A steatoma is a cyst of the sebaceous gland and duct, produced by retained secretion. The contents may be hard and friable, soft and cheesy, or even fluid, of a grayish, whitish or yellowish color, and with or without a fetid odor; the ma.s.s consisting of fat-drops, epidermic cells, cholesterin, and sometimes hairs.

Are sebaceous cysts likely to be confounded with gummata?

No. Gummata grow more rapidly, are usually painful to the touch, are not freely movable, and tend to break down and ulcerate.

Describe the treatment of steatoma.

A linear incision is made, and the ma.s.s and enveloping sac dissected out. If the sac is permitted to remain, reproduction almost invariably takes place.

CLa.s.s II.--INFLAMMATIONS.

Erythema Simplex.

What do you understand by erythema simplex?

Erythema simplex is a hyperaemic disorder characterized by redness, occurring in the form of variously-sized and shaped, diffused or circ.u.mscribed, non-elevated patches.

Name the two general cla.s.ses into which the simple erythemata are divided.

Idiopathic and symptomatic.

What do you include in the idiopathic cla.s.s?

Those erythemas due to external causes, such as cold and heat (_erythema caloric.u.m_), the action of the sun (_erythema solare_), traumatism (_erythema traumatic.u.m_), and the various poisons or chemical irritants (_erythema venenatum_).

What do you include in the symptomatic cla.s.s?

Those rashes often preceding or accompanying certain of the systemic diseases, and those due to disorders of the digestive tract, stomachic and intestinal toxins, to the ingestion of certain drugs, and to use of the therapeutic serums.

Describe the symptoms of erythema simplex.

The essential symptom is redness--simple hyperaemia--without elevation or infiltration, disappearing under pressure, and sometimes attended by slight heat or burning; it may be patchy or diffused. In the idiopathic cla.s.s, if the cause is continued, dermat.i.tis may result.

What is to be said about the distribution of the simple erythemata?

The idiopathic rashes, as inferred from the nature of the causes, are usually limited.

The symptomatic erythemas are more or less generalized; desquamation sometimes follows.

Describe the treatment of the simple erythemata.

A removal of the cause in idiopathic rashes is all that is needed, the erythema sooner or later subsiding. The same may be stated of the symptomatic erythemata, but in these there is at times difficulty in recognizing the etiological factor; const.i.tutional treatment, if necessary, is to be based upon general principles. Intestinal antiseptics are useful in some instances.

Local treatment, which is rarely needed, consists of the use of dusting-powders or mild cooling and astringent lotions, such as are employed in the treatment of acute eczema (q. v.).

Erythema Intertrigo.

(_Synonym:_ Chafing.)

What do you understand by erythema intertrigo?

Erythema intertrigo is a hyperaemic disorder occurring on parts where the natural folds of the skin come in contact, and is characterized by redness, to which may be added an abraded surface and maceration of the epidermis.

Describe the symptoms of erythema intertrigo.

The skin of the involved region gradually becomes hyperaemic, but is without elevation or infiltration; a feeling of heat and soreness is usually experienced. If the condition continue, the increased perspiration and moisture of the parts give rise to maceration of the epidermis and a mucoid discharge; actual inflammation may eventually result.

What is the course of erythema intertrigo?

The affection may pa.s.s away in a few days or persist several weeks, the duration depending, in a great measure, upon the cause.

Mention the causes of erythema intertrigo.

The causes are usually local. It is seen chiefly in children, especially in fat subjects, in whom friction and moisture of contiguous parts of the body, usually the region of the neck, b.u.t.tocks and genitalia, are more common; in such, uncleanliness or the too free use of soap washings will often act as the exciting factor. Disorders of the stomach or intestinal ca.n.a.l apparently have a predisposing influence.

What treatment would you advise in erythema intertrigo?

The folds or parts are to be kept from contact by means of lint or absorbent cotton; thin, flat bags of cheese cloth or similar material partly filled with dusting-powder, and kept clean by frequent changes, are excellent for this purpose, and usually curative. Cleanliness is essential, but it is to be kept within the bounds of common sense.

Dusting-powders and cooling and astringent lotions, such as are employed in the treatment of acute eczema (_q. v._), can also be advised. The following lotion is valuable:--

[Rx] Pulv. calaminae, Pulv. zinci oxidi, .. [=a][=a] ...... [dram]iss.

Glycerinae, .......................... [minum]x.x.x Alcoholis, .......................... f[dram]ij Aquae, ............................... Oss. M.

Exceptionally a mild ointment, alone or supplementary to a lotion, acts more satisfactorily.

In persistent or obstinate cases attention should also be directed to the state of the general health, especially as regards the digestive tract.