Under the designation pemphigus contagiosus Manson describes a very common skin disease of the tropics. The condition, however, is not pemphigus. A bacteriological examination shows in the smear great numbers of pus cells containing phagocytized diplococci. Wherry has named the organism Diplococcus pemphigi contagiosi. As a matter of fact, culturally, this organism is the common Staphylococcus pyogenes aureus.
It is also a matter of common observation that this organism when in pus cells of active inflammatory processes shows a diplococcus morphology rather than a staphylococcal one.
These staphylococcal lesions which do not start in the hair follicles are often designated as “pyoses.”
The disease is markedly contagious in children and is strikingly autoinoculable so that unless the first lesion is taken in hand immediately the eruption may become generalized. A small spot of erythema first appears which rapidly becomes vesicular, the bleb covering the entire spot, so that there is practically no surrounding inflammatory areola.
The diaphanous covering rubs off with the slightest touch and leaves underneath a raw-looking surface which extends peripherally to form an angry-looking red patch an inch or more in diameter. In adults it rarely affects parts other than the axilla or crotch.
The general health of the child is practically unaffected.
The usual treatment is with bichloride lotions followed by a dusting powder of equal parts of boric acid, starch and zinc oxide. I have found, however, that an ointment of ammoniated mercury, 2% to 5% according to age, is the most satisfactory treatment.
Tropical Boils.—It is interesting that the same organism responsible for this more fulminating lesion should be the one responsible for the common cosmopolitan boil and in fact boils are exceedingly common in the tropics. These boils may be larger and with a greater tendency to widespread distribution and in some regions they are so common as to have a regional designation (Nile boils). The staphylococcus of tropical impetigo seems to have greater virulence than that of the boils. Autogenous vaccines are often most successful in the treatment of boils.