Acne* due to hormonal imbalance: how hormones affect the skin

Last updated: July 24, 2020

Allergic rashes in children are a very common and common occurrence. Most often, this disease manifests itself in the form of a rash, but the causes can be different. You will learn in this article how allergic rashes in children are treated and what they are like.

• For what reason does an allergic rash appear on a child's skin?
• What does a child's skin allergy look like?
• How to diagnose allergies?
• First aid and treatment
• What is done to prevent allergic rashes in children?
• Types of allergic reactions with photos
• Conclusion

Causes

Allergic rashes can occur in children from birth until the age of 7 years. This is explained by the fact that the immune system has not yet been formed. Below are the main causes of allergic reactions in children:

• Medicines, the body may react negatively to some components of medicines;
• Breast milk if the diet is not followed;
• Hygiene products and household chemicals;
• Plants and animals can also cause rashes;
• Ultra-violet rays;
• Various infections and diseases.

Introduction

According to the United Nations, the share of older people in the world population will reach 22% by 2050.
Today in European countries this share is already 25%, in Japan – more than 30%. In many countries, pension costs may increase by 2–3 times [1]. In 2022, the World Health Organization (WHO) highlighted the lack of preparedness of the international health care system to respond to the needs of older people and called for improved coordination of efforts between doctors of different specialties in providing them with medical care. The director of the WHO Department of Aging and the Life Course, John Bird, said that “health and social workers at all levels can play an important role in improving the situation of older people.” WHO recommends responding to their “complex needs” beyond discussing the illnesses with which they come to doctors [2]. The structure of diseases changes significantly as we age, incl. skin Changes occurring in the body leave an imprint on the nature and characteristics of the course of dermatoses. Many researchers have shown that skin diseases are more common in older people than in the rest of the population. Thus, it was found that 40% of Americans between 65 and 74 years of age have at least one skin disease serious enough to require seeking help from a doctor. In elderly people over 74 years of age, an even greater incidence of severe dermatoses was detected. Unfortunately, Russian official statistics do not contain information about the true prevalence of skin diseases among the studied population [3–4].

An assessment of the somatic condition of an elderly patient must necessarily include an examination of all skin integuments (even in the absence of relevant complaints). Skin aging is conventionally divided into natural internal and exogenous aging (caused primarily by ultraviolet rays and other external factors, synonymous with photoaging). Natural aging is changes that represent manifestations of normal maturity, characteristic of all people [5, 6].

Features of dermatoses in the elderly

In older people, significant morphological and functional changes occur in the skin:

• the number of nerve receptors decreases, neurovascular reactions weaken and change;
• the bactericidal properties of the skin, its electrical resistance, and thermoregulation decrease;
• metabolic processes in the skin decrease, under-oxidized metabolic products accumulate, tissue hypoxia develops;
• the epidermis becomes thinner due to a predominant reduction in the rows of cells of the spinous layer (apoptosis of keratinocytes); in the dermis - dystrophic changes in fibrous structures, reduction in the number and degeneration of cellular elements, thickening and obliteration of blood vessels, atrophy of pilosebaceous follicles and sweat glands;
• age-related characteristics of immune deficiency (exhaustion syndrome), tendency to develop immunopathological reactions [5].

Microscopy of the skin of older people reveals the following disorders:

• smoothing of the border between the dermis and epidermis (the normal folded appearance is lost);
• decrease in the number of melanocytes and Langerhans cells;
• atrophy with a decrease in the number of fibroblasts, mast cells and blood vessels;
• hair depigmentation;
• loss of hair follicles;
• reduction in the number of sweat glands;
• reduction in the amount of collagen, elastin and ground substance [5].

In conditions of demographic aging of the population, the number of comorbid diseases increases significantly. The presence of high comorbidity leads to an increase in mortality in patients with chronic diseases, a decrease in the quality of life and their social maladjustment [7]. The prevalence of comorbidity is up to 98% in patients of the older age group (>65 years) [8]. The number of older people suffering from four or more diseases at the same time, according to the forecast of scientists from Newcastle University, will double by 2035 [9]. A distinctive feature of dermatoses in older people is the occurrence of dermatoses against the background of other, most often chronic, diseases, resulting in the development of the so-called. mutual burden syndrome. At the same time, the combination of symptoms of dermatosis with symptoms of concomitant diseases, the number of which increases with aging, creates significant diagnostic and therapeutic difficulties. On the other hand, the source of diagnostic errors may be the presence of a “bouquet” of symptoms in systemic dermatoses, the proportion of which is quite high. In gerontology, there are cases of discrepancy between scanty symptoms and the severity of the disease with a tendency towards a chronic relapsing course and the appearance of atypical forms of dermatoses [10]. Senile unresponsiveness causes the development of subclinical forms with a slow increase in clinical signs of dermatosis, but skin lesions often become disseminated. According to a number of authors, in the Russian Federation, about 75% of elderly patients are chronically in a state of decompensation, which leads to a decrease in the quality of life, disability and death. In old age, a dermatologist is often the only specialist to whom the patient turns, and the first who can identify the presence of somatic pathology [11].

Types of skin lesions in old age

The most common skin lesions (not dermatoses) in old age are trophic changes and ulcers, with which many patients turn directly to the surgeon. In the Russian Federation, according to a number of authors, elderly people at outpatient appointments with a dermatologist account for 24.3% of patients with eczema and 15.5% with psoriasis, in inpatient settings - 26.7 and 46.7% of cases, respectively [ eleven]. According to another Russian study, of 457 geriatric patients with dermatoses included in the study, 22% consulted a dermatologist with a diagnosis of eczema (Fig. 1) [11–13].

Age-related changes are characteristic of many chronic dermatoses; we will note only some common diseases.

Among inflammatory skin diseases, the following dermatoses are the most common in the elderly [5]:

• xerosis (dry skin);
• superficial mycoses;
• contact dermatitis;
• congestive dermatitis;
• seborrheic dermatitis;
• rosacea (including rhinophyma).

In old age, allergic and pruritic dermatoses occupy a leading place in the structure of skin pathology, accounting for 55.8 and 47.4%, respectively, which determines the high relevance of the problem [14]. At the same time, the incidence, and, accordingly, the need for certain types of specialized care (including dermatological) is 1.5–3 times higher than in people of working age [15]. Itching is one of the most common skin-related complaints in elderly patients. In most cases, itching is caused only by xerosis and is often exacerbated by low humidity, frequent washing, or application of irritants to the skin. The so-called pathological itching can be caused by various reasons: diseases of the nervous system (parkinsonism, psychosis, epilepsy, psychopathy, etc.), internal organs (liver, pancreas, kidneys), endocrine disorders (diabetes mellitus, thyrotoxicosis), malignant tumors of internal organs and blood (leukemia, lymphogranulomatosis) [16]. Given the numerous changes that accompany advancing age, the management of pruritus in old age represents a particular clinical, often multidisciplinary problem [17].

Shingles. In old age, due to a decrease in the body's immune reactivity, the incidence of viral infections increases, incl. recurrent forms. Shingles, caused by the herpes virus, often develops. The incidence of herpes zoster reaches its peak at the age of 75 years and is approximately 1500 cases per 100 thousand people annually [18]. The disease develops when a virus penetrates a weakened body or occurs as a result of reactivation of a previously acquired infection. Most often, painful grouped blisters with transparent contents on a hyperemic base appear on the skin of the chest, face, and upper extremities (Fig. 2). Postherpetic neuralgia, rare among patients under 40 years of age, is observed in more than 40% of patients 60–69 years of age and in 50% of patients 70 years of age and older [18].

Onychomycosis occurs in approximately 40% of patients over 60 years of age, and mycosis of the feet occurs in approximately 80% of this population (Fig. 3, 4) [19–21].

Para-oncological dermatoses (syn. paraneoplastic dermatoses) are skin reactions to malignant neoplasms of internal organs and systems that change the physiological processes in the body and lead to the accumulation in it of usually biologically active substances (hormones, growth factors, etc.) and tumor antigens that contribute to the occurrence of new clinical symptoms (Fig. 5) [5].

Lesions of the skin and mucous membranes can be divided into 3 groups [5]:

• hereditary syndromes in which a malignant tumor is combined with diseases of the skin and mucous membranes;
• paraneoplastic dermatoses caused by the influence of the tumor on the metabolism, immunity and regulatory systems of the body;
• metastasis of malignant tumors to the skin and mucous membranes.

Neoplasms. The incidence of skin cancer, including melanoma, increases exponentially with age, apparently in part due to cumulative exposure to carcinogens throughout life that affect cell division and lead to the risk of mutations. The main etiological factor in the development of skin cancer is ultraviolet radiation. Malignant tumors most often appear on the face, with unclear contours, pink or brown, and are prone to ulceration and decay [22].

The most common types of skin tumors in older people [5]:

Benign tumors:

• seborrheic keratosis;
• capillary hemangiomas;
• acrochordons;
• hyperplasia of the sebaceous glands.

Precancerous formations [5]:

• actinic keratosis (Fig. 6, 7);
• Bowen's disease.

Malignant tumors [5]:

• basal cell carcinoma (basal cell carcinoma; Fig. 8, 9);
• squamous cell carcinoma;
• melanoma.

It is necessary to devote a lot of time to collecting anamnesis in elderly people with dermatoses, because the effectiveness of subsequent therapy will largely depend on its thoroughness. It is necessary to find out previous skin and somatic diseases, concomitant somatic diseases, medications received by patients in the past and present, and allergy history.

Treatment

Pharmacotherapy of elderly patients has a number of difficulties for the following reasons [23]:

• age-related changes in pharmacokinetics and pharmacodynamics;
• forced polypharmacy due to polymorbidity;
• low adherence to treatment;
• high incidence of side effects;
• limited financial opportunities to purchase effective medications.

It is also important to pay attention to the fact that in the elderly, not only under-diagnosis, but also over-diagnosis is harmful due to incorrect perception of age norms, data from functional studies and clinical tests, interpretation of them as symptoms of the disease and subsequent irrational pharmacotherapy [24].

In elderly patients, due to polymorbidity, it is important to take into account the drug interactions of various drugs and consider the possibility of temporarily discontinuing some of them (balancing the importance of solving skin and somatic problems). Of course, if possible, it is necessary to give preference to external treatment and pay close attention to skin care (it should be different from that in other age periods). Through the sensitive skin of older people, drugs are absorbed faster and systemic effects appear faster, so lighter dosage forms are preferable for the elderly - creams or emulsions (especially on the face and in skin folds) [25].

Conclusion

In conclusion, it should be noted that in the process of postgraduate training of geriatricians, family doctors and therapists, it is important to pay more attention to the issues of proper skin care for elderly patients, the differences between physiological and pathological aging of the skin, the connection between somatic diseases and skin diseases in the elderly, and an individual approach to therapy appropriate to the age characteristics of patients.

What do allergic rashes look like?

There are a large number of types of allergy rashes in children, it all depends on the irritant that caused it. In many cases, exanthemas appear on the child’s body (this is the name given to various manifestations of allergic rashes):

• pustules (filled with pus);
• plaques;
• spots;
• vesicles (filled with liquid);
• blisters (large vesicles larger than 0.5 cm).

With food allergies in children, the rash can be found primarily on the cheeks and near the mouth. With a contact allergy, a rash or irritation will appear in the area where the allergen touched. If the child’s body reacts negatively to medications, inflammation will appear in the area of ​​the lymph nodes.

How to diagnose allergies?

An allergic rash in children is often confused with an infectious one. If the treatment is incorrect, then the consequences of such a therapeutic course will not be the best. Before choosing an effective remedy, you need to learn to distinguish one disease from another. Only a doctor can make an accurate diagnosis, since a visual examination is not always enough to determine the cause of the disease; tests are required.

First aid and treatment

If children develop an allergic rash on their skin, it is strictly forbidden to squeeze pimples or open blisters. It is necessary to explain to the child that it is also forbidden to scratch the sores.

If he is still too small, make sure that he does not touch the wounds with dirty hands. He can get an infection, and this will only worsen his condition.

Treatment of rashes in children is selected depending on the type of disease. Parents who do not know how to treat allergic rashes in children should not select medications on their own.

Are there any complications?

Acute urticaria in children can have a dangerous complication - Quincke's edema (giant urticaria, angioedema). It consists of swelling of the mucous membrane of the respiratory tract. The child has coughing attacks and has difficulty breathing. Very young children may experience swelling of the gastrointestinal mucosa (the reaction to this is vomiting). In severe cases, the membranes of the brain and nervous system are affected. Any of these conditions is very dangerous and can be fatal. Therefore, it is very important not to delay visiting a doctor if there are signs of illness.

Important! Many parents do not know what to do with Quincke's edema. You should immediately give your child an antihistamine (any one from your home medicine cabinet) and call emergency medical help.

How to avoid allergies in children?

Preventive measures will prevent the child from developing an allergic rash. Doctors give the following recommendations:

• Make sure that the baby does not come into contact with the allergen (remove allergenic foods from his diet; if necessary, change baby powder, soap or dishwashing liquid.
• Maintain order in his room, regularly do wet cleaning.
• If there are pets in the house, keep them clean.
• Strengthen the baby’s immunity (walk more often, play sports).
• Do not violate your doctor’s recommendations for taking medications.

Estrogen

It is rightly called the hormone of beauty and femininity. Maintaining adequate estrogen levels is important because it provides the following134:

• stimulation of hyaluronic acid production, maintaining a sufficient level of skin moisture;
• elasticity, beauty and strength of nails and hair;
• active regeneration processes;
• collagen synthesis;
• maintaining skin metabolism.

If there is a lack of estrogen in the body, hormone replacement therapy may be prescribed.

Examples of rashes with photos

Colorless rash "goosebumps"

Exudative diathesis

Hives

Food allergies