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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. Much less often, the first manifestations of atopic dermatitis occur in adulthood.

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

Causes of atopic dermatitis

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

Theories for the development of atopic dermatitis are:

• theory of allergic genesis;
• genetic theory of atopic dermatitis;
• theory of 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 the clinical picture of 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 pollen allergens become of great importance. Pollen allergies among adults occur in 65 percent of cases. Household allergens are in second place (30 percent); epidermal and fungal allergens are in third place.

Frequency of different types of allergens in atopic dermatitis

Genetic theory of atopic dermatitis

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

Theory of impaired cellular immunity

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

Risk factors for atopic dermatitis

These factors significantly increase the risk of developing atopic dermatitis. They also influence the severity and duration of the disease. Often, the presence of one or another risk factor is the mechanism that delays the remission of atopic dermatitis. For example, pathology 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 a protective function of the body. This function is realized thanks to the abundant intestinal lymphatic system, intestinal flora and immunocompetent cells that it contains. A healthy gastrointestinal system ensures that pathogenic bacteria are neutralized and eliminated from the body. The lymphatic vessels of the intestine also contain a large number of immune cells, which at the right time resist infections. Thus, the intestines are a kind of link in the chain of immunity. Therefore, when there are various pathologies at the level of the intestinal tract, this primarily affects the human immune system. Proof of this is the fact that more than 90 percent of children with atopic dermatitis have various functional and organic pathologies of the gastrointestinal tract.

Gastrointestinal diseases that most often accompany atopic dermatitis include:

• biliary dyskinesia.

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

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

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

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

Risk factors are also living conditions, namely the temperature and humidity of the room in which a person lives. Thus, temperatures above 23 degrees and humidity below 60 percent negatively affect the condition of the skin. Such living conditions reduce the resistance (resistance) of the skin and trigger immune mechanisms. The situation is aggravated by the irrational use of synthetic detergents, which can enter the human body through the respiratory tract. Soap, shower gel and other hygiene products act as 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 at 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 looks like 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 is milky crusts that form on the eyebrows and scalp of the child. Beginning at the age of 2–3 months, these signs reach their maximum development by 6 months. In the first year of life, atopic dermatitis goes away with virtually no remissions. In rare cases, atopic dermatitis begins at one year of age. In this case, it reaches its maximum development by 3–4 years.

Atopic dermatitis in infants

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

What does skin look like with atopic dermatitis?

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

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

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

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

Atopic dermatitis on the face

Manifestations of atopic dermatitis on the skin of the face are not always found. Skin changes affect the facial skin in the eczematous form of atopic dermatitis. In this case, erythroderma develops, which in young children affects mainly the cheeks, and in adults also the nasolabial triangle. Young children develop 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 at which the rashes first appeared is taken into account. Children are characterized by the development of erythema in the cheeks and upper half of the body, while in adults, foci of lichenification predominate (thickening of the skin, disturbed pigmentation). Also, after adolescence, dense, isolated papules begin to appear.
• Recurrent (wavy) course of the disease - with periodic exacerbations in the spring-autumn period and remissions in the summer.
• The presence of a concomitant atopic disease (for example, atopic asthma, allergic rhinitis) is an additional diagnostic criterion in favor of atopic dermatitis.
• The presence of a similar pathology among family members - that is, the hereditary nature of the disease.
• Increased dry skin (xeroderma).
• Increased pattern on the palms (atopic palms).

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

Additional signs of atopic dermatitis are:

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

Tests for atopic dermatitis

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

Laboratory signs of atopic dermatitis are:

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

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

Severity of atopic dermatitis

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

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

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

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

The degrees of activity of atopic dermatitis include:

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

Before use, you should consult a specialist.

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

What is atopic dermatitis

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

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

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

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

Development factors

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

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

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

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

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

Features of the course in adults

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

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

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

Treatment of atopic dermatitis in adults

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

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

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

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

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

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

Acute period

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

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

Remission period

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

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

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

Drug treatment

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

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

Glucocorticosteroids

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

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

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

Antihistamines

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

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

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

Immunosuppressants of the macrolide class

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

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

Moisturizers

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

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

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

Tablets for atopic dermatitis in adults

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

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

Membrane stabilizing drugs

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

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

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

Sedatives

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

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

Drugs to normalize intestinal function

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

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

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

Hyposensitizing agents

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

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

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

Calcium gluconate

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

Sodium thiosulfate

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

Prednisolone

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

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

External therapy

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

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

Antibacterial ointments for secondary infection

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

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

Physiotherapeutic procedures

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

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

Vitamins

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

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

Folk remedies

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

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

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

Raw potato compress

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

Antipruritic ointment made from chamomile and fireweed

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

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

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

Herbal decoction for oral administration

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

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

Sanatorium-resort treatment of dermatitis in adults

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

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

Diet therapy

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

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

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

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

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

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

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

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

What is atopic dermatitis?

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

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

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

Interesting fact:

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

In some patients, the first symptoms of atopic dermatitis are observed in childhood, while in others the disease is latent and first appears only in 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 skin's barrier functions and to the fact that skin irritating agents penetrate 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. In addition to food allergens, irritants can be:

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

Factors contributing to the manifestation of atopic dermatitis in adults:

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

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

Stages and types of disease

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

• Infant,
• Children's,
• Adult.

Disease stages, age and prevalence

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

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

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

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

Sometimes dermatitis is combined with other allergic diseases:

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

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

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

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

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

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

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

Symptoms

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

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

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

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

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

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

• Morgana (deep wrinkles on the lower eyelids),
• “fur 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 disruption of the integrity of the skin and weakening of its barrier functions.

Complications of atopic dermatitis:

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

How to treat atopic dermatitis?

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

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

Treatment has the following goals:

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

Measures to treat the disease:

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

Diet therapy

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

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

Drug treatment

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

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

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

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

Despite the high effectiveness of corticosteroids, it should be remembered that they have many side effects. In particular, they can negatively affect internal organs with prolonged use and 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 wear clothes only made from natural materials (cotton, linen, flannel, bamboo).

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

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

• • • • restore the integrity of the epidermis,
      • strengthen the barrier functions of the 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 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 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, 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.

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

What is it?

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

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

Causes

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

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

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

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

Provoking factors

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

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

Stages of disease development

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

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

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

Classification

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

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

Disease development phase

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

Age

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

The extent of the inflammatory process

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

Change in general condition

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

Main symptoms and signs

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

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

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

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

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

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

Diagnostics

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

General blood test

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

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

Biochemical research

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

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

Quantitative determination of immunoglobulin E

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

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

Special allergy tests

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

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

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

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

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

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

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

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

Determination of specific antibodies

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

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

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

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

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

Principles of basic treatment

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

During an exacerbation

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

During remission

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

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

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

Drug therapy

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

Local treatment

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

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

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

Are water treatments allowed?

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

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

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

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

What to eat?

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

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

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

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

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

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

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

How to properly organize your daily routine?

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

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

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

Possibilities of spa treatment

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

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

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

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

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

Complications

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

The most common symptoms of atopic dermatitis are:

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

Is disability established?

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

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

Prevention of exacerbations

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

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

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

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

– a hereditary non-infectious skin disease of an allergic nature, which can 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. Artificial mixtures can also cause allergic reactions.

In approximately 70% of patients, the disease resolves during adolescence; in the rest, it progresses to an adult form, in which exacerbations alternate remissions for a short time, and then the disease worsens again. In adults, allergens include house dust, animal hair, mold, and plants; symptoms also vary slightly.

Thus, the main causes of atopic dermatitis are allergic in nature and are a reaction to contact or consumption of certain substances - .

Symptoms of atopic dermatitis

In most cases, the disease manifests itself during the first five years of life, with the peak occurring in the first year. In adulthood, the symptoms of atopic dermatitis may disappear or weaken, but in half of the cases they persist throughout life. The disease may be accompanied by diseases such as bronchial asthma and .

Anti-inflammatory medications are mandatory. These can be corticosteroids, as well as sedatives, various sedative herbal mixtures, peony, and others.

For external use, antiseptics such as Fukartzin , . To maintain the general condition of the patient, a complex of vitamins and microelements is prescribed, and hardening is recommended.

In case of secondary infections, drugs are prescribed depending on the type of pathogen. Additionally, enzyme preparations are prescribed for disorders of the pancreas and eubiotics for. In the acute stage of oozing, wet-dry dressings and corticosteroid aerosols are used.

The most important condition, without which the treatment of atopic dermatitis cannot be effective, is not to rub or scratch the skin. Like some other 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 the symptoms of atopic dermatitis in you or your child appeared only at the 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.

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. As for bedding, they must be filled with synthetic fillers; the use of down and feathers is unacceptable. In other words, for people prone to the disease, prevention of atopic dermatitis is aimed at minimizing contact with allergens.

Clothing should be easily breathable so that the skin can breathe. Clothes made of wool, nylon and polyester are not the best option, as they increase itching and irritate the skin. Do not use hot water when washing, only warm water. After washing, you should pat your skin rather than dry it. Be sure to use cosmetics to moisturize and care for the skin. They must be neutral and free of dyes, fragrances and preservatives. That is, additionally, the prevention of atopic dermatitis includes measures to prevent mechanical irritation of damaged areas.

Equally important for prevention is the timely treatment of chronic diseases, taking vascular-strengthening drugs and sedatives before important events. Allergenic foods should be avoided in the diet even during periods of remission of the disease.

Complications of atopic dermatitis

The most common complications of atopic dermatitis are caused by secondary infections. This occurs when scratching the skin, which leads to a violation of its protective properties.

Damaged areas are exposed to microbial and fungal flora, as well as viral infections. Secondary infections complicate treatment of atopic dermatitis, causing new lesions and negatively affecting the general condition of the patient.

Pyoderma, that is, a bacterial infection, which is characterized by the appearance of pustules that gradually dry out and form crusts, is ahead of other complications of atopic dermatitis in terms of frequency of occurrence. The disease is accompanied by disturbances in general condition, fever, and itching. The rash can occur all over the body and on the scalp.

A viral infection caused by the simplex virus can also often be a complication. 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 with a degree in 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. Work as a pharmaceutical representative for a year at the Rubicon company.

Presented 3 rationalization proposals on the topic “Optimization of antibiotic therapy depending on the species composition of microflora”, 2 works took prizes in the republican competition-review of student scientific works (categories 1 and 3).

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