(Varicella gangrenosa; Multiple cachectic gangrene; Infantile gangrenc)
Definition: A rare gangrenous inflammation of the skin of unknown origin, following varicella and other vesicular or pustular eruptions or childhood.
Symptoms. Originally, this condition was looked upon as secondary to varicella but it has since been discovered following other vesicular or pustular diseases of the skin in children and occasionally without presenting any antecedent cutaneous history. Following varicella or variola or even simple pustular diseases, crusted, pea-sized pustules, surrounded by a marked inflammatory areola, develop and in a short time throw off the crusts, leaving a marked ulceration. The lesions may be few or many and if they are near together, may coalesce and form large, irregular ulcers. they are commonly located on the lower half of the body, if not connected with antecedent lesions, and begin as small papulopustules which develop on an erythematous base, enlarge to the size of a pea and form a crust, sometimes with a pustular border, much like the vaccine pustule. Fever, vomiting, diarrhea, bronchial and lung complications are general symptoms and sepsis may be present.
Etiology and Pathology. The majority of cases occur in the first year of life. My own cases were all under two years of age, and were hospital subjects, in which neglect, debility and anemia appeared to be contributing factors. It would seem probable that some predisposing constitutional state was the real cause although the eruption may be excited by the local lesions of certain skin affections, foul secretions, micro-organisms, etc. Various forms of bacteria have been found in the lesions, including the staphylococcus and streptococcus.
Diagnosis. Its usual occurrence in infancy after some eruptive disease, characteristic lesions; which in their evolution form pustules, crusts and gangrenous ulcers, all lesions occurring at the same time in one case, should be sufficient to differentiate this condition from ecthyma or syphilis.
Prognosis and Treatment. A constitutional weakness, extreme youth of the patient, the number of the lesions or the character of developed complications, all tend to make the prognosis grave, although the disease itself is probably not of a fatal character.
Treatment includes absolute cleanliness, mechanical protection and mild antisepsis. Alkaline baths or sponging, followed by the application of a weak boric acid or aristol ointment (5 to 15 grains to an ounce of fresh lard) is the only local treatment needed for most cases. When the bacterial feature is pronounced, antiseptic treatment may be used such as boric acid, aristol or ichthyol ointments (5 to 10 per cent.), or mercuric chlorid solution (1:5000). Supportive measures in the shape of abundant nourishment and prompt attention to any complication, together with the indicated remedy, comprise the balance of the treatment. See indications for Arnica, Arsen., Crot., Kali bichrom., Kreosotum, Nit. acid, Secale and Sul.acid.