FIG. 25.
Acne Rosacea.
Are there any subjective symptoms in acne rosacea?
As a rule, no. Some of the acne lesions may be tender and painful, and at times there is a feeling of heat and burning.
What do you know in regard to the etiology?
In many cases the causes are obscure. Chronic digestive and intestinal disorders, anæmia, chlorosis, continued exposure to heat or cold, menstrual and uterine irregularities, and the too free use of spirituous liquors, tea, etc. are often responsible factors.
It is essentially a disease of adult life, common about middle age, occurring in both sexes, but rarely reaching the same degree of development in women as observed at times in men.
Is acne rosacea easily recognized?
Yes. The redness, acne lesions, dilated capillaries, and, at times, the glandular and connective-tissue hypertrophy; the limitation of the eruption to the face, especially the region of the nose; the evident involvement of the sebaceous glands, the absence of ulceration, taken with the history of the case, are characteristic.
It is to be distinguished from the tubercular syphiloderm and lupus vulgaris, diseases to which it may bear rough resemblance.
State the prognosis of acne rosacea.
All cases may be favorably influenced by treatment; the mild and moderately-developed types are, as a rule, curable, but usually obstinate. It is a persistent disease, showing little, if any, tendency to disappear spontaneously.
What is the method of treatment?
Both constitutional and local measures are demanded in most cases.
Upon what is the constitutional treatment to be based?
The constitutional treatment, beyond a regulation of the diet, is to be based upon a correct appreciation of the etiological factors in the individual case. There are no special remedies. Iron, cod-liver oil, tonics, ergot, alkalies, saline laxatives, and similar drugs are to be variously prescribed.
What is the external treatment?
In many respects, both as to the preliminary measures and remedies,essentially the same as that employed in the treatment of simple acne (q. v.). Thex-ray treatment is not so efficient in this disease, however, as in acne. In addition to the treatment there found, several other applications deserve mention:—
In many casesVleminckx's solution[C]is valuable, applied diluted with one to ten parts of water. Also, a mucilaginous paste containing sulphur:—
℞ Mucilag. acaciæ, ................................ fʒiijGlycerinæ, ...................................... fʒijSulphur, præcip., ................................ ʒiij. M.
[C]℞ Calcis, .......................................... ℥ssSulph. sublimat., ................................ ℥jAquæ, ............................................ ℥x.To be boiled down to ℥vj and filtered.
[C]
℞ Calcis, .......................................... ℥ssSulph. sublimat., ................................ ℥jAquæ, ............................................ ℥x.
To be boiled down to ℥vj and filtered.
Or a similar paste with the glycerine in the foregoing replaced with ichthyol may be used.
In what manner are the dilated bloodvessels and connective-tissue hypertrophy to be treated?
The enlarged capillaries are to be destroyed by incision or by electrolysis. Properly managed the vessels may be thus destroyed, but unless the predisposing causes have disappeared or have been remedied, a new growth may take place.
If the knife is employed, the vessels are either slit in their length or cut transversely at several points. The method by electrolysis is the same as used in the removal of superfluous hair (q. v.).; the needle may, if the vessel is short, be inserted along its calibre, or if long, may be inserted at several points in its length.
Excessive connective-tissue growth, exceptionally met with, is to be treated by ablation with the scissors or knife.
(Synonyms:Acne Frontalis; Acne Rodens; Acne Necrotica; Lupoid Acne; Necrotic Granuloma.)
Describe acne varioliformis.
Acne varioliformis is characterized by lesions of a moderately superficial papulo-pustular type, which in disappearing leave slight orwell-marked pit-like scars. The forehead and scalp are the favorite sites, but they may also occur elsewhere. The eruption is rather scanty as a rule, consisting usually of ten to thirty lesions. They begin as small maculo-papules, as papules, or as minute nodules in or on the skin, and gradually become small pea-sized, with a tendency to slight vesiculation or pustulation at the central part. The lesion is sluggish in its course, drying to a thin crust, which finally falls off, leaving a depressed variola-like scar. New lesions arise from time to time, and the disease thus continues almost indefinitely. There may or may not be itching. In what appears to be a variety of this disease, known usually asacne urticata, there is considerable itching just at the time the lesion is appearing. The malady is not frequent, but occurs in both sexes, usually in those between the ages of twenty and fifty. It seems probable that the eruption is parasitic in origin.
The maladies variously known as hydradenitis suppurativa, acnitis, spiradenitis, folliclis, granuloma necroticum, etc., in which the lesions, primarily at least, are somewhat deeper seated, sluggish in their course, and followed by scarring, could be also included under this head.
Give the prognosis and treatment.
The disease is rebellious and tends to recur. The most efficient applications are those of sulphur and resorcin, the same as prescribed in ordinary acne.
(Synonyms:Sycosis Vulgaris; Sycosis Non-parasitica; Folliculitis Barbæ; Sycosis Coccogenica.)
What do you understand by sycosis?
Sycosis is a chronic, inflammatory affection involving the hair-follicles, usually of the moustache and bearded regions only, and characterized by papules, tubercles, and pustules perforated by hairs.
Describe the symptoms of sycosis.
Sycosis begins by the formation of papules and pustules about the hair-follicles; the lesions occur in numbers, in close proximity,and together with the accompanying inflammation, make up a small or large area. The pustules are small, rounded, flat or acuminated, discrete, and yellowish in color; they are perforated by hairs, show no tendency to rupture, and are apt to occur in crops, drying to thin yellowish or brownish crusts. Papules and tubercles are often intermingled. More or less swelling and infiltration are noticeable.
Fig. 26.
FIG. 26.
Sycosis—not infrequently begins in, and sometimes limited to, this region.
The disease is seen, as a rule, only on the bearded part of the face, either about the cheeks, chin or upper lip, involving a small portion or the whole of these parts. It is also sometimes met with involving the hair follicles just within the nasal orifice, and may even be limited to this region.
Occasionally a sycosiform eruption, usually of the side of the bearded region, leaves behind a smooth or keloidal scar, the disease gradually extending—ulerythema sycosiforme(lupoid sycosis).
An inflammation of the hair-follicles of the scalp apparently sycosiform in character, occurring as discrete or aggregated lesions, is sometimes observed, the follicles being destroyed and atrophy or slight scarring resulting—folliculitis decalvans.
Does conspicuous hair loss occur in sycosis?
Ordinarily not; the hairs are, especially at first, usually firmly seated, but in those cases in which suppuration is active, and hasinvolved the follicles, they may, as a rule, be easily extracted. In some cases destruction of the follicles ensues and slight scarring and permanent hair loss result.
State the character of the subjective symptoms.
Pain and itching and a sense of burning, variable as to degree, may be present.
What is the course of the disease?
Essentially chronic, the inflammatory action being of a subacute or sluggish character, with acute exacerbations.
State the causes of sycosis.
Upon the upper lip it may have its origin in a nasal catarrh. Entrance into the follicles of pyogenic micrococci is now regarded as the essential factor. This view being accepted, carries with it the possibility of contagiousness.
It is seen in the male sex only, usually in those between the ages of twenty-five and fifty; and is met with in those in good and bad health, and among rich and poor. It is comparatively infrequent.
What is the pathology of sycosis?
The disease is primarily a perifolliculitis, the follicle and its sheath subsequently becoming involved in the inflammatory process.
How would you distinguish sycosis from eczema?
Eczema is rarely sharply limited to the bearded region, but is apt to involve other parts of the face; moreover, the lesions are usually confluent, and there is either an oozing, red crusted surface, or it is dry and scaly.
How would you exclude tinea sycosis in the diagnosis?
In tinea sycosis, or ringworm sycosis, the history of the case is different. The parts are distinctly lumpy and nodular; the hairs are soon involved and become dry, brittle, loose, and fall out, or they may be readily extracted. The superficial type of ringworm sycosis is readily distinguished by the ring-like character of the patches. In doubtful cases, microscopic examination of the hairs may be resorted to.
Give the prognosis of sycosis.
The disease is curable, but almost invariably obstinate and rebellious to treatment. The duration, extent, and character of theinflammatory process must all be considered. An expression of an opinion as to the length of time required for a cure should always be guarded.
Ulerythema sycosiforme is extremely obstinate. Folliculitis decalvans is also rebellious.
How is sycosis to be treated?
Mainly, and often exclusively, by external applications.
Fig. 27.
FIG. 27.
Sycosis.
Is constitutional treatment of no avail in sycosis?
In some instances; but, as a rule, it is negative. If indicated, such remedies as tonics, alteratives, cod-liver oil and the like are to be prescribed.
Describe the external treatment.
Crusting, if present, is to be removed by warm embrocations. If the inflammation is of a high grade, and the parts tender and painful, soothing applications, such as bland oils, black wash and oxide-of-zinc ointment, cold cream and petrolatum, are to be used;boric-acid solution, fifteen grains to the ounce, may be advised in place of black wash.
In most cases, however, astringent and stimulating remedies are demanded from the start, such as: diachylon ointment, alone or with ten to thirty grains of calomel to the ounce; oleate of mercury, as a five- to twenty-per-cent. ointment; precipitated sulphur, one to three drachms to the ounce of benzoated lard, or lard and lanolin; a ten- to twenty-five-per-cent. ichthyol ointment; and resorcin lotion or ointment, ten to twenty per cent. strength.
Fig. 28.
FIG. 28.
Sycosis.
A change from one application to another will be found necessary in almost all cases.
In obstinate cases the x-ray treatment can be used, as it has proved itself valuable in some instances; as in other diseases, it should be employed cautiously.
What would you advise in regard to shaving?
When bearable (and after a few days' application of soothing remedies it almost always is), it is to be advised in all cases, as itmaterially aids in the treatment. After a cure is effected it should be continued for some months, until the healthy condition of the parts is thoroughly established.
When is depilation advisable as a therapeutic measure?
When the suppurative process is active, in order to save the follicles from destruction; incising or puncturing the pustules will often accomplish the same end.
Depilation is in all cases a valuable therapeutic measure, but it is painful; as a routine practice, shaving is less objectionable and, upon the whole, is probably as satisfactory. Those who make free use of the x-ray commonly push it to the point of producing depilation.
(Synonym:Acne Keloid.)
Fig. 29.
FIG. 29.
Dermatitis Papillaris Capillitii
Describe dermatitis papillaris capillitii.
This is a peculiar, mildly inflammatory, sycosiform, keloidal, acne-like disease of the hairy border of the back of the neck, often extending upward to the occipital region; partaking,especially later in its course, somewhat of the nature of keloid. Several or more acne-like lesions, papular and pustular, closely grouped or bunched, appear, developing slowly, usually to the size of peas; are red, pale red, or whitish, often enveloping small tufts of hair, and attended with more or less hair loss. Its course is gradual and persistent. It is an exceedingly rare condition, the exact nature of which is still obscure.
Give the treatment.
Treatment, which is usually unsatisfactory, consists of stimulating applications—the same, in fact, as employed in sycosis, sulphur and ichthyol deserving special mention. Depilation is essential.
Give a descriptive definition of impetigo contagiosa.
Impetigo contagiosa is an acute, contagious, inflammatory disease, characterized by the formation of discrete, superficial, flat, rounded, or ovalish vesicles or blebs, soon becoming vesico-pustular, and drying to thin yellowish crusts.
Upon what parts does the eruption commonly appear?
Upon the face, scalp, and hands, and exceptionally upon other regions.
Describe the symptoms of impetigo contagiosa.
One, several or more small pin-head-sized papulo-vesicles or vesicles make their appearance, usually upon the face and fingers. In the male adult the region of the neck and beard is a favorite situation. They increase in size by extending peripherally, but are more or less flattened and umbilicated, and are without conspicuous areola. The lesions may attain the size of a dime or larger, and when close together may coalesce and form a large patch. In some cases distinct blebs result, and a picture of pemphigus eruption presented; it is probable that many of the cases of “contagious pemphigus” belong to this class. New lesions may appear for several days, but finally, in the course of a week or ten days, they have all dried to thin, wafer-like crusts, of a straw or light-yellow color, but slightly adherent, and appearing as if stuck on; these soon drop off, leaving faint reddish spots, which gradually fade. In some cases there isso decided a tendency to clear and dry up centrally while spreading peripherally that the eruption has a ring-like aspect; this seems especially so in the bearded region of the male adult.
Instead of presenting as described, it may occur as one or more pea- or finger-nail-sized, rounded and elevated, usually firm, discrete pustules, scattered over one part, or more commonly over various regions, such as the face, hands, feet and lower extremities. The pustules are such from the beginning, and when developed are usually of the size of a pea or finger-nail, elevated, semi-globular or rounded, with somewhat thick and tough walls, and of a whitish or yellowish color; at first there may be a slight inflammatory areola, but as the lesion matures this almost, if not entirely, disappears. The pustules show no disposition to umbilication, rupture or coalescence; drying in the course of several days or a week to yellowish or brownish crusts, which soon drop off, leaving no permanent trace. This variety was formerly thought to be a distinct disease, and was described under the name ofimpetigo simplex.
As a rule there are no constitutional symptoms, but in the more severe cases the eruption may be preceded by febrile disturbance and malaise. Itching may or may not be present.
State the cause of the disease.
It is contagious, the contents of the lesions being inoculable and auto-inoculable. At times it seems to prevail in epidemic form. Pyogenic microörganisms are now regarded as causative. A relationship to vaccination has been alleged by some observers. It is more commonly observed in infants and young children.
From what diseases is impetigo contagiosa to be differentiated?
From eczema, pemphigus, and ecthyma.
How does impetigo contagiosa differ from these several diseases?
By the character of the lesions, their growth, their superficial nature, their course, the absence of an inflammatory base and areola, the thin, yellowish, wafer-like crusts, and usually a history of contagion.
State the prognosis.
The effect of treatment is usually prompt. The disease, indeed, tends to spontaneous disappearance in two to four weeks; in exceptional instances, more especially in those cases in which itching is present, the excoriations or scratch-marks become inoculated, and in this way it may persist several weeks.
What is the treatment of impetigo contagiosa?
Treatment consists in the destruction of the auto-inoculable properties of the contents of the lesions; this is effected by removing the crusts by means of warm water-and-soap washings, and subsequently rubbing in an ointment of ammoniated mercury, ten to twenty grains to the ounce. Some cases respond more rapidly to the use of a drying ointment, such as Lassar's paste, with ten to twenty grains of white precipitate or sulphur to the ounce. In itching cases, a saturated solution of boric acid, or a carbolic-acid lotion, one to two drachms to the pint, is to be employed for general application.
Describe impetigo herpetiformis.
Impetigo herpetiformis is an extremely rare disease, observed usually in pregnant women, and is characterized by the appearance of numerous isolated and closely-crowded pin-head-sized superficial pustules, which show a decided disposition to the formation of circular groups or patches. The central portion of these groups dries to crusts, while new pustules appear at the peripheral portion. They tend to coalesce, and in this manner a greater part of the whole surface may, in the course of weeks or months, become involved. Profound constitutional disturbance, usually of a septic character, precedes and accompanies the disease; in almost every instance a fatal termination sooner or later results.
It is possibly a grave type of dermatitis herpetiformis.
Give a descriptive definition of ecthyma.
Ecthyma is a disease characterized by the appearance of one, several or more discrete, finger-nail-sized, flat, usually markedly inflammatory pustules.
Describe the symptoms and course of ecthyma.
The lesions begin as small, usually pea-sized, pustules; increase somewhat in area, and when fully developed are dime-sized, or larger, somewhat flat, with a markedly inflammatory base and areola. At first yellowish they soon become, from the admixture of blood, reddish, and dry to brownish crusts, beneath which will be found superficial excoriations. The individual pustules are usually somewhat acute in their course, but new lesions may continue to appear from day to day or week to week. As a rule, not more than five to twenty are present at one time, and in most cases they are seated on the legs. More or less pigmentation, and sometimes superficial scarring, may remain to mark the site of the lesions.
Itching is rarely present, but there may be more or less pain and tenderness.
What is the cause of ecthyma?
It is essentially a disease of the poorly cared-for and ill-fed; the direct exciting cause is the introduction of pyogenic microörganisms into the follicular openings. It is closely allied to impetigo contagiosa, and may in fact be regarded as a markedly inflammatory form of the latter affection. It seems much less contagious, however. It is commonly observed in male adults.
From what diseases is ecthyma to be differentiated?
From impetigo contagiosa, and the flat pustular syphiloderm.
How is it distinguished from these several diseases?
The size, shape, inflammatory action, and the depraved general condition, the distribution and lesser-contagiousness will distinguish it from impetigo contagiosa; and the absence of concomitant symptoms of syphilis, and of positive ulceration, as well as its distribution and more rapid and inflammatory course, will exclude the pustular syphiloderm.
State the prognosis.
The disease is readily curable, disappearing upon the removal of the predisposing cause and the employment of local antiseptic applications.
What treatment is to be advised?
Good food, proper hygiene and tonic remedies; and, locally, removal of the crusts and stimulation of the underlying surface with an ointment of ammoniated mercury, ten to thirty grains to the ounce.
The following mild antiseptic lotion, which materially lessens the tendency to the formation of new lesions, may be applied to the affected region two or three times daily:—
℞ Acidi borici, .................................... ʒivResorcini, ....................................... ʒijGlycerinæ, ...................................... fʒijAlcoholis, ...................................... f℥jAquæ, ....................q.s. ad. ............... Oj. M.
A weak lotion of thymol, corrosive sublimate or ichthyol would doubtless be equally effectual.
What do you understand by pemphigus?
Pemphigus is an acute or chronic disease characterized by the successive formation of irregularly-scattered, variously-sized blebs.
Name the varieties met with.
Two varieties are usually described—pemphigus vulgaris and pemphigus foliaceus.
Describe the symptoms and course of pemphigus vulgaris.
With or without precursory symptoms of systemic disturbance, irregularly scattered blebs, few or in numbers, make their appearance, arising from erythematous spots or from apparently normal skin. They vary in size from a pea to a large egg, are rounded or ovalish, usually distended, and contain a yellowish fluid which, later, becomes cloudy or puriform. If ruptured, the rete is exposed, but the skin soon regains its normal condition; if undisturbed, the fluid usually disappears by absorption. Each lesion runs its course in several days or a week.
A grave type of pemphigus is exceptionally observed in the newborn—pemphigus neonatorum.
What course does pemphigus vulgaris pursue?
Usually chronic. The disease may subside in several months and the process come to an end, constituting the acute type. As a rule, however, the disease is chronic, new blebs continuing to appear from time to time for an indefinite period.
Fig. 30.
FIG. 30.
Pemphigus (mulatto).
In what respects does the severe form of pemphigus vulgaris differ from the ordinary type?
In the severe or malignant type the eruption is more profuse; there is marked, and often grave, systemic depression, and the lesions are attended with ulcerative action.
Describe the symptoms and course of pemphigus foliaceus.
In this, the grave type of the disease, the blebs are loose and flaccid, with milky or puriform contents, rupturing and drying tocrusts, which are cast off, disclosing the reddened corium. New blebs appear on the sites of disappearing or half-ruptured lesions, and the whole surface may be thus involved and the disease continue for years, compromising the general health and eventually ending fatally.
In some cases of pemphigus (pemphigus vegetans) a vegetating or papillomatous condition develops from the base of the lesion, with an offensive discharge; it is usually a grave type of the malady.
Exceptionally cases (dermatitis vegetans) are met with which have a close similarity in their symptoms to pemphigus vegetans, but in which the eruption is more or less limited to the genitocrural region. The disorder is not malignant and usually yields to cleanliness and antiseptics.
What is the character of the subjective symptoms in pemphigus?
The subjective symptoms consist variously of heat, tenderness, pain, burning and itching, and may be slight or troublesome.
What is known in regard to the etiology of pemphigus?
The causes are obscure; general debility, overwork, shock, nervous exhaustion, and septic conditions (microörganisms) are thought to be of influence. There seems no doubt that those who have to do with cattle products, especially butchers, are subjects of acute and usually grave pemphigus. Vaccination has exceptionally been responsible for the disease, probably through some coincidental infection. The disease is not contagious, nor is it due to syphilis. It may occur at any age.
It is a rare disease, especially in this country. Most of the cases diagnosed as pemphigus by the inexperienced are examples of bullous urticaria, bullous erythema multiforme, and impetigo contagiosa.
What is the pathology?
The lesions are superficially seated, usually between the horny layer and upper part of the rete. Round-cell infiltration and dilated blood vessels are found about the papillæ and in the subcutaneous tissue. The contents of the blebs, always of alkaline reaction, areat first serous, later containing blood corpuscles, pus, fatty-acid crystals, epithelial cells, and occasionally uric acid crystals and free ammonia.
From what diseases is pemphigus to be differentiated?
From herpes iris, the bullous syphiloderm, impetigo contagiosa and dermatitis herpetiformis.
How do these several diseases differ from pemphigus?
The acute course, small lesions, concentric arrangement, variegated colors, and distribution, in herpes iris; the thick, bulky, greenish crusts, the underlying ulceration, the course, history, and the presence of concomitant symptoms of syphilis, in the bullous syphiloderm; the history, course, distribution, the character of the crusting, and the contagious and auto-inoculable properties of the contents of the lesions, in impetigo contagiosa; the tendency to appear in groups, the smaller lesions, the intense itchiness, course, multiform characters of the eruption and the disposition to change of type in dermatitis herpetiformis,—will serve as differential points.
State the prognosis of pemphigus.
Its duration is uncertain, and the issue may in severe cases be fatal. In the milder types, after months or several years, recovery may take place.
The extent and severity of the disease and the general condition of the patient are always to be considered before an opinion is expressed.
Pemphigus neonatorum usually ends fatally.
Give the treatment of pemphigus.
Both constitutional and local measures are demanded. Good nutritious food and hygienic regulations are essential. Arsenic and quinia are the most valuable remedies. The former, in occasional instances, seems to have a specific influence, and should always be tried, beginning with small doses and increasing gradually to the point of tolerance and continued for several weeks or longer. The remedy should not be set aside as long as there are signs of improvement, unless the supervention of stomachic, intestinal or other disturbance demand its discontinuance. Other tonics, such as iron, strychnia and cod-liver oil, are also at times of service.The blebs should be opened and the parts anointed or covered with a mild ointment. In more general cases bran, starch and gelatin baths, and in severe cases the continuous bath, if practicable, are to be used.
Define purpura.
Purpura is a hemorrhagic affection characterized by the appearance of variously-sized, usually non-elevated, smooth, reddish or purplish spots or patches, not disappearing under pressure.
Name the several varieties met with.
Three—purpura simplex, purpura rheumatica and purpura hæmorrhagica; denoting, respectively, the mild, moderate and severe grade of the disease. The division is, to a great extent, an arbitrary one.
Describe the clinical appearance and course of an individual lesion of purpura.
The spot, which may be pin-head, pea-, bean-sized or larger, appears suddenly, and is of a bright red or purplish red color. Its brightness gradually fades, the color changing to a bluish, bluish-green, bluish- or greenish-yellow, dirty yellowish, yellowish-white, and finally disappearing; varying in duration from several days to several weeks.
Describe the symptoms of purpura simplex.
Purpura simplex, or the mild form, shows itself as pin-point to pea- or bean-sized, bright or dark-red spots, limited, as a rule, to the limbs, especially the lower extremities; fading gradually away and coming to an end in a few weeks, or new crops appearing irregularly for several months. There is rarely any systemic disturbance, and, as a rule, no subjective symptoms; in exceptional cases an urticarial element is added—purpura urticans.
Describe the symptoms of purpura rheumatica.
Purpura rheumatica (also calledpeliosis rheumatica) is usually preceded by symptoms of malaise, rheumatic pains and sometimesswelling about the joints; these phenomena abate and frequently disappear upon the outbreak of the eruption. The lesions are pea- to dime-sized, smooth, non-elevated, or slightly raised, and of a reddish or purplish color; the eruption may be more or less generalized, most abundant upon the limbs, or it may be limited to these parts. It may end in a few weeks, or may persist for several months, new spots appearing irregularly or in the form of crops.
As somewhat allied to this is another form (Schönlein's disease), quite alarming in its symptoms. It is rare. It is characterized by symptoms partaking of the nature of rheumatism, purpuric spots, blotches and ecchymoses, erythema multiforme, and often associated with considerable edema. The throat is also usually invaded, and indeed the first symptom is commonly in this region. Considerable constitutional disturbance, of a threatening character, is commonly observed. Recovery usually takes place.
Henoch's purpura, observed chiefly in children, resembles the above, with the erythema multiforme character and the œdematous swellings more pronounced, while the actual purpuric symptoms are less conspicuous. Gastric and intestinal symptoms and hemorrhages from the mucous membrane are commonly noted. It is fatal in about 20 per cent. of the cases.
Describe the symptoms of purpura hæmorrhagica.
Purpura hæmorrhagica (also calledland scurvy) is characterized usually by premonitory, and frequently accompanying, symptoms of general distress, and by the appearance of coin to palm-sized, red or purplish hemorrhagic spots or patches, smooth, non-elevated or raised. Hemorrhage from the mouth, gums and other parts, slight or serious in character, may occur. New lesions continue to appear for several days or weeks; and in exceptional instances, repeated relapses take place, and the disease thus persists for months. It may end fatally.
State the etiology of purpura.
In most instances no cause can be assigned. The disease occurs at all ages from childhood to advanced life, and in individuals, apparently, in good and bad health alike. The hemorrhagic type is oftener seen in subjects debilitated or in a depraved state of health. A microörganism is also looked upon as a factor by some observers, especially in the grave type of disease.
State the diagnostic characters of purpura.
The appearance, irregularly or in crops, of bright-red or purplish spots, evidently of hemorrhagic nature, and notdisappearing upon pressure, and as they are fading, going through the several changes of color usually observed in any ecchymosis.
How does scurvy (scorbutus) differ from purpura?
Scurvy, which may resemble the severe grade of purpura, has a different history, a recognizable cause, usually a peculiar distribution, and is accompanied with general weakness and a spongy, soft and bleeding condition of the gums.
What is the pathology of purpura?
The lesion of purpura consists essentially of a hemorrhage into the cutaneous tissues. The blood is subsequently absorbed, the hæmatin undergoing changes of color from a red to greenish and pale yellow, and finally fading away.
State the prognosis
The milder varieties disappear in the course of several weeks or months, and are rarely of serious import; the outcome of purpura hæmorrhagica is somewhat uncertain; although usually favorable, a fatal result from internal hemorrhage is possible. The variety known as Schönlein's disease is alarming, but seldom fatal. Henoch's disease is, however, always of grave import.
What is the treatment of purpura?
Hygienic and dietary measures, the administration of tonics and astringents, and, in severe cases, by relative or absolute rest.
The drugs commonly prescribed are: ergot, oil of erigeron, oil of turpentine, quinia, strychnia, iron, mineral acids, and gallic acid.Externaltreatment is rarely called for, but if deemed advisable, astringent lotions may be employed.
(Synonyms:Scurvy; Sea Scurvy; Purpura Scorbutica.)
Describe scorbutus.
Scurvy is a peculiar constitutional state, developed in those living under bad hygienic conditions, and is characterized by emaciation,general febrile and asthenic symptoms, a more or less swollen, turgid and spongy and even gangrenous condition of the gums; and concomitantly, or sooner or later, by the appearance, usually upon the lower portion of the legs only, of dark-colored hemorrhagic patches or blotches. The skin of the affected part may become brawny and slightly scaly, and not infrequently may break down and ulcerate. Hemorrhages from the various mucous surfaces, slight or grave, may also take place.
State the etiology of scurvy.
It is due to long-continued deprivation of proper food, especially of fruits and vegetables. Other bad hygienic conditions favor its development. It is seen most commonly in sailors and others taking long voyages.
How is scurvy to be distinguished from purpura?
By the asthenic and emaciated general condition and the peculiar puffy, spongy state of the gums. The cutaneous manifestation is more diffused, forming usually large palm-sized patches, and, as a rule, limited to the region of the ankles or lower part of the legs.
Give the prognosis of scurvy.
The disease is remediable, and usually rapidly so. In those instances in which the same bad hygienic conditions and the ingestion of improper food are continued, death finally results.
What treatment would you advise in scurvy?
Proper food, with an abundance of fruit and vegetables. Lemon or lime juice is especially valuable, and is to be taken freely. If indicated, tonics and stimulants are also to be prescribed. For the relief of the tumid, spongy condition of the gums, astringent and antiseptic mouth washes are to be employed.
The cutaneous manifestations, when tending to ulceration, are to be treated upon general principles.