Eczema (overview) L30.9

The term eczema is increasingly losing its meaning in international literature. In this respect, this article refers to the definition and classification commonly used to date. The substitute, nonprejudicial term "dermatitis" is used synonymously.

The term "eczema" was previously used to describe an acute to chronic, noninfectious inflammatory reaction of the epidermis and dermis caused by a variety of exogenous noxious agents and endogenous reaction factors with typical clinical symptoms (pruritus, erythema, papules, seropapules, vesicles, scaling, crusting, lichenification) and characteristic histologic appearance (spongiosis, acanthosis, parakeratosis, lymphocytic infiltration).

In international (Anglo-American) usage, the term eczema ("eczema") is usually replaced by the term "dermatitis", which leads to a not inconsiderable nomenclatural problem.

The eczema group can be classified according to various criteria, whereby a rough classification according to "atopic eczema, toxic and allergic contact eczema" covers a large part of the diseases of the eczema group.

A more advanced classification (according to P. Fritsch) takes into account not only the pathogenesis but also topographical and endogenous influences on the basic eczematous reaction and thus does more subtle justice to the variety of reaction patterns and the different therapeutic modalities that become necessary as a result.

• Pathogenesis:
  • Eczema, atopic
  • Contact eczema, allergic
  • contact eczema, toxic
  • Exsiccation eczema
  • Eczema, seborrheic
  • Stasis eczema
  • Eczema, photoallergic
  • Eczema , post-scabious.
• Localization (e.g.):
  • Hand eczema
  • Foot eczema
  • Fingertip eczema
  • Eczema, intertriginous
  • Lip eczema
  • Eyelid eczema
  • Nipple eczema
  • Eczema, perioral
  • Anal eczema
  • Genital eczema
  • Scrotal eczema
• Acuity:
  • Eczema, chronic
  • Eczema, acute.
• Special features (morphological, etiological):
  • Eczema, dyshidrotic.
  • Eczema, nummular (microbial).
  • Eczema, hyperkeratotic-rhagadiform.
  • Lichen simplex chronicus (Vidal)
  • Photoreactive eczema (see chronic actinic dermatitis below).

Acanthosis of varying severity, lengthening of the reticulum, hyperkeratosis with parakeratotic parts, perivascular, partly also diffuse, predominantly lymphocytic infiltrate in the upper dermis with slight to distinct dermal fibrosis (depending on the duration of the eczema reaction). Mostly proliferation of capillaries in the infiltrate zone. Focally very differently pronounced epidermotropy with spongiosis (up to intraepidermal spongiotic blistering) of varying severity (depending on the degree of acuteity of the eczema reaction).

• Switching off the triggering noxae, phase-specific eczema therapy, according to the prevailing clinical findings. In particular, in the case of chronic eczema, test ointment tolerance as quickly as possible ( epicutaneous test, quadrant test). Selection of suitable or, if possible, indifferent bases (e.g. aqueous solutions, vaselinum alb.). Especially no wool waxes and wool wax alcohols!
• Acute eczema

  :Note!

  Basic principle: The more acute and weeping the eczema, the more watery the ointment base!
  • Acute vesicular to bullous stage (weeping)
    : short-term glucocorticoids of medium to strong potency such as 0.1% triamcinolone acetonide, 0.25% prednicarbate (e.g. Dermatop cream/ointment), 0.1% mometasone (e.g. Ecural ointment) or 0.05% clobetasol(e.g.
    R054, Dermoxin cream/ointment) depending on the clinic and localisation. No isolated application of fatty bases, but better solutions or hydrophilic creams like Ungt. emulsif. aq. (e.g. R054, Dermatop cream, Ecural Lsg.). If greasing basis, then in combination with moist compresses. Moist compresses are also indicated in combination with hydrophilic creams. Envelopes with e.g. Ringer's solution for superinfection with antiseptic additives like quinolinol (e.g. Chinosol 1:1000), quinolinol sulfate monohydrate solution 0.1% or potassium permanganate - light pink).
    In the vesicular stage also fat-moist with glucocorticoid like 1% hydrocortisone in lipophilic base like Vaselinum alb. (hydrocortisone ointment 1%), a dressing moistened over it (e.g. Ringer's solution) or possibly a cotton glove. Caution! Restrained use of glucocorticoids on sensitive skin areas such as face, neck, intertriginous areas (submammary, groin region, ano-genital area)!
  • Crusty or squamous stage: Hydrophilic creams with the highest possible oil content for the regeneration of the skin (e.g. base cream (DAC), Linola cream, Ash base cream, Excipial cream, Dermatop base cream). If necessary also with wound healing additives like dexpanthenol (e.g. R064, Bepanthen ointment).
    After treatment: Nourishing and moisturizing topicals in a compatible base such as Vaselinum alb., Linola fat, Ash Base Ointment, Excipial Almond Oil Ointment) possibly with addition of 2-10% urea (e.g. R102 R107, Basodexan Cream, Excipial U Lipolotio).
• Chronic eczema

  :Remember!

  Basic principle: The more chronic the eczema, the more oily the ointment base!
  • Short-term glucocorticoids of medium to high potency see above in a fatty base (e.g. Ecural fat cream, Dermatop ointment). Subsequently antiphlogistic topicals such as Pix lithanthracis. On a trial basis Pix lithanthracis 2% in zinc oil(coal tar-zinc oil 2-5%) or coal distillate containing or shale oil sulphonate containing topicals (e.g. ichthosin, ichthoderm, tar-linola fat). Soaps and detergents should be omitted, instead oil-containing baths (e.g. Balneum Hermal, Balneum Hermal Plus, Balmandol, Linola Fat-Oil Bath, Liquedin Bath Oil). If necessary also tar-containing oil baths such as Ichtho bath.
  • In chronic, hyperkeratotic and highly scaly plaquelike eczema foci (see also eczema, hyperkeratotic-rhagadiform eczema of the hands and feet), strongly potent glucocorticoids, possibly under occlusion, e.g. clobetasol propionate (e.g. dermoxin). Caution! Cautious use of glucocorticoids in children! No treatment under occlusion!
  • From the subacute stage of eczema onwards, the combination of external therapy with UV therapy is recommended. Cave! No phototherapy for phototoxic and photoallergic eczema! A high-dose UVA1 treatment has proven to be effective in eczema therapy as well as the combination of brine baths with subsequent UVB irradiation. In case of therapy failure, PUVA bath therapy (if necessary locally) is recommended. Aftercare as above.

In highly acute eczema, glucocorticoids (e.g. Solu Decortin H) i.v. in a dosage of 100-150 mg i.v. in a rapidly tapering dosage. Switch to peroral therapy such as prednisone (e.g. Decortin) or cloprednol (e.g. Syntestan) and rapidly taper within one week. In case of pruritus, antihistamines such as desloratadine (e.g. Aerius) 1-2 tbl./day or levocetirizine (e.g. Xusal) 1-2 film tbl./day, if necessary antihistamines with sedative effect such as dimetinden (e.g. Fenistil) 3 times 1-2 drg./day.

In case of pronounced superinfection with systemic reaction (such as fever, ESR acceleration, leukocyte increase) antibiotics internally with a broad spectrum of activity such as cephalosporins.

The term " dermatitis" includes the term eczema. The term "dermatitis" is much broader than the term "eczema" because it also includes diseases (e.g. hypereosinophilic dermatitis, dermatitis herpetiformis, etc.) which do not correspond to the much narrower definition of the term "eczema".

Also in histopathological (descriptive) language the term "dermatitis" claims a wide field for very different inflammatory patterns of the dermis (e.g. neutrophilic dermatitis, granulomatous dermatitis, etc.).

In international literature the term "eczema" is increasingly losing importance. The group of diseases traditionally referred to as "eczema diseases" such as "atopic eczema, contact allergic eczema, microbial eczema, seborrheic eczema etc. are internationally listed under the term "dermatitis": atopic dermatitis, seborrheic dermatitis, contact dermatitis etc. German-speaking dermatology will not be able to escape this trend. In this respect, the term "eczema" is replaced by the internationally used term dermatitis in this online encyclopaedia.

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