Домой Бородавки Бородавки у детей — лечение, удаление на руках, на ногах, на лице

Бородавки у детей — лечение, удаление на руках, на ногах, на лице

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Бородавки у детей

Бородавки у детей – часто встречающееся дерматологическое заболевание преимущественно вирусной этиологии, которое характеризуется возникновением на кожных покровах небольших новообразований округлой формы. Бородавки у детей склонны к распространению, быстрому росту и рецидивированию. При попытках самолечения могут становиться болезненными, на месте новообразования могут появляться шрамы и рубцы.

Заболевание регистрируется во всех возрастных группах, однако наиболее часто диагностируется в детском и подростковом возрасте. Примерно в 25% всех случаев бородавки у детей самопроизвольно исчезают на протяжении полугода, а у 75% пациентов самостоятельное разрешение бородавок происходит в течение двух лет.

Причины и факторы риска

Возбудителем бородавок у детей является вирус папилломы человека, который чрезвычайно широко распространен (по некоторым данным, им инфицировано до 90% всех людей) и способен поражать как кожные покровы, так и слизистые оболочки, провоцируя развитие кожных новообразований – папиллом, кондилом, бородавок (разные штаммы вируса вызывают определенные виды поражений). Инфицирование вирусом происходит чаще всего вследствие контакта с зараженным человеком, также нередко дети заражаются через контаминированные предметы быта (игрушки, одежду, предметы общего пользования). Встречается и аутоинокуляция, то есть самозаражение вирусом, что может наблюдаться, к примеру, при привычке покусывать пальцы или грызть ногти. Помимо этого, заражение вирусом папилломы человека может происходить при прохождении ребенка по родовым путям.

Вирусы папилломы человека относятся к семейству папилломавирусов, в которое входят 27 видов и более 170 штаммов (типов). Вирион не имеет оболочки, его размер составляет 50–55 нм. Вирус размножается в ядрах клеток хозяина. Типы и подтипы вируса папилломы человека определяются по степени гомологичности полинуклеотидной последовательности, при этом ДНК каждого типа гомологична ДНК других вирусов данного класса не менее чем на 50%. Более 40 типов вируса папилломы человека способны вызывать развитие бородавок у детей.

К факторам риска развития заболевания относятся иммунодефицитные состояния, психическое перенапряжение, недостаточно тщательное соблюдение правил личной гигиены, повышенная потливость кожи кистей и стоп. В группе риска находятся дети, которые посещают бассейны, детские спортивные клубы, бани, дошкольные учреждения.

Формы заболевания

Бородавки у детей бывают следующих форм:

  • обыкновенные (простые, вульгарные) – преобладают в общей структуре бородавок, именно они наиболее часто встречаются у детей и подростков;
  • подошвенные бородавки;
  • плоские (юношеские, ювенильные) – встречаются, как правило, у детей старше 10 лет;
  • остроконечные бородавки (кондиломы) – в детском возрасте встречаются редко;
  • папилломатоз гортани – еще одна редкая форма бородавочного поражения, характеризующаяся разрастанием бородавок (папиллом) на слизистой оболочке гортани.

Симптомы

Инкубационный период при инфицировании вирусом папилломы человека составляет от одного до пяти месяцев, однако даже по прошествии этого периода у ребенка может не возникать каких бы то ни было клинических проявлений патологического процесса (бессимптомное вирусоносительство).

Клиническая картина бородавок у детей зависит от формы заболевания.

Бородавки у детей склонны к распространению, быстрому росту и рецидивированию.

Обыкновенные бородавки

Самые частые, обыкновенные бородавки представляют собой небольшие (диаметром 3–10 мм) плотные невоспаленные шершавые на ощупь новообразования, которые, если только не травмированы, являются безболезненными. Мелкие новообразования имеют цвет кожных покровов, бородавки более крупных размеров могут принимать грязно-серый оттенок. Иногда новообразования сливаются между собой, образуя бляшки. Простые бородавки располагаются на ладонях, пальцах рук, тыльной стороне ладони, в более редких случаях – на лице, слизистых оболочках. Редкая подногтевая форма обыкновенных бородавок у ребенка на руках может вызывать деформацию ногтей.

Плоские бородавки

В отличие от обыкновенных бородавок, плоские менее заметны на кожных покровах и представляют собой небольшие (0,5–3 мм) округлые новообразования с гладкой поверхностью. Обычно плоские бородавки у детей располагаются на кожных покровах лица, шеи, груди, тыльной стороны ладони, сгибательных поверхностей предплечий, ног. Часто плоские бородавки множественные, сгруппированные, могут поражать обширные участки кожи, но никогда не сливаются между собой.

Подошвенные бородавки

Подошвенные бородавки у детей имеют вид округлых гиперкератотических образований на подошвах, могут быть единичными или множественными, имеют желтовато-коричневый цвет, возвышаются над кожей, напоминая мозоль. На поверхности подошвенных бородавок виден темный рисунок тромбированных капилляров. Бородавка на ноге у ребенка легко травмируется (при трении, давлении обуви), в этом случае становится болезненной, может кровоточить.

Осложнения бородавок у детей встречаются только при их частом травмировании. Это могут быть кровотечения, болезненность, присоединение вторичной бактериальной или грибковой инфекции с развитием воспалительного процесса.

Остроконечные бородавки (кондиломы)

Остроконечные бородавки у детей локализуются в носогубных складках, имеют дольчатое строение и гладкую поверхность бело-розового или ярко-красного цвета, а также сужение у основания. При травмировании остроконечные бородавки на лице у ребенка легко кровоточат, вокруг новообразования кожные покровы вокруг становятся гиперемированными. Остроконечные бородавки склонны к образованию обширных конгломератов.

Папилломатоз гортани

Папилломатоз гортани встречается редко и, как правило, диагностируется у детей дошкольного возраста (возрастная группа от полутора до пяти лет). Часто появлению папилломатоза гортани предшествует ОРЗ. Новообразования могут быть единичными или многочисленными, в тяжелых случаях способны приводить к развитию угрожающей жизни ребенка обструкции дыхательных путей. Основным симптомом служит охриплость голоса, которая с течением времени усиливается и может переходить в афонию. Позже, по мере разрастания бородавок, присоединяются нарушения дыхания.

Диагностика

В большинстве случаев для диагностики бородавок у детей достаточно осмотра.

В случае необходимости идентификацию возбудителя производят при исследовании соскоба с пораженного участка методом полимеразной цепной реакции. Тип вируса определяют при помощи метода молекулярной гибридизации нуклеиновых кислот.

При развитии стойких или атипичных форм бородавок может потребоваться биопсия с последующим гистологическим исследованием полученного материала.

Для диагностики папилломатоза гортани прибегают к прямой (у дошкольников) или непрямой ларингоскопии.

Дифференциальную диагностику проводят с потертостями и мозолями, красным плоским лишаем, бородавчатым туберкулезом кожи, подошвенными папулами при сифилисе.

Лечение бородавок у детей

В большинстве случаев неосложненные формы простых бородавок специального лечения не требуют, оправдана выжидательная тактика. У ¼ пациентов происходит саморазрешение вульгарных бородавок на протяжении одного месяца, у остальных – в период от трех месяцев до полутора лет. Юношеские бородавки также проходят самостоятельно после завершения гормональной перестройки организма. После выздоровления на пораженном участке не остается никаких следов.

Примерно в 25% всех случаев бородавки у детей самопроизвольно исчезают на протяжении полугода, а у 75% пациентов самостоятельное разрешение бородавок происходит в течение двух лет.

Лечения требуют бородавки часто травмируемые, а также те, которые не склонны к самоизлечению.

В некоторых случаях применяется метод удаления бородавок у детей при помощи кератолитических средств в форме мази или пластыря.

Метод электрокоагуляции заключается в воздействии электрическим током на новообразование, что приводит к коагуляции тканей. Электрокоагуляция проводится под местной анестезией при помощи хирургического коагулятора. Метод позволяет избежать кровотечения и распространения инфекции. На месте удаленной бородавки остается корочка, которая отпадает на протяжении недели. При удалении методом электрокоагуляции бородавки большого размера на ее месте может остаться небольшой рубец. Электрокоагуляция не подходит для удаления крупных бородавок.

Криотерапия заключается в воздействии на новообразование жидким азотом. Время воздействия зависит от размера новообразования. Обычно требуется несколько сеансов криодеструкции с 3-5-дневными интервалами между ними. Удаление бородавок у детей методом криодеструкции имеет преимуществом безболезненность, отсутствие рубцов после проведенного лечения.

Лазерная терапия применяется для лечения у детей бородавок, которые плохо поддаются другим методам. Процедура проводится под местной анестезией и заключается в послойном удалении бородавки. Преимуществом лазерной терапии является отсутствие рубцов и пигментации кожных покровов после проведенного лечения, а также низкая вероятность рецидивов. На месте удаленного новообразования остается углубление, которое затягивается на протяжении 1,5–2 недель.

При невозможности удалить бородавку у ребенка другими методами проводят хирургическую резекцию. Хирургическое лечение бородавок у детей требует местной анестезии. Основа бородавки может разрушаться при помощи криохирургических методик или электроиглы. Внутрикожные косметические швы, которые накладываются при помощи атравматической иглы, снимают через 7–10 дней после операции, впоследствии на этом месте остается небольшой светлый рубец.

Проведение гистологического лабораторного исследования удаленного материала проводится в обязательном порядке.

В ряде случаев, особенно при частых рецидивах или обширной зоне поражения, а также при папилломатозе гортани, оперативное вмешательство сочетают с противовирусной терапией.

Для предотвращения распространения патологического процесса на непораженные участки кожных покровов применяются противовирусные препараты местного действия.

Рецидивы бородавок у детей наблюдаются примерно в 25% случаев.

Возможные осложнения и последствия

Осложнения бородавок у детей встречаются только при их частом травмировании. Это могут быть кровотечения, болезненность, присоединение вторичной бактериальной или грибковой инфекции с развитием воспалительного процесса, в редких случаях возможно злокачественное перерождение.

Прогноз

Прогноз благоприятный, в подавляющем большинстве случаев бородавок у детей происходит их саморазрешение.

Профилактика

Первичная профилактика заболевания заключается в предупреждении инфицирования вирусом папилломы человека.

В целях профилактики бородавок у детей рекомендуется:

  • обработка антисептиками ран и порезов на коже;
  • соблюдение правил личной гигиены;
  • укрепление иммунитета (рациональное питание, избегание психического перенапряжения и т. д.);
  • использование собственной обуви в местах общественного пользования;
  • избегание ношения синтетической обуви.

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