Useful information: what is skin dermatitis and how to treat it?

August 16, 2020

Dermatitis is an inflammation of the skin that can occur due to a variety of irritants: allergens, aggressive chemicals, fungi, and adverse weather factors. Chronic inflammation of the skin also occurs with psoriasis, but in this case the condition is distinguished as a separate disease, and dermatitis is a collective concept, a syndrome that may not relate to any specific disease, occurring periodically.

What are the varieties?

Dermatitis has a complex classification. Depending on the nature of the skin disease, there are:

Simple contact

Occurs with direct physical irritation. Factors that provoke the occurrence of dermatitis are skin friction, pressure, temperature effects, alkalis, acids, poisonous plants. Surely, many have encountered this type of skin irritation. Yes, yes, we are talking about burns, frostbite, chafing, and rashes from detergent.

Contact

Symptoms appear almost immediately after contact, the area of ​​skin damage corresponds to the area of ​​contact with the irritant. With minor exposure, dermatitis manifests itself as mild redness and itching; acute cases may be accompanied by the appearance of blisters filled with liquid and swelling of the skin.

Allergic

This is a hyperreaction of the body to contact with certain substances. Allergic dermatitis, like all forms of allergies, manifests itself in individuals predisposed to it.

Causes of allergic type development

Unlike simple contact, allergic does not develop immediately, but after several contacts with the allergen. An allergic reaction must form; several weeks may pass from the moment of the first interaction.

Manifestation of allergic dermatitis

With the allergic type, the area of ​​the affected skin area may be larger than the immediate site of contact with the irritant. As the disease worsens, the skin becomes bright red with pronounced swelling, weeping blisters appear, which open and erosion develops in their place. As the inflammation heals, scales and crusts form - these may be symptoms of incipient eczema.

Seborrheic dermatitis of the scalp

Irritation appears in the area of ​​greatest accumulation of sebaceous glands - in the scalp, on the ears, and less often on the face (on the wings of the nose). Often the initial form of the disease is dandruff in the hair.

The cause is the Malassezia fungus, which is present on the skin of most people. But its excessive reproduction leads to increased peeling, and as a result, seborrhea develops.

One form of the disease is perioral cutaneous dermatitis - irritation appears near the mouth.

Causes and types of dermatitis

The disease occurs when the protective function of the skin is weakened due to prolonged exposure to aggressive substances or decreased immunity. The cause of the pathology can be the following factors:

• mechanical irritation, friction, compression of the skin;
• thermal burn or frostbite, ionizing, UV and other radiation, electric current;
• contact with chemicals contained in skin care products, household chemicals, decorative cosmetics, as well as salts of heavy metals, acids or alkalis, medications for external use;
• allergic reaction to plant pollen, animal hair, food, medications;
• infection with viruses, bacteria or fungi;
• taking antibiotics, sulfonamides, novocaine-containing drugs;
• systemic diseases, hormonal disorders, hypovitaminosis, pathology of the digestive organs, liver, disorders of carbohydrate and fat metabolism, helminthic infestation, influenza and ARVI.

According to etiological factors, there are:

• Perioral dermatitis. It occurs due to the abuse of cosmetics, improper local use of hormonal drugs, the use of medicated fluoride-containing toothpastes, hypovitaminosis A and E. In childhood, it appears with increased salivation and during teething.
• Atopic dermatitis. Occurs mainly in children prone to allergic reactions and has a hereditary predisposition. Irritants may include foods, allergens of plant or animal origin, dust mites, Staphylococcus aureus enterotoxins, and mold fungi. Rashes in a child of the first years of life are localized mainly on the face and extensor surfaces of the limbs, and at an older age and in adults, dermatitis appears on the elbows and popliteal folds.
• Contact allergic dermatitis. Appears when the skin comes into contact with substances to which the immune system is sensitized. May develop at lightning speed and be accompanied by anaphylactic shock.
• Actinic dermatitis. An allergic reaction to ultraviolet radiation, also known as sun allergy.
• Drug dermatitis. Occurs as a reaction to the use of medications (iodine, brilliant green).
• Seborrheic dermatitis. The cause of the disease is fungi of the genus Malassezia. Exacerbation occurs in hot and humid weather, with stress, hormonal, immune and neuroendocrine disorders, when the activity of the sebaceous glands increases. In places where they accumulate, the symptoms are more pronounced. Most often, seborrheic dermatitis affects the scalp, face, and upper third of the body.
• Infectious dermatitis. It develops when the skin is damaged by pathogenic bacteria, viruses, and fungi.
• Dry dermatitis. Occurs in people with sensitive skin during the cold season.
• Lichen planus. It is characterized by the appearance of red or pink plaques and intense itching. May affect nail plates.
• Toxidermy. A disease of an allergic nature, in which an irritant enters the body through the blood, respiratory system or oral cavity. There are medicinal, food and professional forms.

Atopic dermatitis

Serious chronic disease. It is of an allergic nature: irritation occurs to substances that can penetrate both through contact and through the lungs and stomach. The atopic type often develops in childhood and often remains with a person for life, turning into a chronic form.

Due to the fact that dermatitis is a general name for skin diseases, symptoms and external manifestations of the disease are of great importance in diagnosis.

Choosing a cream for dermatitis on the face and body, depending on the type of disease

Dermatitis is divided into the following types:

• Atopic.
• Allergic.
• Seborrheic.
• Contact.
• Diaper.

These types of diseases have different symptoms and causes of occurrence. Therefore, there is no universal remedy for dermatitis that would be equally effective in treating all types of this disease. In each specific case, the dermatologist prescribes the drug to the patient individually.

Itchy skin dermatitis

Chronic inflammation of the skin, which is characterized by inflammation, itching, burning. Itchy skin is the body's reaction to irritation of nerve endings, accompanied by scratching of the skin and general increased nervousness.

Itchy dermatitis can spread throughout the body (atopic and allergic dermatitis, allergies to animal hair, pollen, etc.) and be localized - on moving parts of the body, on open areas of the skin.

Symptoms of dermatitis

The main manifestations of the disease are redness and increased pigmentation of the skin, the formation of focal rashes, thickening, swelling, itching of varying intensity in the affected areas, burning, pain and other symptoms of tissue irritation. In acute form, the inflammation process occurs in stages:

1. In the erythematous stage, redness, itching and burning are moderate, and there is slight swelling.
2. The bullous stage is more severe. Blistering rashes appear on the affected areas, and the itching becomes intense. When scratching, first weeping wounds are formed, which are subsequently covered with a dense crust.
3. The last necrotic stage is characterized by the formation of scabs and ulcers at the site of scratching. The rash covers increasingly larger areas. Old injuries gradually heal without consequences or with the formation of scars.

With chronic dermatitis, the symptoms are less pronounced, the disease remains in the first stage for a long time.
As a result of prolonged inflammation, the skin becomes rough, dense scales and a white coating resembling a dry callus appear on it. In severe cases, the affected areas atrophy and turn pale. The clinical picture depends on the form of the disease. In the case of its allergic nature, the itching and burning are more intense, the redness is more pronounced than with contact dermatitis. Affected skin areas can spread throughout the body, regardless of where the irritant is applied.

Atopic dermatitis is characterized by intense itching. As it progresses, blisters filled with cloudy liquid form in hyperemic areas of the body. In the last stages of the disease, severe dryness and pallor of the skin predominate.

In the oral form of dermatitis, the first rashes are localized on the face - in the area of ​​the cheeks, bridge of the nose, chin, and near the mouth. This is characterized by the presence of a rim of healthy skin around the red border of the lips. Itching, flaking, dryness and a feeling of tightness are noted.

Contact dermatitis is characterized by local redness of the skin in places of contact with the irritant, swelling, a rash in the form of blisters, the appearance of cracks, dryness and weeping. There is itching of varying severity, burning and pain in the inflamed areas.

Eczema is manifested by a variety of rashes, severe itching, dryness and flaking of the skin, cracks, redness, swelling or weeping.

Toxidermia is characterized by urticaria, the appearance of red and pigmented spots on the skin, oozing, swelling of the face and limbs, peeling of large scales, and acne.

The generalized form can occur as lichen planus, allergic vasculitis, lupus erythematosus.

Infectious dermatitis

The main causes of this disease are infections in non-healing wounds on the skin. The infectious type develops in patients with chickenpox, atopic dermatitis, or another disease if the infection gets into the rash that accompanies these diseases (often by scratching). Also, skin irritation may appear after operations and injuries due to infection with staphylococcus, streptococcus, etc.

The course of the disease is accompanied by the appearance of pustules without clear boundaries on the surface of the skin or purulent inflammation under the skin.

Complications of dermatitis

Any form of dermatitis accompanied by skin damage can be complicated by infection.
In the chronic course of the disease, thinning of the skin and the appearance of small dilated vessels - telangiectasia - are possible. With prolonged atopic dermatitis, a child may develop asthma and allergic rhinitis. Among the adverse consequences of the seborrheic form of the disease are acne with the formation of visible skin defects, abscess, and baldness. The most serious are considered generalized complications such as Quincke's edema, Lyell's syndrome or Stevens-Johnson syndrome.

Red dermatitis, also known as lichen planus

This is a chronic itchy skin disease, which is accompanied by the appearance of pink-red-violet rashes, merging into large plaques, up to 10 cm in size, with the formation of garlands and rings.

Locations: the lateral part of the body, the inner surface of the arms in places of flexion, mucous membranes of the mouth and genitals.

There are several forms of damage to the skin and mucous membranes. Manifestations of the disease are very diverse: papules, spots, erosions, blisters, etc.

Cream for diaper dermatitis

Diaper dermatitis is a common problem occurring in infancy. It appears as a result of non-compliance with hygiene rules, insufficient removal of excrement residues from the skin in the anogenital area of ​​the baby, irrational use and rare changes of diapers, and excessive sweating of the baby. This type of disease can affect not only children, but also adults who are forced to wear diapers - the elderly and bedridden patients.

To reduce the symptoms of this type of disease, non-hormonal children's remedies for dermatitis are usually prescribed - for example, with zinc, panthenol, and plant extracts. To prevent the appearance of diaper dermatitis, you can use La-Cri diaper cream. It contains zinc oxide, panthenol, shea and jojoba butters, beeswax and licorice extract.

If an infection joins the rash and inflammation begins, antimycotics and antibiotics are prescribed.

How to distinguish psoriasis from seborrheic dermatitis?

Diseases are often confused. Although both diseases share common features, they also have many differences. Common characteristics include a chronic type of disease and an undulating course, the presence of rashes, itching, and peeling of the skin. What is the difference between psoriasis and dermatitis?

• Prerequisites for development. If psoriasis appears under the influence of autoimmune, endocrine, and genetic disorders, then seborrheic dermatitis is caused by increased activity of the sebaceous glands and yeast-like fungi.
• Symptoms. Despite the fact that in both cases the skin is covered with scales, their structure and appearance are different. When oily yellow crusts appear, we are talking about seborrheic dermatitis, and when dry gray, white or silvery scales form, psoriasis can be diagnosed.
• Localization. Psoriasis can affect almost all areas of the skin, and seborrheic dermatitis is localized mainly on the scalp, neck and face.

If you experience skin rashes that could be a sign of both dermatitis and psoriasis, be sure to consult a dermatologist. Usually, a qualified doctor can determine what it is by the external manifestations of the disease. If mixed symptoms occur, the dermatologist will write a referral for additional examinations.

Causes of dermatitis in children and adults

The disease is caused by various external and internal causes of dermatitis:

• atopic dermatitis is associated with a complex of factors - dry skin, genetic changes, immune dysfunction, bacterial contamination of the skin, environmental conditions;
• contact dermatitis is the result of direct exposure to one of many irritants - poisonous plants, nickel, cleaning products, preservatives, perfumes, etc.;
• Seborrheic dermatitis is caused by fungal parasitism in the sebaceous secretions of the skin.

Risk factors for the disease:

• Age. The disease can occur at any age, but allergic dermatitis usually begins in infancy.
• Hereditary predisposition. Atopic skin inflammation in a child is more likely if one or both of his parents have allergic diseases.
• Allergic diseases and asthma. People with these conditions are more likely to develop atopic skin lesions.
• Profession. The risk of contact dermatitis increases when working with metals, solvents, cleaning products, and medications.

Accompanying illnesses. The risk of seborrhea is increased by heart failure, Parkinson's disease, and HIV infection.

Reasons for appearance

The main factors that can trigger the appearance of one or another form of dermatitis have already been listed. All inflammation and irritation of skin diseases are the result of remote or provoked causes.

• Remote ones include genetic predisposition or acquired individual predisposition. The latter occurs, for example, due to allergies or a previous infectious disease.

Related causes that trigger the development of dermatitis are various conditions to which the body reacts with skin irritation. These include stress, contact with chemicals, reaction to climate, and hormonal changes in the body.

Regardless of what resulted from the onset of the disease, remember: dermatitis must be treated immediately before it becomes protracted and chronic.

Irritative dermatitis

In irritative dermatitis, the rash may be caused by physical or chemical irritation and damage to the skin, in which case it is not usually associated with an allergy. This type of damage can be caused by soap, detergents, food products, and building materials.

The necessary examination and adequate modern treatment for each form of dermatitis can be determined by highly qualified specialists of our center - the Three I Immunology Clinic - allergists and dermatologist. Come visit us at Novosibirsk, st. Galushchaka, 2, we will help solve your problems!

Dermatitis on the skin of the body

A dermatologist can diagnose the disease. Contact him if you notice the first symptoms.

Symptoms

Typical manifestations of skin disease:

• redness
• itching
• combs
• pustules
• peeling skin

Allergic dermatitis can be accompanied by a prolonged runny nose, paroxysmal cough, nasal congestion and sneezing. Acute dermatitis is usually characterized by the formation of subcutaneous blisters filled with colorless liquid. With wet dermatitis, redness and deep cracks form on the skin, from which pus or lymph oozes. Dry dermatitis is characterized by flaking and a feeling of tightness of the skin. Since it is possible to cure your skin, you should never give up, no matter what the symptoms of the disease are!

Discoid dermatitis

Discoid dermatitis is characterized by the appearance of round or oval spots in symmetrical areas, often on the extensor surfaces, usually in adult patients. Exogenous causes must be excluded.

Dyshidrosis is a variant of eczema in which recurrent vesicles or bullae affect the palms, fingers, toes, or both. The disease is characterized by remissions and exacerbations, which are sometimes provoked by fever, emotional stress, and active fungal infection.

Treatment is real!

How to treat allergic dermatitis is an individual question. Sometimes it is enough to eliminate the irritating substance, sometimes drug therapy is necessary.

Treatment of any type of dermatitis, even such a complex form as chronic itching, begins with determining the source of such a reaction. Often you just need to stop contact with the irritating substance, and the reaction on the skin will gradually go away on its own. In more complex cases, therapy with antihistamines is necessary.

Treatment at home is only possible for mild skin lesions and a known cause. If you have any suspicions or doubts, you should contact a professional.

The answer to the question “How to cure dermatitis?” should be added a little: treatment of dermatitis should be accompanied by maintaining a healthy lifestyle. After all, irritation on the skin can occur with general weakening of the body. Therefore, it is necessary to switch to a diet of natural hypoallergenic products, maintain hygiene of the affected areas, and limit the use of decorative cosmetics that do not allow the skin to breathe.

An important aspect is the impact on the symptoms of the disease in order to relieve itching, eliminate the feeling of dryness and tightness of the skin - this is usually what worries patients the most, preventing them from leading a full lifestyle.

Treatment of dermatitis

Treatment tactics for dermatitis depend on the cause and form of the disease. General recommendations for the patient include:

• establishing a work and rest schedule, sleeping at least 8 hours a day;
• a diet based on limiting fried, spicy and canned foods, possible food allergens;
• carrying out hygiene procedures in warm water (not higher than 34°C);
• eliminating stress and nervous overload.

In case of severe itching, accompanied by sleep disturbances and neurological disorders, the prescription of sedatives, mainly of herbal origin, is indicated.
It is important to stop contact of irritants with the skin or internal environment of the body as soon as possible. To achieve this, cleansing and general detoxification measures are carried out:

• in case of chemical exposure to the skin, it is thoroughly washed and a bandage is applied with a neutralizing substance - alkali for an acid burn or an acid for an alkali burn;
• for perioral, drug-induced and allergic dermatitis, after washing the skin, enterosorbents, a hypoallergenic diet, and in severe cases, intravenous infusions of special solutions are prescribed;
• Treatment of parasitic infestation is carried out using anthelmintic drugs.

Also in the treatment of dermatitis, antihistamines, antibiotics and antifungals are used both locally, on the skin, and systemically.
Wet areas of the skin can be treated with antiseptic solutions and herbal infusions that have a drying effect. Hormonal ointments for dermatitis have an anti-inflammatory effect. Severe itching and pain, as well as a large area of ​​damage and the appearance of areas of tissue necrosis, are indications for urgent hospitalization of the patient. In case of severe disease with damage to more than 20% of the skin, a course of prednisolone tablets is recommended. In such situations, treatment may be supplemented with immunosuppressive drugs.

Author:

Pugonina Tatyana Alekseevna, Therapist

Ointment "La-Cri" - a reliable assistant

To care for affected skin, either alone or in combination with ongoing therapy, we recommend using La Cree cream. This is a non-hormonal product that does not contain dyes or fragrances, and therefore is suitable even for newborns, nursing and pregnant women.

The natural composition of the cream is selected in such a way as to simultaneously solve all the problems of irritated skin. The product perfectly relieves redness and itching, promotes rapid regeneration of damaged skin, nourishes and softens even very dry and flaky skin.

As an auxiliary product, you can use the non-greasy emulsion “La-Cri”, which provides gentle care for the skin, moisturizing it and protecting it from drying out. Treatment of dermatitis on the face will be faster with La-Cri washing gel, which gently cleanses delicate skin without clogging pores.

Experts' opinion

The conducted clinical study proves the high efficiency, safety and tolerability of products for daily skin care of children with mild and moderate forms of atopic dermatitis and during remission, accompanied by a decrease in the quality of life of patients. As a result of therapy, a decrease in the activity of the inflammatory process, a decrease in dryness, itching and flaking was noted.

The products are recommended by the St. Petersburg branch of the Union of Pediatricians of Russia.

It has been empirically proven that La Cree emulsion moisturizes and nourishes the skin, relieves itching and irritation, and also soothes and restores the skin.

External therapy of atopic dermatitis: a view of the problem from the perspective of a pediatrician

Atopic dermatitis (AD) ranks first in the structure of allergic diseases in children, especially in children of the first years of life. AD most often begins in early childhood and has a relapsing course. As a rule, blood pressure is the earliest manifestation of atopy, and in some children it is the beginning of the “allergic march.” Of course, blood pressure significantly reduces the child’s quality of life, so the problem of timely and adequate treatment of the disease has now acquired particular medical and social significance.

The high incidence of the disease, its wave-like course, and frequent relapses of the disease lead to the fact that it is the practicing pediatrician, as a rule, who solves the tactical problems of treating blood pressure in a child. At the same time, issues related to diagnosis and determination of treatment strategy must be resolved in each specific case by an allergist.

The importance of the role of the pediatrician in the monitoring and treatment of patients with AD is also emphasized in the fundamental national documents on the diagnosis and treatment of atopic dermatitis in children. For example, the conciliation document of the Association of Children's Allergists and Immunologists of Russia is called “Modern strategy for the treatment of atopic dermatitis: a pediatrician’s action program.”

It is obvious that the distribution of children with AD in different medical observation groups is different. Thus, according to the allergology department of Children's Clinical Hospital No. 38 of the FU Medbioextrem, children with atopic dermatitis made up 29.5% of all patients hospitalized in the department over 3 years. Of these, the vast majority of children were under the age of 7 years - 78.6%. A widespread form of AD was observed in 62% of observed children, a diffuse form - in 15.6%, severe AD was diagnosed in 31% of patients. Secondary skin infection was detected in 35.7% of patients.

The structure of the distribution of blood pressure according to the forms and severity of the disease turned out to be somewhat different in the pediatric ward, for patients for whom the diagnosis of blood pressure is not typical (children with blood pressure are usually hospitalized in the allergy department). As a concomitant diagnosis, atopic dermatitis was noted in more than 1/4 of children hospitalized in the PBO, while the vast majority of patients with AD were also under 7 years of age. However, mild AD was observed in 1/3 of patients, and moderate AD was observed in 2/3. Moreover, local and less common forms predominated. The diffuse form with severe hypertension in children observed in the boxed department was diagnosed extremely rarely.

In the outpatient practice of a local pediatrician, AD occurs frequently: approximately every third child under the age of 3 years has manifestations of AD, but mainly we are talking about local forms of mild and moderate severity, while children with severe and complicated AD are observed by an allergist. Therefore, the introduction of algorithms for the treatment of blood pressure in children is one of the urgent tasks of modern pediatrics.

Treatment of AD, of course, should be comprehensive, individual and depend on the age of the child, the form and stage of the disease.

General principles of AD treatment include:

• diet therapy;
• elimination regimes, environmental control;
• systemic pharmacotherapy;
• external (local) therapy;
• educational programs.
  External (local) therapy is a mandatory component of complex treatment of AD. Main areas of local therapy:
• elimination (reduction) of inflammatory changes on the skin and the main symptoms of AD associated with it (itching, hyperemia, swelling, skin rashes, etc.);
• reducing skin dryness, improving skin barrier functions;
• prevention and elimination of secondary skin infections.

It is known that the basis of the pathogenesis of AD is allergic inflammation of the skin. Consequently, all patients with AD need anti-inflammatory therapy, mainly external. The prescription of external anti-inflammatory drugs is the main method of treating children with AD and does not depend on the causes of its occurrence. However, the nature of external therapy should be determined by the stage of activity of skin inflammation and its clinical symptoms.

Anti-inflammatory external agents can be divided into two main groups: topical glucocorticosteroids (GCS) and anti-inflammatory drugs that do not contain glucocorticosteroids.

The effectiveness of external GCS in patients with AD has been proven by many years of practice and numerous controlled studies. Currently, GCS are, of course, the most effective anti-inflammatory drugs. However, until recently, both doctors and patients experienced persistent “corticosteroid phobia”, which was explained by the presence of side effects in the previous generation of corticosteroids (fluorinated), as a result of which these drugs were not approved for use in young children. Currently, external corticosteroids of “increased safety” have been created and have undergone controlled clinical trials in pediatric practice: methylprednisolone aceponate (Advantan), mometasone furoate (Elocom), alklometasone dipropionate (Afloderm), hydrocortisone 17-butyrate (Lokoid). Advantan (emulsion, cream, ointment and fatty ointment), Afloderm (cream and ointment) and Lokoid (ointment) are approved for use in children from 6 months of age, and from 2 years - Elokom (lotion, ointment, cream) .

Assessing the effectiveness and safety of external corticosteroids is most important for pediatric practice. The fact is that the skin of children has anatomical and physiological characteristics that increase the risk of side effects when using topical corticosteroids. The skin of children is more sensitive to the effects of corticosteroids: drugs are absorbed into the bloodstream in greater quantities, which increases the risk of increasing their concentration in the blood, as well as the development of local side effects associated with inhibition of collagen and elastin synthesis in the skin and cell mitosis. Therefore, it is so important to take into account age restrictions when prescribing drugs, and the duration of therapy should be determined in accordance with the instructions for use of this drug (in all cases it should not exceed one month with daily use of the drug). In addition, the recommended dosage (frequency of application to the skin) should never be exceeded. So, it is enough to use Advantan and Elokom once a day.

Considering the long chronic course of blood pressure and the need for long-term external therapy, the use of the group has always been the focus of attention of pediatricians. For many years, to treat the chronic and subacute stages of dermatitis, drugs such as ASD preparations of the III fraction, sulfur, tar, naftalan oil, zinc oxide, dermatol, and ichthyol have been used. The effectiveness of these products is low, in addition, most of them have a strong odor and contaminate clothes. Currently, these drugs are used less and less.

The most recent advance in the clinical use of steroid-free topical anti-inflammatory drugs is the advent of the calcineurin inhibitor pimecrolimus (Elidel 1% cream). According to the mechanism of anti-inflammatory action, pimecrolimus is a selective inhibitor of pro-inflammatory cytokines. The principal property of pimecrolimus is lipophilicity, as a result of which it is distributed in the skin and does not penetrate the systemic circulation. The clinical significance of this property is the absence of systemic action and accumulation, which allows the drug to be used for a fairly long time. When started early, with the appearance of the first signs of inflammation, Elidel prevents the development of exacerbations and provides long-term control over the disease. Elidel is well tolerated by patients of all age groups and can be safely used on all areas of the body, including sensitive areas - face, neck and skin folds. This drug has passed all the necessary controlled clinical trials, confirming its high effectiveness and safety in the treatment of blood pressure in children starting from 3 months of age. Our study also showed high efficiency and good tolerability of the drug in young children suffering from mild and moderate atopic dermatitis without pronounced clinical signs of secondary infection.

The drug is applied to the skin 2 times a day (if necessary, it can be applied to large surfaces of the skin), in combination with moisturizers, which can be used immediately after using the drug. An exception is the use of pimecrolimus immediately after swimming, when it is applied to the skin after a moisturizer.

When prescribing external anti-inflammatory treatment to a child with AD, it is extremely important to choose the right drug, depending on the stage of AD and the severity of the disease. Basic anti-inflammatory therapy is currently carried out using two classes of anti-inflammatory drugs: corticosteroids and pimecrolimus. If a patient has severe atopic dermatitis, therapy should always begin with the administration of external corticosteroids. For mild and moderate AD, the choice of drug is determined by the stage of the disease and previous therapy: in case of exacerbation, pimecrolimus is prescribed; if there is no effect within 5 days, external corticosteroids are prescribed. When positive dynamics are achieved, you can switch to pimecrolimus therapy, if necessary - long-term, up to a year.

Thus, therapy with external corticosteroids, in the apt expression of Professor G. A. Samsygina, can be called “fire therapy,” while when inflammation subsides or with moderately severe inflammatory phenomena, it is advisable to use pimecrolimus or other anti-inflammatory non-steroidal external agents.

Skin infections in patients with AD, especially those caused by Staphylococcus aureus (St. aureus), significantly complicate the course of atopic dermatitis and worsen the prognosis of the disease. Moreover, in some cases, both pyoderma and allergic reactions to skin microflora are observed, and St. aureus may act as a superantigen. In the case of an uncomplicated localized skin infection, the child can be prescribed fucorcin, an aqueous solution of methylene blue and other similar antiseptics. If such treatment is insufficiently effective, ointments with antibiotics and antiseptics (gentamicin, lincomycin ointments), antifungal ointments (clotrimazole, nizoral) or combination drugs that include an antibacterial, antifungal agent and an external glucocorticosteroid (pimafucort, triderm, etc.) are used.

When prescribing external anti-inflammatory drugs, you should always remember the need to use moisturizers/emollients . As remission occurs, in no case should the intensity of moisturizing treatment be reduced, since dry skin itself can provoke itching and serve as a factor in the development of exacerbation. It should be noted that to restore the barrier function of the skin, it is necessary to moisturize it (hydration, saturation with water), and also restore its lipid layer with the help of emollients. Many modern preparations for external use combine both of these properties, which makes their use more effective. However, moisturizing and softening products for skin care for children with AD should not contain stabilizers, fragrances, or alcohol. Mineral oils, petroleum jelly, lanolin can also provoke an exacerbation of blood pressure, as they impair the synthesis of lipids in the skin. Such products as Trixera cream, Atoderm, Lipikar, Topikrem, Mustela have proven themselves well. A moisturizer and emollient must be applied quite often, sometimes 5–10 times a day, so that the skin does not remain dry. After bathing, apply the product immediately to slightly damp skin.

The choice of the optimal dosage form of the drug for external use is also important. Thus, for acute inflammation with weeping, lotions, aerosols, lotions, and emulsions are most effective; for acute inflammation without weeping - water mash, aerosols, creams, pastes; if the inflammation is subacute - creams, ointments; for chronic inflammation - ointments, fatty ointments, and in areas of lichenification - ointments with keratolytic properties.

Thus, only a differentiated approach to the treatment of AD in children can ensure stable remission of the disease. External therapy for AD in children includes the use of anti-inflammatory local drugs in combination with moisturizers and emollients and, if necessary, antiseptic, antibacterial and antimycotic drugs for topical use. During the period of exacerbation of the disease, it is most important to rationally determine the tactics of anti-inflammatory therapy.

For severe cases of AD, local corticosteroids are prescribed; for mild and moderate cases, anti-inflammatory drugs that do not contain steroids are first used, and if there is no effect within 5 days, they switch to corticosteroids; when acute inflammation subsides, they return to nonsteroidal drugs, which are used until remission of blood pressure is achieved. During the period of remission, you can limit yourself to moisturizing and softening agents used “as needed” (Fig. 1). This strategy for external therapy of blood pressure is somewhat reminiscent of a “stepped approach” to the basic therapy of bronchial asthma, when the doctor determines the optimal choice of drugs depending on the severity of the disease and the degree of control over the symptoms of the disease. Very figuratively, we can compare this approach to external treatment of blood pressure with traffic light signals (Fig. 2): “red” - severe exacerbation, corticosteroids are indicated, “yellow” - anti-inflammatory drugs that do not contain steroids, “green” - moisturizers and emollients. The Scientific and Practical Program of the Union of Pediatricians of Russia “Atopic dermatitis in children: diagnosis, treatment, prevention” emphasizes that “only timely and adequate treatment of children with atopic dermatitis ensures stable clinical remission of the disease.”

O. V. Zaitseva, Doctor of Medical Sciences, Professor of Russian State Medical University, Moscow

How to care for skin with dermatitis?

Helping herbs

Many plants have an amazing property - when absorbed into the skin, they reduce inflammation and normalize its structure. Therefore, a common remedy for the treatment of dermatitis is herbal compresses, wraps, and herbal ointments for dermatitis.

You can use a single plant or herbal mixtures that contain several herbs.

• Grind the celandine and squeeze the juice out of the resulting mass. Dilute the juice with boiled water in a ratio of 1 to 2. Use the solution for compresses: soak gauze in it and apply to the affected skin for 10-15 minutes.
• 1 tbsp. Pour 100 ml of boiling water over a spoonful of dry crushed string and leave until a dark brown solution is obtained. Moisten gauze or bandage in the prepared concentrate and apply it to the irritated skin until completely dry (not with weeping dermatitis, otherwise the bandage may dry to the skin). The procedure can be carried out 3 times a day.

Recipe with tar soap

The healing properties of tar have been known for a very long time. This thick oily liquid has a positive effect on the condition of the skin. Birch tar has an anti-inflammatory and antiseptic effect, improves blood circulation and stimulates skin regeneration.

You can find tar soap on sale and use it to wash skin affected by dermatitis, or prepare soap according to a folk recipe.

• Mix 100 g of crushed and melted baby soap with 2 tbsp. spoons of any oil, add 2 tbsp. fly in the ointment and 100 ml of water. Mix the resulting mixture until smooth.

Hormonal cream for dermatitis

Hormonal ointments and creams against dermatitis contain glucocorticoid hormones. These drugs are usually prescribed during the acute period of the disease and for extensive skin lesions. The effect of their use becomes noticeable after just a few sessions of use. When acute symptoms of dermatitis gradually decrease, it is recommended to switch to treatment using non-hormonal agents.

Hormonal drugs for dermatitis are divided into 4 groups:

• First (low activity). This group includes drugs for dermatitis, characterized by slow absorption and a slight decrease in the intensity of the symptoms of the disease. Due to the low activity of the main components, such drugs usually require frequent use and a long course of treatment. Corticosteroids included in this group are usually prescribed for minor rashes and inflammatory processes. However, despite their relatively low effectiveness, they are the safest of all hormonal drugs. If there is a need to prescribe glucocorticosteroid drugs to a child, doctors usually give preference to such dermatitis creams for children.
• Second (moderate action). Drugs in this group are more effective, so they are prescribed for moderate and moderate inflammatory processes. The frequency of use is up to 3 times a day.
• Third (high activity). The agents included in this group are characterized by a long-lasting action and a fairly high intensity of absorption of the active components. The frequency of application to the affected areas of the skin is 1-2 times a day.
• Fourth (super strong action). This group includes the most active and aggressive glucocorticosteroids. They are characterized by a prolonged action and a rapid decrease in the intensity of the symptoms of the disease. They are used for severe inflammatory processes, as well as in cases where weaker drugs do not give the desired result. The duration of treatment is no longer than 7 days (under the supervision of a doctor), the frequency of application is 1 time per day.

The main rule to remember when treating dermatitis: never prescribe hormonal drugs to yourself. Their composition is quite aggressive, so you should use such products only as prescribed by a doctor, without exceeding the recommended dose and frequency of application. Otherwise, there is a danger of side effects, including skin atrophy. Withdrawal of corticosteroids should occur gradually. In addition, hormonal products for external use have contraindications: they are not used in cases of liver and kidney dysfunction, in the presence of fungal skin infections and tuberculosis, and skin cancer is also a contraindication.

Chatterbox

Prepare a semi-alcohol solution: to do this, dilute 40 ml of alcohol with the same volume of water. Add 2 ml of 2% lidocaine or novocaine to the resulting solution - this will help relieve the painful symptom.

Add 30 g of dry white clay and the same amount of powdered zinc. Mix thoroughly until smooth.

The finished mash is applied to the affected skin, previously cleaned with an antiseptic, in a thin layer, the mixture is left on the skin for 20 minutes. There is no need to apply a bandage on top; excess talker can be carefully removed, and the remaining part on the skin forms a protective film.

Remember! Do not self-medicate, consult a doctor!

Cutaneous dermatitis is a general name for skin disorders caused by various irritants. All irritants can be divided into 2 large groups: those that cause irritation upon direct contact and those that affect the body when they get inside.

Sources:

1. Molochkova Yulia Vladimirovna, Dermatology. Brief reference book, publishing house: GEOTAR-Media, 2017
2. Baumann Leslie, Cosmetic Dermatology. Principles and practice, publishing house: MEDpress-inform, 2016
3. Ratner Desiri, Avram M.R., Avram M.M., Procedures in Dermatology. Clinical cosmetology, Publishing house: GEOTAR-Media, 2019
4. Sukolin Gennady Ivanovich, Clinical dermatology. A short guide to the diagnosis and treatment of dermatoses, publishing house: Notabene, 2017

Photos of dermatitis

Advantages of the Mama Papa Ya clinic

The network of family clinics “Mama Papa Ya” offers a range of medical services for the diagnosis and treatment of dermatitis. Our advantages:

• consultations with a highly qualified dermatologist and allergist;
• diagnostic studies to detect allergen;
• the possibility of simultaneous treatment in the clinic of several family members, both adults and children;
• affordable prices for diagnostic and treatment procedures.

Make an appointment with a doctor at a time convenient for you by phone or through the form on our website.

Reviews

Good clinic, good doctor!
Raisa Vasilievna can clearly and clearly explain what the problem is. If something is wrong, she speaks about everything directly, not in a veiled way, as other doctors sometimes do. I don’t regret that I ended up with her. Anna

I would like to express my gratitude to the staff of the clinic: Mom, Dad, and me. The clinic has a very friendly atmosphere, a very friendly and cheerful team and highly qualified specialists. Thank you very much! I wish your clinic prosperity.

Anonymous user

Today I had a mole removed on my face from dermatologist I.A. Kodareva. The doctor is very neat! Correct! Thanks a lot! Administrator Yulia Borshchevskaya is friendly and accurately fulfills her duties.

Belova E.M.

Today I was treated at the clinic, I was satisfied with the staff, as well as the gynecologist. Everyone treats patients with respect and attention. Many thanks to them and continued prosperity.

Anonymous user

The Mama Papa Ya clinic in Lyubertsy is very good. The team is friendly and responsive. I recommend this clinic to all my friends. Thanks to all doctors and administrators. I wish the clinic prosperity and many adequate clients.

Iratyev V.V.

We visited the “Mama Papa Ya” Clinic with our child. A consultation with a pediatric cardiologist was needed. I liked the clinic. Good service, doctors. There was no queue, everything was the same price.

Evgeniya

I liked the first visit. They examined me carefully, prescribed additional examinations, and gave me good recommendations. I will continue treatment further; I liked the conditions at the clinic.

Christina

The doctor carefully examined my husband, prescribed an ECG and made a preliminary diagnosis. She gave recommendations on our situation and ordered additional examination. No comments so far. Financial agreements have been met.

Marina Petrovna

I really liked the clinic. Helpful staff. I had an appointment with gynecologist E.A. Mikhailova. I was satisfied, there are more such doctors. Thank you!!!

Olga

How does the immune system normally work?

The concept of atopic dermatitis reflects the immunological mechanism of pathology development. It is based on the body’s ability to produce an excess amount of antibodies in response to incoming allergens. Antibodies combine with the allergen, which provokes a more pronounced allergic reaction than should be normal.

Let's figure out how the immune system should work normally. It’s worth starting with the fact that the system is represented by several organs (thymus, lymph nodes) and immunocompetent cells. Their main task is to protect the body from foreign elements: viruses, bacteria, fungi and allergens. This is accomplished through the development of protective reactions that are provided by certain cells. That is, the immune system recognizes foreign elements, destroys them and forms immunological memory.

Two types of cells help to perform such functions - B-lymphocytes and T-lymphocytes (killers, suppressors and helpers). Each type of cell has its own role in the operation of the system. Thus, B lymphocytes recognize foreign elements and form memory cells. T-killers are necessary to destroy foreign elements, T-helpers are involved in strengthening the immune response in response to the penetration of pathogenic agents. Suppressor T cells regulate the strength of the immune response by controlling the number of helper and killer cells.

The key to proper functioning of the immune system is a certain ratio of immunocompetent cells. With any quantitative disturbances, the immune reaction becomes pronounced, which is what happens during atopic dermatitis.

To prevent repeated exposure to the pathogen, the immune system forms a memory. It is synthesized by certain antibodies, or immunoglobulins, that form on the surface of B lymphocytes. Antibodies are proteins that have high specificity for antigens. As a result of their connection with antigens, an immune response is triggered in the body.

Several types of antibodies may be present in the body - immunoglobulins A, M, G and E. Each of them has its own function. For example, immunoglobulins A are responsible for protecting the respiratory tract. Immunoglobulins M and G are components of humoral immunity and arise as a result of the penetration of bacteria and viruses. Also, immunoglobulins G appear some time after the disease and can remain in the body for up to several years.

Immunoglobulins E arise as a response to the penetration of allergens. They are the ones who trigger an allergic reaction, which is accompanied by the release of various biological substances (for example, histamine). Under the influence of these substances, a person develops characteristic allergy symptoms: redness, itching, swelling.

Normally, the body contains very little immunoglobulin E, since these cells quickly disintegrate. However, as a result of a genetic mutation, some people have very high levels of these immunoglobulins, which increases the risk of developing atopic dermatitis on the face and body.

When it first encounters a foreign element, the immune system synthesizes certain antibodies. They help protect the body from re-infection for a certain period of time. During an allergic reaction, the process occurs differently. Upon contact with an allergen, a sufficient amount of antibodies is produced, which will subsequently bind to the allergen. Upon repeated contact, an antigen-antibody complex appears. An allergen acts as an antigen. An antibody is a protein produced by the body.

The antigen-antibody complex triggers a whole chain of immunoallergic reactions. With a large amount of immunoglobulin E, a pronounced and prolonged allergy appears. Simultaneously with the allergic reaction, a number of biologically active substances are released. It is these substances that trigger pathological processes that lead to the appearance of typical allergy symptoms. If the amount of immunoglobulins remains high, then the allergic reaction does not disappear, which indicates the development of atopy.

results

After therapy, all patients showed positive results, however, the dynamics of itching and signs of inflammation when using combination and monotherapy had statistical differences.

Thus, on lesions where combination therapy was used ( Neotanin

+ Akriderm), the intensity of itching by the 3rd day of the study decreased by 60% (from 10 points to 4), with monotherapy with Akriderm - only by 22% (from 9 points to 7;
p
= 0.02) (Fig. 1).

Rice.
1. Intensity of itching (on a 10-point scale). According to the daily diaries of patients, in areas of the body where Neotanin

, the itching stopped much faster: after 8-15 minutes - compared to monotherapy with Akriderm, in which the cessation of itching was observed on average only after 60 minutes (
p
<0.01) (Fig. 2).

Rice. 2. Time to relieve itching after applying the drug, min. The duration of antipruritic action after application of Neotanin
+ Akriderm was on average 2-3 hours, Akriderm - only 30 minutes (
p
<0.01) (Fig. 3).

Rice.
3. Duration of antipruritic action after application, min. Thus, the duration of antipruritic action (time for resolution of clinical manifestations) with combination therapy of Neotanin
with a topical glucocorticosteroid is 4 times higher compared to monotherapy with a topical glucocorticoid (Fig. 4).

Rice. 4. Terms of resolution of clinical manifestations when using combination therapy compared to monotherapy with a topical glucocorticosteroid: a) in a 35-year-old woman with moderate atopic dermatitis (exacerbation); b) a 35-year-old woman with acute eczema of the hands.

Rice. 4. Terms of resolution of clinical manifestations when using combination therapy compared to monotherapy with a topical glucocorticosteroid: c) in a 25-year-old woman with mild atopic dermatitis (exacerbation).

Frequency of itching on the half of the body to which Neotanin

+ Akriderm, by the end of the 1st week decreased by 75% - from the indicator “very frequent itching” to the indicator “rare itching”;
in the area of ​​application of Akriderm by 25% - from the indicator “very frequent itching” to the indicator “frequent itching” ( p
<0.01).

The severity of itching was assessed on a scale from 0 to 4 points, where 0 points means no itching, 4 means severe itching. At the 1st visit, the average score was 4 on each side. By the end of the 1st week, on the areas of the body where Neotanin

+ Akriderm, severity of itching decreased to 2 points (mild itching);
Akriderm - up to 3 points (moderate itching) ( p
<0.02).

Each of the signs of inflammation (erythema, edema, oozing, excoriation, lichenification and dryness) was assessed on a scale from 0 to 3 points, where 0 points means no symptom, 3 means a pronounced symptom. The intensity of inflammation was determined by the sum of scores of all signs. The intensity of skin inflammation on the 7th day of treatment decreased by 50% on skin areas after application of Neotanin

+ Akriderm, by 22% - in areas with monotherapy with glucocorticosteroids (
p
<0.01).

In addition, during monotherapy with Akriderm, in 3 patients an exacerbation of the skin process was recorded on the 5th-7th day of therapy, in 1 patient a bacterial infection was noted on the skin area.

In general, during treatment, an increase in the quality of life was found in almost all patients included in the study.

On areas of the body where Neotanin

+ Akri-derm, the effectiveness of therapy on the 4th visit (10th day) was assessed by the doctor in 37 (92.5%) patients as a marked improvement, in 3 (7.5%) - as an improvement. After using Akriderm, the indicators were as follows: in 7 (17.5%) patients there was a marked improvement, in 27 (67.5%) there was an improvement, in 5 (12.5%) there was no change, in 1 (2.5%) %) - deterioration.

DIQL was measured at the beginning and at the end of treatment: a decrease was noted from 21 points (the disease has an extremely strong impact on the patient’s life) to 9 (the disease has a moderate impact on the patient’s life).

Preparations for external use

Dermatitis on the hands is often accompanied by itching, which gets worse at night. Many patients complain of waking up in the middle of the night and being unable to fall back to sleep. In such cases, it is recommended to wear cotton gloves before going to bed and take a light herbal sleeping pill.

Acute inflammatory process is relieved with glucocorticoid ointments or creams. Depending on the severity of the lesion, the use of drugs of weak or moderate effect is prescribed. If skin lesions spread and affect not only the skin of the hands, but also other parts of the body, the use of strong hormonal drugs is necessary. Since dermatitis on the hands is accompanied by swelling and burning, patients are often prescribed creams. Due to their structure, they have a cooling effect, which helps reduce swelling, and a rapid antipruritic effect. Weak hormones include hydrocortisone, and moderate hormones include prednisolone, fluocortolone, and prednicarbate. Glucocorticoid creams are used for a limited amount of time, usually no longer than a week.

Relieving acute inflammation is only the first step of therapy. The chronic stage is also characterized by itching (albeit not as intense) and, most importantly, dry skin. Dryness provokes peeling and cracks that interfere with the healing of the skin. To normalize metabolic processes in the skin, including water balance, it is necessary to resort to additional hydration. The greatest effect comes from applying creams after hygiene procedures. Under the influence of warm (but not hot) water, the epidermis softens, and the crusts dissolve and come off.

However, it is worth noting that washing your hands with soap will most likely lead to a negative result, since alkali dries out the skin and, once it gets into the wounds, causes tingling and exudate. Delicate care is provided by special medicinal and cosmetic care products for inflamed skin. Thus, “Losterin” body gel, which can also be used as hand soap, does not contain surfactants, fragrances or dyes. And 4 types of vegetable oils in its composition, deresined naphthalan and Japanese sophora extract provide both cleansing, bactericidal effect, and moisturizing of the skin. In the acute period, it is recommended to cleanse the skin of the hands with micellar water and clean soft wipes.

After water procedures, the skin is carefully blotted (do not wipe!) with a towel and moisturizer is applied. For hand skin dermatitis, creams containing vegetable oils and panthenol are useful, which create a thin fatty film on the surface of the skin and do not allow the liquid to evaporate. Vegetable oils can be applied to the skin in the form of lotions, or they can be included in creams. Traditionally, olive, flaxseed, sea buckthorn, sunflower oil, avocado and jojoba oils are used in dermatology. In addition, products with the addition of plant extracts and vitamins are needed. These components provide nutrition to skin cells and accelerate regeneration. Preparations containing tar, naphthalan, salicylic acid, and zinc help relieve skin itching.

The restoration of epithelial cells is facilitated by preparations with propolis. This natural remedy has desensitizing, anti-inflammatory and regenerative properties due to its composition. Propolis contains flavonoids, aromatic and fatty acids, free amino acids, proteins, alcohols, minerals, sugars, vitamins, steroids, and many microelements. However, ointments, sprays and creams with propolis can be prescribed only to those people who are not allergic to honey and pollen. In other cases, the product may cause a severe allergic reaction.

In most cases, chronic dermatitis on the hands can be treated with external herbal medicine. It can be combined with hygienic procedures. For example, after an evening shower, it is useful to take hand baths with extracts or infusions of pine needles, chamomile flowers, oak bark, calendula, birch buds, string, burdock root, plantain leaves, poplar buds, and lungwort. After a 10-minute bath, the skin of the hands is also dried with a towel and moisturizer is applied.

Cream for dermatitis during pregnancy

Dermatitis in pregnant women is quite common. Even if a woman has never suffered from this disease before, it may first appear during pregnancy. One of the reasons for its appearance during this period is a change in the hormonal background of the expectant mother and a decrease in the defenses of her body.

In most cases, the disease goes away on its own after the birth of the child. But this does not mean that you just need to wait for the body to heal itself, because during pregnancy the disease can cause serious physical and emotional discomfort to a woman and make her irritable. In addition, if an infection gets into the scratching area, there is a real danger of inflammation and suppuration of the skin.

Choosing a remedy for the treatment of dermatitis in pregnant women is a serious task, which only a qualified doctor can cope with. Therefore, under no circumstances use drugs that you are not sure of, and do not follow unverified advice and recommendations from neighbors and friends. Trust a professional in this matter, because an incorrectly selected product can cause harm not only to you, but also to the child.

Hormonal creams for dermatitis are prescribed to pregnant women extremely rarely - only in cases where the benefits of their use outweigh the potential harm. If there is no other option, then the doctor must assess the possible risks and prescribe a glucocorticosteroid drug with a minimum dose of hormones.

If possible, instead of corticosteroid medications during pregnancy, it is recommended to use moisturizing and nourishing products containing natural ingredients - vitamins, zinc, plant extracts and oils.