Svrab je epidemická ektoparazitóza vyvolaná zákožkou svrabovou. Zdrojem nákazy je nemocný člověk. K přenosu infekce dochází buď přímo, nebo nepřímo. Inkubační doba je 2–3 týdny. Onemocnění charakterizuje intenzivní noční pruritus. V dětském věku se toto onemocnění vyskytuje velmi často. Diagnostika choroby je založená na pozitivní anamnéze nočního pruritu, klinickém obraze a průkazu zákožky v kůži nemocného. Metodou první volby v terapii choroby u dětí je permethrin a síra. Svrab podléhá povinnému epidemiologickému hlášení. V článku popisujeme etiologii, patogenezi, diagnostiku, diferenciální diagnostiku a terapii choroby včetně současné legislativy a protiepidemických opatření.
Scabies is epidemic ectoparasitosis caused by human parasite Sarcoptes scabiei, var. hominis. The reservoir of a contagion is the man. The transmission of the disease is caused by direct or indirect contact. The incubation period ranges from two to three weeks. The disease is characterised by an intensive night pruritus. In childhood age we can find this disease very frequently. Diagnostics is based on positive night pruritus, clinical picture and demonstration of Sarcoptes scabiei in skin of ill person. The method of the first alternative at children there is permethrin and sulphur. Scabies is subordinated to the obligatory epidemiologic announcement. In the article we describe aetiology, pathogenesis, diagnostics, differential diagnostics, treatment and present legislation with precaution.
- MeSH
- dermatologické látky farmakologie terapeutické užití MeSH
- dítě MeSH
- hlášení nemocí MeSH
- lidé MeSH
- oznamovací povinnost MeSH
- svrab * diagnóza farmakoterapie prevence a kontrola MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- Publikační typ
- přehledy MeSH
Svrab je epidemická ektoparazitóza vyvolaná zákožkou svrabovou. Zdrojem nákazy je nemocný člověk. K přenosu infekce dochází buď přímo, nebo nepřímo. Inkubační doba je 2–3 týdny. Onemocnění charakterizuje intenzivní noční pruritus. V dětském věku se toto onemocnění vyskytuje velmi často. Diagnostika choroby je založená na pozitivní anamnéze nočního pruritu, klinickém obraze a průkazu zákožky v kůži nemocného. Metodou první volby v terapii choroby u dětí je permethrin a síra. Svrab podléhá povinnému epidemiologickému hlášení. V článku popisujeme etiologii, patogenezi, diagnostiku, diferenciální diagnostiku a terapii choroby včetně současné legislativy a protiepidemických opatření.
Scabies is epidemic ectoparasitosis caused by human parasite Sarcoptes scabiei, var. hominis. The reservoir of a contagion is the man. The transmission of the disease is caused by direct or indirect contact. The incubation period ranges from two to three weeks. The disease is characterised by an intensive night pruritus. In childhood age we can find this disease very frequently. Diagnostics is based on positive night pruritus, clinical picture and demonstration of Sarcoptes scabiei in skin of ill person. The method of the first alternative at children there is permethrin and sulphur. Scabies is subordinated to the obligatory epidemiologic announcement. In the article we describe aetiology, pathogenesis, diagnostics, differential diagnostics, treatment and present legislation with precaution.
- MeSH
- antiparazitární látky aplikace a dávkování MeSH
- benzoáty terapeutické užití MeSH
- diferenciální diagnóza MeSH
- dítě MeSH
- hexachlorcyklohexan aplikace a dávkování MeSH
- hlášení nemocí normy statistika a číselné údaje MeSH
- ivermektin aplikace a dávkování MeSH
- lidé MeSH
- permethrin aplikace a dávkování MeSH
- síra terapeutické užití MeSH
- svrab * diagnóza farmakoterapie prevence a kontrola přenos MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- Publikační typ
- přehledy MeSH
Trichotillomania (TTM) is defined by the Diagnostics and Statistic Manual of Mental Disorders, 4th edition (DMS-IV) as hair loss from a patient`s repetitive self-pulling of hair. The disorder is included under anxiety disorders because it shares some obsessive-compulsive features. Patients have the tendency towards feelings of unattractiveness, body dissatisfaction, and low self-esteem (1,2). It is a major psychiatric problem, but many patients with this disorder first present to a dermatologist. An 11-year-old girl came to our department with a 2-month history of diffuse hair loss on the frontoparietal and parietotemporal area (Figure 1). She had originally been examined by a pediatrician with the diagnosis of alopecia areata. The patient`s personal history included hay fever and shortsightedness, and she suffered from varicella and mononucleosis. Nobody in the family history suffered from alopecia areata, but her father has male androgenetic alopecia (Norwood/Hamilton MAGA C3F3). The mother noticed that the child had had changeable mood for about 2 months and did not want to communicate with other persons in the family. The family did not have any pet at home. At school, her favorite subjects were Math and Computer Studies. She did not like Physical Education and did not participate in any sport activities during her free time. This was very strange because she was obese (body-mass index (BMI) 24.69). She was sometimes angry with her 13-year-old sister who had better results at school. The girl had suddenly started to wear a blue scarf. The parents did not notice that she pulled out her hair at home. Dermatological examination of the capillitium found a zone of incomplete alopecia in the frontoparietal and parietotemporal area, without inflammation, desquamation, and scaring. Hairs were of variable length (Figure 1). There was a patch of incomplete alopecia above the forehead between two stripes of hair of variable length (Figure 2). The hair pull test was negative along the edges of the alopecia. Mycological examination from the skin capillitium was negative. The trichoscopy and skin biopsy of the parietotemporal region of the capillitium (Figure 3) confirmed trichotillomania. Laboratory tests (blood count, iron, ferritin, transferrin, selenium, zinc, vitamin B12, folic acid, serology and hormones of thyroid gland) were negative. We referred the girl for ophthalmologic and psychological examination. Ophthalmologic examination proved that there was no need to add any more diopters. The psychological examination provided us with a picture in which she drew her family (Figure 4). The strongest authority in the family was the mother because she looked after the girls for most of the day. She was in the first place in the picture. The father had longer working hours and spent more time outside the home. He worked as a long vehicle driver. He was in the second place in the picture. There was sibling rivalry between the girls, but the parents did not notice this problem and preferred the older daughter. She was successful at school and was prettier (slim, higher, curly brown hair, without spectacles). Our 11-years-old patient noticed all these differences between them, but at her level of mental development was not able to cope with this problem. She wanted to be her sister's equal. The sister is drawn in the picture in the third place next to father, while the patient's own figure was drawn larger and slim even though she was obese. Notably, all three female figures had very nice long brown hair. It seemed that the mother and our patient had better quality of hair and more intense color than the sister in the drawing. The only hairless person in the picture was the father. The girl did not want to talk about her problems and feelings at home. Then it was confirmed that our patient was very sensitive, anxious, willful, and withdrawn. She was interested in her body and very perceptive of her physical appearance. From the psychological point of view, the parents started to pay more interest to their younger daughter and tried to understand and help her. After consultation with the psychiatrist, we did not start psychopharmacologic therapy for trichotillomania; instead, we started treatment with cognitive behavioral therapy, mild shampoo, mild topical steroids (e.g. hydrocortisone butyrate 0.1%) in solution and methionine in capsules. With parents' cooperation, the treatment was successful. The name trichotillomania was first employed by the French dermatologist Francois Henri Hallopeau in 1889, who described a young man pulling his hair out in tufts (3-5). The word is derived from the Greek thrix (hair), tillein (to pull), and mania (madness) (5). The prevalence of TTM in the general adult population ranges from 0.6% to 4%, and 2-4% of the general psychiatric outpatient population meet the criteria for TTM (2-5). The prevalence among children and adolescents has been estimated at less than 1% (5). The disease can occur at any age and in any sex. The age of onset of hair pulling is significantly later for men than for women (3). There are three subsets of age: preschool children, preadolescents to young adults, and adults. The mean age of onset is pre-pubertal. It ranges from 8 to 13 years (on average 11.3 years) (2-5). The occurrence of hair-pulling in the first year of life is a rare event, probably comprising <1% of cases (5). The etiology of TTM is complex and may be triggered by a psychosocial stressor within the family, such as separation from an attachment figure, hospitalization of the child or parent, birth of a younger sibling, sibling rivalry, moving to a new house, or problems with school performance. It has been hypothesized that the habit may begin with "playing" with the hair, with later chronic pulling resulting in obvious hair loss (2). Environment is a factor because children usually pull their hair when alone and in relaxed surroundings. The bedroom, bathroom, or family room are "high-risk" situations for hair-pulling (5). Men and women also differed in terms of the hair pulling site (men pull hair from the stomach/back and the moustache/beard areas, while women pull from the scalp) (3). Pulling hair from siblings, pets, dolls, and stuffed animals has also been documented, often occurring in the same pattern as in the patient (5). Genetic factors contributing to the development of TTM are mutations of the SLITRK1 gene, which plays a role in cortex development and neuronal growth. The protein SAPAP3 has been present in 4.2% of TTM cases and patients with obsessive-compulsive disorder (OCD). It may be involved in the development of the spectrum of OCD. A significantly different concordance rate for TTM was found in monozygotic (38.1%) compared with dizygotic (0%) twins in 34 pairs (3). The core diagnostic feature is the repetitive pulling of hairs from one`s own body, resulting in hair loss. The targeted hair is mostly on the scalp (75%), but may also be from the eyebrows (42%), eyelashes (53%), beard (10%), and pubic area (17%) (3,5). There are three subtypes of hair pulling - early onset, automatic, and focused. Diagnostic criteria for TTM according to DSM-IV criteria are (2,3,5): 1) recurrent pulling of one`s hair resulting in noticeable hair loss; 2) an increasing sense of tension immediately prior to pulling out the hair or when attempting to resist the behavior; 3) pleasure, gratification, or relief when pulling out the hair; 4) the disturbance is not better accounted for by another mental disorder and is not due to a general medical condition (e.g., a dermatologic condition); 5) the disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. The differential diagnosis includes alopecia areata (Table 1) (6), tinea capitis, telogen effluvium, secondary syphilis, traction alopecia, loose anagen syndrome, lichen planopilaris, alopecia mucinosa, and scleroderma (2-5). Biopsy of an involved area (ideally from a recent site of hair loss) can help to confirm the diagnosis (5). On histologic examination, there are typically increased numbers of catagen and telogen hairs without evidence of inflammation. Chronic hair pulling induces a catagen phase, and more hairs will be telogen hairs. Pigment casts and empty anagen follicles are often seen. Perifollicular hemorrhage near the hair bulb is an indicator of TTM (2). Complications of TTM are rare, but they comprise secondary bacterial infections with regional lymphadenopathy as a result of picking and scratching at the scalp. Many patients play with and ingest the pulled hairs (e.g. touching the hair to lips, biting, and chewing). Trichophagia (ingestion of the hair) can lead to a rare complication named trichobezoar (a "hair ball" in stomach). This habit is present in approximately 5% to 30% of adult patients, but it is less frequent in children. Patient with trichophagia present with pallor, nausea, vomiting, anorexia, and weight loss. Radiologic examination and gastroscopy should not be delayed (2,4,5). The management of the disease is difficult and requires strong cooperation between the physician, patient, and parents. The dermatologist cannot take part in the therapy, strictly speaking, but without the psychological, psychopharmacologic, and topic dermatologic treatment a vicious circle will be perpetuated.
- MeSH
- alopecia areata etiologie MeSH
- dítě MeSH
- lidé MeSH
- trichotilomanie komplikace diagnóza terapie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
Autorky ve článku přehledně analyzují onemocnění sinus pilonidalis, jehož incidence se v České republice pohybuje mezi 26/100 000 obyvatel. Muži jsou postiženi více než ženy. Etiopatogeneze není dosud zcela objasněna. V patofyziologii onemocnění plní klíčovou roli vlasy nebo chlupy. Lékaře vyhledá pouze 35 až 50 % nemocných. Klinický obraz onemocnění je rozmanitý. Diagnostika vychází z aspekce, palpace a sondáže sinu. Terapii vede chirurg, dermatovenerolog může léčbu doplnit laserovou depilací nadměrného ochlupení v intergluteální oblasti. Onemocnění má specifický charakter, snižuje kvalitu života pacientů a způsobuje jim psychické problémy. Interdisciplinární spolupráce chirurga a dermatovenerologa v rámci diagnostiky a terapie je nezbytná.
The authors transparently analyse in the article the disease pilonidal sinus whose incidence in the Czech Republic reaches between 26/100 000 inhabitants. Men are more afflicted by the disease than women. Ethiopathogenesis is not still explained. In pathophysiology of the disease hair fulfils the key role. Only 35–50% of sick people look up the doctor. The clinical picture of the disease is varied. The diagnostics comes out from the inspection, palpation and probing the sinus. The surgeon leads the therapy, the dermatovenerologist can fulfil the disease by laser depilation of hypertrichosis in the intergluteal area. The disease has a specific character, it lowers the quality of the patients’ life and it causes them the psychological problems. Interdisciplinary cooperation of the surgeon and the dermatovenerologist is essential in the frame of the diagnostics and the therapy.
Autorky ve svém sdělení komplexně rozebírají problematiku inkontinence moči, stolice a s ní souvisejících kožních problémů. Zaměřují se na zdravotní, psychologické, sociální a ekonomické důsledky inkontinence, včetně jejího vlivu na kvalitu života pacientů.
The authors completely analyse in their text the problems of incontinence of urine and stool and related skin problems. They are focused on health, psychological, social and economic consequences of incontinence comprising their influence on the quality of patients´ life.
- MeSH
- dermatologické látky terapeutické užití MeSH
- diferenciální diagnóza MeSH
- fekální inkontinence * ekonomika komplikace psychologie MeSH
- inkontinence moči * ekonomika komplikace psychologie MeSH
- intertrigo diagnóza etiologie patofyziologie terapie MeSH
- lidé MeSH
- péče o kůži metody MeSH
- plenková dermatitida * diagnóza etiologie patofyziologie terapie MeSH
- příprava léků MeSH
- vzdělávání pacientů jako téma MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
Molluscum contagiosum (MC) je virové kožní onemocnění vyvolané Virem Molluscum Contagiosum (MCV), který je jediným zástupcem rodu Molluscipoxvirus z čeledi Poxviridae. Existují dva typy viru, které vyvolávají podobný klinický obraz. Zdrojem nákazy je infikovaná osoba. Inkubační doba je 19 až 50 dní. Onemocnění se vyskytuje celosvětově s mírnou prevalencí v tropech. Pro přenos pohlavním stykem řadíme molluska mezi sexuálně přenosné infekce. V článku popisujeme etiologii, klinický obraz, diagnostiku, diferenciální diagnostiku, terapii a protiepidemická opatření.
Molluscum contagiosum (MC) is a viral skin disease caused by The Molluscum Contagiosum Virus (MCV) that is the only representative of subspecies Molluscipoxvirus from the group Poxviridae. There are two types of the virus that cause similar clinical picture. The reservoir of a contagion is the man. The incubation period ranges from nineteen to fifty days. The disease occurs worldwide but is more prevalent in tropical areas. For their transmission by sex contact we put molluscum contagiosum among sexually transmitted infections. In the text we describe aetiology, clinical picture, diagnostics, differential diagnostic, therapy and precaution.
Autorky popisují případ 22letého homosexuálního muže s chronickou gonoroickou proktitidou. Uvádějí současný přehled problematiky gonoroické infekce rektální sliznice. Zaměřují se na možnosti diagnostiky a léčby tohoto onemocnění.
The authors describe the case of a 22-year-old homosexual man with a chronic gonorrhoic proctitis. The article summarize recent knowledge concerning gonorrhoic infection of the rectal mucosa and focus on the possibilities of its diagnosis and treatment.
- Klíčová slova
- gonoroická proktitida, gonococcal proctitis,
- MeSH
- antibakteriální látky aplikace a dávkování terapeutické užití MeSH
- chronická nemoc MeSH
- gonorea komplikace mikrobiologie MeSH
- homosexualita mužská MeSH
- lidé MeSH
- mladý dospělý MeSH
- Neisseria gonorrhoeae izolace a purifikace MeSH
- proktitida diagnóza farmakoterapie patofyziologie MeSH
- rektum mikrobiologie patofyziologie MeSH
- sliznice patologie MeSH
- Check Tag
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Kapavka patří k nejběžnějším sexuálně přenosným chorobám s poměrně krátkou inkubační dobou. Jejím původcem je gramnegativní diplokok, N. gonorrhoeae. Primárně postihuje cylindrický epitel urogenitálního traktu s možnou hematogenní diseminací. Diagnostika vychází z klinického obrazu a laboratorního průkazu patogena. Při pozitivním nálezu přeléčíme nemocného vhodným antibiotikem podle citlivosti gonokoka. Současně provedeme vyšetření na další pohlavně sdělné choroby včetně HIV. Zahájíme depistážní šetření. Všechny udané kontakty vyšetříme na HIV a pohlavně přenosné choroby, při pozitivitě přeléčíme. Nemocného vedeme v evidenci po dobu léčení a kontrol. Onemocnění podléhá povinnému hlášení. Ve třetím dílu článku podrobněji popisujeme kapavku u pacientů s HIV/AIDS, ženskou, extragenitální a metastatickou kapavku, terapii choroby, následky a prognózu.
Gonorrhoea belongs to the commonest sexually transmitted diseases with relatively short incubation period. Its origin can be find in gram-negative diplococcus, N. gonorrhoeae. Primary it affects the columnar epithelium of urogenital tract with possible blood dissemination. Diagnostics comes out from the clinical picture and laboratory demonstration of pathogen. When positive finding, we retreat a patient with a suitable antibiotic according to the sensibility of gonococcus. Simultaneously we do the examination for other sexually transmitted diseases comprising HIV. We start screening tests. We examine all collected contacts on HIV and sexually transmitted diseases, when positive, we retreat again. We have a patient in evidence for the whole period of treatment and checks-up. The disease undergoes compulsory report. In the third part of the article we closely describe HIV/AIDS gonorrhoea, female, extragenital and metastatic gonorrhoea, therapy of the disease, complications and prognosis.
