Various skin diseases have been treated osteopathically with varying
success. So much depends upon the cause of the disturbance and its
removal, in skin diseases, that the cure does not rest so much with
the mere treatment, as with the necessary skill in locating the
disturbing factor. One has to be continually on his guard to locate
external irritations and disorders of the digestive and genito-urinary
tracts. A great deal depends upon the avoidance of external influences;
eating nutritious food and having an unobstructed circulation. The
leading object of osteopathic treatment is to free the circulation
and thus promote a healthy and unobstructed flow of blood; in no
other class of diseases is this more essential than in skin diseases.
After the removal of cutaneous irritations and the correction of
internal disorders, the cure of the case depends upon the removal of
constrictions to the cutaneous blood-vessels. The osteopath corrects
the lesions found, relaxes the muscles thoroughly and stimulates the
circulation to the parts involved, and promotes a healthy activity of
all the excretory organs. When the upper part of the body is affected,
lesions are generally found at the atlas and axis, and when the lower
part of the body is affected, lesions at the fifth lumbar are of
common occurrence, although lesions may be located at various points
corresponding with the seat of disturbance. The constant use of hot
baths will be found a helpful measure in many skin diseases. But use
of soap must be considered as too much alkali will neutralize the oil
of the skin and cause undue dryness, but bran may be substituted to
advantage. Cleanliness is necessary but the result sought is, also,
flushing the cutaneous vessels. There are many cases where a specific
vertebral lesion will cause, through the peripheral nerves, a cutaneous
irritation with intense itching and discomfort. This, in turn, produces
an exudate with or without a crust and a condition results which is not
amenable to any local or constitutional treatment but an adjustment of
the lesion will in most cases bring immediate relief. Application of
this principle will aid greatly in treatment of any skin disease. In no
disturbance of health is it more necessary to find the cause than in
skin disease and once found to apply specific treatment.
=Eczema= is frequently met in osteopathic practice. It is the most
common form of skin disease, comprising nearly one-third of all these
disorders. For a differential diagnosis of the several varieties the
student is referred to special texts. It is well to remember that the
same underlying causes may be basic to the various forms, for several
varieties may occur at the same time or one variety pass into another,
though commonly one form is more prevalent. The limbs, face and
genitalia are the most common sites, though the eruption may occur on
various parts of the body.
=Etiology= includes a number of factors, constitutional and local.
Dietetic errors, indigestion and faulty elimination comprise the
principal underlying causes, often manifested through absorption of
toxins and leucomains. In fact any disorder of the abdominal viscera,
organic or functional, may be a predisposing factor, likewise various
disorders of the pelvis, tuberculosis, diabetes, anemia, etc. should
be considered. So-called gouty and rheumatic tendencies may be the
constitutional basis.
The many osteopathic lesions play a very important role in lowering not
only systemic resistance but of local tissue as well. This feature can
not be over-emphasized.
Then local irritants, mechanical, chemical and thermal, are not to be
neglected. These are usually of secondary importance. Micro-organisms
are probably a complicating factor after the lowered resistance has
been established. Vasomotor neurosis, through constitutional defects,
toxins and the very significant osteopathic lesion, is probably an
essential part of the pathogenesis.
=Treatment= is usually successful if the various etiologic factors
are eradicated. Early treatment is very important. If the disorder
is of more than local significance change the entire daily regimen
of the patient. Diet, outdoor exercise and sufficient sleep should
be definitely regulated. A certain amount of general treatment to
improve digestion, assimilation and elimination is imperative. An
unbalanced diet and over eating must be corrected. In certain moist
types, eliminating fatty foods will be helpful, while in dry forms the
starches and sugars should be reduced.
If there is an underlying disease this should be remedied if possible.
Particular attention should be paid to constipation.
Common sense in diet, rest, change of environment and free elimination,
coupled with due attention to the osteopathic lesions, will cure the
vast majority of cases. The greatest difficulty arises where there
is some underlying disease. The parts should be protected against
irritation such as dirt, cold, soap, and too much water. Meddlesome
local treatment is to be guarded against. A simple application is boric
acid, rice-flour or cornstarch, or where there is much itching add
carbolic acid to the saturated solution of boric acid. Substitute bran
for soap for cleansing purposes.
=Herpes Simplex=, fever-blister, or “cold sore” comprise two principal
varieties: =herpes facialis= and =herpes genitalis=. The first occurs
upon or near the lips, face, neck or ears. When the herpes is on the
tongue or the mucous membrane within the mouth it is commonly termed
“canker sores.”
Herpes genitalis is located on the prepuce, glans penis or farther back
upon the penis. In the female the labia majora and minora and vestibule
are the usual locations. Lack of cleanliness, sexual excitement and
adherent prepuce are causative factors, though predisposing factors
such as faulty circulation and disturbed innervation are to be
considered.
In “cold sores” there is often some gastro-intestinal disturbance,
especially intestinal stasis, cold in the head and other infections
that supply toxins which irritate the nerves. No doubt there are
underlying osteopathic lesions that lower the local nerve resistance or
block the impulses such as vertebral and inferior maxillary lesions.
The predisposing disturbance is probably due to the Gasserian ganglion.
Cold winds and excessive exposure to the sun’s rays will effect the
tissues over the mental and infraorbital foramina, tensing the muscles
and irritating the nerves at these points. On palpation they will be
found sensitive. Frequent rotary motion by tip of finger over foramina
will open them and allow congestion to drain.
=Herpes Zoster=, or shingles, is an acute inflammatory disease
characterized by groups of small vesicles, usually along the course of
the intercostal nerves on one side of the body. Before the vesicles
appear there is more or less severe neuralgia. The eruption is
unilateral, very rarely bilateral. The nearby lymphatics are usually
enlarged.
Though the intercostal nerves are the ones most frequently involved,
still the lumbar, thigh, trifacial and other cutaneous nerves may be
affected.
The most common lesion is an inflammation of the posterior spinal
ganglion which usually involves the fibers of the entire nerve.
Inflammation of the nerve outside of the ganglion will cause the
disorder. Toxins from various infectious sources are often exciting
causes. Vertebral and rib lesions are always found; and where the
Gasserian ganglion is involved lesions of the inferior maxilla and
upper cervical vertebræ are predisposing factors. Thus osteopathic
lesions from traumatism, cold and wet, and imbalance of muscular
tension are important. Exudates, tumors, pleuritic and pulmonary
affections are to be considered as possible sources.
=Treatment.=—Adjust vertebral lesions and carefully raise and separate
ribs if intercostals are affected. Look after vertebral origin of any
other nerve or nerves if otherwise. Local application of talcum or
starch or boric acid will generally be sufficient.
=Urticaria=, hives or nettle rash is a common affection often due to
some derangement of the digestive tract. This may be a mechanical
irritation or of a toxic nature. Every one is familiar with the various
foods that are apt to cause the hives, shell fish, strawberries,
cheese, pork, oatmeal, mushrooms, etc.
The irritation may be a reflex one from the visceral disturbance;
also, there may be irritation of the pelvic organs that would give
rise to the trouble. It is well known that certain drugs will produce
urticarial eruptions. There are cases where the irritation is simply
local due to the nettle, mosquito bites and wasp stings.
In chronic cases intestinal stasis, nervous exhaustion and nephritic
diseases are important.
No doubt osteopathic lesions frequently determine the location of the
wheals. These lesions affect the innervation and thus establish a basis
for the reflex vasomotor effect. This is in the nature of spasm of the
cutaneous vessels quickly followed by dilatation with exudation of
serum. The irritant probably acts on the walls of the blood vessels.
=Treatment= consists of thoroughly emptying the bowels by warm water
enema, correcting the diet, toning the viscera and adjusting the
osteopathic lesions. Thorough attention to the patient’s environment,
daily habits and occupation are of value. Warm soda baths will relieve
the itching.
=Acne= is a common skin disorder that is characterized by an
inflammation of the sebaceous glands of the nature of papules,
tubercles or pustules. The face, shoulders, chest and back are the
regions usually involved. It generally, appears about puberty.
Blackheads is the starting point; these are accompanied with greasy
skin and dust, and influenced by micro-organisms and more or less
intestinal disorder.
The general or systemic health no doubt affects the local disorder,
as in many skin diseases; for various intestinal derangements as
indigestion, constipation, etc.; pelvic and menstrual irregularities;
general ill health; anemia, etc. affect circulatory, glandular and
nervous integrity. Any disturbance of normal elimination is important.
The =treatment= consists of careful attention to the general health and
to the local innervation of the face or region involved. Measures that
tone the bodily organs such as outdoor life, regular habits, plenty of
sleep and correct diet are important. In some cases the X-ray is of
value.