In March 1967, this 3-year-old boy developed diffuse scaliness of the scalp which was treated as impetigo with hexachlorophene (pHisoHex) and neomycin ointment without improvement. During May 1967, the crusted plaques extended on to the nucha and back, and flaccid bullae were noted for the first time. The patient was hospitalized and treated with injections of corticotropin (ACTH), systemic antibiotics, corticosteroid creams, and keratolytic ointments. Despite the treatment, the patient developed a generalized bullous eruption, sparing only the lower extremities.
Numerous flaccid vesicles and bullae, arising on erythematous and urticarial bases, involved the skin except the lower extremities (Fig 1). The entire scalp was covered with a thick crust and the external auditory canals were filled with scales. The child was extremely uncomfortable but was not acutely ill.
Kierland RR, Perry HO, Winkelmann RK, Muller SA, Sams WM. MINNESOTA DERMATOLOGICAL SOCIETY. Arch Dermatol. 1968;98(3):316-322. doi:10.1001/archderm.1968.01610150102025