Hydrocortisone shingles: Can I use hydrocortisone cream on shingles rash?

28.08.202319.07.2023 by alexxlab

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Can I use hydrocortisone cream on shingles rash?

Medically reviewed by Carmen Pope, BPharm. Last updated on Aug 25, 2022.

Hydrocortisone cream is not recommended to put on a shingles rash and there is no evidence that hydrocortisone cream will help treat the pain of a shingles rash. The preferred treatment for shingles are antiviral medicines that you take by mouth, such as acyclovir, valacyclovir and famciclovir. These require a prescription from your doctor.

It is best to keep the rash clean and dry and not put anything on the rash if possible. Cover the rash with a nonstick dressing to prevent the virus that causes shingles being passed onto other people. The shingles rash is contagious until all the blisters have scabbed over and are dry. If the blisters are covered with a dressing, it is unlikely that the virus will pass on to others.

In general, it is best to avoid applying lotions or creams (eg, moisturizer) to the affected area, as this can further irritate the skin. If you do want to put something on your shingles rash, then the American Academy of Dermatology Association recommends using calamine lotion for shingles. Calamine lotion has a cooling effect and can help reduce itching. Other topical treatments for shingles include wet compresses and colloidal oatmeal baths.

But oral antiviral treatment remains the preferred treatment for shingles and this will help the rash heal faster, reduce shingles pain, and reduce the risk of postherpetic neuralgia (long-lasting nerve pain in an area of skin previously affected by shingles) developing. Oral antivirals are most effective when started within 72 hours after the shingles rash appears. The three antiviral drugs used to treat shingles are:

Acyclovir

Famciclovir

Valacyclovir.

Other oral treatments include acetaminophen or ibuprofen for pain relief. Sometimes, oral corticosteroids may be prescribed alongside oral antivirals if inflammation is severe.

References

Centers for Disease Control and Prevention (CDC). Treating Shingles. July 1, 2019. Available at: https://www.cdc.gov/shingles/about/treatment.html. [Accessed May 2, 2022].

Santee JA. Corticosteroids for herpes zoster: what do they accomplish? Am J Clin Dermatol. 2002;3(8):517-524. https://doi.org/10.2165/00128071-200203080-00001.

Patient education: Shingles (Beyond the Basics) Updated Feb 15, 2022. Up to Date. https://www.uptodate.com/contents/shingles-beyond-the-basics

Shingles: Diagnosis and Treatment. American Academy of Dermatology Association. 2022. https://www.aad.org/public/diseases/a-z/shingles-treatment

Drug information

Hydrocortisone Information for Consumers
Hydrocortisone prescribing info & package insert
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Side Effects of Hydrocortisone
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Best Pain Relief For Shingles: Creams And Antiviral Medication

Content

Overview
Symptoms of shingles
Treatment for shingles
Valacyclovir and famciclovir
What are the best over-the-counter creams for shingles?
Natural remedies
The lowdown

If you’ve ever had chickenpox, you’ve been infected with the varicella-zoster virus (VCZ). As a child, the concept of the virus remaining in your body forever may not seem very interesting. However, if the virus does reactivate later in life and causes shingles, it can be very painful and serious.

Your doctor may refer to shingles as herpes zoster (HHV), as the virus is one of the herpes variations that can affect humans, specifically Human Herpesvirus 3 (HHV3). But no matter what it’s called, the virus lives in your nerve cells, and when it’s reactivated, it can cause a painful skin rash. About 30% of the adult population in the US will have shingles at some point.¹

There is medication to treat shingles, but one of the worst characteristics of the disease is the sometimes debilitating pain that can persist months after the rash has healed. If you catch a shingles outbreak early, your doctor can prescribe antiviral medication to ease the acute symptoms and lower your chances of developing persistent postherpetic neuralgia (PHN).

If you’re over 50, the shingles vaccine is recommended to combat the VZV virus — it significantly lowers your risk for both HZ and PHN.

Risks factors for getting shingles

Not everyone who has had chickenpox will get shingles, although there is always that chance. Not remembering you had chickenpox when you were three doesn’t mean the virus has been forgotten as well. If you’ve had the chickenpox vaccine, you may still get shingles later in life, although your risk is lower compared to those that have had chickenpox.

These are some of the risk factors for shingles:

Being over 50
Being immunocompromised
Having certain cancers and treatments
Taking immunosuppressant medication
Having HIV
Being female

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There are only a few symptoms of shingles — a tingling, itching sensation on one side of your body or face, limited to a single area innervated by a particular nerve termed a dermatome, followed a few days later by a rash in a single stripe in that area.

If you have a weakened immune system, or in rare cases, the rash can spread over contiguous dermatomes and possibly cross the midline and resemble chickenpox. These are the other signs of shingles onset:

Shingles complications

Don’t try to treat shingles symptoms on your own — the VCZ virus that causes shingles can have serious complications.

If the rash is on your face, you’re at risk for blisters to form around or in your eyes, which can lead to temporary — or even permanent — vision loss. Ramsay Hunt syndrome is also a possible complication — it is the major otologic complication of VZV reactivation, which typically involves a triad of ipsilateral (same-sided) facial paralysis, ear pain, and vesicles in the ear canal and on the auricle.²

Furthermore, Ramsay Hunt syndrome (herpes zoster oticus) can also cause hearing problems, vertigo, and ipsilateral altered taste perception.

These are some other possible complications of the shingles virus:

Hearing loss
Balance issues
Bacterial infections, typically Staphylococcus aureus
Inflammation of blood vessels
Meningitis, hepatitis, pneumonia
Stroke

Treating shingles with antiviral medication reduces the severity of the outbreak. The sooner you start taking prescription meds, the shorter and milder the illness — see your doctor as soon as you have the first signs of the rash. Your doctor will prescribe one of three antivirals — Zovirax (acyclovir), Valtrex (valacyclovir), or Famvir (famciclovir).

Topical adjunctive corticosteroids — can also be prescribed to manage inflammation in the case of herpes zoster ophthalmicus. If you have persistent PHN pain, your doctor may recommend a tricyclic antidepressant or a gabapentinoid to help reduce postherpetic neuralgia symptoms. Opioid analgesics or lidocaine or capsaicin patches can also be used in patients with PHN.

Topical creams

Creams, lotions, and ointments to treat shingles have a couple of benefits. They usually contain some form of analgesic to relieve the pain and other ingredients to prevent secondary bacterial infection.

Side effects of acyclovir

Acyclovir does have potential side effects. Malaise is common and not serious, but other side effects can create further problems. Here are some of the uncommon but severe side effects of acyclovir:

Tissue necrosis (IV use)
Toxic epidermal necrolysis
Stevens-Johnson Syndrome
TTP (immunocompromised pts)
Erythema multiforme

These are second-generation herpes drugs. Valacyclovir, a prodrug of acyclovir, accelerates both pain relief and persistence in shingles patients. Famciclovir has the benefit of better bioavailability — the concentration of the drug when it reaches the target site, in this case, the inflamed neurons replicating the shingles virus.

Studies comparing valacyclovir and famciclovir were inconclusive regarding superiority and found no differences in endpoints. However, a systematic review of high-quality trials established that famciclovir and valacyclovir were superior to acyclovir in reducing the possibility of prolonged pain.³

Capsaicin

Recent research indicates that capsaicin — the chemical compound that gives cayenne pepper its heat — can help with postherpetic neuralgia pain. Capsaicin can be a double-edged sword, unlike other topical shingles solutions, such as lidocaine or aloe vera.

While it does reduce substance P in the neurons by inhibiting the pain impulses between the peripheral and central nervous system, it can also make your skin burn wherever it’s applied. You can ease the burning by applying a thin layer of Salonpas or another analgesic to the area before the capsaicin.

Capsaicin also has these possible side effects:

Dry, red skin
High blood pressure
Nausea and vomiting
Respiratory symptoms — sinusitis, bronchitis, cold, cough
Dizziness and headache
Limb pain

EMLA

EMLA, or a eutectic mixture of local anesthetics, is a combination of prilocaine and lidocaine. Studies indicate that applying EMLA cream to the shingles rash “significantly” improved the patient’s pain levels.⁴

Patches for PHN

A lidocaine patch (Dermalid, Lidoderm, Ztido) is available with a prescription. The patch is a 5% concentration, but patients can use up to three patches on a single area at any given time for pain management for up to 12 hours daily. Capsaicin patches have also shown positive outcomes in several studies.⁵

Whereas a cream must be applied several times daily to be effective, patients wear the patch for several hours, guaranteeing the constant transmission of the capsaicin chemicals.

Choosing the right OTC shingles cream is largely a matter of personal preference. There is a range of ingredients, effectiveness, and cost of the different creams. Some creams contain natural ingredients, while others have analgesics that control pain.

There isn’t a lot of research on which creams are most effective. Online reviews may be the best place to get unbiased information on OTC cream results. Expense is another consideration — some are quite expensive.

Lidocaine

Lidocaine is a topical anesthetic that numbs the skin and underlying nerve tissue when applied. Prescription-strength lidocaine has better results for shingles pain, but it can ease some itching and burn in an OTC cream.⁶

The highest concentration you can get without a prescription is 5%. Whereas, as a prescription, the cream can be compounded as high as 10%. Some OTC medications with lidocaine include Aspercreme, Absorbine jr, and Salonpas.⁷

Calamine

You probably have some calamine lotion handy for treating poison ivy and mosquito bites, but you can also apply it to open lesions to reduce pain and pruritus.

Hydrocortisone/steroids

Hydrocortisone/steroid creams may seem like a good idea to stop the blister’s itching. But they don’t help with skin infections and would be contraindicated as they may suppress the immune system reacting to the infection.

You can get past shingles without medical intervention — people have been doing it for thousands of years. But they also had no recourse to manage complications and would have probably welcomed a pill to ease the pain. You can do some things to alleviate the symptoms while dealing with the infection, but they are not great substitutes for going to the doctor.

Acupuncture

The Chinese have been using acupuncture for thousands of years. Although studies have not demonstrated a benefit for acupuncture in both shingles and PHN, you may still decide to try acupuncture.⁷

Honey

Clover and Manuka honey have significant antiviral properties that can combat the shingles virus, and they can be useful in managing the rash when applied topically. Citizens in developing nations use honey as a home remedy, and studies have shown that medical-grade honey is beneficial when treating cold sores — another herpes virus.

There’s nothing wrong with trying home remedies to manage some of your shingles symptoms, but you should not attempt to “cure” an outbreak on your own. Shingles, like any other herpes virus, can’t be cured, only tamped down until it returns to a latent state. If you have shingles, you can transmit it to someone who’s never had chickenpox, and they’ll get that and be susceptible to shingles later.

See your doctor if you think you’re getting shingles. Most people only have one outbreak in their lifetime, but some immunocompromised patients run the risk of recurrent infections.

Before you begin self-treatment for shingles, consult your doctor for advice on the best OTC remedies.

Hydrocortisone instructions for use: indications, contraindications, side effects – description Hydrocortisone ointment for external. approx. 1%: tube 10 g (11514)

💊 Composition of the preparation Hydrocortisone

✅ Application of the preparation Hydrocortisone

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Description of the active ingredients of the preparation

Hydrocortisone
(Hydrocortisone)

The scientific information provided is general and cannot be used to make decisions.
decisions about the use of a particular drug.

Update date: 2020.06.02

Marketing authorization holder:

PROMOMED RUS, OOO
(Russia)

Manufactured:

BIOCHEMIK JSC

(Russia)

ATX code:

D07AA02

(Hydrocortisone)

Active substance:
hydrocortisone
(hydrocortisone)

Rec.INN

WHO registered

Dosage form

Hydrocortisone

Ointment for external use approx. 1%: tube 10 g

reg. No.: LS-001724
dated 14.09.11
– Indefinitely

Release form, packaging and composition
drug Hydrocortisone

10 g – aluminum tubes (1) – packs of cardboard.

Clinical and pharmacological group:

GCS for external use

Pharmacotherapeutic group:

Glucocorticosteroid for topical use

Pharmacological action

GCS. Suppresses the functions of leukocytes and tissue macrophages. Limits the migration of leukocytes to the area of inflammation. Violates the ability of macrophages to phagocytosis, as well as to the formation of interleukin-1. Contributes to the stabilization of lysosomal membranes, thereby reducing the concentration of proteolytic enzymes in the area of inflammation. Reduces capillary permeability due to the release of histamine. Suppresses the activity of fibroblasts and the formation of collagen.

Inhibits the activity of phospholipase A ₂ , which leads to suppression of the synthesis of prostaglandins and leukotrienes. Suppresses the release of COX (mainly COX-2), which also helps to reduce the production of prostaglandins.

Reduces the number of circulating lymphocytes (T- and B-cells), monocytes, eosinophils and basophils due to their movement from the vascular bed into the lymphoid tissue; inhibits the formation of antibodies.

Hydrocortisone inhibits pituitary release of ACTH and β-lipotropin, but does not reduce circulating β-endorphin levels. Inhibits the secretion of TSH and FSH.

When applied directly to the vessels, it has a vasoconstrictor effect.

Hydrocortisone has a pronounced dose-dependent effect on the metabolism of carbohydrates, proteins and fats. Stimulates gluconeogenesis, promotes the uptake of amino acids by the liver and kidneys, and increases the activity of gluconeogenesis enzymes. In the liver, hydrocortisone enhances the deposition of glycogen, stimulating the activity of glycogen synthetase and the synthesis of glucose from protein metabolism products. An increase in blood glucose stimulates the secretion of insulin.

Hydrocortisone inhibits the uptake of glucose by fat cells, which leads to the activation of lipolysis. However, due to an increase in insulin secretion, lipogenesis is stimulated, which leads to fat accumulation.

Has a catabolic effect in lymphoid and connective tissue, muscles, adipose tissue, skin, bone tissue. To a lesser extent than mineralocorticoids, it affects the processes of water-electrolyte metabolism: it promotes the excretion of potassium and calcium ions, the retention of sodium and water ions in the body. Osteoporosis and Itsenko-Cushing’s syndrome are the main factors limiting long-term therapy with corticosteroids. As a result of the catabolic action, growth suppression in children is possible.

In high doses, hydrocortisone can increase the excitability of brain tissue and lower the seizure threshold. Stimulates excess production of hydrochloric acid and pepsin in the stomach, which contributes to the development of peptic ulcers.

When applied externally and locally, the therapeutic activity of hydrocortisone is due to anti-inflammatory, anti-allergic and anti-exudative (due to the vasoconstrictor effect) action.

Anti-inflammatory activity is 4 times weaker than prednisolone, mineralocorticoid activity is superior to other corticosteroids.

Pharmacokinetics

Plasma protein binding – 40-90%. It is metabolized mainly in the liver. T _1/2 – 80-120 min. Excreted by the kidneys mainly as metabolites.

Indications of the active substances of the drug
Hydrocortisone

For external use: allergic dermatitis, seborrhea, various forms of eczema, neurodermatitis, psoriasis, pruritus, lichen planus.

Open list of ICD-10 codes

L20. 8	Other atopic dermatitis (neurodermatitis, eczema)
L21	Seborrheic dermatitis
L23	Allergic contact dermatitis
L24	Simple irritant contact dermatitis
L28.0	Simple chronic lichen (limited neurodermatitis)
L28.1	Scabies knotty
L28.2	Other scabies
L30.0	Coin-shaped eczema
L40	Psoriasis
L43	Lichen red flat

Dosage regimen

The method of administration and dosing regimen of a particular drug depends on its form of release and other factors. The optimal dosage regimen is determined by the doctor. Compliance of the dosage form of a particular drug with indications for use and dosing regimen should be strictly observed.

External – 1-3 times/day.

Side effects

For external use: rarely – itching, hyperemia, burning, dryness, folliculitis, acne, hypopigmentation, perioral dermatitis, allergic dermatitis, skin maceration, secondary infection, skin atrophy, striae, prickly heat. With prolonged use or application to large areas of the skin, systemic side effects characteristic of GCS may develop.

Contraindications for use

For short-term use for health reasons – hypersensitivity to hydrocortisone.

For external use: bacterial, viral, fungal skin diseases, skin tuberculosis, skin manifestations of syphilis, skin tumors, post-vaccination period, violation of the integrity of the skin (ulcers, wounds), children’s age (up to 2 years, with itching in the area anus – up to 12 years), rosacea, acne vulgaris, perioral dermatitis.

Use during pregnancy and lactation

Use during pregnancy is possible only if the expected benefit to the mother outweighs the potential risk to the fetus; it is recommended to use minimum doses and short-term therapy. Children whose mothers received hydrocortisone during pregnancy should be carefully monitored for signs of adrenal insufficiency.

If necessary, use during lactation should decide on the termination of breastfeeding.

In experimental studies it is shown that corticosteroids can cause fetal developmental disorders. Currently, there is no clear confirmation of these data in humans.

Use in hepatic impairment

Use with caution in severe hepatic impairment.

Use in impaired renal function

Use with caution in severe chronic renal failure.

Pediatric use

Contraindications for external use: children under 2 years of age, with itching in the anus – up to 12 years.

Special instructions

Use with caution in parasitic and infectious diseases of a viral, fungal or bacterial nature (currently or recently transferred, including recent contact with a patient) – herpes simplex, herpes zoster (viremic phase), chicken pox, measles, amoebiasis, strongyloidiasis (established or suspected), systemic mycosis; active and latent tuberculosis. Use in severe infectious diseases is permissible only against the background of specific therapy.

Use with caution within 8 weeks before and 2 weeks after vaccination, with lymphadenitis after BCG vaccination, with immunodeficiency states (including AIDS or HIV infection).

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Hydrocortisone . Description of the drug in the reference book Vidal.

ranking of the top 7 effective and inexpensive remedies according to the KP with doctors’ reviews

Zhibera pink lichen is an acute inflammatory skin disease, presumably of an infectious nature ¹ .

Pink lichen is more common in spring or autumn. First, a red-pink spot with a yellowish-brown scaly center appears on the body, up to 5 cm in diameter, which is called the “maternal plaque” ² . A few days later, a rash appears all over the torso, arms and legs. In most cases, the general well-being of the patient does not worsen, but sometimes there may be irritation, itching, a slight increase in temperature ³ .

As a rule, rosacea does not require any treatment. If there are no complications, the disease resolves on its own within a few weeks. If the patient complains of irritation and itching, special ointments can be prescribed to speed up recovery.

Rating of the top 7 inexpensive ointments for pink lichen according to KP

To reduce itching, the doctor may prescribe glucocorticosteroids (GCS) and antihistamines ³ . Below we will talk about the various ointments that are indicated for the treatment of pink lichen ³ .

Important! All drugs have side effects and contraindications. Our material is an overview and does not serve as a guide to action. Before buying funds, consult your doctor.

Hydrocortisone-AKOS

The manufacturer did not fantasize with the name: the name of the active substance is indicated in large letters on the package. Hydrocortisone refers to synthetic hormones glucocorticosteroids, has anti-inflammatory and anti-allergic effects.

It is used to treat a wide range of diseases, including pink lichen, neurodermatitis, psoriasis, allergic dermatitis and others. In addition, the ointment can help with insect bites.

Contraindications : bacterial, viral, fungal skin diseases, skin tuberculosis, skin manifestations of syphilis, skin tumors and wounds, post-vaccination period, children under 2 years of age, rosacea, acne vulgaris.

Laticort

Another topical glucocorticosteroid based on hydrocortisone. According to the instructions, the drug has anti-inflammatory, anti-edematous and antipruritic effects.

The ointment can help with non-infectious skin diseases accompanied by severe peeling. It is used not only for the treatment of pink lichen, but also for seborrheic dermatitis, psoriasis, and skin eczema.

Contraindications : bacterial, viral, fungal, parasitic infections of the skin, tuberculous and syphilitic skin lesions, acne, rosacea, post-vaccination period, violation of the integrity of the skin, hypersensitivity to the drug, pregnancy, lactation.

Locoid

This medicine also contains hydrocortisone, which helps reduce inflammation, swelling and itching. The drug is used for non-infected skin diseases: dermatitis, psoriasis, reactions to insect bites, skin itching of various origins.

Contraindications : bacterial, viral, fungal and parasitic skin infections, tuberculous and syphilitic skin lesions, acne, rosacea, post-vaccination period, wounds, ulcers, hypersensitivity to the drug, pregnancy, lactation.

Komfoderm

The ointment belongs to glucocorticosteroids for external use. The active ingredient methylprednisolone aceponate helps to suppress inflammatory and allergic skin reactions, helps to reduce swelling, itching, irritation and pain. Indications for the use of the ointment are atopic and allergic dermatitis, eczema of various origins.

Contraindications : tuberculosis or syphilitic processes on the skin, viral diseases in the area of application of the drug, rosacea, post-vaccination reactions, children under 4 months of age, hypersensitivity to the components of the drug.

Afloderm

The ointment is based on alklomethasone, a glucocorticosteroid with anti-inflammatory, vasoconstrictive and antipruritic effects. The drug is recommended for the treatment of chronic and acute dermatoses, inflammatory skin diseases, especially with dryness and flaking. Therefore, this ointment can help in the fight against irritation and itching with pink lichen.

Contraindications : skin tuberculosis, skin manifestations of syphilis, chickenpox, viral skin infections, skin reactions to vaccination, open wounds, trophic ulcers, rosacea, acne vulgaris, children under 6 months of age, hypersensitivity to alklomethasone.

Advantan

The active substance of the drug is methylprednisolone aceponate – GCS, which helps to reduce the symptoms of inflammation, itching, pain and irritation.

Ointment helps to eliminate dry skin and restore its normal fat content. Indications for the use of the drug are atopic and allergic dermatitis, eczema.

Contraindications : viral, tuberculous or syphilitic skin lesions in the area of application of the drug, rosacea, skin areas with manifestations of a reaction to vaccination, children under 4 months of age, hypersensitivity to the components of the drug.

Pimafucort

This drug can help in case of complications of lichen roseta if a bacterial or fungal infection has joined. In the composition, in addition to hydrocortisone, two more active substances: natamycin (antifungal agent) and neomycin (antibiotic). The combination of these components has an antibacterial, antifungal and anti-inflammatory effect.

Contraindications : skin tuberculosis, skin manifestations of syphilis, viral skin infections, open wounds, skin ulcers, acne, rosacea, ichthyosis, hypersensitivity to the components of the drug, age up to 1 year.

How to choose a rosacea ointment for a person

As a rule, when prescribing treatment, doctors are guided by the clinical recommendations of the Ministry of Health of the Russian Federation. According to these recommendations, Gibert’s pink lichen does not need to be treated unless there are complications and annoying symptoms. If the patient complains of severe itching, the doctor may prescribe glucocorticosteroids, as well as antihistamines.

Rosacea ointment should have an anti-inflammatory and antipruritic effect at any stage of the disease. It should be easy to use and with a minimum of side effects ⁴ .

Reviews of doctors about ointments from pink lichen

Usually, doctors recommend not only external use (ointments, emulsions, creams), but also oral medication – that is, inside.

– As you already understood, the treatment of pink lichen is a simple matter. And even if it is necessary, it is possible to cope with the help of 1-2 drugs, says dermatologist Alexander Chizhov . “Therefore, you should consult a doctor first of all to establish a diagnosis. Indeed, under the guise of an almost harmless pink lichen, psoriasis, eczema and other diseases that require a completely different approach to treatment can be hidden.

Frequently Asked Questions

Pityriasis rosea is often difficult to distinguish from other skin problems. Dermatologist Alexander Chizhov will answer the most popular questions about this disease.

How can I tell if rosacea is going away?

– As soon as fresh rashes cease to appear, this means that the disease has begun to pass.

Is it possible to cauterize with iodine pink lichen in humans?

– Better not – it will not speed up the recovery. On the contrary, irritation of the rashes often leads to an increase in their size and number.

Will traditional medicine help with pink lichen?

– If you look at articles about folk methods for treating pink lichen, you won’t see anything there! Lotions with vinegar, rubbing newspaper ashes into rashes, birch tar with butter, cabbage leaf compresses with kefir …

And the only thing I would like to say about this: treatment with modern drugs is faster, more effective and often cheaper than folk medicine. In addition, the use of any means that have not passed clinical trials can be hazardous to health.

Photo: market.yandex.ru, KP

Sources :

I.V. Tarasova. Rashes in allergic and non-allergic diseases // Allergology and Immunology in Pediatrics. 2019. Volume 56. No. 1. pp. 10-18 https://cyberleninka.ru/article/n/sypi-pri-allergicheskih-i-neallergicheskih-boleznyah-algoritm-differentsialnoy-diagnostiki/viewer
Grebenyuk V.N., Kochetkov M.A., Zatorskaya N.