Features of the treatment of dermatitis in children

Natalia Polonskaya - candidate of medical sciences, associate professor of the department of skin and venereal diseases of the Federal Institute of Internal Medicine of the Russian State Medical University, chief physician of the Optimed Aesthetic Medicine Corporation (Russia, Moscow).

Although these diseases do not lead to such difficult-to-correct skin defects as scars, in many cases they significantly worsen the appearance and are accompanied by itching, peeling and other unpleasant sensations. The situation is further aggravated by the fact that hormonal creams and ointments are used too often and uncontrollably to treat these diseases, which can subsequently lead to the formation of so-called “steroid skin”, which is very difficult to care for and which is problematic in itself.

Frequent use of hormonal drugs is associated with several factors. Firstly, diagnostic errors are possible when an exacerbation of seborrheic dermatitis is mistaken for an allergic reaction. Secondly, since dermatitis is chronic and does not always respond quickly to non-hormonal agents, the doctor and the patient simply do not have the patience for a painstaking selection of skin care products.

Thirdly, the temptation is too great to get results as quickly as possible, which is easily achieved with the help of hormonal drugs. And a possible subsequent withdrawal reaction in the form of an exacerbation is simply not taken into account.

And finally, another reason is self-medication. Many adult patients have used hormonal drugs to solve their own problems and know that if redness occurs, just apply a magic remedy and everything will go away. And most people don’t think about side effects due to the lack of special education and sufficient experience. As a result, creams and ointments with hormones, which are also used to care for the skin of children and adolescents, can be found in many home medicine cabinets. At the same time, when during a consultation the doctor asks whether the patient has used hormonal drugs, the majority says: “No, what are you talking about!” And only by carefully finding out what they tried to “treat” with, it is possible to get the correct answer.

That is why it is very important to correctly diagnose, explain to the patient and his parents the nature of the disease and, if possible, correct these conditions mainly through proper skin care, resorting to potent agents, including corticosteroid drugs, only in case of emergency. And if the prescription of hormonal drugs could not be avoided, it is necessary to explain the rules for their use and warn against uncontrolled transfer of the hormonal drug to others without consultation with a dermatologist.

Next, let's look at how you can help a patient with atopic and seborrheic dermatitis without resorting to hormonal drugs.

Atopic dermatitis (AD)

This is a hereditarily determined chronic disease characterized by polyvalent hypersensitivity and manifested by dry skin, rashes with a morphology and localization characteristic of each age, itching and secondary skin changes.

The disease often begins in infancy as a skin reaction to changes in nutrition, including the transition to artificial feeding, introduction of complementary foods, etc. There is a hereditary predisposition to the disease, but whether it is realized or not largely depends on care for the child, the nature of feeding, the psychological climate in the family, etc.

Rashes can appear even in complete well-being, without any apparent reason. It is interesting that, once appearing as a reaction to some new food product, the rash can persist for a long time even if the provoking factor is completely eliminated.

A huge amount of specialized literature is devoted to atopic dermatitis, so the purpose of this article is not a detailed description of the etiology and pathogenesis. The disease is complex, chronic, and not always amenable to logical explanation. The reasons have not yet been clearly clarified. However, within the framework of this article, I would like to bring a positive note to the attitude towards this disease. Our experience of working with “atopic” patients of various ages shows that in many cases, through proper skin care, an optimistic attitude to life, hardening, and a healthy diet, it is possible to keep the disease under control, and sometimes even forget about it.

Recommendations

During pregnancy

Be happy about your condition. Kids are great. Walk more often, move, communicate with pleasant people. Stop smoking.

In infancy

Try to establish breastfeeding. If it doesn’t work out, don’t panic, continue to give your baby your warmth and care in other ways. Allow your baby to be out of diapers as often as possible.

Whenever possible, use water rather than special wipes to cleanse your skin. Napkins are useful when traveling or in other situations where clean water is not available.

If your child takes a bath every day and rinses with water when changing diapers, there is no need to use soap, including liquid soap, every time. Whenever possible, harden your baby with air and water. Introduce complementary foods gradually, observing the skin's reaction to new foods.

If you see signs of dry skin, lubricate it with natural soothing creams. If redness of the skin occurs and an atopic rash appears, continue to prevent the skin from drying out, lubricate it with creams with panthenol, vitamin C, zinc, and a probiotic complex.

We successfully use C the success cream (contains vitamin C, carotene, chamomile extract, hyaluronic acid), Probiotic balansing cream (contains a probiotic complex that normalizes skin microflora, B vitamins) to care for children's skin, including atopic skin. , amino acids, whey components). These preparations not only relieve dryness, flaking and redness of the baby’s skin, but are also ideal for caring for the mother’s skin, which is very convenient. In case of severe skin irritation, antiseptic Double action powder is applied over the creams to prevent infection.

In childhood and adolescence

Try not to give your child “junk food” (candy, chips, soda, etc.) until at least 3 years of age.

Try to instill the basics of a healthy, varied diet from childhood. Patiently explain which foods are healthy and which are not. Don't put your child on a strict diet. Otherwise, when he grows up and you cannot constantly monitor his nutrition, he will begin to eat everything uncontrollably. In addition, those foods that caused atopic rashes in early childhood, in many cases, begin to be tolerated completely normally with age. The main thing is to choose good quality products, with a minimum amount of preservatives and other additives, and not to overeat.

Allow a child over 3 years old to eat “junk food” occasionally, for example, when visiting or traveling. Provide your child with the necessary psychological support during critical periods (starting to attend kindergarten, school, changing schools, adolescence, etc.).

Any age

Don't panic. Do not consider yourself and your child hopelessly ill. Try to maintain a positive attitude and faith in the best as often as possible. Cleanse your skin well with high-quality cleansing products and do not allow it to dry out. Lead an active lifestyle. Don't play it safe, toughen up. Stop smoking.

Regular skin care for hypertension

The skin of patients with AD is typically dry, with an easily damaged skin barrier. Therefore, it is important to prevent dry skin and regularly use products that restore the integrity of the skin barrier. These include preparations with vitamin F (unsaturated fatty acids), vitamins A, C, group B and, strange as it may seem, fruit acids. After all, high-quality drugs with ANA stimulate the synthesis of ceramides in the skin, and according to some data, in AD there is a deficiency of these substances in the epidermis. Selecting medications to care for atopic skin requires time and patience. For such patients, it is especially important to use high-quality products containing pure hypoallergenic ingredients. We believe that for patients with AD, thorough cleansing of the skin is also important, since if the function of the skin barrier is impaired, there is a high probability of contact of immunocompetent cells with various allergens, including infectious ones, which can provoke an exacerbation of the disease. At the same time, cleansing products should not disturb the pH of the skin and reduce its protective functions.

Therefore, outside of exacerbation, we recommend using the following remedies:

• For cleansing - Probiotic, C the success cleansers or Renew formula balancing soap.
• For regular skin care - Probiotic balancing cream and C the success cream.

The frequency of use of care products depends on the condition of the skin. Indeed, in childhood and adolescence, the skin has a pronounced ability to self-heal. Therefore, if there are no signs of dryness, including accentuated skin patterns and peeling, it is enough to apply creams several times a week after a morning or evening shower. If your skin is uncomfortable, it makes sense to use these products daily.

During the period of exacerbation

During the period of exacerbation of blood pressure, the patient begins to experience severe itching, inflammatory elements appear, and as a result of scratching, skin damage occurs, which allows infectious allergens to penetrate the skin, intensifying the itching and can subsequently lead to the addition of a secondary infection. The exact cause that caused the exacerbation is not always possible to identify, and, unfortunately, even with a known cause, its elimination does not always lead to remission.

Our method of working with a patient in the acute stage is aimed at restoring the integrity of the skin barrier, eliminating itching and inflammation. This breaks the vicious circle and in most cases it is possible to achieve remission.

To cleanse the skin during an exacerbation, Double action soap (contains Peruvian balsam) is used, which cleanses and disinfects the skin well and has a resolving effect. In the morning after cleansing, Probiotic balancing cream is applied, which helps normalize the skin microflora, and in the evening - Alpha beta retinol restoring cream, which, due to the content of the AHA + vitamin C + retinol complex, stimulates the restoration of the skin barrier, has an anti-inflammatory, antipruritic effect, and stimulates the synthesis of ceramides in the skin, evens out its relief, helps eliminate crusts.

On areas where itching is felt, A Nox drying lotion is applied locally on top of the cream, which, due to the content of zinc, calamine and allantoin, has a pronounced disinfectant and antipruritic effect, mechanically closes the damage, preventing the penetration of infection.

Additionally, 1-3 times a week, we recommend applying peeling serum to problem areas - Alpha complex rapid exfoliator serum, which contains not only a complex of natural fruit acids of the highest quality, but also vitamin C, mimosa and fig extract. In combination, these ingredients promote rapid and high-quality cleansing of damaged skin, disinfect it, prevent the proliferation of microorganisms, stimulate skin restoration and the synthesis of ceramides, reduce itching, even out skin texture (reduce lichenification).

Of course, to obtain an optimal result, it is necessary to do all of the above under the supervision of a dermatocosmetologist, who, on the one hand, knows how to work with blood pressure, and on the other, is well acquainted with these drugs.

Seborrheic dermatitis (SD)

Seborrheic dermatitis is a chronic recurrent skin disease that occurs as a result of activation of saprophytic flora, characterized by the localization of erythematosquamous and papular squamous rashes in seborrheic zones and large folds. The disease occurs at different age periods. The scalp and face are most often affected. On the face, rashes are most often localized in the area between the eyebrows and the wings of the nose, as well as in the area of growth of the eyebrows, mustache and beard. The rash can be in the form of peeling on a non-inflamed or inflamed background, the formation of superficial plaques with resolution in the center, as well as yellowish crusts and small follicular papules is possible.

On the scalp, DM manifests itself as simple dry or oily dandruff, hyperemic flaky plaques, and superficial follicular papules.

The rash is often accompanied by itching, which leads to scratching with damage to the skin, the formation of crusts and the addition of a secondary infection. Sometimes the damage and signs of secondary infection are so significant that they make diagnosis difficult.

Important! In case of widespread, difficult-to-treat diabetes, it is necessary to exclude immunodeficiency conditions, including HIV infection.

To treat diabetes, many non-hormonal agents can be used: various antifungal drugs, zinc and its derivatives, sulfur and its derivatives, drugs containing selenium, tar and ichthyol.

Our methods of helping patients with diabetes are based on normalizing the functioning of the skin, which leads to stabilization of the microflora and prevents saprophytes from acquiring pathogenic properties. First of all, every effort is made to reduce inflammation and reduce the activity of microflora; for this purpose, damaged layers of the epidermis are eliminated, the skin is disinfected, and preparations with vitamins A, C and B, lactoferrin and lactoperoxidase are applied. This creates conditions for the complete restoration of the skin barrier and leads to relief of exacerbation of diabetes.

Facial skin care

During exacerbation of diabetes, the following care is recommended.

1. For cleansing, use alternately (one product in the morning, the other in the evening) Probiotic or C the success cleanser and Double action soap (this cleansing regimen allows you to thoroughly cleanse the skin without drying it out).

2. In the morning , areas where itching, oily and inflamed areas are wiped with Double action face lotion (reduces sebaceous shine, inflammation and itching), then Sebo derm cream or Probiotic balancing cream is applied to the entire face (these preparations help normalize microflora and restore skin barrier). In case of severe inflammation and greasy shine, it is useful to apply antiseptic Double action powder on top of the cream.

3. In the evening, wipe the entire face with Azulen face lotion, after which ABR restoring cream is applied (this drug eliminates damaged layers of the epidermis, creates a bactericidal environment on the surface of the skin, normalizes the process of keratinization and restores the barrier function of the skin, while quite effectively reducing inflammation and itching ).

As already mentioned, diabetes is a chronic disease, therefore it recurs under the influence of provoking factors. To reduce the frequency and severity of relapses, we recommend that such patients periodically undergo the procedure “Atraumatic skin cleansing with peeling - ABR deep clean peel serum” (see previous issues of the magazine), as well as procedures for skin renewal, prevention and correction of its aging with peeling serum ABR Premium peel.

Scalp care

To care for the scalp during an exacerbation of diabetes, we have developed a special program “Anti-dandruff ” , which can be used independently or, if necessary, alternated or combined with the use of antifungal shampoos.

Anti-dandruff program

Indications

Used for flaking, irritation, itching of the scalp.

Components of the Anti-Dandruff program

To normalize the skin microflora, preparations containing fruit acids, isopropyl alcohol, benzoic acid, lactoferrin and lactoperoxidase are used. Fruit acids in combination with papain, salicylic acid and retinol also provide complete cleansing of the mouths of hair follicles and regulate the processes of keratinization. Ascorbic acid reduces inflammation, omega-6 acids help restore the skin barrier.

The program is applied while washing your hair 1-2 times a week.

Scheme of application of the program

1. Wipe your scalp with a cotton swab soaked in A-Nox Plus Retinol Face Lotion.

Note: the lotion causes a feeling of warming up the skin, this is necessary for a more intense effect of the subsequent peeling. In addition, the drug disinfects the skin and has antibacterial and antimycotic effects.

1. Apply Alpha Complex Rapid Exfoliator and massage into skin until completely absorbed.

Note: peeling may cause a slight burning sensation, this is a normal reaction to the drug and is not a manifestation of an allergy, the burning sensation goes away completely after washing your hair.

Wait 20 min.

1. Wash your hair with regular shampoo.
2. Wipe your scalp with Double Action Face Lotion.

Note: tingling may be felt on flaky and irritated areas, but after a few minutes the burning will stop, a feeling of freshness will appear, and itching in problem areas will decrease.

1. Apply Sebo Derm Cream to irritated and flaky areas.

Additional recommendations

• Wipe areas where itching or irritation is felt with Double Action Face Lotion daily, then apply Sebo Derm Cream to them.
• Use Double Action Soapless Soap to wash your hair once a week. Lather some soap into your palms. Apply it to damp scalp. Massage for 3 minutes, rinse thoroughly.

Thus, the capabilities of modern cosmetology make it possible to provide effective assistance for various types of problems, including for patients of childhood and adolescence. It is important that in this case it is often possible to avoid the use of hormonal and other potent drugs or reduce the duration of their use and dosage. In addition, from an early age, the child is taught the rules of proper skin care, which will allow him to avoid and/or adequately respond to many problems in the future.

First published: KOSMETIK international journal, No. 1(39), 2010, pp. 70-74