Erythema scarlatiniforme desquamativum recidivans L53.81

Féréol 1876, Besnier 1890

Rare clinical picture with periodically or irregularly recurring, scarlatiniform erythema and subsequent desquamation.

Triggering by infectious diseases (e.g. angina tonsillaris, pleuritis) and drugs (vitamin A, mercury-containing preparations, bismuth, tellurium, gold, quinine, hydantoins, salicylates, diuretics) is discussed.

In many cases, throat swabs could be used to detect superantigen-producing staphylococci (e.g. TSST-1 = toxic shock syndrome toxin 1) or group A streptococci (streptococcal pyrogenic exotoxin A or B).

Mostly generalized, beginning at the trunk and extending to the entire integument, finally head, hands, feet. Very rarely localized forms (only hands and feet).

Prodromal phase with nausea, rise in temperature, headache and aching limbs, gastrointestinal disorders.

Integument: Macular exanthema. Followed by desquamation, typically before the exanthema subsides (medium to coarse lamellar on the trunk, exfoliative scaling on hands and feet in the form of gloves or sandals). Also mucous membrane infestation with raspberry tongue, reversible diffuse hair loss and nail changes are possible.

Possible general symptoms such as enteritis, bronchitis, joint swelling, epistaxis, proteinuria, microhaematuria.

Leukocytosis with eosinophilia; short-term BSG increase.

Scarlet fever; drug-induced scarlatiniform erythroderma; acrodyny.

discontinuation of the drug, treatment of infections.

Symptomatic. Anti-inflammatory and keratolytic external preparations such as lotio alba (if necessary with 2% clioquinol R050 ), urea-containing creams/lotions (e.g. Basodexan®, Nubral®, R102 ), 5% dexpanthenol cream(e.g. Bepanthen®, R065 ), if necessary glucocorticoid-containing lotions such as 1% hydrocortisone emulsion(e.g. Hydrogalen® Lotion, R123 ). In case of mucosal infestation, rinsing with camomile extracts (e.g. Kamillosan®).

Duration of the first episode 2-4 weeks. Recurrences after individually different and irregular intervals (weeks to years). These are increasingly easier and shorter.

A minus variant of the erythema scarlatiniforme desquamativum recidivans is a localized form(Erythema scarlatiniforme desquamativum recidivans localisatum), in which the exanthema is limited to hands and feet.

1. Kresbach H (1969) Erythema scarlatiforme recidivans (Féréol-Besnier) Dermatol Monthly Dressing 155: 365-366
2. Landthaler M et al (1985) Erythema scarlatiniforme desquamativum recidivans localisatum. dermatologist 36: 581-585
3. Lin MH et al (2003) Predictive value of clinical features in differentiating group A beta-hemolytic streptococcal pharyngitis in children. J Microbiol Immunol Infect 36: 21-25
4. Thiers H et al (1969) Fixed scarlatiniform erythema with congestive rushes, symptomatic of a chronic lymphoreticular hemopathy. Bull Soc Fr Dermatol Syphiligr 76: 879-880