Method for individual prediction of deterioration probability of clinical course of eczema, progression into erythroderma

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to dermatology. To predict the deterioration probability of the clinical course of eczema, the progression into erythroderma, an integrated assessment of a pathoigenetic significance of the detected risk factors is made. What is determined is a prognostic coefficient (PC) for such criteria, as: sex; age; petrochemical workers; agricultural workers; construction workers; drivers; office staff; hyper insolation; adverse agricultural labour conditions (pesticide and fertiliser contact); petroleum contact; construction material contact; drug abuse; pockets of chronic bacterial and/or mycotic infections; frequent acute respiratory viral infections; chronic gastrointestinal and/or hepatic diseases; chronic respiratory infections; chronic otorhinolaryngological organs; disturbed liver detoxification; liver metabolic disturbance; immunoregulatory index decrease; stimulation index decrease; cytotoxic index decrease; circulating immune complex increase; average immunoglobulin increase; blood skin antigen; antitissue autoantibody increase; leukocyte migration inhibition index increase. If a factor is absent, the related PC is considered to be zero. The derived PCs are summed up. The PC value is 2.64 to 10.23 enables predicting the low deterioration probability of the clinical course of eczema and the favourable prognosis of the disease implying no progression of the local form of the disease into the disseminated form. The derived PC falling within the range of 10.24 to 30.24 shows the medium deterioration probability of the clinical course of eczema and the possible progression of the local form of the disease into the disseminated form, with the relatively favourable prognosis with no developing erythroderma. The derived total PC within the range of 30.25 to 50.25 and higher provides the high deterioration probability of the clinical course of the disease, and the unfavourable prognosis, and the potential progression into erythroderma.

EFFECT: method enables predicting the deterioration probability of the clinical course of eczema, the progression into erythroderma.

5 ex, 4 tbl

The invention relates to medicine, namely to dermatology, and can be used to predict the likelihood of clinical deterioration of eczema, crossing her erythroderma, obtaining justification of the choice of tactics and observation of patients for targeted prevention unfavorable course of the disease.

There is a method of predicting deterioration in the clinical course of chronic dermatitis, including eczema, by exploring the role of bacterial-fungal infections in the pathogenesis of skin diseases [Kotrehova L.P., Piotrovskaya IV the Role of bacterial-fungal infections in the pathogenesis of skin diseases and their treatment//Clinical dermatology and venereology, 2011, No. 3, S. 38-44]. The authors believe that the risk factors for clinical deterioration of eczema is the presence of endocrine diseases (diabetes, obesity, hypothyroidism), diseases of the cardiovascular system, the presence of metabolic syndrome, immunodeficiency States. By sex and age, the authors of the differences identified. Surveying 2562 patients with chronic dermatoses, with clinical, microbiological studies and species identification of pathogens, the authors concluded that 13% of patients for a long period of pyoderma and her irrational therapy has led to development the microbial eczema and the emergence of pialligo. In this way, the authors predict the probability of occurrence and worsening of the clinical course of eczema as a result of its Association with bacterial, fungal, or bacterial and fungal infections in combination with pathology of internal organs caused by sensitization of the organism, but do not take into account socio-professional identity of the patient, the action of harmful factors of production, changes in detoxification and metabolic functions of the liver, do not conduct an integrated assessment of the identified factors, not counting individual prognostic factor deteriorating clinical course of eczema in each patient individually, do not predict the probability of a transition eczema erythroderma in contrast to the claimed method.

There is a method of predicting the course of eczema by ultrasonic diagnosis of pathological reflux of blood, ultrasound Doppler or duplex angiocardiogram with the definition of impaired patency of deep veins to identify chronic venous insufficiency, which, according to the authors, to the progression of microbial eczema associated with trophic ulcers [Bazayev V.T., Tareeva MS, Cabaeva MB, Fidarov A.A. peculiarities of treatment of microbial eczema associated with trophic ulcers of venous etiology // Klinicheskaya dermatology and venereology, No. 2, 2010. s-71]. The disadvantages of this method are its complexity, high cost of research, disregard of other risk factors for clinical deterioration of eczema, disregard of immunological disorders, detoxification and metabolic functions of the liver, the absence of an integrated assessment of the identified factors, calculating individual prognostic factor of clinical deterioration of eczema, lack of forecasting the possibility of transition of eczema, erythroderma in contrast to the claimed method.

The prototype of the invention, the closest technical solution is a method of predicting the course of eczema through research, medical and social risk factors for the exacerbation of chronic dermatoses (eczema, psoriasis, atopic dermatitis), including the study of demographic characteristics marital status and characteristics of family type, characteristics of production and non-production activities, housing characteristics and household living conditions, characteristics, quality and nutrition, recreational activities, behavioral factors, self-assessment of health, medical activity by using the directional survey 371 Respondent and subsequent structuralizing observation of the respondents in the number of main telephone is stationary conditions, different allocation factors of absolute and relative risk of occurrence and exacerbation of eczema and other dermatitis in individuals living in rural areas and the city [Danilov, S., Nechaev O.S, Pyryatinsky A.B. Medical and social risk factors for the exacerbation of chronic dermatoses // Russian journal of skin and venereal diseases, 2005, No. 1, p.60-62]. The authors distinguish the following medical and social risk factors for the exacerbation of chronic dermatitis, including eczema: insufficient level of medical knowledge of the patient, ignoring healthy lifestyle, adverse living conditions, failure to observe rules of personal hygiene, exposure to harmful factors. This method allows to predict the clinical deterioration of eczema on the received personal information, but does not allow to predict the transition of eczema, erythroderma, does not reflect the state of metabolic and detoxification functions of the liver, does not take into account the role of sensitization and autoimmune process, inducing an inflammatory response in the dermis of patients with eczema, i.e. does not take into account other pathogenesis of this disease, does not conduct an integrated assessment of the identified factors, not mathematically calculates individual prognostic factor deteriorating clinical course of eczema in each clause is of they, individually, in contrast to the claimed method.

The objective of the invention is to develop individual way of predicting the likelihood of clinical deterioration of eczema, crossing her erythroderma, by conducting an integrated assessment of the pathogenetic significance of the identified exogenous, endogenous, medical risk factors contributing to the deterioration in the clinical course of the disease, taking into account the immunological parameters, detoxification and metabolic functions of the liver.

The technical result - getting individual criteria to predict the likelihood of clinical deterioration of eczema, crossing her erythroderma, obtaining justification of the choice of tactics and observation of patients for targeted prevention unfavorable course of the disease by eliminating the identified risk factors, the purpose of timely and adequate rational therapy.

The claimed method of individual forecasting the likelihood of clinical deterioration of eczema, move it to the erythroderma is as follows. Determine gender, age, profession, patients, collect a medical history, identify the presence or absence of factors that contribute to the worsening of the clinical course, conduct clinical, immunological, and biochemical studies. Metabolic function PE the Yeni assessed by biochemical studies, carried out at autoanalyzer firm "SINNOWA - 300", with reagent kits firms Chema Hospitex diagnostics. Patients determine total protein, albumin, urea, creatinine, total lipids and cholesterol, liver enzymes, alanineaminotransferase (ALT), aspartataminotransferaza (ACT), total bilirubin and its fractions, glucose. Detoxification functions of the liver is estimated by the activity of the monooxygenase system (MOS) using antivirusoveho test. The functional activity of lymphocytes is determined in response to betransformed (rbtl) phytohemaglutinin, the activity of natural killer cells (NK activity) analyze standard³N-uredinium cytotoxic test against target cells (KM) K 562 line cells, with a ratio of effector cells and KM (EK:KM) 1:25 on the cytotoxic index (QI). Lymphocyte proliferation appreciate the inclusion of³H thymidine. Detection of circulating immune complexes (CIC) carried out by the method of precipitation by polyethylene glycol (PEG-6000). The concentration of immunoglobulin classes a, M, G (IgA, IgM, IgG) in the blood sera calculated by the method of radial immunodiffusion according to Mancini. To characterize autoimmune processes (titer autoantibodies) put the Treponema pallidum haemagglutination assay (TPHA), blood levels of skin antigen was determined by response inhibition passive haemagglutination (RTP is A), use of capillary variant of response inhibition of migration of leukocytes (RTML). The obtained results are statistically processed using student's criterion and are in the form of a table (table 1). Integrated assessment of the pathogenetic significance of the obtained results revealed exogenous, endogenous and medical factors that contribute to the worsening of the clinical course, conduct Bayesian (1987). Calculate the frequency of the identified factors in 100 patients, determine the normalized intensive index (NIP), rasschityvaet indicator of the relative risk (ERP) deterioration in the clinical course, prognostic factor (PC), integrated risk ratio (IPR) of the transition eczema erythroderma. The results of these calculations are presented in table 2, which shows that men who are suffering from eczema, it 54,63%, women - 45,37%, the relative risk of clinical deterioration of eczema in men 1.16 times higher than among women, those aged 61 years and older it was increased to 5.54. During the history taking were selected following socio-professional groups: selhozraboty - 30,24%construction 25,62%, workers chemical refinery complexes HNK - 23,41%drivers - 12,19%, employees - 8,54%. The relative risk of worsening clinical course of eczema is in these socio-professional groups was 3,63. Every second patient was noted permanent residence during the work shift under the influence of physical, chemical, toxic or other harmful factors of production, every third lived near the source of pollution. Hyperinsulemia subjected 55,86% of patients with eczema, adverse conditions selfhosted, contact with pesticides, fertilizers had 30,24% of patients, contact with oil - 35,6, with construction materials - 25,62%. During prolonged constant contact with the production of harm indicator of the relative risk of clinical deterioration of eczema was 2.3. Surveyed patients in 58,76% of the cases took more than 4 different medicines at the same time on average for 9 years prior to clinical deterioration of eczema, crossing her erythroderma. The presence of foci of chronic bacterial and/or fungal infection had 49,7% of patients with eczema often recurrent SARS - 15,78%. Concomitant diseases of the gastrointestinal tract, the liver had 43,98% of patients, respiratory - 15,92%, ENT - 24,32% (table 2). The relative risk of clinical deterioration of eczema in persons with comorbid chronic diseases barrier of lymphoepithelial masses of the bodies and undergoing viral, bacterial and/or fungal infection was 4.7. In 75.4% of patients ek is emnd was an infringement of liver detoxification function, manifested by decreased activity monooxygenase system of the liver in the form of increased period of preliminaly of antipyrine on average 2.5 hours more than normal. When erythrodermia period of preliminary increased by 17.37 hours, i.e. more than 2.5 times higher than average (table 1). The 68,3% of patients with eczema were identified violation of the metabolic functions of the liver, manifested by reduced levels aminotrasferase (ALT, ACT) on average 1.4 times than normal, bilirubinometry liver 1.5 or more times than normal, total protein and albumin on average 1.45 and more times than normal, the increase in the level of total lipids in average 1.8 and more times than normal, increasing the level of cholesterol in the blood in an average of 1.7 or more times than normal, increased levels of creatinine and urea in the blood on average, 1.5 times or more than normal (table 1). The overall predictive coefficient (PC), the probability of worsening clinical course of eczema, crossing her erythroderma when combined with the violation of detoxification (PC - 8,08) and metabolic (PC - 7,33) liver function high - 15,41 (table 2). Reducing immunoregulatory index of 1.7 or more times than normal found in 59,7% of the examined patients with eczema, reduction of the stimulation index of 2.2 or more times than normal at 63,2%, a decrease of cytotoxic index of 1.7 or more times than normal at 38.4 per cent, HC is the increase in the level of the CEC 3.8 or more times, than normal found in 89.6% of the examined patients with eczema, the increase in the average (a, M, G) of immunoglobulins 1.7 and more times than normal at 75.8 per cent. In healthy people cutaneous antigen in our research is not detected in patients with eczema he revealed in 97.4% of patients. Level protivotankovyh autoantibodies was higher than the control values of 4.0 or more times in 82.7% of patients, the increase in the index of inhibition of migration of leukocytes in 3.1 and more times than normal was found in 96.5% of patients. The relative risk of clinical deterioration of eczema in persons with immune disorders was equal to 2.5, when combined with the pathology of internal organs (ERP - 4,7) increased to 7.2. The overall predictive coefficient of the likelihood of clinical deterioration of eczema, crossing her erythroderma with only complex immune disorders PC(3,4+3,6+2,2+5,7+4,33+5,55+4,73+5,5) was the high amount of PC was 35,01.

Thus, according to the results of our study relative risk factors for clinical deterioration of eczema are: age 50 years and older (ERP is 5.54), the presence of concomitant chronic diseases of the gastrointestinal tract, liver, respiratory system, upper respiratory tract, viral, bacterial and/or fungal infection (LONG - 4,7), belonging to a particular socio-professional group (LONG - ,63), having contact with professional production impurities, allergens and antigens (ERP - 2,3), the development of immune disorders in the body (LONG and 2.5). Given the opportunity to participate and influence identified various factors in the pathogenesis of eczema and eritrodermii, was additionally conducted an integrated assessment of the results of calculation of the risk range, which showed that the integrated risk index (IPR) differs from the relative risk (ERP) and was highest in persons with immune disorders (10,95), in the presence of chronic bacterial and/or fungal infection and pathology of internal organs (9,62). Low range risk of clinical deterioration of eczema with predictive coefficient from 2,64 to 10.23 was calculated and is typical for limited forms of eczema with a favorable prognosis, no transfer of a limited form of the disease in common. The average range of risk with predictive coefficient from 10,24 to 30,24 was calculated and characteristic common form of eczema with a relatively favorable prognosis, with the possibility of moving a limited form of the disease in common, but without the development of eritrodermii. High range of risk with predictive coefficient from 30,25 to 50,25 and above was characterized by poor prognosis, the probability p is the transfer of eczema, erythroderma (table 3). Prognosis the clinical course deteriorated by the combined action of several factors, for example, when the irrational use of drugs (PC - is 3.08) in combination with gastrointestinal diseases, liver (PC - 4,7), failure of detoxification (PC - 8,08), metabolic (PC - 7,33) of the liver, was $ 23,19 and exceeded the maximum low range of risk of clinical deterioration of eczema 2.3 times, predicting the probability of transition of a limited form of the disease in common. If, in addition to the above internal pathology, the patient had immune disorders, adding prognostic factors for each trait for immune disorders(3,4+3,6+2,2+5,7+4,33+5,55+4,73+5,5=35,01), together with PC 23,19 got to 58.2. This PC (58,2) exceeded the maximum high range of risk of clinical deterioration of eczema (50,25) 1.2 times and was characterized by poor prognosis, the probability of transition of eczema, erythroderma (table 3). The calculation of the individual criteria to predict the likelihood of clinical deterioration of eczema, crossing her erythroderma allows you to have the rationale for the choice of tactics and observation of patients for targeted prevention unfavorable course of the disease. For the low range of risk it is recommended that primary preventive measures for environments is its range of risk - secondary, high range of risk - tertiary, which are presented in table 3.

The research of the authors was first proved the possibility of predicting the likelihood of clinical deterioration of eczema, move it to the erythroderma of the claimed method. Therefore, the claimed invention meets the criterion of "inventive step". The authors in scientific medical and patent literature found no information on the integrated risk assessment of the likelihood of clinical deterioration of eczema, crossing her erythroderma, taking into account the history of the disease, effects of exogenous, endogenous and medical factors, immunological parameters, detoxification and metabolic functions of the liver. Thus, the claimed invention meets the patentability criteria of "novelty".

The claimed method of individual forecasting the likelihood of clinical deterioration of eczema, move it to the erythroderma is illustrated by the following examples.

Example 1. Sick, VA, 25, Barber, had complained of limited rashes on the skin, sore throat, often recurrent infection. Considered himself a patient in the course of the year, externally applied various ointments. Objective: pathological process is localized in the region of brushes, PR is dstable symmetric infiltrative lesions size 6-8 cm in diameter congestive-red with fuzzy boundaries, the surface of which had been moist in the form of "pits". The mucous membrane of the mouth was hyperemic, the tonsils are enlarged, some areas are covered with a purulent coating. Subjectively, the patient felt discomfort, a feeling of tightening, itching skin, sore throat. After the examination, in which the pathology of internal organs is not detected, biochemical, immunological parameters were within normal limits, diagnosis: limited eczema brushes; chronic tonsillitis. Treatment the patient was held outside therapy corticosteroid creams, together with antiviral drugs about SARS. The regression process is started on day 2 of treatment in the form of reduced soak, infiltration. Pronounced clinical effect was observed on the 5th day from the start of treatment, moist, infiltration was resolved.

In this example, the sick woman (PC - 1,19), age 25 (PC - 0,72), serving (hairdresser) (PC - 0,69), had often recurrent colds (PC - 1,69), diseases of ENT organs (PC - 2,59), the overall predictive coefficient of the likelihood of clinical deterioration of eczema was 6,88 that included table grades (table 3) in the low risk range with favorable prognosis. This, in turn, helped to justify the choice of tactics of external therapy of eczema, which for 5 days led is to the complete regression of the disease. Our forecast coincided with clinical data: the deterioration of the current eczematous process was not observed, the transition limited form of eczema in common, and then erythroderma has not occurred.

Example 2. Patient I.S., 35 years old, the driver of petroleum products, have complained of rashes, swelling and weeping of the skin, coughing. During the history taking revealed that eczema for 5 years. Smokes 20 years. Often treated as an outpatient and inpatient, took more than 3 drugs inside at the same time about eczema and related respiratory diseases. Diagnosis: limited eczema of the hands. Concomitant diagnosis: chronic bronchitis. The results of laboratory tests: ALT - 0,76 mkat/l, AST - 0,44 mkat/l, total bilirubin 10,81 µmol/l, cholesterol 6.2 g/l, total protein of 78.5 g/l, albumin 34,63 g/l, urea of 5.82 mmol/l, creatinine 90.1 mmol/l; preliminaly of antipyrine of 13.2 hours. Immunoregulatory index of 2.66, rbtl with PHA - 27,43%, the index of inhibition of leukocyte 4,87%, TPHA titer - 2,86, cytotoxic index of 8.4%; IgA - 115,0 ME; IgM - 171,25 ME, IgG - 158,64 ME, the CEC 11,65 used As seen from the above biochemical parameters of metabolic disorders of the liver in this patient is not found, immunological parameters were within the age norm. There was an increase in half-life antifire is and 2 hours, testified to the violation of the detoxification functions of the liver. On the radiograph was revealed enhanced picture of the bronchi. On the basis of clinical data and surveys diagnosed with limited eczema brushes associated with chronic bronchitis. The patient was appointed into fenkarol, doxycycline, nystatin, sulfokamfokain, Narine, externally wet-drying bandage with Ichthyol, corticosteroid creams. On the 7th day of treatment, despite ongoing hospital treatment, experienced a deterioration of General condition of the patient, body temperature rise up to 38°C, weakness, malaise, chills, worsening clinical course eczematous process that manifested transition limited eczema brushes in the common form of the disease on the skin of the hands and feet. The skin in the area of the rash was hyperemic, infiltrated, swollen, hot, dense palpation. Subjectively, the patient felt a burning sensation, itching of the skin. Regression of the spread of the rash came on the 3rd day from the beginning of short-term corticosteroid and detoxification therapy: completely disappeared inflammatory response and significantly decreased infiltration, moist skin. The final regression eczematous process was observed on the 8th day of treatment.

In this example, the sick man (PC - 1,39), age 35 the em (PC - 1,77), driver (PC - 1,01), had contact with petroleum products (PC - 1,86), respiratory diseases (PC - 1,09), irrational had used drugs (PC - is 3.08) and had a violation detoxification functions of the liver (PC - 8,08). The overall predictive factor of clinical deterioration of eczema was 18,28 that included table gradation in the medium range of risk (table 3), did not exceed the maximum value of the prognostic factor (30,24) medium range and predicted the likelihood of clinical deterioration of eczema, without the development of eritrodermii. The deterioration in the clinical course of eczema in the form of transition limited form of eczema in the common form of the disease was caused by a combination of existing risk factors, where nemalovajnuy role played by the violation of the detoxification functions of the liver with increased half-life of drugs from the body, as evidenced antipiracy test. Relatively favorable prognosis allowed to substantiate the choice of tactics of short-term corticosteroid and detoxification therapy, which in a short time stopped the spread ekzematoznogo process on hand and foot, for 8 days led to a complete regression of the disease. Our forecast was consistent with the clinical dynamics of the disease, rapid reg is the ECCA eczematous process without moving her erythroderma.

Example 3. Patient A., 40 years old, came with complaints of a rash on the hands. From the anamnesis it is known that for 10 years suffered from contact dermatitis, passed in chronic eczema localization process on the skin. 4 years ago there was a rash on the face in the form of seals and increased folding. All these years were exposed to insolation, while working as a Builder (reinforced concrete) in the open air. In the summer period, the patient is actively sunbathed, continued to work as a concrete worker at the construction site, and therefore the clinical signs of the disease increased, redness and swelling of the face, the upper third of the chest. Was hospitalized with a referring diagnosis of common eczema. Upon receipt of skin pathological process was widespread and was located on the face, upper third of the chest, hands. The skin was thickened, infiltrated with an accent skin pattern, characterized by deep furrows, had a bright red color. Against this background, a "serous wells", papular elements pink-red color and multiple linear excoriation, covered with hemorrhagic crusts. Submandibular and axillary lymph nodes were enlarged to the size of beans. From internal organs revealed chronic gastritis and chronic colitis, common blood tests revealed anemia, and increased amount of eosin is the Filov. In the biochemical analysis of blood revealed a metabolic disorder, a sharp decline in detoxification functions of the liver. Histological examination of the biopsy of the affected skin were marked intercellular edema of the epidermis, irregular acanthosis, dermal abruptly dilated vessels, swelling of the dermis, perivascular infiltrates. Immunophenotype cells infiltrate of CD3⁺, CD4⁺, CD43⁺. Conclusion histological study: chronic eczema. On the basis of clinical and laboratory data, histology, immunophenotyping of cells infiltrate the patient was diagnosed with common chronic eczema, caused by the worsening of the clinical course limited eczema. This helped to justify the choice of tactics of short-term corticosteroid therapy in conjunction with detoxification and symptomatic treatment, which contributed to the regression of the disease within 4 days.

In this example, the sick man (PC - 1,39), 40 years (PC - 1,77), Builder (PC - 2,11), has been in contact with building materials (PC - 1,33), were hyperinsulemia (PC - 2,92)had gastrointestinal diseases (PC - 4,7), violations of detoxification (PC - 8,08), metabolic (PC - 7,33) liver function. The overall predictive factor was 29,63 and included in the table grades (table 3) in the medium range of risk do not exceed the maximum prognostic factor (30,24) with a relatively favorable prognosis, that corresponded to the clinical dynamics of the disease. Due to the worsening of the clinical course of eczema limited form of the disease had progressed in common, but the transition erythroderma has not occurred. Under the action of therapy of skin disease process regressed within 4 days.

Example No. 4. The patient WAS 65 years, retired, former assistant chemical refinery complex (HNC), was admitted to the hospital RCVD with a diagnosis of erythroderma. Upon receipt complained of chills, fever up to 38.5°C, redness just the skin, pain in the right hypochondrium, cough. When collecting of the anamnesis revealed that the patient considered himself a patient for 20 years, when I first was diagnosed with chronic eczema have different medicines inside and externally, in the last 7 years to 5 drugs simultaneously about liver diseases, gastrointestinal tract, respiratory organs, high blood pressure and eczema. Objectively admission: the process was a universal character, by type of eritrodermii. The skin is bright red, infiltrated, lichenification in the skin folds, thickly covered with coarse lamellar scales. On the palms and soles were marked hyperkeratosis. Submandibular, cervical, axillary, inguinal lymph nodes were at elicina up to 3 cm in diameter, photoelasticity consistency, mobile, painless. In General, the analysis of blood leukocytosis, accelerated erythrocyte sedimentation rate, the number of eosinophils was increased. Conclusion immunologist: the presence of sensitization and autoimmune processes in the body in all indices of cellular and humoral immunity. When biochemical tests he was diagnosed with sharply reduced detoxication and impaired metabolic function of the liver. Data radiography: chronic obstructive pulmonary disease (COPD). Ultrasonography detected echo signs of chronic hepatitis, chronic cholecystitis. Histological examination were found: the detachment of the stratum corneum, irregular acanthosis, pronounced hyperkeratosis. In the dermis vessels were sharply were expanded, it was noted swelling of the dermis, diffuse infiltrates with infiltration of lymphocytes in the epidermis. Immunophenotype cells infiltrate of CD3⁺, CD4⁺, CD43⁺, CD45RO⁺. Morphometric studies of antigen presenting cells revealed: the area of antigen presenting cells amounted to 54.3 μm²; nuclear-cytoplasmic ratio of 0.79. The number of antigen presenting cells per 1 mm length of the epidermis was 8. These parameters fit in the morphometric profile of antigen presenting cells in erythrodermia. Taking into account anamnestic the ski, laboratory data, clinical and histological picture, immunophenotyping of cells infiltrate, morphometric studies was diagnosed with the eritrodermii caused by deterioration in the clinical course of eczema, which helped to justify the choice of tactics detoxification therapy. The patient underwent a course of plasmapheresis in combination with chelators and antihistamines. As a result of therapy on day 5 of treatment hyperemia and infiltration are less apparent, appeared healthy sections of the skin, lymph nodes decreased, the temperature is normalized. After 2 times of injection of diprospan managed to achieve clinical cure.

In this example, the sick woman (PC - 1,19), 65 (PC - 3,99), worked on JNC (PC - 1,92), was in contact with petroleum products (PC-1,86), irrational had used drugs (PC - is 3.08)had pathology of the gastrointestinal tract, liver, (PC - 4,7), respiratory (PC - 1,09), impaired detoxification (PC - 8,08) and metabolic (PC - 7,33) of the liver, had the presence of sensitization and autoimmunization organism (common PC - 35,01). The overall predictive factor was 68,25 and exceeded on the table grades (table 3) maximum value (PC - 50,25) high range of risk transition eczema erythroderma in 1.36 times that coincided with the clinical dynamics of the disease. N is though that the patient was under medical supervision ARCS, received standard therapy, have been deteriorating clinical course of eczema, crossing her erythroderma, which was clinical evidence of our poor prognosis.

Example No. 5. Patient R., 50 years old, was admitted to the dermatology clinic with complaints of itching, redness and swelling of the entire skin. When collecting of the anamnesis revealed that the patient felt sick for 5 years, when first appeared redness and peeling, and then moist hands and forearms. The patient for 25 years was engaged in agriculture: cultivated vegetables and fruits, had contact with pesticides and chemical fertilizers. Repeated treatment over limited diagnosed chronic eczema desensibilisation drugs and local topical therapy was conducted with a temporary effect. After regular work with pesticides pathological process dramatically progressed around the skin type eritrodermii, in connection with which the patient was hospitalized. During the examination in the clinical analysis of blood - anemia, the number of eosinophils within the normal range, in the biochemical analysis of blood reduction in the activity of enzymes and MOS 1.4 times, decrease the amount of protein and its fractions in 1,4 times, hyperlipid and hypercholesterinemia, increased level of creatine is and urea in the blood in an average of 1.5 times, than normal. Immunological studies have shown increased levels of CEC 4 times, the average level of immunoglobulins in 1.8 times, increase protivotankovyh autoantibodies in 5 times than normal and the presence in the blood of cutaneous antigen. Ultrasound of internal organs revealed pathology of the liver. Skin pathological process was widespread (head to toe) and was diffuse hyperemia and infiltration, covered with crusts and coarse lamellar scales. The skin was doskoobraznye" to the touch, had trouble going into the crease. It was noted thinning, hair loss and melkopuzyrchatoy peeling on the head, hyperkeratosis of palms and soles. Submandibular, axillary and cubital lymph nodes were enlarged to pea, inguinal - up walnut. Histological examination were marked detachment of the stratum corneum, irregular acanthosis, pronounced hyperkeratosis. In the dermis was found sudden vasodilatation, edema of the dermis, diffuse infiltrates with infiltration of lymphocytes in the epidermis. Immunophenotype cells infiltrate of CD3⁺, CD4⁺, CD43⁺, CD45RO⁺. Were conducted morphometric study of histological sections of skin biopsies: the number of antigen presenting cells per 1 mm length of the epidermis was 9, their area was equal to 51 μm²nuclear-citpl somaticheskoe ratio - 0,7. These parameters fit in the morphometric profile of antigen presenting cells in erythrodermic arising in benign inflammatory dermatoses. With regard to clinical and laboratory data, histological, morphometric studies, immunophenotyping of cells infiltrate was diagnosed with erythroderma caused by deterioration in the clinical course of eczema, which gave grounds for the choice of tactics detoxification therapy. Complete regression of the disease occurred 5 days after 3 courses of plasmapheresis.

In this example, the sick man (PC - 1,39), 50 years (PC - 2,49), agricultural worker (PC is 2.51), were hyperinsulemia (PC - 2,92), had contact with pesticides, fertilizers (PC - 1,59)had liver disease (PC - 4,7), violation of its detoxification (PC - 8,08) and metabolic (PC - 7,33) function, noted the presence of sensitization of the organism in the form of increased level of the CEC (PC - 5,7), levels of immunoglobulins (PC - 4,33), with the development of autoimmune processes in as the availability of protivotankovyh autoantibodies (PC - 4,73) and cutaneous antigen (PC - 5,55). The overall predictive factor was 51,32 and exceeded on the table grades (table 3) maximum value (PC - 50,25) high range of risk with a poor prognosis, which is consistent with clinical data, have been deteriorating clinical course e is semi, the transformation of erythroderma.

As seen from the above examples, integrated risk assessment, the results of calculating prediction coefficients for each patient individually fully coincided with the clinical evaluation of the disease in all cases, allowed individually to predict the likelihood of clinical deterioration of eczema, its transition erythroderma.

The claimed method was conducted individual assessment of the likelihood of clinical deterioration of eczema, crossing her erythroderma in 38 patients with the limited form of eczema, 43 patients with common form of eczema and in 19 patients with erythrodermia and in all cases was achieved the specified technical result. Way reproduce in conditions of clinic of skin and venereal clinic, hospital, therefore, the claimed invention meets the patentability criterion of "industrial applicability".

Thus, compared with the prototype (table 4) the claimed method individually predict the likelihood of clinical deterioration of eczema, crossing her erythroderma allows you to:

a) individually to predict the likelihood of clinical deterioration of eczema, crossing her erythroderma with the division of risk ranges for low, medium and high;

b) consider participation and vzaimovli is their different possible pathogenesis of eczema and eritrodermii by conducting an integrated assessment of the identified exogenous, endogenous and medical risk factors;

C) on the basis of individual prognostic factors to justify the choice of tactics and observation patients aimed to prevent adverse course of the disease, which in turn, prevents the development of eritrodermii, by addressing the identified risk factors for the appointment of adequate rational therapy.

The WAY an INDIVIDUAL PREDICT the LIKELIHOOD of CLINICAL DETERIORATION of ECZEMA, CROSSING HER ERYTHRODERMA

The WAY an INDIVIDUAL PREDICT the LIKELIHOOD of CLINICAL DETERIORATION of ECZEMA, CROSSING HER ERYTHRODERMA

The WAY an INDIVIDUAL PREDICT the LIKELIHOOD of CLINICAL DETERIORATION of ECZEMA, CROSSING HER ERYTHRODERMA

The WAY an INDIVIDUAL PREDICT the LIKELIHOOD of CLINICAL DETERIORATION of ECZEMA, CROSSING HER ERYTHRODERMA

The way an individual predict the likelihood of clinical deterioration of eczema, crossing her erythroderma, by conducting an integrated assessment of the pathogenetic significance of the identified exogenous, endogenous, medical risk factors contributing to the deterioration in the clinical course of the disease, including the collection of medical history, conducting biochemical, immunological studies of blood serum of the patient, wherein the patient determine gender, age, socio-professional identity, the presence of factors that contribute to the worsening of the clinical course of the disease, immune, detoxification, metabolic disorders of the liver, expect predictive coefficient (PC) of each characteristic separately, and the male is estimated as 1,39, female as 1,19; age 18-30 years estimate as to 0.72, 31-40 - 1,77, 41-50 - as 2,49, 51-60 - as 3,66, 61 and older - as 3,99, the workers of the petrochemical production are estimated as 1,92, behold ihasrabies as of 2.51, builders - as 2,11, drivers 1,01, employees - 0,69; heparinase is estimated as 2,92, adverse conditions selfhosted (contact with pesticides, fertilizers) assess how 1,59, contact with oil - as 1,86, contact with the materials as 1,33, irrational use of drugs as is 3.08, the presence of foci of chronic bacterial and/or fungal infection - how to 5.3, often relapsing SARS - like 1,69, chronic diseases of the gastrointestinal tract and/or liver - as of 4.7, chronic respiratory diseases - as 1,09, chronic diseases of ENT organs as 2,59, disorders of liver detoxification function as 8,08, metabolic disorders of the liver as 7,33; reducing immunoregulatory index of 1.7 or more times, than in norm estimate as of 3.4, reducing the stimulation index of 2.2 or more times than normal - as 3.6, reducing the cytotoxic index of 1.7 or more times, than in norm estimate as of 2.2, an increase in the level of circulating immune complexes 3.8 and more times than normal estimate as to 5.7, the increase in the average level of immunoglobulins in 1.7, and more times than normal - as 4,33, the presence of skin antigen in the blood is estimated as 5,55 in its complete absence in normal, increased levels of protivotankovyh autoantibodies in 4.0 and more times than normal rate as 4,73, the increase in the index of inhibition of migration Le is koltov 3.1 or more times, than normal rate as 5,50; in the absence of factor prognostic factor taken for zero; summarize the obtained predictive coefficients (PC), and when the sum value PC from 2,64 to 10.23 predict a low likelihood of clinical deterioration of eczema and favorable prognosis of the disease without transfer of limited forms of eczema in common; when the value of the sum of the PC from 10,24 to 30,24 - average probability of worsening clinical course of eczema, the possibility of transfer of a limited form of the disease in common, relatively favorable prognosis without the development of eritrodermii; and when the sum value PC from 30,25 to 50,25 and above - high probability of deteriorating clinical course disease and poor prognosis, the possibility of transfer of eczema, erythroderma.