General approaches to the treatment of eczema in the practice of an internist

Eczema is one of the most common dermatological pathologies [1-3]. The incidence of eczema varies from 6 to 15‰ (per 1000 population) and accounts for 30–40% of the total number of skin diseases [4]. Eczema is equally often registered in all countries of the world in representatives of different races and regardless of the gender of patients [5]. Microbial eczema (ME) in the structure of eczema ranks second after true eczema and has a share of 12 to 27% [1, 6-8].

Currently, quite a lot of publications have accumulated on various parts of the pathogenesis of ME, which make it possible to improve diagnostic and treatment measures. ICD-10 does not correspond to the established tradition in Russia of dividing the disease into clinical forms. This not only makes it difficult, but also completely eliminates the possibility of statistically recording the occurrence of ME in our country.

The purpose of the study is to increase doctors’ knowledge about the etiopathogenesis, classification and treatment of ME based on the analysis and systematization of literature data and the results of their own research on this problem.

Causes of eczema

The exact cause of this condition is unknown, but the process is based on an overactive reaction of the body's immune system to an irritant or allergen. Substances are formed in the cells of the dermis that cause inflammation, which is associated with the main symptoms. It is also known that the tendency to this disease is inherited.

The therapy is aimed at suppressing inflammation and allergies, as well as healing, eliminating itching and dryness.

Topical medications are available in various forms. Each type of skin lesion has its own dosage form.

• Ointment - has a fatty base with which the medicine is mixed directly, it is more suitable for dry eczema and dermatitis on the hands, it cannot be used on wet areas, it may not be hormonal, or contain hormones. The active components penetrate the skin well, and the fat base itself is not absorbed.
• The cream contains water with a medicine dissolved in it, which is mixed with a fat base. Contains significantly less fat than ointment, so it is suitable for weeping eczema. It is better absorbed and does not leave greasy marks on clothes. The healing components of the cream penetrate the skin less well and usually act in its upper layers.
• In the paste, the concentration of dry substances is more than 25%.
• Lotion is a liquid dosage form (usually an aqueous solution of a drug plus oil). Lotions are suitable for wet conditions, as well as on the head under the hair.

Expert opinion

— The selection of hormonal/non-hormonal agents for external use is carried out by a specialist after collecting an anamnesis, identifying the causes that provoked the disease, and examination.

Firsakova Svetlana Sergeevna, dermatovenerologist, Melanoma Unit Moscow clinic

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.

Hormonal agents

All hormonal medications contain synthetic derivatives of the adrenal cortex. In a healthy body, they play the role of stress mediators and help adapt the functioning of all organs to changing conditions. Their ability to regulate immunity makes them very useful in many dermatological diseases in which inflammation and allergies play a role. Glucocorticoids affect the functioning of cells responsible for the inflammatory process. Thanks to this, chemical compounds that cause symptoms do not enter the bloodstream. Hormones enter the dermis layers and eliminate redness, swelling, itching, and rashes.

Hormone therapy is contraindicated in certain conditions:

• Rosacea
• Acne
• Viral diseases of the epithelium
• Skin infection caused by bacteria or fungi
• Reaction to vaccine administration
• Tuberculosis
• Scabies
• In pregnant women and children, these medications should not be applied to large areas of the body or covered with a bandage.

Advantan

A modern medicine that is well tolerated and has minimal negative effects. This ointment effectively helps relieve symptoms of psoriasis, eczema and dermatitis, and can be used on the arms and legs, as well as on the face. The drug practically does not enter the bloodstream; even after application over large areas, traces of this drug are not detected in the blood. Advantan is approved for people of any age. Expectant mothers should be treated with caution. Local side effects rarely occur with long-term therapy without medical supervision. This may include atrophy, redness and acne. Systemic adverse effects have not been described.

Hydrocortisone

It is based on the synthetic steroid hydrocortisone, one of the weakest glucocorticoids, with which it is better to start treating eczema. If the lesion covers a large area, the skin is severely damaged and is covered with a bandage, hydrocortisone is likely to enter the bloodstream and produce systemic effects.

Hydrocortisone can be treated from the age of two; it is prohibited during pregnancy.

Dermovate

This drug is the most powerful among pharmacological products with glucocorticoids. It is prescribed only in the most acute period, then switching to less powerful drugs. You should not use it for more than four weeks, as this may lead to side effects. At the same time, if the effect of therapy is not visible within several weeks, you need to recheck the diagnosis, because Dermovate shows extremely high effectiveness for eczema conditions.

Lokoid

Lokoid is a very strong glucocorticoid. It is effective for severe forms of atopy, but with prolonged use it causes serious atrophy of the skin, which sometimes persists even after discontinuation. Lokoid is absorbed into the bloodstream in small quantities, but systemic side effects, unlike local ones, easily go away after the end of the course. Pregnant women are allowed to be treated with Lokoid, using caution. Although it enters the bloodstream and through the placenta, a very short course of therapy is usually required, so there is no harmful effect on the fetus.

Lorinden

Loriden's formulation contains a powerful glucocorticoid combined with salicylic acid, which dissolves epithelial scales and helps the hormone penetrate deeper and work better, and also disinfects the skin in the area of ​​application.

It is safe for children and expectant mothers only in small areas.

Prednisolone

This is a medium-strength remedy with which you can begin treating mild to moderate eczema. It easily penetrates the blood, so the course of treatment should be short, and during pregnancy it should be used carefully.

Soderm

This is an effective ointment for eczema on the skin, including the hands and face, is safe for use in adults and children, and patient reviews indicate that it is well tolerated. The active substance Soderma practically does not penetrate into the blood.

Flucinar

A highly active steroid with pronounced anti-inflammatory activity. Prescribed only for a short course due to local side effects. Since it enters the body, it can cause systemic complications and is contraindicated for pregnant women.

Fluorocort

Fluorocort has high activity, but is quite well tolerated. The result is achieved in 10 days, but if necessary, it is safe to use Fluorocort for up to 25 days.

Celestoderm-B

Contains an active and strong glucocorticoid, which effectively eliminates symptoms, but practically does not pass into the bloodstream. They also produce a combination cream with the addition of the antibiotic gentamicin, which suppresses the growth of microorganisms in the epidermis, but is contraindicated in children.

Cynacort

Cinacort contains the synthetic corticoid triamcinolone, which is well tolerated and has a pronounced anti-inflammatory effect. Suitable for dry eczematous changes, and the cream is suitable for swelling, weeping, as well as in skin folds and the border with the mucous membrane.

Elokom

A modern medicine with very strong anti-inflammatory and anti-allergic effects. It does not cause atrophy and does not enter the body. Due to its prolonged activity, it must be applied once a day. It can be used with caution by pregnant women.

Pills

Antihistamines

Histamine is an important component in the development of eczema symptoms. This is a compound that is produced by immune cells and enters the tissue during inflammation and allergies. Histamine is responsible for many manifestations of the pathological process, but mainly irritates the receptors, which leads to severe itching. Antihistamines are designed specifically to relieve these symptoms. They block histamine receptors and prevent it from showing its effect. These medications cause drowsiness, and the newer ones exhibit this effect to a lesser extent, but they also relieve symptoms to a lesser extent.

Antibacterial

Infections sometimes complicate the course of the disease, especially if there is oozing and the integrity of the epithelium is compromised. Then drugs are needed to treat microbial processes, which are often prescribed for eczema on the legs, because this area is more prone to infection. If local therapy is not enough, antibiotic tablets are used. If we take into account the characteristics of the microbiome of the body, the most suitable are penicillins, cephalosporins and macrolides, which are also quite gentle on their own microflora. But only a doctor should prescribe them; self-medication in this case is dangerous.

Non-hormonal ointments

The formula of non-hormonal anti-eczema pharmaceutical products includes various compounds that mitigate the symptoms of the disease. In some cases, using one of the non-hormonal ointments is sufficient to achieve remission. Combination medications are aimed at several components of the disease at once. They work well and have no systemic complications. Local adverse events vary depending on the formulation.

Akrustal

The active ingredient of this brand is solid oil. It helps with flaking, itching, and inflammation, although the exact mechanism by which it works is unclear. Solidol causes contact dermatitis, so upon first use it is necessary to test the reaction on a small area of ​​the body surface. With prolonged use, oil acne appears due to the fact that solid oil clogs the ducts of the sebaceous glands. If such a reaction occurs, it is recommended to apply Akrustal every other day.

Boron-zinc-naphthalan ointment

This is a combination drug that is used for inflammatory diseases of the epithelium. Boric acid in its composition is an antiseptic. Zinc oxide dries and has an astringent effect, which is useful for weeping. Naftalan oil has a strong anti-inflammatory effect, relieves redness and itching, and cleanses the skin.

Heparin

Contains heparin, which resolves blood clots in the veins and improves blood flow. Thanks to auxiliary additives that dilate blood vessels in the dermis and increase tissue permeability, heparin is more easily distributed under the skin in the area of ​​application. In addition, the composition includes a local anesthetic, which reduces itching, pain and the feeling of fullness. This ointment is useful against venous eczema, but is not effective against atopic eczema on the arms, face and torso.

Dermasan

This is a liquid with a very simple composition, which is used for dry skin, irritation and cracks. Glycerin softens and soothes, and ethyl alcohol destroys germs.

Levomekol

A combined drug that has a wound-healing effect and also fights bacteria that cause infection.

Losterine

A series of combined agents that have a good therapeutic effect for atopic dermatitis. A unique component of the Losterin series is naftalan oil, a powerful anti-inflammatory agent that soothes irritation, reduces swelling, itching and redness, and promotes healing. In addition, among the active ingredients are urea, which is a good emollient, salicylic acid (softens and exfoliates), D-panthenol and almond oil.

Methyluracil

Methyluracil enhances metabolism in epithelial cells, stimulates their division and promotes regeneration.

Radevit

The working components of Radevit are vitamins A, E and D. Vitamin A promotes the renewal of epithelial cells. Vitamin E is an excellent antioxidant. Vitamin D fights inflammation and improves cell nutrition.

Salicylic

Salicylic acid softens scales and helps cleanse the skin in case of eczematous lesions. It also regulates the functioning of the sebaceous and sweat glands, which is useful for seborrheic dermatitis. Thanks to its antiseptic properties, it prevents infection of epidermal lesions. Contraindicated for children.

Skin Cap

Skin Cap cream and shampoo contain the therapeutic component zinc pyrithione. The main direction of Skin Cap's work is anti-inflammatory. It softens the epithelium, eliminates itching and flaking. Active against fungi that support inflammation and flaking in seborrheic dermatitis. Zinc pyrithione also fights bacteria that complicate eczema.

Solipsor

Solipsor products contain medical grease and birch tar, which fight inflammatory manifestations, and natural herbal extracts soothe, eliminate itching, and destroy microorganisms. Solidol sometimes provokes contact dermatitis, so for the first time Solipsor should be tried on a small area.

Thymogen

Thymogen regulates cell renewal, stimulates tissue regeneration and healing.

Zinc paste

Having drying and astringent activity, zinc paste makes it easier to get wet.

Elidel

A highly effective medicine, comparable in strength to hormones. Elidel, penetrating into the dermis, inhibits the division of immune cells responsible for the formation of inflammation and blocks the release of allergy mediators. Elidel does not cause atrophy, does not affect general immunity (even when taken orally, in the form of tablets), and does not reduce resistance to infections. Approved for children from 3 months of age, but not yet sufficiently studied during pregnancy. Adverse reactions such as infection at the site of application are rare with very long-term use.

Emolium

This is a line with significant moisturizing activity. Emulsion Emolium contains natural oils, urea, paraffin oil and other emollients, that is, substances that help the body retain moisture as much as possible.

Eplan

Contains a solution of lanthanes in glycerin - the active Glycolan complex, which promotes skin regeneration and rapid healing of damage, and also prevents infection.

The role of vitamins

Vitamin A

Retinoids, a group of substances derived from vitamin A, are not first-line pharmaceuticals for the treatment of eczema. However, their effects on the skin make these chemical compounds potentially useful for dermatological problems. Retinol binds to special receptors in the nuclei and thereby controls the process of differentiation of skin cells (the formation of various specialized cells from one stem cell), and also suppresses division and stimulates apoptosis - programmed (non-pathological) cell death. Studies have shown that retinoids are effective in treating severe forms of eczema when hormonal treatments have not had the expected effect. First, creams with these substances are prescribed, but if remission cannot be achieved, retinoid tablets are used. The negative effect on the fetus, which may result in developmental defects, makes retinoids inapplicable during pregnancy and breastfeeding. Women of childbearing age should use vitamin A supplements with the greatest caution. But of course, daily intake of vitamin A in a small dose is not dangerous, but only brings benefits for skin health.

B vitamins

Insufficiency of B vitamins is one of the risk factors for the development of eczema. It is useful to take vitamin complexes, and vitamins B5 and B12 are included in ointments.

Vitamin C

This substance plays a key role in maintaining skin health. Ascorbic acid is not produced in the body, and dietary intake is the only source of this vitamin. Once inside, it is distributed in tissues, including high concentrations in the outer layer of the skin - the epidermis. There it regulates cell division, melanin formation, and fights oxidative stress. This vitamin helps maintain the barrier function of the body. It is also an important element in the formation of collagen, a protein that ensures the integrity of the dermis. Acting as an oxidant and at the same time an antioxidant, it controls the balance of oxidized substances in the skin, suppresses free radicals and fights aging. In patients with atopic eczema, it significantly reduces the intensity of the inflammatory process, and also restores the barrier and prevents moisture loss due to the active synthesis of ceramides. It works both when taken orally and as part of topical preparations, but in this case the concentration must be high enough to break through the outer layers of the epidermis.

Vitamin E

An essential nutrient thought to have effects on the immune system and exhibit antioxidant properties. Studies have shown that vitamin E is effective against itching, redness, swelling, loss of skin integrity and thickening of the epithelium. However, this effect lasted only three months after the end of therapy, with a large number of patients experiencing a return of symptoms. Tocopherol is good to use occasionally, as needed, it helps to remove it during the manifestation of the disease.

Among the undesirable effects, increased itching, contact dermatitis, and burning are noted; they occur very rarely.

Side effects

Complications from medicinal products containing glucocorticoids in the area of ​​their application are associated with their effect on cell repair.

• Atrophy. At the site of application, the epidermis becomes thin, dull, easily damaged, and loses hair.
• Decreased protective function of the body. Acne appears and infection easily develops.

In some cases, the hormone contained in the drug mixture can enter the bloodstream and cause a systemic complication. Glucocorticoids affect blood pressure, sugar levels, lead to a significant decrease in immunity, obesity, osteoporosis, and cause growth retardation in children. To prevent hormones from causing such disorders, they should only be used under medical supervision. The doctor will give recommendations on how long and how often to apply the ointment for eczema, depending on whether the area of ​​application is on the arms, legs or body, will help reduce the dose or change treatment in time and, of course, will tell you the name of the most suitable drug for this case.

Side effects of non-hormonal ointments manifest themselves in the form of irritation or an allergic reaction. Medical solid oil in some medications provokes the appearance of contact dermatitis.

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.

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