Fig. 1. Scheme of Prevention of atopic dermatitis
Primary prevention
prevention activities of atopic dermatitis should be spendmore
before birth in the antenatal period (antenatal prophylaxis) and
continue after birth in the first year of life (postnatal
prevention).
Antenatal prevention
significantly increase the risk of allergic disease high
antigenic load (toxaemia during pregnancy, massive dasg therapy
pregnant, the impact on her professional allergens unilateral
carbohydrate diet, abuse of obligate food allergens, etc.).
exception of these moments is important for preventing atopic dermatitis
. Pregnant women with a family history of allergies and
especially if it is available to eliminate most contact with any (food,
domestic, professional) allergens.
Postnatal prevention
In the early postnatal period is necessary to limit neonatal
unnecessary dasg therapy, early artificial feeding, which
lead to the stimulation of synthesis of immunoglobulin E (IgE). As a strict diet is not
only child, but breastfeeding mothers. In infants with risk factors for atopic dermatitis
need proper care for skin, normalization
of gastrointestinal tract, the organization of a balanced diet with
explanation of the need to breast-feeding, management
introduction of complementary foods, as well as compliance with recommendations for hypoallergenic regime.
Primary prevention of atopic dermatitis involves binding
continuity in the work of a dermatologist, allergist, gynecologist and a pediatrician.
Secondary Prevention and Rehabilitation
antirelapse program for atopic dermatitis should be designed taking into account
activities aimed at practical implementation of all aspects of
rehabilitation: medical, physical, mental, vocational and social
. Prevention program is tailored to a comprehensive assessment of the patient
and continuity with the previous treatment.
Preliminary examination of preventive BP
One reason for the high frequency of exacerbations of AD ignoring prevention,
based on a thorough examination of the patient. Here is a collection of critical
allergoanamneza, general clinical examination, and especially the results
allergy examination including determination of total and
allergenspetsifichnyh IgE.
results of laboratory tests for allergy in patients with AD can
doctor immediately evaluate a very wide range of allergens of different groups: domestic,
epidermal, fungal, bacterial, parasitic, food, pollen, etc .
The information obtained is a strategic decision to
preventive measures, sometimes changing the lifestyles of the patient and his family. These
data invaluable in the development of preventive treatment, including allergen immunotherapy
(Asit) and are required when building a program
patient education. General clinical examination reveals foci
chronic infection or other precipitating factors and correct them,
that generally leads to the prevention of relapse of AD.
control environment sick
environmental monitoring and correction of comorbidities, and
as the leading pathogenetic mechanisms is one of the important activities of anti-
treatment.
Communication Development of blood pressure with exposure to house dust and mites contained therein
Dermatophagoides dictates the need for elimination
measures that reduce contact with these allergens.
Considered mandatory use of closed mattresses and pillows in plastic envelopes for solid
lightning. It is desirable that the zipper covered strip of cloth. Recommended
purchase a special bed linen (pillowcases, duvet covers, etc.),
protect against exposure to dust and mite allergens. If the patient uses
ordinary clothes, to its regular (weekly) boil, cover
pillows 2 pillowcases, pillows should be packed with synthetic material.
Bedding should be changed at least 2 times a week. The apartment must not be
large number of upholstered furniture and carpets, carpet is not allowed in the nursery
bedroom, as well as the use of carpet with a sharp odor
synthetic material. Be sure to regularly cleaning the entire apartment, especially the room where
patient spends the most time, cleaning hard to reach areas of dust accumulations
. The apartment where he lives with AD who are allergic to house dust,
should get out in his absence, preferably with the help of special vacuum cleaners.
significantly improve the situation in the application of modern models of vacuum cleaners (Sklassa)
"out" high-carbon and HEPA filters to filter out
particles to 0.3 microns in diameter, as well as the use of household air purifiers
.
If hypersensitivity to fungi after using the bathroom
recommended to dry it thoroughly wet all surfaces. Produce clean rooms with bath
solutions to warn the growth of mold is not less than 1 time per month. At
kitchen must use hood over the stove (removing a couple). Drying clothes
only necessary in a ventilated room, outside living room.
When epidermal allergy do not use clothing made of wool, animal fur,
exclude visits to the sick zoo, circus, houses where the animals. In
flat, where previously there were an animal, and is home sick, you need
repeated thorough cleaning of the room.
In allergy to pollens of plants: in the period of deposition of allergenic plants should
sealed box, to limit walking in windy and sunny weather,
especially in the green area of the city or in asral areas with caution
use herbal cosmetics (soaps, shampoos, creams, etc.),
not be treated phytopreparations.
Elimination of nonspecific factors
in the treatment of patients with AD, there should be elimination not only
prichinnoznachimyh allergens, but also non-specific (non-allergenic)
factors that can provoke exacerbation or maintain
its chronic course. These include: stress, extreme values
temperature, humidity, intense physical exercise (one of the components
effects of sweat), infectious diseases.
known fact exacerbation of AD in children at the background of acute respiratory and / or
intestinal infections. During these periods, for the prevention of exacerbation of blood pressure, amore
strict monitoring of elimination activities.
Caring for dry and overly sensitive skin
Given that the dryness of the skin ( dermatoxerasia) occurs in 1 / 3 AD patients, an important factor in the complex
preventive treatment is skin care. In the pathogenesis of AD
immune processes in the skin cause it hyperresponsiveness not only
when allergens trigger allergic process in general, any skin irritants
often provoke an autoimmune reaction pseudoallergy and character.
Dry skin is one of the triggering factors of blood pressure due to the frequent and continuous
damage cells in the epidermis, triggering a chain reaction immunomediatornyh,
lymphocyte activation and development of the typical pattern of inflammation.
therefore timely and continuous care for dry skin of atopic patients
considered one of the key to successful prevention of relapse of AD.
Patients are advised to avoid frequent washing, at home earlier
recommended salt baths, as well as so-called "Cleopatra's Bath"
self-preparation (1 cup milk emulsified with 1 tablespoon
olive oil and pour in the bath). As emollients years
used simple creams with 10% urea or sodium chloride.
extemporal However, such formulations used before the advent of new
funds have a number of disadvantages, including often been inaccessible to the patient,
require special preparations and brought a lot of other inconveniences, to say nothing of the aesthetic
aspects. Lack of effective components,
cultivable dry skin, along with the lack of quality
osnovynositelya for external therapy for many years complicated the prevention of blood pressure in
our country.
New tools for skin care
As a means of preventive care, especially in those with sensitization
to lanolin, we recommend the new generation of nonsteroidal
for permanent use.
These tools include, inter alia, various products based on
thermal waters, including the French thermal water aven ( Avene).
Thermal Waters recently used in external preparations and means
skincare DERMATOLOGY AND COSMETOLOGY several lines produced for
abroad. As a asle, the effect of thermal water indicate its
calming effect, relieving irritation, as well as strengthening (for
by moisturizing and softening), epidermal barrier function, which increases the stability of its
damage and penetration microorganisms. The latter effect
important for BP, as triggers of inflammation are often
microbial antigens and superantigens elements of bacteria and fungi from the skin surface.
The composition emollient cream "Trikzera" (based on thermal water
Avenue) includes no less important components, which provide
effectiveness of the cream into dry skin and prevention of blood pressure in children and adults
. These include lipids of plant origin with high
ceramides, and unsaturated fatty acids. This composition promotes rapid regeneration
epidermis after injury, impede the process of peroxidation
oxidation, protects cell membranes epidermotsitov. Moderating effect of the cream
combined with moisturizer. Unlike traditional means of skin care cream
"Trikzera" does not contain fragrance, and satisfies the requirements for
lechebnokosmeticheskim Dasgs for atopic and prone to skin irritation.
Along with the cream Trikzera "is now available
soothing bath Trikzera" balanced emulsion containing the same
principal components. The peculiarity of this form is
education on skin evenly distributed protective film. Lipid film
protects the skin from drying and irritation of the usual hard tap water,
which is one of the most common problems in caring for
prone to irritation and dryness of the skin of atopic patients. Emulsion
allows you to clean the skin without detergent action. Components of palliative baths Trikzera "
provide antipasritic effect that is significant not only in preventing
and skin care, but also in daily controlled self-medication of patients with AD.
lipid components (The complex of fatty acids called Omega 6 ") along with glycerol
(5%) and vitamin E (0.5%) are members of another lechebnokosmeticheskogo and
prophylactic cream "Ekzomega" on the basis of an extract of oats
"Realba. Nekomedogenny, hypoallergenic, soothing and nourishing cream "Ekzomega"
suitable for the prevention of exacerbations of AD and continued care for atopic and
irritated skin. It is believed that anti-inflammatory and softening properties
integrated oat extract soothe irritation Realba, fatty acids
Complex "Omega 6" penetrate the membrane phospholipids and intracellular
cement of the stratum corneum and restore its uniformity and integrity,
block inflammation and suppress the synthesis of a number of inflammatory mediators,
prostaglandins and leukotrienes (LTB 4 ).
done to evaluate the effectiveness of the cream "Ekzomega"
two-month study showed reduction of pasritus (86%), and excoriation, which allowed
avoid secondary infection by scratching the ground. Noted
relief of insomnia during the first month of treatment, the overall quality of life
patients and their families. Xerosis (dry skin), moderate to severe
severity decreased by 60% after one month and 73% after two months
treatment.
The survey showed a positive evaluation by patients of the cream "Ekzomega.
In particular, we evaluated the consistency (to satisfy 96%), ease
applying the cream and feeling after application. Vrachidermatologi
also positively evaluated the efficacy (67%) and the aesthetic acceptability of use (82%)
cream.
Thus, at present there were an effective means for
constant care for atopic skin and prevent a recurrence of BP without
application of topical corticosteroids. Undoubtedly, the use of such
lechebnokosmeticheskih funds may be most effective in the complex
prevention program BP (Table 1). New local preparations for the regular
care for dry and easily irritated skin can take one of the leading
in the concept of "self-controlled" atopic patients, providing an independent
effective control of relapses at a stage of preclinical
manifestations of exacerbation, the patient revealed immediately. To implement
This approach requires a preliminary examination and a full course
special education, as well as an active dynamic observation and accessibility
consult your doctor.
Posted with permission from Russian
Medical Journal.