Skin Diseases (5)

WEN (ATHEROMA, SEBACEOUS CYST).
A wen is an abnormally developed sebaceous or oil gland, resulting in a growth or sac filled with an oily or fatty material, usually appearing on the scalp, the neck, or the face, but sometimes on other parts of the body. The growth starts with a plugging of the gland outlet, or with some unusual activity of its secreting portion, resulting in a sac lined with the lining membrane of the gland and containing material similar to that secreted by the gland.

Growth may continue for months or years, but eventually ceases, in some cases while the tumor is still quite small. Large wens, however, are not unusual. They may be from one to several in number, and from the size of a pea to that of an orange. They may be whitish, pinkish, or purplish in color. They may be either soft, doughy, elastic, or firm to the touch.
Wens seldom show up before middle age, and almost never during the growing years of life.

They are rarely tender or painful, but may eventually become chronically inflamed and form pus. Very rarely, they may become malignant in elderly people. When located on the scalp where they are most often found the skin over a wen is usually bald, the hair follicles having either, been killed or having their activity stopped by the pressure of the growing tumor. Surgical removal of a wen is advisable, not only for the sake of appearance but also for safety. The operation is simple and safe, and is permanently successful if care is taken to remove the entire sac as well as its contents.

What to Do
Have the tumor surgically removed. Any other treatment is useless.

Parasitic Diseases

GROUND ITCH (CUTANEOUS AN CYLOSTOMIASIS).
BODY LICE (PEDICULOSIS CORPORIS).
A body louse is slightly larger than a head louse, and it is usually grayish in color. It lives in the seams of the underclothing most of the time, particularly in the regions of the back, the chest, and the waistline, laying its eggs there. The eggs hatch in about six days, the young being ready to reproduce in about two weeks. They invade the skin of the body only when they wish to feed.

The presence of body lice causes severe itching. If the clothing has recently been changed, the lice may be hard to find on the body. The itching, however, the bloody spots or streaks which result from scratching, and the location of the same are enough to indicate the nature of the disease. The parasites themselves can usually be found in considerable numbers in the seams of underclothing worn for a few days or longer. The infestation is spread by body contact, by wearing infested clothing, or by sleeping in an infested bed.
Body lice are known to be able to transmit several different infectious diseases, the most serious of which is typhus fever.

What to Do
1. Do not sleep in underwear worn during the daytime. Underwear and hose that will not be harmed by boiling should be boiled for ten minutes in soapsuds. Pressing the seams of clothing with a hot iron will kill many of the lice and their eggs.
2. A 5 percent DDT powder dusted on the inner surface of the underclothing, especially the seams, is effective.
3. The skin may be dusted lightly with a 5 percent DDT powder.

CRAB LICE (PEDICULOSIS PUBIS).
The crab louse, smaller than either the head louse or the body louse, translucent in appearance and nearly round in form, usually infests the hair covered part of the pubic region. It may, however, be found on other hairy regions of the body, though rarely on the scalp. The bite of this louse causes a sensation like a sharp pinprick. It produces intense itching and often a skin eruption, which may become severe enough to resemble eczema.

The infestation is spread by body contact as a rule most often at the time of sexual intercourse though sometimes by means of infested toilet seats. The infestation is often considered a disgrace because of its being associated with promiscuity. It is frequently mentioned in connection with venereal disease because in both cases illicit intercourse is a common method of spread.

What to Do
1. Shave or clip the hair from the infested regions, and burn this hair.
2. Wash the area or areas daily with soap and warm water. After washing, apply a 25 percent emulsion of benzyl benzoate or Kwell lotion each morning for three mornings. This kills the "nits" by dissolving them off the hair stumps.
3. Dust a 5 percent DDT powder on the affected skin areas each night for three nights. This will kill the active adult lice.
4. One week after completing the treatment program, if there are any signs or symptoms indicating that the infestation is not completely cleared up, repeat the treatment program.

HEAD LICE (PEDICULOSIS CAPITIS).
The presence of head lice on the scalp causes severe itching. Scratching, which is almost sure to occur, causes the oozing of fluid, watery at first, but later pussy or bloody. This fluid usually dries and forms crusts, but may remain sticky and mat the hair. It has a bad odor.

The lice live at the base of the hairs, near the scalp. They are quite dark in color and large enough to be seen easily with the unaided eye. During the short space of six days, a female louse can lay as many as fifty eggs. These are glued to the hair shafts and can easily be seen, being white in color.

They hatch in from three to eight days, and the young lice are able to reproduce in two weeks. Infestation from one person to another is usually spread by personal contact or by the wearing of infested headgear. Since body lice are known to transmit typhus fever and certain other diseases, some medical authorities believe that head lice may also transmit them.

What to Do
1. If any tiny white louse eggs can be seen attached to the base of hairs, usually in the region near the back of the neck, try to loosen and remove them by long continued soaking and washing with a gauze washcloth and a warm mixture of two parts of water and one part of vinegar. Then rinse and dry the scalp.
2. Dust 5 percent DDT powder on the scalp twice a day for three days.
3. One week later inspect the scalp and hair shafts carefully. If any evidence of persistent infestation or of reinfestation is seen, obtain a 1 percent gamma benzene hexachloride lotion (marketed as Kwell) and use as directed.

SCABIES (THE ITCH).
Scabies is a contagious skin disease caused by the itch mite, which bores beneath the surface of the skin, forming burrows. The disease is characterized by intense itching, especially at night, and by a form of eczema caused by scratching. The mite is yellowish-white and barely large enough to be seen by the unaided eye. The female, which is larger than the male, burrows into the skin to lay its eggs. The burrow may be either straight or crooked, is an eighth of an inch (3 mm.) or more in length, and looks somewhat like a very narrow and light pencil mark.

The itch mite seems to prefer the tenderest parts of the skin, such as the webs between the fingers, the inner surfaces of the forearms, thighs, and legs, the armpits, the breasts, the buttucks, and the navel. The face, scalp, palms, and soles are rarely attacked, but breast-fed infants are an exception to this rule. When one member of a family is infested, other members are very likely to become so.

Severe inflammation, with the development of papules, blisters, pustules, and crusts, may come as a result of infection from scratching. The disease may become fully developed within two weeks; the eggs hatch in about six days, and the parasites grow very rapidly. It may persist for months or even years if not recognized or properly treated. It is transmitted by body contact with others suffering from it, or by sleeping in an infested bed or wearing infested clothing.

What to Do
1. If the skin has infected scratch marks or pustules on it, this infection should be treated first before giving treatment for the itch itself. For this purpose, use Neosporin ointment rubbed into the affected skin four or five times a day.
2. Then every night for three nights apply an ointment such as mentioned in the next paragraph to the entire body from the level of the mouth and earlobes downward. Do not leave any area uncovered with the ointment, or the condition may recur. Be sure to apply it beneath the toenails and fingernails and all about the genital regions as well.
Many different ointments have been used in treating scabies. Some of the patent ointments have proved most effective. Among these, Eurax and Kwell may be mentioned.
3. Use the sane underclothes, nightclothes, and sheets throughout the course of the treatment.
4. The first night, before applying the ointment, scrub the entire body with soap and warm water. Each night, apply new ointment without washing off the old ointment. If it is impossible to leave the ointment on during the daytime, wash it off each morning, but continue the treatment for five days instead of three.
5. The next night following the nights of the treatment, take a thorough hot bath and change into clean sheets, nightclothes, and under clothes. All clothes used before and during the treatment should be disinfected by dry cleaning, washing in cleaning solvent, sending them to a laundry, or boiling.
6. During the treatment and every night thereafter for a week, spray the bed and mattress with some liquid such as Flit or a 5 percent DDT solution to kill any living parasites with which they may be infested.
7. Immediately after completing the course of ointment treatment outlined above, apply 1 percent phenol in calamine lotion four or five times a day as a soothing and drying lotion.
8. If the skin still feels irritated, take starch baths for half an hour once or twice a day, mixing one or two cupfuls of Linit starch in a tub of bath water.
9. One week after completing the treatment program, if it seems that the condition is not entirely cleared up, repeat the treatment with ointment, et cetera.
10. A 25 percent emulsion of benzyl benzoate may be used one night, or two successive nights, instead of the ointment for from three to five nights, but it is more likely to be uncomfortable or irritating.

Perspiratory Disorders
Three perspiratory disorders are common enough to merit discussion here: anhidrosis, or lack of sweat; bromidrosis, or foul-smelling sweat; and hyperhidrosis, or too profuse sweat.

Anhidrosis may be caused by sluggish action of the autonomic nerves. The condition may be present from the time of birth. It is a common symptom in ichthyosis, extensive psoriasis, and vitamin A deficiency. If the causative condition can be determined, the an hidrosis can sometimes be corrected, but this is often difficult. As a rule, the best that can be accomplished by way of relief is through care in adjusting to the weather. Cocoa butter, lanolin, or some other soothing creamy application may be used to relieve the dryness and harshness of the skin.

Bromidrosis is usually the result of fermentation, bacterial infection, or a chemical change in the perspiration after it has escaped from the sweat glands onto the skin surface. It is most obvious on parts of the body where perspiration is free but cannot readily evaporate, such as the armpits, or the feet if confined in poorly ventilated shoes. Certain foods, drugs, and germs give the perspiration characteristic odors, and some of these are unpleasant. As to this kind of bromidrosis, the only effective preventive measure is obvious. Bromidrosis affecting the feet or the armpits calls for more than usual care in cleanliness, with perhaps a change to better ventilated shoes or clothing.

Hyperhidrosis may affect the whole skin surface or only parts of it, such as the hands, feet, brow, et cetera. Nervous tension or fear may cause it. If small, circumscribed areas of the skin are affected, increased activity of one or more of the autonomic ganglia may be to blame. In such diseases as tuberculosis, malaria, undulant fever, exophthalmic goiter, and diabetes, profuse sweating is common at times.

When the underlying cause of the hyperhidrosis is corrected, the excessive sweating is usually checked, but this requires effective treatment of any systemic disease that may be present. X-ray treatments may be used in localized areas, but not on the whole skin surface. They work by crippling or destroying the secreting cells of the sweat glands, a result which would be disastrous if too widespread.

Cleanliness is the best method of controlling the unpleasant features of either bromidrosis or hyperhidrosis. A daily bath, with change of underclothing and hose, is recommended. A 5 percent solution of alum or zinc sulfate in 70 percent alcohol, dabbed on the surface of the skin areas especially concerned and allowed to dry on, may be helpful. A good powder for perspiring and malodorous feet is made as follows:

Salicylic acid............. 1|
Aluminum chloride............... 1|
Powdered alum ............... 3|
Starch ....................15|
Talcum powder ...............15|

Mix thoroughly Virus Diseases
COLD SORE (FEVER BLISTER, HERPES SIMPLEX).
A cold sore is a virus disease characterized by acutely inflamed areas of skin, upon which groups of small blisters appear. The sores are usually located on the face, especially the lips, but may also appear on the external genital organs or other parts of the body. The affected spots are not often large, but several of them may appear at the same time or in rapid succession.

They cause moderate stinging, itching, burning, and general discomfort; but they are only slightly tender. The blisters tend to dry up and form yellowish-brown crusts which drop off in a week or two, leaving no scars.

Cold sores often appear as a complication accompanying disease in which fever is a prominent symptom. Sometimes they develop in conjunction with a severe cold, influenza, pneumonia, sun exposure, or menstruation; or they may manifest themselves without any such condition being present.

They may be unusually severe, causing feverishness and weakness, with soreness and swelling of the lymph nodes near the area where they are located. Indigestion or any toxic condition or chronic infection may also bring on a crop or a series of crops of cold sores.

What to Do
1. Eat sparingly for a few days, depending chiefly on fruits and liquids.
2. Dab a 1:500 solution of aluminum acetate or spirits of camphor on the sore frequently.
3. If attacks are persistent or frequently repeated, have a physician, preferably a skin specialist, study the case to find the cause if possible. There are several methods of treatment which he may use, among them being the use of vaccines. Repeated applications of smallpox vaccine sometimes prove effective, for some reason not clearly understood.
4. If the cold sores are obviously a complication of some other existing disease, the treatment should be directed to the underlying condition, and the above directions may not all be suitable.

SHINGLES (HERPES ZOSTER)
Shingles is an acute and painful in flammatory virus disease affecting the skin overlying one or more sensory nerve trunks and the nerve trunks themselves. It is characterized by groups of small blisters on inflamed red skin areas.

The skin eruption breaks out in crops, each succeeding crop tending to locate nearer the end of the related nerve trunk than did the preceding crop. The groups of blisters, each with a red base, dry and form crusts after a week or two. When the crusts fall off, scars are sometimes left. The blisters sometimes become pustules before drying. In severe cases they may turn into small spots of gangrene.

The pain, neuralgic in character, may develop before the blisters appear; and it may persist for weeks, months, or years after all signs of the eruption are gone. This is especially true of elderly people, and outstandingly so when the forehead and face are involved.

The nerves which supply the skin of the chest are most likely to be affected. The eruption in a typical attack of shingles appears on one side of the chest, spreading from near the spinal column around almost to the breast bone.

Nerves on both sides of the body, or more than one nerve on the same side, may be affected, with correspondingly widespread eruption. Occasionally nerves that supply the skin of the neck, arms, abdomen, or thighs are attacked; but second in frequency to the chest, shingles tends to appear on one side of the forehead and face, following the course of the supraorbital branch of the trigeminal nerve.

Shingles is usually less severe in young persons than in old. Overwork, general debility, damp and chilly weather, or the absorption of certain drugs, particularly certain compounds of arsenic, or contact with a case of chicken pox, favor development of the disease. The specific cause, however, is a virus which affects both the nerve roots and the skin over them. One attack of shingles gives a high degree of immunity. Second attacks are rare.

What to Do
1. In severe cases, bed rest is important.
2. Take a simple and easily digestible diet, including an abundance of fluids.
3. An electric heating pad, or the light and heat from an ordinary strong incandescent light globe, applied to the painful area or areas will relieve some of the pain of shingles. The light globe should be held as close as possible without making the skin feel unbearably hot.
4. Applying 1 percent phenol in calamine lotion will help to dry up the blisters. Do not use ointments of any kind on the eruption.
5. It is best to consult a physician in all cases of shingles, but especially in severe cases. Pain may be so distressing that more relief will be needed than home treatments can give. A physician may give treatments that will shorten the course of the disease and help to prevent complications. Cortisone given early may prevent the persistent neuralgic pain.

WART (VERRUCA).
A wart is an overgrowth of certain structures of the. skin. There is conclusive evidence that warts are caused by a virus, and they are contagious under certain circumstances. They appear most commonly in the early years of life, rarely after the age of twenty; but they sometimes persist for years. While they must be distinguished from skin cancer, there is no proof that they never become cancerous.

Though the largest and most troublesome warts occur on the soles of the feet or the external genital organs, they are most common on the hands. Small, slender, threadlike forms occur on the neck, the eyelids, and the bearded areas. This latter form may be spread by shaving.

What to Do
1. If located where they are readily accessible, common seed warts or flat
warts may be safely treated by repeated applications of the following:

Salicylic acid ............. 4|
Acetone .............15|
Flexible collodion.............. 15 |
Mix thoroughly

CAUTION: Take care not to smear this paste on the healthy skin.
2. A 3 percent solution of salicylic acid in 40 percent alcohol may be used in the same way, with the same caution.
3. If the wart is large, not readily accessible, subject to irritation, or has persisted a long time, have it removed by a physician, preferably a skin specialist.