Chronic eczema and its differences from acute. Is it possible to achieve remission?

Causes

The cause of eczema is the body’s reaction to a variety of factors: chemical, infectious, medicinal, physical.
This reaction can be genetically determined (up to 60% if both parents have eczema) and consists of a complex of inadequate reactions of the body’s immune, nervous and endocrine systems to antigens. Why hands? Our hands come into contact with a huge number of different substances and environments: microbes and fungi, various detergents and cleaners, antiseptics (even in soap), temperature effects, prolonged exposure to water, professional contact with various aggressive chemicals. It is not surprising that at some point the body can malfunction and react violently to a seemingly ordinary stimulus.

Eczema - symptoms and treatment

During the course of the disease the following stages :

1. Erythematous - skin redness, swelling and itching appear.
2. Papular - red papules (nodules) form.
3. Vesicular - grouped bubbles with liquid appear, reminiscent of air bubbles when water boils.
4. Weeping - the covers of the bubbles open and weeping and erosion are formed.
5. Cortical - areas of weeping dry out and become covered with crusts.
6. Peeling – exfoliation of crusts and restoration of the skin surface [2].

As eczema enters the chronic stage, the skin undergoes changes: it becomes rougher and drier, as a result, it flakes and pigmentation appears.

Forms of eczema depending on the clinical picture and causes of occurrence [5]:

• true;
• seborrheic;
• microbial;
• nummular;
• mycotic;
• intertriginous;
• varicose;
• sycosiform;
• nipple eczema;
• children's;
• professional.

True eczema

True eczema most often affects the face and limbs. Areas of healthy and affected skin alternate. Other areas may be involved in the process, including erythroderma (generalization of the inflammatory reaction and fever). The process is usually symmetrical. In the acute stage, the disease manifests itself in the form of blisters (vesicles), redness of the skin, erosions with weeping, crusts, excoriations (mechanical damage to the skin when scratching), there may be papules and pustules. Eczematous lesions have uneven boundaries. When the disease enters the chronic stage, redness becomes stagnant, areas of cracks and lichenification (thickening of the skin with increased skin pattern as a result of prolonged scratching) appear, the skin becomes rough and dry. Often the process is complicated by the appearance of ulcers caused by the addition of an infection: beta-hemolytic streptococcus or Staphylococcus aureus [1].

Monetoid (nummular) eczema

Nummular eczema occurs mainly in adults. Men get sick more often than women. The highest incidence occurs between 50 and 65 years of age, in both sexes. In women, the first peak occurs between the ages of 15 and 25, when puberty passes and the woman reaches adult height and weight. But in children, nummular eczema is extremely rare. The lesions are often located in the elbows and behind the knees, with the arms being affected more often than the legs.

The pathogenesis of the disease is still unclear. In some patients, foci of chronic infection are detected, including in the oral cavity and respiratory tract. Allergens, such as house dust mites, play an important role in the development of nummular eczema. With the disease, clearly defined coin-shaped plaques of papules and vesicles appear. Characteristic signs include pinpoint weeping and crusting. Crusts can cover the entire area of ​​the plaque, the diameter of which varies from 1 to 3 cm. Itching can be either minimal or severe. In ring-shaped forms of the disease, the manifestation decreases in the central part. Chronic plaques become dry, flaky, and the skin thickens.

Microbial eczema

Microbial eczema is a polyetiological disease. In the pathogenesis of microbial eczema, the skin barrier plays an important role, because one of its main functions is protection. Itching provokes scratching of the skin, damaging the integrity of the skin, and this, in turn, forms an entry point for infection. Exudation (the release of the liquid part of the blood into the inflamed tissue through the vascular wall) creates favorable conditions for the proliferation of microbes.

An important component of pathogenesis is the skin microbiota. In scrapings from the affected skin of patients with microbial eczema, Staphylococcus aureus and hemolytic staphylococcus, yeast fungi, mainly of the genus Candida, are found. Microbial eczema can also be caused by external physical or mechanical irritants. Often, foci of microbial eczema appear around purulent wounds and in places of long-term pyoderma (a purulent skin disease resulting from the penetration of bacteria).

In microbial eczema, the lesions are round or irregular in shape, with clear boundaries, located asymmetrically and limited by a border of exfoliating epidermis. In the center of the lesions, purulent and serous crusts can be seen; after their removal, weeping, reminiscent of “wells,” is discovered. The rash is characterized by intense itching [2].

Seborrheic eczema

Inflammation begins on the scalp and is localized in areas of the skin with the largest number of sebaceous glands. In this way, seborrheic eczema is similar to seborrheic dermatitis. The lesions are localized behind the ears, on the chest, neck, between the shoulder blades, and on the flexor surface of the limbs. The skin within the lesion is hyperemic, edematous, on its surface there are small yellowish-pink papules and greasy yellowish scales and crusts [2].

Varicose eczema

Varicose eczema, as the name suggests, occurs when the patient has varicose veins. The skin of the legs next to varicose ulcers is predominantly affected. The development of this type of eczema is caused by irrational and untimely treatment of varicose ulcers, skin maceration (wrinkling of the skin during prolonged contact with water), and trauma. Varicose eczema causes severe itching. Differential diagnosis, first of all, must be made with myxedema and erysipelas [3].

Sycozyform eczema

The disease occurs against the background of vulgar sycosis - inflammation of the hair follicles as a result of the penetration of staphylococci into them. The pathological process can go beyond the boundaries of hair growth; as a rule, lesions can be found on the upper lip, armpits, chin and pubis. Clinically, sycosiform eczema is manifested by serous wells, severe itching and weeping, and later areas of skin thickening appear [2].

Childhood eczema

The first symptoms can be noticed at the age of 3-6 months. Eczematous areas are symmetrical, the skin within the lesions is brightly hyperemic, swollen, hot to the touch, has a shiny smooth surface, there is weeping, layering and milky crusts. Eczema primarily affects the cheeks, forehead, scalp, ears, buttocks and extremities (usually extensor surfaces). It is characteristic that eczema does not affect the skin of the nasolabial triangle. When sick, children complain of itching and insomnia. Eczema often transforms into atopic dermatitis[5][10].

Eczema of the nipples

Skin breakdown occurs after nipple trauma during breastfeeding. Externally, eczema manifests itself as slight redness, weeping, crusts of blood collections, and in some cases pustules and cracks, usually without hardening of the nipples. As a rule, the eczematous process spreads to both breasts [5].

Occupational eczema

Occurs under the influence of various industrial allergens. The disease can be caused by mercury, various metal alloys, penicillin and semi-synthetic antibiotics, resins and synthetic adhesives. Occupational eczema is more common among workers in various industries, people who deal with various chemicals (chemists and biologists), as well as those whose work involves constantly immersing their hands in water (for example, cleaners and orderlies). Under the influence of allergens, a delayed-type hypersensitivity reaction develops. Clinically, occupational eczema occurs like ordinary eczema. The lesions are located mainly in the area of ​​contact with allergens and on open areas of the skin. Occupational eczema is characterized by rapid recovery when the cause disappears [6].

Paratraumatic eczema

Occurs in the area of ​​postoperative scars or with incorrectly applied plaster casts. Manifests itself in the form of acute inflammatory erythema (redness), pustules or papules, and crusting. Hemosiderin, a yellow pigment formed during the breakdown of hemoglobin, can be deposited in the affected tissues [5].

Forecast

The prognosis for eczema is most often favorable.
If you start proper treatment in time, you can curb the disease and get rid of its consequences. With adequate therapy, itching and elements of the old rash disappear, a new rash does not appear. Eczema is a chronic disease, so it is worth adhering to preventive measures and maintaining a state of remission. However, the timing of relapse is still unpredictable. Doctors give the most favorable prognosis for acute eczema. Recovery may be worse if eczema develops in young children, the elderly, or people whose bodies are weakened by infection. To enhance drug treatment, a hypoallergenic diet, physical activity, walking and hardening will help.

Bibliography

1. Ayzyatulov R.F. Clinical dermatology. — Donetsk: Donetsk region. - 2002. - P. 9-11, 284-299.
2. Zaslavsky D.V., Tulenkova E.S., Monakhov K.N., Kholodilova N.A., Kondratieva Yu.S., Tamrazova O.B., Nemchaninova O.B., Guliev M.O., Shlivko I L.L., Torshina I.E. Eczema: tactics for choosing external therapy. Bulletin of dermatology and venereology. 2018;94(3):56-66.
3. Markova O.N. Microbial eczema: clinical picture, pathogenesis and principles of treatment//Military Med. magazine - 2004. - No. 7. - P.23-25.
4. Margieva A.V., Khailov P.M., Krysanov I.S., Korsunskaya I.M., Avkentyeva M.V. /Pharmacoeconomic analysis of the use of methylprednisolone aceponate in the treatment of atopic dermatitis and eczema // A.V. Margieva., P.M. Khailov, I.S. Krysanov, I.M. Korsunskaya, M.V. Avkentieva. Medical technologies. Evaluation and selection. - No. 1, 2011. - P. 14-21.
5. Studnitsyn Yu.K. Skripkin Yu.K. Classification of eczema // Vestn. dermatol. and venerol. - 1979.-No. 5. - P. 3-9.
6. Khazizov I. E., Shaposhnikov O. K. On the mechanisms of inflammatory changes in the skin during eczema and eczema-like processes // Vestn. dermatol. and venerol.
7. Barnes PJ Molecular mechanisms of corticosteroids in allergic diseases // Allergy. – 2001. – Vol. 56.– Supp. 10.– P. 928–936.
8. Baumer JH. Atopic eczema in children, NICE // Arch Dis Child Educ Pract Ed. 2010 Dec; 95(12):1071 9. Chang C, Keen CL, Gershwin ME. Treatment of eczema. // Clin Rev Allergy Immunol. 2007 Dec;33(3):204-25.
9. Drago L, Toscano M, Pigatto PD. Probiotics: immunomodulatory properties in allergy and eczema. //G Ital Dermatol Venereol. 2013 Oct;148(5):505-14.
10. Halometasone 0.05% Cream in Eczematous Dermatoses // J Clin Aesthet Dermatol. 2013 Nov; 6(11): 39-44.
11. De Waure C, Cadeddu C, Venditti A, Barcella A, Bigardi A, Masci S, Virno G, Cammisa A, Ricciardi W. Nonsteroid treatment for eczema: results from a controlled and randomized study. // G Ital Dermatol Venereol. 2013 Oct;148(5):471-7
12. Zomer-Kooijker K, van der Ent CK, Ermers MJ, Rovers MM. Lack of Long Term Effects of High Dose Inhaled Beclomethasone for RSV Bronchiolitis - A Randomized Placebo-Controlled Trial // J Pediatr Infect DS.2013 Oct 28. 8.

Diagnosis of pathology

Often, an examination by a dermatologist is sufficient to make a diagnosis, since the clinical picture of true eczema is specific. But for further treatment, it is important to find out the reasons that provoked the pathology.

The set of diagnostic measures includes blood and urine tests; in addition, an immunological study and a blood test for allergens may be required. If the infection reappears, a culture of the discharge from the affected areas is prescribed to determine the response to antibiotics.

There are also cases that are difficult to diagnose. A biopsy of the affected area may then be required to make a diagnosis.

Prevention

For prevention, two types of care products are used.

• Moisturizing products with powerful emollients, such as urea and glycerin, soften and prevent the body from drying out due to the fact that, distributed in the outer layers of the epidermis, they attract moisture. They are applied throughout the day as needed.
• Natural oils, waxes and silicones create a protective barrier on the surface of the skin, preventing moisture evaporation. They are best used after a shower and applied to a damp area of ​​the body.