Pathology.
—The pathology of scleroderma is very obscure. Whether it depend upon primary disturbances of circulation, both of blood and lymph, or whether it is produced by cellular hypertrophies has not been determined.
The characteristic induration of this disease is not imitated in other affections except scleroma neonatorum, but it may, nevertheless, be confused with the infiltration of tuberculosis, of syphilis, or of malignant disease. While the disease persists, in most cases it is not often fatal.
Treatment.
—It is to be treated mainly by tension, the general and constitutional conditions by massage, and inunction with soothing oils or with the ichthyol-mercurial ointment. It has been successfully treated, as is keloid, by the subcutaneous use of a 10 per cent. alcoholic solution of thiosinamin. The ultraviolet rays and even the x-rays, used judiciously and carefully, may also be of service.
Rhinophyma.
—This form of tumor is to be differentiated from rhinoscleroma, the latter being due to a peculiar specific bacillus, while rhinophyma is a filth disease, due to hypertrophy of the sebaceous structures of the nose from obstruction of the sebaceous ducts. It is often seen among alcoholics, perhaps less frequently at home than abroad. Pathologically it consists of enormous and irregular hypertrophy of the sebaceous gland elements and connective tissue of the skin of the nose. Each hypertrophied gland secretes in proportion to its increase in size, and even the vessels of the part become engorged. In consequence there results a lobulated, distorted, most disagreeable appearance, which often becomes exceedingly offensive. The tumors thus formed sometimes increase to a size sufficient to interfere with breathing and with feeding. The resulting nasal enlargement is usually trilobed. The first impetus to the overgrowth comes sometimes from such cutaneous irritation as frostbite, or local irritation of some kind.
Treatment.
—The treatment of rhinophyma consists in the unrestricted use of scissors and the sharp spoon, with the preservation of so much of the integumentary structure as may serve to cover the reduced dimension of the nose. These lesions will bleed freely at first, but bleeding is usually easily checked. When a plastic covering of the defect is impossible, the surface may be left to granulate, with a certain feeling of security that the cicatricial contraction following will reduce the enlargement to normal proportions.