Array
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Уровень 1
Уровень 2
Уровень 3
Уровень 4
Уровень 5
Уровень 6
Уровень 7
Уровень 9
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                    [~LESSON_ID] => 1287
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                    [~SORT] => 500
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                    [~EDGE_SORT] => 500
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                    [~IS_CHILDS] => 0
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                    [~SORT] => 500
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                    [~LESSON_ID] => 1258
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                    [~SORT] => 510
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                    [~LESSON_ID] => 1259
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                    [~SORT] => 500
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                    [~SORT] => 500
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                    [~LESSON_ID] => 1261
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                    [~LESSON_ID] => 1262
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                    [~IS_CHILDS] => 0
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                    [~SORT] => 500
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                    [~DEPTH_LEVEL] => 2
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                    [~SORT] => 500
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                    [~DEPTH_LEVEL] => 2
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                    [~IS_CHILDS] => 0
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                    [~SORT] => 500
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                    [~CHAPTER_ID] => 1258
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                    [~TYPE] => LE
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                    [~DEPTH_LEVEL] => 2
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                    [~#LESSON_PATH] => 1060.1258.1264
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                    [~LESSON_ID] => 1265
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                    [~SORT] => 500
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                    [~DEPTH_LEVEL] => 2
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                    [~LESSON_ID] => 1266
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                    [~IS_CHILDS] => 0
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                    [~SORT] => 500
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                    [~ID] => 1266
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                    [~TYPE] => LE
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                    [~DEPTH_LEVEL] => 2
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                    [~#LESSON_PATH] => 1060.1258.1266
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                    [~IS_CHILDS] => 0
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                    [~SORT] => 500
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                    [~DEPTH_LEVEL] => 2
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                    [~SORT] => 500
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                    [~DEPTH_LEVEL] => 2
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                    [~EDGE_SORT] => 500
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                    [~IS_CHILDS] => 0
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                    [~SORT] => 500
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                    [~DEPTH_LEVEL] => 2
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                    [~LESSON_ID] => 1270
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                    [~SORT] => 500
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                    [~SORT] => 500
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                    [~DEPTH_LEVEL] => 2
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                    [~SORT] => 500
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                    [URL] => /docschool/level8/chapter01293/?LESSON_PATH=1060.1293
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                    [~LESSON_ID] => 1295
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Уровень 9: Диффузные болезни соединительной ткани

Представляет

Раводин Роман Анатольевич
Дерматовенеролог, дерматоонколог, дерматокосметолог
Доктор медицинских наук, доцент
Категория: первая
Консультирует взрослых и детей
Город: Санкт-Петербург
Стаж: 15 лет
Базовое образование:
Военно-медицинская академия им. С.М. Кирова с золотой медалью, 1999
Дополнительное образование:
Адъюнктура при кафедре кожных и венерических болезней Военно-медицинской академии (2002-2005)
Основное место работы:
ООО "НПЦ ЛОГОДЕРМ", Северо-Западный государственный медицинский университет им. И.И. Мечникова,кафедра дерматовенерологии
Должность:
Доцент
Профессиональный опыт:
Занимается лечением и диагностикой всего спектра дерматовенерологических заболеваний, уделяя особое внимание редким и атипичным формам. При необходимости самостоятельно берёт соскобы и мазки, микроскопирует их и выдаёт заключение. Выполняет лазерное удаление невусов (родинок) и опухолей кожи. Является автором и соавтором более 70 научных работ по дерматовенерологии, включая два изобретения.

Девятый уровень включает 25 занятий.

 Он посвящён диффузным болезням соединительной ткани, встречающимся в практике врача-дерматолога: системной и кожным формам красной волчанки, системной склеродермии, морфеа (бляшечной склеродермии), склерозирующему лишаю, дерматомиозиту, смешанному заболеванию соединительной ткани.

 Уровень содержит свыше 400 клинических, дерматоскопических и гистологических фотографий с их подробным описанием.

 По его окончании вы познакомитесь с современной клинической характеристикой различных форм красной волчанки, склеродермии, дерматомиозита, узнаете об особенностях клинической диагностики склерозирующего лишая и смешанного заболевания соединительной ткани.

 Учитывая частое поражение кожи лица при этих заболеваниях, особое внимание уделено вопросам дифференциальной диагностики, включая клинические и дерматоскопические изображения с их описанием и комментариями.

 Приведены наиболее эффективные схемы лечения и профилактики, основанные на зарубежных и Российских клинических рекомендациях по дерматовенерологии 2015.

 После каждого занятия доступен тест для самопроверки (кнопка Тесты), а в конце уровня – Итоговый тест по всему пройденному материалу.

[~DETAIL_TEXT] =>

Уровень 9: Диффузные болезни соединительной ткани

Представляет

Раводин Роман Анатольевич
Дерматовенеролог, дерматоонколог, дерматокосметолог
Доктор медицинских наук, доцент
Категория: первая
Консультирует взрослых и детей
Город: Санкт-Петербург
Стаж: 15 лет
Базовое образование:
Военно-медицинская академия им. С.М. Кирова с золотой медалью, 1999
Дополнительное образование:
Адъюнктура при кафедре кожных и венерических болезней Военно-медицинской академии (2002-2005)
Основное место работы:
ООО "НПЦ ЛОГОДЕРМ", Северо-Западный государственный медицинский университет им. И.И. Мечникова,кафедра дерматовенерологии
Должность:
Доцент
Профессиональный опыт:
Занимается лечением и диагностикой всего спектра дерматовенерологических заболеваний, уделяя особое внимание редким и атипичным формам. При необходимости самостоятельно берёт соскобы и мазки, микроскопирует их и выдаёт заключение. Выполняет лазерное удаление невусов (родинок) и опухолей кожи. Является автором и соавтором более 70 научных работ по дерматовенерологии, включая два изобретения.

Девятый уровень включает 25 занятий.

 Он посвящён диффузным болезням соединительной ткани, встречающимся в практике врача-дерматолога: системной и кожным формам красной волчанки, системной склеродермии, морфеа (бляшечной склеродермии), склерозирующему лишаю, дерматомиозиту, смешанному заболеванию соединительной ткани.

 Уровень содержит свыше 400 клинических, дерматоскопических и гистологических фотографий с их подробным описанием.

 По его окончании вы познакомитесь с современной клинической характеристикой различных форм красной волчанки, склеродермии, дерматомиозита, узнаете об особенностях клинической диагностики склерозирующего лишая и смешанного заболевания соединительной ткани.

 Учитывая частое поражение кожи лица при этих заболеваниях, особое внимание уделено вопросам дифференциальной диагностики, включая клинические и дерматоскопические изображения с их описанием и комментариями.

 Приведены наиболее эффективные схемы лечения и профилактики, основанные на зарубежных и Российских клинических рекомендациях по дерматовенерологии 2015.

 После каждого занятия доступен тест для самопроверки (кнопка Тесты), а в конце уровня – Итоговый тест по всему пройденному материалу.

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Уровень 10
Уровень 11
Уровень 12
Уровень 13

Хроническая кожная красная волчанка

Дискоидная красная волчанка
Дискоидная и её разновидность диссеминированная красная волчанка представляют собой несистемные кожные формы хронической красной волчанки и характеризуются триадой симптомов: эритемой, кератозом и рубцовой атрофией, различаясь между собой лишь размерами высыпаний, их расположением и степенью выраженности атрофии. При дискоидной красной волчанке поражается преимущественно кожа лица, часто в форме «бабочки»; реже волосистая часть головы, ушные раковины (наружные слуховые проходы) и другие участки тела. При диссеминированной красной волчанке высыпания носят множественный характер, локализуясь на лице, ушных раковинах, верхней части груди и спины.

При дискоидной красной волчанке процесс поражения кожи начинается с появления одной или нескольких розовых или ярко-красных эритем, которые постепенно увеличиваются в размерах и трансформируются в инфильтрированные бляшки размерами до 5 см в диаметре и более. На их поверхности, начиная с центра, развивается гиперкератоз, вначале фолликулярный ‒ в виде небольших шипиков, в затем ‒ разлитой.

Поражение волосистой части головы
На волосистой части головы очаги поражения обычно имеют значительную величину и вначале имеют вид слегка инфильтрированных пятен красного цвета с гиперкератозом на поверхности. После разрешения пятен остаются рубцовая атрофия и стойкое облысение. Более подробно о поражении волосистой части головы при красной волчанке можно узнать в уровне 10 (Рубцовые алопеции) системы Logoderm.

При локализации высыпаний на пальцах кистей рук ‒ образуются пятна фиолетового цвета с очагами гиперкератоза и атрофии. На красной кайме губ и слизистой щек могут появляться ограниченные розово-красные пятна, центральная часть которых становится серовато-белой. Иногда в их центральной части образуется пузырь, вскрывающийся с образованием эрозии или поверхностного изъязвления. Поражение, как правило, захватывает не только красную кайму губ и слизистую оболочку, но и прилегающие участки кожи.


Диссеминированная красная волчанка
При диссеминированной красной волчанке возникающие воспалительные пятна не имеют тенденции ни к выраженному периферическому росту, достигая не более 2-3 см в диаметре, ни к инфильтрации.

На их поверхности также возникает гиперкератоз в виде белых, с трудом удаляемых чешуек, при соскабливании которых возникает болезненность (симптом Бенье-Мещерского). Могут встречаться отёчные воспалительные пятна неправильной формы с нечёткими границами различных оттенков: от светло-красного до застойно-багрового. При диаскопии таких пятен гиперемия исчезает, но становится различимой расширенная капиллярная сеть. При разрешении очагов диссеминированной красной волчанки атрофия очень поверхностна, порой едва различима. У половины больных диссеминированной красной волчанкой могут отмечаться периодически повторяющиеся субфебрильная температура, анемия, ускоренная СОЭ, гипергаммаглобулинемия, следы белка в моче, эта форма чаще дискоидной трансформируется в СКВ.

Постепенно почти вся поверхность бляшек покрывается плотными, с трудом удаляемыми чешуйками, лишь по периферии высыпаний всегда остается свободная от роговых наслоений красная кайма, нередко в форме валика. Снятие чешуек обычно сопровождается резкой болью (симптом Бенье-Мещерского), т.к. на нижней поверхности снятых чешуек обнаруживаются роговые шипики (в виде «дамского каблучка» или «канцелярской кнопки»), которыми они укреплены в расширенном устье волосяных фолликулов. Постепенно происходит разрешение очагов. Оно начинается в центре, распространяется к периферии и заканчивается образованием выраженной рубцовой атрофии. Атрофия представляется в виде значительного истончение кожи, собирающейся в складки наподобие смятой папиросной бумаги белого цвета; или в форме грубых, несколько вдавленных в кожу, слегка пигментированных или гипопигментных рубцов, обезображивающих больного. На рубцах нередко впоследствии появляются новые высыпания.

Глубокая красная волчанка (люпус-панникулит, глубокая красная волчанка Капоши-Ирганга)
Крайне редкая форма красной волчанки ‒ глубокая проявляется одним или несколькими плотными, подвижными, болезненными (при надавливании) или бессимптомно протекающими узлами, которые чаще всего возникают в областях с развитой подкожной жировой клетчаткой (на голове, шее, молочных железах, руках, бёдрах и ягодицах). Глубокая красная волчанка часто провоцируется механической травмой кожи. Кожа над узлами нормальная или синюшно-красного цвета, иногда имеются высыпания типичной дискоидной красной волчанки (в этом случае говорят о сочетании глубокой и дискоидной форм). Узлы разрешаются с образованием участков атрофии подкожной жировой клетчатки в виде глубоких западений кожи или подвергаются кальцификации. Очень редко узлы изъязвляются с последующим образованием втянутых рубцов. Заболевание склонно к хроническому рецидивирующему течению.

Веррукозная (гипертрофическая) красная волчанка
Представляет собой необычный вариант заболевания, когда очаги поражения приобретают бородавчатый вид и напоминают кератоакантому или бородавчатый красный плоский лишай. Характерно образование одиночных бляшек с гиперкератозом и бородавчатой поверхностью, наиболее часто они локализуются на лице, разгибательной поверхности плеч и предплечий, тыле кистей. Обычно наряду с этими гиперкертотическими очагами отмечаются высыпания типичной дискоидной красной волчанки, что облегчает постановку диагноза.


Красная волчанка вследствие обморожения (озноблённая, Гетчинсона)

Красная волчанка вследствие обморожения (озноблённая, Гетчинсона) является крайне редкой формой заболевания, возникающей на местах ранее бывших обморожений (спустя 3-4 года), чаще у женщин. Для неё характерны синюшно-красные папулы и бляшки, локализующиеся на коже ушных раковин, носа, кистей и стоп. Бляшки напоминают клиническую картину ознобления, могут эрозироваться и изъязвляться. У 20% пациентов с данной формой заболевания развивается СКВ.



Опухолевидная красная волчанка

Опухолевидная красная волчанка характеризуется появлением уртикароподобных высыпаний красного или синюшно-красного цвета, округлой, овальной, неправильной или кольцевидной формы на лице, шее, верхней части груди, спины, в области плеч. Элементы могут сливаться с образованием полициклических фигур и бесследно разрешаться спустя несколько недель после своего появления. Характерно хроническое рецидивирующее течение с обострениями в весенне-летний период после пребывания на солнце с появлением сыпи в одних и тех же местах.



Лихеноидная дискоидная красная волчанка
Лихеноидная дискоидная красная волчанка (перекрёстный синдром красной волчанки и красного плоского лишая) встречается редко. Для данной формы характерно сочетание симптомов красного плоского лишая в виде папул и бляшек синюшно-красного цвета и красной волчанки в виде очагов атрофии кожи, сопровождающихся выраженной гипопигментацией. На очагах атрофии кожи позднее появляются телеангиэктазии и шелушение. Высыпания локализуются в верхней части спины и на разгибательных поверхностях конечностей. Характерен ладонно-подошвенный кератоз, а также ониходистрофии, иногда полное отсутствие ногтевых пластинок. Возможна рубцовая алопеция на волосистой части головы, а также высыпания на слизистых.



Красная волчанка слизистых оболочек
Может сочетаться с поражением кожи или предшествовать ему. Встречается у 25% больных с хроническими кожными формами красной волчанки. Характеризуется возникновением воспалительных пятен или синюшно-красных папул на слизистых оболочках полости рта, носа, конъюнктивы и гениталий. Иногда образуются пузыри. Элементы могут эрозироваться и изъязвляться с последующим формированием рубцов.


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