Eczema of the head of nurslings is of different kinds: (I) the entire face may be attacked, especially in early infancy: (2) sharply demarcated large surfaces of the forehead, cheeks and upper lips may be attacked; (3) the eruption may be confined to small islands of the face: (4) it may originate at the hairy part of the head, when, under the influence of seborrInea whieh may often be present, it may spread on. Under the irritation of eczema, together with the honey-colored serous perspiration, with seborrhecie masses, a thick crust is formed, matting the hair together, which emits an offensive odor, and beeonie8 disintegrated. Under this thiek conglomeration of hair, crusts, etc., the eczema easily becomes impetiginous, in which case the neighboring lymphatic glands, especially the cervical ones, niay be observed to become enlarged and ulcerate. This glandular enlargement as well as the impetiginous changes of the eczema of the head usually spreads symmetrically to the ears, thence to the cheeks and neck, and finally to the entire body. These eczemas of the head and face are exceedingly obstinate and have a tendency to relapse.
In a child with scrofulous diathesis we generally find the pathological picture which has been described scrofulous eczema. The nose and the mucous membrane of the nasal ostia are eczematously affected and swollen, and there is cedema of the edges of the lids and lips. The in volvement of the upper lip especially frequently cause.s such an exten sive swelling that it assumes a probosciform appearance, and together with the eczema of lids and nose and the scrofulous conjunctivitis which is often present, it often represents the type of scrofulous eczema which may lead to a kind of leontiasis.
The auricles, which become considerably enlarged, are (edematous and crusty, and often, especially in the chronic stage, there are perma nent fissures behind the ears at the folds. Very often aural eczema is connected yvith a purulent catarrh of the middle car.
Occasionally there is a complication of facial eczema of small chil dren in the shape of a varicellar eczema accompanied by high fever and occurring in sudden rushes, which usually attacks the face first and then spreads to the neck and shoulders. The affection lasts two to three weeks and heals, leaving pigmented spots and flat scars behind which resemble varicella. Kaposi, to whom we are indebted for this communication, has observed one such case with fatal termination. But whether this particular ease w-as not complicated by a secondary varicellar affection, is an open question.
If the eczema involves the trunk of the body, it usually extends first in the shape of eczematous intertrigo u the cervical folds, articular flexures, genitals (scrotum or vulva), and then affects nates, thighs and feet. Eczematous intertrigo is caused by friction in the folds and
flexures through maceration consequent upon excretions and secretions, and usually occurs in excessively fat children in places where the skin of two parts comes in contact. Intertrigo is accompanied by consider able itching. In this form of eczema we observe all stages of the eczema tous process (erythematous, pustulous, impetiginous and similar forms), there are erosions, ulcerations and dermatie changes, which can only with difficulty be distinguished from syphilitic manifestations. For this reason it has been designated by the French erythema syphiloide post6rosive or syphilide post-6rosive (Jacquet). The forms of eczema occurring at the extremities do not show any peculiarities, but attention should be paid also in these eases to eruptions at the articular flexures.
In the more advanced infantile period tw-o further forms of enema are of particularly frequent occurrence, aside from the frequently re curring scrofulous eczema. One form occurs especially with the lower class of the population in connection with head lice. As a rule the exceedingly violent itching is responsible for scratches of the skin, a secondary' impetiginous eczema developing, w-hich with the crusts and matted hair forms that peculiar tissue which is knolvn under the name of plica polonica, and in which both pedieuli and their eggs (nits) are always encountered.
Occasionally an acute eczema with febrile manifestations occurs under the form of eczema rubrum which rapidly involves the entire body and is characterized by the phenomenon of the skin of the entire body assuming a bright red to blue red hue, and a scarlatiniform ap pearance. This is soon followed by the exudative stage, the skin becomes squamous and crusty, and either heals under appropriate treatment or passes into a chronic state, if neglected. The cases are amenable to proper treatment and respond rapidly.
As to so-ealled eczematous metastasis, I cannot bring myself to believe in the occurrence of interior disease after rapid healing of an extensive eczema, although quite a series of observers (Henoeh, Comby and especially Gaudier) express themselves in favor of such a possi bility. In spite of the relatively large eczematous material which has been at my disposal in the course of years, I have never seen a single case of so-called eczematous metastasis. Nevertheless, it is of course sometimes perfectly possible to observe complications in extensive eczema, such as nephritis; and eases of febrile eczema have likewise been observed (see Prognosis).