Combined pathogenetic therapy of allergic dermatoses in children

Abstract

Allergodermatoses make up the majority of allergic skin diseases in childhood, have a recurrent course and significantly disrupt the quality of life of patients and their families. The constant use of emollients, allowing to lengthen periods of remission and reduce the need for topical drugs, is associated with defects in the skin barrier function. Treatment with topical glucocorticosteroids (TCS) and topical calcineurin inhibitors (TCI), which are the basis of pharmacotherapy, should be carried out differentially, taking into account the localization, stage and activity of the inflammatory process, the area of the lesion, the age of the child and the multifactorial genesis of the disease. The basic principles of rational local therapy include the choice of the degree of activity of the drug, its concentration, dosage form, dosage frequency, duration of use to obtain a therapeutic effect and minimize side effects. In case of severe exacerbation and localization of inflammatory elements on the body and limbs in children, it is necessary to start treatment with class 2–3 THCS. When the process is localized on the face and other sensitive areas of the skin (neck and large folds), it is recommended to use class 7 TCS or give preference to TCI. The duration of a continuous course of TCS therapy in children depends on the severity of the exacerbation and should not exceed 2 weeks. The most effective way to reduce the course steroid load and avoid side effects is the early and correct use of TCS during an exacerbation. The advantages of TCI in comparison with TCS are the low incidence of side effects, the absence of contraindications for use on sensitive skin areas, and the possibility of longer use. The article contains Russian and foreign literature data on the use of THCS and TEC in the treatment of allegodermatosis in children and our own clinical observations of the effectiveness of the use of combination therapy: Comfoderm K cream (methylprednisolone aceponate with ceramides in the base), 0.03% tacrolimus ointment and emollient means - special cream Sensoderm with physiological lipids omega 3–6–9.

Keywords

• atopic dermatitis
• allergic contact dermatitis
• topical glucocorticosteroids
• topical calcineurin inhibitors
• emollients