Atopic dermatitis - symptoms, causes and treatment of atopic dermatitis. Atopic dermatitis (atopic eczema) What causes atopic dermatitis

Usually people think about this disease in the spring and autumn, during the off-season. But now it’s winter, not winter, and that’s why outbreaks of atopic dermatitis are right here. This disease has many names: constitutional eczema... But the essence is the same: a hereditary, immune-allergic disease. Is it possible to get rid of the disease forever and how?

Strange manifestations of atopic dermatitis

Atopic dermatitis (from the Greek "atopos" - strange, wonderful) is a truly strange phenomenon. Sometimes an exacerbation is preceded by severe stress, and immediately the neck and arms become covered with eczema - an itchy, weeping crust, which is not so easy to get rid of. In addition to the neck and elbow bends of the arms, favorite places for localization of itchy crusts are the skin around the eyes, mouth (cheilitis), in the area of the earlobes, and popliteal fossae. The area of skin damage can be completely local.

Where else does atopic dermatitis live?

But atopic dermatitis, as a rule, is not limited to one skin. Often, skin lesions are accompanied by a respiratory syndrome, reminiscent in its manifestations of attacks of bronchial asthma. Often such patients (in childhood) are unsuccessfully treated for adenoids. Until the sufferer gets an appointment with... an allergist-dermatologist. Such combined forms of the disease have recently become more and more common, which most experts attribute to the deteriorating environmental situation.

When the disease appears

As a rule, the disease manifests itself in early childhood, but can also appear in adulthood, either fading or reappearing. Anything can serve as an impetus for an exacerbation: puberty (in childhood), emotional overload (for the same children, outbreaks of atopic dermatitis often coincide with the first entry into kindergarten and school). As well as taking antibiotics, eating disorders, etc. The disease is often seasonal. Spring and autumn for atopics are the most difficult time, which many experts associate with weather changes (autumn) and the flowering period of pollen-bearing plants (spring). Well, now that we have winter - not winter, but something like March, don’t be surprised if the disease manifests itself “in all its glory”

Atopic dermatitis is a multifactorial disease

However, despite the similarity of development mechanisms, atopic dermatitis is not a purely allergic disease, as it might seem at first glance. This disease is multifactorial. Atopic dermatitis may be based on hereditary weakness of the endocrine, nervous and/or immune systems. Everyone has their own Achilles heel, which only an experienced doctor can determine. Along with a visual examination and analysis of the patient’s complaints, a specific allergological examination, a study of the immune status, a stool test for dysbacteriosis, etc. helps to reveal the truth.

How to treat atopic dermatitis

The success of treatment, which is purely individual in each specific case, depends on the competent actions of the doctor. Some are helped by long-acting antihistamines, others by hormonal drugs (in the form of ointments or sprays for respiratory manifestations of the disease), others by immunostimulants or, conversely, immunosuppressants that suppress excessive activity of the immune system. And for some, the only salvation from exacerbations of the disease is moving to another climate zone with a dry, warm climate. It has been noticed that sun rays suppress the activity of complexes that form the atopic reaction. The main method of physiotherapy for atopic dermatitis is based on the same principle - selective phototherapy, which looks like a solarium. Only in contrast to this popular cosmetic procedure, phototherapy uses mid-wave (UVB) and long-wave (UVA) ultraviolet rays, which have a milder effect . In especially severe cases, when eczema covers the entire body, they resort to a more serious version of this procedure, using photosensitizers (substances that enhance the effects of ultraviolet rays) . Fortunately, such situations rarely arise.

How not to start the disease

The sooner you start fighting the disease, the better. Without adequate treatment, atopic dermatitis is fraught with quite serious consequences, ranging from infection of skin areas affected by eczema to the development of bronchial asthma. Often people suffering from atopic dermatitis contract new diseases. Losing its protective functions, their skin becomes especially vulnerable to molluscum contagiosum, flat warts, fungal and other skin infections. Psychological disorders and neuroses often occur against the background of atopic dermatitis. In this case, you cannot do without modern antidepressants, which are prescribed not only to adults, but also to children.

How to learn to live with illness

Unfortunately, it is impossible to completely get rid of atopic dermatitis. In some cases, the disease may seem to “fall asleep”, but then flare up again. You need to learn to live with this disease. How? Trying to lead a measured lifestyle, avoiding stressful situations, traveling to the south every year (to a hot, dry climate), and in the off-season to a sanatorium. Outside of an exacerbation, the entire range of sanatorium-resort procedures (with the exception of mud applications) is useful. Acupuncture, electrophoresis with diphenhydramine, novocaine also have a good preventive and therapeutic effect for atopic dermatitis.

Diet is secondary

But following a diet for atopic dermatitis, as a rule, is of a secondary nature. Patients and their loved ones (if we are talking about a child) usually know themselves which foods they should avoid. True, you need to eat often and in small portions, trying to ensure that your diet contains foods that promote good digestion (constipation is a frequent companion to this disease).

How important it is to avoid self-medication

Recently, self-medication has become very common. In the case of atopic dermatitis, this can have fatal consequences. Especially when it comes to hormonal drugs. If they are used inadequately and if they are abruptly discontinued, you can get an even greater exacerbation of the disease than before taking them. Not to mention the serious side effects of such therapy, which only a doctor can prescribe. The leading doctor for patients with atopic dermatitis should be a dermatologist, interacting with an allergist and other specialists (neurologist, gastroenterologist).

Start your treatment in your apartment

Often the source of torment for the patient is in... his own apartment:

Try to keep it clean, especially if there are animals in the house. In this case, you cannot do without frequent wet cleaning. Prevent mold from forming in the kitchen and bathroom. Try to reduce contact with household products. Remove carpets from walls and floors, and thick curtains from windows; do not pile up books or keep them in glass cabinets.

Atopic dermatitis– one of the most common and severe allergic diseases, and the most common allergic skin lesion. Statistics indicate that the prevalence of atopic dermatitis exceeds 12% (that is, out of 100 people, 12 suffer from atopic dermatitis). Despite the huge strides made in this area in recent years, the treatment of atopic dermatitis is a rather complex problem and requires the collaboration of the doctor, the patient and his family members.

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

Currently, atopic dermatitis can be hidden under the names eczema and neurodermatitis. It is sometimes mistakenly called allergic dermatitis or diathesis.

Causes of atopic dermatitis.

Atopic dermatitis is a disease that develops through the mechanism of immediate hypersensitivity (IgE-dependent immune response). This is one of the most common mechanisms for the development of allergies. Its main feature is the rapid reaction of the immune system to an incoming allergen (minutes, or less often hours, pass from the moment the allergen arrives until the symptoms appear).

Family history plays an important role in the development of atopic dermatitis, that is, among close relatives you can almost always find a person with an allergic disease. Most often, allergic mood is transmitted through the maternal line. Recent studies indicate that this is a polygenic disease, that is, about 20 genes located on several chromosomes are responsible for the development of allergic inflammation.

But in order for an allergic predisposition to develop into an allergic disease, in particular atopic dermatitis, exposure to a number of external factors is necessary. The main trigger points: toxicosis of pregnant women, especially those developing in later stages, smoking and alcohol consumption by the mother during pregnancy, infectious diseases in the mother during pregnancy. A major role in the development of allergic diseases in children is played by the pathology of the gastrointestinal tract, in particular intestinal dysbiosis, insufficient duration or complete absence of breastfeeding, early introduction of complementary foods, introduction of age-inappropriate foods into the diet, earlier and inadequate prescription of antibiotics, etc. .

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 as to what this may be connected with, but no consensus has yet been reached.

Among the allergens that cause the development of atopic dermatitis, the most important are food ones (allergy to various foods). Household (various types of house dust mites, house dust, library dust, pillow feathers) and epidermal (animal hair and dander, bird feathers, fish food, etc.) allergens are of less clinical significance. Allergy to pollen as a cause of atopic dermatitis is extremely rare.

Symptoms of atopic dermatitis with photographs

Currently, the following diagnostic criteria for atopic dermatitis have been identified::

1) early onset of the disease (before two years of age),
2) the presence of allergic diseases in close relatives,
3) widespread dry skin,
4) localization of skin rashes in the area of the flexor surfaces of the arms and legs,
5) the presence of skin itching.

If four of the five criteria are found, the diagnosis of atopic dermatitis can be considered practically proven.

Symptoms of atopic dermatitis vary depending on the age of the patient. Thus, there are three variants of the clinical course of atopic dermatitis: the infant form, the childhood form, and the adolescent-adult form.

Infantile form of atopic dermatitis (diathesis). Symptoms of atopic dermatitis in newborns and infants.

The infantile form of atopic dermatitis occurs before the age of 2 years. Inflammatory elements like red spots appear on the child’s skin, localized mainly on the face in the forehead and cheeks. Such skin rashes are popularly called diathesis, although in fact diathesis is atopic dermatitis.

The disease is characterized by an acute course, weeping, swelling, and crusting. Foci of inflammation may also appear in other areas: in the area of the legs, buttocks, and scalp of the child. Periods of severe exacerbation, accompanied by weeping, are replaced by a subacute stage, which is characterized by papular elements (a papule is a skin element that rises above the skin like a tubercle) against the background of hyperemic (reddened) skin.

The photo shows an infant form of atopic dermatitis

Children's form of atopic dermatitis, symptoms.

During the period of exacerbation of atopic dermatitis, skin elements (red spots, papules) are located mainly in the area of skin folds, on the flexor surfaces of the elbow and knee joints, as well as behind the ears. The skin becomes dry, peeling and lichenification appear (on dry skin there is a clearly defined, enhanced skin pattern). The child develops a so-called “atopic face”: dull skin color, increased pigmentation around the eyes, an additional skin fold of the lower eyelid. Outside of exacerbation, severe dryness of the skin. The skin may crack, especially on the backs of the hands and fingers.

In the photo: Atopic dermatitis. Children's uniform. Patient 3 years old.

Adolescent-adult form of atopic dermatitis, symptoms.

Skin lesions in atopic dermatitis are widespread and permanent. Changes are noted on the skin of the face, neck, chest, back, neck. The skin is dry, widespread lichenification, traces of scratching. There may be cracks in the hands and feet. Exacerbations of atopic dermatitis, manifested by redness of the skin, are quite rare.

The photo shows atopic dermatitis in a 15-year-old teenager (dry skin, peeling).

In the photo: atopic dermatitis. Adult form.

If an infection occurs, fungal lesions, pustules, and greenish crusts may appear.

Depending on the severity, atopic dermatitis is classified into mild, moderate and severe.

Symptoms of chronic atopic dermatitis

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

The symptom of “winter foot” is hyperemia and moderate infiltration of the soles, peeling, cracks.

Morgan's sign (Denier-Morgan, Denier-Morgan folds) - deep wrinkles on the lower eyelids in children.

The symptom of “polished nails” is the disappearance of longitudinal striations and the characteristic appearance of the nail, due to constant scratching of the skin.

The symptom of a “fur hat” is dystrophy of the hair in the occipital region.

Pseudo Hertog's symptom is a temporary loss of hair, first in the outer third, and then in other areas of the eyebrows in some patients.

What tests will you need to take if you suspect atopic dermatitis?

Atopic dermatitis is in the area of interest of two medical specialties: an allergist-immunologist and a dermatologist. Taking into account the high prevalence of this problem among children, according to modern medical standards, mild forms of atopic dermatitis can be treated by a pediatrician, but it is better to still try to get to a specialist.

The diagnosis of atopic dermatitis is made on the basis of characteristic clinical symptoms and data obtained after questioning the patient or his parents (if the patient himself does not yet speak properly).

A patient newly diagnosed with atopic dermatitis must undergo an in-depth examination, which will identify the factors that provoke an exacerbation of the disease and underlie its development.

If the rashes are persistent and localized strictly in certain areas, then consultation with a neurologist or orthopedist (or better yet both) is necessary, since concomitant pathology of the spine is possible.

If the child is hyperexcitable, a consultation with a neurologist is required.

It is mandatory to conduct an allergic examination aimed at identifying those substances that directly cause the development of an allergic disease.

Taking into account that atopic dermatitis is a disease that occurs with skin lesions, the only acceptable method of diagnosis is a blood test for IgE-specific (specific immunoglobulins E produced in response to specific allergens). First of all, they donate blood for food allergens. In patients over three years of age, it is advisable to donate blood for household and epidermal allergens.

In case of infection, the discharge from the inflammation sites is cultured for microflora and fungi, as well as for sensitivity to antibiotics.

Sometimes a skin biopsy is performed (a small area of skin is taken for analysis) to clarify the nature of the inflammatory process. But this research method is carried out quite rarely and only for strict indications, for example, if skin lymphoma is suspected.

If exacerbations of atopic dermatitis coincide in time or begin immediately after a cold, then it is advisable to take a blood test for an immunogram. This will help identify possible problems with the immune system.

In general, when designing an examination program, the doctor must understand that atopic dermatitis is not only an allergic disease. Both the nervous and endocrine systems may be involved in its occurrence. There are almost always problems in other organs and systems of the body. And if these provoking and aggravating factors are not found, then it will be extremely difficult to transfer the child into a state of stable and long-term remission (recovery). It is in finding and eliminating the cause of atopic dermatitis that the main task of the attending physician is, and not in prescribing only creams and tablets to relieve the symptoms of the disease.

Treatment of atopic dermatitis

Treatment of atopic dermatitis should be prescribed by a specialist only after an accurate diagnosis has been established. You should not start treatment on your own if symptoms of atopic dermatitis occur. A number of very serious diseases can have similar symptoms, and inadequate treatment tactics can be a threat to the life of the patient, especially the patient - a child. Never increase the duration of the course of medications recommended for you on your own, even if they help well and cope with the symptoms of the disease, and there is no time to go to the doctor. Even the most harmless creams with banal vitamins have side effects that can occur if treatment tactics are not followed.

General principles of treatment of atopic dermatitis:

Elimination of allergen effects, hypoallergenic diet;
antihistamines (relieve itching) (erius, tavegil, suprastin, ketotifen, claritin, fexadine, loratodine, telfast, etc.);
detoxification agents (cleansing) (enterosgel, polyphepan, activated carbon, sodium thiosulfate, etc.)
hyposensitizing agents (calcium gluconate, sodium thiosulfate);
corticosteroids (anti-inflammatory effect) (elokom, lokoid, celestoderm, acriderm, sinaflan, diprosalik, belosalik, etc.);
antiseptics (fucarcin, brilliant green, methylene blue, etc.)
sedatives (calming) (glycine, persen, various sedative herbs, valerian, peony, etc.);
enzymes (if pancreatic function is impaired) (Creon, Mezim, Pancreatin, etc.);
antibacterial agents (in case of infection) (ointments, celestoderm cream with garamycin, Lorinden C, lincomycin ointment, sumamed table, zitrolide, doxycycline, erythromycin, zanocin, rovamycin, etc.);
eubiotics (for intestinal dysbiosis) (Linex, Probifor, etc.);
with the addition of both a fungal and a bacterial component (externally: triderm, acriderm GK, etc.);
when a viral infection is attached (acyclovir, valtrex, famvir, alpizarin, etc.).
If Kaposi's eczema or other viral infections are suspected, antiviral agents are prescribed. For infection - antibiotics (to which the pathogen is sensitive). For weeping in the acute stage, use wet-dry bandages or corticosteroid aerosols.

Therapeutic tactics during exacerbation of atopic dermatitis and without exacerbation differ significantly.

Treatment of exacerbation of atopic dermatitis

Treatment of exacerbation of atopic dermatitis consists of the complex use of the following groups of drugs:

1) Topical glucocorticosteroids. The most commonly used group of drugs for external use, used to relieve symptoms of exacerbation. The drugs have a number of side effects and contraindications, so they can only be used as prescribed by a doctor. It is preferable to use the latest generation drugs that do not contain fluorine in their structure. Their safety profile is much higher. Examples: Advantan, Afloderm, Elakom, etc. Topical glucocorticosteroids are available in the form of ointments, creams, emulsions, fatty ointments, and lotions. It is not recommended to use drugs in this group for more than 7-10 days in a row. The instructions for a number of drugs imply the possibility of prescribing them for up to 1 month, but this should still be avoided. Gradual withdrawal of topical glucocorticosteroids is recommended. For example, during the main part of the treatment course you apply ointment to the entire affected area. Then apply it using the stroke method every day, leaving a little more distance between the strokes.

Another option for gradual withdrawal is to apply the cream one day, and then give the skin a rest the other day, using non-hormonal remedies.

It should also be remembered that no glucocorticosteroids for external use should be applied to the skin of the eyelids in the immediate vicinity of the eyes, as this can lead to the development of glaucoma and cataracts.

2) Combined drugs. Drugs in this group contain a combination of glucocorticosteroids, antibiotics and antifungal drugs. Medicines of this pharmacological group are used if an infection is associated with allergic inflammation in atopic dermatitis. Examples: Triderm cream, pimafucort, etc.

3) Preparations with active zinc. These are products for external use (ointments, creams). Some experts regard it as an alternative to local glucocorticosteroids. The duration of treatment must be monitored by a doctor, preferably with experience in working with these drugs, as the development of chronic dermatoses of other, non-allergic, origin is possible.

4) Antihistamines. Preference should be given to drugs of the second and third generations. The average duration of treatment is ten days. Although there are treatment regimens that provide for long-term (at least three months) use of third-generation drugs. Examples: Zyrtec, Erius.

5) Pimecrolimus derivatives. This group includes the drug Elidel. A relatively new group of drugs used to relieve symptoms of exacerbation. Its effectiveness is not inferior to local glucocorticosteroids and, at the same time, according to studies conducted by the manufacturer, it is much safer. Disadvantages of the drug: high cost, little clinical experience in its use.

6) Sorbents. Carrying out detoxification therapy with the help of sorbents is a necessary component in the treatment of exacerbations of most allergic diseases. Examples of drugs: lactofiltrum, enterosgel, filtrum, etc. The drugs are prescribed two to three times a day at an average age dosage for 7-14 days.

7) Glucocorticosteroids. Oral medications are prescribed only for severe forms of atopic dermatitis. The dosage and duration of treatment are determined by the doctor. Examples of drugs: metypred, prednisolone.

8) Cytostatics. Can be used only for severe forms of atopic dermatitis that are resistant to all other treatment methods. The dosage and duration of treatment are determined by the doctor. Treatment is carried out in a hospital setting.

Treatment of atopic dermatitis beyond exacerbation.

Atopic dermatitis– a chronic disease that requires long-term treatment even beyond the symptoms of exacerbation.

Currently, much attention is paid to the use of medicinal cosmetics during this period. Due to the presence of allergic inflammation, even sluggish without external clinical manifestations, the properties of the skin change. Its permeability and humidity are impaired. And the purpose of regular use of fortified cosmetics is to restore the damaged properties of the skin. Examples of drugs related to medicinal cosmetics: radevit, bipanten, pantoderm, locobase-ripea, etc.

In addition, treatment of concomitant diseases identified during the examination of the patient is carried out. The functioning of the gastrointestinal tract is corrected, the functioning of the nervous system is normalized, etc. The nature of the measures is selected individually, depending on the specific test results.

Thus, it is not enough to simply relieve the exacerbation of atopic dermatitis; it is necessary to identify and eliminate the factors that caused the development of the disease or provoke its exacerbations. Only in this case can you stop the progression of allergies, bring atopic dermatitis into remission, and then completely get rid of it.

Folk remedies for the treatment of atopic dermatitis

In folk medicine, there are a number of methods actively used by patients with atopic dermatitis. Thus, in mild forms of the disease, baths with decoctions of medicinal herbs, such as chamomile and string, have a good effect.

For children, baths with soothing herbs such as oregano, hops, valerian, and motherwort can be recommended. To prepare the bath, take 2 tablespoons of the herb, pour 1 glass of boiling water and leave for at least 10 minutes. The resulting broth is added to the baby’s bathtub.

But still, allergists are quite wary of traditional medicine, since patients with allergies very often experience individual allergic reactions to “traditional” recipes.

Treatment of atopic dermatitis during pregnancy.

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

There are some features for treating an existing disease in women during pregnancy. Moisturizing cosmetics are carefully selected to soften the skin without exacerbation. For a number of fortified creams, for example, the fairly popular Radevit cream, pregnancy is a contraindication.

The principles of treatment during exacerbation of atopic dermatitis during pregnancy are practically no different from those in the rest of the population. If there is a need for local hormonal therapy or the prescription of antihistamines, then it is preferable to use the latest generation of drugs that are safer (Advantan, Elakom, Lokoid).

The main focus should be on creating a hypoallergenic environment.

There is no negative effect of atopic dermatitis on the fetus. Although toxic effects on a child are still possible, but only when using medications prohibited for this period of a woman’s life.

Wear cotton clothes. The skin must breathe. Clothing made of wool or synthetics will increase irritation and itching.
Frequent wet cleaning and ventilation of the room is necessary. Minimum carpets and upholstered furniture - minimum dust.
It is better to use bedding with synthetic filling, without down or feathers.
When washing, including your hands, use only warm water.
After washing, do not rub the skin, but gently pat dry with a towel.
Be sure to use moisturizers after showering. Skin care products should be neutral, without fragrances or dyes.
Timely treatment of all chronic diseases, courses of taking vasoconstrictors, sedatives (especially before significant events, such as exams, weddings, etc.), hardening, vitamins, eliminating allergic foods even during the period of resolution of rashes.

Features of nutrition, diet and lifestyle with atopic dermatitis

Creating a special hypoallergenic, that is, devoid of allergens, environment and following a diet are the most important components of the treatment of atopic dermatitis. Without following these recommendations, the effectiveness of treating the disease is significantly reduced.

Let's start by creating a hypoallergenic environment. In essence, it is the observance of a special way of life. The goal is to eliminate factors that can irritate the skin and thereby provoke exacerbations of atopic dermatitis.

It is also preferable to avoid intense physical activity or factors that increase sweating and itching. For the same reason, it is not recommended to participate in sports, as this causes active sweating and is accompanied by close contact of the skin with clothing. If possible, avoid stressful situations (as much as possible, of course). It is not recommended to wear rough clothes, especially those made of wool, synthetics, or animal fur. New clothes should be washed before wearing. When washing clothes and bedding, use a minimal amount of fabric softener, after which the laundry should be rinsed additionally. Do not use personal hygiene products containing alcohol.

You will have to install a hood in the kitchen. It would be a good idea to install an air purifier in your bedroom. During the hot season, use an air conditioner with an outlet filter.

Bed linen should be changed 1-2 times a week. Sources of dust and mold accumulation must be eliminated. The TV, computer, and household appliances must be removed from the patient’s bedroom. Light wet cleaning is carried out once a day, general cleaning is carried out at least once a week. Use vacuum cleaners with good filters (the best ones with HEPA filters). If there is a confirmed allergy to house dust mites, treat the apartment with acaricidal (mite-killing) drugs, for example, Allergoff, once every 3-6 months.

Smoking is not allowed in the house. This means family members. The patient should not smoke anywhere: neither in the house nor on the street.

Much attention is paid to water procedures. You cannot use regular soap; it is better to use shower oil or medicated shampoo (for example, Friederm series shampoos). After a shower, be sure to lubricate your skin with moisturizers.

The patient's nails should be cut as short as possible to avoid involuntary damage to the skin in case of exacerbation of the disease and the appearance of skin itching.

People with atopic dermatitis should not sunbathe. Extended exposure to the sun is a common mistake. Immediately after this there will be a slight improvement, which parents usually notice and strive for, but then a severe exacerbation of the disease almost always follows.

Do not comb or rub the skin; no products will be effective if you scratch the lesions.

Be sure to consult with your doctor regarding adherence to the principles of hypoallergenic living. The recommendations offered on our website may be supplemented depending on the allergens to which you (or your child) react.

Hypoallergenic diet for atopic dermatitis:

It is also necessary to adhere to a special diet. During an exacerbation, the diet should be observed especially strictly; outside of an exacerbation, it can be expanded a little so as not to cause some kind of neurosis-like state in the child due to the fact that he “cannot do everything.”

Products excluded for atopic dermatitis:

It is not recommended to consume citrus fruits, nuts, seafood, fish, chocolate, coffee, mustard, spices, mayonnaise, tomatoes, eggplants, red peppers, milk, eggs, mushrooms, sausages, carbonated drinks, strawberries, wild strawberries, watermelons, pineapples, honey . Alcohol is strictly prohibited.

Products allowed for atopic dermatitis:

You can eat boiled beef; cereal and vegetable soups; vegetarian soups; olive oil; sunflower oil; boiled potatoes; porridge from buckwheat, rice, oatmeal; lactic acid products; cucumbers; parsley; dill; baked apples; tea; sugar; bran or whole grain bread; apple or dried fruit compote (except raisins); organic yoghurts without additives; one-day cottage cheese; curdled milk.

Atopic dermatitis– a disease that begins in early childhood. Most often within a period of 6 to 12 months. Atopic dermatitis in children is popularly called " Diathesis", in medicine concepts diathesis no, there is a concept infant stage of atopic dermatitis.

The clinical picture (symptoms with photos) of infant and childhood forms of atopic dermatitis is described in detail in the section Symptoms of atopic dermatitis. The younger the child is, the more prone he is to exudation (wetting).

The photo shows a child with atopic dermatitis

The nature of activities aimed at creating a hypoallergenic environment around a child does not differ from those for adults and is described in detail above.

Particular attention in children is paid to restoring damaged skin properties through the constant use of moisturizing cosmetics. It should be applied 3-4 times a day, sometimes more often.

It is very important to maintain breastfeeding for as long as possible (at least 6 months). But at the same time, the mother should not eat foods that can aggravate allergies (see the diet in the section Features of nutrition and lifestyle with atopic dermatitis).

It is important to properly bathe a child in the first year of life, especially a newborn. You can't use soap. It is better to use medicated shampoos. For example, Friederm shampoo with zinc during an exacerbation and Friderm Balance during an exacerbation. Before bathing, add one capful of shampoo to a bath of water. After bathing, do not rub your child with a towel - this will irritate the skin. It is better to lightly blot the skin with a towel or let it dry on its own.

An urgent problem is vaccination of a child with atopic dermatitis. The very fact of having a disease is not a reason to refuse vaccinations, but vaccination is possible only during the stage of stable remission of the disease (at least 2-3 months). It is mandatory to take antihistamines 7 days before vaccination on the day of vaccination and 3-5 days after vaccination. Multiple vaccines cannot be administered on the same day. If several vaccinations have already been missed, then vaccination should begin with less allergenic vaccines. Your attending physician (allergist-immunologist or pediatrician) will help you correctly draw up an individual vaccination calendar.

Complications of atopic dermatitis and prognosis for cure

The prognosis for life is favorable. However, skin lesions, especially in adolescence, can contribute to the social maladjustment of the patient.
Atopic dermatitis is a chronic allergic skin disease. If adequate treatment is carried out and risk factors are eliminated, most patients experience stable remission and subsequently the diagnosis can be removed. But since the diagnosis of atopic dermatitis is a reflection of a general allergic mood (atopic constitution), a large proportion of these patients (more than 40%) may develop other allergic diseases in the future, most often associated with damage to the respiratory tract (allergic rhinitis, atopic bronchial asthma). This progression of allergic mood and the change of allergic diseases from less severe to more serious in the medical literature is called the atopic march.

In case of severe disease and/or inadequate treatment, non-compliance with a special lifestyle, the disease continues into adolescence and adults.

The most common complications of atopic dermatitis are the addition of a bacterial infection (pyoderma) and skin atrophy (most often due to unreasonably long use of local glucocorticosteroid drugs). Constantly scratching the skin atopic dermatitis leads to a violation of its protective, barrier properties, which contributes to the addition of infection caused by microbial and fungal flora.

Pyoderma is characterized by the appearance of pustules on the skin, which gradually dry out and crusts form. The rash can be located on the body, arms, legs, and scalp. This may be accompanied by a disturbance in the person’s general condition, and the temperature may rise.

Another common complication when atopic dermatitis- viral infection. Bubbles with transparent contents form on the skin. The causative agent is the herpes simplex virus, the same one that causes “colds” on the lips. Usually the rashes are located in the area of inflammatory foci, but they can also involve healthy skin and also affect the mucous membranes (oral cavity, throat, genitals and conjunctiva). A particularly common localization of the rash is the skin of the face (around the mouth, lips, wings of the nose, on the cheeks, ears, eyelids).

A common complication of atopic dermatitis is fungal (most often candidal) infection. In adults, the skin (especially skin folds), nails, scalp, feet, and hands are most often affected; and in children - the oral mucosa, the so-called thrush (a “curdled” coating appears, which may be accompanied by soreness and redness). Sometimes bacterial and fungal infections are combined together.

Prevention of atopic dermatitis

There are no measures aimed at preventing the development of atopic dermatitis. The only recommendation that really works is to continue breastfeeding for as long as possible (at least 6 months). Some authors recommend excluding cow's milk from the diet of children under 1 year of age if there is a patient with an allergic disease in the family.

In case of an already manifested (started) disease, preventive measures are reduced to eliminating the causally significant allergen (allergen causing allergies) from the environment, following the general principles of diet, creating a hypoallergenic lifestyle and providing adequate treatment.

Answers to frequently asked questions on the topic of atopic dermatitis:

Why should a child with atopic dermatitis follow a diet?

The diet should exclude foods directly to which allergies develop, and foods containing large amounts of histamine. Histamine is one of the most important participants in allergic disease. Absorbed in the intestines, it enhances the existing allergic process. Eating foods rich in histamine for patients with allergic diseases can be compared to throwing wood on a fire.

Can atopic dermatitis be completely cured?

Modern medical methods make it possible in most cases to put the disease into remission in a child. In this case, during adolescence, the disease may completely go away. In the old medical literature this was called "outgrowing the disease."
But for this to happen, long-term joint work between the doctor and the patient is necessary.

I have atopic dermatitis, what is the likelihood of passing it on to my child?

The probability of transmitting an “allergic mood” from the father is about 15-20%, from the mother about 40%, if both parents are sick - 70%. But for this attitude to result in disease, a combination of a number of external factors is necessary. Therefore, the real probability is less. Talk to your doctor about preventive measures.

Allergist-immunologist, Ph.D. Mayorov R.V.

Almost every mother can experience atopic dermatitis in her baby. This disease often appears from the first days after birth and occurs throughout life. Children who are diagnosed with atopic dermatitis are forced to see an allergist for life. Only correct knowledge about this disease will help control the course of the disease.

What it is?

Scientists have identified a number of genes that encode a predisposition to perceive various substances. These genes cause the body's increased susceptibility to various foreign components. As a rule, several family members can have such a predisposition at the same time.

Atopic dermatitis develops as a result of an acute response of the immune system to a trigger factor. This reaction is accompanied by pronounced skin and systemic manifestations. Various substances and allergens can act as triggering or provoking agents. The specificity of an individual reaction depends on genetic predisposition and the initial level of the immune system.

Causes

A severe allergic reaction, manifested by the appearance of a rash or other skin lesions, does not occur in all children. Currently, scientists have identified more than a thousand different causes that can lead to the appearance of atopic dermatitis. . In most cases, the triggering agents are chemicals.

The only exact cause of the disease is unknown to scientists. This is due to the individual coding of genes in each human body. It has been established that when a specific trigger occurs, the risk of developing atopic dermatitis in the presence of a specific genetic predisposition is more than 95-98%.

Canadian scientific studies have shown a statistically significant connection between the presence of stressful situations and exacerbations of the disease. After severe psycho-emotional or physical stress, the risk of new exacerbations of the disease increases by 12-15%.

Among the possible causes, some scientists note the presence of skin pathologies. When the integrity of the skin is damaged, allergens enter the child’s body much more easily and trigger a whole cascade of inflammatory reactions. As the disease develops, periods of exacerbation are replaced by remission. As a result of a long-term illness, the structure of the skin changes. This may also affect the likelihood of the disease progressing.

Provoking factors

Atopic dermatitis can be triggered by numerous factors. All triggers can be divided into several categories. Most provoking agents enter the body from the outside. They account for more than 80% of disease cases. Internal provoking factors are much less common. Typically, such forms of disease are typical for children who have many chronic diseases.

All provoking factors that trigger a cascade of allergic reactions can be divided into several etiological categories:

Stages of disease development

Unfortunately, atopic dermatitis is a chronic disease. In the presence of individual sensitivity and genetic predisposition to various provoking factors, a new exacerbation of the disease can occur at any age. Like any chronic disease, atopic dermatitis goes through several successive stages in its development:

Primary contact with the allergen. In this case, when a provoking agent enters, the cells of the immune system are activated. Lymphocytes, which are designed to recognize substances foreign to the body, are activated and release a huge amount of biologically active substances. Subsequently, when the same trigger hits, the inflammation proceeds much more severely. This property is due to cellular memory. Cells of the immune system “remember” the antigens of a substance foreign to the body and, upon repeated exposure, release a huge amount of protective antibodies.
Development of immune inflammation. Activated lymphocytes, which recognize a foreign agent, begin to release a huge amount of interleukins. These protein substances have a pronounced biologically active effect. It is with them that the development of all unfavorable clinical symptoms and manifestations is usually associated. This reaction has a positive meaning. It is designed to limit inflammation and prevent damage to vital organs. The body wants to limit inflammation to only the skin, protecting the brain and heart.
Development of classic manifestations of the disease. During this period, the inflammatory process reaches such strength that the first adverse symptoms of the disease begin to appear. As a rule, they last 7-14 days. The most acute manifestations of initial contact with the allergen appear after 48-72 hours. If the provoking factor enters the body again, the period before the onset of symptoms can be reduced from several hours to a day.
Subsidence of exacerbation and transition to a chronic form. During this period, the amount of toxic substances that are formed during an allergic reaction decreases. The immune system calms down and goes into “sleep” mode. The subsidence of the process can last up to 2-3 weeks. At this time, there are only residual skin manifestations: dryness, slight flaking, slight redness. After the acute period of the disease subsides, the skin clears up and takes on its normal appearance.
Remission. During this period, practically nothing bothers the child. The baby leads a normal life. The child's health is excellent. The skin changes slightly. In some cases, crusts or areas of dry skin may form at the folds.

The development of the disease involves a sequential alternation of several stages. After a period of exacerbation, remission occurs. The duration of this period largely depends on the condition of the baby and the absence of exposure to provoking factors. With any change in the level of immunity or inflammation, remission can quickly give way to exacerbation.

Classification

Today, doctors use several different categories in their work to help clarify the diagnosis. Such classifications include the distribution of various variants and forms of the disease - depending on the stage of the inflammatory process, its duration, as well as the severity of the child’s general condition.

The various forms of atopic dermatitis can be divided into several broad categories.

Disease development phase

Start. Corresponds to the primary contact of immune system cells with a provoking factor.
Development of clinical manifestations. During this period, all the main manifestations of the disease characteristic of the acute period develop.
Subsidence of exacerbation. Disappearance of unpleasant symptoms, improvement of the baby’s general condition.

Age

Infant version. Develops in children under two years of age. It usually occurs with the appearance of red itchy spots. These rashes are quite large. This option is also characterized by pronounced swelling of the baby’s buttocks, arms and legs. The skin on the body becomes very thin. Numerous white scales may form on the head, which are easily torn off.
Children's version. It usually lasts until adolescence. This form of the disease is characterized by severe itching and drying of the skin. Skin elements can be varied. Various vesicular rashes filled with transparent contents often appear.
Teen version. It can develop before the child’s eighteenth birthday. This form occurs with the appearance of severe itching on damaged areas of the skin. The disease occurs with alternating periods of exacerbation and remission. This leads to the formation of dense crusts and areas of severe lichenification. The appearance of vesicles does not always occur. Much more often, skin rashes appear as large areas of erythema.

The extent of the inflammatory process

Option with limited areas. Damage to the skin in such cases amounts to no more than five percent of the entire skin surface.
Option with common elements. Occurs when there are lesions that cover up to a quarter of the entire surface of the skin.
Option with diffuse changes. An extremely unfavorable form of the disease. In this case, numerous damage to the skin is noted. The only areas that remain clean are the inner surface of the palms and the area on the face near the nose and above the upper lip. This variant of atopic dermatitis causes severe unbearable itching. Numerous scratch marks appear on the skin.

Change in general condition

Relatively mild course. Involves the occurrence of a small number of skin rashes during exacerbations. Usually these are single vesicular elements. This option is characterized by the appearance of moderate itching, slight swelling, and dry skin. The course of the disease is usually well controlled. Periods of remission are usually long.
Moderate form. With this variant of the disease, a large number of different vesicular formations filled with serous fluid appear in various parts of the body. When the vesicles rupture, the fluid leaks out and weeping ulcers form. As a rule, the baby's condition worsens. The child constantly scratches the itchy elements. The condition may also be complicated by the addition of a secondary bacterial infection.
Heavy current. Typical for children with low immunity levels. The child looks terrible. Skin elements appear almost everywhere: on the face, on the arms and legs, covering the buttocks and abdomen. Numerous vesicles, rupturing, contribute to the development of strong weeping wounds, which are poorly epithelized.

Main symptoms and signs

Atopic dermatitis is manifested by numerous symptoms that cause severe discomfort to the baby. The severity of the disease depends on a combination of many factors. With a mild course of the disease, symptoms appear to a lesser extent. If the child’s allergic predisposition is sufficiently pronounced, then the immune response to the provoking factor will be very strong.

During an exacerbation, dermatitis manifests itself with the following characteristic signs:

Severe itching. It bothers the child throughout the day. Decreases somewhat at night. Children scratching damaged areas of the skin can cause additional infection and worsen the course of the disease. The use of antihistamines helps to somewhat reduce the manifestation of this uncomfortable symptom.
The appearance of erythematous spots. Numerous bright red spots begin to form on the skin. With a mild course of the disease, skin rashes may appear only in limited areas of the body. They often appear on the back, stomach or arms. The affected skin acquires a characteristic “fiery” color. It becomes hot to the touch, somewhat compacted.
Appearance of dryness. It is also one of the most common symptoms of atopic dermatitis. The longer the disease lasts, the more pronounced this manifestation becomes. This is due to a violation of the water-lipid composition of the skin (due to a long-term inflammatory process). The structure of the skin layers is disrupted, which contributes to a change in its quality. The skin becomes very dry to the touch and thins.
Various skin rashes. Atopic dermatitis is characterized by a variety of different manifestations. In most cases, the disease manifests itself by the appearance of vesicular elements. As a rule, they contain serous fluid inside. In more rare cases, papular elements occur or various crusts appear. Such rashes most often occur in all folds of the skin. Very often they appear in the cubital fossa, under the knees, and can also appear behind the ears or on the cheeks.
Lichenification phenomena. This sign appears quite late. It occurs with constant scratching, in the presence of damaged areas of the skin. In this case, a change in the structure and structure of the skin occurs. It becomes denser, the architecture of collagen and elastin fibers is disrupted.
The child is not feeling well. Severe itching causes severe anxiety in the baby. Babies are more capricious and often cry. In severe cases of the disease, they may even refuse to eat. Older children are characterized by increased excitability and even somewhat aggressive behavior. Sleep is disturbed.

After the acute process subsides, a period of remission begins. All symptoms that were characteristic during an exacerbation are replaced by others. The length of remission can depend on many different factors. With a favorable course of the disease, such periods can even last several years.

The period of remission of atopic dermatitis is characterized by the following symptoms:

Changes in skin structure. Some areas of the skin become thicker, while others become thinner. This occurs due to changes in the structure and structure of the skin layers. The areas where the weeping ulcers were located usually heal, but become less dense to the touch. Crusts may form on healed wounds.
Traces of scratching. They are found in almost all children with atopic dermatitis. They are most pronounced in children with frequent exacerbations of the disease. Usually appear as narrow stripes of white or reddish color. Cover the entire surface of the body. You can see them in large quantities on the baby’s arms or cheeks.
Change in skin pattern. During the long-term inflammatory process that occurs with this disease, the architecture of the skin structure changes. Areas of hyperpigmentation appear.
Severe dryness of the skin and the appearance of areas with peeling. This symptom is typical in the very first days after the exacerbation subsides. The skin becomes very dry. Numerous scales may appear on the scalp and on the folds of the arms. They come off easily when washed or touched.
With a long course of the disease, severe dryness and peeling around the red border of the lips may appear. Often this is a manifestation of atopic cheilitis. This condition requires no special treatment other than the use of mild lip balms approved for use in children. In some cases, atopic cheilitis goes away on its own, without the use of additional drugs.

Diagnostics

Auxiliary laboratory and instrumental tests will help identify a specific allergen that contributes to the appearance of symptoms of atopic dermatitis.

General blood analysis

An increase in the level of leukocytes above normal indicates the presence of an inflammatory process in the body. Severe eosinophilia (increased number of eosinophils) indicates the presence of an allergic nature of the disease. All allergies occur with accelerated ESR during the acute period of the disease.

The leukocyte formula helps doctors understand the stage of the inflammatory process. An increase in the level of peripheral lymphocytes also speaks in favor of the allergic nature of the disease.

Biochemical research

To carry out the analysis, a little venous blood is taken from the baby. This test can look at your liver and kidney function. An increase in transaminase levels may indicate the involvement of liver cells in the systemic process. In some cases, there is also an increase in bilirubin levels.

Kidney damage can be assessed by measuring urea or creatinine levels. With a long course of the disease, these indicators can change several times. If your creatinine level changes, be sure to show your child to a nephrologist. He will help you choose the right tactics for further treatment of the baby.

Quantitative determination of immunoglobulin E

This substance is the main protein substrate that cells of the immune system secrete in response to allergens entering the body. In a healthy baby, the level of immunoglobulin E remains normal throughout life. Children with atopic diseases are characterized by increased levels of this substance in the blood serum.

The material for the study is venous blood. The analysis is ready, as a rule, in 1-2 days. During an exacerbation of the disease, the level of immunoglobulin E is many times higher than normal. An increase in the value of more than 165 IU/ml may indicate the presence of atopy. During remission, the level of immunoglobulin E decreases slightly. However, for quite a long time it can remain somewhat elevated.

Special allergy tests

This method is a classic way to determine allergens in immunology. It has been used in pediatrics for more than a hundred years. The method is quite simple and informative. Such provocative tests are carried out for children over four years of age. Younger children may give false positive results during the test. This is largely due to the peculiarities of the functioning of the immune system at this age.

Only a pediatric allergist-immunologist can conduct allergy tests. Most often they are carried out in allergy clinics of clinics or in private centers.

The study usually takes no more than an hour. Small incisions are made on the baby's skin with a special sharp scalpel. There is no need to be afraid of such cuts. They are too small to become a threat of infection or suppuration.

After applying special incisions, the doctor applies diagnostic solutions of allergens. Substances are applied in strong dilution. This allows you to minimize the risk of a possible violent allergic reaction. Such diagnostic solutions can be applied in several ways. Usually drip is chosen.

Today, the application method is widely used. It does not require additional notches. With this method of applying the allergen, the diagnostic solution is applied to the material in advance. The doctor simply glues it to the child’s skin and evaluates the result after a while.

Usually the result is assessed in 5-15 minutes. This time depends on the initial diagnostic solution used in the study. If the baby has an allergic predisposition or severe sensitivity to a specific allergen, then after a specified time redness (and even skin manifestations) will appear at the application site. They can be papules or vesicles.

The undoubted disadvantage of this test is its low specificity.. If the baby has very sensitive and delicate skin, then various false-positive reactions may be observed. Under the influence of any chemical provocateur, too delicate skin can react excessively. In such cases, it is impossible to speak about the unambiguous presence of an allergy.

If it is impossible to unambiguously assess the presence of individual allergic sensitivity to a specific allergen, doctors use additional serological tests.

Determination of specific antibodies

These studies are considered the most modern among all methods for diagnosing atopic diseases. They began to be used quite recently, but have shown excellent results in the diagnosis of allergic diseases. The test does not require making incisions or making cuts in the skin. The material for the study is venous blood.

The turnaround time for analysis usually ranges from three days to several weeks. This depends on the number of allergens tested. For the convenience of young patients, modern laboratories immediately identify a whole range of allergens that are similar in antigenic structure. This allows not only to accurately identify one provoking factor, but also to identify all cross-allergens that can also trigger an exacerbation.

The essence of the method comes down to determining specific antibodies that are formed in the body after allergens enter it. They are protein molecules that are very sensitive to various foreign agents. Whenever there is contact with an allergen, cells of the immune system release huge amounts of antibodies. This protective reaction is designed to quickly eliminate the foreign agent from the body and eliminate inflammation.

A serological test is an important diagnostic test in identifying triggers that may trigger an allergic reaction. It has a fairly high specificity (95-98%) and information content. The disadvantage of the study is the high cost. Typically, the price for determining 10 different allergens is 5,000-6,000 rubles.

Before performing any serological tests, it is important to remember to prepare for research. All such tests are best performed during remission. This will minimize false positives. Before conducting the study, it is better to adhere to a therapeutic hypoallergenic diet. It is better to stop all antihistamines and desensitizing medications a couple of days before the test.

Principles of basic treatment

Therapy for atopic dermatitis is divided into several stages: during exacerbation and remission. Dividing treatment allows you to cope with different symptoms that occur at different periods of the disease. With the long-term development of the disease, drug therapy also changes. This is largely due to changes in the architecture and structure of the skin.

During an exacerbation

Elimination of the provocative factor. It is an important condition for successful treatment of the disease. Often in infants there is a contact form of atopic dermatitis. It occurs when wearing diapers that are poorly suited for a particular child. The area of tissue that is closely adjacent to the baby's genitals can be impregnated with various antiseptic agents. Babies prone to allergies may develop acute contact dermatitis . In this case, it is better to abandon this brand of diapers and change them to others.
Use of drug therapy. Today, the pharmaceutical industry offers a huge selection of different products that help cope with the discomforting symptoms of atopic dermatitis. The choice of medications is carried out based on the skin manifestations that arose during a given exacerbation. The most commonly used are various hormonal and anti-inflammatory ointments, creams, gels, as well as various powders or mash.
Following a hypoallergenic diet. During an exacerbation, doctors prescribe the most stringent therapeutic diet. This diet includes an abundance of permitted protein foods and cereals with the almost complete exclusion of a variety of fruits and vegetables. You can only eat green plants.
In severe cases of the disease - elimination of systemic manifestations. In such cases, hormonal drugs may be prescribed in the form of injections or tablets. In case of severe itching, which brings severe suffering to the baby, tablet forms of antihistamines are prescribed. E it could be “Suprastin”, “Fenistil” and others. They are prescribed for a long time: from several days and even up to a month.
Compliance with personal hygiene rules. Mothers should keep their babies' nails clean and long. When itching is severe, children scratch the inflamed skin vigorously. If there is dirt under the nails, they can cause additional infection and aggravate the disease. With the addition of secondary bacterial flora, the inflammation noticeably intensifies, and signs of suppuration may appear.
Maintaining a daily routine. For the immune system to function properly, children require mandatory rest. Children should sleep at least ten hours during the day. This time is required for the body to maintain a good ability to fight inflammation, it gives strength to fight the allergen.

During remission

The use of drug therapy for damaged skin areas. After the acute process subsides, various crusts and peelings remain on the skin. To eliminate the consequences of the inflammatory process, ointments and creams with a fairly oily texture are ideal. Such preparations penetrate well into all layers of the skin and eliminate severe dryness. To eliminate crusts or scales on the scalp, various ointments are used that have a keratolytic effect.
Strengthening the immune system. For children weakened after an acute period of illness, restoring the strength of the immune system is an important stage of rehabilitation. Children with atopic diseases do not need to be at home all the time. Sterile conditions are absolutely useless for them.

Active walks and games in the fresh air will strengthen your immune system and improve your health. Normalizing the protective function of the intestines also helps restore immunity. Preparations enriched with beneficial lacto- and bifidobacteria restore damaged microflora. “Liveo baby”, “Bifidumbacterin” help the intestines work fully and strengthen the immune system.

Regular adherence to a hypoallergenic diet. A child who is prone to allergic diseases or atopic dermatitis must eat only approved foods. All food that contains possible allergenic components is completely excluded from the baby’s diet. You should follow a hypoallergenic diet throughout your life.
Complete exclusion of possible triggering allergens from household use. For babies who are prone to atopic dermatitis, feather-based pillows or blankets should not be used. It is better to give preference to other natural and synthetic materials on a hypoallergenic basis. Pillows should be dry cleaned at least twice a year. This will get rid of household mites, which often live in such products and can cause allergic reactions.

Drug therapy

Drug treatment plays a significant role in eliminating the adverse symptoms of atopic dermatitis. The choice of drug directly depends on what manifestation needs to be eliminated. In the treatment of the disease, both cutaneous forms and systemic injections and tablets are used.

Local treatment

Anti-inflammatory ointments, creams and suspensions (paints). These include " Tsindol", "Elidel", "Triderm", "Ketotifen"and many other means. These drugs have an anti-inflammatory effect and help cope with inflammation. Many remedies are combined. They may contain antibiotics in small concentrations. Such drugs are usually well tolerated and do not cause systemic side effects. They are prescribed, as a rule, 2-3 times a day and for a period of 10-14 days. In more severe cases of the disease, they can be used for a long time, until the unfavorable symptoms of the disease are completely eliminated.
Hormonal ointments. Used for long-term illness. There is no need to be afraid of using such drugs. The content of glucocorticosteroid hormones in them is quite small. Such drugs simply cannot cause systemic side effects. Most topical medications contain beclomethasone or prednisolone in small concentrations. In treatment, you can use Advantan, Elokom and many other ointments approved for pediatric practice.
Desensitizing drugs. Doctors often prescribe antihistamines to eliminate severe itching. This could be Suprastin, as well as Fenistil, drugs based on desloratadine. Many of the drugs are used for children over two years of age. These remedies can eliminate severe inflammation and cope with debilitating itching. Such medications are prescribed in a course of 10-14 days.

Tablet forms can also be used for a month or more from the moment the adverse symptoms of exacerbation are eliminated. To relieve itching, you can use calcium gluconate. It helps eliminate the moderate manifestation of this unfavorable symptom.

Cell membrane stimulants. They have a mechanism of action that is similar to the action of antihistamines. They have been used in pediatric practice relatively recently. They are tolerated quite well by children. There are practically no side effects from use. Ketotifen is often prescribed. This drug is used for children over three years of age. The course is prescribed for 2-3 months. The treatment plan is chosen by the attending physician. To properly discontinue the drug, a gradual reduction in dosage is required.
Drugs that support immunity. Children with atopic dermatitis are often advised to maintain good intestinal microflora. For this purpose, various drugs containing live bifidobacteria or lactobacilli are prescribed. Such medications should be used in courses: 2-3 times a year. To remove toxic products from the body, enterosorbents are used: “Polysorb”, activated carbon tablets, “Enterosgel”.

Are water treatments allowed?

In order for the skin to remain sufficiently hydrated during an exacerbation of atopic dermatitis, it must be moisturized. Even during acute manifestations of the disease, the baby can be bathed. It is not recommended to wash your baby in the bath. This can increase the itching and lead to additional drying of the skin. It is better to give preference to a simple hygienic shower.

To reduce itching on the scalp, you can use special medicated shampoos. Such products have a physiological neutral pH and do not cause irritation.

Hygiene procedures can be carried out daily. After which it is necessary to treat the skin with medicinal ointments or creams. This will further moisturize damaged skin and eliminate the adverse manifestations of atopy.

For very young children, you can add a decoction of celandine when bathing. To prepare it, take 2-3 tablespoons of crushed leaves and pour a liter of boiling water over them. Leave for 3-4 hours. A glass of the resulting decoction is added to the bath when bathing the baby. You can bathe your child with wormwood or infusion of string. These herbs have a beneficial effect on the skin and help prevent infection of wounds that occur during an exacerbation.

What to eat?

Nutritional therapy for atopic dermatitis is very important for the treatment of the disease. That Only adherence to a diet throughout life will prevent frequent exacerbations of the disease. This is especially important for children who have severe food allergies to various foods.

Pediatricians have developed a separate nutrition system especially for children with atopic dermatitis and allergic diseases.

It completely excludes provoking foods that have strong antigenic properties and can cause allergies.

The following foods should be completely excluded from the baby’s diet:

All tropical fruits and vegetables. Most berries are red or burgundy. Citrus fruits are also prohibited.
Seafood and fish that live in the ocean. River fish is added to the diet gradually. It is necessary to monitor the child’s reaction to the introduction of a new product.
Chocolates and other sweets containing cocoa beans.
Candies and sweet sodas, which contain many chemical dyes and food additives.

The diet of a baby with atopic dermatitis must include the following products:

High in protein. Perfect for: lean poultry, veal, fresh beef, and rabbit. Fermented milk products should be included in your child’s diet. A large amount of the right protein in combination with beneficial bifidobacteria will help kids strengthen their immune system. At each meal, it is better to add some specific allowed protein product.
Cereals or porridge. Can be a great addition or side dish. They help provide the body with energy and give new strength to fight the disease. It is better to alternate different cereals. They contain large amounts of B vitamins, as well as zinc and selenium. These substances have a positive effect on the skin and even promote its healing.
Green vegetables. During the period when the exacerbation subsides, you can add potatoes and some carrots. An excellent side dish for very young children would be boiled cauliflower (or broccoli). You can add grated cucumber to your dishes. Vegetables are an excellent source of insoluble dietary fiber. They are also needed for the formation of healthy intestinal microflora.
Fruits. Apples and pears are usually recommended for Russian children. The content of antigenic components in these fruits is significantly lower than in tropical fruits. During the acute period, you should slightly reduce the consumption of such products. Fruits contain large amounts of natural sugars. This can negatively affect the restoration of the cellular structure of the skin and somewhat impair the functioning of leukocytes.
Sufficient amount of liquid. To remove decay products that form in the body during the inflammatory process, water is required . You can drink regular boiled water. It is also acceptable to consume fruit drinks or compotes, prepared from dried garden apples or pears. It is better to avoid berry drinks until the period of remission.
Taking vitamins. During the period of a strict diet, which is necessary during an exacerbation, too few beneficial microelements enter the child’s body, so the introduction of such substances from the outside is required. Synthetic complexes are an excellent source of various vitamins. They contain a combination of useful microelements necessary for the growth and development of the baby. Currently, vitamin preparations are available in the form of chewable tablets, syrup or caramel. Such vitamins will bring joy to the child, and will also help restore the deficiency of useful microelements in the body.

How to properly organize your daily routine?

It is very important for children with atopic diseases to follow the correct routine. . The daily routine must include naps during the day. It is better to spend at least 3-4 hours on it. During such rest, the nervous and immune systems are restored. The child gains new strength to fight the disease.

Night sleep should be at least 8-9 hours. For babies in the first year of life - even up to 12. As a rule, histamine levels decrease during sleep. This substance is formed during an acute inflammatory reaction and causes severe itching. Reducing the concentration of histamine can reduce this unfavorable symptom. This brings some relief to the baby.

During the acute period of illness, active games are noticeably reduced. Exhausting itching brings severe discomfort to babies. When unfavorable symptoms are eliminated during treatment, children begin to feel much better and return to their normal lifestyle. During the acute period of illness, it is better to limit active physical activity. Kids should rest more and try to get a good night's sleep.

Possibilities of spa treatment

The long course of the disease often becomes chronic. Symptoms that occur during an exacerbation are best treated in a hospital, and in mild cases - at home .

Remission of the disease is an excellent time for specialized treatment in sanatoriums or health centers.

Various methods of physiotherapy have a positive effect on the course of the disease. For children with a long-term illness, various methods of ultrasound treatment, magnetic and light therapy, as well as inductothermal methods are used. Usually, during a stay in a health center, a child is prescribed several different techniques at once, in courses of 10-14 days. In some cases, longer treatment is indicated, for up to three weeks.

Therapy at the sanatorium has a very pronounced clinical effect. With regular use of such balneological treatment, the number of exacerbations of the disease is noticeably reduced. Children who undergo therapy at sea noticeably strengthen their immunity. Sea ions have a positive effect on the functioning of immune system cells and also heal the skin.

Doctors recommend that children with atopic dermatitis undergo sanatorium-resort treatment at least once a year. It is better to do this when the exacerbation subsides or during remission. The duration of the trip can be 14-21 days. It is better to choose sanatoriums that are located in close proximity to the sea, or specialized health centers that provide medical services for children with atopy and allergic skin diseases.

Complications

At the initial stage, the disease usually occurs without significant adverse consequences. After several exacerbations and the use of numerous medications, the child may experience certain complications of the disease.

The most common symptoms of atopic dermatitis are:

Various suppurations(as a result of the addition of a secondary bacterial infection). Staphylococcal and streptococcal flora are common. Usually, a baby can introduce germs while scratching itchy items. After this, within a few hours the inflammation noticeably increases and pus appears.
Weeping wounds often become infected. Even a small amount of the pathogen is enough to start a bacterial infectious process. These cases require immediate consultation with a doctor and prescription of antibiotics. In severe cases of the bacterial process, emergency hospitalization is required.
Atrophic phenomena on the skin or its pronounced thinning. Usually encountered as side effects after long-term use of corticosteroid ointments. Some children may experience alternative patterns. Instead of areas of thinned skin, dense crusts (or even scabs) form. In such conditions, discontinue the use of hormones and switch to other medications. During the period of such withdrawal, children are prescribed immunomodulatory drugs to normalize the impaired function of the child’s immune system.

Is disability established?

Typically, for children with atopic dermatitis, establishing a disability is not mandatory. With a mild course of the disease and sufficient control, there is no permanent loss of function. With this variant of the disease, doctors recommend treatment of exacerbations in a clinic, with mandatory monitoring by an immunologist.

Adolescents and young adults who have a history of a long course of the disease and numerous hospitalizations for treatment of exacerbations can contact the ITU for examination. Expert doctors will examine all the child’s medical documentation and identify the presence or absence of disabling signs. If a child has signs of persistent loss of function, he may be assigned a disability group. As a rule, the third.

Prevention of exacerbations

Preventive measures help prevent acute manifestations of the disease and control the course of the disease. When it comes to babies with atopic dermatitis, you should always remember about prevention. Avoiding contact with the trigger helps reduce the risk of a possible exacerbation.

To avoid the appearance of adverse symptoms and the acute stage of the disease, you should:

Be sure to follow a hypoallergenic diet. All products with strong allergenic properties are completely excluded from the baby’s diet. Only neutral dishes that do not contain allergens are allowed. Meals should be provided several times a day, in small portions. Be sure to include complete protein (in sufficient quantity for the child’s body).
Use only hypoallergenic materials. All pillows, bedding, and clothing should be made of synthetic materials with low allergenic properties. It is better not to wear items made from natural silk or wool. Pillows should be cleaned at least once or twice a year. The blanket should also be professionally dry cleaned.
Toys, dishes and cutlery belonging to the child are processed in warm water using special liquids that do not contain aggressive chemicals. Such products are usually labeled that they are hypoallergenic and cannot cause allergic reactions. For children with atopic dermatitis, it is better to use household chemicals that are approved for use from the first days after birth.
The use of antihistamines before the onset of plant flowering. Especially necessary for babies with allergic reactions to pollen. Antihistamines in prophylactic doses will reduce the likelihood of a severe allergic reaction. The disease may pass in a more subtle form.
Strengthening the immune system. Proper nutrition with enough fiber and vitamins, active games in the fresh air will be excellent ways to restore and activate the immune system. Children with atopic dermatitis should also not avoid hardening and water procedures. Such techniques have a positive effect on the immune system, and also improve mood and normalize sleep.
Long-term breastfeeding. Scientists from many countries have proven that protective antibodies enter the infant’s body along with mother’s milk. This allows you to protect the child’s body from various infectious pathologies and reduce the risk of developing possible allergic reactions. Breast milk also helps normalize the baby's intestinal microflora and helps strengthen the immune system.
Maintaining hygiene rules. Children's rooms for children who are prone to allergic reactions should be cleaned much more often. Achieving completely sterile conditions is not necessary. Much more important is just a clean and freshly washed floor. Be sure to ventilate the room. This improves air exchange in the children's room and even helps reduce the concentration of pathogenic microbes in the air.
Regular walks in the fresh air. Sufficient insolation has a positive effect on the immune system. The sun's rays stimulate the nervous system and also help normalize hormonal levels. Walking in the fresh air is very important for infants. They help restore immunity.

Atopic dermatitis very often occurs in children of different ages. The course of the disease in most cases becomes chronic. Regular monitoring, preventive measures, as well as timely and competent treatment of exacerbations will help control the development of the disease and improve the baby’s quality of life.

Atopic dermatitis– a chronic inflammatory disease of an allergic nature, the main symptoms of which are a rash on the skin of the exudative and/or lichenoid type, severe itching and seasonality. In winter and summer, exacerbations often occur, and symptoms intensify, but remissions, sometimes even complete, are common.

Atopic dermatitis is one of the types. Previously it had a different name - diffuse neurodermatitis.

To make the picture of the disease clearer, let’s look at the question: “ what is atopy?».

Atopy, or atopic diseases– the tendency of newborn children to allergic diseases, which is transmitted to infants through hereditary means. That is why the development of atopic dermatitis occurs at a fairly early age - 2-4 months, and one of the root causes is the incorrect lifestyle and diet of a pregnant woman. The expectant mother, especially in the last trimester of pregnancy, should try to refrain from consuming foods from the highly allergenic category - chocolate, citrus fruits, strawberries, etc.

Another factor without which the development of atopic dermatitis in a child is impossible is the infant’s incompletely formed immune and other systems, which at this age are not yet able to adequately fight allergens.

Due to the above features, atopic dermatitis often goes away by the age of 4, but there are cases when it accompanies a person throughout his life.

Secondary triggers for the development or exacerbation of atopic dermatitis can also be contact or respiratory allergens - dust, pollen, clothing, animals.

Atopic dermatitis. ICD

ICD-10: L20
ICD-9: 691.8

Development of atopic dermatitis

So, let’s summarize the beginning of the article and continue the topic with the question - “ How does atopic dermatitis develop?».

1 situation: An infant 2-3 months or 2 years old receives highly allergenic foods through mother's milk or other means. His gastrointestinal tract organs, immune system, etc. have not yet fully formed. An allergen (any product that causes an allergic reaction in a particular person) entering the body cannot be processed in the intestines, and the liver, in turn, also cannot neutralize its adverse effects on the body. The kidneys also cannot remove it in any way. Thus, due to various biochemical processes in the body, this allergen is transformed into substances with the properties of antigens (substances foreign to the body). The body produces antibodies to suppress them. The rash that we can observe in a child with atopic dermatitis is the body’s reaction to foreign substances produced by the allergen.

Situation 2: A pregnant woman consumes large quantities of highly allergenic foods, or has been in contact with various substances that cause. The fetal body can also receive part of these products or substances that will be in the child’s body after birth. Further, when the baby eats or comes into contact with allergens that he was in contact with during the prenatal period, his body will react to this with a rash and other symptoms of atopic dermatitis.

Thus, we can come to the conclusion that atopic dermatitis is not a skin disease, but an internal reaction of the body to an allergen, transmitted hereditarily.

Causes of atopic dermatitis

The following factors can cause atopic dermatitis:

- consumption of highly allergenic foods by a pregnant woman - citrus fruits, chocolate, red berries, alcoholic drinks;
- consumption of highly allergenic foods by the child himself;
- hereditary predisposition;
- fungal, viral and bacterial infections;
- weakened immune system;
— physical contact with the allergen: clothing, chemicals, building materials, medications;
— respiratory contact: dust, pollen, gases;
- non-compliance;
— ;
- sudden change of diet;
— uncomfortable temperature in the living room;
- emotional instability, psychological disorders, .

The main symptoms of atopic dermatitis are:

- severe itching;
- redness, red spots on the skin with unclear boundaries;
- rash on the body, sometimes dry, sometimes filled with liquid;
- weeping areas of skin, erosions, ulcers;
- dry skin, with further peeling;
- scales on the scalp, glued together with the secretion of the sebaceous glands.

Accompanying symptoms may include:

- coating on the tongue;
- respiratory diseases: false croup;
— ;
— ;
— , .

Atopic dermatitis most often appears on the following areas of the body: elbows, knees, neck, folds, dorsums of the feet and hands, forehead, temples.

Experts note that atopic dermatitis has a seasonal pattern – symptoms worsen in winter and summer. Partial or complete remissions may also occur.

If the treatment of atopic dermatitis is not given due attention, this disease can develop into allergic rhinitis and other diseases of an allergic nature.

Complications of atopic dermatitis

Viral infection;
Fungal infection
Pyoderma

Treatment of atopic dermatitis includes:

— preventing patient contact with the allergen;
- taking antiallergic drugs;
— relief of inflammatory processes on the skin;
— strengthening the immune system;
— diet correction;
— normalization of the work/rest regime;
- treatment of concomitant diseases.

Medicines against atopic dermatitis

Antiallergic drugs

Antihistamines are used to relieve the main symptoms - severe itching and rash. There are 3 generations of them. Each subsequent generation has improved characteristics - reduced addiction, a decrease in the number of side effects and an increase in the duration of the therapeutic effect.

First generation: “Dimetindene”, “Clemastine”, “Meclizine”;
Second generation: “Azelastine”, “Loratadine”, “Cetrizine”;
Third generation: Desloratadine, Levocetrizine, Sehifenadine.

It is better to take antihistamines before bedtime, because... many of them are sleepy.

Anti-inflammatory and antipruritic drugs

To stop inflammatory processes on the surface of the skin and relieve itching, anti-inflammatory and antipruritic agents are used.

The group of these drugs includes: glucocorticosteroid drugs, Burov's liquid, non-steroidal anti-inflammatory drugs (with sodium thiosulfate solution), silver nitrate, lead lotion, decoctions with infusions of string and other medicinal plants.

Remedies for infiltration and thickening of the skin

For these purposes, various creams, ointments and patches with a resolving effect are used, the bases of which are: tar, sulfur, naftalan oil, ichthyol. Such drugs begin to be used in small doses, gradually increasing the concentration of the active substances, or changing them to a stronger drug.

Means for softening and removing rough scales and crusts

Keratolytic ointments and creams, which also contain: acids (salicylic, lactic, fruit), urea and resorcinol, are used as a means to soften and remove hardened scales and crusts.

Hormonal drugs

Hormonal drugs are widely used, but strictly under the supervision of the attending physician, for all forms of dermatitis, especially the acute course of the disease. For weeping dermatitis, lotions and pastes are preferred; for dry dermatitis, creams, ointments and lotions with the addition of keratolytics are used.

The advantage of using hormonal agents is the rapid and powerful relief of inflammatory processes on the skin, relieving itching, as well as further restoration of the skin. The disadvantage is addiction and withdrawal symptoms.

Weak hormonal agents - hydrocortisone. They are used mainly to treat children or when the disease manifests itself on the face.

Medium-acting hormonal agents - glucocorticosteroids (Prednisolone, Fluocortolone). Used to treat all areas of the body.

Strong hormonal agents - Betamethasone, Halomethasone, Mometasone, Flumethasone. They are used for long-term dermatitis, as well as for lichenification of the skin.

For severe skin lesions, glucocorticosteroids are prescribed for 2-4 days, after which they switch to weaker hormonal drugs - medium intensity.

Remedies for chronic atopic dermatitis

During remission, as well as at the stage of chronic atopic dermatitis, it is recommended to externally use various lotions or baths that will help relieve itching, redness, reduce inflammation, and also speed up the healing and restoration of the skin.

Such remedies include: birch buds, speedwell, oak bark, borage, fireweed and chamomile flowers, basil, pear leaves.

Antibacterial and antifungal agents

When ( , etc.), i.e. When the skin is damaged, there is always a risk of various infections getting into the papules and vesicles - viruses, fungi, bacteria, which in many people complicate the already complex picture of the course of dermatitis. To prevent this, or at least minimize this possibility, antibacterial, antiviral or antifungal agents are used externally. These can be ointments, creams, and aerosols. The main feature of these products is the content of substances such as furacilin, boric acid, iodine solution, silver nitrate, ethacridine lactate, gentamicin, oxytetracycline and glucocorticoid.

Means for normalizing and improving the functioning of the digestive system

As we already know, dear readers, from the beginning of the article, atopic dermatitis is a complex disease, the basis of which lies inside the body, and externally it manifests itself in a video of the inflammatory process of the skin.

Doctors have established a connection between normalizing or improving the functioning of the digestive system and accelerating recovery from dermatitis.

Thus, for this result, two types of drugs are used - enterosorbents and drugs for normalizing intestinal microflora.

Enterosorbents. Designed to stop the activity of unfavorable microflora in the body and its rapid removal from the body. Also, these drugs help reduce the level of toxicity in the body. The most popular enterosorbents: “Activated carbon”, “Diosmectite”, “Povidone”.

Preparations for normalizing intestinal microflora. This can include the following agents: probiotics (Baktisubtil, Linex), prebiotics (Inulin, Lysozyme), synbiotics (Maltodofilus, Normoflorin), hepatoprotectors (ademetionine, beatine, glycyrrhizic acid), bacteriophages (coliproteus, pseudomonas), enzymes (pancreatin).

Preparations to strengthen the immune system and accelerate skin recovery

Lack of vitamins () and microelements in the body, metabolic disorders, disturbances in the immune and digestive systems play some important roles in the development of not only atopic, but also other types of dermatitis.

We already know how to improve the functioning of the digestive system from the previous paragraph. An additional point that will have a beneficial effect on the entire body as a whole is an additional intake of minerals. The greatest emphasis should be placed on vitamins - or echinacea.

To speed up the process of skin restoration, anabolic drugs are used, which contain substances such as methandienone, methionine, nandrolone.

Normalization of the mental and nervous system

Violations of the work/rest/sleep regime, mental stress, weaken the immune system, making the entire body more susceptible to various diseases. If all these areas are not put in order, there is a risk of developing secondary diseases.

If you work in a job where you are constantly exposed to stress, think about whether there is perhaps an opportunity to change this job? Here it is fair to say that “Health is more valuable than money.”

To normalize the functioning of the nervous system, it is very important to get enough sleep. Scientists have found that a person needs from 6 to 8 hours of sleep to fully rest and recuperate. The best result is achieved if you go to bed at 21:00-22:00, and sleep will be uninterrupted.

Additionally, but after consultation with a doctor, the following drugs can be used to normalize the nervous system, especially during stress, and other disorders:

sedative herbal medicines or agents;
remedies for insomnia;
antidepressants.

The correct menu or diet for atopic dermatitis is a necessary measure, without which treatment of dermatitis is virtually impossible.

The menu for dermatitis is aimed at:

- exclusion of highly allergenic foods from the diet;
— enriching the body with essential vitamins and minerals;
- normalization of the digestive system.

What not to eat if you have atopic dermatitis:

red and orange fruits, berries, vegetables: strawberries, raspberries, etc.;
citrus fruits: oranges, tangerines, pomelo, grapefruits, etc.;
sweets: chocolate, cocoa, candies, lemonades;
nuts, greens;
fish;
milk, dairy products;
chicken eggs;
smoked, spicy and fried foods;
mayonnaise, ketchup, spices;
alcoholic drinks.