May 8 2008

ECZEMA

ECZEMA

Dr. Mujeeb Rehuman

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The term eczema and dermatitis are synonymous. They refer to distinctive reaction pattern in the skin, which can be either acute or chronic.

Acute eczema

• Ø Redness, swelling, usually with ill defined margins.
• Ø Papules, vesicles and more rarely large blisters.
• Ø Exudation and cracking.
• Ø Scaling.

Chronic eczema

• Ø Many show all of the above features, though it is usually less vesicular and exudative.
• Ø Lichenification, a dry leathery thickening with increased skin markings and is secondary to rubbing and scratching.
• Ø Fissures and scratch marks.
• Ø Hypo or hyper pigmentary changes.

Clinical Features

1. Atopic eczema: The cardinal feature of atopic eczema is itch and scratching. Widespread dryness of skin is another feature. The eczema is often acute and involves the face and trunk. The napkin areas are frequently spared. The rash settles on the back of the knees, front of the elbow, wrist and ankles in childhood. In adults the face and trunks are more involved. Lichenification is common.
2. Seborrhoeic eczema: This condition is characterized by a red scaly rash classically affecting the scalp, central face, nasolabial folds, eyebrows and central chest. It is due to pityrosparum ovale infection.
3. Discoid eczema: This is a common form of eczema recognized by discrete coin shaped lesion of eczema seen on the limbs of young men, associated with alcohol excess and of elderly men.
4. Irritant eczema: Detergents, alkalies, acids, solvents and abrasive dusts are common causes. There is a wide range of susceptibility to weak irritants. The elderly those with fair and dry skin and atopic background are especially vulnerable. Napkin eczema in babies is the commonest example.
5. Allergic contact eczema: This is due to delayed hypersensitivity reaction following contact with antigens or haptens. Previous exposure to allergen is required for sensitization and the reaction is specific to the allergen or closely related to chemicals.
6. Asteatotic eczema: This is seen in hospitalized elderly, especially when the skin is dry. Low humidity caused by central healing, over washing and diuretics are contributory factors. It occurs most often on the lower legs as a rippled or ‘crazy paving’ pattern of fine fissuring on an erythematous background.
7. Stasis eczema: This occurs on the lower legs and is often associated with signs of venous insufficiency (oedema, red or bluish discolouration, loss of hair, indurations, hemosiderin pigmentation and ulceration).
8. Lichen planus: This describes a plaque of lichenified eczema due to repeated rubbing or scratching as a habit or in response to stress. Common sites include the neck, lower legs, and the ano-genital areas.

Investigation of eczema

Ø Patch test: In suspected case of contact allergic dermatitis.

Ø Specific IgE: These are occasionally performed to support the diagnosis of atopic eczema and to determine specific allergens.

Ø Prick test: The indications are same for specific IgE but are less commonly performed.

Ø Microscopy and culture test: Tests in suspected secondary infection. Skin swabs for bacteriological assessment invariably reveal the presence of bacteria.

MIASMATIC BASIS

Eruptions suppressed by local means have produced the following skin diseases, according to Hahnemann.

All skin eruptions are either secondary or tertiary expressions of miasmatic actions. The skin is the mirror or reflector of the internal stress, the internal dynamis, the internal working of the human machine. It has in the skin its reflections, its kaleidoscope, and its kinetoscopic views of its internal movements and its multiple shading of disease, its lights and its shadows that go to make up a picture thrown upon that human canvas, the skin, showing much of perverted life action in the organism.

Pathologically speaking, we look upon the outer man for signs, for marking or penciling that tell of the kind of life within the organism itself. Sometimes these pencilling are like the shadowgraphs, showing only faint trainings of the presence of a latent miasm and again they may be well defined and well developed even to physiological changes of form, colour and proportions. When we look upon these lesions of skin as local states or changes in itself, we simply ignore that co-operative principle that rules throughout the organism as a whole and we attribute that power to a part and not that which governs the whole. Therefore our therapeutic efforts are themselves misdiverted and instead of directing the perverted forces, we misguide them, bringing about nothing but confusion.

It was upon the skin that Hahnemann first saw the true psoric vesicle. It was there he first became familiar with psora as it came forth or receded under the potent influence of the applied law (similia). It was there that the mysterious veil was sent or lifted and he was permitted to look into the psoric mystery and see the true etiology of disease.

The skin of psora is dry, rough, dirty or unhealthy looking, has an unwashed appearance. Pruritis, very little suppurative in psoric skin disease, apt to be dry with scanty suppuration, seropurulent and occasionally bloody. Eruptions often papular in form accompanied by intense itching. Psora presents with normal colour of skin unless there is an inflammatory process. Itching scales and crusts thin and light, fine and small and usually quite general over the affected part. Vesicles of the itch, voluptuous tickling itching. Patient rubs and scratches, better for a few moments after which there is a long continuous burning of the affected part late in evening and before midnight. This itching is more frequent and more un bearable. Eczema with papular eruption. Eruption formed about the joints, flexors of the body or arranged in circular groupings, rings ,or segments of circles. The copper coloured or raw ham coloured or brownish or very reddened at their base. Scales and crusts thick and heavy patchy and in circumscribed spots.

Eczema with pustular is pseudo-psoric. Eczema exfoliata is sycotic. Condylomata will reveal the presence of both syphilis and sycosis and also verucae accuminata, pointed papillary growths, cox’comb and warts. The malignancies of psora snd syphilis are prone to develop at the age of 40. It is the tubercular diathesis that complaints all over skin diseases and makes them so difficult to remove. Malignancies may develop at any areas. Malignancies of skin are more violent intiactable in proportion as the sycotic taint is increased.

Erythematous eczema comes under sycotic miasm. Psora spends its force when suppressed, upon the venous system largely or upon the nerve centers often producing nervous and mental phenomenon of a serious character, all ameliorated when eruption is thrown upon the skin. There is no itching in syphilitic, very little soreness. Itching is wholly psoric symptom. The vesicle is also a psoric lesion when found in non syphilitic cases. If scalp is affected in psora, the scaly condition is quite universal while in other conditions like syphilis or sycosis, it is patchy or in circumscribed spots. The skin looses all moisture and becomes exceedingly dry and free from oil or sebaceous secretions we recognize it by the touch in psora. It is very oily or greasy; we will find the sycotic element present or the pseudo psoric. Skin affections with glandular involvement will necessarily have the syphilitic or the tubercular element to confirm with the glandular involvement.

All throughout Hahnemann’s experience the suppression of pseudo psoric eruption produces hemorrhages, spasms, convulsions, coma and death. It has also produced reflexes of all kinds, nervous disorder, asthma, paralysis stomach and intestinal disorders, catarrhal conditions and chronic cough. When the tubercular taint is present we have dyspnoea, infiltration of lung, pneumonia, chronic lung affection, tuberculosis and especially chest diseases.

Treatment of eczema can be achieved only by means of anti miasmatic remedy either anti psoric or anti syphilitic or anti sycotic depending on the dominant miasm which the patient has.

Dr. Mujeeb Rehuman

[email protected]