Location of an eczema

The location of an eczema greatly influences its appear­ance, and exhibits also preference for certain varieties of lesion. Thus, in eczema of the scalp, especially in infants and children, the process is usually acute, with profuse lymphy or purulent exudation, which mats the hair together in a tangled mass, offensive to both sight and smell. If by chance pediculi find lodgment in such a scalp, they multiply rapidly, and by their irritation increase and aggravate the trouble. If proper care and cleanliness are not prac­tised, the scalp may become a mere mass of animated filth.

When eczema attacks the scalp in children, it frequently extends to the face, and presents an active form of inflammation of the vesicular, pustular, or nudose type, accompanied with a good deal of heat and pruritus. If it extends behind the ears, fissures may form.

In adults, eczema of the scalp is usually of the subacute form, without much exudation; and on the face it may be of the erythematous type, without other lesion.

When the palmar and planar surfaces are attacked by eczema, we may have a purely erythematous lesion, characterized by a red, dry, and glossy surface, on which the natural skin lines/ are greatly exaggerated as to size and distinctness, and many lines appear which are not noticeable in the normal condition. In addition fissures may form, accompanied with slight exudation. This type of the disease is the most common, and is usually subacute and chronic. On the other hand, we may have an acute eczema of the hands and feet, accompanied with vesicle formation. In consequence of the thickness of the horny epidermis on those parts, the vesicles do not easily rupture, but instead retain their integrity, and even become larger, and remain as vesicles until absorption of the contents occurs, when what was the summit of the vesicle separates as a small scale.

The penis and scrotum usually exhibit the erythematous variety, vesicle and scale formation being rarely met with.

The inner aspect of the thighs and legs is the favorite location of the papular form, although it may be met with on almost any part of the body, and even on the face.


On the lower extremities below the knees eczema is frequently encountered as a direct result of varicose veins, and, if these latter have given rise to ulcers, a broad and diffuse zone of erythematous eczema will almost always surround them, with scattered patches on the neighboring parts.

Eczema about the anus is frequently marked by radiating fissures of greater or less depth.

Eczema may extend from the skin proper down into the follicular openings, especially those of the face and other hairy parts, except the scalp. In these cases the surface eczema may play a very secondary part. On the one hand, we may have the hair-follicles especially involved. When this appears, the general surface of the patch will be found red, and either dry or exuding, but the inflammation having invaded the lining membrane of the follicles, they will be found swollen and loosened. Slight traction on the hair will extract it, accompanied with its root-sheaths. Frequently the exudation which forms within the follicle comes to the surface, and lifts the epidermis surrounding the hair, and forms a pustule (rarely a vesicle) pierced through the center by the hair. This deep-seated inflammation sometimes results in extension of the action beyond the proper outline of the follicle, and nodules form. This condition must be distinguished from sycosis, with nodules, etc., resulting from parasitic invasion.

The sebaceous glands may also become the seat of eczematous inflammation, either with or without marked participation of the surface. Under the stimulus of the eczema the glands exhibit increased functional activity, and the eczematous exudation when present becomes mixed with the increased sebaceous secretion, and, instead of a purely lymphy or purulent exudate, we have some thin sebum mingled with it, which usually dries into greasy scales or crusts.


When an eczema persists for any great length of time, and becomes chronic, we find additional features that are important both as regards description and treatment. The chief of these is infiltration. The skin is still red, but usually dry, and appears to possess double or treble its natural thickness, and the patch is very appreciably raised above the surrounding surface.

Dr. Taylor reports three cases of malaria accompanied by an eczematous eruption, both making their appearance simultaneously; under proper treatment both conditions were relieved, the remedies given relieving both conditions.

Dr. Stettler reports an interesting case of vulvar eczema as a sequel of the climacteric period.

The extreme prevalence of eczema makes its correct and certain diagnosis of the first importance; and, if the rules laid down in the general chapter be closely followed, there need not, in the great majority of cases, be any very great difficulty. The history of the attack, the frequently multiple lesions, and their progress as observed or, as related by the patient, should not leave the physician long in doubt.

It is important, however, to distinguish a dry scaly eczema of the scalp in children from a condition sometimes presenting very similar appearances, but due to an entirely different cause - namely, the vegetable parasite, tricophyton, which is the etiological factor of ringworm. In cases of doubt the microscope will decide by revealing the presence of the fungus. In like manner eczema of the hair-follicles of the face must be carefully distinguished from ringworm of the same parts, to which the name of barbers itch is commonly given.

Eczema sometimes resembles psoriasis, and psoriasis sometimes resembles eczema; or, again, we may have an eruption which no one would be justified in pronouncing either one or the other from the appearance only. Usually the history will enable us to decide. On the hands and feet we may have appearances which may present difficulties in diagnosis between eczema, psoriasis, and syphilis.

Lastly, we have known a lichen planus to be mistaken for a papular eczema even by gentlemen well versed in cutaneous diagnosis.