The Constitution is a combination of morphological and functional properties of a person, due to his genotype, as well as long-term environmental influences, which determines the functional abilities and reactivity of an organism.
Anomalies in the constitution or diathesis are a predisposition to inadequate responses to common influences. This condition can transform into a disease under the influence of various factors: household stresses, poor nutrition, infectious factors, etc.
According to the WHO , 17 diathesis are currently released . With a deepening of knowledge about the characteristics of metabolism predisposing to certain diseases, their number will increase.
One of the options for diathesis is immunodiathesis , which is a predisposition to the occurrence of diseases, in the genesis of which changes in immunological reactivity are of paramount importance.
One of the most common types of immunodiathesis is allergic diathesis , which includes 2 types of predisposition:
- to diseases of atopic nature
- to autoimmune diseases.
Lymphatic diathesis also belongs to immunodiathesis .
Children with these diathesis are more likely to suffer from acute respiratory viral infections, gland. diseases, diseases of the urinary system. Against the background of diathesis, diseases have a tendency to a protracted, recurrent course, the development of complications. With diathesis, the formation of further pathology of the gastrointestinal tract, gastrointestinal tract and ICD, bronchial asthma, gout, and sah can be associated . diabetes, rheumatoid arthritis, etc.
It is characterized by a tendency to allergic reactions. It is detected in 10-30% of children. Atopic diathesis predisposes to diseases such as atopic dermatitis, bronchial asthma, hay fever, allergic gastritis, etc.
The tendency to allergies is due to hereditary characteristics that persist throughout life.
Blood Pressure Markers:
- genetically determined hyperproduction of IG E
- functional, and often quantitative, deficiency of Th 1 and Th 2 lymphocytes
- the ability of target cells to respond to contact with an allergen with increased production of histamine, leukotrienes, prostaglandins, and other allergy mediators
- low production of gamma interferon by leukocytes
- hyperproduction of IL 5
- Vagotonia and bronchial hyperreactivity
- Positive family allergic history
Environmental factors also play a role in the development of allergic diseases , in particular food products, household and drug allergens.
Children with atopic diathesis, as a rule, have excessive weight gain, they have an increased hydrophilicity of tissues, pale pink skin. As a rule, they have an enlarged liver, there are signs of biliary tract dysfunction, dysbiosis: constipation or unstable stools, flatulence. Marked “geographical” language, an increase in regional lymph nodes, prolonged subfebrile conditions. ARVI often occurs with obstructive syndrome.
During the implementation of atopic diathesis in young children, the skin is most often involved in the process , therefore, atopic dermatitis, as a rule, is the earliest clinical manifestation of atopy. (HELL). The likelihood of atopy increases if, along with atopic dermatitis , the child has repeated bouts of obstructive bronchitis and recurrent gallstones.
Prevention of the development of allergic diseases in children should begin antenatally with an exception in the diet of a pregnant woman with an unfavorable allergic history of foods that cause allergic reactions.
After birth – the longest possible natural feeding with a later introduction of complementary foods (from 6 months). You should not give juices from yellow and red fruits, citrus fruits. It is advisable to exclude meat broths, fish.
With artificial and mixed feeding, it is necessary to use adapted mixtures of fermented milk products.
After 1 year – a diet with the exception of obligate allergens, hypoallergenic conditions at home (wet cleaning at least 2 times a day, lack of pets, aquarium fish, flowers, etc.)
An individual vaccination plan with preliminary hyposensitizing therapy, identification and rehabilitation of foci chron is needed. infections, helminthiases, anemia, rickets, etc.
AD occurs in 14-28% of children, and in the structure of allergic diseases it occupies one of the leading places. Its manifestations in the majority (60-70%) of children appear in the first year of life.
Atopic dermatitis is a chronic allergic disease that develops in people with a genetic predisposition to atopy, has a relapsing course with age-related features of clinical manifestations, and is characterized by exudative and / or lichenoid rashes, increased levels of serum IG E and hypersensitivity to specific (allergenic) and non-specific irritants. The skin of a young child does not accidentally become a “target organ” of an allergic reaction. This is due to the anatomical and histological features, as well as to the nature of the immune response of the skin of a newborn and an infant to the effect of environmental antigens.
The subcutaneous fatty tissue of young children is considered a reticulo-histiocytic organ, reminiscent of bone marrow in function. In the dermis there are many fibrocytes, histiocytes, lymphocytes, plasma, endothelial cells. Of particular importance is the presence of mast cells in the skin and subcutaneous tissue .
Due to these features, the skin becomes one of the main organs involved in the formation of the atopic type of response to antigenic effects.
Risk factors for developing blood pressure in children
- HELL is a multifactorial disease. Risk factors can be endogenous and exogenous. The leading role in the development of blood pressure belongs to endogenous factors , which include:
- Genetically determined predisposition;
- Skin hyperreactivity
A genetically determined predisposition is confirmed by the fact that the frequency of blood pressure in monozygotic twins is 75% compared with 23% in dizygotic twins. The risk of developing blood pressure increases significantly if their parents are also sick with blood pressure: for example, if the parents are not sick, the risk is 10%, 1 parent is sick – the risk is 50%, both sick – risk – 75-80%.
By exogenous include factors: malnutrition, poor care for baby’s skin, fatigue, concomitant diseases (asthma, allergic rhinitis, diseases of the gastrointestinal tract, and others.), Stressful situations at home or in child care.
One of the most common risk factors for developing natural blood pressure are dietary disorders . These include irrational or unbalanced nutrition of the mother during pregnancy and lactation, the use of products containing an increased amount of allergens and protein, and insufficient consumption of fruits and vegetables.
Of particular importance is the unsustainable feeding of young children: early transfer to artificial and mixed feeding with the predominant use of non-adapted milk mixtures, early introduction of complementary foods, excess protein and carbohydrates in the diet, early use of whole milk.
Dietary family traditions are also of particular importance . This is an excessive consumption of gluten-containing (i.e. pasta and cereal) products, as well as canned and protein foods, and insufficient consumption of vegetables and fruits. As a result of the lack of fruits and vegetables , the intake of enterosorbents and ballast substances into the body decreases , the passage of food through the intestines slows down with the formation of toxic compounds, the delay in the intestinal lumen of possible food allergens with their further absorption. Excessive intake of allergens through the digestive tract triggers immunopathological processes that contribute to the formation of allergies.
Of great importance in the occurrence of blood pressure are diseases of the gastrointestinal tract, dysbiosis, and biliary dysplasia.
An important role in the formation of blood pressure is given to violations of the regime and rules for skin care , which include the use of funds not intended for children. Soaps, shampoos with high (alkaline) pH values cause dry skin. They can clog the ducts of the sebaceous glands and cause allergic reactions.
By household factors of risk are high ( 23) temperature of the air in the flat, low ( 60%) humidity, irregular, dry cleaning, dishwashing and laundry with the use of detergents, the content of the apartment pet fish aquarium.
Violation of vaccination rules , frequent acute respiratory viral infections, chronic foci can provoke the appearance of blood pressure . infections. In the nasopharynx and oral cavity, medication, secondhand smoke.
Etiology of blood pressure
The etiological or causative factors of blood pressure include allergens. Allergens can be non-infectious (food, inhalation, drug) and infectious (bacteria, fungi, viruses
Food allergens take a leading place among non-infectious causative factors in blood pressure, and in children of the 1st year of life, as a rule, they are the first and main cause of the development of the disease, because most often children of this age come into contact with food allergens, and the gastrointestinal tract they have immature. ) Food allergies lose their dominant role with age.
Almost any food product can cause blood pressure, but in children of the 1st year of life, sensitization to dairy products, eggs, food grains, soy, and fish most often develops.
. In children older than 3 years, the etiological significance of inhaled allergens increases , which at this age become leading. These include house dust mite allergens, epidermal, pollen, fungal. In the presence of pollen allergy, blood pressure is characterized by distinct seasonal exacerbations. Evidence of the role of the dust mite allergen in blood pressure is an improvement in the condition of the skin when the child is away from home, moving to another apartment.
Medications often become the cause of the development and exacerbation of blood pressure, especially after their uncontrolled use. Cause-significant allergens are antibiotics – penicillin and its semisynthetic analogues, sulfonamides, NSAIDs, B vitamins, etc.
Non-allergenic triggers of blood pressure
They can support the symptoms of blood pressure, or be a trigger factor in the disease.
The main ones are:
- high T and low humidity
- chemical irritants (soaps, detergents)
- physical irritants (combing, sweating, synthetic clothing)
- irritating food (spicy, sour)
- psychosocial factors
- chronic diseases
- emotional stress
- sleep disturbance
The same factors (for example, climate) in some patients can lead to improvement, while in others they cause an exacerbation of the disease.
Pathogenesis of blood pressure
Allocate immune and non-immune mechanisms in the pathogenesis of blood pressure.
1. Immune allergic reactions are characterized by:
- hyperproduction of IG E
- high level of specific IG E-antibodies
- the prevalence of TH 2 –response, accompanied by an increase in the production of IL-4, 5, 13.
With true immune reactions, 3 stages are conditionally distinguished:
1) immunological – the formation of allergic antibodies after the first contact with an allergen;
2) pathochemical – the interaction of target cells carrying a complex of IG E and other antibodies with a specific antigen and the subsequent release of mediators;
3) pathophysiological – the expansion of capillaries and stagnation of blood in them, an increase in their permeability, edema of the surrounding tissue, blood clotting, gland hypersecretion, smooth muscle spasm.
2. Non-immune (pseudo-allergic) reactions are characterized by the absence of the immunological phase of allergic inflammation, i.e. they occur without the formation of allergic antibodies and the release of mediators is carried out in a non-specific way.
The main role in the pathogenesis of blood pressure is played by IG E – mediated allergic reactions, i.e. type 1 immune responses. The basis of immunological disorders in blood pressure is an imbalance of TH 1 and TH 2-
lymphocytes, which is manifested by increased activity of TH 2-lymphocytes and is accompanied by hyperproduction of IL-4, 5, 13 and IG E.
When a causative allergen is directly exposed to the skin of a patient with AD, the allergen-presenting cells are activated, namely, Langerhans cells that carry IG E antibodies on their surface . Activated Langerhans cells migrate to the lymph nodes, where, in turn, they activate TH 2-lymphocytes secreting pro-inflammatory cytokines: IL-4, -5, -13. These cytokines play a major role in maintaining allergic inflammation in the skin. IL-4 and IL-13 switch the synthesis of immunoglobulins to IG E-response, facilitate the migration of eosinophils and mononuclear cells to the site of inflammation. IL-4 also inhibits the production of gamma-interferon and inhibits the differentiation of lymphocytes towards TH 1 cells. IL-5 enhances the response mediated by eosinophils.
These changes are characteristic of the acute phase of inflammation .
Further, the inflammation acquires a chronic course characterized by activation of TH 1-lymphocytes. It is due to increased synthesis of eosinophils and macrophages of IL-6, -8, -12. Increased production of gamma-interferon is noted. In this phase, the content of eosinophils in cells increases. Langerhans and macrophages. Eosinophils secrete highly toxic proteins (neurotoxin), lipid mediators, cytokines, enzymes, and active forms of O-2, which are involved in the development of inflammation. In the development and maintenance of chronic. inflammation in blood pressure plays an important role apoptosis , i.e. programmed cell death (in particular, eosinophils, whose survival in blood pressure is increased to 3 months, while normal life expectancy is 1 month).
Of great importance in the pathogenesis of blood pressure are functional disorders of the central nervous system, in particular, changes in neurovegetative regulation (the parasympathetic link is predominant).
The importance of microorganisms in the development of blood pressure
Infectious agents are currently regarded as very important factors in maintaining allergic skin inflammation. Damage to skin barriers in patients with AD promotes the penetration of microorganisms that activate mast cells, basophils, and cols. Langerhans and other immunocompetent cells. The most commonly sown is Staphylococcus aureus . Skin contamination with staphylococcus in patients reaches 90%, and in healthy children only 5%. The role of staphylococcus in pathogenesis is confirmed by a large effect in treatment with the inclusion of antibiotics along with local therapy.
Yeast and fungi take part in maintaining the pathological process in the skin , which are usually part of the normal skin flora, but become a pathological factor in blood pressure. The most common yeast. In patients with AD, the concentration of this fungus is redistributed on the surface of the skin and their highest concentration is found in the neck, face, and upper body. Proof of the role of yeast fungi is the detection of specific IG E-antibodies to yeast fungi and the effect of antifungal therapy in patients with blood pressure, which had skin lesions in the head, neck, upper torso.
- Age stages of blood pressure
- Infant (up to 2 years)
- Children (from 2 to 12 years old)
- Teenage (12 to 15 years old)
- Disease periods
- Process prevalence
- Remission (full, incomplete)
- Limited (affected to 5% of the skin surface)
- Common (over 5%)
- Diffuse (whole surface)
Diagnosis example: common blood pressure, infant stage, acute period, severe course.
The following typical clinical picture is characteristic of blood pressure:
- Itching of the skin
- Persistent hyperemia or transient erythema
- Papular vesicular eruptions
- Exudation (weeping)
- Dry skin
- Excavation (combs)
- Lichenification (thickening and strengthening of the skin pattern)
These changes are common or limited.
HELL usually appears in the first months of life , then taking a relapsing course with the possibility of complete or incomplete remission of various frequencies and durations.
Clinical symptoms depend on the age and period of the disease.
Acute period and stages of blood pressure
- Infant stage . At this age, there can be 2 forms: exudative (weeping ) and erythematic-squamous
With an exudative form during an exacerbation, hyperemia, swelling of the skin, papules, vesicles, erosion, wetting areas covered with serous and serous-purulent crusts are noted. There is an itching of the skin. Bubbles easily open with the formation of small erosions, from which a clear liquid oozes . These manifestations are located either localized (usually in the face: cheeks forehead, chin; scalp), or extend to the extensor surface of the upper and lower extremities, neck, trunk, inguinal and axillary regions, buttocks.
The erythematous-squamous form of blood pressure during the exacerbation period is characterized by severe dry skin, hyperemia, and slight swelling in the foci. The main elements are very itchy, sometimes draining, papules. There are secondary elements: a lot of erosion, crusts, peeling, excoriation. The transition from one form to another is possible.
2.Children’s stage. At this stage, acute inflammatory changes and exudation are less pronounced, an erythematous-squamous form of blood pressure is formed with the first signs of lichenification . The appearance of lichenification is evidence of a chronic process. Hyperemia, indurative (dense) skin edema, erythematous-squamous foci with flat small papules are noted. There is a pronounced dryness of the skin, signs of lichenification, peeling with a large number of finely lamellar and bran-shaped scales, numerous excoriations. The lesions are shifted to the natural folds and folds ( elbow and popliteal fossae, neck, rear of the hand), often they are symmetrical.
3. The teenage stage. During exacerbation in children over 12 years old, skin infiltration and lichenification predominate not against inflammatory erythema and low-intensity edema. And there are papules, dry skin, peeling, intense itching. There are many excoriations and hemorrhagic crusts that are localized on the face, neck, wrists, rear of the hands, in the elbow and popliteal fossae, the perineum.
In the subacute period of blood pressure , the extinction of symptoms of acute inflammation of the skin is noted. Prevailing dry, flaky skin, excoriation; in the period of child and adolescent stages – along with these symptoms has
During the period of remission, the clinical symptoms of blood pressure significantly decrease or completely disappear.
There are a large number of diagnostic criteria that are constantly being improved. The following option is most acceptable for a practitioner (United Kingdom):
Mandatory presence of itching and 3 or more of the following symptoms:
- The presence of dermatitis (or a history of dermatitis) in the region of the flexion surface of the limbs (elbow and popliteal folds, anterior surface of the ankles);
- The presence of bronchial asthma or pollinosis in the next of kin;
- Widespread dry skin;
- The onset of dermatitis before 2 years of age
The specificity of these signs is 96%.
1) A thorough history taking
2) Determination of specific IG E – antibodies to specific allergens
3) Skin testing
4) Provocative tests with an allergen or provocative elimination tests.
When using skin testing with food allergens, if a negative result is obtained, then this product can be used. The positive results of skin testing indicate only the presence of sensitization to a food product and are not proof of its causative significance in the occurrence of exacerbation of blood pressure, and therefore are not absolute evidence of the mandatory exclusion of a food product from a child’s diet. Despite a positive skin test, some children may tolerate this product normally. This is the so-called “latent sensitization” (there are antibodies to the product, but there are no clinical symptoms when using it).
To prove intolerance to such a food product, a provocative food test should be performed , or, more preferably, an elimination provocation test (all “suspected” products are excluded for 7-14 days).
Patients with AD often have positive skin tests for many food allergens, while from one to 3 food products are clinically significant, and only extremely rarely more than 3. If in such cases, based on the results of only skin tests to exclude many foods from food, this will damage the physical and mental development of the child.
Intradermal tests with food products are strictly prohibited due to the possibility of anaphylactic shock.
TREATMENT OF HELL
There are 3 areas of therapy (“3 whales”), the effectiveness of which is proven. Moreover, treatment can be successful only when it is carried out simultaneously in all 3 directions that make up “ first-line therapy” .
1) Elimination of causally significant factors causing exacerbation.
2) External anti-inflammatory therapy.
3) Medical and cosmetic skin care.
Elimination of causative factors causing exacerbation
Diet therapy is an essential component of the prevention and treatment of children with blood pressure. The exclusion of cause-significant food allergens from the diet of a young child can significantly improve its condition.
The most common reason for the development of blood pressure in children of the 1st year of life is an allergy to cow’s milk proteins (79-89%), which is facilitated by an early transfer to mixed and artificial feeding. Therefore, the child of the risk of formation of blood pressure during the transfer to artificial feeding should receive prophylactic mixture – hydrolysates based partially – gidrolizovnnogo protein (Humana HA HA hippies, Nan HA).
When symptoms of blood pressure in the first year of life appear in a child who is breast-fed, soy mixtures are often used (Alsoy, Nutrilaxoy, Similak-isomil, Enfamilsoy, etc.). However, often in children with allergies to cow’s milk, an allergy to soy is formed. In such cases, it is recommended to switch to therapeutic mixtures- hydrolysates based on high protein hydrolysis ( Alfare, Alimentum, Pepti-Junior, Nutramigen, Pregestimil, Frisopep).
Hydrolysates are obtained by splitting the protein into free amino acids and peptides, which reduces their allergenic properties.
The higher the degree of protein hydrolysis in the mixture, the higher its cost and more bitter taste. An exception is Frisopep , which retains its palatability and is relatively inexpensive. In addition, it can be used both as a therapeutic and as a prophylactic mixture, i.e. this mix is unique.
Breastfeeding is optimal for the baby.
However, 10-15% of breastfed babies are also allergic to cow’s milk proteins. This is due to excessive consumption of pregnant and lactating milk and dairy products. In such cases, the mother should exclude milk and products based on cow’s milk from her diet . If this does not work, then you need to carefully review the diet of a nursing mother. Using an elimination-provocative diet with “suspected” allergenic products, one can identify which of them causes an exacerbation and exclude it from the mother’s diet.
Breastfeeding should be maintained as long as possible (preferably at least 6 months).
It is advisable to prescribe complementary foods during breastfeeding not earlier than 6 months of age, and during artificial feeding – at the usual time.
In the 1st feeding – vegetable puree – it is recommended to introduce zucchini, squash, cabbage, potatoes. Cut the potatoes and soak them for 12-14 hours, the remaining vegetables 1-2 hours. Vegetable puree is prepared on a vegetable broth or on water.
2nd feeding – dairy-free cereal . The assortment of cereals is selected individually, since allergic reactions to protein (gluten) of cereal products (22-25%), often to wheat, rye, oats and even rice, buckwheat, and corn, are often noted. Cereals are soaked for 1-2 hours.
3rd feeding is given in the form of a second vegetable puree or a cereal-vegetable dish.
If you are allergic to cow’s milk proteins, due to a possible cross-allergy to beef from meat products, it is recommended to use rabbit, turkey, lean pork meat. The meat is double digested.
Expansion of the diet and the introduction of dairy products is possible no earlier than 6-12 months after achieving remission. Children over 1 year old are excluded from the diet broths, spicy, salty, fried foods, smoked meats, spices, liver, canned foods, fish, caviar, seafood, eggs, sharp cheeses, mayonnaise, ice cream, nuts, citrus fruits, strawberries, strawberries, chocolate, coffee, cocoa, honey, cakes, muffins.
External anti-inflammatory drugs
External anti-inflammatory therapy takes a leading place in the treatment of blood pressure. All patients with AD need external anti-inflammatory therapy, the nature of which is determined by the activity of skin inflammation.
As p / inflammatory therapy , glucocortcosteroids are used . Particularly effective are non-fluorinated corticosteroids, which are preferable to use in children: Advantan, Afloderm, Lokoid, Elokom. They can be applied to any area, including the face, neck, folds. With these drugs, treatment of children with severe blood pressure should begin, regardless of the stage of the disease.
Advantan ( methylprednisolone aceponate) quickly penetrates the skin and has a prolonged effect and minimal side effects. Approved for use in children from 6 months. It is applied once a day. Course up to 1 month. Available in the form of an emulsion, cream, ointment and oily ointment.
Afloderm (aclomethasone dipropionate) – contains 1 chlorine atom, which ensures good penetration of the drug into the focus of inflammation. Used by children from 6 months. It is applied from 1 to 3 times a day. Dosage forms – cream, ointment.
Lokoid (hydrocortisone 17-butyrate) is approved for use in children from 6 months. It is applied 1-3 times a day. Dosage form – ointment.
Elokom (mometasone furoate) has a high p / inflammatory activity. More active compared to other drugs in this group. Includes 2 chlorine molecules. Used in children from 2 years. It is applied to the skin 1 time per day. Dosage forms – lotion, cream, ointment.
Treatment with corticosteroids should be carried out for a long time, until the symptoms of dermatitis disappear completely, but not more than 1 month with daily use (duration and age – strictly according to the instructions).
In children up to 6 months, if necessary, you can apply 1% ointment of hydrocortisone acetate 1-2 times a day.
In 2003, a non-steroidal p / inflammatory drug appeared in Russia from the group of calicineurin inhibitors – pimexol and m u s ( Elidel cream ) . This drug, along with corticosteroids is the main means of external therapy. It is used from 3 months of age. It is prescribed after the relief of acute manifestations of severe blood pressure. In case of mild to moderate blood pressure, treatment begins with the use of Elidel , and in the absence of effect, GCS is prescribed for 5 days. Elidel can be used for a long time, because the period of its use is unlimited (even up to 1 year). It is always applied 2 times a day.
The preparation Skin-Cap , which is an activated zinc perition, has P / inflammatory activity . It has antibacterial and antifungal effects. The cream is used from 1 year 2-3 times a day for 3-4 weeks with increased flaking.
In complicated forms of blood pressure, combined drugs (GCS + antibiotic) are used – Triderm, Acriderm GK.
“Traditional” inflammatory drugs: ASD-3 fraction, tar, naphthalan, zinc oxide are rarely used at present due to their low effectiveness.
The dosage form of the drug
- Ointments have more powerful p / inflammatory activity than creams. They are used in the treatment of mainly subacute and chronic forms of blood pressure. Fatty ointments are prescribed for chronic lichenificating blood pressure.
- Creams – for acute and subacute inflammatory processes
Gels and lotions have a drying effect, so it is undesirable to use them with dry skin. They are useful in treating affected skin on the scalp.
This is standard therapy for blood pressure. They should be used in patients as a means of combating itching. You can apply them both constantly throughout the day, and only before bedtime.
First-generation drugs are used : diazolin (from 2 years), suprastin (from 1 month), tavegil (from 1 year), phencarol (from 6 months), fenistil (from 1 month). The course of treatment is 10-14 days. Their side effect is a sedative effect.
Ketotifen is a 1st generation drug (multifunctional drug), the effect of which occurs only after 1-2 months, therefore it is better to prescribe it for the prevention of exacerbation (from 1 month).
New generation antihistamines (2nd and 3rd): the most effective of them are clarithin (loratadine) (from 2 years old), zyrtec (cetirizine) (from 1 year old). New generation drugs do not have a sedative effect, along with anti-allergic have anti-inflammatory effect. The duration of their action is up to 24 hours, so they are prescribed 1 time per day. You can use them for a long time, because they are not addictive.
During exacerbation, Vit B 6 (pyridoxine), B 5 (calcium pantothenate) are used for 4-6 weeks, Vit A is 10-20 days.
Currently, there are a sufficient number of moisturizers and emollients, created specifically for the skin care of patients with blood pressure. Among them, special attention should be paid to the high-quality products of the French laboratories AVEN, A-DERMA and the BIODERMA company, our domestic MUSTEL line.
There are general rules for skin care for patients with blood pressure and their variations, depending on the phase of the disease.
- elimination of dry skin and restoration of damaged lipid layer of the skin
- the exclusion (restriction, as far as possible) of exposure to the skin of irritating factors.
- To eliminate dry skin, various moisturizers and emollients are used. Dry skin during blood pressure is associated with a violation of its barrier function, so only moisturizing the skin (hydration) does not restore the lipid layer. On the other hand, the use of funds that only restore the fat composition of the skin, without hydration, is also not enough.
In this regard , a combination of hydration with the use of emollients / lipid-reducing / agents is mandatory. Many modern tools combine these two qualities.
/ Bathing a child. Most common hygiene products contain alcohol, astringents that have an alkaline reaction, so they / soaps, shower gels, shampoos / cannot be used in patients with blood pressure because of their drying effect.
The soap used for patients with blood pressure should have a neutral pH and have minimal degreasing activity. The Cold Cream Soap / Lab meets these requirements. “Aven” /, which includes beeswax, paraffin, sweet almond oil, palm oil, and hydration is provided by Aven thermal water. You can use mousses and gels: A Toderm, Lipikar, Nutritious gel with cold cream. /
Skin hydration is provided by daily bathing for 15-20 minutes at a water T of 35-36g / bathing in hot water causes an exacerbation of blood pressure! /
/ Tap water before bathing should settle for 1-2 hours / to remove chlorine, followed by the addition of boiling water /. To enhance the therapeutic effect, you can add special gel creams for the bath / Trikzer / to the bath –– for 1 bath –1.5–2 caps of the “Trikzer bath” product. During the day, skin hydration should be supported by special irrigation. Water / Aven thermal water / or use moisturizing-emollients: Trikzer cream, Atoderm, Lipikar, Topikrem, Detsky cream, Rosa, Bepanten, Drapolen, d-Panthenol. Among domestic remedies, the Mustel moisturizer is worthy of attention, which can be used starting from the neonatal period.
The basic rule of using moisturizing-emollients: U-S means must be applied to the skin so often during the day so that the skin does not remain dry “not a minute”. On the 1st day, this is 5-10 times, then no more than 3 times can be enough (after sleep, after bathing, before bedtime). After bathing, the skin should be dampened with a towel ( without wiping it dry!) And apply on moist skin for 3 minutes after bathing. (If special agents were added to the water during bathing, then it is not necessary to apply a moisturizing – emollient).
2) Elimination of skin irritants
You should not use ordinary soap, detergents, rough clothes, it is necessary to avoid overheating and hypothermia of the skin. To reduce trauma to the skin caused by combs, use soft bedding, while small ones use gloves and socks for the night.
Skin care depending on the phase of blood pressure
In the acute and subacute phase in the presence of wetness :
– shows the use of wet-drying dressings, lotions, irrigation with thermal water, aerosols;
– cleansing the affected skin from pus, crusts, flakes with swabs with disinfectant solutions.
In the acute and subacute phases without weeping :
-day bathing followed by the use of creams;
– irrigation of the skin with thermal water, water chatterboxes, the use of special. soap, gel, cream for skin care.
In the chronic phase of blood pressure, the main is the use of moisturizers and, mainly, emollients.
Additional therapy for blood pressure
Cyclosporin A – in severe blood pressure resistant to conventional therapy. It suppresses the T-cell immune response, inhibits the synthesis of IL-5.
Interferons – gamma interferon suppresses the IG E-response
Sodium cromoglycate and cromoglycic acid (Nalkrom) – with increased sensitivity to many allergens.
Prevention of blood pressure
Allocate primary, secondary and tertiary prevention of blood pressure
1) Primary prevention involves the prevention of immunological sensitization (i.e., the appearance of specific IG E).
Only breastfeeding up to 4 months is recommended for all children. Children at risk for artificial feeding are recommended to use partially hydrolyzed mixtures : NAS GA, FRISOPEP, a mixture of goat’s milk “NENNI”.
2) Secondary prevention is carried out to prevent the onset of symptoms of the disease in a child with the presence of sensitization. These children should be referred to an allergist to determine the scope and nature of preventive measures.
3) Tertiary prevention is a warning of repeated exacerbation and timely treatment of the developed exacerbation.
This type of diathesis is a condition characterized by a hereditary predisposition to autoimmune diseases, which are classified as multifactorial (polygenic). The predisposition is realized in the disease when exposed to adverse environmental factors. Antigenic properties acquire their own cells and body tissues.
Clinical markers of autoimmune diathesis include thrombocytopenic purpura, autoimmune hemolytic anemia, systemic connective tissue diseases, autoimmune thyroiditis, diffuse glomerulonephritis , etc.
A common feature of these diseases is the chronic course, often leading to severe irreversible consequences with inadequate therapy.
Factors that provoke the transition of diathesis from a latent state to a manifest one are virus-bacterial infections, the effects of certain drugs, xenobiotics, vaccination, insolation, etc.
The most distinct markers of this diathesis are tissue histocompatibility antigens – HLA.
LD is characterized by a generalized persistent increase in l / y, endocrine system dysfunction with reduced adaptation to environmental influences, a tendency to allergic reactions. Its prevalence is 3-11%. Along with hyperplasia of the lymphatic tissue, there is hypoplasia of the internal organs (most often the heart, sex glands, thyroid and parathyroid glands), insufficiency of the adrenal cortex, mainly glucocorticoid function.
LD is caused by functional insufficiency of the adrenal cortex. However, the main role in its formation belongs to environmental factors acting both in utero (toxicosis of pregnant women, intravenous hypoxia of the fetus, diseases of the mother, leading to increased permeability of the placenta and sensitization of the fetus), and in utero – infectious diseases, unsustainable feeding, rickets and etc. Long-term infectious diseases cause a decrease in adrenal cortex function. Along with these factors, a hereditary genetically determined predisposition to LD is also observed.
There is an inverse relationship between the thymus and adrenal glands. It is assumed that the substances synthesized by the thymus reticuloepithelial apparatus inhibit the secretion of glucocorticoids, which is the case with LD. The synthesis of catecholamines is also reduced. This leads to the predominance of mineralocorticoids, which results in poor tolerance of stressful situations , a delay in the body of water, sodium, and chlorides. Secondarily, the activity of the pituitary gland is activated, the production of ACTH and growth hormone is increased. As a result, the proportionality of the development of the child’s body is violated, thymus hyperplasia occurs with a functional violation of its activity, and then hyperplasia of the entire lymphoid tissue. The functional inferiority of the thymus is expressed in a decrease in the humoral and cellular parts of the immune system (the number of T and B lymphocytes decreases)
Appearance is characteristic: children are pasty, pale, puffy face, excess body weight, tissue turgor and muscle tone are reduced. Disproportionality of physique is noted: short trunk and neck, long limbs. Children are apathetic, inactive, do not show curiosity, lag behind in the development of speech and static functions. Their inhibitory reactions predominate. All groups of lymph nodes are enlarged, there is hyperplasia of the tonsils and adenoid tissue. There is an increase in the thymus gland, liver and spleen, a “drip” median heart, and some have hypoplasia of the aortic arch and CHD. In 5% of children, thymomegaly is so pronounced that it can cause intrathoracic compression syndrome: shortness of breath, cyanosis, cough, tachycardia appear. A tendency to repeated SARS, otitis media, conjunctivitis and their prolonged course is characteristic . From the skin , dryness, eczema are possible. In the blood – leukocytosis, lymphocytosis, monocytosis and relative neutropenia, hypoglycemia, acidosis.
The danger of LD in children lies in the fact that under the influence of strong irritants, anesthesia, diseases, and sometimes with ordinary medical manipulations , fainting, collapse, and sometimes sudden death can occur. The cause of death is the development of acute adrenal insufficiency.
Therapeutic measures for LD
Mild treatment, elimination of stressful situations, infection prevention, nonspecific stimulation of the body’s defenses. It is necessary to observe the regimen of the day, a sufficient stay in the fresh air. Diet with the restriction of easily digestible carbohydrates, fats, liquids, salts. The total calorie content of food should be reduced by 10-15%. Hardening and water treatments are shown. Physical education should be carried out with a gradual load. All medical procedures must be carried out carefully.
Drug therapy is prescribed in courses 2 times a year – in spring and autumn: desensitizing agents, vitamins A, groups B, C, pentoxyl, eleutherococcus, ginseng tincture, dibazole, glycyram, aloe.
NERVO-ARTHRITIC DIATHESIS (OVER)
NAD (according to Veltishchev-uric acid) is characterized by genetically determined disorders of a number of enzymes involved in purine metabolism and uric acid synthesis.
It is less common than other diathesis (1.4-3%). Children have a predisposition to diseases such as gout, migraines, cholelithiasis and urolithiasis.
The formation of NAD in a child is associated with hereditary disorders of purine metabolism and uric acid, as well as with environmental influences: overloading with protein (first of all meat) diet products of a pregnant and young child.
In a family of children, metabolic diseases are detected: gout, cholelithiasis, ICD, atherosclerosis, hypertension, diabetes mellitus, etc.
Of primary importance is the change in the activity of liver enzymes, impaired purine metabolism with increased formation of uric acid and its accumulation in the blood, which leads to the development of acidosis. Excess uric acid and acidosis irritate the central nervous system, leading to increased excitability of the child. Along with this, uric acid inhibits the synthesis of cyclic nucleotides, adenylate cyclase, which leads to a tendency to allergic diseases with NAD. With NAD, instability of carbohydrate and lipid metabolism, a tendency to ketoacidosis, are noted .
Symptoms of NAD appear at an early age and become pronounced in preschool and school age.
Early manifestations are disorders of the central nervous system, manifested in increased excitability. Children are irritable, timid, capricious. The sleep is restless. Irritation of the central nervous system by products of purine metabolism contributes to earlier mental development: children are ahead of their peers in development. They are very curious, they develop speech early, they remember well what they read, and early they begin to read. The usual vomiting, constipation, abdominal pain is characteristic. Appetite is reduced and even absent. Children are usually thin.
Violation of fat metabolism leads to the accumulation of under-oxidized products, in connection with which acetonemic vomiting occurs periodically, which is indomitable, lasts 1-2 days. Vomit and exhaled air have the smell of acetone. Children are dehydrated, intoxication is noted , sometimes – cramps. Acetone is detected in the urine, acidosis in the blood.
There is a re-development of acute Quincke edema, periodic migraines, bouts of abdominal pain, and sometimes pain in the limbs and joints. On the skin there may be neurodermatitis, urticaria rashes, seborrhea, dry eczema. May be subfebrile temperature for a long time. Dysuric disorders periodically occur, while in the urine, urates, oxalates, phosphates are determined.
In the blood, lymphocytosis with neutropenia. A characteristic increase in the level of uric acid in the blood. Uraturia, oxaluria are determined.
Therapeutic measures for NAD
The main treatment is a rational regimen and nutrition. Children must be protected from excessive mental stress, limit the viewing of television programs. Useful hardening, physical education, a sufficient stay in the fresh air.
In a diet, restriction of foods rich in purine bases is necessary – these are eggs, liver, kidneys, white meats, meat and fish broths. From vegetables, it is not recommended to give legumes, cauliflower, sorrel, parsley, rhubarb. The restriction of products that stimulate the nervous system is shown: coffee, cocoa, strong tea, chocolate.
The children’s diet should be mainly milk and dairy products, vegetarian products with a predominance of alkaline valencies: vegetables, except prohibited, berries and fruits, flour and cereal products. It is useful to drink plentifully, alkaline mineral waters (Borjomi, Essentuki-17, Arzni, etc.).
With a decrease in appetite, gastric juice, abomin, pancreatin and other drugs are prescribed that help to improve appetite.
Urine pH is adjusted to prevent urolithiasis. With an acid reaction, vitamins B 1 and B 6 are administered, alkaline drink, magnesium oxide preparations are prescribed.
The appointment of repeated courses of calcium pantothenate (100-150 mg / day), potassium orotate (5-10 mg / kg / day) is shown.
With acetonemic vomiting, infusion therapy is carried out – reopoliglukin, 5% glucose solution, Vit. C, an alkaline drink is prescribed.
These measures can to some extent prevent the development of metabolic diseases in children.