Exfoliative dermatitis is a severe infectious lesion of the skin of newborns, which is a malignant variant of pemphigus. It is characterized by redness of the skin with the formation of sluggish blisters that transform into erosion. Starting in the mouth area, the process spreads to the entire skin and is accompanied by a pronounced violation of the general condition of the child. The diagnosis of Ritter’s exfoliative dermatitis is established on the basis of a typical clinic with the exclusion of other dermatological diseases with similar manifestations. Treatment consists in antibiotic therapy, administration of parenteral solutions and agents that increase antistaphylococcal immunity, treatment of affected skin areas.
L26 Exfoliative dermatitis
Exfoliative dermatitis (Ritter’s exfoliative dermatitis) is a special form of staphyloderma that affects infants of the 1st month of life. The risk group includes premature and weak newborns with impaired adaptive reactions to the external environment. The disease was first described in 1870 by Czech pediatrician Gottfried Ritter von Rittershain. The relevance and danger of exfoliative dermatitis in clinical neonatology is associated with a high risk of generalization of staphylococcal infection with the development of a septic condition.
In most cases, Ritter’s exfoliative dermatitis is caused by infection of the newborn’s skin with Staphylococcus aureus. Some authors point to the detection of mixed staphylococcal and streptococcal infections in sick children. Infection of a newborn can occur from the mother or medical staff. The immaturity of the barrier functions of the skin and immune mechanisms in children of the first month of life contribute to the development of the disease. In dermatology, cases of Ritter’s exfoliative dermatitis have also occurred in older children receiving immunosuppressive therapy.
Like epidemic pemphigus of newborns, Ritter’s exfoliative dermatitis usually develops in the 1-2 weeks of a child’s life. Typically, the onset of the disease begins with intense redness and lamellar peeling of the skin around the mouth and in the navel area. During Ritter’s exfoliative dermatitis, there are three stages: erythematous, exfoliative, regenerative.
- The erythematous stage is characterized by the rapid spread of redness (erythema) from the area of its appearance to the places of large folds, the skin of the anal area and genitals, and then throughout the body. The process is accompanied by swelling and the formation of large unstressed bubbles, which are quickly opened. There is a typical positive symptom of Nikolsky for all types of pemphigus. It is possible to damage the mucous membrane of the mouth and nose, the red border of the lips, the mucous membranes of the genitourinary organs.
- The exfoliative stage begins with the appearance of erosions on the site of the opened bubbles. Erosive defects increase in size and tend to merge with each other. Externally, the clinical picture of this stage of Ritter’s exfoliative dermatitis is similar to a grade II skin burn. The condition of the newborn is sharply disturbed. There are rises in body temperature up to 40 ° C, diarrhea, asthenization. The child sucks poorly and noticeably loses weight.
- The regenerative stage occurs with a favorable course of Ritter’s exfoliative dermatitis. There is a decrease in erythema and swelling, epithelialization of erosive surfaces. The process ends with the child’s recovery.
Mild forms of Ritter’s exfoliative dermatitis are characterized by an erased course without pronounced stages of skin lesions. After 2 weeks, there is a decrease in inflammatory phenomena and the end of the disease, accompanied by abundant lamellar peeling. Similar variants of the course of Ritter’s exfoliative dermatitis occur, as a rule, in older children.
The course of Ritter’s exfoliative dermatitis becomes extremely severe with the addition of septic complications: pneumonia, meningitis, otitis, pyelonephritis, acute enterocolitis, phlegmon, etc. In such cases, a fatal outcome of the disease is possible.
I diagnose Ritter’s exfoliative dermatitis on the basis of a rapidly developing and typical clinic, the infancy of the patients, the data of back-seeding of the separated blisters and erosions. To exclude early congenital syphilis, PCR diagnostics and an RPR test are performed. Differential diagnosis is carried out with:
- congenital ichthyosiform erythroderma,
- During ‘s herpetiform dermatitis,
- herpes simplex,
- syphilitic pemphigus,
- bullous form of simple contact dermatitis.
Treatment of newborns with Ritter’s dermatitis is carried out in a cuvette. Parenteral administration of cephalosporin antibiotics (cephaloridin, cefazolin, etc.), antistaphylococcal plasma and antistaphylococcal gamma globulin has been shown. In order to detoxify and prevent dehydration, infusion therapy with dextran or complex saline solutions is carried out. Probiotics are prescribed to prevent the development of dysbiosis against the background of antibiotic therapy.
Healthy areas of the skin are treated with salicylic alcohol or fucorcin. Bubbles are opened. Sprays or ointments with antibiotics, naphthalan liniment, zinc oil, powders with xeroform are applied to the affected areas. A daily change of linen and baths with potassium permanganate are required.
Ritter’s exfoliative dermatitis is an infectious disease. To prevent its spread, patients are placed in separate boxes, mothers and staff are examined, mandatory quartz wards and other quarantine measures are carried out.