Рецепт. 2020; 24: 86-96
Основные аспекты диагностики и лечения атопического дерматита
https://doi.org/10.34883/PI.2020.23.1.009Аннотация
В представленной работе изложены общие вопросы этиологии и патогенеза формирования атопического дерматита, его эпидемиологические особенности.
Автор подробно изложил главные и дополнительные диагностические критерии. Рассмотрены особенности клинической картины заболевания в зависимости от возрастной периодизации, характера течения заболевания и распространенности процесса. Дана оценка тяжести по международной системе SCORAD, которая лежит в основе ступенчатого подхода к лечению атопического дерматита у детей и взрослых.
Изложены подходы к лечению, включая немедикаментозные методы и базисную терапию эмолиентами, направленную на восстановление водно-липидного барьера кожи, восстановление регенерации кожного покрова, а также особенности терапии осложненного атопического дерматита бактериальной, грибковой инфекцией.
Медикаментозная терапия представлена топическими и системными лекарственными средствами. Наружная терапия состоит из топических кортикостероидных препаратов и ингибиторов кальциневрина. Дана классификация наружных средств, показания к их применению, побочные эффекты, а также тактика назначения в зависимости от клинического состояния.
Лекарственные препараты системного действия представлены антигистаминными, системными кортикостероидами, циклоспорином. Подробно изложены показания для каждой группы препаратов, особенности тактики их назначения и побочные эффекты, которые они вызывают.
Список литературы
1. Astaf’eva N.G., Eremina M.G., Eremin A.V. (2013) Individual’noe bremya atopicheskogo dermatita [Individual burden of atopic dermatitis]. Saratovskij nauch.-med. zhurnal, vol. 9, no 3, pp. 543–548.
2. Kubanova A.A., Proshutinskaya D.V., Tekucheva L.V., Avdienko I.N. (2010) Integral’nyj podhod k naruzhnoj terapii atopicheskogo dermatita [Integral approach to external therapy of atopic dermatitis]. Vestnik dermatologii i venerologii, no 1, pp. 20–26.
3. Revyakina V.A., Taganov A.V., Lar’kova I.A, Muhortyh V.A. (2019) Atopicheskij dermatit, sovremennaya strategiya v terapii [Atopic dermatitis, modern strategy in therapy]. Lechashchij vrach, no 5, pp. 32–37.
4. Revyakina V.A. (2015) Etapnaya terapiya atopicheskogo dermatita u detej [Stage therapy of atopic dermatitis]. Consilium Medicum. Pediatriya, no 1, pp. 50–53.
5. (2015) Federal’nye klinicheskie rekomendacii po vedeniyu bol’nyh s atopicheskim dermatitom [Federal clinical recommendations for patients management with atopic dermatitis]. Moskva, 33 p. (in Russian)
6. (2018) European Dermatology Forum (EDF), the European Academy of Dermatology and Venereology (EADV), the European Academy of Allergy and Clinical Immunology (EAACI), the European Task Force on Atopic Dermatitis (ETFAD), European Federation of Allergy and Airways Diseases Patients’ Associations (EFA), the European Society for Dermatology and Psychiatry (ESDaP), the European Society of Pediatric Dermatology (ESPD), Global Allergy and Asthma European Network (GA2LEN) and the European Union of Medical Specialists (UEMS). Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part II. J. Eur. Acad. Dermatol. Venereol., vol. 32, no 6, p. 850–878.
7. (2014) Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis. J. Am. Acad. Dermatol., vol. 70, no 2, pp. 338–351.
8. Mortz C.G. (2015) Atopic dermatitis from adolescence to adulthood in the TOACS cohort: prevalence, persistence and comorbidities. Allergy, vol. 70, pp. 836–845.
9. Leung T.N., Chow C.M., Chow M.P. (2013) Clinical guidelines on management of atopic dermatitis in children. Hong Kong J Paediatr (new series), vol. 18, pp. 96–104
Recipe. 2020; 24: 86-96
Main Aspects of Diagnosis and Treatment of Atopic Dermatitis
https://doi.org/10.34883/PI.2020.23.1.009Abstract
The paper presents general questions of the etiology and pathogenesis of atopic dermatitis, its epidemiological features.
The author described in detail the main and additional diagnostic criteria. The features of the clinical picture of the disease depending on the age periodization, the nature of the course of the disease and the prevalence of the process are considered. The severity assessment is based on the international SCORAD system, which is the basis of a step-by-step approach for the treatment of atopic dermatitis in children and adults.
Treatment approaches are described, including non-drug methods and basic therapy with patients aimed at restoring the water-lipid barrier of the skin, restoring and regenerating the skin, as well as features of the treatment of complicated atopic dermatitis with bacterial and fungal infection.
Drug therapy is represented by topical and systemic medications. External therapy consists of topical corticosteroid medications and calcineurin inhibitors. The classifcation of external agents, indications for their use, side effects, and tactics of appointment depending on the clinical condition are given.
Systemic medications are represented by antihistamines, systemic corticosteroids, and cyclosporine. The indications for each group of drugs, the specifc tactics of their administration and the side effects they cause are described in detail.
References
1. Astaf’eva N.G., Eremina M.G., Eremin A.V. (2013) Individual’noe bremya atopicheskogo dermatita [Individual burden of atopic dermatitis]. Saratovskij nauch.-med. zhurnal, vol. 9, no 3, pp. 543–548.
2. Kubanova A.A., Proshutinskaya D.V., Tekucheva L.V., Avdienko I.N. (2010) Integral’nyj podhod k naruzhnoj terapii atopicheskogo dermatita [Integral approach to external therapy of atopic dermatitis]. Vestnik dermatologii i venerologii, no 1, pp. 20–26.
3. Revyakina V.A., Taganov A.V., Lar’kova I.A, Muhortyh V.A. (2019) Atopicheskij dermatit, sovremennaya strategiya v terapii [Atopic dermatitis, modern strategy in therapy]. Lechashchij vrach, no 5, pp. 32–37.
4. Revyakina V.A. (2015) Etapnaya terapiya atopicheskogo dermatita u detej [Stage therapy of atopic dermatitis]. Consilium Medicum. Pediatriya, no 1, pp. 50–53.
5. (2015) Federal’nye klinicheskie rekomendacii po vedeniyu bol’nyh s atopicheskim dermatitom [Federal clinical recommendations for patients management with atopic dermatitis]. Moskva, 33 p. (in Russian)
6. (2018) European Dermatology Forum (EDF), the European Academy of Dermatology and Venereology (EADV), the European Academy of Allergy and Clinical Immunology (EAACI), the European Task Force on Atopic Dermatitis (ETFAD), European Federation of Allergy and Airways Diseases Patients’ Associations (EFA), the European Society for Dermatology and Psychiatry (ESDaP), the European Society of Pediatric Dermatology (ESPD), Global Allergy and Asthma European Network (GA2LEN) and the European Union of Medical Specialists (UEMS). Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part II. J. Eur. Acad. Dermatol. Venereol., vol. 32, no 6, p. 850–878.
7. (2014) Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis. J. Am. Acad. Dermatol., vol. 70, no 2, pp. 338–351.
8. Mortz C.G. (2015) Atopic dermatitis from adolescence to adulthood in the TOACS cohort: prevalence, persistence and comorbidities. Allergy, vol. 70, pp. 836–845.
9. Leung T.N., Chow C.M., Chow M.P. (2013) Clinical guidelines on management of atopic dermatitis in children. Hong Kong J Paediatr (new series), vol. 18, pp. 96–104
