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#31
06.12.2005, 20:30
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#32
06.12.2005, 21:43
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Специально для доктора Олега объясняю в последний раз принцип "женской логики".
Вернемся к первому посту в теме " Работая участковым педиатром уже 3 раза (дети 2, 4, 7 мес.) сталкивался с атопическими дерматитами, практически резистентными к применению антигистаминных препаратов. Положительный эффект появился после назначения гомональных мазей ("Адвантан","Белосалик" и др.), а в одном случае - преднизолона в/м" т.е. доктор пытался лечить атопический дерматит антигистаминными препаратами. На это он совершенно справедливо получил ответ, что антигистаминные препараты НЕ ЯВЛЯЮТСЯ препаратами первого ряда при лечении атопического дерматита, т.к. они неэффективны. Более того, была дана ссылка, в которой объясняется, что такое атопический дерматит и как его лечить. Могу добавить ( это из той ссылки, что д-р Олег не нашел, но она есть в "желтых сообщениях", а, если бы д-р Олег воспользовался поиском по предложенной ему ссылке, то он бы тоже ее нашел)... BACKGROUND: Atopic dermatitis (AD) is an inflammatory skin disorder that is exceedingly challenging to treat. A prominent feature of AD is chronic pruritus. Early evidence suggested that pruritus in AD was partially due to mast cell release of histamines. Conversely, recent studies do not validate the role of histamine in the pathogenesis of pruritus Таким образом, разумеется, можно применять антигистаминные в лечении атопического дерматита, как вспомогательное лечение, но рассчитывать на то, что от их применения можно получить существенный эффект, не нужно, т.к. его не будет. Кстати, при лечении применяются антигистаминные первого поколения, т.к. при лечении зуда, в основном используется их снотворный эффект. Я понятно объяснила, или еще у кого-то остались вопросы и замечания по-поводу моей "женской логики"? |
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#33
06.12.2005, 22:06
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#34
06.12.2005, 22:20
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В ожидании вашей секретной ссылки могу предложить свою. PEDIATRICS Vol. 112 No. 2 August 2003, pp. 462 LONG-TERM TREATMENT WITH CETIRIZINE OF INFANTS WITH ATOPIC DERMATITIS: A MULTI-COUNTRY, DOUBLE-BLIND, RANDOMIZED, PLACEBO-CONTROLLED TRIAL (THE ETAC TRIAL) OVER 18 MONTHS Cetirizine proved to be safe as patients in the treatment group did not experience significantly more adverse reactions, but, in fact, had a significantly decreased risk of urticaria. [Ссылки доступны только зарегистрированным пользователям ] |
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#35
06.12.2005, 22:30
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[Ссылки доступны только зарегистрированным пользователям ]
Atopic Dermatitis Hywel C. Williams, Ph.D. New England Journal of medicine Volume 352:2314-2324 June 2, 2005 Number 22 Treatment Topical Corticosteroids One systematic review identified 83 randomized controlled trials of the use of topical corticosteroids in atopic dermatitis.30 Vehicle-controlled studies lasting less than one month indicate that approximately 80 percent of people report good, excellent, or clear responses with topical corticosteroids, whereas 38 percent of persons in control groups reported such responses. Potency of topical corticosteroids is classified by the potential for vasoconstriction — a surrogate for clinical efficacy and skin thinning (Table 3). In general, only preparations that have very weak or moderate strength are used on the face and genital area, whereas those that have moderate or potent strength are used on other areas of the body.31 Lower-potency corticosteroids may be sufficient on all areas of the body in younger children. Preparations are typically used in bursts of three to seven days in order to achieve control. There is little difference in outcome between short-term use of potent preparations or longer use of weaker preparations in children with mild-to-moderate disease.32 Lichenified atopic dermatitis requires more potent preparations for longer periods. Long-term studies of moderate-to-potent preparations in children are scarce. One study of 231 children with stabilized atopic dermatitis randomly assigned to receive twice-weekly 0.05 percent fluticasone propionate (plus emollients) or vehicle alone plus emollients for 16 weeks showed that patients in the control group were more likely, by a factor of 8, to have a relapse (95 percent confidence interval, 4.3 to 15.2).33 A four-month trial of persons 12 to 64 years of age with moderate-to-severe disease showed that the application of fluticasone to previously active and new sites of atopic dermatitis for two consecutive days each week reduced flares significantly, as compared with a group receiving an emollient only.34 Reduced efficacy of topical corticosteroids may be related to disease severity rather than to glucocorticoid resistance.35 There is little evidence that the application of topical corticosteroids twice a day is more effective than once-daily applications,36 and more frequent use may cause more local side effects. A main concern with the use of topical corticosteroids is irreversible skin thinning. Although thinning is possible, the concern on the part of patients (and parents) is often well out of proportion to the true risk.37 Although inappropriate use of potent preparations can cause skin thinning, four 16-week randomized trials did not show any clinically significant skin thinning,32,33,34,38 and a 1-year study showed no significant effect on collagen synthesis.39 A one-year study of unrestricted continual use of a potent corticosteroid on the limbs and trunk, a weak preparation on the face, or both showed that striae developed in 3 of 330 adults with moderate-to-severe atopic dermatitis.40 Similar studies in children are lacking. Other possible side effects of corticosteroids include facial telangiectasia and glaucoma from periocular use (rarely reported in adults). Secondary adrenal suppression and the suppression of growth resulting from systemic absorption of topical corticosteroids are also concerns, although clinically relevant adrenal suppression is very rare.41 One study involving children with atopic dermatitis did not find any relationship between height velocity and the use of mild-potency as compared with moderate-potency topical corticosteroids.42 Another study showed biochemical evidence of suppression of the hypothalamic–pituitary–adrenal axis only in children with atopic dermatitis who used potent or very potent topical corticosteroids and in those who had received glucocorticoids from other routes, and not in those who had used topical corticosteroids of mild or moderate strength for a median of 6.9 years.35 Emollients There is no evidence that emollients improve atopic dermatitis directly. However, emollients are widely used because they improve the appearance and symptoms of the dry skin (xerosis) associated with this condition.30,31,43 One study has shown that emollients may reduce the need for topical corticosteroids by approximately 50 percent,44 and another study found that emollients enhanced the response to treatment with topical corticosteroids.45 There is little basis for suggesting the use of one emollient over another, and the preference of the patient is probably the most important factor.31 Topical Calcineurin Inhibitors Topical tacrolimus and pimecrolimus have both been shown to be effective in vehicle-controlled studies. For 1 percent pimecrolimus, the rate ratio for the proportion of patients clear or almost clear of atopic dermatitis at three weeks in five vehicle-controlled trials involving 783 patients was 2.72 (95 percent confidence interval, 1.84 to 4.03).46 For 0.03 percent and 0.1 percent tacrolimus, the rate ratios for the proportion of patients who were clear or who had excellent improvement at 12 weeks were 4.50 (95 percent confidence interval, 2.91 to 6.96) and 5.62 (95 percent confidence interval, 3.67 to 8.61), respectively, in three vehicle-controlled trials involving 656 patients.46 Short-term studies suggest that 0.1 percent topical tacrolimus may be similar in strength to potent topical corticosteroids,46 whereas topical pimecrolimus is considerably weaker.40,47 Few long-term studies compare intermittent use of topical calcineurin inhibitors with intermittent use of topical corticosteroids. A 12-month vehicle-controlled study of children with atopic dermatitis showed that early use of pimecrolimus reduced the frequency of flares from 51 percent to 28 percent,48 although early use of mild topical corticosteroids might have shown similar effects. Topical calcineurin inhibitors do not cause skin thinning. Both tacrolimus and pimecrolimus are associated with mild burning sensations when applied to the skin (Table 3). Five-year studies show a good safety profile for these agents.49 In the United Kingdom, the National Institute of Clinical Excellence approves the use of topical tacrolimus for children older than two years of age with moderate-to-severe atopic dermatitis not controlled by topical corticosteroids, and of topical pimecrolimus as a second-line option for resistant dermatitis of the head and neck.50 In the United States, both of these topical calcineurin inhibitors are approved as second-line agents, and the site of application is not restricted for pimecrolimus. In March 2005, the Food and Drug Administration issued an alert to health care professionals concerning a potential link between topical pimecrolimus and tacrolimus and cancer (mainly lymphoma and skin cancer) on the basis of studies in animals, case reports, and knowledge of how these drugs work.51,52 The alert emphasizes the importance of using these preparations only as labeled and when first-line treatment has failed or cannot be tolerated. Other Topical Agents A study of a refined-coal cream used on one side of the body in adults with mild-to-moderate atopic dermatitis as compared with 1 percent hydrocortisone used on the other side suggested similar efficacy after four weeks.53 There is insufficient evidence to conclude whether topical cromoglycate preparations are effective.30,54 Other topical treatments — such as St. John's wort cream, vitamin B12, and licorice gel — whose use is supported by single small, randomized trials require further evaluation before they can be recommended for the treatment of atopic dermatitis. Oral Antihistamines Evidence is lacking to support the use of antihistamines for the treatment of atopic dermatitis,55 although they are sometimes recommended for their sedative effects.56 Reports on nonsedative antihistamines are conflicting.30,56,57 The largest study failed to demonstrate any overall benefit from prolonged use of cetirizine in children with atopic dermatitis.58 [Ссылки доступны только зарегистрированным пользователям ] [Ссылки доступны только зарегистрированным пользователям ] [Ссылки доступны только зарегистрированным пользователям ] [Ссылки доступны только зарегистрированным пользователям ] |
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#36
06.12.2005, 22:55
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Я не считаю, что атопический дерматит у детей (по крайней мере, у детей раннего возраста) и у взрослых - одно и то же. Это в отношении ссылки, данной yananshs
Кстати, вот что говорит FDA: The FDA recommends that Elidel and Protopic be used only as second line agents in the management of AD in children 2 years of age and older. In other words, they should be prescribed only after an attempt at disease control is made with moisturizers, antihistamines and appropriate topical steroids. [Ссылки доступны только зарегистрированным пользователям ] |
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#37
06.12.2005, 23:07
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Это известная вешь, уважаемый Олег. Был специальный документ выпущенный FDA. Сейчас найду.
FDA ALERT [03/2005]: [Ссылки доступны только зарегистрированным пользователям ] The FDA has issued a public health advisory to inform healthcare professionals and patients about a potential cancer risk from use of Elidel (pimecrolimus). This concern is based on information from animal studies, case reports in a small number of patients, and knowledge of how drugs in this class work. It may take human studies of ten years or longer to determine if use of Elidel is linked to cancer. In the meantime, this risk is uncertain, and FDA advises Elidel should be used only as labeled, for patients after other prescription treatments have failed to work or cannot be tolerated. European Journal of Dermatology. Volume 15, Number 4, July-August 2005 Consensus Conference Management of atopic dermatitis in children. Recommendations. [Ссылки доступны только зарегистрированным пользователям ] Annals of Dermatology and Venereology. 2005 Jan; 132 (1): 81-91. Management of atopic dermatitis of the child [Ссылки доступны только зарегистрированным пользователям ] |
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#40
06.12.2005, 23:20
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#41
06.12.2005, 23:26
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А вот еще одна, где как раз и говорится о "разнице" между атопическим дерматитом у детей и взрослых [Ссылки доступны только зарегистрированным пользователям ] . Там, в частности, написано следующее: Treatment of eczema in childhood has the same components as in adults. А вот Вам и про антигистаминные [Ссылки доступны только зарегистрированным пользователям ] |
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#42
06.12.2005, 23:28
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Назначают - значит видят в этом смысл. и эффект Не вижу смысла дальше продолжать дискуссию |
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#43
06.12.2005, 23:31
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#44
06.12.2005, 23:36
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Между прочим, там написано: CONCLUSION: Dermatologists require additional evidence regarding the efficacy of antihistamines and their mechanism of action in the treatment of AD. Им нужен дополнительный опыт. Вам, очевидно нет, так как вы на весь инет заявили: НЕЭФФЕКТИВНО. |
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#45
06.12.2005, 23:38
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Линейный вид
