Eczema of the nasal vestibule: causes, symptoms, diagnosis, treatment

Eczema of the nasal vestibule is a very common disease that complicates various infectious rhinitis due to abundant nasal discharge and skin maceration. It is most often observed in people with metabolic disorders, in whom eczema of the nasal vestibule is prone to relapses and chronicity of the process. Microbiota can be polymorphic, depending on the nature of the infection in the nasal cavity or paranasal sinuses.

Pathogenesis of eczema of the nasal vestibule. The pathogenesis is based on polyvalent (less often monovalent) sensitization of the skin, as a result of which it inadequately reacts violently to various exogenous and endogenous effects, which can be defined as a neuroallergic process of myofactorial genesis. As a rule, skin sensitization develops against the background of functional changes in the nervous system that occur under the influence of stressful situations and somatogenic neuroses (liver diseases, gastrointestinal tract, endocrine system). In childhood, eczema is associated with exudative diathesis. Professional factors, as well as genetic predisposition, can play a certain pathogenetic role. A distinction is made between true eczema, the etiology of which is associated with neuroendocrine disorders, microbial eczema (typical for eczema of the nasal vestibule), seborrheic and professional eczema.

Pathological anatomy: hyperemia of the skin of the entrance to the nose, the appearance of small vesicles from which serous fluid is released, causing maceration of the skin and its inflammation. When the vesicles open, small ulcers appear. After a few days (second phase), the vesicles dry up, grayish-yellowish crusts appear. Desquamation of the vestibular epidermis occurs, and cracks appear in the skin. The process can become chronic, depending on the presence of favorable conditions.

The clinical course is determined by the phases of the disease. The first phase is characterized by an acute course: itching, burning sensation, hyperemia of the skin of the nasal vestibule. Touching the affected areas causes pain caused by secondary inflammation. In the chronic stage, the most common, subjective symptoms are characterized by a feeling of compaction of the tissues of the nasal vestibule, dryness and the presence of painful cracks in the area of the transition of the wings of the nose to the base of the entrance to the nose.

Complications are caused by superinfection, which can manifest as impetigo, furunculosis and erysipelas of the nose and adjacent areas of the face.

Treatment of eczema of the nasal vestibule is very difficult and long. First of all, it is necessary to eliminate local causes of eczema, such as chronic rhinorrhea, inflammation of the paranasal sinuses, allergic processes in the PNS. Conduct appropriate treatment for concomitant diseases and normalize the function of the central nervous system. Prescribe antihistamines and sedatives, often "minor" tranquilizers give an effect. The diet during exacerbations is mainly dairy and vegetable. In acute phenomena, accompanied by swelling and oozing - diuretics, calcium preparations, ascorbic acid and rutin. Locally - lotions of boric acid, ethacridine lactate (rivanol), furacilin, etc. After acute symptoms have been eliminated, pastes are used (2-5% boric-naphthalan, boric-tar, zinc, etc.), then ointments (sulfur, naphthalan tar - if eczema spreads to adjacent areas of the face). With pronounced infiltration and lichenification - UHF. For widespread forms with persistent course, corticosteroids are prescribed per os.

The prognosis for true eczema regarding final recovery is questionable, since any stressful situation of psychogenic or somatogenic nature leads to a relapse of the disease. At the same time, other forms of eczema can be completely cured with rational treatment.

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