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.
Seborrhoea is a functional affection of the sebaceous glands, and its chief varieties are Seborrhoea oleasa, sicca, and kerativa.
Seborrhoea Oleasa.
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.
Seborrhoea Sicca.
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.
Seborrhoea Kerativa.
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.
Diagnosis.-The diagnosis of seborrhoea oleosa is self- evident. S. sicca is to be distinguished, on the one hand, from eczema oleosa, and, on the other, from pityriasis capitis. This latter is distinctively an affection of the adult scalp, characterized by excessive hyperplasia and exfoliation of the horny cells of the epidermis, and mingled with but a scant amount of sebaceous secretion.
Treatment.-Lotions containing hydrochloric and chromic acids-either of which may be employed in the strength of from two to four per cent., are highly recommended by the old school.
The indications for the homoeopathic remedies are:
Arsen. alb.-Smutty brown, mottled skin; yellow color of face.
Ammonium mur.-Large accumulation of bran-like scales, with falling off of the hair.
Bufo.-Skin greenish, and always looking dirty and oily.
Bryonia.-In long lasting cases.
Calcarea carb.-Nose shines as from oil. Seborrhoea with hyperaemia of the scalp and headache.
Graphites.-Seborrhoea behind the ears.
Iodine.-Firmly adhering scales, which leave the skin red and painful, on removal.
Kali carb.-Dry hair rapidly falling off, with much dandruff.
Lycopodium.-Seborrhoea on the chin.
Mercurius sol.-Seborrhoea of the genitals, accompanied with hyperaemia.
Mezereum.-Excessive formation of smegma.
Natrum mur.-Severe itching of the scalp; the hair falls out in masses; seborrhoea of the face.
Plumbum.-The skin of the face shines as if oily, and feels oily.
Phosphorus.-Copious dandruff; falls off in clouds.
Potass. brom.-Seborrhoea on hairy parts of the face, forehead and neck.
Raphanus.-Skin is greasy and makes the hands greasy to touch
it.
Sepia.-Seborrhoea of the genitals in women.
Sulphur.-Dandruff.
Thuja.-White scaly dandruff. Hair dry and falling off.
Vinca minor.-Seborrhoea on upper lip and base of the nose.
Asteatodes.
This is deficiency of the sebaceous secretion. The skin appears to be dry and harsh, and this arises from deficient action of the sebaceous glands. Asteatodes is seen in hereditary syphilis, and in badly-nourished or uncleanly folk. The treatment consists especially in the use of the bath, oily in frictions, generous diet, and cod-liver oil.
Allosteadodes.
Alteration in the quality of secretion is the characteristic of this form of disease. The secretion may be of various colors- yellow (seborrhoea flavescens), or black (so-called seborrhoea nigricans).
Structural Diseases.
Xanthelasma.
Hypertrophy of the epithelial lining and adjacent structures of the follicle, with fatty degeneration, is called Xanthelasma, because of the yellow laminae which characterize it. The disease may occur in two forms- “either as tubercles, varying from the size of a pin’s head to that of a large pea, isolated or confluent; or secondary, as yellowish patches or irregular outline, slightly elevated, and with but little hardness.” These are mere modifications of one disease, but may occur together in the same person. The disease is seen about the face, the ear, and the limbs and palms of the hands. The most common form and seat is a yellowish patching about the inner part of the eye; the disease is symmetrical; the cuticle over the diseased part is unaffected. It never occurs in children; but it is fairly common in middle and senile periods of life. In a small proportion of cases, that are very severe, jaundice with enlargement of the liver is met with. When jaundice occurs, it almost always precedes the xanthelasmic patches. The form of jaundice is peculiar, the skin becoming of an olive brown, or almost black tint, rather than yellow, and the color being remarkable for its long persistence.
Xanthelasma occurs more frequently in females than in males, the proportion being two to one. The patches occur to those who have been liable to have dark areola round the eyes, whether from “sick-headaches,” ovarian disturbance, nervous fatigue, pregnancy, or from any other causes. Hence their frequency in bilious subjects, and in the female sex.
Retention of Secretion.
Comedones, or Comedo.
This name is applied to an affection of the skin characterized by little black corresponding to the openings of the sebaceous follicles. If the skin in the neighborhood of these specks be squeezed between the finger nails, the sebaceous plug which fills the follicles will be pressed out.
This affection is more frequent in youth and adolescence that at any other ages. The glands of the face are the ones that are chiefly affected.
The causes of comedo are probably similar to those which lead to the development of ordinary acne simplex, in company with which affection they are usually found, though they sometimes exist without any inflammatory complication.
One author holds that comedones in children differ from those of adults in being mainly dependent on local causes, on their greater tendency to group and to be more closely set, i n their involving the hairy scalp, and finally to their being generally readily amenable to treatment, all that is usually required being friction with a weak soft soap and spirit liniment, or a weak sulphur application may be employed in mild cases, preceded by fomentation with very hot water.
