|Classification according to ICD-10|
|L20||Atopic (endogenous) eczema|
|L23||Allergic contact dermatitis|
|L24||Toxic contact dermatitis|
|L25||Unspecified contact dermatitis|
|L28||Lichen simplex chronicus and prurigo|
|ICD-10 online (WHO version 2019)|
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.
In severe cases, glucocorticoids are also given internally . Antihistamines can help relieve itching. In the case of a strong superinfection with bacteria, antibiotics are used internally.
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