Essentials of Diseases of the Skin Part 28

The disease, in its severer types is, as a rule, incurable, but much can be done to alleviate the condition. Good, nouris.h.i.+ng food, pure air and exercise are of importance. Tonics and cod-liver oil are usually beneficial. The local management is similar to that employed in chronic eczema. An ointment of [beta]-naphthol, one-half to five per cent.

strength, is highly extolled.

Acne.

Give a definition of acne.

Acne is an inflammatory, usually chronic, disease of the sebaceous glands, characterized by papules, tubercles, or pustules, or a mixture of these lesions, and seated usually about the face.

At what age does acne usually occur?

Between the ages of fifteen and thirty, at which time the glandular structures are naturally more or less active.

Describe the symptoms of acne.

Irregularly scattered over the face, and in some cases also over the neck, shoulders and upper part of the trunk, are to be seen several, fifty or more, pin-head- to pea-sized papules, tubercles or pustules; commonly the eruption is of a mixed type (_acne vulgaris_), the several kinds of lesions in all stages of evolution and subsidence presenting in the single case. Interspersed may generally be seen blackheads, or comedones. The lesions may be sluggish in character, or they may be markedly inflammatory, with hard and indurated bases. In the course of several days or weeks, the papules and tubercles tend gradually to disappear by absorption; or, and as commonly the case, they become pustular, discharge their contents, or dry and slowly or rapidly disappear, with or without leaving a permanent trace, new lesions arising, here and there, to take their place. In exceptional instances the eruption is limited to the back, and in these cases the eruption is usually extensive and persistent, and not infrequently leaves scars.

What do you understand by acne punctata, acne papulosa, acne pustulosa, acne indurata, acne atrophica, acne hypertrophica, and acne cachecticorum?

These several terms indicate that the lesions present are, for the most part, of one particular character or variety.

Describe the lesions giving rise to the names of these various types.

Blocking up of the outlet of the sebaceous gland (comedo), which is usually the beginning of an acne lesion, may cause a moderate degree of hyperaemia and inflammation, and a slight elevation, with a central yellowish or blackish point results--the lesion of _acne punctata_; if the inflammation is of a higher grade or progresses, the elevation is reddened and more prominent--_acne papulosa_; if the inflammatory action continues, the interior or central portion of the papule suppurates and a pustule results--_acne pustulosa_; the pustule, in some cases, may have a markedly inflammatory and hard base--_acne indurata_; and not infrequently the lesions in disappearing may leave a pit-like atrophy or depression--_acne atrophica_; or, on the contrary, connective-tissue new growth may follow their disappearance--_acne hypertrophica_; and, in strumous or cachectic individuals, the lesions may be more or less furuncular in type, often of the nature of dermic abscesses, usually of a cold or sluggish character, and of more general distribution--_acne cachecticorum_.

What is acne artificialis?

Acne artificialis is a term applied to an acne or acne-like eruption produced by the ingestion of certain drugs, as the bromides and iodides, and by the external use of tar; this is also called _tar acne_.

What course does acne pursue?

Essentially chronic. The individual lesions usually run their course in several days or one or two weeks, but new lesions continue to appear from time to time, and the disease thus persists, with more or less variation, for months or years. In many cases there is, toward the age of twenty-five or thirty, a tendency to spontaneous disappearance of the disease.

[Ill.u.s.tration: Acne.]

Is the eruption in acne usually abundant?

It varies in different cases and at different periods in the same case.

In some instances, not more than five or ten papules and pustules are present at one time; in others they may be numerous. Not infrequently several lesions make their appearance, gradually run their course, and the face continues free for days or one or two weeks.

Does the eruption in acne disappear without leaving a trace?

In many instances no permanent trace remains, but in others slight or conspicuous scarring is left to mark the site of the lesions.

Are there any subjective symptoms in acne?

As a rule, not; but markedly inflammatory lesions are painful.

State the immediate or direct cause of an acne lesion.

Hypersecretion or retention of sebaceous matter. Recent investigations point to the possibility of a special bacillus being the exciting cause, in some instances at least. The pyogenic cocci are added factors in the pustular and furuncular cases.

Name the indirect or predisposing causes of acne.

Digestive disturbance, constipation, menstrual irregularities, chlorosis, general debility, lack of tone in the muscular fibres of the skin, scrofulosis; and medicinal substances such as the iodides and bromides internally, and tar externally.

Working in a dusty or dirty atmosphere is often influential, resulting in a blocking-up of the gland ducts. Workmen in paraffin oils or other petroleum products often present a furuncle-like acne.

The disease is more common in individuals of light complexion.

Is there any difficulty in the diagnosis of acne?

Not if it be remembered that acne eruption is limited to certain parts and is always follicular, and that the several stages, from the comedo to the matured lesion, are usually to be seen in the individual case.

In what respect does the pustular syphiloderm differ from acne?

By its general distribution, the longer duration of the individual lesions, the darker color, and the presence of concomitant symptoms of syphilis.

What is the pathology of acne?

Primarily, acne is a folliculitis, due to retention or decomposition of the sebaceous secretion or to the introduction of a micro-organism; subsequently, the tissue immediately surrounding becoming involved, with the possible destruction of the sebaceous follicle as a result. The degree of inflammatory action determines the character of the lesions.

State the prognosis of acne.

It is usually an obstinate disease, but curable. Some cases yield readily, others are exceedingly rebellious, especially acne of the back.

Success depends in a great measure upon a recognition and removal of the predisposing condition. Treatment is ordinarily a matter of months.

What measures of treatment are usually demanded in acne?

Const.i.tutional and local measures; the former when indicated, the latter always.