scholarly journals External therapy of allergic dermatoses in children (literature review)

2020 ◽  
pp. 41-47
Author(s):  
O.M. Mochulska ◽  
Keyword(s):  
Clinical Course ◽  
Life Quality ◽  
Allergic Inflammation ◽  
Local Therapy ◽  
Calcineurin Inhibitors ◽  
Allergic Diseases ◽  
Skin Lesions ◽  
Stevens Johnson Syndrome ◽  
Topical Calcineurin Inhibitors ◽  
Allergic Skin

Allergic dermatoses have a special place in the structure of allergic diseases in children due to their weight. The most common allergic skin lesions: simple and allergic contact dermatitis, atopic dermatitis, various forms of eczema, acute and chronic allergic urticaria, Quincke's edema, multiforme exudative erythema (Stevens—Johnson syndrome), acute epidermal necrolysis (Lyell's syndrome), toxicodermias, as well as less common dermatoses, in the pathogenesis of which are leading allergic reactions. Despite a number of research research, the difficulties in the determining of the therapeutic approach of allergic dermatoses in children are still observed. According to the international program documents EAACI (European Academy of Allergy and Clinical Immunology), AAAAI (American Academy of Allergy, Asthma & Immunology), PRACТALL (Practical Allergology Consensus Report) in treatment of allergic dermatoses the leading place takes external therapy, which requires an individual approach and daily care of skin. External therapy consists of local application of emollients, topical glucocorticosteroids, topical calcineurin inhibitors, topical antihistamines, keratolytic, keratoplastic, reparants, epithelializing and anti-inflammatory medications, in the case of complicated clinical course of the disease — antibacterial, antifungal, antiviral medications, also with skin care. Purpose — to increase information on modern possibilities of external therapy of allergic dermatoses in children. External pharmacotherapy of allergic dermatoses should be etiopathogenetic and should affect on the mechanisms of allergic inflammation in the skin, elimination of itching, dryness,so finding ways to improve it will help to control the clinical course of the disease, to reduce disability, will promote to improve the life quality in patients. No conflict of interest was declared by the author. Key words: children, allergy, allergic dermatoses, external therapy, local therapy.

scholarly journals Peculiarities of the clinical course of allergic dermatoses in children (literature review)

2020 ◽  
pp. 58-63
Author(s):  
O.M. Mochulska ◽  
◽  
K.T. Hlushko ◽  
Keyword(s):  
Skin Diseases ◽  
Clinical Course ◽  
Clinical Manifestations ◽  
Allergic Diseases ◽  
Skin Lesions ◽  
Stevens Johnson Syndrome ◽  
Clinical Criteria ◽  
Johnson Syndrome ◽  
Allergic Skin ◽  
Allergic Contact

The prevalence of allergic diseases is constantly growing around the world. According to WHO forecasts, most of the world's population will suffer from various allergies by 2050, at the same time any substance can be an allergen, and the XXI century will be the era of allergies. In the structure of allergic diseases in children the leading place is occupied by allergic skin lesions — allergic dermatoses, which are characterized by pronounced clinical polymorphism, acute or chronic stage with the development of concomitant pathological changes in many systems of the growing child's body. Allergic dermatoses are a large group of skin diseases, including: simple and allergic contact dermatitis, atopic dermatitis, various forms of eczema, acute and chronic allergic urticaria, Quincke's edema, multiforme exudative erythema (Stevens-Johnson syndrome), acute epidermal necrolysis (Lyell's syndrome), toxicodermias, as well as less common dermatoses, in the pathogenesis of which are leading allergic reactions. Purpose — to describe clinical criteria for the differential diagnosis of allergodermatoses in children in order to increase its effectiveness. Conclusions. Allergodermatoses in children are characterized by polymorphism of clinical manifestations, which depends on the specific nosology. There is a tendency to increase the frequency of allergic skin diseases in children, especially severe forms with recurrent course, resistant to traditional pharmacotherapy. Comprehensive detailed study of clinical manifestations of allergic dermatoses in children will contribute to the development of differential diagnostic criteria for allergic dermatoses in children, to verify accurate diagnosis and to prescribe the pathogenesis-based treatment for various allergic skin diseases in time. No conflict of interest was declared by the authors. Key words: children, allergy, allergic dermatoses, clinical criteria.

scholarly journals Features of pathogenesis of itch and anti0itch therapy in children with allergic dermatosis (literature review)

2021 ◽  
pp. 57-67
Author(s):  
O.M. Mochulska ◽  
Keyword(s):  
Skin Diseases ◽  
Environmental Control ◽  
Allergic Inflammation ◽  
Calcineurin Inhibitors ◽  
Stevens Johnson Syndrome ◽  
Individual Approach ◽  
Topical Calcineurin Inhibitors ◽  
Multi Stage ◽  
Johnson Syndrome ◽  
Allergic Skin

Allergic dermatoses are allergic skin diseases, the most common of which are: simple and allergic contact dermatitis, atopic dermatitis, various forms of eczema, acute and chronic allergic urticaria, Quincke's edema, toxicodermias, multiforme exudative erythema (Stevens–Johnson syndrome), acute epidermal necrolysis (Lyell's syndrome). The clinical course of all allergic dermatoses is accompanied by itch, although its severity varies depending on the nosology. An important focus of treatment of allergic dermatoses is to control of skin itch, as it is the leading symptom. According to the international program documents EAACI (European Academy of Allergy and Clinical Immunology), AAAAI (American Academy of Allergy, Asthma & Immunology), PRACТALL (Practical Allergology Consensus Report) in treatment of allergic dermatoses the leading place takes anti-itch therapy, which requires an individual approach and daily care of skin. Systemic anti-itch therapy includes using of the following drugs: antihistamines, glucocorticosteroids, membrane's stabilizators (kromons), leukotriene receptor antagonists, anti-IgE. External anti-itch therapy consists of local application of emollients, topical glucocorticosteroids, topical calcineurin inhibitors, topical anti-histamines, reparants and epithelializing medications. Purpose — to increase knowledge about features of etiopathogenetically-based anti-itch therapy of allergic dermatoses in children. Conclusions. Treatment of itch of allergic dermatoses is diverse, complex and multi-stage, requires an individual approach to each patient, and includes: environmental control to eliminate allergenic and non-allergenic factors, systemic and local pharmacotherapy, skin care. Modern anti-itch therapy of allergic dermatoses should be etiopathogenetic and affect on local and system mechanisms of allergic inflammation with itch, it should be differentiated according to the stage of the disease, the phase of inflammation and the severity of skin manifestations and to be based on the rational use of drugs. No conflict of interest was declared by the author. Key words: children, allergy, allergic dermatoses, itch, anti-itch therapy.

scholarly journals LONG-TERM CONTROL OF SKIN ALLERGIC INFLAMMATION IN ATOPIC DERMATITIS PATIENTS

2014 ◽  
Vol 11 (3) ◽  
pp. 30-36
Author(s):  
O G ELISYUTINA ◽  
E S FEDENKO
Keyword(s):  
Atopic Dermatitis ◽  
Topical Treatment ◽  
Allergic Inflammation ◽  
Calcineurin Inhibitors ◽  
Intermittent Treatment ◽  
Topical Corticosteroids ◽  
Topical Calcineurin Inhibitors ◽  
Proactive Therapy

Modern approaches to topical treatment of atopic dermatitis (ad) are presented in the review. the application of different proactive therapy patterns like topical corticosteroids intermittent treatment and topical calcineurin inhibitors as antirecurrent therapy of ad patients are discussed.

scholarly journals Lichen Planus Pigmentosus Inversus: A Rare Subvariant of Lichen Planus Pigmentosus

2021 ◽  
pp. 407-410
Author(s):  
Anne Guertler ◽  
Natalie Evenschor ◽  
Marlene Seegraeber ◽  
Lars Einar French ◽  
Véronique Weiler ◽  
...  
Keyword(s):  
High Risk ◽  
Lichen Planus ◽  
Medical Literature ◽  
Calcineurin Inhibitors ◽  
Skin Lesions ◽  
Topical Steroids ◽  
Skin Atrophy ◽  
Topical Calcineurin Inhibitors ◽  
Oral Corticosteroids ◽  
Safe Treatment Option

Lichen planus pigmentosus inversus (LPPI) is a rare subvariant of Lichen planus pigmentosus (LPP), presenting with sharply defined brown to gray macules, papules, and plaques limited to the intertriginous areas, with only a few cases reported in the medical literature so far. While LPP mostly affects patients with Fitzpatrick skin type III–IV in sun-exposed areas such as the neck, LPPI is seen in Caucasians and spares sun-exposed areas. Skin lesions tend to be very refractory to treatment attempts including potent topical steroids and oral corticosteroids. Given the increased penetration of potent topical steroids and the high risk of skin atrophy, especially when applied to intertriginous areas, this case shows that topical calcineurin inhibitors (tacrolimus 0.1%) might offer an effective and safe treatment option for LPPI.

scholarly journals Combined pathogenetic therapy of allergic dermatoses in children

2021 ◽  
pp. 28-38
Author(s):  
J. S. Kovaleva ◽  
N. K. Zyablitskaya ◽  
M. V. Orobei ◽  
N. K. Bishevskaya
Keyword(s):  
Side Effects ◽  
Skin Diseases ◽  
Local Therapy ◽  
Calcineurin Inhibitors ◽  
Skin Barrier ◽  
The Body ◽  
Skin Barrier Function ◽  
Severe Exacerbation ◽  
Omega 3 ◽  
Topical Calcineurin Inhibitors

Allergodermatoses make up the majority of allergic skin diseases in childhood, have a recurrent course and significantly disrupt the quality of life of patients and their families. The constant use of emollients, allowing to lengthen periods of remission and reduce the need for topical drugs, is associated with defects in the skin barrier function. Treatment with topical glucocorticosteroids (TCS) and topical calcineurin inhibitors (TCI), which are the basis of pharmacotherapy, should be carried out differentially, taking into account the localization, stage and activity of the inflammatory process, the area of the lesion, the age of the child and the multifactorial genesis of the disease. The basic principles of rational local therapy include the choice of the degree of activity of the drug, its concentration, dosage form, dosage frequency, duration of use to obtain a therapeutic effect and minimize side effects. In case of severe exacerbation and localization of inflammatory elements on the body and limbs in children, it is necessary to start treatment with class 2–3 THCS. When the process is localized on the face and other sensitive areas of the skin (neck and large folds), it is recommended to use class 7 TCS or give preference to TCI. The duration of a continuous course of TCS therapy in children depends on the severity of the exacerbation and should not exceed 2 weeks. The most effective way to reduce the course steroid load and avoid side effects is the early and correct use of TCS during an exacerbation. The advantages of TCI in comparison with TCS are the low incidence of side effects, the absence of contraindications for use on sensitive skin areas, and the possibility of longer use. The article contains Russian and foreign literature data on the use of THCS and TEC in the treatment of allegodermatosis in children and our own clinical observations of the effectiveness of the use of combination therapy: Comfoderm K cream (methylprednisolone aceponate with ceramides in the base), 0.03% tacrolimus ointment and emollient means - special cream Sensoderm with physiological lipids omega 3–6–9.

scholarly journals Modern approaches to external therapy of sensitive skin area in atopic dermatitis in children: focus on topical calcineurin inhibitors

2019 ◽  
pp. 156-167
Author(s):  
E. N. Saverskaya
Keyword(s):  
Atopic Dermatitis ◽  
Pediatric Population ◽  
Clinical Manifestations ◽  
Local Therapy ◽  
Calcineurin Inhibitors ◽  
Skin Barrier ◽  
The Body ◽  
Skin Area ◽  
Sensitive Skin ◽  
Topical Calcineurin Inhibitors

Due to high prevalence in the pediatric population, chronic recurrent course and difficulties in choosing the local therapy, atopic dermatitis is an urgent problem for pediatricians, dermatologists and allergists. The review presents data on the prevalence and features of the clinical manifestations of atopic dermatitis in various age periods. The authors consider structural, functional and immunological features of the skin barrier are considered in detail under normal and under pathological conditions. They emphasize the problems of quality of life, compliance and steroidophobia of patients with atopic dermatitis. Particular attention is paid to the concept of sensitive skin, the definition of this concept and the localization of sensitive skin area on the surface of the body. The article describes approaches to the method of choosing external therapy according to the European guidelines for the treatment of atopic dermatitis in 2018. It presents a modern practical algorithm for prescribing local anti-inflammatory drugs (topical glucocorticosteroids, topical calcineurin inhibitors) taking into account the severity of the clinical manifestations of the disease and the areas of application (sensitive skin areas/other parts of the body). The authors provide evidence of the efficacy and safety of topical calcineurin inhibitors, in particular pimecrolimus, in the treatment of patients with mild to moderate severity of atopic dermatitis, especially in sensitive skin areas.

Pathophysiology and Management of Atopic Dermatitis: A Laconic Review

2020 ◽  
Vol 15 (4) ◽  
pp. 321-336
Author(s):  
Pravin Kumar ◽  
Dinesh Kumar Sharma ◽  
Mahendra Singh Ashawat
Keyword(s):  
Monoclonal Antibody ◽  
Atopic Dermatitis ◽  
Topical Therapy ◽  
Human Monoclonal Antibody ◽  
Life Quality ◽  
Calcineurin Inhibitors ◽  
Developed Countries ◽  
Skin Lesions ◽  
Lymphoid Cells ◽  
Immunological Factors

Conclusion: : Atopic Dermatitis (AD) is long-lasting degenerating skin disease with a characteristic phenotype and stereotypically spread skin lesions. The AD results due to a complex interface among genetic factors, host’s surroundings, pharmacological anomalies and immunological factors. In previous decades, researchers had shown marked interest due to increased prevalence in developed countries. In this review, basics along with the advances in pathogenesis and management of AD have been discussed. The immunological factors i.e. Innate Lymphoid Cells, IL-22 and Toll-like receptors have an important role in the pathogenesis. The proactive topical therapy by skincare, topical glucocorticosteroids and calcineurin inhibitors have improved effect in the management of AD. The human monoclonal antibody-based systemic drug (Duplimab) is a considerable advancement in the management of AD. Other monoclonal antibody-based drugs (Lebrikizumab, Tralokinumab, Apremilast and Nemolizumab) are in different phases of clinical trials. A better understanding of genetics and immunoregulatory cascade will lead to the development of efficacious drugs and better management therapy preventing the relapse of flares and improved life quality of AD patients.

scholarly journals Systemic therapy of allergic dermatosis in children (literature review)

2021 ◽  
pp. 62-67
Author(s):  
O.M. Mochulska ◽  
◽  
T.M. Kosovska ◽  
Keyword(s):  
Systemic Therapy ◽  
Environmental Control ◽  
Life Quality ◽  
Allergic Inflammation ◽  
Stevens Johnson Syndrome ◽  
Johnson Syndrome ◽  
Immunosuppressive Medications ◽  
Allergic Contact ◽  
Based Medicine

Allergic pathology of skin is one of the most pressing problems of modern pediatry. The most common allergic dermatoses: simple and allergic contact dermatitis, atopic dermatitis, various forms of eczema, acute and chronic allergic urticaria, Quincke's edema, toxicodermias, multiforme exudative erythema (Stevens-Johnson syndrome), acute epidermal necrolysis (Lyell's syndrome). Many aspects of systemic treatment of allergic dermatoses in children are complex and controversial. The modern strategy of treatment of allergic dermatoses in children is based on the principles of evidence-based medicine. According to the international program documents EAACI (European Academy of Allergy and Clinical Immunology), AAAAI (American Academy of Allergy, Asthma & Immunology), PRACТALL (Practical Allergology Consensus Report) treatment of allergic dermatoses consists of: environmental control to eliminate allergenic and non-allergenic factors, skin care, systemic and local pharmacotherapy. Systemic pharmacotherapy includes using drugs of the following groups: antihistamines, glucocorticosteroids, membrane's stabilizators (kromons), leukotriene receptor antagonists, anti-IgE, cytostatics, sorbents, hepatoprotectors, probiotics, vitamins and minerals, antioxidants, sedative medications, enzymes, antibacterial, antifungal and antiviral, immunomodulatory and immunosuppressive medications. Purpose — to increase information on modern possibilities of systemic therapy of allergic dermatoses in children. Conclusions. Systemic pharmacotherapy of allergic dermatoses should be etiopathogenetic and influence the systemic mechanisms of allergic inflammation, which will help control the clinical course of the disease, reduce disability, improve the life quality of patients. No conflict of interest was declared by the authors. Key words: children, allergy, allergic dermatoses, systemic therapy, internal therapy.

scholarly journals The role of mixed Mycoplasma and Herpesvirus infections in case of skin lesions in children

2019 ◽  
Vol 18 (3) ◽  
pp. 5-10
Author(s):  
H. O. Kuvardina ◽  
F. S. Kharlamova ◽  
I. V. Polesko ◽  
O. V. Shamsheva ◽  
O. S. Ostapuschenko
Keyword(s):  
Skin Diseases ◽  
Skin Lesions ◽  
Stevens Johnson Syndrome ◽  
Vascular Endothelial ◽  
Herpesvirus Infection ◽  
Inflammatory Reactions ◽  
Immune Mediated ◽  
Johnson Syndrome ◽  
Allergic Skin

Numerous literature data show the role of mycoplasma infection in the development of non-respiratory lesions of various organs and systems, including the skin. Herpesvirus and mycoplasma infections can trigger the development of immune-mediated inflammatory reactions of the skin and mucous membranes — erythema multiforme exudative, Stevens-Johnson syndrome, vesicular pustular dermatosis — Sneddon-Wilkinson syndrome, etc.In order to study the frequency and nature of skin lesions with mycoplasmosis combined with herpesvirus infection, 45 patients aged 3 to 15 years of life were observed. A comprehensive clinical and laboratory study revealed skin lesions in 27 patients associated with current mycoplasma and herpesvirus infections. Thus, multiforme exudative erythema in the small form variant was diagnosed in 13 patients, skin vasculitis in 4, hemorrhagic purpura in 3, urticaria rash in 3, erythema nodosum in 2, mucositis in 2 children. In 18 children, a combined mycoplasma and herpesvirus infection was established. In 9 children, a mono infection was detected (in 5 — herpes virus and in 4 — mycoplasma).All observed patients showed antibodies to smooth muscle antigens in titers from 1:80 to 1:160 (normal 1:40) and in the vast majority (in 24 patients) — antibodies to vascular endothelial antigens in titers from 1:80 to 1:320 (with the norm of 1:40). Compaction of the intima-media complex was detected in 6 patients with monoinfection and in 16 patients with co-infection, according to ultrasound duplex scanning of the vessels of the brachiocephalic department.Thus, for various immuno-inflammatory, allergic skin diseases, screening for infections, in particular, mycoplasma and herpesvirus, is necessary to optimize treatment.

scholarly journals Results of Histidine (His) Supplementation in a Case of Severe Nummular Eczema (NE)

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1141-1141 ◽  
Author(s):  
Michael Rothkopf
Keyword(s):  
Immune Modulation ◽  
Therapeutic Option ◽  
Calcineurin Inhibitors ◽  
Skin Lesions ◽  
Symptomatic Improvement ◽  
Skin Hydration ◽  
Current Therapy ◽  
Funding Sources ◽  
Topical Calcineurin Inhibitors ◽  
Anti Inflammatory

Abstract Objectives NE (coin-shaped, severely pruritic skin lesions) is an idiopathic, histologically indistinguishable form of atopic dermatitis (AD). NE is chronic, relapsing and debilitating. Treatment is limited to skin moisturizers and anti-inflammatory agents. Recurrence is common. Recent studies suggest that lack of the protein, filaggrin (FLG) and its derivative natural moisturizing factors (NMFs) play a role. Because FLG is a His-rich compound, l-His supplementation (LHS) may provide a nutritional NE option. In this report, we present a patient with severe, resistant NE who responded to LHS. Methods The patient is a 57 yo female with NE, unresponsive to topical emollients, topical and oral steroids, oral antihistamines, phototherapy, topical calcineurin inhibitors and immune modulating agents. She attempted nutritional options by eliminating food allergens (dairy, nuts, wheat, eggs) and followed an anti-inflammatory diet. Because these had only modest effects, a trial of oral LHS (8 gm/d) was begun. After 4 months on therapy NE improved significantly. Lesions diminished in size and number. The pruritus was nearly eliminated. Liver and kidney function remained normal. Results NE is a debilitating form of AD. Current therapy is essentially palliative, relying on the use of topical emollients and anti-inflammatory agents. Phototherapy and even systemic immune modulation provide only partial results. Standard nutritional approaches are generally of little value. In this case, LHS was attempted after all other options failed. LHS had a dramatic effect on the patient's NE, markedly reducing the pruritus and visibly improving the rash. The NE lesions became smaller and less numerous. LHS was well tolerated without notable adverse effects. His is an essential amino acid whose deficiency results in negative nitrogen balance, anemia and decreased histamine and carnosine production. His is a major component of FLG (∼10%). FLG degrades into NMFs which contribute to skin hydration and stratum corneum acidity. LHS is believed to increase FLG and NMF production. Conclusions LHS produced symptomatic improvement in a case of severe, treatment-resistant NE. We believe this effect was the result of increased FLG production due to LHS, with subsequent improvements in NMFs and skin hydration. LHS may be a therapeutic option for selected cases of resistant NE. Funding Sources None.

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