Essentials of Diseases of the Skin Part 30

Acne Rosacea.

Give a descriptive definition of acne rosacea.

Acne rosacea is a chronic, hyperaemic or inflammatory disease, limited to the face, especially to the nose and cheeks, characterized by redness, dilatation and enlargement of the bloodvessels, more or less acne and hypertrophy.

Describe the symptoms of acne rosacea.

The disease may be slight or well-marked. Redness, capillary dilatation, and acne lesions seated on the nose and cheeks, and sometimes on chin and forehead also, const.i.tute in most cases the entire symptomatology.

A mild variety consists in simple redness or hyperaemia, involving the nose chiefly and often exclusively, and is to be looked upon as a pa.s.sive congestion; this is not uncommon in young adults and is often a.s.sociated with an oily seborrh[oe]a of the same parts. In many cases the condition does not progress beyond this stage. In other cases, however, sooner or later the dilated capillaries become permanently enlarged (_telangiectasis_) and acne lesions are often present--const.i.tuting the middle stage or grade of the disease; this is the type most frequently met with. In exceptional instances, still further hypertrophy of the bloodvessels ensues, the glands are enlarged, and a variable degree of connective-tissue new growth is added; this latter is usually slight, but may be excessive, the nose presenting an enlarged and lobulated appearance (_rhinophyma_).

[Ill.u.s.tration: Fig. 25. Acne Rosacea.]

Are there any subjective symptoms in acne rosacea?

As a rule, no. Some of the acne lesions may be tender and painful, and at times there is a feeling of heat and burning.

What do you know in regard to the etiology?

In many cases the causes are obscure. Chronic digestive and intestinal disorders, anaemia, chlorosis, continued exposure to heat or cold, menstrual and uterine irregularities, and the too free use of spirituous liquors, tea, etc. are often responsible factors.

It is essentially a disease of adult life, common about middle age, occurring in both s.e.xes, but rarely reaching the same degree of development in women as observed at times in men.

Is acne rosacea easily recognized?

Yes. The redness, acne lesions, dilated capillaries, and, at times, the glandular and connective-tissue hypertrophy; the limitation of the eruption to the face, especially the region of the nose; the evident involvement of the sebaceous glands, the absence of ulceration, taken with the history of the case, are characteristic.

It is to be distinguished from the tubercular syphiloderm and lupus vulgaris, diseases to which it may bear rough resemblance.

State the prognosis of acne rosacea.

All cases may be favorably influenced by treatment; the mild and moderately-developed types are, as a rule, curable, but usually obstinate. It is a persistent disease, showing little, if any, tendency to disappear spontaneously.

What is the method of treatment?

Both const.i.tutional and local measures are demanded in most cases.

Upon what is the const.i.tutional treatment to be based?

The const.i.tutional treatment, beyond a regulation of the diet, is to be based upon a correct appreciation of the etiological factors in the individual case. There are no special remedies. Iron, cod-liver oil, tonics, ergot, alkalies, saline laxatives, and similar drugs are to be variously prescribed.

What is the external treatment?

In many respects, both as to the preliminary measures and remedies, essentially the same as that employed in the treatment of simple acne (_q. v._). The _x_-ray treatment is not so efficient in this disease, however, as in acne. In addition to the treatment there found, several other applications deserve mention:--

In many cases _Vleminckx's solution_[C] is valuable, applied diluted with one to ten parts of water. Also, a mucilaginous paste containing sulphur:--

[Rx] Mucilag. acaciae, ..................... f[dram]iij Glycerinae, ........................... f[dram]ij Sulphur, praecip., .................... [dram]iij. M.

[Footnote C: [Rx] Calcis, .............................. [Oz]ss Sulph. sublimat., .................... [Oz]j Aquae, ................................ [Oz]x.

To be boiled down to [Oz]vj and filtered.]

Or a similar paste with the glycerine in the foregoing replaced with ichthyol may be used.

In what manner are the dilated bloodvessels and connective-tissue hypertrophy to be treated?

The enlarged capillaries are to be destroyed by incision or by electrolysis. Properly managed the vessels may be thus destroyed, but unless the predisposing causes have disappeared or have been remedied, a new growth may take place.

If the knife is employed, the vessels are either slit in their length or cut transversely at several points. The method by electrolysis is the same as used in the removal of superfluous hair (_q. v._).; the needle may, if the vessel is short, be inserted along its calibre, or if long, may be inserted at several points in its length.

Excessive connective-tissue growth, exceptionally met with, is to be treated by ablation with the scissors or knife.

Acne Varioliformis.

(_Synonyms:_ Acne Frontalis; Acne Rodens; Acne Necrotica; Lupoid Acne; Necrotic Granuloma.)

Describe acne varioliformis.

Acne varioliformis is characterized by lesions of a moderately superficial papulo-pustular type, which in disappearing leave slight or pit-like scars. The forehead and scalp are the favorite sites, but they may also occur elsewhere. The eruption is rather scanty as a rule, consisting usually of ten to thirty lesions. They begin as small maculo-papules, as papules, or as minute nodules in or on the skin, and gradually become small pea-sized, with a tendency to slight vesiculation or pustulation at the central part. The lesion is sluggish in its course, drying to a thin crust, which finally falls off, leaving a depressed variola-like scar. New lesions arise from time to time, and the disease thus continues almost indefinitely. There may or may not be itching. In what appears to be a variety of this disease, known usually as _acne urticata_, there is considerable itching just at the time the lesion is appearing. The malady is not frequent, but occurs in both s.e.xes, usually in those between the ages of twenty and fifty. It seems probable that the eruption is parasitic in origin.

The maladies variously known as hydradenitis suppurativa, acnitis, spiradenitis, folliclis, granuloma necrotic.u.m, etc., in which the lesions, primarily at least, are somewhat deeper seated, sluggish in their course, and followed by scarring, could be also included under this head.

Give the prognosis and treatment.

The disease is rebellious and tends to recur. The most efficient applications are those of sulphur and resorcin, the same as prescribed in ordinary acne.

Sycosis.

(_Synonyms:_ Sycosis Vulgaris; Sycosis Non-parasitica; Folliculitis Barbae; Sycosis Coccogenica.)

What do you understand by sycosis?