Thuja.-Dirty, gray, cadaverous looking skin. Wart shaped excrescences; brittle or soft nails; lymphatic temperament.
Hypertrophic Diseases of the Corium.
Under this head are included all those diseases in which the fibrous tissue of the skin is in excess. and in which the disease extends to or involves the subjacent cellular tissue. These may be termed fibro-cellular hyperplasiae. They are: Morphoea; scleroderma; keloid; fibroma; buenemia tropica; and dermatolysis.
Morphoea.
Morphoea, formerly called Addison`s keloid is a chronic cutaneous affection, characterized by the appearance of one or more discrete spots or patches, usually isolated and roundish in form, pinkish in color, and slightly elevated when hyperaemic and hypertrophic, surrounded by a tinted or violaceous border, later becoming whitish, anaemic, atrophic, and slightly depressed; and upon their surface, in the early stage, may be seen small streaks of dilated blood-vessels.
Forms.-This rather infrequent affection assumes various definite forms, according as the character of its development is mainly hypertrophic or atrophic.
Patches of the first form which are mainly hypertrophic, enlarge until they are of the size of small or large coins, and are roundish in outline; after a preliminary hyperaemic stage, they gradually assume a lardaceous appearance, and later on show a distinct atrophic aspect.
Lesions of the second form, which mainly atrophic, manifest little or no tendency to hyperplasia, and occur in small, pit- like, or slightly depressed, cicatriform or telangiectasia, isolated or grouped spots or steaks, forming maculae et striae atrophicae.
Symptoms.-A typical case of morphoea usually makes its appearance by the formation of one or more roundish, circumscribed, hyperaemic, slightly elevated macules or patches, varying in diameter from one-quarter to a couple of inches; the centre gradually whitens, and is bordered by a tinted circle of violaceous or pinkish hue, composed of dilated capillaries and often there is to be seen a plexus of small blood-vessels extending upon the surface of the lesion. The hyperaemia of the patch is soon succeeded by an anaemic state, which may be sometimes so decided as to cause a slight depression of the surface. The patch from this time, undergoes a gradual change until it present the characteristic smooth, lardaceous appearance, resembling inlaid wax, or old ivory. The connective tissue of the skin is increased and becomes condensed. The activity of its process of development becomes lessened during this stage of the disease and enters on a chronic course. The skin of the patch may be soft, or quite firm and inelastic.
In its further progress the affections may manifest atrophic changes in the tissues as well as of the glands and vessels of the affected skin, resulting in contraction and also depression of its surface, together with a lessening or cessation of the secretions of the sweat and sebaceous glands; and the skin feels stretched and thinned. These later changes may extend over a period of years and become permanent, or the affection, before it has become decidedly atrophic, sometimes displays its tendency to recovery by the disappearance of the lesion.
The distribution of the lesions is asymmetrical, and has been found upon various regions of the body, as upon the face, chest, back, buttocks, arms and thighs. The shape of the patches, even in individual cases, is irregular and varies, being round or elongated, but usually roundish.
In its early stage, morphoea develops usually without any or with but slight attending subjective symptoms; later there may be more or less anaesthesia.
Diagnosis.-In its advanced stage, morphoea is so characterized that its diagnosis is readily made. Sometimes, however, it is so very like scleroderma that it is difficult to differentiate between them.
In scleroderma the patches are usually symmetrically distributed, and the affected skin is hide-bound, or can not be lifted up into a fold by the fingers, and feels hard. In Morphoea the patches are asymmetrically disturbed, and the affected skin feels soft or firm.
In scleroderma the patches are not circumscribed, but show a tendency to spread over a large surface, and at their border merge indistinctly and gradually into the surrounding skin. In morphoea the patches are often distinctly circumscribed, and confined to a limited area; and in their early stage are surrounded with a tinted border of pinkish or lilac hue, or the surrounding healthy skin is more or less pigmented.
When the pigmentless spots in Vitiligo resemble the whitish spots of morphoea, it is only to be remembered that the former is due simply to the absence of pigment, while the latter is caused by an abnormal state of structure, and of vascular supply.
Patches of morphoea sometimes present appearances very similar to those of anaesthetic leprosy. The objective and subjective symptoms in the progress of these disease are so different as to render the diagnosis between them certain.
Prognosis.-The prognosis of the disease is, to a certain extent, favorable, but depends largely on the degree of development, particularly if it has not yet become atrophic. In this latter condition the lesions are lasting; but in its earlier stage, and especially when there is only moderate hypertrophic change in the connective tissue, there is a tendency to spontaneous disappearance.
Its course of development, when mainly hypertrophic, is quite short, as compared with the period elapsed during the atrophic stage, which is usually slow and chronic, extending over several years.
Etiology.-The cause of this disease is yet to be determined. From what is known concerning the functional disturbances and trophic changes that occur in the development of its lesions, and their appearances in the hypertrophic and atrophic stages, the disease is thought to be due to some disorder of the nervous system, and probably of tropho-neurotic nature. Its occurrence has been noted mostly in females, and is at times attended with symptoms of more or less nervous debility. Scleroderma, in some essential respects, resembles morphoea, and inferentially is very likely of a similar origin. Indeed, some view morphoea as merely a localized form of scleroderma.
Treatment.-In the treatment of this disease, locally, some mild stimulant may be applied, as a mercurial preparation, and electricity to promote resolution. Phosphorated oil inunctions are beneficial. The patient should be well-fed, and have a daily allowance of either cod-liver or chaulmoogra oil.
Phosphorus is the principal internal remedy.
Scleroderma.
Scleroderma is a a chronic circumscribed affection of the skin, appearing on almost any part of the body, having been observed on the face, neck, upper and lower extremities and elsewhere. It commences with slowly-forming infiltration, apparently permeating the entire thickness of the skin, with slight elevation of the affected area. The color is slightly heightened, with a brownish red tint. At the same time the integument becomes matted to the underlying connective tissue and fasciae, and so tightly bound down to them that no motion of the skin over them is possible resembling scleriasis in this respect. This condition remains for a varying period, with constant tendency to spread, usually in the form of a band. Thus, when it commences on one of the lower extremities, for instances, it slowly progresses upward, involving a breadth of integument equally perhaps one-fourth or one-third of the circumference of the limb. after a time, the other limb, or one of the arms, may become involved. As the disease progresses, however, the part first involved undergo a change. The infiltration subsides, and gradually reveals the fact that the normal connective tissue of the skin has in part disappeared. In other words, marked atrophy is manifest. The skin, however, has not loosened its hold on the underlying tissues, and still remains as firmly bound down to them as ever.
The affection is accompanied with very little pain or other local inconvenience, except so far as it interferes with free action of the joints of the action of the joints and muscles.
The diagnosis of scleroderma is not difficult, as the hide- bound condition above described is met with in but one other affection, namely, scleriasis. The history of the invasion and the course of the affection should be sufficient to enable it to be distinguished from Morphoea.
The prognosis of scleroderma varies. In some cases it may continue for many years without apparently compromising the general health, while in others its progress may be more rapid, and possibly be the exciting cause of visceral troubles that ultimately prove fatal. Treatment.-There are no drugs known to the old school which given internally or applied externally, influence the progress of the disease in the slightest degree.
Frictions, massage, and the constant galvanic current, however, will sometimes result in very marked improvement in the condition of the affected parts.
