Definition And Description

Impetigo contagiosa is a contagious affection of the skin, characterized by the appearance of vesicles subsequently drying into peculiar crusts. It commences not unfrequently with constitutional symptoms of a pyrexial character, varying in severity In different cases. In two or three days, one or more small vesicles may appear upon any portion of the cutaneous surface. These gradually enlarge for a few days, then dry into thin light yellowish or straw-colored scabs or crusts. The vesicles and crusts may be indefinite in number, and successive eruptions may prolong the disease for several months. During the progress of the affection, associates - adults as well as children - may contract it. Inoculation with the fluid contained in the vesicles will give rise to similar lesions.

Removal of the crust reveals a slightly reddened surface, with very little or no moisture, and no ulceration or even erosion of the surface, the lesion being extremely superficial. After the spontaneous fall of the crust, a bluish-red macule or stain is left, which gradually fades away.

The affection sometimes follows shortly after vaccination, generally within the second or third week after falling of the crust.

Diagnosis

The diagnostic features of this affection are specially. dwelt on by Tilbuby Fox, who gave it the name it now bears. "They are," he says, " its apparently epidemic character in many cases; the antecedent febrile condition; its attacking children;* the origin from isolated vesicles, which tend to enlarge into blebs and to become pustular, the bleb having a depressed centre, and it may be a well-defin-slightly raised, rounded edge; the isolation of the spots; the uniform character of the eruption, and its general and scattered condition; its frequent seat and commencement about the face or head; the circular, flat, granular, yellow crusts, looking as if stuck on; its contagious nature and inoculability, its frequently following in the wake of vaccination; the absence of pain, and especially troublesome itching at night

The affection is to be differentiated from eczema, pemphigus, echthyma. scabies, and syphilis, for all of which I have known it to be mistaken

Prognosis

The prognosis is good, as the affection is readily amenable to appropriate treatment.

Etiology

The disease is eminently contagious, and I believe the contagious element to be a fungous growth which is plentifully distributed through the crusts. The same fungus is found in vaccine trusts, which explains our ability to trace the affection in so many cases to a recent vaccination. I have elsewhere (155, June and July, '72) given in detail the evidence on these points.

Treatment

The treatment of this affection is exceedingly simple; all that is necessary is to remove the crusts and to apply a mercurial or a sulphur ointment, two or three times a day, and in a short time all traces of the affeection wil1 disappear, except the macules, which mark the previous site of the eruption. These gradually fade, and ultimately the skin assumes a normal aspect, without mark or scar.

* I have seen it in adults. - H.G. P.