Atopic dermatitis in adults. Causes, symptoms, signs, diagnosis and treatment of pathology

Leather- this is the most vulnerable organ that performs an important protective function and is constantly exposed to adverse effects from the environment. It is for this reason that the number of skin diseases is so high. One of the most unpleasant is atopic dermatitis - a chronic inflammatory disease of an allergic nature. Treatment of the disease is a long and complex process, and the manifestations of atopic dermatitis cause patients a lot of suffering.

What is atopic dermatitis?

The disease is also called atopic eczema, exudative-catarrhal diathesis, neurodermatitis. The main factor causing the appearance of atopic dermatitis is exposure to allergens.

The disease affects 15-30% of children and 2-10% of adults, and the incidence is increasing worldwide. And over the past 16 years, the number of cases has approximately doubled. The reason for this is the following factors:

• Poor environmental situation,
• Increased amount of stress
• Violation of the principles of proper and healthy nutrition,
• Increased exposure to allergens, primarily of chemical origin.

Interesting fact:

2/3 of the cases are female. The disease most often affects residents of large cities.

In some patients, the first symptoms of atopic dermatitis are observed in childhood, while in others the disease is latent and first appears only in childhood. mature age.

In children, the disease manifests itself mainly in the first year of life. This feature is influenced by the characteristics of children's skin that distinguish it from the skin of adults:

• Insufficient development of sweat glands,
• Fragility of the stratum corneum of the epidermis,
• Increased content of lipids in the skin.

Causes

– hereditary disease. The word "atopy" is translated from Latin as "strangeness." And in modern medicine This is what is commonly called a genetic predisposition to allergies.

An allergy is a disruption of the body’s normal reaction to foreign substances (immunity). People prone to the disease often experience various abnormalities in the functioning of the immune system. First of all, this consists in increasing the synthesis of immunoglobulin proteins IgE, which are important for the immune system, compared to the norm (in 90% of cases). Increased immune reactivity leads to the formation of inflammatory mediators - histamines.

There are other factors that contribute to the occurrence of atopic dermatitis. Firstly, these are disturbances in the functioning of the autonomic nervous system. They are expressed in an increased tendency to spasm of small vessels, including those on the skin. Patients also often experience:

• disruption of the synthesis of certain adrenal hormones responsible for the body’s anti-inflammatory reactions;
• decreased functionality of the skin sebaceous glands;
• impairment of the skin's ability to retain water;
• decreased lipid synthesis.

All this leads to a general weakening of the barrier functions of the skin and to the fact that irritating agents penetrate the skin into all its layers, causing inflammation.

Dermatitis is often accompanied by chronic gastrointestinal diseases that reduce intestinal barrier function:

• Dysbacteriosis,
• Gastroduodenitis,
• Pancreatitis,
• Biliary dyskinesia.

However, the leading role still plays hereditary factor. The disease develops in 4 out of 5 cases when both parents suffer from it. If only one parent is sick, then the probability of illness in the child also remains quite high - 55%. The presence of allergic respiratory diseases in the other parent increases this figure. The disease is more often transmitted through the maternal side than through the paternal side. Moreover, the disease can also occur in children born from healthy parents who did not have atopic dermatitis even in childhood.

Racial factors also influence the development of the disease - it is more common in children with fair skin.

In addition to heredity, other factors contribute to the development of atopic dermatitis in infancy:

• Lack of breastfeeding or too early transfer to artificial feeding,
• Toxicosis of pregnancy in the mother,
• Improper nutrition of the mother during pregnancy or lactation.

Less significant, but also contributing factors to the disease in children:

• high air temperature leading to increased sweating;
• weak immunity;
• presence of stress;
• poor skin hygiene or, conversely, too frequent washing.

In early childhood, food allergens most often act as irritants. These can be substances that come from food or from breast milk (for nursing women).

In adult patients, the list of allergens can be much wider. In addition to food allergens, irritants can be:

• House dust,
• Medicines,
• Household chemicals,
• Cosmetics,
• plant pollen,
• Bacteria and fungi,
• Pet hair.

Factors contributing to the manifestation of atopic dermatitis in adults:

• Poor environmental conditions;
• Endocrine diseases;
• Metabolic diseases;
• Acute infectious diseases;
• Complicated pregnancy;
• Sleep disorders, stress, psychological stress.

Often the disease is aggravated by self-medication, including with the help of herbal medicines, which may also contain allergens.

Stages and types of disease

Depending on age, the following stages of the disease are distinguished:

• Infant,
• Children's,
• Adult.

Disease stages, age and prevalence

Depending on the clinical course The following types of atopic dermatitis are distinguished:

• Elementary,
• Exacerbation,
• chronic,
• remission,
• clinical recovery.

Clinical recovery is considered a condition in which symptoms of atopic dermatitis are not observed for more than 3 years.

The initial stage develops mainly in childhood. In 60% of cases, the manifestation of symptoms is observed before the age of 6 months, 75% of cases - up to a year, in 80-90% of cases - up to 7 years.

Sometimes dermatitis is combined with other allergic diseases:

• With bronchial asthma - in 34% of cases,
• With allergic rhinitis – in 25% of cases,
• With hay fever - in 8% of cases.

The combination of hay fever, bronchial asthma and atopic dermatitis is called the atopic triad. The disease can be combined with angioedema and food allergies.

According to the criterion of the area of ​​skin damage, dermatitis is distinguished:

• limited (up to 10%),
• common (10-50%),
• diffuse (more than 50%).

According to the severity criterion, dermatitis is divided into mild, moderate and severe.

There is also a scale that evaluates the intensity of the six main manifestations of atopic dermatitis - erythema, swelling, crusting, scratching, peeling, dry skin. Each feature is assigned a score from 0 to 3, depending on its intensity:

• 0 – absence,
• 1 – weak,
• 2 – moderate,
• 3 – strong.

Symptoms

Main symptom of the disease– itching of the skin, which is characteristic of any stage of the disease (infancy, childhood and adulthood). Itching is observed in both acute and chronic forms of the disease, it can occur even in the absence of other symptoms, and intensifies in the evening and at night. Itching is difficult to get rid of even with the help of medications, and can lead to insomnia and stress.

In terms of symptoms, the infant, childhood and adult phases of atopic dermatitis have some differences. In infancy, the exudative form of dermatitis predominates. Erythemas are bright red in color. Vesicles appear against the background of erythema. The rashes are concentrated on the skin of the face, scalp, limbs, and buttocks. Weeping formations on the skin are common. The infant stage ends with recovery by 2 years (in 50% of patients) or goes into childhood.

In childhood, exudation decreases, formations become less bright in color. There is a seasonality of exacerbations of dermatitis.

In adult patients, erythema has a pale pink tint. The rashes are papular in nature. Localization of skin formations is mainly on the bends of joints, on the neck and face. The skin becomes dry and flaky.

With exacerbation of dermatitis, redness of the skin (erythema), small blisters with serous contents (vesicles), erosions, crusts, and peeling of the skin appear. During remission, the manifestations of the disease disappear partially or completely. With clinical recovery, there is an absence of symptoms for more than 3 years.

The chronic phase of dermatitis is characterized by the following signs: thickening of the skin, pronounced skin patterns, cracks on the soles and palms, increased pigmentation of the skin of the eyelids. Symptoms may also occur:

• Morgana (deep wrinkles on the lower eyelids),
• “fur cap” (thinning hair on the back of the head),
• polished nails (due to constant scratching of the skin),
• “winter foot” (cracks, redness and peeling of the skin of the soles).

Also, patients with atopic dermatitis are often characterized by disorders of the central and autonomic nervous systems - depressive states, increased reactivity of the autonomic nervous system. Gastrointestinal disorders may also occur:

• • Malabsorption syndrome,
  • Enzyme deficiency.

Diagnostics

Diagnosis begins with an examination of the patient by a doctor. He needs to separate atopic dermatitis from other allergic dermatitis, as well as from non-allergic dermatitis.

For diagnostic purposes, doctors have identified a set of main and auxiliary manifestations of atopic dermatitis.

Main features:

• • • • Specific affected areas are the flexor surfaces of the joints, face, neck, fingers, shoulder blades, shoulders;
      • Chronic course with relapses;
      • Presence of patients in the family history;

Auxiliary signs:

• • • • Early onset of the disease (up to 2 years);
      • Macular and papular rashes covered with scales;
      • Increased levels of IgE antibodies in the blood;
      • Frequent rhinitis and conjunctivitis;
      • Frequent infectious skin lesions;
      • Distinct pattern of the skin of the soles and palms;
      • Whitish spots on the face and shoulders;
      • Excessive dry skin;
      • Increased sweating;
      • Peeling and itching after a bath (in children under 2 years of age).
      • Dark circles around the eyes

To make a diagnosis of atopic dermatitis, it is necessary that the patient has at least 3 main signs and at least 3 auxiliary signs.

A blood test reveals eosinophilia, a decrease in the number of T-lymphocytes, and an increase in the number of B-lymphocytes.

Also, during diagnosis, skin prick tests for allergens can be performed, and urine and stool tests can be taken.

Complications

Complications of atopic dermatitis most often occur due to scratching of the skin. This leads to disruption of the integrity of the skin and weakening of its barrier functions.

Complications of atopic dermatitis:

• • • • Lymphadenitis (cervical, inguinal and axillary),
      • Purulent folliculitis and furunculosis,
      • Multiple papillomas,
      • Fungal and bacterial skin lesions,
      • Heilite,
      • Stomatitis and periodontal disease,
      • Conjunctivitis,
      • Depression.

How to treat atopic dermatitis?

There is no one way or cure to cure dermatitis. This disease requires complex treatment.

The disease is treated by a dermatologist or allergist. You may need to consult an endocrinologist or gastroenterologist.

Treatment has the following goals:

• • • • Achieving remission
      • Reducing the severity of symptoms and inflammatory processes,
      • Prevention of severe forms of dermatitis and respiratory manifestations of allergies,
      • Improving the quality of life of patients and restoring their ability to work.

Measures to treat the disease:

• • • • Preventing the entry of identified allergens into the body,
      • Increased skin barrier function,
      • Anti-inflammatory treatment,
      • Treatment of concomitant diseases (asthma, rhinitis, conjunctivitis, bacterial, fungal and viral infections),
      • Reducing the body's sensitivity to allergens (desensitization),
      • Detoxification of the body.

Diet therapy

Dermatitis often goes side by side with food allergies. Therefore, during the period of exacerbation, the patient is prescribed a hypoallergenic diet. However, in the chronic phase of the disease, the diet must also be followed, although not in such a strict form.

It is necessary to exclude from the patient’s diet both foods containing potential allergens - fish and seafood, soy, nuts, eggs, and foods containing an increased amount of histamine - cocoa, tomatoes. Products containing dyes and preservatives, and semi-finished products are removed from the diet. The amount of salt is limited (no more than 3 g per day). Fried foods are contraindicated. The diet should contain an increased amount of fatty acids, primarily those contained in vegetable oils. Lean meat, vegetables, and cereals are also shown.

Drug treatment

The list of drugs used for treatment depends on the severity of the disease. The most commonly used are first and second generation antihistamines, as well as anti-inflammatory drugs. Many first-generation antihistamines, such as Diphenhydramine, Suprastin, Tavegil, also have a sedative effect, which allows them to be prescribed to patients suffering from sleep disorders.

However, the sedative effect means they are contraindicated in people who require alertness. In addition, first-generation drugs can be addictive during long-term therapy. In this case, second-generation drugs (Cetirizine, Ebastine, Fexofenadine, Astemizole, Loratadine) are more effective.

Concomitant infections are treated with antibacterial agents, skin herpes with antiviral drugs based on acyclovir.

Anti-inflammatory treatment may include corticosteroid medications, both topical and oral. Glucocorticosteroids are prescribed orally only during exacerbation of the disease. In the form of ointments, GCS are used both in the chronic course of the disease and during exacerbation. Combination drugs are also used (GCS + antibiotic + antifungal agent).

Despite the high effectiveness of corticosteroids, it should be remembered that they have many side effects. In particular, they can have a negative impact on internal organs with prolonged use, they cause drug dependence. The most commonly used ointments contain glucocorticosteroid drugs such as Hydrocortisone, Dexomethasone, Prednisolone.

Oil-based emollients and moisturizers (emollients) are prescribed externally. If there is exudation, lotions are used (tincture of oak bark, solutions of rivanol and tannin).

Also applicable:

• • • • Calceneurin inhibitors;
      • Membrane stabilizing drugs;
      • Vitamins (primarily B6 and B15) and polyunsaturated fatty acids;
      • Drugs for the treatment of gastrointestinal diseases (enzyme preparations, drugs against dysbacteriosis, enteric agents);
      • Immunomodulators (only indicated for severe forms and ineffectiveness of other treatment methods);
      • Antibiotics and antiseptics (to combat secondary bacterial infection);
      • Antifungal drugs (for the treatment of fungal infections);
      • Tranquilizers, antidepressants, antipsychotics and sedatives(to reduce depression and reactivity of the autonomic nervous system);
      • Peripheral alpha-blockers;
      • M-anticholinergics.

Immunomodulators include drugs that affect the functions of the thymus, B-correctors.

It should be remembered that for atopic dermatitis, alcohol and alcohol solutions, as they dry out the skin excessively.

Dependence of the choice of treatment methods on the severity of symptoms

Non-drug methods

Non-drug methods include maintaining an optimal indoor microclimate, proper selection of clothing, and nail care. Maintenance required temperature and indoor humidity reduces skin irritation and sweating. The optimal temperature for patients with atopic dermatitis is +20-22°C during the day and +18-20°C at night, the optimal humidity is 50-60%. People suffering from dermatitis should wear clothes only made from natural materials (cotton, linen, flannel, bamboo).

It is necessary to stop using household chemicals that cause irritation: varnishes, paints, floor and carpet cleaners, washing powder, etc.

An important element of therapy is skin care, including the use of moisturizing and softening cosmetics that:

• • • • restore the integrity of the epidermis,
      • strengthen skin barrier functions,
      • protect the skin from exposure to irritants.

Moisturizers must be applied to the skin regularly, at least twice a day. You can do this more often, every 3 hours, the main thing is to make sure that the skin is not dry. During an exacerbation, a larger amount of the drug is required. First of all, moisturizers should be applied to the skin of the hands and face, as they are exposed to more intense irritants.

• • • • reduce the amount of stress;
      • carry out daily wet cleaning of the premises;
      • remove from the room items that cause dust accumulation, such as carpets;
      • do not keep pets at home, especially those with long hair;
      • limit intense physical activity;
      • use hypoallergenic cosmetics;
      • Avoid exposing the skin to cold, direct sunlight, tobacco smoke, burns.

To wash the body, it is necessary to use detergents with a low pH (especially during an exacerbation period). It is not recommended to wash the main areas of skin damage during the acute phase of the disease with water. To do this, it is better to use disinfectant lotions or swabs with vegetable oils. During the period of remission, the washing technique should also be gentle. It is advisable to do this process without a washcloth.

Physiotherapy (irradiation with UV rays) is also used as an aid. In severe cases, blood plasmaphoresis can be used.

Forecast

If the treatment is chosen correctly, the prognosis of the disease is favorable. In 65% of children, the signs of atopic dermatitis completely disappear at primary school age (by 7 years), in 75% - in adolescence (at 14-17 years). However, others may experience relapses of the disease in adulthood. Exacerbations of the disease usually occur in the cold season, while remission is observed in the summer. In addition, many children who get rid of atopic dermatitis subsequently develop allergic rhinitis.

Prevention

Prevention of atopic dermatitis has two types - primary and prevention of exacerbations. Since the disease first appears in infancy, primary prevention should begin during the period of intrauterine development of the baby. It should be remembered that factors such as taking certain medications and toxicosis of pregnancy play a role in the development of the disease. Also, in terms of prevention, the first year of a child’s life is important. A nursing mother must follow a diet to avoid exposure to allergens on the baby’s body, and the child should be switched to artificial feeding as late as possible.

Secondary prevention is measures aimed at preventing relapses of the disease. Proper skin care, wearing clothes made from natural fabrics, using hypoallergenic detergents, and keeping the room clean are important here.

People suffering from atopic dermatitis should avoid work involving chemicals, dust, changes in temperature and humidity, and contact with animals.

Comprehensive treatment includes a number of mandatory measures - physiotherapy, diets, medication, and prevention.

Considering the pathogenesis of the disease, treatment methods should be aimed at achieving long-term remission, as well as skin restoration.

Causes

I distinguish external and internal reasons development of dermatitis.

Internal factors:

1. genetic predisposition. Atopic dermatitis occurs more often in those whose relatives or parents have a predisposition to allergies. But this does not mean that dermatitis will definitely be inherited;
2. metabolic disorders in the skin. Any violation in the protective function of the skin leads to it becoming more susceptible;
3. skin reaction to external irritants. In some people, the immune system reacts instantly to many substances;

External factors:

1. stress. Overworking the body leads to disruption of the immune system;
2. environmental exposure to the skin contributes to the occurrence of atopic dermatitis;
3. excessive physical activity;
4. food products. Improper nutrition of pregnant mothers will lead to dermatitis not only in them, but also in the child;
5. environment. Doctors say that excessive toxins in the air can trigger the disease;

Development mechanism

The mechanism of development comes down to disruption of the immune system.

The entry of allergy pathogens into the body leads to the onset of an inflammatory process of an allergic nature.

Antibodies begin to be produced in the blood, which gradually accumulate in the skin. The protective function of the skin is impaired. That is why the further inflammatory process concerns the skin.

Main symptoms of manifestation

One of the main manifestations is a feeling of severe itching.

It can be different - barely noticeable, intense, capable of causing depression and sleep disturbances.

The skin peels off and lichenification appears. If treatment measures are not taken in time, the skin will begin to harden, dryness and ulcers will appear.

It is possible that secondary infections will occur, causing swelling and purulent discharge.

Methods for treating atopic dermatitis in adults

Atopic dermatitis is an insidious skin disease. In the fight against nm, people will use both traditional and non-traditional methods of treatment. Traditional treatment methods for adults consist of various complex measures.

Some of them can be done while at home:

1. diet. It is prescribed by a doctor after an examination. Patients need it in acute form of the disease;
2. medicinal- use of drugs to relieve inflammatory processes;
3. physiotherapy. Doctors say this is one of the most safe ways treatment. The immune system is restored, inflammation on the skin recedes;

Non-traditional methods include treatment with herbal tinctures.

Exacerbation of the disease is always associated with exposure to allergens, which is why there are recommendations that are important to follow:

• try to completely limit contact with the irritant;
• do not keep pets in the premises where the patient lives;
• make sure that the skin is not dry;
• use hypoallergenic cosmetics;

A dermatologist will probably prescribe ointments and medications. Be sure to take them as recommended. If you have the slightest suspicion of dermatitis, go to the doctor.

Medicines

Treatment of atopic dermatitis begins only after examination by a specialist. He will prescribe a number of medications, taking into account age, individual tolerance, and the nature of the disease.

Self-medication is dangerous and can cause complications.

Antihistamines are prescribed for therapy:

• Zodak;
• Diazolin;
• Nalcom.

Desensitizing agents will help reduce itching. The drugs will reduce the level of sensitivity to allergens - calcium gluconate, sodium thiosulfate.

Sedative medications are prescribed that can normalize the functioning of the nervous system - motherwort, valerian. For more severe disorders - Diazepam.

In most cases, atopic dermatitis is accompanied by inflammatory processes, as well as diseases of the digestive system.

In order to restore normal microflora, you need to take medications such as:

1. enzymes - festal;
2. sorbents - enterosgel;
3. probiotics - duphalac;

To improve metabolism and normalize the immune system, you need to take vitamins regularly.

Exacerbated forms of the disease, as described above, require physical therapy.

Products for external use

Externally used products are aimed at the following:

• reduce or completely eliminate itching;
• restore skin;
• soften the skin;
• restore protective properties;

External preparations - external glucocorticoids, topical immunosuppressants.

Almost all medications of this type are produced in the form of creams, lotions, and ointments.

Fenistal gel is a multifunctional product. Cares for damaged skin, moisturizes it.

A few hours after application the first effect will be felt. You need to use it at least 4 times a day.

Zinc ointment is a caring and anti-inflammatory agent. Safe for children and pregnant women. Treatment with ointment in adults can be lengthy.

She fights dermatitis for a month, until the symptoms completely disappear. This is the only ointment that can be used independently without being prescribed by a doctor.

Folk recipes

As practice shows, treatment of atopic dermatitis with folk remedies in adults is quite effective.

After all, the disease is not life-threatening and is not incurable. It’s unlikely that anyone will like inflammation on the skin, which not only itches, but also interferes with work.

In order to get rid of this unpleasant illness, folk recipes were “invented”.

It is worth noting that they can treat not only adults, but also children.

1. lotion. To prepare it, you need to take a glass of boiled water and a tbsp. a spoonful of medicinal veronica. Pour boiling water over the herb and leave for 3 hours. Then strain and treat the skin in affected areas 5-6 times a day. The lotion is safe and has no side effects;
2. compress. You can prepare this folk remedy at home. The only thing you need for this is fresh raw potatoes. Wash it, peel it, and grate it. Squeeze the resulting mass from the water and wrap it in gauze. Apply the compress to sore areas at night;
3. antipruritic ointment. In addition to redness on the skin, dermatitis also causes another discomfort - constant itching. In order to remove it, you can prepare an ointment. For this you will need: 1 tbsp. spoon of butter, glycerin, 2 tbsp. pre-boiled hay dust, 4 tbsp. water, chamomile, fireweed. Mix fireweed and chamomile in a container, bring to a boil and simmer over low heat for 5 minutes. Add butter and dust, cook until the mass takes on a thick consistency. The ointment should be stored in the refrigerator. Lubricate the skin 4 times a day;

Review of drugs

A number of medications are used to treat atopic dermatitis.

They are prescribed by a doctor; unauthorized use is prohibited, in order to avoid complications:

• tavegil- Available in the form of tablets and syrup. Relieves itching, eliminates swelling. Taken as prescribed by a doctor;
• fenistil- drops for oral administration. If prescribed by a doctor, it can be given to children starting from one month. Side effects include drowsiness;
• fenisti - gel. Used for severe skin itching. There is no need to apply a thick layer to the skin. It is strictly forbidden to give to children on their own;
• lomilal- comes in the form of a suspension and tablets. Has an anti-inflammatory effect. You can take the pills from the age of 12.

Rules for therapy at home

Atopic dermatitis can develop at any age, regardless of gender. Despite the fact that this is not an infectious disease, there is still discomfort from it. While at home, you can try to relieve the itching and initial signs diseases.

There are certain means for this:

1. Aloe Vera Gel. You can buy it at a pharmacy without a doctor's prescription. The cold effect of the drug relieves itching. If such a plant grows at home, you can cut the leaves and get fresh gel.
2. Oil therapy. This the best option for the treatment of atopic dermatitis at home. To do this, you can take castor oil, coconut oil, almond oil. It has a calming and healing effect.
3. Salt. It is good for relieving itching and inflammation. Take a cup of salt, dissolve it in a liter of warm water. Wet the affected areas for 15 minutes.

Principles of therapy in children

To carry out therapy for atopic dermatitis in children, a number of measures need to be taken. The main attention should be paid to restoring the outer layers of the skin. To do this, you need to use moisturizing cosmetics 3-4 times a day.

If the disease affects the baby, it is important to continue breastfeeding for as long as possible. At the same time, the mother’s diet should be correct, without any allergic foods.

You need to bathe your child every day, without using soap. Buy medicated shampoos. After swimming, do not rub your skin; pat dry with a towel and let it dry on its own.

Vaccination of a child with atopic dermatitis is a problem today. After all, the mere fact of having a disease is not a reason to refuse vaccinations.

But the nuance is that they can only be used during remission.

It is mandatory to take antihistamines, but only those prescribed by the attending physician.

Treatment of atopic dermatitis in children is not difficult. If mothers go to the hospital in a timely manner, they can get rid of the disease as quickly as possible.

Preventive methods

To treat the disease, as well as prevent its recurrence, several rules must be followed:

1. nutrition. Eliminate from the diet foods that can provoke allergies - chocolate, nuts, citrus, eggs;
2. skin care. It is important not just to use creams and moisturize the skin. It is also necessary to take water procedures correctly. Add decoctions of medicinal herbs to them. Do not wipe the skin dry, but let it dry on its own;
3. do not keep pets at home;
4. use hypoallergenic products.

Unfortunately, there is no single cure to combat the disease. But even these simple rules will delay the onset of remission.

When to see a doctor

You should consult a doctor in the following cases:

• the symptoms bother you so much that you can’t sleep peacefully;
• soreness of the skin;
• ulcers appeared on the skin, yellow in color;
• all attempts at skin care do not bring results;

If you observe these symptoms, even in significant quantities, go to the doctor. This will help specialists quickly identify the source of the allergy and prescribe medications.

And you, in turn, will quickly return to your normal lifestyle, without unnecessary discomfort.

Atopic dermatitis in infants is a chronic immune inflammation of the child’s skin, characterized by a certain form of rashes and their staged appearance.

Childhood and infant atopic dermatitis significantly reduces the quality of life of the entire family due to the need for strict adherence to a special therapeutic diet and a hypoallergenic lifestyle.

Main risk factors and causes of atopic dermatitis

A risk factor for atopic disease is often a hereditary history of allergies and. Factors such as constitutional features, nutritional disorders, and insufficiently good care for the child are also unfavorable.

Understanding the pathogenesis of this allergic disease will help you understand what atopic dermatitis is and how to treat it.

Every year, scientists' knowledge about the immunopathological processes occurring in the body during atopic childhood is increasing.

During the course of the disease, the physiological skin barrier is disrupted, Th2 lymphocytes are activated, and immune defense is reduced.

Concept of the skin barrier

Dr. Komarovsky, in his articles popular among young parents, touches on the topic of the characteristics of children's skin.

Komarovsky highlights 3 main features that are important in breaking the skin barrier:

• underdevelopment of sweat glands;
• fragility of the stratum corneum of the children's epidermis;
• high lipid content in the skin of newborns.

All these factors lead to a decrease in the protection of the baby’s skin.

Hereditary predisposition

Atopic dermatitis in infants can occur due to a filaggrin mutation, in which changes occur in the filaggrin protein, which ensures the structural integrity of the skin.

Atopic dermatitis develops in children under one year of age due to a decrease in the local immunity of the skin to the penetration of external allergens: the biosystem of washing powder, the epithelium and hair of pets, fragrances and preservatives contained in cosmetic products.

Antigenic loads in the form of toxicosis in pregnant women, taking medications by a pregnant woman, occupational hazards, highly allergenic food - all this can provoke an exacerbation of an allergic disease in a newborn.

• food;
• professional;
• household

Prevention of allergies in infants can be achieved through natural, long-term, rational use of medications and treatment of diseases of the digestive system.

Classification of atopic dermatitis

Atopic eczema is divided according to age stages into three stages:

• infant (from 1 month to 2 years);
• children's (from 2 years to 13);
• teenage

In newborns, the rash looks like redness with blisters. The bubbles break easily, forming a wet surface. The baby is bothered by itching. Children scratch out rashes.

Bloody purulent crusts form in places. Rashes often appear on the face, thighs, and legs. Doctors call this form of rash exudative.

In some cases, there are no signs of weeping. The rash looks like spots with slight peeling. Affected more often hairy part heads and face.

At 2 years of age, sick children have different skin increased dryness, cracks appear. The rashes are localized in the knee and elbow pits, on the hands.

This form of the disease has the scientific name “erythematous-squamous form with lichenification.” In the lichenoid form, peeling is observed, mainly in the folds and elbow bends.

Facial skin lesions appear at older ages and are called “atopic face.” Pigmentation of the eyelids and peeling of the skin of the eyelids are observed.

Diagnosis of atopic dermatitis in children

There are criteria for atopic dermatitis, thanks to which the correct diagnosis can be made.

Main criteria:

• early onset of the disease in an infant;
• itching of the skin, often occurring at night;
• chronic continuous course with frequent serious exacerbations;
• exudative nature of the rash in newborns and lichenoid in older children;
• presence of close relatives suffering from allergic diseases;

Additional criteria:

• dry skin;
• positive skin tests during allergy testing;
• white dermographism;
• presence of conjunctivitis;
• pigmentation of the periorbital region;
• central protrusion of the cornea - keratoconus;
• eczematous lesions of the nipples;
• strengthening of the skin pattern on the palms.

Laboratory diagnostic measures for severe atopic dermatitis are prescribed by a doctor after examination.

Complications of atopic dermatitis in children

Frequent complications in children include various types of infections. The open wound surface becomes a gateway for Candida fungi.

Prevention of infectious complications consists of following the recommendations of an allergist regarding the specific use of emollients (moisturizers).

List of possible complications of atopic dermatitis:

• folliculitis;
• boils;
• impetigo;
• anular stomatitis;
• candidiasis of the oral mucosa;
• skin candidiasis;
• Kaposi's eczema herpetiformis;
• molluscum contagiosum;
• genital warts.

Traditional treatment of atopic dermatitis

Treatment of atopic dermatitis in children begins with the development of a special hypoallergenic diet.

An allergist prepares a special elimination diet for a mother with atopic dermatitis in her baby. This diet will help you maintain breastfeeding for as long as possible.

An approximate hypoallergenic elimination diet for children under one year of age with atopic dermatitis.

Menu:

• breakfast. Dairy-free porridge: rice, buckwheat, oatmeal, butter, tea, bread;
• lunch. Fruit puree from pears or apples;
• dinner. Vegetable soup with meatballs. Mashed potatoes. Tea. Bread;
• afternoon tea Berry jelly with cookies;
• dinner. Vegetable and cereal dish. Tea. Bread;
• second dinner. Formula or .

The menu for a child, and especially for a child with atopic dermatitis, should not contain spicy, fried, salty foods, seasonings, canned food, fermented cheeses, chocolate, or carbonated drinks. On the menu for children with allergic symptoms limit semolina, cottage cheese, sweets, yoghurts with preservatives, chicken, bananas, onions, garlic.

Mixtures based on it will also help in the treatment of atopic dermatitis in a child.

In case of hypersensitivity to cow's milk proteins, the World Organization of Allergists strongly does not recommend the use of products based on non-hydrolyzed goat's milk protein, since these peptides have a similar antigenic composition.

Vitamin therapy

Patients with atopic dermatitis are not prescribed multivitamin preparations, which are dangerous from the point of view of the development of allergic reactions. Therefore, it is preferable to use single preparations of vitamins - pyridoxine hydrochloride, calcium pathotenate, retinol.

Immunomodulators in the treatment of allergic dermatoses

Immunomodulators that affect the phagocytic component of immunity have proven themselves in the treatment of allergic dermatoses:

1. Polyoxidonium has a direct effect on monocytes, increases resistance cell membranes, is able to reduce the toxic effect of allergens. It is used intramuscularly once a day with an interval of 2 days. A course of up to 15 injections.
2. Lycopid. Strengthens the activity of phagocytes. Available in 1 mg tablets. May cause an increase in body temperature.
3. Zinc preparations. They stimulate the restoration of damaged cells, enhance the action of enzymes, and are used for infectious complications. Zincteral is used at a dose of 100 mg three times a day for up to three months.

Hormonal creams and ointments for atopic dermatitis in children

It is not possible to treat severe atopic dermatitis in children without the use of local anti-inflammatory glucocorticosteroid therapy.

For atopic eczema in children, both hormonal creams and various forms of ointments are used.

Below are basic recommendations for the use of hormonal ointments in children:

• in case of severe exacerbation, treatment begins with the use of strong hormonal agents - Celestoderma, Cutivate;
• to relieve symptoms of dermatitis on the torso and arms in children, the drugs Lokoid, Elokom, Advantan are used;
• It is not recommended to use Sinaflan, Fluorocort, Flucinar in pediatric practice due to serious side effects.

Calcineurin blockers

An alternative to hormonal ointments. Can be used on the face and natural folds. The drugs Pimecrolimus and Tacrolimus (Elidel, Protopic) are recommended to be used in a thin layer on the rash.

These drugs should not be used in immunodeficiency states.

The course of treatment is long.

Products with antifungal and antibacterial activity

For infectious uncontrolled complications, it is necessary to use creams containing antifungal and antibacterial components - Triderm, Pimafucort.

The previously used and successful zinc ointment has been replaced by a new, more effective analogue - activated zinc pyrithione, or Skin-cap. The drug can be used in a one-year-old child to treat rashes with infectious complications.

For severe weeping, an aerosol is used.

Dr. Komarovsky writes in his articles that there is no more formidable enemy for a child’s skin than dryness.

Komarovsky advises using moisturizers (emollients) to moisturize the skin and restore the skin barrier.

The Mustela program for children with atopic dermatitis offers a moisturizer in the form of a cream-emulsion.

The Lipikar program of the La Roche-Posay laboratory includes Lipikar balm, which can be applied after hormonal ointments to prevent dry skin.

Treatment of atopic dermatitis with folk remedies

How to cure atopic dermatitis permanently? This is a question that scientists and doctors around the world are asking themselves. The answer to this question has not yet been found. Therefore, many patients are increasingly resorting to homeopathy and traditional methods of traditional medicine.

Treatment with folk remedies sometimes brings good results, but it is better if this method of treatment is combined with traditional therapeutic measures.

When the skin gets wet during a severe exacerbation of allergic dermatosis, folk remedies in the form of a lotion with a decoction of string or oak bark help well. To prepare the decoction, you can purchase a series in filter bags at the pharmacy. Brew in 100 ml of boiled water. Use the resulting decoction to apply lotions to the rash areas three times during the day.

Spa treatment

Most Popular sanatoriums for children with manifestations of atopic dermatitis:

• sanatorium named after Semashko, Kislovodsk;
• sanatoriums “Rus”, “DiLuch” in Anapa with a dry maritime climate;
• Sol-Iletsk;
• sanatorium "Klyuchi" Perm region.

• limit your child’s contact with all types of allergens as much as possible;
• give preference to cotton clothes for your baby;
• avoid emotional stress;
• Trim your child’s nails short;
• the temperature in the living room should be as comfortable as possible;
• try to keep the humidity in the child’s room at 40%.

What follows Avoid for atopic dermatitis:

• use alcohol-based cosmetics;
• wash too often;
• use hard washcloths;
• take part in sports competitions.

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

What it is?

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

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

Causes

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

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

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

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

Provoking factors

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

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

Stages of disease development

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

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

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

Classification

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

Various shapes Atopic dermatitis can be divided into several broad categories.

Disease development phase

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

Age

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

The extent of the inflammatory process

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

Change in general condition

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

Main symptoms and signs

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

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

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

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

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

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

Diagnostics

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

General blood analysis

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

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

Biochemical research

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

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

Quantitative determination of immunoglobulin E

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

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

Special allergy tests

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

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

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

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

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

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

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

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

Determination of specific antibodies

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

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

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

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

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

Principles of basic treatment

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

During an exacerbation

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

During remission

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

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

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

Drug therapy

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

Local treatment

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

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

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

Are water treatments allowed?

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

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

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

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

What to eat?

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

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

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

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

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

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

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

How to properly organize your daily routine?

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

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

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

Possibilities of spa treatment

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

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

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

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

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

Complications

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

The most common symptoms of atopic dermatitis are:

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

Is disability established?

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

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

Prevention of exacerbations

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

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

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

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

Thank you

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

What is atopic dermatitis?

Atopic dermatitis is a genetically determined, chronic skin disease. Typical clinical manifestations of this pathology are eczematous rash, pruritus and dry skin.
At the moment, the problem of atopic dermatitis has become global, because the increase in incidence in recent decades has increased several times. Thus, in children under one year of age, atopic dermatitis is registered in 5 percent of cases. In the adult population, this figure is slightly lower and varies from 1 to 2 percent.

For the first time, the term “atopy” (which from Greek means unusual, alien) was proposed by scientists Coca. By atopy he understood a group of hereditary forms of increased sensitivity of the body to various influences external environment.
Today, the term “atopy” refers to a hereditary form of allergy, which is characterized by the presence of IgE antibodies. The reasons for the development of this phenomenon are not completely clear. Synonyms for atopic dermatitis are constitutional eczema, constitutional neurodermatitis and prurigo (or pruritus) of Beignet.

Statistics on atopic dermatitis

Atopic dermatitis is one of the most frequently diagnosed diseases among the child population. Among girls it is allergic disease occurs 2 times more often than among boys. Various studies in this area confirm the fact that residents of large cities are most susceptible to atopic dermatitis.

Among the factors that accompany the development of childhood atopic dermatitis, the most significant is heredity. So, if one of the parents suffers from this skin disease, the likelihood that the child will have a similar diagnosis reaches 50 percent. If both parents have a history of the disease, the chances of a child being born with atopic dermatitis increase to 75 percent. Statistics show that in 90 percent of cases, this disease manifests itself between the ages of 1 and 5 years. Very often, in about 60 percent of cases, the disease debuts before the child reaches one year of age. Much less often, the first manifestations of atopic dermatitis occur in adulthood.

Atopic dermatitis is a disease that has become widespread in recent decades. Thus, in the United States of America, at the moment, compared with data twenty years ago, the number of patients with atopic dermatitis has doubled. Official data suggests that today 40 percent of the world's population is struggling with this disease.

Causes of atopic dermatitis

The causes of atopic dermatitis, like many immune diseases, remain not fully understood today. There are several theories regarding the origin of atopic dermatitis. Today, the most convincing theory is the theory of allergic genesis, the theory of impaired cellular immunity and the hereditary theory. In addition to the direct causes of atopic dermatitis, there are also risk factors for this disease.

Theories for the development of atopic dermatitis are:

• theory of allergic genesis;
• genetic theory of atopic dermatitis;
• theory of the disturbed cellular immunity.

Theory of allergic genesis

This theory connects the development of atopic dermatitis with congenital sensitization of the body. Sensitization is the body's increased sensitivity to certain allergens. This phenomenon is accompanied by increased secretion of immunoglobulins E (IgE). Most often the body develops increased sensitivity to food allergens, that is, to food products. Food sensitization is most common in infants and preschool children. Adults tend to develop sensitization to household allergens, pollen, viruses and bacteria. The result of such sensitization is an increased concentration of IgE antibodies in the serum and the launch immune reactions body. Antibodies of other classes also take part in the pathogenesis of atopic dermatitis, but it is IgE that provokes autoimmune phenomena.

The amount of immunoglobulins correlates (is interrelated) with the severity of the disease. Thus, the higher the concentration of antibodies, the more pronounced clinical picture atopic dermatitis. Also involved in disruption of immune mechanisms mast cells, eosinophils, leukotrienes (representatives of cellular immunity).

If in children the leading mechanism in the development of atopic dermatitis is food allergy, then in adults pollen allergens become of great importance. Pollen allergies among adults occur in 65 percent of cases. Household allergens are in second place (30 percent); epidermal and fungal allergens are in third place.

Frequency of different types of allergens in atopic dermatitis

Genetic theory of atopic dermatitis

Scientists have reliably established the fact that atopic dermatitis is a hereditary disease. However, it has not yet been possible to establish the type of inheritance of dermatitis and the level of genetic predisposition. The latter figure varies in different families from 14 to 70 percent. If both parents in a family suffer from atopic dermatitis, the risk for the child is more than 65 percent. If this disease is present in only one parent, then the risk for the child is halved.

Theory of impaired cellular immunity

Immunity is represented by humoral and cellular components. Cellular immunity refers to a type of immune response in the development of which neither antibodies nor the compliment system take part. Instead, immune function is carried out by macrophages, T lymphocytes and other immune cells. This system is particularly effective against virus-infected cells, tumor cells and intracellular bacteria. Disturbances at the level of cellular immunity underlie diseases such as psoriasis and atopic dermatitis. Skin lesions, according to experts, are caused by autoimmune aggression.

Risk factors for atopic dermatitis

These factors significantly increase the risk of developing atopic dermatitis. They also influence the severity and duration of the disease. Often, the presence of one or another risk factor is the mechanism that delays the remission of atopic dermatitis. For example, pathology gastrointestinal tract the child may be held back from recovery for a long time. A similar situation is observed in adults during stress. Stress is a powerful psycho-traumatic factor that not only prevents recovery, but also aggravates the course of the disease.

Risk factors for atopic dermatitis are:

• pathology of the gastrointestinal tract;
• stress;
• unfavorable ecological environment.

Pathology of the gastrointestinal tract (GIT)
It is known that the human intestinal system performs a protective function of the body. This function is realized thanks to the abundant intestinal lymphatic system, intestinal flora and immunocompetent cells that it contains. A healthy gastrointestinal system ensures that pathogenic bacteria are neutralized and eliminated from the body. The lymphatic vessels of the intestine also contain a large number of immune cells, which at the right time resist infections. Thus, the intestines are a kind of link in the chain of immunity. Therefore, when there are various pathologies at the level of the intestinal tract, this primarily affects the human immune system. Proof of this is the fact that more than 90 percent of children with atopic dermatitis have various functional and organic pathologies of the gastrointestinal tract.

Gastrointestinal diseases that most often accompany atopic dermatitis include:

• biliary dyskinesia.

These and numerous other pathologies reduce the intestinal barrier function and trigger the development of atopic dermatitis.

Artificial feeding
Premature transition to artificial formula and early introduction of complementary foods are also risk factors for atopic dermatitis. It is generally accepted that natural breastfeeding reduces the risk of developing atopic dermatitis several times. The reason for this is that breast milk contains maternal immunoglobulins. Later, together with milk, they enter the child’s body and provide him with the formation of immunity for the first time. The child’s body begins to synthesize its own immunoglobulins much later. Therefore, in the early stages of life, the child’s immunity is provided by immunoglobulins from mother’s milk. Premature cessation of breastfeeding weakens the baby's immune system. The consequence of this is numerous abnormalities in the immune system, which increases the risk of developing atopic dermatitis several times.

Stress
Psycho-emotional factors can provoke exacerbation of atopic dermatitis. The influence of these factors reflects the neuro-allergic theory of the development of atopic dermatitis. Today it is generally accepted that atopic dermatitis is not so much a skin disease as a psychosomatic one. This means that the nervous system plays a crucial role in the development of this disease. This is confirmed by the fact that antidepressants and other psychotropic drugs are successfully used in the treatment of atopic dermatitis.

Unfavorable ecological environment
This risk factor has become increasingly important in recent decades. This is explained by the fact that emissions from industrial enterprises create an increased burden on human immunity. An unfavorable environment not only provokes exacerbations of atopic dermatitis, but can also participate in its initial development.

Risk factors are also living conditions, namely the temperature and humidity of the room in which a person lives. Thus, temperatures above 23 degrees and humidity below 60 percent negatively affect the condition of the skin. Such living conditions reduce the resistance (resistance) of the skin and trigger immune mechanisms. The situation is aggravated by the irrational use of synthetic detergents, which can enter the human body through the respiratory tract. Soap, shower gel and other hygiene products are irritants and contribute to itching.

Stages of atopic dermatitis

It is customary to distinguish several stages in the development of atopic dermatitis. These stages or phases are characteristic of certain age intervals. Also, each phase has its own symptoms.

The phases of development of atopic dermatitis are:

• infant phase;
• child phase;
• adult phase.

Since the skin is an organ of the immune system, these phases are considered as features of the immune response in different age periods.

Infant phase of atopic dermatitis

This phase develops at the age of 3 – 5 months, rarely at 2 months. This early development of the disease is explained by the fact that, starting from 2 months, the child’s lymphoid tissue begins to function. Since this body tissue is a representative of the immune system, its functioning is associated with the onset of atopic dermatitis.

Skin lesions in the infant phase of atopic dermatitis differ from other phases. So, in this period the development of weeping eczema is characteristic. Red, weeping plaques appear on the skin, which quickly become crusted. In parallel with them, papules, blisters and urticarial elements appear. Initially, the rashes are localized in the skin of the cheeks and forehead, without affecting the nasolabial triangle. Further, skin changes affect the surface of the shoulders, forearms, and extensor surfaces of the lower leg. The skin of the buttocks and thighs is often affected. The danger in this phase is that infection can set in very quickly. Atopic dermatitis in the infantile phase is characterized by periodic exacerbations. Remissions are usually short-lived. The disease worsens during teething, the slightest intestinal disorder or a cold. Spontaneous cure is rare. As a rule, the disease moves into the next phase.

Childhood phase of atopic dermatitis
The childhood phase is characterized by a chronic inflammatory process of the skin. At this stage, the development of follicular papules and lichenoid lesions is characteristic. The rash most often affects the area of ​​the elbow and popliteal folds. The rash also affects the flexor surfaces of the wrist joints. In addition to the rashes typical of atopic dermatitis, so-called dyschromia also develops in this phase. They appear as flaky brown lesions.

The course of atopic dermatitis in this phase is also wavy with periodic exacerbations. Exacerbations occur in response to various provoking environmental factors. Relationship with food allergens during this period it decreases, but there is increased sensitization (sensitivity) to pollen allergens.

Adult phase of atopic dermatitis
The adult phase of atopic dermatitis coincides with puberty. This stage is characterized by the absence of weeping (eczematous) elements and the predominance of lichenoid foci. The eczematous component is added only during periods of exacerbation. The skin becomes dry, infiltrated rashes appear. The difference between this period is the change in the localization of the rash. So, if in childhood the rash predominates in the area of ​​​​the folds and rarely affects the face, then in the adult phase of atopic dermatitis it migrates to the skin of the face and neck. On the face, the nasolabial triangle becomes the affected area, which is also not typical for the previous stages. The rash may also cover the hands, top part torso. During this period, the seasonality of the disease is also minimally expressed. Basically, atopic dermatitis worsens when exposed to various irritants.

Atopic dermatitis in children

Atopic dermatitis is a disease that begins in infancy. The first symptoms of the disease appear by 2–3 months. It is important to know that atopic dermatitis does not develop until 2 months. Almost all children with atopic dermatitis have a polyvalent allergy. The term "multivalent" means that an allergy develops to several allergens at the same time. The most common allergens are food, dust, and household allergens.

The first symptoms of atopic dermatitis in children are diaper rash. Initially, they appear under the arms, buttock folds, behind the ears and in other places. At the initial stage, diaper rash appears as reddened, slightly swollen areas of the skin. However, very quickly they move into the stage of weeping wounds. The wounds do not heal for a very long time and often become covered with wet crusts. Soon the skin on the baby’s cheeks also becomes chafing and red. The skin of the cheeks very quickly begins to peel off, as a result of which it becomes rough. Another important diagnostic symptom are milky crusts that form on the eyebrows and scalp of a child. Beginning at the age of 2–3 months, these signs reach their maximum development by 6 months. In the first year of life, atopic dermatitis goes away with virtually no remissions. In rare cases, atopic dermatitis begins at one year of age. In this case, it reaches its maximum development by 3–4 years.

Atopic dermatitis in infants

In children of the first year of life, that is, infants, there are two types of atopic dermatitis - seborrheic and nummular. The most common type of atopic dermatitis is seborrheic, which begins to appear from 8 to 9 weeks of life. It is characterized by the formation of small, yellowish scales in the scalp area. At the same time, in the area of ​​the baby’s folds, weeping and difficult-to-heal wounds are detected. The seborrheic type of atopic dermatitis is also called skin fold dermatitis. When an infection occurs, a complication such as erythroderma develops. In this case, the skin of the baby's face, chest and limbs becomes bright red. Erythroderma is accompanied by severe itching, as a result of which the baby becomes restless and constantly cries. Soon, hyperemia (redness of the skin) becomes generalized. All skin covering the child becomes burgundy and covered with large-plate scales.

The nummular type of atopic dermatitis is less common and develops at the age of 4–6 months. It is characterized by the presence of spotted elements covered with crusts on the skin. These elements are localized mainly on the cheeks, buttocks, and limbs. Like the first type of atopic dermatitis, this form also often transforms into erythroderma.

Development of atopic dermatitis in children

In more than 50 percent of children suffering from atopic dermatitis in the first year of life, it goes away by 2–3 years of age. In other children, atopic dermatitis changes its character. First of all, the localization of the rash changes. Migration of atopic dermatitis into skin folds is observed. In some cases, dermatitis can take the form of palmoplantar dermatosis. As the name suggests, in this case, atopic dermatitis affects exclusively the palmar and plantar surfaces. At the age of 6 years, atopic dermatitis can be localized in the buttocks and inner thighs. This localization can persist until adolescence.

Atopic dermatitis in adults

As a rule, after puberty, atopic dermatitis can take an abortive form, that is, disappear. As you get older, exacerbations become less common, and remissions can drag on for several years. However, a strong psychotraumatic factor can again provoke an exacerbation of atopic dermatitis. Such factors may include severe somatic (physical) illnesses, stress at work, or family troubles. However, according to most authors, atopic dermatitis in people over 30–40 years of age is a very rare phenomenon.

The incidence of atopic dermatitis in different age groups

Symptoms of atopic dermatitis

The clinical picture of atopic dermatitis is very diverse. Symptoms depend on age, gender, environmental conditions and, importantly, on concomitant diseases. Exacerbations of atopic dermatitis coincide with certain age periods.

Age-related periods of exacerbation of atopic dermatitis include:

• infancy and early childhood (up to 3 years)– this is the period of maximum exacerbation;
• age 7 – 8 years– associated with the start of school;
• age 12 – 14 years– period of puberty, exacerbation is caused by numerous metabolic changes in the body;
• 30 years- most often in women.

Also, exacerbations are often associated with seasonal changes (spring - autumn), pregnancy, stress. Almost all authors note a period of remission (disease subsidence) in the summer months. Exacerbations in the spring-summer period occur only in cases where atopic dermatitis develops against the background of hay fever or respiratory atopy.

Characteristic symptoms of atopic dermatitis are:

• rash;
• dryness and flaking.

Itching with atopic dermatitis

Itching is an integral sign of atopic dermatitis. Moreover, it can persist even when there are no other visible signs of dermatitis. The causes of itching are not fully understood. It is believed that it develops due to too dry skin. However, this does not fully explain the reasons for such intense itching.

Characteristics of itching in atopic dermatitis are:

• persistence – itching is present even when there are no other symptoms;
• intensity – the itching is very pronounced and persistent;
• persistence – itching responds poorly to medication;
• increased itching in the evening and at night;
• accompanied by scratching.

Persisting (being constantly present) for a long time, itching causes severe suffering to patients. Over time, it becomes the cause of insomnia and psycho-emotional discomfort. It also worsens the general condition and leads to the development of asthenic syndrome.

Dryness and flaking of the skin in atopic dermatitis

Due to the destruction of the natural lipid (fat) membrane of the epidermis, the skin of a patient suffering from dermatitis begins to lose moisture. The consequence of this is a decrease in skin elasticity, dryness and flaking. The development of lichenification zones is also characteristic. Lichenification zones are areas of dry and sharply thickened skin. In these areas, the process of hyperkeratosis occurs, that is, excessive keratinization of the skin.
Lichenoid lesions often form in the area of ​​folds - popliteal, ulnar.

What does skin look like with atopic dermatitis?

The way the skin looks with atopic dermatitis depends on the form of the disease. At the initial stages of the disease, the most common form is erythematous with signs of lichenification. Lichenification is the process of thickening the skin, which is characterized by an increase in its pattern and an increase in pigmentation. In the erythematous form of atopic dermatitis, the skin becomes dry and thickened. It is covered with numerous crusts and small-plate scales. These scales are located in large numbers on the elbows, sides of the neck, and popliteal fossae. In the infant and childhood phases, the skin looks swollen and hyperemic (reddened). In the purely lichenoid form, the skin is even more dry, swollen and has a pronounced skin pattern. The rash is represented by shiny papules, which merge in the center and only remain in small quantities at the periphery. These papules very quickly become covered with small scales. Due to painful itching, scratches, abrasions, and erosions often remain on the skin. Separately, foci of lichenification (thickened skin) are localized on the upper chest, back, and neck.

In the eczematous form of atopic dermatitis, the rashes are limited. They are represented by small blisters, papules, crusts, cracks, which, in turn, are located on flaky areas of the skin. Such limited areas are located on the hands, in the area of ​​the popliteal and elbow folds. In the prurigo-like form of atopic dermatitis, the rash mostly affects the skin of the face. In addition to the above forms of atopic dermatitis, there are also atypical forms. These include “invisible” atopic dermatitis and the urticarial form of atopic dermatitis. In the first case, the only symptom of the disease is intense itching. There are only traces of scratching on the skin, and no visible rashes are detected.

Both during exacerbation of the disease and during remission, the skin of a patient with atopic dermatitis is dry and flaky. In 2–5 percent of cases, ichthyosis is observed, which is characterized by the presence of numerous small scales. In 10–20 percent of cases, patients experience increased folding (hyperlinearity) of the palms. The skin of the body becomes covered with whitish, shiny papules. On the lateral surfaces of the shoulders, these papules are covered with horny scales. With age, there is increased pigmentation of the skin. Pigment spots, as a rule, are of a non-uniform color and are distinguished by their different colors. Reticulate pigmentation, together with increased folding, can be localized on the anterior surface of the neck. This phenomenon gives the neck a dirty appearance (dirty neck symptom).

Patients with atopic dermatitis often develop whitish spots on the face in the cheek area. In the remission stage, signs of the disease may be cheilitis, chronic seizures, cracks on the lips. An indirect sign of atopic dermatitis may be a sallow skin tone, pale facial skin, periorbital darkening (dark circles around the eyes).

Atopic dermatitis on the face

Manifestations of atopic dermatitis on the skin of the face are not always found. Skin changes affect the facial skin in the eczematous form of atopic dermatitis. In this case, erythroderma develops, which in young children affects mainly the cheeks, and in adults also the nasolabial triangle. Young children develop what is called a bloom on their cheeks. The skin becomes bright red, swollen, often with numerous cracks. Cracks and weeping wounds quickly become covered with yellowish crusts. The area of ​​the nasolabial triangle in children remains intact.

In adults, changes on the facial skin are of a different nature. The skin takes on an earthy tint and becomes pale. Spots appear on the cheeks of patients. In the remission stage, a sign of the disease may be cheilitis (inflammation of the red border of the lips).

Diagnosis of atopic dermatitis

Diagnosis of atopic dermatitis is based on patient complaints, objective examination data and laboratory data. At the appointment, the doctor should carefully question the patient about the onset of the disease and, if possible, about the family history. Data on the diseases of a brother or sister are of great diagnostic significance.

Medical examination for atopic

The doctor begins the examination with the patient's skin. It is important to examine not only the visible areas of the lesion, but also the entire skin. Often the elements of the rash are masked in folds, under the knees, on the elbows. Next, the dermatologist evaluates the nature of the rash, namely the location, number of rash elements, color, and so on.

Diagnostic criteria for atopic dermatitis are:

• Itching is an obligate (strict) sign of atopic dermatitis.
• Rashes – the nature and age at which the rashes first appeared is taken into account. Children are characterized by the development of erythema in the cheeks and upper half of the body, while in adults, foci of lichenification predominate (thickening of the skin, disturbed pigmentation). Also, after adolescence, dense, isolated papules begin to appear.
• Recurrent (wavy) course of the disease - with periodic exacerbations in the spring-autumn period and remissions in the summer.
• The presence of a concomitant atopic disease (for example, atopic asthma, allergic rhinitis) is an additional diagnostic criterion in favor of atopic dermatitis.
• The presence of a similar pathology among family members - that is, the hereditary nature of the disease.
• Increased dry skin (xeroderma).
• Increased pattern on the palms (atopic palms).

These signs are the most common in the clinic of atopic dermatitis.
However, there are also additional diagnostic criteria that also speak in favor of this disease.

Additional signs of atopic dermatitis are:

• frequent skin infections (for example, staphyloderma);
• recurrent conjunctivitis;
• cheilitis (inflammation of the mucous membrane of the lips);
• darkening of the skin around the eyes;
• increased pallor or, conversely, erythema (redness) of the face;
• increased folding of the neck skin;
• dirty neck symptom;
• the presence of an allergic reaction to medications;
• periodic seizures;
• geographical language.

Tests for atopic dermatitis

Objective diagnosis (i.e. examination) of atopic dermatitis is also complemented by laboratory data.

Laboratory signs of atopic dermatitis are:

• increased concentration of eosinophils in the blood (eosinophilia);
• the presence in the blood serum of specific antibodies to various allergens (for example, pollen, some foods);
• decreased level of CD3 lymphocytes;
• decrease in CD3/CD8 index;
• decreased phagocyte activity.

These laboratory findings should also be supported by skin allergy testing.

Severity of atopic dermatitis

Often atopic dermatitis is combined with damage to other organs in the form of atopic syndrome. Atopic syndrome is the presence of several pathologies at the same time, for example, atopic dermatitis and bronchial asthma or atopic dermatitis and intestinal pathology. This syndrome is always much more severe than isolated atopic dermatitis. In order to assess the severity of atopic syndrome, a European working group developed the SCORAD (Scoring Atopic Dermatitis) scale. This scale combines objective (signs visible to the doctor) and subjective (provided by the patient) criteria for atopic dermatitis. The main advantage of using the scale is the ability to assess the effectiveness of treatment.

The scale provides a score for six objective symptoms - erythema (redness), swelling, crusting/scale, excoriation/scratching, lichenification/flaking and dry skin.
The intensity of each of these signs is assessed on a 4-point scale:

• 0 - absence;
• 1 – weak;
• 2 – moderate;
• 3 – strong.

By summing these scores, the degree of activity of atopic dermatitis is calculated.

The degrees of activity of atopic dermatitis include:

• Maximum degree of activity equivalent to atopic erythroderma or widespread process. The intensity of the atopic process is most pronounced in the first age period of the disease.
• High degree of activity determined by widespread skin lesions.
• Moderate degree of activity characterized by a chronic inflammatory process, often localized.
• Minimum degree of activity includes localized skin lesions - in infants these are erythematous-squamous lesions on the cheeks, and in adults - local perioral (around the lips) lichenification and/or limited lichenoid lesions in the elbow and popliteal folds.

Before use, you should consult a specialist.