Atopický ekzém u dojčiat

8.4.2012 , Jiří Dyntr

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Atopický ekzém u dojčiat je dlhodobé a ťažko liečiteľné ochorenie. Typická je tvorba začervenaných, svrbivých ložísk na koži, do ktorých môže byť ľahko zanesená infekcia. Najčastejšie sa atopický ekzém vyskytuje na hlave, lakťoch, slabinách, kolenách a priehlavkoch. Príčinou atopického ekzému je precitlivenosť k určitým látkam prostredia tzv. alergénom. Preto sa atopický ekzém môže objaviť v spojení s astmou alebo napr. alergickou nádchou.

Atopický ekzém u dojčiat

Atopický ekzém u dojčiat je dlhodobé a väčšinou ťažko liečiteľné ochorenie kože. Pre atopický ekzém je typická tvorba výrazne svrbivých začervenaných ložísk na koži, ktoré môžu byť ďalej komplikované zanesením infekcie alebo krvácaním. Príčinou vzniku atopického ekzému je tzv. atopia, čo je vrodená precitlivenosť k niektorým látkam vo vonkajšom prostredí. Týmto látkam hovoríme alergény. Často sa uplatňujú alergény prítomné v potrave alebo tie, ktoré sú rozptýlené vo vzduchu. Spoločne s výsevom atopického ekzému sa u pacientov môžu objaviť aj ďalšie ochorenia s príčinou v alergii, napr. astma alebo alergická nádcha.

Vznik atopického ekzému u dojčiat

Atopický ekzém je ochorenie, ktoré vzniká spolupôsobením vonkajších a vnútorných faktorov. Jedná sa o výsledok patologickej imunitnej reakcie, ktorý vzniká na genetickom podklade. Uplatňujú sa však aj niektoré vonkajšie faktory, čo sú rôzne látky z vonkajšieho prostredia, ktoré fungujú ako alergény. Uplatňujú sa tiež najrôznejšie klimatické vplyvy a dôležitú úlohu hrá aj psychický stav človeka. Súhrou týchto faktorov vznikajú typické prejavy atopického ekzému. Okrem alergické formy atopického ekzému existuje tiež tzv. nealergická forma, pri ktorej nie sú aktivované rovnaké imunitné mechanizmy ako pri alergickej forme, výsledný obraz je preto totožný.

Prejavy atopického ekzému u dojčiat

Dojčenská forma je najčastejším typom atopického ekzému a vyskytuje sa obyčajne v 2. až 6. mesiaci života. Postihuje najprv čelo a líca a neskôr sa rozšíri na celú hlavu. Ďalej je výsev atopického ekzému u dojčiat pozorovaný na miestach, ktoré sú viac vystavené mechanickému tlaku. Jedná sa napríklad o predlaktie, triesla, kolená, priehlavky a priestor medzi lopatkami. Koža je výrazne červená a na jej povrchu sa vytvárajú drobné pľuzgieriky, dochádza k mokvaniu a postupne sa povrch pokryje chrastami a šupinami. Veľmi nepríjemným prejavom atopického ekzému u dojčiat je silné svrbenie, ktoré núti deti sa škriabať, a tie sú preto nepokojné, mrzuté a majú problémy nielen v dennom živote, ale hlavne so spánkom. Najhoršie prejavy bývajú zvyčajne u detí okolo 3. mesiaca života. Výsev atopického ekzému dojčiat je v tomto období najrozsiahlejší a dochádza aj k zosilneniu svrbenia. Do 2. roku života však dochádza vo väčšine prípadov k výraznému zlepšeniu stavu a často dokonca k úplnému vyhojeniu ekzému. Atopický ekzém sa potom u dojčiat nadobro stratí alebo prechádza z formy dojčenskej do formy detskej, ktorá je typická pre deti v predškolskom a mladšom školskom veku.

Diagnostika atopického ekzému u dojčiat

Diagnostika atopického ekzému vychádza predovšetkým z klinických prejavov ochorenia. V súčasnej dobe stále nie sú k dispozícii spoľahlivé laboratórne vyšetrenia, ktoré by k stanoveniu diagnózy výraznejšie prispeli. Diagnostika spočíva na prítomnosti troch veľkých a troch malých príznakov.

Medzi veľké príznaky patrí výskyt ochorenia v rodine, typická lokalizácia, svrbenie, dlhodobý priebeh a typické kožné zmeny.

Medzi malé príznaky patrí suchosť kože, bledosť alebo začervenanie tváre, stmavnutie kože okolo očí, prerednutie vonkajších okrajov obočia, šedý zákal, svetloplachosť, ekzém vo hrivu, ekzém bradaviek, olupovanie kože na chodidlách a dlaniach, belavé škvrny na pažiach či zvýšená hladina imunoglobulínu typu E.

Liečba atopického ekzému u dojčiat

Liečba atopického ekzému patrí do rúk špecialistu na kožné ochorenia, dermatológa. Ten na základe posúdenia štádia ochorenia navrhne vhodnú terapiu. Liečba atopického ekzému môže byť farmakologická alebo podporná. Najčastejšie sa však obe tieto metódy aplikujú súčasne.

Farmakologická liečba atopického ekzému u dojčiat

Pre liečbu atopického ekzému, ktorý nemokvá, je nevyhnutné aplikovať miestnu protizápalovú liečbu. Tá spočíva v aplikácii kortikosteroidov alebo imunomodulačných liekov. V prípade, že sa stav nezleší, podávajú sa celkové lieky ako sú antibiotiká, antihistaminiká, cyklosporín A či celkovej imunomodulátory.

Kortikosteroidy sa aplikujú vo forme mastí, zvyčajne raz denne. Postupne sa frekvencia aplikácie masti znižuje a prechádza sa na premazávanie kože. Možná je aj kombinácia s inými protizápalovými liekmi.

Miestne imunomodulátory sú lieky, ktoré zasahujú do imunitnej reakcie kože a tým ovplyvňujú aj samotný vznik atopického ekzému. Tieto lieky, vzhľadom k malému výskytu nežiaducich účinkov, je možné užívať aj dlhodobo. Spravidla sa aplikujú vo forme krému dvakrát denne. Liečba imunomodulátormi patrí výhradne do rúk dermatológa.

Podporná liečba atopického ekzému u dojčiat

Podporná liečba atopického ekzému spočíva v pravidelnom a dôkladnom premazávaní oblasti postihnutej kože mastnými krémami, najlepšie neparfemizovanými. Pred ich použitím je vhodné poradiť sa o ich užívaní s dermatológom. Nevyhnutné je tiež vysadiť všetky potraviny, ktoré by mohli atopický ekzém vyvolať.

Rizikové faktory vzniku atopického ekzému u dojčiat

Rizikových faktorov, ktoré sa podieľajú na vzniku atopického ekzému u dojčiat alebo jeho priebeh výrazne zhoršujú, je veľké množstvo. Najvýznamnejšie z nich sú niektoré látky v potrave, najmä citrusové plody, ďalej vajcia a kravské mlieko. Medzi ďalšie časté potravinové alergény patria aj obilniny, presnejšie v nich obsiahnutý lepok a ďalej je to sója či dokonca rybie mäso. Mimo potravinových alergénov sa môže jednať o najrôznejšie vdychované častice, a to napríklad peľ a prach.

Prevencia atopického ekzému u dojčiat

Prevencia znamená predchádzanie rozvoja ochorenia. Pre prevenciu atopického ekzému u dojčiat je veľmi dôležité podávať dojčatám vhodnú stravu, ktorá nepôsobí na detský organizmus dráždivo a nevyvoláva tak možné nežiaduce reakcie. Odporúča sa preto matkám, ak je to možné, aby svoje deti radšej dojčili, pretože v materskom mlieku sa za normálnych okolností žiadne také alergény nevyskytujú. Ak však matka dojčiť nemôže, možno využiť špeciálne dojčenské potravinové prípravky, ktoré počas výroby prechádzajú prísnou kontrolou na najrôznejšie škodlivé látky a sú preto vhodné ako náhrada prírodného materského mlieka. Dôležité je tiež zabrániť nadmernému vdychovaniu alergénov zo vzduchu a snažiť sa, aby sa deti pohybovali v prostredí s čo najlepšou kvalitou ovzdušia.

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