Application of the drug "lactofiltrum" in the complex treatment of patients with itchy dermatoses

According to the International Classification of Diseases, 10th Revision (ICD-10), AD has its own diagnostic criteria and is a distinct nosological entity. The incidence of AD among children in developed countries ranges from 12% to 37%, while among the adult population it is 0.2-2%; in Russia, the incidence of AD is 5.9% [1].

Children most frequently develop AD within the first two years of life, although the disease can manifest at any age. The frequency of AD decreases with age: it resolves in half of the patients by 15-16 years, while in the rest it may persist throughout life [2]. AD involves a complex interaction of several immune and non-immune factors, which are only partially understood to date.

There is no single classification for AD. AD is subdivided into exogenous, associated with respiratory allergy, and endogenous, not associated with it. AD of a non-allergic nature is observed in 10-40% of all AD patients. The working classification of AD, recognized by national authors, distinguishes age periods, disease stages, severity degrees, and the extent of the skin process. Age periods of the disease are: infant (up to 2 years), childhood (from 2 to 13 years), adolescent and adult (from 13 years and older) [3].

The following disease stages are identified:

• The exacerbation stage is characterized as the phase of pronounced and moderate manifestations of AD.
• The remission stage (complete and incomplete).

Based on extent, AD is assessed as limited, widespread, and diffuse. Based on the severity of the process, AD is divided into mild, moderate, and severe. To assess the severity of AD, semi-quantitative scales are used, with the SCORAD (Scoring of Atopic Dermatitis) scale being the most widely applied.

AD is often complicated by the addition of a secondary infection: bacterial, fungal, or viral [2].

The clinical diagnosis of AD is made based on a characteristic clinical picture in the form of papular eruptions, dry skin, scaling, erythema, infiltration, excoriations, lichenification, and skin itching. Patients with AD have disturbed sleep.

Treatment of AD includes the following directions:

• Elimination of causal allergens;
• Topical and systemic pharmacotherapy;
• Education, rehabilitation, and prevention.

Systemic pharmacotherapy involves the use of antihistamines, glucocorticosteroids, antibacterial, sedative and other psychotropic agents, immunotropic drugs, as well as medications affecting other organs when their function is impaired [1, 2, 3].

A direct correlation has been established between the level of total IgE and the presence of foci of bacterial infection [4]. An extremely important factor in the development of AD is parasitic infection caused by various helminths and protozoa. According to N.P. Toropova [5], 30% of examined children suffering from AD were found to have 15 different species of parasites. The waste products of helminths and their toxins can cause activation of immunocompetent cells, hyperproduction of immunoglobulins, especially IgE, as well as the formation of immune complexes and impairment of T-cell immunity [4, 5].

Also, causal factors, or according to the definition by Leung (1996), immunological stimulators of atopy in general, and AD in particular, include allergens, infectious agents, and irritants [6].

Numerous studies have proven the role of food and inhalant allergens in the formation of AD. In early childhood and preschool age, the most common allergens are food allergens, while in older age groups they are inhalant allergens [2]. Essentially, food allergy is the initial sensitization, against which, due to the similarity of the antigenic structure and the development of cross-allergic reactions, hypersensitivity to other types of allergens is formed: pollen, household, epidermal [3].

One of the risk factors for the development of skin manifestations of AD, especially its severe forms, is the unjustified and often uncontrolled use of medications or their combinations. The administration of complex therapy with hyposensitizing, sedative drugs, and enterosorbents for AD seems justified [1].

LF consists of two active components: lignin and lactulose. The high sorbing activity of lignin is due to it being a natural enterosorbent from wood hydrolysis products. Furthermore, lignin has a nonspecific detoxifying action – it binds and removes from the intestines pathogenic bacteria and their toxins, medications, alcohol, allergens, excess of some metabolic products responsible for the development of exogenous intoxication [7].

The other component of LF is lactulose, a synthetic disaccharide that is hydrolyzed in the large intestine, where under its influence the flora changes (the number of bifidobacteria and lactobacilli increases), and due to the resulting organic acids (lactic, formic, acetic), the growth of pathogenic flora is suppressed and the production of nitrogen-containing toxic substances is reduced. This enhances the osmotic pressure in the lumen of the large intestine and stimulates peristalsis. The complex action of the drug is aimed at normalizing the microbiocenosis of the large intestine and reducing the intensity of exogenous toxic states [2, 7].

• atopic dermatitis – 11 people;
• diffuse neurodermatitis – 5 people.

All patients exhibited pronounced intoxication and severe itching. We prescribed complex therapy, including detoxification agents, hyposensitizing drugs, antihistamines, various digestive enzymes, and for some patients – hepatoprotectors. All patients received Lactofiltrum, 2 tablets 3 times a day for 14 days.

1. Kurbacheva O.M. Principles of therapy for allergic diseases // Consilium medicum. - 2002. - Volume 2. - N 2. - P. 19-29.

2. Smirnova G.I. Modern concept of atopic dermatitis in children. M., 2006. 132 p.

3. Ivanov O.L. Atopic dermatitis: modern concepts // Russian Medical Journal. — 2007. — Volume 15, N 19. — P. 1362-1366.

4. Nazarov P.G., Gorlanov I.A., Milyavskaya I.R. Atopic dermatitis: immunological aspects // Allergology: Scientific and practical journal. — 1999. — N 2. — P. 28-35.

5. Toropova N.P., Sinyavskaya O.A. Eczema and neurodermatitis in children, 3rd ed. Sverdlovsk, 1993. 447 p.

6. Leung D.Y.M. Current Allergy And Clinical Immunology. 1996. P. 24-29.

7. Gracheva N.M., Shcherbakova I.T., Partin O.S. et al. Influence of the prebiotic "Lactofiltrum" on the mucosa of the gastroduodenal zone in patients with chronic diseases of the stomach and duodenum // New Drugs: Express Information. - 2006. - N 1. - P. 24-30.