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April 29, 2012
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The small tortoiseshell is an illness of allergic character which main manifestation is an emergence on mucous membranes and integuments of blisters. Similar reaction of an organism arises as a result of a certain irritation. By urticaria call group of diseases, which have one general symptom – blisters, constantly pruritic and having an accurate otgranicheniye. They tower over a surface of the reddened integument, the size of such blisters can make both several millimeters, and several centimeters.
The main feature of this illness is that urticaria which symptoms are shown very quickly can disappear similarly quickly at adequate treatment. So, the illness sometimes manages to develop and disappear for several hours.
Reasons of the small tortoiseshell
Any substance can serve as allergen which provokes development of the small tortoiseshell. It can be both products, and pollen of flowers, and medicine. Also the small tortoiseshell at children and adults is sometimes shown after a sting of insects or as an effect of impact on an infection human body. Even waste products of microorganisms can provoke development of the small tortoiseshell. To prevent emergence of such allergic reaction further, it is important to define what served as an origin of the small tortoiseshell. In certain cases usual observation will be effective, but sometimes the patient needs to carry out a number of laboratory analyses.
Development of the acute small tortoiseshell most often happens as a result of influence of medicines, food stuffs, stings of insects or infections. The chronic form of the small tortoiseshell is shown as an effect of some pathological processes which happen in internals of the patient. Also chronic form of the small tortoiseshell arises at disturbances of a nervous system. In classification of forms of a disease allocate physical urticaria which arises as reaction to heat, cold, pressure, influence of sunshine, vibrations, exercise stresses.
Owing to some etiological factors in tissues of the person chemically active agents, for example, the histamine increasing permeability of vascular walls collect. Respectively, capillaries extend, there is hypostasis of a papillary layer of a derma, and as a result the patient on skin has blisters.
Not up to the end split proteinaceous products which, getting into blood, induce a producing antibodies to some foodstuff sometimes act as allergens. Toxins which contain the spoiled food stuffs, toxic substances which are formed in an organism of patients with colitis, and also at people with insufficient function of kidneys can provoke also allergic reaction. Also the bacterial allergy can be shown. In the course of developing of urticaria an important factor are functional disturbances of a nervous system. So, the cholinergic small tortoiseshell is shown at nervous excitement in view of allocation of acetylcholine.
The small tortoiseshell develops owing to a hyperpermeability of vessels of a microcirculator bed and the subsequent edematization around vessels. Blisters at the small tortoiseshell – an effect of hypersensitivity which arises against the increased level of concentration of biologically active agents.
Urticaria is a toksiko-allergic dermatosis which has polyetiological genesis.
As factors which have the pathogenetic importance it should be noted the accompanying diseases — persistent focal infection, a helminthic invasion, dyskinesia of zhelchevyvodyashchy ways, disturbances in work of a gastrointestinal tract, an allergy to drugs.
Symptoms of the small tortoiseshell
It is accepted to distinguish several different types of the small tortoiseshell. At an acute form of a disease urticaria suddenly affects the person, at the same time it shows urtikarny rashes, very severe itch. The appeared blisters differ in a light pink shade, they have the different size. At the same time in the center a blister opaque, and at the edges it has pink color. The form of blisters can be both roundish, and absolutely uneven. In certain cases such blisters can merge in a uniform zone. Such process for the patient is fraught with the general deterioration in its state: there is so-called urticaceous fever. The acute small tortoiseshell can be shown on mucous membranes of the sky, language, a throat, on lips. As a rule, this form of a disease arises as allergic reaction to some food stuffs or to medicines. In certain cases urticaria which symptoms are shown very sharply arises after inoculations, introduction of some drugs, hemotransfusion.
The so-called artificial small tortoiseshell – it is atypical a form of this disease of which emergence on skin of the rashes having the linear form is characteristic. In this case patients do not complain of an itch. Such form of the small tortoiseshell arises at people mainly as an effect of irritations of mechanical character.
If at the patient high sensitivity of an organism to allergens takes place, then in that case it can have a chronic recurrent small tortoiseshell. The similar form of the small tortoiseshell is provoked by persistent infection, problems in work of a digestive tract or other reasons. Often it develops against chronic infectious illnesses – cholecystitis, tonsillitis, etc.
Periodically there is a change of palindromias at which there are blisters on skin, remissions which last different spans. At emergence of blisters of the person the itch torments, at it temperature can increase, arise headaches. The itch sometimes happens so strong that the patient suffers from sleep disorders and neurotic frustration.
At acute sharp development of limited hypostasis of an integument, and also hypodermic fatty tissue of the person happens a limited Quincke's edema (the so-called huge small tortoiseshell). At the person cheeks, lips, eyelids suddenly swell, generative organs can also swell. The habit view of skin changes: it gains white or pink color, becomes plotnoelastichesky. In development of a Quincke's edema emergence of a stenosis and asphyxia is possible.
If the person has solar urticaria, symptoms of this illness appear at him in summertime. Generally this illness is shown at women. Especially often solar small tortoiseshell accompanies liver diseases, and also arises at people who suffer from disturbances of a porphyrinic exchange and have high sensitivity to ultraviolet radiation. At the solar small tortoiseshell urtikarny rashes appear on those sites of skin which remain opened under direct sunshine. Generally in this case hands and a face suffer. Solar urticaria is a kind of a photodermatosis. If the person having this illness stays under sunshine a long time, then except rashes at it also general reaction of an organism at which cordial activity and breath is broken sometimes develops. Emergence of shock is possible.
One more kind of a disease — a cold urticaria (other name — a cold allergy). In this case damage of skin happens after long stay of the person on cold. Too large amount of cryoglobulins is the reason of rash. It the antibodies collecting in an organism.
Subdivide primary and secondary cold urticaria. The secondary form of the small tortoiseshell arises as an effect of allergic reaction to metabolism products which appear in integuments in view of influence of low temperature. Also cold urticaria arises in view of specific features of the constitution of a body.
For confirmation of the diagnosis of both a solar, and cold urticaria, from skin exposition sample is taken.
At contact urticaria which is a kind of allergic dermatitis the person has blisters at once after it had contact with certain antigens. In certain cases the organism reacts to such contact by generalized urtikarny rash.
Diagnosis of the small tortoiseshell
As a rule, it is rather simple to diagnose acute urticaria, both the allergist-immunologist, and the specialist of the general practice can make it. But in certain cases for selection of the correct therapy it is necessary to define allergen. It can be allocated by means of a number of special researches. It is possible to allocate autoantibodies by means of markers of viruses of Epstein-Barre and hepatitis B. Also sick the general and developed blood test, the analysis of urine, skin, hepatic tests is carried out. Sometimes carrying out a biopsy of skin is required.
If at the patient symptoms of system pathology take place, then he needs to carry out rheumatological tests. The matter is that urtikarny and urtikaropodobny elements can meet also at other diseases therefore careful inspection of the patient is important.
Treatment of the small tortoiseshell
There is a certain group of medicines which effectively stop allergic reaction and are applied to treatment of the small tortoiseshell. Effect of such drugs consists in release of a gistaimin who is one of direct responsible for developing of an allergy. Such drugs are included into group of antihistaminic medicines.
If at the patient the acute form of a disease which was provoked by meal or medicamentous means is shown, treatment of the small tortoiseshell in this case assumes reception of purgatives, the hyposensibilizing drugs, and also antihistaminic medicines. If very heavy attack takes place, it is stopped administration of adrenaline, corticosteroid drugs. Treatment of the small tortoiseshell at children and adults is outwardly made also by means of antipruritic means: spirit solution of menthol, calendula, salicylic acid.
To cure a chronic form of a disease, it is necessary to define an etiological factor, first of all. If allergen was found, it is necessary to carry out specific desensitization, sanitation of the centers of an infection, to get rid of helminths, to cure gastrointestinal tract diseases, etc.
If identification of allergen is impossible, the patient is treated in a hospital. To it appoint a special eliminative diet at which starvation for three-five days is shown. These days it is possible to use only water.
If at the person disturbance of a nervous system takes place, to it appoint treatment sedatives. At the same time the use of exciting products and means is forbidden.
The photodesensibilizing means (Plaquenil, Delagil) are applied to treatment of the solar small tortoiseshell.
If at the patient the Quincke's edema develops, it is necessary to define surely what allergen provoked an illness, and quickly to eliminate it. After that to the patient treatment by antihistamines is appointed.
Ointments with the content of antihistaminic drugs and glikortikosteroidny hormones, and also 3% solution of boric acid are applied to reduction of a severe itch.
At patients with a chronic recurrent form of a disease treatment of the small tortoiseshell is carried out after full and careful inspection of an organism. Perhaps, in this case, first of all, treatment of the accompanying pathologies, infectious diseases will be required. Often in this case the plasmapheresis and an enterosorbtion is applied.
Therapy of a cold urticaria assumes use of antihistaminic drugs and hemosorption.
Regardless of what clinical displays of a disease are, at treatment of the small tortoiseshell at children and adults the correct mode of rest and food is important.
There are also some folk remedies which are applied to treatment of the small tortoiseshell.
It is possible to apply previously prepared lotion from essential oils of a lavender, a camomile on affected areas of skin blue (on two drops) and essential oils of an immortelle, a peppermint (on one drop). It is necessary to put means several times a day and to hold before full absorption. Also traditional medicine recommends bathing in broth of a fresh or dry nettle, acceptance in peppermint infusion.
Prevention of the small tortoiseshell
Use of preventive measures is available if the reason of the small tortoiseshell is precisely known. So, at a cold urticaria it is necessary not to allow overcoolings, at the solar small tortoiseshell – to hide from direct beams of the sun. Also it is necessary not to allow drug intake, the uses of food causing such reactions, etc. It is impossible to warn a chronic form of an illness today.