A peculiar variety is described by Dr. Dumesnil, as occurring in two patients. In both cases, the unusual eruption occurred on the back, which was also well covered with acne. The comedones, in both cases, were well marked, the skin not being elevated at the sites where they existed. The distribution of these comedones was all over the back, though inclined to be discrete. One peculiarity of the distribution was, that many of them were in pairs, the distance between each varying from one- eighth or less to about three-sixteenths of an inch, with a channel connecting them. By bringing firm lateral pressure upon one of the condones in the direction of the other; both follicles were emptied from one point, and a fine probe introduced at one opening would appear at the other. There was but one plug, and that was black at both extremities.
Treatment.-The comedones may in most instances be readily removed by pressure with the fingers or aided by some one of the many comedone extractors. Sexual hygiene is to be enforced if the trouble is to be radically cured.
The principal internal remedies are Baryta carb. and Selenium.
Others may be indicated as follows: Bellad.-Comedos in young full-blooded people. Cicuta.-Black spots on the skin.
Digitalis.-Black comedos on the skin of the face, which suppurate.
Mezereum.-Small comedos on the nose and cheeks.
Nitr. ac.-Black sweat pores in the skin of the face.
Sabina.-Comedos that can be easily pressed out, in the cheeks and about the nose.
Sulphur.-Blackish pores in the face.
Sumbul.-Numerous black pores on the face; skin pale.
Molluscum.
This affection is characterized by the development of small, umbilicated papules, or tubercles, from the size of a small bird- shot to that of a pea, and sometimes even larger.
The natural color of the skin is usually preserved, and the tubercles are not accompanied with inflammatory action. If they are squeezed between the fingers, a cheesy or sebaceous-looking matter issues from the hilum.
These molluscous growths are met with on the face, neck, chest, limbs, and genitals, and may be few or numerous, coming out one after the other for several weeks or months.
After they have attained a certain size they may persist for an indefinite period, often at the end shriveling up and leaving a little tab of loose skin.
This affection is most frequently developed in young females, but is occasionally met with in males and in persons more advanced in years.
The etiology of molluscum is obscure, but the weight of evidence appears to be in favor of contagion. In what the contagious element, however, consists is unknown.
The diagnosis of molluscum is easy, as we have simply to recognize a non-inflammatory, umbilicated tubercle, with cheesy contents.
Treatment.-The quickest way to get rid of them is to snip them off with scissors; and, after pressing out the remaining contents, to introduce the point of a pencil of nitrate of silver.
Silicea as an internal remedy ranks first, and Teucrium next. Bryonia, Bromine, Calcarea ars., Lycopodium, Natr. mur. and Potass. iod. complete the list.
INFLAMMATORY AFFECTIONS.
Acne.
Acne is an inflammatory affection of the sebaceous glands.
Acne, in its mildest form of development, consists of a small papule, usually seated on the face, chest, or back. The papule is red, pointed, and may be slightly sore to the touch, presenting the usual features of a localized inflammation. The papules may vary in number from one or two to several hundred, scattered over the nose, cheeks, forehead, temples, chest, and back. The little pimple may, on pressure with the finger, present slight firmness, indicative of the inflammatory effusion. After a few days it may undergo spontaneous resolution and disappear, others appearing from time to time to take the places of those which have disappeared. This constant succession may be kept up for an indefinite period. Instead of undergoing resolution, pus may make its appearance, either at the summit of the papule or more deeply in its structure, thus converting the papule into a pustule. If the pustule be squeezed between the fingers, the pus is discharged, and with it the somewhat altered contents of the sebaceous glands. This form of acne, in which there is little or no implication of the tissues surrounding the follicle, is usually termed acne simplex, or on account of the age at which it is most prevalent, acne juvenilis.
The variety of acne just considered is the special appendage of youth, and occurs in both sexes between the ages of fifteen and twenty-five. Associated with it we frequently and perhaps usually find comedones in greater or less number scattered over the surface affected by the acne.
In more advanced life-from twenty-five or thirty up to fifty years-we may encounter a form of acne characterized by much larger lesions than those of acne simplex. In fact, they are large enough to be classed as tubercles and the affection has received the name of acne tuberculata, and, when seated on a hardened base, acne indurata. In this form there is more or less involvement of the tissues surrounding the follicles. These larger lesions are usually more sluggish in their development and coarser than those of acne simplex, but go through essentially the same phases as the smaller ones. That is, there is the same tendency to pus formation, and the larger ones may form veritable abscesses, followed by permanent cicatrices.
The cause of the affection are well-known to be local irritants, cosmetics, want of cleanliness, exposure to heat, cold winds, some varieties of soap, all debilitating causes, too rich or insufficient food, onanism or sexual excesses, liver, stomach or uterine derangements, and any cause that may lead to congestion of the face. Scrofulous subjects are very prone to this form of skin disease.
Acne tuberculata is not a very common affection in women; but when not associated with intemperance will usually be found accompanied by disease of derangement of the uterine or ovarian functions.
Gastric and hepatic disturbances, associated with constipation, are unquestionably important factors in the causation of acne, and too free indulgence in alcoholic stimulation is well recognized as the promoter of acne tuberculata in men who are advancing from youth to middle age.
Treatment.-Time alone, without special medical treatment, is sufficient in many cases of acne simplex in young persons to bring about a cure. Acne simplex is in a certain sense a self- limited affection, but this limitation is not a matter of weeks or months but of years, and the patient who leaves the affection entirely alone may usually count on six or eight years of annoyance. The majority prefer a quicker cure, and to that end consult the physician. Now, the “cure” of an acne involves two quite different questions. The first relates to the speedy removal of the existing eruption, and the second to the prevention of the ever-recurring tendency to relapse.
Baehr says that acne patients are very hard to treat, as they generally feel so well that a restriction in their diet is hardly ever taken with good grace, or strictly followed out.
Hebra says: “I must confess that, in spite of many efforts, I have not yet succeeded in finding a remedy by which acne can be prevented from developing itself, or quickly got rid of when established”.
In acne simplex the measures best calculated to promote disappearance of the eruption are: Puncture of the papules and pustules; hot fomentations, in cases characterized by marked inflammatory action; stimulant and discutient applications in those of a more sluggish nature. It is good practice in every case to puncture the papules with a lancet-point, and at the earliest possible moment. If pus has already formed, this should be squeezed out. Hot fomentations for several minutes should then follow, and the fomentations with water, as hot as it can be borne, repeated night and morning.
In subacute cases an artificial irritation should be set up by nightly rubbing with green soap. Usually in a week, or in less time, the skin will be inflamed to as great an extent as the patient’s endurance will permit. Soothing applications should now be employed, and in a few days the irritation will subside, accompanied with desquamation of the outer layers of the cuticle. This will be followed by a greater or less disappearance of the eruption. If necessary, the applications may be repeated. In like manner, sulphur, either pure or diluted with some violet powder, may be applied with a ladies’ puff. Chrysarobin, in the strength of four or ten grains to the ounce of traumaticin, effects similar results. In the use of chrysarobin, however, it will be wise to commence with rather mild applications confined to the papules themselves, and not permitted to spread to the adjacent healthy skin, as this drug when too freely applied to the face may set up a considerable degree of inflammation, almost simulating erysipelas.
Dr. Hutchinson advises the passage of the cold urethral sound every third day in cases that are attended with or caused by hyperaemia or irritability of the genital organs. In females, he orders hot water vaginal injections every other night, and claims in both instances successful results.
