—The surface indication is always for excision or eradication, but one cannot give the slightest guarantee against recurrence in even worse form in the same scar. Electrolysis may have a beneficial effect on some of the lesions, but will only occasionally prove satisfactory. A number of years ago thiosinamin was introduced, and has perhaps given a larger measure of success than any other remedy. It is used in 5 or 10 per cent. solution, which is injected into and around the growth, and may lead to gradual absorption of the hypertrophied tissue. The pain which the injection produces does not last long and I have seen many excellent results follow its use.
The same injections may be resorted to in general keloidal disease, which is seen most often in the colored race. In negroes it may follow traumatism of the skin surface, and attain the size of a saucer or plate. (See [Plate XXIX].)
Neurofibroma.
—Fibroma of the skin may happen at any time and is likely to develop in the finer branches of the cutaneous nerves, where it will constitute a small tumor, known as painful subcutaneous tubercle. These little tumors attain the size of a pea and appear between the skin and superficial fascia. Sometimes they are painful and are always tender. Unless thoroughly removed they tend to recur. Nevertheless complete removal is the only remedy.
Fibroma Molluscum.
—A much larger, softer, and more complex tumor is that known by Virchow as fibroma molluscum. These tumors may attain large size, and may be single or multiple. Over four thousand of these lesions have been counted on one subject. They develop from the connective tissue of the cutaneous nerves, and involve later the globular and follicular structures of the skin, softening and undergoing such changes as to deserve the adjective molluscum. Changes analogous to these lead to what has been described as dermatolysis, i. e., hypertrophy of the skin, with loosening of the subcutaneous tissue, by which it is thrown more or less into folds. Another clinical expression of the same condition has been known as pachydermatocele, in which pendulous masses of skin hang from various parts of the body, especially the face and neck, and undergo pigmentation and other changes.
Treatment.
—These lesions can be excised, always with temporary cosmetic improvement, but not always with a guarantee against recurrence of the trouble.
Scleroderma.
—This name is given to a leathery induration of the skin occurring in circumscribed areas, which have been called “morphea,” or in diffuse patches, which shade off into surrounding normal skin. The first indication is a stiffening accompanied by some thickening and hardness. Sometimes the affection is painful, and the brawny hardening which it produces makes it irksome and uncomfortable. The skin thus affected can not be picked up between the fingers, and is more or less adherent to the tissues beneath. When the difficulty is pronounced the sweat and sebaceous glands cease to functionate. If it occur about a joint the movement of the latter may be interfered with, even to the extent of producing ankylosis. Wherever it appears there is impediment to motion and flexibility of the parts beneath. The tendency usually is to spontaneous disappearance with atrophy. While subsiding at one locality it may recur in another. Upon the hands it may effect such great disturbance of function as to produce what has been described as “sclerodactylia.” The skin over bony prominences, when irritated, may break down; ordinarily it does not go on to ulceration.