Treatment of atopic dermatitis

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

The hypoallergenic diet for atopic dermatitis includes the following basic principles:

• limitation or complete exclusion from the diet of foods that have high sensitizing activity (eggs, fish, nuts, caviar, honey, chocolate, coffee, cocoa, alcoholic beverages, canned goods, smoked meats, mustard, mayonnaise, spices, horseradish, radish, horseradish, eggplant, mushrooms; berries, fruits, vegetables that have orange and red color: strawberries, strawberries, raspberries, peaches, apricots, citrus fruits, pineapple, carrots, tomatoes);
• complete elimination of cause-dependent food allergens;
• ensuring the patient’s physiological needs for essential nutrients and energy through adequate replacement of excluded products;
• The following are recommended for inclusion in a hypoallergenic diet: light-colored berries and fruits, fermented milk products; cereals (rice, buckwheat, oatmeal, pearl barley); meat (beef, lean pork and lamb, rabbit, turkey, horse meat); vegetable oils and melted butter; rye bread, second-grade wheat bread; sugars - fructose, xylitol. Food is steamed or boiled, potatoes and cereals are soaked in cold water for 12-18 hours, meat is boiled twice.

This diet is prescribed in the acute and subacute periods of the disease for a period of 1.5-2 months, then it is gradually expanded by introducing previously eliminated products. If there is no positive dynamics from the diet used within 10 days, the diet should be reviewed.

Given the pathogenesis of atopic dermatitis, therapy should be aimed at quickly achieving stable 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 various drugs for the treatment of atopic dermatitis. Diet therapy occupies an important place. Due to severe dysfunction of the gastrointestinal tract, timely and adequately prescribed diet therapy in most cases contributes to remission of the disease or even complete recovery. The elimination diet is based on the reliably proven sensitizing role of certain products in the development of exacerbations of atopic dermatitis and their elimination. The diet of patients suffering from atopic dermatitis excludes products containing food additives (dyes, preservatives, emulsifiers), as well as strong meat broths, fried foods, spices, hot, salty, smoked, canned products, liver, fish, caviar, eggs, cheeses, coffee, honey, chocolate and citrus fruits. The diet should include fermented milk products, cereals (oatmeal, buckwheat, pearl barley), boiled vegetables and meat. The developed diets should be optimal in terms of protein and vitamin content and are compiled in close cooperation with an allergist and a nutritionist.

Among the drug treatment methods, a distinction is made between general, pathogenetic and local therapy. General (traditional) treatment is carried out in mild and limited forms of atopic dermatitis and consists of prescribing hyposensitizing (30% sodium thiosulfate), antihistamines (tavegil, fenistil, apalergin, diazolin, loratal, claritin, etc.), vitamins (A, C, group B, nicotinic acid), enzyme (festal, hilak-forte, mezim-forte) preparations, biostimulants, immunomodulators (having determined the state of the immune system before treatment), antioxidants, membrane stabilizers (ketotifep, sodium cromoglycate), drugs for the correction of concomitant diseases and external agents (glucocorticoid creams, ointments and lotions). The effectiveness of antipruritic therapy is enhanced by the combined use of fenistil (in the morning - 1 capsule or drops depending on age) and tavegil (in the evening - 1 tablet or 2 ml intramuscularly). To correct vegetative dysfunctions and psychological disorders, weak neuroleptics in small doses or antidepressants (depress, sanapax, chlorproteksin, ludiolil, etc.) are used.

Pathogenetic treatment

This type of treatment is prescribed when there is a weak effect or no effect from general therapy and in severe cases of the disease. In this case, it is advisable to conduct conventional treatment simultaneously with pathogenetic therapy. Pathogenetic methods of therapy include phototherapy (selective phototherapy, PUVA therapy), cyclosporine A (sandimupperoral) and glucocorticosteroids. It is impossible to imagine the treatment of atopic dermatitis without the use of external agents, and in some cases (mild course or limited form) they acquire primary importance.

Local therapy

Local corticosteroids are the basis of therapy for atopic dermatitis, as they have anti-inflammatory, antiproliferative and immunosuppressive properties. The action of local corticosteroids can be explained by the following mechanisms: suppression of phospholipase A activity, leading to a decrease in the production of prostaglandins, leukotrienes; decreased 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 relieve 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 infections, atrophy, telangiectasia of the skin, hypertrichosis, hyperpigmentation, acne, roseola rashes most often occur. Fenistil gel has a good effect as an itching reliever. In the case of long-term atopic dermatitis, it is advisable to replace corticosteroids with fenistil gel from time to time, which will help to avoid the side effects of corticosteroids. The frequency of administration is 2-4 times a day.

For most patients with atopic dermatitis, topical therapy is the mainstay of treatment. Successful treatment depends on many factors - patient motivation, the extent to which the patient understands the treatment method and its limitations, and the pragmatic approach of the physician in terms of confidence in the acceptability and therapeutic efficacy of the treatment prescribed. However, for many patients, treatment of their disease remains unsatisfactory because effective disease control requires repeated application of different drugs to different areas of the body over long periods of time. Recent developments in topically active nonsteroidal immunomodulators such as pimecrolimus and tacrolimus represent a potential breakthrough for these patients.

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

Newer generation corticosteroids such as nonhalogenated esters (eg, prednicarbate, methylprednisolone aceponate, mometasone fumarate) have high anti-inflammatory activity with a lower risk of systemic toxicity. Once remission is achieved, patients should be instructed to switch to a weaker drug or to gradually reduce the frequency of drug administration.

The main purpose of pimecrolimus (elidel) is long-term maintenance of remission without periodic use of external corticosteroids. The drug is used in the form of 1% cream and is approved for use in children from 3 months of age. The indication for prescribing elidel is moderate and mild atopic dermatitis. A necessary condition for effective treatment with Elidel cream is its combined use with moisturizing and emollient agents. Elidel cream can be applied to all affected areas of the skin, including the skin of the face, neck, genitals, even in small children, provided that the surface of the skin is intact. The effect of therapy with the drug is noted from the end of the first week of treatment and lasts for one year. Elidel cream is not used to treat patients with severe forms of atopic dermatitis and in severe exacerbations of the disease.

Multiple inflammatory mediators have been identified in atopic dermatitis, so agents that block any one mediator are unlikely to be of clinical benefit. However, some antagonists have value in atopic inflammation (particularly asthma), suggesting a dominant role for certain mediator mechanisms.

Doxepin, a tricyclic antidepressant with potent H1, H2, and muscarinic receptor blocking activity, has recently been licensed as a topical therapy for the control of pruritus associated with atopic dermatitis.

Macrolide immunosuppressants have a macrolide-like structure and exhibit potent immunomodulatory activity both in vivo and in vitro. Cyclosporine is perhaps the best known of this group and is extremely active when administered systemically. However, some newer agents in this class exhibit topical activity and are the subject of intense research interest. Elidel cream (pimecrolimus) and Protopic ointment (tacrolimus) have reached the most advanced stages in terms of development for clinical use.

Pimecrolimus (Elidel cream) is specially designed for use as an anti-inflammatory topical preparation for the treatment of patients with atopic dermatitis. Pimecrolimus belongs to the group of macrolactam antibiotics and is an ascomycin derivative. The drug has 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, as a result of which there is no activation of T-cells and mastocytes, which is necessary for the "start" and maintenance of inflammation. Due to the selective effect of pimecrolimus on the synthesis of pro-inflammatory cytokines by T-lymphocytes and the release of inflammatory mediators by 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 an 822-Da macrolide compound originally isolated from the fermentation fluid of Streptomyces tsukubaensis. The latter was extracted from a soil sample in Tsukuba, Japan, hence the acronym T in the drug name, acrol from macrolide, and imus from immunosuppressant. Tacrolimus has a variety of actions on different cell types that are potentially significant for its therapeutic efficacy in atopic dermatitis.

Essential oils of menthol (peppermint leaves) and camphor (camphor tree) exert their antipruritic action by stimulating cutaneous sensory receptors. Many patients report a pleasant cooling effect. Menthol (0.1-1.0%) and camphor (0.1-3.0%) are synthetically produced for topical therapy. These preparations are not indicated for children due to their 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 due to the release of neuropeptides from peripheral slow-conducting C-fibers. With continued use, depletion of neuropeptides occurs, which explains the antipruritic and analgesic effects.

Fundamental research in immunology has allowed us to better understand the immunopathogenesis of atopic dermatitis, as a result of which, along with drugs that have a systemic effect, drugs (elidel and protopic) have appeared that have a local immunomodulatory property. Elidel is a non-steroidal drug that is an inhibitor of calcipeurin and has a selective effect on T-lymphocytes. As a result, the secretion of interleukins and other proinflammatory cytokines is suppressed. The tactics of using 1% elidel cream consists of applying applications to children with mild to moderate atopic dermatitis and together with corticosteroids - in severe cases, 2 times a day.

Systemic treatment of atopic dermatitis

Of course, for a torpid disease, especially widespread dermatitis, systemic therapy is the most suitable. 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. The choice remains between benefit and possible risk.

Cyclosporine (Sandimmune-Neoral) is the most studied of the drugs used for the systemic treatment of severe forms of atopic dermatitis. The usual initial dose is 5 mg/kg/day. The first therapeutic results are visible within a few days to a week. After two weeks, the dose can be reduced by 100 mg every other week. Switching to taking the drug every other day is possible if the initial daily dose was 300 mg/kg/day; the desired goal is to complete treatment in 3-6 months. When reducing the dose of cyclosporine, stabilizing therapy should be started, combining the use of ultraviolet A and B irradiation. This ensures a return to local therapy, 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 carried out before treatment, after 2 weeks, after a month, and then every month during treatment. Long-term studies have shown that, with careful patient selection and monitoring, cyclosporine is a safe and effective systemic therapy for severe, intractable atopic dermatitis. Because the initial treatment dose can be selected, it is preferable to start with an effective dose in the hope of reducing the overall treatment duration. Some physicians suggest a low initial dose of 2-3 mg/kg/day, especially in pediatrics, where nausea has been reported with higher doses. In contrast, in adults, a higher dose of 7 mg/kg/day is needed to achieve remission, especially in severe cases.

The oral systemic drug tacrolimus has been shown to be effective in psoriasis, but its use in atopic dermatitis has not been formally studied. At doses of 1-4 mg/day, the drug has a safety and side effect profile similar to that of cyclosporine, with which it may be interchangeable. This should be especially taken into account in patients who do not respond adequately to cyclosporine.

A new systemic drug for atopic dermatitis, pimecrolimus, is currently being developed. Until now, the topical formulation of this drug has been studied, but a recent study in psoriasis has shown that this drug may be effective when given orally with a safer side effect profile than cyclosporine and tacrolimus. This formulation is expected to be effective in atopic dermatitis as well.

Azathioprine is often used in severe dermatological diseases as an immunosuppressant. The therapeutic dose for atopic dermatitis is considered to be 2-2.5 mg/kg/day, and patients should be aware that it may take 6 weeks for the drug to take effect. Azathioprine is well tolerated, with occasional reports of nausea and vomiting. Routine laboratory monitoring is performed every two weeks during the first month of treatment and then monthly thereafter. Investigations should include a complete blood count, liver and kidney function tests, and urinalysis. The duration of therapy, dosage reduction regimens, and the need for stabilizing therapy during the tapering phase are the same as for cyclosporine and methotrexate.

Systemic corticosteroids, including intramuscular triamcinolone acetonide injections, are very effective in controlling the symptoms of atopic dermatitis. Rapidity of response, good tolerability in short-term use, and relatively low cost make prednisolone therapy attractive to both harassed patients and clinicians. However, the documented side effects of long-term steroid therapy (eg, osteoporosis, cataracts) limit their use in chronic conditions such as atopic dermatitis. Prednisolone may be used once or twice a year for 6 to 8 days to prevent severe attacks, and steroid dependence and pressure to repeat prednisolone therapy are common. However, rebound effects and loss of efficacy make repeated corticosteroid therapy unattractive.

The experience of many authors shows that it is possible to break the vicious circle from itching to scratching in atopic dermatitis with the help of sedative antihistamines. Anti-inflammatory non-sedative antihistamines of the new generation (loratidine, cetirizine-amertil, parlazin are indicated for atopic dermatitis), in addition to the H1-antihistamine effect, reduce itching in one of the subgroups of patients with atopic dermatitis.

Patients with atopic dermatitis often have superficial staphylococcal infections, which in turn can cause exacerbations of the dermatitis. Systemic antibiotics are the mainstay of treatment for these patients. Staphylococcal isolates are invariably resistant to penicillin and usually to erythromycin, leaving cyclosporine and dicloxacillin as the drugs of choice at doses of 250 mg 4 times daily for adults and 125 mg twice daily (25-50 mg/kg body weight per day, divided into two doses) for younger children. Pustules usually resolve quickly, and patients rarely require more than 5 days of treatment. If patients have recurrent infections, they are best treated with another 5-day course to prevent exacerbations. Some patients have multiple or continuous relapses, and for these to be reliably treated a month's course of tetracycline is necessary to prevent the development of cephalosporin resistance (patients must be over 12 years of age).

Phototherapy

Phototherapy with UV light is generally used as a supplement to the treatment of atopic dermatitis, as well as to stabilize the skin at the end of other therapeutic measures when the disease is no longer in the acute stage. A distinction is made between therapy with selective UV-B spectrum (SUV), combinations of UV-B with UVA, PUVA and the latest monotherapy with “high-dose” UVA.

A disadvantage of phototherapy is increased drying of the skin of atopic patients and an increased risk of cancer. The mechanism of action of phototherapy on atopic dermatitis has not yet been sufficiently studied. It is known that UV-B light leads to inhibition of cell-mediated immune responses, in particular, through a quantitative reduction or weakening of 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. The antimicrobial effect may also play a role. Precise data on the specific effect of PUVA and UVA radiation on atopic dermatitis are not yet available. It is believed that the active mechanism is a special effect of UVA radiation on IgE-bearing Langerhans cells. Before starting treatment, photosensitizing medications should be excluded. A preliminary medical examination is recommended. Preschool-aged children are less suitable for phototherapy, since their mobility makes it difficult to accurately determine the radiation dose. Patients with skin type I already react with severe, prolonged erythema at low UV doses, so that therapeutically effective doses can hardly be applied. The use of UV is contraindicated in the presence of concurrent light-induced dermatoses.

Selective UV-B phototherapy

Selective UVB phototherapy (SUV). Initial doses of UVB irradiation (mainly 290-320 nm) should correspond to the individual dose for minimal erythema (MED) in the UVB range. During the 2nd session, the MED increases by 50%, during the third - by 40% and subsequently - by 30%. A minimum of 3, and preferably 5 sessions per week should be aimed at. If the unwanted appearance of too strong erythema, the treatment should be interrupted and topical corticosteroids should be used, if necessary. After the erythema has faded, irradiation should be continued at a dose of 50% of the previous irradiation. If therapy is interrupted for several days, treatment is also continued at a dose of half of that prescribed before the interruption of therapy. Side effects include the possibility of solar dermatitis, as well as the risk of developing epithelial or melanocytic neoplasia. During irradiation, it is recommended to cover the face and genital area. Recently, for severe atopic dermatitis, lamps with a narrow UV-B spectrum (312 + 2 nm) have been recommended, but there is not yet sufficient experience in using such lamps.

Combination of UVB and UVA irradiation (UVAB therapy)

Recent studies suggest that a combination of UVB (300 + 5 nm) with UVA (350 + 30 nm) has a better effect on atopic dermatitis than UVA or UVB irradiation alone. The therapeutic effect of this combination also appears to be longer lasting. However, this treatment option is not used as monotherapy, but only as an accompanying measure to local application of corticosteroids. The patient is irradiated simultaneously with two different light sources in the same cabin. To begin treatment, the DER is determined again and the first irradiation is started at 80% of the DER. The initial UVA dose should be approximately 3 J/cm2 ^, and the initial UVB dose should be 0.02 J/cm2 ^. Continuation of irradiation is carried out in the same way as irradiation with UVB. The increase in dosage for both types of irradiation corresponds to the initial dose and should be 6 J/cm2 ^for UVA and 0.18 J/cm2 ^for SUS at the maximum dosage. Side effects and contraindications are the same as for SUS therapy.

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

High dose UVA1 irradiation

This is a new variant, the so-called UVA, i.e. UVA irradiation in the long-wave range of 340-440 nm at high doses of up to 140 J/cm2 ^per session. This requires special light sources. The duration of irradiation is 30 min. It is reported that after 6-9 sessions one can expect a clear therapeutic effect (improvement up to 50%), and therefore this type of irradiation can be successfully used in some cases as monotherapy. Due to the high doses of UVA, the long-term side effects of which have not yet been fully studied, it is considered absolutely necessary to carry out such a procedure only in the acute period of severe generalized atopic dermatitis. Their use as an experimental therapy is currently limited to a few European university centers. This method is used as an acute interventional measure for a short time. A more precise study for a longer period of time is still to be carried out. The mechanism of action is unknown, but it is believed that light exposure may reduce inflammatory responses, including gamma interferon.

PUVA therapy

PUVA therapy is indicated only in cases of exacerbation of atopic dermatitis, in which there are contraindications to the use of corticosteroids. The response to therapy is quite good, but the use of PUVA to achieve a stable result generally requires twice as many sessions as, for example, in psoriasis. One of the latest studies indicated the average required cumulative dose of UVA as 118 J/cm ², and the average number of required sessions was 59. Rapid withdrawal is often associated with the phenomenon of "rebound" or suppression reaction after excitation. The use of PUVA in adolescents and young adults should occur only according to strict indications and after appropriate preliminary examinations. In young patients with atopy, this type of treatment should be approached with great caution due to its still unknown long-term effects. For women wishing to have children and pregnant women, as well as for people with liver and kidney diseases, PUVA therapy is contraindicated.

Acupuncture (acupuncture)

Given the complexity of the pathogenesis and the variety of clinical manifestations of atopic dermatitis, it is recommended to formulate a prescription for points taking into account their general action and the localization of skin rashes. Treatment begins with points of general action, then local points are included according to the localization of the process and auricular points. 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 stages - the second variant of the inhibitory method. During the procedures, combinations and combinations of points are used individually for each patient, taking into account the characteristics of the skin lesion, the severity of itching, the presence of concomitant diseases. The procedures are carried out daily, 10-12 procedures per course. After a week, a repeat course of treatment is prescribed, consisting of 6-8 procedures carried out every other day. During periods of the most likely exacerbations or relapses, auricular therapy is carried out.

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Inductothermy on the adrenal gland area

Prescribed for atopic dermatitis with decreased functionality of the adrenal cortex. High-frequency inductothermy with a resonant inductor (EVT-1) from the UHF-30 device is used. The inductor is placed on the back at the level of T10-T12, the dose is low-heat, the duration is 5-10 minutes, the first 5 procedures are daily, then every other day, for a course of 8-10 procedures. The adrenal area is affected by microwave inductothermy (UHF and UHF ranges) from the Luch-3 and Romashka devices, for a course of 10-15 procedures every other day.

Magnetic therapy with alternating or constant magnetic field

The alternating magnetic field from the Pole device is recommended in acute and subacute periods of atopic dermatitis in order to influence the central and autonomic nervous system, tissue trophism. The effect is carried out segmentally on the collar, lumbar regions and locally on the lesions of the skin. Inductors with a straight core are used, the mode is continuous, the current shape is sinusoidal. The intensity of the alternating magnetic field from 8.75 to 25 mT, duration 12-20 minutes, per course of 10-20 procedures, daily.

Central electroanalgesia (CEA)

Electrotherapy and electrotranquilization by transcutaneous electrostimulation with pulsed currents. The method is used in patients with atopic dermatitis with neurosis-like conditions. Central electroanalgesia achieves a change in the polarization and conductivity properties of tissues, which creates favorable conditions for a normalizing effect on the central nervous system. Pulse action is performed with the frontal-cervical position of the LENA device electrodes with a frequency of 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.

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Low energy laser radiation

Low-intensity laser irradiation treatment is performed using the Uzor device: pulse mode 2 W, pulse frequency 3000 Hz, wavelength 0.89 μm. The course of treatment is 12-15 procedures daily.

Therapeutic fasting (fasting and diet therapy)

The method is indicated for patients with excess weight, resistance of the disease to other types of therapy, as well as with concomitant pathology of the gastrointestinal tract. Unloading and dietary therapy (method 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, drinking mineral water up to 3 liters per day, a daily shower followed by the use of softening creams. The recovery period lasting 14-15 days begins with the intake of fruit juices in the first days, then grated vegetables and fruits with a transition to a special dairy and plant diet. In the future, to maintain the achieved effect, patients are recommended a strict hypoallergenic diet. The therapeutic effect of fasting-diet therapy is provided by the cleansing effect of the fasting process itself by washing out circulating immune complexes, allergens, toxins from the body, its sanitizing effect on the functions of the gastrointestinal tract, as well as the ability to maintain a hypoallergenic diet after the fasting process. The method of therapeutic fasting is contraindicated for patients with cardiovascular pathology.

Hyperbaric oxygenation (HBO)

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

Plasmapheresis

The method of extracorporeal detoxification in the form of plasmapheresis is prescribed to patients with a torpid course, erythrodermic variant of the disease, as well as in case of drug intolerance. In a surgical procedure room, blood is exfused from the cubital vein into plastic containers and centrifuged at 3000 rpm for 10 minutes at a temperature of +22°C. The plasma is removed, and the formed elements are reinfused into the patient in plasma-substituting solutions. The volume of plasma removed is from 300 to 800 ml, which is compensated by the same or slightly larger volume of plasma substitutes. The procedures are usually carried out once every 2-3 days, up to 8-12 per course; in especially severe forms - daily. During plasmapheresis, the body is freed from pathological metabolites, circulating immune complexes, its receptors are cleansed, and sensitivity to various therapeutic, including medicinal, effects increases.

Other methods of physiotherapy are also used to treat patients with atopic dermatitis: puncture physiotherapy (phonopuncture, laserpuncture); millimeter-wave therapy (UHF therapy); ultrasound therapy (paravertebral ultrasound and ultrasound on the lesions - ultraphonophoresis); endonasal electrophoresis of antihistamines; diadynamic therapy of the cervical sympathetic nodes.

Severe, widespread atopic dermatitis that does not respond to topical therapy therefore requires systemic therapy. Inflammation and itching can in most cases be clearly improved by the substances described, but a balance must be maintained between the paroxysmal nature of the disease, the recurrent and chronic course of the disease, and the toxicity of the substances used. The available systemic therapies can relieve persistent itching and should be used universally in severe and sluggish disease. A well-judged use of additional “stabilizing” therapies, such as UVA/B or aggressive local therapies, can facilitate a return to topical therapy alone and prevent a relapse of the inflammation.

Sanatorium and resort treatment for atopic dermatitis

Sanatorium and spa treatment involves staying in local sanatoriums with a familiar climate and at 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. Resorts allow the use of hydrogen sulphide, radon, sea baths, mud therapy. Treatment with mineral waters is prescribed for concomitant diseases of the gastrointestinal tract and liver.