is a chronic, non-contagious inflammatory skin lesion that occurs with periods of exacerbations and remissions. Manifested by dryness, increased skin irritation and severe itching. It causes physical and psychological discomfort, reduces the patient’s quality of life at home, family and work, and externally presents cosmetic defects. Continuous scratching of the skin leads to secondary infection. Diagnosis of atopic dermatitis is carried out by an allergist and dermatologist. Treatment is based on diet, general and local drug therapy, specific hyposensitization and physiotherapy.
General information
Atopic dermatitis is the most common dermatosis (skin disease), developing in early childhood and maintaining certain manifestations throughout life. Currently, the term “atopic dermatitis” refers to a hereditary, non-contagious, allergic skin disease of chronic relapsing course. The disease is the subject of supervision of specialists in the field of outpatient dermatology and allergology.
Synonyms for atopic dermatitis, also found in the literature, are the concepts of “atopic” or “constitutional eczema”, “exudative-catarrhal diathesis”, “neurodermatitis”, etc. The concept of “atopy”, first proposed by American researchers A. Coca and R. Cooke in 1923, implies a hereditary tendency to allergic manifestations in response to a particular stimulus. In 1933, Wiese and Sulzberg coined the term “atopic dermatitis,” which is now generally accepted, to refer to hereditary allergic skin reactions.
Causes
The hereditary nature of atopic dermatitis determines the widespread prevalence of the disease among related family members. The presence of atopic hypersensitivity (allergic rhinitis, dermatitis, bronchial asthma, etc.) in parents or immediate relatives determines the likelihood of atopic dermatitis in children in 50% of cases. A history of atopic dermatitis in both parents increases the risk of transmitting the disease to the child by up to 80%. The vast majority of initial manifestations of atopic dermatitis occur in the first five years of life (90%) of children, of which 60% occur during infancy.
As the child continues to grow and develop, the symptoms of the disease may not bother or weaken, however, most people live with a diagnosis of atopic dermatitis all their lives. Atopic dermatitis is often accompanied by the development of bronchial asthma or allergies.
The widespread spread of the disease throughout the world is associated with problems common to most people: unfavorable environmental and climatic factors, dietary errors, neuropsychic overload, an increase in infectious diseases and the number of allergic agents. A certain role in the development of atopic dermatitis is played by disturbances in the immune system of children, caused by a shortening of the life span. breastfeeding, early translation to artificial feeding, maternal toxicosis during pregnancy, poor nutrition of women during pregnancy and lactation.
Symptoms of atopic dermatitis
The initial signs of atopic dermatitis are usually observed in the first six months of life. This can be triggered by the introduction of complementary foods or transfer to artificial mixtures. By the age of 14-17, in almost 70% of people the disease goes away on its own, and in the remaining 30% it goes into adult form. The disease may proceed long years, worsening in the autumn-spring period and subsiding in the summer.
According to the nature of the course, acute and chronic stages of atopic dermatitis are distinguished.
The acute stage is manifested by red spots (erythema), nodular rashes (papules), peeling and swelling of the skin, the formation of areas of erosion, weeping and crusts. The addition of a secondary infection leads to the development of pustular lesions.
For chronic stage Atopic dermatitis is characterized by thickening of the skin (lichenification), pronounced skin patterns, cracks on the soles and palms, scratching, and increased pigmentation of the skin of the eyelids. In the chronic stage, symptoms typical of atopic dermatitis develop:
- Morgan's sign - multiple deep wrinkles in children on the lower eyelids
- Symptom of “fur hat” - weakening and thinning of hair on the back of the head
- Symptom of “polished nails” - shiny nails with worn edges due to constant scratching of the skin
- The symptom of “winter foot” is puffiness and hyperemia of the soles, cracks, peeling.
There are several phases in the development of atopic dermatitis: infant (first 1.5 years of life), childhood (from 1.5 years to puberty) and adult. Depending on the age dynamics, features of clinical symptoms and localization of skin manifestations are noted, however, the leading symptoms in all phases remain severe, constant or periodically occurring skin itching.
The infant and childhood phases of atopic dermatitis are characterized by the appearance on the skin of the face, limbs, and buttocks of areas of bright pink erythema, against which bubbles (vesicles) and areas of weeping appear, followed by the formation of crusts and scales.
In the adult phase, foci of erythema are pale pink in color with a pronounced skin pattern and papular rashes. They are localized mainly in the elbow and popliteal folds, on the face and neck. The skin is dry, rough, with cracks and areas of peeling.
In atopic dermatitis there are focal, widespread or universal lesions skin. Areas of typical localization of rashes are the face (forehead, area around the mouth, near the eyes), skin of the neck, chest, back, flexor surfaces of the limbs, inguinal folds, buttocks. Plants that can aggravate the course of atopic dermatitis house dust, animal hair, mold, dry fish food. Often atopic dermatitis is complicated by a viral, fungal or pyococcal infection, and is a background for the development of bronchial asthma, hay fever and other allergic diseases.
Complications
The main reason for the development of complications in atopic dermatitis is constant trauma to the skin as a result of scratching. Violation of the integrity of the skin leads to a decrease in its protective properties and contributes to the addition of a microbial or fungal infection.
The most common complication of atopic dermatitis is bacterial skin infections - pyoderma. They manifest themselves as pustular rashes on the body, limbs, and scalp, which dry out and form crusts. At the same time, general well-being often suffers, and body temperature rises.
The second most common complication of atopic dermatitis is viral skin infections. Their course is characterized by the formation of bubbles (vesicles) filled with clear liquid on the skin. The causative agent of viral skin infections is the herpes simplex virus. The most commonly affected area is the face (skin around the lips, nose, ears, on the eyelids, cheeks), mucous membranes (conjunctiva of the eyes, oral cavity, throat, genitals).
Complications of atopic dermatitis are often fungal infections caused by yeast-like fungi. The affected areas in adults are often skin folds, nails, hands, feet, hairy part head, in children - oral mucosa (thrush). Often fungal and bacterial infections are observed together.
Treatment of atopic dermatitis
Treatment of atopic dermatitis is carried out taking into account the age phase, severity of the clinic, concomitant diseases and is aimed at:
- exclusion of allergic factor
- desensitization (reduced sensitivity to allergen) of the body
- itching relief
- detoxification (cleansing) of the body
- removal of inflammatory processes
- correction of identified concomitant pathology
- prevention of relapses of atopic dermatitis
- combating complications (if an infection occurs)
Used to treat atopic dermatitis different methods and medications: diet therapy, PUVA therapy, acupuncture, specific hyposensitization, laser treatment, corticosteroids, allergoglobulin, cytostatics, sodium cromoglycate, etc.
Diet therapy
Regulating nutrition and following a diet can significantly improve the condition and prevent frequent and severe exacerbations of atopic dermatitis. During periods of exacerbation of atopic dermatitis, a hypoallergenic diet is prescribed. At the same time, fried fish, meat, vegetables, rich fish and meat broths, cocoa, chocolate, citrus fruits, black currants, strawberries, melon, honey, nuts, caviar, and mushrooms are removed from the diet. Products containing dyes and preservatives are also completely excluded: smoked meats, spices, canned food and other products. For atopic dermatitis, a hypochloride diet is indicated - limiting the amount of table salt consumed (however, not less than 3 g of NaCl per day).
In patients with atopic dermatitis, there is a violation of synthesis fatty acids, therefore diet therapy should include nutritional supplements saturated with fatty acids: vegetable oils (olive, sunflower, soybean, corn, etc.), linoleic and linolenic acids (vitamin F-99).
Drug treatment
A significant disadvantage of first-generation antihistamines (mebhydrolin, clemastine, chloropyramine, hifenadine) is the rapidly developing addiction of the body. Therefore, these medications must be changed every week. The pronounced sedative effect, leading to a decrease in concentration and impaired coordination of movements, does not allow the use of first-generation drugs in the pharmacotherapy of people of certain professions (drivers, students, etc.). Due to the atropine-like side effects, a number of diseases are contraindications to the use of these drugs: glaucoma, bronchial asthma, prostate adenoma.
Significantly safer in the treatment of atopic dermatitis in persons with concomitant pathology use of second generation antihistamines (loratadine, ebastine, astemizole, fexofenadine, cetirizine). They do not become addictive, and there are no atropine-like side effects. The most effective and safest antihistamine used to date in the treatment of atopic dermatitis is loratadine. It is well tolerated by patients and is most often used in dermatological practice for the treatment of atopy.
To alleviate the condition of patients with severe attacks of itching, drugs affecting the autonomic and central nervous systems (hypnotics, sedatives, tranquilizers) are prescribed. The use of corticosteroid drugs (methylprednisolone or triamcinolone) is indicated for limited and widespread skin lesions, as well as for severe, unbearable itching that is not relieved by other medications. Corticosteroids are prescribed for several days to relieve acute attack and are canceled with a gradual dose reduction.
In severe cases of atopic dermatitis and severe symptoms of intoxication, intravenous infusion of infusion solutions is used: dextran, salts, saline, etc. In some cases, it is advisable to carry out hemosorption or plasmapheresis - methods of extracorporeal blood purification. With the development of purulent complications of atopic dermatitis, the use of antibiotics is justified wide range actions in age-specific dosages: erythromycin, doxycycline, metacycline for 7 days. When a herpetic infection occurs, they are prescribed antiviral drugs- acyclovir or famciclovir.
If the complications are recurrent (bacterial, viral, fungal infections) immunomodulators are prescribed: solusulfone, thymus preparations, sodium nucleinate, levamisole, inosine pranobex, etc. under the control of blood immunoglobulins.
External treatment
The choice of external therapy method depends on the nature inflammatory process, its prevalence, the patient’s age and the presence of complications. At acute manifestations For atopic dermatitis with weeping surfaces and crusts, disinfectant, drying and anti-inflammatory lotions (infusion of tea, chamomile, Burov's liquid) are prescribed. When stopping an acute inflammatory process, pastes and ointments with antipruritic and anti-inflammatory components are used (ichthyol 2-5%, tar 1-2%, naftalan oil 2-10%, sulfur, etc.). The leading drugs for external therapy of atopic dermatitis remain corticosteroid ointments and creams. They have antihistamine, anti-inflammatory, antipruritic and decongestant effects.
Light treatment of atopic dermatitis is an auxiliary method and is used when the disease is persistent. Ultraviolet irradiation procedures are carried out 3-4 times a week and practically do not cause adverse reactions (except for erythema).
Prevention
There are two types of prevention of atopic dermatitis: primary, aimed at preventing its occurrence, and secondary, anti-relapse prevention. Measures for the primary prevention of atopic dermatitis should begin during the period intrauterine development child, long before his birth. A special role during this period is played by toxicosis of the pregnant woman, taking medications, and occupational and food allergens.
Particular attention to the prevention of atopic dermatitis should be paid in the first year of a child’s life. During this period, it is important to avoid excessive medication and artificial feeding, so as not to create a favorable background for the body’s hypersensitivity to various allergic agents. Following a diet during this period is no less important for a nursing woman.
Secondary prevention aims to prevent exacerbations of atopic dermatitis, and, if they occur, to facilitate their course. Secondary prevention of atopic dermatitis includes correction of identified chronic diseases, exclusion of exposure to disease-provoking factors (biological, chemical, physical, mental), adherence to hypoallergenic and elimination diets, etc. Prophylactic use of desensitizing drugs (ketotifen, sodium cromoglycate) during periods of probable exacerbations (autumn, spring) allows you to avoid relapses. As anti-relapse measures for atopic dermatitis, treatment is indicated in the resorts of the Crimea, the Black Sea coast of the Caucasus and the Mediterranean.
Particular attention should be paid to issues daily care for skin and the right choice linen and clothes. When taking a daily shower, you should not wash yourself. hot water with a washcloth. It is advisable to use gentle hypoallergenic soaps (Dial, Dove, baby soap) and a warm shower, and then gently pat the skin with a soft towel without rubbing or injuring it. The skin should be constantly moisturized, nourished and protected from adverse factors (sun, wind, frost). Skin care products should be neutral and free of fragrances and dyes. In underwear and clothing, preference should be given to soft natural fabrics, Not itchy and irritation, and also use bedding with hypoallergenic fillers.
Forecast
Children suffer the most severe manifestations of atopic dermatitis; with age, the frequency of exacerbations, their duration and severity become less pronounced. Almost half of patients recover by the age of 13-14 years. Clinical recovery is considered a condition in which there are no symptoms of atopic dermatitis for 3–7 years.
Periods of remission in atopic dermatitis are accompanied by subsidence or disappearance of symptoms of the disease. The time interval between two exacerbations can range from several weeks to months and even years. Severe cases of atopic dermatitis occur with virtually no clear intervals, constantly relapsing.
The progression of atopic dermatitis significantly increases the risk of developing bronchial asthma, respiratory allergies and other diseases. Extremely for atopics important point is the choice of professional field of activity. They are not suitable for professions that involve contact with detergents, water, fats, oils, chemicals, dust, animals and other irritating agents.
Unfortunately, it is impossible to completely protect yourself from the influence environment, stress, illness, etc., which means that there will always be factors that aggravate atopic dermatitis. However, Attentive attitude to your body, knowledge of the characteristics of the course of the disease, timely and active prevention can significantly reduce the manifestations of the disease, extend periods of remission for many years and improve the quality of life. And under no circumstances should you try to treat atopic dermatitis on your own. This can cause complicated variants of the course of the disease and severe consequences. Treatment of atopic dermatitis should be carried out
– hereditary non-communicable disease skin, allergic in nature, may be chronic. According to statistics, the disease most often occurs in members of the same family. If one of your relatives or parents has diseases such as , or atopic dermatitis , the probability of transmitting the disease to a child by inheritance is 50%. In the case when both parents are sick, the probability of heredity increases to 80%. Sometimes the presence of asthma alone in parents can cause atopic dermatitis in a child.
Causes of atopic dermatitis
Manifestations of the disease in the first year of life are most often associated with the introduction of complementary foods into the child’s diet. Allergenic products include cow's milk, eggs and fish, so it is not recommended to introduce them into complementary foods until 10-12 months. Call allergic reactions Artificial mixtures can also.
In approximately 70% of patients, the disease resolves in adolescence, for the rest it passes into the adult form, in which exacerbations are replaced by remissions for a short time, and then the disease worsens again. In adults, allergens include house dust, animal hair, mold, and plants; symptoms also vary slightly.
Thus, the main causes of atopic dermatitis are allergic in nature and are a reaction to contact or consumption of certain substances - .
Symptoms of atopic dermatitis
In most cases, the disease manifests itself during the first five years of life, with the peak occurring in the first year. In adulthood, the symptoms of atopic dermatitis may disappear or weaken, but in half of the cases they persist throughout life. The disease may be accompanied by diseases such as bronchial asthma and .
IN mandatory drugs with anti-inflammatory effects are used. These can be corticosteroids, as well as sedatives, various sedative herbal mixtures, peony, and others.
For external use, antiseptics such as Fukartzin , . To maintain the general condition of the patient, a complex of vitamins and microelements is prescribed, and hardening is recommended.
In case of secondary infections, drugs are prescribed depending on the type of pathogen. Additionally prescribed enzyme preparations for disorders of the pancreas and eubiotics. At acute stage For oozing, wet-dry dressings and corticosteroid aerosols are used.
The most important condition, without which the treatment of atopic dermatitis cannot be effective, is not to rub or comb the skin. Like some others skin diseases it is accompanied by unbearable itching, which is very difficult to tolerate. By scratching the lesions, patients cause exacerbations and complications of the disease, and in this case all medications will be useless.
If you or your child have symptoms of atopic dermatitis only initial stage– this is not a reason to self-medicate. You should definitely contact a dermatologist.
Complications of this disease can lead to severe infectious diseases. It is necessary to strictly follow the doctor’s instructions, adhering to his recommendations in everyday life, this is the only way to avoid constant exacerbations.
The doctors
Medicines
People who have atopic dermatitis, you have to be more careful and attentive to your lifestyle, and devote more time to your home. There should be no objects accumulating dust in the house, as it is the main allergen. The room should have a minimum of carpets and upholstered furniture, all surfaces should be easy to wet clean, which is carried out as often as possible, but without chemical detergents. You should ventilate your home more often by installing mesh on the windows to prevent pollen from entering the house. Concerning bedding, then they must be with synthetic fillers; the use of down and feathers is unacceptable. In other words, for people prone to the disease, prevention of atopic dermatitis is aimed at minimizing contact with allergens.
Clothing should be easily breathable so that the skin can breathe. Clothes made of wool, nylon and polyester are not the best option, as it increases itching and irritates the skin. Can not use hot water When washing, only warm. After washing, you should blot your skin rather than dry it. Be sure to use cosmetics to moisturize and care for skin. They must be neutral and free of dyes, fragrances and preservatives. That is, additionally, the prevention of atopic dermatitis includes measures to prevent mechanical irritation of damaged areas.
No less important for the prevention and timely treatment chronic diseases, taking vasoconstrictor drugs and sedatives before important events. Should be avoided in diet allergenic products even during periods of remission of the disease.
Complications of atopic dermatitis
The most common complications of atopic dermatitis are caused by secondary infections. This occurs when scratching the skin, which leads to a violation of its protective properties.
Damaged areas are exposed to microbial and fungal flora, as well as viral infections. Secondary infections complicate treatment of atopic dermatitis, causing new lesions and negatively affecting the general condition of the patient.
Pyoderma, that is, a bacterial infection, which is characterized by the appearance of pustules that gradually dry out and form crusts, is ahead of other complications of atopic dermatitis in terms of frequency of occurrence. The disease is accompanied by disturbances in general condition, fever, and itching. The rash can occur all over the body and on the scalp.
It can also often be a complication viral infection caused by a simple virus. The same virus causes . Bubbles with liquid form on the skin, which are localized not only around the affected area, but also on healthy skin. Often, blisters appear on the mucous membranes of the mouth, throat, conjunctiva and genitals. Fungal infections affect the skin, nails, scalp, feet and hands. In children, such complications more often have symptoms, and the oral mucosa is affected. The curdled coating is often accompanied by redness and itching.
Diet, nutrition for atopic dermatitis
List of sources
- Atopic dermatitis // Pediatrics / Ed. A.A. Baranova. - GEOTAR-Media, 2009. - T. 2.
- “Handbook of skin and venereal diseases” by A.N. Rodionov, 2005.
- "Diagnostics of skin diseases." B.A. Berenbein, A.A. Studnitsin, 1996.
Education: Graduated from Vitebsk State medical University specialty "Surgery". At the university he headed the Council of the Student Scientific Society. Advanced training in 2010 - in the specialty "Oncology" and in 2011 - in the specialty "Mammology, visual forms of oncology".
Experience: Worked in a general medical network for 3 years as a surgeon (Vitebsk Emergency Hospital, Liozno Central District Hospital) and part-time as a district oncologist and traumatologist. Worked as a pharmaceutical representative for a year at the Rubicon company.
Presented 3 rationalization proposals on the topic “Optimization of antibiotic therapy depending on the species composition of microflora”, 2 works were taken top places in the republican competition-show of student scientific works(categories 1 and 3).
Leather- this is the most vulnerable organ that performs an important protective function and is constantly exposed to adverse effects from the environment. It is for this reason that the number of skin diseases is so high. One of the most unpleasant is atopic dermatitis - a chronic inflammatory disease 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.
Causes
– hereditary disease. The word "atopy" is translated from Latin as "strangeness." And in modern medicine that’s what they call it 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 important for immune system immunoglobulin proteins IgE 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 chronic diseases Gastrointestinal tract, reducing intestinal barrier function:
- Dysbacteriosis,
- Gastroduodenitis,
- Pancreatitis,
- Biliary dyskinesia.
However, the leading role still plays hereditary factor. The disease develops in 4 out of 5 cases when both parents suffer from it. If only one parent is sick, then the probability of illness in the child also remains quite high - 55%. The presence of allergic respiratory diseases in the other parent increases this figure. The disease is more often transmitted through the maternal side than through the paternal side. Moreover, the disease can also occur in children born from healthy parents who did not have atopic dermatitis even in childhood.
Racial factors also influence the development of the disease - it is more common in children with fair skin.
The development of atopic dermatitis in infancy In addition to heredity, other factors contribute:
- Lack of breastfeeding or too early transfer to artificial feeding,
- Toxicosis of pregnancy in the mother,
- Improper nutrition of the mother during pregnancy or lactation.
Less significant, but also contributing factors to the disease in children:
- high air temperature leading to increased sweating;
- weak immunity;
- presence of stress;
- poor skin hygiene or, conversely, too frequent washing.
In early childhood, food allergens most often act as irritants. These can be substances that come from food or from breast milk(for nursing women).
In adult patients, the list of allergens can be much wider. In addition to food allergens, irritants can be:
- House dust,
- Medicines,
- Household chemicals,
- Cosmetics,
- plant pollen,
- Bacteria and fungi,
- Pet hair.
Factors contributing to the manifestation of atopic dermatitis in adults:
- Poor environmental conditions;
- Endocrine diseases;
- Metabolic diseases;
- Acute infectious diseases;
- Complicated pregnancy;
- Sleep disorders, stress, psychological stress.
Often the disease is aggravated by self-medication, including with the help of 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, 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 smaller bright 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 cap” (thinning hair on the back of the head),
- polished nails (due to constant scratching of the skin),
- “winter foot” (cracks, redness and peeling of the skin of the soles).
Also, patients with atopic dermatitis are often characterized by disorders of the central and autonomic nervous systems - depressive states, increased reactivity of the autonomic nervous system. Gastrointestinal disorders may also occur:
- Malabsorption syndrome,
- Enzyme deficiency.
Diagnostics
Diagnosis begins with an examination of the patient by a doctor. He needs to separate atopic dermatitis from others allergic dermatitis, as well as from dermatitis of non-allergic nature.
For diagnostic purposes, doctors have identified a set of main and auxiliary manifestations of atopic dermatitis.
Main features:
- Specific affected areas are the flexor surfaces of the joints, face, neck, fingers, shoulder blades, shoulders;
- Chronic course with relapses;
- Presence of patients in the family history;
Auxiliary signs:
- Early onset of the disease (up to 2 years);
- Macular and papular rashes covered with scales;
- Increased levels of IgE antibodies in the blood;
- Frequent rhinitis and conjunctivitis;
- Frequent infectious skin lesions;
- Distinct pattern of the skin of the soles and palms;
- Whitish spots on the face and shoulders;
- Excessive dry skin;
- Increased sweating;
- Peeling and itching after a bath (in children under 2 years of age).
- Dark circles around the eyes
To make a diagnosis of atopic dermatitis, it is necessary that the patient has at least 3 main signs and at least 3 auxiliary signs.
A blood test reveals eosinophilia, a decrease in the number of T-lymphocytes, and an increase in the number of B-lymphocytes.
Also, during diagnosis, skin prick tests for allergens can be performed, and urine and stool tests can be taken.
Complications
Complications of atopic dermatitis most often occur due to scratching of the skin. This leads to disruption of the integrity of the skin and weakening of its barrier functions.
Complications of atopic dermatitis:
- Lymphadenitis (cervical, inguinal and axillary),
- Purulent folliculitis and furunculosis,
- Multiple papillomas,
- Fungal and bacterial skin lesions,
- Heilite,
- Stomatitis and periodontal disease,
- Conjunctivitis,
- Depression.
How to treat atopic dermatitis?
There is no one way or cure to cure dermatitis. This disease requires complex treatment.
The disease is treated by a dermatologist or allergist. You may need to consult an endocrinologist or gastroenterologist.
Treatment has the following goals:
- Achieving remission
- Reducing the severity of symptoms and inflammatory processes,
- Prevention of severe forms of dermatitis and respiratory manifestations of allergies,
- Improving the quality of life of patients and restoring their ability to work.
Measures to treat the disease:
- Preventing the entry of identified allergens into the body,
- Increased skin barrier function,
- Anti-inflammatory treatment,
- Treatment of concomitant diseases (asthma, rhinitis, conjunctivitis, bacterial, fungal and viral infections),
- Reducing the body's sensitivity to allergens (desensitization),
- Detoxification of the body.
Diet therapy
Dermatitis often goes side by side with food allergies. Therefore, during the period of exacerbation, the patient is prescribed a hypoallergenic diet. However, in the chronic phase of the disease, the diet must also be followed, although not in such a strict form.
It is necessary to exclude from the patient’s diet both foods containing potential allergens - fish and seafood, soy, nuts, eggs, and foods containing an increased amount of histamine - cocoa, tomatoes. Products containing dyes and preservatives, and semi-finished products are removed from the diet. The amount of salt is limited (no more than 3 g per day). Fried foods are contraindicated. The diet should contain an increased amount of fatty acids, primarily those contained in vegetable oils. Lean meat, vegetables, and cereals are also shown.
Drug treatment
The list of drugs used for treatment depends on the severity of the disease. Most often used antihistamines first and second generation, 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 - using antiviral drugs based on acyclovir.
Anti-inflammatory treatment may include corticosteroid medications, both topical and oral. Glucocorticosteroids are prescribed orally only during exacerbation of the disease. In the form of ointments, GCS are used both in the chronic course of the disease and during exacerbation. Also applicable combination drugs(GCS + antibiotic + antifungal agent).
Despite the high effectiveness of corticosteroids, it should be remembered that they have many side effects. In particular, they can have a negative impact on internal organs with prolonged use, they cause drug dependence. The most commonly used ointments contain glucocorticosteroid drugs such as Hydrocortisone, Dexomethasone, Prednisolone.
Oil-based emollients and moisturizers (emollients) are prescribed externally. If there is exudation, lotions are used (tincture of oak bark, solutions of rivanol and tannin).
Also applicable:
- Calceneurin inhibitors;
- Membrane stabilizing drugs;
- Vitamins (primarily B6 and B15) and polyunsaturated fatty acids;
- Drugs for the treatment of gastrointestinal diseases (enzyme preparations, drugs against dysbacteriosis, enteric agents);
- Immunomodulators (only indicated for severe forms and ineffectiveness of other treatment methods);
- Antibiotics and antiseptics (to combat secondary bacterial 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, as they dry out the skin excessively.
Dependence of the choice of treatment methods on the severity of symptoms
Non-drug methods
From non-drug methods It should be noted the maintenance of an optimal indoor microclimate, proper selection of clothing, and nail care. Maintenance required temperature and indoor humidity reduces skin irritation and sweating. The optimal temperature for patients with atopic dermatitis is +20-22°C during the day and +18-20°C at night, the optimal humidity is 50-60%. People suffering from dermatitis should wear clothes only made from natural materials (cotton, linen, flannel, bamboo).
It is necessary to stop using household chemicals that cause irritation: varnishes, paints, floor and carpet cleaners, washing powder, etc.
An important element of therapy is skin care, including the use of 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 irritants.
- reduce the amount of stress;
- carry out daily wet cleaning of the premises;
- remove from the room items that cause dust accumulation, such as carpets;
- do not keep pets at home, especially those with long hair;
- limit intense physical activity;
- use hypoallergenic cosmetics;
- Avoid exposing the skin to cold, direct sunlight, tobacco smoke, burns.
To wash the body, it is necessary to use detergents with a low pH (especially during an exacerbation period). It is not recommended to wash the main areas of skin damage during the acute phase of the disease with water. To do this, it is better to use disinfectant lotions or swabs with vegetable oils. During the period of remission, the washing technique should also be gentle. It is advisable to do this process without a washcloth.
Physiotherapy (irradiation with UV rays) is also used as an aid. In severe cases, blood plasmaphoresis can be used.
Forecast
If the treatment is chosen correctly, the prognosis of the disease is favorable. In 65% of children, the signs of atopic dermatitis completely disappear in the youngest age school age(by 7 years), in 75% - in adolescence (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 fetal development of the baby. It should be remembered that factors such as taking certain medications and toxicosis of pregnancy play a role in the development of the disease. Also, in terms of prevention, the first year of a child’s life is important. A nursing mother must follow a diet to avoid exposure to allergens on the baby’s body, and the child should be switched to artificial feeding as late as possible.
Secondary prevention is measures aimed at preventing relapses of the disease. Proper skin care, wearing clothes made from natural fabrics, and using hypoallergenic detergents, maintaining cleanliness in the room.
People suffering from atopic dermatitis should avoid work involving chemicals, dust, changes in temperature and humidity, and contact with animals.
Usually people think about this disease in the spring and autumn, during the off-season. But now it’s winter, not winter, and that’s why outbreaks of atopic dermatitis are right here. This disease has many names: constitutional eczema... But the essence is the same: a hereditary, immune-allergic disease. Is it possible to get rid of the disease forever and how?
Strange manifestations of atopic dermatitis
Atopic dermatitis (from the Greek "atopos" - strange, wonderful) is a truly strange phenomenon. Sometimes an exacerbation is preceded by severe stress, and immediately the neck and arms become covered with eczema - an itchy, weeping crust, which is not so easy to get rid of. In addition to the neck and elbow bends of the arms, favorite places for localization of itchy crusts are the skin around the eyes, mouth (cheilitis), in the area of the earlobes, and popliteal fossae. The area of skin damage can be completely local.
Where else does atopic dermatitis live?
But atopic dermatitis, as a rule, is not limited to one skin. Often, skin lesions are accompanied by a respiratory syndrome, reminiscent in its manifestations of attacks of bronchial asthma. Often such patients (in childhood) are unsuccessfully treated for adenoids. Until the sufferer gets an appointment with... an allergist-dermatologist. Such combined forms of the disease in Lately are occurring more and more often, which most experts attribute to the deteriorating environmental situation.
When the disease appears
As a rule, the disease manifests itself in early childhood, but can also appear in adulthood, either fading or reappearing. Anything can serve as an impetus for aggravation: puberty(in childhood), emotional overload (for the same children, outbreaks of atopic dermatitis often coincide with the first entry into kindergarten and school). As well as taking antibiotics, eating disorders, etc. The disease is often seasonal. Spring and autumn for atopics are the most difficult time, which many experts associate with weather changes (autumn) and the flowering period of pollen-bearing plants (spring). Well, now that we have winter - not winter, but something like March, don’t be surprised if the disease manifests itself “in all its glory”
Atopic dermatitis is a multifactorial disease
However, despite the similarity of development mechanisms, atopic dermatitis is not a purely allergic disease, as it might seem at first glance. This disease is multifactorial. Atopic dermatitis may be based on hereditary weakness of the endocrine, nervous and/or immune systems. Everyone has their own Achilles heel, which only an experienced doctor can determine. Along with a visual examination and analysis of the patient’s complaints, a specific allergological examination, a study of the immune status, a stool test for dysbacteriosis, etc. helps to reveal the truth.
How to treat atopic dermatitis
The success of treatment, which is purely individual in each specific case, depends on the competent actions of the doctor. Long-acting antihistamines help some, while others hormonal agents(in the form of ointments or sprays - for respiratory manifestations of the disease), the third - immunostimulants or, conversely, immunosuppressants that suppress excessive activity of the immune system. And for some, the only salvation from exacerbations of the disease is moving to another climate zone with a dry, warm climate. It has been noticed that sun rays suppress the activity of complexes that form the atopic reaction. The main method of physiotherapy for atopic dermatitis is based on the same principle - selective phototherapy, which looks like a solarium. Only in contrast to this popular cosmetic procedure, phototherapy uses mid-wave (UVB) and long-wave (UVA) ultraviolet rays, which have a milder effect . In especially severe cases, when eczema covers the entire body, they resort to a more serious version of this procedure, using photosensitizers (substances that enhance the effects of ultraviolet rays) . Fortunately, such situations rarely arise.
How not to start the disease
The sooner you start fighting the disease, the better. Without adequate treatment Atopic dermatitis is fraught with quite serious consequences, ranging from infection of skin areas affected by eczema to the development of bronchial asthma. Often people suffering from atopic dermatitis contract new diseases. Losing yours protective functions, their skin becomes especially vulnerable to molluscum contagiosum, flat warts, fungal and others skin infections. Against the background of atopic dermatitis, psychological disorders, neuroses. In this case, you cannot do without modern antidepressants, which are prescribed not only to adults, but also to children.
How to learn to live with illness
Unfortunately, it is impossible to completely get rid of atopic dermatitis. In some cases, the disease may seem to “fall asleep”, but then flare up again. You need to learn to live with this disease. How? Trying to lead a measured lifestyle, avoiding stressful situations, traveling to the south every year (to a hot, dry climate), and in the off-season to a sanatorium. Outside of an exacerbation, the entire spectrum is useful spa procedures(except for mud applications). Acupuncture, electrophoresis with diphenhydramine, novocaine also have a good preventive and therapeutic effect for atopic dermatitis.
Diet is secondary
But following a diet for atopic dermatitis, as a rule, is of a secondary nature. Patients and their loved ones (if we are talking about a child) usually know themselves which foods they should avoid. True, you need to eat often and in small portions, trying to ensure that your diet contains foods that promote good digestion (constipation is a frequent companion to this disease).
How important it is to avoid self-medication
Recently, self-medication has become very common. In the case of atopic dermatitis, this can have fatal consequences. Especially when it comes to hormonal drugs. If they are used inadequately and if they are abruptly discontinued, you can get an even greater exacerbation of the disease than before taking them. Not to mention serious side effects a therapy that can only be prescribed by a doctor. The leading doctor for patients with atopic dermatitis should be a dermatologist, interacting with an allergist and other specialists (neurologist, gastroenterologist).
Start your treatment in your apartment
Often the source of torment for the patient is in... his own apartment:
Try to keep it clean, especially if there are animals in the house. In this case, you cannot do without frequent wet cleaning. Prevent mold from forming in the kitchen and bathroom. Try to reduce contact with household products. Remove carpets from walls and floors, and thick curtains from windows; do not pile up books or keep them in glass cabinets.
