Essentials of Diseases of the Skin. Henry Weightman Stelwagon
syphilis cutanea, 11.2%; acne, 7.3%; pediculosis, 4%; psoriasis, 3.3%; ringworm, 3.2%; dermatitis, 2.6%; scabies, 2.6%; urticaria, 2.5%; pruritus, 2.1%; seborrhœa, 2.1%; herpes simplex, 1.7%; favus, 1.7%; impetigo, 1.4%; herpes zoster, 1.2%; verruca, 1.1%; tinea versicolor, 1%. Total: eighteen diseases, representing 81 per cent. of all cases met with.
(These percentages are based upon statistics, public and private, of the American Dermatological Association, covering a period of ten years. In private practice the proportion of cases of pediculosis, scabies, favus, and impetigo is much smaller, while acne, acne rosacea, seborrhœa, epithelioma, and lupus are relatively more frequent.)
CONTAGIOUSNESS.
Name the more actively contagious skin diseases.
Impetigo contagiosa, ringworm, favus, scabies and pediculosis; excluding the exanthemata, erysipelas, syphilis and certain rare and doubtful diseases.
[At the present time when most diseases are presumed to be due to bacteria or parasites the belief in contagiousness, under certain conditions, has considerably broadened.]
RAPIDITY OF CURE.
Is the rapid cure of a skin disease fraught with any danger to the patient?
No. It was formerly so considered, especially by the public and general profession, and the impression still holds to some extent, but it is not in accord with dermatological experience.
OINTMENT BASES.
Name the several fats in common use for ointment bases.
Lard, petrolatum (or cosmoline or vaseline), cold cream and lanolin.
State the relative advantages of these several bases.
Lard is the best all-around base, possessing penetrating properties scarcely exceeded by any other fat.
Petrolatum is also valuable, having little, if any, tendency to change; it is useful as a protective, but is lacking in its power of penetration.
Cold Cream (ungt. aquæ rosæ) is soothing and cooling, and may often be used when other fatty applications disagree.
Lanolin is said to surpass in its power of penetration all other bases, but this is not borne out by experience. It is an unsatisfactory base when used alone. It should be mixed with another base in about the proportion of 25% to 50%.
These several bases may, and often with advantage, be variously combined.
What is to be added to these several bases if a stiffer ointment is required?
Simple cerate, wax, spermaceti, or suet; or in some instances, a pulverulent substance, such as starch, boric acid, and zinc oxide.
CLASS I.—DISORDERS OF THE GLANDS.
Hyperidrosis.
Fig. 6.
A normal sweat-gland, highly magnified. (After Neumann.)
a, Sweat-coil: b, sweat-duct; c, lumen of duct; d, connective-tissue capsule; e and f, arterial trunk and capillaries.
What is hyperidrosis?
Hyperidrosis is a functional disturbance of the sweat-glands, characterized by an increased production of sweat. This increase may be slight or excessive, local or general.
As a local affection, what parts are most commonly involved?
The hands, feet, especially the palmar and plantar surfaces, the axillæ and the genitalia.
Describe the symptoms of the local forms of hyperidrosis.
The essential, and frequently the sole symptom, is more or less profuse sweating.
If the hands are the parts involved, they are noted to be wet, clammy and sometimes cold.
If involving the soles, the skin often becomes more or less macerated and sodden in appearance, and as a result of this maceration and continued irritation they may become inflamed, especially about the borders of the affected parts, and present a pinkish or pinkish-red color, having a violaceous tinge. The sweat undergoes change and becomes offensive.
Is hyperidrosis acute or chronic?
Usually chronic, although it may also occur as an acute affection.
What is the etiology of hyperidrosis?
Debility is commonly the cause in general hyperidrosis; the local forms are probably neurotic in origin.
What is the prognosis?
The disease is usually persistent and often rebellious to treatment; in many instances a permanent cure is possible, in others palliation. Relapses are not uncommon.
What systemic remedies are employed in hyperidrosis?
Ergot, belladonna, gallic acid, mineral acids, and tonics. Constitutional treatment is rarely of benefit in the local forms of hyperidrosis, and external applications are seldom of service in general hyperidrosis. Precipitated sulphur, a teaspoonful twice daily, is also well spoken of, combined, if necessary, with an astringent.
What external remedies are employed in the local forms?
Astringent lotions of zinc sulphate, tannin and alum, applied several times daily, with or without the supplementary use of dusting-powders. Weak solutions of formaldehyde, one to one hundred, are sometimes of value.
Dusting-powders of boric acid and zinc oxide, to which may be added from ten to thirty grains of salicylic acid to the ounce, to be used freely and often:—
℞ Pulv. ac. salicylici, … … … … … … … … … gr. x-xxx.
Pulv. ac. borici, … … … … … … … … … . … . ʒv.
Pulv. zinci oxidi, … … … … … … … … … . … ʒiij M.
Diachylon ointment, and an ointment containing a drachm of tannin to the ounce; more especially applicable in hyperidrosis of the feet. The parts are first thoroughly washed, rubbed dry with towels and dusting-powder, and the ointment applied on strips of muslin or lint and bound on; the dressing is renewed twice daily, the parts each time being rubbed dry with soft towels and dusting-powder, and the treatment continued for ten days to two weeks, after which the dusting-powder is to be used alone for several weeks. No water is to be used after the first washing until the ointment is discontinued. One such