ÇOCUKLARDA ATOPİK DERMATİT TANI VE TEDAVİSİ

Year 2025, Volume: 26 Issue: 4, 390 - 400, 13.10.2025

Ümmügülsüm Dikici , Öner Özdemir

https://doi.org/10.18229/kocatepetip.1435072

Abstract

Atopik dermatit, tekrarlayan egzamatöz lezyonlar ve yoğun kaşıntı ile karakterize, alevlenme ve iyileşme periyotlarıyla seyreden yaygın bir inflamatuvar cilt hastalığıdır. Yaşa göre lezyonların görüldüğü bölgeler değişmekle beraber, hastalık her yaştan ve etnik kökenden insanı etkilemektedir. Yoğun kaşıntının gece uyku düzenini bozması sonucu oluşan uykusuzluk, ağır egzamatöz lezyonların görüntüsü, kuru cildin sürekli bakım gerektirmesi, hastalar ve yakınları üzerinde psikososyal negatif etkilere neden olmaktadır. Bunun yanında epitel bariyer bütünlüğünün bozuk olması bu hastalarda gıda alerjisi, astım ve alerjik rinit dahil olmak üzere birden fazla komorbit hastalık riskinin artmasıyla ilişkili bulunmuştur. Güçlü bir genetik yatkınlığı, epidermal disfonksiyonu, T hücre kaynaklı inflamasyonu ve mikrobiyal disbiyozu içeren patofizyolojisi oldukça karmaşıktır. Terapötik hedefler, kaşıntıyı azaltmaya ve hastalık kontrolünü sağlamaya odaklanan çok adımlı bir yaklaşım gerektirir. Hastalara temel cilt bakımı ve tetikleyicilerden kaçınma konusunda tavsiyelerde bulunulmalıdır. Üç yaşından küçük çocuklarda tetikleyici ajan olarak gıdalar, daha ileri yaşlardaki hastalarda ise aeroalerjenler akılda tutulmalıdır. Mikrobiyal disbiyozun düzeltilmesine yönelik probiyotik tedavi güncel literatürde yerini almaktadır. Tüm bunların yanında tedavinin her basamağında cildin nemlendirilmesi yer almalıdır. Nemlendirme, tedavi basamaklarının temelini oluşturmaktadır. Antihistaminiklerin kaşıntıyı gidermek amaçlı kullanılması tartışmalıdır. Sedatif etkili antihistaminiklerin kısa süreli kullanımının uyku üzerine olumlu etki yaptığı bilinmektedir. Hastalığın alevlenme döneminde ve/veya kronik/tekrarlayan lezyonlarda topikal antiinflamatuar ajanlar düşünülmelidir. Bununla birlikte, orta ila şiddetli atopik dermatitin tedavisi halen zordur. Yeni, etkili, güvenli ve hedefe yönelik tedavilere ihtiyaç duyulmaktadır. Topikal ve sistemik tedavi seçenekleri olsa da atopik dermatitin günümüzde küratif bir tedavisi mevcut değildir. Fakat giderek artan sayıda yenilikçi ve hedefe yönelik tedaviler, dirençli atopik dermatiti olan hastalar da dahil olmak üzere hastalık kontrolünün sağlanması için umut vaat etmektedir.

Keywords

Atopik dermatit , Çocuk , Tanı , Tedavi

DIAGNOSIS AND TREATMENT OF ATOPIC DERMATITIS IN CHILDREN

Abstract

Atopic dermatitis is a common inflammatory skin disease characterized by recurrent eczematous lesions and intense itching with periods of exacerbation and recovery. Although the areas where lesions occur vary depending on age, the disease affects people of all ages and ethnic backgrounds. Insomnia caused by intense itching disrupting night sleep patterns, the appearance of severe eczematous lesions, and dry skin requiring constant care cause negative psychosocial effects on patients and their relatives. Furthermore, impaired epithelial barrier integrity has been associated with an increased risk of multiple comorbid diseases, including food allergy, asthma, and allergic rhinitis in these patients. Its complex pathophysiology includes a strong genetic predisposition, epidermal dysfunction, T cell-mediated inflammation, and microbial dysbiosis. Therapeutic goals require a multi-step approach focused on reducing pruritus and achieving disease control. Patients should be advised on primary skin care and avoiding triggers. Foods should be considered triggering agents in children under three years of age, and aeroallergens should be considered in older patients. Probiotic treatment for correcting microbial dysbiosis takes its place in the current literature. Moisturizing the skin should be included in every step of the treatment. Skin moisturization is the cornerstone of all treatment steps. The use of antihistamines to relieve itching is controversial. It is known that short-term use of sedative antihistamines has a positive effect on sleep. Topical anti-inflammatory agents should be considered during flare-ups and/or chronic/recurrent lesions. However, moderate to severe atopic dermatitis remains difficult to treat. New, effective, safe, and targeted treatments are needed. Although topical and systemic treatment options exist, there is currently no curative treatment for atopic dermatitis. However, a growing number of innovative and targeted therapies hold promise for achieving disease control, including in patients with refractory atopic dermatitis.

Keywords

Atopic Dermatitis , Child , Diagnosis , Treatment

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