Правильный уход за кожей новорожденных и детей раннего возраста: что нужно знать педиатру
Правильный уход за кожей новорожденных и детей раннего возраста: что нужно знать педиатру
Захарова И.Н., Пшеничникова И.И., Мачнева Е.Б. Правильный уход за кожей новорожденных и детей раннего возраста: что нужно знать педиатру. Consilium Medicum. Педиатрия (Прил.). 2016; 1: 24–30.
________________________________________________
Zakharova I.N., Pshenichnikova I.I., Machneva E.B. Proper skin care of newborns and young children: what the pediatrician needs to know.
Правильный уход за кожей новорожденных и детей раннего возраста: что нужно знать педиатру
Захарова И.Н., Пшеничникова И.И., Мачнева Е.Б. Правильный уход за кожей новорожденных и детей раннего возраста: что нужно знать педиатру. Consilium Medicum. Педиатрия (Прил.). 2016; 1: 24–30.
________________________________________________
Zakharova I.N., Pshenichnikova I.I., Machneva E.B. Proper skin care of newborns and young children: what the pediatrician needs to know.
Кожа является самым крупным многофункциональным органом в организме человека, сложным по своему строению. Изменения структуры и целостности кожи неизбежно ведут к нарушению ее функций, что в итоге сказывается на состоянии организма в целом. Кожа новорожденных и детей раннего возраста обладает рядом анатомо-физиологических особенностей, которые предрасполагают к развитию типичных патологических состояний. Одним из наиболее распространенных заболеваний кожи у детей данной возрастной группы является пеленочный дерматит (ПД).
В статье рассмотрены факторы риска, дана характеристика особенностей течения ПД у новорожденных и детей раннего возраста в зависимости от степени тяжести, приведен алгоритм действий педиатра в плане профилактики и лечения ПД. Даны характеристика и особенности применения основных средств, используемых в терапии ПД. В статье приведена оценка эффективности средств, содержащих декспантенол для профилактики и терапии ПД у новорожденных и детей раннего возраста.
Ключевые слова: кожа, функции кожи, новорожденные, дети раннего возраста, пеленочный дерматит, декспантенол, профилактика, лечение.
________________________________________________
The skin is the largest organ of multi-function in the human body, complex in its structure. Changes in the structure and integrity of the skin inevitably lead to a breach of its functions, which ultimately affects the state of the organism as a whole. The skin of newborns and infants has a number of anatomical and physiological characteristics that predispose to the development of the typical pathological conditions. One of the most common skin diseases in children in this age group is diaper dermatitis (DD). The article discusses the risk factors the characteristic features of the flow of DD in newborns and infants depending on the severity, the algorithm of actions pediatrician in terms of its prevention and treatment, characteristics and features of application of the basic tools used in the treatment of DD. The article presents the evaluation of the effectiveness of drugs containing dexpanthenol for the prevention and treatment of DD in infants and young children.
Key words: functions of the skin, newborns, infants, diaper dermatitis, dexpanthenol, prevention, treatment.
1. Нобл У.К. Микробиология кожи человека. Пер. с англ. М.: Медицина, 1986. / Nobl U.K. Mikrobiologiia kozhi cheloveka. Per. s angl. M.: Meditsina, 1986. [in Russian]
2. Рыбкина Н.Л. Современные подходы к уходу за кожей новорожденного тактика педиатра. Вестн. соврем. клин. медицины. 2014; 7: 6. / Rybkina N.L. Sovremennye podkhody k ukhodu za kozhei novorozhdennogo taktika pediatra. Vestn. sovrem. klin. meditsiny. 2014; 7: 6. [in Russian]
3. Аравийская Е.Р., Соколовский Е.В. Барьерные свойства кожи и базовый уход: инновации в теории и практике. Вестн. дерматологии и венерологии. 2010; 6: 135–9. / Araviiskaia E.R., Sokolovskii E.V. Bar'ernye svoistva kozhi i bazovyi ukhod: innovatsii v teorii i praktike. Vestn. dermatologii i venerologii. 2010; 6: 135–9. [in Russian]
4. Fluhr JW, Rao J, Jain M et al. Generation of free fatty acids from phospholipids regulates stratum corneum acidification and integrity. J Invest Dermatol 2001; 117 (1): 44–51.
5. Feingold KR, Schmuth M, Elias PM. The regulation of permeability barrier homeostasis. J Invest Dermatol 2007; 127: 1574–6.
6. Rawlings A. Fifty years of stratum corneum and moisturisation research. IFSCC Mag 2009; 12: 169–70.
7. Elias PM. Stratum corneum defensive functions: an integrated view. J Invest Dermatol 2005; 125 (2): 183–200.
8. Cork MJ, Robinson DA, Vasilopoulos Y et al. New perspectives on epidermal barrier dysfunction in atopic dermatitis: gene-environment interactions. J Allergy Clin Immunol 2006; 118 (1): 3–21.
9. Yosipovitch G, Maayan-Metzger A, Merlob Pet al. Skin barrier properties in different body areas in neonates. Pediatrics 2000; 106: 105–8.
10. Gillman T, Champion RH, Rook AJ, Smith RT, eds. The dermis. An Introduction to the Biology of the Skin. Philadelphia, Pa: FA Davis Co Publishers, 1970.
11. Яцык Г.В., Акоев Ю.С. Клиническая эффективность различных средств по уходу за кожей новорожденных на основе D-пантенола. Consilium Medicum. Педиатрия (Прил.). 2004; 2: 41–3. / Iatsyk G.V., Akoev Iu.S. Klinicheskaia effektivnost' razlichnykh sredstv po ukhodu za kozhei novorozhdennykh na osnove D-pantenola. Consilium Medicum. Pediatrics (Suppl.). 2004; 2: 41–3. [in Russian]
12. http://lopkoffsbiolog.files.wordpress.com/2012/12/depositphotos_5555570-anatomy-of-the-epidermis3.jp....
13. Воронцов И.М., Мазурин А.В. Пропедевтика детских болезней. СПб.: Фолиант, 2009. / Vorontsov I.M., Mazurin A.V. Propedevtika detskikh boleznei. SPb.: Foliant, 2009. [in Russian]
14. Дьячкова С.Я. Местная терапия аллергодерматозов у детей. Вестн. ВГУ. 2005; 2: 162–6. / D'iachkova S.Ia. Mestnaia terapiia allergodermatozov u detei. Vestn. VGU. 2005; 2: 162–6. [in Russian]
15. Зверькова Ф.А. Болезни кожи детей раннего возраста. СПб.: Сотис, 1994. / Zver'kova F.A. Bolezni kozhi detei rannego vozrasta. SPb.: Sotis, 1994. [in Russian]
16. Чеботарев В.В., Тамразова О.Б., Чеботарева Н.В., Одинец А.В. Дерматовенерология. Учебник для студентов высших учебных заведений. 2013. / Chebotarev V.V., Tamrazova O.B., Chebotareva N.V., Odinets A.V. Dermatovenerologiia. Uchebnik dlia studentov vysshikh uchebnykh zavedenii. 2013. [in Russian]
17. http://www2.sunysuffolk.edu/czuraa/BIO130LectureMaterials/BIO130Chapter5Notes.pdf
18. Odland GF, Short JM. Structure of the skin. In: Dermatology in General Medicine, edited by T.B. Fitzpatrick. New York: McGraw-Hill, Inc., 1971; p. 39–40.
19. Krafchik BR. Eczematous disorders. Dans: L.F.Eichenfield, I.J.Frieden, N.B.Esterly, rédacteurs. Textbook of Neonatal Dermatology. Philadelphia: WB Saunders Co., 2001; p. 241–59.
20. Геппе Н.А., Белоусова Н.А., Пахомова О.А., Им В.В. Профилактика пеленочного дерматита. Consilium Medicum. Педиатрия (Прил.). 2002; с. 33–5. / Geppe N.A., Belousova N.A., Pakhomova O.A., Im V.V. Profilaktika pelenochnogo dermatita. Consilium Medicum. Pediatrics (Suppl.). 2002; s. 33–5. [in Russian]
21. Коровина Н.А., Заплатников А.Л., Захарова И.Н. Пособие для врачей. Новые разработки по уходу за кожей детей раннего возраста. М., 1998. / Korovina N.A., Zaplatnikov A.L., Zakharova I.N. Posobie dlia vrachei. Novye razrabotki po ukhodu za kozhei detei rannego vozrasta. M., 1998. [in Russian]
22. Адаскевич В.П., Козин В.М Кожные и венерические болезни. М.: Медицинская литература, 2006. / Adaskevich V.P., Kozin V.M Kozhnye i venericheskie bolezni. M.: Meditsinskaia literatura, 2006. [in Russian]
23. Афанасьев Ю.И., Юрина Н.А., Котовский Е.Ф. и др. Гистология. Учебник. 5-е изд., перераб. и доп. М.: Медицина, 2002. / Afanas'ev Iu.I., Iurina N.A., Kotovskii E.F. i dr. Gistologiia. Uchebnik. 5-e izd., pererab. i dop. M.: Meditsina, 2002. [in Russian]
24. Stamatas GN, Tierney NK. Diaper Dermatitis: Etiology, Manifestations, Prevention, and Management. Pediatr Dermatol 2014; 31 (1): 1–7.
25. Berg RW. Etiology and pathophysiology of diaper dermatitis. Adv Dermatol 1988; 3: 75–98.
26. Adalat S, Wall D, Goodyear H. Diaper dermatitis-frequency and contributory factors in hospital attending children. Pediatr Dermatol 2007; 24: 483–8.
27. Liu N, Wang X, Odio M. Frequency and severity of diaper dermatitis with use of traditional Chinese cloth diapers: observations in 3- to 9-month-old children. Pediatr Dermatol 2011; 28: 380–6.
28. Hermoso F. Evolution of nappy dermatitis in the general infant population. Submitted 1998.
29. Brown WM, Berg JE, Li Q et al. A clinical study to evaluate the efficacy of two marketed zinc oxide-based diaper rash ointments in children with diaper dermatitis. Clin Dermatol Conference Las Vegas, NV, 2006.
30. http://diseasespictures.com/wp-content/uploads/2013/08/Diaper-Rash-5.jpg
31. Shin HT. Diaper dermatitis that does not quit. Dermatol Ther 2005; 18: 124–35.
32. Wolf R, Wolf D, Tuzun B et al. Diaper dermatitis. Clin Dermatol 2000; 18: 657–60.
33. Lund CH, Kuller J, Raines DA et al. Neonatal skin care-evidence-based clinical practice guideline, 2nd ed. Washington, DC: Association of Women's Health, Obstetric and Neonatal Nurses and the National Association of Neonatal Nurses, 2007.
34. Blume-Peytavi U, Cork MJ, Faergemann J et al. Bathing and cleansing in newborns from day 1 to first year of life: recommendations from a European round table meeting. J Eur Acad Dermatol Venereol 2009; 23: 751–9.
35. Jordan WE, Lawson KD, Berg RW et al. Diaper dermatitis: frequency and severity among a general infant population. Pediatr Dermatol 1986; 3: 198–207.
36. Benjamin L. Clinical correlates with diaper dermatitis. Pediatrician 1987; 14 (Suppl. 1): 21–6.
37. Berg RW, Buckingham KW, Stewart RL. Etiologic factors in diaper dermatitis: the role of urine. Pediatr Dermatol 1986; 3: 102–6.
38. Коровина Н.А., Захарова И.Н., Овсянникова Е.М. Профилактика и лечение пеленочного дерматита у детей. РМЖ. 2004; 18 (10): 41–7. / Korovina N.A., Zakharova I.N., Ovsiannikova E.M. Profilaktika i lechenie pelenochnogo dermatita u detei. RMZh. 2004; 18 (10): 41–7. [in Russian]
39. Xhauflaire-Uhoda E, Henry F, Pierard-Franchimont C et al. Electrometric assessment of the effect of a zinc oxide paste in diaper dermatitis. Int J Cosmet Sci 2009; 31: 369–74.
40. Adam R. Skin care of the diaper area. Pediatr Dermatol 2008; 25: 427–33.
41. Ebner F, Heller A, Rippke F, Tausch I. Topical use of dexpanthenol in skin disorders. Am J Clin Dermatol 2002; 3 (6): 427–33.
42. Prasad H, Srivastava P, Verma K. Diaper dermatitis – an overview. Indian J Pediatr 2003; 70: 635–7.
43. Мачарадзе Д.Ш. Пеленочный дерматит: особенности дифференциальной диагностики и лечения у детей. Мед. совет. 2012; 2: 77–80. / Macharadze D.Sh. Pelenochnyi dermatit: osobennosti differentsial'noi diagnostiki i lecheniia u detei. Med. sovet. 2012; 2: 77–80. [in Russian]
44. Sznurowska К, Liberek А, Brzozowska Cieloch К et al. Evalution of a new cosmetic topical formulation in the management of irritant diaper dermatitis in infants. Self Care 2015; 6 (S1): 12–24.
________________________________________________
1. Nobl U.K. Mikrobiologiia kozhi cheloveka. Per. s angl. M.: Meditsina, 1986. [in Russian]
2. Rybkina N.L. Sovremennye podkhody k ukhodu za kozhei novorozhdennogo taktika pediatra. Vestn. sovrem. klin. meditsiny. 2014; 7: 6. [in Russian]
3. Araviiskaia E.R., Sokolovskii E.V. Bar'ernye svoistva kozhi i bazovyi ukhod: innovatsii v teorii i praktike. Vestn. dermatologii i venerologii. 2010; 6: 135–9. [in Russian]
4. Fluhr JW, Rao J, Jain M et al. Generation of free fatty acids from phospholipids regulates stratum corneum acidification and integrity. J Invest Dermatol 2001; 117 (1): 44–51.
5. Feingold KR, Schmuth M, Elias PM. The regulation of permeability barrier homeostasis. J Invest Dermatol 2007; 127: 1574–6.
6. Rawlings A. Fifty years of stratum corneum and moisturisation research. IFSCC Mag 2009; 12: 169–70.
7. Elias PM. Stratum corneum defensive functions: an integrated view. J Invest Dermatol 2005; 125 (2): 183–200.
8. Cork MJ, Robinson DA, Vasilopoulos Y et al. New perspectives on epidermal barrier dysfunction in atopic dermatitis: gene-environment interactions. J Allergy Clin Immunol 2006; 118 (1): 3–21.
9. Yosipovitch G, Maayan-Metzger A, Merlob Pet al. Skin barrier properties in different body areas in neonates. Pediatrics 2000; 106: 105–8.
10. Gillman T, Champion RH, Rook AJ, Smith RT, eds. The dermis. An Introduction to the Biology of the Skin. Philadelphia, Pa: FA Davis Co Publishers, 1970.
11. Iatsyk G.V., Akoev Iu.S. Klinicheskaia effektivnost' razlichnykh sredstv po ukhodu za kozhei novorozhdennykh na osnove D-pantenola. Consilium Medicum. Pediatrics (Suppl.). 2004; 2: 41–3. [in Russian]
12. http://lopkoffsbiolog.files.wordpress.com/2012/12/depositphotos_5555570-anatomy-of-the-epidermis3.jp....
13. Vorontsov I.M., Mazurin A.V. Propedevtika detskikh boleznei. SPb.: Foliant, 2009. [in Russian]
14. D'iachkova S.Ia. Mestnaia terapiia allergodermatozov u detei. Vestn. VGU. 2005; 2: 162–6. [in Russian]
15. Zver'kova F.A. Bolezni kozhi detei rannego vozrasta. SPb.: Sotis, 1994. [in Russian]
16. Chebotarev V.V., Tamrazova O.B., Chebotareva N.V., Odinets A.V. Dermatovenerologiia. Uchebnik dlia studentov vysshikh uchebnykh zavedenii. 2013. [in Russian]
17. http://www2.sunysuffolk.edu/czuraa/BIO130LectureMaterials/BIO130Chapter5Notes.pdf
18. Odland GF, Short JM. Structure of the skin. In: Dermatology in General Medicine, edited by T.B. Fitzpatrick. New York: McGraw-Hill, Inc., 1971; p. 39–40.
19. Krafchik BR. Eczematous disorders. Dans: L.F.Eichenfield, I.J.Frieden, N.B.Esterly, rédacteurs. Textbook of Neonatal Dermatology. Philadelphia: WB Saunders Co., 2001; p. 241–59.
20. Geppe N.A., Belousova N.A., Pakhomova O.A., Im V.V. Profilaktika pelenochnogo dermatita. Consilium Medicum. Pediatrics (Suppl.). 2002; s. 33–5. [in Russian]
21. Korovina N.A., Zaplatnikov A.L., Zakharova I.N. Posobie dlia vrachei. Novye razrabotki po ukhodu za kozhei detei rannego vozrasta. M., 1998. [in Russian]
22. Adaskevich V.P., Kozin V.M Kozhnye i venericheskie bolezni. M.: Meditsinskaia literatura, 2006. [in Russian]
23. Afanas'ev Iu.I., Iurina N.A., Kotovskii E.F. i dr. Gistologiia. Uchebnik. 5-e izd., pererab. i dop. M.: Meditsina, 2002. [in Russian]
24. Stamatas GN, Tierney NK. Diaper Dermatitis: Etiology, Manifestations, Prevention, and Management. Pediatr Dermatol 2014; 31 (1): 1–7.
25. Berg RW. Etiology and pathophysiology of diaper dermatitis. Adv Dermatol 1988; 3: 75–98.
26. Adalat S, Wall D, Goodyear H. Diaper dermatitis-frequency and contributory factors in hospital attending children. Pediatr Dermatol 2007; 24: 483–8.
27. Liu N, Wang X, Odio M. Frequency and severity of diaper dermatitis with use of traditional Chinese cloth diapers: observations in 3- to 9-month-old children. Pediatr Dermatol 2011; 28: 380–6.
28. Hermoso F. Evolution of nappy dermatitis in the general infant population. Submitted 1998.
29. Brown WM, Berg JE, Li Q et al. A clinical study to evaluate the efficacy of two marketed zinc oxide-based diaper rash ointments in children with diaper dermatitis. Clin Dermatol Conference Las Vegas, NV, 2006.
30. http://diseasespictures.com/wp-content/uploads/2013/08/Diaper-Rash-5.jpg
31. Shin HT. Diaper dermatitis that does not quit. Dermatol Ther 2005; 18: 124–35.
32. Wolf R, Wolf D, Tuzun B et al. Diaper dermatitis. Clin Dermatol 2000; 18: 657–60.
33. Lund CH, Kuller J, Raines DA et al. Neonatal skin care-evidence-based clinical practice guideline, 2nd ed. Washington, DC: Association of Women's Health, Obstetric and Neonatal Nurses and the National Association of Neonatal Nurses, 2007.
34. Blume-Peytavi U, Cork MJ, Faergemann J et al. Bathing and cleansing in newborns from day 1 to first year of life: recommendations from a European round table meeting. J Eur Acad Dermatol Venereol 2009; 23: 751–9.
35. Jordan WE, Lawson KD, Berg RW et al. Diaper dermatitis: frequency and severity among a general infant population. Pediatr Dermatol 1986; 3: 198–207.
36. Benjamin L. Clinical correlates with diaper dermatitis. Pediatrician 1987; 14 (Suppl. 1): 21–6.
37. Berg RW, Buckingham KW, Stewart RL. Etiologic factors in diaper dermatitis: the role of urine. Pediatr Dermatol 1986; 3: 102–6.
38. Korovina N.A., Zakharova I.N., Ovsiannikova E.M. Profilaktika i lechenie pelenochnogo dermatita u detei. RMZh. 2004; 18 (10): 41–7. [in Russian]
39. Xhauflaire-Uhoda E, Henry F, Pierard-Franchimont C et al. Electrometric assessment of the effect of a zinc oxide paste in diaper dermatitis. Int J Cosmet Sci 2009; 31: 369–74.
40. Adam R. Skin care of the diaper area. Pediatr Dermatol 2008; 25: 427–33.
41. Ebner F, Heller A, Rippke F, Tausch I. Topical use of dexpanthenol in skin disorders. Am J Clin Dermatol 2002; 3 (6): 427–33.
42. Prasad H, Srivastava P, Verma K. Diaper dermatitis – an overview. Indian J Pediatr 2003; 70: 635–7.
43. Macharadze D.Sh. Pelenochnyi dermatit: osobennosti differentsial'noi diagnostiki i lecheniia u detei. Med. sovet. 2012; 2: 77–80. [in Russian]
44. Sznurowska К, Liberek А, Brzozowska Cieloch К et al. Evalution of a new cosmetic topical formulation in the management of irritant diaper dermatitis in infants. Self Care 2015; 6 (S1): 12–24.
Авторы
И.Н.Захарова*, И.И.Пшеничникова, Е.Б.Мачнева
ГБОУ ДПО Российская медицинская академия последипломного образования Минздрава России. 125993, Россия, Москва, ул. Баррикадная, д. 2/1
*zakharova-rmapo@yandex.ru
________________________________________________
I.N.Zaharova*, I.I.Pshenichnikova, E.B.Machneva
Russian Medical Academy of Postgraduate Education of the Ministry of Health of the Russian Federation.
125995, Russian Federation, Moscow, ul. Barrikadnaia, d. 2/1
*zakharova-rmapo@yandex.ru