Exfoliative dermatitis (Ritter dermatitis) is the result of vital activity on the surface of the skin of Staphylococcus aureus. The named disease is characterized by a severe course and manifestations of intoxication of the body. More about this pathology will be discussed later in the article.
How does infection with exfoliative dermatitis occur
Most often, newborns suffer from Ritter dermatitis. This is due to the imperfection of the immune system in the newly born babies and the structural features of their skin. Particularly susceptible to this pathology are premature babies or those born with low weight.
Exfoliative dermatitis in newborns may appear already on the second day after birth or after one to two weeks. By the way, the earlier this disease develops, the more severe it is.
Infection with pathogens comes from the mother or the staff of the hospital and is accompanied by damage and rejection of the epidermis.
Stage Dermatitis
The first symptoms of dermatitis (erythematous stage) are redness and exfoliation of the skin around the mouth, navel and in the natural folds (around the anus, genitalia and neck). The pathological process very quickly, within 6-12 hours, spreads to the whole body of the baby. It becomes hyperemic, swollen, bubbles appear on the skin filled with a clear liquid. Often affected the mucous membrane of the mouth and genital organs of the crumbs.
In the second stage, occurring on the second or third day from the onset of the disease, exfoliative dermatitis is manifested by the opening of blisters, in the place of which weeping erosion occurs. And around them, in seemingly unaffected areas, the skin is easily exfoliated (the so-called Nikolsky syndrome). By the way, outwardly it all reminds a severe burn.
At the same time, the baby's temperature can rise up to 40 ° C, he suffers from indigestion and dehydration, as he does not suckle well. The child cannot sleep, is rapidly losing weight, and death can occur without proper treatment.
The third stage of the disease is regenerative. As its name implies, the child is gradually recovering: erosion heals, hyperemia and swelling go away, and the general condition of the baby is normalized.
Features of the course of dermatitis
Exfoliative dermatitis in newborns is not only dangerous in itself. This disease, which, in the absence of adequate treatment and care for a sick baby, can lead to the development of purulent foci of infection at the site of erosion, which, in turn, will provoke a worsening of the course of the disease. And complications of this pathology can be otitis media, pneumonia, meningitis or peritonitis.
In medicine, three degrees of severity of the described pathology are distinguished.
- A mild degree has blurred clinical signs and poorly distinguishable stages of the disease. Recovery occurs already on the 10th day from the onset of the disease.
- In a moderate degree, the stages of the disease are clearly distinguishable, the symptoms are pronounced, but there are no complications, and the baby is recovering safely.
- A severe course involves the attachment of a secondary infection and purulent inflammatory diseases of other organs. Sometimes the infection enters the bloodstream and the disease is complicated by sepsis. Fortunately, with timely and appropriate treatment, this is extremely rare.
What causes exfoliative dermatitis in adults
In adults, the described pathology is much less common than in children (1-2% of people over 50) and develops against the background of existing serious diseases that greatly reduce immunity. These include diabetes, malignant tumors and various forms of heart disease. True, it should be clarified that in 30% of cases, doctors still fail to establish the cause of erythroderma (this is also called this disease). Moreover, the ratio of the occurrence of the pathological process in men and women is 5: 1.
An important role in the risk of dermatitis exfoliative is played by burdened heredity and congenital diseases. In some cases, erythroderma may be a toxic reaction to taking certain medications or the result of existing psoriasis or drug allergies.
How does exfoliative dermatitis occur in adults
In adults, the features of the course of the disease largely depend on physiological factors and the general health of the patient. In most cases, the pathology is manifested by redness and peeling of the skin. And, which is typical, it can be sloughed from the slightest touch even in seemingly healthy areas.
The patient experiences severe itching, blisters form on the surface of the skin and, after opening, erosion. Lymph nodes increase and temperature rises. Patients often complain of a feeling of chills, cold.
Dermatitis exfoliative proceeds, as already mentioned, with different intensities. With its rapid development in the patient, thick crusts form on the body, which crack, delivering painful sensations.
Diagnosis of the disease
It is not difficult to diagnose Ritter's exfoliative dermatitis, since its symptoms are usually pronounced. A positive Nikolsky's syndrome (easy separation of the upper layer of the epidermis around erosion) gives another opportunity to accurately determine the disease.
Laboratory studies can eliminate the presence of burns and determine the pathogen, for which the contents of the blisters are taken for sowing. Differential diagnostics are also carried out, comparing the course of the disease with pemphigus, epidermolysis bullosa, phlegmon, ichthyosis and contact dermatitis.
Principles of treatment of exfoliative dermatitis
If you suspect exfoliative dermatitis (a photo of the symptoms of which you can see in the article), a separate room (box) is provided for the mother and the sick child. The treatment consists of injections from antibiotics and plasma containing antistaphylococcal gamma globulin.
To avoid dehydration, the baby is given infusion (drip) hemodesis and polyglucin. And at the end of the course of antibiotic use, probiotics (bifidumbacteria) are prescribed.
The skin of the baby is treated with a weak solution of salicylic alcohol or furatsilina, and the bubbles are opened and zinc oil and antibacterial ointments are applied . Exfoliative dermatitis also involves daily bathing with the addition of a weak solution of potassium permanganate to the water . In this case, the newborn is not worn so as not to cause pain, and ironed clean diapers are sprinkled on top with medical talcum powder or zinc oxide. It is also recommended to shift the baby as little as possible to avoid separation and desquamation of the skin.
In severe cases, the baby is placed in a couvez (incubator), where a certain temperature and humidity is maintained.
How to avoid the disease
Exfoliative dermatitis, a photo of the manifestations of which in children and adults you can see in the article, is prevented only by strict adherence by the mother of the newborn to basic hygiene rules in the postpartum department and wearing a gauze bandage.
Maternity staff are required to regularly quartz the ward of newborns, clean and change bedding, and regularly check for Staphylococcus aureus.
In adults, this disease is prevented by avoiding allergens that can cause dermatitis, timely treatment of any kind of inflammation or irritation on the skin, adhering to a diet and maintaining immunity in good condition.