3 Ways to Tell if It’s Eczema or a Skin Infection

Eczema is a skin condition that affects many infants and children. Although its symptoms of dry, itchy and flaky skin are usually mild, eczema can become more than just a nuisance. The more severe forms of this condition can lead to skin infections when bacteria, viruses and other germs enter the body through bleeding and cracking skin.

A skin infection can look a lot like the more serious form of eczema, making it difficult for parents to decipher their child’s symptoms. Luckily, there are a few guidelines to follow. If your little one is suffering from swollen, itchy, crusty and/or oozing skin, here are three ways you can tell if they have eczema or a skin infection.

Look for Visible Signs of Infection

Examining your child’s skin for signs of infection is the first step in determining whether your child is experiencing more than eczema. Of course, this isn’t always easy. Eczema is typically itchy, red and scaly. When it’s flaring, the skin may even appear weepy, oozy or crusty from all the inflammation.

Still, skin infections caused by bacteria usually present with a red, hot, swollen and tender rash that often is accompanied with pus. Skin infections caused by viruses usually result in red welts or blisters that can be itchy and/or painful. Meanwhile, fungal infections usually present with a red, scaly and itchy rash with occasional pustules. Overall, if your child has pus-filled blisters, yellow or orange-colored crusts, swollen red bumps or streaks of redness spreading across the skin, it’s possible that they’ve contracted an infection.

Check Your Child for Other Symptoms

Children who’ve developed an infection often experience other non-skin related symptoms that you can look for. The biggest telltale sign of an infection is fever. If your child has a rapidly spreading rash and a high fever, it’s important to seek immediate medical care. Flu-like symptoms — such as achiness, fatigue, general malaise and chills — also are signs of an infection.

If your child has swollen lymph nodes or is complaining of a sore throat, it’s also time to contact your pediatrician. In general, even if your child isn’t running a fever, a deviation from the normal symptoms of eczema may signal that something else is going on.

The Rash Isn’t Responding to Regular Treatments

Most kids with eczema have an established treatment routine. This may involve applying ointment or moisturizer, giving your child specialized baths, using wet-wrap therapy or undergoing another treatment prescribed by your pediatrician or dermatologist. While there is no cure for eczema, these treatments usually can provide some relief from its symptoms.

If your child’s skin rash seems to worsen in response to their treatment routine though, this could be a sign of infection. Why? Treatments for eczema might only aggravate an infection more.

Whether your child has a bacterial, viral or other form of infection, the treatments differ from those prescribed for eczema. Antibiotic creams and pills are used to treat bacterial infections. Antifungal creams and pills are used to treat fungal infections. And antiviral creams and pills — or just simple supportive care — are used to treat viral infections.

Overall, when in doubt, talk to your pediatrician or dermatologist. Or, in the case of high fever or other serious symptoms, seek urgent care. Not everything that is red and swollen is an infection, but it’s always best to make sure.

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Ringworm Vs Eczema | Forefront Dermatology

Dry, itchy skin conditions can leave you scratching your head wondering what exactly is going on. There are two skin conditions, nummular eczema, a form of eczema, and ringworm that can cause closely similar rashes, but knowing the difference is very important.

What is Nummular Eczema?
Nummular eczema is a condition in which people develop red or brown areas on their skin that are coin-shaped or oval, similar to the shape of ringworm. These spots or patches can appear on the arms, hands, legs, or torso. The skin appears dry and may have a burning or itching feeling. According to the National Eczema Association, nummular eczema most commonly affects men, usually between the ages of 55 and 65 years old. If women experience the condition, they typically notice it between the ages of 13 and 25 years old. Doctors do not know exactly what causes nummular eczema, but some triggers and risk factors may include dry skin from cold weather, some topical creams, history of atopic eczema and injuries to the skin.

What is Ringworm?
According to Dr. Giacomo Maggiolino, board-certified dermatologist with Forefront Dermatology, “Ringworm is a skin infection caused by a fungus. The name signifies the visual sign of this rash which includes a ring-shaped pattern that features a raised and scaly border.” Ringworm has the ability to occur anywhere on your body. Ringworm can happen to anyone, anywhere. It is not a regional problem. Your chances increase though if you live in a tropical area, spend time in hot and humid weather, or sweat heavily. It is also more common for people who play contact sports including wrestling and football.

Ringworm and Eczema: How they appear and how to tell the difference
Both nummular eczema and ringworm appear as a red rash in a ring or coin shape. Both patches can appear dry and itchy and can grow over time and appear in clusters. While it may seem easy enough to self-diagnosis, you should see your local board-certified dermatologist to get proper diagnosis and treatment. Your dermatologist may need to take a tissue sample to confirm their diagnosis.

Treatment for Ringworm vs Eczema
Ringworm is an extremely contagious skin infection, and it is important that you prevent spreading it to others. Without treatment, the rash tends to grow and cover a larger area or possibly infect other areas of your body. If you suspect that you may have ringworm, start by applying antifungal cream, ointment or spray for up to 4 weeks. If it persists or begin to cover a larger portion of the body, visit your local dermatologist to receive a stronger prescription cream or pill. Nummular eczema on the other hand requires a more proactive approach to prevent flare-ups and relieve symptoms while your body slowly recovers. It is important to use gentle soaps, fragrance-free moisturizers, keep rooms in your home cool and moist with a humidifier and wear fabrics such as cotton to reduce skin irritation. If your nummular eczema is effecting your life, your dermatologist may prescribe topical or oral corticosteroids or recommend phototherapy, a treatment that involves exposing the skin to UV light. If your nummular eczema becomes infected, your dermatologist may also prescribe topical or oral antibiotics.

Skin Struggles?
At Forefront Dermatology, we know that life is all about the moments when you don’t need us. That’s why we’re here for all the moments when you do. We offer comprehensive and compassionate care for all skin conditions and create customized treatment plans for all ages – even the tiniest of patients! Find a dermatologist near you today.

How to manage Eczema infection

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Eczema Infection

Eczema, also known as Atopic Dermatitis, a term marked by Dry, Red, Itchy and inflamed skin, itself a chronic condition that requires proper management, But When Such condition is caught by an Infection it only worsens it. The routine Eczema Treatment will not be effective in such condition and requires special care.

Infection is more common in wet eczema than Dry eczema because the former provides the Infection causing germs (Micro-organisms) a favourable environment to survive, grow and multiply.

One of the other common reason for the infection is the habit of uncontrolled scratching. Continuous scratching damages the layer of the skin which acts a barrier causing bruises.

Atopic Dermatitis

These Open bruises from scratching dermatitis permit germs and microbes resulting in infection.

Hence you might have noticed that the Eczema Infection is more common amongst the children because they don’t have control over scratching and also their skin has less resistance to germs.

Atopic Eczema in Children

Adults on the other hand somehow control the scratching, tempted by the itch in eczema. It is also common with the individuals who are currently on eczema treatment but have frequent sores and open wounds related to their eczema condition.

Atopic Eczema itself is not infectious or contagious (it cannot be spread to another person), but it can become infected if germs set in, which can pass on to person nearby as well. There are different kinds of infections that can develop with eczema also known as Atopic Dermatitis and these Infections can develop in or on eczema anywhere on the body right from the scalp to toe.

Causes of Eczema Infection

Infections in Atopic Eczema are caused by a variety of potential, bacteria, fungi or viruses. Coming up next are some of the common microbes which accounts for causing Eczema Infection.

• Bacterial – Staphylococcus aureus (Staph infection)
• Fungal – infections, such as ringworm(tinea)
• Viral – herpes simplex virus

Micro-organism causing Eczema Infection

• Bacteria – Staphylococcus aureus, Streptococcus

Staphylococcus aureus is a bacterium which is found in almost all people with Eczema. They cause colonization, although may not infect the lesions. In 20% of healthy adults without eczema, Staphylococcus aureus lives as a commensal organism (The microorganisms which live on the skin without harming the host). However, when eczematous skin gets damaged these bacteria can get in and cause infection.

• Viruses – commonly Herpes Simplex Virus 1 (HSV 1)

Presence of Eczema lowers the resistance to viral infections. HSV 1 virus spreads from skin to skin contact. HSV which commonly causes Cold sores can cause severe infection in eczematous rashes. This is also known as Eczema Herpeticum. It is an extensive skin eruption with vesicles which occur on eczema rash. Eczema Herpeticum commonly occurs in infants and children with severe eczema. These clusters of small blisters are itchy and painful.

• Fungal infections – Candida (Thrush) can develop in warm and moist skin folds. When the eczema is in flexures such as elbows, behind knees or around abdominal folds, candida can freely infect eczema especially when the skin is damaged by scratching. If the person lives in warm and humid climates, increased sweating can cause infection to spread.

Tinea (Dermatophytes) or Ringworm can also infect eczema rashes causing ring like reddish patches or infect in between toes leading to Athletes foot.

When Eczema rash is infected, it worsens Eczema and allowing it to spread more quickly and making the Treatment and healing process difficult.

Diagnosing infection in Atopic Dermatitis is not always straightforward. But there are a few signs and indications which you can look up to and take prompt actions once you notice them. It’s critical for people with eczema or caregivers of children with eczema to get familiar with the indications of infected eczema so you can look for the proper treatment. Proper treatment at the right time during the infection will help to avoid further complication.

The symptoms of infected Eczema will be very different from normal eczema which suddenly starts getting worst spreading the rash across the body in no time.

Signs and Symptoms of infected Atopic Eczema

• The skin area becomes more inflamed (swollen, hot and red)
• The eczematous lesions get blisters, ‘boils’ and cysts with red or yellow color spots with pus
• pus/weepy fluid (often yellow or green) coming out of the skin and crusts or scabs
• painful skin – “like you’ve got cuts everywhere”
• Very tired and unwell feeling drains the person
• Sudden flaring of eczema all over the body.
• Lesions become sore and painful with a tender to touch in Eczema Herpeticum.
• A person with infected eczema will also experience extreme Itching and burning
• In more advanced cases, a person may experience more severe symptoms including fever, chills, aches, and fatigue

Complications in Eczema Infection

Atopic Eczema Infection may also lead to more dangerous complications such as a serious staph infection that may cause a blood infection known as sepsis (A life-threatening condition) if left untreated.

Some of the other complications include

• Resistance to the topical steroids due to continuous and prolonged use
• Increase in blisters and Itching out of control
• Prolonged Eczema flare and Scarring
• It may cause a growth problem in some children’s too.

When to Approach a Physician?

Because it’s not always obvious if eczema is infected, it’s important to get help from medical professionals.

If an individual is suffering from chronic eczema, he should approach the physician immediately in case he develops a fever, experience chills, Experiencing tiredness/fatigue, or develop signs of infection, such as oozing blisters and excessive itchiness.

Infants and young children with infected Eczema should be taken for medical care as soon as possible and monitored for a clinical outcome more carefully when encountered with Eczema Infection.

Check your Eczema score to understand about your condition well. Manage your eczema by planning the eczema treatment that best suits you.

What’s Causing Your Armpit Rash (And What to Do about It)

Medically reviewed by Kristin Hall, FNP Written by Our Editorial Team Last updated 8/9/2020

Rashes are embarrassing and can be maddening. While a skin rash in, under or on your armpit might not be visible to the people around you, you know it’s there, it’s ugly and the itch is likely driving you crazy. 

It’s one thing to have a medical condition such as an underarm rash; it’s another to know when it’s appropriate to see a healthcare provider about it.

Understanding some of the potential causes of your rash can help you decide if sharing your itchy little secret with a healthcare provider could provide some relief. 

Spoiler: it likely would. 

Common Causes of Armpit Rashes

Dermatitis 

Dermatitis is a general, medical term for a rash, and as you might imagine, there are many types of dermatitis. 

Dermatitis is red and itchy, but exact characteristics of the rash may differ by cause. 

These rashes are caused by an immune response in the skin, which leads to inflammation. 

The proper treatment for dermatitis depends on what’s causing the reaction.

Allergic contact dermatitis. When you have an allergic reaction to something on your skin, it’s known as allergic contact dermatitis. 

Nickel allergy is one of the more common causes of allergic dermatitis, but so are poison ivy and oak. 

Contact allergies generally lead to a reaction within a couple days of contact, and typically result in red, itchy skin where the allergen came in contact with the skin, as well as potential blisters and bumps. 

You may spread remnants of the allergen to other areas of your body, including your armpits, with your fingers.

Mild allergic dermatitis will typically disappear within a few days or weeks, but if the rash is unbearable or lasts uncomfortably long, a healthcare provider can help determine a treatment to reduce the itching and pain. 

Treatments may include: oral and topical steroids, as well as moisturizing creams.

Eczema (Atopic Dermatitis)

Eczema is a type of dermatitis known as atopic dermatitis, and though it’s more common in children and adolescents, adults can have it too. 

It is considered a chronic condition, and people with eczema are at a greater risk for bacterial, viral, and fungal skin infections.

Eczema rashes are very itchy and can result in dark, rough or leathery patches on the skin; oozing or crusting and swelling. 

Certain environmental conditions may cause eczema flare-ups, so managing the condition is a matter of understanding what makes your eczema worse. 

After diagnosis, your healthcare provider may prescribe topical or oral steroids, antihistamines, or intensive moisturizers to manage your eczema symptoms.

Seborrhoeic Dermatitis

Seborrhoeic dermatitis, like eczema, is a chronic form of dermatitis. It affects the sebaceous or oil glands and is most common on the scalp, face and trunk, including the armpits. 

Dandruff is a sign of seborrhoeic dermatitis, and many people mistakenly believe it to be caused by dry skin, which leads them to try treatments that only make it worse. 

Severe seborrhoeic dermatitis results in a powdery or greasy scale forming, known as erythematous plaque, which can lead to bacterial infection if untreated.

Treatment of seborrheic dermatitis involves frequent washing to remove excess oils, and also over-the-counter and prescription drugs. 

Antifungal and anti-inflammatory medications may be prescribed to manage this skin condition.

Virtual Primary Care

Discover the cause of your armpit rash today

Drug Reactions

Your rash could also be due to a medication you’re currently on. Adverse cutaneous drug reactions are relatively common, and some research suggests nearly half (45 percent) of adverse drug reactions are seen in the skin. 

The most common skin reaction to medications are small raised bumps known as a maculopapular rash. 

Drugs that commonly cause skin reactions include antimicrobials, anticonvulsants and anti-inflammatories.

Generally, treatment for drug reactions simply involves finding an alternative drug that you’re not sensitive to. 

Your rash under your armpit should disappear within a week or two of stopping the medicine. Consult with a healthcare provider before stopping any medication they’ve instructed you to take.

Ringworm

Ringworm is an itchy fungal infection — if you’ve ever had jock itch or athlete’s foot, you’d recognize the itch. 

It’s not caused by worms, though the tell-tale sign is a rash with a wavy, ring-shaped outline. Patches of ringworm are generally flat with a raised border. As they clear, the inside of the patch will clear first. 

Treatment of ringworm is typically accomplished with a topical antifungal cream or ointment. The solution is applied to the affected area twice a day for a few weeks.

While over-the-counter antifungals may be effective, prescription medication may be needed for severe outbreaks.

Candida 

Candida is a yeast infection that can occur on your skin. 

It’s fairly common and most often occurs in warm, moist areas like your armpits. 

Also known as candidiasis, this yeast infection appears as red, itchy patches of skin. They may be rimmed with small pimple-like pustules, or develop a crust. 

Candida treatment involves using antifungal ointments and/or creams. 

Also, because repeat infections of candida are common, keeping your skin dry can prevent the moist atmosphere it thrives in. 

Lichen Planus 

Lichen planus is a noncontagious rash that is believed to be caused by an overactive immune response. Hepatitis, herpes and chickenpox can trigger lichen planus development. 

The rash consists of small, raised spots appearing in clusters. When they’re in the armpit, they’re commonly ring-shaped.

Lichen planus can last for years, but steroid creams can lessen the severity of the rash.

The Bottom Line on Armpit Rashes 

Rashes are never fun, but a rash on your armpit is a whole other level of groan. 

While they may look and even feel similar, there are actually several different causes of armpit rashes, which means treatment options aren’t a “one-size-fits-all” kind of deal. 

They can be a result of different fungal or bacterial infections, or can even be a side effect of — or reaction to — a medication you’re taking.

They can be a one-off case, or can be a chronic health issue. They can last for a few days, or even years if left untreated.

The point is, all of this information affects what kind of treatment options your healthcare provider is likely to recommend — from steroid creams, to antibiotics, specialized washes and everything in between.

If you’re dealing with an armpit rash and still aren’t certain what’s causing it, the best thing to do is contact your healthcare provider. They’ll be able to properly diagnose just what, exactly, is causing your underarm rash, and what your best treatment options are.

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

How to manage infected eczema

Red, itchy and inflamed skin is a well-known symptom of what’s generally called eczema. While there are a variety of conditions described in this way, the most common type of eczema is atopic dermatitis. Occasionally, complications develop and the skin becomes infected. When this happens, there are a number of treatment options available. Consult your doctor or medical practitioner if you have any questions regarding your eczema treatment plan, but in the meantime, here are some things you’ll want to know about the condition.

When eczema becomes infected, there are a variety of treatments.

What causes an eczema skin infection?

According to the National Eczema Society, bacteria, fungus and virus can all cause infection in eczema. Unfortunately, infection can make the eczema worse and lead to more difficult treatment. Medical News Today explains that there are different sources for these three types of infections:

• Staphylococcus aureus is a type of bacteria present on the skin of virtually all people with eczema. Weeping or broken skin is particularly susceptible to staph bacteria, and once the infection takes hold the eczema can spread more rapidly.
• Fungal infections like ringworm can also be found on various parts of the body, usually seen as isolated patches. When it occurs between the toes, it’s known as athlete’s foot. The National Eczema Society says that candida or thrush, another type, is a yeast infection that thrives in warm, moist skin folds.
• Viruses, the third source, can include herpes simplex, the cold sore virus, which causes a severe form of infection, eczema herpeticum, due to a lower resistance to the virus.

How do you know if eczema is infected?

Signs that the eczema has become infected include burning sensations, severe itchiness, new blistered skin, fluid drainage and white or yellow pus.

If a staph infection is present, you’ll see increased redness, raised skin that looks like boils, clear to yellow-colored drainage, increased itchiness and pain at the site of infection.

In more severe cases, you may also have flu-like symptoms, including fever, aches, reduced energy and fatigue, chills, and swollen glands in the armpit, neck and groin. If you experience any of these, you’ll want to seek immediate medical intervention.

What’s the usual infected eczema treatment?

The treatment depends on the type of infection.

• If it’s viral, the doctor may prescribe an antiviral medication.
• If it’s bacterial, you’ll be given an oral or topical antibiotic. Physicians usually recommend creams for mild cases and oral antibiotics for more advanced cases. Also, a steroid cream is sometimes used to reduce swelling and redness.
• And, for fungal infections, antifungal creams or medications are prescribed. As with bacterial eczema infections, a steroid cream may also help in cases of rash. Some antifungal creams are available over the counter.

If you need additional wound care supplies to treat your eczema infection, talk to your doctor about smartPAC by Advanced Tissue to get your prescribed products delivered straight to your front door.

Pompholyx (dyshidrotic eczema) – NHS

Pompholyx (dyshidrotic eczema) is a type of eczema that causes tiny blisters to develop across the fingers, palms of the hands and sometimes the soles of the feet.

It can affect people of any age, but it’s most often seen in adults under 40.

Pompholyx can sometimes be confused with similar-looking conditions.

See a GP if you have any sort of blistering skin condition.

Information:

Coronavirus advice

Get advice about coronavirus and eczema from the National Eczema Society

Symptoms of pompholyx

Pompholyx usually starts as intense itching and burning of the skin on the hands and fingers.

The palms and sides of the fingers (and sometimes the soles of the feet) then erupt into tiny itchy blisters that may weep fluid.

Credit:

In severe cases, the blisters may be quite large and may spread to the backs of the hands, feet and limbs.

The skin can sometimes become infected. Signs of an infection can include the blisters becoming very painful and oozing pus or becoming covered in a golden crust.

The blisters will usually heal within a few weeks. The skin tends to become dry and crack or peel as it starts to heal.

What causes pompholyx?

It’s not clear exactly what causes pompholyx, but it may be triggered or made worse by:

• a fungal skin infection – this may be on the hands or at a distant site from the blisters (such as in between the toes) and will need treating
• a reaction to something that has touched your skin – such as certain metals (particularly nickel), detergents, household chemicals, soap, shampoo, cosmetic products or perfume
• stress
• sweating – pompholyx is more common in spring and summer, in warmer climates, and in people with excessive sweating (hyperhidrosis)

How long does it last?

In many cases, pompholyx will clear up on its own within a few weeks. The treatments below may help relieve your symptoms in the meantime.

Sometimes pompholyx may just occur once and never come back, but it often comes and goes over several months or years. Any of the triggers mentioned above can cause it to flare up again.

Occasionally, pompholyx can be more continuous and difficult to treat.

Things you can do to ease pompholyx

You should try to avoid contact with anything that might irritate your skin, including soaps, shampoos and other household chemicals.

Use an emollient as a soap substitute and wear cotton-lined gloves when you’re at risk of contact with other potentially irritating substances, such as when washing your hair or doing housework.

Do not burst the blisters. Let them heal on their own. If they’re particularly big, your GP may be able to drain them.

Treatment for pompholyx from a GP

The main treatments your GP may recommend to treat the symptoms of pompholyx are similar to those used when treating atopic eczema, including:

• emollients (moisturisers) – use these all the time and instead of soap to stop your skin becoming dry
• steroid cream – this reduces the inflammation and irritation and helps the skin heal

Your GP will probably prescribe a strong steroid cream to use for a short period of time to minimise the risk of steroid side effects.

You may be advised to wear cotton gloves at night to help the cream sink into the skin.

You can also try:

• soaking your hands in a dilute solution of potassium permanganate (1:10,000) for 10 to 15 minutes once or twice a day for up to 5 days
• antihistamines to relieve the itching and help you sleep if the itchiness is keeping you awake at night

These treatments are available from pharmacies without a prescription. Your pharmacist can advise whether they’re suitable for you and how you should use them.

Antibiotics may be prescribed if your skin becomes infected.

Specialist treatments

If your pompholyx keeps returning or is severe and does not get better with the above treatments, your GP may refer you to a specialist in treating skin conditions (dermatologist).

A dermatologist may recommend 1 of the following treatments:

• phototherapy – controlled exposure to ultraviolet (UV) light
• steroid tablets or very strong steroid cream
• immunosuppressant creams or ointments, such as pimecrolimus or tacrolimus
• immunosuppressant tablets or capsules, such as ciclosporin or azathioprine
• alitretinoin capsules – medicine that helps improve severe eczema affecting the hands when other treatments have not worked

Similar skin conditions

Conditions that can look similar to pompholyx include:

• bullous impetigo – a contagious skin infection that mainly affects children and causes sores and blisters
• bullous pemphigoid – a blistering skin condition that tends to affect the elderly
• contact dermatitis – a type of eczema caused by skin contact with a substance that causes irritation or an allergic reaction
• hand, foot and mouth disease – a viral infection that mainly affects young children, which can cause small blisters to develop on the fingers and palms of the hands
• herpetic whitlow (whitlow finger) – a collection of pus (abscess) at the end of the finger that can cause it to become suddenly red, swollen, painful and blistered
• pustular psoriasis – an uncommon type of psoriasis that causes pus-filled blisters to appear on your skin

Page last reviewed: 18 June 2018
Next review due: 18 June 2021

Atopic dermatitis | UF Health, University of Florida Health

Definition

Atopic dermatitis is a long-term (chronic) skin disorder that involves scaly and itchy rashes. It is a type of eczema.

Other forms of eczema include:

Video: Atopic dermatitis

Alternative Names

Infantile eczema; Dermatitis – atopic; Eczema

Causes

Atopic dermatitis is due to a skin reaction in the skin. The reaction leads to ongoing itching, swelling and redness. People with atopic dermatitis may be more sensitive because their skin lacks certain proteins that maintain the skin’s barrier to water.

Atopic dermatitis is most common in infants. It may start as early as age 2 to 6 months. Many people outgrow it by early adulthood.

Dermatitis – atopic in an infant

People with atopic dermatitis often have asthma or seasonal allergies. There is often a family history of allergies such as asthma, hay fever, or eczema. People with atopic dermatitis often test positive to allergy skin tests. However, atopic dermatitis is not caused by allergies.

The following can make atopic dermatitis symptoms worse:

• Allergies to pollen, mold, dust mites, or animals
• Cold and dry air in the winter
• Colds or the flu
• Contact with irritants and chemicals
• Contact with rough materials, such as wool
• Dry skin
• Emotional stress
• Drying out of the skin from taking frequent baths or showers and swimming very often
• Getting too hot or too cold, as well as sudden changes of temperature
• Perfumes or dyes added to skin lotions or soaps

Symptoms

Skin changes may include:

• Blisters with oozing and crusting
• Dry skin all over the body, or areas of bumpy skin on the back of the arms and front of the thighs
• Ear discharge or bleeding
• Raw areas of the skin from scratching
• Skin color changes, such as more or less color than the normal skin tone
• Skin redness or inflammation around the blisters
• Thickened or leather-like areas, which can occur after long-term irritation and scratching

Dermatitis – atopic on the legs

The type and location of the rash can depend on the age of the person:

• In children younger than age 2, the rash may begin on the face, scalp, hands, and feet. The rash is often itchy and forms blisters that ooze and crust over.
• In older children and adults, the rash is more often seen on the inside of the knees and elbow. It can also appear on the neck, hands, and feet.
• In adults, the rash may be limited to the hands, eyelids, or genitals.
• Rashes may occur anywhere on the body during a bad outbreak.

Intense itching is common. Itching may start even before the rash appears. Atopic dermatitis is often called the “itch that rashes” because the itching starts, and then the skin rash follows as a result of scratching.

Exams and Tests

Your health care provider will look at your skin and do a physical exam. You may need a skin biopsy to confirm the diagnosis or rule out other causes of dry, itchy skin.

Diagnosis is based on:

• How your skin looks
• Your personal and family history

Allergy skin testing may be helpful for people with:

• Hard-to-treat atopic dermatitis
• Other allergy symptoms
• Skin rashes that form only on certain areas of the body after exposure to a specific chemical

Your provider may order cultures for infection of the skin. If you have atopic dermatitis you may get infections easily.

Treatment

SKIN CARE AT HOME

Daily skin care may cut down on the need for medicines.

Atopic dermatitis

To help you avoid scratching your rash or skin:

• Use a moisturizer, topical steroid cream, or other medicine your provider prescribes.
• Take antihistamine medicines by mouth to reduce severe itching.
• Keep your fingernails cut short. Wear light gloves during sleep if nighttime scratching is a problem.

Keep your skin moist by using ointments (such as petroleum jelly), creams, or lotions 2 to 3 times a day. Choose skin products that do not contain alcohol, scents, dyes, and other chemicals. A humidifier to keep home air moist will also help.

Avoid things that make symptoms worse, such as:

• Foods, such as eggs, that may cause an allergic reaction in a very young child, (always talk to your provider first)
• Irritants, such as wool and lanolin
• Strong soaps or detergents, as well as chemicals and solvents
• Sudden changes in body temperature and stress, which may cause sweating
• Triggers that cause allergy symptoms

When washing or bathing:

• Expose your skin to water for as short a time as possible. Short, cooler baths are better than long, hot baths.
• Use gentle body washes and cleansers instead of regular soaps.
• Do not scrub or dry your skin too hard or for too long.
• Apply lubricating creams, lotions, or ointment to your skin while it is still damp after bathing. This will help trap moisture in your skin.

MEDICINES

At this time, allergy shots are not used to treat atopic dermatitis.

Antihistamines taken by mouth may help with itching or allergies. You can often buy these medicines without a prescription.

Atopic dermatitis is usually treated with medicines placed directly on the skin or scalp. These are called topical medicines:

• You will probably be prescribed a mild cortisone (steroid) cream or ointment at first. You may need a stronger medicine if this does not work.
• Medicines called topical immunomodulators (TIMs) may be prescribed for anyone over 2 years old. Ask your provider about concerns over a possible cancer risk with the use of these medicines.
• Creams or ointments that contain coal tar or anthralin may be used for thickened areas.
• Barrier repair creams containing ceramides may be used.

Wet-wrap treatment with topical corticosteroids may help control the condition. But, it may lead to an infection.

Other treatments that may be used include:

• Antibiotic creams or pills if your skin is infected
• Drugs that suppress the immune system
• Targeted biologic medicines that are designed to affect parts of the immune system involved in atopic dermatitis
• Phototherapy, a treatment in which your skin is carefully exposed to ultraviolet (UV) light
• Short-term use of systemic steroids (steroids given by mouth or through a vein)

Outlook (Prognosis)

Atopic dermatitis lasts a long time. You can control it by treating it, avoiding irritants, and by keeping your skin well-moisturized.

In children, the condition often starts to go away around age 5 to 6, but flare-ups will often occur. In adults, the problem is generally a long-term or returning condition.

Atopic dermatitis may be harder to control if it:

• Begins at an early age
• Involves a large amount of the body
• Occurs along with allergies and asthma
• Occurs in someone with a family history of eczema

Possible Complications

Complications of atopic dermatitis include:

• Infections of the skin caused by bacteria, fungi, or viruses
• Permanent scars
• Side effects from long-term use of medicines to control eczema

When to Contact a Medical Professional

Call your provider if:

• Atopic dermatitis does not get better with home care 

• Symptoms get worse or treatment does not work

• You have signs of infection (such as fever, redness, or pain)

Prevention

Children who are breastfed until age 4 months may be less likely to get atopic dermatitis.

If a child is not breastfed, using a formula that contains processed cow milk protein (called partially hydrolyzed formula) may cut down on the chances of developing atopic dermatitis.

Images

References

Boguniewicz M, Leung DYM. Atopic dermatitis. In: Adkinson NF Jr, Bochner BS, Burks AW, et al, eds. Middleton’s Allergy: Principles and Practice. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 34.

Eichenfield LF, Boguniewicz M, Simpson EL, et al. Translating atopic dermatitis management guidelines into practice for primary care providers. Pediatrics. 2015;136(3):554-565. PMID: 26240216 www.ncbi.nlm.nih.gov/pubmed/26240216.

McAleer MA, O’Regan GM, Irvine AD. Atopic dermatitis. In: Bolognia JL, Schaffer JV, Cerroni L, eds. Dermatology. 4th ed. Philadelphia, PA: Elsevier; 2018:chap 12.

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Treatment of eczema

In each case, for the correct selection of therapy, preliminary diagnostics are required, which may include immunological, allergological, biochemical methods and microbiological examination.If necessary, consultations of narrow specialists (therapist, endocrinologist, gastroenterologist, psychotherapist, etc.) are carried out.

Complex personalized treatment is prescribed taking into account the characteristics and degree of skin lesions and always includes the use of antihistamines.

When prescribing therapy, the doctor also takes into account the gender and age of the patient, history, results of previous treatment, individual drug intolerance. The stage and extent of the disease are key factors.

What is eczema?

Eczema is a chronic inflammatory skin disease with itching, redness and rashes in the form of small blisters with fluid. The rash resembles air bubbles that form when water boils. Hence the name of the disease (from the Greek eczeo – to boil).

Eczema is not spread from person to person. This is a genetically determined disease. Eczema occurs quite often, it is diagnosed in about 30-40% of patients visiting a dermatologist.

What does eczema look like and on which parts of the body it appears

Wet and itchy skin on face and hands

Rash on the skin in the form of blisters and bumps, accompanied by redness, can be manifestations of true eczema. Subsequently, the bubbles open with the release of serous fluid, in their place are formed shallow point erosion (ulcers). The released liquid dries up to form a soft crust.

The appearance of repeated rashes in the area of ​​the pathological focus leads to the simultaneous localization of vesicles, ulcers, and crusts on the skin.All rashes are accompanied by severe itching, which causes significant discomfort to the patient and reduces the quality of life. Sometimes itching at night causes insomnia.

Symmetry is characteristic of the rashes, the absence of clear boundaries at the affected area.

The rash tends to spread to the chest, trunk, abdomen and back.

Scaly layer at the border of the scalp

Seborrheic eczema often develops on the scalp.In the initial stages, it manifests itself as single yellowish nodules, the number of which is rapidly increasing. The nodules turn into spots with the formation of whitish scales on the surface.

As a result of the fusion of lesions on the border of the hair, a “seborrheic crown” is often formed – a scaly ring, along the edges of which areas of hyperemic skin are located. If left untreated, this form of eczema spreads from the scalp to the folds behind the ear and the neck.

Some doctors consider seborrheic eczema only a kind of true seborrhea with minor differences in the course of the pathological process.

Rounded eruptions on the skin of the hands

Itchy rashes on the hands can indicate many different diseases. Eczema is one of them; in 80% of cases, true eczema is localized on the hands.

Rashes at the initial stage have rounded outlines, with the development of the disease, the contours lose their correctness. A similar nature of rashes on the hands is also characteristic of mycotic eczema.

Microbial eczema on the hands is rare and is characterized by the formation of purulent crusts on the surface.

Rash with clear edges on the legs

Due to the increased frequency of skin trauma and chronic venous insufficiency, post-traumatic and microbial eczema appears most often on the legs. In 75% of cases, they are observed in women. Rashes are more often located next to varicose veins, have a rounded shape and clear boundaries.

Often, microbial eczema manifests itself in many separate rounded foci up to 3 cm in size. Due to the similarity with a scattering of coins, this form of eczema is called coin-like.

Symmetrical scaly eruptions on the body

Symmetry of the lesions is characteristic of true eczema. In most cases, it initially appears on the limbs, but sometimes foci are initially formed on the trunk.

In the early stages, the lesions look typical and consist of vesicles filled with liquid. With a prolonged course, in place of weeping foci, areas of thickened skin appear with an increase in the skin pattern. In chronic eczema, the lesions become covered with flaky skin during healing, eczema becomes dry.

Fine-grained eruptions on palms and soles

Eczema can affect the skin of the hands and feet. In these cases, due to the peculiarities of the structure of the skin, foci of eczema appear in the form of small whitish bumps. The bumps come together to form blisters that can burst open. After opening, large ulcers remain on the palms and feet, secreting serous fluid.

Callous eruptions on palms

A rash on the palms in the form of calluses, appearing in places uncharacteristic for calluses, may indicate tylotic eczema.Bubbles are formed, but may not open due to the peculiarities of the structure of the skin.

Tylotic eczema usually accompanies true eczema, therefore, when a callus-like rash appears, it is recommended to pay attention to the rest of the body.

Multiple vesicles in the armpit with hair in the center

Rashes, in the center of which the hair is located, are a sign of sycosis – a special lesion of the hair follicles. This type of rash outside the scalp is called sycosiform eczema.Eczema is also indicated by the presence of itching, which is accompanied by a rash. In addition to the axillary region, this type of eczema can be localized on the chin, upper lip and pubic area.

Seals on the skin of the hands and on the body

Thickening of the skin may be evidence of the transition of eczema to a chronic form. In addition, the chronization of the disease is indicated by a decrease in wetting and the appearance of large areas of compacted, flaky skin.

Areas of depigmentation after peeling on the skin

Usually appear during the recovery phase.At the site of the rash, the skin is lighter. Most often, such light spots disappear on their own within a month.

Areas of depigmentation appear after most types of eczema, but more often after true and microbial.

Multiple tubercles on the face and hands without wetness and crusts

Sometimes, with true eczema, the vesicles do not open, but appear only as multiple tubercles and papules. This is how pruriginous eczema manifests itself – one of the varieties of true eczema.Pruriginous eczema is localized on the extensor surfaces of the arms and on the face.

Itchy areas of redness on the skin of the legs and arms

A hyperemic and itchy area of ​​skin with many rashes indicates true or microbial eczema. The most pronounced pruritus with eczema is manifested at the stages of active formation of fresh papules and vesicles. Itching increases with the addition of bacterial flora.

With varicose and post-traumatic eczema, these symptoms are observed in most cases on the legs.In occupational eczema, itching and flushing are typical symptoms. The severity of symptoms increases after repeated contact with a provoking agent. After elimination of the provoking factor, the symptoms disappear.

Suppuration and itching around wounds on the legs and arms

Hyperemia of the skin and the formation of purulent crusts indicate microbial eczema. Most often, they appear on the areas of the skin that are most susceptible to injury.

When the pus dries, coarse crusts are formed, which fall off, exposing the skin that continues to wet.

Types of eczema

Understanding the types of eczema is essential for proper treatment.

True or idiopathic eczema.

Differs in the classic course, the rash passes through all six stages.

Stages of true eczema:

First stage . It is characterized by wide foci of hyperemia with a red-blue tint and with blurred edges without clear boundaries.

Second stage – papule formation. Soft nodular joints appear, merging into small foci. Puffiness and plaques appear in places.

The third stage is vasecular. The nodules gradually turn into bubbles.

Fourth stage . The accumulation of subcutaneous exudate causes the papules to open and the release of serous fluid. Point foci of maceration with depressions (wells) appear on the skin. At this stage, the development of the disease reaches its peak.

The fifth stage is a tough one. The released serous fluid begins to dry out, the forming crusts are layered on top of each other.

Sixth stage – squamous. Dried whitish scales separate on their own, the skin is restored. Pink or whitish spots may remain in the area of ​​the rash.

Serous wells are the main distinguishing feature of true eczema. The foci of inflammation are more often located in a symmetrical order.The first symptoms appear on the face and hands, then the disease spreads to other parts of the body. There is severe itching and soreness at the sites of ulceration.

Without treatment, the process quickly flows into the chronic stage, when, even during the period of remission, the foci of the lesions become excessively thickened, a pronounced linear pattern appears on the skin.

Chronic eczema

The acute stage of true eczema can quickly turn into a chronic one.It is characterized by thickening and coarsening of endogenous foci. New rashes appear actively, followed by infiltration and the formation of serous wells. Itching intensifies many times over and does not stop even at night, so patients with chronic eczema often suffer from insomnia. After getting rid of the symptoms in the affected areas, pigmentation is disturbed, and dry skin appears.

Exacerbations often occur in the winter period.

Microbial eczema

Caused by infectious or fungal agents.It occurs at the stage of opening papules with true eczema or with chronic ulcerative vegetative pyoderma, in places of fistulas, wounds, etc.

Pathogenic foci have clear pink borders. In addition to papules and weeping erosions, from which fluid is released, layering of purulent crusts occurs. The size of the affected areas increases rapidly. Often, separate pustules with scaly areas form next to the lesions.

Depending on the source of the disease, microbial eczema is divided into coin-like and varicose.

Coin eczema

The name is due to the appearance of red spots, shaped like coins. Formations may not take place for a long time (from a month to several years). In most cases, symptoms begin to appear on the inner thigh and the outer side of the hands.

In addition to bubbles of a red-pink, sometimes bluish tint, severe itching and burning appear, weeping is noted after opening the rash.

Varicose eczema

Primarily develops on the legs. It is accompanied by moderate itching, increased dryness of the skin, scaly formations in the localization of dilated venous vessels. The disease greatly affects the condition of the skin – there are edematous, hyperemic lesions with a burgundy-purple tint. Specific dark spots appear on the skin.

Also, small bubbles form on the skin, which break open with the release of fluid and the formation of ulcers.The soaking stage turns into a drying stage after about two weeks. Crusts are formed. Pathological foci thicken and darken, up to brown. When pressed, soreness appears.

The inflammatory process is accompanied by severe itching. The patient combs the foci of inflammation, as a result of which abrasions and cracks form on the skin, there is a risk of a secondary infection.

Seborrheic eczema

The trigger of this type of eczema is the weakening of local immunity, dysfunction of the sebaceous glands, and malnutrition of the scalp.Most patients have a history of congenital allergic reactions.

Each person has the fungus Pityrosporum ovale in the hair epithelial layer. In case of failures in the protective function, it can penetrate deeper, in response, the local immunity reacts in the form of an allergic reaction. The inflammatory process begins in the form of local edema. Normally, it stops after treatment of the fungus, but with seborrheic eczema, the inflammatory process is more pronounced and lasts a long time.

A feature of seborrheic eczema is the excessive activity of the sebaceous glands in the lesions. The thinned skin scales stick together and yellow fatty flakes are formed.

Localization of eruptions:

• trunk: navel area, chest, around the halo of the mammary glands, in the folds of the axillary and inguinal zones;

• head: nasolabial fold, ears and behind the ears, eyebrows, chin, eyelashes, scalp.

Dry eczema

At the initial stages, spots with blurred pink edges are formed, subsequently the contours acquire a red tint. Acute papules appear, merging into large plaques.

Bubbles are not formed, but there is a violation of the integrity of the skin. The top thin and dry layer peels off, forming small and deep cracks. Without treatment, the disease progresses and turns into an acute form with weeping, the formation of dense crusts and severe redness.In this case, the patient may not experience painful sensations.

The disease worsens during dry and cold seasons.

Allergic eczema

Is a consequence of the body’s hypersensitivity to external or internal stimuli. It develops more often in patients with a weak immune response.

The main factor is contact with foreign compounds that cause excessive production of histamine.

Any manifestations of the disease cause excitation of the nervous system, so the patient experiences irritation, may suffer from insomnia and severe headaches.

Symptoms:

• rashes accompanied by itching,

• dryness and flaking of the skin,

• crusts are formed in place of bursting bubbles,

• redness of the skin, burning sensation,

• thickening of the skin in the eyes of the lesion.

Allergic eczema is divided into dry and weeping. The first type is characterized by dry, flaking skin. The trigger can be direct contact with an allergen or the presence of internal diseases.

The second type is more often localized on the hands and arises from direct contact with a chemical. In this case, the skin swells greatly, red foci with small papules appear, which, after opening, turn into painful ulcers.

Rashes with this type of eczema can appear on any part of the body.

Dyshidrotic eczema

Dyshidrosis affects the sweat glands of the feet (in 20% of cases) and hands (80%), has a chronic course with seasonal exacerbations. Serous vesicles form on the affected areas.

A hallmark of dyshidrosis is the development of vesicles. The rashes are covered with a dense membrane. Purulent discharge appears only when a secondary infection is attached.Under normal conditions, the formations contain a clear liquid.

All stages are accompanied by gradually increasing itching. The lesions are swollen and scaly. The vesicles break open on their own, or in the process of scratching or damage, small wounds and cracks appear in their place. The skin pattern becomes more distinct.

In this type of eczema, itching appears before the skin symptoms, rashes form later, first on the lateral parts of the fingers, then on the palms and feet.

Moist eczema

This species has several phases. The first phase: pink spots of various shapes and sizes appear on the skin, swelling, as well as papules or vesicles. Due to the constant release of subcutaneous exudate, weeping zones are formed.

When opened, the formations are covered with crusts with active exfoliation. The peculiarity of this type is that the rash is at different stages of development. In one zone, new and already opened rashes can be located, and rejection of dead cells is also observed.Severe itching causes insomnia and neuroses.

With the chronicity of the process, the skin in the affected areas thickens and scarred, a blue-red tint appears. During the period of remission, the skin in the lesions constantly peels off.

Symptoms

Symptoms of eczema can vary depending on the type of disease, but there are general symptoms:

• regular increase in body temperature in case of occupational eczema;

• the appearance of a focus of inflammation and redness, thickening of the skin;

• appearance of a rash;

• increased sensitivity of the skin, the appearance of itching, which reduces the patient’s quality of life;

• the appearance of painful cracks, wounds, erosion at the site of the rash, the formation of serous or hemorrhagic crusts;

• increased skin dryness, loss of elasticity during remission.

Eczema has very specific manifestations, even with a small area of ​​the rash. In adults, it usually affects large areas of the body, more often on the arms, shoulders, face, feet and lower leg. Eczema can also occur with swelling and redness of the skin.

Eczema is difficult to treat, frequent relapses are possible, but thanks to modern protocols, doctors are increasingly able to achieve stable remissions. It is important to see a doctor promptly.

Eczema on the face

City air, climate features, improper care can have a negative effect on the skin. If you notice itchy, edematous, reddish spots on your face with rashes in the form of bubbles that burst, forming crusts, and the crusts then merge into a large weeping spot, urgently make an appointment with a dermatologist. This is especially true given that eczema is accompanied by intense burning and itching.

Symmetry is characteristic of the disease, if rashes appear on one side of the face, they will appear on the other.Eczema can affect the mouth and eyes. The skin on the eyelids thickens and coarsens, itching and flaking appears. Lamellar scales form on the lips, which then turn into bleeding painful cracks.

True, seborrheic and professional eczema appears on the face. The symptoms are very similar. Separate areas on the face swell and redden, then small itchy blisters appear, filled with a clear or cloudy liquid. Cracks form on the skin, it begins to peel off.

True eczema is characterized by symmetrical eruptions, seborrheic occurs on the scalp, and professional eczema occurs in places of direct contact with an irritant.

Eczema on legs

Often, eczema on the legs appears as a result of an allergic reaction and the presence of vascular pathology of the lower extremities (varicose eczema). Also triggers can be a psychoemotional state and reduced immunity.

Microbial eczema appears most often on the legs.It is localized in places of burns, postoperative sutures, fungal infections, varicose veins. Eczema occurs against the background of an already existing inflammatory process.

Main symptoms of eczema on the feet:

• swelling of the legs;

• appearance of a characteristic crust;

• painful appearance and dry skin;

• the appearance of bubbles, cracks and pigmentation at localization sites.

Possible sleep disturbances and headache.

Self-medication of eczema is unacceptable. It can lead to the development of complications and complicate the treatment process.

Eczema on hands

According to the intensity of the development of the disease on the hands, acute and chronic eczema can be distinguished.

Depending on triggers, the following are allocated:

• microbial (affects the area around wounds, abrasions, boils),

• professional,

• dyshidrotic (affects palms, nails), horny (may appear in the form of corns).

There is eczema of children, which manifests itself as a severe rash on the hands and can go away with age.

There are 4 stages of the disease:

• Erythematous – swelling and redness of the lesion.

• Papulovesicular – the appearance of rashes.

• Wet – opening bubbles.

• Crustal – crust formation.

When the disease progresses to the chronic stage, the skin becomes rough, pigmentation, peeling, dryness appear.

Causes of the disease

Hereditary factor is the main cause of eczema . If there are cases of eczema in close relatives, the patient is at times more likely to develop this disease.

One of the provoking factors is immunity disorders. Immunity begins to produce immunoglobulins to its own skin cells, which leads to the appearance of areas of inflammation. Violation of intercellular immunity is confirmed by an imbalance of glycoproteins: laboratory values ​​of IgG and IgE are above normal, IgM is in deficit.

There is a connection between exacerbations of eczema and stress.

It has been scientifically proven that eating habits and gastrointestinal disturbances can also affect the development of eczema.

How to treat eczema

Moist eczema

Wet eczema of character for all types of eczema. After the diagnosis, the dermatologist will draw up a personalized treatment plan, including:

• Drug treatment:

a) general;

b) local.

The goal of treatment is to diagnose and eliminate the cause of the disease.

Dry eczema

Dry eczema is manifested by excessive dryness of the skin.Distinctive features are:

• chronic course;

• seasonal exacerbations;

• localization on any part of the skin, but most often on the limbs.

Dry eczema on the hands is often a sign of liver or gastrointestinal disease. It can also appear due to frequent stress.But the main factor is genetic predisposition.

In treatment, adherence to therapy is extremely important, all measures prescribed in the treatment plan must be fully implemented. Treatment should not be interrupted at the first sign of improvement.

A good effect in the early stages of the development of eczema is shown by corticosteroids in the form of an ointment. But they are not recommended for long-term use. To eliminate symptoms in the future, emollients are used.

The treating dermatologist can recommend consultations with specialized specialists: endocrinologist, gastroenterologist, etc.A multidisciplinary approach can improve treatment outcomes.

Treatment of eczema with medicines

The development of eczema is associated with increased sensitivity of the body to a number of irritants. Therefore, treatment should be systemic with the appointment of hormonal ointments, antihistamines, antibiotics. The doctor’s task is to select the most effective drugs in each case.

Sorbents and antihistamines

Antihistamines can relieve itching and inflammation.

Antibacterial therapy

Antibiotics with tetracycline are prescribed with caution in children under 10 years of age. Laboratory diagnostics helps the doctor determine the safest drug.

Anti-itching and sedatives

• moisturizers;

• oral substances;

• intravenous corticosteroids.

Among sedatives, Novopassit, Persen, Valemidin are more often prescribed.

Hormonal preparations

Therapeutic regimens include hydrocortisone. Hormonal preparations are recommended in the form of ointments, tablets, lotions. It is not recommended to use these drugs for more than 2 weeks due to possible complications.

Corticosteroid-based creams are effective for weeping eczema because they dry out the skin.Ointments have a healing effect and remove rough crusts. For localization in the scalp, emulsions and lotions with a light texture are used.

Antiseptic and anti-inflammatory drugs

To exclude additional complications and disorders, antiseptic preparations are used:

• Betadine;

• Miramistin;

• “Dekasan”;

• “Dimexide”;

• Clotrimazole and Polyphepan;

• Radevit;

• “Chlorhexidine”.

The choice of the drug depends on the type of eczema and concomitant diseases, therefore it should be carried out only by the attending physician.

Features of the treatment of eczema on the hands

For local treatment of eczema, ointments (pastes and creams) with corticosteroids, hormones with a pronounced anti-inflammatory effect, are used. They help to reduce the inflammatory response and speed up the skin regeneration process.

Corticosteroid ointments have side effects: skin thinning, increased risk of bacterial and fungal infections, etc.Therefore, they should only be prescribed by the attending physician.

There are non-hormonal drugs that are also effective in treating eczema. These are topical calcineurin inhibitors – tacrolimus ointment (protopic) and pimecrolimus cream. They reduce inflammation and itching. The dosage and duration of admission should also be determined only by the attending physician.

In severe eczema, extensive foci of inflammation and the lack of effect from local therapy, systemic treatment is prescribed in the form of immunosuppressants – drugs that suppress immunity.

In severe disease, as well as in erythroderma, cytostatics are prescribed.

Antibiotics and antifungal agents are used in the treatment of microbial and fungal eczema.

Features of the treatment of eczema on the legs

Eczema on the legs often develops as a result of an allergic reaction or severe vascular pathology (varicose eczema). Additional provoking factors can be a weakened immune system and prolonged psycho-emotional stress.

Microbial eczema most often develops on the legs. The main localization is in the places of burns, postoperative sutures, fungal infections, varicose veins. Eczema develops against the background of an already existing inflammatory process.

Main symptoms of eczema on the feet:

• edema;

• formation of a characteristic crust on the skin;

• the appearance of bubbles, cracks and pigmentation in the lesions.

Sleep disturbances and headache may occur.

With a timely visit to a doctor, the prognosis for the treatment of eczema on the legs is favorable.

What does eczema treatment consist of

The essence of eczema treatment is:

• exclusion of contact with irritants,

• proper nutrition,

• elimination of itching,

• local treatment with ointments and creams,

• general treatment with tablets and injections.

Treatment of eczema in children is no different from treatment in adults. Often, physiotherapy methods are included in the treatment plan, which allow you to act directly on the damaged areas.

Dermatologists, through a combination of different methods, develop the best treatment for each patient.

Treatment of eczema in children

To determine the tactics of treatment, it is necessary to establish the type of eczema, the cause of its appearance and differentiate with other dermatological diseases (herpes rash, diathesis, allergic reactions, urticaria, shingles, etc.).).

Diagnostics include:

• general blood test;

• scraping from the skin for examination under a microscope;

• allergy tests for atopic eczema to identify the source of the allergy;

• histological examination – for the diagnosis of autoimmune diseases.

Treatment is selected taking into account the results of examinations, age and health characteristics of the little patient.

Complex therapeutic treatment includes:

• Individual diet

• Sedatives (for sleep regulation)

• Antihistamines (to relieve itching and burning)

• Anti-inflammatory drugs (to relieve skin puffiness and improve general condition)

• Multivitamins

• Antibiotics or antiviral drugs

Physiotherapy may be prescribed to speed up the recovery process and as an alternative to certain medications.

Mandatory antiseptic treatment of wounds and abrasions to exclude secondary infections.

It is especially important to properly care for your child’s skin and follow all the recommendations of a dermatologist, who will select individual care products.

Prevention of eczema

Personal hygiene is important, frequent overheating accompanied by increased sweating is unacceptable. A balanced diet should include dairy and vegetable foods with a low amount of carbohydrates and spices.

Prevention of eczema in adults

Overwork and stress can be triggers for the development of eczema, therefore it is important to maintain a balance between work and personal life, to devote time to good sleep and rest, and to play sports.

Use gloves when working around the house, this will exclude the possibility of contact with the skin of aggressive detergents. Clean your hands thoroughly and use protective moisturizers.

With increased oily skin and a genetic predisposition to eczema:

• it is recommended to exclude fatty, sweet, fried and spicy foods from the diet.

• it is not recommended to visit the bathhouse and sauna.

• it is not advisable to visit countries with high humidity or too hot climate.

In case of occupational eczema, it is recommended to change jobs to avoid complications.

Prevention of eczema in children

• Compliance with the rules of personal hygiene

• Lack of skin rash

• Healthy and balanced nutrition

• Regular cleaning

• Shoes and clothing made of natural materials

• Rest on the seashore

If symptoms occur, do not delay seeing your doctor.

You can sign up for a consultation with EMC dermatologists by calling +7 (495) 933 66 55.

Good to know about ECZEM (eksem)

Good to know about ECZEM ( eksem)

Useful information on eczema – Fact sheet of the Norwegian Asthmatics and Allergy Association

What is eczema?

Eczema is the generic term for various itchy skin conditions.The most common forms of eczema are atopic, occupational (contact), seborrheic, and childhood. Atopy means difference. In this case, it refers to differences in skin properties and describes hereditary allergic eczema.

Eczema can be chronic , i.e. with a prolonged, or acute form of the course of the disease and in most cases is characterized by an improvement in the condition in the summer and a worsening in the winter. For the chronic form, the appearance of a rash with itching is characteristic.Scratching often results in thickened areas of the skin that crack easily. Acute eczema is characterized by itching, redness, and swelling of the skin, with possible watery blisters.

With eczema, there is a deterioration in the body’s defenses against infections, which easily leads to the occurrence of infectious inflammations, which can lead to a worsening of the condition of eczema.

Symptoms of eczema

Atopic eczema results in itchy, dry skin.

Newly onset or recurrent contact eczema is characterized by itching, redness and swelling of the skin with the formation of small and large blisters, as well as wet wounds in places of direct exposure to the allergen. With prolonged contact eczema, the skin becomes increasingly dry and cracked. Severe itching is common. In the initial stage, eczema occurs only in the area of ​​the skin that was exposed to the allergen, but then the rash can spread to other areas.

With seborrheic eczema in infants, there is the formation of areas with oily, red skin covered with greasy crusts on the forehead, head, face, as well as in the folds of the skin on the neck and in the perineum. In adults, it appears as flaky, red, oily skin on the central areas of the face, on the head, behind the ears, and on the chest.

Infantile eczema is accompanied by the formation of red, smooth, sometimes wet areas of the skin in places where diapers are worn.

Who gets eczema?

Young children are especially prone to atopic eczema. It is estimated that around 15% of Norwegian children suffer from eczema. Often the disease occurs in children in the first months of life, in 60% of them it disappears after reaching the age of four. However, relapse may occur during adolescence or adulthood.

Contact eczema in young children is rare, but cases of its occurrence are noted more and more often, starting from school age.Ear piercings, piercings and skin contact with base metals are responsible for a significant increase in nickel contact allergies. Getting a tattoo can lead to allergic contact eczema, which can occur weeks or even months after getting a tattoo. Hair coloring is also an increasingly common cause of eczema, especially as more young people are dyeing their hair.

Seborrheic eczema is relatively common.Eczema can appear as early as the first months of life, but usually occurs in adults.

Causes of eczema

The cause of atopic eczema is unknown. Allergies can play a role, but only in conjunction with other factors. The disease has a relationship with heredity and the environment. It is common for other family members to have atopic diseases (asthma, eczema, or allergic rhinitis). Allergies can be found in 20-30% of patients, which for some of them may be the cause of eczema.Food allergies are never the only cause of eczema.

The cause of seborrheic eczema is not hypersensitivity, but a painful reaction in the sebaceous glands, which is possibly caused by a special yeast fungus usually found on the surface of the skin. This form of eczema is especially susceptible to persons with oily skin and increased productivity of the sebaceous glands.

Contact eczema occurs when the skin reacts to contact with certain substances.The reaction can be allergic or non-allergic. A non-allergic reaction occurs through direct contact with substances that irritate the skin, such as detergents or disinfectants. An allergic reaction is caused by allergenic substances such as nickel, chromium, rubber, formaldehyde and perfumes. Paraphenylenediamine (PPD) is one of the substances commonly associated with allergic contact eczema. PPD is found in many types of hair dye.

Infant eczema is caused by irritants in urine and feces.

Treatment of eczema

In the treatment of eczema, the most important is hygiene, the systematic use of creams and ointments to prevent dry skin, refraining from scratching, reducing exposure to irritants and abstaining from eating foods known to be allergic. Sunlight and salt baths are good for mild to moderate eczema. Regular baths with calcium permanganates have a good prophylactic effect.

However, in most cases a cortisone ointment is necessary. This treatment will give the desired result, provided that the correct drug is applied to the appropriate area of ​​the body at the prescribed frequency. Once the eczema is under control, it is important to reduce the concentration of the cortisone ointment and, if necessary, lengthen the time between ointment applications. The correct use of cortisone ointment does not lead to negative effects. The attending physician will give you the necessary recommendations for the use and reduction of the drug concentration.

In general terms, it can be said that it is necessary to use potent drugs for a sufficiently long period of time. By opting for weaker drugs, you will not be able to bring eczema under control. In this case, the entire cortisone treatment process may be in vain. This often leads to increased eczema. It is important to remember that the bad effect of cortisone ointment is associated with an infection in the eczema itself, which must be treated with antibiotics, both locally and in general.

In case of a new outbreak of eczema in a child who previously suffered from this disease, treatment can be started with the use of group 2 or 3 cortisone. After the condition has stabilized, the application of the drug can be carried out less often (with an interval of 2-3 days). With further improvement of the condition, you can switch to a weaker ointment, in order to eventually switch to applying the drug with an interval of 2-3 days.

After eczema has healed, it is recommended to continue applying the drug 1-2 times a week for at least 2-4 weeks, in order to achieve the best result.It is also recommended to apply a moisturizer in the morning and evening, and every time after taking a bath or shower, even when there is no eczema.

Children suffering from eczema, which regularly intensifies and worsens, benefit from calcium permanganate baths, even during good periods. During periods of eczema activity, calcium permanganate baths can be performed every day or every other day.

Cortisone-free anti-eczema ointments (Elidel®, Protopic®) are good alternatives to try for chronic eczema.These ointments are applied daily, twice a day. The advantage of these ointments is that they do not affect the thickness of the skin even with prolonged use, and also that they can be used in cases where treatment with cortisin ointments does not lead to the desired result and control over eczema is not established with treatment with cortisone ointments without risk side effects.

In case of skin infections, it is first necessary to treat the infection itself, and only then apply the above means.

Medical light or climatic treatment for eczema may have an effect. However, some patients may experience a temporary increase in eczema, which is probably due to sweat irritation. In addition, such treatment is costly and time-consuming, which makes it unacceptable for school-age children. This treatment is carried out exclusively by a specialist in skin diseases.

Achieving positive results depends on how well the patient is informed about the treatment.Eczema can be a very painful disease, but early treatment allows you to establish control over it in most cases. Fortunately, the disease will give up on its own over time, and 80% of patients recover by the age of 18. There is reason to believe that good treatment for eczema leads to an improved prognosis.

Factors worsening the condition

Coarse, tight clothing, coarse wool, polyester, heavily dyed fabrics, moisture, stress, infections, food, chlorinated water, tobacco smoke, perfumes, allergies, alkaloid soaps, grease removers and heat.

The child himself knows what kind of clothes are itchy!

Prevention of eczema

Prevention of eczema by controlling the nutrition of the expectant mother during pregnancy, or after the birth of the baby, has no effect on the development of atopic eczema in the baby. Research shows that symptoms of atopic eczema may be delayed in some cases in babies who are breastfed for the first four to six months of life.

Where to get help

For mild sporadic eczema in children, advice from a nurse may be sufficient.In more difficult cases, you should contact your doctor who, if necessary, will write out a referral to a specialist. The free choice hospital system in Norway gives you a choice based on the information you receive. On the Internet at www.frittsykehusvalg.no and by calling toll-free 800 41 004, you can get information about the available places for eczema treatment and your rights regarding the choice of hospital.

People suffering from eczema and other skin diseases, as well as people who work with this group of patients, can talk to specialists at the Polyclinic for Skin Diseases, Villa Derma, Oslo University Hospital, by calling the “skin phone” 23075803 , open to calls three hours a week according to the following schedule: Tuesday and Friday from eight to nine in the morning, Thursday from 12 to 13 hours (check the correctness of this schedule!).

Eczema facts developed in collaboration with the Medical Council of the Norwegian Asthmatics and Allergy Association.

Rational therapy of infected dermatoses uMEDp

One of the main conditions for the successful treatment of complicated dermatoses is the rational use of topical combined drugs. With atopic dermatitis, true eczema with the addition of a secondary infection, as well as psoriasis of large folds, it is advisable to use the drug Pimafukort.Its effectiveness in the treatment of these diseases varies from 95 to 100%. The positive effect is observed already in the first week of treatment. Wide antibacterial and antifungal activity makes Pimafukort universal in the treatment of mycotic, bacterial and mixed skin infections.

The frequency of inflammatory skin diseases with the addition of fungal and bacterial infections is steadily increasing. According to various authors, the share of these diseases in the structure of dermatoses accounts for 17 to 40% [1, 2].As a rule, such chronic inflammatory diseases as eczema, atopic dermatitis (AD), psoriasis are accompanied by itching and require constant use of glucocorticosteroids (GCS). Violation of the integrity of the skin structure during scratching and prolonged external GCS therapy contribute to the development of secondary bacterial infection. A fungal infection joins the inflammatory process, localized in the folds and on the feet, which complicates the course of the main dermatosis.

As shown by the analysis of the structure of dermatitis of combined etiology (DSE), carried out by the Research Institute of Medical Mycology named after V.I.P.N. Kashkin in 2009, the addition of fungal and bacterial infections was more often observed in AD (48% of patients) and eczema (30%), less often in psoriasis (20%) [3]. In 42% of patients, the course of chronic dermatosis was complicated by the addition of a pyococcal infection. The causative agents of the purulent process in DSE were Staphylococcus aureus – 48% of cases, Streptococcus pyogenes – 24%, Corynebacterium minutissimum – 20%, Pseudomonas aeruginosa – 8%. The mycelium of pathogenic fungi was found in 45% of cases. The main causative agents of mycoses in patients with DSE are dermatomycetes.They were detected in 45% of cases. Candida spp. Was found in 31% of patients, Malassezia spp. In 24%. Among dermatomycetes, Trichophyton rubrum dominated – 76% of cases. T. mentagrophytes was detected in 16% of patients, Epidermophyton floccosum – in 8%. 13% had a mixed bacterial-fungal infection.

Among patients with complicated dermatoses, somatically burdened patients prevailed. Endocrinopathies, including diabetes mellitus, were recorded in 25% of them, obesity in 37%, and hypothyroidism in 5%.Diseases of the cardiovascular system were detected in 20% of patients, metabolic syndrome – in 18%, immunodeficiency states – in 7% [3].

Atopic dermatitis is a hereditary immuno-neuroendocrine inflammatory chronic recurrent dermatosis, manifested by intense itching, xerosis, sympathetic skin reaction (white dermatographism), mainly erythematous-lichenoid eruptions, in combination with other signs of atopy. In patients with AD, the barrier function of the skin is impaired, which creates favorable conditions for the growth and development of bacterial and fungal microflora.

Prolonged allergic inflammation of the skin leads to negative consequences, in particular to the development of infectious complications. Constant mechanical action on the skin due to severe itching is one of the reasons for the release by epidermal cells of a large amount of pro-inflammatory cytokines – tumor necrosis factor alpha and interleukin-1-beta [2, 4]. The result is a vicious circle: intense itching increases skin inflammation, and inflammation damages the stratum corneum and water-fat film with increased transepidermal water loss, leading to dryness, flaking and itching.Multiple scratching disrupts the integrity of the skin structure, thereby opening the gateway for infection.

Microbiocenosis of the skin of patients with AD in comparison with that of healthy individuals is characterized by an increase in the total number of microorganisms. In addition, there are features regarding the types of microflora and the nature of the body’s response. More often, S. aureus, fungi of the genus Malassezia, and yeast-like fungi of the genus Candida are involved in the inflammatory process.

More than 90% of patients have S.aureus. In areas of exudation and wetting, the number of microorganisms can reach 1 × 107 per 1 cm2. Toxins secreted by S. aureus (enterotoxins A and B, toxic shock syndrome toxin-1) are superantigens that simultaneously stimulate several links of the immune response [4, 5]. They bind to the beta-chain of the T-cell receptor TCR and the molecule of the major histocompatibility complex II class HLA-II and activate the family of T-lymphocyte clones with such a beta TCR chain, which leads to increased production of pro-inflammatory cytokines and enhances the reaction of allergic inflammation [5] …

Fungal flora plays a special role in the pathogenesis of AD. In 39% of AD patients, non-lipophilic yeast was inoculated from the skin surface. Fungi of the genus Candida predominated (49%). Fungi of the genus Rhodotorula (25%) and Cryptococcus (14%) were sown less frequently [6]. In patients with AD, the density of C. albicans colonies both on the affected and intact skin areas is higher than in healthy individuals.

Currently, the participation in the pathogenesis of AD fungi of the genus Candida has been proven as not only pathogens, but also sources of classic allergens that initiate an immune response by IgE-dependent type of allergic reactions.The detection rate of sensitization to Sandida varies from 16 to 85% [6]. The frequency of detection of IgE antibodies to Candida is higher in adult patients, as well as in patients with severe forms of AD.

With AD with a predominant localization in the area of ​​the skin rich in sebaceous glands (face, upper half of the back and chest, neck, scalp) against the background of chronic inflammation of the skin, favorable conditions are created for the development of infection caused by fungi of the genus Malassezia. The clinical picture of skin lesions in AD associated with Malassezia infection is represented by yellowish-brownish scaly spots and papules starting from the orifices of hair follicles, gradually increasing in size and merging with each other.After the rash has resolved, areas of hypopigmentation remain, alternating with hyperpigmentation. In addition to Malassezia furfur, a pathogen that causes characteristic clinical manifestations, an IgE-dependent allergic reaction to the antigens of this microorganism can play a role in inflammation in AD. Sensitization to Malassezia antigens was confirmed by detecting IgE antibodies to Malassezia antigens. Research data showed the presence of IgE antibodies to Malassezia in 20–100% of patients with AD.It has been shown that specific IgE antibodies to Malassezia are detected in 68% of adult patients with severe AD. Sensitization to Malassezia in AD patients supports the Th3-type immune response [7].

Eczema is a chronic inflammatory skin disease of a neuro-allergic nature that occurs in response to external or internal stimuli, characterized by polymorphism of the rash, itching and prolonged recurrent course. In patients with eczema, a number of factors are distinguished that contribute to the development of bacterial and fungal flora on the surface of the skin.First of all, this is the exudation of plasma proteins onto the skin surface, the presence of an entrance gate for infection, a change in pH on the skin surface, a change in the lipid composition of the stratum corneum, and a change in the local immune response [8]. In addition, in such patients, an increased contamination of the skin with bacterial flora was found, which, under favorable conditions (reproduction and increased virulence), promotes the development of pustular diseases, and also, acting as a source of bacterial superantigens, supports allergic inflammation.In patients with true eczema, S. aureus was sown from the surface of lesions in 80% of cases and S. haemolyticus in 14% of cases [9]. In a number of patients, bacterial infection was combined with fungal infection.

Non-dermatophyte fungi can complicate the course of non-fungal diseases. Developing against the background of chronic skin diseases, pathogens of opportunistic mycoses become an additional powerful allergenic factor, often leading to chronicity of the process, torpidity to traditional therapy.Often, patients use GCS-based ointments for a long time and unsuccessfully, which only aggravate the pathological process.

In the study of the microflora of the skin of patients with chronic dermatoses with the contact method of inoculation in the lesions in 40.7% of patients with eczema, non-dermatophyte fungi were identified. Moreover, yeast-like fungi of the genera Candida (44.4–49%) and Rhodotorula (27.8–25%) were more common. In addition, in 44.3% of cases, non-dermatophytic fungi were detected in scrapings from the nail plates of the hands and in 30% of cases – from the nail plates of the feet [6].

These data indicate a high frequency of candidacy in most patients with chronic eczema. They have a pronounced sensitization to fungi of the genus Candida, which is confirmed by positive allergic skin tests (in 55.4% of patients) and a high content of antigen-binding leukocytes in the blood (7 times higher than in practically healthy individuals), identified to the fungal antigen of the genus Candida [6]. This allows us to speak about the special role of fungi of the genus Candida in the development of allergization of the body with the corresponding clinical manifestations.

Psoriasis of large folds (inverse, or intertriginous) – psoriatic lesion of large folds. It usually develops in children and the elderly, especially those with diabetes mellitus. The foci are sharply outlined, their surface is smooth, saturated red, sometimes slightly moist, macerated. Clinical manifestations resemble those of candidiasis of folds, diaper rash and dermatophytosis. Peeling, as a rule, is not expressed or absent, and cracks form in the depths of the skin fold.Due to the optimal temperature and humidity, microorganisms develop in the folds of the skin. In healthy individuals, Propionibacterium acnes is isolated in axillary folds in 70% of samples and S. aureus in 5–10%. In 10% of cases, the skin of the groin folds is colonized by S. aureus, often C. albicans [10].

Violation of the epidermal skin barrier in the foci of psoriasis, maceration, high humidity create favorable conditions for the activation of flora in large folds and adherence to the main dermatosis of bacterial and fungal infection [11].

Usually, intertriginous psoriasis is accompanied by candidiasis. The presence of diabetes mellitus in patients with inverse psoriasis also contributes to the development of infectious and inflammatory diseases, especially with poor glycemic control. In such sick microorganisms on the skin surface, 2.5 times more than in healthy individuals, and the bactericidal activity of the skin is lower by an average of 20%. This decrease directly correlates with the severity of diabetes. The yeast-like fungi C.albicans and other non-dermatophytic infection. Moreover, in a normal population, fungal skin lesions caused by C. albicans do not exceed 20%, while in somatically burdened patients this figure reaches 80–90% [12].

Treatment of complicated dermatoses involves the appointment of a combination therapy using several drugs of different pharmacological groups: topical corticosteroids, antibiotics and antimycotics. The use of combined drugs in the treatment of chronic dermatoses complicated by secondary infection allows simultaneously suppressing allergic inflammation and eliminating the bacterial-fungal flora that supports the allergic process [13].

When choosing a specific combined corticosteroids, it is necessary to take into account many factors, including the patient’s age, localization of the skin process, previous external therapy, duration of treatment, and the presence of concomitant diseases. The appointment of the most commonly used in clinical practice fluorine-containing combined corticosteroids, especially with prolonged use, inevitably leads to the development of side effects, and often to tachyphylaxis. Particularly carefully when choosing an external corticosteroids should be approached when it comes to children, as well as when the rash is localized on skin areas that are highly sensitive to steroids: face, neck, folds, mammary glands, genitals [14].

Inappropriate choice of anti-infectious drug contributes to the further spread of infection, progression of the process and an increase in the number of drug-resistant strains of dermatomycetes and pyococci. The modern strategy of external therapy involves not only the rapid suppression of the inflammatory reaction of the skin, but also the complete elimination of the infectious agent. The selected drug should have a wide spectrum of antifungal, antibacterial activity, high bioavailability.However, it is extremely important that the vast majority of clinically significant strains of dermatomycetes and pyococci have a high sensitivity to the drug. Studies conducted in Russia to study the sensitivity of nosocomial S. aureus strains to antibiotics used for a long time in clinical practice revealed resistance to gentamicin in 31% of isolated strains and to tetracycline in 37%. That is, in more than a third of patients using such drugs, the effect of antimicrobial therapy was absent [15].

Pimafukort ointment and cream is a highly effective remedy in the treatment of complicated dermatoses. The preparation contains three components: hydrocortisone – 1%, natamycin – 1% and neomycin – 0.35%.

Pimafucort can be used in pregnant women, newborns (in these patients it is not recommended to use occlusive dressings, and the area of ​​application of the drug on the skin and the duration of therapy should be limited as much as possible) and the elderly. It can be applied to steroid-sensitive skin areas.

The main advantage of Pimafucort is high safety due to the “mild” natural corticosteroid hydrocortisone, which is a part of the preparation (I class of activity according to the European classification – weak).

Natamycin belongs to the group of polyene antimycotics. It has a fungicidal effect due to the irreversible bond with ergosterol of the fungal cell membrane, causing rupture of the cell membrane, followed by cytolysis and complete destruction of fungal and hyphae cells.Natamycin has a quick and active fungicidal effect on many fungi pathogenic for humans, is active against yeast and yeast-like fungi of the genus Malassezia, dermatophytes and molds, and is highly active against fungi of the genus Candida. The main advantage of this topical antimycotic is the preservation of a stable fungicidal effect in a wide range of skin pH – from 4.5 to 9.0. In addition, there is no resistance to it even with prolonged use. There was no primary resistance either.When using natamycin, allergic reactions do not occur, which is due to the insignificant tropism of the drug to proteins and preferential binding to lipids.

Neomycin – an antibiotic of the aminoglycoside group – is active against a wide range of gram-negative bacteria and staphylococci, has a low level of absorption through intact skin.

The combination of natamycin and neomycin makes Pimafukort universal in the treatment of various variants of fungal and bacterial-fungal skin infections, as well as in cases where therapy is prescribed before the pathogen is identified.

The high efficacy of Pimafucort in AD has been proven in numerous studies [4, 13, 16]. Patients with moderate AD, complicated by superficial staphyloderma and concomitant Candida infection, received Pimafukort ointment 2 times a day for 14 days. In the course of therapy, a decrease in the area of ​​the lesion and the severity of the course of AD, a significant decrease in the absolute values ​​of the SCORAD index (SCORing Atopic Dermatitis – a comprehensive assessment of symptoms and manifestations of atopic dermatitis) from 38 to 6, an improvement in the quality of life of patients (a decrease in the dermatological index of quality of life from 19, 9 to 3.2) [16].

In the course of therapy with Pimafukort, the contamination of the skin of patients with AD by bacterial and fungal flora significantly decreased, which was confirmed by the results of bacteriological and bacterioscopic studies. Before treatment, S. aureus contamination was detected in 100% of patients, at the end of therapy – in 10%, fungi of the genus Candida – in 62.5 and 4% of patients, respectively [16].

In comparative studies with single-component topical corticosteroids, a higher efficacy of the drug Pimafucort in the treatment of AD complicated by staphylococcal infection was shown [4].

We conducted our own study involving patients with true eczema with the addition of a secondary infection with Pimafukort. All patients had concomitant disease – type 2 diabetes mellitus. Complex treatment was carried out with antihistamines, desensitizing agents; Pimafucort cream was used as a means of external therapy 3 times a day. The average EASI (Eczema Area and Severity Index – the prevalence and severity of eczema rash) before the start of therapy was 15.3 ± 1.4.Positive dynamics of the process was noted in the first week of treatment: hyperemia, peeling, weeping decreased, itching disappeared. The average EASI index decreased during treatment to 1.3 ± 0.9. At the end of the second week of therapy, 97% of patients showed regression of the disease.

In addition, we used the drug Pimafucort in psoriasis patients with diabetes mellitus. Complex treatment included desensitization, hepatoprotectors, vitamin therapy, the use of vascular drugs, anxiolytics.As an external agent, Pimafucort cream was applied to the lesions in large folds 3 times a day, and one-component topical GCS was applied to lesions on smooth skin. The process was represented by bright pink plaques, macerated, with cracks and white bloom on the surface (Fig. 1). The symptoms of the disease in the folds of the skin were assessed on a 5-point scale. Before treatment, hyperemia was assessed at 5 points, infiltration – at 3, cracks and whitish plaque – at 2 points. Positive dynamics of the pathological process in the folds was noted on the second – fourth day of treatment and was characterized by a significant decrease in hyperemia, infiltration, disappearance of wetness, whitish plaque and epithelialization of cracks (Fig.2). Regression of rashes in folds was ascertained in 100% of cases after 7–10 days of therapy (Fig. 3).

Thus, an important condition for the successful treatment of complicated dermatoses is the rational use of topical combined drugs. In the treatment of AD, true eczema with the addition of a secondary infection, as well as psoriasis of large folds, it is advisable to use the three-component drug Pimafukort. Its effectiveness in the treatment of these diseases varied from 95 to 100%, and the positive effect was recorded as soon as possible.Taking into account the safety of all components of the drug, it can be recommended for use in any age group, with different localizations of the pathological process. Wide antibacterial and antifungal activity makes Pimafukort universal in the treatment of various variants of mycotic, bacterial and mixed skin infections, as well as in cases when therapy is prescribed before the pathogen is identified.

90,000 Dyshidrotic eczema – the most likely causes of

Why do itchy blisters appear on the palms and feet?

Dyshidrotic eczema is a type of eczema (dermatitis) characterized by an itchy rash in the form of blisters on the fingers, palms and feet.It occurs in children and adults and can be acute, recurrent, or chronic. In the English-language literature, the term “pompholix” is used for this condition, which means “bubble”. The clinical course of dyshidrotic eczema can range from mild self-resolving to severe, chronic and debilitating, resistant to treatment. It is impossible to identify an unambiguous cause of dyshidrotic eczema. It is believed that pompholix is ​​a skin reaction caused by various external and internal provoking factors.

The most likely causes of dyshidrotic eczema are as follows:

1. Genetic factors. Filaggrin is a structural protein of the stratum corneum of the skin that plays an important role in its barrier function. Mutations in the filaggrin gene cause the skin barrier to be disrupted. This leads to an increased permeability of allergens into the skin.
2. Atopy. According to some reports, about half of patients with dyshidrotic eczema have a personal or family history of atopy (atopic dermatitis, asthma, allergic rhinitis).Serum immunoglobulin E (IgE) levels are frequently elevated even in patients who do not report a history of atopy.
3. Hypersensitivity (allergy) to nickel. Nickel contact dermatitis has been reported in 30% of patients with dyshidrotic eczema. The ingestion of nickel by mouth with food can also cause dyshidrotic eczema in some patients. Increased urinary excretion of nickel has been reported during exacerbations of pompholyx.
   Excessive sweating has been suggested to result in localized concentrations of metal salts that can induce a gallbladder reaction.
   A diet low in nickel may reduce the frequency and severity of pompholyx outbreaks.
4. Increased sensitivity to cobalt. When cobalt is consumed with food, allergic dermatitis in the form of dyshidrotic eczema occurs less frequently than when nickel is taken orally. Much more common is the co-occurrence of nickel and cobalt allergy, seen in 25% of nickel-sensitive patients who develop pompholyx. In these cases, the eczema is usually more severe.
   A low cobalt diet has been proposed to help patients limit cobalt intake and keep blood cobalt levels below the threshold for pompholix outbreaks. In addition, this diet reduces the amount of nickel consumed.
5. Contact exposure to allergenic chemicals or metals. Outbreaks of dyshidrotic eczema are sometimes associated with exposure to allergenic chemicals found in metals or cosmetics (e.g. chromium, fragrances, dyes, preservatives, etc.))
   Shower gel, shampoo, hair dye, etc. are often used as contact allergens.
6. Fungal infection. In some patients, pompholix develops against the background of a fungal infection and resolves as a result of treatment with antifungal agents.
7. ID reaction. This is a reaction to distant foci of fungal or bacterial infection. For example, with a fungal infection of the feet (or bacterial interdigital diaper rash), itchy blisters may appear on the hands.
8. Emotional stress. This is a possible factor in dyshidrotic eczema. Many patients report relapses of pompholix during stressful periods.
9. Hyperhidrosis – excessive sweating. To date, it has been proven that hyperhidrosis of the palms and feet is not the cause of pompholix, but is an aggravating factor in 40% of patients with dyshidrotic eczema. Reducing palms sweating after botulinum toxin administration helps to reduce / stop itching and blistering.
10. Climatic and seasonal factors. Environmental factors (seasonal temperature rise, high humidity) aggravate blistering rash.
    Although phototherapy is known to be an effective treatment for pompholix, exposure to ultraviolet A rays can trigger an outbreak in some patients. The use of photoprotective agents in this case leads to a decrease in the frequency and severity of exacerbations.
11. Other factors. The results of various studies describe other possible causes of the development of pompholix, such as taking certain medications, food products, smoking tobacco, and diseases of internal organs.

Given the various causes of dyshidrotic eczema, a detailed history and elimination of provoking factors play an important role in the treatment and prevention of this disease.

To prevent recurrence of pompholix, even in the absence of rashes, skin irritants should be avoided and a moisturizer should be regularly used to restore the skin barrier.

Sources:

1. http://emedicine.medscape.com/article/1122527-overview

7 types of eczema – causes, symptoms, treatment

Eczema usually manifests itself in the fact that areas of a person’s skin begin to become inflamed, itchy and redden. There are several different types of eczema, including atopic and discoid eczema and contact dermatitis.

World statistics indicate that the prevalence of eczema is about 1-2% among the adult population of the planet.The disease affects all races and age categories, women and men. It has been found that women suffer from eczema more often than men. In 70% of cases, eczema is the reason for going to the doctor, in 20% – the cause of temporary disability, in 10% of cases – the reason for changing jobs or professions.

In general, eczema can affect the skin, causing:

• dark spots;
• rough scaly or leathery patches;
• swelling;
• peel and wet.

Eczema is not contagious, which means that a person cannot get it himself and / or infect another person.

This article examines seven different types of eczema and their causes and symptoms. The article also discusses methods of diagnosis, treatment and prevention of the disease.

1. Atopic dermatitis

Atopic dermatitis, or atopic eczema, is the most common type of eczema.

Often onset during childhood and can range from mild to severe.A child often develops atopic dermatitis if one of the parents has had it.

Children with atopic dermatitis are at high risk for food sensitivities. Also, these children are prone to diseases such as asthma and hay fever. In some children, atopic dermatitis can go away with age.

Atopic dermatitis tends to present with patches of dry skin that can become itchy, red, and inflamed. These areas often appear in the folds of the elbows and knees, as well as on the face, neck, and wrists.Scratching these areas can worsen itching and cause clear fluid to ooze out of the skin. Repeated scratching or constant rubbing can cause the skin layer to thicken. This condition is known as Lichen Simplex Chronicus (LSC).

People with atopic dermatitis usually experience flare-ups for a time in which the eczema worsens. The reasons for the manifestations of such outbreaks can be:

• low humidity, cold weather and extreme temperature changes;
• Certain irritants such as detergents, soaps, perfumes and fragrances;
• dust mites;
• animal hair and saliva;
• skin infections;
• Certain fabrics such as wool and synthetics;
• hormonal changes, eg during pregnancy;
• food allergies.

2. Contact dermatitis

In some people, a skin reaction is caused by contact with certain substances. This condition is known as contact dermatitis.

Symptoms of contact dermatitis may include:

• dry, red and itchy skin, the person feels like the skin is on fire;
• bubbles;
• rash that looks like small red bumps;

A person with atopic dermatitis is at increased risk of developing contact dermatitis.

There are two types of contact dermatitis:

Irritant contact dermatitis

Irritant contact dermatitis can result from repeated exposure to a substance that irritates the skin, for example:

• acids and alkalis;
• fabric softeners;
• strong detergents;
• solvents;
• hair dyes;
• chemicals against weeds
• cement:
• some shampoos.

People who regularly use or work with such substances have a higher risk of developing contact dermatitis.

Allergic contact dermatitis

Allergic contact dermatitis occurs when a person’s immune system reacts to a specific substance known as an allergen.

A person may not react to an allergen upon first contact with it. However, once they develop an allergy, it remains for life.

Potential allergens include:

• glues and adhesives:
• latex and rubber:
• Certain medicines such as topical and oral antibiotics;
• fabrics and dyes for clothing;
• some plants;
• ingredients in makeup, nail polish, creams, hair dyes and other cosmetics;
• some metals such as nickel and cobalt.

3. Dyshidrotic eczema

Dyshidrotic eczema usually occurs in adults under the age of 40.It usually manifests itself on the hands and feet and has characteristic symptoms, including severe itching and the appearance of small blisters filled with fluid (vesicles). In some cases, the blisters may become large and watery. The vesicles can also become infected, which can lead to pain and swelling. They may also ooze pus.

Vesicles usually burst within a few weeks. After this, the skin often becomes dry and eroded, which can lead to painful skin cracks.

It is unclear what causes dyshidrotic eczema. However, the disease is more common in humans:

• suffering from hay fever;
• with atopic dermatitis or atopic dermatitis have a family history;
• with fungal skin infections.

People who work with certain chemicals or work with their hands immersed in water during the day are also at greater risk of developing dyshidrotic eczema.

Emotional stress and changes in the weather are among the factors contributing to the development of dyshidrotic eczema.

Dyshidrotic eczema can be a form of contact dermatitis. People with dyshidrotic eczema also tend to experience flare-ups from time to time.

4. Discoid eczema

Discoid eczema or nummular eczema, recognizable by the disc-like patches of itchy, red, cracked and swollen skin it causes.

Disks usually appear on the lower limbs, trunk and forearms.Sometimes the center of the disc is clear, surrounded by a ring of red skin.

Discoid eczema can occur in people of any age, including children.

As with other types of eczema, the causes of discoid eczema are not entirely clear. However, known causes and risk factors include:

• dry skin;
• skin injuries such as friction or burns;
• insect bites;
• poor blood flow;
• cold climate;
• bacterial skin infections;
• some medicines;
• sensitivity to metals and formaldehyde;
• atopic dermatitis.

5. Seborrheic dermatitis

Seborrheic dermatitis is a condition that causes a red, itchy and scaly rash. The rash may appear swollen or raised, and a yellowish or white crust may form on its surface.

Seborrheic dermatitis develops in areas with oily skin, for example:

• skull skin;
• ears;
• eyebrows;
• eyelids;
• person;
• upper chest and back;
• armpits;
• genitals.

Seborrheic dermatitis can affect people of any age. For example, a type of seborrheic dermatitis may develop on the scalp of babies, but this usually disappears after a few months.

There is no cure for seborrheic dermatitis in adults, so the person will periodically experience outbreaks of the disease. This course of the disease is typical for people aged 30 to 60 years.

Certain medical conditions and medical conditions can increase the risk of seborrheic dermatitis.These include:

• Parkinson’s disease;
• HIV;
• acne, rosacea and psoriasis;
• epilepsy;
• alcohol use disorders;
• recovery from stroke or heart attack;
• depression;
• eating disorders.

Certain medications, including interferon, lithium, and psoralen, may also increase the risk of seborrheic dermatitis.

6.Varicose eczema

Varicose eczema is also known as venous, gravitational or static eczema. It is common in older people with varicose veins.

Aging, decreased motor activity can weaken the veins in a person’s legs. This condition can lead to both varicose veins and varicose eczema.

Varicose eczema usually affects the lower legs, symptoms may include:

• itchy spots or blisters;
• dry, scaly seals;
• oozing, hard stains;
• cracked leather.

The skin on the leg can become fragile, so it is important to avoid scratching and scratching spots and blisters.

7. Asteatous eczema

Asteatous eczema, also called xerotic or craquelure eczema, usually only affects people over the age of 60. The disease may be due to the fact that as a person ages, his skin becomes drier.

Asteatous eczema usually occurs on the lower extremities, but it can also appear on other parts of the body.Symptoms include:

• cracked, dry skin with a characteristic appearance;
• pink or red cracks or depressions;
• itching and soreness.

As with other types of eczema, the causes of asteatous eczema are unknown, but the causes of its manifestations can be:

• dry, cold weather:
• hot baths:
• soap and other detergents:
• excessive cleaning of the skin;
• towel drying.

When to see a doctor and diagnostics

People who develop eczema should see a dermatologist. Eczema can indicate an allergy, so it is important to determine what is causing the reaction. Eczema also increases the likelihood of infection with staphylococci and has a serious impact on a person’s mental health. Your doctor may recommend a treatment plan for outbreaks.

There is no specific test for diagnosing most types of eczema.The doctor may need information about the patient’s personal and family medical history. He may also inquire about recent exposure to potential allergens and irritants. It is important that patients inform their doctor if they have hay fever or asthma.

The doctor can also ask the patient about:

• the nature of the sleep period;
• stress factors:
• any previous skin treatments;
• any steroid use.

A physical examination of the rash will help the doctor determine the type of eczema.

A doctor may also perform a test that involves tingling a person’s skin with a needle that contains potential irritants and allergens. Such a test can determine if a patient has contact dermatitis.

Treatment

There is no cure for eczema, so treatment includes managing symptoms and trying to prevent further manifestations of the disease.

Some treatment options for eczema include:

• applying moisturizers or emollients to the skin to reduce itching and cracking;
• use of steroid creams and ointments to reduce swelling, redness and soreness;
• use of antihistamines to reduce itching, especially at night;
• use of calcineurin inhibitors to help reduce inflammation;
• phototherapy, which uses ultraviolet light to fight inflammation
• The use of antibiotics for the treatment of bacterial skin infections.

Prevention of disease manifestations.

A list of tips that can help prevent flare-ups of eczema include:

• use of mild soaps and detergents;
• the need to avoid aromatic fragrances or perfumes;
• use of cool water for showers and baths;
• gentle drying and skin care after washing;
• the need to avoid scratching or rubbing areas of eczema, as damage to the skin can worsen and increase the likelihood of infection;
• thorough and regular moisturizing of the skin using light, oil-rich products;
• Application of non-cosmetic moisturizers after showers and baths to maintain skin moisture
• Wearing clothes made from natural fabrics, refusing tight clothes.

Patients with eczema should be in constant contact with a dermatologist to determine what is causing or worsening the symptoms of the disease. Knowing the causes of eczema or allergens can help prevent or minimize the manifestations of the disease.

Original article on Medical News Today – What are the different types of eczema?

The Professors’ Clinic is attended by qualified dermatologists who will help patients in the treatment of skin diseases.You can clarify information, make an appointment with a specialist by calling a single telephone number in Perm -206-07-67 or using the “Appointment” service on our website.

90,000 What makes eczema worse?

Eczema is an inflammatory skin disease that is accompanied by itching, rashes or redness. This allergic condition most often manifests itself in the form of small bubbles of liquid. The acute form can cause the chronic form of the disease, which further leads to relapses.

At the same time, allergic eczema is not transmitted from person to person and is a genetically determined disease.

Typically, the rash occurs on the following areas of the body:

• neck;
• knee bends;
• ankles;
• elbows.

In this case, the symptoms can worsen from time to time for various reasons. The exacerbation lasts from several hours to several days.

Causes of eczema

The exact causes of eczema are still unknown.Most often, such a disease has a hereditary factor or has a connection with the environment. If relatives have allergic rhinitis, asthma or eczema, then in the future the patient is at times more likely to develop this disease.

Allergies are found in 20-30% of patients, which can cause eczema.

One of the main provoking factors is the impaired functioning of the human immune system.

All sorts of inflammatory reactions appear on the skin, when the immune system begins to gradually produce immunoglobulins to its own skin cells.

In addition, a disturbed intercellular immunity is noted, which occurs as a result of an imbalance of glycoproteins:

• insufficient amount of IgM;
• laboratory values ​​of IgG and IgE exceed the specified norm.

In some cases, stressful situations or prolonged depression can cause eczema.

Studies have shown that an exacerbation of pathology occurs when disturbances in the gastrointestinal tract, as well as in the case of improperly formed eating habits.In general, there are two groups of main reasons – these are external and internal factors.

The category of internal factors that cause the development of eczema include:

• impaired functioning of the human nervous system;
• deviations in the work of internal organs;
• heredity.

External factors include:

• sudden changes in temperature;
• negative effects on the skin of household chemicals;
• negative effect on the body or skin of the extracts of various plants.

Most often, the disease occurs as a result of a combination of these factors.

How does eczema manifest

Regardless of the type of skin disease, a list of specific symptoms is characteristic:

• itching;
• inflammatory reactions in certain areas of the skin;
• red rashes;
• the appearance of bubbles with liquid;
• wounds that give a person special discomfort;
• fever, which is typical during an exacerbation of the disease;
• dry skin, loss of elasticity;
• weakness and malaise.

Symptoms may vary depending on the specific stage of the disease:

1. The erythematous stage is characterized by the formation of inflammatory areas on the skin – red spots.
2. The papular stage is characterized by a change in the elasticity of the skin, the skin becomes unpleasant to the touch.
3. The vesicular stage is characterized by the formation of bubbles.
4. The soaking stage is characterized by cracking of bubbles, from which liquid is released.
5. The crusty stage means drying of the inflamed skin areas, rough yellow crusts appear.
6. Stage dry eczema – the skin begins to peel off.

If a crust appears, it is not recommended to remove it yourself by hand or using improvised means, you need to seek help from a doctor.

Causes of exacerbation

Exacerbation of chronic eczema can occur for several reasons:

• In close contact with pollen.Some people have rather sensitive skin that they instantly react to these allergens.
• Excessive sweating.
• Stressful situations that lead to strong feelings or even nervous breakdowns.
• Changes in the body associated with the functioning of the immune system.
• As a result of taking certain medications that cause similar adverse reactions.
• As a result of the ingestion of certain foods that cause allergic reactions.

Dealing with the question of how to treat eczema, first of all, it is necessary to determine the exact list of reasons that provoked an exacerbation of this chronic disease. This is a prerequisite for effective therapy.

What to do in case of exacerbation

Treatment of eczema is carried out on an individual basis, after the diagnosis. Most often, he prescribes a special hypoallergenic diet, excluding food products from the patient’s diet that can provoke allergic reactions.

To get rid of the consequences of this pathology, doctors prescribe certain ointments to treat the affected areas of the skin.

As a rule, the treatment process involves the use of hormonal creams and ointments, the task of which is to reduce inflammation and quickly heal wounds or cracks that have already formed.

Treatment of eczema in the center “European Dermatology”

Our center employs highly qualified specialists who will help to establish an accurate diagnosis and find the causes of the manifestation, exacerbation of eczema individually for each patient.Only taking into account the type, stage of the disease, as well as the characteristics of the organism, it is possible to draw up a detailed and effective plan for further treatment, achieving the set goals.

Medical Center “European Dermatology” in Kharkov offers several stages of treatment of this pathology under the supervision of experienced doctors. As a result, the patient receives a complete list of foods to change his diet, a list of medications. All drugs for external use are selected individually, taking into account the list of the main components in the composition.

90,000 Treatment of skin diseases: psoriasis, eczema, acne

Skin diseases are widespread. More than 20% of the population suffers from dermatoses, but less than ¼ of patients seek medical help. The skin is not only the largest organ in the human body, but also a biological barrier. In addition, her condition strongly affects a person’s self-awareness and perception by others. Acute and chronic disorders of the normal function of the skin to one degree or another (sometimes severe) affect the activity of the whole organism and require treatment, sometimes difficult, available only in a hospital setting.

Skin diseases have a diverse damaging effect, causing not only local disorders, but also a deterioration in health and a narrowing of social opportunities, which should be taken into account in each individual case, as well as the prevalence of skin changes, the degree of involvement of mucous membranes, hair, nails in the pathological process …

In terms of prevalence, diseases of the skin and subcutaneous tissue are in the first place:

• itchy dermatoses;

• psoriasis;

• acne;

• photodermatosis;

• benign neoplasms;

• infectious diseases (bacterial, fungal and viral infections).

Acne is an inflammatory disease of the sebaceous glands. In the formation of acne, disturbance of keratinization processes in hair follicles, androgens and bacteria Propionibacterium acnes play a role. Acne occurs on the face and trunk, sometimes on the buttocks, usually around puberty. Comedones, papules and pustules, nodules and cysts appear on the skin. All types of acne leave the role of scars.

Eczema – inflammation of the skin, which is characterized by vesicular rashes, one or another degree of exudation (wetness) and peeling.Eczema is accompanied by severe itching in most cases.

Dyshidrotic eczema is a disease of the skin of the hands and feet, with localization on the fingers, palms and soles, when a multitude of transparent, itchy vesicles suddenly appear, located deep in the epidermis, as a result – peeling, cracks, lichenification.

Coin eczema – chronic itchy dermatitis, for which round plaques, like coins (accumulation of small papules and vesicles against the background of erythema).

Atopic eczema – usually affects the flexion surfaces of the elbow and knee joints, the skin of the face and neck, and sometimes the trunk. Dry skin and itching are the main symptoms of atopic dermatitis.

Psoriasis is a skin disease with profusely scaly papules and plaques, chronic and recurrent, solitary or covering almost the entire body, with polygenic inheritance.

The rash is most often located on the elbows, knees and scalp.The defeat of the nails is manifested by point depressions on their surface and thickening with separation from the nail bed. Psoriatic arthritis affects, usually asymmetrically, the distal interphalangeal joints. X-ray reveals deforming arthritis with destruction and atrophy.

Dermatophytosis – skin lesions with manifestations of erythema, peeling and keratinization, maceration, formation of vesicles and blisters. Most often, there is interdigital epidermophytosis of the feet, which manifests itself between the toes, two forms of the disease are distinguished: squamous (peeling) and intertriginous (hyperkeratosis and maceration of the stratum corneum of the epidermis)

Onychomycosis – damage to the nail plates of the hands and feet caused by anthropophilic and mold fungi.Ways of transmission – contact-household (through household items) and contact (especially among family members). Nail plates – thickening, opacity, color from dark yellow to dark gray, subungual hyperkeratosis, plates with longitudinal or transverse striation, the marginal zone is serrated, crumbles.

Viral diseases

Among the skin diseases caused by the human papillomavirus, three are especially widespread. These are simple warts, plantar warts, and flat warts.

Among diseases of the mucous membranes, the most common is genital warts .

Warts are represented by dense papules up to 10 mm in diameter; the surface is covered with cracks, horny layers, vegetation.

Genital warts – represented by papules on a pedicle or on a broad base, small – the size of a pinhead. The groups of genital warts resemble bunches of grapes or cauliflower.

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