Atopic dermatitis in children

What is atopic dermatitis

Atopic dermatitis is a chronic inflammatory skin disease formerly called neurodermatitis or atopic eczema. Most often it manifests itself in babies up to a year and in early childhood.

This is one of the earliest immunological processes associated with increased sensitivity of the child’s body to environmental allergens. In childhood, it accounts for up to 85% of cases of all allergic reactions.

Early signs may appear as early as the first year of life, sometimes even in the first weeks and months. Pathology has an undulating course with periods of exacerbation and attenuation of symptoms. In some children, symptoms disappear by puberty, while others carry atopic dermatitis into adulthood.

Causes of atopic dermatitis in children

For many years, this disease was mistakenly called “diathesis on the cheeks” by parents and pediatricians of the old school, and was not considered a serious problem, and therefore was not treated properly. In fact, atopic dermatitis is a chronic lesion of the skin on the face and body that occurs due to violations of the barrier functions of the epidermis. Penetration into the body of allergens provokes inflammation and immune responses.

Most often, the cause of atopic dermatitis in children lies in a defect in the gene that produces the filagrin protein – this is the link between the cells of the stratum corneum of the skin, which ensures its protective function. But allergies, for example, food, accompanies only a third of cases of atopic dermatitis in children, but it is considered more severe.

The main causes of atopic dermatitis in children can be divided into two groups: allergens and non-specific triggers.

Allergies can occur to food (seafood, chocolate, nuts, and more), dust (more specifically, dust mites), mold, animal dander, or pollen.

Non-specific triggers include dry and hot air, hot water (or poor quality water with a high chlorine content), laundry detergents or other household chemicals, diapers, wearing tight or scratchy clothing, and stress.

Risk Factors for Atopic Dermatitis

The mechanism of the onset of the disease is not yet fully understood. An important role is played by hereditary factors and a violation of the structure of the skin at the genetic level. The result is dryness and increased sensitivity of the skin to irritants. Exacerbation of the disease can be provoked by food allergens, climate change, stressful situations, acute infections, mechanical stimuli.

The main risk factors for atopic dermatitis in children are as follows:

• genetic features: for example, an overreaction of the immune system to allergens or birth defects of the genes responsible for the protective proteins of the skin;
• in fact, “allergic” irritants: contact with house dust, food products that provoke allergies (chocolate, citrus fruits, nuts), animal hair, plant pollen, and others;
• climate and bad ecology;
• second hand smoke;
• stressful situations.

Types and stages of atopic dermatitis in children

There are several types of atopic dermatitis in children.

• Erythematous-squamous form. It is typical for her when a rash appears in the form of nodules-papules on dry, flaky skin. Most of them are formed on the back of the hands, on the side of the neck and in the elbows.
• Prurigo-like form. With such dermatitis, dense bumps appear on dry skin, which are very itchy. Around them, due to scratching, bloody crusts form. Such a rash usually occurs on the upper half of the body, on the face, hands.
• Lichenoid form. The skin with such dermatitis is dry and red, a skin pattern can clearly stand out on it. Against the background of redness, small papules appear.
• Eczematous form. In eczematous atopic dermatitis, the rash usually covers the hands and feet. Small nodules with bubbles are poured onto them, they burst, after which crusts remain on the skin.

Atopic dermatitis in children can be limited, that is, the rash affects the skin only in a certain place, or it can be widespread, covering several parts of the body.

In addition, according to the severity of the course, a mild form of atopic dermatitis is distinguished, as well as moderate and severe.

Symptoms of atopic dermatitis in children

The main symptoms of atopic dermatitis in children are:

• rash (red, rough to the touch, sometimes dry, sometimes weeping),
• dry, irritated skin that is constantly itchy and flaky,
• itching, especially worse at night.

In this case, the rash can be localized in separate areas on the cheeks, buttocks, on the popliteal and elbow folds, wrists, shins and skin folds, and can capture several parts of the body at once. Rashes never affect the genital area, which helps to distinguish atopic dermatitis from other diseases.

Treatment of atopic dermatitis in children

The first thing that is important to do with atopic dermatitis is to exclude exposure to provoking factors or allergens. In addition, you need to properly care for the skin of the child and use therapeutic creams in a timely manner to prevent a secondary infection.

In the treatment of atopic dermatitis in children, it is important to regularly monitor the skin.

Constant skin care allows you to maintain its moisture and barrier functions. Moisturizing (basic) creams should be used regularly, and not only during an exacerbation: 2-4 times a day and after water procedures that dry and irritate the skin.

With an exacerbation of the disease, therapeutic agents and therapeutic procedures are used.

Diagnostics

Before starting treatment for atopic dermatitis, children should be taken to see a pediatrician, dermatologist, or allergist. A visual examination of the rash, as well as skin allergy tests, an immunogram, and, in some cases, provocative tests along with a diet, will help a doctor diagnose this ailment.

With skin tests, the specialist will determine which allergen drops cause a reaction in the child’s immune system, and the immunogram will show the level of antibodies to allergens in the blood. It is important to emphasize that skin tests are performed only in children older than 5 years, before this age they do not give clinically significant results and are technically difficult to perform. In addition, they can only be carried out without exacerbation, which is not always possible in children.

To identify a possible food allergen, one or another product is removed or added from the diet, after which the reaction of the body is evaluated. If, for example, honey appears in the diet and a rash appears, the allergen has been found.

Change in nutrition

An obligatory element of the treatment of atopic dermatitis in children is diet.

In only 15-30% of children with atopic dermatitis, food affects its course, and food allergies are confirmed by tests. Despite this, the role of diet is very important.

The nutrition of a child with such a diagnosis should change, foods that provoke allergic reactions will have to be excluded from the diet. Most often, children with atopic dermatitis have to give up excessive consumption of citrus fruits, honey, nuts, chocolate and a number of other elements that may be allergic.

– Ideally, try to exclude from the diet fried, smoked, salty, spices and sweets, rich products, cocoa, strawberries, black currants, pomegranates, fruits and vegetables of red-orange colors, as well as honey, nuts, mushrooms, fatty meat and caviar, doctors explain.

Along with a change in nutrition, living conditions will also have to be adjusted: exclude the child’s contact with pets, wearing woolen or synthetic clothing. All this can also awaken a bright response of the immune system and cause a rash.

Therapeutic methods

Treatment of atopic dermatitis in children involves not only the rejection of certain products and the use of moisturizers for the skin, but also the use of medicated creams.

Creams for atopic dermatitis in children

In the treatment of atopic dermatitis in children, it is very important to properly care for the skin of the child, especially during the period of exacerbation of the disease – to moisturize it, making up for defects in the barrier function. For this purpose, the doctor prescribes emollients – special preparations (creams, lotions, ointments, emulsions), which include fats that retain moisture.

In exacerbations, topical steroids or calcineurin inhibitors are selected. Topical steroids are prescribed only by a doctor and are approved for use if the child is older than 4 months. If topical steroids are not available, the doctor will prescribe calcineurin inhibitors, which are legal from birth. Also, emollients are necessarily prescribed (they are different in remission and exacerbation), which must be applied to the skin from 2 to 8 times a day, and sometimes every two hours if necessary. As for antihistamines, they are prescribed only for severe itching, because they have no effect on the rashes themselves.

According to the doctor, many parents make several mistakes when treating atopic dermatitis in a child. Often, without understanding which product causes allergies, the child is immediately put on a strict hypoallergenic diet, which is why the baby does not receive many of the necessary vitamins, minerals and trace elements. Also, allergies may not have anything to do with it at all, and the skin is flaky, covered with a rash due to dry air in the room or stress. Also, parents often sin on dysbacteriosis or even worms and rush to treat the intestines, but still atopic dermatitis is primarily a skin disease, and it is she who needs to be treated.

Ointments for the treatment of atopic dermatitis in children

Some parents flatly refuse hormonal drugs (ointments) in the treatment of atopic dermatitis in a child and in vain. It is topical hormonal preparations that are included in the gold standard for the treatment of this disease during an exacerbation. And there are no negative consequences from them, provided that the dosages and recommendations of the doctor are strictly observed.

Preparations for the treatment of atopic dermatitis in children

So, for the treatment of atopic dermatitis in children can be used:

• hypoallergenic creams softening and moisturizing the skin;
• during exacerbation – hormonal ointment courses no more than 5-7 days.
• antihistamines for the relief of allergies.
• ointments with antibiotics and antifungal components if a bacterial infection occurs.

Vitamins A and E are also prescribed, for drying weeping areas – bismuth subgallate, and for tissue regeneration – dexpanthenol.

In severe atopic dermatitis, systemic hormonal therapy is prescribed. Phototherapy is also used, in which the skin is exposed to light using a special apparatus.

Allergen-specific immunotherapy is also used in treatment. At the moments when atopic dermatitis lies at the bottom, small doses of an allergen are introduced into the child’s body, which especially irritates his immune system. This is done so that the body produces blocking antibodies and, over time, the sensitivity to the allergen decreases.

Folk remedies

With atopic dermatitis, doctors do not advise resorting to folk remedies. The best way to deal with the problem will help proper skin care and diet, as well as the advice of a doctor.

If you don’t want to buy lotions in a pharmacy, you can try to prepare them yourself, but you need to take into account the possible risks, because the child may also be allergic to the components of such a folk remedy.

When to see a doctor

Any rash on the body of a child is an alarming symptom. If something has changed in your diet or wardrobe, experiment, maybe new clothes or foods that he did not eat before cause a rash in a child.

If it was not possible to calculate the culprit of dermatitis, go to the doctor. Itching can be quite painful, the sooner it stops, the happier your baby will be. With a rash in a child, you can contact a pediatrician, dermatologist or allergist. Any of these specialists will tell you what actions to take.

Prevention of atopic dermatitis in children

There are few rules for the prevention of atopic dermatitis in children.

First, adjust the child’s diet and daily routine, try to do everything so that he does not experience stress.

Secondly, moisturize and care for your skin. Bathe your baby regularly, dry gently and do not neglect moisturizing hypoallergenic lotions and creams.

Thirdly, remove possible allergens from the environment: refuse synthetic clothing, allergenic foods such as chocolate, nuts, honey, red fruits and vegetables.

Doctors assure that if these rules of prevention are followed, atopic dermatitis in children will not make itself felt.

Popular questions and answers

We discussed with the experts a few more questions regarding atopic dermatitis in children.