kanis daavadebebi
kanis daavadebebi
kanis daavadebebi
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# 23<br />
<strong>kanis</strong> <strong>daavadebebi</strong><br />
akne da rozacea<br />
Temas uZRvebian:<br />
Tbilisis dermatovenerologTa<br />
asociaciis Tavmjdomare soso kobaxiZe<br />
medicinis mecnierebaTa kandidati maia daTuaSvili
<strong>kanis</strong> <strong>daavadebebi</strong>, akne da rozacea<br />
2<br />
ras warmoadgens kani?<br />
kani adamianis kvelaze did organos<br />
warmadgens. igi rogorc zomiT, aseve<br />
woniT pirvel adgils ikavebs, amitomac<br />
ganuzomelia misi mniSvneloba organizmis<br />
normaluri funqcionirebisTvis.<br />
warmoudgenelia adamianis arseboba <strong>kanis</strong><br />
gareSe, mag. arsebobs <strong>kanis</strong> erT-erTi<br />
mZime daavadeba “pemfigusi”, rodesac<br />
adamians kanze uCndeba mravlobiTi bu-<br />
Stebi. daavadebuls scildeba <strong>kanis</strong> safarveli<br />
da ikargeba siTxe. daavadebuli<br />
iRupeba gauwyloebisgan.<br />
ra funqciebi akisria mas?<br />
<strong>kanis</strong> funqciebi mravalia. yvelaze<br />
cnobili barieruli funqciaa, riTac<br />
kani icavs gare faqtorebisgan organizms.<br />
mag. ultraiisferi gamosxivebisgan<br />
da sxvadasxva toqsinebis SeWrisgan.<br />
aseve kanSi ganlagebuli imunuri sistemis<br />
ujredebi axorcieleben imunur<br />
pasuxs sxvadasxva moxvedrili antisxeulebis<br />
mimarT. kani masSi ganlagebuli<br />
saofle jirkvlebis da sisxlZarRvovani<br />
qselis saSualebiT ganaxorcielebs<br />
Termoregulaciur funqciebs, xolo<br />
dermaSi arsebuli nervuli daboloebebis<br />
xarjze ganapirobebs mgrZnobelobas.<br />
TiToeuli am funqciebis darRvevebs<br />
mZime Sedegebamde mivyavarT. mag. mgrZnobelobis<br />
gaqroba keTris dros iwvevs<br />
kidurebis deformacias, radgan avadmyofebi<br />
iReben e.w. SeumCnevel travmebs<br />
mravali wlis ganmavlobaSi.<br />
<strong>kanis</strong> ra saxis <strong>daavadebebi</strong><br />
arsebobs?<br />
<strong>kanis</strong> <strong>daavadebebi</strong> calke jgufs warmoadgens<br />
da maT Seiswavlis mecniereba<br />
dermatologia. arsebobs sakuTriv <strong>kanis</strong><br />
daaavadebebi, romlebic iyofa did jgufebad:<br />
Tandayolili, infeqciuri (romelic<br />
Tavis mxrivac SeiZleba davyoT baqteriul,<br />
virusul, sokovan da parazitul<br />
daavadebebad), simsivneebi (avTvisebiani<br />
da keTilTvisebiani), <strong>kanis</strong> anTebiTi <strong>daavadebebi</strong><br />
(dermatitebi), keratinizaciis<br />
darRveviT mimdinare da mravali sxva.<br />
calke jgufia <strong>daavadebebi</strong> romlebic<br />
vlindeba kanze Sinagani organoebis pa-<br />
Tologiebis dros.<br />
aris Tu ara kavSiri <strong>kanis</strong><br />
gamovlinebebsa da Sinagan<br />
daavadebebs Soris?<br />
xatovani naTqvamia, rom kani organizmis<br />
sarkes warmoadgens. kanze gamovlinebebi<br />
Sinagani organoebis mravali<br />
paTologiis Tanmxleb simptomebs warmoadgens.<br />
aseTi paTologiebia: avTvisebiani<br />
simsivneebi (svitis sindromi,<br />
pejetis daavadeba da a.S.), endokrinuli<br />
jirkvlebis paTologiebi (diabeturi<br />
dermopaTiebi, hipoTireozis dros <strong>kanis</strong><br />
gayviTleba, gasqeleba, frCxilebis<br />
mtvrevadoba da a.S.); saWmlis momnelebeli<br />
traqtis <strong>daavadebebi</strong> (siyviTle, purpura,<br />
angiomebi tuCebze, laqebi); Tirkmlebis<br />
<strong>daavadebebi</strong> (qavili, pigmentaciis<br />
Secvla, frCxilebis firfitis cvlile-
ebi, qserozi-simSrale, buStukovani gamonayari,<br />
kolagenozebi). calke jgufia<br />
aiv (adamianis imunodeficitis virusi)<br />
inficirebul pacientebSi <strong>kanis</strong> gamovlinebebi,<br />
rac 92% Seadgens. yovelive<br />
zemoTqmulidan gamomdinare, marTlac<br />
didi miSvneloba eniWeba <strong>kanis</strong> <strong>daavadebebi</strong>s<br />
Seswavlas da droul analizs.<br />
samwuxarod dRevandel saqarTveloSi<br />
pacientebi da aseve eqimebic moklebulni<br />
arian codnas Tanamedrove msoflio<br />
gamocdilebebis Sesaxeb, sadac mniSvnelovani<br />
nabijebi gadaidga dermatovenerologiaSi.<br />
am broSuraSi ufro<br />
vrclad visaubrebT saxis <strong>kanis</strong> yvelaze<br />
gavrcelebul daavadebebze - aknesa da<br />
rozaceaze da SevexebiT im mcdar warmodgenebs,<br />
romlebic ase farTodaa sazogadoebaSi<br />
damkvidrebuli.<br />
rogoria vulgaruli aknes<br />
gavrceleba?<br />
vulgaruli akne <strong>kanis</strong> erT-erT yvelaze<br />
gavrcelebuli daavadebaa, romelic<br />
awuxebs mosaxleobis daaxloebiT 85%-s<br />
12-25 wlis asakobriv SualedSi, da 11%-s<br />
25 wlis zeviT. igi gvxvdeba msoflios<br />
yvela rasaSi da Tanabrad nawildeba<br />
gen deruli niSniT. mozardTa asakSi mosaxleobis<br />
mier vulgaruli akne xSirad<br />
ganixileba rogorc <strong>kanis</strong> normaluri<br />
reaqcia e.w “gardatexis asakis” sapasuxod<br />
da pacientTa daaxloebiT 25% Tu<br />
akiTxavs <strong>kanis</strong> eqims “priSCikebis” gamo.<br />
miuxedavad amisa, aknes mqone pacienti<br />
dermatologis erT-erTi yvelaze xSiri<br />
stumaria.<br />
3<br />
aknes mZime klinikuri formebi upiratesad<br />
damaxasiaTebelia biWebisTvis,<br />
xolo daavadebis gaxangrZliveba 25 wlis<br />
zeviT ufro xSirad gvxvdeba gogonebSi.<br />
ras warmoadgens akne<br />
Tavisi arsiT da ratom<br />
viTardeba ZiriTadad<br />
mozardebSi?<br />
akne <strong>kanis</strong> cximovani jirkvlebisa da<br />
Tmis Zirebis Semomgarsvelis - folikulebis<br />
daavadebaa, romlis drosac<br />
jirkvlebis gamomtan sadinrebSi ujred-<br />
Ta Warbi gamravleba (hiperkeratozi)<br />
mimdinareobs, rac folikulis dacobas<br />
iwvevs da warmoSobs aknes msubuq elementebs<br />
- TeTr da SavTavian komedonebs.<br />
SavTaviani ferimWamelebi warmoadgenen<br />
mkvrivi, Savi Tavis mqone moruxo-moSavo<br />
sacobebs. isini upiratesad lokalizdebian<br />
cxvirze, nikapze, gulmkerdis winazeda<br />
zedapirsa da zurgze. TeTrTaviani<br />
ferimWamelebi – mkvrivi, wertilovani<br />
kvanZebia, romelnic ganlagebuli arian<br />
ufro saxeze, vidre tanze. Tmis folikulis<br />
sanaTuris dacoba iwvevs infeqciuri<br />
agentis (Propionbacteria. acne-s) gaaqtiurebas,<br />
romelic sapasuxo anTebiT<br />
reaqcias aviTarebs kanze zedapiruli,<br />
sxvadasxva zomis kvanZebisa da momcro<br />
Cirqovani buStukebis saxiT. procesis<br />
gaxangrZlivebasas mimdinareobs kanqveSa<br />
msxvili naxevarmTvarisebri, alublis<br />
kurkis zomis kvanZebis – konglobatebisa<br />
da kistebis Camoyalibeba.<br />
akne ZiriTadad azianebs saxes, iSvia-<br />
Tad tanis zeda nawils – gulmkerdis<br />
<strong>kanis</strong> <strong>daavadebebi</strong>, akne da rozacea
<strong>kanis</strong> <strong>daavadebebi</strong>, akne da rozacea<br />
4<br />
wina-zeda zedapirsa da zurgs. “upiratesad<br />
tanis forma” ufro metad damaxasiaTebelia<br />
mamakacebisTvis, vidre qalebisTvis.<br />
aknes mZime klinikuri formis<br />
Sesabamisi elementebi - kvanZebi da kistebi<br />
upiratesad tanzea ganlagebuli,<br />
vidre saxeze.<br />
ra aris aknes ganviTarebis<br />
xelSemwyobi faqtorebi?<br />
aknes ganviTarebas xels uwyobs cximovani<br />
jirkvlebis mier cximis gaZlierebuli<br />
gamoyofa (hiperseborea) da<br />
misi qimiuri Semadgenlobis cvlileba,<br />
rac Tavis mxriv qmnis aknes infeqciuri<br />
agentis gamravlebisTvis xelsayrel pirobebs.<br />
hiperseboreis mizezi bolomde<br />
garkveuli ar aris. mis ganviTarebaSi<br />
mniSvnelovani roli eniWeba memkvidrul<br />
faqtorebs, agreTve sxvadasxva hormonebs<br />
-yvelaze metad sqesobriv hormons<br />
- testosterons. garkveulad igi damokidebulia<br />
emociur faqtorebsa da sxvadasxva<br />
saxis darRvevebze centralur<br />
nervul sistemaSi.<br />
cnobilia, rom sqesobrivi momwifebis<br />
periodSi mimdinareobs sasqeso hormon-<br />
Ta funqciis saboloo Camoyalibeba. es<br />
procesi gansakuTrebiT moqmedebs hiperseboreaze<br />
– aknes ganviTarebis erTerT<br />
mniSvnelovan rgolze. ZiriTadad<br />
amiT aris ganpirobebuli aknes dawyebis<br />
“mizezad” “gardatexis asakis” miCneva.<br />
hormonul faqtorTa roli, ZiriTadad<br />
qalisa da mamakacis hormonTa<br />
Tanafardoba, gansakuTrebiT mniSvnelovania<br />
aknes ganviTarebisTvis qalebSi.<br />
swored amaze miuTiTebs aknes gamwvaveba<br />
menstruaciis win, fexmZimobis naadrevi<br />
Sewyvetisas, menstruaciuli ciklis<br />
darRvevasa da daavadebis dawyebas Soris<br />
xSiri kavSiri, aknes pirveli niSnebis<br />
gaCena mSobiarobis Semdeg, an qalis<br />
sasqeso organoTa anTebisas.<br />
aknes ganviTarebis aranakleb mniSvnelovan<br />
faqtorad iTvleba stresi.<br />
informacia stresiT gamowveuli aknes<br />
Sesaxeb mwiria da igi mxolod konkretuli<br />
eqsperimentebis Catarebisas vlindeba,<br />
magram akneTi gamowveuli stresis<br />
arseboba eWvs ar iwvevs. es ukanaskneli<br />
amZimebs da axangrZlivebs aknes mimdinareobas.<br />
rac Seexeba daavadebis memkvidreobiTobas,<br />
aRsaniSnavia is faqti, rom<br />
mozardTa aknes ganviTarebis albaToba<br />
gansakuTrebiT izrdeba im SemTxvevaSi,<br />
rodesac orive mSobeli daavadebuli<br />
iyo akneTi.<br />
ramdenad aris aknes<br />
gamwvaveba damokidebuli<br />
sezonze?<br />
sezonuri cvalebadobani naklebad<br />
aris damaxasiaTebeli aknesTvis. misi<br />
tanze gavrcelebis SemTxvevaSi, SesaZlebelia<br />
gamonayris ukuganviTareba<br />
zafxulis periodSi, mzisa da zRvis<br />
procedurebis Sedegad. ufro swored<br />
garujvis Sedegad xdeba anTebiTi procesis<br />
maskireba. rac Seexeba aknes saxismier<br />
formas - gaumjobeseba arcTu ise<br />
xSiria, SesaZlebelia sazafxulo procedurebma<br />
daavadeba gaamwvavos kidec.
a kavSiri aqvs kvebas aknes<br />
mimdinareobasTan?<br />
didi xnis ganmavlobaSi mosaxleoba-<br />
Si musirebda azri garkveuli sakvebi<br />
produqtebis, rogoricaa Sokoladis,<br />
nigozis, mzesumziris da a.S. uaryofiT<br />
gavlenaze daavadebis mimdinareobaze.<br />
magram mravalricxovanma Catarebulma<br />
kvlevebma uaryves es “braldeba”.<br />
rogoria aknes mkurnaloba?<br />
daavadeba iwyeba ra mozardobis asakSi<br />
igi grZeldeba wlebis ganmavlobaSi - 20-<br />
25 wlamde, zogjer ufro didxansac ki.<br />
Sesabamisad, xangrZlivia da xSirad ganmeorebadi<br />
mkurnalobis kursic. mkurnalobis<br />
mimdinareobis xangrZlivoba da<br />
misi ganmeorebis sixSire damokidebulia<br />
daavadebis simZimeze.<br />
aknes msubuqi formis dros Terapia<br />
mxolod adgilobrivi preparatebiT Semoifargleba.<br />
saSualo da mZime formebisas<br />
ki mkurnalobaSi sistemuri moqmedebis<br />
wamlebi erTveba. gansakuTrebuli<br />
mniSvneloba eniWeba sistemuri antibiotikebis<br />
swor SerCevas, romelic naklebadaa<br />
damokidebuli baqteriologiuri<br />
analizis pasuxze (e.w. “stafilokoki<br />
aRmomaCnda”). aknes infeqciuri agenti<br />
P. acne mxolod anaerobul (uJangbado)<br />
garemoSi izrdeba da aseT pirobebSi <strong>kanis</strong><br />
nacxis daTesva, ZviradRirebulia da<br />
Tanac saqarTveloSi mxolod erTeul<br />
laboratoriebSia SesaZlebeli. Jangbadian<br />
garemoSi, <strong>kanis</strong> nacxis pasuxSi mi-<br />
Rebuli stafilokoki da streptokoki<br />
5<br />
naklebmniSvnelovania rogorc daavadebis<br />
ganviTarebis, ise mkurnalobis Ser-<br />
Cevis saqmeSi. Sesabamisad, akneTi daavadebul<br />
pacientebs da maT axloblebs<br />
vurCevT eqimis miTiTebis gareSe naklebad<br />
mimarTon aseTi saxis gamokvlevas.<br />
Cveulebriv, aknes mZime formebis Sem-<br />
TxvevaSi antibiotikoTerapia SeiZleba<br />
gagrZeldes ramodenime Tvis ganmavlobaSi,<br />
an dainiSnos sistemuri retinoidi,<br />
rac arcTu iSviaTad mZime gadasatania<br />
pacientisTvis.<br />
sworad SerCeuli<br />
preparatebi da Terapiuli<br />
kursis xangrZlivoba<br />
aucilebeli pirobaa<br />
imisTvis, rom remisia<br />
ufro xangrZlivi iyos,<br />
xolo Semdgomi gamwvavebis<br />
klinikuri gamovlineba -<br />
naklebi simZimis.<br />
mozardTa aknes mqone pacientebs da<br />
maT mSoblebs vurCevT, rom daavadebis<br />
pirveli niSnebis gaCenisTanave Tu ara,<br />
misi progresirebis SemCnevisTanave, mimarTon<br />
dermatologs da ara kosmetologis<br />
rCeviT miiRon sarecepto preparatebi.<br />
droulad dawyebuli mkurnaloba<br />
imis sawindaria, rom pacients naklebad<br />
daWirdeba xangrZlivi Terapiuli<br />
kursis Catareba da mozardTa akne aRar<br />
gagrZeldeba didxans.<br />
daskvnis saxiT SeiZleba iTqvas rom<br />
aknes sami ZiriTadi faqtori ganapirobebs:<br />
hipeseborea, hiperkeratinizacia<br />
da anTeba. am samive faqtoris cal-cal-<br />
<strong>kanis</strong> <strong>daavadebebi</strong>, akne da rozacea
<strong>kanis</strong> <strong>daavadebebi</strong>, akne da rozacea<br />
6<br />
ke da erTiani mkurnaloba eqimis prerogativaa.<br />
xolo eseTi miTebi rogorebicaa:<br />
gaTxovdebi gaivlis, an colis<br />
moyvanis droa, an etyoba tkbileuls Wam<br />
bevrs, an yava ar dalio, an vitaminebi<br />
gWirdeba da mravali sxva, rac TiTqmis<br />
yoveldRiurad gvesmis, rogorc pacientis<br />
gulSematkivrebisgan, aseve savalalod<br />
eqimebisgan, dromoWmulia.<br />
ras warmoadgens rozacea?<br />
rozacea (laTinurad “vardis magvari”)<br />
saxis <strong>kanis</strong> aknesmagvari daavadebaa,<br />
romelic mimdinareobs upiratesed<br />
saxis Tmovani da cximovani aparatebis<br />
dazianebiT, Tveebisa da zogjer wlebis<br />
ganmavlobaSi. misTvis damaxasiaTebelia<br />
<strong>kanis</strong> gawiTleba, movardisfro-mowiTalo<br />
laqebis, momcro kvanZebisa da<br />
kvanZebis gaCena. garda amisa, daavadebis<br />
xagrZlivi midinareobisas kanze Cndeba<br />
gafarToebul kapilarTa qseli. mZime<br />
formebisas viTardeba <strong>kanis</strong> gasqeleba,<br />
romelic saxis, upiratesad ki cxviris<br />
deformacias iwvevs. igi rinofimas saxelwodebiTaa<br />
cnobili.<br />
Cveulebriv ferimWamelasgan gansxvavebiT<br />
rozacea upiratesad gavrcelebulia<br />
qalebSi 30-dan 50 wlamde. TeTrkanianebSi<br />
igi ufro xSiria, vidre muqkanianebSi.<br />
ra iwvevs rozaceas?<br />
rozaceas warmoSobis mizezebi da ganviTarebis<br />
meqanizmi jer-jerobiT garkveuli<br />
ar aris. pacientebi warsulSi<br />
arcTu iSviaTad uCivian saxis epizodur<br />
gawiTlebas da <strong>kanis</strong> simxurvalis SegrZnebas,<br />
romelTa gaCenac xSirad dakavSirebulia<br />
cxeli sasmelis, alkoholis,<br />
cxare sakvebis an mzis abazanebis miRebasTan,<br />
an gaxurebul qurasTan xangrZlivi<br />
drois gatarebasTan.<br />
rogor vumkurnaloT<br />
rozaceas?<br />
akne zogierT SemTxvevaSi SesaZlebelia<br />
win uswrebdes rozaceas, magram<br />
Cveulebriv, igi vardisferi ferimWamelis<br />
ganviTarebis winapirobas ar warmoadgens.<br />
Sesabamisad, rozaceas mkurnaloba<br />
gansxvavdeba aknes mkurnalobisagan.<br />
igi mocavs rogorc adgilobrivi,<br />
ise sistemuri moqmedebis preparatebs.<br />
maTi dozireba da mkurnalobis xangrZlivoba<br />
gamonayaris gavrcelebasa da sim-<br />
Zimezea damokidebuli. mkurnalobis ar<br />
Catarebis SemTxvevaSi SeiZleba adgili<br />
hqondes sxvadasxva saxis garTulebas.<br />
dazianebul kanze arcTu iSviaTad fexs<br />
ikidebs infeqcia - strepto-stafilokokisa<br />
da <strong>kanis</strong> parazitis - demodeqsis<br />
saxiT. xolo xangrZlivi mimdinareobisas<br />
ki, viTardeba <strong>kanis</strong> gasqeleba da<br />
deformacia. es ukanaskneli ki mxolod<br />
qirurgiul, an lazerul-qirugiul Carevas<br />
eqvemdebareba.<br />
rogorc aknes, ise rozaceas SemTxvevaSi<br />
gamonayari upiratesad lokalizebulia<br />
saxeze, rac arcTu iSviaTad<br />
didi fsiqologiuri stresia pacient-<br />
TaTvis; maT uviTardebaT SfoTviT-depresiuli<br />
mdgomareoba, rac Tavis mxriv<br />
amZimebs daavadebis mimdinareobas.
ase, rom drouli da swori mkurnaloba<br />
iwvevs pacientis rogorc fizikuri, ise<br />
fsiqikuri mdgomareobis gaumjobesebas.<br />
aris SemTxvevebi, rodesac saxeze gamonayaris<br />
gaCenisas pacienti mimarTavs<br />
“kosmetiCkas” saxis “gasawmendad”, rasac<br />
moyveba drobiTi erT-or dRiani gaumjobeseba<br />
da Semdeg gamonayaris momateba.<br />
aRsaniSnavia, rom mocemuli daavadebisas,<br />
gansakuTrebiT <strong>kanis</strong> anTebiTi<br />
elementebis arsebobisas, dauSvebelia<br />
aseTi saxis procedurebis Catareba.<br />
pirvel rigSi pacientma unda imkurnalos<br />
ZiriTadi daavadebis Sesabamisad,<br />
xolo Semdeg mimarTos kosmetologs.<br />
rogorc ukve aRvniSneT, rogorc<br />
aknes, ise rozaceas mkurnaloba arcTu<br />
iSviaTad xangrZliv da ganmeorebad xasiaTs<br />
atarebs. pacients ki sWirdeba, rom<br />
saxe hqondes wesrigSi mkuralobis procesSic,<br />
amitom igi mimarTavs dekorati-<br />
dausviT SekiTxva “Tqvens eqims”<br />
telefonis nomerze: 91 90 10<br />
eleqtronul misamarTze: n.korsantia@ho.gpc.ge<br />
an “wiTeli A”-s afTiaqebSi moiTxoveT da<br />
SeavseT specialuri kiTxvarebi<br />
uyureT gadacemas<br />
`Tqveni eqimi”, kviras 13:15 imedis arxze<br />
7<br />
ul makiaJs. sasurvelia, rom pacientma<br />
igi rac SeiZleba iSviaTad gamoiyenos,<br />
mxolod aucileblobis SemTxvevaSi,<br />
xolo makiaJi specialistis mier Ser-<br />
Ceuli krem-pudriT iqnas gakeTebuli.<br />
cximovani malamoebisa, Tu mkvebavebis<br />
gamoyeneba mizanSewonili ar aris.<br />
Cven SevexeT saxis <strong>kanis</strong> or gavrcelebul<br />
daavadebas, romelnic upiratesed<br />
saxes azianeben da isini SeiZleba<br />
mniSvnelovnad arRvevdnen cxovrebisa<br />
da muSaobis normalur ritms; garda<br />
amisa, garkveul problemebs uqmnidnen<br />
pacientebs saxis <strong>kanis</strong> movlis saqmeSi.<br />
vimedovnebT, rom kanze warmoSobili<br />
arasasurveli cvlilebebis gaCenisas<br />
zemoTaRniSnuli informacia saSualebas<br />
mogcemT droulad mimarToT specialists<br />
da swrafad daubrundeT cxovrebis<br />
normalur ritms.<br />
efeqturi saSualeba<br />
rozaceas, aknesa da perioraluri<br />
dermatitis garegan TerapiaSi<br />
<strong>kanis</strong> <strong>daavadebebi</strong>, akne da rozacea
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