The eczema ( synonym eczema ; from Greek ἔκζεμα eczema , Herausbrodeln, upsurge ') is a group of inflammatory skin diseases , resulting in a non-infectious inflammatory response express the skin. Eczema can be caused by different triggers. They are characterized by a typical sequence of skin reactions (reddening of the skin, blistering, oozing, crusting, flaking). Eczema are different criteria classified . The broader term dermatitis is often used as a synonym, although it also includes skin inflammations that are not eczema. In particular in Anglo-American usage, the term dermatitis is preferred instead of eczema . Even in the classification according to ICD-10 , there is no distinction between the names (see table).
Epidemiology and socio-economic importance
With a prevalence of 3 to 20 percent, eczema is the most common skin disease. The likelihood of developing eczema at least once in a lifetime is approximately 100 percent.
Eczema is very important as an occupational disease . With a number of 2,400 - out of a total of 9,400 in 2017 - the recognized cases account for the majority of recognized work-related illnesses in Germany. 90 percent of these cases are eczema. Due to absence from work, retraining, disability, but also treatment costs and expenses for skin care, there is a high financial burden for the health care system and those affected.
Although the different forms of eczema differ in terms of cause ( etiology ), disease development ( pathogenesis ) and typical clinical picture, they all have a typical eczema reaction. This manifests itself in a typical sequence of symptoms in different stages, which is most pronounced in contact eczema.
The acute eczema reaction begins with a light reddening of the skin , which is limited to the location of the skin irritation ( erythematosum stage ). In less severe cases, the eczema heals after a few days. In the event of a stronger reaction, small vesicles , rarely larger than the size of a pinhead , form, which are filled with clear fluid and are very itchy ( vesicolosum stage ). The blisters usually burst quickly and wet ( madidans stage ). After drying out, crusts form ( crustosum stage ). If the trigger of the eczema occurs only once, then scales form ( squamosum stage ) and the eczema heals. The acute stage is uniform and simultaneous.
If the trigger causes repeated or persistent irritation, the eczema does not heal and becomes chronic . The different forms of reaction (reddening of the skin, blisters, crusts, scales) occur simultaneously and alternately next to one another. In addition, inflammatory nodules and scratch-related traces develop. Eczema in the chronic stage is less sharply delimited. The skin swells. The result is a coarsened skin structure ( lichenification ).
As a complication of eczema, superinfections with bacteria or viruses can occur. A serious but rare complication that occurs mainly in atopic eczema is eczema herpeticatum caused by the herpes simplex virus .
Forms of eczema
Most of the forms of eczema can be traced back to three basic types:
A differentiated classification of the forms of eczema is possible according to different criteria. Eczema is differentiated according to the origin and development of the disease ( pathogenesis ), according to the location of the eczema and according to the characteristics of the histopathology and causes (etiology):
- according to pathogenesis
- Atopic eczema
- Allergic contact eczema
- Toxic contact eczema
- Desiccation eczema
- Seborrheic eczema
- Congestive eczema (symptom of chronic venous insufficiency )
- Photoallergic eczema
- Post scabious eczema
- according to location
- Hand eczema
- Foot eczema
- Fingertip eczema
- Intertriginous eczema
- Perioral eczema ( cheilitis simplex, not to be confused with perioral dermatitis )
- Anal eczema
- Scrotal eczema
- according to morphological or etiological peculiarities
- Dyshidrotic eczema
- Microbial eczema
- hyperkeratotic-rhagadiform eczema
- Lichen simplex chronicus
- Light eczema
The therapy of eczema takes place according to the stage and usually externally with ointments . The consistency of the ointment base should be chosen to match the condition of the skin: the more acute and weeping the eczema, the higher the water content must be. If crusts and flakes form, a greasy ointment base is chosen to regenerate the skin. Ointments can also be applied in the form of compresses . The inflammatory reaction is suppressed with glucocorticoid ointments. Bacterial superinfections are treated with antibiotic or antiseptic ointments.
Depending on the form of eczema, the avoidance of triggers such as allergens or irritating substances is of central importance .
- Peter Fritsch: Dermatology and Venereology . Springer Verlag, Berlin 2004, ISBN 3-540-00332-0 , pp. 180 ff .
- P. Altmeyer: Entry eczema . In: Encyclopedia of Dermatology, Venereology, Allergology, Environmental Medicine . 2002, ISBN 3-540-41361-8 ( online [accessed November 2, 2017] online version 2007).
- Article Recognized Occupational Diseases on hautsache.de, accessed on November 1, 2017