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).

• Elimination of the triggering noxious agents, phase-appropriate eczema therapy according to the prevailing clinical findings. Especially in chronic eczema, test ointment tolerance as quickly as possible ( epicutaneous test, quadrant test). Selection of suitable or preferably indifferent bases (e.g. aqueous solutions, Vaselinum alb.). Especially no wool waxes and wool wax alcohols!
• Acute eczema

  : Remember! 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 high 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 clinical picture and localization. No isolated application of greasy bases, but rather solutions or hydrophilic creams such as Ungt. emulsif. aq. (e.g. R054, Dermatop cream, Ecural Lsg.). If a greasy base is used, then in combination with moist compresses. Moist compresses are also indicated in combination with hydrophilic creams. Envelopes with e.g. Ringer's solution in case of superinfection with antiseptic additives such as quinolinol (e.g. Chinosol 1:1000), quinolinol sulphate monohydrate solution 0.1% or potassium permanganate - light pink).
    In the vesicular stage also fat-moist with glucocorticoid such as 1% hydrocortisone in a lipophilic base such as Vaselinum alb.(hydrocortisone ointment 1%), with a moistened dressing (e.g. Ringer's solution) or cotton glove if necessary. Caution! Cautious use of glucocorticoids on sensitive skin areas such as face, neck, intertrigines (submammary, groin region, ano-genital area)!
  • Crusty or squamous stage: Hydrophilic creams with the highest possible fat content to regenerate the skin (e.g. base cream (DAC), Linola cream, Asche base cream, Excipial cream, Dermatop base cream). If necessary, also with wound-healing additives such as dexpanthenol (e.g. R064, Bepanthen ointment).
    Follow-up treatment: Nourishing, moisturizing topical products with a compatible base (e.g. Vaselinum alb., Linola fat, Asche base ointment, Excipial almond oil ointment), if necessary with the 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 greasier the ointment base!

  • Short-term glucocorticoids of medium to high potency as above in a greasy base (e.g. Ecural fat cream, Dermatop ointment). Then antiphlogistic topicals such as topicals containing shale oil sulphonate(e.g. Ichthosin, Ichthoderm). 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).
  • In chronic, hyperkeratotic and severely scaling plaque-like eczema (see also eczema, hyperkeratotic-rhagadiform hand and foot eczema), highly 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, the combination of external therapy with UV therapy is recommended. Caution! No phototherapy for phototoxic and photoallergic eczema! High-dose UVA1 treatment has proven successful in eczema therapy, as has the combination of brine baths with subsequent UVB irradiation. In the event of treatment failure, PUVA bath therapy (possibly localized) is recommended. Follow-up treatment 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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