Atopic dermatitis in children and infants: causes and treatment

Author:

Butriy Sergey Alexandrovich pediatrician

Quick transition Treatment of atopic dermatitis in children

Atopic dermatitis is a disease in which the skin becomes very itchy, irritated, red, dry, and uneven.

Atopic dermatitis is a common skin disease that is part of a group of skin diseases combined under the broader term “eczema.”

There are other types of eczema: nummular, dyshidrotic, etc. However, the terms “eczema” and “atopic dermatitis” are often used interchangeably.

As a rule, atopic dermatitis debuts in infancy (3–6 months) and occurs in 15–20% of children. Most often, its course is most severe in the first 1–3 years of life; as the child grows older, the severity of the disease decreases. Atopic dermatitis usually disappears by school age or puberty. However, in some people the disease can persist throughout their lives, occasionally worsening, or appearing constantly.

What are the causes of the disease?

It is necessary to distinguish between the cause and triggers of atopic dermatitis.

The reason is not fully known to modern science; the main version is a set of genetic, immune and skin changes, in particular, a deficiency of the skin protein filaggrin, which is responsible for retaining moisture in the skin.

The triggers of atopic dermatitis are very diverse, atopic skin is overly sensitive to irritation, so exacerbation can be caused by increased sweating, heat, rough clothing, detergents, dry air, etc. Children with atopic dermatitis may simultaneously have allergies to food, household or other animals, dust mites, tree and grass pollen - these allergens can also be triggers for exacerbations.

In general, atopic dermatitis has a wave-like course, periods of exacerbations (most often occurring for unobvious reasons or for no reason) are replaced by periods of remission - hence there is a great temptation to associate exacerbations with factors that are not directly related to the disease, and vice versa - to attribute healing properties to completely extraneous factors (for example, a diet that parents started by mistake or out of desperation).

It is impossible not to mention the established harmful domestic tradition of calling atopic dermatitis allergic (usually associating it with an allergy to cow’s milk protein) and treating it with diets (a strict “hypoallergenic” diet for a nursing mother, and/or a hydrolysis/amino acid mixture for a child). Indeed, if a child has an intolerance to cow's milk proteins, it may aggravate or cause atopic dermatitis, but not vice versa. Not every child with atopic dermatitis has an intolerance to cow's milk proteins or any other allergens. This means that by prescribing a diet, or an expensive and unpleasant-tasting mixture, the doctor adds problems to the family without helping them. In most cases of atopic dermatitis, identifying allergies and excluding allergens does not provide any benefit.

Rehabilitation

After the main symptoms of the disease are eliminated, the therapeutic methods do not end, but simply change from therapeutic to rehabilitation. They are presented:

Hirudotherapy.
Massage treatments.
Therapeutic exercises.
Physiotherapy.

If you consult a doctor in time and receive appropriate treatment, you will be able to get rid of the unpleasant consequences, but if you contact a doctor untimely, you will not be able to avoid complications.

Manifestations of atopic dermatitis

Skin symptoms and location of lesions vary in children of different ages. Common symptoms are the appearance of red, dry, itchy patches on the skin that occur as a result of inflammation. There is always itching - from mild to unbearable, disrupting sleep and appetite. Frequent scratching may cause scratches (scratching), oozing (separation of serous exudate through tiny defects in the epidermis), crusting, or erosion due to secondary infection. Sometimes, if atopic skin lesions, lesions from chronic pruritus and secondary infections last for many weeks, areas of skin atrophy (scars, hypopigmentation/hyperpigmentation, thinning or thickening of the skin) may develop.

In infants, atopic dermatitis usually affects the face, scalp, arms and legs. In older children, as a rule, only the elbows, popliteal fossae and wrists are affected. In some children with severe disease, the entire body may be affected. Eczema causes severe itching, which can in turn lead to a number of secondary problems: sleep disturbances, weight loss, depression (in the child or in the adult who cares for him), etc.

Symptoms usually worsen in the autumn-winter period (this fact is usually associated with the inclusion of central heating and more severe external climatic conditions) and improve in the spring-summer period, as well as in seaside resorts (this is usually associated with the abundance of ultraviolet radiation and milder climatic influences on affected skin). Typically, the most severe course of the disease is observed in children aged 6–18 months (in winter, exacerbations are more frequent and severe, in summer - less frequent and milder), then from year to year, exacerbations become less frequent and milder. By school, most children recover or have symptoms that do not reduce their quality of life.

Symptoms

If streptoderma occurs, what is the treatment? Before we know the treatment options, let's find out the symptoms. The disease in children occurs in extremely severe forms:

temperature up to 39C,
poisoning,
large lymph nodes.

The texture of the skin may vary depending on the form of the pathology:

Superficial. Initially, red spots form on the skin. After a couple of days they turn into blisters with a certain liquid inside. The blisters grow up to two cm in diameter, after which they rupture. Yellow crusts form in this area. After this, the skin in this area heals, and the pathology develops further.
Dry streptoderma . This form usually occurs in boys. Light and pink spots up to 5 cm in diameter form on the skin. They are found everywhere on the body. After they disappear, scars may remain.
Streptococcal infection. The pathology extends specifically to the corners of the lips; it is encountered when there is a deficiency of vitamin B. Small cracks form on the skin, causing discomfort. After some time, they form into pustules that become crusty. The child has difficulty consuming food, as it causes pain.
Felon. In a situation where streptococcus spreads to the area around the nails, panaritium develops. Oddly enough, this disease is more often encountered by children at an early age who bite their nails.
Streptococcal diaper rash. This form of pathology is typical for breastfed children. Blisters form in the folds of the skin.

Understanding how streptoderma begins to develop in children, treatment which requires timely contact with a dermatologist and the implementation of therapeutic actions, not a minute can be lost. If you constantly put off going to the doctor, the pathology can develop into a chronic form, and it will be almost impossible to achieve a final cure.

streptoderma, treatment

Diagnostics

There is no specific test or examination to confirm the diagnosis of atopic dermatitis; the diagnosis is made clinically. The doctor will examine the rash and ask about the child's symptoms and family history of atopy and allergies. A history of eczema in family members (either as a child or still today) will be an important clue.

Your doctor will rule out other conditions that may cause your skin to become inflamed or itchy. In case of difficulties with diagnosis or severe course of the disease, the pediatrician will refer the child to a pediatric dermatologist or pediatric allergist.

The doctor may ask you to eliminate certain foods (such as eggs, milk, soy, or nuts) from your child's diet for 2 to 3 weeks before reintroducing them and monitoring symptoms. If the diet leads to relief of the rash, and provocation leads to its obvious exacerbation, this will confirm the diagnosis and the need for a diet.

Since there are no accurate laboratory methods for confirming the diagnosis of atopic dermatitis, there are criteria for standardizing the clinical diagnosis (the best known are the Hanifin and Raika criteria).

The criteria are divided into “large” and “small”. To make a diagnosis of atopic dermatitis, it is necessary and sufficient to detect three major and three minor criteria in the patient.

The big ones include:

itching;
dermatitis affecting the flexor surfaces in adults, or the face and extensor surfaces in infants;
chronic or recurrent dermatitis;
a personal or family history of skin or respiratory allergies.

Small ones include:

specific facial features: facial pallor, erythema, hypopigmented spots, dark circles under the eyes, cheilitis, infraorbital folds, recurrent conjunctivitis, anterior neck folds;
typical triggers: emotional factors, environmental factors, food, skin irritants;
typical complications: susceptibility to skin infections, impaired cellular immunity, predisposition to keratoconus and anterior subcapsular cataracts, immediate skin reactivity;
other signs: early age of onset, dry skin, ichthyosis, hyperlinearity of the palms, piliary keratosis, dermatitis of the hands and feet, nipple eczema, white dermographism, white pityriasis, perifollicular accentuation.

An explanation of each of these symptoms is beyond the scope of this article; The criteria are given here to help you understand what the doctor is guided by when making a diagnosis of atopic dermatitis.

There are also various scales for assessing the severity of atopic dermatitis used by doctors and scientists, the most famous of which is the SCORAD scale. In this scale, the doctor must note the number, prevalence and severity of symptoms of atopic dermatitis, express them in points, sum up the points and, based on this sum, set the severity of the disease.

Therapy

Streptoderma has occurred ? Even in cases where the initial examination was carried out by a pediatrician, only a dermatologist can select therapy. Doctors in this field have an understanding of drugs with a narrow scope of action.

The first step is to limit the child’s diet. The course of treatment also involves avoiding water procedures, which can cause the spread of the disease. Healthy areas of the skin should be washed with a solution of chamomile, and damaged areas should not be touched at all.

The sick person needs to choose the right wardrobe, from which items of clothing made from synthetics and wool must be removed.

Doctors advise popping blisters that form on the skin with a disinfected needle, after which the abscess should be drained twice a day. Healthy areas of the skin are washed with a boron solution.

If crusts appear on the skin, they should be treated with antibacterial gels or ointments.

In more complex situations, many other medications may be prescribed:

antibiotics for streptoderma of the tetracycline or chloramphenicol series,
means that prevent the occurrence of an allergic reaction,
means aimed at improving the body's immune system,
vitamin preparations,
antipyretic.

The set of medications must be discussed with the doctor. With the right treatment, the symptoms disappear within a week, but after the severe form is eliminated, scars may remain. This is what streptoderma looks like .

what does streptoderma look like?

Treatment of atopic dermatitis in children

There is no complete treatment for atopic dermatitis, that is, there are no methods of therapy that would lead to complete recovery (change the long-term prognosis of the disease). All existing methods of therapy change only the short-term prognosis - for the coming months.

However, treatment is necessary:

to improve the quality of life of the child and family; for the prevention of secondary local complications (infections, skin atrophy, etc.);
for the prevention of psychological problems (sleep disorders, depression, etc.).

Treatment is divided into lifestyle changes (eliminating triggers) and drug interventions (eliminating symptoms).

Change of life. What can parents do themselves?

Don't let your baby's skin become excessively dry, severe itching, and avoid triggers. Try following these simple tips:

Children with atopic dermatitis should take short baths or shower with warm (not hot) water. Use mild, unscented soap or soap-free cleansers. Do not wipe, but pat your skin with a towel after washing. Immediately after bathing, apply moisturizer to your entire skin. Teenagers prefer to use unscented cosmetics and oil-free facial moisturizers.
Consult your doctor; if your child has no contraindications, add oat decoction to the bath when bathing; it can reduce itching.
Preference should be given to soft children's clothing made from breathable fabrics, such as cotton. Wool or polyester may be too harsh or irritating for atopic skin.
Your child's nails should be trimmed regularly and short to prevent scratching of the skin. If your child scratches himself at night, try putting him to bed in comfortable, lightweight mittens or with the sleeves of his pajamas sewn up.
Overheating of children should be avoided, as sweat can lead to exacerbations. This is especially true for Russian parents who are accustomed to hot temperatures in the apartment and wrapping their children up during walks.
Children should be encouraged to drink plenty of water.
Try to get rid of common allergens in and outside your home, such as pollen, mold and tobacco smoke.
Stress can make atopic dermatitis worse. Help your child find ways to cope with stress (such as exercise, deep breathing, or talking to a counselor).

Consequences of a cracked coccyx

In the absence of timely and adequate treatment, complications of this injury may occur. The most common consequences of a cracked coccyx include:

the formation of a complete fracture, most often it occurs spontaneously, when trying to rise to your feet, take a step, squat or strain during a bowel movement;
cauda equina syndrome - numerous radicular nerves emerge in the coccyx area, responsible for the innervation of the abdominal and pelvic organs, the performance of the lower extremities; with inflammatory and traumatic edema, this plexus can be compressed;
numbness of the legs and impaired muscle performance (paresis and paralysis);
disruption of the large intestine, leading to the development of persistent functional or spastic constipation;
dysfunction of the bladder sphincter (can manifest itself either in hyperactivity and frequent urination, or in the complete absence of urine excretion for several days);
poor posture due to compensatory redistribution of shock-absorbing load;
subluxation of the coccyx due to weakening of the surrounding muscles and ligaments;
weakening of the pelvic floor muscles and prolapse of internal organs.

In order to prevent the development of such complications, it is necessary to take a very responsible approach to the stage of primary treatment and rehabilitation. You can undergo rehabilitation in our manual therapy clinic. Experienced doctors work here who, using an individually designed course, will help restore the health of the spinal column.