NEW APPROACHES TO THE DIAGNOSIS OF ATOPIC DERMATITIS IN CHILDREN

Atopic dermatitis (AD) takes special place in the structure of allergic diseases as it is one of the most prevalent and very first allergic manifestation, it often transforms into other allergic forms, decreases children’s life quality independent of the age and also needs long term and staged treatment. Purpose of work is to establish the status of immune status parameters and mediators of allergic inflammation and to assess the diagnostic capabilities of dermatoscopy and ultrasound examination of the skin in children with atopic dermatitis. Parameters of cellular and humoral immunnity, cytokine status, inflammatory mediators, morphological features of skin changes according to results of dermatoscopy and ultrasound examination were investigated in 128 children with atopic dermatitis aged from 1 to 18 years. Assessment of clinical course’s severity of atopic dermatitis was conducted by semiquantitative method using SCORAD index. In this article presents the results of immunological examination in children with AD and in healthy children aged from 1 to 18 years. Changes of parameters of cellular, humoral immunity, cytokine status and serum immunoglobulins dependent on severity of clinical course were found in children with atopic dermatitis. Atopic dermatitis is a chronic disease with very polymorphic manifestations in skin. According to the results we can conclude about presence of several dermatoscopy variants of skin damage on background of atopic dermatitis. In the study of echograms of skin areas affected by atopic dermatitis was noted thickening of all layers of skin, presence of hypoechoic wide band between the epidermis and the derma, diffuse decrease of derma echogenicity. Immunogram, dermatoscopy and ultrasound diagnostic of skin can be used in diagnostic process for verification and clarification of clinical diagnosis, evaluating of treatment effectiveness and examination of medical services quality. 

1. Беш Л. В. Атопический дерматит у детей. Здоровье ребенка, 2012; 2: 37. [Besh L.V. Atopic dermatitis in children. Zdorov’e rebenka 2012; 2: 37 (in Russ)]

2. Беш Л. В. Атопічний дерматит у дітей: аналіз діагностичних і тактичних помилок. Здоров’я України, 2013; Тематичний номер, алергологія: 52–53. [Besh L.V. Atopic dermatitis in children: analysis of diagnostic and tactical mistakes. Zdorov’ya Ukrainy 2013; allergology: 52–53. (in Ukr)]

3. On behalf of the World Allergy Organization (WAO), the authors of the WAO White Book on Allergy 2011-2012: Executive Summary express their gratitude to the charity, Asthma, Allergy, and Inflammation Research ( AAIR) for support in the production of this publication. United States of America, 2012; 220.

4. Давлетбаева Г.Р. Иммунные нарушения у детей с атопическим дерматитом в сочетании с хроническими заболеваниями. Вестн соврем клин мед 2015; 8(4): 56–64. [Davletbaieva H.R. Immune disorders in children with atopic dermatitis in combination with chronic diseases. Vestn sovrem klin med 2015; 8(4): 56–64 (in Russ)]

5. Невозинская З.А., Плиева К.Т., Корсунская И.М. Возможности контроля над течением атопического дерматита. Consilium Medicum 2016; Дерматология 49–53. [Nevozynskaia Z.A, Plieva K.T, Korsunskaia I.M. The ability to control atopic dermatitis. Consilium Medicum 2016; Dermatolohia 49–53 (in Russ)]

6. Макаренко Л.А. Неинвазивная диагностика в дерматологии. Рос журн кожн и венерич бол 2013; 2: 40–45. [Makarenko L.A. Non-invasive diagnostics in dermatology. Ros zhurn kozhn venerich bol 2013; 2: 40–45 (in Russ)]

7. Дутчак Г.М. Особенности течения атопического дерматита у детей. Здоровье ребенка 2011; 6: 33–35. [Dutchak H.M, Synoverska O.B. Features of clinical course of atopic dermatitis in children. Zdorov’e rebenka 2011; 6: 33–35 (in Russ)]

8. Охотникова О.М. Механизмы формирования и клинические особенности течения «аллергического марша» у детей. Здоровье Украины 2010; Тематичний номер, квітень: 16–17. [Okhotnikova O.M. Mechanisms of formation and clinical peculiarities of «allergic march» in children. Zdorov’e Ukrainy 2010; thematic volume: 16–17 (in Ukr)]

9. Severity scoring of atopic dermatitis: the SCORAD index. Consensus Report of the European Task Force on Atopic Dermatitis. Dermatol 1993; 186(1): 23–31.

10. Дмитерко С.В. Перспективи застосування дерматоскопії при іхтіозі. Вісник Вінницького національного медичного університету 2013; 1: 81–86. [Dmyterko S.V. Prospects of dermatoscopy for ichthyosis. Vistnyk Vinnytskoho natsionalnoho medychnoho universytetu 2013; 1: 81–86 (in Ukr)]

11. Дворяковский И.В., Кудрявцева А.В., Ларина К.А., Дворяковская Г.М., Сугак А.Б. и др. Ультразвуковая оценка кожи у здоровых детей и детей с атопическим дерматитом. Ультразвуковая и функциональная диагностика 2009; 2: 52–59. [Dvoriakovskyi I.V., Kudriavtseva A.V., La-rina K.A., Dvoryakovskaya G.M., Sugak А.B. et al. Ultrasonic skin evaluation in healthy children and children with atopic dermatitis. Ultrazvukovaia i funktsionalnaia diahnostika 2009; 2: 52–59 (in Russ)]

12. Malvehy J., Puig S., Braun R. P. Handbook of Dermoscopy. New York, Taylor & Francis, 2006; 95.

13. Зубейко К.А., Курлович М.В., Смысленова М.В., Привалова Е.Г. Ультразвуковое исследование кожи. Радиология – практика 2014; 6(48): 40–49. [Zubeiko K.A., Kurlovych M.V., Smyslenova M.V. Privalova E.G. Ultrasound skin research. Radiolohiya – Praktika 2014; 6(48): 40–49 (in Russ)]

14. Dzhor R., Soyer H. P., Ardzhentsiano D. Dermatoscopy. Read Elsiver 2010; 244.

15. Савоськина В.А. Дерматоскопическая картина и гистологические корреляции при некоторых дерматологических заболеваниях. Клин иммунол, аллергол, инфектол 2013; 8(67): 9–22. [Savoskina V.A. Dermatoscopic picture and histological correlation for some dermatological diseases. Klin immunol, allerhol, infektol 2013; 8(67): 9–22 (in Russ)]

16. Kittler H., Rosendahl C., Cameron A. Dermatoscopy – An Algorithmic Method Based on Pattern Analysis. Facultas Verlags & Buchhandels AG, 2011; 334.

17. Суид К., Гончарова Я.А. Опыт применения дерматоскопии в педиатрической дерматологии. Здоровье ребенка 2011; 8: 35. [Suid K., Honcharova Ya.A. Experience of using dermatoscopy in pediatric dermatology. Zdorov’e rebenka 2011; 8: 35 (in Russ)]

18. Lee J.B., Hirokawa D. Dermatoscopy: An overview. Part I: Non-Melanocytic Lesion. Skinmed 2010; 8: 265–272.

19. Безуглый А.П., Бикбулатова Н.Н., Шугинина Е.А., Белков П.А., Хабутдинова Н.Р. и др. Ультразвуковое исследование кожи в практике врача-косметолога. Вестн дерматол и венерол, 2011; 3: 142–152. [Bezuglyi A.P., Bikbulatova N.N., Shuhinina E.A., Belkov P.А., Khabutdinova N.R. et al. Ultrasound skin investigation in practice of doctor-cosmetologist. Vestn dermatol venerol 2011; 3: 142–152 (in Russ)]

20. Jasaitiene D., Valiukeviciene S., Linkeviciute G., Raisutis R., Jasiuniene E., Kazys R. Principles of high-frequency ultrasonography for investigation of skin pathology. J Eur Acad Dermatol Venereol 2011; 25(4): 375–382. DOI: 10.1111/j.1468– 3083.2010.038.