Clinical symptoms in dermatovenerology. Stationary stage of psoriasis

Psoriatic triad

Application: for the diagnosis of psoriasis and differential diagnosis of similar diseases.

When psoriatic papules (plaques) are scraped with a glass slide, a consistent triad of pathognomonic morphological signs is noted: “stearin spot phenomenon” - the appearance of a large number of silver-white scales. This is reminiscent of the scales that appear when a drop of a stearin candle is scraped; “terminal film phenomenon” - after complete removal of the scales, a shiny translucent film appears; “the phenomenon of pinpoint bleeding or blood dew” (Polotebnov’s or Auspitz’s symptom) - with further scraping of the film, droplets of blood appear on its surface due to the destruction of the capillaries of the papillary dermis.

With parapsoriasis, the following phenomena are observed:

Symptom of a “wafer” - when you carefully scrape the papule, the scales covering it are removed entirely, without breaking or forming small chips, as with psoriasis.

Symptom of purpura or Broca's symptom - after removal of the “wafer”, with continued scraping, small intradermal hemorrhages appear on the surface of the papule, which do not disappear with diascopy.

“Apple jelly” symptom and Pospelov’s sign

Application: for the diagnosis of lupoid tuberculosis of the skin.

Apple jelly symptom

When pressing with a glass slide on the surface of the tuberculous tubercle, the color of the tubercle changes. At the same time, under the pressure of the slide, the dilated vessels of the tubercle collapse, and the bloodless yellowish-brown color of the infiltrate, like the color of apple jelly, clearly appears.

Pospelov's or "probe" sign

Allows to identify a pathognomonic diagnostic sign for tuberculous lupus. With light pressure on the surface of the tubercle with a button-shaped probe, it easily sinks into the depths of the tissue (Pospelov's symptom). For comparison, when pressing on healthy skin nearby, the resulting pit is restored faster than on a tubercle.

Nikolsky's symptom P.V. and Asbo-Hansen

Application: for the diagnosis of acantholytic pemphigus and the differential diagnosis of bullous dermatoses.

When you pull a piece of the bladder cover with tweezers, the upper layers of the epidermis are detached in the form of a gradually narrowing band on apparently healthy skin.
Friction with a finger (sliding pressure) on apparently healthy skin, both between the blisters and at a distance, also quite easily causes rejection (shifting) of the upper layers of the epidermis.

Note: this symptom also occurs in other skin diseases in which there is acantholysis (chronic benign familial pemphigus, etc.), but it is caused only in the lesion (Nikolsky’s regional symptom according to N.D. Sheklakov, 1967).

A variant of this symptom is the phenomenon of an increase in the area of the bladder when pressure is applied to its central part, described in true pemphigus by G. Asboe-Hansen.

Tzanck cell research

Application: for the diagnosis of pemphigus vulgaris and differential diagnosis of bullous dermatoses.

For monomorphic rashes of blisters on the skin and erosions on the oral mucosa of unknown origin, the fingerprint smear method is used for the possible detection of acantholytic cells (Pavlova-Tzanck) found in pemphigus vulgaris. Acantholytic cells (Tzanck cells), used as a diagnostic test, should be considered a cytological feature of true pemphigus. Acantholytic cells are characteristic of pemphigus, but can also be detected in other diseases (herpes, chicken pox, bullous form of Darier's disease, chronic benign familial pemphigus, etc.).

Detection technique: A piece of sterile student gum (but you can also firmly attach a fat-free glass slide to the surface of the erosion) is pressed firmly to the bottom of the fresh erosion and transferred to the slide. Usually several prints are made on 3-5 glasses. They are then air-dried, fixed and stained using the Romanowsky-Giemsa method (like regular blood smears). Acantholytic cells are smaller in size than ordinary cells, have a very large nucleus of intense purple or violet-blue color, occupying almost the entire cell. It contains two or more light nucleoli. The cytoplasm of the cells is strongly basophilic, around the nucleus it is light blue, and along the periphery it is blue or dark purple (“rim of concentration”). Often a cell has several nuclei. The polymorphism of cells and nuclei is sharply expressed. Acantholytic cells may be single or multiple. Sometimes there are so-called “monstrous cells”, characterized by their gigantic size, abundance of nuclei and bizarre shapes. At the beginning of the disease, acantholytic cells are not found in every preparation or are not detected at all; at the height of the disease there are many of them and “monstrous” cells appear.

Jadasson's test

Application: for the diagnosis of Dühring's dermatitis herpetiformis and the differential diagnosis of bullous dermatoses.

Potassium iodide test (Jadassohn test) in two modifications: cutaneous and orally. On 1 cm2 of apparently healthy skin, preferably the forearm, an ointment with 50% potassium iodide is applied under a compress for 24 hours. The test is considered positive if erythema, vesicles or papules appear at the site of application. If the test is negative, it is repeated after 48 hours: now the ointment is applied to the pigmented area of the skin at the site of the former rash.

If the result is negative, 2-3 tablespoons are prescribed orally. 3-5% potassium iodide solution. The test is considered positive when signs of exacerbation of the disease appear.

Method for detecting scabies mites

Application: for diagnosing scabies.

A drop of 40% lactic acid is applied to the scabies element (tract, vesicle, etc.). After 5 mcn, the loosened epidermis is scraped off with a sharp eye spoon until capillary bleeding appears, slightly including the adjacent healthy skin. The resulting material is transferred to a glass slide in a drop of lactic acid, covered with a coverslip and immediately examined under a low magnification microscope. The result is considered positive if a mite, eggs, larvae, empty egg membranes, or at least one of these elements is detected in the preparation.

Examination of scales, hair, nails for pathogenic fungi

Application: for the diagnosis of dermatomycosis and differential diagnosis of similar diseases.

To test for pathogenic fungi, scrapings are taken with a scalpel from the affected areas of the skin, mainly from their peripheral part, where there are more fungal elements. In case of dyshidrotic rashes, the covers of vesicles or blisters and scraps of macerated epidermis are taken with tweezers or cut off with pliers. Hair from the peripheral part of infiltrative-suppurative conglomerates or follicular nodular elements is also taken using a scalpel and tweezers. The changed areas of the nail plates, together with subungual detritus, are cut off with pliers.

For rapid diagnosis (within 1-30 minutes) of mycoses, quickly clearing compounds are used. Thus, skin scrapings after treatment with a 10% solution of sodium disulfide in ethanol in a ratio of 3:1 can be microscoped after 1 minute, nail sections - after 5-10 minutes.

Balser test(iodine test)

Application: for the diagnosis of pityriasis versicolor and differential diagnosis of similar diseases.

When the affected areas and surrounding normal skin are lubricated with 3-5% tincture of iodine or a solution of aniline dyes, the lesions are colored more intensely. This is due to the greater absorption of the dye due to the loosening of the stratum corneum of the epidermis by fungi.

Symptom Unny-Darye

Application: for diagnosis of mastocytosis (urticaria pigmentosa).

When you rub the spots or papules of mastocytosis with a finger or a spatula for 15-20 seconds, they become swollen, rise above the surrounding skin, and their color becomes brighter. These phenomena are associated with the release of histamine from mast cell granules.

Allergy skin testing

Application: for the diagnosis of allergic dermatoses.

Most allergy tests are based on reproducing an allergic reaction in a patient through exposure to the minimum amount of allergen required for this. Most often these reactions are carried out on the patient's skin. First, a drop or epidermal skin test with small dilutions of the drug is used. If the droplet or epidermal test is negative, a scratch test is performed. If the result of the scarification test is negative, patch or intradermal tests are performed. It is not recommended to do skin testing while taking multiple medications at the same time. All tests, except for the provocative one, must be performed with a control, which is provided by solvents. Skin tests are contraindicated in the acute period of the disease, with severe concomitant diseases of internal organs, the nervous system, pregnancy, thyrotoxicosis, and the patient’s advanced age.

Drip: A drop of the test solution is applied to the skin (abdomen, inner surface of the forearm, back) for 20 minutes, and the sample area is outlined with ink. The result is taken into account after 20 minutes, 24-72 hours.
Appliqué(compress, patchwork): pieces of gauze (4-6 layers) measuring 1.5/1.5 or 2.0/2.0 cm, moistened with the test solution, are applied to the skin (abdomen, inner surface of the forearm, back), covered with compress paper, strengthened with adhesive plaster or bandage. The result is taken into account after 24-72 hours.
Scarification: A drop of the test substance is applied to the skin (abdomen, inner surface of the forearm, back) pre-treated with alcohol, through which scratches are made with a sterile needle or scarifier without the appearance of blood. The reaction is read after 10-20 minutes and 24-48 hours.
Intradermal: in the area of the skin of the flexor surface of the forearm, 0.1 ml of the test solution is injected strictly intradermally with a tuberculin syringe. The reaction is taken into account after 20 minutes and 24-48 hours.
Provocative: 1/4 of a single therapeutic dose of the test drug is given to the oral cavity, and the tablet or solution must be kept without swallowing. Reads in 10-20 minutes.

If an allergic reaction begins (swelling, itching, burning, rash), spit out the drug and rinse the mouth.

Accounting for allergic reactions.

1. Immediate (after 20 minutes):

negative - with a blister diameter of 6-7 mm;
weakly positive - with a blister diameter of 7-10 mm;
positive - when the blister diameter is over 10 mm.

2. Delayed (after 24-48 hours):

negative - papule 3 mm or erythema less than 10 mm in diameter;
weakly positive - papule 3-5 mm or erythema with edema 10-15 mm;
positive - papule more than 5 mm or erythema with edema more than 15-20 mm in diameter.

Skin biopsy

Application: for the diagnosis of dermatoses.

The choice of biopsy site is important. A small morphological element can be taken as a whole. Cavity elements should be taken as fresh as possible; in case of lymphomas and granulomatous changes, the old element is taken, all others are biopsied at the height of development. Eccentrically growing elements and lesions are biopsied in the marginal zone. In the presence of several lesions that differ clinically, when the diagnosis depends on the result of histological examination, it is advisable to sample from several places. The biopsy should always include subcutaneous fat.

Local anesthesia is carried out with a 0.5% solution of novocaine with the addition of a 0.1% solution of adrenaline (30:1). Subject to the rules of asepsis and antiseptics, a deep excision of the desired area is performed with a scalpel, capturing all layers of the skin. The wound is closed with 1-2 stitches, which are removed after 7-10 days.

The cheapest and most long-term way to fix (for months) the taken material is to immerse it in a 10% aqueous solution of formaldehyde (1 part of a 40% formaldehyde solution and 9 parts of distilled water).

Note: the biopsy is performed with the patient’s consent, which is noted in the medical history.

Shoe disinfection technique

Use a cotton swab moistened with a 25% formaldehyde solution (1 part formaldehyde and 3 parts water) or 40% acetic acid solution to wipe the insole and inner surface of the shoe. Then the shoes are placed in plastic bags for 2 hours. After airing for at least a day, the shoes can be put on. Stockings, socks, and underwear are disinfected by boiling for 10 minutes.

Application: for the diagnosis of lupoid tuberculosis of the skin

Apple jelly symptom

When pressing with a glass slide on the surface of the tuberculosis tubercle, the color of the tubercle changes. At the same time, under the pressure of the slide, the dilated vessels of the tubercle collapse, and the bloodless yellowish-brown color of the infiltrate, like the color of apple jelly, clearly appears.

Pospelov's or "probe" sign

Allows to identify a pathognomonic diagnostic sign for tuberculous lupus. With light pressure on the surface of the tubercle with a button-shaped probe, it easily sinks into the depths of the tissue (Pospelov's symptom). For comparison: when pressing on healthy skin nearby, the resulting pit is restored faster than on a tubercle.

Symptom of Nikolsky P.V. and Asbo-Hansen

Application: for the diagnosis of acantholytic pemphigus and the differential diagnosis of bullous dermatoses.

1. When you pull a piece of the bladder cover with tweezers, the upper layers of the epidermis are detached in the form of a gradually narrowing band on apparently healthy skin.

2. Friction with a finger (sliding pressure) on apparently healthy skin, both between blisters and at a distance, also quite easily causes rejection (shifting) of the upper layers of the epidermis.

Note. This symptom also occurs in other skin diseases in which there is acantholysis (chronic benign familial pemphigus, etc.), but it is caused only in the lesion (Nikolsky’s regional symptom according to N.D. Sheklakov, 1967).

A variant of this symptom is the phenomenon of an increase in the area of the bladder when pressure is applied to its central part, described in true pemphigus by G. Asbo-Hansen.

Tzanck cell research

Application: for the diagnosis of pemphigus vulgaris and differential diagnosis of bullous dermatoses.

acantholytic cells (Tzanck cells), used as a diagnostic test. Acantholytic cells are characteristic of pemphigus, but can also be detected in other diseases (herpes, chicken pox, bullous form of Darier's disease, chronic benign familial pemphigus, etc.).

Detection technique: a piece of sterile student gum (but you can also firmly attach a fat-free glass slide to the surface of the erosion) is pressed firmly to the bottom of the fresh erosion and transferred to the slide. Usually several prints are made on 3-5 glasses. They are then air-dried, fixed and stained using the Romanowsky-Giemsa method (like regular blood smears). Acantholytic cells are smaller in size than ordinary cells, have a very large nucleus of intense purple or violet-blue color, occupying almost the entire cell. It contains two or more light nucleoli. The cytoplasm of the cells is sharply basophilic, around the nucleus it is light blue, and along the periphery it is blue or dark purple (“rim of concentration”). Often a cell has several nuclei. The polymorphism of cells and nuclei is sharply expressed. Acantholytic cells may be single or multiple. Sometimes there are so-called “monstrous cells”, characterized by their gigantic size, abundance of nuclei, and bizarre shapes. At the beginning of the disease, acantholytic cells are not found in every preparation or are not detected at all; at the height of the disease there are many of them and “monstrous” cells appear.

Jadasson's test

Application: for the diagnosis of Dühring's dermatitis herpetiformis and differential diagnosis of bullous dermatoses.

If the result is negative, 2-3 tbsp are prescribed orally. spoons of 3-5% potassium iodide solution. The test is considered positive when signs of exacerbation of the disease appear.

Method for detecting scabies mites

Application: for diagnosing scabies.

A drop of 40% lactic acid is applied to the scabies element (tract, vesicle, etc.). After 5 minutes, the loosened epidermis is scraped off with a sharp eye spoon until capillary bleeding appears, slightly including the adjacent healthy skin. The resulting material is transferred to a glass slide in a drop of lactic acid, covered with a coverslip and immediately examined under a low magnification microscope. The result is considered positive if a mite is detected in the preparation,

eggs, larvae, empty egg shells, or at least one of these elements.

Examination of scales, hair, nails for pathogenic fungi

Application: for the diagnosis of dermatomycosis and differential diagnosis of similar diseases.

For rapid diagnosis (within 1-30 minutes) of mycoses, quickly clearing compounds are used. Thus, scrapings from the skin, after treatment with a 10% solution of sodium disulfide in ethanol in a ratio of 3:1, the material can be microscoped after 1 minute, sections of nails - after 5 - 10 minutes.

Balzer test (iodine test)

Application: for the diagnosis of pityriasis versicolor and differential diagnosis of similar diseases.

When the affected areas and surrounding normal skin are lubricated with a 3-5% iodine solution or a solution of aniline dyes, the lesions are colored more intensely. This is due to the greater absorption of the dye due to the loosening of the stratum corneum of the epidermis by fungi.

Prescriptions of the most common dosage forms in dermatology

Directions for dermatological powders:

Recipes for solutions used for lotions:

Alcohol solutions:

Recipes for shaken mixtures:

Aerosol prescriptions:

Paste recipes:

Zinc paste Rp: Zinci oxydi Talci _ seu Amyli tritici aa 10.0 Vaselini 20.0 M.f. pasta D.S. External. Apply a thin layer twice a day.	Naftalan paste Rp: Naphtha-Naphthalani Zinci oxydi Talci _ Vaselini aa 10.0 M.f. pasta D.S. External. Apply a thin layer twice a day.
Rp: Acidi salicylici 1.0 Zinci oxydi _ Amyli tritici aa 12.5 Vaselini ad 50.0 M.f. pasta D.S. External. (Lassara paste)	Rp: Novocaini Anaesthesini _ Dimedroli aa 0.7 Pastae Zinci 30.0 M.f. pasta D.S. External. Apply a thin layer twice a day.
Rp: Papaverini cetateoride 1.0 Pastae Zinci ad 50.0 M.f. pasta D.S. External. Apply a thin layer twice a day.	Rp: Sol. Tocopheroli cetate. Ol. 5% 1.0 Pastae Zinci ad 50.0 M.f. pasta D.S. External. Apply a thin layer twice a day.
Rp: Zinci oxydi _ Talci aa 7.5 Lanolini _ Vaselini aa ad 40.0 M.f. pasta D.S. External. Soft zinc paste	Rp: Zinci oxydi _ Talci aa 12.5 Lanolini _ Vaselini aa ad 40.0 M.f. pasta D.S. External ( Thick zinc paste)
Rp: Ol. Rusci 1.0-1.5 Naphtha-Naphthalani 5.0 Tincturae Vallerianae _ Tincturae Convalaria Najlis aa 7.5 Pastae Zinci ad 50.0 M.f. pasta D.S. External. Apply a thin layer 2 times a day.	Rp: Naphtha-Naphthalani 5.0 Ichthyoli 10.0 Pastae Zinci ad 50.0 M.f. pasta D.S. External. Apply a thin layer 2 r. in a day.
Rp: Liq. ACD 3 fp. 2.5-5.0 Pastae Zinci ad 50.0 M.f. pasta D.S. External. Apply a thin layer 2 times a day.

Ointment prescriptions:

Rp: Ung. Ung. Heparini 25.0 DS. External. Rub in the ointment 2-3 times a day.	Rp: Ung. Linaetholi 5% 100.0 D.S. External. Rub in the ointment once a day.
Rp: Ung. Ichthyoli 10-20% 25.0 D.S. External. Ointment	Rp: Ung. Acidi borici 25.0 D.S. External. Ointment
Rp: Ung.Acidi salicylici 2-3% 25.0 D.S. External. Rub in the ointment once a day.	Rp: Papaverini hydrochl. 1.0 Ung. Solidoli 50.0 M.D.S. External.

Rp: Sulfuri depurati 3.5-5.0 Ac. borici Zinci oxydi _ Magnesii oxydi aa 5.0 Glycerini 10.0 Axungiae porcinae depur. ad100.0 M.D.S. External.	Rp: Ol. Rusci 1.0-1.5 Naphtha-Naphthalani 10.0-15.0 Tincturae Vallerianae _ Tincturae Convalaria Majalis aa 10.0 Lanolini _ Vaselini aa 100.0 M.D.S. External.
Rp: Sulfuri dep. 3.0 Ichthyoli 10.0 Unq. Solidoli ad 100.0 M.D.S. External.	Rp: Liq. Burowi 12.0 Lanolini anhydrici Zinci oxydi _ Talcii aa 20.0 Ac. borici 1.0 Axungiae porcinae depur. ad 100.0 M.D.S. External

Cream recipes:

Antifungal ointments:

Rp. Ung. Lamisil 1 pack. D.S. External

Rp. Ung. Clotrimazoli 1 pack. D.S. External

Rp. Ung. Fungoterbini 1 pack. D.S. External

Corticosteroid ointments:

Main literature:

1.Skin and venereal diseases (edited by O.L.Ivanov)., M., - “Shiko”, - 2002. - 476 p.

2. Skin and venereal diseases (edited by Yu.K. Skripkin). M., “Medicine.” - 1995, 2000.

3. Atlas “Skin and venereal diseases”, ed. V.V.Vladimirova.- M..1986.

Additional literature:

Dermatology on the Internet: www. drskin.pccenter.ru/resource.htm

Dermatology at the health terminal: mednet.narod.ru/derm.htm

Dermatology, venereology on List.ru (www.list.ru/catalog/11618.sort3.html)

Yellow-brown coloration of tubercles in the skin, revealed by diascopy; a sign of lupus vulgaris or leishmaniasis.

- . A dessert dish made from fruit or berry juices and sugar, prepared using any gelling agent...
Culinary dictionary
- . A dessert dish made from fruit or berry juices and sugar, prepared using any gelling agent...
Great Encyclopedia of Culinary Art by Pokhlebkin
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- syrup from fruits or fruits, to which gelatin or fish glue is added, and when cooled, the whole mass takes on a gelatinous appearance. Gelatin is also prepared by boiling gelatin from veal legs and heads...
Encyclopedic Dictionary of Brockhaus and Euphron
- a dessert dish prepared from fruit and berry juices, as well as wine, milk and other products by boiling with sugar with the addition of small amounts of substances that impart liquid after it has cooled...
Great Soviet Encyclopedia
- by/l I/block...
Together. Apart. Hyphenated. Dictionary-reference book
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Etymological Dictionary of the Russian Language
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Dahl's Explanatory Dictionary
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Ozhegov's Explanatory Dictionary
- p"ol "apple pie"...
Russian spelling dictionary

"apple jelly phenomenon" in books

author

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January 14. Bolotov phenomenon No. 7. Shift phenomenon

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This information is intended for healthcare and pharmaceutical professionals. Patients should not use this information as medical advice or recommendations.

Main clinical diagnostic symptoms in dermatology

Kirchenko Alina
Intern doctor, Kharkov, [email protected]

Atopic dermatitis

The symptom of “winter foot” is hyperemia and moderate infiltration of the soles, peeling, cracks.

Morgan's sign (Denier-Morgan, Denier-Morgan folds) - deep wrinkles on the lower eyelids in children.

The symptom of “polished nails” is the disappearance of longitudinal striations and the characteristic appearance of the nail, due to constant scratching of the skin.

The symptom of a “fur hat” is dystrophy of the hair in the occipital region.

Pseudo Hertog's symptom is a temporary loss of hair, first in the outer third, and then in other areas of the eyebrows in some patients.

Vasculitis

The Marshall-White sign (Beer's spots) is an early sign, pale and cold to the touch spots of angiospastic nature on the skin of the hands.

Mycosis fungoides

Pospelov's symptom (third) is a sensation of cardboard density upon palpation of skin lesions in the 2nd stage of mycosis.

Dyskeratoses

The symptom of a “hairy tongue” - papules on the mucous membrane of the tongue - is a possible sign of Darier disease.

Pospelov's symptom (second) - a sensation of scratching when passing paper over the lesions - spinous, follicular keratosis.

Ichthyosis

The Kuklin-Suvorova symptom is “lacquered” fingertips caused by an abnormality of keratinization of the skin – lamellar ichthyosis.

lupus erythematosus

Sipm. Besnier-Meshchersky - pain when separating and scraping the scales in the foci of discoid lupus erythematosus.

Meshchersky's symptom (“broken heel”) - when grotting (scraping) foci of lupus erythematosus - pain and difficulty in removing scales, on the inside of which horny spines are revealed.

Sipm. vascular pneumonia (Ro-signs in SLE) – the presence of basal discoid atelectasis against the background of an enhanced and deformed pulmonary pattern + high position of the diaphragm.

Khachaturian's sign (possible sign) - pinpoint depressions with follicular keratosis in the area of the external auditory canal.

Lichen planus

Beignet's symptom is pain when papules are grotted.

Kreibach's symptom (isomorphic Kerner reaction) - when the skin is damaged or irritated, fresh rashes appear at the site of injury.

Pospelov-Neumann sign – whitish papules on the mucous membrane of the inner surface of the cheeks.

Wickham's sign (Wickham's grid) - on the surface of the papules, when they are smeared with oil, a visible grid of intersecting lines forms on the surface of the papules.

Leprosy

The symptom of “inflammation and swelling of spots” (Pavlov’s symptom) is irritation (swelling, increase in volume) of lesions after intravenous administration of nicotinic acid.

Leprosy symptoms

A reactive state of acute or subacute hypersensitivity that occurs both during active hyperinfection and during a specific infection - as a type - “leprosy face”.

Parapsoriasis

Bernhardt's symptom (the "white stripe" phenomenon) - appears on the skin in the form of a white stripe, 3-6 mm wide, in patients after using a spatula or hammer.

Symptom of “wafer” (Pospelov phenomenon, Brocca phenomenon) - dense dry scales in the form of a wafer or colloidal film on papules, or pearly color of papules after applying a compress - guttate parapsoriasis.

Symptom of purpura (Brocca-Ivanova) - pinpoint hemorrhages during grottage, not hidden by scales, hidden peeling is revealed.

Psoriasis

Symptom of a “stearic spot” - when psoriatic rashes are grotted, the surface of the rash elements becomes intensely white, stearic scales separate.

Symptom of “psoriatic film” (“terminal film”) – when scales are removed from psoriatic papules, a shiny red surface appears due to acanthosis.

Auspitz's symptom (the "blood dew" phenomenon, the phenomenon of pinpoint bleeding) - with the grottage of psoriatic rashes, after the phenomenon of "stearin spot" and "terminal film", pinpoint bleeding appears.

Progressive stage of psoriasis

Pilnov's sign (Pilnov's rim) is a red rim of hyperemia along the periphery of psoriatic papules that are not covered with scales in these lesions.

Koebner's symptom is an isomorphic reaction when the skin is damaged or irritated; fresh rashes appear at the site of injury.

Stationary stage of psoriasis

Kartomyshev's symptom - upon palpation - a sensation of clear boundaries along the periphery of psoriatic plaques on the scalp, in contrast to foci of seborrheic dermatitis, the delimitation of which from damaged skin is not determined by palpation.

Regression stage

Voronov's symptom (pseudoatrophic rim) - around psoriatic papules there is a shiny, light ring of slightly wrinkled skin.

Pemphigus

Azboe-Hansen's symptom - a type of Nikolsky's symptom for pemphigus: the spread of the bubble when pressure is applied to its tire.

Direct Nikolsky's symptom - with intense, sliding, rubbing movement near the bladder, a slight detachment of the epidermis is noted.

Indirect Nikolsky's Symptom is a slight rejection of the epidermis when the bladder cover is pulled.

Sheklov's symptom ("Pear" symptom) - the fluid of an unopened bladder flows down under the influence of its own gravity, while the bubble itself takes on the shape of a pear - pemphigus vulgaris.

Tinea versicolor

Balser's symptom is a diagnostic test consisting of more intense staining of lesions when smeared with iodine.

Beignet's symptom ("Shavings" symptom) is the peeling of layers of loosened epidermis when the lesions are grotted.

Scleroderma

Giford's sign is the inability to evert the eyelid.

The “pouch-purse” symptom is fan-shaped linear scars near the mouth, it is impossible to open the mouth wide.

The “honeycomb” symptom (Ro-sign) is a 2-sided strengthening and deformation of the pulmonary pattern with a fine-mesh structure.

Toxicoderma

Burton's symptom - a gray border on the gums of the lower incisors - lead intoxication.

Tuberculous lupus

Simt. Pospelov (first, “probe” symptom) – failure of the probe when pressing on the lupomas.

The symptom of “apple jelly” is a light brown or brown coloration of the tubercle during diascopy.

Scabies

Ardi's symptom is the predominance of single purulent crusts in the area of one of the elbows or a few pastulae around the elbow joints.

Bazin's symptom (Bazin's mite elevations) is a small vesicle with a black dot (female mite) at the end of the scabies tract.

Sézary's sign - the scabies tract rises slightly upon palpation

Symptom of probe failure (button probe)

The tubercles in tuberculous lupus, due to the destruction of elastic and collagen fibers in them, acquire a doughy, soft consistency. Taking this feature into account, A.I. Pospelov (1886) proposed a symptom of probe failure: when lightly pressing on the tubercle with a button-shaped probe, an impression remains on the surface of the tubercle, which very slowly disappears. This phenomenon can be compared with the picture observed when pressing a finger on yeast dough.

If you press the probe a little harder on the tubercle, it seems to fall into the depths of the lupoma, and light bleeding and minor pain appear. The symptom is more pronounced with fresh lupoma.

Apple jelly symptom .

Diagnostic technique for tuberculous lupus. When you press firmly on the lupoma with a transparent spatula or glass slide, blood is squeezed out from the dilated vessels of the tubercle and a brownish-yellow color appears, reminiscent of the color of apple jelly. Sometimes you can notice the translucency of the tubercle.

This symptom can be positive, but less pronounced in the tuberculoid form of cutaneous leishmaniasis.

18. Determination of psoriatic phenomena (stearic stain, psoriatic film, blood dew)

Diagnostic triad for psoriasis

An almost constant symptom in the progressive and stationary (less often) stages of psoriasis. When psoriatic elements (papules, plaques) are scraped, the peeling increases and the scales take on a white color, resembling a drop of ground stearin ( “stearin stain” phenomenon). With further scraping to the granular layer of the epidermis, the scales are removed and a pink wet film is exposed ( the phenomenon of “terminal”, or “psoriatic”, films). As scraping continues (up to the papillary layer of the dermis), tiny droplets of blood appear on the surface of the film. Their number depends on the number of capillaries entering the papillae damaged during scraping - the phenomenon of “point bleeding”, or "blood dew".

Scraping is done either with a glass slide or with the blunt side of a scalpel. After scraping with a nail, it is necessary to carefully treat the skin of the hands to avoid infection (psoriasiform papular syphilide).

19. Obtaining a Wickham mesh for lichen planus

Fine meshwork on the surface of the papules; a symptom of lichen planus, especially its usual variety. The papule or plaque is lubricated with some liquid oil (vaseline, sunflower, etc.). At the same time, whitish-opaline dots and intersecting lines in the form of a grid are clearly visible on the surface of the element. This phenomenon is explained by the uneven thickening of the granular layer of the epidermis (granulosis), typical of this disease.

For genital, warty, pigmented, atrophic and other forms of lichen planus, the test is less indicative.

20. Methodology for taking material for preparation of preparations in conducting a study for the detection of treponema pallidum

Microscopic examination of Treponema pallidum in a dark field of view

Material for research is taken from an element suspected of primary or secondary syphiloma (erosion, ulcer, eroded papule), or by puncture of a lymph node.

The element is cleaned with a sterile cotton swab, after which its surface is lightly scraped with a burner heated in a flame and a cooled loop until tissue fluid is obtained. The latter is placed on a clean, grease-free glass slide with a drop of isotonic sodium chloride solution and covered with a thin coverslip.

If it is impossible to obtain tissue fluid using this method, then with a rubber-gloved hand, squeeze the syphiloma from the edges until tissue fluid appears on its surface.

The amount of tissue fluid and isotonic sodium chloride solution should be small, since with a large drop the treponema will float in the liquid, which makes them difficult to detect.

For research in a dark field of view, special devices are used for a conventional microscope. Having passed through these devices (condensers), the light rays take an oblique direction and are concentrated at an acute angle in the place of the studied drop of serrum, without entering the lens, thereby achieving research in a dark field. For this technique, you can use a circle of thick black paper (photo paper envelope) with a diameter of 1.5 cm, which is placed on the lower lens of the unscrewed condenser so that a free rim (clearance) 1.5-2 mm wide remains between the edges of the lenses and the paper.

Lighting when examining in a dark field of view should be quite intense (electric lamp 100-150 W).

Examine the specimen with objective no. 40 and eyepiece no. 10-15. In this case, against a dark background one can see a large number of luminous moving points (protein and colloidal particles), as well as cellular elements that are difficult to differentiate, which, however, is not part of the purpose of the study. Treponema pallidum has the appearance of light, corkscrew-shaped threads moving smoothly or pendulum-like. It can be confused with Treponema crassus, which is often found on the genitals, but the latter is thicker than Treponema pallidum, has wider curls and moves faster.

This method is simple and, perhaps, the most reliable. Treponema pallidum is examined in a living state, which makes it possible to differentiate it from other types of spirochetes.