Домой Бородавки Как выглядит папиллома новорожденных и как лечат папилломы у детей сегодня?

Как выглядит папиллома новорожденных и как лечат папилломы у детей сегодня?

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Причины папилломы у новорожденных – современное лечение папиллом грудничков

Папилломоподобные образования на коже и слизистых оболочках новорожденного встречаются у 10 детей на каждую 1000 родившихся. Их обычно связывают с вирусом папилломы семейства Papoviridae, группы Papillomavirus, или ВПЧ, который поражает от 30% до 80% населения планеты, причем примерно 30% женщин детородного возраста являются носителями этого вируса, а риск перинатального заражения только что родившихся малышей составляет 5%.

Вариабельность данных объясняется отсутствием точной статистики и недлительным пока периодом изучения ВПЧ.

Но всегда ли виноват вирус папилломы человека, и как лечат папилломы у малышей?

Как выглядят папилломы у новорожденных – виды папиллом и места их типичной локализации

Как же выглядит папиллома?

Папиллома – это доброкачественное образование на кожных покровах или слизистых оболочках, имеющее форму сосочка, мягкого бесформенного мешочка на ножке или плотной шишки.

В основном, папиллома имеет цвет той ткани, на которой она возникла, иногда может быть чуть темнее или светлее.

Папиллома может быть единичным образованием или множественным, с локализацией на любых открытых частях тела (кроме волосистой части головы) и слизистых оболочках.

Виды папиллом у новорожденных детей и места их локализации

  1. Нитевидные папилломы, или акрохорды , располагаются единично или группами на любых участках кожи, чаще всего – на щёчках, вокруг глаз и рта, на лбу, шее, веках, подмышками, в складках паховой области. Если они небольшого размера, то могут быть не замечены сразу. Это – очень тонкие и нежные образования, которые могут легко отделиться от кожи при гигиенических процедурах или трении одежды о кожу. На месте сорванной папилломы выступит кровь. Нитевидные папилломы – вид образования данной группы, который наиболее часто бывает врожденным, а не полученным в постнатальном периоде.
  2. Плоские папилломы (или в простонародье – бородавки) – плотные образования в коже, которые могут немного выступать над поверхностью, но не образуют ножку. Чаще всего плоские папилломы располагаются на лице. Они вызывают зуд и беспокоят малыша болевыми ощущениями. Кроме того, эти папилломы чаще других воспаляются, вследствие расчесывания ребенком кожи.
  3. Вульгарные папилломы чаще всего локализуются на ягодицах и ладонях. Они округлы по форме и немного возвышаются над кожей. Верхний слой папилломы – довольно плотный, похож на раневую корочку.
  4. Подошвенная папиллома , как правило, появляется у детей более старшего возраста. Отличаются от других видов образований тем, что располагаются на подошвенной поверхности стопы. Могут сливаться и занимать довольно обширные участки кожи. Довольно болезненные и очень трудно поддаются терапии.
  5. Эпителиальная гиперплазия формируется на слизистой оболочке рта, нёба, на языке и мягком нёбе. Это – одиночное или множественное сосочковое образование, которое может воспаляться, повреждаться во время приема пищи и болеть.
  6. Папилломатоз гортани – это узелковые и сосочковые образования, локализующиеся в области голосовой щели и на задней стенке гортани. Из-за постоянного раздражения дыхательных путей может вызывать их отек и быть причиной угрожающего жизни состояния.
  7. Бородавчатая дисплазия появляется преимущественно у детей с 3 лет и старше. Высыпания локализуются, в основном, на кистях рук, пальцах. Преимущественно множественные, могут сливаться в кластеры. Образования шершавые, округлые, изредка бывают пигментированными. Эти бородавки опасны, так как чаще, чем другие, со временем перерождаются в онкологические опухоли.

Причины папиллом у новорожденных детей и пути передачи инфекции – но всегда ли виновен ВПЧ?

С чем легко спутать папилломы, в том числе и у новорожденных детей?

  1. Невусы (родинки), которые часто внешне похожи на папилломы. Врожденные невусы обнаруживаются у 1% всех малышей (патология поражает исключительно представителей европеоидной расы).
  2. Контагиозный моллюск в постнатальном периоде, который иногда очень точно внешне имитирует папиллому, имея ножку или вытянутую форму. В отличие от папилломы, моллюск чрезвычайно быстро распространяется по коже и гораздо более активно передается другим при любых контактах, в том числе – бытовым путём.
  3. Меланома – врожденная, или появляющаяся в первые недели после рождения. Внешне может быть похожа на папиллому и точно так же возвышаться над поверхностью кожи или слизистых, но в подавляющем большинстве случаев меланома имеет темную пигментацию. Хотя встречаются и обесцвеченные варианты.
  4. Врожденные небольшие дефекты кожи с сосочковыми разрастаниями, которые не являются следствием инфицирования ВПЧ.

Чтобы диагностировать вышеназванные заболевания, проявляющиеся папилломоподобными образованиями, и дифференцировать их от истинной папилломы новорожденных, в каждом конкретном случае назначают необходимый комплекс обследования.

  1. Острый дефицит иммунитета.
  2. Погрешности в работе пищеварительной системы.
  3. Аллергозы.

Вирусное инфицирование ВПЧ может происходить в момент рождения ребенка или в постнатальном периоде.

Важный фактор профилактики папилломы у новорожденного — до беременности пройти обследование, и при необходимости — лечение!

Ещё совсем недавно практически единственной причиной всех папилломоподобных образований на коже у только что родившихся детей категорично считали заражение вирусом папилломы человека, которое происходит в момент движения ребенка по родовым путям матери и контакт его кожи с её слизистыми.

Однако, не так давно была установлена способность вируса проникать через плаценту во время беременности и провоцировать появление папиллом у плода – а значит, ребенок может быть атакован вирусом и внутриутробно.

В постнатальном периоде вирус может быть перенесен в организм малыша также от медицинского персонала с носительством ВПЧ, через грязные инструменты и предметы обихода – то есть, контактным путем.

Как же ВПЧ передается ребенку внутриутробно?

Очень высокая способность ВПЧ передаваться от организма к организму объясняется его очень малыми размерами – вирус может проникать даже через 3-5-ти микронные поры в презервативах (поэтому от вируса ВПЧ – увы! – может не защитить даже этот способ защиты при половом контакте).

Кроме того, существует более 100 разновидностей ВПЧ – из них одни виды более инертны в отношении заражения, другие – более агрессивны.

Установлено, что ВПЧ может «умело» маскироваться в организме и до поры до времени никак не проявлять себя в лабораторных анализах – это так называемая болезнь «непродуктивного типа».

Приходится говорить о довольно распространенных случаях нераспознанного присутствия ВПЧ в организме будущей мамы, а также консервативного лечения при положительных данных диагностики на вирус, которое не приносит ожидаемых результатов.

Поэтому, если ребенок рождается уже с дефектом кожи, вызванным именно ВПЧ, то причина этому одна: внутриутробное заражение от матери, в организме которой присутствует вирус.

О механизме внутриутробной передачи ВПЧ плоду на сегодняшний день данных нет, этот вопрос изучается.

Диагностика ВПЧ у новорожденного – как распознать инфицирование?

В случае, когда речь идет о подготовке к рождению ребенка и профифлактике ВПЧ, чрезвычайно важно специфическое обследование женщины ещё в период планирования беременности, чтобы имелось время пройти курс лечения при положительных данных диагностики.

Итак, женщине могут назначить следующие диагностические процедуры:

  1. Гинекологический осмотр с целью обнаружения внешних признаков инфицирования – бородавок, остроконечных кондилом.
  2. Цитологическое исследование мазков из влагалища и уретры может показать патологически измененные клетки, которые присутствуют в случае инфицирования ВПЧ.
  3. Мазок из влагалища для ПЦР (Полимеразная цепная реакция).
  4. Скрининговый Digene-тест — цитологическое иследование эпителиальных клеток из цервикального канала, взятых путем соскоба. Показывает, как степень концентрации вируса в организме, так и его онкогенную активность.
  5. Гистологические исследование образцов ткани, взятых путем биопсии.

В этих случаях при подозрении на присутствие ВПЧ необходим комплекс обследований из нескольких методов, а также повторные обследования через определенный промежуток времени.

Как обследуют ребенка на ВПЧ?

Папилломы в горле новорожденного

Для подтверждения присутствия вируса папилломы человека в организме новорожденного ребенка и в целях дифференциальной диагноситики иногда необходимо выполнить скрининговый ПЦР-тест.

Для подтверждения ларингеального папилломатоза могут назначить диагностическую процедуру прямой ларинготрахеоскопии.

Лечение ВПЧ и папиллом у новорожденного ребенка – нужна ли операция?

Исследование вируса папилломы человека началось не так давно, и медицина ещё не может предложить системной консервативной терапии, которая бы могла полностью устранить ВПЧ в организме.

Специфической терапии со 100%-й гарантией от ВПЧ на сегодняшний день просто нет.

Безотлагательно лечить папилломы у детей необходимо в следующих случаях:

  1. Папилломы на коже или слизистых очень быстро разрастаются, и\или изменяют цвет на красный или черный.
  2. Признаки сильной болезненности места папилломы.
  3. Отек тканей вокруг папилломы, сосудистая сеточка на коже.
  4. Папиллома расположена в местах, где наиболее высок риск её повредить – возле ануса или в кожных складках, на личике ребенка, вокруг рта и глаз, а также образования на слизистой оболочке рта.
  5. Папиллома имеет неправильную форму.
  6. Ларингеальная форма папилломатоза, когда существует угроза перекрытия дыхательных путей папилломными образованиями и отеком.

Современное лечение папилломовирусной инфекции у новорожденных детей имеет 3 основных направления:

  1. Повышение иммунитета ребенка.
  2. Противовирусная консервативная терапия.
  3. Устранение образований на коже и слизистых – папиллом, бородавок, папилломных кластеров.

При одиночных папилломах ребенку назначают консервативную терапию, включающую в себя:

При повышении иммунных реакций ребенка папилломы поддаются регрессу и часто полностью исчезают, без рецидивов в будущем.

Методы хирургического удаления папиллом у ребенка:

  1. Криоаппликация жидким азотом – безоперационный метод, основанный на деструкции патологических участков кожи. Имеет множество преимуществ перед другими, в частности – он бескровный, выполняется быстро и не оставляет шрамов на коже.
  2. Иссечение папилломы или кластера с частью прилегающих тканей выполняют классическим методом (при помощи хирургического скальпеля), или же импульсным лазером на красителе. Лазерное иссечение предпочтительнее, так как имеет хорошие результаты в плане быстрого заживления раны, меньшей кровопотери и низкой вероятности типичных постоперационных осложнений. Скальпель применяется только при необходимости забора материала для дальнейшего гистологического исследования.
  3. Радиохирургия – облучение патологических тканей высокой дозой ионизирующего излучения. В отношении папиллом у новорожденных детей этот метод практически не применяется, но радионож используется для лечения ларингеального папилломатоза.
  4. Электрокоагуляция в лечении папиллом у детей не применяется.

Нельзя также применять народные методы без рекомендации специалиста!

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