Dermatitis - an inflammation of the skin caused by exposure to external agents (factors). There are three types of dermatitis: dermatitis on physical factors, from chemical factors, from biological factors.
In addition, the dermatitis can be divided into simple (in other words, banal, contact, artifitsialny) dermatitis and allergic contact dermatitis, which often happens dermatitis from exposure to chemical factors. For a simple contact dermatitis characterized by occurrence of the lesion focus solely on the ground impact irritating factor, the lack of sensitization and dissemination of the trend towards the periphery of the hearth. Most often, a simple contact dermatitis occurs acutely, soon after exposure to the stimulus. Upon termination of the stimulus dermatitis rapidly regresses. New irritants might cause dermatitis.
Dermatitis on physical factors Which physical factors can cause dermatitis? This may be the emission of various etiologies (solar radiation, X-rays, radioactivity), high and low temperature (burns and frostbite), electric current, mechanical action (friction, pressure). Clinically, there are three stages of dermatitis (any): erythematous, bullous, necrotic. Treatment. In acute solar dermatitis lesions smeared cold cream Uns, mash, pre-puncturing large blisters. In chronic solar dermatitis prescribe mitigating or corticosteroid ointment. In order to prevent solar dermatitis, especially those with increased sensitivity to sunlight, it is recommended to use sunscreen ointments: quinine, metiluratsilovoy or protective creams that contain para-aminobenzoic acid. In severe radiation injuries of patients are placed in specialized hospitals (mainly hematological profile), where they prescribe stimulants (blood transfusion, biostimulators, serum, plasma, etc.), a diet rich in protein, vitamin therapy
Dermatitis from biological factors to biological factors that may cause a simple contact dermatitis (fitodermatit), include such plants as the northern or white fraxinella, cow parsnip, primrose, Ranunculaceae, some species of mahogany. Defeat occurs when walking in the morning dew resting on the grass (especially after bathing), haymaking. There is erythema and blistering rash with serous content, which allowed for a week, leaving pigmentation. When contacting human skin with different caterpillars caterpillar dermatitis may develop from exposure to substances secreted by glandular cells of caterpillars.
Treatment. When dermatitis caused by plants, produce puncture blisters, apply lotions and lubrication tires 2% solution of aniline dyes.
Dermatitis from chemical factors Dermatitis from chemical factors constitute the largest group, and the degree of skin damage can be divided into obligate stimuli (this includes a strong acid and alkaline solutions), ie those that necessarily cause inflammation of the skin; optional stimuli (the last ones are weak solutions of acids and bases), they can cause, or may not cause inflammation to the skin; sensitizers (this is the biggest and create the largest group of problems of chemical irritants, so exactly how the chemicals-sensitizers may cause such damage to the skin, as contact allergic dermatitis, drug reaction, contact eczema). In order to cause sensitization, an allergen must penetrate into the skin. Eliminating allergens performed in three different ways: through the catabolic and immune elimination through the lymphatic system and blood capillaries. Elimination occurs when the immune adherence to allergen skin's own proteins and their transformation into full-antigens, which accumulate in the cells of Langerhans, and after the presentation of antigen on the surface of Langerhans cells are the immune response. The result is a release of neurotransmitters and, consequently, skin vessels dilate and the skin appears erythema, due to increased vascular permeability appears edema and skin microvesicles. In addition, as a result of stimulation of nerve endings itchy. Clinically, the above-described pathogenetic mechanisms are implemented within the framework of adaptive response as a contact allergic dermatitis (CAD). When KAD erythema, edema, papular-vezikuleznye elements are located in areas exposed to the allergen from going beyond the zone of influence of allergen. Treatment. In the treatment of dermatitis of the chemical etiology of the obligate stimuli (acid, alkali) should attempt to neutralize their effect, washing away the skin surface large amounts of water.
General principles of treatment of simple contact dermatitis are as follows: for mild congestion can restrict the appointment of powders or ointments, corticosteroid (CS-ointment). In cases of severe redness, swelling apply lotions or water mash, and then CS-ointment. In the presence of bubbles initially purify the surrounding skin of 1% boric alcohol, then pierce the bubbles.
Lesion oiling Castellani or hydroalcoholic solution of aniline dyes, which have a beneficial effect in the case of joining a secondary infection. In chronic dermatitis prescribed warm baths and softening ointments, KS-ointment, and then keratoplasticheskie ointment.
In the treatment of CAD, especially, need to identify and eliminate the root cause of allergic dermatitis. When expressed clinical manifestations appointed general treatment: hyposensitizing drugs (calcium supplements, antihistamines, sodium thiosulfate) are eliminated (diuretics, charcoal), vitamins (calcium pantothenate, calcium pangamat, vitamin C, etc.). Apply restricted diet sodium chloride, carbohydrates, extractives. In severe cases, appointed by the COP. Outdoor treatment is carried out taking into account the stage of disease and the inflammatory process.
The greatest clinical practice in dermatology throughout the history of man was, and continues to be eczema (from 10 to 40% of all skin diseases).
So, eczema - a chronic, often relapsing, allergic, polietiologic disease in which the damage occurs the surface layers of the skin. Eczema - is primarily an endogenous disease. Distinguish real, seborrheic microbial (paratravmaticheskuyu), varicose (hypostatic), contact (professional), child (true, seborrheic microbial) eczema.
Etiology and pathogenesis of childhood eczema 50% of all dermatitis is eczema. In 70% of cases there is a genetic predisposition to allergic dermatoses, the formation is influenced by factors pre-and antenatal period (pathological course of pregnancy and childbirth, toxicosis with medication, the threat of miscarriage, hormonal drugs, delivery to the stimulation of hormones, as well as the abuse of food, causing food allergies pregnant and lactating mothers). The main causes of eczema in early childhood are:
1.Funktsionalnaya immaturity of the nervous system and encephalopathy.
2.Povyshennaya mucosal permeability of the gastrointestinal tract.
3.Pervichnaya eczema (enzyme deficiency).
4.Narusheniya in hepatic biliary system, the barrier of the child.
5.Rasstroystva suction due to ultrastructural disturbances in the intestinal villi due to congenital or acquired deficiency of enzymes in enterocytes.
6.Narusheniya cellular immunity and nonspecific resistance of the children. Substances child's immune system are thymus (thymus), spleen, intestinal Peyer's patches, bone marrow. During the period of exacerbation of eczema increased the A-, M-immunoglobulins to 10-11% decrease of E-and C-immunoglobulins. 10% - a true immunodeficiency condition in which there is damage to organs and tissues (including skin) immune complexes. In this period it is recommended immunocorrective immune therapy, but must take into account the state of the immune system, B-and T-lymphocytes. Apply T-activin (Timoptin, thymogen) prodigiozan. Proved that the development of immediate type allergic reaction involving violations of lipid metabolism (p-lipoprotein cholesterol) and a violation of state tioldisulfatnoy system with reduced antioxidant activity of blood and increased lipid peroxidation in the tissues, which leads to the destruction of cell membranes and hepatocytes. This point should be remembered, because treatment will be aimed at stabilizing cell membranes, increasing the resources of antioxidant system. In the development of allergic children leading role belongs to food allergies, as with age, as the maturation of the gastrointestinal tract, nervous system and improving the protective provisions, food allergy is reduced. Balanced diet - the mainstay of treatment and prevention of relapse. On foods produced by immune complexes deposited in the dermis and epidermis and circulating in the blood constantly, even during remission. That is to say a full recovery allergodermatosis not even have to, they are contained in the dermis and epidermis in scanty numbers. Today in the pathogenesis of allergic, these moments are leading. Cause of allergic children is always an early artificial feeding whole cow's milk, which in an immature gastrointestinal tract is not split up the final products due to enzimopatii and products of incomplete cleavage can easily penetrate through the intestinal barrier by acting as allergens, in addition, the cell creates a deficiency of vitamins of group B. With a natural breastfeeding allergic developed, by sensitizing the child products contained in breast milk. The formation of allergic reactivity in the first months of life promotes sensitization to staphylococci and streptococci, therefore, the presence of chronic foci of infection by the respiratory, ENT-organs, teeth, liver, gall bladder, intestine contributes to the development of the secondary enzyme (enzyme) deficiency, in violation of the digestive processes and absorption; violation of cell metabolism, especially liver; distortion adaptive-protective mechanisms; violation of nonspecific resistance.
Violations of the cellular and humoral immunity, which occur when allergodermatosis contribute to chronic to flow.
Remember! All allergic proceed with combined pathology of internal organs. Eczema in children with dysbiosis become torpid course. By three years eczema subsides to five years of the transformation in atopic dermatitis.
True idiopathic eczema
On the background of reddened inflamed skin appears a lot of vesicles (microvesicles) filled with serous contents, which quickly opened in their place are formed erosion. Serous exudate, acting on the skin surface, creating pockets get wet, with maceration and desquamation of the stratum corneum of the epidermis, the formation of the set point of erosion, of which the skin's surface receives a drop of serous content, and which are called serous "soak wells. In children, this process is accompanied neurotoxicosis due to resorption of toxins, enveloping the brain.
Microbial eczema - paratravmaticheskaya, hypostatic - develops due to fracture of microcirculation, sensitization to piokokkovoy (streptococci, staphylococci), yeast flora.
Development of sensitization contribute to the neuro-endocrine disorders, immunodeficiency states. It often leads to inadequate external therapy. This eczema is most often localized in the legs, characterized by asymmetry, rough skin reaction with diffuse moist, no wells, clear boundaries. Varicose eczema, which is characterized by the presence of varicose simptomokom-complex of the lower extremities with polymorphism of the rash and mild pruritus (sycosiform eczema), observed in persons suffering from sycosis complicated eczematization, and is characterized by the release of the pathological process beyond the limits of hair distribution and the presence of clinical manifestations (eczematous soak wells , itching, development in the future lihenifikatsii). Eczema of the nipple and the pigmented circle of women, characterized by pockets of crimson-colored, crusty, scaly and weeping with the appearance of cracks, often a result of injuries while breastfeeding a child or a result of complications of scabies.
Seborrheic eczema begins in the first weeks of life. Characterized by inflammation of the skin in the form of redness, peeling, cracking with localization in places where the sebaceous glands. This is the scalp, face, sternum, interscapular region, neck, between the breasts, large folds, and without clear boundaries. Occupational eczema begins in the open areas of the body that are subjected to the action of occupational factors (allergen) - face, neck, hands. Any of eczema is chastoretsidiviruyuschey and can be transformed into true.
Disgidroticheskaya eczema - the result of psycho-astenovegetative disorders, with the localization of inflammation of the skin in the palms and soles, on this background it is easy to arise fungal infections, for skin conditions correspond to the penetration of the mycelium. Characterized by the formation of small, dense to the touch of bubbles on the sides of the fingers, less frequently on the skin of the palms and soles. Rarely are large, multi bubbles. Through the translucent cuticle vesicles resemble grains of cooked rice. Bubbles can be opened with the formation of erosions followed by drying.
Principles of treatment of eczema
1.Himicheski sparing regime, eliminate orange fruits and vegetables, white porridge, hard liquor. Conduct of specific and nonspecific hyposensitization, develop tolerance to allergens.
2.Provesti detoxication therapy - hemosorption and enterosorption.
3.Immunologichesky stage of treatment prevents the formation of antigen - antibody in the skin. Appointment immunocorrecting therapy, increase nonspecific resistance.
4.Terapiya should be directed to the antigenic destruction, stabilization of cell membranes, the normalization of blood aggregation (constants of liquid blood).
5.Sanatsiya chronic foci of infection, de-worming, recovery eubioz intestine to prevent autosensibilizatsii. Elimination of dyskinesia.
6.Normalizatsiya hepatocytes, eliminating enzimopaty with enzymes, the normalization dismetabolic violations.
7.Poslednim stage treatment is the spa treatment to prevent the breakdown of adaptive mechanisms, which occurs in untrained patients without rehabilitation of chronic infection foci. Patients can not be sent to the resort without examining pediatrician and therapist.
In recent years, in first place in the treatment of eczema came immunocorrective therapy (T-activin, diutsifon, levamisole). In the presence of intoxication rationally enter gemodez, which contributes to the destruction of toxigenic immunosuppression. You can spend the introduction of native plasma, which contains immunoglobulin and lymphokines. In recent years, developed methods for non-medical treatment of eczema low intensity laser radiation (intravenous or sublingual laser therapy), the unit AU-FOA (UVR autologous blood), physical therapy, ultraviolet irradiation, etc. From traditional methods of treatment used hyposensitization therapy (sodium thiosulfate, calcium gluconate, calcium chloride), antihistamines (zirtek, Tsetrin, Kestin, telfast), sedatives, tranquilizers, diuretics, physiotherapy, etc.
Adults and children with intestinal dysbiosis can recommend biologically active additives BIFIDOBAK and ATSIDOBAK (produced by ART LIFE). To improve the function of hepatocytes and as a choleretic funds used HOLEGON, HEPAR Formula, Vitamin E, ESSENTSIAL OIL. Children for the prevention and treatment are recommended SKIN LINE.
Need to say too much about the local treatment. In dermatology is an unwritten rule: "where there's wet - there is sushi." That is in the weeping stage of eczema should be prescribed lotions, as a rule, antiseptics, and then after drying the paste, and then the ointment can be content with hormonal drugs.
During the period of exacerbation of eczema general hygiene carried out with the bath once per week. Bath shown dehlorirovannaya water (after sedimentation or filtration), and infected skin - with the addition of a solution of potassium acid manganese with breeding to light-pink color, a bath of milk (1 cup in the bath), olive oil (1 / 2 cup of the bath ). Hygienic bath with the addition of oak bark, burdock root, leaf chamomile, sorrel, ginseng in remission recommend a once in 5-7 days.
Patients with eczema are at the dispensary. Examination twice a year. During remission recommended spa treatment (Lake Uchum, Shire). Prophylactic treatment is herbal remedies, vitaminopreparatami, drug-free immunocorrectors, sedatives, etc.
In patients with allergic dermatoses occur immune and immune mechanisms of disease development (this is, first of all violations, leading to immuno-suppression dismetabolic and secondary immune deficiency). Biologically active food supplement company HOLEGON ART LIFE is a collection of plants with choleretic, protivospalitelnymi, antispasticheskoe and sorption properties, has a soft regulative effect on the biliary system, contributes to the removal of metabolic products, thereby eliminating the dismetabolic immunosuppression.