ECZEMA (ek-ama), one of the com monest of all dieases of the skin, and al so the most variable in its manifestations. It may be acute or extremely chronic, may affect any portion of the skin, and may occur at any age from infancy to old age.
In typical acute eczema the affected portion of skin is red, and is covered with numerous small papules, which speedily turn into vesicles. These may quickly dry up, but more commonly break, and discharge a clear, glutinous secretion, which hardens and forms scabs or crusts, or if copious keeps the surface in a moist "weeping" condition. In some cases the vesicles are replaced by pustules, and the discharge is partly pur ulent. Chronic eczema may follow the acute form, or may arise without an acute stage. Here the skin is thickened and hard, and covered with crusts or scales; deep cracks are sometimes pres ent, especially where the skin is sub jected to much movement, as near the joints.
One of the most prominent and impor tant symptoms is itching of the part af fected; it is never entirely absent, and in some cases intolerably severe, but in the acute stage is often replaced by a burning sensation; it may precede any visible sign of the disease, and may per sist after the skin has resumed its nat ural appearance. The scratching which it occasions always aggravates the dis ease, and is often very difficult to pre vent. Except in extensive acute attacks, there is no fever and very little consti tutional disturbance. The disease is not contagious. When cured it leaves no scar.
Causes of Eczema. — In many cases it is very difficult, perhaps impossible, to assign a definite cause for an attack. Generally speaking, however, the con stitutional or predisposing cause is some defect in the digestion or assimilation of the food; strumous and gouty individ uals are particularly subject to the dis ease. The local or exciting cause may
be anything whatever which irritates the skin.
Treatment.—There is no specific for eczema; different cases and different stages of the disease require widely dif ferent management, and each must be considered and treated on its own merits. The diet must be nutritious, but as simple and unirritating as possible; di gestion may require aid from medicines; the bowels should be regularly evacuated, by aperients if necessary; a gouty or strumous tendency if present must be counteracted. The use of soap on the part affected must be discontinued, and strained oatmeal gruel, or rice water, or white of egg with boiled water, used for cleansing purposes, but even these as seldom as possible. Thorough removal of scales and crusts by these means, or by oil, or simple bread poultices, is the necessary preliminary to satisfactory local treatment. In the acute stage, where the swelling is great or the dis charge profuse, a sedative lotion applied on rags or lint and kept moist by a waterproof covering, is generally most useful—e.g., thin starch or gruel, with a teaspoonful of boracic acid to the pint, soft water with a similar proportion of baking-soda, or dilute lead lotion. In the later stages, when the skin is moist, soothing ointments are preferable—e.g., zinc ointments, zinc and boracic oint ments mixed in equal parts, or cold cream. The ointment should be evenly spread on linen rag, and kept in close contact with the affected skin.