George Henry Fox

“ In the treatment of lichen planus arsenic is often of service, but in this, as in many other affections, it may do harm as well as good; and when there is much irritability of the skin alkaline remedies will be found to be of much greater service. Of the various local remedies which have been highly recommended no one seems to have any special value in all cases. A mild carbolic or salicylic acid lotion may be advantageously used in acute cases, and the same increased in strength when the patches have assumed a chronic character. ”

“ Upon the scalp the lesions of contagious impetigo are frequently found, and usually appear as small, isolated, circular crusts. These frequently occasion temporary areas of partial baldness, and when the disease is of long standing and there is very much suppuration a permanent loss of some hair may result. The affection is often associated with pediculosis capitis, and in such a case the frequent scratching of the head is very apt to multiply the lesions, and often the diagnosis is obscured by the development of eczema upon the scalp and back of the neck. ”

“ In most cases it is readily recognized by the characteristic location of the excoriated papules which mainly constitute the eruption. The disease, as is well known, is due to the burrowing of the acarus or itch-mite in the soft skin between the fingers and elsewhere, and is usually communicated by sleeping with, or in a bed which has been occupied by, a person affected with the disease. The mature, impregnated female alone makes the burrow in which the eggs are deposited, and dies after performing this function. ”

“ The main object in treating these tumors is to destroy them completely and to excite as little inflammation as possible in so doing. When even a large molluscum is removed by means of the curette no scar or trace of the growth is usually left, since the tumor is an outgrowth of the epidermis and does not involve the true skin. But when an inflamed molluscum is scratched or irritated to the extent of inducing a purulent secretion, a slight pit may be expected to result. ”

“ This affection usually runs a brief course, although a repeated onset of fever and rheumatic pains, followed by cutaneous hemorrhages, may protract it for months. It commonly attacks those who have a rheumatic tendency but are otherwise apparently well.
There is little difficulty in the diagnosis of purpura, as the color of the lesions is characteristic and their hemorrhagic nature can be readily demonstrated by the pressure of the finger. It is well to remember, however, that cutaneous hemorrhage is not infrequently an accompaniment of the eruption in severe cases of the common exanthemata. ”

“ The affection of the skin to which attention is now briefly called under the name of linear papilloma is somewhat rare and is described in the text books of dermatology under a variety of titles. It is frequently congenital, often develops in childhood, but may first appear in later life. ”

“ A characteristic peculiarity is their tendency to return quickly whenever excised. A spontaneous disappearance of keloid is more likely to occur in childhood than in adult life, and tumors developing upon large scars are more likely to disappear than those which seemingly spring from the normal skin. A favorite site of keloid is the sternal region, where it often appears in adults as an elongated flattened tumor crossing the median line in a transverse direction. ”

“ In a typical case of contagious impetigo (and it is questionable whether there is any impetigo which is not contagious) the lesion is usually a flattened vesico-pustule. This is small at the outset, superficial, and without any surrounding area of inflammation. It is always single, although when the pustules are very numerous, a number of them in close proximity may appear like an irregular group. ”

“ The importance of fresh air and nutritious food must never be forgotten, and when the symptoms of the disease have abated the syrup of iodide of iron, and perhaps cod-liver oil, may usually be given with great benefit. ”

“ The location of the eruption in this disease depends, to a great extent upon the character of the clothing which the patient wears, and differs in the case of men, women, and children. The excoriations about the breasts of women and upon the genitals of men and boys are due to the ease with which these parts can be scratched at night, while in young children who wear long, close-fitting night dresses the wrists and ankles are most likely to be the seat of the eruption. ”

“ The daily inunction of the skin with some fat or oil, and the frequent resort to hot baths and vigorous soap frictions, will be productive of much benefit and often restore the skin to its normal condition. ”

“ The term nsevus includes affections of widely different pathological character in which hypertrophy is the only common element. They may be classed as iibrous, pigmented,. hairy, and vascular nsevi. The fibrous or hypertrophic nsevus frequently occurring upon the face in the form of a small, rounded, and non-pigmented tumor or mole is peculiar to adult life, but the pigmented and hairy forms of nsevus are common in childhood and often require treatment at an early age. ”

“ It is usually a congenital affection, although certain forms of skin disease to which the term nsevus is commonly applied may occur in youth or later in life. Many nsevi, especially of the pigmented and hairy variety, exist at birth, but are almost imperceptible, and only become noticeable when they develop, as they are apt to do, after the age of puberty. ”

“ In congenital cases the warty outgrowth is apt to be fibrous and tough, while in cases developing later in life the lesions are softer, sometimes slightly scaly, and far more amenable to treatment. In some cases they have been known to disappear spontaneously or after some cutaneous exanthem, but a tendency to reappear upon the same site is usually manifested.
Of the names which have been applied to the affection the following may be mentioned: ichthyosis hystrix scu localis, ichthyosis linearis neuropathica, naevus verrucosus, naevus unius lateris, nerve naevus, and papilloma neuroticum. ”

“ Syphilis hereditaria.—When syphilis is transmitted from one generation to another it may result in the death of the foetus in utero, or in the development of an infantile eruption which either is present at birth or appears shortly after. ”

“ It should be borne in mind that as the hair in some children is preternaturally dry and in others unusually oily, and that as this condition may vary in the same individual according to the state of health, so the degree of natural oiliness or dryness of the skin may vary greatly in individuals and in accordance with season and general condition. ”

“ It is not always congenital, but frequently appears in youth or adult life as the result of a prick, bruise, or other injury to the skin. On this account some writers class it under the head of telangiectasis or acquired vascular dilatation, assuming that the term nsevus signifies a birthmark and not merely a spot or blemish. It is most frequently noted upon the upper portion of the face, and upon a fair white skin may be quite conspicuous and annoying. ”

“ Upon the legs the patches are frequently roughened and pigmented, and present an appearance quite unlike the eruption seen upon the trunk and forearms.
Lichen planus runs a variable course, some cases disappearing spontaneously and often unexpectedly after an existence of a month or two, while others will sometimes persist for many months in spite of the most approved method of treatment. The itching is often very annoying to the patient, but the general health is usually unimpaired, and, unlike lichen ruber, the disease never terminates fatally. ”

“ In some cases the eruption assumes a papular character (see plate) , and numerous yellowish-red and slightly scaly discs are seen upon the buttocks, thighs, and face, and occasionally over the greater portion of the body. In rare instances the papules are small, flattened, and shining, and present a strong resemblance to lichen planus. Pustular lesions of an ecthymatous character are sometimes present, especially in infants who are ill-nourished and poorly cared for. ”

“ The treatment of linear papilloma consists in the use of agents which tend to destroy or remove the excrescences. In cases of recent development, where the lesions are soft, the repeated application of a saturated solution of salicylic acid in collodion will act as effectively as it usually does in the case of corns and warts, and will soon leave the affected skin in a normal condition. ”

“ From what has been said it is evident that the treatment of this disease must of necessity be palliative rather than curative. The improvement of the patient's general health by a hygienic and tonic regimen will usually accomplish more than the administration of arsenic or any other drug. Meanwhile the comfort of the patient can be greatly increased by baths and inunctions tending to soften the dry, harsh skin and to lessen the pruritus.
Lichen planus is a disease which is entirely distinct in nature ”

“ The treatment of molluscum is simple and effective. Many of the tumors, after a duration of a few weeks or months, undergo a process of destructive inflammation, and a spontaneous cure results. This is especially apt to be the case when two are close together and coalesce as they increase in size. If a tumor is vigorously compressed and the contents evacuated it will usually disappear. ”

“ The congenital growth rarely increases in extent, except as the body grows larger, but often the pigmentation becomes more pronounced and the hair begins to grow coarser in adult life. The development of small hairy moles upon the face of elderly
Fig. 29.
women, especially those suffering from hypertrichosis, is very frequently noted.
In the treatment of the pigmentary mole, acids or the electrolytic needle may be employed. For small, round, dark spots on the skin a minute drop of nitric acid, applied with a wooden toothpick, will often suffice to remove the blemish. ”

“ Erythema nodosum is one of the forms of erythema multiforme, though commonly described in dermatological text books as a distinct disease. It occurs most frequently in childhood, and the female sex seems especially prone to suffer from it.
The lesions in this affection are red, painful swellings, looking very much like recent contusions, and are most frequently seen over the tibiae. ”

“ The prevention of hereditary syphilis is more important than its treatment, and the physician is often in a position to advise against the premature marriage of syphilitic patients, and thus prevent an amount of misery and suffering which he could never cure. ”

“ Bullous lesions are not infrequently seen upon the palms and soles and other portions of the body, and in fact are much more common than in the acquired disease of adult life.
In connection with these early cutaneous manifestations a notable condition of malnutrition is usually observed, and certain characteristic symptoms resulting from affection of the mucous membranes and the osseous structures. The nasal passages are often inflamed and obstructed by an accumulation of mucus. The larynx may be affected, giving rise to a peculiar hoarse cry. ”

“ Excision, as has been remarked, is usually followed by a return of the growth. Good results have been obtained by deep linear scarification and the application of glacial acetic acid to the cuts, and also by the use of the electrolytic needle. ”

“ In the treatment of infantile syphilis a half-grain or more of mercury with chalk may be administered three times a day, and a speedy improvement expected if the child is properly cared for. When irritability of the stomach and intestines is present it is advisable to adopt the plan of mercurial inunctions. ”

“ For generations sulphur ointment has been a standard remedy, and nothing else is needed, although many other remedies and combinations have been recommended. A warm bath should first be taken to soften the skin, and soap used vigorously to remove the dead epidermis covering the cuniculi. ”

“ It is especially liable to affect children of a poorer class, and hence is much more common in dispensary than in private practice. Damp and crowded dwellings seem to favor its development, and in dispensary practice I have known a number of cases to originate in the same locality. Children suffering from molluscum are especially prone to have warts upon the hands.
The diagnosis of molluscum is usually made with ease by any one at all familiar with the appearance of the tumors. Large milia upon the face might be mistaken for them ”

“ But in certain cases, especially those which have existed since birth, the lesions are apt to be of such a dense fibrous character that the curette is of little use, and their removal is best effected by means of the curved scissors. It is doubtful whether any internal remedy is capable of affecting the growth in any notable degree. ”

“ Crusted lesions or scabs resulting from the use of the finger nails and the drying of a copious blood-stained secretion are frequently seen upon the faces of children, but the origin and nature of this eruption are hot always plain. That the lesions are contagious and auto-inoculable is a matter of simple observation, and that pus cocci play an important part in their development is generally admitted. Mothers and nurses are often affected by children under their care. ”