Treatment of atopic dermatitis

Complex treatment of atopic dermatitis includes the following activities: hypoallergenic diet (especially in children); drug treatment; physiotherapy and spa treatment; preventive measures.

Hypoallergenic diet with atopic dermatitis includes the following basic principles:

• restriction or complete exclusion of food products with high sensitizing activity (eggs, fish, nuts, caviar, honey, chocolate, coffee, cocoa, alcoholic beverages, canned food, smoked meats, mustard, mayonnaise, spices, horseradish, radish, radish, eggplant, mushrooms, berries, fruits, vegetables, having orange and red color: strawberries, strawberries, raspberries, peaches, apricots, citrus fruits, pineapple, carrots, tomatoes);
• complete elimination of causative food allergens;
• maintenance of physiological needs of the patient in basic food substances and energy due to adequate replacement of excluded products;
• for inclusion in the hypoallergenic diet are recommended: berries and fruits of light color, dairy products; cereals (rice, buckwheat, oatmeal, pearl barley); meat (beef, low-fat pork and lamb, rabbit, turkey, horse meat); vegetable oils and melted cream; rye bread, wheat of the second grade; sugar - fructose, xylitol. Food, steamed or boiled, potatoes and cereals are soaked in cold water for 12-18 hours, the meat is cooked twice.

Such a diet is prescribed in acute and subacute periods of the disease for a period of 1.5-2 months, then it is gradually expanded by the introduction of previously eliminated products. In the absence of positive dynamics from the diet used for 10 days, the diet should be reviewed.

Given the pathogenesis of atopic dermatitis, therapy should be aimed at the rapid achievement of persistent and long-term remission, restoring the structure and function of the skin, preventing the development of severe forms of the disease with minimal side effects from the drugs used. Currently, there are many methods and different drugs for the treatment of atopic dermatitis. An important place is diet therapy. In connection with pronounced dysfunction from the gastrointestinal tract, timely and adequately prescribed diet therapy in most cases contributes to the remission of the disease or even complete recovery. Elimination diet is based on the reliably proven sensitizing role of these or other products in the development of exacerbations of atopic dermatitis and their exclusion. From the diet of patients suffering from atopic dermatitis, products containing food additives (dyes, preservatives, emulsifiers), as well as strong meat broths, fried dishes, spices, spicy, salted, smoked, canned foods, liver, fish, caviar, eggs , cheeses, coffee, honey, chocolate and citrus fruits. In the diet should include sour-milk products, porridge (oatmeal, buckwheat, pearl barley), boiled vegetables and meat. The developed diets should be optimal for the content of proteins and vitamins and are made with the close cooperation of an allergist and nutritionist.

From medicamental methods of treatment distinguish general, pathogenetic and local therapy. The general (traditional) treatment is carried out with easy flow and limited form of atopic dermatitis and consists in the appointment of hyposensitizing (30% sodium thiosulfate), antihistamines (tavegil, fenistil, apalergin, diazolin, loratal, claritin, etc.), vitamin (A, C, group B, nicotinic acid), enzymes (festal, hilak-forte, mezim-forte) preparations, biostimulants, immunomodulators (before determining the state of the immunity system), antioxidants, membrane stabilizers (ketotifep, cromoglycate sodium) redstv correction comorbidities and external agents (glucocorticoid creams, ointments or lotions). The effectiveness of antipruritic therapy is enhanced by the combined use of fenistil (in the morning - 1 capsule or drops depending on the age) and Tavegil (in the evening -1 tablet or 2 ml intramuscularly). For the correction of vegetative dysfunctions and psychological disorders, use weak antipsychotics in small doses or antidepressants (depress, sanapax, chloroprotein, ludolyl, etc.).

Pathogenetic treatment

Assign this type of treatment, when there is a weak effect or lack of effect from general therapy and in severe disease. Simultaneously with pathogenetic therapy, it is expedient to conduct conventional therapy. Pathogenetic methods of therapy include phototherapy (selective phototherapy, PUVA-therapy), cyclosporin A (sandimmupperal) and glucocorticosteroids. It is impossible to imagine the treatment of atopic dermatitis without the use of external means, and in a number of cases (light flow or limited form), they acquire a paramount importance.

Local Therapy

Local corticosteroids are the basis of therapy for atopic dermatitis, as they have anti-inflammatory, aptyproliferative and immunosuppressive properties. The action of local corticosteroids can be explained by the following mechanisms: inhibition of phospholipase A activity, leading to a decrease in the production of prostaglandins, leukotrienes; decrease in the release of biologically active substances (histamine, etc.) and interleukins; inhibition of DNA synthesis in Langerhans cells, macrophages and keratinocytes; inhibition of the synthesis of connective tissue components (collagen, elastin, etc.); suppression of the activity of lysosomal proteolytic enzymes. They quickly remove the inflammatory process and cause a fairly good clinical effect. It should be taken into account that with prolonged use of corticosteroids, viral, bacterial and fungal lesions most often occur, atrophy, skin telangiectasia, hypertrichosis, hyperpigmentation, acne, and rosaceous eruptions. As an analgesic, Fenistil-gel has a good effect. With a prolonged course of atopic dermatitis, it is advisable to replace corticosteroids with fenistil-gel from time to time, thus avoiding the side effects of corticosteroids. Multiplicity of admission is 2-4 times a day.

For most patients with atopic dermatitis, topical treatment is the main treatment. A successful outcome depends on many factors - the patient's motivation, the degree to which he understands the method of treatment and his limitations, the pragmatic approach of the doctor in terms of his confidence in the patient's acceptability and the therapeutic effectiveness of the treatment he is given. However, for many patients the treatment of their disease remains unsatisfactory, since effective control of the disease requires repeated use of various drugs on different sites of the body for long periods of time. The latest development of topically active non-steroid immunomodulators, such as pimecrolimus and tacrolimus, is potentially a real advance for such patients.

The use of corticosteroids 50 years ago revolutionized the treatment of atopic dermatitis, and for most patients they remain the main therapy. Local side effects, such as skin atrophy and the risk of systemic toxicity, exclude corticosteroids as optimal drugs for the treatment of severe forms of the disease, especially with sensitive skin and in children. However, the biggest barrier to effective treatment is the fear of these side effects on the part of the patients themselves.

New-generation corticosteroids, such as non-halogenated esters (eg, prednicarbat, methylprednisolone aceponate, mometasone fumarate) have high anti-inflammatory activity with a lower risk of systemic toxicity. After remission has been achieved, patients should be instructed to switch to a weaker drug or to gradually reduce the frequency of the drug.

The main purpose of pimecrolimus (elidea) is long-term maintenance of remission without periodic use of external corticosteroids. The drug is used in the form of 1% cream and is allowed for use in children from 3 months of age. Indications for the appointment eledela is the average and mild degree of atopic dermatitis. A necessary condition for effective treatment with "Elidel" cream is its combined use with moisturizing and emollients. Elidel cream can be applied to all affected areas of the skin, including the skin of the face, neck, and genitals, even in young children, provided that the skin is intact. The effect of drug therapy is noted from the end of the first week of treatment and persists for one year. The cream "Elidel" is not used to treat patients with severe forms of atopic dermatitis and with severe exacerbation of the disease.

Atopic dermatitis, numerous inflammatory mediators have been identified, so substances that can block any one of the mediators are unlikely to bring clinical benefit. However, some of the antagonists have a value in atopic inflammation (in particular, with asthma), which assumes the dominant role of certain mediator mechanisms.

Doxepin, a tricyclic antidepressant with a potent ability to block the H1, H2 receptors and the muscarinic receptor, has recently been licensed as a topical therapy for controlling itching associated with atopic dermatitis.

Macrolide immunosuppressants have macrolide-like structure and possess powerful immunomodulatory activity both in vivo and in vitro. Cyclosporine is perhaps the most well-known of the substances in this group, and is extremely active in systemic application. However, some new drugs belonging to this class demonstrate topical activity and are the subject of intense research interest. The cream of "Elidel" (pimecrolimus) and "Protopik" ointment (tacrolimus) reached the most advanced stages in terms of development for clinical use.

Pimecrolimus (cream "Elidel") is designed specifically for use as an anti-inflammatory external drug for the treatment of patients with atopic dermatitis. Pimecrolimus belongs to the group of macrolactam antibiotics and is a derivative of ascomycin. The drug has a high lipophilicity, due to which it is distributed mainly in the skin and practically does not penetrate through it into the systemic bloodstream. The drug selectively blocks the synthesis and release of anti-inflammatory cytokines, resulting in no activation of T cells and mast cells needed to "start" and maintain inflammation. In connection with the selective action of pimecrolimus on the synthesis of pro-inflammatory cytokines by T lymphocytes and the release of inflammatory mediators of mast cells, without inhibition of the synthesis of elastic and collagen fibers, its use excludes the development of atrophy, telangiectasia, hypertrichosis of the skin. Based on these features of the drug, it can be used for a long time without the risk of local side effects.

Tacrolimus ("Protopic" ointment) is a macrolide compound 822-Da, originally obtained from the fermentation fluid Streptomyces tsukubaensis. The latter was extracted from the soil sample in Tsukuba (Japan), hence the acronym T in the name of the drug, "acrole" from the term "macrolide" and "imus" from the term "immunosuppressant". Tacrolimus produces a variety of actions on various types of cells that are potentially significant for its therapeutic efficacy in atopic dermatitis.

Essential oils of menthol (peppermint leaves) and camphor (camphor tree) show their antipruritic effect, stimulating skin sensory receptors. Many patients report a pleasant cooling effect. Menthol (0.1-1.0%) and camphor (0.1-3.0%) for local therapy are manufactured synthetically. For children, treatment with these drugs is not indicated because of the possible toxic and irritating effects.

Capsaicin - a substance obtained from pepper pods, is used for local therapy (0.025-0.075%) of painful and itchy dermatoses. Initially, it causes burning as a result of the release of neuropeptides from peripheral slow-conducting C-fibers. With the continuation of the application, depletion of neuropeptides begins, which explains the antipruritic and analgesic effects.

Fundamental research in immunology made it possible to better understand the immunopathogenesis of atopic dermatitis, as a result of which alongside with drugs that have a systemic effect, drugs (elidel and protopic) with local immunomodulatory properties appeared. Elidel - a non-steroidal drug is an inhibitor of calcipurin and has a selective effect on T-lymphocytes. As a result, the secretion of interleukins and other inflammatory cytokines is suppressed. The tactics of applying 1% cream Elide is to apply to children with atopic dermatitis of mild and moderate severity and together with corticosteroids - at a severe degree 2 times a day.

Systemic treatment of atopic dermatitis

Of course, for a torpid disease, especially common dermatitis, systemic therapy is most appropriate. The main problem of the therapeutic dilemma is the insufficient effectiveness of safe drugs and a large number of side effects in effective drugs used in the systemic therapy of atopic dermatitis. There remains a choice between the use and the possible risk.

Ciclosporin (sandimmun-neoral) is the most studied of the drugs used for systemic treatment of severe forms of atopic dermatitis. The usual initial dose is 5 / mg / kg / day. The first therapeutic results are visible for a period of several days to a week. After two weeks, you can begin to reduce the dose by 100 mg every second week. You can switch to taking the drug every other day if the initial daily dose was 300 mg / kg / day; the desired goal is the end of treatment in 3-6 months. With a decrease in the dose of cyclosporine, stabilizing therapy should be started, combining the use of ultraviolet irradiation A and B. Thus, a return to local therapy is provided, as well as prevention of possible exacerbation of skin inflammation. The primary side effects of cyclosporine are nephrotoxicity and hypertension, so monitoring of these parameters should be performed before treatment, 2 weeks, 1 month and then every month during treatment. Long-term studies have shown that with careful selection of patients and control, cyclosporine is a safe and effective systemic therapy for severe torpid atopic dermatitis. Since the starting dose of treatment can be selected, preferably starting with an effective dosage in the hope of reducing the overall duration of treatment. Some doctors suggest a low initial dosage of 2-3 mg / kg / day, especially in pediatrics, where there are cases of nausea at higher doses. In adults, on the contrary, a higher dose of 7 mg / kg / day is needed to obtain remission, especially in severe cases.

The systemic drug tacrolimus for oral administration has proven effective in psoriasis, but its use in atopic dermatitis has not been formally studied. In doses of 1-4 mg / day, the drug has a safety profile and side effects, similar to that of cyclosporine, with which it can be interchanged. This should be particularly taken into account for patients who respond inappropriately to cyclosporine.

Now a new drug is being developed for systemic use with atopic dermatitis - pimecrolimus. To date, the local dosage form of this drug has been studied, but a recent study with psoriasis has shown that this drug can be effective in oral administration with a safer side effect profile than cyclosporine and tacrolimus. It is expected that this form of the drug will be effective in atopic dermatitis.

Azathioprine is often used in severe dermatological diseases as an immunosuppressive agent. The therapeutic dose for atopic dermatitis is 2-2.5 mg / kg / day, and patients should be aware that before the action of the drug can take 6 weeks. Azathioprine is well tolerated, only sometimes it is reported nausea and vomiting. Regular laboratory monitoring is carried out in the first month of treatment every two weeks, and then every month for the entire duration of therapy. Research should include a complete blood test, liver and kidney function tests, and urinalysis. Duration of therapy, dosage reduction schemes and the need for stabilizing therapy in the phase of drug doses reduction are the same as in the treatment with cyclosporine and methotrexate.

Systemic corticosteroids, including intramuscular injections of triamycinolone acetonide, are very effective in controlling the symptoms of atopic dermatitis. The rapid response, good tolerability for short-term use and a relatively low cost make prednisolone treatment equally attractive for both exhausted patients and clinicians. However, the documented side effects of prolonged therapy with steroids (eg, osteoporosis, cataracts) limit their use in chronic diseases, including atopic dermatitis. Once or twice a year, for 6-8 days, respectively, prednisolone can be used to prevent severe attacks, and steroid dependence and pressure from patients to repeat prednisolone therapy are ubiquitous. However, the ricochet effect and decreased efficacy make re-treatment with corticosteroids unattractive.

The experience of many authors shows that it is possible to interrupt the vicious circle from pruritus to combs in atopic dermatitis with the help of sedative antihistamines. Anti-inflammatory active non-sedating antihistamines of a new generation (for atopic dermatitis, loratidine, cetirizine-amertyl, and parathirin are shown), in addition to the H1-antihistamine effect, itching is reduced in one of the subgroups of patients with atopic dermatitis.

Patients with atopic dermatitis often have a superficial staphylococcal infection, which, in turn, can exacerbate dermatitis. Systemic administration of antibiotics is basic in the treatment of such patients. Staphylococcal cultures are invariably resistant to penicillin and usually to erythromycin, leaving us cyclosporine and dicloxacillin as the drug of choice in doses of 250 mg 4 times a day for adults and 125 mg twice daily (25-50 mg / kg body weight per day, divided by two admission) for younger children. As a rule, pustules are resolved quickly, and patients are rarely required to take the drug for more than 5 days. If patients of the infection recur, it is better to have another 5-day course of treatment to prevent exacerbations of the disease. Some patients have multiple or continuous relapses, for a reliable treatment of these, a course of tetracycline is needed for a month to prevent the development of resistance to cephalosporins (patients must be over 12 years old).

Phototherapy

Phototherapy with UV light is generally performed as an exercise supplementing the treatment of atopic dermatitis, as well as for stabilizing the skin at the end of other therapeutic measures when the disease leaves the acute stage. Distinguish therapy selective UV-B-spectrum (SUF), a combination of UV-B with UV-A, PUVA and the newest monotherapy "highly-dosed" UV-A.

The disadvantage of phototherapy is the increased drying of the atopic skin and an increased risk of cancer. The mechanism of action of phototherapy on atopic dermatitis has not been sufficiently investigated. It is known that UV-B light leads to inhibition of cell-mediated immune responses, in particular, by quantitatively decreasing or decreasing the activity of Langerhans cells. New research methods also indicate that UV-B clearly inhibits the expression of ICAM-1 on human keratinocytes and can thereby lead to suppression of the inflammatory reaction in the skin. Perhaps, a role is also played by the antimicrobial effect. Precise data on the specific effects of PUVA and UV-A-irradiation alone on atopic dermatitis are not yet available. It is believed that, as an operating mechanism, there is a particular effect of UV-A radiation on IgE-carrying Langerhans cells. Before starting treatment, photosensitizing medication should be avoided. A preliminary medical examination is recommended. Children of preschool age are less suitable for phototherapy, because taking into account their mobility, it is difficult to accurately determine the radiation dose. Patients with skin type I already react with severe long erythema at small UV doses, so that therapeutically effective doses hardly can be applied. Contraindicated in the use of UV with simultaneous light-induced dermatoses.

Selective phototherapy UV-B

Selective UV-B-phototherapy (SSF). The initial dose of SUF-radiation (preferably 290-320 nm) should correspond to the individual dose for minimal erythema (EDR) in the range of UVB. During the 2nd session, the EDR increases by 50%, the third - by 40% and the subsequent - by 30%. You should strive for at least 3, and preferably 5 sessions a week. In case of undesirable appearance of too strong erythema, treatment should be interrupted and, if necessary, topical corticosteroids should be applied. After attenuation of erythema, irradiation should continue at a dose of 50% of the previous irradiation. With a multi-day interruption of therapy, treatment is also continued at a dose that is half that prescribed before discontinuation of therapy. Side effects are the possibility of solar dermatitis, as well as the risk of developing epithelial or melanocytic neoplasia. When irradiation is recommended to cover the face and the genital area. Recently, with severe atopic dermatitis, lamps with a narrow UV-B spectrum (312 + 2 nm) are recommended, but there is not enough experience with such lamps yet.

Combination of UV-B and UV-A-irradiation (UV-AV therapy)

The latest studies suggest that the combination of UV-B (300 + 5 nm) with UV-A (350 + 30 nm) has a better effect in atopic dermatitis than only one UV-A or X-ray irradiation. The therapeutic effect with this combination also appears to be more prolonged. However, this treatment option is not used as a monotherapy, but only as a concomitant measure with topical application of corticosteroids. Simultaneous irradiation of the patient is carried out by two different light sources in the same cabin. To start the treatment, the EDR is again determined and at 80% of the DER the first irradiation is started. The initial UVA dose should be about 3 J / cm ², and the initial dose of UV-B should be 0.02 J / cm ². The continuation of the irradiation is carried out by analogy with irradiation with SFR. The increase in dosage for both types of irradiation corresponds to the initial dose and should be at a maximum dosage of 6 J / cm ² for UV-A and 0.18 J / cm ² for SUF. Side effects and contraindications are the same as for SUF therapy.

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

Irradiation with high doses of UV-A1

Here we are talking about a new variant, the so-called UV-A, that is, UV-A-irradiation in the long-wave range of 340-440 nm at high doses up to 140 J / cm ² per session. This requires special light sources. The duration of irradiation is 30 minutes. It is reported that after 6-9 sessions it is possible to count on an obvious therapeutic effect (an improvement of up to 50%), and therefore this kind of irradiation can in some cases be successfully used as a monotherapy. Due to high doses of UV-A, the long-term side effects of which have not yet been fully studied, it is considered necessary to perform this procedure only in the acute period of severe generalized atopic dermatitis. Their use as an experimental therapy is currently limited to several European university centers. This method is used as an acute interventional measure for a short time. A more accurate study for a longer period of time remains to be done. The mechanism of action is unknown, it is assumed that the inflammatory reactions, including gamma interferon, decrease as a result of the light effect.

PUVA-therapy

Therapy PUVA is indicated only with exacerbation of atopic dermatitis, in which there are contraindications to the use of corticosteroids. However, the response to therapy is quite good, but applying PUVA to achieve a stable result requires a total of twice as many sessions as, for example, with psoriasis. In one recent study, the average cumulative dose of UV-A in 118 J / cm ^{2 was} indicated , and the average number of required sessions was 59. Rapid withdrawal is often associated with a "rebound" phenomenon or a suppression reaction after excitation. Applying PUVA in adolescents and young people should occur only on strict indications and after appropriate preliminary examinations. It is in young patients with atopy that this kind of treatment should be treated very cautiously because of its still unknown long-term effects. For women who want to have children and pregnant women, as well as people with liver and kidney disease, PUVA therapy is contraindicated.

Acupuncture (acupuncture)

Given the complexity of pathogenesis and the variety of clinical manifestations of atopic dermatitis, it is recommended to make a recipe for points taking into account their general effect and localization of rashes on the skin. Treatment begins with points of general action, then local points of the localization of the process and the auricular points are included. In the presence of concomitant diseases, symptomatic points are used. In the acute stage of the skin process, the first variant of the inhibitory method is used, in the subacute and chronic stage - the II variant of the inhibitory method. During the procedure, combinations and combinations of points are used individually for each patient, taking into account the characteristics of skin lesions, the severity of the itching, the presence of concomitant diseases. Procedures are conducted daily, 10-12 procedures per course. A week later, a repeated course of treatment consisting of 6-8 procedures, conducted every other day, is prescribed. In periods of the most likely exacerbations or relapses, auricular therapy is performed.

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

Inductothermy on the adrenal gland

It is prescribed for atopic dermatitis with a decrease in the functionality of the adrenal cortex activity. A high-frequency inductothermy is used by the resonant inductor (EVT-1) from the UHF-30 apparatus. The inductor is located on the side of the back at the level of T10-T12, the dose is low-heat, the duration is 5-10 minutes, the first 5 procedures daily, then every other day, for a course of 8-10 procedures. The effect on the adrenal gland is carried out by induction of the microwave (CMV and DMV) induction from Luch-3 and Camomile devices, for a course of 10-15 procedures every other day.

Magnetotherapy with alternating or permanent magnetic field

The alternating magnetic field from the apparatus "Pole" is recommended in acute and subacute periods of atopic dermatitis with the aim of influencing the central and autonomic nervous system, the tissue trophic. The effect is carried out segmentally on the collar, lumbar region and locally on the lesions of the skin. Inductors with a straight core are used, the mode is continuous, the current form is sinusoidal. The intensity of the alternating magnetic field is from 8.75 to 25 mT, the duration is 12-20 minutes, for a course of 10-20 procedures, daily.

Central electroanalgesia (CEAN)

Electrotherapy and electrotranslating by percutaneous electrostimulation with pulse currents. The method is used in patients with atopic dermatitis with neurosis-like conditions. Central electroanalgesia achieves a change in the polarization and electrically conductive properties of tissues, which creates favorable conditions for the normalizing effect on the central nervous system. Impulse action is performed at the frontal-neck position of electrodes of the LENAR apparatus with a frequency from 800 to 1000 Hz, pulse duration from 0.1 to 0.5 ms and an average current value of 0.6 to 1.5 mA. The duration of the procedure is limited to 40 minutes, the course of treatment is 10-15 daily procedures.

[13]

Low-energy laser radiation

Treatment with low-intensity laser irradiation is carried out with the help of the apparatus "Pattern": a pulse mode of 2 W, a pulse frequency of 3000 Hz, a wavelength of 0.89 μm. The course of treatment is 12-15 procedures daily.

Therapeutic starvation (unloading-dietary therapy)

The method is indicated for patients with overweight, resistance to other types of therapy, as well as with the concomitant pathology of the gastrointestinal tract. Unloading and dietary therapy (the technique of Yu. S. Nikolaev) continues for 28-30 days. The unloading period lasts 14-15 days, during which, with complete abstinence from food, patients are prescribed daily enemas, intake of mineral water up to 3 liters per day, daily shower followed by application of softening creams. Restorative period of 14-15 days begins with the reception of fruit juices in the first days, then grated vegetables and fruits with the transition to a special dairy-vegetable diet. In the future, to maintain the achieved effect, patients are recommended a strict hypoallergenic diet. The therapeutic effect of unloading and dietary therapy is provided by the purifying action of the fasting process itself, by washing out circulating immune complexes, allergens, toxins from the body, sanifying its effect on the function of the gastrointestinal tract, and also the ability to maintain a hypoallergenic diet after a fasting process. The method of curative fasting is contraindicated in patients with cardiovascular pathology.

Hyperbaric oxygenation (HBO)

The method is indicated by patients with atopic dermatitis with the phenomena of hypotension, asthenics, as well as with concomitant diseases accompanied by symptoms of anemia. HBO sessions are conducted in a single-chamber OKA-MT pressure chamber. The oxygen pressure is 1.5 atm, the duration of the session is 40 minutes, usually 10 sessions are prescribed for the course of treatment. The therapeutic effect of the method is associated with activation of the enzyme link of antioxidant systems, increased partial pressure of oxygen in the affected tissues, in particular in the skin, and improvement of microcirculation due to increased blood flow velocity, reduction of the degree of erythrocyte aggregation and normalization of the rheological properties of the blood.

Plasmapheresis

The method of extracorporeal detoxification in the form of plasmapheresis is prescribed to patients with torpid current, erythrodermic variant of the disease, and also with drug intolerance. In conditions of a surgical procedure of the ulnar vein, the blood is exfused into plastic containers and centrifuged at 3000 rpm for 10 minutes at a temperature of +22 ° C. Plasma is removed, and the shaped elements are reinfused to the patient in plasma-mozameschayuschih solutions. The volume of the removed plasma is from 300 to 800 ml, which is compensated by the same or slightly larger volume of plasma substitutes. Procedures are usually 1 time in 2-3 days, up to 8-12 per course; with especially severe forms - daily. With plasmapheresis, the body is released from pathological metabolites, circulating immune complexes, its receptors are cleared, sensitivity to various medical, including medicamental influences raises.

To treat patients with atopic dermatitis, other methods of physiotherapy are also used: puncture physiotherapy (phonopuncture, laser puncture); millimeter wave therapy (EHF-therapy); ultrasound therapy (ultrasound paravertebral and ultrasound on the lesion - ultraphonophoresis); endonated electrophoresis of antihistamines; diadynamic therapy of cervical sympathetic nodes.

Thus, severe, widespread atopic dermatitis, not responding to local therapy, requires systemic therapy. Inflammation and itching in most cases can be clearly improved by using the described substances, while maintaining a balance between its seizure, recurrent and chronic course of the disease, and the toxicity of the substances used. The available systemic therapies can alleviate persistent itching and must be universally applied in the presence of a pronounced and torpid course of the disease. Well-designed use of additional "stabilizing" therapies - for example, UFA / B or aggressive local therapies - can facilitate a return to the use of only topical therapy and prevent a second exacerbation of inflammation.

Sanatorium and spa treatment for atopic dermatitis

Sanatorium treatment provides for the stay in local sanatoriums of the usual climate and in resorts with a sea climate (Evpatoria, Anapa, Sochi, Yalta). Climatotherapy in the warm season is carried out in the form of air, sun baths and sea bathing. The resorts allow the use of hydrogen sulphide, rhodonoids, sea baths, mud treatment. Treatment with mineral waters is prescribed with concomitant diseases of the gastrointestinal tract and liver.