ECZEMA Eczema is essentially a superficial catarrh of the skin, with an inflammation of the upper layers of the connective tissue and epithelitn» of the epidermis, and is attended by perspiration; there is therefore a surface infiltration and transudation of the C01.1 LIM and vesicle form ation of the epithelium. The affection is characterized by acute onset, frequent generalization, extreme irritability of the eczematous skin, tendency to relapses and chronic stage, and healing without leaving any sears (see Plate 65).
The course of the affection is generally as follows: At first the skin becomes slightly erythematotts and mdematous, tense (stadium erythematosunt); then small, more or less hypergonic, not very coarse nodules appear on the skin, which collect. around the sweat-glands and hair follieles (stadium papillosu tn). Gradually the small nodules develop into vesicles (stadium sesiculosum) ancl become ulcerative as soon as an infectious stimulus penetrates into the vesicles (stadium itupetigino sum.). If they are opened through scratching and rubbing, ancl the base of the vesicles is exposed, we observe the hyperiernic, exudative, eczematous layer of the skin (stadium madidans). 'fins hyperaPnie skin exudes a highly serous, honey-colored fluid, which dries and collects on the skin, forming crusts and scabs (stadium. squamosum). The longer the affection persists, the more intense becomes the inflammation of the corium and cutis; the skin becomes coarsely infiltrated, highly irritable and responds immediately to irritation by the formation of new vesicles.
Acute eczema occurs in localized, sharply demarcated foci of a pitpulous and vesicular nature. Soon new foci are being formed in the neighborhood which become confluent. and spread; in this way they may involve the entire bocdxt, but considerable areas may escape. There is slight. elevation of temperature with considerable pruritus which oectirs in paroxysms at day and night, estusing patients to seratch them selves to such an extent as to expose the exuding skin. After the acute stage has passed into the exudative stage, it may persist for weeks and months, gradually becoming squainous, or the skin may gradually heal so that on superficial examination it appears healthy; nevertheless it is susceptible to every fresh irritation, causing new eruptions and ex acerbations at the old spots which had apparently healed. In chronic
cases the entire body is often attacked, and the general condition suffers not only from the excessive itching, but. also from the sleeplessness it occasions. There arise, especially in children, disorders of nutrition, vomiting and diarrhoea, all of whieh probably being connected with the eczema: there may be bronchitis and frequently even asthmatic attacks which may occur vicariously with fresh eczematous eruptions. Infan tile eczema is divided into attacks during the nursing and later periods.
The eczema of the nursing period very often begins during the first few weeks of life, and has been observed by some authors (Dubreuilh) crusta Inetea as early as the beginning of the third IA eck. Commencing at the head, face, cheeks, ears, it slowly spreads to the nape of the neck, the chest, and may involve the arms, legs and abdomen. This eczema of the nursing period causes very considerable itching, and children are apt to scratch the pustules open very promptly. At first an crythematous and papulous eruption, it ,soon becomes vcsieulous and remains in a crusty and impetiginous condition for a considerable time because infected from the continuous scratching to which children are prone. In such eases the affection attacks the entire body in the shape of plaques, spreads to the back, chest and extremities, proceeds in the shape of eczematous intertrigo to the genito-crural folds of the perineum and anus, or travels to the cervical folds and articular flexures. This condition remains stationary for many weeks and months; it is a tor ment not only to the children, but also to parents and physicians. The axtent to which nurslings suffer from eczema, varies: especially in the localized trouble children are frequently observed to be of very good general appearance and to thrive well, and only in the highly exudative forms which attack the whole body is there often a considerable dis turbance of the constitutional eondition.