Common Skin Diseases Of Adolescence And Adult Life
( Originally Published 1927 )
A brief description of all the skin diseases which may occur during youth and manhood would exceed the limits of this volume, therefore only those affections that appear frequently at these periods are here considered. It must not be supposed that the conditions described are found only during these ages, for many of them are apt to occur at any time of life, and some are included only as a matter of convenience in grouping.
Eczema (Tetter, Salt Rheum).—General Remarks.—Probably the most frequent and important disease of the skin of these epochs of life is eczema, for it constitutes about 30 per cent of all skin affections. Eczema or tetter is a form of inflammation of the skin in which germs, as a rule, play no leading part. However, they may act as producers of complications. There are numerous forms of inflammations of the skin, but the one distinguishing feature of the inflammation of eczema is the presence of tremendous amounts of the fluid part of the blood (the serum) in certain parts of the top layer (epidermis), demonstrable by examination with the microscope.
Classification.—There are but few diseases or conditions which do not present variations whether in duration, form, or severity. This applies especially to eczema, for to the unitiated, eczema be-cause of its many types appears an almost hopeless puzzle. However, attention' to some few fundamental facts will greatly serve to clarify the situation. Broadly speaking, we may state that eczema can be divided into two great groups: primary types, which are the earliest to appear, and the secondary, which usually follow later and develop from the primary.
Primary Types.—Description, Course and Explanation.—In describing the primary forms of eczema, it will be simpler and easier if we start with the least complicated expression of this condition. Let us take a familiar example. We are called upon to visit a friend who has been in con-tact with some chemical which has injured the skin. In all probability, we will find that the part affected is red, swollen, and hot, and the patient complains of more or less severe itching. Those observant will notice that the redness does not stop abruptly, but fades gradually into the normal skin. If the face is affected, the swelling may be so in-tense as to close the eyes, but this is not to be considered a source of alarm.
What has taken place within the skin to cause this picture? When any poison, either manufactured within the body or applied from the outside, attacks the skin, nature immediately sends increased amounts of blood to that part, with the hope of neutralizing the poison or at Ieast weakening its effects. As a result of this beneficent act, that part naturally becomes swollen and hot, and its color heightens. In the beginning the redness is in rather small patches but later these enlarge by joining with others.
This state of affairs lasts, as a rule, about one week to ten days when, usually, the redness and swelling begin to fade, the itching subsides, the skin feels slightly rough, fine scales make their appearance, and islands of normal skin are to be seen here and there. Even if the sufferer is so fortunate as to recover, it is by no means an assurance that this affliction will never return. It is well to know that this form of eczema usually appears on the face, arms, and about the groin and that it is most apt to attack those of middle or advanced age.
However, the cause responsible for the eczema may not be influenced or controlled by the anti-septic power of the blood, and its harmful effects may continue. One of the recourses at Nature's command in such an emergency is to build out-posts throughout the affected region, so as to further fortify its position. Nature calls upon certain of the cells of the affected skin to help and they respond by increasing in numbers and forming into small elevations. Therefore, in addition to the redness, swelling, heat, and itching, this form of eczema also presents solid elevations, red in color, pointed or flat, and technically known as papules. The itching results both from the effect of the irritant upon the nerves of the skin and from the pressure. of the increased number of cells. The scratching is often very intense and prolonged. At first these elevations remain separated one from the other, but in time many of them join, forming thickened and slightly elevated patches in which the peculiarities of the individual elevations are lost. This type of eczema usually appears on the arms, back, and legs.
As soon as the cause of the eczema is overcome, favorable changes appear on the skin surface. The itching lessens, the swelling is reduced, and the redness loses its intensity. These changes alone are not sufficient to restore the skin to normal, for the excessive number of cells must be taken care of. This is done by increasing the number of dead cells that are thrown off; in other words, the amount of scaling on the skin surface increases. This is a helpful measure, for in this manner the natural elastic character of the skin is restored. It must not be taken for granted that recovery from one attack of eczema means total immunity, for this form may return from time to time, especially if the condition has not been completely cured.
We have discussed circumstances in which the irritant or poison permits nature to further fortify itself so as to be better able to come out victorious. However, under certain circumstances, the poison may be so deadly in its effect and so overwhelming, that no such opportunity is afforded. Nature, recognizing this state of affairs, pours tremendous amounts of blood into the affected part with the hope of stemming the tide. As a result, the affected part of the skin is intensely swollen, red, and hot. But what is to become of this enormous amount of blood? Nature has provided for this emergency by separating the watery part of the blood (the serum), which trickles down from the true skin into the deepest part of the epidermis. Here it seeks open areas and fills up the spaces between certain of the cells and forms collections of fluid. The pressure in these spaces often becomes so great that the cells are squeezed into mere lines. As the cells of this part are pushed upwards, these filled spaces also ascend and when the surface of the skin is reached, these eruptions which resemble small balloons filled with watery fluid become visible. These blister-like elevations are usually closely 'crowded. They often break and a watery, sticky fluid escapes, which dries on the skin surface and forms yellow, gummy crusts. A significant peculiarity of this fluid is that it will stiffen linen brought in contact with it. Throughout the course of this affliction, the sufferer experiences intense itching, burning, and soreness, but usually with the breaking of the blisters, a certain amount of relief is obtained. It is indeed remarkable that in this type of eczema itching may be felt for a number of days before the eruptions appear and is so constant that patients can often foretell an oncoming attack.
This type of eczema usually reaches its height in about two weeks and as recovery takes place, the itching diminishes, the redness and swelling leave, and the crusts dry and fall off. The upheaval in the skin has been so great that a fully normal skin does not reappear at once. The skin surface is red and thin and only after a number of weeks does it become normally thick and of the natural color. This condition is most often seen on the faces of infants and on the hands and feet of adults.
The last type of primary eczema is one in which blister-like elevations, containing pus, are present. This variety is rather rare. It is usually encountered on the faces and scalps of children who are poorly nourished. When the pus escapes, it forms into extensive greenish or greenish yellow crusts. The itching is rather mild.
Chronic Type.—Description, Course and Explanation.—We now shift our interest to those varieties of eczema which have lasted for months or years. These are the so-called secondary or chronic types.
The word chronic as used here refers to long duration and not to curability. There are two principal forms of chronic eczema. In the one type the skin is dry, thickened, without the normal elasticity, somewhat red, and there is a certain amount of itching.
What is the explanation of these changes? Let us go back to our so-called primary eczemas. Let us imagine a neglected case in which the cause has been intense but not of sufficient severity to prevent Nature from building her secondary fortifications in the shape of an increase of cells. For some reason these cells continue to increase and are not cast off. As time goes on, the involved structures harden, become more firm, and constitute them-selves an unwelcome addition to the skin. While this is going on, Nature's work does not stop. On the contrary, she makes every effort to throw off these cells and this is seen in the increased amount of scaling. These scales are thin, grayish, and are easily removed. The extra amount of tissue robs the skin of its softness and elasticity, so that the skin cracks, especially in those parts where motion is more or less constant. Indeed the pain caused by the splits in the skin may be quite intense.
We now turn to that form of secondary eczema where the irritant has been so intense as to overwhelm all the defensive measures of the body and where, in spite of time, its action continues. Here the part affected is red, swollen, and hot. But this is only a small part of the story. The constant and harmful presence of the watery part of the blood (the serum) interferes with the normal hardening of the cells of the epidermis in such a manner as to soften these same cells so that they lose their resistance, and are very easily shed in one mass. As a result, we see a raw, reddened surface, due to exposure of the living part of the epidermis which normally is protected and which is here only partially shielded by crusts which cover it. As long as this condition exists, the oozing of a clear or slightly cloudy fluid never ceases. Can one imagine the tremendous upheaval which has taken place, and can one realize the damage done and the length of time necessary for the proper repairs? No wonder that this form of eczema requires lengthy and faithful treatment before the normal skin is reestablished.
When finally the condition is controlled, the oozing ceases, the redness and swelling diminish, the crust drops off and a new, thin, red skin forms. This variety of eczema is usually seen on the faces of infants and on the legs of elderly persons. The itching is usually very intense, and especially so when such an eczema is on the face of an infant.
Causes.—The recognition of eczema as a disease is not difficult, as a rule, but the labeling of each instance of this disease with the particular cause responsible is a most difficult task. The causes of eczema are numerous and the most important will be outlined so as to serve as a guide for the prevention of attacks of this affliction and with the hope that the reader will foster a tolerance and patience with his medical adviser.
Eczema may be produced by certain applications when used upon a sensitive skin. Strong soaps, iodine, arnica and similar substances may cause this disease. Excessive heat or cold, the pressure of trusses, garters and plaster casts may act similarly.
Aside from these external applications, various poisons within the body as well as certain states of the system may affect the human structure in such a manner as to produce an eczema. Disturbances of digestion, and by this we particularly refer to constipation and intestinal poisoning, are probably the most potent and common causes. Eczema may result from the oversensitiveness of the patient to various foods. The writer can well recall the in-stance of a woman who had suffered from an eczema for years. She was exceedingly pale and weak and upon consulting the author, it was learned that every physician she had seen insisted upon her drinking large quantities of milk. However, a careful study of her diet showed that milk and milk foods acted as a poison to her system, and consequently upon their discontinuance there was an almost miraculous disappearance of her eczema.
The absorption of poisons from teeth, tonsils, and other sources may be responsible. Diseases of the nervous system, particularly emotional excitement, shock or worry, and nervous breakdown, especially if occurring about the period of change of life, may be the causative factors. Pregnancy, diabetes, diseases of the kidneys, gout, asthma and many other similar conditions may also, at times, produce this affection.
Suggestions for Treatment.—It would be a most hopeless task to attempt to lay down fixed regulations for the positive prevention of an eczema. Just a mere glance at the list of causes which pro-duce an eczema will serve as sufficient proof of the impossibility of such a task. It will also emphasize that the hope of cure for the eczema sufferer lies in an intelligent effort to arrive at the particular cause responsible. The taking of a lot of blood tonics without "rhyme or reason" is a hit and miss proposition, which most often ends in failure, for there is no drug which is a sure cure. Special dieting is often futile, although it is advisable to abstain from salted meats, pork, shell fish, cake, pastry, candies, ice cream, stimulating sauces, condiments and cheese. The amount of tea and coffee should be reduced and alcoholic beverages should be entirely discontinued. Lean meats and fresh fish, in small amounts, usually do no harm. It is always wise to reduce the amount of food and insist upon regularity of meals as well as the e-proper chewing of food. When constipation is more or less habitual, the drinking of water between meals and the eating of fresh and stewed fruits and particularly figs and dates should be encouraged, as these home remedies often do good.
The care of the skin must not be neglected and the observance of the following suggestions will afford some measure of relief. Neither soap nor plain water must be used for the cleansing of the skin, but when water must be used, it can be made nonirritating through the addition of bran, starch, or boric acid. Small areas of skin surface are to be cleansed with sweet oil or cold cream and the same materials will also remove crusts and the remains of salves. As there are many and varied forms of eczema, each requiring a somewhat different application, it appears ridiculous for any one to claim that such and such a preparation will benefit any and all types. It is for this reason that the author is opposed to the indiscriminate use of patent eczema salves, for they cannot possibly benefit all types of this affliction.
Pimples (Acne). — Introduction. — Sufferers with skin diseases deserve sympathy and encouragement because they experience physical pain or discomfort, or their affliction is more or less contagious, or their general health seriously under-mined. Acne is neither contagious nor painful and does not directly affect the general health, and yet we know of no skin condition that causes so much mental suffering and agony as this disease. Take a youthful girl or man with a face covered more or less completely with hideous looking blemishes or pus marks. Penetrate into the depths of their feelings, get their outlook on life and you will find a most touching and pathetic picture. Such per-sons regard themselves outcasts, they shun society and feel as if they have been branded as unclean. It is because of the frequency of such tragedies, many of which could be avoided, that the author feels it his humble duty to devote considerable space to the study and discussion of pimples or acne.
Description.—Pimples do not usually appear instantaneously, for as a rule, a soil favorable for their development is usually previously prepared. One of the most important objectives of this study is to point out the ease with which acne may be cured if attention is given it early, and the many difficulties which are encountered if treatment is long delayed.
The first stage of acne is usually of the nature of a mechanical process. For some reason, there is a closing off of oil glands and those affected present a black dot on their surface, called "blackhead" or comedo. These blackheads are really our friends for they serve as a warning of the danger ahead. They resemble threads or worms when squeezed out, but when within the skin they appear as black dots. This color is caused by certain chemical changes. They may be few in number or quite numerous, and when abundant, the skin surface is usually oily and greasy. If pimples are treated during the stage when only blackheads are present, the course of treatment is short and the result most gratifying, as no permanent disfigurement of the face occurs. If this condition is neglected, the oily material locked up within the closed-off oil glands undergoes decomposition which results in an irritation and inflammation in and about these structures. This results in the appearance of solid elevations (papules). They may be small or large, bright red or dark red in color, with many of the centers showing blackheads, about which they are formed. In severe cases, these elevations may be deeply situated, and by uniting form large, hard, lumpy masses.
The damage does not stop at this point, for the irritated and inflamed skin proves a rather easy victim for pus germs. The changes brought about by these germs vary. In some cases only a small part of the solid eruptions is affected, recognized by a yellowness of the top of the papule. Such a condition results in a very slight form of scarring which is hardly noticeable. In others, the entire solid elevation may be liquified into pus and each spot becomes a slight pit which, while visible, is not very disfiguring. However, when the hard lumpy masses are attacked by the pus germs, the pus pockets (really abscesses) which are formed result in deep hard scars, most disfiguring and very difficult to remove. Disastrous effects of this nature can be avoided by early and judicious attention to the early blemishes of acne.
The eruptions of this affliction appear in crops; indeed, new pimples may continue to present them-selves for months or even years if untreated. In girls, outbreaks of eruptions may occur just before, during, or immediately after each monthly period. Sometimes, sudden improvement takes place when the age of twenty-five or thirty is reached, but one would hardly be so foolish as to wait until this age for such a possible event.
Acne usually attacks the face and sometimes the chest, shoulders and back.
Causes.—No attempt will be made to discuss the causes of acne from an academic viewpoint, but only those facts, important from the standpoint of prevention, will be emphasized.
Pimples, a disease of youth, are usually seen between the ages of fifteen and twenty-five. At this time tremendous changes take place in the life cycle of the young girl or boy, among which are marked growth of the body, increased activity of the oil glands and hair, and the establishment of the sex function. Most of the changes are of such a nature as to demand a greater supply of fuel for the human furnace, so that nature, with her eye ever alert for the needs of the future, creates a greater appetite and these growing people eat more, especially of starchy foods and sweets, because such materials are more readily burned up. As many of them are not satisfied with three meals a day, they develop the habit of eating between meals and late at night. When these demands on the digestion are brought about rather gradually and within reasonable limits, the human machine usually does not resent it and when an acne does appear, it is usually mild and but slowly progressive. But when the extra burden is not only suddenly thrown upon the digestive organs but also with the fullest force, or when the digestion has. been weak for a long time previously, the acne which develops is usually severe and apt to last for a long while. Thus we have learned of two great causes of this affliction, namely, overeating (especially sweets), eating between meals or late at night, or both, and disturbed digestion as a result of these indiscretions. The instinctive knowledge displayed by our mothers and grandmothers relative to acne was not far from the truth, for they treated this condition by administering medicines to cleanse the stomach. To-day we still follow the same principle, although we use more efficient methods in its execution.
Other conditions which may cause acne are an impoverished state of the blood, lack of outdoor life, and disturbances of the monthly periods. This affection may also be induced by taking various drugs such as may be used for quieting the nerves or for headaches (bromides) and blood tonics (iodides). This is a very opportune occasion to impress upon our readers the folly of taking medicines unless prescribed by a physician.
Finally, a word about cosmetics and their relation to acne. Those who are so unfortunate as to have enlarged pores ought to be very careful about the use of any creams or even powder, for it is the author's belief that the use of even the blandest preparations tends to aggravate an existing acne. Individuals with very small pores may use powders and even rouge, but with discretion.
Suggestions for Prevention.—No effort will be made to give suggestions for the cure of this affliction but only those measures known to prevent acne will be emphasized.
It becomes very apparent, from what has already been stated, that one of the most important factors in the prevention of acne is strict attention to the diet and the condition of the digestion. It is the parents' duty to impress upon growing children the dangers of eating irregularly, eating between meals or late at night. The possible harm of overindulgence in sweets, fried foods, and tea and coffee, should be pointed out, so that they may be avoided entirely or be used in moderation. Grown children should be impressed with the advantages of drinking large amounts of water, especially between meals, of taking plenty of exercise outdoors and of regular hours of rest. Above all, it is a good investment for parents to have their children thoroughly examined by a competent medical man, especially if there is inclination for blackheads. The state of the digestion and especially constipation should be looked after and, if faulty, be corrected under the guidance of a physician. An impressive medical sermon as to the proper mode of living is a money-saving as well as a heartache-saving investment.
Aside from the suggestions relative to the care of the general health, some hints concerning the care of the face will be found helpful. The pernicious habit of constantly cleansing the face with cream cannot be too strongly condemned. It is realized that there are some with a skin so dry that one form of cream or another must be used in order to preserve the softness of the skin. For these the daily use of creams is an absolute necessity as the use of the usual soap and plain water proves irritating. However, before resorting to creams, boric acid solution or a solution of bran in water and a neutral soap should be tried. When acne is developing, or is already present, the use of plain or modified water, hot, and either ordinary or neutral soap must be insisted upon as best for the skin, for only by this method can the pores (follicles) be thoroughly cleansed. This is to be followed by the application of either cold water or ice, which serves to stimulate and invigorate the skin and also close the pores. When it is desirable to remove blackheads from the face, the observance of the following suggestions will prove useful. At first, the skin is softened either by the use of hot towels or by steaming nightly, for ten to twenty minutes. When removing blackheads, but little force should be used. After the completion of this operation, a mild antiseptic, such as a saturated solution of boric acid in 50 per cent alcohol, should be sopped on the face. Any good blackhead re-mover may be used.
Our reasons for believing that cosmetics often favor the development of an acne have been fully stated. We again take the opportunity to voice the opinion that creams are harmful to the sufferers of this affliction and that rouge and powder may be used and do but little harm, especially if the pores of the skin are tightly closed and the skin itself rather dry.