Eczema is a skin disease from allergic, acute or chronic. It manifests itself by red zones topped by a blister that cause intense itching. This is one of skin diseases most prevalent.

The signs of the disease

The acute eczema

The rash typically evolves into four phases:

Erythemateuse first with redness badly limited and very small blisters. At this stage itching are important;
Then the gallbladder come together, sometimes forming a bubble;
The opening will cause blisters oozing with crusts and laid bare the dermis at the lesion;
The scabs fall in one to two weeks, leaving scars pink.
The pruritus (itch) is a constant sign. Scratching and rubbing after causing a vicious circle pruritus – scraping – eruption – itching.

The intolerance vis-à-vis irritants is common. The assault of a psycho, external changes of temperature and humidity, bacterial infections, skin and clothing wool exacerbate the original injury.

Eczema is surinfecter (impetiginisation) and especially to generalize (erythroderma).

The chronic eczema

Form dry skin has red placards and crusty ill-defined, with a scaling variable;
Form lichenifie: placards thick skin, travelled Path;
Form dysidrosique: blisters on the side faces fingers, which is breaking can form crusts or cracks.
The constitutional eczema (atopic dermatitis)

Atopic dermatitis is a skin disease that evolves on a chronic or recurrent outbreaks. It occurs on a particular field, genetically predisposed, said atopic, characterized by a high rate in the serum of a variety of antibodies, immunoglobulin E (IgE).

The terrain atopic promotes the development of atopic eczema, asthma, allergic rhinitis, allergic conjunctivitis at the same patient or so separated from one or more family members.

The eczema begins in 70% of cases before 6 ° months of life, reaching first cheeks and forehead and then winning major folds bending. The surges were punctuated by climatic factors and psychoaffectifs.

The forecast is variable. Eczema can disappear to 3-4 years, it may be replaced by an asthmatic disease. It may also persist into adulthood.

Among adolescents and young adults, pruritus and lichenification are the two dominant elements. The severe chronic itching leads and contributes to the character lichenifie of eczema: the face, neck, creases bending and trunk are the elective seats. The cheilitis (violation lips) is common. The skin is xerose major skin is dry, rough, very itchy.

Some symptoms are frequently found in atopic dermatitis:

The dryness of the skin;
The keratosis pilaris: small caps cornes follicular give the skin a sensation râpeuse, especially on the external surface of arm, neck thighs, buttocks;
Signs eye and peri-ocular;
A dermographisme: when you press the skin with an edge, a trait appears bright red with swelling of the skin (like after a stinging nettle);
An aggravation of injuries under the influence of environmental factors and emotion;
A itching to perspiration;
An intolerance to wool;
A prurigo (repeated appearance of red lesions, topped by a blister, often located in the legs).
Among the biological signs, hypereosinophilia and raising the rate of total IgE, characteristic of atopic ground, are found in 40 to 80% of cases

The complications of atopic dermatitis are mainly infectious: erythroderma, superinfections by staphylococci, herpes, fungal infections, and so on.

In most cases, the spontaneous evolution of the disease is to cure within a few years. It is impossible to determine the age of the disappearance of dermatitis for a patient.

The contact dermatitis

It is a delayed hypersensitivity reaction-type cellular vis-à-vis an allergen externally. A latency period of a few days to several years between the time of first exposure to allergenic product and the reexposition which induced eczema.

Patients often find it hard to believe that they have become allergic to products they have handled for years or to drugs used for example to treat their eczema, yet the constituents of topical (products applied to the skin) represent a major cause of contact dermatitis.

We must review with the patient all products that could be a source of affection.

The list is very long. For example:

The drugs (antibiotics, phenothiazines, anesthetics, antihistamines);
All drugs in local application or by the molecule drug itself or by recipients, preservatives or dyes);
The rubber masks resuscitation, epoxy resin nasal canola, metal electrodes for ECG or GET … ;
The tape;
The balsam Peru;
Disinfectants (formalin);
The beauty products, dyes … ;
The cosmetic products (depilatory creams, nail polish, deodorants): excipients (lanolin), preservatives, dyes, perfumes natural (petrol lemongrass, thyme) or synthetic surface-active agents of some shampoos … ;
The household products;
The clothing and underwear;
The substances dealing textiles (dyes, etc.).
The cleaning products (detergents, washing);
The shoes (tanning products, rubber, plastics, dyes);
Plants: ivy, oak, ambroise, primrose … ;
The dietary protein (mutton, pork, turkey, chicken, fish, plants);
The industrial substances (chrome, nickel, mercury, rubber, epoxy resins, etc.)..
After questioning very complete, the doctor uses a test patch or patch tests.

Eczema contact Photoallergic phototoxic and is caused by exposure to light after local application of certain chemicals. It takes the appearance of an exaggerated response to sunlight. It must be distinguished from photosensitivity reactions caused by taking medication through.

The Photoallergic contact dermatitis is due to the after shave lotions, sunscreens and sulfonamides used as topical. The phototoxic contact dermatitis is caused by perfumes, coal tar, psoralens, oils protection.

Special forms

Eczemas by internal reactogenes

A eczema occurring after administration of the allergen through general, in a patient previously sensitized by skin contact with the allergen, defines eczema by internal reactogenes. It is important to note that awareness by contact before the introduction by General (oral, injections, respiratory tract, dental amalgams, tattoos, prosthetics …).

The allergen triggering the reaction is either the allergen that previously induced sensitization by contact, or an allergen different but sharing with the first awareness group (chemical structure close).

The potential allergens are many: drugs, food additives (anti-oxidants, preservatives, dyes, contaminants), metals (nickel, chromium), orthopedic implants, dental amalgam of metals, copper IUD, pace-makers, lens implants, extraneous metal …

The diagnosis is difficult and requires careful investigation allergologic

The total ouster of the allergen responsible is the only guarantor of the definitive cure. The removal of a prosthesis responsible obviously raises difficult issues.

Eczemas microbial and mycotic

They are associated with eczema an awareness of the products secreted by microbes and fungi. The infected responsible for eczema may be skin or not.

In the case of home skin, it is carrying a sick dermatitis microbial who, near or distance, allergic skin reactions to heal only by the treatment of microbial initial outbreak.

Staphylococcus;
Streptococci, and so on.
Eczema often the main seat folds, the perimeter of leg ulcers and natural orifices. It is often difficult to say whether this is an infectious dermatitis, which was eczematisee or eczema, which was surinfecte. The diagnosis and treatment are difficult.

[?] Treatment

The best treatment is prevention: it is to remove all contact with the allergen detected. A desensitization is sometimes possible. Avoidance can be very complicated when there polysensibilisation. In the case of an allergen vocational rehabilitation measures can be considered.

In the case of atopic dermatitis, it must avoid the maximum exposure to air allergens (pollen, dust mites…).

The local treatment

It is based partly on the antiseptic to prevent infection and partly on local corticosteroid.

The antiseptic

A phase erythematous, antiseptics, aqueous solution or alcohol are prescribed in a systematic way before dermocorticoïdes: Hexamidine, chlorhexidine, Septeal …

The Silver Nitrate is effective to dewater very localized lesions oozing (attention indelible stain on clothing).

Corticosteroids premises

The dermocorticoïdes have an anti-inflammatory remarkable. The local corticosteroid is the only effective treatment in atopic dermatitis. There are several forms of corticosteroids local cream in acute forms oozing, lotion in areas pileuses, ointments in chronic forms lichenifiees. There are products of different activity (class I very strong, low-class IV). Good use is to strike hard at the beginning and then make a gradual reduction to find a maintenance dose correct.

Side effects are known and can be avoided by prescribing appropriate:

Premises: atrophy of the epidermis and dermis, purpura and telangiectasia, hypertrichosis (appearance of hair), acne, perioral dermatitis (around the mouth), cataract and glaucoma in the case of applications on the eyelids, allergy or derivative corticosteroid the vehicle …
General: digestive complications, infectious, metabolic, endocrine in case of prolonged treatment.

The toilet and hygiene

The skin should be lubricated with oil bath or ointments emollient. The treatment of dry skin with a moisturizer is essential. Surgras soaps and bath oils are useful. The water and soap are assechants and should be avoided.

The nails should be cut flush to avoid aggravating the injury scratch.

The oral treatment

He especially designed to avoid aggravating factors: food, climate, stress, sweating.

If an oral treatment is necessary, it will rely on antihistamines to calm itching.

The oral corticosteroids should be avoided as much as possible.

The PUVAtherapie is sometimes used (psoralen and ultraviolet A). The cyclosporine is sometimes proposed in very severe.

In case of infection, antibiotics are used.

The spa treatments can have a beneficial effect: Avene, Inverness, La Roche-Posay, Molitg-les-Bains, Saint-Gervais, Uriage …

Special precautions
The risk of herpes in atopic makes him avoid contact with people with a herpes outbreak and more particularly herpes labialis. It is important to immediately stop local corticosteroid. The acyclovir may be necessary.