Management and treatment of Eczemas.Yes they are curable!

Eczemas are a group of etiologically unrelated conditions that have similar clinical morphology. They have been defined as a pattern of skin inflammation that has characteristic morphologies in acute, subacute, chronic phases; viz, :

Acute phase : Erythema, edema, vesiculation, oozing and crusting.

subacute phase : Erythematous, hyperpigmented plaques with scaling and crusting.

Chronic phase : Lichenification (a combination of thickening, hyperpigmentation and prominent skin

markings).

The word dermatitis is usually used synonymously with eczema.

Causes of eczemas:

The causes may be in the body (endogenous eczemas) e.g. seborrheic dermatitis or atopic dermatitis or in the environment (exogenous eczemas) e.g. contact dermatitis, drug induced dermatitis.Most eczemas are curable if removal of the cause can be ensured.

Treatment of eczemas:

General principles of therapy - In order to bring rapid resolution and more importantly to prevent future relapses it is extremely important to explain to the patient the causes that underlie initiation and perpetuation of the disease and advice her or him to take corrective measures.The more acute an eczema the more bland and drying should be the topical agent used.

Acute - Topical open wet compresses with diluted (1: 10000) KMnO4 (Condy's solution) administered by placing a soaked layered cotton cloth over the lesions is cooling, relieves pruritis, removes crusts and reduces erythema and oozing.

Subacute - Topical steroid creams are highly effective.Potent steroids should be avoided over face and intertriginous areas for fear of causing atrophy or striae.Systematic steroids may occasionally be needed for extensive affections.

Chronic - Potent (fluocinolone or beclomethasone) or highly potent (clobetasol propionate or betamethasone dipropionate) topical steroids are usually effective. For resistant cases, efficacy of steroids can be raised by combining them with a keratolytic agent (salicylic acid) or the use of non occlusive plastic film (occlusive therapy) for a period of 4-8 hours following steroid application. Residual lesions can be injested with intralesional depot preparation of a steroid like triamcinolone acetonide 5 mg/ml. intralesional injection may be repeated after 4-6 weeks if needed.