Blastomycetic dermatitis
Blastomycetic dermatitis.
to tuberculosis cutis verrucosa. A muco-purulent or purulent secretion can visually be pressed out from between the papillomatous elevations. It may also present the appearance of a serpiginous lupus vulgaris or syphiloderm. As a rule it is slow in its course. Furuncular or abscess-like formations may develop, usually from secondary infection. The disease is due to the invasion of the cutaneous tissues by the blastomyces.
Treatment consists in administration of moderate to large doses of potassium iodide, and in the employment of antiseptic and parasiticide applications; usually, however, radical treatment, such as employed in lupus vulgaris, may be necessary.
(Synonym:The Itch.)
What is scabies?
Scabies, or itch, is a contagious animal-parasitic disease characterized by a multiform eruption of a somewhat peculiar distribution, attended by intense itching.
Describe the symptoms of scabies.
The penetration and presence of the parasites within the cutaneous structures besides often giving rise to several or more complete or imperfectly formedburrows, excite varying degrees of irritation, and in consequence the formation of vesicles, papules and pustules, accompanied with more or less intense itching. Secondarily, crusting, and at times a mild or severe grade of dermatitis, may be brought about. The parasite seeks preferably tender and protected situations, as between the fingers, on the wrists, especially the flexor surface, in the folds of the axilla, on the abdomen, about the anal fissure, about the genitalia, and in females also about the nipples, and hence the eruption is most abundant about these regions. The inside of the thighs and the feet are also attacked, as, indeed, may be almost every portion of the body. The scalp and face are not involved; exceptionally, however, these parts are invaded in infants and young children.
Is the grade of cutaneous irritation the same in all cases of scabies?
No; in those of great cutaneous irritability, especially in children, the skin being more tender, the type of the eruption is usually much more inflammatory. In those predisposed a true eczema may arise, and then, in addition to the characteristic lesions of scabies, eczematous symptoms are superadded; in long-persistent cases, indeed, the burrows and other consequent lesions may be more or less completely masked by the eczematous inflammation, and the true nature of the disease be greatly obscured.
What do you mean by burrows?
Burrows, orcuniculi, are tortuous, straight or zigzag, dotted, slightly elevated, dark-gray or blackish thread-like linear formations, varying in length from an eighth to a half an inch.
Fig. 76.
FIG. 76.
Burrow, or cuniculus, greatly magnified. (After Kaposi.)
Showing the mite, ova, empty shells and excrement.
How is a burrow formed?
By the impregnated female parasite, which penetrates the epidermis obliquely to the rete, depositing as it goes along ten or fifteen ova, forming a minute passage or burrow.
Upon what parts are burrows most commonly to be found?
In the interdigital spaces, on the flexor surface of the wrists, about the mammæ in the female, and on the shaft of the penis in the male.
Are burrows usually present in numbers?
No. Several may be found in a single case, but they are rarely numerous, as the irritation caused by the penetration of the parasites leads either to violent scratching and their destruction, or gives rise to the formation of vesicles and pustules, and consequently their formation is prevented.
What course does scabies pursue?
Chronic and progressive, showing no tendency to spontaneous disappearance.
To what is scabies due?
To the invasion of the cutaneous structures by an animal parasite, the sarcoptes scabiei (acarus scabiei). The male mite is never found in the skin and apparently takes no direct part in the production of the symptoms.
Fig. 77. FIG. 78.
FIG. 77. FIG. 78.
Sarcoptes scabiei x 100. (After Duhring.)
Female. Ventral surface. Male.
The disease is contagious to a marked degree, and is most commonly contracted by sleeping with those affected, or by occupying a bed in which an affected person has slept. It occurs, for obvious reasons, usually among the poor, although it is now quite frequently met with among the better classes.
State the diagnostic features of scabies.
The burrows, the peculiar distribution and the multiformity of the eruption, the progressive development, and usually a history of contagion.
How do vesicular and pustular eczema differ from scabies?
Eczema is usually limited in extent, or irregularly distributed, is distinctly patchy, with often the formation of large diffused areas; it is variable in its clinical behavior, better and worse from time to time, and differs, moreover, in the absence of burrows and of a history of contagion.
How does pediculosis corporis differ from scabies?
In the distribution of the eruption. The pediculi live in the clothing and go to the skin solely for nourishment, and hence the eruption in that condition is upon covered parts, especially those parts with which the clothing lies closely in contact, as around the neck, across the upper part of the back, about the waist and down the outside of the thighs;the hands are free.
State the prognosis of scabies.
It is favorable. The disease is readily cured, and, as soon as the parasites and their ova are destroyed, the itching and the secondary symptoms, as a rule, rapidly disappear.
How is scabies treated?
Treatment is entirely external, and consists of a preliminary soap-and-hot-water bath, an application, twice daily for three days, of a remedy destructive to the parasites and ova, and finally another bath.
Inquiry as to others of the family should be made, and, if affected, treated at the same time. The wearing apparel should be looked after—boiled, baked, or sulphur-fumigated.
What remedial applications are employed in scabies?
Sulphur, balsam of Peru, styrax, and β-naphthol, singly or severally combined. In children, or in those of sensitive skin, the following:—
℞ Sulphur. præcip., ................................ ʒivBalsam. Peruv., .................................. ʒijAdipis,Petrolati, .....................āā................ ℥iss. M.
And in adults, or those of non-irritable skin:—
℞ Sulphur, præcip., ................................ ℥jBalsam. Peruv., .................................. ℥ssβ-Naphthol, ...................................... ʒijAdipis,Petrolati, ..............āā......... q.s. ad. .... ℥iv. M.
Styrax is a remedy of value and is commonly employed as an ointment in the strength of one part to two or three parts of lard.
Is one such course of treatment sufficient to bring about a cure?
Yes, in ordinary cases, if the applications have been carefully and thoroughly made; exceptionally, however, some parasites and ova escape destruction, and consequently itching will again begin to show itself at the end of a week or ten days, and a repetition of the treatment become necessary.
Does the secondary dermatitis which is always present in severe cases require treatment?
Only when it is unusually persistent or severe; in such cases the various soothing applications, lotions or ointments employed in acute eczema are to be prescribed.
Is a dermatitis due to too active and prolonged treatment ever mistaken for persistence of the scabies?
Yes.
(Synonyms:Phtheiriasis; Lousiness.)
Define pediculosis.
Pediculosis is a term applied to that condition of local or general cutaneous irritation due to the presence of the animal parasite, the pediculus, or louse.
Name the several varieties met with.
Three varieties are presented, named according to the parts involved,pediculosis capitis, pediculosis corporis, and pediculosis pubis; the parasite in each being a distinct species of pediculus.
Describe the symptoms of pediculosis capitis.
Pediculosis capitis (pediculosis capillitii), due to the presence of the pediculus capitis, occurs much more frequently in children than in adults. It is characterized by marked itching, and the formation of various inflammatory lesions, such as papules, pustules and excoriations— resulting from the irritation produced by the parasites and from the scratching to which the intense pruritus gives rise. In fact, an eczematous eruption of the pustular type soon results, attended with more or less crust formation. In consequence of the cutaneous irritation the neighboring lymphatic glands may become inflamed and swollen, and in rare cases suppurate. The occipital region is the part which is usually most profusely infested, more especially in young girls and women. In those of delicate skin, especially in children, scattered papules, vesico-papules, pustules, and excoriations may often be seen upon the forehead and neck. In some instances, however, especially in boys, there may be many pediculi present, with but little cutaneous disturbance, the itching being the sole symptom.
Fig. 79.
FIG. 79.
Pediculus Capitis x 25. (After Duhring.)
Female. Dorsal surface.
Fig. 80.FIG. 80.Ova of the headlouse attached to a hair. Magnified.(After Kaposi.)
Fig. 80.
Ova of the headlouse attached to a hair. Magnified.(After Kaposi.)
In addition to the pediculi, which, as a rule, may be readily found, theirova, ornits, are always to be seen upon the shaft of the hairs, quite firmly attached.
Describe the appearance of the ova.
They are dirty-white or grayish looking, minute, pear-shaped bodies, visible to the naked eye, and fastened upon the shaft of the hairs with the small end toward the root.
Is there any difficulty in the diagnosis of pediculosis capitis?
No. The diagnosis is readily made, as the pediculi are usually to be found without difficulty, and even when they exist in small numbers and are not readily discovered,the presence of the ovawill indicate the nature of the affection.
Pustular eruptions upon the scalp, especially posteriorly, should always arouse a suspicion of pediculosis. The possibility of the pediculosis being secondary to eczema must not be forgotten.
What is the treatment of pediculosis capitis?
Treatment consists in the application of some remedy destructive to the pediculi and their ova. Crude petroleum is effective, one or two thorough applications over night being usually sufficient; in order to lessen its inflammability, and also to mask its somewhat disagreeable odor, it may be mixed with an equal part of olive oil and a small quantity of balsam of Peru added.
Tincture of cocculus indicus, pure or diluted, may also be applied with good results.
When the parts are markedly eczematous, an ointment of ammoniated mercury or β-naphthol, thirty to sixty grains to the ounce may be used.
Daily shampooing with soap and water, and the twice daily application of a five per cent. carbolic acid lotion, together with the use of a fine-toothed comb, is a safe and efficient method for dispensary practice; as it is, indeed, for any class of patients.
How are the ova or their shells to be removed from the hair?
By the frequent use of acid or alkaline lotions, such as dilute acetic acid and vinegar, or solutions of sodium carbonate and borax.
Describe the symptoms of pediculosis corporis.
Pediculosis corporis is dependent upon the presence of the pediculus corporis (pediculus vestimenti), a larger variety than that infesting the scalp. It is characterized by more or less general itching, together with various inflammatory lesions and excoriations. As the parasites are to be found chiefly in the folds and seams of the clothing, visiting the skin for the purpose of feeding, the various symptoms—the minute hemorrhagic puncta showing the points at which they have been sucking, and the consequent papules, pustules and excoriations—are, therefore, to be found most abundantly on those parts with which the clothing comes closely in contact, as, for instance, around the neck, across the shoulders, around the waist, and down the outside of the thighs. It is uncommon in children.
Fig. 81.
FIG. 81.
Pediculus Corporis x 25. (After Duhring.)
Female. Dorsal surface.
State the diagnostic characters of pediculosis corporis.
The presence of the minute hemorrhagic puncta, the multiform character and peculiar distribution of the eruption. Careful search will almost invariably disclose one or more pediculi.
What is the treatment of pediculosis corporis?
The clothing and bed-coverings are to be thoroughly baked or boiled, the pediculi and their ova being in this manner destroyed; a thymol or carbolized boric-acid lotion may be used to relieve the cutaneous irritation.
When attention to the wearing apparel is not immediately practicable, ointments of sulphur and staphisagria, and lotions of carbolic acid, may be advised as temporary measures. The wearing of a bag of loosely woven texture containing some lump sulphur next to the skin is useful in such cases; at the temperature of the body the sulphur undergoes slow oxidation. In hairy individuals the malady is often persistent, due to the fact that ova have become attached to the hair and a new progeny soon hatched out. Continued treatment over a few weeks will usually suffice to rid the patient of their presence.
Describe the symptoms of pediculosis pubis.
Pediculosis pubis is a condition due to the presence of the pediculus pubis, or crab-louse. It is characterized by more or less itching about the genitalia, together with papules, excoriations, and other inflammatory lesions. The amount of irritation varies; it may be slight, or, on the other hand, severe. The parasite, which is the smallest of the three varieties, may be discovered upon close examination seated near the roots of the hairs, clutching the hair, with its head downward and buried in the follicle. The ova may be seen attached to the hair-shafts.
It infests adults chiefly, being in many instances probably contracted through sexual intercourse.
Is the pediculus pubis found upon any other part of the body?
Yes. Although its favorite habitat is the region of the pubes, itmay, in exceptional instances, also infest the axillæ, the sternal region of the male, the beard, eyebrows, and even the eyelashes.
State the diagnostic characters of pediculosis pubis.
The region involved, itching, variable amount of irritation, and, above all, the presence of the pediculi and their ova.
Fig. 82.
FIG. 82.
Pediculus Pubis x 25. (After Duhring.) Female. Dorsal surface.
Name several applications prescribed for pediculosis pubis.
A lotion of corrosive sublimate, one to four grains to the ounce; infusion of tobacco; a ten to twenty per cent. ointment of oleate of mercury; ammoniated mercury ointment, and a five to ten per cent. β-naphthol ointment. Repeated washings with vinegar or dilute acetic acid, or with alkaline lotions, will free the hairs of the ova.
Describe the cutaneous disturbance produced by the cysticercus cellulosæ.
The presence of cysticerci in the skin and subcutaneous tissue gives rise to pea to hazelnut-sized, rounded, firm, movable tumors which, when developed, may remain unchanged for months. The parasites are disclosed by microscopic examination.
Most of the cases have been observed in Germany.
(Synonym:Guinea-worm.)
State the character of the lesions produced by the filaria medinensis.
The young microscopic worm penetrates the skin or deeper tissue, where it grows gradually, finally reaching several inches or more in length and about a half-line in thickness; inflammation is excited and a tumor-like swelling makes its appearance, which, sooner or later, breaks, disclosing the worm. It may also present a cord-like appearance. It is rarely met with outside of tropical countries.
Treatment consists in gradual extraction, or in the injection of a corrosive sublimate solution (1:1000) into the forming tumor. Asafetida internally has been found to be curative, the parasite being destroyed and subsequently absorbed or discharged.
(Synonym:Wood-tick.)
State the character of the cutaneous disturbance produced by the ixodes.
The tick sticks its proboscis into the skin and sucks blood until it is several times its natural size, and then falls off; an urticarial lesion results. If caught in the act the animal should not be forcibly extracted, as its proboscis may be thus broken off and remain in the skin, and give rise to pain and inflammation. It may be made to relinquish its hold by placing on it a drop of an essential oil.
A thymol or carbolized boric-acid lotion will relieve the irritation.
(Synonym:Harvest-mite.)
State the characters of the lesion produced by the leptus.
This minute brick-red mite buries itself in the skin, especially about the ankles and feet, giving rise to papules, vesicles and pustules.
Treatment consists of the use of a mild sulphur ointment or of a carbolic-acid lotion.
(Synonym:Gad, or Bot-fly.)
Describe the cutaneous disturbance produced by the œstrus.
The ova are deposited in the skin, develop and give rise to the formation of furuncle-like tumors with central aperture, through which a sanious discharge exudes; or as the result of the burrowing of the larvæ, irregular serpiginous lines or wheals are produced.
It is chiefly met with in Central and South America.
Larva migrant, orcreeping disease, is doubtless in this same class. It is characterized by a thread-like linear formation of an erythematous, erythemato-papular, or vesicular nature that gradually extends, the older part disappearing; considerable surface may be covered before the parasite disappears or dies. The treatment consists in endeavoring to destroy the organism by means of excision or caustic applications at the point of its suspected site which is just ahead of the extending line.
(Synonyms:Sand Flea; Jigger.)
Describe the cutaneous disturbance produced by the pulex penetrans.
This microscopic animal penetrates the skin, especially about the toes, producing an inflammatory swelling, vesicle or pustule, or even ulceration. It is met with in warm and tropical countries.
Treatment consists in extraction. Essential oils are used as a preventive. A carbolic-acid or alkaline lotion relieves irritation.
(Synonym:Bed-bug.)
Describe the characters of a bed-bug bite.
An inflammatory papule or wheal-like lesion results, somewhat hemorrhagic; the purpuric or hemorrhagic point or spot remains after the swelling subsides, but finally, in the course of several days or a few weeks, disappears.
Treatment consists in the application of alkaline or acid lotions.
(Synonym:Gnat; Mosquito.)
Describe the cutaneous disturbance produced by the culex.
It consists of an erythematous spot or a wheal-like lesion.
Alkaline or acid lotions usually give relief.
(Synonym:Common Flea.)
Describe the cutaneous disturbance produced by the pulex irritans.
It consists of an erythematous spot with a minute central hemorrhagic point. In irritable skin, a wheal-like lesion may result.
Treatment consists of applications of camphor or ammonia-water; carbolic acid and thymol lotions are also useful.
RELATIVE FREQUENCY OF THE VARIOUS DISEASES OF SKIN AS SHOWN BY THE STATISTICS (123,746 CASES) OF THE AMERICAN DERMATOLOGICAL ASSOCIATION FOR TEN YEARS, 1878-87.
[E]Indicating affections of this class not properly included under other titles.
[E]Indicating affections of this class not properly included under other titles.