Affections of the Skin
The skin, as the investment of the body, is practically the only part thereof that is “intended” to come in direct contact with the outside world. It is naturally possessed of great resistance to external influences so that few of these can damage the skin and produce affections therein so long as it is well nourished and, not poisoned from within. True as this is, it must be admitted that much skin “disease” has gone out of fashion since the use of the bath tub became general. A clean skin is more resistant than a dirty one.
Skin affections are grouped into a few natural groups. We shall deal with them alphabetically under these groupings.
SKIN INFLAMMATIONS
ACNE
Definition: Acne is inflammation of the oil glands of the skin and of the follicles of the fuzzlike hairs attached to the oil glands. It manifests as small, or large, pimples, often containing pus. Various qualifying terms have been added to the term acne to distinguish its most important features.
Acne artificialis, or artificial acne, is papules produced by the internal use of such drugs as the bromides and iodides and the external application of tar, chrysorobin, etc.
Acne atrophica, or atrophic acne, is simple acne in which the lesions are followed by scars or small pits.
Hypertrophic acne, or overgrowth acne, is acne followed by thickening of the skin from an overgrowth of connective tissue.
Acne indurata differs from the simple form chiefly in the degree and extent of the symptoms and the hardening (induration) which are present.
Acne papulosa, or papular acne, is simple acne in which papular eruptions (solid raised spots on the skin) predominate.
Acne pustulosa, or pustular acne, is acute acne simplex with papules developing into pustules.
Acne rosacea is acne plus rosacea, or a chronic congestion of the nose and parts of the face.
Acne scorbutis, or scurvy acne, is a papular acne with hemorrhages into the skin.
Acne scrofulosum, or malnutritional acne, called also scrofulous acne and acne cachecitcorum, occurs in undernourished or scrofulous or emaciated individuals. If develops chiefly on the trunk and lower limbs, though, occasionally, the arms and face are affected.
Acne simplex is simple acne, which is the most common form, hence the term acne vulgaris.
Acne varioliformis is a form of acne, the pustules of which resemble those of variola (smallpox). It develops chiefly on the forehead, along the hair margin, also the scalp, face and neck, and, sometimes, the shoulders and breastbone.
With the exception of acne artificialis, these various forms of acne are merely variations of simple acne, hence we will describe this only.
Simple acne is seen more often in girls and women than in boys and men; develops chiefly on the forehead, cheeks, lower jaw and chin, and sometimes on the chest, shoulders, upper arms, and even down the back and thighs; develops chiefly during the adolescent years and tends to disappear upon the attainment of maturity, although it may persist long after thirty is passed. It is often aggravated before and during menstruation.
Blackheads usually constitute the center or nucleus for the beginning of the inflammation. A papule develops around this center and later becomes a pustule. However, acne may develop without blackheads and blackheads may exist without acne developing.
A crust forms on the pustule, then falls off, leaving a redness which lasts a few days, or a depression or scar may be left. In many cases no pustules develop, the condition remaining in the papule stage, in which cases, the papules are absorbed after a few days.
On the same face, or other portions of the body, and without any semblance of regularity, there may be seen all stages — blackheads, papules, pustules, crusts, redness, pittings or scars. Frequently we see faces that have become so badly pitted their owners look like they have had smallpox. Few things can so completely spoil the beauty of the face as acne. The scars may be permanent, or they may gradually smooth out. In some cases no scars are formed. The stain that often remains tends to fade out, eventually.
If the papule of acne is opened or squeezed, blood, pus and fatty substance and, if present at the beginning of the papule, the blackhead, are found. Healing is usually rapid after evacuation of the contents, though squeezing usually tends to aggravate the local lesion. If the pustule is not molested spontaneous evacuation occurs.
In acne indurata the areas of hardening vary from the size of a pea to as a large as a hazel nut. They begin deep below the epidermis, are usually deep red or purplish, often involve several adjacent glands, thus giving the appearance of boils, and may contain much pus. The lesions often fail to rupture spontaneously. When opened and evacuated artificially, they tend to refill rather than to heal. Scar formation is often very pronounced, especially where there has been much squeezing or direct pressure. Fibroid changes in the scars may cause them to resemble fibroid tumors.
There are no general symptoms with acne and the sufferer is inclined to regard himself as otherwise healthy.
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ACRODYNIA
Definition: A symptom-complex marked by pricking pains in the palms and soles, hyperesthesia, and eruption on hands and feet.
Symptoms: This is an acute non-febrile erythema accompanied by nervous symptoms. It is considered to be related to pellagra, as it possesses similar symptoms. There are swelling of the face or extremities, erythematous eruptions on the hands up to the wrists and the feet up to the ankles, involving, as well, the fingers and toes; there is redness of the eyes, sensory disturbances such as a sensation of crawling insects on the skin, pain in the fingers and toes, sticking pains in the palms and soles, feeling of weight in the extremities, hyperesthesia and, sometimes, anesthesia. There is also irritation of the stomach and intestine. This symptom-complex occurs epidemically usually following the many catarrhal crises called “influenza.”
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ANGIONEUROTIC EDEMA
Definition: This is an acute circumscribed edema — a giant urticaria of neurotic origin.
Symptoms: Its main characteristic is a transient, well-defined edema or swelling of the skin, which appears suddenly upon the surface of some part of the body, especially the hands and face. The skin is not discolored. There are usually well-marked digestive disturbances associated with the condition. Usually the swellings last but a short time, disappear, and leave no traces in the skin. Crises of this kind may occur every few weeks.
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CARBUNCLE
Definition: This is a circumscribed subcutaneous inflammation, having a deep-red knob and often ending in a suppurating slough.
Symptoms: Carbuncles resemble boils but are more extensive, the inflammation involves the deeper tissues as well as the skin, are very painful and discharge their contents through several openings. Beginning as a fairly rapidly increasing painful knob on the skin, of a deep-red color, and flattened on top, surrounded by a hardened, painful and dusky-red area, It enlarges, pus forming in seven to ten days, which is discharged through craters formed by sloughing of the top. General symptoms such as may appear in any suppuration — fever, malaise, etc. — are pronounced. Carbuncles develop most often on the nape of the neck, back and buttocks. The scalp, face and back of the forearm are less frequent locations of development.
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DERMATITIS (Cutitis)
Definition: This is simple inflammation of the skin caused by some irritant.
Symptoms: Several forms are described as follow:
Atrophic dermatitis: See under skin atrophies.
Dermatitis Excoriation Infantum, or scaling dermatitis of infancy is seen in very young babies. It begins the fifth week after birth, develops quickly, results in excessive scaling and leaves the skin red and usually dry. The mucous membranes may be raw and crusted. Nutrition is commonly very poor in these cases.
Dermatitis Ambustionis (burns) is inflammation of the skin due to heat or scorching — from flame or hot articles or from water, steam, hot oil, electric wire, X-ray apparatus, or sunburn. Three stages or degrees of burning are recognized:
First degree burn is an erythema (redness of the skin) with only very superficial destruction.
Second degree burn is a bullosa (bleb or blister) which results from deeper burns, and the deeper tissues are affected. The pain and tenderness may be and usually are less pronounced than in first degree burn, there may be some symptoms of shock; pus develops and scars are formed in healing.
Third degree burn is a sloughing dermatitis (inflammation of the skin) from more severe burns of greater area and which is likely to result fatally. Serious and fatal results come from shock, interference with skin function, and the formation and absorption of poisons in the burnt flesh.
Dermatitis artefacta is a term applied to “feigned eruptions” frequently seen in beggars, criminals, hysterical people, especially women, and others. The eruptions are artificially produced for the purpose of eliciting sympathy, securing aid or attracting attention. Friction, acids, caustics, coals or other hot articles are used to produced erythematous, bullous, ulcerous or gangrenous lesions of the skin. They differ from “disease” eruptions in their deviations from regular types of dermatoses, by their distinctness, and in being confined to parts easily reached by the hands.
Dermatitis medicamentosa, or drug eruptions, follow the taking by mouth, rectum or subcutaneous injection, of drugs of various kinds. Some people throw out drugs through the skin more readily than others — these are said to be “more susceptible.” Breast-fed babies often develop rashes from drugs taken by the mother.
Antipyrin is eliminated by means of a generalized papular eruption; arsenic by an erythema, or by papular, or vesicular, or pustular eruptions; atropin or belladonna by a rash resembling scarlet fever on the face, neck and chest and accompanied by dry throat, fast pulse, and sometimes large pupils; borax by an eruption resembling psoriasis; copaiba by a macular, papular, or hive-like eruption; chloral by a hive-like papule or an erythema potassium bromide by an acne-like eruption or an erythema, and pustules; potassium iodide most often by a widespread acne-like eruption, bright red in color and sometimes an erythema, or a papular, pustular, hive-like or purpuric eruption; quinine usually by an erythema, sometimes by an acne-like eruption; salicylates by an erythematous or urticarial eruption; etc., etc.
Dermatitis Multiformis, or dermatitis herpetiformis (many-formed dermatitis) is a chronic inflammation of the skin presenting groups and combinations of reddened, papular, vesicular, pustular and bullous eruptions, with burning and itching; the itching often being very intense. The eruptions may develop either suddenly or gradually. In severe cases fever, chilliness, general uneasiness and other acute symptoms are present. There is a marked tendency for one form of eruption to evolve into another form.
The chief forms are erythematous (red, diffuse patches), bullous (crops of large, irregular blebs), papular (groups of papules in crops), pustular (clusters of pustules), vesicular (groups of irregular shaped vesicles appearing in crops), and mixed (containing various combinations of lesions).
Dermatitis venenata (inflammation of the skin from external poisons) includes all dermatoses due to direct or indirect contact with poisons of animal, vegetable and mineral origin. Poison ivy, poison oak, poison dogwood, poison sumac, poison elder, the nettle, oleander, rue, and smartweed are among the plants contact with which causes itching, burning, redness and eruptions, etc.
Epidemic dermatitis (epidemic eczema) is an acute inflammation of the skin which begins with hard, bright-red papules grouped around hair follicles. Vesicles may form on the papules and rupture leaving moist surfaces which produce thickened patches upon drying. After from three to seven days the lesions rum together, sometimes covering the whole body, the skin becoming very red and dry, with thick scales, sometimes crusts. Pints of scales may be given often in a day’s time. Itching is intense. In from three to eight weeks a gradual return to normal sets in, though the skin may remain pigmented for months, covered with a smooth, shiny and inelastic skin. In some cases the hair of the body (not of the head) and even the nails are shed.
Vaccination dermatitis: Various skin lesions result from the efforts of the body to expel pus and virus from the blood and lymph through the skin. Smallpox vaccination and all serum inoculations are frequently followed by erythema, erythema multiforme, hives, lichen, malaria, impetigo contagiosa, erysipelas, and boils. These may develop shortly after or a few weeks subsequent to vaccination and may come out in crops. Gangrene sometimes develops.
X-ray dermatitis is due to exposure to the X-rays from a diagnosing or treating apparatus. Its development indicates carelessness or lack of knowledge on the part of the doctor or technician. X-ray burns may be severe, deep-seated and stubborn.
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ECTHYMA
Definition: The word means pustule. It is applied to an inflammatory skin affection characterized by separate, flat, deep-seated pustules having broad inflamed bases.
Symptoms: This condition seems to be secondary to other skin inflammations and is seen chiefly in the poorly-nourished and debilitated. The pustules range from the size of a pea to as large as a dime, are sometimes long and narrow, and are yellowish in color. The pustules usually dry, forming reddish-brown crusts. Pigmentation and raw surfaces, followed by scar formation, usually succeed the disappearance of the pustules. The legs are most often affected; sometimes the trunk and neck.
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ECZEMA
Definition: A common skin inflammation characterized by itching, redness, and infiltration. It constitutes about thirty per cent of all skin affections, is found in all ages and conditions of life, but chiefly among the young and aged, and is commonly known by such names as tetter and salt rheum.
Symptoms: Primarily there is redness of the skin, scales, papules or pustules; and secondarily scales and crusts. Usually a tendency to a moist or weeping surface is present. The itching and burning are very annoying. It is seen in acute and chronic forms. Several forms are recognized as follow:
Eczema fissum (fissured eczema) of which chapping is one degree. It is seen most often upon the fingers, but develops also upon the palms, soles, back of the ears, and at the corners of the mouth and on the outlet of the rectum. Considerable pain and some slight or considerable bleeding are usually present. It is very persistent, usually disappearing in summer and reappearing in winter.
Eczema rubrum (red eczema) is a secondary form, usually of vascular or pustular eczema, commonly developing on the faces of infants and on the extremities of adults. Sometimes it develops where there is considerable heat and moisture — the arm pits, folds of the breasts and buttocks. It is characterized by an intensely red, raw-appearing, continuously weeping and oozing surface, with hardening of the elements of the skin, frequently combined with crusted areas. The term eczema madidans is applied to it when the weeping is very prominent. This is one of the most distressing forms of eczema as it is chronic and is accompanied with constant and intense burning and itching.
Eczema Sclerosum (hard eczema) begins as an ordinary eczema, becomes chronic and produces thickening of the skin and underlying tissues. It is almost entirely confined to the palms and soles, though it sometimes develops on the ankles and lower legs. The skin appears calloused, and it may be impossible to close the palms and fingers.
Eczema squamosus (scaly eczema) often evolves out of some other form of eczema, or it may develop in point of time between two other forms. It is characterized by dull redness, hardening and considerable scaling. These scales are small and easily brushed off. It is usually located on the scalp, face, and back of the neck, but sometimes develops upon the extremities and trunk. When near a joint the thickened skin is likely to become fissured or cracked resulting in fissured eczema.
Eczema verrucosum (warty eczema) is similar to hard eczema, though the lesions are warty or horny. The usual location is the lower legs: these may resemble legs affected with elephantiasis. Excretions accumulate between the protuberances and give off a nauseous odor. The condition is also sometimes located where heat and moisture are present and where cleanliness is likely to be incomplete — armpits, under hanging breasts and about the genitals.
Erythematous eczema is found most often on the face, neck and genital organs and consists of irregular, swollen and red patches, with rough and hardened skin, slight scaling, itching and burning. It recurs frequently. It may continue in this form or develop into scaly eczema.
Papular eczema occurs chiefly upon the extremities and consists of patches of pin-head-sized pointed papules accompanied by extreme itching. Vesicles are frequently associated with it, and leave the skin exposed and raw. The eruption often recurs.
Pustular eczema is frequently associated with, or is a later stage of vesicular eczema and appears most frequently on the face and scalp of scrofulous and ill nourished children and in elderly people. When it develops on the face and scalp of infants, it is known as “milk crust” or “milk crust eruption” or “milk scurf.” It appears as many papules which quickly change to vesicles and then to pustules, on which form thick greenish-yellow crusts. An extremely nauseating odor is given off when the hairy region is affected. Itching is slight.
Vesicular eczema is essentially an acute form developing as poorly outlined red patches covered with small vesicles which, upon rupturing, permit the escape of a sticky serum on a raw surface. Yellow gummy crusts commonly form, under which the “weeping” may continue. The itch is relieved when the vesicles rupture, but smarting and burning soon follow. This form develops usually on the extremities in adults; on the face in infants.
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ERYSIPELOID
Definition: An inflammatory dermatosis resembling erysipelas but lacking the constitutional symptoms. This is a local infection which affects the hands of those whose cut or wounded hands come in contact with decomposing meat — butchers, fish handlers, medical students in the dissecting room, etc.
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ERYTHEMA
Definition: The word erythema means redness and is applied to certain skin affections in which there is hyperemia or redness which disappears upon pressure, and passive inflammation. It is a symptom and must be qualified by another word descriptive of the recognizable affection. Several forms are described as follow:
Erythema induratum is a rare inflammatory skin affection occurring in scrofulous individuals; chiefly in girls and young women.
Symptoms: It develops frequently in winter, largely in those who suffer with cold hands and feet. Circumscribed semi-hard lumps develop in the skin, usually on the calves of the legs, but sometimes, also, on the thighs and arms. These end either in absorption or in foul suppuration. Though usually absent, pain and tenderness may be marked. These subjects usually present signs of tuberculosis. Healing is slow ordinarily, with frequent recurrences.
Erythema multiforme is a skin inflammation characterized by lesions of different kinds — papular, vesicular, or bullous.
Symptoms: Occurring most frequently in women or girls in youth or adolescence, and chiefly in spring or autumn, it is marked by an eruption, usually on the extremities, of macules, papules, resides, or, more rarely, blebs or blisters. The lesions may run together or remain discrete; they last one or two weeks and gradually fade. There is little or no itching but in some cases there are such constitutional symptoms as fever, headache, general uneasiness, and rheumatoid pains. Its various forms are named according to the leading eruption: Papular erythema with separate or merged maculopapules of reddish or violet hue — the most common form; erythema circinatum or Erythema annulare, circular patches that clear in their centers as they spread at their borders; erythema iris, various colored rings or crescents: erythema gyratum, erythema circinatum with overlapping lesions; vesicular erythema when vesicles are the chief lesions; erythema perstans, practically permanent, ring-shaped patches — these appear to be permanent because of so frequent recurrence.
Erythema nodosum (dermatitis contusiformis) is an acute inflammatory skin affection characterized by crops of rosy-red or purplish swellings of various sizes.
Symptoms: Appearing most often on the extremities, this affection is seen chiefly in children and early adult life and occurs twice as frequently in males as in females. It resembles somewhat erythema multiforme; the eruption of bright-red nodes appears suddenly, these becoming dark and fading, presenting the appearance of the late stages of the “black and blue” of bruises and contusions. At first the eruptions resemble boils, but there is no suppuration. They are very painful to the touch and fever, headache, general uneasiness and rheumatoid joint pains usually accompany them.
Erythema scarlatiniform (erythema scralatinoides) is a mildly acute skin eruption resembling scarlet fever but running a different course.
Symptoms: Appearing gradually or suddenly on the chest, the eruption spreads over the body. Usually there are chills, slight fever and uneasiness. Frequently there are burning amid itching. The eruption fades and gradually disappears within a few days, with little scaling except in some severe cases in which casts of the hands, and even the hair and nails, may be shed.
Erythema simplex (simple hyperemic erythema) presents lion-elevated bright red or dull patches of various sizes amid shapes in the skin. The redness always disappears readily upon pressure, as there is only congestion, not inflammation, of the skin. Usually itching and mild burning are present but there is no hardening of the skin structures.
This is divided into several forms according to its causes, as: erythema caloricum when due to exposure to either extreme of temperature (further divided into erythema ab igne when due to heat and erythema pernio — chilblains — when due to cold j; erythema solare or sunburn; erythema traumaticum when due to skin injuries; erythema venenatum when due to plant poisons.
Symptomatic erythema is erythema appearing as a symptom of other affections as erythema diphthereticum which occurs in diphtheria; serum rash resulting from serum inoculations: “stomach rashes” seen in indigestion; erythema cholericum sometimes seen in cholera; and the erythemas of chronic nephritis and of uremia.
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FURUNCLE (Boil)
Definition: An inflammation of the skin and underlying connective tissue surrounding a hair follicle or oil gland, leading to the formation of pus and death of the central portion or core, which is expelled. If a crop of boils appears the condition is called furuncolosis.
Symptoms: Boils are more common in men, especially youths, than in girls or women. The boil, develops rapidly, reaching full development within three or four days. It begins with a dull, aching pain, which rapidly grows more intense, with severe throbbing and a sense of tightness, these symptoms being more intense at night. The boil becomes “ripe” in seven to ten days. When the boil cap ruptures the core is usually expelled spontaneously leaving a small cavity of considerable depth. This heals quickly, leaving a small scar which gradually fades. Boils are occasionally accompanied with slight fever and other symptoms of a general nature. A “blind boil” is one in which no core is found. They may develop anywhere on the body, in the outer canal of the ear, etc.
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FURUNCULUS ORIENTALIS (Oriental sore)
Definition: A boil-like sore, endemic in hot countries, known also as alepo boil.
Symptoms: it begins as a papule, which rapidly develops into a nodule or large tubercule, which breaks and forms an ulcer. Healing is spontaneous (all healing is) but is slow, sometimes not taking place for six months or a year.
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GANGRENOUS ECTHYMA
Definition: This is a gangrene of the skin seen in infancy.
Symptoms: A more or less extensive gangrenous dermatitis develops in children and especially following some pustular eruption, such as chicken pox, though also developing “spontaneously.”
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HERPES SIMPLEX
Definition: This is an eruption of deep-seated vesicles on a red base, appearing on the face (herpes facialis) and the genitals (herpes progenitalis).
Symptoms: The most common form, seen on or about the lips, is known as fever blisters, or herpes febriles. Vesicles may be single or in groups. Whether appearing on the face, genitals or elsewhere, they have the same appearance — that of small vesicles or blisters on a red base. The frequency with which they are associated with “fevers” and “colds” has given rise to the terms “fever blisters” and. “cold sores.” Digestive derangements from any cause will produce them.
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IMPETIGO (Scrum pox)
Definition: This is a skin inflammation characterized by a pustular eruption occurring chiefly around the mouth and nostrils, the pustules of which rupture within a short time or become encrusted.
Symptoms: Two chief forms are described as follow:
Impetigo contagiosa is the, common form and is considered “contagious” since epidemics are common among children under ten in institutions. It is the most common skin affection of school children, especially among the poor, and is seen often in adults, especially in the beards of men. The eruptions are flat, yellowish, superficial vesicles or blebs, usually on the face, neck and hands. These rapidly develop into indented pustules, surrounded by a red area. Wafer-like crusts form, their edges loosen, the crust curls up and falls off, leaving a red spot that soon fades to normal. There may be slight fever and itching.
Impetigo herpetiformis is a rare acute form presenting crops of clustered small pustles developing usually on the lower front of the trunk (pelvis), the groins, and inner and back sides of the thighs. Chills and fever accompany each eruption of pustules and various severe general symptoms may develop.
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LICHEN
Definition: This is a term meaning tetter-like eruption applied to any papular skin eruption, but now applied to two varieties in particular, as follow:
Lichen planus is a not very common inflammation of the skin characterized by the development of small, fiat, angular, shining, bluish-red papules, scattered or bunched on the extremities, which later become covered with fine, white scales. There is slight to moderate itching, but the general health does not appear much the worse. As the old eruptions vanish new ones appear.
Lichen scrofulosus is a chronic inflammation developing in some scrofulous individuals, especially children, and characterized by small, conical, scaly papules, which usually form in clusters. These are usually on the trunk, and sometimes spread to the neck, thighs and arms. There are no subjective symptoms. The color of the lesions fades from pale red to salmon colored to normal skin, leaving slight pigmentation.
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LUPUS
Definition: This is often called tuberculosis of the skin. Two chief forms are recognized as follow:
Lupus erythematosus is a superficial hardening of the skin presenting well-defined, red patches more or less covered with adherent yellowish-gray scales developing chiefly in adult women, and frequently following acne or seborrhea. Lupus pernio appears on the ears and hands after frost bite. Small red, somewhat scaly, papules form on the face, chiefly about the nose and gradually unite forming red patches without ulcer formation. Rarely are there subjective symptoms.
Lupus vulgaris develops usually before the age of twenty, often before the age of ten, usually on the nose, cheeks and ears, particularly the nose, but at times on the trunk, extremities and even on mucous membranes and cartilages.
The first lesions are numerous deep-seated, reddish-yellow or brownish papules which slowly evolve into tubercules, which, because of their consistency, are called “apple-jelly nodules.” They are embedded in the skin but are perceptibly softer than the skin. The ulcers spread slowly, and may reach down into the underlying soft tissues, though the bone is never affected. One part of the ulcer spreads, while scar tissue forms in other parts. The scar tissue often becomes the location of new tubercules. Itching is absent, and pain is slight.
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PEMPHIGUS
Definition: A skin inflammation characterized by successive crops of variously sized bullae (blisters) and occurring either in acute or chronic forms. Several varieties are described as follow:
Acute pemphigus develops in those who handle dead animals or their products and usually follows local injury. Blebs form, accompanied with chills, high fever, and delirium.
Pemphigus congenitalis occurs near the end of the first year of life, possibly at birth, usually developing as a result of rubbing, scratching or pressure.
Pemphigus contagiosus is a local bullous form that appears to be transmitted by contact.
Pemphigus foliaceous is a rare and serious form presenting crops of flabby blebs which soon rupture and form crusts which are thrown off, leaving a reddened weeping inner skin. New crops develop in rapid succession, and the whole body surface, also the mucous membranes, may be involved at one time. The condition may last for years.
Pemphigus gravidarum is seen during pregnancy or soon after birth.
Pemphigus neonatorum is pemphigus of the newborn and is seen occasionally at or immediately after birth.
Pemphigus vegitans is a rare form in this country. In this form the rupture of the blebs is followed by wart-like growths upon their sites. These unite and form fungus-like masses. Severe constitutional symptoms accompany. The most common locations are the neck, mouth, armpits, flexures of the arms and legs, and the genital and anal regions.
Pemphigus vulgaris is the most common form and is chronic. It is characterized by successive crops of tense blebs with clear fluid that rapidly become cloudy and purulent. The surrounding skin appears normal. Usually the blebs do not rupture, but their contents are absorbed in five to six days. A small pellicle is left which falls off and leaves a pigmented spot. In severe cases there are itching and burning. No part of the body is exempt.
Pemphigus of hysteria, of leprosy and of “syphilis” are also described.
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POMPHOLYX (Dysidrosis)
Definition: A rare acute skin inflammation occurring usually in those who sweat excessively and characterized by the formation of deep-seated vesicles symmetrically between the fingers and on the palms.
Symptoms: Developing on the hands, and occasionally the feet, the vesicles gradually increase in size until they become blebs, which do not rupture, their contents being gradually absorbed, to be followed by extensive scaling which exposes a red skin beneath. Heat, itching, tingling or burning, pain and sensitiveness, and often some nervous depression, usually develop. The surrounding skin becomes sodden, painful and scaly. Repeated crops of vesicles and blebs, differing in intensity, are frequent. Healing takes place slowly within a few weeks.
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PRURIGO
Definition: A chronic skin inflammation characterized by multiple pale-red papules and intense itching.
Symptoms: Developing in infancy or early childhood, especially in the under nourished, this condition often lasts for years, even for life. It develops chiefly on the face, extensor surfaces of the extremities and the trunk. The skin is likely to be well marked by scratches and blood-crusts. It often becomes dry, harsh and thickened.
Prurigo mitis is the term applied to mild cases; prurigo ferox (cruel) and prurigo agric (wild) to severe cases; prurigo aestivalis (summer prurigo) to a form that recurs each summer and remains severe until cold weather; prurigo infantalis to a form that develops during the eruption of the front teeth.
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PRURITIS (Itch)
Definition: This is an indescribable subjective symptom causing an impulse to scratch. It is loosely applied to any prominent itching not accompanying a definite lesion. It is a symptom that also accompanies many skin affections. Several forms of “itch” are named, but these distinctions are unimportant.
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PSORIASIS (Lepra)
Definition: A chronic skin inflammation having dry, grayish, or white scales upon a shining red base usually first appearing in adolescence or early adult life.
Symptoms: It begins as small, reddish papules crowned by minute silvery scales. The papules gradually increase to the size of a dime or dollar, patches often uniting and thus involving extensive areas with overlapping scales. The papules are dry, sharply defined, slightly elevated, and hardened. The eruption is most commonly located upon the extensor surfaces, though any or all parts of the body may be involved. Patches of “normal” skin are found between the lesions. Itching may be slight or absent. The general health appears good, though muscle and joint disturbances occur. The scaliness reduces as the eruption subsides and eventually the redness fades and the skin re-turns to its normal condition and color, except where pigmentation occasionally remains. The condition gets better in summer and worse in winter. The generalized form usually does not develop until in later years.
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ROSEOLA
Roseola is a term applied to various eruptions of a trifling and “non-infectious” character. The term is obsolescent.
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SYCOSIS VULGARIS (Barber’s Itch)
Definition: An inflammation of the hair follicles of the bearded regions, also called tinea sycosis.
Symptoms: It first appears as a scaly patch of red, upon which pustules soon form, these being usually perforated by hairs. The pustules dry and form crusts instead of rupturing. There is itching, burning and soreness. The eruption comes out in crops, the hair becomes lusterless, brittle and loose.
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URTICARIA (Nettle Rash, Hives)
Definition: This is a transitory inflammation of the skin characterized by short-lasting elevations that itch intensely. It is also called hives, in America. In Great Britain, the term hives is applied to croup, laryngitis, and chicken pox.
Symptoms: This affection seems to develop most often in the nervous type of child and in children with a very sensitive skin. The eruption in the form of firm, well-defined wheels with red bases and white summits, raised irregularly on various parts of the body, appears suddenly. They may appear locally or generally. “Individual” hives usually last but a few hours, but each crisis usually lasts a few days, new eruptions appearing as others subside. Occasionally, chronic hives develops. The term nettle rash is applied to these symptoms because they resemble those occasioned by the sting of the nettle.
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URTICARIA PIGMENTOSA
Definition: Pigmentation hives is a rare form of urticaria seen in young children, usually during the first six months of life, and characterized by pigmentation.
Symptoms: The eruptions or nodule-like wheels are buff-colored, itchy and persistent. When they gradually disappear, they leave brownish or yellowish pigmented atrophic spots behind them. The condition is chronic and often runs a course of months or years, perhaps due to wrong care and neglect of cause.
SKIN INFLAMMATIONS
Etiology: The careful student is struck by the great similarity, often apparent identity, of the many inflammations and exudations of the skin and the similarity of conditions under which these “different” affections arise. He is also struck by the fact that the supposed causes of a given skin affection often fail to produce it.
There exists an appallingly tragic ignorance of the constitutional background of skin affections. For that matter, we need not confine our statement to skin affections, since these are only a few of the affections (covered by hundreds of names) that grow out of toxemia and gastro-intestinal decomposition.
Affections of the skin occur as the direct and indirect result of a large number of visceral failures. Functional weakness and actual pathology of the stomach, intestine, liver, kidneys, nervous system, etc., frequently lead to eliminative efforts through the skin. These are also seen in rheumatism, gout, diabetes, etc.
Carbuncles, furuncles, and other skin eruptions seen in diabetic cases are explained by the saturation of the skin with sugar and, even if we grant the claim of bacteriologists that these things represent staphylococcal infection, the sugar saturation is necessary to provide a favorable nidus for the growth of microbes.
Pruritis and eczema occurring in a patient suffering from chronic interstitial nephritis is due to a failure of elimination through the kidneys. There is also an intimate relationship between gastro-intestinal disorders and such skin affections as eczema, pruritis, urticaria, acne, etc. These are frequently observed in association with and are seen to be influenced by digestive disturbances which involve decomposition of food and partial digestion.
Pruritis is often observed in connection with pathology of the liver, especially when jaundice exists; xanthoma and chronic jaundice are often associated. Eczema and gout are so common together that they have both been classed as belonging to the “gouty diathesis,” while there is also a close connection between psoriasis and chronic arthritis.
It is often difficult to trace the relationship between eruptions and other skin symptoms and the internal failings and pathologies with which they are associated; but we may be sure that faulty digestion, incomplete metabolism, and deficient excretion, these growing out of bad dietary habits and other devitalizing practices, are the underlying causes of these skin affections.
Malnutrition, scrofulous conditions, and personal uncleanliness are frequent backgrounds for the development of skin eruptions.
Certain foods, such as strawberries and peaches, cause a skin rash in some people, when eaten. Oysters and shell-fish do the same with many people. Such people are said to possess an idiosyncrasy or hypersensitiveness to such foods. Some article of food is often blamed for trouble when it is the combination that is at fault. Cow’s milk, particularly if sugar is added, is a common cause of eruptions in children. Any “disease” associated with digestive disorders and nutritive impairments, such as Bright’s “disease,” diabetes, rheumatism, uric-acid diathesis, ulcerative processes, child-bed fever, scrofula and menstrual disturbances, may be accompanied by skin disorders.
Serums and vaccines are frequent causes of skin eruptions. Serum rashes may be of different forms and degrees and may be apparently cured only to recur immediately in the same or other form. There are few skin “diseases” that cannot be produced by drugs alone. Morphine, turpentine, copaiba, chloral, iodine, salicylic acid, arsenic, the bromids, coal-tar products (most of which are used to reduce fever and “kill” pain), mercury, belladonna, formalin, digitalis, arsphenamine, veronal, tea, coffee, alcohol, insulin, etc., used internally, are frequent causes of skin “diseases.” Belladonna produces eruptions resembling scarlet fever; mercury may produce eruptions simulating measles, while its eruptions are frequently called “syphilis.” Many drugs produce urticarial eruptions (hives), papules (small bumps), pustules and even hemorrhagic (blood-filled) eruptions. Others produce scaling or desquamation of the skin. The prevention of drug and serum-induced skin affections is accomplished by avoiding the drugs and serums.
Such irritants as strong soaps, mustard, acids, cantharides or Spanish fly, croton oil, aniline dyes, iodoform, some salves, carbolic acid and other antiseptic and counter-irritant preparations and washes, cause skin trouble. Soaps, salves, lotions, antiseptics, etc., are best omitted from the care of the skin.
Mercury may be used as a medicine or may be absorbed from working in quicksilver mines, and mirror and thermometer factories. Arsenic may be absorbed from wall paper. Quinine is used in many hair tonics. Bromids form an important ingredient of Bromo-seltzer, so freely used in this land of “beverage” guzzlers. Paraphenylenediamine, used to color furs black, and quinine, used to make brown furs, produce skin troubles in fur workers and fur wearers. The artificial leather used in making hat bands and for other purposes may cause skin troubles. Phosphorus matches have been causes of skin trouble. Many face powders, creams, lotions, bleachers, whiteners, etc., cause skin eruptions.
Poison ivy, or poison oak, dogwood, sumac, poison primrose and certain nettles and other poisonous and irritating plants cause skin disorders.
Putrescent matter from decaying meats and vegetables, coming in contact with the skin may cause a local infection and give rise to skin eruptions of various forms.
Uncleanliness, the use of soiled diapers which have been dried without washing, allowing a baby to go for long periods without drying or cleaning it, etc., may give rise to irritation of the skin, with redness, rawness, soreness, pain, etc.
X-ray burns, radium burns, burns from so-called therapeutic lamps, sun burns, cuts, bruises, tearing, scalds, burns, friction from tight bands, garters, etc., and like thermal and mechanical injuries cause local trouble.
Not everyone develops skin affections from the above causes. Indeed, there are those whose skins seem to glow with health even when they are nearing dissolution. Even contact dermatoses do not develop in many who come in contact with the causitive influences. On the other hand, some are so constituted that skin eruptions develop on the slightest provocation. These have what the German school calls the exudative diathesis.
Care of the Patient: Skin eruptions, if not due to purely local causes, as in poison ivy, are eliminative efforts. No attention should be given to the eruption beyond obeying the impulse to scratch and keeping the skin clean. First, last and all the time, proper care of the skin consists in removing the morbid systemic condition — toxemia and autointoxication — that the eruption seeks to throw off. The first principle in dealing with skin affections is to deal with the internal conditions with which they are associated by removing and correcting the causes of these.
Functional impairments — faulty elimination, digestive derangements, glandular defects, etc. — growing out of enervation and toxemia, even skin eruptions due to allergy, necessitate the removal of the organismal impairment, for the systemic impairment and not the specific food, is the cause of the allergy. Only by removing the fundamental cause of allergy can we prevent the systemic degeneration that is otherwise inevitable in allergic individuals.
Weger says: “We have found psoriasis to respond to dietetic treatment in all cases. In some, a complete cure can be effected in four to six weeks. Cases of long standing occurring in people of low vitality may require six months or longer before the eruption disappears entirely. Excess of sugars and starches in the diet is the most important of food factors. The patches begin to fade at the end of a week of complete fasting and in two weeks they have usually disappeared leaving only a smooth, pink surface at the site of the lesion. * * * Once overcome dietetically there is no recurrence of psoriasis unless the patient returns to former habits of eating or becomes so enervated as to bring about the same kind and degree of toxemia as had previously existed. Psoriasis undoubtedly represents a toxic state and should be so treated.” All so-called “diseases” are liable to recur, unless the habits of life that brought them on in the first place are understood and corrected.
This care will serve equally as well in boils, acne, herpes, eczema, and all the other inflammations of the skin. In herpes simplex, Weger says, there is “no constitutional remedy so effective as clearing out the intestinal tract and stopping all food for a day or two.”
Besides fasting, proper diet and cleanliness, we find sun-bathing to be very beneficial in all skin affections. It is necessary to remove all causes of enervation.
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ATROPHIES OF THE SKIN
Definition: Atrophoderma is a general term for wasting of the skin. Skin atrophy may result from insufficiency of blood supply, dietary deficiencies, toxemia, nervous impairment or general metabolic perversion.
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ALBINISM
Definition: A congenital absence or deficiency of pigmentation in the skin, hair, and eyes. Though it is an “inherited” condition, albino children may be born to normally pigmented parents. What is called piebald skin is partial albinism and is found chiefly among negroes. The cause of albinism is unknown and there is nothing that can be done about it.
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ATROPHODERMA NURITICUM (Glossy Skin)
Definition: A rare affection of the skin characterized by a glossy skin.
Symptoms: One or more fingers or toes (usually the fingers) become smooth and glossy, they lose any hair that may be on them, the normal skin lines are obliterated, there are local burning pains and neuralgia, and they appear “blotched as if by chilblains.” The nails may also undergo nutritional changes.
Etiology: Nutritional changes in the skin due to injury to the nerves of the parts affected produce this condition.
Care of the Patient: Improve general and local nutrition, circulation and nerve tone, by correcting all enervating habits and improving the diet, is the only care worthwhile.
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LEUKODERMA (Vitiligo)
Definition: This is the development of white spots and patches on the skin. It is called piebald skin, or acquired leucoderma.
Symptoms: The spots are of various sizes and shapes, and, in color, are milk-white or pale pinkish-white. Commonly they spread slowly and they may unite forming a larger white patch. In all other respects the skin appears normal. The hair on the white spots may or may not become white. The spots may occur in either the young or old and usually last throughout life, though a few cases undergo a spontaneous restoration of normal color.
Etiology: The cause is unknown. It is supposed to be due to altered local nerve supply, which would, in turn, be due to toxemia.
Care of the Patient: There is nothing to do except build up the general health. We have had one case to make some improvement during eight weeks under our care for arthritis.
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SCLERODERMA (Hard Skin)
Definition: A hardness or harshness of the skin. The skin is rigid, pigmented and wasted, either in spots or fairly generally.
Symptoms: The condition may develop quite suddenly or may develop slowly over months or years. It may be preceded or accompanied by abnormal sensations in the skin. In time, the skin grows tense, hard and fixed to the underlying structures (hidebound) so that it cannot be pinched up. It feels like wood, or leather or frozen skin. Yellowish or brownish discolorations usually appear. The skin is very smooth and dry and often shiny. The joints may be rendered more or less immovable.
Circumscribed Scleroderma (called generally morphea, or Addison’s keloid) is also a skin atrophy. It presents limited, rounded, ivory-like patches of various sizes, surrounded by hyperemic or pigmented borders. The patches are firm but not hard.
Scleroderma Neonatorum (scleroderma of the newborn) is a rare affection that develops shortly after birth, rarely as late as the sixth month. Beginning in the lower limbs it spreads rapidly over the trunk, arms, and face, giving the infant the appearance of being frozen. It develops chiefly in premature infants, but is occasionally seen in full-term babies and those whose skin circulation is faulty.
White-Spot “Disease” is a hardening of the skin characterized by a few or many pea-sized or larger chalk-white patches on the chest, neck and back. The patches are often atrophied.
Care of the Patient: Remove all causes of ill health and build up the general health.
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XERODERMA PIGMENTOSUM
Definition: This is a skin atrophy usually appearing in the first or second year after birth and slowly progressing to death; also known as atrophoderma pigmentosum.
Symptoms: Freckle-like spots first appear on the face and hands. Later these atrophy and become depressed. Dilatation of minute skin blood vessels follows and then diffuse atrophy. After a few years, wart-like growths develop on the pigmented areas and these develop into tumors. In these cases the skin is very sensitive to the actinic rays of the sun which affect it somewhat as do X-ray burns.
Etiology: The condition is thought to be due to some nerve impairment, “probably some congenital predisposition.” This is not cause. Cause must reside in metabolic perversion from wrong life.
Care of the Patient: The condition runs a chronic course and there should be ample time for a revolution in the mode of care, particularly of feeding, to produce improvement if not complete recovery. A fruit and vegetable diet should be religiously adhered to. Sun-baths should not be employed until the skin has lost at least a large part of its sensitiveness.
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ATROPHIC DERMATITIS
Definition: This is a diffuse or localized atrophy of the skin, involving the hair and nails, affecting chiefly the extremities and face. It is often seen following upon the heels of dermatitis and chronic external irritation of the skin.
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HYPERTROPHIES OF THE SKIN
Hyperthrophy is an abnormal increase in the size of an organ or part due to an increase in size of its cells. Hyperplasia is an increase in size resulting from an increase in the number of cells. These usually appear together. There are several hypertrophies of the skin.
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CALLOSITY (Callous)
Definition: This is a hardened, thickened, horny condition of a local area of skin composed of an overgrowth of the corneous layer of the epidermis produced by friction or intermittent pressure, and appearing largely on the feet, hands, fingers and toes. They develop as protective devices. They disappear spontaneously when pressure and friction are removed or avoided.
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CLAVUS (Corn)
Definition: This is a small callous or thickening of the outer skin, generally resulting from the friction of ill-fitting shoes, developing usually on the toes, over bony prominences, occasionally upon the soles, fingers and palms.
Symptoms: Two varieties are recognized as follow:
Hard corns usually develop over the joints of toes. These are hard, painful elevations.
Soft corns usually develop between the toes, where they become softened by the moisture of perspiration and insufficient drying after bathing.
Etiology: Intermittent pressure causes both forms of corns to develop.
Care of the Patient: Full correction requires the removal of cause and correct fitting of shoes. They will disappear in a short time without further attention when cause is removed. Cutting corns and treating them with corn removers is of no value.
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CORNU CUTANEUM (Horny skin)
Definition: A cutaneous horn or horny formation on the skin due to hypertrophy of the epidermis.
Symptoms: These horn-like growths form most often on the face, scalp and penis — usually in old age. They are conical, tapering, usually curved or straight projections, which are generally over half an inch in length, but have been known to reach a foot in length. Pain is present only upon injury.
Etiology: This is unknown.
Care of the Patient: The usual treatment is surgical removal followed by cautery. This does nothing to remove the metabolic perversion that must be back of the growth.
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KERATOSIS
Definition: The term means any affection of the epidermal layer of the skin, but is particularly applied to localized overgrowths of the horny layer. Three chief forms are described as follow:
Contagious Follicular Keratosis is seen generally in childhood, but may develop in adults. Several members of the same family may be affected at the same time thus giving rise to the belief that it is “contagious.” It begins as small, black points that spread from the elbows and knees practically over the whole body. Papules develop around the black points and often become inflamed.
Follicular Keratosis is a rare hypertrophic affection of the oil glands at the roots of the hair. Small, dark papules embedded in the follicles, often crowned with horny projections, which, when removed, leave pits. They are most common on the scalp, face, chest, loins and inguinal region, chiefly of men. The condition is chronic and progressive. The general health is said “not to be disturbed,” though there may be annoying subjective symptoms.
Keratosis Pilaris (lichen pilaris) is keratosis of the hair follicles and presents the development of small papules due to hypertrophy of the outer skin at the mouth of the hair follicles. Developing as dirty-gray, pin-head elevations, each pierced by a hair, usually upon the extensor surfaces of the arms and legs; they have the appearance of “goose flesh” in mild cases and feel like a nutmeg grater to the touch. There is little or no itching. Most people develop the affection in some degree.
Etiology: Toxemia and a lack of cleanliness seem to account for these conditions.
Care of the Patient: Adequate bathing and good general hygiene should result in speedy disappearance of all forms of keratosis.
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NEVUS PIGMENTOSA (Mole)
Definition: This is a pigmented, raised spot in the skin. It is sometimes covered with hair. The term nevus means “birthmark” as they are often congenital. The term birthmark means more than moles.
Symptoms: They vary from the size of a pin head to as large as a hand, or larger and are usually found on the face, neck and trunk. The color ranges from yellow to black and there may be one or many. They are given descriptive names as follow:
Nevus lipomatsus is a mole composed largely of fat and connective tissue. Nevus maternus is a congenital birthmark. Nevus pilosus is a mole covered with hair. Nevus spilus is a smooth mole. Nevus verrucosus is a wart-like mole.
Etiology: Moles are usually congenital and their causes are unknown.
Care of the Patient: They may be removed by the use of a blue lens which concentrates the infra-red rays of the sun upon the mole. One to a few applications are enough to remove them without leaving a scar. This should be done by one who knows how to use the lens.
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KELOID (Kelis)
Definition: A new growth of connective tissue of the corium of the skin and resembling a crab, hence its name. It is also called cheloid and Alibert’s keloid.
Symptoms: It commences as a pea-sized nodule which slowly enlarges and extends claw-like processes. It may reach the size of a hand. They are firm, elastic, sharply defined, slightly elevated, firmly implanted in the skin and are shining, pinkish or reddish in color. They develop most often on the back and chest. After removal they usually return often developing faster than before.
Etiology: Some keloids follow injury, but are not due to injury alone. So-called spontaneous keloid is said to “develop upon a normal skin” and is “of obscure origin.” Irritation and toxemia and an abnormal skin is the more likely explanation. False keloid (cicatrical or scar keloid) develops at the site of cuts, burns, wounds, bites, skin lesions, etc. The scars are not sufficient to account for their growth. Toxemia is the more likely explanation. The Negro race seems to be particularly susceptible to keloid growths. Certain families are said to be predisposed.
Care of the Patient: This must be constitutional and should start with a fast. Spontaneous shrinkage and return of the skin to normal is frequent enough to show that when metabolism is normalized the growth will be absorbed.
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ICHTHYOSIS (Xeroderma)
Definition: A chronic, congenital affection of the skin characterized by roughness, dryness and scaliness, with hypertrophy of the papillae. If the ichthyosis is extreme with marked hypertrophy of the papillae it is called ichthyosis hystrix. Its common name is Fish-Skin “disease.”
Symptoms: The skin is dry amid harsh; its surface is covered with adherent polygonal scales and the papillae are more or less hyper-trophied. The usual location is on the extensor surfaces of the extremities. It usually manifests in early childhood.
Etiology: Under this heading we are told “it is often hereditary,” but no cause is given. It is our belief that it is due to toxemia.
Prognosis: “The disease is incurable (so is all so-called “disease”), but the patient can be rendered comfortable by appropriate treatment. (=medical verdict)” The condition will get well if its cause is removed.
Care of the Patient: Improved nutrition following a period of disintoxication and proper use of sunbaths will restore these conditions to health.
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VERRUCA (Warts)
Definition: These are clearly defined papillary outgrowths on the skin, due to overgrowth of the papillae and true skin. They are painless.
Symptoms: Warts appear chiefly in childhood. Several forms are described as follow:
Verruca digitata are finger-like warts that develop on the scalp. They are elevated with several slender projections reaching out from their bases.
Verruca acuminata, or venereal warts, are groups of soft red vascular growths developing upon the skin and mucous membranes of the mouth, anus, penis, and labia in young people. They often grow rapidly and may resemble a raspberry or cockscomb. Those on the sex organs are covered with an offensive pus-like secretion. (See affections of the sex organs.)
Verruca filiformis (slender warts) are slender, thread-like outgrowths developing upon soft parts, chiefly upon the neck, face and eyelids.
Verruca plana or flat warts are well-defined flat elevations, pigmented brown or black, developing usually upon the backs of old people. This type is said to occasionally become cancerous as a result of irritation by injury or caustics for removal.
Verruca vulgaris, or common warts, are commonly found on the fingers and backs of the hands of children. They are irregular, round, firm and elevated.
Etiology: Their cause is unknown.
Care of the Patient: They tend to disappear when nutrition is normalized. If they do not, the blue lens may be employed.
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NEUROSES OF THE SKIN
Definition: These are affections of the nerves of the skin and are almost always symptomatic of affections elsewhere in the body, particularly are they symptomatic of nervous affections. Chief among these are anesthesia, analgesia, causalgia, dermatalgia, hemianesthesia, hyperesthesia, paranesthesia, paresthesia, thermoanesthesia, and zonesthesia. They are symptoms, not affections, and disappear when the causes of the primary pathology (the nervous affection) are removed.
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HYSTERICAL DERMATOSES
Definition: These are affections of the skin produced by emotional or nervous over-irritation.
Symptoms: Among the most common hysterical dermatoses are acne, hives, dermographia, erythemia, psoriasis, and black-and-blue spots. They present the symptoms described elsewhere for these affections.
Etiology: Hysteria combined with a very unstable vaso-motor control and nutritional impairment and, in case of very sensitive skins, external irritants, produce these conditions.
Care of the Patient: Hysterical dermatoses develop quickly and many of them disappear quickly when the emotional causes are corrected. We have seen very severe cases clear up in twenty-four hours when the patient’s mind was put at rest and the body relaxed.
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NERVOUS ITCH
Definition: This is an itch that comes on during periods of quiet.
Symptoms: Any part of the body — scalp, face, extremities, back, chest, or even the whole body — may be affected. The itch comes on in the theatre, church, parlor, office, while sewing, or when quiet. It is often impossible for some people to remain long at any pleasure or duty that requires quiet without developing itch.
Etiology: Lack of sleep, mental, emotional or physical stress, sexual excesses, lack of exercise, insufficient bathing, overeating, intestinal toxemia, etc., are the chief causes.
Care of the Patient: Remove the cause. Secure more rest; poise the mind, cease the excesses, keep the body clean and eliminate toxemia.
AFFECTIONS OF THE OIL DUCTS
ASTEATITIS
Definition: This is a symptomatic affection of the oil glands.
Symptoms: There is a diminution or total absence of the oil, resulting in a dry, harsh, and frequently scaling skin. It frequently accompanies psoriasis, scleroderma, prurigo, ichthyosis, and leprosy.
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COMEDONES (Blackheads)
Definition: These are plugs of oil or sebum which form in the oil ducts of the skin. There is usually an overgrowth of the lining membrane of the ducts, and added to the plug may be scales from this membrane. It. is sometimes called a “flesh worm.”
Symptoms: Blackheads are occasionally seen in children, even in babies, and in later life, but are most common in puberty and young adults. They may be either slightly elevated or slightly depressed, and are yellowish, bluish, brown or black in color. The nose, cheeks, and forehead are their most common locations. They are sometimes seen in the temples, ears, neck, back and chest, or wherever oil glands are present. They may be single, or with a “head” attached to two or more plugs; may be few or numerous; and upon pressure, exude a slender body, colored at its outer end, its body yellowish or white, its lower end white and soft.
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CRUSTA LACTEA (Milk crust)
Definition: This is seborrhea of the scalp in infants — an abnormal secretion of the oil glands in the face and scalp.
Symptoms: Though sometimes developing soon after birth, it most frequently develops during dentition. It consists of irregular groups of little pustules on the face and scalp, which discharge a viscid and yellowish or greenish fluid. At times, there is intense itching.
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MILIUM (Grutum)
Definition: A functional affection of the oil glands.
Symptoms: It presents small, round, yellowish, or pearl-white, non-inflamed elevations in the skin. They appear chiefly on the face and their contents cannot be squeezed out until an opening is made. In this, they differ from blackheads with which they are frequently associated. They often develop under scars. The elevations are about the size of millet seed, hence the name. They feel gritty to the touch, hence the name grutum (grit).
Etiology: They result from the retention and hardening of the oil secretion in the ducts of the oil glands, the outlets of which have become closed.
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SEBORRHEA
Definition: This is an increase, decrease, or alteration in the secretion of the oil ducts of the skin. Two forms are described:
Seborrhea Oleosa is an excessive oiliness of the skin, which is usually seen upon the face, particularly the forehead, cheeks, and nose. The duct mouths are enlarged and often the superficial blood vessels also. The settling dust causes the face to appear dirty and begrimed.
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SEBORRHEA SICCA (Dandruff)
Definition: An excessive scaling of the skin, particularly of the scalp, as a result of a decrease or absence of skin oil. The condition is seen largely in older people, but occasionally it is seen on the head and eyebrows of babies. In adults it may also develop on the hairless surfaces. The scales are yellowish or grayish. Often dandruff and falling hair are associated symptoms. When on the scalp it is frequently associated with falling hair, though there may be considerable dandruff with loss of hair.
AFFECTIONS OF THE OIL DUCTS
Care of the Patient: Locally, cleanliness is all that is required.
Constitutionally, toxemia and its causes must be removed. A healthy skin is not troubled with any of these functional short-comings or excesses. Cleanliness will both prevent and remedy milium in infants. In adults, cleanliness will prevent it, but the whiteheads may require puncturing and squeezing out if they have been allowed to form.
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AFFECTIONS OF THE SWEAT GLANDS
ANIDROSIS
Definition: This is a deficiency of sweat.
It is a symptom and is seen in fevers, diabetes, certain skin affections, and in cases of lowered nerve tone.
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BROMIDROSIS (Osmidrosis)
Definition: A functional affection of the sweat glands characterized by the secretion of sweat of an offensive odor.
Symptoms: An offensive odor, chiefly of the feet and in the axillae, and often associated with excessive sweating are the, characteristic symptoms.
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CHROMIDROSIS
Definition: A functional affection characterized by the secretion of colored sweat.
Symptoms: The sweat is most commonly red or yellow. The face and trunk are most frequently affected. It is often associated with excess sweating.
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HEMATIDROSIS
Definition: This is bloody sweating occurring usually in young hysterical women, upon the hands, feet, face, ears, and umbilicus, due to hemorrhage into the sweat pores.
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HYDROCYSTOMA
Definition: This is the development upon the face and neck of discrete firm vesicles, due to obstruction of the sweat glands. The ducts become dilated. It is seen most often in washer-women, appears in summer and disappears in winter
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HYPERIDROSIS
Definition: Excessive sweating.
Symptoms: Excessive sweating is the primary symptom. Prickly heat, eczema or intertrigo often ensue in its wake. Local hyperidrosis is most frequently seen in the hands, feet and axillae. Unilateral sweating of the face is sometimes seen.
Etiology: Marked debility, tuberculosis, affections of the sympathetic nervous system and aneurysm are given as causes. These are effects — effects of enervation and toxemia. Overeating, too much fluid intake, the use of tea, coffee, fat and alcoholics lead to excessive sweating.
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SUDAMEN
Definition: An affection of the skin characterized by the eruption of minute vesicles, resulting from the retention of sweat in the upper layers of the skin.
Symptoms: Minute, irregular, translucent vesicles appear on the skin. They are not surrounded by an area of inflammation and do not rupture, but dry up and are followed by slight desquamation.
Etiology: It is often seen in healthy persons who sweat profusely and is seen in febrile crises, like pneumonia and typhoid, that are associated with sweating.
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URIDROSIS
Definition: This is sweating of urinary constituents, seen in suppression of the urine, as in nephritis, cholera, and certain nervous affections.
AFFECTIONS OF THE SWEAT GLANDS
Care of the Patient: All of these affections of the sweat glands are to be cared for alike. The remedy is: remove the cause. The underlying systemic impairment should be removed by freeing the body of toxemia and reforming the mode of living, particularly the mode of eating. Cut out excessive water drinking, stop the use of tea, coffee, alcoholics, cease the excessive use of fats, abandon overeating and stop the use of stimulants. Normal nerve energy will soon end these troubles. Locally, cleanliness is the only need.
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AFFECTIONS OF THE HAIR
ALOPECIA (Baldness)
Definition: This is partial or complete loss of hair and is also known as calvities. In rare cases all the hair on the body is lost.
Symptoms: Partial or complete baldness is the rule in the aged. The hair begins to thin at the brow or crown and progressing from these points, the head or much of it loses all of its hair. In congenital cases, baldness is usually only partial.
Etiology: No cause for congenital baldness is known. Baldness in “old age” is considered normal and is probably as normal as toothlessness in old age. It is considered to result from changes “due to senility” or some degree of atrophy of the scalp and hair follicles. Senility and atrophy are due to chronic toxemia. Hair is often lost in anemia, diabetes, chronic intoxications and various affections, as well as in seborrhea, psoriasis, folliculitis, and ringworm of the scalp. These things account for but few cases of baldness. Hair is often lost rapidly during or immediately after fever. The fact is that the cause of most cases of baldness is still unknown.
Care of the Patient: Once bald-headed, always baldheaded is the rule. I have seen one case of spontaneous regrowth of hair on the head of an aged man who had been baldheaded for, more than twenty years. Hair lost during or immediately after a serious acute affection like typhoid, usually (though not always) grows back immediately after normal health is restored. There is no way to restore lost hair and no known way to prevent its loss, once it begins to fall out. Better health and better nutrition should help.
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ALOPECIA AREATA
Definition: This is localized areas of baldness without skin lesions.
Symptoms: Usually appearing in early adult life, it is usually confined to the scalp, but may develop in the eyebrows, eyelashes, beard, or other hairy parts of the body. The patches appear suddenly or gradually.
Etiology: This is unknown. Parasites and neurosis are often blamed.
Care of the Patient: If the condition develops in children, these usually recover after a variable time — months to years — ; but in adults recovery is rare. Build up the general health.
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CANITIES (Gray hair)
Definition: This is a skin atrophy resulting immediately from loss of pigment in the hair.
Symptoms: Though considered normal in advanced life (canities senilis), premature graying may occur even in adolescence. Albinism is a congenital form.
The hair may become gray in spots or patches, or it may involve all the hair of the head or body, and the loss of color may be partial or complete.
Etiology: The loss of hair pigment usually takes place slowly, though in some instances, its loss is comparatively rapid. Enervation and poisoning of the pigment secreting glands is the probable cause of graying.
Prognosis: Once developed it usually remains, though occasional cases are recorded. Where the hair returned to its original color or to some other dark color. The existence of such cases, though rare, points to the possibility that someday, a way may be found to restore normal color to gray hair.
Care of the Patient: There is nothing to do except adopt a wholesome mode of living and stick to it.
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AFFECTIONS OF THE NAILS
Like the hair, nails are outgrowths or appendages of the skin. Hard as they are, they are liable to affections of the nail-bed and matrix. These arise from the same toxic states and nutritive deficiencies that produce trouble elsewhere in the body.
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ATROPHY OF THE NAILS
Atrophia unguis, as this is called, may be either congenital or acquired. In the congenital form the nail may be defective or distorted or absent from birth. In the acquired form, which is more common, the nails become thin, narrowed, furrowed, crumbly and distorted and lose their transparency. The condition is symptomatic of constitutional impairment and is seen in prolonged fevers, psoriasis, eczema and ringworm.
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LEUCONYCHIA
Definition: This is white-spotted nails (leucopthia unguium).
Symptoms: White areas on the nails are very common and are often the occasion for much mental distress. Rarely are the spots general. They are thought to be due to interference with the normal process of change to a horny substance, caused by injury, defective nutrition and illness. Slight injury to the nail-bed, and, especially, to the matrix, as in manicuring, causes them to appear. The spots cannot be removed and care should be exercised to avoid the injury.
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ONYCHIA
Definition: This is inflammation of the matrix (paronychia) and may be either acute or chronic. It may affect one or several nails.
Acute onychia follows contusion of the nail, where the matrix is bruised. It is very painful and if the matrix is seriously damaged, may result in shedding of the nail.
Chronic onychia is a low-grade inflammation developing in those who are forced to keep their bands more or less constantly in water. It may also be seen in certain types of malnutrition. One or several fingers may be involved. There is slight redness, swelling, little pain, no pus, and, if allowed to continue, deformity of the nails.
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ONYCHORRHEXIS
Definition: This is splitting of the nails and is usually due to defective local or general nutrition, or to constant use of the bands in water.
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ONYCHAUXIS
Definition: This is hypertrophy of the nails (hyperonychia).
Symptoms: There is enlargement of the nail, either in length, breadth or thickness, or any combination of these. The nails of the big toes are especially liable to hypertrophy and marked darkening.
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PANARIS
Definition: This is commonly called whitlow or felon and is applied to inflammation of the bone or bone covering, but is also correctly applied to inflammation of structures about the nail (paronychia) which is usually associated with inflammation of the matrix. It is common in washerwomen and scrubwomen, in diabetes, arsenic poisoning, glossy skin, leprosy, Reynaud’s “disease,” and other affections. Acute inflammation, redness, swelling and agonizing, throbbing pain are the symptoms. Pus forms and burrows around under the nail, which becomes thickened and discolored and is, finally, shed. The new nail may be normal but frequently is deformed.
AFFECTIONS OF THE NAILS
Care of the Patient: Remove all causes of impaired health and protect the nails from further injury.
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SKIN AFFECTIONS CAUSED BY OUTSIDE AGENTS
ARGYRIA
Definition: A bluish-gray or slate-gray discoloration of the skin and deep tissues resulting from chronic silver poisoning and most pronounced in the exposed parts. The condition is less common now than in the days when silver was administered in nervous “diseases.” The discoloration first shows up in the gums which are discolored and swollen. The discoloration is permanent.
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CHAPPED SKIN
Definition: A cracked and roughened skin.
Symptoms: The skin becomes dry, rough, broken and painful. Some of the cracks or fissures are quite deep and bleeding often occurs. Washing tends to aggravate the trouble.
Cracking of the lips is frequently a source of much annoyance, pain and bleeding. In many cases the crack lasts throughout the winter months. The crack may be in the middle, on one side, or at the corner of the lips. Often the fissure is deep and stretching the lips tends to tear it and prevent healing. There may be no scar but sometimes a well-marked scar develops.
Etiology: Exposure to cold air and wind, especially without careful drying of the skin after bathing, soap, and the overuse of hot water are the most common external causes. Vigorous skin health prevents chapping under all ordinary conditions. Soap and hot water rob the skin of its oil and leaves it dry. Some people are troubled as much by chapping in winter as others are by sunburn in summer. It is most common in those having delicate skins and is seen most often on the hands, cheeks and lips.
Care of the Patient: Cut out the use of soap. Use few hot baths, keep the affected parts out of water as much as possible. Thoroughly dry the body, face and hands after bathing and washing. Protect the chapped portions from wind. But, most of all, build up the general health with better diet and hygiene; in the case of the lips, avoid stretching the lips so that the crack may heal.
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ECCYMOSIS (Black-eye)
Definition: This term is applied not only to black-eye but to other purplish or black-and-blue patches in the skin, due to changes in the blood that has passed from the blood-vessels into the skin. Most cases are due to blows; but the condition is seen in whooping cough in children and chronic bronchitis in adults. It may also occur in arterial degeneration.
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FROSTBITE
Definition: A local inflammation of the skin and deeper structures resulting from prolonged exposure to great cold.
Symptoms: There are three degrees of frost-bite as follow:
First degree: This is a mere redness or erythema.
Second degree: This presents much swelling and lividity with the formation of blisters and ulceration. Usually the surrounding tissues are considerably inflamed.
Third degree: This presents pallor of the parts, which lose their sense of feeling, though there may often be intense pain in the parts above the frostbite. The frozen parts becomes cold, swollen and puffy, then discolored and shriveled, with the formation of the typical line of separation between gangrenous and non-gangrenous tissue produced by a protective inflammatory wall.
The fingers, being small, and far from the circulatory centers, are the parts most often frostbitten, except the ears and nose. The feet are also frequent sites of frostbite.
Etiology: Poor circulation, with poor tone of the blood vessels predisposes the individual to frostbite. Alcoholism also renders one more liable to its development. Exposure to cold produces frostbite in a susceptible individual.
Care of the Patient: Sudden application of warmth causes much pain and severe inflammation. The parts are best rubbed with snow or cold water in a cold room. The temperature of the room should be slowly increased. When warmth has returned to the parts, they may be wrapped in flannel to keep them warm, but no heat should be applied. The blisters need not be evacuated, although evacuation probably produces no harm.
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INTERTRIGO (chafing)
Definition: This is a hyperemia of the skin caused by friction of surfaces that rub one upon the other. It is especially common in children and fat, people. Lack of cleanliness, friction, the fat-“disease” (sweating, in the folds of babies suffering with fat-bloat), perspiration and friction, as under hanging breasts, between the upper parts of the thighs, and around the sexual organs, frequently produce chafing. Diffuse redness, a sensation of heat, irritation and usually, some degree of moisture are the common symptoms. If the cause continues, a definite dermatitis results.
Care of the Patient: Cleanliness and dryness are the immediate needs. Reduction in weight is essential in most cases.
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MILIARIA (Prickly heat)
Definition: This is an acute inflammation of the sweat glands accompanied by prickling, tingling and burning of an aggravated character. It is also known as miliaria rubra, and miliaria alba.
Symptoms: It is common in hot weather and is seen most often in fat adults who perspire freely. It disappears when the weather becomes cool. There is a fine, burning, itching eruption. Overclothing, flannel clothing, tight clothing, over-eating, bottle-feeding of infants, and any health-impairing influence may induce the condition.
Care of the Patient: Cleanliness and less fluid soon remedy the trouble. Fatty foods, coffee, tea, beer, etc., should be specially avoided.
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PERNIO (Chilblain)
Definition: A chronic skin inflammation and swelling resulting from frost-bite.
Symptoms: Chilblain is seen in various grades ranging from a mere transient redness to a deep destruction of tissues. The usual case presents redness, swelling, itching and intense burning, the parts being shiny and cold to the touch. Vesicles and deep ulceration may occur in the worst cases. The fingers and toes may develop a sausage-like appearance. Exposure to artificial heat causes intense stinging and burning or itching. The extremities — fingers and toes — and the ears and nose are the parts commonly affected.
Etiology: Chilblain is due to exposure to cold and damp. A sudden change from a low to a high temperature seems to be the chief cause. Anemic individuals and those with poor circulation are most likely to suffer.
Care of the Patient: Prevention. Care for as instructed under frost-bite.
Remedy: Keep the feet dry and gradually innure them to cold. Vigorous use of the feet, as in walking and running, will build up the circulation in them and gradually overcome the tendency to frost-bite.
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SUNBURN
This is a very common skin affection during the summer months, practically all people have experienced some degree of it at one time or another in their lives.
Undue exposure to the sun’s rays, especially before preparatory graded exposure has built up a protective tan, results in sun-burn. Burning is easiest in blondes and red heads, and in the mountains or in water where the rays are stronger.
Various degrees of burn occur. A moderate redness of the skin is a normal, healthy reaction and produces no harm. Beyond this there may be severe skin inflammation, with swelling and large blister formations, accompanied by high fever. In all degrees there later follows shedding of the skin, sometimes in large sheets.
Gradual exposure prevents sunburn.
Care of the Patient: Cold cream, sweet, unsalted butter and other things are smeared on the skin. These palliate the discomfort but do no good. The main thing is to stay out of the sun until the skin is healed.
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NEOPLASMS OF THE SKIN
Definition: The term neoplasm means new growth and is applied to tumors, cancers, cysts, etc., of which several may develop on the skin in almost any location.
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EPITHELIOMA
Definition: This is skin cancer. There are a few varieties of epithelial cancer or carcinoma as follow: Deep-seated Epithelioma; Papillary Epithelioma; and Superficial Epithelioma(rodent ulcer). See Cancer and Tumors.
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CYSTS
Definition: These are usually sacs in the skin formed by the closing up of the hair follicles and oil glands or their ducts, due to retention of the oil. Small, millet-seed sized, white cysts of the sweat glands are common. The larval stage of the hog-tape-worm may result in the formation of a skin cyst.
Symptoms: These are painless, non-inflammatory enlargements, filled with fluid.
Etiology: Dermoid cysts are comparatively rare and are congenital cysts sometimes having in them hair or other skin elements or appendages. Larval cysts result from the encapsulation of the larval tapeworm received from pork. Other cysts are probably due to inflammatory obstruction of a follicle or duct.
Care of the Patient: It is usually best to open the cyst and destroy its sac. They may often be absorbed by fasting.
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FATTY TUMOR (lipoma)
Definition: This is a non-malignant tumor composed of fat cells bound together by delicate fibrous or connective tissue. One or more may be present. See Tumors.
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FIBROMA
This is a connective tissue growth situated in the true skin and subcutaneous tissues. A fibroma may be soft or firm and may range in size from that of a split-pea to that of an egg. They often become pendulous, in which case there may be ulceration. See Tumors.
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STEATOMA (Wen)
Definition: This is a sac composed of a distended oil gland or duct, filled with the oily matter from the gland.
Symptoms: Wens are painless, round or oval elevations ranging from the size of a pea to as large as an egg. They occur most often on the scalp, but also on the face, neck and back. They may remain stationary for years, or may grow slowly, or undergo inflammation and suppuration.
Care of the Patient: They should be evacuated and the sac removed. If the envelope is not removed the cyst re-forms. The frequent advice to break them is not sound.
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PARASITIC SKIN AFFECTIONS
In discussing skin affections due to parasites we shall devote no space to mere bites like those of the bed bug, gadfly, or other flies, chigger, mosquito, tick, flea, etc., and stings like those of the browntail moth (caterpillar dermatitis) or the ant, etc. These things are evanescent and require no attention.
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BOTFLY
This fly deposits its eggs in the skin, where a painful boil-like swelling results, which may suppurate. The larvae are usually expelled with the pus; after which one only needs to await healing. The botfly is common in the tropics.
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ERYTHRASMA
Definition: A rare skin affection caused by a vegetable fungus, the microsporon.
Symptoms: It appears as small, round or irregular, well-defined, slightly bran-like patches which are reddish brown in color. These develop usually in the arm pits and groins and between the hips and thighs in the rear. They are accompanied by intense itching, are slowly progressive, and may last for years.
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GROUND ITCH
Definition: This is a vesicular dermatitis seen among barefoot workers in India, and other tropical and subtropical parts of Asia, and, less frequently, in America.
Symptoms: It is characterized by swelling and itching preceding the eruption which is first papular or macular and later becomes vesicular. It affects, almost entirely, the feet.
Etiology: It is considered to be the result of the entrance of a type of hookworm into the skin.
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HARVEST MITE
This little mite, also called mower’s mite, harvest tick, and red bug, is the larval state of certain ticks found upon grasses and bushes during the summer and autumn. It is brick-red or yellowish in color. They get onto the legs and thighs where they either burrow beneath the skin or burrow their heads into the openings of hair follicles, causing intense itching. Their removal ends the discomfort, as they are not poisonous.
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PEDICULOSIS (Lousiness)
Definition: This is infestation by lice, pediculi: it is also called phthiriasis. Three varieties are described.
Pediculosis capitis (head-lice) is the presence, on the scalp, of head lice, or their ova or “nits.” They cause severe itching which leads to scratching, and this causes the formation of excoriations, with either serous, purulent or bloody discharge. The exudate dries into crusts and mats the hair together. A foul odor usually accompanies. Irritation often causes the glands in the back of the neck to enlarge and sometimes to suppurate. More often this occurs on the back part of the head. Frequently there are papules, pustules and excoriations scattered about the face and neck.
Pediculosis corporis (body lice) is lice on the body. These are larger than head lice. They hide in the seams of the underclothing and deposit their eggs where they hatch in about 6 days. The louse gets out upon the skin only when searching for food. Crawling upon the skin, it causes intense itching which results in scratching, making lines or marks (excoriations), blood crusts, and, in chronic cases, pigmentation and thickening of the skin. The shoulders, chest, waist and thighs are most affected.
Pediculosis pubis (crab lice or pubic lice) is lice in the hairs of the genital region. These are the smallest of the lice. These lice fasten themselves to the hair of the pubic region, where they cling tenaciously while burying their heads deeply in the orifices of their follicles. The pubes and perineum are usually involved. Occasionally the armpits and the hairy region of the chest, and even the eyebrows, eyelashes, and beard are involved. Itching is intense and is accompanied by hemorrhagic punctures, papules, and scratches about the affected parts.
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PORK MEASLES
Definition: This is the larva of the taenia (pork tape-worm).
Symptoms: They usually find their way into the skin of the trunk and limbs where they may remain unchanged for years. They cause tumor-like lesions, which are rounded, firm, and elastic, ranging in size from a pea to a walnut.
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RINGWORM
Definition: This is a common skin affection caused by the presence in the skin of a vegetable parasite called tinea trichophytina. There are six varieties.
Tinea circinata is ringworm of the body. It begins as one or more rounded or irregular pea-sized hyperemic scaly patches. These form into a circle in a few days with very small papules or vesicles around the outside. The patches heal in the center as they spread from their outer borders. Adjacent patches may coalesce, producing ring-shaped patches of skin that overlap or fold over each other. They are pink or red in color, with slightly elevated borders and, upon scaling, give off bran-like flakes. Itching is usually slight.
Tinea circinata cruris is ringworm of the thighs. This begins and develops as does tinea circinata.
Tinea Cruris (eczematoid ringworm) is so-called washerwoman’s itch. It is very common and resembles intertrigo. There are macular, vesicular, papular, scaling, macerated (soft from cooking) and callous (like keratosis) types. It is common for several forms to develop in the same individual. The thigh, pubes, (around but not in the hairy region), the penis, labia, scrotum, perineum, arms, and the cleft between the buttocks as far up as the sacrum are common locations for the vesicular type. Extreme itching may be present around the labia, anus, and buttocks. The macular form is especially likely to develop under hanging breasts, between the toes, between the penis and scrotum, and between the buttocks. The feet is the location of the callous type.
Tinea trichophytina unguium is ringworm of the nails. Ring-worms form under the nails.
Tinea tonsuraus is ringworm of the scalp. This begins as does tinea circinata and may occur anywhere upon the hairy scalp, often producing partial baldness.
Tinea sycosis is ringworm of the beard or barber’s itch and was discussed elsewhere.
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SCABIES (Itch)
Definition: This is the well-known “seven-year itch.” It is an itching of the skin due to the itch mite, sarcoptes scabiei.
Symptoms: Small papules, vesicles or pustules form at points where the mite enters the skin. Slightly dark elevations of the skin show along the course of the burrow, which varies in length from one-eighth to one-half of an inch. Well marked cases also present various forms of eruptions — papules, vesicles, pustules, crusts, excoriations (raw areas from scratching), and thickening of the skin. In extreme cases the skin may look like the bark of a tree. There is intense itching which is worse at night or when warm. Much inflammation may develop in children with sensitive skins.
The affection commonly starts between the fingers or toes from where it rapidly spreads, often reaching advanced stages in a week or two. The front surfaces of the wrists, the flexor surfaces of the extremities, the armpits, the breasts of women, the navel, buttocks and penis, are other common locations.
Etiology: Scabies may be acquired at any age and is transferred by direct contact, or by bed clothes, towels, toilet seats, etc. It is common among people who live in filth.
The mite is a yellowish-white parasite, barely visible to the unaided eye; the female being twice the size of the male. The mite burrows beneath the skin and then burrows, either in a straight or zigzag line in the skin. Along the course of these burrows she deposits her eggs and excreta. She perishes but the eggs hatch in eight to ten days and the new mites make burrows of their own in which they also deposit eggs and waste. The new crop matures and repeats the process and in this way the affection spreads.
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STRAW ITCH
Definition: This is a skin eruption produced by a minute animal parasite, a mite that is received from cereal or straw.
Symptoms: Mild systemic symptoms sometimes precede the eruption. These are general restlessness, loss of appetite, slight fever, and sometimes vomiting. The eruption occurs chiefly as wheels, many of which are crowned by a central vesicle from the size of a pin point to considerably larger. Frequently the eruption consists of barely raised, red, hive-like macules or edematous papules. These quickly become pustular and closely resemble the vesicles of chickenpox. The eruption is of rose tint, usually profuse, covering the trunk and lower limbs, but varying in extent. Rarely a few eruptions develop on the face, seldom on the hands and feet. There is intense itching.
Etiology: Straw-itch develops in the United States usually between May and October, in farmers, harvest hands, laborers, etc., who come in contact with the mite in the grain field, granary or store house, in stacking, baling, or otherwise handling the straw. Shippers, porters and others who carry the grain in sacks; those who use straw in packing, by contact with the straw; and those who sleep on straw bedding. Some of the most severe cases have developed in those who sleep on straw mattresses. The mite lives upon the larvae of grain-destroying insects.
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TINEA FAVOSA (Favus)
Definition: This is a skin affection largely confined to the scalp, caused by the presence of a vegetable parasite; occasionally found on non-hairy sections of the body and the nails, causing these to become thickened, brittle, yellow and opaque.
Symptoms: There is diffuse or confined superficial inflammation, with scaling, around the hair follicles. This is soon followed by the formation of yellowish crusts about the size of pin-heads. The crusts increase to the size of peas, are sulphur yellow color, pierced by a hair, and become cup-shaped. When removed from the scalp a shining, reddened, cup-shaped and atrophied excavation, which is often in a state of suppuration, is revealed. When the excavation heals it leaves a scar and results in more or less permanent baldness. The crusts may be scattered or may run together forming irregularly horny-comb-like patches. They give off a peculiar odor resembling that of a mouse or damp straw. The hair loses its lustre, becomes dry and brittle and tends to split or break off or to fall out. Itching of varying intensity is usually present.
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TINEA VERSICOLOR (Chromophytosis)
Definition: This is “Liver spots” and is closely allied with ringworm but is not a true ringworm. It is due to a vegetable parasite.
Symptoms: Though usually found on the trunk, in rare cases it may develop on the neck, arm, armpit and face. It begins as yellowish, pin-head to pea-sized macules which are scattered over the affected sections. Within a few weeks or months these increase in size and run together forming large, irregularly shaped patches, with sharply defined edges. Usually fawn-hued they vary in color from pale yellow to brown, or may present a distinctly pink tint. A fine mealy scale covers the involved area, which, if not apparent, becomes noticeable upon scratching the surface. Itching is mild but usually persistent. It is seen chiefly in adults.
Etiology: Parasitic skin affections are due to animal and vegetable parasites that come in contact with the skin, most often in filthy surroundings. Most of these parasites are powerless against normal skins of full resistance. A healthy skin and cleanliness constitute the best protection against them.
A lowering of the powers of life, with abnormal nutrition and consequent slow and imperfect renewal of the tissues are essential before parasites can gain a foothold in the skin and thrive therein. When the skin is weakened and debilitated and ready to undergo de-generation, physiological scaling of the skin occurs prematurely and the skin fails to renew itself promptly and perfectly. This affords opportunity for parasitic invasion.
The resulting inflammation, eruption, suppuration, etc., are efforts to dislodge them.
PARASITIC SKIN AFFECTIONS
Care of the Patient: Care consists of two general processes. The most important of these is that of increasing the skin’s resistance by building up the general health, especially by improving nutrition.
The second is that of killing the parasites. Lice may be killed by oil. Most parasites may be destroyed by ultraviolet rays. A paste made of lard or butter and sulphur and spread over ringworms speedily destroys these.
Cleanliness is always essential.
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