One of the most common skin pathologies in children is dermatitis. The nature of the disease is due to widespread or local inflammation of the skin, provoked by direct or indirect exposure to various factors - chemical, physical or biological. According to selective data from pediatric dermatologists and pediatricians, dermatitis in children is diagnosed in more than 40% of cases among all childhood skin diseases.
The disease usually manifests itself in the first years of a child’s life. It is quite rare for preschoolers and schoolchildren to develop for the first time.
Children are susceptible to diaper, contact, seborrheic dermatitis, but most often - atopic and allergic. At their core, these two dermatitis are a type of one disease of allergic origin. The only difference is in etiology - the cause and condition of development.
Allergic dermatitis
This is a disease caused by the presence of inflammatory processes on the child’s skin when it interacts exclusively with one specific, provoking irritant - an allergen. This reaction is usually called delayed, which is associated with a rather long period of its development - the first signs of the disease may appear only two weeks after contact with the allergen.
The speed of the immune response depends on how quickly a specific allergen is able to contact the amino acid composition of proteins contained in the skin and form an antigen. In response to the penetration of a foreign component into the body, macrophages form a standard immune response, which is manifested by the creation of a protective barrier in the form of an inflammatory reaction. Immune phagocytic (protective) cells (T-lymphocytes) remember the “intruder” and when it reappears, the inflammatory reaction resumes.
The cause of the development of allergic dermatitis in children can be both internal and external allergenic factors. Internal allergens include those allergens that a child takes orally with food or liquid (including medications), or inhales.
External factors include those allergens that directly affect the skin:
- Chemical exposure – dyes in children’s clothing and washing powders, hygiene products, food additives, flavorings and stabilizers, acrylic toys.
- Physical impact - cold or heat.
- Biological effects – fungal, bacterial or viral pathogens.
Allergic dermatitis can occur in children of any age - from two months to the end of puberty.
Treatment of dermatitis on the hands - selection of therapy
The selection of therapy for inflammation of the skin of the hands depends on the form and severity of the disease. The first step to recovery is identifying the allergen and stopping contact with it. If the reaction is caused by food products, a hypoallergenic diet is prescribed; if household chemicals or inks or paints are used, then rubber gloves must be used when working with them. If dermatitis on the hands appears upon contact with a certain metal, it is worth replacing it with another or completely abandoning jewelry. Often, for mild contact dermatitis, this treatment is enough to relieve symptoms. More serious cases of the disease require drug treatment and observation by a dermatologist.
The second stage of therapy is to relieve the acute stage of inflammation, during which severe itching, swelling and redness of the skin, and even pain are observed. Drugs are prescribed for internal and external use.
Symptoms
The severity of symptoms of allergic dermatitis in children depends on:
- depending on age - the younger the child, the brighter the symptoms;
- duration of allergenic exposure;
- the current state of the immune system.
As a rule, dermatitis in children of an allergic nature affects the skin of the face, the skin of natural folds, the outer surface of the legs and arms, manifesting itself:
- swelling and hyperemia in places of contact with the irritant;
- burning and itching sensation;
- a rash of small, exudate-filled blisters (opening forms weeping lesions and ulcers);
- peeling of the skin (if you are allergic to certain injectable drugs).
In severe cases (Lyell's syndrome), the following are possible:
- chills and fever;
- headache accompanied by nausea and vomiting;
- dehydration;
- hyperemia of the skin of the groin area, buttock and axillary folds with subsequent formation of blisters and erosions;
- epithelial detachment.
An exacerbation of the disease occurs against the background of stressful situations, severe fatigue, poor nutrition, or prolonged exposure to chemical factors.
Dermatitis in children
Symptoms of atopic dermatitis
Usually manifests in the first half of life;
less often develops in preschool, school or adolescence. Skin rashes with atopic dermatitis in children can be represented by persistent hyperemia or transient erythema, dryness and flaking of the skin, or a weeping papular-vesicular rash on an erythematous background. Characteristic signs of atopic dermatitis in children include symmetry of skin lesions on the face, limbs, and flexor surfaces of joints; itching of varying intensity. Quite often, with atopic dermatitis in children, folding (hyperlinearity) of the palms and soles is detected; follicular hyperkeratosis of the elbows, forearms, shoulders; white dermographism, skin scratching, pyoderma, hyperpigmentation of the eyelids (“allergic radiance”), cheilitis, urticaria, keratoconus, recurrent conjunctivitis, etc. The natural progression of atopic dermatitis in children in the absence of proper treatment can become the so-called “atopic march” or atopic disease , characterized by the addition of other allergic diseases: allergic conjunctivitis, allergic rhinitis, bronchial asthma.
Symptoms of seborrheic dermatitis
This type of dermatitis occurs in approximately 10% of children in the first 3 months of life and completely stops by 2-4 years. The first manifestations of seborrheic dermatitis in a child may appear as early as 2-3 weeks of life. At the same time, grayish scalp-like scales (gneiss) are formed on the scalp, which, merging, turn into a continuous greasy crust. Gneiss can spread to the skin of the forehead, eyebrows, and behind the ear; sometimes maculopapular rashes, covered with scales on the periphery, are found in the natural folds of the torso and limbs.
Distinctive features of seborrheic dermatitis in children are minimal itching and absence of exudation (scales are greasy, but dry). When the crusts are forcibly removed, brightly hyperemic skin is exposed; in this case, it can become wet and easily become infected.
Symptoms of diaper dermatitis
Diaper dermatitis is characterized by irritation of the skin of the buttock area, inner thighs, perineum, lower back, abdomen, i.e., areas of the skin in contact with wet and soiled diapers, diapers, and onesies. Diaper dermatitis occurs in 35-50% of infants, most often developing in girls aged 6 to 12 months.
Depending on the severity of clinical manifestations, there are 3 degrees of diaper dermatitis. With mild manifestations of dermatitis in children, moderate skin hyperemia, a mild rash and maceration of the skin in areas of typical localization occur. Moderate diaper dermatitis is characterized by the formation of papules, pustules and infiltrates on irritated areas of the skin. Severe diaper dermatitis in children occurs with the opening of blisters, the formation of areas of weeping and erosion, and extensive drainage infiltrates.
The development of diaper dermatitis affects the general well-being of children: they become restless, cry often, sleep poorly, since the inflamed areas of the skin are very itchy, and touching them causes discomfort and pain. In girls, diaper dermatitis can lead to the development of vulvitis.
Symptoms of contact dermatitis in children
Manifestations occur directly on the area of the skin that came into contact with any irritant. The main signs of contact dermatitis in children include edematous hyperemia of the skin with sharp boundaries, severe itching, burning, soreness, and the formation of blisters, the opening of which leads to the formation of weeping erosive areas.
Contact dermatitis in children can take an acute or chronic course. The acute phase begins immediately after contact with the irritant and ends shortly after the end of exposure. Dermatitis in children acquires a chronic course after frequent repeated exposure to an aggressive factor.
Features of atopic dermatitis
The disease is characterized by a relapsing chronic course: it is difficult to treat and cannot be completely cured. Unlike allergic dermatitis, the development of which involves only one pathogen - an allergen, atopic dermatitis in children is multifactorial. In more than 40% of cases, skin pathology develops in the first year of a child’s life. It usually develops in children with a hereditary predisposition.
The likelihood of a child inheriting atopic dermatitis increases to 60% if one parent is sick, and if both parents are sick - up to 80%. It is important who is sick - the father or the mother. If the child and mother are sick at the same time, the clinical picture of the disease is more pronounced.
The condition of the child’s skin plays an important role in the development of the disease.
Diet for atopic dermatitis
The key to treating the disease is strict adherence to the diet. If the infant form of the disease occurs mostly in an acute form, then the next period manifests itself in a chronic course of inflammatory processes.
The impact of allergens on a child's body is of great importance in the development of atopic dermatitis. Plant pollen, house dust, mites, pets, poor diet, stress due to conditions at home or in child care institutions, weather influences and other factors aggravate the manifestations of the disease.
Following simple rules will help you avoid the acute form of atopic dermatitis:
- minimize the amount of sugar and salt in the patient’s diet;
- divide your daily nutrition intake into 6 meals;
- completely eliminate alcohol;
- it is necessary to get rid of tobacco addiction;
- provide plenty of fluids;
- the diet must contain a sufficient amount of vitamins and microelements;
- avoid overeating;
- exclude the possibility of provoking skin and food allergies (to do this, you need to identify the cause that provokes the disease).
Experts offer a wide range of dietary program options, but it is wiser to seek medical help. This will allow us to determine the individual characteristics of the patient and prescribe the most effective therapy and nutrition. It is this approach that guarantees the most long-term results. Most often, for dermatitis, a dairy-vegetable diet with a low carbohydrate content, as well as immunomodulating drugs are recommended[3].
How it works?
Human skin consists of 3 layers - epidermis, dermis and subcutaneous fat. A special role in the development of atopic dermatitis belongs to the so-called “dermal response” gene. This means that the basis of the pathology is hereditarily caused increased inflammatory activity of the dermal layer. The pathogenesis of atopic dermatitis is caused by three types of skin defects:
- Violation of the barrier functions of the epidermal layer, which increases the possibility of penetration of allergens and promotes rapid loss of moisture. The resulting dryness of the skin is enhanced by a significant decrease in the synthesis of lipids - a kind of “cement” for the structure of the skin.
- Congenital defects of the immune system (reduced synthesis of antimicrobial peptides and sensitivity of skin receptors) in combination with defects in barrier functions, which leads to recurrent processes of skin infections.
- Violation of immune physiological regulation. The basis of the pathological process is a violation of the ratios of various subpopulations of phagocytic immune cells and increased secretion of a protein that stimulates the synthesis of Ig E (immunoglobulin). The interaction of the allergen with Ig E causes the release of histamine and other biological compounds into the intercellular space, provoking the development of a local inflammatory reaction and itching. An increased concentration of Ig E is a diagnostic sign of atopic dermatitis in children.
Many factors can provoke diseases.
Products
Despite the established opinion, food allergies are diagnosed in only 30% of infants and 4% of older children who suffer from severe dermatitis. Sugar in its pure form is not a food allergen and there is no need to exclude it from the diet of sick children.
Meals are selected according to the age of the children. The best option for up to one year is breast milk. There are practically no allergies to it. But if there is an error in the nutrition of nursing mothers, the food antigen with milk can enter the child’s body and provoke the development of the disease.
If symptoms of the disease appear with the introduction of mixtures and complementary foods, the provoking product must be excluded. This could be cow's milk, eggs or fish, grains, red or orange vegetables and fruits. It is important to know about cross-allergic reactions - if an allergy is caused by eggs, the same reaction can be caused by the eggs of other birds, chicken and duck meat, feather pillows, some medications and vaccines. With age, the leading role of food allergies is lost.
Background pathologies
Chronic foci of infection (including parasitic infestation), bronchopulmonary diseases, gastrointestinal pathologies.
Psycho-emotional stress
There are many nerve receptors in human skin. When it is damaged, the excitation signal is transmitted to the central nervous system, forming a kind of feedback: a severe course of the disease supports a neurotic disorder, and neurotic disorders worsen the clinical picture of the disease. Neuropsychiatric abnormalities are observed in more than 80% of children with atopic dermatitis.
To eliminate such deviations, it is necessary to provide the child with a restful night and daytime sleep, take him for walks more often, create the right psycho-emotional background in the environment, undergo a course of medication and physical therapy on the recommendations of a neurologist, and, if necessary, involve a psychologist.
</3>Contact allergens
Preservatives in hygiene products, metals in children's accessories and clothing, components of rubber, glue and dyes in children's toys or household items.
Aeroallergens
Mold, pet hair, house dust, grass and tree pollen.
Exposure to irritants
Synthetic or woolen clothing, disinfectants, chemical reagents, increased sweating (as an irritant).
Climate
The influence of sharp fluctuations in temperature, air humidity and other natural factors.
Ecology
The child’s residence near enterprises and highways, his prolonged or constant presence among smokers.
Dermatitis on hands photo
Photo 1. Dermatitis of the palms.
Photo 2. Dermatitis on the back of the hand.
Photo 3. Dermatitis on the hands.
Photo 4. Dermatitis on the hands.
Causes of dermatitis: contact with an aggressive chemical environment.
Prolonged exposure to low temperatures.
Dermatitis on the hands is not only a physical problem, but also a cosmetic one. Most of the time, hands are seen by strangers, who may react to rashes, papules and scratching in completely different ways. The patient’s experiences and psychological discomfort aggravate the course of the disease. According to statistics, the risk group consists of women living in big cities, but dermatitis on the hands can appear in anyone, regardless of gender, age, and lifestyle.
In addition to mental factors, the treatment of dermatitis on the hands is complicated even by hygiene and contact with the environment: with air (which can be dusty, dry, etc.), cleaning products, water, and various surfaces, sometimes contaminated. That is why dermatitis is called a disease of civilization: the development of industry and the emergence of new household chemicals have led to the fact that people are constantly faced with new types of cleaning, washing, dyeing, and adhesive products. Even the rules of hygiene, so necessary in a modern city, can do a disservice to a patient with dermatitis on the hands. Public and home toilets, money, door handles and handrails - contact with these objects, firstly, increases the risk of infection of diseased skin, and secondly, makes frequent hand washing necessary, which leads to drying, peeling, and cracking of the skin.
Through wounds formed at the site of scratching or bursting dry skin, infection can enter the bloodstream. In turn, this can lead to serious consequences for the body, including a general decline in immunity and the spread of dermatitis to other parts of the body.
Classification of the disease
When atopic dermatitis develops in children, there are 4 clinical stages of development:
- initial;
- stage of pronounced changes;
- remission;
- clinical recovery.
Depending on the duration of development of the pathological process and clinical and morphological indicators of manifestations on the skin, atopic dermatitis in children is divided into 3 forms according to age:
- infant form - from birth to 3 years;
- children's - from 3 years to 12;
- teenage – 12–18 years.
These forms are capable of restructuring (transitioning from one to another) or going into remission.
According to the severity, the clinical picture of the disease can be mild, moderate and severe.
According to the prevalence of the pathological process, the following are distinguished:
- Limited atopic dermatitis - pathological lesions are located on the body in a certain area, skin damage does not exceed 5% of the entire surface.
- Disseminated (widespread) - the pathological process affects up to 15% of the skin surface, localizing in various areas of the body.
- Diffuse – almost the entire skin surface is affected.
Atopic dermatitis in adults
The adolescent-adult form of AD is characterized by the presence of pathological manifestations not only on dry skin of the face, but also on almost any place on the body, except the extremities.
With atopic dermatitis in this age category, traces of scratching are always observed, which is facilitated by constant itching. Often there are cracks on the hands and feet of patients. Exacerbations of the disease are manifested by redness of the skin, but with age these periods occur much less frequently.
The following types of disease are classified according to severity:
- heavy;
- moderate;
- lung[2].
Clinical signs
Throughout the childhood period, the clinical picture of dermatitis in children can change many times, not only regarding the type of rash itself, but also regarding the location of the lesions.
Signs of the infant form
They manifest themselves as the formation of red spots, skin swelling, and blistering rash. The opening of the bubbles forms pockets of weeping, which, when dry, become covered with yellow-brown crusts. The skin of the cheeks, forehead, scalp, buttocks and extensor joint surfaces is affected. The whole process is accompanied by severe itching, disturbing the child’s peace of mind.
At the initial stage of the disease, only the superficial layer of the skin is exposed to allergic inflammation. With timely elimination of the causative factor, the allergic process is easily amenable to involution. An attempt to stop the inflammatory reaction with medications or local preparations (creams, ointments) will not yield results. If the provoking allergen is not removed, the initial stage of atopic dermatitis will enter the phase of pronounced changes.
Manifestations of the child form
Vivid symptoms appear during periods of exacerbation. The localization of pathological foci is noted mainly in the folds of the skin in the area of flexion of the elbows, knees, feet, hands, on the neck and in the area behind the ears. The skin becomes dehydrated, peels off, and a pronounced, clear skin pattern appears (lichenification). The child’s face changes – the skin is dull, there is pronounced pigmentation around the eyes, and an additional fold of skin appears on the lower eyelid.
Even in the absence of exacerbation, intense itching is noted. The skin of the fingers and hands cracks due to severe dryness.
Symptoms of adolescent atopic dermatitis
They manifest themselves as widespread and permanent lesions of the skin. Localization of the pathological process - back, chest, face, neck, joint extension area.
Characterized by lichenification and dry skin, scratch marks, cracks on the feet and hands.
General preventive recommendations
- Minimize the child’s contact with external irritants that can cause relapse.
- Use products with a moisturizing effect for hygiene.
- Do not use alcohol-containing products for hygiene.
- To soften and moisturize the skin, use emollients (preferably odorless). These products do not contain acids or hormones, perfectly moisturize and nourish the skin, reducing dryness and itching. Apply 2 times a day, even during the period of remission, when there are no allergic manifestations or itching.
- The duration of water procedures to cleanse the skin should not exceed 15 minutes. The water should be warm or cool, dechlorinated (filtered or settled for 1–1.5 hours). If the child has good tolerance to herbs, you can add infusions or decoctions of one of the plant components to the water - birch leaves, string grass, burdock root, oak bark.
- Do not use washcloths or rub the skin during water procedures. Shampoos for washing hair should be neutral acidic. After water procedures, the body is not wiped. It is necessary to carefully blot the skin with a soft sheet and apply emollients.
- To prevent scratching, your child's nails should be trimmed short.
- During periods of relapse, children should sleep in gloves and socks made of cotton fabric or yarn. Pajamas should be spacious and made of natural cotton.
- New clothes should be washed before wearing (only with liquid detergents).
- When washing bed linen and clothes, do not use industrial conditioners and fabric softeners. Linen is rinsed with clean water and ironed thoroughly after drying.
- You should not buy heavy and rough clothes for sick children.
- Tanning should be avoided. On sunny days use sunscreen.
- It is important to exclude children with atopic dermatitis from participating in sports competitions. Intense sweating, skin friction and close contact with clothing can trigger a relapse of the disease.
- The entire apartment and the child’s room should be cleaned regularly (preferably in his absence).
- Avoid smoking in the presence of a child. Even passive contact with nicotine can trigger the production of antibodies.
Diagnosis and treatment of dermatitis in a child
Any rash on the skin of children requires a professional assessment by a pediatric dermatologist, pediatrician or allergist-immunologist (sometimes an infectious disease specialist). To confirm the likelihood of children developing dermatitis, the doctor conducts a thorough examination of the skin, a detailed medical history, and prescribes a series of clinical and laboratory examinations.
When diagnosing allergic dermatitis, it is important to identify signs of eosinophilia in the blood plasma, increase the concentration of total and allergen-specific immunoglobulin E and G, using various allergy diagnostic methods (MAST, RAST, ELISA or RIST), skin and provocative tests.
Laboratory tests include:
- bacteriological analysis of smears for suspected secondary infection;
- examination of scrapings from a smooth area of skin to identify the pathogen;
- coprogram - to identify helminths and dysbacteriosis.
If necessary, an ultrasound examination of the peritoneal organs or a skin biopsy may be prescribed for a differential diagnosis.
During the diagnostic search, the form and cause of the development of dermatitis in a child are clarified, the presence of immunodeficiency and other skin pathologies, such as lymphoma, psoriasis, ichthyosis, scabies, microbial eczema, and pityriasis rosea is excluded or confirmed.
