Atopic dermatitis occurs most often in early childhood. The main cause of its occurrence in children can be called burdened heredity (mother or father had allergy manifestations due to poor nutrition, intoxication, metabolic disorders, disorders of the nervous and endocrine systems). But the disease can be formed in adulthood.
The leading sign of atopic dermatitis is severe itching. The skin, especially in the period of “dormant flow” (remission), is dry and peeling. The skin of the trunk and extensor surfaces of the limbs is covered with shiny, flesh-colored plaques.
In the period of “dormant flow”, the only minimal manifestations of atopic dermatitis can be barely flaking spots or cracks in the area of attachment of the auricle. In addition, these signs can be sticking to the corners of the mouth (cheilitis), the midline crack of the lower lip, as well as peeling and redness of the upper eyelids.
In the course of the disease (depending on the characteristics in different age periods), it is conditionally possible to distinguish three phases – infant, child and adult.
Atopic dermatitis in children
The development of atopic dermatitis usually begins with the 7-8th week of a child’s life. Rashes are located mainly on the face, affecting the skin of the cheeks and forehead. Gradually, changes appear on the extensor surface of the legs, shoulders, and forearms. Often affects the skin of the buttocks and torso.
It begins after 18 months of age and continues until adolescence.
Skin atopic dermatitis in children in the early stages of this phase is represented by red, swollen spots, prone to the formation of continuous lesions. As a result of combing the lesions are covered with crusts. Rashes are located mainly in the elbows and popliteal folds, on the lateral surfaces of the neck, upper chest, and hands. Over time, in most children, the skin is cleared of rashes, and only the popliteal and elbow creases remain affected .
Atopic dermatitis in adults
The adult phase of atopic dermatitis occurs in adolescence. Particularly often, the upper torso, neck, forehead, skin around the mouth, flexion surface of the forearm and wrist are affected . In severe cases, the skin can be affected all over the body.
Observations point to the role of heredity in transmitting painful symptoms from parents to children. So, from an allergic father, signs of atopic dermatitis in a child develop in 40–50% of cases, from mother –– 60–70%. If both parents are carriers of atopy , the incidence of the disease in a child reaches 80%.
A certain number of children form a latent allergization , which is realized in the form of atopic dermatitis at the age of 19–20 years. It is not a disease that is inherited, but a combination of genetic factors contributing to the formation in the body.
In the formation of the disease is of great importance the functional state of the gastrointestinal tract. The risk of developing atopic dermatitis increases due to non-observance of the rational nutrition of a pregnant woman, children of the first months of life who are on artificial feeding.
Thus, in children of the first year of life, chicken eggs, cow’s milk proteins, and cereals are a frequent cause of the disease.
The course is aggravated by the development of intestinal dysbiosis, due to the uncontrolled intake of antibiotics, hormones, the presence of foci of chronic infection, allergic diseases (asthma, rhinitis), dysmetabolic nephropathy, parasites.
An important direction in the treatment of atopic dermatitis is the creation of an optimal psycho-emotional environment. It must be borne in mind that emotional stress can provoke itching.
First of all, it is necessary to exclude:
- meat and fish broths,
- grilled meat,
- chocolate, cocoa,
- citrus fruits (lemons, tangerines, oranges, grapefruits),
- strawberry, black currant, melon,
- pomegranates, nuts,
- fish caviar
- spices, smoked meats,
- canned and other products containing additives preservatives and dyes.
It is advisable to add to the diet of vegetable oil (sunflower, olive, etc.) up to 30 g per day in the form of spices for salads. Assigned to vitamin F-99, containing a combination of linoleic and linolenic acids – in high doses (4 capsules 2 times a day), or on average (1-2 capsules 2 times a day). The drug is especially effective in adults.
It is carried out strictly individually and can include tranquilizers, antiallergic, anti-inflammatory and detoxifying agents.
It should be noted that with atopic dermatitis, a large number of methods and means have been proposed (hormones, cytostatics, Intal, allergoglobulin, specific hyposensitization, PUVA therapy, plasma exchange, acupuncture, unloading diet therapy, etc.). However, anti -pruritic drugs — antihistamines and tranquilizers — are most important in practice.
Antihistamines are prescribed to relieve itching and swelling in skin manifestations, as well as in atopic syndrome (asthma, rhinitis).
Applying daily antihistamines of the first generation (suprastin, tavegil, diazolin , fercarol ), it must be remembered that they are rapidly becoming addictive. Therefore, these drugs should be changed every 5-7 days. Penetrating through the blood into the brain tissue, first-generation drugs cause a calming effect, so they should not be prescribed to students, drivers and all those who should lead an active lifestyle, as attention concentration decreases and coordination of movements is disturbed.
Preparations of the second generation – loratodin (claritin), astemizole , ebostine , cetirizine , fexofenadine .
Hormones are used with limited and common processes, as well as unbearable, painful itching, not eliminated by other means. Hormones (preferably metipred or triamcinolone ) are given for several days to relieve the severity of the attack with a gradual decrease in dose.
With the prevalence of the process and symptoms of intoxication, intensive therapy is applied using intravenous agents ( hemodez , reopolyglucine , polynon solution, saline, etc.). Hemosorption and plasmapheresis (special blood purification methods) have proven themselves well.
In the treatment of persistent atopic dermatitis, light therapy can be a very useful auxiliary method. Ultraviolet light requires only 3-4 treatments per week and has few side effects.
At accession of an infection antibiotics of a wide range are applied. Erythromycin, rondomitsin , vibramycin are prescribed for 6-7 days. In childhood, tetracycline drugs (tetracycline, doxycycline ) are prescribed from 9 years. A complication of herpes infection is an indication for the appointment of acyclovir or famvirin age dosages.
The complicated forms of therapy should include atopic dermatitis, particularly in children, enzyme preparations (abomin, Festalum, mezim -Fort, panzinorm) and high eubiotiki (bifidumbakterin, baktisubtil, lineks et al.). It is better to prescribe eubiotics based on the results of a microbiological examination of feces for dysbacteriosis.
The prescription of antioxidants, especially aevita and veterone , also has a good effect .
External treatment is carried out taking into account the severity of the inflammatory response, the prevalence of the lesion, the age and associated complications of a local infection.
In the acute stage, accompanied by moistening and crusts, lotions containing anti-inflammatory and disinfecting preparations are used (for example, Burov’s liquid, chamomile, tea infusion). After removal of the phenomena of acute inflammation, creams, ointments and pastes are used that contain itching and anti-inflammatory substances ( naphthalan oil 2-10%, tar 1-2%, ichthyol 2-5%, sulfur, etc.).
Hormonal preparations are widely used in external therapy. These include tselestoderm (cream, ointment), tselestoderm with garamitsinom and triderm (cream, ointment), Elokim and advantan.
The skin of patients with atopic dermatitis due to its dryness and increased permeability becomes sensitive to moisture. In this regard, the use of conventional varieties of toilet soap is undesirable. It is advisable to use gentle varieties of soap (such as Dove, Dial, Lowila, baby, etc.). Washing powders, even in small quantities remaining on freshly washed clothes and underwear, can also have an annoying effect. Therefore, some authors recommend the use of ” allergen-free ” laundry detergents (such as Tide Free ) and repeated cycles of gargling. Clothing should not be too tight. In addition, it is undesirable to wear wool products.
Sweat can irritate the skin of the patient, and, therefore, requires more frequent changes of linen.
A certain value for the prevention of atopic dermatitis has a microclimate in the house. Thus, the temperature and humidity of the air in the room should be as comfortable as possible (constant temperature of 20-24 ° C and humidity of 45-55%).
Patients are also recommended swimming. However, it must be borne in mind that chlorine-containing compounds and other antiseptics used to decontaminate the pool can cause skin irritation. Usually, in order to remove this effect, it is enough to take a light shower after class.
To eliminate dry skin with atopic dermatitis, it is necessary to use nutrients and emollients, and they should be applied to the skin often enough so that the skin remains soft throughout the day. It is also necessary to treat the skin with nourishing and emollients after a shower, and before walks in windy and cold weather – with protective creams and ointments.
Correction of associated diseases includes the examination, detection and treatment of foci of chronic infection, parasitic invasions, dysbiosis, restoration of cortical neurodynamics and autonomic disorders.
The prognosis of the course of atopic dermatitis and the quality of life of the patient largely depend on the reliable knowledge he has received about the causes of the development of skin rashes, itching, and the careful implementation of all the recommendations of the doctor and prevention.
The main directions of the prevention of atopic dermatitis is the observance of the diet, especially for pregnant and lactating mothers, and breastfeeding of children. Particular attention should be paid to limiting the effects of inhaled allergens, reducing contact with household chemicals, preventing colds and infectious diseases, and the prescribed prescription of antibiotics. When staging anti-relapse therapy, sanatorium-resort treatment is recommended .