– hereditary non-infectious disease skin, allergic in nature, may be chronic. According to statistics, the disease most often occurs in members of the same family. If one of your relatives or parents has diseases such as , or atopic dermatitis , the probability of transmitting the disease to a child by inheritance is 50%. In the case when both parents are sick, the probability of heredity increases to 80%. Sometimes the presence of asthma alone in parents can cause atopic dermatitis in a child.
Causes of atopic dermatitis
Manifestations of the disease in the first year of life are most often associated with the introduction of complementary foods into the child’s diet. Allergenic products include cow's milk, eggs and fish, so it is not recommended to introduce them into complementary foods until 10-12 months. Call allergic reactions Artificial mixtures can also.
In approximately 70% of patients, the disease resolves during adolescence; in the rest, it progresses to an adult form, in which exacerbations alternate remissions for a short time, and then the disease worsens again. In adults, allergens include house dust, animal hair, mold, and plants; symptoms also vary slightly.
Thus, the main causes of atopic dermatitis are allergic in nature and are a reaction to contact or consumption of certain substances - .
Symptoms of atopic dermatitis
In most cases, the disease manifests itself during the first five years of life, with the peak occurring in the first year. In adulthood, the symptoms of atopic dermatitis may disappear or weaken, but in half of the cases they persist throughout life. The disease may be accompanied by diseases such as bronchial asthma and .
Anti-inflammatory medications are mandatory. These can be corticosteroids, as well as sedatives, various sedative herbal mixtures, peony, and others.
For external use, antiseptics such as Fukartzin , . To maintain the general condition of the patient, a complex of vitamins and microelements is prescribed, and hardening is recommended.
In case of secondary infections, drugs are prescribed depending on the type of pathogen. Additionally prescribed enzyme preparations for disorders of the pancreas and eubiotics. In the acute stage of oozing, wet-dry dressings and corticosteroid aerosols are used.
The most important condition, without which the treatment of atopic dermatitis cannot be effective, is not to rub or comb the skin. Like some others skin diseases it is accompanied by unbearable itching, which is very difficult to tolerate. By scratching the lesions, patients cause exacerbations and complications of the disease, and in this case all medications will be useless.
If you or your child have symptoms of atopic dermatitis only initial stage– this is not a reason to self-medicate. You should definitely contact a dermatologist.
Complications of this disease can lead to severe infectious diseases. It is necessary to strictly follow the doctor’s instructions, adhering to his recommendations in Everyday life, this is the only way to avoid constant exacerbations.
The doctors
Medicines
People who have atopic dermatitis, you have to be more careful and attentive to your lifestyle, and devote more time to your home. There should be no objects accumulating dust in the house, as it is the main allergen. The room should have a minimum of carpets and upholstered furniture, all surfaces should be easy to wet clean, which is carried out as often as possible, but without detergents chemicals. You should ventilate your home more often by installing mesh on the windows to prevent pollen from entering the house. As for bedding, they must be filled with synthetic fillers; the use of down and feathers is unacceptable. In other words, for people prone to the disease, prevention of atopic dermatitis is aimed at minimizing contact with allergens.
Clothing should be easily breathable so that the skin can breathe. Clothes made of wool, nylon and polyester are not the best option, as they increase itching and irritate the skin. Do not use hot water when washing, only warm water. After washing, you should blot your skin rather than dry it. Be sure to use cosmetics to moisturize and care for the skin. They must be neutral and free of dyes, fragrances and preservatives. That is, additionally, the prevention of atopic dermatitis includes measures to prevent mechanical irritation of damaged areas.
Equally important for prevention is the timely treatment of chronic diseases, taking vascular-strengthening drugs and sedatives before important events. Allergenic foods should be avoided in the diet even during periods of remission of the disease.
Complications of atopic dermatitis
The most common complications of atopic dermatitis are caused by secondary infections. This occurs when scratching the skin, which leads to a violation of its protective properties.
Damaged areas are exposed to microbial and fungal flora, as well as viral infections. Secondary infections complicate treatment of atopic dermatitis, causing new lesions and negatively affecting the general condition of the patient.
Pyoderma, that is, a bacterial infection, which is characterized by the appearance of pustules that gradually dry out and form crusts, is ahead of other complications of atopic dermatitis in terms of frequency of occurrence. The disease is accompanied by disturbances in general condition, fever, and itching. The rash can occur all over the body and on the scalp.
It can also often be a complication viral infection caused by a simple virus. The same virus causes . Bubbles with liquid form on the skin, which are localized not only around the affected area, but also on healthy skin. Often, blisters appear on the mucous membranes of the mouth, throat, conjunctiva and genitals. Fungal infections affect the skin, nails, scalp, feet and hands. In children, such complications more often have symptoms, and the oral mucosa is affected. The curdled coating is often accompanied by redness and itching.
Diet, nutrition for atopic dermatitis
List of sources
- Atopic dermatitis// Pediatrics / Ed. A.A. Baranova. - GEOTAR-Media, 2009. - T. 2.
- “Handbook of skin and venereal diseases” by A.N. Rodionov, 2005.
- "Diagnostics of skin diseases." B.A. Berenbein, A.A. Studnitsin, 1996.
Education: Graduated from Vitebsk State medical University specialty "Surgery". At the university he headed the Council of the Student Scientific Society. Advanced training in 2010 - in the specialty "Oncology" and in 2011 - in the specialty "Mammology, visual forms of oncology".
Experience: Work in a general medical network for 3 years as a surgeon (Vitebsk Emergency Hospital medical care, Liozny Central District Hospital) and part-time as a district oncologist and traumatologist. Worked as a pharmaceutical representative for a year at the Rubicon company.
Presented 3 rationalization proposals on the topic “Optimization of antibiotic therapy depending on the species composition of microflora”, 2 works took prizes in the republican competition-review of student scientific works (categories 1 and 3).
Atopic dermatitis– one of the most common and severe allergic diseases, and the most common allergic skin lesion. Statistics indicate that the prevalence of atopic dermatitis exceeds 12% (that is, out of 100 people, 12 suffer from atopic dermatitis). Despite the huge strides made in this area in recent years, the treatment of atopic dermatitis is a rather complex problem and requires the collaboration of the doctor, the patient and his family members.
Atopic dermatitis– chronic, genetically determined, allergic inflammation of the skin, characterized by a typical clinical picture ( typical symptoms). The leading clinical symptom of atopic dermatitis, found in all age groups, is itching.
Atopic dermatitis in the vast majority first appears in children aged 6 to 12 months. Less often from 1 to 5 years. The first disease corresponding to the symptoms of atopic dermatitis was described in 1844.
Currently, atopic dermatitis can be hidden under the names eczema and neurodermatitis. It is sometimes mistakenly called allergic dermatitis or diathesis.
Causes of atopic dermatitis.
Atopic dermatitis is a disease that develops through the mechanism of immediate hypersensitivity (IgE-dependent immune response). This is one of the most common mechanisms for the development of allergies. Its main feature is the rapid reaction of the immune system to an incoming allergen (minutes, or less often hours, pass from the moment the allergen arrives until the symptoms appear).
Family history plays an important role in the development of atopic dermatitis, that is, among close relatives you can almost always find a person with an allergic disease. Most often, allergic mood is transmitted through the maternal line. Recent studies indicate that this is a polygenic disease, that is, about 20 genes located on several chromosomes are responsible for the development of allergic inflammation.
But in order for an allergic predisposition to develop into an allergic disease, in particular atopic dermatitis, it is necessary to be exposed to a number of external factors. The main trigger points: toxicosis of pregnant women, especially those developing in later stages, smoking and alcohol consumption by the mother during pregnancy, infectious diseases in the mother during pregnancy. A major role in the development of allergic diseases in children is played by the pathology of the gastrointestinal tract, in particular intestinal dysbiosis, insufficient duration or complete absence of breastfeeding, early introduction of complementary foods, introduction of age-inappropriate foods into the diet, earlier and inadequate prescription of antibiotics, etc.
A number of studies conducted in Europe and the USA have shown that atopic dermatitis is more common in families with a higher standard of living. There are several theories as to what this may be connected with, but no consensus has yet been reached.
Among the allergens that cause the development of atopic dermatitis, the most important are food ones (allergy to various foods). Household (various types of house dust mites, house dust, library dust, pillow feathers) and epidermal (animal hair and dander, bird feathers, fish food, etc.) allergens are of less clinical significance. Allergy to pollen as a cause of atopic dermatitis is extremely rare.
Symptoms of atopic dermatitis with photographs
Currently, the following diagnostic criteria for atopic dermatitis have been identified::
1) early onset of the disease (before two years of age),
2) the presence of allergic diseases in close relatives,
3) widespread dry skin,
4) localization of skin rashes in the area of the flexor surfaces of the arms and legs,
5) the presence of skin itching.
If four of the five criteria are found, the diagnosis of atopic dermatitis can be considered practically proven.
Symptoms of atopic dermatitis vary depending on the age of the patient. Thus, there are three variants of the clinical course of atopic dermatitis: the infant form, the childhood form, and the adolescent-adult form.
Infantile form of atopic dermatitis (diathesis). Symptoms of atopic dermatitis in newborns and infants.
The infantile form of atopic dermatitis occurs before the age of 2 years. Inflammatory elements like red spots appear on the child’s skin, localized mainly on the face in the forehead and cheeks. Such skin rashes are popularly called diathesis, although in fact diathesis is atopic dermatitis.
The disease is characterized by an acute course, weeping, swelling, and crusting. Foci of inflammation may also appear in other areas: in the area of the legs, buttocks, and scalp of the child. Periods of severe exacerbation, accompanied by weeping, are replaced by a subacute stage, which is characterized by papular elements (a papule is a skin element that rises above the skin like a tubercle) against the background of hyperemic (reddened) skin.
The photo shows an infant form of atopic dermatitis
Children's form of atopic dermatitis, symptoms.
During the period of exacerbation of atopic dermatitis, skin elements (red spots, papules) are located mainly in the area of skin folds, on the flexor surfaces of the elbow and knee joints, and also behind the ears. The skin becomes dry, peeling and lichenification appear (on dry skin there is a clearly defined, enhanced skin pattern). The child develops a so-called “atopic face”: dull skin color, increased pigmentation around the eyes, an additional skin fold of the lower eyelid. Outside of exacerbation, severe dryness of the skin. The skin may crack, especially on the backs of the hands and fingers.
In the photo: Atopic dermatitis. Children's uniform. Patient 3 years old.
Adolescent-adult form of atopic dermatitis, symptoms.
Skin lesions in atopic dermatitis are widespread and permanent. Changes are noted on the skin of the face, neck, chest, back, neck. The skin is dry, widespread lichenification, traces of scratching. There may be cracks in the hands and feet. Exacerbations of atopic dermatitis, manifested by redness of the skin, are quite rare.
The photo shows atopic dermatitis in a 15-year-old teenager (dry skin, peeling).
In the photo: atopic dermatitis. Adult form.
If an infection occurs, fungal lesions, pustules, and greenish crusts may appear.
Depending on the severity, atopic dermatitis is classified into mild, moderate and severe.
Symptoms of chronic atopic dermatitis
People with atopic dermatitis are characterized by thickening of the skin and increased skin pattern, painful cracks in the skin, especially on the palms and soles, and hyperpigmentation of the eyelids (darker skin color on the eyelids).
The symptom of “winter foot” is hyperemia and moderate infiltration of the soles, peeling, cracks.
Morgan's sign (Denier-Morgan, Denier-Morgan folds) - deep wrinkles on lower eyelids oh in children.
The symptom of “polished nails” is the disappearance of longitudinal striations and characteristic appearance nails due to constant scratching of the skin.
The symptom of a “fur hat” is dystrophy of the hair in the occipital region.
Pseudo Hertog's symptom is a temporary loss of hair, first in the outer third, and then in other areas of the eyebrows in some patients.
What tests will you need to take if you suspect atopic dermatitis?
Atopic dermatitis is in the area of interest of two medical specialties: an allergist-immunologist and a dermatologist. Taking into account the high prevalence of this problem among children, according to modern medical standards, mild forms of atopic dermatitis can be treated by a pediatrician, but it is better to still try to get to a specialist.
The diagnosis of atopic dermatitis is made on the basis of characteristic clinical symptoms and data obtained after questioning the patient or his parents (if the patient himself does not yet speak properly).
A patient newly diagnosed with atopic dermatitis must undergo an in-depth examination, which will identify the factors that provoke an exacerbation of the disease and underlie its development.
If the rashes are persistent and localized strictly in certain areas, then consultation with a neurologist or orthopedist (or better yet both) is necessary, since concomitant pathology of the spine is possible.
If the child is hyperexcitable, a consultation with a neurologist is required.
It is mandatory to conduct an allergic examination aimed at identifying those substances that directly cause the development of an allergic disease.
Taking into account that atopic dermatitis is a disease that occurs with skin lesions, the only acceptable method of diagnosis is a blood test for IgE-specific (specific immunoglobulins E produced in response to specific allergens). First of all, they donate blood for food allergens. In patients over three years of age, it is advisable to donate blood for household and epidermal allergens.
In case of infection, the discharge from the inflammation sites is cultured for microflora and fungi, as well as for sensitivity to antibiotics.
Sometimes a skin biopsy is performed (a small area of skin is taken for analysis) to clarify the nature of the inflammatory process. But this research method is carried out quite rarely and only for strict indications, for example, if skin lymphoma is suspected.
If exacerbations of atopic dermatitis coincide in time or begin immediately after a cold, then it is advisable to take a blood test for an immunogram. This will help identify possible problems with the immune system.
In general, when designing an examination program, the doctor must understand that atopic dermatitis is not only an allergic disease. Both the nervous and endocrine systems may be involved in its occurrence. There are almost always problems in other organs and systems of the body. And if these provoking and aggravating factors are not found, then it will be extremely difficult to transfer the child into a state of stable and long-term remission (recovery). It is in finding and eliminating the cause of atopic dermatitis that the main task of the attending physician is, and not in prescribing only creams and tablets to relieve the symptoms of the disease.
Treatment of atopic dermatitis
Treatment of atopic dermatitis should be prescribed by a specialist only after an accurate diagnosis has been established. You should not start treatment on your own if symptoms of atopic dermatitis occur. A number of very serious diseases can have similar symptoms, and inadequate treatment tactics can be a threat to the life of the patient, especially the patient - a child. Never increase the duration of the course of medications recommended for you on your own, even if they help well and cope with the symptoms of the disease, and there is no time to go to the doctor. Even the most harmless creams with banal vitamins have side effects that can occur if treatment tactics are not followed.
General principles of treatment of atopic dermatitis:
- Elimination of allergen effects, hypoallergenic diet;
- antihistamines (relieve itching) (erius, tavegil, suprastin, ketotifen, claritin, fexadine, loratodine, telfast, etc.);
- detoxification agents (cleansing) (enterosgel, polyphepan, activated carbon, sodium thiosulfate, etc.)
- hyposensitizing agents (calcium gluconate, sodium thiosulfate);
- corticosteroids (anti-inflammatory effect) (elokom, lokoid, celestoderm, acriderm, sinaflan, diprosalik, belosalik, etc.);
- antiseptics (fucarcin, brilliant green, methylene blue, etc.)
- sedatives (calming) (glycine, persen, various sedative herbs, valerian, peony, etc.);
- enzymes (if pancreatic function is impaired) (Creon, Mezim, Pancreatin, etc.);
- antibacterial agents (in case of infection) (ointments, celestoderm cream with garamycin, Lorinden C, lincomycin ointment, sumamed table, zitrolide, doxycycline, erythromycin, zanocin, rovamycin, etc.);
- eubiotics (for intestinal dysbiosis) (Linex, Probifor, etc.);
- with the addition of both a fungal and a bacterial component (externally: triderm, acriderm GK, etc.);
- when a viral infection is attached (acyclovir, valtrex, famvir, alpizarin, etc.).
- If Kaposi's eczema or other viral infections are suspected, antiviral agents are prescribed. For infection - antibiotics (to which the pathogen is sensitive). For weeping in the acute stage, use wet-dry bandages or corticosteroid aerosols.
Therapeutic tactics during exacerbation of atopic dermatitis and without exacerbation differ significantly.
Treatment of exacerbation of atopic dermatitis
Treatment of exacerbation of atopic dermatitis consists of the complex use of the following groups of drugs:
1) Topical glucocorticosteroids. The most commonly used group of drugs for external use, used to relieve symptoms of exacerbation. The drugs have a number of side effects and contraindications, so they can only be used as prescribed by a doctor. It is preferable to use the latest generation drugs that do not contain fluorine in their structure. Their safety profile is much higher. Examples: Advantan, Afloderm, Elakom, etc. Topical glucocorticosteroids are available in the form of ointments, creams, emulsions, fatty ointments, and lotions. It is not recommended to use drugs in this group for more than 7-10 days in a row. The instructions for a number of drugs imply the possibility of prescribing them for up to 1 month, but this should still be avoided. Gradual withdrawal of topical glucocorticosteroids is recommended. For example, during the main part of the treatment course you apply ointment to the entire affected area. Then apply it using the stroke method every day, leaving a little more distance between the strokes.
Another option for gradual withdrawal is to apply the cream one day, and then give the skin a rest the other day, using non-hormonal remedies.
It should also be remembered that no glucocorticosteroids for external use should be applied to the skin of the eyelids in the immediate vicinity of the eyes, as this can lead to the development of glaucoma and cataracts.
2) Combined drugs. Drugs in this group contain a combination of glucocorticosteroids, antibiotics and antifungal drugs. Medicines of this pharmacological group are used if an infection is associated with allergic inflammation in atopic dermatitis. Examples: Triderm cream, pimafucort, etc.
3) Preparations with active zinc. These are products for external use (ointments, creams). Some experts regard it as an alternative to local glucocorticosteroids. The duration of treatment must be monitored by a doctor, preferably with experience in working with these drugs, as the development of chronic dermatoses of other, non-allergic, origin is possible.
4) Antihistamines. Preference should be given to drugs of the second and third generations. The average duration of treatment is ten days. Although there are treatment regimens that provide for long-term (at least three months) use of third-generation drugs. Examples: Zyrtec, Erius.
5) Pimecrolimus derivatives. This group includes the drug Elidel. Relatively a new group medicines, used to relieve symptoms of exacerbation. Its effectiveness is not inferior to local glucocorticosteroids and, at the same time, according to studies conducted by the manufacturer, it is much safer. Disadvantages of the drug: high cost, little clinical experience in its use.
6) Sorbents. Carrying out detoxification therapy with the help of sorbents is a necessary component in the treatment of exacerbations of most allergic diseases. Examples of drugs: lactofiltrum, enterosgel, filtrum, etc. The drugs are prescribed two to three times a day at an average age dosage for 7-14 days.
7) Glucocorticosteroids. Oral medications are prescribed only for severe forms of atopic dermatitis. The dosage and duration of treatment are determined by the doctor. Examples of drugs: metypred, prednisolone.
8) Cytostatics. Can be used only for severe forms of atopic dermatitis that are resistant to all other treatment methods. The dosage and duration of treatment are determined by the doctor. Treatment is carried out in a hospital setting.
Treatment of atopic dermatitis beyond exacerbation.
Atopic dermatitis– a chronic disease that requires long-term treatment even beyond the symptoms of exacerbation.
Currently, much attention is paid to the use of medicinal cosmetics during this period. Due to the presence of allergic inflammation, even sluggish without external clinical manifestations, the properties of the skin change. Its permeability and humidity are impaired. And the purpose of regular use of fortified cosmetics is to restore the damaged properties of the skin. Examples of drugs related to medicinal cosmetics: radevit, bipanten, pantoderm, locobase-ripea, etc.
In addition, treatment of concomitant diseases identified during the examination of the patient is carried out. The functioning of the gastrointestinal tract is corrected, the functioning of the nervous system is normalized, etc. The nature of the measures is selected individually, depending on the specific test results.
Thus, it is not enough to simply relieve the exacerbation of atopic dermatitis; it is necessary to identify and eliminate the factors that caused the development of the disease or provoke its exacerbations. Only in this case can you stop the progression of allergies, bring atopic dermatitis into remission, and then completely get rid of it.
Folk remedies for the treatment of atopic dermatitis
In folk medicine, there are a number of methods actively used by patients with atopic dermatitis. Thus, in mild forms of the disease, baths with decoctions of medicinal herbs, such as chamomile and string, have a good effect.
For children, baths with soothing herbs such as oregano, hops, valerian, and motherwort can be recommended. To prepare the bath, take 2 tablespoons of the herb, pour 1 glass of boiling water and leave for at least 10 minutes. The resulting broth is added to the baby’s bathtub.
But still, allergists come to the remedies traditional medicine They are quite wary, since patients with allergies very often experience individual allergic reactions to “folk” recipes.
Treatment of atopic dermatitis during pregnancy.
Atopic dermatitis does not manifest for the first time during pregnancy. The disease always begins in early childhood.
There are some features for treating an existing disease in women during pregnancy. Moisturizing cosmetics are carefully selected to soften the skin without exacerbation. For a number of fortified creams, for example, the fairly popular Radevit cream, pregnancy is a contraindication.
The principles of treatment during exacerbation of atopic dermatitis during pregnancy are practically no different from those in the rest of the population. If there is a need for local hormone therapy or prescribing antihistamines, it is preferable to use drugs of the latest generation, which have greater safety (Advantan, Elakom, Lokoid).
The main focus should be on creating a hypoallergenic environment.
There is no negative effect of atopic dermatitis on the fetus. Although toxic effects on a child are still possible, but only when using medications prohibited for this period of a woman’s life.
- Wear cotton clothes. The skin must breathe. Clothing made of wool or synthetics will increase irritation and itching.
- Frequent wet cleaning and ventilation of the room is necessary. Minimum carpets and upholstered furniture - minimum dust.
- It is better to use bedding with synthetic filling, without down or feathers.
- When washing, including your hands, use only warm water.
- After washing, do not rub the skin, but gently pat dry with a towel.
- Be sure to use moisturizers after showering. Skin care products should be neutral, without fragrances or dyes.
- Timely treatment of all chronic diseases, courses of vascular strengthening agents, sedatives(especially before significant events, such as exams, weddings, etc.), hardening, vitamins, exclude allergic foods, even during the period of resolution of rashes.
Features of nutrition, diet and lifestyle with atopic dermatitis
Creating a special hypoallergenic, that is, devoid of allergens, environment and following a diet are the most important components of the treatment of atopic dermatitis. Without following these recommendations, the effectiveness of treating the disease is significantly reduced.
Let's start by creating a hypoallergenic environment. In essence, it is the observance of a special way of life. The goal is to eliminate factors that can irritate the skin and thereby provoke exacerbations of atopic dermatitis.
It is also preferable to avoid intense physical activity or factors that increase sweating and itching. For the same reason, it is not recommended to participate in sports, as this causes active sweating and is accompanied by close contact of the skin with clothing. If possible, avoid stressful situations (as much as possible, of course). It is not recommended to wear rough clothes, especially those made of wool, synthetics, or animal fur. New clothes should be washed before wearing. When washing clothes and bedding, use a minimal amount of fabric softener, after which the laundry should be rinsed additionally. Do not use personal hygiene products containing alcohol.
You will have to install a hood in the kitchen. It would be a good idea to install an air purifier in your bedroom. During the hot season, use an air conditioner with an outlet filter.
Bed linen should be changed 1-2 times a week. Sources of dust and mold accumulation must be eliminated. The TV, computer, and household appliances must be removed from the patient’s bedroom. Light wet cleaning is carried out once a day, spring-cleaning at least once a week. Use vacuum cleaners with good filters(the best ones with HEPA filters). If there is a confirmed allergy to house dust mites, treat the apartment with acaricidal (mite-killing) drugs, for example, Allergoff, once every 3-6 months.
Smoking is not allowed in the house. This means family members. The patient should not smoke anywhere: neither in the house nor on the street.
Much attention is paid to water procedures. You cannot use regular soap; it is better to use shower oil or medicated shampoo (for example, Friederm series shampoos). After a shower, be sure to lubricate your skin with moisturizers.
The patient's nails should be cut as short as possible to avoid involuntary damage to the skin in case of exacerbation of the disease and the appearance of skin itching.
People with atopic dermatitis should not sunbathe. Extended exposure to the sun is a common mistake. Immediately after this there will be a slight improvement, which parents usually notice and strive for, but then a severe exacerbation of the disease almost always follows.
Do not comb or rub the skin; no products will be effective if you scratch the lesions.
Be sure to consult with your doctor regarding adherence to the principles of hypoallergenic living. The recommendations offered on our website may be supplemented depending on the allergens to which you (or your child) react.
Hypoallergenic diet for atopic dermatitis:
It is also necessary to adhere to a special diet. During an exacerbation, the diet should be observed especially strictly; outside of an exacerbation, it can be slightly expanded so as not to cause some kind of neurosis-like state in the child due to the fact that he “cannot do everything.”
Products excluded for atopic dermatitis:
It is not recommended to consume citrus fruits, nuts, seafood, fish, chocolate, coffee, mustard, spices, mayonnaise, tomatoes, eggplants, red peppers, milk, eggs, mushrooms, sausages, carbonated drinks, strawberries, wild strawberries, watermelons, pineapples, honey . Alcohol is strictly prohibited.
Products allowed for atopic dermatitis:
You can eat boiled beef; cereal and vegetable soups; vegetarian soups; olive oil; sunflower oil; boiled potatoes; porridge from buckwheat, rice, oatmeal; lactic acid products; cucumbers; parsley; dill; baked apples; tea; sugar; bran or whole grain bread; apple or dried fruit compote (except raisins); organic yoghurts without additives; one-day cottage cheese; curdled milk.
Atopic dermatitis– a disease that begins in early childhood. Most often within a period of 6 to 12 months. Atopic dermatitis in children is popularly called " Diathesis", in medicine concepts diathesis no, there is a concept infant stage of atopic dermatitis.
The clinical picture (symptoms with photos) of infant and childhood forms of atopic dermatitis is described in detail in the section Symptoms of atopic dermatitis. The younger the child is, the more prone he is to exudation (wetting).
The photo shows a child with atopic dermatitis
The nature of activities aimed at creating a hypoallergenic environment around a child does not differ from those for adults and is described in detail above.
Particular attention in children is paid to restoring damaged skin properties through the constant use of moisturizing cosmetics. It should be applied 3-4 times a day, sometimes more often.
It is very important to maintain breastfeeding for as long as possible (at least 6 months). But at the same time, the mother should not eat foods that can aggravate allergies (see the diet in the section Features of nutrition and lifestyle with atopic dermatitis).
It is important to properly bathe a child in the first year of life, especially a newborn. You can't use soap. It is better to use medicated shampoos. For example, Friederm shampoo with zinc during an exacerbation and Friderm Balance during an exacerbation. Before bathing, add one capful of shampoo to a bath of water. After bathing, do not rub your child with a towel - this will irritate the skin. It is better to lightly blot the skin with a towel or let it dry on its own.
An urgent problem is vaccination of a child with atopic dermatitis. The very fact of having a disease is not a reason to refuse vaccinations, but vaccination is possible only during the stage of stable remission of the disease (at least 2-3 months). It is mandatory to take antihistamines 7 days before vaccination on the day of vaccination and 3-5 days after vaccination. Multiple vaccines cannot be administered on the same day. If several vaccinations have already been missed, then vaccination should begin with less allergenic vaccines. Your attending physician (allergist-immunologist or pediatrician) will help you correctly draw up an individual vaccination calendar.
Complications of atopic dermatitis and prognosis for cure
The prognosis for life is favorable. However, skin lesions, especially in adolescence, can contribute to the social maladjustment of the patient.
Atopic dermatitis is a chronic allergic skin disease. If adequate treatment is carried out and risk factors are eliminated, most patients experience stable remission and subsequently the diagnosis can be removed. But since the diagnosis of atopic dermatitis is a reflection of a general allergic mood (atopic constitution), a large proportion of these patients (more than 40%) may develop in the future other allergic diseases, most often associated with lesions respiratory tract(allergic rhinitis, atopic bronchial asthma). This progression of allergic mood and the change of allergic diseases from less severe to more serious in the medical literature is called the atopic march.
In case of severe disease and/or inadequate treatment, non-compliance with a special lifestyle, the disease continues into adolescence and adults.
The most common complications of atopic dermatitis are the addition of a bacterial infection (pyoderma) and skin atrophy (most often due to unreasonably long use of local glucocorticosteroid drugs). Constantly scratching the skin atopic dermatitis leads to a violation of its protective, barrier properties, which contributes to the addition of infection caused by microbial and fungal flora.
Pyoderma is characterized by the appearance of pustules on the skin, which gradually dry out and crusts form. The rash can be located on the body, arms, legs, and scalp. This may be accompanied by a disturbance in the person’s general condition, and the temperature may rise.
Another common complication when atopic dermatitis- viral infection. Bubbles with transparent contents form on the skin. The causative agent is a virus herpes simplex, the same one that causes a “cold” on the lips. Usually the rashes are located in the area of inflammatory foci, but they can also involve healthy skin and also affect the mucous membranes (oral cavity, throat, genitals and conjunctiva). A particularly common localization of the rash is the skin of the face (around the mouth, lips, wings of the nose, on the cheeks, ears, eyelids).
A common complication of atopic dermatitis is fungal (most often candidal) infection. In adults, the skin (especially skin folds), nails, scalp, feet, and hands are most often affected; and in children - the oral mucosa, the so-called thrush (a “curdled” coating appears, which may be accompanied by soreness and redness). Sometimes bacterial and fungal infections are combined together.
Prevention of atopic dermatitis
There are no measures aimed at preventing the development of atopic dermatitis. The only recommendation that really works is to continue breastfeeding for as long as possible (at least 6 months). Some authors recommend excluding cow's milk from the diet of children under 1 year of age if there is a patient with an allergic disease in the family.
In case of an already manifested (begun) disease, preventive measures are reduced to eliminating the causally significant allergen (allergen causing allergies) from the environment, following the general principles of diet, creating a hypoallergenic lifestyle and providing adequate treatment.
Answers to frequently asked questions on the topic of atopic dermatitis:
Why should a child with atopic dermatitis follow a diet?
The diet should exclude foods directly to which allergies develop, and foods containing large amounts of histamine. Histamine is one of the the most important participants allergic disease. Absorbed in the intestines, it enhances the existing allergic process. Consumption of histamine-rich foods in patients with allergic diseases can be compared to throwing wood on a fire.
Can atopic dermatitis be completely cured?
Modern medical methods make it possible in most cases to put the disease into remission in a child. In this case, during adolescence, the disease may completely go away. In the old medical literature this was called "outgrowing the disease."
But for this to happen, long-term joint work between the doctor and the patient is necessary.
I have atopic dermatitis, what is the likelihood of passing it on to my child?
The probability of transmitting an “allergic mood” from the father is about 15-20%, from the mother about 40%, if both parents are sick - 70%. But for this attitude to result in disease, a combination of a number of external factors is necessary. Therefore, the real probability is less. Talk to your doctor about preventive measures.
Allergist-immunologist, Ph.D. Mayorov R.V.
Atopic dermatitis is an itchy dermatosis of a neuroallergic nature, manifested by redness and rashes on various parts of the body. More often, exacerbations occur after contact with a specific irritant, but in some situations the provoking factor cannot be identified or there are several of them. The disease first manifests itself in childhood, and some time ago this pathology was considered primarily of children. But in recent years, atopic dermatitis in adults is not much less common than in children. This is due to an unfavorable environmental situation, poor quality nutrition and improper treatment of a newly occurring disease.
More about atopic dermatitis
Most people have a rough idea of what atopic dermatitis is, since this disease is very common. It first makes itself felt in early childhood and manifests itself as redness and itchy papular rashes on the face, in the folds of the body (especially in the groin area and buttocks), on the arms and legs. Other areas are affected less frequently. The disease often immediately becomes chronic and after contact with allergens it certainly makes itself felt.
In most patients, with age, the number of exacerbations of atopic dermatitis gradually decreases until complete disappearance. But there are exceptions, and in Lately more often. In adults, favorite places for rashes are the face, hands, elbows, popliteal fossae, and skin of the legs.
Relapses occur more often in spring and autumn. Summer and winter are a time of short-term respite for atopics.
Causes of atopic dermatitis
Heredity plays the largest role in the occurrence of atopic dermatitis. Transmitted genetic predisposition on the maternal side. If a mother has this disease, the risk that it will manifest itself in the child reaches up to 50%. And if the father also suffers from atopic dermatitis, in 70-80% of cases the baby will also develop it.
The following reasons also play a huge role in the development of this pathology:
- poor nutrition (preservatives, flavors, dyes, nitrates, pesticides and other substances in food, fast food);
- environmental situation (in large cities the statistics on the incidence of atopic dermatitis is much higher);
- sources of chronic infections (untreated teeth, diseases of internal organs);
- frequent colds;
- autoimmune and endocrine diseases;
- systematic stress and overwork;
- treatment with certain medications (antibiotics, hormones, etc.).
Allergic factors directly causing exacerbations, food products, plant pollen, animal hair, cosmetics, household chemicals, etc.
How does atopic dermatitis manifest in adults?
As already mentioned, first of all, atopic dermatitis of adults is manifested by rashes and itching. In addition, patients note severe dry skin and flaking.
Rashes due to atopic dermatitis
The favorite localization of rashes in this pathology is the face and various folds of the skin. In each patient, the rash occurs in one or more areas, and with each relapse it occurs in the same places. New areas are rarely affected during exacerbations.
After contact with an irritating substance or as a result of stress, red, swollen spots with unclear boundaries appear on the skin. Against this background, papules appear, and in some cases, vesicles (bubbles) with liquid contents. Due to dry skin and scratching, crusts and peeling are added to the affected areas.
Itching
The rash of atopic dermatitis is accompanied by severe itching. This causes a lot of anxiety for patients. In addition to psychological discomfort, this problem can lead to the addition of a bacterial or fungal infection due to trauma to the skin due to scratching.
Since the itching intensifies at night, patients report problems sleeping and become irritable and nervous.
Peeling skin
The skin of atopics is predominantly very sensitive and dry, prone to peeling, and during exacerbations, to the formation of crusts and cracking. It is extremely difficult for them to take care of their face due to frequent reactions to creams and other cosmetics. Therefore, the skin of these patients often thickens in the affected areas, up to hyperkeratosis, and the skin pattern intensifies. This is especially noticeable in the area of the palms and feet.
Diagnosis of atopic dermatitis
A preliminary diagnosis of atopic dermatitis is made based on the patient’s complaints, medical history, characteristic symptoms and external examination data. Confirmation requires specific blood tests to determine immunoglobulin E, which confirms allergic sensitization of the body. If necessary, your doctor may prescribe skin allergy tests to identify a specific allergen.
Treatment of atopic dermatitis
Treatment of atopic dermatitis in adults includes a special diet, antihistamines and hormonal drugs, detoxification therapy, sedatives, tranquilizers, etc.
Diet for atopic tendencies
With atopic dermatitis, it is necessary to adhere to certain nutritional principles based on the exclusion of allergenic foods from the diet. It is very important to limit, or better yet completely stop, eating:
- eggs;
- whole cow's milk and products made from it;
- spicy and smoked dishes;
- red fish species;
- red caviar;
- mushrooms;
- rich broths;
- chocolate;
- red berries;
- citrus;
- carbonated drinks;
- honey, etc.
Antihistamines
Antihistamines for atopic dermatitis are the basis of drug treatment. Names of popular remedies from this group that have proven themselves in the treatment of this pathology:
- Claritin;
- Tavegil;
- Zodak;
- Zirtek et al.
If the patient is engaged in a profession that requires increased attention, be sure to inform the doctor about this, since many of these drugs cause drowsiness and decreased attention and reaction speed.
Hormonal treatment
Systemic glucocorticosteroids quickly relieve inflammation and reduce allergic reactions in the human body. Depending on the severity of the pathology and the severity of itching, they are used as external agents or taken systemically in the form of tablets. A popular and effective ointment for atopic dermatitis is Advantan. But there are other good local drugs:
- Elokom;
- Celestoderm;
- Flucinar;
- Sinaflan;
- Lorinden;
- Triderm et al.
Hormonal tablets for atopic dermatitis are prescribed less frequently, as they have many side effects and are addictive with subsequent withdrawal syndrome. For extensive lesions and severe painful itching, as prescribed by a doctor, use:
- Metipred;
- Medrol;
- Polcortolon;
- Triamcinolone and others.
It is almost impossible to cure atopic dermatitis in adults without the use of hormonal drugs. But it is important to use them only as prescribed by a doctor and give preference to local remedies, without resorting to systemic therapy unless really necessary.
Sedatives
Sedatives (Tenoten, Persen, Novopassit, tinctures of Motherwort, Valerian, etc.) help improve sleep, calm patients and to some extent reduce itching. For serious sleep and well-being disorders, tranquilizers and antidepressants can be used as prescribed by psychotherapists.
Detoxification therapy
Detoxification therapy with sorbents followed by the use of probiotics provides good effects in the treatment of atopic dermatitis. The most commonly used sorbents are Enterosgel, Polysorb and Smecta for a period of at least a month. Then probiotics are prescribed - Linex, Hilak forte, Bifidumbacterin, Acipol, etc. This treatment helps to normalize the intestinal flora and strengthen the immune system.
Physiotherapy
Physiotherapeutic methods in dermatology are important as they bring good results with virtually no side effects. How to treat atopic dermatitis in adults in the physiotherapy department:
- magnetotherapy;
- using lasers;
- various types of massages, including acupuncture;
- water treatments (various types of baths, Charcot shower, circular shower, etc.).
Skin care
Atopic dermatitis on the face requires special skin care. If there is severe dryness and a tendency to peeling, it is necessary to use moisturizers as often as possible, but their choice should be treated carefully and with caution. They should not contain aggressive agents. Preference should be given to cosmetics marked “hypoallergenic” and with a neutral pH.
Good skin care products that meet all requirements are Lipikar, Lokobase, Bepanten, Panthenol, etc. The last two items are sold in various dosage forms. For daily use, it is better to choose a cream, and for the treatment of exacerbations, an ointment for atopic dermatitis is more suitable.
All moisturizers should be applied to cleansed skin. You need to wash your face with warm (not hot) water using mild cleansers with a natural pH.
Another effective cream for atopic dermatitis, which quickly relieves irritation and inflammation, is Elidel. It should be used at the first symptoms of an exacerbation. This is a non-hormonal drug, so it is not addictive and is suitable for long-term therapy.
ethnoscience
Treatment of atopic dermatitis with traditional medicine methods should be treated with caution so as not to provoke new allergic reactions. But there are fans of such methods who claim that the following plants help reduce irritation and soothe the skin:
- raw potatoes (in the form of compresses);
- chamomile;
- fireweed;
- peppermint;
- violet;
- oats, etc.
Traditional medicine methods can only be used with the permission of a doctor and in addition to the main treatment.
Treatment of complications
Scratching and frequent trauma to the skin can lead to various types of infections. Depending on the genesis of infection, the following is used for treatment:
- antibiotics (Sumamed, Amoxiclav, Doxycycline, etc.);
- antifungal agents (Pimafucin, Ketoconazole, Fluconazole, Terbinafine, etc.).
Also, often with atopic dermatitis, herpes infection worsens. Which requires treatment with antiherpetic drugs - Acyclovir, Valtrex, Famvir, etc.
Atopic dermatitis is a common pathology that plagues not only children, but also adults. The frequency of exacerbations depends on proper nutrition and lifestyle. Skin care is also important. It is better to entrust the choice of medicines and cosmetics to a competent doctor. This is the surest way to achieve long-term remission and beautiful, well-groomed skin.
Video about dermatitis
If skin rashes appear, the development of a serious disease - atopic dermatitis - should be excluded. The process of forming skin atopy is somewhat more complicated than a common allergic reaction, therefore the treatment of the disease should be taken more seriously in order to avoid unpleasant cosmetic defects and serious complications.
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Atopic dermatitis - what is this disease?
What it is? Atopic dermatitis is a long-term disease belonging to the group allergic dermatitis. This pathology is characterized by:
- Hereditary predisposition - the risk of developing atopy reaches 80% in children whose parents suffer from atopic dermatitis or other allergic pathologies;
- The appearance of the first signs in early childhood (in 75% of cases);
- Recurrent course with exacerbations in winter;
- Specific clinical picture at different age periods;
- Changes in immunological blood parameters.
Atopic dermatitis is more pronounced in children and is almost always associated with repeated sensitization (contact with an allergen). There are frequent cases of clinical recovery.
With age, the symptoms of the disease change somewhat, but can cause serious psychological discomfort to a person.
Causes and stages of development of atopic dermatitis
atopic dermatitis - photo
one of the manifestations of the disease in children
Although atopic dermatitis is initially associated with sensitization of the body to food and chemical allergens and microorganisms (fungus, dust mites), subsequent exacerbations may not be associated with allergenic contact. In addition, incompetence of the digestive tract plays an important role in the development of atopy: the disease often occurs against the background of intestinal dysbiosis, biliary dyskinesia and other gastrointestinal pathologies.
Causes of atopic dermatitis (its exacerbations) in adults:
- Stress and depression,
- Bad habits (smoking, alcohol),
- Poisoning by various toxins from the environment,
- Hormonal imbalances (including pregnancy in women),
- Poor nutrition
- Severe infections and immune disorders.
Atopic dermatitis is usually divided into several age stages. The reason for this is the completely different symptomatic picture of atopy in patients of different ages.
- Stage 1 (infantile atopy) - at the age of 2 months - 2 years, exudation (wetting) and a pronounced inflammatory reaction come to the fore.
- Stage 2 (atopic dermatitis in children 2-10 years old) - before the child begins puberty, atopy is expressed in increasing dry skin and the periodic appearance of a papular rash.
- Stage 3 (atopy in adults) - exacerbations depend less and less on contact with allergens, morphological changes occur in the skin (lichenification).
Important! — Many experts identify atopic dermatitis with diffuse neurodermatitis. Although clinical manifestations neurodermatitis and atopic dermatitis in adolescence and older are almost identical, the process of formation of the disease itself is somewhat different.
Therapeutic tactics always take into account the nature of skin manifestations and laboratory data on the composition of the blood.
Symptoms and signs of atopic dermatitis
The symptoms of atopic dermatitis differ radically depending on the patient’s age and determine the main therapeutic measures.
Infantile neurodermatitis
A sick baby looks like this: redness of the cheeks and forehead (diathesis), diaper rash in the folds of the skin. against the background of swelling and severe hyperemia, foci of maceration (wetting) form. Also characteristic is the presence of milky scabs on the scalp of the baby.
Severe itching provokes anxiety in the child, scratching and suppuration of cracks, intensifies after water procedures. The baby is capricious and does not sleep well. Oral candidiasis (thrush) is often diagnosed, which makes the child even more nervous, even to the point of refusing to eat.
Childhood atopy
Wet elements stop appearing with age. The skin gradually becomes more and more dry and flaky. Itchy papules (small blisters) and cracks appear behind the ears, on the neck, behind the knee, in the ankle area and on the delicate skin of the forearm.
Atopic dermatitis on the face gives a characteristic picture: a gray face, a thickened fold on the lower eyelid and dark circles under the eyes, depigmented (lightened) lesions on the cheeks, neck, and chest.
Often, against the background of atopy, a child develops other severe allergic conditions (inclusive).
Adult atopic dermatitis
In adult patients, relapses occur less frequently, clinical picture less pronounced. Often the patient notes the constant presence of pathological lesions on the skin. At the same time, the signs of lichenification are maximally manifested: focal thickening of the skin, a clearly defined skin pattern, massive peeling.
Pathological foci are localized on the arms, face and neck (thickened folds form on its anterior surface). Pronounced folding (hyperlinearity) is clearly visible on the palms (less often, soles).
Itching in chronic atopic dermatitis occurs even with the slightest changes in the skin, and intensifies with sweating. Decreased skin immunity leads to frequent fungal, staphylococcal and herpetic infections skin.
A patient's blood test at any stage of the disease reveals eosinophilia, a decrease in the number of T-lymphocytes, and a reactive increase in B-lymphocytes and IgE antibodies. Moreover, changes in immunogram parameters are in no way related to the severity of clinical manifestations of atopic dermatitis.
Treatment of atopic dermatitis - drugs and diet
Atopic dermatitis is treated by a dermatoallergist, but patients often need consultation with a gastroenterologist and endocrinologist.
The treatment regimen includes identifying and, if possible, eliminating the allergen that provoked the pathological reaction (especially important when diagnosing atopy in children) and a complex effect on the symptoms of the disease and pathological changes in the body.
The medication course includes:
- Antihistamines - Tavegil, Allertek, Claritin, Zodak perfectly relieve itching. For the treatment of atopic dermatitis in adults, the latest generation antihistamines (Erius, Lordes, Aleron) are more suitable - they do not cause drowsiness.
- Immunocorrectors - thymus preparations (Timalin, Taktivin), B-correctors (Methyluracil, Histaglobulin), membrane stabilizers (Intal, Ketotifen, Erespal).
- Calming - infusions of valerian and motherwort, antipsychotics (Azaleptin), antidepressants (Amitriptyline) and tranquilizers (Nozepam) in small doses and only for adults.
- Restoring the function of the gastrointestinal tract - probiotics (the best is Bifiform), choleretic (Allohol), fermentative agents (Mezim forte, Pancreatin).
- Vitamin-mineral complexes - it is necessary to compensate for the lack of zinc in the body, vit. C and group B should be taken with caution (they may aggravate the allergic reaction).
Local treatment:
- Antiseptics (furacilin, boric acid) - when the elements become wet, alcohol-containing solutions are prohibited (they dry out the skin);
- Anti-inflammatory and antifungal ointments (Akriderm, Methyluracil, Lorinden S) - in case of emerging foci of suppuration or the addition of a fungal infection;
- Emollients (A-Derma, Emolium, Lipikar) are mandatory for atopic dermatitis (emollients that effectively moisturize the skin should be used even during remission);
- Corticosteroid ointments (Triderm, Hydrocortisone, Prednisolone) - with severe symptoms and no effect from other drugs (long-term use of hormonal creams for atopic dermatitis is not recommended);
- Physiotherapy - PUVA therapy - the use of the drug Psolaren and subsequent irradiation with ultraviolet rays gives an excellent therapeutic effect even with severe atopic dermatitis.
Dietary nutrition for atopic dermatitis
Dietary nutrition is mandatory to achieve a speedy recovery. The diet for atopic dermatitis excludes from the menu all conditionally allergenic foods (eggs, fatty fish, nuts, smoked meats and pickles, chocolate, citrus fruits), semi-finished products and finished products containing chemical dyes and preservatives.
You should avoid eating oatmeal and legumes. These products contain nickel, which aggravates atopic dermatitis.
Green apples, lean meat, cereals (especially buckwheat and barley), and cabbage have a beneficial effect on the body in case of skin atopy. Following a diet, especially in childhood, will prevent the development of exacerbations of atopic dermatitis.
Treatment prognosis
Having first appeared in childhood, atopic dermatitis can gradually disappear. Clinical recovery is stated in the absence of relapses for 3 years in mild cases of the disease, 7 years in severe forms of atopy.
However, in 40% of patients, the disease periodically manifests itself even at an older age. At the same time, complications are recorded in 17% of patients: cracked lips, pyoderma, recurrent herpes.
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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 is 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 of the digestive system can act both as triggering factors and as the 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 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.
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.
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.
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 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.
- weather;
- detergents;
- cloth;
- emotions, stress.
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, 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 of 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.
The forms of atopic dermatitis are:
- erythematous form;
- lichenoid form;
- eczematous 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 worker to determine 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;
- Availability additional symptoms allergies ( 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?
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 trace remains in the pressure zone white );
- damage to the skin of the breast nipples.
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 the patient a series of questions that 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 appearance of skin changes;
- environmental factors patient's living environment ( proximity to 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?
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 the upper lip to the nose;
- enhanced skin pattern and protrusion of capillaries on the inner surface of the palms.
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 remission of atopic dermatitis in general analysis blood there is 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 comes down to identifying antibodies that were produced by the body for some reason. 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 ( for example, to 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 diagnostic method 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 for late development of atopic dermatitis in adults for differential diagnosis it with 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 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 tests are a modern diagnostic method. With this type of study, the epithelium ( upper layer 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).
Causes false results skin testing for allergen
One of the most common causes of a false positive result is increased sensitivity skin to mechanical influence. 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 accompanying 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 wide range medicines.Groups of drugs used for atopic dermatitis:
- glucocorticosteroids;
- antihistamines;
- immunosuppressants of the macrolide class;
- moisturizers of various groups.
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. At chronic course ointments are prescribed for atopic dermatitis. 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 acute period diseases 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, they are used as herbal remedies, and tranquilizers. 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. | Daily dose 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 | Removes 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, has 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 | It 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.
Except 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 is 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 therapeutic effect 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 the external environment will reduce the level of negative emotions;
- sudden change in air temperature– the microclimate in stationary conditions is characterized by its stability;
- physical exercise– the absence of contact of the affected areas of the skin with sweat promotes tissue regeneration.
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 - the main factor in 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 found in most cereals), since the tolerance of this substance during allergies is significantly reduced;
- conducting special observations about reactions to food taken ( food diary).
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.
The types of meat and meat products that are recommended for atopic dermatitis are:
- beef;
- rabbit;
- turkey;
- low fat pork.
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.
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.
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.
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.
- buckwheat;
- oatmeal;
- pearl barley;
- bran bread;
- unsweetened dry goods, crackers, dry cookies;
- crackers.
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).
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.
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.
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.
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. Fruits and vegetables with a high fiber content promote the passage of food through the intestinal tract. 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).
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 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.
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 for several hours in cold water- this will allow you to remove from the vegetable potato starch, 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.
- 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;
- performance 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 implies 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.
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 bedding to protect against dust mite, are:
- allergoff spray;
- easy air;
- Dr. al;
- ADS spray.
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.
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 once a month by special means. 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.
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.
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.
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 such natural vegetable oils like olive, almond, 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 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.
Preventive 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.The main provisions of the preventive diet for atopic dermatitis include:
- 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, nonspecific factors are of great importance, which 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.
Negative emotions and worries 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).
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. Maintain constant favorable climate indoors can be done using air conditioners and humidifiers.
Diseases associated with atopic dermatitis
When preventing atopic dermatitis, special attention should be paid concomitant diseases internal organs and systems of the body. 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;
- diseases of the endocrine system;
- poor functionality of the digestive system ( various forms of hepatitis, gastritis, cholecystitis);
- weak immunity;
- chronic tonsillitis ( tonsillitis) and other ENT diseases.
