Eczema is one of the most common dermatological pathologies [1-3]. The incidence of eczema varies from 6 to 15‰ (per 1000 population) and accounts for 30–40% of the total number of skin diseases [4]. Eczema is equally often registered in all countries of the world in representatives of different races and regardless of the gender of patients [5]. Microbial eczema (ME) in the structure of eczema ranks second after true eczema and has a share of 12 to 27% [1, 6-8].
Currently, quite a lot of publications have accumulated on various parts of the pathogenesis of ME, which make it possible to improve diagnostic and treatment measures. ICD-10 does not correspond to the established tradition in Russia of dividing the disease into clinical forms. This not only makes it difficult, but also completely eliminates the possibility of statistically recording the occurrence of ME in our country.
The purpose of the study is to increase doctors’ knowledge about the etiopathogenesis, classification and treatment of ME based on the analysis and systematization of literature data and the results of their own research on this problem.
Causes of eczema
The exact cause of this condition is unknown, but the process is based on an overactive reaction of the body's immune system to an irritant or allergen. Substances are formed in the cells of the dermis that cause inflammation, which is associated with the main symptoms. It is also known that the tendency to this disease is inherited.
The therapy is aimed at suppressing inflammation and allergies, as well as healing, eliminating itching and dryness.
Topical medications are available in various forms. Each type of skin lesion has its own dosage form.
- Ointment - has a fatty base with which the medicine is mixed directly, it is more suitable for dry eczema and dermatitis on the hands, it cannot be used on wet areas, it may not be hormonal, or contain hormones. The active components penetrate the skin well, and the fat base itself is not absorbed.
- The cream contains water with a medicine dissolved in it, which is mixed with a fat base. Contains significantly less fat than ointment, so it is suitable for weeping eczema. It is better absorbed and does not leave greasy marks on clothes. The healing components of the cream penetrate the skin less well and usually act in its upper layers.
- In the paste, the concentration of dry substances is more than 25%.
- Lotion is a liquid dosage form (usually an aqueous solution of a drug plus oil). Lotions are suitable for wet conditions, as well as on the head under the hair.
Expert opinion
— The selection of hormonal/non-hormonal agents for external use is carried out by a specialist after collecting an anamnesis, identifying the causes that provoked the disease, and examination.
Firsakova Svetlana Sergeevna, dermatovenerologist, Melanoma Unit Moscow clinic
Which ointment for eczema is best?
After getting acquainted with the top names of remedies for eczema, based on the indicated criteria, making a choice in favor of one will be much easier. Vyborexperta.ru does not give instructions on what ointment to buy, since this is in the competence of a dermatologist, but it highlights several leaders in the review:
- Advantan is a modern Italian remedy, approved for children from 4 months of age, well tolerated and with a minimum of contraindications;
- Pheniveit is an effective ointment for wet eczema, a drug of the latest generation that has a targeted effect, does not accumulate in the body, and is low toxic;
- Flucinar is a highly active steroid for a short course of use, appropriate for severe disease, the possibility of using an occlusive dressing;
- Elidel is a homogeneous, effective product with antibacterial activity, a pronounced effect, and can be applied to any part of the body.
Only a doctor knows what eczema is and what it looks like. Accordingly, self-medication is dangerous. In addition to creams, it is important to eliminate bad habits, adjust your diet, avoid contact with chemicals, and take vitamins. And most importantly, visit your doctor regularly to monitor the dynamics of the disease.
Hormonal agents
All hormonal medications contain synthetic derivatives of the adrenal cortex. In a healthy body, they play the role of stress mediators and help adapt the functioning of all organs to changing conditions. Their ability to regulate immunity makes them very useful in many dermatological diseases in which inflammation and allergies play a role. Glucocorticoids affect the functioning of cells responsible for the inflammatory process. Thanks to this, chemical compounds that cause symptoms do not enter the bloodstream. Hormones enter the dermis layers and eliminate redness, swelling, itching, and rashes.
Hormone therapy is contraindicated in certain conditions:
- Rosacea
- Acne
- Viral diseases of the epithelium
- Skin infection caused by bacteria or fungi
- Reaction to vaccine administration
- Tuberculosis
- Scabies
- In pregnant women and children, these medications should not be applied to large areas of the body or covered with a bandage.
Advantan
A modern medicine that is well tolerated and has minimal negative effects. This ointment effectively helps relieve symptoms of psoriasis, eczema and dermatitis, and can be used on the arms and legs, as well as on the face. The drug practically does not enter the bloodstream; even after application over large areas, traces of this drug are not detected in the blood. Advantan is approved for people of any age. Expectant mothers should be treated with caution. Local side effects rarely occur with long-term therapy without medical supervision. This may include atrophy, redness and acne. Systemic adverse effects have not been described.
Hydrocortisone
It is based on the synthetic steroid hydrocortisone, one of the weakest glucocorticoids, with which it is better to start treating eczema. If the lesion covers a large area, the skin is severely damaged and is covered with a bandage, hydrocortisone is likely to enter the bloodstream and produce systemic effects.
Hydrocortisone can be treated from the age of two; it is prohibited during pregnancy.
Dermovate
This drug is the most powerful among pharmacological products with glucocorticoids. It is prescribed only in the most acute period, then switching to less powerful drugs. You should not use it for more than four weeks, as this may lead to side effects. At the same time, if the effect of therapy is not visible within several weeks, you need to recheck the diagnosis, because Dermovate shows extremely high effectiveness for eczema conditions.
Lokoid
Lokoid is a very strong glucocorticoid. It is effective for severe forms of atopy, but with prolonged use it causes serious atrophy of the skin, which sometimes persists even after discontinuation. Lokoid is absorbed into the bloodstream in small quantities, but systemic side effects, unlike local ones, easily go away after the end of the course. Pregnant women are allowed to be treated with Lokoid, using caution. Although it enters the bloodstream and through the placenta, a very short course of therapy is usually required, so there is no harmful effect on the fetus.
Lorinden
Loriden's formulation contains a powerful glucocorticoid combined with salicylic acid, which dissolves epithelial scales and helps the hormone penetrate deeper and work better, and also disinfects the skin in the area of application.
It is safe for children and expectant mothers only in small areas.
Prednisolone
This is a medium-strength remedy with which you can begin treating mild to moderate eczema. It easily penetrates the blood, so the course of treatment should be short, and during pregnancy it should be used carefully.
Soderm
This is an effective ointment for eczema on the skin, including the hands and face, is safe for use in adults and children, and patient reviews indicate that it is well tolerated. The active substance Soderma practically does not penetrate into the blood.
Flucinar
A highly active steroid with pronounced anti-inflammatory activity. Prescribed only for a short course due to local side effects. Since it enters the body, it can cause systemic complications and is contraindicated for pregnant women.
Fluorocort
Fluorocort has high activity, but is quite well tolerated. The result is achieved in 10 days, but if necessary, it is safe to use Fluorocort for up to 25 days.
Celestoderm-B
Contains an active and strong glucocorticoid, which effectively eliminates symptoms, but practically does not pass into the bloodstream. They also produce a combination cream with the addition of the antibiotic gentamicin, which suppresses the growth of microorganisms in the epidermis, but is contraindicated in children.
Cynacort
Cinacort contains the synthetic corticoid triamcinolone, which is well tolerated and has a pronounced anti-inflammatory effect. Suitable for dry eczematous changes, and the cream is suitable for swelling, weeping, as well as in skin folds and the border with the mucous membrane.
Elokom
A modern medicine with very strong anti-inflammatory and anti-allergic effects. It does not cause atrophy and does not enter the body. Due to its prolonged activity, it must be applied once a day. It can be used with caution by pregnant women.
How to choose an ointment for eczema
An effective ointment for eczema is an individual solution for each patient; for some, a non-hormonal composition is enough, while others are saved only by potent formulas. They also take into account the purpose in the instructions, contraindications, and the effectiveness declared by the manufacturer.
Hormonal or non-hormonal
Hormonal formulas are used for severe inflammation, accompanied by severe itching, pain, and swelling. They work quickly and effectively, but have limitations and risks.
Non-hormonal formulas are used as maintenance therapy, in the initial stages of development, and also in cases where hormones are strictly contraindicated for health reasons.
Purpose
Before buying one topical product, it is important to compare the current state of affairs, the doctor’s diagnosis with what is indicated in the instructions. Some formulations are appropriate for weeping eczema, others are applied only to certain areas.
Contraindications
The largest list of contraindications is usually for hormonal drugs. Therefore, consultation and supervision of a doctor is extremely important here. Non-hormonal drugs have much fewer restrictions on their use.
Efficiency
The effectiveness of local treatment depends on the bioavailability, digestibility and rate of absorption of the components. These factors determine the speed of onset of action, when the inflammatory process and the resulting clinical picture begin to decrease.
Non-hormonal ointments
The formula of non-hormonal anti-eczema pharmaceutical products includes various compounds that mitigate the symptoms of the disease. In some cases, using one of the non-hormonal ointments is sufficient to achieve remission. Combination medications are aimed at several components of the disease at once. They work well and have no systemic complications. Local adverse events vary depending on the formulation.
Akrustal
The active ingredient of this brand is solid oil. It helps with flaking, itching, and inflammation, although the exact mechanism by which it works is unclear. Solidol causes contact dermatitis, so upon first use it is necessary to test the reaction on a small area of the body surface. With prolonged use, oil acne appears due to the fact that solid oil clogs the ducts of the sebaceous glands. If such a reaction occurs, it is recommended to apply Akrustal every other day.
Boron-zinc-naphthalan ointment
This is a combination drug that is used for inflammatory diseases of the epithelium. Boric acid in its composition is an antiseptic. Zinc oxide dries and has an astringent effect, which is useful for weeping. Naftalan oil has a strong anti-inflammatory effect, relieves redness and itching, and cleanses the skin.
Heparin
Contains heparin, which resolves blood clots in the veins and improves blood flow. Thanks to auxiliary additives that dilate blood vessels in the dermis and increase tissue permeability, heparin is more easily distributed under the skin in the area of application. In addition, the composition includes a local anesthetic, which reduces itching, pain and the feeling of fullness. This ointment is useful against venous eczema, but is not effective against atopic eczema on the arms, face and torso.
Dermasan
This is a liquid with a very simple composition, which is used for dry skin, irritation and cracks. Glycerin softens and soothes, and ethyl alcohol destroys germs.
Levomekol
A combined drug that has a wound-healing effect and also fights bacteria that cause infection.
Losterine
A series of combined agents that have a good therapeutic effect for atopic dermatitis. A unique component of the Losterin series is naftalan oil, a powerful anti-inflammatory agent that soothes irritation, reduces swelling, itching and redness, and promotes healing. In addition, among the active ingredients are urea, which is a good emollient, salicylic acid (softens and exfoliates), D-panthenol and almond oil.
Methyluracil
Methyluracil enhances metabolism in epithelial cells, stimulates their division and promotes regeneration.
Radevit
The working components of Radevit are vitamins A, E and D. Vitamin A promotes the renewal of epithelial cells. Vitamin E is an excellent antioxidant. Vitamin D fights inflammation and improves cell nutrition.
Salicylic
Salicylic acid softens scales and helps cleanse the skin in case of eczematous lesions. It also regulates the functioning of the sebaceous and sweat glands, which is useful for seborrheic dermatitis. Thanks to its antiseptic properties, it prevents infection of epidermal lesions. Contraindicated for children.
Skin Cap
Skin Cap cream and shampoo contain the therapeutic component zinc pyrithione. The main direction of Skin Cap's work is anti-inflammatory. It softens the epithelium, eliminates itching and flaking. Active against fungi that support inflammation and flaking in seborrheic dermatitis. Zinc pyrithione also fights bacteria that complicate eczema.
Solipsor
Solipsor products contain medical grease and birch tar, which fight inflammatory manifestations, and natural herbal extracts soothe, eliminate itching, and destroy microorganisms. Solidol sometimes provokes contact dermatitis, so for the first time Solipsor should be tried on a small area.
Thymogen
Thymogen regulates cell renewal, stimulates tissue regeneration and healing.
Zinc paste
Having drying and astringent activity, zinc paste makes it easier to get wet.
Elidel
A highly effective medicine, comparable in strength to hormones. Elidel, penetrating into the dermis, inhibits the division of immune cells responsible for the formation of inflammation and blocks the release of allergy mediators. Elidel does not cause atrophy, does not affect general immunity (even when taken orally, in the form of tablets), and does not reduce resistance to infections. Approved for children from 3 months of age, but not yet sufficiently studied during pregnancy. Adverse reactions such as infection at the site of application are rare with very long-term use.
Emolium
This is a line with significant moisturizing activity. Emulsion Emolium contains natural oils, urea, paraffin oil and other emollients, that is, substances that help the body retain moisture as much as possible.
Eplan
Contains a solution of lanthanes in glycerin - the active Glycolan complex, which promotes skin regeneration and rapid healing of damage, and also prevents infection.
Treatment depending on the type
Dry eczema
Dry eczema is characterized by itching, flaking, and thinning of the skin. The main goal in treating this condition is to retain moisture in the skin. What home methods will help improve the condition?
| Vegetable oils | Fatty acids seal the surface of the skin and prevent moisture from evaporating. Dryness and flaking, as well as the inflammatory process, are significantly reduced. Olive and coconut oils work best. They should be applied immediately after washing. |
| Aloe | Aloe is a healing plant that has been used for thousands of years for various ailments, including to relieve eczema. Properties of aloe:
You can use aloe juice, leaf pulp or cosmetic aloe gel from the pharmacy. The drug is applied directly to the affected areas. |
| Oat decoction | Oat decoction and jelly are a powerful antioxidant and anti-inflammatory agent. It envelops damaged skin and reduces the manifestations of the disease. Its application points:
The product is added to baths or applied as a lotion. This method is not suitable for people with gluten intolerance because oats are processed together with wheat. |
| Honey |
|
| Tea tree oil | A natural and effective remedy for skin problems, tea tree oil fights inflammation and promotes regeneration. For dry eczema, its ability to moisturize the epithelium and reduce itching is valuable. This essential oil must be diluted in a carrier oil (such as olive) before application. |
Weeping eczema
With weeping eczema, itchy blisters of the epidermis appear, filled with serous fluid; when the blisters collapse, erosions form and the watery discharge constantly irritates the affected area, further worsening the condition. This type of eczema is complicated by infection, and drying and antiseptic agents are suitable to relieve symptoms.
| Apple vinegar | Restores skin acidity, which is reduced in eczema patients, dries wet areas and fights germs. A tablespoon of vinegar is diluted in a glass of warm water, soaked in a gauze bandage and applied as a compress for 3 hours. |
| Decoction of string | Baths with a decoction of the string soothe and dry the skin. The water temperature should be slightly warm, and the frequency of procedures should not be more than once a week to avoid overdrying. |
| Oak bark decoction | Tannins in this folk remedy significantly reduce weeping and inflammation. Apply the liquid directly to the eczematous sores. |
| Baking soda | Baths with soda in the proportion of 400g. soda per 170 liters of water helps soften and cleanse the body. |
| Fir oil | The property of fir oil to influence the functioning of the sebaceous glands, its softening and antimicrobial effect make this aromatic liquid a miracle cure for eczema. Apply the solution in base oil topically. |
Microbial eczema
This type of eczema develops when damaged skin becomes infected with bacteria or fungi. Microorganisms increase the inflammatory response, swelling and pain appear, and pus is released.
Antimicrobial and antiseptic recipes will be beneficial for such pathology. These are baths with infusion of chamomile and calendula, or lotions with these herbs.
It is important to remember that folk wisdom alone will not help overcome the infection, and in most cases, the help of a doctor is required.
Dyshidrotic eczema
Dyshidrosis on the hands and feet responds best to hormonal treatment prescribed by a doctor. But as auxiliary methods you can use baths with sea salt, lotions and baths with oat decoction, compresses with fresh potatoes.
Side effects
Complications from medicinal products containing glucocorticoids in the area of their application are associated with their effect on cell repair.
- Atrophy. At the site of application, the epidermis becomes thin, dull, easily damaged, and loses hair.
- Decreased protective function of the body. Acne appears and infection easily develops.
In some cases, the hormone contained in the drug mixture can enter the bloodstream and cause a systemic complication. Glucocorticoids affect blood pressure, sugar levels, lead to a significant decrease in immunity, obesity, osteoporosis, and cause growth retardation in children. To prevent hormones from causing such disorders, they should only be used under medical supervision. The doctor will give recommendations on how long and how often to apply the ointment for eczema, depending on whether the area of application is on the arms, legs or body, will help reduce the dose or change treatment in time and, of course, will tell you the name of the most suitable drug for this case.
Side effects of non-hormonal ointments manifest themselves in the form of irritation or an allergic reaction. Medical solid oil in some medications provokes the appearance of contact dermatitis.
Rating of ointments for eczema
When studying the question of which ointment for eczema is effective, efficient and appropriate in different cases, we consulted with leading dermatologists. Their many years of experience have shown what criteria you need to pay attention to when selecting nominees:
- Group of drugs;
- Active substance;
- Mechanism of action;
- Purpose, list of indications;
- Restrictions on use;
- Performance;
- Organoleptic properties.
The result of the comparative analysis was a top list of 8 positions. These are the most purchased ointments this year, helping with eczema and the clinical picture characteristic of this disease. Review monitoring identified the features, advantages, and disadvantages of the nominees.
Prevention
For prevention, two types of care products are used.
- Moisturizing products with powerful emollients, such as urea and glycerin, soften and prevent the body from drying out due to the fact that, distributed in the outer layers of the epidermis, they attract moisture. They are applied throughout the day as needed.
- Natural oils, waxes and silicones create a protective barrier on the surface of the skin, preventing moisture evaporation. They are best used after a shower and applied to a damp area of the body.
Diets and adherence
Diet influences the course of eczema. Due to the allergenic nature of this disease, it is important not to eat the food that causes the reaction. This measure alone helps control the severity of symptoms. To make it easier to identify the allergen, try keeping a food diary.
Some products exhibit anti-inflammatory properties, so including them in the menu helps in the fight against the disease.
- Fatty fish species;
- Leafy vegetables;
- Lentils and legumes;
- Vegetables and fruits of bright colors (but be careful with tomatoes, strawberries, raspberries - they may be allergens);
- In general, a large number of vegetables;
- Turmeric and cinnamon.
Pro-inflammatory foods to avoid:
- Eggs;
- Wheat;
- Soy;
- Dairy products;
- Sugar.
Important points regarding the regime and lifestyle for eczema
| the washing up | With eczema, the body needs hydration, so a bath or shower has a beneficial effect on the condition.
|
| Household chemicals | It is important that all chemicals that come into contact with the skin are hypoallergenic, as soft as possible, without dyes or fragrances. Do not use fabric softener or add an extra rinse to the machine wash program. |
| Microclimate | It may be pleasant to sit by the fireplace or radiator, but it is harmful for skin affected by eczema. Hot and dry air dries out the epithelium. Use a humidifier. |
| Cold | Protect your skin from frost and temperature changes. Dress warmly, wear gloves, cover your face with a scarf. |
| Stress | Stress always makes things worse for people with eczema conditions. Get enough sleep, use breathing techniques, try to avoid mental stress. |
Bibliography
- Akhtyamov, S.N. Practical dermatocosmetology / S.N. Akhtyamov, Yu.S. Butov. M.: Medicine, 2003. - 391 p.
- Arkhangelskaya, E.I. Materials on the clinic, etiology and pathogenesis of diffuse streptoderma and microbial eczema: abstract. dis. Dr. med. Sciences / E.I. Arkhangelskaya. L., 1973. - 38 p.
- Aizikovich, JI.A. Abstracts of scientific works of the VIII All-Russian Congress of Dermatovenerologists / JI.A. Aizikovich, T.V. Sokolova. 4.1. // Dermatology. - 2001.- P. 205.
- Buxton, P.K. Dermatology / P.K. Buxton. M.: Publishing house BINOM, 2005, - 175 p.
- Belousova, T.A. Neurogenic factors in the pathogenesis of eczema: abstract. dis. . Ph.D. honey. Sciences/T.A. Belousova. M., 1984. - 18 p.
- Demidova, M.A. Epidemiological and pharmacoeconomic aspects of the use of antihistamines in the treatment of patients with eczema / M.A. Demidova, E.V. Bogdanova // Ross. magazine skin and venereal diseases. 2009. - No. 2. — P. 46-49.
- Kudryavtseva, E.V. Lokoid and modern approaches to external therapy of atopic dermatitis / E.V. Kudryavtseva, AB Karaulov // Immunopathology, allergology, infectology. 2003. - No. 4. — P. 57-62.
- Mikhailenko, A.A. Allergy and allergic diseases /AA Mikhailepko, G.A. Bazanov. M.: Med. information agency, 2009. - 304 p. thirty.
- Prokhorenkov, V.I. Eczema / V.I. Prokhorenkov, T.A. Yakovlev 3rd ed. - Krasnoyarsk: PIK "Offset", 1994. - 255 p.
