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BR- S N E M IB ET E GS G EK

Irta

R A J K A D N S S Z O D O R A Y LAJOS

HARMADIK, TDOLGOZOTT KIADS

B u d a p e s t , 1 9 6 0
TARTALOM

E lsz............................................................................ 13
Bevezets . ..................................
A brgygyszat rvid trtnete ................, ............... 17

LTALNOS RSZ
I. A br anatmija
A ) A br fejldse ............................................................................ 27
B ) A br szveti szerkezete............................................................ 28
C) A br festanyaga .................................................................. 33
D ) A br fedhm jnak fggelkei (ezoderma) .................... 34
1. A szr (h a j).................................... 34
2. A m irigyek ......................................................... 39
3. A k r m .................................. 41
4. A br izm ai......................... 42
5. A br e r e i ........................................................................ 42
6. A br id e g e i .............................................................................................. 44

II. A br lettana
A ) A br le tv e g y ta n a ................................................................................. 46
B ) A br m k d se........................................................... 49
1. Elektrophysiologiai sneurophysiologiai jelensgek a brben ............ 52
2. A br vdelmi funkcii ........................................ 52
3. A br m int rz k sz e rv ............................................. 56
C) A normlis br baktrium flrja s az autogn ste rilisa tio .......................... 59

III. A br ltalnos krtana


A) A kros br vizsglata ........................................... 61
1. K relzm ny....................................................... 62
2. A kros br elemi jelensgei ................. 63
a) Elsdleges (primer) laesik ....................................................................... 64
b) Msodlagos laesik .................................................................................... 68
c) Szubjektv idegrendszeri jelensgek ......................... 71
d) A br sszefoglal krszvettana ................. 73
Epiderm a .............................. 73
Gorium ................................................................................... . 74
3. A brjelensgek elhelyezkedse (lokalisatio) ........... 75
4. A brjelensgek vizsglati mdszerei ........................................ 78
5. Kiegszt laboratrium i vizsglatok ...................................................... 82
6. A jelensgek keletkezsi tjn ak s m djnak m eghatrozsa 85
a) A normergis brgyullads ..................................................................... 87
b) Az allergis brgyullads ......................................................................... 90
c) Elfajulsok a brben................................................................................. 93
d) Sorvads s t lte n g s ................................................................. 94
B) A brbetegsgek osztlyozsa .......................................................................... 94

IV . A brbetegsgek ltalnos therapija


A) Kls helyi kezelsi eljrsok ............................................................................ 97
B) Fizikai eljrsok .............................................. 103
C) Bels kezelsi eljrsok ....................................................................................... 107
D) Brgygyszati szerek .................... 113

RSZLETES RSZ
I. Fertzses eredet brbetegsgek
A) Baktrium ok okozta d erm ato siso k . . ................................................. 125
1. Goeeogen fo ly a m a to k ........................... 125
A coecogen fertzsek fbb alakjai. .......................... 126
A pyoderm k felosztsa.................................................................................. 126
a) Szabad pyoderm k .................................................................................. 128
Im petigo c o n tag io sa................................................................................... 128
Angulus in feetio su s...................................................................................... 131
E k th y m a ................................................................ ........................................ 132
Erysipelas .................................................................................................... 132
Pyoderm a vegetans ................................................................................... 134
Granuloma telea n g ie ctatieu m ................................................. 135
b) Ezodermalis kpletekhez k t tt formk ............................................ 135
F o llieu litis......................... 135
Furunculus ............................................................................... 137
Carbunculus ....................................................................................... . . . 138
H idradenitis . . . . ........................................................................................ 138
Paronyehia coceogenes....................... 139
c) Atpusos pyoderm a-form k...................................................................... 140
Follieulitis decalvans.................................................................................... 140
Follieulitis sklerotisans nuchae .............................................................. 140
Perifolliculitis suffodiens et abseedens (Hoffmann) ................. 141
Follieulitis nekrotica seu varioliformis .................................... 141
A kroderm atitis eontinua perstans ( Hallopeau) ................................ 141
A pyoderm k megelzse ......................................................................... 142
d) Pyogen (coecogen) sensibilisatio k rk p e i............................................ 143
Impetigo ekzematiformis (Trk) .......................................................... 143
Intertrigo coceogenes ............................................................................... 143
Coecogen ekzema ........................................................................................ 144
Msodlagos coecogen sensibilisatis fo ly a m a to k ................. 144
G cfertzs....................... 146
2. Baeillaris folyam atok ........................................................................... 147
B rd ip h th e ria ............................................................................................ 147
E k th y m a gangraenosum ...................................................................... 148
A n th ra x ..................... 148
Erysipeloid Rosenbach ............................................................................... 149
tpBang-fle betegsg ...................................................................................... 150

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Tulraem ia .......................................................................... 151
S k te ro m a .............................................. 151
Mlleus ...................................... 152
f Ulcus vulvae aeutum ( L ip s c h tz )................................... 152
Fusospiroehaetosisos krkpek .......................................... 153
jzf N o m a .................................................................................... 154
A br gmkrja. T u b ercu lo d erm a........................................ ......................... 155
A brgm kr fo rm i................................................................ 156
a) Tpusos lokalizlt krform k ............................ 158
A br gms prim er complexusa ............................... 158
Tubereulosis eutis luposa ........................ 159
Tubereulosis eutis verrucosa................................... 170
Tubereulosis eutis c o lliq u ativ a........................ 171
Tubereulosis miliaris uleerosa eutis et mucosae .................... 174
b) Szrdsos gmkr-formk .. 174
Tubereulosis miliaris generalisata e u t i s ..................... 174
Lupus miliaris dissem inatus faciei ........................... 175
Hyperallergis form k: tuberculidok........................... 175
Tubereulosis follicularis seu lichenoides......................... 176
Tubereulosis eutis papulonekrotica ........................... 176
Tubereulosis cutanea et subcutanea indurativa ................... 177
c) A tpusos brgmsdsi formk ......... 179
Boeck-s a rk o id .......................................................................... 179
Pityriasis rubra Hebrae ....................................................... 181
Lichen nitidus vagy granulom a n itid u m ...................................... 181
d) Polyaetiologij, esetenknt gms aetiologij k rf o rm k 181
E ry th em a nodosum .......................................... 181
E rythem atodes ............................................................. 183
E rythem atodes dissem inatus a e u tu s ..................... 187
Granuloma anulare ......................................................... 188
B) Gombk okozta brbetegsgek ................ 189
1. ltalnos rsz............................................................................... 189
a) A mykologia alapelemei .................. 190
b) A gombk botanikai s a j ts g a i.................... 191
c) Gombk k im utatsra szolgl m dszerek.................. 194
d) A dermatomykosisok im m unbiolgija.................. 197
e) A ntim ykoticum ok hatsvizsglata .................... 198
f) A dermatomykosisok ltalnos therapija .................. 199
2. Rszletes dermatomykologia ............................. 200
Sugrgomba-betegsg, aktinom ykosis vagy noeardiosis . ............. 200
M y ee to m a........................................................................... 202
E ry thrasm a ............................. 202
Trichomykosis palmellina Pick ................................ 203
P ie d ra ................................................................................... 203
Cryptoeoccosis . _ ....................................................... 203
szak-am erikai blastom ykosis.................................... 204
Dl-amerikai blastomykosis .................................. 205
Coecidioidomykosis ....................................................... 205
C hrom oblastom ykosis............................................ 205
Pityriasis versicolor ......................................................... 205
Moniliasis ............................................................................. 206
S p o ro triehosis ............................................... 208
Histoplasmosis . . ..................................................... 209
E p id erm o p h y tia.......................................... 209
Erosio interdigitalis m ykotica.................................... 210
Ekzem a m ykoticum ................. 211
E piderm ophytia inguinalis .................................... 213

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Triehophytia ............ 214
Trichophytia superficialis capillitii et barbae .................................. 214
T riehophytia superficialis eorporis ............... 215
T riehophytia profunda capillitii et barbae .................................. 215
Granuloma trichophytieum Majocchi .. 217
T richophytia agm inata ......................................................................... 217
O nychomykosis.............................................................................................. 219
Mikrosporia .................................................................................................. 220
Favus .......... 221
Favus c a p itis ...................................... 221
Favus e o rp o ris..................................................... 223
Mykidek ............ 223
Dyshidrosis m y k o tic a ................................................................................. 224
3. Gombs eredet brbetegsgek megelzse ................................................ 226

) Vrusok okozta brbetegsgek ........................................................................... 227


1. Csoport ................. 228
Szemlcs....................................................................................... 238
Hegyes fggly ................................................................................. 229
Molluscum co ntagiosum ............... 231
A hlyagos brvirosisok cso p o rtja................................................................ 231
Herpes sim plex.......................... ............................................................... 231
Stom atitis aphthosa ................. 231
Herpes simplex generalisatus .......................................................... 233
Herpes zoster .......................................................................................... 233
Tehenszcsom .................................... 237
C at-scratch (m aeskakarm olsi)-betegsg............................................... 237
2. Csoport ......................................................................................................... 238
Vaccinia . ..................................................................................................... 238
P a ra v a c c in ia ................................................................................................... 238
H eveny fertz betegsgek k rt n e te i........................................................ 239
Variola ............ 239
Varicella. ............................................................................................ 239
Morbilli ......................................................................................................... 239
Rubeola . ....................................................................................................... 239
S carlatin a.............................. 239
3. Csoport . .......... 240
A phthosis......................................................................................................... 240
Virobacterialis gangraenk ................................................................... 242
E rythem a ehronicum (toxieum) migrans ( Afzelius) .......................... 242

D) llati parazitk okozta b rb eteg sg ek .............................................................. 242


1. Dermatozoonok ................................................................................................ 242
R h ssg ......................................................................................................... 242
Kszlrva ..................................................... 245
Myiasis .......... 246
2. Epizoonok ................................................................................................ 246
Tetvessg ....................................................................................................... 246
Rovarcspsek ..................................................................................... 248
Demodex folliculorum .......... 249
3. E ndoparazitk ................................................................................. . . . 249
Filariasis ..................................................................................................... 249
Blfrgek okozta betegsgek ................................................................... 249

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II. Vegyi anyagok, fizikai behatsok okozta dermatosisok
A ) Foglalkozsi brbetegsgek ............................ 252
Olajakne ............................................................................... 255
B ) Phytophotoderm atosisok ................ 258
C ) Vegyi anyagok okozta brelvltozsok....................................... 259
Em blia eutis m edicamentosa ...................................... 260
D ) Fizikai (h-) rta lm a k ................................................................ 261
A br gsi s r l se ....................................................... 261
Inflam m atio eutis (livedo) racemosa ................. 267
A br fagysos srlse .................................. 268
Fagydaganatos lla p o t......................................................... 269
Mechanikai rtalm ak ............................................... 270
Bvrbetegsg .................................... 271
D erm atitis Solaris . . ....................................................... 271
A radioaktv sugrzsok betegt h a t s a .............. 272
Rntgensugrzs okozta brrtalm ak ..................... 273
R adioderm itis a c u t a ........................... 273
Radioderm itis chronica............................................ 274
Rntgensugr-krosodsok therapija ....................... 275

III. Allergodermatosisok
U rtiearia s Quincke-oedema ............ 279
Prurigo-csoport ...................................................................... 284
Csecsem -ekzem a.............................................................. 288
E k z e m a ............................................................................... 291
K o n tak t ekzema .................................. 294
Bels eredet ekzema .. .......... 303
Mikrobs e k z e m a ................................................................. 304
Bacterialis eredet flekzem k .................................... 305
Eltr e k z e m a fa jt k ............................. 306
Az ekzema kezelsi elvei .......................................... 307
E rythroderm a allergicum .................................... 309
PuVpura allergica (Schnlein Henoch) ................... 310
Gygyszerallergia ................................................................ 310
Mikrobs allergia ....................... ... ............. 313
E rythem a exsudativum m ultiform e ................. 316
Autosensibilisatis allergia .......... 320
P ru ritu s allergicus ................... 320
Az antiallergis kezels elvei .............. 321

IV . Sugarak okozta brelvltozsok


Fnybetegsgek 323
1. P hototraum s elv lto z so k ............ 324
D erm atitis Solaris ......................................................... ....................... . 324
Pseudomilium colloidale (W agnerPellizari) . . . . . . . . . . . . . . . . . 324
2. Photoallergis e lv lto z so k ................... ...................... 325
U rtiearia photogenica ......................... 325
Ekzem a s o la r e .................................. 325
Prurigo aestivalis ................................................... 325
Sulfanilam id-sensibilkatio ................... 326
3. Photodynam is elvltozsok ........... 326
Hydroa-csoport ................................ 326
X eroderm a pigmentosum ................. 327
A photoderm atosisok kezelsnek elvei . . . . . . . . . . . . . . . . . . . . . . . . . . 329

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V. Bels eredet brbetegsgek
A ) Vitam inhiny okozta brelvltozsok . 332
1. Az A -vitam inhiny okozta brbetegsgek ....................... 332
Keratosis pilaris .................................. . . ........... 333
Elszarusodsi rendellenessgek................................................................ 333
Pityriasis ra b ra pilaris ........................................................................... 333
Dyskeratosis (miliaris) vegetans ............................................. 334
2. A B -vitam incsoport hinynak b rt n etei................................................. 335
P e lla g ra ........................................................................................................... 336
3. A C-vitam inhiny b rt n e te i......................................................................... 337
4. Egyb vitam inhinyok brtnetei ............................................................. 338
B) Endokrin zavarok okozta brbetegsgek.......................................................... 333
1. A hypophysis mkdsi zavaraival kapcsolatos brelvltozsok . . . . 339
2. A mellkvese mkdsi zavaraival jr b rt n e te k .............................. 340
3. A pajzsm irigy mkdsi zavarain alapul brjelensgek ................... 341
4. Az ovarium mkdsi zavarain alapul b r t n e te k ................................ 342
5. Androgen hormonok tlterm eldsvel vagy hinyval kapcsolatos
brjelensgek .................................... 343
Impetigo herpetiform is ............ 343
Herpes gestationis ...................................................................................... 344
Akanthosis nigricans .................................... 344
A pankreas m kdsi zavarai .............................................................. 345
A kroderm atitis e n te ro p a th ic a .............................. 346
C) Anyagcserezavarok okozta brfolyam atok .................................................... 346
1. Seborrhoes krkpek ...................................................................................... 347
A knevulgris ........................................ 343
Rosacea ........................................................................ 354
2. Klnleges5 helyi vagy ltalnos anyagcserezavarok okozta brbeteg
sgek ................................................... 356
Elfajulsos elvltozsok ................................................. 356
Amyloidosis .............. 356
Colloid d e g e n e ra tio ................... 356
Galcinosis ............ 357
Trolsi betegsgek . ...................................................................................... 357
Skleroderma- (skleropathia-) csoport .......................................................... 353
K rlrt skleroderma vagy m orphea ................................................... 358
Progresszv diffz skleroderma .............................................................. 359
A krosklerosis................................................. 360
Morphea g u t t a t a .......................................................................................... 363
Skleroedema adultorum ( Buschke)................... 363
Derm atom yositis ........................................................................................ 364
Sklerema neonatorum ............................................................ 364
D) regkori brelvltozsok .................................................................. 365
E) Pigm entzavarok .......... 367
1. Pigm ent-hypertrophia .........................................................................................368
2. Pigm ent-atrophia ............................................ 369
F ) B ra tro p h i k ......................................................... . 370
G) Egyes verejtkm irigy-, haj-, krm- s nylk ah rty a-b eteg sg ek ............. 372
1. Verejtkm irigy-elvltozsok ........................................................................... 372
2. Hajbetegsgek .................................................................................. 375
A lopecik ............ 375
H ajdystrophik .................................... 378

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3. Krmbetegsgek ............ .................. ................ 373
4. N ylkahrtya-folyam atok ............... d /u

H) Az rrendszeri s a vegetatv idegrendszeri mkdsek zavarai a brn 382


1. A hajszlerek neurovegetatv jelleg m kdszavarai ................... 383
Cutis m arm orata ................. 383
Akroeyanosis ................................ ............................................................... 383
Erythroeyanosis crurum puellarum ............ 383*
2. A vgtagok szimmetrikus gangraenja. Ragnaud-kr ................. 384
3. Arteriabetegsgek .............................. 385
Throm bangitis obliterans ............ 385
Periarteritis (panarteritis) nodosa .......... 386
4. Yenabetegsgek ........................... 387
S tatus varicosus .......... 387
Elephantiasis cutis ..................... 391
Lipogranulomatosisok ......................... 392
Vasculitis nodularis .............................................................. 393
Granuloma malignum faciei ( F r i e d m a n n ) ................................................. 393
Chondrodermatitis nodularis chroniea helicis ( W i n k l e r ) ....................... 394

V L Eddig ismeretlen kroktan dermatosisok


Pityriasis r o s e a ........................................................................... 395
E rythem a anulare eentrifugum (Darier) .................................... 393
Pityriasis lichenoides e t varioliformis aeuta
( Mucha Habermann) .............. 393
Psoriasis ................................................... 399
Parapsoriasis-csoport ................. 406
Lichen-csoport . . ................................ . .................................. 406
Pem phigus-esoport. ............... 410
D erm atitis herpetiform is Duhring .............. 410
Pemphigus vulgris .............. 413
Pemphigus v e g e ta n s ......................... 416
Pemphigus foliaceus (Cazenave) ............................ 416
Senear Usher-tpus pemphigus ............................................... 416

VI I . Fejldsi rendellenessgek s rkletes hatsokon alapul brelvltozsok


Keratosisok ................. 423
Pigm entosisok ............... 426
B u llo siso k ............................................. 426
Angiosisok ............................................ 427
D y s tro p h i k ............................. 427
B lastomatosisok .......... 427
Phakom atosisok ...................................... 427

VI I I . A br daganatai
A) Anyajegyek ......................... 432
Festkes (melanotikus) anya jegy ................. 433
Melanoma m alignum ............ 435
Epiderm alis anyajegyek ................. 438
ra n y a je g y e k ................... ..................... ......................... .................................... 438
Ktszveti anyajegyek ............... 441
Vegyes szerkezet a n y a je g y e k .................................. 441
Lym phangiom k. Naevus lym phangiom atosus ................. 441
U rticaria pigm entosa ......... 442
B ) Hm eredet brdaganatok .............................. 443
Jindulat hm daganatok ........................... 443
R osszindulat hm daganatok .................................. 445
Rkelz llapotok s megelzsk ............................................................ 445
A brrkok felosztsa .......... 447
A br basoeellularis rk ja ............................. 448
Intraepiderm alis rkok ....................... 452
E rythroplasia glandis ( Queyrat) ................... 452
Bowen-kr ............................................................................. 452
Paget-kr ................................................................................. 453
A br elszarusod laphm rkja ....................... 454
Az ttteles (msodlagos) brrkok ....................... 455
tm eneti s kevert tpus rkok . ......................................................... .. . 456
A brrkok gygytsa ................................................................ 456
G ) Ktszveti eredet daganatok ................... 457
Jindulat ktszveti daganatok .............................................................. 457
Fibrom a ............................. 457
Kelid ................... 458
N eu ro fib rom atosis . . . . . ..................... 459
Ideg eredet daganatok a brben .................................... 460
Z srdaganat .......... 460
Leiomyoma cutis .. 461
M yoblastoma ....................... 461
Chondromk s osteom k ............ 461
Glomus-tumor ....................... 461
rdaganatok ..................... 462
X anthom a ....................................................... 462
A ktszvet rosszindulat d a g a n a ta i................. 463
Angiosarkoma haemorrhagieum (Kaposi) .............................. 464
D) A br retieularis elemeibl kiindul daganatok s systems
b u rjnzsok .................................................................. 465
Leukosisok ........................................................................ .. . 466
Reticulosisok ..................... 467
Granulomatosisok ........................................................................... 467
Lym phogranulom atosis (Hodgkin) .............. 467
Granuloma fungoides .................................. 468
Eosinophil granulom a . ....................... 469

IX . Brgygyszati syndromatologia

NEM IB E T E GS GE K

I. A nemibetegsgek szocilis jelentsge


17. A syphilis
A) A syphilis trtnete ................... 482
B) A syphilis kroktana s krtana ..................... 483
) A syphilis diagnosisa ............ 489
D) A syphilis klinikai tnetei ..................................................................... 492
E ) A vilgrahozott syphilis ............... 505
F) A syphilis gygyszerei .............................................................. 508
G) A syphilis elassificatija a kezels szem pontjbl ...................................... 512

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M) A syphilis gygytsa...... ........................................................................................ 513
T jkoztat a syphilis-kezelsre................. . ..................................................... 513
Szvdmnyek arsenobenzol-kezels kapcsn ......................................... 515
Gygyts higanyksztm nyekkel....................... 521
Gygyts bizm utksztm nyekkel ......................... 521
Gygyts penieillinksztm nyekkel........................... 522
A penicillin m ellk h atsai......................................................................... 523
Gygyts j d k sztm n y ek k el.................................................................... 525
l) A syphilis kezelsnek ltalnos irnyelvei ..................................... 525
1. A korai syphilis gygytsa .......................................................................... 526
2. Terhesek syphilisnek kezelse ...................................................................... 527
3. Gyermekek syphilisnek kezelse .................................................. 527
4. A ksi rrendszeri s szervi syphilises elvltozsok kezelse................. 528
5. A neurolues kezelse..................................... 528
6. A syphilis gygyulsnak kritrium ai ....................................................... 529
7. A syphilis megelzsnek krdsei.................................................................. 531
8. A syphilis egyni prophylaxisa .................................................................... 532
9. A syphilis s a hzassg krdse ............................................................... 533
10. Tjkoztat a vrbaj fertzkpessgnek m egllaptsrl .............. 533

I I I . A kartk
A) A kank d iag n o sisa................................................................................................. 536
B) A frfi heveny kanks fertzse . . . . ........................ 537
C) A frfi kank szvdmnyei ............................................................ 538
D) A ni k a n k ........................ 539
E) A kank gygytsa................ 540
F) Kislenyok gonorrhoes vulvovaginitise .......... 542
G) A nem-gonorrhoes urethritisek .................................. 543
1. Mikrobs, bacterialis u re th ritisek ................................................................... 544
2. Abacterialis, amikrobs u re th ritis e k ............................................................. 544
H ) Trichom onas-fertzsek ............................................................................... 545

IV . Lgy fekly
V. A IV . nemibetegsg

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