Definition. This general term represents a non-contagious eruption, resembling scarlet fever in its cutaneous aspects but running a different course.
Symptoms. More or less diffused erythema, followed by partial or complete exfoliation, have been variously named, and especially elaborated by the French dermatologists, but it seems unnecessary to differentiate between the different degrees of this desquamative erythema. It appears suddenly, attended with a rising temperature from 100* to 103* F., chill and malaise. The eruption may begin on any part of the body, and often only involves a small portion. It may be punctiform or diffuse, and the duration varies according to its density, but desquamation usually occurs on the third or fourth day, and may be so profuse that the hairs, nails and epidermal casts of the hands and feet are shed. The severe type of this disease is apt to recur, more so than the mild form, and at periodic intervals. No doubt many of the so-called abortive and mild types of scarlet fever should be classed under this head.
Etiology and Pathology. While the etiology is obscure, idiosyncrasy undoubtedly plays a prominent part. Changes of season without a corresponding change in diet, clothing or habits, or certain foods, either fruit, vegetable, shell fish or meat, may cause it. It is apt to appear during the course of such diseases as typhoid fever, malaria, diphtheria, rheumatism, septicemia, pyemia, and peritonitis, malaria, diphtheria, rheumatism, septicemia, pyemia, and peritonitis, but it is distinctly less common since the introduction of antisepsis. It has appeared after the external application of mercury, iodoform, and other irritants, and has followed the ingestion of many drugs, especially quinin and the coal-tar derivatives. The most reasonable theory advanced to explain this eruption is that certain individuals possess an intolerance of their centers to the presence of some substances, either circulating in the system or influencing it from the outside, which produce reflexly a dilatation of the cutaneous blood vessels. The condition is really rare, judging from my own records of nearly 12,000 case, among which only fifteen cases have been noted.
Diagnosis. Some of the many cases of recurrent scarlet fever are in reality cases of erythema scarlatiniforme, but its recognition is not always easy, although it is always important. A comparison of the common symptoms of the two affections will usually determine the diagnosis. Thus while the throat may be red in erythema, it is not swollen as in scarlatina; the strawberry tongue of the latter is absent; the rise of temperature may be considerable, but is not continuous as in scarlet fever; the erythema patches are apt to be well defined with areas of clear skin between in contrast with the less red and diffused scarlatina eruption; nephritis is not associated with erythema except as a cause; the latter is non-contagious and desquamation begins early, on the third or fourth day; scarlatina is contagious, and desquamation does not begin until the ninth or tenth day. The latter difference will generally clear up doubtful cases, but isolation is the only safe course in the interval. When an erythema resemble measles, there would not be a history of a prodromal coryza and fever with continued rise of temperature after the outbreak of the eruption as characterizes the latter, neither would be rash of erythema be likely to begin upon the face. If rotheln is suspected from the appearance of the erythematous rash, and there is no enlargement of the submaxillary, sternomastoid or occipital glands found, it may be excluded, unless there is a clear history of contagion.
Prognosis and Treatment. The former is always favourable, though recurrences are frequent. Any of the formulae mentioned in the treatment of erythema hyperemicum may be applied if necessary, but commonly no local treatment is necessary beyond cooling lotions or dusting powders, or possibly a starch or bran bath, followed by applications of non-medicated oil or fat if desquamation is a feature. The internal remedy is all-important, especially to prevent a tendency to recurrence. See indications for Ailanth., Am., carb., Belladonna, China sulph., Colchicum, Hyoscy., Juglanms cin., Stramon. and Terebinth.