Eczema (eczema) is an allergic polymorphic dermatitis caused by a variety of internal and external factors. It is histologically characterized by cellular infiltration with plasma exudation and is mainly characterized by an itchy, polymorphic rash that is prone to recurrence. If it occurs in the external auditory canal, it is called external auditory canal eczema. If it occurs not only in the external auditory canal, but also in the auricle and the skin around the ear, it is called external ear eczema.
Eczema in the external auditory canal is often caused by contact allergies, purulent secretions, bacterial or viral infections, etc. It can also occur in the external ear canal. Eczema can be prevented by avoiding the consumption of or contact with allergens, timely treatment of otitis media and eczema of the head, and changing bad habits such as ear-picking.
Disease Etiology
The etiology and pathogenesis of eczema is still unclear, but it is mostly thought to be related to allergic reactions, and may also be related to mental factors, neurological dysfunction, endocrine dysfunction, metabolic disorders, and indigestion. Factors causing allergic reactions can be food (such as milk, fish and shrimp, seafood, etc.), inhalants (such as pollen, animal fur, paint, chemical gases, etc.), contacts (such as lacquer trees, drugs, cosmetics, fabrics, soap, chemicals in the shell of hearing aids, etc.) and other intrinsic factors. Humidity and high temperature are often causative factors.
Disease classification
Classification is based on the course of the disease and is divided into acute eczema, subacute eczema and chronic eczema.
Disease symptoms
Different stages of eczema behave differently.
1. Acute eczema: the affected area is itchy, mostly accompanied by a burning sensation, and yellow watery secretion flows out after digging the ear, which forms a yellow crust after solidification. Sometimes the discharge flows to the area and causes lesions there.
2. Subacute eczema: Mostly caused by untreated acute eczema, improper treatment or prolonged treatment. Local still itchy, oozing less than acute eczema, but there is crusting and flaking.
3. Chronic eczema: Acute and subacute eczema becomes chronic eczema when it recurs or is not cured for a long time, with severe itching in the external auditory canal, thickened skin and flaking. Eczema in the external auditory canal may recur.
Examination
1.Acute eczema: the affected area is red and swollen, with scattered erythema, corn-like papules and small blisters; after these papules and blisters rupture, there is yellowish discharge, and the skin is red vesicular surface, or there is yellow crust.
2, subacute eczema: the affected area of the skin is less red and swollen, exudate less and thicker, with scales and crusts.
3, chronic eczema: the affected area of the skin thickening, rough, chapped, moss-like changes, with flaking and pigmentation.
Disease treatment
Find the cause of the disease and remove allergens as much as possible. If the cause is unknown, stop eating spicy, irritating or strongly allergenic foods.
Systemic treatment
Take oral anti-allergy drugs such as Benadryl, loratadine, desloratadine, cetirizine, terfenadine, fexofenadine, etc. In case of secondary infection, systemic and topical antibiotics are added. Topical treatment with topical treatment. The principle of “wet is treated by wet, dry is treated by dry”. For acute eczema with more exudate, clean the exudate and scab with glycolite lotion and then apply a wet dressing with boric acid solution or aluminum acetate solution. After drying, use zinc oxide paste or boric acid zinc oxide paste to apply. Physical therapy such as local ultraviolet radiation is also helpful.
Sub-acute eczema exudate not much, local application of 2% gentian violet solution, after drying with zinc oxide paste or boric acid zinc oxide paste application.
Chronic eczema, local dryness, topical application of zinc oxide paste or boric acid zinc oxide paste, 10% zinc oxide ointment, white mercury ointment, antibiotic hormone ointment or Elocon ointment. If there are more dry scabs, first clean the area with hydrogen peroxide and then use the above creams. For thickened skin, 3% salicylic acid ointment can be used.
At present, our department mainly uses high-definition otoscope with special cleaning tools to remove dead skin and pus scabs from the external ear canal, especially the necrotic materials in the deep part of the ear canal and on the surface of the eardrum, the cleaner the cleaning, the better the treatment effect. The cleaner the cleaning, the better the treatment effect. After the cleaning, we can apply the special ointment to cure it at once (more than 95%), and then apply the medicine once after a week to prevent recurrence. This treatment is one of the characteristics of our department, with no pain, low cost, short time, remarkable effect, no recurrence, no injection, no medicine, does not affect work and study, the treatment process is clearly visible, and has been praised by patients and peers.
Disease prevention
1. Avoid eating or contacting allergenic substances, drinking alcohol and eating seafood, timely treatment of otitis media and eczema of the head, and change bad habits such as ear digging.
2. Avoid sweating in heat and water in the ear, and keep the skin clean and dry.
3.The baby’s clothes should be loose, soft and made of cotton.
4.If you find yellow water in the ear, go to the hospital for cleaning and medication in time.
5.Regulated treatment, avoid prolonged use of in-the-ear antibiotics and hormones.
Misconceptions about diagnosis and treatment
1.Ear running water such as when middle ear infection mistakenly uses ear drops can aggravate the external ear canal impregnation.
2. Performing acoustic impedance testing of the middle ear without cleaning the external ear canal for flaking and crusting can easily lead to a false negative diagnosis.
3. Self-administered medication at home may cause damage to the deep part of the external ear canal and the eardrum by mistake.
4. In case of combined infection, the resistance of the body may be reduced and otitis media may be complicated.