Allergic dermatitis
The content of the article:
- Causes and risk factors
- Symptoms of allergic dermatitis
- Features of allergic dermatitis in children
- Diagnostics
-
Treatment of allergic dermatitis
An experimental treatment for allergic dermatitis
- Nutrition for allergic dermatitis
- Alternative treatment of allergic dermatitis
- Potential consequences and complications
- Forecast
- Prevention
Allergic dermatitis is an inflammation of the skin that develops as a result of its direct contact (sometimes short-term) with an optional irritant, that is, a substance that does not cause the development of any pathologies in most healthy people. The second name of this disease is contact dermatitis.
The main role in the development of allergic dermatitis in children belongs to genetic factors.
Causes and risk factors
Allergic dermatitis refers to delayed-type allergic reactions, in which the main role is played not by antibodies, but by cells of the immune system and, above all, lymphocytes.
Symptoms of allergic dermatitis can be caused by chemicals:
- paint and varnish products;
- washing powders;
- cosmetic and perfumery products;
- synthetic fabrics;
- latex.
Some medicines (antibiotics, vitamins, synthomycin emulsion), nickel jewelry can also act as allergens. Very often, contact with plants (white ash, primrose, hogweed) becomes the cause of allergic dermatitis on the hands. This form of the disease is called phytodermatitis.
Allergic dermatitis can be a reaction to household chemicals
A special role in the development of an allergic reaction upon direct contact between an irritant and the skin is played by phagocyte cells located in it. They absorb and digest allergens and immune complexes that enter the skin. After applying a specific irritant to the skin of a sensitized person, the number of phagocyte cells in a short period of time increases several times.
Phagocyte cells not only digest allergens, but also promote their contact with specific cells of the immune system, which becomes the cause of an expanded immune response, i.e., the development of an allergic reaction.
With repeated contact of the skin with the allergen, the allergic reaction occurs more brightly and violently than the first time. This is due to the fact that the patient's body already contains antibodies and immune cells to this allergen.
Phagocytes and lymphocytes in the focus of inflammation also contribute to redness and swelling of the skin, dilation of blood vessels, and increased itching.
The predisposing factors for the development of allergic dermatitis are:
- thinning of the stratum corneum;
- excessive sweating (hyperhidrosis);
- chronic inflammatory diseases, accompanied by impaired immune response;
- predisposition to the development of allergic reactions.
Symptoms of allergic dermatitis
Skin lesions in allergic dermatitis are always localized at the site of contact with an irritating factor. For example, if the allergen is washing powder, then you should expect the development of allergic dermatitis on the hands. At the same time, the symptoms of allergic dermatitis on the face are most often due to individual intolerance to cosmetics (powder, mascara, foundation, lipstick, blush).
In allergic dermatitis, the lesion always has clearly defined boundaries. Initially, there is swelling of the skin and its redness. Then papules (dense nodules) appear, which quickly enough turn into bubbles filled with transparent liquid. After a while, the bubbles open, and erosion appears in their place. All these skin changes are accompanied by severe itching.
Repeated skin contact with an allergen can lead to the formation of chronic allergic dermatitis. In this case, the lesion becomes blurred, and the inflammatory process can spread to distant areas of the skin, including those not in contact with the irritant. The symptoms of the chronic form of allergic dermatitis are:
- thickening of the skin;
- dryness;
- peeling;
- the formation of papules;
- lichenization (increased severity of the skin pattern).
Due to pronounced itching, patients constantly comb the lesions, which is accompanied by trauma to the skin and can lead to the addition of secondary purulent-inflammatory lesions.
Severe itching is characteristic of allergic dermatitis.
Features of allergic dermatitis in children
Allergic dermatitis is a fairly common pathology in childhood. The disease is characterized by a chronic course, which is characterized by alternating periods of remission and exacerbations. After puberty, in most adolescents, the signs of allergic dermatitis completely disappear.
The main role in the development of the disease in children belongs to genetic factors. If one of the parents suffers from allergies, then the probability of the disease in the child is 50%, if both - 80%. If both the father and the mother are healthy, then the risk of allergic dermatitis in their offspring does not exceed 20%. However, the disease develops in children only when the effect of a specific irritant, that is, an allergen, is added to the hereditary factor. Allergy factors can be:
- respiratory factor (inhalation of dust, aerosols, plant pollen);
- food factor (some foods that are perceived by the child's immune system as harmful irritants);
- contact factor (aggressive substance such as soap, shampoo or baby cream).
Allergic dermatitis in infants initially manifests itself as a type of food allergy resulting from non-compliance by a nursing mother with a hypoallergenic diet or early introduction of complementary foods (eggs, cow's milk, cereals) into the child's diet. In the future, exacerbations of the disease are provoked not only by food allergens, but also by other irritants (house dust, fungal spores, animal epidermis, plant pollen). In many children of the first years of life, the cause of the development of allergic dermatitis is infection with certain types of staphylococcus, which cause chronic inflammation of the skin.
In children, allergic dermatitis initially appears as a variant of food allergy
The main symptoms of allergic dermatitis in children are:
- local or generalized redness of the skin (hyperemia);
- areas of irritation and / or peeling of the skin;
- itching or burning;
- tearfulness;
- sleep disorders;
- dysfunction of the digestive system.
In the course of allergic dermatitis in children, several age stages are distinguished:
- Infant dermatitis. It occurs from the first months of a baby's life and lasts up to two years of age. The disease is manifested by the appearance of characteristic rashes on the flexor surface of the child's arms and legs, in the natural skin folds. It is not uncommon for children with allergic dermatitis to develop a profuse, small rash on the cheeks on the face, making the cheeks look painfully crimson. The lesions are often wet, crusted.
- Children's dermatitis. It is observed in children from 2 to 12 years old. It is characterized by the appearance of areas of redness of the skin, with plaques, cracks, scratching, erosion and crusts. These lesions in most cases are localized in the area of the elbows and neck.
- Adolescent dermatitis. It is diagnosed in adolescents from 12 to 18 years old. At this age, in most cases, the manifestations of allergic dermatitis disappear on their own, but in some adolescents, the symptoms of the disease, on the contrary, increase their severity. In these cases, contact with the allergen leads to rashes on the face, neck, elbow fossa, hands, feet, fingers and natural folds of the skin.
Diagnostics
The diagnosis is made when a patient has identified a combination of three large and at least three small criteria. The major diagnostic criteria for allergic dermatitis include:
- recurrent nature of the disease;
- a family or individual history of allergies;
- typical localization of rashes (under the earlobes, scalp, groin, popliteal and ulnar fossa, armpits, neck and face);
- severe itching of the skin, even with a small amount of rash elements.
Additional, or minor, diagnostic criteria include:
- the onset of the disease in the first years of life;
- increased level of IgE antibodies;
- follicular hyperkeratosis affecting the skin of the elbows, forearms and lateral surfaces of the shoulders);
- whitish spots on the skin of the shoulder girdle and face (Pityriasis alba);
- folded soles and palms (hyperlinearity);
- folding of the anterior surface of the neck;
- white dermographism;
- frequent infectious skin lesions of herpetic, fungal or staphylococcal etiology;
- nonspecific dermatitis of the feet and hands;
- ichthyosis, xerosis, desquamation;
- redness and itching of the skin after taking a bath (this symptom is detected in children during the first two years of life);
- symptom of "allergic glow" (dark circles around the eyes);
- increased sweating (hyperhidrosis), accompanied by itching.
Allergy skin tests help determine the cause of allergic dermatitis
To identify the allergen that caused the development of the disease, special skin tests are performed. To perform them, test strips soaked in different allergens are used. These strips are fixed on the area of well-cleaned skin. After a certain time, they are removed and the presence or absence of an allergic reaction is assessed by edema and redness of the skin.
To identify concomitant pathology, additional diagnostic tests may be required:
- general blood analysis;
- blood biochemistry;
- blood sugar;
- general urine analysis;
- general analysis of feces;
- microbiological examination of feces.
If necessary, the patient is consulted by a gastroenterologist, endocrinologist.
Treatment of allergic dermatitis
First aid for allergies, in particular for allergic rashes - removal of allergens from the stomach and intestines with the help of enterosgel gel enterosorbent.
The gel saturated with water gently cleanses the mucous membrane from allergens. Enterosgel does not stick to the mucous membrane, but gently envelops and promotes recovery.
The collected allergens are securely retained in the globular structure of the gel and removed from the body.
Other powder sorbents have the smallest particles, which, like dust, become clogged in the villi of the intestinal walls, injure and prevent the restoration of the mucous membrane.
Therefore, enterosgel gel enterosorbent is the right choice for allergies in adults and children from the first day of life.
Under the influence of allergens in the patient's body, many complex biochemical processes are triggered, therefore, the treatment of allergic dermatitis should be long and complex, including the following areas:
- identification and elimination of contact with the allergen;
- diet therapy;
- systemic pharmacotherapy (membrane stabilizing and antihistamines, corticosteroids, antibiotics, immunomodulators, vitamins, drugs that regulate the functions of the gastrointestinal tract and the central nervous system);
- external therapy (talkers, ointments, lotions);
- rehabilitation.
The main goals of the treatment for allergic dermatitis are:
- restoration of the functions and structure of the skin (normalization of moisture, improvement of metabolism and decrease in the permeability of the walls of blood vessels in the lesion);
- elimination of itching and manifestations of an inflammatory reaction;
- prevention of the transition of the disease to a severe form, which can cause patients to lose their ability to work;
- therapy of concomitant pathology.
Considering that allergic inflammation plays the main role in the basis of the pathological mechanism of the development of allergic dermatitis, basic therapy is carried out with antihistamines and anti-inflammatory drugs.
In the chronic course of the disease, it is important to observe the stages and duration of treatment.
The general regimen for the treatment of allergic dermatitis in the acute phase includes the appointment of the following drug groups of drugs:
- antihistamines with additional membrane stabilizing and anti-mediator action (second generation) for 4-6 weeks;
- first generation antihistamines (sedative) at night;
- lotions with a 1% tannin solution or a decoction of oak bark in the presence of exudation;
- creams and ointments with corticosteroids (prescribed in a short course lasting no more than 7-10 days);
- systemic corticosteroid therapy (only in the absence of the effect of the therapy described above).
In the treatment of allergic dermatitis, ointments and creams with corticosteroids are prescribed
Treatment for chronic allergic dermatitis includes:
- long-term antihistamines of the second generation (3-4 months);
- polyunsaturated fatty acids;
- immunosuppressive drugs (drugs that suppress the excessive activity of the immune system);
- topically ointment with corticosteroids and antibiotics.
After achieving remission, it is necessary to treat allergic dermatitis, aimed at preventing the occurrence of exacerbations of the disease. In this case, the following scheme is usually applied:
- antihistamines of the third generation (active metabolites) for a course of 6 months or more;
- immunomodulators;
- specific immunotherapy with allergens;
- preparations containing polyunsaturated fatty acids.
An experimental treatment for allergic dermatitis
Currently, clinical trials are underway for the use of nemolizumab in the treatment of allergic dermatitis. He is a member of the group of humanized monoclonal antibodies specific to interleukin-31.
The results of the second phase were published in 2017 in The New England Journal of Medicine. The drug was prescribed for three months to 264 adult patients suffering from severe forms of allergic dermatitis, in whom traditional treatment did not lead to a lasting positive effect. The patients were divided into two groups, one of them received nemolizumab, the other (control) - placebo. Evaluation of the effectiveness of therapy was carried out on the basis of measuring the area of the affected area and the severity of the intensity of itching (assessed using a special visual analogue scale).
During treatment with nemolizumab, the intensity of itching decreased in 60% of patients, in the control group in 21%. Reduction of the lesion area in the main group was recorded in 42% of patients, and in the control group in 27%. These results gave reason to consider nemolizumab a promising drug in the treatment of allergic dermatitis.
Nutrition for allergic dermatitis
Diet therapy in the complex treatment of allergic dermatitis plays an important role. It allows to shorten the treatment time and contributes to the achievement of stable remission. Foods that enhance sensitization of the body are excluded from the diet. These include:
- coffee;
- cocoa;
- chocolate;
- nuts;
- citrus;
- pickles and marinades;
- legumes;
- Strawberry;
- seafood.
You should not eat foods that contain dyes, emulsifiers, preservatives, since all these substances are strong allergens.
With allergic dermatitis, all allergenic foods should be excluded from the diet.
Also, patients suffering from allergic dermatitis are not recommended fried foods and rich strong broths. This is because they enhance the absorption of irritating substances by the mucous membrane of the gastrointestinal tract.
It is recommended to reduce the consumption of salt and sugar by 2-3 times, or even better, if possible, completely abandon their use during therapy. Before use, cereals must be washed in several waters and soaked for several hours.
For allergic dermatitis, nutritionists recommend eating:
- Lean meat stews or steamed
- black bread;
- natural fermented milk products (without preservatives, sweeteners and dyes);
- freshly squeezed apple juice;
- greens (dill, parsley);
- cereals (rice, oatmeal, buckwheat);
- olive oil (no more than 25-30 grams per day).
Alternative treatment of allergic dermatitis
In agreement with the attending physician, some methods of traditional medicine can be used in the complex therapy of allergic dermatitis, for example:
- lotions with decoctions of medicinal herbs (chamomile, viburnum or oak bark, black currant bark, string);
- compresses with decoctions of felt burdock, calendula, lemon balm, elecampane roots;
- lubrication of lesions with ointment from a mixture of baby cream or ghee and sea buckthorn oil;
- aromatherapy with sandalwood, geranium or lavender oil;
- therapeutic baths with decoctions of marsh rosemary leaves, medicinal valerian roots, flowers of blue cornflowers or chamomile, nettle leaves and common oregano.
Folk remedies can be used as part of the complex treatment of allergic dermatitis
Potential consequences and complications
Skin lesions in allergic dermatitis are accompanied by severe itching. When scratching, microtraumas are formed on the skin, which are the entrance gate for pathogenic microorganisms (fungi, bacteria). Their penetration becomes the cause of the development of purulent-inflammatory complications (abscesses, phlegmon).
Forecast
If it is possible to identify and eliminate contact with the allergen, then the prognosis for allergic dermatitis is favorable, the disease ends in full recovery.
In cases where contact with the allergen cannot be eliminated, allergic dermatitis becomes chronic and periodically worsens. The sensitization of the patient's body gradually increases, which ultimately becomes the cause of the generalization of the process and the development of systemic allergic reactions, up to life-threatening ones.
Prevention
There is no primary prevention to prevent allergic dermatitis. You can reduce the risk of its development by limiting contact with household chemicals. When working with them, use personal protective equipment (respirator, rubber gloves).
When buying clothes and jewelry, you should give preference to quality goods, reliable manufacturers. This will reduce the likelihood of skin contact with toxic metals and dyes, which often become allergens.
When the disease has already arisen, it is necessary to carry out active treatment aimed at achieving a state of remission. For this, first of all, it is necessary to identify the allergen and exclude further contact of the patient with it.
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Elena Minkina Doctor anesthesiologist-resuscitator About the author
Education: graduated from the Tashkent State Medical Institute, specializing in general medicine in 1991. Repeatedly passed refresher courses.
Work experience: anesthesiologist-resuscitator of the city maternity complex, resuscitator of the hemodialysis department.
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
