Dermatitis at children – a complex of the inflammatory and allergic reactions of skin arising in response to influence of various irritants. Dermatitis at children is shown eritemy skin of various sites, an itch, existence of rash or scales, change of sensitivity of the inflamed sites of skin, deterioration in the general health. Diagnosis of dermatitis at children and its form is based on data of visual survey, analyses of scrape from the struck surface of skin, immunological and biochemical inspection. Treatment of dermatitis at children provides elimination of contact with the irritant which caused reaction, processing of affected areas of skin, reception antihistaminic, immunomodulatory, sedatives.
Dermatitis at children
Dermatitis at children – the local or widespread inflammation of integuments of the child developing owing to direct or the mediated influence of factors of the biological, physical or chemical nature. In children's dermatology and pediatrics dermatitis make 25-57% of cases of all diseases of skin. Atopic, seboreyny, contact and diaper dermatitis most often occurs at children. As a rule, dermatitis at children demonstrates on the first year of life, and at preschool and school age for the first time develops rather seldom. Having begun in the early childhood, dermatitis can get a recidivous current and lead to decrease in social adaptation of the child.
The dermatitis reasons at children
Atopic dermatitis at children is a typical allergodermatoz of which development hereditary predisposition, allergenic and not allergenic causal factors is the cornerstone. For designation of atopic dermatitis at children dermatologists and pediatricians sometimes use the terms "children's eczema", "ekssudativny diathesis", "allergic diathesis", etc.
Children with atopic dermatitis most often have a burdened family anamnesis on allergic diseases (to bronchial asthma, food allergy, a pollinoz, etc.). To atopic dermatitis the inclined children who are on artificial feeding, having a food, medicinal, pollen or household allergy, frequent infectious viral diseases, GIT pathology (gastroduodenity, askaridozy, dysbacteriosis, etc.), an immunodeficiency.
Diaper dermatitis at children is connected with bad or wrong care of the child: insufficiently frequent change of diapers and clothes, rare bathings etc. Diaper dermatitis at children can arise at long contact of skin with mechanical (fabric of a diaper or a diaper), physical (humidity and temperature), chemical (ammonia, salts of bilious acids, digestive enzymes) and microbic (opportunistic and pathogenic bacteria, barmy fungi of a sort Candida) factors.
The insufficient morfofunktsionalny maturity of integuments at children of chest age caused by weakness of a soyedinitelnotkanny component terms, fragility of basal membranes, a subtlety and vulnerability of epidermis, weak moisture content of skin, imperfection of thermoregulatory and immune function of skin contributes to development of diaper dermatitis. The premature children having a hypotrophy, rickets, an intestinal dysbiosis, frequent ponosa treat risk group on developing of diaper dermatitis.
As the Etiologichesky agent of seboreyny dermatitis at children Malassezia furfu fungus, being the representative of a normobiota of healthy skin of the person acts. At good immune responsiveness the fungus behaves quietly, however at different violations of a homeostasis can cause dandruff, follikulit also seboreyny dermatitis at children.
Contact dermatitis at children can arise at excessive impact on skin of low or high temperatures, sunshine, Ural federal district, X-rays; to frequent processing of skin disinfectants (alcohol, air, iodine); application of means of hygiene and cosmetics (laundry detergents, creams, powders), contact with some species of plants (cow-parsnip, euphorbia, buttercup, primrose, arnica) and insects.
Dermatitis symptoms at children
Symptoms of atopic dermatitis at children
Atopic dermatitis at children usually demonstrates in the first half of the year of life; develops at preschool, school or teenage age less often. Skin rashes at atopic dermatitis at children can be presented by persistent hyperaemia or passing eritemy, dryness and a peeling of skin or the rash which is becoming wet papular on an eritematozny background. At children treat characteristic symptoms of atopic dermatitis symmetry of damage of face skin, extremities, the sgibatelny surfaces of joints; itch of various intensity. Quite often at atopic dermatitis the skladchatost (giperlinearnost) of palms and soles is found in children; follicular elbows, forearms, shoulders; a white dermografizm, raschesa of skin, a piodermiya, the hyperpegmentation a century ("allergic shine"), heylit, a small tortoiseshell, , recurrent conjunctivitis, etc.
The natural course of progressing of atopic dermatitis children in the absence of appropriate treatment can have a so-called "atopic march" or the atopic disease which is characterized by accession of other allergic diseases: allergic conjunctivitis, allergic rhinitis, bronchial asthma.
Symptoms of seboreyny dermatitis at children
Seboreyny dermatitis occurs approximately at 10% of children of the first 3 months of life and completely stops by 2-4 years. The first displays of seboreyny dermatitis at the child can appear on 2-3 week of life. At the same time on hairy sites of the head grayish otrubevidny scales (gneiss) which, merging, turn into a continuous grease crust are formed. Gneiss can spread to skin of a forehead, eyebrows, zaushny area; sometimes the spotty and papular rashes covered with scales on the periphery are found in natural folds of a trunk and extremities.
As distinctive features of seboreyny dermatitis at children serves the minimum expressiveness of an itch, lack of an ekssudation (a scale grease, but dry). At violent removal of crusts brightly hyperemic skin is bared; in this case it can become wet and is easy be infected.
Symptoms of diaper dermatitis at children
Diaper dermatitis at children is characterized by irritation of integuments of buttock area, the internal surface of hips, crotches, waists, a stomach, i.e. the sites of skin adjoining to the wet and polluted diapers, diapers, a romper suit. Diaper dermatitis occurs at 35-50% of babies, develops at girls aged from 6 up to 12 months more often.
On degree of expressiveness of clinical manifestations allocate 3 degrees of diaper dermatitis. At easy displays of dermatitis children have moderate hyperaemia of skin, softly expressed rash and maceration of skin in places of typical localization. Diaper dermatitis of moderate severity is characterized by formation of papules, and infiltrates on the angry sites of integuments. Heavy diaper dermatitis at children proceeds with opening of bubbles, formation of sites a moknutiya and erosion, extensive drain infiltrates.
Development of diaper dermatitis influences the general health of children: they become uneasy, often cry, sleep badly as the inflamed sites of skin strongly itch, and touches to them cause discomfort and pain. At girls diaper dermatitis can lead to development of a vulvit.
Symptoms of contact dermatitis at children
Displays of contact dermatitis at children arise directly on that site of skin to which any irritant adjoined. The main symptoms of contact dermatitis at children include edematous hyperaemia of skin with sharp borders, a severe itch, burning, morbidity, formation of blisters which opening leads to formation of the becoming wet erosive sites.
Contact dermatitis at children can accept a sharp or chronic current. The sharp phase comes right after contact with an irritant and stops soon after completion of influence. The chronic current gets dermatitis from children after frequent repeated influence of an aggressive factor.
Diagnosis of dermatitis at children
Emergence of any rashes on skin of the child demands attentive assessment from the pediatrician, the children's dermatologist, the children's allergist-immunologist, sometimes – the children's infectiologist. At suspicion of dermatitis at children careful collecting the anamnesis, survey of integuments, clinical laboratory inspection is carried out.
In diagnosis of atopic dermatitis at children an important role is played by identification in blood of an eozinofiliya, the increased level of the general IgE, allergenspetsifichesky IgE and IgG by IFA, RAST, RIST, MAST methods; existence of positive skin or provocative tests with allergens.
In the presence of a secondary infection the bacteriological research of dabs is conducted; for detection of pathogenic fungi scrape from smooth skin is studied. Within inspection of children with dermatitis the koprogramma research, a calla on dysbacteriosis and eggs of helminths, performing ultrasonography of abdominal organs is important. Sometimes for the purpose of differential diagnostics the skin biopsy is carried out.
In the course of inspection it is important to specify the reasons and a form of dermatitis at children, and also to exclude existence of immunodeficient diseases (Viskotta-Aldrich's syndrome, a giperimmunoglobulinemiya E), pink depriving, microbic eczema, itch, an ichthyosis, psoriasis, a skin lymphoma.
Treatment of dermatitis at children
Realization of an integrated approach to therapy of atopic dermatitis at children includes decrease or an exception of contact with allergen, the correct selection of a diet, medicamentous therapy, allergen - a specific immunotherapy. The system pharmacotherapy provides reception of antihistaminic medicines, NPVS, enterosorbents, enzymes, vitamin medicines; at the heavy course of dermatitis at children – glucocorticoids. For knocking over of exacerbations of atopic dermatitis at children the plasma exchange or haemo sorption is used.
Topichesky therapy is directed to elimination of an inflammation and dryness of skin, restoration of barrier properties of skin and prevention of a secondary infection. It includes external use of kortikosteroidny ointments, nonsteroid hydrolipidic creams, disinfecting liquids, lotions, the damp drying bandages. At atopic dermatitis at children well proved not pharmacological methods of treatment: reflexotherapy, hyperbaric oxygenation, induktotermiya, magnetotherapy, svetoterapiya. At forms of atopic dermatitis, resistant to traditional therapy, at children PUVA-therapy can be applied.
The basis of treatment of seboreyny dermatitis at children is made correctly by the organization of care of the affected skin by means of special antifungal shampoos and creams. To children washing of the head dermatological shampoos with ketokonazoly tsiklopiroksy, tar, etc.), possessing fungistatic, fungicide, keratoreguliruyushchy and anti-inflammatory and action is appointed. After that mineral or olive oil is applied on head skin. For clarification of sites of seborrhea on smooth skin special gels then skin is greased with dermatological cream are used. On average the course of therapy of seboreyny dermatitis at children lasts about 6 weeks.
In treatment of diaper dermatitis at children the leading role is assigned to the organization of the correct hygienic leaving: to frequent change of diapers and diapers, the child's podmyvaniye after each act of an urination and defecation, to acceptance of air and grass bathtubs. Affected areas of skin of the child have to be dried up, processed carefully by the powders and remedies of hygiene containing , , a pirokton , etc.). It is necessary to avoid purpose of topichesky corticosteroids at treatment of diaper dermatitis at children.
Therapy of contact dermatitis at children assumes an exception of impact on skin of aggressive substances. Pastes on the basis of zinc, ointments on the basis of lanolin, powders, broths of herbs are applied to removal of an inflammation.
Prevention of dermatitis at children
At any forms of dermatitis at children the general actions are important: the tempering procedures, the correct care of children's skin, use of high-quality children's cosmetics and hypoallergenic means of hygiene, wearing clothes from natural materials etc. Change of diapers each 4 hours (or right after defecation), prevention of long contact of skin with allocations is necessary. Correction of a food allowance, normalization of activity of a GIT is important.
At atopic dermatitis at children it is necessary to avoid contact with household and food allergens. Extension of remission is promoted by long courses of a climatotherapy.