Atopic dermatitis and Ritter's disease: differential diagnosis by means of total and specific serum IgE

Atopic dermatitis and Ritter's disease in infants and children frequently present diagnostic as well as therapeutic problems. Both conditions are characterized by generalized exfoliative dermatitis, and are prone to recurrent infections with Staphylococcus. However, in Ritter's disease, it has been shown that these are specifically coagulase-positive Staphylococcus phage Group 2 organisms. This combination of exfoliative dermatitis, with lysis and separation of the skin, associated with infection has been aptly named the staphylococcal scalded skin syndrome. An unusual case is reported herein of a nine year old boy who had a condition clinically resembling Ritter's disease since birth, but with enormously elevated total and specific serum IgE levels characteristic of atopic dermatitis and not seen in Ritter's disease.