Dermatitis

Role of dermatitis medications in comprehensive systemic therapy

As part of the management of complex systemic pathologies, such as bronchial asthma, special attention is paid to patients with persistent symptoms. This refers to adult patients who do not achieve disease control despite the use of high doses of inhaled glucocorticosteroids combined with long-acting beta2-agonists (LABAs).

In such scenarios, anti-inflammatory therapy is considered, specifically the drug Azithromycin. The target group also includes patients receiving genetically engineered biologic therapies. Notably, these drugs include agents from the D11AH group — medications intended exclusively for the treatment of dermatitis (excluding corticosteroids). Systemic glucocorticosteroids (H02AB) and other systemic agents (R03DX) may also be used. The recommendation grade is classified as the highest (A), and the level of evidence is rated as 1.

It should be noted that when assessing comorbid factors such as obesity, a weight loss program is mandatory in the treatment plan (unlike other pathologies such as atopic dermatitis, COPD, or allergic rhinitis, where these indications are viewed differently). In adults, the greatest efficacy is demonstrated by a combination of dietary therapy and regular physical activity (aerobic and strength training twice a week).

Dermatitis as a complication of antitumor treatment

During aggressive chemotherapy or radiation therapy, cancer patients frequently develop specific complications that require immediate management. One such manifestation is induced dermatitis, as well as concurrent oral mucositis.

For the prevention and direct treatment of these skin and mucosal inflammations, low-level laser therapy is strongly recommended. This method demonstrates high efficacy in reducing the severity of inflammatory responses.

In addition to dermatitis, antitumor treatment causes several other complications that require attention:

• Peripheral polyneuropathy: managed using transcutaneous electrical nerve stimulation (TENS), magnetotherapy, physical exercise, and the aforementioned low-level laser therapy.
• Alopecia: to minimize hair loss, the technique of local scalp cooling (scalp cooling) is used.
• Bone metastases (especially in non-small cell lung cancer — NSCLC): pain control is achieved by prescribing denosumab, radioisotopes, and bisphosphonates.

Skin syndrome of viral etiology: pathogenesis and clinical features

When discussing dermatological manifestations, one cannot overlook lesions caused by the Varicella-zoster virus. Pathogenetically, primary infection in childhood manifests as chickenpox, whereas in adults, reactivation of the pathogen occurs, leading to the development of herpes zoster.

Epidemiological data show an incidence rate of 3–5 cases per thousand population annually, with the risk of developing the pathology being directly proportional to the patient's age. The clinical presentation develops sequentially:

1. Prodromal period: characterized by nonspecific symptoms such as general malaise, fatigue, and fever.
2. Onset of pain syndrome: unilateral hyperesthesia, severe pain, or a burning sensation arises, strictly localized within several dermatomes.
3. Skin eruption stage: a characteristic rash forms within the pain zone after a few days.

Typical localization of lesions includes the thoracic segments (more than half of all cases), the lumbosacral region (about 20%), and the ophthalmic branch of the trigeminal nerve (ramus ophthalmicus nervi trigemini — also 20%).

Evolution of rash elements and potential complications

The skin syndrome in viral infections has a distinct staging. Initially, erythematous spots and papules form on the skin, which subsequently transform into vesicles. In an atypical course, in addition to strict segmental eruptions, scattered vesicular elements may be observed throughout the body.

In an uncomplicated course, the disease resolves within a few weeks: the pain subsides, and the rash disappears completely. However, scars or areas of pronounced dyspigmentation often remain at the site of former vesicles.

Postherpetic neuralgia is the most formidable complication, developing in nearly 30% of cases (especially in elderly patients). Its main clinical feature is that intense pain persists even after the complete regression of all skin elements. The pain syndrome can be of two types:

• Paroxysmal: sharp, cutting, or stabbing pain.
• Constant: boring or burning pain, localized strictly in the area of former skin eruptions.

Diagnostic algorithm and therapeutic approaches

Diagnosis of the described skin lesions is based exclusively on a thorough collection of clinical data. The combination of a characteristic pain syndrome with specific vesicular eruptions located along the dermatomes makes diagnosis a straightforward task that causes no difficulty for the clinician.

In cases of mild, uncomplicated disease, when eruptions are sparse and the pain is moderate, conservative symptomatic therapy is applied. The standard treatment plan includes:

• Analgesics — for adequate pain relief.
• Topical antiseptics — critically important for preventing secondary bacterial colonization and the development of purulent complications in the vesicle zone.
• Topical anesthetics — applied locally to reduce sensitivity in affected skin areas.

Class and exam questions

What else to study on this topic

• Assessment of the general condition of patients using the Karnofsky scale.
• Use of liquid biopsy in non-small cell lung cancer (NSCLC).
• Biofeedback methods in rehabilitation.
• Impact of weight loss programs (combination of aerobic and strength training) on the course of obstructive diseases.
• Tools for assessing depressive symptoms in adult patients with comorbidities.

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.