vspВопросы современной педиатрииCurrent Pediatrics1682-55271682-5535Издательство «ПедиатрЪ»10.15690/vsp.v24i2.2867vsp-3729Research ArticleКЛИНИЧЕСКОЕ НАБЛЮДЕНИЕCLINICAL OBSERVATIONSРезультаты терапии эмолентами на фоне применения генно-инженерного биологического препарата у ребенка с тяжелым атопическим дерматитом: клинический случайResults of Emollient Therapy in a Child with Severe Atopic Dermatitis Treated with Genetically Engineered Biological Drug: Clinical Casehttps://orcid.org/0000-0002-8232-8936АмбарчянЭ. Т.AmbarchyanEduard T.

Амбарчян Эдуард Тигранович, кандидат медицинских наук, заведующий отделением дерматологии

117593, Москва, Литовский бульвар, д. 1а

Moscow

edo_amb@mail.ruhttps://orcid.org/0000-0003-3003-9398АлексееваА. Д.AlekseevaAnastasiya D.

Москва

Moscow

https://orcid.org/0000-0002-6760-3119ИванчиковВ. В.IvanchikovVladislav V.

Москва

Moscow

НИИ педиатрии и охраны здоровья детей НКЦ №2 «РНЦХ им. акад. Б.В. Петровского»РоссияResearch Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of SurgeryRussian Federation2025180520252429095Copyright © Амбарчян Э.Т., Алексеева А.Д., Иванчиков В.В., 20252025Амбарчян Э.Т., Алексеева А.Д., Иванчиков В.В.Ambarchyan E.T., Alekseeva A.D., Ivanchikov V.V.This work is licensed under a Creative Commons Attribution 4.0 License.https://vsp.spr-journal.ru/jour/article/view/3729

Обоснование. Базисная терапия детей с тяжелым атопическим дерматитом (АтД) является важным условием достижения необходимого клинического эффекта независимо от выбора системного лечения. Описание клинического случая. У мальчика, возраст 9 лет, с жалобами на распространенные высыпания на туловище и конечностях, сопровождающиеся сухостью кожи и зудом, установлен диагноз АтД. В лечении применяли топические глюкокортикоиды, курс локальной узкополосной средневолновой фототерапии 311 нм, топические ингибиторы кальциневрина со слабой положительной динамикой. В связи с частыми рецидивами заболевания и отсутствием контроля над ним инициирована генно-инженерная биологическая терапия. Спустя 10 нед стойкого улучшения не отмечено. Ребенок госпитализирован, продолжена циклическая биологическая терапия, проведены коррекция топического лечения и модификация ухода за кожей, назначено средство из группы эмолентов-плюс. После коррекции лечения с добавлением эмолентов спустя 4 нед отмечено клинически значимое снижение индексов EASI и CDLQI, а также снижение показателей шкал SCORAD и NRS. Заключение. Согласно клиническим рекомендациям, обязательным компонентом терапии детей с АтД независимо от тяжести течения болезни являются смягчающие средства. Представленный клинический случай подтверждает целесообразность терапии с использованием средств из группы эмолентов-плюс, в результате которой удалось добиться коррекции дисфункции эпидермального барьера и, как следствие, выраженного клинического эффекта.

Background. Baseline therapy for children with severe atopic dermatitis (AD) is crucial for achieving required clinical effect, regardless the systemic treatment variants. Clinical case description. The boy, 9 years old, had complaints on widespread rashes on the body and limbs accompanied by dry skin and itching and was diagnosed with AD. Topical glucocorticoids, course of local medium wave narrowband phototherapy of 311 nm, topical calcineurin inhibitors were used in the treatment but with weak positive dynamics. Genetically engineered biological therapy was initiated due to frequent relapses and lack of disease control. No persistent improvement was noted after 10 weeks of therapy. The child was hospitalized, cyclic biological therapy was continued, topical therapy was corrected, and skin care was modified, the emollient-plus drug was prescribed. Clinically significant decrease in EASI and CDLQI indices, as well as a decrease in SCORAD and NRS scores was noted 4 weeks after treatment correction and emollients implementation. Conclusion. Emollients are mandatory in the management of children with AD (despite the disease severity) according to clinical guidelines. This clinical case confirms the feasibility of therapy with emollient-plus agents, as it was possible to achieve the correction of epidermal barrier dysfunction and significant clinical effect.

атопический дерматиткожадетиэмолентэмолент-плюскожный барьерсмягчающие средстваatopic dermatitisskinchildrenemollientemollient-plusskin barriersoftening productsОтсутствует.Not specified.ReferencesBieber T. Atopic dermatitis: an expanding therapeutic pipeline for a complex disease. Nat Rev Drug Discov. 2022;21(1):21–40. doi: https://doi.org/10.1038/s41573-021-00266-6Bieber T. Atopic dermatitis: an expanding therapeutic pipeline for a complex disease. Nat Rev Drug Discov. 2022;21(1):21–40. doi: https://doi.org/10.1038/s41573-021-00266-6Esaki H, Brunner PM, Renert-Yuval Y, et al. Early-onset pediatric atopic dermatitis is TH2 but also TH17 polarized in skin. J Allergy Clin Immunol. 2016;138(6):1639–1651. doi: https://doi.org/10.1016/j.jaci.2016.07.013Esaki H, Brunner PM, Renert-Yuval Y, et al. Early-onset pediatric atopic dermatitis is TH2 but also TH17 polarized in skin. J Allergy Clin Immunol. 2016;138(6):1639–1651. doi: https://doi.org/10.1016/j.jaci.2016.07.013Maintz L, Bieber T, Simpson HD, Demessant-Flavigny AL. From skin barrier dysfunction to systemic impact of atopic dermatitis: implications for a precision approach in dermocosmetics and medicine. J Pers Med. 2022;12(6):893. doi: https://doi.org/10.3390/jpm12060893Maintz L, Bieber T, Simpson HD, Demessant-Flavigny AL. From skin barrier dysfunction to systemic impact of atopic dermatitis: implications for a precision approach in dermocosmetics and medicine. J Pers Med. 2022;12(6):893. doi: https://doi.org/10.3390/jpm12060893Araviiskaia E, Pincelli C, Sparavigna A, Luger T. The Role of a Novel Generation of Emollients, ‘Emollients Plus’, in Atopic Dermatitis. Clin Cosmet Investig Dermatol. 2022;15:2705–2719. doi: https://doi.org/10.2147/CCID.S389697Araviiskaia E, Pincelli C, Sparavigna A, Luger T. The Role of a Novel Generation of Emollients, ‘Emollients Plus’, in Atopic Dermatitis. Clin Cosmet Investig Dermatol. 2022;15:2705–2719. doi: https://doi.org/10.2147/CCID.S389697Siegfried E, Simpson EL, Boguniewicz M, et al. Dupilumab treatment provides long-term improvement in itch in pediatric patients with moderate-to-severe atopic dermatitis over 1 year. British Journal of Dermatology. 2024;190(Suppl 2):ii56–ii57. doi: https://doi.org/10.1093/bjd/ljad498.058Siegfried E, Simpson EL, Boguniewicz M, et al. Dupilumab treatment provides long-term improvement in itch in pediatric patients with moderate-to-severe atopic dermatitis over 1 year. British Journal of Dermatology. 2024;190(Suppl 2):ii56–ii57. doi: https://doi.org/10.1093/bjd/ljad498.058Magnolo N, Jaenicke T, Tsianakas A, et al. Comparison of different skin care regimens in patients with moderate to severe atopic dermatitis receiving systemic treatment: A randomized controlled trial. J Eur Acad Dermatol Venereol. 2023;37(Suppl 5): 18–26. doi: https://doi.org/10.1111/jdv.18949Magnolo N, Jaenicke T, Tsianakas A, et al. Comparison of different skin care regimens in patients with moderate to severe atopic dermatitis receiving systemic treatment: A randomized controlled trial. J Eur Acad Dermatol Venereol. 2023;37(Suppl 5): 18–26. doi: https://doi.org/10.1111/jdv.18949Мурашкин Н.Н., Намазова-Баранова Л.С., Опрятин Л.А. и др. Биологическая терапия среднетяжелых и тяжелых форм атопического дерматита в детском возрасте // Вопросы современной педиатрии. — 2020. — Т. 19. — № 6. — 432–443. — doi: https://doi.org/10.15690/vsp.v19i6.2145Murashkin NN, NamazovaBaranova LS, Opryatin LA, et al. Biologic Therapy of Moderate and Severe Forms of Atopic Dermatitis in Children. Voprosy sovremennoi pediatrii — Current Pediatrics. 2020;19(6):432–443. (In Russ). doi: https://doi.org/10.15690/vsp.v19i6.2145Grobe W, Bieber T, Novak N. Pathophysiology of atopic dermatitis. J Dtsch Dermatol Ges. 2019;17(4):433–440. doi: https://doi.org/10.1111/ddg.13819Grobe W, Bieber T, Novak N. Pathophysiology of atopic dermatitis. J Dtsch Dermatol Ges. 2019;17(4):433–440. doi: https://doi.org/10.1111/ddg.13819Nakahara T, Kido-Nakahara M, Tsuji G, Furue M. Basics and recent advances in the pathophysiology of atopic dermatitis. J Dermatol. 2020;48(2):130–139. doi: https://doi.org/10.1111/1346-8138.15664Nakahara T, Kido-Nakahara M, Tsuji G, Furue M. Basics and recent advances in the pathophysiology of atopic dermatitis. J Dermatol. 2020;48(2):130–139. doi: https://doi.org/10.1111/1346-8138.15664Yang G, Seok JK, Kang HC, et al. Skin Barrier Abnormalities and Immune Dysfunction in Atopic Dermatitis. Int J Mol Sci. 2020;21(8):2867. doi: https://doi.org/10.3390/ijms21082867Yang G, Seok JK, Kang HC, et al. Skin Barrier Abnormalities and Immune Dysfunction in Atopic Dermatitis. Int J Mol Sci. 2020;21(8):2867. doi: https://doi.org/10.3390/ijms21082867Halling-Overgaard AS, Kezic S, Jakasa I, et al. Skin absorption through atopic dermatitis skin: A systematic review. Br J Dermatol. 2017;177(1):84–106. doi: https://doi.org/10.1111/bjd.15065Halling-Overgaard AS, Kezic S, Jakasa I, et al. Skin absorption through atopic dermatitis skin: A systematic review. Br J Dermatol. 2017;177(1):84–106. doi: https://doi.org/10.1111/bjd.15065Zaniboni MC, Samorano LP, Orfali RL, Aoki V. Skin barrier in atopic dermatitis: Beyond filaggrin. Bras Dermatol. 2016;91(4):472–478. doi: https://doi.org/10.1590/abd1806-4841.20164412Zaniboni MC, Samorano LP, Orfali RL, Aoki V. Skin barrier in atopic dermatitis: Beyond filaggrin. Bras Dermatol. 2016;91(4):472–478. doi: https://doi.org/10.1590/abd1806-4841.20164412McLoughlin IJ, Wright EM, Tagg JR, et al. Skin Microbiome-The Next Frontier for Probiotic Intervention. Probiotics Antimicrob Proteins. 2022;14(4):630–647. doi: https://doi.org/10.1007/s12602-021-09824-1McLoughlin IJ, Wright EM, Tagg JR, et al. Skin MicrobiomeThe Next Frontier for Probiotic Intervention. Probiotics Antimicrob Proteins. 2022;14(4):630–647. doi: https://doi.org/10.1007/s12602-021-09824-1Mahe YF, Perez MJ, Tacheau C, et al. A new Vitreoscilla filiformis extract grown on spa water-enriched medium activates endogenous cutaneous antioxidant and antimicrobial defenses through a potential toll-like receptor 2/protein kinase C, zeta transduction pathway. Clin Cosmet Investig Dermatol. 2013;6:191–196. doi: https://doi.org/10.2147/CCID.S47324Mahe YF, Perez MJ, Tacheau C, et al. A new Vitreoscilla filiformis extract grown on spa water-enriched medium activates endogenous cutaneous antioxidant and antimicrobial defenses through a potential toll-like receptor 2/protein kinase C, zeta transduction pathway. Clin Cosmet Investig Dermatol. 2013;6:191–196. doi: https://doi.org/10.2147/CCID.S47324Ch’ng CC. Rebalancing of the skin microbiome with an emollient ‘plus’ for effective management of atopic dermatitis: A mini review. Med J Malaysia. 2024;79(2):203–205.Ch’ng CC. Rebalancing of the skin microbiome with an emollient ‘plus’ for effective management of atopic dermatitis: A mini review. Med J Malaysia. 2024;79(2):203–205.Zelenkova H, Kerob D, Salah S, Demessant-Flavigny AL. Impact of daily use of emollient ‘plus’ on corticosteroid consumption in patients with atopic dermatitis: An open, randomized controlled study. J Eur Acad Dermatol Venereol. 2023;37(Suppl 5):27–34. doi: https://doi.org/10.1111/jdv.18947Zelenkova H, Kerob D, Salah S, Demessant-Flavigny AL. Impact of daily use of emollient ‘plus’ on corticosteroid consumption in patients with atopic dermatitis: An open, randomized controlled study. J Eur Acad Dermatol Venereol. 2023;37(Suppl 5):27–34. doi: https://doi.org/10.1111/jdv.18947Аллергия у детей: от теории — к практике / под ред. Л.С. Намазовой-Барановой. — М.: Союз педиатров России; 2010–2011. — 668 с.Allergiya u detei: ot teorii — k praktike. Namazova-Baranova LS, ed. Moscow: Union of Pediatricians of Russia; 2010–2011. 667 p. (In Russ).Наружная терапия и уход за кожей при атопическом дерматите у детей: практическое руководство для врачей / под ред. Л.Ф. Казначеевой. — Новосибирск; 2003. — 24 с.Naruzhnaya terapiya i ukhod za kozhei pri atopicheskom dermatite u detei: Practical guideline for doctors. Kaznacheeva LF, ed. Novosibirsk; 2003. 24 p. (In Russ).

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