Lietuvos atopinio dermatito diagnostikos ir gydymo protokolas

Abstract

Atopinis dermatitas – tai paveldima, lėtinė uždegiminė odos liga, dažniausiai prasidedanti ankstyvoje kūdikystėje ir vaikystėje (85 proc. iki 5 m. amžiaus), bet galinti išlikti ar prasidėti ir suaugusiųjų amžiuje. Serga 10-20 proc. vaikų ir 1-3 proc. suaugusiųjų. Niežulys bei nukasymai ir lėtinė recidyvinė ligos eiga yra pagrindiniai ligos požymiai. Dažnai tai pirmasis atopijos pasireiškimas pacientams, kuriems vėliau atsiranda astmos ar (ir) alerginio rinito simptomai, todėl atopinis dermatitas vadinamas "atopinio maršo" pradžia. Nėra diagnostinių, laboratorinių testų atopiniam dermatitui patvirtinti. Atopinis dermatitas diagnozuojamas remiantis tipiniais klinikiniais simptomais ir tam tikrais atvejais alergenams specifinių IgE nustatymu. Straipsnyje pateikiamos naujausios atopinio dermatito diagnostikos ir gydymo rekomendacijos. Atskirų rekomendacijose pateiktų teiginių svarumas vertintas pagal tarptautinę GRADE įrodymų patikimumo klasifikaciją. Atopic dermatitis or atopic eczema is one of the commonest childhood skin conditions. The consensus of AD diagnosis and treatment process consisted of working group from Kaunas and Vilnius Universities process. Atopic dermatitis (AD) has a wide spectrum of dermatological manifestations and despite variuos validated sets of diagnostic criteria that have been developed over the past decades, there is disagreement about its definition and diagnostic criterias. In the diagnozes of AE several criteria have been taken into account (Hanifin and Rajka criteria, total or allergen specific IgE I evels in serum, Prick and Patch tests, SCORAD test and etc. Basic therapy is focused on hydrating topical treatment, and avoidance of specific and unspecific provocation factors. Anti-inflammatory treatment based on topical glucocorticosteroids and topical calcineurin inhibitors (TCI) is used for exacerbation management and more recently for proactive therapy in selected cases. Topical corticosteroids remain the mainstay of therapy, but the TCI tacrolimus and primecrolimus are preferred in certain locations. Systemic immun-suppressive treatment is an option for severe refractory cases. Microbial colonization and superinfection may induce disease exacerbation and can justify additional antimicrobial treatment. Adjuvant therapy includes UV irradiation preferably with UVA1 wavelenght or UVB 311 m. Dieatry recommendations should be specific and given only in diagnosed individual food allergy. Allergen-specific immunotherapy to aeroallergens may be useful in selected cases. Stress-induced exacerbations may make psychosomatic counselling recommendable. "Eczema school" educational programs have been proven to be helful. Pruritus is targeted with the majority of the recommended therapies, but some patients need additional antipruritic therapies.