Atopic dermatitis clinical. Atopic dermatitis: clinical picture and treatment

"ATOPIC DERMATITIS ADVICE TO PARENTS ATOPIC DERMATITIS ADVICE TO PARENTS Edited by: Professor Radionov V. G. ..."

Edited by:

Professor Radionov V. G.

Professor Litus A.I.

This guide has been prepared by:

Radionov V. G. - Honored Doctor of Ukraine, Doctor of Medical Sciences, Professor, Head of the Department of Dermatovenereology, Luhansk State Medical University, Chief Physician of the Luhansk Regional Dermatovenerologic Dispensary, Chief Dermatovenereologist of the Main Health Department of the Lugansk Regional State Administration.

Litus A.I. - Doctor of Medical Sciences, Professor of the Department of Dermatovenereology, NMAPE named after I.I. P.L. Shupika, chief freelance specialist of the Ministry of Health of Ukraine in the specialty "Dermatovenereology", director of TMO "Dermatovenereology", Kyiv.

Atopic dermatitis: advice to parents Radionov V. G., Litus A. I. - Kyiv: 2014. - 52 p.

This publication presents some clinical features, course, issues of hypoallergenic diet and nutrition, preventive measures and modern methods of caring for dry, problematic skin with elements of external therapy for atopic dermatitis, mostly in children. The manual in the form of useful information and advice is intended for future or already established parents, grandparents and close relatives of children suffering from atopic dermatitis, for the patients themselves suffering from this disease. No less interesting for dermatovenereologists, pediatricians, allergists, gastroenterologists, immunologists, family doctors, interns of these specialties, senior students of medical faculties of universities, but mainly designed for a mass readership.

Illustrations: Vladimir Cherny Design and layout: Alexey Martynov Introduction In this book you will find answers to the most common answers regarding atopic dermatitis. What is this disease, who gets it?

How to prevent atopic dermatitis and what to do when a child is diagnosed with this disease? In this book, you will also find recommendations for women during pregnancy and breastfeeding that can help reduce the risk of developing atopic dermatitis in a child. Particular attention is paid to the diet and principles of skin care for a child prone to atopy, as well as modern methods of treating atopic dermatitis.

Remember, atopic dermatitis is not a death sentence, the vast majority of patients can be helped by minimizing the manifestations of atopic dermatitis. The main task of treating atopic dermatitis is to quickly remove the manifestations of the disease and prolong remission as much as possible, but its solution depends not only on doctors and medications, but also on the patient himself and his parents. This book will help us consolidate our efforts and defeat atopic dermatitis!

What is atopic dermatitis?

Atopic dermatitis (AD) is a chronic relapsing disease

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Most often, this disease develops in children with a genetic (hereditary) predisposition to allergies under the influence of external and internal environmental factors. In the presence of an allergic disease in both parents, the risk of developing AD in a child is 60-80%, in one of the parents up to 45-50%.

The risk of developing AD in children from healthy parents can reach from 10 to 20%. Allergy is a disease of our growing well-being.

How and when does atopic dermatitis manifest itself in children and adults?

The earliest and most common symptoms in infancy are hyperemia (redness) and swelling of the skin of the cheeks, accompanied by slight peeling and the appearance of small (poppy seed-sized) nodules. Together with these symptoms, “gneiss” (fatty scales around a large fontanel), “milky scab” (limited reddening of the skin of the face and the appearance of yellowish crusts on it), periodically occurring flushing of the skin of the cheeks and buttocks can be observed.

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What do we see on the skin?

foci of weeping appear on the cheeks (accumulation of opening bubbles with small erosions separating a clear liquid);

the process becomes more widespread, capturing the forehead, ear areas, scalp, collar zone, torso (Fig. 1);

skin rashes can spread over the entire surface of the upper and lower extremities, the elbow and popliteal fossae, wrists, buttocks, etc. are affected.

children are concerned about constant or periodic, severe or moderate itching of the skin.

Rice. one

In children older than two years and before puberty, the disease manifests itself somewhat differently. The process is widespread. The skin in places of typical localization (face, neck, ulnar and popliteal fossae, flexion surfaces of the ankle and wrist joints) gradually swells, thickens, becomes pigmented, becomes dry, looks dull, thickened, flaky, i.e. skin changes take on a shagreen appearance (Fig. 2).

Severe itching is noted, scratches, crusts appear, sometimes deep linear scratches and scars remain. Often on such skin there are pustules, Fig. 2 Places of typical localization of a skin rash in AD are enlarged lymph nodes, body temperature rises, there is a decrease in sweating, and often in patients, exacerbation is associated with sweating during physical exertion.

Reddened and swollen areas of the skin as a result of prolonged and constant scratching and rubbing (Fig. 3) are transformed into areas of lichenification, which is a thickening, swelling and thickening of the skin, as a result of which its physiological pattern increases, dryness of the skin occurs, pigmentation is disturbed, etc. The lips become inflamed and dry (Fig. 4), cracks appear in the corners of the mouth (jamming), eczematous irritation occurs around the mouth, and peeling with increased pigmentation is noted around the eyes.

Appears dryness (xeroderma) of the entire skin, which significantly reduces the quality of life of a child, and in the future, an adult. Such a skin

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constantly is the entrance gate for pustular and fungal infections.

The skin of the palms and soles becomes dry, thickened, rough, sometimes with cracks, cracks appear on the fingertips, sweating is disturbed with relapses in the cold season. The child, like an adult, is worried about severe itching, leading to a vicious circle: the stronger the itching, the more willingly the patient wants to scratch, and the more he irritates the skin, the more intense itching occurs, and this will continue until as long as it does not forcibly damage the skin, up to the appearance of deep bloody scratches.

Parents should remember that the longer the problem exists, the more difficult and expensive it is to get out of this circle.

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Among the factors that provoke the occurrence and development of atopic (allergic) rashes in children with a hereditary predisposition, the most important are: food, inhalation allergens, external stimuli of a physical nature, animal and plant origin (contact allergens), meteorological factors. Of no small importance in the occurrence of allergies in children is given to domestic and exotic animals, birds and small birds, wool, fluff, dander and excrement of which are powerful allergens, which parents often do not pay attention to.

Rice. 5 The child's skin is shagreen with a pronounced skin pattern and looks like a little "old man"

In young children, of course, food allergy plays a leading role in the occurrence and development of the skin process. It should be noted that many diseases of adults are laid in the first year of a child's life.

Atopic manifestations on the skin that have arisen in infants or young children, with strict adherence to the mother's diet (during breastfeeding) and the most rational diet of the child, in most cases disappear on their own by 5-6 years of his life, and mild skin manifestations severity within 1-2 years, as the digestive organs of the child's body mature.

However, with age, in severe, advanced cases of AD (self-medication, negligence of the mother and relatives, non-compliance with the medical recommendations of dermatologists, pediatricians, allergists), there is a great risk against the background of food allergies, the formation of household, pollen, fungal allergies, followed by the occurrence of complex in their own way. course, treatment and prognosis of diseases, such as bronchial asthma, allergic conjunctivitis, rhinitis, etc.

diseases.

Nutrition during pregnancy of the expectant mother in order to prevent the occurrence of AD Pregnancy is not a disease, but a normal physiological process, in which it is advisable not to interfere, but to understand the main thing - the higher the mother's health level, the healthier her child will be! During pregnancy, women's basic natural instincts prevail: to eat, sleep and take care of the child.

In order for the fetus to develop properly in utero, the mother must observe the sleep schedule, move as much as possible, be in the fresh air and, most importantly, eat right. In other words, lead a healthy lifestyle.

So how should the expectant mother eat and take care of her own health and the health of her child?

As you know, our food consists of proteins, fats, carbohydrates, vitamins, microelements, water, and various biologically active substances. Recently, the use of dietary supplements (chemical biologically active additives, food and, unfortunately, not quite food) has become very popular. The advisability of a pregnant woman using these substances is often highly questionable, and a key factor in their use is the strong recommendation of some "unscrupulous" doctors, as well as paramedics and other charlatans, sometimes with no medical education at all. Do not give in to and follow dubious recommendations, and if you want to take supplements, consult a doctor who monitors your pregnancy.

Eat what your ancestors ate, you will be healthier.

It is very important during the period of embryonic development, and it lasts almost up to 3 months of pregnancy, to take care of your health, nutrition and regimen.

Remember that most congenital malformations originate from this time. In addition to the growth of the child, proteins and other nutrients are needed by the body of the woman herself, for the growth of the uterus, placenta, and breasts.

Protein foods - meat of animals, birds, fish, milk, eggs, cheeses, as well as vegetable proteins should be consumed per day up to 200g. As for the volume of carbohydrates and fats, a pregnant woman does not need to worry too much. Our traditional cuisine allows you to consume even too much of them, the question is more often how to resist this temptation and restrain yourself from overeating.

Separately, it is worth mentioning the need for protein foods in the diet of nursing mothers, because the most important component of milk is protein. Remember, a nursing mother needs to get 500 kilocalories more than normal per day so that she has enough milk and do not forget that lactic acid products, fresh vegetables, spices, etc., can cause distress in an infant, even when they come to him along with breast milk. It is better to limit or exclude them.

Women with a high risk of developing allergies, especially those with a aggravated family history of allergies during the last months of pregnancy and nursing mothers for the entire period of breastfeeding, if the child already has signs of food allergies, a hypoallergenic diet is recommended, i.e. the use of those products that will not cause an exacerbation, and this goal can only be achieved by observing, at least for the most part, the recommendations we have outlined.

Recommended products First of all, all products must be of high quality, with a normal shelf life and not modified. Now in many countries of Western Europe, prices for organic products are an order of magnitude higher than in ordinary supermarkets.

And much attention is paid to this problem, especially by medical specialists involved in the problem of nutrition (the science of proper, rational nutrition).

Meat and broths should be consumed only non-fat, preferably domestic chickens, rabbits, veal, pork, if desired, lamb, turkey.

Use sea fish more often, the assortment of which in stores allows you to choose to your taste. Cooking method - better steam, boiled, worse baked, fried.

Important in the diet of a pregnant woman are products containing calcium ions, which ensure the growth and formation of the baby's skeleton: milk, preferably boiled and better, from under a cow, and not from a supermarket.

It is also good to use homemade cottage cheese, kefir, yogurt, curdled milk, fermented baked milk.

It must be remembered that the older the fetus (in the later weeks of pregnancy), the more calcium is spent on its formation, since during this period it is actively “built”

the skeletal system of the child, and the more he takes it from you. Remember how in childhood you wanted to chew on chalk or school chalk. In this case, biological supplements in the form of calcium or its combination with vitamin D will come in handy. But they should be taken on the recommendation and supervision of a doctor.

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It is advisable to take complex multivitamins with microelements in parallel, the arsenal of which in the pharmacy network is so large that it will take up not a single page of text. Do not forget that not only a deficiency can be harmful, but also an excess of vitamins, for example vitamin A, which increases the risk of various defects in the fetus. More useful is provitamin A (beta-carotene), found in carrots, pumpkins, melons, and it is he who should be present in multivitamins.

If you decide to take multivitamins, be sure to tell your doctor about it, he will advise which ones and how much!

An important role in nutrition is given to vegetables and fruits, and it is better if these fruits are of "organic" origin - grown without the use of pesticides and other chemical fertilizers harmful to humans. Preference should also be given to vegetables that grow in our latitudes: cucumbers, potatoes, cabbage in any form, parsley, green and onions, spinach, salads, carrots (with olive oil or sour cream), turnips, table beets, many varieties of radish , these vegetables will be better absorbed by the body.

You can also eat fruits from our latitudes: apples, grapes, cherries, pears, apricots, watermelons, melons, freshly prepared fruit and berry juices, fruit drinks. In the absence of fresh - dried apricots, dried apricots, raisins, plums, pears, apples, if desired, compotes (uzvars) from dried fruits. Drink non-carbonated water and other liquids in moderation and only as desired. You can use decoctions of herbs, black and green tea with milk and sugar, you can use honey, but do not forget that it is sometimes an allergen.

With the appearance of any edema - water regime and a direct path to the doctor!

Unwanted foods, or which should be limited.

Excessive consumption of exotic foods or medicines by a pregnant or already nursing mother, and even more so dietary supplements without a doctor's recommendation, is fraught with serious consequences for the baby and unambiguously predisposes him to the development of allergies.

Exotic fruits, namely citrus fruits (lemons, oranges, tangerines, grapefruit), coffee, cocoa (creams, pastes, chocolate bars, sweets, butter), bananas, pineapples, persimmons, pomegranates, nectarine are more likely to cause allergies. Moreover, the usual watermelons, melons, strawberries, strawberries, raspberries and other berries out of season are also more prone to allergization of the body of the mother and child.

Any canned and preserved foods (cucumbers, tomatoes, eggplants, zucchini, mushrooms, salad mixes), spicy, salty, sour foods, including salted fish, as well as sweets and spices (cakes, pies, muffins, pastries) should be limited to a minimum. , gingerbread, cookies). Avoid fried foods and especially smoked meats (sausages, balyki, ribs, basturma, lard, poultry in assortment), chemicals that are used for so-called cold smoking are especially allergenic. Alcohol, of course, is contraindicated in pregnant and lactating mothers, as well as children, but even in adult patients with AD, alcohol can cause an exacerbation.

It must be remembered.

Overeating is not good for health in general and for BP in particular! It is better to eat food in fractional portions and get up from the table with a slight feeling of hunger. It is especially undesirable for pregnant women to overeat, this contributes to increased intra-abdominal pressure and can adversely affect the condition of the child. At night, it is advisable to prefer a light dinner, of plant origin (vegetables, fruits, porridge). Monitor the quality and safety of products, check their shelf life when buying.

Evening walks are very useful, they contribute to the work of the muscular and cardiovascular systems, physical activity is the key to health for mother and child.

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Not always overfed "loose" child, quickly gaining weight, is healthy! Watch your baby's weight, exclude sugar and sweets in excess, limit the volume of any kind of cereals, mashed potatoes, especially semolina, which often causes an allergic reaction.

Do physical exercises with your child, play more, move, put away the TV, computer, video games. Try to have your child drink up to 200 ml of liquid per day in the first 6 months (water and tea in equal proportions), and as they grow up, up to one liter of water, low-fat milk and juices per day, but only on the recommendation and under the supervision of a pediatrician.

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It is necessary to start with small portions throughout the day, bringing within 2 weeks (at least) to the required amount, which will facilitate the adaptation of the gastrointestinal tract to these mixtures and to the general adaptation of the child's body. For each new food product (juices, all kinds of purees, cereals, etc.) that you add to the diet, the child must get used to it! And there is absolutely no need to experiment and change milk mixtures in the first 6 months of a baby's life. Strictly the same scheme for the introduction of any products and dishes of complementary foods cannot be strictly the same for everyone, and start introducing complementary foods only if the child is healthy.

New dishes should be introduced only one at a time (each after 2 weeks), gradually adding volume and preferably in the first half of the day in order to trace their tolerance, and if an allergic reaction to this product occurs, it should be excluded and replaced with an equivalent one. If it was not difficult for you to identify the culprit of the allergic reaction, eliminate this cause for 2-3 months and try not to introduce new foods for at least 1 week. Usually, a skin rash after the elimination of the identified "culprit" from the diet disappears after 5-7 days.

Best of all, on the introduction of milk formulas and complementary foods, consult not with your mother, seller or girlfriend who already had a baby, but with your pediatrician - this is the key to reducing the allergic burden on the child and, as a result, successful child nutrition!

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The most common (80-90%) cause of AD in children of the first year of life is an allergy to cow's milk proteins, which is facilitated by the early transfer of a child to mixed and artificial feeding. Therefore, nursing mothers and their environment should make every effort to preserve breast milk. Breastfeeding creates optimal conditions for the normal growth and development of the child due to the unique composition of easily digestible nutrients, vitamins, trace elements and special biologically active components that reliably protect the baby's body from various infectious diseases and allergies.

Breast milk is the best food for your baby!

However, 10-15% of breastfed children are also allergic to cow's milk proteins. And why? This happens when a woman during lactation (breastfeeding) consumes a lot of whole cow's milk, milk soups, cereals.

In such cases, for the entire period of breastfeeding, she should exclude these dairy products from her diet (the use of sour-milk products, mild cheeses, etc., described in the section on pregnant women's nutrition is allowed) and a number of other products that have a high allergenic potential (see the same section and table 1).

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Products from Chocolate, cakes, pies, pi- Buckwheat, rice, Buckwheat, rice, kukumuki, cereals, rye, creams, caramels, pa- corn ruza confectionery, muffins, cereals: oatmeal, Terek pearl barley, millet, rye and products white bread, semolina

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Eliminate all foods that affect the taste of milk (onions, garlic, peppers, a variety of seasonings, spicy, salty, sour dishes), give special preference to non-fat foods - the child will more easily cope with its digestion. Eat not animals, but vegetable fats (preferably olive, corn, pumpkin oil, sunflower oil with caution, it can be an allergen, like sunflower honey).

Be carefull! Do not break your diet, and thus do not provoke allergies in your child, take care of healthy skin, stomach and intestines of the child. You should be aware that allergies can manifest themselves in more than just the skin. Gastrointestinal (damage to the stomach and intestines) allergy is accompanied by a significant violation of the digestive processes, intestinal disorders in the form of diarrhea, and most importantly, a change in the ratio of the normal microflora of the small and large intestines, which in most cases is the trigger for skin manifestations in AD.

Do not force children to drink milk if they do not want to or if the child does not like it? Undoubtedly, milk is the main source of calcium, which is so necessary for strengthening bones and teeth. Children under 3 years of age need up to 800 mg of calcium per day. Senior up to 1 gram or more.

If milk proteins are intolerant, replace it with lactic acid products: yoghurts (without fruit additives), cottage cheese, low-fat curd cheeses, etc. If, with the exclusion of cow's milk, the child still has allergic rashes for 2 or more weeks, milk proteins are not the only cause of skin rashes. So, in recent years, allergic reactions to protein (gluten) of cereal products, primarily to wheat, rye, and oats, have become more frequent. If gluten intolerance is proven, it is necessary to use gluten-free and dairy-free (liquid at first) cereals in the child's diet, for example: rice, buckwheat, corn, etc. Often, children with intolerance to cow's milk proteins are prescribed soy mixtures as a substitute. However, some children may be allergic to soy proteins.

In such cases, mixtures based on products of high hydrolysis of milk protein should be used.

Complementary foods for children suffering from AD are prescribed at the same time as for healthy children. It is necessary to introduce each new product under the strict supervision of a pediatrician.

It is better if the mother (smart, observant and patient) learns to keep a food diary (notebook), in which she will record the name of food products, changes in the state and well-being of the baby every day. This will help her, the dermatologist or pediatrician herself, to determine one or another product that caused the child to develop a rash on the skin.

The first complementary food is vegetable puree. It may include zucchini, squash, cauliflower, white cabbage (may increase gas exchange in the intestines, like legumes), Brussels sprouts, potatoes (no more than 20% in vegetable puree). At the same time, peeled and chopped potatoes are recommended to be pre-soaked in cold water (chlorine-free) for 12-14 hours. The remaining vegetables are soaked for 1-2 hours.

The second dish of complementary foods is dairy-free cereals. The least allergenic of cereals are corn, buckwheat and rice, and the most allergenic are semolina and oatmeal. But remember, in any case, the selection of cereals for feeding a child is carried out individually. When including meat (meat puree) in a child's diet from 6 months, one should take into account the fact that beef has a natural resemblance to cow's milk proteins. Therefore, if they are intolerant, it is recommended to use lean pork, lamb, rabbit meat, white meat of turkey and other birds.

With the introduction of kefir (not earlier than 8 months), you must first find out its tolerance. At the same time, you can add non-butter cookies, crackers, a little later (by 9 months) wheat loaves from flour of the 2nd grade, but with caution, given the intolerance to gluten (proteins) of cereals. As a third complementary food (from 8-9 months), preference is given to vegetable or vegetable-cereal dishes with the inclusion of rice, buckwheat in combination with cauliflower, zucchini in a ratio of 1: 1, it is possible to add mashed potatoes. The introduction of complementary foods, of course, requires a competent approach and taking into account the season of the year, both on the part of pediatricians and on the part of mothers and her home environment.

Freshly squeezed fruit juices (fresh) are not recommended for children under 6 months old, and later they can be introduced into the diet after he gets used to natural fruits. Are they needed in the first year of a child's life? Until the baby's digestive system is formed, they are not particularly shown. The main thing is that the benefits outweigh the harm! But if you give juices, then dilute them equally with water, it is safer and no more than 100 ml per day. A useful product is pumpkin, which contains many trace elements, including iron, vitamins, especially vitamin A. There is a lot of iron in pomegranate, but do not forget that it strengthens, it is better to add it to kefir.

In any case, if you have any questions about formulating a diet for a child, you should be guided by the recommendations of the pediatrician and the attending physician, so that if one or another product is excluded, you can adequately replace it with products of equal nutritional value and calorie content that maximally provide age-related physiological needs of the child.

Must be remembered! From the diet of children suffering from AD, products containing food additives (dyes, emulsifiers, preservatives), broths, spicy, salty, fried foods, smoked meats, canned foods, liver, caviar, seafood, fish, eggs, spicy and processed cheeses, ice cream, mayonnaise, ketchups, mushrooms, nuts, refractory fats and margarine, carbonated fruit drinks, kvass, coffee, cocoa, honey, chocolate products, caramel, cakes, pies, muffins and other spices. But this does not mean that absolutely all of the above is harmful and should be completely excluded, it is important to limit as much as possible only what causes allergies.

Moms! It all depends on your vigilance, attention and attitude towards your child.

Make room for non-allergenic foods at home. Do not eat in front of your child what you forbid him! Explain to the baby what a food allergy is and the sooner the better, while not turning it into a big problem, children are very sensitive and suspicious. You need to do this calmly, not intrusively, so that your explanation will do more good than harm. Report your problem to a kindergarten or school, preferably to medical workers, in their absence to a teacher or class teacher. If possible, prepare breakfasts in a kindergarten or school at home, notifying the educators or class teacher in advance. You can ask to organize an anti-allergic diet for your baby in the dining room of the children's institution, taking into account the identified products that cause allergies and exacerbate the skin process.

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Children are very susceptible to diseases of the nasopharynx and upper respiratory tract. Pay attention to the general condition of your child and monitor his health. Protect your baby from colds and acute respiratory viral diseases.

If it occurs, take measures to quickly eliminate them under the supervision of pediatricians and do everything necessary so that any infectious disease does not turn into a chronic process, which can contribute to more pronounced manifestations of allergies, including exacerbation and spread of skin rashes!

The effectiveness of AD therapy will increase significantly if you strictly follow the recommendations of a pediatrician, dermatologist, allergist and, if possible, independently reduce the impact of the above allergens and factors (with food, air, through the skin), which is the key to our overall success, and in parallel also properly care for the skin of your sick child.

General rules for problem skin care

1. It is very important to properly cleanse the skin. The use of conventional detergents and cosmetics, with a pH of 7.0 (alkaline), destroys the water-fat mantle of the skin, can increase skin dryness, reduce the thickness of the protective stratum corneum (surface layer), and serve as a factor in the exacerbation of AD. Preference should be given to soap-free soaps or gels with a slightly acidic pH (5.5).

2. Persons with AD, regardless of age, need daily 15-20 minute water procedures (shower, bath) that cleanse and moisturize the skin, prevent its infection, improve the penetration of drugs and cosmetic products that you should be applied immediately after water procedures.

3. Bathing water should not be hot (37-38°C).

4. It is advisable to use dechlorinated water by standing it in the bath for 1-2 hours, followed by warming or adding boiling water. You can also use water that has been purified using special filters.

5. It is not advisable to add decoctions of herbs of succession, chamomile, celandine, etc. to bathing water, as this dries out the skin, sometimes causing allergic reactions. Shown (during the absence of inflammation and weeping on the skin) skin softening baths with the use of medical and cosmetic skin care products. A decoction of flaxseed is useful for baths, adding starch, bran at the rate of 100 g per 30 liters of water or using Cleopatra's bath: - mix or beat with a mixer half a glass of cream and half a glass of vegetable oil, it is better to pour the mixture into the bath.

6. When bathing, do not use washcloths and rub the skin.

7. After bathing, the skin is blotted (do not wipe dry!) ​​with a cotton towel. To prevent the effect of evaporation on still wet skin, especially on areas of increased dryness, softening and moisturizing therapeutic and cosmetic skin care products are applied.

8. For washing, it is better to use filtered or mineral water. Remarkable old recipe for water for washing:

2/3 boiled water and 1/3 boiled milk. After washing with tap water, it is necessary to wipe the face with a non-alcoholic tonic, otherwise the remnants of the salts contained in such water dry the skin.

9. The skin of patients with AD is more sensitive to the effects of residual chlorine in tap water than the skin of healthy individuals. In addition, the effect of residual chlorine itself can play a provocative role in the development and exacerbation of AD.

10. Increased skin dryness and exacerbation of AD may be associated with swimming in pools with chemically treated water. Immediately after swimming in pools, AD patients are advised to use mild cleansers to remove chlorine or salt residue, followed by moisturizing skin care products (see Table 2). The cream is applied in places to problematic (dry) areas of the skin, rubbed and gradually rubbed in.

11. If a feeling of tightness of the skin appears, it is necessary to reapply moisturizers during the day. The choice may be to use a spray (aerosol) with thermal water, preferably daily and an unlimited number of times.

12. Moisturizers are used in the morning and evening. With the appearance of severe dryness and tightness of the skin, it can be applied several times throughout the day and always after a bath or shower, according to the indications and recommendations of a dermatologist, in combination with anti-inflammatory drugs that do not contain hormones (tacrolimus, pimecrolimus, etc.).

Basic therapy of atopic dermatitis Recently, more and more attention is paid to the use of medical cosmetics, which is used not only for skin care during remission, but also during exacerbation. Thanks to skin care in patients with atopic dermatitis, dry skin is eliminated, the barrier function of the skin is restored and improved, the frequency and severity of exacerbations of the skin process is reduced, the need for ointments and creams containing corticosteroids (hormones) is reduced, the remission of the disease is prolonged and the quality of life of a sick child or adult.

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In the adopted consensus document "Diagnosis and treatment of atopic dermatitis in children and adults" of 2006, international experts classify skin hydration and the use of moisturizers (emollients) as an auxiliary basic therapy, the use of which is an absolutely necessary element of the treatment of AD. This was also reflected in the draft clinical guidelines for the diagnosis, treatment and prevention of this disease, prepared by a group of expert scientists from the Ministry of Health of Ukraine in 2010-2011 (headed by Prof. Kalyuzhnaya L.D.).

It should be noted that the mechanism of action of most moisturizers is based on the reduction of transepidermal (through the skin) water loss and the replacement of the deficit in the skin of fats that form the skin barrier, and all this is due to their constituent components. But, unfortunately, the duration of exposure and the effectiveness of some products is calculated in hours, from 1-2 to 6-7, so it is advisable to apply them to the skin 3-4 times a day. For more hydration, just before applying the cream, you can use a spray with thermal water.

Taking into account the above consensus document of international and domestic experts on moisturizing and general skin care of patients suffering from atopic dermatitis, we recommend that you use the following medical and cosmetic products from different manufacturers for these purposes, if possible. These emollients and moisturizers are added to the generally accepted standard therapy for children with persistent atopic dermatitis, as the skin of the affected child always remains dry, and also during remission for gentle cleansing, softening, reducing itching and redness of the skin during an exacerbation. They are applied to the skin or added to the bath, which helps to restore the damaged stratum corneum of the skin and increase its protective functions.

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Undoubtedly, the indicated arsenal of moisturizers and cosmetic skin care products on the Ukrainian market is much wider, but we tried to present you with those that are more often used by you and prescribed by dermatologists and pediatricians to care for your baby's problem skin. Of course, these funds in no way fully claim and cannot be a panacea in the treatment of atopic dermatitis and simply dry skin in children, but one cannot do without their use during the remission period. They are the basis for moisturizing the skin, and this is very important, nutrition and reducing subjective sensations, and most importantly, when using them, the hormonal load on the child, and even the adult, is significantly reduced in case of exacerbations of the disease.

Local therapy: therapeutic ointments Basic therapy is the basis of treatment, with the restoration of the skin barrier and proper skin care, the treatment of AD begins. Moreover, sometimes a slight exacerbation of the disease can be removed with one cosmetic cream, but sometimes it is necessary to include specific anti-inflammatory therapy in the treatment. The main two groups of drugs used in the treatment of AD are topical glucocorticosteroids (TCS) and topical calcineurin inhibitors (TCIs).

TCS - popularly referred to as "hormones" is a lifeline that allows you to pull the patient's skin out of exacerbation. These drugs have a fast action, relieve itching and inflammation of the skin. Despite all the advantages of this group of drugs, there are many stereotypes and misconceptions about TCS. It is safe to say that modern drugs, when used correctly, will not cause harm to patients, even very small ones.

1. Do not prescribe the ointment / cream on your own, even if the doctor advised you to use this ointment before, you should consult your doctor before using it again.

2. Do not use funds on the advice of relatives or acquaintances whom this remedy has helped from the same disease. Ointments, even from the same pharmacological group, are very different in properties, action, and method of application.

3. Follow the doctor's recommendations: do not replace the drug with another one on your own; buy only the form (ointment, cream, lotion, etc.) prescribed by the doctor. The same drug in the form of an ointment and an emulsion is indicated for one stage of the disease and may be contraindicated for others.

4. Do not stop treatment on your own, in order to avoid the withdrawal effect.

Also, do not extend the course of therapy without the advice of a doctor, this will help to avoid side effects from the drug.

5. Do not mix the remedy with baby cream, supposedly to reduce the risk of side effects. This can lead to unwanted drug interactions, and significantly reduce the therapeutic effect, while side effects may even increase. Cosmetic cream should be applied about half an hour before the remedy.

6. Observe the dosage and frequency of application of the ointment / cream. Using a larger amount of the drug is fraught with side effects, and a smaller amount may simply not give the expected result.

7. If you notice any reaction on the child's skin after applying the medicine, consult a doctor. If the remedy does not help or, on the contrary, helped very quickly, go to the doctor, he will give you recommendations for further treatment.

TIC is a new era in the anti-inflammatory treatment of AD. These drugs are devoid of side effects characteristic of hormones, since their action is narrowly targeted selective. The drugs of this group can be used both after corticosteroid therapy and instead of it. Given the good safety profile of these drugs, they can be used for a long time to completely eliminate allergic inflammation in the skin.

Phototherapy: when the disease progresses Patients with experience have probably noticed that in the summer, as a rule, the disease recedes. This is due to the higher humidity of the air, and also to the therapeutic effect of ultraviolet (UV). UV has immunomodulatory, anti-inflammatory, antiallergic and antipruritic effects. The use of UV radiation for therapeutic purposes was called phototherapy, and the method of "light therapy" itself was popular back in the days of ancient Egypt.

But solar ultraviolet carries both healing and dangerous parts of the spectrum.

Investigating the effect of UV on skin diseases, in the second half of the 1980s, artificial ultraviolet lamps were developed that emit UV rays in a narrow spectrum with a wavelength of 311+/-1.5 nm. This type of phototherapy is also called narrow-spectrum UVB therapy, or narrow-band phototherapy, in the English version - “narrow-band phototherapy”. These waves have the most healing properties and are much safer for the body than, for example, ordinary quartz. In the modern version, phototherapy is used to treat atopic dermatitis, as well as a number of other skin diseases such as psoriasis, vitiligo, eczema, and a number of others.

Phototherapy can be used in addition to topical ointments/creams, or as an alternative if they fail. Narrow-spectrum phototherapy can be used to treat both the whole body and individual anatomical zones, it can be used in children from 5 years old, as well as in pregnant women and nursing mothers.

Attention parents and others!

1. Avoid stressful situations!

2. Do not forget that the nervous system, both in you and in the child, is the “head” of everything.

3. Soothe the baby by distracting with any toys, games and start any external therapy procedures only when he is in a good mood. Children love gifts so much, something new, interesting. Enter his world!

4. Give him the opportunity to see you as a mom or dad doctor, and show that you are just as interested in treating, applying ointments, creams, lotions, sprays as he is. Involve him in the healing process. He is always interested in new things.

5. Do not irritate or pull the child, he is already torn apart by the disease both inside and out, and besides, he is completely innocent of this!

7. A child needs any signs of love and attention so much!

8. You are given (with the smart approach of parents) a unique opportunity, in parallel with the basic treatment of the affected skin of the baby, to develop his intellectual abilities.

Memo to parents on rational skin care for children with AD

–  –  –

Skin care should be carried out both during the period of exacerbation and during the period of remission, using a wide arsenal of dermatological and cosmetological products, water and physiotherapy procedures, but only if indicated.

External complex therapy is prescribed only by a doctor. You can not use hormonal ointments on their own.

It is necessary to devote time daily to the treatment of lesions (in the morning and in the evening, preferably 30-40 minutes before bedtime).

Immediately after water procedures, the above moisturizing or nourishing products should be applied to slightly damp skin, according to the age of the child.

Stop all water procedures only for a period of pronounced exacerbation (with symptoms of eczematization) and complications of AD with a purulent infection in order to prevent its spread.

Change underwear and bedding daily, especially with a common skin process. Linen should be from undyed cotton or linen fabrics.

Avoid wearing clothes made of dense synthetic, woolen and fluffy materials.

Wash the child's underwear only with soap, rinse repeatedly, iron with a hot iron on both sides.

Use underlay medical oilcloth for small children, and not various plastic films, if possible, avoid their use, especially if the child has skin on the buttocks and thighs.

Do not use pots made of polymer materials, use only enameled ones, treating them with hot water and baby or laundry soap.

Avoid intense sweating, which often occurs during physical exertion, insolation, i.e. prolonged exposure to the sun, which is not always useful!.

Don't wear jewelry. Only products made of natural gold or silver are well tolerated by the skin.

Avoid sudden changes in temperature. Before entering a warm room from a frost, it is advisable to stand on the landing or in the lobby.

To reduce the dryness of the skin, supported by a deficiency of linolenic acid, vegetable oils (preferably olive, corn or sunflower) and fish, mainly sea, and if river or lake, not fed with modified proteins and hormones, should be consumed in sufficient quantities. Remember, you can use all products, but only if they are tolerated!

What should not be!

1. In the rooms of carpets and carpets.

2. Open upholstered furniture - smooth surfaces accumulate less dust.

3. Open bookshelves and books like dust collectors. Only 1/5 of the books are read, and the rest of the dust collectors should not be!

4. Rough clothing, especially wool or synthetic materials, prefer cotton clothing.

5. Scattered clothes around the room. Get things in order in the house. Store clothes in a closed closet. Woolen clothes should be put in suitcases with a zipper or in boxes with tight lids.

6. Various irritating substances (washing powders, strong detergents, solvents, gasoline, varnishes, paints, aerosol deodorants, air fresheners, mothballs and other pungent substances, furniture cleaners, floors, carpets, etc.). d.).

7. Contact of the skin of the child's hands with plants that cause inflammation of the skin, as well as with vegetable and fruit juices.

8. Pets, birds, aquarium fish (rather their food).

9. Soft toys. Use washable toys (plastic, wood, metal).

10. House flowers, with the exception of those that do not emit fragrances.

11. Perfume, aerosol deodorants, air fresheners and other strong-smelling substances, especially in aerosols.

12. Washable wallpaper or painted walls should be preferred.

13. Curtains should be cotton or synthetic and washed at least once every 3 months. Do not use draped curtains.

14. If an air conditioner is installed in the room, the filters should be washed at least once every 2 weeks. Do not use electric fans that raise room dust.

15. Don't smoke! And it’s better not to smoke at all, especially for mom.

16. Do not use feather and down pillows and blankets. Pillows should be made of synthetic winterizer or other synthetic fibers, made of cotton.

17. Bedspreads should be of light, washable, lint-free fabrics.

18. Do not store things under the bed.

19. Daily wet cleaning of the room. When cleaning, use a respirator "petal".

20. Thorough cleaning with a vacuum cleaner should be carried out at least once a week.

21. During the renovation of your apartment, it is advisable to live elsewhere.

The foregoing does not at all claim to be the absolute fulfillment of our recommendations, but, on the contrary, should convince you that their maximum implementation will help you, together with the doctors, to cope with the elimination of many significant factors that contribute to maintaining the pathological process in your baby's skin. Shouldn't be doesn't mean shouldn't be. Only a reasonable individual approach is, at times, a way out of a difficult home situation, when it is not easy to identify one or another home allergen.

Using our tips, you will only win! And believe me, a dermatologist, pediatrician or any other specialist is needed not by the child, but by you, dear parents, because the health of your child is in your hands!

You, and only you, are fully responsible for his health and stay in this world!

In a difficult situation related to the treatment and prevention of AD, it is necessary to consolidate the efforts of the patients themselves and their parents, as well as doctors (pediatricians, dermatologists, etc.), only in this case the disease will remain in the minority and we will be able to defeat it. The key to success is your education on the issue of blood pressure, observation and daily work, which, believe me, will be rewarded with the healthy skin of your child.

–  –  –

"BELUPO skins and cosmetics dd", Republic of Croatia SPECIALIST IN DERMATOLOGY Notes Notes Notes www.atopic.com.ua not for sale

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MINISTRY OF HEALTH OF THE RUSSIAN FEDERATION UNION OF PEDIATRICS OF RUSSIA

RUSSIAN SOCIETY OF DERMATOVENEROLOGISTS AND COSMETOLOGISTS RUSSIAN ASSOCIATION OF ALLERGOLOGISTS AND CLINICAL IMMUNOLOGISTS

CHILDREN WITH ATOPIC DERMATITIS

Chief freelance specialist pediatrician of the Ministry of Health of Russia Academician of the Russian Academy of Sciences A.A. Baranov

Chief Freelance Pediatric Allergist-Immunologist of the Ministry of Health of Russia Corresponding Member of the Russian Academy of Sciences L.S. Namazova-Baranova

These clinical guidelines were prepared, reviewed and approved at a meeting of the Executive Committee of the Professional Association of Pediatricians of the Union of Pediatricians of Russia at the XVII Congress of Pediatricians of Russia "Actual Problems of Pediatrics" on February 15, 2014; agreed in July 2014. with the chief freelance specialist in dermatovenereology and cosmetology of the Ministry of Health of Russia, Academician of the Russian Academy of Sciences Kubanova A.A., updated. Approved at the XVIII Congress of Pediatricians of Russia "Actual problems of pediatrics" on February 14, 2015.

Members of the working group: acad. RAS Baranov A.A., Corr. RAS Namazova-Baranova L.S., acad. RAS Khaitov R.M., Corr. RAS Kubanova A.A., prof., MD Ilyina N.I., Prof., MD Kurbacheva O.M., prof., d.m.s. Novik G.A., Prof., MD Petrovsky F.I., prof., d.m.s. Murashkin N.N., Ph.D. Vishneva E.A., Ph.D. Selimzyanova L.R., Ph.D. Alekseeva A.A.

METHODOLOGY

Methods used to collect/select evidence : search in electronic databases.

Description of the methods used to evaluate the quality and strength of the evidence:

Methods used to assess the quality and strength of evidence:

expert consensus;

attached).

Methods used to analyze the evidence:

systematic reviews with tables of evidence.

Description of the methods used to analyze the evidence

When selecting publications as potential sources of evidence, used in

In every study, the methodology is reviewed to ensure its validity. The outcome of the study affects the level of evidence assigned to the publication, which in turn affects the strength of the recommendation.

To minimize potential errors, each study was evaluated independently. Any differences in the estimates were discussed by the whole group of authors in full. If it was impossible to reach a consensus, an independent expert was involved.

Evidence tables: filled in by the authors of clinical guidelines.

Methods used to formulate recommendations : expert consensus.

Good Practice Points (GPPs)

Economic analysis

Cost analysis was not performed and publications on pharmacoeconomics were not analyzed.

External peer review.

Internal peer review.

These draft guidelines have been peer-reviewed by peer reviewers, who were primarily asked to comment on the ease of understanding of the interpretation of the evidence underlying the recommendations.

All comments received from the experts were carefully systematized and discussed by the members of the working group (the authors of the recommendations). Each item was discussed separately.

Consultation and expert assessment

Working group

For the final revision and quality control, the recommendations were re-analyzed by the members of the working group, who came to the conclusion that all the comments and comments of the experts were taken into account, the risk of systematic errors in the development of recommendations was minimized.

1+,1-, 2++, 2+, 2-, 3, 4) and good practice points (GPPs)

DEFINITION

Atopic dermatitis is a multifactorial inflammatory skin disease characterized by itching, a chronic relapsing course, and age-related features of localization and morphology of lesions. Atopic dermatitis (AD) in typical cases begins in early childhood, may continue or recur in adulthood, significantly impairs the quality of life of the patient and his family members. In most cases, it develops in individuals with a hereditary predisposition and is often combined with other forms of allergic pathology, such as bronchial asthma (BA), allergic rhinitis (AR), allergic conjunctivitis, food allergy (FA).

L20 - Atopic dermatitis.

L20.8 - Other atopic dermatitis.

L20.9 Atopic dermatitis, unspecified

EPIDEMIOLOGY

Atopic dermatitis (AD) occurs in all countries, in both sexes and in different age groups. To date, the prevalence of AD in the US pediatric population has reached 17.2%, in children in Europe - 15.6%, and in Japan - 24%, which reflects a steady increase in the incidence of detection of AD over the past three decades (J. Spergel et al ., 2003). The frequency of AD is much higher in residents of economically developed countries, the incidence of AD is significantly increased in migrants from developing countries to developed ones (Williams H. C. et al., 1995).

The prevalence of AD symptoms in various regions of the Russian Federation ranged from 6.2 to 15.5%, according to the results of the standardized epidemiological study ISAAC (International Study of Asthma and Allergy in Childhood - International Study of Asthma and Allergy in Children). Repeated studies (after 5 years) of the prevalence of AD symptoms within the framework of this program demonstrate an increase in this indicator by 1.9 times in the children's population of the Russian Federation. In recent years, the Expert Committee on Asthma and Allergy of the WHO European Office has developed the GA2LEN (Global Allergy and Asthma European Network) program.

The study of the prevalence of allergic diseases among adolescents aged 15 to 18 years (GA2LEN) has made it possible to accumulate the most reliable data on the prevalence of allergies in Russian adolescents. In two centers (Moscow and Tomsk, Russia), a cross-sectional parallel-group study was conducted in a continuous sample of children aged 15 to 18 years. The presence of symptoms of the disease according to the study was

was detected in 33.35% of adolescents, the prevalence of atopic dermatitis according to the results of the questionnaires was 9.9%, the verified diagnosis was in 6.9% of the study participants. Among the respondents with the current incidence of AD, the proportion of girls is 1.6 times higher compared to males (p = 0.039). The results of the observation indicate significant discrepancies with the official statistics on atopic dermatitis in the children's population (in 2008 in Moscow, the official incidence of AD was 1.3% - 5 times less than the study showed).

PATHOGENESIS

The pathogenesis of atopic dermatitis is based on immune-dependent inflammation of the skin against the background of Th2 cell activation, which is accompanied by an increase in its sensitivity to external and internal stimuli. When the process is chronic, in addition to the persisting activity of Th2 cells, Th1, Th17, and Th22 cells are included in the inflammatory process.

In AD, the importance of violations of the epidermal barrier, increased dryness and transepidermal water loss has been established, which creates the possibility of allergens entering transdermally with the involvement of mechanisms that lead to skin damage and contribute to early sensitization of the body and the initiation of inflammation.

In the pathogenesis of AD, there is a genetically determined damage to the skin barrier, mediated by a violation of keratinization processes, due to a defect in the synthesis of structure-forming proteins and changes in the lipid composition of the skin. As a result, there is a violation of the formation of the normal stratum corneum, which is clinically manifested by severe dryness.

There is no doubt that neuropeptides and pro-inflammatory cytokines released from keratinocytes as a result of skin itching play a certain role in the development of inflammation in AD.

Genetic studies have shown that AD develops in 82% of children if both parents suffer from allergies, mainly in the first year of a child's life; 59%

If only one parent has AD and the other has an allergic respiratory pathology, 56% if only one parent is allergic, 42% if first-line relatives have symptoms of AD.

CLASSIFICATION

There is no generally accepted classification of AD. A working classification of atopic dermatitis was proposed by the Russian Association of Allergists and Clinical Immunologists (RAAKI) in 2002. It is convenient for practitioners, reflects age dynamics, clinical morphological forms, severity and stages of the course of the disease (Table 3).

Diagnosis of atopic dermatitis is based primarily on clinical data. There are currently no objective diagnostic tests to confirm the diagnosis. The examination includes a thorough collection of allergic anamnesis, an assessment of the extent and severity of the skin process, as well as an allergological examination.

Diagnostic criteria for AD

Main criteria

Skin itching.

Typical morphology of lesions and localization:

- children of the first years of life: erythema, papules, microvesicles with localization on the face and extensor surfaces of the limbs;

- older children: papules, lichenification of symmetrical areas of the flexion surfaces of the limbs.

Early manifestation of the first symptoms.

Chronic relapsing course.

Hereditary burden for atopy.

Additional Criteria(help to suspect atopic dermatitis, but are non-specific):

immediate type reactions during skin testing with allergens;

palmar hyperlinearity and pattern enhancement (“atopic” palms);

persistent white dermographism;

eczema of the nipples;

recurrent conjunctivitis;

longitudinal suborbital fold (Denny-Morgan line);

periorbital hyperpigmentation;

keratoconus (conical protrusion of the cornea in its center).

CLINICAL PICTURE

Usually the manifestation of AD in children occurs in the first year of life. The disease goes through three stages in its development, which can be separated by periods of remission or pass one into another.

Infant stage AD is formed in children from the neonatal period to two years and is characterized by acute inflammation of the skin with rashes on the skin of papules and microvesicles with severe exudation and weeping (exudative form). Localization of rashes - mainly on the face, less often - on the lower leg and thighs. At the same time, against the background of hyperemia and exudation, infiltration and edema of individual skin areas, microvesicles with

serous contents, sluggish tire, quickly opened with the formation of "eczematous wells." Eczematous papules and microvesicles, manifestations of an acute inflammatory process, are void-free limited formations in the form of small nodules (up to 1 mm), slightly elevated above the skin level, rounded in shape, soft in texture, usually focal, sometimes grouped and rapidly evolving. In addition, there is a pronounced itching and burning of the skin, soreness and a feeling of tension. A sick child scratches the skin, as a result of which the foci become covered with serous-bloody crusts, and when a secondary infection is attached, serous-bloody-purulent crusts. The location of the skin lesions is symmetrical.

With limited forms such rashes are localized more often on the face in the area of ​​the cheeks, forehead and chin, with the exception of the nasolabial triangle, and symmetrically on the hands.

With common, disseminated forms of AD there is a lesion of the skin of the trunk, limbs, mainly their extensor surfaces.

At 30% of AD patients are characterized by hyperemia, infiltration and slight peeling of the skin without exudation, which are manifestationserythematosquamous form of the disease. Erythematous macules and papules typically first appear on the cheeks, forehead, and scalp and are accompanied by itching. Usually erythema increases in the evening and is almost not determined in the morning.

Children's stage of AD forms in children aged 2 to 12 years, may follow the infantile stage without interruption, and usually continues until adolescence. At the same time, exudative foci characteristic of the infantile phase are less pronounced on the skin, its significant hyperemia, pronounced dryness and an underlined pattern, thickening of the folds and hyperkeratosis, and the folded nature of the lesions are noted. The presence of these elements is defined as erythematosquamous form of AD with lichenification. Subsequently, lichenoid papules and lichenification foci with typical localization in skin folds predominate on the skin surface. Rashes are localized most often in the elbow, popliteal, gluteal folds, on the skin of the flexor surfaces of the elbow and wrist joints, the back of the neck, hands and feet. At the same time, rashes in the form of lichenoid papules, profuse peeling, multiple scratching and skin cracks are noted - these manifestations are defined as lichenoid form of AD.

This stage of AD is characterized by a lesion of the facial skin, defined as "atopic face", manifested by hyperpigmentation of the eyelids with accentuated folds, peeling of the skin of the eyelids, and combing out of the eyebrows. All these patients have a very characteristic persistent and painful itching of the skin, especially pronounced at night.

Adolescent AD observed in children over the age of 12 and is characterized by pronounced lichenification, dryness and flaking, predominant lesions of the skin of the face and upper body, and a continuously relapsing course. This stage begins at puberty and often continues into adulthood. The defeat of the flexion surfaces in the area of ​​natural folds, face and neck, shoulders and back, dorsal surface of the hands, feet, fingers and toes prevails. The rash is characterized by dry, scaly, erythematous papules and plaques and the formation of large, lichenified plaques in chronic skin lesions. Significantly more often than in the previous age group, lesions of the skin of the face and upper body are observed.

At adolescents may experiencepruriginous form AD, which is characterized by severe itching and multiple follicular papules, dense consistency, spherical shape with numerous scattered excoriations on the surface of the papules. These rashes are combined with severe lichenification with localization typical for this age on the flexion surfaces of the extremities.

According to the prevalence of the inflammatory process on the skin, there are: AD limited- with localization mainly on the face and the area of ​​skin lesion is not

more than 5–10%; AD common- with a lesion area from 10 to 50%; Diffuse AD - with an extensive lesion of more than 50% of the surface of the skin.

According to the stages of the course of AD, there are: exacerbation, incomplete remission and remission.

Assessment of the severity of clinical manifestations

Assessment of the severity of AD in children, taking into account clinical manifestations, is presented in Table. four.

Table 4

Evaluation of the severity of atopic dermatitis according to the severity of clinical manifestations

The severity of clinical manifestations of AD is assessed using the following scales: SCORAD (Scoring Atopic Dermatitis), EASY (Eczema Area and Severity Index), SASSAD (Six Area Six Sign Atopic Dermatitis Severity Score).

In Russia, the most widely used scale is SCORAD (Fig. 1), which is used by specialists to assess the effectiveness of treatment and the dynamics of clinical manifestations of AD.

Parameter A

The prevalence of the skin process is the area of ​​the affected skin (%), which is calculated according to the rule of nine (see Fig. 1). For evaluation, you can also use the "palm" rule (the area of ​​the palmar surface of the hand is taken equal to 1% of the entire skin surface).

Parameter B

To determine the intensity of clinical manifestations, the severity of 6 signs (erythema, edema / papules, crusts / weeping, excoriations, lichenification, dry skin) are counted. Each sign is evaluated from 0 to 3 points (0 - absent, 1 - weakly expressed, 2 - moderately expressed, 3 - sharply expressed; fractional values ​​are not allowed). The assessment of symptoms is carried out on the area of ​​the skin where they are most pronounced. The total score can be from 0 (no skin lesions) to 18 (maximum intensity of all 6 symptoms). The same area of ​​affected skin can be used to assess the severity of any number of symptoms.

A. Surface area of ​​individual parts of the body (estimated by a doctor)

The area of ​​manifestations of atopic dermatitis in certain parts of the body

C. Severity of subjective symptoms (assessed by the patient)

The origins of such a problem as atopic dermatitis in children should be sought in infancy. The unreasonably early transfer of the baby to milk formulas for feeding and their constant change in search of the best provoke the development of food allergies in the baby. In the case of contact allergic dermatitis, skin contact with substances (objects) comes to the fore, due to contact with which the child has a negative reaction.

Dermatitis is an inflammatory skin disease that occurs under the influence of any adverse factor.

In children, the so-called atopic dermatitis is most often observed, which is a chronic allergic skin disease.

Atopic dermatitis is a multifactorial dermatosis with a hereditary predisposition that develops in 80-85% of children in the first year of life, characterized by functional disorders of the nervous system, itchy skin lesions with the presence of polymorphism.

Why does atopic dermatitis appear in children: causes

In atopic dermatitis, the trigger is a food allergy, which manifests itself in early childhood. For the child's immune system, food proteins are foreign. In the gastrointestinal tract of a child, proteins are converted into polypeptides and amino acids. Polypeptides are the cause of allergies in early childhood, but not all cause allergic reactions. In some cases, food allergies are manifested by rare episodes of skin rashes. Only a small percentage of the process is chronic.

Atopy in Greek means “unusual, strange”. Another reason why dermatitis appears in children is the allergic diseases of the parents. With a hereditary predisposition, allergic antibodies are produced in increased quantities and react to a variety of stimuli - food, medicinal, pollen, fungal, epidermal, house dust mites, etc.

Readiness for allergies in such children is present from birth, but the disease can manifest itself only after prolonged contact with the allergen. At the first contact, memory cells remember the allergen, and upon repeated contact, specific antibodies, immunoglobulins E (IgE), begin to be produced, which cause hypersensitivity. And subsequent meetings with the allergen cause the development of an allergic disease. Mast cells (those cells that produce specific antibodies) are found in the skin, respiratory tract, and gastrointestinal tract (GIT). The normal state of these tissues limits the entry of the allergen into the body, preventing the development of clinical manifestations. Accordingly, diseases of the skin, respiratory tract, gastrointestinal tract provoke the appearance of various allergic reactions.

Healthy children can also be born in atopic families, but their offspring (the third generation) may already suffer from allergic diseases.

Atopic dermatitis in an infant is the first and earliest manifestation of the disease, often leading to the development of bronchial asthma. The development of atopic dermatitis can occur with the use of any product in the baby's diet. An allergic reaction depends on the nature of the antigen, its dose, frequency of administration, and individual tolerance.

Causes of atopic dermatitis and allergies in infants

Milk is the most common cause of atopic dermatitis in children. In fact, milk allergy is quite rare, and the causes of dermatitis (skin rashes) in infants in 85% of cases are:

• early weaning;
• early and abrupt introduction of mixtures and complementary foods;
• permanent;
• immaturity of organs and systems, adaptation to new living conditions - air, microbes, nutrition.

These causes of atopic dermatitis in children are not associated with allergies, but only with the fact that the little man does not have time to adapt to a new and difficult life. Weakened by excessive stress, the child's organs work worse, leading to changes in blood tests, feces "for carbohydrates", coprology, etc.

If you start changing or canceling foods, mixtures, complementary foods, prescribing a diet for a nursing mother, instead of helping the child heal minor disorders in the immune system, pancreas, then the situation will only get worse, since a new product is a new burden on already weak systems sick child.

The search for an allergen by blood test or skin tests in this case will not give a clear picture: some slightly suspicious foods, plants, etc., may be found, but worms or Giardia, of course, will not be found, which means they will continue to live in the child's body, breaking his immunity and poisoning the body.

The causes of atopic dermatitis in children can be different, but in most it occurs as follows. Usually, infants begin to introduce complementary foods drop by drop, a few grams, 1/4 teaspoon, between feedings or before them. And even if gross mistakes are not made, when a child is immediately given a large amount of new food or a product is introduced that is not age-appropriate (for example, baby kefir at 1 month, when the package says “from 6 months”), the child is covered with a rash.

No one is to blame - parents followed the advice from decent books, pediatricians - instructions and textbooks. Is it an allergy? Probably not. Books, textbooks and instructions were written a long time ago, and since then, due to the deterioration of the environment, the way of life of a person, newborn children have become a little different.

Now it is necessary to introduce new products to children under one year of age much more carefully than our grandmothers or even you did with older children.

A more careful introduction of complementary foods will not harm your child in any way, he will not experience any lack of food, vitamins, etc. But you will minimize the risk of developing it, and subsequently, you may avoid allergies, and other diseases, up to.

Diathesis as a reaction to the introduction of complementary foods occurs when the child's body, its enzymatic systems are not ready to digest a new product. Not knowing how to digest an apple, porridge or kefir, the pancreas “tenses up”, trying to produce the necessary enzymes in the right amount. This leads to a slight "inflammation" of the pancreas (on ultrasound, it is usually enlarged in such children). The child's immune system must respond to any inflammation and heal it, but the baby's systems are still immature, unformed, so an inadequate reaction of the immune system appears on the skin in the form of diathesis.

The best food for a baby is mother's milk. But there are situations when you need to introduce additional nutrition - an adapted milk formula. As mentioned above, the introduction of supplementary feeding is necessary when there is a shortage of breast milk, when the child does not eat up, requires breasts earlier than 2.5 hours after the end of the previous feeding, and is not gaining weight well. Another indication for the introduction of the mixture is the appointment of mother therapy that is incompatible with breastfeeding (treatment of cancer, serious hormonal therapy). Another reason may be a group or Rhesus conflict. In exceptional cases, it is recommended to cancel breast milk and introduce a mixture when prescribing antibiotics to the mother (but in most cases this situation does not require the abolition of breastfeeding), as well as in very severe decompensated lactase deficiency (most often in these cases, treatment is carried out without canceling breast milk, but sometimes the introduction of a therapeutic mixture and the transition to mixed feeding are required).

The child may react to the introduction of the mixture with a deterioration in the general condition, skin rashes, abdominal pain, changes in the nature of the stool (greens, mucus, constipation). Late regurgitation or regurgitation with a "fountain" may appear. Sometimes the problems that were before the introduction of supplementary feeding are exacerbated, or new symptoms of existing diseases appear. Deterioration occurs due to the immaturity of the baby's adaptation systems up to 4 months, so any change in nutrition at this age can lead to breakdowns.

Sometimes the reason for the deterioration of the condition is the individual immunity of the baby to a particular mixture. To assess the individual response to the mixture, it is necessary to track changes in the state from the initial one according to the following criteria: skin, stool, behavior (anxiety, regurgitation). That is, before the introduction of the mixture, you need to remember or write down all the problems that the baby has, and, starting to give the mixture, track the changes. If deterioration occurs, do not immediately remove the mixture, but continue to give in the amount at which the problems began.

If the deterioration is associated with the difficulties of adaptation, then within 2-3 days the reactions will end and the child's condition will return to its original level. If the deterioration is significant and does not go away in 4 days, then this means that this mixture is not suitable for the child and you need to try another one. Therefore, do not immediately buy a large amount of the mixture that the child has not tried before.

To avoid the development of dermatitis in infants, the introduction of the mixture must be carried out gradually, starting with 5-10 g of the finished mixture (no more than 30 g, which corresponds to a measuring spoon of the dry mixture), after breastfeeding. On the first day, you can give a small amount of formula in each feeding or in some. On the second day and beyond, the amount of the mixture can be increased by introducing a scoop or less per feeding. The less, the better - at least a pinch. If the mixture is introduced for supplementary feeding (with a lack of breast milk), then feedings can be made mixed (in one feeding both the breast and the mixture, but first the breast). The gradual introduction of the mixture reduces the risk of reactions. If the mixture suited the child, that is, did not cause any reactions, then it is better not to change it (you can only change the number according to age - the mixture level, but you can not change the level either). Change the mixture of one stage to the same mixture of the next stage also gradually: replace within 5-7 days in the amount of one scoop per feeding.

Adaptation is a combination of the work of the immune and digestive systems. In young children, the process of getting used to a new food usually lasts up to 7-14 days. It is during this period that reactions to the introduction of a new mixture may occur. If the adaptation process has passed, the baby eats some kind of mixture for a long time and suddenly he starts having problems with the skin or tummy, then the mixture and nutrition in general (hereinafter - juices, cereals, mashed potatoes) have nothing to do with it: the problem must be sought in the work of the gastrointestinal tract. intestinal tract, other organs and systems, and do not change the diet.

The risk of a child's illness increases when exposed to adverse external factors, which can be not only artificial feeding, but also eating foods rich in substances that can cause allergies. In the role of allergens, particles of pet hair and dander, mites, cockroaches, mold fungi, house dust, drugs (for example, antibiotics), food additives, preservatives can also act.

In young children, one of the first allergens is cow's milk, which contains about 15–20 antigens, of which the most allergenic are: β-lactoglobulin, α-lactoalbumin, casein, bovine serum albumin. 85-90% of children with atopic dermatitis are allergic to cow's milk proteins.

The most common allergic reactions occur on the following products: whole milk, eggs, fish and seafood, wheat, rye, carrots, tomatoes, peppers, strawberries, strawberries, raspberries, citrus fruits, pineapples, persimmons, melons, coffee, cocoa, chocolate, mushrooms, nuts, honey

Disease dermatitis in children can cause food additives containing preservatives, flavors, flavors, emulsifiers. These dyes include E-102 - tartrazine, which colors food products yellow. The development of allergic reactions can be facilitated by sulfur additives in the form of metabisulfate, sulfur compounds (E-220-227), sweeteners.

Risk factors for atopic dermatitis and allergies in children

Factors contributing to the manifestation of overt allergies can be overt allergens:

• aeroallergens (air allergens): pollen, mold fungi (spores), dust mites, animal dander, cockroaches;
• mushrooms: Pityrosporum ovale (P. orbiculare, Malassezia furfur), Trichophyton, Candida;
• food allergens: milk - mainly in young children; eggs; nuts (peanuts, walnuts, hazelnuts, etc.); soy; wheat; fish, crustaceans; citrus fruits (oranges, tangerines, grapefruits); wild strawberries, strawberries, raspberries, black currants, pineapple, melon, etc.; tomatoes, eggplants, radishes, etc.;
• allergens of microorganisms: bacteria (Staphylococcus aureus, Streptococcus aureus).

Non-allergenic risk factors for atopic dermatitis in children:

• unfavorable climate; high temperature and humidity;
• chemical irritants (laundry detergents, soaps, cleaning chemicals, perfumed lotions);
• physical irritants (sweat, scratching, synthetic clothing);
• food that has an irritating effect: spicy, sour, sauces, spices;
• infections;
• psychosocial stress; emotional stress;
• chronic diseases;
• sleep disturbance.

What the manifestations of atopic dermatitis look like in children (with photos and videos)

Signs of the disease may appear on the 2-3rd month of a baby's life, but most often they occur after transferring him to artificial feeding.

At the initial stage, there are such symptoms of atopic dermatitis in children as redness and swelling of the skin of the cheeks. Then, yellow crusts and cracks form on the changed skin. The skin on the head, buttocks, in the area of ​​the elbow and knee folds, and wrists can also be affected.

The development of dermatitis is facilitated by exposure to the skin of cold or elevated temperatures, exposure to the sun, contact with chemicals, and wearing irritating clothing (coarse fabrics, synthetics, thick internal seams).

At the sites of skin lesions in children, a manifestation of dermatitis occurs, such as skin itching, which is so pronounced that it disturbs the baby's sleep. The skin thickens, becomes dry, covered with scales, peels off. In such places, cracks are formed, healing with great difficulty.

See what atopic dermatitis looks like in children in these photos:

The child loses weight, becomes restless, irritable, whiny.

The disease proceeds for a long time, characterized by alternating periods of pronounced inflammation and remission of the process. Violations of the diet, psycho-emotional stress can provoke an exacerbation.

The disease can continue for many years. Exacerbations of atopic dermatitis are noted mainly in the autumn period of the year. In the infant and child phases, focal spotty-scaly rashes are observed with a tendency to form bubbles and areas of weeping on the skin of the face, buttocks, and extremities. In the pubertal and adult periods, nodular rashes of a slightly pink color dominate, which are located mainly on the flexion surfaces of the limbs, especially in the elbows, popliteal cavities, on the neck in the form of a characteristic pattern. Atopic dermatitis is characterized by dry, pale skin with an earthy tint. Skin lesions can be localized, widespread, and affect the entire skin. In a typical case, the skin lesion is expressed on the face, where there are spotty-scaly lesions with fuzzy contours, mainly in the periorbital region, in the area of ​​the nasolabial triangle, around the mouth. The eyelids of the patient are edematous, thickened, the lips are dry, with small cracks. On the skin of the neck, chest, back, limbs there are abundant small nodular elements of a pale pink color, some of them are covered in the central zone with a hemorrhagic crust. In the area of ​​the lateral surfaces of the neck, elbows, wrist joints, popliteal cavities, the skin is rough, stagnant red in color, with an enhanced skin pattern. Peeling, cracks, abrasions are expressed in the lesions. In severe cases, the process is persistent, the lesions cover large areas, they also occur on the back of the hands, feet, legs and other areas, the lymph nodes increase, the temperature may rise.

These photos show what dermatitis looks like in children:

In older children, the main manifestations of atopic dermatitis are:

• characteristic location of the rash;
• chronic or recurrent dermatitis.

Additional features are:

• onset in early childhood;
• frequent skin infections;
• dermatitis of the hands and feet;
• recurrent conjunctivitis;
• paleness or redness of the face;
• perfollicular localization of the rash;
• folds on the front surface of the body;
• itching with increased sweating;
• white dermographism;
• increased sensitivity to emotional influences and the influence of environmental factors.

Watch the video "Atopic dermatitis in children", which shows all the manifestations of this disease:

Causes of contact dermatitis in children

Contact dermatitis most often develops as a result of skin contact with chemicals: acids, alkalis, chromium salts, nickel, mercury.

In addition, in schoolchildren, medications, physical, biological, climatic and other influences can cause manifestations of dermatitis.

Features of the course of dermatitis and the severity of its clinical manifestations depend on the properties of the irritating factor itself, the duration of its exposure and the state of the body's reactivity.

A characteristic feature of dermatitis is a rather rapid regression after the removal of the irritant.

The causes of contact dermatitis are often direct prolonged or repeated exposure to the skin of chemicals (acids, alkalis in high concentrations, etc.), mechanical (scuffs, friction of tight clothing, shoes, plaster casts, instrument pressure, etc.), physical (high and low temperature, ultraviolet (actinic dermatitis), x-rays, radioactive isotopes, as well as contact with biological irritants and plants (such as buttercup, euphorbia, coastal grasses, primrose, etc.).

In everyday life, simple (contact) dermatitis in schoolchildren can be triggered by shampoos, caustic soaps, cosmetics, detergents, citrus juice and a number of topical drugs.

Dermatitis, localized around the mouth, occurs in children who have a habit of licking their lips.

Contact dermatitis occurs at the site of exposure to the irritant and, as a rule, does not spread beyond it.

The predisposition to the development of contact dermatitis in schoolchildren is different. So, in some children, the disease occurs with minimal exposure to the stimulus. Symptoms of contact dermatitis in children are the appearance on the skin of erythema, swelling, and then vesicles, papules and pustules. Skin changes are accompanied by burning and soreness in the lesions.

With the development of contact dermatitis from exposure to x-rays, high temperature and some other irritants, the lesions subsequently ulcerate and scar.

Simple (contact) dermatitis resolves fairly quickly (within a few days) after contact with the irritant is eliminated.

Plantar dermatitis is caused by wearing tight synthetic shoes. The disease occurs mainly in schoolchildren in the prepubertal period.

Lesions are localized on the supporting surfaces and have a vitreous appearance. Cracks may appear. Skin changes are accompanied by soreness.

For the treatment of this disease, a change of shoes with the use of temporary local applications of emollients is sufficient.

Types of allergic contact dermatitis in children

Allergic contact dermatitis in children also occurs as a result of exposure to external stimuli, however, unlike simple contact dermatitis, it is based on an allergic restructuring of the body.

Allergic dermatitis can be caused by substances such as chromium salts, formalin, phenol-formaldehyde and other artificial resins that are part of varnishes, adhesives, plastics, etc. Also pronounced allergenic properties are inherent in penicillin and its derivatives, mercury salts.

Some children are extremely sensitive to nickel. Allergic dermatitis in this case may occur upon contact with nickel-containing fasteners on clothing or jewelry. The nickel type of contact dermatitis is often localized on the earlobes.

Shoe dermatitis can be caused by antioxidants found in shoe lubricants, or by tannins and chromium salts in the leather the shoes are made from. With profuse sweating, these substances are usually leached out.

Allergic shoe dermatitis usually develops on the back of the foot and toes without affecting the interdigital spaces. Unlike simple contact dermatitis, it rarely affects the palms and soles. In typical cases, the lesions are symmetrical.

Clothing dermatitis develops in contact with the following allergens: factory dyes, elastic fibers of fabrics, resins, fabric mordants. Dyes, resins, and fabric mordants can be poorly fixed and leach out when the garment is worn.

Allergic dermatitis on the face can be caused by all kinds of cosmetics (especially often on the eyelids). Unexpectedly, allergic dermatitis can develop with the use of topical remedies, especially when used to treat pre-existing dermatitis. These allergens include local antihistamines, anesthetics, neomycin, merthiolate, and ethylenediamide, which is present in many ointments.

Allergic contact dermatitis can occur in 2 forms - acute and chronic, prone to exacerbations. Once hypersensitivity to a particular allergen occurs, it usually persists for many years.

Skin symptoms in allergic contact dermatitis in children resemble the morphological elements of simple contact dermatitis with the difference that in allergic dermatitis the inflammatory process extends beyond the lesion and manifests itself as weeping like eczema.

Diagnosis of this disease is carried out by setting skin tests with minimal concentrations of the relevant allergens.

The most common among schoolchildren are toxic-allergic dermatitis of drug origin, which occurs when taking medications. The disease is caused by both allergic and toxic components of the drug.

Drug toxic-allergic dermatitis develops with prolonged repeated, less often - short-term administration of the drug orally or when administered parenterally.

The combination of the allergic and toxic effects of the irritant, which is different in severity and strength, causes the development of the so-called drug disease, in which, in addition to lesions of the skin and mucous membranes, tissues of the nervous, vascular systems and internal organs are involved in the inflammatory process.

The prognosis of drug-induced toxic-allergic dermatitis depends on the severity of general clinical and allergic reactions. The most severe consequences, often leading to death, are observed in Lyell's syndrome.

Children with atopic dermatitis may later develop other allergic diseases (bronchial asthma, allergic rhinitis, urticaria, etc.).

Methods for diagnosing atopic dermatitis in children

The diagnosis of atopic dermatitis on the basis of the available signs will be considered reliable if the patient has three main and three or more additional signs. However, the main clinical signs are pruritus and increased skin reactivity. Itching is characterized by its persistence during the day, as well as its intensification in the morning and at night. Itching disturbs the child's sleep, irritability appears, the quality of life is disturbed, especially in adolescents, and learning difficulties appear. Skin manifestations in atopic dermatitis are characterized by severe itching, erythematous papules on the background of hyperemic skin, which are accompanied by scratching and serous exudate. This is typical for acute dermatitis.

Diagnosis of atopic dermatitis in children is based on complaints, information that clearly indicates the relationship of exacerbation of the disease with a causally significant allergen, the definition of clinical symptoms of dermatitis, the presence of factors provoking an exacerbation of the disease - allergenic and non-allergenic. For diagnosis, a special allergological examination is carried out, which includes the analysis of anamnestic data, the determination of specific antibodies to the allergen in the composition of IgE, and the setting of skin tests.

The level of immunoglobulin E to various allergens is determined in the blood using an enzyme immunoassay or radioimmunoassay method. Results are expressed in points from zero to four. An increase in the level of IgE to the allergen by two points or more confirms the presence of sensitization.

The main method for diagnosing atopic and allergic dermatitis in infants and older babies are elimination-provocation tests. In practice, an open test is used, in which the product is given to the patient and the reaction is observed.

Contraindications to the production of provocative tests may be:

• immediate reaction within 3 minutes to 2 hours after eating, or contact with vapors, skin exposure;
• anaphylactic shock, angioedema in history, an attack of bronchial asthma;
• severe somatic disease;
• the presence of an infectious disease.

Provocative tests are carried out without exacerbation of the disease.

If a child has problems in the form of skin rashes, first of all, the gastrointestinal tract should be examined, because almost 90% of skin rashes are of intestinal origin. Necessary studies are stool tests for dysbacteriosis and coprology, often useful information is provided by ultrasound of the abdominal organs. With these tests, you need to contact a pediatric gastroenterologist or immunologist, because the gastrointestinal tract is not only a digestive organ, but also the largest organ of the immune system. If necessary, additional tests may be prescribed: skin tests (not recommended for up to 3 years) or blood tests to detect allergy antibodies - IgE (not recommended for up to 1 year). The presence of "allergic" antibodies in a very high concentration is a sign of true allergy - the highest degree of immune dysfunction. As a rule, with such an allergy, allergists are connected to the treatment of a child. But this form of allergy is much less common than "pseudo-allergic" reactions against the background of impaired adaptation to nutrition, in which the blood test will contain specific antibodies to "allergens" in low and medium concentrations (and this will not be the basis for the diagnosis of "allergy", on the contrary - this will be proof of the absence of allergies).

To search for the cause of complaints, additional tests may also be prescribed to identify infections that can cause allergies, such as chronic viral infections, chlamydial infection, mycoplasma infection, giardiasis, and helminthic infestations. A dermatologist may recommend topical treatments for food allergies, but in general atopic dermatitis is not a dermatological problem.

Among the therapeutic measures for atopic dermatitis, one can single out treatment aimed at eliminating the causes of allergies (immunocorrection, dysbacteriosis therapy, restoring the normal functioning of the gastrointestinal tract, removing foci of chronic infection), as well as symptomatic therapy - first of all, elimination of itching. Symptomatic agents include antihistamines and topical agents. Among external agents, hormonal ointments can be prescribed. It is desirable to use them for severe exacerbations, when other means do not help, but not more than 10 days.

If symptoms of dermatitis occur in children, treatment should be started immediately.

Diet recommendations for allergic and atopic dermatitis in children

Treatment of atopic and allergic dermatitis in children is carried out in a complex manner. It is necessary to start treating dermatitis in the early stages, otherwise the disease progresses and becomes chronic. It is necessary first of all to eliminate contact with the allergen.

In the first place are the elimination of causally significant allergens, which is carried out on the basis of the results of an allergological examination. There is no standard elimination diet for allergic dermatitis in children. In this regard, when a patient's hypersensitivity to certain foods is detected, a certain elimination diet is prescribed. In the absence of positive dynamics within ten days, the diet should be reviewed. For children, an elimination diet is prescribed at 6-8 months, then it is revised, as sensitivity to allergens changes with age.

In the diet of children under one and a half years old, the most allergenic foods are excluded, such as: eggs, fish, seafood, peas, nuts, millet.

Dairy-free mixtures are prescribed in cases where the child is allergic to cow's milk. Mixtures based on protein hydrolyzate are prescribed. The child must be breastfed for at least six months. A nursing mother is obliged to exclude from her diet foods to which hypersensitivity in a child has been identified. Complementary foods for children are prescribed no earlier than 6 months.

To reduce the allergenicity of some products, you can use long-term heat treatment.

It is important not to include foods with the addition of dyes, fruit essences, vanilla, and smoked products in the diet. Meat broths are best replaced with vegetable soups. Chewing gum is strictly contraindicated. Sugar can be replaced with fructose.

If the baby is bottle-fed, a special formula for children with allergies should be used. If the baby is breastfed, it is necessary to adjust the mother's diet for the entire period of feeding. When introducing complementary foods, preference is given to green vegetables - cabbage, zucchini and dairy-free cereals.

But when following a diet, it must be remembered that excessive restrictions can lead to a lack of nutrients in the child's diet and a violation of his physical development.

When treating allergic dermatitis in children, you can keep a food diary to monitor the correct diet. In it, make a daily record of what time and what foods the child consumed, and also record the occurrence or exacerbation of symptoms of dermatitis. So you can establish a connection between the use of a particular product and the disease. This will allow you to customize the diet for your child. Show the diary to the doctor.

How to get rid of atopic dermatitis in a child

Before you start treating atopic dermatitis in a child, avoid contact of the baby's skin with irritants such as wool, synthetic fabrics, and metal objects, including beads, bracelets, chains.

Contact of a child with household chemicals is highly undesirable. Symptoms of dermatitis can provoke washing powders, soaps, shampoos, various cosmetics. All of them should be intended for children.

Make sure that the child does not scratch the affected skin. Cut your baby's nails often, put him to bed in a long-sleeved shirt. Scratching the skin can lead to the development of an infectious process. Treat all abrasions with a slightly pink potassium permanganate solution or brilliant green solution. It is important to follow the rules of skin care.

To get rid of atopic dermatitis in a child as quickly as possible, it is necessary to bathe the baby daily and use medical cosmetics and ointments for skin care. Ordinary cosmetics in this case are not suitable, the doctor will help you choose them. For bathing a child, you can use a decoction of a string, chamomile.

In severe cases, hormonal ointments are used for treatment.

They have a quick effect and greatly alleviate the condition of the child, but they are allowed to be used only under the supervision of a doctor.

Of the drugs, antiallergic drugs are also prescribed (antihistamines - tavegil, suprastin, ketotifen, calcium preparations), usually in the form of tablets. Modern drugs have a minimum of side effects and act for a long time.

And what to do with atopic dermatitis in a child on house dust? In this case, the following activities are carried out:

1. regular wet cleaning;
2. mattresses and pillows are covered with plastic envelopes with a zipper;
3. bed linen is washed weekly in hot water;
4. pillows should have synthetic filling and be covered with two pillowcases;
5. furniture in the apartment should be made of wood, leather, vinyl;
6. patients are not allowed to be present during the cleaning of the premises;
7. when using air conditioners, the temperature should be regular, humidifiers and evaporators should not be used without controlling the humidity in the room.

In case of allergy to mold fungi, the following elimination measures are carried out:

1. when cleaning the bathroom, it is necessary to use anti-mold products at least once a month;
2. an extractor hood is installed in the kitchen to remove moisture during cooking;
3. sick people are not allowed to mow the grass, remove the leaves.

Measures to prevent epidermal sensitization in dermatitis:

1. it is not recommended to wear clothes that include wool, natural fur;
2. it is recommended to avoid visiting the zoo, circus, apartments where there are pets;
3. If an animal enters the premises, it is necessary to carry out wet cleaning repeatedly after its removal.

With pollen allergies, the following activities are carried out:

1. when flowering tightly close windows and doors;
2. walks are limited;
3. for the period of dusting, the place of residence changes;
4. it is forbidden to use herbal cosmetics;
5. it is not recommended to carry out treatment with herbal preparations.

The following describes how to treat dermatitis in a child using medicines.

What to do with atopic dermatitis in a child: how and how to treat the disease

With symptoms of atopic dermatitis in children, effective means are used for treatment that block individual links of allergic reactions:

1. antihistamines;
2. membranotropic drugs;
3. glucocorticoids.

In the complex treatment, enterosorbites, sedatives, drugs that improve or restore the function of digestion, and physiotherapy are used.

In the treatment of atopic and atopic dermatitis in children, symptoms, age, stage of the disease, features of the clinical picture, severity, prevalence of the pathological process, complications and comorbidities are taken into account.

Antihistamines. The main mechanism of action of antihistamines is the blockade of the inflammatory process caused by the binding of IgE antibodies to the allergen. Antihistamines block histamine H1 receptors, which reduces the severity of edema, hyperemia, and itching. The last symptom, itching, does not always disappear with this therapy. When prescribing antihistamines, the features of the mechanism of their action are taken into account. So, first-generation drugs have a sedative effect. In this regard, they are not assigned to school-age children due to the fact that when they are used, concentration of attention and the ability to concentrate are reduced. Due to the decrease in the effectiveness of first-generation drugs with their long-term use, it is recommended to change them every 7-10 days or prescribe second-generation drugs. In the chronic course of the process, with severe eosinophilia, cetirizine, claritin are prescribed (drugs of prolonged action H1-blockers of the second generation). They have high specificity, begin to act after 30 minutes, the main effect lasts up to 24 hours, do not affect other types of receptors, and they do not penetrate the hepato-brain barrier.

The use of corticosteroids. The use of glucocorticoids orally is indicated for extremely severe allergic dermatitis. They are appointed in these cases locally. When applied topically, corticosteroids suppress the components of allergic inflammation, the release of mediators, cell migration to the area of ​​skin lesions, they cause vasoconstriction, and reduce swelling. They remove the phenomena of dermatitis in the acute and chronic periods.

Currently, a series of preparations has been developed that are safe enough for use in children: in the form of lotions, creams, and ointments. The use of such agents as advantan and others is recommended. It is used from 4 months and in various forms. Elocom is effective. It does not cause a systemic effect, and it can be used once a day, its effect is detected already in the first days.

When choosing corticosteroid drugs, it is necessary to strive to eliminate the acute symptoms of atopic and allergic dermatitis in children in a short time. Despite the risk of side effects, corticosteroid drugs are the mainstay in the treatment of atopic dermatitis.

How else can you cure atopic dermatitis in a child

To cure atopic dermatitis in a child as quickly as possible, it is recommended to use β-methasone-containing ointments, the use of which is not recommended for a long time. These funds include akriderm. Akriderm and Akriderm GK have a moisturizing effect and prevent drying of the skin. Akriderm C contains salicylic acid, which softens and exfoliates the scales of the epidermis. The combined drug akriderm GK contains gentamicin (antibiotic) and an antifungal agent. It has an antibacterial and antifungal effect.

In the treatment of atopic dermatitis in children, anti-inflammatory external agents are also used: sulfur, tar, LSD-3, Peruvian balsam, clay.

It is necessary to wash the child with cool water (long bathing and hot water are not recommended, use special shampoos such as Friderm tar, Friderm zinc, Friderm pH balance.

In case of secondary infection of the skin, pastes containing 3-5% erythromycin are used in the form of ointments. Skin treatment with solutions of brilliant green, methylene blue.

With a fungal infection, Nizoral, Clotrimazole, etc. creams are prescribed.

A stable clinical effect in atopic dermatitis occurs with the right combination of allergen elimination, taking into account all factors of the disease development mechanism, the use of local glucocorticosteroids, and the correction of neurovegetative dysfunctions.

Methods of treatment and prevention of atopic dermatitis in a child

Many doctors are sure that atopic dermatitis in a child can be cured, and there are four ways to do this.

The most common- Always prescribe and change antihistamines. The method firmly and permanently connects the patient with the doctor, but does not bring permanent and final relief. It is even difficult to call quality treatment.

Second option- block the immune response with mast cell membrane stabilizers for the duration of the allergen in the hope that the immune system, developing with the child, will wean itself from overreaction to the allergen. Treatment is long and can only be effective against pollen allergens. The doctor and parents are waiting for the child to “outgrow” the allergy as a result of hormonal changes in the body. Sometimes it works out.

Third way- elimination of the allergen, that is, the creation of conditions under which the child will not meet with the allergen. For example, you don’t keep fish or pets, you don’t give certain foods, you leave for the time of the allergen bloom in distant countries. Hope is the same as in the second option. It also works sometimes.

Fourth way- desensitization - the introduction of minimal, close to homeopathic, doses of the allergen into the child's body. It works like this. Although a microscopic amount of the allergen is sufficient for the occurrence of a true allergic reaction, nevertheless, the doctor can reduce this amount by tens and hundreds of times. By injecting such a dose into the body, he begins to teach him not to react to the allergen. It is very important to know what exactly the child is allergic to. They learn about this based on the results of tests to identify the allergen.

It is necessary to avoid errors in maternal nutrition during pregnancy and lactation, to treat chronic diseases of the mother before and during childbirth. For the prevention of outbreaks of atopic dermatitis in children and adults, sanatorium treatment is recommended in a warm southern climate, in gastrointestinal sanatoriums.

The prognosis in most cases in young children is favorable, provided proper nutrition and therapeutic measures are taken to normalize the functioning of the gastrointestinal tract and adaptation systems. Most often, food allergies go away without a trace and without consequences. But you should not expect that the child himself will "outgrow" the disease, and do nothing.

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Atopic dermatitis is an allergic skin disease that usually occurs in early childhood in individuals with a hereditary predisposition to atopic diseases, which have a chronic course and are characterized by skin itching and skin lesions.

Atopic dermatitis is characterized by a variety of clinical forms of skin lesions, a staged course and the development of concomitant pathological changes in many body systems.

The course of atopic dermatitis is difficult to predict: in almost half of patients, the disease resolves by the age of 15, while the rest can be observed throughout life.

Atopic dermatitis is a multifactorial disease based on a genetic (hereditary) predisposition to allergies.

Risk factors for atopic dermatitis

• hereditary predisposition.
• Allergics are important in the formation of atopic dermatitis.
• The exacerbation of the disease is associated with the action of various provoking factors (triggers).

hereditary predisposition

It is one of the characteristic features of allergic diseases. If one of the parents fell ill with an allergic disease, then the probability of the disease rises to 45-55%, if more, then up to 60-80%. The likelihood of developing atopic dermatitis in a child is higher if the mother had an allergic disease.

Allergens

Food allergens are considered to be the main factors that determine the realization of a predisposition to atopic dermatitis in children. Approximately 30-40% of children of different ages suffering from atopic dermatitis have a food allergy to chicken egg protein, milk, fish, and cereals.

Aeroallergens (house dust, house dust mites, animal allergens, plant pollen, fungal allergens) play a major role in atopic dermatitis, and reducing their exposure leads to a decrease in the risk of atopic dermatitis and its exacerbation.

Factors that provoke exacerbations (triggers)

- Irritants (irritants): clothes made of wool, synthetic fabrics, detergents (soap, washing powder, etc.), pathogenic tobacco smoke;

- hormonal factors: menstruation, pregnancy, menopause;

- emotions: stress, anxiety, feeling of disappointment, etc.;

- climatic factors: cold season (autumn, winter) and a sharp change in climate;

- infection: bacterial, fungal, viral. Microorganisms can exacerbate atopic dermatitis and maintain skin inflammation;

- food allergens: cow's milk, chicken eggs, cereals, nuts, (mainly in children of the first years of life);

— aeroallergens: household, epidermal, pollen. They can cause exacerbations of atopic dermatitis when they enter the patient's body by inhalation and contact (through the skin) routes;

— pollutants (industrial emissions, exhaust gases, etc.). Their role in the development of atopic dermatitis is indirect.

Thus, the implementation of a genetic predisposition to atopic dermatitis can be carried out under the action of a number of adverse environmental factors. Their elimination is one of the conditions for successful treatment of patients.

Clinic

Age features.

Most often, atopic dermatitis affects children in the first 2 years of life, although the disease can manifest itself at any age. In a small number of children, atopic dermatitis begins before the first 6 months of life with age, the incidence of atopic dermatitis decreases.

Each age period is characterized by a certain localization and morphology of skin elements.

The clinical picture of atopic dermatitis in children aged 2 months to 2 years has its own characteristics. Therefore, the "infantile" stage of the disease is distinguished, which is characterized by acute and subacute inflammatory nature of skin lesions with a tendency to exudative changes and a certain localization. In most cases, there is a clear connection with food irritants.

Initial changes usually appear on the cheeks, less often on the outer surfaces of the legs. Severe pruritus is characteristic. By the end of the first - the beginning of the second years of life, exudative manifestations usually decrease. Infiltration (thickening of the skin) in certain areas of the skin increases, cracks appear, and the skin pattern is strengthened.

The second age period - "children's stage" - covers the age from 3 to 13-15 years. It is characterized by: a chronic course with exacerbations in spring and autumn. Periods of severe exacerbations can be followed by prolonged remissions, during which children feel practically healthy.

Rashes are localized, as a rule, in the elbow and popliteal folds, on the back of the neck, flexion surfaces of the ankle and carpal joints, in the behind-the-ear areas and are represented by redness, papules, peeling, thickening of the skin, and increased skin pattern. At the time of resolution of the rashes, areas of pigmentation remain in the lesions. In some children, an additional fold of the lower eyelid and allergic cheilitis are formed in this period - a lesion of the red border of the lips and skin.

The third age period "adult stage" is characterized by a lesser tendency to acute inflammatory reactions and a less noticeable reaction to allergic stimuli.

The main complaint of patients is pruritus. Characterized by increased skin pattern, thickening of the skin, multiple scratches and cracks. Most patients note a clear connection between exacerbations of the disease and psycho-emotional factors. Many patients have a dependence of exacerbations of the disease on foci of chronic infection. However, most patients note deterioration in the summer, and during their stay in the southern resorts.

Atopic dermatitis and comorbidities

Atopic dermatitis is combined in most cases with other diseases of the allergic range, however, these combinations should be assessed as a manifestation of a single pathological process!

In young children, gastrointestinal dysfunction is noted.

In persons suffering from atopic dermatitis with frequent severe exacerbations, often functional changes in the nervous system are found, in particular, vegetative-vascular dystonia.

Atopic dermatitis is often accompanied by intolerance to various drugs - more often penicillin antibiotics, vaccines, serums.

Often, patients suffering from atopic dermatitis develop bronchial asthma or other allergic diseases.

Treatment of atopic dermatitis

It is carried out strictly individualized depending on the age period of the disease, the degree of activity of the pathological process, concomitant diseases.

Treatment includes the main areas:

• elimination of the causative allergen;
• external therapy;
• pharmacotherapy;
• if necessary, allergy-specific immunotherapy.

Prevention

• the introduction of complementary foods is justified only after 4 months of life with products with low allergenic activity;
• control over environmental factors;
• exclusion of exposure to tobacco smoke;
• reduction of exposure to allergens in the first years of life (house dust, animals, cockroaches);
• maintaining low humidity and adequate ventilation in the premises where the child is (avoid dampness);
• reducing the impact of polleotants;
• if a child has atopic dermatitis with a confirmed allergy to aeroallergens (plant pollen, house dust, pet hair), adequate therapy with antiallergic drugs, a group of cetricins, begins up to 18 months, in order to prevent bronchial asthma.

Skin care

• During the period of exacerbation of atopic dermatitis, general hygienic baths are carried out weekly.
• For baths, dechlorinated water is used (after settling or filtration), in case of infection of the skin - with the addition of a solution of potassium permanganate to a slightly pink color.
• For hygiene purposes, special mild detergents are used, as well as shampoos containing tar and zinc.
• After the bath, the skin must be dried with a towel (do not rub) and apply a cream with a softening and moisturizing effect (Bepanten, Drapolen, Glutamol, Myosten, etc.)
• Apply moisturizers and emollients so often that there is no feeling of tightness and dryness of the skin.
• It is important to ensure sufficient humidity in the room
• When bathing, you can not use washcloths, rub the skin, use a large amount of soap.
• To wash the skin, it is recommended to use products that do not contain soap.

• Do not use various irritating agents, washing powders, aggressive detergents, thinners, gasoline, various cleaning agents for furniture, carpets, etc.
• Avoid contact of the skin of the hands with plants, as well as with the juices of vegetables and fruits.
• Do not wear coarse clothing, especially wool or synthetic materials.
• It is preferable to wear cotton clothing.
• Intense physical activity should be avoided as a factor that increases sweating and itching.
• Avoid exposure to extreme temperatures and humidity
• Avoid stressful situations.
• During the repair in the apartment to live in another place.

• Provide good ventilation, maintain optimal humidity in the living room (about 40%).
• Do not keep carpets in the room.
• The TV and computer must be removed from the patient's room, as the concentration of dust around them is significantly increased
• Books should be kept in glass bookcases.
• Store clothing in closed closets.
• Wall covering: washable wallpaper or painted walls should be preferred.
• Curtains must be cotton; wash them at least once every 3 months, do not use draped curtains.
• Do not use feather and down pillows and blankets. The pillow should be made of synthetic winterizer or other synthetic fibers.

Bedspreads should be of easily washable fabrics. For children, it is necessary to use mattresses and pillows closed in tight envelopes with a zipper, 2 pillowcases on a pillow. Pillows and blankets should be washed once a month. Change bed linen once a week.

• Do not store things under the bed.
• Carry out wet cleaning of the premises, as well as cleaning carpets, upholstered furniture using vacuum cleaners at least 1 time per week. The apartment where the patient lives must be cleaned in his absence.
• To reduce the concentration of house dust mites, it is necessary to use special anti-mite underwear that is safe for the patient.
• Wash bedding at 55 C. Freezing, as well as exposure to direct sunlight on bedding, causes the death of mites

• It is necessary to carefully clean rooms that are easily affected by mold (showers, basements). After using the bathroom, dry all wet surfaces. For cleaning, you need to use solutions that prevent the growth of mold.
• Prevent the growth of mold fungi in the kitchen, use a hood to remove steam.
• Dry clothes only in a ventilated area, outside the living room.
• Avoid visiting poorly ventilated areas (basements, barns, cellars).
• Do not take part in gardening in autumn and spring, as it is stale leaves, hay, straw and grass that serve as a source of mold in the air.
• It is not recommended to eat foods whose preparation is based on fermentation (fermentation) processes: spicy cheeses with white, green, blue or any other mold, smoked meat and fish, sauerkraut, kefir and fermented milk products, kvass, beer, wine, freshly baked bread, etc.
• It is not recommended to plant indoor flowers at home, as the earth in pots serves as a source of growth for some mold fungi.
• If there is an air conditioner in the premises, it is necessary to regularly change the filters, otherwise favorable conditions are created for the development of mold fungi in them.

• During the flowering season of the causative plants, outdoor time should be limited.
• Sealing windows or installing hermetic double-glazed windows; when opening the vents, use damp gauze.
• When traveling in a car, keep the windows closed.
• Do not use herbal remedies for treatment.
• Do not use herbal cosmetics - soaps, shampoos, creams, balms, etc.
• When outdoors, wear tight-fitting goggles; coming from the street, take off your clothes, take a shower, rinse your mouth, rinse your eyes, nasal passages.
• You should refrain from flowering plants in the house, especially primrose and geraniums.
• Exclude the use of foods that have cross-allergenic properties with causally significant allergens, for example, if you are allergic to trees, you should not eat stone fruit, nuts, carrots, kiwi. If you are allergic to ragweed, it is forbidden to eat watermelons, sunflower oil, halva, gozinaki, honey.

Allergist Shnip N.I.

Atopic dermatitis most often occurs in young children as a reaction to allergens. Not always red cheeks in a baby is a sign of good health. Parents should be aware that this is a rather dangerous disease. It manifests differently in children of different ages. Sometimes the pathology worsens throughout a person's life. The presence of atopic dermatitis in children requires especially careful attention to the choice of food, skin care products. When using drugs, one must take into account his age.

Content:

What is atopic dermatitis. Flow forms

This disease is also called childhood eczema. It is an inflammatory allergic reaction of the skin to the action of toxic substances and allergens. This disease is characterized by such manifestations as redness, dryness and peeling of the skin, the formation of itchy blisters with liquid. Children of different ages meet with it, but most often atopic dermatitis appears in babies of the first year of life.

The disease is divided into the following types:

• infantile (in children 0-3 years old);
• children (3-7 years);
• teenage (over 7 years old).

Often, skin allergies in a child are combined with intestinal dysbacteriosis, allergic rhinitis, conjunctivitis. The disease is chronic. Treatment can reduce its manifestations and reduce the frequency of relapses.

Light form atopic dermatitis is manifested by slight reddening of the skin, the appearance of separate, slightly itchy vesicles. Between periods of exacerbation can take 8 months.

Medium form. Multiple areas of redness and thickening appear on the skin. The skin itches and gets wet. This condition can last up to 3 months and often recurs.

Severe form. A lot of weeping and itchy rashes are formed, which merge, become covered with cracks and ulcers. There are almost no breaks in the occurrence of relapses.

Causes

The main causes of atopic dermatitis in a child are genetic predisposition and the adverse effects of external factors. The occurrence of an allergic skin reaction is associated with the innate characteristics of immunity, an increased content of antibodies to certain substances in the blood.

From birth, a child may develop food allergies to foods that a nursing mother consumes, as well as to allergens contained in milk mixtures. Atopic dermatitis can manifest itself when the baby begins to feed cereals, vegetable and fruit purees.

Warning: Doctors always warn that it is impossible to accustom the crumbs to 2 or more products at the same time. It is necessary to start feeding with insignificant portions of any one of them, observing the reaction of the baby. If there are no skin or intestinal manifestations, gradually increase the portion, and then accustom him to new food in the same order.

Allergens are often plant pollen, household dust, washing powders, cleaning products. Babies are allergic to creams, products that impregnate wipes for skin care.

The reasons for exacerbation of atopic dermatitis can be experiences, nervous overexcitation of the child, being in harmful environmental conditions (including in the same apartment with a smoking person), the baby's stay in a too warm room or overheating while walking. Often the child has seasonal relapses of the disease.

Video: Causes of dermatitis, its danger and consequences

Manifestations and symptoms

The onset of the disease in infants is the formation of yellow crusts in the fontanel area, redness, itching and peeling of the skin behind the ears, on the cheeks, in the eyebrow area. The occurrence of diaper atopic dermatitis is characteristic (rashes in the buttocks and perineum as a result of a rare change of diapers, improper care behind baby's skin).

In children under 2 years of age, the main manifestations of atopic dermatitis are:

• reddish rash on the face, neck, buttocks, in the folds of the legs and arms, in the inguinal folds;
• rashes in the form of bubbles with a clear liquid, leading to the formation of weeping areas;
• cracks and crusts on the skin;
• inflammation and itching in the area of ​​​​rashes, which intensifies at night, from which the child cannot sleep peacefully, is naughty, and loses weight.

At the age of 2-7 years, the skin reaction in children manifests itself mainly in the folds of the limbs, on the palms and feet. In areas of inflammation, the skin is thickened, looks dry and rough, covered with weeping bubbles.

It is not uncommon for children to develop so-called contact atopic dermatitis, when the skin becomes inflamed upon direct contact with an allergen (synthetic clothing, a certain type of cream or soap). As a rule, such an allergy disappears after the removal of the irritant.

Symptoms of chronic atopic dermatitis in children can be swelling and redness of the feet (especially in the cold season), coarsening of the skin, thinning hair in the back of the head, and the appearance of wrinkles on the lower eyelids. Symptoms of atopic dermatitis can be confused with diseases such as psoriasis, seborrheic dermatitis, microbial eczema, and others. However, there are still differences.

In psoriasis, there are bright and well-demarcated areas of reddening of the skin, moderate itching, damage to the joints of the hands and feet (arthritis), and nails. Seborrheic dermatitis is characterized by the appearance of greasy yellow crusts on the head. In this case, as a rule, itching is absent. Microbial eczema is a bacterial inflammation of the skin after microbes enter them through cracks. Often it appears in the area of ​​fungal infection or in areas with dilated veins.

A more accurate diagnosis is established after the examination.

Video: Causes and treatment of dermatitis in children

Diagnosis and principles of treatment of atopic dermatitis

The development of the disease in a child occurs gradually, in several stages.

Initial- this is redness and swelling of the cheeks, peeling of the skin. As a rule, timely treatment and a hypoallergenic diet can completely eliminate symptoms.

Expressed. There are characteristic manifestations of acute skin allergies, then the disease becomes chronic. Treatment helps to relieve symptoms, put the disease into remission.

Remission- disappearance of symptoms for up to several months.

clinical recovery- no symptoms for 3-7 years.

Possible Complications

With untimely or incorrect treatment of atopic dermatitis, the following complications may occur:

• bronchial asthma, allergic rhinitis;
• purulent skin lesions as a result of bacteria getting into cracks, as well as scratching in areas affected by dermatitis (pyoderma);
• skin death occurs with prolonged treatment with ointments containing hormones;
• herpes due to entry into the wounds of the virus;
• fungal diseases of the skin.

Diagnostics

The dermatologist, after studying the external signs and finding out the history of their occurrence, if allergies are suspected, sends the child for examination to an allergist-immunologist. Since the cause of the disease can be nervous disorders, intestinal diseases or endocrine disorders, consultations are held with a neuropathologist, gastroenterologist and endocrinologist.

During the examination, a number of tests are taken. So, the analysis of feces allows you to establish the presence of dysbacteriosis or worms. A blood test for the presence of antibodies to various substances is carried out to detect immune disorders. The contents of the vesicles are sown to exclude the bacterial nature of the rashes.

Ultrasound of the abdominal cavity is also performed to detect diseases of the gastrointestinal tract.

Warning: Without knowing the diagnosis, in no case should you start self-treatment. There may be severe complications that may pose a threat to the life of the child.

Treatment of the disease at the initial stage

One of the first manifestations of an allergy in a small child is prickly heat and diaper dermatitis. In order to eliminate them, it is necessary to rid the baby of too warm clothes, maintain a temperature in the room of 20 ° -21 ° C, no more. It is advisable to remove the oilcloth from under it, change diapers more often. The child must be bathed in a weak solution of potassium permanganate or in an infusion of succession. In order for the skin to "breathe", it is useful to leave a diaper for a while, making sure that it does not freeze.

Another early manifestation of atopic dermatitis is diathesis - food allergies. First of all, it is necessary to exclude allergens from the child's diet. Reddened cheeks are rubbed with infusion of string or bay leaf. This relieves irritation and inflammation of the skin.

Diet

In the presence of dermatitis, cow's milk, eggs, honey, chocolate, citrus fruits, as well as products containing preservatives, dyes, and dietary supplements are excluded from the diet of children. The child should not be given fried and spicy foods. Nuts, wheat, fish can provoke a relapse of the disease. An allergy occurs to any individual product, so the diet is made individually.

The use of medications

Treatment of atopic dermatitis is carried out mainly at home. Indications for hospitalization of a child are extensive infectious processes on the skin, deterioration in general health.

When prescribing medications, the stage and form of atopic dermatitis in a child, specific manifestations, the extent of skin lesions, and age are taken into account. The principle of treating a child is to cleanse his body of toxins, eliminate itching, dryness, infection and inflammation of the skin. To do this, various medications are used.

Antihistamines

Elimination of pruritus, especially if it is combined with insomnia, allergic rhinitis, conjunctivitis, is performed using antihistamines such as suprastin, tavegil. The safest drugs for children are Zyrtec and Erius, which are not addictive. They come in a variety of child-friendly forms (syrups, drops, potions, and tablets). The course of treatment is 3-4 months.

Reduction of sensitivity to allergens is carried out with the help of hyposensitizing drugs, such as fenistil, histane.

Sedatives

Glycine, persen, as well as drops based on peony and valerian extracts are prescribed as soothing drugs.

Body detoxification

Means that are able to absorb molecules of toxins and allergens are used. Children are given activated charcoal tablets, as well as enterosgel, polyphepan.

Antiseptics

Skin cleansing is carried out using solutions of miramistin, chlorhexidine, hydrogen peroxide or 1-2% ethyl alcohol solution. Treatment is carried out to prevent the development of bacterial processes on the skin.

Dermatol, furatsilin, xeroform ointments, as well as sulfargin, dermazin, dioxidin, bepanten are used as antiseptic agents. These bactericidal ointments relieve inflammation, accelerate healing, and activate the growth of new cells. Skin treatment is carried out 1-2 times a day.

Antifungal and antiviral drugs

If a fungal skin disease is detected against the background of atopic dermatitis, the affected areas are lubricated with antifungal creams (clotrimazole, pimafucin). For herpes, acyclovir is used in the form of ointments and tablets for oral administration.

Antibiotics

Such therapy is carried out only with bacterial skin lesions. For treatment, ointments containing antibiotics (levomekol, fucidin, lincomycin, erythromycin and others) are used.

Antibiotic tablets (eg, erythromycin) are also used.

Anti-inflammatory treatment

Steroid ointments. In the treatment of children from dermatitis, accompanied by extensive inflammation of the skin, ointments and creams containing hormones (lorinden, elokom, akriderm) are prescribed. Their action is based on the ability to suppress the production of proteins that increase the sensitivity of the skin to allergens.

Such ointments can be used strictly as prescribed by a doctor and in short courses, as they have many side effects (decreased immunity, skin atrophy, and others). Their use should not be stopped abruptly, as this can lead to a recurrence of the disease in an even more severe form. Means differ in different activity (weak, moderate and strong). Treatment begins with the use of drugs of weak action, and only if they are ineffective, they move on to stronger ones.

In the first days, the ointment is applied in its pure form. As the condition improves, it is smoothly canceled within 6 days as follows:

1. In 1-2 days, the ointment is diluted with baby cream in a ratio of 1: 1.
2. For 3-4 days - in a ratio of 1: 2.
3. For 4-6 days - in a ratio of 1: 3.

After that, the use of the ointment is stopped. If there is a need for re-treatment, an ointment with a different hormone is used. Lubrication is carried out in the morning and in the evening.

Non-hormonal anti-inflammatory drugs. They are used for simple forms of atopic dermatitis. Such means are ichthyol, zinc ointment, birch tar, as well as healing ointments and sprays bepanten, panthenol, solcoseryl.

Elimination of dysbacteriosis

Preparations containing useful lactobacilli are used, which allow normalizing the functioning of the intestines, speeding up the metabolism and removing toxins and allergens from the body (linex, probifor).

Improving the functioning of the pancreas

Creon, mezim are prescribed, containing enzymes necessary for normal digestion and assimilation of food. Choleretic agents are also used, in which children can be given an extract of rose hips, an extract of corn stigmas. Treatment with these drugs is carried out for 2 weeks.

Other treatments for atopic dermatitis

The use of vitamins and herbal remedies for atopic dermatitis in children can increase its manifestations, so they are prescribed only for individual indications.

Physiotherapy

From the age of 3-4, such methods of alleviating the symptoms of atopic dermatitis as electrosleep (putting the child to sleep by exposing the centers of the brain to low-frequency currents), as well as massage with carbon dioxide bubbles (carbon baths), mud therapy, balneotherapy, are used.

Folk methods of treatment

To eliminate itching, inflammation and irritation in case of skin allergies, baths with string and chamomile are actively used in folk medicine. In order for the child to be less nervous and sleep more calmly, it is recommended to add decoctions of hops, valerian, oregano, motherwort to the bathing water. At the same time, 2 tbsp. l. herbs are boiled in 1 glass of water for 10 minutes, filtered and poured into a bath of water. You can not use funds if the child has an allergy to plants.

A bath with the addition of starch helps to relieve itching (50 g of starch is taken for a baby bath, dissolved in hot water and mixed with bathing water).

Aloe juice and potato juice have a good healing, anti-inflammatory effect.

To lubricate the affected skin, you can use an ointment of the following composition: milk, rice starch and glycerin (take 1 tsp of the components).

Video: Skin care for a child with atopic dermatitis

Allergists emphasize the need for a special approach to caring for the skin of a child suffering from such a disease. It is not recommended to use soaps and shampoos containing dyes and fragrances. The child's skin can only be blotted with a soft cotton towel, and then be sure to lubricate with a moisturizer. To prevent the baby from combing the sores, his nails are cut short.

Antihistamines should be given to a child who has a similar disease with any vaccination. A week before vaccination and within a week after it, allergen foods should be completely excluded from the diet.