Exfoliative dermatitis of Ritter
Ritter’s exfoliative dermatitis is an infectious, severe disease that affects the skin of newborn children; it is a malignant variant of pemphigus. The disease is characterized by redness of the skin and the formation of sluggish bubbles, which transform into erosion. The process begins in the mouth area, and later spreads throughout the skin and affects the overall condition of the child. The conclusion of the diagnosis of Ritter’s exfoliative dermatitis is confirmed on the basis of a typical picture of the course of the disease, with the exclusion of other similar dermatological diseases. Therapy consists of taking antibiotics, administering solutions and means in the form of injections that increase immunity to staphylococcus, treating the affected areas of the skin.
Most often, the appearance of exfoliative dermatitis of Ritter is caused by infection of the skin of a newborn child with Staphylococcus aureus. Sometimes sick children are diagnosed with mixed streptococcal and staphylococcal infection. Infection of a newborn baby can occur from medical staff or the mother. Immaturity of the protective function of the skin and the immune system in newborns contributes to the development of the disease. In dermatology, cases of Ritter’s exfoliative dermatitis are also observed in older children who have been treated with immunosuppressants.
The content of the article:
Symptoms of Ritter’s exfoliative dermatitis
Erythematous stage
Exfoliative stage
Regenerative stage
Diagnosis of Ritter’s exfoliative dermatitis
Treatment of Ritter’s exfoliative dermatitis
Exfoliative dermatitis of Ritter
Symptoms of Ritter’s exfoliative dermatitis
Similarly with epidemic pemphigus of newborn children, Ritter’s exfoliative dermatitis usually develops in the first two weeks of a child’s life. A typical onset of the disease is intense redness and peeling of the skin in the navel area and around the mouth. There are three stages of the course of exfoliative dermatitis: erythematous, exfoliative, regenerative.
Erythematous stage
The first (erythematous) stage of the disease is characterized by rapidly spreading redness (erythema) from the place of its origin to places with large folds (the skin of the genital and anal areas), and then — all over the body. The process of spreading redness is accompanied by swelling and the appearance of large unstressed bubbles, which quickly open. The positive symptom of Nikolsky is a symptom characteristic of all types of pemphigus, characterized by peeling with light rubbing of the skin. Possible damage to the red border of the lips, oral mucosa, nose, genitourinary organs.
Exfoliative stage
The second (exfoliative) stage is characterized by the appearance of erosion on the site of the opened bubbles. Erosion elements increase in size and tend to merge with each other. In appearance, the manifestation of the disease at this stage resembles grade II skin burns. The general condition of the newborn baby is sharply disturbed. There is a high temperature, austenization, diarrhea. The child noticeably loses weight and sucks badly.
Regenerative stage
The third (regenerative) stage of the disease occurs when its course is favorable. There is a decrease in redness and swelling, epithelization of erosive elements. After that, the child recovers.
Mild forms of the disease are characterized by a difficult to recognize course without a pronounced skin lesion. After a couple of weeks, there is a decrease in inflammatory phenomena and the end of the disease, which is accompanied by abundant peeling of the skin. Similar variants of the development of Ritter’s exfoliative dermatitis are most often found in older children.
With concomitant septic complications (pneumonia, otitis media, meningitis, pyelonephritis, phlegmon, acute enterocolitis), it becomes very difficult to transfer Ritter’s exfoliative dermatitis to a child.
Diagnosis of Ritter’s exfoliative dermatitis
On the basis of a typical rapidly developing clinical picture, the infancy of patients, the results of back-seeding of separated blisters and erosive elements, Ritter’s exfoliative dermatitis is diagnosed. In order to exclude early congenital syphilis, an RPR test and PCR diagnostics are performed.
Differential diagnosis is carried out with congenital ichthyosis developing against the background of erythoderma, other types of dermatitis with the appearance of fluid bubbles characteristic of them: herpes simplex, During’s herpetiform dermatitis, bullous form of contact dermatitis, syphilitic pemphigus.
Treatment of Ritter’s exfoliative dermatitis
Newborn children with Ritter’s exfoliative dermatitis are treated in a cuvette. Injection of antibiotic drugs of the cephalosporin series (kefzol, tseporin), antistaphylococcal plasma, thymalin and antistaphylococcal gamma globulin has been shown. In order to prevent dehydration of organism and detoxification, it is necessary to carry out infusion therapy with polyglucine and hemodesis. Probiotics (lactobacterin, bifidumbacterin) are prescribed to prevent dysbiosis developed against the background of antibiotic treatment.
Healthy areas of the skin are treated with fucarcin or salicylic alcohol. The bubbles are opened, ointments or antibiotics are used for treatment, zinc oil, naphthalan liniment, powders with xeroform. You should change your underwear daily and make baby baths with potassium permanganate.
Ritter’s exfoliative dermatitis is an infectious disease. In order to avoid its spread, newborns are placed in separate sterile boxes, medical staff and mothers are examined, quartz wards and other quarantine measures are necessarily carried out. Do not ignore the wet cleaning. Nurses and doctors should wear gauze masks when they come into contact with newborn children.
It is important to keep the cleanliness of the house where the newborn will be after his discharge from the hospital.
