Symptoms are those manifestations of disease by which its existence is recognised. They are divided into subjective symptoms which are felt only by the patient and hence must be outlined by him, and the objective which may be observed by another person with or without the aid of the patient. In dermatological practice, more than in any other department of medicine, the relative importance of these two classes is more equal. While symptoms may be limited to the skin alone, they frequently show the relationship of the cutaneous disease with some functional or organic disorder. Often the skin affection is secondary to the internal disturbances, whether these be general or local in character. Hence the relationship between internal and external conditions is one of cause and effect. The symptomatology of any skin condition is not complete unless it embraces all the symptoms skin condition is not complete unless it embraces all the symptoms present at any particular time in the skin as well as elsewhere. The careful study and critical analysis of symptoms will determine etiology, diagnosis and treatment.
Subjective symptoms are of great clinical significance, especially to the homoeopathic prescriber. They vary in intensity and character from the mildest sensation of burning or indefinite itching to the intolerable pain of destructive and malignant diseases. Almost any variety of paresthesia may be present in the skin. Thus there may be more or less pronounced burning or heat, tingling, pricking, stinging, formication or itching. The last, however, is the most common form of all the subjective symptoms of the skin and is commonly termed pruritus. It may be present as a distinct itching of any degree up to an almost intolerable sensation which results in scratching and various secondary lesions, or it may be exemplified in some modified form. Total absence of pruritus aids greatly in distinguishing syphilitic from non-syphilitic lesions, which objectively have a close resemblance. Not infrequently there is an absence of subjective symptoms in benign cutaneous diseases, as in acne where they may be slight or wanting. Subjective symptoms, indicative of disturbances of the digestive, genitourinary or upper respiratory tract, are often noted. A cachexia with debility, sensations of weakness, languor, headache, etc. may form a group of subjective symptoms and the sharp neuralgic pains which commonly precede an outbreak of herpes zoster are characteristic. Painful sensations as noted in the so-called bone pains of syphilis are due to a constitutional condition, others may be of a direct character as experienced in furuncles, or they may be purely reflex as is seen in exaggerated cases of pruritus.
To one who has studied the characteristics of subjective symptoms as a means to cure disease, they are nearly if not quite as important as objective manifestations. This is not the opinion of many dermatologists because their viewpoint is limited to the consideration of the disease picture rather than of the individual. The chief value of subjective symptoms, whether in or apart from the skin, depends on their nature, location and behaviour under varied influences, acting from without or from within the body. The nature of sensations, whether burning, smarting, stinging, gnawing, aching, shooting, etc.; the location, whether limited to one or a few parts or generalized; their behaviour, whether unaffected, relieved or aggravated by time of day, season, cold, heat, water, clothing, rest, exercise, eating, drinking, sleep, mental or physical occupation, etc.; all these give character to subjective symptoms and establish their value from the therapeutists standpoint.
Objective symptoms are due to the varying pathological processes which occur in the skin modified to a great extent by the character of the cutaneous structure. These symptoms or modifications are known as elementary or primary lesions and, while as distinct manifestations they are few in number and only successive stages in pathological evolution, they may by differences in grouping, modes of occurrence and other features form the many varieties of the skin eruptions. Strictly speaking, the primary lesions are the visible changes with which cutaneous diseases begin. While the elementary lesions may continue as such, they often undergo modification either from accidental or natural changes or from purely extraneous causes and develop into what are known as consecutive or secondary lesions. So-called primary lesions are not always first in order of occurrence, but secondary lesions invariably follow some primary manifestation. Some lesions are common to several diseases. But ordinarily one or more lesions presenting certain features, with or without the presence of certain subjective symptoms, distinguish each disease and form the basis of descriptive dermatology.
A few lesions such as cutaneous horns, some warts, the burrow produced by the itch mite, etc., cannot be classified in any of the following groups but need no specific attention beyond that found in the description of the diseases in which they occur. It may be gathered from the preceding remarks that a knowledge of lesions is essential to a correct understanding of skin diseases. Lesions are grouped as follows: