Atopic dermatitis is treated or not. Atopic dermatitis: How to get rid of once and for all

The frequency of occurrence of this disease among the adult population varies from 5 to 10 percent. This figure increases significantly in industrialized countries, reaching 20 percent. The incidence of this pathology is growing every year. Very rarely, atopic dermatitis is an independent disease. So, in more than 35 percent of cases it occurs with bronchial asthma, in 25 percent with rhinitis, in 10 percent with hay fever. For every 100 cases of atopic dermatitis, there are 65 women and 35 men. Atopic dermatitis in the complex of other atopic reactions of the body was known in ancient times. Since the causes of this disease were not clear, at that time atopic dermatitis was called "idiosyncrasy". Thus, the name reflected the mechanism of the development of the disease ( namely, an increased reaction of the body to the allergen), but did not specify its etiology.

In the etymology of the phrase atopic dermatitis lie the Greek words - atopos ( translates as unusual and strange), dermis ( leather) and itis ( inflammation). For the first time the term atopy was used in 1922 to define the hypersensitivity of an organism of a hereditary type to environmental factors.
The causes of an allergic reaction can be not only classic allergens, but also a number of unusual factors.

Normally, immunoglobulins E are contained in negligible amounts in the body, since they break down very quickly. However, in atopic people, the content of these immunoglobulins is initially high, which is an indicator of a high risk of developing atopic disease.

At the first meeting with a foreign object, the immune system synthesizes antibodies. These antibodies are synthesized by the immune system and can persist for a long period of time, and sometimes throughout life. For example, at the first contact of an organism with a virus or bacterium, the organism is defenseless, since it does not have the corresponding antibodies. However, after a person has been ill with an infection in his body, there are a huge amount of antibodies. These antibodies protect the body from re-infection for a certain time.

In allergic reactions, the immune system works differently. At the first contact with the allergen, the body becomes sensitized. It synthesizes a sufficient amount of antibodies, which will later bind to the allergen. Upon repeated contact of the body with a substance that causes an allergy, an antigen-antibody complex is formed. The allergen acts as an antigen be it dust or egg yolk), and as an antibody, a protein synthesized by the body.

Further, this complex activates the system of immunoallergic reactions. The severity of the immune response depends on the type of allergic reaction, the duration of contact with the allergen and the degree of reactivity of the body. Class E immunoglobulins are responsible for the immunoallergic response of the body. Their number is directly proportional to the severity of the response. The more of them in the body, the stronger and longer the allergic reaction.

Mediators of allergic reactions

The main role among the mediators of the immunoallergic reaction is given to histamine. It increases the permeability of the vascular wall and dilates the vessels. Expansion of blood vessels ( vasodilation) is clinically accompanied by a symptom such as redness. At the same time, fluid comes out of the dilated vessels into the intercellular space. This phenomenon is accompanied by the development of edema. Another effect of histamine is bronchospasm and the development of asthma attacks.

In addition to histamine, leukotrienes, prostaglandins, and kinins are involved in immunoallergic reactions. All these mediators in atopic dermatitis are released from epidermal skin cells ( Langerhans cells). It has been established that the upper layer of the skin of atopic people contains an increased number of such cells.

Causes of atopic dermatitis

genetic predisposition

The genetic predisposition of the disease is very important in predicting the risk of atopic dermatitis. So, knowing that the family has a burdened history of atopic dermatitis, it is easier to prevent the impact of provoking factors.

The involvement of a genetic factor in the development of atopic dermatitis is confirmed by numerous immunogenetic studies. Thus, it is reliably known that atopic dermatitis is associated with the HLA B-12 and DR-4 genes.

immune system dysfunction

Dysfunction of the immune system affects both the humoral and the cellular link. At the level of humoral immunity, an increased level of IgE is noted. The growth of these immunoglobulins is noted in 9 out of 10 cases. At the same time, in parallel with the growth of immunoglobulins, the weakening of the cellular link occurs. This weakening is expressed in a reduced number of killer and suppressor cells. A decrease in the number of these cells, which normally regulate the body's response to a provoking factor, leads to an imbalance at the level of the killer-helper. This disturbed ratio is the reason for the increased production of cells of the immunoallergic reaction.

Pathology of the digestive system

Pathologies that may be the causes of atopic dermatitis are:

• intestinal dysbacteriosis;
• helminthic invasions;
• diseases of the liver and gallbladder;
• intestinal motility disorders;
• various fermentopathies ( cystic fibrosis, phenylketonuria);

Dysfunction of the autonomic nervous system

endocrine dysfunction

Genetic anomalies

Genetic disorders that create prerequisites for the development of atopic dermatitis are:

• Reduced production of sebum by the sebaceous glands or sebostasis. This is one of the causes of dry skin;
• Violation of the synthesis of filaggrin. This protein regulates the process of keratinization of skin cells. It also regulates the formation of moisturizing factors that retain water. Due to this, water is retained in the upper layer of the skin.
• lipid barrier disruption. Normally, the skin contains a fatty waterproof layer, thanks to which harmful substances from the environment do not penetrate into it. In atopic dermatitis, the synthesis of these lipids is reduced, making the lipid barrier weak and incompetent.

triggers

Triggers can be conditionally divided into specific ( which are individual for each person) and nonspecific ( which provoke an exacerbation of dermatitis in almost all people).

Specific trigger factors are:

• food allergens;
• medicines;
• aeroallergens.

The most common food allergens are:

• dairy products - milk, eggs, soy products;
• seafood - oysters, crabs, lobsters;
• nuts - peanuts, almonds, walnuts;
• chocolate;
• eggs.

Medications
Some drugs can not only exacerbate the allergic process, but also be the main cause of its development. So, aspirin can not only provoke an allergic reaction, but also cause bronchial asthma.

Most of the medicines only start the immunoallergic process on already prepared soil.

Medications that can cause atopic dermatitis are:

• antibacterial drugs from the penicillin group - ampicillin, amoxicillin;
• sulfonamides - streptocide, sulfazine, sulfalene;
• anticonvulsants - valproic acid preparations ( depakine), drugs from the carbamazepine group ( timonil);
• vaccines.

Allergens that cause atopic dermatitis:

• animal hair;
• perfume;
• plant pollen;
• house dust;
• volatile chemicals.

• weather;
• detergents;
• clothes;
• emotions, stress.

Warm, tight, synthetic clothing can also trigger atopic dermatitis. The main mechanism in this case is the creation of a microclimate of high humidity under clothing.
Occupational hazards also take part in the development of atopic dermatitis. So, for example, people who have direct contact with volatile chemicals, medicines, detergents, are most at risk of developing atopic dermatitis.

Thus, the main reasons for the development of atopic dermatitis are hereditary predisposition, impaired immunological background with a tendency to hyperreactivity, and the triggers themselves.

Symptoms of atopic dermatitis

Itching

Dry skin

Dry skin in atopic dermatitis goes through several stages. At the first stage, it is manifested only by a feeling of tightness of the skin, especially the face. This feeling quickly disappears after applying the cream. At the second stage, peeling of the skin, redness and itching join the dryness. Small cracks may appear. After the violation of the protective properties of the skin associated with the loss of moisture and the violation of the lipid membrane of the epidermis, the third period begins. During this period, the skin looks rough, stretched, and the cracks become deeper.

rashes

Type of rash	Characteristic	A photo
Primary elements
Spots	Manifested by local reddening of the skin without changing its relief. Spots in atopic dermatitis can be barely noticeable or bright red, highly flaky. As a rule, with atopic dermatitis, spots reach sizes from 1 to 5 centimeters, that is, they acquire the character of erythema. They can be simply edematous or accompanied by severe peeling.
bubbles	Cavity manifestations of atopic dermatitis. Bubbles are up to 0.5 cm in diameter. Inside the bubble contains an inflammatory fluid. In severe cases, with the exudative form of atopic dermatitis, the vesicles can be filled with an inflammatory fluid mixed with blood.
secondary elements
Scales and crusts	These are the cells of the epidermis that are torn away and form peeling. However, in atopic dermatitis, this process is more pronounced. Scales are rejected intensively and form crusts. These crusts are most often localized on the elbows, in the folds. Sometimes they can become saturated with purulent or serous contents of the vesicles.
Erosion and cracks	Erosion occurs at the site of cavity elements ( bubbles) and represents a violation of the integrity of the skin and mucous membranes. The contours of erosion coincide with the contours of vesicles or vesicles. Unlike erosion, a crack is a linear violation of the integrity of the skin. Cracks develop due to a decrease in skin elasticity and dryness. Most often they are localized superficially and can heal without scarring.
Lichenification	Thickening and thickening of the skin, which makes it look rough and rough. At the same time, the skin pattern intensifies, takes the form of deep furrows. From above, the skin may be covered with scales. The cause of lichenification is the thickening of the spinous layer of the dermis of the skin due to its infiltration by inflammatory cells.
Hypopigmentation	Areas of skin discoloration. Most often, these foci of discoloration are localized in places of primary and secondary elements. Thus, the focus of hypopigmentation may be located at the site of former erosions or vesicles. As a rule, the form of hypopigmented areas repeats the form of the element preceding it.

cheilite

atopic face

The manifestations that are inherent in an atopic person are:

• pallor of the face and peeling of the eyelids;
• atopic cheilitis;
• thinning and breaking off of the eyebrows as a result of combing;
• deepening of the folds on the lower and upper eyelids.

Forms of atopic dermatitis are:

• erythematous form;
• lichenoid form;
• eczematous form.

Lichenoid form
The skin of patients with this form is characterized by dryness and the presence of large erythema. Against the background of these erythemas, papules appear, which are covered with large, bran-like scales. Due to the excruciating itching, patients experience severe scratching, ulceration, erosion and cracks. It affects mainly the skin of the neck, elbow and popliteal folds, as well as the upper third of the chest and back. Occurs in one fifth of cases.

Eczematous form
With this form of atopic dermatitis, limited foci of dry skin are detected, with the presence of crusts, scales and vesicles on them. These foci are localized mainly in the area of ​​the hands, elbows and popliteal folds. This variant of atopic dermatitis occurs in 25 percent of cases.

Special forms of atopic dermatitis

Damage to the scalp
With this form, scratching, erosion and crusts appear in the occipital or frontal part of the head. The skin under the hair is always dry, often covered with white scales. This form of atopic dermatitis is accompanied by severe itching, which leads to scratching and sores.

Ear lobe injury
In this form of the disease, a chronic, painful fissure develops behind the ear crease. Sometimes, due to constant scratching, it turns into an ulcer that bleeds constantly. This crack is very often complicated by the addition of a secondary infection.

Nonspecific dermatitis of the feet
It is manifested by bilateral symmetrical lesions of the feet. At the same time, spots and cracks appear on both feet, which are accompanied by itching and burning.

Atopic hand eczema
On the hands with this form of atopic dermatitis, foci of redness appear, on which cracks subsequently appear. Cracks can turn into ulcers under the influence of household chemicals, water, soap.

Diagnosis of atopic dermatitis

Allergist consultation

Poll
A visit to an allergist begins with a questioning of the patient, during which the doctor receives the necessary information about the development of the disease, the patient's living conditions, and heredity. The information obtained allows the medical officer to establish a preliminary diagnosis.

Topics that are covered by the allergist when taking an anamnesis are:

• predisposition of family members to allergies;
• the nature of the patient's diet whether there is an increased consumption of allergen products such as citrus fruits, cow's milk, eggs);
• professional activity of the patient;
• type and duration of skin rashes;
• the relationship between the deterioration of the condition with changes in the diet or lifestyle of the patient;
• seasonality of disturbing patient disorders;
• the presence of additional symptoms of allergies ( coughing, sneezing, nasal congestion);
• comorbidities ( diseases of the kidneys, digestive organs, nervous system);
• the frequency of colds;
• housing and living conditions;
• the presence of pets.

Here is a list of sample questions an allergist might ask:

• What was the patient's disease in childhood and adolescence?
• What pathologies exist in the family, and does any of the relatives suffer from bronchial asthma, rhinitis, dermatitis?
• How long ago did these rashes appear, and what preceded their appearance?
• Is the rash associated with food, medication, flowering plants, or with some season?

Diagnostic indicators of atopic dermatitis of the external type include:

• lichenification ( thickening and roughness of the skin) in the area of ​​the flexion surface of the limbs;
• excoriation ( violation of the integrity of the skin, which in most cases occurs when combing);
• xerosis ( dryness) skin;
• peeling and thickening of the skin next to the hair follicles;
• cracks and other skin lesions on the lips;
• atopic palms ( enhancement of the skin pattern);
• the presence of cracks behind the ears;
• persistent white dermographism ( as a result of passing a thin object over the patient's skin, a white trace remains in the pressure zone);
• damage to the skin of the breast nipples.

Consultation with a dermatologist

Patient Interview
To diagnose atopic dermatitis, a dermatologist asks a patient a series of questions that allow him to determine the influence of external and internal factors on the development of the disease.

The topics that a dermatologist discusses with a patient at an appointment are:

• the duration of the onset of symptoms;
• factors that preceded the appearance of skin changes;
• environmental factors of the patient's living environment ( proximity to industrial enterprises);
• area in which the patient works whether there is contact with chemicals and other substances with a high level of allergenicity);
• living conditions ( the presence in the apartment of a large number of carpets, furniture, books, the level of dampness, humidity);
• whether the patient's condition depends on changing climatic conditions;
• the presence of chronic diseases;
• whether the patient's condition worsens with stress and emotional unrest;
• the nature of the diet;
• whether close relatives suffer from allergic reactions;
• whether there is constant contact with animals, birds, insects.

Secondary external signs of atopic dermatitis are:

• severe dryness of the skin;
• dermatitis in the nipples;
• conjunctivitis ( inflammation of the mucous membrane of the eye);
• dry skin, cracks in the lip area;
• folds along the edge of the lower eyelids;
• transverse fold from the upper lip to the nose;
• enhanced skin pattern and protrusion of capillaries on the inner surface of the palms.

Laboratory tests:

• determination of the concentration of immunoglobulins E in the blood;
• determination of allergen-specific antibodies;
• Fadiatop test.

General blood analysis

Determination of the concentration of immunoglobulins E in the blood

Normally, the amount of immunoglobulin E in the blood of adults ranges from 20 to 80 kU / l ( kilounits per liter). With atopic dermatitis, this indicator can vary from 80 to 14,000 kU / l. Lower numbers of immunoglobulins are typical for the period of remission, while higher ones for exacerbation. With such a form of atopic dermatitis as hyper Ig-E syndrome, the concentration of immunoglobulins E in the blood reaches 50,000 kU / l. This syndrome is considered to be a severe variant of atopic dermatitis, which is combined with chronic infections and immune deficiency.

However, despite the importance of this analysis, it cannot be an absolute indicator for making or excluding a diagnosis. This is due to the fact that in 30 percent of patients with atopic dermatitis, immunoglobulins E are within the normal range.

Determination of allergen-specific antibodies

There are many methods for determining these antibodies, including RAST, MAST and ELISA tests. The choice of technique depends on the laboratory. The essence of the analysis is to identify antibodies that have been produced by the body for some specific allergen. It can be antibodies to food, aeroallergens, medicines, fungi, house dust.

In adults, sensitization to household allergens, fungi and medicines predominates. Therefore, when diagnosing atopic dermatitis in adults, it is most often carried out to study antibodies to household chemicals ( e.g. formaldehyde, methylene, toluene) and medicines ( e.g. diclofenac, insulin, penicillins).

Fadiatop test

If the result of the fadiatop test is positive, that is, the level of immunoglobulins is high, then further studies are carried out with certain allergen groups. These can be both laboratory tests with specific antigens and skin tests.

The study of the immune system allows not only to establish the diagnosis of atopic dermatitis, but also to identify the cause of the latter.

Other diagnostic methods

Allergen testing

Allergological research methods are:

• scarification skin tests;
• prick tests;
• skin tests by application method;
• intradermal tests.

The criteria for determining the test result are:

• the size of the redness is up to 1 millimeter - the skin reaction is negative and corresponds to the norm;
• if swelling occurs, the result of the study is considered doubtful;
• swelling diameter up to 3 millimeters - the result is weakly positive;
• swelling and blister reaches 5 millimeters - the result is positive;
• the size of the swelling and blister reaches 10 millimeters - the result is sharply positive;
• swelling with a blister exceeding 10 millimeters - an extremely sharply positive result.

Skin tests by application method
Application tests are carried out on areas with intact skin. To implement this type of study, a cotton swab dipped in a diagnosed allergen is applied to the skin. Polyethylene is applied and fixed on top of the cotton wool. The skin reaction is analyzed after 15 minutes, then after 5 hours and after two days.

Intradermal tests
Intradermal allergen tests are more sensitive than skin prick tests, but more complications occur when they are carried out. For this analysis, using a special syringe, from 0.01 to 0.1 milliliters of the allergen is injected under the patient's skin. With the correct implementation of the intradermal test, a clearly defined white bubble forms at the injection site. The reaction of the body to the administered drug is evaluated after 24 and 48 hours. The result is determined by the size of the infiltrate ( induration at the injection site).

Skin test results
A positive allergy test result means that the patient is allergic to the substance. A negative result indicates that the patient is not allergic.

It should be borne in mind that the results of skin tests for an allergen are not always accurate. Sometimes diagnostics can show the presence of an allergy when in fact it does not exist ( false positive result). Also, the results of the study may be negative if the patient has an allergy in reality ( false negative result).

Causes of False Allergen Skin Test Results
One of the most common causes of a false positive result is increased skin sensitivity to mechanical stress. Also, an error can occur due to the body's sensitivity to phenol ( a substance that acts as a preservative in an allergen solution). In some cases, a false negative reaction may occur due to weak sensitivity of the skin. To prevent false results, three days before the test, it is necessary to stop taking antihistamines, adrenaline, hormones.

Treatment of atopic dermatitis

In cases where atopic dermatitis is part of an atopic disease, treatment should be aimed at correcting comorbidities ( bronchial asthma, hay fever).

Acute period
During this period, intensive therapy is carried out with the appointment of glucocorticosteroids, antihistamines and membrane stabilizers. When an infection is attached, antibiotics are prescribed. In the acute period, medications are prescribed as inside ( in the form of injections and tablets) and externally ( creams, aerosols).

Remission
During the period of remission fading) maintenance therapy is prescribed, which includes immunomodulators, sorbents, vitamins, moisturizers and emulsions. During this period, prevention of atopic dermatitis, physiotherapy and spa treatment are also carried out.

Medical therapy

Groups of drugs used in atopic dermatitis:

• glucocorticosteroids;
• antihistamines;
• immunosuppressive macrolide class;
• moisturizers of various groups.

Antihistamines
These drugs have an antiallergic effect. By blocking the release of histamine, they eliminate redness, relieve swelling, and reduce itching. They are mainly given in tablet form, but can also be given as injections. This group of drugs includes medicines such as chloropyramine ( suprastin), clemastine, loratadine.

macrolide immunosuppressive agents
These drugs, like steroids, have an immunosuppressive effect. These include pimecrolimus ( elidel) and tacrolimus. The first drug was developed as a means of local therapy and is available in the form of an ointment, the second - in the form of capsules.

Moisturizers of various groups
This group of drugs includes various products based on lanolin, as well as based on thermal waters. Basically, they moisturize the skin. These funds are prescribed during the period of remission, that is, in the chronic and subacute period of the disease.

This group also includes drugs that accelerate the process of epithelialization. They are prescribed if patients have wounds, cracks. Like skin moisturizers, these drugs are prescribed in the chronic period of atopic dermatitis.

Ointments and creams for the treatment of atopic dermatitis

In tablet form, antihistamines, membrane-stabilizing and sedative drugs are prescribed.

Membrane stabilizing drugs
These drugs are prescribed in the acute period of the disease together with antihistamines. They prevent the release of mediators of an allergic reaction, such as histamine, serotonin. Representatives of this group of drugs are sodium cromoglycate, ketotifen.

Sedatives
Constant, sometimes painful itching is the cause of disorders of the psycho-emotional sphere. In turn, stress and tension act as provoking factors in the development of atopic dermatitis. Therefore, it is very important to normalize the emotional background of the patient in order to prevent the exacerbation of atopic dermatitis. For the purpose of sedation, both herbal remedies and tranquilizers are used. The first include tinctures of motherwort and passionflower, the second - alprazolam, tofisopam.

Drugs that normalize bowel function
These drugs are essential in the treatment of atopic dermatitis, since pathologies of the intestinal tract can be not only provoking factors, but also the main cause of atopic dermatitis. First of all, these drugs include agents that absorb toxins from the intestines or sorbents ( smectite, lignin). They are prescribed in the acute period of the disease, lasting 7 to 10 days. After a course of treatment with sorbents, preparations are recommended that normalize the flora and restore the protective properties of the intestine. These drugs include eubiotics ( bifidumbacterin) and prebiotics ( hilak forte).

Tablets for the treatment of atopic dermatitis

In addition to the above medications, hyposensitizing drugs are used in the treatment of atopic dermatitis. They are prescribed in the acute period of the disease and most often in the form of injections.

Drugs that reduce sensitization in atopic dermatitis

In addition to drug therapy, the treatment of atopic dermatitis includes diet, physiotherapy and spa treatment.

Physiotherapy treatment

Physiotherapy that is prescribed for atopic dermatitis are:

• electrosleep;
• electrophoresis;
• paraffin on the foci of lichenification;
• ultraviolet irradiation ( UFO);
• dynamic currents on paravertebral nodes.

Spa treatment

Is hospitalization necessary for the treatment of atopic dermatitis?

The role of hospitalization in atopic dermatitis
The goal of inpatient treatment of a patient with atopic dermatitis is to isolate the person from allergens. Also, during hospitalization, the patient is protected from the effects of a large number of non-specific factors that provoke an exacerbation of the disease.

Circumstances from which atopic is protected ( person with atopic dermatitis) in inpatient treatment are:

• stress- minimal contact with the external environment will reduce the level of negative emotions;
• abrupt change in air temperature- the microclimate in stationary conditions is distinguished by its stability;
• physical exercise- the absence of contact of the affected areas of the skin with sweat promotes tissue regeneration.

Diet for atopic dermatitis

The basic rules of the diet for atopic dermatitis are:

• exclusion of foods that are allergens ( substances that cause allergies) or histamine liberators ( in the composition of such products there are elements that release histamine from cells - the main factor in allergic reactions);
• providing the body with the necessary vitamins and elements for rapid skin regeneration;
• reducing the load on the liver, which ensures the cleansing of the body from the effects of allergies;
• ensuring the normal functionality of the intestine;
• reduced intake of gluten ( protein found in most cereals), since the tolerance of this substance during allergies is significantly reduced;
• conducting special observations about the reaction to the food taken ( food diary).

Allergen products
According to the content of the substance that provokes the development of an allergic reaction, products can have a low, medium and high degree of allergenicity.
With atopic dermatitis, it is necessary to exclude food products from the diet, which include ingredients with high allergic activity.

Meat and meat products
Meat products with a high level of allergenicity are:

• chicken, duck, goose meat;
• fatty pork;
• mutton.

Types of meat and meat products that are recommended for atopic dermatitis are:

• beef;
• rabbit;
• turkey;
• low fat pork.

Fish and fish products
Fatty varieties of red and white fish are also classified as allergenic foods.

Types of fish and fish products that are not recommended for atopic dermatitis are:

• chum salmon, trout, pink salmon, salmon;
• mackerel, sturgeon, sprat, herring;
• caviar ( red and black);
• mussels, oysters;
• crayfish, crabs, lobsters.

Vegetables, fruits and berries
When choosing vegetables and fruits for the diet of a person with atopic dermatitis, red and orange varieties should be excluded. It is necessary to give preference to green and white crops.

Vegetables and fruits with a high degree of allergic activity are:

• peaches, apricots;
• melon;
• tangerines, oranges, grapefruits;
• red apples;
• grenades;
• persimmon;
• mango, kiwi and other tropical fruits;
• strawberries, strawberries;
• raspberry;
• cherry, sweet cherry;
• pumpkin;
• tomatoes;
• radish;
• eggplant;
• beets, carrots;
• red bell pepper.

Vegetables and fruits allowed for atopic dermatitis are:

• apples, green pears;
• plums, prunes;
• cherries ( white);
• currant ( white);
• gooseberry;
• cabbage ( white, brussels, color);
• turnip;
• green pea;
• dill, parsley;
• zucchini;
• cucumbers;
• potato;
• spinach, lettuce.

Products with a high degree of allergic activity are:

• semolina;
• White bread;
• pastry products;
• pasta;
• confectionery.

• buckwheat;
• oatmeal;
• pearl barley;
• bran bread;
• unsweetened dryers, crackers, dry cookies;
• crackers.

Dairy products that need to be excluded from the diet of a person with this disease are:

• whole cow's milk;
• fermented baked milk;
• cream;
• sour cream;
• cheese ( spicy, salty, melted).

Histamine Releasing Foods
Histamine liberators are a group of products that stimulate the release of histamine without being allergens.

Histamine liberators include:

• alcohol;
• cocoa;
• chocolate;
• coffee;
• chicken eggs ( protein);
• pork liver;
• shrimp meat;
• strawberry;
• pineapples ( fresh and canned);
• wheat.

Products for the rapid restoration of the skin
The diet of a patient with atopic dermatitis should ensure the intake of substances that accelerate skin regeneration. Effectively promote the healing of the epidermis ( top layer of skin) unsaturated fatty acids ( omega 3 and omega 6). In large quantities, these substances are found in vegetable oils.

• sunflower;
• corn;
• rapeseed;
• linen;
• cedar.

Reduced load on the liver
Atopic diet ( people with atopic dermatitis) should ensure good liver function. The volume and meals should be evenly distributed throughout the day. Preference should be given to fermented milk products, lean meats, soups and mashed vegetables. products used ( food and drink) should not contain dyes, food additives, preservatives. Do not take animal and combined fats, as well as products that contain them.

Foods to avoid to reduce liver stress include:

• lard, margarine, confectionery fat;
• hot spices, flavor enhancers, seasonings, sauces;
• carbonated drinks, strong coffee and tea;
• lamb, fatty pork, duck, goose.

Products that ensure the correct functionality of the gastrointestinal tract in atopic dermatitis are:

• baked apples;
• stewed or boiled zucchini, cauliflower and white cabbage;
• yogurt, one-day kefir ( fermented milk product with a long shelf life is rich in lactic acid and saprophytic bacteria that inhibit bowel function);
• barley, barley, buckwheat and oatmeal.

Foods that inhibit bowel function include:

• foods rich in starch wheat flour products, potatoes);
• foods high in animal protein meat, fish, eggs);
• drinks and food with a high concentration of tannins ( strong tea, quince, pear, dogwood).

Most gluten is found in wheat. A sufficient amount of gluten is present in cereals such as rye and barley. Therefore, from the diet of an atopic, it is necessary to exclude, first of all, pasta, wheat or rye bread, flour products and cereals, which contain wheat, rye or barley. A large amount of gluten is found in drinks such as beer and vodka.
Wheat flour is part of a large list of dishes. You can reduce your gluten intake without compromising your diet by replacing wheat flour with buckwheat flour. To prepare this product, you need to take buckwheat, wash it several times and roast it in a pan without using fat or vegetable oil. After cooling the buckwheat, you need to grind it in a coffee grinder. Buckwheat flour can retain its nutritional qualities for two years. According to a similar recipe, you can make flour from rice or pearl barley.

Other foods that can replace wheat flour in an atopic dermatitis diet include:

• sorghum flour;
• corn flour;
• corn starch.

Recommendations for compiling a menu for atopic dermatitis
If an allergic reaction to a certain product is detected, it should, if possible, not be excluded, but replaced with another, similar component. So, if you find an allergy to cow's milk, you should try to replace it with soy, mare, sheep or goat. Before use, any kind of milk must be diluted with water in a ratio of one to one and boiled. Chicken eggs can be replaced with quail eggs.
To minimize the likelihood of an allergic reaction, a number of recommendations should be followed when preparing dishes for the atopic diet.

The rules for cooking with atopic dermatitis are:

• heat treatment reduces the allergic activity of many products, so the consumption of raw vegetables and fruits should be minimized;
• before eating potatoes, it should be kept for several hours in cold water - this will allow potato starch to be removed from the vegetable, which is not recommended for this disease;
• it is necessary to cook porridge on the third water - after the cereal boils, you need to drain the water and pour a new one. This needs to be done twice;
• when preparing vegetable purees and soups, boiled water must be drained once;
• when cooking broths, the first water should also be drained.

• breakfast- porridge ( oatmeal, buckwheat, barley) on water, baked apple;
• dinner- vegetable soup soaked potatoes, zucchini, cauliflower) seasoned with vegetable oil, 50 grams of boiled beef;
• afternoon tea- dry cookies, a glass of kefir;
• dinner- steamed cutlets ( turkey, rabbit), stewed white cabbage.

Prevention of atopic dermatitis

Preventive measures for atopic dermatitis are:

• providing a hypoallergenic environment;
• observance of personal hygiene and sanitary and hygienic standards;
• implementation of proper skin care;
• implementation of a hypoallergenic diet;
• exclusion of non-specific non-allergic) factors that can exacerbate the disease.

Hypoallergenic environment

Sources of dust and organisms living in it in domestic conditions are:

• mattresses, pillows, blankets;
• carpets, rugs, rugs;
• cushioned furniture;
• curtains, curtains.

Carpets and upholstered furniture
In a room where a person prone to atopic dermatitis lives, the number of carpets and upholstered furniture with pile must be minimized. The remaining products are recommended to be treated once every six months with special acaricidal agents ( drugs that kill ticks). Also, carpets and upholstered furniture should be taken outside in summer and winter.

Preparations that should be treated with carpets, upholstered furniture and bedding to protect against dust mites are:

• spray allergoff;
• easy air;
• Dr. Al;
• ADS spray.

Other sources of dust
Books, figurines, souvenirs are areas of increased dust accumulation. Therefore, if it is not possible to completely remove them from the patient's room, it is necessary to keep these items in cabinets with tightly closing doors. A large amount of dust is observed near objects such as a computer and TV. Therefore, this technique should not be placed in the room where the atopic sleeps.

Sanitary and hygienic standards

The rules for restoring order in the room where a person prone to this disease lives are:

• systematic cleaning;
• use of special household appliances;
• the use of hypoallergenic detergents.

Molds are a common type of allergen. Therefore, in the bathroom and other areas of the apartment with high humidity, all surfaces should be wiped dry and treated with special products once a month. These steps will help prevent mold growth. In the dining room, you should install a hood over the stove for high-quality steam removal.

Tobacco smoke is a trigger ( factor provoking exacerbation of atopic dermatitis), so an atopic should avoid places that are smoky. Smokers living in the same area with a sick person should stop using tobacco products indoors.

Personal hygiene
Hygiene procedures play an important role in the prevention of atopic dermatitis. Compliance with a number of rules of personal hygiene will help an atopic to prevent an exacerbation of the disease.

The provisions of personal hygiene, which should be followed in the prevention of atopic dermatitis, include:

• personal hygiene products containing alcohol should be excluded from use;
• taking water procedures, it is necessary to give preference to the shower, not the bath;
• the water temperature should vary in the range from 30 to 35 degrees;
• bathing time - no more than twenty minutes;
• dechlorinated water is the best option ( you can get such water by installing household cleaning filters);
• when taking water procedures, do not use hard washcloths;
• soap and detergents you need to choose those that do not include dyes and flavors;
• after water procedures, the skin should be blotted, and not rubbed with a towel;
• underwear should be made of high-quality natural hypoallergenic materials;
• you should carefully consider the choice of size - clothes should be loose and not fit tightly to the body;
• clothes should be washed with liquid detergents;
• the nails of a person with atopic dermatitis should be cut short to avoid scratching;
• atopic people are advised not to visit public pools, as the water in them contains a large amount of chlorine.

The stages of an atopic skin care program are.

• proper cleansing;
• moisturizing;
• nutrition;
• restoration of skin barrier functions.

Skin cleansing
Most personal care products contain ingredients such as alcohol, astringents, fragrances, and preservatives. These substances not only cause dry skin, but also exacerbate atopic dermatitis. Soap is the best option for skin cleansing ( shower gel, facial wash), which has a neutral acid-base balance ( pH), minimal degreasing surface and hypoallergenic composition. It is recommended to purchase hygiene products for atopic dermatitis in pharmacies.

Popular brands of cosmetics for cleansing the skin are:

• bioderma ( atoderm series) - alkali-free soap - does not contain aggressive detergents and is recommended during an exacerbation of atopic dermatitis. The composition includes cucumber extract, which has an anti-inflammatory effect, and glycerin, which moisturizes and softens the skin; mousse for washing - contains sulfates of copper and zinc, which have an antiseptic effect. Indicated for use during the period of remission of the disease;
• ducret ( a-derma program) - soap, gel with oat milk - do not contain alkali and can be used daily;
• aven ( line based on thermal water) - nourishing soap and cream - do not contain alkali and have a softening effect.

In order to relieve itching before going to bed and prevent scratching, you can do moisturizing compresses. The juice of raw potatoes, pumpkins or aloe has an effective effect. It is necessary to moisten a cotton swab in the juice and apply to the affected skin. Well moisturizes the skin ointment, prepared on the basis of butter and St. John's wort. One tablespoon of the plant's juice should be mixed with 4 tablespoons of freshly melted butter. The resulting composition must be applied to a gauze bandage and applied to damaged areas.

Skin nutrition
High-quality nutrition of the skin in atopic dermatitis helps to prevent the occurrence of irritations. According to statistics, if during the year the patient does not experience such phenomena as itching and dryness of the skin, the likelihood of an exacerbation of the disease is reduced to 2 percent.
When choosing cosmetics for softening, preference should be given to those creams that include such natural vegetable oils as olive, almond, coconut. Well nourish the epidermis ( outer layer of skin) vitamins such as A and E.

Rules for the use of nourishing and moisturizing products
Means for nourishing and moisturizing the skin with atopic dermatitis must be used at least three times a day ( morning, evening and after swimming). After water procedures, the cream should be applied for approximately three minutes. It is worth paying attention to areas with increased dryness, and skin folds do not need to be processed. Nourishing and moisturizing products should not be used during the hot season. A new product must be tested for allergenicity. To do this, for several days you need to lubricate the area in the area of ​​\u200b\u200bthe inner bend of the elbow with cream.

Restoration of the protective functions of the skin
Skin affected by atopic dermatitis loses its protective properties and ceases to be a barrier between the human body and the environment. Therefore, the prevention of this disease includes measures to restore the health of the skin. The atopic diet should include foods that are rich in vitamins such as A, C, E, B, PP, D and K. It is these vitamins that help restore the protective function of the skin.

Products that contain vitamins A, C, B, PP, D and K and are allowed for atopic dermatitis include:

• vitamin A (responsible for skin elasticity) - found in spinach, sorrel, green lettuce, green peas;
• vitamin C (provides elasticity) - cabbage, spinach, parsley, rose hips;
• vitamin E (has a beneficial effect on the process of cell renewal) - olive, sunflower, corn oil, oatmeal;
• B vitamins (speed up the regeneration process) - brown rice, oatmeal, buckwheat, potatoes, beef, cauliflower;
• vitamin PP (fights dry skin) - lean pork, mild cheese, buckwheat.

Preventive diet

The main provisions of the preventive diet for atopic dermatitis include:

• exclusion from the diet of allergens;
• ensuring good bowel function with food;
• eating foods that reduce the load on the liver;
• reducing the amount of gluten consumed ( gluten);
• the inclusion in the menu of elements that contribute to the rapid restoration of the skin.

Non-specific factors

Triggers for atopic dermatitis are:

• stress, emotional overexcitation;
• increased level of physical activity;
• climatic impacts;
• diseases and failures in the functionality of various body systems.

Ways to deal with stress are:

• sport;
• complete rest;
• laughter and positive emotions;
• hobby;
• special techniques that promote muscle relaxation ( breathing exercises, alternating muscle tension and relaxation, meditation).

Climatic factors in the prevention of atopic dermatitis
Exacerbation of atopic dermatitis in most cases is observed in the cold season. Low air temperature combined with wind has a negative effect on the skin. Therefore, in winter, you should use special protective equipment for the skin. Particular attention should be paid to clothing. It is worth choosing things in such a way that they provide a comfortable temperature, but at the same time do not cause overheating of the body, because this can cause itching.

In the warm season, atopic skin also needs special care, it should be protected from direct sunlight. In summer, between 11 a.m. and 4 p.m., you should stay indoors or in places protected from the sun outside. Before leaving the house, the skin should be treated with sunscreen, using those products that are intended for atopics.

A comfortable microclimate should also be maintained in the room in which a person with atopic dermatitis lives. Temperature ( no higher than 23 degrees) and air humidity ( at least 60 percent) should remain stable, as their abrupt changes can provoke exacerbations of the disease. You can maintain a constant favorable indoor climate with the help of air conditioners and humidifiers.

Diseases in atopic dermatitis
In the prevention of atopic dermatitis, special attention should be paid to concomitant diseases of internal organs and body systems. It is necessary to strive for the timely detection of diseases and their treatment.

Pathologies that predispose to the development or exacerbation of atopic dermatitis include:

• malfunctions of the nervous system;
• diseases of the endocrine system;
• poor functioning of the digestive system ( various forms of hepatitis, gastritis, cholecystitis);
• weak immunity;
• chronic tonsillitis ( tonsillitis) and other ENT diseases.

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 international classification of diseases used to define this disease as diffuse neurodermatitis. Now, according to ICD-10, the disease is called atopic dermatitis and has the L20 code, which indicates a pathological effect on the skin and subcutaneous tissue. Atopic dermatitis is also called childhood eczema.

If the disease manifests itself in young children, its cause is most likely hereditary or related to the course of pregnancy. Such children may also suffer from other types of allergies - asthmatic attacks, allergic rhinitis or conjunctivitis, lack of perception of certain nutrients. The onset of the disease at a later age is usually associated with the influence of external factors. Atopic dermatitis is more often found in children under one year old and, without the necessary therapy, takes a chronic form with periodic exacerbations throughout life.

In addition to the genetic disposition, the prerequisites for atopic dermatitis in infants may be:

In addition to these reasons, risk factors for eczema in infants include various household allergens - from detergents and baby care products to pharmaceuticals.

Especially attentive to the impact of adverse factors should be treated by those parents who themselves suffer from allergies. If both dad and mom have similar hypersensitivity, the likelihood of childhood eczema in their heir rises to 80 percent. Is one parent hypersensitive to antigens? The risk is halved.

Atopic dermatitis in older children (at 2–3 years old) can manifest itself against the background of psycho-emotional stress, passive smoking, excessive physical exertion, poor ecology in the place of residence, and frequent infectious diseases. These same factors provoke an exacerbation of eczema in the chronic course of the disease.

But contact with pets can play a positive role. Italian scientists conducted a study and found that if there is a dog in the house, the risk of allergic dermatitis is reduced by a quarter. Communication between a pet and a child not only gives the immune system an impetus for development, but also relieves stress.

The main signs of the disease

Symptoms of atopic dermatitis in infants:

• skin itching, worse at night;
• the appearance of seborrhea scales on the head;
• redness and cracks on the cheeks, in the area of ​​​​the eyebrows and ears;
• loss of appetite;
• poor sleep, due to itching.

In difficult cases, not only the scalp suffers. There may be atopic dermatitis on the arms, neck, legs, buttocks. Sometimes irritation is accompanied by pyoderma - small pustules, combing which a child can get a secondary infection, which is expressed in difficult-to-heal wounds.

In the process of growing up, if the disease could not be stopped, the signs are modified or supplemented. So, if the baby is already 1 year old, it is possible to increase the skin pattern and the appearance of dry, flaky foci of thickened skin under the knees, in the bends of the elbows, on the wrists, feet and neck. At 2 years old, almost half of the children with suitable treatment get rid of the disease. But some babies suffer even after two years: the infantile stage of the disease passes into childhood, and then into adolescence. Painful areas are hidden in skin folds or localized on the palms and feet. Exacerbations occur in the winter, and in the summer the disease does not manifest itself.

Such dermatitis in a child can become an "allergic march", and subsequently attach allergic rhinitis and bronchial asthma. Every fifth patient additionally develops hypersensitivity to bacterial microflora, which contributes to the complicated and protracted course of the disease.

Clinical picture and diagnosis of the disease

Atopic dermatitis in children is important to differentiate from other skin diseases. After all, the symptoms may be similar to those of scabies, pink lichen, psoriasis, microbial eczema or seborrheic dermatitis.

The diagnosis should be made by experienced doctors: a dermatologist and an allergist-immunologist. Doctors conduct the following diagnostic studies: they collect a complete history, find out the possibility of a hereditary predisposition, conduct a thorough examination and send the baby for a general blood test. A high serum IgE concentration will confirm the diagnosis.

Mild form of atopic dermatitis in a child

Moderate atopic dermatitis with secondarily infected scratch wounds

Diagnosis of atopic dermatitis in children takes into account not only the age of the patient, but also the stage of the disease:

1. The initial stage (signs): hyperemia (redness), tissue swelling, peeling, most often on the face.
2. Pronounced stage: Skin problems move to other parts of the body, unbearable itching, burning, small papules appear.
3. Features of remission: Symptoms decrease or disappear altogether.

Therapy for allergic disease

Complete healing is possible with proper treatment at the initial stage. But we can talk about clinical recovery if an average of 5 years have passed since the last period of exacerbation.

Experienced doctors who know how to cure atopic dermatitis believe that only complex therapy is effective. It includes proper nutrition, clear control of the surrounding space, taking pharmaceuticals and physiotherapy. You may need the help of not only an allergist and a dermatologist, but also a nutritionist, gastroenterologist, otolaryngologist, psychotherapist and neurologist.

Diet for atopic dermatitis in children

Diet therapy is essential: it is food allergens that can give a violent skin response. In the first place - products from cow's milk. If a "milk" allergy is detected in an "artificial worker", mixtures with soy substitutes will be preferable for him: "Alsoy", "Nutrilak soy", "Frisosoy" and others.

However, it may turn out that the baby does not perceive soy. For children of the first year of life, hypoallergenic formulations with an increased degree of protein hydrolysis are suitable: Alfare, Nutramigen, Pregestimil, and others. If you have a reaction to gluten, you will have to exclude cereals or replace them with gluten-free ones.

In difficult cases, the doctor may prescribe a complete hydrolyzate, such as Neocate, along with the therapy ""

For complementary foods, you can not choose foods with high sensitizing activity, for example, citrus fruits, nuts, honey, strawberries.

Subsequently, when compiling a diet, it should be taken into account that when reacting to milk protein, an allergy to beef is real. The organism of the crumbs, which does not perceive mold fungi, will give a violent response to yeast products - from bread to kefir.

The diet for atopic dermatitis in children involves a special menu. Broths, mayonnaise, marinades, pickles, roasts, food containing dyes and preservatives are not recommended.

Sample menu for this disease:

1. Breakfast - porridge from soaked buckwheat with vegetable oil.
2. Lunch - vegetable cream soup, a little boiled chicken, freshly squeezed apple juice.
3. Dinner - millet porridge with vegetable oil.

As a snack - gluten-free cookies, an apple.

Drinking water should choose artesian or non-carbonated mineral. It should be at least 1.5 liters per day so that toxins can be freely excreted in the urine.

The doctor may also prescribe fish oil to strengthen the child's immunity and strengthen cell membranes.

Control of the surrounding area

The well-known pediatrician Komarovsky is sure that with atopic dermatitis in children, the main thing is to exclude the effect of irritating factors on the skin. For this you need:

• regular wet cleaning, washing linen, covers on upholstered furniture;
• keeping toys in perfect cleanliness;
• the use of hypoallergenic detergent compositions;
• refusal of washcloths and hard towels;
• lack of electrical appliances in the bedroom;
• selection of loose clothing made from natural fabrics.

You can bathe your baby only in dechlorinated, filtered water. Use baby soap only once a week. After washing, the skin is blotted with a gentle towel and an emollient is applied, for example, Bepanten cream or Bepanten ointment in difficult cases, Lipikar or F-99.

It is important to avoid non-specific risk factors - nervous and physical overload, passive smoking, infectious diseases.

Essential emollients

How to treat atopic dermatitis? In acute conditions, a doctor for external use may prescribe corticosteroids. Compositions for softening and moisturizing are needed constantly. Ideal emollients for atopic dermatitis in children.

Here is a list of the most popular tools:

• Locobase Lipikrem. The same company produces another cream for atopic dermatitis in children - Locobase Ripea. In the first case, the active ingredient is liquid paraffin, which softens the skin. In the second - ceramides, cholesterol and polyunsaturated fatty acids, which contribute to the regeneration of the skin.
• A series of products "Topicrem" for the care of atopic children. For babies, a lipid-replenishing balm and Ultra Rish gel, which cleanses the skin, are suitable.
• Milk or cream "A-Derma" - a good prophylactic agent, moisturizes and protects the skin.
• Stelatopia series from the manufacturer Mustela. These are creams, emulsions and bathing compositions that soften the epidermis and help its regeneration.
• Balm "Lipikar". It contains lipid-replenishing karite and canola oils, glycine to relieve itching and wound healing thermal water. In addition, the pharmaceutical laboratory La Roche-Posay has created hygiene products Lipikar Surgra, Lipikar Syndet, Lipikar Bath Oil, suitable for babies with atopic dermatitis.

These products reduce flaking and inflammation, restore the water and lipid balance of the skin, cleanse impurities and prevent the development of bacteria. Emollients penetrate no further than the epidermis, which in principle eliminates side effects. Therefore, they can be used even for the youngest patients.

Systemic pharmaceutical treatment

Sometimes systemic therapy is needed. The course may include:

• Antihistamines. Those with a relaxing effect (Suprastin, Tavegil) are useful if the baby cannot fall asleep due to itching. And new generation pharmaceuticals (Cetrin, Zirtek, Erius) in all other cases - they do not provoke drowsiness and are very effective.
• Antibiotics for secondary infection. With atopic dermatitis in children, antibiotic ointments (erythromycin, gentamicin, xeroform, furatsilin, levomikol, others) are ideal. The drug "Zinocap" is good - it has not only antibacterial, but also antifungal, anti-inflammatory effects. In difficult cases, doctors prescribe oral antibiotic drugs. Antibiotics should only be used under medical supervision so as not to aggravate the allergic process. Applications with Vishnevsky ointment can also be applied to wounds; this drug promotes rapid healing of wounds.
• Means against viruses and fungi - if the corresponding infection has been introduced.
• Immunomodulators according to the prescription of an allergist-immunologist and vitamin complexes with B15 and B6 to accelerate skin regeneration.
• Drugs to improve digestion ("Panzinorm", "Pancreatin", "Creon", "Festal"), as well as choleretic agents and hepatoprotectors ("Gepabene", "Essentiale Forte", "Allochol", infusion of corn stigmas or rose hips) .
• Enterosorbents ("Enterosgel", "", activated carbon) to block intestinal toxins.

Therapy for allergic dermatitis is carried out on an outpatient basis. But with a serious skin lesion, the baby is hospitalized.

Treatment with folk remedies and physiotherapy

Treatment of atopic dermatitis in children with alternative methods is carried out only under the supervision of a physician. Healing decoctions and potions, which abound in any forum about medicinal herbs and traditional medicine, with individual intolerance, can only harm the child.

The safest of these products are cleansing baths. They help relieve itching and discomfort.

They bathe the baby in a weak solution of potassium permanganate, in water with the addition of a decoction of celandine or string, chamomile, calendula. It is good to pour a mixture of potato starch with water into the bath (a small spoonful of powder per liter). The water should not be too hot, and the procedure itself does not last more than 15 minutes. Bathing with the addition of oatmeal also has a very good effect on the condition of the baby's skin.

Therapeutic effect on inflammation also have ointments based on birch tar.

Spa treatment and physiotherapy procedures are very useful for atopic children. With remission, pearl, sodium chloride, hydrogen sulfide, iodine-bromine baths, mud therapy are suitable. With a bright manifestation of symptoms - electrosleep, magnetotherapy, carbon baths, relaxing procedures.

Atopic dermatitis is an itchy dermatosis of a neuroallergic nature, manifested by redness and rashes on various parts of the body. More often, exacerbations occur after contact with a specific stimulus, but in some situations the provoking factor cannot be identified or there are several of them. For the first time, the disease manifests itself in childhood, and some time ago this pathology was considered predominantly for children. But in recent years, atopic dermatitis in adults is not much less common than in babies. This is due to the unfavorable environmental situation, poor nutrition and improper treatment of the first disease.

More about atopic dermatitis

What is atopic dermatitis, most people roughly imagine, since this disease is very common. It first makes itself felt in early childhood and is manifested by redness and itchy papular rashes on the face, in the folds of the body (especially in the groin and buttocks), on the arms and legs. Other areas are affected less frequently. The disease often immediately becomes chronic and after contact with allergens, it certainly makes itself felt.

In most patients with age, the number of exacerbations of atopic dermatitis gradually decreases until it disappears completely. But there are exceptions, and in recent years more and more often. In adults, the favorite places for rashes are the face, hands, elbows, popliteal fossae, skin of the legs.

Relapses occur more often in spring and autumn. Summer and winter are a time of short respite for atopics.

Causes of atopic dermatitis

In the occurrence of atopic dermatitis, heredity plays the greatest role. The genetic predisposition is transmitted through the maternal line. If a mother has this disease, the risk that it will manifest itself in a child reaches 50%. And if dad also suffers from atopic dermatitis, in 70-80% of cases it will also occur in the baby.

Also of great importance for the development of this pathology are the following reasons:

• irrational nutrition (preservatives, flavors, dyes, nitrates, pesticides and other substances in food, fast foods);
• environmental situation (in large cities, the incidence of atopic dermatitis is much higher);
• sources of chronic infections (untreated teeth, diseases of internal organs);
• frequent colds;
• autoimmune and endocrine diseases;
• systematic stress and overwork;
• treatment with certain drugs (antibiotics, hormones, etc.).

Allergic factors that directly cause exacerbations can be food, plant pollen, animal hair, cosmetics, household chemicals, etc.

How does atopic dermatitis manifest in adults?

As already mentioned, in the first place, atopic dermatitis in adults is manifested by rashes and itching. In addition, patients note severe dryness of the skin and peeling.

Rashes in atopic dermatitis

The favorite localization of rashes in this pathology is the face and various skin folds. Each patient develops a rash in one or more areas, and with each recurrence occurs in the same places. New zones during exacerbations are rarely affected.

After contact with an irritating substance or as a result of stress, red edematous spots appear on the skin with fuzzy boundaries. Against this background, papules appear, and in some cases - vesicles (vesicles) with liquid contents. Due to dry skin and scratching, crusts and peeling are added to the affected areas.

Itching

The rash in atopic dermatitis is accompanied by severe itching. This causes a lot of anxiety for patients. In addition to psychological discomfort, this problem can lead to the addition of a bacterial or fungal infection due to trauma to the skin due to scratching.

Since the itching intensifies at night, patients report problems with sleep, become irritable and nervous.

peeling skin

Atopic skin is predominantly very sensitive and dry, prone to flaking, and in exacerbations - to the formation of crusts and cracking. It is extremely difficult for them to take care of their face due to frequent reactions to creams and other cosmetics. Therefore, the skin in these patients often thickens in the affected areas, up to hyperkeratosis, the skin pattern increases. This is especially noticeable in the area of ​​​​the palms and feet.

Diagnosis of atopic dermatitis

A preliminary diagnosis of atopic dermatitis is made on the basis of the patient's complaints, anamnesis, characteristic symptoms and external examination data. For confirmation, specific blood tests are required for the determination of immunoglobulins E, which confirms the allergic sensitization of the body. If necessary, the doctor may prescribe skin tests to identify a specific allergen.

Treatment of atopic dermatitis

Treatment of atopic dermatitis in adults includes a special diet, antihistamines and hormonal drugs, detoxification therapy, sedatives, tranquilizers, etc.

Diet with a tendency to atopy

With atopic dermatitis, it is necessary to adhere to certain nutritional principles based on the exclusion of allergenic foods from the diet. It is very important to limit, and it is better to completely stop eating:

• eggs;
• whole cow's milk and products from it;
• spicy and smoked dishes;
• red fish species;
• red caviar;
• mushrooms;
• rich broths;
• chocolate;
• red berries;
• citrus;
• carbonated drinks;
• honey, etc.

Antihistamines

Antihistamines for atopic dermatitis are the basis of medical treatment. The names of popular drugs from this group that have proven themselves in the treatment of this pathology:

• Claritin;
• Tavegil;
• Zodak;
• Zyrtec and others

If the patient is engaged in a profession that requires increased attention, it is necessary to inform the doctor about this, as many of these drugs cause drowsiness and a decrease in attention and speed of reactions.

Hormonal treatment

Systemic glucocorticosteroids quickly relieve inflammation and reduce allergic reactions in the human body. Depending on the severity of the pathology and the severity of itching, they are used as external agents or taken systemically in the form of tablets. A popular and effective ointment for atopic dermatitis is Advantan. But there are other good local preparations:

• Elocom;
• Celestoderm;
• Flucinar;
• Sinaflan;
• Lorinden;
• Triderm and others.

Hormonal pills for atopic dermatitis are prescribed less frequently, as they have many side effects and are addictive, followed by a withdrawal syndrome. With extensive lesions and severe painful itching, as prescribed by the doctor, apply:

• Metipred;
• Medrol;
• Polcortolon;
• Triamcinolone and others.

It is almost impossible to cure atopic dermatitis in adults without the use of hormonal drugs. But it is important to use them only as prescribed by a doctor and give preference to local remedies, without resorting to systemic therapy unless there is a real need.

Sedatives

Sedatives (Tenoten, Persen, Novopassit, Motherwort tinctures, Valerian, etc.) help improve sleep, calm patients and, to some extent, reduce itching. In case of serious sleep disorders and well-being, tranquilizers and antidepressants can be used as prescribed by psychotherapists.

Detoxification therapy

Good effects in the treatment of atopic dermatitis are given by detoxification therapy with sorbents followed by the use of probiotics. Of the sorbents, Enterosgel, Polysorb and Smecta are most often used for a period of at least a month. Then probiotics are prescribed - Linex, Hilak forte, Bifidumbacterin, Acipol, etc. This treatment helps to normalize the intestinal flora and strengthen immunity.

Physiotherapy

Physiotherapeutic methods in dermatology are important, as they bring good results with little or no side effects. How to treat atopic dermatitis in adults in the physiotherapy department:

• magnetotherapy;
• with the help of lasers;
• various types of massages, including acupuncture;
• water types of treatment (various types of baths, Charcot shower, circular shower, etc.).

Skin care

Atopic dermatitis on the face requires special skin care. With severe dryness and a tendency to peeling, it is necessary to use moisturizers as often as possible, but their choice should be treated carefully and with caution. They should not contain aggressive agents. Preference should be given to cosmetics marked "hypoallergenic" and neutral pH.

Good skin care products that meet all requirements are Lipikar, Locobase, Bepanthen, Panthenol, etc. The last two items are sold in various dosage forms. For daily use, it is better to choose a cream, and for the treatment of exacerbations, an ointment for atopic dermatitis is more suitable.

Apply all moisturizers to cleansed skin. Wash with warm (not hot) water using mild cleansers with a natural pH.

Another effective cream for atopic dermatitis, which quickly relieves irritation and inflammation, is Elidel. It should be used at the first symptoms of exacerbation. This is a non-hormonal remedy, so it is not addictive and suitable for long-term therapy.

ethnoscience

The treatment of atopic dermatitis with traditional medicine should be treated with caution so as not to provoke new allergic reactions. But there are fans of such methods who claim that the following plants help reduce irritation and soothe the skin:

• raw potatoes (in the form of compresses);
• chamomile;
• fireweed;
• peppermint;
• violet;
• oats, etc.

You can use traditional medicine methods only with the permission of a doctor and in addition to the main treatment.

Treatment of complications

Scratching and frequent traumatization of the skin can lead to the attachment of various kinds of infections. Depending on the genesis of infection, the following are used for treatment:

• antibiotics (Sumamed, Amoxiclav, Doxycycline, etc.);
• antifungal agents (Pimafucin, Ketoconazole, Fluconazole, Terbinafine, etc.).

Also, often with atopic dermatitis, a herpes infection is exacerbated. What requires treatment with antiherpetic drugs - Acyclovir, Valtrex, Famvir, etc.

Atopic dermatitis is a common pathology that annoys not only children, but also adults. The frequency of exacerbations in this case depends on the correct diet and lifestyle. Skin care is also important. It is better to entrust the choice of medicines and cosmetics to a competent doctor. This is the surest way to achieve long-term remission and beautiful well-groomed skin.

Video about dermatitis

Treatment of atopic dermatitis is not a matter of one day. First of all, you need to establish the cause of the rash and the type of allergy, only then proceed to complex treatment. To get rid of atopic dermatitis, it is necessary to follow a diet with the elimination of all possible allergens, cleanse the body of toxins, take antihistamines and, in addition, local treatment in the foci of redness or rash. You can supplement the treatment with sedatives and spa therapy.

Diet in the treatment of atopic dermatitis

One hundred percent method of how to cure atopic dermatitis simply does not exist in nature. The disease often has a genetic predisposition, and one treatment option is to eliminate the causative agent. In this case, these are allergens. How to identify them?

• When introducing the first complementary foods to an allergic baby, it is important to adhere to the progressive principle, maintain the interval between taking new products, and record all the consequences, as well as their absence, in the child's nutrition diary.
• Atopic dermatitis can manifest itself at any age, often after suffering from complex diseases and the use of antibiotics, as well as when the immune system is weakened. In this case, the anti-allergic diet should be supplemented with yogurts with beneficial bacteria to restore intestinal balance, you should not refuse vitamins, the main thing is to determine safe foods.
• With manifestations of atopic dermatitis, you need to abandon the products listed in the list of potential allergens. The leading positions belong to citrus fruits, cow's milk, chicken eggs, seafood and peanuts. A more accurate prognosis regarding individual food intolerance can be given by special blood tests or allergenic scrapers.
• A rash and itching in a baby can appear even during breastfeeding, provided that the mother abuses allergen products. In this case, the mother of the child should sit on an anti-allergic diet.

After the disappearance of allergy symptoms, prohibited foods can be gradually introduced, but in minimal doses and not every day.

Removal of toxins from the body in atopic dermatitis

Skin manifestations are only the outer part of the problem. With atopic dermatitis, both the gastrointestinal tract and the liver go out of tune. The reason for this is the toxins that need to be removed from the body. Enterosorbents and complex cleaning preparations are used.

• Enterosorbents. These drugs not only remove toxins from the body, but also reduce the burden on the kidneys, liver and other organs that are involved in the detoxification process. Synthetic sorbents - Enterosgel, Sorbolong. Sorbents of natural origin - activated carbon and its analogues (Sorbeks, White coal, Karbolen), preparations based on silicon (Smecta, Atoxil), based on medicinal plants (Polifepan, Lakto Filtrum).
• Preparations of complex cleansing. Only herbal preparations are used based on birch and tansy leaves, stigmas and columns of corn, fennel, immortelle, pharmacy turnip.

After a course of cleansing the body, it will not be superfluous to drink probiotics and other drugs that improve the intestinal microflora (Bifidumbacterin, Mezim, Laminolact).

Taking antihistamines

These drugs are directed against the product of an allergic reaction - histamine. There are antihistamines of the 1st, 2nd and 3rd generations. These medicines cannot completely rid the patient of the disease, their task is to alleviate the symptoms and relieve discomfort.

• Old generation drugs Ketotifen, Chloropyramine, Clemastine) . They are inconvenient because they must be taken several times a day, are addictive and affect general behavior, often cause drowsiness and are not recommended for driving. The advantage is the price.
• New generation drugs(Suprastin, Loratidin, Erius,) . Speed ​​of action, minimal dosage, minimal side effects - these are the advantages of this type of drugs.

An allergy remedy is an important step in the treatment of atopic dermatitis, but be careful when choosing a drug. Antihistamine drugs can cause allergies if the selection is incorrect or intolerance to one of the constituent components. In this case, it is necessary to replace the drug.

Is it possible to cure atopic dermatitis with ointments

It is not possible to achieve a cure for dermatitis with ointments alone. Even the most potent remedy will relieve a rash or redness for only a few days. If the allergic reaction in the body progresses, then dermatitis may appear elsewhere.

When deciding how to cure atopic dermatitis in a child, you can start with proven folk methods.

• Lotions from a decoction of chamomile, succession, sage, wiping problem areas with astringents, such as a decoction of oak bark.
• Chatterboxes on an oil (for moisturizing) or zinc (drying) basis.
• Zinc-based pastes.
• Nourishing ointments with lanolin and vaseline.
• Creams and gels of a lighter structure.
• Absorbable patches for thickened skin areas.

Means for local treatment can relieve inflammation (Advantan, medicinal decoctions, Burov's liquid), fight infections (Triderm, Baktobarn, Furacilin, Boric acid), dissolve seals on the skin (Ichthyol, Methyluracil ointment), relieve itching and burning (Menthol, Camphor , Menovazin).

Anti-anxiety drugs for atopic dermatitis

Skin rashes can also appear as a result of nervous stress and experiences. In this case, sedatives (Persen, tincture of valerian, motherwort) and relaxing procedures (pearl baths, hydromassage) will be appropriate.

Spa therapy

The method is efficient and extremely useful. Allergics with dermatosis manifestation of the disease are recommended dry sea air and bathing in salt water. One of the ideal options is the resorts of the Sea of ​​\u200b\u200bAzov.