Atopic dermatitis – the chronic noncontagious inflammatory damage of skin proceeding with the periods of aggravations and remissions. It is shown by dryness, the increased irritation of skin and a severe itch. Brings physical and psychological discomfort, reduces quality of life of the patient in life, a family and at work, externally represents cosmetic shortcomings. Continuous combing of skin leads to its secondary infection. Diagnosis of atopic dermatitis is carried out by the allergist and the dermatologist. Treatment is based on observance of a diet, performing the general and local medicamentous therapy, a specific hyposensitization and physical therapy.
Atopic dermatitis is the most widespread dermatosis (a skin disease) developing in the early childhood and keeping these or those manifestations during all life. Now as the term "atopic dermatitis" it is understood the caused, noncontagious, allergic disease of skin of a chronic recidivous current is hereditary. The disease is a subject of a kuration of experts in the sphere of dermatology and allergology.
As the synonyms of atopic dermatitis which are also found in literature serve the concepts "atopic" or "constitutional eczema", "ekssudativno-catarrhal diathesis", "neurodermatitis", etc. The concept "atopiya" for the first time offered by the American researchers of A. Coca and R. Cooke in 1923 means hereditary tendency to allergic manifestations in response to this or that irritant. In 1933 for designation of hereditary allergic reactions of skin Wiese and Sulzberg entered the term "atopic dermatitis" which is considered standard now.
Reasons of atopic dermatitis
Hereditarily the caused nature of atopic dermatitis defines prevalence of a disease among related family members. Presence at parents or the immediate family of atopic hypersensitivity (allergic rhinitis, dermatitis, bronchial asthma etc.) defines probability of developing of atopic dermatitis at children in 50% of cases. Atopic dermatitis in the anamnesis of both parents increases risk of transfer of a disease to the child to 80%. The vast majority of initial displays of atopic dermatitis fall on the first five years of life (90%) of children, from them 60% are noted in the period of chest age.
In process of the further growth and development of the child symptoms of a disease can not disturb or weaken, however, most of people live with the diagnosis "atopic dermatitis" all life. Quite often atopic dermatitis is followed by development of bronchial asthma or allergy.
Wide circulation of a disease is around the world connected with the general for most of people problems: adverse ecological and climatic factors, errors in food, psychological overloads, growth of infectious diseases and the number of allergic agents. A part in development of atopic dermatitis is played by the violations in immune system of children caused by shortening of terms of breastfeeding, early transfer to artificial feeding, toxicosis of mother during pregnancy, improper feeding of the woman during pregnancy and a lactation.
Symptoms of atopic dermatitis
Initial symptoms of atopic dermatitis are usually observed in the first half a year of life. It can be provoked by introduction of feedings up or conversion to artificial mixes. By 14-17 years at nearly 70% of people the disease independently passes, and at other 30% passes into an adult form. The disease can proceed for many years, becoming aggravated during the autumn and spring period and calming down in the summer.
On character of a current distinguish sharp and chronic stages of atopic dermatitis.
The sharp stage is shown by red spots (eritemy), nodular rashes (papules), a peeling and swelling of skin, formation of sites of erosion, a moknutiya and crusts. Accession of a secondary infection leads to development of pustulous defeats.
The thickening of skin (likhenization), expressiveness of the skin drawing, crack on soles and palms, raschesa, strengthening of pigmentation of skin are characteristic a century of a chronic stage of atopic dermatitis. In a chronic stage symptoms, typical for atopic dermatitis, develop:
- Morgan's symptom – multiple deep wrinkles at children on lower eyelids
- Symptom of "a fur cap" - easing and a poredeniye of hair on a nape
- Symptom of "the polished nails" - brilliant nails with the ground-off edges because of constants having combed skin
- Symptom of "winter foot" - puffiness and hyperaemia of soles, cracks, a peeling.
In development of atopic dermatitis allocate several phases: infantile (the first 1,5 years of life), the nursery (from 1,5 years to the puberty period) and adult. Depending on age dynamics features of clinical symptoms and localization of skin manifestations are noted, however the leading symptoms in all phases have the strongest, the constant or periodically arising skin itch.
Infantile and children's phases of atopic dermatitis are characterized by emergence on face skin, extremities, buttocks of sites of an eritema of bright pink color against the background of which there are bubbles (vesicles) and sites a moknutiya with the subsequent formation of crusts and scales.
In an adult phase the centers of an eritema of light pink color with the expressed skin drawing and papular rashes. Are localized mainly in elbow and popliteal bends, on a face and a neck. Skin is dry, rough, with cracks and sites of a peeling.
At atopic dermatitis focal, widespread or universal damages of skin meet. Zones of typical localization of rashes are the person (a forehead, area around a mouth, about eyes), skin of a neck, a breast, a back, the sgibatelny surfaces of extremities, inguinal folds, buttocks. Plants, house dust, hair of animals, a mold, dry feeds for small fishes can aggravate the course of atopic dermatitis. Often atopic dermatitis is complicated by a viral, fungal or piokokkovy infection, is a background for development of bronchial asthma, a pollinoz and other allergic diseases.
Complications of atopic dermatitis
As the main reason of development of complications at atopic dermatitis serves continuous traumatizing skin as a result of its combing. Violation of integrity of skin leads to decrease in its protective properties and promotes accession of a microbic or fungal infection.
The most frequent complication of atopic dermatitis are bacterial infections of skin – a piodermiya. They are shown by pustulous rashes on a body, extremities, in a hairy part of the head which, drying up, form crusts. At the same time the general health often suffers, body temperature increases.
Complication of atopic dermatitis viral infections of skin serve the second for emergence frequency. Their current is characterized by education on skin of bubbles (vesicles) filled with transparent liquid. The causative agent of viral infections of skin is the virus of simple herpes. Most often the person (skin around lips, a nose, auricles, on centuries, cheeks), mucous membranes (a conjunctiva of eyes, an oral cavity, a throat, genitals) is surprised.
As complications of atopic dermatitis quite often serve the fungal infections caused by drozhzhepodobny fungi. Defeat zones at adults more often are skin folds, nails, brushes, feet, a hairy part of the head, at children - mucous oral cavities (milkwoman). Often fungal and bacterial damage are observed together.
Treatment of atopic dermatitis
Treatment of atopic dermatitis is carried out taking into account an age phase, expressiveness of clinic, associated diseases and is directed on:
- exception of an allergic factor
- desensitization (decrease in sensitivity to allergen) an organism
- removal of an itch
- detoxication (clarification) of an organism
- removal of inflammatory processes
- correction of the revealed accompanying pathology
- prevention of a recurrence of atopic dermatitis
- fight against complications (at accession of an infection)
For treatment of atopic dermatitis different methods and medicines are used: dietotherapy, PUVA-therapy, acupuncture, plasma exchange, specific hyposensitization, laser treatment, corticosteroids, , cytostatics, sodium etc.
Dietotherapy at atopic dermatitis. Regulation of food and observance of a diet can improve considerably a state and prevent the frequent and expressed exacerbations of atopic dermatitis.
Eliminative diets are directed to an exception of a diet of all food allergens known to the patient. As a rule, it is easy to make it at children of advanced age and adult patients. Besides, regardless of shipping cow's milk and eggs are excluded from food.
During the periods of exacerbations of atopic dermatitis the hypoallergenic diet is appointed. At the same time from a diet fried fish, meat, vegetables, rich fish and meat broths, cocoa, chocolate, a citrus, blackcurrant, a wild strawberry, a melon, honey, nuts, caviar, mushrooms clean up. Also the products containing dyes and preservatives are completely excluded: smoked products, spices, canned food and other products.
At atopic dermatitis observance of a hypochloride diet – restriction of the used table salt is shown (however, NaCl in days there is not less than 3 g).
At patients with atopic dermatitis violation of synthesis of fatty acids therefore the dietotherapy has to include the nutritional supplements saturated with fatty acids is observed: vegetable oils (olive, sunflower, soy, corn, etc.), linoleic and linolenic acids (F-99 vitamin).
Drug treatment. Medicinal therapy in treatment of atopic dermatitis includes application of tranquilizers, antiallergic, dezintoksikatsionny and resolvents. In practice of treatment the medicines possessing protivozudny action – antihistaminic (antiallergic) medicines and tranquilizers have the greatest value.
Essential lack of antihistaminic medicines of the first generation (, , , ) is quickly developing accustoming of an organism. Therefore change of these medicines needs to be carried out every week. The expressed sedative effect leading to decrease in concentration of attention and an incoordination of movements does not allow to apply medicines of the first generation in pharmacotherapy of people of some professions (drivers, pupils, etc.). Because of the had atropinopodobny side effect as a contraindication to use of these medicines serves a number of diseases: glaucoma, bronchial asthma, prostate gland adenoma.
Much more safely in treatment of atopic dermatitis at persons with the accompanying pathology use of antihistamines of the second generation (, , , , ). To them accustoming does not develop, there is no atropinopodobny side effect. The most effective and the antihistaminic medicine safe today applied in treatment of atopic dermatitis is . He is well had by patients and most often used in dermatological practice for treatment of an atopiya.
For simplification of a condition of patients at strong attacks of an itch the means influencing on vegetative and the central nervous system (hypnotic drugs, demulcents, tranquilizers) are appointed. Use of kortikosteroidny medicines (a metiprednizolon or a triamtsinolon) is shown at limited and widespread damages of skin, and also at the expressed, intolerable itch, not acting other medicines. Corticosteroids are appointed to several days for knocking over of a bad attack and are cancelled with gradual decrease in a dose.
At the heavy course of atopic dermatitis and the expressed phenomena of intoxication intravenous injection of infusion solutions is applied: dextran, salts, physiological solution, etc. In some cases there is expedient a carrying out haemo sorption or a plasma exchange – methods of extracorporal clarification of blood. At development of purulent complications of atopic dermatitis application of antibiotics of a broad spectrum of activity in age dosages is reasonable: erythromycin, doxycycline, metacycline within 7 days. At accession of a herpetic infection antiviral medicines - an acyclovir or are appointed.
At recidivous character of complications (bacterial, viral, fungal infections) immunomodulators are appointed: , medicines of a timus, sodium, , inosine , etc. under control of immunoglobulins of blood.
External treatment. The choice of a method of external therapy depends on the nature of inflammatory process, its prevalence, age of the patient and existence of complications. At sharp displays of atopic dermatitis with moknutiy surfaces and crusts are appointed the disinfecting, drying and anti-inflammatory lotions (infusion of tea, a camomile, Burov's liquid). At knocking over of sharp inflammatory process pastes and ointments with protivozudny and anti-inflammatory components are applied (Ichthyol of 2-5%, tar of 1-2%, the Naftalan oil of 2-10%, sulfur, etc.). Kortikosteroidny ointments and creams remain the leading medicines for external therapy of atopic dermatitis. They render antihistaminic, anti-inflammatory, protivozudny and antiedematous actions.
Ultra-violet radiation. Light treatment of atopic dermatitis is an auxiliary method and is applied at the persistent nature of a disease. Procedures of Ural federal district are carried out 3-4 times a week, practically do not cause collateral reactions (except an eritema).
Prevention of atopic dermatitis
Distinguish two types of prevention of atopic dermatitis: primary, directed to prevention of its emergence, and secondary – antirecurrent prevention. Holding actions for primary prevention of atopic dermatitis has to begin even during pre-natal development of the child, long before his birth. A special role during this period is played by toxicoses of the pregnant woman, reception of medicines, professional and food allergens.
Special attention to questions of prevention of atopic dermatitis should be paid on the first year of life of the child. During this period it is important to avoid excessive reception of medicines, artificial feeding not to create a favorable background for hypersensitivity of an organism to various allergic agents. Observance of a diet during this period is not less important also for the feeding woman.
Secondary prevention aims at prevention of exacerbations of atopic dermatitis, and, in case of emergence, - simplification of their course. Secondary prevention of atopic dermatitis includes correction of the revealed chronic diseases, an exception of influence of the factors provoking a disease (biological, chemical, physical, mental), observance of hypoallergenic and eliminative diets etc. Preventive reception of the desensibilizing medicines (a ketotifen, a kromoglikat of sodium) during the periods of probable aggravations (fall, spring) allows to avoid a recurrence. As antirecurrent measures at atopic dermatitis treatment in the resorts of the Crimea, the Black Sea coast of the Caucasus and the Mediterranean is shown.
Special attention should be paid to questions of daily care of skin and a right choice of linen and clothes. At a daily shower it is not necessary to wash hot water with a bast. It is desirable to apply gentle hypoallergenic grades of soap (Dial, Dove, children's soap) and a warm shower, and then to accurately blot skin with a soft towel, without pounding and without injuring it. Skin should be humidified, fed and protected constantly from adverse factors (the sun, wind, a frost). Skin care products have to be neutral not containing fragrances and dyes. It is necessary to give preference in linen and clothes to the soft natural fabrics which are not causing an itch and irritation and also to use bedding with hypoallergenic fillers.
The forecast at atopic dermatitis
Children suffer from the heaviest displays of atopic dermatitis, with age the frequency of aggravations, their duration and weight become less expressed. Nearly a half of patients recovers at the age of 13-14 years. The state at which symptoms of atopic dermatitis are absent within 3–7 years is considered clinical recovery.
The remission periods at atopic dermatitis are followed by subsiding or disappearance of symptoms of a disease. The period between two aggravations can fluctuate from several weeks to one months and even years. Hard cases of atopic dermatitis proceed practically without light intervals, constantly recuring.
Progressing of atopic dermatitis considerably increases risk of development of bronchial asthma, respiratory allergy, etc. diseases. For atopik extremely important point is the choice of a professional field of activity. They do not suit the professions providing contact with detergents, water, fats, oils, chemicals, dust, the animal and other irritating agents.
Unfortunately, it is impossible to protect completely himself from influence of the environment, stresses, diseases etc., and it means that there will be factors aggravating atopic dermatitis. However, the attentive relation to the organism, knowledge of features of a course of a disease, timely and active prevention allow to reduce considerably displays of a disease, to prolong the remission periods for many years and to increase quality of life. And it is not necessary to try to treat atopic dermatitis independently at all. It can cause the complicated options of a course of a disease and serious consequences. Allergologists and dermatologists have to perform treatment of atopic dermatitis.