19. DISORDERS OF THE GLANDS



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.

Osmidrosis.

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.

Chromidrosis

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.

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.

Hydro-Adenitis.

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.

Sudorrhoea.

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.

Melford Eugene Douglass
M.E.Douglass, MD, was a Lecturer of Dermatology in the Southern Homeopathic Medical College of Baltimore. He was the author of - Skin Diseases: Their Description, Etiology, Diagnosis and Treatment; Repertory of Tongue Symptoms; Characteristics of the Homoeopathic Materia Medica.