Eczema is an inflammation of the superficial dermis and epidermis caused by various internal and external factors. In clinical practice, the acute stage of skin lesions is mainly characterized by papules with a tendency to exudation, while the chronic stage is mainly characterized by lichenoid changes, which are prone to recurrence.
Clinical classification
- Acute eczema, subacute eczema, and chronic eczema
According to the course of the disease and clinical characteristics, it can be divided into acute eczema, subacute eczema, and chronic eczema.
- Generalized eczema and localized eczema
(1) Localized eczema: only occurs in specific areas, named after the location, including ear eczema, scrotal eczema, external genital eczema, perianal eczema, hand eczema, breast eczema, calf eczema, etc.
(2) Generalized eczema: Multiple skin lesions that are widespread or scattered throughout the body.
- Special type eczema
(1) Coin shaped eczema: It is a subacute eczema characterized by patches of erythema, blisters, or papules with clear boundaries of coin size, or localized scabbing and scaling, causing severe itching. It usually occurs on the limbs, dorsum, shoulders, or buttocks.
(2) Adipose eczema: It mostly occurs in autumn, winter, and spring due to dry weather, loss of skin moisture, and reduced sebum secretion. More common in elderly people, it is more likely to occur in the calves, but also in the upper limbs and trunk. The skin lesions are characterized by a light red color, shallow cracking, resembling “broken porcelain”, and mild flaking.
(3) Accumulated eczema: It is a type of eczema characterized by exudation, scabbing, scaling, and pigmentation in the lower limbs, especially the calves. It usually occurs in patients with varicose veins and is also known as varicose eczema.
epidemiology
contagious
Non infectious.
incidence rate
This disease is a common skin condition in dermatology. The general population in our country has a disease incidence rate of about 3% to 5%, and children can reach 10% to 20%.
Easy to reach people
- People with allergies are more prone to it.
- The incidence rate of infants is higher than that of adults.
Easy season
Eczema is more common in summer and winter seasons.
cause of disease
executive summary
The etiology of this disease is not yet clear, and may be related to internal factors such as chronic infection lesions, endocrine and metabolic changes, blood circulation disorders, neurological and psychological factors, genetic factors, as well as external factors such as food, inhalation, and living environment.
underlying cause
- Internal factors
(1) Chronic infectious lesions: such as chronic cholecystitis, tonsillitis, intestinal parasitic diseases, etc.
(2) Endocrine and metabolic changes: such as menstrual disorders, pregnancy, etc.
(3) Blood circulation disorders, such as varicose veins in the calf.
(4) Neuropsychiatric factors: mental stress, insomnia, excessive fatigue, emotional fluctuations, etc.
(5) Abnormal immune function: such as immune imbalance, immunodeficiency, etc.
(6) Other systemic diseases such as malnutrition, tumors, etc.
(7) Hereditary: related to individual susceptibility.
- External factors
(1) Food factors: such as fish, shrimp, beef, mutton, etc.
(2) Inhalation substances: such as pollen, dust mites, etc.
(3) Living environment: such as living in a hot and dry environment.
(4) Other: such as contact with animal fur, various chemicals (including cosmetics, soap, synthetic fibers), etc.
Risk factors
- Frequent allergies are indicative of an allergic constitution.
- Has a family history of eczema.
symptom
executive summary
Eczema can be divided into acute, subacute, and chronic types based on the course of the disease and clinical characteristics. Different types of eczema have different manifestations. Whether acute, subacute, or chronic eczema, the course of the disease is unpredictable, prone to recurrence, and can switch between each other, with no lasting cure. Consciously experiencing severe itching. Drinking alcohol, scratching, soap washing, and hot water scalding can all worsen symptoms, and in severe cases, affect sleep.
Typical Symptoms
- Acute eczema
It is more common in exposed areas such as the face, ears, hands, feet, forearms, and calves. In severe cases, it can spread throughout the body and is often symmetrically distributed. It often manifests as papules and papules ranging in size from the needle to the grain on the basis of erythema. In severe cases, small blisters may appear, often merging into patches with unclear boundaries. Scratching often forms a point like erosive surface with obvious serous exudation. Consciously severe itching, scratching, and hot water washing can aggravate skin lesions. If secondary infection occurs, pustules, abscesses, swollen lymph nodes, and fever may occur; If combined with herpes simplex virus infection, it can form severe herpetic eczema.
- Subacute eczema
It develops over a longer period of time due to the alleviation or inappropriate treatment of acute eczema inflammation. Manifested as redness, swelling, and reduced exudation, but there may still be papules and a small amount of papules. The skin lesions are dark red and may have some scales and mild infiltration. Still feel severe itching.
- Chronic eczema
Derived from acute and subacute eczema, it can also manifest as chronicity from the beginning due to mild and persistent irritation. It is more common in the hands, feet, calves, elbow sockets, thighs, breasts, external genitalia, anus, and other areas, with symmetrical onset. Manifesting as infiltrative dark erythema on the affected skin with papules, scratches, and scales, local skin thickening, rough surface, varying degrees of lichenification, pigmentation, or hypopigmentation. Consciously, there is also obvious itching, often presenting as paroxysmal. The condition can be mild or severe, lasting for several months or longer.
- Localized eczema manifestations
(1) Ear eczema: often occurs at the folds behind the ear, characterized by redness, exudation, cracking, and scabbing. Sometimes with seborrheic characteristics. Often symmetrical on both sides. External ear canal eczema can be caused by fungal contamination or secondary infectious eczema caused by otitis media.
(2) Breast eczema: occurs around the nipple, areola, and their surroundings, with clear boundaries, brownish red skin lesions, obvious erosion, and intermittent scales or thin scabs. When there is infiltration, cracking may occur. Self perceived itching accompanied by pain. It is more common in breastfeeding women and is more easily cured after stopping breastfeeding. If it persists or occurs on one side, attention should be paid to ruling out eczema like cancer.
(3) Umbilical eczema: occurs within the umbilical fossa. Manifested as bright red or dark red spots, with exudate and scabs, moist surface, clear edges, minimal waves on the skin around the navel, and a chronic disease course. Umbilical eczema should be distinguished from contact dermatitis of the skin near the navel, which has a history of contact with jeans with nickel buttons.
(4) Scrotal eczema: It is a common type of eczema that is limited to the scrotal skin, sometimes extending to the area around the anus, and a few can extend to the penis. The clinical manifestations often present as chronic eczema symptoms. The skin has deep and wide wrinkles, infiltrates and thickens, mostly dry, with thin scabs and scales, increased pigmentation, and occasional partial depigmentation. When there is exudation, the scrotal skin becomes edematous, swollen, scabbed, and cracked. I feel itchy, so I often scratch. Chronic process, often lasting for many years without recovery. This disease needs to be distinguished from riboflavin deficiency scrotal inflammation, which has a short course, no obvious infiltration or hypertrophy, often accompanied by glossitis, and takes effect about one week after oral administration of riboflavin.
(5) Female genital eczema: It is a common type of eczema in women. Involves the labia minora and adjacent skin. The affected area is infiltrated and thickened, with a clear boundary. It is frequently scratched due to itching, and visible erosion and scratch marks can be seen. Sometimes it appears edematous. The stimulation of menstruation and secretions can make the course of the disease chronic and difficult to cure. This disease can lead to secondary hypopigmentation and is easily misdiagnosed as vulvar leukoplakia, which should be taken seriously.
(6) Perianal eczema: limited to the skin around the anus, with a few cases affecting the perineum. The itching is unbearable. Often damp, the skin becomes wet and thick, and may cause cracking.
(7) Hand eczema: Skin lesions present as subacute or chronic eczema, mostly occurring on the back of the fingers and the palm surface of the fingers, and can spread to the back of the hands and wrists. The boundary is unclear or small patches of skin lesions may appear, and in chronic cases, there may be infiltration and thickening, and cracks due to finger movement. Swelling of the skin around the nails and irregular thickening of the nails. Hand eczema can also occur on the palmar side, with limitations, but the edges may not be very distinct, often rough, with small bumps, blisters, and infiltrative hypertrophy. It often cracks in winter. Due to frequent exposure of both hands to external substances, hand eczema, regardless of its cause, is often influenced by secondary factors, leading to changes in the condition and generally being stubborn and difficult to treat. If hand eczema occurs at the fingertips, also known as fingertip eczema, it occurs in the middle and side of the palm, with dry skin lesions, keratinous hyperplasia, and cracking, known as chronic recurrent blisters/keratinous hyperplasia hand eczema. If the skin lesion occurs on the foot, it is called foot eczema. If it occurs on the skin of the metacarpophalangeal joint from the adjacent two fingers to the distal end of the palm, and the shape of the skin lesion is apron like, it is also called apron like eczema. Hand eczema caused by frequent contact with animal meat and organs, also known as slaughterhouse eczema or butcher dermatitis.
(8) Calf eczema: It is also a common type of eczema. Mostly occurring in the anterior or lateral aspect of the tibia, often symmetrical, presenting as subacute or chronic eczema. Some cases of calf eczema often have varicose veins, also known as varicose eczema or gravitational eczema.
complication
If the patient frequently scratches the affected area, causing skin damage, it is easy to develop bacterial infections.