Since eczema is not an etiologic diagnosis, it is important not to be satisfied with the diagnosis of eczema in the clinical setting, but rather to ask for a careful history and do relevant examinations to actively search for the causes and aggravating factors, and to strive to treat the disease at its root. Dermatologists should be familiar with the causative factors of endogenous eczema as well as the causative substances of exogenous eczema, in order to be able to examine and treat patients in a targeted manner.
Care must be taken to protect the skin's barrier function when choosing treatments, especially topical treatments. Even if the inflammation is very mild dermatitis, the skin barrier function has been damaged, if you do not pay attention to protect the skin barrier, often may aggravate eczema. Such as pepper water or chili water to stop itching, or dry cracked eczema using infrared lamp physiotherapy can further damage the skin barrier, and aggravate dermatitis. It takes weeks for the skin's barrier function to recover after the clinical symptoms have improved significantly.
(1) Systemic drugs
①Antihistamines: antihistamines are very commonly used in dermatology, but their therapeutic effect on eczema has not been fully demonstrated. Mechanistically, these drugs have antihistamine effect, so they are effective for histamine-mediated skin erythema, cellulite or itching caused by type I allergic reaction, while there is no sufficient evidence to prove their effectiveness for eczema dermatitis caused by non-type I allergic reaction. Since most of these drugs have sedative and somnolent side effects, they may be beneficial for the treatment of eczema by relieving to some extent the itch-induced sleeplessness of eczema patients. Because of the new generation of antihistamines are not sleepy side effects, the therapeutic effect on eczema seems to be poorer, but these assumptions are yet to be proved by the exact experiment.
②Corticosteroids: for acute severe eczema, but not for chronic eczema.
③Antibacterial drugs: for infected eczema and eczema co-infected. Perioral dermatitis can be oral tetracycline or erythromycin.
(2) local treatment
①Acute eczema: acute eczema skin with erythema, edema, papules, but no blisters vesicles or oozing can be treated with mild powder or lotion, such as glycerite lotion. Corticosteroid creams can also be applied directly topically. For the skin lesions have been vesicles oozing application of wet compresses, such as boric acid water wet compresses. If the combination of infection application of antibacterial water such as Livanol liquid wet compresses.
②Subacute eczema: it is appropriate to use oil or paste for treatment, but also direct external corticosteroid cream. Combined infection should be used first antibacterial ointment or selection of corticosteroid hormones and antibacterial drugs combined preparations.
Mild dry eczema can be treated with emollients. Many emollients are effective, such as petroleum jelly and mineral oil, which are best applied immediately after bathing to keep the water in the skin from evaporating. Mineral oil, in particular, should be applied while the skin is still wet.
The application of emollients should be rubbed from top to bottom in the direction of the hairs over and over again, not back and forth, otherwise it is easy to trigger folliculitis.
Wash such as hand wash, lactic acid wash, etc. is also commonly used to relieve mild dry skin, the advantages of these lotions is not greasy, comfortable after use. If the skin itching is obvious can also use some topical antipruritic agent. If the dermatitis is obvious, you can use 1% hydrocortisone cream or 5% doxorubicin cream.
In addition to medication, improving the local environment, such as increasing indoor humidity, avoiding excessive bathing and hot water scalding, wearing non-irritating clothing, etc. have a certain role in the treatment and prevention of this disease. If there is a primary disease, the primary disease should be actively treated.
Hand eczema should pay attention to the protection of hands. Because of hand eczema skin barrier function damage, so the smallest stimulus can also cause hand dermatitis aggravation or prolonged. Must pay attention to the protection of hands, including hand washing, do not use too strong alkaline soap, do not use non-skin cleansing agents such as alcohol hand washing. The number of times you wash your hands each day should not be too much, and you can achieve the purpose of cleaning.
After washing your hands, dry them immediately, paying special attention to drying between the fingers and wrists and so on. If your hands are dry, you should use hand oil or silicone cream. Wear gloves when in contact with irritants or allergens. Be aware that some gloves only protect against certain substances but not others. Rubber gloves should not be used if you are allergic to the rubber milk in them. It is best to wear a layer of cotton thread gloves inside the rubber gloves and change them immediately after sweating to minimize the irritation of sweat.
Perioral dermatitis should stop having fluoride-containing hormones and be replaced with hydrocortisone ointment.
3 chronic eczema: chronic hypertrophic skin damage is mainly treated with topical corticosteroids, the application process should pay attention to the lesion site and the effectiveness of the hormone. Corticosteroids are divided into four categories: low-potency, medium-potency, high-efficiency and strong-potency. Low-potency steroids such as hydrocortisone cream should be used for lesions on the face and folds, while high-potency steroids can be used for eczema and keratotic lesions on the hands, feet, and metatarsals. Hormone dosage form and concentration also affects its effectiveness, such as low concentration of hydrocortisone is low-potency, while in high concentration or with the addition of osmotic agents, it becomes high-efficiency.
Hypertrophic chapped lesions can be treated with a keratinolytic agent, such as 20% urea cream, to thin the skin before topical application of corticosteroid hormone preparations, and nighttime sealing can enhance the therapeutic effect.
But attention should be paid to adverse effects such as skin atrophy and secondary infection. Chronic eczema is prone to secondary bacterial or fungal infections, this time should use the appropriate antibacterial or fungal drugs. The application process should pay attention to secondary allergies.
Silent dermatitis is often secondary to allergy to topical drugs, it is best to do patch test, choose not allergic to topical drugs. Corticosteroid hormones should be selected with low potency preparations. In addition to the treatment of eczema lesions, attention should be paid to the treatment of venous hypertension. Conservative treatment includes elevating the affected limbs, using elastic bandages, reducing prolonged standing, etc. Surgery or sclerotherapy can be performed if necessary. The feet should be elevated with extra pillows when the patient is in bed or sleeping at night, or elevated above the knee when sitting. Elastic bandages should be applied from the toes to the knee. The above measures can effectively improve foot circulation and reduce venous hypertension and stasis.
To treat an ulcer, first clear the wound. Be careful not to use disinfectants such as hydrogen peroxide and povidone-iodine for debridement. These substances are toxic to the wound and can slow healing. After debridement, use a bandage containing petroleum jelly to keep the wound hydrated, reduce drying and scarring, and protect the wound. If there is an infection, the infection should be fought first. Surgical skin grafting may be indicated for longstanding ulcers, but the long-term results of skin grafting are poor if the venous hypertension cannot be removed.
(3) Other treatments: foreign reports, PUVA therapy for chronic eczema, especially chronic refractory hand eczema has a certain efficacy. Reported severe use of immunosuppressants or enhancers effective in controlling skin lesions, but because most of the etiology of eczema is unknown, often recurring, should be careful to use immunosuppressants, so as not to stop after the drug aggravation of the condition.
(4) the treatment of persistent cases: for persistent eczema patients, first of all, attention should be paid to find the cause. For example, the initial development of therapeutic measures in the treatment of the condition after the change is still appropriate? Has the treatment aggravated the destruction of the skin barrier function? Has the patient followed the prescribed treatment? Are there substances in the patient's living environment to which he or she is still allergic? Are there allergens that have not yet been detected? Are there any secondary allergies during the treatment? Are there any cross-sensitizing factors? Are there any secondary infections? Is the patient's living environment conducive to eczema recovery? Will the patient's diet aggravate the condition? Does the patient have any co-morbidities? Whether the combined diseases and their treatments have any effect on eczema, etc. Finally, should we check whether the diagnosis of eczema is correct? In order to better control the above uncertainty factors, you can hospitalize the patient, so that the patient's life and treatment environment can be closely observed and regular treatment.