Óâàæàåìûé êîëëåãà! Ðåêîìåíäàöèè ïî ëå÷åíèþ ïåëåíî÷íîãî äåðìàòèòà íå ñèëüíî çàâèñÿò îò òîãî, ïîíîñ èõ âûçâàë èëè ñëèøêîì âûðàæåííàÿ â òó èëè èíóþ ñòîðîíó "ëþáîâü" ìàìû ê ãèãèåíå îáëàñòè ïîäãóçíèêîâ ó ìàëûøà. Ïðè ïðèñîåäèíåíèè êàíäèäû ( à îíà ïðèñîåäèíÿåòñÿ ïðàêòè÷åñêè âñåãäà è ïðàêòè÷åñêè ñðàçó) ê ñòàíäàðòíûì íàçíà÷åíèÿì äîáàâëÿåòñÿ ïðîòèâîãðèáêîâûé ïðåïàðàò è òîëüêî. Ïðè ïðèñîåäèíåíèè âòîðè÷íîé èíôåêöèè - àíòèáèîòèêè ìåñòíî èëè ñèñòåìíî, â çàâèñèìîñòè îò êîíêðåòíîãî ñëó÷àÿ. Ìàçè, ñîäåðæàùèå öèíê, êîíå÷íî âûãëÿäÿò î÷åíü ýôôåêòíî (Zinc oxide may also be effective) ïîñêîëüêó ïðeêðàñíî "çàòóøåâûâàþò" êàðòèíó äåðìàòèòà, íî íàèáîëåå áëèçêèé ïî ñîñòàâó ê êîæíîìó æèðó ìàëûøà, âñå-òàêè, ëàíîëèí.
Prevention of diaper dermatitis can be summarized with the acronym ABCDE (air, barrier, cleansing, diaper, and education).
prevention of diaper dermatitis.6
Keep the skin clean and dry, ïîýòîìó, ñëèøêîì ÷àñòî ìûòü òàê æå íåïîëåçíî (ñ) êàê è ñëèøêîì ðåäêî.
Provide diaper education.
Frequently change diapers.
Use disposable diapers with superabsorbent material.
When compared with cloth diapers, disposable diapers provide a lower prevalence and severity of diaper dermatitis.
Wash genitalia with warm water and mild soap.
Frequently apply a bland protective topical agent after thorough washing.
Íî ñîâñåì ðÿäîì ìû ÷èòàåì â ãëàâå Medical Care ïåðâûì æå ïóíêòîì:
Öèòàòà:
Öèòàòà:Ideally, the first-line therapy for individuals with diaper dermatitis is zinc oxide ointment or various products containing zinc oxide.5 Zinc oxide is an inexpensive treatment with the following properties:
* Antiseptic and astringent
* Significant role in wound healing
* Low risk for allergic or contact dermatitis
è ÷óòü íèæå:
Öèòàòà:
Öèòàòà:Medication
Medical therapy for diaper dermatitis includes the use of protective topical agents, topical anticandidal agents, and, possibly, topical low-potency steroids.
Protective topical agents
Ideally, first-line therapy for diaper dermatitis is zinc oxide ointment. The safest over-the-counter (OTC) emollient available for newborns is pure white petrolatum ointment. Another safe alternative is Aquaphor ointment, which is principally composed of white petrolatum, mineral oil, and lanolin. It is more expensive than pure white petrolatum ointment.
Êðîìå òîãî, àïòóäåéò 18.1 â ãëàâå Overview of diaper dermatitis in infants and children óòâåðæäàåò:
Öèòàòà:
Öèòàòà:
Management*—*The most effective way to treat irritant diaper dermatitis is to eliminate direct skin contact with urine and feces (ie, by discontinuing or limiting the use of diapers). However, in today's society, diapers are necessary to limit fecal contamination and the spread of enteric diseases [11]. If possible, an infant with irritant diaper dermatitis should be allowed periods of rest without a diaper, allowing the skin to be exposed directly to air [8]. Frequent diaper changes limit prolonged skin contact with stool and urine [6,7].
Topical barriers*—*Topical barriers in the form of ointments or pastes are considered first-line therapy for treating and preventing irritant diaper dermatitis [8,37]. Topical barriers are applied with every diaper change; they should be applied thickly and can be covered with petroleum jelly to prevent sticking to the diaper [38].
The use of topical barrier ointments and pastes for the treatment of diaper dermatitis is based upon long-standing clinical experience; there are few randomized controlled trials comparing these agents to placebo or to one another [37,39].
Topical barriers physically block chemical irritants and moisture from contacting the skin; they also minimize friction [9,37]. Topical barriers should be long-lasting and adherent to macerated and eroded skin. Pastes and ointments generally are better barriers than creams and lotions, which are poorly adherent, minimally occlusive, and contain preservatives [9,37].
The most common over-the-counter topical barriers contain petrolatum, zinc oxide, or both (examples include Desitin, Triple Paste, A & D Ointment, and Balmex) [7,8,16,22]. Some also contain lanolin, paraffin, or dimethicone (a silicone oil) [22].
*• White petrolatum (Vaseline) is an inexpensive, hypoallergenic product that physically protects the skin.
*• Zinc oxide*cream, ointment, or paste is also inexpensive and provides an impermeable barrier to irritants.
*• Sucralfate, a prescription medication labeled for the treatment of duodenal ulcers in the United States, also acts as a physical barrier to irritants and has antibacterial activity. Topical application of sucralfate has been reported to be useful in the management of severe or recalcitrant irritant diaper dermatitis [40].
Candidal Diaper Dermatitis.
...
Treatment consists of applications of an anticandidal agent (nystatin, miconazole, clotrimazole, ketoconazole) with each diaper change or four times daily. Ointments are better tolerated than creams; lotions and creams may cause a burning sensation when applied to irritated skin, and powder may cake and cause erosion due to friction during movement. The combination of a corticosteroid and an antifungal agent is justified if inflammation is severe but may confuse the situation if the diagnosis is not firmly established. Corticosteroid should not be continued for more than a few days. Protection of the diaper area by an application of thick zinc oxide paste overlying the anticandidal preparation may be helpful; the paste is more easily removed with mineral oil than with soap and water. Fungal id reactions gradually abate with successful treatment of the diaper dermatitis or may be treated with a mild corticosteroid preparation. When recurrences of diaper candidosis are frequent, it may be helpful to prescribe a course of oral anticandidal therapy to decrease the yeast population in the gastrointestinal tract. Some infants seem to be receptive hosts for C. albicans and may reacquire the organism from a colonized adult.
13.09.2010, 09:50
,ò.å. êîãäà ðÿäîì íåò âîäû.
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Ëèíåéíûé âèä
