scholarly journals Features of pathogenesis of itch and anti0itch therapy in children with allergic dermatosis (literature review)

2021 ◽  
pp. 57-67
Author(s):  
O.M. Mochulska ◽  
Keyword(s):  
Skin Diseases ◽  
Environmental Control ◽  
Allergic Inflammation ◽  
Calcineurin Inhibitors ◽  
Stevens Johnson Syndrome ◽  
Individual Approach ◽  
Topical Calcineurin Inhibitors ◽  
Multi Stage ◽  
Johnson Syndrome ◽  
Allergic Skin

Allergic dermatoses are allergic skin diseases, the most common of which are: simple and allergic contact dermatitis, atopic dermatitis, various forms of eczema, acute and chronic allergic urticaria, Quincke's edema, toxicodermias, multiforme exudative erythema (Stevens–Johnson syndrome), acute epidermal necrolysis (Lyell's syndrome). The clinical course of all allergic dermatoses is accompanied by itch, although its severity varies depending on the nosology. An important focus of treatment of allergic dermatoses is to control of skin itch, as it is the leading symptom. According to the international program documents EAACI (European Academy of Allergy and Clinical Immunology), AAAAI (American Academy of Allergy, Asthma & Immunology), PRACТALL (Practical Allergology Consensus Report) in treatment of allergic dermatoses the leading place takes anti-itch therapy, which requires an individual approach and daily care of skin. Systemic anti-itch therapy includes using of the following drugs: antihistamines, glucocorticosteroids, membrane's stabilizators (kromons), leukotriene receptor antagonists, anti-IgE. External anti-itch therapy consists of local application of emollients, topical glucocorticosteroids, topical calcineurin inhibitors, topical anti-histamines, reparants and epithelializing medications. Purpose — to increase knowledge about features of etiopathogenetically-based anti-itch therapy of allergic dermatoses in children. Conclusions. Treatment of itch of allergic dermatoses is diverse, complex and multi-stage, requires an individual approach to each patient, and includes: environmental control to eliminate allergenic and non-allergenic factors, systemic and local pharmacotherapy, skin care. Modern anti-itch therapy of allergic dermatoses should be etiopathogenetic and affect on local and system mechanisms of allergic inflammation with itch, it should be differentiated according to the stage of the disease, the phase of inflammation and the severity of skin manifestations and to be based on the rational use of drugs. No conflict of interest was declared by the author. Key words: children, allergy, allergic dermatoses, itch, anti-itch therapy.

scholarly journals External therapy of allergic dermatoses in children (literature review)

2020 ◽  
pp. 41-47
Author(s):  
O.M. Mochulska ◽  
Keyword(s):  
Clinical Course ◽  
Life Quality ◽  
Allergic Inflammation ◽  
Local Therapy ◽  
Calcineurin Inhibitors ◽  
Allergic Diseases ◽  
Skin Lesions ◽  
Stevens Johnson Syndrome ◽  
Topical Calcineurin Inhibitors ◽  
Allergic Skin

Allergic dermatoses have a special place in the structure of allergic diseases in children due to their weight. The most common allergic skin lesions: simple and allergic contact dermatitis, atopic dermatitis, various forms of eczema, acute and chronic allergic urticaria, Quincke's edema, multiforme exudative erythema (Stevens—Johnson syndrome), acute epidermal necrolysis (Lyell's syndrome), toxicodermias, as well as less common dermatoses, in the pathogenesis of which are leading allergic reactions. Despite a number of research research, the difficulties in the determining of the therapeutic approach of allergic dermatoses in children are still observed. According to the international program documents EAACI (European Academy of Allergy and Clinical Immunology), AAAAI (American Academy of Allergy, Asthma & Immunology), PRACТALL (Practical Allergology Consensus Report) in treatment of allergic dermatoses the leading place takes external therapy, which requires an individual approach and daily care of skin. External therapy consists of local application of emollients, topical glucocorticosteroids, topical calcineurin inhibitors, topical antihistamines, keratolytic, keratoplastic, reparants, epithelializing and anti-inflammatory medications, in the case of complicated clinical course of the disease — antibacterial, antifungal, antiviral medications, also with skin care. Purpose — to increase information on modern possibilities of external therapy of allergic dermatoses in children. External pharmacotherapy of allergic dermatoses should be etiopathogenetic and should affect on the mechanisms of allergic inflammation in the skin, elimination of itching, dryness,so finding ways to improve it will help to control the clinical course of the disease, to reduce disability, will promote to improve the life quality in patients. No conflict of interest was declared by the author. Key words: children, allergy, allergic dermatoses, external therapy, local therapy.

scholarly journals Peculiarities of the clinical course of allergic dermatoses in children (literature review)

2020 ◽  
pp. 58-63
Author(s):  
O.M. Mochulska ◽  
◽  
K.T. Hlushko ◽  
Keyword(s):  
Skin Diseases ◽  
Clinical Course ◽  
Clinical Manifestations ◽  
Allergic Diseases ◽  
Skin Lesions ◽  
Stevens Johnson Syndrome ◽  
Clinical Criteria ◽  
Johnson Syndrome ◽  
Allergic Skin ◽  
Allergic Contact

The prevalence of allergic diseases is constantly growing around the world. According to WHO forecasts, most of the world's population will suffer from various allergies by 2050, at the same time any substance can be an allergen, and the XXI century will be the era of allergies. In the structure of allergic diseases in children the leading place is occupied by allergic skin lesions — allergic dermatoses, which are characterized by pronounced clinical polymorphism, acute or chronic stage with the development of concomitant pathological changes in many systems of the growing child's body. Allergic dermatoses are a large group of skin diseases, including: simple and allergic contact dermatitis, atopic dermatitis, various forms of eczema, acute and chronic allergic urticaria, Quincke's edema, multiforme exudative erythema (Stevens-Johnson syndrome), acute epidermal necrolysis (Lyell's syndrome), toxicodermias, as well as less common dermatoses, in the pathogenesis of which are leading allergic reactions. Purpose — to describe clinical criteria for the differential diagnosis of allergodermatoses in children in order to increase its effectiveness. Conclusions. Allergodermatoses in children are characterized by polymorphism of clinical manifestations, which depends on the specific nosology. There is a tendency to increase the frequency of allergic skin diseases in children, especially severe forms with recurrent course, resistant to traditional pharmacotherapy. Comprehensive detailed study of clinical manifestations of allergic dermatoses in children will contribute to the development of differential diagnostic criteria for allergic dermatoses in children, to verify accurate diagnosis and to prescribe the pathogenesis-based treatment for various allergic skin diseases in time. No conflict of interest was declared by the authors. Key words: children, allergy, allergic dermatoses, clinical criteria.

scholarly journals Systemic therapy of allergic dermatosis in children (literature review)

2021 ◽  
pp. 62-67
Author(s):  
O.M. Mochulska ◽  
◽  
T.M. Kosovska ◽  
Keyword(s):  
Systemic Therapy ◽  
Environmental Control ◽  
Life Quality ◽  
Allergic Inflammation ◽  
Stevens Johnson Syndrome ◽  
Johnson Syndrome ◽  
Immunosuppressive Medications ◽  
Allergic Contact ◽  
Based Medicine

Allergic pathology of skin is one of the most pressing problems of modern pediatry. The most common allergic dermatoses: simple and allergic contact dermatitis, atopic dermatitis, various forms of eczema, acute and chronic allergic urticaria, Quincke's edema, toxicodermias, multiforme exudative erythema (Stevens-Johnson syndrome), acute epidermal necrolysis (Lyell's syndrome). Many aspects of systemic treatment of allergic dermatoses in children are complex and controversial. The modern strategy of treatment of allergic dermatoses in children is based on the principles of evidence-based medicine. According to the international program documents EAACI (European Academy of Allergy and Clinical Immunology), AAAAI (American Academy of Allergy, Asthma & Immunology), PRACТALL (Practical Allergology Consensus Report) treatment of allergic dermatoses consists of: environmental control to eliminate allergenic and non-allergenic factors, skin care, systemic and local pharmacotherapy. Systemic pharmacotherapy includes using drugs of the following groups: antihistamines, glucocorticosteroids, membrane's stabilizators (kromons), leukotriene receptor antagonists, anti-IgE, cytostatics, sorbents, hepatoprotectors, probiotics, vitamins and minerals, antioxidants, sedative medications, enzymes, antibacterial, antifungal and antiviral, immunomodulatory and immunosuppressive medications. Purpose — to increase information on modern possibilities of systemic therapy of allergic dermatoses in children. Conclusions. Systemic pharmacotherapy of allergic dermatoses should be etiopathogenetic and influence the systemic mechanisms of allergic inflammation, which will help control the clinical course of the disease, reduce disability, improve the life quality of patients. No conflict of interest was declared by the authors. Key words: children, allergy, allergic dermatoses, systemic therapy, internal therapy.

scholarly journals The role of mixed Mycoplasma and Herpesvirus infections in case of skin lesions in children

2019 ◽  
Vol 18 (3) ◽  
pp. 5-10
Author(s):  
H. O. Kuvardina ◽  
F. S. Kharlamova ◽  
I. V. Polesko ◽  
O. V. Shamsheva ◽  
O. S. Ostapuschenko
Keyword(s):  
Skin Diseases ◽  
Skin Lesions ◽  
Stevens Johnson Syndrome ◽  
Vascular Endothelial ◽  
Herpesvirus Infection ◽  
Inflammatory Reactions ◽  
Immune Mediated ◽  
Johnson Syndrome ◽  
Allergic Skin

Numerous literature data show the role of mycoplasma infection in the development of non-respiratory lesions of various organs and systems, including the skin. Herpesvirus and mycoplasma infections can trigger the development of immune-mediated inflammatory reactions of the skin and mucous membranes — erythema multiforme exudative, Stevens-Johnson syndrome, vesicular pustular dermatosis — Sneddon-Wilkinson syndrome, etc.In order to study the frequency and nature of skin lesions with mycoplasmosis combined with herpesvirus infection, 45 patients aged 3 to 15 years of life were observed. A comprehensive clinical and laboratory study revealed skin lesions in 27 patients associated with current mycoplasma and herpesvirus infections. Thus, multiforme exudative erythema in the small form variant was diagnosed in 13 patients, skin vasculitis in 4, hemorrhagic purpura in 3, urticaria rash in 3, erythema nodosum in 2, mucositis in 2 children. In 18 children, a combined mycoplasma and herpesvirus infection was established. In 9 children, a mono infection was detected (in 5 — herpes virus and in 4 — mycoplasma).All observed patients showed antibodies to smooth muscle antigens in titers from 1:80 to 1:160 (normal 1:40) and in the vast majority (in 24 patients) — antibodies to vascular endothelial antigens in titers from 1:80 to 1:320 (with the norm of 1:40). Compaction of the intima-media complex was detected in 6 patients with monoinfection and in 16 patients with co-infection, according to ultrasound duplex scanning of the vessels of the brachiocephalic department.Thus, for various immuno-inflammatory, allergic skin diseases, screening for infections, in particular, mycoplasma and herpesvirus, is necessary to optimize treatment.

Calcineurin Inhibitors: A Novel Approach to Canine Atopic Dermatitis

2005 ◽  
Vol 41 (2) ◽  
pp. 92-97 ◽  
Author(s):  
Rosanna Marsella
Keyword(s):  
Atopic Dermatitis ◽  
Adverse Effects ◽  
Mechanism Of Action ◽  
Broad Spectrum ◽  
Skin Diseases ◽  
Calcineurin Inhibitors ◽  
Relevant Information ◽  
Novel Approach ◽  
Allergic Skin ◽  
Traditional Therapies

The introduction of calcineurin inhibitors represents a major addition to the armamentarium of drugs available to veterinary clinicians for the management of allergic skin diseases. Both cyclosporine and tacrolimus have been proven to be well tolerated and effective for the treatment of atopic dermatitis in dogs. Although broad spectrum in their mechanism of action, they lack the major adverse effects of glucocorticoids and provide an appealing alternative to traditional therapies. The purposes of this article are to review clinically relevant information regarding these agents and to provide tips for maximizing the benefit obtained from these therapies.

scholarly journals LONG-TERM CONTROL OF SKIN ALLERGIC INFLAMMATION IN ATOPIC DERMATITIS PATIENTS

2014 ◽  
Vol 11 (3) ◽  
pp. 30-36
Author(s):  
O G ELISYUTINA ◽  
E S FEDENKO
Keyword(s):  
Atopic Dermatitis ◽  
Topical Treatment ◽  
Allergic Inflammation ◽  
Calcineurin Inhibitors ◽  
Intermittent Treatment ◽  
Topical Corticosteroids ◽  
Topical Calcineurin Inhibitors ◽  
Proactive Therapy

Modern approaches to topical treatment of atopic dermatitis (ad) are presented in the review. the application of different proactive therapy patterns like topical corticosteroids intermittent treatment and topical calcineurin inhibitors as antirecurrent therapy of ad patients are discussed.

scholarly journals Clinical and paraclinical features of course of allergic dermatosis in children

2020 ◽  
pp. 33-39
Author(s):  
O.M. Mochulska ◽  
◽  
T.M. Kosovska ◽  
Keyword(s):  
Humoral Immunity ◽  
Skin Diseases ◽  
Clinical Manifestations ◽  
Stevens Johnson Syndrome ◽  
Moderate Increase ◽  
Healthy Children ◽  
Statistical Research ◽  
Immunological Mechanisms ◽  
Allergic Skin ◽  
Cellular And Humoral Immunity

In recent years, in most countries of the world there is a significant increase in allergic skin diseases — allergodermatoses, especially in children. Allergodermatoses include: simple and allergic contact dermatitis, atopic dermatitis, various forms of eczema, acute and chronic allergic urticaria, Quincke's edema, multiforme exudative erythema (Stevens—Johnson syndrome), acute epidermal necrolysis (Lyell's syndrome), toxicodermias, and other less common dermatoses with allergic reactions in the pathogenesis. Various disorders of the morphofunctional state of the skin and immune mechanisms of pathogenesis in children with allergic dermatoses have been insufficiently studied. That is why a promising area of research is to study clinical and paraclinical features of allergic dermatoses in children for identify possible diagnostic criteria. Purpose — to improve the diagnostic of allergic dermatoses in children, to analyze clinical and paraclinical features of the course of allergic dermatoses, to study the indicators of cellular and humoral immunity, cytokine status, biomarkers of sensitization to allergens. Matherials and methods. 50 children with allergic dermatoses and 32 healthy children of the control group aged 1 to 18 years were examined. General clinical, immunological, allergic and statistical research methods were used. Results. The comprehensive study of the clinical manifestations of various allergic dermatoses in children was done. Allergic dermatoses are characterized by pronounced polymorphism of clinical manifestations, acute or chronic stage course, with the development of concomitant pathological polysystemic changes. In children with allergic dermatoses was detected disorders of the cellular immuneity with the development of an imbalance between individual subpopulations of lymphocytes: a decrease of CD3 with an increase of CD4 and a decrease of CD8, a corresponding increase of the immunoregulatory index, as well as an increase of CD20, CD19 and CD16 in the blood. Analysis of humoral immunity in children with allergic dermatoses showed dyssimmunoglobulinemia with decrease concentration of IgA, a significant increase concentration of IgE and a moderate increase concentration of IgM, IgG in the blood. Also in children with allergic dermatoses an increase concentration of circulating immune complexes and histamine in the blood was found. Conclusions. As the result of the conducted research similar immunological mechanisms in the pathogenesis of allergic skin diseases in children were established, together with etiologically significant factors and the only one mechanism for the formation of sensitization to allergens. The obtained data gave grounds to combine all allergic skin lesions in children into the one nosological group of allergic dermatoses. Dedicated clinical and paraclinical criteria of the diseases will promote to verify timely accurate diagnosis. The study was conducted in accordance with the principles of the Helsinki Declaration. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent of parents of children was obtained for the research. The authors were declare no conflict of interest. Key words: children, allergy, allergic dermatoses, cellular and humoral immunity, cytokine status.

scholarly journals Combined pathogenetic therapy of allergic dermatoses in children

2021 ◽  
pp. 28-38
Author(s):  
J. S. Kovaleva ◽  
N. K. Zyablitskaya ◽  
M. V. Orobei ◽  
N. K. Bishevskaya
Keyword(s):  
Side Effects ◽  
Skin Diseases ◽  
Local Therapy ◽  
Calcineurin Inhibitors ◽  
Skin Barrier ◽  
The Body ◽  
Skin Barrier Function ◽  
Severe Exacerbation ◽  
Omega 3 ◽  
Topical Calcineurin Inhibitors

Allergodermatoses make up the majority of allergic skin diseases in childhood, have a recurrent course and significantly disrupt the quality of life of patients and their families. The constant use of emollients, allowing to lengthen periods of remission and reduce the need for topical drugs, is associated with defects in the skin barrier function. Treatment with topical glucocorticosteroids (TCS) and topical calcineurin inhibitors (TCI), which are the basis of pharmacotherapy, should be carried out differentially, taking into account the localization, stage and activity of the inflammatory process, the area of the lesion, the age of the child and the multifactorial genesis of the disease. The basic principles of rational local therapy include the choice of the degree of activity of the drug, its concentration, dosage form, dosage frequency, duration of use to obtain a therapeutic effect and minimize side effects. In case of severe exacerbation and localization of inflammatory elements on the body and limbs in children, it is necessary to start treatment with class 2–3 THCS. When the process is localized on the face and other sensitive areas of the skin (neck and large folds), it is recommended to use class 7 TCS or give preference to TCI. The duration of a continuous course of TCS therapy in children depends on the severity of the exacerbation and should not exceed 2 weeks. The most effective way to reduce the course steroid load and avoid side effects is the early and correct use of TCS during an exacerbation. The advantages of TCI in comparison with TCS are the low incidence of side effects, the absence of contraindications for use on sensitive skin areas, and the possibility of longer use. The article contains Russian and foreign literature data on the use of THCS and TEC in the treatment of allegodermatosis in children and our own clinical observations of the effectiveness of the use of combination therapy: Comfoderm K cream (methylprednisolone aceponate with ceramides in the base), 0.03% tacrolimus ointment and emollient means - special cream Sensoderm with physiological lipids omega 3–6–9.

760 Patients with Pre-existing Mental Illness Who Developed Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: Lessons Learned at a Large Tertiary Burn Center and the Importance of Accurately Diagnosing Psychiatric Disorders

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S213-S214
Author(s):  
Sarah L Laughon ◽  
Michael Duplisea ◽  
Carolyn Ziemer ◽  
Lori Chrisco ◽  
Felicia N Williams ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Psychiatric Disorder ◽  
Toxic Epidermal Necrolysis ◽  
Psychiatric Disorders ◽  
Skin Diseases ◽  
Case Series ◽  
Lessons Learned ◽  
Stevens Johnson Syndrome ◽  
Burn Center ◽  
Johnson Syndrome

Abstract Introduction In recent years, burn centers are managing more patients with exfoliative skin disorders including Stevens-Johnson Syndrome (SJS), Toxic Epidermal Necrolysis (TEN), and SJS/TEN overlap. While it is well known that burn patients have higher rates of co-morbid psychiatric disorders than the general population, the incidence of pre-existing psychiatric disorders among patients who develop SJS, SJS/TEN overlap, and TEN is unknown. This study aimed to characterize a cohort of patients with pre-existing psychiatric disorders admitted to a tertiary burn center for treatment of SJS, SJS/TEN overlap, and TEN with specific focus on those who received the offending agent for a psychiatric indication. Methods A retrospective descriptive case series using an institutional burn center registry was performed. All patients admitted to a single verified burn center between January 1, 2009 and December 31, 2018 with biopsy-proven SJS, SJS/TEN overlap, or TEN and the presence of a co-morbid psychiatric disorder were identified. Demographic, hospital, and clinical information were extracted from the burn registry and verified through review of the electronic medical record. Results Among 168 patients with biopsy-proven SJS, SJS/TEN overlap, or TEN, 18% (30/168) had a pre-existing psychiatric disorder, with the offending agent being prescribed for a psychiatric indication in 30% (10/30) of patients. Lamotrigine was the offending agent in 80% of cases and prescribed 100% of the time for a psychiatric indication. Of those who received lamotrigine, patients were 100% female, 63% black, and had an average age of 38 years. The mean length of stay was 24 days and 88% received a psychiatric consultation. While 75% of patients were started on lamotrigine for a diagnosis of bipolar disorder, none of these patients met criteria for bipolar disorder. Conclusions Pre-existing psychiatric comorbidity is less common among patients that develop SJS, SJS/TEN overlap, and TEN than in burn-injured patients. For patients with pre-existing psychiatric disorders who develop these potentially fatal skin diseases from an offending agent that was prescribed for a psychiatric indication, early involvement of psychiatry colleagues is recommended to ensure proper psychiatric diagnosis and management moving forward. Applicability of Research to Practice This study highlights the importance of accurate assessment for and diagnosis of bipolar disorder prior to determining treatment approach. For the burn surgeon treating these patients, early involvement of psychiatric consultants is recommended and extremely important.

scholarly journals The control of skin allergic inflammation in atopic dermatitis with topical calcineurin inhibitors

2015 ◽  
Vol 12 (6) ◽  
pp. 84-93
Author(s):  
O G Elisyutina ◽  
O A Erina
Keyword(s):  
Atopic Dermatitis ◽  
Topical Treatment ◽  
Calcineurin Inhibitor ◽  
Allergic Inflammation ◽  
Calcineurin Inhibitors ◽  
Topical Calcineurin Inhibitors

Modern approaches to topical treatment of atopic dermatitis patients with calcineurin inhibitor - pimecrolimus are presented in the review.

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