848 Eczema. 



portions of the skin become reddened, whereupon a serous in- 

 tiltration also forms (stadium erythematosum ; s. Eczema 

 erythematosum), the celhilar infiltration being at this time quite 

 inconsiderable or completely absent. In consequence of the 

 serous and later the cellular infiltration, single groups of papilla^ 

 swell and are raised above the adjacent tissue in the form of 

 small nodules (Eczema papulosum). 



If the cellular infiltration becomes more intense, the hTiiph 

 spaces between the cells of the Malpighian layer widen, and 

 small vesicles are formed, up to lentil size, which are filled with 

 a clear serous fluid, the outer (Unna) walls of which are formed 

 by the horny layer, while the base is in the rete mucosum or the 

 stratum germinativum (Eczema vesiculosum). It is generally 

 supposed, however, that the vesicles may also form by liquefied 

 prickle cells, but this is denied by Unna. White blood corpuscles 

 rarely enter the interior of the vesicles in sufficient quantity to 

 give to the contents a purulent nature (Eczema pustulosum). 



If the numerous contiguous vesicles burst by rubbing, are 

 torn by scratching, or if the horny epidermal layer of the dis- 

 eased skin becomes chafed, then the corium, scarcely covered by 

 1 or 2 layers of epidermis cells, becomes exposed and oozing 

 serum appears on its surface, in consequence of which its red, 

 fine grained exterior becomes very moist (Eczema rub rum et 

 madidans). (After isolated vesicles have burst spots form 

 in size up to that of a lentil, which are moist but not red. They 

 may be found in ev^ery stage of eczema but are not an integral 

 part of weeping eczema.) 



In consequence of desiccation of the oozing serous fluid or 

 of the pus, yellow or brown crusts form which soon are loosened 

 or become thicker by coagulation of the fluid which continues to 

 be secreted (Eczema crustosum). If as a result of more inten- 

 sive inflammation many white corpuscles emigrate, a green 

 layer of pus is formed under the scabs or on the bare skin 

 (Eczema impetiginosum). With the cessation of the inflamma- 

 tion the exudate lessens, a layer of epidermis cells consisting of 

 several series forms under the protection of the dry scab, and 

 in course of time the crusts fall off. 



The inflammatory process may be arrested in any of the 

 above mentioned stages, but healing only occurs by the inter- 

 mediation of one of the subsequent stages. But to wjiatever de- 

 gree the eczema may have developed, the skin remains hyperemic 

 and scaly for some time before it heals completely (Eczema 

 squamosum). If, however, vesicles or moist spots have formed, 

 then the stage of desquamation will in every case be prefaced 

 by the formation of crusts. 



In this form the disease may last for 3 to 6 weeks (E, 

 acutum). After an inflammation continuing for more than 3 to 

 6 weeks, the papillae increase in size, the lymph spaces remain 

 distended, the connective tissue proliferates and becomes harder, 

 often the layer of prickle cells thickens, in other cases the horny 



