Transcript Tashkent Medical Academy Department of Skin and Venereal

Tashkent Medical Academy
Department of Skin and Venereal
Diseases
generalized pruritus
Professor Vaisov Adham Shavkatovich
Tashkent-2011
The position of a general physician rural
medical centres
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A general practitioner (GP) - A graduate with higher
medical education in the profile "medicine" or "GP",
which has the right to conduct activities in support of
medical multidisciplinary primary health care and
disease prevention attached to the population,
regardless of gender and age.
The GP provides outpatient care and home visits, to
provide hospital emergency and urgent care, the
comprehensive preventive, immunological, antiepidemic, medical diagnostics and rehabilitation
measures, assist in addressing health and social
problems of families attached to the population
according to qualification requirements specifications.
The population served by the RMC, established by the
parent body of the health care for each individual SVP,
but the load on a GP should not exceed 1500 attached
population.
Services Category 1
Providing early and correct diagnosis and the
full, effective treatment of certain conditions
and diseases (listed below) at the level of SVP
that GPs should be able to realize
independence, under normal circumstances,
and in most cases. Only in exceptional cases.
When the patient's condition does not improve,
the patient should be sent to a consultant
dermatologist, or HPC for further consultation
or effective treatment. Carries on the
recommendation of the dermatologist
rehabilitation and clinical examination of
patients treated at the SVP or other institutions,
and have long health problems that require
special care and supervision.
SERVICES 1 category
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dermatitis
seborrhea
warts
acne vulgaris
Patchy hair loss (Alopecia areata)
pediculosis
scabies
urticaria
Colorful lichen
Services Category 2
Implementation on the ability to properly
diagnose or identify an acute condition and
destination syndromic treatment where
possible and necessary, such by AEP and
DEP patients to the dermatologist or the ARC
to conduct a full and proper diagnosis, more
wholesome advice or treatment
Services Category 2
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allergodermia
toxicoderma
 pyoderma
 neurodermatitis
 dermatophytosis
 eczema
 psoriasis
 Lichen planus
 zoster
 leprosy
 pemphigus
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Pigmented lesions of the
skin
Photodermatosis and
lupus erythematosus
juccuya
serum sickness
Angioma, skin cancer
STIs (gonorrhea, syphilis,
trichomoniasis,
candidiasis, chlamydia,
herpes, AIDS)
Services category 3.1.
Implementation of a comprehensive, relevant
(correct, adequate and effective) procedures,
manipulation and studies of patients who have
competently, professionally and independently run
GPs.
Professional inquiries and patient survey
Specimen collection for examination under a
microscope
Defining agents lice and scabies
Inspection of skin elements Wood's lamp
Principles and methods for topical treatment
Services category 3.2.
GP TO KNOW readings and location facilities
where possible implementation of full,
appropriate and necessary procedures,
manipulation and research that can not be
conducted in the SVP
Serological methods - Wasserman, RIT, RIF
The study of HIV infection
A skin biopsy
Microscopic and cultural methods
Services 4 categories
Providing individual preventive and educational
assistance (training, advice, demonstrations it.d.)
healthy and the sick, especially those that are prone to
specific risks and inclinations.
Personal hygiene
Control occupational hazards
Prevention of head lice and scabies
Keeping passports patients with allergic diseases
sex education
Hygiene sex
placement
Generalized itching
Itching - an unpleasant sensation on the
skin, which is trying to eliminate the patient
instinctively.
Itching can be a "sharp" and well localized,
or "burning," badly localized.
Itching is caused by a variety of stimuli
and has 2 meanings.
Itching reduces quality of life and a sign of
an illness.
Pathophysiology of itching
Specific receptors or nerve endings, which receive
no itching feeling rather different spatial and
temporal excitation of different combinations of
skin receptors detected in the central nervous
system as a feeling of itching, pain, touch or
pressure. From the skin nerve impulses are
conducted by myelinated fiber diameter in the
spinal ganglia, back to the thalamus, and then
pass to the sensitive areas of the cortex. Despite
indications of involvement of histamine in the
pathogenesis of pruritus in most itchy,
antihistamines are ineffective, suggesting that
histamine is not the only mediator of itch.
The frequency and cause itching.
Itching is the most common symptom of many
skin diseases and a frequent reason for seeking
a patient to a doctor. For skin diseases
Accompanying severe itching and rashes
include:
scabies
pediculosis
allergodermia
urticaria
neurodermatitis
Lichen planus
eczema
diathesis
Neurodermatitis
Urticaria
SCABIES
Allergodermia
ECZEMA
Lichen planus
Diathesis
Systemic diseases associated with generalized
pruritus.
Kidney
Hepatic
Hematologic
Endocrine
Other
Chronic renal failure
Primary biliary cirrhosis
cholestasis of pregnancy
Extrahepatic biliary obstruction
hepatitis
Medication
polycythemia vera
Hodgkin's disease
Other lymphomas and leukemias
multiple Myeloma
mastocytosis
iron deficiency anemia
hyperthyroidism
carcinoid
diabetes mellitus
Malignant tumors of the internal organs
neurological syndromes
Acceptance of opiates
Drug allergy or toxic effects of drugs
psychosis
parasitic
age
Subclinical skin changes indicating a possible
cause itching
Elements on the skin
possible Cause
Point scars, scabs or ecchymosis
of subcutaneous veins
opiate addiction
The bugs (lice) pubic hair
distribution, or other areas
pubic lice
Minor scratches, papules and
vesicles in skin folds, interdigital
intervals, at the head of the penis
scabies
Small groups of vesicles, erosions dermatitis herpetiformis
covered with crusts, especially in
the elbows and rump
Laboratory tests are necessary for the study of
patients with pruritus
Method
detectable pathology
blood test
Anemia (iron deficiency or by chronic
disease)
Cellular composition of blood
polycythemia
leukosis
Some allergic conditions
The level of urea nitrogen and creatinine
Chronic renal failure
The level of alanine transferase, bilirubin,
alkaline phosphatase in the blood
Primary biliary cirrhosis,
Cholestasis, hepatitis
Fasting glucose
diabetes mellitus
levels of thyroxine
hyperthyroidism
Urinalysis:
5 Gidroksindoluksusnaya acid
The level of drug in plasma and urine
carcinoid syndrome
Acceptance of opiates
Allergy to drugs
Fecal ova and parasites
Parasitic invasion
Chest X-ray
lymphoma,
Metastasis of malignant tumors
History and examination of the patient
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1. Do you suffer, or how serious disease? The most common
cause of generalized pruritus without rash systemic diseases
are listed in Table 1.
2. Do you take any medications regularly, or drugs? Taking
medications can cause drug allergy manifested by itching
without skin rash, or may indicate the patient's existing
condition. Aspirin, morphine-like drugs and some antibiotics can
increase the itch by stimulating the release of histamine from
mast cells. Other drugs can cause itching due to stimulation of
cholestasis and opiates act directly on the central nervous
system.
3. Have you not done in the past while traveling, trips to visit?
Parasitic infections may be manifested by itching.
4. What do you think made ​you itch? Patients with psychosis
and hallucinations begin parasitosis often in great detail to
describe their feelings.
5. Have you not noticed the heat intolerance, irritability,
palpitations, weight loss? Hyperthyroidism is often
accompanied by itching.
6. No Where do you dry skin? Xerosis itself can cause itching,
also a symptom of "dry skin" indicates subclinical skin or the
presence of other dermatoses.
7. Did you have contact with your glass? Fiberglass particles
penetrating the skin can cause intense itching without
causing nzmeneny visible on the skin.
8. Do not provoke itching hot baths or showers? Believe that
this is a typical symptom of itching in polycythemia vera, but
it can also occur with any cause itching.
9. Women ask another obligatory question. It itch associated
with the menstrual cycle, with the use of oral contraceptives
or pregnancy? Moderate cholestasis caused by increased
levels of estrogen and progesterone can cause itching.
Chronic renal failure
The cause of pruritus in uremia is hyperparathyroidism,
which can cause increased levels of histamine in
plasma, subtotal removal of the parathyroid glands in
these patients often results in a rapid, temporary
cessation of itching. In patients with uremia also
observed hyperplasia of mast cells (the source of
histamine). Established ineffectiveness of
antihistamines (including H1 - H2-histamine blockers)
and the effectiveness of phototherapy, and some
effect of cholestyramine and activated charcoal
Hepatic cholestasis
Itching is one of the most unpleasant for the patient and
the most constant symptoms of chronic cholestasis,
which accompanies liver disease (Table 1.). Itching
occurs in approximately 20-25% of patients with
jaundice and almost 100% of patients with primary
liver cirrhosis and almost 50% of them is the reason
for seeking medical attention.
Itching is seen in pregnant women, the frequency of
which is increased by cholestasis of pregnancy.
Itching caused by cholestasis is also common in
women taking oral contraceptives continuously, and
itching appears in 50% of cases in the first menstrual
cycle, and in 90% of cases, within the first six cycles.
Extrahepatic bile duct obstruction from any cause, drugs
(phenothiazines, tolbutamide, erythromycin, anabolic
hormones, estrogens and progestins) contribute to the
development of cholestasis often cause itching.
Hematologic disorders
Many malignant blood disease are
accompanied by generalized itching.
Thus, approximately 50% of patients with
polycythemia vera suffer itching, which is
worse when taking hot baths. Up to 30%
of patients with Hodgkin's disease also
suffer from itching.
Other reasons
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Generalized pruritus may be accompanied by adenocarcinoma and
squamous cell carcinoma of many internal organs. Running brain
tumors are often accompanied by itching, limited only by the nostrils.
Drug use can cause generalized itching due to central mechanisms
or by degranulation of mast cells. Many medications can also cause
itching without skin rash as a manifestation of sensitization.
Psychosis patients sometimes complain of marked itching, the
etiology of which is unclear. Many of them have hallucinations in the
form of "creeping Goosebumps" etc.
Invasion of intestinal, pulmonary and systemic parasites can cause
generalized pruritus as a manifestation of allergic sensitization of the
host.
Frequent cause of generalized pruritus in the elderly is xerosis
or one of the conditions listed above. With age increases the
likelihood of idiopathic pruritus, or so-called "Senile pruritus", which
may be accompanied by co-senile age degenerative changes of the
peripheral nerves.
Principles of treatment of
generalized pruritus
In the first place to establish the cause of
itching and fix it. You must
necessarily exclude:
The presence of skin disease
The presence of systemic disease
The impact of drugs and food