Origem: Wikipdia, a enciclopdia livre.
Eczema, tambm chamada de dermatite,[1] se refere a qualquer tipo de inflamao da pele. Os eczemas, em geral, iniciam-se pela aparecimento, superfcie da pele, de vermelhido (eritema) e inchao (edema) da superfcie cutnea. Como consequncia, pode ocorrer um acmulo de lquidos em pequenas vesculas, com prurido das vesculas, um lquido seroso secretado, o que favorece a formao de crosta. Com a progresso do quadro a pele torna-se espessa (liquenificada).[2]
bastante comum na infncia e adolescncia, afetando cerca de um em cada nove jovens (11%-15%), mas provavelmente muitos casos no so diagnosticados.[3] Tambm frequente em profissionais de sades, pessoas responsveis pela limpeza e lactantes. Atinge cerca de 5-10% dos adultos.[4]
Em alguns pases, como a Inglaterra, 15-20% das crianas j foram diagnosticadas com eczema em algum momento e o ndice para adultos semelhante ao nosso (5-10%).[5] Enfermeiras desenvolvem dermatites pelo menos uma vez em 85% dos casos, sendo mais comum nas que lavam as mos frequentemente com lcool gel ou sabo bactericida, pois seu uso regular danifica a pele.[6] Entre profissionais de sade a mdia varia entre 10 e 45%, sendo considerado uma sria doena ocupacional.[7]
Os principais sintomas so:
Os outros sintomas vo depender da origem do eczema. Manchas tambm causam prejuzo significativo na socializao, um problema srio para crianas com dermatites frequentes que so estigmatizadas e excludas do convvio social.
O diagnstico essencialmente clnico e consiste na localizao das leses e dos sintomas levando em conta a idade do doente, o carcter crnico ou agudo da doena e o histrico pessoal ou familiar de alergias. A bipsia cutnea pode ser til no diagnstico diferencial mas raramente necessria.[2]
Os eczemas e dermatites so abordados pelo Dicionrio Internacional de Doenas como sinnimos, e esto no L20 ao L30:[1]
Existem tambm dermatites classificadas em outras partes do CID:[1]
A principal causa a hipersensibilidade, nesse caso sendo chamada de dermatite atpica, que possui fatores hereditrios mas s so ativados por um estmulo que desencadeie a alergia (como leite,[10]camaro ou plen).[11] Podendo ser originada por fatores de ordem interna ou externa, variando de acordo com a resposta imune de cada organismo, ao ambiente em questo.
Pessoas vulnerveis a dermatites frequentemente possuem um defeito na filagrina, uma protena estrutural da pele, fundamental para a manuteno de uma funo barreira normal.[12]
Fatores psicolgicos como estresse excessivo ou situaes traumticas podem desencadear uma dermatite por somatizao. Outras possveis causas incluem fatores hormonais (como a menstruao), a troca do leite materno pelo industrial (uma das principais causas em bebs), pode ser desencadeado por certas vacinas (geralmente na infncia e sem graves consequncias) e pode ocorrer por atrito com certos materiais (fibras sintticas). Pacientes acamados h muito tempo geralmente desenvolvem eczema por no mudarem muito de posio, mantendo as mesmas partes do corpo em contato constante com o tecido.
Uso de cremes com corticoide, como hidrocortisona, recomendado para o tratamento de episdios agudos e hidratao da pele mas no para episdios crnicos pelo risco de repercusses graves quando o tratamento interrompido subitamente.[2] Uma alternativa so os inibidores da calcineurina como pimecrolimus e tacrolimus.[13]
Deve-se, tambm, evitar coar a pele para prevenir agravamento da infeco. A melhor opo procurar um bom dermatologista que indique que quais remdios voc deve usar. Pacincia, acompanhamento mdico e cuidado so muito importantes.
As infeces bacterianas, geralmente por Staphylococcus aureus, devem ser tratadas com antibioterapia sistmica, como cefalosporinas de 1.a gerao ou as penicilinas. A limpeza deve ser feita gentilmente, o banho deve ser rpido e morno e em seguida aplicar um emoliente (creme hidratante) com alta oleosidade.[2]
Anti-histamnicos sedativos podem ser usados para controlar o prurido e coceira, e assim permitir um sono mais revigorante.[14]
Quando as causas envolverem fatores psicolgicos como ansiedade, compulses, transtornos de humor, transtornos somatoformes ou traumas psicolgicos necessrio acompanhamento psicolgico de longo prazo.[15]
No h evidncia que leo de peixe, leo de borragem ou outros, bem como suplementos vitamnicos ou minerais tenham qualquer eficcia teraputica na dermatite alrgica.[14] Alguns dermatologistas tambm podem recomendar fototerapia e ciclosporina ou outros imunossupressores dependendo do caso.
Um alergologista pode fazer testes com diversas substncias para descobrir as causas de crises alrgicas frequentes.
Link:
Eczema Wikipdia, a enciclopdia livre
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