CHAPTER XXVIII DERMATOLOGICAL MEMORANDA SYNOPSIS: Introductory Remarks.-Anomalies of Pigmentation.-Diseases of the Sweat and Sebaceous Glands.-Eruptive Fevers (see Chapter on Pædiatrics).—Inflammations, Eczema, Ulceration, Phlegmon, Atrophies, etc.-Parasitic Skin Diseases, Benign and Malignant Neoplasms, Dermatoneuroses.-Diseases of the Appendages (Hair, Nails).— Formulary. INTRODUCTORY REMARKS THE skin performs various important functions. It is endowed with the power of respiration, by means of which there is a constant, although very subordinate, interchange of oxygen and carbonic acid. The secretory function of the skin is performed by the sweat and sebaceous glands. Sweating may be profuse or scanty, localized or general, or altered in color or smell. The secretion of sweat is not a continuous process, but is influenced or affected by many factors. The secretion of the sebaceous glands is probably continuous. The skin has a vasomotor heat regulating function which influences the radiation of heat and evaporation of moisture from the surface. The sensory function of the skin is a most important one. The color of the skin varies according to race, exposure, occupation, and the general state of health. We recognize the habitual pallor of indoor life and the pallor of anæmia from any cause. Localized or diffused redness may be physiological or pathological. A localized or general cyanosis may result from respiratory or circulatory embarrassment or from intoxication (acetanilide poisoning, etc.). Yellow discoloration of the skin may result from obstructive or toxæmic jaundice. A bronzing of the skin is associated with the so called Addison's disease. A gray discoloration (argyria) has been observed after the long continued internal administration of silver salts. The temperature of the skin may vary considerably; the whole or a portion of the integument may be warm or cold. The skin receives the brunt of the bodily injuries and protects underlying organs and tissues. Skin diseases are due to infection and autointoxication from the gastrointestinal tract. Many skin phenomena are simply the expression of an effort to eliminate. An unbroken skin or mucous membrane is an effective barrier to local and systemic infection by animal and vegetable microorganisms. The lymph nodes are an efficient ally in repelling microbial invasion by catching in their meshes infecting material; they generally participate also in the inflammatory and destructive processes which threaten the skin. The vulnerability of the skin from within, i. e., from internal conditions and causes, should always be borne in mind (eliminative rashes) in contradistinction to skin lesions which come from without the body. The classification of skin diseases is unsatisfactory to such an extent that in some publications the group classification has been dropped and skin lesions are described in alphabetical order. Although faulty and unsatisfactory, the author gives preference to a clinical grouping of skin lesions. As the diagnosis and management of skin diseases cannot be taught from books, however elaborate and voluminous, the definition, characteristic signs, and treatment of skin lesions are presented in a condensed form. At the end of the chapter a number of well tried formulæ are given, and their selection is to be accomplished by means of reference numbers. Diet is important in skin diseases, but there are no formulated diet rules for universal application. The person afflicted with a skin lesion should avoid food which experience has shown does not agree with digestion or with the skin. Alcohol is harmful in many skin diseases; tobacco is less harmful. Climate and air have their influence, but no general rules can be laid down. Soap and water may act as an irritant in skin lesions, particularly in eczemas, and when washing cannot be avoided a small quantity of sal soda may be dissolved in the wash water. Dyspeptic and anæmic conditions and constipation should receive foremost attention, and syphilis as an underlying cause of skin lesions should not be overlooked. DISEASES OF THE GLANDULAR APPARATUS SWEAT GLANDS Anidrosis. Diminution or suppression of sweat. 1. Primary, due to faulty innervation. 2. Secondary, or symptomatic, as in diabetes, fevers, etc. The PROGNOSIS depends upon the underlying cause. TREATMENT.-Massage, vapor and alkaline baths, and enteroclysis may be of use. Bromidrosis (Osmidrosis). This is the secretion of sweat of an offensive odor. The cause is unknown. It may be symptomatic, as in uræmia, rheumatism, etc. It mostly occurs upon the feet of young persons. The prognosis is favorable. TREATMENT.-Bathe in hot water and soap every night, and dust with talcum powder medicated with formalin (10 drops to 1 oz.). Chromidrosis (Colored Sweat). 1. Idiopathic, due to obscure disorder of the sweat glands. 2. Accidental, due to absorption of certain substances into the system. Green sweat is often found in copper workers. Red sweat is caused by Bacterium prodigiosum. The PROGNOSIS is bad in the first, but good in the second variety. Hæmatidrosis (Bloody Sweat).-Hæmorrhage from the sweat pores. It occurs in hysterical women. SEBACEOUS GLANDS The PROGNOSIS is favorable. The TREATMENT is symptomatic. 771 Hyperidrosis, excessive secretion of sweat, may be general or local. The hands, if affected, are cold and clammy. If the feet are affected, the skin is macerated and walking produces pain. It is usually due to vasomotor disturbance. The PROGNOSIS is favorable. TREATMENT.-See Bromidrosis; use also camphor ice and ichthyol between the toes as an ointment. SEBACEOUS GLANDS Acne (Pimples). 1. Acne Albida (Milium, Grutum, Strophulus Albidus).—The lesions are minute rounded, opaque white, seedlike grains-distended sebaceous follicles occurring mostly on the face, the eyelids, the scrotum, and the lower surface of the penis. The PROGNOSIS is favorable. TREATMENT.-Puncture the little cysts, turn out the contents, and destroy the remaining cyst wall by painting with iodine. 2. Acne Punctata (Papulosa, Atrophica, Hypertrophia, Cachecticorum, Pustulosa, Indurata).—A pinhead to pea-sized papular and pustular eruption, mostly penetrated by a minute sebaceous plug, comedo, occurs on the forehead, face, and shoulders. It is mostly a disease of puberty, and often secondary to gastrointestinal and genitourinary disturbance or to anæmia. PROGNOSIS.-It is a very chronic affection, giving rise to marked nodular induration. TREATMENT.—Attention should be given to the removal of constitutional causes. Prescribe local bathing with hot water and occasionally with soap and application of formula No. 8. Puncture the pustules as they form. 3. Acne Rosacea (Gutta Rosea).-The nose and face are hyperæmic and greasy and traversed by irregular tortuosities of blood vessels and isolated papules and pustules. Hypertrophy of the skin is present (pseudoelephantiasis). The constitutional causes are similar to those of the preceding variety; besides, it often appears during the menopause. It may also be caused by abuse of spirituous liquors and constant exposure to the weather. The PROGNOSIS is favorable under early and persistent treatment. TREATMENT.-Search for and remove the constitutional causes. Locally formula No. 25 is to be applied during the day and No. 24 at night. Perform scarification of the tortuosities, if they are very marked. Comedo (Acne Punctata Nigra, Black Heads, or Flesh Worms). These are minute sebaceous plugs with black, yellow, or brown external points. They occur mostly on the face, neck, chest, and back. If not squeezed out, they are apt to give rise to an acnelike eruption. The etiology is obscure, but is partly the same as that of acne. PROGNOSIS. They are very obstinate, but the outlook is favorable. The TREATMENT is the same as in acne punctata. Locally, use formula No. 25. Seborrhæa (Acne Sebacea; Tinea Furfuracea; Dandruff) 1. Seborrhoea Oleosa.-This is an inordinate oiliness of the skin of the forehead, nose, and cheeks; it is not attended by itching. 2. Seborrhoea sicca gives rise to an accumulation of yellow or grayish scales upon the scalp or non-hairy regions. It is attended with decided itching. When the face is involved, the eyebrows and beard are affected first. When the scalp is affected it is frequently a source of premature baldness (defluvium capillorum). The PROGNOSIS is favorable, though the course is chronic. TREATMENT. In seborrhoea oleosa, use astringent lotions, e. g., formula No. 27. In seborrhoea sicca the scales are to be removed by prolonged applications of olive or castor oil, the surface is washed with green soap, and then the hair wash, No. 47, is to be used. ANOMALIES OF PIGMENTATION CHLOASMA; VITILIGO; LENTIGO; ALBINISMUS Chloasma (Liver Spots, Moth).-Fawn-colored, yellowish, brownish, or blackish (melanoderma) patches of various sizes, irregular, rounded with fairly defined borders, may form on any part of the body. a. The idiopathic, due to external causes, may include all pigmentations resulting from local irritants, such as burns, blisters, etc., and scratching. b. The symptomatic is secondary to visceral and uterine diseases and occurs in pregnancy, Addison's disease, malarial disease, cancer, tuberculosis, etc., also from the prolonged administration of silver (argyria). TREATMENT.-Remove the cause. Formulæ Nos. 1 and 10. Vitiligo (leucoderma) consists of rounded, oval, or irregular, milk white. or pinkish white spots, spreading slowly or rapidly, at times coalescing and forming large patches, the surrounding skin being usually brownish yellow. It is of slow progress, lasts throughout life, affects any part of the body, especially the backs of the hands and the trunk, is frequent in negroes, and may be associated with morphœa, alopecia areata, and exophthalmic goître. TREATMENT.-Give arsenic internally, also iodine, and use weak lotions. of acetic acid or corrosive sublimate locally. Lentigo (freckles), due to an increased deposition of pigment in the basal layer of the epidermis, we observe mostly on the face and hands in individuals of fair complexion. The lesions are pinhead to pea-sized, round, oval, or irregular, and of a yellowish, brownish, or blackish color. TREATMENT.-Use formulæ 9 or 10, and particularly 42, 43, 44, and 45. Albinism is a lack of pigmentation. INFLAMMATIONS Bedsores (decubitus) are caused by undue pressure and irritating secretions with underlying constitutional or trophoneurotic changes. Pathologically they may be looked upon as local patches of moist gangrene. They are common in the course of various wasting diseases and fevers, and especially in the course of lesions of the brain and spine. TREATMENT.-Harden the skin by means of alcohol or spirit of camphor and reduce the pressure by air cushions or a water bed. If ulcers develop, treat them antiseptically. Ulcer of the Leg.-Eczematous, senile, from varicose veins, syphilitic, tuberculous, carcinomatous, etc. PRINCIPLES OF TREATMENT OF SIMPLE ULCER.-Cleansing of the parts. Rest in bed and a lead lotion if the ulcer is inflamed. If it is not inflamed, cauterize or remove with a sharp spoon all foul granulations or débris, and dress with zinc adhesive plaster or zinc and ichthyol ointment or plain mutton suet. If the patient is obliged to be up and about, he should wear an elastic bandage over a thin summer stocking, with the toe end cut off. Almost all ulcers can be healed. DERMATITIS Dermatitis calorica (burns) results from exposure to the sun (erythema or eczema solare, "sun burn"), to radiating sources of heat (x rays), or to heated solids or fluids. The degree of the burn depends upon the duration of the exposure, the degree of heat, and the resistance and sensitiveness of the skin. There is erythema, tumefaction, vesiculation, or partial or complete de FIG. 215.-DRESSING FOR ULCER OF THE LEG. Absorbent gauze in position over rubber tissue-roller bandage securing dressing. The gauze is turned back to show the rubber tissue beneath. (Dr. W. S. Schley, the Med. Record, 1904.) struction of the skin. There may be desquamation, with consequent pigmentation or scarring. There is a tendency to severe septic complications, and in large, especially abdominal, burns ulceration of the duodenum is apt to occur, with perforation, etc. There is shock even in slight burns. The PROGNOSIS is favorable in mild burns, but very unfavorable if more than a third of the entire body surface is affected. TREATMENT.-Relieve pain and shock. Keep the burnt surface clean. Apply sedative lotions, powders, and ointments--carron oil, zinc and starch powder, and formula Nos. 21 and 36. |
