Eczema

Description:

Eczema is a chronic inflammatory dermatosis which often has recurrent character of a current, with a characteristic variety of elements of skin rash. Inflammatory process is localized in upper layers of skin. Feature of a disease is distribution on the remote sites.
The term "eczema" was entered in the 2nd century BC, and was used for designation of an acute dermatosis. Eczema acquired the status of an independent nosological form only at the beginning of the 18th century.
Eczema affects the population in independence of an age group, and makes up to 40% of the reasons of negotiability for the help to the dermatovenereologist.

Eczema reasons:

Eczema is a polyetiological disease with the multistage mechanism of a pathogeny. This inflammatory disease develops as a result of interaction of many factors which include exchange, exogenous, endocrine and neuroallergic components.
To exogenous a factor carry bacteria, chemical and physical substances, medicines, food stuffs, etc. An important role is played by allergic reactivity of an organism on external and internal irritants, this reaction proceeds as allergic the slowed-down or immediate type.
Accurate communication of development of eczema and disturbances in immune system of an organism is revealed. Disturbances in a cycle of prostaglandins and nucleotides are involved by shift in the field of immunity that is shown in decrease in lymphocytes, in particular the T-lymphocytic pool, the T-helperov level. Direct link of degree of depression of the immune status with expressiveness of clinical displays of eczema is noticed.  As it is established, incidences of eczema are more subject persons of Slavic race that is explained by positive association of antigens of system of histocompatability of HLA.
Along with disturbance of the immune status the role of functional disorders of the central nervous system is defined. The change of a trophicity of fabrics caused by false neuroendocrinal and humoral shifts promote development of eczema.
Thus, it is revealed that eczema has the difficult mechanism of development forming against the background of genetic predisposition. This mechanism causes further spread of a disease in succeeding generations. Pregnancy pathology, including associated diseases of mother, give an impetus to developing of a disease. From chest feeding, untimely introduction of feedings up, baby food with dominance of cow's milk can lead refusal to exudative diathesis which quite often leads further to children's eczema. Due to the genetic nature of a disease the penetrance role is defined (gene "probivayemost" in a sign). If one of parents has eczema, the chance of the child also to ache is equated to 40%; at zabolevayemot of both parents the indicator reaches 60%.

Eczema symptoms:

The standard classification of eczema does not exist, however there is a division on a current and in a form.
Eczema can proceed in a chronic, subacute and acute form. There are such main forms of eczema: microbic, professional, true, seborrheal, children's and atopic.

True (idiopathic) eczema usually has the acute beginning, and can arise in any age. The process hronifikation, with periodic aggravations is characteristic. As a result a spongiosa (an exudative inflammation) against the background of hypostasis skin rashes - microvesicles develop. They are quickly opened, and on site vesicles dot erosion which are called eczematic wells are found. Availability of serous exudate in these wells defines the exudative character of an inflammation characteristic of the becoming wet eczema. Over time the quantity of vesicles decreases, erosion dry up and on a surface of the centers of an inflammation there are a scaly peeling and small crusts which remained from vesicles. Gradual transition of an acute stage of an inflammation in chronic is observed that is followed by such damages of an integument as cracks, formation of scales and a congestive erythema. Sites of injury of skin at true eczema are various in size, have indistinct outlines and are located on a body in a chaotic order, is preferential on a dorsum of brushes, feet, forearms in a symmetric order. For children's age the arrangement of the pathological centers of true eczema on buttocks, a face, a breast, upper and lower extremities is more peculiar. Emergence of the centers of an inflammation is followed by a painful itch.
Disgidrotichesky eczema which is option of true eczema is shown mainly by small skin rash in the form of bubbles on feet and palms. As skin of feet and palms consists of 7 words (unlike an integument in other parts of a body where there are 5 layers), the erythema is slight, and the centers having accurate contours in the center have microvesicles or scales.
Against the background of the secondary eczematization of the centers of a pyoderma, a fungal infection infected herbs and burns, disturbance a shelter - and lymphokineses there is microbic eczema. The asymmetric arrangement of the pathological centers, with accurate outlines is characteristic. On border with healthy skin "collar" of the exfoliating corneous layer is found. At microbic eczema the juicy erythema with lamellar crusts after which removal intensively becoming wet surface is bared develops. Against the background of damage small dot erosion of red color, with impurity of serous exudate are visible. Around the main center elements of skin rash - microvesicles, small pustules, seropapula are located. Allergic rashes (allergids) can arise far from the main center.
One of options of microbic eczema is nummulyarny (monetovidny) eczema of which existence of sharply limited roundish centers of defeat with a diameter from 1,5 to 3 cm and more cyanotic-red color with vesicles, seropapula, moknutiy, scales on a surface is characteristic. Such centers are found on a dorsum of a brush and extensor surfaces of extremities more often.
Carry to microbic eczema also such types as varicose, eczema of nipples and a pigmental circle at women, sikoziformny.
As the etiological agent of a seborrheal ekzemaa Pityrosporum ovale which is found in the pathological center often acts. Important value as antigen is played staphylococcus and by sort Candida mushrooms. Seborrheal eczema voznakat against the background of already available neuroendocrinal frustration or seborrhea. Defeat localization - a pilar part of the head, a forehead, bends of extremities, skin folds behind auricles, an upper part of a breast, interscapular area. Scaly scales of gray color arise on hyperemic skin with the increased dryness. After mechanical removal of these scales the becoming wet surface is visible. The centers are accurately outlined, the skleennost of hair, cracks pleated, their reddening and hypostasis is found. On the periphery of the centers scales or cheshuyko-crusts of yellow color are formed. On a trunk and extremities there are yellow-pink shelled spots with a clear boundary, in the center of the centers there can be melkouzelkovy elements.
Children's eczema can proceed in the form of idiopathic (true), seborrheal and microbic eczemas, at the same time these signs can be combined among themselves, on one sites signs true, on others of seborrheal or microbic eczema can prevail. Symptoms of children's eczema are shown more often at the age of 3-6 years at the children who are on artificial feeding. Symmetry of an arrangement of rashes, their accurately outlined edges, a hyperemia, puffiness in the defeat center, with characteristic skin rash in the form of vesicles and sites a moknutiya in the form of wells, and also yellow-brown crusts, scales is characteristic, papules are more rare. Pathological process begins with cheeks and a forehead, is characteristic that the centers do not appear in the field of a noso-gubgny triangle. Gradually process extends to a pilar part of the head, a neck, auricles, extensor surfaces of extremities, buttocks, a trunk. The itch and the related sleep disorders disturbs.
Seborrheal eczema develops on the 2-3rd week of life against the background of subnutrition. Elements of skin rash are located on a pilar part of the head, a forehead, cheeks, quirky sinks, in zaushny and cervical folds.
Professional eczema – the allergic disease of skin developing owing to contact with the substances irritating her in conditions of production. In the beginning open sites of skin are surprised: dorsums of brushes, forearms, a face, a neck, are more rare – shins and feet. Also the hyperemia, puffiness, existence of vesicles, a moknutiya and an itch is noted. Over time there are signs characteristic of true eczema. The current is long, but regress quickly occurs after elimination of contact with production allergen. However each new aggravation proceeds in more severe form.
The raised xeroderma, with sites of a peeling, reddening and a local inflammation is characteristic of atopic eczema. Inflammatory process is followed by an intensive itch that leads to raschesa. Through raschesa the infection easily gets, on site what pustules appear. Quite often the course of atopic eczema is complicated by a pyoderma and a herpes infection.

Treatment of Eczema:

Treatment of eczema long also demands an integrated approach taking into account character of a current, type of eczematic defeat, prevalence of pathological process and other factors. Definition of the reasons which caused a disease is important. For example, an important point in treatment of atopic eczema is elimination of contact with allergen. Pathogenetic use of antihistaminic, antiinflammatory, glucocorticoid drugs, physiotherapy is reasonable. Complex treatment of use of these methods allows to reach optimum influence on all links of a pathogeny of eczema.

Dietary food which limits extractive substances, beef-infusion broths, mushrooms, spices is shown to the people having eczema. Patients should give preference to a sour-milk and vegetable diet. As necessary appoint fermental drugs, a probiotics, eubiotik. To limit to Sluduyet amount of table salt, liquid, to reduce consumption or at all to refuse animal fats, transfats,  milk. When subsiding acute the phenomena perhaps sanatorium improvement using hydrosulphuric or radonic bathtubs.
Desensitization of an organism is reached by purpose of Calcii chloridum, Natrium thiosulfuricum, Suprastinum, tavegil, Diazolinum. At treatment of children it is necessary to dose purpose of antihistaminic drugs strictly. It is contraindicated to apply to children Pipolphenum and Dimedrol owing to their side effect.
Glucocorticoid drugs are appointed in small doses. Their positive therapeutic effect is connected with oppression of synthesis of the cells developing inflammation mediators. Puffiness of fabrics is eliminated with diuretics (верошприрон, lasixum, broths of diuretic herbs). Magnesia uses are also eliminated by puffiness and renders the desensibilizing effect.
Intradermal administrations of hystoglobulin cause blockade of production of immunoglobulin E which matters in development of eczematic process. Injections carry out as "a lemon crust", titrating a dose, bringing it to 2 ml. Usually the drug is administered in the outside surface of a shoulder.
Sedation is reached at purpose of drugs of a motherwort, valerian, tranquilizing means (to alprozola, paksit, Phenazepamum, Sibazonum).
From glucocorticosteroid drugs I apply Prednisolonum and dexamethasone, the course of treatment is led up to a week, then gradually reduce a dose in order to avoid a withdrawal. Glucocorticosteroid drugs are used at the heavy course of eczema.
Vitamin therapy is carried out taking into account individual portability, for the purpose of increase in nonspecific resistance of an organism. Group B vitamins, fat-soluble vitamins A, D, K, E are shown.  Uses of antibiotics reasonablly at microbic eczema, and also  in cases of accession of infectious process.
The research of the immune status of the patient and carrying out an immunnokorretion taking into account the revealed disturbances is obligatory. For this purpose use the proved drug Diuciphonum which purpose allows to extend the term of clinical remission. Also apply sodium nucleinate, extract of a placenta and other immunnokorrektor.
One of the most effective non-steroidal anti-inflammatory drugs is indometacin which blocks enzyme to a prostaglandinsintetaz, than inhibits formation of prostaglandins.
Also outside treatment of eczema is not less important. At microbic eczema apply the gauze bandages impregnated with boric acid, resorcin and other dezsredstvo. It is necessary to consider that the specified substances should not be applied at children in order to avoid intoxication.  After reduction of the phenomena of puffiness, a moknutiya it is reasonable to pass to use of ointments and pastes. Apply prednizolonovy, indometatsinovy ointment, Flyutsinar, "Ftorokortum", etc. Zinc paste, sulfur, tar ointment, Ichthyolum also found the application in treatment of eczema.

Prevention:

At eczema it is reasonable to carry out secondary prevention which is expected preventions of development of complications. Accession of consecutive infection significantly aggravates the course of eczema therefore it is necessary to process carefully struck centers. The inflamed follicles need to be greased with spirit solutions of dyes. Use of bathtubs with antiinflammatory broths is shown.
The great value is given to treatment of intercurrent diseases, normalization of work of digestive organs.
Prevention of varicose eczema is shown first of all at varicosity of extremities, and it consists in wearing special stockings and timely treatment, including surgical. An important point is the exception of contact with allergen as in life, so under production conditions.
The patients having eczema need to watch carefully hygiene of a body, it is necessary to give preference to linen from natural fabrics, to observe the principles of a balanced diet.