Essentials of Diseases of the Skin - Henry Weightman Stelwagon

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      Describe phosphoridrosis.

      Phosphoridrosis is a rare condition, in which the sweat is phosphorescent. It has been observed in the later stages of phthisis, in miliaria, and in those who have eaten of putrid fish.

       Table of Contents

      Synonyms: (Steatorrhœa; Acne sebacea; Ichthyosis sebacea; Dandruff.)

      What is seborrhœa?

      Seborrhœa is a disease of the sebaceous glands, characterized by an excessive and abnormal secretion of sebaceous matter, appearing on the skin as an oily coating, crusts, or scales.

      In many cases the sweat-glands are likewise implicated, and the process may also be distinctly, although usually mildly, inflammatory.

      At what age is seborrhœa usually observed?

      Between fifteen and forty. It may, however, occur at any age.

      Name the parts most commonly affected.

      The scalp, face, and (less frequently) the sternal and interscapular regions of the trunk. It is sometimes seen on other parts.

      What varieties of seborrhœa are encountered?

      Seborrhœa oleosa and seborrhœa sicca; not infrequently the disease is of a mixed type.

      What are the symptoms of seborrhœa oleosa?

      The sole symptom is an unnatural oiliness, variable as to degree. Its most common sites are the regions of the scalp, nose, and forehead. In many instances mild rosacea coexists with oily seborrhœa of the nose.

      Give the symptoms of seborrhœa sicca.

      A variable degree of greasy scalines, which may be seated upon a pale, hyperæmic or mildly inflammatory surface.

      The parts affected are covered scantily or more or less abundantly with somewhat greasy, grayish, or brownish-gray scales. If upon the scalp (dandruff, pityriasis capitis), small particles of scales are found scattered through the hair, and when the latter is brushed or combed, fall over the shoulders. If upon the face, in addition to the scaliness, the sebaceous ducts are usually seen to be enlarged and filled with sebaceous matter.

      Describe the symptoms of the ordinary or mixed type.

      It is common upon the scalp. The skin is covered with irregularly diffused, greasy, grayish or brownish scales and crusts, in some cases moderate in quantity, in others so great that large irregular masses are formed, pasting the hair to the scalp. If removed, the scales and crusts rapidly re-form. The skin beneath is found slate-colored, hyperæmic or mildly inflammatory, and exceptionally it has in places an eczematous aspect (eczema seborrhoicum). Extraneous matter, such as dust and dirt, collects upon the parts, and the whole mass may become more or less offensive. There is a strong tendency to falling-out of the hair. Itching may or may not be present.

FIG. 5.

      Seborrhœa (Eczema Seborrhoicum).

      Describe the symptoms of seborrhœa of the trunk and other parts.

      Fig. 7.

FIG. 7.

      A normal sebaceous gland in connection with a lanugo hair. (After Neumann.)

      a, Capsule; b, fatty secretion; c, h, secreting cells; d, root of lanugo hair; e, hair-sac; f, hair-shaft; g, acini of sebaceous gland.

      Seborrhœa corporis differs in a measure, in its symptoms, from seborrhœa of the scalp and is usually illustrative of the variety known as eczema seborrhoicum; it occurs as one or several irregular or circinate, slightly hyperæmic or moderately inflammatory patches, covered with dirty or grayish-looking greasy scales or crusts, usually moderate in quantity, and upon removal are found to have projections into the sebaceous ducts. It is commonly seen upon the sternal and interscapular regions. It rarely exists independently in these regions, being usually associated with and following the disease on the scalp. It may also invade the axillæ, genitocrural, and other regions.

      What is the usual course of seborrhœa?

      Essentially chronic, the disease varying in intensity from time to time. In occasional instances it disappears spontaneously.

      Give the cause or causes of seborrhœa.

      General debility, anæmia, chlorosis, dyspepsia, and similar conditions are to be variously looked upon as predisposing.

      In some instances, however, the disease seems to be purely local in character, and to be entirely independent of any constitutional or predisposing condition. The view recently advanced that the disease is of parasitic nature and contagious has been steadily gaining ground.

      What is the pathology of seborrhœa?

      Seborrhœa is a disease of the sebaceous glands, and probably often involving the sweat-glands also; its products, as found upon the skin, consisting of the sebaceous secretion, epithelial cells from the glands and ducts, and more or less extraneous matter. Not infrequently evidences of superficial inflammatory action are also to be found, and it is especially for this type that the name eczema seborrhoicum is most appropriate. In long-continued and neglected cases slight atrophy of the gland-structures may occur.

      With what diseases are you likely to confound seborrhœa?

      Upon the scalp, with eczema and psoriasis; upon the face, with lupus erythematosus and eczema; and upon the trunk, with psoriasis and ringworm.

      As a rule, the clinical features of seborrhœa are sufficiently characteristic to prevent error.

      What are the differential points?

      Eczema, psoriasis, and lupus erythematosus are diseases in which there are distinct inflammatory symptoms, such as thickening and infiltration and redness; moreover, psoriasis, and this holds true as to ringworm also, occurs in sharply-defined, circumscribed patches, and lupus erythematosus has a peculiar violaceous tint and an elevated and marginate border. A microscopic examination of the epidermic scrapings would be of crucial value in differentiating from ringworm.

      Quite frequently, especially in the interscapular and sternal regions, the segmental configuration constitutes an important feature of seborrhœa—of the eczema seborrhoicum variety.

      What is the prognosis in seborrhœa?

      Favorable. All types are curable, and when upon the non-hairy regions, usually readily so; upon the scalp it is often obstinate. Relapses are not uncommon.

      In those cases of seborrhœa capitis which have been long-continued or neglected, and attended with loss of hair, this loss may be more or less permanent, although ordinarily much can be done to promote a regrowth (see Treatment of Alopecia).

      How would you treat seborrhœa of the scalp?

      By constitutional (if indicated) and local remedies; the former having in view correction or modification of the predisposing factor or factors, and the latter removal of the sebaceous accumulations and the application of mildly stimulating antiseptic ointments or lotions.

      What constitutional remedies are commonly employed?

      The various tonics, such as iron, quinine, strychnia, cod-liver oil, arsenic, the vegetable bitters, laxatives, malt and similar preparations. The line of treatment is to be based upon indications.

      How do you free the scalp of the sebaceous accumulations?

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