Impetigo Bullosa

Impetigo bullosa is characterized by eruption of phlyctena as large as a hazel-nut or a dove's egg. The erosion forming after the bulla ruptures grows gradually and remnants of the top of the bulla are left on its periphery. This form is localized commonly on the dorsal surface of the hands and less frequently of the foot and leg.

Angulus Infectiosus, Perleche

Angulus infectiosus, or angular stomatitis, or perleche is a condition marked by a rapidly rupturing phlyctena in one or both angles of the mouth. Areas at the wings of the nostrils and lateral margin of the palpebral fissure may also be involved in the process. Flabby vesicles form at first in the angles of the mouth, which rupture and expose superficial linear slit-like fissures. The formed honey-yellow crusts drop off because of maceration. The disease is attended with a sensation of itching, salivation, and pain during eating. It takes a prolonged course in dental caries, rhinitis, conjunctivitis, in persons who have a habit of licking the angles of the mouth (that is why disease is encountered mostly in children), in elderly individuals with dentures, and in persons whose diet lacks vitamins of the B complex.

High contagiosity of the disease through kissing and the use of common towels and dishes is generally known. If not treated, the disease lasts for a long time because the patients lick the angles of the mouth all the time and maceration therefore remains.

Perleche must be differentiated from superficial candidiasis of the angles of the mouth, in which maceration is so severe that the horny layer is separated (fissures). In secondary stages of syphilis, the erosive papules in the angles of the mouth have an infiltrated base and other symptoms of this disease are found (the tissue juice is examined for Treponema pallidum and serological blood tests are performed in questionable cases).

Pityriasis Simplex

Pityriasis simplex is considered to be a dry variety of impetigo streptogenes. It is particularly common in children and is characterized by round or oval, strictly circumscribed whitish or pink foci, which are abundantly covered with small scales. The disease may be cured by exposure to sunrays, but the affected areas are tanned weakly so that mottling of the skin surface occurs. The favoured localization is the skin around the mouth, the cheeks, and the region of the lower jaw, sometimes the lesions occur on the skin of the trunk and limbs.There is sometimes a sensation of mild itching.

Impetigo of the Nail Folds (Tourniole)

Tourniole (Fr. tourn circuit) is mostly encountered in adults. Phlyctenae form around the fingernails, first with serous secretions, which later become cloudy-purulent. The disease develops in wounding of the fingers and hand nail, which create conditions for the entry of streptococci. The affected phalange swells and is painful.

After the phlyctena ruptures an erosion forms embracing the nail plate like a horseshoe. The process may terminate in the loss of the nail plate. Lymphangitis, a chill, indisposition, and fever are sometimes encountered.