The most efficacious treatment is the creolin bath: about 15 gallons of com fortably-warm water at, 95° F., to which 21/z pints of a I-per-cent. solution of creolin are added. A bath is taken regu larly once a day—in very bad cases twice —remaining in it twenty minutes. It is best given at night, the patient being subsequently dried and put to bed.
Creolin ointment CA, 1, and 2 per cent., rubbed with lanolin and water in almost equal parts) ranks next to ereo lin baths in efficacy, especially if used in quite an early stage. Sari11 (Edin burgh Med. Jour., Apr., '95).
(B) Chronic General Exfoliative Der matitis.
Definition. — A chronic generalized dermatitis, accompanied by constant ex foliation of the epidermis in dry, papery scales: the pityriasis rubra of Hebra.
Symptoms.—The disease begins with the appearance of red patches, gradually increasing in size, uniting with others until finally the entire surface is a sheet of red, dry skin. There is no thickness or infiltration. In about a week the epi dermis begins to scale off in large, thin, white or grayish scales, which soon be come very profuse and shed in large sheets. The skin, at the same time be comes of a dusky- or brownish- red. The inguinal glands also enlarge. Later the skin becomes infiltrated to some extent, and looks tense and shiny in places. The mouth becomes puckered, and the skin of the joints may be fissured and some times moist. There may also be boils or pustules, the hair may fall out, and the nails atrophy and exfoliate. There is often fever at the beginning and at in tervals during the course of the disease. There is little itching. The subjective symptom mostly complained of is a sen sation as if the skin were too small, and the patient frequently is chilly.
The course of the disease is chronic, lasting months or years, with exacerba tions of greater severity, alternating with remissions.
There is usually progressive emacia tion, and the patient dies of inanition, or is carried off by some intercurrent affec tion. Happily the disease is rare.
Case of dermatitis exfoliativa in an infant, which appeared on the tenth day of life and gradually (five weeks) spread over the entire body. It was characterized by diffuse redness, more intense in some places than in others, and by folia,ceous desquamation. Small
vesicles also appeared. The eruption caused itching, but did not interfere with the patient's general condition. There were no lesions in the mouth, and the hair fell in certain spots. Raymond and Ea,rbe (Ee Progres Med., Jan. in, '92).
Case of dermatitis exfoliativa in a girl aged 11 years. She was first seized with fever and nausea. Three days later her tongue was heavily coated, the breath offensive. and sores were present. The face, neek, and upper chest presented a scalded appearance, the epidermis being lifted from the true skin, rolling up like tissue-paper, and being broken in a nun2ber of places. The temperature was 103° F.; thc pulse 144. The disease pursued its usua.1 fatal course, carrying off the patient two days later. No drug was held accountable for the symp toms. H. M. Beatty (Archives of Ped., Feb., '96).
The cause of chronic general exfolia tive dermatitis is not known.
Diagnosis.—The only disease likely to be mistaken for chronic exfoliative der matitis is scaly eczema. Still, this is never so universally distributed; has usu ally a history of moisture and exudation at some time in its course; is attended by intense itching and considerable infiltra tion. Lichen planus is a papular dis ease, and, while the papules are some times aggregated in solid. sheets, has a different history from this disease.
Treatment.—The treatment is unsatis factory. Arsenic, which seems indicated, has little effect on the course of the erup tion. Good results are sometimes ob tained from codliver-oil, both internally and externally. Saline diuretics and aperients are occasionally beneficial. Externally bland ointments may be ap plied. The extensive surface involved prohibits the use of mercurial applica tions, as salivation would be likely to follow. Glycerite of starch or Lassar's paste may at times relieve the uncom fortable sensation of tightness of the skin.
(C) Local Exfoliative Dermatitis.
Definition.—A localized dermatitis of mild character, occurring in rounded or oval spots; rosy, red, or mottled in color. and attended by furfuraceous desquama tion. It is the pityriasis rosea of Gilbert and Duhring.