And optical dermatitis in adults. Atopic dermatitis in adults symptoms and treatment

According to medical statistics, over the past decade the prevalence has increased significantly skin pathologies. One of the most common reasons for visiting a dermatologist is atopic dermatitis, the symptoms of which manifest themselves to one degree or another in 80% of preschool children. As patients grow older, signs of the disease disappear in 60% of cases; in the remaining patients, dermatitis becomes chronic. Clinical course The disease in adults is characterized by its specificity, which requires a special approach to treatment.

What is atopic dermatitis

The occurrence of an allergic reaction in a person is preceded by sensitization (acquisition of increased sensitivity) of the body by a certain allergen. The reasons that provoke the process of sensitization are varied - from non-compliance with hygiene standards to genetic predisposition. If disturbances in the mechanism of the immune response are congenital features, the term “atopy” is used in relation to them.

The hereditary form of allergy has several manifestations, one of which is dermatitis - an inflammatory skin lesion with eczematous signs. The specific features of atopic dermatitis (or atopic eczema syndrome) include the following facts:

• development is associated with genetic predisposition;
• chronic nature of the course;
• tendency to relapse;
• clear seasonality of manifestation (the manifestation of severe symptoms of the disease after a latent period occurs in the winter);
• clinical manifestations depend on the age of the patient;
• morphological manifestations are exudative rashes with lichenification (sharp thickening of the skin in the area where the rash appears, increased severity of its pattern, changes in pigmentation);
• Dermatitis develops in childhood(synonym for the disease - diathesis), after which either complete clinical recovery can occur, or the disease remains for life (synonym for atopic dermatitis in adults - neurodermatitis or diffuse neurodermatitis);
• a constant symptom characteristic of all stages of the development of the disease (children and adults) is paroxysmal itching.

Atopic eczema syndrome is of two types in terms of prevalence and severity: moderate (focal rashes) and severe (extensive skin lesions). If left untreated, the skin disease can lead to serious complications - damage to the skin by pyogenic bacteria (pyoderma), viruses or fungi. Inherited skin hyperreactivity (increased sensitivity) predisposes endogenous factor to the development of pathology, but potentiation of the appearance allergic manifestations due to a number of exogenous reasons.

Development factors

Pathophysical changes in the skin that occur during periods of exacerbation of atypical dermatitis are caused by natural allergic reactions of the body of immediate type. Consecutive changes in internal biological environment(formation, release of skin-sensitizing antibodies and tissue reaction to the processes that have occurred) have their own genetically determined characteristics.

The main factor determining the implementation of hereditary atopy in the form of atopic eczema is the tendency to hyperreactivity of the skin, the risk of inheritance of which is:

• up to 20% – if both parents are healthy;
• 40–50% – if one of the parents has atopy (atopy is transmitted from the father in 40–50% of cases, from the mother in 60–70%);
• 60–80% – if both parents suffer from hyperreactivity.

The presence of a predisposition to the disease alone does not lead to the appearance of clinical signs of allergic dermatosis - this requires the presence of other exogenous causes. Manifestations of diffuse neurodermatitis can occur under the influence of the following factors:

• Contact with allergens. The most common substances that can have an allergenic effect are dust and mites contained in it, tobacco smoke, plant pollen, food products, medicinal substances (usually antibiotics of the penicillin group, antimicrobials, local anesthetics), physiological secretions of insects (cockroaches, ticks), hair and skin particles of pets, chemical products (washing powders, cosmetics, etc.), mold fungi.
• Sedentary lifestyle. This factor indirectly influences the triggering of the mechanism for the development of an allergic reaction. Physical inactivity leads to a decrease in the level of oxygen saturation of the body (hypoxia), which causes disruption of the functioning of internal organs and systems and increases the tendency of the immune system to sensitization.
• Moral and biological violations. Psycho-emotional overload, frequent nervous breakdowns, fear, anxiety and excitement also often act as causes of allergic dermatitis.
• Instability of thermal parameters. The development of the disease can be triggered by temperature changes, changes in climate zones, and exposure to strong winds.
• Aggressive impact of the technogenic environment. The deterioration of the environmental situation and the use of chemical products in everyday life create the preconditions for changes in the internal environment by disrupting the functioning of the endocrine glands and nervous system.
• Impaired functionality of the gastrointestinal tract. This factor can influence both the development of neurodermatitis and act as a catalyzing factor in the manifestation of the disease.

Features of the course in adults

Under the influence of allergens or other potentiating factors for the development of atopic eczema, a chain of inflammatory reactions is triggered in the body, resulting in the formation of a cellular infiltrate at the site of inflammation. The affected cells begin to secrete mediators (biologically active substances, transmitters of nerve impulses), hormone-like substances (cycotins) and immunoglobulin E, ensuring self-maintenance of inflammation. The processes occurring inside the body are reflected in specific symptoms.

Due to the presence of differences in the functioning of organs and systems in children and adults, the clinical manifestations of atopic dermatitis in different age groups of patients differ. Characteristic symptoms diseases in persons over 13 years of age (the stage of development of the disease is defined as “adult” if the patient’s age is more than 13 years), are:

• prurigo (pruritus) – severe itching that can appear even with minimal rashes, the sensation intensifies with sweating;
• dry skin – occurs due to a lack of natural moisturizing factors, which leads to disruption of the formation of the lipid layer and dehydration of the epidermis;
• the appearance of a blistering rash - typical places for localization of rashes are the face, neck, armpits, popliteal and elbow bends, groin area, scalp, area under the earlobes;
• swelling of the affected surfaces;
• hyperemia, darkening and thickening of the skin in places where the rash is localized (occurs in later stages of the disease);
• anxiety-depressive state, caused both by a reaction to a deterioration in the quality of life and by the development functional disorders central nervous system resulting from pathological changes in the body;
• increased susceptibility to infectious agents;
• follicular hyperkeratosis - in adult patients, as a result of neurodermatitis, keratinization of the skin surface of the lateral surfaces of the shoulders, elbows, and forearms may occur (looks like “goose bumps”);
• the appearance of cracks on the heels, bald spots in the occipital region - manifestations are typical for older people;
• peeling of the skin of the feet, madarosis (excessive loss of eyelashes and eyebrows) is a consequence of dysfunction of the thyroid gland, which is caused both by the allergic process itself and by the hormonal therapy undertaken.

Treatment of atopic dermatitis in adults

After diagnostics confirming the diagnosis of “atopic dermatitis” and identification of allergens that provoke the disease, a dermatologist prescribes a treatment regimen. To determine the optimal therapeutic methods Specialists in the following specialized areas may be involved:

• gastroenterologist;
• otolaryngologist;
• allergist;
• therapist;
• psychotherapist;
• neurologist;
• endocrinologist

Before starting treatment, there is a need to conduct a full examination of the body in order to detect concomitant pathologies and assess the functionality of all organs and systems. Based on all the measures taken, treatment tactics are determined, the basis of which is control of the symptoms of atopic eczema. It is very difficult to achieve complete recovery in an adult patient with diffuse neurodermatitis, so the main goals of therapy are:

• elimination or reduction of the severity of external symptoms;
• treatment of background pathologies that aggravate the course of dermatosis (bronchial asthma, hay fever);
• preventing the disease from reaching a severe stage;
• restoration of the structural and functional structure of the affected skin.

The methods used to achieve treatment goals are prescribed to adult patients on an individual basis, taking into account the characteristics of the body and the clinical picture of the disease. Complex therapy may include the following methods:

• medicinal (using external and systemic agents);
• physiotherapeutic (physical or physico-chemical effects on the affected surface);
• psychotherapeutic (to prevent the development of neuroses or psychoses against the background of illness, electrosleep, hypnosis and, in agreement with a neuropsychiatrist, medications are used);
• spa therapy ( Spa treatment);
• therapeutic and prophylactic diet (to restore intestinal microflora), hypoallergenic diet therapy;
• herbal medicine (the use of traditional medicine recipes must be agreed with the attending physician).

Acute period

The goal of treatment of neurodermatitis during the acute phase is to quickly relieve key symptoms and normalize the patient’s condition. The basis of therapeutic measures during exacerbation of the disease are medications from the group of topical corticosteroids (Prednisolone, Triamsinolone, Sinalar). For atopic eczema of moderate severity, corticosteroids of mild and moderate activity are used, for severe disease and large areas of damage - high activity. Drugs of this pharmacological class are prescribed in short courses.

At the acute stage of neurodermatitis, it is advisable to prescribe intravenous administration antihistamines (sodium thiosulfate solution or calcium gluconate). If there is exudation, it is recommended to use antiseptic lotions (Fukortsin, methylene blue solution, etc.). If the course of the disease is complicated by a secondary infection, systemic antibacterial agents (Erythromycin, Leukomycin) are prescribed. To potentiate the effectiveness of the treatment, the therapeutic course can be supplemented with immunomodulators (Levamisole, Thymus extract).

Remission period

During the latent phase of atopic dermatitis, treatment measures are aimed at preventing exacerbations. Due to the allergic nature of neurodermatitis, the main preventive measure is compliance with a treatment and prophylactic regimen, which is aimed at limiting the patient’s contact with potential allergens. At the stage of remission, drug therapy also plays an important role in ensuring the maximum duration of the asymptomatic period of the disease.

The drugs used to maintain a stable condition of the patient belong to the third generation of antihistamines, which can be taken continuously for six months. If there is a connection between the exacerbation of the disease and emotional stress, taking psychotropic medications in small or moderate doses is indicated. To prevent the appearance of symptoms of neurodermatitis, it is recommended to carry out therapy with sorbents, after which a course of drugs that normalize the intestinal flora (pre-, pro-, synbiotics, bacteriophages, enzymes) is prescribed.

For weakened adult patients whose disease occurs in a moderate to severe form, the use of anabolic steroids (Nerobol, Retabolil), which correct the effect of corticosteroids on the body, is indicated. At all stages and forms of dermatosis, the use of vitamin and mineral complexes is recommended. Depending on the patient’s condition, a course of mono- or multivitamin therapy is carried out. Vitamin supplements are often prescribed for a short period of time in dosages that significantly exceed normal physiological needs.

Drug treatment

Treatment protocols for atopic eczema in adult patients include a large number of medications, but antihistamines and tranquilizers are of greatest practical importance. Medicines of other groups are prescribed taking into account the prevalence inflammatory process, the presence of complications and concomitant pathologies. The range of drugs used during the treatment of neurodermatitis may include the following pharmacological groups:

• antimicrobial (usually local action);
• cytostatics (antitumor);
• anti-inflammatory drugs of nonspecific action;
• membrane stabilizers;
• antimediators;
• psychotropics and desensitizers (tranquilizers, antipsychotics, antidepressants, alpha-blockers, M-anticholinergics);
• antimycotics;
• immunocorrectors (immunostimulants, immunosuppressors), adaptogens;
• enterosorbents;
• drugs to normalize intestinal function (bacteriophages, prebiotics, probiotics, synbiotics, enzymes, hepatoprotectors);
• vitamins, multivitamin complexes;
• glucocorticosteroids;
• reducing agents (ointments, creams, patches for resorption of infiltrates);
• keratolytics (soften skin seals).

Glucocorticosteroids

Drugs belonging to the group of glucocorticosteroids (GCS) are artificially synthesized analogues of natural steroid hormones produced by the adrenal cortex. GCS have a multifactorial effect on the body, being simultaneously desensitizing, anti-inflammatory, antiallergic, antitoxic, antiproliferative and immunosuppressive agents.

For the treatment of atopic eczema in adults, internal and external forms of GCS are used. To non-external hormonal drugs for intramuscular administration is Betamethasone, injections of which are prescribed in a course with a frequency of use once every 2 weeks. The most frequently prescribed tablet medications in this group are Prednisolone, Metypred, Triamcinolone. For external use, the treatment regimen may include Laticort (hydrocortisone-based cream), Advantan ointment (methylprednisolone) and Afloderm cream (alclomethasone)

The use of GCS for the treatment of allergic dermatoses is due to their mechanism of action, which is to mediate the body's adaptive capabilities to external stress factors. Indications for the prescription of glucocorticosteroids are unbearable itching during the exacerbation phase of the disease (external forms) and lack of effect from the treatment (systemic corticosteroids). During remission, GCS can be used in the form of ointments to achieve an occlusive effect (blocking the release of pathogenic exudate).

Antihistamines

The drugs of first choice in the treatment of neurodermatitis are antihistamines 2nd and 3rd generations. This pharmacological group includes drugs that can block histamine neurotransmitter receptors and inhibit their potentiating effects. When treating allergic pathologies, H1 blockers are used, which are represented by 4 generations of drugs:

• 1st generation – Clemastine, Atarax;
• 2nd generation – Loratadine, Cetirizine;
• 3rd and 4th generation – Levocetirizine, Desloratadine.

Antihistamines for atopic dermatitis in adults have a pronounced antiallergic effect, effectively eliminating the key symptoms of the disease (redness, itching, swelling). 2nd and 3rd generation antihistamines are more effective than 1st generation drugs, are less likely to cause side effects and have reduced cardiotoxicity. During the treatment of the chronic form of the disease, H1-blockers in tablets are prescribed; in the acute phase, the medicine can be administered intravenously.

Immunosuppressants of the macrolide class

Basic therapy prescribed to adult patients after relief of the acute process includes external agents, which include immunosuppressants. Drugs in this group, unlike steroids, are non-hormonal drugs. The most well-known representatives of the macrolide class of immunosuppressants are tacrolimus (Protopic) and pimecrolimus (Elidel), the targets of which are T-lymphocytes and mast cells of the skin.

According to the results of a comparative analysis of the clinical effectiveness of immunosuppressive drugs for topical use with GCS of low and moderate activity, it was found that the use of tacrolimus and pimecrolimus in the face and neck area is more effective and safe than GCS. Using macrolide class drugs 2 times a week for a year increases the remission period by 3 times.

Moisturizers

Dermatological practice involves the widespread use of local therapy, which can be etiological, symptomatic or pathogenetic in nature. In the treatment of dermatitis in adult patients, reducing agents play an important role, restoring the structure and functionality of the skin. Dry skin is not only a symptom of neurodermatitis, but also a factor that supports inflammatory processes. Constant itching that occurs due to excessive dryness causes nervous disorders that interfere with the treatment process.

Reducing the dryness of the epidermis and accelerating the healing process is an important stage of therapy during remission, the purpose of which is to prolong the asymptomatic period of the disease. To achieve this task, moisturizing creams, ointments, gels, emulsions, lotions based on lanolin or thermal water are used. The choice of dosage form depends on the severity and localization of the inflammatory process:

• ointments – have pronounced nutritional properties, are prescribed in the presence of infiltration (ichthyol ointment);
• creams - ointment bases, which additionally have a cooling effect and have a gentle effect on the skin (Aisida cream, Atoderm);
• gels - high-molecular mixtures that keep low-molecular compounds (water, alcohols) from spreading (Solcoseryl);
• emulsions, solutions, aerosols - use is advisable during the acute stage of the disease, which is accompanied by exudation and weeping.

Tablets for atopic dermatitis in adults

The basis of systemic treatment of atopy in adults is drugs in tablet form. Due to the variety of factors influencing the development and course of the disease, the list of drugs for the treatment of neurodermatitis is extensive. All medications are prescribed exclusively by a doctor, based on the clinicopathological etiology of the disease. The main groups of medications in the form of tablets that can be used to treat atopic eczema are:

• membrane stabilizers;
• antihistamines;
• psycholeptics (sedatives).

Membrane stabilizing drugs

In diseases of an allergic or inflammatory nature, cell membranes are primarily damaged. Favorable conditions for the functioning of receptors built into the membrane are provided by the lipid component, which is especially vulnerable to the action of pathogens. The effectiveness of therapy for diffuse neurodermatitis depends on the degree of protection of the cellular structure, and therefore the complex of therapeutic measures should include membrane-stabilizing drugs that restore cell integrity.

During the treatment of allergic dermatosis, patients may be prescribed the following membrane stabilizers:

Name	Mechanism of action	Method of administration
Suprastin	The main active ingredient (chloropyramine) has an antihistamine effect by blocking H1-histamine receptors and may have a weak hypnotic effect.	The daily dose for adults is 3-4 tablets (75-100 mg), taken with meals. The duration of the treatment course is determined individually, on average it is 5–7 days.
Clemastine	H1-histamine blocker, in case of atopy, prevents the development of allergic symptoms, has a calming effect, relieves itching and swelling.	Tablets should be taken in the morning and evening, 1 piece, the maximum daily dose is 6 tablets.
Sodium cromoglycate	Reduces the severity of allergic manifestations and the inflammatory process by stabilizing the mast cell membrane (the release of histamine and inflammatory mediators is slowed down).
Ketotifen	Suppresses the development of allergy symptoms by inhibiting the release of inflammatory and allergic mediators.	The tablets are taken before meals twice a day. The recommended daily dosage is 2 mg. If necessary, the dose can be increased to 4 mg.

Sedatives

Psycholeptics (sedatives, sedatives) are prescribed for atopic dermatitis, if a connection between exacerbation of the disease and stress factors has been identified. Drugs in this group are also indicated in the case of psycho-emotional disorders that arise against the background of neurodermatitis. The calming effect is achieved due to the regulating effect of the active components of psycholeptics on the nervous system. During the treatment of adult patients, the following sedative medications may be used:

Name	Mechanism of action	Method of administration
Grandaxin (Tofisopam)	The anxiolytic has a general calming effect, normalizes the emotional background, and reduces the level of anxiety.	The medicine is prescribed to adults 3-6 tablets per day, the daily dose must be divided into 3 doses.
Bellataminal	Relieves itching in neurodermatitis, prevents the development of depression and anxiety.	Take 1 tablet after meals. three times a day. The duration of the course is from 2 to 4 weeks.
	Psycholeptic plant origin, has a pronounced antispasmodic and calming effect, eliminates symptoms of anxiety and irritability.	Adults should take 2-3 tablets 2 or 3 times a day (maximum daily dose 12 tablets). The duration of the continuous course should not exceed 1.5–2 months.
Diazepam	The sedative effect is manifested in the relief of anxiety, nervous tension, and anti-panic effect.	Depending on the severity of nervous tension, you should take from 1 to 3 tablets per day. The course continues until the emotional state improves.
Amitriptyline	An antidepressant with an analgesic effect, reduces restlessness, anxiety, agitation (nervous agitation).	The tablets should be swallowed whole immediately after meals. The recommended daily dosage for neurodermatitis is 2 tablets. (after 2 weeks you can increase to 4 tablets).

Drugs to normalize intestinal function

In order to speed up the healing process for atopic dermatitis, it is necessary to cure dysbiosis (violation of the ratio of beneficial and pathogenic bacteria inhabiting the intestines), which is often a provoking factor for exacerbation of the disease. The first stage of restoring normal intestinal microflora is detoxification, which is carried out using agents that can adsorb substances harmful to the body (Polysorb, Enterosgel).

The next stage after cleansing should be the restoration of the normal functioning of the gastrointestinal tract, which is achieved through the use of medications that improve intestinal microflora:

Name	Mechanism of action	Method of administration
	It has pronounced enveloping properties due to which it enhances the barrier functions of the mucous membrane, increases its resistance to irritants, adsorbs and removes toxic substances from the body.	Dissolve the contents of 1 sachet in 0.5 cups of water. Take the suspension after meals 3 times a day. The duration of the course is determined individually.
Preparations containing Lignin (Lactofiltrum, Polyphepan)	Regulation of the balance of intestinal microflora, adsorption and elimination of exogenous, endogenous toxins and allergens, increasing nonspecific immunity.	Take the sachet 1 hour before meals, after dissolving it in a small amount of water. The frequency of doses for adults is 2–4 times a day, the course duration is 2–4 weeks.
Bifidumbacterin	Normalization of the digestive tract, prevention of dysbacteriosis.	1 bottle (5 doses) 2-3 times a day with meals or 20-40 minutes before. before eating, course – 10–14 days.
Hilak forte	Regulation of the composition of intestinal microflora, regeneration of epithelial cells of the intestinal walls.	The daily dose is 9.9 ml (180 drops). It is recommended to take 40–60 drops diluted with liquid (except milk) three times a day with meals.

Hyposensitizing agents

There are two main ways of influencing the immunological phase of an allergic reaction - complete limitation of contact with the allergen and specific desensitization (reduction of the body's hypersensitivity). The first method is preferable, but due to a number of factors it is difficult to implement (it is not always possible to identify the allergen or completely eliminate contact with it).

The method of specific desensitization in practice gives satisfactory results and is used during an exacerbation of atopic eczema or in the absence of data on the cause of the allergic reaction. Specific hyposensitizing therapy is associated with a risk of exacerbation of the disease, so it is combined with nonspecific hyposensitizing antihistamines.

Hyposensitizers reduce the body's sensitivity to irritants by inhibiting the immunological mechanism of allergy development. The basis of drugs in this group are histamine antagonists (calcium preparations, sodium thiosulfate, corticosteroids, etc.), injections of which are often used during the acute phase of neurodermatitis to achieve a rapid antiallergic effect.

Calcium gluconate

Development allergic reactions often accompanied by hypocalcemia, as a result of which the permeability of the vascular walls increases, and the allergen quickly enters the bloodstream. Calcium in the form of gluconate is a source of calcium ions, which are involved in the transmission of nerve impulses and prevent the release of histamine. In case of exacerbation of atopic eczema, the medicinal solution is administered intravenously for 5–7 days, 1 ampoule (10 ml). Before administration, the contents of the ampoule should be warmed to body temperature.

Sodium thiosulfate

The sodium salt and thiosulfuric acid is used in the treatment of neurodermatitis in order to achieve a detoxification effect. The drug is available in the form of a solution for intravenous injection. After introduction into the body, the substance is distributed in the extracellular fluid and forms non-toxic compounds with cyanides, facilitating their elimination. The medicine is prescribed for severe itching to minimize allergic manifestations of dermatitis. The duration of the course is 5 days, during which adult patients are administered 1–2 ampoules (5–10 ml) of sodium thiosulfate.

Prednisolone

To achieve maximum anti-inflammatory and immunosuppressive effect during the acute phase of the disease, the systemic glucocorticosteroid Prednisolone is used. The mechanism of action of the drug is due to the ability of the active substance to bind to specific receptors in the cellular cytoplasm and inhibit the synthesis of mediators of an immediate allergic reaction.

The immunosuppressive effect is ensured by potentiation of lymphopenia (decreased lymphocytes) and involution (decreased mass) of lymphoid tissue. In case of exacerbation of severe allergic dermatosis, intravenous or intramuscular injections of Prednisolone are prescribed at a dosage of 1–2 mg per 1 kg of the patient’s body weight. The course lasts no more than 5 days

External therapy

Local treatment of atopy is aimed at eliminating the cause and symptoms of dermatitis. To achieve these tasks, a large arsenal of external medications is used. From the right choice The success of therapy depends on the active components and dosage form of the medicine. During the treatment of atopic eczema, adult patients can be prescribed the following medications, which can be purchased in city pharmacies:

Pharmacological group	Drugs	Mechanism of action	Mode of application	Price range, rub.
Corticosteroids	Hydrocortisone (Laticort, Lokoid)	Relieves inflammation, inhibits allergic processes, eliminates swelling and itching. The ointment has a cumulative effect.	Apply to wound surfaces 2-3 times a day for 6-20 days. For limited areas of inflammation, it is recommended to use occlusive dressings.
	Dermovate	Cream and ointment based on clobetasol propionate. Eliminates inflammatory processes, reduces exudation, has antiallergic and antipruritic effects.	Lubricate the affected area every morning and evening until the desired effect is achieved. The duration of the course should not exceed 4 weeks.
		Inhibits the release of allergic reaction mediators, has an antiexudative and antipruritic effect.	To eliminate peeling in case of increased dryness of the skin, ointment should be used (applied once a day); with active exudation, a cream should be used (1 time/day). For lesions on the scalp, it is recommended to use lotion, which is rubbed into the skin until completely absorbed.
	Afloderm	Prevents the expansion of capillaries, thereby slowing down the development of edema. Has immunosuppressive and anti-inflammatory effects.	Apply cream (suitable for sensitive areas) or ointment to inflamed areas 2-3 times a day until the symptoms of the disease disappear.
Macrolides		Inhibits the synthesis and release of protein phosphatase (inflammatory mediator), which stops the development of the inflammatory process and reduces the severity of histopathological changes (disturbances in the intercellular connections of the epidermis).	The cream should be used at the first sign of exacerbation of dermatitis. Apply twice a day and rub into the skin until completely absorbed. Continuous use can be carried out for no more than 6 weeks.
Antihistamines	Fenistil gel	Reduces the severity of skin itching, eliminates irritation, blocks H1-histamine receptors and reduces capillary permeability.	The gel is applied externally 2–4 times a day.
Emollients and moisturizers	Ichthyol ointment	The therapeutic effect is due to the presence of sulfur-containing compounds in the composition, which contribute to pain relief, softening and removal of infiltrates, potentiation of the process of tissue regeneration, local constriction of blood vessels, due to which the production of purulent secretion is reduced.	The ointment is applied in a thin layer to the affected areas of the skin and distributed evenly (no need to rub in); the layer should be so thick that there are no gaps left. A sterile bandage is applied over the ointment, which should be changed after 8 hours. The course is 10–14 days.
		Accelerates the process of epithelization, has a moisturizing effect on all layers of the epidermis.	Apply the cream to dry areas of the skin once a day, if necessary, you can increase the number of applications.
	Trickzera	Softens very dry skin, increases its elasticity, restores the lipid barrier.	Apply to previously cleansed dry skin 2-3 times a day.
		Helps correct skin dryness and reduce hypersensitivity.	The cream is applied twice a day, the skin should be pre-prepared (cleansed and moisturized).
		Has a calming effect on irritated skin, restores the lipid layer.	Apply the cream daily with gentle movements to the skin of the body and face.
	Topicrem	Hydration upper layers epidermis, eliminating the feeling of “tightness” due to the formation of a moist film on the surface of the skin.	Apply daily after hygiene procedures.
Wound healing drugs	Silver sulfathiazole (Argosulfan)	It has a bactericidal effect, helps accelerate the healing process and epithelization of wounds.	Apply a layer of 2–3 mm to the wound surface in the morning and evening. You can treat with cream in an open or closed way (applying the product under a bandage).
	Solcoseryl	Wound healing effect, acceleration of regenerative processes, increased collagen synthesis.	Apply to the wound surface pre-treated with an antiseptic 2-3 times a day (used only for weeping wounds without crusts).
	Actovegin	Treatment of wounds at all stages of the disease (gel is used at the initial stage of wound formation, cream is indicated for wet wounds, ointment is optimally used for long-term therapy of dry wound surfaces).	Apply to a wound cleaned of exudate, pus, etc. The product is applied 2-3 times a day in an open or closed way.
	Methyluracil ointment	Accelerates the process of cell formation, activates humoral and cellular immunity, stimulates repair (correction of cell damage due to exposure to pathogens).	Apply to damaged areas 2–4 times a day, duration of use should not exceed 2 weeks.

Antibacterial ointments for secondary infection

When intensively scratching itchy skin, the integrity of its surface is disrupted, which facilitates the penetration of infectious agents from the environment into the inner layers of the epidermis. Pathogens cause irritation and itching, completing the “atopic skin cycle” (where symptoms of dermatitis become factors in its development). In order to break the vicious circle, it is necessary to stop the development of secondary infection. For this purpose, external antibacterial agents are prescribed, such as:

1. Levomekol (cost from 102 rubles) - has a multifactorial effect due to the combined composition, which includes an antibiotic (chloramphenicol) and an immunostimulant (methyluracil). Levomekol for dermatitis helps relieve inflammation by inhibiting protein synthesis in pathogen cells and accelerates the process of tissue regeneration by accelerating the exchange of nucleic acids. The ointment should be applied to sterile napkins that are applied to the wound surface. The dressings should be changed daily until the wound is completely clean.
2. Erythromycin (cost from 80 rubles) - an ointment based on erythromycin (the first antibiotic of the macrolide class). The antibacterial effect consists of disrupting peptide bonds between amino acid molecules and disrupting the protein synthesis of pathogenic cells. Along with the bacteriostatic effect, a bactericidal effect may appear (with increasing dose). The medicine should be applied to the affected skin 2-3 times a day for 1.5-2 months.
3. Dioxidin (cost from 414 rubles) is an antibacterial agent, a derivative of quinoxaline, that can have a bactericidal effect on those strains of microorganisms that are insensitive to other types of antibiotics. Treatment of wounds with dermatitis with ointment accelerates the process of marginal epithelization and reparative regeneration. The medicine should be applied in a thin layer once a day; the duration of therapy for adult patients is no more than 3 weeks.

Physiotherapeutic procedures

The frequent use of various methods of physiotherapy in the practice of treating diffuse neurodermatitis in adults indicates their high effectiveness. When prescribing physical procedures, the indications and contraindications of specific types of exposure to physical factors are taken into account. The most common methods of physical treatment for dermatosis are:

1. Phototherapy is dosed irradiation of affected areas of the skin with ultraviolet rays, thereby suppressing local cellular immunity.
2. Phototherapy is the effect of bright light from artificial sources (lasers, diodes, fluorescent lamps) on the body of a patient who has previously consumed a photosensitizing substance (psoralen or ammifurin).
3. Acupuncture – stimulation of biologically active points of general action (at the acute stage of the disease) and local ones (during the treatment of subacute and chronic forms), corresponding to the localization of the inflammatory process.
4. Electrotherapy - the action of dynamic currents on the paravertebral ganglia (autonomous nerve nodes located along the spine) gives a sedative effect.
5. Hyperbaric oxygenation – saturation of tissues with pure oxygen under high pressure, which leads to an improvement in the rheological properties of blood and acceleration of the process of tissue regeneration.
6. Electrosleep - electrical stimulation of parts of the brain helps to inhibit those structures whose excessive activity can provoke the development of neurodermatitis.
7. Paraffin therapy is a heat treatment method that involves heating tissue in areas of lichenification using paraffin. The purpose of the procedure is to moisturize the affected skin and increase its elasticity.
8. Electrophoresis - through intranasal administration medicinal substances(Diphenhydramine, Novocaine) with the help of electric current, a direct effect is exerted on the vessels and autonomic parts of the nervous system through the mucous membrane of the nasal cavity.

Vitamins

Degradation of the skin often accompanies hypovitaminosis, so vitamin support for the body is of great importance in the treatment of dermatological diseases. Therapy for neurodermatitis at the stage of remission is supplemented with vitamin and microelement complexes. The main vitamins that accelerate the healing process in atopy are:

• retinol (vitamin A) - drugs Tigazon, Neotigazon for diffuse neurodermatitis are used for a long time and in high dosages;
• B vitamins (thiamine, riboflavin, cyanocobalamin, pyridoxine, nicotinic acid) - used in isolation or as part of vitamin-mineral complexes;
• ascorbic acid - during the acute phase, taking mega-doses of vitamin C is indicated;
• vitamin D3 – prescribed in combination with calcium salts;
• tocopherol – the effectiveness of therapy increases when combining vitamin E and retinol (Aevit);
• zinc preparations - internal administration of zinc-containing preparations (Zincteral) enhances the effect of external agents used to care for affected tissues;
• multivitamin complexes - indicated for use in chronic dermatoses (Centrum, Oligovit).

Folk remedies

Traditional therapy for dermatitis can, in agreement with the doctor, be supplemented with non-traditional methods. Products made according to traditional medicine recipes can provide additional support to an organism weakened by disease and the action of highly active medicinal substances. To relieve the main symptoms of neurodermatitis, herbal remedies can be taken orally (decoctions, infusions) or used externally (ointments, lotions, compresses, lotions).

Before starting self-medication using traditional methods, it is necessary to agree with your doctor on the feasibility and safety of using certain medicinal herbs. Due to the effect they provide, the following methods of home therapy are very popular among patients with atopic eczema:

• oat decoction (taken orally for 1 month);
• potato compresses;
• ointments based on herbal ingredients;
• decoctions of medicinal herbs that have anti-inflammatory and antipruritic effects;
• alcohol tinctures;
• herbal baths.

Raw potato compress

Traditional recipes for getting rid of allergic dermatosis based on potatoes are safe to use and easy to prepare. The tubers of this vegetable consist of 75% water, which determines its moisturizing and softening effect on the skin. To prepare the medicinal composition, you should peel fresh raw potatoes and chop them using non-metallic tools. The potato mass should be wrapped in gauze, squeezed out and applied to the affected surface overnight. Procedures are performed until the skin condition improves.

Antipruritic ointment made from chamomile and fireweed

You can get rid of severe itching, which is the main symptom that bothers patients, using an antipruritic ointment based on fireweed (fireweed) and chamomile. This herbal medicine can only be used on open areas of the body. To achieve a sustainable effect, it is necessary to carry out the procedure for a month, applying the ointment 3-4 times a day. If necessary, the course continues after a week's break. The components necessary for preparing the antipruritic composition should be prepared in advance. The recipe includes the following ingredients:

• chamomile (flowers);
• fireweed;
• decoction of hay dust (0.5 cups of hay dust per 1.5 cups of water);
• butter (1 tbsp);
• glycerol.

Chamomile and fireweed flowers should be crushed and mixed in equal proportions. 1 tbsp. l. Pour the mixture with 4 cups of water and bring to a boil. After boiling, the broth is covered with a lid and boiled for 5 minutes, then a decoction of hay dust and butter are added to it. The resulting mass should be cooked over low heat until it reaches a homogeneous consistency. The last step in preparing the ointment is adding glycerin in a ratio of 1 to 1. After cooling, the product is stored in the refrigerator.

Herbal decoction for oral administration

Along with traditional medicine for external use, decoctions for oral use have a good healing effect. The main components of the herbal drink are tree peony grass, motherwort, nettle, valerian root and mint. The decoction has a calming effect, helps strengthen the immune system and improves metabolic processes in the body. In order to prepare a healing drink, mix 50 g of ingredients, pour 1.5 liters of boiling water and leave for 1 hour.

The course of herbal medicine should last 20–30 days, during which the drink is prepared daily and drunk throughout the day. During the entire period of using the decoction, you should not take baths with hot or cold water (recommended temperature is 36–40 degrees). After water procedures It is necessary to lubricate wounds with emollient compounds.

Sanatorium-resort treatment of dermatitis in adults

Carrying out spa therapy as part of the complex treatment of allergic dermatitis in adult patients increases the overall effectiveness of therapy. This method is only indicated during remission. The direction of sanatorium-resort treatment is assigned to the patient, taking into account all indications and possible contraindications. The following procedures can be performed during spa therapy:

• peloidotherapy (mud baths or applications);
• thalassotherapy (treatment using all factors formed in the marine climate - water, algae, seafood, etc.);
• balneotherapy (use of the healing properties of mineral waters - showering, irrigation, drinking, intestinal lavage, etc.);
• heliotherapy (solar therapy, sunbathing);
• climatotherapy (staying in a dry, warm climate zone for more than 2 months ensures long-term remission, more than 3 years - complete recovery).

Diet therapy

An important stage in the course of treatment for atopy is the preparation of a hypoallergenic diet, the main task of which is to prevent allergens and histamine liberators (products that stimulate the release of histamine) from entering the patient’s body. If, using laboratory diagnostics, a specific product is identified that has caused sensitization of the body, a specific exclusion diet is prescribed (exclusion of products containing the identified substances).

In the absence of data on a specific allergen and during the acute phase of the disease, a nonspecific elimination diet is indicated. Foods that must be excluded from the diet in all cases of atopic eczema during relapse are:

• spicy, fried, pickled, extracted (dry mixtures) foods;
• pickles;
• smoked meats;
• citrus;
• Tea coffee;
• chocolate;
• milk;
• chicken eggs;
• jam;
• chicken, goose, duck meat;
• seafood;
• fatty fish;
• red fruits and vegetables;

In addition to avoiding foods with high level allergenicity, patients are advised to follow a number of dietary rules, the implementation of which will help achieve sustainable remission of atopy:

• inclusion in the diet of foods containing all the necessary vitamins and minerals;
• ensuring the supply of substances that accelerate regeneration processes (sunflower oil, olive oil, corn, flax);
• reducing the consumption of gluten (protein amino acids found in cereal products);
• maintaining normal functioning of the liver and intestines (exclude alcohol, fatty foods, consume more fiber);
• short-term fasting under medical supervision;
• Maintaining water balance (drink at least 2 liters of water daily);
• monitoring the body’s reactions to consumed foods (keeping a food diary).

To determine the most likely food allergens, it is necessary to monitor and record reactions that occur in response to the consumption of a particular product. Guidelines for keeping records are as follows:

• before starting to keep a diary, you must abstain from food for 1 day (you are allowed to drink clean water, unsweetened tea);
• introduce foods into the diet gradually (first dairy, then eggs, meat, fish, vegetables and citrus fruits);
• describe in detail the composition of the dishes consumed (ingredients, quantity, time of intake, method of preparation);
• record all body reactions, indicating the time of their occurrence and severity.

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Almost every mother can experience atopic dermatitis in her baby. This disease often appears from the first days after birth and occurs throughout life. Children who are diagnosed with atopic dermatitis are forced to see an allergist for life. Only correct knowledge about this disease will help control the course of the disease.

What it is?

Scientists have identified a number of genes that encode a predisposition to perceive various substances. These genes cause the body's increased susceptibility to various foreign components. As a rule, several family members can have such a predisposition at the same time.

Atopic dermatitis develops as a result of an acute response of the immune system to a trigger factor. This reaction is accompanied by pronounced skin and systemic manifestations. Various substances and allergens can act as triggering or provoking agents. The specificity of an individual reaction depends on genetic predisposition and the initial level of the immune system.

Causes

A severe allergic reaction, manifested by the appearance of a rash or other skin lesions, does not occur in all children. Currently, scientists have identified more than a thousand different causes that can lead to the appearance of atopic dermatitis. . In most cases, the triggering agents are chemicals.

The only exact cause of the disease is unknown to scientists. This is due to the individual coding of genes in each human body. It has been established that when a specific trigger occurs, the risk of developing atopic dermatitis in the presence of a specific genetic predisposition is more than 95-98%.

Canadian scientific studies have shown a statistically significant connection between the presence of stressful situations and exacerbations of the disease. After severe psycho-emotional or physical stress, the risk of new exacerbations of the disease increases by 12-15%.

Among the possible causes, some scientists note the presence of skin pathologies. When the integrity of the skin is damaged, allergens enter into the skin much more easily. children's body and trigger a whole cascade of inflammatory reactions. As the disease develops, periods of exacerbation are replaced by remission. As a result of a long-term illness, the structure of the skin changes. This may also affect the likelihood of the disease progressing.

Provoking factors

Atopic dermatitis can be triggered by numerous factors. All triggers can be divided into several categories. Most provoking agents enter the body from the outside. They account for more than 80% of disease cases. Internal provoking factors are much less common. Typically, such forms of disease are typical for children who have many chronic diseases.

All provoking factors that trigger a cascade of allergic reactions can be divided into several etiological categories:

Stages of disease development

Unfortunately, atopic dermatitis is a chronic disease. In the presence of individual sensitivity and genetic predisposition to various provoking factors, a new exacerbation of the disease can occur at any age. Like any chronic disease, atopic dermatitis goes through several successive stages in its development:

1. Primary contact with the allergen. In this case, when a provoking agent enters, the cells of the immune system are activated. Lymphocytes, which are designed to recognize substances foreign to the body, are activated and release a huge amount of biologically active substances. Subsequently, when the same trigger hits, the inflammation proceeds much more severely. This property is due to cellular memory. Cells of the immune system “remember” the antigens of a substance foreign to the body and, upon repeated exposure, release a huge amount of protective antibodies.
2. Development of immune inflammation. Activated lymphocytes, which recognize a foreign agent, begin to release a huge amount of interleukins. These protein substances have a pronounced biologically active effect. It is with them that the development of all unfavorable clinical symptoms and manifestations is usually associated. This reaction has a positive meaning. It is designed to limit inflammation and prevent damage to vital organs. The body wants to limit inflammation to only the skin, protecting the brain and heart.
3. Development of classic manifestations of the disease. During this period, the inflammatory process reaches such strength that the first adverse symptoms of the disease begin to appear. As a rule, they last 7-14 days. The most acute manifestations upon initial contact with the allergen, they appear within 48-72 hours. If the provoking factor enters the body again, the period before the onset of symptoms can be reduced from several hours to a day.
4. Subsidence of exacerbation and transition to a chronic form. During this period, the amount of toxic substances that are formed during an allergic reaction decreases. The immune system calms down and goes into “sleep” mode. The subsidence of the process can last up to 2-3 weeks. At this time, there are only residual skin manifestations: dryness, slight flaking, slight redness. After the acute period of the disease subsides, the skin clears up and takes on its normal appearance.
5. Remission. During this period, practically nothing bothers the child. The baby leads a normal life. The child's health is excellent. The skin changes slightly. In some cases, crusts or areas of dry skin may form at the folds.

The development of the disease involves a sequential alternation of several stages. After a period of exacerbation, remission occurs. The duration of this period largely depends on the condition of the baby and the absence of exposure to provoking factors. With any change in the level of immunity or inflammation, remission can quickly give way to exacerbation.

Classification

Today, doctors use several different categories in their work to help clarify the diagnosis. Such classifications include the distribution of various variants and forms of the disease - depending on the stage of the inflammatory process, its duration, as well as the severity of the child’s general condition.

The various forms of atopic dermatitis can be divided into several broad categories.

Disease development phase

• Start. Corresponds to the primary contact of immune system cells with a provoking factor.
• Development of clinical manifestations. During this period, all the main manifestations of the disease characteristic of the acute period develop.
• Subsidence of exacerbation. Disappearance of unpleasant symptoms, improvement of the baby’s general condition.

Age

• Infant version. Develops in children under two years of age. It usually occurs with the appearance of red itchy spots. These rashes are quite large. This option is also characterized by pronounced swelling of the baby’s buttocks, arms and legs. The skin on the body becomes very thin. Numerous white scales may form on the head, which are easily torn off.
• Children's version. As a rule, it lasts until adolescence. This form of the disease is characterized by severe itching and drying of the skin. Skin elements can be varied. Various vesicular rashes filled with transparent contents often appear.
• Teen version. It can develop before the child’s eighteenth birthday. This form occurs with the appearance of severe itching on damaged areas of the skin. The disease occurs with alternating periods of exacerbation and remission. This leads to the formation of dense crusts and areas of severe lichenification. The appearance of vesicles does not always occur. Much more often skin rashes appear as large areas of erythema.

The extent of the inflammatory process

• Option with limited areas. Damage to the skin in such cases amounts to no more than five percent of the entire skin surface.
• Option with common elements. Occurs when there are lesions that cover up to a quarter of the entire surface of the skin.
• Option with diffuse changes. An extremely unfavorable form of the disease. In this case, numerous damage to the skin is noted. The only areas that remain clean are the inner surface of the palms and the area on the face near the nose and above the upper lip. This variant of atopic dermatitis causes severe unbearable itching. Numerous scratch marks appear on the skin.

Change in general condition

• Relatively mild course. Involves the occurrence of a small number of skin rashes during exacerbations. Usually these are single vesicular elements. This option is characterized by the appearance of moderate itching, slight swelling, and dry skin. The course of the disease is usually well controlled. Periods of remission are usually long.
• Moderate form. With this variant of the disease, a large number of different vesicular formations filled with serous fluid appear in various parts of the body. When the vesicles rupture, the fluid leaks out and weeping ulcers form. As a rule, the baby's condition worsens. The child constantly scratches the itchy elements. The condition may also be complicated by the addition of a secondary bacterial infection.
• Heavy current. Typical for children with low level immunity. The child looks terrible. Skin elements appear almost everywhere: on the face, on the arms and legs, covering the buttocks and abdomen. Numerous vesicles, rupturing, contribute to the development of strong weeping wounds, which are poorly epithelized.

Main symptoms and signs

Atopic dermatitis is manifested by numerous symptoms that cause severe discomfort to the baby. The severity of the disease depends on a combination of many factors. With a mild course of the disease, symptoms appear to a lesser extent. If the child’s allergic predisposition is sufficiently pronounced, then the immune response to the provoking factor will be very strong.

During an exacerbation, dermatitis manifests itself with the following characteristic signs:

• Severe itching. It bothers the child throughout the day. Decreases somewhat at night. Children scratching damaged areas of the skin can cause additional infection and worsen the course of the disease. The use of antihistamines helps to somewhat reduce the manifestation of this uncomfortable symptom.
• The appearance of erythematous spots. Numerous bright red spots begin to form on the skin. With a mild course of the disease, skin rashes may appear only in limited areas of the body. They often appear on the back, stomach or arms. The affected skin acquires a characteristic “fiery” color. It becomes hot to the touch, somewhat compacted.
• Appearance of dryness. It is also one of the most common symptoms of atopic dermatitis. The longer the disease lasts, the more pronounced this manifestation becomes. This is due to a violation of the water-lipid composition of the skin (due to a long-term inflammatory process). The structure of the skin layers is disrupted, which contributes to a change in its quality. The skin becomes very dry to the touch and thins.
• Various skin rashes. Atopic dermatitis is characterized by a variety of different manifestations. In most cases, the disease manifests itself by the appearance of vesicular elements. As a rule, they contain serous fluid inside. In more rare cases, papular elements occur or various crusts appear. Such rashes most often occur in all folds of the skin. Very often they appear in the cubital fossa, under the knees, and can also appear behind the ears or on the cheeks.
• Lichenification phenomena. This sign appears quite late. It occurs with constant scratching, in the presence of damaged areas of the skin. In this case, a change in the structure and structure of the skin occurs. It becomes denser, the architecture of collagen and elastin fibers is disrupted.
• The child is not feeling well. Severe itching causes severe anxiety in the baby. Babies are more capricious and often cry. In severe cases of the disease, they may even refuse to eat. Older children are characterized by increased excitability and even somewhat aggressive behavior. Sleep is disturbed.

After the acute process subsides, a period of remission begins. All symptoms that were characteristic during an exacerbation are replaced by others. The length of remission can depend on many different factors. With a favorable course of the disease, such periods can even last several years.

The period of remission of atopic dermatitis is characterized by the following symptoms:

• Changes in skin structure. Some areas of the skin become thicker, while others become thinner. This occurs due to changes in the structure and structure of the skin layers. The areas where the weeping ulcers were located usually heal, but become less dense to the touch. Crusts may form on healed wounds.
• Traces of scratching. They are found in almost all children with atopic dermatitis. They are most pronounced in children with frequent exacerbations of the disease. Usually appear as narrow stripes of white or reddish color. Cover the entire surface of the body. You can see them in large quantities on the baby’s arms or cheeks.
• Change in skin pattern. During the long-term inflammatory process that occurs with this disease, the architecture of the skin structure changes. Areas of hyperpigmentation appear.
• Severe dryness of the skin and the appearance of areas with peeling. This symptom is typical in the very first days after the exacerbation subsides. The skin becomes very dry. Numerous scales may appear on the scalp and on the folds of the arms. They come off easily when washed or touched.
• With a long course of the disease, severe dryness and flaking around the red border of the lips may appear. Often this is a manifestation of atopic cheilitis. This condition requires no special treatment other than the use of mild lip balms approved for use in children. In some cases, atopic cheilitis goes away on its own, without the use of additional drugs.

Diagnostics

Auxiliary laboratory and instrumental tests will help identify a specific allergen that contributes to the appearance of symptoms of atopic dermatitis.

General blood analysis

An increase in the level of leukocytes above normal indicates the presence of an inflammatory process in the body. Severe eosinophilia (increased number of eosinophils) indicates the presence of an allergic nature of the disease. All allergies occur with accelerated ESR during the acute period of the disease.

Leukocyte formula helps doctors understand the stage of the inflammatory process. An increase in the level of peripheral lymphocytes also speaks in favor of the allergic nature of the disease.

Biochemical research

To carry out the analysis, a little venous blood is taken from the baby. This test can look at your liver and kidney function. An increase in transaminase levels may indicate the involvement of liver cells in the systemic process. In some cases, there is also an increase in bilirubin levels.

Kidney damage can be assessed by measuring urea or creatinine levels. With a long course of the disease, these indicators can change several times. If your creatinine level changes, be sure to show your child to a nephrologist. He will help you choose the right tactics further treatment baby.

Quantitative determination of immunoglobulin E

This substance is the main protein substrate that cells of the immune system secrete in response to allergens entering the body. In a healthy baby, the level of immunoglobulin E remains normal throughout life. Children with atopic diseases are characterized by increased levels of this substance in the blood serum.

The material for the study is venous blood. The analysis is ready, as a rule, in 1-2 days. During an exacerbation of the disease, the level of immunoglobulin E is many times higher than normal. An increase in the value of more than 165 IU/ml may indicate the presence of atopy. During remission, the level of immunoglobulin E decreases slightly. However, it is enough long time it may remain slightly elevated.

Special allergy tests

This method is a classic way to determine allergens in immunology. It has been used in pediatrics for more than a hundred years. The method is quite simple and informative. Such provocative tests are carried out for children over four years of age. Younger children may give false positive results during the test. This is largely due to the peculiarities of the functioning of the immune system at this age.

Only a pediatric allergist-immunologist can conduct allergy tests. Most often they are carried out in allergy clinics of clinics or in private centers.

The study usually takes no more than an hour. Small incisions are made on the baby's skin with a special sharp scalpel. There is no need to be afraid of such cuts. They are too small to become a threat of infection or suppuration.

After applying special incisions, the doctor applies diagnostic solutions of allergens. Substances are applied in strong dilution. This allows you to minimize the risk of a possible violent allergic reaction. Such diagnostic solutions can be applied in several ways. Usually drip is chosen.

Today, the application method is widely used. It does not require additional notches. With this method of applying the allergen, the diagnostic solution is applied to the material in advance. The doctor simply glues it to the child’s skin and evaluates the result after a while.

Usually the result is assessed in 5-15 minutes. This time depends on the initial diagnostic solution used in the study. If the baby has an allergic predisposition or severe sensitivity to a specific allergen, then after a specified time redness (and even skin manifestations) will appear at the application site. They can be papules or vesicles.

The undoubted disadvantage of this test is its low specificity.. If the baby has very sensitive and delicate skin, then various false positive reactions. Under the influence of any chemical provocateur, too delicate skin can react excessively. In such cases, it is impossible to speak about the unambiguous presence of an allergy.

If it is impossible to unambiguously assess the presence of individual allergic sensitivity to a specific allergen, doctors use additional serological tests.

Determination of specific antibodies

These studies are considered the most modern among all methods for diagnosing atopic diseases. They began to be used quite recently, but have shown excellent results in the diagnosis of allergic diseases. The test does not require making incisions or making cuts in the skin. The material for the study is venous blood.

The turnaround time for analysis usually ranges from three days to several weeks. This depends on the number of allergens tested. For the convenience of young patients, modern laboratories immediately determine a whole range of allergens that are similar in antigenic structure. This allows not only to accurately identify one provoking factor, but also to identify all cross-allergens that can also trigger an exacerbation.

The essence of the method comes down to determining specific antibodies that are formed in the body after allergens enter it. They are protein molecules that are very sensitive to various foreign agents. Whenever there is contact with an allergen, cells of the immune system release huge amounts of antibodies. This protective reaction is designed to quickly eliminate the foreign agent from the body and eliminate inflammation.

Serological test is important diagnostic study when identifying provoking factors that can trigger an allergic reaction. It has a fairly high specificity (95-98%) and information content. The disadvantage of the study is the high cost. Typically, the price for determining 10 different allergens is 5,000-6,000 rubles.

Before performing any serological tests, it is important to remember to prepare for research. All such tests are best performed during remission. This will minimize false positives. Before conducting the study, it is better to adhere to a therapeutic hypoallergenic diet. It is better to stop all antihistamines and desensitizing medications a couple of days before the test.

Principles of basic treatment

Therapy for atopic dermatitis is divided into several stages: during exacerbation and remission. Dividing treatment allows you to cope with different symptoms that occur at different periods of the disease. With the long-term development of the disease, drug therapy also changes. This is largely due to changes in the architecture and structure of the skin.

During an exacerbation

• Elimination of the provocative factor. It is an important condition for successful treatment of the disease. Often in infants there is a contact form of atopic dermatitis. It occurs when wearing diapers that are poorly suited for a particular child. The area of ​​tissue that is closely adjacent to the baby's genitals can be impregnated with various antiseptic agents. Babies prone to allergies may develop acute contact dermatitis . In this case, it is better to abandon this brand of diapers and change them to others.
• Use of drug therapy. Today, the pharmaceutical industry offers a huge selection of different products that help cope with the discomforting symptoms of atopic dermatitis. The choice of medications is carried out based on the skin manifestations that arose during a given exacerbation. The most commonly used are various hormonal and anti-inflammatory ointments, creams, gels, as well as various powders or mash.
• Following a hypoallergenic diet. During an exacerbation, doctors prescribe the most stringent therapeutic diet. This diet includes an abundance of permitted protein foods and cereals with the almost complete exclusion of a variety of fruits and vegetables. You can only eat green plants.
• In severe cases of the disease - elimination of systemic manifestations. In such cases, hormonal drugs may be prescribed in the form of injections or tablets. In case of severe itching, which brings severe suffering to the baby, tablet forms of antihistamines are prescribed. E it could be “Suprastin”, “Fenistil” and others. They are prescribed for a long time: from several days and even up to a month.
• Compliance with personal hygiene rules. Mothers should keep their babies' nails clean and long. When itching is severe, children scratch the inflamed skin vigorously. If there is dirt under the nails, they can cause additional infection and aggravate the disease. With the addition of secondary bacterial flora, the inflammation noticeably intensifies, and signs of suppuration may appear.
• Maintaining a daily routine. For the immune system to function properly, children require mandatory rest. Children should sleep at least ten hours during the day. This time is required for the body to maintain a good ability to fight inflammation, it gives strength to fight the allergen.

During remission

• The use of drug therapy for damaged skin areas. After the acute process subsides, various crusts and peelings remain on the skin. To eliminate the consequences of the inflammatory process, ointments and creams with a fairly oily texture are ideal. Such preparations penetrate well into all layers of the skin and eliminate severe dryness. To eliminate crusts or scales on the scalp, various ointments are used that have a keratolytic effect.
• Strengthening the immune system. For children weakened after an acute period of illness, restoring the strength of the immune system is an important stage of rehabilitation. Children with atopic diseases do not need to be at home all the time. Sterile conditions are absolutely useless for them.

Active walks and games in the fresh air will strengthen your immune system and improve your health. Normalizing the protective function of the intestines also helps restore immunity. Preparations enriched with beneficial lacto- and bifidobacteria restore damaged microflora. “Liveo baby”, “Bifidumbacterin” help the intestines work fully and strengthen the immune system.

• Regular adherence to a hypoallergenic diet. A child who is prone to allergic diseases or atopic dermatitis must eat only approved foods. All food that contains possible allergenic components is completely excluded from the baby’s diet. You should follow a hypoallergenic diet throughout your life.
• Complete exclusion of possible triggering allergens from household use. For babies who are prone to atopic dermatitis, feather-based pillows or blankets should not be used. It is better to give preference to other natural and synthetic materials on a hypoallergenic basis. Pillows should be dry cleaned at least twice a year. This will get rid of household mites, which often live in such products and can cause allergic reactions.

Drug therapy

Drug treatment plays a significant role in eliminating the adverse symptoms of atopic dermatitis. The choice of drug directly depends on what manifestation needs to be eliminated. In the treatment of the disease, both cutaneous forms and systemic injections and tablets are used.

Local treatment

• Anti-inflammatory ointments, creams and suspensions (paints). These include " Tsindol", "Elidel", "Triderm", "Ketotifen"and many other means. These drugs have an anti-inflammatory effect and help cope with inflammation. Many remedies are combined. They may contain antibiotics in small concentrations. Such drugs are usually well tolerated and do not cause systemic side effects. They are prescribed, as a rule, 2-3 times a day and for a period of 10-14 days. In more severe cases of the disease, they can be used for a long time, until the unfavorable symptoms of the disease are completely eliminated.
• Hormonal ointments. Used for long-term illness. There is no need to be afraid of using such drugs. The content of glucocorticosteroid hormones in them is quite small. Such drugs simply cannot cause systemic side effects. Most drugs for local application contains beclomethasone or prednisolone in small concentrations. In treatment, you can use Advantan, Elokom and many other ointments approved for pediatric practice.
• Desensitizing drugs. Doctors often prescribe antihistamines to eliminate severe itching. This could be Suprastin, as well as Fenistil, drugs based on desloratadine. Many of the drugs are used for children over two years of age. These remedies can eliminate severe inflammation and cope with debilitating itching. Such medications are prescribed in a course of 10-14 days.

Tablet forms can also be used for a month or more from the moment the adverse symptoms of exacerbation are eliminated. To relieve itching, you can use calcium gluconate. It helps eliminate the moderate manifestation of this unfavorable symptom.

• Cell membrane stimulants. They have a mechanism of action that is similar to the action of antihistamines. They have been used in pediatric practice relatively recently. They are tolerated quite well by children. There are practically no side effects from use. Ketotifen is often prescribed. This drug is used for children over three years of age. The course is prescribed for 2-3 months. The treatment plan is chosen by the attending physician. To properly discontinue the drug, a gradual reduction in dosage is required.
• Drugs that support immunity. Children with atopic dermatitis are often advised to support good condition intestinal microflora. For this purpose, various drugs containing live bifidobacteria or lactobacilli are prescribed. Such medications should be used in courses: 2-3 times a year. To remove toxic products from the body, enterosorbents are used: “Polysorb”, tablets activated carbon, "Enterosgel".

Are water treatments allowed?

In order for the skin to remain sufficiently hydrated during an exacerbation of atopic dermatitis, it must be moisturized. Even during acute manifestations of the disease, the baby can be bathed. It is not recommended to wash your baby in the bath. This can increase the itching and lead to additional drying of the skin. It is better to give preference to a simple hygienic shower.

To reduce itching on the scalp, you can use special medicated shampoos. Such products have a physiological neutral pH and do not cause irritation.

Hygiene procedures can be carried out daily. After which it is necessary to treat the skin with medicinal ointments or creams. This will further moisturize damaged skin and eliminate the adverse manifestations of atopy.

For very young children, you can add a decoction of celandine when bathing. To prepare it, take 2-3 tablespoons of crushed leaves and pour a liter of boiling water over them. Leave for 3-4 hours. A glass of the resulting decoction is added to the bath when bathing the baby. You can bathe your child with wormwood or infusion of string. These herbs have a beneficial effect on the skin and help prevent infection of wounds that occur during an exacerbation.

What to eat?

Nutritional therapy for atopic dermatitis is very important for the treatment of the disease. That Only adherence to a diet throughout life will prevent frequent exacerbations of the disease. This is especially important for children who have severe food allergies to various foods.

Pediatricians have developed a separate nutrition system especially for children with atopic dermatitis and allergic diseases.

It completely excludes provoking foods that have strong antigenic properties and can cause allergies.

The following foods should be completely excluded from the baby’s diet:

• All tropical fruits and vegetables. Most berries are red or burgundy. Citrus fruits are also prohibited.
• Seafood and fish that live in the ocean. River fish is added to the diet gradually. It is necessary to monitor the child’s reaction to the introduction of a new product.
• Chocolates and other sweets containing cocoa beans.
• Candies and sweet sodas, which contain many chemical dyes and food additives.

The diet of a baby with atopic dermatitis must include the following products:

• High in protein. Perfect for: lean poultry, veal, fresh beef, and rabbit. Fermented milk products should be included in your child’s diet. A large amount of the right protein in combination with beneficial bifidobacteria will help kids strengthen their immune system. At each meal, it is better to add some specific allowed protein product.
• Cereals or porridge. Can be a great addition or side dish. They help provide the body with energy and give new strength to fight the disease. It is better to alternate different cereals. They contain large amounts of B vitamins, as well as zinc and selenium. These substances have a positive effect on the skin and even promote its healing.
• Green vegetables. During the period when the exacerbation subsides, you can add potatoes and some carrots. An excellent side dish for very young children would be boiled cauliflower (or broccoli). You can add grated cucumber to your dishes. Vegetables are an excellent source of insoluble dietary fiber. They are also needed for the formation of healthy intestinal microflora.
• Fruits. Apples and pears are usually recommended for Russian children. The content of antigenic components in these fruits is significantly lower than in tropical fruits. During the acute period, you should slightly reduce the consumption of such products. Fruits contain large amounts of natural sugars. This can negatively affect the restoration of the cellular structure of the skin and somewhat impair the functioning of leukocytes.
• Sufficient amount of liquid. To remove decay products that form in the body during the inflammatory process, water is required . You can drink regular boiled water. It is also acceptable to consume fruit drinks or compotes, prepared from dried garden apples or pears. It is better to avoid berry drinks until the period of remission.
• Taking vitamins. During the period of a strict diet, which is necessary during an exacerbation, too few beneficial microelements enter the child’s body, so the introduction of such substances from the outside is required. Synthetic complexes are an excellent source of various vitamins. They contain a combination of useful microelements necessary for the growth and development of the baby. Currently, vitamin preparations are available in the form chewable tablets, syrup or caramel. Such vitamins will bring joy to the child, and will also help restore the deficiency of useful microelements in the body.

How to properly organize your daily routine?

It is very important for children with atopic diseases to follow the correct routine. . The daily routine must include naps during the day. It is better to spend at least 3-4 hours on it. During such rest, the nervous and immune systems are restored. The child gains new strength to fight the disease.

Night sleep should be at least 8-9 hours. For babies in the first year of life - even up to 12. As a rule, histamine levels decrease during sleep. This substance is formed during an acute inflammatory reaction and causes severe itching. Reducing the concentration of histamine can reduce this unfavorable symptom. This brings some relief to the baby.

During the acute period of illness, active games are noticeably reduced. Exhausting itching brings severe discomfort to babies. When unfavorable symptoms are eliminated during treatment, children begin to feel much better and return to their normal lifestyle. During the acute period of illness, it is better to limit active physical activity. Kids should rest more and try to get a good night's sleep.

Possibilities of spa treatment

The long course of the disease often becomes chronic. Symptoms that occur during an exacerbation are best treated in a hospital, and in mild cases - at home .

Remission of the disease is an excellent time for specialized treatment in sanatoriums or health centers.

Various methods of physiotherapy have a positive effect on the course of the disease. For children with a long-term illness, various methods of ultrasound treatment, magnetic and light therapy, as well as inductothermal methods are used. Usually, during a stay in a health center, a child is prescribed several different techniques at once, in courses of 10-14 days. In some cases, longer treatment is indicated, for up to three weeks.

Therapy at the sanatorium has a very pronounced clinical effect. With regular use of such balneological treatment, the number of exacerbations of the disease is noticeably reduced. Children who undergo therapy at sea noticeably strengthen their immunity. Sea ions have a positive effect on the functioning of immune system cells and also heal the skin.

Doctors recommend that children with atopic dermatitis undergo sanatorium-resort treatment at least once a year. It is better to do this when the exacerbation subsides or during remission. The duration of the trip can be 14-21 days. It is better to choose sanatoriums that are located in close proximity to the sea, or specialized health centers that provide medical services for children with atopy and allergic skin diseases.

Complications

On initial stage the disease usually proceeds without significant adverse consequences. After several exacerbations and the use of numerous medications, the child may experience certain complications of the disease.

The most common symptoms of atopic dermatitis are:

• Various suppurations(as a result of the addition of a secondary bacterial infection). Staphylococcal and streptococcal flora are common. Usually, a baby can introduce germs while scratching itchy items. After this, within a few hours the inflammation noticeably increases and pus appears.
• Weeping wounds often become infected. Even a small amount of the pathogen is enough to start a bacterial infectious process. These cases require immediate consultation with a doctor and prescription of antibiotics. In severe cases of the bacterial process, emergency hospitalization is required.
• Atrophic phenomena on the skin or its pronounced thinning. Usually encountered as side effects after long-term use of corticosteroid ointments. Some children may experience alternative patterns. Instead of areas of thinned skin, dense crusts (or even scabs) form. In such conditions, discontinue the use of hormones and switch to other medications. During the period of such withdrawal, children are prescribed immunomodulatory drugs to normalize the impaired function of the child’s immune system.

Is disability established?

Typically, for children with atopic dermatitis, establishing a disability is not mandatory. With a mild course of the disease and sufficient control, there is no permanent loss of function. With this variant of the disease, doctors recommend treatment of exacerbations in a clinic, with mandatory monitoring by an immunologist.

Adolescents and young adults who have a history of a long course of the disease and numerous hospitalizations for treatment of exacerbations can contact the ITU for examination. Expert doctors will study everything medical documentation child and identify the presence or absence of disabling signs. If a child has signs of persistent loss of function, he may be assigned a disability group. As a rule, the third.

Prevention of exacerbations

Preventive measures help prevent acute manifestations of the disease and control the course of the disease. When it comes to babies with atopic dermatitis, you should always remember about prevention. Avoiding contact with the trigger helps reduce the risk of a possible exacerbation.

To avoid the appearance of adverse symptoms and the acute stage of the disease, you should:

• Be sure to follow a hypoallergenic diet. All products with strong allergenic properties are completely excluded from the baby’s diet. Only neutral dishes that do not contain allergens are allowed. Meals should be provided several times a day, in small portions. Be sure to include complete protein (in sufficient quantity for the child’s body).
• Use only hypoallergenic materials. All pillows, bedding, and clothing must be made from synthetic materials with low allergenic properties. It is better not to wear items made from natural silk or wool. Pillows should be cleaned at least once or twice a year. The blanket should also be professionally dry cleaned.
• Toys, dishes and cutlery belonging to the child are processed in warm water using special liquids that do not contain aggressive chemicals. Such products are usually labeled that they are hypoallergenic and cannot cause allergic reactions. For children with atopic dermatitis, it is better to use household chemicals that are approved for use from the first days after birth.
• The use of antihistamines before the onset of plant flowering. Especially necessary for babies with allergic reactions to pollen. Antihistamines in prophylactic doses will reduce the likelihood of a severe allergic reaction. The disease may pass in a more subtle form.
• Strengthening the immune system. Proper nutrition with enough fiber and vitamins, active games in the fresh air will be excellent ways to restore and activate the immune system. Children with atopic dermatitis should also not avoid hardening and water procedures. Such techniques have a positive effect on the immune system, and also improve mood and normalize sleep.
• Long-term breast-feeding. Scientists from many countries have proven that protective antibodies enter the infant’s body along with mother’s milk. This allows you to protect the child’s body from various infectious pathologies and reduce the risk of developing possible allergic reactions. Breast milk also helps normalize the baby's intestinal microflora and helps strengthen the immune system.
• Maintaining hygiene rules. Children's rooms for children who are prone to allergic reactions should be cleaned much more often. Achieving completely sterile conditions is not necessary. Much more important is just a clean and freshly washed floor. Be sure to ventilate the room. This improves air exchange in the children's room and even helps reduce the concentration of pathogenic microbes in the air.
• Regular walks in the fresh air. Sufficient insolation has a positive effect on the immune system. The sun's rays stimulate the nervous system and also help normalize hormonal levels. For infants Walking in the fresh air is very important. They help restore immunity.

Atopic dermatitis very often occurs in children of different ages. The course of the disease in most cases becomes chronic. Regular monitoring, preventive measures, as well as timely and competent treatment of exacerbations will help control the development of the disease and improve the baby’s quality of life.

• do not smoke in the apartment;
• try to get away from stress;
• do not scratch or rub the skin;
• do not use irritating synthetic detergents, washing powders, glue, paints, varnishes, solvents;
• do not wear clothes made of synthetics or wool on your bare body, or wear cotton clothes inside;
• It's better not to keep pets.

The skin with atopic dermatitis in adults and children is very dry, it easily loses moisture and allows allergens and microbes to pass through. Therefore, it is necessary to constantly restore the protective layer. This is achieved by hydration.

How to care for skin with atopic dermatitis?

How to properly care for your skin?

1. Water treatments for fifteen minutes are required. The water should not be hot.
2. Do not use hard washcloths to rub the skin.
3. Use products with a neutral pH of 5.5. There are special products for diseased skin (Trickzera, Bodyzhel, Friederm pH balance).
4. After washing, the skin is blotted, but not wiped dry.
5. Apply a softening and moisturizing product to still moisturized skin.
6. The moisturizer is also applied throughout the day to prevent dryness.

There are many products available in the pharmacy for the care of skin with atopic dermatitis (Aven, La Roche Posay, Vichy, Uriage).

What to do with atopic allergic dermatitis?

What to do for atopic allergic dermatitis caused by exposure to dust?

If you are hypersensitive to mold fungi.

1. In the bathroom, wipe wet tiles and other surfaces with a cloth and treat them once a month with anti-fungal agents.
2. Do not use kefir.
3. Do not dry clothes in the room.

For pollen allergies:

• during the flowering period, limit festivities and close windows;
• do not contact with plants that produce pollen;
• do not use medicinal herbs.

How to deal with exacerbation of atopic dermatitis?

What do people with atopic dermatitis need to know?

There are three phases of flow.

1. The acute phase is accompanied by itching, redness, and blistering. the bubbles, if scratched, burst with the release of a yellowish liquid.
2. During the acute phase - peeling, redness, scratching;
3. Chronic phase - thickened plaques, dense itchy nodules.

How to cure atopic dermatitis?

During the period of exacerbation of dermatitis, in addition to mandatory skin moisturizing, anti-inflammatory treatment is needed. Typically, topical steroids are used. Modern drugs (Advantan, Elokom, Afloderm) are safe in terms of the development of side effects. However, long-term use reduces the effectiveness of medications, so they need to be changed and alternated.

In the acute stage of atopic dermatitis, there are no equal corticosteroids. In the acute and chronic phases, non-hormonal medications are used:

• Elidel cream;
• cream, shampoo, Skin-cap aerosol.

Of course, the choice of therapy should be made by a doctor.

Conclusion: atopic dermatitis is a common disease; you should try to identify the allergen and exclude it from your diet, constantly moisturize your skin and follow a diet. To identify an allergen, you need to try to eat a minimum amount of food per day to make it easier to determine what you are allergic to.

Best regards, Olga.

I suggest watching an educational video by the famous doctor Evgeniy Komarovsky, who will tell you everything about dermatitis in detail and very clearly.

The incidence of this disease among adults varies from 5 to 10 percent. This figure increases significantly in industrialized countries, reaching 20 percent. The incidence of this pathology is growing every year. It is extremely rare that atopic dermatitis is an independent disease. So, in more than 35 percent of cases it occurs with bronchial asthma, in 25 percent with rhinitis, in 10 percent with hay fever. For every 100 cases of atopic dermatitis, there are 65 women and 35 men. Atopic dermatitis in a complex of other atopic reactions of the body was known back in ancient times. Since the causes of this disease were not clear, at that time atopic dermatitis was called “idiosyncrasy.” Thus, the name reflected the mechanism of disease development ( namely, an increased reaction of the body to the allergen), but did not specify its etiology.

The etymology of the phrase atopic dermatitis lies in the Greek words atopos ( translated as unusual and strange), dermis ( leather) and itis ( inflammation). The term atopy was first used in 1922 to define the increased sensitivity of an organism of a hereditary type to environmental factors.
The causes of an allergic reaction can be not only classical allergens, but also a number of unusual factors.

Normally, immunoglobulins E are contained in negligible quantities in the body, since they break down very quickly. However, in atopic people the content of these immunoglobulins is initially high, which is an indicator of a high risk of developing atopic disease.

When it first encounters a foreign object, the immune system synthesizes antibodies. These antibodies are synthesized by the immune system and can persist for a long period of time, and sometimes throughout life. For example, when the body first comes into contact with any virus or bacteria, the body is defenseless because it does not have the appropriate antibodies. However, after a person recovers from an infection, his body contains a huge amount of antibodies. These antibodies protect the body from re-infection for a certain time.

In allergic reactions, the immune system acts differently. Upon first contact with an allergen, the body becomes sensitized. It synthesizes a sufficient amount of antibodies, which will subsequently bind to the allergen. When the body comes into repeated contact with a substance that causes an allergy, an “antigen-antibody” complex is formed. The allergen acts as an antigen ( be it dust or egg yolk), and as an antibody - a protein synthesized by the body.

Next, this complex activates the system of immunoallergic reactions. The severity of the immune response depends on the type of allergic reaction, the duration of contact with the allergen and the degree of reactivity of the body. Class E immunoglobulins are responsible for the body's immunoallergic response. Their quantity is directly proportional to the severity of the response. The more of them in the body, the stronger and longer the allergic reaction.

Mediators of allergic reactions

After the antigen-antibody complex has been formed, a cascade of allergic reactions is launched with the release of a number of biologically active substances. These substances trigger the pathological processes that lead to the formation of symptoms of atopic dermatitis ( redness, swelling, etc.).

The main role among the mediators of the immunoallergic reaction is played by histamine. It increases the permeability of the vascular wall and dilates blood vessels. Dilatation of blood vessels ( vasodilation) is clinically accompanied by a symptom such as redness. At the same time, fluid emerges from the dilated vessels into the intercellular space. This phenomenon is accompanied by the development of edema. Another effect of histamine is bronchospasm and the development of asthma attacks.

In addition to histamine, leukotrienes, prostaglandins, and kinins participate in immunoallergic reactions. All these mediators in atopic dermatitis are released from the epidermal cells of the skin ( Langerhans cells). It has been established that the upper layer of the skin of atopic people contains an increased number of such cells.

Causes of atopic dermatitis

Atopic dermatitis is a multifactorial disease, that is, there are many causes for this phenomenon. Its development is predetermined not only by trigger factors ( immediate reasons), but also genetic predisposition, dysfunction of the immune and other body systems.

Genetic predisposition

More than 80 percent of people with atopic dermatitis have a strong family history. This means that they have one or more relatives suffering from some kind of atopic disease. These diseases are most often food allergies, hay fever or bronchial asthma. In 60 percent genetic predisposition observed in females, that is, the disease is transmitted through the mother. Genetic transmission through the father's line is observed in one fifth of all cases. The genetic factor is supported by the fact that for identical twins the concordance rate is more than 70 percent, and for fraternal twins it is more than 20 percent.

Genetic predisposition of the disease is very important in predicting the risk of atopic dermatitis. So, knowing that there is a family history of atopic dermatitis, it is easier to prevent exposure to provoking factors.

The participation of a genetic factor in the development of atopic dermatitis is confirmed by numerous immunogenetic studies. Thus, it is reliably known that atopic dermatitis is associated with the HLA B-12 and DR-4 genes.

Immune system dysfunction

It is disturbances in the functioning of the immune system that provoke increased sensitivity of the body to various irritants, that is, atopy. Thus, the immune system creates those preconditions against the background of which, under the influence of provoking ( trigger) factors will cause symptoms of atopic dermatitis to appear.

Dysfunction of the immune system affects both humoral and cellular components. At the level of humoral immunity, an increased level of IgE is noted. An increase in these immunoglobulins is observed in 9 out of 10 cases. At the same time, in parallel with the growth of immunoglobulins, a weakening of the cellular link occurs. This weakening is expressed in a reduced number of killer and suppressor cells. A decrease in the number of these cells, which normally regulate the body's response to a provoking factor, leads to an imbalance at the killer-helper level. This disturbed ratio is the reason for the increased production of immunoallergic reaction cells.

Pathology of the digestive system

Pathologies digestive system can act both as triggering factors and as a basis for weakening the immune system. It is known that the intestinal mucosa contains numerous lymphatic formations (Peyer's patches), which play the role of immunomodulators. Thus, along with the lymph nodes, the intestines in the body create a barrier to the penetration of harmful factors. However, with various pathologies of the digestive system, this barrier is broken, and harmful substances enter the blood. This happens, first of all, because the intestinal mucosa suffers. Violation of the integrity of the mucous membrane with the development of inflammation in it leads to the fact that bacteria and their toxins easily penetrate through the intestines into the bloodstream. Subsequently, bacteria and toxic substances that penetrate from the intestinal mucosa into the bloodstream can intensify allergic reactions. At the same time, chronic pathologies helminthic infestations lead to decreased immunity.

Pathologies that may be causes of atopic dermatitis are:

• intestinal dysbiosis;
• helminthic infestations;
• liver and gallbladder diseases;
• intestinal motility disorders;
• various enzymopathies ( cystic fibrosis, phenylketonuria);

Dysfunction of the autonomic nervous system

This dysfunction consists of increasing the adrenergic effect on the body. This leads to the patient becoming prone to vasospasm. This tendency is more pronounced during exposure to cold, stress, and mechanical impact on the skin. This leads to poor nutrition of the skin, which leads to dryness. Dry or xerotic skin is a prerequisite for excessive penetration of allergens through the skin. Through cracks and wounds in the skin allergens ( be it dust or poplar fluff) penetrate the body and trigger a cascade of allergic reactions.

Endocrine dysfunction

People suffering from atopic dermatitis experience a decrease in hormones such as cortisol and adrenocorticotropic hormone. They also have a reduced concentration of estrogens and androgens. All this leads to a protracted, chronic course of atopic dermatitis.

Genetic abnormalities

As you know, the skin in the body performs a number of functions, including protection. This function assumes that in a healthy state, human skin is a barrier to the penetration of microbial agents, mechanical and physical factors. However, in people suffering from atopic dermatitis, dry and dehydrated skin does not perform this function. This occurs due to certain genetic abnormalities at the level of the skin barrier function.

Genetic disorders that create the prerequisites for the development of atopic dermatitis are:

• Reduced sebum production by the sebaceous glands or sebostasis. This is one of the causes of dry skin;
• Impaired filaggrin synthesis. This protein regulates the process of keratinization of skin cells. It also regulates the formation of humectant factors that retain water. Thanks to this, water is retained in the upper layer of the skin.
• Violation of the lipid barrier. Normally, the skin contains a fatty, waterproof layer, thanks to which harmful substances from the environment do not penetrate into it. In atopic dermatitis, the synthesis of these lipids is reduced, making the lipid barrier weak and ineffective.

All these predisposing factors create the ground for easy penetration of allergens. At the same time, the skin becomes vulnerable and is easily attacked by various triggers. Failure of the skin barrier function is the cause of a long, sluggish allergic process. Some factors also increase the spread of the allergic reaction.

Triggers

Triggers are those factors under the influence of which the immunoallergic process underlying atopic dermatitis is launched. Since they start the entire process, they are also called triggers or trigger factors. Also, these factors provoke periodic exacerbations of atopic dermatitis.

Triggers can be divided into specific ones ( which are individual for each person) and nonspecific ( which provoke exacerbation of dermatitis in almost all people).

Specific trigger factors are:

• food allergens;
• medicines;
• aeroallergens.

Food allergens
This group of trigger factors that can cause exacerbation of atopic dermatitis is the most common. Most often in adults these are dairy products and seafood.

The most common food allergens are:

• dairy products - milk, eggs, soy products;
• seafood - oysters, crabs, lobsters;
• nuts – peanuts, almonds, walnuts;
• chocolate;
• eggs.

This list of products is very individual and specific. Some adults may have polyallergy, that is, to several foods at once. Others may be intolerant to only one product. Also, food sensitivities vary depending on the time of year ( in the spring it worsens) and from the general condition of the body ( It is known that diseases aggravate sensitivity). Some medications can also aggravate or weaken nutritional sensitivity.

Medicines
Some medications can not only aggravate the allergic process, but also be the main cause of its development. Thus, aspirin can not only provoke an allergic reaction, but also cause bronchial asthma.

Most medications only trigger the immunoallergic process on already prepared soil.

Medicines that can cause atopic dermatitis are:

• antibacterial drugs from the penicillin group - ampicillin, amoxicycline;
• sulfonamides - streptocide, sulfazin, sulfalene;
• anticonvulsants - valproic acid preparations ( depakine), drugs from the carbamazepine group ( timonil);
• vaccines.

Aeroallergens
Aeroallergens most often cause atopic dermatitis together with bronchial asthma, hay fever, that is, together with other components of atopic disease.

Allergens that cause atopic dermatitis:

• animal hair;
• perfume;
• plant pollen;
• house dust;
• volatile chemicals.

Nonspecific trigger mechanisms:

• weather;
• detergents;
• cloth;
• emotions, stress.

These factors are not mandatory and do not provoke atopic dermatitis in everyone. Different weather conditions can have different effects on the development of atopic dermatitis. For some people it is cold, for others it is heat and dry air.

Warm, tight-fitting, synthetic clothing can also trigger atopic dermatitis. The main mechanism in this case is the creation of a microclimate of high humidity under clothing.
Occupational hazards also play a role in the development of atopic dermatitis. For example, people who have direct contact with volatile chemicals, medications, and detergents are at greatest risk of developing atopic dermatitis.

Thus, the main reasons for the development of atopic dermatitis are hereditary predisposition, a disturbed immunological background with a tendency to hyperreactivity, and the triggering mechanisms themselves.

Symptoms of atopic dermatitis

The symptoms of atopic dermatitis are very variable and depend on the form of the disease. The main clinical manifestations are itching and rashes. Constant companions of atopic dermatitis, even during remission, are dryness and redness of the skin.

Itching

Itching is one of the most persistent symptoms atopic dermatitis. Its intensity depends on the form of dermatitis. Thus, itching is most pronounced with lichenoid rashes. Even when the rash disappears for a while, the itching remains due to dryness and irritation of the skin. Severe, sometimes unbearable itching is the cause of scratching, which, in turn, is complicated by infection.

Dry skin

Dryness and redness are localized not only in the favorite areas of dermatitis ( folds, under the knee, on the elbows), but also on other parts of the body. Thus, dryness of the face, neck, and shoulders may occur. The skin looks rough and rough.
Increased dryness of the skin is also called xerosis. Skin xerosis in atopic dermatitis, together with peeling and redness, is an important diagnostic criterion.

Dry skin in atopic dermatitis goes through several stages. At the first stage, it manifests itself only as a feeling of tightness of the skin, especially the face. This sensation quickly passes after applying the cream. At the second stage, dryness is accompanied by flaking of the skin, redness and itching. Small cracks may appear. After a violation of the protective properties of the skin associated with loss of moisture and disruption of the lipid membrane of the epidermis, the third period begins. During this period, the skin looks rough, stretched, and the cracks become deeper.

Rashes

Atopic rashes are divided into primary and secondary. Primary rashes occur on healthy, unchanged skin. Secondary rashes appear as a result of changes in primary elements.

Type of rash	Characteristic	Photo
Primary elements
Stains	They manifest themselves as local redness of the skin without changing its relief. Spots with atopic dermatitis can be barely noticeable or bright red and very flaky. As a rule, with atopic dermatitis, the spots reach sizes from 1 to 5 centimeters, that is, they acquire the character of erythema. They may simply be swollen or accompanied by severe peeling.
Bubbles	Cavity manifestations of atopic dermatitis. The bubbles reach up to 0.5 centimeters in diameter. The vesicle contains inflammatory fluid inside. In severe cases, with the exudative form of atopic dermatitis, the blisters can be filled with inflammatory fluid mixed with blood.
Secondary elements
Scales and crusts	These are the epidermal cells that have been rejected and form peeling. However, with atopic dermatitis this process is more pronounced. The scales are rejected intensively and form crusts. These crusts are most often localized on the elbows, in the folds. Sometimes they can become saturated with purulent or serous contents of the vesicles.
Erosion and cracks	Erosion occurs at the site of cavity elements ( bubbles) and represents a violation of the integrity of the skin and mucous membranes. The contours of the erosion coincide with the contours of the vesicles or vesicles. Unlike erosion, a crack is a linear violation of the integrity of the skin. Cracks develop due to decreased elasticity of the skin and its dryness. Most often they are localized superficially and can heal without scarring.
Lichenification	Thickening and hardening of the skin causing it to appear rough and rough. The skin pattern intensifies and takes on the appearance of deep furrows. The top of the skin may be covered with scales. The cause of lichenification is the thickening of the spinous layer of the dermis of the skin due to its infiltration by inflammatory cells.
Hypopigmentation	Areas of skin discoloration. Most often, these areas of discoloration are localized in areas of primary and secondary elements. Thus, the focus of hypopigmentation may be located at the site of former erosions or blisters. As a rule, the shape of hypopigmented areas repeats the shape of the element that precedes it.

Cheilitis

Cheilitis is an inflammation of the oral mucosa. It manifests itself as dry, cracked lips, dryness and increased wrinkling. Sometimes the mucous membrane of the lips becomes covered with small scales and is accompanied by severe itching. With atopic cheilitis, the red border of the lips is damaged, especially the corners of the mouth and the surrounding skin. Cheilitis may be the only manifestation of atopic dermatitis during its remission.

Atopic face

An atopic face is characteristic of people who have suffered from atopic dermatitis for many years. The resulting symptoms give the face a characteristic tired appearance.

Manifestations that are characteristic of an atopic face are:

• pallor of the face and peeling of the eyelids;
• atopic cheilitis;
• thinning and breaking of eyebrows as a result of scratching;
• deepening of folds on the lower and upper eyelids.

Depending on the predominance of certain morphological elements, atopic dermatitis is divided into several clinical forms.

The forms of atopic dermatitis are:

• erythematous form;
• lichenoid form;
• eczematous form.

Erythematous form
This form of atopic dermatitis is dominated by elements such as spots ( or erythema), papules and scales. The patient's skin is dry, covered with many small, very itchy scales. These rashes are localized mainly on the elbows and in the popliteal fossae. Occurs in more than 50 percent of cases.

Lichenoid form
The skin of patients with this form is dry and has large erythemas. Against the background of these erythemas, papules appear, which are covered with large, pityriasis-like scales. Due to excruciating itching, patients experience severe scratching, ulcerations, erosions and cracks. The skin of the neck, elbow and popliteal folds, as well as the upper third of the chest and back is mainly affected. Occurs in one fifth of cases.

Eczematous form
With this form of atopic dermatitis, limited areas of dry skin are identified, with the presence of crusts, scales and blisters. These lesions are localized mainly in the area of ​​the hands, elbows and popliteal folds. This variant of atopic dermatitis occurs in 25 percent of cases.

Special forms of atopic dermatitis

There are special forms of atopic dermatitis that manifest themselves with specific symptoms.

Damage to the scalp
With this form, scratches, erosions and crusts appear in the occipital or frontal part of the head. The skin under the hair is always dry, often covered with white scales. This form of atopic dermatitis is accompanied by severe itching, which leads to scratching and sores.

Earlobe lesion
In this form of the disease, a chronic, painful fissure forms behind the ear fold. Sometimes, due to constant scratching, it turns into an ulcer that constantly bleeds. This crack is very often complicated by the addition of a secondary infection.

Nonspecific dermatitis of the feet
Manifests itself as a bilateral symmetrical lesion of the feet. In this case, spots and cracks appear on both feet, which are accompanied by itching and burning.

Atopic eczema of the hands
With this form of atopic dermatitis, areas of redness appear on the hands, which subsequently develop cracks. Cracks can turn into ulcers under the influence of household chemicals, water, and soap.

Diagnosis of atopic dermatitis

The main diagnostic criteria are reduced to the symptoms of the disease and the nature of their course. Thus, itching, characteristic rashes and a chronic, periodically worsening course are the basic criteria for diagnosing atopic dermatitis.

Consultation with an allergist

Consultation with an allergist is an integral step in making a diagnosis of atopic dermatitis. The consultation includes interviewing the patient and examining him.

Survey
A visit to an allergist begins with a questioning of the patient, during which the doctor receives the necessary information about the development of the disease, the patient’s living conditions, and heredity. The information obtained allows the medical professional to make a preliminary diagnosis.

Topics covered by the allergist when taking anamnesis are:

• predisposition of family members to allergies;
• Patient's nutritional pattern ( Is there an increased consumption of allergenic foods such as citrus fruits, cow's milk, eggs?);
• professional activity of the patient;
• type and duration of skin rashes;
• the connection between the deterioration of the condition and changes in the patient’s diet or lifestyle;
• seasonality of disorders bothering the patient;
• presence of additional allergy symptoms ( cough, sneezing, nasal congestion);
• concomitant pathologies ( diseases of the kidneys, digestive organs, nervous system);
• frequency of colds;
• housing and living conditions;
• presence of pets.

A list of sample questions that an allergist might ask:

• What did the patient suffer from in childhood and adolescence?
• What pathologies exist in the family, and does any relative suffer from bronchial asthma, rhinitis, or dermatitis?
• How long ago did these rashes appear, and what preceded their appearance?
• Are the rashes associated with food, medications, flowering plants, or any time of year?

Inspection
During the examination, the allergist examines the nature and size of the affected areas. The physician pays attention to the location of the rashes on the patient’s body and the presence of other external criteria for atopic dermatitis.

Diagnostic indicators of external type atopic dermatitis include:

• lichenification ( thickening and roughening of the skin) in the area of ​​the flexor surface of the limbs;
• excoriation ( violation of the integrity of the skin, which in most cases occurs when scratching);
• xerosis ( dryness) skin;
• peeling and thickening of the skin near the hair follicles;
• cracks and other skin lesions on the lips;
• atopic palms ( enhancement of skin pattern);
• presence of cracks behind the ears;
• persistent white dermographism ( As a result of passing a thin object over the patient’s skin, a white trace remains in the pressure zone);
• damage to the skin of the breast nipples.

Next, the doctor prescribes the appropriate tests ( allergen tests, fadiatope test) and makes a preliminary diagnosis. The need for additional consultation with a number of specialists may also be determined ( dermatologist, endocrinologist, gastroenterologist). A repeat consultation with an allergist includes interpretation of tests and examination of the patient. If atopic dermatitis is confirmed, the doctor prescribes drug therapy, diet and compliance with the therapeutic and health regime.

Consultation with a dermatologist

How to prepare for a visit to a dermatologist?
During the examination, the dermatologist may need to completely examine the patient's body. Therefore, before visiting a doctor, you need to take a shower and take the necessary hygiene measures. The day before visiting a specialist, you must avoid cosmetics and other skin care products. You should also avoid taking antihistamines and not apply medicinal ointments or other agents to the affected areas.

Patient Interview
To diagnose atopic dermatitis, the dermatologist asks a series of questions to the patient, which allow him to determine the influence of external and internal factors on the development of the disease.

The topics that the dermatologist discusses with the patient at the appointment are:

• duration of symptoms;
• factors that preceded the emergence skin changes;
• environmental factors of the patient’s living environment ( closeness industrial enterprises );
• area in which the patient works ( Is there any contact with chemicals and other substances with a high level of allergenicity?);
• living conditions ( the presence in the apartment of a large number of carpets, furniture, books, level of dampness, humidity);
• does the patient’s condition depend on changing climatic conditions;
• presence of chronic diseases;
• does the patient’s condition worsen due to stress and emotional unrest;
• nature of diet;
• Do close relatives suffer from allergic reactions?
• Is there constant contact with animals, birds, insects?

Patient examination
During the examination, the dermatologist examines the nature of skin changes and their location on the patient’s body. The doctor also pays attention to the analysis of additional external criteria that are characteristic of atopic dermatitis. The main signs of this pathology include a skin rash that affects the arms and legs ( front surfaces), back, chest, stomach. In addition to rashes, dense nodules may appear that are very itchy.

Secondary external signs of atopic dermatitis are:

• severe dry skin;
• dermatitis in the nipple area;
• conjunctivitis ( inflammation of the eye mucosa);
• dry skin, cracks in the lip area;
• folds along the edge of the lower eyelids;
• transverse fold from upper lip to the nose;
• enhanced skin pattern and protrusion of capillaries on the inner surface of the palms.

To exclude other pathologies and to confirm atopic dermatitis, additional clinical and laboratory tests are carried out.

Lab tests:

• determination of the concentration of immunoglobulins E in the blood;
• determination of allergen-specific antibodies;
• Fadiatope test.

General blood analysis

In atopic dermatitis, an increased content of eosinophils is found in the peripheral blood. In adults, the concentration of eosinophils is considered elevated if it exceeds 5 percent. Although this is not a specific symptom for atopic dermatitis, it is the most constant. Even during the period of remission of atopic dermatitis, a general blood test shows an increased content of eosinophils - from 5 to 15 percent.

Determination of the concentration of immunoglobulins E in the blood

Immunoglobulins E play an important role in the development of atopic dermatitis. Therefore, determining the concentration of this immunoglobulin plays an important role in making a diagnosis.

Normally, the amount of immunoglobulin E in the blood of adults ranges from 20 to 80 kE/l ( kilo units per liter). In atopic dermatitis, this figure can vary from 80 to 14,000 kE/l. Lower numbers of immunoglobulins are characteristic of the period of remission, while higher numbers are characteristic of exacerbation. In this form of atopic dermatitis, hyper Ig-E syndrome, the concentration of immunoglobulin E in the blood reaches 50,000 kE/l. This syndrome is considered to be a severe variant of atopic dermatitis, which is combined with chronic infections and immune deficiency.

However, despite the importance of this analysis, it cannot be an absolute indicator for making or excluding a diagnosis. This is explained by the fact that in 30 percent of patients with atopic dermatitis, immunoglobulins E are within normal limits.

Determination of allergen-specific antibodies

This type of diagnosis allows you to determine the presence of antibodies to various antigens. These tests are similar to skin tests, but they are much more specific and less likely to give false results.

There are many methods for determining these antibodies, including RAST, MAST and ELISA tests. The choice of technique depends on the laboratory. The essence of the analysis is to identify antibodies that were produced by the body to a specific allergen. These can be antibodies to food products, aeroallergens, medications, fungi, and house dust.

In adults, sensitization to household allergens, fungi and medications predominates. Therefore, when diagnosing atopic dermatitis in adults, antibodies to household chemicals are most often tested ( e.g. formaldehyde, methylene, toluene) and to medications ( for example, diclofenac, insulin, penicillins).

Fadiatop test

This test is a screening not only for atopic dermatitis, but also for atopic disease in general. The test examines the presence in the blood of specific immunoglobulins to the most common allergens. This method diagnostics allows you to determine the level of immunoglobulins simultaneously to several groups of allergens ( fungi, pollen, medications), and not to any specific one.

If the fadiatope test result is positive, that is, the level of immunoglobulins is high, then further studies are carried out with certain allergen groups. These can be either laboratory tests with specific antigens or skin tests.

The study of the immune system allows not only to establish the diagnosis of atopic dermatitis, but also to identify the cause of the latter.

Other diagnostic methods

In addition to the above laboratory tests, bacteriological examination and diagnostic biopsy are also performed. The first method is performed when atopic dermatitis is complicated by a bacterial infection. A diagnostic biopsy is performed in the late development of atopic dermatitis in adults to differentiate it from skin neoplasms.

Allergen tests

Allergen testing is a diagnostic method that identifies the body’s individual sensitivity to certain substances and studies the subsequent inflammatory response. The indication for this type of study is the patient's medical history, which reflects the role of allergens ( one or a group) in the development of atopic dermatitis.

Methods for conducting allergological research are:

• prick skin tests;
• prick tests;
• skin tests using the application method;
• intradermal tests.

Scarification skin tests
Scarification tests are a painless procedure, for which special instruments are used ( needle or lancet) to damage the integrity of the skin. Shallow scratches are made at a distance of 4–5 centimeters from each other on the surface of the forearm or back. A drop of the allergen being tested is applied to each mark. After 15 minutes, the patient's skin is examined. If the patient is allergic to one or more diagnosed substances, a reaction occurs at the site of the scratches ( skin swelling, blister, itching). The results of the scratch skin test are determined by the nature of the skin changes that occur.

The criteria for determining the test result are:

• the size of redness is up to 1 millimeter - the skin reaction is negative and corresponds to the norm;
• if swelling occurs, the test result is considered doubtful;
• swelling diameter up to 3 millimeters – the result is weakly positive;
• swelling and blister reaches 5 millimeters - the result is positive;
• the size of the swelling and blister reaches 10 millimeters - the result is sharply positive;
• swelling with a blister exceeds 10 millimeters - an extremely positive result.

Prick test
Prick tests are a modern diagnostic method. With this type of study, the epithelium ( top layer of skin) is damaged by a thin needle that contains an allergen.

Skin testing using the patch method
Application tests are carried out on areas with intact skin. To carry out this type of study, a cotton swab soaked in the allergen being diagnosed is applied to the skin. Polyethylene is placed and secured on top of the cotton wool. The skin reaction is analyzed after 15 minutes, then after 5 hours and after two days.

Intradermal tests
Intradermal allergen tests are more sensitive than prick tests, but they cause more complications. To carry out this analysis, using a special syringe, 0.01 to 0.1 milliliters of allergen is injected under the patient’s skin. If the intradermal test is carried out correctly, a clearly defined white bubble will form at the injection site. The body's response to the administered drug is assessed after 24 and 48 hours. The result is determined by the size of the infiltrate ( lump at the injection site).

Skin test results
A positive allergy test result means that the patient is allergic to the substance. A negative result indicates that the patient is not susceptible to allergies.

It should be taken into account that the results of allergen skin tests are not always accurate. Sometimes diagnostics can show the presence of an allergy when in fact it does not exist ( false positive result). Also, the results of the study may be negative if the patient has allergies in reality ( false negative result).

Reasons for false allergen skin test results
One of the most common reasons for a false positive result is increased sensitivity of the skin to mechanical stress. Also, an error may occur due to the body's sensitivity to phenol ( a substance that acts as a preservative in an allergen solution). In some cases, a false negative reaction may occur due to poor sensitivity of the skin. To prevent false results, three days before testing, you must stop taking antihistamines, adrenaline, and hormones.

Treatment of atopic dermatitis

Treatment of atopic dermatitis should be comprehensive and include drug therapy, diet and the creation of an optimal psycho-emotional environment.

In cases where atopic dermatitis is part of an atopic disease, treatment should be aimed at correcting concomitant pathologies ( bronchial asthma, hay fever).

Acute period
During this period, intensive therapy is carried out with the prescription of glucocorticosteroids, antihistamines and membrane stabilizers. When an infection occurs, antibiotics are prescribed. In the acute period, medications are prescribed either orally ( in the form of injections and tablets) and externally ( creams, aerosols).

Remission
During the period of remission ( fading) maintenance therapy is prescribed, which includes immunomodulators, sorbents, vitamins, moisturizing creams and emulsions. During this period, prevention of atopic dermatitis, physiotherapeutic and spa treatment are also carried out.

Drug therapy

Drug therapy is basic in the treatment of atopic dermatitis. It includes a wide range of medications.

Groups of drugs used for atopic dermatitis:

• glucocorticosteroids;
• antihistamines;
• immunosuppressants of the macrolide class;
• moisturizers of various groups.

Glucocorticosteroids
This group of drugs is traditional in the treatment of atopic dermatitis. They are prescribed locally ( in the form of ointments), and systemically ( orally in tablet form). Drugs in this group vary in degree of activity - weak ( hydrocortisone), average ( elocom) and strong ( dermovate). However, recently, the effectiveness of these drugs has been called into question, since very often their prescription is complicated by secondary infection.

Antihistamines
These drugs have an antiallergic effect. By blocking the release of histamine, they eliminate redness, relieve swelling, and reduce itching. They are mainly prescribed in tablet form, but can also be given as injections. This group of drugs includes medications such as chloropyramine ( suprastin), clemastine, loratadine.

Immunosuppressants of the macrolide class
These drugs, like steroids, have an immunosuppressive effect. These include pimecrolimus ( elidel) and tacrolimus. The first drug was developed as a means of local therapy and is available in the form of an ointment, the second - in the form of capsules.

Moisturizers of various groups
This group of drugs includes various lanolin-based products, as well as those based on thermal waters. Basically, they moisturize the skin. These drugs are prescribed during the period of remission, that is, in the chronic and subacute period of the disease.

This group also includes drugs that accelerate the epithelization process. They are prescribed if patients have wounds or cracks. Like skin moisturizers, these drugs are prescribed during the chronic period of atopic dermatitis.

Ointments and creams for the treatment of atopic dermatitis

Drug name	Mechanism of action	Mode of application
Group of glucocorticosteroids
Hydrocortisone	Inhibits allergic reactions and the development of edema in the lesion. Reduces redness.	Apply a 1 mm layer onto the affected areas of the skin twice a day.
Elokom	Relieves swelling and has an antipruritic effect.	It is recommended to use ointment in case of severe peeling of the skin and cream if inflammatory infiltration predominates.
Dermovate	Has anti-inflammatory and immunosuppressive effects.	Apply a thin layer once or twice a day. The duration of treatment should not exceed 4 weeks.
Afloderm	It has an anti-inflammatory and antipruritic effect. It also constricts blood vessels, thereby reducing swelling at the site of inflammation.	The ointment is applied several times a day ( depending on the severity of the lesion) within 3 weeks.
Macrolide group
Elidel	Blocks the release of inflammatory mediators, thereby providing an antiallergic effect.	The product is applied in a thin layer and gently rubbed into the affected surface. The procedure is performed twice a day for 6 – 8 weeks.
Antihistamine group
Fenistil gel	Blocks H1 receptors, thereby preventing the release of histamine.	The gel is applied to the itchy surface for 3 to 5 days.
Ointments and creams from various groups
Ichthyol ointment	The ointment prevents excessive keratinization of the skin. It also has an antiseptic effect, thus preventing secondary infection of atopic dermatitis.	The ointment is applied once or twice a day to areas of rough skin.
Isis cream	Has an antiseptic effect, increases metabolic processes in the skin. Deeply moisturizes the skin and restores the lipid layer.	Apply the cream with light circular movements morning and evening to damaged areas of the body.
Silver sulfathiazole	Promotes wound healing and prevents the development of secondary infection.	A thin layer of 1 - 2 mm of ointment is applied with a tampon to the affected surface twice a day.
Emollient creams
Topicrem	Restores the lipid barrier of the skin, eliminating the feeling of tightness.	Apply to dry areas of skin twice a day.
Lipikar	Intensively moisturizes the skin, relieves itching and promotes wound healing.	Lubricate areas of dry and rough skin once a day.
Trickzera	Reduces skin hypersensitivity, moisturizes and restores the lipid layer.	Apply the cream to previously cleansed skin once or twice a day.
Atoderm	Moisturizes the skin and eliminates its hypersensitivity.	The cream is applied to slightly damp but cleansed skin twice a day.
Xemosis	Relieves irritation and has a calming effect on the skin.	Apply to previously cleansed skin once or twice a day.
Ointments and creams that accelerate the healing process
Solcoseryl	Thanks to its composition, it promotes tissue healing and enhances restoration processes in the area of ​​inflammation.	The gel or ointment is applied directly to the wound surface, which is previously cleaned. Apply 1 – 2 times a day, and if necessary, cover the wound with a bandage.
Actovegin	Increases metabolic processes at the healing site, thereby accelerating the healing of wounds and other elements of atopic dermatitis.	The ointment is applied in a layer of 2–3 mm to the affected surface twice a day.
Methyluracil ointment	Has an anti-inflammatory effect, stimulates and accelerates healing.	Apply a thin layer of ointment to the previously cleaned damaged surface. After application, fix with a bandage.

The choice of dosage form of the drug, be it ointment, cream or emulsion, depends on the form of atopic dermatitis and the stage of its development. So in the acute phase, which is accompanied by weeping and the formation of crusts, emulsions, tinctures and aerosols are recommended. For example, chamomile tincture is prescribed ( which has antiseptic properties) or Burov's fluid. If the acute phase is not accompanied by maceration ( moist softening of the skin), then you can use creams and pastes. For chronic atopic dermatitis, ointments are prescribed. Any pharmaceutical drug, intended for the treatment of atopic dermatitis, is available in several forms. For example, solcoseryl is available in both ointment and gel form.

Antihistamines, membrane-stabilizing and sedatives are prescribed in tablet form.

Membrane stabilizing drugs
These drugs are prescribed in the acute period of the disease together with antihistamines. They prevent the release of allergic reaction mediators, such as histamine and serotonin. Representatives of this group of drugs are sodium cromoglycate and ketotifen.

Sedatives
Constant, sometimes painful itching is the cause of psycho-emotional disorders. In turn, stress and tension act as provoking factors in the development of atopic dermatitis. Therefore, it is very important to normalize the patient’s emotional background in order to prevent exacerbation of atopic dermatitis. For the purpose of calming, both herbal remedies and tranquilizers are used. The first include tinctures of motherwort and passionflower, the second - alprazoles, tofisopam.

Drugs that normalize intestinal function
These drugs are integral in the treatment of atopic dermatitis, since pathologies of the intestinal tract can be not only provoking factors, but also the main cause of atopic dermatitis. First of all, such drugs include agents that absorb toxins from the intestines or sorbents ( smectite, lignin). They are prescribed during the acute period of the disease, lasting 7–10 days. After a course of treatment with sorbents, drugs are recommended that normalize the flora and restore the protective properties of the intestines. These drugs include eubiotics ( bifidumbacterin) and prebiotics ( hilak forte).

Tablets for the treatment of atopic dermatitis

Drug name	Mechanism of action	Mode of application
Suprastin	Blocks histamine receptors, thereby preventing its release in atopic dermatitis.	One tablet three times a day. The maximum daily dose is 100 mg, which is equal to 4 tablets. Apply for 5 – 7 days.
Clemastine	Prevents the development of edema, eliminates itching.	1 mg each ( one tablet) twice a day.
Loratadine	Reduces itching and redness, facilitates the course of the allergic process.	One tablet ( 10 mg) once a day.
Sodium cromoglycate	Stabilizes the cell membrane, preventing the release of inflammatory mediators from it. Prevents the development of allergic reactions.	Two capsules ( 200 mg) 2 to 4 times a day. Capsules should be taken half an hour before meals.
Ketotifen	Inhibits the release of histamine and other mediators, thereby eliminating their effects.	The tablets are taken orally with meals. One tablet is recommended ( 1 mg) in the morning and in the evening.
Tablets that normalize emotional background
Tofisopam	Has a stress-protective effect, relieves tension.	The daily dose of the drug is 150–300 mg, which is equal to 3–6 tablets. This dose is divided into 3 doses.
Bellataminal	Relieves increased excitability and has a calming effect.	One tablet 2 to 3 times a day. It is recommended to take the tablets after meals.
Persen	It has a pronounced sedative effect and has a mild hypnotic effect.	2 tablets three times a day. For insomnia, take 2 tablets before bed.
Atarax	Relieves tension, has a moderate sedative and hypnotic effect.	The average dose is 50 mg per day, which corresponds to 2 tablets of 25 mg. As a rule, the dose is divided into 3 doses - half a tablet in the morning and at lunch, and one whole tablet at night.
Amitriptyline	It has a pronounced sedative effect, eliminates tension, and normalizes the emotional background.	Initial dose - 50 mg per day ( 2 tablets). After 2 weeks, the dose is increased to 100 mg per day.
Diazepam	Relieves nervous tension, anxiety, has a moderate hypnotic effect.	The daily dose is 5 – 15 mg ( 3 tablets of 5 mg each). It is recommended to divide the dose into 2 – 3 doses.
Tablets that normalize the function of the gastrointestinal tract
Smectite	Adsorbs toxic substances in the intestines and has a protective effect on the intestinal mucosa.	The contents of the sachet are dissolved in 100 ml of water and taken after meals. The daily dose is from 2 to 3 sachets of the drug.
Lignin	Has a detoxifying effect, adsorbs harmful microorganisms and their toxins from the intestines. Increases local immunity.	The drug is taken before meals 3-4 times a day. The paste is diluted in a small volume of water.
Bifidumbacterin	Normalizes intestinal microflora, increasing nonspecific immunity.	One - two sachets twice a day. The contents of the sachet are diluted in 50 ml of boiled water.
Hilak forte	Regulates the balance of intestinal flora, restores the intestinal mucosa, thereby increasing its protective properties.	A special pipette ( included with the drug) measure out 40–50 drops, which are diluted with a small amount of water. Drops are taken with meals. The daily dose is 150 drops, divided into 3 meals.

In addition to the above medications, hyposensitizing drugs are used in the treatment of atopic dermatitis. They are prescribed in the acute period of the disease and most often in the form of injections.

Drugs that reduce sensitization in atopic dermatitis

Drug name	Mechanism of action	Mode of application
Calcium gluconate	Has anti-allergic and anti-inflammatory effects.	10 ml of solution ( one ampoule) is administered intravenously for 5–7 days.
Sodium thiosulfate	It has a detoxifying and desensitizing effect, and also has an antipruritic effect.	Intravenous 5 – 10 ml ( one two ampoules) within 5 days.
Prednisolone	It has an antiallergic and immunosuppressive effect.	1 to 2 mg per kg of patient weight intravenously or intramuscularly for 3 to 5 days.

If a secondary infection occurs, antibiotics are prescribed ( erythromycin), if bacterial flora has joined and antifungal drugs, if a fungal infection has joined.

In addition to drug therapy, treatment of atopic dermatitis includes diet, physiotherapy and spa treatment.

Physiotherapeutic treatment

The prescription of physiotherapy for atopic dermatitis should be strictly individual, based on the form of the disease and the characteristics of the body. Treatment is prescribed exclusively during the period of remission and in the absence of complications ( such as infection).

Physiotherapy procedures prescribed for atopic dermatitis are:

• electrosleep;
• electrophoresis;
• paraffin on foci of lichenification;
• ultraviolet irradiation ( Ural Federal District);
• dynamic currents to paravertebral nodes.

Spa treatment

Spa treatment very important, since the maritime climate is optimal for patients with atopic dermatitis. Moderate sunbathing prolongs the period of remission. Thus, experienced patients notice that in the summer their illness recedes. This is due to higher air humidity ( at the same time, humidity should not be excessive) and the healing effects of ultraviolet rays. It has been proven that moderate ultraviolet rays have immunomodulatory, antiallergic and antipruritic effects. The absence of dust in the air and moderate humidity have a beneficial effect on the skin of patients. In addition to sunbathing, hydrogen sulfide and radon baths are allowed.

Is hospitalization necessary to treat atopic dermatitis?

Hospitalization for atopic dermatitis is necessary in cases where there has been a positive result from outpatient treatment for a long time ( at home) does not occur. Inpatient treatment is prescribed when there is a risk of deterioration of the patient’s general condition. This can happen due to severe skin damage, the size of which occupies most of the body area. Also, indications for patient hospitalization are cases when atopic dermatitis manifests itself as erythroderma ( severe peeling that covers at least 90 percent of the skin).

The role of hospitalization in atopic dermatitis
The goal of inpatient treatment of a patient with atopic dermatitis is to isolate the person from allergens. Also, during hospitalization, the patient is protected from the influence of a large number of nonspecific factors that provoke an exacerbation of the disease.

Circumstances from which atopic is protected ( person with atopic dermatitis) during inpatient treatment are:

• stress– minimal contact with external environment will reduce the level of negative emotions;
• sudden change in air temperature– microclimate in inpatient conditions is distinguished by its stability;
• physical exercise– the absence of contact of the affected areas of the skin with sweat promotes tissue regeneration.

During hospitalization, the patient's skin condition returns to normal, allowing skin testing to be performed and potential allergens identified.

Diet for atopic dermatitis

The diet for atopic dermatitis should exclude the entry into the body of products that can cause allergies. Also, the diet of a person suffering from this disease must provide substances that promote epithelialization ( restoration of damaged skin areas), normal functionality of the liver and intestines.

The basic rules of the diet for atopic dermatitis are:

• exclusion of foods that are allergens ( substances that cause allergies) or histamine liberators ( Such products contain elements that release histamine from cells - main factor allergic reactions);
• providing the body with the necessary vitamins and elements for rapid skin regeneration;
• reducing the load on the liver, which ensures cleansing of the body from the consequences of allergies;
• ensuring normal intestinal functionality;
• reduction in gluten intake ( protein, which is part of most cereal crops ), since the tolerance of this substance during allergies is significantly reduced;
• conducting special observations about reactions to food taken ( food diary).

A diet for an adult with atopic dermatitis is compiled taking into account his field of activity, external provocateurs and characteristics of the disease.
From the diet of a person who has atopic dermatitis or is prone to this disease, foods that contain histamine or promote its release should be excluded. If allergen tests have not been carried out, then at the initial stage the use of traditional causative agents of allergic reactions should be eliminated.

Allergenic products
According to the amount of substance that provokes the development of an allergic reaction, products can have a low, medium and high degree of allergenicity.
In case of atopic dermatitis, it is necessary to exclude from the diet food products that contain ingredients with high allergic activity.

Meat and meat products
Meat products with a high level of allergenicity are:

• chicken, duck, goose meat;
• fatty pork;
• mutton.

When preparing a diet for a patient with atopic dermatitis, these products must be replaced with those whose allergenicity level is low.

The types of meat and meat products that are recommended for atopic dermatitis are:

• beef;
• rabbit;
• turkey;
• low fat pork.

When preparing these products, preference should be given to such types of heat treatment as boiling, steaming, and stewing.

Fish and fish products
Fatty varieties of red and white fish also fall into the category of allergenic foods.

Types of fish and fish products that are not recommended for atopic dermatitis are:

• chum salmon, trout, pink salmon, salmon;
• mackerel, sturgeon, sprat, herring;
• caviar ( red and black);
• mussels, oysters;
• crayfish, crabs, lobsters.

These products can be replaced with such varieties of fish as pike perch, cod, hake.

Vegetables, fruits and berries
When choosing vegetables and fruits for the diet of a person with atopic dermatitis, red and orange varieties should be excluded. It is necessary to give preference to green and white crops.

Vegetables and fruits with a high degree of allergic activity are:

• peaches, apricots;
• melon;
• tangerines, oranges, grapefruits;
• red apples;
• grenades;
• persimmon;
• mango, kiwi and other tropical fruits;
• strawberries, strawberries;
• raspberries;
• cherry, sweet cherry;
• pumpkin;
• tomatoes;
• radish;
• eggplant;
• beets, carrots;
• red bell pepper.

Not only pure products should be removed from the diet, but also purees, compotes, jams and other dishes prepared from them.

Vegetables and fruits allowed for atopic dermatitis are:

• apples, green pears;
• plums, prunes;
• cherries ( white);
• currant ( white);
• gooseberry;
• cabbage ( cabbage white, Brussels sprouts, cauliflower);
• turnip;
• green pea;
• dill, parsley;
• zucchini;
• cucumbers;
• potato;
• spinach, lettuce.

Cereals and other high carbohydrate foods
Carbohydrates are valuable suppliers of energy. Therefore, in the diet of a person with atopic dermatitis, carbohydrate-containing allergenic foods must be replaced with those in which the level of allergenicity is lower.

Products with a high degree of allergic activity are:

• semolina;
• White bread;
• pastry products;
• pasta;
• confectionery.

Carbohydrate-containing products allowed for atopic dermatitis include:

• buckwheat;
• oatmeal;
• pearl barley;
• bran bread;
• unsweetened dry goods, crackers, dry cookies;
• crackers.

Milk and dairy products
Milk is a classic allergen product, so patients with atopic dermatitis should be excluded from the diet first. Milk and dairy products should be replaced with fermented milk products.

Dairy products that should be excluded from the diet of a person with this disease are:

• whole cow's milk;
• fermented baked milk;
• cream;
• sour cream;
• cheese ( spicy, salty, melted).

Fermented milk products that are recommended for atopic dermatitis include kefir, yogurt, and cottage cheese.

Foods that release histamine
Histamine liberators are a group of products that stimulate the release of histamine without being allergens.

Histamine liberators include:

• alcohol;
• cocoa;
• chocolate;
• coffee;
• chicken eggs ( protein);
• pork liver;
• shrimp meat;
• strawberry;
• pineapples ( fresh and canned);
• wheat.

A group of products such as food additives also provokes the release of an element that contributes to allergic reactions. These include preservatives, artificial colors, flavors and flavor enhancers. These substances are not consumed on their own, but are included in a large number of sausages, semi-finished products, canned fish, pickled and salted vegetables.

Products for quick skin restoration
The diet of a patient with atopic dermatitis should provide the body with substances that accelerate skin regeneration. Effectively promote healing of the epidermis ( top layer of skin) unsaturated fatty acids ( omega-3 and omega-6). These substances are found in large quantities in vegetable oils.

• sunflower;
• corn;
• rapeseed;
• linen;
• cedar.

Oils should be used as a salad dressing, when preparing soups ( not for frying) and vegetable purees.

Reducing the load on the liver
Diet of atopics ( people with atopic dermatitis) should ensure good liver functionality. The volume and meals should be distributed evenly throughout the day. Preference should be given to fermented milk products, lean meats, soups and pureed vegetables. Products consumed ( food and drink) must not contain dyes, food additives, or preservatives. You should not take animal and combined fats, as well as products that contain them.

Foods to avoid to reduce stress on the liver include:

• lard, margarine, confectionery fat;
• hot spices, flavor enhancers, seasonings, sauces;
• carbonated drinks, strong coffee and tea;
• lamb, fatty pork, duck, goose.

Ensuring normal bowel function
Against the background of poor functionality of the gastrointestinal tract and associated constipation, the body's reaction to allergens is more acute. Therefore, the diet of a patient with atopic dermatitis must include foods that promote good bowel function. Helps food pass through intestinal tract fruits and vegetables high in fiber. Also, to prevent constipation, you need to drink about two liters of fluid per day. Fermented milk products normalize intestinal function.

Products that ensure proper functionality of the gastrointestinal tract in atopic dermatitis are:

• baked apples;
• stewed or boiled zucchini, cauliflower and white cabbage;
• yogurt, one-day kefir ( fermented milk product with a long shelf life is rich in lactic acid and saprophytic bacteria, which inhibit intestinal function);
• pearl barley, barley, buckwheat and oatmeal porridge.

Foods that inhibit bowel function include:

• foods rich in starch ( wheat flour products, potatoes);
• food high in animal protein ( meat, fish, eggs);
• drinks and food with a high concentration of tannins ( strong tea, quince, pear, dogwood).

Low Gluten Products
The body of a person with atopic dermatitis does not absorb gluten well ( protein, the second name of which is gluten). As a result, the disease worsens and treatment is not effective. This happens because if gluten is poorly tolerated, the process of breakdown and absorption of nutrients by the intestine is disrupted.

Wheat contains the most gluten. A sufficient amount of gluten is present in cereals such as rye and barley. Therefore, it is necessary to exclude from the atopic diet, first of all, pasta, wheat or rye bread, flour products and cereals that contain wheat, rye or barley. Large amounts of gluten are found in drinks such as beer and vodka.
Wheat flour is included in a large list of dishes. You can reduce gluten consumption without compromising your diet by replacing wheat flour with buckwheat. To prepare this product, you need to take buckwheat, rinse it several times and heat it in a frying pan without using fat or vegetable oil. After cooling the buckwheat, you need to grind it in a coffee grinder. Buckwheat flour can retain its nutritional qualities for two years. Using a similar recipe, you can prepare flour from rice or pearl barley.

Other products that can replace wheat flour in the diet for atopic dermatitis are:

• sorghum flour;
• corn flour;
• corn starch.

Keeping a food diary
A food diary will help you independently diagnose and identify foods that cause allergies in atopic dermatitis. Before you start keeping records, it is necessary to carry out a one-day fast, during which the patient is allowed to drink water, tea and crackers without sugar. Next, you should gradually introduce dairy products, vegetables, meat, and fish into your diet. In the diary you need to indicate the dishes and the body’s reaction to their use. The main condition is to keep notes in as much detail as possible, writing down not only the name of the dish, but also its characteristics. It is necessary to describe in detail all the included components, the method of cooking, and the time of eating. It is also necessary to note in detail any allergic symptoms that appear.

Recommendations for creating a menu for atopic dermatitis
If an allergic reaction to a certain product is detected, it should, if possible, not be excluded, but replaced with another, similar component. So, if you are allergic to cow's milk, you should try to replace it with soy, mare's, sheep or goat's milk. Before drinking, any type of milk must be diluted with water in a one-to-one ratio and boiled. Chicken eggs can be replaced with quail eggs.
To minimize the likelihood of an allergic reaction when preparing dishes for an atopic diet, a number of recommendations should be followed.

The rules for preparing food for atopic dermatitis are:

• heat treatment reduces the allergic activity of many foods, so the consumption of raw vegetables and fruits should be kept to a minimum;
• before eating potatoes, they should be kept in cold water for several hours - this will remove potato starch from the vegetable, which is not recommended for this disease;
• It is necessary to cook porridge in the third water - after the cereal boils, you need to drain the water and pour in new one. You need to do this twice;
• when preparing vegetable purees and soups, boiled water should be drained once;
• When cooking broths, the first water should also be drained.

Sample menu for atopic

• breakfast- porridge ( oatmeal, buckwheat, pearl barley) on water, baked apple;
• dinner– vegetable puree soup ( soaked potatoes, zucchini, cauliflower) seasoned with vegetable oil, 50 grams of boiled beef;
• afternoon tea– dry cookies, a glass of kefir;
• dinner– steamed cutlets ( turkey, rabbit), stewed white cabbage.

Prevention of atopic dermatitis

The basis for the prevention of atopic dermatitis is the organization of those living conditions that will reduce contact with the allergen. Also, the goal of preventive measures is to eliminate factors from a person’s life that contribute to exacerbations of this pathology.

Preventive measures for atopic dermatitis are:

• providing a hypoallergenic environment;
• compliance with personal hygiene and sanitary standards;
• implementation proper care for the skin;
• following a hypoallergenic diet;
• exclusion of nonspecific ( non-allergenic) factors that can cause exacerbation of the disease.

Hypoallergenic environment

House dust and the mites it contains cause exacerbation of atopic dermatitis, regardless of the allergen that provokes pathogenic reactions in the patient. Therefore, prevention of this disease involves providing high-quality protection against these factors.

Sources of dust and organisms living in it in domestic conditions are:

• mattresses, pillows, blankets;
• carpets, carpets, rugs;
• cushioned furniture;
• curtains, curtains.

Bed dress
For patients with atopic dermatitis, it is recommended to use special plastic bags with a zipper for mattresses and pillows. Blankets and pillows must be chosen with synthetic filling. Wool and down not only provide a favorable environment for Dermatophagoides mites ( dust mites), but are also traditional epidermal allergens ( allergens, which include saliva, feathers, dander, animal excrement). Patients with atopic dermatitis should use special bedding that provides effective protection against dust and mites. If you use regular bed linen, you need to change it twice a week and boil it once every seven to ten. Sleep accessories that cannot be washed ( mattresses, pillows) must be treated with special preparations. Pillows should have 2 pillowcases.

Carpets and upholstered furniture
In a room where a person prone to atopic dermatitis lives, the number of carpets and upholstered furniture with pile must be kept to a minimum. It is recommended to treat the remaining products once every six months with special acaricidal agents ( drugs that kill ticks). Also, carpets and upholstered furniture should be taken outside in summer and winter.

Preparations that should be used to treat carpets, upholstered furniture and bed dress for protection against dust mites are:

• allergoff spray;
• easy air;
• Dr. al;
• ADS spray.

Curtains
Curtains, tulles and other textile products for windows in the room where atopic people live must be replaced with vertical blinds made of polymer materials. Plant pollen is a factor that causes exacerbation of atopic dermatitis. Therefore, during the flowering period, indoor windows should be sealed.

Other dust sources
Books, figurines, souvenirs are areas of increased dust accumulation. Therefore, if it is not possible to completely remove them from the patient’s room, it is necessary to keep these items in cabinets with tightly closing doors. A large amount of dust is observed near objects such as a computer and TV. Therefore, this equipment should not be in the room where the atopic sleeps.

Sanitary standards

Sanitary and hygienic standards for atopic dermatitis require compliance with a number of rules when cleaning premises.

The rules for putting things in order in a room where a person prone to this disease lives are:

• systematic cleaning;
• use of special household appliances;
• use of hypoallergenic detergents.

Prevention of atopic dermatitis includes regular cleaning of the living space where a person predisposed to this disease lives. Wet cleaning should be done daily, general cleaning should be done once a week. Restoring order should be carried out in the absence of atopic using special household appliances. It should be noted that ordinary vacuum cleaners are not recommended, as mites penetrate the filters and spread throughout the room, worsening the patient’s condition. Modern vacuum cleaners with carbon fiber and HEPA are more effective when cleaning. by air) filters. When cleaning rooms where there is a person prone to atopic dermatitis, you should not use detergents with strong fragrances or a high content of chlorine.

Molds are a common type of allergen. Therefore, in the bathroom and other areas of the apartment with high humidity, you should wipe all surfaces dry and treat them with special products once a month. These measures will prevent mold growth. In the dining room, you should install a hood above the stove for high-quality steam removal.

Tobacco smoke is a trigger ( factor provoking exacerbation of atopic dermatitis), therefore an atopic should avoid places where it is smoky. Smokers living in the same area as a sick person should stop using tobacco products indoors.

Personal hygiene
Hygiene procedures play an important role in the prevention of atopic dermatitis. Compliance with a number of personal hygiene rules will help atopic patients prevent exacerbation of the disease.

Personal hygiene provisions that should be followed when preventing atopic dermatitis include:

• Personal hygiene products that contain alcohol should be excluded from everyday use;
• When taking water procedures, it is necessary to give preference to a shower rather than a bath;
• the water temperature should vary from 30 to 35 degrees;
• bathing duration - no more than twenty minutes;
• The best option is dechlorinated water ( You can get such water by installing household purifying filters);
• When taking water procedures, you should not use hard washcloths;
• soaps and detergents should be chosen that do not contain dyes or fragrances;
• after water procedures, the skin should be blotted and not rubbed with a towel;
• underwear should be made from high-quality natural hypoallergenic materials;
• you should be careful when choosing the size - clothes should be loose and not fit tightly to the body;
• clothes should be washed with liquid detergents;
• The nails of a person with atopic dermatitis should be cut short to avoid scratching;
• Atopic people are not recommended to visit public swimming pools, as the water in them contains large amounts of chlorine.

Skin care
The skin of a person with atopic dermatitis is dry, which leads to its damage, facilitating the penetration of pathogenic factors ( bacteria, viruses, fungi).

The stages of an atopic skin care program are.

• proper cleansing;
• hydration;
• nutrition;
• restoration of skin barrier functions.

The scalp needs special care.

Skin cleansing
Most personal care products contain ingredients such as alcohol, astringents, fragrances, and preservatives. These substances not only cause dry skin, but also contribute to the exacerbation of atopic dermatitis. The best option for cleansing the skin is soap ( shower gel, foam for washing), which has a neutral acid-base balance ( pH), minimal degreasing surface and hypoallergenic composition. It is recommended to purchase hygiene products for atopic dermatitis in pharmacies.

Popular brands of skin cleansing cosmetics are:

• bioderma ( atoderm series) - alkali-free soap – does not contain aggressive detergents and is recommended during periods of exacerbation of atopic dermatitis. The composition includes cucumber extract, which has an anti-inflammatory effect, and glycerin, which moisturizes and softens the skin; mousse for washing - contains copper and zinc sulfates, which have an antiseptic effect. Indicated for use during remission of the disease;
• ducray ( a-derma program) - soap, gel with oat milk - do not contain alkali and can be used daily;
• aven ( line based on thermal water) - nourishing soap and cream - do not contain alkali and have a softening effect.

Skin hydration
You can maintain the required level of skin moisture during the day using irrigation with special products. These preparations contain thermal water, which not only moisturizes the skin, but also reduces itching. The products are available in the form of aerosols, which greatly simplifies their use.

In order to relieve itching before bed and prevent scratching, you can apply moisturizing compresses. The juice of raw potatoes, pumpkin or aloe has an effective effect. You need to soak a cotton swab in the juice and apply it to the affected skin. An ointment prepared on the basis of butter and St. John's wort moisturizes the skin well. One tablespoon of plant juice should be mixed with 4 tablespoons of fresh melted butter. The resulting composition should be applied to a gauze bandage and applied to the damaged areas.

Skin nutrition
High-quality nutrition of the skin with atopic dermatitis helps prevent the occurrence of irritations. According to statistics, if a patient does not experience such phenomena as itching and dry skin over the course of a year, the likelihood of an exacerbation of the disease is reduced to 2 percent.
When choosing cosmetic products for softening, you should give preference to those creams that contain natural vegetable oils such as olive, almond, and coconut. Well nourish the epidermis ( outer layer of skin) vitamins such as A and E.

Rules for using nourishing and moisturizing products
Products for nourishing and moisturizing the skin with atopic dermatitis must be used at least three times a day ( morning, evening and after bathing). After water procedures, the cream should be applied for approximately three minutes. You should pay attention to areas with increased dryness, and there is no need to treat skin folds. Nourishing and moisturizing products should not be used during the hot season. A new product must be tested for allergenicity. To do this, you need to lubricate the area in the area of ​​the inner bend of the elbow with cream for several days.

Restoring the protective functions of the skin
Skin affected by atopic dermatitis loses its protective properties and ceases to be a barrier between the human body and the environment. Therefore, prevention of this disease includes measures to restore the health of the skin. The atopic diet should include foods that are rich in vitamins A, C, E, B, PP, D and K. It is these vitamins that help restore the protective function of the skin.

Products that contain vitamins A, C, B, PP, D and K and are allowed for atopic dermatitis include:

• vitamin A (responsible for skin elasticity) – found in spinach, sorrel, green salad, green peas;
• vitamin C (provides elasticity) – cabbage, spinach, parsley, rose hips;
• vitamin E (has a beneficial effect on the process of cell renewal) – olive, sunflower, corn oil, oatmeal;
• B vitamins (accelerate the regeneration process) – brown rice, oatmeal, buckwheat, potatoes, beef, cauliflower;
• vitamin PP (fights dry skin) – lean pork, mild cheese, buckwheat.

Preventative diet

Maintaining a balanced diet and eliminating allergenic foods is one of the most effective ways to prevent atopic dermatitis. The effectiveness of diet therapy is increased by keeping a food diary, in which the patient must note the dishes consumed ( components, heat treatment method) and the body's reaction. The main principle of the diet for atopics is not the exclusion of foods that provoke allergic reactions, but their replacement with other ingredients. Together with food, a person must receive a sufficient amount of vitamins and other useful elements in order to ensure good functionality of all body systems.

To the main provisions preventive diet atopic dermatitis includes:

• exclusion of allergens from the diet;
• ensuring good bowel function with food;
• eating foods that reduce the load on the liver;
• reducing the amount of gluten consumed ( gluten free);
• inclusion in the menu of elements that contribute to rapid recovery skin.

Nonspecific factors

In the prevention of atopic dermatitis great importance have nonspecific factors that are not allergens, but can cause an exacerbation of the disease or contribute to its chronic course.

Triggers for atopic dermatitis are:

• stress, emotional overexcitement;
• increased level of physical activity;
• climate impacts;
• diseases and disruptions in the functionality of various body systems.

Stress in atopic dermatitis
Negative emotions and anxiety are closely related to the manifestations of atopic dermatitis. During periods of intense anxiety, the skin rash and itching become more intense, which only increases the patient’s stress. This pathology has a great influence on the formation of complexes - 25 percent of atopics have mental disorders. Quite often, people with atopic dermatitis experience difficulties in communication, limit their circle of friends, and minimize contact with the outside world. Therefore, in the prevention of this disease, a significant role is given to the patient’s relatives, who should help the sick person gain self-confidence. People with atopics should discuss their illness openly with friends, doctors, and others who suffer from similar disorders. Much attention should be paid to developing resistance to stress. By controlling your reactions and controlling your anxiety, you can prevent this condition from getting worse.

Ways to deal with stress are:

• sport;
• complete rest;
• laughter and positive emotions;
• hobby;
• special techniques that promote muscle relaxation ( breathing exercises, alternating muscle tension and relaxation, meditation).

Physical activity for atopic dermatitis
Atopics should avoid intense physical activity, which increases sweating. Close contact of the body with clothing, combined with sweat, increases the itching of the skin. You should not completely give up sports, as it helps maintain normal physical and emotional health of the patient.

Climatic factors in the prevention of atopic dermatitis
Exacerbation of atopic dermatitis in most cases is observed in the cold season. Low air temperatures combined with wind have a negative effect on the skin. Therefore, in winter you should use special skin protection products. Particular attention should be paid to clothing. It is worth choosing things in such a way that they provide a comfortable temperature, but do not cause overheating of the body, because this can cause itching.

In the warm season, atopic skin also needs special care; it should be protected from exposure to direct sunlight. In summer, between 11 a.m. and 4 p.m., you should stay indoors or in places protected from the sun outside. Before leaving home, the skin should be treated with sunscreen, using products that are intended for atopics.

A comfortable microclimate should also be maintained in the room in which a person with atopic dermatitis lives. Temperature ( no higher than 23 degrees) and air humidity ( at least 60 percent) must remain stable, since their sudden changes can provoke exacerbations of the disease. You can maintain a constant favorable indoor climate using air conditioners and humidifiers.

Diseases associated with atopic dermatitis
When preventing atopic dermatitis, special attention should be paid to concomitant diseases of internal organs and body systems. One should strive for timely detection of diseases and their treatment.

Pathologies that predispose to the development or exacerbation of atopic dermatitis include:

• disruptions in the functioning of the nervous system;
• illnesses endocrine system;
• poor functionality of the digestive system ( various shapes hepatitis, gastritis, cholecystitis);
• weak immunity;
• chronic tonsillitis ( tonsillitis) and other ENT diseases.

Atopic dermatitis in children is an inflammatory skin disease that occurs against the background of increased sensitivity of the body to contact and food allergens. The pathology manifests itself as itching, skin rashes, crust formation and other symptoms. Atopic dermatitis is predominantly encountered by young children, which makes the disease quite dangerous for their fragile bodies.

To diagnose atopic dermatitis in children, skin tests, specific IgE and other procedures are performed. When the diagnosis is confirmed, physiotherapy, therapeutic nutrition and the use of medications (systemic and local) are prescribed. The child is also provided with psychological assistance to enhance the therapeutic effect.

Description of the pathology

Atopic dermatitis in children is a chronic disease of an allergic nature. In medicine, there are other names for this pathology - diffuse neurodermatitis, atopic dermatitis syndrome and atopic eczema. But all this is one and the same disease, the occurrence of which is determined by factors such as negative environmental influences and genetic predisposition.

Note! Symptoms of atopic dermatitis are often encountered by young patients, so the disease should be considered in pediatric practice. According to statistics, recently, representatives of the children's population have predominantly encountered dermatological diseases of a chronic nature.

Causes

Genetics is far from the only factor that can trigger the development of dermatitis in children. There are other reasons:

• diseases of the gastrointestinal tract;
• non-compliance with the diet (the child eats too often or too much);
• the body's reaction to some food;
• impact cosmetic products or household chemicals with which the child came into contact;
• allergy to lactose.

If, while carrying a child, the mother often consumed harmful foods that contain potential allergens, then atopic dermatitis may occur in the newborn baby. Self-healing, as statistics show, occurs in approximately 50% clinical cases. The second half of children are forced to suffer from signs of pathology for many years.

Risk factors for the development of atopic dermatitis (AD) in children

Classification

In medicine, there are several types of diseases that manifest themselves in different age categories:

• erythematous-squamous dermatitis. Occurs in children under 2 years of age, accompanied by excoriation, increased dry skin, itching and papular rash;
• eczematous dermatitis. This type of dermatitis is diagnosed mainly in children under 6 years of age. Eczematous atopic dermatitis is accompanied by severe itching, papular-vesicular rash and swelling of the skin;
• lichenoid dermatitis. A common form of pathology, which is most often encountered by school-aged patients. Except standard symptoms, such as itching of the skin, swelling and hardening of the affected areas of the skin;
• pruriginous dermatitis. Manifests itself in the form of numerous papules and excoriation. A prurigo-like type of atopic dermatitis is diagnosed in adolescents and older children.

Ignoring the disease can lead to unpleasant consequences, so if suspicious symptoms appear in a child, you should consult a pediatrician as soon as possible.

Stages of occurrence

Doctors divide 4 main stages:

• initial. Accompanied by swelling of the affected areas of the skin;
• expressed. Additional signs occur, such as skin rashes and peeling. The expressed stage of the pathology can be chronic or acute;
• remission. Gradual reduction in the severity of symptoms until their complete elimination. The duration of this period can range from 4-6 months to several years;
• recovery. If relapses have not been observed for more than 5 years, then he can be considered clinically healthy.

On a note! Correct definition The stage of atopic dermatitis is an important stage in the diagnostic examination, because this factor influences the choice of therapeutic course.

Characteristic symptoms

Regardless of the type of pathology or the age of the patient, dermatitis is accompanied by the following symptoms:

• inflammation of the skin, causing severe itching. The patient begins to uncontrollably scratch all the affected areas of the skin;
• redness of thinner areas of the skin (neck, knee and elbow joints);
• pustular formations on the skin and acne.

The most dangerous sign of atopic dermatitis in children is itching, because it forces the sick child to intensively scratch the affected area, which causes small wounds to appear. Through them, various bacteria penetrate the body, provoking the development of a secondary infection.

Will the symptoms of dermatitis go away with age?

In most cases, approximately 60-70%, the signs of atopic dermatitis in children disappear over time, but in the rest, the disease persists in the child and accompanies him throughout his life, periodically renewing. The severity of the pathology directly depends on the period of its occurrence, therefore, with early onset, dermatitis is especially severe.

Doctors say that if, in parallel with atopic dermatitis, children develop another allergic disease, for example, bronchial asthma or hay fever, then the symptoms will appear almost constantly, which will significantly worsen the patient’s quality of life.

Diagnostic features

At the first suspicious signs of atopic dermatitis in children, the child should be immediately taken to a doctor for examination. Diagnosis is carried out by an allergist and a pediatric dermatologist. During the examination, the general condition of the patient’s skin (dermatographism, degree of dryness and moisture), the localization of the rash, the severity of the signs of pathology, as well as the area of ​​the affected area of ​​the skin are assessed.

To make an accurate diagnosis, a visual examination alone will not be enough, so the doctor prescribes additional procedures:

• coprogram (laboratory stool analysis for helminthiasis and dysbacteriosis);
• general urine analysis;
• general and biochemical blood test;
• identification of possible allergens using provocative (through the nasal mucosa) or skin scarification (through a small scratch on the skin) tests.

Note! During diagnosis, it is important to distinguish childhood atopic dermatitis from other diseases, e.g. pityriasis rosea, psoriasis, microbial eczema or seborrheic dermatitis. Only after differentiation will the doctor be able to prescribe an appropriate course of therapy.

Treatment methods

The main goal of therapy for atopic dermatitis in children is to desensitize the body, limit provoking factors, eliminate symptoms and prevent the development of serious complications or exacerbations of the pathology. Complex therapy should include taking medications (the use of local and systemic drugs), following a special diet, as well as traditional medicine.

Pharmacy drugs

To relieve the symptoms of atopic dermatitis, the child may be prescribed the following groups of drugs:

• antihistamines – have antipruritic properties. Such products as “Zodak”, “Cetrin” and “Finistil” are used;
• antibiotics - prescribed in cases where the disease is accompanied by a bacterial infection (Differin, Levomikol, Bactroban and others);
• antimycotics and antivirals are required when diagnosing additional infections. If a viral infection occurs, the doctor may prescribe Gossypol or Alpizarin, and if a fungal infection develops, Nizoral, Pimafucin, Candide, etc. are used;
• immunomodulators - used for atopic dermatitis, if signs of immune deficiency have been added to the symptoms of the pathology. These are potent drugs, so only the attending physician should select them;
• drugs to normalize the functioning of the gastrointestinal tract;
• Glucocorticosteroids are steroid hormones designed to eliminate pronounced symptoms of dermatitis. They are used in rare cases due to the large number of contraindications and side effects.

To speed up the regenerative functions of the body and restore affected areas of the skin, the doctor may prescribe special ointments that stimulate regeneration. The most effective drug is Panthenol.

Nutrition

A well-known doctor works hard on the topic of treating atopic dermatitis in children. Komarovsky, who devoted many years to this issue. He recommends organizing meals when the child’s diagnosis is confirmed (see). This will speed up the healing process and prevent recurrence of the disease.

To do this, you should follow a few simple nutritional rules:

• do not overfeed the child, because this will lead to disruption of metabolic functions, which is fraught not only with obesity, but also with the development of skin diseases;
• Reduce the fat content of breast milk if possible. To do this, a nursing mother must also follow a special diet, do not overeat fatty foods and drink enough fluids;
• When feeding a baby, you need to make a small hole in the nipple, thereby slowing down this process. This manipulation promotes normal digestion of food.

Also Komarovsky advises maintaining the room temperature no more than 20C. This will reduce the level of sweating in the child.

Folk remedies

If the disease was diagnosed in a child over 3 years old, then many parents use traditional medicine as therapy, which is in no way inferior in effectiveness synthetic drugs. But before using them, you should definitely consult with your doctor.

Table. Traditional medicine for atopic dermatitis in children.

Product name	Application
	Pour 1 liter of boiling water over 3 tbsp. l. chamomile flowers and leave in a closed thermos for 2-3 hours. Use the finished product to wipe your baby's skin after bath procedures.
	Grind the currant shoots (necessarily young ones) and, placing them in a thermos, pour boiling water over them and leave for 2 hours. Strain the product through cheesecloth and give it to your child to drink throughout the day.
	A simple and at the same time effective anti-inflammatory agent used in the treatment of atopic dermatitis. Squeeze the juice from several potatoes and apply it to the affected areas of the skin. An hour after application, the juice should be washed off with warm water.
	Mix 4 tbsp in one bowl. l. butter and 1 tbsp. l. St. John's wort juice. Heat ingredients over low heat, stirring occasionally. Place the mixture in the refrigerator for storage. Apply the ointment to the affected areas 2 times a day.
	To prepare the decoction, pour 500 ml of boiling water into 3 tbsp. l. chopped plant and cook over low heat for 30 minutes. After this, the medicine should infuse for 2 hours. The finished decoction should be taken 1 tbsp. l. 3-4 times a day. The duration of the treatment course is 3 weeks.

Application homeopathic remedies helps normalize the gastrointestinal tract, and also restores the child’s immune and nervous system.

Many doctors recommend supplementing traditional treatment methods hyperbaric oxygen therapy, reflexology and phototherapy methods. This will speed up the recovery process, strengthen the child’s body and reduce the likelihood of re-development of the pathology.

Often, when diagnosing atopic dermatitis, children require the help of not only a dermatologist, but also a psychologist.

Possible complications

Incorrect or untimely treatment of atopic dermatitis in children can lead to the development of serious complications, which, in turn, are divided into systemic and local. Systemic complications include:

• psychological disorder;
• hives;
• bronchial asthma;
• allergic form of conjunctivitis and rhinitis;
• the development of lymphadenopathy - a pathology that is accompanied by enlargement of the lymph nodes.

TO local complications atopic dermatitis in children include:

• lichenification of the skin;
• development viral infection(as a rule, patients develop herpetic or papillomatous lesions);
• candidiasis, dermatophytosis and other fungal infections;
• infectious inflammation accompanied by pyoderma.

To avoid such complications, the disease must be treated in a timely manner, so at the first suspicious symptoms, the child should be shown to a doctor as soon as possible.

Prevention measures

To prevent your child from encountering unpleasant symptoms of atopic dermatitis in the future, the following recommendations should be followed:

• ventilate the children's room, maintain a cool climate;
• regularly walk with your child in the fresh air, preferably not on city streets, but in nature;
• maintain a drinking regime, especially in the summer;
• Monitor your baby’s diet – it should contain a sufficient amount of nutrients;
• Don't overdo it with hygiene. Too frequent bathing procedures can harm the baby’s skin by disrupting its protective lipid barrier;
• Buy clothes made exclusively from natural materials that are comfortable and do not restrict movement. experts recommend giving preference to cotton products;
• Use only “baby” laundry detergent.

Atopic dermatitis in children- This serious illness skin, requiring increased attention. The disease can periodically disappear and then appear again, so only timely therapy and preventive measures will get rid of dermatitis forever.

Video - 10 rules for treating atopic dermatitis in children