Dr Mujeeb Rehuman
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
Redness, swelling, usually with ill
defined margins.
Papules, vesicles and more rarely
large blisters.
Exudation and cracking.
Scaling.
Chronic
eczema
Many show all of the above features,
though it is usually less vesicular and exudative.
Lichenification, a dry leathery
thickening with increased skin markings and is secondary to rubbing
and scratching.
Fissures and scratch marks.
Hypo or hyper pigmentary changes.
Clinical
Features
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.
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.
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.
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.
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.
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.
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).
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
Patch test:
In suspected case of contact allergic dermatitis.
Specific IgE:
These are occasionally performed to support the diagnosis of atopic
eczema and to determine specific allergens.
Prick test:
The indications are same for specific IgE but are less commonly
performed.
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.
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