Diseases of the Skin

An erythema of the palm of the hands and sole of the feet, attended with burning heat, pain, and numbness, with numbness of the limbs, pains throughout the body, and general disorder of the digestive and nutritive functions. […]

Acrodynia begins with symptoms of disorder of the digestive organs, for example, loss of appetite, nausea, weight at the epigastrium, sometimes vomiting, colicky pains, and diarrhea. The eyes are suffused and sensitive there is lachrymation and puffing of the face; and with these symptoms, or a little later, a patchy redness appears upon the palms and soles, sometimes extending upwards to the forearms and legs, and subsequently spreading more or less extensively over the rest of the body. The erythema is at first brightly red, but gradually becomes brownish and dark-red; while some of the patches have been compared to ecchymoses, and not unfrequently there is a dark-brown and even black discoloration of the epidermis from the deposition of pigment; moreover, there appear occasionally prominent papule, phlycten, pustules, and edema.

After a time, the cuticle exfoliates, and the exfoliation is repeated from time to time, the denuded surface being smooth and glossy, and of a bright red hue. Sometimes the exfoliation of the epidermis is accompanied with perspirations, and occasionally the cuticle of the whole of the palm or of the sole of the foot is shed in a single piece. The erythema is attended with stinging and smarting pains, a sense or numbness, and an extreme burning beat, which is greatest during the night, and disturbs sleep. Not unfrequently the numbness in the limbs amounts to a partial paralysis and is sometimes associated with loss of muscular substance and spasmodic cramps. […] Acrodynia commonly lasts from a few weeks to several months, and is liable to relapse, but is rarely fatal except in aged persons.

Wilson, E. (1868). On diseases of the skin: A system of cutaneous medicine. Philadelphia: Henry C. Lea.

Entered by: Bernardo Galvan, 7/15/2020

In its earliest stage, only a slight elevation without redness is present, but hard to the touch and dotted in the center with the black point of a comedo. The progress of congestion and inflammation raises the slight prominence into a well-marked conical pimple of a red color. Ultimately, the summit of the cone is converted into a well-marked pustule.

Pustulation becomes imperfect, and the skin becomes tuberculated by thickening and infiltration of its tissue. The skin then becomes indurated and deeply scarred. […] In the two latter the skin becomes purple, and often livid, and the disease is usually accompanied with small cutaneous abscesses.

Wilson, E. (1868). On diseases of the skin: A system of cutaneous medicine. Philadelphia: Henry C. Lea.

Entered by: Bernardo Galvan, 7/15/2020

A hard, circumscribed, flattened tumor, very little raised above the level of the skin, but extending deeply (an inch or more) into the cutaneous tissue. It is red in color, the redness being more or less vivid or dark at first, often presenting a mahogany tint; then becoming more or less purple, then livid; and after the separation of the sloughs and the healing of the skin, leaving behind it a chronic redness and deep-brown stain, which lasts for a considerable time. The pain of carbuncle is very severe, and of the throbbing and burning kind.

[…] When it has attained its full size, and the surface is purple or livid, the cuticle becomes raised into one or more blisters, numerous suppurating points appear in the skin, and these suppurating points are succeeded by perforations, through which the core issues from the stratum beneath in the form of sloughs, the sloughs being the fibrous tissue of the derma, converted into a grayish and whitish pulp, more or less soft and viscous, and mingled with an ichorous, purulent, and sanious discharge. Perforated all over its surface in this way, the face of the carbuncle has the appearance of a colander or sieve. Sometimes, instead of numerous perforations, a portion of the skin of considerable size loses its vitality, and becomes converted into a black eschar, and the slough which follows is homogeneous and extensive. […] Carbuncle is accompanied with more or less irritative fever and general disturbance of the nutritive, vascular, and nervous system. It occasions loss of appetite and loss of sleep; and when the pain is severe, the patient is not unfrequently delirious.

Wilson, E. (1868). On diseases of the skin: A system of cutaneous medicine. Philadelphia: Henry C. Lea.

Entered by: Bernardo Galvan, 7/15/2020

Characterized by scaliness of the epidermis, by erythematous redness, papules, vesicles, and in some cases by pustules; to which may be added, excoriations, accidental abrasions, and scratches produced by the nails. It is accompanied with excessive itching, the itching being augmented by warmth, and especially by the heat of bed. The above appearances are due to the presence in the skin of a minute animalcule, the acarus scabiei, which burrows within the epidermis, and excites irritation in the papillary surface of the derma. […] The vesicles, which are few and scattered, bearing no proportion to the number of acari and little relation to their seat, present some differences in form and character, resulting from their position. Thus, in the thin epidermis of the lateral surfaces of the fingers they are conical and acuminated; on the wrists and other parts of the body they are frequently more or less rounded, and resemble the vesicles of eczema; while in the latter situations they are also variable in size. The vesicles differ in reference to contents; in those of a conical form, the contained fluid is transparent and viscous; in some it is more or less opaque and puriform.

Wilson, E. (1868). On diseases of the skin: A system of cutaneous medicine. Philadelphia: Henry C. Lea.

Entered by: Bernardo Galvan, 7/15/2020

A condition of localized or diffuse induration of the skin [...].

In the circumscribed form there are patches, ranging from a few centimeters in diameter to the size of the hand or larger, in which the skin has a waxy or dead-white appearance, and to the touch is brawny, hard, and inelastic. Sometimes there is a preliminary hypaeremia of the skin, and subsequently there are changes in color, either areas of pigmentation or of complete atrophy of the pigment—leucoderma. The sensory changes are rarely marked. The secretion of sweat is diminished or entirely abolished. The disease is more common in women than in men, and is situated most frequently about the breasts and neck, sometimes in the course of the nerves. The patches may develop with great rapidity, and may persist for months or years; sometimes they disappear in a few weeks.

The diffuse form, though less common, is more serious. It begins in the extremities or in the face, and the patient notices that the skin is unusually hard and firm, or that there is a sense of stiffness or tension in making accustomed movements. Gradually the skin becomes firm and hard, and so united to the subcutaneous tissues that it cannot be picked up or pinched. It may look natural, but more commonly is glossy, drier than normal, and unusually smooth. With reference to the localization [...] universal; [...] regions of the trunk; [...] parts of the head or face; [...] portions of one or other of the upper extremities; and [...] portions of the lower extremities [...]. There were disturbances of sensation. The disease may gradually extend and involve the skin of an entire limb. When universal, the face is expressionless, the lips can not be moved, mastication is hindered, and it may become extremely difficult to feed the patient. The hands become fixed and the fingers immobile, on account of the extreme induration of the skin over the joints. Remarkable vaso-motor disturbances are common, as extreme as cyanosis of the hands and legs. Tachycardia may be present. The disease is chronic, lasting for months or years [...]. Recovery may occur, or the disease may be arrested [...]. The patients are apt to succumb to pulmonary complaints, or to nephritis. Arthritic troubles have been noticed in some instances; in others, endocarditis. Raynaud’s disease may be associated with it [...]. Scleroderma may occur as a complication of exophthalmic goitre.

Osler, W. (1892). The Principles and Practice of Medicine. New York and London: D. Appleton and Company. Pg. 1117-1118.

Entered by: Sonia Y. Khan, 6/26/2020

A congenital disease; it presents the appearance of a dry, impoverished, discolored, ill-developed, and ill-nourished skin. In a young child possessing such a skin, we may find, instead of the smooth, pliant, elastic, fresh, healthy pellicle of infancy, the dry, wrinkled, tough, and discolored skin of extreme old age. We see at a glance defect of development and defect of nutrition. The characters of the disease are too obvious to be mistaken. The defect of development and growth of the skin is often curiously manifest on the face, where the skin appears to be too small for the features. The eyelids are insufficiently large, the nose looks pinched, and the skin is stretched across the cheeks. It is equally exhibited on the hands and on the feet; the bones have grown faster than the skin; the fingers look contracted, and the knuckles of the metacarpophalangeal articulation crop up in what should be the middle of the back of the hand.

The same singular want of relation between the substance and the envelope is seen in the feet. On other parts of the body, as on the neck, the skin forms wrinkles, from its hardness and want of elasticity; and on the upper arms and legs hangs loosely about the limb, from the total absence of fat in the subcutaneous cellular tissue. Another peculiarity is observed in the palms of the hands, where the skin is thick, dense, and rigid, dry to the touch, and deeply marked by the lines of motion; and the nails are very generally brittle and imperfect. The color of the skin is a grayish yellow, which gives it a dirty look that no washing will remove; and the scarlet tint of the arterial blood seen through the more vascular parts of the integument, as of the face, has a strangely dull and unnatural appearance. The epidermis necessarily participates in the abnormal state; besides being discolored, it is imperfectly elaborated; it is inelastic and fragile, and breaks up into segments of various size and shape; the size of the broken particles being in some measure dependent on the organization of the cuticle, and in some measure upon the distribution of the lines of motion of the part.

Wilson, E. (1868). On diseases of the skin: A system of cutaneous medicine. Philadelphia: Henry C. Lea.

Entered by: Bernardo Galvan, 7/15/2020