A system of practical medicine. By American authors. Vol. 4

by Unknown

The following formula may also be given:

Rx.	Hydrargyri ammoniati,	drachm j;
	Bismuthi magist.,	drachm ss;
	Ugt. aquæ rosæ,	ounce j.

M.—Sig. Apply at night.

Sulphur ointments, as of precipitated sulphur one or two drachms to the ounce, are also at times useful. The applications may be suspended from time to time should irritation occur. The treatment in some cases is followed by good results, while in others it is unsatisfactory. The discoloration, having been removed, may remain away, or, as often happens, may recur. The treatment recommended for chloasma is that which will be found of most service in lentigo.

There are other discolorations, of a different nature, which may be referred to here, as the staining due to the coloring matter of the bile, and that sometimes following the internal use of nitrate of silver, known as argyria, where the skin assumes a bluish-gray, bronze, or blackish shade. Neumann states that reduced silver is found in all parts of the skin except the lining epithelia of the glands and the cells of the mucous layer of the epidermis. The deposit also occurs in the internal organs.

Keratosis Pilaris.

Keratosis pilaris (also called lichen pilaris and pityriasis pilaris) is an hypertrophy of the epidermis about the apertures of the hair-follicles, forming pinhead-sized, conical epidermic elevations. The lesions are met with usually about the extensor surfaces of the thighs and arms, especially the former, but they may also occur on other parts. They are whitish, grayish, or blackish in color, are rarely larger than a pinhead, each being pierced by a hair, around which are accumulated, in the form of strata, the horny cells of the epidermis. In some lesions the hair is broken off at the apex, appearing as a black central point; in others the hair is not visible, but is found coiled or twisted up within the papules. The skin is dry, harsh, or rough, and together with the papules may feel like a nutmeg-grater. The skin at the base of each papule is of a normal color or slightly reddened. The elevations consist of an accumulation of epidermic cells and sebaceous matter about the orifices of the hair-follicles. The affection in its milder forms is not uncommon, and is encountered usually in cold weather, and especially in those who bathe infrequently. It may occur at any age, but is most common in early adult life. Slight itching is occasionally present. As ordinarily observed, it is a slight disorder, but shows a tendency to persist. It resembles somewhat cutis anserina, the miliary papular syphiloderm in the desquamating stage, and also lichen scrofulosus. In goose-flesh (cutis anserina) the elevations are of a different nature, being due to cold, heat, or nervous excitement. The papules of the syphiloderm tend to group, are firmer, more deeply seated, less scaly, and of a reddish color. In lichen scrofulosus the papules are more solid in character, incline to group, are less scaly, and usually appear about the abdomen.

The disease is readily removable by treatment. Hot baths with the free use of strong soap, as sapo viridis, will usually suffice in ordinary cases; alkaline baths are also serviceable. In rebellious cases oily applications, such as the petroleum preparations, lard, and glycerin, or sulphur ointment, may be used in conjunction with the baths.

Molluscum Epitheliale.

Molluscum epitheliale, also called molluscum contagiosum and molluscum sebaceum, is characterized by rounded, semiglobular, flattened, or verrucous papules or tubercles of a whitish or pinkish color, varying in size from a pinhead to a pea. As generally met with, they are the size and shape of a small split pea; in other cases they are more acuminated or are in the form of a very small pearl button. They have a broad base and are seated close to the general surface. As a rule, they are multiple, three or six or more being present in different stages of evolution. They are unaccompanied by subjective symptoms. The skin covering them is stretched, and they have a glistening or waxy look, and at times resemble a drop of wax. In consistence they are usually firm, becoming soft with age. Their summits are sometimes flattened and umbilicated, with a central darkish point representing the mouth of the follicle. Their usual seat is the face, especially the eyelids, cheeks, and chin, but the neck, breast, and genitalia may also be invaded. They grow slowly in most cases, and are unaccompanied by inflammatory symptoms. Later, they become soft and tend to break down, with at times ulceration.