Essentials of Diseases of the Skin - Henry Weightman Stelwagon

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essential symptom is redness—simple hyperæmia—without elevation or infiltration, disappearing under pressure, and sometimes attended by slight heat or burning; it may be patchy or diffused. In the idiopathic class, if the cause is continued, dermatitis may result.

      What is to be said about the distribution of the simple erythemata?

      The idiopathic rashes, as inferred from the nature of the causes, are usually limited.

      Describe the treatment of the simple erythemata.

      A removal of the cause in idiopathic rashes is all that is needed, the erythema sooner or later subsiding. The same may be stated of the symptomatic erythemata, but in these there is at times difficulty in recognizing the etiological factor; constitutional treatment, if necessary, is to be based upon general principles. Intestinal antiseptics are useful in some instances.

      Local treatment, which is rarely needed, consists of the use of dusting-powders or mild cooling and astringent lotions, such as are employed in the treatment of acute eczema (q. v.).

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      (Synonym: Chafing.)

      What do you understand by erythema intertrigo?

      Erythema intertrigo is a hyperæmic disorder occurring on parts where the natural folds of the skin come in contact, and is characterized by redness, to which may be added an abraded surface and maceration of the epidermis.

      Describe the symptoms of erythema intertrigo.

      The skin of the involved region gradually becomes hyperæmic, but is without elevation or infiltration; a feeling of heat and soreness is usually experienced. If the condition continue, the increased perspiration and moisture of the parts give rise to maceration of the epidermis and a mucoid discharge; actual inflammation may eventually result.

      What is the course of erythema intertrigo?

      The affection may pass away in a few days or persist several weeks, the duration depending, in a great measure, upon the cause.

      Mention the causes of erythema intertrigo.

      What treatment would you advise in erythema intertrigo?

      The folds or parts are to be kept from contact by means of lint or absorbent cotton; thin, flat bags of cheese cloth or similar material partly filled with dusting-powder, and kept clean by frequent changes, are excellent for this purpose, and usually curative. Cleanliness is essential, but it is to be kept within the bounds of common sense. Dusting-powders and cooling and astringent lotions, such as are employed in the treatment of acute eczema (q. v.), can also be advised. The following lotion is valuable:—

      ℞ Pulv. calaminæ,

       Pulv. zinci oxidi, … … … … … . … .āā … … … ʒiss.

       Glycerinæ, … … … … … … … … … … … … … ♏xxx

       Alcoholis, … … … … … … … … … … … . … . fʒij

       Aquæ, … … … … … … … … … … … … … . … . Oss. M.

      Exceptionally a mild ointment, alone or supplementary to a lotion, acts more satisfactorily.

      In persistent or obstinate cases attention should also be directed to the state of the general health, especially as regards the digestive tract.

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      What is erythema multiforme?

      Erythema multiforme is an acute, inflammatory disease, characterized by reddish, more or less variegated macules, papules, and tubercles, occurring as discrete lesions or in patches of various size and shape.

      Upon what parts of the body does the eruption appear?

      Usually upon the extremities, especially the dorsal aspect, from the knees and elbows down, and about the face and neck; it may, however, be more or less general.

      Describe the symptoms of erythema multiforme.

      With or without precursory symptoms of malaise, gastric uneasiness or rheumatic pains, the eruption suddenly makes its appearance, assuming an erythematous, papular, tubercular or mixed character; as a rule, one type of lesion predominates. The lesions tend to increase in size and intensity, remain stationary for several days or a week, and then gradually fade; during this time there may have been outbreaks of new lesions. In color they are pink, red, or violaceous. Slight itching may or may not be present. Exceptionally, in general cases, the eruption partakes of the nature of both urticaria and erythema multiforme, and itching may be quite a decided symptom. In some instances there is preceding and accompanying febrile action, usually slight in character; in others there may be some rheumatic swelling of one or more joints.

      Fig. 11.

FIG. 11.

      Erythema Multiforme, in which many of the lesions have become bullous—

      Erythema Bullosum.

      

      What type of the eruption is most common?

      The papular, appearing usually upon the backs of the hands and forearms, and not infrequently, also, upon the face, legs and feet. The papules are usually pea-sized, flattened, and of a dark red or violaceous color.

      Describe the various shapes which the erythematous lesions may assume.

      Often the patches are distinctly ring-shaped, with a clear centre—erythema annulare; or they are made up of several concentric rings, presenting variegated coloring—erythema iris; or a more or less extensive patch may spread with a sharply-defined border, the older part tending to fade—erythema marginatum; or several rings may coalesce, with a disappearance of the coalescing parts, and serpentine lines or bands result—erythema gyratum.

      Does the eruption of erythema multiforme ever assume a vesicular or bullous character?

      Yes. In exceptional instances, the inflammatory process may be sufficiently intense to produce vesiculation, usually at the summits of the papules—erythema vesiculosum; and in some instances, blebs may be formed—erythema bullosum. A vesicular or bullous lesion may become immediately surrounded by a ring-like vesicle or bleb, and outside of this another form; a patch may be made up of as many as several such rings—herpes iris. In the vesicular and bullous cases the lips and the mucous membranes of the mouth and nose also may be the seat of similar lesions.

      What is the course of erythema multiforme?

      Acute, the symptoms disappearing spontaneously, usually in one to three or four weeks. In some instances the recurrences take place so rapidly that the disease assumes a chronic aspect; it is possible that such cases are midway cases between this disease and dermatitis herpetiformis.

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