Atopik dermatit

Vikipediya, ochiq ensiklopediya

Atopik dermatit (AD), shuningdek, atopik ekzema sifatida ham tanilgan, terining uzoq muddatli yallig'lanish turi (dermatit)[1]. Bu terining qichishi, qizarishi, shishishi va yorilishiga olib keladi[1]. Ta'sirlangan sohalardan shaffof suyuqlik kelishi mumkin, bu sohalar vaqt o'tishi bilan ko'pincha qalinlashadi[1]. AD har qanday yoshda paydo bo'lishi mumkin bo'lsa-da, u odatda bolalikdan boshlanadi va yillar davomida o'zgarib turadi[1][2]. Bir yoshgacha bo'lgan bolalarda tananing ko'p qismiga ta'sir qilishi mumkin[2]. Bolalar ulg'aygan sayin, tizzalar va tirsaklarning ichki qismidagi joylar ko'pincha ta'sirlanadi[2]. Katta yoshlilarda qo'llar va oyoqlar ko'proq ta'sirlanadi[2]. Ta'sirlangan joylarni tirnash simptomlarni yomonlashtiradi va ta'sirlanganlarda teri infeksiyalari xavfi ortadi[1]. Atopik dermatiti bo'lgan ko'p odamlarda pichan isitmasi yoki astma rivojlanadi[1].

Sababi noma'lum, ammo genetik buzilishlar, immunitet tizimining disfunksiyasi, atrof-muhitning ta'sir qilishi va terining o'tkazuvchanligi bilan bog'liq qiyinchiliklar bilan bog'liq bo'lishi mumkin[1][2]. Agar bir xil egizaklardan biri kasal bo'lsa, ikkinchisida ushbu kasallikka chalinish ehtimoli 85% ni tashkil qiladi[3]. Shaharlarda va quruq iqlim sharoitida yashovchilar ko'proq kasallanadi[1]. Ba'zi kimyoviy moddalar bilan ta'sirlanish yoki tez-tez qo'l yuvish simptomlarni yomonlashtiradi[1]. Ruhiy stress simptomlarni yomonlashtirishi mumkin bo'lsa-da, bu asosiy sabab emas[1]. Kasallik yuqumli emas[1]. Tashxis odatda belgilar va alomatlarga asoslanadi[2]. Tashxis qo'yishdan oldin istisno qilinishi kerak bo'lgan boshqa kasalliklarga kontakt dermatit, psoriaz va seboreyali dermatit kiradi[2].

Atopik dermatit odamlarning taxminan 20 foiziga hayotining biror nuqtasida ta'sir qiladi[1][4]. Bu yosh bolalarda ko'proq uchraydi[2]. Ayollar erkaklarga qaraganda bir oz ko'proq kasallanadi[5]. Atopik dermatit ba'zan ekzema deb ataladi, bu atama teri kasalliklarining katta guruhiga ham tegishli[1]. Boshqa nomlar orasida "infantil ekzema", "fleksural ekzema", "prurigo Besnier", "allergik ekzema" va "neyrodermatit" mavjud[6].

Belgilari[tahrir | manbasini tahrirlash]

Atopik ekzemaning shakli yoshga qarab o'zgaradi.

AD bilan og'rigan odamlar ko'pincha butun tanani qamrab olgan quruq va qobiqli teriga ega bo'lib, u qo'l yoki oyoq, yuz va bo'yinning bukilish joylarida kuchli qichima, qizil, dog'li, ko'tarilgan jarohatlar paydo bo'ladi [7][8][9].

AD ko'pincha ko'z qovoqlariga ta'sir qiladi, bu yerda Denni-Morgan infraorbital burmalari, quloq orqasida yoriqlar va periorbital pigmentatsiya kabi belgilar ko'rinadi[10]. Bo'yindagi yallig'lanishdan keyingi giperpigmentatsiya klassik "iflos bo'yin" ko'rinishini beradi. Lixenifikatsiya, ekskoriatsiya, eroziya yoki tanada qobiq paydo bo'lishi ikkilamchi infeksiyani ko'rsatishi mumkin. Ko'pincha bilak, barmoq bo'g'imlari, to'piq, oyoq va qo'llarning bukilish sohalarida giperchiziqli yoki giperchiziqli bo'lmagan aniqlangan qirralar bilan kuzatiladi[11].

Sabablari[tahrir | manbasini tahrirlash]

ADning sababi noma'lum, ammo ba'zi dalillar genetik, atrof-muhit va immunologik omillarning rolini ko'rsatadi[12].

Iqlim[tahrir | manbasini tahrirlash]

Past namlik va past harorat atopik dermatit bilan og'rigan bemorlarda jarayonning og'irlashish xavfini oshiradi[13].

Genetika[tahrir | manbasini tahrirlash]

AD bilan og'rigan ko'plab odamlarning oilaviy tarixi yoki shaxsiy atopiya tarixi bor. Atopiya - bu astma, oziq-ovqat allergiyasi, AD yoki pichan isitmasi kabi namoyon bo'lishi mumkin bo'lgan darhol boshlanadigan allergik reaksiya ( IgE ishtirogida 1-tur yuqori sezuvchanlik reaksiyasi). Atopik dermatit bilan og'rigan odamlarning 80% gacha umumiy yoki allergenga xos IgE darajasi ko'tarilgan[14].

Atopik dermatit bilan og'rigan odamlarning taxminan 30 % da filagrin ( FLG ) ishlab chiqaruvchi genida mutatsiyalar kuzatiladi, bu atopik dermatitning erta boshlanishi va astma rivojlanishi xavfini oshiradi[15][16].


Diagnostika[tahrir | manbasini tahrirlash]

AD odatda klinik tashxis qo'yiladi, ya'ni u maxsus testlarsiz faqat belgilar va alomatlarga asoslanadi[17]. Tashxis qo'yishda bir nechta turli usullar ham tasdiqlangan[18]. Ulardan Hanifin va Rajka ishlariga asoslangan Buyuk Britaniya diagnostika usullari eng keng tarqalgan[18] [19].

Davolash[tahrir | manbasini tahrirlash]

AD uchun hech qanday davolash usuli mavjud emas, ammo davolanishlar kasallikni zo'rayishini va tezligini kamaytirishi mumkin[20].

Dori vositalari[tahrir | manbasini tahrirlash]

Gidrokortizon kabi mahalliy kortikosteroidlar AD kasalligini boshqarishda samarali ekanligini isbotladi [21]. Agar mahalliy kortikosteroidlar va namlantiruvchi surtma beriladi. Ushbu dori vositalar samarasiz bo'lsa, takrolimus yoki pimekrolimus kabi mahalliy kalsineurin ingibitorlari bilan qisqa muddatli davolashni sinab ko'rish mumkin, garchi ulardan foydalanish munozarali bo'lsa-da, chunki ba'zi dori vositalari shuni ko'rsatadiki, ular teri saratoni yoki limfoma rivojlanish xavfini oshiradi[20] [22]. 2007 yilgi meta-tahlil shuni ko'rsatdiki, mahalliy pimekrolimus kortikosteroidlar va takrolimus kabi samarali emas[23]. 2015 yilgi meta-tahlil shuni ko'rsatdiki, mahalliy takrolimus va pimekrolimus past dozali topikal kortikosteroidlarga qaraganda samaraliroq va malign o'sma yoki teri atrofiyasi xavfi ortishi uchun hech qanday dalil topilmadi[24] . 2016 yilda PDE-4 ingibitori bo'lgan crisaborole yengil va o'rtacha ekzema uchun mahalliy davolash sifatida tasdiqlangan[25][26].

Manbalar[tahrir | manbasini tahrirlash]

  1. 1,00 1,01 1,02 1,03 1,04 1,05 1,06 1,07 1,08 1,09 1,10 1,11 1,12 „Handout on Health: Atopic Dermatitis (A type of eczema)“. National Institute of Arthritis and Musculoskeletal and Skin Diseases (2013-yil may). 2015-yil 30-mayda asl nusxadan arxivlangan. Qaraldi: 2015-yil 19-iyun.
  2. 2,0 2,1 2,2 2,3 2,4 2,5 2,6 2,7 "Atopic dermatitis: skin-directed management". Pediatrics 134 (6): e1735–44. December 2014. doi:10.1542/peds.2014-2812. PMID 25422009. 
  3. Evidence-Based Dermatology. John Wiley & Sons, 2009 — 128 bet. ISBN 9781444300178. 
  4. "Atopic dermatitis: natural history, diagnosis, and treatment". ISRN Allergy 2014: 354250. 2014. doi:10.1155/2014/354250. PMID 25006501. PMC 4004110. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4004110. 
  5. „Atopic Dermatitis“ (en). National Institute of Arthritis and Musculoskeletal and Skin Diseases (2019-yil sentyabr). Qaraldi: 2022-yil 29-avgust.
  6. "Epidemiology of atopic dermatitis". Clinical and Experimental Dermatology (Cambridge University Press) 25 (7): 522–529. October 2000. doi:10.1046/j.1365-2230.2000.00698.x. ISBN 9780521570756. PMID 11122223. Archived from the original on 2015-06-19. https://web.archive.org/web/20150619134904/https://books.google.ca/books?id=q8OZ4O_gjQUC&pg=PA10. 
  7. „Atopic Dermatitis“,Encyclopedia of molecular mechanisms of diseases Lang, F: . Berlin: Springer, 2009. ISBN 978-3-540-67136-7. 
  8. "Guidance on the diagnosis and clinical management of atopic eczema". Clinical and Experimental Dermatology 37 (Suppl 1): 7–12. May 2012. doi:10.1111/j.1365-2230.2012.04336.x. PMID 22486763. 
  9. "Assessment of clinical signs of atopic dermatitis: a systematic review and recommendation". The Journal of Allergy and Clinical Immunology 132 (6): 1337–47. December 2013. doi:10.1016/j.jaci.2013.07.008. PMID 24035157. https://archive.org/details/sim_journal-of-allergy-and-clinical-immunology_2013-12_132_6/page/1337. 
  10. "The infra-auricular fissure: a bedside marker of disease severity in patients with atopic dermatitis". Journal of the American Academy of Dermatology 66 (6): 1009–10. June 2012. doi:10.1016/j.jaad.2011.10.031. PMID 22583715. http://www.jaad.org/article/S0190-9622(11)01188-1/abstract. Qaraldi: 2016-03-20. Atopik dermatit]]
  11. Problem-Based Medical Case Management (en). Hong Kong University Press, 2006-01-01. ISBN 9789622097759. 
  12. "Atopic Dermatitis: Update for Pediatricians". Pediatric Annals 45 (8): e280–6. August 2016. doi:10.3928/19382359-20160720-05. PMID 27517355. 
  13. "The effect of environmental humidity and temperature on skin barrier function and dermatitis". Journal of the European Academy of Dermatology and Venereology 30 (2): 223–249. February 2016. doi:10.1111/jdv.13301. PMID 26449379. 
  14. "Atopic Dermatitis". The New England Journal of Medicine 384 (12): 1136–1143. March 2021. doi:10.1056/NEJMra2023911. PMID 33761208. 
  15. "The Pathogenetic Effect of Natural and Bacterial Toxins on Atopic Dermatitis". Toxins 9 (1): 3. December 2016. doi:10.3390/toxins9010003. PMID 28025545. PMC 5299398. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=5299398. 
  16. "Filaggrin mutations associated with skin and allergic diseases". The New England Journal of Medicine 365 (14): 1315–27. October 2011. doi:10.1056/NEJMra1011040. PMID 21991953. 
  17. "Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis". Journal of the American Academy of Dermatology 70 (2): 338–51. February 2014. doi:10.1016/j.jaad.2013.10.010. PMID 24290431. PMC 4410183. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4410183. 
  18. 18,0 18,1 "Diagnostic criteria for atopic dermatitis: a systematic review". The British Journal of Dermatology 158 (4): 754–65. April 2008. doi:10.1111/j.1365-2133.2007.08412.x. PMID 18241277. 
  19. "The U.K. Working Party's Diagnostic Criteria for Atopic Dermatitis. III. Independent hospital validation". The British Journal of Dermatology 131 (3): 406–16. September 1994. doi:10.1111/j.1365-2133.1994.tb08532.x. PMID 7918017. https://archive.org/details/sim_british-journal-of-dermatology_1994-09_131_3/page/406. 
  20. 20,0 20,1 "Atopic dermatitis: an overview". American Family Physician 86 (1): 35–42. July 2012. PMID 22962911. Archived from the original on 2015-09-06. https://web.archive.org/web/20150906111528/http://www.aafp.org/afp/2012/0701/p35.pdf. 
  21. „Atopic Dermatitis“. Medscape Reference. WebMD (2014-yil 21-yanvar). 2014-yil 10-fevralda asl nusxadan arxivlangan. Qaraldi: 2014-yil 3-mart.
  22. „Public Health Advisory: Elidel (pimecrolimus) Cream and Protopic (tacrolimus) Ointment“. U.S. Food and Drug Administration (2005-yil 10-may). 2015-yil 29-martda asl nusxadan arxivlangan. Qaraldi: 2015-yil 23-mart.
  23. "Topical pimecrolimus for eczema". The Cochrane Database of Systematic Reviews (4): CD005500. October 2007. doi:10.1002/14651858.CD005500.pub2. PMID 17943859. http://www.cochrane.org/CD005500/SKIN_topical-pimecrolimus-for-eczema. 
  24. "Topical tacrolimus for atopic dermatitis". The Cochrane Database of Systematic Reviews 2015 (7): CD009864. July 2015. doi:10.1002/14651858.CD009864.pub2. PMID 26132597. PMC 6461158. http://www.cochrane.org/CD009864/SKIN_topical-tacrolimus-atopic-dermatitis. 
  25. „FDA Approves Eucrisa for Eczema“. U.S. Food and Drug Administration (2016-yil 14-dekabr).
  26. „Eucrisa (crisaborole) Ointment, 2%, for Topical Use. Full Prescribing Information“. Anacor Pharmaceuticals, Inc. Palo Alto, CA 94303 USA. Qaraldi: 2016-yil 17-dekabr.