[Reprinted from the Journal of Cutaneous and Genito-Urinary Diseases, August, 1895.J 
A CASE OF DERMATITIS EXFOLIATIVA NEONATORUM. 
By DAVID KIRK WHITE, M. D., 
THE extreme rarity and unusual fatality of the disease described 
and identified by Ritter von Rittershain render the report of 
all such cases of considerable importance, as well as any addi- 
tional light which may be thrown on the aetiology of the disease. 
With these objects in view, I desire to place on record the case of 
baby W., male, fifth child, born February 25, 1895, of healthy but 
somewhat nervous, excitable parents, giving no history of any heredi- 
tary taint whatever. The child was well nourished and performed all 
physiological functions normally. The umbilical cord sloughed off 
in five days, the umbilicus healing without further trouble three days 
later. The sanitary surroundings were not good ; the child, however, 
received good attention, was properly washed, well dressed and cared 
for in every particular. Ten days after the birth of the child the 
draught damper in a hard-coal stove in the child's room was carelessly 
closed tight, causing a very noticeable amount of gas to escape in the 
house-sufficient, indeed, to cause the mother, who lay in an adjoining 
room, to have marked dizziness, followed by a violent headache lasting 
for almost twenty-four hours afterward. In the child were noticed 
drowsiness, bronchial irritation, and lividness of the skin. The house 
was promptly cleared of the gas, and no further immediate deleterious 
effects were noticed. Two days after this incident the child's forehead 
and face became the seat of a dark-red eruption, followed secondarily 
by numerous minute sudamina, and thirdly by complete exfoliation 
of the epidermis covering the affected areas, and within from forty- 
eight to sixty hours the entire body and limbs were implicated in some 
stage of the diseased process in the order named. Flakes of epidermis 
as large as a Columbian postage stamp could easily be detached, by 
mechanical means, from the body and limbs, while without interfer- 
ence it was shed in much smaller segments. Four irregularly shaped 
bullae formed on the anterior aspect of the body, and appeared to be 
simply the result of friction between the loosened epidermis and the 
inflamed rete beneath. A secondary squamous exfoliation took place 
from the body alone, consisting of dry, bright, silvery-white scales, 
generally about one centimetre in diameter, their original outlines hav- 
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Original Communications. 
ing been marked by fissures which were obliterated in the desquama- 
tion. The disease extended much more rapidly on the face and body 
than on the limbs, and the main severity of the case was shown on the 
body. There was no perceptible amount of moisture noticed at any 
time in the history of the case, excepting the bullae. Neither was the 
disease preceded by any unusual dryness of the skin. The mucous 
membranes were not affected, save a slight conjunctival injection with 
little exudation. The advent of the disease was unheralded by pre- 
monitory phenomena, nor did the system recognize its presence by any 
marked departure from the normal. The pulse and temperature were 
found by repeated examinations to be not far from the limits of health. 
The child greedily took its nourishment, slept soundly, and only 
evinced signs of discomfort or pain at being washed or handled, while 
the disease was at its height. In the earlier part of affection there 
was a slight ammoniacal odor from the urine. The bowels acted regu- 
larly, the faeces presenting no evidence of any disturbance of the digest- 
ive organs. The case yielded readily to treatment in fourteen days, 
consisting of a bath of a warm boric-acid solution, followed by a 
thorough application of an ointment of zinc oxide and bismuth sub- 
nitrate in lanolin, which was replaced later in the disease by one of 
ichthyol in lanolin. 
Up to the present date there have been no signs of a relapse or evi- 
dence of untoward sequelae. 
I have little to say in regard to the aetiology of the disease. 
No attempt was made to discover the fungus of Riehl. Since the 
gas from the hard-coal stove was the only recognized source of irri- 
tation the patient was exposed to, attention is necessarily directed 
to that fact. Whether the inhalation of the carbon monoxide could 
be a factor, in part or in toto, in the aetiology of this disease of the 
skin, even in the already susceptible skin of an infant not yet fully 
through the physiological desquamation incident to the age, either 
in the production of a dermal asphyxia by intercepting the supply 
of oxygen, or in the production of a dermal syncope brought about 
through the agency of the vaso-constrictor nerve centers in the cere- 
bral hemispheres or not, is a question. While the parasitic theory of 
Riehl is probably the most acceptable of the day, it must be admitted 
that peculiar and rare internal or external conditions are necessary for 
its development. If the carbon monoxide or the effects of its pres- 
ence in the blood were not the direct cause of the disease, it evidently 
furnished conditions favorable to the growth of the fungus. 
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