Atopic dermatitis in children 6 years old treatment. Possibilities of spa treatment

Nature and chronic course... Known as atopic eczema, neurodermatitis, and atopic eczema syndrome or dermatitis. The development of pathology occurs in several stages with the appearance of specific rashes.

The process of the formation of elements on the body annoys little patients with itching.

Why does atopic dermatitis develop in childhood?

Factors predisposing to the onset of the disease in babies can be:

• intake of food allergens into the body;
• infectious skin lesions;
• hereditary predisposition;
• neglect of hygiene rules;
• constant stay in stressful situations;
• intolerance to climatic or environmental conditions;
• dust mites (example of a nonspecific factor).

Food allergens How the causes of atopic dermatitis in children vary by age. In the smallest, allergies can develop to protein components that make up food. They are found in cow's milk, grains, honey, fish, soybeans, nuts, and eggs.

As a person grows up, they may lose sensitivity to food components. But it also happens that the characteristic symptomatology for a certain product manifests itself throughout life.

The exacerbation of atopy in the spring and summer months may be associated with the spread of plant pollen through the air. But if we discard everyday, natural and nutritional factors, disorders of nervous activity may come to the fore. The affected skin transmits specific signals to the nervous system, which the brain returns to the body with neurotic disorders. But if they were already a problem for the child, the disruptions only exacerbate the course of the disease.

Microorganisms are a separate group of causes that cause atopic eczema in babies. The disease is often complicated by bacterial infections. Their pathogens include Malassezia yeast and Saures bacteria. The yeast synthesis process serves as a favorable condition for the development of atopy. At the same time, dermatologists pay attention to the fact that with hay fever (allergic rhinitis) and bronchial asthma, the synthesis of microorganisms does not occur.

The number of nonspecific irritants is made up of chemicals and detergents with which the baby was in contact. The problem of atopy can also appear as a result of wearing clothes made of rough fabrics or things washed in powder with ingredients harmful to baby's skin. The identification of non-specific influencing factors occurs by the method of exclusion.

Age features of the course of the disease

Experts explain the definition of three forms of atopic dermatitis in children by different clinical symptoms that depend on the age of the patients. Let's consider them in more detail.

Diffuse neurodermatitis in children is rare. This type of pathology belongs to adult form.

In each age period, skin changes have their own morphological characteristics. From 3 to 6 months atopy is manifested by erythematous elements on the cheeks. They look like a milk crust, serous erosions and papules. Parakeratosis develops - peeling of the integument. In addition to the cheeks, the disease also affects:

• auricles;
• scalp;
• extensor surfaces of the arms and.

When the baby is at the age of 6 months. up to 1.5 years, atopy is expressed by edema, hyperemia and the expiration of exudate. Eczema affects the mucous membranes of the genitals, nose, organs of vision, digestive tract, urinary and respiratory systems.

From one and a half to 3 years, the papules merge and form single foci called stropulus. Babies experience dryness and hardening of the skin tissue. Strengthening the natural pattern indicates lichenification of the skin. Basically, changes are observed on the flexion surfaces of the limbs and in rare cases they occur on the feet, neck and wrists.

Regardless of the baby's age, the acute stage of atopy may disappear as suddenly as it appeared. However, this does not mean complete self-destruction of pathology. She simply hides in the body and waits for a suitable occasion to activate. Therefore, the disease should be treated immediately, as long as there are clear signs.

For the age range 3 - 5 years, the development of persistent neurodermatitis or ichthyosis is characteristic. The disease affects only the flexion areas of the limbs. What does atopic dermatitis look like in children? of different ages, shown in the photo:

External and internal manifestations of neurodermatitis

Clinical signs of atopic dermatitis in children are expressed by changes in the skin, in nervous activity and in the qualitative composition of the blood. Outwardly, the pathology is manifested by erythema, that is, reddening of the tissues with the appearance of the capillary mesh on them. The mechanism of its occurrence is due to the influence of non-specific protection factors leading to the expansion of blood vessels and capillaries. This facilitates the transport of unnecessary immune cells to the inflammatory area.

The disease always proceeds with itching. In connection with this unpleasant phenomenon, children become restless, aggressive and all the time strive to scratch the itchy integument. As a result, scratches appear on the body, through which pathogenic microbes can easily penetrate and complicate the course of eczema.

There are several reasons for itching in children with atopic dermatitis:

As for the rashes, they are formed on the basis of inflammatory skin lesions. The previously described changes reduce the protective functionality of the integument that protects against infection. Itchy and irritated skin is attacked by bacteria, covered with vesicles, pustules or crusts.

The elements of atopic rash can be described as follows:

• spots - foci of irregular shape with shades of red;
• areas with exudate;
• vesicles - small blisters with contents;
• plaques - collection of rashes into a single pathological zone;
• papules are thickened formations with a color that differs from a healthy body.

Therapy of neurodermatitis in children is not limited to the prescription of medications. Small patients are offered light treatment to relieve rashes. Its essence lies in the irradiation of diseased integuments with ultraviolet light.

On the part of the nervous system with eczema, there is anxiety, aggression or depression, general irritability, sleep disturbance. All this is associated with debilitating itching and the influence of irritating substances on the central and vegetative parts of the nervous system.

Nowadays everything more people faces allergic diseases. Moreover, they often manifest themselves in childhood... Such a difficult ailment in treatment as atopic dermatitis in children is familiar to many parents. The first signs of this ailment often appear already in the first weeks of a child's life. Let's figure out what is the cause of this ailment and how it is treated.

Red cheeks in a baby are not always a sign of a healthy blush. Sometimes red spots on the face are one of the symptoms of a severe systemic disease like atopic dermatitis.

Some parents do not consider it necessary to treat such a disease, since many in the family had it in childhood, and then passed without a trace. However, this is not always the case, it happens that the disease does not go away with age and accompanies a person in adulthood.

What kind of disease?

Atopic dermatitis is the earliest and most common symptom of hypersensitivity to certain substances. Atopic dermatitis in children, it is diagnosed in 80-85% of all babies suffering from allergic diseases.

Most often, parents notice the onset of symptoms in the very early age, it proceeds for a long time with periodic relapses. Often, atopic dermatitis in a child passes by the onset of school age, but sometimes the disease exacerbates in adolescents and even after adulthood.

The prevalence of atopic reactions is steadily growing, according to statistics, about 15% of children under the age of 5 suffer from atopic dermatitis. The disease is extremely unpleasant, causing the child not only physical, but also mental suffering.

Advice! A tendency to atopy can cause the development of other diseases of allergic origin.

Atopy and allergic reactions are very similar in manifestations and many parents confuse them, although this different states... Allergy is a hypersensitivity to one or more substances that accompanies a person throughout his life. The reaction occurs even if contact with the allergen was minimal.

In atopy, the body reacts to a large list of allergens, and the substances that cause the negative reaction can vary over time. In addition, the reaction depends on the dose of the allergen; with minimal contact, the skin reaction may not appear at all.

What is the reason?

Atopic dermatitis in children is caused by causes of a different nature, acting in combination. These are the individual features of functioning. immune system, and the negative impact of external factors. The main causes of atopic dermatitis:

• Heredity. The tendency to hypersensitivity is transmitted at the genetic level.

Advice! A baby with both allergic parents is 80% more likely to develop atopic eczema. If only one of the parents is sick, then the risk is reduced to 50%.

• Complications during pregnancy. Fetal hypoxia during gestation and / or childbirth is a common cause of atopy.
• Improper feeding. Too early introduction of complementary foods, as well as the introduction of unsuitable products into the child's menu. In addition, malnutrition of the mother during pregnancy can lead to the development of the disease.
• Digestive system pathologies. The disease often occurs in children with dysbiosis, gastritis, helmitosis.

Provoking factors

If the exact cause of the development of atopy is difficult to name, then the factors that provoke exacerbations are well known:

• Violation of the diet. This is perhaps the most common cause of exacerbation of childhood atopic eczema.
• Inhalation of plant pollen. This reason often causes exacerbation inflammatory process in the skin of older preschool children.

• Antibiotic therapy, provoking the development of dysbiosis. It is important to remember that almost 80% of the work of immunity depends on the composition of the intestinal microflora.
• Animal hair, house dust. In the rooms where the child lives, you should remove all the "dust collectors", and you will have to abandon the use of feather pillows.
• Any diseases that cause weakening of the immune system. Children who often have acute respiratory infections or infectious diseases, are more often faced with manifestations of atopy.
• Stress. Nervous tension may cause an exacerbation.
• Environmental factor. Children who live in industrial cities are more likely to deal with manifestations of atopy than their peers living in ecologically safe areas.
• Chronic pathologies. Atopy is often exacerbated in babies suffering from various chronic diseases of internal organs.
• Chemical compounds. Most often, exacerbations of atopy occur upon contact with drugs household chemicals, for example, with clothes washed with powder. Sometimes a reaction occurs to cosmetic and hygiene products- shampoos, cleansing foams, etc.

Stages

Dermatitis of atopic nature occurs chronically, when an exacerbation occurs, the development of the process takes place in several stages:

• Primary contact. The first interaction with an allergen produces antibodies. On subsequent contacts with the same substance, the antibodies react almost instantly, which leads to the development of an inflammatory skin reaction.
• Development of inflammation. Antibodies produce a large number of specific substances that have increased activity. These substances restrain the spread of the inflammation process, limiting its manifestations on the skin. Thus, the body is protected from the spread of inflammation to the internal organs.
• Peak inflammation. This is the period during which the symptoms of the disease become noticeable. With initial contact with an irritant, the symptoms appear after 2-3 days, with repeated contacts, the time separating the moment of contact from the moment the signs of inflammation appear is reduced.
• Abatement. The acute period lasts 7-14 days, after which the symptoms begin to subside. This stage can last up to 3 weeks.
• Quiet period. At this time, the child looks and feels completely healthy. However, after a while, changes appear on the skin, they become dry, and can become crusted.

• Complete remission. Full clinical recovery is said if exacerbation of dermatitis has not been noted for more than 3 years.

Views

There are several options for the classification of atopic dermatitis. The classification is carried out by the age of the patients, as well as by the severity of the symptoms.

According to the age

There are several types of the disease, classified by the age of the patient:

• Babies. This form is observed in babies up to two years of age. It is manifested by the appearance of red spots, puffiness and severe itching on the baby's face, the skin of the limbs and buttocks.
• Children. Age group 2-12 years old. It is characterized by severe itching, dry skin. With an exacerbation, not only red spots may appear on the skin, but also vesicles - small blisters. Areas of damage - neck, articular folds on the arms and legs, sides.
• Teenagers. The age group is 12-18 years old. Manifested by severe itching, the formation of dense crusts, areas with severe lichenification (thickening of the skin and increased skin pattern). In adolescents, atopic dermatitis often develops on the hands, the back surfaces of the hands and fingers, as well as the elbow and knee bends, and the neck are affected.

Areas of defeat

Atopic eczema in children can develop in localized areas or be widespread. Distinguish:

• Limited. With this form, less than 5% of the entire body surface is affected.
• Common. Affected is 25% of the entire skin area.
• Diffuse. With this form, a large amount of damage is noted. Only the palms, soles, and also the triangle under the nose remain free from inflammation.

Flow

Depending on the severity clinical manifestations distinguish forms:

• Easy. With an exacerbation, a small number of rashes are noted, itching is moderate or absent at all.
• Average. A large number of rashes appear in the form of vesicles, when they are opened, weeping areas are formed.
• Heavy. With this form, most of the skin becomes inflamed, abundant rashes, extensive weeping wounds are formed.

Manifestations

With a predisposition to atopic dermatitis with exacerbation, the following signs are noted:

• Itching. It can be light or unbearable.
• Redness. Bright red skin patches form on the skin.
• Dryness. The longer the disease lasts, the drier the skin becomes.
• Rash. Most often, the formation of vesicles is noted, the appearance of papules and crusts is less common.
• Lichenification. This symptom appears with a long course of the disease. There is a structural change in the skin, it becomes denser and thicker.
• In severe cases, there is a violation of general well-being.

Diagnostics

It is not difficult to diagnose the disease on your own by the symptoms. However, it is necessary not only to make a diagnosis, but also to identify the causes of inflammation. With atopic dermatitis in children, the symptoms and treatment are individual, therefore, independently carrying out therapeutic measures, you can harm the child.

Only a specialist can answer the question of how to treat atopic dermatitis. A child who is sick with atopic dermatitis needs to consult not only a pediatrician, but also an allergist, as it is necessary to identify substances that provoke exacerbations of the inflammatory process.

Treatment principles

Many parents want to know how to treat atopic dermatitis in their toddler. However, it is impossible to give general recommendations. Each child needs an individual approach to treatment. You can only list the basic principles of treatment. During the period of exacerbation, it is necessary:

• Eliminate the provoking factor. In order for the ailment to pass, it is necessary to exclude contact with substances that cause exacerbation.
• Apply drug therapy. Atopic dermatitis in children can be treated with local and systemic drugs. The choice of medicines is carried out depending on the age of the patient and the clinical manifestations of the disease.
• Compliance is an important consideration in treatment.
• Compliance with the rules of hygiene. Often parents ask if it is possible to bathe a child with atopic dermatitis? Bathing is allowed, but a number of rules must be followed. Bathing water must be boiled or filtered and softened. The water should be warm, the use of ordinary soap and hard washcloths should be excluded. You cannot swim for a long time, the maximum duration of the bath is 20 minutes.

ethnoscience

During the period of remission or during mild lesions are allowed to treat atopic dermatitis in children folk remedies... However, the use of folk remedies is not a panacea, therefore, the features of treatment childhood disease need to be discussed with your doctor.

With atopic dermatitis in children, treatment with folk remedies can bring both benefits and harm. After all, medicinal herbs can not only heal, but also cause allergic reactions. Therefore, pick up folk recipes for a child you need individually.

One of the popular recipes traditional medicine is the wormwood treatment. Silver wormwood broth can be used starting from 3 years old. At an earlier age, children's dermatitis is treated with decoctions of a string, chamomile, oak and willow bark.

So, atopic dermatitis in children is a common problem. You should not try to treat the disease yourself. It is necessary to contact a specialist. Having received the necessary consultations, you need to go through the required examinations with the child. After that, the specialist will prescribe treatment, depending on the individual indications. It is necessary to treat the disease persistently and persistently in order to prevent the development of complications.

Doctors note that every year there are more and more children with atopic dermatitis. Can the parents themselves somehow influence the onset and development of this disease? And how to properly treat rashes and eczema on the skin of a baby with atopic dermatitis, so that the child does not turn into a "collector" of infections?

According to domestic doctors, there are almost no children among "our" babies who have never shown signs of atopic dermatitis. Which most often manifests itself in the form of skin lesions on the face and hands.

Atopic dermatitis in children: what's what

First, let's define the concepts and terms. It so happened that in the minds of most parents, "atopic dermatitis", "" and "food allergy" are the same thing. Apparently, the reason for this erroneous judgment is in similar symptoms, which are inherent in all three ailments: itching, rash and pronounced redness on the skin.

Meanwhile, all three disease states have different nature and requires different treatment.
Let's put everything in its place:

Food allergy- this is the individual hypersensitivity of the immune system (in other words, an inadequate reaction) of the organism to a particular food product (more precisely, to its constituent substance). Among the symptoms of food allergy, there are those that are inherent in atopic dermatitis (itching, inflammation on the skin), but they are not limited to this. Severe allergic reactions can be expressed and much more terrible and dangerous symptoms - difficulty breathing, anaphylactic shock, Quincke's edema. Like any other, food allergy, once having made itself felt, remains with a person for life.

The primary symptoms of atopic dermatitis (usually itching, redness and skin rash) always appear before the age of 2 years. This means that if a baby under 2 years old did not have any skin lesions, and at an older age he was "sprinkled with something" - then this is probably not atopic dermatitis, but an allergic reaction.

Moreover: if allergic dermatitis, as a symptom, remains with a person for life, then atopic dermatitis in children, in most cases, with adequate therapy and prevention, disappears by 3-5 years.

Atopic dermatitis is a non-infectious inflammatory skin lesion. Which is due to genetic factors, individual characteristics the structure of the skin, as well as the climate in which the child lives.

If one of the parents of the baby suffered from atopic dermatitis in childhood, the child will also develop it with a probability of 50 to 50. If both parents had this disease in childhood, the probability increases to 80%.

The first signs of atopic dermatitis appear in a baby up to 2 years old (in 90% of cases). If it is properly treated, it disappears without a trace by about 5 years. But if the disease is ignored, it develops into a more severe and chronic form, which can accompany a person throughout his life.

Atopic dermatitis in children: symptoms and signs

Atopic has pronounced symptoms:

• severe itching;
• redness in those places where the skin is thinnest: on the folds of the arms and legs, on the neck, in the folds of the skin;
• often - and pustular formations on the face;

Moreover, the most disturbing and dangerous symptom atopic dermatitis in children is severe itching. The degree of redness and the size of the rash is not as terrible as the "manic" uncontrolled scratching of the inflamed skin.

The danger of itching is that regular scratching of the skin leads to the appearance of micro-wounds on it, into which bacteria or fungi almost instantly enter, causing a so-called secondary infection.

Allergy or atopic dermatitis: how to tell

A typical situation: the first signs (rash, itching, redness on the skin) appeared in the baby during the period - about 6-8 months. You, the parents, and possibly the pediatricians who are observing your child, have logically concluded that there are manifestations of food allergies - some new foods are perceived by the baby's body extremely negatively. And gradually you remove from the child's diet: first everything is bright, then everything is colored, and then, possibly, valuable protein in the form of milk and eggs, etc. Sometimes the situation "rolls over" to the extreme, leaving only rice porridge and dried apples in the diet of the unfortunate child ...

However, from time to time outbreaks of redness and rashes on the skin happen anyway. You sin on the fact that the kid somewhere "snatched" a piece of the forbidden product, which caused an exacerbation of the disease.

But in fact, the periodic deterioration of the skin condition shows you something completely different - it is a clear signal that you still have not removed the main "causative agent of skin anxiety" from the child's environment. And that, most likely, we are talking not so much about food allergies, but about atopic dermatitis, the "causative agent" of which foods are extremely rare. Why? Let's explain below.

A well-known children's doctor, Dr. Komarovsky: “This is a typical philistine delusion - as if an exacerbation of atopic dermatitis occurs in response to certain foods eaten. In fact, there is no fundamental relationship between atopic dermatitis and the quality (composition) of the products. "

Indeed, in response to some foods, an allergic reaction of the body may occur with symptoms similar to that of atopic dermatitis: itching, redness and a rash on the skin. However, the symptoms of such an allergy should appear within a maximum of the first 24 hours from the moment the product was eaten. But if the rash and itching arose two days after your Mitya, relatively speaking, ate the peanuts, then the point is not at all in the peanuts! And the face is not allergic, but atomic dermatitis.

Dr. Komarovsky: “In 85% of cases of itching and eczema on the skin in children under 2 years of age (and most often in children from 6 months to a year), this is not an allergy to certain foods that the child ate or a nursing mother ate, and nothing more than atopic dermatitis, which has nothing to do with food. "

Not by bread alone ...

To stop sinning on food, you need to understand how skin lesions occur. And first of all - how the skin works. In the upper (stratum corneum) layer of the skin, we have a special lipid barrier that protects our skin from penetration into its depths. harmful factors from the outside, as well as an extremely important layer consisting of water molecules that hold a special substance in the skin (in fact, a complex of organic molecules). Water molecules in the skin provide its elasticity, firmness and additionally protect it from external harmful factors.

If a child spends most of his time in a room with a warm and dry microclimate, if he is constantly dressed in a cabbage style, or if his clothes contain non-natural irritating fibers, all this leads to excessive evaporation of moisture from the skin, to the destruction of the lipid barrier and , respectively, to extreme vulnerability. As a result, the skin becomes dry and hypersensitive. This means that it is too "open" to attack harmful external factors: allergens, toxins, various chemicals, pollution, bacteria and fungi, etc.

At the slightest inflammation, microscopic bubbles form in the sensitive skin, which eventually burst and become covered with a crust - they cause severe intolerable itching, which intensifies many times at night, during sleep.

Babies are most likely to scratch the itchy skin when they sleep.

Consequences and complications of prolonged atopic dermatitis in children

If an atopic baby is constantly uncontrollably combing the affected areas of the skin, cracks and wounds inevitably appear on it, in which bacteria easily "settle" and actively multiply. A pustular infection (pyoderma) occurs, in the treatment of which antibiotic therapy is already resorted to. This worsens not only the quality of the skin itself, but also the quality of life of the baby - he does not sleep well, does not get enough sleep, he is given painful discomfort by movement, bathing, and wearing clothes.

In addition to bacterial infection, against the background of atopic dermatitis, viral and fungal infections... Often, all three types of infections can "pounce" on the baby at once - thus, the little sufferer can have a cold sore and purulent inflammation at the same time.

However, do not despair ahead of time! Such terrible complications can be completely avoided - not with great effort and with excellent chances for a full recovery. How? First of all, observing all preventive measures against atopic dermatitis.

Prevention of atopic dermatitis

In the case of atopic dermatitis, measures to prevent this disease are one of the most important conditions for effective treatment. And therefore, about them - in detail and point by point.

• 1 Eliminate the factors leading to dry skin. Namely - maintain a humid and cool climate in the nursery, spend more time in nature, do not wrap the child during walks. Watch that.

Dr. Komarovsky: “Drying out of the skin is the most important factor (naturally, unfavorable), which makes skin cells hypersensitive to all kinds of external factors. As soon as you solve the problem of loss of skin moisture, you immediately solve the problem of atopic dermatitis.

• 2 Make sure that the atomic child does not overeat. As in the case of diathesis, excess food eaten, which simply does not have enough enzymes to digest, almost always leads to negative reactions on the skin - dryness, cracking, redness, rashes and acute itching. In this case, the skin experiences an attack from toxins and other harmful substances not from the outside, but from the inside.

A funny paradox: which, in fact, is only the body's tendency to a particular disease, it is fundamentally impossible to cure. Whereas atopic dermatitis (which in everyday life is now and then called diathesis), it is treated very successfully.

• 3 Don't be a "manic" cleanliness! No matter how disappointing it may be to hear "exemplary mothers", but children who are washed often and before they squeak suffer from atopic dermatitis many times more often than "grimaces". Frequent washing, and especially with soap, destroys the protective lipid layer on the skin, which makes it more vulnerable to external factors and more "porous" to lose its own moisture. The optimal bathing regimen for babies up to a year is once a day and only with the help of special "non-aggressive" baby cosmetics. After a year, you can bathe even less often - once every two days.
• 4 Choose quality clothing for your baby. By and large, there are only three global claims to children's clothing:

• it should be made of natural materials (primarily cotton);
• it must meet the rule of three "not": do not rub, do not press, do not press;
• it should be washed with special products (a marker on the packaging - “for washing children's clothes”) and rinsed well.

Inappropriate clothing and too aggressive cosmetics for care can be the factors responsible for the development of negative complications of atopic dermatitis in a baby.

Methods for the treatment of atopic dermatitis in children

Main principles in the treatment of atopic dermatitis the following:

• Elimination of provoking factors;
• Adjunctive therapy (the goal is to moisturize the skin);
• The main treatment is the use of topical corticosteroids (ointments);
• In rare cases, UV radiation and stronger drugs.

Provoking factors

In fact, all of the above circumstances (dry and hot climate in the nursery, overeating, excessively frequent washing of the skin with the help of "aggressive" cosmetics, etc.) are among the provoking factors, which worsen the condition of the child's skin, making it vulnerable and prone to inflammation. Prevention of atopic dermatitis is precisely aimed at eliminating provoking factors.

Adjunctive (supportive) therapy

Adjunctive therapy usually consists of various methods of moisturizing the skin. For this purpose, special hygiene preparations are used - emollients... In other words, fats and fat-containing cosmetic substances that are retained only in stratum corneum skin and do not penetrate deep into living cells.

The main purpose of emollients is to soften the surface of the skin and increase the percentage of moisture in its layers. By themselves, these funds, of course, do not moisturize the skin (it would be strange to expect this from an oily substance), but they successfully suppress the loss of the moisture that is still in the skin.

There are three groups of emollients:

• products for application to the skin;
• detergents;
• and bath products.

Funds within these groups can also be classified according to the active funds. The doctor will tell you which one is best for your child. His recommendation directly depends on the intensity of dryness and inflammation, on the presence (or absence) of a secondary infection and on other factors.

Usually, the emollient is applied to the skin of an atopic child 2 times a day, one of which is mandatory after bathing (just in order to retain the maximum amount of moisture in the skin).

How to bathe an atopic baby before using emollient. Alas, for a child with atopic dermatitis, although he must take water procedures every day, it is somewhat different from usual. Bathing water should be slightly warm - about 32-33 ° C. It is not recommended to keep the baby in the water for more than 8-10 minutes. After the baby has been taken out of the bath, in no case should you actively wipe it off, even if you have the most weightless and softest towel in the world. No matter how delicate your movements are, you will still cause microtraumas to dry, inflamed skin. Don't rub! Just lightly blot the skin with a bath or regular sheet, and nothing more. And then gently apply an emollient to your skin to block moisture loss.

And don't be "greedy"! Doctors insist on the following norms: about 250-300 ml of cream will be needed to care for a one-year-old toddler with atopic eczema per week. This means 1 liter per month! In other words, if you are faced with atopic dermatitis, forget about saving on cosmetics for baby's skin care, they need to be used generously - only then they are effective.

The main treatment for atopic dermatitis

Treatment of inflammation in atopic dermatitis usually consists of topical corticosteroids (called topical anti-inflammatory hormones). They are strictly prescribed by a pediatrician, and no initiative in their selection and use is permissible.

The above methods of treating atopic dermatitis, applied together, in a "bouquet", are usually enough to save the baby from the disease. In 98% of cases, this strategy is more than effective.

The remaining 2% of children with severe atopic dermatitis require more serious attack on the disease. In these cases, doctors are forced to resort to the use of other pharmacological agents(antihistamines, various sorbents, local and general immunomodulators and some other agents), as well as ultraviolet radiation.

How to minimize the risk when using corticosteroids

In order for the risk from the use of local hormones to be zero or negligible, you should adhere to the special rules for the use of these drugs:

• 1 Corticosteroids are applied to the skin prior to using emollients. Otherwise, the fatty film will not allow the drug to pass to the skin.
• 2 Corticosteroids are divided into several groups, depending on the strength and activity of their action. It is very important to choose a corticosteroid drug for the child, the strength of which would exactly correspond to the severity of atopic dermatitis in the baby.
• 3 Only the most low-potency corticosteroids are applied to the face and neck.
• 4 Only new rashes can be treated with corticosteroids, from the moment of appearance of which no more than 2 days have passed.
• 5 Inflamed skin areas are treated with local hormones no more than 2 times a day.
• 6 The specific drug (or group of drugs), as well as the regimen and schedule of their application, must be agreed with the pediatrician.

As a rule, atopic dermatitis is in the nature of an age-related disease - and in children of 3-5 years of age, the manifestations of this disease are already sharply reduced. Especially if you are adequate, prudent, not lazy, responsible and loving parents ...

Atopic dermatitis (allergic dermatitis) diathesis - all these are skin manifestations of allergies, caused by essentially the same thing - allergens, toxins and their interaction with the child's skin.

Atopy is a genetic predisposition to the production of an excess amount of immunoglobulin E in response to contact with environmental allergens. The term "atopy" comes from the Greek word for alien. Various allergic diseases and their combinations are manifestations of atopy. The term "allergy" is often used as a synonym for allergic diseases mediated by immunoglobulin E, but in some patients with these diseases, the levels of this immunoglobulin turn out to be normal, and then a variant of the course of the disease that is not mediated by immunoglobulin E is released.

Dermatitis is an inflammatory skin disorder. There are several forms of dermatitis: atopic, seborrheic, contact, etc. The most common form is atopic dermatitis.

Atopic (or allergic) dermatitis, one of the most common skin diseases in infants and children, usually begins within the first 6 months of life and often continues into adulthood. Children under the age of 1 year are more likely to get sick, in whose families there are cases of allergic diseases. This chronic skin condition affects 9 out of 1000 people. Atopic dermatitis is often associated with allergic diseases such as bronchial asthma and allergic rhinitis.

Other terms are often used to refer to atopic or allergic dermatitis. The most common is eczema, even a new term has been proposed: "Atopic eczema / dermatitis syndrome." Previously, such terms as diffuse Broca's neurodermatitis, Benier's pruritus, eczematoid, constitutional eczema, etc. were widely used. In our country, almost all skin lesions in children were called diathesis. Atopic dermatitis is also called childhood eczema. Atopic dermatitis was included in the group of allergic diseases in 1933 on the basis of the association of this form of eczema with bronchial asthma and allergic rhinitis. Indeed, atopic dermatitis is most often the first manifestation of this atopic triad. Atopic dermatitis is characterized by a hereditary predisposition to allergies, age-related morphology of rashes, stages of development and a tendency to chronic recurrent course.

Atopic dermatitis usually occurs with exacerbations and remissions until adolescence. However, for some people, it stays longer. Atopic dermatitis can lead to viral, fungal and bacterial infections and even eye damage.

Clinical forms of atopic dermatitis depending on age.

Atopic dermatitis is divided into 3 successive phases: infantile (up to 2 years old), children (from 2 years to 13 years old), adolescent and adult (13 years old and older), with different manifestations.

The infant form of atopic dermatitis is observed in a child from birth to 2 years. Favorite localization of dermatitis: face, extensor surfaces of the limbs, can spread to the trunk. Oozing, crusting, dry skin is characteristic. Atopic dermatitis is often exacerbated by the introduction of complementary foods and teething.

Children's form of atopic dermatitis (2-12 years old): skin rashes mainly on the flexor surface of the limbs, on the neck, in the ulnar and popliteal fossa and on the back of the hand. Characterized by hyperemia and edema of the skin, lichenification (thickening and strengthening of the skin pattern), papules, plaques, erosion, cracks, scratching and crusts. Cracks are especially painful on the hands and soles. There may be hyperpigmentation of the eyelids due to scratching, the appearance of a characteristic fold of skin under the eyes under the lower eyelid (Denier-Morgan line).

In the adult form of atopic dermatitis, the adolescent form stands out (up to 18 years old). In adolescence, both the disappearance of rashes (more often in young men) and a sharp exacerbation of dermatitis with an increase in the area of ​​the lesion, lesions of the face and neck (red face syndrome), décolleté and skin of the hands, around the wrists and in the elbow fossa are possible.

The adult form of atopic dermatitis often continues into adulthood. Allergic lesion of flexion surfaces in the area of ​​natural folds, face and neck, dorsum of the hands, feet, fingers predominates. Moisture usually indicates a secondary infection. But in any phase of atopic dermatitis, dry skin, pruritus, thickening of the skin with increased skin pattern (lichenification), peeling, hyperemia and rashes typical for each age are typical.

With atopic dermatitis, a vicious circle is formed: itching - scratching - rash - itching. The mandatory criteria for the diagnosis include itching, chronic recurrent course, atopy in the patient himself or his relatives, and rashes typical in type and localization. There are many more additional symptoms atopic dermatitis, not necessary, but often very striking. The diagnosis of atopic dermatitis depends on the exclusion of diseases such as scabies, allergic contact dermatitis, seborrheic dermatitis, psoriasis and ichthyosis.

The skin with atopic dermatitis is changed even without exacerbation and on externally unchanged areas of the skin. Its structure and water balance violated. This dictates the need for special skin care.

Photo of skin manifestations of atopic or allergic dermatitis

The reasons for the development of atopic dermatitis

It has not yet been possible to pinpoint the exact cause of atopic dermatitis, but there are predisposing factors (genetics, food allergies, infections, chemical irritation, extreme temperatures and humidity, and stress). Approximately 10% of all cases of atopic dermatitis are caused by allergies to certain types of food (eg eggs, peanuts, milk).

Atopic (allergic) dermatitis tends to exacerbate with increased sweating, mental stress and extreme temperatures and humidity.

Irritation is a secondary cause of atopic dermatitis; causes a change in the structure of the skin, which ultimately leads to chronic skin damage.

Factors playing a role in the realization of atopic dermatitis.

In 80% of cases, the family history is burdened, more often on the mother's side, less often on the father's side, and often on both. If both parents have atopic diseases, the risk of the disease in a child is 60-80%, if one - 45-50%, if both are healthy - 10-20%. Endogenous factors in combination with various exogenous factors lead to the development of symptoms of atopic dermatitis.

In the first years of life, atopic (allergic) dermatitis is a consequence of food allergy. Proteins are a common cause cow's milk, eggs, cereals, fish, and soy. The benefits of breastfeeding are known, but a hypoallergenic diet is essential for the nursing mother. But in some cases, when the mother herself suffers from severe allergies, it is necessary to use artificial feeding with milk formulas based on highly hydrolyzed or partially hydrolyzed milk proteins, less often soy formulas.

With age, the leading role of food allergy in the occurrence of atopic dermatitis decreases (for example, up to 90% of children who cannot tolerate cow's milk acquire the ability to tolerate it - tolerance - by 3 years), and allergens such as house dust mite, pollen come to the fore , mold spores. Staphylococcus aureus plays a special role in the course of atopic dermatitis. It is sown from 93% of the affected and from 76% of intact (not changed in appearance) skin. Staphylococcus aureus produces endotoxins with superantigens properties and may support chronic inflammation in atopic dermatitis.

Symptoms of prickly heat

Outwardly, the signs of allergic dermatitis differ from each other in the nature of the rash.

Miliaria occurs on the bends of the arms, legs, neck, armpits, in places where moisture is high and which sweat more often. The rash with prickly heat is small, pink, does not become inflamed and quickly disappears within 2-3 days. The question is often asked if there can be prickly heat on the face when the whole child is covered small pimples, a rash from head to toe is not prickly heat, but allergic dermatitis (this is the same atopic dermatitis), although these concepts are similar, and such a rash goes away much longer - within a month, subject to a strict hypoallergenic diet and moderate nutrition.

Symptoms of diathesis, atopic dermatitis

Diathesis often manifests itself as reddening of the cheeks, peeling, pimples on the cheeks and face and does not spread beyond the face. The reason for the diathesis is simple - “they ate something wrong,” this is an instant allergic reaction of a child to a food product and passes if this allergen is excluded from the child's menu. Diathesis is not an independent disease, but an infantile stage of atopic dermatitis, and if you ignore its manifestations and do not treat it, allergic dermatitis will go into the adult stage.

Rash with allergic dermatitis - small red pimples mainly on the folds and hands, legs, armpits, on the sides, on the stomach, on the head, including in the hair, and reddened rough spots around the eyes and on the cheeks, often on the body. The spot of the rash can grow in size and get wet (children's eczema), become inflamed, resembling a pimple or rash with chickenpox, the skin can thicken, crack. The rash is often itchy, especially at night and after the baby has sweated. A rash with atopic dermatitis does not go away for a long time even with a hypoallergenic diet, leaving behind dark spots on the skin.

The main reason for the exacerbation of atopic dermatitis at the age of one year is the same allergen and overeating. Allergy is an overly active reaction of the immune system to a foreign protein. The immune system finds it, produces antibodies that neutralize the allergen - the process is accompanied by an inflammatory reaction. The fact is that the child's enzymes cannot completely break down some substances and they enter the intestines in the form of an allergen. When overeating, not all food has time to decompose into components assimilated by the body and it begins to rot in the intestines, toxins appear that are absorbed into the blood and cause an allergic reaction of the body. A baby's immature liver is unable to neutralize these toxins, and they are excreted in urine, lungs and sweat. With sweat, toxins - allergens - get on the skin, the skin becomes inflamed, atopic dermatitis appears, and an infection joins the inflammation.

A child's liver is one of the most immature organs, but its activity, its ability to neutralize absorbed toxins are individual. That is why not everyone has allergic dermatitis; the adult liver can neutralize almost everything, so adults do not have these problems; atopic dermatitis often resolves with age, due to the maturation of liver cells.

Atopic march.

Atopic march is a natural course of development of manifestations of allergic dermatitis. It is characterized by a typical sequence of development of clinical symptoms of atopic disease, when some symptoms become more pronounced, while others decline. Usually the symptoms and signs of atopic dermatitis precede the onset of bronchial asthma and allergic rhinitis... According to several studies, approximately half of patients with atopic dermatitis subsequently develop bronchial asthma, especially with severe allergic dermatitis, and two-thirds develop allergic rhinitis. In children with the most easy flow the disease was not marked by the development of allergic rhinitis or bronchial asthma. The severity of atopic dermatitis can be considered a risk factor for bronchial asthma. According to studies, with severe atopic dermatitis, the risk of developing bronchial asthma is 70%, with mild - 30%, and in general among all children - 8-10%. Therefore, it is so important that treatment is aimed not only at preventing exacerbations of atopic dermatitis itself, but also at preventing the development of other forms of atopic disease.

The disease negatively affects the quality of life of patients and their families, and also requires considerable expenses. Research has shown that caring for a child with atopic dermatitis is associated with more stress than caring for a child with insulin-dependent diabetes mellitus.

Treatment of allergic skin symptoms and atopic dermatitis

Treatment of prickly heat: do not allow the baby to sweat, change the diaper often, wet sliders, maintain normal humidity in the baby's room and a temperature of 20-21 degrees. At least temporarily remove the oilcloth from under the baby's sheet. Bathe the child in a slightly pink solution of potassium permanganate, or add an infusion of the series to the bath. Lubricate the affected areas with baby cream or sterilized vegetable oil.

Diathesis treatment - initial stage atopic dermatitis - is the exclusion from the child's diet of foods that can cause allergies. Elimination of the allergen from the mother's menu if she is breastfeeding. The manifestations of diathesis can be lubricated with an infusion of a series, but it is better with an infusion bay leaf- does not dry the skin as much as a string. Individual pimples can be greased with brilliant green.

The treatment and consequences of atopic dermatitis are very multifaceted and have more nuances. In addition to the fact that the treatment of atopic (allergic) dermatitis is successful only if the recommendations listed above for the treatment of prickly heat are followed, there are also additional methods treatment.

Treatment of atopic dermatitis

Currently, a complete cure for atopic dermatitis is not possible. Atopic dermatitis is a chronic disease that requires long-term monitoring of the course of the disease. An integrated approach to therapy is required. Treatment consists of the selection of the most appropriate combinations of auxiliary basic therapy (skin care) and anti-inflammatory therapy as needed. The elimination or reduction of contact with the allergen and the reduction of non-allergenic effects prevents the exacerbation of allergies. The effectiveness of treatment for atopic dermatitis is significantly increased if the patient, his parents and family are educated in the system of allergic schools.

Since atopic dermatitis is a chronic disease, constant cooperation between the doctor and the parents of the little patient is required for the success of its treatment.

The doctor's efforts are primarily aimed at suppressing allergic inflammation of the baby's skin and reducing the action of allergens. A properly selected diet, with the exclusion of food allergens from the diet, can significantly improve the condition, prognosis and outcome of atopic dermatitis.

The leading physician for children with atopic dermatitis should be a dermatologist interacting with an allergist and other specialists (neuropathologist, gastroenterologist).

External treatment plays an important role in the complex treatment of children with atopic dermatitis. Its choice depends on the condition of the skin, the area of ​​the lesion and the stage of the disease, and the goals are: suppression of inflammation in the skin, reduction of itching, elimination of dryness, prevention of secondary infection.

The main goals of the treatment of atopic dermatitis.

1. Elimination or reduction inflammatory changes on the skin and itching.
2. Restoration of the structure and function of the skin, normalization of skin moisture.
3. Prevention of the development of severe forms of the disease.
4. Treatment of concomitant diseases.
5. Prevention of the progression of atopic disease (atopic march).

Treatments for atopic dermatitis logically follow from its causes:

Allergic symptoms are provoked by an allergen, therefore, all potential allergens from the child's menu and around him must be excluded, since allergens also reinforce each other's action. Example: you gave your child a cherry - there were no rashes on the skin, but you gave the child a cherry during an exacerbation of atopic dermatitis and the rash spread over the whole body with lightning speed. The same applies to fried, sweet. Fatty foods cannot be split and absorbed completely, and sugars intensify fermentation processes in the intestines, poisoning the child's body with toxins. Exclude from the menu at the time of allergic rashes all red vegetables and fruits, berries and juices from them, herbs, cereals containing gluten, especially semolina. The nutrition, diet of a child with atopic dermatitis is fully extended to the mother if she is breastfeeding.

Elimination of contact with the allergen.

In the treatment of atopic dermatitis, measures to reduce contact with allergens play an important role. At an early age, dietary restrictions play a major role.

The diet usually includes avoiding eggs and cow's milk, as well as extractives, food additives, preservatives, emulsifiers, fried smoked foods, sauces, carbonated drinks and foods with high allergenic activity (honey, chocolate, cocoa), regardless of whether they were a causal factor or not. Moreover, in about 90% of cases, food products that cause exacerbations of atopic dermatitis are milk, eggs, peanuts, soybeans, wheat and fish. If the food allergen is significant, then removing it from the diet results in significant clinical improvement. But, since almost any product can cause an allergic reaction, the selection of such an elimination diet (a diet excluding certain foods) should be strictly individual and based on proven intolerance to the product. In addition, it is recommended to reduce the amount of salt in food.

Hypoallergenic diet. Approximate child's menu - atopic

breakfast - porridge from unroasted buckwheat (boiled in third water and soaked at first for a couple of hours) + half a teaspoon oil per 200 gram of porridge.
lunch - puree soup: boiled and slightly mashed vegetables (soaked potatoes, white cabbage, onions, vegetable oil, a teaspoon) + 50 grams of beef, cook for 30 minutes. then drain and cook again until tender.
dinner - millet porridge (gluten-free, it's not wheat!) In short, sort it out, wash 6 times in cold water, then cook in third water. Let me explain: on the 3rd water, it means it boiled, it was drained and so on 2 times.
From fruits only apples, but not store-bought.
All herbs can be allergens and give a cumulative allergy, that is, they will pour out in 3-4 weeks and it is not clear why.

Do not overfeed the child, let him eat slowly, in small portions and chew food well if he is already chewing - this way he will be saturated with less food and it will be absorbed completely. When bottle feeding is used, dilute a smaller amount of the formula in water than the norm, make a smaller hole in the nipple. Take the bottle sometimes and give again after a while. Any pediatrician will tell you that atopic dermatitis is very rare in thin children.

At an older age, an increasing role is played by measures to eliminate house dust mite allergens, animal allergens, molds, pollen, etc. from the environment.

Some measures should be taken regardless of which particular allergen is "culpable" in the onset of atopic dermatitis. First of all, we are talking about reducing contact with dust, recommendations for cleaning and caring for bedding.

You should not put a computer, TV and other household appliances in the bedroom. In the house where the allergic person lives, it is absolutely forbidden to smoke.

Also, children with a tendency to atopic dermatitis should avoid contact with irritants (irritants), including alkaline soaps and detergents that are part of common household chemicals, avoid irritating effects of temperature and humidity factors, tissue structure.

Do not wear tight-fitting clothing, but replace with loose cotton or blended items to avoid overheating. The most important qualities in this case, apparently, are breathability and softness (clothes should not chafe!). Two randomized controlled trials found that factors such as texture or softness / roughness of the fabric played a greater role in terms of comfort and non-irritation of the skin than the use of natural or synthetic material. Nails should be cut short so as not to damage the skin when combing atopic manifestations.

As for measures such as the use of special anti-allergenic protective covers that are impervious to allergens, this measure may also be useful for all patients with atopic dermatitis. This is evidenced by medical research data. Thus, in a 12-month study in adults, the use of special protective covers on bedding led to a clinical improvement in the course of atopic dermatitis, even in patients who did not show hypersensitivity to house dust mite. This indicates that such covers reduce contact with a number of factors (with allergens of other groups, irritating factors and even, possibly, with bacterial superantigens).

Remove all fur toys, plastic and rubber toys that have even a slight odor. Leftover toys are often washed with baby soap.

We have limited the ingress of allergens into the bloodstream, what to do with the existing ones? Since toxins can be excreted in the urine, give your child plenty of water if atopic dermatitis worsens. It is better to give water not boiled, but artesian water with minerals.

Sorbents will help to limit the absorption of toxins from the intestines: enterosgel, sorbogel, smecta, Activated carbon- they are absolutely harmless, they are not absorbed in the intestines and it makes sense to take them for both the nursing mother and the child.

It is very important for atopic dermatitis to achieve stable stool 1-2 times a day in both the child and the nursing mother. Lactulose syrup works well in this sense - duphalac, normase - it can be used even by a small child, it is not addictive, but it is better to start with the smallest dosage and gradually bring it to the norm recommended for age group... It is better to give syrup in the morning on an empty stomach, cancel it as gradually reducing the dose.

Now you need to minimize sweating and skin contact with all kinds of microbes. Maintain the optimal temperature regime of 20-21 degrees and humidity of 60-70% in the child's room, ventilate more often, change bed linen every day. Change your underwear often, it should be cotton, with long sleeves and legs. Change the laundry immediately as soon as it becomes damp. To wash things of a child with atopic dermatitis - bedding (including your own), clothes only in baby powder or with baby soap.

You need to walk more, while wearing the minimum amount of clothes for the child. Clothes should not rub, generally minimize skin contact with outerwear, synthetics, dyes.

Especially about bathing with atopic dermatitis.

Baths do not have a very good effect on the course of atopic dermatitis. Bathing with an exacerbation of the disease does not take long, in warm and only boiled water, or water passed through a good filter - the water should not contain chlorine! You can bathe in a weak celandine, a slightly pink solution of potassium permanganate, in a bath with the addition of sea salt (a little). Use soap and shampoo for atopic dermatitis only for children and no more than 1 time a week, so as not to wash off the protective fatty film from the child's skin.

Banning bathing in Atopic dermatitis is a mistake, but a few simple rules must be followed:

1. Bath or shower should be moderately warm. The optimal bathing time is about 20 minutes. It is better, if possible, to use dechlorinated water (filters or settling the water in the bath for 1-2 hours, followed by the addition of boiling water.
2. Do not use washcloths, rub the skin, regardless of whether there are symptoms of allergic dermatitis at the moment. Only high quality hypoallergenic cleansers with neutral pH can be used.
3. In case of exacerbation of atopic dermatitis after bathing, the skin should be blotted with a soft towel (do not wipe dry or rub!) And apply within 3 minutes emollient(Bepanten, Lipikar, F-99, etc.).
4. Avoid swimming in pools with chlorinated water. In some cases, the negative effects can be avoided by applying a shower after the session using mild cleansers, followed by the application of moisturizing and softening products.

Drug treatment for atopic dermatitis

Treatment of atopic dermatitis is prescribed only by a doctor individually, based on the symptoms and nature of the rash.

Some pediatricians advise taking anaferon during an exacerbation of atopic dermatitis. Anaferon has a modulating effect on all key components of the immune system, significantly increasing the production of IFN, which reduces the level of Th 2 (T-helpers 2) activation and provides not only the prevention of acute respiratory viral infections, but also helps to reduce the level of immunoglobulin E IgE (one of the indicators of the body's allergic mood). ). This has been proven in clinical studies of Anaferon for children on a group of children with bronchial asthma.

The role of allergen-specific immunotherapy in the treatment of atopic dermatitis.

If a causal allergen has been identified, essential acquires allergen-specific immunotherapy (ASIT). The data obtained indicate that ASIT can not only prevent exacerbations of atopic dermatitis, but also prevent the progression of the atopic march.

What means of systemic (general) action are used for atopic dermatitis?

First of all, antihistamines. The indications for their appointment are due to the most important role of histamine in the mechanisms of the development of itchy skin.
The ETAC study investigated the role of cetirizine (zyrtec) in preventing the onset of the atopic march. The infants were treated with high doses of cetirizine (0.25 mg / kg twice daily) or placebo. The results of the study are not entirely unambiguous, but in general, the use of Zirtek led to a 2-fold decrease in the risk of developing bronchial asthma in children with sensitization to aeroallergens.

Antiallergenic medicines: suprastin, tavegil, diphenhydramine. With severe itching, you can use topical antihistamines - fenistil gel. Dry skin and cracks are often smeared with bipanten, dermopanthen (cream or ointment).

Antihistamines of the first generation are prescribed during the period of severe exacerbation of atopic dermatitis, when their sedation is necessary. For long-term use, drugs of the 2nd and 3rd generations are chosen, because they do not cause drowsiness, dry mouth; there is no need for frequent drug changes.

Systemic antibiotics are used for fever and lymphadenitis, clear signs of a secondary infection.
The group of macrolides and cephalosporins of 2-3 generations are preferred.
In especially severe, stubborn cases, in the presence of extensive eroded skin surfaces, systemic hormones (glucocorticoids) are used.
Sometimes drugs are prescribed that regulate the function of the nervous system.
In the usual uncomplicated course of atopic dermatitis in the absence of signs of immunological deficiency, immunotherapy is not prescribed.

External (local, topical) treatment of atopic dermatitis.

It is impossible to imagine the treatment of atopic dermatitis without external therapy.

Topical treatment goals for atopic dermatitis:

1. Suppression of inflammation in the skin and associated main symptoms of acute (hyperemia, edema, pruritus) and chronic (lichenification, pruritus) phases of the disease.
2. Elimination of dry skin.
3. Prevention of secondary infection.
4. Restoration of damaged epithelium.
5. Improving the barrier function of the skin.

The use of moisturizers in conjunction with hydration can help restore and maintain the stratum corneum barrier. Eliminating dry skin is an essential part of the treatment of atopic dermatitis.

In exacerbations, external hormonal preparations of topical (local) action are used. Preference is given to drugs of the latest generation (Advantan, Elokom). Treatment begins with highly active agents (3-5 days), and then (if necessary) continue therapy for less active drug(up to 2-3 weeks).

They help well with external manifestations of allergies (only to the rash itself, without eliminating the causes of dermatitis) corticosteroid hormonal ointments and creams. The latest generation of corticosteroid hormones are relatively safe and have a minimum side effects due to the fact that they are practically not absorbed into the systemic circulation, they are used for atopic dermatitis from six months. These are, for example, elokom, advantan. When wet, it is better to use the form of a cream, with dry skin and cracks - ointments. It is not worth abruptly canceling hormones, gradually reduce the dose of the drug by mixing hormonal cream with baby cream, ointment with bipanthen.

Do not apply fluoridated hormones to children in the first years of life, as well as to all patients - on the face, neck, in natural skin folds and in the anogenital area due to the risk of skin atrophy.

Hormonal external agents are absolutely contraindicated:
1.with tuberculous, syphilitic and any viral process (including chickenpox and herpes simplex) at the site of application of the drug,
2.in case of a skin reaction to vaccination at the site of application of the drug,
3. with hypersensitivity to the components of the drug.

Reasons why treatment with topical hormonal drugs may not be effective:
1.continued contact with an allergen,
2.superinfection with Staphylococcus aureus,
3.inadequate drug activity,
4.insufficient use,
5. non-compliance with the treatment regimen,
6.reaction to the components of the drug,
7. rarely - steroid insensitivity.

In addition, with exacerbation of atopic dermatitis, various lotions, wet-drying dressings, disinfecting liquids (fucorcin, Castellani liquid, methylene blue, brilliant green) are used. When a secondary infection is attached, there are ready-made forms of external antibiotics (tetracycline ointment), antifungal agents (candida, clotrimozole) and their combinations. For deep cracks, drugs are used that affect the regeneration and microcirculation processes in the skin (zinc ointment).

A new drug and a new approach to the external therapy of atopic dermatitis.

Despite the effectiveness of steroids, their use, especially in areas with thin skin (face, neck, natural folds, anal area, external genitals) can cause a number of side effects: skin atrophy, development of stretch marks, telangiectasias (dilated small vessels), etc. etc. If the area of ​​the lesion is very large, then the use of steroids can cause a systemic effect. Therefore, the development of topical non-hormonal drugs is underway.

Currently, such a new non-hormonal topical preparation is Elidel (pimecrolimus 1% cream). It belongs to a new class of calcineurin inhibitors (blocks a special enzyme in T-lymphocytes responsible for the production of inflammatory mediators). It penetrates well into the skin, but practically does not penetrate through the skin into the systemic circulation. Its use is allowed from the age of 3 months, and it does not cause the formation of stretch marks, telangiectasias and skin atrophy. In addition, in terms of itching relief, the drug demonstrates more quick effect than corticosteroids.

A new approach to the treatment of exacerbation of atopic dermatitis based on Elidel has been proposed, in which moisturizing and softening agents are used as permanent maintenance treatment, and at the first, earliest signs of an impending exacerbation of allergic dermatitis, treatment with Elidel begins 2 times a day, and only in severe exacerbations, topical hormonal drugs are used.

In the latter case, after a course of topical hormones, Elidel is used to continue treatment after the process subsides to a moderate one and continues until the exacerbation subsides, and in the future it is recommended to use it when the first symptoms of atopic dermatitis appear. Studies have shown that such a strategy can prevent the progression of an exacerbation to a severe one, that when treating mild to moderate exacerbations, hormonal drugs can be avoided altogether, and with an early application strategy, disease control can be achieved. The new strategy is expected to have a long-awaited opportunity to interrupt the progression of the atopic march. Unfortunately, the drug is not cheap. But already now it has taken a firm place in the treatment of manifestations in areas with sensitive thin skin.

Physiotherapy and herbal medicine in the treatment of atopic dermatitis.

In atopic dermatitis, phototherapy is widely used as a useful adjunct to medical treatment. This allows not only to improve symptoms, but also to reduce the use of steroid drugs. Other physiotherapeutic methods are also used (lazarotherapy, phonophoresis, alternating magnetic field, EHF therapy.

Spa treatment can have a good effect.
The possibility of treating atopic dermatitis with anti-IgE antibodies (omalizumab, or Xolair) is being considered. A similar method began to be used for moderate and severe bronchial asthma. Research on its use in atopic dermatitis is still pending.

More drugs used for atopic dermatitis: Sunamol C (from eggshell), zodak, smear the rash at choice and, according to the situation, either with elokol (if itching is very severe) or drapolen. Fucidin G ointment and Fenistil drops, Creon, Zyrtec.

Prevention of atopic dermatitis.

Atopic dermatitis is one of the most common skin diseases in childhood, occurring primarily in children with a hereditary predisposition to allergic diseases having a chronic recurrent course, age features localization and morphology of foci of inflammation and due to hypersensitivity to allergens.

Hereditary burden of atopy is estimated at 50-70% or more. It was revealed that in such children one of the parents suffers from allergies in 20-50% of cases. When both parents are allergic, the child is up to 75% more likely to develop atopic dermatitis. In addition, it has been proven that in 80% of patients with atopic dermatitis, hereditary complication of such atopic diseases as atopic bronchial asthma, atopic conjunctivitis, urticaria, vasomotor rhinitis is also traced.

Atopic dermatitis mostly (66%) affects girls, less often boys (35%). According to many studies, atopic dermatitis is more common in children living in megacities than in rural children.

Measures for the prevention of atopic dermatitis should be carried out even before the birth of the child - in the antenatal period (antenatal prophylaxis) and continued in the first year of life (postnatal prophylaxis).

Antenatal prophylaxis should be carried out in conjunction with an allergist, doctors of the gynecological department and a children's clinic. Massive drug therapy of a pregnant woman, exposure to professional allergens, unilateral carbohydrate nutrition, abuse of obligate food allergens, etc., significantly increase the risk of atopic dermatitis.

In the early postnatal period, it is necessary to try to avoid unnecessary drug treatment, early artificial feeding, which lead to the stimulation of immunoglobulin synthesis. A strict diet applies not only to the child, but also to the breastfeeding mother. If a risk factor for atopic dermatitis is present, proper care for the skin of a newborn, normalization of the activity of the gastrointestinal tract.

But you should not completely exclude contact with allergens, you need to gradually accustom the child's body to them and, without exacerbation of atopic dermatitis, in minimal quantities, one by one, introduce such products into the baby's menu.

The article was written using the literature: Atopic dermatitis in children: diagnosis, treatment and prevention.
Scientific and practical program of the Union of Pediatricians of Russia. M., 2000

Do I need a diet and therapeutic mixtures for atopic dermatitis

Atopic dermatitis at the reception - a breakthrough. In the past couple of weeks, almost every third child has had this problem.

The problem is widespread, doctors are often guided by outdated recommendations, prescribe what should not be (bacteriophages, probiotics, strict elimination diets, etc.), do not prescribe what should be (emollients are rare and weak, they are afraid of steroids, etc.), sabotage (they put the mother on such a terrible diet that she cannot stand it and gives up breastfeeding; or it is directly forbidden to breastfeed in favor of the hydrolyzate), etc.

Patients continue to bathe children in line, wash tar soap, change the mixture every four days, smear the rash with a fat baby cream, be afraid of hormones and talk to children "at the grandmother's" (no, this is not a metaphor).

But there is good news: more and more patients and doctors are reading international guides and memoranda on AD, and adhere to adequate treatment and care regimens for such children. This means that not all is lost. So, what is the most important thing to know about the treatment of atopic dermatitis in children?

Constantly, for many months, until a stable remission occurs, we use emollients (they are lubricants, they are also moisturizers / ointments), from twice a day to at least every two hours, depending on the severity. It is especially important after bathing the baby. This is the mainstay of AD treatment.

My top prescriptions for drugs from this group (I do not pretend to be complete and objective, I have no conflict of interest): Lokobase Ripea, Mustela Stelatopia, Emolium special cream, Lipikar AR +, Lipobase.

Emollients should not be saved; a 250 ml tube of cream should go away in 1-2 weeks, depending on the severity and area of ​​the lesions.

The emollients are selected individually, by trial and error. Some, even more expensive ones, are not suitable (ineffective) for a particular child, and some even worsen the skin condition. Therefore, do not buy half a bucket at once, it will be a shame if it does not fit. Ideally: get some probes and experiment to find the best one.

Important: baby cream is not an emollient! Generally, from the word "absolutely".

What to feed a child with atopic dermatitis and what can a nursing mother eat

Only a third of AD cases are associated with food allergies, so the issue of an elimination (excluding some foods) diet for a child is very controversial, and a breastfeeding mother needs a diet very infrequently (only with a clear connection between food and rashes).

Sometimes AD is combined with blood streaks in the stool. This combination almost always indicates the presence of an allergy to cow's milk proteins (and here the elimination diet is quite justified).

Goat milk formulas (Nanny, Cabrita, etc.) are not a treatment for AD. If a child has a cow's milk intolerance, he almost certainly has a goat intolerance, their protein composition is almost identical.

Soy protein mixtures (Frisosoy, Similak, Isomil, etc.) should be used with caution in AD, since soy itself is a strong allergen. Sometimes, however, soy blend provides clinical relief for AD.

Mixtures with partial protein hydrolysis (Nutrilon Comfort, Nan GA, etc.) are not a treatment for AD, they are prevention of food allergies; are used before the onset of symptoms, if there are prerequisites (first of all, a burdened family history).

Mixtures with complete protein hydrolysis (Nutrilon Pepti Allergy, Frisopep AS, etc.) are shown only for the part of children in whom AD is associated with food allergies. This is determined individually: by blood in the stool, by eosinophilia in a blood test, by the level of total IgE, and, most importantly, by a positive clinical response to these mixtures.

Amino acid mixtures (Neocate, Alfare Amino, etc.) are used when there is a severe food allergy, with insufficient clinical response to full-hydrolysis mixtures.

Local (topical) glucocorticosteroid creams or, colloquially, "Hormonal ointments" are indicated only with pronounced exacerbation, only in a short course, only after discussing the rules for their use with the doctor.

Topical calcineurin inhibitors (pimecrolimus and tacrolimus) are similar in effect and indication to topical steroids, but do not contain hormones(for some fearful parents this is critical) and are the second line of therapy in cases where steroids do not work.

Antihistamines the first (Suprastin, Fenistil, etc.) and the second (Zirtek, Claritin, etc.) generations do not treat AD, they only reduce itching... Useful only at the peak of itching, to relieve health.

Analyzes for total IgE, specific IgE, eosinophilic cationic protein, Fadiatop Immunocap, scarification skin tests, prick tests and other allergological examinations have a high cost and are not indicated for all patients. And for those who are nevertheless shown, it often does not help in any way in treatment tactics. Therefore, it is not necessary to take all this before the direct recommendation of your doctor.

Vaccinations a child with AD is shown even more than a healthy one. Because if he gets sick, for example, whooping cough, then the risk allergic reactions and exacerbations of AD from disease and drugs, he has several orders of magnitude higher than the risk of exacerbations and allergic reactions to whooping cough vaccine. Therefore, here we choose the lesser of two evils.

But you should vaccinate at the minimum manifestation of AD: for some it is velvety skin, but for someone dryness, lichenification and a little scratching and scratching are all individual. And be prepared for the fact that the vaccine can cause a temporary exacerbation of AD, which is then removed by adequate therapy.

Modern treatment of atopic dermatitis in children

AD flows in waves. It becomes aggravated, then it passes. Sometimes these exacerbations are provoked by something, sometimes they are not provoked by anything. And what you gave before the exacerbation, you will certainly consider the cause. And what was used before the onset of remission, you will consider an effective treatment. And in both cases, there is a very high probability of making a mistake, stumbling upon a coincidence, and wishful thinking. Be careful with conclusions, check them several times and discuss with your doctor.

Over time (by about school time), AD disappears without a trace in 9 out of 10 children. Basis of treatment: permanent emollients and topical steroids shortly and locally, in case of exacerbation. The essence of the treatment is to moisturize the skin, prevent exacerbations, treat emerging exacerbations and treat their complications.

There is no connection between dysbiosis or intestines in general and AD, these are myths.

Identifying and ruling out an allergen to treat AD is a tempting idea, but almost never works. Firstly, because only a third of patients have this connection (see above), and secondly, if it is possible to identify a food allergen, it is not as easy to exclude it as it seems. Especially when there are a lot of allergens.

However, sometimes the doctor may prescribe a switch to hydrolyzate or diet. In case of doubtful results, he will prescribe a provocative test (return to the milk mixture or introduce the product back) and if this provokes an exacerbation, the elimination diet will be justified. But not all atopics in a row, for sure.

These are the very, very basics. ATD - large, multi-layered and long problem; it, like any other chronic disease, should be treated by the same (for the sequence of appointments) a competent doctor.