Atopic Erythroderma Treatment

Filed under: 4 - Atopic Dermatitis

Treatment.-The two most impor­tant things in treatment are to eradi­cate infection in so far as it can be done, and to keep the baby in as good general condition as possible by giving him plenty to eat. He is in for a long sickness, no matter what is done, and adequate nutrition is of great importance to enable him to weather it. These babies are the most highly allergic people there are; their degree of sensitivity to egg white is terrific, and every one of them that I have  been able to  follow has later developed asthma or hay fever. In years gone by I did fairly com­plete indirect testing on twenty-three of these babies.

Fig.   25,-Atopic  erythroderma  without scaling.     Local   treatment:     petroleum   jelly, washing with pHisoHex

Fig.   26,-Atopic  erythroderma with slight  scaling.     Note   enlarged  glands   in  groin   and   poor nutrition.

There were reagins to egg white in twenty-three, to wheat in nineteen, and to milk in ten, and occasionally  reagins  to   other  foods and to dust and feathers. Removal of foods or environmental allergens does little or no good- these patients do no better in a hos­pital than at home. I am sure, however, that if they ate egg white they would have violent symptoms, and it is best to give them no wheat.

Fig. 27.-Severe atopic   dermatitis,   changing  later  to  atopic   erythroderma.     Before   extensive scaling”.    Note normal skin in diaper area.     (From Brennemann’s Practice  of  Pediatrics.)

Fig 28 – Atopic erythroderma. Same patient as in Pig. 27, three weeks later. Local treatment: petroleum jelly with 5 grains of salicylic acid to the ounce. (Prom Brennemann’s Practice of Pediatrics.)

A milk-free food does them no good; in­deed it may do harm, for diarrhea is to be avoided at all costs. For over ten years I have done no skin testing either direct or indirect on these babies and am able to treat them better now than I did previously be­cause after a good deal of useless dietetic treatment I have come to realize that food sensitivity is not the main cause of their trouble. For some years I have given them the diet mentioned before, consisting of milk, rice or oat, lamb, banana, squash, string beans, carrots, apple sauce, and Vi-Penta drops. I think they do better on a formula with half the cream removed, and with 3 or 4 added tablespoonfuls of Casec to the quart, as discussed under Seborrheic Dermatitis. I have also thought that large doses of ascorbic acid (100 mg. a day) possibly did some good.

Reduction of the bacterial flora of the skin and the prevention of any localized pyogenic infection are of prime importance, and it is best to give moderate doses of some antibiotic right along. This, however, does not produce any striking results.

Local treatment likewise is directed at antisepsis of the skin. For the arms and legs I use 2 per cent Vio-form either in petrolatum or in zinc oxide paste, depending upon the con­dition of the skin, or a mild tar paste. For the face, the same, and for the trunk, a mild vanishing type cream or plain petrolatum. I like to have these babies washed twice a day with pHisoHex, which is a mild antiseptic and may do some good. An alternative to this method of treatment is to dip the baby twice a day in a bath of 1 to 10,000 potassium permanganate solution and let him stay there ten minutes. I have sometimes seen this do very well, particularly if there is a tendency to oozing.

I think these measures do some good, but progress is slow no matter what is done. These babies are never cured quickly. Toward the end of the second year they recover. One of the first signs of beginning recovery is that the feet are no longer blue and cold. Then the enlarged glands begin to go down, the erythroderma gradually lessens and white patches of skin begin to appear. It is my im­pression that they do not have atopic dermatitis later in childhood, but I have not enough accurate figures to be sure of this.

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