Atopic dermatitis - chronic inflammatory disease skin, accompanied by itching and eczematization, often associated with a hereditary predisposition to atopy and having typical localization sites, often combined with respiratory manifestations of atopy - allergic rhinitis, conjunctivitis, bronchial asthma.
Code by international classification diseases ICD-10:
Incidence: 102.7 per 100,000 population in 2001.
Causes
Etiology. Allergens - the leading role belongs to food, household, epidermal, pollen.
Genetic aspects. Atopic dermatitis in combination with deafness (221700, r).
Risk factors Pathology of pregnancy (risk factor for the child) Viral diseases during pregnancy (a risk factor for the child) Preeclampsia, especially in women with a history of allergies (a risk factor for the child) Artificial feeding Wrong diet Functional disorders Gastrointestinal tract: biliary dyskinesia, dysbacteriosis, helminthiasis Violation of the integrative function of the central and autonomic nervous system Antibacterial therapy during pregnancy and lactation (risk factor for the child) Various lesions chronic infection Frequent and uncontrolled use of drugs Skin infections often lead to exacerbations and worsening of atopic dermatitis.
Pathogenesis Increased IgE levels, often positive skin tests and specific antibodies (IgE) to some inhaled and food allergens.
Eosinophilia is characteristic peripheral blood Decrease in indicators cellular immunity: reduction in the severity of delayed-type hypersensitivity reactions (incl.
h. in skin tests for tuberculin), a decrease in the number of T lymphocytes (primarily CD8+ cells) and their functions, which leads to an increased susceptibility to the development of viral and fungal infections. Disturbances of autonomic regulation and intracellular regulatory systems.
Symptoms (signs)
Clinical manifestations General signs Severe itching Dry skin Facial erythema (mild to moderate) Pityriasis alba (lichen) - areas of hypopigmentation on the face and shoulders Characteristic fold along the edge of the lower eyelid (Denny's sign/Morgan's line) Increased pattern of palm lines (atopic palms) By clinical course three periods are distinguished: infant (up to 2 years), children (from 2 to 10 years) and adolescent-adult (over 10 years) Infant period Hyperemia, swelling, weeping Later, areas of infiltration and peeling, papular elements and areas of lichenification appear Localization mainly in areas of the forehead, cheeks Childhood The process is localized mainly in the area of skin folds Characterized by infiltrated dry skin, pityriasis-like peeling, multiple excoriations An “atopic face” is formed (the face is wrinkled, with folds, areas of peeling, pasty, somewhat reminiscent of senile skin) Adolescence - adult period Infiltration predominates skin, lichenoid papules, lichenization, excoriation Localized mainly in the skin of the face and neck; the flexor surfaces of the limbs, wrists, upper sections chest In patients over 40 years of age, the typical location is the neck and dorsum of the hands.
Diagnostics
Research methods Blood test: eosinophilia Increased serum IgE If the allergic nature of the disease is suspected, skin tests with allergens Dermographic test: white dermographism Test with intradermal injection of acetylcholine.
Apply diagnostic criteria- a set of mandatory symptoms Typical location skin process - popliteal fossa, elbow bends, back of the neck, face atopic diseases Tendency to ichthyosis Disease onset in early age(up to 2 years).
Differential diagnosis Contact dermatitis Scabies Seborrheic dermatitis Psoriasis Chronic lichen simplex Ichthyosis.
Treatment
General recommendations Diet Elimination of causally significant allergens (elimination diet), limiting the consumption of potentially allergenic and histamine-liberating foods and additives. In newborns and children, obligate allergens are isolated that contribute to the development of dermatitis: eggs, milk, wheat, nuts.
In case of exacerbation, it is recommended to restrict the diet for 3–4 weeks. If there is a hereditary predisposition to atopic diseases, the introduction of solid complementary foods is not recommended until 6 - one month old, and obligate allergens - up to a year. Protective regime, it is recommended to wear cotton clothes.
Heat worsens the course of atopic dermatitis, so the temperature in the room should not exceed +25 ° C. If allergies to mites or house dust are detected, adherence to an elimination dust-free regime. Treatment of concomitant pathologies and sanitation of chronic foci of infection. specific immunotherapy(cm.
Local therapy: baths are useful, but it is necessary to use emollients. In case of acute weeping inflammatory process, lotions, aerosols, water mash, powders, pastes, creams are used. Local GCs (for example, methylprednisolone aceponate in the form of an emulsion or cream) are the drugs of choice for the treatment of atopic dermatitis in acute period In case of infection, it is necessary to treat the skin with rami antiseptics and use local antibacterial agents, as well as drugs that combine local GCs with antibacterial drugs (for example, betamethasone + salicylic acid with gentamicin) For subacute inflammatory process- creams, pastes, powders For a chronic inflammatory process, ointments are prescribed (for example, methylprednisolone aceponate in the form of an ointment or a fatty ointment), warming compresses For severe infiltration in the lesions - ointments and creams with keratolytic properties Physiotherapy - UV irradiation in suberythemal doses helps to reduce the duration of exacerbation and has a preventive effect.
Systemic therapy Antihistamines I generation, for example chloropyramine, clemastine, hifenadine II generation - acrivastine, ebastine, loratadine III generation - fexofenadine Membrane stabilizers are used mast cells- ketotifen GC in a short course until the effect is achieved (usually 1–2 weeks) with gradual withdrawal - only in case of severe exacerbation and in case of ineffectiveness of other treatment methods For secondary infection Antibiotics (usually erythromycin or semisynthetic penicillins) For herpetic infection- acyclovir 200 mg every 4 hours for 5–10 days If the treatment is ineffective, possible concomitant contact dermatitis should be excluded. Often necessary sedative therapy Currently, plasmapheresis is widely used to remove toxins.
Description
Eosinophilia of peripheral blood is characteristic. Decreased levels of cellular immunity: decreased severity of delayed-type hypersensitivity reaction (including
A chronic skin disease of neurogenic-allergic origin, manifested in the form of papular rashes, prone to fusion, characterized by itching.
Contact dermatitis is an acute or chronic inflammatory skin disease caused by the irritating or sensitizing effect of exogenous factors. Incidence: 669.2 per 100,000 population in 2001.
Classification Primary irritation dermatitis (simple contact dermatitis) Allergic contact dermatitis (ACD) Phototoxic dermatitis (see Photodermatitis).
Atopic dermatitis is a chronic inflammatory skin disease, accompanied by itching and eczematization, often associated with a hereditary predisposition to atopy and having typical localization sites, often combined with respiratory manifestations of atopy - allergic rhinitis, conjunctivitis, bronchial asthma.
Incidence: 102.7 per 100,000 population in 2001.
Causes
Infancy is characterized by thin and susceptible to irritation skin, so atopic dermatitis (ICD code 10: L20) often makes itself felt from the cradle.
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The main cause of the disease is a hereditary factor. If parents suffer from any types of allergies, then there is a high probability that atopic dermatitis will appear in the baby in the first months of his life.
Sometimes this occurs at 2-3 months of a baby’s life, but there are cases of the disease manifesting itself at about 6 months of age. It is then that the first complementary foods in the form of vegetables and cereals begin to be introduced.
The disease is caused by skin contact with an allergen. Such irritants may include:
- chemical substances;
- coloring matter;
- household chemicals;
- some food products;
- medications;
- perfumery;
- cosmetical tools;
- some materials, including construction materials.
In this disease, the skin reacts sharply to contact with an irritant, resulting in a characteristic rash. All people are equally susceptible to the disease, regardless of age and gender.
The list of irritants that cause dermatitis is very long. Each patient can detect an individual skin reaction to seemingly safe substances and materials.
Etiology. Allergens - the leading role belongs to food, household, epidermal, pollen.
Genetic aspects. Atopic dermatitis in combination with deafness (221700, r).
Pathogenesis Increased IgE content, often revealed by positive skin tests and specific antibodies (IgE) to some inhalation and food allergens.
Eosinophilia of peripheral blood is characteristic. Decreased levels of cellular immunity: decreased severity of delayed-type hypersensitivity reaction (including
including in skin tests for tuberculin), a decrease in the number of T lymphocytes (primarily CD8 cells) and their functions, which leads to an increased susceptibility to the development of viral and fungal infections. Disorders of autonomic regulation and intracellular regulatory systems.
Etiology unknown.
Pathogenesis: polyvalent (less often monovalent) sensitization of the skin, as a result of which it reacts inadequately to various exogenous and endogenous influences.
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Sensitization is promoted by stressful experiences, endocrinopathies, gastrointestinal diseases intestinal tract, liver, as well as mycoses of the feet, chronic pyococcal processes and allergic diseases.
IN childhood eczema is pathogenetically related to exudative diathesis.
ICD disease codes
The acronym ICD stands for International Catalog of Diseases and Health Problems. Disease codes are a kind of medical language that unites and organizes all medical diagnoses.
Any problem of the patient indicated in the documentation through the appropriate code becomes clear and accurately identified by any doctor in any country. There is only one condition - the country must be a member of the World Health Organization (WHO).
The purpose of creating an international classification of diseases:
- Statistical accounting of health problems, their identical designation, in which words are excluded. Complete replacement of the diagnosis with the corresponding disease codes (letters and Roman Arabic numerals) allows you to avoid confusion when translating from one language to another.
- Diagnosis of diseases and routing of treatment based on accumulated world experience.
The need to create a global catalog of diseases, injuries, pathological conditions(ICD 10 code) explained general work over the protection of public health.
From time to time (about once every 10 years) this normative document revised, supplemented and clarified. This occurs under the control and direct guidance of WHO.
After revision it comes into force the new kind ICD. Currently, the classification of the tenth revision is in force - ICD 10.
Note! ICD 10 codes contain not only a description of diseases, but also detailed description necessary treatment indicating medications.
Correct diagnosis of a disease determines the success of its treatment and the further prognosis for the patient’s life. In the case of allergic dermatitis, the doctor must diagnose the type of disease with similar external manifestations.
The official diagnosis for allergic dermatitis may be one of those listed in the table below.
Codes of allergic dermatitis according to ICD 10
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ICD 10 (International Classification of Diseases) is designed to systematize and simplify the registration, analysis, decoding, transmission and comparison of data on diseases or deaths received in various countries and in different time. Each disease is assigned a three-digit code.
According to ICD 10, atopic dermatitis is classified as follows:
- Skin diseases and subcutaneous tissue(L00-L99).
- Dermatitis and eczema (L20-L30).
- Atopic dermatitis (L20).
- Scabies Beignets (L20.0).
- Unspecified atopic dermatitis (L20.9).
- Other atopic dermatitis (L20.8): eczema (flexor, childhood, endogenous), neurodermatitis (atopic, diffuse).
Etiology. Allergens - the leading role belongs to food, household, epidermal, pollen.
Incidence: 102.7 per 100,000 population in 2001.
Contact dermatitis is an acute or chronic inflammatory skin disease caused by the irritating or sensitizing effect of exogenous factors. Incidence: 669.2 per 100,000 population in 2001.
Classification Primary irritation dermatitis (simple contact dermatitis) Allergic contact dermatitis (ACD) Phototoxic dermatitis (see Photodermatitis).
Atopic dermatitis: etiology, pathogenesis, classification, therapy
One of the most difficult and widespread allergic diseases, which occur in 12% of the population, is atopic dermatitis. Despite the fact that medicine and pharmacology have made huge strides forward over the past decades, the treatment of this disease in children still has many difficulties, which can be overcome by the joint work of all family members with a doctor.
Etiology of atopic dermatitis
Factors that cause atopic dermatitis can be various substances:
- epidermal;
- household;
- food;
- pollen;
- fungal and others.
In children of different ages, there is a close relationship between the disease and the reaction to food products and pathologies of the digestive system. In adults, atopic dermatitis is also associated with diseases digestive tract(ulcer, gastritis, dysbacteriosis), chronic diseases ENT organs, mental state disorders and helminthic infestations.
The likelihood of developing atopic dermatitis is directly related to genetic predisposition.
In this case, it is not the disease itself that is inherited, but a combination of genetic factors associated with a possible allergic reaction. Symptoms will appear only when several external or internal conditions. Risk factors are very diverse, here are the main ones:
- early weaning and wrong mode nutrition;
- infectious diseases mothers during pregnancy;
- unfavorable social and environmental factors;
- taking antibiotics during pregnancy or in infancy in children;
- digestive dysfunction;
- chronic infectious diseases and helminthic infestations;
- disorder of the nervous system.
Pathogenesis of atopic dermatitis
Causes
Etiology. Allergens - the leading role belongs to food, household, epidermal, pollen.
Genetic aspects. Atopic dermatitis in combination with deafness (221700, r).
Pathogenesis Increased IgE content, often revealed by positive skin tests and specific antibodies (IgE) to some inhalation and food allergens.
Eosinophilia of peripheral blood is characteristic. Decreased levels of cellular immunity: decreased severity of delayed-type hypersensitivity reaction (including
including in skin tests for tuberculin), a decrease in the number of T lymphocytes (primarily CD8 cells) and their functions, which leads to an increased susceptibility to the development of viral and fungal infections. Disorders of autonomic regulation and intracellular regulatory systems.
Allergic dermatitis is a skin disease caused by contact with an external irritant. Unlike others, the cause of this type of disease can be not only mechanical contact with the allergen. Irritants in in this case may act:
- medicines;
- cosmetical tools;
- perfumery;
- paints;
- natural and artificial polymer materials;
- metals;
- substances of industrial origin.
The main cause of allergic dermatitis is increased sensitivity to the stimulus. Despite local impact allergen, the course of the disease can manifest itself in symptoms throughout the body.
Typically, sensitization or hypersensitivity develops to one allergen or a group of similar ones. chemical composition substances.
Allergic dermatitis code according to ICD 10 covers 12 positions, each of which has its own nature. The international classification identifies and describes the manifestations of allergic dermatitis depending on the allergen.
Allergic dermatitis is included in the section under the letter L and corresponds to class XII - diseases of the skin and subcutaneous tissue.
ICD disease codes
The acronym ICD stands for International Catalog of Diseases and Health Problems. Disease codes are a kind of medical language that unites and organizes all medical diagnoses.
Any problem of the patient indicated in the documentation through the appropriate code becomes clear and accurately identified by any doctor in any country. There is only one condition - the country must be a member of the World Health Organization (WHO).
The purpose of creating an international classification of diseases:
- Statistical accounting of health problems, their identical designation, in which words are excluded. Complete replacement of the diagnosis with the corresponding disease codes (letters and Roman + Arabic numerals) avoids confusion when translating from one language to another.
- Diagnosis of diseases and routing of treatment based on accumulated world experience.
The need to create a global catalog of diseases, injuries, pathological conditions (ICD code 10) is explained by the general work on protecting public health.
From time to time (approximately once every 10 years) this regulatory document is revised, supplemented and clarified. This occurs under the control and direct guidance of WHO.
After the revision, a new type of ICD is introduced. Currently, the classification of the tenth revision is in force - ICD 10.
Allergic dermatitis - types, treatmentNote! ICD 10 codes contain not only a description of diseases, but also a detailed description of the necessary treatment, indicating medications.
Allergic dermatitis - types, causes, diagnosis
Allergic dermatitis is a disease in which allergies manifest themselves skin pathologies. There are several types of dermatitis:
- Contact – the disease is characterized by limiting the cause to physical contact of the skin and the irritating agent
- Atopic – allergic dermatitis or eczema, which are caused by internal processes in the patient’s body with unclear external influence. It is generally accepted that atopic form dermatitis occurs as a response to the patient’s psychological experiences. Pathological processes, triggered by stress factors, manifest themselves in the form of skin inflammation. The patient is diagnosed with neurodermatitis.
- Toxic allergic – allergic dermatitis as a response to ingested allergens – oral route, injections during treatment. This type of allergic dermatitis includes a reaction to medications and food.
- Infectious dermatitis – an allergic reaction to the attack of bacteria, viruses, helminths, fungal agents.
Special mention should be made perianal allergic dermatitis in children - irritation, inflammation of the skin in the groin, perineum and anus.
This disease is often caused by simple diaper dermatitis, which occurs due to poor care of the newborn.
Causes of allergic dermatitis
As well as the types of allergic reactions have been studied, described and classified, their causes are just as poorly known. Today, experts cannot say for sure why the body of a child or adult suddenly reacts with skin inflammation to any type of food, medicine, or even condition environment(allergy to cold).
Factors influencing the development of allergies:
- hereditary predisposition;
- pathological pregnancy;
- bad habits of a woman during pregnancy;
- reception medicines during pregnancy;
- artificial feeding;
- unfavorable living conditions;
- insufficient, unbalanced nutrition;
- chronic gastrointestinal diseases;
- chronic stress, overwork;
- self-medication.
If left untreated, contact allergic dermatitis will eventually cause the development of eczema.
Eczema is a disease that is allergic in nature and chronic course. Exacerbation is caused by any contact with an irritant. Eczema is often a disease of nervous people.
Skin lesions with eczema are localized on the hands, a more extensive lesion spreads to the arms to the elbow, face, neck, and décolleté.
Eczema appears as small subcutaneous blisters filled with fluid and very itchy. At this stage, there may be no redness of the skin, the rashes do not protrude above the surface.
As the blisters burst, the itching decreases and the skin turns red, cracks, and crusts. Young skin is hyperemic, very thin and sensitive. Acute period lasts up to 2 months.
Symptoms and diagnosis
Dermatitis is diagnosed based on external manifestations and identifying the causative agent.
Symptoms of contact allergic dermatitis:
- skin rashes that can be associated with exposure to food, drugs, and chemicals;
- rashes or skin irritation that occur in response to contact with certain materials or substances;
- rashes take the form of blisters, urticaria, erythema and are localized on areas of the skin in the area of exposure to the agent.
To identify the provoking agent, the patient is interviewed. As a rule, a person who consults an allergist has some suspicion of an allergen.
The doctor’s task is to narrow the range of possible irritants and conduct skin tests for allergens. The final test is to collect and analyze samples of the affected skin.
Allergic dermatitis - diagnosis according to ICD 10
Correct diagnosis of a disease determines the success of its treatment and the further prognosis for the patient’s life. In the case of allergic dermatitis, the doctor must diagnose the type of disease with similar external manifestations.
The official diagnosis for allergic dermatitis may be one of those listed in the table below.
Codes of allergic dermatitis according to ICD 10
| Code | Cause allergic reaction on the skin (deciphering the code) |
| L23.0 | Allergic dermatitis, which is caused by skin touching chromium, nickel (metal allergy) |
| L23.1 | Allergy to adhesives |
| L23.2 | Reaction to cosmetics (decorative cosmetics, facial and body skin care cosmetics) |
| L23.3 | Allergic contact dermatitis caused by the action of medications when applied to the skin. If it is necessary to indicate which particular drug caused the allergy, then use the appropriate designation. Allergies to medications taken or administered orally are not included in this code. |
| L23.4 | Allergic dermatitis due to dyes |
| L23.5 | Skin reaction to cement, rubber (latex), plastics, chemicals to kill insects. |
| L23.6 | Food allergy manifested by skin inflammation |
| L23.7 | Allergic dermatitis caused by non-food plants |
| L23.8 | Allergic dermatitis caused by substances not specifically mentioned |
| L23.9 | Allergic dermatitis or eczema of unknown etiology |
An allergic reaction to several irritants, which is expressed in combinations of symptoms, is called a multivalent allergy. Polyvalent allergy according to ICD 10 belongs to class XIX (consequences of exposure to external reasons) Code T78.4 allergy, unspecified.
Treatment
Treatment according to ICD 10 includes the use of the following medications:
- systemic antihistamines Loratadine, Clemastine, Promethazine
- non-steroidal anti-inflammatory drugs
- glucocorticoids Prednisolone, Triamcinolone, Mazipredone
External preparations are used to relieve itching, inflammation, and swelling of the skin. Antibiotics are used to prevent secondary infection.
Complex allergy therapy always involves isolating the patient from the provoking agent, adjusting nutrition and lifestyle.
Video
There are several different opinions about the group of diseases to which atopic dermatitis belongs. Some experts believe that we are talking about a skin disease, others insist that this is a genetic variation of the disease, and the third group points to the immune nature of dermatitis. In fact, all theories are true. Atopic dermatitis is a genetic disorder (complicated by heredity) leading to an abnormal immune response of the body, which appears as a lesion skin. Due to its prevalence, it is important to know what atopic dermatitis is (ICD-10, symptoms, difference from a number of other diseases).
Atopic dermatitis is a very common disease, affecting about 20% of children and 6% of adults. According to all-Russian data, in our country this is a skin disease accompanied by itching and other unpleasant symptoms, affected about 10% of the population. It often occurs along with other allergic processes and disorders caused by various allergens.
Factors leading to the development of the disease include:
- bronchial asthma;
- hay fever;
- allergic conjunctivitis;
- hives.
This condition is called atopic syndrome. It is characterized by a long-term course with repeated new inflammations.
Classification according to ICD-10
In accordance with international medical classification diagnostic code for atopic dermatitis is L20.
Main code: Chapter XII – diseases of the skin and subcutaneous tissue.
Clinical picture
Atopic dermatitis is a chronic skin disease of inflammatory etiology, manifested by dry skin, red rash, swelling, and itching. Most often, the lesions are located on the hands. Other areas are the surface of the neck, face and other parts of the body.
However, the disease can develop into a wet form. In this case, the risk of infection increases.
Atopy usually appears in children in infancy and disappears at an older age (over 20 years). Symptoms and their severity vary depending on clinical form diseases.
In accordance with the course, three periods of the disease are distinguished:
- infant;
- children's;
- adult.
Infant form
Usually appears at 3 months of age. During this period, red pimples predominate, including blisters with scales or phlegm on the cheeks, chin, torso, limbs, and head. Babies are restless severe cases sleep disturbances occur.
Children's uniform
The characteristics of atopic dermatitis acquire typical features. During exacerbation, the rash appears in the elbows, under the buttocks, on the arms and legs.
Manifestation in several degrees is possible. From rough, dry skin, the disease easily transforms into blisters and wet spots, then into cracked skin. By about 7 years of age, about 50% of patients with the childhood form forget about the disease.
Adult form
The disease in adults either persists from childhood or occurs in adulthood. The affected areas are similar to the childhood form, sometimes affecting the skin of the face and neck.
Differential diagnosis
Some forms of atopic dermatitis are diagnostically difficult. For example, when localized only on the eyelids, corners of the lips, and hands, the symptoms are similar to those of neurodermatitis (with atopy occurring in 60% of cases). Manifestation on the nipples, genitals, arms, legs can be mistaken for mycosis (in this case, special antibacterial drugs for external use do not help, since they do not act against the pathogen).
Today, “extended criteria of the new millennium” are used in diagnostics. Based on these criteria, the term “atopy” is confirmed only after a demonstrated increase in IgE levels. The disease is characterized by peripheral blood eosinophilia (increased eosinophils above 450/μl). During the diagnostic process, it is often revealed positive antibodies in blood serum or skin.
Treatment
The principles of treatment include, first of all, measures to remove known triggers, creating a safe environment to prevent an allergic reaction.
Modern drugs used for atopy are topical calcineurin B inhibitors.
At severe course diseases, plasmapheresis is used to purify the blood.
“Skin is a reflection of the soul.” This statement proves that mental condition person significantly influences the course of the disease. When psychological problems, do not be afraid to visit a psychosomatic dermatologist or psychologist. Psychotherapy can have miraculous effects on the disease.
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