Atopic dermatitis

August 12, 2017 17:51 | Genetic Diseases

Atopic dermatitis - a chronic allergic skin disease that occurs in people with a genetic predisposition to allergies.Atopic dermatitis occurs with periodic exacerbations, age has particular manifestations and is characterized by specific skin rashes, increased protein levels (serum IgE), and increased sensitivity to the specific (allergen) and nonspecific stimuli.The role of hereditary predisposition to the formation of atopic dermatitis is undeniable.It was found that 60% of children whose parents suffer from atopic dermatitis, also suffered from this disease.

often in childhood causal factors triggers the disease, are food allergens.Possible etiologic role of allergens from house dust, epidermal, pollen, fungi, bacteria and allergens of vaccine.

For non-allergenic causative factors that can trigger the development of atopic dermatitis include psycho-emotional stress, changes meteosituatsii, food additives, substances that may pollute the environment for foreign organisms chemicals.Adverse weather c

onditions (excessively high or low temperatures), disorders of skin care rules (wearing coarse clothes, use of various chemicals, excessively hot water), poor living conditions (high temperatures combined with low humidity), vaccinations, various infectious diseases canexacerbate the impact of causal factors listed above.In

human skin contains specific cells - Langerhans cells, which account for about 2-4% of all skin cells.Due to its shape and ability to move, they form a uniform network with other cells of the skin.On the surface of Langerhans cells are receptors for the protein responsible for the allergic reactions.Thus a protein of the human body is the immunoglobulin class E (IgE).The presence of these receptors on Langerhans cells is strictly specific for atopic dermatitis.Upon contact with the allergen, the cells can leave the typical location and move into deeper layers of the skin.Functions of the Langerhans cells is to present the allergen (a substance foreign to the body) other cells participating in the development of allergic reactions.In deeper layers of skin Langerhans cells interact with lymphocytes, which, after recognition of a foreign substance in differentiated cells of another species, which trigger the mechanism of formation of antibodies to a given allergen and fixing it on mast cells and basophils (allergic cells).Repeated exposure to allergens leads to release of granules contained in mast cells of mediators ( "launcher") allergy.After that allergic inflammation becomes chronic.Itching of the skin, which is a constant symptom of atopic dermatitis, results in the formation zudoraschesochnogo cycle of skin cells damaged by scratching, release substances that attract inflammatory cells to the lesion.

However, not all infants with dermatitis there are signs of an allergic diathesis and laboratory confirmation of the allergic disposition of the body.Prior year rashes on the skin can be a manifestation of the so-called transient (temporary) food allergies due to a temporary increase in IgE levels.These children have the increased spontaneous release of biologically active substances from allergic cells associated with the instability of cell membranes, and increased sensitivity to allergens.

Selecting a large number of chemical substances that cause allergic reactions, possibly under the influence of substances found in many fruits, grains and legumes.Also, such products include strawberries, citrus fruits, sauerkraut, nuts, coffee, and many others.

addition to atopic dermatitis, which is caused by this organism predisposition to allergies, there are also pseudoallergy reaction.Factors predisposing to formation pseudoallergic reactions are: a lack of vitamin B6 and other B vitamins, micronutrient deficiencies (particularly zinc) deficiency of unsaturated fatty acids, worm and parasitic infestations, broken processes of digestion, cholecystitis, intestinal dysbiosis, excess productspower alien to the body substances and fertilizers.All of these factors contribute to the disruption of cell membrane stability (particularly mast), which promotes the development of cutaneous manifestations outwardly similar to atopic dermatitis.

manifestations of atopic dermatitis are very diverse - nodules, towering above the skin;small blisters, red spots, flaking, scabs, cracks and erosion.A characteristic feature of atopic dermatitis - severe itching.In infants (infantile form of atopic dermatitis, appears up to 3 years), rash elements are located mainly on the face, the body, the inner surfaces of the hands and feet, scalp.At the age of 3 to 12 years (children's form of atopic dermatitis), rash elements are arranged on the inner surfaces of the extremities, face, elbow and popliteal fossa.When teenage form of the disease (manifested in the age of 12-18 years) affected the neck, the inner surfaces of the extremities, wrists, upper chest.In younger men, usually localized rash on the neck, back of the hands.Often you can see portions of the lack of skin pigment on the face and shoulders (white lichen), the characteristic crease on the edge of the lower eyelid (Denier-Morgan line), increasing line drawing palm (atopic palm).In carrying out the skin with a blunt object (such as a key) is a white trail, which persists for quite a long time (white dermographism).

degree of atopic dermatitis severity is determined by the SCORAD international system based on objective symptoms, the area of ​​skin lesions, evaluation of subjective symptoms (itching and sleep disturbance).

research methods, which allow the doctor to confirm or refute the diagnosis of atopic dermatitis are blood tests on the content of IgE, and skin allergy tests.Also, if necessary, provocative tests conducted with foodstuffs.

Therapy BP includes diet therapy, local and general (systemic) treatment.

Dietotherapy - the mainstay of treatment of atopic dermatitis.Breastfeeding while respecting mother-gipoal lergennoy diet is optimal for children with this disease.In the absence of mother's milk and cow's milk allergy using soya blend (Nutrilon Soya, Alsoy, Bon-soy, Frisosoy et al.) When soy intolerance - a mixture based on hydrolysis products (partial digestion) Protein (Nutrilon hypoallergenic, Alfaro, peptidesJunior et al.).The introduction of complementary foods start with vegetable puree (squash, squash, cauliflower, cabbage potatoes).The second complementary foods - dairy-free porridge (buckwheat, corn, rice).At intolerance of beef, having antigenic similarity to the proteins of cow's milk, it is recommended to use lean pork, horse meat, white meat turkey, rabbit.When observing a strict diet for one or more years, increased sensitivity to allergens eggs, milk, soybeans and wheat in children may disappear.Sensitivity to allergens peanuts, tree nuts, shellfish and fish are usually persists throughout life.Duration of strict dieting is largely dependent on the age at which the diet therapy was started.Deleting from the diet of dairy products in the first six months of life may limit the deadline for up to 3-6 months.When the delay of treatment, the mean duration of the diet is 6-12 months.Partial diet is acceptable if pseudoallergic reactions and secondary (arising in the background of any disease) forms of food allergy.An example of an incomplete diet is replacing the natural milk dairy products.From the child's diet with atopic dermatitis exclude strawberries, citrus fruits, beans, sauerkraut, nuts, coffee and others. The measures that reduce the allergic effect of food include observance of production technology, conditions and shelf life of products, the use of fruits and vegetables grown without the use of fertilizers, soaking grains and vegetables for 10-12 hours before cooking, double digestion of meat, drinking water purification.It is necessary to limit the sugar at least 50%, as well as salt.Conducting

diets requires correction of mineral substances, particularly calcium, vitamin B6, A, E, B5, and they fall into a dietary food child body in a minimal amount or not received at all.Given the lack of activity of the gastrointestinal tract glands in children with atopic dermatitis, the treatment is widely used enzyme preparations (festal, panzinorm, Oraz, pantsitrat, Creon).When dysbacteriosis use biologics courses, depending on the results of bacteriological examination of feces (2 three-week courses a year).

For children of any age diet is based on reliably proven role of a food product in the development of exacerbations of atopic dermatitis.The absolute criterion is a positive result of a specific survey conducted in allergy centers, as well as evidence of their parents or of the child of the provocative role of this product in the exacerbation of the disease.Of great importance in the treatment of dermatitis is limited sugar, salts (such as substances that enhance allergic manifestations), broths, acute and savory fried foods, which can increase the permeability of the gastrointestinal tract to allergens.For cooking, use purified water filters.Vegetables and grains are soaked before cooking.Avoid food canning industry, which contain coloring agents, preservatives, emulsifiers.

necessary to eliminate any household allergens (pets, dust, etc.).

Drug treatment in any case should be prescribed only by the attending physician as self can lead to adverse consequences.In case of exacerbation of the disease are appointed antihistamines.Use formulations I, II and III generation.Sedative (calming) effect of the drugs I generation is used to relieve itching, violates the child's sleep.If necessary, long-term therapy (treatment and prevention of exacerbations) used antihistamines II and III generation (Zyrtec, Claritin, ketotifen, Telfast).

widely used drugs that stabilize the membrane of allergic cells, preventing the release of these chemicals that trigger mechanisms of allergic reactions.To membrane stabilizing drugs include ketotifen ksidifon, antioxidants (vitamins A, E, C, etc.), Nalkrom.The effectiveness of the treatment of atopic dermatitis promotes the use of vitamins B6 and B15.Promising is the use of β-carotene, which is a source of intake of vitamin A, increases the resistance of the cell membranes to the action of toxic substances, and stimulates the immune system.Useful calcium supplements (gluconate, lactate, glycerophosphate) and (or) of phosphorus, phytotherapy (licorice root).A number of children a good effect is achieved after a three-month course combines reception stomach drops and extract Eleutherococcus.

Due to the importance of failure digestive function in the development of dermatitis after fecal decide on the advisability of the appointment of digestive enzymes (Festal, Digestal, pancreatin, etc..), Choleretic funds.If you have giardiasis, Helicobacter pylori infection, helminth infections, carried out specific treatment.It should be mandatory treatment of intestinal dysbiosis.

In marked purulent lesions of the skin and the ineffectiveness of the local use of antibiotics, these drugs are administered orally or intramuscularly.

necessary to limit the impact of factors causing aggravation.The nails on the fingers of a child must be cut short in order to reduce damage to the skin by scratching.After washing in cool water with mild soap, use emollient creams or oils.Exterior treatment begins with the application of pastes, ointments, boltushek containing anti-inflammatory agents.In acute inflammatory manifestations use lotion with liquid Boorowa (aluminum solution) 1% solution of tannin and other

When expressed manifestations of atopic dermatitis has to resort to the use of hormonal drugs -. Elokoma (cream, ointment, lotion), Advantan (emulsion, cream, ointment).These drugs have a high efficiency and safety.They appoint I once per day in the period of exacerbation, including in young children.Irrational use of hormones may cause systemic and local side effects.

Full recovery occurs in 17-30% of children with atopic dermatitis.Unfavorable prognosis factors are: the beginning of persistent rash on the skin at the age of 1-3 months, the combination of atopic dermatitis, bronchial asthma, atopic dermatitis, a combination with chronic infection, the combination of atopic dermatitis with ichthyosis vulgaris, inadequate treatment.When pseudoallergic reactions more favorable prognosis.Most of the children process the skin is reduced to 1.5-2 years and disappears by 5 years.

Prevention:

• Use hypoallergenic mild detergent;

• the use of special detergents and thorough rinsing of laundry after washing;

• abandonment of tight clothing and woolen products;

• daily skin treatment after bath with special emollients;

• spa treatment at sea.

forecast of atopic dermatitis depends on the reliability of establishing the cause of the disease, treatment and care compliance treating doctor recommendations.