Skin lesion

“ In addition, at the time of the biopsy, the President elected to have the tissue around the lesion treated superficially with a technique called scraping and burning, in the event that the lesion was to be confirmed as skin cancer.
The risk of recurrence of basal cell skin cancer is low; but the risk of developing a new lesion in the future is increased over the rest of the population, due to the fair skin years of sun exposure. ”

“ Upon the extremities, especially the legs, friction of the clothing, dirt, and constant scratching frequently inflame the lesion, and a dark crust upon a superficial ulceration with a narrow red areola is produced, which has generally been described as a distinct skin affection under the name of ecthyma. These ecthymatous pustules, common in cachectic children, are often associated with the characteristic lesions of contagious impetigo upon the face and hands and are evidently of similar if not identical origin. ”

“ Hysterical Cutaneous Conditions.—There are certain cracks of the skin with ulcerative lesions which occur in hysterical patients in the neighborhood of the knuckles that represent a phase of unfavorable influence of the mind. When these patients begin to worry or be anxious they know that these skin lesions will follow. Expectancy seems to make it certain that the lesions will come and attention adds to their chronicity. ”

“ The regions commonly invaded are the face, neck, chest, mammæ, back, abdomen, arms, and thighs. The lesions pursue a variable though usually chronic course, lasting, as a rule, years. There is always a marked tendency to varied atrophic changes, which in most cases appear early, the skin becoming thin, shrivelled, or parchment-like, later being bound down to the tissues beneath, forming cicatriform, keloidal lesions, which may cause contraction and deformity, with, in some cases, wasting and general atrophy, more particularly of the extremities. ”

“ 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. ”

“ Recurrent attacks of inflammation frequently occur, especially in wens of the face and scalp. Suppuration may ensue and be followed by cure of the cyst, or an offensive fungating ulcer forms which may be mistaken for epithelioma. True cancerous transformation is rare.
Wens are to be _diagnosed_ from dermoids, from fatty tumours, and from cold abscesses. Dermoids usually appear before adult life, and as they nearly always lie beneath the fascia, the skin is movable over them. A fatty tumour is movable, and is often lobulated. ”

“ The rash developed, according to the patient’s history, in the form of red spots, on which a blister full of clear fluid formed. The fluid then became mattery, and an ulcer resulted. The development of an ulcer was heralded by a pricking sensation. On exhibition, the striking characteristics were the presence of patches of excoriated skin and white scars, surrounded by pigmentation. The patches were oval in shape, with the long axis running down the limb or transversely on 143the trunk. The more recent lesions consisted of red, raised papules with an excoriation on the summit. ”

“ The lesions, having attained a certain size or development, may remain so for a time, but sooner or later retrogressive changes occur: the matured papules or tubercles, or infiltrated patches, slowly disappear by absorption, fatty degeneration, and exfoliation, leaving a yellowish or brownish pigmentation, usually with more or less atrophy or cicatricial-tissue formation—lupus exfoliativus; or disintegration and destruction result, terminating in ulceration—lupus exedens, lupus exulcerans. ”

“ 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. ”

“ The hairy portion of the neck may also be invaded. The disease may begin by the formation of papules and pustules about the hair-follicles on previously healthy skin, or chronic hyperæmia, or even eczema, may have preceded. The lesions generally occur in numbers, in close proximity, and, together with the accompanying inflammation, make up a patch of disease involving a greater or less area. The pustules are discrete, flat or acuminated, small in size, yellowish in color, perforated by hairs, show no disposition to rupture, and are, as a rule, apt to appear in crops. ”

“ In certain diseases of nervous origin, notably in herpes zoster, the eruption follows the course of a certain nerve. In the face we get erythema, lupus erythematosus, rosacea, eczema, actinomycosis, &c, and syphilitic and malignant ulcers. Rodent ulcer usually selects the face, and generally the nose or orbit. The face too is usually the selective site of lupus vulgaris. The scalp is the chief site oi two varieties of lesion — the pustular, as in pustular eczema and impetigo contagiosa, or the dry and scaly eruptions, as psoriasis, ringworm and squamous syphilides. ”

“ 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. ”

“ The first usually begins as a small pimple like a pin's head, and, if neglected, breaks, and gradually increases in size. Its origin is something which has caused the minute vessels of the skin at the spot to give way, so that they remain congested with bad blood, which soon becomes practically poisonous, and so the sore enlarges and eats into the surrounding tissue. If such a sore appears on the leg, it is often due to over-pressure through too much standing. Rest, with the leg kept horizontal or inclined slightly upwards to the foot, will often be enough to cure. ”

“ But the changes in the papillæ, the infiltration of the upper layer of the corium, the widening of the blood-vessels, the dilatation of the lymph-channels, taken in conjunction with the clinical symptoms and the results of treatment, leave no doubt that the case was one of true psoriasis vulgaris of the mucous membrane of the mouth. Previously, very few cases of scaly lesions of the mucous membranes had been described, and in psoriasis of the skin the extensive and destructive infiltration seen in these lesions of mucous membranes is unknown. ”

“ In the former, after nerve-injuries more especially, we observe loss of thickness, glossiness, and perverted circulation and secretion; the hairs may fall out or grow abnormally; the nails are slow of growth, thick, rugose, incurvated, and brittle. In other cases, as in cerebral and spinal paralyses, the skin of the paralyzed part is abnormally dry, rough, and furfuraceous, and it loses its elasticity. In some varieties of so-called skin diseases the patches of altered nutrition (eczema, bullæ, herpes, psoriasis, leucoderma, scleroderma, etc.) ”

“ Those of a light complexion are more liable to its development, while menstrual difficulties, chlorosis, scrofulosis, and general debility may all predispose to the disease. Medicinal substances, such as the iodides and bromides, and tar externally, are also prone to produce acne-form lesions. The retention of the secretion within the sebaceous gland is the first step in the formation of an acne lesion, and its presence—or it may be its decomposition—gives rise to inflammation, which usually involves the gland-structure and the surrounding tissue. ”

“ They are whitish, grayish, or blackish in color, are rarely larger than a pinhead, each being pierced by a hair, around which are accumulated, in the form of strata, the horny cells of the epidermis. In some lesions the hair is broken off at the apex, appearing as a black central point; in others the hair is not visible, but is found coiled or twisted up within the papules. The skin is dry, harsh, or rough, and together with the papules may feel like a nutmeg-grater. ”

“ In other cases, we see disfigurations of the face in consequence of vascular dilatations, especially on the nose and on the adjoining portions of the cheeks, 634rosacea, in which disease also there is associated inflammation of the sebaceous glands. Another disorder of the skin of the face which is greatly dreaded by women at this time of life, owing to the unsightly appearance it produces, is the development of sinuous dilatations of some of the superficial vessels, at times associated with connective tissue proliferation in the form of red or violet-coloured painless nodules. ”

“ Irregularly scattered over the face, and in some cases also over the neck, shoulders and upper part of the trunk, are to be seen several, fifty or more, pin-head- to pea-sized papules, tubercles or pustules; commonly the eruption is of a mixed type (acne vulgaris) , the several kinds of lesions in all stages of evolution and subsidence presenting in the single case. Interspersed may generally be seen blackheads, or comedones. The lesions may be sluggish in character, or they may be markedly inflammatory, with hard and indurated bases. ”

“ The excoriations from scratching in pediculosis, scabies, pruritus, eczema, and other itchy diseases are to the dermatologist the most frequent examples of traumatic dermatitis. They subside on removal of the cause, leaving often, especially if the scratching has been at all violent and the cause long continued, thickening of the skin and pigmentation, both of which, notably the latter, may be more or less permanent. ”

“ In contrast to ordinary dropsy, there is no pitting on pressure, and the swelling does not disappear on elevation of the limb. The skin becomes rough and warty, and may hang down in pendulous folds. Blisters form on the surface and yield an abundant exudate of clear lymph. From neglect of cleanliness, the skin becomes the seat of eczema or even of ulceration attended with foul discharge. ”

“ The contents of a wen are from sebaceous glands—fat secretions—fat tumor. The following names are frequently mentioned in the skin diseases:
Macule. (Spots, patches) . Skin is altered in color, but the skin is not raised or depressed; freckle, etc.
Papule. (Pimple) . Elevated piece of skin, varying in size from a pin-head to a coffee bean.
Tubercle. (Node-lump) . A solid elevation of the skin, varying in size from a pea to a cherry.
Tumors. These are soft or firm elevations of the skin, like a wen or hard lump. They are always deep-seated. ”

“ Infection is liable to occur and to lead to wide destruction of the surrounding skin. The amount of granulation tissue necessary to fill the gap is therefore great; and as the epithelial covering can only be derived from the margins—the skin glands being completely destroyed—the healing process is slow. The resulting scars are irregular, deep and puckered, and show a great tendency to contract. Keloid frequently develops in such cicatrices. When situated in the region of the face, neck, or flexures of joints, much deformity and impairment of function may result (Fig. 63) . ”

“ They never exude serum. The lesions are, as a rule, circumscribed and sharply defined from the surrounding healthy integument, differing in this respect from similar patches of eczema. The skin between the lesions is perfectly healthy. In markedly inflammatory cases they occasionally possess a slightly raised border, and sometimes, especially in certain localities, as the hands, fissures form, as in eczema and syphilis.
The disease pursues an eminently chronic course, often lasting years or even throughout life, disappearing and recurring from time to time. ”

“ Generally, the patches come out very gradually and in small numbers and, in the main, symmetrically, but as the older patches never go away spontaneously, while fresh ones are continually evoluting at short or long 120intervals, large areas are involved, and in the course of years (in one case, months) the whole trunk and limbs are crowded with lesions, though there are always spaces of normal skin intervening, or sometimes completely enclosed by the diseased process, where the original patches have coalesced. ”

“ 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. ”