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May 1992

On An Epidemic Skin Disease Somewhat Resembling Eczema and Pityriasis Rubra

Arch Dermatol. 1992;128(5):726. doi:10.1001/archderm.1992.01680150160034

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Under this title, the author describes a peculiar form of skin disease which apparently appeared in an epidemic form in the Lambeth Infirmary. The cases which occurred were 163 in number—89 males, 74 females—and they were observed between July 1st and October 31st, 1891 and represented 19.2 percent of all the patients who came under treatment during that length of time. His definition of the disease is: A contagious malady, in which the main lesion is a dermatitis, sometimes attended by the formation of vesicles, and always resulting in a desquamation of the cuticle; usually accompanied by a certain amount of constitutional disturbance and running a more or less definite course of seven or eight weeks.

The eruption presented three stages:

  1. A papulo-erythematous stage, which lasted from three to eight days.

    The eruption began as an erythematous papular rash, the skin being considerably thickened and indurated and in parts oedematous. The margin of the patch faded out and terminated sometimes with and sometimes without an abrupt raised edge, a few papules being scattered beyond. Instead of the papular rash, the first symptom was in some cases a raised blotch of congestion, having an abrupt margin and a circular outline, or in others, there were one or more flat papules which enlarged and resembled tinea circinata.

  2. Stage of exudation and desquamation—three to eight weeks.

    Confluence of the rash taking place, the appearances for days and weeks would be a crimson thickened and indurated surface, continually desquamating in scales and flakes of all sizes mixed with dried up exudation. According to the presence or absence of the latter, there were two varieties of the disease—a moist type, which ran a more rapid course and in which the papules became vesicles and a copious exudation, such as is seen in eczema, took place; the second variety, a dry one, was more prolonged, the skin remaining dry throughout, no exudation occurring and the appearances being those of a pityriasis rubra.

  3. Stage of subsidence.

    By degrees the inflammation subsided, the skin remaining thick, indurated, polished in appearance, brown in color, sometimes raw or smooth, shiny and parchmentlike, with cracks and fissures here and there. In some cases, eversión of the eyelids was noted and in some of the older people, a purpuric condition. . .

George T. Elliot.

J Cutan Genito-Urin Dis.

May 1892;10:207-209.

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