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Twardzina układowa przyczyną trudno gojących się ran na dłoniach

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Twardzina układowa to przewlekłe układowe schorzenie tkanki łącznej. Jednym z charakterystycznych objawów twardziny są zmiany skórne, które prowadzą do powstawania trudno gojących się ran i owrzodzeń, które goją się z pozostawieniem blizn.

Twardzina układowa to przewlekłe układowe schorzenie tkanki łącznej o charakterze autoimmunologicznym, które występuje najczęściej u osób pomiędzy 30. a 50. rokiem życia. Choroba częściej dotyka kobiety niż mężczyzn. Wśród możliwych przyczyn choroby wskazuje się na czynniki genetyczne, hormonalne oraz środowiskowe (długotrwała ekspozycja na substancje szkodliwe).

W przebiegu twardziny układowej dochodzi do postępującego włóknienia skóry i narządów wewnętrznych. Następstwem rozwoju zmian skórnych jest zwiększona podatność na urazy i utrudnione gojenie ran.

Skórne objawy twardziny układowej

Postępujące włóknienie skóry oraz zajęcie drobnych naczyń krwionośnych przez proces chorobowy prowadzi do rozwoju charakterystycznych zmian skórnych. Zmiany początkowo pojawiają się w obrębie palców, by następnie stopniowo rozszerzać się na dalsze partie kończyn i reszty ciała.

W początkowej fazie choroby rozwija się obrzęk związany z naciekami komórek zapalnych. Następnie dochodzi do stwardnienia i zgrubienia skóry. Ponadto zwiększa się napięcie skóry, traci ona elastyczność. Gruczoły potowe i łojowe oraz mieszki włosowe ulegają zanikowi, występują przebarwienia i zmiany w postaci podskórnych grudek (efekt odkładania soli wapnia).

W wyniku zajęcia przez proces chorobowy naczyń krwionośnych skóra staje się podatna na urazy, a powstałe rany wykazują duże trudności w gojeniu. Na opuszkach palców dochodzi do powstawania zmian troficznych pod postacią nadżerek, owrzodzeń i ognisk martwicy, które goją się z pozostawieniem blizn pod postacią drobnych zagłębień.

U chorych na twardzinę układową występuje również objaw Raynauda (95-99 proc. przypadków). Pod wpływem czynników takich jak stres lub zimno dochodzi do zmiany zabarwienia skóry palców rąk i stóp (najpierw zasinienie wskutek niedotlenienia tkanek, a następnie zaczerwienienie w wyniku gwałtownego rozszerzenia naczyń krwionośnych). Po napadzie występują dolegliwości bólowe lub parestezje.

Leczenie twardziny układowej

W leczeniu twardziny układowej stosuje się leki immunosupresyjne, które hamują proces odkładania się kolagenu w obrębie skóry i narządów wewnętrznych. Duże znaczenie mają również leki poprawiające drożność naczyń krwionośnych, ponieważ zaburzenia naczyniowe stanowią czynnik patogenetyczny objawu Raynauda oraz zmian troficznych skóry.

W leczeniu ograniczonych, powierzchownych zmian chorobowych stosuje się z sukcesem miejscową farmakoterapię oraz fototerapię.


Przeczytaj także: Badania przesiewowe całego ciała kluczowym czynnikiem we wczesnej diagnostyce czerniaka u osób z grup wysokiego ryzyka

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