Dermatitis combines inflammatory skin diseases of various types. Disease is classified depending on the causes and localization of the lesion. Healthy human skin has protective functions, but with prolonged exposure to aggressive substances or with a decrease in immunity, the protective properties of the skin decrease, resulting in dermatitis. The group includes atopic dermatitis, simple and allergic contact dermatitis, actinic, drug-induced dermatitis, etc. The general principles of treatment of any dermatitis are: elimination of the factor that provoked dermatitis, local anti-inflammatory therapy and detoxification.
The cause of contact form can be contact with any irritant: physical, chemical, biological and mechanical. As a result of severe irritation, an inflammatory reaction of the skin occurs, proceeding according to the type of allergy or mechanically caused inflammation. The degree of clinical manifestations depends on the type of irritant, the time of exposure to the skin and its characteristics. That is, disease can manifest as a slight redness of the skin, and deep ulcerative lesions.
People with an allergic predisposition usually have allergic contact form as a result of contact with sensitizing substances. When contact with antigens occurs, a delayed-type response develops, the allergen interacts with the cells of the dermis and antigen-antibody complexes are produced, that is, the body’s immune system becomes hypersensitive to this stimulus and an inflammatory skin reaction or disease is observed upon repeated contact with the antigen. With the allergic nature of dermatitis, a response may occur immediately after contact with the irritant, at a subsequent meeting, or after 5-7 days; the speed of the immune response and the intensity of manifestations depend on the concentration of antibodies in the human blood. In the development of allergic form, hereditary predisposition and a history of allergic diseases (pollinosis, bronchial asthma) are of great importance.
In women, with prolonged therapy of vulgar acne and rosacea with corticosteroids, the skin becomes thinner, its structure and the chemical composition of sebum change, which leads to perioral and periorbital form, since the skin in the mouth and around the eyes is the most sensitive. Perioral dermatitis occurs in children with increased salivation and during teething. Provocative moments in the development of perioral dermatitis are chronic diseases of the digestive system, hormonal dysfunction, the presence of foci of chronic infection in the body. In people suffering from bulimia or neurological disorders, disease can be observed in the perioral region due to frequent contact with acidic stomach contents, due to provocation of vomiting.
Atopic form occurs in young and middle-aged children with a burdened allergic history and irrational nutrition. Atopic dermatitis has a chronic course, even if only one episode has been diagnosed; in adults, under unfavorable conditions, atopic dermatitis can recur.
The pathogenesis is based on the influence of exogenous and endogenous factors. Exogenous causes include external causes, and endogenous causes include internal causes.
External causes are mechanical influences, such as friction and prolonged compression, which leads to cracks, scuffs and swelling. Physical exposure to high and low temperatures, ultraviolet, radioactive and X-ray radiation are also factors that provoke dermatitis. The cause due to contact with chemicals are heavy metal salts, acids, alkalis, household chemicals, chemical warfare agents. Some plants, fungi, bacteria and viruses also cause local inflammation of the dermis, most often these are primroses, plants of the buttercup family, hogweed and ash.
Endogenous factors that reduce the protective functions of the skin are hypo- and vitamin deficiency, metabolic disorders, endocrine disorders such as Addison’s disease and scleroderma. Taking drugs of the group of antibiotics, sulfonamides and the use of novocaine-containing drugs most often provokes drug-induced dermatitis. Allergic form can occur as a result of eating disorders (strawberries, chocolate, coffee abuse). Diseases in which autointoxication is noted are often complicated by dermatitis, which are characterized by dryness, peeling and severe itching of the skin.
Perioral dermatitis occurs due to the abuse of cosmetics, irrational local treatment with hormonal drugs, sometimes the cause of such dermatitis is therapeutic toothpastes that contain fluoride. Lack of vitamins A and E cause dry skin, which can provoke the appearance of perioral dermatitis.
The main causes of atopic dermatitis are eating disorders in infancy, eating disorders of pregnant women, the presence of a history of allergic diseases and neuropsychiatric disorders. Statistical data on the incidence of atopic dermatitis in adults confirm that asthenic people with mental disorders of the type of anxiety-depressive states and with chronic diseases of the gastrointestinal tract due to low enzymatic activity, dyskinesia and dysbiosis are at risk.
The symptoms of dermatitis depend on the severity of the disease. So, with simple contact form, there is a slight redness of the skin, a local increase in temperature and slight infiltration, some patients may have itching and a tingling sensation in the affected area. But with prolonged contact with the irritant, dermatitis can manifest itself in the form of ulcerative-necrotic lesions, wet blisters, after opening of which it is possible to attach a secondary infection. Although in the anamnesis of the disease, the triggering factor is still contact with an irritant, which distinguishes complicated forms of dermatitis from pyoderma. An important clinical point for diagnosis is a clear limitation of the affected area, contact dermatitis appears only at the site of exposure to an irritant factor, this is necessary to differentiate it from allergic dermatitis.
With allergic dermatitis, the course of the disease is more acute, swelling and redness are more pronounced, itching joins; an important symptom in the development of allergic form is the spread of clinical manifestations to areas of the skin that has not been in contact with an allergen irritant.
Perioral dermatitis manifests itself in the form of small nodules and pustules that are localized around the mouth, on the cheeks, in the nasal folds and on the bridge of the nose. The presence of a narrow rim of healthy skin around the red border of the lips is an important diagnostic sign. The course of such disease is prolonged, rashes appear gradually, itching, peeling, dryness and a feeling of tightening of the skin are noted. For women, especially young women, cosmetic defects add a sense of psychological discomfort.
Atopic form is characterized by erythematous rashes with a tendency to exudation and the formation of vesicles, the elements are localized in the knee-elbow bends, on the buttocks and on the face. In adults, with relapses of atopic form, rashes are also noted in the places of bends, but papular infiltration develops on flaky dry skin with a tendency to dermography.
Clinical manifestations and the presence of contacts with irritating factors in the anamnesis of the disease are usually sufficient to diagnose dermatitis. From laboratory studies to confirm the diagnosis, a clinical blood test is performed (eosinophilia is noted in the blood), determination of the concentration of immunoglobulins and skin allergic tests. In allergic dermatitis, skin tests help to identify the allergen or group of allergens that are the cause of dermatitis. To diagnose diseases associated with dermatitis, you may need to consult a gastroenterologist, therapist, allergist and other specialists.
First of all, it is necessary to eliminate the effects of the irritating factor in order to prevent further skin lesions. A hypoallergenic diet improves the condition of the skin, both with allergic and other types of dermatitis. To eliminate itching, reduce infiltration and swelling, antihistamines such as clemastine, loratadine, fexofenadine are prescribed. At the same time, antihistamines of the latest generation do not cause drowsiness and attention disorders, which makes it possible for patients with dermatitis to lead a normal lifestyle.
If necessary, detoxification therapy is prescribed – activated charcoal, hydrolytic lignin, intravenous injections of sodium thiosulfate. But with intravenous detoxification therapy, especially if dermatitis is of an allergic nature, it is necessary to pre-test for sensitivity to drugs. Preparations containing calcium reduce the sensitization of the body, but if there is a history of bronchial asthma, it is better to abandon such drugs.
Local treatment of dermatitis consists in the use of hormonal ointments. If dermatitis is wet, with the presence of vesicles, then treatment with antiseptics and infusions of chamomile, oak bark have a drying effect, wet-drying dressings with antiseptics and ointments give a good result in the treatment of wet contact dermatitis.
If the course of dermatitis is complicated by the formation of vesicles and pustules, then the bubbles are opened in compliance with the rules of asepsis and antiseptics, and the surface is treated with aniline dyes. The use of iodine solutions in the affected areas is prohibited, they can only be treated with the edges of the wound to prevent the spread of infection.
Since itching and discomfort with dermatitis cause neurological disorders that prevent a speedy cure, the appointment of light sedatives of plant origin is indicated for all patients. These are tinctures of motherwort, valerian, peony. Glycine and combined herbal medicines also have a good sedative effect.
If the main cause of dermatitis is pancreatic dysfunction, then enzyme replacement therapy is necessary. In this case, taking pancreatin preparations is necessary after each meal. With dysbiosis, it is advisable to include fermented milk products in the diet, prebiotic therapy. As soon as the normal intestinal microflora is restored, the symptoms of dermatitis usually fade away.
Rational nutrition, observance of personal hygiene and sanitary and hygienic standards in the organization of work are fundamental points in the prevention of dermatitis. Citrus fruits, chocolate, nuts, fish and fish dishes should be excluded from the diet. Coffee, cocoa, spicy spices and sauces, vinegar and mayonnaise are also not recommended for eating with dermatitis. Eggplants, mushrooms, eggs, whole milk, strawberries, strawberries, pastries, smoked meats, fried and baked dishes during the treatment of dermatitis should not be present on the menu. And the use of low-fat dairy products, green vegetables and light soups make the drug therapy of dermatitis more productive.