Eczema is an inflammation of the surface layers of the skin of a neuro-allergic nature that occurs in response to exposure to external or internal stimuli, characterized by rash polymorphism, itching and a long relapsing course.

Currently, up to 40 percent of all skin diseases are due to eczema, and an increasing number of people suffer from this disease. For example, 30 years ago this number was 2-3 times less. Among babies, the disease accounts for 15% (every 15th child has eczema), among adults this value is less – 1-3% (1-3 people suffer from eczema in every 100 adults). Rarely, eczema begins in adulthood.

Eczema is a serious disease and if the correct treatment is not started at the first signs of the disease, the disease can become chronic and last a lifetime.

There are the following main forms of eczema: true, microbial, seborrheic, professional, children’s, atopic.

Types of eczema

True eczema traditionally begins acutely at any age, proceeds jerkily with frequent relapses and, as a rule, passes into the chronic stage with periodic exacerbations. In the acute stage, the process is characterized by the rash of microvesicles (as a result of spongiosis), located on an edematous erythematous background. The vesicles quickly break open, exposing small punctate erosions (eczematous wells) separating serous exudate (weeping) – weeping acute eczema.

As the inflammatory phenomena subside, the number of vesicles decreases, the erosions dry up, and pityriasis peeling and small crusts from dried vesicles are found on the plane of the foci. The transition of the process to the chronic stage occurs gradually, accompanied by the appearance of congestive erythema, scales and cracks. The foci of true erythema are variable in size, indistinct contours and scattered like islands of an archipelago, alternating with areas of healthy skin. The process is traditionally symmetrical and is localized mainly on the back of the hands, forearms, feet, in babies – on the face, buttocks, limbs, chest. Relieves itching. The process can capture other areas of the skin.

A variant of true eczema isdyshidrotic eczema , localized on the palms, soles and lateral surfaces of the fingers and characterized by the appearance of many small bubbles with a dense cover 1–3 mm in diameter, resembling boiled sago grains. Erythema in the lesions due to the large thickness of the stratum corneum in these areas is weakly expressed. Foci of dyshidrotic eczema in a developed form are clearly limited and are not often surrounded by a rim of an exfoliating stratum corneum, beyond which new vesicles can be seen during exacerbation. In the center of the foci, microerosion, crusts, and scales are also visible.

microbial eczemaoften occurs due to secondary eczematization of foci of pyoderma, mycosis (mycotic eczema), infected injuries, burns, fistulas (paratraumatic eczema), against the background of trophic disorders on the lower extremities with symptoms of trophic ulcers, lymphostasis (varicose eczema). With all this, the lesions are often located asymmetrically, have sharp borders, rounded or scalloped outlines, along the periphery of which the collar of the exfoliating stratum corneum is often visible. The focus is represented by juicy erythema with lamellar crusts, after the removal of which an intensely weeping surface is found, against which bright red small punctate erosions with drops of serous exudate are clearly visible. Microvesicles, small pustules, seropapules are visible around the main focus.

A kind of microbial eczema isnummular (coin-shaped) eczema , characterized by the formation of sharply limited rounded lesions with a diameter of 1.5 to 3 cm or more of a bluish-red color with vesicles, seropapules, weeping, scales on the plane. Lesions are more often localized on the back of the hands and extensor surfaces of the limbs.

eczema seborrheicoften associated with the presence of Pityrosporum ovale in lesions. Fungi of the genus Candida and staphylococcus can also play an antigenic role. Seborrhea and associated neuroendocrine disorders predispose to the development of the disease. The scalp, forehead, skin folds behind the auricles, upper chest, interscapular region, folds of the limbs are affected. On the scalp, against the background of dry, hyperemic skin, a large number of gray bran-like scales, serous yellow crusts appear, after removal of which a weeping surface is exposed. The boundaries of the foci are clear, the hair is glued together. In the folds of the skin – edema, hyperemia, deep painful cracks, along the periphery of the foci – yellow scales or scale-crusts. On the trunk and limbs, yellow-pink scaly spots with clear boundaries are found,

eczema in babiesmanifested by clinical signs of true, seborrheic and microbial eczema, while these signs can be combined in various combinations, in some areas signs of true may prevail, in others seborrheic or microbial eczema. Signs of eczema in babies (traditionally bottle-fed) appear at the age of 3-6 months. The lesions are symmetrical, their boundaries are indistinct. The skin in the lesions is hyperemic, edematous, against this background there are microvesicles and areas of weeping in the form of wells, as well as yellow-brown crusts, scales, less often papules. First, the cheeks and forehead are affected (the nasolabial triangle remains intact), then the process spreads to the scalp, auricles, neck, extensor planes of the limbs, buttocks, and torso. Children suffer from itching and insomnia. The clinical picture of seborrheic eczema can develop as early as the 2nd or 3rd week of life against the background of reduced nutrition. The rash is localized on the scalp, forehead, cheeks, ear shells, behind the ear and cervical folds.

Eczema professional– an allergic skin disease that develops as a result of contact with irritating substances in production conditions. Initially, open areas of the skin are affected: the back planes of the hands, forearms, face, neck, and less often, the shins and feet. The lesions are hyperemic, edematous, with the presence of vesicles, weeping and itching. Over time, signs characteristic of true eczema are found. The course is long, but the regression quickly begins after the elimination of contact with the industrial allergen. Each new exacerbation is more difficult. The diagnosis is established by an occupational pathologist on the basis of an anamnesis, clinical manifestations, the course of the disease, clarification of working conditions and the etiological factor of the disease. Increased susceptibility to industrial allergens is detected using skin tests or in vitro (strongly positive RTML, etc.). A patient with occupational eczema will need to be transferred to work outside contact with industrial allergens, skin irritating substances, adverse physical factors; with a persistent course of occupational eczema, the patient will be examined to determine disability due to occupational disease.

Eczema proceeds chronically with periods of exacerbations and remissions and is often complicated by the addition of pyoderma, herpes.

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