Eczema and dermatitis are the most common clinical diseases in dermatology, and all types of eczema can account for 20% or more of the dermatology outpatient visits. With the development of society and changes in eating habits and the surrounding environment, allergic diseases are becoming more and more common. According to research, the impact of eczema on the quality of life is greater than that of certain medical conditions such as diabetes.
A. Causes of eczema
The etiology of eczema is still unclear, and is believed to be caused by a combination of internal factors, such as abnormal immune function, systemic diseases (such as endocrine diseases, nutritional disorders, chronic infections, tumors, etc.) and genetic or acquired skin dysfunction, plus external factors such as environmental or food allergens, irritants, microorganisms, changes in environmental temperature or humidity, and sun exposure. Psychosocial factors such as stress and anxiety can also trigger or aggravate the disease.
Second, the clinical manifestations of eczema
Acute phase: manifested as redness, edema based on corn-sized papules, papules, blisters, vesicles and exudate, the center of the lesion is often heavy, and gradually spread to the periphery, the periphery and scattered papules, papules, so the boundary is unclear.
Subacute stage: the redness and exudation are reduced, and the vesicular surface is crusted and desquamated.
Chronic phase: the main manifestation is roughness and hypertrophy, may be accompanied by deepening of pigmentation, hand and foot eczema can be accompanied by nail changes. The rash is usually symmetrically distributed, often recurrent, and the self-conscious symptoms are pruritus, even severe itching.
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What laboratory tests can be done to differentiate eczema from other diseases or to screen for possible causes?
The routine blood tests include eosinophilia and increased serum IgE, allergen tests to help find possible allergens, patch test to help diagnose contact dermatitis, fungal microscopy to identify fungal disease, scabies test to help rule out scabies, serum immunoglobulin test to help identify congenital diseases with eczema dermatitis lesions, bacterial culture of lesions to help diagnose secondary bacterial infections, etc. If necessary, skin histopathological examination should be performed.
Fourth, the treatment of eczema
1, basic treatment.
(1) health education: help patients understand the characteristics of the disease and the impact on health, the efficacy of various treatment methods and possible adverse reactions, guide patients to find and avoid common allergens and irritants in the environment, and guide patients in their daily lives.
(2) Avoid triggering and aggravating factors: The doctor and patient cooperate to carefully search for various suspected causes and triggering and aggravating factors in order to achieve the purpose of removing the causes and thorough treatment.
(3) Protecting the skin barrier function: Eczema patients have damage to the skin barrier function and are prone to secondary irritant dermatitis, infection and allergy which aggravate the lesions, so it is important to protect the barrier function. The patient’s skin should be selected for treatment without irritation, the prevention and timely treatment of secondary infections, the skin dry subacute and chronic eczema with moisturizers.
2.Topical treatment.
Local treatment is the main means of eczema treatment. According to the stage of lesions should be selected according to the appropriate drug type such as lotions, creams, solutions, pastes, oils, etc.. Topical glucocorticoids are still the main drug for the treatment of eczema. The appropriate strength of glucocorticoids should be selected according to the nature of the lesions: weak glucocorticoids for mild eczema; strong hormones for severe hypertrophic lesions; and medium hormones for moderate eczema. Weak or medium-acting hormones are generally effective in pediatric patients, facial lesions and skin folds. The continuous application of strong glucocorticoids should not exceed 2 weeks to reduce acute tolerance and adverse effects. Calcium-regulated neurophosphatase inhibitors have therapeutic effects on eczema without the adverse effects of glucocorticoids, and are especially suitable for eczema on the head, face and inter-rub areas.
3.Systematic treatment
(1) antihistamines: according to the patient’s condition, choose appropriate antihistamines to stop itching and anti-inflammatory.
(2) antibiotics: for those with extensive infection, it is recommended to apply systematically for 7-10 days.
(3) Vitamin C, calcium gluconate, etc.: they have certain anti-allergic effect and can be used for acute attacks or obvious itching.
(4) Glucocorticosteroids: generally do not advocate routine use, but can be used for patients with clear etiology and short-term elimination of the cause, such as contact, drug factors or self-sensitivity dermatitis; for severe edema, generalized rash, erysipelas, etc., can also be applied short-term for rapid symptom control, but must be cautious, under the guidance of doctors to regulate the use, to avoid systemic adverse reactions and rebound of the disease.
(5) Immunosuppressants: application should be cautious and limited to patients with severe disease where other methods are ineffective and glucocorticoid application is contraindicated.
4.Physical therapy
Ultraviolet therapy, including long-wave, medium-wave and narrow-spectrum UVB irradiation, has a better effect on chronic intractable eczema.
5.Chinese herbal medicine therapy
The Chinese medicine can be treated internally or externally, and should be treated according to the evidence of the disease. Chinese herbal extracts such as compound glycyrrhizin and rehmannia polysaccharide are effective for some patients. It should be noted that herbal medicines may also lead to allergy, liver and kidney damage, etc. Therefore, it is important to go to a regular hospital for prescription and treatment.
6. Follow up consultation and follow-up
The disease is prone to recurrence and patients are advised to follow up regularly. Patients with acute eczema should preferably be seen 1 week after treatment, 1-2 weeks after treatment for subacute patients, and 2-4 weeks after treatment for chronic patients. At the follow-up visit, it is necessary to evaluate the efficacy, changes in condition, and the need for further tests. Patients with recurrent attacks that do not heal should be analyzed for their causes. The most common causes are irritants (bad lifestyle habits), exposure to allergens, cross-allergies, secondary allergies (e.g. to topical and oral medications in treatment), secondary infections, unfavorable environmental factors, systemic factors, etc.
V. Answers to other frequently asked questions about eczema
1.Is eczema contagious?
A: Eczema is not contagious
2, can eczema be cured?
A: Eczema itself is a chronic, easily recurring inflammatory skin disease, due to the complex causes, and the patient’s constitution, the environment and other closely related, and these are difficult to change, so there is no a cure and avoid recurrence of the treatment means.
3.What do I need to pay attention to in my daily life?
A: Attention should be paid to avoid all kinds of external stimuli, such as hot water scalding, violent scratching, excessive cleaning, etc.. Actively seek and avoid allergens in the environment. Avoid allergenic and irritating food, fish, shrimp, beef and mutton, spicy and irritating food and strong tea, coffee, alcohol, etc. Cooperate with your doctor and seek medical attention in a timely manner, under the guidance of your doctor.