simple dryness or harshness of the skin (_xeroderma_); but as commonly
met with it is more developed, more or less marked scaliness in the form
of thin or somewhat thick epidermal plates being present. The papillae of
the skin are often slightly hypertrophied. In slight cases the color of
the scales is usually light and pearly; in the more marked examples it
is dark gray, olive green or black.
In the severe variety--ichthyosis hystrix--in addition to scaliness
there is marked papillary hypertrophy, forming warty or spinous patches.
This type is rare, and, as a rule, the surface involved is more or less
limited.
#Are there any inflammatory symptoms in ichthyosis?#
No. In fact, beyond the disfigurement, the disease causes no
inconvenience; in those well-marked cases, however, in which the scales
are thick and more or less immovable, the natural mobility of the parts
is compromised and fissuring often occurs. In the winter months, in the
severer cases, exposed parts may become slightly eczematous.
#Does ichthyosis vary somewhat with the season?#
Yes. In all cases the disease is better in the warm months, and in the
mild forms may entirely disappear during this time. This favorable
change is purely mechanical--due to the maceration to which the
increased activity of the sweat glands gives rise.
#Is the general health affected in ichthyosis?#
No.
#What course does ichthyosis pursue?#
Chronic. Beginning in early infancy or childhood, it usually becomes
gradually more marked until adult age, after which time it, as a rule,
remains stationary.
#What is the etiology?#
Beyond a hereditary influence, which is often a positive factor, the
causes are obscure. It is not a common disease.
#State the pathology.#
Anatomically the essential feature is epidermic hypertrophy, with
usually a varying degree of papillary hypertrophy also.
#Mention the diagnostic features of ichthyosis.#
The harsh, dry skin, epidermic and papillary hypertrophy, the
furfuraceous or plate-like scaliness, the greater development upon the
extensor surfaces, a history of the affection dating from early
childhood, and the absence of inflammatory symptoms.
#How is ichthyosis to be distinguished from eczema, psoriasis, and other
scaly inflammatory diseases?#
By the absence of the inflammatory element.
#What is the outlook for a case of ichthyosis?#
The prognosis is unfavorable as regards a cure, but the process may
usually be kept in abeyance or rendered endurable by proper measures.
#What treatment would you prescribe for ichthyosis?#
Treatment that has in view removal of the scaliness and the maintenance
of a soft and flexible condition of the skin.
In mild cases frequent warm baths, simple or alkaline, will suffice; in
others an application of an oily or fatty substance, such as the
ordinary oils or ointments, made several hours or immediately before the
bath may be necessary. In moderately developed cases the skin is to be
washed energetically with sapo viridis and hot water, followed by a warm
bath, after which an oily or fatty application is made. In some of the
more severe cases the following plan is often useful: The parts are
first rubbed with a soapy ointment consisting of one part of
precipitated sulphur and seven parts of sapo viridis; a bath is then
taken, the skin wiped dry, and a one to five per cent. ointment of
salicylic acid gently rubbed in.
Glycerine lotions, one or two drachms to the ounce of water, are also
beneficial; as also the following:--
[Rx] Ac. salicylici, ...................... gr. x-xl
Glycerini, ........................... [dram]ss-[dram]j
Lanolin,
Petrolati, .................. [=a][=a] [Oz]ss
In severe cases of ichthyosis hystrix it may be necessary, also, to
employ caustics or the knife.
#What systemic treatment would you prescribe?#
Constitutional remedies are practically powerless; occasionally some
good is accomplished by the internal administration of linseed oil and
jaborandi.
#Onychauxis.#
(_Synonym:_ Hypertrophy of the Nail.)
#Describe onychauxis.#
Onychauxis, or hypertrophy of the nail, may take place in one or all
directions, and this increase may be, and often is, accompanied by
changes in shape, color, and direction of growth. One or all the nails
may share in the process. As the result of lateral deviation of growth,
the nail presses upon the surrounding tissues, producing a varying
degree of inflammation--_paronychia_.
#What is the etiology of hypertrophy of the nail?#
The condition may be either congenital or acquired. In the latter
instances it is usually the result of the extension to the matrix of
such cutaneous diseases as psoriasis and eczema; or it is produced by
constitutional maladies, such as syphilis.
#Give the treatment of hypertrophy of the nail.#
Treatment consists in the removal of the redundant nail-tissue by means
of the knife or scissors; and, when dependent upon eczema or psoriasis,
the employment of remedies suitable for these diseases. When it is the
result of syphilis, the medication appropriate to this disease is to be
employed.
In paronychia the nail should be frequently trimmed and a pledget of
lint or cotton be interposed between the edge of the nail and the
adjacent soft parts; astringent powders and lotions may often be
employed with advantage; and in severe and persistent cases excision of
the nail, partial or complete, may be found necessary.
#Hypertrichosis.#
(_Synonyms:_ Hirsuties; Hypertrophy of the Hair; Superfluous Hair.)
#What is meant by hypertrichosis?#
Hypertrichosis is a term applied to excessive growth of hair, either as
regards region, extent, age or sex.
#Describe the several conditions met with.#
The unnatural hair growth may be slight, as, for instance, upon a naevus
(_naevus pilosus_); or it may be excessive, as in the so-called hairy
people (_homines pilosi_); or it may also appear on the face, arms and
other parts in females, resulting from a hypertrophy of the natural
lanugo hairs.
#State the causes of hypertrichosis.#
Hereditary influence is often a factor; the condition may also be
congenital.
If acquired, the tendency manifests itself usually toward middle life.
In women, it is not infrequently associated with diseases of the
utero-ovarian system; in many instances, however, there is no apparent
cause. Local irritation or stimulation has at times a causative
influence.
#How is hypertrichosis to be treated?#
For general hypertrichosis there is no remedy. Small hairy naevi may be
excised, or, as also in the larger hairy moles, the hairs may be removed
by electrolysis.
On the faces of women, if the hairs are coarse or large, electrolysis
constitutes the only satisfactory method; if the hairs are small and
lanugo-like, the operation is not to be advised. It is somewhat painful,
but never unbearable. In the past several years the _x_-ray has been
advocated by several writers, but it requires usually numerous exposures
pushed to the point of producing erythema; it is not without risk, and
the hairs are said to return in some months.
#What temporary methods are usually resorted to for the removal of
superfluous hair?#
Shaving, extraction of the hairs and the use of depilatories. As a
depilatory, a powder made up of two drachms of barium sulphide and three
drachms each of zinc oxide and starch, is commonly (and cautiously)
employed; at the time of application enough water is added to the powder
to make a paste, and it is then spread thinly upon the parts, allowed to
remain five to fifteen minutes, or until heat of skin or a burning
sensation is felt, washed off thoroughly, and a soothing ointment
applied. This preparation must be well prepared to be efficient.
#Describe the method of removal of superfluous hair by electrolysis.#
A fine needle in a suitable handle is attached to the _negative_ pole of
a _galvanic_ battery, introduced into the hair-follicle to the depth of
the papilla, and the circuit completed by the patient touching the
positive electrode; in several seconds slight blanching and frothing
usually appear at the point of insertion; a few seconds later the
current is broken by release of the positive electrode, and the needle
is then withdrawn. Sometimes a wheal-like elevation arises, remains
several minutes or hours, and then disappears; or occasionally, probably
from secondary infection, it develops into a pustule.
A strength of current of a half to two milliamperes is usually
sufficient; the time necessary for the destruction of the papilla
varying from several to thirty seconds.
#How are you to know if the papilla has been destroyed?#
The hair will readily come out with but little, if any, traction.
#What is the result if the current has been too strong or too long
continued?#
The follicle suppurates and a scar results.
#Why should contiguous hairs not be operated upon at the same sitting?#
In order that the chances of marked inflammatory action and scarring
(always possibilities) may be reduced to a minimum.
#In case of failure to destroy an individual papilla, should a second
attempt be made at the same sitting?#
As a rule not, in order to avoid the possibility of too much destructive
action, and consequent scarring.
#Can scarring always be prevented?#
In the average case, with skill and care, the use of an exceedingly fine
needle and the avoidance of too strong a current, _perceptible_ scarring
(scarring perceptible to the ordinary observer or at ordinary distance)
need rarely occur.
#What measures are to be advised for the irritation produced by the
operation?#
Hot-water applications and the use of an ointment made of two drachms
cold cream and ten grains of boric acid are of advantage not only in
reducing the resulting hyperaemia, but also in preventing suppuration and
consequent scarring. To lessen the chances of the latter, cleansing the
parts with alcohol just before and after the operation is also of
service.
#[OE]dema Neonatorum.#
#Describe [oe]dema neonatorum.#
The essential symptoms are [oe]dema and a variable degree of hardness
and induration. It develops in the first few days of life, and usually
upon the extremities, especially the lower. It may remain more or less
limited to these parts, but, as a rule, slowly extends. The skin is of a
yellowish, dusky, or livid color, and sometimes glossy or shining. There
are general symptoms of drowsiness, subnormal temperature, weakened
circulation, and impaired respiration, which gradually increase, and in
eighty to ninety per cent. of the cases lead to death. It is believed to
be similar to anasarca in the adult and to be due to like causes.
Treatment consists in maintaining the body-heat, sufficient and proper
nourishment and stimulation.
#Sclerema Neonatorum.#
(_Synonyms:_ Scleroderma Neonatorum; Sclerema of the Newborn.)
#What is sclerema neonatorum?#
Sclerema neonatorum is a disease of infancy, showing itself usually at
or shortly after birth, and is characterized by a diffuse stiffness and
rigidity of the integument, accompanied by coldness, [oe]dema,
discoloration, lividity and general circulatory disturbance.
#Describe the symptoms, course, nature and treatment of sclerema
neonatorum.#
As a rule the disease first manifests itself upon the lower extremities,
and then gradually, but usually rapidly, invades the trunk, arms and
face. The surface is cold. The skin, which is noted to be reddish,
purplish or mottled, is [oe]dematous, stiff and tense; in consequence
the infant is unable to move, respires feebly and usually perishes in a
few days or weeks. In extremely exceptional instances the disease, after
involving a small part, may retrogress and recovery take place.
The disease is rare, and in most cases is found associated with
pneumonia and with affections of the circulatory apparatus.
Treatment should be directed toward maintaining warmth and proper
alimentation.
#Scleroderma.#
(_Synonyms:_ Sclerema; Scleriasis; Dermatosclerosis; Morph[oe]a; Keloid
of Addison.)
#What is scleroderma?#
Scleroderma is an acute or chronic disease of the skin characterized by
a localized or general, more or less diffuse, usually pigmented, rigid,
stiffened, indurated or hide-bound condition.
Morph[oe]a, by some formerly thought to be a distinct affection, is now
believed to be a form of scleroderma; as typically met with it is
characterized by one or more rounded, oval, or elongate, coin- to
palm-sized, pinkish, or whitish ivory-looking patches. In some instances
such patches are seen in association with the more classic type of
scleroderma just defined.
#Describe the symptoms of ordinary scleroderma.#
The disease may be acute or chronic, usually the latter. A portion or
almost the entire surface may be involved, or it may occupy variously
sized and shaped areas. The integument becomes more or less rigid and
indurated, hard to the touch, hide-bound, and in marked cases immobile.
[OE]dema may, especially in the more acute cases, precede the
induration. Pigmentation, of a yellowish or brownish color, is often a
precursory and accompanying symptom. The skin feels tight and
contracted, and in some instances numbness and cramp-like pains are
complained of.
#Describe the variety known as morph[oe]a.#
The patches (one, several, or more), occurring most frequently about the
trunk, are in the beginning usually slightly hyperaemic, later becoming
pale-yellowish or white, and having a pinkish or lilac border made up of
minute capillaries. They are, as a rule, sharply defined, with a smooth,
often shining and atrophic-looking surface; are soft, fine or leathery
to the touch, on a level or somewhat depressed, and appearing not unlike
a piece of bacon or ivory laid in the skin. Occasionally the patches are
noted to occur over nerve-tracts. The adjacent skin may be normal or
there may be more or less yellowish or brownish mottling. The subjective
symptoms of tingling, itching, numbness, and even pain, may or may not
be present.
#What is the course of the disease?#
Sooner or later, usually after months or years, the disease ends in
resolution and recovery, or in marked atrophic changes, causing
contraction and deformity. As a rule, the general health remains good.
#State the causes of scleroderma.#
The condition is to be considered as probably of neurotic origin.
Exposure and shock to the nervous system are to be looked upon as
influential. It is a rare disease, observed usually in early adult or
middle life, and is more frequent in women than in men.
#What is the pathology?#
In typical and advanced cases both the true skin and the subcutaneous
connective tissue show a marked increase of connective tissue-element,
with thickening and condensation of the fibers.
#Is there any difficulty in reaching a diagnosis in scleroderma?#
As a rule, no. The characters--rigidity, stiffness, hardness, and
hide-bound condition of the skin--are always distinctive.
The peculiar appearance, the course and character of the patches, of
morph[oe]a are quite distinctive.
#Give the prognosis of scleroderma.#
It should always be guarded. In many instances recovery takes place,
whilst in others the disease is rebellious, lasting indefinitely. The
prognosis of the variety known as morph[oe]a is less unfavorable than
general scleroderma, and recovery more frequent.
#What is the treatment of scleroderma?#
Tonics, such as arsenic, quinia, nux vomica, and cod-liver oil;
conjointly with the local employment of stimulating, oily or fatty
applications, friction, and electricity. Roentgen-ray treatment is often
of value, more especially in the morph[oe]a type.
#Elephantiasis.#
(_Synonyms:_ Elephantiasis Arabum; Pachydermia; Barbadoes Leg; Elephant
Leg.)
#Give a descriptive definition of elephantiasis.#
Elephantiasis is a chronic hypertrophic disease of the skin and
subcutaneous tissue characterized by enlargement and deformity,
lymphangitis, swelling, [oe]dema, thickening, induration, pigmentation,
and more or less papillary growth.
[Illustration: Fig. 35. Elephantiasis of moderate development.]
#What parts are commonly involved in elephantiasis?#
Usually one or both legs; occasionally the genitalia; other parts are
seldom affected.
#Describe the symptoms of elephantiasis.#
The disease usually begins with recurrent (at intervals of months or
years) erysipelatous inflammation, with swelling, pain, heat, redness
and lymphangitis; after each attack the parts remain somewhat increased
in size, although at first not noticeably so. After months or one or two
years the enlargement or hypertrophy becomes conspicuous, the part is
chronically swollen, [oe]dematous and hard; the skin is thickened, the
normal lines and folds exaggerated, the papillae enlarged and prominent,
and with more or less fissuring and pigmentation.
#What is the further course of the disease?#
There is gradual increase in size, the parts in some instances reaching
enormous proportions; the skin becomes rough and warty, eczematous
inflammation is often superadded, and, sooner or later, ulcers,
superficial or deep, form--which, together with the crusting and
moderate scaliness, present a striking picture. There may be periods of
comparative inactivity, or, after reaching a certain development, the
disease may, for a time at least, remain stationary.
#Are there any subjective symptoms?#
A variable degree of pain is often noted, especially marked during the
inflammatory attacks. The general health is not involved.
#State the cause of elephantiasis.#
The etiology is obscure. The disease rarely occurs before puberty. It is
most common in tropical countries, more especially among the poor and
neglected. It is not hereditary, nor can it be said to be contagious.
Inflammation and obstruction of the lymphatics, probably due, according
to late investigations, to the presence of large numbers of filaria
(microscopic thread-worms) in the lymph channels and bloodvessels, is to
be looked upon as the immediate cause.
#What is the pathology?#
All parts of the skin and subcutaneous connective-tissue are
hypertrophied, the lymphatic glands are swollen, the lymph channels and
bloodvessels enlarged, and there is more or less inflammation, with
[oe]dema. Secondarily, from pressure, atrophy and destruction of the
skin-glands, and atrophic degeneration of the fat and muscles result.
#What are the diagnostic characters of beginning elephantiasis?#
Recurrent erysipelatous inflammation, attended with gradual enlargement
of the parts.
The appearances, later in the course of the disease, are so
characteristic that a mistake is scarcely possible.
#Give the prognosis of elephantiasis.#
If the case comes under treatment in the first months of its
development, the process may probably be checked or held in abeyance;
when well established, rarely more than palliation is possible.
#What is the treatment of elephantiasis?#
The inflammatory attacks are to be treated on general principles.
Quinia, potassium iodide, iron and other tonics are occasionally useful;
and, especially in the earlier stages, climatic change is often of
value. Between the inflammatory attacks the parts are to be rubbed with
an ointment of iodine or mercury, together with galvanization of the
involved part.
In elephantiasis of the leg, a roller or rubber bandage, or the gum
stocking, is to be worn; compression and ligation of the main artery,
and even excision of the sciatic nerve, have all been employed, with
more or less diminution in size as a result. In elephantiasis of the
genitalia, if the disease is well advanced, excision or amputation of
the parts is to be practised.
Eczematous inflammation, if present, is to be treated with the ordinary
remedies.
#Dermatolysis.#
(_Synonym:_ Cutis Pendula.)
#Give a descriptive definition of dermatolysis.#
Dermatolysis is a rare disease, consisting of hypertrophy and looseness
of the skin and subcutaneous connective tissue, with a tendency to hang
in folds.
#Describe the symptoms and course of dermatolysis.#
It may be congenital or acquired, and maybe limited to a small or large
area, or develop simultaneously at several regions. All parts of the
skin, including the follicles, glands and subcutaneous connective and
areolar tissue, share in the hypertrophy; and this in exceptional
instances may be so extensive that the integument hangs in folds. The
enlargement of the follicles, natural folds and rugae gives rise to an
uneven surface, but the skin remains soft and pliable. There is also
increased pigmentation, the integument becoming more or less brownish.
#What course does dermatolysis pursue?#
Its development is slow and usually progressive. It gives rise to no
further inconvenience than its weight and consequent discomfort.
#Give the etiology.#
The etiology is obscure. It is considered by some authors as allied to
molluscum fibrosum, and, in fact, as a manifestation of that disease,
ordinary molluscum tumors sometimes being associated with it. It is not
malignant.
#What is the pathology?#
The disease consists of a simple hypertrophy of all the skin structures
and the subcutaneous connective tissue.
#What is the treatment of dermatolysis?#
Excision when advisable and practicable.
#CLASS V.--ATROPHIES.#
#Albinismus.#
#What do you understand by albinismus?#
Congenital absence, either partial or complete, of the pigment normally
present in the skin, hair and eyes.
#Describe complete albinismus.#
In complete albinismus the skin of the entire body is white, the hair
very fine, soft and white or whitish-yellow in color, the irides are
colorless or light blue, and the pupils, owing to the absence of pigment
in the choroid, are red; this absence of pigment in the eyes gives rise
to photophobia and nystagmus. _Albinos_--a term applied to such
individuals--are commonly of feeble constitution, and may exhibit
imperfect mental development.
#Describe partial albinismus.#
Partial albinismus is met with most frequently in the colored race. In
this form of the affection the pigment is absent in one, several or more
variously-sized patches; usually the hairs growing thereon are likewise
colorless.
#Is there any structural change in the skin?#
No. The functions of the skin are performed in a perfectly natural
manner, and microscopical examination shows no departure from normal
structure save the complete absence of pigment.
#What is known in regard to the etiology?#
Nothing is known of the causes producing albinismus beyond the single
fact that it is frequently hereditary.
#Does albinismus admit of treatment?#
No; the condition is without remedy.
#Vitiligo.#
(_Synonyms:_ Leucoderma; Leucopathia.)
#Give a definition of vitiligo.#
Vitiligo may be defined as a disease involving the pigment of the skin
alone, characterized by several or more progressive, milky-white patches
surrounded by increased pigmentation.
#Describe the symptoms of vitiligo.#
The disease may begin at one or more regions, the backs of the hands,
trunk and face being favorite parts; its appearance is usually
insidious, and the spots may not be especially noticeable until they are
the size of a pea or larger. The patches grow slowly, are milky or dead
white, smooth, non-elevated, and of rounded outline; the bordering skin
is darker than normal, showing increased pigmentation. Several
contiguous spots may coalesce and form a large, irregularly-shaped
patch. Hair growing on the involved skin may or may not be blanched.
There are no subjective symptoms.
#What course does vitiligo pursue?#
The course of the disease is slow, months and sometimes years elapsing
before it reaches conspicuous development. It may after a time remain
stationary, or, in rare instances, retrogress; as a rule, however, it is
progressive. Exceptionally, the greater part, or even the whole surface
may eventually be involved.
#Give the etiology of vitiligo.#