Eczema is an inflammatory skin disease that has a long–term chronic course with frequent exacerbations. It is characterized by polymorphic rashes undergoing the stages of redness – formation of nodules – bubbles – wet erosions – crusts – peeling. Rashes are accompanied by burning, skin itching. There is a high probability of secondary purulent infection. Infection in children is especially dangerous, because Kaposi’s eczema may develop with a possible fatal outcome. A neglected course can lead to neurosis: insomnia, irritability, as well as persistent cosmetic skin defects. Treatment depends on its form and course. Systemic use of corticosteroids, extracorporeal hemocorrection, local therapy and physiotherapy are effective.
Eczema is a chronic inflammatory skin disease of an allergic nature, the etiology and pathogenesis of the disease has not been fully studied, but the presence in close relatives, allergic diseases in the anamnesis, the effects of endogenous and exogenous factors in the causes of the appearance of small–bubble eczema rash come out on top. Psychovegetative, neuroendocrine and immunological disorders can provoke eczema. In modern dermatology, there are several types (idiophatic, microbial, occupational, seborrheic, children’s), which differ in clinical features.
Idiopathic eczema has a chronic course with frequent relapses and is manifested by symmetrical areas of inflammation in open areas of the skin. With idiophatic eczema, the foci of inflammation are hyperemic, edematous, and the surface is wet. Groups of small vesicles with serous contents are found within the focus. After the vesicles are opened, they leave microerosions typical of eczema. Idiophatic form is characterized by the syndrome of “serous wells”, when droplets of exudate opalesce on the eroded surface, resembling dew.
On the periphery of the eczema focus, single larger rashes and bubbles are observed. Over time, the number of newly emerging bubbles decreases and microerosions shrink into crusts, after healing of which a flaky bran-like surface remains.
With disease, polymorphism of all elements is pronounced, and inflamed areas of different stages of resolution can be found on the affected skin. Most eczema patients complain of itchy skin. In addition to the main lesions, there may be scattered rashes on various areas of the skin, but without wetting. Patients with long-diagnosed eczema note stagnant hyperemia of the skin, infiltration and hyperpigmentation after relief of exacerbations, over time the skin pattern becomes pronounced.
Idiophatic eczema is diagnosed by its acute onset and clinical manifestations, the symmetry of the foci and the fine-grained nature of the lesion, combined with pronounced polymorphism of the elements, as well as the presence of allergic diseases in the anamnesis and possibly recently suffered stress, make it possible to diagnose “idiophatic eczema”.
In the pathogenesis of microbial eczema, various varicose symptom complexes, recurrent skin injuries and fungal infection come out on top. The lesions in microbial eczema are asymmetric and are located mainly on the lower extremities, the favorite localization is the projection of the skin affected by varicose veins. The appearance of foci in the folds of the skin is associated with sweating and violation of personal hygiene. The borders of the eczematous spots are uneven, the adjacent skin is infiltrated, has a bluish-red hue.
Wetness and purulent crusts are present in all affected areas, single papules and papulovesicles are found along the periphery. Microbial eczema is complicated by ostiofolliculitis and impetiginous crusts. Microbial form is divided into mycotic, varicose and paratraumatic.
The diagnosis is made on the basis of clinical manifestations, the presence of mycoses in the patient’s anamnesis, varicose veins of the lower extremities and frequent injuries. Microscopy can detect mycotic cells, bacteriological examination is used to identify the exact type of mycosis and to determine sensitivity to drugs.
Histological examination is characterized by edema of the dermis with epidermal localization of blisters, massive lymphoid infiltration with a predominance of plasmocytic elements, if microbial eczema is of a prolonged nature, then sclerotic changes of the dermis are noted.
A feature of seborrheic eczema is the appearance of lesions on the scalp, in addition, the foci are located in the natural folds of the skin, on the face, around the navel, behind the auricles and on the flexor surfaces. Hyperemia, dry skin and itching are noted on the scalp on inflamed areas, gray bran-like scales are separated when combing. The boundaries of lesions have clear outlines. In some cases, seborrheic eczema is accompanied by exudation, then serous and serous-purulent crusts arise, which, after removal, expose the eroded wet surface.
If the foci occur in places of natural folds, then deep painful cracks, pronounced edema and infiltration can be noticed at their bottom, and small grayish-yellow scales and scaly crusts along the periphery of the foci. Foci of seborrheic eczema on the lower extremities and trunk have smooth and clear edges and outwardly look like yellow-pink peeling spots, in the center of which there is a rash of a small nodular nature.
There is no exact classification of eczema, and therefore some experts do not recognize seborrheic eczema as a type of eczema, considering it a modified seborrheic dermatitis, with complications in the form of seborrhea. But the histological changes in seborrheic eczema are different from the changes in seborrhea and in idiophatic eczema. The epidermal outgrowths are elongated, the expansion of the vessels of the dermis is pronounced, in which glycosaminoglycans are accumulated.
Histological examination also reveals changes that are nonspecific for other skin diseases, including weakening of respiratory enzymes of the dermis, loosening of the collagen stroma and coarsened elastic fibers. It is also possible to differentiate microbial eczema from idiophatic eczema by the presence of coccal flora and a large amount of lipids in the surface layers of the epidermis.
Occupational eczema is a long–term, sluggish chronic skin disease of an allergic nature that occurs in response to constant contact with irritating substances. The pathogenesis of occupational form is caused by constant exposure to industrial factors (dust, chemical aggression, dry or humid air, frequent microtrauma, etc.), disorders of the autonomic nervous system, permeability disorders and vascular fragility. As a result of the combination of these factors, sensitization of the body to occupational hazards develops.
Clinically, occupational eczema is similar to idiophatic eczema, but the provoking factor is constant contact with an irritant. Rashes of different sizes are localized throughout the body, but mainly in places of contact with a sensitizing substance. Clinical manifestations occur after repeated contact with allergens or on the skin with previously altered reactivity. First, edema and areas of hyperemia appear, on which small multiple vesicles form later.
When interviewing the patient, it turns out that there are harmful factors at work or at home, and the manifestations increase after direct direct contact with the stimulus and each subsequent contact increases the symptoms of eczema. During the absence of exposure to occupational hazards, for example on vacation, the skin looks clinically healthy.
After a confirmed diagnosis, it is necessary to eliminate or reduce the influence of provoking factors: neuropsychiatric overload, taking medications, contact with allergens and aggressive substances, to treat mycoses and microbial skin diseases.
Hyposensitizing drug treatment using sedatives and antihistamines is indicated for any type, plasmapheresis and other methods of extracorporeal hemocorrection also have a positive effect on the patient’s condition. Vitamin therapy, both internal and local, activates the process of cell regeneration.
If the exacerbation is acute, has a generalized character, or it is not possible to stop the relapse with conventional therapy, then the use of glucocorticosteroids inside and place in the minimum effective dose is indicated, after the condition improves, the dose of hormones is gradually reduced. But for some patients, which takes a systemic wave-like character, taking glucocorticosteroids and antihistamines is indicated daily in a maintenance dose, intramuscularly administered vitamins B and C.
Retinol ointments are used locally, applications are applied with ointments and pastes that have keratolytic properties, have a pro-itching effect and contain anti-inflammatory and antiseptic components. Local therapy of eczema with still unopened bubbles consists in applying neutral ointments, talkers and powders. The composition of the drug for local treatment is selected individually and is made according to a prescription prescribed by a doctor.
Treatment of the affected areas with water, vegetable oil and aggressive disinfectant solutions is strictly prohibited. The affected areas should be protected from frost, wind, exposure to solar radiation, if disease affects the face, then the foci are covered with an aseptic bandage.
There are numerous physiotherapeutic methods of treatin. These include: ozone therapy, magnetotherapy, laser treatment. Cryotherapy of eczema-affected skin areas is possible. After relief of the acute phase, patients are shown irradiation with therapeutic ultraviolet light, therapeutic mud and baths. Individual selection of a complex of physiotherapy procedures for patients with eczema is carried out by a physiotherapist.
People diagnosed with eczema should follow a hypoallergenic diet, give up alcohol and smoking. Great importance should be paid to personal hygiene, the use of non-aromatized soaps and water-based creams can reduce the risk of recurrence of eczema.