Eczema is the result of the interaction of internal and external causes The causes of eczema can be divided into two types of causes: internal and external. Endogenous causes refer to physical problems, where the patient is allergic, has problems with the skin barrier, and has a genetic predisposition. “The main thing that plays a barrier function in our skin is the epidermal stratum corneum, which is made up of keratin, like a brick wall structure, and the structural proteins in the stratum corneum are like bricks, while the sebum in between is like cement, allowing the skin to be insulated from harmful substances from the outside world.” Xie said, “If the skin barrier, especially the epidermal stratum corneum, has problems, the skin and nerves will be easily irritated, leading to allergic reactions or irritation reactions, itching, redness and other symptoms, so that patients can not help but scratch with their hands, as a result, the more scratching the more itchy, the more damage to the skin barrier, forming a vicious circle, the rash, or what we call eczema. “ External causes are external environmental irritants and allergens, such as chemical stimuli such as acids, alkalis, hair dyes, mechanical stimuli formed when wearing and taking off sweaters, metal stimuli such as belt buckles and watches, rubber stimuli such as elastic bands and shoes, plant stimuli such as mangoes, dust mites, fungi, bacterial proteases, etc. These irritants or allergens act on susceptible individuals and cause itching of the skin, which in turn promotes or leads to eczema. Atopic dermatitis is a typical representative of eczema Regarding the types of eczema, distinctions can be made in terms of the site of onset, and differences can be found in the etiology. In terms of the site of onset, eczema can be divided into two types: limited eczema and generalized eczema. Limited eczema refers to eczema symptoms on certain parts of the patient’s body, such as hands, calves, perianal area, scrotum, pediatric face, etc.; while generalized eczema refers to eczema symptoms that appear symmetrically on multiple parts of the patient’s body. In terms of the cause of eczema, it can be divided into exogenous eczema and endogenous eczema, each of which includes many subtypes, but due to the limitations of current testing methods, no specific distinction can be made, Xie said. If the patient has a high level of IgE in the blood when the test is performed, the skin test result is positive and the allergen can be detected, which is called exogenous eczema. And endogenous eczema patients with normal IgE levels in the blood and negative skin test results, no allergens can be detected, not much to do with external allergen factors. Controlling itching is the key to treating eczema Once eczema flares up, you need to rely on medication for treatment. Currently, eczema is treated mainly by means of skin protection, anti-itching and anti-inflammatory, and avoidance of irritants. ”The primary symptom of eczema is itching; therefore, controlling itching is the key to treating eczema. Pruritus is mediated by sensory nerves and occurs by at least two mechanisms, one is pruritus triggered by activation of histamine receptors; the other is pruritus unrelated to histamine receptors, such as pruritus mediated by protease receptors and capsaicin receptors.” In general, the itching mechanism of eczema is closely related to the latter, so antihistamines alone do not control itching well in clinical practice. If patients have mild itching symptoms, they can take some sedative antihistamines orally to stop itching, while patients with severe itching can use some drugs targeting the central nervous system to stop itching or some topical drugs that act directly on the sensory nerves of the skin under the guidance of a doctor. In eczema, itching and inflammation coexist, so glucocorticoids to control inflammation are still the most common topical medications used to treat eczema. If the symptoms are severe or city-fixed, short-term treatment with oral or injectable hormones may also be required, as well as some immunosuppressive drugs aimed at rapidly reducing the condition. Nowadays, many patients are reluctant to use glucocorticoids or have “hormone phobia”, thinking that hormones have great side effects. On the contrary, if you do not actively treat the condition, you will end up itching, scratching and rubbing repeatedly, causing problems such as sleep and bad mood, which will aggravate the condition.
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