B Y T TRNG I HC Y H NI NGUYN TH XUN HNG ảNH HƯởNG Của CHĂM SóC Da hiệu điều trị bệNH viêm da địa TRẻ EM LUN VN BC S CHUYấN KHOA II H NI - 2015 B Y T TRNG I HC Y H NI NGUYN TH XUN HNG ảNH HƯởNG Của CHĂM SóC Da hiệu điều trị bệNH viêm da địa TRẻ EM Chuyờn ngnh: Da liu Mó s: CK 62723501 LUN VN BC S CHUYấN KHOA II Ngi hng dn khoa hc: PGS.TS Trn Lan Anh H NI - 2015 LI CM N Sau mt quỏ trỡnh hc v nghiờn cu, n tụi ó hon thnh lun tt nghip v kt thỳc chng trỡnh o to bỏc s chuyờn khoa cp Tụi xin by t lũng bit n sõu sc ti cỏc thy, cỏc cụ: PGS.TS Trn Lan Anh- Nguyờn Phú Ch nhim b mụn Da liu Trng i hc Y H Ni, Nguyờn trng phũng o to Bnh vin Da liu Trung ng, ngi ó trc tip hng dn, giỳp tụi sut quỏ trỡnh hc v hon thnh lun GS.TS.Trn Hu Khang- Nguyờn Ch nhim b mụn Da liu Trng i hc Y H Ni, Nguyờn Giỏm c Bnh vin Da liu Trung ng, Ch tch hi Da liu Vit Namngi ó dy d tụi v tn tỡnh ch bo cho tụi sut thi gian hc PGS.TS Nguyn Vn Thng- Ch nhim b mụn Da liu Trng i hc Y H Ni, Giỏm c Bnh vin Da liu Trung ng ngi ó tn tỡnh ch bo cng nh to iu kin cho tụi sut quỏ trỡnh hc PGS.TS Nguyn Hu Sỏu- Phú ch nhim B mụn Da liu i hc Y H Ni,Phú Giỏm c Bnh vin Da liu Trung ng, PGS.TS Phm Th Lan - Trng phũng hnh chớnh i hc Y H Ni, PGS.TS ng Vn Em Ch nhim b mụn Da liu Vin nghiờn cu khoa hc Y-Dc lõm sng 108- cỏc thy, cụ ó tn tỡnh giỳp , ng viờn tụi quỏ trỡnh hc v hon thnh lun Tụi xin trõn trng cm n ng y, Ban giỏm hiu, phũng o to sau i hc, B mụn Da liu Trung ng ó to mi iu kin thun li cho tụi sut quỏ trỡnh hc v hon thnh lun Tp th cỏn b, nhõn viờn Bnh vin Da liu Trung ng ó giỳp tụi quỏ trỡnh hc cng nh hon thnh lun Ban lónh o Bnh vin Hu ngh Vit Tip, ban lónh o cựng ton th ch em nhõn viờn ca khoa Da liu bnh vin Hu ngh Vit Tip ó to iu kin cho vic hc ca tụi Tụi vụ cựng bit n cha m, chng, cỏc v ton th ngi thõn gia ỡnh ó luụn c v, ng viờn v l ch da vng chc cho tụi vt qua nhng khú khn sut quỏ trỡnh hc v nghiờn cu BS Nguyn Th Xuõn Hng LI CAM OAN Tụi xin cam oan cụng trỡnh nghiờn cu ny chớnh tụi thc hin Cỏc s liu v kt qu lun l trung thc v cha h cụng b bt k cụng trỡnh nghiờn cu no H Ni, ngy thỏng 12 nm 2015 Tỏc gi Nguyn Th Xuõn Hng CC CH VIT TT EASI : Eczema area and severity index (Ch s nng v din tớch ca eczema) IgE : Immunoglobulin E IL : Interleukin NMF : Natural moisturasing factor (Yu t dng m t nhiờn) SCORAD : Scoring Atopic Dermatitis (Thang im Viờm da c a) Th : Lympho T helper (Lympho T h tr) TNF : Tumor neucrosis factor (Yu t hoi t u) VDC : Viờm da c a MC LC T VN CHNG 1: TNG QUAN 1.1 i cng v Viờm da c a 1.1.1 Thut ng bnh v tỡnh hỡnh dch t 1.1.2 C ch bnh sinh 1.1.3 c im lõm sng ca VDC 10 1.1.4 Tin trin v bin chng 13 1.1.5 Chn oỏn 14 1.1.6 iu tr v qun lý bnh VDC 15 1.2 Chm súc da VDC 18 1.2.1 Hn ch tỏc ng ca cỏc yu t kớch thớch 18 1.2.2 Ch tm 19 1.2.3 B xung m cho da 21 1.3 Mt s nghiờn cu v chm súc da cho tr VDC 24 1.3.1 Cỏc nghiờn cu v chm súc da cho tr VDC trờn th gii 24 1.3.2 Cỏc nghiờn cu v chm súc da cho tr VDC Vit Nam 25 CHNG 2: I TNG V PHNG PHP NGHIấN CU 26 2.1 i tng nghiờn cu 26 2.1.1 Tiờu chun chn oỏn 26 2.1.2 Tiờu chun chn bnh nhõn 28 2.1.3 Tiờu chun loi tr 28 2.2 Vt liu nghiờn cu 28 2.3 Phng phỏp nghiờn cu 28 2.3.1 Thit k 28 2.3.2 C mu 29 2.3.3 Cỏc bc tin hnh 30 2.4 a im v thi gian nghiờn cu 33 2.5 X lý s liu 33 2.6 o c nghiờn cu 33 2.7 Hn ch ca ti 33 CHNG 3: KT QU 34 3.1 c im ca i tng nghiờn cu 34 3.2 Thúi quen dựng sn phm chm súc da cho tr VDC 36 3.2.1 Thúi quen dựng sn phm tm cho tr VDC 36 3.2.2 Thúi quen s dng sn phm dng m cho tr VDC 42 3.3 nh hng ca chm súc da i vi kt qu iu tr viờm da c a tr em 45 3.3.1 c im ca nhúm nghiờn cu 45 3.3.2 So sỏnh s triu chng lõm sng ca nhúm nghiờn cu 46 3.3.3 ỏnh giỏ hiu qu iu tr theo im SCORAD 46 3.3.4 ỏnh giỏ hiu qu iu tr theo triu chng khụ da v mt s triu chng ch quan 48 3.3.5 Tỏc dng khụng mong mun ca sn phm dng m 52 CHNG 4: BN LUN 53 4.1 c im ca i tng nghiờn cu 53 4.2 Thúi quen chm súc da cho tr VDC 54 4.2.1 Thúi quen s dng sn phm tm cho tr VDC 54 4.2.2 Thúi quen dựng dng m lm mm da cho tr VDC 60 4.3 nh hng ca chm súc da i vi iu tr VDC tr em 63 4.3.1 c im ca nhúm nghiờn cu 63 4.3.2 So sỏnh s triu chng lõm sng ca VDC gia nhúm nghiờn cu 64 4.3.3 ỏnh giỏ hiu qu iu tr theo im SCORAD 64 4.3.4 ỏnh giỏ hiu qu iu tr mc khụ da v mt s triu chng ch quan 67 4.3.5 Tỏc dng khụng mong mun ca sn phm dng m 73 KT LUN 74 KIN NGH 76 PH LC DANH MC BNG Bng 3.1: Phõn b bnh nhõn theo tui v gii 34 Bng 3.2: Thụng tin v ngi chm súc tr 35 Bng 3.3: Mc bnh theo thang im SCORAD 36 Bng 3.4: Cỏc cỏch thc tm cho tr VDC 36 Bng 3.5: Cỏc loi cõy c thng dựng tm 37 Bng 3.6 S loi cõy c dựng cho tr 38 Bng 3.7: Cỏc ch tm theo a d 38 Bng 3.8: Cỏc cõy c c dựng tm theo a d 39 Bng 3.9: Cỏc ch tm theo tui ngi chm súc 39 Bng 3.10: Cỏc ch tm theo hc ngi chm súc 40 Bng 3.11: Cỏc ch tm theo mc bnh 40 Bng 3.12: Thúi quen s dng dng m 42 Bng 3.13: Thúi quen s dng dng m theo a d 42 Bng 3.14: Thúi quen s dng dng m theo tui ngi chm súc 43 Bng 3.15: Thúi quen s dng dng m theo trỡnh ngi chm súc 43 Bng 3.16: Thúi quen s dng dng m v mc bnh 44 Bng 3.17: So sỏnh c im ca nhúm nghiờn cu 45 Bng 3.18: So sỏnh s triu chng lõm sng ca nhúm nghiờn cu 46 Bng 3.19: Hiu qu iu tr ca nhúm c chm súc da theo SCORAD 46 Bng 3.20: Hiu qu iu tr ca nhúm chng theo im SCORAD 47 Bng 3.21: Hiu qu iu tr triu chng khụ da ca nhúm c chm súc da 48 Bng 3.22: Hiu qu iu tr triu chng khụ da ca nhúm chng 48 Bng 3.23: Hiu qu iu tr triu chng nga ca nhúm c chm súc da 49 Bng 3.24: Hiu qu iu tr triu chng nga ca nhúm chng 50 Bng 3.25: Hiu qu iu tr triu chng mt ng ca nhúm c chm súc da 51 Bng 3.26: Hiu qu iu tr triu chng mt ng ca nhúm chng 51 Bng 3.27: Tỏc dng ph ca sn phm dng m 52 DANH MC BIU Biu 3.1: Phõn b bnh nhõn theo tui v gii 34 Biu 3.2: Phõn b bnh nhõn theo a d 35 Biu 3.3: Cỏc ch tm theo mc bnh 41 Biu 3.4: So sỏnh hiu qu iu tr ca nhúm nghiờn cu theo SCORAD 47 Biu 3.5: So sỏnh hiu qu iu tr triu chng khụ da ca nhúm nghiờn cu 49 Biu 3.6: So sỏnh hiu qu iu tr ca triu chng nga ca nhúm nghiờn cu 50 Biu 3.7: So sỏnh hiu qu iu tr triu chng mt ng ca nhúm nghiờn cu 52 74 KT LUN Qua nghiờn cu 182 tr ( 12 tui) b VDC n khỏm ti Bnh vin Da liu Trung ng giai on t 12/2014 - 5/2015 v 9/2015-11/2015, chỳng tụi cú mt s kt lun sau: Thúi quen dựng sn phm chm súc da cho tr b viờm da c a - Thúi quen s dng sn phm tm cho tr VDC Cú 50% tr b VDC c tm bng cỏc loi cõy c, 37,4% tm bng cỏc loi sa tm thụng thng v 7,1% tm bng nc thụng thng Ch 4,4% tr VDC c tm bng sa tm dng m Cú s khỏc bit v ch tm gia nhúm tui vi tr di tui tm cõy c nhiu hn Cõy c hay c s dng tm cho tr VDC nht l chanh, lỏ chố, mp ng Cú ti 30 loi cõy c c s dng a s tr 49,4% ch c tm bng loi cõy c, nhng cú 5,6% ó c tm n loi S tr c tm t trờn loi cõy u nm nhúm di tui Khụng cú s khỏc bit v thúi quen s dng cỏc sn phm tm nụng thụn v thnh th Khụng cú s khỏc bit gia cỏc mc trỡnh hc ca ngi chm súc v s dng cỏc sn phm tm cho tr VDC Tr tm cõy c cú mc bnh nng hn, ngc vi nhúm tr tm dng m - Thúi quen s dng dng m cho tr VDC T l dựng dng m cho tr VDC l 19,7% ú dựng thng xuyờn rt thp 2,8% Khụng cú s khỏc bit v s dng dng m gia tui Khụng cú s khỏc bit v t l s dng dng m nụng thụn v thnh th Khụng cú s khỏc bit v t l dựng dng m cho tr VDC gia cỏc tui cng nh trỡnh hc ca ngi chm súc 75 nh hng ca chm súc da i vi kt qu iu tr bnh VDC tr em - Hiu qu iu tr theo im SCORAD im SCORAD trung bỡnh ca c nhúm iu sau tun v tun iu tr u thp hn so vi trc iu tr Tuy nhiờn, im SCORAD trung bỡnh ca nhúm chm súc da gim hn hn so vi im ca nhúm chng - Hiu qu iu tr theo mc khụ da v triu chng ch quan Sau iu tr tun v tun im trung bỡnh ca triu chng khụ da, nga v mt ng theo thang im SCORAD ca c nhúm nghiờn cu u gim so vi trc iu tr (Riờng triu chng mt ng ch gim rừ sau tun) Tuy nhiờn, khụ da, nga v mt ng ca nhúm chm súc da u gim nhiu hn so vi im ca nhúm chng cú ý ngha thng kờ - Sn phm dng m khỏ phự hp, khụng gõy khú chu vi cỏc tr 76 KIN NGH Cn s dng sa dng m thng xuyờn cho tr b VDC nh l mt cỏc thnh phn ca qun lớ, iu tr bnh VDC Khụng nờn khuyn khớch vic tm cõy c cho tr VDC v nờn cú nghiờn cu sõu hn v nh hng ca vic tm cõy c cho tr VDC v chm súc VDC Cn cú chng trỡnh giỏo dc cho b m cng nh cỏc tr VDC v vai trũ ca dng m núi riờng v chm súc da núi chung trờn cỏc phng tin truyn thụng i chỳng BNG THU THP S LIU Ngy khỏm:../ /201 S h s H tờn BN: Nm sinh N Gii: Nam a ch Nụng thụn Thnh th T: Ngi chm súc: Tui: Trỡnh : Tiu hc THCS THPT Trung cp Cao ng i hc Ch tm: Nc sch Satm Sa tm dng m thng Cõy c Khỏc - Loi cõy c: S dng dng m lm mm da: Khụng Dựng khụng u Dựng u ỏnh giỏ im SCORAD ln khỏm u ỏnh giỏ im SCORAD sau 1tun: ỏnh giỏ im SCORAB sau tun Tỏc dng khụng mong mun: da Núng rỏt Nga Nhy m TI LIU THAM KHO Leung D.Y.M., Eichenfield L.F., Boguniewiczn M (2012) Atopic dermatitis Dermatology in general medicin of Fitzpatrick, Mac GrawHill,8thedn , 165-182 H Nguyn Phng Anh (2006), Nghiờn cu nh hng ca viờm da c a n cht lng cuc sng ngi bnh iu tr ti Vin Da Liu Quc gia Lun Thc s Y hc, Hc vin quõn y Eichenfield L.F., Tom W.L., Chamlin S.L et al (2014), Guidelines of care for the management of atopic dermatitis: section Diagnosis and assessment of atopic dermatitis J Am Acad Dermatol, 70(2), 338-351 Catherine M., Correa M., Nebus J et al(2012), Mannagement of patient with atopic dermatitis The role of Emolient Therapy Dermatology Reseach and practice, ID836931, 15 Arnold R.L., Odom R.B., James W.D (1990), Atopic dermatitis Andrew's disease of the skin clinical der matology, W.B.Saunders, 8th edn, 68-74 Schauner L.A (2010), Atopic dermatitis Pediatric Dermatology, 851886 Habif T.P (2010), Atopic dermatitis Clinical dermatology, Mosby,5thedn, 154-180 Phm Vn Hin (2001), Tỡnh hỡnh chm th tng ti Vin Da Liu t 1995 - 2000 Ni san Da Liu, 1-9 Trn Vn Trung (2001), Tỡnh hỡnh, c im lõm sng, cỏc yu t liờn quan ca bnh viờm da c a tr em ti Vin Da liu Vit Nam 19952001 Lun Thc s Y hc 10 B mụn Da liu i hc Y H Ni (2014), Viờm da c a Bnh hc Da liu, Nh xut bn Y hc, 75-83 11 Reitamo S.,T homas A Luger T.A.,Martin Steinhoff M (2008), Textbook of Atopic Dermatitis, Informa healthcare, London 12 Coderch L., Lúpez O., de la Maza A.et al (2003), Ceramides and skin function Am J Clin Dermatol, 4(2), 107-129 13 Loden M (2003), Role of topical emollients and moisturizers in the treatment of dry skin barrier disorders Am J Clin Dermatol, 4(11), 771-788 14 Wolf R., Wolf D (2012), Abnormal epidermal barrier in the pathogenesis of atopic dermatitis Clin Dermatol, 30(3),329-334 15 Vivie A (2012), Atopic dermatitis Atlas of clinical dermatology, 38-47 16 Irvine A.D (2007), Fleshing out filaggrin phenotypes J Invest Dermatol, 127, 504- 507 17 Van den Oord R.A., Sheikh A (2009), Filaggrin gene defects and risk of developing allergic sensitisation and allergic disorders: systematic review and meta-analysis BMJ, b2433,339 18 Rahman S., Collins M., Williams C.M.et al (2011), The pathology and immunology of atopic dermatitis Inflamm Allergy Drug Targets,10(6), 486-496 19 Nguyn Th Lai (2001), Nghiờn cu c im lõm sng v dch bnh viờm da c a ngi ln Lun ỏn tin s, Trng i hc Y H Ni 20 V Tun Anh (2012), Viờm da c a - mt s c im c ch bnh sinh Tp Da liu hc Vit Nam, 68-71 21 Nowicki R., Trzeciak M., Wikowska A., et al (2015), Atopic dermatitis: current treatment guidelines Statement of the experts of the Dermatological Section, Polish of the Allergology, and the Allergology Section, Polish Society of the Dermatology Postepy Dermatol Alergol,32(4), 239-249 22 V Tun Anh (2010), Vai trũ ca t cu vng viờm da c a Tp Da liu hc Vit Nam, 46-50 23 m Th Thỳy Hng (2009), Xỏc nh s hin din ca t cu vng trờn thng tn da v ỏnh giỏ hiu qu iu tr viờm da c a tr em bng bụi Fucidin H Lun Thc s Y hc, i hc Y H Ni 24 Asahina A., Hosoi J., Murphy G.F et al (1998), Calcitinon gene-related peptid modulated langerhans cell antigen-presenting function Proc Asoc Am Physicians, 107, 242-244 25 Champion R.H Burton J.L., Burns D.A et al (1999), Atopic dermatitis Textbook of dermatology, 6th edn, Blackwell science, 681-708 26 Steinhoff M., Steinhoff A., Homey B et al (2006), Role of vasculature in atopic dermatitis.J Allergy Clin Immunol, 118(1), 190-197 27 Parker J.N., PARKER P.M (2002), The oficial Patient's sourse look on Atopic Dermatitis 28 Willemsen M.G., van Valburg R.W., Dirven-Meijer P.C.et al (2009), Determining the severity of atopic dermatitis in children presenting in general practice: an easy and fast method Dermatol Res Pract, 357046 29 Kim D.H., Li K., Seo S.J., et al (2012), Quality of life and disease severity are correlated in patients with atopic dermatitis J Korean Med Sci, 27(11), 1327-1332 30 Emerson R.M., Charman C.R., Williams H.C (2000), The Nottingham Eczema Severity Score: preliminary refinement of the Rajka and Langeland grading Br J Dermatol, 142(2), 288-297 31 Consensus Report of European Task Force on Atopic Dermatitis (1993), Severity scoring of atopic dermatitis: the scorad index Dermatology Reseach and practice 186, 23-31 32 Kunz B., Oranje A.P., Labrốze L et al (1997) Clinical validation and guidelines for the SCORAD index: consensus report of the European Task Force onAtopic Dermatitis Dermatology, 195(1), 10-19 33 Grimalt R., Mengeaud V., Cambazard F et al (2007), The steroidsparing effect of an emollient therapy in infants with atopic dermatitis: a randomized controlled study Dermatology, 214(1), 61-67 34 Wang IJ., Wang J.Y (2015), Children with atopic dermatitis show clinical improvement after Lactobacillus exposure Clin Exp Allergy, 45(4), 779-787 35 Ohshima-Terada Y., Higuchi Y., Kumagai T., et al (2015), Complementary effect of oral administration of Lactobacillus paracasei K71 on canine atopic dermatitis, Vet Dermatol, 26(5), 350-353 36 Kleeyton de Mesquita C., et al (2013), Atopic dermatitis anh Vitamin D: Facts and controvessies An Bras Dermatitis, 88, 945-953 37 Hon KL, Chan BC, Leung PC (2011), Chinese herbal medicin reseach in eczema treatment ChinMed, 7, 17 38 Font-Ribera L., Gracia-Lavedan E., Esplugues A et al (2015), Water hardness and eczema at and 4y of age in the INMA birth cohort Environ Res, 142, 579-585 39 Tt Li (2004), Nhng cõy thuc v v thuc Vit Nam Nh xut bn Y hc 40 Del Rosso J Q (2009), Moisturizers: Function, formulation and clinical applications Cosmeceuticals Procedures in Cosmetic Dermatology, 2th edn, 97-102 41 Anderson P.C., Dinulos J.G (2009) Are the new moisturizers more effective? Curr Opin Pediatr Aug, 21(4), 486-490 42 Loden M (2005), The clinical benefit of moisturizers J Eur Acad Dermatol Venereol, 19(6), 672-688 43 Flynn T.C., Petros J., Clark R.E.et al (2001), Dry skin and moisturizers Clin Dermatol, 19(4), 387-392 44 Nolan K., Marmur E (2012), Moisturizers: reality and the skin benefits Dermatol Ther, 25(3), 229-233 45 Sirikudta W., Kulthanan K., Varothal S et al (2013), Moisturizers for Patients with Atopic Dermatitis: an Overview J Allergy Ther, 4, 46 Fowler J.F., Nebus J., Wallo W., et al (2012), Colloidal oatmeal formulations as adjunct treatments in atopic dermatitis J Drugs Dermatol, 11(7), 804-807 47 Riethmuller C., Maeve A McAleer M.A (2015), Filaggrin breakdown products determine corneocyte conformatin in patients with atopic dermatitis J Allergy Clin Immunol, 6749(15), 00649-1 48 Hon K.L., Leung A.K (2013), Use of ceramides and related products for childhood-onset eczema Drugs R D, 13(1), 37-42 49 Tofte S.J., Hanifin J.M (2001), Current management and therapy of atopic dermatitis J Am Acad Dermatol, 44(1), 13-16 50 Hon K.L., Leung T.F., Wong Y et al (2005), A survey of bathing and showering practices in children with atopic eczema Clin Exp Dermatol, 30(4), 351-354 51 Breternitz M., Kowatzki D., Langenauer M.et al (2008), Placebocontrolled, double-blind, randomized, prospective study of a glycerolbased emollient on eczematous skin in atopic dermatitis: biophysical and clinical evaluation Skin Pharmacol Physiol,21(1),39-45 52 Chiang C., Eichenfield L.F (2009), Quantitative assessment of combination bathing and moisturizing regimens on skin hydration in atopic dermatitis Pediatr Dermatol, 26(3), 273-278 53 Na J.I., Hwang J.S., Park H.J., et al (2010), A new moisturizer containing physiologic lipid granules alleviates atopic dermatitis J Dermatolog Treat, 21(1), 23-27 54 Hon K.L., Ching G.K., Leung T.F (2010), Estimating emollient usage in patients with eczema Clin Exp Dermatol, 35(1), 22-26 55 Giordano-Labadie F., Cambazard F., Guillet G.et al (2006), Evaluation of a new moisturizer (Exomega milk) in children with atopic dermatitis J Dermatolog Treat, 17(2), 78-81 56 Simpson E., Trookman N.S., Rizer R.L., et al (2012), Safety and tolerability of a body wash and moisturizer when applied to infants and toddlers with a history of atopic dermatitis: results from an open-label study Pediatr Dermatol, 29(5), 590-597 57 Gelmetti C., Boralevi F., Seitộ S.et al (2012), Quality of life of parents living with a child suffering from atopic dermatitis before and after a 3month treatmentwith an emollient Pediatr Dermatol, 29(6), 714-718 58 Hon K.L., Pong N.H., Wang S.S et al (2013), Acceptability and Efficacy of an Emollient Containing Ceramide-Precursor Lipids and Moisturizing Factors for Atopic Dermatitis in Pediatric Patients Drugs R D, 13(1), 37-42 59 Weber T.M., HerndonJ.H., Ewer M., et al (2015), Efficacy and Tolerability of Steroid-free, Over- the-Counter Treatment Formulations in Infants and Children With Atopic Dermatitis J Dermatol nurse Assos, 7(1), 17-24 60 Nguyn Hu Sỏu, Trnh Minh Trang (2014), Hiu qu iu tr khụ da bnh viờm da c a ca Eucerin senitive skin, pH Washlotion v Eucerin Dry skin smoothing lotion 12% omega Tp Da liu hc Vit Nam, 19, 24-31 61 Nguyn Th Thoa (2015) Kho sỏt kin thc ca ngi m v viờm da c a tr di tui Khúa lun tt nghip bỏc s a khoa, Trng i hc Y H Ni 62 Liu J, Mo X, Wu D et al (2015) Efficacy of a Chinese herbal medicine for the treatment of atopic dermatitis: A randomised controlled study Complement Ther Med, 23(5), 644-651 63 Tarr A., Iheanacho I (2009), Should we use bath emollients for atopic eczema? BMJ, 13, 339 64 Jung Eun Kim, Hyun Jeong Kim, Bark-Lynn Lew et al (2015), Consensus Guidelines for the Treatment of Atopic Dermatitis in Korea (Part I): General Management anh Topical Treatment Ann Dermatol, 27(5), 563-577 65 Canpolat F., Erkoỗolu M., Tezer H.et al (2012), Hydrocortisone acetate alone or combined with mupirocin for atopic dermatitis in infants under two years of age - a randomized double blind pilot trial Eur Rev Med Pharmacol Sci,16(14), 1989-1993 66 Chõu Vn Tr (2013), Nghiờn cu siờu khỏng nguyờn ca t cu vng v hiu qu iu tr viờm da c a In Lun ỏn tin s Y hc, Trng i hc Y H Ni 67 Tagami H., Kobayashi H., O'goshi K et al (2006), Atopic xerosis: employment of noninvasive biophysical instrumentation for the functional analyses of the mildly abnormal stratum corneum and for the efficacy assessment of skin care products J Cosmet Dermatol, 5(2), 140-149 68 Watanabe M., Tagami H., Horii I.et al (1991), Functional analyses of the superficial stratum corneum in atopic xerosis Arch Dermatol, 127(11), 1689-1692 69 Elias P.M., Wakefield J.S (2011), Therapeutic implications of a barrier-based pathogenesis of atopic dermatitis Clin Rev Allergy Immunol, 41(3), 282-295 70 Yosipovitch G., Patel T.S (2012), Pathophysiology and Clinical Aspectsof Pruritus Dermatology in general medicin of Fitzpatrick, 1146-1158 71 Mostaghimi L (2008), Prevalence of mood and sleep problems in chronic skin diseases: a pilot study Cutis, 81(5), 398-402 72 Yano C., Saeki H., Ishiji T et al (2013), Impact of disease severity on sleep quality in Japanese patients with atopic dermatitis J Dermatol Sci, 72(2), 195-197 ...B Y T TRNG I HC Y H NI NGUYN TH XUN HNG ảNH HƯởNG Của CHĂM SóC Da hiệu điều trị bệNH viêm da địa TRẻ EM Chuyờn ngnh: Da liu Mó s: CK 62723501 LUN VN BC S CHUYấN KHOA II Ngi hng... tr viờm da c a tr em vi mc tiờu: Kho sỏt thúi quen dựng sn phm chm súc da cho tr b viờm da c a ti Bnh vin Da liu Trung ng ỏnh giỏ nh hng ca chm súc da i vi hiu qu iu tr viờm da c a tr em 3 CHNG... dng m Sn phm dng m da cú th dng lotion, kem hoc m [4], cha hot cht gi m Cỏc cht lm m da bao gm cht lm mm da (emollients), cht lm m da (humectants), cht hỳt gi ngn nga mt nc qua da (occlusives)