Affections of the Skin

the hygienic system orthopathy chapter 21

SKIN INFLAMMATIONS

ACNE

Definition: Acne is inflammation of the oil glands of the skin and of the follicles of the fuzzlike hairs attached to the oil glands. It manifests as small, or large, pimples, often containing pus. Various qualifying terms have been added to the term acne to distinguish its most important features.

Acne artificialis, or artificial acne, is papules produced by the internal use of such drugs as the bromides and iodides and the external application of tar, chrysorobin, etc.

Acne atrophica, or atrophic acne, is simple acne in which the lesions are followed by scars or small pits.

Hypertrophic acne, or overgrowth acne, is acne followed by thickening of the skin from an overgrowth of connective tissue.
Symptoms To Expect
Acne indurata differs from the simple form chiefly in the degree and extent of the symptoms and the hardening (induration) which are present.

Acne papulosa, or papular acne, is simple acne in which papular eruptions (solid raised spots on the skin) predominate.

Acne pustulosa, or pustular acne, is acute acne simplex with papules developing into pustules.

Acne rosacea is acne plus rosacea, or a chronic congestion of the nose and parts of the face.

Acne scorbutis, or scurvy acne, is a papular acne with hemorrhages into the skin.

Acne scrofulosum, or malnutritional acne, called also scrofulous acne and acne cachecitcorum, occurs in undernourished or scrofulous or emaciated individuals. If develops chiefly on the trunk and lower limbs, though, occasionally, the arms and face are affected.

Acne simplex is simple acne, which is the most common form, hence the term acne vulgaris.

Acne varioliformis is a form of acne, the pustules of which resemble those of variola (smallpox). It develops chiefly on the forehead, along the hair margin, also the scalp, face and neck, and, sometimes, the shoulders and breastbone.

With the exception of acne artificialis, these various forms of acne are merely variations of simple acne, hence we will describe this only.
Simple acne is seen more often in girls and women than in boys and men; develops chiefly on the forehead, cheeks, lower jaw and chin, and sometimes on the chest, shoulders, upper arms, and even down the back and thighs; develops chiefly during the adolescent years and tends to disappear upon the attainment of maturity, although it may persist long after thirty is passed. It is often aggravated before and during menstruation.
Blackheads usually constitute the center or nucleus for the beginning of the inflammation. A papule develops around this center and later becomes a pustule. However, acne may develop without blackheads and blackheads may exist without acne developing.
A crust forms on the pustule, then falls off, leaving a redness which lasts a few days, or a depression or scar may be left. In many cases no pustules develop, the condition remaining in the papule stage, in which cases, the papules are absorbed after a few days.
On the same face, or other portions of the body, and without any semblance of regularity, there may be seen all stages — blackheads, papules, pustules, crusts, redness, pittings or scars. Frequently we see faces that have become so badly pitted their owners look like they have had smallpox. Few things can so completely spoil the beauty of the face as acne. The scars may be permanent, or they may gradually smooth out. In some cases no scars are formed. The stain that often remains tends to fade out, eventually.
If the papule of acne is opened or squeezed, blood, pus and fatty substance and, if present at the beginning of the papule, the blackhead, are found. Healing is usually rapid after evacuation of the contents, though squeezing usually tends to aggravate the local lesion. If the pustule is not molested spontaneous evacuation occurs.
In acne indurata the areas of hardening vary from the size of a pea to as a large as a hazel nut. They begin deep below the epidermis, are usually deep red or purplish, often involve several adjacent glands, thus giving the appearance of boils, and may contain much pus. The lesions often fail to rupture spontaneously. When opened and evacuated artificially, they tend to refill rather than to heal. Scar formation is often very pronounced, especially where there has been much squeezing or direct pressure. Fibroid changes in the scars may cause them to resemble fibroid tumors.
There are no general symptoms with acne and the sufferer is inclined to regard himself as otherwise healthy.

ACRODYNIA

Definition: A symptom-complex marked by pricking pains in the palms and soles, hyperesthesia, and eruption on hands and feet.

Symptoms: This is an acute non-febrile erythema accompanied by nervous symptoms. It is considered to be related to pellagra, as it possesses similar symptoms. There are swelling of the face or extremities, erythematous eruptions on the hands up to the wrists and the feet up to the ankles, involving, as well, the fingers and toes; there is redness of the eyes, sensory disturbances such as a sensation of crawling insects on the skin, pain in the fingers and toes, sticking pains in the palms and soles, feeling of weight in the extremities, hyperesthesia and, sometimes, anesthesia. There is also irritation of the stomach and intestine. This symptom-complex occurs epidemically usually following the many catarrhal crises called "influenza."

CARBUNCLE

Definition: This is a circumscribed subcutaneous inflammation, having a deep-red knob and often ending in a suppurating slough.

Symptoms: Carbuncles resemble boils but are more extensive, the inflammation involves the deeper tissues as well as the skin, are very painful and discharge their contents through several openings. Beginning as a fairly rapidly increasing painful knob on the skin, of a deep-red color, and flattened on top, surrounded by a hardened, painful and dusky-red area, It enlarges, pus forming in seven to ten days, which is discharged through craters formed by sloughing of the top. General symptoms such as may appear in any suppuration — fever, malaise, etc. — are pronounced. Carbuncles develop most often on the nape of the neck, back and buttocks. The scalp, face and back of the forearm are less frequent locations of development.

CTHYMA

Definition: The word means pustule. It is applied to an inflammatory skin affection characterized by separate, flat, deep-seated pustules having broad inflamed bases.

Symptoms: This condition seems to be secondary to other skin inflammations and is seen chiefly in the poorly-nourished and debilitated. The pustules range from the size of a pea to as large as a dime, are sometimes long and narrow, and are yellowish in color. The pustules usually dry, forming reddish-brown crusts. Pigmentation and raw surfaces, followed by scar formation, usually succeed the disappearance of the pustules. The legs are most often affected; sometimes the trunk and neck.

FURUNCLE (Boil)

Definition: An inflammation of the skin and underlying connective tissue surrounding a hair follicle or oil gland, leading to the formation of pus and death of the central portion or core, which is expelled. If a crop of boils appears the condition is called furuncolosis.

Symptoms: Boils are more common in men, especially youths, than in girls or women. The boil, develops rapidly, reaching full development within three or four days. It begins with a dull, aching pain, which rapidly grows more intense, with severe throbbing and a sense of tightness, these symptoms being more intense at night. The boil becomes "ripe" in seven to ten days. When the boil cap ruptures the core is usually expelled spontaneously leaving a small cavity of considerable depth. This heals quickly, leaving a small scar which gradually fades. Boils are occasionally accompanied with slight fever and other symptoms of a general nature. A "blind boil" is one in which no core is found. They may develop anywhere on the body, in the outer canal of the ear, etc.

IMPETIGO (Scrum pox)

Definition: This is a skin inflammation characterized by a pustular eruption occurring chiefly around the mouth and nostrils, the pustules of which rupture within a short time or become encrusted.

Symptoms: Two chief forms are described as follow:

Impetigo contagiosa is the, common form and is considered "contagious" since epidemics are common among children under ten in institutions. It is the most common skin affection of school children, especially among the poor, and is seen often in adults, especially in the beards of men. The eruptions are flat, yellowish, superficial vesicles or blebs, usually on the face, neck and hands. These rapidly develop into indented pustules, surrounded by a red area. Wafer-like crusts form, their edges loosen, the crust curls up and falls off, leaving a red spot that soon fades to normal. There may be slight fever and itching.

Impetigo herpetiformis is a rare acute form presenting crops of clustered small pustles developing usually on the lower front of the trunk (pelvis), the groins, and inner and back sides of the thighs. Chills and fever accompany each eruption of pustules and various severe general symptoms may develop.

POMPHOLYX (Dysidrosis)

Definition: A rare acute skin inflammation occurring usually in those who sweat excessively and characterized by the formation of deep-seated vesicles symmetrically between the fingers and on the palms.

Symptoms: Developing on the hands, and occasionally the feet, the vesicles gradually increase in size until they become blebs, which do not rupture, their contents being gradually absorbed, to be followed by extensive scaling which exposes a red skin beneath. Heat, itching, tingling or burning, pain and sensitiveness, and often some nervous depression, usually develop. The surrounding skin becomes sodden, painful and scaly. Repeated crops of vesicles and blebs, differing in intensity, are frequent. Healing takes place slowly within a few weeks.

URTICARIA (Nettle Rash, Hives)

Definition: This is a transitory inflammation of the skin characterized by short-lasting elevations that itch intensely. It is also called hives, in America. In Great Britain, the term hives is applied to croup, laryngitis, and chicken pox.

Symptoms: This affection seems to develop most often in the nervous type of child and in children with a very sensitive skin. The eruption in the form of firm, well-defined wheels with red bases and white summits, raised irregularly on various parts of the body, appears suddenly. They may appear locally or generally. "Individual" hives usually last but a few hours, but each crisis usually lasts a few days, new eruptions appearing as others subside. Occasionally, chronic hives develops. The term nettle rash is applied to these symptoms because they resemble those occasioned by the sting of the nettle.

ATROPHIES OF THE SKIN

ATROPHODERMA NURITICUM (Glossy Skin)
Definition: A rare affection of the skin characterized by a glossy skin.

Symptoms: One or more fingers or toes (usually the fingers) become smooth and glossy, they lose any hair that may be on them, the normal skin lines are obliterated, there are local burning pains and neuralgia, and they appear "blotched as if by chilblains." The nails may also undergo nutritional changes.

Etiology: Nutritional changes in the skin due to injury to the nerves of the parts affected produce this condition.

Care of the Patient: Improve general and local nutrition, circulation and nerve tone, by correcting all enervating habits and improving the diet, is the only care worthwhile.

SCLERODERMA (Hard Skin)
Definition: A hardness or harshness of the skin. The skin is rigid, pigmented and wasted, either in spots or fairly generally.

Symptoms: The condition may develop quite suddenly or may develop slowly over months or years. It may be preceded or accompanied by abnormal sensations in the skin. In time, the skin grows tense, hard and fixed to the underlying structures (hidebound) so that it cannot be pinched up. It feels like wood, or leather or frozen skin. Yellowish or brownish discolorations usually appear. The skin is very smooth and dry and often shiny. The joints may be rendered more or less immovable.

Circumscribed Scleroderma (called generally morphea, or Addison's keloid) is also a skin atrophy. It presents limited, rounded, ivory-like patches of various sizes, surrounded by hyperemic or pigmented borders. The patches are firm but not hard.

Scleroderma Neonatorum (scleroderma of the newborn) is a rare affection that develops shortly after birth, rarely as late as the sixth month. Beginning in the lower limbs it spreads rapidly over the trunk, arms, and face, giving the infant the appearance of being frozen. It develops chiefly in premature infants, but is occasionally seen in full-term babies and those whose skin circulation is faulty.

White-Spot "Disease" is a hardening of the skin characterized by a few or many pea-sized or larger chalk-white patches on the chest, neck and back. The patches are often atrophied.

Care of the Patient: Remove all causes of ill health and build up the general health.

XERODERMA PIGMENTOSUM
Definition: This is a skin atrophy usually appearing in the first or second year after birth and slowly progressing to death; also known as atrophoderma pigmentosum.

Symptoms: Freckle-like spots first appear on the face and hands. Later these atrophy and become depressed. Dilatation of minute skin blood vessels follows and then diffuse atrophy. After a few years, wart-like growths develop on the pigmented areas and these develop into tumors. In these cases the skin is very sensitive to the actinic rays of the sun which affect it somewhat as do X-ray burns.

Etiology: The condition is thought to be due to some nerve impairment, "probably some congenital predisposition." This is not cause. Cause must reside in metabolic perversion from wrong life.

Care of the Patient: The condition runs a chronic course and there should be ample time for a revolution in the mode of care, particularly of feeding, to produce improvement if not complete recovery. A fruit and vegetable diet should be religiously adhered to. Sun-baths should not be employed until the skin has lost at least a large part of its sensitiveness.
HYPERTROPHIES OF THE SKIN
CLAVUS (Corn)

Definition: This is a small callous or thickening of the outer skin, generally resulting from the friction of ill-fitting shoes, developing usually on the toes, over bony prominences, occasionally upon the soles, fingers and palms.

Symptoms: Two varieties are recognized as follow:

Hard corns usually develop over the joints of toes. These are hard, painful elevations.

Soft corns usually develop between the toes, where they become softened by the moisture of perspiration and insufficient drying after bathing.

Etiology: Intermittent pressure causes both forms of corns to develop.

Care of the Patient: Full correction requires the removal of cause and correct fitting of shoes. They will disappear in a short time without further attention when cause is removed. Cutting corns and treating them with corn removers is of no value.

KERATOSIS

Definition: The term means any affection of the epidermal layer of the skin, but is particularly applied to localized overgrowths of the horny layer. Three chief forms are described as follow:

Contagious Follicular Keratosis is seen generally in childhood, but may develop in adults. Several members of the same family may be affected at the same time thus giving rise to the belief that it is "contagious." It begins as small, black points that spread from the elbows and knees practically over the whole body. Papules develop around the black points and often become inflamed.

Follicular Keratosis is a rare hypertrophic affection of the oil glands at the roots of the hair. Small, dark papules embedded in the follicles, often crowned with horny projections, which, when removed, leave pits. They are most common on the scalp, face, chest, loins and inguinal region, chiefly of men. The condition is chronic and progressive. The general health is said "not to be disturbed," though there may be annoying subjective symptoms.

Keratosis Pilaris (lichen pilaris) is keratosis of the hair follicles and presents the development of small papules due to hypertrophy of the outer skin at the mouth of the hair follicles. Developing as dirty-gray, pin-head elevations, each pierced by a hair, usually upon the extensor surfaces of the arms and legs; they have the appearance of "goose flesh" in mild cases and feel like a nutmeg grater to the touch. There is little or no itching. Most people develop the affection in some degree.

Etiology: Toxemia and a lack of cleanliness seem to account for these conditions.

Care of the Patient: Adequate bathing and good general hygiene should result in speedy disappearance of all forms of keratosis.
NEUROSES OF THE SKIN
HYSTERICAL DERMATOSES
Definition: These are affections of the skin produced by emotional or nervous over-irritation.

Symptoms: Among the most common hysterical dermatoses are acne, hives, dermographia, erythemia, psoriasis, and black-and-blue spots. They present the symptoms described elsewhere for these affections.

Etiology: Hysteria combined with a very unstable vaso-motor control and nutritional impairment and, in case of very sensitive skins, external irritants, produce these conditions.

Care of the Patient: Hysterical dermatoses develop quickly and many of them disappear quickly when the emotional causes are corrected. We have seen very severe cases clear up in twenty-four hours when the patient's mind was put at rest and the body relaxed.

NERVOUS ITCH
Definition: This is an itch that comes on during periods of quiet.

Symptoms: Any part of the body — scalp, face, extremities, back, chest, or even the whole body — may be affected. The itch comes on in the theatre, church, parlor, office, while sewing, or when quiet. It is often impossible for some people to remain long at any pleasure or duty that requires quiet without developing itch.

Etiology: Lack of sleep, mental, emotional or physical stress, sexual excesses, lack of exercise, insufficient bathing, overeating, intestinal toxemia, etc., are the chief causes.

Care of the Patient: Remove the cause. Secure more rest; poise the mind, cease the excesses, keep the body clean and eliminate toxemia.