OBSERVATION OF MEDICINES FOR THE TREATMENT OF DIAPER DERMATITIS ON THE PHARMACEUTICAL MARKET OF UKRAINE

diaper dermatitis occurs in every second child of  rst year of life. Breakdown of the skin barrier function and incorrect care are considered to be the primary cause of dermatitis. The literature data on the causes, symptoms, prevention and treatment of diaper dermatitis are presented in the work. The range of drugs for its treatment, that are available on the pharmaceutical market of Ukraine were studied.

Etiology. Newborn skin is very thin (3-4 layers), the layer between the epidermis and dermis is looser in comparison with skin of older children and adults, thin layer of epidermis is prone to damage, connective tissue is poorly developed , the basal membrane is fragile. That is why the skin is less protected and quickly irritated [1,3,11].
Diaper dermatitis can occur under conditions of: -late diapers changing -prolonged skin contact with feces and urine; -mechanical friction -wrong size of diapers or clothing may cause irritation of the skin by constant friction; -usage of some care products -baby skin can negatively react to wipes, diapers, some kinds of tissues, soap, powders, creams etc.; -transition from breastfeeding to arti cial feedingchange of defecation frequency and its pH; -individual sensitivity of the child's skin; -usage of antibiotics [8, 10]. Pathogenesis. On the  rst stage of DD when skin is damaged, the protective function of the horny layer of the epidermis is reduced, skin contact with the feces and urine leads to its excessive moisture, it is easily rubbed and permeability to enzymes, ammonia and urea increases.
The second stage of the disease evolves the in ammatory process, which is manifested by hyperemia, edema, rash (papules, vesicles) in the diaper area. At this stage, as a rule, the accession of microbial infection happens. The formation of redness with exudate and pustules evidences on the accession of bacterial or fungal infection. Most often staphylococcal, streptococcal or candidal diaper dermatitis occurs. The in uence of microorganisms causes the most prolonged and severe diaper dermatitis [1,5].

Pharmaceutical management, marketing and logistics
The main symptoms of diaper dermatitis are blistering, redness, rashes, changes in behavior of the child, such as bad sleep and appetite, feeling of discomfort, trembling, crying, and screaming during diaper changes and washing of the affected areas [1,8,9].
The prevention of DD consists of child's rational care, including timely toilet of the skin, frequent air baths, usage of special wipes that do not contain alcohol and fragrances and are designed not only for gentle cleansing of the skin, but also to moisturize and maintain of the natural pH balance, usage of care products (cleansers, creams, lotions, etc.) that are adapted for infants, usage of disposable diapers which absorb moisture and their suf cient frequency of change [3,5,8,12].
American researchers (Ruchir Agrawal, MD; Chief Editor: Dirk M Elston, 2016) offered treatment of diaper dermatitis using the ABCDE system (air, barrier, cleansing, diaper, and education): air -to increase access of air to the affected skin, leaving a baby without diapers for at least 10 minutes three times a day; barrier -usage of ointments, creams, pastes and lotions which will form a protective  lm on the baby's skin and treat it at the same time; cleansing -keep the diaper area as clean and dry, that is possible, change diapers immediately after bowel movements or urination and cleanse the skin; diaper -choose diapers bigger in size than usual while there is a rash in the affected area; education -the dissemination of information on proper care of baby's skin, methods of prevention and treatment of diaper dermatitis among parents and guardians [8,12]. Mild redness on the area not less than 10 % Marked redness in the area from 2 to 10 % and/or scattered papules, less than 10 % of the area and/or moderate dryness Very intense redness on the area for at least 2 %

Average
Marked redness over the area of 10 to 50 % Very intense redness on the area for at least 2 % and/or from one to several papules from 10 to 50 % with 5 or fewer acne sores Possible slight desquamation or edema 2.5 Moderately heavy Marked redness in the area of more than 50 % Very marked redness in the area from 2 to 10 % without edema and/or the area of more than 50 %, with multiple papules and/or pustules Possible slight desquamation or edema

Heavy
Very intense redness on the area of more than 10 % and/or severe peeling, severe edema, erosion and ulcers Possible large areas of papules, which coalesce or numerous bubbles/acne sores So, the aim of our work was to analyze the range of medicines for the treatment of diaper dermatitis that are presented at the pharmaceutical market of Ukraine.
The object of the study was the informaton of the State register of drugs of Ukraine, formed by "State expert center of the Ministry of health of Ukraine".
Methods of research: search, analysis, generalization and systematization of data.
Results and discussion. According to the ATC classi cation, the range of medicines for the treatment of diaper dermatitis constitute drugs form several groups: D01 (antifungals for dermatological use), D02 (emollients and protective), D03 (preparations for treatment of wounds and ulcers), D06 (antibiotics and chemotherapeutics for dermatological use) and D07 (corticosteroids, dermatological preparations) [4].
There are 18 drugs, which are used for DD treatment according to the State register of medicines (at 1 December 2016).
Analysis of drugs for the DD treatment, depending on the type of dosage form (DF) showed that drugs are represented by the four DF. The greatest number have the soft dosage forms (ointments -47.4 % and creams -42.1 %) (Fig.1).  By legal status 42 % of drugs used for the treatment of diaper dermatitis are released from drugstores and their structural units with prescription [2,4].
Conclusions. There were 18 drugs, which are used for treatment of diaper dermatitis according to the State register of medicines (1 December 2016). 95 % of them are intended for the treatment of both children and adults and more than 20 % of drugs can be used only for Фармацевтичний менеджмент, маркетинг та логістика Pharmaceutical management, marketing and logistics children in age 3-6 months. It should also be noted that the nature of the disease is in uenced by the individual characteristics of the child, this requires a differentiated approach to the choice of therapy in each case. The creation of an effective pediatric medicines both industrial production and extempore formulation according to the requirements of good manufacturing practice and good pharmacy practice is an actual problem.