Clinical Manifestations Of Atopic Dermatitis Research Articles

The Role of Inhalant Allergens on the Clinical Manifestations of Atopic Dermatitis.

Inhalant allergens provide a source of environmental factors that contribute to the development of clinical symptoms in patients with atopic dermatitis (AD). To review the relationship between inhalant allergens and AD. A literature review was conducted using three databases: PubMed/MEDLINE, ClinicalKey, and Web of Science. Search terms, including "atopic dermatitis," "atopic eczema," and "eczema," were used in combination with "inhalant allergen," "inhaled allergen," and "aeroallergen" to identify relevant published manuscripts that highlight the relationship between AD and exposures to inhalant allergens. Fifteen articles were suitable for review. The studies included in the review investigated the effect of inhalant allergens on the clinical manifestations of AD through bronchial provocation, direct skin contact, and allergen sensitization. There is a significant relationship between exposures to inhalant allergens and AD. Inhalant allergens may aggravate AD symptoms by either bronchial provocation or direct skin contact. Sensitization of inhalant allergens, mainly house dust mites, follows a specific age-related pattern.

The Efficacy and Effectiveness of the Biological Treatment of Pruritus in the Course of Atopic Dermatitis.

Atopic dermatitis is a heterogenous inflammatory disease with high variety in terms of clinical symptoms and etiopathogenesis, occurring both in pediatric and adult populations. The clinical manifestation of atopic dermatitis varies depending on the age of patients, but all age groups share certain common features, such as a chronic and recurrent course of disease, pruritus, and a co-occurrence of atopic diseases in personal or family medical history. Treating pruritus is a high priority due to its incidence rate in atopic dermatitis and substantial impact on quality of life. In recent years, treatments with biological drugs have increased the range of therapeutic possibilities in atopic dermatitis. The aim of the study is to present the safety profile, efficacy, and effectiveness of various biological treatment methods for the therapy of pruritus in the course of atopic dermatitis.

<i>DSG4</i> Gene Variants as a Cause of Hypotrichosis in the Child with Severe Atopic Dermatitis: Clinical Case

Background. Hypotrichosis is a heritable form of alopecia that causes almost complete scalp hair loss in childhood. The diagnosis is typically established according to medical history and clinical picture. Genetic testing is an additional diagnostic method that allows to establish “hypotrichosis” in cases of ambiguous or subtle clinical signs of the disease, as well as to perform differential diagnosis of this condition with others commonly associated with atopic dermatitis (focal and diffuse alopecia). Clinical diagnosis of hypotrichosis in patients with severe dermatosis is challenging.Clinical case description. The girl, aged 2 years 4 months, was hospitalized with complaints on extended rash on the body with severe itching, and changes in hair thickness, quality of hair shaft, and hair loss. Severe atopic dermatitis and hypotrichosis were diagnosed. The diagnosis of atopic dermatitis was established clinically (SCORAD — 65), the diagnosis of hypotrichosis (type 6, monilethrix-like hypotrichosis) was confirmed via molecular genetic testing (nucleotide variant c.699C>T in exone 13 of the DSG4 gene (OMIM # 607892)). Patient's mother, brother, and two sisters were diagnosed with the nucleotide variant chr18:31409487C>T in heterozygous state in the DSG4 gene. Mother and brother had no clinical manifestations, while both sisters had mild scalp hair damage, as well as eyebrows and eyelashes, since birth. There were no clinical manifestations of atopic dermatitis in parents and other children in the family.Conclusion. Hypotrichosis clinical signs can be subtled, smoothed, or imitate the symptoms of other comorbid conditions, especially in patients with comorbidities or severe dermatosis. Also worth noting is that changes in certain genes can aggravate the course of atopic dermatitis. In this clinical case, mutation in the DSG4 gene leads to epidermal barrier failure by disrupting the synthesis of desmosomes transmembrane components. Thus, geneticist consultation and genetic testing (search for changes in certain genes) are crucial in such cases.

Dupilumab Treatment Efficacy and Impact on Clinical Scores, Serum Biomarkers, and Itch in Adult Patients with Atopic Dermatitis: A Retrospective Analysis.

Dupilumab, a fully human monoclonal antibody that inhibits the signaling pathways of interleukin (IL)-4 and IL-13, has demonstrated remarkable efficacy in the treatment of atopic dermatitis (AD). Dupilumab has been reported to attenuate itch and reduce several serum markers, including blood lactate dehydrogenase (LDH), blood eosinophil count, and serum total immunoglobulin E (IgE). The present study investigated retrospectively changes in clinical scores and serum biomarker from 175 adults with moderate-to-severe AD treated with dupilumab. Clinical manifestations were assessed using eczema area and severity index (EASI) and visual analogue scale (VAS) for itch at baseline and subsequently at 16-week intervals up to a duration of 48 weeks. Total IgE, LDH and blood eosinophil count were also collected. The dupilumab treatment significantly improved EASI and VAS scores and decreased serum levels of IgE, LDH, and total eosinophil count. The EASI scores were positively correlated with VAS for itch at all recorded time points, whereas serum biomarkers did not exhibit a strong correlation with EASI scores. These findings highlight the close relationship between the extent and severity of eczema and the intensity of itch experienced by patients and suggest that factors beyond the measured serum biomarkers play a significant role in the clinical manifestations of AD, emphasizing the complex nature of the disease.

Application of noninvasive hardware technique of transcranial electrical stimulation (TES) in patients with atopic dermatitis

BACKGROUND: Transcranial electrostimulation (TES therapy) is a physiotherapeutic non-invasive technology that allows painlessly, selectively and strictly dosed activation of certain brain structures producing endogenous opioid peptides by modulating activity in these brain regions that are involved in the processing of pain and itching signals. Originally, this technique was used as an electronarcosis, then the scope of TES therapy in medicine expanded and began to be used in neurology, gynecology, urology, gastroenterology. The efficacy of its use in dermatology as an antipruritic action remain poorly understood.
 AIM: the purpose of the pilot study was to evaluate the effectiveness and acceptability of the use of non-invasive TES therapy in patients with atopic dermatitis.
 MATERIAL AND METHODS: According to the existing concept, itching is considered as a kind of pain sensation caused by an altered threshold level of nerve endings in the skin that perceive pain. Given this similarity of the mechanisms of pain and itching, noninvasive brain stimulation can simultaneously reduce itching, which opens up broad prospects for its further use in itchy dermatoses.
 A pilot controlled study was conducted, the object of the study was patients with moderate atopic dermatitis (9 women and 6 men) aged 19 to 48 years. TES therapy was carried out by a pulsed bipolar electrical stimulator with acoustic effect "TRANSAIR-07" according to the standard method. All patients who received a course of TES monotherapy underwent 10 procedures, 1 time a day, lasting 3040 minutes, with a current of 13 mA. To assess the dynamics of clinical manifestations of atopic dermatitis and the severity of the disease, the following scales were used: SCORAD, EASI, IGA, DLQI, HADS, BDI. The assessment was carried out twice: the first time on the day of diagnosis verification and again on the 10th day of treatment.
 RESULTS: As a result of the treatment, there was a decrease in itching from 5 to 2 points, an improvement in mood from 5 to 1 point, an increase in performance from 4 to 1 point, a decrease in anxiety and depression from 4 to 2 points. With a general assessment of the dynamics of the indicators of the applied clinical scales (SCORAD, EASI, IGA, DLQI, HADS, BDI), the total average effectiveness in the form of parameter improvement amounted to 66.25% reduction by the end of the 10-day course.
 CONCLUSION: The work presents the modern aspects of the application of non-invasive hardware transcranial electrical stimulation technique. The positive results of our own pilot study are presented and data confirming the clinical efficacy of transcranial electrical stimulation in patients with atopic dermatitis are presented, which determines the prospect of developing a combined application of TES therapy for this persistent disease.

Prevalence and risk factors of atopic dermatitis in Chinese adults: a nationwide population-based cross-sectional study.

Prevalence and risk factors of atopic dermatitis in Chinese adults: a nationwide population-based cross-sectional study.

Possibilities of increasing the efficiency of atopic dermatitis treatment in children using physiotherapeutic methods

Introduction. Modern complex treatment of atopic dermatitis (AD) in children involves not only drug treatment, but also the use of physiotherapy techniques. Purpose: to develop an effective complex method for the treatment of children with AD with the combined use of hydrotherapy (HT), non-selective chromotherapy (NCT) and low-intensity laser blood irradiation (NLBI), which reduces the severity of the disease and improves the children and their families’ quality of life. Material and methods. We examined 164 children diagnosed with AD from 4 to 15 years old (mean age 8±2.9 years). For a comparative study of the effectiveness of various treatment methods, 5 groups of patients were formed who received: basic drug therapy (BMT), GT+BMT, NHT+BMT, NLBI+BMT, GT+NHT+NLBI+BMT. Before the start of treatment, after 1 month and 3 months. assessed the severity of clinical manifestations of AD using the SCORAD scale, children’s dermatological quality of life index (DQLI), family DQLI (FDQLI), Results. After 1 month from the beginning of treatment in the groups of BMT, GT+BMT, NHT+BMT, NLBI+BMT, GT+NHT+NLBI+BM, the values of the SCORAD indices decreased by 1.5; 2; 2.5; 3.4; 4.6 times (respectively), the DQLI index — 1,5 times; 1.9; 2.3; 2.9; 4.6 times (respectively), the FDQLI index of 1.3; 1.5; 2.1; 2.7; 4.5 times (respectively). Conclusion. The developed method of combined use of HT, NCT, NLBI and basic drug therapy in the treatment of children with AD is more effective than the use of these methods in isolation. This is confirmed by a decrease in the DQLI and FDQLI indices by 78.3% and 71.7%, respectively, and a decrease in the SCORAD index by 78.3% with the transition from a moderate to mild form of the disease.

Assessments of Histopathology In Skin of Patients With Allergic Asthma

The atopic march is the observed linear and time-dependent progress of allergic diseases as they develop during childhood, beginning with clinical manifestations of atopic dermatitis (AD) followed by allergic asthma (AA) then allergic rhinitis. However, it has been noted that some patients with AA have no clinical history of AD. We examined the skin of AA and AD patients to compare measures of histopathology at the cellular level.

Алельний поліморфізм гена eNOS у дітей, які страждають від бронхіальної астми, за еозинофільного та пауцигранулоцитарного субтипу запалення бронхів

Метою роботи було вивчити вплив алельного поліморфізму гена eNOS, що кодує активність ендотеліальної NO-синтази та синтез монооксиду нітрогену в дихальних шляхах, на окремі клінічно-параклінічні показники бронхіальної астми в дітей шкільного віку за еозинофільного і пауцигранулоцитарного запального фенотипу. Обстежені 22 хворі на бронхіальну астму з еозинофільним характером запалення дихальних шляхів та 15 пацієнтів — із пауцигранулоцитарним. Проведено імунологічні, спірометричні дослідження, генотипування ендотеліальної NOS.Тяжкість бронхіальної астми у хворих із різним типом запалення бронхів суттєво не залежить від алельного поліморфізму гена eNOS. Відсутність мутацій гена eNOS у вигляді генотипу GG виявилася характернішою для хворих із пауцигранулоцитарним характером запалення бронхів, алельний поліморфізм GT/TT — для дітей з еозинофільним запаленням. За наявності алельного поліморфізму гена eNOS за генотипу GT/TT дітям із пауцигранулоцитарним характером запалення бронхів були притаманні частіші клінічні прояви атопічного дерматиту й алергічного риніту, більший індекс лабільності бронхів та нижча концентрація метаболітів NO в конденсаті повітря, що видихається.

Атопічний дерматит у дітей: диференційна діагностика (Частина 2)

Abstract. The article is devoted to the topical problem of clinical allergology — differential diagnosis of atopic dermatitis. The clinical manifestations of atopic dermatitis are quite similar to the extremely large number of different diseases and pathological conditions in children, which often leads to misdiagnosis. The complexity of the differential diagnosis of atopic dermatitis in children with a detailed description of different pediatrics diseases: from dermatological diseases (seborrheic dermatitis, eczema, shingles, scabies, ichthyosis, psoriasis, bullous epidermolysis, allergic dermatitis, cutaneous mastocytosis) to oncological (T-cell skin lymphoma), orphan metabolic diseases (hereditary disorders of tryptophan metabolism, phenylketonuria, Netherton’s syndrome, etc.) and primary immunodeficiencies (Bruton’s disease, Job’s syndrome, Wiskott-Aldrich syndrome, selective IgA immunodeficiency etc.) are described. Сommon features of above mentioned diseases are listed, also, special attention is paid to variety of the pathognomonic symptoms.

Correlation between Interleukin 31 and clinical manifestations in children with atopic dermatitis: an observational study.

Itching is one of the major and mandatory signs of atopic dermatitis (AD) in children. Interleukin 31 (IL-31) is strongly involved in the genesis of pruritus. In our study, 68 patients aged 0-18 years with proven AD were followed clinically. The role of IL-31 in pruritus as clinical manifestation of AD is known but its etiopathogenetic mechanism is not well known. Serum was collected from 31 patients with moderate and severe forms of AD to determine IL-31 and its correlation with activity and severity of the disease. We also studied 30 healthy patients to compare the results of determinations. The IL-31 value was determined using the sandwich enzyme-linked-immunosorbent serologic assay (two antibodies assay). The IL-31 values were expressed as picograms per milliliter (pg/mL) and compared with activity and severity of the disease. The IL-31 value was much higher in patients with AD compared to the control group. The mean value of findings was 1600 pg/mL compared to the control group with an average of 220 pg/mL. The IL-31 values were positively correlated with the severity and activity of the disease. The results of our pediatric study established the involvement of IL-31 in the pathophysiology of AD. IL-31 could be a marker of AD track.

Features of CD-­­phenotype of peripheral blood lymphocytes in adult patients with atopic dermatitis during the exacerbation

Objective — to study the dynamics of peripheral blood lymphocytic populations in adult patients with atopic dermatitis (AD) with the onset of the disease in childhood, depending on the level of IgE secretion and the method of treatment.
 Materials and methods. We examined 67 adult patients with AD, which were divided into 4 groups depending on the level of total serum IgE and the basic treatment or treatment in combination with Glycine and Ketotifen. The severity of AD was determined by the SCORAD index. The content of peripheral blood lymphocytes according to the phenotype CD3+, CD4+, CD8+, CD19+, CD65+, HLADR+ and CD95+ was assessed during hospitalization of patients, at the end of the inpatient stage of treatment and after 1 month of outpatient follow-up. The obtained data were compared with the indices of the control group and between the groups of examined patients with AD in the dynamics of their treatment and observation. The results were processed statistically using the methods of parametric and nonparametric statistics.
 Results and discussion. The indices of the number of cells of peripheral lymphocytic populations of different CD pheno­type in the groups in the dynamics of observation were determined, their relationship with the severity of the course of AD was established, and differences were found depending on the pathogenetic variant of AD. Against the background of an exacerbation of AD, a significant increase in the number of cells in most of the defined populations was revealed, with its gradual decrease as the clinical manifestations of AD subsided. It was established that 1 month after achievement of clinical/subclinical remission, a part of the peripheral blood lymphocytic populations was characterized by higher values compared to the norm. In patients with an IgE-dependent AD variant, aggravation is accompanied by high levels of peripheral lymphocytes with CD3+, CD4+, CD8+, CD19+ and HLA-DR phenotypes, which more often than in the case of an IgE-independent variant of AD, remain above the norm after 1 month of outpatient monitoring. Introduction of glycine and ketotifen to the treatment complex for patients with AD is accompanied by a faster return of peripheral lymphocyte cells to normal values, which is more evident in patients with an IgE-dependent variant of AD.
 Conclusions. In adult AD patients, the dynamics of the number of peripheral lymphocyte population cells depends on the severity of the disease, its pathogenetic variant and the treatment received by the patient. Against the background of the use of glycine and ketotifen, the normalization of indicators of peripheral lymphocytic populations occurs significantly faster than with only standard basic therapy.

Рівень сироваткового еотаксину як маркер тяжкості атопічного дерматиту в дітей раннього віку

Актуальність. Атопічний дерматит (АтД) — це хронічне запальне захворювання шкіри. В основі клінічної маніфестації АтД лежить алергічне запалення шкіри. Як відомо, еозинофіли є одними з найбільш значущих ефекторних клітин алергічного запалення. Разом з тим тільки в частини дітей з АтД виявляється еозинофілія в периферичній крові. У клінічній практиці на сучасному етапі активність алергічного запалення оцінюється не тільки за рівнем еозинофілії, а й за концентраціями цитокінів, одним з яких є еотаксин. Мета дослідження. Завданням наукової роботи було встановлення ролі еотаксину в патогенезі атопічного дерматиту. Матеріали та методи. Досліджено 60 дітей віком від 60 днів до 3 років із клінічними проявами АтД у періоді загострення хвороби (основна група) та 36 здорових дітей (контрольна група). Результати. Встановлено медіану та інтерквартильні інтервали рівнів сироваткового еотаксину при легкому (32,10 [16,05–41,86] пг/мл), середньотяжкому (33,5 [27,9–80,94] пг/мл) та тяжкому (25,11 [18,14–54,42] пг/мл) перебігу АтД — не виявлено вірогідної різниці між групами та референтними значенням групи контролю (46,05 [27,9–61,4] пг/мл). Були відокремлені хворі з високим (18 дітей — 50,2–189,78 пг/мл) та низьким (16 дітей — 2,79–19,54 пг/мл) рівнями еотаксину. Встановлено кореляційні зв’язки між рівнем еотаксину та клінічними ознаками АтД: загальною оцінкою за шкалою SCORAD (р = 0,01), поширеністю (р = 0,09), сумарною інтенсивністю морфологічних проявів (р = 0,01), еритемою (р = 0,01), ліхенізацією (р = 0,01), набряком/папулою (р = 0,06), мокнуттям/кірками (р = 0,06), екскоріаціями (р = 0,01), свербежем (р = 0,01) та порушеннями сну (р = 0,01). Виявлено вірогідне підвищення кількості CD3, CD4, CD8, CD16, CD22, CD25 лімфоцитів, IgG та загального IgE у групі дітей з високим рівнем еотаксину порівняно з пацієнтами з низьким рівнем еотаксину. Висновки. Еотаксин відіграє роль у розвитку гострої фази АтД та може використовуватися як об’єктивний маркер тяжкості загострення.

ПИЛОТНОЕ ИССЛЕДОВАНИЕ УРОВНЕЙ TOLL-ПОДОБНОГО РЕЦЕПТОРА 2 И ТИМИЧЕСКОГО СТРОМАЛЬНОГО ЛИМФОПОЭТИНА В СЫВОРОТКЕ КРОВИ ДЕТЕЙ С АТОПИЧЕСКИМ ДЕРМАТИТОМ

The aim of this study is to assess the level of Toll-like receptor level 2 (TLR-2) and thymic stromal lymphopoietin (TSLP) in the blood serum of children and to establish the relationship between these parameters and the severity of clinical manifestations of atopic dermatitis (AD) and the degree of microbial contamination of the gut. Research materials and methods: 68 children aged from 3 months to 6 years with an AD and 31 conditionally healthy children of the corresponding age were examined. Determination of the level of TLR-2 and TSLP in blood serum was carried out by enzyme immunoassay, and the composition of the intestinal microflora was assessed by MALDITOF mass spectrometry. Results: in children with AD, the median serum TLR-2 level was 2,88 [1,60; 4,91] ng/ml, TSLP – 6,01 [1,11; 9,5] pg/ml, which is statistically significantly higher than in conventionally healthy children (p<0,0001). The highest levels of TLR-2 and TSLP were found in erythematoussquamous with lichenification of the AD form – Me=6,10 [3,55; 10,62] ng/ml and Ме=12,73 [5,81; 22,70] pg/ml respectively. In children with moderate severity of AD, TLR-2 and TSLP values were statistically significantly higher (p<0,0001) compared to mild AD (Me=5,58 [2,29; 8,18] ng/ml versus 0,72 [0,22; 2,02] ng/ml and 7,48 [4,25; 12,95] pg/ml versus 0,64 [0,39; 0,75] pg/ml, respectively). The level of TLR-2 and TSLP increased with the degree of intestinal dysbiosis: Me=6,27 [4,14; 8,02] ng/ml at grade 3 dysbiosis versus 1,25 [0,46; 2,15] ng/ml at the 1st degree of dysbiosis and 16,28 [10,01; 22,6] pg/ml at the 3rd degree of dysbiosis versus 0,63 [1,33; 0,70] pg/ml at the 1st degree of dysbiosis, respectively (p<0,0001). Results: the obtained data on the activation of TLR-2 and TSLP in AD emphasize the systemic nature of the inflammatory response; however, the causal relationship between the level of TLR-2 and TSLP and AD activity requires further verification.

НУТРИТИВНЫЙ СТАТУС У ДЕТЕЙ С АТОПИЧЕСКИМ ДЕРМАТИТОМ, ОБУСЛОВЛЕННЫМ ПИЩЕВОЙ АЛЛЕРГИЕЙ

The prevalence of food allergy (FA) among children with atopic dermatitis (AD) ranges from 26 to 38%. The article presents an analysis of domestic and foreign publications devoted to the peculiarities of the AD flowing from the FA in children, in which the withdrawal diet plays a leading role in elimination diet. The complete or partial exclusion of one or several foods from the diet contributes to an insufficient intake of macro- and micronutrients, which can lead to a decrease not only in body weight, but also in a delay in the growth of children, as well as in decrease in parameters of bone mineral density. According to research results, the intake of calcium and vitamin D in children with AD and FA is below the recommended levels. The serum 25(OH)D level in these patients is lower than in the general population and is inversely proportional to the SCORAD index. Vitamin D supplementation improves the effectiveness of treatment, helps to reduce the clinical manifestations of AD, as evidenced by a decrease in indicators of both the SCORAD index and the EASI index. The timely and adequate correction of the diets of children with FA who follow strict elimination diets requires an interdisciplinary approach in close cooperation between the pediatrician, allergist and nutritionist.

The Association Between the Use of Oclacitinib and Antibacterial Therapy in Dogs With Allergic Dermatitis: A Retrospective Case-Control Study.

Background: Canine allergic dermatitis, including atopic dermatitis, often requires antibacterial therapy for concurrent infections. Oclacitinib is indicated for treatment of pruritus associated with allergic dermatitis and the clinical manifestations of atopic dermatitis in dogs aged ≥12 months.Hypothesis/Objectives: We aimed to determine if there was a quantitative difference in antibacterial use by dogs with allergic dermatitis receiving oclacitinib vs. other anti-pruritic therapies and before vs. after oclacitinib.Animals: In this retrospective case-control study, cases (n = 58) included dogs suffering from allergic dermatitis aged ≥12 months receiving oclacitinib and controls (n = 205) were counterpart dogs treated with other anti-pruritic therapies.Methods: Clinical histories of dogs with allergic dermatitis were collected from a small animal university hospital. Multivariable logistic regression models were developed adjusting for underlying skin or ear conditions to determine whether cases were prescribed fewer antibacterials than controls.Results: The odds of systemic antibacterial usage were lower in cases vs. controls [odds ratio (OR): 0.29 (95% confidence interval 0.12–0.71); P = 0.007]. The odds of amoxycillin clavulanic acid usage (12.5–25 mg/kg orally every 12 h) was lower in cases vs. controls [OR: 0.08 (0.01–0.71); P = 0.024]. Topical antibacterial drug use was reduced overall; however, only the odds of neomycin use was lower in cases vs. controls [OR: 0.3 (0.1–0.89); P = 0.029]. Cases had higher odds of experiencing improvements in allergic dermatitis categories vs. controls [OR: 7.89 (3.26–19.13); P < 0.001].Conclusions and Clinical Importance: Our results suggest that use of oclacitinib to treat allergic dermatitis in dogs is associated with less antibacterial use than other anti-pruritic therapies.

Analysis of animal model of atopic dermatitis based on characteristics of clinical symptoms traditional Chinese and Western medicine

Based on the clinical characteristics of atopic dermatitis( AD) in traditional Chinese medicine( TCM) and Western medicine,the existing animal models were analyzed,and the coincidence degree,advantages and disadvantages between the models and the clinical manifestations of AD were evaluated,so as to provide reference for establishing a rational animal model. After consulting relevant literatures in recent years and summarizing the existing modeling methods,it is found that spontaneous,transgenic/gene knockout models were highly consistent,but with high breeding conditions and expensive prices. The hapten-induced model was low in cost and fast in modeling. It revealed the corresponding mechanism of AD to a certain extent,but did not fully reflect the state of the entire process of AD. The modeling method was guided by Western medicine,but with a lack of pathogenic factors of traditional Chinese medicine,and so has certain limitations in TCM research. Therefore,it is necessary to combine the etiology,pathogenesis and clinical mani-festations of AD with traditional Chinese and Western medicine,so as to improve the coincidence degree between the model and the characteristics of clinical symptoms and lay the foundation for in-depth studies on AD.

АТОПІЧНИЙ ДЕРМАТИТ У ДІТЕЙ: ДИФЕРЕНЦІЙНА ДІАГНОСТИКА (ЧАСТИНА 1)

The article is devoted to the topical problem of clinical allergology — differential diagnosis of atopic dermatitis (AD). The clinical manifestations of AD are quite similar to the extremely large number of different diseases and pathological conditions in children, which often leads to misdiagnosis. The complexity of the differential diagnosis of AD in children with a detailed description of different pediatrics diseases: from dermatological diseases (seborrheic dermatitis, eczema, shingles, scabies, ichthyosis, psoriasis, bullous epidermolysis, allergic dermatitis, cutaneous mastocytosis) to oncological (T-cell skin lymphoma), orphan metabolic diseases (hereditary disorders of tryptophan metabolism, phenylketonuria, Nezerton’s syndrome, etc.) and primary immunodeficiencies (Bruton’s disease, Job’s syndrome, Wiskott-Aldrich syndrome, selective IgA immunodeficiency etc.) is described. Сommon features of above mentioned diseases are listed in the article, also, special attention is paid to variety of the pathognomonic symptoms. Key words: atopic dermatitis, differential diagnosis, children.

Pruritus and Atopic Dermatitis: from Etiological Features to Management

Pruritus is one of the main clinical manifestations of atopic dermatitis, and it significantly reduces the quality of life of patients in childhood. Scientific images on its pathophysiological basis have now undergone significant changes. The histamine exceptional role in pruritus development was confounded, as well as data on immune system involvement in its maintenance was given. This article presents current data on differential approaches to pruritus management depending on its etiopathogenetic characteristics. The role of dermocosmetics in restoration of the skin barrier as the first stage prevention of pruritus in atopic dermatitis was considered. The results of clinical studies showing efficacy of topical agents (innovative component with anti-pruritic action — STIMU-TEX) application are presented.

PECULIARITIES OF CLINICAL PASSING OF ATOPIC DERMATITIS AND VITAMIN D EXCHANGE IN EARLY CHILDREN

The article is devoted to the study of features of clinical course of atopic dermatitis and vitamin D exchange in young children conducted by us by estimation of severity of atopic dermatitis depending on the value of SCORAD index, determination of 25(OH)D concentration in serum of children by immunochemical method with chemocentric analysis according to the classification approved by experts of the international endocrinological society. In the examination of 188 young children, two groups were formed on the basis of the Lviv City Children's Clinical Hospital. Children from 1 month to 1 year of age with manifestations of atopic dermatitis (n = 120), who were born full-term and had no birth defects, metabolic disorders, severe perinatal CNS lesions formed the main group. The comparison group consisted of 68 healthy young children without chronic diseases. All children had atopic dermatitis in the main group and were classified by severity (depending on the SCORAD index): children with mild severity – 31 (26 %), moderate 47 (39 %), and severe 42 (35 %). As a result of the study, we found a association between the severity of clinical manifestations of atopic dermatitis and the level of vitamin D in the serum. Comparative analysis of the severity of atopic dermatitis, depending on the level of vitamin D in the serum, showed that with severe atopic dermatitis in children of the main group, the level of 25(OH)D was significantly lower compared to its indicators in children with moderate to severe (P &lt; 0.05). Serum vitamin D levels are significantly lower in all forms of atopic dermatitis severity and correlate significantly with the overall SCORAD severity score, erythema intensity, excoriation, itching, and sleep disturbances. The scientific data on the presence of feedback correlation (r = –0,48; P &lt; 0,05) between the development of atopic dermatitis in children and their level of 25(OH)D in serum were added. Our findings suggest that there is a need for a differentiated approach to treating early-stage atopic dermatitis of varying severity, a personalized therapeutic approach to choosing a vitamin D supplementation, given the level of 25(OH)D in the serum.