DERMATITIS EXFOLIATIVA (Ritter) In 1870 Ritter von Rittershayn first described this affection which had been first observed in the Foundlings Home in Prague. It is not yet established as a pathological picture, and although it probably belongs to pcmphigus neonatorum, it has still to be described separately (Plate 97).
Clinical Picture.—Esually the affection commences in the second week, but lias also been observed in the first and up to the fifth week. The normal desquaniation of the newborn infant being completed, a considerable hyperiernia of the skin appears, beginning at the fissure of the mouth, at the lower half of the face, forming fissures at the angles of the mouth and spreading rapidly over the body. The hyperminia becomes more intense, the skin becomes thicker and more mdernatous, vesicles detach the corneal layer from the rete and can bp stripped off with the finger. Extensive areas of the epidermis become detached and ean be pulled off in large pieces. The buccal mucous membrane may also be involved, being covered by grayish white erosions; in severe eases the epithelium of the cornea may likewise be involved (Elliot). The eourse of the affeetion is usually afebrile, only in excep tional cases has fever been observed (Escherich). Gradually the new covering of the epidermis is formed, after which recovery takes place; otherwise the detaching proeess of the skin continues and a rapidly fatal termination ensues in consequence of the great loss of lymph and seeondary infection.
The affection generally lasts one to two weeks; according to Ritter one half of the cases recover, the other half clie. Intestinal catarrhs, pneumonia and ulcerous affections have been reported as complications; abscesses and furuncles may also add their quotum.
Pathology.--According to the investigations of Imithlen and Winternitz there is a dilatation of the vessels, (edema of the papillary and subpapillary tissue with considerable small-eelled infiltration. Luithlen claims that there is considerable proliferation of the rete and defeetive cornifieation, while Winternitz states there is almost total absence of the same.
etiology of dermatitis exfoliativa is as yet completely obscure. Ritter looks upon the disease as pyamiie, Eseherieh believes in a general septic infection, Luithlen in the influence of toxic factors, which seems to be supported by the appearance of the primary erythema.
establish the diagnosis is comparatively easy, the formation of fissures at the angles of the mouth being particularly characteristic. It is impossible to mistake these fissures for hereditary syphilis on account of the general pathologic picture.
The prognosis is unfavorable, the mortality being 50 per cent. These are Ritter's figures which, aside front isolated cases, are the only ones available for statistical purposes.
Treatment.—The treatment endeavors to improve the general condition and by proper bandaging to avoid injuries to the sensitive skin (packing in cottonwool). At the same time suitable baths of bran and oak bark should be prescribed to make the skin firm and promote healing. Salves and pastes (borie ointment, zinc paste, etc.) are to be recommended and limewater liniments in extensive defects.