Acute Eczema
Eczema is an inflammatory skin condition with many causes and varying manifestations. It is synonymous with “dermatitis.” In the acute phase, direct contact with an endogenous or exogenous irritant or allergen results in a vesicular eruption with associat
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Acute Eczema Sarah Shaffer and Colleen K. Stockdale
43.1 Introduction
43.3 Clinical Presentation
Eczema is an inflammatory skin condition with many causes and varying manifestations. In the acute phase, direct contact with an endogenous or exogenous irritant or allergen results in a vesicular eruption with associated erythema and localized edema. Stinging, burning, or profound pruritus are commonly described. Vesicles in the genital area are easily unroofed leaving erosions or ulcers.
An acute reaction to an irritant is equivalent to a chemical burn with immediate sensation of burning or stinging preceding the rapid development of vesicles, erythema, and edema in the area of exposure (Fig. 43.1). Acute allergic eruptions occur when the skin is exposed to a substance to which the patient has a previously established hypersensitivity. One notable difference is the lack of immediate symptoms with application of the allergen. Likewise, the development of edema and confluent vesicles may take several days, although these appear in the area of contact (Figs. 43.2 and 43.3). In some cases, linear or geometric erythematous plaques extending away from the eruption can delineate where fingers or
43.2 Pathophysiology Irritants are more common exposures than allergens, but the vulva is particularly susceptible to either. The barrier function of the vulvar skin is ever at risk for compromise by moisture, enzymes, friction, occlusion, and heat. Estrogen deficiency, urinary incontinence, and preexisting dermatoses, among other issues, can further weaken the vulvar skin barrier. Both irritants and allergens can cause an acute eczematous eruption; subtle differences should be noted. Irritants are often associated with hygiene and may include topical medications or native fluids in contact with altered or damaged skin.
S. Shaffer · C. K. Stockdale (*) Department of Obstetrics and Gynecology, University of Iowa, Iowa City, IA, USA e-mail: [email protected]
Fig. 43.1 Acute vulvar eczema. Several scaly lesions are noticed. Courtesy of Professor Jacob Bornstein
© Springer International Publishing AG, part of Springer Nature 2019 J. Bornstein (ed.), Vulvar Disease, https://doi.org/10.1007/978-3-319-61621-6_43
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Fig. 43.2 Perineal and perianal acute eczema. A pruritic lesion composed of plaques and thickened patches. Small blisters were eroded. Courtesy of Dr. Colleen Stockdale
Fig. 43.3 Perineal and perianal acute eczema. A pruritic lesion composed of thickened skin. Excoriations are evident. Courtesy of Dr. Colleen Stockdale
skin folds contacted and spread the allergen (Figs. 43.4 and 43.5). Identification of an allergen can be more difficult with the slow onset of an acute allergic eczematous reaction, which mimics the more indolent onset of other blistering diseases of the vulva. Furthermore, an allergic reaction may manifest at a body site distant from the site of acute contact with a known allergen; this “recall” phenomenon can be quite confusing.
43.4 Treatment The main therapeutic interventi
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