Diathesis in adults

The famous American medical dictionary Stedman's Medical Dictionary defines diathesis as a hereditary predisposition of the body to a disease, group of diseases, allergies and other disorders.

So, according to medical terminology, diathesis in adults and children is a tendency to certain diseases or inadequate reactions to common irritants (that is, allergies: allos ergon from Greek - “different action”).

In certain circumstances or in the presence of provoking exogenous causes, diathesis caused by hereditary or constitutional factors becomes a catalyst for the development of the disease.

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Causes of diathesis in adults

Diathesis manifests itself in adults in different ways, and the forms of its manifestation are determined by pathogenesis. But they are classified into different classes of diseases. Thus, the ICD 10 code for allergic diathesis is L20 (class XII - diseases of the skin and subcutaneous tissue). By the way, congenital predisposition to allergies is also called atopy and atopic and allergic conditions are distinguished, in particular, atopic dermatitis (with the same code L20). Urticaria (allergic urticaria) has such a coding.

The International Classification of Diseases also provides for class XIX, which includes, in addition to injuries and poisoning, other "consequences of external causes." And manifestations of an abnormal reaction to food have the code T78.1, while dermatitis caused by food products is coded L27.2. And any allergy of unknown origin is assigned the code T78.4.

If you look at how uric acid diathesis is coded in adults (i.e. predisposition to uric acid metabolism disorder), the picture is similar: it has the ICD 10 code - N20.9 (unspecified urinary stones), as well as E79 (purine and pyrimidine metabolism disorder). In addition, some specialists call this diathesis neuro-arthritic.

As you can see, there are enough problems with terminology, so the specific causes of diathesis in adults play a special role. Today, it is absolutely obvious to allergists that diathesis in adults is an expression of polygenic and phenotypic immunological deviations characteristic of people with a genetic predisposition to allergies. The immunopathological mechanism of these hypertrophied reactions is the same: a change in the ratio of Th1 and Th2 lymphocytes towards Th2 helpers with immunoglobulin receptors, which leads to a change in the cytokine profile (an increase in proinflammatory gene variants) and increased production of IgE antibodies, which promotes the release of mediators - histamine, neuropeptides and cytokines.

Diathesis can appear on the skin surface anywhere and from any effect that causes a common allergy. Thus, diathesis on the cheeks of an adult can be an allergy to food products (for example, diathesis from sweets in adults is caused by an allergic reaction to haptens - honey, chocolate, nuts, as well as many other ingredients in confectionery products), to cold (cold allergy) and even to fluoride contained in toothpastes.

In addition, diathesis on the face in adults, as well as on the neck and armpits, can be a cholinergic allergy, which is provoked by sweating during physical activity, swimming, staying in a heated room, or emotional stress.

The causes of diathesis on the legs in adults (on the calves, under the knees, on the surface of the thighs), diathesis on the arms in adults (on the wrists, shoulders and in the elbows), as well as diathesis behind the ears in adults are the same.

Available data - in particular, research by the Department of Clinical Social Medicine (Germany) - show that in 20-23% of cases of occupational skin diseases, a decisive role is played by existing atopic or allergic diathesis in adults, which, in fact, is an endogenous risk factor for the occurrence of occupational dermatological pathologies (dermatitis, folliculitis, eczema).

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Symptoms and diagnosis of diathesis in adults

The first signs observed in diathesis are most often visible on the skin. At first, it may simply be increased sensitivity of certain areas of the skin (especially on the face and hands). Why? Because, as it turned out, in people with diathesis, the density of distribution of skin nerve fibers in subepidermal and intraepidermal structures is much higher than in people who do not have a predisposition to inadequate reactions of the body. In addition, the diameter of these fibers is much larger - due to the increase in the number of processes of nerve cells (axons) in each nerve fiber. There is even such a concept as "nervous skin".

Typical symptoms of diathesis in adults include:

• xerosis (dry and flaky skin).
• itching of the skin (pruritis) – from barely noticeable to unbearable;
• skin rash, including urticaria (hives); vesicles (blisters) filled with fluid (exudate); pink and red papules; erythema (red spots of varying sizes) or lichenoid rashes similar to lichen. This is how exudative diathesis in adults and atopic diathesis manifest themselves.

Chills (urticaria); headache, abdominal or joint pain; nausea; rhinorrhea; swelling of the face and rash-covered areas of the body. At the same time, skin rashes - without any apparent reason - can increase or decrease (with the temporary disappearance of other signs of the disease). In general, the symptoms of diathesis in adults create a general clinical picture of chronic dermatological pathology with alternating remissions and relapses and many individual characteristics.

Diagnosis of diathesis in adults involves examining the patient and studying the family history regarding the presence of increased sensitivity to various irritants in blood relatives.

Necessary tests: blood test for serum IgE level; if skin infections are suspected – general and biochemical blood test for viral and bacterial infection. Instrumental diagnostics include skin allergy (scarification) tests. A dermatoscope can be used for better visualization of rashes.

Differential diagnostics are also carried out, since a rash on the skin surface and itching are one of the symptoms of dermatophytosis, lichen ruber, Duhring's dermatitis, secondary syphilis, strophulus, toxicoderma, sarcoidosis, etc.

Treatment of diathesis in adults

Today, the main treatment for diathesis in adults in most cases comes down to prescribing antihistamines that block the receptors of the allergic reaction mediator histamine, since in more than half of patients the cause of diathesis remains unknown.

The following medications are used: Cetirizine (Cetirizine hydrochloride, Allertek, Zyrtec, Zodak, Cetrin) - one tablet (10 mg) once a day (in the evening, during meals); Deslotaradin (Lotaradine, Cloramax, Clorinex, Loratek) - one tablet once a day; Fexofenadine (Fexadine, Telfast, Allegra, Microlabs) - once a day 180 mg. It should be borne in mind that all medications of this pharmacological group are contraindicated for pregnant and lactating women.

In addition, moderate to severe diathesis in adults may require the use of dermatotropic immunosuppressive drugs for external use that suppress the activation of T-lymphocytes and the release of inflammatory mediators. These include 0.1% ointment for diathesis in adults (and 0.03% for children from 3 months) Protopic and Elidel cream (Pimecrolimus), which should be applied to the rash twice a day - until it disappears completely.

Reduces skin itching with ointments for diathesis in adults: 0.1% antihistamine gel Fenistil; ointment and cream Akriderm (with glucocorticosteroid betamethasone dipropionate, use for no more than five days); Diprosalik (betamethasone + salicylic acid); ointment with GCS Elok (Uniderm, Mometasone, Momat) and Flucinar (fluocinolone acetonide + neomycin sulfate); ointment Videstim (with retinol), etc.

It is also recommended to take vitamins for diathesis in adults - A, C and B6.

Traditional treatment of allergic skin reactions in adults consists of lotions with a strong decoction of oak bark (2 tablespoons per 300 ml of water) or with an infusion of succession. External treatment with herbs is also used - chamomile, yarrow, sweet clover, bugleweed, plantain, knotweed - in the form of washing and dousing the affected areas of the skin.

Diet for diathesis in adults

First of all, a diet for diathesis in adults should exclude food products that provoke an allergic reaction of the body. That is, everyone who suffers from diathesis should know exactly what he cannot and can eat with allergies.

Read more on our website:

• diet for dermatitis
• diet for atopic dermatitis
• diet for urticaria
• diet for eczema.

Complications of diathesis in adults include eczema with weeping ulcerations covered with crusts, with increased hyperemia of the skin and swelling of the underlying tissues. When scratching the rash and getting a pyogenic infection (Streptococcus pyogenes, Staphylococcus aureus, etc.), diathesis can take the form of severe inflammation of a bacterial nature, in particular, vulgar impetigo.

The consequences are expressed in a deterioration in general well-being, an increase in the frequency of relapses of the disease and a reduction in periods of remission - up to the point of disability of patients with severe forms of allergic and exudative diathesis.

The prognosis is complicated by the chronic autoimmune nature of the pathology, but there is no threat to life. And with proper treatment, diet, and when prevention is carried out - maximum neutralization of triggers of atopy and allergies - diathesis in adults can be controlled, preventing exacerbations in time.