Skin disease

“ In the pustular and bullous varieties there may be mild or grave systemic symptoms, but even in these types the constitutional involvement is, in most instances, slight in comparison to the intensity of the cutaneous disturbance.
What is the course of dermatitis herpetiformis?
Extremely chronic, in most instances lasting, with remissions, indefinitely. The skin is rarely entirely free. From time to time the type of the disease may undergo change. From the continued irritation and scratching more or less pigmentation results. ”

“ Treatment of Liver Spots, Sallow Complexion, Pimples, Acne, and Eczema.—First, the general treatment. While every case of skin disease must be treated according to the peculiarities of that patient’s case, still, there are general rules which should be followed in the treatment of all cases, and first in importance comes attention to the bowels. There must be procured, by some means or other, a free daily evacuation. A hard, constipated movement is not sufficient. ”

“ Eczema, a common skin disease, which may be either chronic or acute; develops in a red rash of tiny vesicles, which usually burst and produce a characteristic scab; is not contagious, and leaves no scar. ”

“ A few months ago I saw the patient again, and I feel sure that the disease is eradicated.
Miss W., 42 years old, passed her childhood in the West Indies, and brought from there a peculiar skin disease. When I saw her for the first time her features looked old for her age, skin gray and sallow, hair gray, rough, full of dandruff, and moisture oozing from the ears and forehead. The scalp feels hard and thickened. The cervical glands are indurated all around the neck. On the left chest an herpetic eruption of the size of a dollar, and on the mamma a hard tumor of the size of a fist. ”

“ It occurs in all walks of life, being found among the rich and the poor in about like proportions. Statistics show it to be one of the most common diseases of the skin. It is of more frequent occurrence in some countries than in others. According to White's report of 5000 consecutive cases of skin disease observed in Boston, 152 cases of psoriasis were recorded, while Anderson in Glasgow reports 725 cases among 10,000 cases of skin disease, the difference being more than two to one in favor of Scotland. Diet in the majority of cases possesses but little influence over the disease. ”

“ One and all, they are afflicted with every form of malignant skin disease. Some have ringworm, others have bukua. This latter is caused by a vegetable parasite that invades the skin and eats it away. The itching is intolerable. ”

“ Hence additional work is thrown upon other organs, chiefly the lungs and the kidneys, which already have enough to do. This extra work they can do for only a short time. Sooner or later they become disordered, and illness follows. Moreover, as this unwholesome layer is a fertile soil in which bacteria may develop, many skin diseases may result from this neglect. It is also highly probable that germs of disease thus adherent to the skin may then be absorbed into the system. Parasitic skin diseases are thus greatly favored by the presence of an unclean skin. ”

“ There is hardly another department of medicine where the "quack" reaps so great a harvest as in the treatment of skin diseases. Thus the suppression of symptoms becomes the rule; the removal of causes is invariably neglected. Many forms of skin disease, being the result of sexual infections, are allowed to develop because prudery and other motives prevent the early investigation of the cause, and hence delay its prompt treatment and healing. ”

“ Dermatitis herpetiformis is a somewhat rare inflammatory disease, characterized by an eruption of an erythematous, papular, vesicular, pustular, bullous or mixed type, with a decided disposition toward grouping, accompanied by itching and burning sensations, with, as a rule, more or less consequent pigmentation, and pursuing usually a chronic course with remissions. ”

“ Impetigo contagiosa, ringworm, favus, scabies and pediculosis; excluding the exanthemata, erysipelas, syphilis and certain rare and doubtful diseases.
[At the present time when most diseases are presumed to be due to bacteria or parasites the belief in contagiousness, under certain conditions, has considerably broadened.]
RAPIDITY OF CURE.
Is the rapid cure of a skin disease fraught with any danger to the patient? ”

“ In doubtful cases, an observation of several weeks will always suffice to distinguish it from eczema, erythema multiforme, herpes iris and pemphigus, diseases to which it at times bears strong resemblance.
Give the prognosis of dermatitis herpetiformis.
An opinion as to the outcome of the disease should be guarded. It is exceedingly rebellious to treatment, and relapses are the rule. Exceptionally the bullous and pustular varieties prove eventually fatal. The erythematous and vesicular varieties are the most favorable. ”

“ Galen97 distinguishes between λειχὴν ἁπλοῦς and λειχὴν ἄγριος (simple lichen, and malignant lichen) in his enumeration of Skin-diseases, and still more plainly in another place98 he says: “λειχὴν is likewise a Skin-disease; there are two forms of it, ὁ μὲν ἥμερος καὶ πρᾳότερος, ὁ δὲ ἄγριος καὶ χαλεπώτερος (the one benignant and milder, the other malignant and more serious) . But in both of them minute scales are detached from the skin, and the part of the skin underneath the scales is reddened and almost ulcerated. ”

“ SYMPTOMS.—Eczema, known popularly as tetter, is the most important and the commonest of the diseases of the skin. It may be defined as an inflammatory, non-contagious disease of the skin, characterized in the beginning by erythema, papules, vesicles or pustules, or a combination of these lesions, pursuing an acute or chronic course, accompanied by infiltration and itching, terminating either in discharge with the formation of crusts, in absorption, or in desquamation. The disease is multiform in character, and is capable of manifesting itself in a great variety of forms ”

“ These glands are peculiarly apt to become morbidly affected in travellers visiting the South during their acclimatisation; though natives too are yearly attacked in the Summer months by complaints of the skin-glands.170 The fact has long been recognized171 that147 in Southern countries not only the greater number of skin-diseases, but even Venereal disease itself in an especial degree, appear as an exanthema of the skin, and for this reason it there displays far less destructive effects ”

“ They may be overtaxed, and then but one avenue remains for the escape of surplus impurity—the skin. It responds, and in responding, suffers. Sometimes it is the skin itself that is called upon to work to its limit, or it may be that it is affected by exposure and chill with closing of its pores ”

“ 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. ”

“ Psoriasis is a more inflammatory disease, is seen usually more abundantly upon the limbs, the scales are profuse and silvery, and the underlying skin is red and has a glazed look; moreover, psoriasis, as a rule, appears slowly and runs a chronic course. ”

“ Having observed, as in the year 1802, a spontaneous moisture on the skin on the first day of the disease, in several cases, I was led to assist this disposition in nature to be relieved by the pores, by means of sweating remedies, but in no instance did I follow it, without previous evacuations from the blood-vessels or bowels; for, however useful the intimations of nature may be in acute diseases, her efforts should never be trusted to alone, inasmuch as they are in most cases too feeble to do service, or so violent as to do mischief. ”

“ Various degrees of inflammation of the skin may be produced by the action of the sun, the injury being due not to the heat but to the actinic rays. In a mild degree of exposure only redness and a strong sense of heat are produced, but in prolonged exposure an exudate is formed which causes the skin to swell and blisters to form, these being due to the exudate which passes through the lower layers of the cells of the epidermis and collects beneath the impervious upper layer, detaching this from its connections. ”

“ They are, as a rule, sharply defined, with a smooth, often shining and atrophic-looking surface; are soft, fine or leathery to the touch, on a level or somewhat depressed, and appearing not unlike a piece of bacon or ivory laid in the skin. Occasionally the patches are noted to occur over nerve-tracts. The adjacent skin may be normal or there may be more or [Pg 173] less yellowish or brownish mottling. The subjective symptoms of tingling, itching, numbness, and even pain, may or may not be present.
What is the course of the disease? ”

“ If your skin be red, or itchy, or scaly, or out of condition in any way, go to a doctor and get the appropriate treatment for that particular disease, instead of smearing on the surface of your body some drug of which you know nothing, in the hope of its being the proper thing for the little patch of diseased skin. ”

“ Eczematous symptoms may be superadded. In severe cases the entire extensor surfaces of the legs and arms, and in some instances the trunk also, are invaded. It is worse in the winter season. [Pg 119]
What is known in regard to etiology and pathology?
It is a disease of the ill-fed and neglected, usually developing in early childhood, and persisting throughout life. It is extremely rare, even in its milder types, in this country. Clinically and pathologically it bears some resemblance to papular eczema.
Give the prognosis and treatment of prurigo. ”

“ Thorough ablution of the body every morning at least is essential to health. I maintain that no one can be in the enjoyment of perfect health who does not keep his skin—the whole of his skin—clean. In the absence of cleanliness, a pellicle forms on the skin 1319which engenders disease. Moreover, a person who does not keep his skin clean is more susceptible of contracting contagious disease, such as small-pox, typhus fever, cholera, diphtheria, scarlet fever, etc. ”

“ Nearly all the people were disfigured by dark blotches on the skin, the effect of a cutaneous disease very prevalent in this part of the country. The face of one old man was completly blackened, and looked as though it had been smeared with black lead, the blotches having coalesced to form one large patch. ”

“ 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. ”

“ Affections of the Skin.—Although all types of skin affection are met with in the inherited disease, the most important is a papular eruption, the papules being of large size, with a smooth shining top and of a reddish-brown colour. It affects chiefly the buttocks and thighs, the genitals, and other parts which are constantly moist. It is necessary to distinguish this specific eruption from a form of eczema which occurs in these situations in non-syphilitic children, the points that characterise the syphilitic condition being the infiltration of the skin and the coppery colour of the eruption. ”

“ Applications of cool and iced water to the skin are commonly grateful, and, as a rule, are accompanied by no danger to the patient, though in the early periods of the disease they unquestionably retard the full evolution of the cutaneous symptoms. For the pain in the back, therefore, which is often the most urgent symptom of the invasion stage of the disease, it is usually preferable to make hot applications. ”

“ Amongst the bulk of the people, the skin is more commonly of a dull hue, with some degree of roughness, especially the parts that are not covered, which perhaps may be occasioned by some cutaneous disease. ”

“ In the course of the next four-and-twenty hours in some cases, and in others not until the expiration of two or three days, it completely covers the body; not being confined exclusively to the skin, but frequently extending to the mouth and throat, and even to the external membrane of the eye.
In the course of two or three days from their first appearance the little pimples, increasing in size, will be found to contain a thin transparent fluid, to pit or become depressed in their centre, and the skin in the spaces between them will be found red. ”

“ Describe the bullous type of dermatitis herpetiformis.
The bullous expression of the disease is usually of a markedly inflammatory nature, often innumerable blebs, small and large, appearing almost continuously, and in some instances involving the greater part of the surface. The lesions arise from erythematous skin, from preëxisting vesicles or vesicular groups, or from apparently normal integument. There is a marked disposition to appear in clusters. A change of type to the erythematous or vesicular varieties is not unusual. ”