Erythema Scarlatiniforme Desquamativum Recidivans – A Forgotten Disease (Recurring Localized Scarlatiniform Scaled Erythema)

tion starts (within 1 week after the beginning) with an extensive gross lamellar peeling of the trunk, pityriasiform scaling of the head and highly characteristic desquamation of the hands and feet. ESDR exists in a generalized and localized variant, the latter mainly involving the hands and feet [3] . The exanthema is usually preceded by a prodromal phase with general malaise, nausea, headache, muscle pain, gastrointestinal disorders, sometimes bronchitis and joint pain. Other associated symptoms are Beau lines of the nails, conjunctivitis, pharyngeal infl ammation, white-gray tongue, epistaxis, hair loss [4] , infections (pneumonia, enteritis, Aspergillus niger skin infection), lymph node swelling and glomerulonephritis. In the localized variant, the leading symptom is the suggestive asymptomatic gross lamellar peeling of the hands and feet; the prodromi and the associated symptoms (even the erythematous rash) are clearly milder or may even be absent. In general one needs a high index of suspicion to think about ESDR in these cases. Interestingly, in the general variant, despite the fact that the rash covers most parts of the skin, the patients do not feel very ill. The fi rst bout of the disease lasts about 2–4 weeks; later relapses are shorter and milder. They can occur after days, weeks, months or even years after the fi rst episode. Erythema scarlatiniforme desquamativum recidivans (ESDR; synonyms: morbus Féréol-Besnier, dermatitis exfoliativa acuta benigna) is a rare (or almost forgotten) disease fi rst described by Féréol in 1876 [1] . Thereafter about more than 60 articles appeared mainly in the French and German literature (most during the 50s and 60s); after a long period of silence about this topic, in 1985 a group from Munich’s University [2] fi nally published an article which describes 2 cases of ESDR. In this issue of Dermatology, Braun-Falco et al. [3] report a further case of recurring localized scarlatiniform scaled erythema type Féréol-Besnier. During the last 6 years, we encountered 7 patients with localized and 1 with generalized ESDR ( table 1 ). We think that this entity is not as rare as taught some years ago. To increase the attention to this disease we summarize our experiences with ESDR. ESDR is characterized by recurrent episodes of fever accompanied by a macular erythematous exanthema beginning on the trunk with rapid secondary generalization; lastly the head, hands and feet are affected, too. The skin eruption does not itch or burn, there are no blisters, no papules or pustules and no hyperkeratosis. Eczematous lesions are absent; in fact, at the beginning it is a macular confl uent erythema without other further primary lesions. The mucosae and conjunctivae are usually not affected. Before the rash disappears, a typical desquamaReceived: September 28, 2005 Accepted: October 2, 2005