Atopic dermatitis (aka: allergic dermatitis, childhood eczema, diathesis) is a chronic recurrent inflammatory skin disease accompanied by intense itching and lesions of the visible areas of the skin.
Initially, atopic dermatitis was considered an allergic disease (some doctors still call characteristic rashes simply allergies). Indeed, in some patients, contact with allergens provokes exacerbations, and a high level of IgE is observed in the blood. However, there are many patients with pronounced manifestations of atopic dermatitis who are not sensitive to common allergens, their IgE level, despite the rash, is normal.
In this regard, back in 2001, European experts on atopic dermatitis proposed to classify the disease in two forms: allergic (atopic) and non-allergic (non-atopic). This classification reflects the fact that allergy (atopy) is not a prerequisite for the development of atopic dermatitis, and other, nonspecific factors may play a key role in its development. On the one hand, this is a great discovery, and the doctors should reassure the mother – it is far from the fact that her child is allergic. On the other hand, you need to look for the reason, but it’s much easier to tell the mother of the sprinkled toddler that she ate something wrong.
Perhaps the main cause of atopic dermatitis, as a chronic disease, is the skin, which lacks lipids and filaggrin protein.
Bacteria, viruses and other exogenous substances, as a rule, enter the body through the intercellular spaces of the stratum corneum. These gaps cover lipids, ensuring the integrity of the skin. Filaggrin protein, in turn, prevents excess moisture loss in the skin and helps maintain the skin’s barrier properties.
Allergies or dysbiosis do not always lead to atopy, but dry skin that is not protected from external influences will constantly irritate even from mechanical friction when crawling, from sweat, from saliva, etc. If you look closely at the skin of a sprinkled toddler, it is usually dry everywhere, and not only on the inflamed parts of the body, therefore, when treating atopic dermatitis, you should always take into account this feature of the skin of atopics. This is not “covering up” the problem, it is the restoration of the natural protective functions of the skin, which for some reason are not fully fulfilled (you can read more about skin care for atopic dermatitis here ).
Also, one of the main causes of atopic dermatitis is the heredity of genetic factors that contribute to the formation of pathology.
In the case of atopic dermatitis of both parents, the risk of developing pathology in a child is 81%. If only one parent is sick, the risk is 56%, and it increases if the mother is sick.
However, the baby inherits, as a rule, not the disease itself, but a predisposition to it, in other words, the possibility of getting sick. In order for the probability of getting sick in a child’s body to “come to life”, certain conditions are needed (problems during pregnancy, unfavorable environmental conditions, artificial feeding, early feeding, etc.).
As for exacerbations, the provocative factors are the following:
1. Immaturity of the gastrointestinal tract and liver.
Currently, it is the immaturity of the gastrointestinal tract (hereinafter referred to as the gastrointestinal tract) and liver that is considered to be the main cause of exacerbations of atopic dermatitis in infants. This immaturity is expressed in intestinal dysbiosis, insufficient amount of bile, and also in insufficient (less often in excessive) production of enzymes of the digestive tract and liver.
Dysbacteriosis can be of two types: a lack of useful flora (lacto and bifido bacteria, E. coli) or an excess of opportunistic and / or pathogenic flora. In infants, as a rule, both of these types are combined.
All children are born with a sterile intestine, its further settlement largely depends on the type of delivery (therefore, it is important, if possible, natural childbirth with passage through a healthy birth canal), the time of first attachment to the breast (the earlier, the better that the child, in the first place, received flora from colostrum, and then from the delivery room and the environment), the type of feeding (colostrum and breast milk in composition are close to the nutrition that the baby received in the womb, therefore they do not cause such stress for the body as when feeding a heavy and unfamiliar gastrointestinal tract mixture).
The resulting bacteria attach to the intestinal wall and form a continuous biofilm on it, the thickness of which in an adult reaches 2 cm.About two months after birth, this film is formed, and then another 8-10 months is stabilized, therefore, violations in the composition of the intestinal microflora – dysbiosis – is a physiological phenomenon common to all babies.
Due to the formed film, the “useful” flora protects the intestinal mucosa from damage by aggressive substances that it contains, and also prevents toxins and allergens from being absorbed into the bloodstream. All substances, before entering the blood vessels, are rendered harmless by bacteria.
In addition, bacteria secrete enzymes that break down food (in particular, they secrete 3 groups of enzymes: fats, proteins and carbohydrates). Accordingly, enzyme deficiency is also normal for infants. However, undigested food can ferment in the intestines, releasing toxins into the bloodstream (since the membrane of the beneficial flora is still too thin, and the liver, which must remove excess toxins, is still immature and cannot fully cope with its task). Further, the toxins with sweat go to the skin prone to atopy, and under the influence of external irritants the skin becomes inflamed.
Enzyme deficiency is determined by the results of the coprogram (undigested fat) and the analysis of feces for carbohydrates. Visually, these are white lumps (or pieces / drops of other food after the introduction of complementary foods) in the baby’s stool. Up to a year, undigested fragments with a stable weight gain are the norm.
Dermatitis, exacerbations of which are caused by the immaturity of the gastrointestinal tract, in some sources is called exudative-catarrhal diathesis.
Russian scientists consider allergy to cow’s milk proteins (hereinafter – BCM) as the cause of atopic dermatitis in 70-90% of cases. However, according to skin patch tests, only 3-22% (in other sources – 2-6%) of children of the first year of life show a positive reaction to CMP, and by 3 years the number of such children decreases to 1%.
Moreover, according to statistics, less than 10% of children diagnosed with atopic dermatitis, diagnosed before the age of 12 months, subsequently develop a food allergy to any product.
Where, then, does the figure of 70-90% come from? Most often, “food allergy” (which Russian pediatricians love to define after one quick glance at red cheeks) is associated with immaturity or disorders of the digestive system and disappears with age or after treatment without strict diets.
As for breastfeeding, here you need to understand that with a reasonable use of food by the mother (not a kilogram of strawberries per day, but 2-3 berries), all proteins in breast milk (and allergies are precisely to foreign proteins) fall in a split form (otherwise in words, in the form of traces of food consumed by the mother). The only protein that passes into breast milk unbroken is BCM. Why this happens is still not clear. However, for this feature of it, Russian doctors are so fond of putting mothers on a dairy-free diet.
In fact, the elimination of CMP from the mother’s diet is necessary when blood streaks are found in the baby’s stool. At the same time, dairy products and beef should be replaced by equivalent products. In any case, the product should be excluded after the fact and not in advance.
Household, pollen, bacterial and other allergens in exacerbations of atopic dermatitis play a role mainly in older patients, however, infants may also experience sensitization to them.
3. A sharp change in food.
During the entire first year, the child has to adapt to changing nutritional conditions: adaptation to milk nutrition; adaptation to mixtures; adaptation to the introduction of complementary foods; adaptation to the introduction of common table elements.
The transition from hemotrophic (feeding through the umbilical cord) to milk feeding in the first days of life is a complex chain of interrelated processes. Breastfeeding is an analogue and continuation of hemotrophic nutrition, so adaptation to breast milk is much calmer for a newborn’s body than adaptation to an artificially created mixture.
Replacing breastfeeding with artificial or mixed is a gross interference in the metabolic processes of the newborn’s body. A sharp change in diet and a meeting of an unprepared organism with a foreign, difficult to digest and containing a large amount of antigens BCM (40 ml of a regular infant formula contains the same amount of beta-lactoglobulin protein (it causes allergies) as 40,000 liters of breast milk), lead to a slowdown ripening of the baby’s gastrointestinal tract, overloading the liver and other organs, increasing several times the risk of developing allergic reactions and atopic dermatitis.
The next phase in the development of the child’s autonomous nutrition is associated with the introduction of complementary foods. In any case, complementary foods are stressful for the body, since these are completely new types of food that require more enzymes, gastric juice, etc. With an insufficient degree of maturity of the digestive tract, the introduction of complementary foods is another metabolic catastrophe with possible adverse consequences, therefore, children with atopic dermatitis are not recommended to introduce complementary foods earlier than six months.
4. Decreased immunity.
Very often there are exacerbations of atopic dermatitis during teething (you can read more about the connection between exacerbations of atopic dermatitis and teething here ), after vaccination, with ARVI, intestinal infections and in other cases of decreased immunity. During such periods, it often sprinkles even those toddlers who have always had perfect skin. And here mothers are often told about cumulative allergies.
In fact, with a decrease in immunity, all metabolic processes in the body slow down, because the main challenge is recovery and infection control. Usually on such days, the child refuses to eat, since the activity of the beneficial flora decreases, less enzymes are produced, and accordingly, the appetite decreases. You should not insist, otherwise there is an additional load on the body and the portion that the child normally absorbed easily will now overload the digestive tract, will ferment and throw toxins into the blood. It is better to temporarily switch to more easily digestible food.
In addition, with a decrease in immunity, pathogenic and conditionally pathogenic flora is activated, which also does not contribute to good digestion.
It should be noted that the immunity of any person is reduced from late autumn to spring, therefore, many patients with atopic dermatitis experience remission in the summer and exacerbation during the cold season.
Also, initially, there may be an immaturity of the immune system in children whose mothers were sick during pregnancy, including infectious diseases, took hormones, antibiotics, and faced the threat of miscarriage.
6. Taking antibiotics.
Taking antibiotics is one of the main reasons for the appearance of dysbiosis, since antibacterial drugs destroy not only disease-causing, but also beneficial bacteria. Many mothers notice that after antibiotic treatment, children who have already eaten complementary foods with perfectly clean cheeks begin to pour on breast milk and / or formula.
7. External irritants in contact with the skin, ecology.
There are many factors here.
First, dry air. Very often, periods of exacerbation occur during the heating season, when the air humidity in the apartment does not rise above 20% (at a rate of 40-60% for the normal existence of the body). For a skin that is unable to retain moisture, such air is destructive.
Very often, mothers note that at sea (where the air is humid and, as a rule, clean), the baby’s skin is cleansed in 2-3 days, and after a month or two after returning home, the cheeks turn red again. It was also found that urban dwellers suffer from atopic dermatitis more often than rural dwellers.
Secondly, chlorinated water. Chlorine dries out already dry skin even more.
Thirdly, a high air temperature means excess sweat (the optimum room temperature is 18-22 degrees).
Fourth, synthetic fabrics. In general, any fabric (as well as any surface), in contact with dry skin, will irritate it due to friction, but synthetics are more irritating because they promote sweat and prevent the skin from “breathing”.
The list is endless. In general, everything that comes into contact with the skin and / or dries it out are all irritants, which is why proper care and prevention of overdrying of the skin is so important.
8. Lack of calcium.
Calcium is found not only in bones and teeth, but also in blood vessels. With a lack of calcium, the vessels become thinner and more permeable, respectively, more toxins and allergens enter the bloodstream. For babies who have so much calcium going into the growth of teeth and bones, this factor is often relevant.
9. Vitamin D and other dietary supplements.
The question of the participation of vitamin D in the course of atopic dermatitis is very controversial. On the one hand, vitamin D is necessary for the absorption of calcium, and calcium, as mentioned above, plays an important role in the control of the course of atopic dermatitis.
On the other hand, infants diagnosed with atopic dermatitis usually have gastrointestinal problems that do not allow adequate absorption of heavy artificial supplements. Very often, mothers of sprinkled toddlers are surprised: I have been giving iron supplements for two months, and hemoglobin has not risen at all (or has not risen significantly). Artificial vitamins and minerals are much more difficult to assimilate than natural ones supplied with food. Moreover, they very often overload the digestive tract and lead to exacerbations of atopic dermatitis.
As for vitamin D itself, its intake by an atopic child should be especially carefully monitored. The fact is that excess vitamin D (unlike other vitamins) is not excreted in the urine, but accumulates in adipose tissue. In infants, there is not so much adipose tissue, and given the poor digestibility, there is often a lot of excess vitamin left, which leads to an overdose and, as a result, to an exacerbation of atopic dermatitis.
10. Parasitic diseases (worms, lamblia).
Small children pull everything into their mouths, so parasite infestation in babies from one to three to four years old is widespread. Parasites throw toxins into the bloodstream and poison the body with their waste products.
Moreover, constipation both in the baby itself and in the nursing mother. Undigested food residues rotting in the intestines are an excellent environment for bacteria and, again, toxins go into the blood (for more information about what constipation is and how to deal with it, see here ).
12. Psycho-emotional stress.
Stress, emotional stress, depression have an extremely negative effect on the course of the disease. Moreover, a vicious circle is often observed: stress causes rashes and itching, which, in turn, disturb a person, exacerbating stress.
Thus, the cheeks of babies do not always turn red due to allergies, so it is very important for the mother to understand the problem, and not just transfer the child to a full hydrolyzate or go on a hypoallergenic diet of water and buckwheat herself.
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