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 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, anti-epidemic, 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 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 allergodermia toxicoderma pyoderma neurodermatitis dermatophytosis eczema psoriasis Lichen planus zoster leprosy pemphigus 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 covered with crusts, especially in the elbows and rump dermatitis herpetiformis

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 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 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