Problems in the treatment of atopic dermatitis in infants

Atopic dermatitis in newborns (atopic eczema, diathesis) is a skin disease of allergic origin. Without the assistance of a specialist, it is impossible to accurately determine the factor causing the development of pathology. Treatment of atopic dermatitis in infants involves the use of an integrated approach. It includes the organization of dietary nutrition for the newborn, local application of anti-inflammatory drugs, and correction of the infant’s daily routine. Only a doctor can prescribe what children need to be treated with: the use of traditional medicine is contraindicated.

What is atopic dermatitis

Atopic dermatitis is a chronic skin disease characterized by a relapsing course.
Babies with atopic dermatitis are bothered by itching and dry skin. Foci of inflammation can be located throughout the body, but they especially “love” children’s cheeks and folds, as well as the area under the diaper. Statistics indicate that atopic dermatitis occurs in every fifth baby [1]. Why is he dangerous? Lack of treatment can lead to the development of severe forms of atopic dermatitis, the spread of inflammation and the atopic march. In this condition, the disease begins to “march” through the child’s body, provoking the appearance or exacerbation of concomitant diseases. In 20-43% of cases, the development of bronchial asthma is possible, and twice as often - allergic rhinitis or eczema [2].

In addition, disruption of the hydrolipid barrier that occurs with atopic dermatitis in children can cause a secondary infection. Unfortunately, atopic dermatitis cannot be “outgrown.”

Features of cooking porridge

We will cook with milk, with the addition of butter, provided that its fat content does not reach 82.5%. What to do:

1. Add milk to the water and add cereal; first soak it and rinse it under running water.
2. We wait until the porridge boils and reduce the temperature, bring the dish to readiness, stirring occasionally.
3. At the final stage, add salt (just a little), and before serving, add butter.

We must heat-treat the milk and do not add it to ready-made porridge cooked in water. This will increase the risk of developing a lactose allergy.

Symptoms of atopic dermatitis in children

According to recent studies [3], in 45% of babies, atopic dermatitis debuts between the ages of two and six months. In 60% of patients during the first year of life.

With atopic dermatitis in children, clinical symptoms and localization of inflammation largely depend on age. There are infant (up to one and a half years), child (from one and a half years to puberty) and adult phases. The following symptoms are common to all phases:

1. Severe dryness of the skin (xerosis), which cannot be treated with regular baby cream .
2. Redness and inflammation on the skin (especially symmetrical ones).
3. Itching, causing severe discomfort to the child.
4. Recurrent course (alternating periods of remissions and exacerbations). Moreover, in the cold season, deterioration is more often observed, and in the warm season, improvement is observed.

According to the nature of the course, acute and chronic stages of atopic dermatitis are distinguished, which are expressed by different signs (symptoms):

● Acute stage. Rough red spots (erythema), nodular rashes (papules), swelling, and crusts (including weeping) may appear on the baby's skin.

● Chronic stage. Accompanied by lichenification (thickening of the skin), cracks on the soles and palms, scratching, and increased pigmentation of the skin of the eyelids.

Causes of atopic dermatitis in children

Atopic dermatitis can be considered a hereditary disease, because the most important role in its occurrence is played by a genetic factor [3]:

• In 80% of children, it occurs if both parents have or have had atopic dermatitis.
• In more than 50% of children - if at least one of the parents was sick, especially the mother (this doubles the risk of transmitting the disease “by inheritance”).

Some prenatal factors can also provoke atopic dermatitis in a baby: for example, poor nutrition of the expectant mother, contact with toxic substances, infections suffered during pregnancy, as well as bad habits and stress.

In addition, atopic dermatitis more often develops in babies who suffered oxygen deprivation during childbirth, were born prematurely and were bottle-fed (perinatal factors).

Allowed subject to individual tolerance

• Vegetables and fruits of green and white color (all types of cabbage, zucchini, squash, sweet potato, Jerusalem artichoke, apples, pears, yellow plums, white currants, white raisins, etc.)
• Soups – vegetarian;
• Meat – turkey, rabbit, lean pork (boiled, stewed, steamed);
• Cereals (buckwheat, corn, rice, oatmeal, millet, pearl barley);
• Pasta;
• Wheat, wheat-rye bread;
• Drinks – tea, compotes, fruit drinks from the above mentioned fruits.

The author of the article is professor, doctor of medical sciences. Svetlana Gennadievna Makarova

Diagnosis of atopic dermatitis in children

For a long time it was believed that atopic dermatitis in children is predominantly an allergic disease. However, it has now been proven that this is, first of all, a disease with dysfunction of the epidermis! And food allergies are detected only in 30-40% of children with atopic dermatitis.

The symptoms of atopic dermatitis are almost always influenced by certain environmental triggers. This could be chlorinated or “hard” water, soap, contact with an allergen, unfavorable climate and even stress. Another common trigger is bacteria that enter the skin through a damaged epidermal barrier.

Only a doctor (pediatrician, dermatologist, allergist) can make a diagnosis of “atopic dermatitis in children”! It takes into account the presence of external signs of disease and itching, as well as hereditary factors. Laboratory tests may be prescribed for children to carry out diagnostics. For example:

• General detailed (clinical) blood test.
• Biochemical general therapeutic blood test.
• General (clinical) urine analysis.
• Study of the level of total immunoglobulin E in the blood.
• Skin testing with allergens.
• Skin biopsy.

Treatment of atopic dermatitis in children

In modern medicine, there are three degrees of severity of atopic dermatitis in children:

1. Easy. The child responds well to treatment, remission can last more than 10 months, the itching is minor, the redness is slight. Exacerbations occur no more than twice a year.
2. Medium-heavy. Exacerbations occur 3-4 times a year, and periods of remission are reduced to 2-3 months. The therapy gives less pronounced results, the redness “stubbornly” returns.
3. Heavy. Long-term exacerbations are interrupted by short periods of remission - up to one and a half months. Treatment helps little or for a short period of time; the baby’s behavior is greatly affected by itching [4].

At all stages of atopic dermatitis, pediatricians and dermatologists recommend emollients - cosmetic skin care products. They moisturize the skin and help restore the level of lipids - the most important structural components. During periods of exacerbation, emollients can be applied frequently and generously.

Pay attention to the composition; it is advisable that emollients are not addictive. Their main tasks are to help the skin produce its own lipids, providing effective hydration and softening. In addition, the constant use of emollients prolongs periods of remission and alleviates the symptoms of atopic dermatitis.

The Mustela Stelatopia line of cosmetics will help restore skin comfort for a long time! Stelatopia emollients are effective at all stages of atopic dermatitis , incl. at its first signs - increased dryness of the skin.

Studies have confirmed that the use of Stelatopia emollient cream can reduce the likelihood of developing atopic dermatitis by 51% ! [6]

Treatment (use of hormonal drugs) for atopic dermatitis in children can only be prescribed by a doctor, taking into account age, symptoms, concomitant diseases and test results. Self-medication can be dangerous!

• For external therapy for moderate and severe degrees of atopic dermatitis, topical glucocorticosteroids, topical calcineurin inhibitors and others are used.
• In case of mild disease, the use of Stelatopia Emollient Cream reduces the severity of inflammation after 32 hours, due to the presence of sunflower oil in the distillate [5].
• In systemic therapy, the drugs dupilumab, cyclosporine, glucocorticosteroids and others are used orally or in injection forms.
• To relieve itching - clemastine, hifenadine, cetirizine, chloropyramine, levocetirizine and others. The use of Stelatopia emollient cream as a cosmetic skin care product reduces the severity of itching in 80% of cases [7].
• Physiotherapy treatment may include phototherapy. Sometimes, in the treatment of atopic dermatitis, diet therapy, acupuncture, plasmapheresis and some other methods may be prescribed.

Excluded from food

• All products containing cow's milk proteins (including whole milk, all fermented milk products, cheese, cottage cheese, butter), milk products from other animals, beef, veal.
• Highly allergenic foods - eggs, peanuts, nuts, fish, seafood, soy;
• Products that often cause both allergic and non-immune (pseudo-allergic) reactions (caviar, mushrooms, honey, chocolate, coffee, cocoa, citrus fruits, kiwi, pineapples);
• Broths, marinades, salty and spicy dishes, canned food, smoked meat and fish, spices;
• Products containing artificial additives - dyes, flavors, preservatives;
• Products containing histamine liberators and histamine (sauerkraut, sorrel, spinach);
• Products that irritate the gastrointestinal tract and change the taste of milk - onions, garlic, radishes, radishes.

Prevention of atopic dermatitis in children

For atopic dermatitis, primary, secondary and tertiary preventive measures are distinguished.

Primary prevention

is aimed at preventing the occurrence of atopic dermatitis in children.

Recommended:

• Expectant mothers with a tendency to allergic reactions should exclude allergenic foods from their diet.
• Introducing complementary foods to babies begins at four months of age.
• Pregnant women and newborns at risk should take probiotics containing lactobacilli.
• Practice breastfeeding whenever possible.
• Eliminate exposure of your baby to tobacco smoke.
• Maintain humidity levels and regularly ventilate the children's room.

Secondary prevention

is aimed at eliminating risk factors that, under certain conditions (stress, weakened immunity, etc.) can lead to the occurrence, exacerbation and relapse of atopic dermatitis.

Recommended:

• Regular consultations with specialists.
• Maintaining awareness of new research and drugs in the treatment of atopic dermatitis.

3.Tertiary prevention

is a set of measures aimed at preventing exacerbations or development of complications of atopic dermatitis.

Recommended:

• Avoid contact of the baby with provoking factors: soap (it dries the skin), clothes made of rough or synthetic fabrics, low-quality cosmetics, etc.
• Take care of your child's skin and apply emollients on a regular basis, including during periods of remission.

• Bath your baby daily using cosmetic cleansers for atopic skin.

[1] Isaac Steering Committee. (1998). Worldwide variation in prevalence of symptoms of asthma. The Lancet, 351, 1225-1235. (International Committee on Asthma and Allergy in Childhood 1998. Worldwide differences in the prevalence of asthma symptoms. The Lancet, 351, 1225-1235). [2] Studies Watson W., 2011, Larsen F.S., 2002, Draaisma E., 2015, ISAAC Steering Committee, 1998. (Studies Watson W., 2011, Larsen F.S., 2002, Draaisma E., 2015 International Committee on the study of asthma and allergies in childhood, 1998). [3] Clinical guidelines. Atopic dermatitis, 2022. [4] Atopic dermatitis: recommendations for practitioners. Russian national consensus document on atopic dermatitis. Ed. P.M. Khaitova, A.A. Kubanova. M.: Pharmacus Print, 2002. 192 p. [5] ODT and inflammation June 2010 [6] Scientific dossier “Atopic-prone skin: latest discoveries” [7] Test report “Stelatopia” emollient cream, self-assessment by users

Diet for pregnant and lactating women

If, during the period of bearing a child, a woman does not monitor her diet, then the risk of the baby developing dermatitis increases. On average it increases by 15-20%.

What foods are prohibited for pregnant and nursing mothers:

1. Fatty and fried foods, chocolate and drinks containing caffeine.
2. Exotic fruits because they may contain harmful preservatives.
3. Carbonated drinks, smoked foods, salty canned food and processed foods will cause swelling and increase blood pressure levels.
4. Sweets in large quantities, fatty sauces and pickled dishes, garlic, onions.
5. Red and orange fruits and vegetables are often the cause of food allergies.

The diet should be balanced; a woman is recommended to eat food in small portions; if she is very hungry, then have snacks. Drink kefir and eat apples.