Atopic dermatitis: treatment and skin care - Tashkent

How it manifests itself at different ages

1. До 2 лет: покраснение, мокнутие и корочки на щеках, лбу, наружной поверхности рук и ног. Область подгузника обычно свободна.
2. 2–12 лет: высыпания перемещаются в складки — локтевые и подколенные сгибы, шея, запястья. Кожа утолщается, усиливается кожный рисунок.
3. Подростки и взрослые: сухость, утолщение кожи, поражение лица, шеи, кистей; часто ведущая жалоба — постоянный зуд.

Itching is a mandatory sign: without it, the diagnosis of atopic dermatitis cannot be made. It intensifies in the evening and at night, interferes with sleep and starts a vicious circle of “itching - scratching - inflammation - even more itching.”

The role of nutrition: no myths

The idea that atopic dermatitis is always a “food allergy” is erroneous. Food triggers are significant in about a third of young children and much less common in older children and adults.

• You should exclude a product only if there is a clear, reproducible connection: eaten - it worsened within hours
• Broad “hypoallergenic diets” are blindly harmful: they do not improve the skin, but disrupt the child’s nutrition
• IgE analysis for dozens of products without a clinic gives many false results and leads to unreasonable restrictions
• In some patients, it is not food that is more important, but house dust mites, animal hair, and pollen

Basic care is the basis of treatment

1. Купание ежедневно 5–10 минут в тёплой (не горячей) воде, мягкое средство без мыла и отдушек.
2. После купания промокнуть кожу полотенцем, не растирая.
3. В течение 3 минут нанести эмолент на всю кожу — «правило трёх минут», пока кожа ещё влажная.
4. Наносить эмолент не реже 2 раз в день, а при выраженной сухости чаще; расход у ребёнка — около 250 г в неделю.
5. Одежда of хлопка, стирка без кондиционера, ногти коротко острижены.
6. Влажность в комнате 40–60%, температура не выше 20–22 °C: перегрев усиливает зуд.

Anti-inflammatory therapy

• Topical glucocorticosteroids are the basis for the treatment of exacerbations; applied in a short course to the affected areas
• The “fingertip unit” rule helps not to exceed the dose: a strip of ointment from the fingertip covers the area of ​​two palms
• Topical calcineurin inhibitors - for face, eyelids, folds and long-term maintenance treatment
• Proactive therapy: applying the drug 2 times a week to “problem” areas after the exacerbation subsides - reduces the frequency of relapses
• Antihistamines - help mainly with concomitant allergies; They relieve itching in atopy poorly
• In severe cases - phototherapy, systemic drugs and biological therapy

Atopic March

Some children with atopic dermatitis later develop allergic rhinitis and bronchial asthma - this is called the atopic march. Early and proper control of skin inflammation reduces the likelihood of such development, so treatment of dermatitis also contributes to the prevention of respiratory allergies.