The eczematous process in children usually develops against
the background of exudative diathesis, often as a result of the inheritance of
altered immunological reactivity. Most parents or close relatives of children
with eczema have experienced allergic diseases of the skin and mucous membranes
in the past. In children suffering from exudative diathesis, foci of focal
chronic infection, bronchial asthma, hay fever, acute respiratory diseases,
conjunctivitis, keratitis, gastrointestinal disorders, dysfunction of the liver
and pancreas are often noted [Zverkova F. A., 1975; Toropova N. P., Gradinatov
A. M., 1975; Skripkin Yu. K. et al., 1983].
In children suffering from eczema, against the background of a reduced
immunobiological reactivity of the body, manifestations of alimentary allergy
(to casein in women’s or cow’s milk), infectious and allergic reactions, often
caused by foci of chronic infection, hypersensitivity to drugs and other
chemicals are noted.
The disease develops at an early age. Rashes appear on the skin of the
face, scalp, which gradually spread to other parts of the body. On the reddened
edematous skin of the face, abundant, merging exudative papules and small
vesicular rashes appear, covered with massive brownish crusts, which leave
behind weeping eroded areas. Along with the weeping foci described above, in
children suffering from childhood eczema, spotted seborrheic rashes
(erythematous-squamous spots – seborrheas – on the face, trunk, limbs) can be
observed.
Thus, childhood eczema is most often characterized by the presence of signs of
true, microbial and seborrheic eczema. Children are usually overfed, pasty, do
not sleep well, are agitated, their lymph nodes are enlarged. Eosinophilic leukocytosis
is often noted. The disease of children’s eczema is most often noted in
children under the age of 3 years, then the process is transformed into
persistent diffuse or disseminated neurodermatitis.
Histopathology
For the acute period of eczema, foci of spongiosis are typical in the
malpighian layer of the epidermis. Spongiosis is characterized by edema of the
predominantly styloid layer, separation and detachment of spinous cells, and
the formation of small, often multi-chamber cavities directly under the stratum
corneum. In the stratum corneum, parakeratosis is determined. In the papillary
layer of the dermis, vasodilatation and the formation of a
lymphocytic-histiocytic infiltrate around them, as well as swelling of the
connective tissue, are noted. The infiltrate in microbial eczema contains
polymorphonuclear leukocytes.
The chronic form of eczema is characterized by acanthosis , parakeratosis, a
more pronounced cellular infiltrate of the dermis. With seborrheic eczema,
moderate thickening of the epidermis, parakeratosis, significant acanthosis ,
absence of a granular layer, mild vacuolar degeneration, spongiosis are noted ;
in the dermis there is a slight perivascular infiltrate of lymphocytes and
neutrophils.
Munro microabscesses may occur in the epidermis . In vaccinia (a
complication of eczema with a viral infection after smallpox vaccination or
contact of a child with eczema with children who received a smallpox vaccine),
degenerating cells are determined in the lesions.
The diagnosis of eczema is made on the basis of an altered clinical picture.
Differential diagnosis should be carried out depending on one form or another
of eczema. So, for example, true eczema must be distinguished from atopic
dermatitis, microbial eczema from allergic contact dermatitis, streptoderma ,
seborrheic eczema from psoriasis.
Forecast
In acute eczema, the prognosis is more favorable. Microbial and
seborrheic eczema can be completely cured. Idiopathic, sycosiform , pruriginous
eczema is more difficult to treat. The prognosis is much worse if eczema
develops in small pasty and asthenized children, in the elderly and people
whose body is weakened by infection or intoxication.
Prevention
Good hygiene is essential for all forms of eczema. In addition, it helps prevent the addition of a secondary infection, which aggravates the course of the main process.
- Small folliculitis should be lubricated with Castellani liquid or 1-2% aqueous or alcoholic solution of aniline dyes.
- Baths and showers with extensive skin lesions must be temporarily canceled.
- However, in some patients, baths, for example, with a decoction of chamomile, bran, oak bark , etc., have a healing effect.
- Under no circumstances should the body be allowed to overheat.
- Patients with eczema are recommended a milk -vegetarian diet, boiled meat, cereals, carrot, apple juices, compotes, vegetables, fruits.
- Citrus fruits in some patients can cause a sharp exacerbation of eczema.
- It is necessary to limit the intake of liquids and easily digestible carbohydrates, avoid extractives, prohibit the intake of alcoholic beverages, salty and spicy foods, canned food and marinades.
- In children, both overfeeding and underfeeding should not be allowed.
- Great importance is attached to the normal functioning of the gastrointestinal tract, the treatment of intercurrent diseases.
- With varicose symptom complex, wearing rubber stockings or bandaging the legs with therapeutic rubber bandages is a prevention of the development of varicose eczema.
- In order to prevent such eczema, varicose veins (together with the surgeon), ulcers, cracks, fistulas, and wounds should be actively treated.
- Improper treatment of burns or frostbite can also lead to the development of eczema.
- Nursing mothers with eczema of the nipples should express milk.
- When the process is localized in the area of \u200b\u200bthe hands, you should not wet your hands, use synthetic powders when washing.
- It is necessary, if possible, to exclude any contact with the alleged allergens in everyday life and at work.
In order to prevent eczema herpetiformis and vaccinia , children with eczema should not be cared for by persons suffering from lichen lichen. In the prevention of eczema in children, deworming, sanitation of foci of focal infection in pregnant women, and a rational diet for pregnant women are essential, since allergens circulating in their blood, penetrating through the placenta, sensitize the child even during fetal development. Pregnant women should not consume large amounts of milk, eggs, sweets. Their food should be rich in vitamins and include a variety of vegetable dishes, boiled meat, lactic acid products, fruits. The exceptions are oranges, tangerines, apricots, peaches, strawberries, raspberries, strawberries, their use should be sharply limited. It is advisable to prescribe some vitamins additionally (in the form of drops of vitamin A concentrate, in the form of dragees vitamins of group B, ascorutin ). Those suffering from eczema are not recommended to wear synthetic, flannel or wool underwear. Patients with eczema should be registered with a dispensary with a periodic visit to a dermatologist to monitor and prescribe the necessary therapy.