Eczema is a common inflammatory reaction skin disease of the epidermis and superficial dermis caused by a variety of internal and external factors, characterized by intense itching, polymorphic lesions, a tendency to exude, a chronic course, and easy to recur. It is generally called “dip sore” and “wet sore” in Chinese medicine.
I. Etiology and pathogenesis
The etiology of this disease is complex, and it is generally believed that it is a delayed metamorphosis caused by the interaction of various internal and external factors, in addition, individual quality is also related to the occurrence of this disease. The following factors are mainly related.
1, external factors are common food, such as fish, shrimp, crab, eggs, beef, mutton and other heterosexual proteins; inhalants, such as pollen, dust, animal fur, etc.: living environment, such as sunlight, cold, heat, friction, and plants, silk, wool, soap, dyes, detergents; topical drugs, cosmetics, etc. and the occurrence of eczema is also related.
2, intrinsic factors chronic focal infections, intestinal parasitic diseases, endocrine disorders, metabolic disorders or digestive tract dysfunction, menstruation and pregnancy, etc.
3, neuropsychological factors such as mental tension, overwork, insomnia, “anxiety,” etc. are closely related to the occurrence of this disease.
In Chinese medicine, it is believed that the allergy of endowment, the evil of wind, dampness and heat on the skin, or due to the weakness of the spleen and stomach, the spleen does not exercise, resulting in internal dampness and heat, and external exposure to wind, dampness and heat, the two internal and external evil fighting each other, soaked skin.
Clinical manifestations
According to the performance of the lesions can be divided into acute, subacute, chronic eczema. However, the three do not have obvious boundaries, can be transformed into each other. Acute eczema and chronic eczema have obvious clinical features, while subacute eczema is only a transitional stage.
1, acute eczema lesions can occur in any part, but most often found on the face, behind the ears, breasts, hands, limbs, etc., symmetrical distribution, serious cases can be generalized throughout the body, conscious of intense itching; lesions manifested as polymorphic, erythematous first, on the basis of erythematous appear densely distributed pinpoint to rice-sized papules, papules or blisters, blisters broken to form a vesicular surface, visible beads of pulpy exudate.
The lesions gradually spread to the surrounding area, the boundary is unclear, and the exudate dries and crusts. If secondary infection occurs, pustules or dirty brown scabs may appear. If treated properly, the inflammation is reduced and the lesions may subside after 2-3 weeks. If not handled properly, it turns into subacute or chronic eczema.
2, subacute eczema acute eczema after the reduction of inflammation, in addition to more intense itching, lesions to papules, crust, scales mainly, a small number of papules, mild vesicles. If the treatment is appropriate, within a few weeks can be cured, and improperly handled, can be an acute attack or turn into chronic eczema.
3, chronic eczema is often due to acute, subacute eczema repeated episodes do not heal and turn into chronic eczema. Can also start the inflammatory response is not obvious, due to itching often scratching or other stimuli, so that the beginning of the chronic eczema. The skin of the affected area is infiltrated and thickened, the surface is rough, dark red or with pigmentation, and the lesions are mostly limited patches with clear edges. The chronic eczema course is slow and can last for months or years, but can also be acute due to irritation. The site of onset is commonly on the back of the hands, calves, elbow sockets, breasts, vulva, anus and other places. The clinical manifestations may have some specificity due to the different sites of onset.
Diagnosis and differential diagnosis
Diagnosis is generally based on medical history, rash pattern and disease duration. In the acute phase, the lesions are polymorphic, often with exudation, symmetrical distribution, and pronounced itching; in chronic cases, the lesions are infiltrated and thickened, pigmented, and recurrent. Acute eczema should be distinguished from contact dermatitis (Table 7-l), and chronic eczema should be distinguished from neurodermatitis (Table 7-2).
Acute eczema and contact dermatitis should be distinguished from acute eczema contact dermatitis Table items Acute eczema contact dermatitis etiology is often unclear with a clear history of sensitization site of onset can occur in any part of the occurrence in contact with the site distribution is often symmetrical distribution asymmetric damage manifestations lesions are polymorphic, the edges are unclear lesions single, clear edges course of disease long course of disease, often recurrent short course of disease, easy to cure after removal of the cause chronic eczema and neurodermatitis table items Chronic eczema neurodermatitis course often evolved from acute eczema, itching and rash occur at the same time first local itching, scratching rash onset sites are mostly found in the hands, feet, calves, trunk and vulva, etc., the upper eyelids, extremities and sacrococcygeal lesions show skin infiltration hypertrophy, pigmentation, the periphery of the lesions can have small papules or papules moss-like changes are evident, the edge can be seen normal skin color flat papules
IV. Treatment
1.General treatment:
As far as possible to find the cause, isolate the source of allergy, avoid touching again, prohibit alcohol, spicy stimulating food. Avoid excessive fatigue and mental tension. Treatment of chronic systemic diseases, such as dyspepsia, intestinal parasitic disease, diabetes, etc.
(1) Systemic treatment:
For the purpose of antipruritic and anti-allergic, use antihistamines such as aminoglutethimide maleate (paracetamol), gentamicin, trimethoprim (desmin), loratadine/Kelthane, cetirizine, epalrestine, cyproheptadine, ketotifen, doxepin, pyrimethamine potassium tablets for internal use; also use sedatives: diazepam (Valium), fenadine, glutamate, etc. 2 antihistamines can be used in combination or alternately. Also available 10% calcium gluconate 10-20ml, vitamin c injection 1.0-3.0g static push or static drip anti-itch symptomatic treatment; if the itch is even available procaine closed therapy can be selected large static seal (500~600mg) or (300~400mg) anti-itch symptomatic treatment; also available cyclophosphate adenosine electron amine 60~120mg anti-itch treatment; also available compound glycyrrhizin (Mennen) If there is secondary infection or serious inflammation, effective antibiotics can be given to prevent infection or anti-inflammatory treatment, such as macrolides (erythromycin, azithromycin, etc.), quinolones (pazufloxacin, levofloxacin, etc.); if the effect of various treatments is unknown and conventional drugs are ineffective, short-term application of corticosteroids can be considered. steroids, (Depo-Provera, prednisone, etc.).
(2) Local treatment.
Acute eczema without exudate, can be used externally compound boron lotion, corticosteroid cream (Youzol, mometasone furoate, etc.), dermatoprost, exudate more, can be selected solution wet, such as 3% boric acid solution, 1: 5000 ~ 1: 8000 potassium permanganate solution or 10% cypress solution or compound cypress solution wet, subacute period available snake yellow cream or snake yellow zinc oxide paste or corticosteroids used externally, such as accompanied by fungal infection If there is fungal infection, tretinoin econazole cream should be used topically, such as anti-infection or anti-inflammatory treatment can be combined with ofloxacin gel, Bactrim, such as chronic eczema, corticosteroid ointment can be used, such as tretinoin econazole cream, mometasone furoate, Guaixin cream, snake yellow cream and other topical application, clinical selection of topical rubbing drugs can be used in combination with several drugs, such as snake yellow cream and mometasone furoate combined, or mometasone furoate and dandruffin combined. .
(3) physical therapy.
Chronic eczema can be treated with liquid nitrogen freezing or sealing package.
2, Chinese medicine treatment
The type is mostly seen in acute eczema, the lesions are mainly flushed, swollen, blisters, vesicles, oozing, symmetrically distributed and itchy. Dry mouth, bitter mouth, dry stool; urine, red and yellow tongue, slippery pulse. The treatment is to clear heat and dampness, cool the blood and detoxify the toxin. The formula is to cool the blood and dispel the wind (thorny mustard, windproof, fried atractylodes, cicada, Zhi Mu, burdock, bitter ginseng, raw earth, red peony, carpenter’s wort, gardenia, angelica, mouton, raw licorice) or gentian diarrhea liver soup or dioscorea percolating dampness soup or Duo Pi drink or Yin Chen Artemisia soup or Huang Lian detoxification soup or Guo Chi San combined with Liu Yi San plus or minus.
(2) Spleen deficiency and dampness: equivalent to subacute eczema, with erythema, papules and papules as the main lesions, vesicles and exudation are not obvious, and itching does not stop. The tongue is red with yellow coating and the pulse is floating or moistened. The treatment is to dispel wind and dampness and relieve itching, with the formula of Si Jun Zi Tang or De-Damp Stomach Ling Tang (Atractylodes macrocephala, Atractylodes macrocephala, Hou Pu, Chen Pi, Yun Ling, Zeligia, Poria, Bitter Ginseng, Bai Xian Pi, Danshen, Huang Bai) or Ping Gastric San or Ginseng and Atractylodes San or Tonifying Zhong Yi Qi Tang.
Blood deficiency and wind dryness: equivalent to chronic eczema, with dry, rough, thick, scaly, mossy, pigmented skin lesions. Dry mouth, restless sleep at night, dry stool, light tongue with thin coating and weak pulse. The formula should be used to nourish blood, dispel wind and relieve itching (Gymnema sylvestre, Huangjing, Wuzhu snake, Siberian silkworm, Red peony, Danpi, Angelica sinensis, Bai Xianpi, Fu Ling, Yu Zhu, Glycyrrhiza glabra) or Sifu Fengshan (Angelica sinensis, Chuanxiong, Fangfeng, Thornbush, Red peony, Shengdi, Bai Xianpi, raw Coix seed) or Sanhuang Guben Tang or Shouwu Dihuang Tang with reduction.
Wind-heat evidence: the lesions are mainly red papules, accompanied by itching symptoms, the lesions are widespread all over the body or confined to the face and neck, symmetrically distributed, the patient may have symptoms such as sore throat, dry mouth, bitter mouth, etc., the tongue is red, the moss is thin and yellow, the pulse is string, the treatment should be to dredge the wind and clear heat, quench the wind and relieve itching, the formula is used Yin San or burdock relieving muscle soup or add flavor cool blood and eliminate wind or Pu Ji disinfectant drink with addition.
(5) Dampness and stasis obstruction evidence: it occurs in the lower limbs, with a history of varicose veins, swelling of the lower limbs, and may be accompanied by dry mouth, thirst, unpleasant stools and other symptoms, with red tongue, white greasy coating and stringent pulse. The treatment is to clear heat and remove dampness, ventilate the veins and relieve itchiness, using Si Miao San and Tao Hong Si Wu Tang with addition and reduction.
V. Prevention and care
1. Prohibit the consumption of spicy and hairy substances.
2, pay attention to skin hygiene, prohibit hot water, soapy water, salt water, pepper water scalding.
3, avoid scratching, and suspend vaccination during the acute period.