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.
Strawberry-like: Medor.
Suppurating (see Moist): Ka. iod., Acid nitricum, Thuja.
Tubular: 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.
White: Lyco.
SUBJECTIVELY.
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.
Painless: Lyco.
Pain in bones or bone pains, with: Pho. ac.
Sore; Euphr., Sabi., Thuja.
when touched: Euphr., Thuja.
Stinging: Thuja.
Stitches in: Euphr.
especially when walking: Euphr.
Ichthyosis.
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.
Ichthyosis Simplex.
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.
Ichthyosis Hystrix.
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.
Etiology.-Ichthyosis is an hereditary affection, and usually transmitted in the line of sex; but there are many exceptions to this rule, and numerous instances of the crossing of the sex. It is common to find several instances in the same family.
Treatment.-This disease is seldom, if ever, radically cured, but the condition of the patient can be considerably bettered. The general health is apparently unaffected. The treatment should be directed to the relief of the symptoms present. The anidrotic condition of the skin may be improved by the employment of such agents as will increase the sweat-secretion. For this purpose the old school recommend jaborandi, in the form of fluid extract, taken daily, in drachm-doses, and they claim that in some instances it has prompt effect, and at the same time loosening of the epidermic scales occur. The wet-pack has also been advantageously employed, or frequent washing and alkaline or other baths may be substituted with success for this purpose. After the removal of the epidermic accumulations, the newly exposed epidermis should be kept as soft and pliable as possible, by inunctions of some bland oil, to prevent a return to its former condition. Such treatment will afford relief, more or less permanent. A generous diet should be allowed the patient.
An infusion of quillaya saponaris bark sometimes works well as a local fomentation.
Internal homoeopathic remedies are:
Arsen iod.-Dry scaly; itching and burning in scrofulous subjects with swelling of the lymphatic glands.
Clematis.-When there are fine scales with some itching worse, when getting warm in bed; painful swelling and induration of the glands. Eruption changes character with the changes of the moon.
Graphites.-Skin dry and inclined to crack; unhealthy skin; every injury tends to ulceration; thick and crippled toes nails; extremities go to sleep; itching of the genitals.
Iodine.-The skin has a brown dingy color; ravenous hunger; swelling and distension of the abdomen; emaciation in dark- complexioned, scrofulous children.
Mercurius.-Dirty, yellow color of the skin; itching, worse at night when warm in bed; dry, scaly spots; in syphilitic and scrofulous subjects.
Natrum carb.-Skin of the whole body becomes dry, rough and cracked here and there; frequent empty or sour eructations; great prostration.
Phosphorus.-Skin is dry and wrinkled; skin of hands is rough and dry; pains in the chest; desire for acids and spicy foods; falling of the hair; great indisposition; in tall, slender people.
Potassium iodide.-Skin dried up; rough, like hog skin; sensitive swelling of the thyroid gland; oedematous infiltration of the tissues; after mercury or syphilis.
Plumbum.-Dry skin; absolute lack of perspirations; obstinate constipation; paralytic weakness of the limbs.
