ECZEMA
The term eczema literally means to “boil over”. When simple dermatitis “boils over” with added oedema exudation and crusting, the condition is acute eczema and when dermatitis gets associated with hyperstasia and hyperkeratosis, the condition is chronic eczema.
In fact, clear cut demarcation between dermatitis and eczema is hardly possible. Chronic dermatitis of long standing often turns eczematous however, in case of eczema, an element of hypersensitivity to one or more allergens (exogenous or endogenous) is superimposed over and above the inflammatory reaction of simple dermatitis.
AETIOLOGY OR CAUSES:-
Hypersensitivity reaction to a foreign protein is the root cause of eczema. The offending protein may be derived from chemicals, drugs, plants, synthetic garments or infecting microorganisms.
1. DRUGS AND CHEMICALS:-
In fact, any drug can cause hypersensitivity reaction in a sensitive individual. Certain drugs more prone to produce such a reaction (e.g. penicillin, streptomycin, sulpho group of drugs, chloramphenicol chlorpromazine, B complex vitamins, liver extract, iodine, procaine and other local anaesthetic agents etc).
Certain chemicals (e.g. alkalies, solvents, soaps, bleaching agents, detergents, formalin, etc) can also cause eczema. Silimilarly, certain cosmetics (e.g. talcum powder, lip stick, nail paints, hair dyes and perfumes) can cause eczema.
2. PLANTS:-
several flowers (even rose), fruits (e.g. banana, pel of orange or lemon) and vegetables (e.g. onion, garlic, carrots, etc) can cause eczema.
3. GARMENTS:-
synthetic clothes (e.g. nylon, terylene, terycotton), dyes used for colouring and certain accessories used in garments (e.g. nickel clips, zips or hooks, rubber or plastic acessories) can cause eczema. Rubber shoes or shoes made of other synthetic materials can cause a special type of eczema known as shoe dermatitis.
4. SKIN INFECTIONS:-
chronic infective conditions of the skin such as impetigo or a patch of ringworm may undergo eczematous changes after some time.
TYPES OF ECZEMA:-
a. EXOGENOUS ECZEMA:-
- Eczema caused by exogenous allergens.
- The offending allergens are derived from substances that come in close contact in day to day life.
- Common examples of exogenous eczema are contact eczema, infective eczema and eczema caused by drugs (eczema medicamentosa).
b. ENDOGENOUS ECZEMA:-
- Eczema caused by constitutional factors operating from within.
- Certain factors render a person hypersensitive to a known or unknown allergen, present even in a minute amount. Often the nature of the offending allergen in any particular case remains unknown. The factors causing this type of sensitization may either be familial or acquired. Consequently, there are two types of endogenous eczema, atopic and acquired.
1. CONTACT ECZEMA:-
contact eczema is caused by hypersensitivity reaction to a known allergic substance placed in close contact with the skin for some time. The offending substance may be a drug, a chemical or a micro organism. Certain very common articles in day to day use (e.g. synthetic clothes, washing materials, cosmetics, dyes, plastic or rubber shoes, condoms, nickel straps and clips, artificial jewellery, drugs and chemicals) can cause this type of eczema.
2. ATOPIC ECZEMA:-
this eczema is due to inherited hypersensitivity to a known or unknown allergen. This type only when triggered off by certain precipitating factors such as changes in humidity or temperature, trauma (cuts, abrasions or cracks in the skin), skin infections or psychological stress. Atopic eczema is frequently associated with other atopic disorders such as bronchial asthma or hay fever. Reagenic antibodies to certain common antigens (e.g. pollens, house dust, items of food, etc.) are found to be increased.
a. INFANTILE ECZEMA:-
Infantile eczema occurs in newborn infants and young children. Face is the commonest site. The eczematous patch usually appears over one or both the cheeks and spreads to involve the forehead, scalp and the chin. Initially the affected part of the skin is red which is soon followed by papulovesicular eruptions and still later by minute cracks at the surface. Exudation of serum may occur from those cracks (weeping eczema). Still later, there is formation of crusts over the lesions, itching is severe. In most cases, infantile eczema clears out within a short time.
b. FLEXURAL ECZEMA:-
Flexural eczema occurs in a adults and affects the flexor surfaces of the elbow and the knee joints. Occasionally the face, neck and the upper part that occurs during adulthood. The affected part of the skin assumes a leathery texture (lichenification). It is thick and dry, pale and pigmented. There is no sweating over the affected part.
c. ECZEMA OF THE HANDS AND FEET(POMPHOLYX):-
This type mainly affects the palms and soles. Vesicular eruptions are present but the vesicles are not raised above the surface and are not likely to rupture because of the thick horny layer of the skin at the soles or the palms. They appear just as flat elevations scattered all over the palms and soles and do not exude any fluid except in an occasional severe case. This type of eczema is usually caused either by the irritating effect of soap, detergents or chemicals or as a complication of chronic ringworm infection.
d. NUMMULAR ECZEMA:-
The lesions are typically coin-shaped. Raised patches appear over the extensor surfaces of the limbs, claves and the shins. Smaller lesions coalesce to form bigger ones. Numerous vesicles are seen erupting out of the lesions. It is a recurrent type of eczema occurring only in adults. Itching is present but is not severe.
SOME SPECIAL TYPES OF ECZEMA:-
1. VARICOSE ECZEMA;-
Varicose eczema occurs in association with either varicose veins or varicose ulcers. Elderly and obese persons are usually affected. The lower half of the legs, particularly the inner sides are mostly affected. The eczema is due to irritation caused by chronic venous stasis. An element of contact dermatitis due to drugs used as local applications may also be superimposed.
2. INFECTIVE ECZEMA;-
Infective eczema occurs at the site of an infective skin condition such as a wound or a patch of ringworm. Eczema occurs due to hypersensitivity reaction to the offending microorganism or their toxins. Eczematous patch that develops around the ear lobule in case of Otitis interna is a common example.
SYMPTOMS;-
- A lesion starts either as a diffuse erythematosus patch or as a papule due to some irritation.
- Next, an exaggerated reaction occurs with formation of vesicles or a papule over and above the existing patch of erythema with intense itching. This signifies early eczematous change.
- Following this, there is oedema of the epidermis, exudation of serum from the vesicles (weeping eczema) and formation of crusts. These changes signify the acute stage of eczema.
- Ultimately, the whole process becomes chronic with thickening of the skin (leathery skin), or acanthesis, increased pigmentation and scaly excoriation (lichenification). The oedema of acute stage decreases, instead, vasodilatation occurs. These changes signify the chronic stage of eczema.
INVESTIGATIONS:-
- The skin patch test should be done in case of a suspected allergen particularly in case of contact eczema.
- The prick test is useful in atopic eczema. The test is done by placing a drop of commercially prepared dilute antigen (a variety of such antigens are now available) and giving a prick with a needle. If the reaction is positive, a flare reaction occurs within 10 minutes. The radioallergosorbent technique (RAST) may be employed instead of naked eye observation.
- Culture of the skin scrapings may be done to know the nature of the superadded infecting agent, bacterial, fungal or yeast.
TREATMENT:-
- In case of contact eczema use of soap and synthetic garments should generally be avoided.
- During the acute stage, wet dressings with either potassium permanganate solution (1:8000) or calamine lotion are more useful.
- If secondary infection starts, a corticosteroid cream and neomycin should be advised.
- Prednisolone should be given orally in short courses.
- Avoid oily foods, fish, brinjal, citrus fruits.
HOMEOPATHIC TREATMENT:-
1. ARSENIC ALBUM:-
Itching, burning, swellings; oedema, eruption, papular, dry, rough, scaly; worse cold and scratching. Urticaria, with burning and restlessness. Epithelioma of the skin. Gangrenous inflammations. Ulcers with offensive discharge. Psoriasis.
2. ARSENICUM IODUM:-
Dry, scaly, itching. Marked exfoliation of skin in large scales, leaving a raw exuding
Surface beneath. Debilitating night-sweats. Eczema of the beard; watery, oozing, itching; worse, washing. Acne hard, shotty, indurated base with pustule at apex. Debilitating night-sweats.
3. CALCAREA CARB.
4. CALCAREA SULPH.
5. CICUTTA.
6. DUL CAMARA.
7. GRAPHITIS.
8. HEPAR SULPH.
9. MEZERIUM.
10. PETROLINUM.
11. PSORINUM.
12. RHUS TOXI.
13. SULPHUR.
14. BOVISTA.
15. CALADIUM.
16. CARBO VEG.
17. CAUSTICUM.
18. KALI SULPH.
19. LYCOPODIUM.
20. MERC SOUL.
21. SEPIA.
22. STAPHYSAGRIA.
23. THUJA.
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