Eczema – the inflammatory disease of skin having a long chronic current with frequent aggravations. It is characterized by the polymorphic rashes passing reddening stages - formations of small knots – bubbles - the becoming wet erosion – crusts – peelings. Rashes are followed by burning, a skin itch. The probability of accession of a secondary purulent infection is high. Infection at children since Kaposha's eczema with a possible lethal outcome can develop is especially dangerous. The started current can lead to neurosis: to sleeplessness, irritability, and also to resistant cosmetic defects of skin. Treatment of eczema depends on its form and a current. System application of corticosteroids, extracorporal haemo correction, local therapy and physiotherapeutic treatment are effective.
Eczema is a chronic inflammatory disease of skin of the allergic nature, an etiology and pathogenesis of a disease is up to the end not studied, but presence of eczema at close relatives, allergic diseases in the anamnesis, influence of endogenous and exogenous factors come out in the reasons of emergence of melkopuzyrkovy ekzemny rash on top. Psychovegetative, neuroendocrine and immunological violations can provoke eczema.
Manifestations by the eczema truth: True eczema has a chronic current with a frequent recurrence and is shown by symmetric sites of an inflammation on open sites of skin. At the truth to eczema the centers of an inflammation are hyperemic, edematous, it is noted moknuty surfaces. Within the center groups of small vesicles with serous contents are found. After vesicles are opened, they leave microerosion, typical for eczema. For the truth of eczema the syndrome of "serous wells" when on an erozirovanny surface of a droplet of exudate opalestsirut is characteristic, reminding dew.
On the periphery of the center of eczema single larger rashes and bubbles are observed. Over time the quantity of again arising bubbles decreases and microerosion shrink in crusts after which healing the shelled otrubevidny surface remains.
At eczema polymorphism of all elements is pronounced, on the affected skin it is possible to find also the inflamed sites of different stages of permission. Most of patients with eczema show complaints to a skin itch. Except the main centers of defeat there can be disseminated rashes on various sites of skin, but without moknutiya. Patients with long ago the diagnosed eczema note at themselves stagnant hyperaemia of skin, infiltration and a hyperpegmentation after knocking over of aggravations, over time the skin drawing becomes pronounced.
Diagnostics by the eczema truth: Diagnose true eczema on the sharp beginning and on clinical manifestations, symmetry of the centers and the melkopappulezny nature of defeat, in combination with the expressed polymorphism of elements, and also existence in the anamnesis of allergic diseases and perhaps recently postponed stress allow to make the diagnosis "True eczema".
Displays of microbic eczema: In pathogenesis of microbic eczema various varicose simptomokompleks, the repeating injuries of skin and a fungal infection come out on top. The defeat centers at microbic eczema are asymmetric and settle down generally on the lower extremities, favourite localization – a projection of the skin affected with varicosity. Emergence of the centers of microbic eczema pleated skin is connected with perspiration and violation of personal hygiene. Borders of ekzematozny spots uneven, adjacent skin of an infiltrirovan, has a cyanotic-red shade. Moknuty and purulent crusts are present at all affected areas, on the periphery single papules and papulovezikula meet. Microbic eczema is complicated by ostiofollikulita and impetiginous crusts. Microbic eczema is divided on mikotichesky, varicose and paratraumatic.
Diagnosis of microbic eczema: The diagnosis is made on the basis of clinical displays, existence in the anamnesis of the patient of mycoses, varicose changes of veins of the lower extremities and frequent injuries. At microscopy it is possible to find mikotichesky cages, the bacteriological research is applied to identification of an exact type of mycosis and to definition of sensitivity to medicines.
At histologic inspection hypostasis terms with epidermalny localization of bubbles, massive lymphoid infiltration with prevalence of plazmotsitarny elements is characteristic if microbic eczema has long character, then sclerous changes terms are noted.
Displays of seboreyny eczema: Feature of seboreyny eczema is emergence of the centers of defeat on a hairy part of the head, besides the centers settle down in natural folds of skin, on a face, around a navel, behind auricles and on sgibatelny surfaces. On a hairy part of the head on the inflamed sites hyperaemia, dryness of skin and an itch is noted, when combing gray otrubevidny scales separate. Borders of defeats have accurate outlines. In certain cases seboreyny eczema is followed by an ekssudation, then there are serous and serous and purulent crusts which after removal bare the erozirovanny becoming wet surface. If the centers arise in places of natural folds, then at their bottom it is possible to notice deep painful cracks, pronounced hypostasis and infiltration, and on the periphery of the centers small grayish-yellow scales and scaly crusts. The centers of seboreyny eczema on the lower extremities and a trunk have equal and edges are accurate and externally look as the yellow-pink shelled spots in which center there is rash of melkouzelkovy character.
Diagnosis of seboreyny eczema: There is no exact classification of eczemas, and therefore a part of experts do not recognize seboreyny eczema as eczema type, including it modified seboreyny dermatitis or true eczema, with complications in the form of seborrhea.
But histologic changes at seboreyny eczema are other than changes at seborrhea and at true eczema. Epidermalny outgrowths are extended, expansion of vessels terms in which glikozaminoglikana kumulirutsya is expressed. At a histologic research change skin, also not specific to other diseases, among them weakening of respiratory enzymes terms, a loosening of a collagenic stroma and the coarsened elastichesky fibers come to light. It is possible to differentiate microbic eczema from true also to existence of kokkovy flora and a large number of lipids in epidermis blankets.
Displays of professional eczema: Professional eczema is a long, slow chronic disease of skin of the allergic nature which arises in response to continuous contact with the irritating substances. In pathogenesis of professional eczema lie continuous influence of production factors (dust, chemical aggression, dry or damp air, frequent microinjuries, etc.), violations of the autonomic nervous system, violation of permeability and fragility of vessels. As a result of a combination of these factors the organism sensitization to professional vrednost develops.
Clinically professional eczema is similar with true, but a provocative factor is the continuous contact with an irritant. Rashes of the different size are localized on all body, but mainly in places of contact with the sensibilizing substance. Clinical manifestations occur after repeated contact with allergens or on skin with the reactivity which is already changed earlier. At first there is hypostasis and sites of hyperaemia on which small multiple vesicles are formed further.
Diagnosis of professional eczema: At poll of the patient it becomes clear that there are harmful factors at work, or houses, and manifestations amplify after direct direct contact with an irritant and each subsequent contact strengthens eczema symptomatology. During lack of influence of professional vrednost, for example on a holiday, skin looks clinically healthy.
Principles of treatment of eczemas
After the confirmed diagnosis of eczema, it is necessary to eliminate or reduce influence of provocative factors: psychological overloads, administration of drugs, contact with allergens and aggressive substances to carry out treatment of mycoses and microbic diseases of skin.
Performing the hyposensibilizing drug treatment with use of sedative and antihistaminic medicines is shown at any kind of eczemas, the plasma exchange and other methods of extracorporal haemo correction also positively influence a condition of the patient. Vitamin therapy both internal, and local intensifies process of cell regeneration.
If the exacerbation of eczema proceeds sharply, has generalized character or it is not possible to stop a recurrence by means of usual therapy, then application of glucocorticosteroids inside and the place in the minimum effective dose is shown, after improvement of a state the dose of hormones is gradually reduced. But reception of glucocorticosteroids and antihistaminic medicines is shown to some patients with eczema which accepts system wavy character daily in the supporting dose, intramuscularly enter vitamins of group B and C.
Locally use retinolovy ointments, apply applications with ointments and pastes which have keratolitichesky property, render proivozudny effect and contain anti-inflammatory and antiseptic components. Local therapy of eczema at yet not opened bubbles consists in putting neutral ointments, talkers and powders. The composition of medicine for local treatment is selected individually and is made according to the recipe which is written out by the doctor. Processing of affected areas water, vegetable oil and aggressive disinfecting solutions is strictly forbidden. Affected areas should be preserved against a frost, wind, impact of sunlight if eczema the person is surprised, then the centers are covered with an aseptic bandage.
Physiotherapeutic methods of treatment of eczema are numerous. Treat them: ozonoterapiya, magnetotherapy, laser treatment. Performing cryotherapy of the sites of skin affected with eczema is possible. After knocking over of a sharp phase, radiation by medical ultraviolet, therapeutic muds and bathtubs is shown to patients with eczema. Individual selection of a complex of physiotherapeutic procedures for patients with eczema is carried out by the physiotherapist. Persons for whom eczema is diagnosed need to keep to a hypoallergenic diet, to refuse alcohol and smoking. The great value needs to be given to personal hygiene, use of not flavored soap and creams on a water basis allow to reduce risk of a recurrence of eczema.