Health Significance Of Other Eczemas: Endogenous, Infantile And Atopic Eczemas

These are endogenous eczemas. They are caused probably by endogenous allergens such as toxins from focal sepsis, products of metabolism, diet or drugs. No obvious external irritants or allergens are recognizable.

Infantile eczema: This is seen in children between the ages of 3 months to two years. It usually starts on the checks and spreads to the forehead, chin, scalp, arms, trunk, groin, gluteal region and legs. The lesions are pruritic. The natural course is one of remissions and exacerbations. The exact cause of infantile eczema is not clear but it is possible that dietary allergens may play a role in exacerbating the lesions. The two clinical varieties can be distinguished:

1. The atopic variety in which a familial predisposition to allergic disorders is evident and
2. The simple variety in which there is no familial predisposition. The former tends to be more protracted and resistant to treatment and on follow up it may develop into atopic dermatitis. The latter is more amenable to treatment and the child is completely free by the age of two.

Atopic eczema (Bessnier’s prurigo): This is also known as the “asthma eczema syndrome”. These subjects show a strong family history of allergic disorders like asthma, eczema, hay fever, and other drug or food allergies. The eczema shows flexural distribution and chronicity with periodic exacerbation. Those individuals show emotional instability. The eczema usually results from endogenous sensitization. Emotional factors aggravated the condition.

Neurodermatitis (Lichen Simplex Chronicus)

This is seen more in neurotic subjects. It may be defined as the lichenification process caused by chronic scratching and rubbing of the skin under emotional stress. It is seen more often in neurotic young subjects and in postmenopausal women. Emotional stress leads to further irritation of the part. A vicious cycle is established resulting in lichenification. The skin is thickened, infiltrated, and pigmented. The common sites are the nape of the neck, arms, anogenital region, scrotum, popliteal fossae, legs and ankles.

Dermatitis Medicamentosa

This term includes all cutaneous eruptions resulting from the systemic (oral and parenteral) administration of drugs.

Dermatitis Artifacta (Dermatitis Autophytica)

This is self- inflicted dermatitis seen in hysterical or other emotionally abnormal subjects. The lesions are caused by strong physical or chemical irritants.

As a rule, there are curable conditions, if judiciously managed. Simple eczema generally heal without leaving permanent scars. Acute eczemas heal promptly. Whereas the chronic ones are very slow to do so. Recurrence is also a problem in such cases. Reassurance to the patient and relatives about the curability of the condition goes a long way in ensuring patient compliance and allaying emotional stress.

Principles of treatment: Elimination of the predisposing and aggravating factor is the first step. All avoidable allergens and irritants should be avoided. If this is impossible, attempts should be made to desensitize the individual. Environmental and physical factors should be suitably modified.

Systemic therapy is the next course of action. Corticosteroids given systemically are helpful in many cases to alleviated the condition, but these are by no means curative. Antihistamines help in relieving pruritis and also in reducing acute sensitization. Calcium gluconate given intravenously helps in relieving pruritis and bringing in symptomatic relief. Antibiotics are indicated if secondary infection is present. Sedatives and tranquilisers are helpful in providing rest and sleep and in allaying anxiety. Correction of nutritional disorders and treatment of underlying diseases go a long way in correcting the skin condition as well.

The next is application of local treatment. It is a golden rule that strong irritants and sensitizing drugs should be avoided. Bland non-irritant preparations are preferable. Weeping eczemas respond to astringents applied as wet soaks or lotions, eg, 0.5 to 1% silver nitrate lotion, or 1 to 5% lotio calamine or lotio aluminum subacetate. These are applied repeatedly every 2 to 4 hours. If crusts are formed, these are removed and fresh application of the lotion is continued for up to 48 hours.

For scaly and popular eczemas, bismuth subgallate and starch (amylum) paste or zinc cream are preferable. These are applied twice daily. In infective eczemas, local application of gentian violet helps in clearing infection. When infection occurs, medicated pastes are applied. Antibacterial creams containing vioform, neomycin or bacitracin may be tried with care. Antihistamine ointments should be avoided since they may aggravate local sensitization. Several local applications are available for chronic eczemas. These include corticosteroid ointments (betamethason benzoate 0.025% W/W) and crude tar preparations. In intractable cases, application of occlusive dressings over corticosteroid ointment or intralesional instillation of steroids gives better cure rates. In localsed chronic eczema with lichenfication, superficial x-ray therapy helps in bringing back the skin to normal state.