Бородавка
Бородавка — преимущественно доброкачественное новообразование кожи, зачастую вирусной этиологии, имеющее вид узелка или сосочка. Вызывается разными вирусами папилломатоза человека. Передача возбудителя осуществляется при контакте с больным, через предметы, которыми он пользовался. Предрасполагающими к возникновению бородавок факторами являются психическая травма, снижение иммунологической активности, вегетоневроз, акроцианоз, а также повышенная потливость кожи кистей и подошв.
Содержание
Виды бородавок
Различают следующие виды бородавок: обыкновенные, плоские, остроконечные кондиломы и старческие. Обыкновенные, плоские бородавки и остроконечные кондиломы вызываются общим для них вирусом. Инкубационный период — 2-5 мес.
Обыкновенные (вульгарные) бородавки — плотные сухие ограниченные безболезненные ороговевшие возвышения с неровной ворсинчатой поверхностью, величиной от булавочной головки до горошины. Могут сливаться, образуя большие бляшки. Наиболее часто располагаются на кистях рук.
Разновидность обыкновенных бородавок — подошвенные бородавки — появляются в местах давления обуви, особенно у сильно потеющих. Очень плотные, ороговевшие, серо-грязного цвета подошвенные бородавки отличаются сильной болезненностью, препятствующей ходьбе; иногда вызывают временную потерю трудоспособности.
Плоские, или юношеские бородавки возникают обычно у детей и молодых людей. Имеют вид округлых или неправильной формы плоских узелков, которые располагаются на тыльной поверхности кистей рук, а также на коже лица. Появлению плоских бородавок способствует раздражение кожи (возникают нередко по ходу царапин, порезов и т. п.). Образование плоских бородавок на теле связано с инфицированием папилломавирусом (ВПЧ), а именно его четырнадцатым, пятнадцатым и двадцать седьмым штаммами.
Остроконечные кондиломы — мельчайшие розового цвета узелки, которые, сливаясь, образуют вегетирующие разрастания мягкой консистенции на основании в виде тонкой ножки. Локализуются преимущественно на половых органах, в паховых и межъягодичной складках, в перианальной области. Передача инфекции происходит половым путем, дети могут инфицироваться в родах, при контакте с зараженными родовыми путями. Особую опасность представляют ВПЧ высокоонкогенных подтипов, что связано с риском развития рака шейки матки.
Поскольку бородавки могут иметь сходство с некоторыми другими новообразованиями кожи, имеющими иногда неблагоприятное течение, при появлении бородавки необходима консультация врача-дерматолога.
Медикаментозные методы
Идеализированное лечение вирус-индуцированных бородавок включает применение противовирусных препаратов или иммунизацию против вируса. Однако для плоских бородавок это не всегда приемлемо.
Применяется иммунотерапия — инъекции антигенов candida или trichophytin USP, либо современные варианты — применение низкомолекулярных производных имиквидазохинолинамина, которые являются индуктором цитокинов, в частности, интерферона.
Хирургические методы
Обыкновенные, старческие и плоские бородавки разрушают замораживанием жидким азотом, хлорэтаном, диметиловым эфиром, смесью диметилэфира и пропана или «сухим льдом», электрокоагуляцией (радиоволновой хирургией).
Остроконечные кондиломы лечат хирургически. Подошвенные бородавки иногда уничтожают многократным введением под основание раствора новокаина, как противовоспалительное средство.
Народная медицина
Существует миф об эффективности терапии бородавок с помощью клейкой ленты. Исследование, проведенное в 2002 году доктором Дином Фохтом (Dean R. Focht III) [2] показало относительное преимущество данного метода перед криотерапией: 80% пациентов успешно вывели бородавки (против 60% использовавших процедуру с жидким азотом). Метод состоит в том, что пациенты заклеивают бородавки клейкой лентой и ждут шесть дней, после чего несильно скоблят бородавку пемзой. Затем, через 12 часов, снова заклеивают ее лентой, повторяя цикл в течение двух месяцев.
Исследование неоднократно подвергалось критике, так как проводилось с нарушением этических принципов (отсутствие контрольной группы, сбор информации по телефону, наблюдение в течение короткого промежутка времени). Повторные исследования не смогли подтвердить эффективность данного метода [3] [4] , что объясняет его действенность эффектом плацебо.
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