Домой Бородавки Первый подологический центр — Подошвенная бородавка

Первый подологический центр — Подошвенная бородавка

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ПОДОШВЕННАЯ БОРОДАВКА

При работе в педикюрном кабинете часто сталкиваешься со все возможными проявлениями кожных заболеваний, в том числе и инфекционных. Нередко мастера педикюра встречают на стопах клиентов образования, которые в народе называют шипигами. Так что же это такое?

Бородавки (лат. = verrucae) – это доброкачественные инфекционные новообразования вирусного происхождения на коже или слизистой. Они вызываются вирусом Human papilloma Virus (HPV), который объединяет до 100 разновидностей. Различают четыре вида бородавок: простые (verrucae vulgaris); плоские или юношеские (verruca juveniles); остроконечные (остроконечные кондиломы); подошвенные. Бородавки возникают достаточно часто, однако в большинстве случаев являются безобидными. Тем не менее, инфекционная способность вируса чрезвычайно высока. Из-за инкубационного периода от 4 недель до 18 месяцев в редких случаях удается точно определить время и место инфицирования. В большинстве случаев бородавки передаются от человека к человеку, однако существует также возможность передачи инфекции при контакте с инфицированными предметами. Вирус проникает в организм человека через мельчайшие трещины кожи. Особенно благоприятно он чувствует себя в теплой и влажной среде. Таким образом, бассейны и спортивные залы представляют собой наиболее частые места передачи инфекции HPV. Наиболее подвержены заражению лица со слабым иммунитетом, перенёсшие стресс, диабетики и пожилые люди.

Если вирус поражает подошвенную поверхность стопы, то речь идет о подошвенной бородавке (от лат. verruca plantaris). Она относится к наиболее часто встречающимся бородавкам и имеет разнообразную симптоматику. Подошвенные бородавки могут появляться как по отдельности, так и в больших количествах. Чаще всего бородавки на стопе бывают величиной с горошину и выступают над здоровой кожей на 1-3мм. Они достаточно твердые, в большинстве своем того же цвета, что и кожа, вначале имеют гладкую поверхность, которая по мере роста бородавки становится более шероховатой. Со временем поверхность бородавки меняется таким образом, что она становится похожей на потрескавшийся гиперкератоз (чрезмерное ороговение) серо-желтого или серо-черного цвета. При ближайшем рассмотрении можно нередко обнаружить вокруг многочисленные «дочерние бородавки», которые говорят о высокой инфекционной способности вируса.

Рис. 1 Типичная подошвенная бородавка в области пятки

Бородавки, образующиеся на участках, подверженных трению и сдавливанию, особенно болезненны. Расположенная вокруг кожа в большинстве случаев покрывает бородавку целиком, так что на первый взгляд можно предположить локальный гиперкератоз или даже мозоль (clavus). Характерным признаком бородавки является отсутствие кожного рисунка. Однако бородавка становится заметной лишь после того, как ороговелость снимается. Поэтому при диагностике нужно действовать с особой тщательностью. Многочисленные черно-коричневые точки или полоски, вызванные закупоркой поверхностных капилляров, нередко можно распознать сразу. Их можно удалить, но при этом они вызывают многочисленные точечные кровотечения – что является особой приметой «активности» данной бородавки. Если подошвенные бородавки появляются в большом количестве, то речь идет о «мозаичных бородавках».

Передача вируса происходит через инфицированные клетки кожи. Поэтому развитию заболевания способствуют:

  • Травмирование кожи;
  • Деформация стопы;
  • Неправильно подобранная обувь;
  • Сухость кожи;
  • Избыточное потоотделение.

Если у человека есть подошвенные бородавки, то вирус может распространяться достаточно быстро. Поэтому бородавку на стопе нужно контролировать регулярно, чтобы вовремя заметить увеличение ее размера и назначить необходимую терапию. Тем не менее, спонтанное исчезновение бородавок встречается довольно часто. Это означает, что даже без терапевтического ухода многие бородавки через несколько лет исчезают сами при условии, что они не подвергаются никакому механическому воздействию в виде трения, царапин, срезания и т.д. В случае подошвенных бородавок это маловероятно и обусловлено постоянным ношением обуви.

Особую опасность представляет инфекция HPV протекающая в латентной форме. Это значит, что вирус можно определить при помощи лабораторных методов, но на соответствующем участке кожи он визуально не обнаруживается. В этом случае внешне здоровая стопа может передавать вирус.

Лечением бородавок любого вида должен заниматься только врач или медицинская сестра под наблюдением врача.

В педикюрных кабинетах решать проблему бородавок нельзя!

Как уже упоминалось, многие бородавки исчезают сами. Но не каждый хотел бы ждать этого годами. Поэтому убедите клиента обратиться к врачу в следующих случаях:

  • Бородавки вызывают боль;
  • Бородавки с большой тенденцией к разрастанию вширь, например мозаичные бородавки;
  • Есть высокий риск аутоинфицирования, например, из-за зуда или вследствие самолечения.

Среди методов удаления бородавок различают химические, физические и общие методы поддерживающей терапии. В зависимости от глубины, болезненности и размера бородавки можно удалять различными химическими методами. При очень старых и глубоких бородавках один этот метод редко приводит к желаемому лечебному эффекту. Поэтому мастер по педикюру должен тщательно и осторожно снять перед прижиганием роговой слой, так как он препятствует воздействию веществ на подлежащую бородавочную ткань. К прижигающим средствам относят салициловую, уксусную, ретиноевую кислоты и нитрат серебра.

Рис. 2 Бородавка после прижигания нитратом серебра

Известным средством для физического удаления бородавок является криотерапия — обработка холодом. Речь идет о сжиженных газах, которые при испарении замораживают бородавку, что ведет к её разрушению. Основной принцип: чем ниже температура воздействия, тем эффективнее метод.

Преимущества криотерапии однозначны:

  • это бескровный метод;
  • процедура менее болезненна, чем обычные методы;
  • отсутствие рубцов;
  • низка вероятность рецидива;
  • целенаправленное воздействие и простота применения.

В течение нескольких дней возможно образование пузырей, которые в большинстве случаев засыхают сами. Если пузырь болезненный, подолог должен его вскрыть, обработать и закрыть перевязочным материалом, при необходимости наложить ортез.

Осторожно! Находящаяся в волдыре жидкость содержит вирус!

Немногие подошвенные бородавки исчезают после одной обработки, в большинстве случаев требуется несколько процедур. Чтобы достичь оптимального эффекта, пациент должен подойти повторно через 10-14 дней. На месте обработки неизбежно возникает гиперкератоз, поскольку данная процедура всегда вызывает раздражение, и ткань с помощью повышенного образования клеток пытается защитить себя. По окончанию сеансов криотерапии этот процесс нормализуется.

Рис. 3 Бородавка после криотерапии

Поскольку терапия подошвенных бородавок зачастую очень длительна, особое значение отводится профилактике. Значительно улучшают эффект некоторые поддерживающие терапию методы, такие как:

  • уменьшение механического раздражения бородавок (разгрузочные корректоры, ортезы, ортопедические стельки);
  • нормализация потоотделения (местные подсушивающие средства, обувь из натуральных материалов);
  • гомеопатические средства;
  • воздействие на рефлексогенные зоны;
  • улучшение кровоснабжения нижних конечностей;
  • отказ от некоторых привычек (применение ножных ванн и т.д.);
  • прием иммуностимулирующих средств;
  • в бассейнах и других местах общего пользования надо носить соответствующую обувь.

Мастер педикюра должен рассказать пациенту о личной гигиене:

  • пемзы, пилки и другие подобные инструменты совершенно непригодны для удаления бородавок и значительно увеличивают риск инфицирования;
  • полотенце для ног следует кипятить;
  • исключается хождение босиком, и даже в обуви на босу ногу;
  • запрещается после криотерапии вскрывать волдыри самостоятельно.

При работе с клиентом, имеющим подошвенные бородавки, любой мастер педикюра всегда должен чётко представлять себе, что он может сделать. Во-первых, обработать роговое образование над самой бородавкой. Во-вторых, убрать жёсткий валик, который иногда образуется вокруг бородавки, но не до конца. Все ваши манипуляции должны быть максимально точными и щадящими, чтобы не вызвать кровотечения из области бородавки. Это может повлечь за собой распространение вирусной инфекции. После этого надо обработать пораженное место маслом чайного дерева. Масло чайного дерева – универсальный антисептик с пролонгированным действием, который должен находиться на рабочем столе у каждого мастера по педикюру. Мастер может рекомендовать это средство клиенту и для домашнего ухода. А всем членам его семьи – средства, способные оказать профилактическую защиту от вирусной инфекции. Для этого оптимально подойдут профессиональные линии косметики для ног (Peclavus, Gehwol, Yards и др.)

Чем больше вы разговариваете с клиентом, тем больше он доверяет вам, чувствуя ваш профессионализм. В поддержку ваших процедур вы можете порекомендовать клиенту один из народных рецептов. Самый распространённый способ лечения бородавок: возьмите кусочек ваты размером чуть больше площади бородавки, вотрите в него «распущенное» в воде хозяйственное мыло и закрепите пластырем на бородавке. Пластырь должен быть большой, чтобы не съезжал при ходьбе. Через сутки пластырь снять — размягчённая бородавка легко отделяется от здоровой кожи. Если она достаточно велика, и полностью её удалить не удаётся, то процедуру следует повторить.

Если же случилось так, что народные средства не помогли вашему клиенту, вы как грамотный мастер можете порекомендовать медицинский центр, специализирующийся на данной проблеме.

При работе с любой инфекцией мастер должен использовать защитные средства (перчатки и маски), правильно дезинфицировать кожу до и после процедуры, провести стерилизацию инструмента и немедленную утилизацию одноразовых материалов!

Елена ПАНОВА, врач – миколог,
методист компании «Нэт Лайн ХХI век»
Екатеринбург 2005г.

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