Atopic dermatitis is the first among allergic diseases in children and adolescents: it occurs one and a half times more often than bronchial asthma and 2.5 times more often than allergic rhinitis. In total, according to statistics, from 5 to 15% of children suffer from this disease.
The disease is chronic, not cured completely and requires attention every day throughout life.
The main cause of atopic dermatitis is a genetic predisposition. In families where both parents are allergic, the risk of developing allergic reactions in children is 60–80%. However, a hereditary factor alone is not enough, and much depends on adverse environmental conditions.
These include both chronic diseases and bad habits of the mother before and during pregnancy, and her unhealthy diet, due to which the baby is still exposed to food allergens, both natural and chemical (artificial colors, preservatives, etc.). .). During breastfeeding, such gastronomic habits cause a similar harm to the crumbs. It is quite possible that an early conversion of a baby to artificial feeding, and premature acquaintance with orange and red fruits and exotic fruits, can provoke the onset of atopic dermatitis.
Frequent respiratory viral infections, chronic infections of the respiratory tract and oral cavity (adenoiditis, pharyngitis, tonsillitis, caries), otitis, helminthiasis and giardiasis make their contribution. Passive smoking is another trigger factor.
There are several names for this disease, but one is correct. In the synonymous series “eczema” – “exudative-catarrhal diathesis” – “neurodermatitis” – “atopic dermatitis” only the last term clearly reflects the essence of the disease. What is dermatitis, almost everyone knows.
This is an inflammation of the skin. With the decoding of the word “atopy” many people have problems. In fact, to comprehend its meaning is not so difficult.
Allergy – a broad concept. This is a disease of the immune system, in which the body perceives the usual environmental factors in hostility. In total there are 4 types of allergic reactions.
Atopy refers to the first of them (its other name is “immediate allergic reaction”). The main difference is that after contact with the allergen, the first signs of inflammation appear on the skin over the next 4 hours.
All other types of allergic reactions are slower.
The second classic feature of atopy is an increased level of immunoglobulin E in the blood. These proteins normally perform a protective function, participating in the fight against parasites, some viruses and bacteria. But in the body of atopic people, they behave differently.
Namely: immunoglobulin E destroys the membranes of connective tissue cells (mast cells). Of these, a large amount of biologically active components is poured into the extracellular space, among which histamine is listed – the very substance that triggers allergic inflammation in the skin.
While the child is small, he does not experience psychological discomfort about his appearance and he is only worried about itching. Parents survive his illness much more strongly, and their anxiety is transmitted to the baby.
From these “alien” experiences, itching may intensify. If adults understand that periods of exacerbations are temporary, not life-threatening, and always giving way to remission, this problem can be avoided.
However, with age, the attitude towards one’s own appearance changes, especially when the atopic baby joins a group of peers who are always ready to prick a sore spot. But if you carry out soft preventive conversations in advance, the child will learn to treat the disease philosophically.
It is also necessary to instill in your child the idea that you need to take care of your skin every day (this habit will be very useful for him in the future), and help to realize a simple axiom: if he eats a forbidden product, it will instantly affect his skin. Having mastered the causal relationship, the child will gain powerful motivation to continue not to break the taboo.
The skin becomes the favorite target of immunoglobulin E, but she does not suffer from atopic dermatitis alone. The impact falls on many internal organs, and goes to the central nervous system. So, in atopic, as in all allergic people, the permeability of the mucous membrane of the gastrointestinal tract is increased.
By the way, therefore, a lot more food allergens penetrate into their bodies a priori. This feature often leads to the development of gastritis, gastroduodenitis, dysbacteriosis.
Since itching inevitably leads to bloody scratching, all conditions arise for the attachment of bacterial, viral and fungal infections. Another unpleasant complication of atopic dermatitis is cataract.
According to some reports, lens opacification develops in 25% of children suffering from severe atopic dermatitis.
Disorders of the central nervous system causes itching. If periods of exacerbations occur frequently, then the child itches a lot and for a long time, regularly irritating the nerve endings. As a result, a permanent focus of excitation arises in the nervous system.
This leads to the fact that the baby becomes irritable and restless. If skin manifestations are localized on the face or open areas of the body, the child may develop complexes. Moreover, atopic children usually do not sleep well (again because of itching), which is why they often develop insomnia.
The latter leads to a violation of cognitive functions: memory and attention. However, each of these troubles can be prevented.
Early onset is one of the characteristic signs of atopic dermatitis. In 80% of children, the disease manifests itself already in the first year of life (but not earlier than 2-3 months), in 10-15% – in the period up to 4-5 years, and only in 5% – in the age over 5 years. Over the years, the symptoms mutate: skin manifestations change their appearance and dislocation, for which atopic dermatitis is called “chameleon disease”.
The main reason for the metamorphosis associated with the structural features of the skin of the child and the amount of intercellular fluid in his body. Both of these parameters are variable.
The younger the child, the more water in its “bodily” composition, so at an early age the skin manifestations are “wet” in nature, and in other periods – “dry”.
Doctors distinguish three stages of atopic dermatitis. The first, or infant, lasts from 2 months to 2 years.
At this time, rash appears on the cheeks, in the places of the bend of the limbs, on the buttocks. Against the background of bright edematous red skin, tiny bubbles appear at first, which then either open themselves or the baby combs them. Crusts form at the site of bursting bubbles.
The second stage is called the nursery and lasts up to 13 years. During this period, the “wet” manifestations completely disappear, the skin becomes very dry and rough, deep grooves appear on it. Lesions occur in the popliteal and ulnar fossae, on the face, neck and decollete.
The third stage is called teenage or adult, and it also has its own characteristics.
With age, the body’s susceptibility to different groups of allergens also changes. So, in the first year of life, the main aggravating factor is the food that a child eats or his mother eats if she feeds her baby.
However, these manifestations are not related to food allergies. Atopic dermatitis is a skin disease with classic symptoms that always appear the same.
Food allergies can declare themselves in different ways. For example, in response to a non-grata product, the body can react with skin rashes, and indigestion, a runny nose, and even a migraine.
Among the products that can provoke atopic dermatitis in the first year of life, the first place is given to cow’s milk protein. The baby can get acquainted with it both on breast, and on artificial feeding.
In the first case – through breast milk, in the second – through the mixture, which includes this component. Another allergen that can trigger atopic dermatitis in the very first stages is soy protein (it is also present in some mixtures).
During the introduction of complementary foods, the danger is represented by gluten (this protein is found in many cereals, and therefore, in most children’s cereals), fish, eggs, and citrus fruits. At an older age, you can sin on chocolate, nuts and seafood.
After a year, the skin reaction usually occurs in response to environmental allergens – house dust mites, wool and particles of the epidermis of domestic animals, household chemicals. After 3-5 years, children become very susceptible to plant pollen and street dust.
In adults, atopic dermatitis for the first time in life usually occurs when using low-quality cosmetics.
Inexperienced doctors and parents often confuse atopic dermatitis with other skin diseases, such as scabies or seborrheic dermatitis. An experienced specialist, whether a dermatologist, allergist or pediatrician, is an easy diagnosis to make.
Usually the verdict is based on clinical symptoms. In this case, 5 criteria are considered mandatory, and 23 – additional. But usually it is enough for a doctor to reveal the following 7 points:
- The appearance of typical skin reactions is not earlier than 2 months, but not later than 2 years: in most cases, atopic dermatitis manifests itself at this age.
- Chronic disease.
- The presence of itching.
- Typical character and localization of lesions plus their evolution according to three stages.
- Even if the rash and itching are eliminated during treatment, the skin remains dry during remission.
- As a rule, 90% of atopic children have a so-called positive family history, that is, an allergy is observed in parents, siblings and grandparents.
- If it is not possible to recognize atopic dermatitis based on dermatological signs, the doctor may recommend an immunological blood test to detect an increased level of immunoglobulin E. This method is effective, it has no contraindications, it is prescribed to children from birth even during periods of exacerbations and while taking antihistamines. There is only one “but”: low levels of immunoglobulin E do not necessarily indicate the absence of atopy, therefore this criterion is considered additional.
The second stage of diagnosis is the detection of allergens that cause an acute “skin” response. The goal can be achieved in three ways: to make a skin test, to pass an immunological blood or feces test, to carry out the so-called trial elimination.
The first method is suitable for children older than 3 years: the baby must sit motionless for half an hour. The second is applied from birth, but due to the human factor the results are not always reliable.
If a blood test or feces detects an allergy to fish or apples, and the mother tells you that the child endures calmly, but the itch appears on buckwheat, semolina and milk, the doctor will quickly believe her words. The third method involves the alternate exclusion of suspicious foods from the baby’s diet.
When the “culprit” is removed from the menu, the child’s condition improves markedly.
If the diagnosis is confirmed, the success of the fight against the disease is 10% dependent on the doctor and 90% on the efforts of the parents. There is no panacea for atopic dermatitis.
Treatment must be comprehensive, and in order to achieve remission, it is necessary to minimize contact with major allergens.
In children of the first years of life, a reasonably built diet becomes the main point of treatment, because the main trigger factor at this age is food. Under the complete ban, usually only 2–3 of the most “aggressive” products are found: it is highly undesirable to deplete the diet during a period of active growth. Most likely, these “instigators” will have to be excluded from the diet for a long time.
If the mother is breastfeeding the baby, she will have to abandon the dangerous dishes. All other products that the baby also suffers poorly, the doctor will select an adequate replacement. You do not need to think that the child will never taste the “forbidden fruits”.
Most often, even the powerful aggressors are subtracted from the menu only for a while. For example, cow’s milk protein should be eliminated for at least a year, and a maximum of 3. If food allergy joins atopic dermatitis (which happens often), after a year the baby is prescribed a low-allergenic diet, but also not forever, but, as a rule, at 6–12 months. After this period, a re-examination is carried out, and with satisfactory results, the imposed restrictions are removed.
There is another encouraging phenomenon. By the age of 3, children develop food tolerance, which means that 80–85% of all existing products do not cause them any problems from now on.
Nevertheless, in some cases, the child has to abstain from any dishes all the time.
In the period of exacerbations may require medical assistance. Prescribe drugs should only a doctor.
If necessary, the baby can prescribe antihistamines and membrane stabilizers. The former inhibit the production of histamine, the latter protect mast cells.
To remove skin manifestations used external creams and ointments, including those containing corticosteroid hormones. These tools are much more effective than traditional lotions and wet dressings.
During remission, all powers should be thrown for everyday care. The main task at this stage is the fight against dry skin with the help of emollients (medical moisturizers).
It is necessary to use them after water procedures, and whenever possible – as often as possible. The structure of the skin in atopic genetically altered, and even if at the moment it looks healthy, it still needs constant care.
And this is the only way to achieve long-term remission.
It is equally important to establish a hypoallergenic regime in the house: remove carpets, open book racks, indoor plants and an aquarium from the nursery, and store soft toys in containers. Humidity in the nursery should be about 40%, the temperature – not higher than 22 ºС.
In such conditions, house dust mites and harmful microorganisms have to be bad, and the person feels comfortable.