War Surgery and Medicine
Causes: The seborrhoeic constitution was again the commonest factor underlying cases of eczema. A characteristic variety was the chronic sweat dermatitis, or ‘dysidrotic eczema’, which affects seborrhoeics especially. It was uncommon for an eczema to have its origin in a fungous infection.page 693
Clinical Features: In a dysidrotic eczema the eruption runs closely parallel to the amount of sweating which occurs. The milder cases clear up entirely in the winter, only to recur when the hot weather comes round again.
There are the following three sites of predilection:
The dorsum of the toes and of the foot in their neighbourhood. This is greatest in the region of the big toe. This distribution distinguishes it from tinea, which affects the under surface of the toes and is greatest in the region of the little toe.
The hollow of the ankle behind the malleoli, more on the inner, and often continuous with the lesions on the instep.
The lesions of eczema are papules, vesicles, and scales. These may become confluent, giving rise to raw, weeping areas and large, red scaly patches. Itching is generally severe.
Treatment: As a routine the milder cases may be treated with calamine or lead and calamine lotion. Severer cases should be dressed daily with Lassar's Paste. In the chronic stages the best routine dressing is coal-tar paste—3 per cent of prepared coal tar in Lassar's Paste.
In dysidrotic cases the feet should be washed frequently to remove sweat, but in all eczemas the actual affected areas should first be protected from soap and water by the application of vaseline. A bland dusting powder should be used in the socks.
The prognosis in cases of dysidrotic eczema severe enough to be incapacitating was poor. Hospital treatment and X-ray therapy cleared them up, but they rapidly recurred when the soldier returned to duty in hot weather. It was best for them to be regraded.