Atopic dermatitis in children and adults

Atopy is a hypersensitivity of the skin to the effects of environmental substances, in which there is an increased production of IgE and / or a violation of nonspecific reactivity.

One of the main problems of dermatology is atopic dermatitis, the incidence of which is much more common than other common dermatitis.

Children often suffer from atopic dermatitis, but adults also suffer from this ailment.

The reasons

The reason for the development of an allergic reaction in the skin with atopic dermatitis in children and adults is the body's hyper-reactivity in response to the interaction with various substances. These substances are allergens for the patient.

Plant pollen, house dust, animal dander, various food products, household chemicals, etc. can act as an allergen. They distinguish the air, contact and food route of allergen penetration into the body.

Leading causes of atopic dermatitis:

  1. Hereditary predisposition Moreover, in some relatives allergy can be expressed by rhinitis, conjunctivitis, in others, asthma and pollinosis, and in the third it is the specific reaction of the skin. That is why, as already mentioned, AD is first manifested in a small child.
  2. Increased sensitivity of the skin to detergents, washing powder, which washed things, the type of fabric of clothing.
  3. Contact with allergens. A variety of allergens can start the process, and often rashes appear after a while. Naturally, allergens will be different for different people and may change throughout life.
  4. Taking certain medications, especially antibiotics. These drugs kill not only pathogenic bacteria, but also the beneficial intestinal microflora, as a result of which their balance in the body is disturbed and the child’s immunity is reduced.
  5. Frequent viral and infectious diseases - this leads to a decrease in the protective forces of a person, as a result of which the first symptoms of dermatitis appear.

Contribute to the occurrence of dermatitis problems with the gastrointestinal tract, metabolic disorders, hormonal imbalances in the body. Atopic dermatitis can occur with periods of remission, the duration of which depends on compliance with the diet, the use of preventive measures.

Symptoms of atopic dermatitis

In atopic dermatitis, severe itching is the leading symptom of the disease. During the period of remission, the skin of patients in the affected areas is dry and compacted, pink, variegated or bluish-red, often covered with scaly scaly. The disease is characterized by a pronounced skin pattern, giving the skin a shagreen look.

The main symptoms of atopic dermatitis in adults include:

  1. The presence of itchy skin, present even with minimal skin manifestations.
  2. The characteristic morphological picture of the elements and their location on the body is dryness of the skin, localization (often) in symmetrical zones on the arms and legs in the area of ​​the flexor surface of the joints. In places of defeat there are spotty and papular rashes, covered with scales. They are also placed on the flexion surfaces of the joints, on the face, neck, shoulder blades, shoulder girdle, as well as on the legs and arms - on their outer surface and in the area of ​​the outer surface of the fingers.
  3. The presence of other diseases of an allergic nature in the patient himself or his relatives, for example, atopic bronchial asthma (30-40%). Chronic course of the disease (with or without relapses).

Atopic dermatitis occurs with exacerbations and remissions. Exacerbations of skin manifestations can be caused both by a violation of the diet, and by abrupt changes in the weather, concomitant diseases, dysbacteriosis, inoculation, etc. At the same time, a trip to the sea can significantly improve skin condition.

Symptoms in children

The clinical manifestations of atopic dermatitis in children are:

  • peeling of the skin;
  • itching that is worse at night;
  • weeping of combed skin;
  • enhancement of skin pattern in the field of injury;
  • compaction of the affected skin, coarsening.

After the scratching of the combing, these places are covered with brown crusts that itch intolerably, the child combs them again and starts all over again.

Atopic dermatitis: photo

What is atopic dermatitis in children and adults in the photo.

Diagnostics

The differential diagnosis of atopic dermatitis is always based on the collection of allergic history:

  • study of the history of the development of skin lesions and family predisposition;
  • the presence of atopic respiratory diseases;
  • the presence of concomitant skin diseases;
  • the presence of risk factors (pregnancy, childbirth, the type and nature of feeding, the presence of infections
  • in infancy, antibacterial drugs);
  • detection and identification of associated diseases;
  • intolerance to medication;
  • determination of foci of focal infection.

In some cases, it is required to conduct a complex of additional studies consisting of determining the total amount of IgE, identification of allergen-specific IgE by means of a radio allergenic sorbent test (RAST), tests for allergies (prick-test or patchwork test) and provocative tests with ingestion of possible food allergens. there is a need to take crops for the presence of a viral or bacterial culture.

Differential diagnostics

Atopic dermatitis must be differentiated with the following diseases: limited neurodermatitis, lichen planus, prurigo Gebra, fungoid mycosis, chronic eczema.

The limited neurodermatitis (depriving Vidal) is characterized by the absence of atopy in history, the onset of the disease in the adult period of life; lack of dependence of exacerbations on the action of allergens; localized lesion; the presence of three zones in the lesion: central lichenification, lichenoid papular lesions and dyschromic zone; comorbid diseases precede skin rashes; serum total IgE is normal; skin tests are negative.

Treatment of atopic dermatitis

When atopic dermatitis is diagnosed, how to treat the disease depends on the age phase, the severity of the clinic and related diseases.

The first treatment is aimed at:

  • exclusion of an allergic factor;
  • desensitization (reduced sensitivity to the allergen) of the body
  • removal of itching;
  • detoxification (cleansing) of the body;
  • removal of inflammatory processes;
  • correction of identified associated pathology;
  • prevention of recurrence of atopic dermatitis;
  • fight against complications (at accession of an infection);

For the treatment of atopic dermatitis in adults, different methods and drugs are used: diet therapy, PUVA therapy, acupuncture, plasmapheresis, specific desensitization, laser treatment, corticosteroids, allergoglobulin, cytostatics, intal, etc.

You should also abandon the use of citrus, coffee, chocolate, honey, chicken, fish, nuts and spices, as well as fatty and fried foods. Dairy products, cereals, boiled meat, and various vegetable dishes are shown to patients.

Treatment of dysbiosis and gastrointestinal diseases

Often the development of dermatitis is associated with intestinal dysbacteriosis, therefore, taking various probiotics is also advisable - RioFlora Immuno, Bifidobakterin, Lactobacterin, Atsipol, etc

A possible additional cause of such dermatitis and dysbacteriosis, may be a violation of the digestive system, namely the function of the pancreas, with the prescribed enzyme preparations, such as Pancreatin, Creon, Mezim.

Non-hormonal ointment

Such creams and ointments are very wide selection. These include Protopic, Elidel, Eplan, Fenistil, Losterin, cream Timogen, Naft-derm, Videstim, Destin, Aisida and others.

Anti-inflammatory therapy for blood pressure

In the acute phase are assigned:

  1. Antihistamines of the 2nd generation (with additional antiallergic properties - anti-mediator and membrane stabilizing (loratadine)) - 4-6 weeks. (There is an aggravation on such preparations and various additives in these preparations).
  2. Antihistamines of the 1st generation for the night (if sedation is needed) - 4-6 weeks. (There is an aggravation on such preparations and various additives in these preparations).
  3. Lotions (tincture of oak bark, 1% solution of tannin, solution of rivanol 1: 1000, etc.), dyes (fucorcin, Castelani liquid, 1-2% solution of methylene blue, etc.) - in the presence of exudation.
  4. External glucocorticosteroids (Mometasone (Mometasone) cream, lotion) - 3-7 days.
  5. Systemic glucocorticosteroids (in the absence of the effect of therapy).

Atopic dermatitis has a wave-like course: in 60% of children, symptoms disappear completely with time, while others remain or recur throughout their lives. The earlier the debut and the more severe the disease, the higher the chance of its persistent course, especially in cases of combination with another allergic pathology.

Atopic dermatitis in children treatment: Komarovsky

The success of the treatment of children's atopic dermatitis depends on the identification of an allergen or a provoking factor, and its elimination from the child's life. Food, chemical, natural allergens should be removed from the child.

Even with minor manifestations of dermatitis, you need to show the child to a specialist, and do not rely on reviews on the Internet. A doctor can prescribe tablets or injections with antihistamines, an ointment with corticosteroids that can quickly suppress itching and inflammation in children in severe cases to treat atopic dermatitis in children.

In some cases, the doctor may prescribe treatment with ultraviolet (UV) radiation. And also to prescribe a special diet for the child with atopic dermatitis and / or, if the child is breastfed, prescribe a special diet for the mother.

On the video you can see the advice of Dr. Komarovsky, how to treat atopic dermatitis in children.

Power Features

During remission, the basic rules of hypoallergenic diets should be followed. However, with severe exacerbations reduce the diet of foods to a minimum. Individual intolerance is often encountered, which can lead to a sharp deterioration in the disease. Sometimes it is advisable to adhere to a strict diet for a long time: from several months to two years.

There are products whose consumption should be minimized during dermatitis. It is strictly not recommended to use seafood, chocolate, citrus fruits, nuts, fish, coffee, mayonnaise, eggplants, mustard, spices, tomatoes, red pepper, milk, eggs, sausages, sausages, mushrooms, carbonated drinks, strawberries, strawberries, honey, watermelons, pineapples. Alcohol is strictly prohibited.

People who suffer from the symptoms of atopic dermatitis, it is recommended to include in your diet foods with a high content of saturated fatty acids. Unfortunately, such components in sufficient quantities can be found in seafood, which are classified as major allergens, so they can be replaced by vegetable oils, for example, olive and flaxseed. In addition, it is useful to use low-fat dairy products, whose components allow you to maintain a healthy intestinal microflora.

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.

With staged anti-relapse therapy, sanatorium-resort treatment is recommended in the Crimea, on the Black Sea coast of the Caucasus and the Mediterranean.

Watch the video: Atopic Dermatitis Ep. 1 A Constellation of Problems. MedscapeTV (December 2019).

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