Features of eczema in children

In the development of eczema in children, constitutional anomalies play an important role - allergic (syn.: exudative-catarrhal) and other diatheses.

As is known, diathesis is a special form of hereditary predisposition of the body to certain pathological conditions and diseases, characterized by an unusual reaction of the body to physiological stimuli and normal living conditions. Diathesis is not yet a pathological condition or disease, but creates a background for their development under unfavorable environmental conditions. Diathesis can proceed latently for a long period and only under unfavorable environmental conditions (improper child care, nutrition, regimen, harmful exogenous factors), disorders of the functional state of the endocrine, central and autonomic nervous systems can constitutional anomalies be identified.

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Causes of Eczema in Children

The essence of exudative diathesis lies in a hereditarily determined polygenic and heterogeneous predisposition with pronounced gene expressivity, transmitted both by autosomal dominant and autosomal recessive inheritance, which, together with general nonspecific and immunological reactivity, mediates the readiness of the child's body for recurrent inflammatory-exudative skin diseases with a protracted chronic course in response to even ordinary endo- and exogenous influences.

It has been established that in the presence of allergic diseases in the paternal line, eczema is diagnosed in 30% of children, in the maternal line - in 50%, in the paternal and maternal lines - in 75% of children. In the latter case, it develops in the first weeks or months of the child's life and is characterized by a continuously relapsing course with an extensive area of skin damage. Moreover, it has been reliably established that children with eczema have genetically determined, mainly maternal, and secondary - acquired immune disorders with an increased content of IgG, IgE and a decrease in the IgM level with an increased number of B-lymphocytes. Disorders of the humoral phase of immunity are accompanied by a decrease in the number of functionally active T-lymphocytes and a decrease in the content of T-cells. It has been established that sensitization and immediate-delayed hypersensitivity of the child can occur in utero (transplacentally) due to antigens circulating in the body of the pregnant woman.

In the postnatal period, a number of authors note dysfunctions of the liver, pancreas, digestive tract, imperfection or insufficiency of the enzymatic systems of the digestive apparatus, increased permeability of the mucous membranes of the stomach, intestines and disruption of the liver barrier in 95% of infants. It is impossible not to note the great importance that violations of the mother's diet, early complementary feeding, supplementary feeding of the child against the background of exacerbation of foci of chronic infection, acute respiratory viral infections, helminthic invasion, exacerbation of diseases of internal organs, etc. have in the occurrence of eczema in children.

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Symptoms of Eczema in Children

Eczema in young children has a number of features in the clinical picture and course. In 72% of children, the first rashes on the skin appear during the first half of life. Eczema in children aged 1-2 years is usually associated with exudative diathesis and occurs with weeping. Most often, the cheeks and forehead are affected (true form of eczema), then the process captures the scalp and the entire face. The skin diffusely reddens, swells, small blisters appearing on it quickly open, leaving eroded surfaces. The process most often develops in the 3-6th month of life. The nose and nasolabial triangle are usually not affected. In children, extensive weeping surfaces devoid of the stratum corneum are most often diagnosed. The process tends to spread from the scalp to other areas of the skin.

Severe (biopsizing) itching of a constant nature bothers the child throughout the day (more often when eczema is combined with diseases of the digestive organs).

Children complain of sleep disturbances and have a characteristic appearance upon examination: pastosity of the skin with a pale (pale pink) color, fullness with loose but not elastic fatty tissue. The turgor of soft tissues in children is reduced.

In children, seborrheic (67% of cases), impetiginous (56% of cases), microbial (49% of cases) and pruriginous (23% of cases) forms of eczema are most often diagnosed. When a pyogenic infection is added, impetiginous pustules or folliculitis appear on areas of eczema in children, the crusts become layered, yellow-green in color, sometimes lymphadenitis is added, and the temperature often rises.

In small children, impetiginous eczema of the buttocks is observed (untidy maintenance of children, diarrhea). In older children (from 5 to 14 years old), disseminated manifestations of eczema are sometimes observed with localization of lesions on the skin of the trunk, less often on the face and even less often on the extremities. The lesions are usually oval, irregular in shape in the form of spots or infiltrated plaques. Itching persists constantly throughout the day.

Histological changes: in acute cases of eczema, exudation is characteristic, and in the chronic form, proliferation. Edema is observed in the epidermis and dermis, especially in the spinous layer of the epidermis. Inside it, intercellular edema pushes the cells apart and forms cavities of various sizes. In the Malpighian layer, infiltrate cells are sometimes found, creating the impression of forming microabscesses. In chronic eczema, acanthosis and often parakeratosis are observed in the epidermis.

The blood and lymphatic vessels are dilated, some of the blood vessels are filled with erythrocytes. In the dermis, an infiltrate is diffusely located between the collagen fibers, along the vessels and around the skin appendages. In acute eczema, the infiltrate consists of polymorphonuclear leukocytes, and in chronic eczema, lymphocytes and fibroblasts predominate in the infiltrate, and polymorphonuclear leukocytes are sometimes encountered. The elastic mesh in the papillary layer is in a state of disintegration; the bundles of nerve fibers that are encountered are edematous.

Treatment and diet for eczema in children

A properly prescribed diet can have a non-specific desensitizing effect and help improve the child's condition. During the first 3 days of acute eczema, a strict milk diet is necessary. Spicy foods, sweets, eggs, coffee, tea and alcoholic beverages are prohibited. Products that are allergens for a given child are excluded from the diet (elimination diet). The child's diet should be based on the identified diseases of the digestive organs and the form of eczema. Thus, with true eczema in children, lipostasis is increased and protein deficiency is pronounced, and with the seborrheic form of eczema, lipolysis and dysproteinemia are noted. Therefore, children of group I are recommended a diet with an increased content of animal and vegetable fat and an increase in protein by 10-12%, and children of group II have an increased consumption of vegetable fat. The amount of carbohydrates consumed is compensated for by hypoallergenic fruits and vegetables. Xylitol should be introduced into children's diets, as it reduces sugar consumption and has a pronounced cholecystokinetic effect.

Principles of General Treatment of Eczema in Children

1. Staged and continuous treatment (hospital - clinic - sanatorium).
2. Comprehensiveness and individual approach in developing treatment plans.
3. Mandatory sanitation of foci of chronic infection in the ENT organs (tonsillitis, sinusitis, otitis), digestive organs (chronic pancreatitis, intestinal dysbacteriosis), in the bronchopulmonary system, and urinary organs.
4. Antibiotics should be prescribed with caution and only in a hospital setting for strict indications.
5. Detoxification therapy and elimination of allergens are carried out in parallel with the treatment of infection foci, primarily in children with disseminated eczema.
6. Deworming is justified if there are signs of eczema.
7. Non-specific hyposensitization of the body, administration of antihistamines of classes II-IV, etc. are indicated.

Principles of local treatment of eczema in children

1. External therapy is prescribed taking into account the stage of the eczematous process (exacerbation, remission).
2. Local therapy is carried out taking into account the clinical form of eczema.
3. External glucocorticoids (prednisolone or hydrocortisone ointments, Elokom or Apulein cream, ointment) are applied to limited areas of skin lesions for no more than 10 days.
4. Strict adherence to the method of application of external medicinal product (lotion, bandage, etc.).

Prevention of childhood eczema

Primary prevention of eczema in children:

• healthy lifestyle of spouses;
• maintaining home hygiene;
• training regimen for the child's life;
• antenatal prevention of allergic dermatoses: (recommendations on the diet of the expectant mother; medical care for toxicosis);
• obstetric and pediatric advice (courses). Secondary prevention:
• early identification of children at risk;
• their full medical examination;
• comprehensive consultative and therapeutic assistance;
• rational external therapy.