Eczema : What Is It ? Natural Treatment, Nursing Management, and Classification
Eczema is a recurrent inflammatory disorder of the skin precipitated by persistent itching followed by erythmatous, edematous vesicular and oozing lesion. Eczema could be sub acute or chronic. In acute stage erythema (redness), papules, vesicles, scales, crusts, or scabs appear alone or together. In chronic stage thickening of the skin, hyper pigmentation and lichinification due to longterm scratching.
Eczema is not a specific disease. It is characterized by a vicious cycle of inflammation itch – scratch.
-Dermatitis and eczema are terms that may be used interchangeably to describe a group of disorders with a characteristic appearance.
Classification of eczema
Eczemas are basically classified into endogenous and exogenous factors.
Endogenous factors constitutional
• Atopic
• Seborrhoeic
Exogenous factors:
• Contact dermatitis ( irritant and allergic contact)
• Photo dermatitis (Phototoxic and photo allergic)
Unclassified (special group )
• Neurodermatitis
• Juvenile plantar dermatitis
Clinical Features Common to Most Patterns Of Eczema ( different stage of eczema)
1. Acute eczema
Is characterized by:
-Redness and swelling, usually with an ill-defined border
-Papule, vesicles, and large blisters
- Exudation and crusting
-Oozing
-It can be itchy, but not always
2. Sub acute dermatitis
Characterized by:
-Moist lesion, erythematous, excoriated, scaling papules
-Plaques that are either grouped or scattered over erythematous skin
3. Chronic eczema
-More likely to be lichenified (a dry leathery thickened state, with increased skin markings, secondary to repeated scratching or rubbing)
-More likely to develop painful fissures
Complications
1. Heavy bacterial colonization is common in all types of eczema (but overt infection is most trouble some in the seborrhoeic and atopic types).
2. Reaction to medications may provoke dissemination, especially in stasis czema.
3. Anxiety states may develop with all severe forms of eczema
4. Herpes infection of the eczematous is serious complication
5. Scarring and permanent hyperpigmentation.
Differential diagnosis
-Psoriasis
-Fungal infections
-Scabies etc.
Treatments
A. For acute weeping eczema
-Application (soaking with) potassium permanganate or saline solution followed by
-Application of smear of corticosteroid cream or lotioin
-Application of non-sticky dressing or cotton gloves when hands & feet are involved
-For wider areas: - systemic corticosteroid and lotion
-frequent application of calamine lotion
-Systemic antihistamine.
-Rest
-Control secondary infection with systemic antibiotics.
B. For sub acute eczema
- Steroid
- Antibiotic creams like neomycin
- Antibiotic will be given if it is infected
C. For chronic eczema
- Steroids in ointment base with keratolytic such as salicylic acid
- Systemic antibiotics for bacterial super infection
- Sedative antihistamines, eg. Trimeprazine or hydrolyzine may be prescribed for severe itching
Nursing management
- It is important to distinguish between exogenous and endogenous eczema
- Identification and removal of source of irritation/offending material
- Explain, reassure and encourage patient
- Apply occlusive bandaging to interrupt scratch /itch cycle
- Teach patient – to keep his finger nails short
- to avoid scratching
- reduce anxiety/stress
- Inspect the affected area for infection
- Prevent drying of the skin by using emollients (oil) like Vaseline and liquid paraffin
- Rest, nutritious food
- Compliance to prescribed medication
- Apply wet dressing
The purpose of wet dressing
1. To reduce inflammation by reducing constriction of blood vessels
2. Cleanse the skin of exudates, crusts and scales
3. Maintain drainage of infected area
Wet dressing is used for vesicular, bullous, pustular and ulcerative conditions. The dressing solutions generally consist of room temperature of tap-water or saline and other agent including silver nitrate, aluminum acetate, and potassium permanganate 5% acetic acid with sodium hypochlorite.
Although some dressing must be covered to prevent evaporation, most are allowed to remain open. The open dressing requires frequent changes because evaporation israpid.
Wet dressing should be reapplied every 5 minutes to ensure their wetness It should be applied for 15-minute period three to four times daily, during the acute phase. Medication applied to moist skin immediately after treatment with compresses is absorbed better than dry skin.
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