Essentials of Diseases of the Skin Part 13

Occasional. Scarlatinoid and urticarial, and exceptionally purpuric; in rare instances, if drug is continued, eruption becomes vesicular, hemorrhagic, ulcerative and even gangrenous.

State frequency and types of eruption following the administration of copaiba.

Not uncommon. _Urticarial_, erythemato-papular and _scarlatinoid_.

Mention frequency and types of eruption resulting from the ingestion of cubebs.

Uncommon. Erythematous and small papular.

[Ill.u.s.tration: Fig. 14.

A somewhat rare form of eruption from the ingestion of iodine compounds.

(_After J.C. McGuire._)]

Mention frequency and types of eruption resulting from the administration of digitalis.

Exceptional. Scarlatinoid and papular.

State frequency and types of eruption resulting from the iodides (iodine).

Common. _Pustular_, but may be erythematous, papular, vesicular, bullous, tuberous, purpuric and hemorrhagic. Co-administration of a.r.s.enic or pota.s.sium bitartrate is thought to have a preventive influence in some cases.

Give the frequency and types of eruption observed to follow the administration of mercury.

Exceptional. Erythematous and erysipelatous.

Give the frequency and types of the cutaneous disturbance following the ingestion of opium (or morphia).

Not uncommon. Erythematous and _scarlatinoid_, and sometimes urticarial.

Mention the frequency and the types of eruption following the administration of quinine.

Not infrequent. Usually _erythematous_, but may be urticarial, erythemato-papular, and even purpuric. There is, in some instances, preceding or accompanying systemic disturbance. Furfuraceous or lamellar desquamation often follows.

State frequency and types of eruption resulting from the ingestion of salicylic acid.

Not common. Erythematous and urticarial; exceptionally, vesicular, pustular, bullous, and ecchymotic.

Give frequency and type of cutaneous disturbance due to the administration of stramonium.

Not common. Erythematous.

State frequency and types of eruption resulting from the administration of turpentine.

Not uncommon. _Erythematous_, and small-papular; exceptionally vesicular.

X-Ray Dermat.i.tis.

What several grades of x-ray dermat.i.tis (x-ray burns, Rontgen-ray burns) are observed?

Three grades are usually described: erythema, superficial vesication, and necrosis. The first and second may come on shortly--a few hours to several days--after exposure; occasionally later. The third grade may present also in the first several days, but in many cases one to several weeks may elapse before it appears; it is quite commonly preceded by erythema and vesication. The necrosis may be superficial or deep, and quite usually results in a persistent ulcer covered by a leathery coating; it is usually painful.

[Ill.u.s.tration: Fig. 15. _x_-ray burn]

Give the prognosis and treatment of x-ray dermat.i.tis.

The first grade--the erythematous--usually disappears in one to ten days; the second grade requires one to several weeks, and may be quite sore and tender; the severe or necrotic burns are persistent, sometimes lasting for months and several years, with little tendency to spontaneous disappearance, and rebellious to treatment.

Treatment of the milder types is that of erythema (_q. v._); the necrotic type occasionally demands thorough curetting and skin-grafting before it will heal.

Dermat.i.tis Fact.i.tia.

(_Synonym:_ Feigned Eruptions.)

What do you understand by feigned eruptions?

Feigned, or artificial, eruptions, occasionally met with in hysterical females and in others, are produced, for the purpose of exciting sympathy or of deception, by the action of friction, cantharides, acids or strong alkalies; the cutaneous disturbance may, therefore, be erythematous, vesicular, bullous, or gangrenous. It is usually limited in extent, and, as a rule, seen only on parts easily reached by the hands.

[Ill.u.s.tration: Fig. 16.

Dermat.i.tis Fact.i.tia--note the unusually uniform and regular character and arrangement of the lesions.]

Dermat.i.tis Gangraenosa.

What do you understand by dermat.i.tis gangraenosa?

Dermat.i.tis gangraenosa (_erythema gangraenosum_, _Raynaud's disease_, _spontaneous gangrene_) is an exceedingly rare affection, characterized by the formation of gangrenous spots and patches. It may be idiopathic or symptomatic. Some of these cases, especially in hysterical subjects, belong under the "feigned eruptions," being self-produced.

As an idiopathic disease, it begins as erythematous, dark-red spots--usually preceded and accompanied by mild or grave systemic disturbance--which gradually pa.s.s into gangrene and sloughing; the eventual termination may be fatal, or recovery may take place. As a symptomatic disease, it is occasionally met with in diabetes and in grave cerebral and spinal affections.

In Raynaud's disease (symmetric gangrene) the parts affected are the extremities, such as fingers and toes, the ears and nose, only occasionally other parts. The first symptoms observed are coldness and paleness of the part; followed sooner or later by congestion of a dark red, livid, or bluish color, with sometimes swelling, and tenderness and shooting pains. The termination is usually in gangrene of a dry character, with, in some instances, vesicles and blebs along the edges; in other cases the parts become atrophied, withered, and indurated.

Treatment is based upon general principles.