Antimonium crud., Alumina, Berberis, Causticum, Mercurius, Pulsatilla, Rhus tox., and sulphur may often be of service.
Scleriasis.
Scleriasis is an acute affection of the skin, characterized by the student development of a curious scleroid condition over an extensive surface. In few days the greater part of the integument of the chest, abdomen, or back may, without change of color or any inflammatory symptoms, become rigid and firmly bound down to the tissues beneath. It appears to have absolutely lost its elasticity, and to be so firmly attached that it is as impossible to raise or pinch it up in folds as it would be to pinch up paint or varnish from a board.
This condition may exist in varying extent and of varying degrees of severity for several weeks, when a gradual return to the normal may ensue.
The prognosis is good, as the cases usually recover.
The etiology is obscure, but the affection is probably of rheumatic origin.
Treatment.-Little need be done in the ways of special treatment, but proper attention should be given to the correction of any marked impairment of the general health. Turkish baths and massage, with or without electricity, appear to shorten the course of the affection.
As internal remedies Hydrocotyle, Phosphorus, and Stillingia may be thought of.
Sclerema Neonatorum.
This is an affection of the skin met with in new-born infants, in which the greater part of the integument may become rapidly involved in a progress which results in a generalized hide-bound condition, which interferes with motion of the limbs, and even restricts the action of the thoracic muscles. A fatal termination is usually to be looked for in a few days.
The nature of the disease is obscure-in fact, its exact etiology is unknown; but its general feature point to a close relationship to the affection described as scleriasis, as met with in adults-the better prognosis in this latter disease being due to the greater resisting powers of the adult.
Treatment, other than sustaining, appears to be of little avail.
Keloid.
Keloid is characterized by the growth upon the skin of one or more rounded or oval, flat, smooth-surfaced tumors of varying size, from the margins of which irregular projections are frequently met with.
The development and progress of the affection is chronic, and is attended with but little pain or other inconvenience. The color of the skin is in some cases little changed, while in others it becomes paler and even completely blanched, like that of ordinary scar tissue.
The affection is said to arise spontaneously, and at other times at the site of some traumatism or wound of the skin; and the terms true and false Keloid have been been applied to these two forms, which are to be distinguished only by their etiology.
Vidal reports the case of a 53 year old man in whom a keloid, nine centimetres long, three centimetres wide and one centimetre high, developed spontaneously in the sternal region. He did not have syphilis and no discoverable cause could be found. At first it increased in size, but slowly; since 1878, however, it grew more rapidly and became painful. A second keloid has lately developed in the flexure of the right elbow, also without visible cause.
We know, however, that keloid may arise from even the minutest wounding of the skin, as from the prick of a pin or lancet point.
Amicus reports the case of a young nervous woman who, from childhood, suffered from nervous symptoms. One year before coming under his observation she was attacked with a symmetrical eruption on the trunk and lower extremities, showing 318 keloids, the size of millet seeds. The lymphatics were normal; the urine showed nothing wrong. During her sojourn in the hospital she had several convulsions, retention of urine, etc. These so-called keloids were small pinkish elevations on the skin, which might be mistaken for sarcomata. No trauma preceded the trouble.
Mr. Hutchinson mentions some rare forms of Keloid, in which he details several interesting cases, with the following conclusions: 1. That with keloid, as with other skin disease we must not expect too close a conformity to the type form.
2. That for clinical convenience, we may recognize several varieties of keloid, the prognosis as to spontaneous disappearance and proneness to return after excision differing much in each.
3. That the first and most typical is that in which keloid begins in very small, perhaps forgotten scars, and slowly spreads far beyond their limits into sound skin. In most cases, the extension and duration are indefinite; and the hardness, glossiness, abruptness of outline, etc., are always well marked. The proneness to recur very quickly after excision is very great in these.
4. That in the second group, in which keloid growth begins in the middle of large scars, such as those of burns, it is seldom so well characterized. It often does not extend beyond the scar, and often, especially in young persons, soon begins to soften again, and to gradually disappear.
5. That in a third form the keloid growth is deeper, never produces the glossy, superficial, elevated and spurred patches which occur in the others. These cases are very slow, and show but little tendency to spontaneous disappearance. They do not develop in connection with large scars, but rather with inflammatory damage to the skin. They are less prone than the others to recur after excision.
6. That although definite scars almost invariably precede the formation of keloid, yet that there are allied conditions which result rather from inflammation after injury, than from anything which is demonstrable as cicatrix.
7. That the cases of multiple keloid prove either that there is in some persons a remarkable tendency to the disease, or that primary patches have the power of infecting the blood and producing others. 8.That there is little or no clinical proof of tendency on the part of keloid to pass into cancer.
The etiology of keloid is unknown, and we can only say that some individuals possess a certain peculiarity or idiosyncrasy that leads to the development of this curious affection.
Treatment.-Excision, cauterization, potential caustics, whether alkaline or acid, when of sufficient power to rapidly destroy the tumor, are almost invariably followed by relapse and often in an aggravated form. Relief sometimes follows scarifications followed by the application of acetic acid. The operation should be performed a number of times, according to the size, etc., of the tumor. In cases of excessive keloidal growth, excision may be employed as a means of temporary relief.
Several cases are recorded where electricity has been employed with excellent results.
Fluoric acid is the principal internal remedy, and the next is Graphites. Nitric acid and Sabina are occasionally indicated.
Dr. Neatly reports a number of cases as cured by the persistent use of Silicea for a few months.
Fibroma.
This name is applied to tumors of varied size and form, which take their origin from the dermal or sub-dermal tissues, which are single or multiple, and vary in size from a small nodule to a tumor of many pounds` weight. These tumors may be sessile or pedunculated.
The affection is chronic, taking years for its complete development, but the growth are usually painless, and give little or no inconvenience, except such as may arise from their size or particular location.
The causes of fibroma are unknown, but they are of perhaps more frequent occurrence in mulattoes than in either the pure white or black races.
Diagnosis.-Fibromata are to be distinguished from sarcomata and neuromata, and this may be readily done when we remember that the former are of more rapid growth, and exhibits changes in the color and texture of the skin, which in fibroma are unaffected. Neuromata are usually painful. The diagnosis must be made in the early stage from sebaceous cysts; in the case of cysts, the origin from a flat gland, the central aperture or entrance to it, and the fatty contents which can be squeezed out, determine the nature of disease. The hard contractile sessile outgrowths of keloid could not well be mistaken for the lax, flabby, pedunculated tumors of fibroma, which have the aspect of normal integument.
Treatment.-Piffard says: “Excision is the only practicable method of treatment, and this is to be recommended only when the tumors are few in number, or when their situation demands it.”
Fox says the treatment is simple: “When small, fibromata may be removed. In elderly men they are sometimes small, flat, and numerous-especially about the back, over the shoulders, and on the chest. I have never had the least trouble in getting rid of them all by the use of acid nitrate of mercury caustic to the smaller, and the joint use of that remedy and the ligature to the larger ones. I generally, after applying the acid, give an oxide of zinc paste to be used, to prevent too much irritation.”
The Arsenite of calcarea and Lycopodium are the principal internal remedies.
There is yet another form of fibrous hypertrophy, in which greater laxity of tissue is observed. It is called-
