Introduction: It is believed that if the child ate only a cow’s milk formula (CMF), and сow's milk allergy is the only possible at the age of <6 months. This approach leads to erroneous treatment tactics. Presentation of the clinical case: a child aged 3 months with the debut of atopic dermatitis (AtD) of light degree (on the scale of the assessment of the researcher IGA 2). The patient was fed on artificial with a CMF from 1,5 months. Infant was examined at the place of residence. The CMF was changed to full hydrolysis CMF and without examination. Additionally, cosmetics were applied to the skin as needed. The child was examined by an allergologist after 3-4 weeks of diet. Negative dynamics were observed. Atopic dermatitis has become moderately severe with secondary infection complications (IGA 3, 50% affected skin). Prick-tests with allergens of milk, eggs, wheat, fish were carried out. High sensitization to egg and controversial to cow’s milk was found. The results were clarified during enzyme immunoassay: IgE ovomucoid – 0.78 IU/ml (norm <0.3 IU/ml); cow's milk 0.01 kUA/ l; casein – 0.01 kUA / l (norm <0.1 kUA/l). Considering the infected AtD, "hydrocortisone + natamycin + neomycin" 2 times a day was used in the therapy. Cosmetics on infected foci was canceled, while maintaining the treatment of dry unaffected skin. It is recommended to limit household contacts with eggs. After 2 weeks, the rash is residual (IGA 0-1). The cow’s milk formula was returned to the diet without exacerbations of the skin process. Conclusion: The case illustrates that sensitization in children can begin and be maintained without oral ingestion of the allergen. Sensitization at the age of up to 6 months is likely with a moderate – severe recurrent course of dermatitis. A specific allergological examination can be conduct with a developed disease at an early age. Skin tests and enzyme immunoassay are applicable in infants. The appointment of a diet without examination is unreasonable and should not be used.
Objective. Evaluate the possibility of using a cream with 5 % filagrinol ("Admera") in children (0-18 years old) as an emollient in atopic dermatitis (AtD) and receive hardware measurements of skin hydration.Materials and methods. Open interventional study in parallel groups of children with AtD 0-18 years old (n = 72, median age 6 [3.75; 7.0] years). 2 equal groups: group 1 received methylprednisolone cream 1 time daily on lesions for 14 days + Admera emollient on the other skin; group 2 received the same treatment + cream with filagrinol 5 % applied from day 5 on the lesions.Results. Standard therapy with topical steroids and emollients was effective. The severity indices during steroid + emollient treatment decreased significantly: EASI 11.5 [6.0; 17.0] vs 2 [1; 3.8] scores, p < 0.001; skin lesion area from 17.5 % [10.0; 26.8 %] to 3.5 % [1.25; 6.0 %], p < 0.001; IGA score — 2 [2; 3] vs 1 [1; 2], p < 0.01.The total itching score for AtD (max 10) became significantly lower with therapy: nocturnal itching decreased from 3 [1; 7] to 1 [1; 3] and daytime itching from 4 [3; 7] to 2.5 [1; 4] points, p < 0.01.The mean values of hardware-measured skin hydration outside the lesion areas were 8 [6.0; 12.0] units at baseline. After 14 days of emollient, hydration of dry clear skin increased to 10 [8.0; 15.0] units (p = 0,017). The hydration of the skin on the affected areas increased significantly from 8 [6; 10] to 12.0 [8; 15] units (p = 0.001).The patients' organoleptic evaluation of the cream was 4.48 (max 5). No serious or moderate adverse events (AEs) were reported in this study. In 11.3 % of cases, the skin itching was detected, but resolved rapidly without treatment.Conclusion. The cream with 5 % filagrinol (“Admera”) significantly improved skin hydration, as measured instrumentally, in the area of dermatitis and dry skin without ones. The cream caused no significant adverse reactions and could be used together with topical steroids.
Hand eczema is a common disease – up to 5% in the general population. In addition, eczema is closely related to atopy and, like atopic dermatitis, to a mutation in the FLG gene. In addition to genetic factors, eczema is caused by external irritants and toxic substances. Eczema often occurs in families with atopic diseases, including asthma, allergic rhinitis/hay fever (and food allergies), and atopic dermatitis. These diseases share a common pathogenesis and often occur together in the same person and/or family. Eczematous rashes are often accompanied by itching. This symptom can lead not only to sleep disturbances but also to secondary infections. According to some data, the rate of infections in eczema can be more than 70%. In such cases, the drugs of choice are combined glucocorticosteroids (GC), which in addition to GC contain an antimycotic and an antibiotic. Our practical experience shows the high effectiveness of the combination of beclomethasone dipropionate, gentamicin, and clotrimazole not only in cases of eczema complicated by secondary infection but also in patients with other infected chronic dermatoses. This article reviews these and other practical aspects and problems in the treatment of hand eczema, discusses the etiological factors that lead to the development of the disease, and presents current data from clinical recommendations and guidelines for the treatment of eczema.
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