Eczema: Symptoms and Treatment
- Causes of eczema
- The mechanism of development of eczema
- Symptoms of Eczema
- Classification of eczema
- Diagnosis of eczema
- Treatment of eczema
- Prevention of eczema
Eczema is a multifactorial chronic cutaneous pathology that occurs with characteristic erythematous-vesicular rashes and serous inflammation of the papillary layer of the connective tissue part of the skin, itching and focal intercellular edema in the spiny layer of the dermis.
Causes of eczema
According to experts, eczema occurs in people with hereditary heredity, as well as in patients with complex functional disorders of various systems and organs of the body. However, the leading pathogenetic link at the present stage is considered to be disorders occurring in the immune system.
The main causes of eczema include various internal and external stimuli.
Exogenous (internal) factors provoking the development of the pathological process are diseases of internal organs. This pathology of the digestive tract, metabolic disorders, as well as diseases of the excretory system.
Exogenous circumstances include contacts of patients with various chemicals, paints and solvents, cement, petroleum products, cosmetic and detergents, etc. However, seasonal factors can cause the development of the disease: overheating, hypothermia and excessive insolation. An important role in the development of the pathological process is played by infectious agents (staphylococcus, streptococcus, various fungi, etc.). Also, eczema can occur due to neuropsychic stress and stress, stress and overwork. May cause skin damage (mechanical and thermal) and some medications.
With the development of the pathological process in the body, instead of immunity, sensitization develops, that is, it acquires an increased specific sensitivity to foreign agents (allergens). At first it is monovalent (to one allergen), and then, together with a change in the reactivity of the organism, becomes polyvalent (to several allergens).
The mechanism of development of eczema
Most experts are inclined to believe that changes in the reactivity of the skin, that is, increasing their sensitivity to various stimuli (a condition preceding eczema) is due not only to neurogenic, but allergic mechanisms. Most likely, in the development of true eczema, the main role is given to reflex influences emanating from internal organs, skin and central nervous system. And with the development of microbial or occupational eczema - sensitivity to pathogens that provoke the development of chronic infectious skin diseases, or to chemicals.
Symptoms of Eczema
Acute form of eczema
For the acute form of pathology, rashes of the smallest vesicles on the reddened, slightly edematous background are characteristic. In clinical practice, these rashes are called microvesicles. They resemble air bubbles that arise when water boils (in translation from Greek ekzeo means boil).
Microvesicles very quickly open, turning into point erosion. Their them, like drops of dew, are serous exudate. With the passage of time, the process gradually subsides, the bubbles become smaller, and on the affected surface there is a scaly otrubrious peeling. A part of the microvesicle dries up without opening up, leaving behind crusts.
It should be emphasized that eczema is a disease characterized by a wavy course. Therefore, microvesicles, eczematous wells (erosion with drip wetting), crusts and scales can appear simultaneously on the affected skin site. Such a condition, in clinical practice, is called evolutionary polymorphism. It is considered the most characteristic sign of eczema.
At the same time, in the case of pronounced polymorphism, one of the morphological elements can prevail over others, and therefore clinicians distinguish separate stages of the disease: wet eczema, squamous and crustal.
Chronic form of eczema
The transition of the acute form of the pathological process into a chronic one takes place gradually. It is accompanied by an increase in infiltration (anomalous percolation of substances inside the cell), densification of the affected skin area and lichenification (enhancement of the skin pattern). Also at this stage of the disease, active hyperemia becomes passive, that is, the skin covers acquire a pronounced stagnant shade. The affected area of the skin is flaky, but at the same time, microvesicles, spot erosions and crusts may appear on it in small amounts.
For the chronic form of the disease are characterized by periods of exacerbations that occur with active hyperemia, rashes and drip wetness.
Eczema is a disease that is always accompanied by itching, which is aggravated by the aggravation of the pathological process. Eczematous foci may be different in magnitude, and their contours either are sharply outlined, or have no clear boundaries.
Single lesions of the skin in eczema in clinical practice are very rare. As a rule, skin rashes, arising on one site, quickly spread to others (sometimes the entire skin is affected).
The very first rashes with eczema occur on the back of the hands and on the face. It should be emphasized that the transition from acute to chronic forms often lasts for years, and even during treatment, new eczematous foci may appear in the patient.
Classification of eczema
Idiopathic (true) eczema
This is a pathological process, which is characterized by the above described symptoms. It can be localized on any part of the skin, gradually acquiring a chronic course, and accompanied by a permanent itch.
The clinical picture of eczema with different localizations of the pathological process remains unchanged. However, as elsewhere, there are exceptions. On the palms and soles of the horny layer of the epidermis is much thicker than in other areas of the skin, and therefore in these areas, eczema manifests itself in a dyshidrotic form.
For this form of the disease is characterized by the appearance of dense bubbles, the size of a small pea, similar to the digested sago granules. Due to the thickness of the epidermal layer on the palms and on the soles, the inflammatory color of the skin is poorly expressed. Opened vesicles can turn into erosion, or dry up, forming flat yellowish crusts, which can merge into large multi-chamber formations.
In the event of further rashes, sharply defined foci of lesions develop on the skin, which have a distinctly inflammatory color. Against this background, new, smaller microvesicles, wet erosions, crusts and scales appear.
The focus of the lesion with dyshidrotic eczema is clearly separated from the healthy skin, and it is also often surrounded by the so-called "collar", which is a peeling stratum corneum. During the period of exacerbation, new, resembling sago seeds, bubbles appear outside it. The lesion focus, gradually increasing, can cover the back of the hands or feet. In such a situation, a clinical picture characteristic of eczema develops (rashes of microvesicles).
Sometimes in patients suffering from a disgidotic form of the disease, transverse furrows appear on the nails.
In patients with chronic eczema of soles and palms, hyperkeratosis (corneal eczema) develops.
Corneal (tylotic or horny) eczema
Corneal eczema, or hyperkeratosis, is a chronic form of dyshidrotic eczema, as it is limited only to the area of the palms and soles. Because of the thickened stratum corneum, the erythematous stage of the disease is not very pronounced, and instead of microvesicles, the skin becomes homozygous and hyperkeratosis.
This form of pathological process, as a rule, is localized around infected wounds, trophic ulcers, fistulas, abrasions or scratches. It is characterized by the formation of acute, large and large-scaly, sharply outlined foci having a well-formed horny layer that tears off at the edges, consisting of the remains of streptococcal blooms (small blisters with serous contents). On the surface of the eczematous foci, in addition to microvesicles and wet erosions, a massive stratification of purulent crusts is observed. The pathological process is accompanied by severe itching. As a rule, the foci of microbial eczema are located on the lower limbs.
Plaque (coin-like or nimular) eczema
Nymphular eczema is usually considered a kind of microbial eczema. In this case, the patient's body forms sharply outlined lesions, which have a rounded shape, reaching 1.5-3.0 cm in diameter and slightly elevating above the healthy skin. Their surface is cyanotic red, with abundant drip wetness. Plaque eczema is very difficult to treat and is prone to relapse.
In almost 80% of cases, this form of eczema develops in patients who have lipophilic yeast fungus Pityrosporum ovale in lesions. Also, seborrhea and associated neuroendocrine disorders can provoke the development of the disease.
Itching and inflammation with seborrheic eczema are insignificant, the boundaries of the eczematous foci are clear. Often, the pathological process extends to the scalp and is accompanied by the appearance of dandruff. Hair in patients with seborrheic eczema is oily, dull and glued.
Foci of lesions in the development of this form of pathology are localized on the lower limbs. Varicose eczema is a condition that occurs in patients with varicose symptom-complex (dermatosis, developing against the background of varicose veins of the lower limbs). In this case, the eczematous foci are localized around varicose ulcers and in areas of sclerosis of the subcutaneous veins. This condition can be caused by trauma, as well as an increased sensitivity of the patient to prescribed medications. The clinical picture of varicose eczema is very similar to microbial and near-term eczema.
This form of pathological process arises from the contact of the skin with various production stimuli. Most often it develops in people working in chemical industries, from builders, hairdressers, nurses and weavers.
In the early stages of the disease, eczematous foci occur in open areas of the body (palms, forearms, face and neck, less often - shins and feet). Their borders are quite clear, the skin on the affected areas is edematic and hyperemic, and against its background there are microvesicles and nodules with drip wetness. Patients complain of very severe itching. After a while, signs that are characteristic of idiopathic eczema develop, and the pathological process spreads to the closed skin areas. It should be noted that after the termination of contact with the allergen, occupational eczema completely passes.
This form of pathology is diagnosed in patients suffering from sycosis (chronic recurrent inflammation of the hair follicles), complicated by eczematization. With the development of sycosiform eczema, the pathological process spreads beyond the limits of the hair and is accompanied by the formation of eczematous wells, severe itching and wetting. On the affected areas, the skin thickens, and follicles continuously appear on it. Most often, the eczematous foci are located in the pubic region, under the arms, on the upper lip and on the chin.
Eczema nipples and pigment mug in women
This disease is usually considered a kind of microbial eczema. As a rule, it develops when the baby is breastfed because of an injury, and can also become a complication of scabies. The eczematous foci in this form of pathology have a crimson color, in some places they are covered with scales and layering of crusts, which constantly crack and become wet.
Children's eczema is a disease of an allergic nature, which develops most often in newborn infants with disturbed nutrition, with exudative diathesis and metabolic disorders. As a rule, this form of pathology is hereditary in nature, and it can manifest itself with varying intensity.
Often, close relatives of the child suffer from eczema, urticaria, allergic reactions to medications or food products, as well as from bronchial asthma.
Often the transition from normal to hypersensitivity to allergens occurs even in the intrauterine period, during their penetration through the placental barrier from the mother's body.
However, eczema in children can develop against a background of focal chronic infection, bronchial asthma, hay fever, gastrointestinal disorders, keratitis and conjunctivitis, as well as acute respiratory infections.
Note: when developing eczema in early childhood, this term is replaced by "exudative diathesis".
According to experts, exudative diathesis is not a disease, but only an inclination to the disease due to this or that anomaly. It can be reduced resistance to infections, increased irritability of cutaneous and mucous membranes, a predisposition to the development of a pathological process. That is why very often exudative diathesis can occur without skin lesions.
Diagnosis of eczema
The diagnosis of eczema is based on the clinical picture of the disease. Each patient with characteristic symptoms should be carefully and comprehensively examined. Particular attention is paid to the state of the nervous and endocrine system, as well as to the nature of the metabolism.
However, important in the diagnosis of eczema is the detection of allergens that provoked the development of the pathological process. Microbiological methods of investigation, which allow to identify the pathogen and determine its sensitivity to antibiotics, are prescribed to patients with suspected development of microbial eczema.
In any case, before proceeding to the treatment of eczema, it is necessary to find out the true cause of its occurrence. After a visit to a dermatologist, most likely the patient will need additional advice from an immunologist-allergist and nutritionist.
Treatment of the disease is done in a complex. It provides for the use of detoxifying and hyposensitizing drugs that reduce the sensitivity of the body to the allergen, sedatives and drugs that correct the changes on the part of the digestive tract. Also, the patient is obliged to take vitamin and immunomodulatory therapy, and if necessary, corticosteroids and antibiotics are prescribed
At the same time, the treatment of eczema uses physiotherapy techniques and means for external therapy.
All patients suffering from eczema, shown fractional food. In the diet should include products with a normal fat content and increased amounts of protein. In this situation, carbohydrates, as well as table salt, are limited to a minimum. Necessary food products are fresh vegetables and fruits, dairy products. Very useful infusion of dog rose.
In the acute period of the disease, patients are prescribed anti-inflammatory, keratolytic agents and external drugs with antipruritic effect.
Patients suffering from neurotic disorders are recommended bromine and sedatives, as well as, in small doses, tranquilizers or antipsychotics.
In mandatory order, persons suffering from acute and chronic eczema form are given enterosorbents that reduce the syndrome of endogenous intoxication, as well as hyposensitizing preparations of calcium and sodium (intravenously and intramuscularly).
Well proven in the treatment of eczema antihistamines, blocking the receptors of histamine in the body. With the development of pronounced edema, patients are assigned osmotic diuretics, and in the presence of severe inflammation - corticosteroids, short courses. In some cases, intramuscular administration of long-acting corticosteroids, in combination with calcium or potassium preparations, is recommended.
Patients with severe forms of eczema, conducted plasmapheresis and hemosorption (removal of toxic products from the blood).
When the aggravation subsides, a physiotherapy procedure (ultraphonophoresis of medications, endonasal electrophoresis, diodynamics, UHF therapy, UFOs or therapeutic muds, paraffin or ozocerite) provides a good effect. Вместе с тем пациентам с приобретенным (вторичным) иммунодефицитом, под контролем иммунограммы проводится иммуностимулирующая терапия.
При обострении дерматозов назначаются витаминные препараты, обладающие выраженной иммунотропной активностью.
В том случае, когда экзема сочетается с нарушениями в работе пищеварительного тракта ( панкреатитом или гастродуоденитом), показан прием ферментативных средств, а при дисбактериозе кишечника назначаются пробиотики (препараты, восстанавливающие кишечный биоценоз).
При нарушении периферического кровообращения (как правило, это наблюдается у пациентов, страдающих атеросклерозом, сахарным диабетом или варикозной экземой), показан прием ангиопротекторов, улучшающих микроциркуляцию крови.
При диагностике варикозной, паратравматической или микотической экземы в обязательном порядке проводится санация очагов грибковой инфекции, параллельно назначается лечение варикоза, а также, при необходимости – свищей. В том случае, когда у пациента экзематозные очаги формируются на половых органах, им показано лечение хронических патологий урогенитального тракта, глистных инвазий или колита, которые могут спровоцировать развитие дерматоза.
Микробная экзема – это заболевание, которое требует обязательного проведения антибактериальной терапии (предварительно необходимо сделать посев на микрофлору и её чувствительность к антибиотикам).
При себорейной экземе внутрь назначаются препараты серы.
В том случае, когда у пациента развивается отек, эритема, а также возникают эрозии с капельным мокнутием, требуется наружное лечение. Оно предусматривает использование различных примочек, отваров ромашки и зверобоя, анилиновых красителей и специальных аэрозолей.
В стадии ремиссии и в подостром периоде назначаются пасты и болтушки, в которые добавляются кератолитические, пластические, противозудные или антисептические препараты. Пациентам, у которых диагностируется хроническая экзема, показаны индифферентные мази, в которые могут быть добавлены вышеперечисленные средства, или наружные кортикостероидные препараты.
Пациентам, страдающим одной из форм экземы, рекомендуется ограничить водные процедуры, неукоснительно соблюдать правила личной гигиены, избегать нервно-эмоциональных перенапряжений. Вместе с тем им показана гипоаллергенная витаминизированная молочно-растительная диета, полноценный сон и адекватные физические нагрузки. В обязательном порядке в целях профилактики дальнейшего развития патологического процесса требуется полностью исключить контакт с аллергенами, нормализовать работу пищеварительной системы и проводить лечение попутной патологии.
Все пациенты, страдающие от экземы, должны находиться на диспансерном учете и периодически проходить клинико-диагностические обследования. В целях профилактики профессиональной экземы следует обеспечивать персонал средствами индивидуальной защиты кожных покровов, а также постоянно следить за санитарно-техническими и санитарно-гигиеническими условиями труда на производстве.