vspВопросы современной педиатрииCurrent Pediatrics1682-55271682-5535Издательство «ПедиатрЪ»10.15690/vsp.v15i3.1566vsp-1641Research ArticleКЛИНИЧЕСКИЕ РЕКОМЕНДАЦИИCLINICAL RECOMMENDATIONSАтопический дерматит у детей: современные клинические рекомендации по диагностике и терапииAtopic Dermatitis in Children: Current Clinical Guidelines for Diagnosis and Therapyhttps://orcid.org/0000-0002-2209-7531Намазова-БарановаЛ. С.Namazova-BaranovaLeyla S.https://orcid.org/0000-0003-3987-8112БарановА. А.BaranovAlexander A.КубановаА. А.KubanovaAnna A.ИльинаН. И.IlinaNatalia I.КурбачёваО. М.KurbachevaOlga M.https://orcid.org/0000-0001-7398-0562ВишнёваЕ. А.VishnevaElena A.

кандидат медицинских наук, заместитель директора НИИ педиатрии по научной работе, заведующая отделом стандартизации и клинической фармакологии НЦЗД, врач аллерголог-иммунолог отделения восстановительного лечения детей с аллергическими болезнями и заболеваниями органов дыхания НИИ педиатрии НЦЗД Адрес: 119991, Москва, Ломоносовский проспект, д. 2, стр. 1, тел.: +7 (499) 134-03-92

vishneva@nczd.ruНовикГ. А.NovikGennadiy A.ПетровскийФ. И.PetrovskiiFedor I.МакароваС. Г.MakarovaSvetlana G.МурашкинН. Н.MurashkinNikolai N.АлексееваА. А.AlekseevaAnna A.https://orcid.org/0000-0002-3678-7939СелимзяноваЛ. Р.SelimzianovaLiliia R.ЛевинаЮ. Г.LevinaJulia G.ЭфендиеваК. Е.EfendievaKamilla E.ВознесенскаяН. И.VoznesenskayaNatalya I.Научный центр здоровья детей, Москва, Российская Федерация Первый Московский государственный медицинский университет им. И.М. Сеченова, Москва, Российская Федерация Российский национальный исследовательский медицинский университет им. Н.И. Пирогова, Москва, Российская ФедерацияРоссияScientific Center of Children’s Health, Moscow, Russian Federation I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation Pirogov Russian National Research Medical University, Moscow, Russian FederationRussian FederationНаучный центр здоровья детей, Москва, Российская Федерация Первый Московский государственный медицинский университет им. И.М. Сеченова, Москва, оссийская ФедерацияРоссияScientific Center of Children’s Health, Moscow, Russian Federation I.M. Sechenov First Moscow State Medical University, Moscow, Russian FederationRussian FederationГосударственный научный центр дерматовенерологии и косметологии, Москва, Российская ФедерацияРоссияState Research Center for Dermatovenerology and Cosmetology, Moscow, Russian FederationRussian FederationГНЦ «Институт иммунологии», Москва, Российская ФедерацияРоссияSSC “Institute of Immunology”, Moscow, Russian FederationRussian FederationСанкт-Петербургский государственный педиатрический медицинский университет, Санкт-Петербург, Российская ФедерацияРоссияSaint Petersburg State Pediatric Medical University, St. Petersburg, Russian FederationRussian FederationХанты-Мансийская государственная медицинская академия, Ханты-Мансийск, Российская ФедерацияРоссияKhanty-Mansiysk State Medical Academy, Khanty-Mansiysk, Russian FederationRussian FederationНаучный центр здоровья детей, Москва, Российская Федерация Первый Московский государственный медицинский университет им. И.М. Сеченова, Москва, оссийская ФедерацияРоссияScientific Center of Children’s Health, Moscow, Russian FederationRussian Federation201610082016153279294Copyright © Намазова-Баранова Л.С., Баранов А.А., Кубанова А.А., Ильина Н.И., Курбачёва О.М., Вишнёва Е.А., Новик Г.А., Петровский Ф.И., Макарова С.Г., Мурашкин Н.Н., Алексеева А.А., Селимзянова Л.Р., Левина Ю.Г., Эфендиева К.Е., Вознесенская Н.И., 20162016Намазова-Баранова Л.С., Баранов А.А., Кубанова А.А., Ильина Н.И., Курбачёва О.М., Вишнёва Е.А., Новик Г.А., Петровский Ф.И., Макарова С.Г., Мурашкин Н.Н., Алексеева А.А., Селимзянова Л.Р., Левина Ю.Г., Эфендиева К.Е., Вознесенская Н.И.Namazova-Baranova L.S., Baranov A.A., Kubanova A.A., Ilina N.I., Kurbacheva O.M., Vishneva E.A., Novik G.A., Petrovskii F.I., Makarova S.G., Murashkin N.N., Alekseeva A.A., Selimzianova L.R., Levina J.G., Efendieva K.E., Voznesenskaya N.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://vsp.spr-journal.ru/jour/article/view/1641

Атопический дерматит — достаточно распространенное в детском возрасте хроническое мультифакториальное заболевание кожи. В статье представлены актуальные данные по эпидемиологии и динамике распространенности патологических симптомов, основам патогенеза и ключевым факторам развития болезни, приведена современная классификация заболевания. Авторами детально рассматриваются ключевые принципы диагностики и особенности клинической картины в зависимости от возраста. Предложены алгоритмы тактики лечения, а также основы гипоаллергенной индивидуальной диеты. Даны общие рекомендации и возможный прогноз для пациентов детского возраста с атопическим дерматитом.

Atopic dermatitis is a chronic multifactorial skin disease that is common enough in childhood. The article presents the current data on epidemiology and dynamics of incidence of pathological symptoms, pathogenesis basics, and key factors of the disease development, shows the current classification of the disease. The authors consider in detail the key principles of the diagnosis and peculiarities of a clinical aspect depending on age. Algorithms of a therapeutic approach, as well as basics of an individual hypoallergenic diet are proposed. General recommendations and possible prognosis for pediatric patients with atopic dermatitis are given.

атопический дерматитдетиместные глюкокортикостероидытопические ингибиторы кальциневринапроактивная терапияatopic dermatitischildrenlocal corticosteroidstopical calcineurin inhibitorsproactive therapyReferencesAkdis CA, Agache I, editors. Global atlas of allergy. Zurich: EAACI; 2014. 388 p.Akdis CA, Agache I, editors. Global atlas of allergy. Zurich: EAACI; 2014. 388 p.Weidinger S, Novak N. Atopic dermatitis. Lancet. 2016;387 (10023):1109–1122. doi: 10.1016/s0140-6736(15)00149-x.Weidinger S, Novak N. Atopic dermatitis. Lancet. 2016;387 (10023):1109–1122. doi: 10.1016/s0140-6736(15)00149-x.Eichenfield LF, Tom WL, Berger TG, et al. Guidelines of care for the management of atopic dermatitis: section 2. Management and treatment of atopic dermatitis with topical therapies. J Am Acad Dermatol. 2014;71(1):116–132. doi:10.1016/j.jaad.2014.03.023.Eichenfield LF, Tom WL, Berger TG, et al. Guidelines of care for the management of atopic dermatitis: section 2. Management and treatment of atopic dermatitis with topical therapies. J Am Acad Dermatol. 2014;71(1):116–132. doi:10.1016/j.jaad.2014.03.023.Sidbury R, Davis DM, Cohen DE, et al. Guidelines of care for the management of atopic dermatitis: section 3. Management and treatment with phototherapy and systemic agents. J Am Acad Dermatol. 2014;71(2):327–349. doi:10.1016/j.jaad.2014.03.030.Sidbury R, Davis DM, Cohen DE, et al. Guidelines of care for the management of atopic dermatitis: section 3. Management and treatment with phototherapy and systemic agents. J Am Acad Dermatol. 2014;71(2):327–349. doi:10.1016/j.jaad.2014.03.030.Eichenfield LF, Tom WL, Chamlin SL, et al. Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis. J Am Acad Dermatol. 2014; 70(2):338–351. doi:10.1016/j.jaad.2013.10.010.Eichenfield LF, Tom WL, Chamlin SL, et al. Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis. J Am Acad Dermatol. 2014; 70(2):338–351. doi:10.1016/j.jaad.2013.10.010.Akdis CA, Akdis M, Bieber T, et al. Diagnosis and treatment of atopic dermatitis in children and adults: European Academy of Allergology and Clinical Immunology/American Academy of Allergy, Asthma and Immunology/PRACTALL Consensus Report. Allergy. 2006;61(8):969–987. doi: 10.1111/j.1398-9995.2006.01153.x.Akdis CA, Akdis M, Bieber T, et al. Diagnosis and treatment of atopic dermatitis in children and adults: European Academy of Allergology and Clinical Immunology/American Academy of Allergy, Asthma and Immunology/PRACTALL Consensus Report. Allergy. 2006;61(8):969–987. doi: 10.1111/j.1398-9995.2006.01153.x.Аллергия у детей: от теории — к практике. / Под ред. Намазовой-Барановой Л.С. — М.: Союз педиатров России; 2010–2011. 668 с. [Allergiya u detei: ot teorii — k praktike. Ed by L.S. Namazova-Baranova. Moscow: Soyuz pediatrov Rossii; 2010– 2011. 668 p. (In Russ).]Аллергия у детей: от теории — к практике. / Под ред. Намазовой-Барановой Л.С. — М.: Союз педиатров России; 2010–2011. 668 с. [Allergiya u detei: ot teorii — k praktike. Ed by L.S. Namazova-Baranova. Moscow: Soyuz pediatrov Rossii; 2010– 2011. 668 p. (In Russ).]Miller DW, Koch SB, Yentzer BA, et al. An over-the-counter moisturizer is as clinically effective as, and more cost-effective than, prescription barrier creams in the treatment of children with mild-tomoderate atopic dermatitis: a randomized, controlled trial. J Drugs Dermatol. 2011;10(5):531–537.Miller DW, Koch SB, Yentzer BA, et al. An over-the-counter moisturizer is as clinically effective as, and more cost-effective than, prescription barrier creams in the treatment of children with mild-tomoderate atopic dermatitis: a randomized, controlled trial. J Drugs Dermatol. 2011;10(5):531–537.Grimalt R, Mengeaud V, Cambazard F. The steroid-sparing effect of an emollient therapy in infants with atopic dermatitis: a randomized controlled study. Dermatology. 2007;214(1):61–67. doi: 10.1159/000096915.Grimalt R, Mengeaud V, Cambazard F. The steroid-sparing effect of an emollient therapy in infants with atopic dermatitis: a randomized controlled study. Dermatology. 2007;214(1):61–67. doi: 10.1159/000096915.Eschler DC, Klein PA. An evidence-based review of the efficacy of topical antihistamines in the relief of pruritus. J Drugs Dermatol. 2010;9(8):992–997.Eschler DC, Klein PA. An evidence-based review of the efficacy of topical antihistamines in the relief of pruritus. J Drugs Dermatol. 2010;9(8):992–997.Ersser SJ, Cowdell F, Latter S, et al. Psychological and educational interventions for atopic eczema in children. Cochrane Database Syst Rev. 2014;(1):CD004054. doi: 10.1002/14651858.CD004054.pub3.Ersser SJ, Cowdell F, Latter S, et al. Psychological and educational interventions for atopic eczema in children. Cochrane Database Syst Rev. 2014;(1):CD004054. doi: 10.1002/14651858.CD004054.pub3.Ng SY, Begum S, Chong SY. Does order of application of emollient and topical corticosteroids make a difference in the severity of atopic eczema in children? Pediatr Dermatol. 2016;33(2):160–164. doi:10.1111/pde.12758.Ng SY, Begum S, Chong SY. Does order of application of emollient and topical corticosteroids make a difference in the severity of atopic eczema in children? Pediatr Dermatol. 2016;33(2):160–164. doi:10.1111/pde.12758.Svensson A, Chambers C, Ganemo A, Mitchell SA. A systematic review of tacrolimus ointment compared with corticosteroids in the treatment of atopic dermatitis. Curr Med Res Opin. 2011; 27(7):1395–1406. doi: 10.1185/03007995.2011.582483.Svensson A, Chambers C, Ganemo A, Mitchell SA. A systematic review of tacrolimus ointment compared with corticosteroids in the treatment of atopic dermatitis. Curr Med Res Opin. 2011; 27(7):1395–1406. doi: 10.1185/03007995.2011.582483.Yin Z, Xu J, Luo D. Efficacy and tolerance of tacrolimus and pimecrolimus for atopic dermatitis: a meta-analysis. J Biomed Res. 2011;25(6):385–391. doi: 10.1016/s1674-8301(11)60051-1.Yin Z, Xu J, Luo D. Efficacy and tolerance of tacrolimus and pimecrolimus for atopic dermatitis: a meta-analysis. J Biomed Res. 2011;25(6):385–391. doi: 10.1016/s1674-8301(11)60051-1.Berger TG, Duvic M, Van Voorhees AS, Frieden IJ. The use of topical calcineurin inhibitors in dermatology: safety concerns. Report of the American Academy of Dermatology Association Task Force. J Am Acad Dermatol. 2006;54(5):818–823. doi: 10.1016/j.jaad.2006.06.001.Berger TG, Duvic M, Van Voorhees AS, Frieden IJ. The use of topical calcineurin inhibitors in dermatology: safety concerns. Report of the American Academy of Dermatology Association Task Force. J Am Acad Dermatol. 2006;54(5):818–823. doi: 10.1016/j.jaad.2006.06.001.Sigurgeirsson B, Boznanski A, Todd G, et al. Safety and efficacy of pimecrolimus in atopic dermatitis: a 5-year randomized trial. Pediatrics. 2015;135(4):597–606. doi: 10.1542/peds.2014-1990.Sigurgeirsson B, Boznanski A, Todd G, et al. Safety and efficacy of pimecrolimus in atopic dermatitis: a 5-year randomized trial. Pediatrics. 2015;135(4):597–606. doi: 10.1542/peds.2014-1990.Schmitt J, von Kobyletzki L, Svensson A, Apfelbacher C. Efficacy and tolerability of proactive treatment with topical corticosteroids and calcineurin inhibitors for atopic eczema: systematic review and meta-analysis of randomized controlled trials. Br J Dermatol. 2011;164(2):415–428. doi: 10.1111/j.1365-2133.2010.10030.x.Schmitt J, von Kobyletzki L, Svensson A, Apfelbacher C. Efficacy and tolerability of proactive treatment with topical corticosteroids and calcineurin inhibitors for atopic eczema: systematic review and meta-analysis of randomized controlled trials. Br J Dermatol. 2011;164(2):415–428. doi: 10.1111/j.1365-2133.2010.10030.x.Roekevisch E, Spuls PI, Kuester D, et al. Efficacy and safety of systemic treatments for moderate-to-severe atopic dermatitis: a systematic review. J Allergy Clin Immunol. 2014;133(2):429–438. doi: 10.1016/j.jaci.2013.07.049.Roekevisch E, Spuls PI, Kuester D, et al. Efficacy and safety of systemic treatments for moderate-to-severe atopic dermatitis: a systematic review. J Allergy Clin Immunol. 2014;133(2):429–438. doi: 10.1016/j.jaci.2013.07.049.Baumer JH. Atopic eczema in children, NICE. Arch Dis Child Educ Pract Ed. 2008;93(3):93–97. doi: 10.1136/adc.2008.139626.Baumer JH. Atopic eczema in children, NICE. Arch Dis Child Educ Pract Ed. 2008;93(3):93–97. doi: 10.1136/adc.2008.139626.Garritsen FM, Brouwer MW, Limpens J, Spuls PI. Photo(chemo) therapy in the management of atopic dermatitis: an updated systematic review with implications for practice and research. Br J Dermatol. 2014;170(3):501–513. doi: 10.1111/bjd.12645.Garritsen FM, Brouwer MW, Limpens J, Spuls PI. Photo(chemo) therapy in the management of atopic dermatitis: an updated systematic review with implications for practice and research. Br J Dermatol. 2014;170(3):501–513. doi: 10.1111/bjd.12645.Darne S, Leech SN, Taylor AE. Narrowband ultraviolet B phototherapy in children with moderate-to-severe eczema: a comparative cohort study. Br J Dermatol. 2014;170(1):150– 156. doi: 10.1111/bjd.12580.Darne S, Leech SN, Taylor AE. Narrowband ultraviolet B phototherapy in children with moderate-to-severe eczema: a comparative cohort study. Br J Dermatol. 2014;170(1):150– 156. doi: 10.1111/bjd.12580.Sibbald C, Pope E, Ho N, Weinstein M. Retrospective review of relapse after systemic cyclosporine in children with atopic dermatitis. Pediatr Dermatol. 2015;32(1):36–40. doi: 10.1111/pde.12367.Sibbald C, Pope E, Ho N, Weinstein M. Retrospective review of relapse after systemic cyclosporine in children with atopic dermatitis. Pediatr Dermatol. 2015;32(1):36–40. doi: 10.1111/pde.12367.Bae JM, Choi YY, Park CO, et al. Efficacy of allergen-specific immunotherapy for atopic dermatitis: a systematic review and metaanalysis of randomized controlled trials. J Allergy Clin Immunol. 2013;132(1):110–117. doi: 10.1016/j.jaci.2013.02.044.Bae JM, Choi YY, Park CO, et al. Efficacy of allergen-specific immunotherapy for atopic dermatitis: a systematic review and metaanalysis of randomized controlled trials. J Allergy Clin Immunol. 2013;132(1):110–117. doi: 10.1016/j.jaci.2013.02.044.Darsow U. Allergen-specific immunotherapy for atopic eczema: updated. Curr Opin Allergy Clin Immunol. 2012;12(6):665–669. doi: 10.1097/aci.0b013e3283588cf4.Darsow U. Allergen-specific immunotherapy for atopic eczema: updated. Curr Opin Allergy Clin Immunol. 2012;12(6):665–669. doi: 10.1097/aci.0b013e3283588cf4.Lee J, Seto D, Bielory L. Meta-analysis of clinical trials of probiotics for prevention and treatment of pediatric atopic dermatitis. J Allergy Clin Immunol. 2008;121(1):116–121. doi: 10.1016/ j.jaci.2007.10.043.Lee J, Seto D, Bielory L. Meta-analysis of clinical trials of probiotics for prevention and treatment of pediatric atopic dermatitis. J Allergy Clin Immunol. 2008;121(1):116–121. doi: 10.1016/ j.jaci.2007.10.043.Foisy M, Boyle RJ, Chalmers JR, et al. Overview of Reviews The prevention of eczema in infants and children: an overview of Cochrane and non-Cochrane reviews. Evid Based Child Health. 2011;6(5):1322–1339. doi: 10.1002/ebch.827.Foisy M, Boyle RJ, Chalmers JR, et al. Overview of Reviews The prevention of eczema in infants and children: an overview of Cochrane and non-Cochrane reviews. Evid Based Child Health. 2011;6(5):1322–1339. doi: 10.1002/ebch.827.Kim SO, Ah YM, Yu YM, et al. Effects of probiotics for the treatment of atopic dermatitis: a meta-analysis of randomized controlled trials. Ann Allergy Asthma Immunol. 2014;113(2):217– 226. doi: 10.1016/j.anai.2014.05.021.Kim SO, Ah YM, Yu YM, et al. Effects of probiotics for the treatment of atopic dermatitis: a meta-analysis of randomized controlled trials. Ann Allergy Asthma Immunol. 2014;113(2):217– 226. doi: 10.1016/j.anai.2014.05.021.Barnes PM, Bloom B, Nahin RL. Complementary and alternative medicine use among adults and children: United States, 2007. Natl Health Stat Report. 2008;(12):1–24. doi: 10.1037/e623942009-001.Barnes PM, Bloom B, Nahin RL. Complementary and alternative medicine use among adults and children: United States, 2007. Natl Health Stat Report. 2008;(12):1–24. doi: 10.1037/e623942009-001.Simpson EL, Chalmers JR, Hanifin JM, et al. Emollient enhancement of the skin barrier from birth offers effective atopic dermatitis prevention. J Allergy Clin Immunol. 2014;134(4):818– 823. doi: 10.1016/j.jaci.2014.08.005.Simpson EL, Chalmers JR, Hanifin JM, et al. Emollient enhancement of the skin barrier from birth offers effective atopic dermatitis prevention. J Allergy Clin Immunol. 2014;134(4):818– 823. doi: 10.1016/j.jaci.2014.08.005.Foolad N, Brezinski EA, Chase EP, Armstrong AW. Effect of nutrient supplementation on atopic dermatitis in children: a systematic review of probiotics, prebiotics, formula, and fatty acids. JAMA Dermatol. 2013;149(3):350–355. doi: 10.1001/jamadermatol. 2013.1495.Foolad N, Brezinski EA, Chase EP, Armstrong AW. Effect of nutrient supplementation on atopic dermatitis in children: a systematic review of probiotics, prebiotics, formula, and fatty acids. JAMA Dermatol. 2013;149(3):350–355. doi: 10.1001/jamadermatol. 2013.1495.Panduru M, Panduru NM, Salavastru CM, Tiplica GS. Probiotics and primary prevention of atopic dermatitis: a meta-analysis of randomized controlled studies. J Eur Acad Dermatol Venereol. 2015;29(2):232–242. doi: 10.1111/jdv.12496.Panduru M, Panduru NM, Salavastru CM, Tiplica GS. Probiotics and primary prevention of atopic dermatitis: a meta-analysis of randomized controlled studies. J Eur Acad Dermatol Venereol. 2015;29(2):232–242. doi: 10.1111/jdv.12496.Spergel JM, Paller AS. Atopic dermatitis and the atopic march. J Allergy Clin Immunol. 2003;112(6 Suppl):118–127. doi:10.1016/ j.jaci.2003.09.033.Spergel JM, Paller AS. Atopic dermatitis and the atopic march. J Allergy Clin Immunol. 2003;112(6 Suppl):118–127. doi:10.1016/ j.jaci.2003.09.033.Williams HC, Pembroke AC, Forsdyke H, et al. London-born black Caribbean children are at increased risk of atopic dermatitis. J Am Acad Dermatol. 1995;32(2 Pt 1):212–217. doi: 10.1016/0190- 9622(95)90128-0.Williams HC, Pembroke AC, Forsdyke H, et al. London-born black Caribbean children are at increased risk of atopic dermatitis. J Am Acad Dermatol. 1995;32(2 Pt 1):212–217. doi: 10.1016/0190- 9622(95)90128-0.

The authors declare that there are no conflicts of interest present.