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    Dmitrenko S. V.

    CONCEPT EXTENT OF SEVERITY ICHTHYOSIS


    About the author: Dmitrenko S. V.
    Heading CLINICAL MEDICINE
    Type of article Scentific article
    Annotation Aim of our work – proposed criteria for the use of different variants of flow that determines the optimal tactics of treatment. Ichthyosis is the most common henodermatozom in the world and Ukraine, which includes a heterogeneous group of species with different disease etiology, intensity of symptoms and prevalence of lesions. Ichthyosis is defined as a heterogeneous group of diseases with several subspecies, and there are views of ichthyosis, who see it as a heterogeneous disease that has individual manifestations of genetic disorders. Current proposals for classification ichthyosis into account its heterogeneity. However, these recommendations do not indicate the need for finding different severity of the disease, which is why, diagnosis and management of ichthyosis is quite complicated problem. The course of ichthyosis is little known and urgent task in dermatology. New data on the etiology and pathogenesis of the disease, current therapies require a comprehensive approach to evaluation. Materials and methods We conducted a cohort study and analysis of clinical and laboratory features of 70 patients with ichthyosis ichthyosis respect to age, gender, living and working conditions, the presence of harmful habits, heredity, number of calls per year, the date of diagnosis, concomitant diseases. All patients diagnosed according to clinical guidelines MH of Ukraine and made the recommended minimum level of clinical and laboratory research. All patients were in clinical supervision. dermatologist at the residence during the period 2010 - 2014 years, treated according to the protocols of medical care MoH Ukraine. A survey of patients conducted at the residence and when accessing the Regional STI clinic. In addition to research methods Standart patients conducted DNA cytometry, immunological, immunohistochemical, dermatoskopichni, dermatoglyphic, the study of quality of life according to standardized methods. The sample of patients randomly conducted, results analyzed statistical methods recommended for cohort studies in the software package "STATISTICA 5.5" (CNIT VNMU belongs to them. Pirogov, license № AXXR910A374605FA. Results. Discussions We conducted a comprehensive obste6zhennya 70 patients with ichthyosis suggest heterogeneity of clinical and laboratory signs of progress ichthyosis. Identified changes correlated relatively manifestations and severity of strengthening the presence of signs of damage to the body at different levels from the molecular to the general indicators of clinical and QOL. The main result of our study was to determine the main clinical and laboratory features that distinguish allow easy and difficult disease. The main clinical manifestations are characterized by severe burdened heredity, increased hospitalizations polimorfnistyu skin and complaints need retinoid application to control the disease. The overall incidence of hospitalizations in patients with ichthyosis was quite low - less than once a year, identified a group of patients - 8 of 70 in the condition required hospitalization 2-3 times or more a year. The most common manifestation in patients was dry and skin tightening - 100 and 96% respectively, slightly less - 80% of patients experienced itching least represented symptom was pain that bothered 10% of patients. In most patients, the combination of skin lesions observed upper or lower limbs and trunk (68%) of the 8 people that already belonged to the group of severe which was a combination of 4 or more locations destruction. Among dermatoglyphics features only essential feature is the identification chotyrohpaltsevoyi flexural creases with ichthyosis. According to our records, it was detected in 11 of 47 patients with ichthyosis (22%). These patients were 7 men and 4 women. Also in this group included 6 patients who had severe course ichthyosis and marked clinical signs. Note that among 8 patients with severe ichthyosis use retinol palmitate proved effective only in 2 patients, only 6 other combination therapy with topical retinoids (radevit, videstym, redetsyl) resulted in clinically significant results. Serious side effects at the local and systemic use retinoids us not observed. Against the backdrop of severe ichthyosis proved significantly higher rates of proliferation index, interval SUB-G0G1, S phase and significantly reduced performance phase G2 + M. Patients with ichthyosis are complete violation of immunity, more pronounced in cell link - immunological differences in a significant increase of IgA, reduce immunoregulatory index CD4 / CD8 in the group with severe relative to the control group and the group of indicators mild (p <0.05). Among dermatological symptoms in patients with severe ichthyosis clinical picture of skin manifestations was pronounced hyperkeratosis, sometimes fulikulyarnoho, with massive dirty gray scales, cracks. Also for severe ichthyosis dermatoskopichni found specific signs: skin picture atypical - in the form of massive cubic structures marked hyperkeratosis also available in the form of massive multi crusts and conglomerates separated by cracks of the horny layer of the epidermis - a symptom of "melting ice" There are massive horny crusts and atrophy tallow-hair follicles. Symptom "melting ice", we proposed to describe dermatoskopichnyh signs of severe ichthyosis, points to the deep breach keratynyzatsiyi. When imately in these patients observed: massive hyperkeratosis, akantokeratoliz, uneven acanthosis, granular layer was thickened and granular degeneration of cells malpihiyevoho layer with the weakening of intercellular connections and the formation of cavities. The existence of two variants of ichthyosis course we found in the complex examination of patients with ichthyosis first stated in the scientific research available to us, although other scientists indicated the presence of a group of patients in whom it was necessary to use systemic retinoids. The main criterion for selecting this type of therapy then becomes inefficiency means the use of local therapy. We were met work, which would be carried out to develop prognostic signs or analysis of factors that might be predictive of systemic retinoids. In most cases, an analysis of the effectiveness of this group of drugs, especially in recent years, which marked the high efficacy of retinoids in ichthyosis, it means in resistance to topical therapy and the presence of generalized lesions. However, along with this, the question remains about the preventive purpose retinoids, which would significantly reduce the duration of therapy and its potential toxicity, on the one hand, and on the other hand the timely use of systemic retinoids will effectively control the disease and significantly improve the quality of life of patients. Prospects for further research are that the research can be applied in practice doctors, general practitioners and potentially can increase the effectiveness of treatment and improve the quality of life of patients with ichthyosis.
    Tags ichthyosis, severity, symptoms, treatment, diagnostic criteria
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    Publication of the article «World of Medicine and Biology» №3(51) 1 part 2015 year, 044-047 pages, index UDK 616.5-003.871 -08