IMPETIGO IIERPETIFOR3IIS OF HEBRA, which was at first regarded by Duhring as merely a variety of D. herpetiformis, is now conceded by him to be a distinct disease. Its lesions are always pustular. It nearly always occurs in pregnant women, or during the puerperal period; is attended by symptoms of grave con stitutional involvement, and generally terminates fatally. In some cases, pro longed observation will be necessary to make a definite diagnosis.
The value of the new diagnostic sign between pemphigus and dermatitis her petiforrnis first formulated by Leredde and Perrin confirmed. This consists in the simultaneous presence, in the latter disease, of eosinophile-cells in the blood and in the serum of the bullae. In two eases examined at intervals of fifteen days the eosinophile-lencocytes and granules were found in abundance. On the contrary, in an instance of pem phigus foliaceus the eosinophile-cells were entirely absent from the blood and serum on the first and second examina tions; also at an interval of fifteen days; in the blood only were found a. very few eosinophile-leucocytes con taining well-stained eosinophile-gran ules. IIallopeau and Lafitte (Ann. de Derm. et de Syph., Dec., '96).
Case resembling pemphigus and der matitis herpetiformis, though a history of recent illicit intercourse seems tor a time to have raised a suspicion, ap parently erroneously, of syphilis. It occurred in a lad of 21, depressed and slightly feverish, with a profuse billions eruption, discrete anti Ns-ell formed, on i the lower limbs, but sparingly on the trunk, present also on the MUCOUS membrane of the mouth. Itching was marked. In the course of two or three months the entire body became attacked. With this there was a dark-brown pig mentation anti a disagreeable odor, and the temperature was continuously above 101.5° F. No examination for eosino piffles was made. Biddle (Jour. Cutan. and Genito-Urin. Dis., ...\1ay. '97).
Prognosis.—The prognosis, so far as life is concerned, is usually favorable, but the disease is generally chronic in dura tion, and has a marked tendency to recur.
Duhring has reported cases lasting thir teen and fourteen years.
Treatment.—The treatment of derma titis herpetiformis is far from satisfac tory. In some cases the lesions yield promptly to local applications, while in others, as Duhring states, the lesions de velop, relapse, and recur from time to time in spite of the most varied measures employed. The internal treatment should be directed toward the improve ment of the general health, and the ascer tainment and removal, if possible, of dis ease or disorder of the stomach, intes tines, or kidneys. The apparent close connection of the nervous system with the etiology of the disease would lead one to expect benefit from neurotic remedies, such as arsenic, phosphorus, -and strych nine. Unfortunately, neither of these can be relied upon in all cases, though some show distinct improvement after the use of the first named.
Cannabis Indica, chloral, opium, and antipyrine have been tried as sedatives and anodynes; but little benefit can be expected from them.
Local applications likewise are often disappointing. Dr. Duhring has had most success—in the vesicular, bullous, and pustular forms—from a strong sul phur ointment, 2 drachms to the ounce, applied with sufficient friction to rupt ure the lesions. In the erythematous form soothing applications are indicated.
Tar, in the form of liquor picis alkalinus, 1 drachm to 8 ounces of water, or liquor carbonis detergens of the same strength may be used with benefit in some cases. They relieve the itching, but have ap parently little influence upon the prog ress or duration of the eruption. A 2 per-cent. ointment of cocaine is also of value as a local anodyne when the burn ing and itching are severe.
Ichthyol, resorcin, carbolic acid, sali cylic acid, and thiol have been used, but without much success. A hot bath be fore retiring sometimes gives grateful re lief from the subjective symptoms.