Diathesis in adults

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

So, according to medical terminology, diathesis in adults and children is a tendency to some diseases or inadequate reactions to usual irritants (that is allergies: allos ergon from Greek - "other action").

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

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14]

Causes of diathesis in adults

There is a diathesis in adults in different ways, and the form of its manifestation determines the pathogenesis. But they are classified as different classes of diseases. Thus, the code for the ICD-10 in allergic diathesis is L20 (class XII - diseases of the skin and subcutaneous tissue). By the way, congenital predisposition to allergy is also called atopy and distinguishes atopic and allergic conditions, in particular, atopic dermatitis (with the same code L20). Hives (allergic urticaria) has this coding.

Also in the International Classification of Diseases, class XIX is provided, which includes, in addition to injuries and poisonings, other "consequences of external causes". And manifestations of an abnormal reaction to food have code T78.1, while food-derived dermatitis is encoded by L27.2. And any allergy of uncertain origin is assigned code T78.4.

If you look at how uric acid diathesis is coded in adults (that is, predisposition to a disturbance of uric acid metabolism), the picture is similar: it has a code for MKB 10 - N20.9 (urinary stones, unspecified), and E79 (impaired metabolism of purines and pyrimidines) . In addition, some experts call such a diathesis neuro-arthritic.

As you can see, there are enough problems with terminology, therefore the specific causes of diathesis in adults play a special role. To date, for allergists, it is quite obvious that adult diathesis is an expression of polygenic and phenotypic immunological abnormalities 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 the Th2 helper-bearing immunoglobulins, which leads to a change in the cytokine profile (increased proinflammatory gene variants) and increased production of IgE antibodies, which promotes the release of histamine mediators, neuropeptides and cytokines.

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

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

The causes of diathesis on the legs in adults (on calves, under the knees, on the hips), diathesis in adults on the hands (on the hands, shoulders and in the ulnar folds), as well as diathesis behind the ears in adults, are the same.

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

[15], [16], [17], [18], [19], [20], [21]

Symptoms and Diagnosis of Adult Diathesis

The first signs that are observed in diathesis are most often seen on the skin. At first, it may simply be the increased sensitivity of individual skin areas (especially on the face and arms). Why? Because, as it turned out, in people with diathesis the density of distribution of cutaneous nerve fibers in subepidermal and intraepitermal structures is much higher than in people who are not predisposed 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 thing as "nervous skin".

Typical symptoms of adult diathesis include:

• xerosis (dryness and peeling of the skin).
• itching of the skin (pruritis) - from barely perceptible to intolerable;
• rash on the skin, including in the form of urticaria (hives); vesicles (blisters) filled with fluid (exudate); pink and red papules; erythema (different in size red spots) or lichen-like lichenoid rashes. Thus, exudative diathesis occurs in adults, and atopic.

There may also be a chill (nettle fever); headache, pain in the abdomen or in the joints; nausea; rhinorrhea; swelling of the face and covered with rash areas of the body. In this case, rashes on the skin - without any visible cause - can then 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 a variety of individual characteristics.

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

Required tests: blood test for serum IgE; when suspected of skin infections - a general and biochemical blood test for the presence of viral and bacterial infection. And instrumental diagnostics consists in carrying out skin allergological (scarification) samples. To better visualize the rash, a dermatoscope can be used.

Differential diagnosis is also performed, as the rash on the surface of the skin and itching is one of the symptoms of dermatophytosis, red lichen, Duhring's dermatitis, secondary syphilis, strobulus, toxicodermia, sarcoidosis, etc.

Treatment of diathesis in adults

To date, the main treatment of diathesis in adults in most cases is reduced to the appointment of antihistamines that block the receptors of the mediator of allergic reactions of histamine, since more than half of the patients the cause of diathesis remains unknown.

Drugs such as Cetirizine (Cetirizine hydrochloride, Allertec, Zirtek, Zodak, Cetrin) are used - one tablet (10 mg) once a day (in the evening, during meals); Desloratedadine (Lotharadine, Cloramax, Clorinex, Lauratec) - one tablet once a day; Fexofenadine (Fexadine, Telfast, Allegra, Microbalans) - once a day 180 mg. It should be borne in mind that all medicines of this pharmacological group are contraindicated in pregnant and lactating women.

In addition, diathesis in middle-to-severe adults may require the appointment of external dermatotropic immunosuppressive drugs that inhibit the activation of T-lymphocytes and the release of inflammatory mediators. These include 0.1% ointment from diathesis in adults (and 0.03% for children from 3 months) Protopik and Elidel cream (Pimecrolimus), which should be greased rashes twice a day - until complete disappearance.

Reduces the itching of the skin ointment from diathesis in adults: 0.1% antihistamine gel Fenistil; ointment and acryderm cream (with betacetaston beta-metazone dipropionate glucocorticosteroid, apply no more than five days); Diprosalik (betamethasone + salicylic acid); ointment with SC 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.

Alternative treatment of allergic manifestations on the skin in adults consists of lotions with strong decoction of oak bark (2 tablespoons per 300 ml of water) or with infusion of string. External treatment with herbs - camomile, yarrow, sweet clover, budra, plantain, sporich - in the form of washing and doucheing of affected skin areas is also applied.

The diet for diathesis in adults

First of all, a diet for diathesis in adults should exclude foods that provoke an allergic reaction of the body. That is, anyone who suffers from diathesis must know exactly what he can not and what can be eaten with allergies.

Read more on our website:

• diet with dermatitis
• diet with atopic dermatitis
• a diet for hives
• a diet with eczema.

Complications of diathesis in adults - eczema with lacrimal ulceration, covered with crusts, with increased skin hyperemia and swelling of the underlying tissues. When combing rashes and ingesting pyogenic infection (Streptococcus pyogenes, Staphylococcus aureus, etc.), diathesis can take the form of severe bacterial inflammations, in particular, vulgar impetigo.

The consequences are expressed in the deterioration of general health, the increase in relapses of the disease and the reduction of remission periods - up to the 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 with it. And with proper treatment, dieting, and when prophylaxis is carried out - maximum neutralization of atopy triggers and allergies - adult diathesis can be controlled, in time preventing exacerbations.