Essentials of Diseases of the Skin Part 24

What course does vesicular eczema pursue?

Usually chronic, with acute exacerbations. Not infrequently it pa.s.ses into eczema rubrum.

Describe the symptoms of pustular eczema.

Pustular eczema (_eczema pustulosum_, _eczema impetiginosum_) is probably the least common of all the varieties. It is similar, although usually less actively inflammatory, in its symptoms to eczema vesiculosum, the lesions being pustular from the start or developing from preexisting vesicles; not infrequently the eruption is mixed, the pustules predominating. There is a marked tendency to rupturing of the lesions, the discharge drying to thick, yellowish, brownish or greenish crusts.

Its most common sites are the scalp and face, especially in young people and in those who are ill-nourished and strumous.

What course does pustular eczema pursue?

Usually chronic, continuing as the same type, or pa.s.sing into eczema rubrum.

Describe the symptoms of squamous eczema.

Squamous eczema (_eczema squamosum_) may be defined as a clinical variety, the chief symptoms of which are a variable degree of scaliness, more or less thickening, infiltration, and redness, with commonly a tendency to cracking or fissuring of the skin, especially when the disease is seated about the joints. It is developed, as a rule, from the erythematous or papular type. Itching is slight or intense.

The disease is not uncommon upon the scalp.

What is the course of squamous eczema?

Essentially chronic.

[Ill.u.s.tration: Fig. 23. Eczema of the Face and Scalp.]

Describe the symptoms of eczema rubrum.

Eczema rubrum is characterized by a red, raw-looking, weeping, oozing or discharging surface, attended with more or less inflammatory thickening, infiltration and swelling; the exudation, consisting of serum, sometimes b.l.o.o.d.y, dries into thick yellowish or reddish-brown crusts. At one time the whole diseased area may be hidden under a ma.s.s of crusting, at other times a red, raw-looking, weeping surface (_eczema madidans_) is the most striking feature. Itching is slight or intense, or the subjective symptom may be a feeling of burning. It is an important clinical type, usually developing from the vesicular, pustular or other primary variety.

It is common about the face and scalp in children, and the middle and lower part of the leg in elderly people.

What is the course of eczema rubrum?

Chronic, varying in intensity from time to time.

Describe the symptoms of fissured eczema.

The conspicuous symptom is a marked tendency to fissuring or cracking of the skin (_eczema fissum_; _eczema rimosum_). This tendency is usually a part of an erythematous or squamous eczema, the fissuring const.i.tuting the most conspicuous and troublesome symptom. _Chapping_ is an extremely mild but familiar example of this type.

It is especially common about the hands and fingers.

What is the course of fissured eczema?

It is more or less persistent, the tendency to fissuring varying considerably according to the state of the weather, often disappearing spontaneously in the summer months.

Describe eczema sclerosum and eczema verrucosum.

In eczema sclerosum the skin is thickened, infiltrated, hard, and almost h.o.r.n.y. Eczema verrucosum presents similar conditions, but, in addition, displays a tendency to papillary or wart-like hypertrophy. In both varieties the disease is usually seated about the ankle or the foot, developing from the papular or squamous type. They are uncommon, and obstinately chronic.

State the nature of the subjective symptoms in eczema.

Itching, commonly intense, is usually a conspicuous symptom; it may be more or less paroxysmal. In some cases burning and heat const.i.tute the main subjective phenomena.

Is eczema accompanied by febrile or systemic symptoms?

No. In rare instances, in acute universal eczema, slight febrile action, or other systemic disturbance, may be noted at the time of the outbreak.

Is the eczematous eruption (patch or patches) sharply defined against the neighboring sound skin?

No. In almost all instances the diseased area merges gradually and imperceptibly into the surrounding healthy integument.

What is the character of eczema as regards the degree of inflammatory action?

The inflammatory action may be acute, subacute or sluggish in character, and may be so from the start and so continue throughout its whole course; or it may, as is usually the case, vary in intensity from time to time.

State the character of eczema as regards duration.

As a rule, it is a persistent disease, showing little, if any, tendency to spontaneous disappearance.

Is eczema influenced by the seasons?

Yes. With comparatively few exceptions the disease is most common and much worse in cold, windy, winter weather.

To what may eczema be ascribed?

Eczema may be due to const.i.tutional or local causes, or to both. It may be considered, in fact, as a reaction of the skin tissues against some irritant, and the latter may have its origin from within or without.

Name some of the important const.i.tutional or predisposing causes.

Gouty diathesis, rheumatic diathesis, disorders of the digestive tract, general debility or lack of tone, an exhausted state of the nervous system, dent.i.tion and struma.