The acute stage of the disease is characterized by the appearance of vesicles, pinpoint erosions with oozing, serous crusts, excoriations, and less frequently, papules and pustules (with sterile contents) on erythematous and edematous skin. Depending on the evolution of morphological elements, several stages of eczema are distinguished: erythematous, papular, vesicular, weeping, and crusted.

The subacute stage of the disease is characterized by erythema, lichenification, scales, and excoriations.

The chronic stage of the disease is characterized by infiltration and accentuation of the skin pattern on the affected area, along with post-inflammatory hypopigmentation and hyperpigmentation.

Constant symptoms of eczema include itching, which worsens during exacerbations, burning, and tenderness in the affected areas.

Idiopathic eczema

In the acute stage, it is characterized by presence of vesicles, erythema, pinpoint erosions with weeping, serous crusts, excoriations and, less frequently, papules and pustules. The borders of the lesions in idiopathic eczema are indistinct. The process is symmetrical and often localized on the face and limbs. It may spread to other areas of the skin, even resulting in erythroderma. Pruritus of moderate intensity is observed. In the transition to the chronic stage of the disease, infiltration increases, erythema becomes stagnant, appear lichenification and cracking. The process is often complicated by impetiginous eczema.

Dyshidrotic eczema

Dyshidrotic eczema is characterized by the appearance of itchy blisters, vesicles on the lateral surfaces of the fingers of hands and feet, on palms and soles. These blisters are deep in the epidermis and can be seen through it, resembling grains of boiled rice. After rupture of the blisters with dense covers, erosions with oozing and serous crusts, cracks and scaling develop.

Tylotic form of dyshidrotic eczema. Manifests as hyperkeratosis of the palms and soles, sometimes with deep, painful fissures. It is chronic and often resistant to treatment.

Nummular eczema

Lesions with asymmetric involvement have a round shape with a central part covered by purulent and serous crusts. After removal of the crusts, an erosive surface with weeping is exposed. The borders of the lesions are clear. The eruptions are accompanied by pruritus.

Stasis dermatitis

Occurs against the background of varicose veins. Trauma, skin maceration, and irrational topical therapy of varicose ulcers contribute to the development of the disease. The lesions are localized on the lower extremities, predominantly in the lower third of the shins.

Nipple eczema

Often results from trauma during breastfeeding or complications of scabies, but in some cases the cause remains unknown. Nipple eczema is characterized by the development of minimal erythema with weak infiltration, weeping with the presence of serous-hemorrhagic crusts, scaling and the possible appearance of cracks and pustules. Nipple eczema is usually bilateral and is not associated with nipple thickening.

Occupational eczema

Develops due to changes in the body's allergic reactivity under the influence of industrial allergens (chemical, bacterial, etc.). Occupational allergens include amine hardeners, synthetic adhesives, paraphenylenediamine, dinitrochlorobenzene, epoxy resins, phenol-formaldehyde, penicillin and semisynthetic antibiotics, heavy metal salts, turpentine and its derivatives, mercury compounds, alloys of precious and semi-precious metals, etc. Occupational eczema develops as a delayed-type reaction to a substance used in production and is an occupational allergen. Occupational eczema occurs only in those workers whose reactivity has changed. Occupational eczema most often develops on exposed areas of the skin, i.e. areas in contact with the irritant (face, neck, chest, back of the hands, forearms, shins). When the etiological factor disappears, the disease resolves quickly. With the development of polyvalent sensitization, the elimination of the etiological factor does not prevent the development of relapses. Occupational eczema is often accompanied by respiratory changes, bronchospasm, allergic rhinitis, allergic conjunctivitis. The disease may be a continuation of occupational allergic dermatitis, drug eruption. Patients with occupational eczema are examined for work capacity and the degree of disability due to occupational disease is determined.

Diagnosis is based on the patient's history and clinical presentation of the disease.

Laboratory tests:

• Complete blood count and urinalysis.
• Blood biochemistry (ALT, AST, triglycerides, creatinine, total bilirubin, glucose, etc.).
• Determination of the total IgE level in serum
• Determination of specific IgE/IgG antibodies to food, household antigens, antigens of plant, animal, and chemical origin.
• In the case of secondary infection - culture examination for the identification of the pathogen and determination of its sensitivity to antibiotics.

Idiopathic eczema

• Atopic dermatitis
• Drug eruption condition
• Bacterial infections
• Allergic contact dermatitis

Dyshidrotic eczema

• Palmoplantar psoriasis
• Tinea pedis (athlete's foot)
• Acrodermatitis continua of Hallopeau
• Bullous pemphigoid
• Herpetic whitlow

Nummular eczema

• Large plaque parapsoriasis
• Pityriasis rosea
• Tinea corporis

Treatment Goals

• Stop disease progression.
• Reduce itching.
• Resolve skin eruptions.
• Prevent recurrences.

Systemic Therapy

Antihistamine Drugs

• Loratadine 10 mg orally once a day for 10-20 days or
• Cetirizine 10 mg orally once a day for 10-20 days or
• Levocetirizine 5 mg orally once a day for 10-20 days or
• Desloratadine 5 mg orally once a day for 10-20 days or
• Clemastine 1.0 mg orally twice a day or 2.0 mg intravenously or intramuscularly twice a day for 10-20 days or
• Mebhydroline 100 mg orally twice a day for 10-20 days or
• Fexofenadine 120-180 mg orally once a day for 10-20 days.

Glucocorticoids are used in cases of inflammation:

• Betamethasone sodium phosphate + betamethasone dipropionate 2.0 mg/5.0 mg (1.0 ml) intramuscularly once (if necessary, repeated after 10 days, but not more than 2 injections) or
• Prednisone 25-30 mg per day orally for 5-25 days; when prescribed for more than 7 days, gradually reduce the dose by 5.0 mg every 5 days until complete discontinuation of the drug or
• Dexamethasone 0.004-0.008 mg (1.0-2.0 ml) per day for 3-7 days.

In cases of severe itching, tranquilizers with antihistaminic action are prescribed:

• Hydroxyzine 25 mg orally 2-4 times a day for 3-4 weeks.

In the presence of secondary infection, lymphangitis, lymphadenitis, and fever, antibiotics are used:

• Ampicillin + clavulanic acid 875 mg + 125 mg orally twice a day or 500 mg + 125 mg orally three times a day for 7-10 days or
• Doxycycline 200 mg initially, then 100 mg orally twice a day for 7-10 days or
• Levofloxacin 250 mg or 500 mg orally once or twice a day for 5-7 days or
• Ofloxacin 200 mg orally twice a day for 5-7 days or
• Cefazolin 1.0 g intramuscularly twice a day for 7-10 days or
• Ciprofloxacin 250-500 mg orally twice a day for 5-7 days.
• Ceftriaxone 1.0-2.0 g intramuscularly once a day for 7-10 days or

Topical therapy:

Wet sompresses with a 2% solution of boric acid, 0.25% solution of silver nitrate, applied 1-2 times a day for 4-7 days during the acute stage of eczema.

Topical Glucocorticoids:

• Betamethasone valerate, cream, ointment 0.1% applied once a day for 7-20 days or
• Betamethasone dipropionate, cream, ointment 0.025%, 0.05% applied twice a day for 7-14 days or
• Hydrocortisone 17-butyrate, cream, ointment 0.1% applied twice a day for 2-4 weeks or
• Clobetasol propionate, cream, ointment 0.05% applied twice a day for 7-10 days or
• Methylprednisolone aceponate, cream, ointment 0.1% applied once a day for 2-4 weeks or
• Mometasone furoate, cream, ointment 0.1% applied once a day for 2-4 weeks or
• Alclometasone dipropionate, cream, ointment 0.05% applied 2-3 times a day for 10-20 days.

Combined products:

• Gentamicin + Betamethasone + Clotrimazole applied topically twice a day for 7-14 days or
• Betamethasone + Gentamicin applied topically twice a day for 7-14 days or
• Neomycin + Natamycin + Hydrocortisone applied topically 2-4 times a day for 7-14 days or
• Betamethasone + Fusidic acid applied topically twice a day for 7-14 days or
• Hydrocortisone + Fusidic acid applied topically twice a day for 7-14 days.

Phototherapy:

• Narrowband ultraviolet therapy with a wavelength of 311 nm, administered 4-5 times a week, for a course of 25 to 30 sessions.
• Low-intensity laser therapy with red spectrum wavelength of 0.632 µm and infrared with a wavelength of 0.8-1.2 µm, for a course of 15-20 sessions in cases of localized forms.
• PUVA therapy: administered 4 times a week for a course of 15-20 sessions (in severe cases with widespread eruptions).

Prevention:

The lifestyle of a person with eczema includes avoiding contact with potential allergens, reducing stress, limiting exposure to water, and using moisturizers, emollients, and neutral detergents for prevention. Clothing should not cause overheating and should not contain wool or synthetic components. Indoor air should be humidified. In eczema prevention, the most important tasks are proper skin care and minimizing factors that lead to flare-ups.