Atopic dermatitis (AD)

Definition of Atopic Dermatits

Atopic dermatitis - chronic allergic inflammation of the skin surface, accompanied by itch, often combined with the presence of respiratory manifestations of immediate allergy: allergic rinoconjuctivitis's, atopic bronchial asthma.

The degree of severity of AD is determined by the prevalence of skin, location, availability of respiratory manifestations of atopic and the availability of secondary purulent infection.

To assess the severity of the skin, as well as to the effectiveness of therapy should be used Semiquantitative method - scale SCORAD (Scoring of Atopic Dermatitis), a score of six of objective and subjective symptoms, which are recorded in the grade sheet.

AD is characterized by a high content of total serum IgE and sensitization to multiple allergens atopic (domestic, epidermal, fungi, pollen, food).

At AD there are violation of blood of T-cell regulation (the predominance of Th2-response), which may determine the presence of IgE-indirect reactions. For the AD is characterized by a high degree of colonization of Staph. aureus; viral infection caused by Herpes simplex, Varicella, by virus of warts and molluscum contagiosa, as well as fungal infections (dermatomycosis caused by Trichophyton, high procent of colonization conditionally pathogenic mushroom genus Candida albicans, parapsilosis, Rhizopus spp., Spegazzinia tessarthra, Pitirosporum ovale). Of the opportunistic diseases most frequent is range pathology of the gastrointestinal tract: stomach ulcer and a duodenum, a violation of Intestinal microflora, as well as pockets of chronic infection, disease of ENT organs,of mental disturbances and of cataracts.

Survey

1. Mandatory laboratory and instrumental studies:

Clinical analysis of blood (in deviation from the norm, 1 time every 10 days);

Biochemical analysis of blood (total protein, bilirubin, ALT, AST, urea, creatinine, fibrinogen, C-reactive protein, glucose) once, in the case of plasmapheresis - control of total protein before each session;

Determination of blood group, Rh-factor;

RW, HIV;

An overall analysis of urine, if necessary - an analysis of urine on Nechiporenko once;

Immunological examination (level of total serum IgE, subpopulations of lymphocytes);

Bacteriological study of faeces (stool analysis on dysbacteriosis) upon receipt and check in 2 weeks after the end of corrigent treatment;

Esophagogastroduodenofiberscopy - when you are admission;

ECG (electrocardiogram);

X-ray research of accessory sinuses of nose - when you receive.

2. Additional studies:

Ultrasound of the abdominal cavity, pelvic, kidney - on medical testimony;

X-ray of the chest - on medical testimony.

3. Allergological survey:

Allergologic histories;

Skin tests with atopic allergens (scarifications, prick);

Determination of specific IgE antibodies to atopic allergens (using the methods of MAST, RAST);

Provocative tests if necessary (nasal, conjunctival).

4. Mandatory consultation:

Allergist;

Dermatologist;

Therapist;

Gastroenterologist;

ENT;

Endocrinologist;

Neuropsychiatrist.

In diffuse AD staging of skin tests can be conducted only after a remission / relative remission of the skin.

Characteristics of treatment

We recommend that you stick gipoallergennoy diet.

Treatment.

Step 1 - blocking of worsening (in the case of expressed aggravation of skin process with the phenomen of partial erythrodermatitis, eczema, lymphadenopathy, hypothermia) shall take place within 3 -7 days, in some cases - for 10 days:

intravenously(i.v.) drop-by-drop introduction: hemodez-n 200 ml per day - every day;

Clemastin (tavegil) 2.0 ml per 100 ml of 0.9% solution, sodium chloride 1-2 times a day;

Dexamethasone (dexone) 4-8 mg per 100 ml of 0.9% solution, sodium chloride 1-2 times per day (total dose of dexone course are 8-64 mg depending on the severity and incidence of skin).

Therapeutic plasmapheresis in the blood or intermittent fraktsionatore method: 3-4 session with removal for 1 session 1000 ml of plasma. Replacement is done protein solution is equivalent in terms of protein and saline. Plasmapheresis is contraindicated in case of aggravation of pyodermia and other pockets of chronic infection. Multiplicity sessions, 2 times a week.

Step 2 - correction of associated diseases, and rehabilitation centers of chronic infection.

3rd stage - per achievement of clinical remission, a specific immunotherapy (SIT) causallymarking allergens expedited basis, if necessary - against the backdrop of antihistamine medications or ketotifen. SIT should be conducted annually for 3 years.

Psychotropic drugs with sedative effects (appointed, if it's necessary):

alimemazine - 2,5-5mg 2 times a day or night courses within 1 month;

tioridazin (sonapax) - 10 mg 2-3 times daily rates for 1 month;

oxazepam (tazepam) - 10 mg at night;

fenazepam - 0.0005 g per night.

Antihystamine medications are appoint with rates for 7-10 days, as well as preventive purpose:

Suprastin per one pill for 2-3 times a day;

Tavegyl per 1 pill 2 times a day;

Claritin per 1 pill 1 times a day;


Stabilizers fat cell membranes:

ketotifen per one pill for 2 times a day rate of not less than 3 months to 6 - 12 - 24 months;

bisodium salt chrom glicerine acid (nalcrom) per 1 capsule 3 times a day for 10-15 minutes before eating, course per 1-2 months.

In the case of aggravation pyodermia should undertake a course of antibacterial therapy (against the background of antihystamine medications).

Absolutely contraindicated medications penicillin series!

In low treatment of purulent processes to antibacterial therapy should be combined with immunologically drugs.

Patients with respiratory manifestations of atopic need to make corrigent therapy.

Correction of associated diseases

Dysbacteriosis:

Piobacteriophage (combined or polivalent) eubiotics depending on the expression violations Intestinal microflora (bificol, bifidumbacterius, acylact, primadofilus, floradofilus, normadofilus, linecs) in combination with enzyme preparations: pankreatin (festal, espumisan, maalox) .

Terms of skin care:

1. The daily shower gels with non-soap.

2. Extenuating, nourishing cream, cream with olive oil with the addition of steroid creams or ointments in the proportion of 1:1 (advantan). At perioral area zaeds - a combination of drugs: triderm, travochort etc.

3. With escalating piodermia: leather 3% solution of hydrogen peroxide to remove purulent content and korochek, after which - 0.2% chlorhexidine solution or a solution furatsillina, then - fukocin or green diamond, and as the final stage - the local antibacterial drugs ( baneocin, oxyciclozol, levavinizol, etc.). Sports hold 1-2 times a day.

In the course of treatment is necessary to educate patients and their families the rules of care, compliance with hygiene measures, especially in the presence of domestic and epidermology of sensibilization (Appendix N2), prevention of exacerbations.

Recommended physiotherapy mud, MSS, selective phototherapy, PUVA therapy, climatic therapy at sea.

Length of hospital

Hospitalization, if necessary, be divided into 2 stages:

Step 1 - stopping worsening, a survey and correction of associated diseases, duration of phase from 20 to 35 days.

Step 2 - take SIT allergens; phase duration 14-20 days.

Requirements for the results of treatment

The disappearance of itching, reducing the size and intensity of skin lesions to the clinical remission, normalization of sleep, the improvement of psycho-emotional and general condition of patients, stabilization of respiratory manifestations atopic and associated diseases. Patients with AD are subject to a dispensary observation allergist for timely treatment and preventive measures to reduce temporary disability.

Patients with a limited form of blood to be outpatient treatment for patients with generalized form of AD is shown hospitalization period of 20-35 days.