Infectious Eczematoid Dermatitis
Filed under: 3.2 - Infectious Eczematoid Dermatitis(Bacterial Eczema, Infective Eczema)
There is a distinction between secondarily infected eczema and bacterial eczema. In the former, the eczema is not caused by bacteria; it simply has bacterial infection engrafted upon it-in the latter, low-grade bacterial infection usually without pustulatioii and often bacterial sensitization as well are contributory or even primary causes of the eczema. Originally by “infectious eczematoid dermatitis” was meant an eczema caused by the irritating effects on the skin of a purulent discharge from such a focus as a chronic otitis media, a draining sinus, or a boil. In pedi-atric practice before the days of antibiotics this used to be fairly common in children whose ears ran all winter, as they often did.
In the last few years this conception of bacterial eczema has been somewhat broadened. It is recognized that many eczemas which show no gross evidence of infection are kept active by low-grade infection and by allergic sensitivity to the infecting organism, and that treatment must be combined antieczematous and antibacterial. Cultures are of little use in diagnosis, for the organisms which cause the trouble are, as a rule, the same which can be recovered from normal skins (Staph. aureus and occasionally beta hemolytic streptococcus). Although the bacterial flora of the eczema lesions is not likely to be any different qualitatively from that of the normal skin, it is very different quantitatively; the number of bacteria is enormously greater. This has been especially emphasized by Storck.3 And what is even more important, he obtained positive patch tests in many patients with suspensions of bacteria recovered from their own eczema lesions. Bacterial eczema is likely to be chronic, thickened, often somewhat oozy and crusted in acute exacerbations, and usually rather sharply circumscribed. It is common behind the ears in combination with localized seborrheic dermatitis of the scalp, and on the face and backs of the hands in infants, although it may occur on any part of the body. The eczematous skin is a skin with diminished resistance, and the products of inflammation make excellent culture media for bacteria; it seems likely that they may play a part in almost any fairly deep-seated moist and crusted eczema.
The treatment of bacterial eczema is a combination of treatment directed against the eczema and against infection (see atopic dermatitis). Antibiotics given internally are often worth while, but they are not likely to accomplish as much as they do in secondarily infected eczema with pustulation. Antieczematous and antibacterial local treatment is likely to do more good, but it is very difficult to get rid of bacteria in a deep-seated patch of eczema. Staphylococcus toxoid and vaccine have been highly recommended by some-others say they are of little value. I have not had enough experience with either to be able to express an opinion that would mean anything.
The boy shown in Fig. 14 was about 3 years old. The large areas on his cheeks began as small “spots” when he was about 2 years old and gradually spread. There was never any eczema anywhere else on his body. The cheeks had been treated with many ointments and lotions, without result. Neomycin ointment produced remarkable improvement in a short time.
Fig’. 14.-Infectious eczematoid dermatitis in a child of 3 years. Ordinary atopic dermatitis is uncommon on the face at this age.
I think it is probably true that almost all oozy and crusted eczemas of the scalp and face with much detritus in young babies, even if they are not ordinarily classed as bacterial eczema, are aggravated by bacterial infection, and it is a good plan to give penicillin orally as a routine to such patients for a short time, and to continue it if it has produced good results.
Leave a Reply