Flebotodermiya (mosquito dermatosis) – itching parasitic , characterized by reaction sensibilized terms on a sting of a mosquito of the sort Phlebotomus. It is clinically shown by development of an inflammation within the first hour after a sting of a mosquito mosquito in the form of hyperaemia against the background of which the itching blisters are formed. Over time they turn into papules, then into dense knots, the itch becomes intolerable. Usually general state is not broken, the prodroma phenomena are sometimes possible. In hard cases arises Quincke to whom the bullous rashes which are opened with accession of a secondary infection precede swelled. Etiotropny therapy does not exist, use hormones and antihistamines.
Flebotodermiya – rare tropical inflammatory character, developing sharply as a result of a sting of a mosquito of the sort Phlebotomus. Pathological process is characterized by an endemichnost, arises in the Middle East, in the countries of Central Asia where climate hot and damp that is a necessary condition for Flebotomus's activity. The disease has no age, gender, racial, seasonal distinctions. As the exception to the rules, a flebotodermiya can sometimes come to light in a different climate as mosquitoes are capable to survive also in more severe conditions, than tropical countries. In this case seasonal aestivo-autumnal surges in incidence will be characteristic of pathology. The first description of entomoz in dermatology belongs to the beginning of the 15th century. The most dangerous complication of a flebotodermiya – Quincke swelled 150 years ago the author whose name is born by this syndrome described. Relevance of a problem at the present stage is connected with this syndrome.
Pathological process arises only at a sting of a female of Phlebotomus which is going to lay eggs. Flebotodermiya malaria, helminthic invasions, promote. The mechanism of development of pathology, in fact, is the answer of skin to toxins of saliva of a mosquito mosquito which for many is allergen and causes toksiko-allergic reactions in an organism. Feature of such manifestations of immediate type in this case is lack of any signs of damage of skin after the first sting. Only the repeated contact with saliva causes visual damage of skin with development of a flebotodermiya.
At a sting of a female saliva anti-gene partially gets to blood, partially to skin where damages corpulent cages – the specialized immune educations of connecting fabric disseminated in a term, but concentrating about blood and lymphatic vessels. Because of toxic effect of saliva their permeability increases by a vascular wall of capillaries, toxins from a blood-groove also get in a term. Corpulent cages take part in adaptive reactions of immune system, possibly lack of the response of skin to the first contact with saliva is connected with it. During the second contact the visual symptomatology of a flebotodermiya develops: from corpulent cages the histamine and prostaglandins are released, intercellular substance terms changes. Mediators of an inflammation provoke an inflammation and allergic reaction an anti-gene antibody, support the immune attack of T-lymphocytes on the alien anti-gen.
In parallel at development of a flebotodermiya in a term there is a stimulation of proliferative processes caused by effect of pathogenic toxin, directed to restoration of integrity of skin. Mitotic activity of cells of epidermis is activated, papules are formed. Surplus of a free histamine impregnates collagenic fibers, causing their swelling that is shown by developing of local or widespread hypostasis terms depending on a condition of protective forces of an organism, conditions of the endocrine system accompanying pathology. If it is only about toxic option of a flebotodermiya, then saliva of mosquitoes stimulates development of IgE which degranulates corpulent cages, stimulates development of eosinophils which directly attack an alien anti-gene, causing an inflammation and the related proliferation of cells of epidermis. However synchronization of pathological process and emergence of primary elements in the places located far from the place of a sting speak about development and in this option of a sensitization of an organism the corpulent cages which are initially damaged by toxins.
Classification of a flebotodermiya
The modern dermatology subdivides pathological process on the nature of its emergence and a current into three forms:
- The sharp form of a flebotodermiya arising within the first minutes after a sting, which is followed by manifest symptomatology.
- The chronic form of a flebotodermiya which is developing for several hours, and sometimes days after a sting, characterized by the erased clinical manifestations.
- The mixed flebotodermiya form arising no later than an hour after a sting developing slowly possessing a long current with tendency to polymorphism and resistance to the carried-out therapy.
Symptoms and diagnostics of a flebotodermiya
Emergence of blisters or papules with a diameter up to 1 cm of light pink color with a nacreous shade and dot hemorrhage in the center becomes primary clinical display of a disease. Elements arise against the background of an edematous eritema. Localization – the place of penetration of mosquito saliva in a term. Rashes are followed by a severe itch, burning of skin. Sharply arisen rash independently is allowed in 2-5 days, late reaction to a sting has most expressed stability. Process extends to open sites of skin. If danger of stings is constant, then with each new attack of a papule are condensed, transformed to knots, the itch becomes persuasive and continuous. The general health at a flebotodermiya is not broken, temperature increase, weakness is possible.
Very seldom the flebotodermiya at allergic persons is complicated by development of hypostasis of Quincke when instead of blisters and papules on skin sharply pour out bulls of the size of pigeon egg and an inflammatory nimbus on the periphery. Bulls tend to distribution, are opened, erozirutsya, become covered by crusts, will join them secondary, most often a piokokkovy infection. Swelled accrues, mucous are involved in process, language grows dumb, arise tachycardia, nausea, vomiting, the patient needs hospitalization. At the same time bubbles can self-resolve within a week. If the mosquito which bit the patient is a carrier of a leyshmanioz and other parasitic or viral infections, there is a development not only flebotodermiya, but also the accompanying pathology.
The clinical diagnosis is made by the dermatologist. The flebotodermiya does not cause big difficulties as the anamnesis confirming the sting fact with a mosquito mosquito, and clinical manifestations are sufficient for its statement. At a flebotodermiya it is accepted to carry out a clinical minimum of inspection, in difficult cases use results of histology ( the top layer of epidermis, , lymphocytic infiltration terms, the phenomena of an acute inflammation, dystrophic changes in collagenic and elastichesky fibers with dystrophy of nervous bunches). Differentiate a flebotodermiya with knotty pochesukhy, dermatitis of Dyuringa, stings of other insects and arthropods, a small tortoiseshell, .
Treatment and prevention of a flebotodermiya
Etiotropny therapy does not exist. Dermatologists if necessary (taking into account self-permission of a flebotodermiya) stop the developed symptoms. Apply antihistamines, vitamins, corticosteroids, protivozudny medicines. Sometimes in treatment of a flebotodermiya use an autogemoterapiya. At complications appoint antibiotics. Sea, hydrosulphuric, radonic bathtubs, bathtubs with starch and needles give good effect. The ointments with Naftalan and tar containing sulfur and hormones are outwardly shown. From physiotherapeutic procedures at a flebotodermiya heliotherapy and applications of ozokerite are applied. In cases, resistant to therapy, connect cryomassage and laser therapy. Single knots elektrokoagulirut, carry out injection destruction methylene blue in novocaine.
To patients recommend to exclude contact with possible mosquito threat: to use anti-mosquito grids of the house and at the dacha, to outdoors apply repellents and the clothes which are most covering an integument. Perhaps preventive destruction of mosquitoes chemicals. The forecast at a flebotodermiya favorable.