DERMATITIS EXFOLIATIVA EPIDEMICA

Synonyms.—Epidemic skin disease; Epidemic eczema; Dermatitis epidemica;
Savill‘s disease.

Under the name of epidemic skin disease Savill first described (1891)
a disease observed in London institutions presenting essentially the
symptoms of dermatitis exfoliativa, with, in some cases, an eczematous
aspect.⁴ Since then others have observed and reported similar cases

¹ Mook, “Large Doses of Quinin in the Treatment of Dermatitis Exfoliativa, with
Report of Six Cases,” Jour. Cutan. Dis., 1908, p. 408 (with 3 good case illustrations);
and ibid., 1910, p. 458.                                   ² Jackson, Hyde, ibid., 1910, p. 21.

³  C. J. White, Boston Med. and Surg. Jour., May 4, 1911, and more extensively in
Jour. Cutan. Dis., Dec, 1912, p. 705.

⁴ Literature: Savill, Brit. Jour. Derm., 1892, pp. 35 and 69 (with colored plate and
several phototypes); Brit. Med. Jour., Dec 5, 1891, and Jan. 9, 1892; with discussion
in Medical Society of London, Brit. Med. Jour., Dec 5, 1891, p. 1207; Jour. Cutan.
Dis., 1894, pp. 281 and 329; Russell (bacteriology), Brit. Jour. Derm., 1892, p. 106;
Fordyce, Soc‘y Trans., Jour. Cutan. Dis., 1897, p. 141; Colby and Winfield, ibid.,
1898, p. 73; Hutchinson, Arch, of Surgery, 1891-92, pp. 146 and 221; Echeverria
(histology), Brit. Jour. Derm., 1895, p. 9. A monograph on the disease by Savill,
London, 1892, is complete, with a number of illustrations.

DERMATITIS EXFOLIATIVA EPIDEMICA                 205

(Hutchinson, Lees, Richards, Milner, and others). Unlike dermatitis
exfoliativa, however, it was observed to attack a number of individuals
simultaneously, or one rapidly after the other, and with fatal issue in
10 to 20 per cent, of the cases. Those of advancing age are its chief
subjects, and more commonly males. In this country but a few cases
are recorded (Fordyce, Colby and Winfield). The malady begins gener­
ally in summer weather, and in most cases without premonitory symptoms.
In others anorexia, vomiting, diarrhea, and sore throat were observed.
It first appears usually as patchy erythematous or papular, bright or
crimson red efflorescences, and, as a rule, on several regions and with slight
itching. Sometimes vesiculation is noted. The legs show less tendency
to primary invasion than other parts, the principal first sites being the
face, scalp, and arms. Very soon, from the confluence of the beginning
and constantly arising new patches, more or less extensive involvement
results. In those cases with vesicular lesions, owing to their rupture,
a moist surface is seen at first; it rarely persists, but gives place to scali—
ness. There is noted some infiltration, and in all cases exfoliation rapidy
results, and this stage—exfoliating—lasts a variable time—on the
average, about five or six weeks. The scales, differing as to size, are
rapidly formed and are produced in great quantities. The cervical and
postoccipital lymphatic glands are frequently enlarged, and independently
of face or scalp eruption. The redness begins to subside, the infiltration
still persisting; the skin assumes a shining brownish appearance. Im­
provement takes place slowly, and in many cases there are several re­
lapses before recovery is complete and permanent. In almost all cases
conjunctivitis is observed. The hairs and nails fall out, and, although a
regrowth takes place, it is slow. Itching, somestimes slight, sometimes
intense, is present.

When the disease is completely established, general symptoms of
malaise, anorexia, and prostration, and in many albuminuria, are noted;
in some instances which are complicated by furuncular development
there is some temperature elevation. Diarrhea is often associated.
In unfavorable cases tremor, muscular twitching, labored respiration,
intestinal disturbance, pulmonary complication, cardiac weakness, and,
in some cases, marasmus, lead to a fatal issue.

Russell and Savill found a diplococcus, in rod-like segments, resem­
bling the staphylococcus, but differing from the latter in the above par­
ticular and by the fact that it does not liquefy gelatin. Experimental
animal inoculations seem to bear out its pathogenic importance. The
food and the milk supply were suspected as being the possible source,
but nothing definite could be demonstrated. Anatomically, according
to Savill, engorgement of the vessels and extravasation of leukocytes in
the corium, serous effusion, etc, were to be noted. Echeverria found
“a remarkable and new sort of degeneration of the nuclei of the prickle
layer of the epidermis—viz., the peridiaphania of the nuclei.”

Treatment consists of mild applications, such as prescribed in acute
eczema, but seems to have but little influence in shortening the course
of the disease. In a few instances in which the disease began as a small
area, painting it over with iodin tincture or collodion aborted it (Crocker).

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