Elena S. Bolshakova

Введение. Атопический дерматит является одним из самых часто встречающихся дерматологи-ческих заболеваний у детей и подростков. Как любое хроническое заболевание, требующее ограничений впитании, может влиять на физическое развитие и нутритивный статус детей. Цель — выявить нарушения в ком-понентном составе тела у детей при разном нутритивном статусе по показателю Z-score индекса массы тела(ИМТ) у детей с атопическим дерматитом. Материалы и методы. В одноцентровое одномоментное когортноеисследование вошли 74 пациента с атопическим дерматитом в возрасте от 6 лет до 17 лет 11 месяцев (среднийвозраст 13,6 года), 40 (54%) из них — мальчики, 34 (46%) — девочки. Изучено физическое развитие по Z-score,нутритивный статус первоначально оценивали по Z-score ИМТ, на втором этапе методом биоимпедансометрииопределяли компонентный состав тела. Результаты. По шкале SCORAD у 59 (78%) пациентов заболевание со-провождалось среднетяжелым течением (чаще в период второго детства и у подростков), а у остальных 15(22%) — тяжелым течением. Удовлетворительный нутритивный статус был у 48 (66%) пациентов, ожирение —у 3 (4%), избыток массы тела — у 10 (14%) детей. Недостаточность питания разной степени выявлена у 12(16%) пациентов. В компонентном составе тела для них характерен дефицит доли активной клеточной массы(%АКМ) — у 66,7%, удовлетворительное содержание доли жировой массы (%ЖМ) и умеренный избыток долискелетно-мышечной массы (%СММ) — у всех детей, имеющих Z-score ИМТ менее –1. У пациентов с избыточноймассой тела превышали нормативы %ЖМ — у 20%, а резко превышали у 60%. При этом %АКМ был в преде-лах возрастных норм у 70%, как и доля СММ — у 50%. Среди пациентов с ожирением у всех отмечено резкоепревышение %ЖМ, при этом у 25% дефицит и доли %АКМ, и доли %СММ, что на фоне избытка %ЖМ являетсясаркопенией. Треть (27%) детей с удовлетворительным нутритивным статусом по Z-score ИМТ имели резкоепревышение %ЖМ, еще 18% — превышение нормальных для половозрастных значений доли %ЖМ, и толькотреть детей со средними показателями Z-score ИМТ демонстрировали средние показатели доли %АКМ, %СММи %ЖМ. Выводы. Удовлетворительный нутритивный статус по данным Z-score ИМТ наблюдался у двух третейдетей с атопическим дерматитом (66%), у 13% — дефицитный и у 21% пациентов — избыточный нутритивныйстатус и ожирение. В каждой группе детей с разными нутритивными статусами выявлены пациенты с избыточ-ным накоплением жировой массы на фоне снижения активной клеточной и скелетно-мышечной массы. Стартизменений в компонентном составе тела начинается еще при удовлетворительном нутритивном статусе. Чащеэто были пациенты с тяжелым поражением кожи по шкале SCORAD, подросткового и юношеского возраста. Introduction. Atopic dermatitis is one of the most common dermatological diseases in childrenand adolescents. Like any chronic disease requiring dietary restrictions, it can affect physical developmentand nutritional status. Aim — to identify features of body composition in children with atopic dermatitis anddifferent nutritional status based on the body mass index (BMI) Z-score. Materials and methods. This singlecenter,cross-sectional cohort study included 74 patients with atopic dermatitis aged 6 to 17 years 11 months(mean age 13.6 years), comprising 40 (54%) boys and 34 (46%) girls. Physical development was assessed usingZ-scores. Nutritional status was initially evaluated using the BMI Z-score. Body composition was subsequentlydetermined using bioimpedance analysis. Results. According to the SCORAD index, a moderate disease coursewas observed in 59 patients (78%; more frequently in the second childhood and adolescent periods), and a severecourse in 15 patients (22%). Satisfactory nutritional status was found in 48 children (66%), obesity in 3 (4%), andoverweight in 10 (14%). Undernutrition of varying degrees was detected in 12 patients (16%). In the group withundernutrition, body composition was...

Objective. To present a new method of physiotherapeutic treatment for children with atopic dermatitis in the exacerbation stage. Material and Methods. One hundred eighty-four patients (aged 5-12) with moderate atopic dermatitis in the acute stage (SCORAD 33.46±7.27 points) were included. The study group (n=92) received physiotherapy, including green and red light photochromotherapy, in addition to standard therapy. The comparison group (n=92) received inpatient treatment according to clinical guidelines. Results. After the therapy, there was a regression of subjective and objective indicators in patients of the main group: reduction of itching, improvement of sleep and psychoemotional state, significant improvement in the quality of life of children and their families according to the quality of life questionnaires (CDLQI and FDLQI); improvement of skin status (reduction of inflammatory manifestations, regression of papular elements of the rash, reduction in the degree of lichenification and manifestations of xerosis, absence of fresh rashes), a significant decrease in the SCORAD index after this type of therapy (12.41 ± 4.19 points). Conclusions. A course of photochromotherapy in children suffering from atopic dermatitis and placed in a dermatology hospital contributes to the achievement of more significant sustainable positive clinical results, as evidenced by subjective data and objective indicators. The inclusion of a new method of photochromotherapy, using green light applied to the neck and collar area and red light applied to two or three of the most affected skin areas, in the complex therapy of children with moderate atopic dermatitis expands the potential of physiotherapy for these patients as an effective and safe method in pediatric practice.

Dry skin (xerosis, xeroderma) in various age groups of the population causes serious concern for many specialists. According to literary data, the dry phenotype is diagnosed in every fifth inhabitant of our planet. Particularly complex is the combination of xeroderma with hypersensitivity to various exogenous and endogenous factors. Dry skin significantly disrupts the psycho-emotional state, causes certain difficulties in communication, and disrupts the quality of life in general [1–6]. Xeroderma can be the basis for the formation of immunoallergic pathological processes in the skin, and contribute to the development of inflammatory dermatological diseases. Xerosis is recorded in such chronic dermatoses as ichthyosis, atopic dermatitis, psoriasis, etc. In particular, disturbances in the skin barrier have been identified that accompany atopic dermatitis and lead to the formation of dry skin in such patients, closing the vicious circle: dry skin — atopy — sensitive dry skin with increased manifestations of xeroderma [2–6]. Conclusion. Genetic mutations, combined with acquired endogenous disorders and negative exogenous factors, can act as triggers, clinically inducing a dry skin phenotype. Xeroderma manifestations not only cause aesthetic discomfort but can also serve as an underlying condition for the development of dermatological diseases, leading to a decline in the quality of life of patients and their families. Atopic dermatitis, the most common chronic dermatological pathology, is clinically accompanied by pronounced manifestations of xerosis. Patients require therapeutic and preventive measures (care procedures, corneotherapy) to restore the skin barrier and prevent transepidermal water loss, bacterial contamination, and allergen penetration. Modern physiotherapy procedures are effective for dermatological patients of all ages. They expand and complement traditional conservative treatment for patients with atopic dermatitis and are indicated for rehabilitation. A promising physiotherapeutic method in the complex treatment of children and adolescents suffering from atopic dermatitis is photochromotherapy.

Objectives. To study the clinical manifestations of atopic dermatitis in adolescents undergoing inpatient treatment and to substantiate the need to include physiotherapy methods in complex therapy. Material and Methods. We observed 242 adolescents (105 girls and 137 boys) aged 12–17 years, hospitalized in 2024 in the Dermatovenereology Department of the Saint Petersburg State Pediatric Medical University, Ministry of Health of the Russian Federation. The diagnosis of atopic dermatitis was established based on clinical and anamnestic data, coding was performed according to ICD-10: L20.8 Other atopic dermatitis. The primary and secondary criteria for atopic dermatitis proposed by J. M. Hanifin and G. Rajka were taken into account when making the diagnosis. Comprehensive treatment of patients was carried out in accordance with the «Standard of Medical Care for Children with Atopic Dermatitis (Diagnosis and Treatment)» and «Clinical Guidelines. Atopic Dermatitis.» Results. The adolescents observed presented with widespread and diffuse forms of atopic dermatitis, including lichenoid, erythematosquamous with lichenification, and eczematized clinical patterns. Complicated pyoderma was observed in 55 % of cases, significantly complicating the underlying dermatological process. Concomitant pathologies were identified in two-thirds of patients, including gastrointestinal and hepatobiliary disorders (67 %), ENT pathologies, and respiratory diseases (28 % and 19 %, respectively). Physiotherapy methods used included photochromotherapy, laser therapy, ultratonotherapy, and phonophoresis, which demonstrated clinical efficacy based on the SCORAD index. All children who completed the full course of prescribed physiotherapy procedures in conjunction with the necessary dermatological treatment were discharged with improvement and in satisfactory condition. Conclusion. Based on the obtained results, it is recommended to include physiotherapy methods in the comprehensive treatment of children with atopic dermatitis at various stages, including in health resorts.

Nevus comedonicus is a rare benign hamartoma of the sebaceous follicle which is more common on the face, neck, shoulders, chest or abdomen. Nevus is group of small or large open comedones. It is a type of organoid epidermal nevus and usually appears before the age of 10 years. The linear configuration of the lesion along Blaschko’s lines suggests that the nevus is a manifestation of mosaicism. A possible cause of nevus comedonicus is mosaic postzygotic mutation of the NEK9 gene. Nevus comedonicus syndrome is also associated with extracutaneous abnormalities. Extracutaneous manifestations most often include ocular abnormalities: ipsilateral cataracts and corneal changes. Associated skeletal abnormalities include abnormalities of the fingers/toes (polysyndactyly or clinodactyly, etc.), scoliosis and other spinal malformations. We present our patient with a large nevus comedonicus localized on the left half of the abdomen with transition to the thigh. The lesion consists of multiple densely located elements with a diameter up to 1–2 mm in the form of expanded orifices of hair follicles — open comedones and inflammatory nodes. Scars remain in place of resolved nodes. A feature of the nevus in our patient is the large size of the nevus and the presence of inflammatory nodes. Dermoscopy reveals numerous light and dark brown, round or barrel-shaped, homogeneous areas with protruding keratin plugs. The treatment was carried out at the clinic with minocycline and gel adapalene externally. Thus, comedo nevus is a rare skin pathology that usually appears at birth and can affect any area of the skin. It can be an isolated skin pathology or as a component of comedo nevus syndrome, which requires additional examination of patients.