Definition. An acute, contagious inflammatory disease of the skin, characterized by the formation of multiple, discrete, flat, superficial vesicles, blebs, pustules and thin crusts.
Symptoms. There may be a mild febrile disturbance preceding the development of erythema or papules which rapidly become transformed into small vesicles or vescopustules. These in turn quickly enlarge, become milky or purulent, flattened out with a tendency to central depression, and sometimes decided unbilication. These latter lesions vary in size from a split pea to a cherry. They may coalesce and form large irregular patches but they are very superficial and, if broken, show a slightly red, eroded and exuding base. If undisturbed, they dry up in a few days into wafer-like, straw colored crusts. Unless the attack is unusually severe, there is no areola about the lesions. The lesions may or may not be numerous and are nearly always situated on the face or hands, although they may occur on any part of the body even rarely on the mucous surfaces of the nose, mouth and conjunctiva. Autoinoculations of slight abrasions of the surface are likely, and new lesions may appear singly or in crops at intervals of a day or two. The disease usually runs its course in one to two weeks but is very contagious. Hence, it may be almost epidemic in schools or among children in certain localities and even adults may become infected, usually from contact with children. Swelling of the submaxillary glands has been noted in severe cases, and pronounced atypical forms may seek unusual locations on the body and be widely scattered. The lesions may be pemphigoid in character and two to three times the average size, as has been noted in the epidemic type (so-called “epidemic pemphigus”) among children. The vesicular eruption from the beginning like non-contagious impetigo, or rarely there may be an ecthymatous tendency. No matter what the difference may be in clinical types, some characteristic features as to origin, evolution, duration or termination will seen. It is possible for all types to exist in any one epidemic, as I was able to observe in the Summer and Fall of 1900, among nearly 200 cases occurring on the East Side of New York City.
Etiology and Pathology. while more often seen among the poor and uncleanly, it is not rare among children of the well-to-do classes. Excoriations of the skin incident to scratching from the presence of pediculi, scabies, urticaria, etc., may open the way to inoculation. Likewise vaccination or other suppurating surfaces of the skin or abrasions that are quite unnoticeable may afford an entrance point. It always rises from infection and is inoculable and autoinoculable. It s chiefly a disease of childhood, much more common before the age of ten years and, when present in adults, is usually mild and transient in form. While the exact character of the exiting organism is not known, both the streptococcus and the staphylococcus have been found in the lesions. It is possible that the vesicular and more actively contagious form is due to the streptococcus while the pustular form is due to the staphylococcus.
Diagnosis. Varicella lesions are usually more or less frequent over the trunk as well as on the face, do not tend to group or coalesce and terminate with slight crusting. Pustular eczema presents small, pin-head-sized pustules in patches, with marked itching, infiltrated skin, a much longer course and an entire absence of large isolated pustules. Pemphigus rarely occurs in childhood, but it blebs are the same size from the start, seemingly springing from sound skin and have no special preference for the face or hands. Ecthyma is a disease of adult life, commonly for the face or hands. Ecthyma is a disease of adult life, commonly located on the legs. The lesions are deeper seated and do not respond to superficial treatment.
Prognosis and Treatment. This condition is quickly cured by treatment in from one to three weeks. A 2 to per cent. ointment of ammoniated mercury, rubbed into the parts three times a day after the crusts have been loosened with soap and water, or some other antiparasitic, such as betanaphthol (10 to 15 grains), resorcin (10 to 20 grains), or boric acid (10 to 30 grains) to the ounce may be used. If the mucous surfaces are affected, a saturated aqueous solution of boric acid may be used three times a day or more often. Internal remedies may be given as indicated, but the contagious nature of the disease forbids reliance on them alone. See Antim crud., Ant. tart., Calcarea sulph., Cicuta, Kali bichrom., Lycopodium, Nat. sulph., Pic. acid, Silicea, Thuja, Viola.