A. WHAT IS ATOPIC DERMATITIS (ECZEMA)?
It is a chronic, recurrent, pink-coloured, itchy rash with a rough surface. Active lesions may be widespread throughout the body
or limited to one area. These may be in the form of pink, watery, itchy lesions. They may become infected as a result of excessive scratching. During periods when lesions constantly recur or do not heal, skin thickening, lines, peeling and darkening may occur. The distribution of lesions in the body varies depending on the age of onset of the disease.
1. Infantile Atopic Dermatitis:
It is seen in children between 2 months and 2 years old. Lesions occur especially on the face (often on the cheeks), scalp, neck, back, knees and elbow areas. The disease, which begins in this period, may recover by the age of 3
or may continue into later childhood years.
2. Childhood Atopic Dermatitis:
It is seen between the ages of 2-12. Skin lesions are frequently seen in the front of the elbow, behind the knee, neck, wrist and ankle. There is dryness, streaking, watering and itching in the skin areas where the lesions are located.
3. Adult Atopic Dermatitis:
It may occur as a continuation of childhood atopic dermatitis or as a skin disease that first begins between the ages of 12-20. Skin lesions are often found in front of the elbow and behind the knee. Sometimes
it can also occur in the hands. It usually causes lines, thickening and browning of the skin. Sometimes it may be accompanied by dryness and flaking of the skin around the eyes and mouth. It usually has a chronic
course.
Findings that may accompany Atopic Dermatitis:
· Distinctive lines on the palms and soles of the feet
· Dark shadows under the eyes
/> · Pale colored areas with well-defined borders on the cheeks, back, arms and legs
· Babies with atopic dermatitis may develop asthma or allergic rhinitis in later years
How is Atopic Dermatitis (Eczema) Treated?
1.Protective Measures:
The skin of these patients is extremely dry. Skin dryness causes symptoms to flare up. Therefore
It is extremely important to constantly moisturize the skin. Also, these people should not use normal soap
. It is recommended to use creamy soaps. Since sweating increases complaints, it is recommended to be careful, especially in hot weather. If any allergen (such as cow's milk, egg, house dust mite) that causes symptoms is detected during the examinations, precautions recommended by the doctor must be taken to avoid this allele.
2. Drug Treatment:
1.Anti-itchers (antihistamines-syrup, tablet)
The most important complaint of these patients is itching. In order to eliminate these complaints, it is necessary to use the medicine recommended by your doctor
in periods when the complaints flare up.
2.Local Corticosteroids (ointment, cream)
For skin lesions. During active periods, it is applied externally as a thin layer on the lesion, taking into account the duration of use recommended by your doctor. These medications should be applied after moisturizing the skin with the moisturizer recommended by the doctor.
B. URTICARIA (HIRVES) AND/OR ANGIOEDEMA (BIRD)
Skin with clear borders, pink color, sometimes pale in the middle, raised on the surface, itchy, diameter varying from a few
millimeters to a few centimeters Rashes are called urticaria. These rashes
can occur on any part of the body. Angioedema is a swelling of the skin and subcutaneous layer in some parts of the face, often such as the eyelids, lips and tongue. In angioedema, there is no color change and there is no itching. Rarely, angioedema in the larynx (entrance area of the trachea) or pharynx (
entrance area of the esophagus) can cause serious conditions such as hoarseness and difficulty in breathing
. Urticaria and angioedema can sometimes be seen together in the same patient.
What are the Clinical Types of Urticaria and Angioedema?
1. Acute Urticaria and Angioedema:This is the sudden appearance of the typical itchy rash
described. Lesions usually disappear within 24 hours, but may reappear intermittently for up to 6 weeks. Sometimes angioedema may accompany urticaria.
2.&nb sp;Chronic Urticaria:If recurrent urticaria and angioedema last longer than 6 weeks
, it is called chronic urticaria. It may be caused by medications, food additives, allergens, parasites or some other
infections. The causative agent can only be detected in 10% of patients.
3.Cholinergic Urticaria: The rash appears a few minutes after situations that cause the central body temperature to rise (such as a hot shower, or
exercise).
4. Physical Urticaria:
1.Demographicism:After scratching the skin with a hard pointed object or nail, a few It is a pink-colored swelling that occurs in the drawn area within
minutes. People with acute or chronic urticaria
usually have dermographism.
2.Pressure Urticaria:
1. Early type of pressure urticaria:It is the formation of red, burning rashes that occur within a few minutes following the application of pressure to the skin
. It usually takes 30 minutes.
2. Late type of pressure urticaria:Following a long-term pressure application on the skin (such as hanging a heavy bag on the shoulder for a long time, carrying a suitcase in hand, sitting for a long time) for 30 minutes It is the occurrence of rashes in the area exposed to pressure within 9
hours. Sometimes it may be accompanied by fever, chills and headache.
1. Solar Urticaria: It is a condition in which urticarial lesions occur within a few
minutes or a few hours after exposure to strong light or ultraviolet (sun rays) rays.
2. Cold Urticaria: Urticarial rashes that cause a burning sensation on the skin within minutes after contact with cold air or cold water. Sometimes it may be accompanied by fainting, headache, respiratory distress, dizziness and rapid pulse. There are also clinical forms that may appear a few hours after contact with cold. These patients should definitely be prevented from going into the cold sea
after diagnosis.
3. Adrenergic Urticaria:Behind situations that create psychological stress in the person It is a condition in which pink rashes of a few millimeters
appear in groups.
1. Contact Urticaria: It is an urticarial rash that occurs as a result of the person's skin coming into contact with a substance to which he/she is sensitive. The most accused substance in recent years is latex. Latex is a product used in surgical gloves and many medical supplies. In people with latex allergy, various
reactions, ranging from urticaria to serious allergic conditions called anaphylaxis, may occur after medical intervention with materials containing latex. People who are found to have such an allergy must be diagnosed with appropriate tests and necessary precautions must be taken before medical intervention.
2. Urticaria Triggered by Exercise: It is a condition in which a person has an allergic rash on the skin following exercise.
Sometimes accompanying angioedema, bronchial spasm (shortness of breath, wheezing), hypotension and fainting may occur.
How are Urticaria and Angioedema Recognized?
1.History Taking and Approach:
The detailed history taken by a specialist about the time, form, duration and triggering factors of urticarial rashes and accompanying reactions are the most important factors in diagnosis. part. In addition, all other possible factors that may cause the patient's rash (such as environmental conditions, medications used, diseases he/she has experienced) should be carefully questioned. This history should be taken by an allergist.
2.Specific Approach:
Following the taking of a detailed history, a careful physical examination should be performed. Depending on the type of urticaria (acute, chronic
or other types of urticaria), the patient is asked for necessary laboratory tests.
How Are Urticaria and Angioedema Treated?
1.Elimination: It is recommended to stay away from food,
medicines, other substances and factors that are noticed or detected through examinations to cause symptoms. The patient is informed about the ones that are suitable to be used instead. If there is an infection, it is treated. Patients experiencing serious reactions should use epinephrine-containing tablets that they can self-administer in case of emergency. preparations are recommended.
2.Drug Treatment:
1.H1 receptor blockers (antihistamines) (syrup, tablet): This group of drugs are the most important
drugs in treatment. H1 receptor blockers are divided into two groups: 1st and 2nd generation drugs. There are treatment methods that include using one
group of drugs alone or sometimes two groups of drugs together when necessary. It is necessary to use these drugs in the dose and duration recommended by your doctor.
2.H2 receptor blockers (tablets):In cases where there is no adequate response to treatment with H1 receptor blockers
, with the recommendation of the allergist. These are drugs added to the treatment.
3.Corticosteroids (tablets, injection):In cases of severe acute reactions or in cases of resistance to other treatments
, a single dose or for a certain period of time must be taken under the supervision of a doctor. These are the drugs that should
be used.
Adrenergic agents (injection):They are drugs that are administered urgently in cases of
laryngeal edema that may cause difficulty in breathing accompanied by urticaria or angioedema. Patients who have recurrent angioedema attacks are taught to carry this medication with them and to apply it as a subcutaneous injection into the arm in case of sudden airway obstruction
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