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

by Unknown

Hypertrichosis (hirsuties), or hypertrophy of the hair, is a term applied to unnatural growth of hair, either as regards region, extent, age, or sex. It may be slight or excessive; thus, it may be universal, as in the so-called hairy people (homines pilosi), or limited, as upon a wart or nævus (nævus pilosus). The hairs themselves may be fine, coarse or of the average thickness. The hair of the scalp, eyebrows, axillæ, pubes, and beard in men may show excessive development either in thickness or length. Increased activity of hair-growth may take place in the fine downy hairs present over the greater portion of the surface. It may occur in the very young—in fact, may be congenital—and the growth may also appear on the face, arms, and other parts of females, resulting, of course, from a hypertrophy of the natural lanugo hairs.

It is difficult to give any definite or satisfactory explanation of the causes which give rise to unnatural growth of the hair. It is seen more frequently in persons of dark complexion, and may be congenital or acquired; if the latter, the tendency to excessive development manifesting itself, as a rule, toward middle life. It is frequently associated in women with other masculine peculiarities, appearing especially at the climacteric period, and also noted in connection with the diseases of the uterus and ovaries. It is sometimes seen in sterile women, also on the faces of insane women. Local stimulation or irritation will at times have a curative influence.

For general hirsuties there is no remedy. Hairy nævi, if small, may be treated by excision, or, if large, the hairs may be removed by electrolysis, as described below. The excessive growth seen about the faces of women is an annoying disfigurement, and such patients will submit to almost any treatment with the hope of relief. Extraction of hairs and shaving are frequently employed, but give only temporary relief. The method of removal by electrolysis is the only plan which promises permanent success. A fine needle in a suitable handle is attached to the negative pole of a galvanic battery, introduced into the hair-follicle alongside of the hair to the depth of the papilla, and the circuit made by the patient touching the sponge electrode attached to the positive pole. At the point of insertion the parts become blanched, and frothing appears at the aperture of the follicle, a result of the decomposition of the tissues at the point of the needle. The action should be continued for several seconds or longer, and then the circuit broken by the patient removing the hand from the sponge electrode, after which the needle is to be withdrawn. If the papilla has been destroyed, the hair may be readily extracted by the forceps with very little traction. In most cases, after the needle is withdrawn, or at times even before this, a wheal-like elevation appears at the point of insertion. In some cases the follicles may suppurate. Scarring, which is liable to take place, is to be guarded against. It occurs more markedly in some subjects than in others. Noticeable scarring, however, may generally be prevented if the operator is skilful. The operation is somewhat painful, the amount of pain varying with different persons, in some being slight, while in others it is severe. A current from four to twelve cells of a freshly-charged battery usually suffices.

Removal of hairs by the use of depilatories is considerably practised, but, as they are caustic in their nature, they should be employed with care. If prescribed, one made up of two drachms of barium sulphide and three drachms each of oxide of zinc and starch may be recommended. Enough water is added to the powder to make a paste, which is thinly laid on the parts for ten or fifteen minutes. Heat of skin or a burning sensation soon occurs, upon the advent of which the paste is immediately to be scraped off, the parts thoroughly cleansed, and a mild ointment applied. As with extraction and shaving, this method is only temporary in its effects.

Sclerema Neonatorum.

Sclerema neonatorum, or sclerema of the new-born, is a disease of infancy manifesting itself usually at birth, characterized by a diffuse stiffness, rigidity or hardness of the integument, accompanied by coldness, oedema, discoloration, lividity, and general circulatory disturbance. Frequently it is congenital. It usually begins on the lower extremities, extending upward and invading the trunk, arms, and face. The skin is reddish, purplish or brownish, glossy, and tense or stretched, causing more or less rigidity and stiffness. The surface is usually cold, and upon pressure oedema, together with an infiltrated state of the tissues, is noted. When the disease is general the body bears resemblance to a half-frozen corpse. The child is unable to move, respires feebly, and usually perishes in a few days. The disease is very rare. It is in most cases found associated with pneumonia or with affections of the circulatory apparatus. The causes are obscure. After death the condition of the skin undergoes but little change, the induration remaining; on incision a considerable quantity of serous fluid is poured out, when the tissues become softer and resemble ordinary oedematous tissue. The treatment should consist of warm applications, frictions, and like measures. The prognosis is unfavorable.

Scleroderma.

Scleroderma, known also as sclerema and scleriasis, is an acute or chronic disease, characterized by a diffuse, more or less pigmented, rigid, stiffened or hardened, hide-bound condition of the skin. It was first described by Alibert with the name sclérèmie des adultes, since which time many cases have been recorded. The first symptoms consist of more or less rigidity or induration of the integument, which may increase rapidly, or, as is usually the case, slowly, until the region affected becomes hard and bound down to the tissues beneath. In some cases febrile symptoms, oedema, and pigmentation precede the induration, but usually the process asserts itself insidiously, the first symptom noted by the patient being the sclerosis. In marked cases the skin is rigid, tight, or immovable, and is firm or positively hard to the touch, as though frozen, but without the sensation of cold. In some cases it may seem wooden or as though undergoing petrifaction. It is hide-bound, and cannot be made to glide over the structures beneath, nor can it be taken up between the fingers. The skin, owing to the immobility, becomes set or fixed, the natural lines and wrinkles disappearing, causing persons to look younger. The induration is diffuse, being neither circumscribed nor defined, and generally occupies a considerable area, the face, neck, back, chest, and upper extremities being the regions most frequently involved. It may occupy variously sized and shaped areas, for the most part irregular in outline, or it may appear in the form of narrow or broad bands or elongated patches, which usually become more or less shrunken and sunken atrophic lesions.

The surface of the integument in scleroderma is usually on a level with the neighboring healthy skin, except in the later stages where atrophy has occurred, and is generally smooth and shining. Pigmentation is in most cases a marked symptom, being yellowish or brownish, in the form of patches, giving a dirty, chloasmic appearance to the part. Subjective symptoms are usually wanting, although there may be numbness or cramp-like pains, especially when the limbs are the seat of the disease. The skin in all cases feels contracted, tightly stretched or too short. The disease may be limited, as is generally the case, or it may occupy the greater portion, or even the whole, of the body. It is usually symmetrical. It pursues a variable course, at times acute, but more frequently chronic, extending over a period of years or throughout life. Sooner or later resolution and recovery set in, or atrophic changes take place, characterized by a wasting or a condensation of the integument and of the subjacent tissues, causing contraction and deformity, which are especially marked when occurring about joints. As a rule, the general health remains good. The disease in some cases is accompanied by patches of morphoea, which affection is regarded by some authors as being merely a circumscribed variety of scleroderma.