January 16th. Phenomenon of the Bolotovs № 7. Shift phenomenon (end) The organism is not able to get out of the critical state on its own, since it, from the point of view of Nature, is indifferent. (It is not indifferent only to the person himself.) Consequently, the disease of the body from the kidney

Application: for the diagnosis of lupoid tuberculosis of the skin

Symptom of "apple jelly"

When a glass slide is pressed on the surface of a tuberculous tubercle, the color of the tubercle changes. At the same time, under the pressure of a glass slide, the dilated vessels of the tubercle collapse, and the bloodless yellowish-brown color of the infiltrate, similar to the color of apple jelly, clearly appears.

Symptom of Pospelov or "probe"

Allows you to identify a pathognomonic diagnostic sign in lupus erythematosus. With light pressure with a bellied probe on the surface of the tubercle, it easily sinks into the depth of the tissue (Pospelov's symptom). For comparison: when pressing on healthy skin nearby, the resulting fossa is restored faster than on the tubercle.

Symptom of Nikolsky P.V. and Asbo-Hansen

Application: for the diagnosis of acantholytic pemphigus and the differential diagnosis of bullous dermatoses.

1. When pulling with tweezers on a piece of the bladder cover, the upper layers of the epidermis are detached in the form of a gradually tapering tape on apparently healthy skin.

2. Finger friction (sliding pressure) on apparently healthy skin, both between the blisters and at a distance, also quite easily causes rejection (shift) of the upper layers of the epidermis.

Note. This symptom is also found in other skin diseases in which there is acantholysis (chronic benign familial pemphigus, etc.), but it is caused only in the lesion (Nikolsky's marginal symptom according to N.D. Sheklakov, 1967).

A variant of this symptom is the phenomenon of an increase in the area of ​​the bladder with pressure on its central part, described by G. Asbo-Hansen in true pemphigus.

Tzank cell test

Application: for the diagnosis of pemphigus vulgaris and the differential diagnosis of bullous dermatoses.

With monomorphic rashes of blisters on the skin and erosions on the mucous membrane of the oral cavity of unknown origin, the smear-prints method is used to possibly identify acantholytic cells (Pavlova-Tzanka) that occur in pemphigus vulgaris. The cytological feature of true pemphigus should be considered

acantholytic cells (Tzank cells), used as a diagnostic test. Acantholytic cells are characteristic of pemphigus, but can also be determined in other diseases (with herpes, chickenpox, bullous varieties of Darier's disease, chronic benign familial pemphigus, etc.).

Detection technique: a piece of sterile student gum (but you can also tightly attach a fat-free glass slide to the erosion surface) is firmly pressed to the bottom of a fresh erosion and transferred to a glass slide. Usually they make several prints on 3-5 glasses. They are then air-dried, fixed, and stained according to Romanowsky-Giemsa (like regular blood smears). Acantholytic cells are smaller than ordinary cells, have a very large nucleus of intense violet or violet-blue color, which occupies almost the entire cell. It has two or more light nucleoli. The cytoplasm of the cells is sharply basophilic, around the nucleus it is light blue, and on the periphery it is blue or dark purple (“the rim of concentration”). Often there are several nuclei in a cell. The polymorphism of cells and nuclei is pronounced. Acantholytic cells may be single or multiple. Sometimes there are so-called "monstrous cells", characterized by gigantic size, an abundance of nuclei, and bizarre shapes. At the beginning of the disease, acantholytic cells are not found in every preparation or are not detected at all, at the height of the disease there are many of them and "monstrous" cells appear.

Yadasson's test

Application: for the diagnosis of Dühring's dermatitis herpetiformis and the differential diagnosis of bullous dermatoses.

A sample with potassium iodide (Yadasson's test) in two modifications: on the skin and inside. For 1 cm 2 of apparently healthy skin, preferably the forearm, an ointment with 50% potassium iodide is applied under a compress for 24 hours. The test is considered positive if erythema, vesicles or papules occur at the site of application. With a negative test after 48 hours, it is repeated: now the ointment is applied to the pigmented area of ​​​​the skin at the site of the former rashes.

With a negative result, 2-3 tbsp is prescribed orally. spoons of 3-5% potassium iodide solution. The test is considered positive when signs of exacerbation of the disease appear.

Scabies mite detection method

Application: for the diagnosis of scabies.

A drop of 40% lactic acid is applied to the scabies element (stroke, vesicle, etc.). After 5 minutes, the loosened epidermis is scraped off with a sharp eye spoon until capillary bleeding appears, slightly capturing the adjacent healthy skin. The resulting material is transferred to a glass slide in a drop of lactic acid, covered with a cover slip and immediately examined under a low magnification microscope. The result is considered positive if a tick is found in the preparation,

eggs, larvae, empty egg shells, or at least one of these elements.

Examination of scales, hair, nails for pathogenic fungi

Application: for the diagnosis of ringworm and differential diagnosis of similar diseases.

For research on pathogenic fungi, a scalpel is used to take a scraping from the affected areas of the skin, mainly from their peripheral part, where there are more fungal elements. When dyshidrotic rashes are taken with tweezers or cut off with wire cutters, the covers of bubbles or blisters, scraps of macerated epidermis. Hair from the peripheral part of the infiltrative-suppurative conglomerates or follicular-knotty elements is also taken with a scalpel and tweezers. The altered areas of the nail plates, together with the subungual detritus, are cut off with nippers.

For express diagnostics (within 1-30 minutes) of mycoses, fast clearing compounds are used. So, scrapings from the skin, after treatment with a 10% solution of sodium disulfide in ethanol in a ratio of 3: 1, you can microscopic material after 1 minute, sections of nails - after 5-10 minutes.

Balzer test (iodine test)

Application: for the diagnosis of multi-colored lichen and differential diagnosis of similar diseases.

When lubricating the affected areas and the surrounding normal skin with a 3-5% solution of iodine or a solution of aniline dyes, the lesions are stained more intensely. This is due to the large absorption of the dye due to the loosening of the stratum corneum of the epidermis by fungi.

Prescriptions of the most common dosage forms in dermatology

Prescription dermatological powders:

Prescription solutions used for lotions:

Alcohol solutions:

Prescriptions of shaken mixtures:

Aerosol formulations:

Prescription pastes:

Ointment prescriptions:

Cream recipes:

Antifungal ointments:

Corticosteroid ointments:

Main literature:

1. Skin and venereal diseases (under the editorship of O.L. Ivanov)., M., - "Shiko", -2002.- 476 p.

2. Skin and venereal diseases (under the editorship of Yu.K. Skripkin)., M., - "Medicine". - 1995., 2000.

3. Atlas "Skin and venereal diseases", ed. V.V.Vladimirova.- M..1986.

Additional literature:

Dermatology on the Internet: www. drskin.pccenter.ru/resource.htm

Dermatology at the health terminal: mednet.narod.ru/derm.htm

Dermatology, venereology on List.ru (www.list.ru/catalog/11618.sort3.html)

Symptom of probe failure (button probe)

Tubercles in lupus erythematosus, due to the destruction of elastic and collagen fibers in them, acquire a doughy, soft texture. Considering this feature, A. I. Pospelov (1886) suggested a symptom of probe failure: with light pressure on the tubercle with a bellied probe, an impression remains on the surface of the tubercle, which disappears very slowly. This phenomenon can be compared with the picture observed when pressing a yeast dough with a finger.

If the tubercle is pressed with a probe a little stronger, then it seems to fall into the depths of the lupoma, while light bleeding and slight pain appear. The symptom is more pronounced with fresh lupoma.

Symptom of "apple jelly" .

Diagnostic procedure for lupus erythematosus. With strong pressure on the lupoma with a transparent spatula or glass slide, blood is squeezed out of the dilated vessels of the tubercle and a brownish-yellow color appears, resembling the color of apple jelly. Sometimes you can see the translucency of the tubercle.

This symptom may be positive, but less pronounced in the tuberculoid form of cutaneous leishmaniasis.

18. Definition of psoriatic phenomena (stearin stain, psoriatic film, blood dew)

Diagnostic triad for psoriasis

An almost constant symptom in progressive and stationary (less often) stages of psoriasis. When scraping psoriatic elements (papules, plaques), the peeling increases and the scales take on a white color, resembling a drop of pounded stearin ( phenomenon of “stearin stain”). With further scraping to the granular layer of the epidermis, the scales are removed and a pink wet film is exposed ( phenomenon of “terminal”, or "psoriatic", films). With continued scraping (up to the papillary dermis), tiny droplets of blood appear on the surface of the film. Their number depends on the number of capillaries damaged by scraping, entering the papillae - the phenomenon of "spot bleeding", or "blood dew".

Scraping is done either with a glass slide or with the blunt side of a scalpel. After scraping with a fingernail, it is necessary to carefully treat the skin of the hands to avoid infection (psoriasiform papular syphilis).

19. Obtaining a Wickham mesh for lichen planus

Fine mesh on the surface of the papules; a symptom of lichen planus, especially its common variety. The papule or plaque is lubricated with some kind of liquid oil (vaseline, sunflower, etc.). At the same time, on the surface of the element, whitish-opal dots and lines intersecting in the form of a grid are clearly visible. This phenomenon is explained by uneven thickening of the granular layer of the epidermis (granulosis), typical of this disease.

In acute, warty, pigmented, atrophic and other forms of lichen planus, the test is less indicative.

20. The method of taking material for the preparation of preparations in the study for the detection of pale treponema

Microscopic examination of pale treponema in the dark field of vision

Material for research is taken from an element suspicious of primary or secondary syphiloma (erosion, ulcer, eroded papule), or by puncture of the lymph node.

The element is cleaned with a sterile cotton swab, after which its surface is slightly scraped with a burner calcined in the flame and a cooled loop until a tissue fluid is obtained. The latter is placed on a clean, fat-free glass slide with a drop of isotonic sodium chloride solution and covered with a thin coverslip.

If it is impossible to obtain tissue fluid in this way, then the syphiloma is squeezed from the edges with a rubber glove until tissue fluid appears on its surface.

The amount of tissue fluid and isotonic sodium chloride solution should be small, since with a large drop, treponema will float in the liquid, which makes it difficult to detect them.

For research in the dark field of view, special devices are used for a conventional microscope. After passing through these devices (condensers), the light rays take an oblique direction and concentrate at an acute angle in the place of the investigated drop of serrum, without falling into the lens, which achieves research in a dark field. For this technique, you can use a circle of thick black paper (an envelope from photographic paper) with a diameter of 1.5 cm, which is placed on the lower lens of the unscrewed condenser so that between the edges of the lenses and paper there is a free rim (clearance) 1.5-2 mm wide.

Lighting during the study in the dark field of vision should be sufficiently intense (electric lamp 100-150 W).

Examine the preparation with objective No. 40 and eyepiece No. 10-15. At the same time, on a dark background, one can see a large number of luminous moving points (protein and colloidal particles), as well as cellular elements that are difficult to differentiate, which, however, is not included in the research task. Pale treponema has the appearance of light corkscrew threads moving smoothly or pendulum. It can be confused with crassus treponema, which is often found on the genitals, but the latter is thicker than treponema pallidum, has wider curls and moves faster.

This method is simple and perhaps the most reliable. Pale treponema is considered in a living state, which allows it to be differentiated from other types of spirochetes.

The purpose of the proposed collection is to remind physicians of the typical signs of dermatovenereological pathology, which ultimately should contribute to understanding the mechanisms of the disease and simplify diagnostic issues.

In dermatovenerological practice, only a few dozen symptoms are used, which significantly distinguishes this branch of medicine from such medical specialties as surgery, neurology and pediatrics, which operate with hundreds of symptoms. It is all the more important for students in the study of skin and venereal diseases to pay attention to a number of the most common signs that can play a supporting role in the daily work of a doctor.

In addition, we considered it necessary to supplement this manual with the section "Changes in the skin in the pathology of internal organs." Even based on the fact that this section in terms of volume turned out to be no less significant than the section of dermatological symptoms, we can conclude that the surface cover of a person plays a special role. In fact, the skin is a mirror image of most of the pathological processes that occur inside the body. In this regard, we hope that this manual will be of interest not only to narrow specialists, but also to general practitioners.

All symptoms are classified according to the nosological principle. Within the section, signs are presented in accordance with the Russian alphabet. In the verbose names of signs, the symptoms are usually located according to the defining (semantic) noun (for example, "white spots" symptom) or the author's surname. Also given are those signs in the name of which the term "phenomenon" is used.

Dermatology Atopic dermatitis

"WINTER FOOT" symptom - hyperemia and moderate infiltration of the soles with peeling and cracks

LIMBARSKY symptom - weeping in patients with childhood eczema is detected when blotting paper is applied to erosive elements, while Selm's points appear on the paper - prints of "serous wells"

MORGAN 2 symptom; Morgan's folds; Denis lines - deep wrinkles on the lower eyelids in children with atopic dermatitis.

"POLISHED NAILS" symptom - the disappearance of longitudinal striation and the characteristic appearance of the nail as a result of constant scratching of the skin

PSEUDO-HERTOG symptom - temporary disappearance of hair, first in the outer third, and then in other parts of the eyebrows in some patients with atopic dermatitis due to constant hand rubbing and scratching of the eyebrows. Compare with the true symptom of Hertog in hypothyroidism (Hertog-Levy).

"FUR HAT" symptom - dystrophy of the hair of the occipital region.

Vasculitis

MARSHALL-WHITE symptom (Marshall, White); Beer spots; chronic vasostrictor spots - pale and cold spots of angiospastic nature on the skin of the hands; early sign of vasculitis.

Fungal mycosis

POSPELOVA 3 symptom - a feeling of cardboard density during palpation of skin lesions in the II stage of mycosis fungoides.

Dyskeratosis

"HAIRY TONGUE" symptom - papules on the mucous membrane of the tongue; possible sign of Darier-White disease

POSPELOVA 2 symptom - a feeling of scratching when paper is passed over the lesions with Crocker-Adamson spiny follicular keratosis.

KUKLIN-SUVOROV symptom - "varnished pads" of the fingers with lamellar ichthyosis, due to anomaly of keratinization of the skin and hypoplasia of the epidermal ridges.

lupus erythematosus

BENE-MESHCHERSKY symptom - soreness during separation and scraping of scales in the foci of discoid lupus erythematosus, due to follicular hyperkeratosis.

MESHCHERSKY symptom; "torn heel" symptom - when grafting foci of lupus erythematosus, soreness and difficult removal of scales are observed on the inside of which horny spines are detected.

"VASCULAR PNEUMONIA" symptom - the presence of basal discoid atelectasis against the background of an enhanced and deformed pulmonary pattern, as well as a high standing of the diaphragm; X-ray sign of lung damage in systemic lupus erythematosus.

KHACHATURYAN's symptom - punctate depressions with follicular hyperkeratosis in the area of ​​the external auditory canal; possible sign of lupus erythematosus.