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Acute eczema
Last reviewed: 05.07.2025
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[ Causes and pathogenesis of acute eczema
There are many causes of acute eczema. These include contact hypersensitivity to specific plant allergens such as poison ivy, oak, and other allergens. Nickel, topical medications such as bacitracin, neomycin, and benzocaine fragrances, preservatives in personal care products, and organic substances in supplements are also common causes of acute eczematous inflammation. Irritant dermatitis usually occurs after repeated contact with water, solutions, or solvents. In the so-called "id" reaction, acute eczema with vesicles occurs at a site remote from the active fungal infection (such as the palms and soles). Stasis dermatitis, scabies, irritant reactions, and dyshidrotic and atopic eczemas can present as acute eczematous inflammation.
Symptoms of Acute Eczema
Clinical symptoms of acute eczema include erythema, swelling, vesiculation, and oozing. Inflammation is moderate to severe. Small, clear, fluid-filled vesicles appear on the skin surface. Bullae may develop. If triggers are avoided, the rash improves in 7 to 10 days, and the skin is completely clear by the third week. Excoriation predisposes to infection and causes accumulation of serous fluid, crusts, and pus. Secondary staphylococcal infection may result from excoriation, as well as worsening and prolongation of the dermatitis.
Laboratory diagnostics of acute eczema
A patch test should be performed to assess for delayed-type hypersensitivity if the location of the eczema suggests contact, if the condition is recurrent and refractory to treatment, or if there is known exposure to skin allergens at work or in other habitual activities.
Treatment of acute eczema
Cool, moist dressings and topical steroid creams help to constrict the skin vessels, suppress inflammation and itching. A clean cloth is moistened with cool water or Burow's solution and placed on the affected area for 30 minutes. An appropriate steroid cream (Group II or III) is then rubbed in thoroughly. Systemic corticosteroids are used only in cases of severe or generalized eczema. The initial dosage is approximately 1 mg/kg/day, tapered over 3 weeks. Too short a course of treatment may cause relapse or resonance effects. First-generation systemic antihistamines can relieve itching in acute eczema, and their sedative effect may improve sleep. In secondary infections, an antibiotic against Staphylococcus aureus (eg, cephalexin) is prescribed for 10 to 14 days.