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
(DERMATITIS HERPETIFORMIS, PEMPHIGOID) 117

120
- -
()
122
HENOCH-SCHONLEIN
124
ERYTHEMA NODOSUM
125

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% . -
, , ,
, , . ,
.
Finn Chamber Scanpor- patch-

.
. , TRUE
Na .
48 . 24 72- .
3-5 .
9-10 .
10 .
patch-,
.
photopatch-
. patch-,
. 24- , -
-, 5-20 J/cm2. 2-5 .
.
.
-
-. -
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 .
, prick, patch, photo- photo

patch- .
(,
) .
- .
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
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
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) .
1. Baltimore R. Treatment of impetigo: a review. Pediatr infect dis 1985;4:597-601

2. Blumer J, Obrien C, Lemon E ym. Skin and soft tissue infections: pharmacologic
approaches. Pediatr infect dis 1985;4:336-41
3. Finch R. Skin and soft-tissue infections. Lancet 1988;1:164-7
4. White DG, Collins PO, Rowsell RB. Topical antibiotics in the treatment of superficial skin
infections in general practicea comparison of mupirocin with sodium fusidate. Journal
of Infection 1989;18:221-9
5. Morley PA, Munot LD. A comparison of sodium fusidate ointment and mupirocin ointment
in superficial skin sepsis. Current Medical Research and Opinion 1988;11:142-8
6. Demidovich CW, Wittler RR, Ruff ME, Bass JW, Browning WC. Impetigo. Current
etiology and comparison of penicillin, erythromycin, and cephalexin therapies. Am J Dis
Child 1990;144:1313-5
7. Pekka Autio, Article ID: ebm00274 (013.022), 2005 Duodecim Medical Publications
Ltd
2. 3
3. 2007

.
-
.
.
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
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
1. Bernard P, Plantin P, Roger H ym. Roxithromycin versus penicillin in the treatment of

erizipel in adults: a comparative study. Br J Dermatol 1992;127:1559
2. Kontiainen S, Rinne E. Bacteria isolated from skin and soft tissue lesions. Eur J Clin
Microbiol 1987;6:420422
3. Jorup-Ronstrom C, Britton S, Gavlevik A, Gunnarson K, Redman AC. The course, costs
and complications of oral versus intravenous penicillin therapy of erizipel. Infection
1984;12:3904
4. Sjoblom AC, Eriksson B, Jorup-Ronstrom C, Karkkonen K, Lindqvist M. Antibiotic
prophylaxis in recurrent erizipel. Infection 1993; 21: 6903
5. Wang JH, Liu YC, Cheng DL ym. Role of benzathine penicillin G in prophylaxis for
recurrent streptococcal cellulitis of the lower legs. Clin Infect Dis 1997; 25: 6859
Publications Ltd
2. 2
3. 2006
ERYSIPELOID
39
(Erysipelothrix rhusiopathiae)
(, , ).
.
, , ,
.
, , . .
, .
, .
.
.
.
39
.
,
.
1,5 .
, , (-D).
() .
1. Barnet JH,Estes Sa,Wirman JA Erysipeloid. J Am Acad Dermatol 1983;9:116-123

2. Venditti M,Gelfusa V,Tarasi A ntimicrobial Erysipelothrix rhusiopathiae.Antimicr Agents
Chemother 1990;34:2038-2040
3. Petteri Carlson, Article ID: ebm00033 (001.022), 2005 Duodecim Medical Publications Ltd
2. 2
3. 2006
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
2. 3
3. 2007
- ()
40-43

.

, .
Borrelia burgdorferi sensu lato
25
26
.
:
B. afzelii
B. garinii
B. burgdorferi sensu stricto.
B.burgdorferi
().
, , .
Ixodes ricinus ( 40) .

Ixodes persulcatus.
,
.
,
. ,
1.500/100.000 , 1/100.000.
,
.

.

1.000/100.000/ 12% 45%
.

( )
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).
( ).
(Erythema migrans lymphocytoma)
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 .
1. Editorial. Lyme borreliosis. Wien klin Wochenschr 1996;108/21:739-740

2. Wahlberg P, Granlund H, Nyman D, Panelius J, Seppl I. Late Lyme borreliosis:
Epidemiology, diagnosis and clinical features. Ann med 1993;25:349-356
3. Steere A. Diagnosis and treatment of Lyme arthritis. Med Clin N Am 1997;81(1):179194
4. Stanek G, OConnell S, Cimmino M, Aberer E, Kristoferitsch W, Granstrm M, Guy E,
Gray J. European Union concerted action on risk assessment in Lyme borreliosis. Wien
klin Wochenschr 1996;1008/23;741-747
5. Karma A, Seppl I, Mikkil H, Kaakkola S, Viljanen M, Tarkkanen A. Diagnosis and
clinical characteristics of ocular Lyme borreliosis. Am J Ophthalmol 1995;119:127-135
6. Weber K, Burgdorfer W (eds). Aspects of Lyme borreliosis. Berlin, Heidelberg, New
York: Springer, 1993.
7. Steere AC. Lyme disease. N Engl J Med 1989;321:586-596
8. Steere AC, Taylor E, McHugh GL, Logigian E. The overdiagnosis of Lyme disease.
JAMA 1993;269:1812-1816
9. Golithly MC. Laboratory considerations in the diagnosis and management of Lyme
borreliosis. Am J Clin Pathol 1993;99:168-174
10.Mouritsen CL, Wittwer CT, Litwin CM, Yang L, Weis JJ, Martins TB, Jaskowski TD, Hill
HR. Polymerase chain detection of Lyme disease. Am J Clin Pathol 1996;105:647-654
11.Wilske B, Zller L, Brade V, Eiffer M, Gbel, UB, Stanek, G unter Mitarbeit von HW Pfister.
MIQ 12 Lyme-Borreliose. In Qualittsstandards in der mikrobiologisch-infektiologischen
Diagnostik. Edited by Mauch H and Ltticken R; im Auftrag der Deutschen Gesellschaft
fr Hygiene und Mikrobiologie (DGHM). Urban & Fischer Verlag, Mnchen Jena; 2000
12.European Union Concerted Action on Lyme Borreliosis http://vie.dis.strath.ac.uk/vie/
LymeEU/
13.Hauser U, Lehnert G, Lobentanzer R, Wilske B (1997) Interpretation criteria for
standardized western blots for three European species of Borrelia burgdorferi sensu
lato. J Clin Microbiol 35:1433-1444
14.Hauser U, Lehnert G, Wilske B (1998) Diagnostic value of proteins of three Borrelia
species (Borrelia burgdorferi sensu lato) and implications for development and use of
recombinant antigens for serodiagnosis of Lyme Borreliosis in Europe. Clin Diagn Labor
Immunol 5:456-462
15.Hauser U, Lehnert G, Wilske B (1999) Validity of interpretation criteria for standardized
western blots (immunoblots) for the serodiagnosis of Lyme borreliosis based on sera
collected throughout Europe. J Clin Microbiol 37:2241-2247
16.Robertson J, Guy E, Andrews N et al. A european multicenter study of immunoblotting in
serodiagnosis of Lyme borreliosis. J Clin Microbiol 2000, 38: 2097-2102
17.Sackett DL, Straus SE, Richardson WS et al. (Eds.). Evidence-Based Medicine, 2d
Ed., 2000, Churchill Livingstone, Edinburgh/ London/ New York/ Philadelphia/ St.Luius/
Sydney/ Toronto, Pages 67-93
18.Morel P, Modai E. Treatment of Erythema chronicum migrans and preventio of stage 2
Lyme disease with amoxycillin. Abst IV Internat Conf on Lyme borreliosis, Stockholm
1990
19.Wormser GP, Nadelman RB, Dattwyler RJ, Dennis DT, Shapiro ED, Steere AC, Rush TJ,
Rahn DW, Coyle PK, Persing DH, Fish D, Luft J. Practice guidelines for the treatment of
31
Lyme disease. Clin Inf Dis 2000;31 (Suppl. 1):S1-S14

20.Cameron D, Gaito A, Harris N, Bach G, Bellovin S, Bock K, Bock S, Burrascano J,
Dickey C, Horowitz R, Phillips S, Meer-Scherter L, Raxden B, Shert V, Smith H, Smith
P, Stricker R. Evidence-based guidelines for the management of Lyme disease. Expert
Rev Anti-Infect Ther 2004;2(Suppl 1):S1-S13
21.Wahlberg P, Granlund H, Nyman D, Panelius J, Seppl I. Treatment of late Lyme
borreliosis. J Inf 1994;29:255-261
22.Oksi J, Marjamki M, Nikoskelainen J, Viljanen M. Borrelial DNA detected by PCR in
plasma of patients with late Lyme borreliosis and treatment failure. Infection 1995;23:1/15/5
23.Gross DM, Forsthuber T, Tary-Lehmann M, Etling C, Ito K, Nagy ZA, Field JA, Steere
AC, Huber BT. Identification of LFA-1 as candidate autoantigen in treatment-resistant
Lyme arthritis. Science 1998;281:703-706
24.Dickman S. Possible cause found for Lyme arthritis. Science 1998;281;631-632
25.Kahl O, Janetzki-Mittmann C, Gray JS, Jonas R, Stein J, de Soer R. Risk of infection with
Borrelia burgdorferi sensu lato for a host in relation to the duration of nymphal Ixodes
ricinus feeding and the method of tick removal. Zentrbl Bakteriol 1998;287:41-52
26.Steigbigel RT, Benach JL. Immunization against Lyme diseasean important first step.
NEJM 1998;339;263-264
27.Steere AC, Sikand VJ, Meurice F, Parenti DL, Fikrig E, Schoen RT, Nowakowski J,
Schmid CH, Laukamp S, Buscarino C, Krause DS. Vaccination against Lyme disease
with recombinant Borelia burgdorferi outer-surface lipoprotein A with adjuvant. NEJM
1998;339:209-215
28.Sigal LH, Zahradnik JM, Lavin P, Patella SJ, Bryant G, Haselby, Hilton E, Kunkel M, AdlerKlein D, Doherty T, Evans J, Malawista SE. A vaccine consisting of recombinant Borrelia
burgdorferi outer-surface protein A to prevent Lyme disease. NEJM 1998;339;216-222
29.Tugwell P, Dennis DT, Weinstein A, Wells G, Shea B, Nickol G, Hayward R, Lightfoot R,
Baker P, Steere A. Laboratory diagnosis of Lyme disease: clinical guideline, part 2. Ann
Intern Med 1997;127:1109-1123
30.The Database of Abstracts of Reviews of Effectiveness (University of York), Database
no.: DARE-988128. In: The Cochrane Library, Issue 4, 1999. Oxford: Update Software
31.Warschafsky S, Nowakowski J, Nadelmann RB, Kamer RS, Peterson SJ, Wormser
GP. Efficacy of antibiotic prophylaxis for prevention of Lyme disease. J Gen Int Med
1996;11:329-333
33.Loewen PS, Marra CA, Marra F. Systematic review of the treatment of early Lyme
disease. Drugs 1999;57:157-173
35.Dag Nyman and Peter Wahlberg, Article ID: ebm00031 (001.029), 2005 Duodecim
2. 4
3. 2008
Tinea pedis
Tinea cruris
Tinea corporis
Tinea capitis
Cheilitis angularis Monilia
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).
.
.
Trychophyton rubrum, Trychphy

ton mentagrophites, Epidermophyton floccosum.
,
.
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-),
.
.
. .
CHEILITIS ANGULARIS MONILIA

, .

( 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%)
.
1. Crawford F, Hart R, Bell-Syer S, Torgerson D, Young P, Russell I. Topical treatments for

fungal infections of the skin and nails of the foot. The Cochrane Database of Systematic
Reviews, Cochrane Library number: CD001434. In: The Cochrane Library, Issue 2,
2002. Oxford: Update Software. Updated frequently.
2. Abdel-Rahman SM, Nahata MC. Treatment of tinea capitis. Ann Pharmacother
1997;31:338-348
3. The Database of Abstracts of Reviews of Effectiveness (University of York), Database
4. Bell-Syer SEM, Hart R, Crawford F, Torgerson DJ,Tyrrell W, Russell I. Oral treatments for
fungal infections of the skin of the foot.The Cochrane Database of Systematic Reviews,
Cochrane Library number: CD003584. In: The Cochrane Library, Issue 2, 2002. Oxford:
Update Software.
5. Glyn E, Evans V, Sigurgeirsson B for the LION study group. Double-blind, randomised
study of continuous terbinafine compared with intermittent itraconazole in treatment of
toenail onychomycosis. BMJ 1999;318:1031-1035
2. 2
3. 16.11.2006
PITYRIASIS VERSICOLOR
51
Pityrosporum ovale (Malassezia

furfur). .
43
, ( 51),
.
, . , .
.
Pityrosporum .
, ( )
Pityrosporum .
10 , . ,
, .
(400mg x 2 )
.
,
. 10
. .
Pityriasis versicolor . ,
.
1. Pekka Autio, Article ID: ebm00268(013.051),c 2004 Duodecim Medical Publications

Ltd.
2. 4
3. 2007
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
HSV1 HSV2 , HSV1

HSV2 .
HSV1 .
1-3 ,
. , , .
HSV1 ( 52).
(
47
48
, -), .
- - .
HSV ,
( 53,54).
, HSV .

.
HSV ,
(eczema herpeticum) ( 55).
HSV1 HSV2, .
HSV
65%.
2-26 .
HSV
.
().
3
.
.
HSV
acyclovir, valacyclovir19 famcyclovir20

. ,
.
(/) (acyclovir,
pencyclovir); , ( ).
: acyclovir 200 mg x 5, valacyclovir 500
mg x 2 famcyclovir 125 mg x 2 5 .
1-2 . acyclovir 400 mg 2 ,
valacyclovir 250 mg x 2 500 mg x 1.
Erythema multiforme
erythema multiforme.
, , .

1-2 ( 56).
.
19 .
20 .
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
.
Acyclovir, famcyclovir valacyclovir .

, :
,
,
,
.
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
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
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
Acad Dermatol 1990;23:685-8

Ltd
2. 4
3. 2008
(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.
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.
.
.
1. Yamanishi K,Shiraki K, Kondo T, ym. Identification of human herpesvirus-6 as a causal

agent for exanthema subitum. Lancet 1988;1:1065-1067
2. Kimberlin D. Human herpesviruses 6 and 7: identification of newly recognized viral
pathogens and their association with human disease. Pediatr Infect Dis J 1998;17:5968
2. 2
3. 23.6.2006
.
, .

.
,
("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
Issue 2, 2002. Oxford: Update Software. Updated frequently.

3. Vander Stichele RH, Dezeure EM, Bogaert MG. Systematic review of clinical efficacy of
topical treatment of head and face. BMJ 1995;311:604-608
5. Roberts R. Head and face. N Engl J Med 2002;346:1645-1650
6. Pekka Autio, Article ID: ebm00270 (013.041), 2005 Duodecim Medical Publications Ltd
1. EBM Guidelines, 21.6.2003 http://www.ebm-guidelines.com,
2. 4
3. 2007
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
63
64

6. 4
7. 2007
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:emb00922(013.042), 2005 Duodecim Medical Publications Ltd

2. 5
3. 2007
()
.
,
.
( ).
.
.
.
.
.
2. 5
3. 2006
( < 3 )
( > 3 )
1,2
70
- .
.
.
- .
( 9).
. .
1 mm .
.
24 .
Quincke- .
, .
24 .
, :
, erythema multiforme, erythema nodosum, erythema fixum urticaria
vasculitis.
(Quincke- ) ( 70): , , , . 1-3 .

.
Strophulus urticaria papulosa. ,
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)
, , . , ,
.
73
74

2. 5
3. 2006

.
, .
prick- IgE
.
, , (, ), .
.
2 ,
, , ,
.
24%
.
,
, .
,
(-B).
( )
(-C).
, .
4-6 .

(
) (-A).
.
.
.
, . , , .
.
.
.
,
.
:
: , , , .
: , , , , , , ,
.
: , , , .
: , .
(,
) ,
.
, , . ,
- prick- -
.
, , , , , , , ', , , .
, , .
, .
( ).
, , , .
.
, , , ,
75
76
.
.
: , , , , , ,
.
: , ,
.
50-80% .
, , :
, ( ).
, , ( ,
).

(, ).
( , ), , , .

.
. , 10 1
( ).
, .
, ,
.
() , , .
,

.
. ( ) , , .
( 1-2
).
/ .
,
.
().
, ( ) .

( ) .
.
, .
: .
.
prick- .
IgE . IgA IgG .
Patch . , .
.

.
(
).
.
.
,
.
.
.

.

.
.
,
.
.
5-
:
- ?
?

77
78
, .

(-B).
1. Minna Kaila, Article ID: ebm00299 (014.006), 2005 Duodecim Medical Publications Ltd
2. 3
3. 2007
( )

, , / .
.

.

.
()
.
3% ,

.
.
.

, , /
.
.
(, ,
, , ).
(,
, , ,
). ; .
/ ( ).
, , .
.
, IgE.
() .

( ,
).
()
.
()
(
, ) .
() .
.

.
.
; ,
.

/ .
,

79
80
.
.
prick-
.
Patch- .
IgE (RAST) , , .

.
( )
.
;
.
,
, ( ).
:
, .
5 , ,
. 20-30 .
, 2030 (10 ml; 25ml; 50ml; 100ml).
,
. ,
.

, .
,
. : / .

. :
, .
, .
;
.
2 ( ).
: , , , ( ).
6
( ).
, .
( ). ,
. , .
(500 mg
/ )
. 1
.
.

.
.
;
.

.
.
: .
1. Saarinen KM, Juntunen-Backman K, Jrvenp AL. ym. Supplementary feeding in

maternity hospitals and the risk of cows milk allergy: a prospective study of 6 209 in
fants. J Allergy Clin Immunol 1999:117;318-23
2. Kaila M, Isolauri E. Diagnosis of cow milk allergy in infants: open or blinded? J Allergy
Clin Immunol, 1997; 100 (5): 714-715
3. Author: Minna Kaila, Article ID: ebm00645 (014.007), 2005 Duodecim Medical Publi
cations Ltd
2. 2
3. 18.6.2006
81
82
,
, , . .
.
, - .
, .

. 1996 -.
, , .
. 0,01 - 0,23%. .
. IgE
, prick- , .
-
.
- .
,
.
.
(210- 219): , ,
, , , ,
, , .
(220-228): , , , , , , ,
, , , .
.
- (620-625):
, , ,
.
: , , .
.
;
, . ( ) (cochineal, 120)
,
IgE -
prick- .
(). , , ,
.

, , (C).
1. Simon RA. Update on sulfite sensitivity. Allergy 1998;53(Suppl 46):78-9

2. Taylor SL, Dormedy ES. Flavorings and colorings. Allergy 1998;53(Suppl.46):80-2
3. Haahtela T, Hannuksela M. Food additives and hypersensitivity. In: Branen AL, Davidson
PM, Salminen S, eds. Food additives. New York and Basel: Marcel Decker, 1990:617-61
4. Ardern KD, Ram FSF. Tartrazine exclusion for allergic asthma. The Cochrane Database
of Systematic Reviews, Cochrane Library number: CD000460. In: The Cochrane Library,
Issue 2, 2002. Oxford: Update Software. Updated frequently
5. Wtrich B, Kgi MK, Stcker W. Anaphylactic reactions to ingested carmine (E120).
Allergy 1997;52:1133-7
6. Kirsti Kiviranta, Article ID: ebm00297 (014.004), 2005 Duodecim Medical Publications Ltd
83
84

2. 3
3. 2008
71- 73
,
, , , , , .
.
.
, . ,
.
.
.
, .
. , , .
. erythema multiforme, Stevens-Johnson , (S. Lyell), , ,
.. , , lupus
erythematosus, erythema nodosum .
,
.
. -
, , ,
.
( ), ()
( phenytoin carbamazepine) ( 71).
trimethoprim (Stevens-Johnson Lyell sindrom).
,
(), .
. 10%
, .
, .
. ( ) , phenytoin, carbamazepine, oxcarbazepine lamotrigine.
.
.
.
, , . ,
.
, , .
1 IgE .
, , , ..
. ,
- .
, .
.
,
, , , hydralazine,
quinine .
:
.
.
, , ,
85
86

chlorhexidine .

.
1,2
( ) ( ).
( ) .
. , .
1,2
. . ,
. (..
).
vasculitis leucocytoclastica
( 72).

.
, , , , . phenazone
salicylate .
.
, ,
( 73).
, ,
.
-
.
.
, .
?

.
?
. .
?
, ,
().
?

.
?
,

. , ,
24 .
?
. .
.
, 1-2 .
. ,
.
.
,
,
.
, ,
1 .
24 ,
.
, , .
, , .
, ,
lupus erythematosus ().
87
88
.
.
prick- IgE (RAST). ,
. ,
.
IgE, prick- IgE (penicilloyl G
penicilloyl V), ,
ACTH .
prick-
/ .
prick- .
prick- . ,
.
() , , .
Patch- . Patch- ,
( ).
, (
).
. ,
.
.
. , .
: .

. .
.
( , , ), .
, .
, -
, .
.
,
.
.
,
. ,
.
, .
, .
IgE (, 1-6
), .
. , prick-
. ,
prick- .

.
1. , .
2.
.
3. , . .
1. Kristina Alanko, Article ID: ebm00296(014.003), 2005 Duodecim Medical Publications

Ltd
2. 3
3. 2007
89
90
- Hymenoptera.
- , , .
- IgE-:
,

(hymenoptera).
- .
- hymenoptera.
3 (-5) .
80-90% (
) .
, .
IgE- ( ) .

.
. ( -
).
.
.
,
. .
Hymenoptera.
:
,
:
/ ( ).
(-A):
,
:
/ ( ).
(
, ).
.
.
, .
Hymenoptera
- .
.
.
( 10 mg prednisolone/
).
5 .
.

.
, 1-2 .
,
.
6 (4-8) .
(
),
91
92
( , ).

.
.
.
.

.
,
.
30 .
15- .
.
:
.

( , prick !)
(, , , ).
:
,
,
,
.

.
.
- ( ) . .
.
1. Malling HJ. Immunotherapy as an effective tool in allergy treatment. Allergy 1998;53:461472

3. Abramson MJ, Puy RM, Weiner JM. Allergen immunotherapy for asthma. The Cochrane
Database of Systematic Reviews, Cochrane Library number: CD001186. In: The
Cochrane Library, Issue 2, 2002. Oxford: Update Software. Updated frequently.
4. Erkka Valovirta, Article ID: ebm00302 (014.009), 2005 Duodecim Medical, Publications Ltd
2. 3
3. 2007
74-78
.
, , , , ( 74 75).
. ,
, .
,
( 76).
1-2
.
.
:
( 77) (),
(, ),
93
94
(, , , ),
(, ) ( 78),
( ),
(, ,
),
(, , , , , ,
).
: .
.
.
2. 3
3. 12.8.2007
79-81
, ,
.
:
. , .
- .

. ,
, ,
.
( 16). , .

. ,
.
.
. .
, ,
.
.
.

. , ,
.
?
.
Nobecutan
? thiuram , ,
.
I-III?
.
? sulphonamide
formaldehyde ( 79).
? ?
,
.
( 15). ,
. . , .
.
95
96
. , .
.
, .
.
.
Prick- IgE- , ( )
(), , ,
.
.

.
.
.
Beau- ( 80).
.
, .
, .
, .
.
,
( ).
.

.

.
;
.
, .

, .

. .
, .
.
. ( , , ) .
.
( 81).
, : cephalexin
cefadroxil 500 mg 2-3 7-10 .
.
(1 g/)
. 1-2 ,
, 6 .
,
.

(30 5 mg , 30
mg/).
.
-
(= = + ).

.
, .
, .
, ,
.
-/ .

.
, .
.
.
.
,
97
98
10- ,
.
() .
,
.
Ltd
2. 3
3. 2007
82-88
.
.
, ( ) .

( 82).
.
dermatophytosis ( ).
. -
(eczema venosum hypostaticum)
.
( 83)
.
,
.

.
,
.
(eczema allergicum)
.

.
.
.
.
(lichen siplex chronicus)
, , .
( 24).

.
.
.
.
2-3 2 4 .
.
.
84
.
Lichen planus
Lichen planus ,
( 85).
lichen planus .
Erysipelas
99
100
, ,
( 38) erysipel .
.

erythema nodosum ( 86), erythema induratum, polyarteritis nodosa, nodular
vasculitis thrombophlebitis. . .
Necrobiosis lipoidica ( 87) . , , .
Erythema migrans ( 88) .
.
.
1. Bernard P, Plantin P, Roger H. Roxithromycine versus penicillin in the treatment of

erysipel in adults, comparative study. Br J Dermatol 1992; 127:155-9
2. Jorup-Renstrom C, Britton S, Gavlevik A, Gunnarson K, Redman AC. The course,
prise and complicatiosn of per os versus intravenous therapy of erysipel. Infection
1984;12:390-4
Publications Ltd
2. 4
3. 2007
89-91
( 18-40 ) .
.
- :
,
( 5), , ( 89),
,
,
( ") (
90),
, , ( 21), ,
.
( 91).
,
.
.
.
.
.
, Pityrosporum.
.
101
102
.
(, ). .
.
, (B).

( ) .
.
(B).
.
( ).
.
( ) (B).
( ).
.
.
1. Peter RU, Richarz-Barthauer U. Successful treatment and prophylaxis of scalp

seborrhoeic dermatitis and dandruff with 2% ketokonazole shampoo: results of a
multicentre double-blind, placebo-controlled trial. Br J Dermatol 1995;132:441-5
2. Hersle K, Mobacken H, Nordin P. Mometasone furoate solution 0.1% compared with
ketoconazole shampoo 2% for seborrheic dermatitis of the scalp. Current Ther Res Clin
Exp 1996;57:516-22
3. Eero Lehmuskallio, Article ID: ebm00282 (013.015), 2005 Duodecim Medical
Publications Ltd
2. 4
3. 2008
92, 93
.

.
.
( 82,
92).
.
.
.
.
.
.
Staphylococcus aureus, .
, , .
(ringworm):
;
;
.
:
;
;
;
103
104
;
, , .
:
( ).
; ( 93).
(, 0,01
0,1%).
, 1:25.000 ( ).
26 - . .
,
(
), .
2. 3
3. 2007
94, 95
( ) -
26 .
.
.
:
(, ),
pH,
,
, , .
, ( 94) ( 95)
, .
( ).
.
.

.
.
( ).
.
.

Publications Ltd
2. 3
3. 2007
105
106

(NAPPY RASH)
9 12 . .

.
.
, , .

:
(, , ).
.
, , .
8 .
.
-
.
, .
1. Editors, Article ID: ebm00648 (032.040), 2005 Duidecim Medical Publications Ltd
2. 4
3. 2007
- , , ,
.
- ( 1) .
( 4)
.
0,1% 3-10%
.
, .
.
( ).
.
.
.
.
.
.
.
.
.
.
.
107
108
.
( , ).
, , .
.
.

, . , , .
, .
(, , ) .
prick-
.
.
.
,
.

,
.

.
1
1. Turjamaa K,Alenius H,Makinen-Kiljunen S,Reunala T,Palosuo T.Natural rubber latex

allergy.Allergy
2. Kristiina Turjanmaa. Article ID: ebm00298 (014.005), 2005 Duodecim Medical
Publications Lt
2. 3
3. 2008
96
(
96).

.

.
.
, , .
,
.
,
, , .
.
. '.
, .
109
: .
.
: , , , ,
, .
, -.
( )
,

: , ,
: , ,

2. 2
3. 12.8.2006
.
.
,
, .
, .
:
.
().
, ,
.
, - , .
- ,
-.
.
, .
.

.
15 (-B),
.
,
.

. , -
113
.
.

.
( , ) .
1. Thompson SC, Jolley D, Marks R. Reduction of solar keratoses by regular sunscreen

use. N Engl J Med 1993;329:1147-51
2. Naylor MF, Boyd A, Smith DW, Cameron GS, Hubbard D, Neldner KH. High sun protection
factor sunscreens in the suppression of actinic neoplasia. Archives of Dermatology
1995;131:170-5
2. 5
3. 2006

,

,

(DERMATITIS HERPETIFORMIS,
PEMPHIGOID)
97
Dermatitis herpetiformis pemphigoid .
. (), (, , ) ,
.
DERMATITIS HERPETIFORMIS
( 97) , ,
.
,
.
, ,
( !).
. .

. .
dapson27 ( ) -
27 .
117
118
.
.
.
,
dermatitis herpetiformis.
PEMPHIGOID
,
.
.
( 60- ).
, , .
.
.
() .
, .
.
.
(
).
Pemphigus (vulgaris, foliaceus, erythematosus, vegetans)

,
Epidermolysis bullosa

- Porphyria cutanea tarda
Dermatitis herpetiformis ,
.

. (40-60 mg/
) (-C).
.
.

(-B).
() . .
Cyclophosphamide
epidermolisis bullosa aquisita (-C).
Cyclophosphamide28
pemphigoid epidermolysis bullosa acquisita.
1. Morel P, Guilliane JC. Tretment of bullous pemphigoid with prednisolon only: 0.75mg/
kg/day versus 1.25mg/kg/day. Multicenter randomized study. Ann Dermatol Venereol
1984; 111:925-928.
2. Pekka Auttio, Article ID: ebm00271 (013.070), C 2005 Duodecim Medical Publications
Ltd.
2. 2
3. 16.4.2006
28 .
119
120
98, 99
, , , .
.
100-200/
30-50 .
Raunayd .
.
, . , ( 98, 99)
.
20-30% .
, .
, .
, .
: , , , .
. CRP .
.
, () -
90% , () 30% -Scl-70 30% (-B).

CREST- (,
Raunayd , , ) (-B).
( , Raunayd ).
.
(-B).
, .
,
.
.
.

.
()
.
Iloprost29 (-B) .. , (-C)
Raunaud .
, .
.
1. Spencer-Green G, Alter D, Welch HG. Test performance in systemic sclerosis: nticentromere and Anti-Scl-70 antibodies (review). Am J Med 1997;103:242-248
3. Pope J, Fenlon D, Thompson A, Shea B, Furst D, Wells G, Silman A. Iloprost and
cisaprost for Raynauds phenomenon in progressive systemic sclerosis. The Cochrane
Cochrane Library, Issue 2, 2002. Oxford: Update Software. Updated frequently.
4. Pope J, Fenlon D, Thompson A, Shea B, Furst D, Wells G, Silman A. Prazosin for
Raynayds phenomenon in progressive systemic sclerosis. The Cochrane Database of
5. Tom Pettersson, Article ID: ebm00445 (021.040), 2005 Duodecim Medical Publications Ltd
2. .
3. 2006
29 .
121
122
-
()
: / 1
.
(
).
.
.
.
.
.
.
:
,
.
: AIRE (
21q22.3)
;
, .
.
.
:
,
123
(, , , )
, .
.
15- ,
.
.
1.
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

.
.

. , .
, . .
1. Perheentupa J. APS-I/APECED: the clinical disease and therapy. Endocrinol Metab Clin
North Am 2002;31:295-320
2. Jaako Perheentupa, Article ID: ebm00532 (024.063), 2005 Duodecim Medical
Publications Ltd
124

2. 2
3. 11.6.2006
HENOCH-SCHONLEIN
100

Henoch-Schnlein .
2-10 .
( 100).
,
, , .
.

.
.
38.5 C.
CRP 20 mg/L 35
mm/.
.
,
, . (<100)
.
, ,
.
,
.
,
6 . .
,
,
, .
Henoch-Schnlein
, .
1. Ronkainen J, Nuutinen M, Koskimies O. The adult kidney 24 years after childhood

Henoch-Schnlein purpura: a retrospective cohort study. Lancet 2002;360:666-670.
2. Ilkka Kunnamo, Article ID: ebm00653 (032.053), 2005 Duodecim Medical Publications Ltd.
2. 3
3. 2007
ERYTHEMA NODOSUM
101
erythema nodosum
, , .
3-4 .

.
.
.
125
:
(7-14 ),
Chlamydia pneumoniae,
Yersinia, ,
.
:
,
: , .
.
, , (
86, 101), .
, , .
.

.
.
.
(, ).
, CRP.
.
(
).
Yersinia.
Chlamydia pneumoniae .
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- ).
5% .
(-A)
.

.
30 .
31 .
131
132
32
33
34
35

.
.

1 4 , ,
.
. ,
.
.
.
,
.
32 .
.
Dithranol (anthralin)33 -.
1-3% dithranol 20-30 . .

.
.
Calcipotriol . ,
.
. 100 gr.
50g/g , .
calcipotriol 34 (-A) .

.
,
4 .

(
, , ).
Calcitriol35 (-A)
.

.
35%
.
30 gr (3g/g) 210 g .
.
.
.
.
.
.
Tazarotene36
(-B).
.
.

.
(>20% ) (-A).
.
.
, ,
/ , . ( )37
.
(.. ).
().
, ..
.
.

.
, , ,
, .
.
,
.
:
,
,
(amiodarone, piroxicam doxycycline),
.
, , .
() .
- ( 12), ( 385 400 nm) ( 01)38 , - ( 309-313 nm) 01
.
-
36 .
37 .
38 .
133
134
- . -
.
-
(39)
- .
- . -
(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).
.
.
.
.
.
.
1. Henseler T. The genetics of psoriasis. Arch Dermatol 1994;130:216-224

2. Swanbeck G, Inerot A, Martinsson T, Wahlstrm J. A population genetic study of
psoriasis. Br J Dermatol 1994;131:32-39
3. Henseler T, Christophers E. Psoriasis of early and late onset: Characterization of two
types of psoriasis vulgaris. J Am Acad Dermatol 1985;13:450-456
4. Swanbeck G, Inerot A, Martinsson T et al. Genetic counselling in psoriasis: empirical
data on psoriasis among first-degree relatives of 3095 psoriatic probands. Br J Dermatol
1997;137:939-942
5. Jacobson C, Cornell RC, Savin RC. A comparison of clobetasol propionate 0,05 percent
ointment and an optimized bethamethasone dipropionate 0,05 percent ointment in the
treatment of psoriasis. Cutis 1986;37:213-220
6. Olsen EA, Cram DL, Ellis CN et al. A double-blind, vehicle-controlled study of clobetasol
propionate 0,05% (Temovate) scalp application in the treatment of moderate to severe
scalp psoriasis. J Am Acad Dermatol 1991;24:443-447
7. Tham SN, Lun KC, Cheong Wk. A comparative study of calcipotriol ointment and tar in
chronic plaque psoriasis. Br J Dermatol 1994;131:673-677
8. Runne U, Kunze J. Short-duration (minutes) therapy with dithranol for psoriasis: a new
out-patient regimen. Br J Dermatol 1982;106:135-139
9. Kragballe K, Beck HI, Sogaard H. Improvement of psoriasis by a topical vitamin D3
analogue (MC 903) in a double-blind study. Br J Derm 1988;119:223-230
10.Kragballe K. Treatment of psoriasis by the topical application of the novel cholecalciferol
analogue calcipotriol (MC 903). Arch Dermatol 1989;125:1647-1652
11.Dubertret L, Wallach D, Souteyrand P et al. Efficacy and safety of calcipotriol (MC 903)
ointment in psoriasis vulgaris. J Am Acad Dermatol 1992;27:983-988
12.Highton A, Quell J and the Calcipotriene Study Group. Calcipotriene ointment 0,005%
for psoriasis: A safety and efficacy study. J Am Acad Dermatol 1995;32;67-72
13.Lebwohl M, Siskin SB, Epinette W et al. A multicenter trial of calcipotriene ointment and
halobetasol ointment compared with either agent alone for the treatment of psoriasis. J
Am Acad Dermatol 1996;35:268-269
14.Lebwohl MG, Breneman DL, Goffe BS, Grossman JR, Ling MR, Milbauer J, Pincus SH
et al. Tazarotene 0.1% gel plus corticosteroid cream in the treatment of plaque psoriasis.
J Am Acad Dermatol 1998;39:590-596
15.Gollnick H, Menter A, Combination therapy with tazarotene plus topical corticosteroid fo
the treatment of plaque psoriasis. Br J Dermatol 1999;140(suppl 54):18-23
16.Kragballe K, Gjertsen BT, De Hoop D et al. Double-blind, right/left comparison of
calcipotriol and betamethasone valerate in treatment of psoriasis vulgaris. Lancet
1991;337:193-196
17.Cunliffe WJ, Berth-Jones J, Claudy A et al. Comparative study of calcipotriol (MC 903)
ointment and betamethasone 17-valerate ointment in patients with psoriasis vulgaris. J
Am Acad Dermatol 1992;26:736-743
18.Molin L, Cutler TP, Helander I et al. Comparative efficacy of calcipotriol (MC903) cream
and betamethasone 17-valerate cream in the treatment of chronic plaque psoriasis. A
randomized, double-blind, parallel group multicentre study. Br J Derm 1997;136:89-93
19.Bruce S, Epinette WW, Funicella T et al. Comparative study of calcipotriene (MC 903)
ointment and fluocinonide ointment in the treatment of psoriasis. J Am Acad Dermatol
1994;31:755-759
20.Lebwohl M, Ast E, Callen JP, Cullen SI, et al. Once-daily tazarotene gel versus twice-
135
136
daily fluocinonide cream in the treatment of plaque psoriasis. J Am Acad Dermatol

1998;38:705-11
21.Meffert H, Metz D, Snnichsen N. Selektierte ultraviolett-phototherapie (SUP) mit
fluoreszenzbrennern bei psoriasis vulgaris. I. Behandlungsergebnisse.Dermatol
Monatsschr 1981; 167:210-216
22.Pinzer B, Kadner H, Kleine-Natrop HE. Selektive ultraviolett-phototherapie (SUP) bei
psoriasis. Dermatol Monatsschr 1981;167:293-297
23.Spuls PI, Witkamp L, Bossuyt PMM, Bos JD. A systematic review of five systemic
treatments for severe psoriasis. Br J Derm 1997;137:943-949
24.Lowe NJ, Prystowsky JH, Bourget T et al. Acitretin plus UVB therapy for psoriasis. Comparison
with placebo plus UVB and acitretin alone. J Am Acad Dermatol 1991:23:591-594
25.Green C, Lakshmipathi T, Johnson BE, Ferguson J. A comparison of the efficacy
and relapse rates of narrowband UVB (TL-01) monotherapy vs etretinate (re-TL-01)
vs etretinate-PUVA (re-PUVA) in the treatment of psoriasis patients. Br J Dermatol
1992;127:5-9
26.Hannuksela M, Karvonen J. Trioxsalen bath plus UVA effective and safe in the treatment
of psoriasis. Br J Dermatol 1978;99:703-707
27.Salo OP, Lassus A, Taskinen J. Trioxsalen bath plus UVA treatment of psoriasis. Acta
Dermatovener (Stockholm) 1981;61:551-554
28.Saurat J-H, Geiger J-M, Amblard P et al. Randomized double-blind multicenter study
comparing acitretin-PUVA, etretinate-PUVA and placebo-PUVA in the treatment of
severe psoriasis. Dermatologica 1988;177:218-224
29.Griffiths CEM, Clark CM, Chalmers RJG,Li Wan Po A, Williams HC.A systematic review
of treatments for severe psoriasis. Health Technol Assess 2000;4(40)
30.Spuls PI, Witkamp L, Bossuyt PM, Bos JD. A systematic review of five systemic
treatments for severe psoriasis. Br J Dermatol 1997;137:943-949
32.Mason J, Mason AR, Cork MJ. Topical preparations for the treatment of psoriasis: a
systematic review. Br J Dermatol 2002;146:351-64.
33.Ashcroft DM, Li Wan Po A, Williams HC, Griffith CE. Systematic review of comparatative
efficacy and tolerability of calcipotriol in treating chronic plaque psoriasis. BMJ
2000;320:963-967
34.The Database of Abstracts of Reviews of Effectiveness (University of York), Database no.:
DARE-20008265. In: The Cochrane Library, Issue 3, 2001. Oxford: Update Software
35.Weinstein GD, Krueger GG, Lowe JL et al. Tazarotene gel, a new retinoid, for topical
therapy of psoriasis: Vehicle-controlled study of safety, efficacy and duration of
therapeutic effect. J Am Acad Dermatol 1997;37:85-92
36.Owen CM, Chalmers RJG, OSullivan T, Griffiths CEM. Antistreptococcal interventions for
guttate and chronic plaque psoriasis. The Cochrane Database of Systematic Reviews,
Cochrane Library number: CD001976. In: The Cochrane Library, Issue 2, 2002. Oxford:
Update Software
37.Asumalahti K, Ameen M, Suomela S ym. Genetic analysis of PSORS1 distinguishes
guttate psoriasis and palmoplantar psoriasis. J Invest Dermatol 2003;120:267-632
38.Swanbeck G, Inerot A, Martinsson T et al. Genetic counselling in psoriasis: empirical
data on psoriasis among first-degree relatives of 3095 psoriatic probands. Br J Dermatol
1997;137:939942
39.Elder JT, Nair RP, Guo S-W, Henseler T, Christophers E. The genetics of psoriasis. Arch
Dermatol 1994;130:216224
40.Lebwohl M. Psoriasis. Lancet 2003; 361: 1197-1204

41.Lebwohl M, Suad A. Treatment of psoriasis. Part 1. Topical therapy and phototherapy. J
Am Acad Dermatol 2001;45:487-98.
42.Douglas WS, Poulin Y, Decroix J, Ortonne JP, Mrowietz U, Gulliver W, Krogstad AL, Larsen
FG, Iglesias L, Buckley C, Bibby AJ. A new calcipotriol/betamethasone formulation with
rapid onset of action was superior to monotherapy with betamethasone dipropionate or
calcipotriol in psoriasis vulgaris. Acta Derm Venereol 2002;82:131-5
43.Guenther L, Cambazard F, van de Kerkhof PCM ym. Efficacy and safety of a new
combination of calcipotriol and betamethasone dipropionate (once or twice daily)
compared to calcipotriol (twice daily) in the treatment of psoriasis vulgaris: a randomised,
double-blind, vechicle-controlled trial. Br J Dermatol 2002;147:316-323
44.Ortonne JP, Humbert P, Nicolas JF, Tsankow N, Tonew SD, Janin A, Czerniewski J,
Lahfa M, Dubertret L. Intra-individual comparison of the cutaneous safety and efficasy
of calcitriol 3 microg g(-1) ointment and calcipotriol 50 microg g (-1) ointment on chronic
plaque psoriasis localized in facial hairline, retroauricular or flexural areas. Br J Dermatol
2003; 148:326-33.
45.Kowalzick L. Clinical experience with topical calcitriol (1,25-dihydroxyvitamin-D3) in
psoriasis. Br J Dermatol 2001;144 (Suppl.58):21-25.
46.Langner A, Stapr W, Ambroziak M. Efficasy and tolerance of topical calcitriol 3 g g-1 in
psoriasis treatment: a review of our experience in Poland. Br J Dermatol 2001;144(Suppl
58):11-16.
47.Hnigsmann H. Phototherapy for psoriasis. Clinical Exp Dermatol 2001;26:343-350.
48.Lebwohl M, Darake L, Menter A, Koo J, Gottlieb AB, Zanolli M, Young M, McClelland P.
Concensus conference: Acitretin in combination with UVB or PUVA in the treatment of
psoriasis. J Am Acad Dermatol 2001;45:544-53.
49.Snellman E, Lauharanta J, Reunanen A, Jansen CT, Jyrkinen-Pakkasvirta T, Kallio
M, Luoma J, Aromaa A, Waal J. Effect of heliotherapy 6-month follow-up study. Br J
Dermatol 1993;128:172-177.
50.Snellman E, Aromaa A, Jansen CT, Lauharanta J, Reunanen A, Jyrkinen-Pakkasvirta T,
Luoma J, Waal J. Supervised four-week heliotherapy alleviates the long-term course of
psoriasis. Acta Derm Venereol 1993;73:388-392.
51.Snellman E Maljanen T, Aromaa A, Reunanen A, Jyrkinen-Pakkasvirta T, Luoma J. Effect
of heliotherapy on the cost of psoriasis. Br J Dermatol 1998;138:288-292.
52.Green C, Ferguson J, Lakshmipathi T, Johnson BE. 311 nm UVB phototherapy an
effective treatment for psoriasis. Br J Dermatol 1988;119:691-696.
53.Karvonen J, Kokkonen E-L, Ruotsalainen E. 311 nm UVB lamps in the treatment of
psoriasis with the Ingram regimen. Acta Derm Venereol 1989;69:82-85.
54.Gordon PM, Diffey BL, Matthews JNS, Farr PM. A randomised comparison of narrowband TL-01 phototherapy and PUVA photochemotherapy for psoriasis. J Am Acad
Dermatol 1999;41:728-32.
55.Markham T, Rogers S, Collins P. Narrowband UV-B (TL-01) phototherapy vs oral 8methoxypsoralen psoralen-UV-A for the treatment of chronic plaque psoriasis. Arch
Dermatol 2003;139:325-328.
56.Voss A, Leverkus M, Brcker E-B, Goebler M. Topical psoralen photochemotherapy with
lethal outcome. Arch Dermatol 2001;137:383.
57.Garnstein RD. New treatments for psoriasis. New Engl J Med 2001;345:284-286
58.Heydendael VM, Spuls PI, Opmeer BC, de Borgie CA, Reitsma JB, Goldschmidt WF,
Bossuyt PM, Bos JD, de Rie MA. Methotrexate versus cyclosporine in moderate-tosevere chronic plaque psoriasis. N Engl J Med. 2003 Aug 14;349(7):658-65.
137
138
59.Krueger G, Callis K. Potential of tumor necrosis factor inhibitors in psoriasis and psoriatic
atrhitis. Arch dermatol 2004;140:218-225.
60.Erna Snellman, Article ID: ebm00288 (013.071), 2005 Duodecim Medical Publications
Ltd
2. 3
3. 2007
5-7% . ,
40% .
. HLA-B27 . HLA-B27.
.
, .
:
,
,
- ( +),
( ),
( ),
,
,
.

:
.
(-B).
, , .
.

.
, .
.
.
,
.
1. Jones G, Crotty M, Brooks P. Interventions for psoriatic arthritis. The Cochrane Databasa
of Systematic Reviews, Cochrane Library number: CD000212. In: The Cocrane Library,
Issue 2, 2002. Oxford: Update Softwere. Updated frequently.
2. 2
3. 2006
PITYRIASIS ROSEA
109, 110
. .
( ) .
, 3 cm ( 109, 110).
.
(0,5-3 cm) -
139
140
. .
.
. .

.
Pityriasis versicolor .
.
. , .
6-8 .
.
.
.

.
1. Drago F et al, Human herpesvirus 7 in pityriasis rosea. Lancet 1997;349:1367-1368

Publications Ltd
2. 4
3. 2007
LICHEN PLANUS
111-114
-, , , - (Wickhman- ) ( 111 112).

(Lichen bullosus).
(Lichen hypertrophicus).
( 113)
.
: () .
,
( 114). , , , . ,
.
.
.
.
.
. .
(-C) .
.
Lichen planus . ,
45
, cyclosporine (-C), (C). .
lichen-.
.
lichen planus
acitretin (-C), griseofulvin (C), cyclosporin (-C).
50% , .
1. Chan ES-Y, Thornhill M, Zakrzewska J. Interventions for treating oral lichen planus. The
Cochrane Database of Systematic Reviews, Cochrane Library number: CD001168. In:
The Cochrane Library, Issue 2, 2002. Oxford: Update Software. Updated frequently.
2. Buajeeb W, Kraivaphan P, Pobrurksa C. Efficacy of topical retinoic acid compared with
topical fluocinolone acetonide in the treatment of oral lichen planus. Oral Surg Oral Med
Oral Pathol Oral Radiol Endod 1997;83:21-5
3. Harpenau LA, Plemons JM, Rees TD. Effectiveness of a low dose of cyclosporin in the
45 .
141
4.
5.
6.
7.
management of patients with oral erosive lichen planus. Oral Surg Oral Med Oral Pathol
Oral Radiol Endod 1995;80:161-7
Lundquist G, Forsgren H, Gajecki M, Emtestam L. Photochemotherapy of oral
lichen planus. A controlled study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod
1995;79:554-8
Cribier B, Frances C, Chosidow O. Treatment of lichen planus: an evidence-based
medicine analysis of efficacy. Archives of Dermatology 1998;134:1521-30.
The Database of Abstracts of Reviews of Effectiveness (University of York), Database
Pekka Autio, Article ID: ebm00289 (013.073), 2004 Duodecim Medical Publications
Ltd

2. 5
3. 2006
115, 116
(A. comedonicus) ( 115).

, .
(A. vulgaris) ( 116).
.
(A. cystica).
.
Acne conglobata.
.
.
Acne fulminans.
(, , ).
, .
acne fulminans . .

.
.
:
,
adapalen46,
benzoyl peroxide (3-10%),
. , .
.
46 .
145
146
:
( Clindamycin),
( 15
) .
2-3 , .
Tetracycline (-B) Erythromycin .

250-500 mg/ . tetracycline erythromycin 1 gr/
. 12- .

.
acne cystica acne conglobata. .

.

Cyproterone acetate () + oestrogen 6 .

(- D) .

.
(Acne cystica, conglobata, fulminans).

,
isotretinoin47. , .
spironolactone
(-D).
1. Garner SE, Eady EA, Popescu C, Newton J, LiWan Po A. Minocycline for acne vulgaris.
The Cochrane Database of Systematic Reviews, Cochrane Library number: CD002086.
In: The Cochrane Library, Issue 2, 2002. Oxford: Update Software
47 .
2. Jordan R, Cummins C, Burls A. Laser resurfacing of the skin for improvement of facial
acne scarring. West Midlands: Department of Public Health and Epidemiolog. West
Midlands Development and Evaluation Service. 11. 1998. 1-51.
4. Jordan R, Cummins C, Burls A. Laser resurfacing of the skin for the improvement of facial
acne scarring. Birmingham: Department of Public Health and Epidemiology, University
of Birmingham. West Midlands Development and Evaluation Service, Department of
Public Health and Epidemiology (DPHE). DPHE Report No. 11. 1998. pp51.
5. The Health Technology Assessment Database, Database no.: HTA-998502. In: The
Cochrane Library, Issue 1, 2001. Oxford: Update Software
6. Lee O, Farquhar C, Toomath R, Jepson R. Spironolactone versus placebo or in
combination with steroids for hirsutism and/or acne. The Cochrane Database of
7. Jorma Lauharanta, Article ID: ebm00285 (013.060), 2005 Duodecim Medical
Publications Ltd
2. 2
3. 13.8.2006
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).
1. Cullum N, Fletcher AW, Nelson EA, Sheldon TA. Commpresion bandages and stockings
in the treatment of venous leg ulcers. The Cochrane Database of Systematic Reviews,
Cochrane Library number: CD000265. In: The Cochrane Library,Issue 2, 2002. Oxford:
Update Software.Update frequently.
2. Palfreyman SJ,Lochiel R, Michaels JA. A systematic rewiew of compression therapy for
venous leg ulcers. Vascular Medicine 1998;3:301-313.
No :DARE-993749. In The Cochrane Library ,Issue 1,2001. Oxford:Update Software.
4. Peters J. A review of the factors influencing nonrecurrence of venous leg ulcers. J Clin
Nurs 1998;7:3-9
6. Nelson EA, Bell-Syer SEM, Cullum NA. Compression for preventing recurrence of
venous ulcers. The Cochrane Database of Systematic Reviews, Cochrane Library
number: CD002303. In: The Cochrane Library, Issue 2, 2002. Oxford: Update Software.
Updated frequently
7. Jull AB, Waters J, Arroll B. Oral pentoxifylline for treatment of venous leg ulcers. The
The Cochrane Library, Issue 2, 2002. Oxford: Update Software
8. Bradley M, Cullum N, Sheldon T. The debridement of chronic wounds: a systematic
review. Health Technology Assessment 1999;3:1-78
10.Briggs M, Nelson EA. Topical agents or dressings for pain in venous leg ulcers. The
11.Flemming K, Cullum N. Laser therapy for the treatment of venous leg ulcers. The
12.Flemming K, Cullum N. Therapeutic ultrasound for venous leg ulcers. The Cochra
153
154
ne Database of Systematic Reviews, Cochrane Library number: CD001180. In: The

Cochrane Library, Issue 2, 2002. Oxford: Update Software. Updated frequently
13.Johannsen F, Gam AN, Karlsmark T. Ultrasound therapy in chronic leg ulceration: a
meta-analysis. Wound repair Regeneration 1998;6:121-126
15.Wilkinson EAJ, Hawke CI. Oral zinc for chronic leg ulcers. The Cochrane Database of
16.Evans D, Land L. Topical negative pressure for treating chronic wounds. The Cochrane
17.Author: Ken Malanin, Article ID: ebm00104 (005.050), 2005 Duodecim Medical Pub
lications Ltd
2. 2
3. 11.6.2006

()
4 - 9
117
.
, , ( 117).

:
;
;
;
,
.
.
, , , .
, , , , - .

.
( 2 ).
.
. , , .

.
, (-A). .
( ) .
.
,
(
2-3 cm).
(
) .
( )

.
(-A) 3 4.
.
, .
.
.
155
156
( 51)
.
.
.
.
,
.
.
.
.
( 10% ), (-D).
1% - (-D).
.
( ).

.
.
(, ) .
( ).

.
.
, .
hydrogen peroxide ,
.
0,1%
.
( ).
(!).
(-C)
30-35 kcal/kg/ 1.25-1.5 g

//.
(-C).
51 .
1. Bergstrom N, Bennett MA, Carlson CE ym. Treatment of pressure ulcers. Clinical

practice guideline, No. 15. Rockville, MD. U.S. Department of Health and Human
Services. Publich Health Service, Agency for Health Care Policy and Research. AHCPR
Publication No. 95-0652. December 1994
2. Cullum M, Deeks J, Sheldon TA, Song F, Fletcher AW. Beds, mattresses and cushions
for pressure sore prevention and treatment. The Cochrane Database of Systematic
Reviews, Cochrane Library number: CD001735. In: The Cochrane Library, Issue 2,
2002. Oxford: Update Software. Updated frequently.
3. Margolis DJ, Lewis VL. A literature assessment of the use of miscellaneous topical
agents, growth factors, and skin equivalents for the treatment of pressure ulcers
5. Flemming K, Cullum N. Therapeutic ultrasound for pressure sores. The Cochrane
1. EBM Guidelines,21.10.2004, http://www.ebm-guidelines.com
2. 3
3. 2007
Alopecia areata
118
ALOPECIA AREATA
( 118).
.
, ,
.
, , .
,
.
.
- .
.
.
.
,
.
. ,
.
52 .
1 mg/ 53 .
, ,
,
.
3 - 12
. .
- .
1. Eero Lehmuskallio, Article ID: ebm00291 (013.003) 2005 Duodecim Medical Publications Ltd
52 .
53 .
161
162

2. 3
3. 2007
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,
2. 5
3. 2008
, , , , .
.
(
, ).
( : 5 , IgE- ).
:
( 2-3 ),

IgE-
,
,
( 6-8 ), ,
,
, ,
.
Ilkka Kunnamo, Article ID: ebm00587 (028.017), 2005 Duodecim Medical Publications Ltd

2. 2
3. 2006
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
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).
.
, ..
.
.

.
, .
.
1. Minna Kaila, Article ID; ebm00295(014.0020,2005 Duodecim Medical Publications Ltd.

2. 3
3. 2007
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.
2. 3
3. 2006
56 .
173
174
.
. .
.
.

.
, .
, , . .
,
.
.
: , .
.
(urticaria pigmentosa) .
Ginsburg C. Scabies. Pediatr Infect Dis 1984;3:133-134

Reeves J. Head and face and scabies in children. Pediatr Infect Dis 1987:6:598-602
Editors, Article ID:emb00649(032.041),2004 Duodecium Medical Publications Ltd.

2. 4
3. 2007
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.
2. 4
3. 2007

, ,

,
.
,
.
(.-, ).
( , , Sjgren ).

.
,
. , .
3% .
.
.

. . .
.
.
( , ).
, .
().
179
180
, .
- .
.
( , , , ).
.
.
, ,
, .
.
.
(lichen planus, erythema multiforme, pemphigus).

.
.
.
.
.
.
Sjgren .

, , .

.
,
.
.
. ,
.. . ( ).
. , . .
- . .
.
.
,
, .
.
.
, , .

. .

. , . . ,
,
.
, , .

.
.
.
.
.
, .

, .
.
,
.

. , .
.
.
( , , ,
)
.

.
.
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.
4. Bargdahl J, Anneroth G. Treatment of burning mouth syndrome.. The Cochrane Data
base of Systemic reviews,Cochrane Lybrary number: CD 002779. In The Cochrane
Library, Issue 2,2002.Oxford:
5. Zakrewska JM, Glenny AM, Forssel H. Treatnent of burning mouth syndrome Scand J
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.
7. Author: Arja Kullaa, Article ID: ebm00156 (007.015), 2005 Duodecim Medical Publi
cations Ltd
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
2. 2
3. 13.8.2006
57 .
183
184
Erythema multiforme
Pemphugus vulgaris
Pemphigoid
Lichen ruber planus
Stomatits aphtosa recurrens ()
124-127
1.
( )

Candidiasa, ( / ),

, , , Lichen
planus, , , Leukoedema, white
sponge nevus, , M.
Darier, , ,
, , ,
, , Fordyce- ,
, , , .
Candidiasis atrophica, lichen planus, , ,

pemphigoid, , ( ), , granuloma pyogenicum,
, , erythroplakia, Kaposi- ,
, , , - ,
( )
, , , , , , , , M. Behet, Reiter , lichen planus, erythema

multiforme, lupus erythematosus, , ,
Wegener , , (granulomatosis disciformis chronica et progressiva),
, , .
, , , , ,
, , , epidermoliysis bullosa,
,
, papilloma sqamosa, condylomata accuminata,

condylomata lata, verruca vulgaris oris, ,
keratoacanthoma, leukoplakia verrucosa, carcinoma verrucosus, pyostomatitis
vegetans, xantoma verrucosa
, , ,
, , , , M.Addison, S. Peutz Jeghers, S.
Laugier-Hunziker, , ,
Granuloma pyogenicum, ,
, , exostosis, ,
, epulis congenitalis ,

, , ,
,
, , fibroma traumatica,

Fibroma traumatica, granuloma pyogenicum, ,

, , ,
, , , ,
,
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).
.
/ .

( , ).
LICHEN PLANUS (LICHEN RUBER PLANUS)
, -
.
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,
, ).
.
.
LUPUS ERYTHEMATODES DISCOIDES ()
, , , , .
() .
.
. , ,
.
, , , .
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).
1. Chan ES-Y, Thornhill M, Zakrzewska J. Interventions for treating oral lichen planus. The
2. Lodi G, Sardella A, Bez C, Demarosi F, Carassi A. Interventions for treating oral
leukoplakia. The Cochrane Database of Systematic Reviews, Cochrane Library number:
CD001829. In: The Cochrane Library, Issue 2, 2002. Oxford: Update Software. Updated
frequently
3. Saenz A, Ausejo M, Shea B, Wells G, Welch V, Tugwell P. Pharmacotherapy for Behcets
syndrome. The Cochrane Database of Systematic Reviews, Cochrane Library number:
CD001084. In: The Cochrane Library, Issue 2, 2002. Oxford: Update Software. Updated
frequently.
4. Tuula Salo and Maria Siponen, Article ID: ebm00153 (007.023), 2005 Duodecim
2. 4
3. 2007
OTITIS EXTERNA
.
.

.
(Acc.diffuse external otitis

).
.
, , , -
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
2. Jukka Luotonen, Article ID: ebm00852 (038.037), 2005 Duodecim Medical Publications
Ltd
2. 3
3. 2007
128-130
(
).
.

.
.
. :
.
.
(Spanish collar, ) ( 128)
.
:
, , , ;
, ,
( 21);
Candida; ,
.
:
.
(
).
197
198
Balanitis xerotica obliterans (BXO, lichen sclerosus et atrophicus) ( 129,

130).
Balanitis circinata Reiter- ?
Balanitis plasmacellularis Zoon ().
:
Lichen rubber planus (
22).
Psoriasis .
Erythema fixum - .
Erythroplasia Queyrat ( M. Bowen ),
carcinoma in situ.
( )
. .
Patch- ( ): .
( )
.
(, ).
(1:10 000) .
.
.
sulcus coronarius,
.
.
,
.
, .
1. Pekka Autio. Article ID: ebm00252 (011.020),C 2004 Duodecim Medical Publication Ltd
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 .
2. 3
3. 2007
PRURITUS ANI
(
).
.
(60%)
. , ( ),
.
, .
.
(
) .
. , 1% hydrocortison (
hydrocortison).
, .
1. Kari-Matti Hiltunen, Article ID: ebm00204 (008.061), 2005 Duodecim Medical

Publications Ltd
2. 4
3. 2007
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 .
Procaine penicillin 1.2 IU 1 , . 10 (

, , 3
). .
, doxicycline (200 mg
- 15 ) ceftriaxone 1 g/.
, 3 , 6 1
TPHA-. .
, .
. ,
3 .
(-C).
(-B).
1. Hernandez-Aguado I, Bolumar F, Moreno R, Pardo FJ, Torres N, Belda J, Espacio A.

False-positive tests for syphilis associated with human immunodeficiency virus and
hepatitis B virus infection among intravenous drug abusers. Valencian Study Group on
HIV Epidemiology. Eur J Clin Microbiol Infect Dis 1998; 17: 784-787
2. Morse SA, Trees DL, Htun Y ym. Comparison of clinical diagnosis and standard
laboratory and molecular methods for the diagnosis of genital ulcer disease in Lesotho.
J Infect Dis 1997; 175: 583-589
3. Gerbase AC, Rowley JT, Heymann DH, Berkley SF, Piot P. Global prevalence and
incidence estimates of selected curable STDs. Sex Transm Infect 1998; 74 Suppl 1:
S12-16
5. Walker GJA. Antibiotics for syphilis during pregnancy. The Cochrane Database of
Issue 2, 2002. Oxford: Update Software. Updated frequently
6. 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
61 .
207
208
evidence. Can J Publ Health 1994;85(suppl 1):41-47

7. Timo Reunala, Article ID: ebm00255 (012.003), 2005 Duodecim Medical Publications
Ltd
2. 4
3. 2007
Neisseria gonorrhoeae (gonococcus), -

.
.
, .
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).
Ciprofloxacin 500 mg 5-7 per os.
62 .
63 .
209
210
.
, 3 .

ciprofloxacin, a .
().
1. Edwards S, Carne C. Oral sex and transmission of non-viral STIs. Sex Transm Infect
1998; 74: 95-100
2. Ng PP, Chan RK, Ling AE. Gonorrhoea treatment failure and ciprofloxacin resistance. Int
J STD AIDS 1998; 9: 323-325
3. Dosen LK, Moi H. Gonore forarsaket av fluorokinolonresistente gonokokker. Tidsskr Nor
Laegeforen 1998; 118: 2783-2785
4. Edwards S, Carne C. Oral sex and transmission of non-viral STIs. Sex Transm Infect
1998; 74: 95-100
5. Ng PP, Chan RK, Ling AE. Gonorrhoea treatment failure and ciprofloxacin resistance. Int
J STD AIDS 1998; 9: 323-325
6. Brocklehurst P. Antibiotics for gonorrhoea in pregnancy. The Cochrane Database of
7. Koumans EH, Johnson RE, Knapp JS, St Louis ME. Laboratory testing for neisseria
gonorrhoeae by recently introduced nonculture tests: a performance review with clinical
and public health considerations. Clinical Infectious Diseases 1998;27:1171-1180
9. Oxman AD, Scott EA, Sellors JW, Clarke JH, MIllson ME, Rasooly I, Frank JW, Naus
11.Timo Reunala, Article ID: ebm00254 (012.002), 2005 Duodecim Medical Publications
Ltd
2. 3
3. 2007
.
,
, .
,
.
Herpes simplex virus 2 (HSV-2). , 20%

HSV-1. , .
. , .
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 .
.
,
.
.
1. Diaz-Mitoma F, Sibbald RG, Shafran SD, Boon R, Saltzman RL. Oral famciclovir for
the suppression of recurrent genital herpes: a randomized controlled trial. Collaborative
Famciclovir Genital Herpes Reasearch Group. JAMA 1998; 280: 887-892
2. Faro S. A review of famciclovir in the management of genital herpes. Infect Dis Obstet
Gynecol 1998; 6: 38-43
3. Taylor S, Drake SM, Dedicoat M, Wood MJ. Genital ulcers associated with acute EpsteinBarr virus infection. Sex Transm Infect 1998; 74: 296-297
4. Pereira FA. Herpes simplex: evolving concepts. J Am Acad Dermatol 1996; 35: 503520
5. Eija Hiltunen-Back, Article ID: ebm00258 (012.005), 2005 Duodecim Medical
Publications Ltd
2. 3
3. 2007
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).
1. Hiltunen-Back E, Haikala O, Kautiainen H ym. A nationwide sentinel clinic survey of

chlamydia trachomatis infection in Finland. Sex Transm Dis 2001:28;252-8
2. Scholes D, Stergachis A, Heidrich FE ym. Prevention of pelvic inflammatory disease by
screening for cervical chlamydia infections. N Engl J Med 1996;334:1362-6
3. Egger M, Low N, Smith G ym. Screening for chlamydial infections and the risk of ectopic
pregnency in a county of Sweden. BMJ 1998:16;1776-80
4. Pasternack R, Vuorinen P, Miettinen A. Evaluation of Gen-Probe Chlamydia trachomatis
transcription-mediated amplification assay with urine specimens from women. J Clin
Microbiol 1997:35;676-8
5. Puolakkainen M, Hiltunen-Back E, Reunala T ym. Comparison of performances of two
commercially available tests, a PCR assay and a ligase chain reaction test, in detection
of urogenital Chlamydia trachomatis infection. J Clin Microbiol 1998:36;1489-93
6. stergaard L, Anderssen B, Olesen F ym. Efficacy of home sampling for screeing of
Chlamydia trachomatis: a randomized study. BMJ 1998:317;26-7
67 .
215
216
7. Pimenta J, Cacthpole M, Cray M ym. Screening for genital chlamydial infection. Evidence
based health policy report. BMJ 2000:629-31
8. Paavonen J, Puolakkainen M, Paukku M ym. Cost-benefit analysis of first-void urine
Chlamydia trachomatis screening programme. Obstet Gynecol 1998:92;292-8
9. Koskela P, Antti T, Bjorge T ym. Chlamydia trachomatis infection as a risk factor for
invasive cervical cancer. Int J Cancer 200:85;35-9
10.Anttila T, Saikku P, Koskela P ym. Serotypes of Chlamydia trachomatis and risk for
development of servical cancer. Jama 2001:285;57-51
11.Brocklehurst P, Rooney G. Interventions for treating genital chlamydia trachomatis
infection in pregnancy. The Cochrane Database of Systematic Reviews, Cochrane
Library number: CD000054. In: The Cochrane Library, Issue 2, 2002. Oxford: Update
Software
12.Mathews C, Coetzee N, Zwarenstein M, Lombard C, Guttmacher S, Oxman A, Schmid
G. Strategies for partner notification for sexually transmitted diseases. The Cochrane
13.Oxman AD, Scott EA, Sellors JW, Clarke JH, Millson ME, Rasooly I, Frank JW, Naus
15.Turrentine MA, Newton ER. Amoxicillin or erythromycin for the treatment of antenatal
chlamydial infection: a meta-analysis. Obst Gynecol 1995;86:1021-1025
17.Timo Reunala, Article ID: ebm00253 (012.001), 2005 Duodecim Medical Publications
Ltd
2. 3
3. 2008

(HPV) -
132
Condyloma acuminatum ( )
.
.
podophyllotoxin68, , imiquimod69.
.
.
, ().
( 1 8
)
,
condyloma acuminatum,
-.
(HIV, ).
- ,
.
68 .
69 .
217
218

, .
.
(Candida, Herpes, Chlamidia).
(
132). , , () ).
- - (
). - ( 2
ASCUS) .
(3-5%)
,
. .
,
.
:
, ,
,
( , ),
- ( 2 ASCUS).
.
30-40% ,
.
( ), ( ).
( lichen sclerosus et atrophicus, lichen planus,
psoriasis, ).
- .
.

Podophyllotoxin70
, 2
3 .
1 .
70 .
.
, ,
.
Imiquimod71
.
(3 )
( 6-10 ).
, 16
.
, ( , / ).
.
72

.
,
.
(, )73 .
().
(CO2)74 .
- (, , ) , , CO2
.
.
-
71
72
73
74
.
.
.
.
219
.

.
HPV-DNK
- - (-D).
1. Jorma Paavonen, Article ID: ebm00257 (012.004), 2005 Duodecim Medical

Publications Ltd
2. 3
3. 2007
(
).
. .
, , .
. , - , , .
.
.
6 ,
.
.
3-4 .
.
( 30).
.
: , (
), , , .
, .
.
, .
223
224
. . 5
methylprednisolon 40mg/ml ( ).
1-2 6 .
.
, , ,
.
.
.
1. Layton AM,Yip,Cunliffe WJ.A comprasion of intalesional triamcinolone and cryosurgery

in the treatment of acne keloids.British Journal of Deermatology 1994;130;498-501
2. Pekka Autio, Article ID: emb00263*(o13.079),2005Duodecim Madical publications Ltd
2. 4
3. 2007
133-135

. , .
. .
, , .

( 133).
. , cornu cutaneum ( 134).
( 135).
.
.
, .
,
.
Iminiquimod75 photodynamic76 .
tretinoin77 (0,05%) .
2-3 .
.
, .
.
,
.

2. 4
3. 2007
75 .
76 .
77 .
225
226
(basalioma, carcinoma basocellulare)

(c. epidermoides, c. spinocellulare, c. squamocellulare,
)
10
136-155
.
. ,
,
.
78.

.
. :
;
;
;

.
.
.
,
.

.
,
.
(
78 . ( )
136), fibroma molle ( 137) () ( 138).

. , ,
.
, ,
(), ,
(-C).
,
.
Granuloma pyogenicum ( 139).
:
( 140),
( 141),
Naevus spilus ( 142),
Spitz naevus ( 143).

144, 145, 146
,
:
;
;
;
.
.
,
.
.
, ( Breslow) ( ) .
(Clark I-II, Breslow<1mm) 1 cm .
2-5 cm.
.

.
227
228
3 2
. , 6 5 . (
) .
.
, .
.
.
,
.

.
.
, : ,
, .
,
.
.
.
BASILOMA (BASALIOMA, CARCINOMA BASOCELLULARE, BASAL

CELL CARCINOMA, BCC)
147,148,149,150
. . ( 151, 152).
.
.
.
.
.
(-C) ,
79.

.
.
5 mm . 5
. ,
.
79 . ( )
, , ( 153).
.

, .
, ,
80, .
, .
.
(C. EPIDERMOIDES, C.SPINOCELLULARE, C.

SQUAMOCELLULARE, SPINALIOMA)
.
.
1-2 cm, .

.

Keratoacanthoma .
Bowen "" (in situ)
( 154).
, , , .
6 5
.
( ) ( 155). .

.

.

. (-C).

80 . ( )
229
230

, (-D).
1. Whited JD, Grichnik JM. Differential diagnosis of mole and melanoma. JAMA
1998;279:696-701
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
5. Prevention of skin cancer: a review of available strategies. University of Bristol Health
Care Evaluation Unit 1995;31
7. Mayer J. Systematic review of the diagnostic accuracy of dermatoscopy in detecting
malignant melanoma. Med J Aust 1997;167:206-210
2. 3
3. 2007
()
.
( ) ,
.
.
, .
:
,
.
.
, ,
.
, , , .
:
,
.
()
.
,
.
.
()
.

.
.
.
,
.
, 20-30%
.

. , .
,
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 moè 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
Algoritam 1. Akutna urtikarija / angioedem
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 ukaùva
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
Krvna slika, urina, SE, LFT

i drugi relevantni testovi
indicirani od anamnezata, PE,
ROS
Da
10
SPECIFIÊN TRETMAN
Otstrani gi faktorite koi
moè 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 ukaùva na
etiologijata?
14
Tretiraj go pacientot
za idiopatska
urtikarija i/ili
angioedem
Da
13
TRETMAN NA SPECIFI^NITE SOSTOJBI
Otstrani gi faktorite koi moè da ja zasilat ili induciraat urtikarijata/angioedemot
Specifi~en farmakolo{ki tretman
Algoritam 2. Hroni~na urtikaria / angioedem
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 teìnata na aknite
3a
3b
3b
Lesna forma Sredno te{ki akni Te{ka forma
KD
3v. Te{ka forma

Primarni
inflamatorni nodusi i
cisti. Prisutni se i
komedoni, papuli i
pustuli ili vkupniot
broj na lezii e pogolem
od 125
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
Odrùvawe
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 koàta/ran tretman
8
Napatstvija za
mehani~ko
optovaruvawe i
povr{inska
poddr{ka
Algoritam 4. Predviduvawe za otvarawe na

dekubitalen ulkus i algoritam za prevencija
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
Algoritam 5. Vodewe na pacient so dekubitalen ulkus: pregled
239
1
Albumin 3.5
Limfociti 1800
Ishranata i
teìnata 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
Algoritam 6. Evaluacija na ishranata i poddr{kata
Da
240
1
Soodvetno pozicionirawe na pacientot
2
Multipli, golemi,
trunkalni ulkusi
stadium III ili
IV?
Da
Ne
Da
3
Moè da go drì 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 dviì
vozduhot po koàta
Da
6
Ima problem so
vla`nost
na koàta?
Ne
6
Ima problem so vla`nost
na koàta?
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
Algoritam 7. Manaxment na nadvore{niot pritisok vrz tkivoto
241
Debridman na ulkusot
2
îstewe 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
îstewe na
ulkusiot i debridman
3
Gnojna sekrecija, lo{ miris ili
periulkusna inflamacija?
Da
Obezbedi kompletno ~istewe

na ulkusot i debridman
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
Obezbedi kompletno ~istewe

na ulkusot i debridman
Da
11
Dali ulkusot
zazdravuva soodvetno
za 2-4 nedeli?
Da
13
Dali ulkusot se
podobruva?
12
2-nedelen obid so topi~ni

antibiotici
Da
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)
Algoritam 9. Manaxment na bakteriskata kolonizacija i infekcija
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
NMKK-ne melanoti~en koèn karcinom
Nesoodvetnen
kompliciran
Monitoriraj
Tretiraj
* Tumor >1 cm, rekurenten tumor, nekompletno ekscidiran tumor i

prepora~an tretman koj gi nadminuva ve{tinite na doktorot vo
primarnoto zdravstvo
Ne NMKK
Do specijalist
Ekscidiraj
Videna somnitelna
ko`na promena
Mo`ni
ishodi
Algoritam 10. Upatstva za tretman na nemelanoti~en koèn 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
13. VERRUCAE PLANTARES
14.
( )
15.

16. TINEA MANUS
17. PATCH
18.

249
19. TINEA INGUINALIS
20.
21.
22. LIHEN
PLANUS GLANS PENIS
23.
(
)
24. LICHEN SIMPLEX CHRONICUS

250
25.

26.
27.
28. CHEILITIS ANGULARIS
29. CHEILITIS ANGULARIS
30.
251
3.
31.

32. IMPETIGO CONTAGIOSA
33. PEMPHIGUS NEONATORUM
34. IMPETIGO CONTAGIOSA
4.
35.
36.
252
5. Erysipelas
37.
38.
6. Erysipeloid
7. Lyme borreliosis
39. ERYSIPELOID
40. IXODES RICINUS

BORELLIA
41. ERYTHEMA MIGRANS
42. LYMPHADENOSIS CUTIS

BENIGNA BORRELIA BURGDORFERI
253
8.
43. ACRODERMATITIS
ATROPHICANS
44. TINEA CORPORIS (

)
45. TINEA
46. ONYCHOMYCOSIS
(
)
47. ONYCHOMYCOSIS
( )
48 ONYCHOMYCOSIS

254
49. TINEA CRURIS

50. TINEA FACIEI

9. Pityriasis versicolor
10. herpes
simplex
51. PITYRIASIS VERSICOLOR

53. HERPES SIMPLEX
52. HERPES SIMPLEX LABIALIS
54. HERPES SIMPLEX NASI

255
55. ECZEMA HERPETICUM
56. ERYTHEMA MULTIFORME

11. Herpes zoster
57. HERPES ZOSTER

58. HERPES ZOSTER

INTERCOSTALIS
12. Molluscum contagiosum
59. HERPES ZOSTER OPHTALMICUS
60. MOLLUSCUM CONTAGIOSUM

256
13. Verrucae vulgares
61. VERRUCA VULGARIS

62. VERRUCAE VULGARES



PLANTARES
14. Scabies
65.
66.
257
67.

15.
69.

68. -
16.
70.
17.
71.
72. VASCULITIS
LEUCOCYTOCLASTICA
258
18.
73. ERYTHEMA FIXUM

74.

75.

76.
77.

78.
259
19.
79.

80. BEAU-

20.
81.

82. ECZEMA NUMMULARE
83 ECZEMA VENOSUM
HYPOSTATICUM
84. PSORIASIS
260
85. LICHEN PLANUS
86. ERYTHEMA NODOSUM
87. NECROBIOSIS LIPOIDICA
88. ERYTHEMA MIGRANS
21. Dermatitis seborrhoica
89.

90.
261
22. Eczema nummulare
91.
CRUSA LACTEA

23. ( )

94.

24.
95.

96.

262
25.
26. Sclerodermia
97. DERMATITIS HERPETIFORMIS

DUHRING

98. SCLERODERMIA
27. Henoch-Schoenlein purpura
99. SCLERODERMIA

100. PURPURA
HENOCH-SCHONELEIN
28. Erythema nodosum
29.
101. ERYTHEMA NODOSUM

102.

263
103.

104.
105.
106.

107. ACRODERMATITIS CONTINUA

- HALLOPEAU
108.

264
30. Pityriasis rosea
109. PITYRIASIS ROSEA
110. PITYRIASIS ROSEA
31. Lichen ruber
111. LICHEN PLANUS
112. LICHEN PLANUS WICKHAM
113. LICHEN PLANUS
114. LICHEN PLANUS
265
32.
115. ACNE COMEDONICA

( \)
116. ACNE PUSTULOSA
33.
34.
117.
35. :
119.
118. ALOPECIA AREATA
36.
120.

266
37.
121.

122.

38. Cheilitis
39.
123.
124. LICHEN PLANUS

WICKHAM-
125. STOMATITIS APHTOSA
126.

267
40.
127.

128.
129. BALANITIS XEROTICA

OBLITERANS (LICHEN SCLEROSUS AT
ATROPHICUS)
130. BALANITIS XEROTICA

OBLITERANS
41 Syphilis
131. ULCUS
DURUM
42. HPV
132. CONDYLOMATA ACUMINATA
268
43.
133. KERATOSIS SOLARIS
134. CORNU CUTANEUM
44.
135. KERATOSIS SENILIS

136.
137. FIBROMA MOLLE
138. HAEMANGIOMA SENILIS
269
139. GRANULOMA PYOGENICUM
140. NAEVUS CAERULEUS
141. LENTIGO MALIGNA
142. NAEVUS SPILUS
143. MELANOMA JUVENILE S.

ALLEN SPITZ NAEVUS
144. MELANOMA MALIGNUM
270

147. BASALIOMA NODULARE
148. BASALIOMA
TELANGIECTASIAE
149. BASALIOMA
150. BASALIOMA
271
151. BASALIOMA
152. BASALIOMA
153. KERATOACANTHOMA
154. MORBUS BOWEN
155. SPINALIOMA

Dermatovenerologija

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Dermatovenerologija

Uploaded by

Copyright:

Available Formats

-

(DERMATITIS HERPETIFORMIS, PEMPHIGOID) 117

Finn Chamber Scanpor- patch-

, prick, patch, photo- photo

1. Baltimore R. Treatment of impetigo: a review. Pediatr infect dis 1985;4:597-601

1. Bernard P, Plantin P, Roger H ym. Roxithromycin versus penicillin in the treatment of

1. Barnet JH,Estes Sa,Wirman JA Erysipeloid. J Am Acad Dermatol 1983;9:116-123

Borrelia burgdorferi sensu lato

Ixodes ricinus ( 40) .

(Erythema migrans lymphocytoma)

1. Editorial. Lyme borreliosis. Wien klin Wochenschr 1996;108/21:739-740

Lyme disease. Clin Inf Dis 2000;31 (Suppl. 1):S1-S14

Cheilitis angularis Monilia

Trychophyton rubrum, Trychphy

CHEILITIS ANGULARIS MONILIA

1. Crawford F, Hart R, Bell-Syer S, Torgerson D, Young P, Russell I. Topical treatments for

Pityrosporum ovale (Malassezia

1. Pekka Autio, Article ID: ebm00268(013.051),c 2004 Duodecim Medical Publications

HSV1 HSV2 , HSV1

acyclovir, valacyclovir19 famcyclovir20

Acyclovir, famcyclovir valacyclovir .

Acad Dermatol 1990;23:685-8

1. Yamanishi K,Shiraki K, Kondo T, ym. Identification of human herpesvirus-6 as a causal

Issue 2, 2002. Oxford: Update Software. Updated frequently.

5. EBM Guidelines, 19.2.2003 http://www.ebm-guidelines.com,

1. Editors, Article ID:emb00922(013.042), 2005 Duodecim Medical Publications Ltd

1. EBM Guidelines, 29.8.2002 http://www.ebm-guidelines.com,

(Quincke- ) ( 70): , , , . 1-3 .

1. EBM Guidelines, 24.4.2001, http://www.ebm-guidelines.com

1. Saarinen KM, Juntunen-Backman K, Jrvenp AL. ym. Supplementary feeding in

1. Simon RA. Update on sulfite sensitivity. Allergy 1998;53(Suppl 46):78-9

1. EBM Guidelines, 25.2.2005 http://www.ebm-guidelines.com,

1. Kristina Alanko, Article ID: ebm00296(014.003), 2005 Duodecim Medical Publications

1. Malling HJ. Immunotherapy as an effective tool in allergy treatment. Allergy 1998;53:461472

2. The Database of Abstracts of Reviews of Effectiveness (University of York), Database

(eczema venosum hypostaticum)

(lichen siplex chronicus)

1. Bernard P, Plantin P, Roger H. Roxithromycine versus penicillin in the treatment of

1. Peter RU, Richarz-Barthauer U. Successful treatment and prophylaxis of scalp

1. Eero Lehmuskallio, Article ID: ebm00281 (013.014), 2005 Duodecim Medical

1. Turjamaa K,Alenius H,Makinen-Kiljunen S,Reunala T,Palosuo T.Natural rubber latex

1. EBM Guidelines, 12.8.2004, http://www.ebm-guidelines.com

1. Thompson SC, Jolley D, Marks R. Reduction of solar keratoses by regular sunscreen

Dermatitis herpetiformis pemphigoid .

Pemphigus (vulgaris, foliaceus, erythematosus, vegetans)

90% , () 30% -Scl-70 30% (-B).

1. EBM Guidelines, 11.6.2004, http://www.ebm-guidelines.com

1. Ronkainen J, Nuutinen M, Koskimies O. The adult kidney 24 years after childhood

1. Henseler T. The genetics of psoriasis. Arch Dermatol 1994;130:216-224

daily fluocinonide cream in the treatment of plaque psoriasis. J Am Acad Dermatol

40.Lebwohl M. Psoriasis. Lancet 2003; 361: 1197-1204

1. Drago F et al, Human herpesvirus 7 in pityriasis rosea. Lancet 1997;349:1367-1368

-, , , - (Wickhman- ) ( 111 112).

1. EBM Guidelines, 30.12.2001, http://www.ebm-guidelines.com

(A. comedonicus) ( 115).

Tetracycline (-B) Erythromycin .

(Acne cystica, conglobata, fulminans).

ne Database of Systematic Reviews, Cochrane Library number: CD001180. In: The

30-35 kcal/kg/ 1.25-1.5 g

1. Bergstrom N, Bennett MA, Carlson CE ym. Treatment of pressure ulcers. Clinical

1. EBM Guidelines, 13.8.2004, http://www.ebm-guidelines.com

1. EBM Guidelines, 14.5.2001, http://www.ebm-guidelines.com

1. Minna Kaila, Article ID; ebm00295(014.0020,2005 Duodecim Medical Publications Ltd.

Ginsburg C. Scabies. Pediatr Infect Dis 1984;3:133-134

(DERMATITIS HERPETIFORMIS, PEMPHIGOID) 117