Eczema and Hemolytic Streptococcal Disease in Children *

In discussions of eczema, brief mention is usually made of the fact that superimposed infection often complicates the disease, but one does not gather that the secondary malady is regarded as a factor which may be of prime importance in determining the clinical pattern of the sickness. The parasites may be viruses, fungi, or bacteria and the infection may be single or multiple in etiology. Examples of grave virus infection in cases of eczema are seen in certain patients with generalized vaccinia and in those with the "pox-like" disease associated with eczema recently described from this Clinic by Wenner;18 in both circumstances, the secondary disease is more serious than is the primary. An example of serious bacterial infection of eczema is furnished by hemolytic streptococcal disease associated with atopic dermatitis. The importance of this condition came to light in the course of studies on streptococcosis" 2, 13 which have developed in this Department under the stimulus -of Dr. Trask. In the various clinical patterns of hemolytic streptococcal disease in children, lesions of the skin and its appendages are important-erysipelas, cellulitis, pyodermia, ecthyma, paronychia, and some cases of impetigo contagiosa and pemphigus neonatorum. In Table 1 may be found data on the relative incidence of certain skin infections due to the hemolytic streptococcus as observed on the Pediatric Service (in-patients) of the New Haven Hospital during a period of six years-three years before the introduction of the sulfonamides and three years thereafter. The patients who had streptococcal dermatitis of whatever type often, indeed usually, suffered from streptococcal fever, and rhinopharyngeal cultures were positive for the hemolytic strepto-