Eczema is an inflammatory skin disease characterized by severe itching and a rash of papules filled with serous (protein-leukocyte) fluid. There are several varieties of this disease: true (most common), dyshidrotic , children’s, varicose, seborrheic eczema. In most cases, the mechanism of development of any type of eczema is the same: improper metabolism in combination with an external or internal factor (allergen, diseases of various body systems), so treatment and prevention measures may coincide.

For the acute phase of any kind of eczema, the following symptoms are characteristic: the appearance of groups of serous papules surrounded by inflamed, highly flaky skin. Affected areas may merge with each other. Papules may burst or dry out, forming “serous wells” or serous crusts, respectively. Any kind of eczema is accompanied by itching.

The main thing in the treatment of eczema is an individual approach. Therapy is prescribed based on the form of eczema, the results of the examination and the combination of factors that influenced the development of the disease. Basically, to treat eczema, you need to follow a diet and use drugs for internal and external use.

Diet

If the trigger of the disease is an allergic reaction to any product, it is completely excluded from the diet, and the patient is prescribed a hypoallergenic diet. Also, during the period of exacerbation, all patients, regardless of the form and cause of eczema, are recommended to build a menu only from neutral products that do not cause allergies.

Fatty, sweet, starchy foods, red vegetables and fruits are excluded from the menu, and the consumption of simple carbohydrates and salt is reduced. The diet should include lean meat, vegetable soups, plant foods of any color except red, cereals, dairy products, diluted fruit and vegetable juices, mineral water (Slavyanovskaya, Moskovskaya, Arzni, Narzan). About 40% of proteins and fats should come from plant foods, and the amount of fluid consumed is reduced to 1-1.2 liters per day. The most optimal mode of eating is very small portions 5-6 times a day.

With severe weeping and extensive swelling, eczema is often treated with a three-day salt-free diet. Patients with excess weight may be assigned fasting days. In some cases, 1-2-day fasting courses with the intake of alkaline mineral waters and a solution of magnesium sulfate are effective.

Preparations for internal and external use

In the acute period of the disease, to get rid of symptoms, eczema is treated with hormonal ointments with glucocorticosteroids . They differ in their power of action – weak (hydrocortisone), moderate (prednisolone, prednicarbate , fluocortolone ) and strong ( mometasone , budesonide , betamethasone , halomethasone , dexamethasone, flumethasone ).

Also, for the treatment of exacerbation of eczema, tableted antihistamines are recommended . They have anti-allergic, anti-inflammatory and sedative effects. First-generation antihistamines are quite powerful, but due to their hypnotic effect, they are undesirable for outpatients. These include quifenadine , clemastine , chlorpyramine , promethazine , diphenhydramine , cyproheptadine , mebhydroline , meclizine , dimethindene , chlorphenamine . Second-generation drugs can adversely affect the state of the cardiovascular system, so the treatment of eczema with these drugs also has limitations. This group is represented by astemizole , terfenadine , loratadine , acrivastin , cetirizine , ebastine , azelastine , acrivastin . The third generation of antiallergic drugs are currently considered the most effective and safe. They are represented by fexofenadine , hifenadine , desloratadine , sekifenadine .

Antihistamines are prescribed for up to 15 days with a possible alternation or switch to another drug.

Acute inflammation in eczema is a reason to use cooling lotions with the addition of silver nitrate, lead, Burov’s liquid, herbal decoctions. To do this, a piece of gauze is folded into 5-8 layers, dipped into the solution, and then applied to the affected area for 3-7 minutes, until the matter heats up. Then the procedure is repeated. Lotions relieve itching, cool the skin, constrict blood vessels.

wet-drying bandage impregnated with an antibacterial drug may be useful . The dressing has not only anti-inflammatory, but also disinfecting and drying effects.

After applying lotions and dressings, ointments and pastes are used.

Pastes are usually made from an equal amount of fat base and powders. Applied to the affected area, they absorb and evaporate exudate, cool the skin and relieve inflammation. The lipids in the composition of the pastes soften the stratum corneum of the skin, due to which medicinal substances penetrate deeply into it. Pastes are used 2 times a day, in some cases, you can powder the applied mass or apply a very light gauze bandage. If necessary, the paste is removed with a cotton-gauze swab with vegetable oil. Often, with eczema, an indifferent zinc paste is used, a paste with salicylic acid, ichthyol, naftalan , dermatol , sulfur, resorcinol, boric acid. Components can be mixed with each other.

The ointment has a longer and deeper effect due to the consistency. The fatty base (of animal or vegetable origin, some products of oil and wax distillation) delays the evaporation of moisture, dilates blood vessels, warms the skin, and makes its upper layer more susceptible to the action of drugs. Good results are demonstrated by ointments based on lanolin , an organic fatty substance obtained during the processing of sheep’s wool. Lanolin is close in composition to human sebum, is well absorbed into the skin and has hydrophilic properties.

non-hormonal ointments are widely used to treat eczema . They are well tolerated by most patients, can be used for a long time and have almost no contraindications. Ointments may include tar, ichthyol, naftalan , sulfanilamide preparations, methyluracil , phytocomponents , glycerin, zinc, vegetable oils, various acids (salicylic, boric), as well as oil solutions of tocopherol, retinol. Depending on the composition of the ointment, they can relieve inflammation, itching, accelerate regeneration, sanitize and anesthetize the affected area, and dry the wounds.

thiosulfate solution also has desensitizing and anti-inflammatory effects . It is administered intravenously every day at 10 ml or taken orally 1-2 tablespoons 3 times a day. For infusions, a 30% solution is used, for internal administration – 10%.

Vitamins are recommended for internal or intramuscular intake . B1 ( thiamine ), acting on the peripheral and central nervous system, helps to cope with itching and eliminate pain. In addition, thiamine regulates water, protein and carbohydrate metabolism.

Recovery from seborrheic eczema is facilitated by taking pyridoxine (B6) and riboflavin (B2), which normalize skin regeneration and the functioning of the sebaceous glands. In the chronic period, the condition of the skin helps to maintain vitamins A and E.

Weeping of the skin in eczema is associated with the separation of protein-leukocyte exudate. Moreover, wetting causes itching, and itching, in turn, again provokes wetting , so drying preparations are a necessity. Ointments and creams may contain zinc, silver nitrate, egg yolk oil, ichthyol, tar, salicylic acid, dimexide , creolin, urea, naftalan oil. Boric acid solution, lotions with Burov’s liquid and Castellani ‘s liquid , baths and baths with starch, sea salt, decoction of string, oak bark , chamomile also have anti- exudative ability.

Cream ” Losterin ” due to the multicomponent composition has a multidirectional action. At the same time, it has antipruritic , anti-inflammatory and anti- exudative effects. Urea in Losterin serves as an excellent conductor for other components: naftalan deresined , salicylic acid, almond oil, Japanese Sophora extract – ensuring their penetration into the deep layers of the epidermis. In addition, dexpanthenol in the cream stimulates regenerative processes in the skin.

Eczema and associated diseases

Eczema is often associated with chronic diseases of various body systems. In these cases, it is necessary to carry out parallel treatment – it has been noticed that the treatment of diseases of the digestive system, nervous system, metabolism and others affects the speed of recovery and the severity of eczema.

So, for digestive diseases , drugs with pancreatic enzymes, bile salts, pepsin are prescribed.

When acute eczema is combined with symptoms such as indigestion, arterial hypertension, irritability, adults and elderly patients are advised to take an oral or parenteral solution of magnesium sulfate (15-25%). It has a choleretic, desensitizing, antispasmodic and sedative effect. It is not recommended to combine it with calcium preparations.

Stress, nervous strain, insomnia are frequent companions of eczema. Preparations, which include extracts of motherwort, valerian, peony and other plant sedatives, bromides, have a calming effect on the motor and emotional sphere, improve night sleep, and relieve smooth muscle spasm.

Hygiene and prevention

In therapeutic measures, personal hygiene also plays an important role. Serous wells are open wounds, a kind of “gateway” for the penetration of infection. In case of infection, blisters filled with pus appear on the skin. In this case, you should immediately consult a doctor, take a blood test to determine the causative agent of the infection and undergo treatment. Oral broad-spectrum antibiotics of the penicillin group and external preparations with erythromycin, tetracycline, terramycin , ofloxacin , chloramphenicol , and others are usually prescribed.

With extensive skin lesions, it is not recommended to take a bath or shower. At this time, it is more useful to cleanse the skin with gauze soaked in purified water with the addition of zinc, silver nitrate or phytotherapeutic decoctions. At other times, skin care for eczema involves taking a cool herbal bath or, preferably, a lukewarm shower with a cleanser specially formulated for painful skin. When inflammation of the hair follicles occurs, it is necessary to lubricate them with a 2% solution of camphor or salicylic alcohol.

In addition to general recommendations, there are specific therapeutic and preventive measures. Thus, the first step in the treatment of microbial eczema is the elimination of the background (fungal or microbial) disease. With seborrheic eczema, it is necessary to take antimycotic drugs that inhibit the vital activity of Pityrosporum fungi ovale , Candida and Staphylococcus bacteria . In both cases, antibiotics or antifungals with terbinafine , miconazole , natamycin , naftifine , econazole , sanguinarine , polymyxin , fluconazole, etc. may also be prescribed.

Treatment of childhood eczema requires, first of all, a strict hypoallergenic diet, not only by the child, but also by the mother, if she is breastfeeding.

Varicose eczema occurs against the background of diseases of the blood vessels of the lower extremities. In addition to the above recommendations, patients need to maintain vascular health: wear compression underwear, attend therapeutic massage sessions, and exercise therapy.

For any eczema, spa treatment, thalasso and heliotherapy are useful. The mineral composition of sea water has an anti- exudative effect and normalizes metabolic processes in the skin, ultraviolet light provokes the production of vitamin D, which is necessary for skin health. It is most useful to combine rest and treatment in resorts. The largest Russian dermatological sanatoriums are located in the Krasnodar Territory (Sochi-Matsesta, Yeysk, Goryachiy Klyuch, Krasnoyarsk Territory, Arkhangelsk Region ( Solvychegorsk ), Samara Region (Sergievsky Mineral Waters), Perm Region (Klyuchi), Crimea (Evpatoria, Feodosia, Saki), Tula region ( Krainka ), Novgorod region (Staraya Russa), Caucasian mineral waters (Pyatigorsk) and Altai (Belokurikha).

In addition to natural healing factors, sanatoriums can provide such methods of treatment as physiotherapy exercises, diet therapy, herbal medicine, as well as laser , photo and magnetotherapy. For example, ultraviolet irradiation shows good results in patients with chronic eczema, especially microbial and seborrheic. But with true eczema, on the contrary, the action of ultraviolet radiation can cause deterioration. Phonophoresis can also help with some types of eczema . with hormonal, naftalan , sulfur-salicylic, retinol ointments. With thickening of the skin, a change in its pigmentation, excessive dryness, applications of ozocerite, paraffin and therapeutic mud are prescribed.