Eczema is an inflammatory skin disease caused by a variety of internal and external factors with a pronounced tendency to exude, accompanied by significant itching, prone to recurrence, and seriously affecting the quality of life of patients. The disease is a common dermatological condition, with a prevalence of about 7.5% in the general population in China and 10.7% in the United States.
Causes: The cause of eczema is still unclear. Internal factors include abnormal immune function (such as immune imbalance, immunodeficiency, etc.) and systemic diseases (such as endocrine diseases, nutritional disorders, chronic infections, tumors, etc.) and genetic or acquired skin barrier dysfunction, external factors such as environmental or food allergens, irritants, microorganisms, changes in environmental temperature or humidity, sun exposure, etc. can trigger or aggravate eczema. Psychosocial factors such as stress and anxiety can also trigger or aggravate the disease.
The pathogenesis of this disease is not clear. Currently, it is believed that the disease is the result of a combination of internal and external factors based on internal factors such as abnormal immune function and skin barrier dysfunction. Both immune mechanisms such as allergic reactions and non-immune mechanisms such as skin irritation are involved in the pathogenesis. Microorganisms can trigger or aggravate eczema through direct invasion, superantigenic action or induction of immune response.
Symptoms: The clinical manifestations of eczema can be divided into three phases: acute, subacute and chronic.
The acute phase is characterized by erythema, edema on the basis of corn-like papules, papules, blisters, vesicles and exudates, the center of the lesion is often heavy, and gradually spreads to the periphery, and there are scattered papules, papules, so the boundary is unclear.
In the subacute stage, redness and exudation are reduced, and the vesicular surface is crusted and desquamated.
Chronic eczema mainly manifests as rough hypertrophy, moss-like changes, may be accompanied by pigment changes, hand and foot eczema can be accompanied by nail changes. The rash is generally symmetrically distributed, often recurrent, and the conscious symptoms are pruritus, even severe itching, as shown in the figure.
Treatment and care
1.Basic treatment
(1) Try to find and avoid common allergens and irritants in the environment, avoid scratching and excessive washing, and pay close attention to the environment, diet, use of protective equipment, skin cleaning methods, etc.
(2) Avoid triggering or aggravating factors: You can take a detailed medical history, meticulous physical examination, reasonable use of diagnostic tests, and carefully search for various suspected causes and triggering or aggravating factors to achieve the purpose of removing the causes and thorough treatment. For example, lack of lipid eczema should remove the factors that make the skin dry, and infectious eczema should treat the primary infection, etc.
(3) protect the skin barrier function: eczema baby’s skin barrier function has been damaged, easy to secondary irritant dermatitis, infection and allergy and aggravate the lesions, so it is very important to protect the barrier function. Should be selected for treatment without skin irritation, prevention and timely treatment of secondary infections, subacute and chronic eczema on dry skin with moisturizers.
2.Topical treatment
It is the main means of eczema treatment, should be based on the stage of the lesions to choose the appropriate drug formulations.
In the acute stage without blisters, vesicles, exudation, it is recommended to use furnace glycolate lotion, glucocorticoid cream or gel; a large number of exudation should choose cold wet compresses, such as 3% boric acid solution, 0.1% berberine hydrochloride solution, 0.1% Levanox solution, etc.; vesicles but not much exudation can be used when the zinc oxide oil.
For subacute lesions, topical application of zinc oxide burnt and glucocorticoid cream is recommended. For chronic lesions, topical glucocorticoid ointment, hard cream, emulsion or tincture is recommended, and moisturizers and keratolytic agents such as 20%-40% urea ointment and 5%-10% salicylic acid ointment can be used in combination.
Topical glucocorticoid preparations are still the mainstay of eczema treatment. Initial treatment should be based on the nature of the lesions and the choice of the appropriate strength glucocorticoid: for mild eczema, weak glucocorticoids such as hydrocortisone and dexamethasone cream are recommended; for severe hypertrophic lesions, strong hormones such as harcinexide and halometasone cream are recommended; for moderate eczema, medium-acting hormones such as tretinoin and mometasone furoate are recommended. If bacterial infection is suspected, topical antibiotic preparations or compounded preparations with antimicrobial effects can be used in combination. Strong glucocorticosteroids are generally applied for no more than 2 weeks consecutively to reduce acute tolerance and adverse effects.
Bacterial colonization and infection can often trigger or exacerbate eczema, so antimicrobial agents are also an important aspect of topical treatment. Topical preparations of various antimicrobials and chemical antimicrobials are available, as well as a combination of glucocorticoids and antimicrobials. Other topical drugs such as tar, antipruritic agents, topical preparations of non-steroidal anti-inflammatory drugs, etc. can be applied according to the situation of choice.
3.Systematic treatment.
(1) antihistamines: select appropriate antihistamines to stop itching and anti-inflammation according to the patient’s condition.
(2) Antibiotics: For those with extensive infection, systemic application of antibiotics for 7-10 days is recommended.
(3) Vitamin C and calcium gluconate, which have some anti-allergic effect, can be used in acute attacks or in those with marked itching.
(4) Glucocorticoids: routine use is generally not advocated. They are suitable for patients with clear etiology and short-term elimination of etiology, such as those caused by contact factors, drug factors or self-sensitivity dermatitis; for severe edema, generalized rash, erythroderma, etc., they can also be applied short-term for rapid control of symptoms, but caution must be exercised to avoid systemic adverse reactions and rebound of the disease.
(5) Immunosuppressants: should be used with caution, to strictly grasp the indications. It should only be used in patients with severe disease who have contraindications to the application of glucocorticosteroids, or when the condition is significantly relieved by short-term systemic application of glucocorticosteroids, and when the use of hormones needs to be reduced or stopped.
4.Physical therapy.
Ultraviolet therapy has a better effect on chronic intractable eczema.
5, Chinese herbal medicine therapy.
Chinese medicine can be treated internally as well as externally, and should be administered according to the condition. Chinese medicine extracts such as compound glycyrrhetinic acid glycosides, tretinoin polysaccharide, etc. are effective for some patients. It should be noted that herbal medicines can also lead to serious adverse reactions, such as allergic reactions, liver and kidney damage, etc.
Observation and prevention: The disease is prone to recurrence and it is recommended to bring your baby for regular follow-up. Patients with acute eczema should preferably be seen once 1 week after treatment, 1-2 weeks after treatment for subacute patients, and 2-4 weeks after treatment for chronic patients.
In cases of recurrent, persistent attacks, it is important to analyze the presence of.
(1) irritating factors.
(2) neglected exposure to allergens.
(3) cross-allergy.
(4) Secondary allergies: e.g., allergy to topical medications used in treatment.
(5) Secondary infections.
(6) adverse environmental factors and.
(7) adverse systemic factors, etc.