Ritter's exfoliative dermatitis of the newborn.

The literature on exfoliative dermatitis of the newborn, first described by Ritter von Rittershain in i878, is meagre and almost all of the papers have been reports of sporadic cases which suggested a cause or were remarkable for recovery after some one or other method of treatment. What appears to be the extremely uncommon occurrence of the malady in Britain is supported by the fact that Hallez (I932) could not find a case report in the British literature up to 1925. Since 1925 I have been able to find only two papers by British authors. Bell and Woods (1942) reported a case satisfactorily treated with sulphapyridine; Bell mentioned that he had come across two other cases of typical Ritter's disease. MacGillivray in the same year published two cases in his care that recovered after proseptasine therapy. A survey of the literature gave rise to the question whether or not the few cases reported in Britain are a true reflection of the actual incidence in this country. All dermatologists and paediatricians are aware of this peculiar disease, but the published work shows disagreement over the identity of the disease, so that it can be assumed that the disorder has been and still is being diagnosed as a variant of pemphigus neonatorum. Ever since Behrend in I88o denied Ritter von Rittershain's claim to a new disease different views of its nosology have been expressed. Since Ritter von Rittershain's full account of his observations made on 297 patients admitted to a foundlings asylum in Prague; there has not been a series remotely comparable with his. Ritter von Rittershain's convictions, evolved from so many cases under his care, should carry more weight than impressions derived from prominent features in a few patients. A relevant point is that as a result of Ritter von Rittershain's description of a disease unrecognized until he made known his observations, the condition was looked for retrospectively. Although it was found in this way Hallez (1932) in the French literature could discover only seven that had adequate diagnostic criteria. Against this Ritter von Rittershain's figures had shown a high frequency of the illness in Central Europe. His 297 cases were collected from I868 to the end of the first half of I878, and averaged 30 a year in his own experience. Nevertheless by I932, when Hallez wrote, the incidence in Central Europe appeared to be decreasing and this he attributed to improved hygienic environment. On the other hand there is no evidence that in countries with a low standard of sanitation, dermatitis exfoliativa neonatorum is anything but rare. Dermatitis exfoliativa 'neonatorum, or Ritter's disease, is not specially or separately tabulated by the Registrar-General and so his medical statistical returns do not help to give any idea of the incidence of the disease in England and Wales. Perhaps (this is proposed with considerable reserve) an inkling may be got from the mortality figures for pemphigus neonatorum (which is tabulated separately) for there are those who regard Ritter's disease as essentially a malignant form of pemphigus in the newborn. The mortality returns for pemphigus neonatorum for the years I938 to I949 inclusive are given in Table I.