Atopic dermatitis is an infant form of the subacute phase of the diet. Causes of atopic dermatitis in children. What is blood pressure

Lecture number 1

Modern ideas about

atopic dermatitis

      What is atopic dermatitis

      Risk factors for developing atopic dermatitis

      Classification

      Prevention of atopic dermatitis

The problem of atopic dermatitis (AD) in children (synonyms: neurodermatitis, atopic eczema, endogenous eczema and others), which is closely related to the increase in the number of allergic diseases in general and the growing unfavorable environmental situation, is one of the most urgent in modern medicine. The special attention of physicians, pediatricians, allergists and dermatologists to blood pressure is caused by an increase in the number of patients over the past 30 years by more than two times: from 3-5% to 10-12%. The importance of the problem is also due to the early manifestation of the disease. In 80% of children, the disease makes itself felt before 1 year, and another 15% get sick before 5 years. Another reason for the increased attention to blood pressure is connected with this. Being, as a rule, the first and earliest manifestation of the so-called atopic disease, that is, "the first step of the allergic march", it often entails the development of bronchial asthma, hay fever, Quincke's edema, etc. And blood pressure itself often proceeds so severely that it leads to social maladjustment and disability of children.

1.1. What is blood pressure

In recent years, allergic diseases have become more and more severe. Doctors attribute this to a deterioration in the environment, an increase in ozone concentration, and a change in people's lifestyle. Under the strong influence of factors harmful to humans, the protective functions of the body are weakened. This is how a state of immunodeficiency arises, and allergy is one of its manifestations.

The concept of "allergy" was proposed in 1906 by Pirke to characterize changes in the body's reactivity, guided by a number of observations from the field of experimental and clinical pathology. In modern science, the term "allergy" denotes hypersensitivity to a particular substance.

Allergic diseases are one of the most important problems of our time, since along with their continuing steadily growth, especially in children and young people, the number of severe forms leading to disability has increased.

According to the WHO, allergic diseases in developed countries occupy the third place in terms of prevalence, second only to cardiovascular diseases and injuries.

And skin allergies are the most common. The high incidence of chronic dermatoses at the current stage of the development of civilization is explained by the rapid pace of social life, an increase in emotional stress that requires tremendous nervous and intellectual efforts, as a result of which there are often “scissors” between the capabilities of human biological nature and living conditions.

Based on this, a number of chronic dermatitis, incl. and AD is often referred to the group of so-called “diseases of civilization”. "Disruption" of protective and adaptive mechanisms leads to structural and functional disorders at all levels and, above all, the immune system.

Statistics of recent years assert that in the total incidence of skin diseases, the proportion of allergic dermatoses is 22%, and in the group of children under 1 year old - 38%, from 1 to 2 years old - 30%, from 3 to 7 - 24%.

Atopic dermatitis is one of the most common allergic diseases of childhood (it accounts for 50 - 75%), and the most severe among allergic dermatoses in children.

Official statistics based on rates of medical care are usually underestimated and do not give a true idea of ​​the prevalence of blood pressure in different regions, because there is no common terminology and research methodology. There are no uniform methodological approaches, diagnostic criteria.

But it is absolutely certain that in the last 10 years there has been a progressive increase in the incidence of blood pressure.

Atopic dermatitis Is a chronic allergic disease that develops in individuals with a genetic predisposition to atopy, with a recurrent course that requires long-term observation and treatment.

In clinical practice, the term "atopic dermatitis", which is currently adhered to by most researchers, was proposed by L. Hill and M. Subzberger in 1935. However, in the official international classification system of diseases (ICD), blood pressure was introduced only in the 70s of the twentieth century. In domestic medicine, it has been widely used since the late 80s, gradually replacing other names. In ICD 1992. AD includes such chronic forms of allergic skin lesions as atopic eczema, atopic neurodermatitis and Benier's pruritus (synonymous with diffuse neurodermatitis), exudative diathesis.

AD begins, as a rule, in the first three months of a child's life and has a tendency to further chronicity or a course with frequent exacerbations.

The diagnosis of blood pressure is made if the child has 3 or more main and the same number of additional signs.

The main clinical signs are:

Itching of the skin

Skin rashes on open areas of the body (face, hands)

Hereditary predisposition

Chronic recurrent course

Additional signs:

Dry skin

Frequent skin infections

Dermatitis of hands and feet

Cracks behind the ears

Early onset, etc.

Long-term observations of patients with AD, allow us to speak of it as a general disease with damage not only to the skin, but also to the internal organs and systems of the body. The following are most commonly diagnosed

accompanying illnesses:

    pathology of the digestive system - in 80 - 97% of patients in the form of gastritis, gastroduodenitis, colitis, enterocolitis, ulcerative lesions of the stomach and intestines, hepatitis, biliary dyskenesia. In almost every child with AD, disorders of the digestive system should be suspected,

    pathology of the nervous system - in 55 - 68% of children in the form of vegetative-vascular dystonia, neuropsychic disorders, intracranial hypertension,

    pathology of ENT organs - in 50-60% of children (allergic rhinitis, rhinosinusitis),

    respiratory system pathology - in 30 - 40% of children (recurrent inflammation of the oropharynx organs, bronchial asthma),

    pathology of the urinary tract - in 20 - 30% of children (pyelonephritis, interstitial nephritis),

Medical data on the complete recovery of children with AD are different - from 17 to 30% of cases. This means that in the vast majority of patients, the disease continues throughout their lives, but it proceeds in different ways.

What are the causes of this serious chronic allergic disease?

1.2. Risk factors for the development of AD

Scientists are more and more inclined to believe that blood pressure is the result of a whole complex of factors affecting the body, but the state of the immune system is still decisive.

There are endogenous and exogenous risk factors for the development of blood pressure.

Table 1

Risk factors for developing atopic dermatitis

Endogenous factors

Exogenous factors

Causal factors (triggers)

Factors that aggravate the effect of triggers

heredity

* skin hyperreactivity

Allergenic

* food

* household

* pollen

* epidermal

* fungal

* bacterial

* vaccine

Non-allergenic

* psycho-emotional stress

* change of meteorological situation

* tobacco smoke

* nutritional supplements

* pollutants

* xenobiotics

* klimoto - geographic

* eating disorders

* violation of the rules of the regime and skin care

* living conditions

* vaccination

* psychological stress

* acute viral infections

The leading role in the development of blood pressure in children belongs to endogenous factors .

80% of children with AD have a history of allergic diseases, i.e. parents or close relatives have allergic diseases. Hereditary predisposition to blood pressure is more often transmitted through the maternal line (60-70%), less often through the father's line (18-22%). In the presence of atopic diseases in both parents, the risk of developing blood pressure in a child is 60-80%. However, perfectly healthy children can grow up in these families. If one of the parents is sick, the risk is 45-50%. The risk of BP formation from healthy parents can reach 10-20%.

In addition, the tendency of skin cells in some people to hyperreactivity often becomes the factor that determines the realization of atopic disease in the form of blood pressure.

The second group of factors - exogenous - includes causal factors (triggers) and factors that aggravate their action. Causal factors are allergenic (food, household, fungal, etc.) and non-allergenic.

The development of blood pressure is closely related to the effects of various allergens - substances that cause an allergic reaction.

In most children of the 1st year of life, AD is a consequence of food allergy. Almost any product can cause allergic reactions. The nature of food sensitization significantly depends on the age of the child. So in children 1 year of life, the most common causes of the development of AD are cow's milk proteins, cereals, eggs, fish, seafood, etc.

In recent years, children are often allergic to bananas, kiwi, persimmons, pomegranates.

But at the age of 3 to 7 years, sensitization to some food allergens decreases, but the importance of allergens present in the air increases. These are microscopic mites that live in house dust, pollen, pet hair, feathers and down of birds.

A special group of causative factors should include bacterial, fungal, medicinal and others. First, they are less common as independent etiologically significant allergens that cause AD. Secondly, they more often act in association with the allergens listed above, forming a polyvalent allergy.

The non-allergenic factors that can cause an aggravation of blood pressure include - psycho-emotional stress, unfavorable psychological climate in the family, children's collective, lack of parental faith in the child's recovery, changes in the meteorological situation, tobacco smoke, food additives, etc. The mechanisms of their influence on the development of blood pressure remain undeciphered until the end.

Climatic and geographic zones should be attributed to exogenous factors that aggravate the effect of triggers. According to Russian authors, a direct dependence of the prevalence of blood pressure on the degree and nature of environmental pollution was found, and in areas with an unfavorable environmental situation, the manifestation of skin manifestations occurs at an earlier age. Harmful industrial emissions put an increased strain on the immune system. The nature of the vegetation in a given area, altitude, absolute and relative humidity, temperature variability, and the duration of sunshine are of great importance.

But it should be borne in mind that increased sensitivity to climatic and geographical features is detected mainly in visitors, and not in the indigenous population of such regions.

An important factor is the violation of dietary nutrition. On the one hand, irrational and unbalanced nutrition of the mother during pregnancy and lactation, on the other hand, improper nutrition of the baby - early transfer to artificial feeding, early introduction of complementary foods, excess protein and carbohydrates in food, etc. Diet family traditions are also important. If the family's diet contains a lot of pasta, bakery products - products with a high sensitizing potential and a lack of vegetables and fruits, then the risk of developing AD increases. Violation of the rules of the child's skin care regimen using products not intended for children can also contribute to the development and exacerbation of blood pressure.

Household risk factors include high (above + 23 * C) indoor air temperature, low (less than 60%) humidity, irregular and dry cleaning. All this leads to the development of dry skin and mucous membranes, a decrease in their bactericidal properties and increased permeability to allergens. The same risk factors include oversaturation of the apartment with electrical appliances (an excess of electromagnetic radiation has a detrimental effect on the child's immune system), keeping pets in the apartment, passive smoking, chronic infections in the family, the presence of giardiasis in the mother or father.

Finally, such a risk factor as an unfavorable psychological climate in the family, preschool institutions, moral and / or physical punishment should be noted.

Adverse factors can act even before the birth of a child, during intrauterine development, these include:

Chronic diseases of the expectant mother, they must be treated before pregnancy,

The influence of harmful occupational factors (contact with chemicals, pesticides, nervous stress, etc.),

Toxicosis and the threat of carrying a pregnancy,

Infectious diseases, anemia during pregnancy and concomitant drug therapy,

Smoking, drinking alcoholic beverages,

Complications during childbirth.

All these factors, together or separately, can provoke the development of AD.

1.3. Blood pressure classification

One of the characteristic features of AD is clinical polymorphism, which determines the diversity of clinical forms.

Despite the existence to date of some terminological disagreements, the discussion of which is presented in a number of domestic monographs and on the pages of scientific journals, researchers are unanimous that blood pressure begins in early childhood, has a staged course with age-related clinical manifestations.

There is no official generally accepted classification of blood pressure. The working classification highlighted:

    stages of development,

    phases and periods of the disease,

    clinical forms depending on age,

    the prevalence of the skin process,

    severity of the course,

    clinical and etiological options.

table 2

Working Classification of Atopic Dermatitis in Children

Development stages, periods and phases of the disease

Clinical forms depending on age

Prevalence

The severity of the current

Clinical and etiological

options

initial stage

stage of pronounced changes(exacerbation period):

* acute phase;

* chronic phase;

stage of remission:

* incomplete (subacute period);

clinical recovery

infant

adolescent

limited

common

diffuse

moderate

predominantly

* food

* tick-borne

* fungal

* pollen, etc.

allergies

According to the presented classification, there are four stages of the course of blood pressure.

Stages of blood pressure

initial stage develops, as a rule, in children with exudative-catarrhal type of constitution, is characterized by hereditary, congenital or acquired features of the functions of the child's body, which determine his predisposition to the development of allergic reactions.

Typical symptoms of the initial stage: hyperemia and swelling of the skin of the cheeks, accompanied by slight peeling. A feature of this stage is its reversibility with timely initiation of treatment. The opinion that changes in the skin will go away on their own, without treatment, is fundamentally wrong.

Untimely and inadequate treatment of skin rashes leads to the transition of the disease to stage of pronounced changes on the skin or a period of exacerbation.

The onset of the disease, as a rule, occurs in the first year of life, but can begin at any age. The period of exacerbation almost always goes through two stages: acute and chronic.

V remission period , at the third stage of the disease, there is a disappearance (complete remission) or a significant decrease in the symptoms of blood pressure (incomplete remission), this period can last from several weeks to 5-7 years or more. In severe cases, the disease can proceed without remission and recur throughout life.

Clinical recovery - the fourth stage of the disease, in which there are no clinical symptoms of the disease for 3-7 years.

Determination of the stage, period and phase of the development of blood pressure is a key point for solving the main issues of treatment tactics.

Depending on age, there are: infant (from 2-3 months to 3 years), children (from 3 to 12 years), adolescent (from 12 to 18 years) forms of blood pressure.

Clinical forms of blood pressure

Skin in children vinfant form red and swollen, covered with tiny vesicles (vesicles). The bubbles "burst" and a bloody liquid is released from them, which, when dry, turns into yellowish-brown crusts. This form is characterized by itching of varying intensity, intensifying at night, while traces of scratching and cracks are formed. Infant blood pressure often affects the face area with the exception of the nasolabial triangle. Skin rashes can be observed on the arms and legs (more often in the elbow and popliteal folds), buttocks. This form is characterized by the so-called diaper dermatitis.

In a child's form characteristic signs are redness and swelling, nodules, crusts, the integrity of the skin is disrupted, the skin thickens and its pattern intensifies. Papules, plaques, erosion are observed. Cracks are especially painful in the palms, toes, and soles. Itching of varying intensity, leading to a vicious circle: itching - scratching - rash - itching.

Teenage uniform characterized by the presence of red plaques with vague boundaries, severe dry skin, many cracks, accompanied by itching. Favorite localization - flexion surfaces of the arms and legs, wrists, dorsum of the feet and hands.

Prevalence of the skin process

According to the prevalence of the skin process, they are distinguished:

    limited blood pressure - the lesions are limited to the elbow or popliteal folds or the area of ​​the back of the hands, wrist joints, the front of the neck. Outside the lesions, the skin is not visually changed. Itching is moderate.

    widespread blood pressure (more than 5% of the skin area) - skin rashes are not limited to the places listed above, but spread to the adjacent areas of the limbs, chest and back. Outside the lesions, the skin has an earthy tint. Intense itching.

    diffuse blood pressure - the most severe form of the disease. With it, the entire surface of the skin is affected (with the exception of the palms and the nasolabial triangle). Itching of pronounced intensity.

The severity of the course of blood pressure

In terms of severity, given the intensity of skin rashes, the prevalence of the process, the size of the lymph nodes, the frequency of exacerbations per year and the duration of remission, it happens:

    mild blood pressure , which is characterized by mild hyperemia, exudation and desquamation, single papulo-vesicular elements, mild itching. The frequency of exacerbations is 1-2 times a year, the duration of remission is 6-8 months.

    at HELL moderate multiple lesions appear on the skin with a fairly pronounced exudation. Moderate or severe itching. The frequency of exacerbations is 3-4 times a year, the duration of remission is 2-3 months.

    for severe blood pressure characterized by multiple and extensive foci of lesions with deep cracks, erosion. Itching is severe, “throbbing,” or persistent. The frequency of exacerbations is 5 or more times a year. Remission is short, from 1 to 15 months, and is usually incomplete.

Clinical and etiological options

Clinical manifestations of blood pressure, depending on this, are:

    food allergy arising after eating foods, the sensitivity to which is increased;

    tick-borne sensitization caused by house dust mites; fungal; pollen;

    epidermal (on contact with pets)

    dermatitis Document

    ...; - erythematosis; - scleroderma; - eczema; - atopicdermatitis; - itchy dermatoses: pruritus, strofulus ... genetic characteristics of hereditary diseases; - modernperformanceabout etiology and pathogenesis of hereditary diseases; - ...

  • modern ideas about psychosomatic pathology concept diagnostics therapy rehabilitation

    Toolkit

    Zinkovsky, I.E. Yurov MODERNREPRESENTATION ABOUT PSYCHOSOMATIC PATHOLOGY: CONCEPT .... I.P. Pavlov's teachings about conditioned reflexes and ... Urticaria. Near-mouth dermatitis... Other dermal ...; rheumatoid arthritis; atopic bronchial asthma. V...

Atopic dermatitis, while maintaining its clinical manifestations for many years, has an adverse effect on the physical and mental development of children, changes their usual way of life, contributes to the formation of psychosomatic disorders, leads to social maladjustment, difficulties in choosing a profession and creating a family. At the same time, relationships in the family of sick children are often violated: labor losses of parents increase, problems arise in the formation of the environment surrounding the child, material costs associated with the arrangement of life, compliance with the regime and food ration, etc. increase. and itching, but also restrictions in daily activity (physical, social, professional), which dramatically reduces the quality of life.

Risk factors and causes of atopic dermatitis in children

Atopic dermatitis develops, as a rule, in persons with a genetic predisposition to atopy under the influence of factors of the external and internal environment. Among the risk factors for the development of atopic dermatitis in children, the leading role is played by endogenous factors (heredity, atopy, skin hyperreactivity), which, in combination with various exogenous factors, lead to the clinical manifestation of the disease.

Causes of atopic dermatitis in children (Kaznacheeva L.F., 2002)

Endogenous causes of atopic dermatitis in children

80% of children with atopic dermatitis have a family history of allergy (neurodermatitis, food allergy, hay fever, bronchial asthma, recurrent allergic reactions). Moreover, more often the connection with atopic diseases is traced along the mother's side (60-70%), less often - along the father's side (18-22%). Currently, only the polygenic nature of the inheritance of atopy has been established. In the presence of atopic diseases in both parents, the risk of developing atopic dermatitis in a child is 60-80%, in one of the parents - 45-56%. The risk of developing atopic dermatitis in children whose parents are healthy reaches 10-20%.

In addition to genetically determined IgE-dependent skin inflammation, the atopic genotype may be due to non-immune genetic determinants, for example, increased synthesis of pro-inflammatory substances by mast cells. Such selective induction (excitation) of mast cells is accompanied by skin hyperreactivity, which ultimately can become the main realizing factor of the disease. There is also the possibility of an acquired breakdown of the immune response (similar to the atopic genotype) or spontaneous mutation as a result of exposure to various stressful situations (diseases, chemical and physical agents, psychological stress, etc.).

Exogenous causes of atopic dermatitis in children

Among the exogenous causes of atopic dermatitis in children, triggers (causal factors) and factors that aggravate the effect of triggers are distinguished. Both allergenic substances (food, household, pollen, etc.) and non-allergenic factors (psychoemotional stress, changes in the meteorological situation, etc.) can act as triggers.

Depending on the age of children, various etiological causes of atopic dermatitis in children act as triggers or relevant ("culprit") of atopic skin inflammation. So, in young children, in 80-90% of cases, the disease occurs due to food allergies. According to the literature, the degree of sensitizing potential of various foods can be high, moderate or weak, however, in most cases, food allergies at an early age are provoked by proteins of cow's milk, cereals, eggs, fish and soy.

Why is it the skin that becomes the target organ of an allergic reaction, and why atopic dermatitis is the earliest clinical marker of atopy in young children? Probably, the anatomical and physiological characteristics of children of this age can predispose to the development of allergic reactions, namely:

  • huge resorptive intestinal surface;
  • decreased activity of a number of digestive enzymes (lipase, disaccharidase, amylase, protease, trypsin, etc.);
  • a peculiar structure of the skin, subcutaneous fat layer and blood vessels (extremely thin layer of the epidermis, richly vascularized dermis itself, a large number of elastic fibers, loose subcutaneous fat layer);
  • low production of diamine oxidase (histaminase), arylsulfatase A and B, phospholipase E, which are contained in eosinophils and are involved in the inactivation of allergy mediators;
  • vegetative imbalance with insufficient sympathicotonia (dominance of cholinergic processes);
  • predominance of mineralocorticoid production over glucocorticoids;
  • reduced production of IgA and its secretory component - IgAS;
  • age-related dysfunction of the adrenergic cyclic system of nucleotides: reduced synthesis of adenylate cyclase and cAMP, prostaglandins;
  • a peculiar structural structure of the plasma membrane bilayer: an increased content of arachidonic acid (a precursor of prostaglandins), leukotrienes, thromboxane in it, and the associated increase in the level of platelet activating factor.

Obviously, with an unjustifiably massive antigenic load and hereditary predisposition, these age-related features can lead to the realization of an atopic disease.

As children grow up, food allergies gradually lose their dominant importance, and at the age of 3-7 years, household (synthetic detergents, library dust), tick-borne (Dermatophagoides Farinae and D. Pteronissinus), pollen (grasses, trees, etc.) weeds) allergens. Children 5-7 years old develop sensitization to epidermal allergens (hair of a dog, rabbit, cat, sheep, etc.), and their effect through damaged skin can be very intense.

A special group of causes of atopic dermatitis in children is made up of bacterial, fungal, vaccine allergens, which usually act in association with other allergens, potentiating individual links of allergic inflammation.

In recent years, many authors have noted the great importance in the development and course of atopic dermatitis of the enterotoxin superantigen Staphylococcus aureus, the colonization of which is observed in almost 90% of patients. The secretion of superantigens by staphylococcus stimulates the production of inflammatory mediators by T cells and macrophages, which exacerbates or maintains skin inflammation. Local production of staphylococcal enterotoxin on the skin surface can cause IgE-mediated release of histamine from mast cells, thus triggering the mechanism of atopic inflammation.

In about 1/3 of patients, the cause of atopic dermatitis in children is mold and yeast fungi - Alternaria, Aspergillus, Mucor, Candida, Pénicillium, Cladosporium, under the influence of which a superficial fungal infection usually develops. It is believed that, in addition to the infection itself, an immediate or delayed allergic reaction to the components of the fungus may play a role in maintaining atopic inflammation in this case.

In young children, the cause of atopic dermatitis in children is sometimes a viral infection caused by Herpes simplex.

Sometimes the triggering factor for the clinical manifestation of the disease can be vaccination (especially with live vaccines), carried out without taking into account the clinical and immunological status and appropriate prophylaxis.

In a number of causes of atopic dermatitis in children, drugs can serve, more often antibiotics (penicillins, macrolides), sulfonamides, vitamins, acetylsalicylic acid (aspirin), sodium metamizole (analgin), etc.

The non-allergenic causes of atopic dermatitis in children include psycho-emotional stress, sudden changes in weather conditions, tobacco smoke, food additives, etc. However, the mechanisms of their participation in the development of atopic dermatitis remain unclear.

The group of exogenous causes of atopic dermatitis in children, aggravating the effect of triggers, includes climatic-geographical zones with extreme temperatures and increased insolation, anthropogenic pollution of the environment, exposure to xenobiotics (industrial pollution, pesticides, household chemicals, medicines, etc.) ).

In maintaining allergic inflammation, especially in infants and young children, factors such as a violation of the diet, dietary regimen and skin care rules are important.

Among the everyday causes of atopic dermatitis in children, which increase the effect of triggers, the following can be distinguished: poor home hygiene (dry air, low humidity, "collectors" of house dust and mites, etc.), synthetic detergents, keeping pets in the apartment (dogs, cats, rabbits, birds, fish), passive smoking.

All this leads to increased dryness of the skin and mucous membranes, a decrease in their bactericidal properties, inhibition of phagocytosis and increased permeability to allergens.

Chronic infections in the family also have a stable trigger effect (microbial proteins can selectively stimulate the production of type 2 T-helpers), psychological conflicts (form astheno-neurotic reactions, hyperreactivity syndrome), disorders of the central and autonomic nervous system, somatic diseases (lungs, gastrointestinal tract, kidney), psychosomatic and metabolic disorders.

Pathogenesis of atopic dermatitis in children

Immune disorders play a leading role in the multifactorial pathogenesis of atopic dermatitis. It is generally accepted that the development of the disease is based on a genetically determined feature of the immune response, characterized by a predominance of type 2 T-helper activity, which leads to overproduction of total IgE and specific IgE in response to environmental allergens.

The differences in the atopic and non-atopic (normal) type of immune response are determined by the function of T-cell subpopulations, which restrain the corresponding pools of memory T-cells. The population of memory T-cells under constant stimulation with antigen can direct the T-cell (CD4 +) response of the body towards the production of T-helpers of type 1 (Th1 or type 2 (Th2). The first path is typical for people without atopy, the second - in atopy. in patients with atopic dermatitis, the predominance of Th2 activity is accompanied by a high level of interleukins (IL-4 and IL-5), which induce the production of total IgE, against the background of reduced production of γ-interferon.

The role of an immune trigger in atopic dermatitis is the interaction of antigens with specific antibodies on the surface of mast cells, which in children (especially young children) are concentrated in large quantities in the dermis and subcutaneous fat layer. In turn, non-immune relevant agents increase allergic inflammation through the nonspecific initiation of the synthesis and release of pro-inflammatory mediators of allergy, such as histamine, neuropeptides, and cytokines.

As a result of violation of the integrity of biological membranes, antigens penetrate into the internal environment of the body -> presentation of antigens by macrophages on the molecule of the main histocompatibility complex class II (MHC) and the subsequent expression of antigens by Langerhans cells, keratinocytes, endothelium and leukocytes -> local activation of T-lymphocytes with an increase the process of differentiation of T-helpers (CD4 +) along the Th2-like pathway -> activation of the synthesis and secretion of proinflammatory cytokines (IL-2, IL-4, IL-5, TNF-a, TNF-y, MCSF) -> an increase in the production of total IgE and specific IgE with further fixation of Fc fragments of the latter to specific receptors on mast cells and basophils -> an increase in the number of dendritic and mast cells in the dermis -> impaired metabolism of prostaglandins -> colonization of S. aureus and their production of superantigens -> realization of allergic inflammation with predominant localization in the skin.

Although immune disorders are of primary importance in the pathogenesis of atopic dermatitis, the activation of immunocompetent cells is controlled by neuroimmune interactions, the biochemical substrate of which is neuropeptides (substance P, neurotensins, calcitoninogen-like peptide) produced by the endings of nerve fibers (C-fibers). In response to various stimuli (extreme temperature, pressure, fear, overexcitation, etc.), neuropeptides are released in C-fibers, resulting in vasodilation, manifested by erythema (axon reflex). The involvement of the peptidergic nervous system in the manifestation of atopic dermatitis is due to the anatomical relationship between Langerhans cells, blood vessels and C-fibers.

Thus, the causes of atopic dermatitis in children are very different, therefore, the clinical manifestation of the disease develops as a result of the combined effect on the body of genetic factors, triggers and factors that enhance their effect.

Atopic dermatitis in infants is a chronic immune inflammation of the skin of a child, characterized by a certain form of rashes and their stages of appearance.

Children's and infant atopic dermatitis significantly reduces the quality of life of the whole family due to the need to strictly adhere to a special therapeutic diet and hypoallergenic life.

Major risk factors and causes of atopic dermatitis

The risk factor for atopic is often a hereditary burden of allergies and. Factors such as constitutional features, nutritional disorders, and insufficiently good child care are also unfavorable.

Knowledge about the pathogenesis of this allergic disease will help to understand what atopic dermatitis is and how to treat it.

Every year, the knowledge of scientists about the immunopathological processes occurring in the body in atopic nursery is increasing.

In the course of the disease, the physiological skin barrier is disturbed, Th2 lymphocytes are activated, and the immune defense decreases.

Understanding the skin barrier

Dr. Komarovsky, in his articles popular among young parents, touches on the topic of the characteristics of children's skin.

Komarovsky highlights The 3 main features that matter in breaking the skin barrier:

  • underdevelopment of sweat glands;
  • fragility of the stratum corneum of the children's epidermis;
  • high lipid content in the skin of newborns.

All these factors lead to a decrease in the protection of the skin of the baby.

Hereditary predisposition

Atopic dermatitis in infants can result from a filaggrin mutation, which changes the filaggrin protein, which ensures the structural integrity of the skin.

Atopic dermatitis is formed in children under one year of age due to a decrease in local skin immunity to the penetration of external allergens: biosystems of washing powder, epithelium and hair of pets, fragrances and preservatives contained in cosmetic products.

Antigenic loads in the form of toxicosis of pregnant women, taking a pregnant woman of medications, occupational hazards, highly allergenic nutrition - all this can provoke an exacerbation of an allergic disease in a newborn.

  • food;
  • professional;
  • household.

Prevention of allergies in infants can be the natural, maximum long-term, rational use of medicines, treatment of diseases of the digestive system.

Classification of atopic dermatitis

Atopic eczema is divided by age in three stages:

  • infant (from 1 month to 2 years);
  • children's (from 2 years old to 13);
  • teenage.

In newborns, the rash looks like redness with bubbles. The bubbles break open easily, forming a weeping surface. The baby is worried about itching. Children comb the rash.

Bloody-purulent crusts form in the field. Rashes often appear on the face, thighs, and legs. Doctors call this form of rash exudative.

In some cases, there are no signs of wetness. The rash looks like spots with slight peeling. The scalp and face are more often affected.

At 2 years of age in sick children, the skin is characterized by increased dryness, cracks appear. Rashes are localized in the knee and elbow fossa, on the hands.

This form of the disease is scientifically called "erythematous-squamous form with lichenization." In the lichenoid form, peeling is observed, mainly in the folds, in the elbow bends.

Facial skin lesions appear at an older age and are called "atopic face". There is pigmentation of the eyelids, peeling of the skin of the eyelids.

Diagnosis of atopic dermatitis in children

There are criteria for atopic dermatitis, thanks to which the correct diagnosis can be made.

Main criteria:

  • early onset of the disease in an infant;
  • itching of the skin, often manifested at night;
  • chronic continuous course with frequent severe exacerbations;
  • the exudative nature of the rash in newborns and lichenoid in older children;
  • the presence of close relatives suffering from allergic diseases;

Additional criteria:

  • dry skin;
  • positive skin tests on allergy testing;
  • white dermographism;
  • the presence of conjunctivitis;
  • pigmentation of the periorbital region;
  • central protrusion of the cornea - keratoconus;
  • eczematous lesions of the nipples;
  • strengthening of the skin pattern on the palms.

Laboratory diagnostic measures for severe atopic dermatitis are prescribed by a doctor after examination.

Complications of atopic dermatitis in children

A common complication in children is the addition of various kinds of infections. The open wound surface becomes a gateway for fungi of the genus Candida.

Prevention of infectious complications consists in following the recommendations of the allergist on the peculiarities of the use of emollients (moisturizers).

List of possible complications of atopic dermatitis:

  • folliculitis;
  • boils;
  • impetigo;
  • annular stomatitis;
  • oral mucosa candidiasis;
  • candidiasis of the skin;
  • Kaposi's herpetiformis eczema;
  • molluscum contagiosum;
  • genital warts.

Traditional treatment for atopic dermatitis

Therapy of atopic dermatitis in children begins with the development of a special hypoallergenic diet.

An allergist makes a special elimination diet for a mother with atopic dermatitis in a baby. Such a diet will help keep breastfeeding as long as possible.

Approximate elimination hypoallergenic diet for children under one year old with atopic dermatitis.

Menu:

  • breakfast. Dairy-free porridge: rice, buckwheat, oatmeal, butter, tea, bread;
  • lunch. Fruit puree from pears or apples;
  • dinner. Vegetable soup with meatballs. Mashed potatoes. Tea. Bread;
  • afternoon tea. Berry jelly with cookies;
  • dinner. Vegetable and cereal dish. Tea. Bread;
  • second supper. Milk mixture or.

The menu for a child, and especially for a child with atopic dermatitis, should not contain spicy, fried, salty foods, seasonings, canned food, fermented cheeses, chocolate, carbonated drinks. The menu for children with allergic symptoms is limited to semolina, cottage cheese, sweets, yoghurts with preservatives, chicken, bananas, onions, and garlic.

The mixtures based on the treatment of atopic dermatitis in a child will also help.

In case of hypersensitivity to cow's milk proteins, the World Organization of Allergists strongly discourages the use of products based on non-hydrolyzed goat milk protein, since these peptides have a similar antigenic composition.

Vitamin therapy

Patients with atopic dermatitis are not prescribed multivitamin preparations, which are dangerous from the point of view of the development of allergic reactions. Therefore, it is preferable to use monopreparations of vitamins - pyridoxine hydrochloride, calcium pathotenate, retinol.

Immunomodulators in the treatment of allergic dermatoses

Immunomodulators that affect the phagocytic link of immunity have proven themselves well in the treatment of allergic dermatoses:

  1. Polyoxidonium has a direct effect on monocytes, increases the resistance of cell membranes, and is able to reduce the toxic effect of allergens. It is applied intramuscularly once a day with an interval of 2 days. The course is up to 15 injections.
  2. Likopid. Enhances the activity of phagocytes. Available in 1 mg tablets. May cause an increase in body temperature.
  3. Zinc preparations. They stimulate the restoration of damaged cells, enhance the action of enzymes, and are used for infectious complications. Zincteral is applied at 100 mg three times a day for a course of up to three months.

Hormonal creams and ointments for atopic dermatitis in children

It is not possible to treat severe atopic dermatitis in children without the use of local anti-inflammatory glucocorticosteroid therapy.

For atopic eczema in children, both hormonal creams and various forms of ointments are used.

Below are the basic recommendations for the use of hormonal ointments in children:

  • with severe exacerbation, treatment begins with the use of strong hormonal agents - Celestoderm, Kutiveyta;
  • to relieve the symptoms of dermatitis on the trunk and arms in children, the drugs Lokoid, Elokom, Advantan are used;
  • it is not recommended to use Sinaflan, Ftorocort, Flucinar in pediatric practice due to serious side effects.

Calcineurin blockers

Alternative to hormonal ointments. Can be used for facial skin, areas of natural folds. Preparations of Pimecrolimus and Tacrolimus (Elidel, Protopic) are recommended to be used in a thin layer on rashes.

You can not use these drugs in immunodeficiency states.

The course of treatment is long.

Antifungal and antibacterial agents

In case of infectious uncontrolled complications, it is necessary to use creams containing antifungal and antibacterial components - Triderm, Pimafukort.

The previously used and successful zinc ointment was replaced by a new, more effective analogue - activated zinc pyrithione, or Skin-cap. The drug can be used in a one-year-old child in the treatment of a rash with infectious complications.

With pronounced weeping, an aerosol is used.

Dr. Komarovsky writes in his articles that there is no more formidable enemy for a child's skin than dryness.

Komarovsky advises using moisturizers (emollients) to moisturize the skin and restore the skin barrier.

The Mustela program for children with atopic dermatitis offers a moisturizer in the form of a cream emulsion.

The Lipicar program of the La Roche-Posay laboratory includes Lipikar balm, which can be applied after hormonal ointments to prevent dry skin.

Treatment of atopic dermatitis with folk remedies

How to cure atopic dermatitis permanently? This is the question scientists and doctors around the world are asking themselves. The answer to this question has not yet been found. Therefore, many patients are increasingly resorting to homeopathy and traditional methods of traditional medicine.

Treatment with folk remedies sometimes brings good results, but it is better if this method of treatment is combined with traditional therapeutic measures.

When the skin becomes wet during a severe exacerbation of allergic dermatosis, folk remedies in the form of a lotion with a decoction of a string or oak bark help well. To prepare the broth, you can purchase a series of filter bags at the pharmacy. Brew in 100 ml of boiled water. With the resulting broth, apply lotions to the rashes three times during the day.

Spa treatment

Most Popular sanatoriums for children with manifestations of atopic dermatitis:

  • sanatorium them. Semashko, Kislovodsk;
  • sanatoriums "Rus", "DiLuch" in Anapa with a dry maritime climate;
  • Sol-Iletsk;
  • sanatorium "Klyuchi" of the Perm Territory.
  • limit the child's contact with all types of allergens as much as possible;
  • give preference to cotton clothes for the baby;
  • avoid emotional stress;
  • cut your child's nails short;
  • the temperature in the living room should be as comfortable as possible;
  • try to keep the humidity in the child's room at 40%.

What follows avoid with atopic dermatitis:

  • apply cosmetics for alcohol;
  • wash too often;
  • use hard washcloths;
  • take part in sports competitions.

TO HELP A PRACTICAL DOCTOR

UDC 616-056.3-084-053.2

Original Russian Text © D.A. Bezrukova, N.A. Stepin, 2011

YES. Bezrukova1, N.A. Stepina2

RISK FACTORS AND PREVENTION OF ATOPIC DERMATITIS

1GOU HPE "Astrakhan State Medical Academy" of the Ministry of Health and Social Development of Russia 2 Children's Polyclinic No. 1 MUZ "GKB No. 4 named after IN AND. Lenin "

In recent years, there has been a steady increase in the frequency of allergic diseases (AD), among which atopic dermatitis (AD) occupies one of the leading places. The study of the factors contributing to the formation of allergic altered reactivity and their use for prognostic and preventive purposes can be key in solving this problem.

Key words: allergic diseases, atopic dermatitis, risk factors, prevention, children.

D.A. Bezrukova, N.A. Steopina RISK FACTORS AND PROPHYLAXIS OF ATOPIC DERMATITIS IN CHILDREN

During the last years the steady growing of frequency of allergie diseases (AD) is noted, among which the atopic dermatitis (AtD) occupies one of the leading places. The studying of factors promoting formation of allergie changed reactivity and their use with prognosis and preventive purpose is the key in decision of a given problem.

Key words: allergie diseases, atopic dermatitis, prophylaxis, children.

WHO and the International Association of Allergists and Clinical Immunologists attach particular importance to the prevention of allergic diseases (AD), designating this problem as one of the most urgent. Prevention of AD is the most important link in the general complex of therapeutic and prophylactic measures in AB. The chronic course of the disease requires the development of new methods of prevention, reducing the consumption of medicines by patients and improving their quality of life.

The most effective is primary prevention, the purpose of which is to prevent the development of sensitization to an allergen, to prevent the development of allergies, while secondary or tertiary prevention is aimed at alleviating the severity of the course or to reduce the risk of complications of already existing antibiotics, to prevent the development of clinical manifestations of allergy in that the case when sensitization has already occurred.

Modern approaches to the primary prevention of AB in children are based on the implementation of a set of measures for children at high risk of allergic pathology. It is believed that early, from the birth of a child, preventive measures for children at high risk of developing allergies can change the natural course of atopic disease.

The complex of measures includes antenatal and postnatal prophylaxis. The possibility of intrauterine sensitization of the fetus to food and other allergens already in the antenatal period is indicated. Most often, this is due to the excessive consumption of cow's milk and highly allergenic products by a pregnant woman. It is assumed that the antigen can cross the placenta into the fetus in combination with the mother's IgE antibodies. Thus, maternal IgE plays an important role in the new concept of fetal sensitization in the antenatal period.

High antigenic loads (toxicosis of pregnant women, massive drug therapy of a pregnant woman, exposure to occupational allergens, unilateral carbohydrate nutrition, abuse of obligate food allergens, etc.) significantly increase the risk of AB formation. Eliminating these factors is an important aspect of AD prevention.

The ability to identify children with an increased risk of developing allergic reactions based on the analysis of the prenatal, antenatal periods allows for appropriate prevention long before the birth of the child. A detailed family history of allergy is the best method for early detection of children at high risk of developing AD.

At the same time, primary prevention of allergies in children is the least studied, since the immune system begins to form in utero. Sensitization is possible during pregnancy and preventive measures should be taken already during this period. Studies show that when exposed to allergens on the body of a pregnant woman, the fetus activates T-cell immunity along the Th2 pathway. This contributes to an earlier manifestation of the atopic immune response in a newborn, especially one with a genetic predisposition to the development of AB.

In recent years, there has been a noticeable increase in the interest of researchers in the problems of baby nutrition and the study of the influence of nutrition at the early stages of a child's development on his health status in the subsequent years of life. During the entire early childhood period, the child has to adapt to changing nutritional conditions: to milk nutrition, to mixtures, to the introduction of complementary foods, to the introduction of elements of the common table. The transition from hemotrophic to milk nutrition in the first days of life is a complex chain of interrelated processes. Lactotrophic nutrition in the early period of life is the basis for all metabolic processes. Moreover, lactotrophic nutrition, which is an analogue and continuation of hemotrophic nutrition, is a source of substances and stimuli that serve directly for the development and growth of all functional systems of the child's body. That is why the replacement of breastfeeding with artificial or mixed breastfeeding can be regarded as a gross interference in the metabolic processes of the newborn's body, in fact, as a "metabolic catastrophe".

This approach to this problem allowed formulating the concept of "programming" with food. According to this concept, power programming can only occur during certain periods of life, the so-called "critical" periods or "critical windows". Exposures at moments of heightened sensitivity - critical periods of life have long-term consequences for human health and life. In biology, the concept of programming has existed for a long time under the name of imprinting. Metabolic imprinting is a phenomenon in which exposure to certain factors at a critical period in the development of an organism causes persistent metabolic changes that persist in later life. Metabolic imprinting is an adaptive phenomenon well understood by biologists. The period of intrauterine and early postnatal development is a critical period for metabolic imprinting.

There are several assumptions about the possible mechanism of the influence of fetal and postnatal nutrition on metabolism. The most probable theory seems to be epigenetic regulation. Cellular differentiation is characterized by a stable ability to express a certain number of genes in accordance with incoming stimuli. This stability is provided by epigenetic mechanisms that allow some hereditary properties to be controlled.

Nutritional factors during early development significantly influence the epigenetic mechanisms that underlie metabolic differentiation. The researchers emphasize that the "imprinted" genes of the genome are highly sensitive to environmental factors.

Thus, the nutrition of infants occupies a special place in the prevention of many diseases, including AD, as a disease of adaptation.

In children of the first year of life, food allergy (PA) is a starting sensitization, against the background of which AD is formed. The most common cause of development of PA in infants of the first year of life is cow's milk proteins.

According to A.N. Pampura The prevalence of proven food allergy in developed countries among children of the first year of life is 6-8%. The prevalence of PA is higher among urban children; low rates are recorded in mountainous areas. According to research conducted in Spain, about 1/6 of young children have minor symptoms, including skin manifestations, when using cow's milk.

It has been repeatedly emphasized that the leading role in the mechanisms of development of PA in children is played by IgE-mediated, i.e. atopic reactions. An increase in the content of total IgE in the blood serum is observed in 90% of children with PA. The participation of ^ β4-mediated reactions in the development of atopic form of PA is not excluded.

In contrast to the above, there is an opinion that the level of food reactions in children of the first year of life rarely rises. The central moment in the development of atopic dermatitis is determined not simply by an increase in IgE, but by an impaired regulation of these immunoglobulins. A decrease in the synthesis of γ-interferon, which blocks the production of IgE, can trigger the development of AD. The blood concentration of γ-interferon is lower in children at risk, who developed AD in the first year of life, than in children without atopy, although the levels of IgE in these children did not differ significantly. In connection with the above, indicators of cytokine status (IL-12 and γ-interferon) are recommended to be used as additional criteria for predicting sensitization of newborn children.

The main links in the prevention of allergies are the development of food tolerance (tolerance) to food proteins and the prevention of the child's premature meeting with antigens. The difficulty of developing food tolerance in newborns is associated with their physiological characteristics. A child is born with an almost sterile intestine, the walls of which are characterized by increased permeability; the functionally immature system of adaptive immunity is characterized by a tendency of the immune response towards the production of IL-2, which facilitates the development of AB. Therefore, if breastfeeding is impossible, it is necessary to give preference to milk formulas, the prophylactic efficacy of which against PA has been proven. The most common food allergens are proteins with molecular weights between 10 and 60 kDa. The allergenicity of proteins can be reduced by technological processes such as enzymatic hydrolysis and heat treatment. As a result of using these methods, proteins with a lower molecular weight can be obtained. Numerous studies have been carried out on the use of infant formula, white

the main component of which is represented by partially hydrolyzed protein in the risk group for the formation of atopy.

G. Moro et al. Confirm the key role of the composition of the intestinal microflora in the process of postnatal development of the child's immune system. This provision has been confirmed empirically. Thus, the use of AMS with the addition of prebiotics led to a significant decrease in the incidence of AD in high-risk children by the age of 6 months. It has been proven that the stimulation of the entire intestinal microflora with the help of prebiotics is an effective method of influencing the development of the immune system.

The work of N.P. Toropova, which indicates that among children born to mothers with AD, only 18% had manifestations of the disease. The author explains such a low incidence of AD in the studied group of children not only by observation before conception, but also during pregnancy, after birth by specialists who have carried out painstaking work to eliminate risk factors (RF) at all stages of fetal and child development. Consistent and conscious implementation by patients of all the doctor's recommendations is the second, no less important component of both the prevention of AD and the treatment of patients.

In the literature, a high incidence of AD morbidity in infants is noted due to the functional immaturity of the immune system and digestive organs. The important role of local immunity is confirmed by the fact that PA is more common in children with IgA deficiency. In addition, in the child's stomach, compared to adults, less hydrochloric acid is produced, the activity of digestive enzymes is reduced, and the production of mucus is lower, the glycoproteins of which differ from those in adults, both in chemical composition and in physiological properties. All these factors in genetically predisposed children can contribute to the formation of food hypersensitivity.

The issue of the influence of social factors, such as the material well-being of the population, the state of the country's economy in changes in morbidity, is actively discussed. It is noted that the frequency of AD increases with the growth of social well-being, which is explained from the position of the so-called "hygienic hypothesis", according to which the reason for the increase in the incidence of AB is a decrease in the microbial antigenic load on the child's body due to a decrease in family size and improved living conditions. A regularity is considered to be proven: a decrease in contact with bacterial antigens reduces the possibility of switching the Th2-cellular immune response formed in the antenatal and neonatal period, with its predominance over the Th1-cellular immune response in the direction of a balanced ratio of Th1- and TfrZ-responses, which contributes to the persistence of the allergic response. There is a number of studies showing a link between infections carried in early childhood and a reduced risk of atopy. Moderate impacts, repeated with a frequency sufficient to adapt to them, are of a training nature and increase the reserve capacity for autoregulation of the biological system. However, there is currently no direct evidence of the predisposing effect of reduced exposure to bacterial antigens on the onset of atopy in children.

In parallel with the above, there is an opinion that with an unfavorable course of pregnancy, the immunological relationship "mother-placenta-fetus" is violated. As a result of intrauterine exposure to infectious factors on the immature immune system of the fetus, an imbalance of T-helpers is observed with a relative predominance of the T2-cell immune response, which contributes to an increased production of IgP.

Microbial endotoxins play a significant role in the development of AD, eczema in children. These cleavage products of a number of opportunistic microorganisms are homologous to the IgE receptor CD23. By binding with CD23 on B-lymphocytes, they are able to stimulate IgE synthesis, causing hypersensitization and inflammatory allergic reactions in the skin. Circulating in the bloodstream, endotoxins damage the vascular endothelium, which leads to the release of amino acid peptides (endotheliins), which have a pronounced vasoactive effect, thereby disrupting microcirculation and triggering the mechanism of inflammation in the epidermis. The same effect is possessed by endogenous and exogenous aminotoxins formed in the process of indigestion or introduced from the outside.

There is evidence of the vector significance of some large-structure antigens, which, penetrating into the child's body during the formation of his immune system, orient the production of Ig E antibodies for a long time. Such an inertial mechanism of immunogenesis is possible with perinatal bacterial infection and early artificial feeding. The RF of induced atopy can be considered a switching of the immune response to the synthesis of Ig class E due to infection of a child with insufficient T-cell immunity, as well as infection during the formation of immunogenesis. This situation is already possible with

a fetus that responds to infectious agents, food antigens of a pregnant woman, as well as to tissue antigens in non-infectious embryopetopathy.

The macroorganism, as an integral part of the environment, is also the habitat of the microorganisms that inhabit it. I.B. Kuvaeva defines the dynamic balance between the host and the colonizing biota as a microecological system, emphasizing that both the host's organism and the microorganisms inhabiting it have a mutually regulating effect on each other. Thus, the factors that change the quantitative and qualitative composition of the microbial flora of the organism also contribute to changes in the response system of the macroorganism, established as a result of connections with this flora.

Currently, the influence of intestinal microflora on the formation of the immune system is being actively studied. So Nagler-Anderson C., Walker W.A. in their work, they note that microbial stimulation provides the formation of regulatory signals necessary to overcome the prevalence of Th2 cells in the lymphoid tissue of the intestine, and prevents an allergic reaction. Colonization of the intestine by indigenous microorganisms affects the structure of the intestinal mucosa and the rate of regeneration and absorption, and also stimulates the local immune system (lymphatic follicles, production of lymphocytes, immunoglobulins), determines the balanced response of helper cells (Th1 = Th2 = Th3 / Th1) and prevents them instability. As a result, the strength and nature of the systemic, including the immune response of the body to the action of unfavorable environmental factors, will largely depend on the state of the intestinal microbiocenosis.

In a clinical setting, the difference in the immune response of peripheral blood lymphocytes to contact with the commensal and pathogenic flora was demonstrated: the commensal flora did not increase the production of proinflammatory cytokines, while the pathogenic flora induced active production of TNF a, I112 and inflammation processes. In an unfavorable situation, this process can be protracted and repeated in the future. The entry into the infant's body of commensal bacteria (during the period of passage through the birth canal of the mother, from breast milk) does not lead to the activation of the nuclear factor and the production of inflammatory cytokines. This is attributed to the fact that in the process of thousands of years of human evolution, his body began to perceive lactobacilli and bifidobacteria as "old friends", therefore the intake of these bacteria does not activate the synthesis of pro-inflammatory cytokines. At the same time, the absence of lacto- and bifidobacteria disrupts the processes of immunoregulation, the development of tolerance in the infant's body. The task of commensal bacteria is to initiate, teach, train the infant's immune system, and their absence becomes a risk factor for the development of autoimmune and AB in the child.

Thus, children with realizations of the risk of atopic dermatitis have deviations in their health state even before the manifestation of the pathological process, therefore, for a more accurate forecast of the disease, and effective preventive measures, it is necessary to determine the quantitative value of risk factors and correct the prognosis during the first year of life.

BIBLIOGRAPHY

1. Azarova E.V. Clinical and microbiological approaches to predicting the nature of adaptation of newborns: author. dis. ... Cand. honey. sciences. - Orenburg, 2007 .-- 28 p.

2. Borovik TE Prevention of food allergies in children // Russian pediatric journal. - 2004. -№ 2. - S. 61-63.

4. Kopanev Yu.A., Sokolov A.L. Dysbacteriosis in children. - M .: JSC "Publishing House" Medicine ", 2008. -128 p.

5. Kotegova OM Improvement of methods of primary prevention of allergy formation in children: author. dis. ... Cand. honey. sciences. - Perm, 2008 .-- 19 p.

6. Kuvaeva I.B., Ladodo K.S. Microecological and immune disorders in children. - M .: Medicine, 1991 .-- 240 p.

7. Kungurov N.V. Gerasimova N.M., Kokhan M.M. Atopic dermatitis: types of course, principles of therapy. - Yekaterinburg: Ural Publishing House. University, 2000 .-- 267 p.

8. Mazankova L.N. Ilyina N.O., Kondrakova O.A. Metabolic activity of intestinal microflora in acute intestinal infections in children // Russian Bulletin of Perinatology and Pediatrics. - 2006. - T. 51. - No. 2. - S. 49-54.

9. Netrebenko O.K. Separated consequences of the nature of feeding children in the early stages of development // Medical scientific and educational journal. - 2005. - No. 29. - S. 3-20.

10. Netrebenko O.K. Food tolerance and allergy prevention in children // Pediatrics. - 2006. -№ 5. - S. 56-60.

11. Pampura A.N., Khavkin A.I. Food allergy in children: principles of prevention // Attending physician. -2004. - No. 3. - S. 56-58.

12. Revyakina V.A. Prospects for the development of children's allergological service in the Russian Federation // Allergology and immunology in pediatrics. - 2003. - No. 4. - S. 7-9.

13. Sergeev Yu.V. Atopic Dermatitis: New Approaches to Prevention and Topical Therapy: Recommendations for Practitioners. - M .: Medicine for all, 2003 .-- 55 p.

14. Toropova, N.P. Atopic dermatitis in children (to questions about terminology, clinical course, pathogenesis and differentiation of pathogenesis) // Pediatrics. - 2003. - No. 6. - S. 103-107.

15. Eady D. What 's new in atopic dermatitis? // Br. J. Dermatolol. - 2001. - Vol. 145. - P. 380-384.

Atopic dermatitis - hr. an allergic disease that develops in individuals with a genetic predisposition to atopy has a recurrent course with age-related clinical manifestations and is characterized by exudative or echiloid rashes, increased serum Ig E levels and hypersensitivity to specific and nonspecific irritants.

At the heart of atopic dermatitis is hr. allergic inflammation. The pathogenesis of atopic dermatitis is multifactorial with the leading role of immune disorders. The leading immunological change is the change in the ratio of Th 1 and 2 lymphocytes in favor of the latter. The role of an immunological trigger in atopic dermatitis is the interaction of allergens with specific antibodies on the surface of mast cells. Non-immune trigger factors increase allergic inflammation by nonspecific initiation of the release of mediators of allergic inflammation (histamine, cytokines). An important role in the maintenance of Chr. inflammation of the skin with atopic dermatitis is eliminated by fungi and coccal flora on the surface of the skin.

Risk factors for atopic dermatitis: 1 Endogenous (heredity); 2 Exogenous.

The role of heredity: if the parents are not sick, the risk is 10%, 1 of the parents is sick - 50-56%, both parents are sick - 75-81%

Exogenous risk factors (triggers): 1 allergenic (foods - cow's milk protein; aeroallergens - pollen, spores; m / o allergens - streptococci; fungi). 2 non-allergenic triggers (climate; high values ​​of temperature and humidity; physical and chemical irritants; infection; chronic diseases; sleep disturbances). Chemical irritants: detergents; soap; cleaning chemicals; perfumed lotions. Physical irritants: scratching; sweating; irritating clothing (synthetic and woolen).

34. Criteria for the diagnosis of atopic dermatitis.

Diagnostic criteria for blood pressure: 1) mandatory; 2) additional.

Itching and three criteria are required to make a diagnosis of AD.

Mandatory BP criteria:

1. itching of the skin.

2. the presence of dermatitis or dermatitis in the anamnesis in the area of ​​flexion surfaces.

3. dry skin.

4. onset of dermatitis before 2 years of age.

5. the presence of bronchial asthma in the closest relatives.

Additional criteria for blood pressure:

Palmar ichthyosis

Immediate reaction to allergen testing

Localization of the skin process on the hands and feet

Nipple eczema

Susceptibility to infectious skin lesions associated with impaired cellular immunity

Erythroderma

Recurrent conjunctivitis

Denier-Morgan folds (suborbital folds)

Keratoconus (bulging of the cornea)

Anterior subcapsular cataracts

Cracks behind the ears

High Ig E

36. Lupus erythematosus. Etiology, pathogenesis, classification.

The etiology has not been identified. Severe photosensitivity.

It is based on genetically determined processes, which is confirmed by dysimmune disorders: suppression of the T-link and activation of the B-link of immunity. Ag HL (Ag-histocompatibility). There are suggestions about a viral origin: retroviruses. Sensitization, mainly bacterial. Frequent sore throats, ARVI - a bacterial concept of the genesis of lupus erythematosus. The provoking factor is sun exposure, hypothermia, mechanical injury.

Intravascular coagulation concept: increased membrane permeability, tendency to aggregation of platelets, increased blood coagulation, which leads to aseptic inflammation.

KV classification:

1.localized or cutaneous

2.system

The localized cutaneous form of the lesion is limited to foci on the skin.

The options are:

Discoid

Centrifugal erythema Bietta

Chr. disseminated

Deep lupus erythematosus Kaposi-Irgamga

38.Biett's erythema centrifugal. Etiology, pathogenesis, clinical picture, differential diagnosis, principles of treatment.

Lupus erythematosus is an autoimmune disease with a predominant lesion of the connective tissue, caused by gene disorders of immunity with a loss of immune tolerance to its Ag. A hyperimmune response develops, antibodies arise against their own tissues, immune complexes circulate in the blood, which are deposited in the vessels of the skin, internal organs, vasculitis occurs. In the tissues - an inflammatory reaction. Cell nuclei are destroyed - ME cells or lupus erythematosus cells appear.

Centrifugal erythema Bietta - superficial lupus erythematosus, a fairly rare form of discoid lupus erythematosus. Described by Biett in 1828.

With this form, more often on the face, a limited, somewhat oematic, centrifugally spreading erythema of red or pink-red, and sometimes bluish-red color without subjective sensations develops on the face, capturing the back of the nose and both cheeks (in the form of a "butterfly"), and in some patients - only the cheeks or only the bridge of the nose ("butterfly without wings"). However, follicular hyperkeratosis and cicatricial atrophy are absent. Biett's centrifugal erythema may be a harbinger of systemic erythematosis or be combined with damage to internal organs in systemic lupus erythematosus. For treatment, synthetic antimalarial agents are used - delagil, plaquenil, rezokhin, hingamin, administered orally in age-related dosages 2 times a day for 40 days or 3 times a day in 5-day cycles with 3-day breaks. They have photoprotective properties, prevent DNA and RNA polymerization and suppress the formation of Ab and immune complexes. At the same time, vitamins of the B complex, which have an anti-inflammatory, photosensitizing effect, as well as vitamins A, C, E, P, normalizing the processes of oxidative phosphorylation and activating the exchange of connective tissue components of the dermis.

Loading ...Loading ...