195. Erythema-Inflammatory Redness of the Skin.
DEFINITION.- Hyperaemia of the cutis, manifesting itself by superficial redness or blush of the skin without swelling or breach of continuity.
Erythema, especially if chronic, is sometimes due to stomachic derangement; flushing of the face after meals is a common erythematous symptom.
There is no marked itching; no heat, tension, burning, or exudation, as in erysipelas, for which it is sometimes mistaken.
EPITOME OF TREATMENT.-
Belladonna (simple redness); Aconite (febrile disturbance, and flushing of the face from excitement), Apis, Rhus, K.-Bich., Nux V. (flushing after food), Bryonia, Mang., Ferrum, Arsenicum, Ranunculus- Bulb.
ACCESSORY MEASURES.- Regular open-air exercise; sufficient time for, and freedom of the mind during meals; simple food; a nd the free use of water internally and externally. Where there is pain, a compress moistened with Goulard-water relieves.
ERYTHEMA NODOSUM.- There is a form of Erythema known by this name, and associated with Rheumatism. The spots are sometimes as large as a walnut, and raise above the surface. They occur generally on the shins, rarely above the knee, and are accompanied often by pain. Apis., Rhus., K.-Bich, are most likely to be useful, but the general condition must be treated.
196.- Intertrigo-Chafing-Soreness of Infants.
DEFINITION.- Redness and chafing produced by the friction of two folds of skin, especially in fat children and adults; it is seen in the groin, axilla, and neck; sometimes a fluid is exuded, the acridity of which increases the local mischief, and presently an offensive raw surface is produced.
EPITOME OF TREATMENT.-
Chamomilla (in infants); Calcarea carb. (tubercular children); Lycopodium (obstinate cases); Mercurius (rawness and great soreness); Sulph. The parts should be well washed with cold or tepid water, and carefully dried, two or three time a day; a piece of linen, saturated with Calendula lotion, may be laid between the opposed surfaces; or, in bad cases, a lotion composed of one part of tincture of Hydrastis of ten of Glycerine may be applied in the same manner.
Dusting the chafed parts with a fine powder consisting of equal parts of powdered Lycopodium seeds and Oxide of Zinc, or of Fuller’s earth, is very useful.
DEFINITION.- A transient, non-contagious affection, characterized by an eruption of prominent patches or wheals, either redder or whiter than the natural skin, of regular or irregular shape, with heat, tingling, and itching, more or less sever. In patient subject to this disease there is often a condition of lowered blood coagulability and the administration of lime salts in such cases will relieve.
VARIETIES.- Urticaria may be acute or chronic. The acute form may be accompanied by fever and sometimes will alternate with attacks of asthma.
SYMPTOMS.- Similar to or more intense than those produced by nettle-stings. The eruption consists of elevations, occurring in streaks or wheals of an irregular shape, on a red ground; the character of the rash becomes much more marked after scratching or rubbing, “so that it is possible, by using the nail of the finger, to write one’s name on the skin;” it is generally worse in the evening, and when the body is exposed to cold air. There is much tingling and burning, and often the eruption, after disappearing suddenly from one part, shows itself in another. “In the Urticaria from irritant food-hyperaemia and burning heat are present in the most aggravated form” (Wilson). The spots contain no fluid, and do not end in desquamation. It is most common in spring and early summer, is not contagious, may occur at any age, and in the same person repeatedly.
CAUSES.- Derangement of the digestive organs, following the use of some particular kinds of the food, among which we may specify shell fish, tinned foods, acid fruits or other articles of diet for which the patient has an idiosyncrasy; and certain kinds of medicines, such as Cubebs Copaiba, Valerian, etc. It may also occur after the injection of serum, e.g., anti-tetanic serum, and is then associated with a group of symptoms to which the name “Serum Disease” is given. Also mental depression, anxiety, defective innervation, and sometimes, according to Hebra, uterine irritation. The skin being extremely sensitive, it is easily excited by external irritants-such as the wearing of flanner next in the skin, the bites of fleas, the sting of bees, etc.
Chronic, also intermittent, Urticaria is frequently associated with uterine or other diseases, and is often very obstinate. Cold, damp, rapid changes of temperature, and Dentition, favour its development in patients predisposed.
EPITOME OF TREATMENT.-
1. Simple Urticaria.- Apis., Urt.-U., Aconite, Chlorum-Hyd.
2. From Gastric Disorder.- Ant.-C. Nux V., Pulsatilla
3. From cold.- Aconite (from draughts and cold winds); Dulcamara (from damp).
4. Associated with other affections.- Bryonia, Cimic., Rush (rheumatic patients); Colchicum (gouty subjects); Arsenicum, Ipecac. (Asthma); Pulsatilla, Hydras. (uterine irregularities).
5. Chronic cases.-Arsenicum, China-Sulph. (intermittent); Apis. Sulph., Chlorum- Hyd.
6. Special Symptoms.- Aconite (febrile disturbance); Chlor-Hyd. (appearing when warm in bed); Bryonia (sudden retrocession); Ignatia, Anacardium (mental depression and confusion); Coffea(sleeplessness and nervous irritability).
ACCESSORY MEASURES.- A general warm both is invaluable; it soothes the skin and often cures at once. When the eruption is thoroughly out, the heat an irritation may be materially alleviated by smearing the whole surface of the body with lanoline, or the parts may be rubbed with slices of lemon.
HYGIENE.- A dry, uniform, and moderate temperature; plain food; plenty of open-air exercise; great cleanliness; Draughts, change of temperature, indigestible food, and all exciting causes must be removed and avoided. If flannel be worn it should be over a garment of a different material.
198.- Prurigo-Itching of the Skin.
DEFINITION.- “A chronic affection of the skin, characterised by a thickened and discolored state of the surface, with excessive itching, and, generally an eruption of papuloe.”
SYMPTOMS.- Intense itching, and creeping sensation; patients scratch and tear themselves till the blood flows; their sleep is frequently disturbed, and their existence is thus often rendered almost unendurable; or the impulse to incessant scratching is so powerful as to induce the patient to seek seclusion. Sometimes the itching is diffused irregularly over the surface; at other times it affects the extremities; frequently it occurs round the anus, or on the scrotum, or on the female genitals. It is often a horrible and most obstinate disease.
CAUSES.- Prurigo is specially apt to occur at the two extremes of life and is probably a blood disorder with irritability of the nerve endings in the skin. Irritation of the alimentary tract by improper food is liable to commence the disease and it is greatly influenced by unhealthy surroundings. In uncleanly persons it may be associated with scabies or pediculi. It may predispose to some existing chronic disease.
TREATMENT.- Aconitum.- Furious itching all over the skin, with febrile symptoms.
Sulphur.- Severe itching, attended with thirst and dryness of the skin, worse in the evening, and in bed. This is generally a prominent remedy, and it is frequently specific, especially in recent cases.
Arsenicum.- Itching with burning; or an eruption emitting watery fluid like sweat, and attended with much constitutional weakness. It is most suitable in chronic cases.
Ignatia.– Itching of the skin, of a fine pricking character, resembling flea-bites, and changing from one part to another.
Other remedies are sometimes required:– Mercurius, Dolichos., Fagopyrum., Carbo V., Rhus., Mez., Apocy., Causticum Radium produces most intense itching, and Radium will sometimes effect a striking cure in this disease, either in potencies or by local application in the hands of an expert.
ACCESSORY MEANS.– The skin must be strengthened by wholesome and regular diet, frequent exercise in a bracing air, and daily ablutions with cold or tepid water, shower-baths, etc. Without these measures medicine will be of the little permanent use. Stimulating food or drink, pastry, rich sauces, pickles, and indigestible food generally, must not be indulged in. The use of ointments is generally injurious. Scratching must be avoided. in several cases, temporary relief may be obtained by bathing the parts with alcohol and water in equal proportions; or with Mezereum lotion ( one part of ten of water); or by sponging the skin, on retiring to bed, with a warm infusion made by pouring boiling water on bran.
The Wet Compress.– Prurigo, if confined to one or two places, is much benefited by the constant use of a wet compress over the affected part; for although it often increases the irritation at first, it finally assists nature in expelling the morbid matter.
SCRATCHING.– Notwithstanding the incentive to scratching in Prurigo and other skin affections, the practice greatly aids in keeping up the irritation and increasing the disease. On this point the following remarks by Dr. Tilbury Fox will express a condition we have often observed:–
“When the disease is non-contagious, secretion, if present, may be transferred (by scratching) and, when acrid, set up local inflammations; and, hen contagious, scratching is the surest method of inoculation, as in the case of the contagious Impetigo or Porrigo. Children in this way transplant the disease from the head to various other parts of the body. mothers, beyond a doubt, get it about their hands from children.”
DEFINITION.– A non-contagious chronic disease of the skin, characterized by the appearance of small hard papules, about the size of millet seeds, uniform, slightly red, or of the same colour as the skin, closely grouped, but distinct from each other; there is itching and the skin is generally dry and thickened. When disappearing very fine, dry, greyish scales are formed.
The disease appears on different parts of the body, but generally on the front of the fore-arms and hands, and on the inner aspect of the knees.
VARIETIES.– Lichen simplex.– occurring in summer; L. pilaris– the follicles of the hair the seat of the affections; L. circumspectus– the pimples being grouped in small circular patches, with a well-defined border, sometimes with a clear centre; L. agrius– the most serious from of the disease– is seen in grocers, bakers, bricklayers, and washerwomen, sometimes called “baker’s itch”; the pimples are very close, red, inflamed, and have a secretion, with intense itching and burning, febrile symptoms, pains in the limbs, gastric derangements, etc., and lasting, in the acute stage, ten or fifteen days; or L. tropicus– “prickly heat,” which occurs chiefly in hot climates, attacking the parts covered by the clothes, accompanied by a peculiar tingling and pricking; the papillae are of a vivid-red colour, about the size of a pin’s head, but there is no redness of the skin generally; the disease sometimes occurs in this country.
CAUSES.– Constitutional predisposition; irregularities in habits or diet; certain occupations, as those of cooks, bakers, grocers, etc.; hot weather or climate.
EPITOME OF TREATMENT.– Sulph. (simple); Ant.- Crud. (with digestive derangements); Apis or Ledum-P (“prickly-heat”); Ars (L. agrius; chronic cases); Nux jug., Sulphur
ACCESSORY TREATMENT.– Simple, unstimulating food and drink; proper attention to the general health. The daily tepid or cold bath is both preventive and curative of “prickly heat”. it is seldom seen on the face, neck, and hands of persons who frequently wash those parts. See “Causes,” and also “Accessory Measures,” in the two previous Sections.
200.– Strophulus– Red-gum– Tooth-rash.
VARIETIES.– Strophulus may be red or white. Red strophulus (red gum) begins as red blotches, each slightly elevated in the centre; the redness soon fades, and the central elevation enlarges and forms a flattened pimple. They occur on the face, neck, arms, and may even extend over the whole body. White S. consists of pearly, white, opaque pimples, smaller than the preceding– about the size of a pin’s head, usually on the face and arms.
CAUSE.– This is a disease of infants. The appearance of Strophulus, as of Nettle-rash, on the body of an infant is certain evidence of unsuitable diet, and of derangement of the digestive functions. It is also most frequent in children who are kept too much in hot rooms, and excluded from the fresh air.
TREATMENT.– Chamomilla.–This remedy is generally the best, and is often sufficient. A dose thrice daily.
Ant-Crud.– Associated with indigestion, white tongue, etc. Pulsatilla may also be required under like conditions.
Calcarea Carb.– With chronic Acidity.
ACCESSORY MEANS.– The regulation of the diet; abundance of fresh air; clothing sufficient to protect the body from cold, and at the same time, permit of the access of air to the skin; and daily use of the cold or (at first) the tepid bath. Favourable hygienic conditions are necessary in every case, or medicine will prove inefficient. Local irritation from teething, acidity, etc.,, should corrected.
201.– Pityriasis– Branny Tetter.
DEFINITION.– A superficial cutaneous affection, in which there is desquamation — the skin falling off in whitish bran-like scales. Also more or less redness, itching, and heat.
TREATMENT.– Arsenicum is generally homoeopathic. A dose may be given thrice daily. Graphites or Lycopodium may be given if Arsenicum be not sufficient.
ACCESSORY MEANS.– Frequent baths, check the formation of scales. As an application, Glycerine-of-borax is often of great service.
202.– Psoriasis– Lepra Vulgaris– Dry Tetter.
DEFINITION.– A non contagious, cutaneous affection characterized by well-formed, dry, and whitish scales, without vesiculation or pustulation, accompanied by cracking of the skin, and having a disposition to recur.
The general health is not appreciably affected, there being few if any symptoms beyond slight itching, which is worse at the commencement.
VARIETIES.– In the common form of psoriasis there are whitish minute spots, made up of dry, silvery-looking scales, heaped together on tawny-red patches of skin about the extensor aspects of the elbow and knee, and other places where the bones are near the surface ( P. Vulgaris); when the spots are larger, they resemble drops of mortar, and are found on the breast, back, and limbs (P. guttata); then the eruption may be more developed, and extend over a larger surface., sometimes covering an entire limb (P. diffusa); when the eruption runs together in a serpentine form, the scales are thin, and quickly reproduced (P. gyrate); when the scales are large, dry, and adherent, and the patches thickened and cracked, a slight discharge may occur, causing scabs– this is the chronic form (P. inveterate), but none of these are real varieties, only descriptive names.
Psoriasis progresses by an increase in the size and number of the patches, and their extension along the extremities to the trunk. On the other hand, the cure of the disease is marked by diminution of the scales, and more full exposure of the surface beneath, until gradually the eruption disappears, leaving little or no trace of its former existence. It is sometimes, however, a most obstinate disease.
CAUSES.– Psoriasis occurs in persons apparently in good health, but who are probably suffering from some form of defective nutrition, as too growth, bad-living, over-study, anxiety, prolonged lactation, etc., especially where a disposition, often hereditary, exists. The frequent use of state dried fish, and the want of fresh unboiled vegetables, are probably frequent causes. There is some evidence that constitutions more susceptible to Tubercle are more liable to Psoriasis.
TREATMENT.–Mercurius, Iodium, Ac.-nit., iris., Sulphur, Lycopodium, Nux Juglans, Nux Ciner., K.-Hydriod, Petrol, (obstinate cases, scaly patches with deep fissures); Ac.-Carbol., Teuc., Arsenicum(chronic and inveterate cases). Arsenicum is an excellent remedy, and may be given for two or three months in gradually increasing doses. Veterinaries give this drug freely to horses, and it causes great improvement in their coats.
ACCESSORY MEANS.– Local.– Warm baths; preparations of Glycerine (See Secale 27), if the skin be much cracked, or occasional poultices if it be very hard. The application of the ointment of the Iodide of Sulphur or an ointment of Liquor Carbonis Detergens, often proves most useful in Psoriasis. It should be preceded by a warm bath. The ointment of Chrysarobin is almost specific in removing Psoriasis, but as with all skin diseases it is very important to treat the case constitutionally as well as locally. Merely to get rid of the external appearance is not necessarily to cure the disease, of which the eruption is a symptom. General.– Nourishing diet, including frequent small quantities of unboiled vegetables; for growing persons, Cod-liver oil (see Secale 22), except when stale fish is the cause. Any defects in the functions of digestion and assimilation should, if possible, be corrected. Patients who have been overtaxed in mind or body should have rest and change. The daily habit of bathing or cold sponging should be adopted, and will, to a large extent, prevent relapses. Warm and tepid soft-water baths, with the use of pure soap, at bedtime, softens the scales, and promotes the healthy functions of the skin, Free out-of-door exercise is also most useful, and favours the healthy action of the lungs, and the whole of the digestive organs.
203.– Herpes– Shingles.
DEFINITION.– Large vesicle, or small blebs, distinct from each other ( not confluent as in Eczema), occurring in patches on different parts of the body, having an inflamed base, and containing fluid– at first clear, then milky, afterwards quickly disappearing,– and ultimately shriveling, leaving scabs, or being ruptured, then dry up into light-brownish scabs.
VARIETIES.– H. zoster or zona, commonly called Shingles– derives its name from its manner of encircling one-half of the body. It is an acute disease, lasting from fourteen to twenty days, and follows the course of one or more of the cutaneous nerves, generally stopping short in the middle, and has the appearance of a line of patches, like a belt half round the body. It generally affects the trunk, chiefly on the right side, but occasionally the face, shoulder, abdomen, or upper part of the thigh. Ordinary, simple Herpes frequently appears on the lips of persons suffering from pneumonia, Intermittent Fever, Ephemera, and epidemic Cerebro-spinal Meningitis, and often in the course of a common cold. It is most common in the young, particularly during change of weather, and is often preceded by neuralgic pains, the eruption following in the same locality. In some rare cases, ulceration may supervene; there may be much pain, smarting, or burning; and the scars may remain for same time, Herpes zoster is due to an irritation of one of the ganglia of the spinal nerves, and it is preceded, accompanied, and often followed by agonising neuralgic pains. Zona is much dreaded, and uninstructed nurses foolishly state that if the patches extend round the body death is certain to result. There is, however, no danger unless the patient be very old and feeble. it has been found recently that it is in some way connected with exposure to cases chicken pox.
GENERAL SYMPTOMS.– In addition to what is stated above, there is often a feeling of malaise– feverishness, Headache, shivering– and, perhaps, neuralgic pain in the inside, which may be very acute, especially in Shingles. The disease is mostly accompanied by sensation of heat, tension, and burning, felt even before the appearance of the eruption, and is followed by weakness and depression. When in the disease occurs in the aged, or in persons of feeble constitution, there is much debility, and Ulceration may arise, further debilitating the patient.
CAUSE.– Irritation of the nerves– as when Catarrh affects the air passages, and Herpes is developed on the nose or lips; or during the course of other diseases.
EPITOME OF TREATMENT.–
1. Earliest symptoms– Acon.( with neuralgia consequent on anxiety, etc.,).
2. DEVELOPED HERPES — Rhus ( in all simple cases); Sulph. ( to follow Rhus if necessary); Ars; (neuralgia and in debilitated constitutions); Phyto., Graphites( ulcerating conditions and in old persons); Phosphorus (tubercular patients); Tellur., Phosphorus, Sepia (Herpes circinnatus)
3. Pleurodynia.– Ranunculus, Bulb.
4. Additional remedies.– Mang., Staphysagria, Cist., Nat.-Mur., Comocladia, Mezer.
ACCESSORY MEASURES.– The daily bath; plenty of out-of-door exercise; and the “Accessory Measures” suggested in Section 91. Locally the patches must be protected by cotton-wool and starch powder. An alcohol compress relieves pain sometimes.
204.– Eczema– Catarrhal Inflammation of the Skin– Scald Head– Milk-crust.
DEFINITION.– Eczema is essentially a Dermatitis or catarrhal inflammation of the skin characterized by more or less superficial redness, of small closely-packed vesicles, usually not larger than a pin’s head, which run together, burst, and pour out serous fluid, that dries into thin yellow crusts. The exuded fluid has the property, when dried, of stiffening linen, which distinguishes this form other skin diseases, Pain, smarting, or itching, are also present.
Eczema is one of the most common eruptions, constituting one- third or more of all skin affections; it lasts a varying time, in consequences of successive local developments, and its tendency to spread. After its disappearance no traces are left of the disease.
SYMPTOMS.– The most usual is a red surface with vesicles or fissures from which the serous fluid exudes. A great plane of interwoven capillaries renders the skin very vascular, and gives rise to a copious exudation. The deeper layers of cuticle, including that lining the sweat ducts, appear most implicated. The vesicles appear in successive crops, may prolong the disease for an indefinite time, and are attended with itching and local heat. The skin is irritable; occasionally excoriations or cracking of the part occur, and sometimes the parts around the patch inflame, probably from the irritating nature of the discharge. If no vesicles be apparent, the disease may be recognised by the skin feeling thick when raised by the finger and thumb, by the starchy nature of the discharge, the formation of thin yellow crusts, and the irritation. The most common seats of the patches are the scalp, behind the ears, the face, the fore-arms, and the legs, and its appearance differs greatly in each of these locations. If the disease be extensive, there may be considerable fever, a pallid appearance, Headache, loss of appetite, etc. The mucous surfaces may become the seat of Inflammation, either by the spread of the disease from the skin or as a consequence of the general condition. The retrocession of Eczema may be followed by other Diseases– Diarrhoea, bronchitis, or Leucorrhoea in the female.