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 somewhatincreased 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, œdematous and hard; the skin is thickened, the normal lines and folds exaggerated, the papillæ 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 œdema. 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.
(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 rugæ gives rise to an uneven surface, but the skin remains soft andpliable. 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.
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 ormore 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.
(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.
Disturbed innervation is thought to be influential. The disease develops often without apparent cause. Alopecia areata and morphœa have been observed associated with it.
Fig. 36.
FIG. 36.
Vitiligo.
State the pathology of vitiligo.
The disease consists, anatomically, of both a diminution and increase of the pigment—the white patch resulting from the former, and the pigmented borders from the latter. There is no textural change, the skin in other respects being normal.
From what diseases is vitiligo to be differentiated?
From morphœa and from the anæsthetic patches of leprosy.
In what respects do these diseases differ from vitiligo?
In morphœa there is textural change, and in leprosy both textural change and constitutional or other symptoms.
What prognosis is to be given?
It should always be guarded, the disease in almost all cases being irresponsive to treatment.
What is the treatment of vitiligo?
The general health is to be looked after, and remedies directed especially toward the nervous system to be employed. Arsenic, in small and continued doses, seems at times to have an influence; when there is lack of general tone it may be prescribed as follows:—
℞ Liq. potassii arsenitis, ........................ fʒjTinct. nucis vom., .............................. fʒiijElix. calisayæ, ............... q.s. ad. ........ f℥iv. M.SIG.—fʒj t.d.
Suprarenal-gland preparations in moderate dosage long continued has appeared in a few instances to be of some benefit.
When upon exposed parts, stimulation of the patches, with the view of producing hyperæmia and consequent pigment deposit; conjoined with suitable applications to the surrounding pigmented skin, with a view to lessen the coloration (seetreatment of chloasma), will be of aid in rendering the disease less conspicuous. Or the condition may be, in a measure, masked by staining the patches with walnut juice or similar pigment.
(Synonym:Grayness of the Hair.)
Describe canities.
Canities, or graying of the hair, may occur in localized areas or it may be more or less general; the blanching may be slight, scarcely amounting to slight grayness, or it may be complete. It is common to advancing years (canities senilis); it is seen also exceptionally in early life (canities præmatura). The condition is usually permanent. The loss of pigment takes place, as a rule, slowly, but several apparently authentic cases have been reported in which the change occurred in the course of a night or in a few days.
What is the etiology of canities?
The causes are obscure. Heredity is usually an influential factor,and conditions which impair the general nutrition have at times an etiological bearing. Intense anxiety, fright, and other profound nervous shock are looked upon as causative in sudden graying of the hair.
Give the treatment.
Canities is without remedy. Dyeing, although not to be advised, is often practised, and the condition thus masked.
(Synonym:Baldness.)
What do you understand by alopecia?
By alopecia is meant loss of hair, either partial or complete.
Name the several varieties of alopecia.
The so-called varieties are based mainly upon the etiology, and are named congenital alopecia, premature alopecia and senile alopecia.
Describe congenital alopecia.
Congenital alopecia is a rare condition, in which the hair-loss is usually noted to be patchy, or the general hair-growth may simply be scanty. In rare instances the hair has been entirely wanting; in such cases there is usually defective development of other structures, such as the teeth.
Describe premature alopecia.
Loss of hair occurring in early and middle adult life is not uncommon, and may consist of a simple thinning or of more or less complete baldness of the whole or greater part of the scalp. It usually develops slowly, some months or several years passing before the condition is well established. It is often idiopathic, and without apparent cause further than probably a hereditary predisposition. It may also be symptomatic, as, for example, the loss of hair, usually rapid (defluvium capillorum), following systemic diseases, such as the various fevers, and syphilis; or as a result of a long-continued seborrhœa or seborrhœic eczema (alopecia furfuracea).
Describe senile alopecia.
This is the baldness so frequently seen developing with advancing years, and may consist merely of a general thinning, or, morecommonly, a general thinning with a more or less complete baldness of the temporal and anterior portion or of the vertex of the scalp.
What is the prognosis in the various varieties of alopecia?
In those cases in which there is a positive cause, as, for instance, in symptomatic alopecia, the prognosis is, as a rule, favorable, especially if no family predisposition exists. In the congenital and senile varieties the condition is usually irremediable. In idiopathic premature alopecia, the prognosis should be extremely guarded.
How would you treat alopecia?
By removing or modifying the predisposing factors by appropriate constitutional remedies, and by the external use of stimulating applications.
Name several remedies or combinations usually employed in the local treatment.
Sulphur ointment, full strength or weakened with lard or vaseline; a lotion of resorcin consisting of one or two drachms to four ounces of alcohol, to which is added ten to thirty minims of castor oil; and a lotion made up as follows:—
℞ Tinct. cantharidis, ............................. fʒivTinct. capsici, ................................. f℥jOl. ricini, ..................................... fʒss-fʒjAlcoholis, ................. q.s. ad. ........... f℥iv. M.
The following is sometimes beneficial:—
℞ Resorcin, ........................................ gr. lxxxQuininæ (alkaloid), .............................. gr. xvOl. ricini, ...................................... ♏v-♏xxAlcoholis, ...................................... f℥iv. M.
Another excellent formula is:
℞ Resorcin, ........................................ gr. lxxx-cxxAc. carbolici cryst., ............................ gr. xxSpts. myrciæ, ................................... f℥iv. M.
And also the various other stimulating applications employed in alopecia areata (q. v.).
Other measures of value are: Faradic electricity applied daily for five minutes with a metallic brush or comb; daily massage, with the object of loosening the skin and giving more freedom to cutaneous and subcutaneous circulation; and the application, two or three times weekly, of static electricity by means of the static crown electrode.
(The application selected should be gently—not rubbing—applied daily or every second or third day, according to the case; if a lotion, moistening the parts with it; if an ointment, merely greasing the parts. Shampooing every one to three weeks, according to circumstances.)
(Synonyms:Area Celsi; Alopecia Circumscripta.)
What do you understand by alopecia areata?
Fig. 37.
FIG. 37.
Alopecia Areata.
Alopecia areata is an affection of the hairy system, in which occur one or more circumscribed, round or oval patches of complete baldness unattended by any marked alteration in the skin.
Upon what parts and at what age does the disease occur?
In the large majority of cases the disease is limited to the scalp; but it may invade other portions of the body, as the bearded region, eyebrows, eyelashes, and, in rare instances, the entire integument.
It is most common between the ages of ten and forty.
Describe the symptoms of alopecia areata.
The disease begins either suddenly, without premonitory symptoms, one or several patches being formed in a few hours; or, and as is more usually the case, several days or weeks elapse before the bald area or areas are sufficiently large to become noticeable. The patches continue to extend peripherally for a variable period, and then remain stationary, or several gradually coalesce and form a large, irregular area involving the entire or a greater portion of the scalp. The skin of the affected regions is smooth, faintly pink or milky white,
Fig. 38.
FIG. 38.
Alopecia Areata—complete hair loss.
and at first presents no departure from the normal; sooner or later, however, the follicles become less prominent, and slight atrophy or thinning may occur, the bald plaques being slightly depressed.
Occasionally, usually about the periphery and in the early stages, a few hair-stumps may be seen.
What course does alopecia areata pursue?
Almost invariably chronic. After the lapse of a variable period the patches cease to extend, the hairs at the margins of the bald areas being firmly fixed in the follicles; sooner or later a fine, colorless lanugo or down shows itself, which may continue to grow until it is about a half-inch or so in length and then drop out; or it may remain, become coarser and pigmented, and the parts resume their normal condition. Not infrequently, however, after growing for a time, the new hair falls out, and this may happen several times before the termination of the disease.
Are there any subjective symptoms in alopecia areata?
As a rule, not; but occasionally the appearance of the patches is preceded by severe headache, itching or burning, or other manifestations of disturbed innervation.
State the cause of alopecia areata.
The etiology is obscure. Two theories as to the cause of the disease exist: one of these regards it as parasitic, and the other considers it to be trophoneurotic. Doubtless both are right, as a study of the literature would indicate that there are, as regards etiology, really two varieties—the contagious and the non-contagious. In America examples of the contagious variety are uncommon.
Does the skin undergo any alterative or destructive changes?
Microscopical examination of the skin of the diseased area shows little or no alteration in its structure beyond slight thinning.
How do you distinguish alopecia areata from ringworm?
The plaques of alopecia areata are smooth, often completely devoid of hair, and free from scales; while those of ringworm show numerous broken hairs and stumps, desquamation, and usually symptoms of mild inflammatory action. In doubtful cases recourse should be had to the microscope.
What is the prognosis in alopecia areata?
The disease is often rebellious, but in children and young adults the prognosis is almost invariably favorable, permanent loss of hair being uncommon. The same holds true, but to a much less extent, with the disease as occurring in those of more advanced age. In extensive cases—those in which the hair of the entire scalp finallyentirely disappears, and sometimes involves all hairy parts—the prognosis is unfavorable. Only exceptionally does recovery ensue in such instances.
The uncertain duration, however, must be borne in mind; months, and in some instances several years, may elapse before complete restoration of hair takes place. Relapses are not uncommon.
How is alopecia areata treated?
By both constitutional and local measures, the former having in view the invigoration of the nervous system, and the latter a stimulating and parasiticidal action of the affected areas.
Give the constitutional treatment.
Arsenic is perhaps the most valuable remedy, while quinine, nux vomica, pilocarpine, cod-liver oil and ferruginous tonics may, in suitable cases, often be administered with benefit.
Name several remedies or combinations employed in the external treatment of alopecia areata.
Ointments of tar and sulphur of varying strength; the various mercurial ointments; the tar oils, either pure or with alcohol; stimulating lotions, containing varying proportions, singly or in combination, of tincture of capsicum, tincture of cantharides, aqua ammoniæ, and oil of turpentine. The following is a safe formula, especially in dispensary and ignorant class practice:
℞ β-naphthol, ...................................... ʒss-ʒjOl. cadini, .................................... ʒjUngt. sulphuris, ................. q.s. ad. ...... ℥j M.
The cautious use of a five to twenty per cent. chrysarobin ointment is of value. Painting the patches with pure carbolic acid or trikresol every ten days or two weeks sometimes acts well; it should not be applied over large areas nor used in young children. Galvanization or faradization of the affected parts may also be employed, and with, occasionally, beneficial effect. Stimulation with the high-frequency current by means of the vacuum electrode is also of value. When practicable, the Finsen light can be applied with hope of benefit and cure.
(Synonym:Atrophy of the Hair.)
What do you understand by atrophy of the hair?
An atrophic, brittle, dry condition of the hair, and which may be either symptomatic or idiopathic.
Describe the several conditions met with.
As a symptomatic affection, the dry, brittle condition of the hair met with in seborrhœa, in severe constitutional diseases, and in the various vegetable parasitic affections, may be referred to.
As an idiopathic disease it is rare, consisting simply of a brittleness and an uneven and irregular formation of the hair-shaft, with a tendency to split up into filaments (fragilitas crinium); or there may be localized swelling and bursting of the hair-shaft, the nodes thus produced having a shining, semi-transparent appearance (trichorrhexis nodosa). This latter usually occurs upon the beard and moustache.
State the causes of atrophy of the hair.
The causes of the symptomatic variety are usually evident; the etiology of idiopathic atrophy is obscure, but by many is thought due to parasitism.
Fig. 39.
FIG. 39.
Trichorrhexis Nodosa. (After Michelson.)
What would be your prognosis and treatment in atrophy of the hair?
Symptomatic atrophy usually responds to proper measures, but always slowly; treatment is based upon the etiological factors.
For the idiopathic disease little, as a rule, can be done; repeated shaving or cutting the hair has, in exceptional instances, been followed by favorable results.
(Synonyms:Atrophy of the Nails; Onychatrophia.)
Describe atrophy of the nails.
The nails are soft, thin and brittle, splitting easily, and are often opaque and lustreless, and may have a worm-eaten appearance. Several or more are usually affected.
State the causes of atrophy of the nails.
The condition may be congenital or acquired, usually the latter. It may result from trauma, or be produced by certain cutaneous diseases, notably eczema and psoriasis; or it may follow injuries or diseases of the nerves. Syphilis and chronic wasting constitutional diseases may also interfere with the normal growth of the nail-substance, producing varying degrees of atrophy. The fungi of tinea trichophytina and tinea favosa at times invade these structures and lead to more or less complete disintegration—onychomycosis.
Fig. 40.
FIG. 40.
Atrophy of the Nails.
What is the treatment of atrophy of the nails?
Treatment will depend upon the cause. When it is due to eczemaor psoriasis, appropriate constitutional and local remedies should be prescribed. If it is the result of syphilis, mercury and potassium iodide are to be advised. In onychomycosis—an exceedingly obstinate affection—the nails should be kept closely cut and pared, and a one- to five-grain solution of corrosive sublimate applied several times a day; a lotion of sodium hyposulphite, a drachm to the ounce, is also a valuable and safe application.
(Synonyms:Atrophoderma; Atrophy of the Skin.)
What do you understand by atrophy of the skin?
By atrophy of the skin is meant an idiopathic or symptomatic wasting or degeneration of its component elements.
State the several conditions met with.
Glossy skin, general idiopathic atrophy of the skin, parchment skin, atrophic lines and spots, senile atrophy, and the atrophy following certain cutaneous diseases.
Describe glossy skin (atrophoderma neuriticum), and state the treatment.
Glossy skin is a rare condition following an injury or disease of the nerve. It is usually seen about the fingers. The skin is hairless, faintly reddish, smooth and shining, with a varnished and thin appearance, and with a tendency to fissuring. More or less severe and persistent burning pain precedes and accompanies the atrophy.
Protective applications are called for, the disease tending slowly to spontaneous disappearance.
Describe general idiopathic atrophy of the skin, and give the treatment.
General idiopathic atrophy of the skin is extremely rare, and is characterized by a gradual, more or less general, degenerative and quantitative atrophy of the skin structures, accompanied usually with more or less discoloration and pigmentation.
Treatment is palliative and based upon indications.
Describe parchment skin, and state the treatment.
Parchment skin (xeroderma pigmentosum, angioma pigmentosum et atrophicum) is a rare disease, the exact nature of which is not understood. It is characterized by the appearance of numerous disseminated, freckle-like pigment-spots, telangiectases, atrophied muscles, more or less shrinking and contraction of the integument, and followed, in most instances, by epitheliomatous tumors and ulceration, and finally death. It is usually slow in its course, beginning in childhood and lasting for years. It is not infrequently seen in several children of the same family.
Treatment is palliative, consisting, if necessary, of the use of protective applications and of the administration of tonics and nutrients.
Describe atrophic lines and spots.
Atrophic lines and spots (striæ et maculæ atrophicæ) may be idiopathic or symptomatic, the lesions consisting of scar-like or atrophic-looking, whitish lines and macules, most commonly seen on the trunk. They are smooth and glistening. Slight hyperæmia usually precedes their formation. As an idiopathic disease its course is insidious and slow, and its progress eventually stayed. The so-calledlineæ albicantes, resulting from the stretching of the skin produced by pregnancy or tumors, and from rapid development of fat, may be mentioned as illustrating the symptomatic variety.
In course of time the atrophy becomes less conspicuous.
Describe senile atrophy.
Senile atrophy is not uncommon, the atrophy resulting, as the name inferentially implies, from advancing age. It is characterized by thinning and wasting, dryness, and a wrinkled condition, with more or less pigmentation and loss of hair. Circumscribed pigmentary deposits and seborrhœa, with degeneration, are also noted.
What several diseases of the skin are commonly followed by atrophic changes?
Favus, lupus, syphilis, leprosy, scleroderma and morphœa.
(Synonyms:Keloid of Alibert; Cheloid.)
Give a descriptive definition of keloid.
Keloid is a fibro-cellular new growth of the corium appearing as one or several variously-sized, irregularly-shaped, elevated, smooth, firm, pinkish or pale-reddish cicatriform lesions.
Describe the clinical appearance of keloid.
The growth begins as a small, hard, elevated, pinkish or reddish tubercle, increasing gradually, several months or years usually elapsing before the tumor reaches conspicuous size. When developed, it is one or more inches in diameter, is sharply defined, elevated, hard, rounded or oval, fungoid or crab-shaped, and firmly implanted in the skin. It is usually pinkish, pearl-white, or reddish, commonly devoid of hair, with no tendency to scaliness, and with, usually, several vessels coursing over it. In some instances it is tender, and it may be spontaneously painful.
The breast, especially over the sternal region, is a favorite site for its appearance. One, several or more may be present in the single case.
What course does keloid pursue?
Chronic; usually lasting throughout life. In rare instances spontaneous involution takes place.
State the etiology of keloid.
The causes are obscure. The growth usually takes its start from some injury or lesion of continuity; for instance, at the site of burns, cuts, acne and smallpox scars, etc.—cicatricial keloid, false keloid; or it may also, so it is thought, originate in normal skin—spontaneous keloid, true keloid.
What is the pathology of keloid?
The lesion is a connective-tissue new growth having its seat in the corium.
Is there any difficulty in the diagnosis of keloid?
No. It resembles hypertrophic scar; but this latter, which is essentially keloidal, never extends beyond the line of injury.
Give the prognosis.
The growth is persistent and usually irresponsive to treatment. In some cases, however, there is eventually a tendency to spontaneous retrogression, up to a certain point at least.
What is the treatment of keloid?
Usually palliative, consisting of the continuous application of an ointment such as the following:—
℞ Acidi salicylici, ................................ gr. x-xxEmplast. plumbi,Emplast. saponis, ....................āā.......... ʒiijPetrolati, ....................................... ʒij. M.
An ointment of ichthyol, twenty-five per cent. strength, rubbed in once or twice daily, is sometimes beneficial.
Operative measures, such as punctate and linear scarification, electrolysis and excision, are occasionally practised, but the results are rarely satisfactory and permanent; not infrequently, indeed, renewed activity in the progress of the growth is noted to follow. Thex-ray can be tried with some hope of improvement. The administration of thyroid has been thought to have a possible influence in some instances.
(Synonyms:Molluscum Fibrosum; Fibroma Molluscum.)
What do you understand by fibroma?
Fibroma is a connective-tissue new growth characterized by one or more sessile or pedunculated, pea- to egg-sized or larger, soft or firm, rounded, painless tumors, seated beneath and in the skin.
Describe the clinical appearances of fibroma.
The growth may be single, in which case it is apt to be pedunculated or pendulous, and attain considerable dimensions; as a result of weight or pressure surface-ulceration may occur. Or, as commonly met with, the lesions are numerous, scattered over large surface, andvary in size from a pea to a cherry; the overlying skin being normal, pinkish or reddish, loose, stretched, hypertrophied or atrophied.
The tumors are painless. The general health is not involved.
Fig. 41.
FIG. 41.
Fibroma. (After Octerlony.)
What is the course of fibroma?
Chronic and persistent.
What is the etiology of fibroma?
The cause is not known. Heredity is often noted. The affection is not common.
State the pathology of fibroma.
The growths are variously thought to have their origin in the connective tissue of the corium, or in that of the walls of the hair-sac, or in the connective-tissue framework of the fatty tissue. Recent tumors are composed of gelatinous, newly-formed connective tissue, and the older growths of a dense, firmly-packed, fibrous tissue.
From what growths is fibroma to be differentiated?
From molluscum contagiosum, neuroma and lipoma; the first is differentiated by its central aperture or depression, neuroma by its painfulness, and lipoma by its lobulated character and soft feel.
Give the prognosis of fibroma.
The disease is persistent, and irresponsive to all treatment save operative measures.
What is the treatment of fibroma?
Treatment consists, when desired and practicable, in the removal of the growths by the knife, or in large and pedunculated tumors by the ligature or by the galvano-cautery.
Describe neuroma.
Neuroma of the skin is an exceedingly rare disease, characterized by the formation of variously-sized, usually numerous, firm, immovable and elastic fibrous tubercles containing new nerve-elements, and accompanied by violent, paroxysmal pain. Their growth is slow and usually progressive. Later they are painful upon pressure. They are limited to one region.
The tumors are seated in the corium, extending into the deeper structure, and consist of nerve-fibres, yellow elastic tissue, blood vessels and lymphoid cells.
In the two cases reported, excision of the nerve-trunk gave, in one instance, permanent relief; in the other the effect was only temporary.
(Synonyms:Vitiligoidea; Xanthelasma.)
What is xanthoma?
Xanthoma is a connective-tissue new growth characterized by the formation of yellowish, circumscribed, irregularly-shaped, variously-sized, non-indurated, flat or raised patches or tubercles.
Name the two varieties met with.
The macular or flat (xanthoma planum) and the tubercular (xanthoma tuberculatumortuberosum). In some instances both varieties (xanthoma multiplex) are seen in the same individual.
Describe the clinical appearances of xanthoma planum.
The macular or flat variety is usually seen about the eyelids. It consists of one, several or more small or large, smooth, opaque, sharply-defined, often slightly raised, yellowish patches, looking not unlike pieces of chamois-skin implanted in the skin.
Describe the clinical appearances of xanthoma tuberosum.
The tubercular variety is commonly met with upon the neck, trunk and extremities. It occurs as small, raised, isolated, yellowish nodules, or as patches made up of aggregations of millet-seed-sized or larger tubercles. The lesions may be few or they may exist in great numbers.
What is the course of xanthoma?
Extremely slow; after reaching a certain development the growths may remain stationary.
State the etiology of xanthoma.
The causes are obscure. Jaundice not infrequently precedes and accompanies its development, especially in the tubercular variety. The disease is uncommon, and is usually seen in middle and advanced life, and more frequently in women. In some cases (xanthoma diabeticorum) of general xanthoma diabetes is the causative factor.
What is the pathology of xanthoma?
It is a benign, connective-tissue new growth, with concomitant or subsequent, but usually partial, fatty degeneration.
Give the prognosis of xanthoma.
The condition is persistent, and usually irresponsive to all treatment save destructive or operative measures.
What is the treatment of xanthoma?
Treatment consists, in suitable cases, of excision; in some instances, electrolysis is serviceable. Applications of trichloracetic acid cautiously made are sometimes of value. In that form of general xanthoma due to diabetes the treatment of this latter condition will materially and sometimes completely remove the eruption.
(Synonyms:Myoma Cutis; Dermatomyoma; Liomyoma Cutis.)
Describe myoma.
The disease is rare, and consists usually of one or several (exceptionally numerous), variously-sized tumors of the skin, made up of smooth muscular fibres. They are flat, rounded, oval or pedunculated, and have a smooth surface and a pale-red color; as a rule, they are painless.
The growth is benign, and consists essentially of a new formation of unstriped muscular fibres; but it may also be composed largely of connective tissue (fibromyoma); or it may contain an abundance of bloodvessels (myoma telangiectodes, angiomyoma); or there may be lymphatic involvement (lymphangiomyoma).
(Synonyms:Nævus Vasculosus; Nævus Sanguineus.)
Give a definition of angioma.
Angioma is a congenital hypertrophy of the vascular tissues of the corium and subcutaneous tissue. Exceptionally it makes its appearance a few weeks or a month after birth.
Into what two classes may angiomata be roughly grouped?
The flat (or non-elevated) and the prominent (or elevated).
Describe the flat, or non-elevated, variety of angioma.
The flat, or non-elevated, angioma (nævus flammeus, nævus simplex, angioma simplex, capillary nævus) may be pin-head- to bean-sized; or it may involve an area of several inches in diameter, and,exceptionally, a whole region. It is of a bright- or dark-red color, and is met with most frequently about the face. In some instances it extends after birth, reaches a certain size and then remains stationary; occasionally, when involving a small area, it undergoes involution and disappears.
The so-calledport-wine markis included in this group.
Describe the prominent, or elevated, variety of angioma.
The prominent variety (venous nœvus, angioma cavernosum, nœvus tuberosus) is variously-sized, often considerably elevated, clearly-defined, compressible, smooth or lobulated, and of a dark, purple color; it may, also, be erectile and pulsating. The growth is usually a single formation, and is met with upon all parts of the body.
What is the pathology of angioma?
It is a new growth, consisting of a variable hypertrophy of the cutaneous and subcutaneous arterial and venous bloodvessels, with or without an increase of the connective tissue.
Give the treatment of angioma.
In some instances, especially in infants, painting the parts repeatedly with collodion or liquor plumbi subacetatis will act favorably. For well-established, small, capillary nævi electrolysis or puncturing with a red-hot needle or with a needle charged with nitric acid may be employed; for “port-wine mark” frequent and closely contiguous electrolytic punctures are occasionally followed by a slight diminution in color. For theprominent growths, vaccination, the ligature, puncturing with the galvano-cautery, and excision are variously resorted to.
In recent years applications of liquid air and carbon dioxide have proved of service in some cases.
Describe telangiectasis.
Telangiectasis consists of a new growth or enlargement of the cutaneous capillaries, usually appearing during middle adult life, and seated, for the most part, about the face.
To what extent may telangiectasis develop?
It may be limited to a red dot or point, with several small radiatingcapillaries (nævus araneus, spider nævus), or a whole region, usually the face, may show numerous scattered or closely-set capillary enlargements or new formations (rosacea). The latter is frequently associated with acne (acne rosacea).
The etiology is obscure.
What is the treatment of telangiectasis?
Destruction of the vessels by electrolysis or by the knife. (See treatment of acne rosacea.)
(Synonym:Lymphangiectodes.)
Describe lymphangioma.
Lymphangioma is a rare disease, consisting of localized dilatations of the lymphatic vessels, appearing as discrete or aggregated pin-head or pea-sized, compressible, hollow, tubercle-like elevations, of a pinkish or faint lilac color, and occurring for the most part about the trunk. It is of slow but usually progressive development, and is unaccompanied by subjective symptoms.
A rare condition, Kaposi described as lymphangioma tuberosum multiplex, characterized by more or less solid, somewhat cystic, pearly to pinkish red, sometimes crowded lesions, is now known to be “benign cystic epithelioma”; its most common site is the face. While called “benign,” ulcerative action may eventually ensue.
Treatment, when demanded, consists of operative measures.
Describe rhinoscleroma.
Rhinoscleroma is a rare and obscure disease, slow but progressive in its course, characterized by the development of an irregular, dense and hard, flattened, tubercular, non-ulcerating, cellular new growth, having its seat about the nose and contiguous parts. The overlying skin is normal in color, or it may be light- or dark-brown or reddish. Marked disfigurement and closure, partial or complete, of the nasalorifices gradually results. It is met with chiefly in Austria and Germany.
Treatment, consisting of partial or complete extirpation, is rarely permanent in its results, the disease tending to recur.
(Synonyms:Lupus Erythematodes; Lupus Sebaceus; Seborrhœa Congestiva.)
What is lupus erythematosus?
Lupus erythematosus may be roughly defined as a mildly to moderately inflammatory superficial new-growth formation, characterized by one, several, or more circumscribed, variously sized and shaped, pinkish or dark red patches, covered slightly, and more or less irregularly, with adherent grayish or yellowish scales.
Upon what parts is lupus erythematosus observed?
Its common site is the face, usually the nose and cheeks, with a tendency toward symmetry; it is often limited to these parts, but may occasionally be seen upon other regions, more especially the lips, ears, and scalp. In rare instances a great part of the general surface may become involved.
Describe the symptoms of lupus erythematosus.
Usually the disease begins as one or several rounded, circumscribed, pin-head- to pea-sized lesions; slightly scaly, somewhat elevated, and of a pinkish, reddish or violaceous color. They slowly, or somewhat rapidly, increase in area, and after attaining variable size remain stationary; or they may progress and coalesce, and in this manner sooner or later involve considerable surface. The patches are sharply defined against the sound skin by an elevated border, while the central portion is somewhat depressed and usually atrophic. More or less thickening and infiltration are observed.There is no tendency to ulceration. The scaliness is, as a rule, scanty. The gland-ducts are enlarged, patulous or plugged with sebaceous and epithelial matter.
The subjective symptoms of burning and itching are usually slight and often wanting.
What course does lupus erythematosus pursue?
As a rule, the disease is persistent, although somewhat variable.At times the patches retrogress, involution taking place with or without slight sieve-like atrophy or scarring.
State the causes of lupus erythematosus.
The etiology is obscure. Some observers believe it to be a variety of cutaneous tuberculosis. It is essentially a disease of adult and middle age; is more common in women, and more frequent in those having a tendency to disorders of the sebaceous glands. It may, in fact, begin as a seborrhœa.
What is the pathology?
It was formerly considered a new growth, but recent opinion tends toward regarding it as a chronic inflammation of the cutis, superinducing degenerative and atrophic changes. Variable œdema of the prickle layer and of the cutis is found. There is no tendency to pus formation.
Fig. 42.