There are two sets of organs to deal with here-the sweat glands and the sebaceous glands.
I. Diseases of the Sweat Glands.
The deviations from health may be functional or structural; the former include all those cases in which the sweat varies in amount and kind, but in which there is no change in the actual of tissue of the glands or follicles themselves; the latter, those in which the sweat follicles are likewise congested, obliterated, inflamed, enlarged, or otherwise structurally altered.
The disorders may be arranged thus:
A. Disorders of Function and B. Structural Disorders.
A. Functional Disease of the Sweat Glands.
HYPERIDROSIS is the term applied to excessive sweating. It is, however, not very often an independent form of disease. it occurs in connection with general febrile disturbances, as in pneumonia, phthisis, rheumatism-appearing to be ” critical ” in some cases. It may, however, occur as a purely local disease, and then the excessive secretion of sweat takes place from the face, the hands, the feet, or the armpits, an it is very annoying. A similar state of things is natural to some persons. The sweat may be very offensive. Hyperidrosis may give rise to eczema and intertrigo, as about the feet frequently. In some cases hyperidrosis, that is, freer secretion of sweat then usual, may be conjoined with or followed by more or less congestion of the follicles, and then the morbid states known as miliaria and lichen tropicus result. If the sweat fails to escape it may collect under the cuticle, forming sweat vesicles. This is sudamina.
Probably the most annoying form of this affection is that where the feet are the parts attacked. Various means have been used with varying success. Dr. Armingaud recommends a hypodermic injection of Pilocarpine in cases of fetid foot-sweat.
Chronic acid has been used with excellent results. Frequently, one application of a five per cent. solution of chromic acid suffices. The solution should be applied with cotton-wool to the soles of the feet and between the toes. If there are wounds on the feet, they had better be healed before applying the chromic acid.
Baryta carb.- Fetid foot-sweat, with callosities on the soles which are painful on walking; soles feel bruised at night, keeping one awake, after rising and walking.
Calcarea carb.- Foot-sweat which makes the feet sore feet feel cold and damp, as if she had wet stockings; burning in the soles.
Canthar.- Temporary cold sweat on feet; smells like urine.
Carbo veg.- foot-sweat excoriating toes; toes red, swollen’ stinging, as if frosted; tip of toes ulcerated.
Graphites.- profuse foot-sweat, not fetid as in Sepia or Silic, but the most moderate walking causes soreness between the toes, so that the parts become raw; spreading blisters on the toes, thick and crippled toe-nails.
Helleborus.- Humid, painless vesicles between the toes.
Iodum.- Acrid, corrosive foot-sweat; edematous swelling of the feet.
Kali carb.- Profuse fetid foot-sweat; swelling and redness of the soles; chilblains; stitches in the painful and sensitive corns.
Acid Lacticum- Profuse foot-sweat, but not fetid.
Lycopod.- Profuse and fetid foot-sweat, with burning in the soles; one foot hot, the other cold, or both cold and sweaty; swelling of the soles; they pain when walking fissures on the heel.
Mur.ac.- Cold sweat on the feet, evening in bed; swelling, redness and burning of tips of toes; chilblains.
Nitr. ac.- Foul-smelling foot-sweat; chilblains on the toes.
Petrol.- Feet tender and bathed in a foul moisture; feet swollen and cold; hot swelling of the soles, with burning; heel painfully swollen and red; chilblain; tendency of skin to fester and ulcerate.
Plumbum.- Fetid foot-sweat, swelling of the feet.
Podoph.- Foot-sweat evenings.
Sepia.- Profuse foot-sweat or very fetid, causing soreness of toes; burning, or heat of the feet at night; crippled nails.
Silicea.- Offensive foot-sweat with rawness between the toes; itching of soles, driving to despair.
Squilla.- Cold foot-sweat; sweat only on toes; soles red; and sore when walking.
Sulphur.- Sweating and coldness of the soles; burning soles, wants them uncovered.
Thuja.- Fetid sweat on toes, with redness and swelling of the tips; nets of veins, as if marbled, on the soles of the feet; suppressed foot-sweats, nails crippled, brittle or soft.
Zincum.-The feet are sweaty and sore about toes; also fetid; chilblains from scratching and friction; the suppression of sweat causes paralysis of the feet.
A disorder of the function of the sweat-glands, characterized by deficiency or absence of perspiration.
It is either idiopathic or symptomatic, general or confined to a location, and derived from ancestors or acquired in life from such predisposition, and may or may not be permanent.
This functional disorder of the skin is found apparently alone, unaccompanied by any other disturbance of health, in which case it is known as idiopathic. a typical case is the instance of a person who perspires but little, or apparently not at all, under conditions which would naturally provoke or accelerate the secretion of sweat, were the glands in their normal condition, as when no effect results from moist or dry heat, or diaphoretics. The skin is dry and harsh to the touch, such as seen in cases of ichthyosis or xeroderma.
The symptomatic is the more common form, and is often found associated with other cutaneous or general diseases or nervous disorders, and accompanied by general debility and impaired nutrition. There is the same dry, rough skin as in the idiopathic form, and the patient feels a tightness of the skin, with an itching sensation. This condition is general, as in diabetes; or local, as in nervous disorders like certain forms of neuralgia and paralysis; and it may be temporary, as in fevers, eczema, and psoriasis; or permanent, as in diabetes and tuberculosis.
Etiology.- Idiopathic anidrosis may be ascribed to a faulty development of, or defect in, the sweat-glands from hereditary, congenital, or other causes, as shown in the ichthyotic, xerodermic, and paralytic conditions, the otherwise general good health remaining unaffected. Symptomatic anidrosis, on the other hand, may be ascribed to functional torpor resulting in deficient secretion without structural defects in the sweat-glands, as found in cases of eczema, psoriasis, diabetes, and phthisis.
Prognosis.- In the idiopathic form, this is uncertain and unfavorable; but in the symptomatic form it is to be determined by the nature and duration of the primary disorder.
Treatment.- In the old school, the concensus of opinion seems to be that when treatment is admissible in the idiopathic form, benefit is only to be derived by stimulating the functions of the sudoriparous glands, and by the application of suitable emollients to relieve the existing dryness of the skin. In the symptomatic form the exciting cause would be removed, and the treatment directed to the relief of the subjective symptoms present. They claim that the activity of the sweat-glands may be restored mainly by diaphoretics. Resort should also be made to friction and to the use of alkaline, Turkish, or other hot baths.
Internal remedies may assist in some cases, and those heretofore found of benefit are:
AEthusa.- The skin has a dry, white, leathery appearance.
Natrum carb.- The skin of the whole body becomes dry and cracked.
Phosphorus.- The skin is dry and wrinkled.
Plumbum.- Dry skin, with absolute lack of perspiration.
Potass. iod.- The skin is dried up, and rough, like hog skin.
This name is applied to an acute affection of the sweat- glands and ducts, characterized by vesicular eruptions, usually located and confined upon the palms of the hands, but sometimes upon the soles of the feet; and in either case the sides of the fingers and toes may be involved. The vesicles at first are small, discrete, and deep; afterward they become confluent and superficial; and, finally, disappear by absorption.
The earliest symptoms of this affection, previous to the appearance of the eruption, are a tingling sensation, accompanied by heat and tension of the parts involved. When the eruption first appears, the vesicles are minute, transparent, and discrete, imbedded deeply in the skin, and there they slowly increase and become opaque or whitish in color. The end may come here, and the eruption disappear by absorption, accompanied by slight scaling of the parts affected; but, when the affection continues, the vesicles grow larger and coalesce, forming bullae; and when its course is run, usually in a few days or weeks, absorption, or rupture and evaporation of the fluid contents take place, and the bullae disappear, leaving a dry, reddened skin. The reaction of the fluid contained is acid. More or less pruritus is always present.
The eruption is usually symmetrically distributed, and, when both the hands and feet are involved, it first appears on the hands. The duration and severity of the attack are increased in persons of impaired health. Such persons, particularly young women, are predisposed to this affection, being in a relaxed and depressed nervous state, manifested in part by a mild, continuous hyperidrosis of the palmar surfaces of the hands.
Diagnosis.-This affection, when mild, somewhat resembles sudamina, but, if severe, might be mistaken for eczema vesiculosum, or scabies.
Itching and burning sensations will distinguish it from sudamina.
In eczema vesiculosum there is increased and severe pruritus, attended with a hot and reddened surface surrounding the vesicles, which are of a pin-head or less in size; these vesicles rupture early and expose a moist surface, and the drying exudation forms crusts. In dysidrosis this exposed surface is dry, and in the vesicular stage unsurrounded with inflamed skin.
In scabies there is the characteristic burrow, or cuniculus, leading up to the vesicle, and, in a later stage, multiform lesions appear, such as papules, pustules, scratch marks, etc., which, together with its favorite regions and the reddened surface surrounding the vesicles, make this affection distinct.
Prognosis.-There is always a favorable termination to this affection. Its tendency is self-limiting, but relapses are likely.
Etiology.-This affection is caused by a disturbance of the functions of the sudoral apparatus, both of secretion and excretion, usually ascribed to disordered innervation; and occurs in persons suffering from nervous depression, weakness, innutrition, and other symptoms of neurasthenia.
Treatment.-This will consist in carefully considering every abnormal condition of the patient, and prescribing that remedy whose symptoms cover most closely those complained of the patient. As almost any remedy in the materia medica may be needed, it would not be possible to give the indications here.
This is that disease in which the odor of the perspiration becomes so offensive as to constitute “the thing to be remedied.”
Osmidrosis may co-exist with other functional derangements of the sweat apparatus. In general diseases the sweat exhibits very peculiar odors-in rheumatism it is “rank,” in scurvy, “putrid,” in chronic peritonitis, “musky,” in scrofula like “stale beer,” in intermittent fevers like “fresh-baked brown bread,” in fevers, “ammoniacal,” and so on. When the feet are affected, the sweat is sometimes most offensive, especially in the summer time.
This term signifies colored perspiration, a condition by no means common. The perspiration may be changed to a black, a blue, a red, or a green color in certain cases. The black (melanidrosis) and the blue (cyanidrosis) varieties of perspiration are probably the same in nature, the substance giving the color being identical, but varying in hue in the two cases.
It generally occurs in hypochondriacs, or in women with uterine disorders of different kinds. It is seen as a symmetrical affection attacking mostly in eyelids, and the lower one chiefly, but in other instances and more rarely the upper eyelid, the cheeks, the forehead, the sides of the nose, the breast, the stomach, and the hands. It consists of an oozing of black matter which can be wiped away, but only as a rule to quickly reappear. The discolored secretion is excited by grief, by emotions, by fright, and the like, it is said.
The disease may be, and often is, simulated. But there appears to be no doubt that there is a real chromi-drosis. The coloring matter is probably indican, which is, as it normally exists, colorless, and occurs pathologically in human urine. The indican is believed to be secreted by the sweat glands in a colorless state, and to be acted upon by the air so as to be oxidized blue, or brown, or blackish, as the case may be.
Haematidrosis, or Bloody Sweating, occurs under similar circumstances and is supposed to be due to the escape into the sweat glands of blood from the capillaries, in its turn the result of great excitement.
B. Structural Diseases of the Sweat Glands.
Miliaria and Sudamina.
These two affections really have no right to be considered as separate diseases. Sudamina is the lesser degree of miliaria, the contents of the vesicles being acid; miliaria is the more developed condition, in which inflammation has occurred and the contents are alkaline- in fact, inflamed sudamina. Sudamina have been described as little round vesicles, produced by distension of the cutis by sweat, and therefore seated at the orifices of the sweat follicles. These vesicles may be attended with more or less inflammation. Then the disease is termed miliaria. Sometimes the vesicles are reddish (miliaria rubra), sometimes white (miliaria alba). These vesicles are developed about the neck, axillae, clavicles, and trunk, in diseases in which profuse sweating occurs, their contents quickly dry; each crop is usually succeeded in from three to six days by furfuraceous desquamation. The disease is seen in phthisis during summer-time, in acute febrile diseases, the parturient state, fevers, and rheumatism. Since the adoption of a cooler regimen in sick-rooms, the disease has been altogether less frequent than formerly.
Bryonia, Ammonium mur., Arsen. alb., Ledum, and Urtica urens are the most important internal remedies. Sulphur and Apis may be studied.
A weak carbolated bran bath, followed by dusting with either the nitrate of bismuth and starch, or lycopodium powder, is the best local treatment.
Lichen Propicus, or Prickly Heat.
This has nothing to do with lichen. It is a congestive or inflammatory disorder of the sweat follicles of the skin. It occurs as the result of the stimulant action of heat upon the surface. It is therefore common in hot countries, but not rare in this climate. “Prickly heat” is generally described as an eruption of numerous papillae of vivid red color, about the size of pin’s head, without redness of the skin generally, often interspersed with vesicles and accompanied by a peculiar tingling and prickling sensation, which may be almost intolerable, and is excited and intensified by heat, warm drinks, flannel, etc. The disease attacks chiefly the parts covered by the clothes, the arms, legs, breast, thighs, flanks, and the upper part of the forehead.
The treatment is the same as that for miliaria.
This is an inflammatory state of the perspiratory follicles, ending in suppuration. The disease may occur in every region of the body where there are glands, except in the sole of the foot; but it is most frequent in the axilla, at the margin of the anus, and near the nipple. It also is seen on the face. The disease commences by a crop of, or perhaps only one or two small inflammatory, tumors, always distinct, about the size of peas, of bright red hue. and at first somewhat like boils; but they are unlike boils in the fact that the little inflamed indurations begin not on the surface of the skin, in a sebaceous or hair follicle, but beneath the skin, which is reached and involved secondarily. The suppurating follicles offer no prominent “point” or “head,” and there is no discharge till the swelling bursts, When the disease is brought to a sudden termination. The causes are said to be uncleanliness, friction, the contact of irritants, pus, parasites, profuse perspiration, and, according to Bazin, the arthritic dyscrasia, syphilis, and scrofula, but nothing is known about this. This disease is often mistaken for scrofuloderma.
Cystic Formations (Obstructed Sweat Glands).
In some cases one sees developed in the skin a cyst, which takes its origin in a dilated follicle or sac of the perspiratory glands. The follicle of the sweat gland becomes obstructed, and instead of the gland inflaming and suppurating the fluid collects and distends to follicle. The line of demarcation between hydro- adenitis and cyst formation in the early stage is not well defined.
The continuous application of collodion is the best treatment; the cysts, however, may be punctured, and the contents allowed to escape; the incisions must, however, be deep enough.
This is characterized by the appearance of one or more slightly reddened, barely elevated, and sharply limited patches, more or less thickly covered with a few greasy scales. These appear occasionally on the scalp; more frequently, however, on the contiguous skin along the hairy border; and still more frequently on the chest in men-rarely in this region in women.
The affection is essentially sub-acute in its behavior, and chronic in its duration. Vigorous friction will remove the scales and leave a surface not wholly unlike that of a dry eczema which has been submitted to the same treatment, and occasionally will excite a slight oozing of oleaginous matter, quite different, however, from the clear but plastic exudation of eczema. If a little liquor potassae be rubbed on the spot, we will have under the finger a thin, non-adhesive emulsion, and not the sticky layer which follows a like application to a patch of eczema.
Besides the regions mentioned, the affection may appear on the back, and, according to Unna, on the lower extremities. The patches may vary in number and in shape, being round, oval, semilunar, or irregular, as if made up of several circular patches which had united; in fact, it may assume the varieties of form that are familiar to us in connection with psoriasis, for which disease it is not infrequently taken.
Sudorrhoea, when left unchecked by treatment, often persists, with varied activity, for an indefinite period, even for years.
Nothing definite is known as to the cause of the affection. It is possibly due to a micro-organism, but this has not as yet been positively shown to be the case.
Treatment.-There is little difficulty in causing a temporary amelioration, and even disappearance, of the lesions. Frictions, with precipitated sulphur, sulphur-ointment, white precipitate, and applications of chrysarobin, will usually be sufficient to restore the skin to a comparatively healthy condition, but within a few weeks after treatment is discontinued we not infrequently see evidences of relapse. These must be immediately taken in hand, and we can usually count on a complete cure if treatment be followed up with needful persistence.
I know of no homoeopathic remedy that is especially useful in this complaint as I have never had an opportunity of treating a case of sudorrhoea.
II. Diseases of the Sebaceous Glands.
The diseases of the sebaceous glands are divided into two groups-namely:
FUNCTIONAL.-Including seborrhoea (increased secretion), asteatodes (deficient secretion) and allosteotodes, or alternation in the character of the secretion. Retention of secretion is usually accompanied by alternation of structure.
STRUCTURAL.-Including diseases of the lining membrane of the sebaceous glands; retention of the secretion and its consequences, and, lastly, congestive diseases and inflammatory diseases.
Seborrhoea is a functional affection of the sebaceous glands, and its chief varieties are Seborrhoea oleasa, sicca, and kerativa.
This variety is characterized by the excessive formation of a thin, oily, sebaceous secretion, which flows in abnormal quantity from the orifices of the glands and covers the affected parts with a shiny and greasy coating, plainly visible to the eye, and on this account annoying to the patient. The usual seat of the trouble is the forehead, cheeks, and nose, and especially the latter. If this organ be taken between the fingers and squeezed, the fluid may sometimes be seen to exude like little droplets of sweat. The affection is perhaps more frequent in youth, and often lasts for several years, and appears to be connected with puberic changes. If the secretion be not wiped off, it may lose its watery parts by evaporation and leave thin scales, consisting of epidermic cells mingled with oil-globules, and more or less dirt and dust from the atmosphere.
In this variety there is excessive formation of sebum, possessing more nearly the character of the normal secretion-that is less, fluid than in the last named affection. There is also a larger proportion of epidermic cells, and these, mingled with the oil, dry upon the skin as thin, slightly adhering, and usually circumscribed crusts. The affection is usually of an extremely mild inflammatory type, with slight redness of the skin underlying the scales. It may be found on the situations favored by the last mentioned variety, or upon the chest in man and other parts where the sebaceous glands are well developed, but the hairs not so abundant or long as upon the head, except in infancy, during the early periods of which it is quite common.
This affection is rare and peculiar, and the few cases that have been observed during recent years have been described under a variety of names. It appears to consist in a hyperplasia of the lining cells of the sebaceous glands, associated with keratization in place of the usual fatty degeneration of these cells. The result of this pathological process when generalized is a condition of the skin that may be likened to the surface of a magnified nutmeg grater. The orifices of the sebaceous follicles are widened, and from them project horny plugs in almost infinite number. The affection is chronic in its development, spreading gradually until almost the entire surface is involved. We have little definite knowledge of the subsequent course of the affection.