Symptoms of exacerbation of atopic dermatitis. Atopic dermatitis (atopic eczema)

- a hereditary non-infectious disease of the skin, allergic in nature, can be chronic. According to statistics, most often the disease occurs in members of the same family. If one of the relatives or parents has diseases such as , or atopic dermatitis , the probability of transmission of the disease to the child by inheritance to the child is 50%. In the case when both parents are ill, the probability of heredity rises to 80%. Sometimes the presence of only asthma in the parents can cause atopic dermatitis in the child.

Causes of atopic dermatitis

The manifestations of the disease in the first year of life are most often associated with the introduction of complementary foods into the child's diet. Allergenic foods include cow's milk, eggs and fish, so they are not recommended to be introduced into complementary foods until 10-12 months. Artificial mixtures can also cause allergic reactions.

In about 70% of patients, the disease resolves in adolescence, in the rest it passes into the adult form, in which exacerbations are replaced remissions for a short time, and then the disease worsens again. In adults, allergens are house dust, animal hair, mold, plants, the symptoms also change slightly.

Thus, the main causes of atopic dermatitis are allergic in nature and are a reaction to the presence of contact or the use of certain substances - .

Symptoms of atopic dermatitis

In most cases, the disease manifests itself during the first five years of life, with the peak occurring in the first year. In adulthood, the symptoms of atopic dermatitis may disappear or weaken, but in half of the cases they persist throughout life. The disease can be accompanied by diseases such as bronchial asthma and .

It is mandatory to use anti-inflammatory drugs. These can be corticosteroids - as well as sedatives - various sedative herbs, peony, and others.

For external use, antiseptics such as Fukartsin , . To maintain the general condition of the patient, a complex of vitamins and microelements is prescribed, hardening is recommended.

In the case of secondary infections, drugs are prescribed depending on the type of pathogen. Additionally, enzyme preparations are prescribed for violations of the function of the pancreas and eubiotics for. In the acute stage of weeping, wet-drying dressings and corticosteroid aerosols are used.

The most important condition, without which the treatment of atopic dermatitis cannot be effective, is not to rub or comb the skin. Like some other skin diseases, it is accompanied by unbearable itching, which is very difficult to endure. Combing the lesions, patients cause exacerbations and complications of the disease, and at the same time all medicines will be useless.

If the symptoms of atopic dermatitis in you or your child appeared only at the initial stage, this is not a reason to self-medicate. Be sure to contact a dermatologist.

Complications of this disease can lead to severe infectious diseases. It is necessary to strictly follow the instructions of the doctor, adhering to his recommendations in everyday life, this is the only way to avoid constant exacerbations.

The doctors

Medications

People who have atopic dermatitis, you have to be more careful and attentive to your lifestyle, devote more time to your home. The house should not have items that accumulate dust, as it is the main allergen. The room should have a minimum of carpets and upholstered furniture, all surfaces should be easy to wet clean, which is carried out as often as possible, but without detergents. It is necessary to ventilate the dwelling more often by installing grids on the windows that do not allow plant pollen to enter the house. As for bedding, they must be with synthetic fillers, the use of fluff and feathers is unacceptable. In other words, for people prone to the disease, the prevention of atopic dermatitis is aimed at minimizing exposure to allergens.

Clothing should be breathable so that the skin can breathe. Wool, nylon, and polyester clothing is not the best option, as it increases itching and irritates the skin. Do not use hot water when washing, only warm. After washing, you should blot the skin, and do not wipe it. Be sure to use cosmetics to moisturize and care for the skin. They should be neutral and free of dyes, fragrances and preservatives. That is, in addition, the prevention of atopic dermatitis provides for measures to prevent mechanical irritation of damaged areas.

Equally important for the prevention and timely treatment of chronic diseases, taking vasoconstrictive drugs and sedatives before important events. In the diet, allergenic foods should be avoided even during periods of remission of the disease.

Complications of atopic dermatitis

The most frequent complications of atopic dermatitis are caused by the addition of secondary infections. This occurs when combing the skin, which leads to a violation of its protective properties.

Damaged areas are affected by microbial and fungal flora, as well as viral infections. Secondary infections complicate atopic dermatitis treatment, causing new lesions, and negatively affecting the general condition of the patient.

pyoderma, that is, a bacterial infection, which is characterized by the appearance of pustules that gradually dry out and form crusts, is ahead of other complications of atopic dermatitis in terms of frequency of occurrence. The disease is accompanied by violations of the general condition, fever, itching. Rashes can be all over the body and on the scalp.

Also, a viral infection caused by a simple virus can often be a complication. It causes the same virus. Bubbles with liquid form on the skin, which are localized not only around the affected area, but also on healthy skin. Often, bubbles appear on the mucous membranes in the mouth, throat, conjunctiva and genitals. Fungal infections affect the skin, nails, scalp, feet, and hands. In children, such complications often have symptoms, the oral mucosa is affected. Curd plaque is often accompanied by redness and itching.

Diet, nutrition for atopic dermatitis

List of sources

• Atopic dermatitis // Pediatrics / Ed. A.A. Baranov. - GEOTAR-Media, 2009. - Vol. 2.
• "Handbook of skin and venereal diseases" A.N. Rodionov, 2005.
• "Diagnosis of skin diseases". B.A. Berenbein, A.A. Studnitsin, 1996.

Education: Graduated from Vitebsk State Medical University with a degree in Surgery. At the university, he headed the Council of the Student Scientific Society. Advanced training in 2010 - in the specialty "Oncology" and in 2011 - in the specialty "Mammology, visual forms of oncology".

Experience: Work in the general medical network for 3 years as a surgeon (Vitebsk Emergency Hospital, Liozno Central District Hospital) and part-time as a district oncologist and traumatologist. Work as a pharmaceutical representative for a year in the Rubicon company.

He presented 3 rationalization proposals on the topic “Optimization of antibiotic therapy depending on the species composition of microflora”, 2 works won prizes in the republican competition-review of student scientific works (categories 1 and 3).

is a chronic non-contagious inflammatory skin lesion that occurs with periods of exacerbations and remissions. It is manifested by dryness, increased skin irritation and severe itching. It causes physical and psychological discomfort, reduces the patient's quality of life at home, family and at work, outwardly presents cosmetic imperfections. Continuous scratching of the skin leads to its secondary infection. Diagnosis of atopic dermatitis is carried out by an allergist and a dermatologist. Treatment is based on diet, general and local drug therapy, specific hyposensitization and physiotherapy.

General information

Atopic dermatitis is the most common dermatosis (skin disease) that develops in early childhood and persists throughout life. Currently, the term "atopic dermatitis" refers to a hereditary, non-contagious, allergic skin disease of a chronic relapsing course. The disease is the subject of curation of specialists in the field of outpatient dermatology and allergology.

Synonyms of atopic dermatitis, also found in the literature, are the concepts of "atopic" or "constitutional eczema", "exudative catarrhal diathesis", "neurodermatitis", etc. The concept of "atopy", first proposed by American researchers A. Coca and R. Cooke in 1923, implies a hereditary tendency to allergic manifestations in response to a particular stimulus. In 1933, Wiese and Sulzberg introduced the term "atopic dermatitis" to refer to hereditary allergic skin reactions, which is now considered generally accepted.

Causes

The hereditary nature of atopic dermatitis determines the prevalence of the disease among related family members. The presence of parents or close relatives of atopic hypersensitivity (allergic rhinitis, dermatitis, bronchial asthma, etc.) determines the likelihood of atopic dermatitis in children in 50% of cases. Atopic dermatitis in the anamnesis of both parents increases the risk of transmission of the disease to the child up to 80%. The vast majority of the initial manifestations of atopic dermatitis occur in the first five years of life (90%) of children, of which 60% occur during infancy.

As the child grows and develops, the symptoms of the disease may not bother or weaken, however, most people live with a diagnosis of atopic dermatitis all their lives. Often, atopic dermatitis is accompanied by the development of bronchial asthma or allergies.

The wide spread of the disease throughout the world is associated with problems common to most people: adverse environmental and climatic factors, dietary errors, neuropsychic overload, an increase in infectious diseases and the number of allergic agents. A certain role in the development of atopic dermatitis is played by disorders in the immune system of children, due to the shortening of breastfeeding periods, early transfer to artificial feeding, maternal toxicosis during pregnancy, malnutrition of a woman during pregnancy and lactation.

Symptoms of atopic dermatitis

The initial signs of atopic dermatitis are usually observed in the first six months of life. This can be triggered by the introduction of complementary foods or the transfer to artificial mixtures. By the age of 14-17, in almost 70% of people, the disease resolves on its own, and in the remaining 30% it passes into the adult form. The disease can proceed for many years, aggravating in the autumn-spring period and subsiding in the summer.

According to the nature of the course, acute and chronic stages of atopic dermatitis are distinguished.

The acute stage is manifested by red spots (erythema), nodular rashes (papules), peeling and swelling of the skin, the formation of areas of erosion, weeping and crusts. Accession of a secondary infection leads to the development of pustular lesions.

The chronic stage of atopic dermatitis is characterized by thickening of the skin (lichenization), the severity of the skin pattern, cracks on the soles and palms, scratching, increased pigmentation of the skin of the eyelids. In the chronic stage, symptoms typical of atopic dermatitis develop:

• Morgan's symptom - multiple deep wrinkles in children on the lower eyelids
• Symptom "fur hat" - weakening and thinning of hair at the back of the head
• Symptom of "polished nails" - shiny nails with sharpened edges due to constant scratching of the skin
• Symptom of the "winter foot" - puffiness and hyperemia of the soles, cracks, peeling.

In the development of atopic dermatitis, several phases are distinguished: infant (first 1.5 years of life), childhood (from 1.5 years to puberty) and adult. Depending on the age dynamics, the features of clinical symptoms and localization of skin manifestations are noted, however, the strongest, permanent or intermittent pruritus remains the leading symptom in all phases.

The infantile and childhood phases of atopic dermatitis are characterized by the appearance of bright pink erythema on the skin of the face, limbs, buttocks, against which vesicles (vesicles) and weeping areas appear, followed by the formation of crusts and scales.

In the adult phase, foci of erythema are pale pink in color with a pronounced skin pattern and papular rashes. They are localized mainly in the elbow and popliteal folds, on the face and neck. The skin is dry, rough, with cracks and peeling areas.

In atopic dermatitis, focal, widespread or universal skin lesions occur. Areas of typical localization of rashes are the face (forehead, area around the mouth, near the eyes), skin of the neck, chest, back, flexion surfaces of the limbs, inguinal folds, buttocks. Plants, house dust, animal hair, mold, dry food for fish can aggravate the course of atopic dermatitis. Often atopic dermatitis is complicated by a viral, fungal or pyococcal infection, is the background for the development of bronchial asthma, hay fever and other allergic diseases.

Complications

The main reason for the development of complications in atopic dermatitis is the constant trauma to the skin as a result of scratching it. Violation of the integrity of the skin leads to a decrease in its protective properties and contributes to the attachment of a microbial or fungal infection.

The most common complication of atopic dermatitis is bacterial skin infections - pyoderma. They are manifested by pustular rashes on the body, limbs, in the scalp, which, drying out, form crusts. In this case, general well-being often suffers, body temperature rises.

Viral skin infections are the second most common complication of atopic dermatitis. Their course is characterized by the formation of vesicles (vesicles) filled with a clear liquid on the skin. The causative agent of viral infections of the skin is the herpes simplex virus. The face is most often affected (the skin around the lips, nose, auricles, on the eyelids, cheeks), mucous membranes (conjunctiva of the eyes, oral cavity, throat, genitals).

Complications of atopic dermatitis are often fungal infections caused by yeast-like fungi. The affected areas in adults are more often skin folds, nails, hands, feet, scalp, in children - the oral mucosa (thrush). Often fungal and bacterial lesions are observed together.

Treatment of atopic dermatitis

Treatment of atopic dermatitis is carried out taking into account the age phase, the severity of the clinic, concomitant diseases and is aimed at:

• exclusion of the allergic factor
• desensitization (decrease in sensitivity to the allergen) of the body
• itching relief
• detoxification (cleansing) of the body
• removal of inflammatory processes
• correction of identified concomitant pathology
• prevention of recurrence of atopic dermatitis
• combating complications (when infection is attached)

Various methods and drugs are used to treat atopic dermatitis: diet therapy, PUVA therapy, acupuncture, specific hyposensitization, laser treatment, corticosteroids, allergoglobulin, cytostatics, sodium cromoglycate, etc.

diet therapy

Nutritional regulation and dietary compliance can significantly improve the condition and prevent frequent and severe exacerbations of atopic dermatitis. During periods of exacerbation of atopic dermatitis, a hypoallergenic diet is prescribed. At the same time, fried fish, meat, vegetables, rich fish and meat broths, cocoa, chocolate, citrus fruits, black currants, strawberries, melons, honey, nuts, caviar, mushrooms are removed from the diet. Also, products containing dyes and preservatives are completely excluded: smoked meats, spices, canned food and other products. In atopic dermatitis, compliance with a hypochlorite diet is indicated - limiting the amount of table salt consumed (however, not less than 3 g of NaCl per day).

In patients with atopic dermatitis, there is a violation of the synthesis of fatty acids, so diet therapy should include nutritional supplements saturated with fatty acids: vegetable oils (olive, sunflower, soybean, corn, etc.), linoleic and linolenic acids (vitamin F-99).

Medical treatment

A significant disadvantage of first-generation antihistamines (mebhydrolin, clemastine, chloropyramine, hifenadine) is the rapidly developing addiction of the body. Therefore, the change of these drugs must be carried out every week. A pronounced sedative effect, leading to a decrease in concentration and impaired coordination of movements, does not allow the use of first-generation drugs in the pharmacotherapy of people in certain professions (drivers, students, etc.). Due to the atropine-like side effects, a number of diseases are a contraindication to the use of these drugs: glaucoma, bronchial asthma, prostate adenoma.

Significantly safer in the treatment of atopic dermatitis in persons with comorbidities is the use of second-generation antihistamines (loratadine, ebastine, astemizole, fexofenadine, cetirizine). They do not develop addiction, there is no atropine-like side effect. Loratadine is the most effective and safe antihistamine drug currently used in the treatment of atopic dermatitis. It is well tolerated by patients and is most commonly used in dermatological practice for the treatment of atopy.

To alleviate the condition of patients with severe attacks of itching, drugs that affect the autonomic and central nervous system (hypnotics, sedatives, tranquilizers) are prescribed. The use of corticosteroid drugs (methiprednisolone or triamcinolone) is indicated for limited and widespread skin lesions, as well as for severe, unbearable itching that is not relieved by other medications. Corticosteroids are prescribed for several days to stop an acute attack and are canceled with a gradual decrease in the dose.

In severe atopic dermatitis and severe symptoms of intoxication, intravenous infusion of infusion solutions is used: dextran, salts, saline, etc. In some cases, it is advisable to carry out hemosorption or plasmapheresis - methods of extracorporeal blood purification. With the development of purulent complications of atopic dermatitis, it is reasonable to use broad-spectrum antibiotics in age dosages: erythromycin, doxycycline, metacycline for 7 days. When a herpes infection is attached, antiviral drugs are prescribed - acyclovir or famciclovir.

With the recurrent nature of complications (bacterial, viral, fungal infections), immunomodulators are prescribed: solyusulfone, thymus preparations, sodium nucleinate, levamisole, inosine pranobex, etc. under the control of blood immunoglobulins.

External treatment

The choice of the method of external therapy depends on the nature of the inflammatory process, its prevalence, the age of the patient and the presence of complications. In acute manifestations of atopic dermatitis with wetting of the surface and crusts, disinfectant, drying and anti-inflammatory lotions (tea infusion, chamomile, Burov's liquid) are prescribed. When stopping an acute inflammatory process, pastes and ointments with antipruritic and anti-inflammatory components are used (ichthyol 2-5%, tar 1-2%, Naftalan oil 2-10%, sulfur, etc.). Corticosteroid ointments and creams remain the leading drugs for external therapy of atopic dermatitis. They have antihistamine, anti-inflammatory, antipruritic and anti-edema effects.

Light treatment of atopic dermatitis is an auxiliary method and is used in the persistent nature of the disease. UVR procedures are carried out 3-4 times a week, practically do not cause adverse reactions (except for erythema).

Prevention

There are two types of prevention of atopic dermatitis: primary, aimed at preventing its occurrence, and secondary - anti-relapse prevention. Carrying out measures for the primary prevention of atopic dermatitis should begin even in the period of intrauterine development of the child, long before his birth. A special role during this period is played by toxicosis of a pregnant woman, taking medications, professional and food allergens.

Particular attention should be paid to the prevention of atopic dermatitis in the first year of a child's life. During this period, it is important to avoid excessive medication, artificial feeding, so as not to create a favorable background for the body's hypersensitivity to various allergic agents. Dieting during this period is no less important for a nursing woman.

Secondary prevention aims to prevent exacerbations of atopic dermatitis, and, in case of occurrence, to alleviate their course. Secondary prevention of atopic dermatitis includes correction of identified chronic diseases, exclusion of exposure to disease-provoking factors (biological, chemical, physical, mental), compliance with hypoallergenic and elimination diets, etc. Prophylactic administration of desensitizing drugs (ketotifen, sodium cromoglycate) during periods of exacerbations (autumn, spring) avoids relapses. As anti-relapse measures for atopic dermatitis, treatment is indicated in the resorts of the Crimea, the Black Sea coast of the Caucasus and the Mediterranean.

Particular attention should be paid to daily skin care and the right choice of underwear and clothing. With a daily shower, do not wash with hot water and a washcloth. It is advisable to use gentle hypoallergenic soaps (Dial, Dove, baby soap) and a warm shower, and then gently pat the skin dry with a soft towel without rubbing or injuring it. The skin should be constantly moisturized, nourished and protected from adverse factors (sun, wind, frost). Skin care products should be neutral and free of fragrances and dyes. In linen and clothes, preference should be given to soft natural fabrics that do not cause itching and irritation, and also use bedding with hypoallergenic fillers.

Forecast

Children suffer from the most severe manifestations of atopic dermatitis; with age, the frequency of exacerbations, their duration and severity become less pronounced. Almost half of patients recover by the age of 13-14 years. Clinical recovery is considered a condition in which the symptoms of atopic dermatitis are absent for 3-7 years.

The periods of remission in atopic dermatitis are accompanied by subsidence or disappearance of the symptoms of the disease. The time interval between two exacerbations can range from several weeks to months and even years. Severe cases of atopic dermatitis occur almost without light intervals, constantly recurring.

The progression of atopic dermatitis significantly increases the risk of developing bronchial asthma, respiratory allergies, and other diseases. For atopics, the choice of a professional field of activity is extremely important. They are not suitable for professions that involve contact with detergents, water, fats, oils, chemicals, dust, animals and other irritating agents.

Unfortunately, it is impossible to completely protect yourself from the influence of the environment, stress, disease, etc., which means that there will always be factors that exacerbate atopic dermatitis. However, careful attention to your body, knowledge of the characteristics of the course of the disease, timely and active prevention can significantly reduce the manifestations of the disease, prolong remission periods for many years and improve the quality of life. And in no case should you try to treat atopic dermatitis on your own. This can cause complicated variants of the course of the disease and severe consequences. Atopic dermatitis should be treated

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)

Causes

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:

Characteristics	Phase
	Infant and child	adult
The main symptom is itching.	+	+
Formation color	bright pink	Pale pink
Places of formations	Face, buttocks, arms, legs	The area of ​​the popliteal, elbow folds, face, neck
Forms of formations	Bubbles, wetting, crusts, scales	Papules, skin pattern, dry skin, peeling, cracks.

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:

Group	Action	Recommendations	Name
Antihistamines	Relieve itching, swelling	Change weekly to avoid habituation	Loratadine, Clemastine, Hifenadine
Corticosteroid	Stop the attack and unbearable itching	Appointed at the initial stage for a short period	Triamcinolone, Metyprednisolone
Antibiotics	Anti-inflammatory	With complications of a purulent nature	Metacycline, Doxycycline, Erythromycin
Antiviral	Fight against viruses	For viral complications	Acyclovir
Immunomodulators	Strengthening immunity	If necessary	Echinacea, Ginseng
Sedatives	Relief of itching and general condition when exposed to the nervous system	They are prescribed when the disease is associated with stressful situations to relieve fear, depression, insomnia	Motherwort, Nozepam, Bellataminal

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:

Ingredients	Cooking method	Application
Bay leaf - 4 pieces, boiling water - 200 ml	Combine, insist under the lid until cool, then strain	Use inside before bedtime for children 40 ml, and for adults - 100; course - 10 days
Viburnum berries - 5 tablespoons, boiling water - 1000 mg	Connect, leave under the lid for up to 10 hours, strain	Use during the day 200 ml for children, 400 for adults; course - up to 2-3 weeks
Oatmeal - 3 tablespoons, hot cow's milk - 1 liter	Mix to a single mass	Apply the substance to the skin for 20 minutes, then rinse, lubricate with a nourishing cream
Veronica (medicinal herb) - 1 spoon, boiling water - 1 cup	Insist, covering and wrapping, 2 hours, then strain	Wash the affected area with lotion up to 6 times a day; course is not limited

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

By frequency of occurrence	Type of skin infection	Pathogen	Manifestation	Where does
1	bacterial(pyoderma)	Different types of bacteria (cocci)	Pustules, crusts on the skin, malaise, fever	Head, any parts of the body, limbs
2	Viral	herpes virus	Bubbles transparent with liquid	Mucous membranes and skin of the face, surface of the throat, genitals
3	fungal	Yeast-like fungi	Rounded rashes, thrush in children	Skin folds, nails, head, feet, hands

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 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

After the antigen-antibody complex has been formed, a cascade of allergic reactions is launched with the release of a number of biologically active substances. These substances trigger those pathological processes that lead to the formation of symptoms of atopic dermatitis ( redness, swelling, etc.).

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

Atopic dermatitis is a multifactorial disease, that is, there are many causes of this phenomenon. Its development is predetermined not only by trigger factors ( immediate causes), but also by genetic predisposition, dysfunction of the immune and other systems of the body.

genetic predisposition

More than 80 percent of people with atopic dermatitis have a positive family history. This means that they have one or more relatives suffering from some kind of atopic disease. These diseases are most often food allergies, pollinosis or bronchial asthma. In 60 percent, a genetic predisposition is observed in the female, that is, the disease is transmitted through the mother. Genetic transmission through the father is observed in one fifth of all cases. In favor of the genetic factor is the fact that in identical twins the degree of concordance is more than 70 percent, in fraternal twins - more than 20 percent.

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

It is violations in the work of the immune system that provoke an increased sensitivity of the body to various irritants, that is, to atopy. Thus, the immune system creates the prerequisites against which, under the influence of provoking ( trigger) factors will appear symptoms of atopic dermatitis.

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 observed 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 of the digestive system can act both as triggers and as a basis for weakening the immune system. It is known that the intestinal mucosa contains numerous lymphatic formations ( Peyer's patches), which play the role of immunomodulators. Thus, along with the lymph nodes, the intestines in the body create a barrier to the penetration of harmful factors. However, with various pathologies of the digestive system, this barrier is broken, and harmful substances enter the bloodstream. This happens primarily because the intestinal mucosa suffers. Violation of the integrity of the mucosa with the development of inflammation in it leads to the fact that bacteria and their toxins easily penetrate the intestines into the bloodstream. Subsequently, bacteria and toxic substances that have penetrated from the intestinal mucosa into the bloodstream can increase allergic reactions. At the same time, chronic pathologies, helminthic invasions lead to a decrease in immunity.

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

This dysfunction is to increase the adrenergic effect on the body. This leads to the fact that the patient has a tendency to vasospasm. This tendency is more pronounced during exposure to cold, stress, and mechanical action on the skin. This leads to malnutrition of the skin, which leads to its dryness. Dryness or xerosis of the skin is a prerequisite for excessive penetration of allergens through the skin. Allergens through cracks and wounds in the skin ( be it dust or poplar fluff) penetrate the body and trigger a cascade of allergic reactions.

endocrine dysfunction

In people suffering from atopic dermatitis, there is a decrease in hormones such as cortisol and adrenocorticotropic hormone. They also have a reduced concentration of estrogens and androgens. All this leads to a protracted, chronic course of atopic dermatitis.

Genetic anomalies

As you know, the skin in the body performs a number of functions, including the function of protection. This function suggests that in a healthy state, the skin of people is a barrier to the penetration of microbial agents, mechanical and physical factors. However, in people suffering from atopic dermatitis, dry and dehydrated skin does not perform this function. This is due to certain genetic abnormalities at the level of the barrier function of the skin.

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.

All these predisposing factors create the ground for easy penetration of allergens. In this case, the skin becomes vulnerable and easily amenable to attack by various triggers. The failure of the skin barrier function is the cause of a long, sluggish allergic process. Some factors also increase the spread of an allergic reaction.

triggers

Triggers are those factors that trigger the immunoallergic process that underlies atopic dermatitis. Since they start the whole process, they are also called triggers or trigger factors. Also, these factors provoke periodic exacerbations of atopic dermatitis.

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.

food allergens
This group of trigger factors that can cause an exacerbation of atopic dermatitis is the most common. Most often in adults it is dairy products and seafood.

The most common food allergens are:

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

This list of products is very individual and specific. Some adults may have a polyallergy, that is, to several products at once. Others may have an intolerance to just one food. Also, food sensitivity varies by season ( in the spring it escalates) and on the general condition of the organism ( diseases are known to exacerbate sensitivity). Also, some medications can exacerbate or weaken alimentary sensitivity.

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.

Aeroallergens
Aeroallergens are most often the cause of atopic dermatitis along with bronchial asthma, hay fever, that is, together with other components of atopic disease.

Allergens that cause atopic dermatitis:

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

Non-specific trigger mechanisms:

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

These factors are not mandatory and not everyone provokes atopic dermatitis. Different weather conditions can affect the development of atopic dermatitis in different ways. For some people it is cold, for others it is hot and dry air.

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 at the greatest 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

Symptoms of atopic dermatitis are very variable and depend on the form of the disease. The main clinical manifestations are reduced to itching and rashes. Permanent companions of atopic dermatitis, even during remission, are dryness and redness of the skin.

Itching

Itching is one of the most persistent symptoms of atopic dermatitis. Its intensity depends on the form of dermatitis. So, itching is most pronounced with lichenoid rashes. Even when the rash disappears for a while, itching remains due to dryness and irritation of the skin. Severe, sometimes unbearable itching is the cause of scratching, which, in turn, is complicated by the addition of an infection.

Dry skin

Dryness and redness is localized not only in the favorite places of dermatitis ( folds, under the knee, on the elbows), but also in other parts of the body. So, dryness of the face, neck, shoulders can be observed. The skin at the same time looks rough, rough.
Increased dryness of the skin is also called xerosis. Skin xerosis in atopic dermatitis, together with flaking and redness, is an important diagnostic criterion.

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

Eruptions in atopic are divided into primary and secondary. Primary rashes occur on healthy, unaltered skin. Secondary eruptions appear as a result of changes in the primary elements.

Type of rash	Characteristic	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

Cheilitis is an inflammation of the oral mucosa. Manifested by dry cracked lips, dryness and increased folding. Sometimes the mucous membrane of the lips is covered with small scales and is accompanied by severe itching. With atopic cheilitis, the red border of the lips is damaged, and especially the corners of the mouth and the surrounding skin. Cheilitis may be the only manifestation of atopic dermatitis in remission.

atopic face

An atopic face is characteristic of people who have suffered from atopic dermatitis for many years. The symptoms that appear in this case give the person a characteristic tired look.

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.

Depending on the predominance of certain morphological elements, atopic dermatitis is divided into several clinical forms.

Forms of atopic dermatitis are:

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

Erythematous form
In this form of atopic dermatitis, elements such as spots predominate ( or erythema), papules and scales. The patient's skin is dry, covered with many small, very itchy scales. These rashes are localized mainly on the elbows and in the popliteal fossae. Occurs in more than 50% of cases.

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

There are special forms of atopic dermatitis, which are manifested by specific symptoms.

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

The main diagnostic criteria are reduced to the symptoms of the disease and the nature of their course. Thus, itching, characteristic rashes and a chronic, periodically aggravated course are the basic criteria for the diagnosis of atopic dermatitis.

Allergist consultation

A consultation with an allergist is an essential step in making a diagnosis of atopic dermatitis. The consultation includes questioning the patient and examining him.

Survey
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?

Inspection
On examination, the allergist examines the nature and size of the affected areas. The physician pays attention to the location of the lesions on the patient's body and the presence of other external criteria for atopic dermatitis.

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.

Next, the doctor prescribes the appropriate tests ( allergen tests, fadiatop test) and makes a preliminary diagnosis. The need for additional consultation of a number of specialists may also be determined ( dermatologist, endocrinologist, gastroenterologist). Repeated consultation with an allergist includes the interpretation of tests and examination of the patient. In case of confirmation of atopic dermatitis, the doctor prescribes drug therapy, diet and compliance with the therapeutic regimen.

Consultation with a dermatologist

How to prepare for a visit to a dermatologist?
During the examination, the dermatologist may need a complete examination of the patient's body. Therefore, before a visit to the doctor, it is necessary to take a shower and take the necessary hygiene measures. A day before visiting a specialist, it is necessary to abandon cosmetic and other skin care products. It is also necessary to exclude the use of antihistamines and not apply medicinal ointments or other means to the affected areas.

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.

Patient examination
On examination, a dermatologist examines the nature of skin changes and their localization on the patient's body. The doctor also pays attention to the analysis of additional external criteria that are characteristic of atopic dermatitis. The main signs of this pathology include a skin rash that affects the arms and legs ( front surfaces), back, chest, abdomen. In addition to rashes, dense nodules may appear that are very itchy.

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.

To exclude other pathologies and to confirm atopic dermatitis, additional clinical and laboratory studies are carried out.

Lab tests:

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

General blood analysis

In atopic dermatitis, an increased content of eosinophils is found in the peripheral blood. In adults, the concentration of eosinophils that exceeds 5 percent is considered elevated. Although this is not a specific symptom for atopic dermatitis, it is the most constant. Even during the period of remission of atopic dermatitis in the general blood test, an increased content of eosinophils is noted - from 5 to 15 percent.

Determination of the concentration of immunoglobulins E in the blood

Immunoglobulins E play an important role in the development of atopic dermatitis. Therefore, determining the concentration of this immunoglobulin plays an important role in making a diagnosis.

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

This type of diagnosis allows you to determine the presence of antibodies to various antigens. These tests are similar to skin tests, but they are much more specific and less likely to give false results.

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

This test is a screening not only for atopic dermatitis, but also for atopic disease in general. The test examines the presence in the blood of specific immunoglobulins to the most common allergens. This diagnostic method allows you to determine the level of immunoglobulins simultaneously to several groups of allergens ( fungi, pollen, drugs), and not to any particular one.

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

In addition to the above laboratory tests, bacteriological examination and diagnostic biopsy are also performed. The first method is performed when atopic dermatitis is complicated by a bacterial infection. Diagnostic biopsy is performed in the late development of atopic dermatitis in adults for its differential diagnosis with skin neoplasms.

Allergen testing

Allergen testing is a diagnostic method in which the individual sensitivity of the body to certain substances is detected and the subsequent inflammatory reaction is studied. The indication for this type of study is the patient's medical history, which reflects the role of allergens ( one or group) in the development of atopic dermatitis.

Allergological research methods are:

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

Scarifying skin tests
Scarification tests are a painless procedure for which special instruments are used ( needle or lancet) to disrupt the integrity of the skin. At a distance of 4 - 5 centimeters from each other, shallow scratches are made on the surface of the forearm or back. A drop of the allergen to be tested is applied to each mark. After 15 minutes, the patient's skin is examined. If the patient is allergic to one or more of the diagnosed substances, a reaction occurs at the site of scratches ( skin swelling, blistering, itching). The results of a scarification skin test are determined by the nature of the skin changes that have occurred.

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.

prick test
Prick tests are a modern diagnostic method. In this type of study, the epithelium ( top layer of skin) is damaged by a thin needle that contains the allergen.

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). 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

Treatment of atopic dermatitis should be comprehensive and include drug therapy, diet and the creation of an optimal psycho-emotional environment.

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

Drug therapy is basic in the treatment of atopic dermatitis. It includes a wide range of medicines.

Groups of drugs used in atopic dermatitis:

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

Glucocorticosteroids
This group of drugs is traditional in the treatment of atopic dermatitis. They are assigned both locally ( in the form of ointments) and systemically ( orally in the form of tablets). The drugs of this group differ in the degree of activity - weak ( hydrocortisone), average ( elocom) and strong ( dermovate). However, recently, the effectiveness of these drugs has been questioned, since very often their administration is complicated by a secondary infection.

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

Name of the drug	Mechanism of action	Mode of application
Group of glucocorticosteroids
Hydrocortisone	It inhibits allergic reactions and the development of edema in the focus. Reduces redness.	Spread with a layer of 1 mm on the affected areas of the skin twice a day.
Elokom	Removes swelling and has an antipruritic effect.	It is recommended to use an ointment in case of the greatest peeling of the skin and a cream if inflammatory infiltration predominates.
Dermovate	It has anti-inflammatory and immunosuppressive effects.	Apply a thin layer once or twice a day. The duration of treatment should not exceed 4 weeks.
Afloderm	It has anti-inflammatory and antipruritic effect. It also constricts blood vessels, thereby reducing swelling in the focus of inflammation.	The ointment is applied several times a day ( depending on the severity of the injury) within 3 weeks.
Macrolide group
Elidel	It blocks the release of inflammatory mediators, thereby providing an anti-allergic effect.	The agent is applied in a thin layer and gently rubbed into the affected surface. The procedure is done twice a day for 6-8 weeks.
Group of antihistamines
Fenistil gel	Blocks H1 receptors, thereby preventing the release of histamine.	The gel is applied to the itchy surface for 3 to 5 days.
Ointments and creams from various groups
Ichthyol ointment	The ointment prevents excessive keratinization of the skin. It also has an antiseptic effect, thus preventing secondary infection of atopic dermatitis.	The ointment is applied once or twice a day to areas of rough skin.
Cream Aisida	It has an antiseptic effect, increases metabolic processes in the skin. Deeply moisturizes the skin and restores the lipid layer.	The cream is applied in the morning and evening to the damaged areas of the body with light circular movements.
Sulfathiazole silver	Promotes healing of wounds, prevents the development of secondary infection.	A thin layer of 1 - 2 mm ointment is applied with a swab to the affected surface twice a day.
Emollient creams
Topikrem	Restores the lipid barrier of the skin, eliminating the feeling of tightness.	Lubricate dry areas of the skin twice a day.
Lipikar	Intensively moisturizes the skin, relieves itching and promotes wound healing.	Lubricate areas of dry and rough skin once a day.
Trixera	Reduces skin hypersensitivity, moisturizes and restores the lipid layer.	Apply the cream to previously cleansed skin once or twice a day.
Atoderm	Moisturizes the skin and eliminates its hypersensitivity.	The cream is applied to slightly damp but cleansed skin twice a day.
Xemosis	Relieves irritation and has a calming effect on the skin.	Apply to previously cleansed skin once or twice a day.
Ointments and creams that speed up the healing process
Solcoseryl	Due to its composition, it promotes tissue healing and enhances regenerative processes in the focus of inflammation.	The gel or ointment is smeared directly on the wound surface, which is pre-cleaned. Apply 1 - 2 times a day, and if necessary, cover the wound with a bandage.
Actovegin	Increases metabolic processes at the site of healing, thereby accelerating the healing of wounds and other elements of atopic dermatitis.	The ointment is applied in a layer of 2 - 3 mm on the affected surface twice a day.
Methyluracil ointment	It has an anti-inflammatory effect, stimulates and accelerates healing.	Apply a thin layer of ointment to the pre-cleaned damaged surface. After application, fix with a bandage.

The choice of the dosage form of the drug, whether it is an ointment, cream or emulsion, depends on the form of atopic dermatitis and the stage of its development. So in the acute phase, which is accompanied by weeping and crusting, emulsions, tinctures and aerosols are recommended. For example, chamomile tincture is prescribed ( which has antiseptic properties) or Burow's liquid. If the acute phase is not accompanied by maceration ( moist skin softening), you can use creams and pastes. In the chronic course of atopic dermatitis, ointments are prescribed. Any pharmaceutical preparation intended for the treatment of atopic dermatitis is available in several forms. For example, solcoseryl is available both in the form of an ointment and in the form of a gel.

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

Name of the drug	Mechanism of action	Mode of application
Suprastin	Blocks histamine receptors, thereby preventing its release in atopic dermatitis.	One tablet three times a day. The maximum daily dose is 100 mg, which is equal to 4 tablets. It is applied within 5 - 7 days.
clemastine	Prevents the development of edema, eliminates itching.	1 mg ( one tablet) twice a day.
Loratadine	Reduces itching and redness, facilitates the course of the allergic process.	One tablet ( 10 mg) once a day.
Sodium cromoglycate	Stabilizes the cell membrane, preventing the release of inflammatory mediators from it. Prevents the development of allergic reactions.	Two capsules ( 200 mg) 2 to 4 times a day. Capsules should be taken half an hour before meals.
Ketotifen	It inhibits the release of histamine and other mediators, thereby eliminating their effects.	Tablets are taken orally during meals. One tablet recommended 1 mg) in the morning and in the evening.
Pills that normalize the emotional background
Tofisopam	It has a stress-protective effect, relieves stress.	The daily dose of the drug is 150 - 300 mg, which is equal to 3 - 6 tablets. This dose is divided into 3 doses.
Bellataminal	Relieves increased excitability, has a calming effect.	One tablet 2 to 3 times a day. Tablets are recommended to be taken after meals.
Persen	It has a pronounced sedative effect, has a slight hypnotic effect.	2 tablets three times a day. For insomnia, take 2 tablets at bedtime.
Atarax	Relieves stress, has a moderate sedative and hypnotic effect.	The average dose is 50 mg per day, which corresponds to 2 tablets of 25 mg. As a rule, the dose is divided into 3 doses - half a tablet in the morning and in the afternoon, and one whole tablet at night.
Amitriptyline	It has a pronounced sedative effect, eliminates stress, normalizes the emotional background.	The initial dose is 50 mg per day ( 2 tablets). After 2 weeks, the dose is increased to 100 mg per day.
Diazepam	It relieves nervous tension, anxiety, has a moderate hypnotic effect.	The daily dose is 5 - 15 mg ( 3 dragees 5 mg). The dose is recommended to be divided into 2-3 doses.
Tablets that normalize the function of the gastrointestinal tract
smectite	Adsorbs toxic substances in the intestines, has a protective effect on the intestinal mucosa.	The contents of the sachet are dissolved in 100 ml of water and taken after meals. The daily dose is from 2 to 3 sachets of the drug.
lignin	It has a detoxifying effect, adsorbs harmful microorganisms and their toxins from the intestines. Increases local immunity.	The drug is taken before meals 3-4 times a day. The paste is diluted in a small amount of water.
Bifidumbacterin	Normalizes the intestinal microflora, increasing nonspecific immunity.	One to two sachets twice a day. The contents of the sachet are diluted in 50 ml of boiled water.
Hilak forte	Regulates the balance of the intestinal flora, restores the intestinal mucosa, thereby increasing its protective properties.	Special pipette ( attached to the drug) measure 40 - 50 drops, which are diluted with a small amount of water. Drops are taken with meals. The daily dose is 150 drops divided into 3 meals.

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

Name of the drug	Mechanism of action	Mode of application
calcium gluconate	It has anti-allergic and anti-inflammatory effects.	10 ml solution ( one ampoule) is administered intravenously for 5 to 7 days.
Sodium thiosulfate	It has a detoxifying and desensitizing effect, and also has an antipruritic effect.	Intravenously, 5 - 10 ml ( one two ampoules) within 5 days.
Prednisolone	It has an anti-allergic and immunosuppressive effect.	From 1 to 2 mg per kg of the patient's weight intravenously or intramuscularly for 3 to 5 days.

When a secondary infection is attached, antibiotics are prescribed ( erythromycin), if bacterial flora has joined and antifungal drugs, if a fungal infection has joined.

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

Physiotherapy treatment

The appointment of physiotherapy for atopic dermatitis should be strictly individual, based on their form of the disease and the characteristics of the organism. Treatment is prescribed only during the period of remission and in the absence of complications ( such as infection).

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

Spa treatment is very important, because for patients with atopic dermatitis, the sea climate is optimal. Moderate sunbathing prolongs the remission period. So, patients with experience notice that in the summer their illness recedes. This is due to the higher humidity at the same time, the humidity should not be excessive) and the therapeutic effect of ultraviolet rays. It has been proven that moderate ultraviolet rays have an immunomodulatory, antiallergic and antipruritic effect. The absence of dust in the air, moderate humidity favorably affect the skin of patients. In addition to sunbathing, hydrogen sulfide and radon baths are allowed.

Is hospitalization necessary for the treatment of atopic dermatitis?

Hospitalization for atopic dermatitis is necessary in cases where a long-term positive result from outpatient treatment ( at home) does not occur. Inpatient treatment is prescribed when there is a risk of deterioration in the general condition of the patient. This can happen due to a severe skin lesion, the size of which occupies a large part of the body area. Also, indications for hospitalization of the patient are cases when atopic dermatitis is manifested by erythroderma ( severe flaking that covers at least 90 percent of the skin).

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.

During hospitalization, the patient's skin condition normalizes, which allows skin tests to be performed and potential allergens to be identified.

Diet for atopic dermatitis

The diet for atopic dermatitis should exclude the ingestion of products that can cause allergies. Also, the diet of a person suffering from this disease should provide the intake of substances that promote epithelialization ( restoration of damaged areas of the skin), the normal functionality of the liver and intestines.

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).

A diet for an adult with atopic dermatitis is compiled taking into account his field of activity, external provocateurs and the characteristics of the disease.
From the diet of a person who is sick with atopic dermatitis or has a tendency to this disease, foods that contain histamine or contribute to its release should be excluded. If allergen tests have not been carried out, then at the initial stage, the use of traditional causative agents of allergic reactions should be removed.

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.

When compiling the diet of a patient with atopic dermatitis, these products must be replaced with those whose level of allergenicity is low.

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

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

When preparing these products, preference should be given to such types of heat treatment as boiling, steaming, stewing.

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.

These products can be replaced with such varieties of fish as pike perch, cod, hake.

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;
• raspberries;
• cherry, sweet cherry;
• pumpkin;
• tomatoes;
• radish;
• eggplant;
• beets, carrots;
• red bell pepper.

Not only pure products should be removed from the diet, but also mashed potatoes, compotes, jams and other dishes prepared on their basis.

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.

Grains and other high carbohydrate foods
Carbohydrates are valuable energy providers. Therefore, in the diet of a person with atopic dermatitis, carbohydrate-containing allergen products must be replaced with those in which the level of allergenicity is lower.

Products with a high degree of allergic activity are:

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

Carbohydrate-containing foods that are allowed for atopic dermatitis include:

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

Milk and dairy products
Milk is a classic allergen product, so patients with atopic dermatitis should be excluded from the diet in the first place. Replace milk and dairy products with fermented milk products.

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).

Fermented milk products that are recommended for atopic dermatitis include kefir, yogurt, cottage cheese.

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.

It provokes the release of an element that contributes to allergic reactions, and such a group of products as food additives. These include preservatives, artificial colors, flavors and flavor enhancers. These substances are not used on their own, but are part of a large number of sausages, semi-finished products, canned fish, pickled and salted vegetables.

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.

Oils should be used as a dressing for salads, when preparing soups ( not for frying) and vegetable purees.

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.

Ensuring normal bowel function
Against the background of poor functionality of the gastrointestinal tract and associated constipation, the body's reaction to allergens is more acute. Therefore, in the diet of a patient with atopic dermatitis, it is necessary to include foods that contribute to good bowel function. Contribute to the patency of food through the intestinal tract, fruits and vegetables with a high fiber content. Also, to prevent constipation, it is necessary to consume about two liters of fluid per day. Dairy products normalize bowel function.

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).

Low Gluten Products
The body of a person with atopic dermatitis does not absorb gluten well ( protein, the second name of which is gluten). As a result, the disease worsens, and the treatment is not effective. This happens because with poor gluten tolerance, the process of splitting and absorption of nutrients by the intestines is disrupted.

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.

Keeping a food diary
A food diary will help you independently diagnose and identify foods that cause allergies in atopic dermatitis. Before starting to keep records, it is necessary to conduct a one-day fast, during which the patient is allowed to drink water, tea and sugar-free crackers. Next, you should gradually introduce dairy products, vegetables, meat, fish into the diet. In the diary, you need to indicate the dishes and the body's reaction to their use. The main condition is to keep records in as much detail as possible, writing down not only the name of the dish, but also its characteristics. It is necessary to describe in detail all the incoming components, the method of cooking, the time of eating. Allergic symptoms should also be noted in detail.

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.

Sample menu for atopic

• 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

The basis for the prevention of atopic dermatitis is the organization of those living conditions that will reduce contact with the allergen. Also, the purpose of preventive measures is the exclusion from human life of factors that contribute to the exacerbation of this pathology.

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

House dust and the mites contained in it cause an exacerbation of atopic dermatitis, regardless of the allergen that provokes pathogenic reactions in the patient. Therefore, the prevention of this disease implies the provision of high-quality protection against these factors.

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

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

Bed dress
For patients with atopic dermatitis, special zippered plastic bags are recommended for mattresses and pillows. Blankets and pillows must be chosen those in which synthetic filler. Wool and down not only provide a favorable environment for Dermatophagoides mites ( dust mites), but are also traditional epidermal allergens ( allergens, which include saliva, feathers, dander, animal excrement). Patients with atopic dermatitis should use special bedding that provides effective protection against dust and mites. In the case of using ordinary bed linen, it must be changed twice a week and boiled once every seven to ten. Sleepwear that can't be washed ( mattresses, pillows) must be treated with special preparations. Pillows should be covered with 2 pillowcases.

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.

Curtains
Curtains, tulle and other textiles for windows in the room where the atopic lives should be replaced with vertical blinds made of polymeric materials. Plant pollen is a factor that causes exacerbation of atopic dermatitis. Therefore, during the flowering period, the windows in the room should be sealed.

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

Sanitary and hygienic standards for atopic dermatitis require compliance with a number of rules when cleaning rooms.

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.

Prevention of atopic dermatitis includes regular cleaning of the living area where a person predisposed to this disease lives. Wet cleaning should be carried out daily, general - once a week. Putting things in order should be carried out in the absence of atopic using special household appliances. It should be noted that ordinary vacuum cleaners are not recommended, as mites penetrate filters and spread throughout the room, worsening the patient's condition. More efficient when cleaning modern vacuum cleaners with carbon and HEPA ( air) filters. In cleaning rooms where there is a person prone to atopic dermatitis, you should not use detergents with strong fragrances, a high content of chlorine.

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.

Skin care
The skin of a person with atopic dermatitis is characterized by dryness, which leads to its damage, facilitating the penetration of pathogenic factors ( bacteria, viruses, fungi).

The stages of an atopic skin care program are.

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

Separate care is necessary for the skin of the scalp.

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.

Skin hydration
It is possible to maintain the required level of skin moisture during the day with the help of irrigation with special means. The composition of such preparations includes thermal water, which not only moisturizes the skin, but also reduces itching. They are available in the form of aerosols, which greatly simplifies their use.

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

Eating a balanced diet and avoiding food allergens is one of the most effective ways to prevent atopic dermatitis. Increases the effectiveness of diet therapy by keeping a food diary in which the patient must note the meals consumed ( components, heat treatment method) and the reaction of the body. The main principle of the atopic diet is not to exclude foods that provoke allergic reactions, but to replace them with other ingredients. Together with food, a person must receive a sufficient amount of vitamins and other useful elements in order to ensure the good functionality of all body systems.

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

In the prevention of atopic dermatitis, non-specific factors that are not allergens, but can exacerbate the disease or contribute to its chronic course, are of great importance.

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.

stress in atopic dermatitis
Negative emotions and worries are closely associated with manifestations of atopic dermatitis. During the period of strong experiences, the rash on the skin and itching become more intense, which only increases the stress of the patient. This pathology has a great influence on the formation of complexes - 25 percent of atopics have mental disorders. Quite often, people with atopic dermatitis experience difficulties in communication, limit the circle of friends, minimize contact with the outside world. Therefore, in the prevention of this disease, a significant role is given to the relatives and relatives of the patient, who should help the sick person gain self-confidence. Atopics should openly discuss their illness with friends, doctors, and others who suffer from similar disorders. Much attention should be paid to the development of resistance to stress. By controlling your reaction and controlling your anxiety, you can prevent the aggravation of this disease.

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).

Physical activity in atopic dermatitis
Atopic patients should avoid intense physical activity, which increases the sweating process. Close contact of the body with clothing, combined with sweat, increases the itching of the skin. You should not completely abandon the sport, as it helps to maintain the patient's physical and emotional health.

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.

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The site provides reference information for informational purposes only. Diagnosis and treatment of diseases should be carried out under the supervision of a specialist. All drugs have contraindications. Expert advice is required!

What is atopic dermatitis?

Atopic dermatitis is a genetically determined, chronic skin disease. Typical clinical manifestations of this pathology are eczematous rash, pruritus and dry skin.
At the moment, the problem of atopic dermatitis has taken on a global character, because the increase in the incidence in recent decades has increased several times. So, in children up to a year, atopic dermatitis is recorded in 5 percent of cases. In the adult population, this figure is slightly lower and varies from 1 to 2 percent.

For the first time, the term "atopy" (which means from Greek - unusual, alien) was proposed by the scientist Koka. By atopy, he understood a group of hereditary forms of increased sensitivity of the organism to various environmental influences.
Today, the term "atopy" refers to a hereditary form of allergy, which is characterized by the presence of IgE antibodies. The reasons for the development of this phenomenon are not completely clear. Synonyms for atopic dermatitis are constitutional eczema, constitutional neurodermatitis, and Besnier's prurigo (or prurigo).

Statistics on atopic dermatitis

Atopic dermatitis is one of the most frequently diagnosed diseases among children. Among girls, this allergic disease occurs 2 times more often than among boys. Various studies in this area confirm the fact that residents of large cities are most susceptible to atopic dermatitis.

Among the factors that accompany the development of childhood atopic dermatitis, the most significant is heredity. So, if one of the parents suffers from this skin disease, the likelihood that the child will have a similar diagnosis is up to 50 percent. If both parents have a history of the disease, the chances of a child being born with atopic dermatitis increase to 75 percent. Statistics show that in 90 percent of cases this disease manifests itself between the ages of 1 and 5 years. Very often, in about 60 percent of cases, the disease makes its debut even before the child reaches the age of one. The first manifestations of atopic dermatitis at a more mature age are much less common.

Atopic dermatitis is one of the diseases that have become widespread in recent decades. So, in the United States of America, at the moment, in comparison with the data of twenty years ago, the number of patients with atopic dermatitis has doubled. Official figures show that today 40 percent of the world's population is struggling with this disease.

Causes of atopic dermatitis

The causes of atopic dermatitis, like many immune diseases, remain unexplored today. There are several theories regarding the origin of atopic dermatitis. To date, the most convincing is the theory of allergic genesis, the theory of impaired cellular immunity and the hereditary theory. In addition to the immediate causes of atopic dermatitis, there are also risk factors for this disease.

Theories for the development of atopic dermatitis are:

• the theory of allergic genesis;
• genetic theory of atopic dermatitis;
• theory of impaired cellular immunity.

Theory of allergic genesis

This theory links the development of atopic dermatitis with congenital sensitization of the body. Sensitization is the increased sensitivity of the body to certain allergens. This phenomenon is accompanied by increased secretion of class E immunoglobulins (IgE). Most often, the body develops hypersensitivity to food allergens, that is, to food products. Food sensitization is most common in infants and younger preschool children. Adults tend to develop sensitization to household allergens, pollen, viruses, and bacteria. The result of such sensitization is an increased concentration of IgE antibodies in the serum and the launch of the body's immune responses. Antibodies of other classes also take part in the pathogenesis of atopic dermatitis, but it is IgE that provokes autoimmune phenomena.

The number of immunoglobulins correlates (interrelated) with the severity of the disease. So, the higher the concentration of antibodies, the more pronounced the clinical picture of atopic dermatitis. Mast cells, eosinophils, leukotrienes (representatives of cellular immunity) also take part in the violation of immune mechanisms.

If in children the leading mechanism in the development of atopic dermatitis is food allergy, then in adults, pollen allergens are of great importance. Pollen allergy among the adult population occurs in 65 percent of cases. In second place are household allergens (30 percent), in third place are epidermal and fungal allergens.

The frequency of different types of allergens in atopic dermatitis

Genetic theory of atopic dermatitis

Scientists have reliably established the fact that atopic dermatitis is a hereditary disease. However, it has not yet been possible to establish the type of inheritance of dermatitis and the level of genetic predisposition. The latter indicator varies in different families from 14 to 70 percent. If both parents in the family suffer from atopic dermatitis, then the risk for the child is more than 65 percent. If this disease is present in only one parent, then the risk for the child is halved.

The theory of impaired cellular immunity

Immunity is represented by humoral and cellular link. Cellular immunity refers to a type of immune response, in the development of which neither antibodies nor the compliment system take part. Instead, immune function is carried out by macrophages, T-lymphocytes, and other immune cells. This system is particularly effective against virus-infected cells, tumor cells and intracellular bacteria. Violations at the level of cellular immunity underlie diseases such as psoriasis and atopic dermatitis. Skin lesions, according to experts, are caused by autoimmune aggression.

Risk factors for atopic dermatitis

These factors significantly increase the risk of developing atopic dermatitis. They also affect the severity and duration of the disease. Often, the presence of one or another risk factor is the mechanism that delays the remission of atopic dermatitis. For example, the pathology of the gastrointestinal tract in a child can hold back recovery for a long time. A similar situation is observed in adults during stress. Stress is a powerful psychotraumatic factor that not only prevents recovery, but also aggravates the course of the disease.

Risk factors for atopic dermatitis are:

• pathology of the gastrointestinal tract;
• stress;
• unfavorable ecological environment.

Pathology of the gastrointestinal tract (GIT)
It is known that the human intestinal system performs a protective function of the body. This function is realized thanks to the abundant lymphatic system of the intestine, the intestinal flora and the immunocompetent cells that it contains. A healthy gastrointestinal system ensures that pathogenic bacteria are neutralized and eliminated from the body. In the lymphatic vessels of the intestine there are also a large number of immune cells that, at the right time, resist infections. Thus, the intestine is a kind of link in the chain of immunity. Therefore, when there are various pathologies at the level of the intestinal tract, this primarily affects the human immune system. Proof of this is the fact that more than 90 percent of children with atopic dermatitis have various functional and organic pathologies of the gastrointestinal tract.

Gastrointestinal diseases that most often accompany atopic dermatitis include:

• biliary dyskinesia.

These and numerous other pathologies reduce the intestinal barrier function and trigger the development of atopic dermatitis.

Artificial feeding
Premature transition to artificial formulas and early introduction of complementary foods are also risk factors for atopic dermatitis. It is generally accepted that natural breastfeeding reduces the risk of developing atopic dermatitis several times. The reason for this is that breast milk contains maternal immunoglobulins. In the future, together with milk, they enter the body of the child and provide him with the formation of immunity for the first time. The child's body begins to synthesize its own immunoglobulins much later. Therefore, at the first stages of life, immunity to the child is provided by the immunoglobulins of mother's milk. Premature refusal of breastfeeding weakens the immune system of the baby. The consequence of this are numerous anomalies in the immune system, which increases the risk of developing atopic dermatitis several times.

Stress
Psychoemotional factors can provoke an exacerbation of atopic dermatitis. The influence of these factors reflects the neuro-allergic theory of the development of atopic dermatitis. Today it is generally accepted that atopic dermatitis is not so much a skin disease as a psychosomatic one. This means that the nervous system plays a critical role in the development of this disease. This is confirmed by the fact that antidepressants and other psychotropic drugs are successfully used in the treatment of atopic dermatitis.

Unfavorable ecological environment
This risk factor has become increasingly important in recent decades. This is explained by the fact that emissions from industrial enterprises create an increased burden on human immunity. An unfavorable environment not only provokes exacerbations of atopic dermatitis, but can also be involved in its initial development.

Risk factors are also living conditions, namely the temperature and humidity of the room in which a person lives. So, temperatures over 23 degrees and humidity less than 60 percent adversely affect the condition of the skin. Such living conditions reduce the resistance (resistance) of the skin and trigger immune mechanisms. The situation is aggravated by the irrational use of synthetic detergents, which can enter the human body through the respiratory tract. Soap, shower gel and other hygiene products act as irritants and contribute to itching.

Stages of atopic dermatitis

In the development of atopic dermatitis, it is customary to distinguish several stages. These stages or phases are characteristic of certain age intervals. Each phase also has its own symptoms.

The phases of development of atopic dermatitis are:

• infant phase;
• baby phase;
• adult phase.

Since the skin is an organ of the immune system, these phases are considered as features of the immune response in different age periods.

Infant phase of atopic dermatitis

This phase develops at the age of 3-5 months, rarely at 2 months. Such an early development of the disease is explained by the fact that starting from 2 months, the lymphoid tissue begins to function in a child. Since this body tissue is a representative of immunity, its functioning is associated with the onset of atopic dermatitis.

The skin lesion in the infantile phase of atopic dermatitis is different from other phases. So, in this period, the development of weeping eczema is characteristic. Red weeping plaques appear on the skin, which quickly become covered with crusts. In parallel with them, papules, vesicles and urticaria elements appear. Initially, rashes are localized in the skin of the cheeks and forehead, without affecting the nasolabial triangle. Further, skin changes affect the surface of the shoulders, forearms, extensor surfaces of the lower leg. The skin of the buttocks and thighs is often affected. The danger in this phase is that an infection can join very quickly. Atopic dermatitis in the infantile phase is characterized by periodic exacerbations. Remissions are usually short-lived. The disease is exacerbated by teething, with the slightest bowel disorder or a cold. Spontaneous healing is rare. As a rule, the disease passes into the next phase.

Childhood phase of atopic dermatitis
The children's phase is characterized by a chronic inflammatory process of the skin. This stage is characterized by the development of follicular papules and lichenoid lesions. Rashes often affect the area of ​​​​the elbow and popliteal folds. The rash also affects the flexor surfaces of the carpal joints. In addition to the rashes typical of atopic dermatitis, so-called dyschromias also develop in this phase. They appear as scaly brown lesions.

The course of atopic dermatitis in this phase is also undulating with periodic exacerbations. Exacerbations occur in response to various provoking environmental factors. The relationship with food allergens during this period decreases, but there is an increased sensitization (sensitivity) to pollen allergens.

Adult phase of atopic dermatitis
The adult phase of atopic dermatitis coincides with puberty. This stage is characterized by the absence of weeping (eczematous) elements and the predominance of lichenoid foci. The eczematous component joins only during periods of exacerbation. The skin becomes dry, infiltrated rashes appear. The difference of this period is the change in the localization of the rashes. So, if in the childhood period the rash prevails in the area of ​​\u200b\u200bthe folds and rarely affects the face, then in the adult phase of atopic dermatitis it migrates to the skin of the face and neck. On the face, the nasolabial triangle becomes the affected area, which is also not typical for the previous stages. Also, rashes can cover the hands, upper body. In this period, the seasonality of the disease is also minimally expressed. In general, atopic dermatitis is exacerbated by exposure to various irritants.

Atopic dermatitis in children

Atopic dermatitis is a disease that begins in infancy. The first symptoms of the disease appear by 2-3 months. It is important to know that atopic dermatitis does not develop before 2 months. Almost all children with atopic dermatitis have polyvalent allergies. The term "polyvalent" means that the allergy develops to several allergens at the same time. The most common allergens are food, dust, household allergens.

The first symptoms of atopic dermatitis in children are diaper rash. Initially, they appear under the armpits, gluteal folds, behind the ears and in other places. At the initial stage, diaper rash looks like reddened, slightly swollen areas of the skin. However, very quickly they go into the stage of weeping wounds. The wounds do not heal for a very long time and are often covered with wet crusts. Soon, the skin on the baby's cheeks also becomes diaper rash and reddened. The skin of the cheeks very quickly begins to peel off, as a result of which it becomes rough. Another important diagnostic symptom is milk crusts that form on the eyebrows and scalp of the child. Starting at the age of 2 - 3 months, these signs reach their maximum development by 6 months. In the first year of life, atopic dermatitis goes away with little or no remission. Rarely, atopic dermatitis begins at one year of age. In this case, it reaches its maximum development by 3-4 years.

Atopic dermatitis in the baby

In children of the first year of life, that is, in infants, two types of atopic dermatitis are distinguished - seborrheic and nummular. The most common type of seborrheic atopic dermatitis, which begins to appear as early as 8-9 weeks of age. It is characterized by the formation of small, yellowish scales in the area of ​​the scalp. At the same time, in the area of ​​\u200b\u200bthe folds, the baby reveals weeping and difficult to heal wounds. Seborrheic type of atopic dermatitis is also called skinfold dermatitis. When an infection is attached, a complication such as erythroderma develops. In this case, the skin of the face, chest and limbs of the baby becomes bright red. Erythroderma is accompanied by severe itching, as a result of which the baby becomes restless and constantly cries. Soon, hyperemia (reddening of the skin) becomes generalized. The entire skin of the child becomes burgundy and covered with large-lamellar scales.

The nummular type of atopic dermatitis is less common and develops at the age of 4-6 months. It is characterized by the presence on the skin of spotted elements covered with crusts. These elements are localized mainly on the cheeks, buttocks, limbs. Like the first type of atopic dermatitis, this form also often transforms into erythroderma.

Development of atopic dermatitis in children

More than 50 percent of children suffering from atopic dermatitis in the first year of life, it goes away by 2-3 years of age. In other children, atopic dermatitis changes its character. First of all, the localization of the rash changes. There is a migration of atopic dermatitis into the skin folds. In some cases, dermatitis can take the form of palmar-plantar dermatosis. As the name suggests, in this case, atopic dermatitis affects only the palmar and plantar surfaces. At the age of 6 years, atopic dermatitis can take on localization in the buttocks and inner thighs. This localization can persist until adolescence.

Atopic dermatitis in adults

As a rule, after puberty, atopic dermatitis can take an abortive form, that is, disappear. As you grow older, exacerbations are less common, and remissions can be delayed for several years. However, a strong psycho-traumatic factor can again provoke an exacerbation of atopic dermatitis. Severe somatic (bodily) diseases, stress at work, family troubles can act as such a factor. However, according to most authors, atopic dermatitis in people older than 30–40 years is a very rare phenomenon.

The frequency of occurrence of atopic dermatitis in different age groups

Symptoms of atopic dermatitis

The clinical picture of atopic dermatitis is very diverse. Symptoms depend on age, gender, environmental conditions and, importantly, on comorbidities. Exacerbations of atopic dermatitis coincide with certain age periods.

Age periods of exacerbation of atopic dermatitis include:

• infancy and early childhood (up to 3 years)- this is the period of maximum exacerbations;
• age 7 – 8 years- associated with the start of school;
• age 12 – 14 years- puberty, exacerbation due to numerous metabolic changes in the body;
• 30 years- most often in women.

Also, exacerbations are often timed to seasonal changes (spring - autumn), the moment of pregnancy, stress. Almost all authors note the period of remission (subsidence of the disease) in the summer months. Exacerbations in the spring-summer period occur only in cases where atopic dermatitis develops against the background of hay fever or respiratory atopy.

The characteristic symptoms of atopic dermatitis are:

• rash;
• dryness and peeling.

Itching in atopic dermatitis

Itching is an essential symptom of atopic dermatitis. Moreover, it can persist even when there are no other visible signs of dermatitis. The causes of itching are not fully understood. It is believed that it develops due to too dry skin. However, this does not fully explain the causes of such intense itching.

The characteristics of itching in atopic dermatitis are:

• persistence - itching is present even when there are no other symptoms;
• intensity - itching is very pronounced and persistent;
• persistence - itching reacts poorly to medication;
• increased itching in the evening and at night;
• accompanied by scratches.

Persistent (constantly present) for a long time, itching causes severe suffering to patients. Over time, it becomes the cause of insomnia and psycho-emotional discomfort. It also worsens the general condition and leads to the development of asthenic syndrome.

Dryness and flaking of the skin in atopic dermatitis

Due to the destruction of the natural lipid (fatty) membrane of the epidermis, the skin of a patient suffering from dermatitis begins to lose moisture. The consequence of this is a decrease in skin elasticity, its dryness and peeling. The development of lichenification zones is also characteristic. Lichenification zones are areas of dry and sharply thickened skin. In these areas, the process of hyperkeratosis, that is, excessive keratinization of the skin, takes place.
Lichenoid foci are often formed in the area of ​​\u200b\u200bfolds - popliteal, elbow.

What does the skin look like with atopic dermatitis?

How the skin looks with atopic dermatitis depends on the form of the disease. At the initial stages of the disease, the erythematous form with lichenification is most common. Lichenification is the process of thickening of the skin, which is characterized by an increase in its pattern and increased pigmentation. In the erythematous form of atopic dermatitis, the skin becomes dry and thickened. It is covered with numerous crusts and small-lamellar scales. In large numbers, these scales are located on the elbows, lateral surfaces of the neck, and popliteal fossae. In the infant and child phase, the skin looks edematous, hyperemic (reddened). With a purely lichenoid form, the skin is even more dry, puffy and has a pronounced skin pattern. The rash is represented by shiny papules that merge in the center and only a small amount remain on the periphery. These papules very quickly become covered with small scales. Due to the excruciating itching, scratches, abrasions, and erosion often remain on the skin. Separately, foci of lichenification (thickened skin) are localized on the upper chest, back, and neck.

In the eczematous form of atopic dermatitis, the rashes are limited. They are represented by small vesicles, papules, crusts, cracks, which, in turn, are located on scaly skin areas. Such limited areas are located on the hands, in the region of the popliteal and elbow folds. In the prurigo-like form of atopic dermatitis, the rash mostly affects the skin of the face. In addition to the above forms of atopic dermatitis, there are also atypical forms. These include "invisible" atopic dermatitis and the urticarial form of atopic dermatitis. In the first case, the only symptom of the disease is intense itching. There are only traces of scratching on the skin, and no visible rashes are detected.

Both during the exacerbation of the disease and during the period of remission, the skin of a patient with atopic dermatitis is characterized by dryness and flaking. In 2 to 5 percent of cases, ichthyosis is noted, which is characterized by the presence of numerous small scales. In 10 - 20 percent of cases, patients have increased folding (hyperlinearity) of the palms. The skin of the trunk is covered with whitish, shiny papules. On the lateral surfaces of the shoulders, these papules are covered with horny scales. With age, there is increased pigmentation of the skin. Age spots, as a rule, are non-uniform in color and are distinguished by their different colors. Net pigmentation together with increased folding can be localized on the front surface of the neck. This phenomenon gives the neck a dirty appearance (a symptom of "dirty neck").

Whitish spots often appear on the face in the cheek area in patients with atopic dermatitis. In the stage of remission, a sign of the disease may be cheilitis, chronic seizures, cracks in the lips. An indirect sign of atopic dermatitis may be an earthy skin tone, pallor of the skin of the face, periorbital darkening (dark circles around the eyes).

Atopic dermatitis on the face

Manifestations of atopic dermatitis on the skin of the face are not always found. Skin changes affect the skin of the face in the eczematous form of atopic dermatitis. In this case, erythroderma develops, which in young children affects mainly the cheeks, and in adults also the nasolabial triangle. Young children develop the so-called "bloom" on the cheeks. The skin becomes bright red, edematous, often with numerous cracks. Cracks and weeping wounds quickly become covered with yellowish crusts. The area of ​​the nasolabial triangle in children remains intact.

In adults, changes on the skin of the face are of a different nature. The skin acquires an earthy hue, becomes pale. Spots appear on the cheeks of patients. In the stage of remission, a sign of the disease may be cheilitis (inflammation of the red border of the lips).

Diagnosis of atopic dermatitis

Diagnosis of atopic dermatitis is based on the patient's complaints, objective examination data and laboratory data. At the appointment, the doctor should carefully ask the patient about the onset of the disease and, if possible, about the family history. Of great diagnostic significance are data on diseases of a brother or sister.

Medical examination for atopic

The doctor begins the examination with the patient's skin. It is important to examine not only the visible areas of the lesion, but the entire skin. Often, the elements of the rash are masked in the folds, under the knees, on the elbows. Next, the dermatologist evaluates the nature of the rash, namely the location, the number of elements of the rash, color, and so on.

Diagnostic criteria for atopic dermatitis are:

• Itching is an obligate (strict) sign of atopic dermatitis.
• Rashes - the nature and age when the first rashes appeared are taken into account. Children are characterized by the development of erythema in the area of ​​the cheeks and the upper half of the body, while in adults foci of lichenification (thickening of the skin, impaired pigmentation) predominate. Also, after adolescence, dense isolated papules begin to appear.
• Recurrent (wavy) course of the disease - with periodic exacerbations in the spring-autumn period and remissions in the summer.
• The presence of a concomitant atopic disease (eg, atopic asthma, allergic rhinitis) is an additional diagnostic criterion in favor of atopic dermatitis.
• The presence of a similar pathology among family members - that is, the hereditary nature of the disease.
• Increased dryness of the skin (xeroderma).
• Strengthening the pattern on the palms (atopic palms).

These signs are the most common in the clinic of atopic dermatitis.
However, there are also additional diagnostic criteria that also speak in favor of this disease.

Additional signs of atopic dermatitis are:

• frequent skin infections (eg, staphyloderma);
• recurrent conjunctivitis;
• cheilitis (inflammation of the mucous membrane of the lips);
• darkening of the skin around the eyes;
• increased pallor or, conversely, erythema (redness) of the face;
• increased folding of the skin of the neck;
• dirty neck symptom;
• the presence of an allergic reaction to medications;
• periodic visits;
• geographical language.

Tests for atopic dermatitis

Objective diagnosis (that is, examination) of atopic dermatitis is also supplemented by laboratory data.

Laboratory signs of atopic dermatitis are:

• increased concentration of eosinophils in the blood (eosinophilia);
• the presence in the blood serum of specific antibodies to various allergens (for example, to pollen, some food products);
• decrease in the level of CD3 lymphocytes;
• decrease in the CD3/CD8 index;
• decreased activity of phagocytes.

These laboratory data should also be supported by allergy skin tests.

The severity of atopic dermatitis

Often, atopic dermatitis is combined with damage to other organs in the form of an atopic syndrome. Atopic syndrome is the presence of several pathologies at the same time, for example, atopic dermatitis and bronchial asthma or atopic dermatitis and intestinal pathology. This syndrome is always much more severe than isolated atopic dermatitis. In order to assess the severity of the atopic syndrome, a European working group developed the SCORAD (Scoring Atopic Dermatitis) scale. This scale combines objective (physician-visible signs) and subjective (patient-presented) criteria for atopic dermatitis. The main advantage of using the scale is the ability to assess the effectiveness of treatment.

The scale provides a score for six objective symptoms - erythema (redness), edema, crusts / scales, excoriations / scratching, lichenification / peeling and dry skin.
The intensity of each of these features is assessed on a 4-point scale:

• 0 - absence;
• 1 - weak;
• 2 - moderate;
• 3 - strong.

Summing up these scores, calculate the degree of activity of atopic dermatitis.

The degrees of activity of atopic dermatitis include:

• Maximum degree of activity equivalent to atopic erythroderma or a common process. The intensity of the atopic process is most pronounced in the first age period of the disease.
• High degree of activity determined by widespread skin lesions.
• moderate degree of activity characterized by a chronic inflammatory process, often localized.
• Minimum degree of activity includes localized skin lesions - in infants, these are erythematous-squamous lesions on the cheeks, and in adults, local perioral (around the lips) lichenification and / or limited lichenoid lesions in the elbow and popliteal folds.

Before use, you should consult with a specialist.