Slavinska V. Clinical and laboratory substantiation of improving diagnostics, treatment and prevention of the oral mucosa lesions in children with atopic dermatitis

The prevalence of atopic dermatitis (AD) in the world and particularly in Ukraine is significant and ranges from 5% to 30% of the population with marked age and genetic characteristics. Atopic dermatitis manifests in childhood and gets medical and social significance in the third part of patients who reach adulthood because it tends to persist. Prolonged relapses are accompanied by an increase in the skin lesions area and resistance development to treatment, which creates significant stress on the patients’ social adaptation. Significant problems constitute associated with AD oral and labial mucous membrane lesions in children, such as erythema multiformе (EM), herpes associated erythema multiforme (HAEM), recurrent herpes simplex labialis (HSL). These not only complicate the disease but also act as additional factors of bacterial, viral sensitization of the child's body. The combination and aggravating relationship of chronic inflammatory and inflammatory-dystrophic processes in the periodontium with changes in resistance of the oral mucosa, local and general protective factors and possible influence of persistent infection of herpes simplex virus and bacterial association are also considered. In this context, complex oral mucosa lesions associated with atopic dermatitis in children burdened with the generalized periodontal disease require analysis to determine the links in the pathogenesis, features of clinical manifestations and the development of adequate treatment and prevention. The aim of the work is to increase the effectiveness of treatment of the oral mucosa lesions associated with atopic dermatitis in children by clinical and laboratory substantiation of the system of pathogenetically directed therapeutical and preventive measures as well as evaluation of their effectiveness. Study objectives: 1. To establish the frequency, nosological structure of diseases of the oral mucosa and their features on the background of IgE-dependent and IgE-independent clinical and immunological forms of atopic dermatitis in children aged 12-18. 2. To carry out a situational analysis of dental health indicators in children with erythema multiforme , simple recurrent herpes and herpes associated EM on the background of AD. 3. To investigate the spectrum of periodontopathogenic microflora of the oral cavity, Staphylococcus aureus identification degree in the biomaterial of the oropharynx and skin, the level of expression of antimicrobial peptides in oral fluid and endogenous intoxication of children as predictors of EM, HAEM and HSL. 4. To determine the state of general and local immunity in children with oral mucosa lesions associated with AD. 5. To substantiate and develop a system of pathogenetically directed measures for the algorithm of diagnosis, treatment and prevention of oral mucosa lesions associated with AD, considering changes in immune reactivity and endogenous intoxication of children. 6. To determine the clinical effectiveness of the developed therapeutical and preventive measures with the usage of drugs with immunomodulatory and detoxifying action; to develop practical recommendations for their introduction into clinical practice.