HEALTH CARE OF PATIENTS WITH ATOPIC DERMATITIS

Koža je najveći ljudski organ koji se sastoji od tri sloja: epidermisa, dermisa i supkutanog masnog tkiva. Koža ima i pomoćne organe, a to su: dlake, žlijezde lojnice, znojnice i mirisne žlijezde te nokte. Dermatitis ili ekcem je vrsta upalne reakcije na koži koji može biti izazvan raznim unutarnjim ili vanjskim čimbenicima. Postoji nekoliko vrsta dermatitisa, a jedan od njih je i atopijski dermatitis. Atopijski dermatitis je kronična upalna bolest kože koju karakterizira crvenilo, suha koža, svrbež. To je najčešća dječja kožna bolest. Udružena je s drugim atopijskim bolestima, tako da kod te djece se mogu očekivati i pojava astme, alergijskog rinitisa. Stvarni uzrok bolesti nije poznat, ali je dokazana nasljedna sklonost. U 80% slučajeva dijete razvije atopijski dermatitis ako ga imaju oba roditelja, a 60% djece ako ga ima jedan roditelj. Bolest najčešće počinje između 2. i 6. mjeseca života, ali može početi i u starijoj dobi. Prognoza bolesti je dobra jer u većine djece tegobe prestanu nakon dojenačke dobi ili nakon puberteta. Simptomi atopijskog dermatitisa su: jak svrbež kože, suha koža, crvenilo, otečenost i stvaranje krasta. S obzirom kada se javljaju kožne promjene, klinička slika atopijskog dermatitisa se dijeli na tri skupine. To su: atopijski dermatitis dojenačke dobi, atopijski dermatitis dječje dobi i atopijski dermatitis odraslih. U dojenčadi kožne promjene se najčešće javljaju na čelu, obrazima, vratu, prednjoj strani ručica i nožica, te oko ručnog i skočnog zgloba. U dječjoj dobi promjene postaju blaže. Najčešće su vidljive na koži pregiba velikih zglobova laktova i koljena. Kod odraslih broj zahvaćenih mjesta je manji jer sazrijeva imunološki odgovor. Promjene se mogu vidjeti oko očiju, usta, kod žena oko bradavica na dojkama. Atopijski dermatitis se dijagnosticira na temelju anamneze i kliničke slike. U kliničkoj slici trebaju biti prisutna tri ili više osnovnih obilježja plus tri ili više sporednih obilježja. U dijagnostici se koristi i alergološka obrada, a to su: testovi za dokazivanje IgE protutijela RIST i RAST, prick test, skarifikacijski test, atopijski epikutani patch test. Komplikacije koje mogu nastati kod atopijskog dermatitisa su bakterijske, virusne i gljivične infekcije te kontaktni alergijski dermatitis. Liječenje atopijskog dermatitisa je simptomatsko. Potrebno je izbjegavati alergene koji dovode do pogoršanja bolesti. Od lijekova se koriste lokalni kortikosteroidi, antibiotici, antihistaminici, lokalni imunomodulatori te se može primjenjivati i fototerapija. Kožu je potrebno njegovati vlažnim kremama. Kroz zdravstveni odgoj medicinska sestra nastoji oboljele osobe i njihove obitelji educirati o bolesti, izlječenju, načinu života. Pruža im podršku koja je jako bitna oboljelom i njegovoj obitelji.Skin is the largest human organ that consist of three layers: epidermis, dermis and subcutaneous fat tissue. Skin has some secondary organs, too: hair, sebaceous gland, sweat gland and apocrine gland as well as nails. Dermatitis or eczema is a kind of an inflamatory reaction on skin that can be provoked by many internal or external factors. There are several types of dermatitis and one of them is atopic dermatitis. Atopic dermatitis is a chronic inflammatory disease that is characterized by redness of the skin, dry skin and itching. It is the most common skin disease among children. It is combined with other atopic illnesses so it can lead to asthma or an allergic rhinitis. The true cause for the illness is unknown but it is proven to have a hereditory predisposition. In 80 % of cases a child develops an atopic dermatitis if both parents suffer of it and 60 % if one parent has it. The illness usually starts between the second and the sixth month of baby's life but it can start later on, too. The prognosis is good because in most cases the symptoms cease after infancy or puberty. The sympthoms of an atopic dermatitis are bad itching, dry skin, redness and swollness as well as forming scrabs. Since some changes occur on the skin, clinical picture of atopic dermatitis is divided into three groups. These are: atopic dermatitis in infants, children and adults. In infancy skin changes usually occur on the forehead, cheeks, neck, front parts of hands and legs, as well as wrists and leg joints. In children changes become milder. They are commonly seen on skin, on crooks of big joints of elbows and knees. In adults it spreads on fewer parts of skin because their immune system reacts. Changes can be seen around eyes, mouth and in women in nipple area and on breasts. Atopic dermatitis is diagnosed according to patient's medical history and clinical feature. In clinical feature there should be three or more basic criteria plus three or more secondar. In diagnostics allergy tests are also done. They are an IgE antibody tests, RIST and RAST, a prick test, a scratch test, patch test. Complications that can be found in atopic dermatitis are bacterial, viral and fungal infections as well as contact allergic dermatitis. Treating of the atopic dermatitis is symptomatical. It is necessary to avoid allergens that can lead to medical deterioration. Drugs that are used are local corticosteroids, antibiotics, antihistamines, local immunomodulators and phototherapy can also be applied. It is necessary to use moisturizing creams. Through medical education a nurse is trying to educate patients and their families on the illness, healing and the way of living. He/she gives them support that is very important to the patient and their family