Eczema is a chronic skin disease characterized by erythematous-vesicular rashes, resulting from the effects of various factors: both exogenous (chemicals, allergens of medicinal, food and bacterial nature) and endogenous (causing an allergic reaction remains of dead microorganisms from foci of chronic infection and their metabolic products). However, more often the cause is immune inflammation in the skin.
An important role in the development of eczema is played by functional disorders of the central nervous system, endocrine disorders, digestive tract, metabolic processes, etc. The disease is chronically recurrent, exacerbations occur, as a rule, under the influence of psychoemotional stress, improper diet, contact with chemicals or other allergens.
There are several forms of the disease: true, microbial, seborrheic, professional, children’s.
True eczema can occur at any age. As a rule, the disease manifests itself acutely, after a while it turns into a chronic form with periodic relapses. Frequent places of localization of lesions are the back of the hands, forearms, feet, in children – the face, buttocks, limbs, chest; however, sometimes the disease can spread to other areas of the skin. It should be noted that skin lesions, as a rule, occur symmetrically. The main clinical symptom is itching.
The microbial form is most often not a primary disease, but occurs after secondary eczematization of the foci of the underlying disease (pyoderma, mycosis) or infected injuries, burns, ulcers, etc. The seborrheic form is usually caused by seborrhea and related neuroendocrine disorders. This form of the disease affects the scalp, forehead, skin behind the ears, upper chest, extensor surfaces of the limbs, the area between the shoulder blades of the back. Professional eczema is considered as an allergic reaction of the skin to any substances related to production. Localization of the process — open areas of the body (hands, forearms, face, neck). The elimination of the allergen leads to a rapid regression of the inflammatory process.
Clinical picture of eczema
True eczema. Wet acute eczema is characterized by redness and swelling of the skin, the appearance of small bubbles that quickly open, leaving behind small point erosions — the so-called “eczema wells” that secrete serous exudate. Gradually, acute inflammatory phenomena disappear, the number of bubbles on the skin decreases, and erosions dry up. At the sites of eczema localization, bran-like peeling occurs, dried bubbles leave small crusts.
The transition of the disease into a chronic form is characterized by redness of the skin caused by stagnant processes in it, the appearance of areas of papular infiltration, compaction of the skin, the appearance of scales and cracks.
As a variant of true eczema, dyshidrotic eczema is isolated. It is localized on the palms, soles, and side surfaces of the fingers. Clinical manifestations of dyshydrotic eczema are identical to the symptoms of the true form of the disease; in addition, patients have the appearance of many small bubbles from 1 to 3 mm in diameter, and on the sides of the lesions — peeling of the stratum corneum of the epidermis.
Microbial eczema. Unlike the true form of the disease, the skin lesion occurs asymmetrically; the lesions have clear boundaries, rounded or uneven outlines with the horny layer of the epidermis peeling off on the sides. Crusts are noticeable on the lesions, under which a strongly wet surface is found with bright red small point erosions that secrete serous exudate. Small bubbles, small pustules, and seropapules appear on the skin surrounding the main focus.
A variant of microbial eczema is nummular (coin-shaped) eczema. It differs from the microbial nature of the foci, which have sharp rounded outlines with a diameter of 1.5 to 3 cm and resemble coins, and the color of the foci, which reaches a bluish-red hue. Nummular eczema is usually localized on the back of the hands and extensor surfaces of the extremities.
Characteristic signs of seborrheic eczema localized on the scalp are dry skin, the appearance of many gray bran-like scales, serous yellow crusts, after removal of which a wet surface with clear boundaries is found; glued hair. Behind the ears, the skin swells, cracks, becomes sharply painful, covered with yellow scales. Peeling foci of yellow-pink color with clear borders appear on the chest, back and limbs. Small nodular elements are sometimes found in the center of such spots.
The clinical picture of children’s eczema combines the symptoms of true, seborrheic and microbial eczema, which occur in various combinations, and symptoms of different forms of the disease may prevail in different parts of the body. Most often, children’s eczema occurs in children aged 3-6 months who are on artificial feeding. The lesions are located symmetrically, do not have clear boundaries. The skin in the lesions swells, sometimes gets wet, small bubbles, yellow-brown crusts, scales appear in them. As a rule, eczema initially affects the cheeks and forehead of the child, then spreads to the scalp, auricles, neck, buttocks, limbs, trunk. Children suffer from itching, insomnia.
Symptoms of professional eczema: hyperemia and swelling of the skin, wetness of the skin, the appearance of vesicles, itching sensation. The disease has a chronic recurrent character, and each new exacerbation proceeds with more pronounced symptoms. The elimination of the allergen leads to a rapid regression of the inflammatory process.
Eczema treatment should be carried out under the supervision of a doctor. The diagnosis is established on the basis of the clinical picture, anamnesis, laboratory examination data. In doubtful cases, histological examination is necessary. Differential diagnosis is carried out with allergic dermatitis, toxicoderma, psoriasis, sometimes mycoses.
Eczema treatment is complex
First of all, it is aimed at eliminating the factor that provoked the development of the disease:
- elimination of neurotic disorders, elimination of neuroendocrine disorders, exacerbations of chronic diseases, hypoallergenic diet;
- hyposensitizing therapy (solutions of sodium thiosulfate, calcium chloride intravenously, calcium gluconate, magnesium sulfate intramuscularly);
- antihistamines (diphenhydramine, pipolfen, suprastin, tavegil, diazoline, cimetidine, duovel, zaditen, peritol, etc.);
- in severe forms of eczema, corticosteroid hormones (prednisone) are prescribed;
- immunocorrecting agents (decaris, tactivin, timalin, diuciphon, methyluracil, pentoxil);
- with microbial eczema, B vitamins, purified sulfur are indicated, with dyshydrotic — bellataminal;
- external treatment: lotions with boric acid, silver nitrate, dimexide (for acute weeping eczema); diprosalic solution, sulfur ointment, salicylic ointment, boric ointment, ketoconazole cream, triderm ointment (for seborrheic eczema); dermosolone, celestoderm, lorinden C, diprogent, Wilkinson ointment, Castellani liquid (for microbial eczema); baths with potassium permanganate with subsequent opening and extinguishing of bubbles (with dyshidrotic eczema).
Physiotherapy procedures are widely used in the treatment of eczema: electrophoresis, UV irradiation, UHF therapy, paraffin treatment, mud therapy, acupuncture, etc.
Prevention of the disease consists in:
- Compliance with the rules of personal hygiene.
- Timely detection and treatment of other skin diseases (pyoderma, foot mycoses, allergic dermatitis).
- Timely detection and treatment of diseases of the digestive tract.
- Compliance with a dairy-vegetable diet by eczema patients, refusal to drink alcohol, salty and spicy foods, canned foods, citrus fruits.