RITTERA DERMATITIS EXFOLIATIVE (G. Ritter, is mute. doctor, 1820 — 1883; Greek derma, dermat [os] skin + - itis; lat. exfoliare to tear off leaves, to otslaivat; synonym: Ritter's disease, exfoliative dermatitis of newborns, keratolysis neonatorum) — one of forms of a staphylococcal and streptococcal infection of newborns which is differing, as a rule, in a heavy current and characterized by the expressed intoxication and local changes of skin in the form of hypostasis, a hyperemia and amotio of epidermis. Ritterom is described in 1870. Etiologically it is close to other forms of a pyoderma of newborns (see. Pyoderma ). River of e. at the child the dignity is one of indicators adverse. - a gigabyte. conditions of a maternity home, chambers of newborns and poor quality of care of newborns, women in labor and women in childbirth.
Anatomo-fiziol. properties of skin and immunobiol. features of an organism of newborns promote easier penetration of coccal flora into an organism (see. Newborn ). Consider that rough reaction from skin with characteristic peeling of epidermis is a consequence of bystry intoxication as a result of implementation of a coccal infection.
The disease is shown at the end of the 1st — the beginning of the 2nd week of life of the newborn, at a severe form — on 4 — the 5th day, sometimes on 2 — the 3rd day of life; begins with emergence of redness and maceration of skin in a navel, cracks and exfoliating of epidermis about a mouth. Face skin, a trunk and extremities becomes edematous and hyperemic, there is its serous treatment. In a face, a neck, trunks, extremities appear the large bubbles having abortal character. Epidermis shrivels, there is its amotio not only in the field of erozirovanny sites, but also in places of externally not changed skin even at its easy potiraniye (Nikolsky's symptom). Full development of R. of e. reaches on 10 — the 11th from the beginning of a disease day: skin of the child reddens, on all body, including on palms and soles, epidermis exfoliates large layers. Mucous membranes of a mouth, a nose are surprised. On a trunk and extremities extensive erosion with bent to distribution and formation of continuous erosive surfaces (fig.) are formed. In the field of an umbilical wound maceration remains. Body temperature is subfebrile, sometimes rises to 40 °. At nek-ry children the disease proceeds without fever. The child badly sucks, loses flesh.
The leukocytosis with a deviation to the left is noted. Quickly enough hypochromia anemia can develop. Often there are dispeptic frustration.
There is more high-quality kind of R. of e., edges proceeds in the form of a lamellar peeling. At the same time single pustules and bubbles can appear only in the beginning; further unsharply expressed erubescence and a lamellar peeling without formation of erosion is noted. The general condition of the child is almost not broken.
the Diagnosis is made on the basis by a wedge, pictures. River of e. differentiate with a pemphigus of newborns (see. Pyoderma ), for a cut the bubbles filled with serous and purulent liquid and more high-quality current are characteristic; with phlegmon (see) newborns, the characterized hyperemia and consolidation of skin, a necrosis of hypodermic cellulose; with a violent epidermolysis, at Krom bubbles are located on extremities, usually in the places which are exposed to traumatization more often (see. Epidermolysis violent ); with a pemphigus at early inborn syphilis, at a cut on skin of soles and palms bubbles on the infiltrirovanny basis — papules appear at positive serol. reactions (see. Syphilis, inborn ). River of e. it is necessary to distinguish from an inborn ichthyosis, or an inborn ikhtiozoformny erythrosis of Brock, to-ry comes to light from the moment of the birth and it is characterized by lack of erosive surfaces and bubbles, existence on skin dense, reminding collodion, films and other signs ichthyosis (see), and also from the desquamative erythrosis of Leyner beginning with an intertrigo and formation of a so-called milk crust on the head in the first weeks of life of the child and further the shown reddening, infiltration and a scaly peeling of skin (see. Erythrosis ).
the Surface of skin several times a day is plentifully strewed with the dried-up sterilized powder (zinc oxide, talc, etc.) or greased with sterile sweet-almond, peach-kernel, sunflower-seed oil and daily do bathtubs with potassium permanganate. Sites with the expressed inflammation process 2% solution of silver nitrate. Appoint antibiotics, infusional therapy, gamma-globulin. When the struck surfaces become dry and the tendency to an epidermization comes to light, pass to the knitting bathtubs with oak bark, a tannin with addition of potassium permanganate. Carry out symptomatic therapy, appoint vitamins. The maximum rest shall be provided to the child (to avoid excessive touches, rearrangements). It is better to leave it without bandages and even diapers. For maintenance of constant body temperature of the child place in couveuse (see) or lay over hot-water bottles. It is necessary to pay attention to food. To the child appoint enough the decanted women's milk (it is forbidden to put to a breast). It is recommended to give tea in half with Ringer's solution.
The forecast and Prevention
the Forecast in the past heavy, in connection with use of complex treatment became more favorable.
Prevention consists in observance a dignity. - a gigabyte. the mode in a maternity home, treatment of a staphylococcal and streptococcal infection at mother during pregnancy.
Bibliography: Golosovker S. Ya. Skin and venereal diseases at children, page 37, L., 1963; Studnitsin A. A., Stoyanov B. G. and Sharapova G. Ya. Skin diseases at children, page 64, M., 1971; Round A. F. Fiziologiya and pathology of children of the period of a neonatality, page 210, L., 1955; Ritter von Rit-tershain G. Dermatitis erysipelatosa, Gangraena, Enkephalitis, Ost. Jb. Padiat., Bd 1, S. 23, 1870.
V. A. Tabolin.