Eczema

“ Frequently the whole body is covered with patches of eczema, the secretions are arrested, and, where the scales fall off, the skin is left dry and feverish.
Eczema has no symptoms proper, since the morbid feelings are due to constitutional debility, of which eczema is the result. The signs of eczema are redness, heat, an itching or smarting sensation, the formation of pimples or vesicles, exudation, incrustation, the separation of the cuticle into scales and a gradual thickening of the skin. ”

“ Eczema of the Face and Scalp.
Describe the symptoms of eczema rubrum.
Eczema rubrum is characterized by a red, raw-looking, weeping, oozing or discharging surface, attended with more or less inflammatory thickening, infiltration and swelling; the exudation, consisting of serum, sometimes bloody, dries into thick yellowish or reddish-brown crusts. At one time the whole diseased area may be hidden under a mass of crusting, at other times a red, raw-looking, weeping surface (eczema madidans) is the most striking feature. ”

“ External Treatment.—The local treatment of eczema is based upon the pathological conditions present. The acute disease requires entirely different management from that employed in chronic cases. The stage of the disease and the amount of skin involved, whether in the form of a circumscribed patch or as a diffuse eruption, are points to be taken into consideration in the selection of a remedy and the mode of its application. ”

“ When eczema sets in acutely, with general feverish disturbance, cooling medicines are required, and the help of the doctor becomes necessary. These are the cases in which the eruption is not confined to the head or the face, but extends over the body generally. The child must be dressed as loosely as possible; and when in its cot, should lie there with no other covering than its little shirt; and nothing gives so much relief to the irritation as the abundant use of powder, either simple starch powder, or ten parts of starch powder to one of oxide of zinc, or carbonate of bismuth. ”

“ No; in those of great cutaneous irritability, especially in children, the skin being more tender, the type of the eruption is usually much more inflammatory. In those predisposed a true eczema may arise, and then, in addition to the characteristic lesions of scabies, eczematous symptoms are superadded; in long-persistent cases, indeed, the burrows and other consequent lesions may be more or less completely masked by the eczematous inflammation, and the true nature of the disease be greatly obscured. ”

“ The physical pain from the eczema, and working with raw and bleeding hands, threatened me with madness. I dare not tell a soul. I dare not even face it for some time, and then I knew I must fight this battle or go under. ”

“ TREATMENT.—There is no other disease of the skin which requires so thorough a knowledge of general medicine for its successful management as does eczema. The exciting cause of the affection is to be ascertained and to be properly treated. It is the specialist who has as the groundwork a comprehensive knowledge of general medicine who is best able to cope successfully with the disease under consideration. In the management of eczema both constitutional and local treatment will be necessary. ”

“ Erythematous eczema (eczema erythematosum) begins as one or more small or large, irregularly outlined hyperæmic macules or patches, with or without slight or marked swelling, and with more or less itching or burning. At first it may be ill-defined, but it tends to spread and its features to become more pronounced. It may be limited to a certain region, or it may be more or less general. When fully developed, the skin is harsh and dry, of a mottled, reddish or violaceous color, thickened, infiltrated and usually slightly scaly, with, at times, a tendency toward the formation of oozing areas. ”

“ A common feature is an offensive odor from the affected skin, and which may betray the persistence of the disease when it has been supposed that all eruption has been overcome. While not prepared to follow Cadeac in making this a diagnostic symptom from other skin diseases, yet as an evidence that an eczema is not yet entirely healed it serves a very useful purpose. In oldstanding cases the continued irritation, the unintermitting itching, the absorption or circulation of morbid products, and the constant nervous excitement may lead to emaciation, exhaustion and death. ”

“ Eczematous symptoms may be superadded. In severe cases the entire extensor surfaces of the legs and arms, and in some instances the trunk also, are invaded. It is worse in the winter season. [Pg 119]
What is known in regard to etiology and pathology?
It is a disease of the ill-fed and neglected, usually developing in early childhood, and persisting throughout life. It is extremely rare, even in its milder types, in this country. Clinically and pathologically it bears some resemblance to papular eczema.
Give the prognosis and treatment of prurigo. ”

“ Cabinet crises in England are found to be likely to be followed by the recurrence of eczematous conditions in older members of the Cabinet or by first attacks in some of those whose skin has been irritated by some internal condition. Unless business worries can be removed or family anxieties allayed the cure of eczema becomes a difficult matter. Men or women who worry about their eczematous condition apparently prolong it. This is particularly true if they have little to do and are likely to be much occupied with themselves and their condition. ”

“ When this nutrition is not sufficient, the skin appears pale, of a peculiar color, and is easily taken up in folds, an evidence of poor nutrition of the skin. When the skin is not properly nourished, every slight irritation is liable to produce eczema. ”

“ It is evident then, that one cannot take too much pains to guard against the occurrence of eczema if possible, and at any rate to prevent its becoming severe. The disposition to it is often controlled by very simple precautions, such as bathing the face, the moment the skin shows any redness or roughness, with thin gruel or barley water, then powdering it with starch powder, and when the infant goes out, smearing the spot very lightly with benzoated zinc ointment, and making the child wear a veil. ”

“ Happily, however, the condition scarcely ever terminates fatally, though feeble health and stunted growth are not seldom the results of the early suffering. But besides, severe eczema in infancy always returns again and again in childhood and in after-life, and there is also a distinct connection between liability to eczema and to asthma ”

“ Eczema, a common skin disease, which may be either chronic or acute; develops in a red rash of tiny vesicles, which usually burst and produce a characteristic scab; is not contagious, and leaves no scar. ”

“ Among the local causes producing the so-called artificial eczemas the preparations of mercury, sulphur, croton oil and tincture of arnica are most notable. Contact with the several varieties of the rhus plant, though usually producing a peculiar dermatitis, may in eczematous subjects provoke a genuine eczema. Heat and cold, especially the rays of the sun, are also factors to be considered, while it is well known that the disease in many instances is influenced by the seasons, being, as a rule, worse in winter than in summer. There are many subjects who suffer only in winter. ”

“ A severe attack of eczema is usually accompanied by some slight constitutional disturbance, but the general health seldom suffers appreciably, unless, as occasionally, the itching is so bad as to make sleep impossible. The irritation and local heat may be out of all proportion to visible changes in the skin, and in neurotic patients the nervous excitement may be extreme. ”

“ Carbolic-acid solution must not be used on them. The folds and creases of their skin must be kept dry and powdered with borated talcum. A great point in the treatment of all eczema is to avoid the use of water, and to substitute oiling with olive oil and wiping off for the usual washing of the affected area. ”

“ This discharge is seldom as abundant as in eczema in the dog or horse. It is produced slowly and dries rapidly.
As the crusts fall, carrying with them a portion of the hair, the general symptoms disappear, but the sites of these vesicular patches now show cracks extending as deep as the dermis and often complicated by secondary infection involving suppuration, adenitis, abscess formation, or diffuse subcutaneous suppuration.
Acute eczema is generally confined to the limbs. It may develop fully in from twenty-four to forty-eight hours. ”

“ Eczema of the external meatus is often associated with eczema of the auricle and of the surrounding parts. Not infrequently there also exists a chronic middle-ear suppuration, which may be the cause of the eczema. Intense itchiness is the most characteristic symptom, and a watery discharge may also be complained of. Deafness and tinnitus are dependent upon the accumulation of epithelium and débris. After the ear is syringed the skin may present a dry, scaly appearance, while sometimes fissures and an indurated condition of the outer end of the meatus may be noted. ”

“ It resembles a very bad case of eczema, affecting the feet and the hands more than any other part of the body. The skin becomes thick and reddened, while the fleshy part rapidly disappears, leaving the fingers crooked and hard, like claws. ”

“ Sometimes they will enforce their will by an appeal to their symptoms. I have had a little patient of no more than thirteen months of age who suffered severely and for a long time from eczema, and who in this way used his affliction to ensure that he got his own way. ”

“ In adults, more especially males, the inner portion of the upper part of the thighs and scrotum (tinea trichophytina cruris, so-called [Pg 253] eczema marginatum) may be attacked, and here the affection, favored by heat and moisture, develops rapidly and may soon lose its ordinary clinical appearances, the inflammatory symptoms becoming especially prominent. The whole of this region may become involved, presenting all the symptoms of a true eczema; the border, however, is sharply defined, and usually one or more outlying patches of the ordinary clinical type of the disease may be seen. ”

“ The history of eczema is different: it rarely begins as circular spots, spreading peripherally; the margins are always more or less irregular; the hairs are not involved, but remain seated firmly in the follicles; the itching is marked, whereas in ringworm it is usually slight. Seborrhoea is non-inflammatory; the scales are greasy; the hairs are not broken off; and the margins of the patch are ill defined. In psoriasis the scaling is a marked feature; the hairs are not involved; and the disease is usually to be found typically expressed on other parts of the body. ”

“ They never exude serum. The lesions are, as a rule, circumscribed and sharply defined from the surrounding healthy integument, differing in this respect from similar patches of eczema. The skin between the lesions is perfectly healthy. In markedly inflammatory cases they occasionally possess a slightly raised border, and sometimes, especially in certain localities, as the hands, fissures form, as in eczema and syphilis.
The disease pursues an eminently chronic course, often lasting years or even throughout life, disappearing and recurring from time to time. ”

“ Pustular eczema (eczema pustulosum, eczema impetiginosum) is probably the least common of all the varieties. It is similar, although usually less actively inflammatory, in its symptoms to eczema vesiculosum, the lesions being pustular from the start or developing from preëxisting vesicles; not infrequently the eruption is mixed, the pustules predominating. There is a marked tendency to rupturing of the lesions, the discharge drying to thick, yellowish, brownish or greenish crusts. ”

“ Another form of eczema is simply a very badly chafed condition accompanied by intense itching, and commonly known as "dry eczema." A very disagreeable form is the pustular variety. One poor little sufferer that was once brought to us had so many pustules on his head that one could not put a ten cent piece on his scalp without touching a pustule. The treatment of these cases, in order to be effective and leave the child's head in normal condition, must be administered with the utmost patience every day for weeks. A doctor's help is always required in combating this sort of skin trouble. ”

“ Eczema, especially in its chronic erythematous forms, exhibited in the face of adults in middle and later life, is of much slower development, is productive of itching, is ill-defined in contour, and is not accompanied by fever.
Erythema in all its varieties is a purely hyperæmic affection and unaccompanied by fever. In erythema multiforme there is an exudative process by reason of which various papules, nodosities, and at times even bullæ, appear upon the surface. None of them, however, are accompanied by a diffused area of redness spreading at the periphery. ”

“ The skin, partly for this reason, and partly because it shares in the general disturbance of nutrition, becomes dry, harsh, and scaly; after a time the face, and especially the nose and neighboring parts, assumes in many instances a violaceous hue, the minute superficial cutaneous veins are enlarged, and acne is common. The resulting appearance is almost characteristic of the habits of the individual. Alcoholic subjects frequently suffer from pruritis, urticaria, and eczema. ”