CLASS XII. DISEASES OF THE SKIN AND SUBCUTANEOUS FIBRE (L00-L99)

This class contains the following blocks:
L00-L04 Infections of the skin and subcutaneous tissue
L10-L14 bullous disorders
L20-L30 Dermatitis and eczema
L40-L45 Papulosquamous disorders
L50-L54 Urticaria and erythema
L55-L59 Diseases of the skin and subcutaneous tissue associated with radiation
L60-L75 Diseases of the skin appendages
L80-L99 Other diseases of the skin and subcutaneous tissue

The following categories are marked with an asterisk:
L14* Bullous skin disorders in diseases classified elsewhere
L45* Papulosquamous disorders in diseases classified elsewhere

L54* Erythema in diseases classified elsewhere
L62* Nail changes in diseases classified elsewhere
L86* Keratoderma in diseases classified elsewhere
L99* Other disorders of the skin and subcutaneous tissue in diseases classified elsewhere

SKIN AND SUBCUTANEOUS TABLE INFECTIONS (L00-L08)

If necessary, identify infectious agent use additional code ( B95-B97).

Excluded: hordeolum ( H00.0)
infectious dermatitis ( L30.3)
local skin infections classified in class I,
such as:
erysipelas ( A46)
erysipeloid ( A26. -)
herpetic viral infection (B00. -)
anogenital ( A60. -)
molluscum contagiosum (B08.1)
mycoses ( B35-B49)
pediculosis, acariasis and other infestations ( B85-B89)
viral warts ( B07)
panniculitis:
NOS ( M79.3)
lupus ( L93.2)
neck and back ( M54.0)
recurrent [Weber-Christian] ( M35.6)
lip adhesion crack [jamming] (due to):
NOS ( K13.0)
candidiasis ( B37. -)
riboflavin deficiency ( E53.0)
pyogenic granuloma ( L98.0)
herpes zoster ( B02. -)

L00 Staphylococcal skin lesion syndrome in the form of burn-like blisters

Pemphigus of the newborn
Ritter's disease
Excludes: toxic epidermal necrolysis [Lyella] ( L51.2)

L01 Impetigo

Excludes: impetigo herpetiformis ( L40.1)
pemphigus of the newborn L00)

L01.0 Impetigo [caused by any organism] [any location]. Impetigo Bockhart
L01.1 Impetiginization of other dermatoses

L02 Skin abscess, furuncle and carbuncle

Includes: boil
furunculosis
Excluded: areas anus and rectum ( K61. -)
genital organs (external):
women's ( N76.4)
male ( N48.2, N49. -)

L02.0 Skin abscess, furuncle and carbuncle of the face
Excludes: external ear ( H60.0)
century ( H00.0)
head [any part other than the face] ( L02.8)
lacrimal:
glands ( H04.0)
paths ( H04.3)
mouth ( K12.2)
nose ( J34.0)
eye sockets ( H05.0)
submandibular ( K12.2)
L02.1 Skin abscess, furuncle and carbuncle of the neck

L02.2 Skin abscess, furuncle and carbuncle of the trunk. Abdominal wall. Back [any part except buttocks]. chest wall. Inguinal region. Perineum. navel
Excludes: mammary gland ( N61)
pelvic girdle ( L02.4)
omphalitis of the newborn P38)
L02.3 Skin abscess, furuncle and carbuncle of the buttocks. Gluteal region
Excludes: pilonidal cyst with abscess ( L05.0)
L02.4 Skin abscess, furuncle and carbuncle of the limb
L02.8 Skin abscess, furuncle and carbuncle of other localizations
L02.9 Skin abscess, furuncle and carbuncle of unspecified localization. Furunculosis NOS

L03 Phlegmon

Includes: acute lymphangitis
Excludes: phlegmon:
anus and rectum ( K61. -)
external auditory canal ( H60.1)
external genitalia:
women's ( N76.4)
male ( N48.2, N49. -)
century ( H00.0)
lacrimal apparatus ( H04.3)
mouth ( K12.2)
nose ( J34.0)
eosinophilic cellulitis [Vels] ( L98.3)
febrile (acute) neutrophilic dermatosis [Svita] ( L98.2)
lymphangitis (chronic) (subacute) ( I89.1)

L03.0 Phlegmon of fingers and toes
Nail infection. Onychia. Paronychia. Peronychia
L03.1 Phlegmon of other parts of the limbs
Armpit. Pelvic girdle. shoulder
L03.2 Phlegmon of the face
L03.3 Phlegmon of the body. Walls of the abdomen. Back [of any part]. chest wall. Groin. Perineum. navel
Excludes: neonatal omphalitis ( P38)
L03.8 Phlegmon of other localizations
Head [of any part other than the face]. scalp
L03.9 Phlegmon, unspecified

L04 Acute lymphadenitis

Includes: abscess (acute) of any lymph node
acute lymphadenitis) except mesenteric
Excluded: increase lymph nodes (R59. -)
human immunodeficiency virus disease
[HIV], manifesting as a generalized
lymphadenopathy ( B23.1)
lymphadenitis:
NOS ( I88.9)
chronic or subacute, other than mesenteric ( I88.1)
mesenteric nonspecific ( I88.0)

L04.0 Acute lymphadenitis face, head and neck
L04.1 Acute lymphadenitis of the trunk
L04.2 Acute lymphadenitis of the upper limb. Armpit. shoulder
L04.3 Acute lymphadenitis lower limb. pelvic girdle
L04.8 Acute lymphadenitis of other localizations
L04.9 Acute lymphadenitis, unspecified

L05 Pilonidal cyst

Includes: fistula coccygeal or
sinus) pilonidal

L05.0 Pilonidal cyst with abscess
L05.9 Pilonidal cyst without abscesses. Pilonidal cyst NOS

L08 Other local skin and subcutaneous tissue infections

L08.0 pyoderma
Dermatitis:
purulent
septic
pyogenic
Excludes: pyoderma gangrenosum L88)
L08.1 erythrasma
L08.8 Other specified local skin and subcutaneous tissue infections
L08.9 Local infection of skin and subcutaneous tissue, unspecified

BULLOUS DISORDERS (L10-L14)

Excludes: benign (chronic) familial pemphigus
[Hailey-Hailey disease] ( Q82.8)
syndrome of staphylococcal skin lesions in the form of burn-like blisters ( L00)
toxic epidermal necrolysis [Lyell's syndrome] ( L51.2)

L10 Pemphigus [pemphigus]

Excludes: pemphigus neonatal L00)

L10.0 Pemphigus vulgaris
L10.1 Pemphigus vegetative
L10.2 Pemphigus foliaceus
L10.3 Pemphigus brazilian
L10.4 Pemphigus is erythematous. Senier-Uscher Syndrome
L10.5 Pemphigus caused by drugs
L10.8 Other types of pemphigus
L10.9 Pemphigus, unspecified

L11 Other acantholytic disorders

L11.0 Acquired keratosis follicularis
Excludes: keratosis follicularis (congenital) [Darieu-White] ( Q82.8)
L11.1 Transient acantholytic dermatosis [Grover's]
L11.8 Other specified acantholytic changes
L11.9 Acantholytic changes, unspecified

L12 Pemphigoid

Excludes: herpes of pregnancy ( O26.4)
herpetiform impetigo ( L40.1)

L12.0 bullous pemphigoid
L12.1 Scarring pemphigoid. Benign mucosal pemphigoid [Levera]
L12.2 Chronic bullous disease in children. Juvenile dermatitis herpetiformis
L12.3 Acquired epidermolysis bullosa
Excludes: epidermolysis bullosa (congenital) ( Q81. -)
L12.8 Other pemphigiodes
L12.9 Pemphigoid, unspecified

L13 Other bullous changes

L13.0 Dermatitis herpetiformis. Duhring's disease
L13.1 Subcorneal pustular dermatitis. Sneddon-Wilkinson disease
L13.8 Other specified bullous changes
L13.9 Bullous changes, unspecified

L14* Bullous skin disorders in diseases classified elsewhere

DERMATITIS AND ECZEMA (L20-L30)

Note In this block, the terms "dermatitis" and "eczema" are used interchangeably synonymously.
Excludes: chronic (childhood) granulomatous disease ( D71)
dermatitis:
dry skin ( L85.3)
artificial ( L98.1)
gangrenous ( L88)
herpetiformis ( L13.0)
perioral ( L71.0)
stagnant ( I83.1 — I83.2 )
diseases of the skin and subcutaneous tissue associated with exposure to radiation ( L55-L59)

L20 Atopic dermatitis

Excludes: localized neurodermatitis ( L28.0)

L20.0 Scabies Beignet
L20.8 Other atopic dermatitis
Eczema:
flexion NEC
pediatric (acute) (chronic)
endogenous (allergic)
Neurodermatitis:
atopic (localized)
diffuse
L20.9 Atopic dermatitis, unspecified

L21 Seborrheic dermatitis

Excludes: infectious dermatitis ( L30.3)

L21.0 Seborrhea of ​​the head. "Baby cap"
L21.1 Seborrheic dermatitis in children
L21.8 Other seborrheic dermatitis
L21.9 Seborrheic dermatitis, unspecified

L22 Diaper dermatitis

Diaper:
erythema
rash
Psoriasis-like rash caused by diapers

L23 Allergic contact dermatitis

Includes: allergic contact eczema
Excludes: allergy NOS ( T78.4)
dermatitis:
NOS ( L30.9)
contact NOS ( L25.9)
diaper ( L22)
L27. -)
century ( H01.1)
simple irritable contact ( L24. -)
perioral ( L71.0)
eczema of the outer ear H60.5)
diseases of the skin and subcutaneous tissue associated with exposure to radiation ( L55-L59)

L23.0 Allergic contact dermatitis caused by metals. Chrome. Nickel
L23.1 Allergic contact dermatitis due to adhesives
L23.2 Allergic contact dermatitis caused by cosmetics
L23.3 Allergic contact dermatitis caused by drugs in contact with the skin
If necessary, identify medicine use additional code external causes(class XX).
T88.7)
L27.0-L27.1)
L23.4 Allergic contact dermatitis caused by dyes
L23.5 Allergic contact dermatitis caused by other chemicals
Cement. insecticides. Plastic. Rubber

L23.6 Allergic contact dermatitis caused by food in contact with the skin
L27.2)
L23.7 Allergic contact dermatitis caused by plants other than food
L23.8 Allergic contact dermatitis due to other substances
L23.9 Allergic contact dermatitis, cause unknown. Allergic contact eczema NOS

L24 Simple irritant contact dermatitis

Includes: simple irritant contact eczema
Excludes: allergy NOS ( T78.4)
dermatitis:
NOS ( L30.9)
allergic contact ( L23. -)
contact NOS ( L25.9)
diaper ( L22)
caused by substances taken orally ( L27. -)
century ( H01.1)
perioral ( L71.0)
eczema of the outer ear H60.5)
diseases of the skin and subcutaneous tissue associated with
with exposure to radiation ( L55-L59)

L24.0 Simple irritant contact dermatitis caused by detergents
L24.1 Simple irritant contact dermatitis caused by oils and lubricants
L24.2 Simple irritant contact dermatitis caused by solvents
Solvents:
chlorine-containing)
cyclohexanoic)
ethereal)
glycolic) group
hydrocarbon)
ketone)
L24.3 Simple irritant contact dermatitis caused by cosmetics
L24.4 Irritant contact dermatitis caused by drugs in contact with the skin
If necessary, to identify the medicinal product, use an additional external cause code (class XX).
Excludes: drug-induced allergy NOS ( T88.7)
drug-induced dermatitis L27.0-L27.1)
L24.5 Simple irritant contact dermatitis caused by other chemicals
Cement. Insecticides
L24.6 Simple irritant contact dermatitis caused by food in contact with the skin
Excludes: dermatitis due to ingested food ( L27.2)
L24.7 Simple irritant contact dermatitis caused by plants other than food
L24.8 Simple irritant contact dermatitis caused by other substances. Dyes
L24.9 Simple irritant contact dermatitis, cause unspecified. Irritant contact eczema NOS

L25 Contact dermatitis, unspecified

Includes: contact eczema, unspecified
Excludes: allergy NOS ( T78.4)
dermatitis:
NOS ( L30.9)
allergic contact ( L23. -)
caused by substances taken orally ( L27. -)
century ( H01.1)
simple irritable contact ( L24. -)
perioral ( L71.0)
eczema of the outer ear H60.5)
lesions of the skin and subcutaneous tissue associated with
with exposure to radiation ( L55-L59)

L25.0 Unspecified contact dermatitis due to cosmetics
L25.1 Unspecified contact dermatitis due to drugs in contact with the skin
If necessary, to identify the medicinal product, use an additional external cause code (class XX).
Excludes: drug-induced allergy NOS ( T88.7)
drug-induced dermatitis L27.0-L27.1)
L25.2 Unspecified contact dermatitis due to dyes
L25.3 Unspecified contact dermatitis due to other chemicals. Cement. Insecticides
L25.4 Unspecified contact dermatitis due to food in contact with skin
Excludes: contact dermatitis due to ingested food ( L27.2)
L25.5 Unspecified contact dermatitis due to plants other than food
L25.8 Unspecified contact dermatitis due to other substances
L25.9 Unspecified contact dermatitis, cause unspecified
Contact(s):
dermatitis (occupational) NOS
eczema (occupational) NOS

L26 Exfoliative dermatitis

Pityriasis Gebra
Excludes: Ritter's disease ( L00)

L27 Dermatitis due to substances ingested

Excludes: unfavorable:
drug exposure NOS ( T88.7)
reaction to food, excluding dermatitis ( T78.0-T78.1)
allergic reaction NOS ( T78.4)
contact dermatitis ( L23-l25)
medicinal:
photoallergic reaction L56.1)
phototoxic reaction ( L56.0)
urticaria ( L50. -)

L27.0 Generalized skin rash caused by drugs and medications
If necessary, to identify the medicinal product, use an additional external cause code (class XX).
L27.1 Localized skin rash caused by drugs and medications
If necessary, to identify the medicinal product, use an additional external cause code (class XX).
L27.2 Dermatitis due to ingested food
Excludes: dermatitis caused by food in contact with skin ( L23.6, L24.6, L25.4)
L27.8 Dermatitis caused by other substances ingested
L27.9 Dermatitis due to unspecified substances ingested

L28 Lichen simplex chronicus and pruritus

L28.0 Simple chronic lichen. Limited neurodermatitis. Ringworm NOS
L28.1 Scabies knotty
L28.2 Another pruritus
Scabies:
NOS
Hebra
mitis
Urticaria papular

L29 Itching

Excludes: neurotic scratching of the skin ( L98.1)
psychogenic itching ( F45.8)

L29.0 Itching of the anus
L29.1 Itching of the scrotum
L29.2 Itching of the vulva
L29.3 Anogenital pruritus, unspecified
L29.8 Another itch
L29.9 Itching, unspecified. Itching NOS

L30 Other dermatitis

Excludes: dermatitis:
contact ( L23-L25)
dry skin ( L85.3)
small-plaque parapsoriasis ( L41.3)
stasis dermatitis ( I83.1-I83.2)

L30.0 Coin eczema
L30.1 Dyshidrosis [pompholyx]
L30.2 Skin autosensitization. Candidal. Dermatophytous. eczematous
L30.3 Infectious dermatitis
Infectious eczema
L30.4 Erythematous diaper rash
L30.5 Pityriasis white
L30.8 Other specified dermatitis
L30.9 Dermatitis, unspecified
Eczema NOS

PAPULOSQUAMOUS DISORDERS (L40-L45)

L40 Psoriasis

L40.0 Psoriasis vulgaris. Coin psoriasis. plaque
L40.1 Generalized pustular psoriasis. Impetigo herpetiformis. Zumbusch disease
L40.2 Acrodermatitis persistent [Allopo]
L40.3 Pustulosis palmar and plantar
L40.4 Guttate psoriasis
L40.5+ Arthropathic psoriasis ( M07.0-M07.3*, M09.0*)
L40.8 Another psoriasis. Flexion inverse psoriasis
L40.9 Psoriasis, unspecified

L41 Parapsoriasis

Excludes: atrophic vascular poikiloderma ( L94.5)

L41.0 Pityriasis lichenoid and pox-like acute. Fly-Habermann disease
L41.1 Pityriasis lichenoid chronic
L41.2 Lymphomatoid papulosis
L41.3 Small plaque parapsoriasis
L41.4 Large plaque parapsoriasis
L41.5 Reticulate parapsoriasis
L41.8 Other parapsoriasis
L41.9 Parapsoriasis, unspecified

L42 Pityriasis rosea [Gibera]

L43 Lichen red flat

Excludes: lichen planus ( L66.1)

L43.0 Lichen hypertrophic red flat
L43.1 Ringworm red flat bullous
L43.2 Lichen reaction to a drug
If necessary, to identify the medicinal product, use an additional external cause code (class XX).
L43.3 Lichen red flat subacute (active). Lichen red flat tropical
L43.8 Other lichen planus
L43.9 Ringworm red flat, unspecified

L44 Other papulosquamous changes

L44.0 Pityriasis red hairy pityriasis
L44.1 Lichen brilliant
L44.2 Lichen linear
L44.3 Ringworm red moniliformis
L44.4 Pediatric papular acrodermatitis [Gianotti-Crosti syndrome]
L44.8 Other specified papulosquamous changes
L44.9 Papulosquamous changes, unspecified

L45* Papulosquamous disorders in diseases classified elsewhere

urticaria and erythema (L50-L54)

Excludes: Lyme disease ( A69.2)
rosacea ( L71. -)

L50 Urticaria

Excludes: allergic contact dermatitis ( L23. -)
angioedema (angioedema) T78.3)
hereditary vascular edema ( E88.0)
Quincke's edema ( T78.3)
hives:
giant ( T78.3)
newborn ( P83.8)
papular ( L28.2)
pigmented ( Q82.2)
whey ( T80.6)
solar ( L56.3)

L50.0 Allergic urticaria
L50.1 Idiopathic urticaria
L50.2 Urticaria caused by exposure to low or high temperature
L50.3 Dermatographic urticaria
L50.4 vibration urticaria
L50.5 Cholinergic urticaria
L50.6 contact urticaria
L50.8 Other urticaria
Hives:
chronic
periodic recurring
L50.9 Urticaria, unspecified

L51 Erythema multiforme

L51.0 Non-bullous erythema multiforme
L51.1 Bullous erythema multiforme. Stevens-Johnson Syndrome
L51.2 Toxic epidermal necrolysis [Lyella]
L51.8 Other erythema multiforme
L51.9 Erythema multiforme, unspecified

L52 Erythema nodosum

L53 Other erythematous conditions

Excludes: erythema:
burn ( L59.0)
arising from skin contact with external agents ( L23-L25)
diaper rash ( L30.4)

L53.0 Toxic erythema
Use an additional external cause code (class XX) if necessary to identify the toxic substance.
Excludes: neonatal toxic erythema ( P83.1)
L53.1 Erythema annulare centrifugal
L53.2 Erythema marginal
L53.3 Other chronic patterned erythema
L53.8 Other specified erythematous conditions
L53.9 Erythematous condition, unspecified. Erythema NOS. erythroderma

L54* Erythema in diseases classified elsewhere

L54.0* Marginal erythema in acute articular rheumatism ( I00+)
L54.8* Erythema in other diseases classified elsewhere

DISEASES OF THE SKIN AND SUBCUTANEOUS FIBRE,
RELATED TO RADIATION EXPOSURE (L55-L59)

L55 Sunburn

L55.0 First degree sunburn
L55.1 Second degree sunburn
L55.2 Third degree sunburn
L55.8 Another sunburn
L55.9 Sunburn, unspecified

L56 Other acute skin changes caused by ultraviolet radiation

L56.0 drug phototoxic reaction
If necessary, to identify the medicinal product, use an additional external cause code (class XX).
L56.1 drug photoallergic reaction
If necessary, to identify the medicinal product, use an additional external cause code (class XX).
L56.2 Photocontact dermatitis
L56.3 solar urticaria
L56.4 Polymorphic light rash
L56.8 Other specified acute skin changes caused by ultraviolet radiation
L56.9 Acute skin change caused by ultraviolet radiation, unspecified

L57 Skin changes due to chronic exposure to non-ionizing radiation

L57.0 Actinic (photochemical) keratosis
Keratosis:
NOS
senile
solar
L57.1 actinic reticuloid
L57.2 Rhombic skin on the back of the head (neck)
L57.3 Poikiloderma Civatta
L57.4 Senile atrophy (flaccidity) of the skin. Senile elastosis
L57.5 Actinic [photochemical] granuloma
L57.8 Other skin changes caused by chronic exposure to non-ionizing radiation
Farmer's skin. Sailor skin. Solar dermatitis
L57.9 Skin change caused by chronic exposure to non-ionizing radiation, unspecified

L58 Radiation dermatitis, radiation

L58.0 Acute radiation dermatitis
L58.1 Chronic radiation dermatitis
L58.9 Radiation dermatitis, unspecified

L59 Other diseases of the skin and subcutaneous tissue associated with radiation

L59.0 Burn erythema [dermatitis ab igne]
L59.8 Other specified skin and subcutaneous tissue diseases associated with radiation
L59.9 Radiation-related skin and subcutaneous tissue disease, unspecified

DISEASES OF THE SKIN ADDITIONS (L60-L75)

Excludes: congenital malformations of integument ( Q84. -)

L60 Diseases of nails

Excludes: club nails ( R68.3)
onychia and paronychia ( L03.0)

L60.0 Ingrown nail
L60.1 Onycholysis
L60.2 Onychogryphosis
L60.3 Nail dystrophy
L60.4 Bo lines
L60.5 yellow nail syndrome
L60.8 Other nail diseases
L60.9 Disease of the nail, unspecified

L62* Nail changes in diseases classified elsewhere

L62.0* Club-shaped nail with pachydermoperiostosis ( M89.4+)
L62.8* Nail changes in other diseases classified elsewhere

L63 Alopecia areata

L63.0 Alopecia total
L63.1 Alopecia universalis
L63.2 Nest baldness (ribbon shape)
L63.8 Other alopecia areata
L63.9 Alopecia areata, unspecified

L64 Androgenetic alopecia

Included: male pattern baldness

L64.0 Androgenetic alopecia due to medication
If necessary, to identify the medicinal product, use an additional external cause code (class XX).
L64.8 Other androgenetic alopecia
L64.9 Androgenetic alopecia, unspecified

L65 Other non-scarring hair loss

Excludes: trichotillomania ( F63.3)

L65.0 Telogen hair loss
L65.1 Anagenic hair loss. Regenerating miasma
L65.2 Alopecia mucinous
L65.8 Other specified non-scarring hair loss
L65.9 Non-scarring hair loss, unspecified

L66 Scarring alopecia

L66.0 Alopecia spotted scarring
L66.1 Ringworm flat hair. Follicular lichen planus
L66.2 Folliculitis leading to baldness
L66.3 Perifolliculitis of the head abscessing
L66.4 Folliculitis reticular scarring erythematous
L66.8 Other scarring alopecia
L66.9 Scarring alopecia, unspecified

L67 Anomalies of hair color and hair shaft

Excludes: knotty hair ( Q84.1)
beaded hair ( Q84.1)
telogen hair loss ( L65.0)

L67.0 Trichorrhexis nodosum
L67.1 Hair color changes. Gray hair. Graying (premature). hair heterochromia
Poliosis:
NOS
limited acquired
L67.8 Other anomalies in the color of the hair and hair shaft. Hair breakage
L67.9 Anomaly of hair color and hair shaft, unspecified

L68 Hypertrichosis

Includes: excessive hairiness
Excludes: congenital hypertrichosis ( Q84.2)
resistant vellus hair ( Q84.2)

L68.0 hirsutism
L68.1 Hypertrichosis vellus hair acquired
If necessary, to identify the medicinal product that caused the violation, use an additional external cause code (class XX).
L68.2 Localized hypertrichosis
L68.3 Polytrichia
L68.8 Other hypertrichosis
L68.9 Hypertrichosis, unspecified

L70 Acne

Excludes: keloid acne ( L73.0)

L70.0 Common acne [acne vulgaris]
L70.1 Acne globular
L70.2 Smallpox acne. Acne necrotic miliary
L70.3 Tropical eels
L70.4 Baby acne
L70.5 Acne excoriee des jeunes filles
L70.8 Other acne
L70.9 Acne, unspecified

L71 Rosacea

L71.0 Perioral dermatitis
If necessary, identify medicinal product that caused the defeat, use an additional code of external causes (class XX).
L71.1 Rinofima
L71.8 Another type of rosacea
L71.9 Rosacea, unspecified

L72 Follicular cysts of skin and subcutaneous tissue

L72.0 epidermal cyst
L72.1 Trichodermal cyst. Hair cyst. sebaceous cyst
L72.2 Stiatocystoma multiple
L72.8 Other follicular cysts of the skin and subcutaneous tissue
L72.9 Follicular cyst skin and subcutaneous tissue, unspecified

L73 Other diseases of hair follicles

L73.0 Acne keloid
L73.1 Beard hair pseudofolliculitis
L73.2 Hydradenitis purulent
L73.8 Other specified diseases of follicles. Sycosis of the beard
L73.9 Disease hair follicles unspecified

L74 Diseases of merocrine [eccrine] sweat glands

Excludes: hyperhidrosis ( R61. -)

L74.0 Red prickly heat
L74.1 Crystal prickly heat
L74.2 The sweat is deep. Tropical anhidrosis
L74.3 Prickly heat, unspecified
L74.4 Anhidrosis. hypohidrosis
L74.8 Other diseases of the merocrine sweat glands
L74.9 Disturbance of merocrine sweating, unspecified. Sweat gland disorder NOS

L75 Diseases of apocrine sweat glands

Excludes: dyshidrosis [pompholyx] ( L30.1)
purulent hidradenitis ( L73.2)

L75.0 Bromhidrosis
L75.1 Chromhidrosis
L75.2 Apocrine sweating. Fox-Fordyce disease
L75.8 Other diseases of the apocrine sweat glands
L75.9 Defeat of apocrine sweat glands, unspecified

OTHER DISEASES OF THE SKIN AND SUBCUTANEOUS FIBRE (L80-L99)

L80 Vitiligo

L81 Other pigmentation disorders

Excludes: birthmark NOS ( Q82.5)
nevus - see Alphabetical index
Peutz-Gigers (Touraine) syndrome ( Q85.8)

L81.0 Post-inflammatory hyperpigmentation
L81.1 Chloasma
L81.2 Freckles
L81.3 coffee stains
L81.4 Other melanin hyperpigmentation. Lentigo
L81.5 Leucoderma, not elsewhere classified
L81.6 Other disorders associated with reduced melanin production
L81.7 Pigmented red dermatosis. Creeping angioma
L81.8 Other specified pigmentation disorders. iron pigmentation. tattoo pigmentation
L81.9 Pigmentation disorder, unspecified

L82 Seborrheic keratosis

Dermatosis papular black
Leather-Trela ​​disease

L83 Acanthosis nigricans

Confluent and reticular papillomatosis

L84 Corns and calluses

Callus (callus)
Wedge-shaped callus (clavus)

L85 Other epidermal thickenings

Excludes: hypertrophic skin conditions ( L91. -)

L85.0 Acquired ichthyosis
Excludes: congenital ichthyosis ( Q80. -)
L85.1 Acquired keratosis [keratoderma] palmoplantar
Excludes: hereditary keratosis palmoplantar ( Q82.8)
L85.2 Keratosis punctate (palm-plantar)
L85.3 Skin xerosis. Dry skin dermatitis
L85.8 Other specified epidermal thickenings. Skin horn
L85.9 Epidermal thickening, unspecified

L86* Keratoderma in diseases classified elsewhere

Follicular keratosis) due to insufficiency
Xeroderma) vitamin A ( E50.8+)

L87 Transepidermal perforated changes

Excludes: granuloma annulare (perforated) ( L92.0)

L87.0 Keratosis follicular and parafollicular penetrating the skin [Kyrle's disease]
Hyperkeratosis follicular penetrating
L87.1 Reactive perforating collagenosis
L87.2 Creeping perforating elastosis
L87.8 Other transepidermal perforation disorders
L87.9 Transepidermal perforation disorders, unspecified

L88 Pyoderma gangrenosum

Dermatitis gangrenous
Dead pyoderma

L89 Decubital ulcer

bedsore
Plaster cast ulcer
Pressure ulcer
Excludes: decubital (trophic) ulcer of the cervix ( N86)

L90 Atrophic skin lesions

L90.0 Lichen sclerosus and atrophic
L90.1 Anetodermia Schwenninger-Buzzi
L90.2 Anethoderma Jadasson-Pellisari
L90.3 Atrophoderma Pasini-Pierini
L90.4 Acrodermatitis chronic atrophic
L90.5 Cicatricial conditions and fibrosis of the skin. Soldered scar (skin). Scar. Disfigurement caused by a scar. Scar NOS
Excludes: hypertrophic scar ( L91.0)
keloid scar ( L91.0)
L90.6 Atrophic stripes (striae)
L90.8 Other atrophic skin changes
L90.9 Atrophic skin change, unspecified

L91 Hypertrophic skin changes

L91.0 Keloid scar. Hypertrophic scar. Keloid
Excludes: keloid acne ( L73.0)
scar NOS ( L90.5)
L91.8 Other hypertrophic skin changes
L91.9 Hypertrophic skin change, unspecified

L92 Granulomatous changes in skin and subcutaneous tissue

Excludes: actinic [photochemical] granuloma ( L57.5)

L92.0 Granuloma annulare. Perforated granuloma annulare
L92.1 Necrobiosis lipoidica, not elsewhere classified
Excluded: associated with diabetes (E10-E14)
L92.2 Facial granuloma [eosinophilic granuloma of the skin]
L92.3 Granuloma of the skin and subcutaneous tissue caused by a foreign body
L92.8 Other granulomatous changes in the skin and subcutaneous tissue
L92.9 Granulomatous change of skin and subcutaneous tissue, unspecified

L93 Lupus erythematosus

Excludes: lupus:
ulcerative ( A18.4)
ordinary ( A18.4)
scleroderma ( M34. -)
systemic lupus erythematosus ( M32. -)
If necessary, to identify the drug that caused the lesion, use an additional external cause code (class XX).
L93.0 Discoid lupus erythematosus. Lupus erythematosus NOS
L93.1 Subacute cutaneous lupus erythematosus
L93.2 Another limited lupus erythematosus. Lupus erythematosus deep. Lupus panniculitis

L94 Other localized connective tissue disorders

Excludes: systemic diseases connective tissue (M30-M36)

L94.0 Localized scleroderma. Limited scleroderma
L94.1 Linear scleroderma
L94.2 Skin calcification
L94.3 Sclerodactyly
L94.4 Gottron's papules
L94.5 Poikiloderma vascular atrophic
L94.6 Anyum [spontaneous dactylolysis]
L94.8 Other specified localized connective tissue changes
L94.9 Localized change in connective tissue, unspecified

L95 Vasculitis limited to skin, not elsewhere classified

Excludes: creeping angioma ( L81.7)
Henoch-Schonlein purpura ( D69.0)
hypersensitivity angiitis ( M31.0)
panniculitis:
NOS ( M79.3)
lupus ( L93.2)
neck and back ( M54.0)
recurrent (Weber-Christian) ( M35.6)
nodular polyarteritis ( M30.0)
rheumatoid vasculitis ( M05.2)
serum sickness ( T80.6)
urticaria ( L50. -)
Wegener's granulomatosis ( M31.3)

L95.0 Vasculitis with marbled skin. Atrophy white (plaque)
L95.1 Erythema sublime persistent
L95.8 Other vasculitis limited to the skin
L95.9 Vasculitis confined to the skin, unspecified

L97 Ulcer of lower limb, not elsewhere classified

L89)
gangrene ( R02)
skin infections ( L00-L08)
A00-B99
varicose ulcer ( I83.0 , I83.2 )

L98 Other diseases of skin and subcutaneous tissue, not elsewhere classified

L98.0 Pyogenic granuloma
L98.1 Artificial [artificial] dermatitis. Neurotic scratching of the skin
L98.2 Febrile neutrophilic dermatosis Sweet
L98.3 Wells' eosinophilic cellulitis
L98.4 Chronic skin ulcer, not elsewhere classified. Chronic skin ulcer NOS
Tropical ulcer NOS. Skin ulcer NOS
Excludes: decubital ulcer ( L89)
gangrene ( R02)
skin infections ( L00-L08)
specific infections classified in rubrics A00-B99
lower limb ulcer NEC ( L97)
varicose ulcer ( I83.0 , I83.2 )
L98.5 Skin mucinosis. Focal mucinosis. Lichen myxedematous
Excludes: focal oral mucinosis ( K13.7)
myxedema ( E03.9)
L98.6 Other infiltrative diseases of the skin and subcutaneous tissue
Excludes: hyalinosis of the skin and mucous membranes ( E78.8)
L98.8 Other specified diseases of skin and subcutaneous tissue
L98.9 Damage to skin and subcutaneous tissue, unspecified

L99* Other disorders of skin and subcutaneous tissue in diseases classified elsewhere

L99.0*Skin amyloidosis ( E85. -+)
nodular amyloidosis. Spotted amyloidosis
L99.8* Other specified changes in the skin and subcutaneous tissue in diseases classified elsewhere
Syphilitic:
alopecia ( A51.3+)
leukoderma ( A51.3+, A52.7+)

A large number of different microbes live on the surface of human skin, for example, epidermal streptococci. They do not harm a healthy body with good immunity.

If the integrity of the outer skin is violated (microtrauma, cuts, eczema), these bacteria can penetrate into the deeper layers and cause inflammation, which is called streptoderma.

The disease most often develops in people with weakened or imperfect immune defenses. Young children are especially susceptible, as well as adults with serious chronic diseases.

Why this pathology arises, how it manifests itself and is treated - let's try to figure it out.

What is this disease

Streptoderma in dermatology refers to a whole group of infectious skin diseases that are caused by streptococcus. These include, streptococcal seizures, simple faces, chronic diffuse pyoderma, erysipelas, ecthyma vulgaris. The first form is the most typical and common.

Streptoderma in children is more common than in adults due to insufficiently perfected immune system, thinner and more delicate skin.

This disease is contagious, it can be transmitted between people through direct contact (kissing, shaking hands) or through shared objects. Outbreaks of the disease often occur in closed communities (boarding schools, military units, colonies).

The following factors may predispose to the development of the disease:

• weakening of the body's immune defenses (stress, overwork, intoxication, moving to another climatic zone, etc.);
• the presence of concomitant infectious diseases (herpes, chicken pox) or chronic diseases in the body (diabetes, psoriasis, eczema, atopic dermatitis);
• malnutrition or starvation (deficiency of protein, vitamins and trace elements);
• work in hazardous industries;
• severe contamination and damage to the skin (microcracks, abrasions, scratches, insect bites);
• disregard for the rules personal hygiene or excessive cleanliness;
• exposure to low (frostbite) or high (burns) temperatures;
• (excessive sweating);
• circulatory disorders (varicose veins).

ICD-10 code

To analyze the general situation with the incidence of the population different countries, and to monitor the frequency and prevalence of diseases and other health-related problems, an international standard classification (ICD) was created. It is needed by all doctors in their daily work.

Every decade, the World Health Organization reviews the classifier to bring it into line with the current level of knowledge. Currently, the ICD is in force in the 10th edition, in which each disease has its own code, understandable to doctors around the world.

According to ICD-10, streptoderma refers to other local infections of the skin and subcutaneous tissue, indicated by the code L08. This section has the code for pyoderma L08.1 (general term) and for specified infectious lesions L08.8.

For cases where it is necessary to identify the pathogen, an additional code is used; for streptococci, it is suitable B95(from B95.1 to B95.5). The most common form of streptoderma is impetigo, which has its own code L01. In the case of a combined infection, additional coding is used individually in each specific case.

How does streptoderma begin?

Incubation period(the time from the moment of infection to the initial manifestations of the disease) is an average of a week. Streptoderma usually begins acutely with the appearance of pink spots on the skin, which are soon covered with a blistering rash, accompanied by severe itching.

This is how the disease begins: photo

The presence of vesicles with purulent contents is a distinguishing feature of streptoderma from dermatitis. Vesicles soon burst, leaving behind erosion covered with honey-colored crusts.

Skin lesions can quickly spread to neighboring and distant areas if the patient scratches the elements of the rash.

streptoderma in adults on the face (cheeks, nasolabial triangle, forehead) can be combined with lesions of the skin folds under the breast, under the armpits. In children more common form of infection affecting the face, neck, back, hands, lower limbs, which is accompanied by a violation general condition due to the development of intoxication (fever, swollen lymph nodes, lethargy, refusal to eat).

Symptoms and treatment in adults and children will differ depending on the type of streptococcal skin lesion.

Types of streptoderma

Depending on the prevailing symptoms, two forms of streptoderma are distinguished:

1. weeping- blisters with purulent contents, erosions and crusts sequentially appear on the surface of the skin, from under which a liquid substance is released.
2. Dry– on the face and neck there are peeling and pink spots without blistering and maceration (moist loosening and swelling of the epidermis).

Depending on the depth of the skin lesion, it happens:

• superficial process (affects only the epidermis) - impetigo, seizures, simple lichen of the skin of the face;
• deep inflammation (spreads to the underlying layers of the skin) - streptococcal cellulitis, ecthyma, ulcerative variant of pyoderma.

Impetigo

This is the most common form of the disease in adults. Rashes appear suddenly and go through all stages of development: papules (tubercles), vesicles (vesicles), small erosive defects, yellow-gray crusts.

Impetigo usually affects the lateral surfaces of the nose, the area above the upper lip, the chin, the spaces behind the auricles, the hands, and large folds of the body (in obese patients). Patients are always worried about severe itching. When combing the elements, the process quickly spreads along the periphery.

After the disappearance of the rash (after about 5-7 days), unstable hyperpigmentation may remain at the site of inflammation.

With the bullous (blistering) form of impetigo, dense blisters appear on the limbs, which grow slowly, are accompanied by severe itching and dry skin.

Zayedy

So called erosion in the form of cracks and crusts in the corners of the mouth. They appear in children as a complication after chickenpox or herpes, in adults they often occur when using dishes after a sick person.

A predisposing factor in the development of this pathology is increased salivation in certain diseases, improper dentures, and also in case of deficiency of B vitamins.

Simple lichen of the face

This is dry streptoderma, which manifests itself on the face with local peeling and pinkish large spots with scales on the surface.

This type of disease occurs mainly in young men and young men. After treatment and the cessation of peeling, depigmentation may temporarily persist on the skin.

Ectima

This is a lesion of the deep layers of the skin, in which an abscess appears with serous-purulent fluid, it is characterized by a tendency to peripheral growth and a rapid increase in size.

Soon after the formation, the abscess dries up into a yellow-green crust, unlike impetigo, it does not separate, but adheres tightly to the skin.

When the crust is removed, a painful deep ulcer is formed with jagged edges and pus inside. Such elements heal for a long time, scar formation almost always occurs. Most often, ecthyma is located on the skin of the legs and thighs.

Treatment

It is necessary to treat streptoderma in order to avoid the transition of the disease to chronic form, which can give periodic relapses with any weakening of the body's defenses.

In most cases, home treatment is effective. Do not try to remove the crusts from the surface of the body on your own. This can only be done by a doctor.

• treat the lesion (dried crust) with 3% hydrogen peroxide;
• dry with sterile material (bandage, napkin);
• lubricate the skin around the problem area (within a radius of at least 2 cm) with a solution of brilliant green, iodine, furacillin, salicylic or chloramphenicol alcohol;
• an ointment with an antibacterial substance (for example, with erythromycin) is applied to the inflamed area under a bandage or without it, depending on the location.

Oral antibiotics may be required for severe, common infections, such as in young children. Until the rash disappears, you can not take baths and use a washcloth.

At chronic course disease, it is advisable to undergo an examination to determine the cause (diabetes, vascular problems etc.) and prescribing treatment from specialists in the profile of the identified pathology, as well as getting advice from an immunologist.

You can get rid of streptoderma if you pay attention to the symptoms in time and do not try to treat yourself.

Video

Skin dyschromia is a condition in which the natural color of the skin is altered. The phenomenon is common and in most cases does not act as a pathological disorder. Discomfort from dyschromia is aesthetic and psychological.

Dyschromia is a pigmentation disorder due to a different nature. The color of the skin is affected by 4 pigments - melanin, red and blue hemoglobin, carotene. The most common cause of an altered skin color is dystrophy or an excess of melanin, a brown pigment.

Dyschromia is divided into:

• hyperpigmentation - the appearance of intensely colored areas (hyperchromia);
• hypochromia or achromia - the appearance of spots with a mild color or its absence;
• pigment displacement is a phenomenon in which "colorless" foci form over hyperpigmented areas.

There are congenital and acquired forms of dyschromia. Congenital include albinism, freckles, pigmented "birthmarks". Acquired - includes all other types of pigmentation and is divided into primary and secondary forms.

Primary ones develop as independent diseases and affect for a long time (vitiligo, syphilitic leukoderma, chloasma). Secondary - arise as a result of previously transferred dermatological disorders and have a short-term effect (psoriasis, lichen planus).

The International Classification of Diseases 10th revision (ICD10) considers dyschromia as a disease of the skin and subcutaneous tissue and classifies it as a pigmentation disorder. To identify the disease, a special ICD-10 code - L81 is used.

Symptoms and causes in adults and children

The disease is recognized by a violation of the pigment - a change in the color of the skin. Symptoms of dyschromia differ depending on the type of disease, the cause of its occurrence.

Vitiligo is a type of achromia. Light spots appear on the human body different shapes and magnitude.

The skin loses pigment, resulting in almost white formations. This is a fairly rare occurrence that does not bring physical discomfort.

Ephelids or freckles are small age spots that occur in people with fair skin (and most often with red hair). Educations have an even round shape, spread mainly on the face, less often on the chest, arms, back.

Chloasma - brown spots with clear contours, irregular shape. Spread over the face, neck, chest, back. Such spots appear in pregnant women during the gestational period.

Lentigo - "senile ripples", dark-colored formations that appear in elderly people. The process of formation of lentigo is associated with the natural aging of the skin, exposure to ultraviolet radiation. Localized on the arms, back, shoulders.

Melanoma is dangerous malignancy that affects the skin. Dark-colored spots with uneven edges and fuzzy borders appear on the body. Education is characterized by inclusions of other shades.

The causes of dyschromia are varied. The occurrence of disorders is influenced by certain factors of external influence or internal processes of the body:

• individual feature of the skin;
• sensitivity to ultraviolet radiation;
• skin aging process;
• lack of vitamins;
• dermatological diseases;
• abuse of UV radiation;
• allergic reactions of the body;
• oncology;
• hormonal changes in the body.

Regardless of the cause of pigmentation disorders in a child or an adult, at the first symptoms, you should consult a doctor.

Features of dyschromia during gestation

Gestation is the period of gestation from conception to the birth of a baby. At this stage, the woman's body undergoes a number of hormonal and physiological changes. One of them is dyschromia chloasma.

Appearance age spots during pregnancy is associated with the protective function of the body. To protect the fetus from the effects of negative external factors, produced increased amount melanin. The pigment acts as a barrier against the influence of ultraviolet radiation.

Dyschromia manifests itself in the second trimester of pregnancy, disappears 1-2 months after birth. These figures are not fundamental, they may differ for some women. Most often, dyschromia during gestation manifests itself on the face, neck, chest (especially in the nipple area), abdomen and genital area. Pregnant women observe the appearance of a brown vertical stripe that starts a few centimeters above the navel and ends at the pubis. Its nature is associated with excessive production of melanin. This phenomenon passes quickly enough, leaving no trace.

A common occurrence is skin dyschromia in a newborn baby. Immediately after birth, small yellow spots similar to freckles appear on the baby's body. This is a normal phenomenon associated with the adaptation of the body of the newborn to the environment. Such formations soon disappear on their own.

Café au lait spots in children on the back, in the groin, or on the inside of the limbs may indicate a genetic disease called neurofibromatosis. If you experience such symptoms, you should contact your pediatrician, pass the necessary tests.

Diagnosis and treatment

The diagnostic examination begins in the therapist's office. The doctor examines the area of ​​dyschromia, taking into account the accompanying factors. Information about the age of the patient, pregnancy, oral contraception is taken into account. To obtain a complete picture of a person's condition, laboratory tests are required. If comorbidities are identified, the patient is referred for additional diagnostics to narrow specialists.

Treatment of pigmentation disorders in the first place is to eliminate the root cause of the disease. Sometimes, after identifying the underlying ailment, dyschromia disappears. In other cases, additional steps are required. The elimination of symptoms also includes drug therapy, the use of drugs for local application, cosmetic procedures. In extremely rare cases, when the scale of the affected skin is too wide, transplantation is performed.

Methods of treatment are selected individually, depending on the nature of the disorders and the patient's condition. The general approach includes the appointment of vitamin complexes, the use of special creams to whiten or darken problem areas, as well as injections of drugs that synthesize the production of melanin. Procedural therapy involves the processes of removing pigments by mechanical action:

• dermabrasion;
• peeling;
• grinding;
• cryotherapy;
• phototherapy;
• laser exposure;
• mesotherapy.

To solve the problem with problem areas on the face, permanent makeup is used. To do this, special substances are injected under the skin, giving the necessary shade to the skin.

Preventive measures and life prognosis

To prevent a pigment disorder, a person needs to pay attention to his own body and health in general. Providing the body with vitamins, using high-quality cosmetics, moderate exposure to sunlight will help reduce the risk of dyschromia.

In cases of absence dangerous diseases, pigment disorders do not affect the physical quality of human life. The need to solve the problem is associated with a psychological factor.

Any changes in the habitual state of the body indicate the need to visit a doctor. Only after the examination at the examination, the patient will receive accurate information about the nature of the disease and will be able to take the necessary measures.

Dyschromia of the skin is quite common. It is diagnosed in people of any age, including newborns and older children. Most deviations do not affect the general well-being of a person, but can lead to psychological discomfort if the defect is noticeable to others. Depending on the cause, the color of the epidermis is restored on its own or requires conservative (or even surgical) correction. Treatment tactics are selected taking into account the underlying disease.

Dyschromia is a generalized concept that includes conditions in which the skin changes its natural color due to an excess or lack of pigment. Such changes are congenital or occur later.

According to international classification diseases (ICD-10), the pathology is assigned the code L81, which denotes other pigmentation disorders.

The main substance that affects skin color is melanin. This is a pigment produced by special cells - melanocytes, which are located in the epidermis and dermis, the retina of the eye, as well as inner ear. The main function of pigment cells is to protect the skin from the toxic effects of ultraviolet radiation.

Other pigments that affect skin coloration include:

• yellow-orange (carotene, vitamin A);
• red (oxygenated hemoglobin);
• blue (reduced iron protein);
• melanoid is a breakdown product of melanin.

Dyschromias are divided into:

• hyperchromic - increased pigmentation;
• hypochromic - a decrease in the intensity of skin color.

In addition to pigments, many diseases lead to a change in the color of the skin:

• red (hypertension, erythrocytosis, tuberculosis, sinusitis);
• earthy (disruption of the thyroid gland, cancer, sepsis, AIDS);
• pale ( peptic ulcer, heart defects, oncology, endometriosis);
• blue (methemoglobinemia, disruption of the heart or lungs, chronic bronchitis);
• yellow - violation of the liver;
• bronze (insufficiency of the adrenal glands or the hypothalamic-pituitary system).

A change in skin color that persists for a long time is a reason to see a doctor and undergo an examination.

The main sign indicating dyschromia is a change in the color of the skin, namely:

• uneven lightening or darkening of the skin;
• the appearance of clearly defined or blurry spots of various shades;
• violation of pigmentation throughout the body or localized symmetrically, for example, on the right and left hand.

Some deviations proceed in an asymptomatic form and are manifested only by visual signs.

Others are accompanied by local discomfort:

• redness;
• peeling;
• itching;
• soreness;
• swelling;
• suppuration;
• bleeding.

Still others cause a general deterioration in well-being:

• weakness and decreased ability to work;
• asthenia, insomnia and irritability;
• dizziness, headaches;
• loss of appetite, weight loss or opposite symptoms;
• dyspeptic disorders.

The causes of dyschromia are different.

Albinism

The congenital absence of pigment is called albinism. It can be partial or complete. The defects are caused by a genetic mutation and discolor the epidermis while still in the womb. When the baby is born, deviations are immediately visible.

The characteristic color of the epidermis is preserved forever and cannot be treated.

Vitiligo

This pathology is characterized by focal clarification. Unlike albinism, pathology appears in children after 5 years and adults. Younger children rarely get sick. The likelihood of developing vitiligo in a newborn or infant is minimal.

Spots are localized throughout the body or in a certain anatomical region, for example, only on the face or hands. Large areas are rarely affected.

Lightened foci are painted in milky or cream tones. Sometimes they are pinkish and bluish.

The exact cause of the appearance is unknown. Presumable provoking factors are a genetic predisposition or a malfunction in the immune system.

Treatment of vitiligo is long and expensive, but with the right regimen, the prognosis is favorable.

This is the name of the spots, the correct form, localized on the face, shoulders, hands. On other parts of the body, they appear less often. People with blond or red hair are prone to freckles.

Often ephelids appear in early childhood, sometimes in newborns. In winter, they turn pale and become almost invisible. Under the influence of ultraviolet light, they are painted in bright orange or brown tones.

Freckles remain with a person for life. If desired, they can be clarified by a beautician or with the help of brightening creams. But getting rid of them forever will not work.

Chloasma and lentigo

These two pathologies are related to acquired age spots. This is the same hyperpigmentation that worries women so much. Chloasma and lentigo look like flat dark foci of irregular shape with clear boundaries. Typical localization is open areas of the body - face, shoulders, limbs. Why such defects occur is not exactly known, but doctors suggest that the predisposing factors are:

• excess ultraviolet radiation;
• natural photoaging;
• hormonal changes;
• diseases of the liver and adrenal glands;
• the use of cosmetics with oxidized components.

Chloasma often appears in pregnant women. Adolescents are diagnosed with juvenile lentigo. IN childhood the probability of occurrence of such defects is minimal.

Initially, chloasma and lentigo are benign formations, but under the influence of adverse factors, they can (very rarely!) degenerate into cancer. According to statistics, lentigo is malignant more often.

After the provoking factor is eliminated, the spots disappear on their own or brighten, but remain for life. Treatment is required if the patient considers them to be a serious cosmetic defect or there are alarming symptoms in the hyperpigmented area.

In the vast majority of cases, such pigmentation does not cause any discomfort, except for psychological, since many women are very concerned about such a cosmetic defect.

These are pigmented formations that consist of nevus cells. They differ in color, structure and occur in people of any age.

Most moles are benign and rarely turn into cancer. Dangerous species are:

• melanosis Dubrey;
• giant;
• dysplastic;
• blue nevus.

Signs of a good mole:

• symmetry;
• uniform color;
• size not exceeding 6 mm;
• lack of discomfort.

Opposite symptoms are considered dangerous and require the advice of a dermatologist.

Nevi are eliminated if cancer is suspected or at the request of the patient.

Melanoma

This is an aggressive type of skin cancer, consisting of reborn pigment cells. Often it occurs in hyperpigmented areas where there are moles and dark spots. Unpigmented forms are rare.

On early stage the disease is manifested by uncomfortable sensations in the area of ​​\u200b\u200bthe darkened area - pain, itching, inflammation. As it progresses, it appears general symptoms indicating involvement in the pathological process of the lymphatic system. The patient develops weakness and signs of intoxication.

The exact causes of the degeneration of a benign spot are unknown. The most common theories include:

• the influence of ultraviolet;
• genetic predisposition;
• mechanical damage.

Treatment of melanoma is surgical. The early stages are well treated, in the later stages the prognosis is unfavorable.

Sometimes dyschromia occurs as a result of skin diseases, for example, white, pityriasis or pink lichen. Toxins produced by fungal pathogens lead to discoloration. After reducing the concentration of these substances, the spots are gradually restored in color. Many such cases are described in the forums dedicated to skin diseases.

To others probable reasons lightening or darkening of the epidermis include:

1. Injuries (burns, cuts, bites), after which there are scars that do not contain pigment cells.
2. product abuse or vitamin complexes containing carotene.
3. Poor patency of the biliary tract, excess bilirubin stains the skin yellow.

A short-term change in skin color may be associated with food eaten the day before, the use of certain medications, and activation of the immune system. To find out the cause, a doctor's consultation is required.

Features of dyschromia during gestation

Gestation is the period from the first day of the last menstruation to the moment the umbilical cord is cut.

With the onset of pregnancy, a powerful hormonal and physical restructuring occurs in a woman's body. During this period, all cells and internal organs start working differently. Melanocytes try to protect the body of the unborn baby from the toxic effects of UV rays, so they accumulate in certain places where chloasma and other age spots form later. The adrenal glands play an important role in this process.

Skin defects often appear in the second trimester. Common localization:

• face;
• breast;
• nipples;
• belly (vertical strip from the navel to the pubis).

Most spots disappear 1 to 2 weeks after birth, but some persist.

If signs of skin dyschromia appear in a child or an adult, it is recommended to visit a dermatologist who will examine the pathological area, collect an anamnesis and give a referral for tests.

The general examination scheme includes:

• general analysis of blood, urine and biochemistry;
• dermatoscopy;
• examination with a Wood's lamp.

The further algorithm is curled from the alleged cause. You may need to consult other specialists - an oncologist, a gastroenterologist, an immunologist, a hepatologist.

The treatment regimen is selected based on the results of the examination. To restore pigmentation apply:

• medicines (tablets, injections, ointments);
• physiotherapy;
• phototherapy;
• minimally invasive procedures (laser, cryodestruction);
• cosmetic creams and serums with a tinting or brightening effect;
• folk recipes;
• surgical methods (excision of suspicious areas, transplantation).

Self-treatment is usually ineffective, and sometimes very dangerous.

Preventive measures and life prognosis

It is not always possible to prevent dyschromia. To reduce the likelihood medical workers recommend:

1. Avoid prolonged exposure to the sun, use creams that protect the skin from sunburn.
2. Give up bad habits and low-quality products.
3. Strengthen immunity.
4. Be less nervous.
5. Exercise.
6. Drink medicines only with the permission of the attending physician.
7. Go to the hospital if something is bothering you.

With absence serious illnesses dyschromia is not dangerous. If there are any, then the forecast is difficult to predict. Many pathologies are successfully treated at an early stage (including melanoma). When the first signs appear, it is recommended to go to the doctor, and not experiment on your own body.

Skin dyschromia is not a separate disease, but a group of pathologies that affect the color of the skin. The reasons are different - malnutrition, autoimmune processes, and so on. To clarify the diagnosis, it is recommended to visit a dermatologist or therapist who will tell you what to do next. Most dyschromias, manifested by lightening or darkening of the skin, are not dangerous, but cases are different.

However, the absence of the corresponding specialty “cosmetologist”, standardized Procedures and Rules for the provision of medical services, the presence of the type of medical activity “therapeutic cosmetology” and the types of household cosmetology services that simultaneously intersect according to OKUN (All-Russian classifier of services to the population) put cosmetology in an “uncertain” position.

Russian cosmetology has been in this state of “uncertainty” for almost 20 years, but since the introduction of cosmetology as a new medical specialty by the Order of the Ministry of Health and Social Development of Russia dated April 23, 2009 “On the nomenclature of specialties with higher and postgraduate medical and pharmaceutical education in the healthcare sector of the Russian Federation”, and then with the entry into force of the Order of the Ministry of Health and Social Development of Russia dated April 18, 2012 "On approval of the Procedure for providing medical care to the population in the field of "cosmetology" and the Decree of the Government of the Russian Federation of October 4, 2012 "On the approval of the Rules for the provision of paid medical services by medical organizations" the issue of registration of medical services and maintaining primary documentation was most acute for clinics.

Currently, cosmetology (with the exception of a narrow group of services classified as domestic in accordance with the Order of the Ministry of Labor of Russia dated December 22, 2014) is becoming a purely medical activity and is equated with any other types of medical services. Accordingly, the provision of medical cosmetology services must be carried out in compliance with all requirements, incl. primary medical records and the reflection in it of unified diagnoses according to ICD-10.

Where and what diagnoses according to ICD-10 should be reflected by a cosmetologist?

The main document that is issued for any medical intervention or service, in accordance with the Order of the Ministry of Health of Russia dated December 15, 2014 "On approval of unified forms of medical documentation used in medical organizations providing medical care on an outpatient basis, and the procedures for filling them out "is the Medical card of a patient (hereinafter MC) receiving medical care on an outpatient basis (form 025 / y) (for persons under the age of 18 - form 112y). That The Order contains information about the rules for filling out the relevant sections of the MC, including the fact that during the initial consultation, a preliminary or final diagnosis must be indicated, which must be made in accordance with ICD-10.

What is the scope of professional competence of a cosmetologist?

According to paragraph 3 of the Order of the Ministry of Health and Social Development of Russia dated April 18, 2012 "On approval of the procedure for providing medical care to the population in the profile" cosmetology ", the area of ​​​​impact of cosmetology is limited to integumentary tissues - skin, its appendages, subcutaneous fat and superficial muscles. Guided by this fact and the primary perception , diagnoses in cosmetology could be searched for in the sections of the ICD-10 devoted to diseases of the skin, its appendages and subcutaneous fat... For several years, specialist doctors did just that: cosmetologists used about 15 diagnoses from these sections, which, unfortunately, did not reflect the whole breadth of problems faced by a cosmetologist in his professional activities.

Topology or methods determine the used ICD-10 diagnoses?

It is important to understand that along with conditions that are directly related to the group of diseases of the integumentary tissues and eliminated by cosmetic methods, there are other diseases and conditions that make up the scope professional competencies cosmetologist.

First, these are diseases topologically manifested in the area of ​​integumentary tissues, but according to the methods of correction referred Procedures for the provision of medical services (relevant orders of the Ministry of Health of the Russian Federation) to other areas of medical specialties. Those. according to these conditions, the cosmetologist does not provide medical interventions, but is limited only to consulting services. An example of such diseases are neoplasms of the skin, its appendages and subcutaneous tissue. Removal of benign neoplasms by order of the Ministry of Health is allowed in the clinic of cosmetology, while the treatment of malignant neoplasms, including those located in the area of ​​integumentary tissues, belongs to the area of ​​professional responsibility of the oncologist, and some externally manifested as skin neoplasms infectious diseases(molluscum contagiosum) is the area of ​​responsibility of a dermatologist. But the patient himself cannot determine the nature of the origin of the neoplasm, which constitutes an aesthetic problem for him, and therefore patients often turn to the cosmetology clinic to remove neoplasms, unaware of their oncological or infectious nature. In this case, the task of the cosmetologist is to conduct a differential diagnosis during consultation and, in the case of a benign neoplasm, remove it with permitted correction methods, followed by histological control. And in case of suspicion of a malignant or infectious nature of the neoplasm, refer the patient to the appropriate specialist by filling out form 057 / y. But in any of these cases, the cosmetologist is required to fill out medical documentation indicating the preliminary and final diagnosis in accordance with ICD-10.

Secondly, these diseases topologically related to other (non-cosmetological) sections of the ICD-10, but according to the methods of correcting their manifestations that constitute the sphere of professional competence of a cosmetologist. An example of such conditions are generalized vascular diseases, reflected in various sections of the ICD-10, related to various areas of medical knowledge (including phlebology, vascular diseases), but having external manifestations in integumentary tissues and in connection with this, the components of the aesthetic problem for the patient. In the arsenal of a cosmetologist, there are currently a number of techniques, primarily hardware (photo- and laser systems), which can effectively eliminate such vascular manifestations. Naturally, when receiving such patients and filling out the primary medical documentation, the cosmetologist must establish an appropriate diagnosis, which is not included in the ICD-10 section of the disease of the skin and its appendages, but according to the area of ​​manifestation and the method of correction, which constitutes the area of ​​professional responsibility of cosmetology.

Accordingly, in the work of a cosmetologist, to fill out medical documentation, diagnoses classified in ICD-10 should and can be used not only for sections that are directly topologically related to cosmetology, but also from any field of medicine that has manifestations in the “responsibility” of the cosmetologist, regardless of whether the cosmetologist independently provides treatment or refers the patient to specialists in other medical professions.

Part of the difficulty in determining the diagnoses that fall within the competence of a cosmetologist lies in the mixed classification system used in the ICD-10, where diagnoses are grouped into sections both by areas of medical knowledge and by topological features, methods of correction, histological features and disease progression. . Therefore, the development of a simple method for selecting diagnoses can both significantly facilitate the maintenance of medical records and improve the quality of the work of a cosmetologist during differential diagnosis diseases.

How to determine and choose from an extensive list those diagnoses according to ICD-10 that are necessary for a cosmetologist in practice?

Realizing that, at least at the consultation level, a cosmetologist must make a judgment about any condition that brought the patient to the cosmetology clinic, and accordingly fill out the MC in order to establish the entire list of diagnoses and systematize them for the practice of a cosmetologist, one should understand what are the reasons for contacting patient in the clinic of cosmetology.

The order of the Ministry of Health of Russia dated 12/15/2014 introduces the concept of "appeal" into everyday practice of a doctor - the reason that prompted the patient to go to the clinic. To date, we have identified a little more than 20 such reasons in cosmetology, ranging from age-related changes to “defectology” associated with the elimination of benign formations, the treatment of post-acne, hypertrichosis, the removal of age spots, etc. The most common diseases, the elimination of external manifestations of which cosmetology deals with, are contained in 6 sections of the ICD-10. Each potential reason for a patient's referral corresponds to several diagnoses. There are about 150 of them in total. For the patient, the cosmetologist is obliged to operate with all of them with varying degrees of accuracy. By systematizing and grouping the diagnoses from the ICD-10 in this way, we have a convenient tool to help practitioners.

Accuracy of diagnosis and practice of a cosmetologist?

Another important point: diagnoses in the ICD-10, depending on the section, have a complex, sometimes three-level, classification system. Since cosmetology services are not of an etiotropic nature, that is, they do not eliminate the cause of the disease, but the consequences of its manifestations, the specification of a diagnosis in cosmetology is not always mandatory. So, for example, in the ICD-10 there are several diagnoses of hypertrichosis, but to select the method of cosmetic correction (laser or photoepilation), an accurate diagnosis is redundant, so the cosmetologist can indicate a general diagnosis when filling out the primary medical documentation.

As a rule, in all sections of the ICD-10 there is a subsection 09 containing diagnoses with unidentified causes or topology. Therefore, in order to protect yourself from incorrect diagnosis and reduce the financial burden on the patient (additional studies will cost him significant amounts, but their result will not affect the work of the cosmetologist in any way), it is recommended to use general diagnoses.

The most difficult, from the point of view of selecting a diagnosis, despite the obviousness of their manifestations, are the causes associated with the correction of age-related changes - wrinkles, dry skin, and a decrease in its turgor. From the point of view of clinical conventional medicine, these conditions correspond to age norm, and the process of natural aging is not considered an independent disease. Therefore, these age-related changes are not reflected in detail in the ICD-10. But it is precisely such conditions and desires to “eliminate age-related changes” that make up the majority of calls to a cosmetology clinic. Under all these conditions, characterized as "anti-aging techniques", general diagnoses, such as degenerative changes in the dermis, fit.

Summary

Thus, the cosmetologist in his work uses diagnoses from various areas medicine. Conventionally, they can be divided into 2 large groups according to the volume of services provided by a cosmetologist: advisory (that is, which the cosmetologist uses to consult and redirect the patient to another specialist) and manipulation (those that the cosmetologist uses directly to provide services in the "cosmetology" profile) .

An example of the selection of ICD-10 diagnoses for a disease not classified as diseases of the skin and its appendages, but with cosmetic methods of correction ("manipulation" group)

An example of the selection of ICD-10 diagnoses for a disease that manifests itself in the area of ​​the skin and its appendages, but with methods of correction by other medical specialties ("advisory" group)

An example of using ICD-10 diagnoses for an unspecified diagnosis

For the provision of hair removal services, it is recommended to use the code L68.9 (Hypertrichosis, unspecified), and if a malignant neoplasm is suspected and the patient is referred to an oncologist, code D48.9 (Neoplasm of an unspecified or unknown nature, unspecified).