Dyshidrotic eczema, true (idiopathic) eczema
Initially, the appearance of erythema is noted, against the background
of which vesicles ( microvesicles ) are formed, the size of a pinhead, as well
as predominantly exudative papules and pustules. In the center of the lesion ,
microvesicles open, serous exudate enters the skin surface, forming areas of
weeping with a macerated and desquamated stratum corneum ( Eczema madidans ). A
careful examination of the lesion can reveal numerous “point”
erosions, from which small drops of serous exudate (serous wells) protrude to
the surface.
The clinical picture is distinguished by clear polymorphism (true and false)
and variegation of rashes; against the background of the development of
inflammatory phenomena, erythematous spots, papules, vesicles, pustules, erosion,
scales, crusts, numerous scratches can be observed. Characteristic is the
alternation of affected areas of the skin with unaffected (“archipelago of
islands”). The rashes are symmetrical, can spread to the skin of the
upper, lower extremities and torso. Patients are concerned about itching of
varying intensity, contributing to the development of neurotic disorders, sleep
disturbance up to insomnia. As the inflammatory phenomena resolve, weeping is
replaced by the formation of crusts, scales; peeling appears, then secondary
pigment -vascular (or depigmented) spots, which gradually disappear. Foci of
dryness and peeling of the skin, cracks in the stratum corneum ( Eczema
tyloticum ). With a long chronic course of eczema, calloused hyperkeratotic
formations with cracks sometimes appear on the palms and soles. Often, the
course of eczema is complicated by the addition of a pyogenic infection:
pustules and purulent crusts appear ( Eczema impetiginosum ).
Despite the pronounced polymorphism characteristic of eczema, sometimes
there is a prevalence of one of the morphological elements, which makes it
possible to diagnose the above forms of true eczema. It should be noted that
the transition from acute weeping eczema to chronic, most often occurs
gradually, is accompanied by increasing infiltration of tissues, the transition
of active hyperemia to passive. The chronic eczematous process is often
exacerbated as a result of the appearance of active hyperemia, microvesicles ,
weeping , and increased itching.
In children, idiopathic eczema occurs at the age of 2-6 months , manifests
itself as symmetrically located on the face (cheek area), upper or lower
extremities, erythematous-squamous and exudative-papular rashes with fuzzy
boundaries, microvesicles , accompanied by severe itching. However, most often
the manifestation of the childhood form of eczema is characterized by a
combination of signs of true, microbial and seborrheic forms of eczema. Against
the background of bright, juicy, edematous erythema, serous papules,
microvesicles are located , which quickly open up, forming typical erosions,
large weeping areas, partially covered with serous crusts.
Varieties of true eczema include pruriginous and dyshidrotic forms.
Pruriginous eczema
manifested by rashes of small (with millet grain) papulovesicular elements on a compacted base, which do not open and do not form erosions. The lesions are located on the skin of the face, elbows, popliteal cavities, inguinal region, on the extensor surfaces of the limbs. They often recur. The disease is chronic. Due to a long course, scratching, abrasions, deposition of cellular infiltrate, the skin in the affected areas becomes coarse, pigmented, becomes dry, rough, lichenized , although less sharply than with neurodermatitis. Paroxysmal itching, severe neurotic reactions, accompanied by sleep disturbance, are very characteristic of this form of dermatosis. The disease usually subsides in the summer and worsens in the winter. It seems to take an intermediate place between true eczema and pruritus.
In children , the pruriginous form of eczema usually develops at the age of 4-6 months (unlike seborrheic and true forms of eczema, which begin in the first weeks and months of life), is characterized by persistent white dermographism, reflecting the predominance of the tone of the sympathetic division of the autonomic nervous system. The lesions described above in children are located on an edematous, erythematous background and are often combined with bronchial asthma.
Dyshidrotic eczema
This form of eczema is characterized by the formation of small (pinhead-sized) hard-to-touch blisters on the sides of the fingers, sometimes on the skin of the palms and soles. Less common are large, multi-chamber vesicles. Located in the epidermis, the bubbles shine through it, resembling grains of cooked rice.
Patients are often disturbed by severe itching. Bubbles can open, turning into abrasions, or dry out, forming flat yellowish crusts. In the future, sharply limited lesions appear, which have a pronounced “inflammatory” color, which distinguishes dyshidrotic eczema from true dyshidrosis and epidermophytosis of the palms (with dyshidrotic epidermophytosis, filaments of epidermophyton fungus mycelium are found in the covers of the bubbles on the arch of the feet).