Eczema

Last updated on: 28.04.2023

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Definition
This section has been translated automatically.

Term of the German-speaking and European dermatological scientific area for an inflammatory intolerance reaction of the skin, which has been revised again and again with regard to its content, but ultimately has a vague definition.

In the past, eczema, from Greek "ekzema", was defined for acute, subacute or chronic, mostly pruritic, inflammatory intolerance reactions of the skin, characterized by clinically and histologically recognizable, stadial processes. The prominent clinical feature of eczema is its polymorphism, areal erythema, vesicles, erosions, papules, plaques, and scaling.

In the acute stage, eczema is characterized by exudative inflammation (vesicles, oozing, crusts); in the chronic stage, it is characterized by lichenification, desquamation, and pruritus, and in predisposed areas by rhagade formation.

Histologically, acute eczema is characterized by lymphocytic epitheliotropy, spongiosis, and possibly vesiculation, while chronic eczema is characterized by acanthosis, papillomatosis, hyper- and parakeratosis.

There are many indications that the term "eczema" will have only a historical meaning in the future (Darsow U et al. 2010) and will be completely replaced by the term "dermatitis".

Classification
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The history of eczema with temporally valid classifications

1.eczema classification

  • Vulgar eczema
  • Endogenous eczema
  • Seborrheic eczema

In this classification, an adjective was assigned to the general term of eczema to reveal the causal relationship. The generic term "vulgar eczema" was essentially understood to mean contact eczema, intolerance reactions of the skin caused by direct contact with exogenous substances.

Later, in leading German-language textbooks, eczema was conceptually distinguished from the term dermatitis. Dermatitis was defined as an epidermal intolerance reaction of acute course and rapid regression, whereas eczema was defined as one of chronic course and low spontaneous regression tendency.

2.eczema classification

acute contact dermatitis:

  • toxic/allergic

chronic contact dermatitis:

  • cumulative-toxic/allergic

seborrheic eczema

microbial (nummular) eczema

atopic (endogenous) eczema/neurodermatitis.

Compared with the older classification, vulgar eczema has been subdivided into acute contact dermatitis and chronic contact dermatitis according to its acuity. Newly included was "microbial eczema", which was also called eczematoid microbid. It was defined as a reactive, consecutive, immunologically induced response to a focal event. With this subdivision, it is clear that the simple activity of an epidermal intolerance reaction hardly justifies the different designations of dermatitis for "acute" and eczema for "chronic," especially since all possible transitions occur in the course. The basic error of this classification is therefore the definition of the term "dermatitis" as an acute epidermal reaction and the term eczema as the same, but now chronicized, event.

Microbial eczema" was replaced by "discoid" or "nummular" eczema. In the meantime, the term "nummular dermatitis", in German "nummuläre Dermatitis" has become accepted in the international literature. In ICD10 2023, the clinical picture is also coded as "eczema nummulare, nummular eczema" under L30.- "other dermatitis".

As "endogenous eczema" the "eczematous" disease complex was summarized, which belongs to the form group of atopic diseases (Greek atopos = out of place). It is a genetically determined, multifactorial, chronically persistent or also chronically recurrent, non-contagious, mostly considerably itchy intolerance reaction of the skin with different acuity, often accompanied by atopic symptomatology of other organs. In the meantime, the generic term "dermatitis", i.e. atopic dermatitis, has become established in international literature. However, the ICD 10 /2023 lists the disease complex under "atopic eczema" (see also Rożalski M et al. 2016).

Future eczema/dermatitis classification:

Contact dermatitis (contact eczema).

  • Acute or chronic contact dermatitis (toxic/allergic).

seborrheic dermatitis (synonym: seborrheic eczema)

atopic dermatitis (atopic eczema)

nummular dermatitis (microbial/nummular eczema)

Note: ICD10 notes in its 2023 version that the terms dermatitis and eczema are synonymous.

Literature
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  1. Darsow U et al. (2010) ETFAD/EADV eczema task force 2009 position paper on diagnosis and treatment of atopic dermatitis. J Eur Acad Dermatol Venereol 24:317-328.
  2. González-Muñoz P et al (2014) Allergic contact dermatitis caused by cosmetic products. Actas Dermosifiliogr 105:822-832.
  3. Knöpfel N et al. (2018) Methotrexate for severe nummular eczema in children: efficacy and tolerability in a retrospective study of 28 patients. Pediatr Dermatol 35:611-615.
  4. Leung AKC et al (2020) Nummular Eczema: An Updated Review. Recent Pat Inflamm Allergy Drug Discov 14:146-155.
  5. Rożalski M et al (2016). Atopic and non-atopic eczema. Acta Dermatovenerol Croat. 2016 Jun;24(2):110-5. PMID: 27477170.
  6. Sohn A et al (2011) Eczema. Mt Sinai J Med 78:730-739.

Incoming links (1)

Eczema vulgar;

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

Last updated on: 28.04.2023