Eczema, ie dermatitis, is characterized by epidermal edema (spongiosis). The leading types of eczema are allergic contact dermatitis and primary irritantcontact-dermatitis. Other types are atopic dermatitis, seborrheic dermatitis, discoid eczema and lichen simplexchronicus.
Atopic dermatitis is a chronic, relapsing and itchy disease that starts in the majority age and is very common. It tends to occur in family members, and many genes are probably responsible. The disease is very much associated with asthma and spring fever. The clinical features of atopic dermatitis include eczema excoriation and lichenification in the flexion areas, generalized exeroderma.
Topical corticosteroids are the most effective topical agents, but on skin examination they suppress the pituitary-adrenal axis and rebound when released.
Seborrheic dermatitis occurs in hairy areas, flexion areas or in the middle of the trunk. Excessive dandruff and flaking and pink areas are seen in the folded areas of the face. It is especially common in the elderly in places of great flexion.
Discoid eczema is more common in middle-aged and elderly people. It is characterized by round and red scaly lesions. It should be differentiated from psoriasis and Bowen’s disease. Treatment uses emollients and corticosteroids.
Eczema craquelee (asteatotic eczema) occurs especially on the dry areas of the legs of the elderly and is characterized by a red rash in the form of a peculiar cobblestone pavement.
Lichen simplexchronicus is a very itchy disease that occurs on the back of the neck and the inner sides of the ankles. Affected areas have well-defined raised red excoriated and lichenified areas. The disease is very persistent, but strong topical corticosteroids can be helpful.
Venous eczema develops on the lower legs of the elderly with venous hypertension. Some patients are thought to have allergic contact dermatitis to substances used in the treatment of venous ulcers.