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Roztocza
Dieta alergiczna
   
Odczulanie:
  Definicja
  Wskazania i przeciwwskazania
  Skuteczność
  Bezpieczeństwo
  Przebieg
  Pytania
   
Astma
Atopowe zapalenie skóry (AZS)
Atopowe zapalenie skóry – pytania
Anafilaksja – alergia pokarmowa

 

Atopic dermatitis (AD) covers all skin problems such as:

cause of strong and irritating itchiness
appear in usual places on the body
are chronic and recurrent
usually associated with other allergic diseases e.g. atopic conjuctivitis, hay fever or asthma. It is normal for these complaints to affect other family or blood relations.

Synonims of AD: endogenous eczema, atopic eczema, neurodermatitis, pruritus.

Atopy is a predisposition to hyperactivity of the immune system which causes rhinitis, asthma, atopic dermatitis or food allergies.

Specifics of AD among infants

1 Itching
Newborn and small infants react differently to itching. They are not able to scratch themselves. They behave like a grown-up whose hands are tied.
They are upset, crying, screaming, stop eating or don’t eat at all. Unfortunately all of these symptoms can be caused by other serious diseases. That is why peadiatric advise is necessary.

2 Common sites affected by AD
The most common sites among infants are cheeks, forehead, the lateral parts of calfs or dispersed over the whole skin area. From time to time these can be worse, and in such cases, swelling, blistering and scabs can be seen. Quite often such changes can be noticed on the wrists, arms, forearms, elbows, on the back part of knees and ankles.
AD as oppossed to seborrhoeic dermatitis does not affect the skin under nappies.
At that time changes to the skin can be a result of overproduction of sebum. That is produced by the sebaceous glands that provide the outer skin protective barrier . This overproduction is called infant or sebaceous acne. To differentiate these two diseases is difficult and prolonged weeks or months of observation is required. In serious cases consultation with a dermatologist is helpful.

3 Chronic and recurrent
Allergic march is a common term for a sequel which begins from AD. Then later follows hay fever and bronchial asthma. AD can begin in early infancy with recurrent rashes. Later such skin abnormalities become chronic.
All children’s rashes worry their mothers so it is important to diagnose the cause.
First of all when dealing with a rash we exclude serious and contagious diseases. Secondly observation of any connections with usage of creams, soaps or washing powders and the disappearance of, or aggravation in skin changes can be crucial in their diagnosis and treatment. Similarly if we think about food.
It is useful to discus with your doctor about the severity of the disease. If we use
a scale from zero to ten, it may be that your rating is ten (i.e. the worst) but on
a doctor’s scale only registers as three.
Skin treatments require patience. Treatment depends on the severity of changes. If there is slight irritation we can treat simply with oils, creams and ointments. If the lesions are serious we must treat them quickly, using sometimes surface steroids. Because of side effects it is important to use steroids only in severe cases.

Etiology of AD

There is no known cause of AD. Some genetic and external factors are important. Structure of skin layers and production of epithelium oil is hereditary. Genetic factors have an influence on neurological and hormonal system. Both of them deal with immunity and inflammation. Other factors are, e.g. allergens, toxins and other environmental factors which can aggravate a patient’s stress. Skin and central nervous system originate from the same , outer embryonic layer (ectoderm) so, they are very close, this is why exacerbations of irritating skin are often connected with serious / acute emotions which can be hidden or not recognized.

Epidemiology and a course of AD

AD is the most common dermatologic disease among children. 1 in 5/6 of them suffer from AD. Half of these show symptoms before they are 6 months old. Most of them develop the disease before school age. Only ten percent show first symptoms over five years of age. Fortunately the majority of them recover before they reach 10. years.

Treatment

There is no causative treatment, because as stated before the real cause of AD is unknown. That is why observing what irritates skin (e.g. food ) is very important.
First of all we should avoid or limit food which irritates the skin. Secondly, we must quickly treat the skin lesions and then seek to maintain soft skin without irritation.

What can provoke skin irritation ? In short the answer is everything which can affect skin functions. – Now we turn to:

Skin functions

1 Function of protection
Skin is the main mechanical barrier which protects the human body from external traumatic factors such as: toxic substances, organic acids and other chemical substances like detergents, gasoline, chemical solvents and lacquers, sand, bacteria, viruses, moulds and other microorganisms and even from water.

2 Thermal function
Skin maintains the balance of temperature and thanks to that protects us from overheating and from freezing.

3 Neuro-regulatory function
Thanks to nerve fibres and receptors, our skin can feel and transfer impulses of heat, pain and humidity.

4 Homeostatic function
The skin is an important factor in the regulation of water balance. It does this
thanks to vaporization and sweating.

Disturbances of skin functions

1 Function of protection
Every skin lesion, mechanical or other provokes a defensive skin reaction which is inflammation. Classic features of this are redness, swelling, pain or itching, an increase in temperature and impairment of this function.

2 Thermal function
If the skin is overheated then we begin to sweat. For example a prolonged hot bath or a room temperature over 20 Celsius degrees can lead to disturbance of the lipid surface of the skin. This makes the skin dry and itchy. Dry skin is additionally irritated by salt from sweat glands.

3 Neuro-regulatory function
The skin produces lipids according to its requirements. It does this thanks to skin receptors. They can recognize environmental stimuli and coordinate current lipid production with sweating and vaporization. Skin is also important in stress reaction. Skin blood vessels tend to be closed and in that way provide blood to more important organs during stress such as brain, muscles and heart. This reaction, if it is prolonged, leads to the impairment of feeding skin tissue. Moreover, substances which are produced during to stress reaction additionally irritate the skin. All of this aggravates skin functions. Lipid production is decreased, skin permeability for irritating substances is increased. That leads to increase leaking of physiologic liquids, which makes the skin dry. Dry skin becomes itchy because of irritating endings of skin nerves because of the lack of lipid. This is a vicious circle in dry skin.
The main factor to reverse this process is the lipid. Rebuilding of lipid tissue on the skin surface is the key element to adequately moisturise the skin. That is why we should put ointments as often as required to maintain soft skin and to avoid drying again. Sometimes topical treatment at the very beginning is required every one – two hours.

4 Homeostatic function
The lipid is important to protect from vaporization. Lack of lipid increase leaking of water and opposite: putting cream on the skin we decrease the permeability of skin and increase its moisture.

Skin treatment and protection

Topical lipid treatment is the most important action to reverse the defect of impaired lipid production among patients who suffer from AD.
Alevation of itching


Alevation of itching is very important for a better quality of life. Special research on quality of life (QOL) shows that itching in AD deteriorates QOL more than in diabetes, bronchial asthma and even some oncologic diseases. Moreover scratching aggravates skin irritation and makes treatment more difficult. The skin of patients with AD is covered with bacteria, or sometimes by mould. Scratching facilitates bacteria to invade deeper layers of the skin. These help bacteria grow and increase inflammation. The inflammation disturbs all skin functions and a vicious circle of irritating skin goes on.

Helpful hints


1 A bath in warm water 25-28 of Celsius degrees.

2 Soft soap with pH less than 5.5 or oil bath liquids. Immediately after bathing cream or ointment should be applied. This increases skin lipid barrier and as a result decreases evaporation. The emollients have different additional compounds such as: ceramides, fatty acids, wax, triglicerides, some oils derivates from plants or animals. Some pharmaceutical companies have dealt in skin products for over one hundred years. However, every patient has different sensitivity. That is why some of them tolerate better for example Panthenol and other Allantoine.

There are some substances added for topical treatment.
Panthenol – provitamine B5, accelerate lipid and protein production that increase healing of surface layer of skin – cornea. It is useful in different causes of skin defects like burning, allergy or other skin diseases.

Alantoin – urea derivate, softens skin and makes it more supple.

Urea – a compound of NMF (Natural Moisturizing Factor). It makes cornea soft thanks to binding water molecules by keratine fibres . The urea also controls the process of callosity.

Lactic acid – fortifies colagen structure of the skin and acts in this process at the same time (Synergy) with urea.

Hialuronic acid – a main compound of extracellular substance. As a surface factor protects skin against evaporation and some external harmful factors.

Borage – contains gammalinolenic and linolenic acids which are compounds of phospholipids of cellular membranes. They protect skin from injury and inhibit inflammation,

Other supporting therapy:
Loose and silk or cotton pyjamas
Loose clothes non woollen.
Special, soft washing powders like Lovela or Jelp.
Cool room temperature (18-20 C degrees) a round the clock.

F.A.Q.:

1 Why do some doctors say atopic dermatitis and others eczema, sebaceous dermatitis or infant acne?

AD according to the definition, covers all skin problems such as:

1 cause of strong and irritating itchiness
2 appear in usual places on the body
3 are chronic and recurrent
4 usually associated with other allergic diseases e.g. atopic conjunctivitis, hay fever or asthma. It is normal for these complaints to affect other family or blood relations
Because of the complicated matter and different views of skin changes AD has several synonims such as: endogenous eczema, atopic eczema, neurodermatitis, pruritus.

2 Why doctors believe or say that allergy tests are irrelevant?
Mostly in therapy of AD allergy tests are less important. The younger the patients the less useful the tests are. It is connected with the unclear mechanisms of AD. Moreover, allergy tests only discover antibodies against different allergens such as: food, moulds, furs or house dust mites, and this is only one mechanism of allergic reaction and not so frequent. That is why a negative test for milk is not enough to exclude skin irritation because of drinking milk. Skin tests only show us that there are no antibodies against milk in the blood.

3 Why are blood tests negative for food and yet my child’s skin becomes significantly worse when I breast feed him after having eaten eggs?

Eggs, nuts, milk, citrus fruit, cacao and soya are the most common foods which can induce allergic reactions on the skin. An observation of the skin is much more important than tests.

Allergy tests discover antibodies against different allergens. This is only one mechanism of an allergic reaction and not so frequent. Additionally, very often allergic reaction to e.g. eggs can not be seen every time. That is why a provocation test with egg should be done twice. If it is worse after the first trial, then we should allow the skin to recover and try again. When we have an allergy reaction on the skin on the second occasion then it is useful to stop eating egg for a couple of weeks.

After some weeks, or sometimes months if reactions are very severe we can check again reaction to egg. We should always start with a very small part (1/16 of slice of the white of egg) and every day we can double the dose if there is no skin or any other reaction (see: anaphylaxis). When we see that, the skin becomes slightly irritated we intensify oil treatment and no longer increase the dosage but do not stop feeding the child with the tested food. It may happen, that the skin was irritated by something other and small doses of the tested food can still be given without exacerbation. Then we can continue to increase the dosage. In that way we induce tolerance to different foods. Dry or irritated skin is very important during such provocation tests to avoid serious aggravation and the necessity of steroid treatment.

4 I am avoiding eating many foodstuffs and have lost weight during my breast feeding but my child’s skin is no better. What I can do now?

A breast feeding mother should not starve herself of food to become slim because of a fast, severe reaction and worsening of a suspicion of food allergy. A mother’s food intake is only partially responsible for AD.

The younger the child the more sensitive the skin. The less experienced mother the stronger the stress and the stronger the stress the worse the skin. That is a viscous circle of dry skin.
Connection of dry skin and stress is well known by adult patients. Very common
are skin exacerbation among students before exams.

The skin and nervous system are closely connected: in the fetus both of these stem from the same external germ layer – ectoderm. Occasionally we can observe skin healing among patients in a coma, when the patient is unconscious.
That is why all chronic diseases should be supported with relaxation training and other stress oriented therapies used by psychologists. Make sure you take time to relax and try not to worry or wait too long if you are concerned.

5 The doctor told me not to drink milk, but that doesn’t help. What now?


Food is only partially responsible for irritating skin. Sometimes milk can aggravate skin in the same way that putting salt on a wound does. When skin is healthy then salt will not harm the surface. But if there is a lesion then salt makes healing very difficult. That is why sometimes it is useful to stop drinking milk to speed up recovery of the skin. To go back to drinking milk later depends on following the course of disease and provocation tests (see question 3).

6 One doctor prescribes steroids, another – not. Who is right?


Steroids can be harmful. However, it is impossible to avoid steroid treatment in probably every branch of medicine. Basically, the most important thing is that the treatment musn’t be worse than the disease…And we should find the cure.

7 What period of steroid treatment is safe?


Steroids should be used as long as needed. If there is no effect after 1-2 weeks the diagnosis must be revisited. Occasionally some types of drugs are used by hospitals for in-patient treatment under thorough control and monitoring.

8 Why does my child suffer from this?


AD has a genetic background. That means we inherit from our families a disposition to develop the disease. It is not necessary directly from parents, it can be from grandparents or from other branches of the family. Usually some members of the family suffer from an allergic disease like asthma, hay fever or food allergy.
Atopy is a predisposition to hyperactivity of the immune system. It is not connected to a particular kind of allergy . It is impossible to prejudge that an allergy will develop at all.

9 I use ointment on my skin once per day according to the instruction but my skin is still dry. Can I use the cream more frequently?

O.T.C. ointments or creams can generally be applied more frequently than the recommended dosage without harmful effect. This is important as we seek to obtain soft skin. However cream containing steroids (e.g. Hydrocortison) should only be used as per the prescribed rate.

10 I use creams all the time but they don’t work. What can I do?
Consult your doctor .

11 The steroid treatment is helpful but my skin becomes pale?


Steroids have several functions, one of them is to reduce blood flow through the vessels which leads to paling of the skin. This is a short-term effect (steroid treatment should be short-term as well). The opposite effect is after a bath. Hot water dilates blood vessels so blood is more visible and skin changes appear more intensive.

12 Will I suffer from AD all my life?


Most children recover from AD in 1-3 years. Unfortunately the disease can sometimes last more than 10 years.