Method for prediction of deterioration probability of clinical course of atopic dermatitis, progression of local form into disseminated form, and then into erythroderma

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to dermatology. To predict the deterioration probability of the clinical course of atopic dermatitis, the progression of an local form of the disease into a disseminated form, and then into erythroderma, an integrated assessment of a pathoigenetic significance of the detected risk factors is made What is determined is a prognostic coefficient (PC) for such criteria, as: sex; age; living in a city, living in the countryside; financial means and living conditions; office staff; agricultural workers; construction workers; drivers; common labour personnel; hyper insolation; adverse agricultural labour conditions (pesticide and fertiliser contact); petroleum contact; construction material contact; office supplies contact; stress situations at work and in the community; drug abuse; pockets of chronic bacterial and/or mycotic infections; frequent acute respiratory viral infections; chronic gastrointestinal and/or hepatic, gall-bladder diseases; chronic respiratory infections; chronic otorhinolaryngological organs; disturbed liver detoxification; liver metabolic disturbance; circulating immune complex increase; average immunoglobulin increase; stimulation index decrease; immunoregulatory index decrease; cytotoxic index decrease; blood skin antigen; antitissue autoantibody increase; leukocyte migration inhibition index increase. If a factor is absent, the related PC is considered to be zero. The derived coefficients are summed up. If total PC is found within the range of 7.92 to 17.92, the low deterioration probability of the clinical course of atopic dermatitis and the favourable prognosis implying no progression of the local form of the disease into the disseminated form. The derived PC falling within the range of 17.93 to 37.93 shows the medium deterioration probability of the clinical course of atopic dermatitis and the possible progression of the local form of the disease into the disseminated form, with a relatively favourable prognosis with no developing erythroderma. The PC value is 37.94 to 57.94 and more enables predicting the high deterioration probability of the clinical course of the disease and the unfavourable prognosis with the possible progression of the local form of atopic dermatitis into the disseminated form, and then into erythroderma.

EFFECT: method enables predicting the deterioration probability of the clinical course of atopic dermatitis and the progression of the local form of the disease into the disseminated form, and then into erythroderma.

3 ex, 4 tbl

The invention relates to medicine, namely to dermatology, and can be used to predict the probability of deterioration in the clinical course of atopic dermatitis, the progression of a limited form of the disease in common, then erythroderma to obtain justification of the choice of tactics and observation of patients, aiming to prevent adverse clinical course.

A known method for predicting the clinical course of atopic dermatitis, by examining the nature and clinical and immunological criteria of the disease, psychological and social status of patients, the effectiveness of medical intervention, including verification of the severity of skin manifestations in the SCORAD scale, allergic, immunological, psychological, sociometry research methods in 246 patients with atopic dermatitis, characterized by assessment of outcome the intervention of a doctor in the natural course of the disease in pharmacoeconomic parameters by the method of evidence-based medicine. [Vasiliev-Tupalski E.A. Methods of research and intervention in atopic dermatitis in adults. // Clinical dermatology and venereology, 2011, No. 1, p.4-9]. In this way, on the basis of the data obtained, the authors predict the clinical course of atopic dermatitis who will verify the severity of skin manifestations, but do not account for detoxification and metabolic functions of the liver, contributing to the deterioration in the clinical course of atopic dermatitis, do not conduct an integrated assessment of the identified factors, not counting individual prognostic factor deteriorating clinical course of atopic dermatitis, do not predict the possibility of progression of the limited form of the disease in common, then erythroderma in contrast to the claimed method.

There is a method of predicting deterioration in the clinical course of common chronic dermatoses such as eczema, psoriasis, atopic dermatitis, by exploring the role of bacterial-fungal infections in the pathogenesis of skin diseases [Kotrehova L.P., Piotrovskaya IV the Role of bacterial-fungal infections in the pathogenesis of skin diseases and their treatment // Clinical dermatology and venereology, 2011, No. 3, S.-38-44]. The authors examined 2562 patients with various chronic dermatoses with clinical, microbiological studies and species identification of pathogens, concluded that 384 (15%) patients of atopic dermatitis was the cause of hospitalization. Of these, 115 (48%) patients with atopic dermatitis marked Association with bacterial, fungal, or bacterial and fungal toxins, of whom 18 (45%) had the causative agents of fungal infections with the development of secondary infectious complications. According to the authors, the change in the biocenosis of the skin, the colonization of pathogenic and conditionally pathogenic agents on the skin, as well as contamination of bacteria and fungi - all of this eventually led to the emergence of specific lesions on the skin in patients with atopic dermatitis, contributing to the progression of the disease. The authors believe that the risk factors for worsening clinical course of atopic dermatitis is the presence of bacterial and fungal infections. By sex and age, the authors of the differences identified. In this way, the authors predict the probability of deterioration in the clinical course of atopic dermatitis as a result of its Association with bacterial, fungal, or bacterial and fungal infections, but do not take into account socio-professional identity of the patient, the action of harmful factors of production, changes in detoxification and metabolic functions of the liver, do not conduct an integrated assessment of the identified factors, not counting individual prognostic factor deteriorating clinical course of atopic dermatitis in each patient individually, do not predict the likelihood of progression limited form of atopic dermatitis in common, then erythroderma, in contrast to the claimed method.

The prototype of the invention, the closest p the technical solution is a method for predicting the clinical course of atopic dermatitis, through the study of medical and social risk factors for the exacerbation of chronic dermatoses (eczema, psoriasis, atopic dermatitis), including demographic characteristics, marital status and characteristics of family type, characteristics of production and non-production activities, housing characteristics and household living conditions, characteristics, quality and nutrition, recreational activities, behavioral factors, self-assessment of health, medical activity by using the directional survey 371 Respondent and subsequent structuralizing observation of respondents in stationary conditions, different allocation factors of absolute and relative risk of occurrence and exacerbation of atopic dermatitis in persons living in rural areas and the city [Danilov, S., Nechaev O.S, Pyryatinsky A.B. Medical and social risk factors for the exacerbation of chronic dermatoses // Russian journal of skin and venereal diseases, 2005, No. 1, p.60-62]. The authors distinguish the following medical and social risk factors for the exacerbation of chronic dermatoses, including atopic dermatitis: an insufficient level of medical knowledge of the patient, ignoring healthy lifestyle, adverse living conditions, noncompliance with rules pers is th hygiene, the impact of harmful factors. This method allows to predict the worsening of the clinical course of atopic dermatitis according to the information received, but does not allow to predict the progression of atopic dermatitis, erythroderma, does not reflect the state of metabolic and detoxification functions of the liver, does not take into account the role of sensitization and autoimmune process, inducing an inflammatory response in the dermis of patients with atopic dermatitis, i.e. does not take into account other pathogenesis of this disease, does not conduct an integrated assessment of the identified factors, not mathematically calculates individual prognostic factor deteriorating clinical course of atopic dermatitis in each patient individually, in contrast to the claimed method.

The objective of the invention is to develop a method for predicting the likelihood of deterioration in the clinical course of atopic dermatitis, the progression of a limited form of the disease in common, then erythroderma, by conducting an integrated assessment of the pathogenetic significance of the identified exogenous, endogenous, medical risk factors contributing to the deterioration in the clinical course of the disease, taking into account the division of risk ranges for low, medium, high.

The technical result of the at - obtaining individual criteria to predict the probability of deterioration in the clinical course of atopic dermatitis, the progression of a limited form of the disease in common, then erythroderma, obtaining justification of the choice of tactics and observation of patients for targeted prevention unfavorable course of the disease, by eliminating the identified risk factors, the purpose of timely and adequate rational therapy.

The claimed method for predicting the likelihood of deterioration in the clinical course of atopic dermatitis, the progression of a limited form of the disease in common, then erythroderma is as follows. Determine gender, age, profession, patients, collect a medical history, identify the presence or absence of factors that contribute to the worsening of the clinical course, conduct clinical, immunological, and biochemical studies. Metabolic liver function assessed by biochemical studies performed on autoanalyzer firm "SINNOWA - 300", with reagent kits firms Chema Hospitex diagnostics. Patients determine total protein, albumin, urea, creatinine, total lipids and cholesterol, liver enzymes lapparikokoonpano (ALT), aspartataminotransferaza (ACT), total bilirubin and E. what about the faction, the glucose. Detoxification functions of the liver is estimated by the activity of the monooxygenase system (MOS) liver using antivirusoveho test. The functional activity of lymphocytes is determined in response to betransformed (rbtl) phytohemaglutinin (PHA), the activity of natural killer cells (NK activity) are examined by standard 3H-uredinium cytotoxic test against target cells (KM) K 562 line cells, with a ratio of effector cells and KM (EK:KM) 1:25 on the cytotoxic index (QI). Lymphocyte proliferation assessed by incorporation of 3H thymidine. Detection of circulating immune complexes (CIC) carried out by the method of precipitation by polyethylene glycol (PEG-6000). The concentration of immunoglobulin classes a, M, G (IgA, IgM, IgG) in the blood sera calculated by the method of radial immunodiffusion according to Mancini. To characterize the autoimmune process (titer autoantibodies) put the Treponema pallidum haemagglutination assay (TPHA), blood levels of skin antigen was determined by response inhibition passive haemagglutination (RTPA), using capillary variant of response inhibition of migration of leukocytes (RTML). The obtained results are statistically processed using student's criterion and are in the form of a table (table 1). Integrated assessment of the pathogenetic significance of the obtained results revealed e is zogenix, endogenous and medical factors that contribute to the worsening of the clinical course, conduct Bayesian (1987). Calculate the frequency of the identified factors in 100 patients, determine the normalized intensive index (NIP), the relative risk (ERP) deterioration in the clinical course, prognostic factor (PC), integrated risk ratio (IPR) progression limited form of atopic dermatitis in common, then erythroderma. The results of these calculations are presented in table 2, which shows that men suffering from atopic dermatitis was 63.8%of women and 36.2%, the relative risk of worsening clinical course of atopic dermatitis in men 1.76 times higher than in women, in 35.8% of cases was observed in those aged 31-40 years, 27,5% of 18-30 years, with 23.7% 41-50 years, 10.2% of 51-60 years, and 2.8% -61 year and older. The data obtained confirm the views of local dermatologists that atopic dermatitis is a disease of young people of working age [Skripkin J.K., Butov YU.S., Clinical dermatology, t-2. M.: 2009; 888]. According to our data, the relative risk of worsening clinical course of atopic dermatitis depending on age was 3,48. Lived in urban areas compared with 68.5% of patients with atopic dermatitis, agriculture is the second area is 31.5 per cent. Good material living conditions had 25.7% of patients, satisfactory - 46,8%, unsatisfactory - 27,5%. The relative risk of worsening clinical course of atopic dermatitis depending on place of residence and material living conditions was of 2.68. During the history taking were selected following socio-professional groups: employees - 36,4%, selhozraboty - 20.5%, the builders are about 17.8 mln%drivers - 15,2%, handymen to 10.1%. Every fourth patient was noted permanent residence during the work shift under the influence of chemical, physical, toxic or other harmful factors of production, one in five lived near the source of pollution. Hyperinsulemia was exposed to 39.5% of patients with atopic dermatitis, adverse conditions selfhosted, contact with pesticides, fertilizers noted 20.5% of patients had been in regular contact with materials at 17.8%, oil products - 15,2%, with stationery, mostly with glue - 7% of patients with atopic dermatitis. The relative risk of worsening clinical course of atopic dermatitis in the present socio-professional groups was 3,67, with long-term constant contact with the production of harm - 5,65 and in the amount reached to 9.32. Stressful situations at work felt 275% of patients with atopic dermatitis, in everyday life is 36.8%. Surveyed patients in 56.5% of cases took more than 4 different medicines at the same time on average during the 10 years preceding the deterioration in the clinical course of atopic dermatitis, the progression of his erythroderma. The relative risk of worsening clinical course of atopic dermatitis depending on stress, irrational use of medicines 2.04.

The presence of foci of chronic bacterial and/or fungal infection was 68.1% of the patients with atopic dermatitis, often recurrent colds is 31.9%. Concomitant diseases of the gastrointestinal tract, liver, gall bladder had 56.5% of patients, respiratory - 27,5%, ENT to 15.7%. The relative risk of worsening clinical course of atopic dermatitis in persons with comorbid chronic diseases barrier of lymphoepithelial masses of the bodies and undergoing viral, bacterial and/or fungal infection, reached 4,34. At 55.9 percent of patients with atopic dermatitis were identified violation detoxification functions of the liver, manifested by decreased activity monooxygenase system of the liver in the form of increased period of preliminaly of antipyrine on average 2.3 hours more than normal. When erythrodermia period of preliminaly of antipyrine was increased by 14.2 hours, i.e. more than 2 times the norms of the (table 1). In 44.1% of patients with atopic dermatitis were identified violation of the metabolic functions of the liver, bilirubinometry liver function is on average 1.5 or more times than normal, manifested by reduced levels aminotrasferase (ALT, ACT) on average 1.25 times than normal, total proteins 1.58 and albumin 1.3 and more times than normal, the increase in the level of total lipids in the middle in 2 and more times than normal, increasing the level of cholesterol in the blood in an average of 1.6 or more times than normal, increasing the level of creatinine in 1.25, and more times than normal, urea 1.7 and more times than normal (table 1). The overall predictive coefficient (PC), the probability of deterioration in the clinical course of atopic dermatitis, the progression of a limited form of the disease in common, then erythroderma when combined with the violation of detoxification (PC-5,9) and metabolic (PC with 4.64) liver function high -10,54 (table 2). The increase in the level of the CEC 3.6 and more times than normal, found in 75.0% of surveyed patients with atopic dermatitis, the increase in the average (a, M, G) of immunoglobulins in 2 and more times than normal - 85,8%, reducing the stimulation index of 1.9 or more times than normal - 73,5%, reducing immunoregulatory index of 1.8 or more times than normal - 89,7%, a decrease of cytotoxic index of 1.4 or more times than normal - 74,8. Healthy is x people cutaneous antigen in our research is not detected, in patients with atopic dermatitis, it was detected in 98.5% of patients. Level protivotankovyh autoantibodies was higher than control values in 2 or more times in 72.8% of the patients, it was observed an increase of the index of inhibition of migration of leukocytes in 2.1 and more times than normal in 45.6% of the surveyed (table 2). The relative risk of worsening clinical course of atopic dermatitis in persons with immune disorders was equal to 2.15, when combined with the pathology of internal organs (ERP - 4,34) increased to 6.49. The overall predictive coefficient of the probability of deterioration in the clinical course of atopic dermatitis, the progression of a limited form of the disease in common, then erythroderma with only complex immune disorders (CCS,91+4,47+3,83+4,69+3,91+5,14+3,81+2,39) the highest amount of PC was 32,15.

Thus, according to the results of our study, the relative risk factors for worsening clinical course of atopic dermatitis were: having contact with professional production impurities, allergens and antigens (ERP-5,65), the presence of concomitant chronic diseases of the gastrointestinal tract, liver, gall bladder, respiratory, upper respiratory tract, viral, bacterial and/or fungal infection (LONG-4,34), belonging to a particular socio-professional g is the SCP (ERP-3,67), age 31-40 years of age and older (ERP-3,48), adverse living conditions (LONG-2,68), the development of immune disorders in the body (LONG-2,15), stress, irrational use of drugs (LONG-2,04), belonging to the male sex (ERP-1,76). Given the opportunity to participate and influence identified various factors in the pathogenesis of atopic dermatitis, was additionally conducted an integrated assessment of the results obtained with the calculation of the risk range, which showed that the integrated risk ratio (IPR) is the highest in persons with immune disorders (of 10.72) and when combined chronic bacterial and/or fungal infection with pathology of internal organs (10,54). Low range the risk of worsening clinical course of atopic dermatitis from the prognostic factor of 7,92 to 17,92 was calculated and is typical for limited forms of atopic dermatitis with a favorable prognosis, progression-limited form of the disease in common, without the development of eritrodermii. The average range of risk prognostic factor of 17,93 to 37,93 was calculated and characteristic common form of atopic dermatitis with a relatively favorable prognosis, progression limited form of the disease in common, but without the development of eritrodermii. High range ri is SC prognostic factor of 37,94 to 57,94 and above was characterized by a poor prognosis, the probability of progression limited form of atopic dermatitis in common, then erythroderma (table 3). Prognosis the clinical course deteriorated by the combined action of several factors, such as hyperinsulemia (PC-5,42), the irrational use of drugs (PC-2,79) in combination with diseases of the gastrointestinal tract, liver, gallbladder (PC-5,99), failure of detoxification (PC-5,9), metabolic (PC with 4.64), liver function, was $ 24,74 and exceeded the maximum value (17,92) low range the risk of worsening clinical course of atopic dermatitis 1.38 times, predicting the likelihood of progression of a limited form of the disease in common, without the development of eritrodermii. If, in addition to the above risk factors, the patient was immune disorders, adding prognostic factors for each characteristic immune disorders, totaling 32,15, got 56,89, which exceeded the maximum value (37,93) mid-range risk of worsening clinical course of atopic dermatitis in 1.5 times and characterized the likelihood of progression limited form of atopic dermatitis in common, then erythroderma, with a poor prognosis (table 3). The calculation of the individual criteria to predict the likelihood of clinical deterioration those who placed atopic dermatitis, the progression of a limited form of the disease in common, then erythroderma provide a rationale for the choice of tactics and observation of patients for targeted prevention unfavorable course of the disease (table 3).

For the low risk range is recommended: an annual medical examination by examination by a dermatologist, a physician with the mandatory treatment of somatic and skin pathology. Elimination of harmful industrial and medical risk factors contributing to the deterioration in the clinical course of the disease, compliance with the measures of primary prevention, which consists in the observance of safety in production, the systematic prophylactic examinations in hazardous industries, health education and promotion of medical knowledge about the underlying disease, adequate methods for timely correction, to improve dermatological and General quality of life index patients.

For the medium range of risk it is recommended that mandatory quarterly inspection and anti-relapse treatment from a dermatologist and physician regarding somatic pathology; laboratory and instrumental examination quarterly, compliance with secondary prevention measures, the identified exogenous, endogenous medical risk factors worsened the Yu clinical course of the disease, adequate employment, maintaining dermatological and General quality of life index patients.

For high risk range recommended urgent patient examination with the use of laboratory and instrumental methods, advice related professionals, hospital treatment, the identified exogenous, endogenous medical risk factors contributing to the deterioration in the clinical course of the disease, adequate employment, maintaining dermatological and General index of the quality of life of patients. Active clinical supervision at the place of residence. Tertiary prevention eritrodermii, is to increase the duration of clinical remission of the disease, reducing the number of relapses, fewer complications, prevention eritrodermii, the persistence to work sick.

The research of the authors was first proved the possibility of predicting the likelihood of deterioration in the clinical course of atopic dermatitis, the progression of a limited form of the disease in common, then erythroderma, the claimed method. Therefore, the claimed invention meets the criterion of "inventive step". The authors in scientific medical and patent literature has not been discovered who the institutions on the application of integrated risk assessment of the probability of deterioration in the clinical course of atopic dermatitis, the progression of a limited form of the disease in common, then erythroderma, taking into account the history of the disease, effects of exogenous, endogenous and medical factors, immunological parameters, detoxification and metabolic functions of the liver. Thus, the claimed invention meets the patentability criteria of "novelty".

The claimed method for predicting the likelihood of deterioration in the clinical course of atopic dermatitis progression limited form of the disease in common, then erythroderma, is illustrated by the following examples.

Example 1. Patient I.A., 28, handyman living in the city, with satisfactory material and living conditions have complained of limited rashes on the skin of the forearm of the hand, often recurrent infection. Objective: pathological process is localized in the region of the flexors of the forearm of the hand, presents a symmetric infiltrative lesions with indistinct borders, with enhanced picture of the skin. Subjectively, the patient felt itchy skin. After the examination, in which the pathology of internal organs is not detected, biochemical, immunological parameters were within normal limits, diagnosis: limited atopic dermatitis, often recurrent infection. Treatment is Aulnay was held outside therapy in conjunction with antiviral drugs about SARS. The regression process began on the 4th day of therapy in reducing itching, infiltration. Pronounced clinical effect was observed on the 7th day from the start of treatment, infiltration and phenomena SARS was resolved.

In this example, the sick man (PC - 2,73), age 28 (PC-2,33), lived in the city (PC is 4.45) with satisfactory material and housing conditions (PC - 3,06), handyman (PC - 0,88), had often recurrent colds (PC - 3,38), the overall predictive coefficient of the probability of deterioration in the clinical course of atopic dermatitis was equal to 16.83 that included table grades (table 3) in the low risk range with favorable prognosis. This, in turn, helped to justify the choice of tactics of external therapy of atopic dermatitis, which for 7 days resulted in complete regression of the disease. Our forecast coincided with clinical data: the deterioration of the current limited form of atopic dermatitis is not mentioned, the progression of a limited form of the disease in common, and then erythroderma, has not occurred.

Example 2. Patient IS, 40 years old, living in the city, with good material and housing conditions, teacher, constantly experiencing stress at work, was admitted to hospital in RCVD with complaints about the presence of itching around the skin, redness and peeling open areas of the body, General weakness, is Otaru appetite and sleep. When collecting medical history revealed that the patient felt sick since childhood, when for the first time in 10 years of age, was diagnosed with limited atopic dermatitis. For over 30 years long, have often been treated as an outpatient and inpatient regarding limited form of atopic dermatitis, getting hyposensitizing, antihistamines and local topical treatment. Ongoing therapy were given temporary positive effect. Recent severe exacerbation was observed in the summer, when after a rest on a mountain lake during the month immediately went to relax on the black sea coast (Matsesta resort). After such "intense" rest came the sharp deterioration of skin status, expressed in reddening and peeling of the open areas of the skin, itching, General weakness and malaise. Upon receipt of skin pathological process was widespread, with predominant localization in the open areas of the body (scalp, neck, shoulders, forearms, wrists, upper third of the chest). Elements of destruction were infiltration, lichenification, coarse lamellar desquamation. Both hands were dry, on the flexor surfaces was determined cracks in the interdigital folds and vaults stop bucovinei peeling, nail plate stop were sharply hypertro the new, the free edges of their corroded. When examining the pathology of internal organs not found; from the arches of the identified fungi; in General, the analysis of blood leukocytosis, left shift formula. Antioxidant activity of blood serum was sharply reduced. Immunophenotype cells infiltrate of CD3⁺, CD4⁺, CD5⁺, CD8⁺, CD19⁺. Histological examination established the diagnosis of atopic dermatitis. Clinical diagnosis: common atopic dermatitis. The patient received three courses of antifungal treatment, detoxification and outdoor therapy, after which the skin is a pathological process regressed. Within three years of recurrence of the disease is not observed. The patient is recommended to avoid stressful situations, exposure to the sun, to carry out the rehabilitation centers fungal infection, to normalize the detoxification function of the liver.

In this example 1 (table 2), the sick man (PC - 2,73); age 40 years (PC=3,03); living in the city (PC is 4.45), with good material and housing conditions (PC - 1,66), employee (PC - 3,23); were hyperinsulemia (PC - 5,42); stress at work (PC - 1,37); had a fungal infection (PC - 7,16), disorders of liver detoxification function (PC - 5,9). The overall predictive factor of deterioration in the clinical course of atopic dermatitis in the patient was 34,95 included n the table grades (table 3) in the middle range of the risk of worsening clinical course of atopic dermatitis, the progression of a limited form of the disease in common, does not exceed the maximum value (37,93) medium risk range, with a relatively favorable prognosis, progression-free common form of atopic dermatitis, erythroderma. Our forecast coincided with the clinical dynamics of the disease. Adequate treatment, carrying out preventive measures aimed resulted in complete regression of the elements of destruction, resulting in absence of recurrence within 3 years.

Example 3. Patient A., 53 years of age, living in rural areas, with poor material living conditions, agricultural worker, was admitted to hospital in the Republican dermatovenerologic dispensary (RCVD) with complaints about the presence of redness just the skin, itching. When collecting medical history revealed that the patient felt sick for 10 years, when for the first time in the extensor region of forearm appeared pink itchy spots, which are then regressed, leaving secondary depigmentation and reinforced the picture of the skin. Ongoing desensitizing, antihistamine therapy and vitamin therapy regarding limited diagnosed atopic dermatitis contributed temporary regression process. In October, after collecting the yield of the vegetables, elements of destruction had anticipated again. Despite this, the patient continued to work, was made in the ground fertilizer, planted winter wheat seeds treated with chemicals that led to the progression of the disease: the elements of the lesions began to appear on the torso, legs in the form of diffuse infiltration and hyperemia, edema of the entire skin, excessive peeling, General malaise, weakness, fever, and therefore the patient was hospitalized in RCVD with a diagnosis of erythroderma. The examination found frequent recurrent respiratory infection, chronic gastritis, chronic cholecystitis, chronic hepatitis, disorders of immunological parameters, detoxification and metabolic functions of the liver. Histological examination infiltrating element of the defeat given the assumption of morphological signs of atopic dermatitis who erythroderma. Was prescribed antihistamines, antisense, somatic treatment and short-term corticosteroid therapy. Elements lesions began to regress on the 4th day of treatment, fully regressed on the 10th day of treatment and the patient was discharged in satisfactory condition for further observation and treatment at the place of residence, with the observance of tertiary prevention eritrodermii (table 3).

This note is d, the sick man (PC - 2,73), 53 years (PC=0,87); rural (PC - 2,04), with poor material living conditions (PC - 1,79), agricultural worker (PC - 1,84); were hyperinsulemia (PC - 5,42), adverse conditions of selfhatred (PC - 2,83); irrational applied drugs (PC - 2,79); noted the presence of frequently recurrent colds (PC -3,38), gastrointestinal diseases, liver and gall bladder (PC-5,99), impaired detoxification (PC=5,9), metabolic (PC with 4.64) of the liver, immunological disorders (General PC-32,15). Taking into account the above exogenous, endogenous and medical risk factors for worsening clinical course of atopic dermatitis in the patient summary prognostic factor of progression opportunities common form of the disease erythroderma was 72,37 and exceeded the maximum value (57,94) high risk range 1.25 times that was characterized by a poor prognosis and a very high likelihood of eritrodermii is fully consistent with the clinical dynamics of the disease.

As seen from the above examples, integrated risk assessment, the results of calculating prediction coefficients for each patient individually fully coincided with the clinical evaluation of the disease in all cases, allowed the individual is but to predict the probability of deterioration in the clinical course of atopic dermatitis, the progression of a limited form of the disease in common, then erythroderma.

The claimed method was carried out on an individual assessment of the probability of deterioration in the clinical course of atopic dermatitis, the progression of a limited form of the disease in common, then erythroderma of 45 patients with the limited form of atopic dermatitis, in 35 patients with common form of atopic dermatitis and in 20 patients with erythrodermia and in all cases was achieved the specified technical result. Way reproduce in conditions of clinic of skin and venereal clinic, hospital, therefore, the claimed invention meets the patentability criterion of "industrial applicability".

Thus, compared with the prototype (table 4) claimed a method for predicting the likelihood of deterioration in the clinical course of atopic dermatitis, the progression of a limited form of the disease in common, then erythroderma allows you to:

a) individually to predict the probability of deterioration in the clinical course of atopic dermatitis, the progression of a limited form of the disease in common, then erythroderma with the division of risk ranges for low, medium and high;

b) to take into account the participation and interaction of the various possible jingle is in pathogenesis of atopic dermatitis and eritrodermii, by conducting an integrated assessment of the identified risk factors;

C) on the basis of individual prognostic factors to justify the choice of tactics and observation of patients, aiming to prevent adverse course of the disease, which in turn prevents the development of eritrodermii, by assigning adequate rational therapy.

A method for predicting the likelihood of deterioration in the clinical course of atopic dermatitis, the progression of a limited form of the disease in common, then erythroderma, by conducting an integrated assessment of the pathogenetic significance of the identified exogenous, endogenous, medical risk factors contributing to the deterioration in the clinical course of the disease, including the collection of medical history, conducting biochemical, immunological studies of blood serum of the patient, wherein the patient determine sex, age, place of residence, material living conditions, socio-professional identity, the presence of factors that contribute to the worsening of the clinical course of the disease, immune, metabolic, detoxification of the liver, expect prognostic factor (PC) each characteristic separately, and the male is estimated as 2,73, female as 1.55V; age 18-30 years is estimated as 2,33, 31-40 - 3,03, 41-50 - as 2,02, 51-60 - as 0,87, 61 and older - as 0,24; accommodation in the city is estimated as 4,45; in rural areas - 2,04; good material housing - as of 1.66; satisfactory - as 3,06; unsatisfactory - 1,79; employees are estimated to 3.2; selhozraboty as 1,84; builders - as 1,58; drivers - 1,36; workers of different specialties (General workers) - as 0,88, hyperinsulemia is estimated as 5,42, adverse conditions selfhosted (contact with pesticides, fertilizers) estimate as of 2.83, contact with oil - as 2,09, contact with the materials as 2,43, contact with the stationary - 0,96; a stressful situation at work is assessed as 1,37, in everyday life - as 1,82; irrational use of drugs - as 2,79, the presence of foci of chronic bacterial and/or fungal infection - how 7,16, often recurrent colds as 3,38, chronic diseases of the gastrointestinal tract and/or liver, gall bladder as 5,99, chronic respiratory diseases - as 2,91, chronic diseases of ENT-organs - as 1,65, disorders of liver detoxification function as 5,9, metabolic disorders of the liver - as with 4.64; increased levels of circulating immune complexes in 3.6 and more times than normal rate as 3,91, the increase in the average level of immunoglobulins in 2 and more times than normal - as 4,47, reducing the stimulation index of 1.9 or more times, than the norm - as 3,83, reducing immunoregulatory index of 1.8 or more times than normal, estimated as 4,69, reduction of cytotoxic index of 1.4 or more times than normal, estimated as 3,91, the presence of skin antigen in the blood ka appreciate what 5,14, in its complete absence in normal, increased levels of protivotankovyh autoantibodies in 2 and more times than normal, estimated as 3,81, the increase in the index of inhibition of migration of leukocytes in 2.1 and more times than normal, estimated as 2,39; in the absence of factor prognostic factor taken for zero; summarize the obtained predictive coefficients (PC), and when the sum value PC from 7,92 to 17,92 predict a low probability of worsening clinical course of atopic dermatitis and positive progression-limited form of the disease in common; when the value of the sum of the PC from 17,93 to 37,93 - average probability deterioration in the clinical course of atopic dermatitis, the possibility of progression of the limited form of the disease in common, relatively favorable prognosis without the development of eritrodermii; and when the sum value PC from 37,94 to 57,94 and above - high probability of deteriorating clinical course and poor prognosis, the possibility of progression limited form of atopic dermatitis in common, then erythroderma.