Updated: Mar 3, 2021
The clinical phenotypes of eczema and atopic dermatitis are very different, but they are characterized by remission and recurrence during acute attacks on the background of chronic dermatitis.
Acute dermatitis is red (erythematous), weeping/crusted (exudative) and may have blisters (vesicles or bullae). Over time the dermatitis becomes chronic and the skin becomes less red but thickened (lichenified) and scaly. Cracking of the skin (fissures) can occur.
In the early or acute phase, there are some erythema, dense or scattered small papules or blisters, which are difficult to see with the naked eye. In severe cases, there will be a large amount of exudate and erosion; in the subacute state, the exudate decreases and forms knots, and the affected area ranges from bright red to dark red without severe erosion. In chronic cases, the exudate is little or completely dry and often mixes with scales to form abdominal scales. The color of the affected area is dark or pigmented, and sometimes the pigmentation is reduced. Skin pictographs are prone to cracks, especially in areas with large movements. Long-term friction and scratching can cause severe mossification.
Chronic eczema usually transforms from acute eczema to subacute stage, but there is no obvious boundary for this change process, and acute, subacute and chronic manifestations can occur at the same time. The initial rash of some patients is already chronic eczema.
The location of skin lesions is variable, can be localized, can also spread to the entire body, and can have different manifestations in different parts. For example, due to purulent infection, scalp eczema usually has thick abscess spots, and eczema on the beard of an adult man is usually erythema or scattered blistering papules. Eczema on the trunk of the body is usually erythema and scaly. Breast eczema is most common in women, especially breastfeeding mothers. The cornea can cause chronic eczema on the palms and soles of the feet. Excessive metamorphosis and similar to calluses, the skin lines are easy to split, forming cracked eczema. Eczema on the elbows and extremities is usually chronic eczema, and eczema on the calves is usually one of the varicose vein syndromes.
Coin-type eczema is eczema with a well-defined boundary, from the forearm to the palm of the hand. It is also called discoid eczema, erythema, blisters or papules. They gather into plaques or condense into scales. It is a localized subacute eczema that usually causes severe itching on the hands, fingers and back of the limbs. On the extensor side, it is the instep, shoulders or buttocks. It often decreases or increases repeatedly, especially in the cold season. Easy to relapse。
The first-line treatment in modern medicine is emollients and topical glucocorticoids.
For patients who do not respond to first-line treatment, other methods can be used, including local calcineurin inhibitors, phototherapy or immunosuppressive agents.
None of the above treatments can be completely cured. Only by restoring the body's self-repair ability can eczema and idiopathic dermatitis be cured.
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