THIS DISCUSSION of dermatologic therapy contrasted the opinions of an empiricist, Dr. Perlman, with those of a nihilist, Dr. Falk. Both speakers based their comments upon personal experience. Participants were forewarned that these remarks would frequently be contrary to classic dermatologic teaching.
Histologic examination reveals that the infant's skin lacks a well-developed stratum corneum. This keratinized outer layer of the epidermis is loosely organized and lace-like, thereby providing a poor defensive barrier against the entrance of bacteria. Poor cornification also explains the frequency of weeping, exudative dermatoses during infancy. Fungus infections of the skin are rare during infancy because the loose stratum corneum does not provide a favorable surface for superficial growth of fungi. The delicacy of the infant's skin and its scanty protective cornification make it particularly vulnerable to damage by overtreatment. Indeed, 40% of the dermatoses seen by dermatologists today are due to the effects of overly-enthusiastic topical therapy.
Dermatologic problems commonly seen by pediatricians were discussed under the following general headings:
(1) Eczematous dermatoses: contact dermatitides, dermatitis venenata (poison ivy), diaper dermatitis, intertrigo, infectious eczematoid dermatitis, atopic dermatitis, atopic erythroderma, nummular eczema and circumscribed neurodermatitis.
(2) Pyodermas: dermatitis exfoliativa neonatorum (Ritter's disease), impetigo contagiosa, ecthyma, erythema streptogenes, dermatitis gangrenosum infantum and periporitis staphylogenes.
(3) Maculopapular squamous dermatoses: pityriasis rosea, seborrheic dermatitis (cradle cap), psoriasis, parapsoriasis, lichen planus, pityriasis rubra pilaris, lichen nitidus and lichen striatus.
Comments regarding the diagnosis and treatment of certain of these conditions, which seemed to be of special interest to participants in the round table discussion, follow.
DERMATITIS VENENATA (POISON IVY)
The irritant principle of poison ivy is a dihydric phenol, urushiol, a catechol-like substance which is contained in every portion of the poison-ivy plant, including leaves, stem, flowers and fruit.
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