Atopic dermatitis: symptoms and treatment
- Classification of atopic dermatitis
- Mechanism of atopic dermatitis
- Causes of atopic dermatitis
- Symptoms of atopic dermatitis
- Diagnosis of atopic dermatitis
- Treatment of atopic dermatitis
Atopic dermatitis is a disease of the skin of allergic etiology. In the structure of allergic diseases, this dermatosis occupies about 50% and recently there has been a steady tendency to increase its share. Atopic dermatitis is characterized by a genetic predisposition and a relapsing course with clinical manifestations, depending on the age of the patient. For the first time, the disease manifests itself in early childhood and, as the patient grows up, either goes into a lighter form, or ceases to disturb at all.
In developed countries with atopic dermatitis, up to 20% of the total population is facing, which indicates the great urgency of this problem. Symptoms in 60% of cases have time to manifest in children under 6 months. There may be a more recent first manifestation of the disease: up to 1 year, 75% of cases are already evident, and by the age of 7, about 90% of cases occur. This suggests that if the disease has not manifested itself in the preschool age, then the probability of getting sick later is very small. Over the past decades, atopic dermatitis has been occurring more and more frequently and is somewhat more complicated. Often, the disease is combined with other diseases of allergic etiology: pollinosis, allergic rhinitis or bronchial asthma.
Classification of atopic dermatitis
This disease doctors classified according to several criteria.
Periods, phases and stages of development of atopic dermatitis
- The initial stage - the first changes appear on the skin, which are not very pronounced and may not attract the proper attention of the child's parents.
- Period of pronounced changes - all symptoms are most pronounced.
- The acute phase is characterized by a pronounced symptomatology, which is rapidly growing, but with proper treatment also quickly recedes.
- The chronic phase - the symptoms are less pronounced, but worried about the patient for a much longer time.
- The stage of remission is the time when the disease does not manifest itself, but the probability of returning its symptoms persists.
- Complete remission - skin integuments are clean, they do not have elements of the rash, the patient does not care about the itching.
- Incomplete remission is also called a subacute period. Clinical manifestations of the disease are partially preserved, but practically do not bother the patient.
Forms of the disease, depending on the age
- Infant - the most common and pronounced. It is observed in children aged 2 months to 2 years. At this time, the pathological processes in the skin integuments are characterized by exudation.
- Children - in most cases is a slightly modified infantile odds. Sometimes it first appears in this age. Symptoms become less pronounced, and exudative processes are declining.
- Adult form - in most cases, the disease itself retreats to this time. Sometimes the symptoms persist and manifest themselves in the form of periodic rashes on the skin, usually weakly expressed.
Types depending on the prevalence of the process
- Limited - the focus is small.
- Common - dermatosis affects a fairly large area of the skin, but in most cases is limited to changing one area of the body.
- Diffusive - inflammatory changes in the skin are observed almost throughout the body.
The severity of the course of the disease
- Easy - the rash is insignificant and quickly passes. Exacerbations occur relatively rarely.
- Medium-heavy - takes an intermediate position.
- Severe degree - the patient very often encounters an aggravation of the process. Most often the rash on the body diffuses, exudative processes are pronounced.
Variants of the disease depending on the etiology
Since the disease is allergic in nature, its aggravation can be caused by various factors.
- The variant provoked by food allergens is probably the most common, as modern products contain many additives and are very diverse. Many exotic fruits were previously inaccessible, and today they can be found on any counter. The organism is more adapted to local products.
- Fungal variant - spores of fungi are found almost everywhere. Some of them can provoke an allergic reaction.
- Pollen, dust variant - depends on the impact of small allergens that enter the body together with the inhaled air.
- Dermatitis, provoked by chemicals - is particularly relevant in relation to cosmetics for skin care. Flavors, fragrances, dyes - all this can be used by manufacturers and increase the danger of cosmetics for our body. It is very important when caring for the baby to give preference to hypoallergenic drugs, which are developed specifically for children. The same applies to adults: you need to carefully choose cosmetics, read its composition and choose the most natural substances.
- Dermatitis with secondary infection - the affected skin can not perform its protective functions properly, which creates conditions for bacteria to penetrate there and multiply them. As a result, the wounds can get stuck, which greatly exacerbates the current situation. Therefore, it is necessary to carefully and carefully care for the skin to avoid this complication.
Mechanism of atopic dermatitis
It is believed that the underlying disease is allergic inflammation. Initially, in the human body, predisposed to the development of atopic dermatitis, pathological changes in the immune system are observed, which are manifested by an increase in the number of one of the leukocyte fractions. As a result of exposure to the allergen, specific receptors on mast cells (this is a kind of leukocytes) catch them and provoke the release of a large number of natural mediators of inflammation (cytokines and histamine). They rush into the affected area and cause there swelling of the tissues, increase the permeability of the wall of blood vessels.
If in addition to everything a bacterial or fungal infection joins, the situation is further exacerbated. By themselves, these microorganisms can damage tissues and cause inflammation. Plus, the entire human body can perceive them as an allergen, further strengthening the response of its immunity.
Causes of atopic dermatitis
On this subject, currently there are active disputes among scientists, because the main, fully proven cause of the disease is not yet there. However, doctors agree on one thing: for the development of atopic dermatitis, a combination of several adverse environmental factors and a hereditary predisposition on the part of the patient is necessary. Hereditary nature of pathology confirms that most patients with atopic dermatitis have immediate relatives who are also suffering from allergic diseases.
- The influence of unfavorable factors even during pregnancy especially affects the body of the future person, because during this period all its organs and systems are only laid and are most sensitive to negative effects.
- Failure to comply with a diet of a pregnant or lactating woman - ensures that the child receives a large number of potential allergens. Which "load" is not yet formed immunity and can change its properties.
- Taking some medicines also affects the baby. Therefore, doctors always try to avoid medical therapy for pregnant women, but this is not always possible. Sometimes you have to take risks because of a big threat (less of the two evils are chosen).
- Smoking and alcohol abuse - unfortunately, some women are irresponsible not only to their health, but also to the health of the baby's future, literally poisoning it.
- The main cause of exacerbation of the disease, the manifestation of itching and rash, is the effect of the allergen. Doctors are not sure if the allergy itself can cause this disease, but here it can easily lead to its aggravation.
- Food allergens are especially dangerous in this regard, milk and dairy products (dairy-based are exception), wheat products, fish and seafood, eggs (their proteins), nuts, exotic fruits, etc. Therefore, special recommendations for feeding young children take into account all this and indicate that the baby is the safest.
- Pollen of plants, animal hair, mold, household pliers - all these products with a high degree of probability can cause allergies.
- Perfumes, soaps, detergents in contact with skin can cause both allergic and contact dermatitis, exacerbating the course of the disease.
- Some professions involve the use of special chemicals, which also has a very bad effect on the skin condition.
- Sharp change of climate or weather conditions. A sharp cooling can aggravate the course of the disease. Especially difficult for patients in the winter, because cold air contains less moisture and more drains the skin, causing it to itch. A sharp increase in air temperature, on the contrary, can lead to the release of a large amount of sweat and additional irritation of the affected area.
- Stresses and emotional overstrain affect the state of the human immune system and can lead to an exacerbation of the disease.
Symptoms of atopic dermatitis
The most frequent and pronounced symptom of atopic dermatitis is itching. He can be very strong and disturb the patient for a long time, significantly reducing the quality of his life. Children at the same time do not control themselves and can scratch their skin, causing themselves additional injuries and aggravating the situation. Therefore, it is necessary to cover the affected area with a bandage if the child constantly tries to scratch herself - this will avoid many unpleasant complications.
On the affected areas there is always a rash - a red color, heterogeneous in its composition and appearance. It can, how to be present on the skin for a long period of time, and relatively quickly disappear virtually without a trace.
- If an infected infection enters the scratched wound, then a significant amount of liquid is released, followed by crust formation. So the body tries to escape from the pathogen. Such a rash is considered acute and passes relatively quickly.
- If the skin has dry scales and marked itching, then it can be described as a subacute rash.
- In the most unfavorable case, the elements of the rash are present for a long time and are constantly combed (lichenification occurs)
The localization of the rashes and their peculiarity depends on the age of the patient
Children under two years old - in most cases the face, the scalp, limbs (especially the elbows and knees), the neck and the trunk are affected.
- Very rarely there is a lesion in the perineum.
- Very often on the affected skin appear crusts or there is a discharge of fluid (exudation).
Children under 11 years of age:
- In the overwhelming majority of cases, the internal surfaces of the hands and feet, neck and other places where there are folds are damaged.
- The rash is dry in most cases, tends to transition to a chronic form, resulting in the skin becoming rough.
- Children continue to scratch the damaged areas, which leads to infection.
Adolescents and adults:
- All manifestations as they grow older are transformed into a lighter form.
- If the symptoms persist, in most cases the skin is damaged in the knee and elbow area (in the folds of the skin). Sometimes there is a rash on the face, wrists and in the groin area.
Diagnosis of atopic dermatitis
To establish the diagnosis, special criteria are chosen by which the specialists are guided. The fact is that during the laboratory tests, one can only detect a violation of the level of certain immunoglobulins, and also reveal an increased sensitivity to certain substances. It speaks in favor of an allergy, but does not indicate that the patient has atopic dermatitis.
Diagnostic criteria of atopic dermatitis
- Large (they are also called mandatory).
- Skin itching, even with minimal damage to the integument.
- Typical location of the rash.
- The presence of atopic dermatitis in the anamnesis of the next of kin.
- Recurrent course.
- Small criteria (additional).
- Increased level of antibodies to IgE.
- The first manifestation of the disease in childhood.
- Presence on the soles and palms of a large number of folds.
- Light spots on the skin of the face and upper extremity belt.
- Peeling of skin.
- Frequent damage to the skin of infectious etiology.
- White dermographism of the skin.
- Appearance of itching with sweating.
- Dark circles around the eyes.
Treatment of atopic dermatitis
In the treatment of this disease a combination of several methods is used, which allows to achieve a better result
It is necessary to exclude from the diet of the patient all products that are likely to cause allergies (they were mentioned earlier). Women during breastfeeding should also follow a strict diet, since much of what the mother eats comes into the milk. Often there is such a situation: a woman during pregnancy restricts herself to favorite delicacies for the sake of the child's health, which is commendable, and immediately after giving birth, she relaxes and feeds the baby with not quite good milk, which reduces all her previous efforts to naught.
Treatment with pharmacological drugs
Depending on what the age of the patient, the principles of treatment and the set of drugs can radically differ. Doctors currently use many substances that affect different processes in the patient's body.
- Antihistamines of the last generation have few side effects and can be used even in children. They block the natural mediators of inflammation and prevent histamine from causing serious inflammatory changes.
- Stabilizers of mast cell membranes have shown themselves very well in pediatric practice, but are practically ineffective in treating adults.
- Vitaminotherapy - contributes to the normalization of metabolism, which can not but affect the condition of the skin of a person.
- Immunomodulators - normalize the immunity of a person, as a result of which it becomes less active with respect to allergens.
- Substances that affect the nervous system - relieve the patient of serious stress and anxiety, which can reduce the likelihood of an exacerbation of the disease.
- Antibiotics - are used in the most severe cases in the presence of an infectious complication.
- Drugs affecting the functions of the digestive system.
- External treatment - used cream, ointments, special cosmetics, moisturizing the skin and relieving the feeling of itching.
If you turn to specialists in time and follow all their recommendations, the disease will eventually recede and leave no traces on the patient's skin. Otherwise, a person can over many years face with exacerbations, constantly limiting himself in some way.
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