(Epidemic eczema; Epidemic skin disease)
Definition. An acute, inflammatory, desquamative disease, similar to dermatitis exfoliativa, with antecedent or concomitant symptoms of anorexia.
Symptoms. This rare condition has been reported as occurring in several English charitable institutions as an epidemic skin disease resembling eczema. The eruption usually begins in the summer and appears in the form of irregularly grouped, acuminate papules located at the hair follicles. The lesions gradually merge into patches and the eruption, spreading over the whole surface, becomes deep red covered with abundant scales. The eruption is usually symmetrical, although it may be localized at first and later becomes general. In a few cases, the eruption developed from round, defined, erythematous patches or flat papules, the latter became enlarged at the border and vesicular in the center, and occasionally gave exit to a moist discharge characteristic of eczema. Whatever the type of initial lesions or subsequent evolution, the final exfoliation follows and the absence of moist exudation at this period in the development was objectively nearly identical with dermatitis exfoliative. There was no fever in most cases, although vomiting, diarrhoea, conjunctivitis and cervical adenitis were present. In severe cases the nails and hair were shed and the skin was deeply pigmented for some time after recovery. The duration was from six to eight weeks, showing many relapses, and a few pronounced second attacks.
Etiology and Pathology. Nothing is known as to be causes. The facts that nearly all cases occurred in institutions whose inmates were disabled by disease or age, of whom about one in five contracted the disease, and that the eruption spread by peripheral extension, point to some local contagion as the cause. A rod-like, segmented diplococcus has been found in the blood, tissues and exudations. A rabbit incoculated with a culture developed the condition and died from no other apparent cause. The food and milk supply was suspected as a possible vehicle of contamination. Pathologically the disease is a dermatitis attended with more or less serous effusion and extravasation of leucocytes in the corium, with an engorgement of the vessels.
Diagnosis. Although in one or more ways it might resemble erysipelas, eczema, dermatitis exfoliativa, ring-worm or rotheln, its epidemic nature, the absence of fever, short course, apparent contagiousness, and preference for the aged, together with resulting desquamation and comparatively large mortality, should make the diagnosis easy.
Prognosis and Treatment. From four to twenty per cent. of those attacked have died. Early local antiparasitic measures have given the best results. The lesions should be painted with tincture of iodin, with or without collodion. In the stage of desquamation, soothing applications as indicated for dermatitis exfoliativa are necessary. A suitable dietary is important. Arsenic and its salts would seem to be indicated.