Urticaria Pigmentosa (Synonym: Xanthelasmoidea.)
Describe urticaria pigmentosa.
Urticaria pigmentosa is a rare disease, variously viewed as an unusual form of urticaria and as an urticaria-like eruption in which [Pg 57] there is an element of new growth in the lesions. It begins usually in infancy or early childhood and continues for months or years, and is characterized by slightly, moderately, or intensely itchy, wheal-like elevations, which are more or less persistent and leave yellowish, orange-colored, greenish or brownish stains. Exceptionally subjective symptoms are almost entirely absent. Anatomical studies show that the lesion has in some respects the structure of an ordinary wheal, with œdema and pigment deposit in the epidermal portion, and cellular infiltration made up principally of mast-cells.
The nature of the disease is obscure and treatment unsatisfactory. Ordinarily as early youth or adult life is reached it spontaneously disappears. The treatment advised is usually on the same lines as that of chronic urticaria. [Pg 58]
Dermatitis.
What is implied by the term dermatitis?
Dermatitis, or inflammation of the skin, is a term employed to designate those cases of cutaneous disturbance, usually acute in character, which are due to the action of irritants.
Mention some examples of cutaneous disturbance to which this term is applied.
The dermatic inflammation due to the action of excessive heat or cold, to caustics and other chemical irritants, and to the ingestion of certain drugs.
What several varieties are commonly described?
Dermatitis traumatica, dermatitis calorica, dermatitis venenata, and dermatitis medicamentosa.
Describe dermatitis traumatica.
Under this head are included all forms of cutaneous inflammation due to traumatism. To the dermatologist the most common met with is that produced by the various animal parasites and from continued scratching; in such, if the cause has been long-continued and persistent, a variable degree of inflammatory thickening of the skin and pigmentation result, the latter not infrequently being more or less permanent. The inflammation due to tight-fitting garments, bandages, to constant pressure (as bed-sores), etc., also illustrates this class.
What is the treatment of dermatitis traumatica?
Removal of the cause, and, if necessary, the application of soothing ointments or lotions; in bed-sores, soap plaster, plain or with one to five per cent. of ichthyol.
What is dermatitis calorica?
Cutaneous inflammation, varying from a slight erythematous to a gangrenous character, produced by excessive heat (dermatitis ambustionis, burns) or cold (dermatitis congelationis, frostbite).
Give the treatment of dermatitis calorica.
In burns, if of a mild degree, the application of sodium bicarbonate, as a powder or saturated solution, is useful; in the more severe [Pg 59] grade, a two- to five-per-cent. solution will probably be found of greater advantage. Other soothing applications may also be employed. In recent years a one-per-cent. solution of picric acid has been commended for the slighter burns of limited extent. Upon the whole, there is nothing yet so generally useful and soothing in these cases as the so-called Carron oil; in some cases more valuable with 1/2 to 1 minim of carbolic acid added to each ounce.
In frostbite, seen immediately after exposure, the parts are to be brought gradually back to a normal temperature, at first by rubbing with snow or applying cold water. Subsequently, in ordinary chilblains, stimulating applications, such as oil of turpentine, balsam of Peru, tincture of iodine, ichthyol, and strongly carbolized ointments are of most benefit. If the frostbite is of a vesicular, pustular, bullous, or escharotic character, the treatment consists in the application of soothing remedies, such as are employed in other like inflammatory conditions.
What do you understand by dermatitis venenata?
All inflammatory conditions of the skin due to contact with deleterious substances such as caustic, chemical irritants, iodoform, etc., are included under this head, but the most common causes are the rhus plants—poison ivy (or poison oak) and poison sumach (poison dogwood). Mere proximity to these plants will, in some individuals, provoke cutaneous disturbance (rhus poisoning, ivy poisoning), although they may be handled by others with impunity.
Many other plants are also known to produce cutaneous irritation in certain subjects; among these may be mentioned the nettle, primrose, cowhage, smartweed, balm of Gilead, oleander, and rue.
The local action of iodoform (iodoform dermatitis) in some individuals is that of a decided irritant, bringing about a dermatitis, which often spreads much beyond the parts of application, and which in those eczematously inclined may result in a veritable and persistent eczema.
Describe the symptoms of rhus poisoning.
The symptoms appear usually soon after exposure, and consist of an inflammatory condition of the skin of an eczematous nature, [Pg 60] varying in degree from an erythematous to a bullous character, and with or without œdema and swelling. As a rule, marked itching and burning are present. The face, hands, forearms and genitalia are favorite parts, although it may in many instances involve a greater portion of the whole surface.
What is the course of rhus poisoning?
It runs an acute course, terminating in recovery in one to six weeks. In those eczematously inclined, however, it may result in a veritable and persistent form of that disease.
How would you treat rhus poisoning?
By soothing and astringent applications, such as are employed in acute eczema (q. v.), which are to be used freely. Among the most valuable are: a lotion of fluid extract of grindelia robusta, one to two drachms to four ounces of water; lotio nigra, either alone or followed by the oxide-of-zinc ointment; a saturated solution of boric acid, with a half to two drachms of carbolic acid to the pint; a lotion of zinc sulphate, a half to four grains to the ounce; weak alkaline lotions; cold cream, petrolatum, and oxide-of-zinc ointments.
How would you treat the dermatitis due to other deleterious substances of this class?
By applications of a soothing and protective character, similar to those used in eczema and burns.