Under the term “eczema” usually understand allergic inflammatory skin reactions that occur in response to the action of internal and external stimuli, prone to chronic course and exacerbations, manifested by rash, hyperemia, infiltration. Exacerbations of eczema significantly worsen the patient's well-being, as they are accompanied by intense itching, weeping, peeling and extensive foci of inflamed skin. Therapy for eczema is selected individually, taking into account the symptoms of the disease.
The eczematous process develops as a result of the complex action of neuroallergic, endocrine, metabolic and exogenous factors. With a genetic predisposition in patients with eczema, suppression of immune reactivity is formed. A unified generally accepted classification of eczema does not exist today. In modern science, the greatest importance in the occurrence of eczema is assigned to neuroendocrine and immunological (in particular, a decrease in the functional activity of T-suppressors) disorders. Psychogenic factors influence the clinical course of the disease.
The course of eczema – types, phases, features
The course of the eczematous process is characterized by acute, subacute and chronic phases. There are several types of eczema.
True eczema is characterized by a chronic course and a tendency to frequent exacerbations. On the face, eczema is localized selectively. The main symptoms of the disease are hyperemia, edema, vesiculation and pronounced weeping. In the focus there are many grouped microvesicles filled with serous fluid. Microvesicles are torn, and microerosion typical for eczema is obtained – “serous wells”, secreting a dewy fluid. On the periphery of the focus of inflammation there are nodules and papules. When the process subsides, the exudate of erosion shrinks into crusts, then a small bran-like peeling appears. Eczema is characterized by true and false polymorphism of the rash. The disease is accompanied by severe itching and burning, sometimes pain.
Acute eczema is clinically characterized by polymorphism: redness, the appearance of small nodules, papules, pustules, scales, crusts, as well as more or less swelling of the skin. On swollen, reddened skin, soft small flat nodules, vesicles appear, some of which quickly turn into pustules. In addition, the clinical picture of acute eczema is characterized by white and light yellow scales, crusts, microvesiculations and weeping are obligatory. In an acute course, regional lymph nodes increase. Acute eczema proceeds with relapses, which pass through the subacute stage into a protracted chronic course; exacerbation quickly passes, and a long remission occurs. The acute phase usually lasts the first 6 weeks.
Chronic eczema is characterized by the presence of an infiltrate in the lesions, due to which the skin in the lesions is dense. On an infiltrated background, groups of small papular and vesicular rashes, peeling and bloody crusts are revealed; weeping may not be, but the itching persists. Chronic eczema is most often localized on the face, although its manifestations can occur throughout the body. Exacerbations occur frequently, both in old foci of inflammation and in new areas of the skin.
Seborrheic eczema is characterized by the occurrence of a process on the scalp and its further spread to other parts of the body. The disease occurs against the background of oily or dry seborrhea. One form of seborrheic eczema can appear on the skin of the trunk as sharply defined pinkish-yellow patches with peeling and sometimes nodular rashes. Subjective sensations are most often absent.
Treatment of eczema: features of diet and individual selection of drugs
With eczema, it is important to provide the patient with a balanced diet, the essence of which should be to limit the amount of carbohydrates, salt (up to a salt-free diet), spicy foods, smoked meats, citrus fruits, canned spices, and chocolate. A certain effect can be obtained by using the unloading expuratory method with magnesium sulphate. Prescribe drugs containing pancreatic enzymes, bile salts. In case of dysbacteriosis, patients are recommended eubiotics: lactobacilli, bactisubtil, bifikol, lineks.
In the complex therapy of eczema, sedatives are recommended to normalize the functions of the nervous system, and in case of especially pronounced itching and associated significant impairment of the neuropsychic state – prescribe small doses of tranquilizers.
Antihistamines for eczema reduce swelling, have a sedative effect. With significant edema, furosemide, hypothiazide are prescribed. Immunomodulatory drugs (T-activin, thymalin, methyluracil) have a good effect.
External therapy includes lotions, pastes, ointments, and in the acute period, topical corticosteroids are preferred.
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