Symptoms of atopic dermatitis in children

Atopic dermatitis in children is an urgent problem of modern medicine, affecting the interests of various medical specialties: pediatrics, dermatology, immunology, allergology, therapy, etc. This is due to the fact that, beginning in early childhood, the disease acquires a chronic course and retains its clinical signs often throughout life, leading to disability and social disadaptation of patients. In 40-50% of children suffering from atopic dermatitis, subsequently develops bronchial asthma, pollinosis, allergic rhinitis ("march atopy").

The term "atopic dermatitis", as a rule, emphasizes the immunological (allergic) concept of the pathogenesis of the disease, based on the concept of atopy as a genetically determined ability of the body to produce a high concentration of total IgE and specific IgE in response to the action of environmental allergens. However, as is known, not only specific (immune), but also nonspecific (non-immune) mechanisms are involved in the development of the disease.

In clinical practice, the term "atopic dermatitis" is often replaced by others, this creates a certain confusion and leads to the fact that patients do not receive timely and adequate medical care. So far, there have been a large number of notations for atopic dermatitis: exudative diathesis, exudative catarrhal diathesis, atopic eczema, endogenous eczema, childhood eczema, diffuse neurodermatitis, etc. However, a growing number of researchers and doctors around the world adhere to the term "atopic dermatitis", proposed in 1935 by L. Hill and M. Sulzberger, since it meets the general principles of the isolation of atopic disease (described the disease as an independent nosological form of E. Beni in 1882).

In the International Classification of Diseases of the 10th revision (ICD-10, 1992), in subheading 691, the following chronic forms of allergic skin damage are attributed to atopic dermatitis: atopic eczema, atopic neurodermatitis and diffuse neurodermatitis (scrapie Bénier). It should be emphasized that atopic eczema and atopic neurodermatitis are forms and stages of development of a single pathological process.

Usually the manifestation of atopic dermatitis in children occurs in the first year of life. Atopic dermatitis in children undergoes three stages in its development, which can be separated by periods of remission or directly transferred into each other.

[1], [2], [3], [4], [5], [6], [7]

Symptoms of atopic dermatitis in children in childhood

Symptoms of atopic dermatitis in children are formed at the age of 2 to 13 years. This form of the disease can follow the infant stage without interruption and continues usually until adolescence. In this case, the skin is less pronounced exudative foci, characteristic of the infant stage, there is a significant hyperemia, pronounced dryness and underlined pattern, thickening of folds and hyperkeratosis, folded nature of lesions. The presence of these elements is defined as erythematosquamous form of atopic dermatitis with lichenization. Later on, the surface of the skin is dominated by lichenoid papules and foci of lichenization with typical localization in the folds of the skin. Eruptions are localized most often in the elbow, popliteal, gluteal folds, on the skin of the flexural surfaces of the elbow and wrist joints, the back surface of the neck, hands and feet. In this case, there are rashes in the form of lichenoid papules, copious exfoliation, multiple scratching and skin cracks - these manifestations are defined as a lichenoid form of atopic dermatitis.

For this stage of atopic dermatitis, the symptoms of atopic dermatitis in children, defined as an "atopic face", manifested by hyperpigmentation of the eyelids with accentuated folds, peeling of the eyelid skin and combing of the eyebrows. These patients are characterized by a very characteristic persistent and painful itching of the skin, especially pronounced at night.

Infant stage of atopic dermatitis in children

It is formed in children from the newborn period to two years and is characterized by acute inflammation of the skin with eruptions in the form of papules and microvesicles with pronounced exudation and mocclusion (exudative form). Symptoms of atopic dermatitis in children are expressed in rashes, which are localized mainly on the face, less often - on the lower leg and thighs. At the same time, against the background of hyperemia and exudation, infiltration and edema of individual skin areas, microvesicles with serous contents, a lumpy cover, are rapidly revealed, with the formation of "eczematous wells". Exematous papules and microvesicles are a manifestation of an acute inflammatory process and represent limitless formations in the form of small nodules (up to 1 mm) slightly elevating above the skin, rounded, soft consistency, usually solitary, sometimes grouped and rapidly evolving. In addition, marked itching and burning of the skin, soreness and a feeling of tension. A sick child combs the skin, which causes the foci to become covered with serous-bloody crusts, and when the secondary infection is attached, serous-bloody-purulent crusts. Skin lesions are located symmetrically.

With a limited prevalence of the process, similar rashes are localized more often on the face in the cheeks, forehead and chin area except for the nasolabial triangle and symmetrically on the hands.

With a common, disseminated form of atopic dermatitis, there is a lesion of the skin of the trunk, extremities (mainly their extensor surfaces).

For 30% of patients, atopic dermatitis is characterized by hyperemia, infiltration and light peeling of the skin without exudation, which are manifestations of the erythematosquamous form of the disease. Erythematous spots and papules in typical cases first appear on the cheeks, forehead and scalp and are accompanied by itching. Usually erythema intensifies in the evening and is almost not detected in the morning.

Teenage stage of atopic dermatitis in children

Symptoms of atopic dermatitis in children are observed over the age of 13 years and are characterized by pronounced lichenization, dryness and desquamation, primary lesions of the facial skin and upper body and continuously recurrent course. This stage begins during puberty and often continues into adulthood. The defeat of flexion surfaces in the area of natural folds predominates, the face and neck, shoulders and backs, the back surface of the hands, feet, fingers and toes. The rashes are presented by dry scaly erythematous papules and plaques with the formation of large lichen-plaques with chronic foci of skin lesions. Significantly more often than in the previous age group, there are lesions of the face and upper body.

Adolescents and adults can have a pruriginous form of atopic dermatitis, which is characterized by severe itching and multiple follicular papules of dense consistency, a spherical shape with numerous scattered excoriations on the surface. These rashes are combined with pronounced lichenization with a typical localization for this age on the flexor surfaces of the limbs.

The prevalence of the inflammatory process on the skin distinguishes the following symptoms of atopic dermatitis in children:

• limited atopic dermatitis (localization predominantly on the face, skin lesion area not more than 5-10%);
• common atopic dermatitis (lesion area 10-50%);
• diffuse atopic dermatitis (extensive skin damage - more than 50%).

In stages of atopic dermatitis, there are:

• acute stage (itching of the skin, papules, microvesicles against the background of erythema, multiple calculi and erosion, allocation of serous exudate);
• subacute stage (erythema, scaling, calculus, including on the background of skin tightening);
• chronic stage (thickened plaques, fibrous papules, underlined skin pattern - lichenization).

Assessment of the severity of clinical symptoms of atopic dermatitis in children

Assessment of the severity of atopic dermatitis in severity of clinical manifestations

	Light current	Medium-heavy current	Heavy Current
Severity of inflammatory changes on the skin	Limited areas of skin lesions, weak erythema or lichenization, mild skin itching, rare exacerbations - 1-2 times a year	The widespread nature of skin lesions with moderate exudation, hyperemia and / or lichenization, mild itching, more frequent exacerbations - 3-4 times a year with short remissions	Diffuse nature of skin lesions with pronounced exudation, flushing and / or lichenization, persistent severe itching and almost continuous recurrent course
Itching of the skin	Weak	Moderate or strong	Strong, bipulsing, permanent
Enlargement of lymph nodes	To the size of a "pea"	To the size of "hazelnut"	To the size of beans or an increase in all groups of lymph nodes to the size of "hazelnut"
Frequency of exacerbations	1-2 times a year	3-4 times a year	5 or more times a year
The duration of remission periods	6-8 months	2-3 months	1-1,5 months
Characteristics of remission periods	Symptoms of the disease are absent	Incomplete clinical and laboratory remission	Presence of persistent infiltration, lichenification, incomplete clinical and laboratory remission
Eosinophilia	5-7%	7-10%	More than 10%
The level of total IgE, IU / l	150% 0	250-500	More than 500

There are several scales for assessing the severity of the clinical symptoms of atopic dermatitis in children: scores SCORAD (Scoring Atopic Dermatitis), EASY (Eczema Area and Severity Index), S ASS AD (Six Area Six Sign Atopic Dermatitis Severity Score). Despite the fact that none of the scales given have received wide distribution in our country, we give a detailed description of the SCORAD scale, since it is used by specialists to evaluate the effectiveness of treatment and the dynamics of clinical manifestations of atopic dermatitis.

[8], [9], [10], [11], [12], [13], [14], [15]

Parameter A

The prevalence of the skin process is the area of the affected skin (%), which is calculated according to the rule of the "nine". For evaluation, you can also use the rule of "palm" (the area of the palmar surface of the hand is taken equal to 1% of the entire surface of the skin.

Parameter B

To determine the intensity of clinical symptoms of atopic dermatitis in children, the expression of 6 signs (erythema, edema / papules, crust / mocculation, excoriation, lichenification, dry skin) is counted. Each attribute is evaluated from 0 to 3 points (0 - absent, 1 - weakly expressed, 2 - moderately expressed, 3 - pronounced sharply, fractional values are not allowed). Evaluation of the symptoms is carried out on the skin area where they are most pronounced. The total score can be from 0 (skin lesions absent) to 18 (the maximum intensity of all 6 symptoms). The same patch of skin can be used to assess the severity of any number of symptoms.

Parameter C

Subjective symptoms of atopic dermatitis in children (itchy skin and sleep disorders) are assessed only in children over 7 years of age. The patient or his parents are asked to indicate a point within the 10-centimeter line, corresponding, in their opinion, the degree of pruritus and sleep disorders averaged over the last 3 days. The sum of subjective symptoms scores can range from 0 to 20.

The overall estimate is calculated by the formula A / 5 + 7B / 2 + C.

The total score on the SCORAD scale can be from 0 (no clinical symptoms of atopic dermatitis in children with skin lesions) to 103 (the most pronounced manifestations of atopic dermatitis).