ECTHYMA GANGR/ENOSUM Multiple cachectic gangrene of the skin (O. pemphigus gangramosus (Stokes), dermatitis gangramosa infantum (Crocker), varicella gangrmnosa (Hutchinson), impetigo ganguenosa (Kreibich) etc.
Ecthyma gangrtenosum, in contradistinction to ecthyma, commences with the formation of indurated, dirt-colored to bluish red knots, On which vesicles promptly develop; these rapidly become peripheral ulcers which grow inward.
Pathological ulcers described above which are striking by reason of their sharp demarcation and appear to be cut out with an iron (lie, rapidly become larger and may attain tbe size of a pea to a five-cent piece; if clo.se enough, they may run into each other. The base of the ulcer is Inemorrhagic and necrotic, surrounded by a hypertemic indurated, infiltrated areola. The ecthyma pustules develop gradually, principally- at the trunk (nates), extremities, and the neck. They are chiefly met with in children (tuberculosis, atrophy, etc.). If healing takes place, the necrotic portion is desquamated, forming a firm pigmented cicatrix. In the. majority of cases, however, death ensues in consequence of sepsis which originates from the various gangrenous foci.
to the investigations of Hitschmann and Kreibich there is a. necrosis of the epidermis and corium, and a local, dense accumulation of bacteria in the infiltrated layers of the epidermis and around the vessels.
view of the site at the nates we must look for the source of the infection in the soiling front urine and feces. While Bau douin and Wickham found streptococci in one case, Ehlers, Neumann and Oettinger, especially however Kreibich and Hitschinann, hold the bacillus pyocyaneus responsible for ecthyma gangnenosum. The last two investigators also consider the bacillus pyocyaneus responsible for the se.vere general conditions.
differential diagnosis as against impetigo and ecthy-ma is established from the ulcerous desintegration and the grave course of ecthyma gangrmnosum.
chief object of the treatment consists in im proving the general condition. Therefore the greatest importance should be attached to providing as nutritious a diet. as possible (aside front iodide of iron, etc.). The local treatment should pay special attention to utmost cleanliness, the pustules should be opened, and the cleansing of the ulcers be promoted by baths (sublimate, potassium permanga nate). Simultaneously bandages of iodoform and its substitutes (xero form, airol, etc.), and salves should be prescribed for the protection of the skin.