ECTHYMA The lesions are flat pustules, pea to bean-sized, first yellowish, then reddish, upon an inflamed base, with crusting, heat, pain, and burning. They are mostly distributed on the thighs, legs, shoulders, and back. The prognosis is favorable. The treatment is constitutional, with tonics and cleanliness. Formula No. 4. ECZEMA (TETTER; SALT RHEUM; SCALL) This is an acute or chronic inflammatory disease of the skin. The eruption varies with the particular variety of the affection and its situation. Hyperæmia, œdema, burning, and itching are present in all varieties. In terized by bright red patches and serous exudation (a "weeping surface") upon the legs of adults and the face of infants. Eczema Squamosum.-Scaly patches are seated on an inflamed base. The course is very chronic. It occurs mostly on the outer aspects of the extremities. Eczema fissum is marked by fissures between the fingers and toes and at the articulations. Eczema sclerosum (keratosis) is a localized leathery infiltration occurring on the palms, soles, finger tips, etc. Eczema Verrucosum.-There is hypertrophy of the papillæ, giving rise to a warty surface. The PROGNOSIS varies. Some cases aid quickly in recovery; others persist for life. ERYTHEMA AND HERPES 777 TREATMENT.-Acute Eczema.-Cleanliness is of primary importance. Prevent scratching by masks of gauze or bandages and by means of celluloid sleeves. Reduce inflammation by lead lotion or soothing ointments. Use prescription No. 21, or mutton tallow. Give laxatives internally. Chronic Eczema.-Remove or treat the constitutional causes, such as syphilis and intestinal toxæmia (laxatives). Soften the crusts with wet carbolic dressing (1 to 60) or oil over night. Apply stimulating ointments. Use formula Nos. 1, 4, 19, or soothing ointments, such as mutton suet, zinc, bismuth ointment, or stearate of zinc with acetanilide (dusting powder) or yellow oxide of mercury ointment, gr. x to 3j. Internally, give arsenic or potassium iodide in obscure cases. ERYTHEMA Erythema simplex is identical with simple dermatitis (q. v.), but milder in degree. Erythema Intertrigo (Chafing).—The skin is red, hot, moist, and macerated, and the disease may terminate in dermatitis or eczema. It occurs in regions where surfaces are in apposition, e. g., the nates, groins, axillæ, mammæ, etc. Erythema Multiforme. The lesions are of various sizes and shapes, consisting of macules, papules, blebs, vesicles, etc. It is mostly symmetrical. It often appears simultaneously on the backs of hands and feet. It has an acute course, with no scaling. There is some constitutional disturbance, with moderate itching. It seems to be an eliminative phenomenon in acute and chronic intestinal indigestion. Erythema Nodosum.-Symmetrically distributed round or oval, rosy red, shining nodules, of the size of a walnut up to that of an egg, occur over the tibia, forearms, thighs, face, back, tongue, and pharynx. The duration is from seven to ten days. There is no suppuration. There are constitutional symptoms, with articular pains and swelling. The PROGNOSIS is generally favorable. The TREATMENT depends greatly upon the cause. Formulæ Nos. 23 and 7. HERPES Herpes simplex (fever blisters) consists of a small cluster of vesicles, first clear, then cloudy, which dry into crusts. They tend to coalesce, and they disappear without scar. It is situated on any portion of the face (herpes facialis), about the lips (herpes labialis), or on the prepuce of the male and the labia majora or minora of the female (herpes progenitalis). are burning and itching. There Herpes Zoster (Shingles).-Groups of vesicles form on a bright red, highly inflamed base, usually along the tract of a nerve, with neuralgic pains. It is unilateral. There is a tendency to coalesce, with the formation of yellowish brown crusts. In herpes zoster ophthalmicus severe damage to the eye may occur. The PROGNOSIS is generally favorable, but there is a tendency to recur rence. TREATMENT.-Camphor ice or formulæ Nos. 3, 7, 11, or 17. IMPETIGO Impetigo Simplex.-There are one or more distinct yellowish pustules, of the size of a split pea, surrounded by an areola and terminating by absorption or crusting. There is no itching. Impetigo Contagiosa.-Discrete flat superficial vesicles or blebs form, soon turning into pustules, which rupture and dry up as waferlike crusts ("stuck on"), curl up, and drop off, leaving behind reddish spots. There is a tendency to umbilication and coalescence. The PROGNOSIS is favorable. TREATMENT.-Formulæ Nos. 1, 2, 4, and 15. ICHTHYOSIS (FISH SKIN DISEASE) This is congenital or begins in early life. It is worse in cold weather. It often affects several members of one family. Ichthyosis simplex involves the greater part of the body. The skin is dry and harsh with scales, either furfuraceous or large and thick, resembling fish scales. Ichthyosis hystrix is rarer and more severe. There is papillary hypertrophy showing itself by irregular or linear corrugated, warty or spinous, horny patches. LICHEN-MILIARIA-PEMPHIGUS (WATER BLISTERS) PROGNOSIS.-The course is extremely chronic. 779 TREATMENT.-Use hot baths with green soap, also glycerine and formulæ Nos. 16 and 20. LICHEN Lichen Ruber Acuminatus.-Discrete, millet seed-sized, acuminated, scaly, reddish papules are disseminated over the trunk, with no disposition to grouping. There is severe itching. Lichen Ruber Planus.-First Stage.-There are minute, reddish, irregularly shaped, sharply defined papules with flattened surface, brilliant under oblique rays of light. Second Stage.-Confluence of the papules occurs, forming plaques (4 mm. to 1 cm. in diameter) of a brownish red color with fine gray scales. Third Stage.-There is thickening of the derma, with white striation upon a red base and distinct grouping, usually upon the flexor surfaces of the forearm and wrist, the lower portion of the abdomen, the lumbar region, the lower extremities, etc., and itching. PROGNOSIS. The acuminate form, if neglected, may constitute a very serious disease. Lichen ruber planus is in the main benign and may undergo spontaneous cure. TREATMENT. Give arsenic internally, with attention to the nervous system. Locally, use tepid douches, from 95° to 100° F., to be continued from two to five minutes, also mercurial plaster or ointment. Formula No. 33. MILIARIA (SUDAMINA; PRICKLY HEAT) STROPHULUS This is characterized by minute red or whitish papules, of a sudden appearance, accompanied by pricking or tingling. The prognosis is favorable. Treatment. Use cooling lotions, such as liq. plumb. subacet. dil., and formula No. 28. PEMPHIGUS (WATER BLISTERS) Pemphigus Simplex. There is a successive development of crops of peasized to egg-sized blebs, distended with a colorless fluid, which changes to yellowish or hæmorrhagic as the eruption grows older. Pemphigus Foliaceus.-There are flaccid and purulent blebs which rupture early, leaving an excoriated, “scalded” surface. There is a tendency to spread over the whole body, including the mucous membranes, hair, etc. It may end fatally. Pemphigus Neonatorum.-Simplex non-syphiliticus. Pemphigus Neonatorum Syphiliticus.-The PROGNOSIS in pemphigus simplex is favorable, while pemphigus foliaceus leads almost invariably to a fatal termination. TREATMENT.-Use arsenic and tonics internally. Puncture the blebs and apply soothing lotions or ointments in severe cases. Prolonged immersion of the patient in a warm medicated bath may be employed, or iodide of potassium and mercury given in the specific form. PITYRIASIS Pityriasis Rosea (Pityriasis Maculata and Circinata).-There are patches and circles barely elevated above the surface, pale red in color, covered by very fine scales, usually on the trunk and upper segments of the limbs, with slight itching. Pityriasis Rubra.-There is redness of the skin, with an abundance of thin, papery exfoliation. The patches are circumscribed and symmetrical and spread peripherally over the whole body. There is a tendency to marasmus. Pityriasis rubra pilaris affects the orifices of the hair follicles, especially of the anterior surfaces of the limbs, leaving the intervening skin intact. The root of each hair is surrounded by a small, hard, conical elevation composed of minute adherent scales. The skin is dry and rough ("goose skin"), and there is slight itching. The PROGNOSIS is favorable, but recurrences are frequent. PRURIGO Prurigo Mitis.-There are circumscribed, individualized, reddish, conical papules, with minute vesicular summits, which dry up and leave behind small brownish crusts. They usually occur on the extensor surfaces of the legs and arms, on the trunk, and sometimes on the forehead. There are tingling, pricking, burning, and shooting pains, worse at night. There is a successive development of new crops. Prurigo ferox usually begins in very early life, often following an ordinary urticaria. It may persist throughout an entire lifetime. The initial symptoms resemble those of prurigo mitis. The skin gradually becomes harsh, dry, hypertrophied, and pigmented, with inflammation of the neighboring glands. The PROGNOSIS is dubious, recovery being possible, although the course is very chronic, with a tendency to be complicated by chronic eczema. TREATMENT.-Prescribe a bland diet, and order arsenic, and pilocarpine internally. Externally, use fresh styrax ointment. Formulæ Nos. 5 and 15. PSORIASIS (LEPRA ALPHOS) This begins with minute white spots, usually on the elbow, knees, and scalp, gradually spreading in size and location, exhibiting incrustations of a mother of pearl-like or silvery lustre, based upon tawny red, slightly elevated patches of the skin. There is very slight itching. Psoriasis Guttata.-There are small rounded patches, giving the skin the appearance of having been splashed with mortar. Psoriasis Nummulata.-The eruption resembles coins of various sizes. Psoriasis circinata is characterized by annular patches, clear in the centre. Psoriasis Gyrata.-There are wavy lines about half an inch wide with circles and semicircles. Psoriasis Diffusa.-The eruption is extensive and irregular, covering large surfaces. |