Exfoliative dermatitis of Ritter
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Description:
Exfoliative dermatitis of Ritter is caused by staphylococcus of the II phage group, fagotipy 71 or 55/71, is the most severe form of a staphyloderma of newborns and is considered as a malignant kind of a piokokkovy pomfigoid. Point out both epidemiological and clinical data identity of both diseases though a peculiar picture is inherent to exfoliative dermatitis. Between them points to close connection that at some children having exfoliative dermatitis, the disease begins with emergence on skin of the separate bubbles characteristic of a piokokkovy pempigus.
In the presence of recurrent diseases with a staphyloderma in a maternity home exfoliative dermatitis the most weakened newborns get sick, is more often premature, been born with a small weight or children full-term with a normal weight, but injured in labor. A certain dependence comes to light between disease severity and age of the child in whom it begins. If Ritter's disease arises for the 2-4th day of life, then it proceeds much heavier, than at its development on the 2-3rd week after the birth.
Symptoms of Exfoliative dermatitis of Ritter:
Allocate three stages of a disease:
1. erythematic
2. exfoliative
3. regenerative
The disease begins with reddening, cracks, exfoliating of upper layers of epidermis around a mouth or about a navel. Further there is a serous treatment of skin and there is an epidermolysis, i.e. there is epidermis amotio from a derma that very reminds a burn of the II degree. Process quickly, sometimes during 6-12 h, extends from the head from top to bottom, taking all body. In other cases the disease begins, as at piokokkovy pemphigoid, t. е there are on not changed skin bubbles which quickly increase in sizes, merge and, being broken off, leave the derma bared from epidermis.
Sites of skin between bubbles externally seem absolutely normal, but they actually are exposed to the same changes, i.e. under the influence of serous treatment of skin communication between epidermis and a derma weakens, and from the slightest touch there is an epidermis otkhozhdeniye and if to pull for the hanging-down bubble remains, then epidermis slips as a stocking or a glove (a positive symptom of Nikolsky). After permission of process of hems does not remain. The general condition of such patients heavy, temperature quite often raises to 40-41 °C. At a biochemical blood analysis the gipoproteipemiya with the disproteinemia phenomena is found. Quite often there are complications (pneumonia, otitises, phlegmons, abscesses, pyelonephritis and so forth). In clinical blood test: hypochromia anemia, a leukocytosis with shift to the left, increase in SOE.
Reasons of Exfoliative dermatitis of Ritter:
Activator: the golden staphylococcus of the II fagogruppa emitting the exfoliative toxin causing a massive acantolysis in epidermis and formation of large superficial bubbles.
Treatment of Exfoliative dermatitis of Ritter:
Parenterally enter antibiotics with preliminary definition of sensitivity (cephalosporins, Fusidinum sodium), intravenous injection of anti-staphylococcal plasma, albumine, intramuscular administration of anti-staphylococcal immunoglobulin, Thymalinum is shown. Daily bathtubs from potassium permanganate 1: 10 000 and change of linen. Opening of bubbles, processing of healthy skin fukortsiny, salicyl alcohol, prokipyachenny vegetable oil. On the centers — pastes and ointments with antibiotics, zinc oil, naftalanovy linimentum, aerosols with antibiotics. The general Ural federal district. Isolation of children to boxes and careful care of them is necessary. Inspection of mothers and medical staff on a carriage of pathogenic stafilokokk. Quartz treatment of chambers, boxes. Disinfection of departments, quarantine actions.
