ECZEMA.—Gr., to boil over.
Definition.—Eezema may either be an acute, subacute, or chronic inflammatory disease of the skin, usually characterized in its earliest stages by the appearances of erythema, papules, vesicles, or pustules, or a combination of two or more of these lesions. It is attended with a variable degree of thickening and infiltration of the cutaneous tissues, terminating either in discharge with tbe formation of crusts or in absorption or in desquamation.
Varieties.—The primary, or element ary, varieties are the erythematous, papu lar, vesicular, and pustular; or the first outbreak may show a mixture of these ' several types. In many cases the begin ning lesions or type soon lose their char acters and the disease develops into the common clinical varieties: eczema ru brum or eczema squamosum. Other clinical or secondary types met with are eczema flssum, eczema sclerosum, and eczema verrucosnm.
Symptoms.—The erythematous type of eczema—also called eczema erythema tosum—is most frequently seen upon the face, although it may make its appear ance upon any other region or may be more or less general. It begins as a single hypermmic area, or several areas may appear simultaneously, usually upon one region. The areas may be small or large, irregularly outlined, ill defined, and attended with slight or con siderable swelling and even cedema. There is more or less itching- and burn ing. The eruption soon becomes pro nounced, the parts reddened, somewhat thickened, and here and there a little scaly. There may also be, here and there (as a result of rubbing or scratching, or spontaneously) a tendency to serous ooz ing. The affected skin is harsh, dry, and reddish or violaceous in color. It often persists in this form, and the skin may become considerably thickened and in filtrated. The swelling and cedema which are often first present may sub side, to a great extent at least, or these symptoms may reappear from time to time whenever there is an acute exacer bation. The parts may become quite scaly. and constitute a mild or well marked scaly eczema: eczema squamo sum. Occasionally, as a result of con stant irritation, rubbing, and scratching, or from other causes, the parts become moist, markedly inflamed, with more or less crusting, constituting eczema ru brum.
The papular type of the disease, or ec zema papulosum, presents itself as one or more aggregations of closely-set papules, pin-point to pin-head, or slightly larger, in size. The disease may also show itself as more or less discrete papules, with here and there aggregations. In color the lesions are bright- or deep- red or violaceous, with often a few vesicles or pustules interspersed. Itching is usually intense. The extremities, and the parts, especially about the joints, are its favor ite sites. The course of this type is es sentially chronic, some lesions disappear ing and others appearing, and thus per sisting for several months or indefinitely. In some instances, especially- in some areas, the papules become so thickly crowded that a solid patch results, be coming more or less scaly—eczema squamosum. Or at times such a patch may develop into eczema rubrum.
The vesicular type of the disease, or eczema vesiculosum, may show itself on one or more regions, and consists of ag gregated or closely-crowded pin-point to pea-sized vesicles, with here and there discrete lesions, and at times with pap ules .and pustules interspersed. It is usually a markedly-inflammatory type, with considerable cedema and swelling. Solid sheets of eruption may form. The vesicles usually rupture in the course of a few hours or days, new outbreaks oc curring, or a raw weeping, more or less crusted surface resulting. The oozing may be continuous or the process may decline, to remain quiescent or to break forth rapidly with repeated vesicular crops. Considerable thickening may take place and with the oozing and crust ing make up a pictitre of the common clinical type: eczema rubrum. The face and scalp of infants, the neck, flexor sur faces and fingers are the more common sites for the vesicular type. Its course is usually chronic, with several acute ex acerbations, or, as already described, it may pass sooner or later into the com mon clinical type: eczema rubrum.