By atrophy of the skin is meant an idiopathic or symptomatic wasting or degeneration of its component elements.

State the several conditions met with.

Glossy skin, general idiopathic atrophy of the skin, parchment skin, atrophic lines and spots, senile atrophy, and the atrophy following certain cutaneous diseases.

Describe glossy skin (atrophoderma neuritic.u.m), and state the treatment.

Glossy skin is a rare condition following an injury or disease of the nerve. It is usually seen about the fingers. The skin is hairless, faintly reddish, smooth and shining, with a varnished and thin appearance, and with a tendency to fissuring. More or less severe and persistent burning pain precedes and accompanies the atrophy.

Protective applications are called for, the disease tending slowly to spontaneous disappearance.

Describe general idiopathic atrophy of the skin, and give the treatment.

General idiopathic atrophy of the skin is extremely rare, and is characterized by a gradual, more or less general, degenerative and quant.i.tative atrophy of the skin structures, accompanied usually with more or less discoloration and pigmentation.

Treatment is palliative and based upon indications.

Describe parchment skin, and state the treatment.

Parchment skin (_xeroderma pigmentosum_, _angioma pigmentosum et atrophic.u.m_) is a rare disease, the exact nature of which is not understood. It is characterized by the appearance of numerous disseminated, freckle-like pigment-spots, telangiectases, atrophied muscles, more or less shrinking and contraction of the integument, and followed, in most instances, by epitheliomatous tumors and ulceration, and finally death. It is usually slow in its course, beginning in childhood and lasting for years. It is not infrequently seen in several children of the same family.

Treatment is palliative, consisting, if necessary, of the use of protective applications and of the administration of tonics and nutrients.

Describe atrophic lines and spots.

Atrophic lines and spots (_striae et maculae atrophicae_) may be idiopathic or symptomatic, the lesions consisting of scar-like or atrophic-looking, whitish lines and macules, most commonly seen on the trunk. They are smooth and glistening. Slight hyperaemia usually precedes their formation. As an idiopathic disease its course is insidious and slow, and its progress eventually stayed. The so-called _lineae albicantes_, resulting from the stretching of the skin produced by pregnancy or tumors, and from rapid development of fat, may be mentioned as ill.u.s.trating the symptomatic variety.

In course of time the atrophy becomes less conspicuous.

Describe senile atrophy.

Senile atrophy is not uncommon, the atrophy resulting, as the name inferentially implies, from advancing age. It is characterized by thinning and wasting, dryness, and a wrinkled condition, with more or less pigmentation and loss of hair. Circ.u.mscribed pigmentary deposits and seborrh[oe]a, with degeneration, are also noted.

What several diseases of the skin are commonly followed by atrophic changes?

Favus, lupus, syphilis, leprosy, scleroderma and morph[oe]a.

CLa.s.s VI.--NEW GROWTHS.

Keloid.

(_Synonyms:_ Keloid of Alibert; Cheloid.)

Give a descriptive definition of keloid.

Keloid is a fibro-cellular new growth of the corium appearing as one or several variously-sized, irregularly-shaped, elevated, smooth, firm, pinkish or pale-reddish cicatriform lesions.

Describe the clinical appearance of keloid.

The growth begins as a small, hard, elevated, pinkish or reddish tubercle, increasing gradually, several months or years usually elapsing before the tumor reaches conspicuous size. When developed, it is one or more inches in diameter, is sharply defined, elevated, hard, rounded or oval, fungoid or crab-shaped, and firmly implanted in the skin. It is usually pinkish, pearl-white, or reddish, commonly devoid of hair, with no tendency to scaliness, and with, usually, several vessels coursing over it. In some instances it is tender, and it may be spontaneously painful.

The breast, especially over the sternal region, is a favorite site for its appearance. One, several or more may be present in the single case.

What course does keloid pursue?

Chronic; usually lasting throughout life. In rare instances spontaneous involution takes place.

State the etiology of keloid.

The causes are obscure. The growth usually takes its start from some injury or lesion of continuity; for instance, at the site of burns, cuts, acne and smallpox scars, etc.--_cicatricial keloid, false keloid_; or it may also, so it is thought, originate in normal skin--_spontaneous keloid, true keloid_.

What is the pathology of keloid?

The lesion is a connective-tissue new growth having its seat in the corium.

Is there any difficulty in the diagnosis of keloid?

No. It resembles hypertrophic scar; but this latter, which is essentially keloidal, never extends beyond the line of injury.

Give the prognosis.

The growth is persistent and usually irresponsive to treatment. In some cases, however, there is eventually a tendency to spontaneous retrogression, up to a certain point at least.

What is the treatment of keloid?

Usually palliative, consisting of the continuous application of an ointment such as the following:--

[Rx] Acidi salicylici, .................... gr. x-xx Emplast. plumbi, Emplast. saponis, ... [=a][=a] ....... [dram]iij Petrolati, ........................... [dram]ij. M.

An ointment of ichthyol, twenty-five per cent. strength, rubbed in once or twice daily, is sometimes beneficial.