Dermatitis Exfoliativa. Definition.—Inflammation of the skin, acute or chronic, accompanied by exfolia tion of the epidermis.
Varieties. — (A) Acute exfoliative dermatitis of infants.
(B) Chronic general exfoliative derma titis.
(C) Local exfoliative dermatitis.
(D) Epidemic exfoliative dermatitis. (A) Acute Exfoliative Dermatitis of Infants.
Definition. — An acute inflammatory affection of the skin of infants, accom panied by exfoliation of the epidermis in flakes, running a rapid course, and in most cases ending fatally.
Symptoms.—The disease was first de scribed by- Prof. Ritter von Rittershain, of Vienna. He had observed nearly three hundred cases in the course of ten years.
The children attacked were nearly all between 2 and 5 weeks old. A pro dromal stage, characterized by abnormal dryness of the integument, with furfu raceous epidermal desquamation, usually occurred. The skin of the lower part of the face, especially about the angles of the mouth, becomes red and slightly tumid. The margin of the redness, which rapidly spreads, is indistinct, not being sharply defined against the healthy skin. The skin at the angles of the mouth becomes fissured and covered with scabs. The mucous membrane lining the pharynx and buccal cavity is reddened, and the palatal arch is the seat of super ficial erosions, covered by a grayish-white exudation.
The appetite and digestion remain un impaired. There is no fever. The red ness and thickening of the skin extend over the entire body. The face becomes covered by yellowish, translucent scabs upon a reddened base, intersected in vari ous directions by fissures. The skin be comes wrinkled, and the upper layer sep arates from the cutis. The epidermis may be detached in large flakes or in scales. This process, continuing until the entire surface is denuded of epi dermis, presents an appearance similar to that following an extensive scalding. In favorable cases the dark, raw-flesh color of the cutis soon gives way to a lighter red, and in some cases the normal color of the skin is restored in twenty-four to thirty-six hours. In unfavorable cases, on the other hand, the color is a dirty brownish-red, and the cutis becomes dry and parchment-like. In those cases
which terminate in recovery, the normal condition is entirely re-established in a week or ten days, the skin for a few days being covered by a fine, branny desqua mation.
As sequels, eczemas of considerable ex tent, or small, superficial boils and ab scesses, sometimes in large numbers, oc cur, and delay recovery. At other times extensive phlegmonous infiltrations oc cupy considerable tracts of skin, and may result in gangrenous destruction of sue and death. In the latter conditions pneumonia and colliquative diarrhoea not rarely precede the fatal termination. Re lapses are rare. The disease is ascribed to a septic or pus infection localized upon the skin.
Diagnosis.—In typical cases, no diffi culty should occur in diagnosis. sipelas, which sometimes closely resem bles this disease, is easily excluded by the high temperature of the former. In pemphigus there are distinct bullm sepa rated by normal skin. In exfoliative dermatitis the redness and thickening are progressive and finally occupy the entire surface.
Case of dermatitis exfoliativa pig mentosa in which the disease bore a close resemblance to the pityriasis rubra of Devergie, with the exception of the pigmentation, which was very intense.
Henry Handford (Brit. Jour. of Derin., Mar., '94).
Prognosis.—This is decidedly unfa vorable. In Rittershain's cases the mor tality was about 50 per cent.
Treatment.—No internal treatment is indicated in uncomplicated cases. Suffi cient nourishment is, of course, impor tant. Locally, cool baths, or bran-baths, afterward drying the skin with fine, soft cloths and carefully avoiding friction, will meet the indications in most cases. Ragged and loose patches of epidermis should be clipped off with scissors, and all denuded and fissured surfaces dusted with finely-powdered calomel. The crusts which accumulate at the angle of the mouth and render nursing difficult and painful are best got rid of by soak ing with oil of sweet almonds and care fully removing the loose ones by means of dressing-forceps. Slightly astringent baths (decoction of oak-bark, 1 pint to the bath) are sometimes beneficial.