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Atopic dermatitis

Lucija Kračun, MD
Specialist of family practise
AAAMED diploma for aesthetic medicine

Atopic dermatitis is a chronic non-contagious skin disease-eczema, which causes constant dry, itchy, and inflamed skin on the face and/or body. The skin is irritated, itches and burns. Atopic dermatitis is very common in children, but it can occur at any age. In recent years, the incidence of atopic dermatitis has been increasing sharply in the developed world.

People with atopic dermatitis are more likely to suffer from asthma, food allergies, hay fever and allergic conjunctivitis.

Atopic dermatitis takes place in 2 phases, namely acute (pronounced symptoms) and chronic phase without pronounced symptoms.

Moisturizing the skin regularly and following other skin care instructions will reduce itching and reduce the frequency of flair ups. Treatment with medicated ointments and creams is often necessary in the acute phase.

SYMPTOMS AND SIGNS

Symptoms can appear anywhere on the body and vary greatly between individuals:

• Dry, cracked skin

• Itching

• A rash on swollen skin that varies in color

• Small, raised bumps on dark or black skin

• Scabs, cracks

• Thickened skin

• Skin sensitive to scratching

COMMON TRIGGERS OF ATOPIC DERMATITIS

• Dry skin

• Skin infections

• Stress

• Dry and cold air

• Perfumes and fragrances

• Washing powders and cleaning agents

• Fever and sweating

• Wool products

• Mold

• Dust mites and pet dander

• Pollen

• Certain types of food, especially for children (cow’s milk, eggs, soy…)

• Cigarette smoke

Babies and young children are most often affected by atopic dermatitis. In 90% of patients, symptoms appear before the age of 5.

Children often have outbreaks of dermatitis due to an allergy to a certain type of food, so it makes sense to test for food allergy (eggs, peanuts, soy, fish, cow’s milk, wheat, ….). It is also necessary to exclude inhalant allergens (pollen, animal dander, dust mites, house dust…) By testing both adults and children, we can exclude potential triggering factors from the diet and thus avoid problems or relieve the symptoms.

For those who are allergic to pollen, we recommend monitoring the pollen forecast at ARSO. Here you can check how much of a certain allergen is currently in the air

POSSIBLE CAUSES OF ATOPIC DERMATITIS

Atopic dermatitis is a disease for which we have no medicine to cure. However, we know of many effective healing ointments and care creams for active treatment, which alleviate and eliminate symptoms in the acute phase.

There are several genetic and environmental theories about the development of AD.

In some people, atopic dermatitis is related to a gene variation that affects the skin’s ability to provide protection from the environment. With a weakened function of the phospholipid barrier of the skin due to a lack of filaggrin and a lack of NMF (natural moisturizing factors), the skin cannot retain enough moisture and offer sufficient protection against bacteria, irritants, and environmental factors. e.g., cigarette smoke.

 In some, atopic dermatitis is caused by too much Staphylococcus aureus bacteria on the skin. These destroy the beneficial bacteria that are normally present on the skin and impair the function of the phospholipid barrier, which causes unwanted microorganisms to enter the skin and cause inflammation.

A weakened skin barrier can trigger an immune response, causing skin inflammation and other symptoms.

COMPLICATIONS OF ATOPIC DERMATITIS

Asthma and hay fever

They can appear at the same time, before or after the development of atopic dermatitis

• Extremely disturbing dermatitis on the hands; it usually affects people who often have wet hands and are in contact with soaps, disinfectants, and detergents.

Skin infections; scratching causes the skin to break and crack, allowing bacteria to enter. Impetigo develops, which is treated with antibiotics.

After inflammatory hyper- or hypopigmentation of the skin; after the healing of eczema, white discoloration of the skin remains due to loss of pigment or dark discoloration due to irregular distribution of pigment

Allergic contact dermatitis; very common in people with atopic dermatitis

• Chronically altered thickened scaly skin; due to chronic scratching, the skin thickens (lichen simplex chronicus)

Food allergies; people with atopic dermatitis often develop food allergies, which can manifest as hives.

Sleeping problems and psychological problems due to itching and resulting insomnia.

IS THERE A SOLUTION? HOW DO WE TREAT ATOPIC DERMATITIS? HOW CAN WE PREVENT FLAIR UPS?

IS THERE A SOLUTION? HOW DO WE TREAT ATOPIC DERMATITIS? HOW CAN WE PREVENT FLAIR UPS?

As we said in the introduction, there is no cure. However, the symptoms can be alleviated very well with consistent and regular care. This is extremely important especially for sensitive children’s skin.

Regular 2x daily use of moisturizing care products (creams, lotions…); regardless of whether there are currently problems or not. This preserves and strengthens the skin’s phospholipid barrier, which retains moisture in the skin. The cream should be such that it contains enough moisturizers and fat to “lock” moisture into the skin. It is recommended to test the cream first.

• Take a shower with warm (not hot) water, but no more than 10 minutes a day.

When showering or bathing, use an oil-based soap to protect the skin as much as possible from drying out and make it soft and supple. At the same time, it reduces itching.

• Do not use soap on small children. Regardless of age, use soaps without perfumes, dyes and alcohol. Do not rub the skin with a bathing glove.

• After bathing/showering, pat dry with a soft towel (not rubbing). Apply moisturizing care and nourishing cream while the skin is still moist (within 3 minutes)

WHICH CREAM TO CHOOSE?

I will list some ingredients that are essential in good products for dry skin and have a soothing, anti-inflammatory, and moisturising effect. Natural/organic cosmetics can be an excellent choice if they are dermatologically tested and formulated with appropriate ingredients. Such cosmetics can be used safely. It also does not contain synthetic dyes, parabens, or artificial perfumes…, which are well-known allergens.

Moisturizers include Aloe vera juice, Hyaluronic acid, EctoinR, NaPCA, Glycerin, Urea (not allowed in natural cosmetics), amino acids (natural skin moisturising factor – NMF, squalane… The more moisturisers a cream has, the better. In addition, it is important that the concentration of moisturizers is high enough.

Ingredients that soothe the skin and have an anti-inflammatory effect: pomegranate extract, evening primrose seed extract (omega-6 fatty acids), panthenol – B5 vitamin, licorice root extract, calendula extract, amaranth seed extract, Q enzyme, bisabolol (from chamomile). peptides, ceramides, immortelle essential oil, …

Gamma oryzanol, which is found in rice and oats, is also an essential ingredient. Namely, it restores the phospholipid barrier, which is damaged in atopic dermatitis.

The fear that natural cosmetics are allergenic and harmful is unnecessary. Of course, it is necessary to choose certified and dermatologically tested natural cosmetics to be on the safe side. Despite everything, when buying any cosmetics, both natural and unnatural, it is necessary to consider possible specific allergens.

Essential oils, which are a common component of natural cosmetics, can in most cases be allergens, especially if they are used in too high a concentration, where they also act as irritants and photosensitizers. These are the pitfalls of homemade and untested natural cosmetics. Not every home cooking is as good for the skin as grandma’s home cooking for your stomach. At Dalu, we use non-photosensitive essential oils in extremely low concentrations. For example, immortelle essential oil has numerous dermatological studies that prove its effectiveness and its extraordinary regenerative and rejuvenating effect on the skin.

All Dalú products are dermatologically tested on sensitive skin. Does not irritate your skin.

Squalane, Gama oryzanol, bisabolol, Coenzyme Q10, licorice root extract, primrose seed extract

Aloe vera juice, hexapeptides, glycerin, hyaluronic acid of two molecular sizes

Aloe vera juice, ectoin ,glycerin, panthenol - B5, hexapeptides, shea butter, gama oryzanol, immortelle essential oil, pomegranate extract

Glycerin, aloe vera juice, Ectoine®, sqalane, bisabolol, panthenol - B5, Herbashield URB®

Carite, cacao, coconut butter, aloe vera

WHEN TO SEE THE DOCTOR? 

– anyone with symptoms of atopic dermatitis, especially children

– when it disturbs your sleep and daily activities

– in case of skin infection – impetigo

– in case of elevated body temperature

TREATMENT OF ATOPIC DERMATITIS IN THE OUTPATIENT

 We have already written some basic instructions, namely about regular and correct skin care, about allergy testing, about avoiding allergens… But we will add something more about the treatment of AD in clinics.

  • When there are no signs of inflammation on the skin, and it is only dry and flaky, only proper care is needed. Therefore, your doctor can prescribe a nourishing ointment if you do not achieve sufficient skin hydration with properly purchased cosmetics.
  • Mild to moderate inflammation. There are reddened, pink, flaky spots on the skin, mild itching is present, slightly raised above the level of the skin. In this case, pimecrolimus is used twice a day until it subsides. Then you can take it once a day for up to 3 months
  • Severe inflammation; bright red, itchy foci, excoriations, and possible secondary bacterial inflammation. In this case, it is necessary to use a topical corticosteroid until the focus is thinned. In principle, we do not apply corticosteroids to the face, neck, and genitals because they thin the skin and cause the formation of capillaries. Only at the discretion of the dermatologist.

VIRI:

  1. Mayo Clinic, spletni vir
  2. Aleksej Kansky in sodelavci: Kožne in spolne bolezni
  3. Atlas of Dermatoscopy, Tayor and Francis Group
  4. Vlasta Dragoš, dr.med, specialist dermatovenerolog, Navodilo za uporabo zdravila pimekrolimus. 

Lucija Kračun, MD
Specialist družinske medicine
AAAMED diploma za estetsko medicino

Atopijski dermatitis je kronična nenalezljiva kožna bolezen – ekcem, ki povzroča stalno suho, srbečo in vneto kožo na obrazu in/ali telesu. Koža je razdražljiva, srbi in peče. Atopijski dermatitis je zelo pogost pri otrocih, pojavi pa se lahko pri katerikoli starosti. Torej tudi pri odraslih. V zadnjih letih se incidenca atopijskega dermatitisa v razvitem svetu strmo povečuje.

Ljudje z atopijskim dermatitisom bolj pogosto zbolijo za astmo, alergijami zaradi hrane , senenim nahodom in alergijskim konjunktivitisom.

Atopijski dermatitis poteka v 2 fazah,  in sicer akutni z izraženimi simptomi in kronični fazi brez izraženih simptomov.

Redno vlaženje kože in upoštevanje drugih navodil za nego kože omili srbenje in zmanjša pogostost izbruhov. Pogosto pa je potrebno v akutni fazi zdravljenje z zdravilnimi mazili in kremami.

Simptomi in znaki

Simptomi se lahko pojavijo kjerkoli po telesu in se zelo razlikujejo med posmazniki.

  • Suha, razpokana koža
  • Srbenje 
  • Izpuščaj na otečeni koži, ki variira v barvi
  • Majhne, privzdignjene izboklinice na temni ali črni koži
  • Kraste, razpoke
  • Zadebeljena koža
  • Občutljiva koža na praskanje 

POGOSTI SPROŽILCI

ATOPIJSKEGA DERMATITISA

  • Suha koža
  • Okužbe kože
  • Stres
  • Suh in mrzel zrak
  • Parfumi in dišave
  • Pralni praški in sredstva za čiščenje
  • Vročina in potenje
  • Volneni izdelki
  • Plesen
  • Pršice in prhljaj hišnih ljubljenčkov
  • Cvetni prah
  • Določene vrste hrane ,zlasti pri otrocih ( kravje mleko, jajca, soja…)

Najpogosteje so zaradi atopičnega dermatitisa prizadeti dojenčki in majhni otroci. Pri 90 % bolnikov se simptomi pojavijo pred 5 letom starosti. 

Otroci imajo pogosto zagone dermatitisa  zaradi alergije na določeno vrsto hrane, zato je smiselno testiranje na alergijo na hrano (jajca, arašidi, soja, ribe, kravje mleko,pšenica,  …..). Prav tako je potrebno izključiti inhalatorne alergene ( cvetni prah, živalski prhljaj, pršica, hišni prah …)  S testiranjem tako odraslih kot otrok lahko izključimo potencialne sprožilne dejavnike iz prehrane in se tako izognemu težavam oz. omilimo simptome. 

Tistim, ki so alergični na cvetni prah, priporočamo spremljanje pelodne napovedi na ARSO. Tukaj lahko preverite, kakšna količina določenega alergena je  trenutno v zraku. 

MOŽNI VZROKI ATOPIJSKEGA DERMATITISA

Atopijski dermatitis je bolezen, za katero nimamo zdravila, da bi ga pozdravili. Poznamo pa številna učinkovita zdravilna mazila in negovalne kreme za aktivno zdravljenje, ki ga blažijo in odpravljajo simptome v akutni fazi.

       Obstajajo številne genetske in okoljske teorije o razvoju AD.  Variacija v genu , ki vpliva na sposobnost kože, da nudi zaščito pred okoljem. Z oslabljeno funkcijo fosfolipidne bariere kože zaradi pomanjkanja filagrina, in pomanjkanja NMF (naravnih vlažilnih faktorjev) koža ne more zadržati dovolj vlage in nuditi dovolj zaščite pred bakterijami, dražilci in okoljskimi dejavniki. npr. cigaretni dim. 

        Pri nekaterih nastane AD zaradi preveč bakterij Staphylococcus aureus na koži. Le – te uničujejo koristne bakterije, ki so normalno prisotne na koži in okvarjajo funkcijo fosfolipidne bariere, kar povzroči vdor neželjenih mikroorganizmov v kožo in povzroči vnetje.

Oslabljena kožna pregrada lahko sproži imunski odziv, kar povzroči vnetje kože in druge simptome.

ZAPLETI ATOPIJSKEGA DERMATITISA

  • Astma in seneni nahod

Pojavita se lahko istočasno, pred ali po razvoju atopičnega dermatitisa

  • Izjemeno moteč dermatitis na rokah ; običajno prizadene ljudi, ki imajo pogosto mokre roke in so v stiku z mili, razkužili in pralnimi sredstvi.
  • Okužbe kože; zaradi praskanja se koža poškoduje in popoka, kar povzroči vdor bakterij. Razvije se impetigo, ki ga zdravimo z antibiotiki.
  • Povnetne hiper- ali hipo-pigmentacije kože; po zacelitvi ekcema ostane belo razbarvanje kože zaradi izgube pigmenta ali pa temno obarvanje zaradi nepravilne razporeditve pigmenta
  • Alergijski kontaktni dermatitis; zelo pogosto pri ljudeh z atopičnim dermatitisom
  • Kronično spremenjena zadebeljena luskasta koža; zaradi kroničnega praskanja se koža zadebeli (lichen simplex chronicus)
  • Alergije na hrano; ljudje z atopičnim dermatitisom pogosto razvijejo alergije na hrano, ki se lahko kaže v obliki urtikarije.
  • Težave s spanjem in psihične težave zaradi srbenja in posledične nespečnosti.
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Ali obstaja rešitev? Kako zdravimo atopijski dermatitis? S čim lahko preprečimo poslabšanje?

Ali obstaja rešitev? Kako zdravimo atopijski dermatitis? S čim lahko preprečimo poslabšanje?

Kot smo povedali uvodoma, zdravila ni. Lahko pa zelo dobro blažimo simptome z dosledno in redno nego.

To je izjemno pomembno zlasti pri občutljivi otroški koži.

  • Redna 2x dnevna  uporaba vlažilnih negovalnih izdelkov  ( kreme , losjoni…) ; ne glede na to, ali so trenutno težave ali ne. S tem ohranjamo in krepimo fosfolipidno bariero kože, ki zadržuje vlago v koži. Krema mora biti taka, da vsebuje dovolj vlažilcev in maščobe, da »zaklene« vlago v kožo. Priporočljivo je, da kremo najprej preiskusite. 
  • Tuširajte se s toplo (ne vročo) vodo, vendar ne več kot 10 min dnevno.

Za tuširanje ali kopanje uporabite milo, ki je na oljni osnovi, da čim bolj zaščiti kožo pred izsušitvijo in jo naredi mehko in voljno. Obenem pa zmanjša srbečico.

  • Za majhne otroke ne uporabljajte mila. Ne glede na starost uporabljajte mila brez parfumov, barvil in alkohola. Kože ne drgnite s kopalno rokavico.
  • Po kopanju/tuširanje se obrišite s polaganjem mehke brisače (ne drgnjenjem). Nanesite vlažilno negovalno in hranilno kremo še dokler je koža vlažna ( znotraj 3 minut)

Katero kremo izbrati?

Navedla bom nekaj sestavin, ki so nujne v dobrih izdelkih za suho kožo in delujejo pomirjujoče, protivnetno in vlažilno. Naravna/organska kozmetika je lahko odličen izbor,če je dermatološko testirana in zasnovana z ustreznimi surovinami. Takšno kozmetiko se lahko varno uporabi. Prav tako ne vsebuje sintetičnih barvil, parabenov, umetnih parfumov…., ki so znani alergeni.

Med vlažilci so odlični: Aloe vera sok, Hialuronska kislina, EctoinR, NaPCA, Glycerin, Urea (ni dovoljena v naravni kozmetiki), aminokisline (naravni faktor vlaženja kože – NMF, skvalan…Več vlažilcev ima krema, boljša je. Poleg tega je pomembno, da je koncentracija vlažilcev dovolj visoka.

Sestavine, ki kožo pomirijo in delujejo protivnetno: izvleček granatnega jaboka, ektoin,  izvleček semen svetlina (omega -6 maščobne kisline), panthenol – B5 vitamin, izvleček korenine sladkega korena, izvleček ognjiča, izvleček semen amaranta, Q encim, bisabolol (iz kamilice) , peptidi, ceramidi, eterično olje smilja, … 

Nujna sestavina je tudi gama orizanol, ki ga najdemo v rižu in ovsu. Obnavlja namreč fosfolipidno bariero, ki je pri atopičnem dermatitisu okvarjena.

Strah, da je naravna kozmetika alergena in škodljiva je odveč. Je pa potrebno izbrati seveda certificirano in dermatološko testirano naravno kozmetiko, da boste na varni strani. Kljub vsemu je ob nakupu vsake kozmetike tako naravne kot nenaravne potrebno upoštevati morebitne specifične alergene.

Eterična olja, ki so pogosta sestavina naravne kozmetike so v večini primerov lahko alergena, sploh če so uporabljena v previsoki koncentraciji, kjer delujejo tudi dražeče in fotosenzitivno.  To so pasti doma narejene in netestirane naravne kozmetike. Vsaka domača kuhinja za kožo ni dobra kot domača babičina kuhinja za želodček.

Pri Dalú uporabljamo nefotosenzitivna eterična olja v izjemno nizkih koncentracijah. Npr. eterično olje smilja ima številne dermatološke študije, ki dokazujejo učinkovitost le-tega ter njegov izjemen regenerativen in pomlajevalni učinek na kožo.

KDAJ K ZDRAVNIKU ?  

  • Vsak, ki ima simptome atopijskega dermatitisa, še posebno pa otroci
  • ko ja tako moteče, da moti vaš spanec in dnevne aktivnosti
  • v primeru okužbe kože – impetigo
  • v primeru povišane telesne temperature

ZDRAVLJENJE ATOPIJSKEGA DERMATITISA V AMBULANTI

 Nekaj osnovnih napotkov smo že napisali in sicer o redni in pravilni negi kože, o alergoloških testiranjih, o izogibanju alergenom…. Dodali pa bomo še nekaj o zdravljenju AD v ambulantah.

  • Kadar na koži ni znakov vnetja in je samo suha in se lušči, je potrebna samo pravilna nega. Torej zdravnik vam lahko predpiše negovalno mazilo, v kolikor z ustrezno kupljeno kozmetiko ne dosežete dovoljšne hidracije kože.
  • Blago  do zmerno vnetje. Na koži so pordela, rožnata luščeča žarišča, blaga srbečica je prisotna, nekoliko dvignjeno nad nivo kože. V tem primeru se uporabi pimekrolimus 2x dnevno do umiritve. Potem lahko do 3 mesece 1x dnevno
  • Hudo vnetje; živo rdeča, srbeča žarišča, ekskoriacije in morebitna sekundarna bakterijska vnetja. V tem primeru je potrebno uporabiti lokalni kortikosteroid, dokler se žarišče ne stanjša. Na obraz, vrat in spolovila načeloma ne nanašamo kortikosteroidov, ker tanjšajo kožo in povzročijo nastanek kapilar. Samo po presoji dermatologa.

VIRI:

  1. Mayo Clinic, spletni vir
  2. Aleksej Kansky in sodelavci: Kožne in spolne bolezni
  3. Atlas of Dermatoscopy, Tayor and Francis Group
  4. Vlasta Dragoš, dr.med, specialist dermatovenerologNavodilo za uporabo zdravila pimekrolimus, 

Preberite še vse o pigmentnih madežih in zgodbo o čudežnem sadežu.

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