Features of eczema in children

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

As you know, diathesis is a special form of the hereditary predisposition of the organism to certain pathological conditions and diseases, it is characterized by an unusual reaction of the body to physiological stimuli and ordinary life conditions. Diathesis is not yet a pathological condition or disease, but creates a background for their development under adverse environmental conditions. Diathesis for a long period can be hidden and only under adverse environmental conditions (improper care for the child, nutrition, regimen, harmful exogenous factors), violations of the functional state of the endocrine, central and autonomic nervous systems can detect anomalies of the constitution.

[1], [2], [3], [4], [5], [6]

Causes of eczema in children

The essence of exudative diathesis consists in hereditarily determined polygenic and heterogeneous predisposition with expressed expressiveness of genes transmitted both in autosomal dominant and in autosomal recessive type of inheritance, which, in combination with general nonspecific and immunological reactivity, mediates the readiness of the child's organism to recurrent inflammatory exudative diseases of the skin with a chronic chronic course in response to even the usual endo- and exogenous effects.

It is established that in the presence of allergic diseases in the pedigree on the paternal line, eczema is diagnosed in 30% of children, on the maternal line - in 50%, on the paternal and maternal line - in 75% of the children. In the latter case, it develops in the first weeks or months of the child's life and is characterized by a continuous-recurrent course with a large area of skin lesions. Moreover, it has been reliably established that in children with eczema, genetically determined, mainly on the maternal line, are observed, and secondary ones - acquired immune disorders with an increased content of IgG, IgE and a decrease in IgM level with an increased number of B lymphocytes. Disturbances of the humoral phase of immunity are accompanied by a decrease in the number of functionally active T-lymphocytes and a decrease in the T-cell content. It has been established that sensitization and hypersensitivity of the immediately delayed type of the child can occur in utero (transplacental) due to the pregnant antigens circulating in the body.

In the postnatal period in 95% of infants, a number of authors note dysfunction of the liver, pancreas, digestive tract, imperfection or deficiency of enzymatic systems of the digestive apparatus, increased permeability of the mucous membranes of the stomach, intestines and violation of the hepatic barrier. It should be noted that the importance of the violation of the diet by the mother, early lure, supplementation of the child against the background of exacerbation of foci of chronic infection, acute respiratory infections, helminthic invasion, exacerbation of diseases of internal organs, etc., can not be overlooked in the occurrence of eczema in children.

[7], [8], [9], [10], [11], [12]

Symptoms of eczema in children

Eczema in young children has a number of features in the clinical picture and flow. 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 proceeds with mocclusion. Most often affected cheeks and forehead (the true form of eczema), then the process captures the scalp and the entire face. The skin diffusely blushes, swells, the small bubbles appearing on it quickly open, leaving the eroded surfaces. The process often develops at 3-6 months of life. The nose and nasolabial triangle are usually not affected. Children are more likely to be diagnosed with extensive, horny surfaces devoid of the horny layer. The process tends to spread from the scalp to other areas of the cover.

A strong (biopsy) itch of a persistent nature worries a child during the day (more often when a combination of eczema with diseases of the digestive system).

Children complain of a sleep disorder, and have a characteristic appearance at the examination: the pastosity of the skin with a pale pink color, fullness with a loose but not elastic fatty tissue. Turgor 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 more often diagnosed in children. When pyogenic infection is attached to the areas of eczema, impetigious pustules or folliculitis appear in children, the cortices become layered, yellow-green, sometimes lymphadenitis joins, and the temperature often increases.

In young children, impetigious eczema of the buttocks is observed (slovenly maintenance of children, diarrhea). In children of older age (from 5 to 14 years), sometimes a disseminated manifestation of eczema with localization of lesions on the skin of the trunk, less often on the face and even less often on the limbs. The foci are usually oval, irregular in form of spots or infiltrated plaques. Itching persists throughout the day.

Histological changes: in acute cases of eczema, the phenomena of exudation are characteristic, and in the chronic form - the proliferation. In the epidermis and dermis there is swelling, especially in the spiny layer of the epidermis. Inside it, intercellular edema spreads the cells and forms a different size of the cavity. In the Malpighian layer, infiltrate cells are sometimes found, creating the impression of forming microabscesses. With chronic eczema in the epidermis there is acanthosis and often parakeratosis.

Blood and lymph vessels are dilated, some of the blood vessels are filled with red blood cells. In the dermis diffusely between collagen fibers, along the vessels and around the appendages of the skin there is an infiltration. In acute eczema, the infiltrate consists of polymorphonuclear leukocytes, and in chronic eczema, lymphocytes and fibroblasts predominate in the infiltrate, sometimes polymorphonuclear leukocytes occur. The elastic grid in the papillary layer is in a state of decay; occurring bundles of nerve fibers are swollen.

Treatment and diet for eczema in children

A properly prescribed diet can have a nonspecific desensitizing effect and help improve a child's condition. During the first 3 days with acute eczema, a strict milk diet is necessary. It prohibits spicy dishes, sweets, eggs, coffee, tea and drinks containing alcohol. Excluded from food (elimination diet) products that are allergens for this child. Nutrition of the child should be built taking into account the revealed diseases of the digestive system and the form of eczema. So, with true eczema, lipostasis is increased in children and protein deficiency is expressed, and with seborrheic form of eczema lipolysis and disproteinemia are noted. Therefore, children of group I are recommended a diet with a high content of animal and vegetable fat and an increase in protein by 10-12%, and children of the second group increase the consumption of vegetable fat. The amount of carbohydrates consumed is compensated by hypoallergic fruits and vegetables. In the nutrition of children it is necessary to administer xylitol, due to which the consumption of sugar decreases and the expressed cholecystokinetic effect is manifested.

Principles of general treatment of eczema in children

1. Stages and continuity of treatment (hospital - polyclinic - sanatorium).
2. Complexity and individual approach when constructing treatment regimens.
3. Obligatory sanation of foci of chronic infection in the ENT organs (tonsillitis, sinusitis, otitis), digestive organs (chronic pancreatitis, intestinal dysbacteriosis), bronchopulmonary system, urinary organs.
4. Antibiotics should be administered with caution and only in a hospital setting according to strict indications.
5. Detoxification therapy, elimination of allergens is carried out in parallel with the sanation of foci of infection, mainly in children with disseminated dissemination of eczema.
6. Deworming is justified in the presence of signs of eczema.
7. Nonspecific hypensensitivity of the body, the appointment of antihistamines II-IV classes, etc. Are shown.

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 ointment, "Elokom" or "Apulein" - cream, ointment) are applied to limited areas of skin lesions for no more than 10 days.
4. Strict adherence to the procedure for the use of an external therapeutic agent (lotion, bandage, etc.).

Prevention of pediatric eczema

Primary prophylaxis of eczema in children:

• healthy lifestyle of spouses;
• observance of house hygiene;
• training the child's life;
• antenatal prophylaxis of allergic dermatoses: (recommendations on the diet of the future mother, medical care for toxicoses);
• obstetric-pediatric advice (courses). Secondary prevention:
• early identification of children in the "risk" group;
• complete their medical examination;
• comprehensive counseling and therapy;
• rational external therapy.