Several varieties of the disease are common in children. Those which will be described are :—Eczema simplex, eczema rubrum, eczema capitis, eczema tarsi, and eczema infantile.
Eczema simplex is the commonest form of the disease. It attacks chil dren behind the ears, at the orifices of the nostrils, on the cheeks, and in deed on any part of the body. The rash occurs in patches of redness on which papules or vesicles very quickly appear, and later pustules are gen-. erally seen. In the latter case the disease is often called eczema impetigi nodes. The red rash exudes a gummy fluid, which dries into thin reddish or brownish crusts. When these are removed, the surface is seen to be red and moist, or covered with fine scales. On hairy parts, a few pustules are almost always seen as well. The pustules are larger than the vesicles, and are situated at the orifices of the hair-follicles ; for the hair can be seen to pats through their centre. They soon burst, and discharge their contents. The fluid dries and forms thick crusts, which are sometimes turned up at the edges. There is some infiltration of the skin at the affected part, and a good deal of itching and heat is complained of by the patient. The pustular form is most common in scrofulous subjects, but may occur in others who suffer from no such constitutional predisposition.
In eczema rubrum the inflammation and redness are very great, and the surface of the patch is seen to be studded with deeper red points, which correspond to the orifices of the cutaneous follicles. The secretion forms thick scabs under which small excoriations are seen—the conse quence of rupture of the vesicles. This variety is especially frequent at the folds of the joints, such as the groins, the arm-pits, and at the backs. of the knees. It causes much itching.
Eczema capitis occurs in the pustular (eczema impetiginodes) or the scaly form. The exudation to which the eruption gives rise becomes en tangled in the hairs and mats them together, so that it can with difficulty be removed. In neglected cases it is not uncommon to find the head covered with a kind of cap or large scab, composed of the hair matted into a mass by dried exudation. This feels soft and boggy to the touch, from the quantity of contained purulent fluid which wells up through any opening in the scab. The odour is most offensive, and usually in such
cases pediculi abound. Superficial ulcerations and small subcutaneous abscesses may sometimes be• seen on the scalp when the crusts are re, moved ; and the glands of the neck and those at the back of the head often become inflamed and swollen. In very chronic cases the hairs may fall out, but they grow again when the disease is at an end.
In infants the scaly form is the more common. The scalp may be seen to be covered with scabs, but exudes only a limited amount of secretion.
A variety of eczema capitis has been described as impetigo contagiosa, being supposed by some authorities to be conveyed from one child to an other by actual contact. There is no doubt that we often find several children of the•same family suffering from impetigo of the scalp at the same time, but the contagious nature of the eruption is not universally recognised. It is, indeed, denied by many good observers. Dr. Tilbury Fox, who believed in the communicability of this form of the disease, states that contagious impetigo always begins as little watery heads.
In eczema tarsi the disease affects the edges of the eyelids. This form is common in scrofulous children and may be combined with strumous ophthalmia and conjunctivitis. A number of pustules appear at the ori fled of the hair-follicles. These burst quickly and form scabs. The eruption is attended with considerable itching and some swelling of the edges of the lids. The margins of the eyelids are scaly from small crusts which cling round the shafts of the hairs as these issue from the follicles. The hairs are often glued together by the secretion, and at night-time the edges of the eyelids are also very apt to stick together. When the scabs are removed, small ulcers are often to be detected on the skin beneath. Eczema tarsi is a very chronic complaint. It is often accompanied by much weakness of the eyes and lachrymation. If allowed to go on it eventually causes obliteration of the Meibomian glands and hair-follicles, and the eyelashes are apt to fall out, or if they remain, to grow irregularly and in very inconvenient directions.