Overview
Eczema is an inflammatory skin reaction with a pronounced tendency to exude caused by a variety of internal and external factors. It is characterized clinically by symmetrical distribution of lesions, polymorphic damage, intense itching, tendency to moisten, recurrent episodes, and a tendency to become chronic. According to the course of the disease, it can be divided into three categories: acute, subacute, and chronic. Acute is mainly papular rash, with a tendency to exude; chronic is mainly mossy, prone to recurrent attacks. The disease can develop in both men and women, and is not seasonal, but often recurs in winter. It is currently believed that the disease is caused by the interaction of internal and external factors. Internal factors such as chronic infectious lesions (e.g. chronic cholecystitis, tonsillitis, etc.), endocrine and metabolic changes (e.g. menstrual disorders, pregnancy, etc.), blood circulation disorders (e.g. varicose veins in the lower legs, etc.), psychoneurological factors (e.g. mental stress, excessive fatigue, etc.), and genetic factors (e.g. allergic qualities, etc.), among which genetic factors are related to the susceptibility and tolerance of individuals. External factors such as food (e.g. fish, shrimp, etc.), inhalants (e.g. pollen, house dust mites, etc.), living environment (e.g. sunlight, cold, heat, etc.), animal fur, various chemical substances (e.g. cosmetics, synthetic fibers, etc.). In terms of pathogenesis, the disease is mainly a delayed metamorphosis caused by complex internal and external factors.
This disease belongs to the category of “dipping sores” and “blood wind sores” in Chinese medicine. In Sui’s “Treatise on the Origin of Diseases? It is a wind-heat sore that develops on the skin in the heart. The initial birth is very small, itchy and then painful and becomes a sore, with the juice coming out to soak the muscles, and the immersion gradually broadening to be all over the body. …… to its gradual growth, because the name dip also.” Song “Sheng Ji General Record? The “Immersion Sore” says: “Wind-heat is contained in the heart meridian, then the spirit is agitated and depressed, the qi and blood are drummed up and sent to the skin for immersion. Its symptoms are very slight at first, itchy and painful juice out, gradually to the surrounding body, such as the immersion of the water, the obscene u more than, so called immersion.” Qing “Medical Zong Jin Jian? Surgical Heart Method Essentials” records: “This evidence is initially born like scabies, scratching itch without time, spreading more than, scratching Jin yellow water, immersion into the film, from the heart fire, spleen dampness by wind.” In the Qing dynasty, “The Golden Book of Medicine? Blood Wind Sores” states, “This evidence is caused by damp heat in the liver and spleen, and by the external wind, which attacks the skin and depresses the lung meridian, resulting in sores all over the body. When scratched, the sores become irritable, thirsty, and itchy, and are very light at night.” It is pointed out that the occurrence of this disease is closely related to the lesions of the heart, lung, liver and spleen meridians.
Clinical manifestations and diagnosis
According to the course of the disease and clinical features can be divided into acute, subacute and chronic eczema.
1. The clinical manifestations of each stage of eczema are as follows.
(1) acute eczema: the disease starts quickly, the lesions are often symmetrically distributed, can occur in any part of the body, but also generalized throughout the body, but commonly on the head and face, behind the ears, hands and feet, scrotum, vulva, anus and other parts. The lesions are often flaky or diffuse, without obvious borders. The lesions are mostly dense corn-sized papules and papules with a flushed base. Due to scratching, the tops of the papules, papules or blisters ooze, vesicles and crusts after scratching, and the center of the lesions are heavy, with scattered papules, erythema and papules around the periphery, so the borders are unclear. If it does not become chronic, it will heal in 1 to 2 months by removing the scabs. Intense itching. Scratching, soap washing, hot water scalding, drinking alcohol, eating spicy hair products can aggravate the lesions and intensify the itching, which affects sleep in severe cases. It can also be combined with folliculitis, boils, local lymphadenitis, etc.
(2) subacute eczema: often caused by acute eczema is not treated in a timely manner, or improperly handled, resulting in a prolonged course of disease. It can also be subacute eczema at first. The lesions are lighter than acute eczema, with small papules, crusts, scales, and only a few blisters and mild erosions. Itching is intense, especially at night.
(3) chronic eczema: can be due to acute, subacute recurrent episodes do not heal, and turned into chronic eczema, but also at the beginning that presents chronic inflammation. The lesions are mostly confined to a certain area, such as the lower legs, hands and feet, elbow sockets, knee sockets, vulva and anus. The skin is thickened, infiltrated, brownish-red or grayish, with a rough surface, covered with a little chaff-like scales, and individual moss-like changes of varying degrees. The surface of the lesion is often accompanied by scratches, blood crust, pigmentation, and some lesions may appear new papules or blisters, and a small amount of water after scratching. If the lesions occur on the hands, feet and joints, they are often prone to cracking and are painful and affect activity. Patients feel pruritic, paroxysmal, and the itching increases at night or when nervousness, drinking alcohol, eating spicy hair products. The duration of the disease is long, recurring, sometimes light and sometimes heavy.
(1) Ear eczema: mostly occurs in the crease behind the ear, also visible in the upper part of the ear wheel and the external auditory canal, lesions manifest as erythema, ooze, crusting and cracking, sometimes with seborrhea, often symmetrical on both sides. External ear canal eczema can be caused by contaminated fungal irritation or secondary infectious eczema caused by otitis media.
(2) Breast eczema: Most often seen in women who are breastfeeding. The damage is confined to the nipple, areola and its surroundings, manifesting as vesicles, oozing, covered with scales, or yellow scabs, recurring episodes, may appear chapped, painful, conscious itching, generally not pus. If it persists or occurs on one side, attention should be paid to exclude eczema-like carcinoma
(3) Umbilical eczema: the lesions are bright red or dark red patches located in the umbilical fossa, or with vesicles, oozing, crusting, with clear borders, not involving the normal skin of the periphery, often with odor, conscious itching, and a long course of disease.
(4) hand eczema: hand eczema is extremely common because the hands are exposed parts and have more opportunities to contact pathogenic factors. Prevalent on the back of the hand and the palm surface of the fingertips, can spread to the back of the hand and wrist, lesions of various forms, unclear boundaries, manifested as flushing, vesicles, exudate, crust. In chronic cases, the skin is thickened and rough. Because of the frequent activities of the fingers and cracking, the disease is long and stubborn.
(5) Scrotal eczema: a common type of eczema. It is confined to the scrotal skin and sometimes extends to the perianal area and even the penis. The former shows the entire scrotum swollen, flushed, mild erosion, oozing, crusting, skin hypertrophy over time, shiny skin color, deepening pigmentation; the latter flushed, swollen than the former, skin infiltration thickened, gray, covered with scales, and fissures, due to frequent scratching there is irregular pigmentation disappeared small pieces, itching intense, more at night, often affecting sleep and work. The disease needs to be differentiated from riboflavin deficiency scrotitis, which has a short course, no obvious infiltration hypertrophy, often accompanied by tongue inflammation, internal riboflavin about a week after the effect.
(6) Female eczema: It is a common type of eczema in women. It affects the skin of the labia majora and minora and its vicinity. The affected area is infiltrated and thickened, with clear boundaries. The stimulation of menstruation and secretions can make the disease process chronic and difficult to heal. The disease can be followed by hypopigmentation, easily misdiagnosed as female pubic leukoplakia.
(7) Anal eczema: confined to the anus, a few may involve the nearby skin and the perineum. It is unbearably itchy. The affected area is often moist, infiltrated and hypertrophic, and may become chapped.
(8) Calf eczema: It occurs in the lower 1/3 of the inner calf, often accompanied by varicose veins, with limited dark red lesions, diffuse dense papules, papules, vesicles, oozing, thickening of the skin over time, and pigmentation. It is often accompanied by ulcers on the lower legs. Some patients, hypopigmentation in the center of the lesions, can form secondary vitiligo.
3, some eczema its clinical manifestations, the course of the disease and general eczema is not exactly the same, for special types of eczema, the common ones are as follows.
(1) self-sensitive eczema: before the onset, certain parts of the skin have eczema lesions, such as coin-shaped eczema or calf eczema. Due to excessive scratching, the stimulation of topical drugs, or co-infection to increase the exudation of the original lesions, redness, swelling and erosion, coupled with improper treatment, unclean trauma, so that the formation of tissue decomposition products, bacterial products and other special antigens, resulting in sensitization of the body, resulting in generalized lesions.
(2) Infectious eczema-like dermatitis: Before the disease occurs, there are chronic bacterial infections near the affected area, such as otitis media, bedsores, ulcers and fistulas, etc. From these lesions, a large amount of secretions are discharged, so that the surrounding skin is stimulated and sensitive to the disease. It manifests as redness, dense papules, blisters, pustules, crusting and scaling of the skin around the lesion. There is more exudation, and in severe cases there may be significant edema.
(3) Coin-shaped eczema: It is a special type of eczema, named because its lesions resemble coins. It is common in winter and occurs at the same time as dry skin. The lesions are found on the back of the hands and feet, the extremities, shoulders, buttocks and breasts. The lesions are small red papules or papules, dense and coin-shaped, with more exudate. In chronic cases, the skin is thickened, with crusts and scales on the surface, and papules and blisters are distributed around the lesions, often in the form of “satellites”. Itching is intense, recurrent and not easily cured.
(4) Cracked eczema: also known as seborrheic eczema. Can occur in many parts of the body, but mostly seen in the extremities, especially the front of the shin in the elderly. The lesions are light red, cracks out of the red more obvious, similar to “broken porcelain”. This disease is most often seen in winter, dry air, combined with hot water scalding too often and stimulated.