Atopic dermatitis in children and adults - Causes, Symptoms and Treatment .MF .
Atopic dermatitis - one of the most common and severe allergic disease, and the most common allergic skin lesions.These statistics indicate that the prevalence of atopic dermatitis incidence greater than 12% (ie 12 out of 100 people suffer from atopic dermatitis).Despite the huge step forward made in this area in recent years, the treatment of atopic dermatitis is a fairly complex issue and requires a collaborative physician, the patient and his family members.
Atopic dermatitis - a chronic, genetically determined, characterized by typical clinical picture, an allergic inflammation of the skin (typical symptoms).Leading clinical symptom of atopic dermatitis, which is found in all age groups - itchy skin.
Atopic dermatitis in the vast majority of first appears in children aged 6 to 12 months.Less than 1 year to 5 years.First disease symptoms corresponding atopic dermatitis, was described in 1844 year.
Currently, atopic dermatitis can hide eczema, atopic dermatitis under the names.Sometimes mistaken
Causes of atopic dermatitis.
Atopic dermatitis - is a disease that develops by 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 rapid reaction of the immune system to the allergen ringing (from the date of receipt of the allergen until the symptoms pass minutes, less time).
an important role in the development of atopic dermatitis play a family history, that is among the next of kin is almost always possible to find a person with allergic disease.Most often, allergic mood is transmitted through the maternal line.Recent studies suggest that this polygenic disease, that is, for the development of allergic inflammation are responsible for about 20 genes located on multiple chromosomes.
But for the necessary exposure to a variety of external factors to allergic predisposition evolved in allergic disease, particularly in atopic dermatitis.The main starting points: toxicosis pregnant, especially developing in the late stages, smoking and alcohol consumption by the mother during pregnancy, infections in the mother during pregnancy.A major role in the development of allergic diseases in children plays a pathology of the gastrointestinal tract, such as intestinal dysbiosis, insufficient duration or total absence of breastfeeding, the early introduction of complementary foods, introduction to the diet products that are not age-appropriate, before and improper use of antibiotics, etc..
proved negative role of common infectious diseases in the child, the presence of foci of chronic infection, including parasitic.
Several studies conducted in Europe and the United States, showed that atopic dermatitis is more common in families with a higher standard of living.There are several theories, with which it can be connected, but have not yet come to a consensus.
Among the allergens that cause the development of atopic dermatitis, the most important are food (allergies to different foods).Less clinical significance have household (various species of house dust mites, house dust, library dust, feather pillows) and epidermal (wool, animal dander, feathers, fish feed, etc.) allergens.Allergies to pollen, as the cause of atopic dermatitis, is extremely rare.
symptoms of atopic dermatitis with photos
Currently identified the following diagnostic criteria for atopic dermatitis :
1) early onset (before the age of two),
2) presence of allergic disease in the immediate family,
3) common dry skin,
4) localized skin rash in the area of the flexor surfaces of the hands and feet,
5) the presence of pruritus.
If you find four of the five criteria, the diagnosis of atopic dermatitis can be regarded as practically proven.
symptoms of atopic dermatitis differ depending on the age of the patient.So there are three variants of the clinical course of atopic dermatitis: a form of infant, child form, teenagers and adult form.
Infant form of atopic dermatitis (diathesis).Symptoms of atopic dermatitis in newborns and infants.
Infant form of atopic dermatitis is marked under the age of 2 years.On the baby's skin appear inflammatory elements by type of red spots, localized predominantly on the face in the forehead and cheeks.These rashes on the skin popularly called diathesis , in fact diathesis - this is atopic dermatitis.
disease is characterized by an acute course, weeping, swelling, crusting.Perhaps the emergence of foci of inflammation in other areas: in the legs, buttocks, hairy part of the baby's head.Periods bright aggravation, accompanied by weeping, replaced by the subacute stage, which is characterized by papular elements (papule - a skin cell, towering above the skin by type tubercle) on the background of hyperemic (reddened) skin.
Pictured infant form of atopic dermatitis
Children form of atopic dermatitis symptoms.
During an exacerbation of atopic dermatitis skin elements (red spots, papules) are located mainly in the skin folds on the flexor surfaces of the elbows and knees, as well as behind the ears.The skin becomes dry, peeling occurs, lichenification (on dry skin is distinct, enhanced skin pattern).The child appears, the so-called "atopic face": dull color of the skin, increased pigmentation around the eyes, extra skin fold of the lower eyelid.Beyond acute severe dryness of the skin.The skin may crack, particularly in the area dorsum of the hand, fingers.
Photo: Atopic dermatitis.Children form.Patient 3 years.
teenage-adult form of atopic dermatitis symptoms.
Skin lesions in atopic dermatitis is a common, permanent.Changes are marked on the skin of the face, neck, chest, back, neck.The skin is dry, spread lichenification, traces of scratching.Perhaps the presence of cracks on the hands and feet.Exacerbation of atopic dermatitis, manifested by redness of the skin, is rarely observed.
Pictured atopic dermatitis in adolescents 15 years of age (skin dryness, peeling).
Photo: atopic dermatitis.The adult form.
In the event of the accession of infection may cause fungal infections, abscesses, greenish crusts.
Photo: Atopic dermatitis.Infant form.Secondary infection.
Depending on the severity emit light, moderate and severe atopic dermatitis.
Symptoms of chronic atopic dermatitis
For people with atopic dermatitis is characterized by thickening of the skin and strengthen the skin pattern, painful cracks in the skin, especially on the palms and soles, hyperpigmentation century (darker color on the eyelids).
• Symptom "winter feet" - redness and mild infiltration of the soles, peeling, cracks.
• Symptom Morgan (Denier-Morgan folds Denier-Morgan) - depth wrinkles on the lower eyelids in children.
• Symptom "polished nails" - the disappearance of longitudinal striations and characteristic appearance of the nail, due to constant scratching of the skin.
• Symptom "fur hats" - hair dystrophy occipital region.
• Symptom pseudo Hertog - temporary disappearance of hair, first in the outer third, and then in other parts of the eyebrows in some patients.
What tests need to take when suspected atopic dermatitis?
Atopic dermatitis is in the interests of two medical specialties: doctor allergist-immunologist and dermatologist.Considering the high prevalence of this problem among children, according to modern medical standards, mild forms of atopic dermatitis can be treated and a pediatrician, but it is better to try to get you to a specialist.
The diagnosis of atopic dermatitis is placed on the basis of characteristic clinical symptoms and the data obtained after questioning the patient or his or her parents (if the patient has not really talking).
patient with newly diagnosed atopic dermatitis, should undergo an in-depth examination which will reveal the factors that provoke the exacerbation of the disease and its underlying development.
is mandatory examination of the gastrointestinal tract.Recommended analysis: analysis of a feces on a dysbacteriosis and coprogram, abdominal ultrasound.It is necessary to identify or exclude parasitic diseases.To do this, pass the fecal worm eggs (but it is a little informative), blood tests for antibodies (proteins produced by the immune system on the fact of the presence of infection in the body) to the main parasites: toxocara, Toxoplasma, roundworm, Giardia, etc.
Recommended advice endocrinologist to exclude concomitant diseases of the endocrine system.
If rashes are durable in nature and strictly localized in certain areas, it is necessary to consult a neurologist or orthopedist (and preferably both), as there may be concomitant spine pathology.
With increased excitability of the child - obligatory consultation of the neurologist.
is mandatory to conduct an allergic survey designed to identify those substances that directly cause the development of allergic disease.
Considering that atopic dermatitis - a disease, occurring with lesions of the skin, the only acceptable method of diagnosis is a blood test to IgE-specific (specific IgE, produced by specific allergens).First of all give blood on food allergens.In patients older than three years, it is advisable to give blood for household and epidermal allergens.
In the case of infection joining spend crops separated from the foci of inflammation in the microflora and fungi, as well as sensitivity to antibiotics.
sometimes spend a skin biopsy (taking a small area of the skin for analysis) in order to clarify the nature of the inflammatory process.But this method of research is carried out infrequently and only on strict conditions, for example, if the skin is suspected lymphoma.
If exacerbation of atopic dermatitis at the same time or just after the start of colds - it is advisable to take a blood test to immunogram.This will help to identify potential problems with the immune system.
In general, building inspection program, a doctor must submit that atopic dermatitis - not only allergic disease.Its occurrence may be involved and the nervous and endocrine system.Almost always there are problems in other organs and body systems.And if these provoking and aggravating factors are not found, then transfer the child to a state of persistent and prolonged remission (recovery) will be extremely difficult.It was in troubleshooting the causes of atopic dermatitis is the main task of the treating physician, and not only in the appointment of creams and pills to relieve symptoms.
Treatment of atopic dermatitis
Treatment of atopic dermatitis should be assigned to a specialist only after accurate diagnosis.Do not self-initiate therapy in the event of symptoms of atopic dermatitis.Similar symptoms may be from a number of very serious diseases, and inadequate treatment strategy may be a threat to the life of the patient, particularly a patient - child.Never alone does not increase the duration of the course recommended by your medications, 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 commonplace creams with vitamins have side effects that can occur with non-compliance of treatment.
General principles of treatment of atopic dermatitis:
- Troubleshooting steps allergen, hypoallergenic diet;
- antihistamines (relieve itching) (erius, tavegil, suprastin, ketotifen, Claritin, feksadin, loratodin, Telfast, etc.);
- detoxification agents (purification) (enterosgel, Polyphepanum, activated carbon, sodium thiosulfate, etc.)
- hyposensitization (calcium gluconate, sodium thiosulfate);
- corticosteroids (anti-inflammatory) (Elokim lokoid, tselestoderm, akriderm, sinaflana, Diprosalik, belosalik, et al.);
- antiseptics (fukartsin, brilliant green, methylene blue, etc.)
- sedatives (tranquilizers) (Glycine, Persia, various sedatives fees herbs, valerian, peony, etc.);
- enzymes (in violation of pancreatic function) (Creon, mezim, pancreatin, etc.);
- antibacterial agents (for accession of infection) (ointment, cream tselestoderm garamitsinom, Lorinden C linkomitsinovaya ointment Table sumamed, zitrolid, doxycycline, erythromycin, zanotsin, Rovamycinum et al.);
- eubiotics (for intestinal dysbiosis) (Linex, Probifor, etc.);
- accession and fungal components, and bacterial (externally: triderm, akriderm GC, et al.);
- accession viral infections (acyclovir, Valtrex, Famvir, alpizarin, et al.).
- At suspicion on Kaposi's eczema or other viral infections prescribe antivirals.When infections - antibiotics (which is sensitive to the pathogen).When you soak in the acute stage- wet-drying bandage or corticosteroid sprays.
Medical tactic at an exacerbation of atopic dermatitis is acute and vary considerably.
Treatment of acute atopic dermatitis
Treatment of acute atopic dermatitis consists of the combined use of the following groups of products:
1) Topical glyukokortikosteroydy.The most commonly used group of drugs for external use, is used to relieve acute symptoms.The drugs have a number of side effects and contraindications, so only on prescription can be used.Preferably use the latest generation of drugs that do not contain fluorine in their structure.Their safety profile is much higher.Examples: advantan, Afloderm, elakom etc.Topical glyukokortikosteroydy produced in the form of ointments, creams, emulsions, fatty ointments, lotions.Not recommended to use drugs in this group more than 7-10 days.Guide number of drugs implies the possibility of their appointment up to 1 month, but it still should be avoided.It recommended phasing out topical glyukokortikosteroydov.For example, the bulk of the medical course, you apply the ointment to the entire affected area.Then apply it bar-by, every day, leaving the distance between the strokes a little more.
Another option phasing out - the day apply the cream and are giving the skin a rest day, using non-hormonal therapeutic agents.
should also remember that no gyukokortikosteroydy for external use can not be applied to the eyelid skin in the vicinity of the eye, as it can lead to the development of cataracts and glaucoma.
2) Combination products.Drugs in this group contain glyukokortikosteroydov combination of antibiotics and antifungal agents.Medicines of this pharmacological group is used when to allergic inflammation in atopic dermatitis associated infection.Examples: triderm cream pimafukort etc.
3) Preparations with active zinc.It is for external use (ointments, creams).Some experts regarded as an alternative to local glyukokortikostroydam.The duration of treatment must necessarily be supervised by a physician, preferably with experience with these drugs, so perhaps the development of other chronic dermatoses, not allergic origin.
4) Antihistamines.Preference should be given drugs second and third generations.The average duration of treatment for ten days.sugar;