Atopic dermatitis It refers to diseases of a multifactorial nature. The most important factors that lead to the development of this disease are aggravated family history and prolonged exposure to allergens.
The main role in the pathogenesis (development of the disease) is: allergic inflammation and hyperreactivity of the skin, altered barrier function of the epidermis (due to a genetically determined defect of the skin cells) and characteristics of cellular and cellular immunity. humoral in patients. The versatility of the pathogenic spectrum of atopic dermatitis determines such a complex and diverse clinical picture of this disease.
Clinical symptoms of atopic dermatitis.
The course and clinical symptoms depend largely on age. So distinguish the infant form (in children up to 3 years old), the infantile form (from 3 to 12 years old) adolescent (from 12 to 18 years old) juvenile (in young people and adults).
Atopic dermatitis is never congenital, in most cases the first signs of the disease appear at 3 months of age.
Symptoms of atopic dermatitis according to age.
Infant form (up to 3 years)
In babies, atopic dermatitis occurs with a predominance of erythematous erythematous (red) elements that cry. The eruptions are represented by microvesicles and serous papules.
The elements form large areas of crying that are sometimes covered with crusts. They are located mainly on the face (cheeks, chin), body, scalp and extensor surfaces.
In addition, children may have signs of gastrointestinal tract disorders and cerebral insufficiency.
Infantile form (from 3 to 12 years old).
This form is characterized by the presence of itching papules, excoriations (excoriation is a superficial mechanical violation of the integrity of the skin, most often as a result of scratching) and lichenification (a sharp thickening of the skin with an increase in your employer, in some cases there may be a violation of pigmentation). Acute inflammation in this form is less pronounced.
Often, children have dry skin, scabs, scales, pronounced cheilitis (inflammation of the mucous membrane of the lips). The elements are located in the area of the large joints, on the extensor surfaces of the extremities, the face.
Teen form (12-18 years).
Lichenification more pronounced, dry skin and fusion of papular eruption. In this way, the neck, the flexor surfaces of the extremities, the wrists and the upper part of the thorax are affected more frequently.
In young people, the favorite location of the elements is the neck, the back surface of the brushes, on the face, along the hairline, around the eyes. The disease progresses as a neurodermatitis.
In addition to itching, patients may have neurotic reactions: increased nervous excitability, unstable mood, slower reaction to stimuli.
Often, patients with atopic dermatitis may find sites of hypopigmentation on the face and shoulders, a characteristic crease along the edge of the lower eyelid (Denier-Morgan line), as well as a larger pattern on the palms and a white dermographism. on the skin.
Stages of atopic dermatitis
There are acute and chronic stages.
For the acute stage it is characteristic:
For the chronic stage:
- Linification of the skin.
- Hyper and hypopigmentation.
In 2003, new diagnostic criteria were proposed.
Main criteria (required):
- Typical clinical and morphological elements of the skin in a characteristic location according to age.
- Chronic or recurrent course of the disease.
Previously, mandatory also included: the onset in white dermographism in early childhood increased blood levels of IgE, decreased T lymphocytes, decreased IgA, IgM with an acute increase in IgG and eosinophilia in blood.
Additional criteria (required for diagnosis)
- Early start
- Presence of atopy
- Family history loaded with atopic and allergic diseases, or the presence of a patient with other atopic diseases (except dermatitis).
- High level of specific IgE
- Xerosis (dry skin).
Related criteria (helps suspect atopic dermatitis)
- Vascular reactions – pallor or erythema of the face, white dermographism.
- Inflammation of the mucous membrane of the lips (cheilitis), recurrent conjunctivitis
- Strengthening of the cutaneous pattern of palms, ichthyosis.
- Changes in the eye, periorbital area.
- The presence of other focal changes: dermatitis of the hands, feet, perioral or periuricular dermatitis (parotid)
- Lichenification, Prurigo.
Gravity of atopic dermatitis.
To evaluate the severity of atopic dermatitis, the SCORAD system is used. In this system, both objective indicators (area of skin lesion, intensity of clinical manifestations) and subjective indicators (itching, insomnia) are taken into account.
The area of skin lesions is evaluated according to the “nine” rule, where the area of the palmar surface of the patient (1 palm – 1%) is taken for one unit.
Up to 5% – it is considered a limited process
More than 5% – common
All the skin is diffuse.
The intensity of clinical manifestations is evaluated according to six symptoms:
- Edema or papule (depending on the shape of the process)
- Peeling / wet (depending on the shape of the process – dry or wet)
- Lichenification (in children over 2 years old)
- Dry Skin
Ranked on a four-point scale.
- no symptom – 0 points
- poorly defined – 1 point
- Moderately pronounced – 2 points
- pronounced – 3 points.
The evaluation of the symptoms is carried out on the skin where they are most pronounced.
Subjective symptoms associated with skin lesions and itching. (sleep disorders, itching) is evaluated in children over 7 years.
Each subjective symptom is estimated in the range of 0 to 10 points, the points are summarized. The total scores of the subjective symptoms can vary from 0 to 20.
Next, calculate the index by the formula
SCORAD Index = А / 5 + 7В / 2 + С
A – The score of the prevalence of skin lesions.
B – the sum of the intensity scores of the symptoms
C – the sum of the points of the subjective symptoms (sleep disorders, itching)
In children under 7 years, subjective symptoms are not taken into account.
The severity of atopic dermatitis:
- Easy flow – 0-20 points
- Moderate severity – 20-40 points
- Heavy current – 40 points and more.
The advantages of this gravity assessment system is that it allows you to objectively evaluate the severity of the process, the dynamics of skin changes during therapy, including the evaluation of the effectiveness of any therapy method in a patient. Simple and accessible to any doctor.