The term "varicose eczema", although made acceptable by its use, is ambiguous and misleading. It would prompt us to believe that varicose eczema is different from common dermatological eczema. There is no such difference, and it would be more correct to speak of eczema of the varicose patient. The development of eczema in the case of a varicose patient may:--either develop in the case of a varicose patient who does not normally suffer from eczematous dermatosis; in this case static dermatitis represents a point of local reference for an eczematous crisis triggered off by a general factor and finding there a zone of reduced resistance;--or develop in the case of a known habitual eczematic. In this case, venous stasis increases and maintains and eczema. In both cases no local dermatological treatment will be able to cure the eczema, which will develop into a critical condition often provoking the development of a leg ulcer, and will necessitate the suppression of the venous counter-current. To try and understand the pathological mechanism of "varicose eczema", we have to remember the rudiments of the physiology of the cutaneous barrier, familiar to dermatologists but less so to phlebologists, and also some elements of the physiopathology of venous insufficiency, and in particular the tissular elements following the pattern explained by Comel's Italian school, by the term "histo-angiological decompensation". The circulatory unit "arteries-capillaries-veins-lymphatic-vessels-tissues" form an ensemble which has to be taken into account, as any disorders in any one of these elements reacts on all the others. These elementary rudiments lead us to understand the importance of an integral aetiopathogenic picture of varicose eczema, and the importance of the multidisciplinary collaboration between phlebologists and dermatologists in order to treat this affection, the border-line of our two specialities.
“静脉曲张性湿疹”这一术语,尽管因常用而被认可,但却含混不清且具有误导性。它会使我们认为静脉曲张性湿疹与普通的皮肤湿疹不同。然而并不存在这种差异,将其称为静脉曲张患者的湿疹会更准确。静脉曲张患者发生湿疹的情况可能有:——要么发生在通常不患湿疹性皮炎的静脉曲张患者身上;在这种情况下,静止性皮炎是由一般因素引发的湿疹发作的局部参照点,且该部位抵抗力降低;——要么发生在已知的习惯性湿疹患者身上。在这种情况下,静脉淤血会加剧并维持湿疹。在这两种情况下,局部皮肤治疗都无法治愈湿疹,湿疹会发展成严重状况,常常引发腿部溃疡,这就需要消除静脉逆流。为了试图理解“静脉曲张性湿疹”的病理机制,我们必须记住皮肤屏障生理学的基本原理,皮肤科医生对此较为熟悉,而静脉病专家则了解较少,同时还要记住静脉功能不全的病理生理学的一些要素,特别是按照科梅尔的意大利学派所解释的模式,用“组织血管性失代偿”这一术语来描述的组织要素。循环单元“动脉 - 毛细血管 - 静脉 - 淋巴管 - 组织”构成一个整体,必须予以考虑,因为这些要素中的任何一个出现紊乱都会对其他要素产生影响。这些基本原理使我们明白静脉曲张性湿疹完整病因病理情况的重要性,以及静脉病专家和皮肤科医生为治疗这种处于我们两个专业交界领域的疾病而进行多学科协作的重要性。