Chronic atopic dermatitis — a self-treatment is forbidden
This type of skin disease is otherwise called constitutional or atopic eczema, exudative-catarrhal diathesis, or neurodermatitis. The more recognized name is “Atopic” which greatly denotes the essence of the disease — heredity.
Due to the main features of the disease, as a rule, several family members suffer from it at once, and it is passed on to the next generations. If, for example, one of the parents has a sign of hypersensitivity to all sorts of allergens, then there is a 50% chance that the child will inherit it. In the case when both parents are allergic, this figure increases to 80%. Thus, parents pass on their children allergic rhinitis, asthma, dermatitis.
Atopic dermatitis (AD) makes itself visible in the first 5 years from birth. 90% of patients are children, and 2/3 of them are babies.
The chronic form of the disease is not cured completely and accompanies by exacerbations and remissions through all life. A person experiences additional torment if the skin disease is supplemented with allergies or bronchial asthma.
Causes are divided into external and internal. The first list includes:
- Adverse effects of the environment (ecology, climatic features).
- Irrational nutrition (predominance of carbohydrates, fats, sugars in the menu, lack of vitamins, fiber, trace elements necessary to replenish the body’s protective resources).
- Stress, emotional traumas.
- Job experience, which is connected with danger to health.
- The increase in the number of infectious diseases, the emergence of new pathogens.
When exposed to viruses, bacteria or fungi, atopic dermatitis becomes a provocateur of bronchial asthma, pollinosis, and allergies.
The risk group includes people with hereditary traits, employees of enterprises with unhealthy conditions. Army servicemen can also be added to this list. In such case, the provocateurs of the disease are specific living conditions: general washing of clothes and bed linen, aggressive detergents.
Certain types of plants, household dust, pet hair, dry food for aquarium fish, mold contribute to the exacerbation of the disease.
The internal reasons are:
- Weak immunity.
- Premature weaning.
- Pregnancy accompanied by strong toxicosis.
The importance of correct diagnosis is huge. It will provide significant assistance for the more accurate and high-quality treatment program.
In infants under six months, the initial symptoms may appear if by this time it was transferred to feeding with infant formula. The illness can disappear independently only by 15-17 years (70% of patients). The rest of them has disease lasts for dozens of years, then escalating during the demi-season, then subsiding in summer and winter.
What are the symptoms of this disease? First of all, it is erythema (reddening spots), papules (nodular eruptions), puffiness, scaly flakings, cracks, erosion, weeping after opening papules. All these manifestations cause itching, the person does not stand it and intensively combs the places of the injury. As a result, it opens the way to a secondary infection, which can be introduced into the formed wounds from under the nails or from contact with objects on the surface of which there can be pathogens.
In the chronic stage of the disease, lichenification is observed (the drowning of individual areas), cracks appear on the feet and palms and excessively pronounced skin patterns on them can be observed. The skin in the area of the eyelids undergoes noticeable pigmentation.
The typical symptoms of chronic AD include:
- Dennie–Morgan fold. A huge number of deep wrinkles appear under the kids’ eyes.
- “Fur cap”. Hair in the back of the head rapidly falls out and becomes weak.
- “Polished nails”. Nails acquire an unnatural shine, due to the constant scratching of the body, they grind off their edges.
- “Winter foot”. The cracks are formed on the feet, the skin flakes, swells, becomes red.
For a more accurate diagnosis, the signs of the disease are considered depending on whether it is in an infant, pediatric or adult phase.
Infant (the first one and a half years) and children (from 1.5 to the onset of puberty) have the following symptoms:
- Erythema is bright pink, spreading on the face, arms, legs, and buttocks.
- Then bubbles appear.
- The vesicle weeping occurs after opening.
- Formation of crusts.
In the adult phase, signs of AD are as follows:
- Erythema is pale pink.
- Blistering rash.
- Pronounced skin pattern.
- It extends to the elbow and knee folds, on the neck and face.
- Increased dryness of the skin surface.
- The epidermis becomes rough, cracked, peeling appears.
The considered type of the disease is characterized by universal, common and focal lesions. The rash is found in the groin, on the buttocks, back, chest, neck, around the mouth, eyes, forehead, limbs.
The patient feels unbearable itching, therefore, constantly combing and injuring the already affected areas. This leads to a loss of protective properties due to the violation of the integrity of the skin. Microbes and fungal infection easily penetrate into the formed wounds, thus the disease is aggravated by secondary infection.
Pyoderma (infection with pathogenic bacteria) is the most common complication. Rashes suppurate, pain is added to the itching. The general condition of the patient is deteriorating, he feels weak and has a high fever.
Somewhat less common is infection with viruses, in particular, herpes. This complication is characterized by the appearance of vesicles with transparent contents. Auricles, cheeks, eyelids, face area around the nose and lips may be affected. A very unpleasant consequence of AD is the lesion of the genitals, throat, mouth, eyes.
Yeast-like fungi can also aggravate the condition of the patient. Seborrheic dermatitis is added to atopic dermatitis and it also takes on a chronic form. Often bacterial and fungal infections occur simultaneously. Skin folds, feet, hands, part of the head, covered with hair, nails can be affected. The mucous membrane of the mouth can be affected in children (the so-called thrush).
When developing a medical course, the doctor necessarily takes into account such nuances: the age phase, external symptoms, the presence of other diseases, laboratory data.
The basis for treatment is the achievement of goals:
- Exclusion of the irritant (allergen).
- Therapy aimed at reducing the reaction to the allergen.
- Elimination of itching.
- Stop the inflammation process.
- Elimination of other pathologies.
- Avoiding exacerbation.
- Prevention of secondary infection.
An integrated approach is applied, the treatment includes:
- Drug therapy.
- Compliance with therapeutic diets.
- PUVA therapy.
- Laser beam treatment.
The purpose of pharmacological drugs is aimed at eliminating itching, inflammation, stabilizing the level of sensitivity. For this, the doctor prescribes the following groups of agents: tranquilizers, anti-inflammatory, detox, anti-allergic drugs.
The specialist approaches the prescription of antihistamines and tranquilizers especially carefully, taking into account the specifics of the patient’s body. For example, taking histamines such as Clemastine, Mebhydrolin, Chloropyramine, Quifenadine (first generation) is very addictive. In this regard, the doctor changes them every week. In addition, we should not forget about the side effects of these drugs: a decrease in concentration. Therefore, it is not always advisable for drivers, pupils, students and other categories of people to take them.
Preparations of the second generation: Cetirizine, Astemizole, Fexofenadine, Ebastine. They have no side effects and the body does not get used to them. It is necessary to single out the most effective of this range — Loratadine. This universal drug has practically no contraindications and is well accepted by even the most hypersensitive patients.
In a situation when all the medicines prescribed by the doctor did not have the desired effect, he has to switch to corticosteroids: Triamcinolone or Methylprednisolone. These potent agents are prescribed in cases of unbearable itching and maximum exacerbation of the disease. Reception is limited to several days and then the dose gradually decreases, and drugs are canceled.
Severe stage of atopic dermatitis causes the physician to resort to more radical treatment: intravenous injections of infusion liquid. Extracorporeal method of blood purification such as plasmapheresis or chemisorption can be used too. During the week, the next antibiotics are prescribed: Metacycline, Erythromycin. In case of secondary infection with the herpes virus, the use of antiviral drugs is indicated: Famciclovir or Aciclovir.
In case of serious relapses, it is necessary to take immunomodulators, for example, Levamisole, Solasulfonum, Sodium nucleate, Inosine pranobex.
Lotions with a decoction of pharmaceutical chamomile, tea leaves, Burow’s solution are recommended for outdoor use. Antipruritic creams (Naftalan oil, sulfuric and ichthammol ointments) are capable of stopping inflammation. For more complex forms, corticosteroids creams can be applied, which act in combination: relieve swelling, itching, pain, reduce the allergic reaction. These include mometasone furoate, fluticasone creams. For children, it is especially recommended to use Pimafucort cream.
An important component of the treatment program for a patient suffering from atopic eczema are diets:
Elimination diet provides for the complete exclusion of products containing food allergens. Milk and eggs are also derived from the diet.
The hypoallergenic diet excludes such food as rich broth, cocoa, citrus, strawberries, melons, honey, caviar, mushrooms, nuts, black currants. In addition, fried foods, spicy seasonings, smoked meats, canned goods are also prohibited.
Hypochlorite is characterized by a salt limit up to 3 grams per day.
The destabilization of the fatty acids’ synthesis that occurs with AD is compensated by specially selected food additives.
In the case of atopic dermatitis, it is advisable to carry out prevention in two ways: the prevention of primary disease and the prevention of secondary infection.
The first type of preventive measures begins with the intrauterine stage. A pregnant woman should be under the supervision of a specialist, to comply with his recommendations, which can prevent the toxicosis. Her diet is also coordinated with the doctor.
The next stage of preventive measures falls on the first year of a baby’s life. It is advisable not to transfer the infant to artificial feeding prematurely because this fact provokes the development of hypersensitivity to allergens in the inferior body of a child. Breastfeeding mom should follow a strict diet.
Preventive actions aimed at secondary infection can exclude provoking causes of a biological, chemical, mental and physical nature. In order to reduce the frequency and degree of relapse desensitizing agents can be taken.
The use of bed linen, the wearing of natural fibers without chemical dyes are important elements of prevention. It should be remembered that hot water with hard washcloths is not recommended. Warm shower and hypoallergenic soap should be enough. Protecting the skin with the help of special creams from external weather irritants (strong wind, sunlight, frost) will also help to maintain a stable moisture level of the epidermis.
Perhaps the most effective preventive measure is a resort treatment on the shores of the Black and Mediterranean Seas.
What awaits patients with AD in the future? The result depends on the phase, severity, duration of the disease. According to statistics, half of the patients recover before the age 14.
However, when we are talking about full recovery it is only conditionally. After all, remission can last from a week to several years.
The progressive form of the disease can lead to bronchial asthma, respiratory allergies. Those who suffer from severe forms of atopic dermatitis, and are engaged in hazardous work, must make a conclusion, up to a change of professional activity.
The most important warning of possible complications is the prohibition of self-treatment. Atopic dermatitis is a serious disease that only specialists should deal with.