ECZEMA is a chronic inflammatory skin disease of a neuro-allergic nature, characterized by erythematous-vesicular itchy rashes. It occurs acutely, then takes a chronic course with a tendency to relapse. Changes preceding the development of an eczematous process on the skin can occur due to dysfunction of the central nervous system, for example, under the influence of severe mental experiences, or as a result of exposure to the skin of various external factors.
Functional changes in the skin can also be caused by diseases of internal organs (gastritis, colitis , cholecystitis , periduodenitis, etc.). In some cases, the development of eczema is facilitated by dysfunction of the endocrine glands, for example, with diabetes mellitus, hyperthyroidism.
Distinguish true, professional, microbial and seborrheic forms of eczema.
True eczema in the acute period is characterized by a rash on the erythematous, slightly swollen skin of the smallest vesicles. Opening quickly, the bubbles form a large number of small point erosions with drops of serous exudate like dew (acute weeping eczema). As the process subsides, the number of newly formed vesicles decreases, and on the surface of the affected area, along with the vesicles, small scaly peeling is revealed. Part of the bubbles, without opening, dries up, forming crusts. All elements (erythema, vesicles, erosion, crusts and scales) are usually observed on the affected area at the same time, causing one of the most characteristic signs of eczema - rash polymorphism. Gradually, the process acquires a chronic course, which is expressed by compaction (infiltration) of the affected area of the skin and strengthening of the skin pattern (lichenification). Skin color takes on an increasingly pronounced stagnant hue. Peeling predominates on the surface of the affected area, along with this, although much less than in the acute period, rash of vesicles, the formation of small point erosions and crusts are observed. Exacerbations are characterized by newly onset active hyperemia, rash of microvesicles and weeping, intensifying skin itching. The foci of eczema have different sizes, their contours for the most part without clear boundaries, less often sharply outlined. The most common initial localization is the rear skin of the hands and face. Relatively rarely, eczema is limited to one focus. The process usually extends to other, primarily symmetrical, sites, sometimes to the entire body. Eczema is often complicated by purulent infection, which is expressed by the formation on the surface of the focus of loose crusts of honey-yellow or green.
A variant of true eczema is dyshidrotic eczema, which is localized on the skin of the palms and soles. Its characteristic feature is the appearance against the background of mild inflammatory infiltration of dense skin, the size of a small pea of multi-chamber vesicles resembling boiled saga grains, which open successively with the formation of erosion or dry out, forming lamellar, yellowish scales and crusts. The lesions are sharply limited. Gradually increasing in size, they can go to the rear of the hand or foot, where the inflammatory process takes on a clinical picture typical of true eczema.
Occupational (contact) eczema is more often observed with increased sensitivity to various, especially chemical, irritants that can occur in the workplace (resins, dyes, varnishes, etc.). In most cases, the process is localized on the skin of the rear of the hands, forearms, and face, where erythematic-edematous, often wetting foci resembling true eczema first appear (in chronic course). Upon elimination of contact with an allergic factor, occupational eczema regresses.
Microbial eczema develops as a result of irritation and secondary eczematization of various, often superficial pyoderma. The lesion foci have different shapes, are sharply limited, covered with crusts, under which a weeping, and on the periphery, peeling rim of the stratum corneum of the epidermis is found. Most often they are localized on the lower extremities, the rear of the hands, face. The process is often asymmetric. Seborrheic eczema is characterized by the appearance on the skin of the scalp, face, neck, chest, between the shoulder blades of areas of various sizes, covered with oily scales.
An abortive form of eczema is eczematide, characterized by multiple, rarely solitary, itchy erythematous flaky spots of oval and round outlines of various sizes. With their irritation, drip weeping occurs. These rashes can appear after a sore throat, acute respiratory infections (including flu), and acute intestinal diseases.
In children suffering from exudative-catarrhal diathesis, eczema often develops, which is most often localized on the skin of the face, scalp and is accompanied by severe exudation, severe itching. In the clinical picture of childhood eczema, signs of true, microbial, and seborrheic eczema are often observed at the same time.
Treatment . Patients are prescribed sedatives, intravenous infusions of a 10% solution of calcium chloride, a 30% solution of sodium thiosulfate, etc. In the acute period, when there is a sharp soak and swelling, cold, often replaced lotions or moist drying dressings from astringent solutions are indicated (lead water, 1 % solution of resorcinol, etc.); in the subacute period, with slight weeping and peeling prevailing - naphthalan or ichthyol (2 - 5%) pastes, ointments and creams with corticosteroids. In the chronic course of the process and the presence of severe infiltration of the affected areas of the skin, keratoplastic agents are used (tar preparations, naphthalan paste in a gradually increasing concentration from 2 - 5 to 10 - 25%). Recommended prolonged sleep (the appointment of small doses of sleeping pills), sleep, hypnosis, spa treatment. With occupational eczema, contact with an irritating factor must be eliminated. With microbial eczema, treatment is supplemented with antibacterial therapy. Remediation of foci of chronic infection is important. Foci of eczematide are treated with a 1-2% alcohol solution of brilliant green, methylene blue, corticosteroid ointments containing antibacterial agents (lorinden C, etc.). Patients with eczema should be under medical supervision.