
specijalist
Soodveten
Prevencija
Rana
detekcija
Nekompliciran
Kompliciran ? *
Ne do
specijalist
Nesoodvetnen
kompliciran
Monitoriraj
Tretiraj
Ne NMKK
Do specijalist
Ekscidiraj
Videna somnitelna
ko`na promena
Mo`ni
ishodi
Algoritam 10. Upatstva za tretman na nemelanoti~en ko`en karcinom (NMKK) Nameneto za doktori od PZZ
Ne NMKK
Ne do
specijalist
Ne
biopsija
Ne
ekscidiraj
Problemati~na
lokalizacija na teloto ?
Ne
Monitoriraj
Ne NMKK
Propu{ten
NMKK
Ne
Monitoriraj
Monitoriraj
243
246
1. ( )
1. PRICK
2. PATCH
2.
3.
4.
5.
6.
()
247
7.
8. NEUREDERMATITIS NUCHAE
10.
11.
( )
12.
( ,
)
248
14.
( )
15.
17. PATCH
18.
249
20.
21.
22. LIHEN
PLANUS GLANS PENIS
23.
(
)
250
25.
26.
27.
30.
251
3.
31.
32. IMPETIGO CONTAGIOSA
4.
35.
36.
252
5. Erysipelas
37.
38.
6. Erysipeloid
7. Lyme borreliosis
39. ERYSIPELOID
253
8.
43. ACRODERMATITIS
ATROPHICANS
45. TINEA
46. ONYCHOMYCOSIS
(
)
47. ONYCHOMYCOSIS
( )
48 ONYCHOMYCOSIS
254
9. Pityriasis versicolor
10. herpes
simplex
255
256
14. Scabies
65.
66.
257
67.
15.
69.
68. -
16.
70.
17.
71.
72. VASCULITIS
LEUCOCYTOCLASTICA
258
18.
75.
76.
77.
78.
259
19.
79.
80. BEAU-
20.
81.
82. ECZEMA NUMMULARE
83 ECZEMA VENOSUM
HYPOSTATICUM
84. PSORIASIS
260
89.
90.
261
91.
CRUSA LACTEA
23. ( )
94.
24.
95.
96.
262
25.
26. Sclerodermia
98. SCLERODERMIA
99. SCLERODERMIA
100. PURPURA
HENOCH-SCHONELEIN
29.
102.
263
103.
104.
105.
106.
108.
264
265
32.
33.
34.
117.
35. :
119.
36.
120.
266
37.
121.
122.
38. Cheilitis
39.
123.
126.
267
40.
127.
128.
41 Syphilis
131. ULCUS
DURUM
42. HPV
268
43.
44.
136.
269
270
148. BASALIOMA
TELANGIECTASIAE
149. BASALIOMA
150. BASALIOMA
271
151. BASALIOMA
152. BASALIOMA
153. KERATOACANTHOMA
155. SPINALIOMA