Atopic dermatitis No. 3 – Western medical treatment of atopic dermatitis

  The pathogenesis of atopic dermatitis is not well understood and is generally believed to be due to the interaction of genetics, environment, defective skin barrier function and immune dysfunction. Studies have shown that its pathogenesis is closely related to type 1 and type 2 allergic reactions. Common allergens include pollen, spores, animal dander such as dogs and cats, house dust mites, chemical gases and other inhalants, and foods such as eggs, milk, peanuts, soybeans, wheat, fish and shrimp. Therefore, first of all, we should actively look for possible triggering factors in the surrounding environment and diet, and try to avoid factors that may trigger or aggravate the disease, such as seafood, spicy condiments, dust mites, pollen and other inhalants and irritating sanitary disinfectants, etc.; avoid wearing chemical fiber and woolen underwear, etc., and do a good job of life protection.  Drug treatment for atopic dermatitis. Antihistamine agents: such as loratadine, cetirizine, etc. have the effect of inhibiting the release of inflammatory mediators and stopping itching, which can eliminate the vicious cycle of itching – scratching – itching aggravation. The first generation of antihistamines (such as ketotifen, cetirizine, etc.) have a more pronounced drowsiness, but are particularly suitable for those who do not sleep well at night due to pruritus. Corticosteroid preparations: prednisone or prednisolone has a strong anti-inflammatory and anti-allergic effect, for acute attacks, serious illness, can be used in appropriate amounts for a short time. Immunosuppressants such as tretinoin can be used in adult and stubborn patients, often with more significant results. Topical corticosteroid creams or creams are generally used for treatment. In recent years, topical immunomodulators, such as tacrolimus and pimecrolimus ointment for the treatment of this disease also achieved better results, they can work by binding specific cytoplasmic proteins and interfere with gene transcription.  In addition, the skin of AD patients is often colonized by pathogenic microorganisms such as Staphylococcus aureus, and about 65% of the Staphylococcus aureus isolated from skin lesions have the ability to secrete superantigens. Superantigens can trigger or aggravate the disease. The colonization and infection of fungi such as Candida albicans and Sporotrichia furfur are also one of the triggers for the onset and aggravation of AD. Therefore, attention should be paid to keep the skin clean, and moderate bathing can remove some allergens, pathogenic bacteria and their secreted super-antigens from the skin surface; infants and children should preferably wrap their hands with cotton cloth to reduce the chance of scratching damage and secondary infection. Treatment is mainly external, such as erythromycin and other macrolides, furomycin and quinolones and corticosteroids combined application; can also be added with econazole, ketoconazole and other antifungal drug treatment. It is often treated with corticosteroid combination containing antibacterial or antifungal agents, such as furomycin plus corticosteroids. Neomycin is easy to cause contact dermatitis, and should be used sparingly. A large number of clinical trials at home and abroad have shown that the efficacy of compounded preparations is significantly better than that of corticosteroid treatment alone.  Furthermore, the barrier and protection of the skin of AD patients are significantly reduced, making them more susceptible to external allergens and irritants; the water loss through their skin is also significantly higher than that of non-AD patients, making the skin more prone to dryness. Therefore, we should pay attention to avoid excessive bathing, especially to use less hot water and soap and other alkaline baths, and to use some skin care products with emollient and moisturizing effects in time after bathing, so as not to destroy the protective film of sebum and make the skin more dry and susceptible. Avoid contact with skin allergens and irritants, do not wear chemical fiber and woolen underwear, keep the environment clean; moisturizing creams are best without lanolin, preservatives and fragrances and other allergens; do not keep animals, birds, etc. in the room, do not keep plants with fragrance and easy to bloom; if you are allergic to decorative chemical materials, it is best to ventilate the new home after renovation for more than six months, and only after testing for toxic substances and irritating odors can be used.