Skin atopy in a child

Atopic allergy refers to an inflammatory dermatological disease in which an allergic reaction develops due to the influence of toxic substances and allergens on the body. One common type of atopy is childhood eczema. Most often, atopic allergies in childhood are congenital, caused by a hereditary factor. Children are susceptible not only to dermatitis, but also to other allergic manifestations - asthma, rhinitis, conjunctivitis, food allergies, hay fever. Based on the child’s age, the specialist determines the form of the disease:

1. infant – characterized by allergic manifestations under the age of 3 years;
2. childhood – characterized by the development of atopy between the ages of 3 and 7 years, flowing from the acute stage to the remission stage;
3. teenage – the disease manifests itself in children at school age from 7 years.

In almost half of the cases, atopic dermatitis is diagnosed in children under six months of age; in 6% of children, allergies occur in the first year of life and in 20% of cases after 5 years. Treatment of this disease in childhood causes certain difficulties, since most often the allergy is chronic and accompanied by other diseases.

Causes of atopic dermatitis in children

There are the following number of causes of atopy in children:

1. Difficult pregnancy. A child may develop a tendency to develop atopy while still in the womb, if during pregnancy the woman suffered from chronic diseases or suffered from an infectious disease, which could lead to hypoxia and infection of the fetus.
2. Food allergies. This reason can cause the development of the disease in the first months of a child’s life. Incorrect or untimely complementary feeding, refusal of breastfeeding and improper diet of the mother can provoke the appearance of dermatological diseases in the child. In addition, atopy occurs when the functioning of the child’s gastrointestinal tract is disrupted and diseases of a viral or infectious nature develop.
3. Additional diseases. Atopy most often affects children who have concomitant diseases of the digestive system (gastritis, the presence of worms, impaired intestinal microflora, enterocolitis).

In addition to food, other household allergens can cause allergies in a child:

1. contact: wipes soaked in liquid, powders and baby skin care products, creams and ointments;
2. inhalation: chemicals for cleaning apartments, air fresheners, powders, pollen and dust, rinses;
3. various medications.

Scientists have proven that having pets in the house reduces the risk of developing atopic dermatitis in a child by 4 times. This process is due to the fact that when the body comes into contact with infectious agents, the baby’s immunity is developed and strengthened. Thus, the body prepares to meet microbes naturally.

A number of factors that can affect the development and exacerbation of atopic allergies in childhood:

1. physical activity that causes heavy sweating;
2. seasonality, with this factor the immune system is overstrained, and the risk of developing diseases of an infectious nature increases;
3. adverse environmental effects: increased radiation, air pollution with toxic substances and vehicle exhaust;
4. if a child is near people who smoke, the body’s defenses and skin are weakened;
5. with nervous overstrain, frequent stressful situations and emotional overexcitation, the risk of exacerbation of the disease increases.

Any of the above factors can cause the development or exacerbation of atopy in a child, and when combined, they cause a more complex form of the disease. Therefore, when diagnosing atopic dermatitis in a child, treatment should have an integrated approach.

Symptoms of atopic dermatitis

With the development of atopic dermatitis, the following symptoms first appear in a child: the surface of the skin is covered with seborrheic scales, and there is also an increased secretion of sebum in these areas, peeling occurs in the eyebrows, ears and fontanel area, redness appears on the cheeks, causing constant itching and burning.

Atopy in childhood manifests itself in the form of eczema, spreading to the skin of the scalp, face, buttocks and neck, accompanied by severe itching. In older children, dermatitis can affect the armpits and groin area, around the eyes, and where the arms and legs bend. Most often, the disease worsens in the cool season.

Additional signs are added to the main symptoms: the child begins to lose weight, sleep becomes restless. Often these signs appear from the first days of the baby’s life; less often, atopy is accompanied by pustular lesions of the skin.

The main signs of the disease include:

1. redness of the cheeks, forehead and chin (diathesis);
2. pyoderma;
3. dry skin, accompanied by peeling;
4. the area of ​​redness becomes covered with painful cracks;
5. spreading redness over most of the face;
6. the appearance of papules and vesicles, after their opening ulcers, crusts and peeling appear;
7. wetness of the inflamed areas is noted;
8. the appearance of nodular rashes;
9. severe itching, worse at night.

In the chronic form of childhood atopy, there is thickening of the skin, increased skin pattern, pigmentation appears on the skin of the eyelids and cracks in the inflamed areas. Chronic dermatitis is characterized by the following symptoms:

1. the baby has a large number of deep folds or wrinkles in the lower eyelid area (Morgan's symptom);
2. there is less hair on the back of the head due to thinning;
3. The winter foot symptom develops - the feet become puffy, the skin in this area becomes peeling and cracked.

When diagnosing and prescribing treatment, all factors must be taken into account: the nature of the disease, the form and extent of the lesion. Most often, atopic dermatosis in an adult is correlated with neurodermatitis, and this often occurs in children. The manifestation of the clinical picture depends on the characteristics of its occurrence, periods of remission and the age of the child.

In the first weeks of life, scales may appear on the baby's head, which indicates the development of seborrheic dermatitis. In children under one year of age, atopic dermatitis occurs according to the nummular type, characterized by the appearance of small spots covered with a crust. The inflammation is localized on the skin of the buttocks and cheeks and develops mainly in children from 2 to 6 months.

Then, in half of the children suffering from the disease, by the age of two, the signs of dermatitis disappear, in the remaining 50%, the inflammation is localized in the folds of the skin, damage to the feet and palms occurs mainly in the winter, and recedes in the summer.

Atopy in young and older children is similar to diseases such as pityriasis rosea, eczema of microbial etiology, allergic contact dermatitis, seborrheic dermatitis, psoriasis.

Atopic dermatitis and stages of its development

Treatment tactics for childhood atopy depend on the severity and form of the disease, and are short-term or long-term. The disease is divided into four stages:

1. The initial stage is characterized by the appearance of redness, peeling and swelling of the skin of the cheeks. With the right approach, changes in diet and timely therapy, this stage can be treated. If treatment is prescribed at the wrong time and incorrectly, the initial stage moves to the next level.
2. The pronounced stage is characterized by acute development with a transition to a chronic form, which differs in the nature and sequence of appearance of the rash. In the acute form, the inflamed area has crusts and scales, the appearance of which is caused by microvesiculation.
3. Remission stage – the disease gradually recedes, the symptoms become less pronounced or disappear altogether. This stage can last from several weeks to several years.
4. Recovery stage – symptoms of the disease are absent for a long time; depending on the severity of the disease, they may not recur for up to 7 years.

Treatment of atopic dermatitis

If the condition is severe, treatment should include the use of topical corticosteroids in combination with emollients. Such therapy will help quickly relieve the baby from unpleasant symptoms. During any period of illness, moisturizers and emollients should be used. Treatment of atopic dermatitis includes the following areas:

1. the use of means and techniques that can change the disease process;
2. reducing the manifestation of the disease in the acute period;
3. over a long period, dermatitis should be strictly controlled.

Sometimes the child’s condition may require hospitalization when the disease contributes to the deterioration of the general condition of the body, and also provokes the re-development of the infection.

In addition to prescribing local medications, treatment of atopy in children should include non-drug therapy, which is aimed at eliminating or reducing the impact of negative factors that can provoke an exacerbation. These include: violation of the integrity of the skin, increased sweating, the presence of infectious diseases, stressful situations, chemical, contact and food allergens.

Depending on the form, stage and period of the disease, drug therapy is prescribed. Important factors that must be taken into account during treatment are the presence of diseases of the internal organs, as well as the extent of inflammation of the skin. Drugs for the treatment of atopic dermatitis in children are divided into drugs for systemic and external use. Systemic therapy is prescribed as independent treatment or as a comprehensive measure, which includes the following types of drugs:

1. Antihistamines. The effectiveness of the use of antihistamines in the treatment of dermatitis in children has not been proven. In case of severe itching and sleep disturbances, the specialist may prescribe the child an antihistamine with a sedative effect (Suprastin, Tavegil), which can also be used in case of allergic conditions such as rhinitis and conjunctivitis. It should be noted that these drugs can be used for a short period of time; instead, they are prescribed anti-allergy drugs of the 2nd or 3rd generation (Erius, Zodak and Zyrtec), which have a prolonged effect, do not cause drowsiness and addiction, and are effective and safe for use in childhood. Medicines come in different forms, in the form of solutions, drops, tablets and syrups. The effect of such treatment can be noticed after 3-4 weeks, so therapy should be at least 3-4 months. But there is an opinion that drugs without a sedative effect do not have the desired effect, so the need for their use should be determined by a doctor, based on the severity of the disease.
2. Antibiotics. If a bacterial infection is detected, the specialist prescribes systemic antibacterial therapy, the duration of which should not exceed 7 days. To combat streptococcal and staphylococcal infections, the following antibacterial and antiseptic agents are prescribed (Dioxidin, Furacilin, Xeroform and Dermatol ointments, Levomikol, brilliant green, Fucaseptol, hydrogen peroxide, Miramistin, Chlorhexidine). These drugs should be used up to two times a day; for severe pyoderma, the specialist prescribes systemic antibiotics. Before prescribing antibiotics, it is necessary to test the sensitivity of the microflora to the selected drugs.
3. Systemic therapy to enhance immunity. Immunomodulators are prescribed for mild or moderate dermatitis. But it is worth considering that such drugs are used as an adjuvant to the main treatment if there are signs of insufficient immune defenses. The danger of using immunomodulators in children is that if one of the child’s parents suffered from autoimmune diseases (diabetes mellitus, multiple sclerosis, Sjögren’s syndrome, rheumatoid arthritis), then even with short-term use of the drugs, the development of an autoimmune disease in the baby may occur. Therefore, if there is a hereditary predisposition to diseases of the autoimmune system, it is better to exclude the use of immunomodulators.
4. Antifungal and antiviral drugs. If concomitant fungal infections are detected, the specialist prescribes antifungal treatment with the following drugs for local use: Ketoconazole, Isoconazole, Clotrimazole, Natamycin. When accompanied by a herpes infection, treatment is carried out with antiviral drugs.
5. Vitamin complexes. The inclusion of vitamins B6 and B15 in therapy increases the effectiveness of treatment by improving the functioning of internal organs and restoring the skin. Vitamins in combination with the main treatment strengthen the body’s protective functions, help eliminate toxic substances and regulate lipid metabolism. But since the child may be intolerant to some herbal remedies and vitamins, such therapy must be included with caution.
6. Medicines to improve the functioning of the gastrointestinal tract. In the acute and subacute period of dermatosis, medications are prescribed to restore and improve the functioning of the digestive organs in the presence of changes in the gastrointestinal tract. This therapy helps improve the digestion process and correct systemic functions; for this purpose, Festal, Digestal, Enzistal, Creon, Panzinorm, Pancreatin, as well as diuretics and hepatoprotectors are prescribed. The course of treatment is 12-14 days.
7. Treatment of infectious diseases. Do not forget about the treatment of infectious diseases of the gastrointestinal tract, genitourinary system, oral cavity and ENT organs that accompany atopy.

In order to provide an anti-inflammatory effect, drugs containing glucocorticoids and non-hormonal drugs are prescribed.

If you need to use these drugs, adhere to the following rules when using:

1. Based on their action, drugs are divided into weak, moderate and strong. When treating dermatitis in children, medications of low activity are selected. An increase in concentration occurs only if the current therapy is ineffective and only on the recommendation of a doctor.
2. If you need to use a hormonal cream for a long time, you need to change the local product to another.
3. You should not abruptly stop using the drug, since such a refusal may worsen the patient’s condition and cause an exacerbation of the disease.
4. Therapy begins with the use of hormonal cream, which in the process must be diluted by 50% with baby cream, thereby reducing the concentration. The concentration should be changed every two days.
5. The use of hormonal drugs should occur in short courses, followed by a reduction and cessation of use.

For minor manifestations of atopic dermatitis, non-hormonal drugs are prescribed, such as antihistamines.

Diet for the treatment of childhood atopic dermatitis

Proper nutrition plays an important role in treatment, especially this point applies to infants. Based on the causes of the disease, it is necessary to exclude the use of products that may contain an allergen.

Up to 1 year of age, a child may have a reaction to such foods as:

If you have an allergic reaction to milk, you need to replace it with a soy product. If there is a severe form of food allergy, as well as intolerance to soy proteins, hypoallergenic mixtures are prescribed.

The introduction of new products should occur only after the consent of the doctor and no more than one product per day in small proportions. If the test for food intolerance results in a positive result, then the allergen product should be excluded from the diet.

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