Contribute to the appearance of eczema disease of internal organs, especially the digestive system - with a change in the acidity gastritis, enterocolitis in violation of the processes of absorption (small intestine), cholecystitis, helminthic infestation, chronic constipation, increased sensitivity to nutrients.
Play the role of exogenous factors, irritating and allergenic effects of chemicals (eg, occupational eczema - resins, chromium, nickel, etc.), plants (geraniums, narcissus, etc.), drugs such as procaine, . Etiological and pathogenetic significance may be radiant energy (solar eczema), exposure to heat, cold, mechanical irritation. One patient in the development of the disease may play a role of several factors that cause persistence of eczema to various kinds of therapy.
Treatment of eczema
Treatment of eczema should be strictly individual. General and local funds designated in the light of exogenous and endogenous factors underlying the development of disease. Previously patients carefully examined (indication - consultation of the therapist, gynecologist and other specialists).
Become important is nutrition. During exacerbation of dermatosis recommend a diet of 10 K, which has sufficient energy value. Apply foods with a high amount of protein, normal-fat diet.
Limit the amount of carbohydrates (especially easily digestible - sugar, jam, etc.), salt (2 g / day.). In marked edema and soak for 3 days is prescribed salt-free diet. Limit fluid intake to 1000-1200 ml / day., Irritating drinks, spicy foods, canned foods, smoked meats, spices, egg white, chocolate, citrus fruits and other foods that have sensitizing properties. About 40% of protein and fat diet should be protein and fats of vegetable origin. Fried dishes containing cleavage products of fat, you should prefer boiled, stewed, steamed. In the daily diet is introduced fresh vegetables, fruit in the form of juices, salads, milk products. Eat small portions of food should be at frequent intervals. For the detection of food allergens recommend a diet that excludes or successively including various foods. Obese patients it is advisable to arrange fasting days. Patients with a chronic eczema recommend repeated short-term (1-2 days) courses of fasting with a purpose into 500-1000 ml of magnesium sulfate and alkaline mineral waters Read More Eczema Free Forever.
When combined with eczema indigestion, with gastroduodenitis hepatitis pankretitom prescribe drugs containing pancreatic enzymes, pepsin, bile salts (panzinorm 1 tablet 3 times daily with meals, Festal inside of 1 tablet 2-3 times a day during or immediately after a meal, Polizim). Adults and especially elderly patients who reveal dysfunction of the digestive system (constipation, cholecystitis, colitis), hypertension, irritability, and edema occur, soak, shows a 15-25% solution of magnesium sulfate into 15 ml three times daily and he has a desensitizing, cholagogue, sedative, antispasmodic properties, due to laxative action displays a significant amount of fluid. Sedative, hypotensive, diuretic effect of the drug is more pronounced when administered parenterally. Magnesium sulfate should not be taken with calcium supplementation (reduced therapeutic effect).
With regard to other diseases eczema spend their simultaneous treatment. For example, the causes of eczema genitals, the anus may be candidiasis, chronic diseases of the genital organs, colitis, helminthic invasion. With the localization of eczema on the hands careful examination of the feet, and the detection of mycosis its mandatory rehabilitation. Of great importance is treatment for varicose veins changed when paratravmaticheskoy eczema - the appropriate treatment of wounds, fistulas, osteomyelitis, and the reorganization of other foci of infection - disease of nasopharynx, chronic otitis media.
To normalize the function of the nervous system used sedatives, including tranquilizers, the positive effect of which depends on the type of nervous system and its functional state. Individuals with a weak type of nervous activity they must be administered in lower doses than with the strong type. Under optimal doses, bromides and concentrated to enhance the processes of inhibition in the cortex of the brain, thereby normalizing the function of the central nervous system, improve sleep.
Of the sedatives are also used valerian preparations (infusion into the 20-30 drops 3 times a day, etc.) which, in addition to a soothing effect on the emotional and motor sphere, impaired smooth muscle spasm, motherwort tincture for 10 - 30 drops 3 times per day. When expressed subjective sensations, poor sleep has a beneficial effect of procaine, which is taken orally, 15 ml of 0.5% solution 3 times daily for 1 hour before a meal (10-14 days) or injected intramuscularly with 5 ml of 2% solution every day or every day (10-12 injections). However, some patients procaine can cause allergic reactions, and therefore it should be used to start with half or even smaller doses. Intravenous administration of the drug, we have seen some severe complications (one patient with loss of vision for several hours).
The combination of eczema with high blood pressure is used inside the reserpine to 0.00025 g of 2 to 3 times daily after meals for 5-7 days, along with calming the nervous system, hypotensive effect, reduces the content of biogenic amines in the tissues ("serotoninopustoshayuschy effect" .) According to the testimony used sleeping pills, hypnotherapy, electric.
Patients (especially microbial eczema) with hypertonicity of the parasympathetic autonomic nervous system failure sympathicotrope reactions, along with other means is recommended to use the central M-holinoblokatory in conjunction with the reflex influence of ultrasound, which stimulates the spinal sympathetic centers.
Important role in the treatment of eczema and desensitization take anti-inflammatory drugs. Most use a 30% solution of sodium thiosulfate in 10 ml intravenously every day or every other day (10-20 injections) has a desensitizing agent, anti-protivotoksicheskoe action, is well tolerated by persons of any age. Less effective is the use of sodium thiosulfate into 1-2 tablespoons of 10% solution 3 times a day.
Widely used for eczema antihistamines have anti-inflammatory, anti-allergic, sedative, most of them - the soporific effect. Duration of diphenhydramine, suprastin, diprazina 4-6 h, diazolin up to 2 days. The drug is used no more than 10-15 days, in the future make a break or replace it with another, because addiction occurs, and the therapeutic effect of weakening. Often the patient is one of the antihistamine is more effective. Because of the sedative and hypnotic action can not be assigned ambulatory patients whose work requires a lot of attention and rapid accurate targeting (surgeons, drivers, pilots, machinists). In such cases it is advisable to use diazolin, which does not give sedative and hypnotic effects, does not violate the mind works longer than other drugs in this group differs marked spasmolytic activity, but has a strong irritating properties, and therefore is contraindicated in diseases of the digestive system. When kidney disease, liver antihistamines should be used with caution. Diphenhydramine is prescribed inside (0.03-0.05 g, 2 times daily after meals) or intramuscularly; suprastin administered orally (0,025 g 2-3 times daily with meals) or intramuscularly (1 ml of 2% solution of 1 once a day). Promethazine (Pipolphenum) has a more effective antihistamine action than diphenhydramine, and has a strong calming effect on the nervous system, the structure and the number of properties (some cholinoblocking, adrenoblokiruyuschee, antiemetic activity) is close to the drug aminazinu; designate the interior of 0.025 g, 2 times a day through 30-40 minutes. after eating or intramuscular injection of 1 mL of a 2.5% solution once a day. Tavegil has a strong and prolonged antihistamine properties than diphenhydramine, a sedative effect but it is weaker; appoint 0,001 g 2-3 times daily after meals. In recent years increasing use fenkarol, its inhibitory effect on the nervous system is less pronounced than dimedrol and Promethazine, an antihistamine activity of more selective, which is associated not only with the blocking of H1-receptors, but also a decrease of histamine in tissues, it is more commonly used for eczema, accompanied by severe edema, the interior of 0.025 g 2-3 times daily after meals. Diazolin assigned to 0.1 g 1-2 times daily after meals. Use and other drugs action-oriented mediator Dimebon, cyproheptadine (Peritol), ketotifen (zaditen) in the acute stage - bikarfen.
To improve the microcirculation (especially in patients with atherosclerosis, diabetes , varicose symptom, trophic ulcers) recommend the use of nicotinate ksantinola 0.5-0.75 g in the first 3-5 days., then 0,15-0,6 g reopolyglukine 400 ml intravenous infusion of 2 to 7 days, each day, then 2 - 3 infusions every other day, Parmidin. Assign as aminophylline, 0.1 g 3 times a day (can be combined with diphenhydramine).
When microbial eczema (except mycotic) use anti-bacterial antibiotics (preferably with a light sensitivity of the flora).
Eczema recommend the use of thiamine (vitamin B1), has the ability to influence the function of the nervous system, increasing the excitatory and inhibitory process in the weakening of the central nervous system that affects the higher nervous activity (some reminiscent of the effects of caffeine). Established a normalizing effect of thiamine on the tone of the sympathetic part of autonomic nervous system. Especially pronounced its effect on the peripheral nervous system (antipruritic effect, the elimination of pain, etc.). Thiamine regulates metabolism - protein, water, particularly carbohydrate (hypoglycemic effect), improves the function of the cardiovascular system (kardiotroficheskoe, cardiac), the digestive system. Increased introduction of carbohydrates greatly increases the need for thiamine, fats, "saving" him. Assign thiamine and 1 ml of 3% solution intramuscularly daily injections of 15-25 (if tolerated). Assign as pyridoxal phosphate, pyridoxine (especially seborrheic eczema) into 0,005 g, 2 times per day, or intramuscular injection of 1 ml solution of 5% per day (25 injections), ascorbic acid and pangamic, biotin, fosfaden, dipromony. When seborrheic eczema, eczema eyelids used to riboflavin 0.002 g, 3 times a day (10-15 days), carnitine chloride, in chronic eczema - retinol to 10 000 ME 3 times a day or AEVIT 1 capsule per day (3 - 4 weeks ..)
Patients with eczema should not be at the same time to appoint a large number of medicines or medical procedures.
In chronic forms of eczema (especially seborrheic, bacterial) and well tolerated during the inflammation subsided using UV (suberitemnye then erythemic doses a day, 10-15 days) . In patients with true eczema UVR often exacerbate the process. In some varieties of eczema (chronic vulgar, horny, etc.) using ointment phonophoresis - a corticosteroid drug, retinol, naftalannoy, sulfur-salicylic. It is advisable to oxygen therapy. With limited Bucca-effective eczema treatment of 26-65 ml / kg, 1 time per week (155-258 ml / kg). In areas lihenifikatsii appoint wax, mineral wax, mud, paraffin every day or every other day (10-20 procedures). In some cases, effective reflex (indirect) physical therapy, for example, segmental effects of ultrasound on the paravertebral lines along the spinal column in a pulsed mode, the intensity of 0.2-0.4 W / cm 2 , duration of procedure, 6-10 min., one day, 10 -12 impacts; UV skin projection area of the acupuncture points with pre-lubrication of the parts 1% aqueous solution of eosin, indirect diathermy. Perspective, seems to be the method of acupuncture (especially with severe comorbidity, intolerance to many medications). We consider it inappropriate to prescribe radiation therapy for eczema - the closest the effect is usually good, but subsequent relapse process has an extraordinary persistence to therapy.
Water treatments patients typically do not tolerate ("eczema is afraid of water"). In the acute phase of illness appoint a hygiene bath once a week (preferably with the addition of a decoction of grass succession, potassium permanganate, starch). However pruriginoznoy and some other forms of eczema conduct hydrotherapy. Thus, when the horny, disgidroticheskoy eczema have a beneficial effect of potassium permanganate bath with (38 ° C), after which the tire puncture bubbles and tushiruyut 1-2% solution of aniline dyes, is recommended to compress Dimexidum for 1 h with eczema anus and good tolerance prescribed seating trays with potassium permanganate, followed by lesions tushirovaniem 1% solution of silver nitrate.
Local treatment is carried out taking into account the stage of eczema, in accordance with the principle of "do not irritate irritable." In acute inflammation, accompanied by swelling, redness, vezikulizatsiey, weeping, erosion prescribed lotions (necessarily cold, with ice and are often subject to recall), their therapeutic effect is based primarily on the cooling effect, the properties of the solution in this case are not essential, lotions can be done with boiled water, but should always be respected rule - "the best is the one lotion, which is cold", otherwise the procedure is not only not bring the desired result, but will also be harmful.
Lotion carried out as follows: 2 pieces of linen cloth or gauze folded in 5-8 layers (corresponding to the size of the lesion with the capture of 2 cm of surrounding skin), immersed in a cold solution with ice. Then one of them a little squeeze, put on the affected skin for 3-7 minutes., Then just use the 2nd piece of the 1st re-cooled (warm lotion is unacceptable). This procedure is carried out for 2 h, with 3 sessions per day. Lotions have a significant cooling, vasoconstrictor, "matchlock" effect, which makes anti-inflammatory, antipruritic effect. They do well on the face, extremities, should not be applied to the chest, torso, head, and young children, which leads to extreme cold.
According to testimony in a liquid, employed for lotions, added binders, disinfectants and other means.
When microbial eczema for a short period as appropriate to apply bandages with a staphylococcal bacteriophage. When using the wet-drying dressings in patients with eczema, we have repeatedly observed a rash generalization, the appearance of edema, eczematid. After the events of acute remitting prescribed zinc oil; on eczematid - shaken mixture (they do not apply to the scalp, moist areas with severe infiltration of the skin). Then go for treatment pastes and ointments.
In subacute inflammatory processes that occur with redness, swelling moderate, small dried erosions (a skin condition after the termination soak) use paste ("test") - a mixture of approximately equal amounts of powdered substances and fat basis (in the soft powder pastes somewhat smaller than the basics, but not less than 25%). Pasta has a deeper and more lasting effect than the powder and shake the mixture, but more superficial than ointments and plasters. With the ability to absorb and evaporate the fluid, it gives a drying, cooling, and thus anti-inflammatory effect (expressed by this action, the greater the percentage of powdery substances in the paste). The fat component of the paste softens the skin, promote deeper penetration of drugs. The paste is applied with a thin layer 2 times a day (not rubbing), the top skin can be copiously powdered with talc, powdered white clay, which extends the therapeutic effect. The bandage is usually not imposed, or use a light dressing of 3-5 layers of cheesecloth. Remove the paste from the skin cotton-gauze pad soaked in a slightly warmed vegetable oil. The paste is not applied to areas soak, scalp and other skin surface with a thick scalp. It is not advisable to appoint for dry skin, severe infiltration, as well as a compress. Often used for eczema indifferent zinc paste. One favorite is the pasta Lassara containing 2% salicylic acid (the author of nearly 100 recipes tested the paste, stopping at one, known by his name). To obtain the desired effect in a variety of pasta add drugs - antipruritic, Ichthyol, tar, naphthalene, SDA III fraction, sulfur, resorcinol, boric acid, dermatol, and other antibiotics (paste becomes an appropriate name). At the same time irritating number of drugs in the paste appears smaller than, for example, in ointments. To mitigate the consistency of toothpaste in its composition can be introduced vegetable oil or 3.44% solution of retinol (10-15 ml per 100 g of paste). Dissolving many drugs, oil facilitates their penetration into the skin (for example, castor oil is a good solvent for salicylic acid). To enhance the antipruritic and anti-inflammatory effect in some pasta (preferably before use) was added hormonal creams (1:3, 1:2).
When eczema is often prescribed paste: 3% ihtiolovaya, zinc-Naftalan, boron-zinc-Naftalan ihtiola naftalannoy-zinc, zinc-ihtiolovaya, zinc, bismuth-ihtiolovaya, 5% tar-5-10% naftalannoy. If necessary, pre pockets tushiruyut 0.5-2% solution of silver nitrate, Fukortsin.
In subacute and especially chronic eczema, accompanied by congestive hyperemia, infiltration, lihenifikatsii, desquamation, crusts, hyperkeratosis, apply the ointment - a mixture of fat and fat-like substances that are the basis, with different medication. Ointment compared with the paste has a more profound and lasting effect. It retards evaporation and heat, expands blood vessels, warms the skin, enhances its ability to resorption. Moisture accumulates under a layer of ointment, causes maceration of the skin, which helps on the one hand, the deeper the penetration of drugs, on the other - can lead to irritation of the skin, creating favorable conditions for the spread of secondary infection. Ointment softens scales, crusts, facilitates the removal of them together with the existing micro-organisms in them, it softens the skin, protects it from drying out, a variety of external factors - moisture, cold, chemicals.
The basis used in ointments animal, vegetable oils, some petroleum products, wax, fat-like substance, of which the most common - Vaseline and lanolin. Petrolatum is a purified product of the distillation of petroleum, has a good consistency, chemically indifferent, stable in storage, however difficult the penetration of drugs into the thickness of the skin, and ointments, made on it, sometimes poorly tolerated by patients with eczema. Devoid of these shortcomings, lanolin, which is a valuable basis for ointments. Lanolin - fatty substance obtained from the wash water during the processing of wool. The composition is close to human dermal salo has hydrophilic properties, is well absorbed into the skin, drugs based on it can have a resorptive effect, stable in storage. Typically, water use lanolin containing 30% water. Along with this there is anhydrous lanolin (as the recipe indicates Lanolinum anhydricum), which has a greater ability to absorb water (up to 150%) but less is absorbed by the skin. Anhydrous lanolin due to water absorption can be included in the ointment (paste) in the treatment process with exudation. Lanolin is usually used in mixtures with petroleum jelly or vegetable oil due to a large density and viscosity. In contrast to the mineral foundations, animal fats easily absorbed, contribute to the penetration into the deeper layers of skin drugs, mixed with them.
Patients with eczema ointment is well tolerated on the basis of pork fat, but it should be used only in fresh form, as perishable, and in this case is irritating to the skin (storage in a cool place not more than 1.5 weeks.). Pork fat is oxidized under the influence of mercury oxide, silver nitrate and other substances. Sometimes in the ointment bases are introduced yellow and white beeswax, spermaceti (obtained from sperm of certain body cavities). In recent years, as the bases used synthetic material (polyethylene, high-silicon-organic compounds, etc.). The positive qualities include their chemical stability, the ability to carry drugs into the skin, ease of use. Along with this synthetic framework can sensitize the skin and cause worsening eczematous process. Silicone cream, well-established as a protective agent, can also be used as a basis for ointments.
In patients with eczema of the skin excessively sensitive to many medicinal substances used indifferent ointment - zinc, etc. With good endurance in the ointment is added a variety of drugs - anti-inflammatory, antipruritic, allowing (tar, Ichthyol), disinfectants (mercury, antibiotics, sulfa drugs), regeneration processes (methyluracil) and others (the name of the ointment is determined by the drugs, its member), and many ointments have proposed the name of the author - boron-Tar Ointment Meshchersky, Unna, diahilnaya algebra, with silver nitrate Mikulic. Some of the officinal ointment used as a basis for other ointments, such as glycerin, zinc, Naftalan.
Sometimes eczema is advisable to use an ointment mixed with paste, and add them to the oil, oily solution of retinol and tocopherol acetate, karotolin (which increases their therapeutic properties, improves and softens the texture), combining "old" ointment bases with ointments "modern" (eg, officinal hormone).
If poor tolerance to use low-fat fat-based ointment (gel, gel), which are prepared on the basis of glycerol, gelatin, agar, casein, starch and other hydrophilic colloids. The gel has a non-irritating, soothing effect, so it is used for sensitive, irritated skin without the soak (but without the addition of antiseptic substances quickly deteriorates).
Appoint an ointment once a day, one of the ointment applied to the average of 7-10 days. Depending on the nature of the eczematous process, and how to apply the desired effect, it may be different: smearing, rubbing, which improves the absorption of drugs, faster resolution of lesions, especially in the chronic course (rub it with caution, given the possibility of aggravation of the process). Sometimes it is better to do without bandages. However, when applying bandages remedy more deeply penetrates the skin (dressing should not be cumbersome.) An even more profound effect of the ointment has a compress, occlusive dressing. In this way, are for the resolution of infiltrates, a softening of crusts, horny layers (applied dermatological pack - no cotton).
Before use, a fresh portion of skin ointment, not hurting, purified from the remnants of previously used drugs, scales, crusts, dirt that may have an irritant effect, be a breeding ground for germs, prevent the action of a fresh preparation. For this purpose, especially for high sensitivity of the skin of patients with eczema, it is best to use vegetable oil (sunflower, linseed, peach), slightly warmed, not boiled, as it loses its own healing properties. Swab dipped in vegetable oil, gently cleanses the skin, and then the oil is removed by a dry cotton wool. When microbial eczema, the skin around impetiginizatsii lesions wipe (from the periphery to the center), a liquid disinfectant, can not be washed with water, using soap and water. In eczema the ear canal is needed especially careful toilet, sometimes with 1% boron, or salicyl alcohol.
With eczema use ointments: 5% kseroformnuyu, boron-Naftalan, indometacin 1-3%, 5% karofilenovuyu, etc. Given the high sensitivity of the skin of patients with eczema, every new means of pre-test a small area for 1-2 hours
Patients with eczema recommend excluding household allergens (flowers, food for aquarium fish, etc.), wearing clothes mostly made of cotton fabrics, avoid skin contact with products made from synthetic fibers.
In the final stages shows a spa treatment with sulfide and radon sources: Lake Yarovoye, Belokurikha (Altai Territory), Tskhaltubo Mendzhi (Georgia), hot key, Eisk, Matsesta Sochi (Krasnodar Territory), Kemeri Baldone (Latvia), Sernovodsk, Pyatigorsk (Stavropol Territory), Archman (Turkmenistan), keys ( Perm Region), Luben, Great Nemiroff (Lviv region, Ukraine), Sergievskie mineral water Solvychegorsk (Arkhangelsk region), Talgi (Dagestan), etc.
When severe infiltration is recommended resorts with therapeutic mud: lake Yarovoye (Altai Territory), Kemeri (Latvia), Saki (Crimea), Pyatigorsk (Stavropol Territory), Slavic (Donetsk region, Ukraine), Staraya Russa (Novgorod region), Usolye (Irkutsk area), Elton (Volgograd Region), Uchum (Krasnoyarsk region), Krainka (Tula region), Lipetsk, Odessa, etc.
Necessary outpatient observation. In remission to prevent recurrence of eczema using bracing, desensitization, vitamins, drugs and other means of bromine, normalizing the function of the nervous system. It is advisable to appoint a liquid extract of Eleutherococcus 20-30 drops 2-3 times a day for 30 minutes. before a meal (20-25 days), an extract of Rhodiola liquid 5-10 drops 2-3 times in the morning for 15-30 minutes. before a meal (10 - 15 days), tincture of Aralia 30-40 drops 2-3 times a day, devil by 30-40 drops 2-3 times a day, and other drugs from the group of adaptogens.