Eczema infantile is a very obstinate form of the disease. It usually ap pears before the end of the sixth month, and attacks infants who in other respects seem to be in perfect health. It begins generally on the cheeks and spreads thence to the neck, chest, arms, and body generally. At first it is not uncommonly complicated by wheals of urticaria. In any case the disease is accompanied by intense itching which evidently causes the utmost distress to the child, and often it is necessary to secure his hands, so as to prevent his increasing the irritation by constant friction. Even when this is done he will rub his cheeks against the pillow of his cot until the skin is completely excoriated, and often wears the hair from the back of his head by constant movement of the occiput upon the pillow to relieve the irritation. The parts affected are intensely red, and are rough and scaly from drying of the secretion poured out by the ruptured vesicles, and pustules. In severe cases the child hardly sleeps at all on account of the constant itching. The course of the disease is seldom uniform ; usually it undergoes curious alternations of improvement and relapse. . An attack of acute gastric catarrh will often cure the skin affection completely for a time, but the eruption returns as badly as ever when the gastric derange ment is at an end.
A sturdy little boy, aged five months, had suffered for a month from an attack of acute eczema infantile, which occupied the whole of the head, face, sides of the neck, and the greater part of the chest. The irritation was extreme. The child had worn the whole of the hair from the back of his head by friction of the occiput against the pillow. This infant had an attack of acute gastric catarrh with violent and repeated vomiting. The eczema at once began to fade, and in the course of three days had almost completely disappeared. Directly, however, the vomiting had ceased and the appetite had begun to return, the cutaneous eruption reappeared, and in a day or two was as bad as before.
This form of eczema often continues for years, and may persist through out the whole of childhood. In such cases, however, the eruption gener ally clears away completely from the head and face, but remains as a patchy rash, more or less extensively diffused over the body and limbs.
Diagnosis.—Eczema as a rule is a disease which is readily recognised. The diagnostic characters of the eruption are :—A red, inflamed, and rather infiltrated surface which gives rise to extreme itching, and presents many scales or crusts, and a more or less punctated appearance, i.e., the red dened skin has a dotted look from small points of a deeper red covering the surface of the patch. It is very important with regard to treatment to exclude scabies, for this parasitic eruption has often the general appear ance of eczema ; indeed, a true eczema is often present on the body ex cited by the irritation of the acarus. In all doubtful cases the character
istic furrow produced by the itch insect should be diligently searched for, for this, if discovered, is pathognomonic. It must be remembered that in young children scabies rarely affects the hands and wrists, but is more commonly found about the buttocks, the belly, the feet, and the ankles. Ecthymatous pustules seated upon the soles of the feet are very strong evidence in favour of scabies.
Sometimes patches of psoriasis, especially if the silvery scales have been removed, bear a great resemblance to eczema in the dry or chronic form. In such cases we should carefully examine all the patches discoverable about the body. In eczema the patches are brighter in colour and less well defined at the edges, the scales are thin and loosely attached, itching is a marked feature, and the parts affected are usually the flexures of the joints and other regions where the skin is delicate and disposed to be moist. In psoriasis the patches are well defined and paler in colour, the scabs are thicker and more adherent, and itching is of moderate intensity. Moreover, psoriasis attacks by preference the outer parts of the limbs where the skin is comparatively thick and coarse.
Syphilitic eruptions in the infant are readily distinguished from eczema by their more coppery tint, the absence of itching to any notable degree, and the presence of hoarseness, snuffling, and other well-marked signs of the syphilitic cachexia.
Eczema capitis can scarcely be confounded with tinea tonsurans or favus by any careful observer. There are no broken or brittle hairs, such as are so characteristic of the former disease ; and the bright yellow cup-shaped crusts of favus have no resemblance to the scabs of impetigo of the scalp. It must be remembered, however, that a real eczema capitis may occur as a complication in a late stage of tinea tonsurans, but in such a case, when the eczema is cured, the broken hairs of the parasitic disease can be dis covered on careful examination.
I have known acute eczema in the early stage to assume a crescentic, slightly papular form, which has been mistaken for measles ; but the ab sence of pyrexia and of cough or lachrymatiou will serve in such a case to exclude the exanthem.
Treatment.—In cases of eczema we must not confine ourselves to local applications to the inflamed surface. Often the general health of the child will also require attention. Eczematous eruptions are common in chil dren of scrofulous constitution or debilitated frame. In such patients the local remedies must be aided by general tonic treatment, if any permanent benefit is to be obtained. In scrofulous children the general treatment recommended for that cachectic state should be adopted, and if the child is thin and spare, cod-liver oil will be found of service. Iron-wine is also a valuable remedy.