Viêm da cơ địa và những điều cần biết

   Viêm da cơ địa là một trong những bệnh ngoài da tương đối phổ biến. Bệnh tiến triển dai dẳng, tái phát lại nhiều lần, từ lúc sơ sinh đến 5-6 tuổi. Một số có thể kéo dài tới tuổi dậy thì, số ít hơn có thể tái xuất hiện ở tuổi 40-50. Bệnh  viêm da cơ địa tuy không gây tử vong nhưng ảnh hưởng rất lớn tới sinh hoạt, tâm lý và năng xuất lao động của người bệnh.

Bệnh viêm da cơ địa
Bệnh viêm da cơ địa

     Nguyên nhân của bệnh viêm da rất phức tạp, liên quan đến nhiều yếu tố, tuy nhiên đóng vai trò quan trọng trong căn sinh bệnh học của bệnh viêm da là: Di truyền, môi trường, khí hậu, ăn uống. Bệnh thường gặp ở những người có cơ địa dị ứng, hay bị các bệnh như Hen phế quản, mày đay, dị ứng thời tiết, thức ăn,…Bệnh còn có tên gọi khác như: Chàm, Chàm cơ địa, Chàm thể tạng (Trẻ em), viêm da thần kinh (Người lớn).

Những điều cần biết về bệnh viêm da cơ địa

– Tỷ lệ hiện mắc: Hiện nay, chưa có nghiên cứu về tỷ lệ hiện mắc viêm da cơ địa ở Việt Nam. Theo báo cáo của phòng khám Viện Da liễu quốc gia, có khi viêm da cơ địa chiếm khoảng 20% số bệnh nhân đến khám tại phòng khám.

– Tuổi phát bệnh: thường vào hai tháng đầu, có tới 60% trẻ viêm da cơ địa phát bệnh trong năm đầu, 30% trong 5 năm đầu và chỉ có 10% phát bệnh từ 6-20 tuổi. Rất hiếm bệnh nhân phát bệnh khi trưởng thành.

– Về giới không khác biệt rõ rệt giữa nam và nữ.

– Yếu tố di truyền, gia đình cho thấy 60% người bị viêm da cơ địa có con cũng bị bệnh này. Nếu cả bố mẹ đều bị viêm da cơ địa thì có tới 80% con bị bệnh.

 60% người bị viêm da cơ địa có con cũng bị bệnh viêm da cơ địa
60% người bị viêm da cơ địa có con cũng bị bệnh viêm da cơ địa

– Các yếu tố làm bệnh khởi phát và nặng lên bao gồm: các dị nguyên trong không khí như các chất thải của rệp nhà, len dạ… Ngoại độc tố của tụ cầu trùng vàng (Staphylococus aureus) đóng vai trò siêu kháng nguyên kích thích hoạt hóa T limphô và đại thực bào. Dị ứng nguyên nội sinh (endogenous antigens): trong huyết thanh bệnh nhân có kháng thể IgE có thể kích thích IgE hoặc T limphô đáp ứng viêm. Thức ăn: Một số thức ăn cũng có thể làm vượng bệnh như trứng, sữa, lạc, đậu tương, cá, bột mỳ…

Biểu hiện lâm sàng bệnh viêm da cơ địa

– Giai đoạn cấp tính: Biểu hiện bệnh khi cấp tính là đám da đỏ ranh giới không rõ, các sẩn và đám sẩn, mụn nước tiết dịch, không có vẩy da. Da bị phù nề, chảy dịch, đóng vảy tiết. Các vết xước do gãi tạo vết chợt, bội nhiễm tụ cầu tạo các mụn mủ và vẩy tiết vàng. Bệnh thường khư trú ở trán, má, cằm, nặng hơn có thể lan ra tay, thân mình.

Biểu hiện bán cấp của viêm da cơ địa

– Giai đoạn mạn tính da dày thâm, ranh giới rõ, liken hoá, các vết nứt đau; đây là hậu quả của việc bệnh nhân ngứa gãi nhiều. Thương tổn hay gặp ở các nếp gấp lớn, lòng bàn tay, bàn chân, các ngón, cổ, gáy, cổ tay, cẳng chân.

Triệu chứng bệnh: khô da, ban đỏ – ngứa tạo thành vòng xoắn bệnh lý: ngứa-gãi-ban đỏ-ngứa… Ngoài ra người bệnh còn có các triệu chứng khác như viêm mũi dị ứng, viêm kết mạc mắt và viêm ngứa họng, hen. Các biểu hiện bệnh lý như chứng vẽ nổi (dermographism), bệnh vẩy cá thông thường, dày sừng nang lông…có thể gặp trên bệnh nhân viêm da cơ địa.

Vị trí hay gặp mặt, trán, mặt gấp các chi, gáy, mi mắt, cổ tay, mu tay, mu chân, trường hợp nặng có thể lan toàn thân.

    Viêm da cơ địa ở trẻ sơ sinh và trẻ nhỏ

Thường gặp ở trẻ vài ngày tuổi đến 24 tháng tuổi với tổn thương là dát đỏ, bên trên có nhiều mụn nước nhỏ li ti tập trung thành từng đám, dập vỡ, chảy dịch dính nhớp nháp, có thể có mủ, vảy tiết nếu bị nhiễm trùng thứ phát. Vị trí lúc đầu ở một bên má sau lan xang má bên kia, đối xứng hình cánh bướm (Trừ sống mũi và miệng), tổn thương lan lên trán tạo thành hình móng ngựa, tổn thương có thể ở quanh miệng, cằm, cổ, đầu, thân mình.

Viêm da cơ địa ở trẻ sơ sinh và trẻ nhỏ
Viêm da cơ địa ở trẻ sơ sinh và trẻ nhỏ

Bệnh viêm da tiến triển tùy theo từng giai đoạn mà có các biểu hiện bệnh khác nhau:

– Giai đoạn cấp tính: Các mụn nước tập trung thành từng đám trên nền da đỏ, phù nề, chảy nước, ngứa nhiều.

– Giai đoạn bán cấp: Thương tổn da ít phù hơn, bắt đầu khô và ngứa ít.

– Giai đoạn mạn tính: Da dày, bong vảy, lichen hóa, vẫn còn ngứa.

– Nếu bị bội nhiễm thì xuất hiện thêm các mụn mủ, đau rát, có thể loét…Vị trí tổn thương hay gặp nhất là ở má, trán, cằm, Trường hợp nặng, thương tổn lan ra chân, tay, toàn thân.

 Viêm da cơ địa ở người lớn

Bệnh xuất hiện từ bé, tái phát nhiều lần, thương tổn chủ yếu là dày da, thâm da, lichen hóa, khu trú ở khoeo chân, khuỷu tay, đối xứng. Bệnh nhân thường kèm theo bị các bệnh dị ứng khác.

 Viêm da cơ địa ở trẻ lớn và người lớn
Viêm da cơ địa ở trẻ lớn và người lớn

Nguyên tắc điều trị và phòng bệnh:

– Tùy từng giai đoạn của bệnh mà dùng thuốc điều trị tại chỗ cho thích hợp.

– Phối hợp điều trị tại chỗ và điều trị toàn thân.

– Hạn chế các kích thích da (Gãi, chà xát da mạnh, kỳ mạnh), tránh tiếp xúc trực tiếp với các loại hóa chất gây kích ứng da…

– Nếu có điều kiện thì dùng các liệu pháp làm thay đổi cơ địa ở bệnh nhân.

– Luôn giữ cho da sạch sẽ, ẩm bằng cách: Cắt móng tay, móng chân, tắm nước ấm hàng ngày, bôi các chất làm ẩm da, mặc quần áo rộng rãi, thoáng, tránh kích thích làm xây xước da.

– Dùng thuốc lúc cấp tính và mãn tính theo chỉ định của Bác sỹ chuyên khoa Da liễu.

– Đảm bảo chế độ ăn uống, sinh hoạt hợp lý. Tránh dùng các thuốc không rõ nguồn gốc để điều trị và không được lạm dụng thuốc.

– Phải điều trị duy trì kể cả khi bệnh đã thuyên giảm để tránh tái phát và các biến chứng.

Điều trị viêm da cơ địa cần rất cẩn trọng, có sự hợp tác rất chặt chẽ giữa thày thuốc và người bệnh, đối với trẻ nhỏ là bố mẹ bệnh nhân. Tuỳ theo giai đoạn bệnh là cấp tính, bán cấp hay mạn tính mà cho thuốc bôi phù hợp.

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