Eczema

Among the most common as well as perplexing cases of skin disease met with by the dermatologist and general practitioner, eczema justly occupies a prominent place, assuming as it does a multitude of forms, general and local, acute and chronic, and appearing so universally among all classes of society, the rich as well as the poor, the ignorant and the well educated, and arising from the most varied causes.

An accurate and at the same time concise description of eczema is impossible, in view of the fact that the disease presents so many forms and phases, and that of a dozen consecutive cases no two may look alike, or even bear what ordinarily would be termed a family resemblance. These differences are due to the occurrence of lesions which may be quite dissimilar in character and appearance and combined in ways and proportions almost without number. The aspect, too, of the individual lesions varies somewhat with the location they occupy, the degree of activity they present, and the length of time they have lasted.


The varieties of eczema dependent on the primitive or characteristic lesion are six in number - namely, erythematous, vesicular, pustular, nudose, papular, and fissured; and these in their progress may undergo changes and become complicated with or give place to certain secondary lesions.

The varieties of eczema dependent on the activity of the process may be classed as acute and subacute, while those that run but a short course may also be termed acute, and those of longer duration chronic.

Location greatly influences the appearances presented by eczematous lesions, and the principal modifications met with in this connection are those seen on the scalp, face, hands and feet, genitals, and about the anus. Eczema may also invade the follicular apparatus of the skin, and give rise to an eczematous affection of the hair-follicles and of the sebaceous glands.


We will best understand the appearances presented by this protein malady if we trace the course of a simple acute eczema of the general surface. It commences with a local congestion, or erythema, followed in a few hours, perhaps, by a crop of minute, closely aggregated vesicles filled with a clear, transparent serum. It often takes a sharp eye, and even a lens, to distinguish their separate contours. When closely examined, we find them to consist of a very thin and delicate epidermic covering, which for a brief period retains the lymphy exudation that is seeking an exit. Rubbing, scratching, or other violence from without, or the pressure of the exudation from within, soon ruplures the epidermis, and usually in twenty-four or thirty-six hours the vesicles have disappeared, and we find in their place a red and exposed surface more or less moist with exudation. If exposed to the air, the watery portions of the exudation evaporate and light, straw-colored crusts remain. As the exudation continues, the crusts thicken until they drop off, or are purposely removed. After a varying period (days or weeks, as the case may be) the exudation diminishes, the crusts lessen or cease to form, and nature makes an attempt to cover the part with a new layer of horny epithelial cells. It may be weeks before this effort is entirely successful, and the affected surface presents in the interval a reddened and somewhat glossy surface scantily covered with loosely attached scales of small size, the scales being composed of embryonic horny cells which have not yet attained a normal character and consistence. Those first formed are less visible than the normal cell, and are quickly shed, to be replaced by others of more natural character and aspect, until finally we find a complete regeneration of the epidermis, and a return to the condition which existed before the appearance of the attack. In eczema pure and simple we never have ulceration or loss of tissue, and recovery takes place without the least trace of scarring.

For practical convenience the course described above may be divided into three stages; the first being that of congestion and vesicle formation, the second that of exudation and crusting, and the third that of dryness and scaling.