DERMATITIS REPENS¹

Synonyms.—Acrodermatite suppurative continué (Hallopeau); Acrodermatitis
perstans.

Definition.—Dermatitis repens is a spreading dermatitis starting
from an injury, extending by a serous undermining of the epiderm,
and usually occurring upon the upper extremities.

Symptoms.—The disease, first described by Crocker, may begin
shortly after an injury, or immediately after a surgical operation, or
even after complete healing has taken place. It begins, as a rule,
by redness and serous exudation; the skin breaks at this point, and the
exudation continues to be produced at the periphery and gradually
undermines the epidermis, in this manner extending and covering con­
siderable area. Or the disease appears first by the development of one,
several, or more vesicles or small blebs, which become confluent, and
followed by gradual peripheral undermining. Exceptionally the first
lesions are papular. When established, a picture is presented of a red,
raw-looking, usually oozing surface, with an elevated, confluent, spread­
ing, vesicular wall, which invades the adjoining skin, and presents toward
the red, weeping surface which has just been passed over a raised, irregular
rim of partially detached or loosened epidermis. As the disease spreads
the oldest part becomes dry and heals, the epidermal covering being thin
and atrophic in appearance. Occasionally the traversed part, while
red, soon becomes dry; and then there presents the spreading peripheral
serous wall with the ragged epidermic edge, under this latter a red

¹ Literature: Crocker, Diseases of the Skin, London, 1888, p. 128, and Trans. Inter­
nat. Cong. Derm, and Syph., in Vienna, 1892; Garden, in Crocker‘s paper in the Trans­
actions; Nepveu, Brit. Med. Jour., 1886, ii, p. 1194 (Paris correspondence); Stowers,
Brit. Jour. Derm., 1896, p. 1; Fréche (“Eruption trophonéurotique des extrémités rap-
pelant la dermatitis repens”), Annales, 1897, p. 491; Hardaway, American Text­book
of Genito­urinary Diseases, Syphilis, and Diseases of the Skin, p. 877, briefly refers to a
case; Hyde and Montgomery, Diseases of the Skin, seventh edit., p. 434, briefly refers to
3 cases in speaking of treatment; Hallopeau, Annales, 1897, pp. 473 and 1277, under
the name of “ Acrodermatites continués,” gives notes of a few cases with some points
in common with dermatitis repens, but which he considers entirely distinct from the
latter—he also considers the cases by Stowers and by Fréche as similar to his own, and
not identical with the disease as described by Crocker; Audry, “Les phlycténoses récidi-
vantes des extremités,” ibid., 1901, p. 913 (2 cases, with a résumé of previously pub­
lished cases); Hartzell, “Dermatitis Repens,” Jour. Amer. Med. Assoc, Dec. 20, 1902,
p. 1581 (1 case, with a review of recorded cases); Sutton, “A Comparative Study of
Dermatitis Repens and Acrodermatitis Perstans,” Jour. Cutan. Dis., 1911, p. 325,
with review of the Radcliffe-Crocker cases and of the features of the Hallopeau cases
(acrodermatite suppurative continué), report of 2 new cases resembling former, and 1
new case resembling latter, with histology and bacteriologic findings—with positive
conclusions as to their clinical and pathologic identity; animal experimentation prac­
tically negative; the organism probably some particular strain of the Staphylococcus
pyogenes aureus or albus.

394

INFLAMMATIONS

oozing surface, and beyond, on the old part, a dry or but slightly moist,
red surface. In some instances the border portion may show some
crust-formation. Exceptionally the malady may spread with a super­
ficial elevated vesicular wall, and, as it extends, the older part collapses
and dries, resulting in a somewhat scaly surface.

The disease may invade a considerable area; it may start at a finger
and traverse the entire arm, and even extend on to the trunk. Mod­
erate cases may not involve more than a greater part of the hand and
the lower part of the forearm. In fact, it may not extend beyond a small
area—as, for instance, over a ringer or a finger and small part of the
hand. It is generally slow in its progress, but exceptionally, as in the
case pictured, quite rapid, covering the surface shown in a period of about

Fig. 98.—Dermatitis repens in a middle-aged woman, of about a week‘s duration,
beginning at a cut shown on the thumb, and followed by progressive serous epidermic
undermining extending down the fingers, across the hand, and up the wrist.

one week. There seems but little, if any, tendency to spontaneous cure.
It is usually seen starting on the finger or some part of the hand, and
rarely elsewhere.

A closely similar and, doubtless, allied condition is acrodermatitis
perstans (acrodermatites continués of the French), in which the erup­
tion is more of a vesicular and pustular nature, the first lesions being
vesicles or pustules. Beginning usually on one finger, it may remain
localized for some time, gradually, by the development of fresh foci,
involving other fingers, the nail regions, and parts of the hand. Other
regions of the body may show a secondary erythematosquamous
eruption.

Etiology.—An injury, usually slight in character, such as a cut

THE IMPETIGOS

395

or a burn, appears to be the starting-point of the disease, probably
from a peripheral neuritis. It would seem to me that the malady is due
to parasitic invasion, the break of continuity affording opportunity
for inoculation. Or a peripheral neuritis may be the causative agent.
It is possible that both factors may, as Crocker states, be etiologic, the
neuritis primary, and parasitic invasion secondary.

Diagnosis.—The disease somewhat resembles eczema rubrum;
but its origin from an injury, method of spread, the elevated vesicular
or bullous spreading wall, usually with the loosened or projecting rim
of epidermis, and the red, oozing, and sometimes atrophic-looking surface
will prevent any confusion. Those cases beginning in a group of several
vesicles or bullæ may at first slightly suggest pompholyx.

Treatment.—The undermined and loose skin should be first
cut away. The few cases which have been under my own care were
cured by applications of a saturated solution of boric acid containing
2 or 5 grains (0.13-033) of resorcin to the ounce (32.); bathing the parts
with this morning and night, and while the surface is still wet with it,
covering over thickly with powdered boric acid, and enveloping in a loose,
light dressing. Should there be considerable oozing, sufficient to lead
to adherence of the enveloping dressing, then the under part of this latter,
in contact with the powder, can be slightly greased with petrolatum.
Once daily the affected area should be gently washed clean with warm
water.

Crocker cured one case by keeping the part constantly wrapped
up with linen cloths wet with lead lactate lotion; one with painting
on a 10 per cent, permanganate of potassium solution three times daily
until a crust is formed. Hardaway had success with an ointment of a
dram (4.) of aristol to an ounce (32.) of unguentum vaselini plumbicum.
Applications of a saturated solution of pyoktanin blue and a solution of
sodium hyposulphite have also been commended.

Hartzell found applications of formalin—1 dram to an ounce of glyc­
erin (4. : 32.)—to the spreading edges, followed by Brooke's paste (see
treatment of cutaneous tuberculosis), efficacious.

Hallopeau and Gastou¹ had results in 1 case (acrodermatite sup-
purative continué), which promised complete success, from x-ray treat­
ment.

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