Essentials Of Diseases Of The Skin Including The Syphilodermata
Chapter 1
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ESSENTIALS OF DISEASES OF THE SKIN
Including the Syphilodermata
Arranged in the Form of Questions and Answers Prepared Especially for Students of Medicine
by
HENRY W. STELWAGON, M.D., PH.D.
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ESSENTIALS OF DISEASES OF THE SKIN.
Since the issue of the first volume of the #Saunders Question-Compends#,
OVER 290,000 COPIES
of these unrivalled publications have been sold. This enormous sale is indisputable evidence of the value of these self-helps to students and physicians.
Saunders' Question-Compends. No. 11.
ESSENTIALS OF DISEASES OF THE SKIN
Including the Syphilodermata
Arranged in the Form of Questions and Answers Prepared Especially for Students of Medicine
by
HENRY W. STELWAGON, M.D., PH.D.
Professor of Dermatology in the Jefferson Medical College, Philadelphia; Dermatologist to the Howard and Philadelphia Hospitals, etc.
Seventh Edition, Thoroughly Revised
Illustrated
Philadelphia and London W. B. Saunders Company 1909
Set up, electrotyped, printed, 1890. Reprinted July, 1891. Revised, reprinted, June, 1894. Reprinted March, 1897. Revised, reprinted, August, 1899. Reprinted September, 1901, May, 1902, September, 1903. Revised, reprinted January, 1905. Reprinted March, 1906. Revised, reprinted March, 1909.
Printed in America
Press of W. B. Saunders Company Philadelphia
PREFACE TO SEVENTH EDITION.
In the present--seventh--edition the subject matter, especially as regards the practical part, has been gone over carefully and the necessary corrections and additions made. Nineteen new illustrations have been added, a few of the old ones being eliminated. It is hoped that the continued demand for this compend means a widening interest in the study of diseases of the skin, sufficiently keen as to lead to the desire for a still greater knowledge.
H.W.S.
PREFACE TO FIRST EDITION.
Much of the present volume is, in a measure, the outcome of a thorough revision, remodelling and simplification of the various articles contributed by the author to Pepper's System of Medicine, Buck's Reference Handbook of the Medical Sciences, and Keating's Cyclopædia of the Diseases of Children. Moreover, in the endeavor to present the subject as tersely and briefly as compatible with clear understanding, the several standard treatises on diseases of the skin by Tilbury Fox, Duhring, Hyde, Robinson, Anderson, and Crocker, have been freely consulted, that of the last-named author suggesting the pictorial presentation of the "Anatomy of the Skin." The space allotted to each disease has been based upon relative importance. As to treatment, the best and approved methods only--those which are founded upon the aggregate experience of dermatologists--are referred to.
For general information a statistical table from the Transactions of the American Dermatological Association is appended.
H.W.S.
CONTENTS.
PAGE ANATOMY OF THE SKIN 17 The Epidermis 18 The Blood-vessels 19 The Nervous and Vascular Papillæ 20 The Hair and Hair-follicle 21
SYMPTOMATOLOGY 22 Primary Lesions 22 Secondary Lesions 23 Distribution and Configuration 24 Relative Frequency 26 Contagiousness 27 Rapidity of Cure 27 Ointment Bases 27
CLASS I.--DISORDERS OF THE GLANDS 28 Hyperidrosis 28 Sudamen 30 Hydrocystoma 31 Anidrosis 31 Bromidrosis 32 Chromidrosis 32 Uridrosis 33 Phosphoridrosis 33 Seborrh[oe]a (Eczema Seborrhoicum) 33 Comedo 38 Milium 42 Steatoma 43
CLASS II.--INFLAMMATIONS 44 Erythema Simplex 44 Erythema Intertrigo 45 Erythema Multiforme 46 Erythema Nodosum 50 Erythema Induratum 51 Urticaria 52 Urticaria Pigmentosa 56 Dermatitis 58 Dermatitis Medicamentosa 60 X-Ray Dermatitis 63 Dermatitis Factitia 64 Dermatitis Gangrænosa 65 Erysipelas 66 Phlegmona Diffusa 68 Furunculus 68 Carbunculus 70 Pustula Maligna 72 Post-mortem Pustule 73 Framb[oe]sia 73 Verruga Peruana 73 Equinia 74 Miliaria 74 Pompholyx 76 Herpes Simplex 78 Hydroa Vacciniforme 80 Epidermolysis Bullosa 80 Dermatitis Repens 81 Herpes Zoster 81 Dermatitis Herpetiformis 83 Psoriasis 86 Pityriasis Rosea 95 Dermatitis Exfoliativa 96 Lichen Planus 98 Pityriasis Rubra Pilaris 99 Lichen Scrofulosus 100 Eczema 100 Prurigo 118 Acne 119 Acne Rosacea 126 Sycosis 130 Dermatitis Papillaris Capillitii 135 Impetigo Contagiosa 136 Impetigo Herpetiformis 138 Ecthyma 138 Pemphigus 140
CLASS III.--HEMORRHAGES 144 Purpura 144 Scorbutus 146
CLASS IV.--HYPERTROPHIES 148 Lentigo 148 Chloasma 149 Keratosis Pilaris 151 Keratosis Follicularis 153 Molluscum Epitheliale 153 Callositas 155 Clavus 156 Cornu Cutaneum 158 Verruca 160 Nævus Pigmentosus 162 Ichthyosis 165 Onychauxis 167 Hypertrichosis 168 [OE]dema Neonatorum 170 Sclerema Neonatorum 171 Scleroderma 172 Elephantiasis 174 Dermatolysis 176
CLASS V.--ATROPHIES 177 Albinismus 177 Vitiligo 178 Canities 180 Alopecia 181 Alopecia Areata 183 Atrophia Pilorum Propria 187 Atrophia Unguis 188 Atrophia Cutis 189
CLASS VI.--NEW GROWTHS 191 Keloid 191 Fibroma 192 Neuroma 194 Xanthoma 195 Myoma 196 Angioma 196 Telangiectasis 197 Lymphangioma 198 Rhinoscleroma 198 Lupus Erythematosus 199 Lupus Vulgaris 203 Tuberculosis Cutis 209 Ainhum 212 Mycetoma 212 Perforating Ulcer of the Foot 213 Syphilis Cutanea 213 Lepra 231 Pellagra 235 Epithelioma 236 Paget's Disease of the Nipple 240 Sarcoma 241 Granuloma Fungoides 242
CLASS VII.--NEUROSES 244 Hyperæsthesia 244 Dermatalgia 244 Anæsthesia 244 Pruritus 244
CLASS VIII.--PARASITIC AFFECTIONS 247 Tinea Favosa 247 Tinea Trichophytina 251 Tinea Imbricata 261 Tinea Versicolor 262 Erythrasma 265 Actinomycosis 266 Blastomycetic Dermatitis 266 Scabies 267 Pediculosis 271 Pediculosis Capitis 272 Pediculosis Corporis 274 Pediculosis Pubis 275 Cysticercus Cellulosæ 276 Filaria Medinensis 277 Ixodes 277 Leptus 277 [OE]strus 278 Pulex Penetrans 278 Cimex Lectularius 278 Culex 279 Pulex Irritans 279
TABLE showing Relative Frequency of the Various Diseases of the Skin 280
DISEASES OF THE SKIN.
#ANATOMY OF THE SKIN.#
#The Epidermis.#
#The Blood-vessels.#
#The Nervous and Vascular Papillæ.#
#The Hair and Hair-Follicle.#
#SYMPTOMATOLOGY.#
The symptoms of cutaneous disease may be objective, subjective or both; and in some diseases, also, there may be systemic disturbance.
#What do you mean by objective symptoms?#
Those symptoms visible to the eye or touch.
#What do you understand by subjective symptoms?#
Those which relate to sensation, such as itching, tingling, burning, pain, tenderness, heat, anæsthesia, and hyperæsthesia.
#What do you mean by systemic symptoms?#
Those general symptoms, slight or profound, which are sometimes associated, primarily or secondarily, with the cutaneous disease, as, for example, the systemic disturbance in leprosy, pemphigus, and purpura hemorrhagica.
#Into what two classes of lesions are the objective symptoms commonly divided?#
Primary (or elementary), and Secondary (or consecutive).
#Primary Lesions.#
#What are primary lesions?#
Those objective lesions with which cutaneous diseases begin. They may continue as such or may undergo modification, passing into the secondary or consecutive lesions.
#Enumerate the primary lesions.#
Macules, papules, tubercles, wheals, tumors, vesicles, blebs and pustules.
#What are macules (maculæ)?#
Variously-sized, shaped and tinted spots and discolorations, without elevation or depression; as, for example, freckles, spots of purpura, macules of cutaneous syphilis.
#What are papules (papulæ)?#
Small, circumscribed, solid elevations, rarely exceeding the size of a split-pea, and usually superficially seated; as, for example, the papules of eczema, of acne, and of cutaneous syphilis.
#What are tubercles (tubercula)?#
Circumscribed, solid elevations, commonly pea-sized and usually deep-seated; as, for example, the tubercles of syphilis, of leprosy, and of lupus.
#What are wheals (pomphi)?#
Variously-sized and shaped, whitish, pinkish or reddish elevations, of an evanescent character; as, for example, the lesions of urticaria, the lesions produced by the bite of a mosquito or by the sting of a nettle.
#What are tumors (tumores)?#
Soft or firm elevations, usually large and prominent, and having their seat in the corium and subcutaneous tissue; as, for example, sebaceous tumors, gummata, and the lesions of fibroma.
#What are vesicles (vesiculæ)?#
Pin-head to pea-sized, circumscribed epidermal elevations, containing serous fluid; as, for example, the so-called fever-blisters, the lesions of herpes zoster, and of vesicular eczema.
#What are blebs (bullæ)?#
Rounded or irregularly-shaped, pea to egg-sized epidermic elevations, with fluid contents; in short, they are essentially the same as vesicles and pustules except as to size; as, for example, the blebs of pemphigus, rhus poisoning, and syphilis.
#What are pustules (pustulæ)?#
Circumscribed epidermic elevations containing pus; as, for example, the pustules of acne, of impetigo, and of sycosis.
#Secondary Lesions.#
#What are secondary lesions?#
Those lesions resulting from accidental or natural change, modification or termination of the primary lesions.
#Enumerate the secondary lesions.#
Scales, crusts, excoriations, fissures, ulcers, scars and stains.
#What are scales (squamæ)?#
Dry, laminated, epidermal exfoliations; as, for example, the scales of psoriasis, ichthyosis, and eczema.
#What are crusts (crustæ)?#
Dried effete masses of exudation; as, for example, the crusts of impetigo, of eczema, and of the pustular and ulcerating syphilodermata.
#What are excoriations (excoriationes)?#
Superficial, usually epidermal, linear or punctate loss of tissue; as, for example, ordinary scratch-marks.
#What are fissures (rhagades)?#
Linear cracks or wounds, involving the epidermis, or epidermis and corium; as, for example, the cracks which often occur in eczema when seated about the joints, the cracks of chapped lips and hands.
#What are ulcers (ulcera)?#
Rounded or irregularly-shaped and sized loss of skin and subcutaneous tissue resulting from disease; as, for example, the ulcers of syphilis and of cancer.
#What are scars (cicatrices)?#
Connective-tissue new formations replacing loss of substance.
#What are stains?#
Discolorations left by cutaneous disease, which stains may be transitory or permanent.
#Distribution and Configuration.#
#What do you mean by a patch of eruption?#
A single group or aggregation of lesions or an area of disease.
#When is an eruption said to be limited or localized?#
When it is confined to one part or region.
#When is an eruption said to be general or generalized?#
When it is scattered, uniformly or irregularly, over the entire surface.
#When is an eruption universal?#
When the whole integument is involved, without any intervening healthy skin.
#When is an eruption said to be discrete?#
When the lesions constituting the eruption are isolated, having more or less intervening normal skin.
#When is an eruption confluent?#
When the lesions constituting the eruption are so closely crowded that a solid sheet results.
#When is an eruption uniform?#
When the lesions constituting the eruption are all of one type or character.
#When is an eruption multiform?#
When the lesions constituting the eruption are of two or more types or characters.
#When are lesions said to be aggregated?#
When they tend to form groups or closely-crowded patches.
#When are lesions disseminated?#
When they are irregularly scattered, with no tendency to form groups or patches.
#When is a patch of eruption said to be circinate?#
When it presents a rounded form, and usually tending to clear in the centre; as, for example, a patch of ringworm.
#When is a patch of eruption said to be annular?#
When it is ring-shaped, the central portion being clear; as, for example, in erythema annulare.
#What meaning is conveyed by the term "iris"?#