The etiology is complex, and it is currently considered as an allergic disease, belonging to type ⅳ allergic reaction. Allergens may come from in vitro or in vivo. Chemical substances, cosmetics, dyes and other external allergens, some animal toxins, eggs, fish, shrimp, milk and other foreign protein, as well as some pollen, dust and so on. Internal allergens, such as internal diseases, intestinal parasitic diseases, some metabolic, endocrine or digestive tract dysfunction, and some human tissues change their components under the influence of certain factors to form autoantibodies.
Children are especially common.
Modern medical pathology:
Eczema patients are mostly allergic constitution, and it is found that allergic constitution has a certain relationship with hereditary IgA deficiency. In addition, when the body is in a state of excessive fatigue and mental stress, a series of corresponding changes take place in the nervous and endocrine systems, and the skin's susceptibility to various stimulating factors is increased through nerve reflex or endocrine influence, which is helpful to the occurrence of eczema.
Etiology and pathogenesis analysis of traditional Chinese medicine;
The disease is often caused by improper diet, excessive drinking or eating spicy and fishy products, which hurts the spleen and stomach and loses health, leading to damp-heat accumulation, exogenous rheumatic fever and phlegm in the skin. Or physical weakness, spleen dampness, skin malnutrition and other factors. Or because of the long-term accumulation of damp heat, it consumes yin and blood, and turns dryness into wind, resulting in blood deficiency and wind dryness, and the skin is not right.
Clinical manifestations:
I. Clinical manifestations and classification
Eczema can be divided into acute, subacute and chronic types:
(1) acute eczema
1. Skin lesions are polymorphic and often occur in a certain order. At first, it was diffuse flushing, and later it developed into papules, blisters, erosion, exudation and scabbing, and constant seed coat lesions coexisted.
2. Lesions are often flaky or diffuse with no obvious boundary. It can be found in all parts of the body, especially in the head, face, distal limbs and scrotum. Often symmetrical onset, severe cases can spread all over the body.
3. After intense and obvious inflammation, it is often wet erosion. If it does not develop into chronic disease, it can be cured in about 2 ~ 3 weeks, but it is often easy to relapse.
4. Conscious burning sensation and severe itching.
(ii) Subacute eczema
1. is a stage between acute eczema and chronic eczema, which is often caused by delayed or improper treatment of acute eczema.
2. Skin lesions are lighter than acute eczema, mainly papules, scabs and scales, with only a small amount of blisters and mild erosion.
(iii) Chronic eczema
1. It is often caused by improper treatment of acute and subacute eczema, long-term unhealed or repeated attacks. Mostly confined to a certain part, such as hands, calves, cubital fossa, scrotum, vulva, etc. The border is obvious and there is no inflammation.
2. The skin of the affected area is thick and rough, and the ridge groove is obvious, showing moss-like changes. The color is brownish red or brown, and the surface is often accompanied by chaff scales, scratches, scabs and pigmentation. It seems that new papules or blisters will appear on some skin lesions, and a small amount of serosity will ooze after scratching. It occurs in hands, feet and joints, often with fractures or warts, and conscious pain affects activities.
3. Chronic disease course, from light to heavy, often presents acute or subacute attacks repeatedly, especially when nervous.
4. I usually feel no symptoms, and I will have severe itching before going to bed or when I am nervous.
Second, several special types of eczema
(1) coin eczema
1. Common in back and limbs.
2. The lesions are scattered in the size of about 5 minutes, with round erythema blisters, mild erosion and scab. The boundary is clear, and the damage can be slightly enlarged in the progressive stage.
3. Most of them pass slowly, and they feel itchy and unbearable.
(2) Autoallergic eczema
1. Some skin such as lower limbs, vulva and thighs often suffer from eczema before onset.
2. Eczema-like lesions appeared in other parts of the body shortly after the deterioration of eczema in the primary site. At first, it was inflammatory papules, which quickly turned into cluster papules, and then merged into small eczema-like lesions.
3. Lesions are mainly distributed in limbs, followed by trunk and face.
4. Severe itching, accompanied by burning sensation, may be accompanied by superficial lymphadenopathy, general malaise and low fever.
5. Generally, the onset is urgent, and the secondary rash can gradually subside after the primary focus of the whole body improves within 1 ~ 2 weeks. The course of the disease is delayed for more than several weeks.
Third, infectious eczema-like dermatitis.
1. It often occurs in ruptured abscess, sinus, ulcer, around fistula or near vulva, etc.
2. At first, it was confined to the periphery of purulent lesions, and the lesions were flushed with clear boundaries. There are many small blisters, pustules or folliculitis, and the surface is covered with serous or purulent secretions or scabs. Skin lesions can spread to the surrounding area, and sometimes desquamate dandruff appears around 1 week, and pus often accumulates. The nearby lymph nodes tend to increase.
3. It has the characteristics of self-inoculation infection, and scratching can make the skin lesions distribute linearly.
4. Conscious itching is lighter than general eczema.
Diagnosis:
Diagnostic criteria for eczema:
1. Acute eczema
(1) Acute onset, with skin lesions consisting of erythema, papules and blisters. Clustered into sheets, scratching often causes erosion, exudation, scabbing, suppuration, unclear edges, and often symmetrical distribution.
(2) severe itching.
2. Subacute eczema: After the inflammatory exudation of acute skin lesions is reduced, the course of disease is prolonged, and the lesions are mainly papules, scales and scabs, with only a small amount of papules and erosion or slight infiltration.
3. Chronic eczema
(1) Recurrent acute eczema can be chronic.
(2) It usually occurs on the face, behind the ears, elbows, popliteal fossa, calves, vulva and anus, accompanied by severe itching.
(3) The focus is localized, with obvious hypertrophy and infiltration, clear boundary and pigmentation.
(4) The course of disease is chronic, often accompanied by acute attack.
4. Self-sensitive eczema
(1) Before the onset, eczema often exists in a certain part of the skin.
(2) On day 7 ~10, papules, papules and blisters were scattered all over the body, showing symmetrical distribution and homotypic reaction.
(3) After the primary skin lesions improved, the systemic skin lesions naturally eased and subsided.
(4) Severe itching
5. Infectious eczema-like dermatitis
(1) There is a primary purulent lesion near the lesion site.
(2) Skin lesions spread around with purulent lesions as the center, showing erythema, blisters, pustules, erosion and scab. It develops rapidly and asymmetrically, and is often distributed in strips along the scraping direction.
According to the location of eczema, eczema often occurs in a certain location, and its clinical manifestations are also specific, as described below.
1. Ear eczema: It mostly occurs in the folds behind the ear, showing erythema, exudation, chapping and scabbing. Sometimes it is seborrheic. Usually symmetrical left and right.
2. Breast eczema: more common in lactating women. The nipple, areola and its surroundings are reddish-brown lesions with clear boundaries, erosion, scabbing, chapped nipple and pain. The folds under the breasts of obese women or breast drippers often have flushing or erosion and exudation.
3. Umbilical fossa eczema: Umbilical fossa is bright red or dark red spots, the surface is moist, oozing and scabbing, and the boundary is clear, which rarely affects the periumbilical skin.
4. Scrotal eczema: During acute attack, scrotal skin is edema, moist or erosive, exudation and scabbing. Mostly chronic, scrotal skin wrinkles are deep and wide, scrotal skin infiltrates and thickens, showing orange peel or walnut shell shape, dry, covered with scales, pigment deepens, and sometimes some pigment is lost. Feel itchy. The course of the disease is long, and it will not heal for months or years.
5. Eczema vulvae: The labia majora and the skin around the labia majora are infiltrated and thickened with clear boundaries. Erythema, erosion and exudation are less common. Due to the unbearable itching and frequent scratching, the skin of labia majora can be lichen-like, and sometimes some pigment spots can appear.
6. Anal eczema: perianal skin is moist, flushed and eroded, or scattered in a small amount of papules, or anal mucosa is shriveled and chapped. The itch is unbearable.
7. Hand eczema: It occurs in the palm and back of the hand, and can invade the wrist and fingers. It happens symmetrically. The skin damage of the palm is localized reddish and yellowish brown spots with thick hard dandruff, which is easy to dry and chapped. The back of the hand is mostly dark erythema with coin-shaped infiltration and hypertrophy, or moss spots covered with a small amount of scales. There are some papules and blisters on my fingers. The skin around the nails is swollen and red, and the deck rises and the deck thickens irregularly. Consciously have different degrees of itching.
8. Eczema of the leg: It mostly occurs in the front or side of the tibia and is often symmetrically distributed. Most of the lesions are localized brown-red spots with dense papules or papules. After rupture, they erode, ooze and scab, and after a long time, the lesions become thicker and pigmentation. Feel itchy.
Differential diagnosis:
First, contact dermatitis and acute eczema.
1, contact dermatitis: the main cause is external contact, and the cause is easy to trace. Mainly limited to contact parts and exposed parts. The rash is mostly in a single form, including clear, blisters, local burning itching, pain and discomfort. The course of disease is short, and it is easy to cure after removing the cause. Unless it is contacted again, it will generally not recur.
2, acute eczema: mainly internal causes, the cause is complex, and it is often difficult to trace. Without a certain part, it is often symmetrically distributed. The rash is polymorphic, with unclear boundaries, no bullae, mostly bullae, accompanied by severe itching. The course of disease is long and easy to turn chronic. Easy to relapse.
Second, the difference between neurodermatitis and chronic eczema
1, neurodermatitis: itching first, then rash. The lesions are round and polygonal flat papules with lichen-like changes, and the edges are often scattered in flat and shiny normal skin papules without blisters. Neck, elbow, knee, face extension and abdomen are more common. The course of the disease is chronic.
2, chronic eczema: often from acute transformation. Infiltration hypertrophy, pigmentation, peripheral herpes, erosion and exudation after rupture. More common in the head and face, limb flexion and vulva. Acute and chronic recurrent attacks.
Third, tinea manuum.
It is easily confused with hand eczema. Tinea manus is common in the palm, usually unilateral, and the fungal test is positive.
Fourth, seborrheic dermatitis
Eczema-like changes can occur in the process, but the disease mainly occurs in the head, chest, back center, armpit, vulva and other parts with more sebum secretion. It often spreads downward from the head, and the damage is mainly yellow-red or bright red spots, covered with greasy scales or scabs.
Modern medical therapy:
Short-term oral corticosteroids can only be considered when the effect of acute generalized eczema is not obvious after various treatments. Topical medicine is mainly symptomatic treatment. According to the performance of different stages of the disease, solutions, lotions, creams, ointments or ointments are selected for wet application or external application. Commonly used boric acid, mint, camphor, rice bran oil, coal tar and corticosteroids have astringent, antipruritic and anti-inflammatory effects. Antibiotics are generally not needed unless there is a secondary infection.
First, the principle of treatment
It is necessary to make patients understand the etiology, development law and prevention methods of eczema, eliminate all suspicious pathogenic factors, and avoid all kinds of external stimuli, such as hot water washing, scratching, excessive use of soap, improper external use of drugs, etc. Should avoid overwork and mental stress, avoid spicy, spicy, fishy, sour and other foods. Keep your skin clean and avoid secondary infection. For patients with chronic generalized eczema, the focus should be removed when necessary to treat systemic diseases.
Second, systematic therapy.
1. antihistamines: such as chlorpheniramine 4mg, taken orally three times a day. Cyproheptadine 2 ~ 4 mg, 3 times a day, orally. Cismin 10mg, daily 1 time, orally, etc.
2. Sedative and antipruritic agent: those with mental disorder or poor sleep can take chlorpromazine 12.5 ~ 50mg orally, three times a day. Perphenazine 8mg/ day, min 1 ~ 2 times. 0.2~0.6g of Mianertong, taken orally three times a day. 10% chloral hydrate 5 ~ 10 ml, diluted with water 1 ~ 2 times, taken orally half an hour before going to bed, etc. However, it should be noted that the above drugs themselves occasionally have allergic reactions, and the medical history should be asked in detail before use.
3. Calcium agent: for example, 10% calcium gluconate injection 10ml, diluted with the same amount of glucose solution and then slowly injected intravenously, 1 time, once a day or every other day.
4. Venous occlusion: intravenous injection of 0.25% procaine 10 ~ 20m 1 ~ 2g, once a day or every other day, 1 0 is a course of treatment.
5. Vitamins: such as vitamin C0.2g, 1 3 times a day. Vitamin B 1 .20mg,13 times a day. Vitamin B620mg, 1, taken orally three times a day.
6. Corticosteroid hormone: If the skin lesions are extensive and the inflammation is sharp, the application of hormone can only be considered if the above methods fail. Such as oral prednisone 5 ~ 20mg/ time, 3 ~ 4 times/day.
7. Histamine globulin: It is an injection made by mixing histamine hydrochloride and gamma globulin. 2ml contains 0. 15~0.2mg of histamine hydrochloride and 0. 15 ~ 0.2mg of gamma globulin. Adults are injected with 2ml subcutaneously every 3 ~ 4 days, and children under 5 years old are injected with 1ml, 3 ~ 6 times as a course of treatment.
Third, local treatment.
1. Acute phase
(1) At the initial stage of the disease, there were only flushing, papules or a few small blisters, and there was no exudation. Therefore, it is appropriate to reduce inflammation and avoid irritation, and you can choose wet compress or lotion with antipruritic effect, such as 2% ~ 3% boric acid water wet compress, calamine lotion or 2% borneol and 5% alum calamine lotion. If you only flush, you can use boric acid talcum powder 1 and sprinkle it several times a day.
(2) Those with obvious blister erosion and exudation should converge and diminish inflammation to promote the recovery of epidermis. Anticorrosive astringent liquid can be used for wet dressing or dressing, such as compound sulfuric ketone solution, 2% ~ 3% boric acid solution and 0.5% lead acetate or aluminum acetate solution. Mild exudation can be coated with zinc oxide oil or wrapped with zinc oxide paste.
2. Subacute stage: The treatment principle is anti-inflammatory, antipruritic, dryness and dampness convergence, and zinc chloride oil, mud paste or emulsion are more suitable. According to the severity of exudation erosion, skin lesion infiltration hypertrophy and itching, appropriate astringent, cutin promoter and antipruritic agent, such as 3% black bean distillate, 2% borneol and 5% black bean distillate, can be added.
3. Chronic stage: the treatment principle is to relieve itching, inhibit the proliferation of epidermal cells and promote the infiltration and absorption of dermal inflammation. According to the hypertrophy and dryness of skin lesions, different concentrations of tar (coal tar, pine oil, bran distillate oil and black bean distillate oil) ointment or paste can be selected. Tar paste can be used for those with thin damage or slight erosion and exudation, tar paste and tar tincture can be used for those with dry hypertrophy, and the common concentration is 5 ~ 10%. Other keratolytic agents, such as salicylic acid or sulfur, can also be added into the tar preparation. For chronic hypertrophic eczema, appropriate concentration of corticosteroids can be added to tar preparation, and the curative effect is better.
Four. Physical and radiation therapy
Chronic eczema can be treated by shallow X-ray irradiation or radioactive isotopes phosphorus 32 and strontium 90. The general radiation dose is 80 ~ 100 rad, 1 time per day, and 1 time is1course of treatment. Generally, the total dose does not exceed 1000 rad, but the maximum dose for very thick lesions is 1500 rad. A small amount of exudation from subacute eczema can also be treated with radioisotopes. The initial amount is about 30 rads, which can gradually increase after the exudation subsides, but the maximum amount should not exceed 800 rads, and the general total amount is 500 ~ 800 rads.
TCM treatment based on syndrome differentiation;
At the beginning of the disease, the spleen and stomach lose their health, and the pathogenic dampness is endogenous. For a long time, the blood stasis turns to heat, and the damp heat accumulates. The skin outside is bright red, soaked in body fluid, recurrent after a long illness, and yin and blood are exhausted. Disharmony between qi and blood, dry wind, skin dystrophy, rough and thick, lingering and difficult to heal. In a word, diseases are caused by damp heat, blood heat, dampness resistance and blood dryness. Clinically, we should choose the prescription according to the patient's physique and pulse condition, and we should not stick to the prescription.
It is very important for legislation to treat this disease and distinguish the damp-heat wind of rash. The different distribution, color and nature of skin lesions are the basis of eczema syndrome differentiation. If the rash is yang on the extended face and back of limbs; The flexion face and abdomen belong to yin; The wind is mostly in the head, upper limbs and upper torso; Most of the lower limbs and genitals are wet. At the same time, combined with the changes of pulse condition and tongue condition, it is comprehensively analyzed that red tongue is blood heat; Yellow and greasy fur, liver and gallbladder fever; White and greasy fur is dampness blocking the spleen and stomach; The detailed rules of pulse sinking are blood deficiency and so on.
1. Damp heat
Syndrome: This type is equivalent to acute eczema, with skin lesions including flushing, blisters, erosion, watery discharge, diffuse border, strange itching, chest tightness, anorexia, dry stool, Huang Chi urine, thin yellow fur and slippery pulse.
Treatment: clearing heat and promoting diuresis, cooling blood and detoxifying.
Prescription: Longdan Xiegan Decoction, Tanshishui Decoction and Ermiao Pill. Radix Gentianae 10g, Radix Scutellariae 10g, Cortex Moutan 15g, Flos Lonicerae 30g, Fructus Forsythiae 15g, Radix Sophorae Flavescentis 10g, Rhizoma Atractylodis 10g, Rhizoma Dioscoreae Septemlobae/Rhizoma Dioscoreae Septemlobae. 30 grams of gypsum and 30 grams of cogongrass rhizome are added into hot water, and 30 grams of green leaves are added when the heat toxicity is high; Dry stool increases yellow 10g (lower back).
2. Blood fever
Syndrome: this type is also equivalent to acute eczema, but there is less exudation. Skin lesions are mainly erythema, papules, scratches and blood scabs, with severe itching, often accompanied by dry mouth, red tongue and rapid pulse.
Treatment: clearing heat and cooling blood, promoting diuresis.
Prescription: Radix Rehmanniae 30g, Cortex Moutan10g, Radix Paeoniae Rubra10g, Rhizoma Imperatae 30g, Rhizoma Coptidis 6g, Fructus Gardeniae10g, Fructus Kochiae10g, Radix Rubiae15g, and Radix Sophorae Flavescentis/kloc. Decoct with water, 1 dose, twice a day.
3. Moisture resistance
Symptoms: Most cases are subacute eczema, with dark skin lesions, reddish or not, and few blisters, but liquid water immersion is often accompanied by poor appetite, sallow complexion, less stool, white greasy fur and slippery pulse.
Treatment: strengthen the spleen and eliminate dampness, nourish blood and moisturize skin.
Prescription: Jiawei Chu Shi Ling Wei Soup. Atractylodes rhizome 15g, Atractylodes macrocephala 15g, Polyporus umbellatus 15g, Poria cocos 20g, Dioscorea opposita 15g, Coicis Semen 30g, Plantago asiatica 10g, Alisma orientalis 15g, Xu Changqing 30g, Pericarpium Citri Tangerinae/kloc. Pogostemon rugosa and Eupatorium odoratum are added to those with no fragrance in the stomach; Adding Rhizoma Dioscoreae Septemlobae and Radix Sophorae Flavescentis when oozing for a long time; If it is as hot as yellow fur, remove Rhizoma Atractylodis and add Cortex Phellodendri and Talcum.
4. Blood dryness
Syndrome: This type is equivalent to chronic eczema, with hypertrophy, keratinization and rupture of skin lesions, or scratches and scabs. Repeated attacks, which persist for several years, often lead to emaciation, pale tongue with white fur, and deep or slow pulse.
Treatment: nourishing blood and expelling wind, removing dampness and moistening dryness.
Prescription: Xiaofeng powder or Siwu Xiaofeng powder. Radix Rehmanniae 30g, Radix Paeoniae Alba15g, Radix Angelicae Sinensis10g, Radix Salviae Miltiorrhizae 20g, Caulis Spatholobi15g, Cortex Dictamni Radicis10g, Fructus Kochiae10g, Rhizoma Dioscoreae Septemlobae/. Decoct with water, 1 dose, twice a day.
Prescription:
1. Qushi Zhiyang Powder: 30g of calamine, 30g of halloysitum rubrum, 30g of gypsum, 30g of talcum powder and 30g of dried alum, and 5g of borneol. Bottle the ground powder for later use. It can be directly sprayed on the affected area, and is suitable for those with erosion and exudation in the acute stage of eczema.
2. Eczema powder: 30g of Cortex Phellodendri, 20g of Borneolum Syntheticum, 20g of Indigo Naturalis, 5g of Rhizoma Atractylodis, alum 10g, gypsum 100g. Cleaning Cortex Phellodendri and Rhizoma Atractylodis with dirt and impurities, air drying, and fine powder; Burn alum and gypsum thoroughly and grind them into powder. Indigo Naturalis and Borneolum Syntheticum are made into powder, mixed, sieved evenly and bottled for later use.
3. Eczema lotion: 50g of Patrinia, 50g of Sophora flavescens15g, 30g of Fructus Cnidii, 6g of Shirakawa10g, 6g of alum, and 0g of horsetail10g. Add appropriate amount of water and boil for 20min, leaving about 500 ~1000ml of liquid medicine. It is especially effective for vulvar eczema.
4. Eczema external application prescription: Portulaca oleracea 60g, Cortex Phellodendri 20g, Sanguisorba officinalis 15g, Sophora flavescens 10g, Rhizoma Atractylodis 15g, water 1200ml, water decoction for 3 times, and wet compress the affected area with 4-8 layers of emery cloth or mask, twice a day, each time. Suitable for acute eczema.
5. Anal eczema prescription: Oyster 60g, Sophora flavescens 60g, Cortex Phellodendri 60g, Zanthoxylum bungeanum 30g, Borneolum Syntheticum 15g, calamine 100g. Grind the medicine into fine powder, apply proper amount to the ointment for treating dampness and relieving pain, and stick it around the anus, once a day/kloc-0. Take it out after use every night and wash the anus with clear water. This prescription has a good effect on anal eczema.
External treatment:
1. Acute phase
(1) At the initial stage of onset, there were only rashes, flushing and herpes, and there was no exudation. You can use 30g of dampness removing powder or talcum powder, 0/0g of mirabilite powder/kloc-0, 2g of borneol, mix them evenly, and sprinkle them frequently several times a day. If there is not much exudation, use Sanhuang lotion for external rubbing, 5 ~ 6 times a day.
(2) For those with more erosion, blisters and exudation, 60g of Portulaca oleracea can be added with 2000~3000ml of water, boiled for 15 ~ 20min, cooled and wet-packed. Or 30 grams of Cortex Phellodendri and 2000 ml of Sanguisorba officinalis are added with water, boiled for 65+/-0.5 ~ 20 minutes, cooled and wet-applied. You can also use dandelion, gentian, wild chrysanthemum, etc. Decoct 20g in water, cool and wet compress.
(3) If there are erosions, blisters and scabs, apply it on 1 for three times with coptis sleeve or indigo naturalis powder sesame oil. Or mix Qushi powder or Sanmiao powder with vegetable oil or licorice oil, 1, 2 ~ 3 times a day.
2. Subacute stage:
Generally, Sanhuang lotion or indigo naturalis powder sesame oil can be mixed and rubbed, or Qushi powder and Xinsanmiao powder oil can be mixed and applied externally, three times a day.
3. Chronic stage:
① Indigo Naturalis cream or sebum cream for external use, 2 ~ 3 times a day. ② Heating and baking therapy of indigo naturalis ointment, daily 1 time. ③20% Cat's Eye Ointment and 80% Indigo Naturalis Ointment are evenly mixed and externally applied, twice a day. ④ Fumigating the affected area, 1 ~ 2 times a day.
Acupuncture therapy massage therapy:
Acupuncture can be used in Quchi, Zusanli, Xue Hai and Huiwei. Ear acupuncture can be selected from lung, adrenal gland, Shenmen and endocrine points.
Efficacy and prognosis:
1. cure: the rash subsided, only the pigment changed, not itchy, and no recurrence was found after 2 years of follow-up.
2. Improvement: the rash and inflammation have obviously subsided, and itching has been alleviated.
Prevention:
Remove all suspicious pathogenic factors and avoid all kinds of external stimuli, such as hot water washing, scratching, excessive use of soap, improper external use of drugs, etc. Should avoid overwork and mental stress, avoid spicy, spicy, fishy, sour and other foods. Keep your skin clean and avoid secondary infection.
You can also drink some mung bean powder, just one spoonful a day.
I wish you a speedy recovery! ~~~~~~~~~~