Atopic dermatitis
Atopic dermatitis is a chronic allergic skin disorder that develops in people with a genetic predisposition to allergies. Atopic dermatitis occurs with periodic exacerbations, has age specific features and is characterized by specific skin rashes, increased protein( serum IgE) and increased sensitivity to specific( allergenic) and nonspecific irritants. The role of hereditary predisposition in the formation of atopic dermatitis is unquestionable. It is established that 60% of children whose parents have atopic dermatitis also suffered from this disease.
Often in childhood, the causative factors that trigger the development of the disease are food allergens. Possible etiological role of allergens of house dust, epidermal, pollen, fungal, bacterial and vaccinal allergens.
Non-allergenic causative factors that are capable of provoking the development of atopic dermatitis include psychoemotional stresses, changes in the meteorological situation, food additives, substances polluting the environment, chemical substances that are alien to organisms. Negative climatic conditions( excessively high or low temperatures), violations of the rules of skin care( wearing coarse clothing, use of various chemicals, excessively hot water), poor living conditions( high temperature in combination with low humidity), vaccination, all kinds of infectious diseases canexacerbate the impact of the causal factors mentioned above.
Human skin contains specific cells - Langerhans cells, the number of which is about 2-4% of all skin cells. Due to their shape and ability to move, they form a uniform network with other skin cells. On the surface of Langerhans cells there are receptors for the protein responsible for the development of an allergic reaction. Such a protein of the human body is the immunoglobulin of class E( IgE).The presence of these receptors on Langerhans cells is strictly specific for atopic dermatitis. Upon contact with an allergen, these cells can leave a typical location and move into the deeper layers of the skin. The functions of Langerhans cells consist in the representation of an allergen( a substance foreign to the body) to other cells that take part in the development of all reactions of an allergic nature. In the deeper layers of the skin, Langerhans cells interact with lymphocytes, which, after recognizing the foreign substance, differentiate into other types of lymphocytes that trigger the mechanism of the formation of antibodies to this allergen and fixation on mast cells and basophils( allergic cells).Repeated exposure to the allergen leads to the release of the mediators( "triggers") of allergies from the granules contained in the mast cells. After this, the allergic inflammatory process acquires a chronic course. Itching of the skin, which is a constant symptom of atopic dermatitis, leads to the formation of an itching cycle: skin cells damaged by scratching release substances that attract inflammation cells to the lesion.
However, not all young children with dermatitis have signs of allergic diathesis and laboratory confirmation of the body's allergic mood. Up to a year of rash on the skin can be a manifestation of the so-called transitory( temporary) food allergy, caused by a temporary increase in the level of IgE.These children have an increased spontaneous release of biologically active substances from allergic cells, associated with the instability of their cell membranes, and increased sensitivity to allergens.
Isolation of a large number of chemicals that cause the development of allergic reactions is possible under the influence of substances contained in many fruits, cereals and legumes. Also to such products are strawberries, citrus fruits, sauerkraut, nuts, coffee and many others.
In addition to atopic dermatitis, which develops as a result of the present predisposition of the body to allergies, there are also pseudoallergic reactions. Factors predisposing to the formation of pseudoallergic reactions are: lack of vitamin B6 and other B vitamins, deficiency of trace elements( in particular, zinc), deficiency of unsaturated fatty acids, helminthic and parasitic invasions, impaired digestion, cholecystitis, intestinal dysbacteriosis, excess in foodssupply of alien substances and fertilizers for the body. All these factors contribute to the disruption of the stability of cell membranes( in particular, fat cells), which contributes to the development of skin manifestations that look similar to atopic dermatitis.
Manifestations of atopic dermatitis are very diverse - nodules that rise above the skin;small bubbles, red spots, scaling, scabs, cracks and erosion. A characteristic sign of atopic dermatitis is severe itching. Infants( the infant form of atopic dermatitis, manifested up to 3 years) elements of the rash are located mainly on the face, trunk, the internal surfaces of the hands and feet, the scalp. At the age of 3-12 years( children's atopic dermatitis) the elements of the rash are located on the inner surfaces of the extremities, the face, in the ulnar and popliteal fossa. When the teenage form of the disease( manifested at the age of 12-18 years) affects the neck, the inner surface of the limbs, wrists, upper parts of the chest. In young people, as a rule, the rash is localized on the neck, the back surface of the hands. Often you can see the areas of absence of skin pigment on the face and shoulders( white lichen), a characteristic fold along the edge of the lower eyelid( the Denier-Morgan line), strengthening the drawing of the palm lines( atopic palms).When a blunt object( for example, a key) is carried over the skin, a white trace remains, which remains for a fairly long time( white dermographism).
The degree of severity of atopic dermatitis is determined by the international SCORAD system, taking into account objective symptoms, skin lesion area, assessment of subjective signs( itching and sleep disturbance).
Research methods that allow a doctor to confirm or refute the diagnosis of atopic dermatitis are blood tests for IgE content, as well as skin allergic tests. Also, if necessary, conduct provocative tests with food.
Therapy of AD includes dietotherapy, local and general( systemic) treatment.
Dietary therapy - the basis for the treatment of atopic dermatitis. Breastfeeding with a mother's hypoallergenic diet is optimal for children with this disease. In the absence of milk from the mother and allergies to cow's milk, soya mixtures( Nutrilon Soya, Alsoy, Bona-soya, Frisoosa, etc.) are used for intolerance of soy - a mixture based on the products of hydrolysis( partial cleavage) of the protein( Nutrilon hypoallergenic, Alfare, Pepti-Junior, etc.).The introduction of lures begins with vegetable puree( zucchini, squash, color, cabbage, cabbage).The second lure is dairy-free porridge( buckwheat, corn, rice).When intolerance to beef, which has an antigenic similarity with the proteins of cow's milk, it is recommended to use lean pork, horse meat, white turkey meat, rabbit meat. If you follow a strict diet for one or several years, increased sensitivity to allergens of eggs, milk, wheat and soy in children can disappear. Sensitivity to allergens of peanuts, hazelnuts, crustaceans and fish is usually maintained throughout life. The duration of strict adherence to a diet largely depends on the age at which diet therapy was started. Removal of the diet of dairy products in the first half of life can limit the duration of admission to 3-6 months. With the delay in treatment, the average duration of the diet is 6-12 months. Partial diet is acceptable for pseudoallergic reactions and secondary( emerged against the background of a disease) forms of food allergy. An example of an incomplete diet is the replacement of natural milk with fermented milk products. From the diet of a child with atopic dermatitis, strawberries, citrus fruits, legumes, sauerkraut, nuts, coffee, etc. are excluded. Measures that reduce the allergic effect of food include compliance with the technology of preparation, conditions and shelf-life of products, the use of fruits and vegetables grown without the use of fertilizers, soaking of cereals and vegetables for 10-12 hours before cooking, double digestion of meat, purification of drinking water. It is necessary to limit sugar by at least 50%, as well as table salt.
Carrying out diets requires correction of minerals, in particular calcium, vitamins B6, A, E, B5, which enter the child's body in minimal quantity with dietary food or do not enter at all. Given the inadequate activity of the glands of the gastrointestinal tract in children with atopic dermatitis, enzyme preparations( festal, panzinorm, oraz, pancitrat, creon) are widely used in treatment. With dysbiosis, biopreparation courses are used, depending on the results of bacteriological examination of feces( 2 three-week courses per year).
For children of any age, the diet is based on the reliably proven role of a particular food product in the development of exacerbations of atopic dermatitis. Absolute criterion is the positive result of a specific survey conducted in allergological centers, as well as evidence of parents or the child about the provocative role of this product in exacerbating the disease. Of great importance in the treatment of dermatitis is the restriction of sugar, salt( as substances that enhance allergic manifestations), broths, spicy, salty and fried foods, which can enhance the permeability of the gastrointestinal tract for allergens. For cooking use water purified by filters. Vegetables and cereals are soaked before cooking. Food preservatives that contain dyes, preservatives, emulsifiers should be avoided.
It is necessary to eliminate any household allergens( pets, dust, etc.).
Medical treatment in any case should be prescribed only by the attending physician, since self-medication can lead to adverse effects. In case of an exacerbation of the disease, antihistamines are prescribed. Use drugs I, II and III generation. The sedative( soothing) effect of I-generation drugs is used to relieve the itch that disturbs a child's sleep. If you need long-term therapy( treatment and prevention of exacerbations) use antihistamines II and III generation( zirtek, klaritin, ketotifen, telphase).
Widely used drugs that stabilize the membranes of allergic cells, preventing the release of them chemicals that trigger mechanisms for the development of an allergic reaction. Membrane stabilizing drugs include ketotifen, xidiphon, antioxidants( vitamins A, E, C, etc.), nalcrome. Increasing the effectiveness of treatment of atopic dermatitis is promoted by the use of vitamins B6 and B15.Promising is the use of β-carotene, which is the source of vitamin A intake, increases the resistance of cell membranes to the action of toxic substances and stimulates the immune system. Calcium preparations( gluconate, lactate, glycerophosphate) and( or) phosphorus, phytotherapy( licorice root) are useful. In a number of children, a good effect is achieved after a three-month course of combined administration of gastric drops and an extract of Eleutherococcus.
In connection with the importance of insufficiency of the digestive function in the development of dermatitis after the study of stool, the question of the advisability of the appointment of digestive enzymes( festal, digestal, pancreatin, etc.), cholagogue. If there is a lambliasis, helikobakterioz, helminthiases, a specific treatment is carried out. Mandatory treatment of intestinal dysbiosis is necessary.
In severe purulent skin lesions and ineffective local use of antibiotics, these drugs are prescribed orally or intramuscularly.
It is necessary to limit the effects of factors that cause an exacerbation. The nails on the fingers of the child should be short-cut to reduce the damage to the skin when combing. After washing in cool water with neutral soap, you should use softening creams or oils. External treatment begins with the use of pastes, ointments, talkers containing anti-inflammatory drugs. When exacerbating with inflammatory manifestations, use lotions with Burov's liquid( aluminum solution), 1% tannin solution, etc.
In severe manifestations of atopic dermatitis, one must resort to the use of hormonal drugs - elokoma( cream, ointment, lotion), advantanum( emulsion,cream, ointment).These drugs are highly effective and safe. They are prescribed once a day during the period of exacerbation, including in young children. Irrational use of hormonal drugs can cause systemic and local side effects.
Complete recovery occurs in 17-30% of children with atopic dermatitis. Adverse factors of the disease prognosis are: the onset of persistent rashes on the skin at the age of 1-3 months, combination of atopic dermatitis with bronchial asthma, combination of atopic dermatitis with chronic infection, combination of atopic dermatitis with vulgar ichthyosis, inadequate treatment. With pseudoallergic reactions, the prognosis is more favorable. In most children, the skin process decreases to 1.5-2 years and disappears by 5 years.
Prevention:
• use of hypoallergenic soft detergents;
• use of special washing powders and thorough rinsing after washing;
• rejection of tight clothing and wool products;
• Daily treatment of the skin after the bath with special emollients;
• sanatorium treatment at sea.
The prognosis of atopic dermatitis largely depends on the reliability of establishing the cause of the disease, the thoroughness of the treatment and the observance of the recommendations of the treating doctor.