Atopic dermatitis in newborns: symptoms, causes, recommendations | La Roche Posay

What is atopic dermatitis

Atopic dermatitis is a chronic relapsing inflammatory skin disease that develops most often in people with a genetic predisposition, characterized by intense itching and typical rashes in typical localizations inherent in this disease.

Approximately 60% of cases of atopic dermatitis in infants are diagnosed in the first year of life, a little less often at the age of 1 to 5 years, but occasionally a debut is also possible in adulthood. Let’s figure out where this disease comes from and how to deal with it.

Why does atopic dermatitis occur?

Some useful dermatological theory. The disease is based on a mutation with loss of function of the skin protein filaggrin. Filaggrin is a special protein that takes part in the process of cell division of the upper layer of the skin – the epidermis and is necessary to maintain the barrier function of the skin. Thanks to it, adhesion and interaction between skin cells – corneocytes is ensured. As a result of a genetic defect, disturbances in the structure of filaggrin occur, the relationship between skin cells weakens and transepidermal (percutaneous) moisture loss increases, which evaporates too quickly, leaving the skin dry and prone to microcracks.

Also in the upper layers of the skin, filaggrin breaks down into organic acids (urocanic and pyrrolidone-5-carboxylic), which are natural moisturizing factors and help maintain normal skin pH. The subcutaneous fat layer of the skin, which is a key place for retaining moisture, becomes thinner, there is a disruption in the functioning of the sebaceous glands and cell division processes.

Thus, this protein supports the most important functions of the skin. When a mutation occurs in the filaggrin gene, its decrease is noted, which leads to a violation of the composition of the water-lipid mantle of the skin, excessive loss of moisture, and a decrease in the barrier function of the skin. All these changes lead to the development of atopic dermatitis. And this, in turn, leads to the appearance of dry skin, the occurrence of an inflammatory process, redness, cracks. Itching appears, leading to scratching of the skin, the risk of skin infection increases. The complete absence of filaggrin leads to the development of another disease – skin ichthyosis.

In addition, due to a violation of the composition of the water-lipid mantle of the skin, its microbiome (a set of bacteria living on the skin) is disturbed and the risk of infection increases.

To understand this complex mechanism and the causes of atopic dermatitis, one can visualize the skin as a brick wall: cells are bricks, the water-lipid mantle is cement. With atopic dermatitis, lipid loss occurs, that is, the “cement” is broken, which should firmly hold our bricks – skin cells. The “wall” becomes unreliable, and the skin becomes fragile, permeable and vulnerable to irritants. A detailed analysis of the mechanisms of development of atopic dermatitis is important in order to understand the principles of treatment and prevention of exacerbations of atopic dermatitis.

Stage of the disease

The incidence of atopic dermatitis is higher in metropolitan areas than in rural areas. Since it is based on a genetic defect, it is necessary to find out if the parents had this disease. If the parents had atopy, then the risk of developing the child significantly increases. If both parents are sick, then the risk of occurrence reaches up to 80%, and if one of the parents, the child will inherit the disease in 50% of cases, and the risk increases if the mother is sick. Genetic predisposition leads to the onset of the disease, under the influence of trigger (provoking) adverse environmental factors.

Atopic dermatitis can manifest itself at different ages, but most often in infancy. Depending on age and clinical manifestations, three stages of the disease are distinguished: infantile (atopic dermatitis in newborns aged 0 to 2 years), children’s (2 to 7 years) and adult. Appearing in most cases in childhood, atopic dermatitis can take a long time, alternating periods of exacerbation and remission. In most patients, the disease improves over time. Recovery may occur by the age of 30-40, or the manifestations of the disease will significantly decrease. In a small number of patients, atopic dermatitis can become lifelong chronic. Factors that may indicate that the disease may continue to be difficult:

• atopic dermatitis in a family history;
• the presence of allergic rhinitis;
• the presence of asthma;
• widespread dermatitis;
• early age of onset and, to some extent, female gender.

Младенческий атопический дерматит часто могут называть «экссудативный диатез». Эта стадия заболевания появляется, как правило, с 3-месячного возраста и может продолжаться до 2 лет. Характеризуется участками сухости и шелушения у новорожденных на лице (щеках и подбородке), причем участки вокруг рта и носа не поражаются. Помимо лица, высыпания располагаются на коже туловища и разгибательных поверхностей конечностей. В более тяжелых случаях атопический дерматит у новорожденных характеризуется более распространенной сыпью, которая часто приобретает мокнущий (экссудативный) характер, появляются ярко-красные бугорки-папулы и мелкие пузырьки – везикулы с обильным серозным отделяемым. Область подгузников обычно не поражается. При засыхании образуются корочки желтоватого цвета. Беспокоит интенсивный кожный зуд.

At the age of 2 to 7 years, the picture of the disease changes, and the childhood stage of the disease is distinguished. Rashes change location: damage to the neck, wrists, flexion surfaces of the limbs, folds of large joints (popliteal fossa, elbow bends) is characteristic. Characteristic weeping foci, as in infancy, are now rare, there is inflammation in the form of redness, the appearance of tubercles, thickening of the skin, cracks may appear, intense itching is disturbing, as a result of which scratching of the skin appears.

From the age of 7, the stage of the disease is called adolescence or adult. The process on the skin becomes chronic and is replaced by periods of exacerbation and subsidence of inflammation. The most favorite localization of rashes in this stage is the face (especially the area around the eyes), neck, hands, feet, flexion surfaces of the limbs. The most characteristic manifestation at this stage is lichenification – thickening of the skin with an increase in the skin pattern and sometimes with a violation of pigmentation. The resulting exacerbation is characterized by burgundy-cyanotic inflammation, a pronounced thickening of certain areas of the skin and its dryness.

A characteristic symptom for all stages is severe dryness of the skin and moderate to superintense itching that complements it. Itching reduces the quality of life of patients with atopic dermatitis, it causes everyday discomfort and increases the risk of complications.

Intense itching can trigger a pathological itching-scratching cycle in which scratching increases the sensation of itching and itching causes an increasing desire to scratch the skin, a process referred to as the “vicious cycle of atopy”. Constant irritation and scratching of the skin only increases inflammation, and the resulting wounds increase the risk of skin infection.

First Aid Measures

Treatment of atopic dermatitis in infants and older children should be prescribed by a doctor. With mild manifestations during the day, you can use a stick for skin prone to atopy Lipikar Stik AP+, it is suitable for babies, children and adults.

Also, after water procedures, it is necessary to moisturize and nourish the skin with special lipid-replenishing balms or creams with a calming effect – this will help reduce discomfort at night – for better sleep.

Кожа младенцев сама по себе еще не совершенна и обладает высокой проницаемостью, а при возникновении атопического дерматита барьерная функция ослабевает и усиливается риск присоединения вторичных инфекций. В таком случае могут понадобиться антибактериальные средства, как для наружного применения, так и системно. Присоединений вторичной инфекции усугубляет течение атопического дерматита у новорожденных и детей, поэтому важно своевременно лечить обострение и соблюдать правила профилактики.

It is also important to remember about the possibility of a child developing the so-called atopic march. When there is no proper control over the condition of the skin, the disease is not taken under control, inflammation of the mucous membranes can join and allergic rhinitis develops. In the future, the lower respiratory tract may be involved, which leads to bronchial asthma. The following measures can help prevent the atopic march: regular skin care that reduces its permeability (bathing with gentle products suitable for age and skin type, mandatory moisturizing after water procedures), avoiding active and passive smoking, nutritional and microbial diversity is also recommended (avoid unnecessary diets and unnecessary space sterilization).

Atopic dermatitis is diagnosed in newborns and adolescents pediatrician, allergist or dermatologist based on the collection of complaints, anamnesis of the disease, family history and examination of the skin. Skin manifestations are quite typical and usually do not cause difficulties for the doctor in making a diagnosis. There are no laboratory tests that can confirm the diagnosis.

Назначаемое обследование может помочь оценить тяжесть состояния, а также исключить провоцирующие обострение факторы (например, бытовые аллергены). В тяжелых случаях назначают гистологическое исследование. Иногда необходимо дифференцировать данное заболевание с контактным дерматитом, чесоткой, грибковыми поражениями кожи, псориазом. Для данных заболеваний характерны свои симптомы, которые выявляются при осмотре, проведении кожных тестов и сборе жалоб. Первичная консультация врача поможет установить диагноз, оценить тяжесть состояния, подобрать лечебные и профилактические мероприятия.

Is a diet necessary?

For a long time it was believed that exacerbations of the disease occur due to food allergies, strict hypoallergenic diets were prescribed for the child and the nursing mother. According to recent data, it has been established that food allergies occur in only a third of children with atopic dermatitis. In 70% of cases of atopic dermatitis, there is no food allergy. Therefore, the appointment of everyone in a row a strict hypoallergenic diet is not shown. On the contrary, it is noted that limiting the variety of foods can weaken the body and further increase the risk of developing allergies. If there is a connection between the exacerbation of the skin process and some food consumed (eggs, fish, dairy products, etc.), then it must be excluded from the diet. Such reactions should be consulted by a doctor, to determine whether this is a true reaction or a coincidence of exacerbation, it may be necessary to conduct allergic tests, keeping a food diary.

We recall that atopic dermatitis is based on a violation of the protective barrier of the skin, so the main goals of therapy are:

• elimination or reduction of inflammatory manifestations on the skin and skin itching;
• restoration of the structure and function of the skin;
• preventing the development of severe forms of the disease;
• treatment of concomitant diseases as factors contributing to exacerbations.

Treatment and prevention

Treatment of atopic dermatitis is always local. In severe cases, systemic drugs are prescribed, but topical treatment is a priority. The doctor at the reception explains to parents how to treat, what creams, ointments, lotions, sprays should be used during periods of exacerbation of the disease, as well as during remission. Any drug for oral administration should always be prescribed by a doctor, after evaluating the causes of atopic dermatitis in infants.

During an exacerbation, topical steroids, hormone-containing ointments are used on the inflamed areas. Hormonal ointments do not need to be afraid, the effect of these drugs is time-tested and well studied, they are prescribed only during an exacerbation period and for a certain period, but for permanent use. The second line of drugs for less severe inflammation are topical calcineurin inhibitors. An obligatory item during the treatment of exacerbation and during remission is the use of emollients – moisturizing ointments, balms, lotions – created on the basis of active lipid-replenishing protective substances. In the presence of scratching and skin injuries, it is acceptable to use Cicaplast Baume B5.

To reduce the risk of atopic dermatitis in a child, a number of preventive measures can be used:

• избегать пассивного и активного курения во время беременности;
• establish breastfeeding up to 4 months, then – if possible;
• use emollients from birth (especially for children at risk).

If, nevertheless, the baby has atopic dermatitis, then a number of measures will help reduce the risk of developing exacerbations of the disease:

1. It is necessary to create a favorable microclimate in the room, high temperatures and overheating of babies and children should not be allowed, the optimum temperature is 18-21 ° C.

2. Humidity also needs to be maintained, the air should not be dry, it is recommended to use a humidifier to maintain the humidity of 40-70%, especially in winter, when heating dries the air in the room.

3. Choose quality clothes: only cotton fabrics should be in contact with the body. During periods of exacerbation, it is permissible to wear cotton clothing with the seams outward to avoid irritation of the already itchy skin at the site of the rash. At present, clothing has also been developed for those suffering from atopic dermatitis – in particular, children.

4. It is necessary to monitor the condition of the child’s nails so that he does not comb or injure the skin.

5. Skin care should be daily: the skin should not be dry, the use of moisturizers is mandatory after each bath – on the whole body and locally on places prone to dryness – during the day. It is recommended to use special products designed for skin prone to atopy. For example, lipid-restoring emollient bath and shower oil Lipikar AP+ Oil.

Suitable for traditional shower lovers lipid-replenishing cleansing cream-gel for face and body Lipikar Syndet AP+.

6. After water procedures, it is unacceptable to rub the body with a towel, you need to gently get wet and during the first 3-5 minutes, while it is still wet, apply emollient – Lipid-replenishing face and body balm Lipikar Baume AP+M.

7. As a therapeutic and preventive measure, it is also recommended to visit balneological resorts that use thermal waters for the treatment of atopic dermatitis. Do not forget about this opportunity when planning a vacation.

We summarize: Atopic dermatitis can and is important to take under control together with the attending physicians: a dermatologist, an allergist, a pediatrician. Proper therapy and special care during periods of exacerbation and no less important care during remission significantly improve the quality of life of those who are faced with this problem. The factor of stable adherence to the recommendations of the attending physicians is the key to success in treatment. As a rule, the lifestyle of people suffering from atopic dermatitis should not change critically – correct adjustments in nutrition / life / daily routine / hygiene and skin care are important.

La Roche-Posay is on a mission to improve the lives of people with very dry and atopic skin by offering Lipikar AP+ hypoallergenic, gentle and effective skin care formulas to protect, nourish and hydrate skin for a feeling of well-being.

1 — (Braun-Falco’s Dermatology Third Edition 2009. W.Burgdorf, G.Plewig, H.Wolff, M.Landthaler (Editors) p.409.)