Atopic Dermatitis and hyperbaric oxygenation

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ABSTRACT

We present the case of a patient of 35 years, the female with the diagnosis of atopic dermatitis in adults with very poor management and persistent course what motive income repeatedly in the Dermatology Department of Clinical Surgical Hospital Provincial de Sancti Spiritus, receiving additional hyperbaric oxygenation therapy, evolving with resolution of their disease.

The Atopic Skin conditions have an impact on developing countries of a l0% of the total population and is a problem in our field because of its ongoing persistent, recurrent and difficulties of treatment and can be defined as an alteration of the immune system, genetically determined, that hyperreactive response leads to the skin a large number of environmental stimuli, both allergic and irritative.

Those who have a tendency to overproduction of immunoglobulin E and very often have personal and family history of other atopy, such as asthma and allergic rhinitis. (1)

Atopic dermatitis usually occurs in the first years of life (childhood eczema), but in 20% of patients diagnosed for the first time in adulthood. Atopic dermatitis of childhood (which sometimes persists into adulthood) can have a profoundly negative effect on the quality of life of patients and their families and / or caregivers. (1)

Three theories are considered fundamental in the pathogenesis of atopic dermatitis: the genetic theory, theory and theory immunological biochemistry.

Furthermore it is considered that this disease is the result of an interaction between an antigen present in the environment, the number of T cells, serum level of IgE and antigen-specific high affinity receptors with Langerhans cells by immunoglobulin E. (2.3,)

Recently there has been much exaggerated importance to the colonization of the skin of these patients by Staphylococcus aureus (93% in affected skin and 76% in healthy skin), compared to 5% in the normal subject.

It has been suggested that the presence of antigenic super toxins of Staphylococcus aureus is responsible, through an IgE immune response, maintain the chronic skin inflammation in these patients, while the acute phase inflammatory, allergic, delayed, would be induced by aeroallergen . (3,4)

In young adults the disease usually appears between l2 and 24 years, and is characterized by the location of the lesions more frequently in flexures. They are dry, lichenified, with skin thickening and discoloration.

Among the most common complications have secondary infections by bacteria, viruses, fungi, and erythroderma reticulosis. (5,6)

During the past 50 years, conventional treatment of atopic dermatitis has been the use of emollients for general skin care and topical corticosteroids to control outbreaks. Other potential therapies have been under investigation.

Steroids have anti-inflammatory, immunosuppressive and antiproliferative properties and are effective in the treatment of atopic dermatitis.

However, its continued use is associated with both local side effects (skin atrophy, striae, telangiectasias and development to other damages including dermatological purpura, erythema and rosacea) and are relatively uncommon systemic (risk of suppression of the hypothalamic-pituitary -adrenal (HPA), which may result in symptoms typical of Cushing’s syndrome, growth impairment, hypertension and cataracts). (7)

The use of antihistamines in this disease produces a sedative effect and this property is believed that the benefit experienced by patients than any direct effect of histamine on the skin.

On the use of antiseptic and antimicrobial long, has been associated with the bacteria Staphylococcus aureus atopic dermatitis. S. aureus represents approximately 90% of the aerobic bacterial count on the skin of atopic dermatitis patients, compared to 30% in healthy subjects.

However, the relationship between atopic dermatitis and colonization by S. aureus is under investigation. No consistent evidence to suggest that oral or topical antibiotics have benefits on atopic dermatitis in areas where the skin is free from infection. (8)

Some patients with atopic dermatitis have been reported to experience fewer outbreaks during the summer months.

This observation has led to the use of ultraviolet light therapy (UV). UVB standard regimens may be adequate to control mild atopic dermatitis, but therapy combined UVA / UVB may be necessary in moderate to severe cases.

UV light therapy is usually reserved for patients refractory to other

regimens. It can be costly in terms of money and time and little is known about the potential effects of skin aging and carcinogenic effects associated with treatment with long-term UV. (9)

There is scientific evidence that warrant investigation in atopic dermatitis treatments used in other atopic diseases (Antiasthmatic). To date, studies have been small and have shown little evidence of effectiveness. (8,9)

The Society of Underwater and Hyperbaric Medicine, recommends the use of hyperbaric oxygenation (HBO) in different diseases where the patient breathes a concentration of 100% O2 with a chamber pressure greater than atmospheric, approving its use in adjuvant treatment or absolute indication of certain pathologies.

Within the beneficial effects of hyperbaric oxygenation have action that activates leukocytes and macrophages, favors the action of T and B lymphocytes, regulating the cell metabolism, decreased tissue hypoxia increases the formation of fibroblastic and regenerating tissues, serotina secretion decreases decreases toxins is bactericidal and antifungal anaerobic organisms inhibitor, enhances the pharmacological action of certain antibiotics and immunomodulatory effect. (10)

It is known that hyperbaric oxygen is used in numerous dermatologic conditions, such results are represented by some authors.

Smirnova treatment was applied in 23 patients of whom 20 had a satisfactory outcome in their study. (11)

Olsansky 10 patients treated with hyperbaric oxygen which 5 were carriers of atopic dermatitis and reported improvement in all cases. (12)

In our country there are about experiences in the Provincial Hospital “Lucia Iiguez Landin” by Dr. Holguin Batalln Jerez and others, in a study conducted for nine years in patients with atopic dermatitis treated with hyperbaric oxygen as adjunctive therapy, where the outcome was satisfactory in 90% of patients, with disappearance of pruritus, insomnia and skin lesions. (13)p align = “center”>

CASE REPORT

SHG patient, 35 years old, female, white, with pathological family history (mother with asthma), and personal medical history of allergic rhinitis in childhood, with the diagnosis of adult atopic dermatitis (personal medical history and family, clinical and biopsy) for ten years, so it has received various treatments for this disease.

It was valued by the Allergy Service and Internal Medicine.

Have injuries in neck, face, eyelids, back of hands and feet as well as site flexion of the elbows and behind the knees, presenting a polymorphism lesion (erythematous papules and plaques isolated chronic course with lichenification) accompanied by intense itching, difficulty sleeping, the patient progressed to erythroderma despite the above measures.

Are made complementary.

* Hemoglobin: 11.1 g / l

* Erythrosedimentation: 5 mm

* Leucogram: 9 x 10 9, sec.: 0.65, lin: 0.31, eos: 0.4

* Absolute eosinophil count: 0.7

* Glucose: 4.6 mmol / l

* Creatinine: 100 mmol / l

* Cholesterol: 2.6 mmol / l

* TGP: 20 IU

* Abdominal ultrasound: liver, gallbladder, pancreas and both kidneys unchanged.

* Nasopharyngeal: Normal Flora

* Biliary Drainage: There were no parasites, gall normal functional capacity.

Hyperbaric oxygen was used in addition to the usual treatment for atopic dermatitis (including diet, antihistamines, oral and topical steroids), receiving 15 sessions with a good evolution is complete resolution of the disease but had some symptoms or signs of the disease during the observation time.

REFERENCES

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* Manzour Katrip / et al. Group of Authors. The Habana.2003

* Fernandez Hernandez-Baquero G. Dermatology. Scientific-Technical Publishing. Havana, 1986, pp. 164-166.

* Thomas B Fitzpatrick; Eisent AZ, Wolff K, Freedberg IM, Austen FK. Dermatology in General Medicine. 4.ed. New York, McGraw – Hill, 1993.

* Lambert, S.I. Dermatology Practice Manual. / S.I. Lambert-Havana: Scientific-Technical Publishing, 1987.-p 227-235 –

* Rudikoff D, Lebwohl M.Atopic dermatitis. Lancet 1998; 351:1715-21

* R. Jaffe Atopic dermatitis. Prim Care 2000; 27:503-13 2000, 4 (37) :1-187.

* Hoare C, Li Wan Po A, Williams H. Systematic review of treatments for atopic eczema. Health Technol Assess 1989; 121:635-7

* Berth-Jones J, Graham-Brown RA. Failure of terfenadine in relieving the pruritus of atopic eczema. Br J Dermatol

* Brehler R, Hildebrand A, Luger T. Recent developments in the treatment of atopic eczema. J Am Acad Dermatol1997; 36:983-4

* Rock, A, J Desoha. Hyperbaric Oxygen. Intensive Care Medicine 12 10: 571-574, 1988.

* Smirnova, O.N. Clinical and immunological evaluation of the effectiveness of hyperbaric oxygenation during combined treatment of adult atopic dermatitis complicated by secondary infection. Vests Venrela Dermatol 2: 30-35, February, 1992.

* Olszansky, R. .. / Et aV. Efficacy of Hiperbaric Oxygenation in Atopic Dermatitis. Bull Inst Trop Miarot Guynin 43 1-4: 78-82, 1992.

* Batalln MP / et al. Hyperbaric Oxygenation in Adult Atopic Dermatitis. 1994-2003. Provincial Teaching Hospital “Lucia Iiguez Landin.” Holguin