Atopic dermatitis in adults symptoms and treatment. Atopic dermatitis: symptoms and treatment Special allergy tests

Leather- this is the most vulnerable organ that performs an important protective function and is constantly exposed to adverse effects from the environment. It is for this reason that the number of skin diseases is so high. One of the most unpleasant is atopic dermatitis - a chronic inflammatory disease of an allergic nature. The treatment of the disease is a long and complex process, and the manifestations of atopic dermatitis cause a lot of suffering to patients.

What is atopic dermatitis?

The disease is also called atopic eczema, exudative catarrhal diathesis, neurodermatitis. The main factor causing the appearance of atopic dermatitis is exposure to allergens.

The disease affects 15-30% of children and 2-10% of adults, and there is an increase in the incidence worldwide. And over the past 16 years, the number of cases has approximately doubled. The reason for this is the following factors:

• Bad environmental situation
• An increase in stress
• Violation of the principles of proper and healthy nutrition,
• Increased exposure to allergens, primarily of chemical origin.

Interesting fact:

2/3 of the patients are female. The disease often affects residents of large cities.

In some patients, the first symptoms of atopic dermatitis are observed in childhood, while in others the disease proceeds latently and first appears only in adulthood.

In children, the disease manifests itself mainly in the first year of life. This feature is influenced by the characteristics of children's skin that distinguish it from the skin of adults:

• Underdevelopment of sweat glands
• Fragility of the stratum corneum of the epidermis,
• Increased lipid content in the skin.

The reasons

- hereditary disease. The word "atopy" in Latin means "strangeness". And in modern medicine, it is customary to call it a genetic predisposition to allergies.

Allergy is a violation of the body's normal reaction to foreign substances (immunity). In people prone to the disease, various deviations in the work of immunity are often observed. First of all, it consists in increasing the synthesis of IgE immunoglobulin proteins important for the immune system compared to the norm (in 90% of cases). Increased reactivity of the immune system leads to the formation of inflammatory mediators - histamines.

There are other factors that contribute to the occurrence of atopic dermatitis. Firstly, these are violations of the autonomic nervous system. They are expressed in an increased tendency to spasm of small vessels, including on the skin. Also, patients often experience:

• violation of the synthesis of certain adrenal hormones responsible for the anti-inflammatory reactions of the body;
• decreased functionality of the skin sebaceous glands,;
• violation of the ability of the skin to retain water;
• decrease in lipid synthesis.

All this leads to a general weakening of the barrier functions of the skin and to the fact that irritating agents penetrate the skin into all its layers, causing inflammation.

Dermatitis is often accompanied by chronic gastrointestinal diseases that reduce the intestinal barrier function:

• Dysbacteriosis,
• gastroduodenitis,
• pancreatitis,
• Biliary dyskinesia.

However, the hereditary factor still plays a leading role. The disease develops in 4 out of 5 cases when both parents suffer from it. If only one parent is sick, then the probability of the disease in the child also remains quite high - 55%. The presence of respiratory diseases of an allergic nature in the other parent increases this figure. The disease is more often transmitted through the maternal side than through the paternal side. In this case, the disease can also occur in children born to healthy parents who did not have atopic dermatitis even in childhood.

Racial factors also influence the development of the disease - in children with fair skin, it is more common.

In addition to heredity, other factors contribute to the development of atopic dermatitis in infancy:

• Lack of breastfeeding or too early transition to artificial feeding,
• Toxicosis of pregnancy in the mother,
• Improper nutrition of the mother during gestation or lactation.

Less significant, but also contributing factors in children:

• high air temperature, leading to increased sweating;
• weak immunity;
• the presence of stress;
• poor skin hygiene or, conversely, too frequent washing.

In early childhood, food allergens are the most common irritants. These can be substances that come with food, or with breast milk (for lactating women).

In adult patients, the list of allergens can be much wider. In addition to food allergens, irritants can be:

• house dust,
• medicines,
• Household chemicals,
• Cosmetics,
• plant pollen,
• bacteria and fungi,
• Fur of pets.

Factors contributing to the manifestation of atopic dermatitis in adults:

• Poor environmental conditions;
• endocrine diseases;
• Metabolic diseases;
• Acute infectious diseases;
• Complicated course of pregnancy;
• Sleep disorders, stress, psychological stress.

Often the disease is aggravated under the influence of self-medication, including with the help of herbal medicines, which may also contain allergens.

Stages and types of the disease

Depending on age, the following stages of the disease are distinguished:

• infant,
• children's,
• Adult.

Disease stages, age and prevalence

Depending on the clinical course, the following types of atopic dermatitis are distinguished:

• Elementary,
• aggravation,
• chronic,
• remission,
• clinical recovery.

Clinical recovery is considered a state in which the symptoms of atopic dermatitis are not observed for more than 3 years.

The initial stage develops mainly in childhood. In 60% of cases, the manifestation of symptoms is observed at the age of up to 6 months, in 75% of cases - up to a year, in 80-90% of cases - up to 7 years.

Sometimes dermatitis is combined with other allergic diseases:

• With bronchial asthma - in 34% of cases,
• With allergic rhinitis - in 25% of cases,
• With hay fever - in 8% of cases.

The combination of pollinosis, bronchial asthma and atopic dermatitis is called the atopic triad. The disease can be combined with angioedema, food allergies.

According to the criterion of the area of ​​skin lesions, dermatitis is distinguished:

• limited (up to 10%),
• common (10-50%),
• diffuse (more than 50%).

According to the severity of the course, dermatitis is divided into mild, moderate and severe.

There is also a scale that assesses the intensity of the six main manifestations of atopic dermatitis - erythema, edema, crusts, scratching, peeling, dry skin. Each attribute is assigned a score from 0 to 3, depending on its intensity:

• 0 - no,
• 1 - weak,
• 2 - moderate,
• 3 - strong.

Symptoms

The main symptom of the disease- itching of the skin, which is characteristic of any stage of the disease (infant, child and adult). Itching is observed in both acute and chronic forms of the disease, it can occur even in the absence of other symptoms, it intensifies in the evening and at night. Itching is difficult to get rid of, even with medication, and can lead to insomnia and stress.

According to the symptoms, the infant, child and adult phases of atopic dermatitis have some differences. In infancy, the exudative form of dermatitis predominates. Erythema are bright red. Against the background of erythema, vesicles appear. Rashes concentrate on the skin of the face, scalp, limbs, buttocks. Weeping formations on the skin are common. The infantile stage ends with recovery by 2 years (in 50% of patients) or passes into the nursery.

In childhood, exudativeness decreases, formations become less bright in color. There is a seasonality of exacerbations of dermatitis.

In adult patients, erythema has a pale pink hue. The rashes are papular in nature. Localization of skin formations - mainly on the folds of the joints, on the neck and face. The skin becomes dry and flaky.

With exacerbation of dermatitis, reddening of the skin (erythema), small vesicles with serous contents (vesicles), erosion, crusts, and skin peeling appear. In remission, the manifestations of the disease disappear partially or completely. With clinical recovery, there is no symptoms for more than 3 years.

The following signs are characteristic of the chronic phase of dermatitis: thickening of the skin, the severity of the skin pattern, cracks on the soles and palms, increased pigmentation of the skin of the eyelids. Symptoms may also be observed:

• Morgana (deep wrinkles on the lower eyelids),
• "fur hat" (thinning of hair at the back of the head),
• polished nails (due to constant scratching of the skin),
• "winter foot" (cracks, redness and peeling of the skin of the soles).

Also, for patients with atopic dermatitis, disorders of the central and autonomic nervous systems are often characteristic - depressive states, increased reactivity of the autonomic nervous system. Gastrointestinal disorders may also be observed:

• • malabsorption syndrome,
  • enzyme deficiency.

Diagnostics

Diagnosis begins with an examination of the patient by a doctor. He needs to separate atopic dermatitis from other allergic dermatitis, as well as from non-allergic dermatitis.

For diagnostic purposes, doctors have identified a set of main and auxiliary manifestations of atopic dermatitis.

Main features:

• • • • Certain affected areas - flexion surfaces of the joints, face, neck, fingers, shoulder blades, shoulders;
      • Chronic course with relapses;
      • The presence of patients in a family history;

Auxiliary signs:

• • • • Early onset of the disease (up to 2 years);
      • Spotted and papular rash covered with scales;
      • Elevated levels of IgE antibodies in the blood;
      • Frequent rhinitis and conjunctivitis,;
      • Frequent skin infections;
      • Distinctly expressed pattern of skin of soles and palms;
      • Whitish patches on face and shoulders;
      • Excessive dryness of the skin;
      • increased sweating;
      • Peeling and itching after a bath (in children under 2 years).
      • Dark circles around the eyes

To make a diagnosis of atopic dermatitis, it is necessary that the patient has at least 3 main signs and at least 3 auxiliary ones.

In the blood test, eosinophilia, a decrease in the number of T-lymphocytes, and an increase in the number of B-lymphocytes are determined.

Also, when diagnosing, skin scarification tests for allergens can be performed, urine and feces tests are taken.

Complications

Complications of atopic dermatitis most often occur due to scratching of the skin. This leads to a violation of the integrity of the skin and a weakening of its barrier functions.

Complications of atopic dermatitis:

• • • • Lymphadenitis (cervical, inguinal and axillary),
      • Purulent folliculitis and furunculosis,
      • multiple papillomas,
      • Fungal and bacterial skin lesions,
      • cheilit,
      • Stomatitis and periodontitis,
      • Conjunctivitis,
      • depression.

How to treat atopic dermatitis?

There is no single way or medicine to cure dermatitis. This disease requires complex treatment.

Therapy of the disease is carried out by a dermatologist or an allergist. You may need to consult an endocrinologist, gastroenterologist.

Treatment has the following goals:

• • • • Achieving remission
      • Reducing the severity of symptoms and inflammatory processes,
      • Prevention of severe forms of dermatitis and respiratory manifestations of allergies,
      • Improving the quality of life of patients and restoring their ability to work.

Measures for the treatment of the disease:

• • • • Preventing the entry of identified allergens into the body,
      • Increase the barrier function of the skin,
      • anti-inflammatory treatment,
      • Treatment of concomitant diseases (asthma, rhinitis, conjunctivitis, bacterial, fungal and viral infections),
      • Reducing the body's sensitivity to allergens (desensitization),
      • Body detoxification.

diet therapy

Dermatitis often goes hand in hand with food allergies. Therefore, for the period of exacerbation, the patient is prescribed a hypoallergenic diet. However, in the chronic phase of the disease, the diet must also be observed, although not in such a strict form.

It is necessary to exclude from the patient's diet both foods containing potential allergens - fish and seafood, soy, nuts, eggs, and foods containing an increased amount of histamine - cocoa, tomatoes. Products containing dyes and preservatives, semi-finished products are removed from the diet. The amount of salt is limited (no more than 3 g per day). Fried foods are contraindicated. The diet should contain an increased amount of fatty acids, primarily those contained in vegetable oils. Lean meats, vegetables, cereals are also shown.

Medical treatment

The list of drugs used for treatment depends on the severity of the disease. The most commonly used are first- and second-generation antihistamines, as well as anti-inflammatory drugs. Many first-generation antihistamines, such as Diphenhydramine, Suprastin, Tavegil, also have a sedative effect, which makes it possible to prescribe them to patients suffering from sleep disorders.

However, the sedative effect means that they are contraindicated in people who require concentration. In addition, first-generation drugs can be addictive with long-term therapy. In this case, second-generation drugs (Cetirizine, Ebastine, Fexofenadine, Astemizol, Loratadine) are more effective.

Concomitant infections are treated with antibacterial agents, skin herpes - with antiviral drugs based on acyclovir.

Anti-inflammatory treatment may include corticosteroids, both topical and oral. Glucocorticosteroids are prescribed orally only with an exacerbation of the disease. In the form of ointments, corticosteroids are used both in the chronic course of the disease and during an exacerbation. Combined preparations (GCS + antibiotic + antifungal agent) are also used.

Despite the high effectiveness of corticosteroids, it should be remembered that they have many side effects. In particular, they can adversely affect the internal organs with prolonged use, cause drug dependence. Most often, ointments containing glucocorticosteroid drugs such as Hydrocortisone, Dexomethasone, Prednisolone are used.

Oil-based emollients, moisturizers (emollients) are prescribed externally. In the presence of exudation, lotions are used (tincture of oak bark, solutions of rivanol and tannin).

Also apply:

• • • • calcineurin inhibitors;
      • Membrane stabilizing drugs;
      • Vitamins (primarily B6 and B15) and polyunsaturated fatty acids;
      • Means for the treatment of diseases of the gastrointestinal tract (enzyme preparations, preparations for dysbacteriosis, enterosobents);
      • Immunomodulators (shown only in severe forms and ineffectiveness of other treatments);
      • Antibiotics and antiseptics (to fight secondary bacterial infection);
      • Antifungal drugs (for the treatment of a fungal infection);
      • Tranquilizers, antidepressants, antipsychotics and sedatives (to reduce depression and reactivity of the autonomic nervous system);
      • Peripheral alpha-blockers;
      • M-anticholinergics.

Immunomodulators include drugs that affect the functions of the thymus, B-correctors.

It should be remembered that in atopic dermatitis, alcohol and alcohol solutions are prohibited as antiseptics, as they dry the skin excessively.

Dependence of the choice of methods of therapy on the severity of symptoms

Non-drug methods

From non-drug methods, it should be noted the maintenance of an optimal microclimate in the room, the correct selection of clothing, and nail care. Maintaining the right temperature and humidity in the room reduces skin irritation and sweating. The optimal temperature for patients with atopic dermatitis is + 20-22 ° C during the day and + 18-20 ° C at night, the optimum humidity is 50-60%. Those suffering from dermatitis should only wear clothes made from natural materials (cotton, linen, flannel, bamboo).

It is necessary to refrain from using household chemicals that cause an irritating effect: varnishes, paints, floor and carpet cleaners, washing powder, etc.

An important element of therapy is skin care, including the use of moisturizing and softening cosmetics that:

• • • • restore the integrity of the epidermis,
      • enhance the barrier functions of the skin,
      • protect the skin from irritants.

Moisturizers must be applied to the skin regularly, at least 2 times a day. You can do this more often, every 3 hours, the main thing is to make sure that the skin is not dry. During an exacerbation, a larger amount of the drug is required. First of all, moisturizers should be applied to the skin of the hands and face, as they are more intensely affected by irritants.

• • • • reduce the amount of stress;
      • carry out daily wet cleaning in the premises;
      • remove objects from the room that provoke the accumulation of dust, for example, carpets;
      • do not keep pets at home, especially with long hair;
      • limit intense physical activity;
      • use hypoallergenic cosmetics;
      • Avoid skin exposure to cold, direct sunlight, tobacco smoke, burns.

To wash the body, it is necessary to use detergents with a low pH (especially during an exacerbation). It is not recommended to wash the main foci of skin lesions in the acute phase of the disease with water. To do this, it is better to use disinfectant lotions or tampons with vegetable oils. During the period of remission, the washing technique should also be gentle. It is advisable to do without a washcloth during this process.

Physiotherapy (UV irradiation) is also used as an aid. In severe cases, blood plasmapheresis may be used.

Forecast

If the treatment is chosen correctly, then the prognosis of the disease is favorable. In 65% of children, signs of atopic dermatitis completely disappear at primary school age (by the age of 7), in 75% - in adolescence (at 14-17 years). However, the rest may experience relapses of the disease in adulthood. Exacerbations of the disease usually occur in the cold season, while remission is observed in summer. In addition, many children who get rid of atopic dermatitis subsequently develop allergic rhinitis.

Prevention

Prevention of atopic dermatitis has two types - primary and prevention of exacerbations. Since the disease manifests itself for the first time in infancy, primary prevention should begin even during the prenatal development of the baby. It should be remembered that factors such as taking certain medications, pregnancy toxicosis, play a role in the development of the disease. The first year of a child's life is also important in terms of prevention. A nursing mother must follow a diet to avoid exposure to allergens on the baby's body, and artificial feeding of the child should be transferred as late as possible.

Secondary prevention - measures aimed at preventing the recurrence of the disease. Here, proper skin care, wearing clothes made from natural fabrics, using hypoallergenic detergents, and maintaining cleanliness in the room are important.

People suffering from atopic dermatitis should avoid work associated with chemicals, dust, temperature and humidity changes, and contact with animals.

Atopic dermatitis- a chronic disease that is accompanied by itching. It is one of the most common allergic manifestations. If earlier it was attributed more to childhood diseases, now former children - adults are getting sick more and more often.

Why is this happening? Due to undertreatment in childhood for various reasons: incorrect diagnosis, incorrect treatment, negligent attitude towards the health of the child on the part of adults.

Causes and localization

Atopic dermatitis in adults is a non-contagious skin disease of a chronic nature on the background of allergies. Accompanied by itching, dryness and irritation of the skin, worsens the quality of life with its cosmetic, physical and psychological discomfort.

Due to the constant itching, the likelihood of secondary infection as a result of scratching the rashes is high. A person suffers from a disease, because itching haunts him, you constantly need to cover the rash.

To better understand where the disease comes from and how to deal with it, you need to figure out what factors affect the development of dermatitis in adults.

Causes of atopic dermatitis in adults:

1. hereditary factors. A very important role in the development of the disease is genetic predisposition. Therefore, if close relatives have this pathology, then the likelihood of manifestation is very high. In cases where both parents are ill in a child, the possibility of developing atopic dermatitis is 80%. Dermatitis manifests itself at an early age, even before 5 years.
2. In most cases, children who suffer from atopic dermatitis and in adulthood suffer from this disease. If it is not treated, then the condition worsens and the likelihood of acquiring other diseases, such as bronchial asthma, is high.
3. Another reason is air and water pollution.
4. A very important negative role is played by unhealthy food with a lot of fat, preservatives, chemical flavorings and flavoring chemical additives.
5. The rise of infectious diseases that are resistant to drugs.
6. Frequent stress and stress.
7. Inability to spend more time outdoors.
8. The most common allergens such as dust, insects, animal seeds and nuts, as well as other foods can be the reasons.
9. The presence of an allergy to the drug. Especially the body reacts to antibiotics, vitamins and anesthetics.

People prone to allergies should definitely monitor food, drink, environmental factors. Allergy sufferers should not take medicines and other unknown products.

In adulthood, the rashes are pale pink in color with a pronounced skin pattern, as well as the presence of pustular rashes.

Localization predominantly noted in the elbow and popliteal folds, often manifested on the face and neck. The skin becomes dry, rough, with cracks and peeling.

Areas of typical localization of the rash are:

• the area around the mouth;
• skin around the eyes;
• the skin of the neck suffers;
• chest;
• back;
• on the flexion surfaces of the limbs;
• in the inguinal folds;
• on the buttocks.

The allergist carefully examines the rash and its localization, this helps to quickly make the correct diagnosis and begin adequate treatment.

Atopic dermatitis in adults symptoms

How to recognize the disease? It is very important to consider the symptoms of atopic dermatitis in adults on the body. Timely diagnosis will help to avoid complications.

People who suffer from this disease, already by the first signs, recognize the beginning of an exacerbation of a chronic disease. After all, the skin of such people is very susceptible and instantly reacts to all irritants.

Symptoms of dermatitis on the hands and face

The favorite place of atopic dermatitis are the hands and face. In severe exacerbations, of course, the rash can affect large areas of human skin (most often in the folds).

In older people, the disease is often manifested by dryness and flaking of the hands and face, in advanced forms, even cracking of the skin is possible.

Patients are haunted by incredible itching, because of which they constantly comb the affected areas, which greatly aggravates the condition.

In addition to peeling, small bubbles may appear, which, when opened, turn into weeping wounds, turning into yellow crusts.

Frequent manifestation of atopic dermatitis may be conjunctivitis.

Symptoms:

• the lower fold of the eyelid is doubled;
• the presence of cracks and hyperemia of the feet;
• nails become polished; hair becomes thin, eyebrows thin, sometimes even completely lose hairs.

All the symptoms in the complex and represent a detailed picture of the diagnosis.

Diagnostics

Diagnosis should only be carried out by a specialist. He examines the patient, interrogates and analyzes all complaints. The doctor takes into account the duration and frequency, the presence of the disease in close relatives. The allergist prescribes a blood test for the level of immunoglobulin E.

In order to properly prescribe treatment, it is worth accurately identifying the allergen. To do this, special substances are applied to the forearm, which can provoke an allergic reaction.

After contact, the skin begins to swell and redden. Based on the results of such tests, the use or contact with the allergen is excluded and treatment is prescribed.

Treatment of atopic dermatitis

Atopic dermatitis has many different causes and symptoms. Therefore, the treatment is prescribed in each individual case.

Definitely worth considering the age of the patient, the degree of neglect and the presence of concomitant diseases.

It is almost impossible to get rid of this disease with the use of antihistamines, treatment should be carried out comprehensively and affect all organs involved.

The following phases are distinguished:

1. if possible, the complete exclusion of the allergen from the life of the patient;
2. minimize sensitivity to the allergen, contact with which cannot be avoided;
3. relieve itching;
4. cleanse the body;
5. relieve inflammation;
6. treatment of concomitant diseases;
7. relapse prevention;
8. treatment of complications.

How to treat folk remedies - recipes

How to eliminate atopic dermatitis in adults - treatment with folk remedies:

1. Excellent help infusion of viburnum. To prepare it, you need to take 1 glass of fresh viburnum berries and pour 1 liter of boiling water over them. After the berries have been settled for 10 hours, the liquid must be filtered from them and taken 2 glasses a day for 2 weeks.

2.A decoction of: 2 tbsp dried tricolor violets is used to treat the disease, 2 tbsp string and three sheets of blackcurrant. Mix everything and pour 1 liter of water at room temperature. Then boil everything and cook for 15 minutes. The broth is filtered and consumed 2 tablespoons daily for 20 days.

3. 3 bay leaves pour a glass of boiling water and leave to cool. Then drink half a cup daily for 10 days.

4. This tincture used by adults only. For its preparation, take 10 g dried tree peony, which is poured into 100 g of vodka. They also take 10 g of dried valerian root, also pour 100 g of vodka and insist both tinctures for 10 days in a cool dark place. Then they are filtered and mixed. Take 10 days, 1 teaspoon three times a day after meals.

5. A glass of dried crushed pear leaves pour the floor with liters of water, bring to a boil and boil for 5-7 minutes. The broth is set aside until it cools completely, after which it is filtered and used for topical application. A piece of cotton fabric is wetted in liquid and applied for 2 hours 2 times a day.

Using these recipes, it is necessary to take into account the individual characteristics of the body.

How to treat atopic dermatitis on the hands

On the hands of atopic dermatitis in adults is treated comprehensively. Assign treatment general strengthening, cleansing the body and local. Recipes that will help get rid of the exacerbation of the disease are varied, you just have to choose the one that is best suited in this case.

Medicinal baths are widely used for hands.. For their preparation, chamomile, string or celandine are brewed in a ratio of 50 g of grass to 1 liter of boiling water. The infusion is diluted in 20 liters of water and hands are kept in it for 10-20 minutes. The water must not be hot. It must be cleaned or boiled. It is better to use such a bath fresh every time.

For the treatment of atopic dermatitis on the hands, medications are also used, which the doctor should advise. It is worth remembering that prolonged treatment of the disease with medication can lead to a number of negative consequences.

Treatment of atopic dermatitis on the face

The manifestation of the disease on the face is especially unpleasant, because it is very noticeable and, in addition to physical, also has a strong cosmetic defect. They are trying to get rid of him as soon as possible.

In the presence of such a disease, special attention should be paid to nutrition, often walk in the fresh air.

Recipe:

1 tbsp dry herb succession to half a glass of boiling water. Pour and insist until the solution becomes dark brown. After that, you need to take gauze, dip it in a decoction and make a compress, applying it to the affected skin area on the face for 15 minutes. Repeat the procedure 4-5 times a day.

There are also a lot of folk recipes that are very effective and do not harm health. The most important thing in the treatment of this disease is time. Do not run and burden the state. It is better to deal with the problem in time, then success in treatment will come faster and more efficiently.

Drugs for atopic dermatitis

The most common treatment is medication. Although it has a risk of negative effects on the body, the effect is noticeable immediately, it does not extort much time for all kinds of procedures.

Treatment of atopic dermatitis in adults - a list of drugs:

• antihistamines;
• desensitizers, which will relieve itching and reduce sensitivity to an irritant;
• soothing;
• to cleanse and relieve inflammation in the digestive tract;
• to enhance immune functions;
• procedures with paraffin and ultraviolet radiation;
• for topical use, solcoseryl, D-panthenol, bepanten, compresses with a solution of boric acid or potassium permanganate, fucorcin or erythromycin ointment are used.

All drugs must be used as directed by a physician.

Nutrition for atopic dermatitis in adults

Since this ailment is not only a skin problem, but also a disease that affects many organs, then it needs to be treated comprehensively. In addition to medications and traditional medicine prescriptions, the treatment of atopic dermatitis in adults involves having a special diet.

Without its observance, there will be no stable positive result. During the treatment period, the most aggressive foods from the point of view of allergology are excluded from the diet.

Foods not to eat:

• whole milk in any form;
• chicken meat and eggs;
• everything fatty, fried, spicy, smoked, salted and pickled;
• saturated broths;
• chocolate;
• all citrus fruits;
• nuts;
• berries, pomegranate and melon;
• mushrooms;
• products with dyes and preservatives.

Worth eating:

• flour;
• various vegetable oils;
• fresh and stewed vegetables (except beets);
• cereals;
• dietary meats;
• bananas and apples (preferably green).

Along with dietary nutrition, do not forget about a sufficient amount of liquid. You can drink water, teas, compotes and herbal decoctions.

Atopic dermatitis in adults diet - menu for the week

Compliance with the diet will help to quickly achieve good results in treatment and consolidate them.

The menu for the week looks like this:

Monday

• Breakfast: oatmeal boiled in water, weak black or green tea. Lunch: dietary soup with lean meat, steamed cutlets and rice, compote.
• Dinner: vegetable stew, herbal tea.

Tuesday

• Breakfast: fat-free cottage cheese, compote.
• Lunch: squash puree, meat stew with vegetables, tea.
• Dinner: steamed fish and fresh vegetable salad.

Wednesday

• Breakfast: a sandwich with salted cottage cheese with chopped herbs, tea.
• Lunch: vegetable soup, buckwheat with veal liver, vegetables, jelly.
• Dinner: fish steam cutlets, steamed vegetables, herbal tea.

Thursday

• Breakfast: fat-free cottage cheese and kefir, herbal tea.
• Lunch: veal baked with vegetables, juice.
• Dinner: boiled corn or broccoli, rice, rabbit.

Friday

• Breakfast: oatmeal with banana, black tea.
• Lunch: vegetable soup, veal, lettuce and vegetable salad, compote.
• Dinner: mashed potatoes, boiled meat, vegetable salad, chamomile tea.

Saturday

• Breakfast: toast with vegetable oil and vegetables, tea.
• Lunch: fish broth soup, meatballs, salad, juice. Dinner: baked duck breast,
• "Greek" salad, mint tea.

Sunday

• Breakfast: oatmeal on the water with an apple, tea.
• Lunch: soup on meat broth, pilaf, vegetable salad, compote.
• Dinner: veal baked with vegetables, jelly.

A therapeutic diet should become a way of life, then the disease will not annoy so often.

Atopic dermatitis- a chronic inflammatory disease of an allergic nature, the main features 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 the symptoms intensify, but remissions are inherent, sometimes even complete.

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

To make the picture of the disease more clear, let's consider the question - " what is atopy?».

atopy, or atopic diseases- the tendency of newborns to allergic diseases, which is transmitted to infants by heredity. 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 wrong lifestyle and nutrition of a pregnant woman. The expectant mother, especially in the last trimester of pregnancy, should try to refrain from eating products from the category of increased allergenicity - chocolate, citrus fruits, strawberries, etc.

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

In connection with the above features, atopic dermatitis often disappears by the age of 4, but there are times 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 sum up some results of the beginning of the article and continue the topic with a question - " how does atopic dermatitis develop?».

1 situation: An infant of 2-3 months or 2 years of age receives food with increased allergenicity along with mother's milk or in another way. He has not yet fully formed the organs of the gastrointestinal tract, the immune system, etc. 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, cannot neutralize its adverse effects on the body. The kidneys also can not remove it in any way. Thus, this allergen, due to various biochemical processes in the body, turns into substances with the properties of antigens (substances foreign to the body). The body produces antibodies to fight 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.

2 situation: A pregnant woman consumes a large number of products of increased allergenicity, or has been in contact with various substances that cause. The body of the fetus may also receive some of these products or substances that will be in the body of the child after birth. Further, when the baby eats or comes into contact with allergens with which he was in contact even in the prenatal period, his body will react to this with a rash and other symptoms of atopic dermatitis.

Thus, we can conclude that atopic dermatitis is not a skin disease, but an internal reaction of the body to an allergen, which is inherited.

Causes of atopic dermatitis

Atopic dermatitis can be caused by:

- the use by a pregnant woman of food products of increased allergenicity - citrus fruits, chocolate, red berries, alcoholic beverages;
- the use of foods of increased allergenicity by the child himself;
- hereditary predisposition;
- fungal, viral and bacterial infections;
- weakened immune system;
- physical contact with the allergen: clothing, chemicals, building materials, drugs;
- respiratory contact: dust, pollen, gases;
- non-compliance;
— ;
- a sudden change in 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 fuzzy borders;
- rash on the body, sometimes dry, sometimes filled with fluid;
- weeping areas of the skin, erosion, abscesses;
- dry skin, with further peeling;
- scales on the scalp, glued together with the secretion of the sebaceous glands.

Accompanying symptoms may include:

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

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

Experts note that atopic dermatitis has a seasonality - in winter and summer, the symptoms worsen. 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 for atopic dermatitis includes:

— prevention of 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 mode;
- Treatment of concomitant diseases.

Medicines for 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: "Dimetinden", "Clemastin", "Meklizin";
Second generation: "Azelastin", "Loratadin", "Cetrizine";
Third generation: Desloratadine, Levocetrizine, Sehifenadine.

It is better to take antihistamines at bedtime, because. many of them tend to sleep.

Anti-inflammatory and antipruritic agents

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

These drugs include: glucocorticosteroid drugs, Burov's liquid, non-steroidal anti-inflammatory drugs (with a solution of sodium thiosulfate), 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 plasters with absorbable effect are used, the bases of which are: tar, sulfur, Naftalan oil, ichthyol. Such drugs begin to be used with small doses, gradually increasing the concentration of active substances, or changing them to a stronger agent.

Means for softening and removing hardened scales and crusts

Keratolytic ointments and creams are used as agents for softening and removing hardened scales and crusts, which also include: acids (salicylic, lactic, fruit), urea and resorcinol.

Hormonal drugs

Hormonal preparations are widely, but strictly under the supervision of the attending physician, used for all forms of dermatitis, especially the acute course of the disease. With weeping dermatitis, lotions and pastes are preferred, with 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, the removal of itching, as well as the further restoration of the skin. The disadvantage is addiction and withdrawal syndrome.

Hormonal agents of weak action - hydrocortisone. They are used mainly for the treatment of children or for manifestations of the disease on the face.

Hormonal agents of medium action - glucocorticosteroids ("Prednisolone", "Fluocortolone"). They are used for lesions of all parts of the body.

Hormonal drugs of strong action - "Betamethasone", "Halomethasone", "Mometasone", "Flumethasone". They are used for prolonged dermatitis, as well as for lichenification of the skin.

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

Remedies for chronic atopic dermatitis

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

These remedies include: birch buds, Veronica officinalis, oak bark, borage, flowers of willow-tea and chamomile, basil, pear leaves.

Antibacterial and antifungal agents

At ( , etc.), i.e. when the skin is affected, there is always a risk of getting into papules and vesicles of various infections - 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 externally used. It can be ointments, creams, and aerosols. The main feature of these funds is the content in them of substances such as furatsilin, boric acid, iodine solution, silver nitrate, ethacridine lactate, gentamicin, oxytetracycline and glucocorticoid.

Means for the normalization and improvement of the digestive organs

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 outwardly it manifests itself in the video of the inflammatory process of the skin.

Doctors have established a link between the normalization or improvement of the digestive system and the acceleration of recovery from dermatitis.

Thus, for this result, two types of preparations are used - enterosorbents and preparations for the normalization of the intestinal microflora.

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

Preparations for the normalization of intestinal microflora. This can include the following agents: probiotics (Bactisubtil, Lineks), prebiotics (Inulin, Lysozyme), synbiotics (Maltodofilus, Normoflorin), hepatoprotectors (ademetionine, beatin, glycyrrhizic acid), bacteriophages (coliproteic, Pseudomonas aeruginosa), enzymes (pancreatin).

Preparations to strengthen the immune system and accelerate skin recovery

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

How to improve the digestive system, we already know from the previous paragraph. An additional item that will have a beneficial effect on the entire body in the complex is an additional intake of minerals. The greatest emphasis should be placed on vitamins -, or echinacea.

To speed up the processes of restoration of the skin, anabolic drugs are used, which have in their composition substances such as methandienone, methionine, nandrolone.

Normalization of the mental and nervous system

Work/rest/sleep disturbances, mental stress, weaken the immune system, making the whole 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 at a job where you are constantly exposed to stress, think about it, is it possible to change this job? It is fair to say here 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 for complete rest and recuperation. The best result is achieved if you go to bed at 21:00-22:00, and your sleep will be uninterrupted.

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

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

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

The menu for dermatitis is aimed at:

- exclusion from the diet of products of increased allergenicity;
- enrichment of the body with essential vitamins and minerals;
- normalization of the digestive system.

What not to eat with atopic dermatitis:

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

The concept of "atopy" as a predisposition of newborns to allergic diseases, transmitted by heredity, was proposed in 1923 by American scientists A. Coca and R. Cooke.

This common skin lesion of an allergic nature, characterized by an inflammatory process, is atopic dermatitis . Over 12% of the population suffer from this non-communicable disease.

ICD-10

In the international classification, atopic dermatitis is defined as a chronic skin disease. He was assigned an ICD-10 code - L 20. The development of pathology is due to the special sensitivity of the body in response to certain irritating factors.

Atopic dermatitis (neurodermatitis) in adults (photo)

The reasons

Basically, the disease is due to heredity.

Problems that activate the process of exacerbation of the disease

The course of the disease is recurrent, alternating with stages of remission. The following factors exacerbate it:

• ecological and climatic anomalies;
• unbalanced diet;
• expansion of a number of allergic reagents;
• nervous overload;
• immune disorders;
• early infant feeding.

Dermatitis is exacerbated as a result of a reaction to allergens and irritants.

Symptoms

The main signs appear on the surface of the skin.

• irritation;
• severe itching;
• dryness.

When combing develops secondary infection (viral or bacterial).

The most common symptoms:

Secondary symptoms are physical, psychological, household, cosmetic, emotional discomforts and complexes.

Disease periods

Dermatitis appears especially often in infants aged (from 2-4 months to 1 year). Before the age of 5 years, dermatitis occurs, but less frequently.

Atopic dermatitis in children

The early development of the disease is explained by the predisposition of infants to allergic diseases.

Atopic dermatitis in children: photo

Prerequisites for early dermatitis:

• poor nutrition and lifestyle of the mother during pregnancy;
• unformed immune system of the child.

By the age of 4, the disease often resolves, but occurs in adolescents and adults. Up to the age of 5 years, 90% of the manifestations of the disease are recorded.

Atopic dermatitis in adults

With age, symptoms tend to subside. However, the disease in adolescents and adults can manifest itself and even occur for the first time. By the age of 15-17, the disease recedes on its own in 70% of cases. Only 30% flows into the adult form.

Clinical indicators in different phases:

The disease proceeds in different ways, depending on the phase, cause, and other diseases.

Seasonal exacerbations occur in spring and autumn. Stages according to the nature of the course: acute, chronic.

Acute stage

Spots, papules, skin peeling, crusts and erosion. With the development of infection, pustular formations are observed.

chronic stage

Thickening of the skin with a bright pattern, scratching, cracks, changes in pigmentation of the eyelids.

Diffuse neurodermatitis- one of the forms of dermatitis. It is also manifested by itching and rashes of an allergic nature. A secondary factor is malfunctions in the functioning of the nervous system, exacerbated by stressful situations.

Diagnostics

Measures to recognize the disease are carried out by specialists: dermatologist, allergist:

• monitoring of the clinical picture;
• allergy tests;
• urine and stool tests.

In diagnostic studies, analysis of a family history is used. If necessary, the knowledge of other specialists is used: a psychoneurologist, an endocrinologist, an otolaryngologist.

Treatment

Since the symptoms differ between children and adults, the treatment is also different. Its process is quite complicated. The basis is diet, drug therapy, specific hyposensitization (decrease in general sensitivity to the allergen).

The main objectives of treatment

• elimination of the allergic factor;
• removal of inflammation, itching;
• cleansing the body of toxic substances;
• prevention of complications, relapses.

The treatment takes into account age, the presence of concomitant pathologies, clinical severity.

Treatment Methods

Methods of therapy are selected by the attending physician in the complex. The most common:

• drug therapy;
• use of a laser;
• photo chemotherapy (PUVA);
• blood purification (plasmapheresis);
• measures to reduce susceptibility to an allergen (hyposensitization);
• exposure to needles (acupuncture);
• diet.

diet therapy

It is designed to regulate nutrition, which contributes to the improvement of the condition and helps prevent exacerbation. First, food allergens are completely excluded. Milk and eggs are not recommended, even if well tolerated.

At hypoallergenic diet completely excluded:

• fried meat and fish;
• vegetables, mushrooms;
• honey, chocolate;
• melon, citrus;
• strawberry, black currant;
• canned food, spices, smoked meats.

Particularly important diet with atopic dermatitis in children . The menu should be dominated by such dishes:

Medical therapy

Includes different groups of drugs:

Local treatment

It takes into account the nature and prevalence of pathology, age-related features, complications, and other factors.

The action of drugs : anti-inflammatory, decongestant, drying, antipruritic, disinfectant.

Forms : lotion, ointment, paste, cream.

Representatives : Losterin, Prednisolone, Flumethasone.

The use of emollients in atopic dermatitis in children

These are substances that soften and moisturize the skin, protecting it from irritants. Especially effective in early childhood after bathing.

They are produced on the basis of hypoallergenic ingredients without the presence of harmful chemical compounds.

List of funds:

• A-Derma;
• Bioderma Atoderm;
• Topicrem;
• Oilan;
• Physiogel intensive;
• Dardia.

The use of emollients helps to fight dryness, inflammation, skin damage in the manifestations of atopic dermatitis.

Atopic dermatitis on the face of a child (photo)

Large studies on how to treat atopic dermatitis in a child, conducted Dr. Komarovsky . Among the important reasons, he highlights the overeating of the child, his intake of food in more quantities than he is able to digest.

With pathologies in children, Komarovsky proposes treatment in three directions:

1. Minimize the entry of harmful substances from the intestines into the blood. Combating constipation, dysbacteriosis, increasing the time of eating, reducing the concentration of infant formula, using activated charcoal, dosing sweets. The main thing is the absence of overeating.
2. Exclusion of skin contact with irritating factors. Boiling water before bathing, using children's washing powders, natural fabrics, bathing with soap no more than 2 times a week, taking care of the quality of toys.
3. Creating conditions to reduce child sweating. Compliance with temperature and humidity, do not wrap excessively, use a sufficient amount of liquid.

Treatment with folk remedies

The people practice decoctions for oral administration, means for local treatment, baths with special means, compresses.

Some folk recipes:

Also popular among the people baths: coniferous, with chamomile and string, calendula, mint and other medicinal plants. The addition of soda or starch is practiced to combat dryness.Recommended daily morning washing of the skin on the face, other parts of the body with a solution of vinegar with water 1:10.

Many folk remedies relieve symptoms and the treatment becomes more effective.

Complications

They occur due to trauma to the skin by scratching. Because of this, its protective properties are reduced, as a result of which infections are added.

Types of complications

Helps avoid complications preventive measures.

Prevention
Starts before the baby is born.

Primary - prevention of dermatitis

It is necessary to breastfeed, limit the intake of medicines, and follow a diet.

Secondary - prevention of relapses, exacerbations

• exclusion of causes and provoking factors;
• compliance with the prescribed diet;
• taking prophylactic drugs;
• skin hygiene.

Hygiene features

• do not wash with a washcloth daily;
• use hypoallergenic soap;
• prefer a warm shower to a hot one;
• blot with a towel, not rub;
• moisturize the skin with special means;
• use natural clothing.

Complete recovery is considered to be the absence of symptoms from 3 to 7 years. The interval between stages of exacerbations lasts from a month to several years.

If left untreated, there is a risk of developing bronchial asthma. It is necessary to carry out treatment under the supervision of a specialist.

Competent prevention and lifestyle protect against the occurrence of relapses. It is important to be attentive to your own body, follow a diet, take care of the condition of the skin.

Video

The term "atopy" refers to a genetically determined predisposition to a number of allergic diseases and their combination, arising in response to contact with certain environmental allergens. These diseases include chronic atopic dermatitis, also called atopic eczema/dermatitis syndrome and atopic eczema.

Atopic dermatitis is a chronic atopic inflammatory skin disease that develops mainly from early childhood and proceeds with exacerbations in response to low doses of specific and nonspecific stimuli and allergens, characterized by age-related features of the localization and nature of the foci, accompanied by severe itching of the skin and leading a sick person to emotional and physical maladjustment.

Causes of atopic dermatitis

Atopic dermatitis develops in 80% of children whose mother and father suffer from this disease; if only one of the parents - 56%; in the presence of a disease in one of the parents, and the second has a pathology of the respiratory organs of allergic etiology - almost 60%.

Some authors are inclined to believe that allergic predisposition is the result of a complex of various genetic disorders. For example, the importance of congenital insufficiency of the enzymatic system of the digestive tract has been proven, which leads to incomplete splitting of incoming products. Violation of the motility of the intestines and gallbladder, the development of dysbacteriosis, scratching and mechanical damage to the epidermis contribute to the formation of autoantigens and autosensitization.

The result of all this is:

• the assimilation of food components that are unusual for the body;
• the formation of toxic substances and antigens;
• dysfunction of the endocrine and immune systems, receptors of the central and peripheral nervous system;
• the production of autoantibodies with the development of the process of autoaggression and damage to the body's own tissue cells, that is, immunoglobulins are formed that play a major role in the development of an atopic allergic reaction of an immediate or delayed type.

With age, the importance of food allergens is increasingly minimized. The defeat of the skin, becoming an independent chronic process, gradually acquires relative independence from food antigens, the mechanisms of the response change, and exacerbation of atopic dermatitis occurs already under the influence of:

• household allergens - house dust, fragrances, sanitary household products;
• chemical allergens - soaps, perfumes, cosmetics;
• physical skin irritants - coarse woolen or synthetic fabric;
• viral, fungal and bacterial allergens, etc.

Another theory is based on the assumption of such innate features of the skin structure as insufficient content of the structural protein filaggrin in it, which interacts with keratins and other proteins, as well as a decrease in lipid synthesis. For this reason, the formation of the epidermal barrier is disrupted, which leads to easy penetration of allergens and infectious agents through the epidermal layer. In addition, it is assumed that there is a genetic predisposition to the excessive synthesis of immunoglobulins responsible for immediate allergic reactions.

Atopic dermatitis in adults can be a continuation of the disease from childhood , late manifestation of a latent (latently, without clinical symptoms) of an ongoing disease or late implementation of a genetically determined pathology (in almost 50% of adult patients).

Relapses of the disease occur as a result of the interaction of genetic and provoking factors. The latter include:

• unfavorable ecology and excessive dryness of the air;
• endocrine, metabolic and immune disorders;
• acute infectious diseases and foci of chronic infection in the body;
• complications during pregnancy and the immediate postpartum period, smoking during pregnancy;
• prolonged and repetitive psychological stress and stressful conditions, shift work, long-term sleep disorders, etc.

In many patients, self-treatment of allergic dermatitis with folk remedies leads to a pronounced exacerbation, most of which are prepared on the basis of medicinal plants. This is due to the fact that they are usually used without taking into account the stage and prevalence of the process, the age of the patient and allergic predisposition.

The active components of these products, which have antipruritic and anti-inflammatory effects, are not purified from accompanying elements, many of them have allergenic properties or individual intolerance, contain tanning and drying substances (instead of the necessary moisturizers).

In addition, self-prepared preparations often contain natural unrefined vegetable oils and/or animal fats that close the skin pores, which leads to an inflammatory reaction, infection and suppuration, etc.

Thus, theories about the genetic cause and the immune mechanism of the development of atopic dermatitis are the main ones. The assumption of the presence of other mechanisms for the implementation of the disease has long been only a subject of discussion.

Video: How to find the cause of allergic dermatitis

Clinical course

There is no generally accepted classification of atopic dermatitis and objective laboratory and instrumental methods for diagnosing the disease. The diagnosis is based mainly on clinical manifestations - typical morphological changes in the skin and their localization.

Depending on age, the following stages of the disease are distinguished:

• infantile, developing at the age of 1.5 months and up to two years; among all patients with atopic dermatitis, this stage is 75%;
• children (at 2 - 10 years of age) - up to 20%;
• adult (after 18 years) - about 5%; the onset of the disease is possible before the age of 55, especially among men, but, as a rule, this is already an exacerbation of the disease that began in childhood or infancy.

In accordance with the clinical course and morphological manifestations, there are:

1. The initial stage, developing in childhood. It manifests itself with such early signs as limited redness and swelling of the skin of the cheeks and buttocks, which are accompanied by slight peeling and the formation of yellow crusts. In half of the children with atopic dermatitis on the head, in the area of ​​\u200b\u200bthe large fontanel, fatty small dandruff flakes form, as with.
2. The stage of exacerbation, consisting of two phases - severe and moderate clinical manifestations. It is characterized by severe itching, the presence of erythema (redness), small vesicles with serous contents (vesicles), erosions, crusts, peeling, scratching.
3. The stage of incomplete or complete remission, in which the symptoms of the disease disappear, respectively, partially or completely.
4. The stage of clinical (!) recovery is the absence of symptoms of the disease for 3-7 years (depending on the severity of its course).

The existing conditional classification also includes an assessment of the prevalence and severity of the disease. The prevalence of dermatitis is determined by the area of ​​the lesion:

• up to 10% - limited dermatitis;
• from 10 to 50% - common dermatitis;
• over 50% - diffuse dermatitis.

The severity of atopic dermatitis:

1. Mild - skin lesions are local in nature, relapses occur no more than 2 times in 1 year, the duration of remissions is 8-10 months.
2. Average - widespread dermatitis, aggravated up to 3-4 times within 1 year, remissions last for 2-3 months. The nature of the course is rather persistent, difficult to correct with drugs.
3. Severe course - damage to the skin is widespread or diffuse, often leading to a severe general condition. Treatment of atopic dermatitis in such cases requires the use of intensive care. The number of exacerbations within 1 year is up to 5 or more with remissions of 1-1.5 months or without them at all.

The nature of the course of atopic dermatitis in pregnant women cannot be predicted. Sometimes, against the background of moderate depression of immunity, there is an improvement (24-25%) or there are no changes (24%). At the same time, 60% of pregnant women experience deterioration, most of them - for up to 20 weeks. Deterioration is manifested by physiological or pathological metabolic and endocrine changes and is accompanied by changes in the skin, hair, nails.

It is also suggested that increased levels of progesterone and some other hormones during pregnancy lead to increased skin sensitivity and itching. Of no small importance are the increase in vascular permeability, the increase in the permeability of the lipid barrier of the skin in the area of ​​the back surface of the hands and the flexor surface of the forearm, psycho-emotional instability, preeclampsia of pregnancy, impaired functioning of the digestive organs, as a result of which there is a slowdown in the removal of toxins from the body.

Symptoms of atopic dermatitis

It is customary to distinguish between major (major) and minor (minor) symptoms. For the diagnosis of atopic dermatitis, the simultaneous presence of any three main and three auxiliary signs is necessary.

The main symptoms include:

1. The presence of itching of the skin, present even with minimal skin manifestations.
2. The characteristic morphological picture of the elements and their location on the body are dry skin, localization (often) in symmetrical zones on the arms and legs in the area of ​​the flexion surface of the joints. In places of defeat there are spotty and papular rashes covered with scales. They are also located on the flexion surfaces of the joints, on the face, neck, shoulder blades, shoulder girdle, as well as on the legs and arms - on their outer surface and in the area of ​​the outer surface of the fingers.
3. The presence of other allergic diseases in the patient himself or his relatives, for example, atopic bronchial asthma (in 30-40%).
4. The chronic nature of the course of the disease (with or without relapses).

Auxiliary criteria (most common):

• the onset of the disease at an early age (up to 2 years);
• fungal and frequent purulent and herpetic skin lesions;
• positive reactions to allergen testing, increased blood levels of general and specific antibodies;
• drug and / and food allergy, occurring in an immediate or delayed (up to 2 days) type;
• Quincke's edema, recurrent rhinitis and/or conjunctivitis (80%).
• reinforced skin pattern on the palms and feet;
• whitish spots on the face and shoulder girdle;
• excessive dryness of the skin (xerosis) and its peeling;
• itching of the skin with increased sweating;
• inadequate reaction of skin vessels to mechanical irritation (white dermographism);
• dark periorbital circles;
• eczematous skin changes around the nipples;
• poor tolerance to wool products, degreasers and other chemicals and other less significant symptoms.

Characteristic for adults are frequent relapses of atopic dermatitis under the influence of many external factors, moderate and severe course. The disease can gradually move into a more or less long-term remission, but almost always the skin tends to itching, excessive peeling and inflammation.

Atopic dermatitis on the face in adults is localized in the periorbital zone, on the lips, in the region of the wings of the nose, eyebrows (with hair loss). In addition, the favorite localization of the disease is in the natural folds of the skin on the neck, on the back surface of the hands, feet, fingers and toes, and flexion surfaces in the joints.

The main diagnostic criteria for skin manifestations of the disease in adults:

1. Severe itching in areas of localization.
2. Skin thickening.
3. Dryness, peeling and weeping.
4. Strengthening the picture.
5. Papular rashes, eventually transforming into plaques.
6. Detachment of significant limited areas of the skin (in the elderly).

Unlike children, exacerbations usually occur after neuro-emotional overstrain and stressful situations, exacerbations of other chronic diseases, and taking any medications.

Skin lesions are often complicated by lymphadenitis, especially inguinal, cervical and axillary, purulent folliculitis and furunculosis, skin lesions with herpes virus and papillomaviruses, fungal infection. Often develop blanching, softening and loosening of the lips with the formation of transverse cracks (cheilitis), conjunctivitis, periodontal disease and stomatitis, pallor of the skin in the eyelids, nose and lips (due to impaired capillary contractility), depression.

With increasing age, the foci become localized, the skin becomes thick and rough, and more flaky.

Video: Atopic dermatitis rules of life

How to treat atopic dermatitis

The goals of therapeutic intervention are:

• maximum reduction in the severity of symptoms;
• ensuring long-term control over the course of the disease by preventing relapses or reducing their severity;
• change in the natural course of the pathological process.

In adult patients with atopic dermatitis, unlike children, only complex treatment is always carried out, based on the removal or reduction of the effect of provoking factors, as well as on the prevention and suppression of allergic reactions and the inflammatory processes caused by them in the skin. It includes:

1. Elimination measures, that is, to prevent the entry into the body and the removal from it of factors of an allergenic or non-allergenic nature that increase inflammation or cause an exacerbation of the disease. In particular, most patients should take vitamins with caution, especially “C” and “B” groups, which cause allergic reactions in many. Preliminary carrying out of various diagnostic tests and other researches on identification of allergens is necessary.
2. Proper medical and cosmetic care aimed at improving the barrier function of the skin.
3. The use of external anti-inflammatory therapy, which provides for getting rid of itching, treatment of secondary infection and restoration of the damaged epithelial layer.
4. Treatment of concomitant diseases - foci of chronic infection in the body; allergic rhinitis and conjunctivitis, bronchial asthma; diseases and dysfunctions of the digestive organs (especially the pancreas, liver and gallbladder); complications of dermatitis, for example, neuropsychiatric disorders.

Video about the treatment of atopic dermatitis

Of great importance is the background on which treatment should be carried out - this is an individually selected diet for atopic dermatitis of an elimination nature. It is based on the exclusion from the diet of products:

• causing allergies;
• not being allergens for a particular patient, but containing biologically active substances (histamine) that provoke or intensify allergic reactions - histamine carriers; these include substances that are part of strawberries and strawberries, soybeans and cocoa, tomatoes, hazelnuts;
• having the ability to release histamine from the cells of the digestive tract (histaminoliberins), contained in citrus fruit juice, wheat bran, coffee beans, cow's milk.

Therapeutic and cosmetic skin care consists in the use of a daily shower for 20 minutes with a water temperature of about 37 ° C in the absence of a purulent or fungal infection, moisturizing and emollients - an oil bath with the addition of moisturizing ingredients, cosmetic moisturizing spray, lotion, ointment, cream. They have indifferent properties and are able to reduce inflammation and itching by maintaining skin moisture and retaining corticosteroids in it. Moisturizing creams and ointments in the absence of wetting) are more effective than spray and lotion in helping to restore the hydrolipidic layer of the skin.

How to relieve itching of the skin, which often acquires painful forms, especially at night? The basis is systemic and topical antihistamines, since histamine plays a crucial role in the development of this heavy sensation. With simultaneous sleep disturbance, first-generation antihistamines are recommended in the form of injections or tablets (Diphenhydramine, Suprastin, Clemastin, Tavegil), which also have a moderate sedative effect.

However, for long-term basic therapy, it is more effective and more convenient (1 time per day) for the treatment of local and general allergic reactions and itching (2nd generation) - Cetirizine, Loratadine or (better) their new derivative metabolites - Levocetirizine, Desloratadine. Of the antihistamines, Fenistil is also widely used in drops, capsules and in the form of a gel for external use.

Local treatment of atopic dermatitis also includes the use of systemic and local preparations containing corticosteroids (hydrocortoison, fluticasone, triamcinolone, clobetasol), which have antiallergic, decongestant, anti-inflammatory and antipruritic properties. Their disadvantage is the formation of conditions for the development of a secondary (staphylococcal, fungal) infection, as well as a contraindication to long-term use.

Second-line drugs (after corticosteroids) include non-hormonal local immunomodulators - calcineurin inhibitors (tacrolimus and pimecrolimus), which suppress the synthesis and release of cellular cytokines that are involved in the formation of the inflammatory process. The impact of these drugs helps prevent hyperemia, swelling and itching.

In addition, according to indications, non-hormonal anti-inflammatory, antibacterial, antifungal or combined drugs are used. One of the popular remedies with anti-inflammatory, moisturizing and regenerative properties is Bepanten in the form of an ointment or cream, as well as Bepanten-plus, which additionally includes the antiseptic chlorhexidine.

It is important not only to eliminate subjective symptoms, but also to actively moisturize and soften the affected areas, as well as restore the damaged epidermal barrier. If you do not reduce the dryness of the skin, it will not be possible to eliminate scratching, cracks, infection and exacerbation of the disease. Moisturizers include preparations containing urea, lactic acid, mucopolysaccharides, hyaluronic acid, glycerol.

Emollients are various emollients. Emollients in atopic dermatitis are the main external, not only symptomatic, but also pathogenetically directed means of influencing the disease.

They are various fats and fat-like substances that can be fixed in the stratum corneum. As a result of its occlusion, fluid retention and natural hydration occur. Penetrating within 6 hours deeper into the stratum corneum, they replenish lipids in it. One of these preparations is a multicomponent emulsion (for baths) and cream "Emolium P triactive", containing:

• paraffin oil, shea butter and macadamia oils, restoring the water-lipid mantle on the surface of the skin;
• hyaluronic acid, glycerin and urea, which are able to bind and retain water, moisturizing the skin well;
• allantoin, corn and rapeseed oils, softening and relieving itching and inflammation.

The current approach to the choice of atopic dermatitis treatment is recommended by the International Medical Consensus on Atopic Dermatitis. These recommendations take into account the severity of the course of the disease and are based on the principle of "steps":

1. Stage I, characterized only by dry skin - removal of irritants, application of moisturizers and emollients.
2. Stage II - minor or moderate signs of atopic dermatitis - topical corticosteroids with mild or moderate activity and/or calcineurin inhibitors.
3. Stage III - moderate or sufficiently pronounced symptoms of the disease - corticosteroids of medium and high activity until the development of the process stops, after which - calcineurin inhibitors.
4. Stage IV, which is a severe degree of the disease, not amenable to the above groups of drugs - the use of systemic immunosuppressants and phototherapy.

Atopic dermatitis in each person is characterized by the peculiarities of the course and diagnosis and requires an individual approach in the choice of treatment, taking into account the prevalence, forms, stage and severity of the disease.