Allergodermatoses make up the majority of allergic skin diseases in childhood, have a recurrent course and significantly disrupt the quality of life of patients and their families. The constant use of emollients, allowing to lengthen periods of remission and reduce the need for topical drugs, is associated with defects in the skin barrier function. Treatment with topical glucocorticosteroids (TCS) and topical calcineurin inhibitors (TCI), which are the basis of pharmacotherapy, should be carried out differentially, taking into account the localization, stage and activity of the inflammatory process, the area of the lesion, the age of the child and the multifactorial genesis of the disease. The basic principles of rational local therapy include the choice of the degree of activity of the drug, its concentration, dosage form, dosage frequency, duration of use to obtain a therapeutic effect and minimize side effects. In case of severe exacerbation and localization of inflammatory elements on the body and limbs in children, it is necessary to start treatment with class 2–3 THCS. When the process is localized on the face and other sensitive areas of the skin (neck and large folds), it is recommended to use class 7 TCS or give preference to TCI. The duration of a continuous course of TCS therapy in children depends on the severity of the exacerbation and should not exceed 2 weeks. The most effective way to reduce the course steroid load and avoid side effects is the early and correct use of TCS during an exacerbation. The advantages of TCI in comparison with TCS are the low incidence of side effects, the absence of contraindications for use on sensitive skin areas, and the possibility of longer use. The article contains Russian and foreign literature data on the use of THCS and TEC in the treatment of allegodermatosis in children and our own clinical observations of the effectiveness of the use of combination therapy: Comfoderm K cream (methylprednisolone aceponate with ceramides in the base), 0.03% tacrolimus ointment and emollient means - special cream Sensoderm with physiological lipids omega 3–6–9.

The skin of children has its own anatomical and physiological characteristics, the epidermis is much thinner than in adults, the layers of the dermis and basement membrane are poorly developed and differentiated, the rate of transepidermal water loss is increased and the level of natural moisturizing factor (NMF) is reduced. Such a structure of the skin predisposes to a violation of its barrier function, contributes to the occurrence of skin diseases, provides an increased resorptive capacity of the skin and requires special attention when prescribing external therapy. The use of high-quality emollients is an important part of the basic treatment of chronic dermatoses and has its own characteristics in childhood. The use of emollients prevents the development of exacerbations and reduces the need for anti-inflammatory topical drugs. With the localization of the inflammatory process on the face, neck, genitals and large folds, it is necessary to give preference to short courses of topical glucocorticosteroids (THCS) with sufficient anti-inflammatory activity, rapid onset of action, minimal side effects. Given the high risk of side effects in children in these areas of the skin, strong fluorinated THCS, high-potency THCS, and the use of THCS under occlusive dressings are not recommended. The Russian experience of using 0.1% methylprednisolone aceponate in children of various age groups in the treatment of allergic dermatoses, including those with localization in sensitive areas, has shown good efficacy, tolerance and the absence of side effects. he article presents own clinical observations of the effectiveness of the use of combination therapy: an emollient agent - a special cream with physiological lipids omega 3-6-9 and cream methylprednisolone aceponate (with ceramides in the base) in the treatment of skin diseases in children with an emphasis on complex localizations, such as face, folds, genital area.

Suppression of kininogenesis is an adaptive phenomenon in cerebral ischemia/reperfusion in rats aimed at elimination of the no-reflow phenomenon. Hyperkininogenesis and suppression of kinin destruction are pathogenetically significant, because they augment the manifestations of no-reflow phenomenon during reperfusion following ischemia.

In recent decades, industrialized countries have recorded a steady increase in the incidence of atopic dermatitis (AD). The pathogenesis of AD is complex and diverse and includes hereditary determinism leading to a disruption of the skin barrier, as well as the Th2 immune response, which is supported by a wide range of pro-inflammatory mediators released by immunocompetent and epithelial cells, which play a key role in the activation and maintenance of inflammation in the skin. Progress in the treatment of immunoinflammatory diseases, including in the skin, has been achieved with the advent of a new class of targeted synthetic oral immunomodulatory drugs, Janus kinase inhibitors. Janus kinases are part of the JAK – STAT intracellular signaling system; STAT proteins are responsible for signaling more than 60 cytokines, hormones and growth factors that regulate key cellular processes. Currently, second generation JAK inhibitors have been developed, such as upadacitinib (trade name Rinvoq), which distinguish them from non-selective JAK inhibitors by their selectivity for certain JAK isoforms. In June 2021, the Ministry of Health of the Russian Federation approved the use of upadacitinib (UPA) for the indication “treatment of moderate to severe atopic dermatitis in adults and children aged 12 years and older who are indicated for treatment with systemic drugs”; the drug can be used in monotherapy or in combination with topical therapy in adults at a dose of 15 or 30 mg per day depending on the individual characteristics of the course, in adolescents weighing at least 40 kg – at a dose of 15 mg per day. Results from a Phase 3 clinical trial program involving more than 2500 patients worldwide in three global key studies: Measure Up 1, Measure Up 2 (UPA monotherapy at a dose of 15 mg or 30 mg per day) and AD Up (UPA in the same doses in combination with topical glucocorticosteroids (TGCS) demonstrated high efficacy and favorable benefit/risk profile of UPA both in monotherapy and in combination with TGCS in patients with moderate to severe AD.