Essentials of Diseases of the Skin Part 41

Onychauxis.

(_Synonym:_ Hypertrophy of the Nail.)

Describe onychauxis.

Onychauxis, or hypertrophy of the nail, may take place in one or all directions, and this increase may be, and often is, accompanied by changes in shape, color, and direction of growth. One or all the nails may share in the process. As the result of lateral deviation of growth, the nail presses upon the surrounding tissues, producing a varying degree of inflammation--_paronychia_.

What is the etiology of hypertrophy of the nail?

The condition may be either congenital or acquired. In the latter instances it is usually the result of the extension to the matrix of such cutaneous diseases as psoriasis and eczema; or it is produced by const.i.tutional maladies, such as syphilis.

Give the treatment of hypertrophy of the nail.

Treatment consists in the removal of the redundant nail-tissue by means of the knife or scissors; and, when dependent upon eczema or psoriasis, the employment of remedies suitable for these diseases. When it is the result of syphilis, the medication appropriate to this disease is to be employed.

In paronychia the nail should be frequently trimmed and a pledget of lint or cotton be interposed between the edge of the nail and the adjacent soft parts; astringent powders and lotions may often be employed with advantage; and in severe and persistent cases excision of the nail, partial or complete, may be found necessary.

Hypertrichosis.

(_Synonyms:_ Hirsuties; Hypertrophy of the Hair; Superfluous Hair.)

What is meant by hypertrichosis?

Hypertrichosis is a term applied to excessive growth of hair, either as regards region, extent, age or s.e.x.

Describe the several conditions met with.

The unnatural hair growth may be slight, as, for instance, upon a naevus (_naevus pilosus_); or it may be excessive, as in the so-called hairy people (_homines pilosi_); or it may also appear on the face, arms and other parts in females, resulting from a hypertrophy of the natural lanugo hairs.

State the causes of hypertrichosis.

Hereditary influence is often a factor; the condition may also be congenital.

If acquired, the tendency manifests itself usually toward middle life.

In women, it is not infrequently a.s.sociated with diseases of the utero-ovarian system; in many instances, however, there is no apparent cause. Local irritation or stimulation has at times a causative influence.

How is hypertrichosis to be treated?

For general hypertrichosis there is no remedy. Small hairy naevi may be excised, or, as also in the larger hairy moles, the hairs may be removed by electrolysis.

On the faces of women, if the hairs are coa.r.s.e or large, electrolysis const.i.tutes the only satisfactory method; if the hairs are small and lanugo-like, the operation is not to be advised. It is somewhat painful, but never unbearable. In the past several years the _x_-ray has been advocated by several writers, but it requires usually numerous exposures pushed to the point of producing erythema; it is not without risk, and the hairs are said to return in some months.

What temporary methods are usually resorted to for the removal of superfluous hair?

Shaving, extraction of the hairs and the use of depilatories. As a depilatory, a powder made up of two drachms of barium sulphide and three drachms each of zinc oxide and starch, is commonly (and cautiously) employed; at the time of application enough water is added to the powder to make a paste, and it is then spread thinly upon the parts, allowed to remain five to fifteen minutes, or until heat of skin or a burning sensation is felt, washed off thoroughly, and a soothing ointment applied. This preparation must be well prepared to be efficient.

Describe the method of removal of superfluous hair by electrolysis.

A fine needle in a suitable handle is attached to the _negative_ pole of a _galvanic_ battery, introduced into the hair-follicle to the depth of the papilla, and the circuit completed by the patient touching the positive electrode; in several seconds slight blanching and frothing usually appear at the point of insertion; a few seconds later the current is broken by release of the positive electrode, and the needle is then withdrawn. Sometimes a wheal-like elevation arises, remains several minutes or hours, and then disappears; or occasionally, probably from secondary infection, it develops into a pustule.

A strength of current of a half to two milliamperes is usually sufficient; the time necessary for the destruction of the papilla varying from several to thirty seconds.

How are you to know if the papilla has been destroyed?

The hair will readily come out with but little, if any, traction.

What is the result if the current has been too strong or too long continued?

The follicle suppurates and a scar results.

Why should contiguous hairs not be operated upon at the same sitting?

In order that the chances of marked inflammatory action and scarring (always possibilities) may be reduced to a minimum.

In case of failure to destroy an individual papilla, should a second attempt be made at the same sitting?

As a rule not, in order to avoid the possibility of too much destructive action, and consequent scarring.

Can scarring always be prevented?

In the average case, with skill and care, the use of an exceedingly fine needle and the avoidance of too strong a current, _perceptible_ scarring (scarring perceptible to the ordinary observer or at ordinary distance) need rarely occur.

What measures are to be advised for the irritation produced by the operation?

Hot-water applications and the use of an ointment made of two drachms cold cream and ten grains of boric acid are of advantage not only in reducing the resulting hyperaemia, but also in preventing suppuration and consequent scarring. To lessen the chances of the latter, cleansing the parts with alcohol just before and after the operation is also of service.

[OE]dema Neonatorum.

Describe [oe]dema neonatorum.

The essential symptoms are [oe]dema and a variable degree of hardness and induration. It develops in the first few days of life, and usually upon the extremities, especially the lower. It may remain more or less limited to these parts, but, as a rule, slowly extends. The skin is of a yellowish, dusky, or livid color, and sometimes glossy or shining. There are general symptoms of drowsiness, subnormal temperature, weakened circulation, and impaired respiration, which gradually increase, and in eighty to ninety per cent. of the cases lead to death. It is believed to be similar to anasarca in the adult and to be due to like causes.