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Äåìîäåêîç (demodicosis)
Î÷åíü âàæíûé è ñïîðíûé âîïðîñ â äåðìàòîëîãèè ñâÿçàí ñ îáíàðóæåíèåì êëåùà äåìîäåêñà íà êîæå ëèöà, âåê, à òàêæå ïîêà åùå ñ íåîïðåäåë¸ííîé åãî ðîëüþ â âîçíèêíîâåíèè êàêîãî-ëèáî ïàòîëîãè÷åñêîãî ïðîöåññà.
Äåìîäåêîç(demodicosis)- îáùåå ñîñòîÿíèå(äàæå ñ òî÷êè çðåíèÿ êëèíè÷åñêîé òåðìèíîëîãèè ëàòèíñêîãî ÿçûêà), îáîçíà÷àþùåå îáíàðóæåíèå íà êîæå ÷åëîâåêà êëåùà Demodex (folliculorum èëè Demodex brevis). Äàííîå ñîñòîÿíèå(äåìîäåêîç, äåìîäèêîç)- íåëüçÿ íàçâàòü ïàòîëîãèåé, òàê êàê äî ñèõ ïîð íè â îäíîì èññëåäîâàíèè íå îïðåäåëåíà ðîëü ýòîãî êëåùà â ïàòîãåíåçå çàáîëåâàíèÿ.  îñíîâíîì â ñîâðåìåííîé ìåäèöèíå èññëåäîâàíèÿ ñâîäÿòñÿ ê êîëè÷åñòâåííîé îöåíêå îáíàðóæåíèÿ ýòîãî êëåùà íà êîæå çäîðîâûõ ëþäåé è ëþäåé ñ ðàçëè÷íûìè ïîðàæåíèÿìè êîæè, âîëîñÿíûõ ôîëëèêóëîâ è ñëèçèñòûõ (ðîçàöåà, áëåôàðèòû, ôîëëèêóëèòû è äð.). Íàëè÷èå íà êîæå ó çäîðîâûõ ëþäåé áåç êàêèõ ëèáî èçìåíåíèé êîæè êëåùà Demodex íå ïîçâîëÿåò îäíîçíà÷íî óñòàíîâèòü åãî êàê ïåðâîïðè÷èíó êàêîãî-ëèáî çàáîëåâàíèÿ. Îäíàêî èìååò çíà÷åíèå òîò ôàêò, ÷òî âñå-òàêè ó ïàöèåíòîâ ñ òàêèìè çàáîëåâàíèÿìè êàê áëåôàðèò, ðîçàöåà, ïàðàçèòàðíûé ôîëëèêóëèò îí îáíàðóæèâàåòñÿ ñ äîñòîâåðíî áîëüøåé ÷àñòîòîé, ÷åì íà íåèçìåíåííîé êîæå ëèöà, ÷òî ïîçâîëÿåò èñïîëüçîâàòü â ëå÷åíèè(êîìáèíèðîâàííî ñ äðóãèìè ñðåäñòâàìè) ïðåïàðàòû ïðîòèâ êëåùà. Ìîæíî ñäåëàòü âûâîä, ÷òî ó÷èòûâàòü åãî îáíàðóæåíèå ìîæíî è èñïîëüçîâàòü ñîîòâåòñòâóþùåå ëå÷åíèå(îñîáåííî ðåêîìåíäóåòñÿ ïðè áëåôàðèòàõ-âîñïàëèòåëüíûõ èçìåíåíèÿõ âåê), íî òîëüêî â ñëó÷àå åãî îáíàðóæåíèÿ è èñêëþ÷åíèÿ äðóãèõ ïàòîëîãèé. Íåîáõîäèìî ó÷èòûâàòü è äðóãèå ñîñòàâëÿþùèå ïàòîãåíåçà òàêèõ çàáîëåâàíèé êàê ðîçàöåà, ôîëëèêóëèòû è ò.ä., ïðè êîòîðûõ ýòîò êëåù íåðåäêî îáíàðóæèâàåòñÿ è íå ñòîèò íåîáîñíîâàííî âûäåëÿòü â ñàìîñòîÿòåëüíîå çàáîëåâàíèå(äåìîäåêîç), ïðè êîòîðîì Demodex ÿâëÿåòñÿ ýòèîëîãè÷åñêèì ôàêòîðîì. - "Association of rosacea with demodicosis." [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] "CONCLUSION: This study suggests that Demodex mites may play a role in pathogenesis of rosacea but it is not clear whether rosacea merely provides a suitable environment for multiplication of mites, or whether the mites play a role in the pathological changes." - "Azelaic Acid in the Treatment of Papulopustular Rosacea" [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] "The cause of rosacea is poorly understood, although numerous theories have been offered. Hypotheses have included gastrointestinal, psychological, infectious, climatic, and immunological causes, although scientific evidence has not substantiated any of these as primary.4 Prevalent current theories involve Demodex folliculorum. This organism feeds on sebum, and increased numbers of mites have been found on patients with rosacea.5 Infection with Helicobacter pylori has also been proposed, and some reports show improvement of rosacea symptoms after eradication of this bacteria.6 Climate, specifically exposure to extremes of sun and cold, may also affect the course of the disease, but the role is not clear. " Áëåôàðèò òàêæå ìîæåò áûòü âûçâàí è äðóãèìè ôàêòîðàìè äàæå ïðè îáíàðóæåíèè êëåùà â ñîñêîáàõ(îáÿçàòåëüíî ýòî ó÷èòûâàòü è ïðîâîäèòü äèôôåðåíöèàëüíóþ äèàãíîñòèêó):-ðîçàöåà, âèðóñ ãåðïåñà(Herpes simplex dermatitis ), îïîÿñûâàþùèé ëèøàé(Varicella-zoster dermatitis),êîíòàãèîçíûé ìîëëþñê(Molluscum contagiosum), àëëåðãè÷åñêèé èëè ðàçäðàæèòåëüíûé êîíòàêòíûé äåðìàòèò(Allergic or irritant contact dermatitis), ñåáîðåéíûé äåðìàòèò (Seborrheic dermatitis ), ïèîäåðìèÿ(Staphylococcal dermatitis ); õðîíè÷åñêèé áëåôàðèò ìîæåò áûòü ñâÿçàí ñ âîçäåéñòâèåì õèìè÷åñêèõ âåùåñòâ, êóðåíèåì è äð. ðàçäðàæèòåëÿìè, àëëåðãè÷åñêîé ðåàêöèåé íà ëåêàðñòâà è äð. àëëåðãåíû. - "Comparison of incidence of Demodex folliculorum on the eyelash follicule in normal people and blepharitis patients." [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] "The incidence of Demodex folliculorum was high in patients with blepharitis compared with normal controls. Incidence was high in males. Anti-Demodex treatment is indicated when the parasite is found." - Demodicosis [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] - Blepharitis, Adult [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] - Rosacea [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] - "Frequency of the appearance of Demodex sp. in various patient and age groups" [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] "Demodex folliculorum and Demodex brevis are acari that can be found in hair follicles and sebaceous glands of the skin, especially on face of humans. In this study, Demodex sp was investigated in regard to allergic diseases, age and gender. A total of 197 patients (117 with rosacea, 29 with akne vulgaris, and 51 with allergic diseases) were examined using the standardized skin surface biopsy (SSSB) and 97 out of 197 (49.23%) cases were found to be positive by the Inonu University Medical Faculty Department of Parasitology. There was no significant difference between mite positivity and negativity between the genders, while a higher rate of Demodex sp. was found in patients with rosacea and a lower rate in patients under 20 years old (p0,005). As a result, patients over 20 years old, especially those with rosacea, must be investigated for Demodex sp." |