The pustular variety of eczema, or ec zema pustulosum or impetiginosum, is less frequently met with than the other varieties of the disease. Its common site is the scalp, especially in infants. It may develop from the vesicular variety, or, as more commonly the case, begin as closely-set pin-point to pin-head, or larger sized pustules; or a mixture of vesicles and pustules may be noticed. In symptomatology it is similar to eczema vcsiculosum, except that the lesions, in stead of containing serum, contain pus. As in the vesicular type, the same dis position to the rupture of the pustules is observed, and there is often a tendency to develop into the type known as eczema rubrum. 3Iore or less crusting is usually a conspicuous feature. The ill-nourished and strumous persons are its most com mon subjects. The type is essentially chronic.
The squamous type of eczema, or ec zema squamosom, is a clinical variety frequently met with, characterized by redness, infiltration, and more or less scaliness, with, especially when about the joints, more or less fissuring. The itch ing is variable, sometimes intense, and at other times slight. This variety is usually a development from the ery thematous or papular types, and, like other types of the disease, is persistent and chronic.
Eczema ruhrum, the Oozing type of eczema, or somewhat dry, raw-looking type of eczema, usually results from a pre-existing vesicular or pustular eczema. It is characterized by a red, weeping, ooz ing, raw-looking surface, with more or less infiltration of the cutaneous tissues. In some cases there is a combination of weeping raw surface with crusted areas. In other cases the weeping nature of the disease is a conspicuous feature, crusting scarcely having time to form: eczema madidans. Its most frequent sites are the face and scalp of children and the legs of adults; in the latter in those espe cially advancing in years. In these cases of eczema of the lower legs varicose veins are often present as a, precursory and concomitant condition. It is essentially chronic, showing little, if any, disposi tion to disappear spontaneously, al though it may be somewhat variable. The degree of inflammation varies from time to time.
The fissured type of eczema, or eczema fissum or eczema rimosum, is that type of eczema in which cracking or fissuring of the skin is the most conspicuous feature. It is common about the joints, especially about the fingers, and in most cases is a part of an apparently slight erythema tous eczema. Fissuring may occur in any type of the disease, especially when about the joints; but in most cases it is but slight in character. It is a persistent
type of the disease, usually disappearing in part or more or less completely in warm weather. ...A. somewhat analogous or allied variety of eczema is the so-called crackled eczema. This is usually a mild subacute erythematous eczema, involving large regions or the entire surface, numerous superficial cracks through the upper epiderm showing over the fissured surface.
Eczema sclerosum and eczema verru cosum are somewhat rare varieties of the disease. These types are usually seen about the ankles, lower leg, or feet. They commonly result from a pre-existing papular eczema. In inany respects these types are analogous in their symptom atology: there is considerable thickening and board-like hardness, with, as a rule, much infiltration, but with the inflam matory element slight or comparatively so. The surface is rough, hard, and somewhat horny to the feel, and in the verrucous variety there is added to these several symptoms a variable degree of papillary hypertrophy-, tbe surface hav ing a distinctly-warty appearance. Both types are essentially chronic and rebell ious to treatment, demanding the strong est application.
Infantile disease is common in infants and young children. It is unusual, comparatively speaking, in children past the age of G. Even in those cases in which thc disease begins in the first or second year and is persistent, it tends to decline spontaneously toward the age of 5 or 6, or even earlier; or at least at this period it will usually respond rapidly to any mild or indifferent appli cation. The disease presents no special characteristics in the young, except that in the majority of such cases the inflam matory element is apt to be more marked. In by far the larger proportion of cases the face or the face and scalp are the seat of the disease; eczema of the region of the genitalia and anal cleft is also not infrequent.
All cases of infantile eczema will usually do well under treatment, al though a disposition in many cases is shown toward relapse till the age of 4 to 6 is reached.
In eczema in infants and young chil dren occurring about the legs and arms, usually as a vcsico-papular or papular eruption, discrete and patchy, the dis ease is often obstinate,—much more so, as a rule, than in those cases where the disease is limited to the face or face and scalp. The vesicular, vesicular-papular, and moist or crusted inflammatory type —eczema rubrum—seem most frequent in the young.