Atopy is the hypersensitivity of the skin to the effects of environmental substances, at which an increased production of IgE and / or a violation of nonspecific reactivity occurs.
One of the main problems of dermatology is atopic dermatitis, the incidence of which is much more common than other common dermatitis.
Children suffer from atopic dermatitis, but adults are also susceptible to this disease.
Causes of
The cause of allergic reaction in the skin in atopic dermatitis in children and adults is the hyperreactivity of the organism in response to interaction with various substances. These substances are for the body of the patient allergens.
As an allergen can act pollen of plants, house dust, animal hair, various food products, household chemicals, etc. Allocate the air, contact and food path of penetration of the allergen into the body.
The leading causes of atopic dermatitis:
- Hereditary predisposition .And in some relatives, the allergy can be expressed in rhinitis, conjunctivitis, in others with bronchial asthma and hay fever, and in others it is a specific reaction of the skin. That is why, as already mentioned, AD appears for the first time in a small child.
- The increased sensitivity of the skin to detergents, washing powder, with which things are washed, the type of clothing fabric.
- Contact with allergens .The most diverse allergens can start the process, and often the rashes appear after a while. Naturally, allergens will be different for different people and can change during life.
- Taking with certain medications - especially antibiotics. These drugs kill not only the pathogenic bacteria, but also the beneficial microflora of the intestines, as a result of which their balance in the body is violated and the immunity of the child is reduced.
- Frequent viral and infectious diseases - this leads to a decrease in human defenses, resulting in the appearance of the first symptoms of dermatitis.
Helps to cause dermatitis problems with the gastrointestinal tract, metabolic disorders, hormonal imbalance in the body. Atopic dermatitis can occur with periods of remission, the duration of which depends on compliance with the diet, the use of preventive measures.
Symptoms of atopic dermatitis
In atopic dermatitis, severe itching is the leading symptom of the disease. During the period of remission, the skin of the patients on the affected areas is dry and compacted, pink, mottled or cyanotic-red, often covered with scaly scales. The disease is characterized by a pronounced skin pattern, giving the skin a shagreen appearance.
The main symptoms of atopic dermatitis in adults include:
- The presence of itching of the skin, which is present even with minimal skin manifestations.
- The characteristic morphological picture of the elements and their location on the body is the dryness of the skin, localization( often) in symmetrical zones on the arms and legs in the area of the flexural surface of the joints. In the lesions there are patchy and papular rashes, covered with scales. They are also placed on the flexural surfaces of the joints, on the face, neck, shoulder blades, shoulder girdle, and also on the legs and hands - on their outer surface and in the area of the outer surface of the fingers.
- The presence of other allergic diseases in the patient or his relatives, for example, atopic bronchial asthma( in 30-40%).Chronic character of the course of the disease( with or without relapses).
Atopic dermatitis occurs with exacerbations and remissions. Exacerbations of skin manifestations can be caused both by a violation of diet, and by sharp weather changes, concomitant diseases, dysbacteriosis, vaccination, etc. At the same time, a trip to the sea can significantly improve the skin condition.
Symptoms in children
The clinical manifestations of atopic dermatitis in children are:
- skin peeling;
- itching, which is worse at night;
- wetting of the brushed areas of the skin;
- strengthening of the skin pattern in the lesions;
- compaction of affected areas of the skin, coarsening.
After the drying out of the combs, these places are covered with brown crusts, which unbearably itch, the child again combs them and starts all over again.
Atopic dermatitis: photo
How atopic dermatitis looks like in children and adults in the photo.
Diagnosis
Differential diagnosis of atopic dermatitis is always based on the collection of an allergological anamnesis:
- studying the history of development of skin lesions and family predisposition;
- presence of atopic respiratory diseases;
- presence of concomitant skin diseases;
- presence of risk factors( the course of pregnancy, childbirth, the type and nature of feeding, the presence of
- infections in infancy, the use of antibacterial drugs);
- detection and detection of concomitant diseases;
- intolerance to medication;
- determine the foci of focal infection.
In some cases, a complex of additional studies is required, consisting of the determination of the total amount of IgE, the identification of allergen-specific IgE by radioallergosorbent test( RAST), allergy tests( prik test or patch test), and provocative intake samples of possible food allergens. Sometimes there is a need to take crops for the presence of a viral or bacterial culture.
Differential diagnosis of
Atopic dermatitis must be differentiated with the following diseases: limited neurodermatitis, lichen planus, prurigo Gebra, mushroom mycosis, chronic eczema.
For limited neurodermatitis( depriving Vidal), there is a lack of atopy in the anamnesis, the onset of the disease in the adult period of life;absence of dependence of exacerbations from action of allergens;localized lesion;presence of three zones in the lesion: central lichenification, lichenoid papular rash and dyschromic zone;accompanying diseases precede skin rashes;the level of total IgE in the blood serum is normal;skin tests are negative.
Treatment of atopic dermatitis
When atopic dermatitis is diagnosed, how to treat the disease depends on the age phase, the severity of the clinic and the concomitant diseases.
First of all, the treatment is aimed at:
- elimination of allergic factor;
- desensitization( decreased susceptibility to allergen) of the body
- relieving itching;
- detoxification( cleansing) of the body;
- removal of inflammatory processes;
- correction of identified concomitant pathology;
- prevention of recurrence of atopic dermatitis;
- combating complications( when joining infection);
Different methods and medicines are used for the treatment of atopic dermatitis in adults: dietotherapy, PUVA therapy, acupuncture, plasmapheresis, specific hyposensitization, laser treatment, corticosteroids, allergoglobulin, cytostatics, intal, etc.
Also it is necessary to refuse to eatcitrus, coffee, chocolate, honey, chicken, fish, nuts and spices, as well as fatty and fried foods. The patient shows sour-milk products, cereals, boiled meat, various vegetable dishes.
Treatment of dysbiosis and diseases of the digestive tract
Often the development of dermatitis is associated with intestinal dysbiosis, therefore, taking various probiotics is also advisable - RioFlora Immunno, Bifidobacterin, Lactobacterin, Acipol and others
A possible additional cause of such dermatitis and dysbacteriosis may be a digestive disorder, namely, pancreatic functionglands, with the appointment of enzyme preparations, such as Pancreatin, Creon, Mezim.
Non-hormonal ointments
Such creams and ointments have a very wide choice. These include - Protopic, Elidel, Eplan, Fenistil, Losterin, cream Timogen, Naftaderm, Videstim, Destin, Isida, etc.
Anti-inflammatory therapy with blood pressure
In the acute phase are appointed:
- Antihistamines of the second generation( with additional antiallergic properties - antimediator and membrane stabilizing( loratadine)) - 4-6 weeks.(There is an exacerbation of such drugs and various supplements in these drugs).
- Antihistamines of the 1st generation at night( if sedation is necessary) - 4-6 weeks.(There is an exacerbation of such drugs and various supplements in these drugs).
- Lotion( tincture of oak bark, 1% of r-tannin, r-rivanol 1: 1000, etc.), dyes( fucorcin, Kastelani liquid, 1-2% of the solution of methylene blue, etc.) - in the presence of exudation.
- External glucocorticosteroids( Mometasone, cream, lotion) - 3-7 days.
- Systemic glucocorticosteroids( in the absence of the effect of the therapy).
Atopic dermatitis has a wavy course: in 60% of children the symptoms completely disappear in time, while in others the symptoms persist or recur throughout life. The earlier the debut and the harder the disease, the higher the chance of its persistent flow, especially when combined with another allergic pathology.
Atopic dermatitis in children treatment: Komarovsky
The success of treating children's atopic dermatitis depends on the detection of an allergen or a provoking factor, and its elimination from the life of the child. Food, chemical, natural allergens should be removed from the child.
Even with minor manifestations of dermatitis, it is necessary to show the child to a specialist, and not rely on reviews on the Internet. The doctor can prescribe for the treatment of atopic dermatitis in children in severe cases pills or injections with antihistamines, ointment with corticosteroids, which can quickly suppress itching and inflammation.
In some cases, a doctor may prescribe treatment with ultraviolet( UV) radiation. And also prescribe a special diet for a child with atopic dermatitis and / or, if the baby is on breastfeeding, appoint a special diet for the mother.
On the video you can see the advice of Dr. Komarovsky, how to treat atopic dermatitis in children.
Features of nutrition
During the remission should adhere to the basic rules of hypoallergenic diets. However, with severe exacerbations, reduce the food intake to a minimum. Often there is an individual intolerance, which can lead to a sharp deterioration in the disease. Sometimes it is advisable to follow a strict diet for a long time: from several months to two years.
There are products, the use of which should be minimized for dermatitis, strictly avoiding the use of seafood, chocolate, citrus fruits, nuts, fish, coffee, mayonnaise, eggplant, mustard, spices, tomatoes, red pepper, milk, eggs, sausages, sausages, mushrooms, carbonated drinks, strawberries, strawberries, honey, watermelons, pineapples. Categorically prohibited alcohol.
People who suffer from the symptoms of atopic dermatitis, it is recommended to include in their diet products with a high content of saturated fatty acids. Unfortunately, such components can be found in sufficient quantities in seafood, which are considered to be the main allergens, so they can be replaced by vegetable oils, for example, olive and linseed. In addition, it is useful to use low-fat dairy products, the components of which allow maintaining a healthy intestinal microflora.
Prevention
The main areas of prevention of atopic dermatitis are compliance with the diet, especially for pregnant and lactating mothers, breast-feeding children. Particular attention should be paid to limiting the effects of inhaled allergens, reducing contact with chemicals in the home, preventing colds and infections and the prescription of antibiotics.
At the stage of anti-relapse therapy, sanatorium-and-spa treatment in the Crimea, on the Black Sea coast of the Caucasus and the Mediterranean is recommended.