Leiner's Disease

LEINER'S DISEASE (Leiner), erythro-dermia desquamativa, erythema neonatorum toxicum, Leiner-Moussous disease, a relatively rare disease first described by Leiner in 1907, who observed only 43 cases of this disease. The disease has an etiology that is unclear; it affects infants of the first months of life (1-3 months), who are most often, according to Beck, breastfed, although it also occurs in artificially fed children; it proceeds over a period from 2-3 weeks to 1-2 months; clinically it presents as a continuous erythema covered with large plate-like desquamation and spreading over the entire skin surface. The eruption almost never weeps or itches. - Etiology and pathogenesis. Leiner considers the disease to be an autotoxic erythema, considering the constantly existing intestinal disorders to be pathognomonic. Individual authors place the disease in connection with exudative diathesis, as well as with an increased fat content in maternal milk. Patho-anatomical changes are mainly reduced to the dilation of vessels and slight infiltration in the papillary layer of the dermis, significant edema of the epidermis, and sharply expressed phenomena of parakeratosis. - Clinical picture. The disease most often begins on the hairy part of the head, the lower part of the abdomen, and the inguinal region [see separate table (to article Lichen), fig. 2]. The disease quickly, at most within one week, spreads over the whole trunk and limbs. On the hairy part of the head there is a diffuse erythema with a moderate amount of scales and yellowish crusts; from here the disease spreads to the face, especially intensely affecting the eyebrows and eyelids, and then to the neck; eyelashes are often completely lost or preserved in insignificant numbers. On the face and extensor surfaces of the limbs, there is either continuous redness occurring immediately, or first small nodules of the size of a pinhead to a small lentil appear, covered with whitish scales. In the further course, these elements first merge into small plaques, and then, as a rule, pass into continuous involvement. In severe cases, superficial linear cracks form on the skin of the face, mainly around the mouth, which hinder sucking. The skin of the trunk is uniformly altered: continuous intense redness covered with large grayish-yellow scales and crusts. The latter easily detach and are quickly replaced by new ones. The skin under them is dry, shiny, and in places appears atrophic. In the skin folds the changes have an intertriginous character. On the palms and soles there is continuous redness with delicate desquamation; nails are thinned, grooved, and bumpy. Lymphatic glands are slightly enlarged, mobile, and of soft consistency. The mucous membrane of the mouth is free from involvement; there is always moderate diarrhea, and in severe cases the stool becomes frequent and with mucus; the temperature reaches 38°, in isolated cases 40-41°. As a rule, first a stop in weight is noted, and then a fall in it, which in severe cases can be very significant. Among complications, insignificant edema, purulent inflammation of the middle ear, pneumonia, and bronchopneumonia are noted. The prognosis of the disease is serious: in 34.9%, according to Leiner, and in 54-88%, according to Wittmann, a fatal outcome from disturbance of nutrition, pneumonia, or sepsis is observed. In cases that run favorably, there is a decrease in hyperemia, large plate-like desquamation is replaced by crust-like, and gradually the skin returns to normal. Restoration of normal weight and general condition occurs more slowly, on average within a period from 1 to 2 months. In differential-diagnostic terms, L. b. needs to be distinguished from Ritter's disease and dermatitis accompanied by maceration. - Treatment. It is necessary to regulate the child's nutrition, avoiding overfeeding and conducting diet therapy accepted in eczema. Sometimes a change in the nursing mother or the introduction of supplementary feeding has an influence. Among external means: baths (with starch) at a temperature of 26-28°, oil compresses, indifferent ointments.