Atopic Dermatitis in Children - Diagnosis and Treatment

Atopijski dermatitis ili atopijski egzem je kronično- recidivirajuća upalna dermatoza, uvjetovana genetskom predispozicijom, obilježena svrbežom, suhoćom kože i tipičnom kliničkom slikom koja u značajnoj mjeri ovisi o dobi bolesnika. Prevalencija je visoka i u stalnom je porastu. Atopijski dermatitis je najčešće prva bolest u atopijskome maršu na putu kasnijeg nastanka drugih atopijskih bolesti kao što su bronhalna astma i alergijski rinitis. Rano prepoznavanje i primjena optimalne i učinkovite terapije nužni su, a možda imaju ulogu i u prevenciji kasnijeg nastanka ostalih atopijskih bolesti.Atopic dermatitis/eczema is a chronic, recurring infl ammatory skin disease, caused by genetic predisposition, and characterized by itch, skin dryness and a typical clinical picture that to a large extent depends on the age of the patient. The prevalence is high and has been increasing over the past few decades. Atopic dermatitis is usually the fi rst to appear in the course of the atopic march and later development of bronchial asthma and allergic rhinitis. Early recognition and introduction of optimal and effi cient treatment is necessary and might have a preventive effect in the development of other atopic diseases

Food Allergy in Children with Atopic Dermatitis

Alergija na hranu čest je problem u bolesnika s atopijskim dermatitisom, osobito u djece. S obzirom na kliničke spoznaje u posljednjih nekoliko desetljeća, jasno je da hrana, kao kravlje mlijeko i kokošje jaje, može direktno dovesti do pogoršanja atopijskog dermatitisa, osobito u senzibilizirane djece. Budući da su uloga, kao i imunosna zbivanja alergije na hranu kod atopijskog dermatitisa još nedovoljno potpuno razjašnjeni, mi ćemo se upravo osvrnuti na utjecaj alergije na hranu kod djece s atopijskim dermatitisom.Food allergy is a common problem in patients with atopic dermatitis, particularly in children. Based on clinical data from the past few decades, it is clear that food as cow’s milk and hen eggs can directly provoke fl ares of atopic dermatitis, particularly in sensitized infants. Because the role and immunology of food allergy in atopic dermatitis remain controversial, here we review data that mainly focus on food allergy in children with atopic dermatitis

Mastocytosis in children

Mastocitoze predstavljaju heterogenu skupinu bolesti, a obilježene su proliferacijom i nakupljanjem mastocita u različitim tkivima. Razlikujemo kožne mastocitoze, u kojih se nakupljanje mastocita nalazi isključivo u koži, od sistemske mastocitoze kod koje je proliferacija mastocita prisutna u koštanoj srži te u drugim organima kao što su gastrointestinalni trakt, limfni čvorovi, jetra i/ili slezena. U djece se javljaju gotovo isključivo kožne mastocitoze, za razliku od odraslih, u kojih se dijagnosticira sistemska mastocitoza. Izgled i rasprostranjenost kožnih promjena, kao i simptomi, mogu značajno varirati. Simptomi su posljedica oslobađanja upalnih medijatora iz mastocita, najčešće svrbež te crvenilo i urtike. Nužne su redovite kontrole ovih bolesnika, a organomegalija, značajno povišene vrijednosti serumske triptaze, kao i prisutnost KIT mutacije u perifernoj krvi, pomaže u odluci u kojeg je bolesnika nužno učiniti biopsiju koštane srži. Liječenje je najčešće simptomatsko, usmjereno na izbjegavanje okidača i smanjivanje simptoma bolesti koji su posljedica oslobađanja upalnih medijatora iz mastocita, najčešće primjenom H1i H2 blokatora, primjenom lokalnih kortikosteroida i pimekrolimusa.Mastocytosis are a heterogeneous group of diseases characterized by proliferation and accumulation of mastocytes in various tissues. Cutaneous mastocytosis is diagnosed if the accumulation of mastocytes is detected only in the skin. In cases of systemic mastocytosis the mastocytes accumulate in the bone marrow, gastrointestinal tract, lymph nodes, liver and/or spleen. Contrary to adults, in who systemic mastocytosis is the most common type of mastocytosis, in childhood the vast majority of patients are diagnosed with cutaneous forms of the disease. The type, distribution and extent of skin lesions, as well as symptoms, can vary from patient to patient. Symptoms are due to release of inflammatory mediators from mastocytes, most often itch, redness of the skin and wheals. Regular follow-ups are necessary, while organomegaly, significantly elevated serum tryptase levels and/or detection of KIT mutation in peripheral blood help in decision if and when to perform bone marrow biopsy. Treatment is aimed toward avoidance of triggers, and alleviation of symptoms caused by mast cell mediators, usually H1 and H2 blockers, as well as topical corticosteroids and pimecrolimus application