Домой Бородавки Подошвенная бородавка у ребенка: лечение, причины возникновения, фото

Подошвенная бородавка у ребенка: лечение, причины возникновения, фото

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Подошвенная бородавка у ребенка

Подошвенная бородавка у ребенка относится к доброкачественным пролиферативным патологиям кожи и имеет инфекционное происхождение. Особенности заболевания:

  1. Чаще подошвенные бородавки возникает у детей старше 10 лет, но появление возможно и в другие возрастные периоды.
  2. Основной путь передачи – контактно-бытовой (бассейн, спортзал). До 80 % всех случаев связаны с микротравмированием кожи стоп.
  3. Корреляционной зависимости между мальчиками и девочками нет.
  4. В связи с особенностями работы иммунной системы у детей старше 10 лет болезнь носит преимущественно бессимптомный характер (до 50-60% всех случаев). Однако у детей до 10 лет в связи с несовершенством иммунного ответа болезнь проявляется типичными клиническими признаками.
  5. Характерен длительный латентный период болезни. Проявление, как правило, сопряжено с угнетением иммунитета (например, после перенесенной вирусной или бактериальной инфекции).
  6. Подошвенные образования отличаются медленным ростом и низким риском перерождения в злокачественные формы.

Дети значительно лучше реагируют на терапию и имеют меньшую вероятность рецидивов, чем взрослые население. При возникновении образования показана консультация дерматовенеролога и онколога (для исключения ряда образований доброкачественной и злокачественной природы, имеющих схожие кожные проявления).

Причины

Главным этиологическим фактором возникновения бородавок является вирус папилломы человека (ВПЧ). Особенности возбудителя:

  • ДНК-содержащий вирус семейства папававирусов (Papavaviridae);
  • поражает базальный слой кожи и вызывает пролиферацию клеток в нем;
  • существует около 100 различных генотипов, но наиболее актуальные это alрhapapillomavirus 2,16, 18, 27 57 (преимущественно поражает слизистые оболочки и имеет высокий канцерогенный риск); beta papillomavirus и gammapapillomavirus 1, 2, 4 (преимущественно вызывает образования на коже стоп и ладоней).
  1. Возрастные особенности работы иммунной системы. У детей до 5 лет клеточный и гуморальный иммунитет несовершенен, и по этой причине не всегда возникает адекватный ответ на действие того или иного возбудителя. В эту же группу попадают ВИЧ-экспонированные дети (рожденные от ВИЧ-инфицированной матери и имеющие высокий риск инфицирования при прохождении через родовые пути).
  2. Вирусные и бактериальные заболевания (ОРИ, грипп). Данные патологии не приводят к непосредственному возникновению бородавок, но при частом их возникновении (более 5-7 раз в год) значительно ослабевает иммунная система.
  3. Травматические повреждения кожных покровов (ссадины, царапины). В этом случае заражение происходит через поврежденный эпидермис. Данный фактор реализуется только в совокупности с ослабленным иммунитетом.
  4. Инфекционные и неинфекционные патологии кожи и слизистых оболочек. Различные заболевания создают благоприятные условия для травматизации, что приводит к нарушению барьерных и защитных функций кожи.
  5. Нарушения в работе эндокринной системы (сахарный диабет I типа, гормональная перестройка в подростком возрасте) приводит к нарушению обменных и метаболических процессов во всем организме, в том числе и на уровне кожи. Это приводит к нарушению ряда функций кожных покровов, в том числе защитной.
  6. Неправильно подобранная обувь вызывает постоянное раздражение кожи стоп и ее инфицирование.
  7. Несоблюдение стандартных правил личной и общественной гигиены.

Помимо всего прочего, имеет значение воздействие вредных факторов внешней среды (например, чрезмерная инсоляция или переохлаждение).

Симптомы

На фото внешний вид подошвенной бородавки имеет следующие особенности:

  1. Плотные округлые образования, выступающие над поверхностью окружающей кожи и имеющие четкие границы. Могут быть как одиночными, так и множественными. Редко происходит слияние образований с возникновением так называемой мозаичной бородавки.
  2. Цвет очага не отличается от окружающей кожи.
  3. Образования болезненны при пальпации или надавливании во время ходьбы. Боль возникает не сразу, а по мере прогрессирования заболевания и увеличения объема пораженной области из-за вовлечения нервных окончаний.
  4. Поверхность образования неровная, зернистая, покрытая гиперкератотическими наслоениями. Кожный рисунок над данной областью отсутствует.
  5. Иногда в центре нароста можно заметить черно-коричневую точку, которая возникла в результате тромбирования капилляров поверхностной сосудистой сети. На начальных этапах отсутствует.
  6. Появляются в местах максимального давления (пятка). Может возникнуть на соприкасающихся поверхностях пальцев («целующиеся» бородавки).

Гистологические особенности подошвенные бородавок:

  • атипичное разрастание многослойного плоского эпителия;
  • на поверхности клеток гипер- и паракератические наслоения;
  • вовлечение глубоких слоев дермы;
  • эозинофильные цитоплазматические включения в клетках.

При постановке диагноза проводится тщательная дифференциальная диагностика с болезнью Рейтера, базалиомой и ладонно-подошвенными сифилидами ввиду схожести их гистологического строения.

Лечение

Лечение подошвенной бородавки у ребенка стоит начинать с консервативных, а в случае необходимости подключать и хирургические методы воздействия.

Местное химическое воздействие

Методы основаны на мумификации образования и постепенном его отмирании с образованием раны, которая закрывается первичным натяжением за 2 недели. Быстро вылечивает практически любой вид бородавок, однако неприменимы к образованиям диаметром более 5 см.

1. На нарост воздействуют 1,5% раствором цинка хлорпропионата в 50% 2-хлорпропионовой кислоте. Проводится процедура с соблюдением всех правил асептики и антисептики (обработка пораженно участка проводится только в процедурном кабинете). Раствор точечно наносится на пораженный участок. Индикатором правильного нанесения служит незначительное изменение цвета бородавки на серовато-белый. Более четким показателем служит зона инфильтрации, которая возникает через 5-10 мин после нескольких аппликаций препарата. Для получения должного результата требуется до 3 обработок в течение 15-20 дней. Во время курса процедур требуется ограничить нагрузку на конечность. Не допускается самостоятельно обрабатывать пораженный участок растворами антисептиков.

2. Бородавку обрабатывают комбинацией азотной, уксусной, щавелевой, молочной кислот и тригидрата нитрата меди. После процедуры показан контроль через 3-5 дней. Избавиться от нароста удается в 90% случаев без риска рецидивирования.

Местное физическое воздействие

Позволяет убрать бородавки у детей любого возраста.

1. Электрокоагуляция. Послойное точечное выжигание образования при помощи электрического тока. Выполняется под местной инфильтрационной анестезией 2% лидокаином.

2. Криодеструкция. Воздействие на очаг сверхнизких температур. Проводится при помощи жидкого азота или закиси азота. Одно из веществ при помощи специальных инструментов прикладывают к очагу на 1-5 мин. Для подошвы может использоваться несколько повторных курсов лечения через 5-7 дней из-за плотной грубой кожи.

3. Лазерная деструкция. Удалять очаг на ступне требуется послойно при помощи концентрированного луча света. Световодом в непрерывном режиме воздействуют на очаг от 2-5 секунд до 2-3 минут в зависимости от размера. После требуется очистить зону марлевой салфеткой, смоченной в спиртовом растворе. На протяжении периода заживления рекомендована обработка очага растворами антисептиков вплоть до отторжения струпа и полного заживления раны. Провидится под местной анестезией.

4. Радиохирургическая деструкция. Метод основан на воздействии электромагнитной волны на зону поражения. При этом возникает интенсивное разогревание тканей нароста и рассечение без непосредственного прижигания и коагуляции. Выполняется под местной инфильтрационной анестезией 2% лидокаином.

Воздействие препаратами местного действия

1. Мазь Виферон. Имеет иммуностимулирующий и противовоспалительный эффект. Действие направлено на торможение репликации вируса в клетках и прекращение интенсивного роста бородавки. Наносить 3-4 раза в день на протяжении 2-3 недель.

2. Панавир. Выпускается в форме геля, имеет противовирусное действие. Применять 2-3 раза в день на протяжении 7-10 дней.

3. Суперчистотел. Препарат, содержащий гидроокись калия и натрия, имеет действие, схожее с кислотами (прижигает очаг). Применяется 1-2 раза в день на протяжении 5 дней.

Терапия направлена на укрепления иммунной системы и снижения риска рецидивов. Группы лекарственных средств:

· системные и местные ретиноиды (Изотретиноин);

· модуляторы иммунного ответа (Интерферон, Изопринозин).

Интерферон. Для подошвенных бородавок доза препарата составляет от 1,5 до 3 млн МЕ внутримышечно или подкожно на протяжении 4 недель.

Изопринозин. Воздействует на клеточный иммунитет. Назначается по 2 таблетки 3 раза в день в сочетании с местной терапией. Курс в среднем длится 28 дней.

Гепон. Вызывает активизацию работы макрофагов и стимулирует выработку цитокинов, имеет выраженную противовирусную активность (тормозит репликацию вируса). Системно используется в дозировке по 10 мг перорально 1 раз в день или по 0,02-0,04% раствора для местной обработки кожи 1 раз в день.

Лечить требуется с учетом площади очагов поражения. Все препараты детям назначаются только врачом, лечение проводится под его контролем.

Методы народной медицины

В дополнение к основному лечению в неосложненных случаях допускается прибегнуть к народным средствам для удаления новообразований. Попытаться вывести подошвенную бородавку в домашних условиях можно следующими средствами:

  1. Чеснок. 3-4 зубчика растереть их до состояния кашицы. Прикладывать по пораженной области 2-3 раза в день в виде компрессов на 15-20 мин.
  2. Картофель. Очистить картофелину и натереть на мелкой терке. Полученную смесь отжать и соком обрабатывать бородавку 5-6 раз в день на протяжении 14 дней.
  3. Чистотел. Надавить на стебель свежесорванного растения до выделения сока. Обрабатывать бородавку 4-6 раз в день на протяжении 1 месяца.
  4. Календула. Растереть 2-3 цветка растения и зафиксировать к бородавке на 1-2 часа. Курс лечения 1-2 месяца.
  5. Лук. Мелко покрошить одну небольшую луковицу, замотать в марлю и прикладывать в виде компресса на 10-20 мин к бородавке. Курс лечения 10-20 дней.

Также применяются внутрь различные настойки и отвары из лекарственных растений (ромашка, календула, алтей, тархун), которые способствуют укреплению иммунитета.

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