Eczema Disease

Chronic inflammatory disease of the superficial layers of the skin neuro-allergic nature, characterized by a polymorphous rash, a tendency to soak and persistent currents.The etiology and pathogenesis. E. When disturbed reactivity, observed in patients with severe skin reaction to the usual effects do not cause others no change. At the heart of eczematous process is the increased sensitivity (sensitization) of the skin to various exogenous and endogenous stimuli. Pathogenesis of E. is very similar to the pathogenesis of atopic dermatitis, which often precedes E. In contrast to the sensitization of atopic dermatitis at the main forms of E. is polyvalent. Allergic theory is confirmed by E. allergy and immunological studies (presence of sensitization to different allergens, changes in functional activity of immune cells, increase the blood levels of circulating immune complexes and some immunoglobulins). Professional development is due to sensitization to E. allergen production, microbial - to piokokkam. In the most common species, E. true - play the main role, apparently, autoimmune disorders (autosensibilization processes, autoallergii). Of great importance in the development of eczematous process have neurogenic factors (trauma, nervous stress, vegetative-vascular dystonia), endocrinopathy (diabetes, hyperthyroidism), as well as diseases such as gastritis, colitis, holetsistopankreatit. Often plays a decisive role of genetic predisposition to eczema reactions. Permanent risk factors for E. exogenous stimuli, particularly the chemical nature.The clinical picture. For E. characterized by an abundance of clinical forms and variants. In most cases the eczematous process proceeds in sequential stages. Thus, the initial (erythematous) stage is characterized by E. poured with no clear boundaries, itching redness of skin. In the second (papular) stage on a background of erythema observed swollen nodules or small lesion transformed into edematous plaques. With the continuing increase in swelling nodules are transformed into small bubbles, which is typical for the next - Vesicular stage of E. Under pressure from accumulating in the skin inflammatory exudate bubbles burst in their place there are small (point) of erosion, of which constantly follows serous fluid ("serous wells "). This condition is most typically E. and is the pinnacle of eczematous process, it is called weeping stage (formerly known as eczema - "weeping zoster"). From this stage is also connected the origin of the term "eczema" (analogous to boiling a liquid formed when the bursting bubbles). Shrivel on the surface of serous exudate forms a focal stratification crusts, which is typical for krustoznoy (korochkovoy) stage E. After the defection of crusts on the background of congestive erythema in a long time maintained a moderate flaking in small whitish flakes (squamous stage), then the skin takes a normal form. The described cycle of eczematous process lasts from several days to several months. For E. characterized polymorphism vysypnyh elements, ie simultaneously in the lesion focus represented different stages of the process. The stage is determined by the number of elements vysypnyh a certain type.In the old primary lesion prior to 2 months. E. is acute, for it typically soak condition (Fig. 1). In the case of prolonged duration (from 2 to 6 months.), When the swelling and less pronounced Moisture, talk about basic forms of subacute E. E. biased toward long-term persistent recurrent course in the form of successive periods of relapse and remitting process, which is characterized by chronic, E. In all forms of E. there is itching.The main clinical forms of E. is a true professional, microbial and seborrheic.True eczema (Fig. 2) occurs most frequently. It is characterized by persistent undulating course, a succession of eczematous process, uncertainty about the etiological factors, polyvalent sensitization, polymorphism vysypnyh elements, the symmetry of their arrangement, the localization of lesions anywhere on the body (mostly on the back of the hands, feet) and the prevalence of lesions, resistance to therapy, tendency to frequent recurrence. Often there a genetic predisposition,For the true E., which is localized in the skin of palms and soles, which differs considerable thickness of the epidermis, usually characterized by small inflammatory foci color, large and dense to the touch the bubbles, sometimes merging into a multi-chambered bladders - disgidroticheskaya E. (Fig. 3).Professional (contact) eczema is different monovalent sensitization and easily identifiable etiological factor. There is only exacerbated and exposed the production of allergen that caused it. Usually limited, localized to areas of the body that are available for contact with a professional allergen (eg, hands, forearms, face, neck). E. Professional differs favorable course, and quickly regresses not recur after removal of contact with the allergen caused the cross. Diagnosis is confirmed by skin test with allergen production. Aggravation of the true E. influenced by occupational exposures do not give grounds to consider it an occupational disease, because it may develop from exposure to many other factors, and often for no apparent reason.Microbial eczema is usually due to skin sensitization pyococcus flora. It is characterized by asymmetric localization during acute, confinement to homes pyoderma, fistulas and ulcers, and copious purulent pustulizatsiya crust, often rounded shape and sharp edges of the lesions (Fig. 4).Seborrheic dermatitis is observed on the background of seborrhea, the process begins with the scalp (Fig. 5a), then goes to the person's back (Fig. 5b), the chest area. For this form of E. characterized by the absence of express soak, fuzzy borders homes, layering fat scales, constant itching of the skin. Seborrheic dermatitis may be complicated by pyoderma in the form of folliculitis, boils, impetigo. This is facilitated by numerous scratches during paroxysmal severe itching.Diagnosis is established on the basis of characteristic clinical picture. With the localization of E. on the palms and soles differential diagnosis with Rubromikozom, athlete's foot (Athlete's foot), investigating the scales from the lesions on pathogenic fungi. The diagnosis of occupational E. is dominated by an allergic skin tests.Treatment in most cases is a difficult problem, because each patient has its own set of etiologic and pathogenetic factors, no correction can not reasonably count on a full therapeutic effect. Treatment of generalized and weeping lesions advisable to carry out a dermatological clinic. It depends on the clinical form and stage of disease. In all cases, especially in the stages of vesiculation and soak, strict adherence to medical treatment, providing maximum obereganie skin from external irritants and may not wash (if necessary, the skin is cleaned with a cotton swab dipped in vegetable oil), laundry, cleaning with detergents and the use of synthetic underwear and woolen fabrics. To prevent complications of pustular should briefly cut your nails and lubricate okolonogtevogo fold aqueous brilliant green. We recommend frequent change of underwear and bed linen, periodic kvartsevanie premises. As the process of remitting mode softens, but the patient always should avoid rough washing the skin, allowed to warm bath (the first time without soap), the skin is dried with blotting motion, a towel should be soft. Even after a cure is not recommended to use cold-hardening or a cold shower followed by rubbing a rough towel.Must strictly observe the hypoallergenic diet during the period of active clinical manifestations, and within six months after the treatment. Prohibited sharp, smoked and salted products, alcoholic beverages, canned foods, citrus fruits, honey, coffee, chocolate, spices, aromatic herbs, limit sweets. Useful fasting days and short-term fasting.We recommend correction of comorbidities, especially those that cause particularly acute and persistent over E. given patient. With professional eczema after appropriate expert advice should be new jobs patient.General treatment in the acute stage of E. provides for the appointment of antihistamines, sedatives (valerian extract, bromides, etc.), antiholinergetikov (eg Bellataminal), tranquilizers, calcium supplements, ascorbic acid, with strong swelling - diuretics (furosemide or gipotiazid morning veroshpiron 3-4 times a day). With generalized lesions, persistent throughout, along with the above means the absence of contraindications prescribed glucocorticoids in moderate doses, followed by their gradual withdrawal after reaching the full therapeutic effect. In chronic E. helpful to repeat courses of acupuncture.Local treatment depends on the stage eczematous process. Under cold soak apply lotions of binders and disinfecting solutions (2% boric acid solution, furatsilin 1:5000, 1:2000 ethacridine lactate, liquid Boorowa - 1 teaspoon per cup of water, 0.25% silver nitrate solution, chilled chamomile extracts , succession, Sage). Lotions for use layers of cheesecloth (at least 16) or cloth (not less than 8), changing as warming up (usually within minutes). Lotions may be replaced by wet-drying bandage, which change as drying. Skin lesions around cuticles soak zinc paste. After the cessation of foci soak 1-2 times a day smeared paste (2% boron-naphthalane, 2% dermatolo-ihtiolovaya, 2% boron-tar, etc.) and cover a light gauze bandage. After the disappearance of swelling and redness of the active use of ointment with a reducing means in increasing concentrations (2-5% dermatolovaya, 2-10 °, Naftalan, 2-5% of Tar). In severe infiltration into the lesions under occlusive ointment applied bandages (use compress paper or plastic wrap). Treatment ointment is useful to complement the warm or hot baths with the addition of a succession of extracts and chamomile. At any stage of the eczematous process can be used corticosteroid sprays (polkortolon, oksikort) or ointment (prednizolonovaya, deperzolon, flutsinar, ftorokort, Lorinden C, etc.).Feature of the microbial treatment of eczema is the use of local disinfectants, and, if necessary, and antibiotics by mouth (preferably erythromycin). When seborrheic dermatitis are used in addition vitamins A, E, B6, F; in medicines for external use include sulfur preparations (ointment sulfodekort). Beyond the period of exacerbation rendered spa and mud baths at resorts (Pyatigorsk, Matsesta, Kemer, naphthalene, Saki and others).Prognosis in most cases is good.Prevention. Primary prevention is the selection of professional persons with a family history of eczematous reactions (contra operation in chemical plants, factories and laboratories). Secondary prevention involves the appropriate placement of patients and their medical check-up by a dermatologist.Baby eczema is seen in children are usually in the background of the manifestations of exudative diathesis. For its development are important genetic predisposition to allergic reactions, chronic foci of infection (eg tonsillitis), disorders of the gastrointestinal tract, liver dysfunction, pancreatic cancer. Affected children, E., identified a number of allergic reactions to food (honey, oranges, tangerines, strawberries, sweets).The disease usually develops in the first year of life (often with the transfer of the child to breastfeed). Affected skin of the face, scalp, buttocks and extensor surface of the lower leg, dorsum of the hands, forearms. Against the background of erythema appears abundant papular vesicular rash-, and after opening the vesicles are still many weeping mikroerozy. Last subsequently covered by crusts, scales (Fig. 6). In the clinical picture of the child can distinguish E. same shape as that of E. adults (Fig. 7), but at the same sick child often signs of various forms of eczema.Children may be complicated by secondary E. pyococcus (impetiginoznaya E.) or viral (herpes simplex E.) infection. When impetigo-noznoy E. lesions appear to conflicts - such as flat pustules with purulent blisters content shrivel in the peels. In herpetic lesions in E. against the fever blisters appear grouped with the attack in the central part, in their place are produced areas of necrosis, leaving small scars (as with chickenpox). The process is accompanied by fever (up to 39 °), changes in the blood (leukocytosis, increased ESR). In severe cases (especially in younger children), the process may be complicated by meningitis, and sepsis.When treating children, E. attaches great importance to food correction (limited carbohydrate and fat load, the exclusion of extractive dishes, including meat broths, spicy pickled, as well as citrus fruits, mushrooms). It is recommended milk-vegetable diet. Inside nominated antihistamines, sedatives, vitamins (especially A, C, B2, B6, B5), calcium supplements, enzymes, normalizing the activities of the digestive system, externally - lotion with infusions of tea, chamomile, succession, softening creams, Naftalan, tar paste ASD (III group) and others Corticosteroid creams are recommended for acutely occurring processes in breeding with a nourishing cream, baby cream, etc. (from 1:10 to 1:2, depending on the child's age). Broad-spectrum antibiotics and antiviral drugs used in children and complications of secondary infection. In exacerbations of E. should refrain from vaccination.