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Eczema. Clinical manifestations
Clinic. Eczema can begin acutely or chronically and subsequently usually lasts a long time with a tendency to relapse. Any area of the skin can be affected. In the acute phase, eczema is manifested by a rash on the hyperemic and slightly edematous skin of small, closely grouped papules that quickly transform into tiny vesicles (the so-called microvesicles), which are arranged in groups and do not merge with each other. Opening quickly, the vesicles form small point erosion that separates serous exudate. As the process subsides, droplet weeping decreases, part of the vesicles, without opening, dries up with the formation of serous crusts, a small, pity-like peeling appears (subacute phase).
With the progression of the process, foci having different sizes and usually unsharp outlines increase due to peripheral growth. Rashes appear in symmetrical areas and in the distance. Morphologically secondary rashes are more often represented by erythematosquamous or papulovascular elements, although spotted, small-papular and bullous rashes are also possible.
The predominance in the clinical manifestations of small yellowish crusts and pityriasis scales characterizes the regression of the disease. In the future, a complete resolution of rashes or a transition to the chronic stage of the disease is possible. In this case, infiltration, peeling and densification of the affected area of the skin increase, the skin pattern (lichenification) increases. Skin color takes a stagnant color with a brownish tint. With an exacerbation in the focus, small vesicles, punctate erosion, and crusts appear again against the background of active hyperemia.
Hand eczema occurs in patients with a history of atopic dermatitis.
The dyshidrotic form of eczema is formed on the palms and soles more often in individuals with a pronounced imbalance of the autonomic nervous system (with increased sweating, persistent red dermographism, vascular lability) and with atopy.
Exacerbations are more often observed in the winter season, although some relapse in hot weather.
Dyshidrotic eczema may occur primarily, but often patients have a history of allergic dermatitis. The skin of the palms and soles is affected, but in some cases a gradual transition of rashes to the lateral surfaces of the fingers and the back surface of the hands and feet is possible. The clinical feature of this form of eczema is large, pea-sized, dense multi-chamber blisters, due to the thick stratum corneum.
If a pyogenic infection joins, the contents of the cavity elements become purulent, regional lymphangitis and lymphadenitis occur, the body temperature rises, and the general condition of the patient worsens. Occupational eczema results from skin contact with chemicals in the work environment. Nummular, or plaque, eczema occurs on the skin of the limbs, less often the body where round erythematous plaques sharply raised from the surrounding skin are formed, slightly elevated.
Varicose (or hypostatic) eczema develops on the lower legs in individuals with a varicose symptom complex.
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Eczema. Clinical manifestations
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