Causes and treatment of scleredema in children

Newborn babies are weak and have insufficient resistance to external factors. Scleredema in children can easily be caused by cold, premature birth, infection, suffocation and other reasons. Scleredema is more common in the cold winter and spring seasons, but it can also occur in the summer if it is caused by premature birth or infection. Here I will introduce you to scleredema in children. Hope that helps.

Relationship with Western Medical Disease Names

Western medicine calls scleredema neonatorum.

Causes

Newborn babies have immature yin and yang bodies, especially twins and premature babies, whose congenital endowment is insufficient. The weak yang is the internal cause of the disease. Improper care and warming after birth lead to exposure to cold pathogens, which are the main external causes of the disease. Some children also become ill due to exposure to warm pathogens. The organs affected by scleredema are the spleen and kidneys.

Pathogenesis

1. Cold causes blood stasis. Cold is a Yin evil that is most likely to damage human Yang. Children with congenital deficiencies who are affected by cold will directly attack the internal organs and damage the Yang of the spleen and kidneys. Or they may be affected by other diseases after birth, which will cause the Yang to become weak, leading to the stagnation of cold evil, Qi stagnation and blood stasis, which will cause illness.

2. When Yang Qi is weak and Spleen Yang is not active, water and dampness will stagnate inside the body, resulting in edema. Cold will invade the skin, causing lung Qi to fail to flow, skin disorder, and worsening of skin swelling. When kidney yang is deficient, yang energy cannot warm the skin and flow to the extremities, resulting in cold body and numb limbs. Yang deficiency leads to coldness, and coldness leads to qi stagnation and blood stasis, causing the skin to become stiff and dark purple. In severe cases, blood does not flow through the meridians and overflows. When Yang Qi is extremely deficient and the vital energy is insufficient, it causes the Yang Qi to decline and die. The patient may have weak breath, cold body and a tenuous pulse.

Clinical diagnosis

Diagnostic points

(1) Medical history: in cold seasons, with low ambient temperature or a history of improper warming; history of severe infection; premature babies or small-for-term babies; insufficient intake or low energy supply caused by asphyxia, birth trauma, etc.

(2) Clinical manifestations include poor breastfeeding, low crying, and slow response in the early stage. As the disease worsens, the body temperature is <35°C, and in severe cases it is <30°C. The axillary temperature-rectal temperature difference changes from positive to negative. Hypothermia does not occur in patients with infection or those who develop the disease in summer. The hard swelling is symmetrical, affecting the lower limbs, buttocks, cheeks, upper limbs, back, abdomen, chest, etc. In severe cases, the limbs are stiff and cannot move. Multiple organ dysfunction.

Differential Diagnosis

(1) Scleroderma can be easily confused with scleredema in the early stages, but scleroderma has a history of Raynaud's phenomenon and atrophic skin changes. in addition. Scleredema rarely affects the hands and feet, and does not cause atrophy, pigmentation, and capillary dilation, so it can be identified by combining pathological changes.

(2) Dermatomyositis is sometimes difficult to distinguish from scleredema at onset, but the former has elevated serum myocardial enzymes, electromyographic changes, and inflammatory pathological changes in the muscles, which can be distinguished from scleredema.

Dialectical treatment

Dialectical points

This disease can be divided into mild and severe cases, which are mainly distinguished by the child's body temperature, the location of the swelling, and the area of ​​the swelling. If the general reaction is acceptable, the body temperature is normal or not elevated, the swelling is mainly in the lower limbs and cheeks, and the swelling area is <50%, it is a mild case; if the reaction is poor, the body temperature does not rise, the swelling involves the limbs, buttocks, cheeks and the whole body, and the area is >50%, it is a severe case. Mild cases are mostly due to cold stagnation and blood stasis syndrome, and severe cases are mostly due to Yang Qi deficiency syndrome. The mortality rate of severe cases is high.

In clinical practice, it is still necessary to distinguish the severity of deficiency, cold, and blood stasis. Severe cases in which the child is cold all over, lies stiffly, moves little, and has extremely poor reactions are mostly due to deficiency; mild cases in which the child has acceptable reactions, but the whole body is cold, the limbs are cold, and the skin is swollen and hard, are mostly due to cold. Both syndromes have blood stasis to varying degrees.

Treatment principles

The treatment principle of scleredema is to invigorate qi and moderate the disease, promote blood circulation and remove blood stasis. For those with yang deficiency, the spleen and kidney should be warmed and tonified; for those with severe cold, the cold should be dispelled and yang should be promoted; for those with blood stasis, qi should be promoted and blood circulation should be activated. At the same time, combined with rewarming, external application of Chinese medicine and other methods, the therapeutic effect can be enhanced.

Syndrome and Treatment Classification

(1) Cold stagnation and blood stasis

Symptoms: The whole body is cold, the limbs are cold, the reaction is normal, the crying is low, the skin is hard and swollen, and it is difficult to pinch. The swelling is mostly limited to the buttocks, calves, arms, cheeks, etc., and the color is dark red, cyanotic, or red and swollen like frostbite. Fingerprints are dark purple.

Analysis: This syndrome is a mild symptom, which is caused by a weak child suffering from a cold. The child is deficient in Yang Qi and suffers from an external cold, so the whole body is cold and the limbs are cold. The cold causes Qi stagnation and blood stasis, resulting in dark red and purple skin.

Treatment method: Warm the meridians and dispel cold, promote blood circulation and dredge collaterals.

Prescription: Danggui Sini Decoction with modifications.

Commonly used medicines: Angelica sinensis, Salvia miltiorrhiza, Ligusticum chuanxiong, peach kernel, safflower, white peony root, cinnamon twig, and asarum.

(2) Deficiency of Yang Qi

Symptoms: Cold body, lying stiffly and moving little, extremely poor reaction, weak breathing, low and timid crying, difficulty sucking, pale face, hard and swollen skin, the whole body is affected, dark red skin, little or no urine. The lips and tongue are pale in color, and fingerprints are pale red and not noticeable.

Analysis: This syndrome is mostly severe. If Yang Qi is weak, the whole body will be cold and stiff. If Yang Qi is deficient and the meridians are not functioning well, the complexion will be pale and the skin will be hard and swollen.

Treatment method: Invigorate Qi and warm Yang, harmonize Qi and blood.

Prescription: Ginseng and Aconite Decoction with added ingredients.

Commonly used medicines: ginseng, astragalus, processed aconite, Morinda officinalis, cinnamon twig, salvia miltiorrhiza, and angelica.

Other treatments

Chinese medicine

(1) Add compound danshen injection to 20 mL of 10% glucose injection and drip intravenously. Take once a day, 7-15 days as a course of treatment. For various types of evidence

(2) Ligustrazine hydrochloride injection: 10 mL/kg per day, with a maximum of 20 mL. Add 100 mL of 100k glucose injection and drip intravenously. Take once a day, 10 days as a course of treatment. Used for various types of evidence.

External Therapy

(1) 30g each of green onion, ginger and fermented black beans. Mash and mix well, stir-fry with wine, and apply hot compress to the affected area. Used for syndrome of cold stagnation and blood astringency.

(2) 15g each of Chinese angelica, safflower, Chuanxiong, red peony root, and radix polygoni lobatae; 9g of cloves; 7.5g each of Chuanwu, Caowu, frankincense, and myrrh; and 6g of cinnamon bark. Grind into powder, add 100g lanolin and 900g vaseline, mix well into a paste. Apply the ointment evenly on the gauze, warm it, and apply it to the affected area. Once a day. Used for Yang Qi deficiency syndrome.

Rewarming therapy

Rewarming is one of the important measures to treat this disease, and there are many methods. For mild cases, place the patient at room temperature of 26-28 degrees Celsius with a hot water bottle to gradually warm him up. For severe cases, place the patient at room temperature of 26-28 degrees first, then place the patient in a warm box at 28 degrees after 1 hour. Increase the temperature of the box by 1 degree every hour to 30-32 degrees, so that the skin temperature reaches about 36 degrees. You can also use various other warming and rewarming methods according to local conditions to restore body temperature to normal within 12-24 hours.

Acupuncture

(1) Acupuncture at Guanyuan, Qihai and Zusanli points. Add moxibustion after acupuncture.

(2) Moxibustion: Use moxa sticks to warm the area.

Outcome

The prognosis of severe cases of this disease is poor. Pneumonia and sepsis may occur during the course of the disease. In severe cases, pulmonary hemorrhage is often present, leading to death.

Preventive care

prevention

Take good care of pregnant women and try to avoid premature birth, birth injuries and asphyxiation. In cold seasons, keep newborns warm and adjust the temperature in the delivery room to around 20 degrees. Pay special attention to keeping premature and low-birth-weight babies warm.

Nursing

Pay attention to disinfection and isolation to prevent cross infection. The child's clothes, bedding and diapers should be clean, soft and dry. The sleeping position should be changed frequently to prevent complications. For newborns with poor sucking ability, milk can be dripped through a dropper, and nasogastric feeding or intravenous glucose injection or plasma can be used when necessary.

The above is the introduction to scleredema in children. "The Golden Mirror of the Medical Ancestral. Volume 55. Miscellaneous Symptoms" records: "The five hardnesses are: when tilting the head back to breathe, it is difficult to move; there is congestion and pain in the chest and diaphragm; the palms and soles of the feet are cold and hard; all of these are caused by the failure of Yang Qi to flow to the four extremities and are the most difficult to treat." I hope this helps. I wish you a speedy recovery.