What causes atopic dermatitis. Atopic dermatitis: symptoms and treatment

Specialist doctors answer frequently asked questions from users.

Medical specialists answer frequently asked questions from users:

Information for doctors and specialists: Clinical pharmacology of Thymogen®
The influence of immunotropic external therapy on the expression of cytokine genes in the skin and peripheral blood of patients with atopic dermatitis

What is atopic dermatitis?

Atopic dermatitis- This is one of the most common allergic diseases, manifesting itself in severe form, affecting the skin. The disease dermatitis is genetically determined and, unfortunately, is chronic. The manifestations of atopic dermatitis are quite typical.

The main clinical symptom of atopic dermatitis can be considered itching. It is found in all age groups Oh.

The disease atopic dermatitis is a local manifestation of internal disorders in the immune system.
When diagnosed with atopic dermatitis, first of all, treatment should be comprehensive and contribute to normalization general functions immune system. In this regard, a key role in the treatment of atopic dermatitis should be given to immunotropic drugs or, in other words, immunomodulators.

In medical practice, for the treatment of atopic dermatitis, the drug Thymogen has been used for several years, which is available in the form of a cream, nasal spray, and also in parenteral form.
(Information on the use of Thymogen for specialists)

Although medicine has made huge strides in this area, the question of how to treat atopic dermatitis is still quite acute. The problem of treating dermatitis is serious and requires both the collaboration of the doctor and the patient, and the support of the patient from his family members.

How does atopic dermatitis manifest?

Typically, the first manifestations of atopic dermatitis begin in childhood. However, there are cases where atopic dermatitis made itself felt at a later age.

In half of patients, the first signs of atopic dermatitis appear already in the first year of life. Of these, in 75% the first symptoms can be detected between the ages of 2 and 6 months. More rare are cases when patients are diagnosed with dermatitis in the period from one to 5 years of life. The rarest case is the appearance of the clinical picture at 30 years of age or even at 50 years of age.

Males, according to statistics, are more susceptible to atopic dermatitis.

At all stages of atopic dermatitis, intense skin itching is noted, as well as increased skin reactivity to various irritants.

Typically, itching is a precursor to a skin rash and changes in intensity throughout the day, intensifying in the evening.

Subsequently, itching on the skin causes unpleasant rashes, swelling and scratching.

Atopic dermatitis in children

Diagnosis and symptoms of atopic dermatitis in children

The concept of “atopic dermatitis” is not very common outside medical circles. In common parlance, dermatitis is usually called diathesis, in medicine, however, such a concept does not exist. At the same time, the stages of atopic dermatitis are distinguished: the earliest, infantile, which is called diathesis, childhood, and also adolescent-adult (late).

Infancy, the earliest stage, is the period up to 2 years. Red spots appear on the child’s skin, most often localized on the face (on the cheeks and forehead). Dermatitis occurs quite acutely: the affected areas become wet, swelling occurs, and crusts form. In addition to the face, other areas of the body (buttocks, legs, hairy part heads). Acute stage characterized by reddened skin and papular elements (skin tubercles).

The period of exacerbation of dermatitis is characterized by the fact that papules and red spots mainly appear in the skin folds, behind the ears, on the surface of the elbow or knee joints. The skin becomes dry and begins to peel. Subsequently, the child develops a so-called “atopic face.” Increased pigmentation around the eyes, additional lining on the lower eyelid, and dull skin color characterize the “atopic face.”

If the stage of atopic dermatitis is not acute, then most often dermatitis manifests itself in the form of dry skin, as well as cracks in the skin on the back surfaces of the hands and in the fingers.

Complications of atopic dermatitis in children

Skin atrophy, along with the addition of pyoderma bacteria, in atopic dermatitis, are among the most common complications.

It is worth remembering that when treating atopic dermatitis, you should avoid scratching the skin, as it disrupts the barrier and protective properties of the skin, having quite a detrimental effect. Intense scratching can contribute to the development of microbial infections and fungal flora.

With pyoderma, pustules form on the skin, which dry out after some time, and crusts form in their place. Rashes can be localized in completely different ways. Pyoderma bacteria cause an increase in temperature and disruption of a person’s general well-being.

Another complication that occurs quite often with atopic dermatitis is a viral infection. Bubbles filled with clear liquid appear on the skin. This phenomenon is provoked by the herpes virus, which is the causative agent of the so-called cold on the lips. Such rashes often form in the area of ​​inflammatory foci, but can also affect healthy skin or mucous membranes (oral cavity, genitals, eyes, throat).

Fungal infection is also a common complication of atopic dermatitis. Most often, the fungus affects the nails, scalp and skin folds. This is typical for adults. In childhood, the fungus most often affects the oral mucosa.

Both bacterial and fungal infections can occur simultaneously.

Approximately 80% of patients who suffer from atopic dermatitis often develop bronchial asthma or allergic rhinitis. This usually occurs in late childhood.

Treatment of atopic dermatitis in children

When wondering how to treat atopic dermatitis, first of all, it is worth remembering that treatment should not be started on your own. To establish an accurate diagnosis and prescribe medications, you should consult a doctor. This is due to the fact that a number of serious diseases have symptoms very similar to dermatitis. Self-treatment can put the health and even the life of a child at risk.

Moreover, you should not independently extend the course of treatment with medications. Any medication has side effects, and even if they help to cope with the disease, if the treatment method is incorrect, these side effects can make themselves felt.

General principles or how to treat atopic dermatitis:

• — follow a hypoallergenic diet, eliminate the allergen;
• - take antihistamines that relieve itching;
• - detoxify the body;
• - use drugs that have an anti-inflammatory effect, for example, Thymogen - cream 0.05%
• - take sedatives (sedatives) (glycine, various sedative herbs, valerian, peony, etc.);
• — use antibacterial agents (if an infection occurs);

It should also be remembered that during exacerbation of dermatitis, treatment methods differ from those recommended for the normal course of the disease.

And remember that atopic dermatitis (AD) is a chronic disease that requires fairly long-term treatment, even if there is no exacerbation of the disease.

Hypoallergenic diet for atopic dermatitis in children

It is important to remember that only a doctor can make an accurate diagnosis and prescribe adequate treatment.

However, it is impossible to completely cure atopic dermatitis, since it is a chronic disease. However, there are methods and remedies that can reduce redness and eliminate itching.
First of all, you should try to eliminate the allergen that may cause a negative reaction in the child.

Taking into account the degree of exacerbation of dermatitis, it is necessary to ensure careful care of the baby’s skin.

There may be cases when allergic inflammation occurs without obvious clinical inflammation, while the properties of the skin change. Skin moisture and permeability are the first to be affected. Helps relieve symptoms medicinal cosmetics. The damaged properties of the skin are well restored with the help of fortified cosmetics.

A special diet plays an important role in the treatment of dermatitis. During periods of exacerbation, nutrition should be monitored especially carefully. You can soften the diet if there is no exacerbation of the disease.

Saving breastfeeding for as long as possible (at least 6 months) is a VERY IMPORTANT element for the child’s health. The mother should exclude foods that can cause an exacerbation of allergies from the diet.

It is important to bathe a newborn baby, as in the first year of his life, correctly. You cannot use soap. It is recommended to use specialized shampoos, or better yet, medicated ones.

Milk protein, eggs, fish, peanuts and soy are some of the most common allergens. It is important to remember that even if you are not susceptible to this, there is a potential risk of your child developing a food allergy.

At different ages, the manifestations of allergies are different. In the first or second year of life, food allergies clearly predominate in children.

In young children, treating food allergies is a rather complex process. During the feeding period, it is necessary to choose the right diet for the child and his mother - this is one of the main principles that helps treat atopic dermatitis.

Prevention of atopic dermatitis in children

In the prevention and treatment of atopic dermatitis, there are two main principles: creating a hypoallergenic environment to eliminate contact with allergens and, of course, following a special diet. If these principles are not followed, the effectiveness of treatment is greatly reduced.

Essentially, building a hypoallergenic environment is about maintaining a specific lifestyle. The main goal is to eliminate factors that could potentially cause skin irritation, thereby causing an exacerbation of dermatitis.
To prevent atopic dermatitis and create a hypoallergenic environment, the following recommendations exist:

• — In the room, the air temperature should be maintained no higher than +23 °C, and the relative humidity should be no less than 60%.
• - It is recommended to take antihistamines that relieve itching;
• — Possible allergens must be excluded from food;
• — Feather, down pillows and wool blankets should be replaced with synthetic ones;
• — Sources of dust in the house should be eliminated (carpets, books);
• — Wet cleaning of the room should be carried out at least once a week;
• — Particular attention should be paid to removing areas of possible mold formation (seams in the bathroom, linoleum, wallpaper);
• — Pets and plants should be isolated. It is necessary to exterminate insects (moths, cockroaches).
• — Pay attention to limiting or eliminating the use of various irritants (washing powders, synthetic detergents, solvents, glue, varnishes, paints, etc.)
• - Clothes made of wool and synthetic materials should only be worn over cotton ones.
• - You must not smoke in the house where the patient is.
• — Treatment with api- and herbal medicines is excluded.
• — It is worth limiting intense, excessive physical activity.
• — For bathing patients, you need to use weakly alkaline or indifferent soaps (lanolin, baby) or high-quality shampoos that do not contain artificial dyes, fragrances and preservatives.
• — When bathing, it is recommended to use soft cloth washcloths.
• — Using a softening, moisturizing neutral cream on the skin after a bath or shower is mandatory.
• — Stressful situations should be kept to a minimum.
• - Avoid scratching and rubbing the skin.

Holidays with a child with atopic dermatitis

A child who suffers from atopic dermatitis should not sunbathe - parents should remember this. A common mistake is to expose the patient to the sun for a long time. Despite the fact that this may lead to temporary improvements, in the future, a strong exacerbation of the disease is practically inevitable.

For patients with atopic dermatitis, the Azov Sea coast and other holiday destinations with a warm but dry climate are favorable.

What causes dermatitis to worsen? What factors provoke relapses?

Environmental factors play a very important role in the pathogenesis of atopic dermatitis: pollution, climatic influences, fungi and cateria, infections and household irritants (cigarette smoke, food and food additives, wool, cosmetics).

Diet and lifestyle of patients with atopic dermatitis

In patients with atopic dermatitis, food should not contain allergens, and the diet should be special, strictly prescribed by the doctor.

There are foods whose consumption should be minimized for dermatitis:

— It is strictly not recommended to consume seafood, chocolate, citrus fruits, nuts, fish, coffee, mayonnaise, eggplant, mustard, spices, tomatoes, red peppers, milk, eggs, sausages, mushrooms, carbonated drinks, strawberries, wild strawberries, honey, watermelons , pineapples.

Products allowed for atopic dermatitis:

— You can: cereal and vegetable soups; vegetarian soups; olive oil; sunflower oil; boiled potatoes; porridge from buckwheat, rice, oatmeal; lactic acid products; cucumbers; parsley; tea; bran or whole grain bread; sugar; dill; baked apples; bio-yogurts without additives; one-day cottage cheese; curdled milk compote from apples or dried fruits (except raisins).

All factors that increase sweating and itching (for example, physical activity) should be avoided. It is necessary to control the effects of temperature and humidity, avoiding their extreme values. Air humidity, which is considered optimal, is 40%. Drying things should take place outside the room where the patient is. It is contraindicated for patients to wear clothes made of coarse fabrics. Before wearing new clothes it must be washed thoroughly.
When washing clothes and bedding, try to use a minimal amount of fabric softener, after which the laundry should be rinsed additionally. Avoid using personal hygiene products containing alcohol.

Stressful situations should be avoided whenever possible.

Bed linen should be changed 1-2 times a week. It is very important to ensure that sources of dust and mold accumulation are eliminated. TV, computer, and household appliances should be removed from the bedroom of a patient with atopic dermatitis. Light wet cleaning is carried out once a day, general cleaning is carried out at least once a week.

Smoking should not be allowed in the house where the patient is located.

For dermatitis, great attention should be paid to water procedures. You should not use regular soap; it is preferable to use shower oil or medicated shampoo.
After a shower, the patient must lubricate the skin with moisturizers.

Prolonged exposure to the sun is contraindicated for all patients suffering from dermatitis.

You should never scratch or rub the skin, otherwise all remedies for the treatment of atopic dermatitis will be ineffective.

Is it possible to cure atopic dermatitis?

Unfortunately, many factors contribute to the disease atopic dermatitis. Atopic dermatitis is usually caused by a genetic predisposition. In addition, its development is influenced by environmental factors. Under the influence of the body's immunological reaction, the functional state of the skin barrier is disrupted, the reactivity of blood vessels and nerves changes, which is reflected in the previously described symptoms.

Atopic dermatitis is a chronic disease. Despite the development of medicine, unfortunately, atopic dermatitis cannot be cured, but it is quite possible to control its course.

Where to relax for people with atopic dermatitis?

Patients with atopic dermatitis are recommended for a dry maritime climate.

Comparison of drugs for the treatment of atopic dermatitis

Product: Elokom cream/ointment/lotion

Wed. selling price: 15 grams – 280 -290 -360 rubles

Composition, effect of the drug: Glucocorticosteroid – mometasone; anti-inflammatory, antipruritic

Indications for use:
Dermatitis, lichen simplex, solar urticaria; use only as prescribed by a doctor and strictly following the instructions

Preparation: Advantan ointment/oily ointment/cream/emulsion

Wed. selling price: 15 grams – 260 -300 rubles

Composition, effect of the drug: Glucocorticosteroid Methylprednisolone aceponate; antipruritic; anti-inflammatory

Indications for use:
Dermatitis, eczema, thermal and chemical burns; use only as prescribed by a doctor and strictly following the instructions

Side effects/special recommendations:
Not recommended for children under 2 years of age, pregnant and lactating women, it is not recommended to use for more than 2 weeks; with prolonged use, suppression of the function of the hypothalamic-pituitary-adrenal system may occur, as well as symptoms of adrenal insufficiency after discontinuation of the drug, which results in slower growth in children.

Product: Thymogen cream

Wed. selling price: 30 g -250 -270 rubles

Composition, effect of the drug: Thymogen – immunostimulant; due to the restoration of immune cells, it has anti-inflammatory, antipruritic, regenerating, healing effects

Indications for use:
Dermatitis, Dermatitis complicated by secondary infection, eczema, mechanical, thermal and chemical injuries to the skin.

Drug: Naftaderm liniment

Wed. selling price: 35 g – 280 -320 rubles

Composition, effect of the drug: Naftalan oil liniment; antipruritic, anti-inflammatory, antiseptic, emollient, analgesic

Indications for use:
Psoriasis, eczema, atopic dermatitis, seborrhea, furunculosis, wounds, burns, bedsores, radiculitis, neuralgia

Side effects/special recommendations:
Severe anemia, renal failure, hypersensitivity, tendency to bleeding of mucous membranes, only after consultation during pregnancy and breastfeeding and use in children, stains underwear, has a peculiar odor, dry skin may occur

Product: Elidel cream

Wed. selling price: 15 g – 890 -1100 rubles

Composition, effect of the drug: pimecrolimus - immunosuppressant, anti-inflammatory, antipruritic

Indications for use: Atopic dermatitis, eczema

Didn't find the answer to your question?

Ask your doctor questions about the use of Thymogen online and you will receive a professional answer from a specialist. The Cytomed research department conducts research and development of drugs for the treatment of atopic dermatitis.

Thank you

The site provides background 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 environmental influences.
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, this 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. The first manifestations of atopic dermatitis are much less common 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 indicates 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 impaired 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 triggering of the body’s immune reactions. 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. Mast cells, eosinophils, and leukotrienes (representatives of cellular immunity) are also involved in the disruption of immune mechanisms.

If in children the leading mechanism in the development of atopic dermatitis is food allergy, then in adults great value acquire pollen allergens. 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 of the gastrointestinal tract in a child can hinder 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 protective function body. This function is realized thanks to the abundant lymphatic system intestines, intestinal flora and immunocompetent cells that it contains. A healthy gastrointestinal system ensures that pathogenic bacteria are neutralized and eliminated from the body. IN lymphatic vessels there is also a large amount of intestines 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 industrial enterprises create an increased burden on the human immune system. 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, vesicles 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 for 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. The relationship with food allergens decreases during this period, 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 and upper body. 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 wounds that are difficult to heal 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. The entire skin of 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.

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 old- 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 heterogeneous color and are distinguished by their different color scheme. 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 skin of the face in the eczematous form of atopic dermatitis. IN in this case erythroderma develops, which in young children affects mainly the cheeks, and in adults also the nasolabial triangle. Young children develop a so-called “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 when the rash 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), edema, 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.

If skin rashes appear, the development of a serious disease - atopic dermatitis - should be excluded. The process of forming skin atopy is somewhat more complicated than a common allergic reaction, therefore the treatment of the disease should be taken more seriously in order to avoid unpleasant cosmetic defects and serious complications.

Quick page navigation

Atopic dermatitis - what is this disease?

What is it? Atopic dermatitis is a long-term disease belonging to the group allergic dermatitis. This pathology characterized by:

• Hereditary predisposition - the risk of developing atopy reaches 80% in children whose parents suffer from atopic dermatitis or other allergic pathologies;
• The appearance of the first signs in early childhood (in 75% of cases);
• Recurrent course with exacerbations in winter;
• Specific clinical picture at different age periods;
• Changes in immunological blood parameters.

Atopic dermatitis is more pronounced in children and is almost always associated with repeated sensitization (contact with an allergen). There are frequent cases of clinical recovery.

With age, the symptoms of the disease change somewhat, but can cause serious psychological discomfort to a person.

Causes and stages of development of atopic dermatitis

atopic dermatitis - photo

one of the manifestations of the disease in children

Although atopic dermatitis is initially associated with sensitization of the body to food and chemical allergens and microorganisms (fungus, dust mites), subsequent exacerbations may not be associated with allergenic contact. In addition, incompetence of the digestive tract plays an important role in the development of atopy: the disease often occurs against the background of intestinal dysbiosis, biliary dyskinesia and other gastrointestinal pathologies.

Causes of atopic dermatitis (its exacerbations) in adults:

• Stress and depressive states,
• Bad habits (smoking, alcohol),
• Poisoning by various toxins from the environment,
• Hormonal imbalances (including pregnancy in women),
• Poor nutrition
• Severe infections and immune disorders.

Atopic dermatitis is usually divided into several age stages. The reason for this is the completely different symptomatic picture of atopy in patients of different ages.

1. Stage 1 (infantile atopy) - at the age of 2 months - 2 years, exudation (wetting) and a pronounced inflammatory reaction come to the fore.
2. Stage 2 (atopic dermatitis in children 2-10 years old) - before the child begins puberty, atopy is expressed in increasing dry skin and the periodic appearance of a papular rash.
3. Stage 3 (atopy in adults) - exacerbations depend less and less on contact with allergens, morphological changes occur in the skin (lichenification).

Important! — Many experts identify atopic dermatitis with diffuse neurodermatitis. Although the clinical manifestations of neurodermatitis and atopic dermatitis in adolescence and older are almost identical, the process of formation of the disease itself is somewhat different.

Therapeutic tactics always take into account the nature of skin manifestations and laboratory data on the composition of the blood.

Symptoms and signs of atopic dermatitis

The symptoms of atopic dermatitis differ radically depending on the patient’s age and determine the main treatment measures.

Infantile neurodermatitis

A sick baby looks like this: redness of the cheeks and forehead (diathesis), diaper rash in the folds of the skin. against the background of swelling and severe hyperemia, foci of maceration (wetting) form. Also characteristic is the presence of milky scabs on the scalp of the baby.

Severe itching provokes anxiety in the child, scratching and suppuration of cracks, intensifies after water procedures. The baby is capricious and does not sleep well. Oral candidiasis (thrush) is often diagnosed, which makes the child even more nervous, even to the point of refusing to eat.

Childhood atopy

Wet elements stop appearing with age. The skin gradually becomes more and more dry and flaky. Itchy papules (small blisters) and cracks appear behind the ears, on the neck, behind the knee, in the ankle area and on the delicate skin of the forearm.

Atopic dermatitis on the face gives a characteristic picture: a gray face, a thickened fold on the lower eyelid and dark circles under the eyes, depigmented (lightened) lesions on the cheeks, neck, and chest.

Often, against the background of atopy, a child develops other severe allergic conditions (inclusive).

Adult atopic dermatitis

In adult patients, relapses occur less frequently and the clinical picture is less pronounced. Often the patient notes constant availability pathological lesions on the skin. At the same time, the signs of lichenification are maximally manifested: focal thickening of the skin, a clearly defined skin pattern, massive peeling.

Pathological foci are localized on the arms, face and neck (thickened folds form on its anterior surface). Pronounced folding (hyperlinearity) is clearly visible on the palms (less often, soles).

Itching in chronic atopic dermatitis occurs even with the slightest changes in the skin, and intensifies with sweating. Decreased skin immunity leads to frequent fungal, staphylococcal and herpetic infections skin.

A patient's blood test at any stage of the disease reveals eosinophilia, a decrease in the number of T-lymphocytes, and a reactive increase in B-lymphocytes and IgE antibodies. At the same time, changes in immunogram parameters are in no way related to the severity of clinical manifestations atopic dermatitis.

Treatment of atopic dermatitis - drugs and diet

Atopic dermatitis is treated by a dermatoallergist, but patients often need consultation with a gastroenterologist and endocrinologist.

The treatment regimen includes identifying and, if possible, eliminating the allergen that provoked the pathological reaction (especially important when diagnosing atopy in children) and a complex effect on the symptoms of the disease and pathological changes in the body.

The medication course includes:

1. Antihistamines - Tavegil, Allertek, Claritin, Zodak perfectly relieve itching. For the treatment of atopic dermatitis in adults, the latest generation of antihistamines (Erius, Lordes, Aleron) are more suitable - they do not cause drowsiness.
2. Immunocorrectors - thymus preparations (Timalin, Taktivin), B-correctors (Methyluracil, Histaglobulin), membrane stabilizers (Intal, Ketotifen, Erespal).
3. Calming - infusions of valerian and motherwort, antipsychotics (Azaleptin), antidepressants (Amitriptyline) and tranquilizers (Nozepam) in small doses and only for adults.
4. Restoring the function of the gastrointestinal tract - probiotics (the best is Bifiform), choleretic (Allohol), fermentative agents (Mezim forte, Pancreatin).
5. Vitamin-mineral complexes - it is necessary to compensate for the lack of zinc in the body, vit. C and group B should be taken with caution (they may aggravate the allergic reaction).

Local treatment:

• Antiseptics (furacilin, boric acid) - for wet elements, alcohol-containing solutions are prohibited (dry the skin);
• Anti-inflammatory and antifungal ointments (Akriderm, Methyluracil, Lorinden S) - in case of emerging foci of suppuration or the addition of a fungal infection;
• Emollients (A-Derma, Emolium, Lipikar) are mandatory for atopic dermatitis (emollients that effectively moisturize the skin should be used even during remission);
• Corticosteroid ointments (Triderm, Hydrocortisone, Prednisolone) - with severe symptoms and no effect from other drugs (long-term use of hormonal creams for atopic dermatitis is not recommended);
• Physiotherapy - PUVA therapy - the use of the drug Psolaren and subsequent irradiation with ultraviolet rays gives an excellent therapeutic effect even with severe atopic dermatitis.

Dietary nutrition for atopic dermatitis

Dietary nutrition is mandatory to achieve a speedy recovery. The diet for atopic dermatitis excludes from the menu all conditionally allergenic foods (eggs, fatty fish, nuts, smoked meats and pickles, chocolate, citrus fruits), semi-finished products and finished products containing chemical dyes and preservatives.

You should avoid eating oatmeal and legumes. These products contain nickel, which aggravates atopic dermatitis.

Green apples, lean meat, cereals (especially buckwheat and barley), and cabbage have a beneficial effect on the body in case of skin atopy. Following a diet, especially in childhood, will prevent the development of exacerbations of atopic dermatitis.

Treatment prognosis

Having first appeared in childhood, atopic dermatitis can gradually disappear. Clinical recovery is stated in the absence of relapses for 3 years with a mild course of the disease, 7 years - with severe forms atopy.

However, in 40% of patients, the disease periodically manifests itself even at an older age. At the same time, complications are recorded in 17% of patients: cracked lips, pyoderma, recurrent herpes.

• Seborrheic dermatitis, photo on the face and scalp...
• Contact dermatitis - photos, symptoms and treatment for...

The term “atopy” refers to a genetically determined predisposition to a number of allergic diseases and their combination, arising in response to contact with certain environmental allergens. Similar diseases include chronic atopic dermatitis, also called atopic eczema/dermatitis syndrome and atopic eczema.

Atopic dermatitis is a skin chronic atopic inflammatory disease that develops mainly from early childhood and occurs with exacerbations in response to low doses of specific and nonspecific irritants and allergens, characterized by age-related features of the localization and nature of the lesions, accompanied by severe itching of the skin and leading the sick person to emotional and physical maladjustment.

Causes of atopic dermatitis

Atopic dermatitis develops in 80% of children whose mother and father suffer from this disease; if only one of the parents - 56%; if one of the parents has the disease, and the other has a respiratory pathology of allergic etiology - almost 60%.

Some authors are inclined to believe that allergic predisposition is a consequence of a complex of various genetic disorders. For example, the importance of congenital deficiency of the enzymatic system of the digestive tract has been proven, which leads to inadequate breakdown of incoming products. Impaired intestinal and gallbladder motility, the development of dysbiosis, scratching and mechanical damage to the epidermis contribute to the formation of autoantigens and autosensitization.

The result of all this is:

• absorption of food components unusual for the body;
• formation of toxic substances and antigens;
• dysfunction of the endocrine and immune systems, receptors of the central and peripheral nervous system;
• the production of autoantibodies with the development of the process of autoaggression and damage to the body’s own tissue cells, that is, immunoglobulins are formed, which play a major role in the development of an immediate or delayed atopic allergic reaction.

With age, the importance of food allergens is increasingly minimized. Skin lesions, becoming an independent chronic process, gradually acquire relative independence from food antigens, response mechanisms change, and exacerbation of atopic dermatitis occurs under the influence of:

• household allergens - house dust, fragrances, sanitary household products;
• chemical allergens - soaps, perfumes, cosmetics;
• physical skin irritants - coarse wool or synthetic fabric;
• viral, fungal and bacterial allergens, etc.

Another theory is based on the assumption of such congenital features of the skin structure as insufficient content of the structural protein filaggrin, which interacts with keratins and other proteins, as well as a decrease in lipid synthesis. For this reason, the formation of the epidermal barrier is disrupted, which leads to easy penetration of allergens and infectious agents through the epidermal layer. In addition, a genetic predisposition to excessive synthesis of immunoglobulins, which are responsible for immediate allergic reactions, is assumed.

Atopic dermatitis in adults may be a continuation of the disease from childhood , late manifestation is hidden (latent, without clinical symptoms) ongoing disease or late implementation of a genetically determined pathology (almost 50% of adult patients).

Relapses of the disease occur as a result of the interaction of genetic and provoking factors. The latter include:

• unfavorable ecology and excessive dry air;
• endocrine, metabolic and immune disorders;
• acute infectious diseases and foci of chronic infection in the body;
• complications during pregnancy and immediate postpartum period, smoking during pregnancy;
• long and repetitive psychological stress and stressful conditions, shifting nature of work, long-term sleep disorders, etc.

In many patients, self-treatment of allergic dermatitis with folk remedies, most of which are prepared on the basis of medicinal plants, leads to a pronounced exacerbation. This is explained by the fact that they are usually used without taking into account the stage and extent of the process, the patient’s age and allergic predisposition.

The active components of these products, which have antipruritic and anti-inflammatory effects, are not purified from accompanying elements; many of them have allergenic properties or individual intolerance, and contain tanning and drying substances (instead of the necessary moisturizers).

In addition, self-prepared preparations often contain natural, unrefined vegetable oils and/or animal fats that close the skin pores, which leads to an inflammatory reaction, infection and suppuration, etc.

Thus, theories about the genetic cause and immune mechanism for the development of atopic dermatitis are the main ones. The assumption about the presence of other mechanisms of disease implementation has been only a subject of debate for a long time.

Video: How to find the cause of allergic dermatitis

Clinical course

There is no generally accepted classification of atopic dermatitis and objective laboratory and instrumental methods for diagnosing the disease. The diagnosis is based primarily on clinical manifestations - typical morphological changes in the skin and their location.

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

• infant, developing at the age of 1.5 months and up to two years; Among all patients with atopic dermatitis, this stage is 75%;
• children's (2-10 years of age) - up to 20%;
• adult (after 18 years) - about 5%; The onset of the disease is possible before the age of 55, especially among men, but, as a rule, this is an exacerbation of a disease that began in childhood or infancy.

In accordance with the clinical course and morphological manifestations, the following are distinguished:

1. The initial stage, developing in childhood. It manifests itself like this early signs as limited redness and swelling of the skin of the cheeks and buttocks, which are accompanied by slight peeling and the formation of yellow crusts. In half of children with atopic dermatitis, fatty small flakes of dandruff form on the head, in the area of ​​the large fontanel, as with.
2. The exacerbation stage, consisting of two phases - pronounced and moderate clinical manifestations. It is characterized by severe itching, the presence of erythema (redness), small blisters with serous contents (vesicles), erosions, crusts, peeling, and scratching.
3. The stage of incomplete or complete remission, in which the symptoms of the disease disappear, respectively, partially or completely.
4. The stage of clinical (!) recovery is the absence of symptoms of the disease for 3-7 years (depending on the severity of its course).

Existing conditional classification also includes an assessment of the prevalence and severity of the disease. The prevalence of dermatitis is determined by the area affected:

• up to 10% - limited dermatitis;
• from 10 to 50% - widespread dermatitis;
• over 50% - diffuse dermatitis.

Severity of atopic dermatitis:

1. Mild - skin lesions are local in nature, relapses occur no more than 2 times per year, the duration of remissions is 8-10 months.
2. Moderate - widespread dermatitis, worsens up to 3-4 times within 1 year, remissions last 2-3 months. The nature of the course is quite persistent and difficult to correct with medications.
3. Severe - widespread or diffuse damage to the skin, often leading to severe general condition. Treatment of atopic dermatitis in such cases requires the use of intensive care. The number of exacerbations within 1 year is up to 5 or more with remissions of 1-1.5 months or without them at all.

The course of atopic dermatitis in pregnant women cannot be predicted. Sometimes, against the background of moderate depression of immunity, improvement occurs (24-25%) or there are no changes (24%). At the same time, 60% of pregnant women experience deterioration, most of them before 20 weeks. Deterioration is manifested by physiological or pathological metabolic and endocrine changes and is accompanied by changes in the skin, hair, and nails.

It is also assumed that increased levels of progesterone and some other hormones during pregnancy lead to increased skin sensitivity and itching. Of no less importance are the increase in vascular permeability, the increase in the permeability of the lipid barrier of the skin in the area of ​​the dorsum of the hands and the flexor surface of the forearm, psycho-emotional instability, gestosis of pregnancy, dysfunction of the digestive organs, as a result of which the elimination of toxins from the body slows down.

Symptoms of atopic dermatitis

It is customary to distinguish between main (major) and auxiliary (minor) symptoms. To make a diagnosis of atopic dermatitis, the simultaneous presence of any three main and three auxiliary signs is necessary.

The main symptoms include:

1. The presence of itching of the skin, present even with minimal skin manifestations.
2. The characteristic morphological picture of the elements and their location on the body is dry skin, localization (often) in symmetrical areas on the arms and legs in the area of ​​the flexor surface of the joints. In the affected areas there are macular and papular rashes covered with scales. They are also located on the flexor surfaces of the joints, on the face, neck, shoulder blades, shoulder girdle, as well as on the legs and arms - on their outer surface and in the area of ​​the outer surface of the fingers.
3. The presence of other allergic diseases in the patient himself or his relatives, for example, atopic bronchial asthma (in 30-40%).
4. Chronic nature of the disease (with or without relapses).

Auxiliary criteria (most common):

• onset of the disease in early age(up to 2 years);
• fungal and frequent purulent and herpetic skin lesions;
• positive reactions to allergen testing, increased levels of general and specific antibodies in the blood;
• drug and/or food allergies, occurring in an immediate or delayed (up to 2 days) type;
• Quincke's edema, frequently recurring rhinitis and/or conjunctivitis (in 80%).
• enhanced skin pattern on the palms and soles;
• whitish spots on the face and shoulder girdle;
• excessive dryness of the skin (xerosis) and flaking;
• itching of the skin with increased sweating;
• inadequate response of skin vessels to mechanical irritation (white dermographism);
• dark periorbital circles;
• eczematous changes in the skin around the nipples;
• poor tolerance to woolen products, degreasers and others chemicals and other, less significant symptoms.

Characteristic for adults are frequent relapses atopic dermatitis under the influence of many external factors, moderate and severe nature of the course. The disease may gradually enter a stage of more or less long-term remission, but the skin almost always remains prone to itching, excessive peeling and inflammation.

Atopic dermatitis on the face in adults is localized in the periorbital zone, on the lips, in the area of ​​the wings of the nose, eyebrows (with hair loss). In addition, the favorite localization of the disease is in the natural folds of the skin on the neck, on the dorsum of the hands, feet, fingers and toes, and flexor surfaces in the joint area.

The main diagnostic criteria for skin manifestations of the disease in adults:

1. Severe itching in localized areas.
2. Thickening of the skin.
3. Dryness, flaking and weeping.
4. Strengthening the picture.
5. Papular rashes that eventually transform into plaques.
6. Detachment of significant limited areas of skin (in the elderly).

Unlike children, exacerbations usually occur after neuro-emotional stress and stressful situations, exacerbations of other chronic diseases, or taking any medications.

Skin lesions are often complicated by lymphadenitis, especially inguinal, cervical and axillary, purulent folliculitis and furunculosis, skin damage by herpetic virus and papillomaviruses, and fungal infection. Pallor, softening and loosening of the lips with the formation of transverse cracks (cheilitis), conjunctivitis, periodontal disease and stomatitis, pallor of the skin in the area of ​​the eyelids, nose and lips (due to impaired capillary contractility), and a depressive state often develop.

With increasing age, the lesions become localized, the skin becomes thick and rough, and flakes more.

Video: Atopic dermatitis rules of life

How to treat atopic dermatitis

The goals of therapeutic intervention are:

• maximum reduction in the severity of symptoms;
• ensuring long-term control over the course of the disease by preventing relapses or reducing their severity;
• change in the natural course of the pathological process.

In adult patients with atopic dermatitis, unlike children, only complex treatment is always carried out, based on removing or reducing the effect of provoking factors, as well as on preventing and suppressing allergic reactions and the inflammatory processes in the skin caused by them. It includes:

1. Elimination measures, that is, to prevent the entry into the body and the removal from it of factors of an allergenic or non-allergenic nature that increase inflammation or cause an exacerbation of the disease. In particular, most patients should take vitamins with caution, especially “C” and group “B”, which cause allergic reactions in many. Various diagnostic tests and other studies to identify allergens are necessary in advance.
2. Proper medical and cosmetic care aimed at increasing the barrier function of the skin.
3. The use of external anti-inflammatory therapy, which provides relief from itching, treatment of secondary infection and restoration of the damaged epithelial layer.
4. Treatment of concomitant diseases - foci of chronic infection in the body; allergic rhinitis and conjunctivitis, bronchial asthma; diseases and dysfunctions of the digestive organs (especially the pancreas, liver and gall bladder); complications of dermatitis, for example, neuropsychiatric disorders.

Video about the treatment of atopic dermatitis

The background against which treatment should be carried out is of great importance - this is an individually selected diet for atopic dermatitis of an elimination nature. It is based on the exclusion of foods from the diet:

• causing allergies;
• which are not allergens for a particular patient, but contain biologically active substances (histamine) that provoke or intensify allergic reactions - histamine carriers; these include substances that are part of wild strawberries, soybeans and cocoa, tomatoes, hazelnuts;
• having the ability to release histamine from the cells of the digestive tract (histamine liberins), contained in the juice of citrus fruits, wheat bran, coffee beans, cow's milk.

Therapeutic and cosmetic care for the skin consists of using a daily shower for 20 minutes with a water temperature of about 37 o in the absence of purulent or fungal infection, moisturizing and softening agents - an oil bath with the addition of moisturizing components, cosmetic moisturizing spray, lotion, ointment, cream. They have indifferent properties and are able to reduce inflammation and itching by maintaining skin moisture and preserving corticosteroids in it. Moisturizing creams and ointments (in the absence of weeping) are more effective than spray and lotion in helping to restore the hydrolipidic layer of the skin.

How to relieve skin itching, which often takes on painful forms, especially at night? The basis is systemic and topical antihistamines, since histamine plays a decisive role in the development of this severe sensation. With simultaneous sleep disturbances, first-generation antihistamines in the form of injections or tablets (Diphenhydramine, Suprastin, Clemastine, Tavegil) are recommended, which also have a moderate sedative effect.

However, for long-term basic therapy more effective and convenient (once a day) drugs for the treatment of local and general allergic reactions and itching (2nd generation) - Cetirizine, Loratadine or (better) their new derivative metabolites - Levocetirizine, Desloratadine. Among antihistamines, Fenistil is also widely used in drops, capsules and in the form of a gel for external use.

Local treatment of atopic dermatitis also includes the use of systemic and local drugs containing corticosteroids (Hydrocortoisone, Fluticasone, Triamsinolone, Clobetasol), which have antiallergic, antiedematous, anti-inflammatory and antipruritic properties. Their disadvantage is the formation of conditions for the development of secondary (staphylococcal, fungal) infections, as well as a contraindication for long-term use.

TO medicinal products The second line (after corticosteroids) includes local non-hormonal immunomodulators - calcineurin inhibitors (tacrolimus and pimecrolimus), which suppress the synthesis and release of cellular cytokines that are involved in the formation of the inflammatory process. The effects of these drugs help prevent hyperemia, swelling and itching.

In addition, non-hormonal anti-inflammatory, antibacterial, antifungal or combination drugs. One of the popular products with anti-inflammatory, moisturizing and regenerative properties is Bepanten in the form of an ointment or cream, as well as Bepanten-plus, which additionally contains the antiseptic chlorhexidine.

It is important not only to eliminate subjective symptoms, but also to actively moisturize and soften the affected areas, as well as restore the damaged epidermal barrier. If you do not reduce dry skin, you will not be able to eliminate scratching, cracks, infection and exacerbation of the disease. Moisturizing products include preparations containing urea, lactic acid, mucopolysaccharides, hyaluronic acid, glycerol.

Emollients are various emollients. Emollients for atopic dermatitis are the main external, not only symptomatically, but also pathogenetically targeted means of influencing the disease.

They are various fats and fat-like substances that can be fixed in the stratum corneum. As a result of its occlusion, fluid retention and natural hydration occur. Penetrating deeper into the stratum corneum for 6 hours, they replenish lipids in it. One of these preparations is a multicomponent emulsion (for baths) and cream “Emolium P triactive”, containing:

• paraffin oil, shea butter and macadamia oil, which restore the water-lipid mantle on the surface of the skin;
• hyaluronic acid, glycerin and urea, which are able to bind and retain water, well moisturizing the skin;
• allantoin, corn and rapeseed oils, softening and relieving itching and inflammation.

The current approach to choosing a treatment method for atopic dermatitis is recommended by the International Medical Consensus on Atopic Dermatitis. These recommendations take into account the severity of the disease and are based on the principle of “steps”:

1. Stage I, characterized only by dry skin - removal of irritants, use of moisturizers and emollients.
2. Stage II - minor or moderate signs of atopic dermatitis - local corticosteroids with mild or moderate activity and/or calcineurin inhibitor drugs.
3. Stage III - moderate or quite pronounced symptoms of the disease - corticosteroids of moderate and high activity until the development of the process stops, after which - calcineurin inhibitors.
4. Stage IV, which represents a severe degree of the disease that is not amenable to the effects of the above groups of drugs - the use of systemic immunosuppressants and phototherapy.

Atopic dermatitis in each person is characterized by peculiarities of its course and diagnosis and requires individual approach in the choice of treatment, taking into account the prevalence, forms, stage and severity of the disease.

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 there is such a large number skin diseases. One of the most unpleasant is atopic dermatitis - a chronic inflammatory disease 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 within 16 recent 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 adulthood.

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.

Reasons

- 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 hereditary factor still plays a leading role. 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. Besides 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 medicines based on herbs, 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 form illness, can manifest itself even in the absence of other symptoms, 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 following signs: thickening of the skin, pronounced skin pattern, 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 hat” (thinning of 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 a violation of the integrity of the skin and a 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 hand in hand with food allergies. Therefore, during the period of exacerbation, the patient is prescribed 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 for chronic course illness, and during the period of 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 (indicated only for severe forms and ineffectiveness of other treatment methods);
      • Antibiotics and antiseptics (to combat secondary bacterial infections);
      • 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 are prohibited as antiseptics, as they excessively dry the skin.

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. Maintaining the required temperature and humidity in the room 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 only wear clothing 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 moisturizers and softening agents. cosmetics, which:

• • • • restore the integrity of the epidermis,
      • strengthen barrier functions skin,
      • 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 exposure to 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 exposure of 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 intrauterine development 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.