THE ROLE OF CONDITIONALLY PATHOGENIC FUNGAL STRAINS IN THE COURSE OF ATOPIC DERMATITIS IN CHILDREN

Abstract

Atopic dermatitis (AD) is a chronic recurrent inflammation of the skin with a prevalence 10-15% in children worldwide. The pathogenesis of AD is complex and insufficiently studied. Patients with AD are sensitive to viral, bacterial and fungal skin infections, because of the skin barrier function defection in an acute period. Irreversible changes of the skin barrier structure and transformation of the skin microbiota, excessive overgrowth of bacteria and fungi lead to chronization of AD. Early detection of the skin superinfection in AD may prevent chronization in early childhood. The purpose is to study the role of conditionally pathogenic fungal strains in the course of AD in children. Methods. 98 children with AD (age 3 months – 3 years) were. Transepidermal water loss, skin pH meas-urements and microbiological study were performed. Results. A group of 56 children among the 98 patients with AD had signs of a complicated course of AD due to rash and its localization, as well as the ineffective therapy with moisturizers, anti-inflammatory drugs and elimination diet, which is the first stage in the AD treatment according to the ICON recommendations. This rash was regarded as a possible fungal superinfection. 12 children out of the 56 had microbiologically confirmed contamination with fungi: Candida albicans (n = 6), Candida nonalbicans (n = 3), Hormodendrum compactum (n = 2), Aspergillus nidulans (n = 1). Detection of Spp. Malassezia did not give positive results. 89% of the children (n = 50) had verified changes of the skin pH (5.8). The patients with nontypical rash, changed pH ( 5.8) had an effective treatment with antifungul drugs and achieved remission in AD. Conclusion. Morphologically altered elements of moderate to severe rash should be regarded as a possible fungal super infection. Revealed changes in the skin pH and the background of altered clinical manifestations of AD (peeling spots with raised or scalloped edge, double contour, clear demarcated, cracks with blood secretion) should be regarded as activation of fungal microorganisms which is considered to be ethiotropically treated due to the guidelines.

Keywords

• children
• atopic dermatitis
• conditionally pathogenic strains.