(Tetter: Salt rheum)
Definition. An acute, subacute or chronic, non-contagious, inflammatory, catarrhal disease of the skin, characterized primarily by erythema, papules, vesicles and pustules, and secondarily by a variable amount of infiltration, thickening, scaling and crusting, accompanied by pronounced subjective sensations.
Symptoms. Eczema is a many sided disease; but for purposes of study four elementary varieties, the erythematous, the papular, the vesicular and the pustular are recognized. These lesions constitute the peculiar type which may remain distinctive, or at least predominate throughout the course of the disease, though the secondary forms, such as eczema rubrum, eczema, squamosum and eczema fissum, may develop. This technical division of a disease which constitutes between ages, in all countries, in all seasons, in both sexes and in all conditions of life, is necessary for the convenience of description, but it is well to again emphasize that even in the mixed types one lesion usually predominates.
Eczema erythematosum. This variety occurs in the extremes of life, in infancy and old age, usually on the face, palms, toes, or genitalia, and while the least common of the primary forms, is very pronounced. The erythematous spots may remain isolated or, rapidly spreading over a large surface, coalesce. There may be swelling, or even edema, about the eyes. There may be rough scales or fissures, or a general weeping of the surface may appear whether vesicles are visible or not. If this scaling persists to any degree, the condition becomes eczema squamosum or eczema exfoliativum. If the eruption remains well defined in small patches throughout its course, it is called eczema circumscriptum. If on opposing surfaces, as between the genital folds, it is known as eczema intertrigo and is usually associated with a muciform secretion. Erythematous eczema may be associated with other forms, especially at its borders. It may be persistent or respond rapidly to treatment, only to reappear in a short time. It is always associated with itching and burning, and in a short time. It is always associated with itching and burning, and is nearly always worse from marked changes of temperature, cold wind or excessive heat.
Eczema vesiculosum is the most typical catarrhal inflammation of the skin, and one of the most common transitional forms. While if may occur on any surface, it is often seen upon the faces of infants and young children, and upon the fingers, hands, necks and flexor surfaces of older people. Ordinarily the eruption is preceded by sensations of itching and burning, followed by a diffused local erythema, upon which, within a short time, closely aggregated pin-point to pin-head-sized vesicles appear; these may enlarge, coalesce, or rupture spontaneously or from friction, but in the end of a sticky serum is exuded which stains and stiffens linen brought in contact with it. The subjective sensations are usually improved with the rupture of the vesicles, only to become more aggravated when new vesicles are forming and always at night during the entire course of the eruption. Scratching or rubbing naturally increases the weeping so typical of most eczema. It not disturbed, the fluid exudation forms yellowish-brown crusts beneath which a moist surface is evident. When the fluid ceases to exude, and scales take the place of crusts, a squamous form of eczema may persist for a time, or a severe form may ensue from the increased inflammation and the discharge, with aggravations from itching and scratching, and eczema rubrum, with its intense red and angry appearance, is established. In a great majority of cases of vesicular eczema, the vesicular type is permanent, although the area involved may be large, because fresh vesicles develop at the margins, or because it becomes generalized. Limited to one region it is apt to run an acute course.