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13MEDICINE
MODERN TACTICS TO TREAT PATIENTS WITH ATOPIC
DERMATITIS
c.m.s. Aitkulova V. R. c.m.s. Kenenbaieva B. Y. c.m.s. Zhagiparova Zh. A.
Shtukert A. V.
Agimbetova L. B.
Kazakhstan, Pavlodar, Pavlodar branch «SMUSemey city»
Abstract. Allergic diseases are an important medical social problem of allergology, dermatology and pediatrics. Atopic dermatitis (AD) as one of the the most widely spread diseases among children and dults has the most severe course. Nowadays AD is considered a systematic disease when many ortgans and systems are involved into the pathological process and they complicate the course of the main disease. AD orevalance among population of the well developed countries is 10-28%.
Keywords: atopic dermatitis, itch, dryness, moistening, medical cosmetics, emollients, prophylaxis.
The topically is conditiend by the fcat that allergic diseases are an important medical social problem of allergology, dermatology and pediatrics.
Allergic diseases take 3 place as to their prevalence among children and adults but the biggest specific weight has allergic dermatosis with the the most severe course of AD.
Npowadays AD is considred a systematic disease when many ortgans and systems are involved into the pathological process and they complicate the course of the main disease. (1)
The disease mainly begins at the first months of living and it is manifested by chronical allergic inflammation of skin of relapsing character and it is difficult to treat.
One of the main symptoms of AD, skin itch, negatively effects all aspects of life quality both of patients themselves so as people who look after them.
It is admitted that for the family the stress connected with taking care of the child who suffers of AD much prevails the stress cuased by the care of the patient with diabetis. (1,2,3,4,5)
Moreover, the material damage is great beacause to terat AD is a serious financial problem for both the family and the health care system. (6,7,8,9,10)
Fig. 1
AD prevalence among the population of the well dveleoed countries is 10-28%. According to the datya of the Scientific-research dermatology-venereology institute (SRDVI) in RK this index in 2013 was 27,1%, 2014 - 27,8%, and in 2015 - 25,4%.
The leding specialists have emphasized many times that it is necessary to train and instruct the support staff thoroughly, including doctors, nurses and also parents who have children ill with AD to avoid severe relapses and complications of AD. (11,12,13)
The survey carried out in Great Britain (Cork M.) showed that only 5% of parents had an idea of AD reasons and knew how to use external medication.
24% of patiens did not apply softening and moisturizing medications.
25% of patients used external ointments for treatment that refer to a corticosteroid class of medications.
As the result there is a necessity to change the stereotype of providing medical aid to people suffering from AD.
In their research the foreign specialists established that in 86% cases to treat their childran with AD the parents used weak external corticosteroid and they had little knowledge about the medications used (Beattie P., Lewis-Jones S, 2003 r).
The main goals of AD therapy:
- elimination or reducing itch and inflammation skin changes;
- recovery of skin structure and function;
- prevention of development severe disease forms;
- treatment of associated diseases.
The goal of external therapy is:
- suppression of skin inflammation indictions and connected with them main symptoms of AD at its acute (itch, hyperemia, edema) and chronical (itching, lichenification) phases of disease;
- elimination and prophylaxis of secondary infection of the damaged skin areas;
- recovery of damaged epithelium;
- improvement of skin barrier functions;
- elimination of skin dryness.
While treating AD one should consider 5 symptoms of the disease: skin dryness, itching, rash, infection of skin, indications of allergy or suspected allergy.
Special attention must be paid to skin hygiene rules of parents and support staff.
The basic skin hygiene rules:
Rrgardless of age patiens with AD need daily warm water precedures (shower, bath) for 15-20 minutes which clean and moisture skin, boost the effect of medical treatment.
Frequent skin dryness and as the result itching increase with disease exacerbation is connected with bthing in the swimming pools filled with chemically treated water. After visiting swimming pools the patients with AD are recommended to take a shower with soft cleaniners and emollients.
While bathing:
- don't use sponge, soap;
- use only quality cleaning agents with neutral pH 5,5;
- dab your skin after bathing, don't rub it dry!
- To soften, moisture skin emollients are applied immediately on wet skin after dabbing it with a towel preventing a evaporation effect.
Cleaning/moisturing the skin is the main thing in AD treatment.
All patients with AD have dry, and some even very dry skin, with expressed scaly skin cracked in places. Ceramids serve as main molecules capturing water in skin. Patients with AD have low level of ceramids in their skin.
Wrong skin care of ptients with AD lead to the change of skin barrier function and appearing dryness spread, and to the secondary infection.
That is why for skin care of patients with AD special medications of the medical cosmetics have been made - emollients. Emollients are applied 1-2 times a day on the damaged skin areas of face and body after water procedures which lead to elimination of skin itching, flackiness and redness, and also tightness on 5-7 day of use.
If there is mucous rash one had better apply local baths with potassium permanganate solution
16 № 5(9), Vol.3, May 2016
WORLD SCIENCE
of light-pink color (for a bath for babies 10 ml of 3% solution per every liter of water) for 15-20 minutes. Immediately after the bath, after drying (but not rubbing dry!) mucous rash must be stopped with water solution (for children under 2 years), strong solution of potassium permanganate, spirit solution of aniline dyes, Castellaani paint-phenol liquid, Fucorcin, or other antiseptics (% spirit return accordingly).
Among children with AD we can observe many cases of scabies. Patients are treated with highly effective abd safe anti-scabies medication - spray Spregal: the medication is very effective and used at any age range, and has no contraindications with AD. Spregal is sprayed in the evening on the patient's skin from their neck to their feet and it is left for 12 hours, then the child is bathed and the linen and clothes are changed. If necessary the second application can be repeated in 4 days after the bacterial treatment.
Recovery from AD is observed if all doctors recommendations are followed and the disease is treated at its first stage.
AD is a chronical disease with a continuing exacerbation and torpid character to the treatment given. To obtain a successful result parents of the children with AD and the support staff should be trained on regular basis during the disease course and therapy.
REFERENCES
1. Гомберг М.А., Соловьев А.М., Аковбян В.А. Атопический дерматит // Русский медицинский журнал.- 1998. - Т. 6. - № 20. - С. 1326-1335.
2. Короткий Н.Г., Тихомиров А.А., Таганов А.В., Каражас М.В. Современные аспекты этиологии, патогенеза, клиники и фармакотерапии атопического дерматита // Российский журнал кожных и венерических болезней.- 2001.- № 2.- С. 56-70.
3. Торопова Н.П., Синявская О.А., Градинаров А.М. Тяжелые формы атопического дерматита у детей / Методы медико-социальной реабилитации // Российский медицинский журнал.- 1998. - Т. 5. - № 11. - С. 119-131.
4. Федоров С.М., Кубанова А.А., Адо В.А., Селисский Г.Д., Мокроновский М.А., Малина И.Д. Генетика и атопический дерматит // вестник дерматологии и венерологии. -1996 -№ 4 .- С. 33-37.
5. Томас П. Хэбиф, Кожные болезни. Диагностика и лечение. Москва, медпрессинформ 2007, 72-77, 190-211 стр.
6. Кацамбасс А.Д., Лотта Т.М. Европейское руководство по лечению дерматологических болезней. Москва, медпрессинформ 2008, 52 стр
7. Романенко И.М., Кулага В.В., Афонин С.Л. Лечение кожных и венерических болезней. Медицинское информационное агенство, МИА, Москва 2006 т.2 466-474
8. Дж. Д. Уилкинсон, С. Шоу, Д.И. Ортон. Дерматология. Атлас- справочник. Москва. Мед. литература 2004 78-149
9. Альтмастер П. Терапевтический справочник по дерматологии и аллергологии. Издательский дом ГЭОТАР - мед. Москва 2003, 9 стр
10. Allen B.R. Review of atopic dermatitis literature // Atopy Reports: Atopic dermatitis and related Disorders. - Vol.1. -№1. - P. 7-9.
11. Bjorksten B., Dumitrascu D., Foncarl T., Khetsutiani N., Khaitv R. et al. Prevalence of childhood asthma, rhinitis and eczema in Scandinavia and Eastern Europe// Eur Resp J - 1997.- № 10. - P. 743-749.
12. Cork M. emollient therapy of atopic eczema: education and outcome// Ann Dermatol Venereol. - 1998. - Vol. 11 (Suppl 2)/ - P. 106 - 107
13. Hanifin M., Raika G. Diagnostic features of atopic dermatitis// Acta Dermatol Veneeol. (Stockh). - 1980.- Vol. 114 (Supp 1.). - P. 146-583
