Idiopathic eczema is a chronic itchy dermatosis, manifested by the appearance of small vesicles (vesicles) and serous papules on the reddened and edematous area of the skin, which quickly open up, turning into point erosions. Serous discharge of the latter causes the characteristic eczema wetness of the affected area of the skin. In most cases, the clinical picture of the disease is so specific that it allows you to diagnose eczema. In complex diagnostic cases, a biopsy is required. Treatment in the acute period of eczema is carried out with antihistamines, glucocorticosteroids and astringents. After the acute process subsides, physiotherapeutic methods of treatment are used.
L30.8 Other refined dermatitis
Idiopathic eczema got its name due to its characteristic rapid opening of the bubbles. The word “eczema” comes from the Greek “eczeo” – “boil”. A person of any age can get sick with idiopathic eczema, but the peak incidence occurs at the age of 40. With the manifestation of the disease in childhood, subsequent spontaneous recovery is possible, in adult patients eczema takes a chronic course. Idiopathic eczema is often accompanied by other allergoses: pollinosis, asthma, urticaria.
Idiopathic eczema is considered a multi-cause disease. Infectious-allergic, endocrine-metabolic, neurogenic and hereditary factors play a role in its occurrence. In patients with idiopathic eczema, a violation in the ratio of immunoglobulins, a decrease in T-lymphocytes and an increase in B-lymphocytes are detected, circulating immune complexes and autoantibodies are determined. At the same time, there is a neurogenic theory of the occurrence of eczema, based on clinical cases of the appearance of this disease on skin areas with impaired innervation due to nerve damage.
The factors contributing to the occurrence of idiopathic eczema include: nervous overstrain, psychologically traumatic situations, vegetative-vascular dystonia, hyperthyroidism, diabetes mellitus, diseases of the gastrointestinal tract, chronic infections, predisposition at the gene level.
Idiopathic eczema begins with the appearance of several edematous and reddened areas on the skin, on which rashes then appear: very small papules or vesicles. After a quick opening of the rash elements, microerosions are formed, from the depths of which abundant serous exudate is separated. Due to this, eczematous erosions are also called “serous wells”. Exudate is the cause of constant wetting of the surface of the affected areas of the skin. The development of rash elements ends with the formation of crusts. Rashes with idiopathic eczema are located in foci with uneven contours and can be localized throughout the skin. Most often, the disease begins with a lesion of the skin of the face and hands. The foci have a symmetrical character. Only in rare cases, a single lesion site is observed.
For eczema eczema, a characteristic feature is an evolutionary polymorphism due to the simultaneous presence of rash elements in various stages of development on the affected area of the skin: redness, vesicles, erosion and crusts. Skin changes are accompanied by constant itching. It can be expressed to varying degrees, but quite often the itching is so strong that it leads to sleep disorders and neurotic disorders.
Gradually, the acute development of idiopathic eczema is replaced by its chronic course. At the same time, there is an increasing compaction of the affected areas of the skin, a change in their color towards a stagnant reddish-bluish color, the skin pattern becomes more pronounced, peeling appears. Against the background of these changes, new papules and vesicles may appear with the formation of a wet surface. Such alternation of an acute inflammatory process with chronic manifestations refers to the characteristic signs of idiopathic eczema.
Having taken a chronic course, idiopathic eczema can last for years. Depigmented or pigmented spots are formed in the area of resolved foci, which gradually disappear. There are areas of flaky and dry skin on which cracks form, and calloused areas of hyperkeratosis with cracks may form on the soles and palms. Idiopathic eczema can be complicated by the addition of infection with the development of pyoderma and the formation of purulent pustules.
The diagnosis of idiopathic eczema allows you to put a characteristic clinical picture for it. When interviewing a patient, much attention is paid to identifying the factors that triggered the onset of the disease. General clinical studies are carried out: blood and urine analysis, determination of Ig E. If there is an indication, an immunological and allergological examination of the patient is carried out. When a secondary infection is attached, the seeding is carried out with the determination of sensitivity to antibiotics. Cases of idiopathic eczema that are difficult in diagnostic terms require a biopsy of the affected area of the skin.
Drug therapy in the acute stage of idiopathic eczema begins with antihistamines of the first generation: promethazine, acrivastine, chloropyramine, mebhydroline. Subsequently, drugs of the II and III generation are used: cetirizine, loratadine, ebastine, terfenadine, etc. In the case of a pronounced inflammatory process, corticosteroids inside are indicated: prednisolone, betamethasone. With severe exudation, dermatologists additionally prescribe intramuscular injections of calcium gluconate solution.
In the local treatment of idiopathic eczema, astringents are used in the form of lotions (a solution of tannin, resorcinol). They reduce exudation and form a protective film on the surface of the affected area of the skin, protecting it from external stimuli. During acute inflammation, so-called “strong” glucocorticosteroids are used locally. In the process of inflammation subsiding, they switch to “medium” and “weak” glucocorticosteroids: 0.025% betamethasone dipropionate, 0.1% hydrocortisone, 0.05% dexamethasone, 0.1% triamcinolone, etc.
The addition of a secondary infection makes it necessary to prescribe antibiotics and the use of ointments containing corticosteroids and antibiotics. Physiotherapeutic treatment is applied after the inflammatory phenomena subside. With idiopathic eczema, PUVA therapy, laser phototherapy, laser therapy, cryotherapy, ozone therapy and magnetotherapy are effective.
For successful treatment and prevention of exacerbation, the patient should follow a diet, adhere to the correct work and rest regime, exclude provoking factors, and carry out skin care coordinated with the doctor. In the presence of foci of chronic infection, their rehabilitation is necessary. It is recommended that a dispensary follow-up by a district dermatologist to control the course of dermatosis and prevent exacerbations.