Under the terms hypertrophy and atrophy may be included all cases of development in excess of the normal tissues of the skin on the one hand and wasting on the other; the atrophy and hypertrophy being in each case primary conditions.
The maladies ranking under these two classes may be arranged as follows:
A. Hypertrophic diseases, comprising:- 1. Diseases of the epithelial layer of the skin, including callosities, corns, and horns, in which the epithelial tissue is especially affected. 2. Diseases involving the dermic portion, in which the true skin is affected with or without the epithelium. In some cases the papillary layer is chiefly affected, but in connection with augmented production of the epithelium also, as in ichthyosis and xeroderma. In other cases the fibro-cellular tissue of the corium proper is the special seat of change, as in the diseases termed scleroderma, keloid, fibroma, Elephantiasis Arabum, and dermatolysis. 3. Diseases seated in the vascular structures, including such growths as vascular naevi.
B. Atrophic diseases, including general wasting and senile atrophy, and local or linear atrophy, which will be incidentally noticed together with morphoea.
We will first deal in detail with hypertrophic affections. It will be understood that no reference is made in this chapter to secondary or accidental hypertrophy-the consequence of congestion or inflammatory conditions, but to those diseases in which hypertrophy is the prominent or only condition.
These are composed of an accumulation of the cells of the horny layer, which, generally, are pressed together into a conical mass that dips deeply downwards. The papillae beneath may be enlarged, but are usually atrophied. The corn mass presses even upon the rete cells, and it also obliterates more or less the sweat glands. Corns are caused by pressure and friction; they are of two kinds-the hard ordinary corns, and soft corns. The soft corns occur between the toes, and being saturated with the secretion of the part, are moist and soft; generally there is some serosity effused under the upper layers or the bursae normally found at the parts over the joints of the toes where the corns form, enlarge and pour out fluid, which is discharged from a little central aperture.
Treatment.-The shoes or boots worn must fit the foot-neither too small nor too large. The corn may be gotten rid of by soaking it in warm water, after which the outer layers may be removed by a sharp knife, and a slice of lemon bound upon it, and worn during the night. This treatment continued for three or four nights, the corn can be removed with but little pain.
Flexible or arnicated colloid may be used as a dressing for painful soft corns.
Ringed corn plasters will protect the corns from pressure.
If the corns are inflamed and painful, a veratrum viride or arnica lotion, one part to two, may be used.
A lotion, composed as follows, applied once or twice a day with a camel’s hair brush, has been used with great success in removing corns:
Rx. Salicylic acid, drachm j.
Ext. Cannabis Ind., grs.x.
M.S. Apply as directed above.
Another excellent application is as follows:
Rx. Acid Salicylic, drachm j.
Emplast. Saponat, z3jjj.
M.f. empl. Sig.: Apply on lint.
Antimon. crud. is the principal internal remedy for hard corns, and Sulphur for the soft variety.
Dr. Berridge reports a case of soft corn between fourth and fifth toes of right foot; the corn shoots and burns; also, dull aching in outer side of right ankle extending up to hip, as cured by the internal use of Wiesbaden 200, a dose every day for fourteen days.
CALLOSITIES are merely hardened conditions of the skin produced by pressure, differing from corns rather in the fact that they are on a larger scale than by any other feature.
Hypertrophy of the Papillae and Epithelium Conjoined.
Horns.-These may be sebaceous in origin; usually, however, they are made up of hypertrophied papillae, each containing one or more vessels and being covered by epidermis; on section they have a granular texture pierced with small orifices, and when dry, numerous concentric cracks. These orifices are the sections of little blood-vessels; a clear amber-colored circular area surrounding each of the vessels, which are separated by the general granular structure of the mass, incapable in the compact part of the horn of being reduced to its ultimate original elements. The central parts of the horn are more compact and less vascular than the outside.
Verrucae, or Warts.
These are little raised tumors, sessile or pedunculated, hard, generally round, rugose, and mammillated. They are made up of coherent and enlarged papillae, each containing a loop of blood vessels, and more or less nerve tissue, especially at their base. The sessile warts, or the true hypertrophous papillae, are seen mostly on the hands in children; they may be multiple, solitary, or aggregated in clusters. They may form a flat mass or present a digitate appearance. Warts are often the result of syphilis about the anus, vulva, penis, but they may also arise from simple irritation.
Venereal warts are pinkish or reddish vascular vegetations, and occur for the most part on the genitals, preferably on the penis and labia. They may also form about the mouth and anus, in the axilla and between the toes. They are apt to grow very rapidly, and may attain considerable size. They are caused by the contact of irritating fluids, and may be either dry or moist, according to their location. They may occur in connection with gonorrhoea, but are never like the Condylomata, a sign of constitutional syphilis.
The causes of warts are unknown; they appear sometimes to be contagious. The local treatment consists in destroying the abnormal growth by caustics-the acid nitrate of mercury, caustic potash, arsenical paste, perchloride of iron, chromic acid. The smaller warts may be removed by the curved scissors, and the larger and more vascular ones by the curette, ligature or galvano-caustic wire.
Venereal warts need the strictest cleanliness. The dry ones may be treated locally by thuja or mercuric bichloride lotion. The moist ones respond best to dusting with the mercuric chloride.
Thuja externally has great reputation in removing all kinds of warts.
Moles may be removed by the topical use of the acid nitrate of mercury.
The following repertory of warts and Condylomata, prepared by Dr. Olin M.Drake, is so complete and excellent, that i transcribe it here:
Warts, confinement, following, small: Calcareac.
girls, upon young: Sepia, Sulphur, Thuja.
horses, upon: Lachesis, Thuja.
upon, about the head and ears; bell-shaped, small at the attachment and one to one-and-a-half inches long: Thuja.
imagines w. upon the body: Mez.
isolated: Calcareac., Causticum, Lyco., Natr.c.
onanists, upon: Nitr. ac., Sepia, Sulphur, Thuja.
salt, from abuse of: Natr. mur., Nit.d.s.
Anus, about: Aurum, Thuja.
Arms, upon: Ant.cr., Arsenicum, Calcareac., Causticum, Dulcamara, Ferrum ma., Lycopodium, Natr.c., Nat. sulph., Nitr.ac., Rhus tox., Sepia, Silicea, Sulphur, Thuja.
left forearm: Sulph.
bend of elbow: Calcareac.
wrist (left): Ferrumma.
Body: Causticum, Medor., Thuja.
Buttocks, small, scattered, flat, grayish-brown: Conium
Cheek (left): Calcareac., Sepia, Thuja.
Chest: Aurum, Calcarea c., Nit.ac.
cornea, warty in appearance: Silicea
Ears, behind: Calcareac., Thuja.
wart-like growths: Calcareac.
Eyeballs, sensation as though was studded with: Euphr.
Eyebrows, upon: anac., Causticum, Thuja.
Eyelids: Calcareac., Causticum, Mag.s., Nit.ac., Sulphur, Thuja.
upper: Calcareac., Mag.s., Nitr.ac.
Eyes, under: Sulph.
Face, upon: Alco., Am.m., Calcareac., Causticum, Dulcamara, Ka.bi., Ka.c., Mag.s., Natr.m., Nitr.ac., Sepia, Thuja.
Feet: Calcareac., Sulphur
Fingers: Ambra, ars., Barytac., Berberis, Calcareac., Carb.
an., Causticum, Dulcamara, Ferrum, Lac.c., Lachesis, Lyco., Nat.m., Nat. sulph., Nit.ac., Ox.ac., Palladium, Petrol., Psorinum, Ranunculus bulbosus, Rhus t., Sarsaparilla, Selenium, Sepia, Sulphur, Thuja, Verrucinum.
index finger: Causticum (right), Lyco. (left), Thuja. little finger: Causticum, Lac caninum
middle finger: Berberis, Lachesis
finger, back of: Lachesis ring finger: Nat. sulph.
back of: Dulcamara, Lachesis
side of: Calcareac., Sepia, Thuja.
tips of: Causticum, Thuja.
joints, around: Sarsaparilla
knuckles, on: Ox.ac., Palladium, Sal.
close to the nails: Causticum
thumb: Lachesis, Ranunculusb., Thuja.
left hand: Psorinum
Forehead, upon: Nitr.ac.
Genitals, upon: Calcarea c., Cinnab., Eucalyp., Nit.
ac., Pho.ac., Secale c., Thuja.
upon glans penis: Nit.ac., Pho.ac., Thuja.
os uteri: Calcarea c., Nit.ac., Secale c., Thuja.
stinging and burning, when urinating: Thuja.
papilloma urethrae: Eucalyp., Thuja.
prepuce, fraenum and inner surface, bleeding when touched: Cinnab., Eucalyp.
Hands, upon back of: Arsenicum, Dulcamara, Ferrum, Nat.c., Nit.ac., Thuja.
ball of the: Berberis
inside of: Ruta.
knuckles: Acid oxalicum, Palladium, Selenium
left: Ferrumma., Psorinum, Thuja.
onanists of: Nitr.ac., Sepia, Sulphur, Thuja.
palm of: Anacardium, Nat.m., Ruta.
wart-like induration in the palm, after a long continued pressure on the part: Borax.
right: Arsenicum, Causticum, Nat. sulph., Thuja.
Head, upon: Causticum, Sepia
Lips: Causticum, Conium, Natrum mur., Nit.ac., Thuja.
upper, smart and bleed on washing: Nit.ac.
drawing pain in an old w.: Conium
Mouth and chin, about the: Calcareac., Calcareaph., Cun., Ka.ca., Lyco., Medor., Psorinum, Sepia, Thuja.
thickly studding the mouths of sheep: Calcarea c.
Neck, upon: Ant. cr., Calcarea c., Lyco., NIt.ac., Sepia, Syphilinum, Thuja.
right side, filled with blood: Thuja.
Nose: Alco., Causticum, Laur., Acid nitricum, Thuja.
Sternum: Acid nitricum
Thighs, upon: Medor.
Thumb, upon: Lachesis, Ranunculusb., Thuja.
Toes, upon: Spigelia
Tongue, upon: Aurum m., Aurumm.n., Mang., Thuja.
Bleeding: Calcareac., Causticum, Cinnab., Ferrum ma., Lyco., Natr.c., Nitr.ac., Pho.ac., Rhus t., Staphysagria, Thuja.
Breaking open: Calcareac.
Brittle: Ant. cr.
Cauliflower, like: Nitr.ac., Ranunculusb., Thuja.
on outer side of terminal phalanx of right thumb: Ranunculus bulbosus
Cleft. See jagged.
Color, almost the color of the skin: Calcareac.
dark: Sepia, Thuja.
red: Arsenicum, Belladonna, Calcareac., Causticum
size of a bean: Calcareac.
and angry looking: Arsenicum
circles around with: Causticum
streaks with: Belladonna
Flat: Ant.cr., Berberis, Dulcamara, Lachesis, Ruta, Sepia, Verrucinum.
Groups or crops, in: Dulcamara, Lachesis, Nat.m., Psorinum, Sepia, Thuja.
Hollow, become: Calcareac.
Horny or hard: Ant. cr., Borax, Calcarea c., Causticum, Dulcamara, Fl.ac., Graphites, Lachesis, Nit.ac., Ranunculusb., Sepia, Silicea, Sulphur, Thuja.
upper surface: Calcareac.
Incipient or recent: Nat.c.
Inflamed: Ammonium carb., Arsenicum, Belladonna, Bovis., Calcarea c., Causticum, Dulcamara, Hepar, Lyco., Natrum carb., Nitr. ac., Rhus t., Ruta, Sepia, Staphysagria, Sulphur, Thuja.
as if ulceration would set in: Hepar
Inveterate or old: Calcarea c., Causticum, Cun., Ka.ca., Nat.m., Acid nitricum, Rhus t., Sarsaparilla, Sulphur, Thuja. grow larger: Cun.
Isolated: Calcarea c., Causticum, Lyco., Nat.c.
Jagged (cleft, divided or indented): Calcarea c., Causticum, Euphr., Lyco., Acid nitricum, Pho. ac., Rhus t., Sabi., Staphysagria, Thuja.
surrounded by a hepatic areola, with bran-like desquamation: Lyco.
Large or fleshy: Causticum, Dulcamara, Ka. c., Lyco., Nat.c., Nat.m., Acid nitricum, Pho.ac., Rhus t., Sabi., Sepia, Silicea, Thuja, Verrucinum.
Moisture, exuding: Calcarea c., Causticum, Lyco., Nitr.ac., Pho ac., Rhus t., Sabi., Thuja.
a fetid humor: Nitr. ac.
Pedunculated: Causticum, Dulcamara, Lyco., Medor., Nit.ac., Pho ac., Rhus t., Sepia, Staphysagria, Thuja.
Small, all over the body: Causticum
with pin-heads, like button mushrooms, on various parts of body and thighs: Medor.
Recent or incipient: Nat.c.
Rough, upper surface whitish and horny: Calcarea c.
Round: Calcarea c.
Rudimentary, on fingers: Berberis
Seedy: Calcareac., Causticum, Medor., Nat.m., Sepia, Thuja.
small: Barytac., Berberis, Calcarea c., Causticum, Cun., Dulcamara, Ferrum, Ferrumma., Fl. ac., Hepar, Lachesis, Medor., Acid nitricum, Psorinum, Rhus t., Sarsaparilla, Sepia, Sulphur, Thuja.
Smooth: Ant.cr., Dulcamara, Psorinum, Ruta.
Soft: Alumina, Ant. cr., Calcarea c., NIt. ac., Thuja.
at the base, almost the color of the skin; upper surface hard, rough, whitish and horny: Calcareac.
with thin epidermis, and moist: Nit.ac.
to touch, like lipoma and pointed, on neck: Thuja.
Solid body, with horny top: Causticum, Rhus t., Sepia
Spongy: Alumina See soft.
Suppurating (see Ulcerating): Arsenicum, Bovista., Calcareac., Causticum, Hepar, Nat.c., Pho., Silicea, Thuja.
then healing: Calcareac.
a previously existing wart, developed a red point, suppurated and disappeared: Bovista.
sensation as if they would suppurate; in the evening in bed: Petrol.
Sycotic: Alumina, Aurum, Cinnab., Medor., Mil., Nat. sulph., Pho. ac., Sarsaparilla
Old, dry; after mercurial treatment for gouty pains: Sarsaparilla
syphilitic: Aurum, Cinnab., Ka.iod., Thuja.
Ulcerating (See Suppurating): Arsenicum, Calcarea c., Causticum, Hepar, Nat.c., Pho., Silicea, Thuja.
Ulcers breaking our around warts: Ant.cr., Arsenicum, Nat.
having the shape of warts: Arsenicum
originating in warts: Thuja.
turning into warts: Calcarea c.
Burning: Ammonium carb., Arsenicum, Lyco., Acid nitricum, Petrol.
Pho., Rhus t., Sepia, Sulphur, Thuja.
Itching: Calcarea c., Carb.a.. Euphr., Hepar, Ka. carb., Nit.ac., Pho., Psorinum, Sepia, Sulphur, Thuja.
Painful: Ars, Ammonium carb., Ant.cr., Barayta carbonica, Bovis., Calcareac., Causticum, Conium, Euphr., Hepar, Ka. carb., Lyco., Nat. carb., Nat. ac., Petrol., Pho., Rhus t., Sabi., Sepia, Silicea, Staphysagria, Sulphur, Thuja.
ameliorated on the appearance of menses: Thuja.
preventing rest at night: Arsenicum
like a boil: Calcareac.
drawing, in an old w. on upper lip: Conium
pricking: Ant.cr., Calcareac., Lyco., Nit.ac., Petrol., Rhus tox., Sepia, Silicea, Sulphur
in the evening in bed: Petrol.
pulsating (beating or throbbing): Arsenicum, Calcareac., Causticum, Hepar, Ka.carb., Lyco., Acid nitricum, Petrol., Sepia, Silicea, Sulphur
shooting: Arsenicum, Bovis.
with plains, sticking: Hepar, Acid nitricum
stinging: Ammonium carb., Ant. cr., Barayta carbonica, Calcarea c., Causticum, Euphr., Hepar, Lyco., Nitr.ac., Rhus t., Sepia, Silicea, Staphysagria, Sulphur, Thuja.
as if ulceration would set in: Hepar
tearing: Ammonium carb.
throbbing: See pulsating.
extending up the arm to the axilla, from a malignant wart on the hand, rendering the arm useless: Arsenicum
Soreness of: Ambra., Arsenicum, Hepar, Lachesis, Nat., carb., Nat. mur., Acid nitricum, Petrol., Ruta., Sabi., Thuja.
Tickling (see itching): Sulph., Thuja.
Condylomata, mercury; after the abuse of: Aurum, Lyco., Nit.ac., Staphysagria
women, particularly in: Mercuriusd., Sabi.
Anus, upon or about: Aurum, Aurumm., Benz. ac., Euphr., Lyco., Mercuriusc., Mercurius d., Mil., Acid nitricum, Sabi., Sepia, Staphysagria, Silicea, Thuja.
a growth, like a w., a quarter of an inch in height, and as thick as a pea, painless, itching, opening at the top and suppurating, in the ridge, close to the anus, lasting four weeks and gradually healed: Thuja.
Clitoris, upon or about: Thuja.
Eyebrows, upon or about: Thuja.
Eyelids, upon or about; either on the internal or external surfaced: Cinnab., NIt. ac., Thuja.
upon or about, lower: Nit.ac.
Fraenum, upon or about: Cinnab.
upon or about, oozing, especially during new moon: Thuja.
Genitals, upon or about: Alumina, Benz. ac., Lyco., Medor., Thuja.
Iris, upon or about: Cinnab., Mercurius sol., Thuja.
Labium, upon or about: Sulph., Thuja.
Labium, upon or about: Sulph., Thuja.
Larynx, upon or about: Mercuriusc., Nit.ac., Thuja. Mouth, upon or about (inner): Phosphorus ac.
Neck, upon or about: Nit.ac.
Penis, upon or about: Ant.t., Aurum, Aurumm., Cinnab., Ka. iod., Ka.mur., Lycopodium, Mercuriusc., Nit.ac., Nux v., Pho. ac., Psorinum, Sabi., Sanicula, Sepia, Staphysagria, Sulphur, Thuja.
glans: Antim tart., Cinnab., Ka.iod., Ka. mur., Lyco., Acid nitricum, Nux v., Pho.ac., Sanicula, Staphysagria, Sulphur, Thuja.
Corona glandes, upon; after chancre: Ka. mur.
upon and behind: Staphysagria
Prepuce, upon: Aurum, Aurumm., Cinnab., Lyco., Nux vomica, Mercuriusc., NIt. ac., Sabi., Thuja.
edge of, itching and burning: Psorinum
Perineum, upon: Mercurius d., Thuja.
Scrotum, upon: Aurumm., Thuja.
Tongue, upon: Aurum mur.
Uterus, upon: Lachesis
cervix: Kreosotum, Mercurius, sol., Acid nitricum, Tarent., Thuja.
os: Calcarea c., Kreosotum, Mercurius sol.
vagina, in Medor., Acid nitricum, Pho., Tarent., Thuja. vulva, upon: Mercurius d.
Bleeding: Argentumn Medor., Acid nitricum, Sulphur, Thuja.
Broad: Ac. ac., Euphr., Mercuriusd., Nit ac., Thuja.
Cauliflower or mulberry like: Staphysagria, Thuja.
Chancre, complicated with: Argentum nitricum, Cinnab., Ka.
bichr., Mercurius sol., Nat. sulph., Acid nitricum, Pho. ac., Staphysagria, Thuja.
after: Kali iod.
Cock`s comb shape: Euphr., Staphysagria, Sulphur
Conical ka. mur., Merc, v., Thuja.
Dry: Ac. ac., Cinnab., Lyco., Mercurius c., Mercurius v., Acid nitricum, Sarsaparilla, Staphysagria, Thuja.
Fan-shaped: Cinnab., Thuja.
Flat: Ac. ac., Euphr., Acid nitricum, Sarsaparilla, Sulphur, Thuja.
Gonorrhoea, complicated with: Cinnab., Conium, Ka.
** 316 ** mur., Lyco., Mercurius c., Acid nitricum, Pic. ac., Pulsatilla, Sarsaparilla, Sulphur, Thuja.
Moist (discharging): Ac. ac., Benz ac., Calcarea c., Euphr., Graphites, Hepar, Ka. iod., Lyco., Medor., Mercuriusd., Nat. sulph., Nit.ac., Psorinum, Sanicula, Staphysagria, Sulphur, Thuja. discharging profuse: Benz.ac., Medor.
greenish: Nat. Sulph.
offensive: Medor., Mercurius d., Acid nitricum
Smelling like fish-brine: Sanicula
herring-brine; Calc-c., Graphites, Hepar, Thuja.
old cheese: Calcareac., Hepar, Thuja.
yellow fluid : Medorrh.
Moon, worse with the increase of the: Thuja.
Mulberry or cauliflower like: Staphysagria, Thuja.
Old, long standing in cachectic subjects: Ka. iod.
Pedicles, growing on. See pedunculated.
Pedunculated: Lyco., Acid nitricum, sulph., Sulphur
Split: Lyco., Acid nitricum, Thuja.
Suppurating (see Moist): Ka. iod., Acid nitricum, Thuja.
Ulcers elevated, which have the appearance as if w. would grow out of them: Cinnab.
Wart-shaped: Benz. ac., Acid nitricum, Nux vomica, Sarsaparilla, Sulphur, Thuja.
Burning: Euphr., Pho. ac., Psorinum, Mercuriusd., Sabi.
when touched: Euphr., Sabi.
Itching Cinnab., Euphr., Phytolacca, Psorinum, Sabi., Thuja.
especially when walking: Euphr.
about the joints: Cinnab.
Painful: Euphr., Sabi., Thuja.
even when free from contact: Sabi.
Pain in bones or bone pains, with: Pho. ac.
Sore; Euphr., Sabi., Thuja.
when touched: Euphr., Thuja.
Stitches in: Euphr.
especially when walking: Euphr.
Ichthyosis is a chronic disease of the skin, in which the epidermis is developed in excessive accumulations, usually accompanied by more or less hypertrophy of the papillae, presenting a dry, harsh, and “scaly” surface whence its name, and arising from a congenital or hereditary predisposition in the patient.
This disease is usually divided into two forms, according to the degree of development.
The mind form, called simplex, is more frequently found, and varies from a very mild xerodermatous to a decidedly scaly condition of the skin.
The severe form, called hysterics, shows its most advanced stage, with the papillae enlarged and the cones between extended and capped with horny excrescences of various sizes and shapes.
While the characteristics of this disease are marked, particularly the objective symptoms, the subjective symptoms are almost entirely lacking.
In this, the mild form, the skin of a new born infant is free from any apparent symptoms. It is usually not until after the lapse of a few weeks or months, and sometimes years, that the disease is sufficiently advanced to attract attention, when there is first noticed a dry, rough condition of the skin; its color, however, remains unaffected. The skin may be generally involved, or the affection may be confined to certain localities, such as the extensor surfaces of the limbs, and afterward extend over the whole surface of the body. By gradual development, the epidermis becomes slightly thickened, and the natural lines of the skin begin to deepen, and those become apparent which ordinarily can not be seen. In its further development the epidemic scales become larger and more abundant. The scales enlarge in area and thickness, their outline being limited and conforming to the natural lines and furrows of the skin, and form plates of various shapes; those on the extensor surfaces of the extremities are the largest and resemble the scales of a fish. The well-developed scales are detached about their edges, but are quite firmly attached in their centres, and can be removed with little difficulty without branding the surface of the papillae beneath, and blood following, as is the case in psoriasis. When the scales are thin and the skin kept clean, they present a white or pearly appearance. When more developed and thickened, this color is deepened, shading from yellowish to darkish-green or even brown or blackish. This is due partly to pigmentary deposits in the plates, but mainly to accumulations and incorporations of extraneous matter not removable by washing. Fissures or cracks are formed on the surface where it is a thickest and most unyielding; but they extend only through the upper layer of the skin, and remain dry, thus differing from those found in eczema, which extend deeper, giving exit to a serous discharge which dries into crusts. The anidrotic or dryish state of the skin, so markedly shown here, is probably due to a sparse and defective development of the sweat glands and follicles and to their functional inactivity in the parts affected; the unaffected parts remaining in the normal state.
This form is the move severe and rare manifestation of the disease, and presents a variety of developments. It is characterized by the excessive growth and accumulation of epidermis in the form of thick, irregularly shaped, variously colored, horny masses, which admit of being detached, exposing a dry and rough surface; or by more marked hypertrophied papillary which are surmounted by variously sized and shaped horny projections.
In some instances they take the semblance of the quills of the porcupine hence the name, hystrix. Its distribution may extend irregularly over various parts of the body, or may be localized in one or more well-defined patches, as, for instance, about the axillary folds, the knees, elbows, neck, or other regions. This form is also of gradual growth, is the most advanced, and its degree of development increases with age.
The eruption is particularly severe and annoying in winter, and sometimes diminishes in summer, recurring again the succeeding winter.
Course.-The disease is progressive as age increases, until the climax is reached, usually at adult age, where after there is little change., A spontaneous cure has rarely, if ever occurred. The two varieties of the disease may occur together.
Diagnosis.-Ichthyosis is so distinctly characterized as to render its diagnosis easy and certain. In its mild form it is to be differentiated from xeroderma, meaning dry skin, which properly refers to a condition not ichthyotic in origin; from eczema, by the absence of pruritus; and from all other inflammatory disorders which tend to desquamation, by the absence of previous inflammation.
Prognosis.-The simplex form may often be ameliorated; but the hystrix form is rarely, if ever, more than temporarily improved. The general health is apparently unimpaired in either case; and there are instances where the mild form has decreased in development with increasing years; but it is a question if the disease once developed ever disappears or is cured radically.