- The causes of the onset and development of neurodermatitis
- Types of neurodermatitis
- Symptoms of neurodermatitis
- Diagnosis of neurodermatitis
- Treatment of neurodermatitis
- Prophylaxis of neurodermatitis
Neurodermatitis is a chronic skin disease of a neurogenic-allergic type that occurs with periods of remission and exacerbation.
In medical terminology, the term "neurodermatitis" was first used in 1891. At that time, this name characterized a pathological process, accompanied by primary itching and scratching.
At present, a neurodermatitis is a disease that accounts for approximately 40% of the total number of all skin lesions.
Most often it is detected in childhood, but in the pubertal period (puberty period), in the absence of other pathologies, disappears independently. Nevertheless, parents should be very careful, since in the absence of adequate treatment of neurodermatitis, complications can develop (changes in skin relief, formation of seals, and likelihood of infection).
As a preventive measure of neurodermatitis in childhood, experts recommend to adhere to the rules of general hygiene and breastfeeding regimen. However, in order to prevent the development of the pathological process in adults, one should observe professional and mental (psychological) hygiene.
The causes of the onset and development of neurodermatitis
- Hereditary predisposition.
- Stresses, nervous disorders and long negative emotions.
- Harmful production factors.
- Long-term mental stress and heavy physical labor.
- Pathology of the digestive system.
- Systematic violation of the regime of the day.
- Nutritional, medicinal and other types of intoxication.
- Environmental factors provoking the development of allergic reactions (dry food for aquarium fish, animal wool, woolen things, house dust, some cosmetics, feather pillow and blanket filler, flower pollen, food preservatives and some food).
Types of neurodermatitis
Neurodermatitis is a disease that has several kinds that determine the degree of prevalence of the pathological process in the patient's skin.
With the development of the focal form of neurodermatitis, patients complain of the occurrence of skin rashes on a limited space. As a rule, in this case, plaques consisting of small papular formations are localized in the neck, on the back of the knees, as well as in the ulnar fossa, in the anus and genital area. Most often these plaques are arranged symmetrically and have a regular oval shape. Their color can range from pink to brown. In the affected foci the skin is dry, infiltrated, with characteristic lichenification (skin pattern). The peripheral part of the lesion is pigmented. It gradually passes into a healthy, unchanged skin. In the center of the focus during the examination, you can identify a zone that consists of papules the size of a pinhead (or slightly more). Papules have a shiny surface and irregular shape.
With focal neurodermatitis (as with other forms of it) there is no mocculation. Pathological foci are usually covered with hemorrhagic crusts or gray-white scales. After their falling off, there are hyper- or depigmented spots. During the development of the disease, patients complain of itching, which is aggravated by irritating factors, and also at night.
Diffuse neurodermatitis, or, as it is also called clinicians, atopic dermatitis , is a more severe form of pathology, which is characterized by the emergence of multiple lesions. As a rule, they are localized on the upper and lower extremities (in popliteal cavities and ulnar folds), as well as on the trunk. At the same time, diffuse neurodermatitis often affects the neck, genitals, anus and the face. In this case, lesions are fused, lichenified and infiltrated skin areas. In some places, apart from lichenification, flat, shiny nodules arise. Sometimes in patients after scratching there is a short wetting. As a consequence, lesions can become infected, complicated by lymphadenitis or pyoderma. Patients suffering from diffuse neurodermatitis are characterized by puffiness and hyperemia of the skin, often covered with small scales.
In the event that the disease develops in childhood, lesions can also occur on the scalp and around the eyes. During puberty, the pathological manifestations of children often subsided.
Neuromuscular Ermann is a rare form of pathology, in which lesions are localized on the inner surface of the thighs and in the groin-femoral folds. In this case, patients have a pronounced infiltration and lichenification of the skin, and severe itching, which is of a paroxysmal nature. Often, the pathological process is accompanied by the appearance of warty-like formations (warty neuroidermis of Kreibich).
This pathology, in which the lesions are localized mainly on the extensor surfaces of the hands and feet and have the shape of bands, sometimes with a warty or scaly surface.
Acute follicular neurodermatitis
With the development of this form of the disease, the papules are located along the mouths of the hair follicles and have a pointed shape.
This form of the disease is characterized by the appearance in the affected areas of pronounced depigmentation (partial or total loss of pigment by tissues).
As a rule, the pathological process affects parts of the body covered with gun hair, and is accompanied by their loss.
Symptoms of neurodermatitis
The most typical signs of the disease include itching, rashes, peeling, redness of the skin and neurotic disorders. The most characteristic symptom of neurodermatitis is the occurrence of severe itching before the appearance of rashes. Further on the skin gradually form small skin nodules with a shiny surface. At first, they do not differ in color from normal skin, and then acquire a brownish-pink coloration. After some time, the nodular formations begin to merge, forming a continuous, scaly or hemorrhagic crust foci with fuzzy boundaries. The affected area of the skin becomes bluish or crimson. At the same time, depigmented areas are often observed in old foci.
It should be emphasized that with neurodermatitis the area of the pathological process differs and depends on its variety. Most lesions are localized in the groin, a fold between the buttocks, in the scrotum, on the large labia, in the popliteal and ulnar folds, and also on the neck. With the development of the disease, there is a significant decrease in the function of the adrenal glands, in connection with which the skin of the patient darkens. At the same time, patients often lose body weight, which has a very negative effect on the general condition of their body. There is also a decrease in blood pressure, complaints of rapid fatigue, weakness, apathy and increased nervous excitability. When conducting a diagnostic laboratory study, there is a decrease in blood glucose and a decrease in the secretion of gastric juice.
In some cases, neurodermatitis can lead to the development of lymphadenitis (inflammation of the lymph nodes), and this, in turn, leads to a deterioration in the work of many organs.
As a rule, relapses of the disease occur in the cold season, and in the summer, patients, on the contrary, notice significant improvements in their health status.
It should be noted that the greatest sufferings are those who have lesions localized on their hands. This is due to the fact that hands are most likely to be affected by moisture and mechanical influences, aggravating the course of the pathological process.
Diagnosis of neurodermatitis
First of all, when diagnosing different types of neurodermatitis differentiate from prurigo, red flat lichen, chronic eczema, mushroom mycosis, lymphatic erythroderma, vulva vulgaris, etc.
Also, the data of anamnesis (including family history) are necessarily taken into account. The patient undergoes a visual examination, he is taken a blood test (to determine the level of immunoglobulin E in the serum) and a sample from the affected area (in the presence of pustules, bacteriosulation is necessarily performed on the microflora). It should be noted that in people with neurodermatitis, the level of immunoglobulins of class E in the blood serum is increased, as well as in such patients there are significant defects in cellular immunity, there is a decrease in the number of T-lymphocytes, and in the peripheral blood an increased number of eosinophils is detected.
Treatment of neurodermatitis
The tactics of treatment for neurodermatitis is aimed at eliminating the disorders that triggered the development of the pathological process, as well as preventing recurrence and prolonging remissions.
General therapeutic measures
- A strict diet, which provides for a complete limitation of marinades, spices, chocolate, spicy and smoked foods, citrus fruits, cocoa, whole cow's milk, eggs, strong meat broths, etc.
- Prohibition of finding pets, aquarium fish and flowering plants in a residential area (especially if sensitization is detected).
- Daily carrying out of wet cleaning, and also refusal of carpets in which dust mites can be.
- If possible, the clothing of a patient suffering from a neurodermitis should be spacious in order to avoid possible friction and pressure. Synthetic and woolen things in this situation are contraindicated.
- An obligatory condition for the patient: a full-fledged sleep, the complete elimination of fatigue and stressful situations.
- Restriction of water procedures.
The use of sedative and psychotropic drugs
In order to reduce the likelihood of developing neurotic reactions, patients are shown taking psychotropic and sedative drugs, tranquilizers and antidepressants. I would like to emphasize that from plant remedies experts recommend using a tincture of valerian root or tincture of a peony.
Sanitation of foci of chronic infection
This is one of the most important conditions that must be observed during the comprehensive treatment of neurodermatitis.
Normalization of the gastrointestinal tract
In the event that a patient suffering from a neurodermitis has a dysfunction of the digestive system, during the treatment he is shown taking enzyme preparations (mezim forte, festal, digestal, pancreatin, etc.). Probiotics are prescribed for dysbacteriosis of the intestine, and hepatoprotectors for severe chronic forms of neurodermatitis.
Systemic drugs used in the treatment of neurodermatitis
The main role in the treatment of this pathology is played by antihistamines (N-histamine blockers).
The first generation of drugs include chloropyramine, mebhydroline, chlorpheniramine, promethazine, diphenhydramine.
Terfenadine, astemizole and fexofenadine are second-generation drugs.
The group of preparations of the third generation includes ebastin, cetirizine and loratadine.
At the same time, in the treatment of neurodermatitis, patients are shown the administration of ketotifen (a stabilizer of fat cells membranes) and cyproheptadine (a blocker of histamine receptors with antiserotonin activity).
At the moment, the most popular drugs are second and third generation, which have a prolonged effect and do not have side effects on the central nervous system (violation of the speed of reaction and coordination of movements, drowsiness, inhibition, etc.).
When the pathological process worsens, patients are shown intravenous administration of 10% calcium gluconate solution or 30% sodium thiosulfate. In the event that a secondary bacterial infection is attached to the acute form of neurodermatitis and furunculosis develops, antibiotic therapy with broad-spectrum antibiotics is prescribed to patients.
In especially severe cases, with a general condition disorder and the appearance of severe exudation for a short time and with great care, hormone therapy is prescribed.
At the same time, not so long ago, immune preparations stimulating T-lymphocytes (levamisole, thymalin, thymogen, t-activin) began to be used in complex therapy of neurodermatitis, and myelopid preparation was used to support B-cell immunity. Also, many specialists and patients respond well about cyclosporine. This immunosuppressor, which is indicated for the treatment of very severe forms of neurodermatitis, which can not be treated with traditional drugs.
Also, without fail, during the treatment the patient is given vitamin therapy with vitamins A, B and E.
Drugs for topical treatment of neurodermatitis
For local treatment of neurodermatitis in dermatological practice, various lotions (boric, resorcinol, tannic), as well as pastes with tar, ichthyol, naftalan, etc. are used. In severe cases, unhalogenized corticosteroid ointments of prolonged action are superimposed on the affected areas of the skin that do not cause atrophy and thinning skin integument. These drugs have a minimum of side effects, and therefore they are allowed to use even when treating young children.
Very well recommended in the treatment of neurodermatitis is a procedure such as light therapy (using a quartz lamp, UV or selective phototherapy). Selective phototherapy involving the use of UV rays with a wavelength of 315-320 nm is indicated for patients suffering from the neurodermitis only during the remission of the disease. The duration of the course of treatment is 15-20 procedures.
Also, as a physiotherapeutic treatment for neurodermatitis, dermatologists recommend cryomassage (use of liquid nitrogen) and irradiation of lesions by a medical laser.
At the same time, sanatorium-and-spa treatment (the coast of the Black and the Dead Seas) is very beneficial for the patient's organism.
Prophylaxis of neurodermatitis
In order to prevent the development of neurodermatitis, experts recommend the timely treatment of childhood eczema and atopic diathesis, as well as constantly maintain normal physical and mental well-being. Skin covers must be constantly protected from overheating or hypothermia, exposure to aggressive substances and other irritants. However, people prone to the development of allergic reactions are recommended to exclude from their diet foods that can trigger the development and exacerbation of the pathological process, as well as limit the intake of carbohydrates and salt.
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