Eczema is a chronic skin disease, accompanied by rash and itching on areas of the body caused by serous inflammation of the dermis. The cause of eczema is still not clear, but it has been established that the disease often appears in patients with autoimmune diseases, decreased immunity, thyroid and kidney diseases, and nervous strain [1]. Eczema appears in people with a predisposition to it. Today there are two theories of the pathogenesis of eczema - neurogenic and allergic.
Causes of eczema
The exact cause of this condition is unknown, but the process is based on an overactive reaction of the body's immune system to an irritant or allergen. Substances are formed in the cells of the dermis that cause inflammation, which is associated with the main symptoms. It is also known that the tendency to this disease is inherited.
The therapy is aimed at suppressing inflammation and allergies, as well as healing, eliminating itching and dryness.
Topical medications are available in various forms. Each type of skin lesion has its own dosage form.
- Ointment - has a fatty base with which the medicine is mixed directly, it is more suitable for dry eczema and dermatitis on the hands, it cannot be used on wet areas, it may not be hormonal, or contain hormones. The active components penetrate the skin well, and the fat base itself is not absorbed.
- The cream contains water with a medicine dissolved in it, which is mixed with a fat base. Contains significantly less fat than ointment, so it is suitable for weeping eczema. It is better absorbed and does not leave greasy marks on clothes. The healing components of the cream penetrate the skin less well and usually act in its upper layers.
- In the paste, the concentration of dry substances is more than 25%.
- Lotion is a liquid dosage form (usually an aqueous solution of a drug plus oil). Lotions are suitable for wet conditions, as well as on the head under the hair.
Expert opinion
— The selection of hormonal/non-hormonal agents for external use is carried out by a specialist after collecting an anamnesis, identifying the causes that provoked the disease, and examination.
Firsakova Svetlana Sergeevna, dermatovenerologist, Melanoma Unit Moscow clinic
How to achieve long-term remission from eczema?
Class Clinic
Eczema - according to the World Health Organization, about 10% of the population on our planet suffers from this disease. In Russia, approximately 1 in 12 citizens encounter this disease. Most patients with eczema are seen by a dermatologist, but despite adequate treatment, exacerbations sometimes prolong or often recur. Polina Aleksandrovna Stepanova, a practicing dermatologist at the Kaliningrad medical center Class Clinic, tells how to maximize the duration of remissions for eczema and reduce the number of exacerbations.
Many eczema sufferers say that it is very difficult to achieve long-term remission, and also complain of frequent and prolonged exacerbations. What can be recommended in such cases?
As a rule, a variety of factors that irritate the skin lead to exacerbations of the process in eczema: household chemicals, water, cosmetics and perfumes, mechanical microtraumas, and the temperature factor can influence. In other words, exacerbations occur when the skin is exposed to one or another negative, traumatic effect.
It is for these reasons that most often during exacerbations of eczema, rashes appear on the hands. Brushes are most susceptible to irritating effects of the external environment. Exacerbations can also be caused by medications for external use if they contain components that can provoke an allergic reaction or cause skin irritation.
In general, the etiology (origin) of eczema is a rather complex issue. It is necessary to give the most effective recommendations based on each specific case. But, of course, there are general principles for preventing exacerbations, which in general can be called careful treatment of the skin.
There are interesting cases when a fungal infection of the skin acts as a provoking factor or allergen, while conventional methods will not be enough, specific therapy is needed. As I already said, each case should be assessed by a dermatologist.
What recommendations do you usually give for preventing exacerbations?
I recommend eliminating skin contact with household chemicals and prolonged contact with water as much as possible. It is necessary to use hypoallergenic preparations for the skin that do not contain any dyes, fragrances, or perfume compositions.
Often the triggering factor is contact with rubber (latex). Because of this, the use of rubber gloves does not protect against irritation in all cases. To protect your skin when performing certain activities that involve danger to your hands (cleaning, washing dishes), I recommend first using cotton gloves (preventing risky contact with latex) and then putting on rubber ones.
Are there pharmacological remedies that can help quickly solve the problem of eczema?
It is important to understand that if you have eczema, you should consult a dermatologist in any case. The doctor will assess the condition and prescribe treatment based on individual characteristics. Today there are a number of hormonal drugs that can quickly stop exacerbations and maintain long-term remission.
I use modern steroid drugs to stop the acute process, after which maintenance therapy begins. And there is absolutely no need to be afraid of hormonal external agents. Modern drugs for topical use are not absorbed into the blood and do not affect the general condition of the body.
I can say that during the use of modern steroid ointments, I have not seen any general reactions from their use.
As maintenance therapy during remission, I use ointments that protect the skin, moisturize, and quickly epithelize cracks. Without the use of such drugs, it is more difficult to prolong remission, even in situations where high-quality hormonal therapy was used to relieve an exacerbation. And, of course, we must not forget about caring for the skin, which I have already mentioned.
Is it possible to use some methods to ensure a guaranteed duration of remission for eczema?
Exclusively comply with all recommendations and fulfill doctor’s prescriptions. It is very difficult to talk about a specific period, but strictly following the dermatologist’s recommendations will ensure the longest possible remission.
I recommend that patients determine which of the likely factors is causing the exacerbation. When you know the reason, it is easier to protect yourself from it. Understanding the provoking factors specifically in your case allows the doctor to give accurate recommendations to ensure the duration and durability of remission.
Make an appointment with Polina Aleksandrovna Stepanova on the website or by phone (4012) 33-44-55.
Hormonal agents
All hormonal medications contain synthetic derivatives of the adrenal cortex. In a healthy body, they play the role of stress mediators and help adapt the functioning of all organs to changing conditions. Their ability to regulate immunity makes them very useful in many dermatological diseases in which inflammation and allergies play a role. Glucocorticoids affect the functioning of cells responsible for the inflammatory process. Thanks to this, chemical compounds that cause symptoms do not enter the bloodstream. Hormones enter the dermis layers and eliminate redness, swelling, itching, and rashes.
Hormone therapy is contraindicated in certain conditions:
- Rosacea
- Acne
- Viral diseases of the epithelium
- Skin infection caused by bacteria or fungi
- Reaction to vaccine administration
- Tuberculosis
- Scabies
- In pregnant women and children, these medications should not be applied to large areas of the body or covered with a bandage.
Advantan
A modern medicine that is well tolerated and has minimal negative effects. This ointment effectively helps relieve symptoms of psoriasis, eczema and dermatitis, and can be used on the arms and legs, as well as on the face. The drug practically does not enter the bloodstream; even after application over large areas, traces of this drug are not detected in the blood. Advantan is approved for people of any age. Expectant mothers should be treated with caution. Local side effects rarely occur with long-term therapy without medical supervision. This may include atrophy, redness and acne. Systemic adverse effects have not been described.
Hydrocortisone
It is based on the synthetic steroid hydrocortisone, one of the weakest glucocorticoids, with which it is better to start treating eczema. If the lesion covers a large area, the skin is severely damaged and is covered with a bandage, hydrocortisone is likely to enter the bloodstream and produce systemic effects.
Hydrocortisone can be treated from the age of two; it is prohibited during pregnancy.
Dermovate
This drug is the most powerful among pharmacological products with glucocorticoids. It is prescribed only in the most acute period, then switching to less powerful drugs. You should not use it for more than four weeks, as this may lead to side effects. At the same time, if the effect of therapy is not visible within several weeks, you need to recheck the diagnosis, because Dermovate shows extremely high effectiveness for eczema conditions.
Lokoid
Lokoid is a very strong glucocorticoid. It is effective for severe forms of atopy, but with prolonged use it causes serious atrophy of the skin, which sometimes persists even after discontinuation. Lokoid is absorbed into the bloodstream in small quantities, but systemic side effects, unlike local ones, easily go away after the end of the course. Pregnant women are allowed to be treated with Lokoid, using caution. Although it enters the bloodstream and through the placenta, a very short course of therapy is usually required, so there is no harmful effect on the fetus.
Lorinden
Loriden's formulation contains a powerful glucocorticoid combined with salicylic acid, which dissolves epithelial scales and helps the hormone penetrate deeper and work better, and also disinfects the skin in the area of application.
It is safe for children and expectant mothers only in small areas.
Prednisolone
This is a medium-strength remedy with which you can begin treating mild to moderate eczema. It easily penetrates the blood, so the course of treatment should be short, and during pregnancy it should be used carefully.
Soderm
This is an effective ointment for eczema on the skin, including the hands and face, is safe for use in adults and children, and patient reviews indicate that it is well tolerated. The active substance Soderma practically does not penetrate into the blood.
Flucinar
A highly active steroid with pronounced anti-inflammatory activity. Prescribed only for a short course due to local side effects. Since it enters the body, it can cause systemic complications and is contraindicated for pregnant women.
Fluorocort
Fluorocort has high activity, but is quite well tolerated. The result is achieved in 10 days, but if necessary, it is safe to use Fluorocort for up to 25 days.
Celestoderm-B
Contains an active and strong glucocorticoid, which effectively eliminates symptoms, but practically does not pass into the bloodstream. They also produce a combination cream with the addition of the antibiotic gentamicin, which suppresses the growth of microorganisms in the epidermis, but is contraindicated in children.
Cynacort
Cinacort contains the synthetic corticoid triamcinolone, which is well tolerated and has a pronounced anti-inflammatory effect. Suitable for dry eczematous changes, and the cream is suitable for swelling, weeping, as well as in skin folds and the border with the mucous membrane.
Elokom
A modern medicine with very strong anti-inflammatory and anti-allergic effects. It does not cause atrophy and does not enter the body. Due to its prolonged activity, it must be applied once a day. It can be used with caution by pregnant women.
Treatment of dry eczema on hands
The most common diagnosis is dry eczema on the hands. The rash can affect either a small area of the skin or the entire hand, including the palms and nails. Typically, dry eczema first appears on the finger in the form of an itchy red spot, which grows and affects an increasingly larger area, spreading to the entire hand, and then to the entire arm. If the disease is not stopped in a timely manner, the pathology can cover a very large area of skin. The larger the focus of the disease, the longer and more difficult the therapy will be.
Treatment of dry eczema on the hands is aimed at eliminating unpleasant symptoms and achieving stable remission. To achieve a positive effect, an integrated approach is required. First of all, the cause of the disease should be eliminated: remove foods that provoke allergies from the diet, do not use cosmetics, and avoid contact with household chemicals.
You should know that even an insignificant factor can provoke irritation of inflamed skin. Therefore, it is better to avoid synthetic and wool gloves. It is recommended to wash your hands with soap containing resins and plant extracts. Losterin cream soap is perfect for this purpose.
Then the doctor selects medications that have antibacterial, antifungal and anti-allergenic properties. In this case, both general and local means are used. Ointments and creams can provide effective results. They eliminate inflammation, get rid of rashes, and moisturize dry skin.
Glucocorticosteroid drugs are especially effective, but they are addictive and cause side effects. Therefore, doctors give preference to non-hormonal ointments containing vegetable oils, extracts of medicinal plants (chamomile, birch leaves, willow bark), and petroleum products. They have a complex effect: nourish and protect the skin, disinfect wounds and activate their healing. Such products include “Losterin”. The drugs in this series can be used not only for therapeutic purposes, but also for preventive purposes.
Non-hormonal ointments
The formula of non-hormonal anti-eczema pharmaceutical products includes various compounds that mitigate the symptoms of the disease. In some cases, using one of the non-hormonal ointments is sufficient to achieve remission. Combination medications are aimed at several components of the disease at once. They work well and have no systemic complications. Local adverse events vary depending on the formulation.
Akrustal
The active ingredient of this brand is solid oil. It helps with flaking, itching, and inflammation, although the exact mechanism by which it works is unclear. Solidol causes contact dermatitis, so upon first use it is necessary to test the reaction on a small area of the body surface. With prolonged use, oil acne appears due to the fact that solid oil clogs the ducts of the sebaceous glands. If such a reaction occurs, it is recommended to apply Akrustal every other day.
Boron-zinc-naphthalan ointment
This is a combination drug that is used for inflammatory diseases of the epithelium. Boric acid in its composition is an antiseptic. Zinc oxide dries and has an astringent effect, which is useful for weeping. Naftalan oil has a strong anti-inflammatory effect, relieves redness and itching, and cleanses the skin.
Heparin
Contains heparin, which resolves blood clots in the veins and improves blood flow. Thanks to auxiliary additives that dilate blood vessels in the dermis and increase tissue permeability, heparin is more easily distributed under the skin in the area of application. In addition, the composition includes a local anesthetic, which reduces itching, pain and the feeling of fullness. This ointment is useful against venous eczema, but is not effective against atopic eczema on the arms, face and torso.
Dermasan
This is a liquid with a very simple composition, which is used for dry skin, irritation and cracks. Glycerin softens and soothes, and ethyl alcohol destroys germs.
Levomekol
A combined drug that has a wound-healing effect and also fights bacteria that cause infection.
Losterine
A series of combined agents that have a good therapeutic effect for atopic dermatitis. A unique component of the Losterin series is naftalan oil, a powerful anti-inflammatory agent that soothes irritation, reduces swelling, itching and redness, and promotes healing. In addition, among the active ingredients are urea, which is a good emollient, salicylic acid (softens and exfoliates), D-panthenol and almond oil.
Methyluracil
Methyluracil enhances metabolism in epithelial cells, stimulates their division and promotes regeneration.
Radevit
The working components of Radevit are vitamins A, E and D. Vitamin A promotes the renewal of epithelial cells. Vitamin E is an excellent antioxidant. Vitamin D fights inflammation and improves cell nutrition.
Salicylic
Salicylic acid softens scales and helps cleanse the skin in case of eczematous lesions. It also regulates the functioning of the sebaceous and sweat glands, which is useful for seborrheic dermatitis. Thanks to its antiseptic properties, it prevents infection of epidermal lesions. Contraindicated for children.
Skin Cap
Skin Cap cream and shampoo contain the therapeutic component zinc pyrithione. The main direction of Skin Cap's work is anti-inflammatory. It softens the epithelium, eliminates itching and flaking. Active against fungi that support inflammation and flaking in seborrheic dermatitis. Zinc pyrithione also fights bacteria that complicate eczema.
Solipsor
Solipsor products contain medical grease and birch tar, which fight inflammatory manifestations, and natural herbal extracts soothe, eliminate itching, and destroy microorganisms. Solidol sometimes provokes contact dermatitis, so for the first time Solipsor should be tried on a small area.
Thymogen
Thymogen regulates cell renewal, stimulates tissue regeneration and healing.
Zinc paste
Having drying and astringent activity, zinc paste makes it easier to get wet.
Elidel
A highly effective medicine, comparable in strength to hormones. Elidel, penetrating into the dermis, inhibits the division of immune cells responsible for the formation of inflammation and blocks the release of allergy mediators. Elidel does not cause atrophy, does not affect general immunity (even when taken orally, in the form of tablets), and does not reduce resistance to infections. Approved for children from 3 months of age, but not yet sufficiently studied during pregnancy. Adverse reactions such as infection at the site of application are rare with very long-term use.
Emolium
This is a line with significant moisturizing activity. Emulsion Emolium contains natural oils, urea, paraffin oil and other emollients, that is, substances that help the body retain moisture as much as possible.
Eplan
Contains a solution of lanthanes in glycerin - the active Glycolan complex, which promotes skin regeneration and rapid healing of damage, and also prevents infection.
Symptoms of dry eczema
Asteatotic eczema is characterized by a slow progression and difficulty in achieving remission. The manifestations of the disease worsen in winter and when the immune system is weakened.
Eczema is accompanied by:
- a feeling of dryness and tightness of the skin on the extremities, loss of elasticity;
- peeling of the skin;
- the appearance of ever-deepening cracks, giving the skin a resemblance to cracked porcelain;
- the appearance of inflamed, ulcerated areas on the skin characterized by uneven edges;
- the formation of papules, combining into plaques, and then into extensive clusters;
- severe itching, burning and pain.
In the first stage, the skin turns red and begins to peel. At the second stage, itching and pain are detected, which can be almost invisible or pronounced, interfering with normal sleep. Cracks may form. If left untreated, the cracks reach the blood vessels, causing ichor or sticky serous fluid to leak out of them (it can be colorless or yellowish). As a result, the skin becomes wet and covered with hard crusts.
If a secondary infection occurs, purulent ulcers form, which cause severe discomfort.
Side effects
Complications from medicinal products containing glucocorticoids in the area of their application are associated with their effect on cell repair.
- Atrophy. At the site of application, the epidermis becomes thin, dull, easily damaged, and loses hair.
- Decreased protective function of the body. Acne appears and infection easily develops.
In some cases, the hormone contained in the drug mixture can enter the bloodstream and cause a systemic complication. Glucocorticoids affect blood pressure, sugar levels, lead to a significant decrease in immunity, obesity, osteoporosis, and cause growth retardation in children. To prevent hormones from causing such disorders, they should only be used under medical supervision. The doctor will give recommendations on how long and how often to apply the ointment for eczema, depending on whether the area of application is on the arms, legs or body, will help reduce the dose or change treatment in time and, of course, will tell you the name of the most suitable drug for this case.
Side effects of non-hormonal ointments manifest themselves in the form of irritation or an allergic reaction. Medical solid oil in some medications provokes the appearance of contact dermatitis.
Treatment of dry eczema on the legs
Asteatotic eczema on the feet is caused by the same factors as dry eczema on the fingers. Among all the reasons, it is especially worth highlighting an allergic reaction to synthetic and wool socks.
In the photo of dry eczema on the legs, the symptoms of the disease are clearly visible. The worst thing is when eczema is combined with tylotic dermatosis. In this case, severe, persistent itching prevents normal movement. Therapy is complicated by the fact that the feet are constantly under stress.
Treatment of dry eczema on the legs, its manifestations are visible in the photo, is no different from the treatment of eczema on the hands. We must not forget that complete recovery is possible only after eliminating the cause. Otherwise, it will not be possible to avoid constant relapses, which will manifest themselves in a more severe form each time.
Traditional medicine can be used as a complement to drug therapy. They will relieve unpleasant symptoms and significantly alleviate the condition.
Prevention
For prevention, two types of care products are used.
- Moisturizing products with powerful emollients, such as urea and glycerin, soften and prevent the body from drying out due to the fact that, distributed in the outer layers of the epidermis, they attract moisture. They are applied throughout the day as needed.
- Natural oils, waxes and silicones create a protective barrier on the surface of the skin, preventing moisture evaporation. They are best used after a shower and applied to a damp area of the body.
Bibliography
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