Dermatology - diseases of the skin

Atopic dermatitis


Atopic dermatitis

Atopic dermatitis – one of the most common and severe allergic diseases, and the most frequent allergic skin lesions. Statistics indicate that the prevalence of atopic dermatitis exceed 12% (i.e. from 100 people 12 suffer from atopic dermatitis). Despite the huge step forward made in this area in recent years, treatment of atopic dermatitis is a difficult problem and requires the joint work of the doctor, the patient and his family members.

The Atopic dermatitis – a chronic, genetically determined, allergic skin inflammation, characterized by a typical clinical picture (typical symptoms). The leading clinical symptom of atopic dermatitis, occurring in all age groups – skin itching.
Atopic dermatitis the vast majority of first manifests itself in children aged 6 to 12 months. Less from 1 year to 5 years. For the first time the disease, corresponding to the symptoms of atopic dermatitis was described in 1844.

Currently atopic dermatitis can hide under the names of eczema, atopic dermatitis. It is sometimes mistakenly referred to as allergic dermatitis or eczema.

Causes of atopic dermatitis.

Atopic dermatitis is a disease that develops on the mechanism of immediate hypersensitivity (IgE-dependent immune response). This is one of the most common mechanisms of Allergy development. Its main feature is the quick response of the immune system to incoming allergen (from the date of receipt of the allergen before symptoms appear are minutes, rarely hours).

Important role in the development of atopic dermatitis burdened heredity plays, that is among the closest relatives almost always possible to find a person with allergic disease. Most often, allergic mood is passed through the maternal line. Recent studies indicate that it is a polygenic disease, or the development of allergic inflammation are responsible for about 20 genes located on several chromosomes.

But to allergic predisposition evolved in allergic disease, in particular atopic dermatitis, need exposure to a range of external factors. The main starting points: toxemia of pregnancy, particularly developing in the later stages, Smoking and alcohol consumption by the mother during pregnancy, infectious diseases in the mother during pregnancy. Important role in the development of allergic diseases in children plays a pathology gastrointestinal tract, in particular the dysbacteriosis of the intestine, insufficient duration or lack of breastfeeding, early introduction of complementary feeding, the introduction of the diet products that are not age-appropriate, previously and inappropriate prescription of antibiotics, etc.

Proved negative role frequent infectious diseases of the child, the presence of foci of chronic infection, including parasites.

A number of studies conducted in Europe and the USA, have shown that atopic dermatitis is more common in families with a higher standard of living. There are several theories to what this may be due, but a consensus has not yet come.

Among the allergens that cause the development of atopic dermatitis, the most important are food (allergic to different foods). Less clinical significance have household (different species of house dust mites, house dust, library dust, feather pillows) and epidermis (dander, bird feathers, fish food, etc.) allergens. Allergy to pollen as the cause of atopic dermatitis, is extremely rare.

Symptoms of atopic dermatitis

Symptoms of atopic dermatitisCurrently, the following diagnostic criteria of atopic dermatitis:

1) early onset (before the age of two),
2) the presence of allergic diseases in close relatives,
3) common dry skin,
4) localization of skin rashes in the flexor surfaces of the hands and feet,
5) the presence of pruritus.

Upon detection of four of the five criteria, the diagnosis of atopic dermatitis can be considered practically proven.

The symptoms of atopic dermatitis vary depending on the age of the patient. So there are three variants of the clinical course of atopic dermatitis: infant form, child form, juvenile-adult form.

Infant atopic dermatitis (diathesis). The symptoms of atopic dermatitis in neonates and infants.

Infant atopic dermatitis is noted before the age of 2 years. On the baby’s skin appear inflammatory studies type of red spots, which are localized primarily on the face in the forehead and cheeks. Such eruptions on the skin is popularly known as skin Allergy, although in fact skin Allergy is atopic dermatitis.

The disease is characterized by acute flow, oozing, swelling, crusting. Perhaps the emergence of foci of inflammation in other areas: the legs, buttocks, scalp of the child. The bright periods of exacerbation, accompanied by oozing, replaced the subacute stage, which is characterized by papular elements (papule is a skin element, towering above the skin type of the tubercle) on a background of erythematous (reddened) skin.

Children’s atopic dermatitis, symptoms.

In the period of exacerbation of atopic dermatitis skin elements (red spots, papules) are located predominantly in the skin folds, on the flexor surfaces of the elbow and knee joints, and behind the ears. The skin becomes dry, appears flaky, licensure (on dry skin is distinct, enhanced skin pattern). The child appears, the so-called “atopic person”: dull skin, increased pigmentation around the eyes, extra skin fold of the lower eyelid. Without exacerbation severe dry skin. Skin can crack, especially in the dorsum of hands, fingers.

Symptoms of atopic dermatitis in adults

For people with atopic dermatitis characterized by thickening of the skin and increased skin pattern, painful cracks in the skin, especially on the palms and soles, hyperpigmentation of eyelid (darker skin color on the eyelids).

• A symptom of “winter feet” – hyperemia and mild infiltration of the soles, peeling, cracked.

• Symptom Morgan (Denier-Morgan folds Denier-Morgan) – deepened the wrinkles on the lower eyelids in children.

• Symptom “polished nails” – the disappearance of the longitudinal iscertainly and distinctive look of the nail, due to constant rasciesa skin.

• A symptom of “fur hats” – degeneration of hair occipital region.

• Symptom of pseudo Hertog – temporary disappearance of hair, first in the outer third, and then in other parts of the eyebrows some of the patients.

What tests have to take if you suspect atopic dermatitis?

Atopic dermatitis is in the interests of two medical specialties: physician allergist-immunologist and dermatologist. Considering the high prevalence of this problem among children, according to modern medical standards, mild forms of atopic dermatitis can heal and pediatrician, but it is better to try to get to a specialist.

The diagnosis of atopic dermatitis is based on characteristic clinical symptoms and data obtained after questioning the patient or his parents (if the patient has not really talking).

A patient with newly diagnosed atopic dermatitis should undergo in-depth screening will identify the factors causing exacerbation of the disease and underlying its development.

Mandatory inspection of a condition of the gastro-intestinal tract. Recommended analyses: the analysis of a feces on a dysbacteriosis and coprogram, abdominal ultrasound. Need identification or exclusion of parasitic diseases. To do this, pass the feces analysis on helminth eggs (but less informative), blood tests for antibodies (proteins produced by the immune system to the presence of infection in the body) to the main parasites: Toxocara, Toxoplasma, Ascaris, Giardia, etc.

It is recommended to consult an endocrinologist to exclude concomitant pathology of the endocrine system.

If rashes are persistent and strictly localized in certain areas, you need to consult a neurologist or orthopedist (and preferably both) because of the possibility of concomitant pathology of the spine.

With increased excitability of the child – obligatory consultation of the neurologist.

It is mandatory allergic surveys aimed at identifying those substances that directly cause the development of allergic disease.

Taking into account that atopic dermatitis is a disease that occur with skin lesions, the only acceptable method of diagnosis is a blood tests for IgE-specific (specific immunoglobulins E, generated at specific allergens). In the first place given blood food allergens. In patients older than three years it is advisable to donate blood for the household and epidermal allergens.

In the case of accession of infection is carried out crops with detachable foci of inflammation on the microflora and fungi, as well as on the sensitivity to antibiotics.

Sometimes spend a skin biopsy (taking a small piece of skin for analysis) with a view to clarifying the nature of the inflammatory process. But this method of research is performed quite rarely and only under strict indications, for example, if you suspect lymphoma of the skin.

If the exacerbation of atopic dermatitis coincide or start immediately after colds – it is advisable to take a blood test for immunity. This will help identify possible problems with the immune system.

In General, building a program of examination, the doctor should imagine that atopic dermatitis is not only allergic disease. In its origin can participate and nervous and endocrine system. Almost always have problems in other organs and body systems. And if these precipitating and aggravating factors not found, transfer the child into a state of persistent and prolonged remission (recovery) will be extremely difficult. To identify and address the cause of atopic dermatitis is the main task of the attending physician, not only the creams and pills to relieve the symptoms of the disease.

Treatment of atopic dermatitis

Treatment of atopic dermatitisTreatment of atopic dermatitis must be prescribed by a specialist only after accurate diagnosis. It is not recommended to start treatment when symptoms of atopic dermatitis. Similar symptoms can be from a number of very serious diseases, and inadequate treatment strategy can be a threat to patient’s life, especially of a child patient. Never independently increase the duration of the course recommended drugs, even if they are good and help cope with the symptoms of the disease, and to go to the doctor once. Even the most innocuous creams with banal vitamins have side effects that may occur when compliance with treatment.

General principles of treatment of atopic dermatitis:

  • Elimination of the action of the allergen, hypoallergenic diet;
  • antihistamines (relieve itching) (erius,tavegil, suprastin, ketotifen, claritin, lexadin, loratadine, Telfast, etc)
  • detoxification (cleansing) (enterosgel, polyphepanum, activated charcoal, sodium thiosulfate, etc)
  • hyposensitizing (calcium gluconate, sodium thiosulfate);
  • corticosteroids (anti-inflammatory) (Elokim, locoid,tselestoderm, akriderm, sinaflana, diprosalic, belosalic,etc.)
  • antiseptics (fukanzen, brilliant green, methylene blue, etc)
  • sedative (sedative) (glycine, person, various sedatives fees herbs, Valerian, peony, etc)
  • enzymes (in violation of the functions of the pancreas) (CREON, Mezim, Pancreatin, etc)
  • anti-bacterial agents (with the accession of infection) (ointment, cream tselestoderm with garamycin, lorinden C, lincomycine ointment, PL. Sumamed, setrole,doxycycline, erythromycin, zanocin,rovamycin, etc)
  • eubiotics (dysbacteriosis of intestine) (Linex, probifor, etc)
  • when joining and fungal component, and bacterial (outer : triderm, akriderm Ledger, etc.)
  • when you join viral infections (acyclovir, valtrex, famvir, alpizarin, etc.).
  • If you suspect eczema’s sarcoma or other viral infections prescribed antiviral agents. When infection – antibiotics (sensitive agent). When weeping in the acute stage – wet-drying bandage or corticosteroid aerosols.

Treatment strategy in patients with exacerbation of atopic dermatitis and without exacerbation differ significantly.

Treatment of acute exacerbation of atopic dermatitis

The treatment of acute exacerbation of atopic dermatitis consists of the integrated application of the following groups of drugs:

1) Topical glucocorticosteroid. The most commonly used group of drugs for external use, used for relieving symptoms of exacerbation. Drugs have a variety of side effects and contraindications, so they can be used only on prescription. It is preferable to use preparations of the last generation, not containing in its structure of fluorine. Their safety profile is much higher. Examples: advantan, alloderm, elecom etc Topical glucocorticosteroid are issued in the form of ointments, creams, emulsions, fatty ointments, lotions. It is not recommended to use drugs in this group more than 7-10 days in a row. Manual of drugs implies the possibility of their appointment up to 1 month, but this still should be avoided. The gradual elimination of topical glucocorticosteroids. For example, the main part of the therapeutic course, you apply the ointment to the entire affected area. Then apply it bar method every day, leaving the distance between the strokes a little more.

Another option, phasing – day apply the cream, and day give the skin a rest, taking non-hormonal therapeutic agents.

You should also remember that no glucocorticosteroid for external use can cause the eyelids to close the eyes, as this may lead to the development of glaucoma and cataracts.

2) a Combination of drugs. These drugs contain a combination of glucocorticosteroids, antibiotics and antifungal drugs. Drugs of this pharmacological group use, if to allergic inflammation in atopic dermatitis associated infection. Examples: triderm cream, we, etc.

3) Drugs with active zinc. This means for external use (ointments, creams). Some experts are regarded as the alternative to local glucocorticosteroid. The duration of treatment must be monitored by a doctor, preferably with experience with these drugs, may develop other chronic dermatoses, non-allergic origin.

4) Antihistamines. Preference should be given to the preparations of the second and third generations. The average duration of treatment for ten days. Although there are treatment regimens, providing long-term (not less than three months) use of drugs of the third generation. Examples: zyrtec, aerius.

5) Derivative pimecrolimus. To this group belong the drug elidel. A relatively new group of drugs used for relieving symptoms of exacerbation. As effective as local glucocorticosteroids and thus, according to the company the producers of research, has a much greater safety. The cons of the product: high cost, small clinical experience of its use.

6) Sorbents. Holding desintoxication therapy using adsorbents – a necessary component in the treatment of exacerbations of most allergic diseases. Examples of drugs: laktofiltrum, enterosgel, filtrum, etc. Drugs are administered two to three times a day the average age dosage for 7-14 days.

7) Glucocorticosteroid. Preparations for oral administration are appointed only in severe forms of atopic dermatitis. Dosage and duration of treatment determined by the doctor. Examples of drugs: metipred, prednisolone.

8) Cytostatics. Can only be used in severe forms of atopic dermatitis, resistant to all other methods of treatment. Dosage and duration of treatment determined by the doctor. The treatment is carried out in a hospital environment.

Treatment of atopic dermatitis in remission.

the Atopic dermatitis – a chronic disease requiring long-term treatment, even outside of the symptoms of acute.

Currently, much attention is paid to use this period of medical cosmetics. Due to the presence of allergic inflammation, sluggish even without external clinical manifestations, change properties of the skin. Violated its permeability and humidity. And the purpose of regular use vitamin cosmetics is the restoration of violated properties of the skin. Examples of drugs belonging to therapeutic cosmetics: radevic, bepanten, pantoderm, locobase-ripea etc.

In addition, treatment of opportunistic identified during examination of the patient, diseases. Adjusts the gastrointestinal tract, normalizes the nervous system, etc. The activities are chosen individually, depending on results of analyses.

Thus, it is not enough just to remove the aggravation of atopic dermatitis, it is necessary to identify and eliminate the factors that caused the development of the disease or provoking its exacerbation. Only in this case it is possible to stop the progression of allergies that lead to atopic dermatitis in remission, and then completely get rid of it.

Folk remedies treat atopic dermatitis

In folk medicine, there are a number of methods actively used by patients with atopic dermatitis. So, in milder forms of the disease have a good effect bath with decoction of herbs, such as chamomile and succession.

Children can recommend baths with soothing herbs such as oregano, hops, Valerian, motherwort. For the preparation of baths take 2 tablespoons herb pour 1 Cup boiling water and infuse for at least 10 minutes. The resulting broth is added to the tub for bathing the baby.

But still, allergists to means of folk medicine are rather cautious, because in patients with allergies are often allergic to the “popular” recipes.

Treatment of atopic dermatitis in pregnancy

Atopic dermatitis manifests not for the first time during pregnancy. The disease always begins in early childhood.

There are some features on the treatment of existing disease in women during pregnancy. Carefully choose moisturizing cosmetics to soften the skin without exacerbation. Some of vitaminized creams, for example, is quite popular cream of radevic, pregnancy is a contraindication.

Principles of treatment during the exacerbation of atopic dermatitis during pregnancy do not differ from those in the rest of the population. If there is a need in local hormone therapy or the appointment of antihistamines, it is preferable to use preparations of last generation, with greater security (advantan, elecom, LOCOG).

The focus should be directed at creating a hypoallergenic environment.

The negative impact of atopic dermatitis on the fetus is not. Although toxic effects on the child’s still possible, but only if the use is prohibited for that period of a woman’s life of drugs.

Recommendations for the treatment of atopic dermatitis:

  • Wear cotton clothes. Leather needs to breathe. Clothing made of wool or synthetics will intensify the irritation and itching.
  • requires frequent wet cleaning and airing of the room. A minimum of carpets and upholstered furniture – a minimum of dust.
  • Bedding is best to use with synthetic filling, with no feathers.
  • When washing, including hand,use only warm water.
  • After washing do not RUB the skin, and gently probabilite towel.
  • be Sure to use an after-shower moisturizer. Means for skin care should be neutral, without perfumes and dyes.
  • Timely treatment of all chronic diseases, courses admission sosudoukreplyayuschim funds, sedative drugs (especially before important events, eg. exams, wedding, etc.) , hardening, vitamins, eliminate allergic productimage in the period of resolution of the rash.

Features food, dieta lifestyle with atopic dermatitis

The creation of a special hypoallergenic, that is, devoid of allergens, environment, diet is a critical component of the treatment of atopic dermatitis. Without adherence to these recommendations, the effectiveness of the treatment of the disease decreases significantly.

Let’s start with building a hypoallergenic environment. In fact, it is the observance of a special lifestyle. The goal is to eliminate factors that can irritate the skin and thereby to provoke the exacerbation of atopic dermatitis.

It is recommended to avoid exposure to extreme temperatures and humidity. The recommended humidity of the air in the room is about 40%. Drying clothes is needed outside the living room.

Also, it is preferable to avoid intense physical activity or factor that increases the sweating and itching. For the same reason it is not recommended to participate in sports as it causes profuse sweating and is accompanied by close skin contact with clothing. If possible, avoid stressful situations (as far as that’s possible). It is not recommended to wear rough clothes, especially wool, synthetics, fur animals. New clothes must be prostitiute before wearable. When washing clothes and bedding to use the minimum amount of softener, then linen need to rinse. Do not use alcohol-based personal care products.

The kitchen will have to raise the hood. In the bedroom would be a good idea to install an air purifier. In hot weather, use a conditioner with a filter at the output.

Bed linen should be carried out 1-2 times a week. It is necessary to eliminate sources of dust and mold. TV, computer, appliances from the bedroom of the patient must be removed. Easy wet cleaning is carried out 1 time a day, General cleaning at least 1 time a week. Use vacuum cleaners with good filters (best available with HEPA filters). When confirmed you are allergic to dust mite 1 every 3-6 months to process an apartment acaricide (kills mites) drugs, for example, Allergoff.

In the house you can not smoke. This refers to family members. The patient can not smoke anywhere: neither in the house nor outside.

Much attention is paid to water procedures. Do not use ordinary soap, it is better to use oil for the shower or therapeutic shampoo (such as shampoos series triderm). After a shower, be sure to lubricate the skin moisturizers.

The nails of the patient to cut as short as possible, to avoid inadvertent damage to the skin in case of aggravation of the disease and the appearance of pruritus.

With atopic dermatitis it is impossible to sunbathe. Prolonged exposure to the sun is a common mistake. Immediately after this will be a small improvement that parents usually notice and are striving for, but then almost always followed by severe exacerbation of the disease.

It is impossible to comb and rub the skin, nothing will be effective if to brush the lesions.

Be sure to consult with your doctor concerning compliance with the principles of the Allergy-free life. On our web site recommendations can be added depending on those allergens to which you (or your child) react.

Hypoallergenic diet in atopic dermatitis:

You must also adhere to a special diet. During the escalation of the diet should be followed especially rigidly, without exacerbation of its possible to expand a little, so as not to arouse any neurosis-like state due to the fact that he was “not all”.

Exclude for atopic dermatitis products:

Do not drink citrus, nuts, seafood, fish, chocolate, coffee, mustard, spices, mayonnaise, tomatoes, eggplant, red pepper, milk, eggs, mushrooms, sausages, sausages, sodas, strawberries, strawberries, watermelons, pineapples, honey. Strictly forbidden alcohol.

Allowed for atopic dermatitis products:

Can be eaten boiled beef; cereals and vegetable soups; vegetarian soups; olive oil; sunflower oil; boiled potatoes; porridge buckwheat, rice, oat cereals; milk products; cucumbers; parsley; dill; baked apples; tea; sugar; branny or whole wheat bread; Apple compote or dried fruit (except raisins); the bio yogurt without additives; day curd; yogurt.

Atopic dermatitis in children

Atopic dermatitis in childrenAtopic dermatitis – a disease that begins in early childhood. Most often in the time period from 6 to 12 months. Atopic dermatitis in children in the vernacular called “skin Allergy” in medicine, the concept of skin Allergy no, there is the concept of infant stage of atopic dermatitis.

Nature of activities aimed at creating a hypoallergenic environment around the child is no different from those for adults and are described in detail above.

Special attention in children is given to the restoration of violated properties of the skin by constant use moisturizing cosmetics. It should be applied 3-4 times a day, sometimes more.

Very important is as long as possible (at least 6 months) preservation of breastfeeding. But the mother should not eat foods that can exacerbate allergies (see the diet section diet and lifestyle with atopic dermatitis).

It is important to bathe the child first year of life, especially a newborn. Do not use soap. It is better to use medicated shampoos. For example, the shampoo triderm with zinc during acute and triderm balance without exacerbation. Before bathing it is necessary to add one capful of shampoo in a bath of water. After bathing can not rub baby towel – it irritates the skin. Better slightly sponged skin with a towel or allow to dry on their own.

The actual problem is to vaccinate a child with atopic dermatitis. The mere presence of the disease is not a reason to refuse vaccination, but vaccination is only possible in the stage of stable remission of the disease (at least 2-3 months). Be sure to take antihistamines for 7 days prior to vaccination on the day of vaccination and 3-5 days after inoculation. You cannot enter multiple vaccines in one day. If ignored for several vaccines, to begin vaccination with less allergenic vaccines. Right to make an individual vaccinations will help your doctor (allergist-immunologist or pediatrician).

Complications of atopic dermatitis and prognosis cure

Forecast favorable for life. However, skin lesions, especially in adolescence may contribute to social maladjustment of the patient.
Atopic dermatitis is a chronic allergic skin disease. In the case of proper treatment, elimination of risk factors in most patients with stable remission occurs and subsequently the diagnosis can be removed. But since the diagnosis of atopic dermatitis is a reflection of a General allergic disposition (atopic Constitution) at most of these patients (40%) may develop in the future, other allergic diseases, often associated with lesions of the respiratory tract (allergic rhinitis, atopic asthma). This progression of allergic disposition and change of allergic diseases from less severe to more serious in the medical literature have called the atopic March.

With severe disease and/or inadequate treatment, the failure of a special lifestyle – disease continues during adolescence and in adults.

The most frequent complications of atopic dermatitis is a bacterial infection (pyoderma) and atrophy of the skin (most often due to unnecessarily long use of local glucocorticosteroid drugs). Constant scratching of the skin with atopic dermatitisleads to the violation of her protective, barrier properties, which contributes to the accession of infection due to microbial and fungal flora.

Pyoderma is characterized by the appearance of pustules on the skin, which gradually dry up and form crusts. Rashes can appear on your body, hands, and feet, and on the scalp. It may be in violation of the General condition of man, may have fever.

Another common complication in atopic dermatitis – a viral infection. The skin formation of vesicles with clear content. The causative agent is herpes simplex virus that causes “cold” on the lips. Usually, lesions are located in the area of inflammatory lesions , but can use and healthy skin, but also affect the mucous membranes (mouth, throat, genital and conjunctival). Especially frequent localization of the rash is the skin of the face (around the mouth, lips, nose, cheeks, ears, eyelids).

Frequent complication of atopic dermatitis – fungal (most often Candida)defeat. Adults often affects the skin (especially skin folds), nails, scalp, feet, hands; and the children – the mucosa of the mouth, called thrush (appears “cheesy” plaque may be accompanied by pain, redness). Sometimes bacterial and fungal infection are combined together.

Prevention of atopic dermatitis

Measures aimed at preventing the development of atopic dermatitis no. The only one really working recommendation is as long as possible (at least 6 months), the persistence of breastfeeding. Some authors recommend the exclusion of cow’s milk from the diet of children up to 1 year, if the family has a patient with allergic disease.

If you already manifestiruuschem (beginning) disease prevention measures are to eliminate cause significant allergen (the allergen causing the Allergy) from the environment, observance of the General principles of diet, creating Allergy-free life and conduct appropriate treatment.