Four cases in all are alluded to in this paper. The first patient, a man aged 31 years, showed all the symptoms of an epidermolysis bullosa, with slight ulceration, but the affection was said to have begun at the age of 18 and only to occur periodically. The second case was that of an old woman, aged 70 years, who also had an abdominal tumour, of which she died. Material showed that there was a complete loss of the papillæ, the elastic tissue had disappeared to only the slightest traces, and there were signs of inflammatory infiltration present. The third case was that of a woman, aged 55 years, with marked syringo-myelia; and the rash, which appeared as small nodules, terminating in atrophy, affected the axillæ, the inner sides of the upper arms, the groins, the inner sides of both thighs, the back, and abdomen. The author says that one is tempted to connect this with the condition of the cord, but to do so is the purest theoretical speculation. The fourth case was a woman, aged 42 years, who showed on the left side of the nose a circular patch as large as a sixpence, over which the skin was of a bluish-red colour, and somewhat infiltrated. There were some scars caused by the therapeutic use of electrolysis.
(From the short description of this last case it does not seem clear why the diagnosis of Lupus erythematosus was not made.—A. W.)
A. W.
ON THE TREATMENT OE TYLOSIS PALMARIS IN ADULTS. Mayer. (Derm. Zeitschr., Bd. xi, Heft 5, p. 865.)
Mayer recommends the rubbing in of rheumasan, a salve-soap containing 10 per cent. of free salicylic acid. This should be massaged in for at least five minutes and then glacé gloves should be worn at night. The patient should be cautioned to discontinue the use of the drug for a few days on the first appearance of redness.
A. W.
PSORIASIS VULGARIS OF THE SKIN AND MUCOUS MEMBRANE, ITS PATHOLOGICAL POSITION AND ÆTIOLOGY. P. Thimm. (Monatsh. f. prakt. Derm., July 1st, 1904, p. 1.)
Dr. Thimm gives the history of a patient, a man aged 36 years, who had been under his care for five years. He had an obstinate recurring extensive psoriasis eruption of the skin of the trunk and limbs, typical psoriasis lesions of the upper and lower lips, extending on to the mucous membranes of the mouth and nasal cavities. In addition, the mucous membrane of the mouth showed, while he was under observation, various circumscribed diseased patches, setting in synchronously with the eruption on the skin, which also disappeared at the same time after general treatment with arsenic. Schimmer’s typical leucoplakia was also present, the patient being an immoderate smoker, and this continued in spite of all treatment. There were no signs of syphilis.
Microscopical examination of two mucous membrane lesions showed great œdema, enlarged intercellular spaces, thickening of the epidermal covering in toto, but a thinning of the rete over the elongated, high-reaching papillæ. Small-celled infiltration of the upper layers of the corium, extending even up into the epithelium, was also present.
But what was not visible, nor present in any of the sections, was the parakeratotic heaping up of scales of the psoriasis lesions. Exceptionally this may be wanting in cutaneous psoriasis patches, but its absence is, as a rule, or even always, characteristic, in psoriasis of mucous membranes. In certain sections, however, the uppermost epithelial layers, one found, to a depth of three cell layers, were pressed together to form a dark-coloured narrow band, but having regard to the smooth contour of the surface this could hardly be looked upon as a partly developed scale. The pathological characters of any lesions are to a certain extent altered according to the position in which they occur. By the word “parakeratosis” is understood, apart from the heaping up of dry, scaly formations, a condition in which we find the following changes of the epithelium: parenchymatous œdema, extension of the basal horny layer, abnormally scanty fat contents of the same, want of keratohyalin, and abnormally good preservation of the nuclei. Such are, however, pathological changes of the external epithelium, but normal conditions of the mucous membranes. Parakeratotic changes of the mucous membranes of the mouth cannot be considered diagnostic of psoriasis. But the changes in the papillæ, the infiltration of the upper layer of the corium, the widening of the blood-vessels, the dilatation of the lymph-channels, taken in conjunction with the clinical symptoms and the results of treatment, leave no doubt that the case was one of true psoriasis vulgaris of the mucous membrane of the mouth. Previously, very few cases of scaly lesions of the mucous membranes had been described, and in psoriasis of the skin the extensive and destructive infiltration seen in these lesions of mucous membranes is unknown.