Atopic dermatitis at children – the inflammatory disease of skin of a chronic recidivous current arising at early children's age owing to hypersensibility to food and contact allergens. Atopic dermatitis at children is shown by the rashes on skin which are followed by an itch, moknutiy, formation of erosion, crusts, sites of a peeling and likhenization. The diagnosis of atopic dermatitis at children is based on data of the anamnesis, skin tests, researches of level of the general and specific IgE. At atopic dermatitis at children the diet, local and system medicamentous therapy, physiotreatment, psychological assistance, sanatorium treatment are shown.
Atopic dermatitis at children
Atopic dermatitis is the earliest and most frequent manifestation of reaction of hypersensitivity of an organism to effect of allergens of the environment: 80-85% of cases of an allergy at children of early age fall to its share. As a rule, atopic dermatitis at the child is shown within the first year of life; can proceed with periodic aggravations and temporary subsiding of skin manifestations to the pubertatny period and even to remain at mature age.
Prevalence of atopic dermatitis steadily grows in children's population and makes 10-15% in age group up to 5 years; 15-20% - among children of school age. Atopic dermatitis significantly reduces quality of life of children, causing psychological discomfort and breaking their social adaptation. Atopic dermatitis at children is risk factor of "an atopic march" - further consecutive development of other allergic diseases: allergic rhinitis, pollinoz, allergic conjunctivitis, bronchial asthma. When weakening an organism atopic dermatitis at children can be complicated by accession of secondary bacterial and fungal infections.
The problem of atopic dermatitis at children, in a type of the relevance, needs close attention from pediatrics, children's dermatology, allergology immunology, children's gastroenterology, dietology.
The reasons of atopic dermatitis at children
Developing of atopic dermatitis at children is caused by complex interaction of various factors of the environment and genetic predisposition to allergic reactions. Atopic damage of skin usually arises at children with hereditary tendency to development of allergic reactions. It is proved that the risk of development of atopic dermatitis in children makes 75-80% with hypersensitivity at both parents and 40-50% - at an atopiya at one of parents.
The fruit hypoxia postponed in the pre-natal period or at the time of delivery leads to more frequent development of atopic dermatitis in children. In the first months of life of the child symptoms of atopic dermatitis can be caused by food allergy owing to early conversion to artificial mixes, the wrong introduction of a feeding up, an overfeeding, the available violations of process of digestion and frequent infectious viral diseases. Atopic dermatitis arises at children with gastritis, enterokolity, dysbacteriosis, helminthoses more often.
Quite often leads overconsumption of high-allergenic products by mother during pregnancy and a lactation to development of atopic dermatitis in children. The food sensitization connected with physiological immaturity of a gastrointestinal tract and features of the immune answer of the newborn exerts considerable impact on formation and the subsequent development of all allergic diseases in the child.
As causal and significant allergens pollen, waste products of domestic ticks, a dust factor, household chemicals, medicines, etc. can act.
The psychoemotional overstrain, overexcitation, deterioration in an ecological situation, passive smoking, seasonal changes of weather, decrease in immune protection can provoke an exacerbation of atopic dermatitis at children.
Classification of atopic dermatitis at children
In development of atopic dermatitis in children distinguish several stages: initial, a stage of the expressed changes, a stage of remission and a stage of clinical recovery.
Depending on age of a demonstration and kliniko-morphological features of skin manifestations allocate three forms of atopic dermatitis at children: infantile (from the neonatality period to 3 years), the nursery – (from 3 to 12 years) and teenage (from 12 to 18 years) which can pass in one into another or come to an end with remission with reduction of symptoms.
On degree of prevalence of process children can have a limited atopic dermatitis (the centers are localized in one of areas of a body, the area of defeat not> 5% of a surface of a body); widespread / (defeat - from 5 to 15% of a surface of a body in two and more areas) and diffusion (with defeat practically all skin surface). Distinguish a lung, average degree and the heavy course of atopic dermatitis at children.
Kliniko-etiologichesky options of atopic dermatitis on causal significantly allergen include a skin sensitization with prevalence of food, tick-borne, fungal, pollen and other allergy.
Symptoms of atopic dermatitis at children
The clinical picture of atopic dermatitis at children is rather diverse, depends on age of the child, sharpness and prevalence of process, weight of a course of pathology.
The infantile form of atopic dermatitis is characterized by sharp inflammatory process – hypostasis, skin hyperaemia, emergence on it eritematozny spots and nodular rashes (the serous papules and microvesicles) which are followed by sharply expressed ekssudation when opening – moknutiy, formation of erosion ("serous wells"), crusts, a peeling.
Typical localization of the centers – it is symmetric in a face (on the surface of cheeks, a forehead, chin); hairy part of the head; on the razgibatelny surfaces of extremities; more rare in elbow bends, popliteal poles and in buttocks. At children are characteristic of initial displays of atopic dermatitis: gneiss - seboreyny scales with the strengthened salootdeleniye in a fontanel zone, at eyebrows and behind ears; a dairy scab - an eritema of cheeks with yellowish-brown crusts. Skin changes are followed by an intensive itch and burning, raschesa (ekskoriatsiy), perhaps pustulous damage of skin (piodermiya).
For a children's form of atopic dermatitis are peculiar eritematoskvamozny and likhenoidny skin defeat. At children hyperaemia and the expressed dryness of skin with a large number of otrubevidny scales is observed; strengthening of the skin drawing, , is plentiful a peeling, painful cracks, a persistent itch with strengthening at night. Skin changes settle down mainly on the sgibatelny surfaces of extremities (elbow bends, popliteal poles), a palmar and plantar surface, inguinal and buttock folds, the back surface of a neck. "the atopic person" with a hyperpegmentation and a peeling a century, Denye-Morgan's line is characteristic (a skin fold under a lower eyelid), we comb out eyebrows.
Displays of atopic dermatitis at children of teenage age are characterized by sharply expressed likhenization, existence of the dry shelled papules and plaques which are localized mainly on face skin (around eyes and a mouth), necks, the top part of a trunk, elbow bends, around wrists, on the back of brushes and a foot, fingers of hands and legs. The aggravation of symptoms in cold season is characteristic of this form of atopic dermatitis at children.
Diagnosis of atopic dermatitis at children
Diagnosis of atopic dermatitis at the child is carried out by the children's dermatologist and the children's allergist-immunologist. During survey experts estimate the general condition of the child; condition of integuments (degree of humidity, dryness, turgor, dermografizm); morphology, character and localization of rashes; area of damage of skin, expressiveness of manifestations. The diagnosis of atopic dermatitis is confirmed in the presence at children of the 3rd and more obligatory and additional diagnostic criteria.
Out of an exacerbation of atopic dermatitis at children apply statement of skin tests with allergens by method of a skarifikation or the prik-test to identification of the IgE-mediated allergic reactions.
Determination of content of the general and specific IgE in blood serum by IFA, RIST, RAST methods preferably at an aggravation, the heavy course and a constant recurrence of atopic dermatitis at children.
Treatment of atopic dermatitis at children
Treatment of atopic dermatitis at children is directed to reduction of expressiveness of an allergic inflammation of skin, an exception of provocative factors, desensitization of an organism, prevention and decrease in frequency of aggravations and infectious complications. Complex treatment includes a diet, the hypoallergenic mode, system and local pharmacotherapy, physical therapy, rehabilitation and psychological assistance.
The diet helps to facilitate the course of atopic dermatitis and to improve the general state, especially at children of chest and early age. The food allowance is selected individually, proceeding from the anamnesis and the allergologichesky status of the child, each new product is entered under strict control of the pediatrician. At an eliminative diet from a diet remove all possible food allergens; at a hypoallergenic diet exclude strong broths, fried, hot, smoked dishes, chocolate, honey, a citrus, canned food, etc.
Drug treatment of atopic dermatitis at children includes reception of antihistaminic, anti-inflammatory, membrane stabilizing, immunotropny, sedative medicines, vitamins and application of local external means.
Antihistaminic medicines of the 1st generation (, , , ) apply only short courses at an exacerbation of the atopic dermatitis at children which is not burdened by bronchial asthma or allergic rhinitis. Antihistaminic medicines of the 2nd generation (, , , ) are shown at treatment of atopic dermatitis at children in combination with respiratory forms of an allergy. For knocking over of heavy exacerbations of atopic dermatitis at children use short courses of system glucocorticoids, immunosupressivny therapy.
Local treatment of atopic dermatitis at children helps to eliminate an itch and an inflammation of skin, to restore its water and lipidic layer and barrier function. At exacerbations of atopic dermatitis at children of medium-weight and heavy degree apply applications of local glucocorticoids, at an infectious complication - in a combination with antibiotics and antifungal means.
In treatment of atopic dermatitis at children use phototherapy (UFA and UFV radiation, PUVA-therapy), reflexotherapy, hyperbaric oxygenation, kurorto-and a climatotherapy. Children with atopic dermatitis quite often need the help of the children's psychologist.
The forecast and prevention of atopic dermatitis at children
The displays of atopic dermatitis which are most expressed at early age can decrease or disappear completely in process of growth and development of children. At most of patients symptoms of atopic dermatitis remain and recur during all life.
Adverse predictive factors are: an early debut of a disease aged up to 2-3 months, the burdened heredity, the heavy course, a combination of atopic dermatitis at children with other allergic pathology and a persistiruyushchy infection.
The purpose of primary prevention of atopic dermatitis – prevention of a sensitization of children from risk groups by the maximum restriction of high anti-gene loads of an organism of the pregnant woman and the nursing mother and her child. Breastfeeding in the first 3 months of life of the child is exclusive, enrichment of a diet of mother and child lactobacilli reduces risk of early development of atopic dermatitis in the children predisposed to it.
Secondary prevention consists in the prevention of exacerbations of atopic dermatitis at children due to observance of a diet, an exception of contact with provocative factors, correction of chronic pathology, desensibilizirushchy therapy, sanatorium treatment.
At atopic dermatitis the correct daily care of skin of children including clarification (short cool bathtubs, a warm shower), mitigation and moistening by special means of medical dermatological cosmetics is important; the choice of clothes and linen from natural materials.