Neurodermatitis in adults and children: symptoms and treatment, causes, photos. Neurodermatitis - modern classification and modern approach in the treatment of the disease Approaches to treatment

Neurodermatitis - chronic illness having a neuro-allergic origin. There are several types of disease, depending on which treatment is prescribed.

Therapy of neurodermatitis is carried out with both hormonal and non-hormonal preparations (ointments). After the disease recedes, creams are prescribed that moisturize and nourish the skin, restoring its protective functions. Patients suffering from neurodermatitis also need to follow a diet.

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Causes of neurodermatitis

Neurodermatitis is a chronic skin disease characterized by neuro-allergic origin and causing a rash accompanied by itching. Psychosomatics often manifests itself in the form of neurodermatitis.

ICD-10 disease code: L20. eight.

Finding out the exact cause of neurodermatitis is difficult. The causes and factors of the disease are varied:

• hereditary predisposition to allergies;
• malfunctions in the central nervous system;
• depressive states, stress;
• excessive physical activity;
• mental strain;
• poor nutrition;
• diseases digestive system;
• weakening of the immune system;
• body poisoning;
• Availability chronic infection.



Symptoms

The main symptom of neurodermatitis is unbearable itching, which increases in the evening and at night. Also, the symptoms of the disease include:

• Eruptions in the form of red spots. They can be located on the face, trunk, elbows and knees. The rash consists of three zones: central (the skin in this place thickens, its pattern intensifies), middle (shiny papules), peripheral (pigmentation intensifies in this zone. The rash occurs mainly in the upper body and gradually descends.
• Decreased activity. The patient feels lethargy, weakness, apathy.
• Low arterial pressure. Against the background of neurodermatitis and the general weakness of the sick organism, blood pressure decreases.
• The onset of the first symptoms childhood.
• Prolonged course of the disease with periods of exacerbation in the winter season and remissions in the summer.
• The patient has other diseases that have an allergic nature of origin ( bronchial asthma, contact dermatitis).



Types of neurodermatitis

The disease has several types, differing in the place where the pathogenic process spreads over the human skin:

• Limited (focal) neurodermatitis. Lesions are formed in a limited space. back side knees, neck, genitals, anus and/or cubital fossae are sites of possible occurrence of plaques of a limited form of the disease, consisting of small papules. The shape of small formations is oval, the location is symmetrical. Papules range in color from pink to brown.
• Hypertrophic neurodermatitis. A form of a rare pathology called Ehrmann's neurodermatitis. The skin is affected on inside hips and inguinal-femoral folds. In the hypertrophic form of the disease, pronounced lichenification and infiltration of the skin (strong thickening and compaction) are noted. In this case, the rash is accompanied by severe itching, which has a paroxysmal manifestation.
• Diffuse neurodermatitis. This form of the disease is a severe pathology, which is characterized by the appearance of many pathological foci. Most often they appear on the lower and upper limbs(folds elbow joints and depressions under the knees), as well as on the torso. It is not excluded the formation of plaques in the neck, face, genitals and anus.
• Pointed follicular neurodermatitis. In this case, pathological formations form along the hair follicles.
• Linear neurodermatitis. Skin lesions are formed in the areas of the joints of the arms and legs, have the form of stripes. The surface of the plaques is most often rough, scaly or warty.
• Psoriasiform neurodermatitis. Pathological skin rashes in this type of disease are red seals, which are covered with silver-white scales. The disease manifests itself mainly on the head and neck.
• Depigmented neurodermatitis. This form of the disease is characterized by the appearance of areas of depigmentation - complete or partial loss of pigment by tissues.
• Decalvanic neurodermatitis. This type The disease affects areas of the body that have vellus hair and is accompanied by hair loss.



Treatment

Therapy of neurodermatitis includes two main areas:

• elimination of disorders of internal organs;
• improvement of treatment methods aimed at preventing exacerbations and prolonging periods of remission.

In the fight against the disease, many ointments are used. There are several groups of such drugs.



Corticosteroid ointments

Eliminate symptoms such as inflammation, redness and itching. Such ointments act quickly and very effectively. Improvement in the condition of the skin occurs within a few days. The use of this group of ointments has some disadvantages. If you apply them long time, then the development of secondary infectious processes, thinning of the skin, as well as addiction is possible.

Ointments-steroids are prescribed in short courses and only during exacerbations. The course of treatment is no more than two weeks.

Therapy of neurodermatitis in children with corticosteroid ointments is carried out modern drugs, such as Elocom, Advantan, Afloderm. When using ointments on sensitive areas of the child's skin, it is necessary to mix them with any baby cream.

Therapy of neurodermatitis in adults is carried out in two stages. In the first stage, which lasts no more than four days, funds are used active action(Dermovate, Diprosalik). After the completion of the use of active drugs, the second stage of therapy with moderately active ointments (Flucinar, Elokom, Celestoderm, Lokoid) begins, lasting no more than a week. For the greatest efficiency, they can be treated at the second stage by putting ointments under the bandage, but in this case they can be used for no longer than three days.



After the transition of the disease to a subacute form, patients are prescribed non-hormonal anti-inflammatory drugs.

The use of hormonal ointments should take place only in consultation with the doctor. Uncontrolled treatment with such drugs can lead to complications of neurodermatitis, for example, to a modification skin rashes. In mild forms of the disease, their use is not necessary.

Non-hormonal anti-inflammatory drugs

The purpose of such drugs depends on the age of the patient, the type and degree of development of the disease.

In children, the disease is often manifested by swelling, and the affected skin becomes weepy. In such cases, zinc ointment is used, which has a drying and antipruritic effect.

For patients of any age group, anti-inflammatory ointments are successfully used, the basis of which is tar, dermatol, naftalan, ichthyol, ASD III fraction. Such drugs are used in acute stage after the course of treatment hormonal ointments or as a separate therapy for exacerbation of a disease that occurs in a mild form.

Ointments are applied twice a day to cleaned disease-affected areas for a week (Kedem, Pantalfamarin, Gistan, Akrustal, Elidel).

For the treatment of moderate and mild disease development, the domestic drug Glutamol is effective. The cream has anti-inflammatory, antipruritic and moisturizing effects. Used for three weeks. In the treatment of severe forms of the disease does not help.

In cases of secondary infection, antibacterial and antifungals in the form of ointments (Pimafucort, Lincomycin, Gentamicin, Fucidin).

Skin protection products

During remission, it is necessary to apply creams and ointments that protect and restore the skin. Moisturizing and softening the skin promotes recovery barrier function epidermis. It becomes less susceptible to the effects of allergens from environment, which can provoke a repeated exacerbation of neurodermatitis.

Diet

A very important condition for a speedy recovery is diet. The patient needs to eat more dairy and vegetable products. The daily menu should include products that do not contain preservatives, flavors, dyes and other food additives. It is necessary to exclude spicy and salty foods, coffee, chocolate and citrus fruits.



Meat (boiled or steamed) should be consumed with greens, which will facilitate the absorption of protein. Sugar is best eliminated if possible or replaced with xylitol.

With diet, proper lifestyle and regular and complex treatment the disease will recede, and relapses will be excluded as much as possible.

Since 1891, for a long period, a pathology that developed as a result of scratching in areas of primary itching was distinguished from a large group of dermatosis as an independent dermatological disease called "neurodermatitis".

Definitions and terminology

The term neurodermatitis refers to a chronic inflammatory dermatological disease (chronic neurodermatitis) that occurs with periods of relapses and remissions, manifested by severe itching, the appearance and fusion of lichenoid papules, and the development of areas of sharply thickened skin with increased skin pattern (lichenification). Sometimes there is also a pigmentation disorder resulting from prolonged scratching in response to the onset of primary itching.

After a long study in 1935, diffuse neurodermatitis was regarded as atopic. Atopy is a genetic condition hypersensitivity to allergens, accompanied by an increased amount of class E immunoglobulins in the blood.

Limited, or localized neurodermatitis was classified as a disease that is not associated with pathological allergic conditions and in International classification diseases X revision (ICD - X) is called Vidal's simple chronic lichen.

Diffuse allergic neurodermatitis was separated from limited on the basis of the assumption of differences in the etiology and mechanisms of development of these diseases. In the same 1935, MS Sulzberger proposed a term in relation to diffuse allergic neurodermatitis, which was used in the ICD - X - “atopic dermatitis”. This term combines such previously existing concepts as "", "skin diathesis", "atopic eczema" and "diffuse neurodermatitis".

In the literature, the terms "atopic dermatitis" and "diffuse neurodemitis" are often used interchangeably, and localized or localized neurodermatitis is traditionally misunderstood as a form of the former.

Thus, diffuse neurodermatitis, unlike localized, is a multifactorial, genetically determined, chronic, recurrent inflammatory skin disease. Pathology in typical cases begins, as a rule, from the age of 6 weeks, is characterized by age-related features of localization and morphological elements in the foci of inflammation, resistance to therapy and is manifested by persistent intense itching of the skin, its reaction according to the sympathergic type (persistent white dermographism), severe lichenification and non-acute inflammatory polygonal (polygonal) papules.

How to treat and is it possible to cure neurodermatitis?

To conduct conscious therapy prescribed by the attending physician, the patient must have at least a minimal idea of ​​the causes of the pathological process.

Which doctor should I contact?

Naturally, with skin diseases, first of all, it is necessary to contact a dermatologist, and if a child is ill, a pediatrician. If necessary, these specialists draw up examination and treatment programs with the participation of a therapist, neurologist, psychoneurologist, allergist, gastroenterologist, endocrinologist.

Causes of neurodermatitis

Vidal's simple chronic lichen

Its etiology has not been fully elucidated. It most often occurs in adults. The main pathogenetic factor is an increase in the sensitivity of the skin to various irritants. It is assumed that this is due to the growth of nerve endings and the predisposition of the epidermis to irritation as a response to mechanical trauma.

The main role in the development of limited neurodermatitis is given to metabolic disorders in the body, functional disorders and diseases of the digestive system, especially the biliary system and pancreas, resulting in chronic autointoxication and the formation of autoantigens. Often, limited neurodermatitis is the final stage in the development of others.

It is also assumed that the cause of the development of pathology may be the influence of environmental factors, various disorders of the functions of the central and autonomic nervous system, endocrine disorders, stress and excessive emotional and psychological stress. In some cases, the involvement of allergic factors is not excluded in the mechanisms of pathology development.

Atopic dermatitis

Its share among all dermatosis is about 4%, and allergic dermatoses - about 30%. The multifactorial nature of the disease consists in the interaction of various hereditary traits and many environmental factors. In the pathogenesis of the disease, the main hereditary links are:

• features of the morphological and functional state of the skin;
• a constitutional anomaly, which consists in the genetically programmed readiness of the body for excessive production of class E immunoglobulins and the release of biologically active substances as a response to allergen exposure.

A predisposition can exist indefinitely without any clinical manifestations therefore, this form of dermatitis, even if the clinic develops only, for example, by the age of 20-30, is called atopic.

So, for example, if the child's parents are healthy, then the risk of developing the disease does not exceed 10%, if one of the parents is sick, the risk of the disease is already approximately 56%, both parents - 75%. In the case of illness of one child, the risk of illness for the second is about 22%, and for monozygotic twins - up to 85%.

External factors take part in the implementation of genetic information in the phenotype of a sick person. They are a provoking factor in the opening pathological condition cause its chronic course and the occurrence of relapses. At the same time, pathogenetic factors and their various combinations under the influence of the external environment different intensity capable of being inherited separately.

The nature of susceptibility to exposure external factors largely depends on age. In children in early infancy and childhood, the main influence on susceptibility is caused by disorders of the function of digestion and absorption, due to insufficient maturity of individual parts of the digestive system (lactase deficiency), allergies to certain foods, malnutrition child, violations of metabolic processes and functions of the liver and biliary tract, excess products (citrus fruits, honey, smoked meats, strawberries and strawberries, chocolate, etc.) containing a large number of histamine liberators - substances that promote the release of histamine in the body by mast cells, etc.

At older ages, allergens in the air (plant pollen, animal hair, house dust and mites, fish food), lack of a rational regimen, stress and psychoemotional overwork, depressive states leading to disorders of the vegetative function are becoming increasingly important in the development of diffuse neurodermatitis. nervous system, hormonal dysfunction or hormonal changes in the body, etc. An example of the latter is neurodermatitis in adolescence or neurodermatitis during pregnancy, both atopic and limited.

So, the causes and risk factors are:

1. genetic predisposition.
2. The presence of fermentopathy, disorders of the stomach and intestines from the moment of birth.
3. Functional disorders of the central nervous and endocrine systems, gastrointestinal tract, liver and biliary system, dysbacteriosis.
4. Improper diet, smoking, alcohol abuse during pregnancy and breastfeeding.
5. Premature transfer of the child to artificial feeding and the lack of a proper diet.
6. Foci of chronic infection in the body and the state of immunodeficiency, manifested by a decrease in the blood of immunoglobulins “M” and “A”, Tn 1 and Th 2 lymphocytes and their imbalance, an increase in immunoglobulins “G” and “E” and eosinophils.
7. The presence of allergic reactions, including the next of kin.
8. Application antibacterial drugs and antibiotics, improper vaccination during pregnancy, breastfeeding and in early childhood.
9. Climatically, environmentally and socially unfavorable factors, incorrect and age-inappropriate use cosmetics for skin care.

Thus, the development and chronic course are due to genetic predisposition in combination with functional disorders central nervous system, psycho-emotional, gastrointestinal, neurovascular, metabolic and neurohumoral disorders, allergic state of the body, poor nutrition, various intoxications and adverse environmental conditions.

Psychosomatics of neurodermatitis

One of the main issues of studying the mechanisms of development of neurodermatitis, which are of great importance in the prevention of its exacerbations and treatment, is the relationship between psychogenic and somatogenic factors. The leading role in the manifestation of the mechanisms of psychosomatic diseases belongs to unconscious emotional conflicts. In pruritic dermatoses, self-combing is considered as a specific way to suppress aggressive tendencies in cases where self-control of one's own emotional aspirations is impossible.

In addition, pronounced itching is the result of the inclusion of disorders of congenital or acquired origin in the mechanisms of development of a psychosomatic disorder as an intermediate link connecting directly psychological (emotional conflict) and somatic mechanisms.

This intermediate link, which combines such connections of the functioning of the body as physiological and neuropsychic, is provoked and remains stable due to the influence of psychogenic factors. With a long course, it causes real morphological changes. skin as an organ. It is psychosomatics that is the factor holding back the "vicious circle".

Mental overstrain, stressful conditions are one of the specific agents that contribute to the development or recurrence of atopic dermatitis. For neurodermatitis of non-allergic etiology, which occurs in 10-20% of neurodermatitis, the main importance in the development and chronic course in the absence of causally significant allergens, they acquire stable disorders of the neurovegetative system of the body.

In any form of the disease, psychosomatic disorders are one of the main links in the development and recurrence of a pathological condition and, at the same time, they are caused and aggravated by the latter, representing a complex "vicious circle". Such patients are characterized by a reduced threshold for the perception of fear, excessive mental stress and various stressful situations.

Practically in all patients with neurodermatitis, especially with the atopic form of the disease, various borderline disorders of asthenic, anxiety-phobic, hysterical, hypochondriacal and depressive nature are detected. Asthenic disorders are expressed in increased fatigue, irritability and instability of mood, in vegetative disorders, sleep disturbances, which leads to a deterioration in memory and mental performance. All this significantly reduces the quality of life, which, in turn, is an additional stress for sick people.

Symptoms of neurodermatitis

The focal process is characterized by a long, sluggish, slowly developing course with foci of various sizes (from 1-2 cm to 10 cm or more) with clear boundaries of irregular outlines. The main features of the focus at the peak of development and in typical cases are represented by three zones:

1. Central (internal) - zone of infiltration and lichenification.
2. Medium, formed by isolated inflammatory papules with a shiny surface.
3. Peripheral (external) - a zone of pronounced pigmentation with flesh-colored papules, which gradually passes into a healthy skin surface.

Localization of foci - various parts of the body, but, mainly, there is a lesion of the scalp (occipital region), posterior and lateral surfaces of the neck, on the hands - the zone of the elbow bend, in the region of the inguinal-femoral fold, perineum - intergluteal folds, anogenital zone and scrotum , as well as on the legs in the area of ​​the inner thighs and popliteal fossae.

Differential diagnosis is carried out with:

• psoriasis;

Atypical varieties of pathology are the following forms:

• according to the type of psoriasis (psoriasisform);
• pointed follicular neurodermatitis;
• depigmented form;
• sycosiform folliculitis (decalving form).

Can neurodermatitis turn into psoriasis?

These two diseases have much in common in terms of appearance and developmental mechanisms, as well as in relation to therapy. However, usually neurodermatitis can be the final stage of other dermatoses, but not vice versa.

Atopic dermatitis

The following main diagnostic criteria for the disease are recognized by domestic and foreign medical schools:

1. Eruptive elements with their true polymorphism - papules of a non-follicular, follicular, lichenoid and pruriginous nature, scales, excoriations (traces of scratching), crusts, lichenification, cracks, dyschromia (change in skin color).
2. The characteristic symmetry of the location of the rash, which differs in dynamics depending on age. As a rule, in childhood, the rash is localized on the face and head. With age, it spreads to the neck, shoulder girdle, cubital fossae with the transition to the skin of the inner and outer surface of the forearms, the back surface of the carpal joint and hands, popliteal fossae, the skin of the legs and inner thighs, genitals.
3. Diffuse neurodermatitis begins six months after birth, but not later than adolescence, proceeds with periods of relapses and remissions or in waves. Exacerbation of the course of the disease occurs seasonally, mainly in winter, and/or under the influence of provoking factors.
4. Age-related evolution of clinical manifestations - a change in localization, a decrease in the severity of inflammatory phenomena, an increase in lichenification processes.
5. Severe, paroxysmal itching, often of a debilitating nature, nocturnal itching.
6. The development of complications as a result of secondary infection.
7. Sleep disturbances, dysfunction of the autonomic nervous system - skin "marbling", white dermographism, impaired pilomotor reflex ("goose bumps"), paradoxical response of skin vessels during pharmacological tests, spasms of smooth muscles.
8. cataract, .
9. Characteristic ("atopic") face - "tired" facial expression, dark coloration of the skin around the eyes against the background of pallor and / or mild cyanosis and swelling of the face, peeling of the skin in the eyelids, deep folds and wrinkles on the lower and (less often) on upper eyelids(Denier-Morgan lines), dry skin (xerosis), cheilitis, hair in the form of "tow".
10. Frequent combination with other atopic diseases (atopic bronchial asthma, allergic rhinitis, allergic conjunctivitis, drug allergy) as well as the frequent presence of the latter in the next of kin.
11. Immunodeficiency state - an increase in the blood levels of immunoglobulins "E" (in 80% of patients), "G" and circulating immune complexes, Th 2 -lymphocytes, eosinophils, a decrease in the level of T-suppressors and T-lymphocytes.

In accordance with the localization of the manifestations of atopic dermatitis, the following 3 forms are distinguished:

• Localized, when the total area of ​​the lesion is less than 10% of the entire skin surface.
• Common - from 10 to 50% of the skin surface.
• Diffuse - over 50%.

During the pathological process, 3 periods are distinguished:

1. Acute or exacerbation, manifested by the predominance of acute inflammatory changes in the skin.
2. Subacute. During this period, the signs of an acute inflammatory process subside - foci of redness, edema, infiltrative processes and weeping.
3. A period of incomplete or complete remission in which symptoms are completely or mostly absent acute inflammation, but lichenification persists. In the areas of localization of foci, a change in skin color (excessive pigmentation or, conversely, reduced pigmentation), atrophic phenomena, peeling and a decrease in skin elasticity are noted. With incomplete remission, there may be separate infiltrative foci and excoriations with a predominance of excessive pigmentation, epidermal desquamation and dryness.

3 degrees of severity of the course:

1. Mild - exacerbations are rare and short-term, the foci are of a limited-localized nature, itching is insignificant, good effect from the therapy.
2. Average - 3 - 4 exacerbations during the year, which, compared with a mild course, are longer, the foci are widespread, the results of therapy are insufficiently expressed or not always.
3. Severe - exacerbations are frequent and prolonged, skin lesions are widespread or diffuse, itching is intense, sometimes unbearable, the results of treatment are insignificant.

Depending on the clinical manifestations, diffuse allergic neurodermatitis is divided into forms:

• Exudative, which is also characterized by edema, microvesicular rashes, accompanied by weeping followed by the formation of crusts.
• Erythematous-squamous simple, accompanied by peeling on the background of erythema.
• Erythematous-squamous with lichenification - the presence of multiple papules, excoriation and lichenification phenomena.
• Lichenoid, characterized by the presence of multiple papules, merging into continuous foci, peeling, multiple excoriations.
• Lichenoid-pruriginous, which is represented by lichenified skin, against which small vesicles and edematous papules are located.

In accordance with age, 3 stages (forms) of the disease are distinguished:

1. Infant - in children under 2 years of age, when the first symptoms appear. Main causal factors- disorders of digestion, absorption, hepatobiliary system, metabolic processes, regimen and diet, dysbacteriosis. During this period, the disease proceeds acutely in the form of an exudative form with a predominance of edematous redness, weeping and crusts, or in the form of an erythematous-squamous (“dry”) form.
2. Children - from 2 to 13 years (before puberty). Of the provoking factors with age, sensitization to pollen, fungal infection, dust mites, as well as polyvalent sensitization, psycho-emotional stress, lack of a rational regimen and overwork are becoming increasingly important. This stage is dominated by chronic inflammation. The disease proceeds in the form of erythematous-squamous simple and erythematous-squamous forms with lichenification. The latter is the beginning of the process chronization. The emergence of psychoneurotic and vegetative-vascular disorders is also noted.
3. Adolescent and adult - in persons older than 13 years. At this stage, the disease proceeds in the form of lichenoid and lichenoid-prurigo-like forms.

Very often, especially with a severe course, it is possible to attach a secondary infection, mainly staphylococcal, with the appearance of pustular elements, purulent crusts, fever, and the occurrence of recurrent infection. When joining herpetic infection Kaposi's eczema herpetiformis develops.

Both children and adults may develop atopic cheilitis, which for a long time may be the only symptom of diffuse allergic neurodermatitis. Atopic cheilitis is manifested by the defeat of the red border of the lips, especially intensively in the area of ​​​​the corners.

The disease begins with the appearance of itching and edematous redness around the mouth and the red border area. The acute period is quickly replaced by lichenification, and dryness, small-lamellar peeling, multiple radial grooves with cracks between the latter appear in the area of ​​the red border. In the region of the corners of the mouth, the skin is infiltrated for a long time with radial cracks.

Diagnostics

Main diagnostic criteria are:

• skin itching;
• typical morphological picture of rashes - papule and vesicle in combination with secondary elements;
• chronic course with relapses;
• early (up to 2 years of age) onset of the pathological process;
• anamnestic data on the presence of atopy.

Additional criteria:

• violation of keratinization of the skin with increased skin pattern on the palms;
• localization of skin changes on the hands and feet;
• recurring staphylococcal and herpetic skin lesions;
• eczematous changes in the nipples;
• relapses of conjunctivitis;
• increased levels of eosinophils in the blood;
• increase in the level of total immunoglobulin "E" in the blood serum;
• when conducting skin tests with allergens - reactions of an immediate type;
• erythroderma;
• white dermographism;
• cataract;
• additional skin folds on the lower eyelid (Denny-Morgan folds");
• dark "circles" under the eyes and excessive periorbital pigmentation.

For the diagnosis of atopic dermatitis, it is necessary to have at least any 3 main and 3 or more additional criteria that persist for at least 6 weeks.

How to treat neurodermatitis

The concept of multifactorial nature of both limited and diffuse neurodermatitis is the rationale for using a wide range of therapeutic effects. Considering the high resistance of these dermatoses to therapy, the terms of treatment are individual, but, as a rule, quite long and depend on the stage, severity of the pathological process and the duration of exacerbations, etc.

Treatment programs are based on the following principles:

1. Measures to prevent contact with allergenic substances.
2. Correction of major background disorders.
3. Use of general therapy.
4. local impact.
5. Preventive treatment.

Avoid contact with allergens

As the first and one of the main measures, the identification of food allergens and the strict observance of the elimination diet are envisaged. In addition, a diet for neurodermatitis should not contain a significant amount of carbohydrates, spicy, smoked, pickled and citrus products, eggs, spices, coffee and cocoa. High-fiber foods are recommended to prevent constipation and to eliminate (remove) from the intestines toxic substances formed during digestion.

It is necessary to exclude medicines and contact with household chemicals, which at least once led to symptoms of their intolerance, constantly take measures to eliminate mold and mites contained in bed linen and house dust, refuse to keep aquarium fish and pets in the apartment.

Correction of the main background violations

It should include recommendations from a psychologist or psychoneurologist to eliminate the conditions for overwork, sleep disturbances, psychoneurotic stress and stressful situations. In order to normalize the psycho-emotional state, drug treatment of neurodermatitis is also used with the use of sedatives, neuroleptics, tranquilizers and antidepressants.

General detoxification and hyposensitizing therapy is carried out through intravenous administration solutions of sodium thiosulfate and gluconate or calcium chloride. The identified intestinal dysbiosis, dysfunctions of the gastrointestinal tract, endocrine, hepatobiliary and urinary systems require appropriate correction. In addition, foci of chronic infection in the body are subject to mandatory sanitation.

General therapy

It consists in the predominant appointment of antipruritic and antiallergic drugs.

How to relieve itching?

Such properties, combined with long-term exposure, are possessed by modern antihistamines, which, moreover, are devoid of a sedative effect - Cetirizine, Loratadine and Desloratadine, Fexofenadine, Astemizol, Ebastin.

Glucocorticosteroids have anti-inflammatory, anti-allergic and antipruritic (indirectly) properties. However, inside they are prescribed only in cases of severe exacerbations, the absence of purulent complications and the resistance of the disease to other therapeutic methods.

In addition, immunotropic agents are prescribed:

• when identifying clinical signs immunological disorders;
• in order to correct immune disorders of a secondary nature in patients who for a long time and often suffer from diseases caused by a respiratory viral infection;
• in cases of development of complications of neurodermatitis in the form of a secondary skin infection, furunculosis, candidomycosis, etc.

Such immunomodulators are Methyluracil, Diucifon, Sodium Nucleinate, Prodigiosan, Likopid, Imunofan, Leukinferon, Affinoleukin, etc.

In the case of a severe course of atopic dermatitis, immunosuppressants are used - mainly cyclosporine A, as well as plasma-, lymph- or leukapheresis (in conditions of inpatient treatment).

Local Therapy

For these purposes, a paste, cream or ointment for neurodermatitis containing naftalan, sulfur, tar, ichthyol, zinc, which have anti-inflammatory and keratolytic properties, can be used. For example, zinc ointment has an anti-inflammatory, drying, astringent and softening effect.

In addition, at home, in agreement with the doctor, you can use such folk remedies, as baths and lotions with extracts or decoctions of St. John's wort, calendula, sage, succession, valerian root.

In cases of severe itching and symptoms of inflammation, a lotion, cream or ointment with such drugs should be applied to limited areas. latest generation, as Lokoid, Elocom, Apulein, Celestoderm, Laticort, Advantan, Beloderm, Mometasone, and with a pustular rash - external dosage forms with antibiotics.

AT last years at the first symptoms of neurodermatitis, the non-hormonal drug pimecrolimus is successfully used in the form of a 1% cream. It selectively inhibits the synthesis and release of inflammatory mediators. The safety of the drug allows it to be used on large areas of damage, even in children from 3 months of age.

Quite a few importance in external therapy, immunosuppressive methods such as selective phototherapy and low-intensity laser therapy are also given.

Preventive measures

aim preventive treatment are the prevention of exacerbations, amplification and expansion of the spectrum of sensitization of the body, an increase in the duration of periods of remission. With a pronounced seasonality of exacerbations, courses of ultraviolet irradiation, taking vitamins, desensitizing and antihistamines, in the spring-summer period, treatment at seaside resorts is desirable.

The success and duration of therapy for any form of neurodermatitis largely depend on a properly designed program based on the principles of an integrated and staged approach to treatment, taking into account the causes, risk factors, age and individual features the body of each patient.

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Neurodermatitis (ICD-10 CODE: L20.8) is one of the most common skin diseases especially among children. It is localized mainly on the hands, on the legs, on the face, on the head and on the body. How to treat neurodermatitis - read the article.

What is neurodermatitis?

The term neurodermatitis (Greek neuro - nerve, derma - skin, itis - inflammation) appeared in the 19th century, when skin inflammation was associated with diseases of the nervous system and considered them main reason occurrence of atopic dermatitis.

Neurodermatitis of the skin (atopic eczema or atopic dermatitis) is one of the most common non-communicable diseases. It is an inflammatory reaction of the skin, which manifests itself in certain periods or proceeds in a chronic form. The typical symptoms are scaly, dry and mostly itchy patches on the skin.

Over time, the rise in the incidence of atopic eczema increases significantly. In 1960, only one child in thirty had atopic eczema. Today, almost every sixth child of preschool age suffers from its manifestations. Possible reasons The sustainability of this increase is the improvement of living conditions and the implementation of excessive hygiene procedures.

Most often, from manifestations this disease infants and about 10% of preschool children suffer. In adulthood, atopic dermatitis is less common and occurs in 1.5-3% of people, but with more severe symptoms than in children.

Reasons for the development of neurodermatitis

The exact causes of neurodermatitis are still unknown. Doctors believe that the interaction of several factors listed below may serve as the basis.

• hereditary predisposition.

The genetic component is important in the development of this disease. That is, if both parents have atopic dermatitis, the likelihood of developing eczema in a child will be 60-80%.

• Overreaction of the immune system.

characteristic inflammatory processes on the skin with neurodermatitis occur because the body, trying to defend itself, reacts intensively to harmless substances (food, house dust , pollen etc.).

In essence, it recognizes these substances as allergens and secretes antibodies to eliminate them, which, in turn, cause an allergic reaction. The exact reasons for this defensive reaction are still unclear.

• Malfunction of the sebaceous glands.

Due to the small amount of sebum produced, the natural barrier that protects the skin from external factors is disrupted, as a result, it becomes more susceptible to damage and inflammation.

• Environment.

Whether neurodermatitis will develop and how severe its manifestations will be, to a large extent, determines the influence of the environment.

The main provocateurs are:

Psychosomatics as a cause of neurodermatitis

Psychosomatics can be the real reason disease, in the event that the symptom worsens when a person thinks about it and at the same time, does not have a hereditary burden.

If you suspect that the disease is psychosomatic in nature, due to the shift of stressful situations from the psychological to the physical sphere, you should seek the help of a professional psychologist.

What does neurodermatitis look like: symptoms and stages

Although there are many various types eczema, signs and course inflammatory disease the skins are very similar. There are common manifestations, which can also be divided into different stages.

Recognizing this disease is quite simple, if a person has neurodermatitis - the symptoms will begin to appear in the following form:

• strong itching ;
• dryness, roughness, redness of the skin;
• bubble formation;
• swelling of the skin.

Acute stage

In the acute stage, eczema begins with a bright reddening of the skin. The skin in the affected area becomes irritated, forming small, fluid-filled blisters that cause severe itching. Over time, the integrity of these bubbles can be broken and small crusts will form.

chronic stage

Due to prolonged contact with the allergen or an existing genetic predisposition, skin irritation can become chronic.

In the chronic form of neurodermatitis, the skin becomes very dry and rough, acquiring a red-blue tint. Unbearable itching occurs, which gives a person great discomfort.

Diagnostics

Diagnosis of neurodermatitis in adult patients is carried out by a dermatologist. First of all, he conducts an examination and determines the further course of treatment.

Neurodermatitis in children at the initial stage can be cured by a pediatrician. However, in more severe cases, consultation with an allergist, dermatologist, gastroenterologist, etc. may be required.

At the initial appointment, you should describe in detail your medical history (anamnesis) to the doctor: whether any of the relatives have atopic dermatitis or allergies, whether psychosomatic or dietary provoking factors are possible, etc.

The information obtained will help the doctor to form an idea about clinical picture diseases, and then prescribe the necessary studies and drugs for the treatment of eczema.

Diagnosis of neurodermatitis is carried out, as a rule, with the help of skin tests. Depending on the method of the test, the result is recorded in minutes or several days. You can learn more about this research method in this article.

The second informative method is laboratory blood tests to determine the level of Immunoglobulin E (IgE). results this study they will show if there are immune substances (immunoglobulins) in the blood that cause an inflammatory skin reaction. With neurodermatitis and allergies, the content of Immunoglobulin E (IgE) in the blood increases significantly.

Neurodermatitis - treatment

With neurodermatitis (atopic dermatitis, atopic eczema), the effectiveness of treatment lies in an integrated approach, including basic therapy and elimination of skin inflammation.

The goal of basic therapy is to provide the epidermis with a sufficient level of moisture. At the same time, careful and regular skin care is especially important to create a natural protective barrier and normalize the functioning of the sebaceous glands.

Medical treatment neurodermatitis in adults and children is divided into:

• external (local): using ointments, creams or emulsions;
• internal (systemic): consisting in taking antihistamine and anti-inflammatory tablets.

Early treatment allows better control of atopic dermatitis and delays the manifestation of relapse for a long time.

External treatment

In most cases, this method is enough to keep the manifestations of neurodermatitis under control.

The main groups of active substances used in the treatment of atopic eczema:

• glucocorticosteroids (cortisone preparations), which suppress excessive immune response organism;
• calcineurin inhibitors, which affect white blood cells involved in inflammation;
• antibacterial and antifungal ointments;
• antiseptics (Chlorhexidine, Furacillin);
• emollients.

Glucocorticosteroids

Ointment from neurodermatitis containing cortisone is effective tool used to provide a quick effect. It is worth noting that cortisone is not suitable for the long-term treatment of eczema. In the long term, its use can lead to increased skin sensitivity (so-called atrophy).

Calcineurin inhibitors

Pimecrolimus and tacrolimus are non-hormonal drugs that affect the body's immune response. They prevent the release of certain messenger substances (cytokines) on the skin, reduce the inflammatory response and the signs of neurodermatitis. Suitable for use on sensitive areas such as the face and neck.

Unlike cortisone, which can lead to side effects with continuous use, active substances pimecrolimus or tacrolimus are suitable for the long-term treatment of atopic dermatitis.
However, they should be used at the first symptoms of atopic eczema or signs of relapse. In this way, you can prevent further aggravation of the disease or help reduce recurrence.

It is worth knowing that treatment with calcineurin inhibitors increases the risk of developing lymphoma and skin cancer. Therefore, it is advisable to use these drugs only if it is justified with medical point vision. Treatment of neurodermatitis in children under the age of two years with the help of these drugs is carried out in exceptional cases.

Means against microorganisms

In some cases, antimicrobial treatment for eczema may be needed. Namely, when harmful fungi or bacteria colonize already damaged skin. Which drug the doctor chooses depends on which microorganisms it is directed to.

emollient

It is a lipid-restoring cream for neurodermatitis in children and adults. Its action is aimed at moisturizing and restoring the skin, as well as creating a protective film that prevents moisture loss, which is very important for this disease. These are: La Roche Posay, Avene, Emolium, etc.

internal treatment

If a external therapy not effective enough systemic treatment neurodermatitis.

Glucocorticosteroids

Only in severe cases of atopic dermatitis does the attending physician recommend internal administration of cortisone or cyclosporine A. Both substances aim to eliminate atopic eczema by reducing the excessive immune response.

Antihistamine

So called antiallergic drugs(or antihistamines) suppress allergic reactions on the skin, reducing itching typical of atopic dermatitis.

Light therapy (phototherapy)

With the help of phototherapy (phototherapy), inflammatory cells that are active in neurodermatitis are inhibited.

In especially severe cases, the so-called PUVA therapy can help. In this case, patients take the drug (psoralen) before the radiation, which multiplies the effect of the rays on the skin (P soralen + UVA = PUVA).

However, after PUVA therapy, the skin becomes very sensitive to light, so an increased risk of cancer from UV radiation cannot be completely ruled out. Therefore, this form of light therapy for the treatment of atopic dermatitis is used very cautiously, especially in children.

Prevention

There are many other ways to relieve the symptoms of atopic dermatitis:

1. For the short-term treatment of atopic dermatitis, the so-called climate therapy is suitable: being in a mountainous or seaside area, you can significantly reduce the symptoms.
2. May also have a positive effect various methods relaxation. The often excruciating itch can develop into an insurmountable problem affecting the quality of life. In this case, relaxation can bring relief.
3. With atopic dermatitis, the skin becomes more sensitive, so it is important to replace aggressive detergents for moisturizers and oils.

It should be understood that only a qualified specialist should treat neurodermatitis. Since self-medication and the wrong medicine can only worsen the manifestation of many symptoms. Therefore, at the first signs of the disease, you should not postpone a visit to the doctor.