eczema
Introduction
Introduction to Eczema Eczema is a common allergic skin disease that is easy to relapse. It occurs in the head, limbs and perineum, and is often distributed in a general or symmetric manner. Eczema is a multifactorial disease and is generally thought to be closely related to allergies. Partly related to endocrine dysfunction, autonomic dysfunction; genetic factors are also one of the factors. The complex cause has brought certain difficulties to the treatment of this disease. basic knowledge The proportion of illness: 0.08%-0.1% Susceptible people: no special people Mode of infection: non-infectious Complications: herpes simplex dermatitis
Cause
Eczema cause
Environmental factors (30%):
Many studies have confirmed that environmental factors are one of the important reasons for the increase in the prevalence of eczema. The environment includes the group environment and the individual environment. The human community environment pathogenic factors refer to a wide range of outdoor air, water, soil, radioactive sources, and large areas. Sensitized pollen vegetation, large area of airborne allergens, etc. Individual small environment refers to the living environment of individuals. Because people live indoors for about 2/3 of the time, the small environment of individuals has a closer impact on eczema. The impact of environmental factors mainly refers to the increasing and complex environmental allergens, including:
1. Artificial fabrics, artificial leather products, printing dyes related to clothing, brighteners, anti-caries agents, anti-mold agents, firming agents and other modern environmental allergens.
2, artificial food, convenience food, anti-season food, fertilizer for food production, pesticides, artificial feed, feed additives, preservatives for food processing, mineral oxidants, spices, pigments, ripeners, thickeners, etc. , modern diet environmental allergens.
3, artificial building components, chemical coatings, plastic products, rubber products, rayon, glue, waterproofing agent, electromagnetic radiation generated by household and office electronic equipment, room cleaners, insecticide functions, environmental changes in modern living Should be original.
4. The gas produced by the combustion of chemical fuels, the manufacture of automobiles, boats, aircraft materials, asphalt pavements of roads, pollen of green plants on the roadside, and other environmental allergens of modern transportation.
5. All the enzyme preparations for detergents in the detergent factory, toluene diisocyanate in plastic factories, latex in rubber factories, antibiotics in pharmaceutical factories and other chemical raw materials, etc.
6, some modern lifestyle-related environmental allergens, such as the use of cosmetics and cats, parrots, etc., when the human body lives under the influence of such adverse environmental factors, can lead to immune dysfunction, and ultimately cause environmental Allergic reactions, causing eczema.
Infection factor (25%):
Some eczema is associated with microbial infections, including Staphylococcus aureus, Malassezia, airborne fungi such as Alternaria, Cladosporium, Penicillium, Aspergillus fumigatus, Fusarium, yellow-green Mildew, Aspergillus niger and Rhizopus oryzae, there are three main aspects:
1. The detection rate of microbial lesions in some patients with eczema is higher.
2, skin microbes have a pathogenic effect on some eczema, domestic scholars reported that the total detection rate of Staphylococcus aureus in the lesions of patients with non-atopic eczema dermatitis was 31.6%, the total bacterial detection rate was 70.6%, Among the bacteria other than golden yellow grape, Staphylococcus epidermidis accounted for 62.7%, hemolytic streptococcus accounted for 1.7, other cocci accounted for 19.6, and bacilli accounted for 5.1%. Among patients with eczema without clinical suspicious bacterial infection, acute eczema dermatitis patients The positive rate of Staphylococcus aureus and total bacteria was 46.1%, 76.9%, respectively. They were higher than those of chronic eczema and subacute eczema dermatitis. The lesions of Staphylococcus aureus and total bacteria were the highest in patients with discoid eczema. 52.9%, 100%; higher than other types of eczema, the detection rate of Malassezia in the seborrheic dermatitis lesions was 81.3%; the detection rate of Malassezia in the tinea versicolor lesions was 96.3% The detection rate of Malassezia in the skin lesions of eczema dermatitis was 59.7%; the detection rate of Malassezia in acute eczema lesions was 56.3%; the detection rate of Malassezia in hand eczema lesions was 47.6%, Some skin microorganisms have a pathogenic effect on eczema, and Fujisanva et al. The leaching solution antigen of airborne fungi such as Aspergillus variabilis, Penicillium chrysogenum, in the summer recurrence or aggravation of eczema dermatitis patients in the patch test, intradermal test and challenge test, the results of the intradermal test rapid response positive rate in the eczema-like Dermatitis, atopic dermatitis patients were higher than the normal control group, and the highest in patients with atopic dermatitis, 68.2%, while the positive rate of intradermal test delayed response (72 hours observation) in eczema-like dermatitis and atopic dermatitis The patients were higher than the normal control group, with eczema-like dermatitis up to 40%, and the patch test and the challenge test were also positive in some patients. The results showed that eczema dermatitis was associated with airborne fungi, and local contact with fungi was also possible. Dermatitis, inhalation of fungi can also cause dermatitis.
3, anti-microbial treatment is effective for some eczema dermatitis, atopic dermatitis system with extensive exudation of skin lesions often use antibiotics to receive better results, because the affected area has a bacterial infection, it is now clear, Ma Lactobacillus is associated with seborrheic dermatitis; bacterial infections, especially Staphylococcus aureus infections, are associated with discoid eczema, which is an eczema-like lesion that occurs around the primary skin infection, and lesions are often secondary to the primary Skin infection; skin sputum rash has a positive primary dermatophyte infection, no fungus can be found in the new skin lesions, and the skin lesions disappear with the regression of the primary skin dermatophyte infection.
Dietary factors (15%):
There are many kinds of human foods, which can be generally divided into plants, animals, minerals. In modern foods, some chemically synthesized foods such as saccharin, acetic acid, citric acid, flavors, synthetic dyes, etc. are often used. It can cause allergic reactions in food, which leads to the production of eczema. It is reported in the literature that foods that are prone to allergies in China are mainly protein-rich foods such as milk, eggs, etc.; seafood-like foods such as onions, garlic, onions, Mutton, etc.; special irritating foods such as pepper, wine, mustard, pepper, ginger, etc.; some raw foods such as raw onions, raw garlic, raw tomatoes, raw shell fruits, such as almonds, Chestnuts, walnuts and certain fruits such as peaches, grapes, lychees, bananas, pineapples, longan, mangoes, strawberries, etc.; some bacteria-rich foods such as dead fish, dead shrimp, dead crabs and unfresh meat, Some fungi-rich foods such as mushrooms, vinasse, rice vinegar, etc.; some foods that are rich in protein and not digestible, such as scorpions, squid, squid, etc.; seed foods, such as various beans Peanuts, sesame seeds, etc. In addition to causing food allergies, these food biochemical studies have found that histamine can be isolated from the skin of bananas and contains high levels of histamine in bananas, pineapples, eggplant, wine, and yeast. Chicken liver, beef, and sausage also contain high levels of histamine, which causes eczema to occur.
Drug factors (15%):
Drug factors are the main cause of certain eczema, especially eczema-type drug eruptions. Generally, any drug has the possibility of causing eczema drug eruption, but the common ones are:
1, ethylenediamine antihistamines such as aminophylline, piperazine; benzoin inhalation; procaine, acesulfame, urea; p-aminosalicylic acid; azo dyes in foods and drugs; chlorothiazide , chlorpropamide, tolbutamide, chloral hydrate, chloroiodohydroxyl, iodide and organic iodide, X-ray contrast agent; streptomycin, kanamycin, gentamicin, paromomycin, Nitroglycerin tablets, aminophylline suppositories and ethylenediamine hydrochloride, aminomercury, Peru balsam, benzocaine and p-aminobenzoic acid, sunscreen, chlorobutanol, halogenated hydroxyquinoline cream, iodine, sulfuric acid Streptomycin, nitroglycerin ointment, etc., mainly cause systemic contact drug dermatitis.
2. Ampicillin, amoxicillin, nickel, heparin and mercury mainly cause Buddha's syndrome.
3. Penicillin, methyldopa.
Genetic factors (10%):
Certain types of eczema are closely related to heredity.
Prevention
Eczema prevention
The disease occurs in the summer, and there are multiple allergies. The incidence of infants and young children is higher than that of adults.
1. Remove the cause
(1) Although the cause of eczema is not easy to be clear, we should still ask for a detailed history, conduct necessary systematic examinations, try to find possible causes and remove them.
(2) People with allergies should avoid physical contact with substances that are allergic to them (see sensitizers in the cause) in addition to clothing, food, shelter, etc., as well as physical exercise to improve allergies.
2. Avoid stimulating factors
Once eczema occurs, as a patient, try to avoid irritating factors, including scratching, boiling water, soaping, drinking and spicy food, so as not to aggravate the condition of eczema.
3. Early diagnosis, early treatment
According to clinical itching severe, pleomorphic damage, oozing tendency, good limb flexion and easy recurrence, easy to diagnose, densely distributed red papules, herpes simplex with severe itching, early treatment, due to early eczema Most of them belong to the acute phase or subacute phase, so the topical treatment should be based on the corresponding principles.
4. Avoid allergens Allergic constitution or family history of allergies, to avoid a variety of external stimuli, such as hot water scalding, scratching, sun exposure, etc., try to avoid sensitizing and irritating food.
5. Life should be regular, pay attention to work and rest .
6. Clothing should be loose to reduce friction and stimulation, and do not allow chemical fiber and wool to directly contact the skin.
Eczema, especially in chronic cases, has not been cured through years of treatment. Patients often lose confidence. In fact, eczema is not an "incurable disease". Because the cause of the disease is extremely complicated, it is difficult for treatment. Patients should cooperate with doctors. Establish a cure confidence, as far as possible to avoid all kinds of suspicious pathogenic factors, such as hot water washing, excessive use of soap, hard work and improper use of external medicine, etc., to avoid mental stress, overwork, food, do not eat chili, fish , shrimp, crab or tea, coffee, alcohol, clothing should not use silk, wool and chemical fiber products, usually keep the stool smooth, sleep enough, pay attention to clean and moisturizing skin in winter, these can reduce the recurrence of eczema, to cure the goal of.
Complication
Eczema complications Complications, herpes simplex dermatitis
In addition to common Staphylococcus aureus skin infections, it is rare to have herpes simplex virus infections, convulsions, or infectious plaques. Some children may be aggravated if they are allergic to food or something in the environment. Symptoms of eczema.
Symptom
Eczema Symptoms Common Symptoms Symptoms of Appearance Skin Moisture Hemorrhagic Papular Pustules Chest Papria Itching Infants Hot Red Spotted Skin Rash Skin Wrinkles During Pregnancy... Scales
1. According to the different course of disease, it is divided into acute, subacute and chronic.
(1) acute eczema: acute onset, often symmetrically distributed, with head, limbs and genital area, in the course of disease development, erythema, papules, blisters, pustules, erosion, crusting and other types of rash can appear sequentially, However, there are often 2-3 kinds of rashes coexisting at the same time or at a certain stage with a certain type of rash, often due to severe itching and often scratching, making the condition worse.
(2) Subacute eczema: Acute eczema inflammation, after the symptoms are alleviated, the rash is mainly papules, scales, and scars, but it still appears to be smashed after scratching.
(3) Chronic eczema: It is caused by repeated episodes of acute and subacute eczema. It can also show chronic inflammation at the beginning. The skin of the affected area is infiltrated and thickened, and it becomes dark red and pigmented. When it lasts for a long time, the skin lesions change. Large, dry and prone to chapped, common in the calf, hands, feet, elbow, vulva, anus and so on.
Patients with chronic eczema should pay attention to "spleen deficiency and wetness".
The skin of the wet person has more blisters, and the sputum swells out of the body after sputum. The patient will have fatigue and poor appetite. The Chinese medicine treats with dehumidification and itching soup.
Patients with chronic eczema should pay attention to the problem of "spleen deficiency and wetness". The patient's skin will be dull and not red, with little exudate, pale yellow desquamation or crusted patches, pale face and bad appetite. , abdominal distension, soft bowel movements, Chinese medicine is often treated with dehumidification stomach soup.
In addition, some patients with chronic eczema belong to the "blood dryness" type, the skin will become rough, hypertrophy, scratches on the surface, bloody, dull complexion and even pigmentation.
Chinese medicine recommends that patients with eczema should avoid drinking alcohol, coffee, spicy and fried foods, diet should be light, eat more fruits and vegetables, durian, mango, longan, lychee and other hot fruits to eat less, so as not to disease, "fire on the fire", patients You can eat mung beans, melon, lotus seeds, bitter gourd and other hot and humid food.
2. Medical diagnosis of eczema clinically, the symptoms of eczema can be divided into the following types:
(1) Infant eczema: Infant eczema Chinese medicine called milk thistle, usually occurs in the second or third month after birth, occurs in the face and skin wrinkles, can also affect the whole body, generally gradually reduced with age Healed, but a few cases continue to develop into childhood or even adulthood.
1. Exudative eczema: common in obese infants, starting from the cheeks, erythema, papules, and herpes, often revealing a lot of exudate of red and erosive surface due to itching, and serious cases can affect the entire face Even the whole body, if there is secondary infection, pustules and local lymph nodes can be seen, and fever.
2. Dry type eczema: more common in thin babies, occurs in the scalp, eyebrows and other parts, showing flushing, desquamation, papules, but no obvious exudation, can be mildly infiltrated and hypertrophic when there is chronic, there is cleft palate, Scratches or blood stasis, often caused by paroxysmal intense itching, causing baby crying and restlessness.
(2) Child eczema: It is a kind of allergic skin disease in children. The skin development of children is not perfect. The stratum corneum of the outermost epidermis is very thin, the capillary network is rich, the endothelium is rich in water and chloride, so it is prone to allergic eczema. reaction.
(3) breast eczema: more common in breast-feeding women, areola moist, erosion, crusting, a little longer can be thickened, cleft palate, pain during feeding, long-term unhealed, subcutaneous induration, should consider the possibility of concurrent eczema-like cancer Therefore, the eczema on the breast should be vigilant and promptly checked.
(4) scrotal eczema: acute people have swelling, running water, crusting, chronic thickening, mossy, very itchy and easy to relapse, often associated with local hyperhidrosis, vulvar stimulation, neuroendocrine disorders, chronic prostatitis, etc. .
(5) Female genital eczema: more common size of the labia and nearby skin redness, erosion and chronic thickening, itching, often associated with fungal vaginitis, increased vaginal discharge and endocrine disorders.
(6) Anal eczema: The eczema around the anus is red and swollen in the acute phase, erosive, infiltrating in the chronic phase, hypertrophy, and even cleft palate, itching and pain, especially after the stool, due to frequent scratching, the skin can become thick or variable Thin, shrinking and shiny, children's anal eczema is more related to aphids, adults are more related to acne, sweating.
(7) hand eczema: occurs in the palm of the hand is easy to infiltrate thickening, excessive keratinization to form cleft palate, finger eczema often repeated blisters, scarring, thickening, desquamation, involving the nail bed can affect nail development, resulting in the deck Rough, uneven depression, contact with water, soap, washing powder, etc. often make eczema worse.
(8) Eczema in the leg and foot: Before the sputum and the ankle, it is often caused by varicose veins or trauma of the lower extremity. It is thick, mossy, and can also be eroded, flowing, easily infected or ulcerated. Stubborn and refractory.
(9) Cleft palate eczema: related to allergies, caused by contact with detergents, soaps, dyes, paints and sunlight in daily life. In the course of the disease, trauma, endocrine disorders and other factors can aggravate the condition.
Examine
Eczema check
Laboratory tests: no specificity, eosinophils may increase in the blood.
Diagnosis
Eczema diagnosis and identification
According to the morphological nature of the original rash in the acute phase, it is easy to have exudate, itching is severe, symmetry and chronic infiltration, hypertrophy and other characteristics are not difficult to diagnose, acute eczema needs to be differentiated from contact dermatitis, chronic eczema needs Different from neurodermatitis, hand and foot eczema, sweat herpes easily confused with hand and foot spasm, the latter often unilateral onset, slow progress. It can have blister and dry desquamation. When it spreads to the hand, there is a great diagnostic value when there is clear damage to the edge of the foot. When the fungus is positive, it can be diagnosed.
Differential diagnosis
1. Contact dermatitis should be differentiated from acute eczema.
2. Neurodermatitis should be differentiated from chronic eczema.
3. Seborrheic dermatitis may have eczema-like changes, but the disease mainly occurs in the head, chest, back center, armpits, genital and other parts of sebum secretion, often starting from the head, down Spread, the damage is mainly characterized by yellow-red or bright red spots, which are covered with greasy scales or suede.
