Atopic Erythroderma

What I have called “atopic erythroderma” is atopic dermatitis, but it is a rather special form of atopic derma­titis, and warrants separate discussion. It may begin in a baby 3 or 4 months old, exactly as Leiner’s disease does, or it may develop from a severe and generalized atopic dermatitis. The skin is bright red all over, usually with extensive scaling. Vesiculation is not prominent. A marked general glandu­lar enlargement is one of the most characteristic features. These glands, particularly in the axillae, may be as large as walnuts, and often break down and suppurate.

Furunculosis, otitis media, pyelitis, and pneumonia are common. One striking feature is a blueness and coldness of the hands and feet; I think that this and the general glandular enlargement are the most important diagnostic signs. There is always a high white count even when there is no fever or other gross signs of infection. Most of the in­crease in white count is made up of eosinophils, which may reach 50 per cent of the total white cells. There is usually a strong seborrheic element, and the appearance of the skin may sometimes be almost exactly that of Leiner’s disease.

I look upon this syndrome as a combination of atopic and seborrheic dermatitis, and in the last few years have become convinced that over­growth of staphylococci or strepto­cocci on or in the skin and probable sensitization to them plays a dominant role in the clinical picture, and is the main reason why treatment is so un­satisfactory. The general glandular enlargement, the tendency of these glands to suppurate, the frequent occurrence of furunculosis, the high white count, and the frequent epi­sodes of fever, all point to infection.

Furthermore, it is not uncommon for the mother to develop small infected papules or pustules on her left fore­arm where the baby rubs his face when she is holding him, and she holds him a good part of the time because she has to rock him in order to keep him quiet. These babies not uncom­monly die. A few years ago I went over the autopsy protocols of twenty-six of them who had died in the In­fants’ Hospital. Nearly all died from infection, plus poor nutrition-septicemia, pneumonia, pyelitis, or otitis media. The most common organism recovered was the Staph. aureus.