Atopic dermatitis: symptoms and treatment
- Classification of atopic dermatitis
- The mechanism of development 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 an allergic etiology. In the structure of all allergic diseases, this dermatosis occupies about 50%, and recently there is a persistent tendency to increase its share. Genetic predisposition and relapsing course with clinical manifestations depending on the patient's age are characteristic of atopic dermatitis. For the first time, the disease manifests itself in early childhood and, as the patient grows older, it either goes into a milder form or stops altogether.
In developed countries, with atopic dermatitis, up to 20% of the total population is affected, which indicates the great relevance of this problem. Symptoms in 60% of cases have time to manifest in children under the age of 6 months. A later first manifestation of the disease is also possible: up to 1 year, already 75% of cases of the disease manifest themselves, and by the age of 7, manifestation occurs in about 90% of cases. This suggests that if the disease did not manifest itself at preschool age, then the probability of getting sick later is very small. Over the past decades, atopic dermatitis is becoming more frequent and proceeds somewhat more difficult. Often the disease is combined with other diseases of an allergic etiology: hay fever, allergic rhinitis, or bronchial asthma.
Classification of atopic dermatitis
Doctors classify this disease according to several criteria.
Periods, phases and stages of development of atopic dermatitis
- Initial stage - the first changes appear on the skin, which are not very pronounced and may not attract the proper attention of the parents of the child.
- The period of pronounced changes - all the symptoms are most pronounced.
- Acute phase - characterized by pronounced symptoms, which quickly increases, but with proper treatment also quickly retreats.
- Chronic phase - the symptoms are less pronounced, but they bother the patient for a much longer time.
- The stage of remission is a time when the disease does not manifest itself, but the likelihood of the return of its symptoms remains.
- Complete remission - the skin is clean, there are no elements of the rash, the patient is not disturbed by itching.
- Incomplete remission - also called a subacute period. Clinical manifestations of the disease are partially preserved, but they do not practically bother the patient.
Forms of the disease, depending on age
- Infant - the most common and pronounced. It is observed in children aged 2 months to two years. At this time, the pathological processes in the skin are characterized by exudation.
- Children's - in most cases, a slightly modified infant odds. Sometimes it first appears at this age. Symptoms become less pronounced, and exudative processes are declining.
- Adult form - in most cases, the disease retreats by itself by this time. Sometimes the symptoms persist and manifest themselves in the form of periodic eruptions on the skin, as a rule, mild.
Types depending on the prevalence of the process
- Limited - the center has a small size.
- Common - dermatosis affects a fairly large area of skin, but in most cases is limited to changing one area of the body.
- Diffuse - inflammatory changes in the skin are observed almost throughout the body.
The severity of the disease
- Easy - rash slight and passes quickly. Exacerbations occur relatively rarely.
- Moderate - occupies an intermediate position.
- Severe - the patient is often faced with an exacerbation of the process. Most often, the rash on the body spreads diffusely, exudative processes are pronounced.
Variants of the disease, depending on the etiology
Since the disease is an allergic nature, various factors can cause its aggravation.
- The food-allergen-provoked option is probably the most common, as modern products contain many additives and are very diverse. Many exotic fruits were previously unavailable, and today they can be found on any counter. The body is more adapted to local products.
- Fungal variant - fungal spores are found almost everywhere. Some of them can provoke an allergic reaction.
- Pollen, dust variant - depends on the effects of small allergens that enter the body along with the inhaled air.
- Dermatitis, provoked by chemicals - this is particularly relevant in relation to cosmetics for skin care. Flavors, fragrances, dyes - all of this can be used by manufacturers and increase the danger of cosmetics for our body. When caring for your baby, it is very important to give preference to hypoallergenic products that are specially designed 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 cannot perform its protective functions to an adequate extent, which creates conditions for the penetration of bacteria and their reproduction. As a result, wounds can fester, which greatly aggravates the situation. Therefore, you need to carefully and carefully care for the skin to avoid this complication.
The mechanism of development of atopic dermatitis
It is believed that the basis of the 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 allergen exposure, specific receptors on mast cells (this is a type of white blood cells) trap them and provoke the release of a large number of natural inflammatory mediators (cytokines and histamine). They rush into the affected area and cause tissue swelling there, increasing the permeability of the walls of blood vessels.
If, in addition to everything, a bacterial or fungal infection joins, then the situation is even more aggravated. By themselves, these microorganisms can damage tissues and cause inflammation. Plus, the human body can perceive them as an allergen, further enhancing the response of its immunity.
Causes of atopic dermatitis
At present, there are active discussions of scientists on this topic, since the main, fully proven cause of the development of the disease is not yet available. However, doctors agree on one thing: for the development of atopic dermatitis, a combination of several adverse environmental factors and a genetic predisposition on the part of the patient is necessary. The hereditary nature of the pathology confirms that the majority of patients with atopic dermatitis have immediate relatives, who also suffer from allergic diseases.
- The impact of adverse factors even during pregnancy is particularly bad for the body of a future person, because during this period all his organs and systems are only laid down and are most sensitive to negative effects.
- Failure to follow the diet of a pregnant or nursing woman ensures that a large number of potential allergens enter the body of a child. Which "load" not yet formed immunity and can change its properties.
- Taking some medication also affects the baby. Therefore, doctors always try to avoid drug therapy for pregnant women, but this is not always possible. Sometimes you have to take risks due to the big threat (the lesser of two evils choose the lesser one).
- Smoking and alcohol abuse - unfortunately, some women are irresponsible not only to their health, but also to the health of the future baby, literally poisoning him.
- The main cause of exacerbation of the disease, the manifestation of itching and rash, is the effect of the allergen. Doctors are not sure whether the allergy itself can cause this disease, but it can easily lead to its aggravation.
- Food allergens are particularly dangerous in this regard, milk and dairy products (fermented milk are the exception), wheat products, fish and seafood, eggs (their proteins), nuts, exotic fruits, etc. Therefore, special recommendations for feeding young children take into account all of this and indicate that it is safest for a baby.
- Plant pollen, animal dander, mold, household mites - all these products are more likely to cause allergies.
- Perfumes, soaps, detergents in contact with skin can cause both allergic and contact dermatitis, aggravating the course of the disease.
- Some professions involve the use of special chemicals, which also have a very bad effect on the skin.
- A sharp change of climate or weather conditions. A cold snap may aggravate the course of the disease. It is especially hard for patients in the winter period, because cold air contains less moisture and more drains the skin, causing it to itch. The 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.
- Stress and emotional strain affect the state of the human immune system and can lead to 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. At the same time, children still do not control themselves and can comb their skin, inflicting additional damage on themselves and aggravating the situation. Therefore, it is necessary to close the affected area with a bandage, if the child is constantly trying to scratch himself - this will avoid many unpleasant complications.
A rash always appears on the affected areas - red in color, heterogeneous in composition and appearance. It can be present on the skin for a long period of time, and relatively quickly disappear almost without a trace.
- If an infection gets into the scratched wound, then a significant amount of liquid is released with the subsequent formation of a crust. So the body is trying to escape from the pathogen. This rash is considered acute and passes relatively quickly.
- If the skin has dry scales and marked itching, then this 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 being combed (lichenification occurs)
Localization of eruptions and their particularity depends on the age of the patient.
Children under two years old - in most cases, the face, scalp, limbs (elbows and knees), neck and body are affected.
- Very rarely there is a lesion in the perineal region.
- Very often, crusts appear on the affected skin or fluid is released (exudation).
Children under 11 years old:
- In the overwhelming majority of cases, the inner surfaces of the arms and legs, the neck, and other places where there are folds are damaged.
- Dry rash in most cases, tends to become chronic, with the result that the skin becomes rough.
- Children continue to comb the damaged areas, which leads to infection.
Teens and adults:
- All manifestations as they grow into a lighter form.
- If the symptoms persist, in most cases the skin in the knee and elbow area (in the folds of the skin) is damaged. Sometimes there is a rash on the face, wrists and in the groin area.
Diagnosis of atopic dermatitis
For the diagnosis of selected special criteria that guide the experts. The fact is that during laboratory studies, you can only detect a violation of the level of certain immunoglobulins, as well as to identify increased sensitivity to individual substances. This is in favor of allergies, but does not indicate that the patient has atopic dermatitis.
Diagnostic criteria for atopic dermatitis
- Large (they are also called mandatory).
- Pruritus, even with minimal damage to the integument.
- The typical location of the rash.
- The presence of atopic dermatitis in history with the next of kin.
- Recurrent course.
- Small criteria (optional).
- Increased levels of antibodies to IgE.
- The first manifestation of the disease in childhood.
- The presence on the soles and palms of a large number of folds.
- Light spots on the skin of the face and girdle of the upper extremities.
- Peeling of the skin.
- Frequent damage to the skin of infectious etiology.
- White dermographism skin.
- The appearance of itching when sweating.
- Dark circles around the eyes.
Treatment of atopic dermatitis
In the treatment of this disease using a combination of several methods that allows you to achieve the best result.
It is necessary to exclude from the patient's diet all foods that can with a high probability of causing allergies (they were mentioned earlier). Women during breastfeeding should also follow a strict diet, because much of what mom eats gets into the milk. This situation often happens: a woman during pregnancy limits herself in her 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 nothing.
Treatment with pharmacological agents
Depending on how old the patient is, the principles of treatment and the range of drugs may be radically different. Doctors currently use many substances that affect different processes in the patient's body.
- The latest generation of antihistamines have few side effects and can be used even in children. They block the natural mediators of inflammation and do not allow histamine to cause serious inflammatory changes.
- Mast cell membrane stabilizers have performed very well in pediatric practice, but are practically not effective in treating adults.
- Vitamin therapy - contributes to the normalization of metabolism, which can not affect the condition of the human skin.
- Immunomodulators - lead to normal human immunity, with the result that he becomes not so active in relation to allergens.
- Substances that affect the nervous system - relieve the patient from serious stress and anxiety, which can reduce the likelihood of developing an exacerbation of the disease.
- Antibiotics are used in the most severe cases in the presence of an infectious complication.
- Drugs that affect the function of the digestive system.
- External treatment - used cream, ointment, special cosmetics, moisturizing the skin and relieves the feeling of itching.
If we turn to specialists in a timely manner and follow all their recommendations, the disease will recede over time and will not leave any marks on the patient's skin. Otherwise, a person may for many years face aggravations, constantly limiting himself in some way.
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