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Десять заблуждений, или Распространенные ошибки в лечении атопического дерматита у детей
Смолкин Ю.С., Сердобинцев К.В., Смолкина О.Ю. Десять заблуждений, или Распространенные ошибки в лечении атопического дерматита у детей. Consilium Medicum. Педиатрия (Прил.). 2016; 3: 116–120.
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Smolkin Yu.S, Serdobintsev K.V., Smolkina O.Yu. Ten misconceptions or Common mistakes in the treatment of atopic dermatitis in children. Consilium Medicum. Pediatrics (Suppl.). 2016; 3: 116–120.
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Аннотация
В статье приводятся основные ошибки в лечении атопического дерматита (АтД) у детей с позиций современных представлений об этиологии и патогенезе заболевания. Особое внимание авторами уделено распространенным в отечественной практике заблуждениям, подменяющим эффективный терапевтический процесс методами и способами, не позволяющими достичь терапевтического эффекта, но и затягивающими патологический процесс, что приводит к большей вероятности дальнейшей хронизации АтД и появлению тяжелых, торпидных к лечению форм заболевания. Обосновывается недопустимость пренебрежения эффективными средствами поддержания увлажненности кожных покровов по достижении клинической ремиссии.
Ключевые слова: атопический дерматит, релевантные аллергены, гипоаллергенная диета, антигистаминные препараты, глюкокортикостероидные препараты, полипрагмазия, эмоленты.
Ключевые слова: атопический дерматит, релевантные аллергены, гипоаллергенная диета, антигистаминные препараты, глюкокортикостероидные препараты, полипрагмазия, эмоленты.
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The article presents the basic mistakes in the treatment of atopic dermatitis (AD) in children from the standpoint of modern concepts of the etiology and pathogenesis of the disease. Particular attention is paid to common errors in domestic practice, substitute methods and techniques effective therapeutic process fails to achieve a therapeutic effect, but also the infeed pathological process that leads to a greater likelihood of subsequent chronic atopic dermatitis, and the appearance of heavy, torpid to treat forms of the disease. Substantiated the inadmissibility of neglecting effective means of maintaining the hydration of the skin by achieving clinical remission.
Key words: atopic dermatitis, relevant allergens, hypoallergenic diet, antihistamines, glucocorticosteroid drugs, polypharmacy, emollients.
Полный текст
Список литературы
1. Pepys J. Atopy. In: Gill PGH, Combs RRA, Lachman PJ, eds. Clinical aspects of immunology. 3rd ed. Oxford: Blackwell Science, 1975; 877–902.
2. Wüthrich B. Clinical aspects, epidemiology and prognosis of atopic dermatitis. Ann Allergy Asthma Immunol 1999; 83: 464–70.
3. Volcheck GW. Clinical Allergy: Diagnosis and Management, Mayo foundation for Medical Education and Research. Abington: Humana Press, 2009.
4. Silverberg NB, Silverberg JI. Inside out or outside in: does atopic dermatitis disrupt barrier function or does disruption of barrier function trigger atopic dermatitis? Cutis 2015; 96 (11): 359–61.
5. Баранов А.А., Хаитов Р.М. Аллергология и иммунология. М.: Союз педиатров России, 2011. / Baranov A.A., Khaitov R.M. Allergologiia i immunologiia. M.: Soiuz pediatrov Rossii, 2011. [in Russian]
6. Атопический дерматит у детей: руководство для врачей. Под общ .ред. Н.Г.Короткого. Тверь: Триада, 2003. / Atopicheskii dermatit u detei: rukovodstvo dlia vrachei. Pod obshch .red. N.G.Korotkogo. Tver': Triada, 2003 [in Russian]
7. Gao L. Polymorphisms in the myosin light chain kinase gene that confer risk of severe sepsis are associated with a lower risk of asthma. J Allergy Clin Immunol 2007; 119: 1111–8.
8. Schlievert PM et al. Secreted virulence factor comparison between methicillin-resistant and methicillin-sensitive Staphylococcus aureus, and its relevance to atopic dermatitis. J Allergy Clin Immunol 2010; 125: 39–49.
9. Campbell DE. Role of food allergy in childhood atopic dermatitis. J Paediatr Child Health 2012; 48: 1058–64.
10. Bath-Hextall FJ, Delamere FM, Williams HC. Dietary exclusions for established atopic eczema. Cochrane Database of Systematic Reviews 2008; Issue 1: 11.
11. Eigenmann PA, Atanaskovic-Markovic M, O'B Hourihane J et al. Testing children for allergies: why, how, who and when. Pediatr Allergy Immunol 2013: 24: 195–209.
12. Greer FR, Sicherer SH, Burks AW. Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children: The role of Maternal Dietary Restriction, Breastfeeding, Timing of introduction of Complementary Foods, and Hydrolyzed Formulas. Pediatrics 2008; 121: 183–91.
13. Современная стратегия терапии атопического дерматита: программа действий педиатра. Согласительный документ Ассоциации детских аллергологов и иммунологов России – АДАИР. М., 2004. / Sovremennaia strategiia terapii atopicheskogo dermatita: programma deistvii pediatra. Soglasitel'nyi dokument Assotsiatsii detskikh allergologov i immunologov Rossii – ADAIR. M., 2004. [in Russian]
14. Ring J, Alomar A, Bieber T et al. Guidelines for treatment of atopic eczema (atopic dermatitis) Part I. J European Academy of Dermatology and Venereology 2012; 26: 1045–60.
15. Аллергология. Федеральные клинические рекомендации. Под ред. Р.М.Хаитова, Н.И.Ильиной. М.: Фармарус Принт Медиа, 2014. / Allergologiia. Federal'nye klinicheskie rekomendatsii. Pod red. R.M.Khaitova, N.I.Il'inoi. M.: Farmarus Print Media, 2014. [in Russian]
16. Brunner PM, Khattri S, Garcet S et al. A mild topical steroid leads to progressive anti-inflammatory effects in the skin of patients with moderate-to-severe atopic dermatitis. J Allergy Clin Immunology 2016 Feb 29.
17. Glazenburg EJ, Wolkerstorfer A, Gerretsen AL et al. Efficacy and safety of fluticasone propionate 0.005% ointment in the long-term maintenance treatment of children with atopic dermatitis: Differences between boys and girls. Pediat Allergy Immunol 2009; 20: 59–66.
18. Атопический дерматит и инфекции кожи у детей: диагностика, лечение и профилактика. Научно-практическая программа Союза педиатров России. Пособие для врачей. М., 2004. / Atopicheskii dermatit i infektsii kozhi u detei: diagnostika, lechenie i profilaktika. Nauchno-prakticheskaia programma Soiuza pediatrov Rossii. Posobie dlia vrachei. M., 2004. [in Russian]
19. Metz M, Wahn U, Gieler U et al. Chronic pruritus associated with dermatologic disease in infancy and childhood: Update from an interdisciplinary group of dermatologists and pediatricians. Pediatr Allergy Immunol 2013; 24: 527–39.
20. Diepgen TL. Long-term treatment with cetirizine of infants with atopic dermatitis: A multi-country, double-blind, randomized, placebo-controlled trial (the ETAC™ trial) over 18 months. Pediatr Allergy Immunol 2002; 13: 278–86.
21. Kleine PA, Clark RA. An evidence-based review of the efficacy of antihistamines in relieving pruritis in atopic dermatitis. Arch Dermatol 1999; 135: 1522–5.
22. Yao T-C, Chang C-J, Hsu Y-H, Huang J-L. Probiotics for allergic diseases: Realities and myths. Pediatr Allergy Immunol 2010; 21: 900–19.
23. Van Der Aa LB, Heymans HSA, Van Aalderen WMC, Sprikkelman AB. Probiotics and prebiotics in atopic dermatitis: review of the theoretical background and clinical evidence. Pediatr Allergy and Immunol 2010; 21: e355–e367.
24. Ahrens B, Staab D. Extended implementation of educational programs for atopic dermatitis in childhood. Pediatr Allergy Immunol 2015; 26: 190–6.
25. Wahn U, Staab D, Nilsson L. Atopic eczema: How to tackle the most common atopic symptom. Pediatric Allergy and Immunology 1999; 10: 19–23.
2. Wüthrich B. Clinical aspects, epidemiology and prognosis of atopic dermatitis. Ann Allergy Asthma Immunol 1999; 83: 464–70.
3. Volcheck GW. Clinical Allergy: Diagnosis and Management, Mayo foundation for Medical Education and Research. Abington: Humana Press, 2009.
4. Silverberg NB, Silverberg JI. Inside out or outside in: does atopic dermatitis disrupt barrier function or does disruption of barrier function trigger atopic dermatitis? Cutis 2015; 96 (11): 359–61.
5. Баранов А.А., Хаитов Р.М. Аллергология и иммунология. М.: Союз педиатров России, 2011. / Baranov A.A., Khaitov R.M. Allergologiia i immunologiia. M.: Soiuz pediatrov Rossii, 2011. [in Russian]
6. Атопический дерматит у детей: руководство для врачей. Под общ .ред. Н.Г.Короткого. Тверь: Триада, 2003. / Atopicheskii dermatit u detei: rukovodstvo dlia vrachei. Pod obshch .red. N.G.Korotkogo. Tver': Triada, 2003 [in Russian]
7. Gao L. Polymorphisms in the myosin light chain kinase gene that confer risk of severe sepsis are associated with a lower risk of asthma. J Allergy Clin Immunol 2007; 119: 1111–8.
8. Schlievert PM et al. Secreted virulence factor comparison between methicillin-resistant and methicillin-sensitive Staphylococcus aureus, and its relevance to atopic dermatitis. J Allergy Clin Immunol 2010; 125: 39–49.
9. Campbell DE. Role of food allergy in childhood atopic dermatitis. J Paediatr Child Health 2012; 48: 1058–64.
10. Bath-Hextall FJ, Delamere FM, Williams HC. Dietary exclusions for established atopic eczema. Cochrane Database of Systematic Reviews 2008; Issue 1: 11.
11. Eigenmann PA, Atanaskovic-Markovic M, O'B Hourihane J et al. Testing children for allergies: why, how, who and when. Pediatr Allergy Immunol 2013: 24: 195–209.
12. Greer FR, Sicherer SH, Burks AW. Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children: The role of Maternal Dietary Restriction, Breastfeeding, Timing of introduction of Complementary Foods, and Hydrolyzed Formulas. Pediatrics 2008; 121: 183–91.
13. Современная стратегия терапии атопического дерматита: программа действий педиатра. Согласительный документ Ассоциации детских аллергологов и иммунологов России – АДАИР. М., 2004. / Sovremennaia strategiia terapii atopicheskogo dermatita: programma deistvii pediatra. Soglasitel'nyi dokument Assotsiatsii detskikh allergologov i immunologov Rossii – ADAIR. M., 2004. [in Russian]
14. Ring J, Alomar A, Bieber T et al. Guidelines for treatment of atopic eczema (atopic dermatitis) Part I. J European Academy of Dermatology and Venereology 2012; 26: 1045–60.
15. Аллергология. Федеральные клинические рекомендации. Под ред. Р.М.Хаитова, Н.И.Ильиной. М.: Фармарус Принт Медиа, 2014. / Allergologiia. Federal'nye klinicheskie rekomendatsii. Pod red. R.M.Khaitova, N.I.Il'inoi. M.: Farmarus Print Media, 2014. [in Russian]
16. Brunner PM, Khattri S, Garcet S et al. A mild topical steroid leads to progressive anti-inflammatory effects in the skin of patients with moderate-to-severe atopic dermatitis. J Allergy Clin Immunology 2016 Feb 29.
17. Glazenburg EJ, Wolkerstorfer A, Gerretsen AL et al. Efficacy and safety of fluticasone propionate 0.005% ointment in the long-term maintenance treatment of children with atopic dermatitis: Differences between boys and girls. Pediat Allergy Immunol 2009; 20: 59–66.
18. Атопический дерматит и инфекции кожи у детей: диагностика, лечение и профилактика. Научно-практическая программа Союза педиатров России. Пособие для врачей. М., 2004. / Atopicheskii dermatit i infektsii kozhi u detei: diagnostika, lechenie i profilaktika. Nauchno-prakticheskaia programma Soiuza pediatrov Rossii. Posobie dlia vrachei. M., 2004. [in Russian]
19. Metz M, Wahn U, Gieler U et al. Chronic pruritus associated with dermatologic disease in infancy and childhood: Update from an interdisciplinary group of dermatologists and pediatricians. Pediatr Allergy Immunol 2013; 24: 527–39.
20. Diepgen TL. Long-term treatment with cetirizine of infants with atopic dermatitis: A multi-country, double-blind, randomized, placebo-controlled trial (the ETAC™ trial) over 18 months. Pediatr Allergy Immunol 2002; 13: 278–86.
21. Kleine PA, Clark RA. An evidence-based review of the efficacy of antihistamines in relieving pruritis in atopic dermatitis. Arch Dermatol 1999; 135: 1522–5.
22. Yao T-C, Chang C-J, Hsu Y-H, Huang J-L. Probiotics for allergic diseases: Realities and myths. Pediatr Allergy Immunol 2010; 21: 900–19.
23. Van Der Aa LB, Heymans HSA, Van Aalderen WMC, Sprikkelman AB. Probiotics and prebiotics in atopic dermatitis: review of the theoretical background and clinical evidence. Pediatr Allergy and Immunol 2010; 21: e355–e367.
24. Ahrens B, Staab D. Extended implementation of educational programs for atopic dermatitis in childhood. Pediatr Allergy Immunol 2015; 26: 190–6.
25. Wahn U, Staab D, Nilsson L. Atopic eczema: How to tackle the most common atopic symptom. Pediatric Allergy and Immunology 1999; 10: 19–23.
________________________________________________
1. Pepys J. Atopy. In: Gill PGH, Combs RRA, Lachman PJ, eds. Clinical aspects of immunology. 3rd ed. Oxford: Blackwell Science, 1975; 877–902.
2. Wüthrich B. Clinical aspects, epidemiology and prognosis of atopic dermatitis. Ann Allergy Asthma Immunol 1999; 83: 464–70.
3. Volcheck GW. Clinical Allergy: Diagnosis and Management, Mayo foundation for Medical Education and Research. Abington: Humana Press, 2009.
4. Silverberg NB, Silverberg JI. Inside out or outside in: does atopic dermatitis disrupt barrier function or does disruption of barrier function trigger atopic dermatitis? Cutis 2015; 96 (11): 359–61.
5. Baranov A.A., Khaitov R.M. Allergologiia i immunologiia. M.: Soiuz pediatrov Rossii, 2011. [in Russian]
6. Atopicheskii dermatit u detei: rukovodstvo dlia vrachei. Pod obshch .red. N.G.Korotkogo. Tver': Triada, 2003 [in Russian]
7. Gao L. Polymorphisms in the myosin light chain kinase gene that confer risk of severe sepsis are associated with a lower risk of asthma. J Allergy Clin Immunol 2007; 119: 1111–8.
8. Schlievert PM et al. Secreted virulence factor comparison between methicillin-resistant and methicillin-sensitive Staphylococcus aureus, and its relevance to atopic dermatitis. J Allergy Clin Immunol 2010; 125: 39–49.
9. Campbell DE. Role of food allergy in childhood atopic dermatitis. J Paediatr Child Health 2012; 48: 1058–64.
10. Bath-Hextall FJ, Delamere FM, Williams HC. Dietary exclusions for established atopic eczema. Cochrane Database of Systematic Reviews 2008; Issue 1: 11.
11. Eigenmann PA, Atanaskovic-Markovic M, O'B Hourihane J et al. Testing children for allergies: why, how, who and when. Pediatr Allergy Immunol 2013: 24: 195–209.
12. Greer FR, Sicherer SH, Burks AW. Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children: The role of Maternal Dietary Restriction, Breastfeeding, Timing of introduction of Complementary Foods, and Hydrolyzed Formulas. Pediatrics 2008; 121: 183–91.
13. Sovremennaia strategiia terapii atopicheskogo dermatita: programma deistvii pediatra. Soglasitel'nyi dokument Assotsiatsii detskikh allergologov i immunologov Rossii – ADAIR. M., 2004. [in Russian]
14. Ring J, Alomar A, Bieber T et al. Guidelines for treatment of atopic eczema (atopic dermatitis) Part I. J European Academy of Dermatology and Venereology 2012; 26: 1045–60.
15. Allergologiia. Federal'nye klinicheskie rekomendatsii. Pod red. R.M.Khaitova, N.I.Il'inoi. M.: Farmarus Print Media, 2014. [in Russian]
16. Brunner PM, Khattri S, Garcet S et al. A mild topical steroid leads to progressive anti-inflammatory effects in the skin of patients with moderate-to-severe atopic dermatitis. J Allergy Clin Immunology 2016 Feb 29.
17. Glazenburg EJ, Wolkerstorfer A, Gerretsen AL et al. Efficacy and safety of fluticasone propionate 0.005% ointment in the long-term maintenance treatment of children with atopic dermatitis: Differences between boys and girls. Pediat Allergy Immunol 2009; 20: 59–66.
18. Atopicheskii dermatit i infektsii kozhi u detei: diagnostika, lechenie i profilaktika. Nauchno-prakticheskaia programma Soiuza pediatrov Rossii. Posobie dlia vrachei. M., 2004. [in Russian]
19. Metz M, Wahn U, Gieler U et al. Chronic pruritus associated with dermatologic disease in infancy and childhood: Update from an interdisciplinary group of dermatologists and pediatricians. Pediatr Allergy Immunol 2013; 24: 527–39.
20. Diepgen TL. Long-term treatment with cetirizine of infants with atopic dermatitis: A multi-country, double-blind, randomized, placebo-controlled trial (the ETAC™ trial) over 18 months. Pediatr Allergy Immunol 2002; 13: 278–86.
21. Kleine PA, Clark RA. An evidence-based review of the efficacy of antihistamines in relieving pruritis in atopic dermatitis. Arch Dermatol 1999; 135: 1522–5.
22. Yao T-C, Chang C-J, Hsu Y-H, Huang J-L. Probiotics for allergic diseases: Realities and myths. Pediatr Allergy Immunol 2010; 21: 900–19.
23. Van Der Aa LB, Heymans HSA, Van Aalderen WMC, Sprikkelman AB. Probiotics and prebiotics in atopic dermatitis: review of the theoretical background and clinical evidence. Pediatr Allergy and Immunol 2010; 21: e355–e367.
24. Ahrens B, Staab D. Extended implementation of educational programs for atopic dermatitis in childhood. Pediatr Allergy Immunol 2015; 26: 190–6.
25. Wahn U, Staab D, Nilsson L. Atopic eczema: How to tackle the most common atopic symptom. Pediatric Allergy and Immunology 1999; 10: 19–23.
Авторы
Ю.С.Смолкин*1,2, К.В.Сердобинцев2, О.Ю.Смолкина2
1 ФГБОУ ДПО Институт повышения квалификации ФМБА России. 125371, Россия, Москва, Волоколамское шоссе, д. 91;
2 Научно-клинический консультативный центр аллергологии и иммунологии. 117513, Россия, Москва. ул. Островитянова, д. 6.
*smolking@df.ru
1 ФГБОУ ДПО Институт повышения квалификации ФМБА России. 125371, Россия, Москва, Волоколамское шоссе, д. 91;
2 Научно-клинический консультативный центр аллергологии и иммунологии. 117513, Россия, Москва. ул. Островитянова, д. 6.
*smolking@df.ru
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Yu.S.Smolkin*1,2, K.V.Serdobintsev2, O.Yu.Smolkina2
1 The Institute of Professional Development. 125371, Russian Federation, Moscow, Volokolamskoe sh., d. 91;
2 Scientific and clinical advisory center of allergy and immunology. 117513, Russian Federation, Moscow, ul. Ostrovityanova, d. 6
*smolking@df.ru
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