The Problem of Eczema in Infancy

The clinical picture of eczema as it appears in infants and young children is sufficiently characteristic to be readily recognized. The earliest lesions consist of minute, pale pink papulo-vesicles which erupt in small groups and at first are set in non-inflamed skin, although the pale pink background soon appears. The eruption is usually symmetrical and in infants most commonly first arises on the cheeks just in front of the ears (Fig. i). Friction, or the application of irritants, such as penicillin ointment or cream, usually quickly aggravates the affected area of skin, and a brighter redness with some oedema indicates that a frictional or a contact dermatitis has been added to the eruption. Secondary infection with pyogenic organisms will also produce a similar picture of dermatitis, but the pattern of the primary eczematous eruption and the subsequent changes, to be described, clearly indicate that we are dealing with a hypersensitive skin which presents the peculiar pattern of reaction that is called eczema. Because erythema, oedema and exudation are almost constant factors in the eczematous reaction, and these are fundamentally inflammatory reactions, the term 'dermatitis' can also be applied to the eruption. However, for many dermatologists the term eczema does bring to mind a clinical picture as sharp in its definition as psoriasis or lichen planus, and it is felt that the term is almost universally adopted to designate the eruption which is peculiar to a hypersensitive skin. This hypersensitivity can be inherited or acquired, but in infants and young children there is good reason to believe that the hypersensitivity is largely inherited and familial cases are common.