DERMATITIS REPENS

Dermatitis repens is an inflammatory disease, be-
ginning as one or more vesicles or blebs or excep-
tionally as a papule, which extends peripherally by
a progressive undermining of the epidermis. The
disease is encountered almost exclusively upon the
upper extremities and begins most frequently upon
the fingers. Its point of origin is often at the site
of some trauma which makes a portal for the in-
fection; it may start from a paronychia. The con-
tent of a bleb is turbid serum or thin pus. When
there are more than one primary lesion all are
in the same region and in a short time they coalesce.
Sooner or later the layer of elevated epidermis
ruptures and uncovers the smooth, red, moist, raw
looking floor of the bulla. As the peripheral under-
mining progresses the first denuded surface may
dry and heal but its thin epidermal covering long
retains a red, tender and atrophic look. The ragged,
partially detached rim of cuticle is of variable width.
On the volar surface of the hand where the epi-
dermis is thick the undermining is often consider-
ably more extensive than a superficial inspection
would seem to indicate. On other portions of the
limb the advancing edge of the lesion is more often
marked by a seam of inflammatory redness or a
ridge of epidermis elevated by the sero-purulent

exudate beneath. Occasionally portions of the
loosened cuticular rim dry and become again more
or less closely adherent to the floor of the lesion
in the form of broad grayish scales. Quite rarely
the disease spreads without any noticeable exuda-
tion in which case there is a progressive reddening,
loosening and scaling of the epidermis. The dis-
ease develops slowly as a rule, and, although it may
last for months and exhibit little tendency to spon-
taneous recovery, nevertheless it will usually be
found confined to comparatively small regions.
However, it has been known to extend over an
entire limb and onto the trunk. The denuded sur-
face burns and is tender but subjective symptoms
as a rule are not pronounced. DIAGNOSIS: The
red, weeping patch resembles an area of eczema
rubrum, but is to be distinguished by its well de-
fined border and undermined edge and the shiny,
atrophic appearance of its healed portion. TREAT-
MENT: It is very essential to remove all the
loose, dead skin. The disease yields best to dress-
ings of astringent antiseptic washes, as for ex-
ample liquor alumini acetatis. Saturated solutions
of lead lactate, of pykotanin blue, and a lotion of
sodium hyposulphite have been successfully em-
ployed.

HST.OOO.OO.I