Treatment of atopic dermatitis in children

The occurrence of atopic dermatitis in children is due to the complex interaction of various environmental factors and a genetic predisposition to allergic reactions. Atopic skin lesions usually occur in children with a hereditary tendency to develop allergic reactions. It is proved that the risk of developing atopic dermatitis in children is 75-80% in the presence of hypersensitivity in both parents and 40-50% in atopy in one of the parents.

To more frequent development of atopic dermatitis in children leads to fetal hypoxia, transferred in the prenatal period or during childbirth. In the first months of a child’s life, symptoms of atopic dermatitis may be caused by food allergies due to early conversion to artificial compounds, improper feeding, feeding, overdosing of digestive problems and frequent infectious viral diseases.

Atopic dermatitis often occurs in children with gastritis, enterocolitis, dysbacteriosis, helminthiasis.

Often, the development of atopic dermatitis in children leads to excessive consumption of highly allergenic products by the mother during pregnancy and lactation. Food sensitization associated with the physiological immaturity of the digestive system and the characteristics of the immune response of the newborn, has a significant impact on the formation and subsequent development of all allergic diseases in a child.

Causative allergens can be pollen, waste products of domestic ticks, dust factor, household chemicals, medicines, etc. Psycho-emotional overstrain, overexcitation, environmental deterioration, passive smoking, seasonal changes in weather, reduced immune protection can provoke an exacerbation of atopic dermatitis.

Classification of atopic dermatitis in children

There are several stages in the development of atopic dermatitis in children: the initial stage, the stage of pronounced changes, the stage of remission and the stage of clinical recovery.

Depending on the age of manifestation and the clinical and morphological features of the skin manifestations, there are three forms of atopic dermatitis in children:

  • infant  (from the neonatal period to 3 years)
  • nursery  – (from 3 to 12 years)
  • teenage  (from 12 to 18 years)

These forms can turn into one another or end in remission with a reduction in symptoms. There are mild, moderate and severe course of atopic dermatitis in children. Clinical and etiological variants of atopic dermatitis for a cause-significant allergen include skin sensitization with a predominance of food, tick, fungal, pollen and other allergies.

According to the degree of prevalence of the process, atopic dermatitis in children can be:

  • limited  (foci are localized in one of the areas of the body, the area of ​​the lesion is not> 5% of the body surface)
  • common / disseminated  (lesion – from 5 to 15% of the body surface in two or more areas)
  • diffuse  (with the defeat of almost the entire skin surface).
Symptoms of atopic dermatitis in children

The clinical picture of atopic dermatitis in children is quite diverse, depending on the age of the child, the severity and extent of the process, the severity of the pathology.

The infant form of atopic dermatitis is characterized by an acute inflammatory process – edema, skin flushing, the appearance of erythematous spots and nodular eruptions (serous papules and microvesicles), accompanied by pronounced exudation, at the opening – weeping, the formation of erosions (“serous wells”), crusts, peeling.

Typical localization of lesions – symmetrically in the face (on the surface of the cheeks, forehead, chin); scalp; on the extensor surfaces of the limbs; less often in the elbow folds, popliteal spaces and in the area of ​​the buttocks. For the initial manifestations of atopic dermatitis in children, the following are characteristic: gneiss – seborrheic scales with increased sebaceous excretions in the area of ​​the spring, at the eyebrows and behind the ears; milk scab – erythema of cheeks with yellowish-brown crusts. Skin changes are accompanied by intense itching and burning, scratching (excoriation), possibly pustular skin lesions (pyoderma).

Erythematous squamous and lichenoid skin lesions are characteristic of the pediatric form of atopic dermatitis. In children, there is hyperemia and severe dryness of the skin with a large number of scaly flakes; increased skin pattern, hyperkeratosis, abundant peeling, painful cracks, persistent itching with increased at night. Skin changes are located mainly on the flexion surfaces of the extremities (elbows, popliteal fossae), palmar-plantar surface, inguinal and gluteal folds, the dorsum of the neck. The “atopic face” with hyperpigmentation and desquamation of the eyelids, the Denier-Morgan line (skin fold under the lower eyelid) is characteristic, combing the eyebrows.

Manifestations of atopic dermatitis in adolescent children are characterized by pronounced lichenisation, the presence of dry scaly papules and plaques localized mainly on the skin of the face (around the eyes and mouth), neck, upper body, elbows, around the wrists, on the back of the hands and feet, fingers and toes. This form of atopic dermatitis in children is characterized by exacerbation of symptoms during the cold season.

Diagnosis of atopic dermatitis in children

Diagnosis of atopic dermatitis in a child is carried out by a pediatric dermatologist and a pediatric allergist-immunologist. During the examination, specialists evaluate the general condition of the child; skin condition (degree of moisture, dryness, turgor, dermographism); morphology, character and location of rashes; skin lesion area, severity of manifestations. The diagnosis of atopic dermatitis is confirmed when children have 3 or more mandatory and additional diagnostic criteria.

Outside the exacerbation of atopic dermatitis in children, the application of skin tests with allergens by the method of scarification or prick-test is used to detect IgE-mediated allergic reactions. Determination of total and specific IgE in serum by ELISA, RIST, RAST methods is preferable in case of exacerbation, severe course and persistent relapses of atopic dermatitis in children.

Atopic dermatitis in children must be differentiated from seborrheic dermatitis, scabies, microbial eczema, ichthyosis, psoriasis, rosy lichen, and immunodeficiency diseases.

Treatment of atopic dermatitis in children

The treatment is aimed at reducing the severity of allergic inflammation of the skin, eliminating provoking factors, desensitizing the body, preventing and reducing the frequency of exacerbations and infectious complications.

Comprehensive treatment includes diet, hypoallergenic regimen, systemic and local pharmacotherapy, physiotherapy, rehabilitation and psychological assistance.

  • Diet. Helps relieve atopic dermatitis and improve the general condition, especially in infants and young children. The diet is chosen individually, based on the history and allergic status of the child, each new product is introduced under the strict supervision of a pediatrician. With an elimination diet, all possible food allergens are removed from the diet; when hypoallergenic diet exclude strong broths, fried, spicy, smoked dishes, chocolate, honey, citrus, canned food, etc.
  • Drug treatment. It includes taking antihistamines, anti-inflammatory, membrane stabilizing, immunotropic, sedatives, vitamins and the use of local external agents. 1st generation antihistamines (clemensin, chloropyramine, hifenadine, dimetinden) are used only in short courses for exacerbation of atopic dermatitis in children, not burdened with asthma or allergic rhinitis. 2nd generation antihistamines (loratadine, desloratadine, ebastine, cetirizine) are indicated in the treatment of atopic dermatitis in children in combination with respiratory allergies. For the relief of severe exacerbations of atopic dermatitis in children, short courses of systemic glucocorticoids and immunosuppressive therapy are used.
  • Local treatment. Helps to eliminate itching and inflammation of the skin, restore its water-lipid layer and barrier function. With acute atopic dermatitis in children of moderate and severe degree, applications of local glucocorticoids are used, in case of an infectious complication, in combination with antibiotics and antifungal agents.

In the treatment of atopic dermatitis in children, phototherapy (UVA and UVB irradiation, PUVA therapy), reflex therapy, hyperbaric oxygenation, spa and climatotherapy are used. Children with atopic dermatitis often require the help of a child psychologist.

Prevention of atopic dermatitis in children

The manifestations of atopic dermatitis that are most pronounced at an early age may diminish or disappear completely as children grow and develop. In most patients, the symptoms of atopic dermatitis persist and recur throughout life.

Unfavorable prognostic factors are: early debut of the disease before the age of 2-3 months, aggravated heredity, severe course, a combination of atopic dermatitis in children with other allergic diseases and persistent infection.

The purpose of primary prevention of atopic dermatitis is to prevent sensitization of children from risk groups by maximizing the high antigenic loads on the body of a pregnant and lactating mother and her child. Exclusively breastfeeding in the first 3 months of a child’s life, enriching the diet of the mother and child with lactic acid bacteria reduces the risk of early development of atopic dermatitis in children who are predisposed to it.

Secondary prevention is the prevention of exacerbations of atopic dermatitis in children due to dieting, avoiding contact with provoking factors, correction of chronic pathology, desensitizing therapy, and sanatorium-resort treatment.

With atopic dermatitis, proper daily care of children’s skin is important, including cleansing (short cool baths, warm showers), softening and moisturizing with special means of therapeutic dermatological cosmetics; selection of clothes and linen from natural materials.

Atopic dermatitis in children is an inflammatory disease of the skin of a chronic relapsing course that occurs in early childhood due to hypersensitivity to food and contact allergens. Atopic dermatitis in children is manifested by rashes on the skin, accompanied by itching, weeping, the formation of erosions, crusts, scaling and lichening sites. The diagnosis of atopic dermatitis in children is based on anamnesis, skin tests, studies of the level of general and specific IgE. In children with atopic dermatitis, diet, local and systemic drug therapy, physiotherapy, psychological aid, and spa treatment are shown.

Atopic dermatitis is the earliest and most frequent manifestation of the body’s hypersensitivity reaction to the action of environmental allergens: it accounts for 80-85% of cases of allergy in young children. As a rule, atopic dermatitis in a child appears already during the first year of life; may occur with periodic exacerbations and temporary subsiding of skin manifestations until puberty, and even persist in adulthood.

The prevalence of atopic dermatitis in the pediatric population is growing steadily and is 10-15% in the age group up to 5 years; 15-20% – among children of school age. Atopic dermatitis significantly reduces the quality of life of children, causing psychological discomfort and disrupting their social adaptation.

Atopic dermatitis in children is a risk factor for the “atopic march” – the further sequential development of other allergic diseases: allergic rhinitis, pollinosis, allergic conjunctivitis, and bronchial asthma. With the weakening of the body atopic dermatitis in children may be complicated by the addition of secondary bacterial and fungal infections.

The problem of atopic dermatitis in children, in view of its relevance, needs close attention from pediatrics, pediatric dermatology, allergology-immunology, pediatric gastroenterology, and dietology.

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