Atopic dermatitis — an inherited skin disorder
The influence of the external environment on the human body, which has inherited sensitive properties, can become a provocateur of this type of pathology. The blame for this is the production of IgE antibodies, which cause allergies in form of a skin rash. Other names for the disease are Besnier’s prurigo, constitutional eczema.
A child, one of whose parents suffer from the disease, may inherit it with a probability of 50%. If both father and mother are sick, then the probability increases to 75%. Hereditary symptoms are more actively occur up to 5 years (90% of cases). Much less often, AD has an effect in adulthood.
According to statistics, in the United States only in the last 20 years, twice more got sick with dermatitis.
Causes of skin disease
The causes of the immune disease are not fully determined until now. Medical researchers have developed several theories about the destructive processes occurring at the cellular level of the body. The most compelling reasons are:
- Reduction of humoral immunity, an excess of Immunoglobulin E.
- Dysfunction of cellular immunity contributes to the occurrence of skin pathologies associated with autoimmune aggression.
- Sensitization (hypersensitivity). IgE antibodies are concentrated in serum, which gives rise to autoimmune phenomena.
- Heredity is a presumptive factor because there is not yet a clear statement regarding the type of inheritance and the degree of susceptibility at the gene level.
The presence of a genetic factor in the development of atopic dermatitis has been proven by science; this disease is associated with the HLA genes B-12 and DR-4. Violations of the body’s genetics become provocateurs of atopic dermatitis for the following reasons:
– Excessive dryness of the epidermis due to insufficient production of sebum.
– Filaggrin protein that controls the process of keratinization of the skin and water retention in the upper layer of the epidermis is not synthesized.
– the composition of the fatty waterproof layer is broken due to the ingress of harmful elements from the external environment.
The disease is dangerous by the presence of factors that reflect on the course of the disease and the results of treatment. The main risk factors include:
- Dysfunction of the digestive system (dysbacteriosis, pancreatitis, gastroduodenitis, biliary dyskinesia). In this regard, the body’s defense weakens, the process of neutralizing harmful bacteria is slowed down, their excretion is inhibited.
- Fermentopathies, including phenylketonuria, cystic fibrosis.
- The presence of worms.
- Diseases of the liver, gallbladder.
- Disruption of the thyroid gland leads to low levels of cortisol and adrenocorticotropic hormone. An insufficient concentration of androgens and estrogens is also observed.
- Early stoppage of child’s breastfeeding. With artificial feeding, the process of formation of the baby’s immunity slows down. It does not receive immunoglobulins contained in breast milk.
- Stressful situations lead to a violation of the autonomic nervous system. Atopic dermatitis has a psychosomatic basis, so the psycho-emotional state plays a huge role. Against the background of an increased surge of negative emotions, the nervous system experiences an additional load, and the skin reacts first.
- Exposure to cold.
- Ecology. Polluted environment adversely affects the human body. Air, water, soil are saturated with harmful emissions from industrial facilities, which contribute to the exacerbation of the disease and create conditions for its rapid development.
Other factors of disease occurrence include living conditions, such as the level of humidity and temperature indicators of the air atmosphere; the use of chemical detergents and cleaners; low-quality food products, the use of gene modifications.
Phases of disease progression
Atopic dermatitis develops in stages. In accordance with the age factor of the patient, it can be divided into the following phases:
- The period of infancy covers an age of 3-5 months, as soon as lymphoid tissue is formed. Dermatitis in newborns is manifested in the form of plaques, crusts, papules on the cheeks, forehead, and nasolabial triangle. At this stage, the disease can worsen and weaken. Most often, it manifests itself at the time of gastrointestinal upset; when teeth are cut; in parallel with cold-related diseases. The treatment is difficult, in most cases it moves to the next age stage.
- During childhood years symptoms of AD are manifested on the elbows and knees, wrists. Follicular papules, lichenoid inflammations and dyschromia (brown foci) are observed on the skin. There is a hypersensitivity to plant pollen.
- The adult period is associated with sexual development. Eczematous elements infiltrate appear in the foci of rash and desquamation. Dermatitis distributes on the upper body, captures the hands. It reacts sharply to stimuli.
Symptoms of atopic dermatitis
The clinic of the disease is ambiguous and may vary depending on age qualifications and other provocateurs.
The main symptoms include:
- The rash, as a result of scratching, takes on other forms — papules, abrasions, erosion.
- Itching appears due to excessive dryness of the skin. Atopic dermatitis pruritus has specific features, like incessant intense character. It does not pass after taking medications, worsening in the evening and at night.
- In the case of peeling the dermis is dehydrated, which contributes to the disruption of the lipid membrane structure. Loss of elasticity leads to the fact that in places of strong peeling the skin becomes keratinized (hyperkeratosis).
The main symptom of atopic dermatitis is severe itching.
Diagnosis of the disease
Medical examination of the patient’s skin condition is the first step of the correct diagnosis. It is important not to miss the places that may be hidden at first glance when the affected areas are inside the folds at the knees and elbows. Next, a dermatologist pays attention to areas where the rash is located, determines the extent of the pathology’ spread.
There are the main criteria for the correct diagnosis:
- Severe itching.
- In children, the cheeks, shoulders, and other parts of the body above the waist are affected. In adult patients a thickening of the skin can be seen, pigmentation changes. In adolescence, while the process of puberty compacted papules is formed.
- The disease is unstable, periodically exacerbated, the peak of relapse falls on the demi-season period. In summer, remission occurs.
- If the patient, in addition to the appearance of a rash, has a diagnosis of atopic rhinitis or asthma, this fact is in favor of the diagnosis of atopic dermatitis.
- A survey on the health of family members is made, the fact of whether they have AD has been clarified.
- Xeroderma is accompanied by excessive dryness of the epidermis.
- Drawing on the palms becomes more pronounced.
Лечение атопического дерматита (на фото) у взрослых назначает врач:
When making a diagnosis, in addition to the main ones, doctors also take into account a number of additional factors indicating the desired disease:
- Excessive pallor or redness of the epidermis of the face.
- Inflammation of the mucous lips (cheilitis).
- The appearance of extra folds on the neck.
- Dark circles around the eyes.
- Geographic tongue.
- Allergy to pharmacological agents.
- Angular cheilitis.
In order to obtain maximum information about the signs of the patient’s illness, laboratory blood tests are added to the visual examination. AD can be signalized by the following test results:
- Excessive concentration of eosinophils.
- The presence of antibodies in the serum, which reacts negatively to pollen or some types of food.
- CD3 lymphocytes are low.
- CD3/CD8 index is reduced.
- Phagocytes are extremely inactive.
To make a final decision, the diagnostician conducts tests for allergies.
Stages of atopic dermatitis
A special SCORAD scale can be applied to determine the severity of atopic dermatitis. It was created by a group of European researchers. It systematizes the objective and subjective signs of illness, allows you to accurately determine the extent of the lesion and prescribe a more effective treatment.
On a scale, it is possible to estimate the intensity of the identified signs from 0 to 3. For example, the degree of swelling or redness; the extent of the affected skin area; the presence of erosion, scratching, their condition:
0 – no symptoms;
1 – mild;
2 – in moderate condition;
3 – strongly pronounced.
The result of simple calculations will be to establish the appropriate degree of the disease.
The activity of the lesion is differentiated by degrees:
- Maximum — atopic erythroderma, particularly pronounced in the first period on the basis of age.
- High — depends on the extent of distribution throughout the body.
- Moderate — lesion is local, has a chronic form.
- Minimum — in children expressed as erythematous-squamous; local lesions on the face, mainly cheeks. In adult patients, perioral lichenification manifests about the disease (around the mouth, on the popliteal and ulnar folds).
Principles of treatment
To achieve the goal in the treatment of atopic dermatitis, the doctor takes into account the presence of all the factors that caused the disease, such as age, clinical picture, the presence of other diseases at the time of diagnosis.
Treatment of the disease is carried out in the following ways:
- Disposal of allergic manifestations.
- Desensitization (reduction of hypersensitivity).
- Elimination of itching.
- Relief of inflammatory processes.
- Preventive measures that eliminate relapses.
- Correction of associated diseases, the appointment of a therapeutic course for their cure.
- Complications avoidance.
The principle of the AD treatment is based on various methods using pharmacological agents:
- The appointment of a special diet.
- PUVA therapy.
- Laser treatment.
- Acceptance of corticosteroids, cytostatics, allergoglobulin, cromolyn sodium, other drugs.
If the development of the disease occurs on the background of a violation of the digestive organs, the doctor includes probiotics in the treatment program (Bifidobacterium remedies, Acipol).
In case of malfunction of the pancreas, the following medications are recommended: Pancrex, Creon etc.
Protopic, Eplan, Elidel, Fenistil and other ointments that contain no hormones could be used in cases of atopic dermatitis.
During exacerbation of the disease, therapy is directed to the suppression of inflammatory foci. It includes taking antihistamine dosage forms of the 2nd generation for 1-1.5 months. Sometimes these drugs can cause the opposite effect. Therefore, their reception is carried out under the supervision of a physician.
1st generation antihistamine medicines belong to the group of sedatives, they are prescribed for the same period, and also under medical supervision.
To achieve the best effect, along with medical treatment, lotions can be applied for external use. For these purposes, tincture of oak bark with the addition of a 1% solution of tannin and rivanol (solution in a ratio of 1:1000) is used. For exudative dermatitis, dyes are used (Castellani’s paint, carbol-fuchsin, methylene blue solution).
Treatment of AD in children
The main principle of curing a child of the disease is getting rid of the provoking factor. Sometimes it is enough to exclude natural, chemical and food allergens, and the disease recedes.
Атопический дерматит у ребенка можно рассмотреть на представленном фото:
Do not rely on your own knowledge, feedback or advice from the Internet. At the first symptoms, you should definitely see a doctor. After all, even harmless but unauthorized actions can lead to an aggravation of the disease, and then even a doctor will be much more difficult to cope with it.
In cases of treatment of atopic dermatitis, the doctor prescribes tablets or injections. Antihistamine medication should be accompanied by medical supervision to avoid unwanted adverse reactions to drugs.
Physical procedures are prescribed for children, in particular, ultraviolet radiation. This decision has the right to take only the attending physician.
In addition to the main methods of treatment, it is very important how a nursing mother eats when it comes to infants. In this regard, the doctor recommends mom to adhere to a special diet.
Nutrition of patients with AD
Sufferers of skin disease are forced to comply with a special diet, the menu of which should not include allergen-containing products. If the disease is at the peak of its development and has reached the maximum stage, a strict diet will be needed. The doctor determines a list of useful and harmful products for each patient. The latter should be completely excluded from use. It is recommended to perform this kind of medical recommendations for a long period (from 1-2 months to 2-2.5 years).
The list of products that are tabooed includes:
- Coffee, cocoa, chocolate.
- Seafood, including fish.
- Oranges, tangerines, and fruits with bright colors.
- Hot spices, mayonnaise.
- Vegetables are red, orange, and eggplants.
- Strawberries, strawberries, pineapples, watermelons.
- Carbonated and alcoholic beverages.
It is possible to allow delicious food, but unfortunately, many dishes have to be abandoned. In addition, when following a diet it is necessary to take into account that the preparation method is equally important. You will have to forget for a long time about fried foods with a golden crust. More neutral to the taste of products in a boiled, steamed or baked state is recommended. Fruits, vegetables that are not on the forbidden list, as well as low-fat sour-milk drinks, cottage cheese are very useful. Food can be refilled only with vegetable oils (sunflower, linseed, olive).
Nutrition of a patient with atopic dermatitis should be aimed at maintaining the natural microflora of the intestine, saturating the body with useful vitamins and microelements.
It is the regime and diet that can be used as effective preventive tools for atopic dermatitis. Given the fact that such a disease overcomes a person from the first months of his life, it is worth starting to take care of the health of the unborn child during the pregnancy. Proper nutrition of the future and nursing mother gives the child a guarantee to avoid atopic dermatitis.
An important point, which also plays a significant role in the prevention of AD is to minimize contact with harmful chemicals, inhalation of hazardous fumes.
Significant preventive measures include the prevention of infectious diseases, including colds. After all, they will have to be treated with antibiotics, which have a strong effect on the body.
For patients with atopic dermatitis who is prone to this disease resort treatment is very useful. The most beneficial climate is observed in the Mediterranean and the Black Sea.
Little known facts about atopic dermatitis
Even ancient people knew about AD, then it was called idiosyncrasy, which meant the body’s hypersensitivity to various stimuli, without determining the etiology of the disease.
Translated from the Greek, atopic dermatitis (the term began to be used since 1922) means unusual or strange inflammation of the skin.
There are unusual causes of the disease. For example, water allergy. This ailment is more often exposed to residents of geographical areas, where there is a shortage of water resources. The skin of some people in India and Africa weaning off moisture, so at the slightest contact with water, an allergic reaction occurs, manifested in the form of atopic dermatitis.
Red wine can cause allergies as well. In fact, people have a negative reaction not to wine, but to the polyphenolic compounds contained in it.
One of the most unusual types of allergies is people one. The results of medical research conducted in the middle of the last century showed that the essence of such a reaction lies in the specific composition of the sweat, by the way, only for men.
Not less unusual factor provoking an allergy is technical progress. This refers to the emergence of modern electronic equipment, like computers, mobile phones etc. All these devices create signals that affect the emission of electromagnetic waves, in addition, they create new magnetic fields, which can become an allergen and cause skin disease