Weeping eczema is an acute form of eczema that occurs with a pronounced exudative component. It is manifested by swelling, hyperemia of the skin, the formation of multiple vesicular rashes and erosions, merging into foci of wetness. To diagnose dermatosis, a comprehensive laboratory examination, histological examination of biopsies of the affected skin areas, consultations of related specialists are carried out. To relieve the acute form of weeping eczema, local use of astringent drugs, systemic treatment with antihistamines, hyposensitizing, anti-inflammatory drugs is indicated.
L20-30 Dermatitis and eczema
Eczema is the most common skin disease, accounting for 25-40% of all skin pathologies. The term “weeping eczema” is not used in official classifications, because it reflects one of the stages of an inflammatory skin reaction that occurs during the acute stage of various clinical forms of the pathological process. Treatment of dermatosis is a difficult task due to the chronic course, frequent relapses, complex etiopathogenesis, so the disease does not lose its relevance in practical dermatology.
Specific etiological factors of weeping have not yet been established. According to the modern generally accepted concept, weeping eczema is a multifactorial skin lesion that occurs with impaired functions of the epidermis. It develops with a combination of endogenous and exogenous provoking factors, the main of which are the following:
- Genetic predisposition. If the pathology is diagnosed in one of the parents, the risk of getting sick is 40%, if both parents have the disease, it increases to 50-60%. Burdened heredity is manifested by certain HLA genes that control the immune response.
- Exogenous factors. The disease is provoked by the negative effects of chemicals (household chemicals, occupational hazards), physical factors (increased insolation, temperature changes), allergization when using certain foods, medicines.
- Infectious and allergic factors. Dermatosis can occur when bacterial or fungal agents enter the body from the outside. It often begins against the background of chronic foci of infection, especially in the absence of adequate treatment. In the second case, the appearance of eczematous symptoms is caused by chronic sensitization of the body to the antigenic determinants of microbes.
- Neurological disorders. Functional nervous disorders with a predominance of parasympathetic influences increase the likelihood of wet rashes. Pathology of peripheral nerves, accompanied by deterioration of microcirculation, provokes the occurrence of clinical symptoms in the affected area.
- Somatic diseases. Stimulate the development of skin lesions and aggravate its course if the treatment regimen is not followed, many pathologies of internal organs: gastrointestinal tract, pancreatobiliary system, urinary system. An important role is assigned to neuroendocrine disorders, metabolic disorders resulting from damage to the endocrine glands.
The main pathogenetic component of weeping eczema is immune inflammation in the skin, proceeding according to the type of delayed reaction. In its formation, 4 predisposing factors are distinguished: violations of cellular and humoral immunity, sensitization to endo- or exoantigens, changes in the function of the central nervous system, genetically determined features of the immune response.
The formation of typical weeping lesions of the skin is associated with dysfunction of T-lymphocytes, which secrete proinflammatory substances into the tissue: interleukins, interferon, tumor necrosis factor. At the same time, the release of leukotrienes, prostaglandins, histamine increases, which ends with an acute inflammatory reaction with a predominance of the exudative component.
Immunological disorders associated with specific antigens of the main histocompatibility complex play an important role in the pathogenesis of dermatosis. In patients, the activity of helper T-lymphocytes and suppressors decreases, which is manifested by inhibition of immunological reactivity. As a result, the activation of chronic infection occurs, the removal of antigens from the body slows down.
Also, in the mechanism of development of weeping eczema, a decrease in the activity of nonspecific protective factors — complement, lysozyme, phagocytes is isolated. At the same time, the risk of secondary infection and complicated course of the disease increases. The situation is aggravated by an allergic restructuring of the body, due to which the skin acquires increased polyvalent sensitivity to antigens.
Today there is no generally accepted systematization, which is due to the variety of clinical variants of pathology, different points of view of experts on the causes and mechanisms of dermatosis formation, the selection of treatment regimens. Practicing dermatologists use several classification options, which take into account the following signs:
- Downstream, the process can be acute, subacute, chronic.
- According to clinical manifestations, the disease is divided into idiopathic, microbial, children’s, professional, varicose forms.
- According to Hornstein’s classification, there is exogenous, endogenous, dysregulatory eczema.
- According to the classification of the American Academy of Dermatovenerology, specific nosological units of dermatosis are distinguished (asteatotic eczema, numular dermatitis, white pityriasis, etc.).
Weeping eczema manifests itself by redness and swelling of the skin, followed by the appearance of rashes in the form of small bubbles. Under mechanical action or spontaneously, the vesicles burst, exposing erosions with intense wetness. A characteristic symptom of the acute form of dermatosis are “serous wells” — erosions, from the depths of which a transparent or slightly yellowish liquid is released.
Gradually, the wet surfaces dry out with the formation of thin crusts. At the same time, papules may appear on the affected areas — small pink nodules, pustules with sterile contents. The presence of various morphological elements on the skin is called a true polymorphism of the rash, this sign is considered typical of true (idiopathic) eczema, it does not occur in other forms of dermatosis.
From subjective sensations without treatment, a strong itching of the skin comes out in the first place, as a result of which patients comb the skin to the blood, aggravating the course of the process. Often, as a result of intense itching, performance disorders occur, irritability, sleep becomes intermittent and does not relieve fatigue. Extensive wet erosions are accompanied by soreness, which increases when the affected skin comes into contact with clothing.
In the clinical picture of wet dermatosis, there are features associated with a specific form. True eczema is characterized by a symmetrical arrangement of elements with their localization on the skin of the trunk, upper and lower extremities. For microbial lesions, asymmetric foci of wet rashes on the lower extremities are typical. In children’s form, foci of wetness have a shiny, hyperemic surface.
During the wet period, the affected skin presents an open wound surface, which becomes a good entrance gate for pathogenic microorganisms. Therefore, the most common complication in the acute period without treatment is the attachment of a secondary bacterial infection, most often caused by staphylococci or streptococci. In severe cases, phlegmon, regional lymphadenitis occurs.
In patients with a long history of pathology, wet elements and combs lead to thickening of the skin, increased skin pattern, hyperpigmentation, increased dryness. Such dermatological changes bring discomfort, because the skin loses elasticity, a significant cosmetic defect is formed, which is especially worrying for women.
The anamnesis data and skin manifestations of dermatosis give the dermatologist valuable information for diagnosis and treatment selection. The presence of multiple erosions, serous discharge, grayish crusts is a confirmation of the weeping stage of eczema. In doubtful cases, as well as to identify possible root causes of the disease are shown:
- Histological analysis. At the wet stage, spongiosis, small vesicles, intracellular edema of the epidermis are detected in skin biopsies. In the structure of the dermis, there is lymphoid-cellular infiltration around the vessels, expansion of the surface network of capillaries.
- Blood tests. To confirm the infectious and allergic etiology, the level of immunoglobulin E is measured, an allergological study is performed to detect antibodies to specific antigens. To assess the general state of health, a clinical, biochemical blood test is prescribed.
- Microbiological studies. In case of suspicion of microbial eczema, complication of the process by secondary infection, back-seeding of the separated skin elements is necessary. According to its results, the exact type of pathogenic pathogen, sensitivity to antibacterial drugs are determined, and a suitable remedy is selected for treatment.
- Consultations of specialists. If, during the initial diagnosis, a person has signs of damage to internal organs that could potentially become a provoking factor of wet dermatosis, further examination and treatment is carried out with the participation of specialized doctors. Most often, the help of a gastroenterologist, a neuropsychiatrist, an endocrinologist is required.
Weeping eczema treatment
The therapy of weeping eczema is selected individually, taking into account the suspected causes of the disease, the severity of clinical manifestations, the presence of concomitant pathologies or complications in the patient. To reduce the sensitization of the body, patients are recommended to follow a hypoallergenic diet, from which fatty varieties of fish and meat, oysters and other seafood, coffee and cocoa products, citrus fruits, tomatoes, legumes are excluded.
If the exacerbation of the disease is associated with the influence of exogenous factors, their elimination is a prerequisite for the success of treatment. Given the specific situation, patients may need to change their place of work, eliminate household allergens, and move to more suitable climatic conditions. Complex treatment of weeping allergodermatosis requires the use of a number of drugs:
- Antihistamines. To eliminate itching in the acute phase, histamine blockers of the first generation are used, and after the symptoms are relieved, it is possible to continue treatment with second and third generation medications.
- Desensitizing drugs. Solutions of calcium, sodium thiosulfate are used. Treatment reduces vascular permeability, has an anti-inflammatory effect, normalizes metabolic reactions in the dermis.
- Stabilizers of cell membranes. To enhance the effectiveness of antihistamines, treatment with mast cell membrane stabilizers is indicated. Some authors recommend the use of polyunsaturated omen-3 fatty acids to normalize the structure of cell membranes.
- Glucocorticosteroids. With generalized forms of weeping eczema, no effect from other treatment options, hormones are used in the pulse therapy mode or long-term administration.
- Immunocorrecting agents. Rational immunocorrection is prescribed to alleviate the condition with a continuously recurrent form of weeping eczema. Treatment includes thymus preparations, leukopoiesis stimulants.
- Antibiotics. Treatment with antibacterial agents is required for the microbial form of dermatosis and the proven infectious-allergic nature of the disease.
Since various somatic disorders play a role in the pathogenesis of weeping eczema, treatment includes correction of these pathologies. To normalize the digestive tract, it is advisable to use enzyme replacement therapy, probiotics and synbiotics, vitamin and mineral complexes. To balance the state of the central nervous system, light sedatives are included in the treatment regimen, tranquilizers and antidepressants are prescribed for individual indications.
In the wet phase, lotions with astringent preparations are used, which reduce exudation, contribute to a faster appearance of crusts and regression of the disease. In the acute stage, daily procedures lasting 1-1.5 hours are prescribed, which involve a constant change of dressings as they dry out. Then proceed to the application of ointments with topical corticosteroids, antiseptics, calcineurin inhibitors.
Of the physiotherapeutic methods of treatment, selective ultraviolet therapy shows the greatest effectiveness, during which irradiation is carried out with light of a narrow range (311 nm). Low-intensity laser irradiation of the red or infrared spectrum, electropuncture of biologically active points, local hyperthermia are also performed. At the stage of remission, ozone therapy, balneotherapy, peloidotherapy gives a good effect.
Prognosis and prevention
Proper treatment of wet acute eczema makes it possible to quickly stop skin symptoms and improve the condition of patients as a whole, therefore the prognosis is favorable. After 5-6 days of intensive therapy, the severity of itching decreases, the volume of skin lesions decreases, and recovery in uncomplicated cases occurs after 3-4 weeks. A less optimistic prognosis for the development of eczema in patients with immunosuppression, chronic pathologies.
Prevention of the disease involves the observance of personal hygiene, the exclusion of typical food, household and professional allergens. In some cases, a dairy-vegetable diet helps patients with eczema. Mandatory preventive measures are the treatment of concomitant disorders and proper skin care of the body: the use of emollient creams, soft cleansing products, avoiding massage with a dry brush and other aggressive influences.